Type 1 diabetes mellitus (DM-1), insulin dependent, is typical for children of different ages and adolescents. Its development is associated with autoimmune aggression of the body in relation to its own pancreatic islet cells, which synthesize insulin to provide cells with glucose and regulate the level of sugar (glucose) in the blood plasma. To correct hyperglycemia, children need insulin injections, which can significantly improve the general condition, normalize metabolic processes, allow the child to fully grow and develop.
But the younger the baby, the worse it takes injections, which can take several times a day, and each of which can face certain problems. Therefore, today, doctors are increasingly considering the use of an insulin pump as a basis for treating children of diabetics, which allows both to control the level of glycemia in dynamics and makes continuous subcutaneous injections. insulin. Consider the pump today, March 3, the day when insulin was discovered almost 100 years ago.
Features of the treatment of children
The most important task in the development of diabetes mellitus in a child is to bring the plasma glucose level as close as possible to the state of normoglycemia. This allows both to normalize the metabolism and feel better, and to provide the child with full growth and development, prevention of serious complications and consequences, disability.
In children, diabetes mellitus-1 is more difficult to control because of the intensity of metabolism, hormonal surges (during adolescence) and the intense level of physical exertion during games and activity, nutritional errors. Therefore, they require a more intensive insulin administration regimen – at almost every meal, load, and even at night, in order to avoid the phenomenon of “morning dawn”, when sugar levels change dramatically due to a long lack of food.
There are two options for administering insulin:
- Subcutaneous injections, which have to be done repeatedly;
- The use of continuous administration of insulin subcutaneously (through the use of the pump).
Each method has its undoubted advantages, as well as certain, sometimes significant, disadvantages.
Glucose Control: Injection of Insulin
Diabetes mellitus has been known for a long time, but the problem of treatment has been acute for many centuries. Therefore, the discovery on March 3, 1921 of the hormone insulin, which then began to be used for administering to patients with diabetes for replacement purposes, made it possible to make a significant step in treatment. Due to daily injections of insulin, sugar was controlled for a long time. diabetes in children, allowing them to less suffer from hyperglycemia and ketoacidosis with its serious consequences.
Although insulin therapy was a breakthrough in the treatment of diabetes mellitus in children (and adults too), but repeated injections of inulin throughout the day, measurements of plasma glucose are tedious, unpleasant and stressful. Various types of insulins appeared – which made it possible to reduce the number of injections, to approach the therapy more flexibly and to bring the level of glucose to normal.
Today, there is the possibility of using the insulin pump in pediatric practice; this is the continuous introduction of subcutaneously specific forms of insulin, which allows for more flexible and precise control of blood sugar. This makes life easier for small patients and allows them to be more mobile, active, and more positive about treatment.
Insulin therapy and multiple injections
The difficulty in the treatment of diabetes mellitus in childhood is that the glycemic level fluctuates significantly, which depends on growth processes, mental and physical exertion, therefore, intensive insulin therapy is needed. To provide it, insulin has to be injected several times a day, and sometimes even at night, disrupting the sleep of the child – the so-called basic bolus mode. It cannot be called ideal, and multiple injections have a number of significant drawbacks.
- It is difficult to motivate a child and to involve him in active participation in unwanted injections for him, which affects the effectiveness of therapy;
- Features of the body and absorption, insulin absorption during injection can lead to unexpected results;
- Insulin resistance may develop, lipo-dystrophic areas are formed at repeated injection sites, inflammatory infiltrates may appear;
- Influenced by individual features of hormonal metabolism, formed an excessively rapid destruction of insulin in the area of ​​subcutaneous fat.
Therefore, multiple injections can achieve the desired treatment goals for relatively adult children and, in general, about only 15%.
Use of an insulin pump
One of the devices that greatly facilitates therapy and glucose monitoring is a system that provides continuous insulin administration subcutaneously. This is the so-called insulin pump, which uses a drug of ultrashort action. These types of insulins are rapidly absorbed and lack some of the drawbacks typical of recombinant insulin. The system has helped to improve the quality of therapy and its flexibility, individuality, which helps modern children better control DM-1 and live a normal children’s life with almost no restrictions. Modern pumps have a dispenser that is flexibly and individually programmed, while simultaneously monitoring blood glucose levels.
The undoubted advantages of pumping mode:
- Very accurate dosage of drugs;
- The relatively controlled action of insulin, their predicted decrease in plasma glucose levels;
- Use only short insulin, which allows you to better predict their work.
- Reducing the number of injuries, skin punctures;
- Reducing the daily dose of insulin, as they are most fully absorbed;
- Permanent plasma glucose monitoring and data storage capabilities.
The technique is simple and today is considered the most physiological method, has already relatively extensive experience in the treatment of diabetes in children.
But she also has problems in application, although the number of contraindications is very small. The method is expensive, and the pump often needs to be purchased and maintained at the expense of the parent budget, which is not available to everyone. Plus, not all types of insulin are used in pump therapy, but only of short or ultrashort action in order to prevent side effects and hypoglycemia associated with meals and insulin injections. Thus, dosing should be compared with food intake so that the peak of blood glucose accumulation and insulin injected coincide and there is no hypoglycemia, from which the child suffers significantly – not less than from high blood sugar.