What is insulin made from? What is insulin made for diabetics Insulin where to get

Insulin production is a complex process, the main component is:

• Raw material of animal origin. Obtaining the necessary components is carried out as a result of processing the pancreas of cattle and pigs. There are three "unnecessary" amino acids in bovine, which differ in structure from human. That is why they can provoke the development of persistent allergies. The porcine pancreatic hormone differs by only 1 amino acid in comparison with the human structure, therefore it is considered safer. The better the biological product is purified, the less it will cause negative reactions.
• Human resources. The medicine from this group is manufactured using very complex technologies. Some pharmaceutical concerns have found a way to make insulin using specific bacteria. Also quite common are the methods of enzymatic transformation in order to manufacture semi-synthetic hormonal agents. There is another technology that involves the use of an innovative method in genetic engineering, its result is the production of special DNA recombinant formulations with insulin.

How do you get your insulin medications?

Not every patient knows exactly how insulin is obtained; in this process, the type of raw material itself and the degree of its purification are important. Means that are derived from products of animal origin are today considered obsolete, as they are made according to old technology. These medicines are not of high quality, since the components do not undergo deep cleaning.

The first insulin-containing drugs were rather poorly tolerated, as they contained proinsulin. Injections of such a hormonal agent provoked various adverse reactions in sick children, as well as elderly patients. Later, thanks to improved purification technologies, it was possible to remove proinsulin from the solution. The use of bovine insulin had to be completely abandoned due to the development of extensive adverse symptoms.

To date, improved drugs do not contain unwanted impurities. Among the drugs of animal origin, one of the best is considered a monopeak product, it is made with the production of the so-called “peak” of a hormonal substance.

The role of excipients

The manufacture of any pharmaceutical product does not take place without the use of excipients.

• Components with disinfectant properties
• Ingredients that provide prolongation of exposure
• Substances that allow you to stabilize the acidity of the solution.

Thanks to the use of additional components, it is possible to improve the chemical characteristics of the drug and achieve a high level of purification.

It should be noted that insulin therapy with the use of modern drugs passes without serious complications. The attending physician will help to choose the necessary medicine and the optimal scheme of application. It may be necessary to switch to another drug in the future due to the manifestation of adverse reactions.

Diabetes mellitus is a disease with social significance. This is due to its widespread prevalence and the constant increase in the incidence. Complications of diabetes mellitus lead to disability, increased risk of premature death of patients.

Therefore, it is planned to allocate funds from the state budget to compensate for the costs of drugs used to treat diabetes. They give free insulin to diabetics, pills for lowering blood sugar, which are included in the corresponding list of medicines, test strips for glucometers, injection syringes.

In addition, patients with diabetes can receive vouchers for sanatorium treatment, and the disabled are paid a pension from the state. All this is enshrined in the Federal Law of the Russian Federation on Diabetes. It spells out the rights that people with diabetes have and the obligations of the state to implement them.

Benefits for diabetics

Free insulin for diabetics is provided for those categories of patients who are prescribed insulin therapy, regardless of the type of diabetes mellitus. Such assistance is provided to Russians, as well as to persons who have received a residence permit.

The regulation on the free provision of medicines provides for the issuance, in addition to insulin, of means for controlling glucose levels in case of diabetes mellitus. For diabetic patients who are on constant insulin therapy, a device for monitoring blood sugar and test strips for it are given free of charge at the rate of 3-time measurement of glycemia.

In type 2 diabetes, the list of free medicines in 2017 includes gliclazide, glibenclamide, repaglinide, metformin. Also, in the second type of diabetes, patients receive test strips in the amount of 1 piece per day, if insulin is not prescribed, then patients must purchase a glucometer at their own expense.

At the same time, if the patient is not on insulin, but belongs to the category of visually impaired, then for him a device for measuring glucose and one test strip per day is issued at the expense of public funds.

The procedure for issuing prescriptions for free insulin includes the following rules:

1. Before issuing a prescription, an endocrinologist conducts an examination and laboratory tests.
2. The frequency of issuing prescriptions is once a month.
3. The patient must receive a prescription only personally.
4. Refusal to issue a prescription cannot be justified by a lack of funds, since all payments are made at the expense of the federal or local budget.
5. Disputable cases are resolved by the administration of the polyclinic or the territorial fund of compulsory medical insurance.

In order to get a prescription from an endocrinologist, you must have a passport, medical policy, insurance certificate, disability certificate (if any) or other document confirming the right to preferential insulin.

In addition, it will be necessary to obtain a certificate from the Pension Fund stating that the patient has not refused the benefits provided.

In case of refusal (partial or complete), beneficiaries are provided with monetary compensation, but its amount may not fully cover the costs of treatment and rehabilitation.

How to get insulin in a pharmacy?

Sugar level

You can get insulin free of charge at pharmacies with which the clinic has an agreement. Their addresses must be reported to the patient by the doctor when issuing a prescription. If the patient did not have time to come to the doctor's appointment on time, and therefore was left without a prescription, then it can be bought for money at any pharmacy.

For patients who need daily insulin injections, it is important to have a supply of the drug in order not to miss an injection for any reason - for example, due to work schedules, lack of insulin in a pharmacy, moving. Without the timely introduction of the next dose of insulin into the body, irreparable metabolic disorders develop and even death is possible.

If only the patient with diabetes himself can apply for a form to the doctor, then a relative or any representative of the patient can get it at the pharmacy. A prescription for medicines and supplies is valid for 2 weeks to 1 month. A note about this must be made on the issued prescription.

If the pharmacy answered that we do not dispense insulin for free, then you will need to receive a written refusal indicating the reason for the refusal, the date, signature and seal of the organization. With this document, you can contact the regional branch of the Compulsory Medical Insurance Fund.

If there is a temporary lack of insulin, you need to take the following actions:

• Enter the prescription number in the social journal at the pharmacist in the pharmacy.
• Leave contact details so that the pharmacy employee can notify you of the receipt of the drug.
• If the order is not fulfilled within 10 days, the administration of the pharmacy must warn the patient and send him to other outlets.

In case of loss of a prescription, you should contact the doctor who wrote it as soon as possible. Since, in addition to issuing a new form, the doctor must notify the pharmaceutical company about this.

Such precautions should prevent the illegal use of medicines.

Refusal to write a prescription for free insulin

In order to get clarifications in case the doctor refuses to provide a prescription for insulin or prescribed medicines and medical products, you must first contact the head physician of the medical institution. If this issue could not be clarified at his level, then you need to ask for a written refusal.

The request for documentary confirmation of the refusal may be oral, but in a conflict situation it is better to make two copies of a written request addressed to the head doctor, and from the secretary to receive a mark on the second copy about the acceptance of the request in incoming correspondence.

In accordance with the law, the medical institution must issue a response to such a request. In this case, you can contact the Compulsory Medical Insurance Fund. In writing, you must submit a statement that a particular medical institution waives its obligation to provide preferential prescriptions for diabetic drugs.

If it is likely that these steps will not result in a positive response, then the next steps might be:

1. Written appeal to the Ministry of Health.
2. Application to the bodies of social protection of the population.
3. Complaint to the Prosecutor's Office against the actions of medical workers.

Each application must be in duplicate, on the copy that remains in the hands of the patient, there must be a mark on the acceptance and registration of correspondence from the institution to which the request is sent.

Benefits for children with diabetes

When type 1 diabetes is detected, children are given disability without determining the group number. Over time, it can be removed or re-registered, depending on the severity of the course of the disease. Children can count on preferential receipt of vouchers for treatment in a sanatorium once a year.

The state pays for travel to and from the place of treatment, treatment and accommodation in a sanatorium, and parents are given the opportunity to receive compensation for accommodation during the child's recovery.

Children, as well as pregnant women with or without a disability group, can receive free of charge test strips, syringe pens, as well as medicines that lower sugar levels.

In order to receive benefits, you must pass a medical examination. This may require the following documents:

• Application from parents.
• Passport of parents or guardian, birth certificate. After 14 years - the child's passport.
• Outpatient card and other medical documentation.
• If this is a re-examination: a certificate of disability and an individual rehabilitation program.

How to get a ticket to the sanatorium?

For diabetics, a referral to spa treatment in specialized sanatoriums is provided. To get a free ticket, in the district clinic you need to take a certificate in the form No. 070 / y-04, and if the child has diabetes, then - No. 076 / y-04.

After that, you must contact the Social Insurance Fund, as well as any social security agency that has concluded an agreement with the Fund. This year, this must be done by December 1st.

Within ten days prescribed by law, a response must be received on the provision of a voucher to a sanatorium that corresponds to the profile of the disease, indicating the date of commencement of treatment. The voucher itself is provided to the patient in advance, no later than 21 days before arrival. It must be fully completed, have the seal of the Social Insurance Fund, a note on payment at the expense of the federal budget. These tickets are not for sale.

Two months before departure or later, you need to issue a health resort card in the same medical institution that issued the referral for sanatorium treatment. It contains information about the main and concomitant diagnoses of the patient, the treatment taken, the conclusion about the possibility of undergoing a rehabilitation course in such a sanatorium.

You can also apply for a ticket to the Department of Federal Vouchers under the Ministry of Health of the Russian Federation. In this case, in addition to the application, you need to collect the following documents:

1. Passport of a citizen of the Russian Federation and its two copies with pages No. 2,3,5.
2. If there is a disability, then two copies of the individual rehabilitation plan.
3. Insurance number of an individual personal account - two copies.
4. Certificate of disability - two copies.
5. From the Pension Fund a certificate stating that there are non-monetized benefits for this year - the original and a copy.
6. Certificate in the form No. 070 / y-04 for an adult, No. 076 / y-04 for a child, issued by the attending physician. It is valid for 6 months only.

If for some reason it is impossible to go for treatment, then you need to return the ticket no later than seven days before the start of the action. After treatment in a sanatorium, you must provide a tear-off coupon to the voucher to the institution that issued it, and an extract on the procedures performed must be provided to the attending physician.

In order not to face problems during registration

Today, various types of immunotherapy are used:

• for the treatment of insulin-dependent patients (type I diabetes mellitus);
• as a temporary, preoperative therapy for patients with type II diabetes;
• for diabetic patients with type II disease, with acute respiratory and other infectious diseases;
• insulin in type II diabetes is required to be injected, in case of low efficiency or intolerance by the patient of other pharmacological agents that reduce the percentage of glucosides in the blood.

Today, three methods of insulin therapy are mainly used in medical practice:

Intensified method of insulin therapy

Modern methods of intensified insulin therapy imitate the natural, physiological secretion of the hormone insulin by the pancreas. It is prescribed if the patient is not overweight and when there is no likelihood of psycho-emotional overload, from a daily calculation - 0.5-1.0 IU (international units of action) of the hormone per 1 kilogram of body weight. In this case, the following requirements must be met:

• the drug must be injected in doses sufficient to completely neutralize the excess content of saccharides in the blood;
• Insulin administered externally in diabetes mellitus should fully mimic the basal secretion of the hormone secreted by the islets of Langerhans, which has a peak value after a meal.

From these principles, an intensified method is formed, when the daily, physiologically necessary dose is divided into smaller injections, differentiating insulins according to the degree of their temporary effectiveness - short-term or prolonged action. The last type of insulin must be injected at night and in the morning, immediately after waking up, which quite accurately and completely imitates the natural functioning of the pancreas.

Short-acting insulin injections are given after a high-carbohydrate meal. As a rule, a single injection is calculated individually according to the number of conventional bread units, which is equivalent to a meal.

Traditional insulin therapy

Traditional (standard) insulin therapy is a method of treating patients with diabetes mellitus, when short-term and prolonged-acting insulins are mixed in one injection. The advantage of this method of administering the drug is to minimize the number of injections - usually you need to inject insulin 1-3 times a day. The main disadvantage of this type of treatment is the lack of 100% imitation of the physiological secretion of the hormone by the pancreas, which makes it impossible to fully compensate for defects in carbohydrate metabolism.

