Insulin or pills, which is better? Insulin doubles the death rate in type 2 diabetes, study.

25.07.2019 Insulin

In the general medical complex for diabetes mellitus, it is difficult to single out something main and secondary - everything is important here in equally: nutrition, drug therapy, physical activity. Of course, having diagnosed a patient, we first of all discuss his diet - without it, all further efforts of doctors will be ineffective. But this is not the end of it. Most often, the question of drug therapy almost immediately arises.

One of them just started working in Poland and summed up the work. Very good news for people with diabetes in Poland. Based on the results of this study, they will receive medications adapted to this condition. Thus, therapy will become more effective and safer than today, and insurers will spend more efficiently their money. Not only do they increase the secretion of insulin by the beta cells of the pancreas, but they also slow down gastric emptying and suppress appetite.

This does not mean, however, that all diabetics should go to genetic laboratories. “Even without these tests, it can be determined in advance that a patient may have a mutation in the gene responsible for the disease,” says prof. These are usually people with diabetes in an unusual way. Like a 25-year-old man. He had elevated level blood sugar, but he was thin and extremely well-groomed, and according to his knowledge, diabetes should lead to an inadequate lifestyle: too much food and no movement.

So, the doctor prescribes hypoglycemic tablets or insulin. The first question that the patient asks is always the same: can we do without them?

It is possible, but for this the following conditions must be met.

This is a mild course of type 2 diabetes
The pancreas is still quite intact and has a certain margin of safety.
The blood sugar level is not much higher than the norm.
The patient's weight does not exceed the 1st degree of obesity.
No diabetic complications.
We are not talking about a pregnant woman - in this case, delay is absolutely unacceptable! And only insulin!
The patient has objective conditions in order to change his lifestyle, because often everyday circumstances impede, for example, regular physical education. Sometimes it is simply difficult for a person to switch to a new style of eating, and he knows that he does not have the willpower to completely abandon sweets or starchy foods ... In such cases, it is better not to take risks, wasting time. Sooner or later, drug therapy will become inevitable, as soon as it begins, when there are already serious complications.

If, within 3 months of non-drug treatment, blood glucose has not decreased to normal values, it is necessary to move on to more intensive therapy, and here one cannot do without the help of pharmacologists.

Genetic testing confirmed doctors' suspicions - men have type 3 diabetes. It was like a child of several years who was initially diagnosed with type 1 diabetes and given insulin. It turned out, however, that the boy was only about 0.1 units per day, and his patients usually received 5-10 times more. - This pre-selection is preceded by careful observation of the patient makes the genetic defect we find on average every other doctor sent us a sample, says prof.

Mlynarski, who runs the genetic research laboratory. The researcher emphasizes that this study should qualify the doctor for whom the patient is being treated, because only he can assess whether the patient has atypical diabetes. Such a reasonable initial consultation is also necessary as these studies cost more than 10,000 people. zlotys.

Pills or insulin - What does modern medicine offer?

What is in the arsenal of a modern endocrinologist?

For treatment diabetes mellitus Type 1 uses only insulin, there is no other alternative today. This is understandable: no matter how you increase the sensitivity of the receptors to insulin, the insulin itself will no longer be there and the lost cells of the pancreas will not force any stimulants to work.

Depending on the type of mutation detected, doctors suggest different methods treatment. However, only a few of the 3000 people. Diabetic patients whose genes have been tested in a Polish laboratory can, at least for the time being, give up insulin. They will only have oral medications. There are also several people, about 400 people, who can speak of exceptional happiness. To fix this, it might just be corny: by changing your diet and getting more physically active.

No medicine needs it. Moreover, they will not have any of the complications typical of this disease - kidney or circulatory disorders or vision problems. How exactly such happy people can be all over Poland is unknown. - Genetic research in the field of diabetes has just begun, - emphasizes prof. Many doctors have not yet found out that some of their patients may have this unusual diabetes. According to Mlynarski, atypical patients in Poland make up no more than 2-5%.

