Treatment of type 1 diabetes mellitus - insulin therapy

This the session we'll see about the treatment of type 1 diabetes filter 2 given all your what are we going to see in these sessions you see what is the puzzle the genesis of this disease we see what are the treatment strategies
we'll see what are the principles behind initiating insulin therapy what are the treatment goals to be achieved and finally how to type in treatment
now let's go one by one let's see what is the patron the genesis of this disease now if you look into
type 1 diabetes there is beta-cell destruction this beta-cell destruction is immune-mediated and because of this beta cell destruction very absence of insulin secretion near-total absence of insulin secretion occurs because of B defenses distraction
now the treatment side C becomes very very simple now there is some deficiency there is a total deficiency of some hormone or substance in their body
now the strategy is very simple whenever there is deficiency we need to give that substance exogenous Li

Treatment of type 1 diabetes mellitus - insulin therapy

so what people startle you to administer insulin exogenous T

so that is a very very simply people study right now let us see what are the principles behind initiating insulin therapy in treatment in for treatment of type 1 diabetes
now let's see the principles first principles are how do we calculate the total dose of insulin for the initiation

so the total dose for initiation equal to 0.6 you need in two bodies and that's the first principle is used to find out what is the total amount of insulin that iPhone has insufficient required for initiating treatment now once we have calculated this total nose now this needs to be
I talked about principles for especially to infection regimes

so now this is common for whatever injection regime we start
now let's see only two injection regime because in our setup this is the most commonly used regime right
now how do we divide this the total the dose we are divided going to give you this morning rule and we are going to do this evening goes so morning dose is two-thirds of the total so easy dos become one seller of the spoken

so that is the entrance ability said how much of the total dose should be given in the body and how much should be given in the evening
now let's see the first principle the third principle says among the morning rules two-thirds are given as long-acting and 130 unit shortening

so two-thirds of it is given as long or intermediate-acting and one-third of morning deuce is shot
now if you feel the evening dews it is one part is given a long-acting or intermediate acumen and the rest the other half is given a shot

so these are the three basic principles presented to tilt again the total dose is calculated as point six units into total body weight of that total dose morning those constitute two-thirds of the total dose and evening use constitute one-third morning to Z sub n divided into two thirds and any along one element is acting and once there is given a short-acting evening those is half of that if given us long or intermediate-acting and after short-acting
now to this, we explained it is an example let's take a small real-life scenario type of diabetes usually, the patient is a small type right

so now let's take the rate of this side our boy who is diagnosed to have this type on that be selected 30 0 now what is the total dose required for this boil

Treatment of type 1 diabetes mellitus - insulin therapy

so then those people do zero politics in 2:30 so it comes to 80 units today

so this is the total dose retirement for this pot now this the molecule is 2/3 of this which will be twelve use it now eating those becomes the remaining 1/3 is

so leaving those become 136 so again if we divide it money goes one of those is divided into two thirds intermediate-acting or shortening and one-third longer one third shot acting a little bit is acting all normal acting and one third shot acted
now two-thirds of 12 is equal and one-third of short-acting because for you to set aside
now the evening news if you look into again this is our short-acting and off it and it isn't long enough into this so this becomes 3 units to start at x equals 3 so are you here

so these are the principles and how these principles is applied in a real-life situation now how will we actually be initiating these readings that teach that unhook
now list it for this boy we know that for a two injection regime, we need to be short-acting or rapid acting insulin along with this intermediate-acting entry now
we have unregulated fluency tutor short-acting insulin and we have a healthy has neutral proteomic edges or III or is okay in English this is an agility tactic
now so we need to give it a to induction regime city

so one is different in the morning the next injection is given that evening
now let's see how we are going to use for this birth of short-acting insulin regular insulin one is how much we need to give

so one in your short item is prohibited slack and short-acting insulin the evening is to you
now intermediate-acting insulin and pH influence intermediate-acting insulin in the morning is to third it is a 2 D and in the evening is hospital really

so now this is what we are going to prescribe for this boy with type 1 and V so it's regular insulin the morning will be for unit his NPH insulin in the morning will be a

chilly now how do we actually, administer this we also know that there are pre-mixed the insulin you might be aware of this

so-called premix insulin it's all available to raise yourself the first is on ecologist 70/30 the other the issue is with premix injuries or what is

so-called by the facility which is nothing but a combination of both and short-acting a salacious intermediate-acting insulin
now if you look into it there are two different mixtures of insulin available
now if you are why are they available in this 70 30 and 50 P ratio the ratio is very much linked to here
now if you look into born induce 230 intermediate-acting and once the early short-acting the incident that's why this job 7030 of intricate acting and short-acting insulin

