Proper administration of insulin is the key to successful diabetes management!

General information

In order for a person to lead an active lifestyle, and for his body to function correctly, without failures, energy must flow into the cells, tissues of organs and systems. Its main source is glucose in the blood. To break it down and convert it into energy, it is necessary to have a certain hormone produced by the pancreas - insulin.

As a result of the development of any diseases of this organ, the production of the hormone decreases. The breakdown of glucose slows down. This leads to energy deficiency, which negatively affects the functioning of all human organs. At the same time, as food continues to enter the body, blood sugar levels rise, sometimes significantly exceeding normal levels. It settles in blood vessels in the form of single crystals. A person develops a dangerous, intractable disease – diabetes mellitus.

There are two types of diabetes:

• T1DM – consists of pancreatic dysfunction, insulin stops being produced completely or partially; energy does not flow to the cells;
• T2DM – characterized by cell insensitivity to insulin; Despite the fact that the gland continues to produce the hormone in sufficient quantities, the cells that have lost sensitivity do not absorb energy, and the sugar level in the blood increases.

Depending on what type of disease a person suffers from, a specific treatment method is prescribed. With T2DM, in some cases, following a special diet may be sufficient. If this method turns out to be ineffective, then over time the gland begins to produce less hormone. In this case, as with type 1 diabetes, insulin preparations are prescribed, which prevent the development of complications, expressed in disturbances in the functioning of internal organs (heart, kidneys), blood vessels, and decreased vision.

Prerequisites for the creation of insulin

Back in the 19th century, during autopsies of patients who died of diabetes, it was noticed that in all cases the pancreas was severely damaged. In Germany in 1869, Paul Langerhans discovered that in the tissues of the pancreas there are certain groups of cells that are not involved in the production of digestive enzymes.

In 1889 in Germany, physiologist Oskar Minkowski and physician Joseph von Mehring experimentally proved that removal of the pancreas in dogs leads to the development of diabetes. This led them to suggest that the pancreas secretes a certain substance that is responsible for metabolic control in the body2. The hypothesis of Minkowski and Mehring found more and more confirmation, and by the first decade of the 20th century, as a result of studying the relationship between diabetes and damage to the islets of Langerhans of the pancreas, the discovery of endocrine secretion, it was proven that a certain substance secreted by the cells of the islets of Langerhans plays a leading role in the regulation of carbohydrate metabolism3. The idea arose that if this substance was isolated, it could be used to treat diabetes mellitus, but the results of the continuation of the experiments of Minkowski and Merking, when dogs after removal of the pancreas were injected with its extract, which in some cases led to a decrease in glucosuria, were not reproducible. and the very introduction of the extract caused an increase in temperature and other side effects.

The administration of pancreatic extract to patients with diabetes was practiced by such European and American scientists as Georg Sulzer, Nicola Paulesco4, Israel Kleiner, but due to the large number of side effects and problems associated with financing, they were unable to complete the experiments.

Insulin tablets

Despite this, many people with diabetes are afraid to start taking insulin. The main reason for this is the need for constant administration of the drug in the form of injections. The dream of many diabetics is insulin tablets. Despite the fact that you can sometimes find media reports that scientists from America and Australia were able to invent insulin tablets, this is most likely not true.

The dream of pills for type 1 diabetes is not yet possible. At the moment, this is the only method of treating T1DM that allows not only to improve the quality of life of a sick person, but also to significantly increase its duration. At the same time, it is not necessary to use a syringe to administer insulin, which is always difficult. Today, scientists, pharmacologists, and doctors suggest using such an invention as a syringe pen. The procedure with their help is simple, and the use of special needles for insulin syringe pens allows you to administer the drug absolutely painlessly.

Nobel Prize

In 1923, the Nobel Committee awarded the Physiology or Medicine Prize to Banting and MacLeod, just 18 months after the drug was first reported at a meeting of the Association of American Physicians. This decision aggravated the already difficult relations between scientists, because Banting believed that MacLeod's contribution to the invention of insulin was greatly exaggerated; in Banting's opinion, the prize should have been divided between him and his assistant Best. To restore justice, Banting shared his share of the prize with Best, and McLeod with the biochemist Collip8.

The patent for the creation of insulin, owned by Banting, Best and Collip, was sold by scientists to the University of Toronto for $3. In August 1922, a cooperation agreement was concluded with the pharmaceutical company Eli Lilly and Co., which helped establish the production of the drug on an industrial scale.