The standard scheme for the use of traditional insulin therapy can be represented as follows:

1. The daily need of the body for insulin is administered to the patient in the form of 1-3 injections per day:
2. One injection contains insulins of medium and short-term action: the share of short-acting insulins is 1/3 of the total amount of the drug;

intermediate-acting insulin accounts for 2/3 of the total injection volume.

Insulin pump therapy

Insulin pump therapy is a method of introducing the drug into the body, when a traditional syringe is not required, and subcutaneous injections are carried out by a special electronic device - an insulin pump, which is capable of injecting ultra-short and short-acting insulins in the form of microdoses. The insulin pump accurately mimics the natural intake of the hormone into the body, for which it has two modes of operation.

• the mode of basal administration, when microdoses of insulin enter the body continuously in the form of microdoses;
• bolus regimen, in which the frequency and dosage of drug administration are programmed to the patient.

The first mode allows you to create an insulin-hormonal background that is closest to the natural secretion of the hormone by the pancreas, which makes it possible not to inject long-acting insulins.

The second mode is usually applied just before a meal, which makes it possible:

• reduce the likelihood of an increase in the glycemic index to a critical level;
• allows you to refuse the use of drugs with an ultrashort duration of action.

When both modes are combined, the natural physiological release of insulin in the human body is simulated as accurately as possible. When using an insulin pump, the patient should know the basic rules for using this device, for which it is necessary to consult with the attending physician. In addition, he must remember when it is necessary to change the catheter through which subcutaneous insulin injections take place.

Insulin therapy in the presence of type I diabetes

Insulin-dependent patients (type I diabetes mellitus) are prescribed to completely replace the natural secretion of insulin. The most common is the following scheme for administering the drug in the form of injections, when it is necessary to inject:

• basal insulin (medium and prolonged action) - once or twice a day;
• bolus (short-term) - immediately before a meal.

As information for diabetics (but by no means as a recommendation), here are some pharmaceutical, brand names of various drugs that reduce blood levels in the blood:

Basal insulins:

• extended validity period, Lantus (Lantus - Germany), Levemir FlexPen (Levemir FlexPen - Denmark) and Ultratard XM (Ultratard HM - Denmark);
• medium term Humulin NPH (Switzerland), Insuman Basal GT (Insuman Basal GT - Germany) and Protafan HM (Protaphane HM - Denmark).

Bolus drugs:

• short-acting insulins "Actrapid HM Penfill" ("Actrapid HM Penfill" - Denmark);
• ultra-short term "NovoRapid" ("NovoRapid" - Denmark), "Humalog" ("Humalog" - France), "Apidra" ("Apidra" - France).

The combination of bolus and basal injection regimens is called a multiple regimen and is one of the subspecies of intensified therapy. The dosage of each injection is determined by doctors based on the tests performed and the general physical condition of the patient. Properly selected combinations and doses of individual insulins make the human body less critical to the quality of food intake. Typically, the proportion of long-acting and intermediate-acting insulins is 30.0% -50.0% of the total dose of the administered drug. Bolus inulin requires individual dose selection for each patient.

Methods of insulin therapy for patients with type II diabetes

Typically, insulin therapy for type II diabetes mellitus begins with the gradual addition of drugs that reduce the level of saccharides in the blood to the usual medicinal environments prescribed for drug therapy of patients. For treatment, drugs are prescribed, the active substance of which is insulin glargine (Lantus or Levemir). In this case, it is desirable to prick the injection solution at the same time. The maximum daily dosage, depending on the course of the course and the degree of neglect of the disease, can reach 10.0 IU.

If there is no improvement in the patient's condition and diabetes progresses, and drug therapy according to the scheme "oral sugar-lowering drugs + injections of balsa insulin" does not give the desired effect, they switch to therapy, the treatment of which is based on the injection of insulin-containing drugs. Today, the most common intensified regimen, in which drugs must be injected 2-3 times a day. For the most comfortable condition, patients prefer to minimize the number of injections. From the point of view of the therapeutic effect, the simplicity of the regimen should ensure the maximum effectiveness of hypoglycemic drugs. Efficacy is evaluated after injections for several days. In this case, the combination of the morning and upper doses is undesirable.

Features of insulin therapy for children and pregnant women

Pregnant women, nursing mothers and children under 12 years of age who have been diagnosed with type II diabetes mellitus are prescribed insulin therapy with some restrictions.

Insulin is injected for children, taking into account the following requirements:

• to reduce the daily number of injections, combined injections are prescribed, in which the ratio between drugs with a short and medium duration of action is individually selected;
• intensive therapy is recommended to prescribe upon reaching the age of twelve;
• with a gradual adjustment of the dosage, the range of change between the previous and subsequent injections was given to lie in the range of 1.0 ... 2.0 IU.

When conducting a course of insulin therapy for pregnant women, it is necessary to adhere to the following rules:

• prescribe injections of drugs in the morning, before breakfast, the glucose level should be in the range of 3.3-5.6 mmol / liter;
• after eating, the molarity of glucose in the blood should lie in the range of 5.6-7.2 mmol / liter;
• a minimum of two injections is required to prevent morning and afternoon hyperglycemia in type I and type II diabetes;
• before the first and last meal, injections are carried out using short-acting and intermediate-acting insulins;
• to exclude nocturnal and "pre-dawn" hyperglycemia, it allows the injection of a hypoglycemic drug before dinner, prick immediately before bedtime.

Technologies for the production of pharmacological insulin

The question of the sources and methods of obtaining insulin worries not only specialists, but also the majority of patients. The effectiveness of drugs that lower blood sugar levels and possible side effects from taking them depends on the technology for the production of this hormone.

Today, pharmaceuticals designed to treat diabetes by lowering the level of glucose in the body use insulin obtained in the following ways:

• obtaining preparations of animal origin involves the use of animal raw materials (bovine or porcine insulin);
• the biosynthetic method uses animal raw materials, with a modified purification method;
• recombinant or genetically modified;
• in a synthetic way.

The most promising is the genetic engineering method of obtaining, which provides the highest degree of purification and can be achieved almost complete absence of proinsulin. Preparations based on it do not cause allergic reactions and have a fairly narrow range of contraindications.

Possible negative effects of insulin therapy

With sufficient safety and good tolerance by patients of insulin obtained by genetic engineering, certain negative consequences are possible, the main of which are:

• the appearance of allergic irritations localized at the injection site associated with improper acupuncture or the introduction of a too cold drug;
• degradation of the subcutaneous layer of adipose tissue in the injection zones;
• the development of hypoglycemia, leading to an intensification of sweating, a constant feeling of hunger, and an increase in heart rate.

To reduce the likelihood of these phenomena during insulin therapy, all doctor's prescriptions should be strictly followed.

What is insulin made from?

Insulin is the main drug for the treatment of people with type 1 diabetes. Sometimes it is also used to stabilize the patient's condition and improve his well-being in the second type of disease. This substance, by its nature, is a hormone that is capable of influencing the metabolism of carbohydrates in small doses. Normally, the pancreas produces enough insulin to help maintain normal blood sugar levels. But with serious endocrine disorders, insulin injections often become the only chance to help the patient. Unfortunately, it is impossible to take it orally (in the form of tablets), since it is completely destroyed in the digestive tract and loses its biological value.

Options for obtaining insulin for use in medical practice

Many diabetics have probably wondered at least once, what is insulin used for medical purposes made of? Currently, most often this medicine is obtained using genetic engineering and biotechnology methods, but sometimes it is extracted from raw materials of animal origin.

Preparations derived from raw materials of animal origin

Obtaining this hormone from the pancreas of pigs and cattle is an old technology that is rarely used today. This is due to the low quality of the resulting drug, its tendency to cause allergic reactions and insufficient purification. The fact is that, since the hormone is a protein substance, it consists of a certain set of amino acids.

At the beginning and middle of the 20th century, when there were no similar drugs, even such insulin became a breakthrough in medicine and made it possible to bring the treatment of diabetics to a new level. Hormones obtained by this method lowered blood sugar, however, they often caused side effects and allergies. Differences in the composition of amino acids and impurities in the drug affected the condition of patients, especially in more vulnerable categories of patients (children and the elderly). Another reason for the poor tolerance of such insulin is the presence of its inactive precursor in the drug (proinsulin), which was impossible to get rid of in this variation of the drug.

Nowadays, there are improved porcine insulins that are devoid of these shortcomings. They are obtained from the pancreas of a pig, but after that they are subject to additional processing and purification. They are multicomponent and contain excipients in their composition.

Modified porcine insulin is practically no different from the human hormone, so it is still used in practice.

Such drugs are much better tolerated by patients and practically do not cause adverse reactions, they do not suppress the immune system and effectively reduce blood sugar. Bovine insulin is not currently used in medicine, because due to its foreign structure, it negatively affects the immune and other systems of the human body.

Genetically engineered insulin

Human insulin, which is used for diabetics, is produced on an industrial scale in two ways:

• using enzymatic treatment of porcine insulin;
• using genetically modified strains of Escherichia coli or yeast.

With a physicochemical change, the porcine insulin molecules under the action of special enzymes become identical to human insulin. The amino acid composition of the resulting drug is no different from the composition of the natural hormone that is produced in the human body. During the production process, the medicine undergoes high purification, therefore it does not cause allergic reactions and other undesirable manifestations.

But most often, insulin is obtained using modified (genetically modified) microorganisms. Bacteria or yeast are biotechnologically altered so that they can produce insulin themselves.

There are 2 methods for obtaining insulin in this way. The first of them is based on the use of two different strains (species) of a single microorganism. Each of them synthesizes only one strand of the hormone DNA molecule (there are two in total, and they are spirally twisted together). Then these chains are connected, and in the resulting solution it is already possible to separate the active forms of insulin from those that do not carry any biological significance.

The second way to obtain a drug using E. coli or yeast is based on the fact that the microbe first produces inactive insulin (that is, its precursor, proinsulin). Then, with the help of enzymatic treatment, this form is activated and used in medicine.

Personnel who have access to certain production areas must always be dressed in a sterile protective suit, due to which contact of the drug with human biological fluids is excluded.

All these processes are usually automated, air and all contact surfaces with ampoules and vials are sterile, and lines with equipment are hermetically sealed.

Biotechnology methods enable scientists to think about alternative solutions to the problem of diabetes. For example, preclinical studies are currently underway on the production of artificial pancreatic beta cells, which can be obtained using genetic engineering methods. Perhaps in the future they will be used to improve the functioning of this organ in a sick person.

The production of modern insulin preparations is a complex technological process that involves automation and minimal human intervention.

Additional components

The production of insulin without excipients in the modern world is almost impossible to imagine, because they improve its chemical properties, extend the duration of action and achieve a high degree of purity.

According to their properties, all additional ingredients can be divided into the following classes:

• prolongators (substances that are used to ensure a longer action of the drug);
• disinfectant components;
• stabilizers, thanks to which optimal acidity is maintained in the drug solution.

Prolonging additives

There are extended-acting insulins, the biological activity of which lasts for 8 to 42 hours (depending on the drug group). This effect is achieved by adding special substances, prolongators, to the injection solution. Most often, one of the following compounds is used for this purpose:

Proteins that prolong the action of the drug are highly purified and are low allergenic (for example, protamine). Zinc salts also do not adversely affect either insulin activity or human well-being.

Antimicrobial Ingredients

Disinfectors in the composition of insulin are necessary so that the microbial flora does not multiply during storage and use. These substances are preservatives and ensure the safety of the biological activity of the drug. In addition, if a patient injects a hormone from one vial only to himself, then the medicine may last him for several days. Due to high-quality antibacterial components, he will not need to throw away an unused drug due to the theoretical possibility of reproduction in a solution of microbes.

The following substances can be used as disinfectants in the production of insulin:

If the solution contains zinc ions, they also act as an additional preservative due to their antimicrobial properties.

For the production of each type of insulin, certain disinfectant components are suitable. Their interaction with the hormone must be investigated at the stage of preclinical trials, since the preservative should not disrupt the biological activity of insulin or otherwise adversely affect its properties.

