Determination of insulin in the blood: what is the norm for a healthy person? Reduced insulin levels in adults. Humulin - instructions for use

pharmachologic effect

Humulin M3 is a DNA recombinant human insulin. It is a two-phase suspension for injection (30% Humulin Regular and 70% Humulin NPH). The main effect of insulin is to regulate glucose metabolism. In addition, it has an anabolic effect. In muscle and other tissues (with the exception of the brain), insulin causes rapid intracellular transport of glucose and amino acids and accelerates protein anabolism. Insulin promotes the conversion of glucose into liver glycogen, inhibits gluconeogenesis, and stimulates the conversion of excess glucose into fat.

Humulin M3 is an intermediate-acting insulin preparation. The onset of action of the drug is 30 minutes after administration, the maximum effect is between 1 and 8.5 hours, the duration of action is 14 - 15 hours. Individual differences in insulin activity depend on factors such as dose, choice of injection site, physical activity of the patient, and others.

Indications

Treatment of patients with diabetes mellitus who are indicated for insulin therapy; treatment of patients with newly diagnosed diabetes mellitus; pregnancy in patients with type 2 diabetes mellitus.

Dosage regimen

The dose of Humulin M3 is determined by the doctor individually depending on the glycemic level. The drug should be administered subcutaneously. Intramuscular administration is also possible. Intravenous administration of Humulin NPH is contraindicated. Subcutaneous injections should be given in the shoulders, thighs, buttocks or abdomen. Injection sites should be rotated so that the same site is used no more than approximately once a month. When injecting insulin subcutaneously, care must be taken not to enter a blood vessel when injecting. After the injection, do not massage the injection site. Patients should be trained in the correct use of insulin delivery devices. Humulin M3 is a ready-made mixture with a certain content of Humulin Regular and Humulin NPH, prepared in order to avoid the need to mix insulin preparations by patients themselves. The insulin administration regimen is individual.

Overdose insulin causes hypoglycemia, accompanied by the following symptoms: lethargy, increased sweating, tachycardia, pale skin, headache, trembling, vomiting, confusion. Under certain conditions, such as long-term diabetes or intensive control of diabetes, the warning signs of hypoglycemia may change. Mild hypoglycemia can usually be treated with oral glucose or sugar. Adjustments to your insulin dose, diet, or physical activity may be necessary. Correction of moderate hypoglycemia can be carried out using intramuscular or subcutaneous administration of glucagon, followed by oral carbohydrates. Severe conditions of hypoglycemia, accompanied by coma, convulsions or neurological disorders, are treated with intramuscular/subcutaneous administration of glucagon or intravenous administration of a concentrated glucose solution. After regaining consciousness, the patient must be given food rich in carbohydrates to avoid re-development of hypoglycemia.

Dose preparation. Immediately before use, Humulin M3 cartridges should be rolled between the palms ten times and shaken, turning at 180ºC, also ten times to resuspend the insulin until it takes the form of a homogeneous cloudy liquid or milk. Do not shake vigorously as this may cause foam, which may interfere with proper dosage delivery. Cartridges should be checked carefully. Do not use insulin if there are flakes in it after mixing. The design of Humulin cartridges does not allow mixing their contents with other insulins directly in the cartridge itself. Cartridges are not intended to be refilled. The manufacturer's instructions regarding refilling the cartridge and attaching the needle must be followed.

Dose administration. Wash your hands, select the injection site, wipe the skin with a cotton swab soaked in alcohol, and remove the outer cap from the needle. Fix the skin by forming a skin fold, insert a needle into the subcutaneous fat in accordance with the doctor’s instructions, and inject insulin in accordance with the instructions of the syringe pen manufacturer. Remove the needle directly from the skin and press lightly on the injection site for a few seconds, without rubbing the injection site. Using the outer needle cap, immediately after insertion, unscrew the needle and safely destroy it. Removing the needle immediately after injection ensures sterility, preventing leakage, air entrapment, and possible needle clogging. Place the cap on the pen.

Needles should not be reused. Needles should be disposed of appropriately. Needles and pens must not be used by others. Cartridges should be used until they are empty, after which they should be thrown away.

Side effect

Lipodystrophy, resistance, and increased sensitivity to insulin are among the side effects associated with the use of animal-derived insulin. The likelihood of such side effects when administering Humulin M3 is minimal.