With type 2 diabetes mellitus, the possibilities are much wider - in mild cases, you can only do with a diet and regular physical activity, and for more complex ones there are several groups medicines affecting different levels of the pathological chain.

These groups are:

agents that improve the sensitivity of insulin receptors;
drugs that stimulate increased production of insulin by cells of the pancreas - stimulants;
drugs that reduce the absorption of carbohydrates in the intestine.

Drug therapy is usually started from the first group or a combination of the first and second groups. Let's get to know them better.

All are affected by diabetes, which is about 100 thousand. human. This, however, means that untreated patients may not be properly treated. Now they have a chance for the right therapy. Studies show the average blood glucose level present in a patient's blood over the past 3 months. Some people cope with the disease with the right diet, but other diabetics need medications, such as insulin or metformin, to lower their blood sugar, which in turn reduces the risk of complications.

Insulin Therapy - Disadvantages and Benefits Researchers who have conducted recent studies on insulin therapy say the benefits of such treatment, especially for people over 50, do not always outweigh the negative effects. In many cases, this therapy does not help prolong the quality of life. If a person with diabetes believes that insulin therapy reduces quality of life by more than 3-4 percent, this outweighs any beneficial effects of treatment in any type 2 diabetic patient over the age of 50.

Type 2 diabetes mellitus is usually called non-insulin dependent. But to date, it has been established that almost all patients suffering from this type of diabetes, at a certain stage of the disease, require the use of insulin. In the treatment of type 2 diabetes, the main thing is not to miss the moment and to prescribe insulin in a timely manner.

Insulin therapy is the leading treatment for diabetes worldwide. It helps to significantly improve the well-being of diabetics, delay the onset of complications and prolong life.
The benefits of therapy depend on the age at which it was started and its side effects... After 20 years, how the treatment affected the overall quality of life of patients and proved to be effective in reducing the risk of complications. We then compared the reduced risk of complications with the burden and side effects associated with insulin therapy. According to the researchers, the benefits of therapy for patients with type 2 diabetes depend on the age of initiation of treatment and potential side effects, not on blood sugar levels.

When it comes to patients aged 75, it is believed that therapy can only give them 3 weeks healthy way life. Doctors say the goal of treatment is not to lower blood sugar levels with the same drop, but also to prevent debilitating or fatal complications. If the risk of complications is low enough and the burden of therapy is high, treatment will lead to more negative than positive effects. The balance between these values cannot be determined by blood sugar alone.

temporarily - to prepare the patient for surgery or in the event of severe infectious diseases;
constantly - with the ineffectiveness of antihyperglycemic drugs in tablets.

The length of the period from the first symptoms of type 2 diabetes to the need for continuous insulin administration directly depends on 2 factors. Namely, from a decrease in the performance of beta cells and an increase in insulin resistance. The state of being constant significantly reduces the duration of this period.

On the other hand, for patients with hemoglobin above this value, the benefits of insulin therapy may be much higher, as they are more prone to complications. The researchers warn that relying solely on hemoglobin in the blood to assess whether insulin therapy is right for a person is the wrong strategy. Instead, they recommend treatment individually based on the age and workload of the patient.

You will read about this insulin. Many people who find out during routine research that they have high blood sugar should ignore this information. There are many excuses: measurement error, too late and hearty dinner, party. Meanwhile, diabetes is developing at its best! It silently damages blood vessels and nerves and often results in disability or death. With a diabetologist, prof. other hub. Leszek Chuprinjak talks with Katarzyna Koper.

In other words, the worse a person controls type 2 diabetes (dieting and taking anti-hypoglycemic drugs), the faster insulin will be prescribed. For diabetics, there are a number of factors that increase insulin resistance: concomitant diseases, the use of drugs with a negative metabolic effect, weight gain, low physical activity, frequent anxiety and anxiety. Together with lipo - and glucose toxicity, they accelerate the decline in beta cell performance in patients with type 2 diabetes.