More than 90 years have passed since the invention of insulin. Preparations of this hormone are being improved; since 1982, patients have been receiving human insulin, and in the 90s analogues of human insulin appeared - drugs with different durations of action, but we must remember the people who were at the origins of the creation of this drug, which saves the lives of millions every day of people.

Bibliography

1. IDF diabetes atlas 7th Edition. Available at: https://www.diabetesatlas.org/.

1. Bliss M. The history of insulin. Diabetes Care 1993;16 Suppl 3:4-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8299476.

1. Bliss M. The discovery of insulin: the inside story. Publ. Am. Inst. Hist. Pharm. 1997;16:93-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11619903.

1. Karamitsos DT. The story of insulin discovery. Diabetes Res. Clin. Pract. 2011;93 Suppl 1:S2-8. doi:10.1016/S0168-8227(11)70007-9.

1. Banting Notebook: 1920-21. Fisher Rare Book Library, University of Toronto, Toronto, Canada.

1. Stylianou C, Kelnar C. The introduction of successful treatment of diabetes mellitus with insulin. JR Soc. Med. 2009;102(7):298-303. doi:10.1258/jrsm.2009.09k035.

1. Rosenfeld L. Insulin: discovery and controversy. Clin. Chem. 2002;48(12):2270-88. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12446492.

1. de Herder WW. Heroes in endocrinology: Nobel Prizes. Endocr. Connect. 2014;3(3):R94-R104. doi:10.1530/EC-14-0070.

Classification of insulin

But even if the patient decides to take insulin injections, he will not be able to purchase the drug at the pharmacy on his own. It must be selected by an endocrinologist, especially since there are a lot of types of insulin on the shelves of modern pharmacies and it is very difficult to understand their purpose without special knowledge.

All insulin preparations are classified into types according to several criteria. For example, depending on the “origin”, the following types of insulin are distinguished.

• Obtained from the pancreas of pigs or cattle. The first option is preferable, since it is closer to the human one. In the second case, an allergic reaction may occur.
• Synthesized artificially using human rDNA insulin.
• Genetically engineered, it is also obtained from pork insulin using modern innovative technologies, which makes it possible to obtain a drug almost identical to the human hormone.

The following classification method takes into account the speed of penetration of the drug into the blood and the duration of its action. On this basis, insulin is divided into the following categories:

• ultra-short;
• short;
• average;
• long.

The drugs of the last two categories are considered basic, basic. They are administered 1-2 times a day, which allows you to maintain blood sugar levels at a normal level for a long period of time. Ultra-short and short preparations are used before each meal, which helps prevent the increase in blood sugar levels caused by the intake of food into the body.

Ultra-short

When used to lower blood sugar levels, it must be remembered that the faster the effect of the drug occurs, the shorter the duration of its action. The fastest, ultra-short drugs begin to work 10 minutes after administration. These are very powerful, effective medications, the effect of which is as close as possible to the natural hormone and lasts for 3 hours. The injection is given immediately before or immediately after a meal.

Short

The effect of the drug begins after 30 minutes and lasts for 5-8 hours. Preliminary administration of the medicine allows it to begin working simultaneously with the intake of food into the body, and it is desirable that it contains predominantly slow carbohydrates. A long period of action leads to the fact that the hormone remains in the blood after all the food has been absorbed and the amount of glucose in the blood has decreased. To prevent this from leading to hypoglycemia, additional food intake (snack) is necessary.

Like other insulin preparations, short- and ultra-short-acting drugs are introduced into the body using disposable syringes or reusable insulin pens into the subcutaneous fatty tissue. This promotes a more uniform, slow penetration of the hormone into the blood. The rate of absorption depends on various factors, primarily:

• injection site, it can be the shoulder, thigh, but the drug begins to act most quickly when it is injected into the stomach;
• the dose of the administered medication, the larger it is, the more effective the effect will be;
• the thickness of the fat layer, the smaller it is, the faster the absorption will be.

The drug and its dose are selected by a specialist endocrinologist, taking into account the characteristics of the patient’s body, depending on the stage of development of the disease. But a person with diabetes can independently regulate the dose, depending on the number of “bread units” entering the body: 1 unit of short-acting insulin is administered per 1 unit of bread, so that no more than 1 unit per kilogram of body weight enters the body at a time.