Side effects associated with the main effect of the drug.

Hypoglycemia is the most common side effect that occurs with the administration of insulin drugs, including Humulin M3. Severe hypoglycemia can lead to loss of consciousness and, in extreme cases, death.

Patients may experience local allergic reactions in the form of redness, swelling or itching at the injection site. These reactions usually subside within a few days to several weeks. In some cases, these reactions may be due to causes unrelated to insulin, such as skin irritation from the cleansing agent or improper injection administration. Systemic allergic reactions caused by insulin occur less frequently but are more severe. They can manifest as generalized itching, difficulty breathing, shortness of breath, decreased blood pressure, increased heart rate, and increased sweating. Severe cases of systemic allergic reactions can be life-threatening. In rare cases of severe allergy to Humulin M3, immediate treatment is required. You may need to change your insulin or undergo desensitization.

Contraindications

Hypoglycemia; hypersensitivity to insulin or to one of the components of the drug.

During pregnancy, it is especially important to maintain good control in patients receiving insulin therapy (insulin-dependent diabetes or gestational diabetes). Insulin requirements generally decrease during the first trimester and increase during the second and third trimesters. People with diabetes are advised to inform their doctor if they are pregnant or planning to become pregnant. Patients with diabetes may need to adjust their insulin dose, diet, or both while breastfeeding.

special instructions

Transferring a patient to another type or insulin preparation with a different trade name should occur under strict medical supervision. Changes in insulin activity, type (for example, Regular, NPH, L, etc.), type (porcine, human insulin, human insulin analogue) or production method (DNA recombinant insulin or animal inulin) may lead to the need for dose adjustment. For some patients, when switching from animal insulin to human insulin, it may be necessary to adjust the dose. This may occur as early as the first time a human insulin product is administered, or gradually over several weeks or months after the transfer. Symptoms that are precursors of hypoglycemia during the administration of human insulin in some patients may be less pronounced or different from those observed during the administration of animal insulin. When blood glucose levels are normalized, for example, as a result of intensive insulin therapy, all or some of the symptoms that are precursors of hypoglycemia may disappear, about which patients should be informed. Symptoms that are warning signs of hypoglycemia may change or be less pronounced with prolonged diabetes mellitus, diabetic neuropathy, or treatment with drugs such as beta-blockers. The need for inulin may be reduced if there is insufficiency of the adrenal glands, pituitary gland or thyroid gland, or with renal or liver failure. With some illnesses or emotional stress, the need for insulin may increase. Insulin dosage adjustments may also be necessary if you increase your physical activity or change your usual diet.

During hypoglycemia, the patient's concentration may weaken and the speed of psychomotor reactions may decrease. This can be dangerous in situations where these abilities are particularly needed (for example, driving a car or operating machinery). Patients should be advised to take precautions to avoid hypoglycemia while driving. This is especially important for patients with mild or absent symptoms - precursors of hypoglycemia or with frequent development of hypoglycemia. In such cases, the doctor should evaluate the advisability of the patient driving a car.

Drug interactions

The hypoglycemic effect of Humulin M3 is reduced by: oral contraceptives, corticosteroids, thyroid hormone preparations, thiazide diuretics, diazoxide, tricyclic antidepressants. The hypoglycemic effect of Humulin M3 is enhanced by: oral hypoglycemic drugs, salicylates (for example, aspirin), sulfonamides, MAO inhibitors, beta-blockers, ethanol and ethanol-containing drugs. Beta-blockers, clonidine, reserpine can mask the symptoms of hypoglycemia.

The effect of mixing human insulin with animal insulin or human insulin from other manufacturers has not been studied.

Storage conditions and periods

At a temperature of 2-8ºС, 2 years. Protect from direct sunlight and heat, avoid freezing. The drug in use in cartridges should be stored at room temperature 15-25ºC for no more than 28 days.

1 ml of insulin-zinc injection suspension contains 40 or 100 units of human insulin; in bottles of 10 ml.

Characteristic

The drug has an average duration of action.

pharmachologic effect

.

Increases the absorption of glucose by tissues. Prevents the breakdown of glycogen in the liver and stimulates its formation.

Clinical pharmacology

The effect develops within 30 minutes, reaches its maximum 4-16 hours after administration and lasts 24 hours.

Indications for the drug Humulin ® L

Insulin-dependent diabetes mellitus, non-insulin-dependent diabetes mellitus.

Contraindications

Hypoglycemia.

Side effects

Hypoglycemia, lipodystrophy, allergic reactions.

Interaction

The hypoglycemic effect is enhanced by MAO inhibitors, alcohol, non-selective beta-blockers, sulfonamides; reduce - oral contraceptives, glucocorticoids, thyroid hormones, thiazide diuretics.

Directions for use and doses

S/c, i/m; the injection site should be changed. The dose is determined individually. In monotherapy, it is administered 1-2 times a day. If necessary, a combination with Humulin Regular is possible.

Precautionary measures

When transferring patients from insulins of animal origin to human ones, it may be necessary to reduce the dosage and/or change the ratio of drugs of different durations of action. The dose is reduced immediately or gradually (over several weeks). The risk of developing hypoglycemia when switching from one type of insulin to another is not significant if the daily dose of the drug is less than 40 units.

Storage conditions for the drug Humulin ® L

Refrigerate at 2-8°C (do not freeze).

Keep out of the reach of children.

Shelf life of the drug Humulin ® L

1.5 years.

Do not use after the expiration date stated on the package.

HUMULIN m3

Compound

pharmachologic effect

Pharmacological action - hypoglycemic.

Directions for use and doses

PC, in the area of ​​the shoulder, thigh, buttock or abdomen. IM administration is allowed.

The dose of Humulin ® M3 is determined by the doctor individually, depending on the concentration of glucose in the blood. IV administration of Humulin ® M3 is contraindicated.

The temperature of the administered drug should be at room temperature. Injection sites should be rotated so that the same site is used no more than approximately once a month. When administering insulin subcutaneously, care must be taken not to enter a blood vessel. After the injection, do not massage the injection site.

Patients should be trained in the correct use of the insulin delivery device.

Humulin ® M3 is a ready-made mixture with a certain content of Humulin ® Regular and Humulin ® NPH, prepared in order to avoid the need for patients to mix insulin preparations. The insulin administration regimen is individual.

Preparing for the introduction

For the drug Humulin ® M3 in vials. Immediately before use, Humulin ® M3 vials must be rolled between the palms several times until the insulin is completely resuspended until it takes the form of a homogeneous cloudy liquid or milk. Do not shake vigorously as this may cause foam to appear, which may prevent the dose from being delivered correctly. Do not use insulin if, after mixing, there are flakes or hard white particles stuck to the bottom or walls of the bottle, creating a frosty pattern effect. Use an insulin syringe that matches the concentration of insulin injected.

For the drug Humulin ® M3 in cartridges. Immediately before use, Humulin ® M3 cartridges should be rolled between the palms ten times and rocked, turning 180° also ten times until the insulin is completely resuspended until it takes the form of a homogeneous cloudy liquid or milk. Do not shake vigorously as this may cause foam to appear, which may prevent the dose from being delivered correctly. Inside each cartridge there is a small glass ball that makes it easier to mix the insulin. Do not use insulin if there are flakes in it after mixing. The design of the cartridges does not allow mixing their contents with other insulins directly in the cartridge itself. Cartridges are not intended to be refilled. Before giving the injection, you must read the manufacturer's instructions for using a syringe pen for administering insulin.

For the drug Humulin ® M3 in the KwikPen ™ syringe pen. Before performing an injection, you must read the Instructions for Use of the KwikPen™ syringe pen.

Guide to using the KwikPen™ syringe pen

The KwikPen™ syringe pen is easy to use. It is a device for administering insulin (“insulin syringe pen”) containing 3 ml (300 units) of an insulin preparation with an activity of 100 IU/ml. You can administer from 1 to 60 units of insulin per injection. You can set the dose with an accuracy of one unit. If too many units are set, the dose can be adjusted without losing insulin. The KwikPen™ syringe pen is recommended for use with manufactured needles Becton, Dickinson and Company (BD) for syringe pens. Before using the pen, you must ensure that the needle is completely attached to the pen.

In the future, the following rules should be followed.

1. Follow the rules of asepsis and antisepsis recommended by the attending physician.

2. Wash your hands.

3. Select the injection site.

4. Wipe the skin at the injection site.

5. Rotate injection sites so that the same site is used no more than approximately once a month.

KwikPen™ Pen Preparation and Administration

1. Pull the pen cap to remove it. Do not rotate the cap. Do not remove the label from the syringe pen. Make sure the insulin is checked for insulin type; expiration date; appearance. Gently roll the pen 10 times between your palms and turn over 10 times.