The use of preservatives in most cases allows you to enter the hormone under the skin without pre-treatment with alcohol or other antiseptics (the manufacturer usually mentions this in the instructions). This simplifies the administration of the drug and reduces the number of preparatory manipulations before the injection itself. But this recommendation only works if the solution is administered using an individual insulin syringe with a thin needle.

Stabilizers

Stabilizers are needed to keep the pH of the solution at a given level. The safety of the drug, its activity and the stability of chemical properties depend on the level of acidity. In the production of injectable hormone for diabetic patients, phosphates are usually used for this purpose.

Solution stabilizers are not always needed for insulins with zinc, since the metal ions help maintain the necessary balance. If they are still used, then other chemical compounds are used instead of phosphates, since the combination of these substances leads to precipitation and the unsuitability of the drug. An important property that is required of all stabilizers is safety and the inability to enter into any reactions with insulin.

The selection of injectable drugs for diabetes for each individual patient should be handled by a competent endocrinologist. The task of insulin is not only to maintain a normal level of sugar in the blood, but also not to harm other organs and systems. The drug should be chemically neutral, low allergenic and preferably affordable. It is also quite convenient if the selected insulin can be mixed with other versions of it for the duration of action.

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ATTENTION! All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. By self-medicating, you can harm yourself!

What insulin is made of: modern developments to meet the needs of diabetics

Insulin is a pancreatic hormone that plays a vital role in the body. It is this substance that contributes to the adequate absorption of glucose, which in turn is the main source of energy, and also nourishes the brain tissue.

Diabetics who are forced to take the hormone as an injection sooner or later think about what insulin is made of, how one drug differs from another, and how artificial analogues of the hormone affect a person’s well-being and the functional potential of organs and systems.

Differences between different types of insulin

Insulin is a vital drug. People with diabetes cannot do without this remedy. The pharmacological range of medicines for diabetics is relatively wide.

Preparations differ from each other in many aspects:

1. Degree of purification;
2. Source (production of insulin involves the use of human resources and animals);
3. Availability of auxiliary components;
4. The concentration of the active substance;
5. solution pH;
6. Potential to combine several drugs at once. It is especially problematic to combine short-acting and long-acting insulin in the same therapeutic schemes.

Every year in the world, leading pharmaceutical companies produce a huge amount of "artificial" hormone. Insulin manufacturers in Russia have also contributed to the development of this industry.

Sources for the hormone

Not every person knows what insulin is made of for diabetics, but the origin of this most valuable drug is really interesting.

Modern insulin production technology uses two sources:

• Animals. The drug is obtained by treating the pancreas of cattle (less often), as well as pigs. Bovine insulin contains as many as three "extra" amino acids, which are alien in their biological structure and origin to humans. This can lead to the development of persistent allergic reactions. Pork insulin differs from the human hormone by only one amino acid, which makes it much safer. Depending on how insulin is produced, how thoroughly the biological product is purified, the degree of perception of the drug by the human body will depend;
• human counterparts. Products in this category are produced using the most sophisticated technologies. Leading pharmaceutical companies have developed bacteria to produce human insulin for medicinal purposes. Enzymatic transformation techniques are widely used to obtain semi-synthetic hormonal products. Another technology involves the use of innovative techniques in the field of genetic engineering to obtain unique DNA recombinant formulations with insulin.

How insulin was obtained: the first attempts of pharmacists

Medicines derived from animal sources are considered to be old technology medicines. Medicines are considered to be of relatively low quality due to the insufficient degree of purification of the final product. In the early 20s of the last century, insulin, even causing severe allergies, became a real "pharmacological miracle" that saved the lives of insulin-dependent people.

The drugs of the first releases were also difficult to tolerate due to the presence of proinsulin in the composition. Hormonal injections were especially poorly tolerated by children and the elderly. Over time, it was possible to get rid of this impurity (proinsulin) by a more thorough cleaning of the composition. Bovine insulin was abandoned altogether, as it almost always caused side effects.

What insulin is made of: important nuances

In modern schemes of therapeutic action on patients, both types of insulin are used: both animal and human origin. Recent developments allow the production of products of the highest degree of purification.

Previously, insulin could contain a number of undesirable impurities:

Previously, such “additives” could cause serious complications, especially in patients who are forced to take large doses of the drug.

Improved drugs are devoid of unwanted impurities. If we consider insulin of animal origin, the best is a monopeak product, which is produced with the production of a “peak” of a hormonal substance.

The duration of the pharmacological effect

The production of hormonal preparations has been established in several directions at once. Depending on how insulin is made, the duration of its action will depend.

There are the following types of drugs:

1. With ultra-short effect;
2. Short action;
3. prolonged action;
4. Average degree of duration;
5. Long-term action;
6. Combined type.

Ultrashort-acting preparations

Typical representatives of the group: Lizpro and Aspart. Insulin in the first version is produced by rearranging the amino acid residues in the hormone (we are talking about lysine and proline). In this way, during production, the risk of hexamers is minimized. Due to the fact that such insulin quickly breaks down into monomers, the process of assimilation of the drug is not accompanied by complications and side effects.

Aspart is produced in a similar way. The only difference is that the amino acid proline is replaced with aspartic acid. The drug quickly breaks down in the human body into a number of simple molecules, instantly absorbed into the blood.

Short acting drugs

Short-acting insulins are buffer solutions. They are intended specifically for subcutaneous injections. In some cases, a different administration format is allowed, but only a doctor can make such decisions.

The drug begins to "work" after 15 - 25 minutes. The maximum concentration of the substance in the body is observed after 2 - 2.5 hours after the injection.

In general, the drug affects the patient's body for about 6 hours. Insulins of this category are created for the treatment of diabetics in a hospital setting. They allow you to quickly bring a person out of a state of acute hyperglycemia, diabetic precoma or coma.

Intermediate insulin

Drugs slowly enter the bloodstream. Insulin is obtained according to the standard scheme, but the composition is improved at the final stages of production. To increase their hypoglycemic effect, special prolonging substances - zinc or protamine - are mixed into the composition. Most often, insulin is presented in the form of suspensions.

Long acting insulin

Long-acting insulins are the most modern pharmacological products to date. The most popular drug is Glargine. The manufacturer has never hidden what human insulin for diabetics is made of. With the help of DNA recombinant technology, it is possible to create an exact analogue of the hormone that is synthesized by the pancreas of a healthy person.

To obtain the final product, an extremely complex modification of the hormone molecule is carried out. Replace asparagine with glycine, adding arginine residues. The drug is not used to treat comatose or precomatous conditions. It is prescribed only subcutaneously.

The role of excipients

It is impossible to imagine the production of any pharmacological product, in particular insulin, without the use of special additives.

According to their classes, all additives for insulin-containing drugs can be divided into the following categories:

1. Substances that predetermine the prolongation of drugs;
2. Disinfectants;
3. acidity stabilizers.

Prolongators

In order to extend the time of exposure to the patient, prolongation drugs are mixed with the insulin solution.

Most often used:

Antimicrobial Ingredients

Antimicrobial ingredients prolong the shelf life of medicines. The presence of disinfectant components prevents the growth of microbes. These substances, by their biochemical nature, are preservatives that do not affect the activity of the drug itself.

The most popular antimicrobial additives used in insulin production are:

For each specific drug use their own special additives. Their interaction with each other without fail is studied in detail at the preclinical stage. The main requirement is that the preservative should not interfere with the biological activity of the drug.

A high-quality and skillfully selected disinfectant allows not only to maintain the sterility of the composition for a long period, but even to make intradermal or subcutaneous injections without first disinfecting the dermal tissue. This is extremely important in the event of extreme situations when there is no time to treat the injection site.

Stabilizers

Each solution should have a stable pH and not change over time. Stabilizers are used just to keep the medicine from increasing the level of acidity.

For injection solutions, phosphates are most often used. If insulin is supplemented with zinc, stabilizers are not used, since the metal ions themselves act as stabilizers for the acidity of the solution.

As in the case of antimicrobial components, stabilizers should not enter into any reactions with the active substance itself.

The task of insulin is not only to maintain the optimal level of sugar in the blood of a diabetic, but the hormone must also not be dangerous to other organs, tissues of the human body.

What is the calibration of insulin syringes

In the very first preparations with insulin, 1 ml of the solution contained only 1 unit. Only over time, the concentration was able to increase. On the territory of the Russian Federation, vials with marking symbols are common - U-40 or 40 units / ml. This means that 40 units are concentrated in 1 ml of the solution.

Modern syringes are complemented by a clear, well-thought-out calibration that will allow you to enter the required dose, avoiding the risk of an unexpected overdose. All the nuances regarding the use of syringes with calibration are explained by the attending physician, choosing a drug for a diabetic for the first time or at the time of correcting the old treatment regimen.

What is insulin made of (manufacturing, production, obtaining, synthesizing)

Insulin is a life-saving drug that has revolutionized the lives of many people with diabetes.

In the entire history of medicine and pharmacy of the 20th century, perhaps only one group of medicines of the same importance can be distinguished - these are antibiotics. They, like insulin, very quickly entered medicine and helped save many lives.

The Day of the fight against diabetes is celebrated at the initiative of the World Health Organization every year since 1991 on the birthday of the Canadian physiologist F. Banting, who discovered the hormone insulin together with J. J. Macleod. Let's take a look at how this hormone is made.

How do insulin preparations differ from each other?

1. The degree of purification.
2. The source of receipt is porcine, bovine, human insulin.
3. Additional components included in the solution of the drug - preservatives, prolongers of action and others.
4. Concentration.
5. solution pH.
6. Possibility of mixing short and long-acting preparations.

Insulin is a hormone produced by special cells in the pancreas. It is a double-stranded protein with 51 amino acids.

About 6 billion units of insulin are used annually in the world (1 unit is 42 micrograms of a substance). The production of insulin is high-tech and is carried out only by industrial methods.

Sources of insulin

Currently, depending on the source of production, porcine insulin and human insulin preparations are isolated.

Pork insulin now has a very high degree of purification, has a good hypoglycemic effect, and there are practically no allergic reactions to it.

Human insulin preparations fully correspond in chemical structure to the human hormone. They are usually produced by biosynthesis using genetic engineering technologies.

Large manufacturing firms use such production methods that guarantee that their products meet all quality standards. Large differences in the action of human and porcine monocomponent insulin (that is, highly purified) have not been identified; in relation to the immune system, according to many studies, the difference is minimal.

Auxiliary components used in the production of insulin

The drug vial contains a solution containing not only the hormone insulin itself, but also other compounds. Each of them plays a specific role:

• prolongation of the action of the drug;
• solution disinfection;
• the presence of buffer properties of the solution and maintaining a neutral pH (acid-base balance).

Extending the action of insulin

To create long-acting insulin, one of two compounds, zinc or protamine, is added to a solution of regular insulin. Depending on this, all insulins can be divided into two groups:

• protamine-insulins - protafan, insuman basal, NPH, humulin N;
• zinc-insulins - insulin-zinc-suspensions mono-tard, tape, humulin-zinc.

Protamine is a protein, but allergic reactions to it are very rare.

To create a neutral environment for the solution, a phosphate buffer is added to it. It must be remembered that insulin containing phosphates is strictly forbidden to combine with insulin-zinc suspension (ICS), since zinc phosphate precipitates, and the effect of zinc-insulin is shortened in the most unpredictable way.

Disinfectants

Some of the compounds that, according to pharmaco-technological criteria, should already be introduced into the preparation have a disinfecting effect. These include cresol and phenol (both of which have a specific odor), as well as methyl parabenzoate (methylparaben), which has no odor.

The introduction of any of these preservatives causes the specific smell of some insulin preparations. All preservatives in the amount in which they are in insulin preparations do not have any negative effect.

Protamine insulins usually include cresol or phenol. Phenol cannot be added to ICS solutions, because it changes the physical properties of the hormone particles. These drugs include methylparaben. Zinc ions in solution also have an antimicrobial effect.