To accurately determine the dose, doctors recommend that patients keep a “food diary”. It is necessary to record each meal, the sugar level measured after that, the dose and name of the administered drug, and the concentration of glucose in the blood after taking the drug. This “Diary” allows the treating endocrinologist to choose a more effective treatment method. In addition, in the event of an emergency (the development of ketoacidosis), an emergency doctor or an intensive care unit specialist called to the house will also be able to use the notes taken to determine which medicine should be used to provide emergency care. In this case, the injection is given intravenously.

Medium and long

These drugs are intended for basic, basic therapy. They must be used daily, regardless of the time and amount of food taken. Medium-duration medications require administration twice a day: 2/3 of the dose in the morning before breakfast and 1/3 of the dose before dinner. With medium-lasting insulin, the effect is achieved after 1-1.5 hours, and the duration is 20 hours. Long-acting (long-term) insulin can be used once a day. It starts working in 1-3 hours. The main advantage of its use: the absence of a peak of activity. The concentration of insulin in the blood remains at a constant level throughout the entire duration of action, that is, 24 hours.

Depending on the type of diabetes mellitus, the stage of development of the disease, and the characteristics of the body, the doctor will prescribe one of two insulin therapy technologies.

• Combined. It is also called traditional and is used to treat patients who cannot take care of themselves or control the dose of the administered drug: elderly people, patients with diabetes with mental disorders, and so on. It involves the simultaneous administration of two drugs using one medical syringe, one of which is basic (medium-acting or long-acting), and the second is a short-acting drug. Its main disadvantage is its low efficiency, which leads to earlier manifestation of various complications.
• Basis-bolus therapy. In this case, both short and long-acting (medium) insulin preparations are also used. But unlike the traditional method, this option does not involve “mixing” them. They are administered in different injections, which makes it possible to bring their effect closer to the physiological production of the hormone by the body itself. This method is considered the best and is used more often.

Lectures DM 2 insulin therapy

Features of insulin therapy for type 2 diabetes, differences from insulin therapy for type 1 diabetes. Insulin therapy: types of insulin, insulin therapy regimens , rules for calculating the dose of insulin. Means of insulin administration .

WHEN IS INSULIN PRESCRIBED?

The discovery of insulin in 1921 and its practical use was a revolution in the treatment of diabetes. People stopped dying from diabetic comas. Due to the lack of other drugs at that time, patients with type 2 diabetes were also treated with insulin, and with very good effect. But even now, when a number of glucose-lowering drugs in tablets have been developed and are being used, the vast majority of patients with type 2 diabetes use insulin.

In most cases, this is not done for health reasons, but to achieve a normal level of glucose in the blood, if such a goal has not been achieved by all of the above means (diet, exercise and glucose-lowering pills).

It should be understood that there can be no harm to the body from treatment with insulin (an example is people with type 1 diabetes mellitus who have been injecting insulin for decades from the very beginning of the disease).

INSULIN PREPARATIONS

Long-acting (long-acting) insulin preparations are obtained by adding special substances to insulin that slow down its absorption from under the skin. This group primarily includes drugs with an average duration of action. Their action profile is as follows: onset - after 2 hours, peak - after 6-10 hours, end - after 12-16 hours, depending on the dose.

Long-acting insulin analogues are produced by changing the chemical structure of insulin; they belong to the group of long-acting insulins. They are transparent, so they do not require stirring before injection. They do not have a pronounced peak of effectiveness, which reduces the likelihood of hypoglycemia at night and between meals, and lasts up to 24 hours. These insulin preparations can be administered 1-2 times a day.

INSULIN TREATMENT REGIMES

It is well known that in people who do not have diabetes, insulin production occurs constantly at a relatively low level throughout the day - this is called basal, or background insulin secretion.

In response to an increase in blood glucose (and the most significant change in its level occurs after eating a carbohydrate meal), the release of insulin into the blood increases several times; this is called dietary insulin secretion.

When treating diabetes with insulin, to maintain blood sugar levels consistent with those of a healthy person, a diabetic patient must inject insulin several times a day. However, every patient wants to administer insulin as early as possible, so a number of insulin treatment regimens are currently used. It is relatively rare to get good results when administering intermediate-acting insulin once or twice a day. This regimen is called traditional insulin therapy.