so this previously filling of 70/30 if used for the morning tool and we have another prediction string acoustic D
now you can see yes by principle evening goes you have to give half of it are intermediate-acting or normality and the other half is short-acting so that's why this is available for expertise in vivid

so this directly thirty-day I really preferred for warning me and this is all that easy in a vise and that's a true injection regime
now coming back to how are we actually going to administer it this regular influence is available to assess clear the influence we can easily ask the patient to identify Infinity's clear as water and NPH insulin is cloudy the reason why this is clear and it conveys is that this has more amounts of sleep or programming of the proteins come back to regular increase
now when we have these two while regular insulin NPH insulin Siffredi always ask the patient who pays regular insulin first in the series for you but then in the same since he can take NPH insulin 8qe injected subcutaneously the reason why regular insulin is to be taken it whenever is inside to take regular insulin and inject the same needed into implicants it's my a small amount might get maybe one drop one get contaminated

so if we use the other the way the regular insulin might become more contaminated because of Anita Dongre it will not be regularly wide it needs to be regular view is that in the case of the emergency, if you want to give it, should ask immediately that like this that's not to be contaminated that SP it can be taken after taking regular insulin right
now let's go to the equipment good

so this is how we started again treatment regime for treatment of type 1 diabetes in a patient
now let's see what are the goals to be achieved and how are we going to titrate that education
now let's take the glycemic goals to be achieved there are three goals at the first plant any guru food is given will be a 1/3 less than 7% the first good than fasting the glucose should be seventy-two hundred and thirty milligrams per liter and post a near to our post branches should be less than utterance a Lingam

so these are the three treatment boots on a glycemic good wish me to be absent this is saying for Taiwan as well as thank you also now let's say we have started this patient on this regime to injection regime and we want to
now find out how to find out whether these goals are not achieved or not and we are saying seeing that this is not as you taught how to do we go ahead with titrating the rule
now to titrate the dose in this patient how differently, do salvation which insulin therapy can be done it can be done at shortest two to three days but it is not necessary that you have to ask the patient to daily monitor and them that clock required but once you have initiators we need to monitor them
now to titrate it we can ask them are the cells monitoring of blood glucose by the patient can be very easily done and we can educate them to alter the dose by themselves also
now based or not for four things we need to what is that the glucose levels before great hunter is fasting what is that blood glucose before knowing what is that less glucose before evening meal while finally what is that blood glucose before bedtime
now you can measure these four levels we can very easily type it now you can BL see here that these four levels correspond to

so if the before breakfast level is not making let's take a blood glucose level scary
now it's very obvious that we need to alter there is under two injection regime the evening goes off intermediate-acting needs to be altered if before letting's neural is not the method then we need to alter the money shot athlete if before evening meal sugar learners are not making we need to order the morning intermediate action and finally if before bedtime it does not alter then we need to sync the shop happen
now how much should be the magnitude of thing, the magnitude of K is usually two

to four you never think about whole units and you can either increase or decrease ask the patient guarantees having symptoms of hypoglycemia if

so then you need to reduce the dose by two to four Emmys or if the blood level first glucose level goes below seventy then you need to take a nap then you think that will push the insulin level if it is above what that means told us the target then you need to increase the insulin level

so you need to see the level you can alter which component talking still by altering again we need are we try to maintain the ratio of these two third one third and half as far as possible

so that those created what we think we mix the think and also need to detect you to use these injections right

so that's about of you typing and your hand in these patients

so if you summarize what can we clean in this session we saw that type of diabetes is due to beta-cell immune-mediated beat assessment session and because of beta cells then if absolute or near-total deficiency of insulin

so our treatments acne becomes very simple we have a deficiency of insulin
we need to substitute a new exogenous Li increase three principles operates for the substitution of insulin or initiation of insulin therapy in a type 1 patient the total dose is calculated as voices into kilogram body, the total module eight and two-thirds of the total the dose is given by this morning and one fare is given in the you arrange the body uses intermediate or shaft technique is given and once a shortest intermediate or nonworking is given two-thirds in the body and once there is given a short-acting in each component least half the long-acting on the intermediate-acting means is one half dollars how few advisors short-acting

so that's this principle in initiating therapy and we solve it like TV good hemoglobin less than seven fasting terms if you were ready for sandals and us also saw the force levels randomly on to take results and titrate apparently in the magnitude of two to four units

so that's all thank you very much if you have any doubts about the attack

The skin fade is the largest organ in the body

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Treatment of type 1 diabetes mellitus - insulin therapy