Insulin therapy

Insulin therapy is the use of insulin for treatment. Insulin is widely used in the treatment of diabetes (see Diabetes mellitus), in psychiatric practice (see below). Insulin is also used for treatment of liver diseases (hepatocellular hepatitis, primary forms of cirrhosis), thyrotoxicosis, exhaustion, furunculosis. In these cases, insulin is prescribed in small doses (5-10 UNITS) followed by a meal (in 10-15 minutes).
Insulin preparations used during insulin therapy, the methods of their introduction - see Insulin, insulin preparations.
The use of insulin should in all cases be made with caution. Not all people are equally responsive to the introduction to the same dose of insulin. Some are highly sensitive to it, while others insulinorezistentne. The duration of insulin therapy is individually. Side effects of insulin may be seen in the development of local or General anaphylactic States, seals subcutaneous tissue at the site of injection, edemas. In some cases it is possible development of hypoglycemic events (see Diabetes diabetes, treatment).
Contraindicated insulin when the pituitary and renal form of diabetes, in tuberculous process with the phenomena of dissemination and decay, with sensitivity to him, and when hemolytic jaundice, pancreatitis, nephritis, renal amyloidosis, kidney stones, stomach ulcer and duodenal ulcer, decompensated heart diseases.
Insulin therapy psychosis. The use of insulin therapy with mental illness based on the effects of hypoglycaemia on the nervous system and metabolism. Apply two methods of treatment: hypoglycemic coma insulin.
When comatose insulin therapy to the patient daily on an empty stomach intramuscularly or subcutaneously injected insulin, beginning with 4 UNITS with the subsequent daily dose is increased to 4 UNITS. Thus, pick up the dose at which the patient after 3-4 hours after injection develops deep hypoglycaemia (insulin coma). The clinical picture of hypoglycaemia develops gradually: first appear lethargy, drowsiness, further increasing oglushennosti, turning into Zaporozhie state and who (see). In presolol stage may be a sharp motor excitation. Coma characterized by the unconscious state, salivation, sudden sweating, often appear convulsive twitching, symptom Babinsky, clonus stop. In a coma patient hold 20-30 minutes For edema coma patient is injected 20 ml 40% glucose solution. After coming out of his coma (usually within 1-5 minutes after administration of glucose) the patient was given to drink hot tea with dissolved sugar (150-200 g); failure to drink a solution of sugar enter it through a tube. Once the patient has fully recovered consciousness, he is given Breakfast, rich in carbohydrates, but after 3 hour lunch. When prolonged coma, glucose and sugar solution, re-introduce, apply adrenaline (0.5-1 ml of 0.1% solution under the skin, nicotinic acid 2-4 ml of 1% solution intravenously slowly.
Among the complications note the repetition of coma (in the afternoon), arrest should likewise. The possibility of re-com requires continuous monitoring of patients from the middle of the personnel during the whole period of insulin therapy. If in the period of hypoglycemia sudden cardiac activity and respiration is immediate relief coma with additional lobelina, koratala. The indication for the relief of coma is also the emergence of epileptiform seizures. When they repeat treatment with insulin stop. Only rarely directly after knocking coma occurs pulmonary edema.
Comatose insulin is used primarily with schizophrenia. It is contraindicated in old age, with organic diseases of the brain, schizophrenia, complicated somatic diseases (hepatitis, cholecystitis, active tuberculosis, bronchiectasis, heart diseases, hypertension, diseases of kidneys, blood-forming organs, endocrinopathies, stomach ulcer and duodenal ulcer, chronic inflammatory processes, and so on). There should be no insulin therapy for patients who find it difficult to enter medicine in Vienna and sugar solution through a tube (bad Vienna, polyps in the nasopharynx, the tendency to nose bleeding).
If hypoglycemic (bessonovoy) insulin increase insulin doses continues until the signs of hypoglycemia (without leading up stage stun, spoor, coma).
Mild hypoglycemic events held as comatose. This technique is shown in asthenic, astheno-depressive, astheno-hypochondriacal conditions of various origins, particularly when expressed nervousness, reactive state.