Pharmacodynamics
s. ICT and insulin pump therapy
Requirements
s. ICT and insulin pump therapy
Indication
For ICT:
-
Type 1 diabetes (now the standard therapy for type 1diabetes [Schmeisel 2019])
-
Type 2 diabetes
- in the context of triple therapy
- in the - in the Anglo-Saxon language area as - 5-S situations described constellation, ICT is recommended in type 2:
- severe hyperglycemia
- symptomatic diabetes
- acute or chronic comorbidity
- special situations such as
- Pregnancy
- childhood
- adolescence
- secondary diabetes mellitus e.g:
- drug-induced
- in endocrine disorders (Priya 2020)
For more details, see. ICT
For insulin pump therapy:
-
Type 1 diabetes mellitus (now represents the standard therapy here [Kolassa 2014]).
- Pregnancy (especially in type 1 DM [Herold 2021]).
- young children (standard therapy for children < 5 years [Kapellen 2013])
- Threat of late complications of DM
- desire for progression inhibition
- pronounced dawn phenomenon with recurrent hypoglycemia (Herold 2021)
- frequent nocturnal hypoglycemias (Lehnert 2010)
- disturbances in the perception of hypoglycemias
- Patient's desire for flexible therapy e.g. due to rotating shifts, frequent travel across different time zones, competitive sports, etc. (Herold 2021)
- Type 2 diabetes mellitus requiring insulin (Rotbard 2017).
However, according to the guideline, insulin pump therapy is rarely indicated in type 2 DM (Bundesärztekammer 2021).
- with ICT only insufficient BG adjustment possible - despite high motivation of the patient.
- desire to have children
-
diabetic nephropathy (Lehnert 2010)
For more details see Insulin pump therapy
Dosage and type of application
The daily insulin requirement is 0.67 I. E. / kg / d = approximately 40 I. E. (Dellas 2018).
- Substitution of basal insulin
On the basal insulin supply falls about 40 - 50% of the total insulin daily dose.
In most cases, basal insulin requirements are met by injecting an NPH- delayed-release insulin (Herold 2021) at least twice, such as detemir early in the morning and late in the evening. Alternatively, intermediate insulin can be used: 3x / d, morning, noon, evening or glargine: 1x / d late evening (Greten 2010).
Verification of adequate insulin dose is checked by fasting blood glucose or by skipping a meal (Bundesärztekammer 2021).
- Prandial substitution of insulin
The remaining 50-60% of the daily insulin dose is administered as a meal-related bolus. Normal ins ulin or short-acting insulin analogues are used for this purpose.
The amount of the dose depends on
- The size of the meal (measured in carbohydrate unit = KE = 10 g of carbohydrate [Dellas 2018]).
- the preprandial blood glucose
- the time of day
- The planned physical exertion (Herold 2021).
For more details, see. ICT
Insulin pump therapy:
Only normal insulin or rapid-acting analog insulin is used with CSII (Herold 2021).
For more details see Insulin pump therapy
Adverse effects
s. Insulin pump therapy
Advantages
s. Insulin pump therapy
Preparations
For ICT:
Semilente MC insulin (Hürter 2001), Lantus, Levemir (Schmeisl 2019), biosimilar Abasaglar, Toujeo, Tresiba (Herold 2021)
Actraphane 30, Human Insulin Profile III, Humalog Mix 25, Insuman Comb 25, Novomix 30 (Herold 2021), Humalog Lilly, NovoRapid (Hürter 2001).
For insulin pump therapy:
-
Normal insulin, formerly known as "altinsulin". Nowadays, synthetically produced human insulin is mostly used such as:
- Actrapid
- Berlinsulin H Normal
- Huminsulin Normal
- Insuman Rapid (Alawi 2019)
-
Insulin analogues such as:
- Insulin Aspart (e.g. NovoRapid)
- Insulin Glulisin (e.g. Apidra)
- Insulin Lispro (e.g., Humalog, Liprolog) (Alawi 2019)