SIGNS OF DIABETES
Normally
Our body needs energy to live like a car needs gasoline. This energy comes in part from glucose. Glucose is a sugar that circulates in the blood to be distributed throughout our body. Its quantity in the blood can be measured: it is the glycemia.
Blood sugar is under the control of insulin. Insulin is a substance made by the pancreas. It passes into the blood to regulate blood sugar.
In diabetes
In diabetes, the pancreas no longer produces enough insulin. In the absence of insulin, blood sugar rises: this is hyperglycemia. When blood sugar is too high, we have glycosuria, and sometimes ketosis (high ketonemia with ketonuria).
To lower blood sugar and ketosis, it is necessary to provide the insulin that the pancreas no longer produces.
HOW TO DISTRIBUTE THE DAILY INSULIN?
Glucose is present in many foods. The digestion of these foods releases the glucose which then crosses the wall of the intestine and passes into the blood. So after a meal, blood sugar rises.
Normally, outside of meals, blood sugar is 0.70 to 1 gram per liter (g/l). During a meal, the rise in blood sugar remains low (blood sugar does not exceed 1.50 g/l), and in 2 or 3 hours, it returns to its normal value of 0.70 to 1 g/l.
Insulin keeps blood sugar from rising too high.
Between meals, the pancreas releases a small amount of insulin into the blood. During a meal, when blood sugar rises, the pancreas delivers more insulin, which keeps blood sugar from rising too high and then brings it back down. So we need a little bit of insulin again.
In summary, at each meal, more insulin is needed to keep blood sugar levels from rising too high: in the morning at breakfast time; noon at lunch time; in the evening at dinner time. Between meals, and during the night, the need for insulin is low and regular.
To release insulin as needed, the pancreas constantly measures blood sugar.
In diabetes, the rhythm of life and insulin requirements are identical. For insulin to be effective, it must be given as needed: in small amounts between meals and at night, and in larger amounts with each meal.
To know what dose of insulin to take, you must monitor blood sugar
INSULINS
All insulins are made in the laboratory. There are two categories of insulin:
- human insulin whose structure is identical to the insulin produced by the pancreas,
- insulin analogues: their structure which has been slightly modified compared to human insulin, which gives them different modes of action (delay of action, duration of action, reproducibility). They are the most prescribed in children.
For treatment, insulin is available with different durations of action:
- rapid-acting insulins,
- long-acting insulins,
- fixed insulin mixtures.
- rapid-acting insulins
Rapid-acting insulin analogues
Their action begins after about 15 minutes and is absorbed just before the meal.
The peak of action occurs 30 to 90 minutes after the injection.
The duration of action is on average 3 hours, but this duration of action is variable (from 2 to 5 hours); the higher the dose, the longer the duration of action.
Long-acting insulins
Long-acting insulin analogues
These are clear solutions. Their duration of action is variable:
18 hours (long intermediate): Levemir® (Detemir). In this case, insulin is injected twice a day.
24 hours (slow): Lantus®, Toujeo® or Abasaglar® (Glargine). Most often, these long-acting insulins are injected once a day, at the same time every day.
42 hours (slow): Tresiba® (Deglutec). This long-acting insulin is injected once a day with more time flexibility than the previous ones.
NPH insulin (intermediate, rapid-acting insulin associated with a protein, Protamine)
NPH is a cloudy solution.
It is active approximately 1 hour after the injection, the peak of action occurs after 4 to 6 hours, it has a duration of action of approximately 12 hours.
It is used less and less in France.
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insulin and child