Thanks to such multi-stage antibacterial protection with the help of preservatives, the development of possible complications is prevented, which could be caused by bacterial contamination when the needle is repeatedly inserted into the vial with the solution.

Due to the presence of such a protection mechanism, the patient can use the same syringe for subcutaneous injections of the drug for 5 to 7 days (provided that only he uses the syringe). Moreover, preservatives make it possible not to use alcohol to treat the skin before injection, but again only if the patient injects himself with a syringe with a thin needle (insulin).

Calibration of insulin syringes

In the first preparations of insulin, one ml of the solution contained only one unit of the hormone. Later the concentration was increased. Most of the insulin preparations in vials used in Russia contain 40 units in 1 ml of solution. The vials are usually marked with the symbol U-40 or 40 units / ml.

Insulin syringes for widespread use are intended for just such insulin and their calibration is carried out according to the following principle: when a person draws 0.5 ml of a solution with a syringe, a person gains 20 units, 0.35 ml corresponds to 10 units, and so on.

Each mark on the syringe is equal to a certain volume, and the patient already knows how many units this volume contains. Thus, the calibration of syringes is a graduation in terms of the volume of the drug, calculated on the use of U-40 insulin. 4 units of insulin are contained in 0.1 ml, 6 units in 0.15 ml of the drug, and so on up to 40 units, which correspond to 1 ml of solution.

In some countries, insulin is used, 1 ml of which contains 100 units (U-100). For such drugs, special insulin syringes are produced that are similar to those discussed above, but they have a different calibration.

It takes into account exactly this concentration (it is 2.5 times higher than the standard one). In this case, the dose of insulin for the patient, of course, remains the same, since it satisfies the body's need for a specific amount of insulin.

That is, if the patient previously used the U-40 preparation and injected 40 units of the hormone per day, then he should receive the same 40 units with injections of U-100 insulin, but inject it in an amount 2.5 times less. That is, the same 40 units will be contained in 0.4 ml of the solution.

Unfortunately, not all doctors, let alone diabetic patients, know about this. The first difficulties began when some of the patients switched to the use of insulin injectors (pen-syringes), which use penfills (special cartridges) containing U-40 insulin.

If you draw a solution labeled U-100 into such a syringe, for example, up to the mark of 20 units (that is, 0.5 ml), then this volume will contain as many as 50 units of the drug.

Each time, filling regular syringes with U-100 insulin and looking at the cut-off units, a person will gain a dose 2.5 times greater than that shown at this mark. If neither the doctor nor the patient notices this error in a timely manner, then there is a high probability of developing severe hypoglycemia due to a constant overdose of the drug, which often happens in practice.

On the other hand, sometimes there are insulin syringes calibrated specifically for the U-100 preparation. If such a syringe is mistakenly filled with the usual U-40 solution, then the dose of insulin in the syringe will be 2.5 times less than that written near the corresponding mark on the syringe.

As a result of this, a seemingly inexplicable increase in blood glucose is possible. In fact, of course, everything is quite logical - for each concentration of the drug, you must use a suitable syringe.

In some countries, such as Switzerland, there has been an elaborate plan to make a smart transition to U-100-labeled insulin preparations. But this requires close contact of all stakeholders: doctors of many specialties, patients, nurses from any department, pharmacists, manufacturers, authorities.

In our country, it is very difficult to implement the transition of all patients to only the use of U-100 insulin, because, most likely, this will lead to an increase in the number of errors in dose determination.

Combined use of short-acting and extended-acting insulins

In modern medicine, the treatment of diabetes mellitus, especially type 1, usually occurs using a combination of two types of insulin - short-acting and long-acting.

It would be much more convenient for patients if drugs with different durations of action could be combined in the same syringe and administered simultaneously to avoid double skin puncture.

Many doctors do not know what determines the possibility of mixing different insulins. This is based on the chemical and galenic (compositionally determined) compatibility of long-acting and short-acting insulins.

It is very important that when the two types of preparations are mixed, the rapid onset of action of short-acting insulin does not stretch or disappear.

It has been proven that a short-acting preparation can be combined in one injection with protamine-insulin, while the onset of short-acting insulin is not delayed, because soluble insulin does not bind to protamine.

In this case, the manufacturer of the drug does not matter. For example, insulin actrapid can be combined with humulin H or protafan. Moreover, mixtures of these preparations can be stored.

With regard to zinc-insulin preparations, it has long been established that insulin-zinc suspension (crystalline) cannot be combined with short insulin, as it binds to an excess of zinc ions and transforms into extended insulin, sometimes partially.

Some patients first inject a short-acting drug, then, without removing the needle from under the skin, slightly change its direction, and inject zinc-insulin through it.

Very little scientific research has been carried out on this route of administration, so it cannot be ruled out that in some cases, with this method of injection, a complex of zinc-insulin and a short-acting preparation can form under the skin, which leads to a violation of the absorption of the latter.

Therefore, it is better to administer short insulin completely separately from zinc insulin, to make two separate injections into skin areas that are at least 1 cm apart from each other. This is not convenient, which cannot be said about the standard intake.

Combined insulins

Now the pharmaceutical industry produces combined preparations containing short-acting insulin together with protamine-insulin in a strictly defined percentage. These drugs include:

The most effective are combinations in which the ratio of short and extended insulin is 30:70 or 25:75. This ratio is always indicated in the instructions for use of each specific drug.

Such drugs are best suited for people who follow a constant diet and have regular physical activity. For example, they are often used by elderly patients with type 2 diabetes.

Combination insulins are not suitable for so-called "flexible" insulin therapy, when it becomes necessary to constantly change the dosage of short-acting insulin.

For example, this should be done when changing the amount of carbohydrates in food, reducing or increasing physical activity, etc. At the same time, the dose of basal insulin (prolonged) remains practically unchanged.

Diabetes mellitus ranks third in the world in terms of prevalence. It lags only behind cardiovascular diseases and oncology. According to various sources, the number of diabetic patients in the world ranges from 120 to 180 million people (about 3% of all inhabitants of the Earth). According to some forecasts, the number of patients will double every 15 years.

To conduct effective insulin therapy, it is enough to have only one drug, short-acting insulin, and one prolonged insulin, they are allowed to be combined with each other. Also, in some cases (mainly for elderly patients), there is a need for a combined drug.

1. High degree of purification.
2. Possibility of mixing with other types of insulin.
3. Neutral pH.
4. Preparations from the category of extended insulins should have a duration of action of 12 to 18 hours, so that it is enough to administer them 2 times a day.

Every diabetic and his relatives face the problem of acquiring a hormone.

Consider what obstacles stand in the way, where and how you can buy the drug, and what benefits patients enjoy.

Prices for insulin

Insulin is sold in pharmacies, like any medical drug. The pharmacy needs a license to sell it. In the Russian Federation, the provision of patients with diabetes with free insulin is provided for by federal law No. 178-FZ and Government Decree No. 890.

The right to receive a free drug will have to be confirmed at the pharmacy with a standard prescription received from a doctor in the district clinic. The majority of those who need daily administration of the hormone acquire it in this way. However, circumstances often develop in such a way that it is impossible or difficult to obtain the desired recipe.

Then the question arises of how much insulin costs and whether it is possible to buy it at a pharmacy without a prescription. Yes, you can. The drug is produced in different forms. Its price depends on the company, on whether it is in a bottle or cartridge.

Insulin is either long-acting or short-acting.

The person purchasing the drug must know exactly what he needs.

The price in the pharmacy for the drug in vials is from 400 rubles. For medicine in cartridges, you will have to pay from 900 rubles. and above, in branded syringe pens - from 2000 rubles.

It should be noted that patients with diabetes throughout the country sell and exchange drugs that they do not need, do not fit or are inconvenient. The Internet and newspapers are full of private ads offering to sell or buy various forms of insulin.

The cost of these goods is negotiable, often much lower than the pharmacy.

How to get the drug for free?

In district clinics, a register of patients with diabetes mellitus and a list of doctors who are entitled to issue preferential prescriptions are being formed. These lists are also in the database of the pharmacy chain.

They have the right to write out a prescription for insulin, a therapist, and a pediatrician for children. A prescription is issued after a visit to the doctor and the formation of a treatment regimen and dosage. In the future, the prescription can be extended by a trusted person of the patient - parents, guardian or social worker.

In accordance with the prescribed dosage and type of insulin, the drug can be obtained free of charge at the pharmacy. Patients need to visit the doctor on time in order to renew the prescription in a timely manner.

The following documents are required for issuing a prescription:

1. Passport. The prescription is issued by the district clinic, the person must be attached to a medical institution. When moving or simply wanting to move to another place of service, you need to unsubscribe and write an application to another clinic.
2. Compulsory medical insurance policy and SNILS - an individual personal account.
3. Certificate of disability or other documents for the right to receive benefits.
4. A certificate from the Pension Fund of the Russian Federation stating that the person has not refused to receive benefits in the form of free medicines.

If a person refused the social package, a free prescription is not issued, the problem with the acquisition of the hormone is solved independently. Whether a person receives a free prescription drug or not depends on him.

Replacing regular insulin with one must be discussed with your doctor.

Video about getting subsidized medicines:

Where is it issued?

Usually, insulin on preferential prescriptions is issued in several (often in one) pharmacies with which an appropriate agreement has been concluded. The address of this point of issue will be reported at the place of issuing the prescription.

The prescription is valid for a month, if the drug is not purchased during this time, you will have to write out a new form. Anyone can get a prescription drug.

What to do if the pharmacy refuses to issue a hormone:

1. Register an application in the journal "Unsatisfied demand" by contacting the pharmacy administrator. Leave a phone number to let you know when the drug is available.
2. This message must arrive within ten days. If it is impossible to fulfill the application, the patient must be notified.
3. In the future, the polyclinic and the pharmacy deal with the problem together, offering different options to the diabetic - another pharmacy, drug replacement, or something else.
4. If the patient cannot receive insulin, one should contact the insurance organization, the Compulsory Medical Insurance Fund, and health authorities.

Usually, insulin delivery can be delayed by only a few days, the patient needs to be prepared for this and have a supply.

What if the doctor does not give a prescription?

Prescriptions for free medicines can be issued by doctors according to their specialty, to patients who are attached to a medical institution. In this case, the doctor must be in the approved register of doctors.

The list of drugs available for free prescription is also regulated. Very often, the combination of these circumstances does not allow the patient to receive the desired type of medicine. Many diabetics refuse free drugs because of the inability to get good insulin with convenient means of administration.

These circumstances do not depend on district polyclinics, which can only prescribe medicines approved by the Ministry of Health.

If you refuse to prescribe the desired drug, you must:

1. Contact the insurance company that issued the CHI policy, the MHIF.
2. Write a complaint to the Federal Service for Surveillance in Healthcare of the Russian Federation. Address for contacting http://www.roszdravnadzor.ru.
3. In the feedback service, you can specify all the data on the medical institution and pharmacy that are unable to provide the hormone, the names of the officials with whom they came into contact. You should also attach scanned copies of documents confirming the right to receive benefits.

The complaint can be sent by mail to the address: 109074, Moscow, Slavyanskaya square, 4, building 1. The more detailed the situation is described, the greater the likelihood of a speedy solution. The complaint must indicate the exact names of all institutions, as well as the positions and names of the people with whom they tried to solve the problem and were refused.

Hotline of Roszdravnadzor for observance of the rights of citizens in the field of health care — 8 800 500 18 35

What if the pharmacy doesn't dispense free insulin?

The regulations for the actions of a pharmacy in the absence of drugs needed by patients, including insulin, are prescribed in the letter of Roszdravnadzor No. 01I-60/06.

The patient must check whether the administrator on duty recorded the required request for insulin in case of his absence at the pharmacy. If the drug is not delivered within ten days, liability is provided, up to the revocation of the license.

If the conditions and terms of drug delivery are not observed, you can file a complaint with the Ministry of Health of the Russian Federation or your region. Page for sending messages - http://www.rosminzdrav.ru/reception/appeals/new .