2. Take a new needle. Remove the paper sticker from the outer needle cap. Use an alcohol swab to wipe the rubber disc at the end of the cartridge holder. Place the needle in the cap straight along the axis onto the syringe pen. Screw the needle until completely connected.

3. Remove the outer cap from the needle. Don't throw it away. Remove the inner needle cap and discard it.

4. Check the KwikPen™ pen for insulin supply. You should check your insulin supply every time. Checking the delivery of insulin from the pen should be performed before each injection until a stream of insulin appears to ensure that the pen is ready to administer a dose.

If you do not check your insulin before the trickle appears, you may receive too little or too much insulin.

5. Fix the skin by stretching it or gathering it into a large fold. Insert the needle subcutaneously using the injection technique recommended by the attending physician. Place your thumb on the dose button and press firmly until it stops completely. To administer a full dose, hold the dose button and slowly count to 5.

6. Remove the needle and gently press the injection site with a cotton swab for a few seconds. Do not rub the injection site. If insulin drips from the needle, the patient most likely did not hold the needle under the skin long enough. It is normal to have a drop of insulin at the tip of the needle and will not affect your dose.

7. Using the needle protective cap, unscrew the needle and discard it.

Even numbers are printed in the dose indicator window as numbers, odd numbers are printed as straight lines between even numbers.

If the dose required to deliver exceeds the number of units remaining in the cartridge, you can inject the remaining amount of insulin in the pen and then use a new pen to complete the required dose, or administer the entire dose required using a new pen.

Do not attempt to inject insulin by rotating the dose button. The patient will not receive insulin if he rotates the dose button. It is necessary to press the dose button along a straight axis in order to receive a dose of insulin.

Do not try to change the insulin dose during the injection.

Note. The pen will not allow the patient to set an insulin dose greater than the number of units remaining in the pen. If you are not sure that the full dose has been administered, do not administer another one. The needle must be removed after each injection. You should read and follow the instructions contained in the instructions for use of the drug. The label on the pen should be checked before each injection to ensure that the drug has not expired and that the patient is using the correct type of insulin; Do not remove the label from the syringe pen.

The color of the dose button of the QuickPen™ syringe pen corresponds to the color of the stripe on the label of the syringe pen and depends on the type of insulin. In this manual, the dose button is shown in gray. The beige color of the body of the KwikPen ™ syringe pen indicates that it is intended for use with the Humulin ® line of drugs.

Storage and disposal

The syringe pen cannot be used if it has been out of the refrigerator for more than the time specified in the instructions for use.

Do not store a pen with a needle attached to it. If the needle is left attached, insulin may leak out of the pen, the insulin may dry out inside the needle, causing the needle to become clogged, or air bubbles may form inside the cartridge.

Syringe pens that are not in use should be stored in the refrigerator at a temperature of 2 to 8 °C. Do not use the pen if it has been frozen.

The pen currently in use should be stored at room temperature, away from heat and light, and out of the reach of children.

Dispose of used needles in a puncture-resistant, lockable container (such as a biohazard or waste container), or as directed by your healthcare provider.

Dispose of used pens without needles attached as directed by your healthcare provider and in accordance with local medical waste disposal regulations.

Do not recycle a filled sharps container.

Release form

Suspension for subcutaneous administration, 100 IU/ml. 10 ml of the drug in neutral glass bottles. 1 fl. placed in a cardboard box.

3 ml in a neutral glass cartridge. 5 cartridges are placed in a blister. 1 bl. placed in a cardboard pack or the cartridge is built into a KwikPen™ syringe pen. 5 syringe pens are placed in a cardboard pack.

Manufacturer

Bottles.

Manufactured by: Eli Lilly and Company, USA. Lilly Corporate Center, Indianapolis, Indiana 46285, USA.

Cartridges, syringe pens KwikPen ™, produced by: Lilly France, France. Zona Industriale, 2 ru do Colonel Lilly, 67640 Fegersheim, France.

Packaged by: ORTAT CJSC, 157092, Russia, Kostroma region, Susaninsky district, village. Severnoe, microdistrict Kharitonovo.

