Diabetes Type 1
Formerly known as' insulin-dependent diabetes "(IDDM, or juvenile diabetes), this disease is a form of diabetes mellitus that appears most often in a brutal childhood or young adulthood. It is characterized by excessive urination (polyuria), thirst (polydipsia) and an abnormally increased appetite (polyphagia). It has also resulted in weight loss despite an abundant food intake, hyperglycemia (that is to say, an excess of glucose in the blood) greater than 1.26 g / l of blood sugar on an empty stomach or upper 2 g / L (11mmol / l) at any time of day, with occasional presence of acetone in urine with a breath of "pippin" feature.
The type 1 diabetes is an autoimmune disease in 90% of cases (10% idiopathic) leading to destruction of beta cells of islets of Langerhans. These cells are responsible for controlling blood sugar (glucose in the blood) by the production of insulin according to blood sugar and, in cases of hyperglycemia, insulin is produced in greater quantity. Insulin is a hormone that allows glucose utilization, in coordination with glucagon, also secreted by the islets of Langerhans in the pancreas, and whose action opposes that of insulin. Insulin is secreted high after meals. High concentrations promote storage of glucose in the liver, muscle and adipose tissue. The concentration of insulin to decrease between meals, allowing the release of these stocks, mainly glycogen formed in liver after a meal glucose from food. If fasting is prolonged over 12 hours, insulin levels decline further, allowing the production of glucose from other substrates: glycerol from adipose tissue lactate and muscle proteins. At the same time, when fasting is prolonged, the functioning of the body, brain in particular is oriented towards the use of other energy substrates: fatty acids and ketones. The destruction of these cells that secrete insulin, which are located in the pancreas has resulted in a lack of insulin in the blood and a blood glucose level. The complete absence of insulin triggers both a mass production of glucose by the liver and a mass production of ketones which, unused, accumulate in the blood is ketoacidosis. The type 1 diabetes must inject insulin several times daily throughout their life and eat a balanced diet. The glycemic control is precarious and food processing vary from day to day depending on circumstances (activities, emotions, schedules, illness, etc..). The diabetic must be autonomous in its management of the disease.
Mixed and NPH insulin
Insulin type NPH insulin is slow, which has a peak effect of about 5-6h after injection. The pattern from this type of insulin is usually two injections of insulin slow, morning and evening, and injections of insulin morning and evening as well. Lunch does not usually require insulin because it is covered by the peak action of insulin slow. The disadvantages of this scheme are: the need to eat at fixed times and inability to skip a meal (risk of hypoglycaemia), waking at set times for the morning injection, risk of hypoglycemia during the night at peak action of insulin slow. The mixed insulins, insulin mixing slow and fast, are convenient because they can do two injections in one. However, they offer less freedom, since it is impossible to change the dose of insulin without changing the dose of insulin slow.
The pump allows insulin treatment of type "basal / bolus. This is a small device the size of a mobile phone, it must address itself continuously. It is connected to a subcutaneous catheter, which must be changed regularly by the diabetic and injects fast acting insulin or continuous insulin corresponding to slow the classic pattern. The advantage of this system is that it allows to regulate the flow of insulin every hour, which is advantageous when needs differ depending on time of day, and reduces the number of severe hypoglycemia, especially during night. This "base flow" is completed, as in the previous case, with supplements of insulin at mealtime or in case of hyperglycemia, which are also administered by the pump. However, the insulin pump is entirely controlled by the diabetic: the device can not only determine how much insulin to inject. As with injection therapy, the diabetic must know how much insulin he needs to when and under what circumstances. This treatment is suitable for everyone. It is especially recommended for pregnant women because of the flexibility it provides and which is adapted to rapid changes in their needs due hormonal changes during pregnancy. It is also recommended for children because of that flexibility: it facilitates the management of diabetes in cases of sickness and prevents the child from having to eat the same amounts every day same time.
Insulin pen injection: schema "basal bolus"
The scheme called "basal bolus" is leaving more freedom to diabetics regarding time and content of meals and physical activity, managing contingencies. It consists of one or two daily injections of ultralente insulin or to slow action curve flat (no peak of action) and an injection of insulin or fast for each meal or snack. Insulin slow, called "basal", covers the basic needs of the body, without any food intake: delaying or skipping a meal is no longer a problem. A single injection may be sufficient (novo), and time of injection should be adapted on a case by case basis. In other cases (treatment Actrapid) insulin has a shorter action, and two daily injections are needed (usually morning and evening). The insulin (bolus) covers every food intake during the day and allows to vary the amount of carbohydrates ingested by varying the number of units injected. The insulin is also used to correct hyperglycemia without food intake. This salary may not be prescribed to everyone: The flat-acting insulins are recent, and we do not yet know all the consequences. Therefore they are generally not recommended for pregnant women and young children.
Read also Diabetes type 2