Antidiabetic therapy is mandatory in type 1 diabetes mellitus (insulin) and necessary in type 2 diabetes, which can be treated with a correct indicated diet by the physician and fully respected by the patient (oral medication or insulin). Insulin has an absolute indication for type 1 diabetes, type 2 diabetes complicated with ketoacidosis or pregnancy. Relative indications of insulin may be permanent: type 2 diabetes requiring insulin or temporary in case of infection, myocardial infarction, during surgery.
Insulin does not cause addiction, which means that its administration in type 2 diabetes may be interrupted if the disease permits it.
Generally any drug can cause adverse effects. It is also the case of insulin that possesses a number of adverse effects that any patient with diabetes should to be aware of.
Insulin side effects
|afc0933fd6f653d2a7811698a6cba9e8| is the most common and most serious side effect of insulin, very serious, sometimes fatal. It is defined by blood sugar levels under 65 mg % (3.6 mmol / l). Hypoglycemia may occur after any type of insulin and results in brain damage by lowering oxygen consumption of the brain, more serious the lower blood sugar levels are. Sometimes, after years of illness, intellectual capacity greatly decreases at a relatively young age (around 50 years) due to destruction of neurons, a condition called hypoglycemic encephalopathy.
Factors that favor the occurrence of hypoglycemia due to insulin are very varied.
- Insulin overdose, most commonly in the intensive treatment
- Not eating – the omission of a meal, after insulin was injected (eg, patient falls asleep)
- The long interval between the injection and the carbohydrate meal or meals containing a small quantity of carbohydrates.
- Injecting insulin into a blood vessel
- More physical activity than usual, without precautions against hypoglycemia.
- The presence of vomiting and diarrhea.
- Alcohol intake
Clinical manifestations of hypoglycemia are extremely varied, depending on blood sugar levels and individual factors, some patients handling hypoglycemia better than others.
In mild and moderate forms:
- Epigastric pain
- Extreme hunger sensation
- Mouth tingling
- Unusual fatigue which is rapidly installed
- Headaches, especially frontal and scheduled
- Diplopia (double vision)
- Mild agitation, disorientation
In severe forms (in addition to mild and moderate form)
- Loss of consciousness (coma) and seizures, bilateral Babinski sign.
If not recognized early, hypoglycemic coma can lead to severe brain damage and even brain death. It is important to state that some patients lose warning signs of hypoglycemia (hypoglycemia awareness), hypoglycemia is asymptomatic and is installed without any warning signs leading to coma very rapidly. Some patients remain asymptomatic at extremely low blood sugar levels (below 30 mg%), while others show signs of mild and moderate hypoglycemia at close to normal blood sugar levels.
Treatment of mild to moderate hypoglycemia: the ingestion of sugar, as such, or sweetened tea, syrups, sweet drinks. This measure is urgent, as rapid progression to coma is very probable. Therefore, all diabetics must have sugar on hand at any time of day, glucose (tablets), or soft candy.
Hypoglycemic coma. 1-2 mg of glucagon is administered (in the muscle). Glucagon increases blood sugar level by releasing glucose deposits from the liver. If glucagon is not available, 33% hypertonic glucose is injected intravenously until the patient recovers (sometimes more than 300ml). Because it is an emergency, treatment is started immediately after diagnosis, including family members (immediately after they called 112 / 911). If you can not differentiate hyperglycaemic coma from hypoglycemic coma (in absence of blood glucose testing),the coma is treated as a hypoglycaemic coma. Glucose administration does not harm in case of hyperglycemia, but saves the patient in the case of hypoglycaemic coma.
- Allergy: human insulin is theoretically free of this risk, which in practice can be observed, however, extremely rare
- Insulin resistance, a condition defined by a higher necessary per day (more than 1.5-2 units / kg or 200 units per day).
- Lipodystrophy (fat redistribution), atrophic and hypertrophic form, modifying the local reabsorption of insulin.
- Local abscess (very common among insulin side effects)
- Injection site pain
- Visual disturbances at the start of treatment (reversible within a couple of weeks)
- Insulin edema (rare in women who use high doses)