Lilly Pharma LLC is the exclusive importer of the drug Humulin ® M3 in the Russian Federation

Insulin aspart INN (short-acting insulin)

International name: Insulin aspart

Dosage form: solution for intravenous and subcutaneous administration

Pharmachologic effect:

Short-acting insulin preparation. After subcutaneous injection, the effect occurs within 10-20 minutes, reaches a maximum after 1-3 hours and lasts 3-5 hours.

Indications:

Diabetes.

Contraindications:

Hypersensitivity, hypoglycemia.

Dosage regimen:

S/C, in the area of ​​the abdominal wall, thigh, shoulder or buttock, immediately before eating. Injection sites within the same area of ​​the body must be changed regularly. The dose and mode of administration are determined individually. The individual need for insulin is 0.5-1 U/kg/day, of which 2/3 is prandial (before meals) insulin, 1/3 is basal (background) insulin.

Side effects:

Hypoglycemia, transient edema, refractive error, allergic reactions; local reactions: hyperemia, swelling and itching at the injection site, lipodystrophy. Overdose. Symptoms: hypoglycemia (weakness, “cold” sweat, pale skin, palpitations, nervousness, tremor, hunger, paresthesia in the hands, legs, lips, tongue, headache, drowsiness, uncertainty of movements, impaired speech and vision, depression) , hypoglycemic coma, convulsions. Treatment: the patient can eliminate mild hypoglycemia on his own by ingesting sugar or foods rich in easily digestible carbohydrates. Glucagon or a hypertonic dextrose solution is administered subcutaneously, intramuscularly or intravenously. When a hypoglycemic coma develops, 20-40 ml (up to 100 ml) of a 40% dextrose solution is injected intravenously until the patient comes out of the comatose state. After restoration of consciousness, oral carbohydrate intake is recommended to prevent recurrence of hypoglycemia.

Special instructions:

Insufficient dosage or interruption of treatment can lead to hyperglycemia and diabetic ketoacidosis. Concomitant infectious diseases increase, and kidney or liver damage reduces the need for insulin. Transferring a patient to a new type or brand of insulin should be done under strict medical supervision. When using insulin aspart, more injections per day or dose changes may be required compared to those when using regular insulins. The need for dose adjustment may occur during the first administration or in the first few weeks or months after transfer. After compensation of carbohydrate metabolism, patients may experience changes in their typical symptoms that are precursors of hypoglycemia, which they should be informed about. Skipping meals or unplanned exercise can lead to hypoglycemia. The drug should not be used if the solution is no longer colorless and transparent. During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions (hypoglycemia may develop, especially in patients with mild or absent symptoms that are precursors of hypoglycemia or its frequent episodes).

Interaction:

Pharmaceutically incompatible with solutions of other drugs. The hypoglycemic effect is enhanced by sulfonamides (including oral hypoglycemic drugs, sulfonamides), MAO inhibitors (including furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (including salicylates), anabolic steroids (including stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, fenfluramine, Li+ preparations, pyridoxine, quinidine, quinine, chloroquinine, ethanol. The hypoglycemic effect weakens glucagon, somatropin, GCS, oral contraceptives, estrogens, thiazide and loop diuretics, BMCK, thyroid hormones, heparin, sulfinpirals, sympathomimetics, Danazole, tricyclic antidepressants, clonidin antagonists, diazopyxides, morphin, morphine marijuana, nicotine, phenytoin, epinephrine, H1-histamine receptor blockers. Beta-blockers, reserpine, octreotide, pentamidine can both enhance and weaken the hypoglycemic effect of insulin.

Insulin is a fairly discussed term, but judging by surveys of clinic visitors, not everyone understands what it is. At best, they answer that it is associated with diabetes and diabetics give injections with it.

The production of its own insulin in the human body is carried out by the pancreas, which is a very important organ. Its importance is demonstrated by the fact that it is the only organ in the body that is supplied with blood from two different arteries.

The main task of insulin is to regulate blood glucose, the level of which should be close to normal. However, elevated insulin in some cases will not be considered a pathology. So after eating, the pancreas releases a portion of insulin into the blood, which helps glucose (energy food for cells) penetrate through cell membranes.

For a certain period after eating, elevated insulin will be considered normal, but by the end of the period its level should return to the established norm.