Apparently, some patients who go to the hospital with a heart attack or stroke have learned that it is the result of untreated diabetes. Can you tell how long the patient worked with this disease before such serious complications? Leszek Cuprinjak: - Sometimes the first symptom of diabetes is loss of vision in one eye, because a damaged blood vessel in the retina is damaged. Or a sore wound on your leg that doesn't want to get wet. The damage to the nerve connections makes the person feel that he or she is not in pain, he is not protecting a wound that is infected.

Indications for the appointment of insulin therapy

With an increasing decrease in the secretion of beta cells and the ineffectiveness of tableted glucose-lowering drugs, insulin is recommended in monotherapy mode or in combination with tableted glucose-lowering drugs.

Antibiotic treatment has no effect. There is an ulcer that does not want to be cured due to circulatory problems. The patient goes to the surgeon, he orders glucose control, and the wound on the leg is a complication of diabetes. Research shows that the first metabolic abnormalities in blood glucose levels occur approximately 10 years before diabetes is diagnosed. In practice, the disease can be detected for several years, several months before the onset of serious complications, but blood sugar levels should be monitored regularly.

How often should you do this to find out if something is wrong? The Polish Diabetes Association recommends that everyone over the age of one who has at least one risk factor for diabetes develop fasting blood glucose levels at least once a year. These risk factors are overweight or obesity, a sedentary lifestyle, low physical activity, cardiovascular diseases, hypertension, polycystic ovary syndrome, having a baby over four kilograms, or a family history of diabetes.

Absolute indications for insulin prescription:

Signs of insulin deficiency (eg, weight loss, symptoms of decompensated type 2 diabetes);
the presence of ketoacidosis and / or ketosis;
any acute complications of type 2 diabetes mellitus;
exacerbation of chronic diseases, acute macrovascular pathologies (stroke, gangrene, heart attack), the need for surgical treatment, severe infections;
newly diagnosed type 2 diabetes, which is accompanied by high sugar during the day and on an empty stomach, not taking into account body weight, age, the estimated duration of the disease;
newly diagnosed type 2 diabetes mellitus in the presence of allergies and other contraindications to the use of sugar drugs in tablets. Contraindications: hemorrhagic diseases, pathology of kidney and liver function;
pregnancy and lactation;
severe disorders of the kidneys and liver;
lack of favorable sugar control during treatment maximum doses tableted antihyperglycemic drugs in acceptable combinations and doses, along with sufficient physical activity;
precoma, coma.

Insulin therapy is attributed to patients with type 2 diabetes mellitus with the following laboratory parameters:

Those who are not affected should have their glucose monitored every three years. Should we be concerned about an abnormal result from one study? Definitely see a doctor. Further research is needed, including the introduction of the so-called Oral Glucose Load Test or Fasting Sugar Test, and then two hours after drinking a glass of water containing dissolved 75 g of glucose. If the results are incorrect, it means we have diabetes or prediabetes.

Patients say: but it's not like that with me! In human nature, there is a disregard for the symptoms of diseases other than pain. And diabetes for a very long time does not give any symptoms, especially pain. This is due to the fact that high levels sugars damage the nerves. Therefore, diabetic patients are more likely to have a heart attack. Many people find it difficult to understand the meaning of diabetes, especially type 2, and, above all, its relationship to obesity and cardiovascular disease. While this type 1 is usually taken seriously because it is about insulin injections, this type 2 is usually not.

fasting blood sugar levels above 15 mmol / l in patients with suspected diabetes;
plasma concentration of C-peptide below 0.2 nmol / l after intravenous test with 1.0 mg of glucagon;
despite the use of the maximum daily doses of tableted drugs for sugar, the level of fasting glucose in the blood is higher than 8.0 mmol / l, after a meal is higher than 10.0 mmol / l;
the level of glycosylated hemoglobin is constantly above 7%.

