Pharmacological means to treat diabetes (insulin therapy)

Diabetes is one of the chronic non-communicable diseases that accompany the patient during the years of his entire life from the moment of diagnosis.
Levels ranging treatment of diabetes according to the extent that disease and illnesses associated with it until it reaches the patient for treatment with insulin.
The fact is that stage one of the shocks facing the patient's diabetes has been re-stages of emotional reaction again from the beginning (denial of the diagnosis, the anger of the diagnosis, begging for healing, compatibility with the diagnosis), so it was necessary to walk with our patient or Marbtna on a tour of this stage at which the patient may need to stand there for long.
The hormone insulin, a constructive manufactured by the body and secreted from that group of cells in the pancreas one of the body is important. These cells are called beta cells are found in clusters called islands of Langerhans in the pancreas tissue
This hormone is to facilitate the entry of glucose into the cells of the body to produce energy for activity, and acts as the hormone on the storage of glucose the liver and muscles to form glycogen to be the strategic storage of energy, adding that this hormone affects the metabolism of fats and proteins to make the balance tends to hand construction.
Insulin is one of the means used to treat patients with diabetes, the so-called compensatory treatment.

There are some medical conditions to start using insulin as a treatment for diabetes. And from these requirements:
1) diabetes type I, or what was previously known as diabetes insulin-dependent
2) diabetes mellitus type II coupled with complications that require aggressive and to maintain the exact level of blood glucose (often considered a level of 150 mg / dL (8 mmol / l) of blood glucose is the safety limit for patients with diabetes). Examples of these ill-retinal complications of diabetes.
3) diabetes who met the highest doses of oral medications without access to a satisfactory level of blood glucose to be less than 250 mg / diesel (14 mmol / L) in so-called secondary failure of oral drugs that are taken
4) diabetes associated with pregnancy, whether induced or associated with pregnancy. Should be strict in the use of insulin in pregnant women especially suffer from the motherfuckin 'sugar before pregnancy to avoid the impact of diabetes on the fetus at the stage of hardware configuration of the body (4-8 weeks of fetal life).
5) a sugar, a complication of high blood severe acidification, such as ketoacidosis or hyper Asmolih blood acetone.
6) patients with diabetes who are preparing for major surgical interventions
7) patients with diabetes who suffer from severe infections and infections

Let's start our journey from the beginning, and the first thing that comes to mind, what is this insulin?.
The hormone insulin is one of many Albbtaadat which consists of two series of amino acids linked together by bridges of bilateral sulphide.
Organisms differ from each other in the components of these chains (amino acids), and less variation within the same family of the genus to another. Human insulin consists of 51 amino acid, lined up in two strings linked with each other. Formed the first series (a) of 21 amino acid and the second series (b) of 30 amino acids. May not affect the differences in the effectiveness of insulin between the races of the same family, but make it interesting for the generation of antibodies, where the body considers foreign substance is active in the formation of antibodies to it.
The animal insulin derived from other species within the family Allbuniat, lies most of the disagreement between him and human insulin in the type of amino acid No. 10.9.8 in the first series (a) In the second series (b) most of the disagreement lies in the type of amino acid No. 30.

Divides the insulin used to treat patients with diabetes into two types:
1) human insulin: so called from a commercial perspective, but is in fact similar to the insulin unformed human insulin. Is the manufacture of this type of insulin using genetic engineering techniques through the reintegration of the gene-carrying code genetic-like code of genetic human insulin with the DNA loop (plasmid) in some types of bacteria or a fungi (fungi Saccharomyces cerevisiae) and then stimulate the process of cell division to be translation of that gene in the form of a protein called insulin polypeptide and corresponds to human insulin. The trade-off between the manufacturing methods depend on the degree of purity of insulin output and it contains impurities that may affect the damage the user. It should be noted that the picture is the manufacturing of insulin dry powder is dissolved and stored in bottles of insulin, known to us
2) animal insulin is taken from some Allbuniat which is similar to insulin, which is made with human insulin to a large degree, such as insulin, bovine and porcine insulin, which prohibits the use of Islamic law, although more types of insulin-like animal with human insulin.

Methods of injection:
Aimed at all the styles and methods used in the injection of insulin to try to simulate the physiological system within the human body, which depends on the secretion of small amounts of insulin in a manner commensurate with the continuous increase in blood glucose. Perhaps the most important things that should be taken when choosing a treatment with insulin is suitable for the type of insulin (pharmacological properties), and before you eat.
Begins glucose sharp rise blood after eating, therefore forming to be a time format to give insulin to avoid the patient suffers from the rise in glucose levels after eating (Post-prandial hyperglycemia) or low glucose, especially if the start of the effectiveness of insulin is shorter than the period during which glucose rise in blood.
Perhaps the insulin short-term (Regular Insulin), or the so-called in the general population of insulin net due to clarity of solution of insulin packaged in containers of this type of insulin in addition to insulin, the medium-range (Neutral Protamine Hagredon-NPH), or the so-called insulin Almekr due to the nature of the solution within the contained in the package, the two most prevalent types of insulin used. Perhaps the synthetic insulin (human insulin) is more of the species used.
There are many types of insulin, some of which is the earlier confusion between the short-term and medium term in the same package (Mixtard Insulin), including what is not a mixture.
Is characterized by insulin mixture that is easy to use for patients but it is not desirable to use for doctors because it is difficult to adjust the therapeutic doses according to the latest changes, where can the processor when using the insulin mixture, such as (Mixtard Insulin) to raise any kind on the unit, where it is imperative to increase and one of them increase the other, which may not be in the condition of the patient in need in to upgrade it.
Different types of insulin in the movement of pharmaceuticals, so it must comply with the guidelines attached to insulin and consistency of the time to give insulin with a meal.
There are many methods of giving insulin, there are some patients enter the physician giving them a dose of insulin a day.

Often given insulin in the morning, but there is some consensus recommends the use of insulin in the afternoon (between five and seven in the evening) and for the following reasons:
1) There are some hormones, anti-insulin action level begins to rise gradually during the night or during sleep, such as growth hormone and other hormones, anti-insulin action. Are advised that the owners of this opinion addressing insulin in this way so as not the patient suffers from high sugar in the evening, especially if we know that certain hormones, such as the hormone leptin (Lipitin Hormone) and a high level during sleep in the afternoon linking many of the studies themselves and between the occurrence of disorders diabetic retina.
2) increase the muscle movement of the patient during the first half of the day, while less than during the second half of the day, so Valhojh to insulin than in the second half of the day.
3) The nature of food intake in the first half of the day for the second half of the day, where the most food in the second half of a small quantity, such as high-calorie sweets and nuts.
4) less than the external friction of the individual to society during the second half of the day, making observations of individuals around the patient less about the amount of intake of foods or those on the types of foods and therefore less number of votes Mahdhirh making the patient susceptible to upset his diet.
On the other hand there are those who object to this method is based on the likelihood of falling glucose during sleep or in the evening. The owners of such opinion, that the human body manufactures glucose in the liver to maintain blood glucose during the night or while fasting from food from multiple sources through one of the most important operations metabolic bio-called Paljlokoneugeniss (Gluconeogenesis) regulate the level of glucose in those conditions, in addition to teaching the patient a glass of juice or a piece of fruit before going to sleep and one of the most successful ways to avoid the problem of low glucose in the night or during the period of sleep.
There are also some of the patients using the injection method as well as drive-reducing sugar. Is often used as a patient of that group that stimulate insulin receptors, such as a set of examples and Almtforman Aljlukovaj property.