Insulin released in response to increased glucose levels is post-nutritive insulinemia (occurs after eating). Increased insulin in the blood, in this case, promotes active utilization of glucose by tissues and a decrease in its amount in the blood. After glucose levels decrease, the amount of insulin also decreases.

For reference. Normally, adequate levels of insulin in the blood are ensured by moderate secretion of the pancreatic hormone, as well as its short half-life. The hormone insulin normally circulates in the blood for about 4 minutes - this time is enough to have the necessary effect on carbohydrate metabolism.

Functions

Insulin has a significant effect on the stages of carbohydrate metabolism. The main effects of the hormone are associated with an anabolic effect in insulin-dependent tissues.

Insulin can stimulate:

• synthesis of glycogen and inhibit the process of gluconeogenesis (glucose formation) by the liver;
• glycolysis process;
• active uptake of glucose into tissues and a decrease in its level in the blood;
• conversion of glucose into triglycerides (long-term “reserve” storage of glucose);
• capture and formation of fatty acids, as well as inhibit the breakdown of fats;
• active uptake of amino acids by cells;
• protein synthesis;
• transport of K and Mg ions inside cells;
• the formation of glycogen, as well as inhibit the breakdown of proteins in muscles.

Action speed

The biological effects of insulin can be classified according to the speed of development of effects into:

• very fast (occurs within a few seconds after the hormone enters the blood);
• fast (appearing in a couple of minutes);
• slow (the development of these effects takes from several minutes to several hours);
• very slow (occurring within a few hours to a day).

The very rapid effects of insulin include its effect on the membranes of insulin-sensitive cells. As a result of this, the rate of glucose flow from the blood into the cells increases almost fifty times.

Quick effects are manifested by the active storage of glycogen (a quickly utilized glucose depot), stimulation of the synthesis of cholesterol and fatty acids. Insulin also increases the activity of phosphodiesterase, which inhibits the catabolism (breakdown) of glycogen to glucose under the influence of adrenaline or glucagon.

The slow action of insulin lies in its effect on metabolic processes and the rate of cell growth and division. Normally, elevated insulin activates the pentose phosphate pathway (oxidation of carbohydrates) and enzymatic oxidation of glucose, accompanied by the storage of energy in the form of adenosine triphosphate (ATP molecule).

The very slow effects of insulin are manifested by accelerated cell proliferation. Insulin is able to stimulate the synthesis of insulin-like growth factor (somatomedin C) in the liver. Somatomedin C stimulates bone growth in length, as well as the uptake of glucose and amino acids by muscle and fat tissue cells.

Why is it important to know your insulin levels?

The level of insulin in the blood is important for:

• maintaining full carbohydrate metabolism;
• control over the rapid utilization of glucose by tissues;
• storing ATP molecules;
• stimulation of cell growth and reproduction;
• maintaining a balance between storing and burning fat tissue.

Elevated insulin may indicate the presence of hormone-producing tumors of the pancreas; insulin may indicate independent type 2 diabetes, etc.

Normally, increased insulin is detected after meals and during pregnancy (in this case, there is a moderate, gradual increase in hormone levels).

Reduced insulin levels are observed with diabetes and exhaustion of the body.

To obtain a complete diagnostic picture, an insulin test should be performed in conjunction with other examinations:

• fasting blood glucose level;
• oral glucose tolerance test;
• C-peptide;
• determination of glucose and ketone bodies in urine (glucosuria and ketonuria);
• Ultrasound of the pancreas.

Attention. An insulin test without assessing blood sugar levels and other studies is not informative. Therefore, only the attending physician should prescribe an examination, determine the scope of diagnostic measures and evaluate the results obtained.

Blood test for insulin. Indications for use

High insulin is not detected with normal sugar; an abnormal increase in hormone levels is always accompanied by hypoglycemia. Most often, excess insulin production is associated with insulinoma, a tumor of the beta cells of the pancreas.

Typically, the disease is diagnosed in patients aged 25 to 55 years. Insulinoma practically does not occur in children. Hyperinsulinism leads to chronic hypoglycemia. Clinically, this is manifested by obesity, a constant feeling of hunger and the need to take easily digestible carbohydrates. Such patients can eat about a kilogram of sweets per day or eat sugar with spoons.

Typical complaints of patients who have increased insulin in the blood are frequent fainting, dizziness, muscle weakness, tachycardia, emotional instability, memory loss, and decreased skin sensitivity.