If the controlling medical authorities have not resolved the problem, you need to prepare for contacting the prosecutor's office. Before this, you should receive a written refusal from the pharmacy to dispense drugs, as well as confirmation of the rights to receive benefits.

Benefits for a diabetic

In addition to the right to free insulin, patients with diabetes have the opportunity to use the following government assistance:

1. Receiving and assigning a pension depending on the severity of diabetes mellitus.
2. Reducing utility bills by 50%.
3. Free dental prosthetics.
4. In addition to insulin, free prescription of other medicines, as well as accessories - devices for injecting insulin, measuring sugar, alcohol, bandages. If necessary, assistance is provided in the acquisition of insoles, orthoses. Medicines are also prescribed for the treatment of hypertension, cardiovascular diseases and others.
5. In women with DM, paid maternity leave is longer by 16 days, they can spend more days in the maternity hospital (by 3 days).
6. Free diagnostic examinations of the endocrine organs in diabetic centers with treatment adjustments. During this time, those in need are exempted from study or work. In such centers, you can get a complete examination.
7. In some regions (in particular, in Moscow) rehabilitation programs are provided in dispensaries.
8. The regions have their own support programs - lump-sum payments, travel benefits, health programs and others.

Video with a list of benefits for patients with diabetes:

In the absence of support from loved ones, a diabetic can count on the help of social workers. Men with diabetes are exempt from military service.

To obtain a disability, you need to apply to the Bureau of Medical and Social Expertise (ITU) with a referral from the attending physician. The patient can receive a disability group from 1 to 3. The appointment of a disability group will allow you to receive a pension in the amount established by Federal Law No. 166-FZ.

Diabetes mellitus is a disease that requires constant monitoring of the patient's condition, regular treatment, and diet. State support in the form of free medicines, including insulin, and other benefits helps diabetics maintain their condition and fight serious illness.

Insulin is a vital hormone in the human body that is responsible for regulating the level of glucose in the bloodstream, which is produced by the pancreas. If for some reason the hormone is produced in insufficient quantities and its deficiency occurs, then the metabolism is disturbed, against which a serious endocrine disease called diabetes develops.

After scientists mastered the method of obtaining insulin artificially using transgenic bacteria, insulin-dependent diabetics got the opportunity for a long and fulfilling life, subject to a number of requirements:

• daily monitoring of blood sugar levels;
• diet and exercise;
• injections of a hormone prescribed by a doctor;

How is insulin obtained?

The scheme for obtaining the drug considers two options for its acquisition:

• Buy at a pharmacy without a prescription (this is provided so that sick people can buy medicine even if they did not have time to fill out a prescription form for free insulin while away from home, on vacation or on a business trip);
• Get the drug for free by writing an insulin prescription from an endocrinologist.

Answering the numerous questions of diabetics: "Who is entitled to free insulin and how to get it?" Doctors explain: Citizens of the Russian Federation and foreigners with a residence permit who have been diagnosed with insulin-dependent diabetes are entitled to receive preferential insulin. Benefits for medicines granted to citizens of Russia are regulated by the federal law "On State Social Assistance" of July 17, 1999, 178-FZ and Government Decree of July 30, 1999 No. 890 (as amended on February 14, 2002).

The right to provide a prescription for receiving a hormonal drug free of charge has an endocrinologist or paramedic included in the register of persons entitled to issue prescription forms on preferential terms. The formation and maintenance of this register is carried out by the territorial health authorities.

Free insulin prescriptions can never be provided over the internet. Following the scheme for obtaining a hormonal drug, a document giving the right to receive it on a preferential basis must be issued by a doctor or paramedic at a personal appointment of the patient after his individual examination if there are medical indications. And also when providing patients with the following documents:

• Passport. A prescription form for a prescribed reduced-price drug for a diabetic will be issued at the place of his registration, and not at the place of actual residence, if the patient has not written an application in advance and has not attached himself to the medical organization of his choice, located near the place of residence. But he has the right to use the right to choose a medical institution no more than once a year;
• Medical insurance policy;
• Individual insurance policy (SNILS);
• Certificate of disability or otherwise confirming the right to preferential treatment;
• Certificate from the pension fund that you have not refused to provide social services;

New forms of registration of preferential prescriptions, laid down by the Program and meeting the requirements of the Ministry of Health, provide for filling in the columns with the numbers of the above documents.

Where can I get a prescription drug?

The period of validity of the document for receiving free medicine varies from 2 weeks to 1 month (this is indicated in the prescription). Both the patient and his relatives can get medicine at the pharmacy by providing the pharmacist with a prescription form.

If the free medicine provided to the diabetic by the Program is temporarily not available in the pharmacy, then you should resort to the following scheme of action: contact the pharmacist-administrator with a request to register your document giving the right to receive a preferential drug in a special journal. After that, in accordance with the order of the Ministry of Health and Social Development of Russia, the medicine must be provided within 10 working days. If for some reason this cannot be done, the pharmacy is obliged to provide you with information on further actions.

If the pharmacy refuses to provide you with prescription drugs prescribed by the Program, then you should notify your attending physician and contact the TFOMS or CMO - organizations whose duties include monitoring the observance of citizens' rights in the general health insurance system.

How to get free insulin if you lose your prescription? If this unfortunate misunderstanding happened to you, then be sure to contact your doctor. He will help you get a new prescription by making a note on the outpatient card and forward the missing information to the pharmaceutical company. This scheme of action will help prevent the pharmacy from issuing a preferential medicine to an unidentified person.

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Medications for type 1 diabetes

For the treatment of type 1 diabetes, your options are quite limited, since the body in type 1 diabetes does not produce insulin at all. In order to manage type 1 diabetes, it is necessary to replace natural insulin with insulin injections or an alternative method, including insulin pens and pumps. There is a wide variety of insulin products on the market today. Your individual needs will determine the type of insulin you use.

Another injectable medicine you can use to treat type 1 diabetes is called Pramlintide (Symlin), a drug analogue of the human hormone amylin, which is produced by the pancreas. Pramlintide works by slowing down digestion. This prevents blood sugar levels from rising too high after a meal. However, if you are using Pramlintide (Symlin), you will still need to use insulin. Together they effectively control diabetes.

Medications for type 2 diabetes

With type 2 diabetes, you have more varied treatment options than with type 1 diabetes. In type 2 diabetes, the body does not produce enough insulin to meet your energy needs and the cells are resistant to it. To treat type 2 diabetes, you can use insulin and other injections, medicines you take by mouth (by mouth), or a combination of both.

Injectable medicines for type 2 diabetes

Injectable medicines are taken with a needle and syringe, or in some cases, injections are given with a pen. You have several options for treating type 2 diabetes with injectables:

• Insulin - for type 1 and type 2 diabetes.
• Pramlintide (Symlin) is prescribed for both type 1 and type 2 diabetes.
• Exenatide (Byetta) is a relatively new drug for the treatment of type 2 diabetes. It works by increasing insulin secretion from the pancreas, but it only does so when your blood sugar is high. An extended "release" of Exenatide called Bydureon was recently put on the market.
• Trulicity (Dulaglutide, Trulicity) is another modern drug for type 2 diabetes. Taken by injection once a week, it helps the body produce its own insulin to improve blood sugar levels. In addition, the drug promotes weight loss.
• Lixisenatide (Adlyxin) is a modern injectable for type 2 diabetes. Lixisenatide is given once a day with meals and works similarly to Trulicity.

Oral drugs for diabetes

Oral medications are medicines that you take by mouth. At the moment, there are oral drugs only for the treatment of type 2 diabetes. In general, oral medications work in one of five ways:

• Increasing insulin production
• Decreased insulin resistance and to improve cell response to insulin
• Reducing the amount of glucose your liver makes. It is the liver that stores extra sugar for use when your body needs it.
• Slowing down digestion to help keep blood sugar levels more consistent
• Increased renal excretion of excess glucose (SGLT2 inhibitors)

What medications are used to treat diabetes?

For most people with type 2 diabetes, it is recommended that oral diabetes medications be started with a medication called Metformin, combined with lifestyle changes. However, Metformin is not a good choice for everyone due to possible side effects, including nausea and diarrhea. If your doctor doesn't think you should take Metformin, he will likely start treating your diabetes with other oral medications.

As a rule, it takes some time to evaluate the effectiveness of the first drug for diabetes. If the goal of stabilizing blood sugar is not met, your doctor may suggest a few more options:

• Increase the dose of medication
• Add a second drug
• Switching to a new drug
• Add insulin
• Switching to insulin only

Insulin and modern diabetes drugs

Fifty-eight percent of adults with diabetes use oral medications to control their blood glucose levels, and only 12% use insulin (Data from the American Diabetes Organization). Are you one of them? Although insulin injections were the only way to keep diabetes in check for a long time, today medicine has come a long way.

Scientists are working hard to develop new treatments for diabetes to lower blood glucose levels in diabetic patients. Read on to find out more about how they work.

Insulin independent injections

Victoza (Victoza, Liraglutide). In 2010, the FDA approved this injection for certain adults with type 2 diabetes. Liraglutide is “injected” only once a day. Your doctor may recommend this drug along with a healthy diet and exercise if other treatments do not control blood glucose well enough.

Victoza is in a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 is a natural hormone in the body and helps the pancreas produce insulin. Therefore, it removes sugar from the blood into the cells. Victoza mimics the action of GLP-1, the drug is almost identical to the hormone, "spurs" the production of insulin and helps to reduce blood glucose levels.

Bydureon, Byeta (Exenatides). Strange but true: this injectable is a synthetic form of a hormone derived from the saliva of the Gila monster lizard (Arizona gilatooth). The drug increases the amount of insulin to lower blood glucose only when blood glucose levels are too high. As a result, Byetta has a low risk of hypoglycemia, which occurs when blood glucose levels drop too low. In 2012, the FDA approved a long-acting version of Exenatidom, Bydureon, which is administered weekly.

Symlin (Pramlintide, Pramlintide). Pancreatic beta cells produce insulin as well as another hormone called amylin. Insulin, amylin, and the hormone glucagon work together to control blood glucose levels.
Symlin is a synthetic form of amylin. If your doctor prescribes Symlin, you will take it along with insulin with meals. It works by slowing down the rate at which food passes through your stomach to prevent blood sugar from rising immediately after eating.

Trulicity (Trulicity,Dulaglutide) This injectable diabetes drug was approved by the FDA in 2014. Trulicity works similarly to Victoza in that it mimics the actions of the hormone GLP-1 to control blood sugar levels. However, while Victoza is a daily injection, Trulicity is only taken once a week. Trulicity also promotes weight loss.

Adlixin (Adlyxin, Lixisenatide)“This is an injectable new injectable for diabetes—it was approved by the FDA in 2016. Adlixin works similarly to the diabetes drugs Victoza and Trulicity, but is given once a day with meals.

Diabetes without drugs: effective but extreme. bariatric surgery

You must have heard of bariatric surgery or weight loss surgery. There are several types of bariatric procedures, but most are based on reducing the amount of food you can eat and limiting the body's ability to absorb some of the calories from food. This leads to weight loss.

A 2010 study evaluated more than 2,000 obese adults with type 2 diabetes who underwent bariatric surgery. It found that within six months, nearly 75% of patients no longer needed diabetes medication, the journal Archives of Surgery reports reported. Two years after surgery, about 85% of patients did not need diabetes medication at all.

Why such amazing results? Weight loss after surgery may only be a partial answer, researchers say. Scientists believe that bariatric surgery causes an increase in the levels of some important hormones in the small intestine, including a glucagon-like peptide. This hormone helps regulate insulin levels and may be largely responsible for maintaining normal blood sugar levels and, in some cases, completely solving the problem of diabetes in people after bariatric surgery.

Of course, bariatric surgery is a major operation. But if you're obese and have type 2 diabetes, talk to your doctor about how this type of surgery might be an effective diabetes treatment option for you without a daily dose of insulin.