Advisable to use this method in patients with diabetes who:
1) suffer from diabetes type II, and who suffer from obesity or blood fat disorder
2) patients with diabetes who suffer from insulin resistance syndrome
3) patients with diabetes secondary and caused by the use of certain drugs that affect the greed and the number of insulin receptors.
4) patients with diabetes who suffer from some diseases, such as multi-fibrosis syndrome in the ovary.
Subject to a large portion of patients with diabetes, the method of bilateral injections (dose morning and evening). When using this method calculates the total insulin dose and then given a two thirds dose in the morning and one third in the evening. Each dose is divided into two parts, two thirds given dose of insulin-term average and one third of the short-term insulin. Should be the doctor and the patient noted signs of low blood sugar, especially when the maximum impact of insulin, which is often two hours after insulin short-term and about 6-8 hours to insulin-term average. The emergence of such marks in the timing of certain components of a mean increase in the mix. Among the signs of low blood sugar, trembling hands, excessive sweat, increased heart rate, blurred sense of view and very hungry, and these symptoms completely disappear when the sugar will use oral or intravenous glucose solutions.
There are other ways to inject insulin, there is a multi-injection method, which depends on the given multiple doses of insulin in an attempt to simulate what happens in nature. There is also a method of injection before eating. Resulted in manufacturing new types of insulin, such as fast-acting insulin, called the Aspreu (Insulin Lispro) to apply such a method which is based on the injection of insulin directly or 5-10 minutes before eating. While the manufacture of other types such as long-insulin effectiveness (Galgarine Insulin), which is characterized by slow absorption as to sufficiency by giving the patient a dose one evening.

Methods of insulin injections:
Insulin is given in different ways have given under the skin, IM or intravenously, depending on what he sees as the physician at the patient's condition. However, some manufacturers of insulin does not recommend the use of some methods such as IM injection. When using insulin with intravenous solutions packaged in glass bottles or plastic should be noted that insulin may be deposited on the walls of the devices as a result of static electricity on the walls of the bottles when added to it, so it is advisable to add some millimeters from the patient's blood so that the protein binding of blood with insulin added and therefore not be lost as a result of its association with insulin Bjdr those vessels or pass about 30 mm from the existing packaging solution through the first connection pipe connected by intravenous infusion of insulin and then added to the solution.
Inside the hospital, it is often used method of successive segments (Sliding Scale Method), is clear from the name of this method is its meaning, where to divide the day into segments are handled separately so that the goal is to adjust the level of sugar in the slide by using short-acting insulin. Thirty-nine different health to determine the time slices according to the protocol followed in the treatment of patients. Some are divided each slide into a period of time ranging from 3-4 hours and divide the other slides to periods ranging between 6-8 hours, and each method is supported by explanations. This method aims to simulate the human body as much as possible. Often are grouped in units given to those segments are given by way of bilateral injections (morning and evening) and often is done after two or three of the start of multi-way slide.
Is used for injection under the skin in most patients with diabetes who receive insulin therapy, while IM injection into a vein or is left to cases that need immediate intervention, as in cases of blood acidification ketoacidosis. The leaves the IM injection to be used often in the case of intravenous injection and can not be said that there were reservations on it.

Places of injection:
Different start time and speed of absorption of insulin absorbed from the injection site from person to person. Can often reduce these differences by controlling the factors affecting the absorption of insulin, such as:
1) the injection: The front area of ​​the abdominal wall the fastest in the region, followed by absorption of foreign arms and finally the external area of ​​the thigh and buttocks. Increases the absorption rate by about 40% in the abdominal area from the groin area.
2) injection angle and depth of injection
3) muscular activity in the area of ​​injection
4) the temperature at the injection
5) the degree of blood supply at the injection site
The abdominal area is more appropriate to give insulin in spite of that fear in patients with diabetes that the syringe needle may penetrate the abdomen into the abdominal cavity. Perhaps this fear is one of the goals of the program of health education for diabetics. And among the reasons for choosing this area:
1) lack of impact of external factors on the speed of absorption from this region
2) the space of the injection
3) ease of injection, where the patient can easily see all the region
4) ease of direct access to the injection by the patient.
5) is always advised to diabetes patients who used insulin injections would not be repeated in the same region several times to avoid the effects of the injection spot. There are also some doctors are advised to repeat taking insulin in the morning in one place, taking care to change the injection site as if the arm, abdomen or thigh that is change of place in the evening dose in order to reduce the difference in the rate of absorption for the same dose every day.

