Regimens of insulin therapy in Type 1 diabetes
There are 5 basic regimens of insulin therapy, which have their both positive and negative characteristics:
1. In a single introduction of insulin of an intermediate action the patients have to consume food more frequently, however the breakfast should be almost without carbohydrates. By the end of night and in the morning the level of glycohemia may be high because this regimen is not physiologic. The increase in a dose can result in hypoglycemia within a day. Frequently, using this method, doctors recur to high doses of insulin that is not justified and causes insulin resistance; as a result complications develop. Doctors practically do not work under this regimen.
2. In a double introduction of insulin of intermediate action the general dose is less than in the previous regimen. The basic 2/3 of the dose is introduced in the morning; in the evening of the patient gets only 1/3 of the dose. However in such a technique there appear problems with the distribution of carbohydrates. The first breakfast should be modest as the insulin received during the evening injection on the eve already almost ceases to operate, and insulin of the morning injection has not started to be developed yet.
Approximately in 4 hours after the morning injection there comes time for the second breakfast. It should be rather substantial (about 4 CE). In 6-7 hours the dinner comes, which must be as substantial as the second breakfast. Before a supper the level of sugar in blood raises, therefore the supper should be light. Patients should consume substantial meal in addition before going to bed because substantial dose of insulin is introduced in the evening.
Doctors work under this regimen usually with patients whose diabetes has developed rather recently and the daily norm of insulin is usually insignificant. In the morning it can be 12 U and in the evening the dose can be 6 U.
The total of cereal units per day should make 15-16. The carbohydrate content in the meal consumption can be the following:
– The first breakfast: 2 CE;
– The second breakfast and the dinner: by 4 CE;
– The supper: 2 CE;
– The second supper: 3-4 CE.
The evening injection of insulin should be performed in 12-14 hours after morning injection, but not later than 23 o’clock.
3. Introduction of the long action preparation in the morning or in the evening (1 time within 24 hours). The average duration of the preparation action is 28-30 hours. Its action consists in the fact that there is as though a stratification of one injection upon another that helps to create the certain basis level of insulin. Within the day, insulin of a short action is introduced after each basic meal intake (approximately 3 times a day). This technique is named the basis – bolus therapy. It most of all meets the natural rhythm of insulin secretion and is close to ideal therapy. But unfortunately, the preparations of long action insulin demonstrate a rather high instability as regards their activity.
4 and 5. Prescribing of double introduction of insulin of intermediate action; or introduction of simple insulin before each food intake. Insulin of intermediate action provides the basic level. Some patients miss the introduction of simple insulin before dinner, explaining it by the fact that at this time there is a high activity of the intermediate insulin introduced in the morning, and besides, at this time they experience the maximal physical activity.
It is not recommended to introduce the insulin of short action for the night. It is introduced before supper, approximately at 19-20 o’clock. Later, the intermediate insulin is introduced, and in 12-14 hours the second morning dose is introduced. After the evening injection a light second supper (approximately 2 CE) is necessary.
The given regimen of therapy is used most frequently because it is physiologic and can be arranged to the life style of the patient. In this case, the time of food consumption is not limited to a strict schedule; in fact, before each food intake short insulin action is introduced. Nevertheless, the patient should not make the big intervals between the food intakes because the intermediate insulin is operating indefatigably in the body.