Long insulin. How to choose long-acting insulin

Insulin is a drug that which is used in the complex therapy of diabetes mellitus. The funds differ in their indications and duration of action (short, long). To choose the right drug, you should consult a specialist.

Principle and mechanism of action of long insulin preparations

The substance is a collection of different amino acids produced by the pancreas. At the same time, it acts on almost all tissues and organs of a person, however, insulin has a direct effect on the liver, muscle and adipose tissue.

The substance reacts with specific receptors that are located on cell membranes. In this case, the so-called insulin-receptor complexes arise.

Injections are responsible for carbohydrate metabolism, help enhance the passage of glucose across cell membranes, and allow glucose to be converted into glycogen. This process takes place in the liver.

In addition, the drug promotes the activation of fat metabolism. It inhibits lipolysis and reduces the amount of fatty acids entering the bloodstream, while activating their synthesis.

Injections are directly involved in metabolic reactions associated with the conversion of proteins. They contribute to an increase in the transport of amino acids, activate the synthesis of peptides.

The level of insulin produced by the pancreas is influenced by the amount in the blood. sugar, concentration of electrolytes, amino acids and some hormones produced by the body (somatostatins, glucagon).

Difference between short and long acting insulin

There is a significant difference between long-acting and short-acting drugs. The main distinguishing feature between insulins is the period of their action. For solutions with a short period of activity, the maximum duration of action varies from 2 to 4 hours.

Long insulin does not have this period of time. At the same time, the agent remains in the blood throughout the day. For short insulin, this indicator varies within 8 hours.

Also, the distinguishing features between short-acting and long-acting drugs are the components from which they are made.

A solution with a short period of activity is made from animal or human insulin, with a long action - exclusively from an animal or its analogs (the closest to a human is considered to be a pig insulin).

Another difference between drugs is the purpose for which they are used. In the first case, injections are given to prevent changes in blood sugar levels after a meal. In the second case, the agent is used to accumulate the required concentration of glucose in the body.

Indications for the use of long insulin

Long insulin should be chosen by the attending physician on the basis of the research carried out.

Recommendations for the appointment:

• type 1 diabetes mellitus, including pathology occurring during pregnancy (if it is necessary to use the drug, insulin-dependent forms of disorder);
• labile type of the disease due to an increased content of antibodies to insulin;
• pancreatic cell transplant;
• type 2 diabetes mellitus (with the body's resistance to these types of drugs);
• intercurrent pathologies;
• surgical interventions;
• the period of bearing the child (while dieting).

The drug is used only with an established diagnosis and with the permission of a doctor.

Contraindications

Long-acting drugs have several limitations that can aggravate the course of the disease and cause additional complications.

Contraindications:

• disorders accompanied by a decrease in blood glucose levels;
• acute liver diseases;
• damage to the pancreas (exacerbated conditions);
• acute kidney disease;
• allergy to components;
• the presence of ulcers in the stomach and duodenum;
• heart failure (in the stage of decompensation).

Before using injections, you should first undergo studies that will confirm or deny the presence of contraindications.

Precautions and special instructions

When replacing and prescribing a different drug, a dosage adjustment may be required. The process should be monitored by a doctor. Before starting therapy, it is necessary to conduct several studies, especially in patients with a predisposition to the development of chronic heart failure. Moreover, during treatment, it is necessary to constantly undergo such examinations.

If a patient has diabetic retinopathy in the first days of therapy, the course of the disease may be complicated. However, taking drugs reduces the risks of further development of pathology. The use of drugs can lead to the formation of antibodies, therefore, it is necessary to systematically monitor these changes. It is recommended to refrain or exercise great care when driving vehicles, since in some cases the medication can cause various reactions from the central nervous systems.

How insulin is selected, by what criteria

You need to choose long insulin according to several basic rules. The main factor for the selection of a drug is the therapy regimen. The most common is the basal-bolus regimen, which maintains normal blood sugar levels.

Other criteria:

• form of the disease;
• the severity of the pathology;
• the age and gender of the patient;
• the method of administration of the drug is oral, injection.

The degree of tolerance of one or another component that is part of the drug is also taken into account.

Where to inject extended insulin?

