Insulin is normally produced continuously by the pancreas, it enters the blood in small quantities - the basal level. When eating with carbohydrates, the main release occurs, and glucose from the blood with its help enters the cells.
Diabetes occurs when insulin is not produced or its amount is below normal. Also, the development of diabetes symptoms occurs when it is impossible for cell receptors to respond to this hormone.
In case of diabetes mellitus type 1, due to the absence of insulin, its administration in the form of injections is indicated. Patients of the second type can also be prescribed insulin therapy instead of pills. For insulin treatment, diet and regular injections are of particular importance.
Skipping insulin injections
Since the treatment of type 1 diabetes mellitus is carried out exclusively in the form of inulin replacement therapy on an ongoing basis, subcutaneous administration of the drug is the only chance to maintain blood sugar levels.
Proper use of insulin preparations helps prevent sudden fluctuations in glucose and avoid diabetes complications:
- Development of comatose conditions that are life-threatening: ketoacidosis, lactic acidosis, hypoglycemia.
- Destruction of the vascular wall - micro-and macroangiopathy.
- Diabetic nephropathy.
- Reduced vision - retinopathy.
- Damage to the nervous system - diabetic neuropathy.
The best way to use insulin is to recreate its physiological rhythm of blood flow. For this purpose, insulins of different duration of action are used. To create a constant level in the blood, prolonged insulin is injected 2 times a day - Protafan NM, Humulin NPH, Insuman basal.
To replace insulin release in response to food intake, short insulin is used. It is administered before a meal at least 3 times a day - before breakfast, lunch and before dinner. After the injection, you need to take food in the interval between 20 and 40 minutes. In this case, the insulin dose should be designed to receive a specific amount of carbohydrates.
It is possible to prick insulin correctly only subcutaneously. For this, the most safe and comfortable places are the lateral and posterior surfaces of the shoulders, the anterior surface of the thighs or their lateral part, the stomach, except for the umbilical region. At the same time, insulin from the skin of the abdomen enters the bloodstream faster than from other places.
Therefore, patients are advised in the morning, as well as, if they need to quickly reduce hyperglycemia (including when they skip the injection), inject insulin into the abdominal wall.
The diabetic's action algorithm, if he forgot to inject insulin, depends on the species, the missed injection and the frequency with which diabetics use it. If the patient missed the injection of long-acting insulin, then it is necessary to take the following measures:
- With injections 2 times a day - for 12 hours, use only short insulin according to the usual rules before meals. To compensate for the missed injection, increase physical activity for a natural decrease in blood sugar. Be sure to make a second injection.
- If a patient suffering from diabetes splits insulin once, that is, the dose is calculated for 24 hours, then the injection can be given 12 hours after skipping, but its dose should be reduced by half. Next time you need to enter the drug at the usual time.
If you skip a shot of short insulin before a meal, you can enter it immediately after the meal. If the patient recalled the pass late, then you need to increase the load - go in for sports, go for a walk, and then measure the blood sugar level. If hyperglycemia is above 13 mmol / l, then it is recommended to inject 1-2 U of short insulin in order to prevent a sugar jump.
If administered incorrectly - instead of a short insulin, a diabetic patient introduced a prolonged one, then his strength would not be enough to process carbohydrates from food. Therefore, you need to pin a short insulin, but at the same time every two hours to measure the level of glucose and carry a few tablets of glucose or candy, so as not to reduce the sugar before hypoglycemia.
If, instead of a prolonged-acting insulin, a prick is short, then the missed injection must still be carried out, since the short amount of insulin needs to be eaten with the right amount of carbohydrate food, and its effect will end before the required period.
In the event that more insulin is injected than needed, or the injection is mistakenly made two times, the following measures should be taken:
- Increase glucose intake from lean foods with complex carbohydrates - cereals, vegetables and fruits.
- Conduct an injection of glucagon - an insulin antagonist.
