Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
| Autor: | Alisa V. Vitebskaya, Anastaiya V. Popovich, Karina V. Aleksanyan, Ekaterina A. Yablokova, E. Afonina, Olga V. Shpitonkova, Mariya I. Grammatopulo, Yuliya O. Kostina |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
RC620-627 Endocrinology Diabetes and Metabolism medicine.medical_treatment Arthritis Gastroenterology 03 medical and health sciences 0302 clinical medicine Endocrinology Insulin resistance children 030225 pediatrics Internal medicine Diabetes mellitus Internal Medicine Medicine Nutritional diseases. Deficiency diseases Juvenile dermatomyositis Glycemic 030203 arthritis & rheumatology glucocorticoids business.industry Insulin medicine.disease Ulcerative colitis Discontinuation diabetes mellitus business |
| Zdroj: | Сахарный диабет, Vol 22, Iss 3, Pp 263-273 (2019) |
| ISSN: | 2072-0378 2072-0351 |
| Popis: | BACKGROUND: In coexistence of diabetes mellitus type 1 (DM1) with severe autoimmune and inflammatory diseases some patients need simultaneous administration of insulin and glucocorticoids (GC). GC therapy in patients with DM1 can worsen glycemic control. AIM: To determine characteristics of insulin therapy of DM1 in children and adolescents receiving GC. DESCRIPTION OF CLINICAL CASES: We observed 5 patients with DM1 receiving GC for juvenile idiopathic arthritis (JIA), juvenile systemic sclerosis (JSS), juvenile dermatomyositis (JDM), ulcerative colitis (UC), and reactive arthritis (RA). Intra-articular administration of GC did not significantly influence glycemic control. In case of GC pulse therapy hyperglycemia and increased insulin requirements were recognized in 36 hours after GC receipt, persisted from few hours up to 3 days after each administration. While therapy with oral GC in high doses the worst glycemic control was registered in daylight hours. To overcome insulin resistance change of time of injection and 10%-increase of long-acting insulin analogue, additional injections of ultrashort-acting insulin analogues, temporal prescription of short-acting human insulin were used. While GC therapy insulin daily dose was individual and could reach 2.0 U/kg. After transition to maintaining doses of GC or discontinuation of GC therapy patients returned to standard or relatively low insulin requirements. Levels of glycosylated hemoglobin differed significantly among patients at different stages of treatment, were maximal while long-term therapy with high doses of oral GC, but mostly depended on patients compliance. CONCLUSION: Bettering of glycemic control while receiving GC can be reached by timely dose correction of insulin therapy, selection of individual schemes, taking into account time of receipt and pharmacokinetic characteristics of GC. Adherence of the patient and his family to treatment of DM1 plays an important role in glycemic control. |
| Databáze: | OpenAIRE |
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