Schemes and regimens of insulin therapy in children, adults, pregnancy

Normally, inulin secretion occurs constantly and is approximately 1 unit of hormone per hour. This indicator is basal or background secretion. Eating provokes a rapid, i.e. bolus increase in hormone concentration many times over. Stimulated secretion is 1-2 units for every 10 g of carbohydrates consumed. In this case, the body maintains a balance between the concentration of the pancreatic hormone and the need for it.

Patients with the first type of the disease need replacement therapy, which imitates the secretion of the hormone under physiological conditions. For this, different types of drugs are used at different times. The number of injections can reach 4-6 per day. Patients with the second type of diabetes, but with preserved beta-cell function, need 2-3 times the drug to maintain compensation.

The insulin therapy regimen is individual for each patient and depends on the main goal of glycemic control. Today, the following treatment regimens exist:

1. Administration of the drug once a day is used in the treatment of patients with both the first and second types of the disease.
2. Taking the medication twice a day is one of the most common regimens for patients with type 1 diabetes. The dosage of the drug is distributed approximately as follows: 2/3 of the dose before breakfast and 1/3 before the last meal.
3. Several injections per day – the patient has a free daily routine, since the time of meals and injections is not strictly established. The medicine is administered 3 or more times per day.

In the normal regimen, 40% of the total dose of the drug is administered before bedtime. In this case, medium-duration and long-acting medications are used. The remaining dose is used 30 minutes before each meal 2-3 times a day. The most commonly used regimens are the normal and intensive ones.

Insulin therapy regimens

An endocrinologist selects the optimal regimen for administering the drug and draws up an insulin therapy regimen. The doctor's task is to achieve maximum compensation of carbohydrate metabolism with minimal daily fluctuations in glucose levels and the lowest risk of developing complications of the disease.

When drawing up a treatment plan, the following factors are taken into account:

• Form of diabetes mellitus: compensated, uncompensated.
• The type of insulin used and the dosage of the drug. The higher the dose, the slower the absorption, but the longer the effect of the drug.
• Injection site - when injected into the thigh, the absorption rate is higher than when injected into the shoulder. At the same time, injections into the abdomen are more effective than injections into the shoulder, which have a minimal absorption rate.
• The method of drug administration and the characteristics of local blood flow. Intramuscular administration is characterized by rapid absorption, but short action, subcutaneous injections are the opposite.
• Muscle activity and local temperature – light preliminary massage of the injection site increases the rate of drug absorption. This effect is also observed at elevated body temperature.

Most often, patients resort to using the following insulin therapy regimens:

1. Traditional – daily administration of the drug with a minimum number of injections, but in the same dosage. Short- and long-acting drugs are used in a ratio of 30:70, i.e. 2/3 of the daily dose before breakfast and 1/3 before dinner. This scheme is suitable only for limited groups of patients, as it does not provide full compensation of the hormone, since the need for it can change throughout the day.
2. Intensive – corresponds to the physiological secretion of the hormone. Consists of long-acting injections in the morning and evening, as well as short-acting injections used before each meal.

To create a treatment plan, it is necessary to determine the glycemia level and monitor it regularly. This will allow you to choose the most effective dosage. Patients are also advised to keep a special diary, recording the consumed carbohydrate units, the amount of hormone administered, physical activity and complications that arise. Thanks to this, it is possible to analyze treatment errors and systematize the knowledge gained.

Read about insulin pump therapy in this article.

Virtuoso insulin therapy

Another method of treating diabetes is the so-called virtuoso insulin therapy regimen. This method was developed by the Peruvian doctor Jorge Canales, who suffered from this pathology since childhood. His method is based on the study of the entire complex of substances secreted by the beta cells of the pancreas. Canales proved that each of the products produced by the organ, like insulin, has biological activity and is important in metabolic disorders.

Virtuoso insulin therapy allows you to select the most accurate dosage of the administered hormone for patients with diabetes mellitus types 1 and 2. The essence of the technique is in the use of coefficients:

• Food is the coefficient per bread unit, that is, the amount of insulin required to assimilate 1 unit of carbohydrates.
• Correction is a glycemic indicator, that is, the amount of insulin per 1 mmol/l of glucose in the blood that exceeds the norm.

