Type 1 diabetes refers to diseases that are diagnosed fairly easily: as a rule, it does not require any instrumental investigations or complicated laboratory tests.Clinical symptoms - that is what the doctor observes and what he tells the patient (or the patient's parents) already suggest the presence of diabetes.In addition to them, it is usually sufficient to make the analysis of blood "sugar" - to determine the level of glucose in the blood.The only disadvantage of this analysis is that the blood is necessary to take on an empty stomach, that is not to eat anything in the morning.

Normally glucose (fasting) is 3.5-5.6 mmol / L (or 60-100 mg / dL) in whole blood or 4,4-6,2 mmol / L (80-110 mg / dL) in the blood plasma.

reliable sign of diabetes is considered to glucose (fasting) above 7.2 mmol / L (above 130 mg / dL).

However, there is also the so-called physiological (ie "normal") hyperglycemia: a minor short-term (up to 7.8 mmol / l) increase in blood glucose levels after a meal rich in carbohy

drate, after intense physical exertion , strongemotional stress.

treatment of type 1 diabetes

Treatment of Type 1 diabetes can say that the life of a person with diabetes, support the "three pillars": the introduction of insulin, diet and exercise, and in that order.Unfortunately, the patient inject insulin type 1 diabetes will have life.All my life I have also to comply with the diet , especially - power mode.

Insulin

in medicine so far, since the discovery of Banting and Best, insulin is used, which is obtained from the pancreas of cattle and pigs - it is the cheapest and most affordable way.Depending on the degree of purification of insulins derived from animal glands can be monopikovye (MP), or purified and monocomponent (MC), or highly purified.But animal insulin is still a foreign protein for the human body and can cause allergic reactions.Therefore, at the present time is the increasing use of crystalline human insulin produced by genetic engineering.This insulin is much less other causes allergic reactions.

Insulin preparations

We have already said that there are two modes of insulin secretion by the pancreas: basal and stimulated, or fast.Basal secretion occurs continuously;stimulated - increase in insulin in response to increased blood glucose levels, such as after a meal.The main goal of insulin treatment - to maintain optimal levels of glucose in the blood at any given time: not more than 5.5 mmol / l of glucose and less than 7.5 mmol / L at 2 hours after a meal (in capillary blood, i.e. if the blood is taken from a finger).To do this, use insulin preparations with different duration.Short-acting drugs mimic the response to stimulation;preparations extended or prolonged, mimic the action of "basal" insulin secretion.There are also combination preparations, which represent different combinations of short and intermediate insulin action.For example, mikstard 30/70 contains 30% of "short" insulin (Actrapid) and 70% intermediate-acting insulin (Monotard).

In Russia now created genetically engineered insulin preparations: insulin and intermediate-acting short - respectively P and Rinsulin Rinsulin NPH.

Regimens

main goal of insulin therapy - possibly mimic the secretion of the pancreas of a healthy person.In order to prevent the rise in blood sugar occurring after meals, prescribe short-acting insulin preparations.The peak concentration of insulin in the blood have to coincide with the peak concentration of sugar.Basal insulin requirements provided by the introduction of intermediate-acting drugs or long-acting.These drugs are administered once or twice during the day.

insulin therapy usually begins with a single or double injection intermediate-acting insulin.For the recently diseased daily dose of an average of 0.5-0.6 units per 1 kg of body weight for the long-ailing maximum daily dose - 0.8-1.0 units per 1 kg of body weight.With the introduction of the double intermediate-acting insulin 2/3 the daily dose is administered at 8 (7-9) in the morning, 1/3 -in 20-22 hours.Initiated with smaller dosages, typically 8-12 units in the morning and 4 units in the evening.Then gradually increase the dose until until normal blood glucose level.This usually 20-26 units in the morning and evening 12-14 units, in some cases, require higher doses (up to 32 units in the morning and 14 units in the evening).If

to 12-13 hours of the day the level of glucose in the blood is high, and in the afternoon and in the morning on an empty stomach - normal, the patient is prescribed in addition to the interim administration of the morning insulin short-acting insulin - 4-8 units - either transferred to the mixed insulins.If during the day the blood glucose level is normal, and in the morning on an empty stomach - increased, the reason for this may be nocturnal hypoglycemia (low blood glucose).To identify nocturnal hypoglycemia do a blood test for glucose in the 3-4 o'clock in the morning.If it appears that during the night the blood glucose level of less than 3 mmol / l, the evening dose of insulin is reduced.