Denial of responsibility : The information provided in this diabetes medication article is for informational purposes only and is not a substitute for consultation with a healthcare professional.

moskovskaya-medicina.ru

Historical reference

Back in the early 20th century, type 1 diabetes was an absolutely fatal disease. The doctors could not provide any effective treatment. Therefore, only a few months passed from the moment of the onset of the disease to the death of the patient.

In the twenties of the last century, Canadian doctors took a revolutionary step in the treatment of diabetes. They isolated a certain substance that can lower blood sugar levels. Doctors received a solution from animal material (pancreas of calves). Based on the open substance, the first drugs for the treatment of diabetes mellitus were subsequently created. From that moment on, doctors were able to prescribe hormone replacement therapy to those who fell ill.

For a long time, all insulin preparations were obtained from the pancreas of animals. Even 10-15 years ago, quite a few patients used porcine and bovine hormone preparations. Of course, these solutions were not very effective and not always safe.

Animal insulins:

• have an unpredictable action profile;
• provoke hypo- and hyperglycemic states;
• cause insulin resistance;
• contribute to the development of local complications (lipohypertrophy);
• often trigger allergic reactions.

In the fifties of the 20th century, the pharmacological industry began to produce new preparations of the pancreatic hormone. These solutions were obtained by genetic engineering. Such insulins are produced by specially modified colonies of bacteria or fungi. Microorganisms are in a comfortable environment and produce a large amount of human hormone. The solution is then cleaned, preserved and packaged. If necessary, proteins or zinc are added to the preparation. These chemicals change the action profile of the drug.

The latest generation of hormone preparations is called human insulin analogues. They are produced from genetic engineering. To change the functional characteristics of the molecules, scientists change the amino acid sequence of the hormone. As a result, insulin acquires new properties and becomes more convenient for the patient.

Currently, in most countries of the world, animal pancreatic hormone preparations are not used. Genetically engineered insulins are the most popular. And analogues of the human hormone are used to a limited extent (due to the high cost).

Insulins by action profile

Only one insulin works in the human body. It is produced by the beta cells of the pancreas. Part of the insulin immediately enters the bloodstream, the other is accumulated and secreted later. Beta cells are able to recognize the level of glucose in the blood. They also respond to some other stimuli.

In quiet mode, when a person is at rest, moving or sleeping, the pancreas releases a small amount of insulin into the blood. This type of secretion is called basal. On average, it is equal in an adult to 0.5-1.5 units per hour.

After a person has eaten, beta cells release their stores of insulin (Figure 1). A large amount of the hormone immediately enters the bloodstream. This type of secretion is called postprandial(after eating). The volume of the hormone depends on the composition of the food, its quantity and tissue sensitivity. More insulin is released in response to the intake of carbohydrates (especially easily digestible). A high concentration of the hormone is observed in people with metabolic syndrome and in the initial stages of type 2 diabetes.

Fig. 1 - Physiological rhythm of insulin secretion.

There are 4 types of medicine:

• short (simple) insulin;
• intermediate-acting insulin;
• ultrashort insulin;
• prolonged insulin.

In addition, the pharmaceutical industry produces mixed preparations (they contain insulin in 2 forms at once).

Table 1 - Duration of action of the most commonly used human insulin preparations (simplified recommendations).

Short-acting and intermediate-acting insulin is genetically engineered in origin. Ultrashort and prolonged are modern analogues of the human hormone.

The first one:

• works 8-14 hours;
• has a peak action (after 3-5 hours).

Such insulin in the complete scheme is administered 2 times a day. Its main disadvantage is the likelihood of hypoglycemia a few hours after the injection. This condition is especially dangerous at night, when the patient is sleeping.

Extended insulin:

• valid 18-26 hours;
• does not have a pronounced peak of action.

Such insulin works very naturally. It imitates the physiological secretion of the hormone, does not provoke a sharp drop in blood sugar. The prolonged drug is administered 1 time per day.

A simple human hormone:

• begins to act in 30 minutes;
• the peak of its action is fixed after 2-4 hours;
• the total duration of action is up to 5-6 hours.

Such insulin must be administered in advance, before meals. Moreover, at least 15-20 minutes should pass from the injection to the start of the meal. Short insulin works quite slowly. It cannot suppress blood glucose surges after eating sweets. Therefore, such insulin should be combined with a fairly strict diet. The preparation of a simple human hormone acts for a long time. 3-4 hours after eating, all food is already completely absorbed, and insulin still continues to work. This property of the drug is associated with a greater risk of hypoglycemia 4-6 hours after breakfast, lunch or dinner. To reduce the likelihood of a drop in the level of glycemia, patients are advised to take small snacks (3 times a day, 1-2 XE). As a result, in addition to the 3 main meals, the patient's diet also includes 3 additional meals. Of course, such a fractional diet is quite useful, but not always convenient.

Ultrashort analogue:

• begins to act in 5-15 minutes;
• has a pronounced peak of action after 1-2 hours;
• the total duration of its work is up to 4-5 hours.

These insulins are more convenient and more closely mimic the natural secretion of the hormone. They can be administered immediately before meals, when the composition and amount of food is already known. Because of this, it is easier to calculate the dose of the drug. Also, these insulins do not require mandatory snacks. Therefore, it is more convenient to use them for working people, students and schoolchildren. In addition, ultrashort analogs can even cope with a rather sharp rise in blood sugar levels. With the right approach, this makes it possible to sometimes break the diet without harm to health.

Mixed preparations may contain insulins:

• medium and short;
• medium and ultrashort;
• prolonged and ultrashort.

Various solutions are produced, differing in the ratio of components. The proportion of basal insulin usually predominates.

In Russia, mixes are prescribed with the ratio:

• 30/70;
• 25/75;
• 50/50 etc.

Insulin mixtures are only effective in type 2 diabetes. Their properties are made up of the action profile of the components. Mixes are prescribed 1-3 times a day. Most often, injections are required before breakfast and dinner. If it contains an ultrashort analogue, then the injection is given immediately before meals. That mixture, which contains simple insulin, should be administered 15-30 minutes before meals.

Mixes with shares of 25/75 and 30/70 are more suitable for elderly patients with moderate appetite. A mixture with equal parts of basal and postprandial insulin (50/50) is usually prescribed for middle-aged people with an active lifestyle and dietary errors.

Devices for administering insulin

Insulin preparations are solutions for subcutaneous and intravenous administration.

The drug is administered into the vein only during the period of acute decompensation of the disease, that is, during ketoacidosis, lactic acidosis or hyperosmolar coma. At the time of such conditions, the vessels of the subcutaneous fat become empty, and microcirculation in the tissues is suppressed. If you do insulin subcutaneously, then the drug will not work.

Insulin is injected into a vein through a special perfusor device. You can also carry out the usual infusion with solutions of glucose or sodium chloride. But conventional droppers are less effective, since insulin partially settles on the walls of the system.

In ordinary life (during compensation or subcompensation of diabetes), patients carry out insulin therapy on their own. They inject the solution subcutaneously.

For injection use:

• insulin syringes;
• syringe pens;
• insulin pumps.

Solution syringes are disposable. Their volume is 0.5-1 ml. There is a scale on the body of the syringe. 1 ml of solution contains 100 units of insulin. Therefore, the last number on the scale is 100. Outdated syringes with a scale for insulin with a concentration of 40 units per 1 ml are still sold in Russia. These injectors should not be used.

Insulin syringe pens are the most convenient. They are reusable and disposable. These dispensers allow for accurate dosing of insulin. A person with impaired vision can make an injection. An insulin cartridge is inserted into the syringe pen. A needle is connected to the dispenser. The dose is chosen using a visual scale.

Insulin pumps are expensive devices designed to deliver insulin continuously. Cartridges with an ultrashort or short preparation are loaded into such an apparatus. The pump injects the solution subcutaneously through a system with a needle. The device is programmed by the doctor and the patient himself. Insulin is injected every few minutes. This most closely mimics the natural workings of the pancreas.

Some insulin pumps have additional features. They help to calculate the dose of the drug for food, save data on the concentration of glucose in the blood and the need for the hormone. Sometimes devices are equipped with sensors for monitoring glycemia. Such pumps can give warning signals when blood sugar drops sharply or when hyperglycemia is severe.

The pump does not replace the pancreas, although it can approximate its operation. The main delusion of many patients who dream of this modern device is the hope for the simplicity of therapy. In fact, administering insulin with a pump is even more difficult. It requires repeated self-monitoring, constant analysis of glycemia. The patient must know the basics of working with the pump, be able to independently change cartridges and systems with needles, and enter the insulin delivery program.

How to administer insulin correctly?

It is most convenient for the patient to make independent injections into the skin of the abdomen and thighs. You can also use other areas of the body. Doctors and assistants (relatives) can inject into the buttocks, shoulders, calves of the patient, etc.

Short insulin is best administered under the skin of the anterior abdominal wall. From this area, the hormone is absorbed most quickly. This means that adequate reduction of postprandial glycemia is ensured.

Insulin of intermediate duration is preferable to inject into the thigh. From here, the hormone is absorbed rather slowly. Therefore, the drug acts stably and for a long time, covering the need for basal insulin.

In order to avoid local complications of therapy, injection sites are constantly changing (within the same zone). For example, the abdomen is mentally divided into 4 squares (upper right and left above the navel and lower right and left). In the first week of the month, all injections are made only in the upper right square. Then they move on to the next zone (upper left square). The next 7 days, injections are made in this part of the abdomen. Next, moving clockwise, go to the lower left square. Here, injections are performed on the third week of each month. Then they move on to the fourth square. From the beginning of the next month, injections are again performed within the upper right abdomen.

To prepare the syringe for injection:

• medium-acting insulin is mixed (slowly roll the vial between the palms);
• treat the bottle cap with an antiseptic;
• draw air into the syringe (the desired dose of insulin);
• pierce the vial cap with a needle;
• introduce air into the vial;
• collect insulin from the vial (in the required dose plus 1-4 units);
• remove the needle from the vial;
• holding the syringe vertically, remove all trapped air;

Preparation for injection with a syringe pen:

• mix insulin of medium duration of action (the handle is moved up and down along the arc);
• put a needle on a syringe pen;
• check the patency of the needle (release 1-2 units of insulin).

How is the injection performed:

• first, the skin is examined (the presence of inflammation, pollution, lipohypertrophy is assessed);
• then a fold of skin is collected;
• then a syringe or pen needle is inserted into the base of the fold;
• then the entire dose of insulin is slowly injected;
• then the patient counts up to 10-20;
• after the needle is removed and the skin fold is released.

There is no need to clean the skin with an antiseptic every time before the injection. This measure is often redundant. An antiseptic dries out the skin and reduces its protective properties.

menquestions.ru

Insulin therapy aims to maximally compensate for diabetes mellitus and prevent the progression of its complications. Treatment with insulin can be both permanent for life in patients with type 1 diabetes, and temporary, due to various situations for patients with type II diabetes.

Indications for insulin therapy:
1. Type I diabetes.
2. Ketoacidosis, diabetic, hyperosmolar, hyperlaccidemic coma.
3. Pregnancy and childbirth with diabetes.
4. Significant decompensation of type II diabetes due to various factors (stressful situations, infections, injuries, surgical interventions, exacerbation of somatic diseases).
5. Lack of effect from other methods of treating type II diabetes.
6. Significant weight loss in diabetes.
7. Diabetic nephropathy with a violation of the nitrogen excretion function of the kidneys in type II diabetes.

Currently, there is a wide range of insulin preparations that differ in duration of action (short, medium duration and long), degree of purification (monopic, monocomponent) and species specificity (human, swine, cattle - beef).

The Pharmaceutical Committee of the Ministry of Health of the Russian Federation recommends using only monocomponent preparations of human and porcine insulin for the treatment of patients, since beef insulin causes allergic reactions, insulin resistance, and lipodystrophy.

Insulin is produced in vials of 40 U/ml and 100 U/ml for subcutaneous administration with disposable syringes specially designed for the use of insulins of the appropriate concentration of 40-100 U/ml.