The coefficients are calculated with the maximum accuracy of up to 4 decimal places, but separately for the time interval before breakfast, from breakfast to lunch and after the last meal. The calculated dose is rounded to 0.5 units of the administered hormone. This value is the dosage step when using an insulin syringe.

According to the conducted research, using the method of virtuoso therapy, a patient weighing 70 kg and measuring blood sugar 4-5 times a day can keep it within 4-7 mmol/l throughout the day.

Intensified insulin therapy

The peculiarity of this regimen of drug administration is that the daily dose is divided between short-acting insulin (used after meals) and extended-acting insulin (used in the morning and before bedtime to simulate basal secretion).

Features of the intensified method:

• Imitation of hormone secretion: basal and food.
• Prevention of complications and control of metabolic processes in the body.
• The need for training in the correct calculation of dosage and administration of medication.
• Regular self-monitoring.
• Tendency to hypoglycemia.

The hormone administration scheme is calculated by an endocrinologist. The doctor takes into account the daily calorie requirement. The patient is prescribed a diet, according to which the carbohydrates consumed are calculated in bread units, and proteins and fats in grams. Based on all this data, the daily dosage of the drug is determined, which is distributed throughout the day.

For example, if a diabetic takes only 3 injections a day, then short-acting and long-acting hormones are administered before breakfast and dinner, and short-acting before lunch. According to another scheme, short-acting and intermediate-acting drugs are used before breakfast, short-acting before dinner, and intermediate-acting before bed. There is no optimal scheme for administering the drug, so each patient adjusts it to suit themselves.

The principle of the intensified regimen is that the more often injections are given, the easier it is to adapt the dosage to the patient's needs during the day. In any case, before each injection, it is necessary to determine the glycemia level and measure the insulin doses correctly. The success of the treatment is based on the patient's responsibility and his awareness of the nuances of the method.

Bolus insulin therapy

In a normal state, on an empty stomach, a stable level of insulin is noted in the blood, that is, the basic norm. The pancreas stimulates the hormone between meals. One part of the insulin normalizes and maintains the level of glucose in the blood, preventing its jumps, and the second part participates in the process of food absorption.

From the beginning of eating and up to 5-6 hours after eating, the body produces so-called bolus insulin. It is released into the blood until all the sugar is absorbed by the cells and tissues of the body. At this point, hormones of the opposite action, i.e. counter-regulatory ones, are activated. They prevent changes in glucose levels.

Bolus insulin therapy is based on the accumulation of the hormone by administering a short- or prolonged-action preparation in the morning/before bedtime. This method allows imitating the natural functioning of the affected organ.

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Traditional insulin therapy

The most common insulin administration regimen for diabetes is the traditional or combined method. It is based on combining all types of the drug in one injection.

Features of the method:

• The number of injections does not exceed 1-3 per day.
• There is no need for constant monitoring of glycemic indicators.
• Ease of implementation.
• Suitable for elderly patients, those with mental disorders, and unruly patients.

But this method requires strict adherence to a diet, which depends on the dosage of the drug. It is also necessary to adhere to a daily routine and maintain physical activity. There should be 5-6 meals per day at strictly designated times.

The endocrinologist calculates the daily insulin dosage and then distributes it according to the regimen:

• 2/3 – before the first meal.
• 1/3 – before the last meal.

The amount of long-acting hormone should be within 60-70%, and short-acting 30-40%. At the same time, patients using the traditional therapy regimen are at risk of developing atherosclerosis, hypokalemia and arterial hypertension.

Insulin therapy for type 1 diabetes

Type 1 diabetes is characterized by absolute insulin deficiency. The pancreas does not produce the hormone at all or produces it in critically low doses that are unable to process glucose. Based on this, insulin therapy is a vital measure.

The treatment is based on exogenous administration of the hormone, without which ketoacidotic or hyperglycemic coma develops. The drug normalizes glycemia, ensures growth and full functioning of the body. Completely replaces the physiological work of the pancreas.

There are several types of insulin used to treat type 1 diabetes:

• Short-acting – administered on an empty stomach before meals. It begins to act 15 minutes after the injection, the peak of activity develops after 90-180 minutes. The duration of its action depends on the dosage, but is usually at least 6-8 hours.
• Medium effect – administered in the morning and evening. The effect develops 2 hours after the injection with a peak activity after 4-8 hours. Works for 10-18 hours.
• Prolonged action - begins to work 4-6 hours after injection, and maximum activity develops after 14 hours. The effect of this type of drug is more than 24 hours.