This scheme is called insulin traditional .

If at a daily dose of 40-50 IU of insulin the blood glucose level remains high, there swings from high to normal, the routine proceeds to the so-called basal-bolus insulin regimen.In this morning and evening still administered insulin intermediate - as a basis;but beyond that before each reception poor, for 20-25 minutes, 4-8 IU injected short-acting insulin (bolus).

Thus, this scheme administration resembles the secretion of insulin in a healthy person, and therefore, the metabolism is as close to normal.In contrast to the traditional scheme, time of administration and dose of insulin "adjusted" under the meal (taking into account the number of so-called "bread units" - XE).Another advantage of intensified insulin therapy is that in such treatment there is less hypoglycemia.

need for insulin

need for insulin in diabetes can be very different not only in different people, but even in one and the same person.

For most children in the initial period of the disease shortly after the start of treatment, insulin requirements greatly reduced, sometimes to the extent that it creates the illusion of a full recovery.Unfortunately, this is an illusion.This period of temporary improvement due to the fact that the cells of the pancreas due to support from the outside as if opened a "second wind" and they begin to produce insulin.The dose of insulin to be administered in the form of injections can be reduced even to two units per day.This period may last several months, and sometimes even a year or two.But then the pancreatic cells are depleted, and the need for insulin rises again.Even more, it increases at puberty, during pregnancy and during different (almost any) disease.

route of administration of insulin

Basically insulin preparations are administered parenterally, intravenously, intramuscularly or subcutaneously.Insulin ingested, that is "the mouth" is destroyed in the gastrointestinal tract under the influence of digestive juices.Recently developed special capsules for oral administration and intranasal ("through the nose") forms of insulin, but is a conventional method of administration are injections.

optimal route of administration - subcutaneous, usually in the abdomen, thighs, buttocks, shoulders.The fastest way insulin is absorbed from the subcutaneous tissue of the anterior abdominal wall, and slowly - of the shoulder and hip.

for insulin injections produce special long, thin needles that are called - "insulin".They have a special graduated scale with graduations 40 - one for each division unit (1 mL aqueous solution of insulin comprises 40 ME).

Currently available for sale and other devices for insulin - so-called pen (penfily).They have a special cartridge in which insulin is contained in a concentrated form: 1 ml contains 100 units of insulin.First, on the scale of the pen set the required number of units that you want to enter, and then inject the needle into the skin and inject insulin button.Depending on the lowest administered dose (ED 1, ED 2 and 4 units) use three types of syringes, pens: respectively optipen-1 optipen-2, 4-optipen.

for patients with diabetes , located on intensified insulin therapy, there is another way insulin - insulin pump that provides continuous subcutaneous insulin in small doses, and replacing the injection syringe or syringe-pen.This device is a compact device that is placed, for example, a belt, a trouser pocket and m. N. A human body, he connects the infusion set by: a thin tube with a needle that is inserted under the skin.

Besides insulin pump includes:
1. Control unit pump (liquid crystal display and a button).2. Two
microprocessor.
3. Motor piston.
4. Power supply.
5. The cartridge with insulin.

What are the benefits of insulin pump compared to the conventional method of insulin injections?

Insulin pump therapy provides physiological basal insulin levels, taking into account individual characteristics of the organism and to avoid nocturnal hypoglycemia, and morning hyperglycemia, the so-called phenomenon of "dawn" - increase in blood sugar levels between 4 and 8 o'clock in the morning because of reductioninsulin sensitivity, which is associated with increased secretion of growth hormone during sleep.

With insulin pump therapy uses only ultra insulins, which are constantly introduced in small doses, which allows to overcome the insulin resistance.Replace the infusion set is carried out every two or three days.

Attention! need to store insulin in the refrigerator, but it can not be frozen - from this it is destroyed.

Complications and side effects of insulin therapy

As with any medication, with insulin therapy, possible side effects and complications:

  • • hypoglycemia,
  • • allergic reactions,
  • • lipoatrophy.

