Insulin therapy

As you know, there are two different types of diabetes mellitus: insulin-dependent (type 1 diabetes) and non-insulin dependent (type 2 diabetes). Insulin-dependent diabetes mellitus develops in patients with decreased insulin production. That is why these people must constantly inject themselves with insulin for diabetes.  

With the correct insulin therapy, blood sugar levels are reduced to a predetermined target range or to normal. Achievement of normoglycemia is an indication that insulin is being dosed correctly. People with insulin-dependent diabetes mellitus have two types of insulin therapy:

  • Traditional insulin therapy (TIT)

It is currently a widespread type of insulin therapy . Its principle is shown in the graph. In the morning “short” and long-acting insulin are injected before breakfast, in the evening “short” and long-acting insulin are injected before dinner; or the “short” insulin is given before dinner and the “long” one before bed.    

The “short” morning insulin helps to assimilate the carbohydrates that the patients enter the body during breakfast, the “long” morning insulin creates a background throughout the day (absorption of carbohydrates that are thrown out by the liver). In addition, the long morning insulin is spent on the absorption of carbohydrates that entered the body during lunch (in the diagram, this is the arrow “a”). Thus, the patient knowingly makes more “long” insulin in the morning so that the carbohydrates that were taken during lunch are absorbed.   

Such insulin therapy for diabetes mellitus has a significant drawback: lunch must be eaten at a strictly defined time (on the diagram – arrow “B”) and at the same time it must contain a strictly defined amount of XE (on the diagram – arrow “A”). If the patient dines earlier or his lunch contains more XE than is acceptable, this will cause hyperglycemia. If lunch takes place later or the patient eats less XE at lunch, hypoglycemia may occur. With traditional insulin therapy, compensation for diabetes mellitus is possible only if the strictest regimen is observed, despite changing circumstances. But there are very few people capable of leading such a lifestyle.     

Most, however, adhere to a more flexible schedule in their lives: they eat as much as they want, and when they want to. Also, factors affecting the increase or decrease in blood sugar levels include: additional physical activity, infectious diseases, etc. Insulin therapy, the principles of which are described below, is more adapted to the changing rhythm of life.

  • Intensified insulin therapy (IIT)

The IIT principle is depicted in the graph. With intensified insulin therapy, the dose of the morning long insulin decreases: the “hump” disappears. In this case, the main purpose of the morning long insulin is to assimilate the glucose that will enter the bloodstream from the liver.    

Before lunch, just before eating, the patient should make an additional injection of short insulin; when he wants to eat (regardless of when lunch will take place). On the graph, this is indicated by horizontal arrows: the time for lunch, as well as the amount of XE, the patient can choose independently.  

You can make the required dose of short insulin before lunch (on the graph – arrow “a”), regardless of what the person wants to eat, and how much XE this food will contain. Even if, for some reason, lunch is missed, nothing terrible will happen. There will simply be no need to do lunchtime “short” insulin.

Whatever it was, but stable compensation of diabetes is possible only with a uniform distribution of XE throughout the day. It is recommended to break food for breakfast, lunch, dinner. In the event that after the main meals , blood sugar is increased, it is necessary to additionally introduce snacks: lunch, afternoon tea and second dinner. To do this, breakfast should be divided into 2 parts: most (2/3) should be eaten in the first breakfast, and a smaller part (1/3) in the second, and so on. Thus, liver function will be stabilized.        

Chart # 1 shows three meals, and you can see that the blood sugar level rises very much, crossing the safe zone. As a result, the sugar is released into the urine.

Graph 2 shows that the amount of food eaten per day does not change, but it is divided into 6 meals. Thus, there is no sharp rise in blood sugar, which means it does not cross the safe zone. In this case, there is a complete assimilation of all consumed carbohydrates and their conversion into energy.

The main difference between IIT lies not in the appearance of an additional injection of “short” insulin before lunch, but in the removal of the ” bolus ” function of the “long” insulin, which is not characteristic of it – long-acting insulin is not used to assimilate carbohydrates that have entered the body with food. It should be noted that IIT is a daily self-monitoring of blood glucose levels.      

IIT helps to simulate the work of a healthy pancreas , releasing insulin into the blood when the patient takes food, and in such an amount that is necessary to assimilate the food that he ate. Also, no less important problems of a psychological nature are removed: you can safely go on a visit, eat when you want and as much as you want, how much the body needs in a certain situation.   

It has been proven that patients who use IIT are less likely to develop long-term complications of diabetes. But they must exercise stricter self-control. With intensified insulin therapy, the likelihood of developing hypoglycemia increases. That is why it is very important to always measure your blood sugar level just before a meal. Today, thanks to such modern devices as blood glucose meters ( iCheck , OneTouchSelectSimple , Kontur TS, Clover Check , etc.), this procedure takes very little time. Control of blood glucose levels with IIT is necessary in order to correctly calculate short-acting insulin doses.        

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