Previously, patients with diabetes mellitus had to strictly follow their therapy; This often meant a rigid daily routine with set mealtimes. Today, diabetics can make their daily lives more flexible, adjust their insulin dose to their lifestyle and simply omit meals if they are not hungry. With the help of new insulin preparations, which have a particularly fast or very long effect, those affected can better adjust their blood sugar and thus avoid the long-term consequences of diabetes mellitus.
Use of insulin as a therapeutic
The goal of any insulin therapy is not just to mimic natural insulin production. It should also improve the quality of life of patients and delay the development of diabetes-related sequelae. A prerequisite for successful therapy is the correct adjustment of blood glucose levels. The so-called HbA 1 c value indicates how well the metabolic control has been within the last eight to ten weeks. Thus, it represents a type of long-term blood glucose level memory of the body. This value should be below 6.5 percent according to the National Care Guidelines for Type 2 Diabetes Mellitus. The German diabetes association recommends diabetics have a HbA 1 c of less than 6.5 percent. From a value of more than 7 percent, a therapy change should be made. Possible therapy options include the combination of tablets and insulin (BOT), as well as the pure insulin therapies (CT and ICT).
BOT - tablets and insulin
If tablets alone can not lower the blood sugar level sufficiently, a combination with insulin makes sense. In addition to the hypoglycaemic tablets, basal-assisted oral therapy (BOT) injects a long-acting insulin. This treatment pattern is preferably used when, in addition to the tablets, insulin is required in addition to the tablets for better adjustment and increased physical well-being. A long-acting insulin ensures a steady insulin level and works ideally over 24 hours.
Two forms of pure insulin treatment
In the past, the person suffering from diabetes should bow to therapy, but today the treatment should be adapted to the lifestyle of the individual patient. There are two basic forms of pure insulin therapy: conventional (CT) and intensified insulin therapy (ICT).
CT - easy to handle
Patients usually inject twice daily a mixture of short and long-acting insulin (normal and delayed insulin), the so-called mixed insulin. The amount of food and the amount of exercise depend on a fixed meal schedule and constant injection times. Although CT is easy for the patient to use, it leads to strict regulation of the daily routine.
ICT - flexible daily routine
In the intensified conventional therapy (ICT), a delay insulin is injected once or three times a day and a fast-acting insulin at mealtimes. Dose and time can be adjusted by the diabetic himself - depending on the meal and / or physical activity. Although injections and blood glucose controls several times a day, ICT is more time-consuming than CT or BOT; but it is crucial that with this therapy, the body's own insulin release of mimics the best of metabolic health. The metabolic position can thus be optimally adjusted and the risk of consequential damage reduced as far as possible.
Often underestimated: poor diabetes and the consequences
The long-term consequences of diabetes mellitus develop slowly, for months or years. The worse the blood sugar is set, the greater the risk of developing diabetes complications of the cardiovascular system, the eyes, kidneys or nerves. On the one hand, diabetics are prone to arterial circulatory disorders, on the other hand, however, the nerve fibers and the organs themselves are damaged by the increased blood sugar. The extent of complications for type 2 diabetics was demonstrated by the CODE-2 ™ study: Every 90 minutes a person with diabetes mellitus in Germany goes blind, a diabetic becomes dialysis-dependent every 60 minutes, every 12 minutes a patient suffers a stroke and every 19 minutes an amputation takes place. A heart attack occurs every 19 minutes, and as the nervous system in diabetics is damaged, the pain is often missing as a typical warning symptom. Against this background, it is even more important for physicians and patients to clarify the HbA 1 c value and to raise awareness of its importance in diabetes therapy.