Typically, these options are used while taking glucose-lowering tablets. It is clear that the increase in glycemia during the day and the peaks of the maximum glucose-lowering effect of insulin do not always coincide in time and severity of the effect.

Quite often, in the treatment of type 2 diabetes mellitus, short- and medium-acting insulin is administered 2 times a day. In connection with the above-described parameters of the action of insulin drugs, this regimen requires that a person must have three main and three intermediate meals, and it is desirable that the amount of carbohydrates in these meals be approximately the same every day.

In some cases, it may be necessary to administer insulin in a manner that most closely resembles the natural insulin production of a healthy pancreas. It is called intensified insulin therapy, or multiple injection regimen.

In this case, the role of basal insulin secretion is taken over by long-acting insulin preparations, and the role of dietary insulin secretion is performed by short-acting insulin preparations, which have a rapid and pronounced hypoglycemic effect.

The most common scheme for this regimen is the following combination of injections:

- In the morning (before breakfast) administration of short- and medium-acting insulin.

- In the afternoon (before lunch) short-acting insulin.

- In the evening (before dinner) short-acting insulin.

- At night, administration of intermediate-acting insulin.

It is possible to use one injection of a long-acting (extra-long-acting) insulin analogue instead of two injections of intermediate-acting insulin.

Despite the increase in the number of injections, an intensified insulin therapy regimen allows a person with diabetes to have a more flexible diet, both in terms of timing and amount of food.

SELF-CONTROL DURING INSULIN TREATMENT

When treating with insulin, more frequent self-monitoring of blood glucose is mandatory, in some cases several times a day every day.

These indicators are the basis for you and your doctor in deciding whether to change your insulin doses.

A special column regarding nutrition during insulin therapy appears in the diabetes diary - bread units.

NUTRITION DURING INSULIN TREATMENT

Unfortunately, the administered insulin “does not know” when and how much food the patient eats. Therefore, you yourself must ensure that the action of insulin corresponds to your diet. Therefore, it is necessary to know which foods increase blood glucose.

As is already known, food products consist of three components: proteins, fats and carbohydrates. They all have calories, but not all increase blood glucose. Fats and proteins do not have a noticeable sugar-increasing effect, so they do not need to be taken into account from the point of view of insulin administration. Only carbohydrates have a real sugar-increasing effect, therefore, they must be taken into account in order to administer the appropriate dose of insulin.

What foods contain carbohydrates? This is easy to remember: most of the products are plant-based, and from animals - only liquid dairy products (milk, kefir, yogurt, etc.).

Products that increase blood glucose levels and require counting can be grouped into 5 groups.

Cereals - bread and bakery products, pasta, cereals, corn.

Fruits and berries.

Potato.

Milk and liquid dairy products.

Products containing sugar.

To eat a varied diet, you need to learn to replace some foods containing carbohydrates with others, but so that the glucose in the blood changes slightly.

This replacement is easy to do using the bread unit system (XE).

One XE is equal to the amount of a product containing 10-12 grams of carbohydrates, for example, one piece of bread weighing 20-25 g. Although such units are called bread units, they can be used to express not only the amount of bread, but also any other carbohydrate-containing products.

For example, 1 XE contains 1 medium-sized orange, or 1 glass of milk, or 2 heaping tablespoons of porridge.

The convenience of the XE system lies in the fact that a person does not need to weigh food on scales, but rather estimate this amount visually using easy-to-perceive volumes (piece, glass, piece, spoon, etc.).

As mentioned above, traditional insulin therapy (two insulin injections per day) will require the same diet day after day. When using intensified insulin therapy, you can eat more freely, independently changing both the timing of meals and the number of bread units

INSULIN DOSE

It is important for a person with diabetes on insulin therapy to learn how to independently change insulin doses as needed. But this can only be done if you self-monitor your blood glucose.

The only criterion that the correct doses of insulin are being administered is the blood glucose levels measured throughout the day!

Thus, an evening dose of long-acting insulin can be considered correct if the fasting blood glucose level is normal and there is no hypoglycemia at night. In this case, a prerequisite for assessment is a normal blood glucose level before bedtime, i.e. Long-acting insulin seems to maintain this level until the morning.

In order to assess the adequacy of the dose of short-term insulin administered before a meal, it is necessary to measure the glucose level in the blood either 2 hours after a meal (at the peak of its increase), or, in extreme cases, just before the next meal (after 5-6 hours).

