We have already evaluated the importance of insulin treatment in person with
diabetes; it is indicated in the following situations:
a) when Glycemic targets are not reached with the ipoglicemizzanti oral;
Diabetic Ketoacidosis b);
c) diabetes at onset with extremely high blood sugar levels and typical symptoms
(polyuria, polydipsia, weight loss, etc.)
d) pregnancy or in women with diabetes who plan a pregnancy
(diabete_e_concepimento )
e) stress acute (cardiovascular events, infections, trauma, surgery)
f) allergy/controindicazioni ipoglicemizzanti oral drugs
g) kidney or liver disease that preclude the use of oral ipoglicemizzanti.
.
In patient type 2 diabetic l insulin may be administered according to the
different schemas:
Basal Insulin (NPH, glargine, detemir) once a day
Premixed Insulin twice/die
Multiple Injections of insulin preprandiale and basal evening
In the study treat-to-target Riddle were compared the effectiveness of the risk
of hypoglycemia in patients with type 2 being treated with insulin and oral
antidiabetici of similar type slow and NPH. The study ultimately o, after 24
weeks, that patients treated with insulin analogue slow release, even if the
target of 7% HbA1c had been reached in all subjects studied, however those
treated with NPH were had pi hypoglycemia compared with the control group,
nocturnal species and, moreover, symptomatic. APOLLO, study on 418 patients not
controlled by the single oral care with antidiabetici glargine was added or
insulin lispro evening for three meals. The study o sovrapponibilit of two
treatments for the glicata, with the advantage that insulin glargine with l not
had hypoglycemia than lispro, while l weight gain was equal.
have been assessed values of glicata to assess the proportion of patients with
HbA1c less than 6.5%, the rate of hypoglycemia, and weight gain. At the end of
the study, the levels are comparable results in the three treatment groups (7.1%
the glicata for two-phase, 6.8% for pre-prandial and 6.9% for the baseline. The
group with the basal insulin, for, had always the fewest hypoglycemia (1.7%
against 3% of the administration of two-phase). From there it is clear that even
the simple basalizzazione as practical scheme was sufficient for the care of
these patients, although l added a dressing preprandiale in subjects with
greatest post prandial Glycemic you didn't make necessary for optimum control of
the patient. This therapeutic strategy is defined basal-plus. Q Also detemir
stated a minor increase of weight compared to NPH insulin glargine or.
L use insulin when he failed the only treatment with sulfonylurea find
indication that with l insulinizzazione hangs the process of neoglucogenesi
hepatic (see glicidi) and, therefore, reduces the values of blood sugar levels
and improves physiology of compensation glicometabolico. In patient that has
failed the target with simple schema basal-plus, because of the apoptosis of
beta-cell, sipassa schema basal-bolus, IOC is used an insulin preprandiale
generally preferring l similar fast and a basalizzazione. In this case the
target to achieve optimal control of blood sugar levels with HbA1c values within
7% and of blood sugar levels to two hours after meal enters the 140 mg%. Once
administered insulin at all three meals, to discontinue the medication
secretagogo insulin (sulfanilurea or glinide) and that the meal should be to pi
suitable for diabetic patients (diet in diabetic).
.
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