Important. Elevated insulin leads to decreased libido, erectile dysfunction and impotence.

In addition to diagnosing insulinoma, an insulin test is informative for a comprehensive examination of patients with metabolic syndrome, hyperandrogenism, PCOS (polycystic ovary syndrome).

How to test for insulin

Venous blood is used for analysis. The material must be collected strictly on an empty stomach. Drinking alcoholic beverages must be avoided at least 24 hours before, smoking – one hour before the procedure.

The time interval between blood donation and the last meal should be at least eight hours (optimally more than 12 hours). It is prohibited to drink juices, teas or coffee. It is acceptable to drink boiled water before the analysis.

Slightly elevated insulin with normal sugar may be observed in patients undergoing treatment:

• antiparkinsonian drugs (levodopa);
• niacin;
• prednisone;
• spirolactone;
• calcium gluconate;
• oral contraceptives;
• medroxyprogesterone;
• growth hormone;
• pancreozymin.

The level of insulin in the blood of women and men is the same, however, in women, insulin levels may increase moderately during pregnancy.

For reference. Taking beta-blockers, furosemide, clofibrate, calcitonin, and phenobarbital leads to a decrease in insulin levels.

Blood insulin levels

Most often, boundaries are indicated from 2.6 to 24.9. In some laboratories until 29.1.

The results are recorded in µU/ml.

The normal values ​​for men and women are the same.

Insulin is elevated, what does this mean?

In addition to insulinoma, an increased amount of insulin can be detected with:

• severe liver diseases,
• hyperandrogenism,
• PCOS,
• acromegaly,
• diabetes mellitus (DM) type 2 (in the initial stages of the disease),
• obesity,
• muscular dystrophy,
• Itsenko-Cushing syndrome,
• disaccharidase deficiency.

Hyperinsulinemia in PCOS

In women, hyperinsulinemia is most often observed with polycystic ovary syndrome. The main symptoms will be an increase in the level of androgens (male sex hormones), severe forms of acne, oily seborrhea, hair loss on the head and hair growth on the body (hirsutism), shrinkage of the mammary glands, deepening of the voice, menstrual irregularities, infertility, miscarriage, lack of sexual intercourse cravings, obesity.

Attention. Obesity and high insulin levels lead to the development of tissue insulin resistance and the formation of type 2 diabetes (insulin-resistant).

An increased amount of insulin, an increase in glucose levels (due to insulin resistance), a sharp increase in the level of triglycerides and cholesterol are fraught with the development of diseases of the cardiovascular system (atherosclerosis, thrombosis, ischemic heart disease, heart attack). In such women, the risk of developing malignant neoplasms in the uterus, mammary glands and ovaries increases significantly.

Adrenal causes of elevated insulin

Hypersecretion of adrenal hormones (hypercortisolism or Itsenko-Cushing syndrome).

Hypercorticism is manifested by obesity. Fat is deposited on the face (moon face), neck, chest and abdomen. The appearance of a specific purple blush is also characteristic.

Due to excess glucocorticoids, steroid diabetes mellitus develops. Patients constantly feel hungry. Against the background of a significant increase in fat deposits, the volume of muscle tissue, on the contrary, decreases (this is manifested by “thinning” of the limbs in relation to the rest of the body).

The skin is characterized by the appearance of specific purple-cyanotic stretch marks. Regeneration is reduced, even small scratches take a long time to heal. A significant amount of acne appears.

Pituitary gland lesion

The disease is manifested by coarsening of the face (specifically, enlargement of the cheekbones and brow ridges, soft tissues also grow), disproportionate growth of the hands and feet, severe arterial hypertension, deforming osteoarthritis, constant sweating, the development of type 2 diabetes, and severe headaches.

How to reduce insulin in the blood

Therapy depends entirely on the underlying disease that caused the increase in hormone levels. The selection of therapy is carried out individually, after a comprehensive examination by an endocrinologist.

General recommendations for lifestyle correction can only be given to patients whose hyperinsulinemia is associated with alimentary (dietary) obesity. In this case, a balanced diet, an active lifestyle and gradual weight loss are indicated. Strict dietary restrictions and fasting are contraindicated and can only increase hormonal imbalance.