Hypoglycemia as a consequence of insulin

Hypoglycemia - this complication of insulin therapy, which consists in the fact that the blood glucose level is reduced dramatically (less than 2.5 mmol / l).Hypoglycemia can be related to dose correctly chosen, a low carbohydrate diet, increased physical activity, alcohol intake.

hypoglycemia essence is as follows.The most active energy consumers, and therefore - glucose - is brain cells.Nature has provided even peculiar mechanism especially for protection of nerve cells in the brain: they are able to absorb glucose from the blood "directly" without the aid of insulin.But for its content of blood should be less than 3-3.3 mmol / L.

If you fall below that glucose values ​​symptoms of hypoglycemia: hunger, sweating, severe tremors, palpitations;the skin moist to the touch, cold, pale.Very characteristic behavioral disorders: unmotivated tears or laughter, rude, stubborn;some people are beginning to confuse words and syllables, they find it difficult to speak, write and count.There may be visual impairment - spots or "fly" before the eyes;disorientation.

This condition may occur and in a healthy person without diabetes, mostly - from hunger.But a healthy body copes with hypoglycemia - include certain mechanisms aimed at to increase blood sugar levels, mainly due to the use of its "depot" in the liver - glycogen.To do this, the pancreas is hard produces glucagon (which is an antagonist of insulin), adrenal gland - epinephrine and norepinephrine, is a redistribution of the blood, and so on. D. A person with diabetes, these mechanisms also exist, but they are not as effective, so if you do not accepturgent measures blood glucose levels continued to decline.

When he drops to 2-2.5 mmol / L, then the brain is not just a "starving" and is "on the brink of starvation."Anxiety behavior is replaced by drowsiness and dizziness, spasms occur and loss of consciousness.This is called hypoglycemic coma.

To prevent this condition, you need to eat 5-6 pieces of sugar or drink a few sips of sweet juice, tea, sugar, lemonade.These products contain digestible carbohydrates that are quickly absorbed, so the state of hypoglycemia usually takes 10-15 minutes.After this, the patient must eat some food rich in carbohydrates - such as sandwiches, cakes, to stabilize blood sugar levels.Something of these products are sick with diabetes should always carry with them, leaving the house.

Attention! hypoglycemia helps only "real" sugar and sugar substitutes and not special "diabetic" drinks and candy.

If hypoglycemic coma occurred with loss of consciousness, it is clear that a person can no longer eat anything himself.In such cases, it requires emergency treatment: 1 ml subcutaneously administered glucagon solution (containing 1 mg glucagon) or intravenously - 20-80 ml of 40% glucose.This can make not only a doctor "first aid", but relatives or friends of the patient, if they have the necessary skills and know how to recognize the signs of hypoglycemia and, most importantly - to distinguish it from a diabetic coma (ketoacidosis), since measures taken under these conditions,directly opposite in nature.

stated above that identify the cause unconsciousness may only doctor.However, hypoglycemic coma in most cases is a complication of insulin therapy, that is the man himself and his family know if only the fact that the original cause - is diabetes, so have to choose all the same two states, not a dozen.So first of all we have to "learn" the differences of diabetic hypoglycemic coma.(Of course, it is possible that a person suffering from diabetes, and in general any person who may be injured, get sick even some disease and as a result, be in any condition - shock, collapse, and so on. N.)

Once the patient regains consciousness, he needs to eat something rich in carbohydrates kakuyu- food (sandwich, porridge and so on. n.).

If the patient with hypoglycemia time does not help, then the consequences can be tragic, or death.It is because of the possibility of hypoglycemia, a person suffering from diabetes and are taking insulin should always carry a card of the patient with diabetes, which indicates that he is suffering from this disease, received treatment with insulin and if it will find in the unconscious, he must enterglucose.

«Late" hypoglycemia

condition of so-called late hypoglycemia develops after a great exercise, but not during class.A person with diabetes can do large and long-lasting physical activity (such as playing football, tennis, badminton), without feeling any deterioration in health.In the evening he will bring his usual dose of insulin, dine in accordance with its usual diet - and at night he may suddenly develop a hypoglycemic coma.

reason for this is that the usual insulin dose, calculated on the state of "peace" and a certain amount of food eaten, turned out to be excessive.In the intense exercise the body "works" quite differently, so after exercise evening dose of insulin should be reduced, and at night to eat more foods rich in protein and starch.

In rare cases of hypoglycemia after a long and strenuous physical activity occurs in practically healthy person.

Why else happens

hypoglycemia Hypoglycemia is primarily divided into related to drugs and non-drugs.