Injection method:
Often insist diabetes patients to use alcohol as an antiseptic topical at the injection site, but this is a very common misconceptions. Eodi may enter alcohol to under the skin to severe pain. Sufficiency can only wash the injection site with soap and water and dry place to be ready for injection and may be sufficient washing with water only position. In the case of a patient's insistence on the use of alcohol as an antiseptic topical him to leave it to dry before direct injection. Perhaps the feeling of cold caused by the evaporation of alcohol gives the patient a sense of Baltkhaddr topical and therefore believed not to feel pain. But it is recommended stringent clean the injection site for patients lying in hospitals and in order to avoid possible contamination of the injection site.
Then the patient should cleanse the plastic cover for the bottle of insulin before pushing the needle into the bottle for the withdrawal of insulin and is done using a piece of cotton and alcohol to be done in a circular motion in one direction and leave to dry a little alcohol.
Not install the skin of one hand with the payment of pagan enough of the skin between the hands. Patient holds the syringe with the other and are at right angles to the injection if the patient is advised to thin oblique injection angle (45 degrees) that is injected quickly to relieve the pain emanating from penetrating the skin.
After the introduction of a needle insulin syringe empties slowly within 2-4 seconds to leave the needle in place for between 10-15 seconds in order to give the tissue long enough to stretch, which reduces leakage of insulin from the injection site. Withdraw the needle slowly from the injection site and should not be on the patient survey the injection site with alcohol, let alone position.
The patient can re-use of syringes more than once but should completely avoid the use of injection used by others, especially among patients with privacy such as those with AIDS or viral hepatitis or patients with poor immune system and so in order not to leak bacteria into the body .
Perhaps the record data on insulin injections, such as the injection site, injection angle and injection in the records of nursing allows the provision of a database, allow adjustment of the process path inside the hydrofoil health nursing.
Insulin is saved in the refrigerator at a temperature ranging from 4-8 degrees Celsius that is not allowed to insulin freezing. The patient may be used insulin in the normal room temperature (15-25 degrees C) in cold regions that does not expose insulin to direct sunlight. Often not advisable to use the package more than a month and because the effectiveness of insulin begin to decline since the start using it, and that conservation was a good may allow lengthening the event.
Before using the device of insulin, the patient should note any changes in the homogeneity of the packaging, such as the emergence of limestone deposits are similar to snow does not melt when you light shaking of the container or the appearance of deposits lose an explosive short-term insulin serenity. Some companies may allow mixing insulin with insulin-processing factory by other companies, while others do not recommend it, and that has not prevented it outright. But because of the different materials added to insulin in containers such as preservatives and solvents to insulin in addition to the different source of insulin, the second opinion is safe in the application.
Diabetes patients face many problems, and perhaps the diabetic retinopathy is one of the most important to you problems and which may amount to total blindness. So, we can take care of those patients who are unable to determine the specific amount of insulin because of the difficulty due to visual or motor disability that they prepare a number of injections containing the prescribed amount for the patient to be kept in the refrigerator away from freezing. Care should be taken to be a needle injection to the top or in a horizontal position so as to prevent the deposition of insulin within the needle, which Eodi to clogging of the injection. Inmkn use this injection the stomach within two weeks of preparation, taking into account her good conservation refrigerator. Before using the injection prepared in this way should be shaken gently to re-mixing of insulin to the rest of the mix.