- Measure glucose at least once every two hours.
- Reduce physical and mental stress.
What patients with diabetes do not categorically recommend is to double the next dose of insulin, as this will quickly lead to a drop in sugar. The most important thing when skipping a dose is to control the level of glucose in the blood until it stabilizes.
Hyperglycemia when skipping an insulin injection
The first signs of an increase in blood glucose with a missed injection are increased thirst and dryness in the mouth, headache, and frequent urination. Nausea, severe weakness in diabetes, and abdominal pain may also appear. The level of sugar can also increase if the dose is incorrectly calculated or when a large amount of carbohydrates is taken in, stress and infections.
If you do not take carbohydrates in time during an attack of hypoglycemia, then the body can compensate for this condition on its own, while the disturbed hormonal balance will maintain high blood sugar levels for a long time.
To reduce sugar, you need to increase the dose of simple insulin, if, when measured, the indicator is above 10 mmol / l. With this increase, for every extra 3 mmol / l, 0.25 U is administered to children of preschool age, 0.5 U, for schoolchildren, 1 -2 U.
If insulin admission was due to an infectious disease, at high temperature or when refusing food because of low appetite, then to prevent complications such as ketoacidosis, it is recommended:
- Every 3 hours to measure the level of glucose in the blood, as well as ketone bodies in the urine.
- The level of prolonged insulin is left unchanged, and hyperglycemia is regulated by short insulin.
- If the content of glucose in the blood is higher than 15 mmol / l, acetone appeared in the urine, then each injection before meals should be increased by 10-20%.
- With a glycemia level of up to 15 mmol / l and traces of acetone, the dose of short insulin is increased by 5%, while decreasing to 10, the previous dosages should be returned.
- In addition to the main injections for infectious diseases, it is possible not earlier than after 2 hours to enter Humalog or insulin NovoRapid, and simple short insulin - 4 hours after the last injection.
- Drink liquids at least a liter a day.
Small children may completely refuse food during the illness, especially if they have nausea and vomiting, so they can switch to fruit or berry juices for a short time, give grated apples, honey
How not to forget about an insulin injection?
The circumstances of skipping the dose may not depend on the patient, so all for the treatment of diabetes mellitus with insulin are recommended means that facilitate regular injections:
Notepad or special forms for filling with the indication of the dose, time of injection, as well as data on all measurements of sugar in the blood.
Put a signal on a mobile phone, reminiscent of the need to introduce insulin.
Install the application on your phone, tablet or computer to monitor the level of sugar. Such special programs allow you to simultaneously keep a diary of nutrition, sugar levels and calculate the dose of insulin. These include NormaSahar, Diabetes magazine, Diabetes.
Use medical applications for gadgets that signal the time of medication, especially when using other tablets other than insulin for the treatment of associated diseases: My tablets, My therapy.
Label the pen with labels on the case to avoid confusion.
In the event that the injection is missed due to the absence of one of the types of insulin, and could not be purchased, since it is not available at the pharmacy or for other reasons, then insulin can be replaced as an extreme case. If there is no short insulin, then the prolonged one should be injected at such a time that the peak of its action coincides with the meal time.
If there is only short insulin, then it should be prick more often, focusing on the level of glucose, including at bedtime.
If there was an omission of taking pills for treating diabetes mellitus of the second type, then they can be taken at another time, since compensation for the manifestations of glycemia with modern antidiabetic drugs is not tied to methods of writing. Doubling the dose of tablets is prohibited even if two doses are missed.
For patients with diabetes, a high blood sugar level is dangerous when skipping an injection or tablet preparations, but the development of frequent hypoglycemic seizures, especially in childhood, can lead to disruption of the formation of the body, including mental development, so correct dose adjustment is important.
If there are doubts about the correctness of dose calculation of drugs or replacement of drugs, then it is better to seek specialized medical assistance from an endocrinologist. The video in this article will show the relationship between insulin and blood sugar.