Measuring blood glucose before dinner will help assess the adequacy of the dose of short-acting insulin before lunch with intensified insulin therapy or morning long-acting insulin with traditional insulin therapy.

Blood glucose at bedtime will reflect the correct dose of short-acting insulin before dinner.

RULES FOR REDUCING INSULIN DOSE

The reason for reducing the planned dose of insulin is the occurrence of hypoglycemia if this hypoglycemia was not associated with an error in nutrition (skipped meals or consuming fewer bread units), insulin administration (technical error when injecting insulin), or was not greater than with normal physical activity or alcohol intake.

The actions should be as follows.

Eliminate hypoglycemia: eat sugar or drink a sweet drink.

Determine blood glucose levels before the next injection. If it remains normal, administer the usual dose.

Think about the cause of hypoglycemia. If one of the main four reasons is determined, then correct the mistake made the next day and do not change the insulin dose. If you do not find the cause, do not change the insulin dose the next day, since this hypoglycemia could be accidental.

Check to see if hypoglycemia recurs at the same time the next day. If it recurs, it is necessary to decide which excess insulin caused it. To do this, you will need knowledge of the time parameters of insulin action.

On the third day, reduce the dose of the appropriate insulin by 10%, rounding to whole numbers (usually 1-2 units). If hypoglycemia recurs again at the same time, the next day further reduce the insulin dose.

RULES FOR INCREASING INSULIN DOSE

The reason for increasing the planned dose of insulin is the appearance of hyperglycemia, which is not associated with any of the following errors or concomitant conditions:

— little insulin (technical error with dose setting, injection into another area of ​​the body from which insulin is less absorbed);

- many bread units in the previous meal (counting error);

- less physical activity compared to usual;

- concomitant disease.

The actions should be as follows:

— Increase the dose of short-acting insulin or mixed insulin at the moment.

— Determine blood glucose levels before the next injection. If it remains normal, take the usual dose.

Think about the cause of hyperglycemia. If one of the main four reasons is determined, then the next day correct the mistake and do not change the insulin dose. If you do not find the cause, do not change the insulin dose the next day, since this episode could be coincidental.

Check to see if hyperglycemia recurs at the same time the next day. If this happens, it is necessary to decide which insulin deficiency is most likely “to blame” for this, knowing the time parameters of the action of insulin.

On the third day, increase the dose of the appropriate insulin by 10%, rounding to whole numbers (usually 1-2 units). If hyperglycemia occurs again at the same time, increase the insulin dose the next day.

You should be aware that any disease (especially of an inflammatory nature) may require more active action to increase the dose of insulin. Almost always in this case you will need to take short-acting insulin in multiple injections

INSULIN INJECTION SITES

Several areas of the body are used for insulin injections: the anterior surface of the abdomen, the anterior surface of the thighs, the outer surface of the shoulders, and buttocks. It is not recommended to inject yourself into the shoulder, since it is impossible to collect the fold, which means the risk of intramuscular injury increases.

You should know that insulin is absorbed from different areas of the body at different rates, in particular, the fastest from the abdominal area. Therefore, it is recommended to inject short-acting insulin into this area before meals. Long-acting insulin injections can be given in the thighs or buttocks.

Rotating injection sites should be the same every day, otherwise it may cause fluctuations in blood glucose levels.

It is also necessary to ensure that no lumps appear at the injection sites (they impair the absorption of insulin!). To do this, it is necessary to alternate injection sites, and also move at least 2 cm away from the previous injection site. For the same purpose, it is necessary to change syringes or needles for syringe pens after each injection.

General rules for administering insulin

The area where the needle is inserted determines how quickly the drug penetrates the blood. It is advisable to inject short-acting insulin into the subcutaneous fatty tissue of the abdomen, and longer-acting insulins into the shoulder, thigh or buttock.

Insulin is injected only into the subcutaneous fat at an angle of 45 degrees, but not intramuscularly or intradermally!

In order to prevent insulin from entering the muscle, the injection must be made into a skin fold, which is taken with the thumb and index (or middle) fingers. The fold can be released only when all the insulin has been injected into the subcutaneous tissue.