Means of insulin injections:
1) There are many methods used to inject insulin such as insulin injections, which vary according to the degree include them. Insulin is measured in units drawn from the international packages. Some injections included up to 40 international units and other up to 100 international units and is the equivalent of one millimeter of the mix or one cubic centimeter and perhaps most common in use.
2) There is also an insulin injection pens and pencils that are similar to the large and contain different types of insulin device. This method has helped many patients and for the following reasons:
A) not in need in the patient to carry bottles of insulin and they need such as the requirements of conservation and conservation requirements.
B) Non-Alihujp to induce insulin
C) avoid feeling embarrassed and vulnerable social Alihujp when to use insulin, where the patient can use the pen in any public place without fear or hesitation.
3) There are also external insulin pumps. This pumps in a continuous insulin pump under the skin can also set the pumps to pump the excess amount of insulin before meals. This is done either automatically or by the patient.
4) There is also an internal insulin pumps. These pumps to pump insulin into the peritoneal cavity through the abdominal store is implanted in the abdomen and is controlled by the amount of insulin sensor.
5) A syringe jet. These syringes by injecting insulin under the skin by air pressure without Alihujp for the use of needles. Think a lot of diabetes patients that this method prevents a sense of tingling pain in the injection needle is used, but this is one of the misconceptions sawmill between patients with diabetes.
Perhaps the evolution of the means used for injection of the devices used and infect many health workers are puzzled and confused, so it is essential for continued access to new knowledge and how to deal with him. The rapid development of the means of knowledge has become not exempt one from the necessity of learning.

Effects resulting from the use of injected insulin:
1) When you start injecting for the first time or the use of a new type of insulin for the first time may be observed in some patients the sensitivity of localized place or around the injection (itching, redness, swelling) may last for several days and it starts to disappear gradually. Such sensitivity is rare, and occurs as a result of stimulating the immune system because of some components of an explosive or non-insulin purity of insulin used in the packaging or the result of faulty injection technique. When such an allergy should consult a physician to discuss the reasons that lead to that and try to address them. The patient should stop the injection if the allergy is severe or has become a year in the whole body and consult a physician immediately.
2) low sugar: low glucose may occur in patients who use insulin as a method of treatment as a result of a variety of reasons, including:
A) taking the patient to a large amount of insulin more than it needed to be
B) not eating enough of the sugars within the food program allowed the patient an injection of insulin after taking a sufficient time.
C) not suitable for motor activity with the amount of insulin given and the amount of sugars intake
W) alcohol may lower sugar Eodi frequent in patients with diabetes in general and especially those who depend on insulin.
Should the patient follow-up of permanent diabetes to the level of blood glucose can even adjust the doses to add to the knowledge of signs of low blood sugar and how to deal with it.

May notice some low sugar in some patients with diabetes to very low levels and with this do not feel the symptoms of decline, probably due to the following reasons:
A) address some of the drugs that inhibit the effect of the sympathetic nervous system, which manages the body in cases of emergency such as the crisis of low glucose, which represents the primary fuel of the human body. Examples of such drugs, beta blockers and is the one month of antihypertensive drugs.
B) get used to the low level of sugar. To return the body to low levels of glucose to make it get used to it, making it less responsive to low sugar sharp and to avoid this problem should be the physician that allows for the level of glucose in the patient to rise, either by reducing the dose given or increase carbohydrate intake for a period of three months and then glucose re-adjust again and so the body can drop sensor again. This does not mean allowing the glucose level to rise to significant levels, but to a level less than 200 mg / dl (11 mmol / L).
3) lipid swelling: swelling Perhaps this is a complication of topical insulin and usually occurs as a result of repeated injections in one place. The Insulin is a hormone that stimulates the constructive composition of fats and stored in the tissues of the body. The frequency of injections in one place and stimulates the formation of fat cells and fat storage, and therefore the onset of swelling, which may take different sizes. Are addressing these swellings to avoid injections in or around it, may take the method and time-consuming and may not succeed for that resort physician to suction the fat from those areas swollen Perhaps this way rejoice patients with these swellings, especially women because it represents a quick solution to that problem.
4) fat atrophy: It is a show put a dent in the skin due to loss of adipose tissue as a result of placement of injections to stimulate the immune system to the presence of some components of a mixture of insulin, which raises the immune system or in the case of insulin is pure. To remedy this problem, patients are advised about the location of the injection Altbajat to stimulate the grease to fill the indentations
The fact that the use of insulin therapy and one of the most important topics of concern to many patients with diabetes and their clinicians, so it was necessary to clarify many of the facts about this important subject.