Insulin is low. Causes and symptoms

Insulin levels decrease when:

• Type 1 diabetes;
• hypopituitarism (reduction or complete cessation of secretion of hormones by the pituitary gland);

In type 2 diabetes, insulin secretion remains normal or increases.

Type 1 diabetes

Type 1 diabetes is a group of metabolic pathologies accompanied by a chronic defect in the secretion of insulin by pancreatic B cells and, accordingly, increased glucose levels.

Symptoms of type 1 diabetes are caused precisely by insulin deficiency.

Due to a sharp decrease in glucose utilization and an increase in glycogenolysis and gluconeogenesis (glucose formation in the liver), the level of sugar in the blood (glycemia) and in the urine increases (glucosuria develops at a glycemia of 8.8 millimoles per liter).

An increase in blood sugar and glucose excretion in the urine is caused by:

• frequent urination;
• thirsty;
• itching, dry skin and mucous membranes;
• urinary tract infections, thrush.

A decrease in the formation of adipose tissue and the mobilization of triglycerides (as well as their breakdown to glucose) leads to an increase in ketogenesis in liver tissue and an increase in ketone bodies in the blood (ketonemia) and urine (ketonuria). Clinically, this is manifested by vomiting, sudden weight loss, and the appearance of the smell of acetone (ketoacidosis).

Disruption of protein metabolism and increased breakdown leads to muscular dystrophy, retarded physical development and a pronounced decrease in immunity (frequent bacterial and fungal infections).

Electrolyte imbalance due to decreased insulin levels leads to the body losing potassium, sodium and magnesium ions. Clinically, electrolyte imbalance manifests itself:

• thirst;
• dry skin;
• weakness;
• decreased blood pressure;
• impaired renal blood flow;
• lack of urine (anuria).

Important. Due to the fact that all symptoms of T1DM are caused by a defect in insulin secretion, the main method of treatment will be insulin replacement therapy (insulin injections).

Diabetes mellitus type 2

In patients with T2DM, unlike patients with T1DM, the function of pancreatic B cells is preserved. Their insulin secretion is normal or even increased.

Important. The basis of therapy is to normalize body weight, follow a balanced diet and take sugar-lowering tablets (if necessary, a combination of several drugs is possible).

Insulin therapy is rarely prescribed to such patients, when glucose-lowering tablets are ineffective. An evening insulin injection with a prolonged effect is more often used.

As a starting therapy, it is recommended to adjust the lifestyle and take metformin (sugar-lowering tablets). If there is no effect, a sulfonylurea derivative (glibenclamide) or a thiazalidinedione derivative (glutazone) is added.

If indicated, insulin therapy may be added.

Types of insulin drugs

Insulins are classified according to their origin:

• human genetically engineered;
• human semi-synthetic;
• pork monocomponent.

Based on their action, drugs are distinguished with:

• ultra-short effect (Humalog, Apidra);
• short-acting (Actrapid NM, Humulin Regular);
• average duration of action (Monodar B, Protafan NM);
• long-acting (Lantus, Levemir Flexpen).

Mixed-action drugs include mixtures (profiles) that combine short- and long-acting drugs. On such insulins there should be a fraction designation 50/50, 40/60, 25/75 with an explanation of how much insulin the drug contains, or a number indicating the percentage of extended-release insulin.

• Gensulin M50 (50% extended-50% short-term),
• Gensulin M40 (40% extended – 60 short),
• Mixtard 30/70 (Mixtard® 30 NM – 30% extended - 70% short).

Rules for administering insulin for diabetes

The dose and frequency of injections should be selected exclusively by the attending physician.

The most commonly used schemes are:

• two injections of a mixed solution (short- and long-acting insulin);
• three injections (mixed preparations in the morning and evening + short actions before lunch);
• basal-bolus injection.

For reference. The use of an insulin pump is indicated for patients with frequent or hidden hypoglycemia, poor glycemic control, high insulin sensitivity, and poorly controlled diabetes. The pump can also be used during pregnancy.

Insulin can be administered using an insulin syringe in:

• stomach (medium with short and mixed effects);
• buttocks and thighs (medium and long acting);
• shoulder (additional injection site).

To prevent the development of lipodystrophy at injection sites, injection sites should be alternated.

Attention. It must be remembered that insulin is injected only into the subcutaneous fat. Therefore, thin patients should form a skin fold before injection and use shorter needles.