INJECTION TECHNIQUE is a very important point, but relatively simple, so that after five to six days the diabetic can confidently use a syringe. Let's consider all operations related to injections, point by point:

1. Skin preparation. There is no need to wipe the injection site with alcohol - alcohol dries the skin. Simply wash the area where you are going to inject with warm water and soap.
2. Preparation of the bottle. The bottle is closed on top with a rubber stopper, which does not need to be removed - the stopper is pierced with a syringe and insulin is drawn out. Rubber is stronger than leather, and with each puncture the syringe becomes dull. To prevent this from happening, take a thick needle for a medical syringe and pierce the plug several times in the very center. In the future, try to insert the needle of the insulin syringe into this puncture.
3. Preparation of insulin. Roll the cylindrical bottle of insulin vigorously between your palms for about thirty seconds. For intermediate and long-acting insulins, this operation is mandatory, since the prolongator in them settles to the bottom and must be mixed with insulin. But it is also recommended to roll the bottle with “short” insulin - the insulin will heat up, and it is better to administer it warm.
4. Preparing the syringe. A syringe - with a cap that protects the needle - is best kept in a glass. Take out the syringe, remove the cap and pull out the rod so that the piston reaches the mark for the dose you need.
5. Insulin kit. Take the bottle in your left hand and the syringe in your right. Insert the syringe needle into the punctured area in the stopper and lower the rod all the way - thereby introducing a volume of air into the bottle that is equal to your dose of insulin. This is necessary in order to create excess pressure in the bottle - then it will be easier to draw insulin. While still holding the bottle in your left hand and the syringe in your right, turn the bottle upside down, pull the plunger and draw the dose you need into the syringe plus a little more - one or two units. Pull out the needle, set the bottle aside and set the exact dose by gently moving the rod - a drop of insulin will appear at the tip of the needle. This means that there is no air under the piston. Do this check carefully; Having released excess insulin, check the dose accuracy again.
6. Injection. Using the fingers of your left hand, pull back the skin on your stomach or leg and insert the needle into the base of the skin fold at an angle of approximately forty-five degrees; you can insert the syringe vertically into the top of the skin fold (Fig. 8.6). Gently press the plunger and inject insulin, and then wait another five to seven seconds (count to ten).
7. Final operations. Pull the needle out and pump the plunger vigorously several times to remove any remaining insulin from the needle and dry the inside of the needle with air. Put the cap on and place the syringe in the glass. It is useful to throw some small object into the glass - a ball or a match; The number of matches in the glass will tell you how many times you inject with this syringe. But, as mentioned earlier, it is preferable to make only one injection with a syringe.

Algorithm for drawing insulin into a syringe:

1. Wash your hands with soap and wipe dry.
2. If you need to administer long-acting insulin, you need to roll the bottle of insulin solution between your palms for one minute. The solution in the vial should become cloudy.
3. Draw air into the syringe.
4. Inject this air from the syringe into the vial with the solution.
5. Take the required dose of the drug, remove air bubbles by tapping the base of the syringe.
6. Inject insulin (it is prohibited to inject the drug into areas of inflammation, scars, cicatrices and traces of mechanical damage - bruises).
7. The next injection must be done in a different area of ​​the skin (at least 2 cm away from the previous one).

Injecting insulin using a pen

A pen syringe is a special syringe that allows you to inject insulin without drawing it out of the bottle each time, and has a device for semi-automatic dosing of insulin. Manufacturers produce disposable and reusable syringe pens. In reusable syringe pens, a replaceable cartridge with insulin is located inside the body. In disposable syringe pens, cartridge replacement is not provided.

The injection sites are the outer surface of the shoulder at the border of the upper and middle third, the anterolateral surface of the abdominal wall, the anterolateral surface of the thigh.

If the insulin preparation is in the form of a suspension, it is necessary to make 10-12 turns of the handle 180° so that the ball located in the cartridge evenly mixes the insulin suspension.

The needle for the syringe pen is located in the outer and inner protective cap.

If you place the needle at an angle, you can damage the rubber membrane, causing insulin to leak and break the needle.

A safety test is carried out before each injection.

If insulin release does not occur, the safety test is repeated until release occurs.

Do not press the trigger button while selecting a dose, as insulin may be released, resulting in incorrect dosing.

SYRINGE PEN. Syringe pens were first developed, and the first model went on sale in 1983. Currently, several companies (including Becton Dickinson) produce syringe pens, and we need to consider what their advantages and disadvantages are.