The main advantage of insulin in the treatment of type 2 diabetes is its effect on all links in the pathogenesis of this disease. First of all, this helps to compensate for the lack of endogenous production of the hormone insulin, which is observed with a progressive decrease in the functioning of beta cells.
For a 40-year-old who has no symptoms, he doesn't want to upset his life just because someone tells him he won't have to take insulin or have a heart attack in a few years. Usually the doctor disappears from the field of view and avoids supervision.

Let's explain what is the link between diabetes and obesity. Type 2 diabetes is caused by excess energy stored in adipose tissue. In pictures - cells are loaded with fat. Since they no longer need energy, they do not absorb glucose. It circulates in the blood and destroys the inner walls blood vessels... Hence, heart attack, stroke, and kidney damage or vision problems. Type 1 diabetes is not associated with obesity. Its cause is destruction immune system- from an unknown medical reason - the cells that produce insulin in the pancreas.

Mechanisms of action and effects of insulin

Insulin therapy is performed to eliminate glucose toxicity and adjust the producing function of beta cells with moderate levels of hyperglycemia. Initially, the dysfunction of the beta cells in the pancreas that produce insulin is reversible. Endogenous insulin production is restored when sugar levels drop to normal levels.

And you cannot live without insulin. Only she can burn glucose. Diabetic coma - diabetic coma. How does it happen and when does it become dangerous? It is a life-threatening condition that results from severe metabolic disturbances in the body. Therefore, one of the first actions taken by rescuers, caused by an unconscious patient, is to determine the glucose concentration in order to exclude this cause. The hypoglycemic effect occurs when the sugar is too low because the patient has consumed too much insulin or ate too little, did not plan proper exercise, did not burn more glucose and eventually passed out.

Early administration of insulin to type 2 diabetics is one of the treatment options for insufficient glycemic control during the diet and exercise phase physiotherapy exercises, bypassing the stage of tablet preparations. This option is preferable for diabetics who prefer insulin therapy over the use of antihyperglycemic drugs. And also in patients with underweight and suspected latent autoimmune diabetes in adults.

Successful lowering of glucose production by the liver in type 2 diabetes mellitus requires the suppression of 2 mechanisms: glycogenolysis and gluconeogenesis. The introduction of insulin can reduce hepatic glycogenolysis and gluconeogenesis, as well as increase the sensitivity of peripheral tissues to insulin. As a result, it becomes possible to effectively "fix" all the main mechanisms of the pathogenesis of type 2 diabetes mellitus.

Positive results of insulin therapy in diabetes mellitus

There are also positive aspects of taking insulin, namely:

decrease in fasting and post-meal sugar levels;
increased production of insulin by the pancreas in response to glucose stimulation or food intake;
decreased gluconeogenesis;
the production of glucose by the liver;
inhibition of glucagon secretion after meals;
changes in the profile of lipoproteins and lipids;
suppression of lipolysis after eating;
improvement of anaerobic and aerobic glycolysis;
decrease in glycation of lipoproteins and proteins.

Treatment of diabetics is primarily aimed at achieving and long-term maintenance of target concentrations of glycosylated hemoglobin, fasting blood sugar and after meals. The result will be a decrease in the possibility of development and progression of complications.

The introduction of insulin from outside has positive impact on carbohydrate, protein and fat metabolism. This hormone activates the deposition and inhibits the breakdown of glucose, fats and amino acids. It lowers sugar levels by increasing its transport to the middle of the cell through the cell wall of adipocytes and myocytes, as well as inhibiting the production of glucose by the liver (glycogenolysis and gluconeogenesis).

In addition, insulin activates lipogenesis and inhibits the use of free fatty acids in energy metabolism. It inhibits muscle proteolysis and stimulates protein production.

Insulin dose calculation

The selection of the dose of the drug is made strictly individually. It is based on the weight of the diabetic, clinical picture and daily glucose profile. The need for this hormone depends on the degree of insulin resistance and the secretory capacity of beta cells, reduced due to glucose toxicity.

Type 2 diabetics with concomitant obesity need more insulin than others to achieve control. The number of injections and the dose of insulin per day depend on the blood sugar level, general condition diabetic and dietary regimen.