In addition, insulin is produced in the form of penfill inserts with an insulin concentration of 100 IU / ml for syringe pens.

Penfills can contain insulins of various durations of action and combined (short + prolonged action), the so-called mixtards.

For use by patients, various syringe pens are produced, allowing you to administer from 1 to 36 IU of insulin once. Novopen I, II, and III pens are produced by Novonordisk (1.5 and 3 ml inserts), Optipen 1, 2 and 4 by Hoechst (3 ml inserts), Berlinpen 1 and 2" - Berlin-Chemie (1.5 ml inserts), Lilipen and B-D pen - Eli Lilly and Becton-Dickenson (1.5 ml inserts).

Domestic production is represented by syringe pens "Crystal-3", "Insulpen" and "Insulpen 2".

In addition to traditional insulins, in the treatment of patients, an insulin analogue, Humalog (by Eli Lilly), is also used, obtained by rearranging the amino acids lysine and proline in the insulin molecule. This led to an acceleration of the manifestation of its hypoglycemic effect and to its significant shortening (1-1.5 hours). Therefore, the drug is administered immediately before meals.

For each patient with diabetes, one or another type of insulin is individually selected in order to improve overall well-being, achieve minimal glucosuria (no more than 5% of the sugar value of food) and acceptable fluctuations in blood sugar levels during the day for this patient (no more than 180 mg% ). J. S. Skyler and M. L. Reeves believe that in order to more reliably prevent or slow down the manifestations of diabetic microangiopathy and other late metabolic complications of diabetes mellitus, the criteria for its compensation should be more stringent (Table 20). For patients prone to hypoglycemic conditions, the glucose level before meals can be 120-150 mg / 100 ml.

Insulin selection should take into account the severity of diseases, previously used therapy and its effectiveness. In polyclinic conditions, the criterion for choosing insulin is fasting glycemia, glucosuric profile data or daily glucosuria. In the hospital, there are great opportunities for a more correct prescription of insulin, as a detailed examination of carbohydrate metabolism is carried out: glycemic profile (determination of sugar in the blood every 4 hours during the day: 8-12-16-20-24-4 hours), 5- one-time glucosuric profile (1st portion of urine is collected from breakfast to lunch; 2nd - from lunch to dinner; 3rd - from dinner to 10 p.m.; 4th - from 22 to 6 a.m.; 5th - from 6 a.m. until 9 a.m.). Insulin is prescribed depending on the level of glycemia and excessive glucosuria.

All insulins, depending on the method of their production, can be divided into 2 main groups: heterologous insulins from the pancreas of cattle and pigs and homologous human insulins from the pancreas of pigs (semi-synthetic) or obtained by bacterial synthesis.

According to the duration of action, insulins are divided into preparations of short, medium duration and long action (Table 21).

At present, monospecies highly purified insulins (monopic and monocomponent) are produced, devoid of impurities. These are mainly preparations of porcine insulin with different duration of action. They are used mainly for allergic reactions to bovine insulin, insulin resistance, lipodystrophy. Certain hopes were pinned on the use of human semi-synthetic and genetically engineered insulin in medical practice. However, the expected significant differences in its hypoglycemic effect or the effect on the formation of antibodies to insulin compared with monocomponent porcine insulin were not found.

Thus, at present, industrial production of various types of insulin has been established, the prolonged action of which depends on special processing and the addition of protein and zinc to them.

Patients with newly diagnosed diabetes mellitus and hyperglycemia and glucosuria that do not disappear within 2-3 days against the background of dietary restriction require insulin therapy. If at the same time the patient's body weight deviates from the ideal by no more than ± 20% and there are no acute stressful situations and intercurrent infections, then the initial dose of insulin can be 0.5-1 U / (kg-day) (based on the ideal weight body) with subsequent correction within a few days. Short-acting insulin can be used in the form of 3-4 single injections or a combination of short-acting and extended-acting insulin. J. S. Skyler and M. L. Reeves recommend even in the remission phase to prescribe insulin to patients at a dose of 0.4 U / (kg x day), and for pregnant women (during the first 20 weeks) - 0.6 U / (kg x day). The dose of insulin for patients with diabetes mellitus who have already been treated before should, as a rule, not exceed, on average, 0.7 U / (kg x day) in terms of ideal body weight.

The presence in medical practice of drugs of various duration of action led at first to the tendency to create "cocktails" to provide a sugar-lowering effect during the day with one injection. However, this method did not allow in most cases, especially in the case of a labile course of the disease, to achieve its good compensation. Therefore, in recent years, various insulin administration regimens have been used that provide maximum compensation for carbohydrate metabolism with glycemic fluctuation limits during the day from 70 to 180 or 100-200 mg / 100 ml (depending on the criteria).

The used regimens of insulin therapy in patients with type 1 diabetes mellitus are largely determined by such factors as the presence and severity of residual secretion of endogenous insulin, as well as the participation of glucagon and other contrainsular hormones in eliminating significant fluctuations in blood sugar (hypoglycemia) and the severity of the insulin response to administered insulin. food components, glycogen stores in the liver, etc. The most physiological is the mode of multiple (before each meal) injections of insulin, which allows to stop postprandial hyperglycemia. However, it does not eliminate fasting hyperglycemia (at night), since the duration of action of simple insulin until the morning is not enough. In addition, the need for frequent injections of insulin creates certain inconveniences for the patient.

Therefore, the mode of repeated administration of insulin is most often used to quickly achieve compensation for diabetes as a temporary measure (to eliminate ketoacidosis, decompensation against the background of intercurrent infections, as preparation for surgery, etc.). Under normal conditions, injections of simple insulin are usually combined with the introduction of an extended-release drug in the evening, taking into account the peak time of their action to prevent nocturnal hypoglycemia. Therefore, in some cases, the drugs "tape" and "long" are administered after the second dinner before bedtime.

The most convenient for students and working patients is a double regimen of insulin administration. At the same time, short-acting insulins are administered in the morning and in the evening in combination with medium-acting or long-acting insulins. If at 3-4 a.m. there is a decrease in blood sugar below 100 mg / 100 ml, then the second injection is postponed to a later time so that the decrease in sugar occurs in the morning, when you can examine the level of glycemia and eat. In this case, the patient should be transferred to a 3-time regimen of insulin administration (in the morning - a combination of insulins, before dinner - simple insulin and before bedtime - extended) (Fig. 48).

The calculation of the insulin dose when transferring the patient to 2-time injections is as follows: 2/3 of the total daily dose is administered in the morning and 1/3 in the evening; 1/3 of each calculated dose is short-acting insulin, and 2/3 is extended-acting insulin. With insufficient compensation for diabetes, increase or decrease the dose of insulin, depending on the level of blood sugar at a specific time of day, by no more than 2-4 units once.

According to the beginning and maximum effect of each type of insulin and the number of injections, meals are distributed throughout the day. The approximate ratios of the daily diet are: breakfast - 25%, second breakfast - 15%, lunch - 30%, afternoon snack - 10%, dinner - 20%.

The degree of compensation for diabetes mellitus against the background of ongoing therapy is assessed by the glycemic and glucosuric profile, the content of hemoglobin HbA1c in the blood and the level of fructosamine in the blood serum. Methods of intensive insulin therapy. Along with traditional methods of insulin therapy, since the beginning of the 80s, a regimen of multiple (3 or more) insulin injections during the day (basal-bolus) has been used.

This method allows you to maximally reproduce the rhythm of insulin secretion by the pancreas of a healthy person. It has been proven that the pancreas of a healthy person secretes 30-40 units of insulin per day. It has been established that the secretion of insulin in healthy people occurs constantly, but at different rates. So, between meals, the rate of its secretion is 0.25-1.0 U / h, and during meals - 0.5-2.5 U / h (depending on the nature of the food).

The intensive insulin therapy regimen is based on the imitation of constant pancreatic secretion - the creation of a basic level of insulin in the blood by administering long-acting or intermediate-acting insulin at a dose of 30-40% of the daily dose before bedtime at 22:00. During the day before breakfast, lunch and dinner, sometimes before the 2nd breakfast, short-acting insulin is administered in the form of supplements - boluses, depending on the need. Insulin therapy is carried out using syringe pens.

When using this method, the level of glucose in the blood is maintained within the range of 4-8 mmol/l, and the content of glycated hemoglobin is within its normal values.

The regime of intensive insulin therapy by multiple injections can only be carried out if there is motivation (the patient's desire), active education, the ability to examine the glucose level at least 4 times a day (test strips or a glucometer) and constant contact between the patient and the doctor.

Indications for intensive care are newly diagnosed type I diabetes, childhood, pregnancy, absence or initial stages of microangiopathy (retino-, nephropathy).

Contraindications for the use of this method of insulin therapy are:
1) a tendency to hypoglycemic states (if before bedtime the glucose level<3 ммоль/л, то ночная гипогликемия возникает в 100 % случаев, а если <6 ммоль/л, то в 24 %);
2) the presence of clinically pronounced microangiopathy (retino-, neuro-, nephropathy).

Side effects of intensive insulin therapy include a possible worsening of the manifestations of diabetic retinopathy and a 3-fold increase in the risk of hypoglycemic conditions (nocturnal and asymptomatic), weight gain.

Another method of intensive insulin therapy is the use of wearable insulin micropumps, which are dosing devices filled with short-acting insulin and injecting insulin under the skin in portions according to a predetermined program. Side effects are similar plus possible pump failure and risk of ketoacidosis. Micropumps have not received wide distribution.

The goal of intensive insulin therapy is the ideal compensation of carbohydrate metabolism to prevent the development of clinical forms of late complications of diabetes mellitus that do not undergo regression.

In a number of countries, the production of individual wearable devices based on the principle of diffusion pumps has been mastered, with the help of which insulin under pressure at a rate regulated depending on the need is delivered through a needle under the patient's skin. The presence of several regulators that change the rate of insulin intake allows, under the control of the level of glycemia, to set the mode of its administration for each patient individually.

The inconveniences of using and disadvantages of these devices include the lack of a feedback system, the possibility of pressure sores, despite the use of plastic needles, the need to change the area of ​​insulin administration, as well as the difficulties associated with fixing the device on the patient's body. The described diffusion pumps have found application in clinical practice, especially in the labile form of diabetes mellitus. In this case, the chamber of the diffusion pump can be filled with any type of short-acting insulin, including homologous ones.

Other methods of treatment with human insulin, associated with transplantation of the pancreas or its fragments, have not yet received wide distribution due to serious obstacles due to manifestations of tissue incompatibility. Attempts to find methods of oral administration of insulin (on polymers, liposomes, bacteria) also failed.

N.T. Starkov

medbe.ru

Benefits for diabetics

Free insulin for diabetics is provided for those categories of patients who are prescribed insulin therapy, regardless of the type of diabetes mellitus. Such assistance is provided to Russians, as well as to persons who have received a residence permit.

The regulation on the free provision of medicines provides for the issuance, in addition to insulin, of means for controlling glucose levels in case of diabetes mellitus. For diabetic patients who are on constant insulin therapy, a device for monitoring blood sugar and test strips for it are given free of charge at the rate of 3-time measurement of glycemia.

In type 2 diabetes, the list of free medicines in 2017 includes gliclazide, glibenclamide, repaglinide, metformin. Also, in the second type of diabetes, patients receive test strips in the amount of 1 piece per day, if insulin is not prescribed, then patients must purchase a glucometer at their own expense.

At the same time, if the patient is not on insulin, but belongs to the category of visually impaired, then for him a device for measuring glucose and one test strip per day is issued at the expense of public funds.

The procedure for issuing prescriptions for free insulin includes the following rules:

1. Before issuing a prescription, an endocrinologist conducts an examination and laboratory tests.
2. The frequency of issuing prescriptions is once a month.
3. The patient must receive a prescription only personally.
4. Refusal to issue a prescription cannot be justified by a lack of funds, since all payments are made at the expense of the federal or local budget.
5. Disputable cases are resolved by the administration of the polyclinic or the territorial fund of compulsory medical insurance.

In order to get a prescription from an endocrinologist, you must have a passport, medical policy, insurance certificate, disability certificate (if any) or other document confirming the right to preferential insulin.

In addition, it will be necessary to obtain a certificate from the Pension Fund stating that the patient has not refused the benefits provided.

In case of refusal (partial or complete), beneficiaries are provided with monetary compensation, but its amount may not fully cover the costs of treatment and rehabilitation.

How to get insulin in a pharmacy?

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You can get insulin free of charge at pharmacies with which the clinic has an agreement. Their addresses must be reported to the patient by the doctor when issuing a prescription. If the patient did not have time to come to the doctor's appointment on time, and therefore was left without a prescription, then it can be bought for money at any pharmacy.

For patients who need daily insulin injections, it is important to have a supply of the drug in order not to miss an injection for any reason - for example, due to work schedules, lack of insulin in a pharmacy, moving. Without the timely introduction of the next dose of insulin into the body, irreparable metabolic disorders develop and even death is possible.

If only the patient with diabetes himself can apply for a form to the doctor, then a relative or any representative of the patient can get it at the pharmacy. A prescription for medicines and supplies is valid for 2 weeks to 1 month. A note about this must be made on the issued prescription.

If the pharmacy answered that we do not dispense insulin for free, then you will need to receive a written refusal indicating the reason for the refusal, the date, signature and seal of the organization. With this document, you can contact the regional branch of the Compulsory Medical Insurance Fund.

If there is a temporary lack of insulin, you need to take the following actions:

• Enter the prescription number in the social journal at the pharmacist in the pharmacy.
• Leave contact details so that the pharmacy employee can notify you of the receipt of the drug.
• If the order is not fulfilled within 10 days, the administration of the pharmacy must warn the patient and send him to other outlets.

In case of loss of a prescription, you should contact the doctor who wrote it as soon as possible. Since, in addition to issuing a new form, the doctor must notify the pharmaceutical company about this.

Such precautions should prevent the illegal use of medicines.

Refusal to write a prescription for free insulin

In order to get clarifications in case the doctor refuses to provide a prescription for insulin or prescribed medicines and medical products, you must first contact the head physician of the medical institution. If this issue could not be clarified at his level, then you need to ask for a written refusal.

The request for documentary confirmation of the refusal may be oral, but in a conflict situation it is better to make two copies of a written request addressed to the head doctor, and from the secretary to receive a mark on the second copy about the acceptance of the request in incoming correspondence.

In accordance with the law, the medical institution must issue a response to such a request. In this case, you can contact the Compulsory Medical Insurance Fund. In writing, you must submit a statement that a particular medical institution waives its obligation to provide preferential prescriptions for diabetic drugs.

If it is likely that these steps will not result in a positive response, then the next steps might be:

1. Written appeal to the Ministry of Health.
2. Application to the bodies of social protection of the population.
3. Complaint to the Prosecutor's Office against the actions of medical workers.

Each application must be in duplicate, on the copy that remains in the hands of the patient, there must be a mark on the acceptance and registration of correspondence from the institution to which the request is sent.

Benefits for children with diabetes

When type 1 diabetes is detected, children are given disability without determining the group number. Over time, it can be removed or re-registered, depending on the severity of the course of the disease. Children can count on preferential receipt of vouchers for treatment in a sanatorium once a year.

The state pays for travel to and from the place of treatment, treatment and accommodation in a sanatorium, and parents are given the opportunity to receive compensation for accommodation during the child's recovery.

Children, as well as pregnant women with or without a disability group, can receive a free blood glucose meter and test strips, syringe pens, as well as medicines that lower sugar levels.

In order to receive benefits, you must pass a medical examination. This may require the following documents:

• Application from parents.
• Passport of parents or guardian, birth certificate. After 14 years - the child's passport.
• Outpatient card and other medical documentation.
• If this is a re-examination: a certificate of disability and an individual rehabilitation program.

How to get a ticket to the sanatorium?

For diabetics, a referral to spa treatment in specialized sanatoriums is provided. To get a free ticket, in the district clinic you need to take a certificate in the form No. 070 / y-04, and if the child has diabetes, then - No. 076 / y-04.

After that, you must contact the Social Insurance Fund, as well as any social security agency that has concluded an agreement with the Fund. This year, this must be done by December 1st.

Within ten days prescribed by law, a response must be received on the provision of a voucher to a sanatorium that corresponds to the profile of the disease, indicating the date of commencement of treatment. The voucher itself is provided to the patient in advance, no later than 21 days before arrival. It must be fully completed, have the seal of the Social Insurance Fund, a note on payment at the expense of the federal budget. These tickets are not for sale.

Two months before departure or later, you need to issue a health resort card in the same medical institution that issued the referral for sanatorium treatment. It contains information about the main and concomitant diagnoses of the patient, the treatment taken, the conclusion about the possibility of undergoing a rehabilitation course in such a sanatorium.

You can also apply for a ticket to the Department of Federal Vouchers under the Ministry of Health of the Russian Federation. In this case, in addition to the application, you need to collect the following documents:

1. Passport of a citizen of the Russian Federation and its two copies with pages No. 2,3,5.
2. If there is a disability, then two copies of the individual rehabilitation plan.
3. Insurance number of an individual personal account - two copies.
4. Certificate of disability - two copies.
5. From the Pension Fund a certificate stating that there are non-monetized benefits for this year - the original and a copy.
6. Certificate in the form No. 070 / y-04 for an adult, No. 076 / y-04 for a child, issued by the attending physician. It is valid for 6 months only.

If for some reason it is impossible to go for treatment, then you need to return the ticket no later than seven days before the start of the action. After treatment in a sanatorium, you must provide a tear-off coupon to the voucher to the institution that issued it, and an extract on the procedures performed must be provided to the attending physician.

In order not to encounter problems when applying for benefits for a child with diabetes mellitus and an adult category of citizens for receiving medicines and vouchers for recovery, you need to regularly visit an endocrinologist and undergo the required examinations from related specialists on time, as well as a set of laboratory diagnostic tests. This interaction contributes to better control of diabetes.

The video in this article talks about benefits for diabetics.

diabetik.guru

Many in every way try to delay the day when they have to sit tight on the needle. Indeed, with diabetes, insulin is simply necessary and in fact it is good that there is an opportunity to support the body in this way.

Sooner or later, all patients with type 2 diabetes are faced with a situation where insulin is prescribed. This helps not only to prolong life, but also to avoid the terrible consequences and symptoms of this disease. A diagnosis of a certain type must necessarily be confirmed in order to prescribe such a serious medicine, otherwise it will only play a negative role.

Features of insulin in the body

Initially, everything in the body is thought out in detail. The pancreas works, in which there are special beta cells. They are responsible for the production of insulin. In turn, he compensates for diabetes.

Doctors do not immediately diagnose insulin diabetes, first they try to restore health in other ways. A variety of medications are prescribed, lifestyle changes, patients must adhere to a very strict diet. In the event that there is no proper result, or over time, these methods cease to work, then insulin is needed for diabetics. The pancreas depletes naturally every year and needs to be monitored to know exactly when to switch to insulin.

Why do they start injecting insulin

A healthy pancreas works stably and can produce enough insulin. However, over time it becomes too small. There are several reasons for this:

• too much sugar content. Here we are talking about a significant increase of more than 9 mmol;
• errors in treatment, these may be non-standard forms;
• too many drugs taken.

An increased amount of glucose in the blood is forced to ask the question that in diabetes mellitus they are pricked, a certain type of diagnosis obliges injections. Naturally, this is insulin, which is not enough in the form of a substance produced by the pancreas, however, the dosage of the drug and the frequency of administration are determined by the doctor.

First of all, you should pay attention to high blood sugar. Already an indicator of more than 6 mmol / l in the blood indicates that it is necessary to change the diet. In the same case, if the indicator reaches nine, it is worth paying attention to toxicity. This amount of glucose practically kills pancreatic beta cells in type 2 diabetes. This state of the body even has the term glucose toxicity. It is worth noting that this is not yet an indication for the prompt appointment of insulin, in most cases, doctors first try a variety of conservative methods. Often, diets and a variety of modern drugs perfectly help to cope with this problem. How much the insulin intake will be delayed depends only on the strict observance of the rules by the patient himself and the wisdom of each doctor in particular.

Sometimes it is only necessary to temporarily prescribe medications to restore the natural production of insulin, while in other cases they are needed for life.

Taking insulin

In the event that there is practically no other way out, you should definitely agree to the appointment of doctors. In no case should you refuse injections because of fear, because without them the body simply continues to break down with great speed with a diagnosis of this type. Often, after the appointment of insulin, patients manage to get off the injections and go back to the pills, this happens if it is possible to achieve the work of beta cells in the blood and they have not yet died completely.

It is very important to observe the dosage and the number of injections as clearly as possible, this may be the minimum amount of the drug only 1-2 times a day. Modern instruments make it possible to make sterile and painless injections of this type very quickly. These are not even ordinary syringes with a minimal needle, but even special pens. Quite often, just fill it up and simply put it in place and press the button so that the medicine is in the blood.

It is also worth paying attention to those places where medicines should be injected. These are the arms, legs, buttocks, as well as the abdomen, excluding the area around the navel. There are many places where it is quite convenient to do injections on your own in any conditions. This is important for patients who cannot afford regular nursing care or who want to be as independent as possible.

In type 2 diabetes mellitus, insulin is prescribed very often, almost everyone will have to hear a terrible phrase from a doctor sooner or later that now the treatment will consist of injections with this drug. By this time, each patient had already read very scary stories, and maybe had seen enough of amputated limbs. Very often it is associated with insulin in the blood.

In fact, you need to remember at what level of blood sugar insulin is prescribed, usually this is already a serious stage, when pancreatic cells are poisoned and they stop working altogether. It is with their help that glucose reaches the internal organs and provides energy. Without this protein, the body simply cannot exist, so if beta cells no longer produce insulin, you just need to inject it, there is no other way out and you should not try to avoid this treatment. Toxicity is provided precisely by the sugar indicator, and not by insulin; moreover, even a heart attack or stroke and an early death are possible. With proper observance of all the doctor's advice and rational treatment, the patient can live for a long time and with many positive emotions.

Dosage Importance

During insulin treatment of diabetes mellitus, sick people often suffer from a variety of consequences. However, these factors appear precisely because of the sugar, and not because of the drug itself. Most often, people themselves simply deliberately reduce the dosage prescribed by the doctor, which means that they continue to maintain sugar levels at a high level. Do not be afraid, a professional doctor will never prescribe too much medicine to bring to a low sugar level.

Serious problems can arise as a result of refusal of insulin or violation of the dosage:

• ulcers on the feet, which in the future even lead to amputation, tissue necrosis occurs, death is accompanied by severe pain;
• blindness, sugar acts as a toxic substance on the eyes;
• poor kidney function or even kidney failure;
• heart attacks and strokes.

All these are irreversible processes. Be sure to start taking insulin in a timely manner, as well as correctly observe the number of injections and its dosage.

A high level of sugar, which is constantly maintained in the blood, leads to serious damage in the body, and the worst thing is that they are not reversible, necrosis, blindness, etc. cannot be cured, and the right dosage can only stop the process.

Consequences of insulin

There are a lot of myths around insulin. Most of them are lies and exaggerations. Indeed, everyday injections cause fear, and his eyes are large. However, there is one true fact. This is primarily what insulin leads to fullness. Indeed, this protein with a sedentary lifestyle leads to weight gain, but this can and even needs to be fought.

Even with such a disease, it is imperative to lead an active lifestyle. In this case, the movement is an excellent prevention of fullness, and can also help reawaken the love of life and distract from worries about your diagnosis.

Also, be sure to remember that insulin does not exempt from the diet. Even if sugar has returned to normal, you must definitely remember that there is a tendency to this disease and you can’t relax and allow anything to be added to the diet.

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