The scheme of administration of the drug and its dosage are calculated by the attending physician, taking into account many factors. The patient is shown the introduction of the basal drug 1-2 times a day, and before each meal - bolus. Combining these regimens is called the basal-bolus method, that is, multiple administration of the hormone. One of the types of this method is intensive insulin therapy.

An approximate scheme for administering the hormone for type 1 diabetes looks like this:

• Before breakfast – short-acting and long-acting insulin.
• Before lunch - short-acting.
• Before dinner - short-acting.
• Before bedtime - prolonged.

According to the conducted studies, a timely and carefully planned treatment regimen in 75-90% of cases of the disease allows it to be transferred to a stage of temporary remission and stabilize its further course, minimizing the development of complications.

Insulin therapy for type 2 diabetes

The second type of diabetes is insulin-independent, that is, the body does not need additional administration of the hormone. But in some cases, the immune system attacks the beta cells of the pancreas. Because of which a significant part of the cells that produce the hormone die. This happens with an unbalanced and unhealthy diet, a sedentary lifestyle, regular emotional stress.

The main indications for insulin therapy for type 2 diabetes are:

• Exacerbation of chronic diseases or infectious infections of the body.
• Upcoming surgery.
• Ketone bodies in urine.
• Signs of insulin deficiency.
• Disorders of the kidneys and liver.
• Pregnancy and lactation.
• Dehydration.
• Precoma, coma.

In addition to the above indications, insulin is prescribed for newly diagnosed diabetes and high glucose levels on an empty stomach that persist throughout the day. Additional administration of the hormone is necessary for glycated hemoglobin above 7%, C-peptide accumulation below 0.2 nmol/l, after internal administration of 1.0 mg of glucagon.

Treatment is carried out according to a scheme developed by the doctor. The essence of therapy is a gradual increase in the basal dosage. The following main modes of insulin administration are distinguished:

• One injection of a medium-acting or prolonged-release preparation before breakfast or at bedtime.
• A mixture of intermediate-acting and long-acting insulins in a 30:70 ratio in a single injection regimen before breakfast or before dinner.
• A combination of intermediate or short/ultra-short acting drugs before each meal, i.e. 3-5 injections per day.

When using prolonged-release hormones, a dosage of 10 units per day is recommended, preferably at the same time. If the pathological condition continues to progress, the patient is transferred to a full insulin therapy regimen. Continuous administration of the synthetic hormone is necessary for patients who do not take tablet medications to lower blood sugar and do not adhere to basic nutritional recommendations.

Insulin therapy during pregnancy

Diabetes mellitus that occurs during pregnancy is not a full-fledged disease. The pathology indicates a predisposition to intolerance to simple sugars and is a risk for developing type 2 diabetes. After childbirth, the disease may disappear or progress further.

In most cases, disorders in the pancreas are associated with changes in hormonal levels. There are also a number of factors that contribute to the development of the disease:

• Excess body weight.
• Metabolic disorders.
• The age of the mother in labor is over 25 years.
• History of diabetes.
• Polyhydramnios and others.

If gestational diabetes is long-term and glucose levels do not decrease, the doctor prescribes insulin therapy. During pregnancy, insulin can be prescribed even with normal sugar levels. Injections are indicated in the following cases:

• Severe swelling of soft tissues.
• Excessive fetal growth.
• Polyhydramnios.

Since the metabolic processes in the body of the expectant mother are not stable, frequent dosage adjustments are made. As a rule, the drug is administered before breakfast 2/3 of the dose, that is, on an empty stomach, and before bedtime 1/3 of the dose. Insulin therapy for gestational diabetes consists of short-acting and long-acting drugs that are combined with each other. For women with type 1 diabetes, injections are given 2 or more times a day. Regular injections are necessary to prevent morning and postprandial hyperglycemia.

In order for childbirth to be successful in gestational diabetes, it is necessary to monitor glucose levels throughout the entire period of drug compensation of carbohydrate metabolism, as well as for 2-3 months after childbirth. In addition, it is necessary to strictly adhere to doctor's prescriptions, since there is a risk of developing macrosomia, that is, a condition when natural childbirth is impossible and a cesarean section is performed.