A pen syringe is a much more complex product than a syringe. In design and appearance, it resembles a conventional piston ink fountain pen. A syringe pen such as NovoPen 3 consists of the following parts:

body, open and hollow at one end. A cartridge with insulin is inserted into the cavity, and on the other side there is a release button and a mechanism that allows you to set the dose with an accuracy of 1 unit (the mechanism clicks when setting the dose: one click - one unit);

- a needle, which is put on the tip of the sleeve protruding from the cavity of the pen - before injection (after injection the needle is removed);

— a cap that is put on the pen when it is not in use;

- a box-case, very similar to a case for a regular fountain pen.

Using the syringe pen is extremely simple:

1. open the case, take out the pen, remove the cap from it;
2. put on the needle, remove the cap from it (the needle with its cap is also placed in the case);
3. roll the pen in your palms or turn it up and down ten times to mix the insulin in the sleeve;
4. set the dose to 2 units and press the trigger button - a drop of insulin is ejected so that no air remains in the needle;
5. set the dose you need, inject into the shoulder, stomach, leg (if necessary, directly through clothing, having previously gathered the skin into a fold);
6. press the shutter button and wait seven to ten seconds. In this case, you should not release the skin fold until all the insulin has been injected.
7. All! Insulin got to where it needed to be. You remove the needle, put a cap on the pen, and hide the whole thing in a case.

A modern method, very convenient, but not without its drawbacks, especially for the Russian user. Let's see what the Novo Nordisk prospectus says about the advantages of the NovoPen 3 syringe pen over syringes and vials:

1. The use of syringes and vials requires good coordination of movements and visual acuity.
2. Even trained personnel may have difficulty administering insulin accurately.
3. Mixing two different types of insulin creates problems that can lead to the patient not following doctor's orders.
4. Using a syringe is difficult, time-consuming, and often embarrassing for the patient.

Let's comment on these statements:

1. True, but most diabetics can easily cope with this - either themselves or with the help of relatives. Syringe pens are absolutely necessary for lonely people with low vision or blindness - they set the dose by clicks.
2. Not entirely true - if only because the loss of accuracy by one unit does not play a big role (although, of course, there are exceptions).
3. Wrong; mixing does not create any problems if the eyes see and the hands do not shake.
4. There are no “many difficulties”, the time is about two or three minutes, but the awkward situation is true.

The main advantage of a syringe pen is that you can inject insulin anywhere without undressing. And there is one more important point, for some reason not mentioned in the prospectus: the needle of a syringe pen is even thinner than the needle in a good syringe, and it practically does not injure the skin.

Do you need alcohol?

In fact, the risk of inflammation at the injection site is negligible, but alcohol destroys insulin, so doctors do not recommend using alcohol antiseptics before an injection. However, if a person still uses such products before an injection, it is recommended that after disinfecting the desired area of ​​skin, wait a while until the alcohol has completely evaporated.

Release form

Insulin preparations go on sale in the form of solutions or suspensions, packaged in glass hermetically sealed bottles (5-10 ml). The top of the cork is rolled with an aluminum cap. For use in conjunction with a syringe pen, medicines are packaged in special cartridges (cases, cartridges).

For use in medical institutions, the drug can be in the form of a soluble white powder. It contains at least 3.1% sulfur. To introduce it into the body, it is diluted with special water for injection with the addition of hydrochloric acid, glycerin, and a solution of phenol (tricresol).

FAQ

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If in theory everything seems simple and clear, in practice people without medical education are faced with a number of problems and questions arise that are difficult to answer. Below are the most frequently asked questions to give clear answers to them:

1. How many ml is a cube in a syringe? One cube equals 1 ml of the drug.
2. How many ml are in a drop? Here, a simple formula is used for calculation: number of ml = number of drops divided by 20. Thus, 1 drop contains 0.05 ml of solution.
3. 5 drops is how many ml in a syringe? 5 drops is 0.25 ml in a standard disposable syringe.
4. 250 mg is how many ml in a syringe? 250 mg is the proportion of dry matter that is dissolved in the ampoule. Thus, if the ampoule says that it contains 250 mg in 1 ml. To administer a 250 mg dose of the drug, you need to administer 1 ml. If the ampoule indicates a dosage of 125 mg in 1 ml, then you need to draw 2 ml into the syringe.
5. 4 ml – how much is in a syringe? 4 ml equals 4 syringe cubes.
6. 0.5 ml – how much is in a syringe? The answer to this question depends on the volume of the syringe. So, in a 2 ml syringe this will be 5 small divisions, in a 5 ml syringe - 2.5 small divisions, and in a 10 ml syringe - one small division, and in a 20 ml syringe - half a small division.

Thus, dividing a syringe is not a complex medical mystery, but a simple and universal device.

pharmachologic effect

Insulin drugs affect all tissues and internal organs of the human body. But its “work” is most pronounced in its effect on muscle and fat tissue, the liver, metabolic processes occurring in the body, and digestion. Among the main functions of these drugs:

• regulation of carbohydrate metabolism due to stimulation of glucose penetration through the cell membrane, which promotes its conversion into glycogen and further utilization;
• increased glycogen content in muscle tissue;
• stimulation of the formation of peptides, glucosyltransferase, hexokinase enzyme, pyruvate dehydrogenase multienzyme complex;
• suppression of fat breakdown (lipolysis), which leads to a reduction in the amount of free fatty acids and reduces their entry into the systemic circulation;
• reduces the formation of glucose from fatty acids and amino acids, prevents the breakdown of glycogen (glycogenolysis);
• prevents the synthesis of ketone (acetate) bodies;
• slows down the process of converting amino acids into oxocarboxylic acids and so on.

The effectiveness of the drug depends on the characteristics of the body, muscle activity, blood flow speed at the injection site, the administered drug and its dose. The effect of a substance can be different not only in different people, but also in the same person, depending on his condition.

Injection technique

Insulin can be administered independently, without assistance. To do this, you can use an insulin syringe or a special syringe pen. The latter method is more preferable, since it allows you to more accurately measure the required amount of substance. Another advantage is that the injection can be given directly through clothing, which is especially convenient for patients with diabetes who lead an active lifestyle: studying at a university, working in offices.

It is imperative to comply with all antiseptic requirements: wash your hands with soap, use only disposable syringes, treat the injection site with alcohol or alcohol-based antiseptic wipes. It should be remembered that alcohol destroys insulin, therefore, after treating the injection site, you must wait until the alcohol-containing liquid used for disinfection has completely dried, and only then inject. Do not inject the drug into the same place multiple times. Each time you need to retreat from the previous puncture by 2-3 centimeters. Changing the area of ​​drug administration is done to prevent lipodystrophy.

Another method of administering insulin is called an insulin pump, which provides a continuous supply of the hormone. The system is a kind of syringe dispenser, consisting of the pump itself, a small computer designed to calculate the dose and control the drug administration regimen, a reservoir with the drug and a thin needle (cannula) for administering the drug.

This method of treatment is becoming increasingly widespread, since it allows one to take into account the amount of residual insulin in the blood and the amount of food entering the body. For administration using an insulin pump, ultra-short and short-acting drugs are used, but the number of skin punctures is minimized.

When using an insulin pump (doser), patients with diabetes have a more stable course of the disease, the quality of life increases, and the likelihood of complications decreases. At the same time, skeptics also note the negative aspects of using this method. First of all, this is an inconvenience, especially for those who want to lead an active lifestyle. In addition, a patient with diabetes is completely dependent on technology, because the process is completely automated. A malfunction of the program, failure of the device, or sudden loss of battery charge can lead to ketoacidosis. Another negative factor that is significant for many Russians is the high cost of the device.

Insulin in bodybuilding

Some athletes and coaches believe that insulin drugs, especially short-acting ones, in combination with anabolic steroids and androgenic substances used in sports, will allow them to achieve better results. Indeed, regardless of whether the drug is administered to a sick or healthy person, its mechanism of action will be the same. In particular, the permeability of cell membranes in muscle tissue will increase. As a result, the process of penetration of steroids into cells will accelerate. Even if there is a small amount, the consequences can be more significant than without the use of insulin.

But athletes, like patients with diabetes, should carefully monitor compliance with the dosage and not forget about other, no less important rules:

• control the amount of nutrients entering the body, an excess of which will lead to their deposition as fat;
• reduce the amount of simple carbohydrates consumed;
• control not only the weight, but also the volume of the biceps, shins, and thighs.

The appearance of fatty deposits and folds indicates an incorrect calculation, the need to reduce the dose or completely stop introducing insulin drugs into the body.