In clinical diabetology, insulin resistance (insulin insensitivity) refers to the daily need for insulin in excess of 80-100 units. Insulin resistance is divided into light (daily dose of insulin 80-125 UNITS), moderate (125-200 UNITS) and severe (more than 200 UNITS), or degrees I, II and III, respectively. The first two degrees are also called relative insulin resistance (dose less than 200 units), and the third – absolute (more than 200 units).
The most common cause of insulin resistance is obesity. In patients without obesity the reason for insulin resistance, is usually the development of antibodies to insulin, a change in insulin receptors. The provoking moments can be foci of chronic infection, liver disease, endocrinopathy. Temporary insulin resistance can develop during pregnancy, ketoacidosis.
The most common cause of insulin resistance is obesity.
Severe forms of insulin resistance are observed in the rare lipoatrophic form of diabetes, as well as in women suffering simultaneously with acanthosis nigricans. The most effective measures to combat insulin resistance are normalization of body weight, rehabilitation of foci of chronic infection, normalization of liver function, prevention of intercurrent diseases, strict implementation of dietary measures. With the ineffectiveness of these general therapeutic effects, insulin resistance therapy is usually difficult and not always effective even when using highly purified insulin preparations.
Prevention of insulin resistance is aimed at preventing the development of factors contributing to it and involves the use in the treatment of newly diagnosed diabetes, highly purified, and in the near future, human insulin.
What is an insulin allergy?
Allergic reactions to insulin can be local and general, or systemic. Local allergic reaction is observed in 8-10% of patients, the general – and 0.1-0.4% of cases, anaphylactic shock is rare. In recent years, these complications of insulin therapy have become increasingly common. Local allergic reactions are manifested by thickening, itching, pale pink erythema of the skin, pain in the injection area.
Two forms of allergy to insulin are known: immediate, in which erythema, pruritus, urticaria appear at the injection site 15-30 minutes after injection of insulin, and delayed, which develops 24-29 hours after injection and is characterized by the appearance of infiltrates at the injection site. A generalized reaction is rare and is manifested by weakness, fever, urticaria, itching, joint pain, dyspeptic disorders, angioedema. An extreme expression of systemic allergy is anaphylactic shock. An allergy can occur immediately after the start of insulin therapy, but more often it is detected in the first week or month of its implementation.
An allergy more often is detected in the first week or month of its implementation and may disappear spontaneously after a few weeks.
Local allergic reactions in individual patients may disappear spontaneously after a few weeks. Most patients require a change in the type of insulin. The condition facilitates the appointment of antihistamines, intramuscular administration of insulin heated to body temperature partially helps, local short-term use of glucocorticoid-containing ointments, resorption at the site of compaction accelerates calcium chloride electrophoresis.
In cases of severe reaction, the usual therapy for allergic conditions is used. At the same time, along with antihistamines, it is advisable to prescribe hormones of the adrenal cortex. The main treatment is to desensitize the body with small doses of various types of insulin, the use of highly purified insulin preparations.