Long-acting insulin is administered in 2 main ways: subcutaneously or intramuscularly. In this case, only drugs with a short duration are injected intravenously. However, for long-term insulin, subcutaneous injections are the most optimal route of administration.

Solutions should be at an acceptable (room) temperature as cold injections have lower absorption. In this case, the duration of the absorption of the solution depends on the area where it is injected.

Thus, preference is given to areas such as the buttocks, abdomen, thighs, upper arms. The area of ​​administration is determined individually, based on the dosage used and the level of insulin in the solution.

How to find the dose of extended insulin

The dosage of the drug is calculated according to the time of day, the severity of the disease, the area of ​​administration and other characteristics. In this case, special attention should be paid to the daily time. For the evening and day, dosages are calculated differently and require mandatory consultation with a doctor.

Night dose

The night dose of the administered solution should be such that in the morning after waking up, blood sugar remains within the permissible range.

If the concentration of sugar in the blood is high in the evening, it is recommended to introduce a standard dosage of the drug with a long period of action. As a supplement, a small dose of a short or ultrashort agent should be administered.

It is recommended to carry out systematic monitoring of blood counts during the day and dinner in order to choose the right evening dose. In this case, you should build your daily routine and nutrition in such a way that by the evening the concentration of sugar in the blood is within normal limits.

Daily dose

Long insulin can be selected for daily administration through partial withdrawal or skipping meals. For more accurate and reliable data, it is recommended to fast throughout the day. In this case, it is necessary to check the concentration of sugar in the blood every hour.

In infants or preschool children, measurements are taken periodically, alternately excluding breakfast, dinner or lunch.

In this case, it is necessary to control the sugar indicators on an empty stomach. It should vary within acceptable limits - from 3.8 to 5.5 mmol / L.

If the glucose level is elevated after sleep, it is recommended to administer a standard dosage of a long-acting solution and a small short-acting or ultra-short-acting rate. This is necessary to normalize sugar indicators and compensate for it before breakfast.

What is the best time to take injections

Patients are advised to administer insulin at the same time no more than 1 time per day. In this case, the time may deviate from the previous injection by 2-3 hours.

However, according to experts, long-acting drugs are recommended to be administered twice a day - in the morning and in the evening before bedtime. Moreover, the first injection must be given immediately after waking up, and the second - as late as possible before going to bed.

This is due to the fact that overnight the concentration of glucose has decreased and its obligatory restoration to the optimal level is required.

How to inject long insulin when acetone is detected in urine

Often, patients with diabetes mellitus are prescribed diet food as a supplement. At the same time, when such diets are observed, acetone is often found in the urine in patients. The condition does not pose a threat to health in cases where the blood glucose concentration is 8-9 mmol / l.

For values ​​over 9 mmol / l, a solution must be injected. The dosage in the presence of acetone in the urine remains unchanged as long as the sugar level is maintained at an optimal level.

It should be borne in mind that the intake of an increased amount of carbohydrates does not affect the level of acetone in any way.

Do I need to eat after a long insulin injection?

The use of injections does not exclude food intake. Regardless of which drug is used, it is imperative to eat food. In this case, the solution is injected in 10-15 minutes. before meals or immediately after breakfast or dinner.

Side effects and overdose

Long insulin in some cases can lead to undesirable effects, therefore, the choice of the drug should be extremely careful and only if all components are well tolerated.

Adverse reactions to the drug occur infrequently and can be associated with both the physiology of the patient and the effect of active substances on the body.

Side effects:

• Low blood sugar (hypoglycemia): nausea, weakness and lethargy, episodes of dizziness, visual impairment, pallor of the skin, increased appetite, heart palpitations. There may also be confusion, impaired coordination of movements, a feeling of numbness, anxiety and anxiety, hyperhidrosis, migraines. In more rare cases, taking the drug can lead to nightmares and stroke.
• Local signs: burning sensation at the injection sites. Allergic reactions may also occur - rash, itching, hyperemia, edema, anaphylactic reactions, hematomas and irritation, lipoatrophy (impaired deposition of subcutaneous fat).
• Other manifestations: weight gain, infections (mycobacteria).