Bolus insulin therapy is most commonly recommended. This is when a human insulin analogue (or insulin short acting) is introduced several times a day. A combination of short-acting and intermediate-acting insulin (2 times a day or before bedtime) or a prolonged-acting insulin analogue (used before bedtime) is possible.

The most commonly prescribed insulin bolus is when short-acting insulin (or human insulin analog) is used several times a day. A short-acting and intermediate-acting insulin complex (before bedtime or 2 times a day) or a prolonged-acting insulin analogue (before bedtime) is possible.

Insulin injection

Insulin solution is injected subcutaneously. The injection site must first be massaged well. The injection sites must be alternated every day.

The injection is performed by the patient himself; for this, a special spitz with a thin needle or a syringe pen is used. If possible, preference should be given to a syringe pen.

Pros of using a syringe pen:

it has a very thin needle, the use of which makes the injection of insulin almost painless;
compactness - the device is convenient and easy to carry;
insulin in a syringe pen is not destroyed, it is protected from temperature and other environmental factors;
the device allows you to individually prepare and use mixtures of insulin preparations.

No more than 30 minutes should elapse between insulin administration and meals. It is allowed to enter no more than 30 units at a time.

Treatment options: monotherapy and combination therapy

For the treatment of type 2 diabetes, there are 2 types of therapy: monotherapy with insulin and combined with antihyperglycemic drugs in tablets. The choice can only be made by a doctor, based on his knowledge and experience, as well as on the characteristics of the general condition of the patient, the presence of concomitant diseases and from drug treatment.

When monotherapy with glucose-lowering tablets does not lead to adequate control of blood sugar levels, a combination therapy with insulin and tablet drugs is prescribed. Combined, as a rule, as follows: insulin with sulfonylurea, insulin with meglitinides, insulin with biguanides, insulin with thiazolidinediones.

The advantages of the combined regimens include an increase in the sensitivity of peripheral tissues to insulin, the rapid elimination of glucose toxicity, and an increase in endogenous insulin production.

Insulin monotherapy for type 2 diabetics according to the traditional or intensified scheme. Significant progress in endocrinology is associated with a huge selection of insulins, which makes it possible to meet all the needs of the patient. For the treatment of type 2 diabetes, any insulin regimens are acceptable that successfully control blood sugar levels and protect against unwanted hypoglycemia.

Insulin regimens

The choice of the insulin administration regimen depends on the patient's age, comorbidities, attitude to treatment, social status and material opportunities.

The traditional scheme implies a strict diet for a diabetic, as well as the same food every day in terms of time of intake and the amount of carbohydrates. The administration of insulin injections is fixed in time and dose.

With this regimen, the patient may not often measure his blood sugar. The disadvantage of this scheme is that there is no flexible adaptation of the amount of insulin to changing blood sugar levels. The patient is tied to a diet and schedule of injections, which prevents him from leading a full life.

The traditional insulin regimen applies to the following categories:

elderly diabetics;
patients who cannot independently use a glucometer and control their sugar;
diabetics with mental illness;
patients requiring constant outside care.

Intensified Scheme - aims, through injections, to mimic the normal natural production of insulin. The advantages of using this scheme for a diabetic are many, but it is somewhat more difficult to apply.

Principles of Intensified Insulin Administration:

base-bolus method of insulin therapy;
a non-strict diet, adaptation of each dose of insulin to a specific food and the amount of carbohydrates eaten;
the need to measure blood sugar levels several times a day.

Complications of insulin therapy

Sometimes there are complications in the treatment of type 2 diabetes:

allergic reactions;
hypoglycemic conditions;
postinsulin lipodystrophy.

Complications develop, as a rule, due to non-observance of the rules for administering insulin.

The main goal of type 2 diabetes treatment is to maintain normal level blood glucose, delaying complications, increasing life expectancy. All this can be achieved if insulin therapy is prescribed in a timely manner. Modern drugs have proven their effectiveness and safety when prescribing them even in severe forms of diabetes.