With the development of such signs, you should consult a specialist for advice. In this case, the termination of therapy is not required. An insulin overdose can occur when the drug is used incorrectly, as well as in cases where breakfast or dinner has been missed.

Possible symptoms:

• increased fatigue and weakness;
• anxious states;
• tremors in the upper limbs (tremors);
• hyperhidrosis (excessive sweating);
• visual impairment - blurred or blurred;
• migraine;
• muscle spasms;
• somatic disorders - sleep disorders, irritability, depressive conditions, increased drowsiness.

When these signs occur, you first need to measure your blood sugar level. When skipping food, eat or consume fresh juice, hard candy, or other sweets.

If the glucose concentration remains low for 2 hours, you must urgently call a doctor at home.

Every patient with diabetes should have an antidote (glucagon) in the medicine cabinet. If necessary and with the permission of a specialist, it should be entered.

As a preventive measure against the development of an overdose, it is recommended to observe and fulfill the following requirements:

• Schedule. It is necessary to keep a record and record the hours of taking medications, as well as their names.
• Compliance with the rules and schedule of meals. You should not skip breakfast, lunch or dinner. You need to eat regularly and in accordance with the established rules (in each case, they are determined individually).
• It is recommended that you inform family, colleagues and friends about what to do if you have a seizure.

It is also recommended to purchase a special device (bracelet) that informs that the patient suffers from diabetes.

List of the best drugs in the group, release forms, prices

Long insulin can be chosen only from the recommendations provided by a specialist. The drugs are available in various dosage forms and carry different trade names. Such funds are selected individually, according to the form of the disease, the physiological characteristics of the patients and other characteristics.

Name of the drug	Release form	Description	Price
Lantus	Solution	Manufacturer - Germany. A medication for subcutaneous administration is used. Indications: diabetes mellitus (insulin-dependent form of pathology). Dosage: 1 injection per day at any time. Daily rates can be changed by the treating specialist. Age restrictions - for adults and children over 2 years old. The product is used with extreme caution while carrying a child.	RUB 2960-3310
Levemir	Solution	Country of origin - Denmark. A medicine is made based on an analogue of human insulin (detemir) and is prescribed in the treatment of insulin-dependent diabetes mellitus. Daily rates: 1 injection at the same time of day. In this case, if necessary, the dosage can be changed by the attending physician. During pregnancy, the medication is used with extreme caution. Age restrictions - for adults and children over 1 year old.	RUB 3000-3670
Tudgeo SoloStar	Solution	Manufacturer - Germany. The drug is used for subcutaneous administration. It is analogous to human insulin (glargine). It is prescribed in the treatment of insulin-dependent diabetes mellitus. Application features: 1 or 2 times a day at the same time. The duration of therapy is constant. Age restrictions - for adults and children at least 2 years old.	RUB 2440-4930
Siofor	Pills	A drug based on metformin is prepared and used in complex treatment with insulin for diabetes mellitus (including overweight patients with ineffective exercise or diet). Dosage regimen: 0.5 g 1-2 times a day. The duration of treatment is constant or as recommended by a doctor. The product is not used during pregnancy and breastfeeding. Age restrictions - for adults and children over 10 years old. The medicine has other contraindications, which should be consulted in advance.	RUB 100-260
Basaglar	Solution	Manufacturer - Switzerland. The active ingredient is insulin glargine. The medicine is intended for subcutaneous administration. Indications: diabetes mellitus, which requires the introduction of insulin. Daily dosage: 1 time, preferably at the same time. Injections can be given while carrying a baby and while breastfeeding. Age restrictions - for adults and children over 2 years old. Contraindications: allergy to the components of the solution.	RUB 2500-3500
Tresiba FlexTouch	Solution	Manufacturer - Denmark. The active ingredient is insulin degludec. The solution is used in the treatment of diabetes mellitus, accompanied by insufficient insulin production. Dosage: 1 time per day, preferably at the same time. Applied daily for a long time (lifelong). Contraindications: carrying a child, breastfeeding period. Age restrictions - for adult patients.	RUB 4140-4500

Before using any of these insulins, you should consult your doctor and thoroughly study the instructions for their use. The doctor who is seeing the patient should choose the most suitable long-acting drug.

Long insulin video

Long insulin: names of drugs, how to prick: