Classes are held within the framework of the project "Educational space for children and adults with type 1 diabetes mellitus" DIA-lab. " the state program "Social support of citizens of the Nizhny Novgorod region".
An insulin pump is by far the most advanced way to deliver insulin. It is an extremely convenient gadget that makes the life of its owner much more comfortable. But at the same time, it should be understood that this is not an artificial pancreas that does everything by itself. The pump requires constant manual control, monitoring, correcting coefficients, etc. It is not enough to go to the hospital and get a pump there - you also need to learn how to use it. That is why training events are periodically held for diabetics.
One of them, the Accu-Chek diabetes school for patients with insulin pumps, was held in Nizhny Novgorod on 23 January. The lesson was held within the framework of the project "Educational space for children and adults with type 1 diabetes mellitus" DIA-lab. " state program "Social support for citizens of the Nizhny Novgorod region". The organizer was the regional public organization of disabled people "Nizhny Novgorod Diabetic League" with the support of the regional ministry of internal regional and municipal policy.
During the lecture, endocrinologist Yekaterina Malysheva talked about the principles of the pump, its advantages over syringe pens, about the rules of nutrition for type 1 diabetes mellitus and about the difficulties people face when installing the pump.
In particular, she named one of the problems that almost none of the doctors know how to treat a patient with a pump for other diseases. For example, if such a person is admitted to the hospital and needs surgery, then the medical staff will require first to remove the pump and switch to traditional insulin injections. Or, as one of the listeners said, the hospital may even try to somehow get rid of the "uncomfortable" patient. Therefore, now, according to Ekaterina Malysheva, it is planned to begin training doctors in the basics of interacting with such people - so that when they get to the hospital, for example, with appendicitis, they do not receive additional inconveniences due to the ban on wearing the pump.
As for nutrition, in general, its principles on the pump are the same as on syringe pens: do not eat too many carbohydrates at one meal, take into account the glycemic index of foods, combine them correctly, and eat balanced. But there is also one peculiarity: since patients with pumps do not deposit basal (long) insulin in the body, after consuming a large amount of proteins and fats, after a few hours, "tails" come out (which would be smoothed by basal insulin on syringe pens). Therefore, in addition to carbohydrates, the amount of BZHE - protein-fat units - should be taken into account on the pump. 100 grams of protein food equals approximately 1 XE (bread unit), which can be learned to compensate with an extended bolus.
The diet of a diabetic should contain, on average, 150 175 grams of carbohydrates per day (that is, 15 17.5 XE or 5 7 XE per meal). This amount is needed for proper metabolism. Severe restriction of carbohydrates (transition to the so-called keto diet) is harmful to health, especially it is contraindicated for children who should receive a variety of satisfying food for full growth and a stable psychological state.
Also Ekaterina Malysheva touched upon the topic of physical activity.In the case of sports training or other active activities (cycling, swimming, working in the garden, etc.), the insulin supply from the pump can be temporarily reduced by setting the temporal baseline rate (temporary basal rate) to 50–70%. What is much more convenient than syringe pens - there you can no longer reduce the previously injected basal insulin, and all that remains is to eat an additional amount of carbohydrates in order to avoid hypoglycemia during sports. The pump gives you much more freedom.
The success of diabetes compensation is expressed in numbers: the closer blood glucose values are to those of healthy people, the better compensation is established. Previously, the only way to find out the approximate level of compensation was the analysis for glycated hemoglobin (that is, the average blood sugar over the last three months). But now, with the advent of continuous monitoring systems, this analysis is no longer considered reliable, since, unlike monitoring, it does not show jumps in glycemia. Meanwhile, diabetic complications arise precisely because of changes in sugar levels - when blood glucose constantly jumps, for example, from 2 3 to 25 30 mmol / l.
In Russia, first-type diabetics are not yet provided with monitoring systems at public expense (by analogy with insulin, test strips and consumables for pumps, which are given out free of charge). But work in this direction is underway, because this will allow avoiding deep disability of a huge number of people who today lose their eyesight and undergo amputation of their legs due to a lack of self-control and, accordingly, poor compensation.
“The most important thing is that there should be no fluctuations in sugar more than 2 mmol / l during the day, the maximum allowed is 2.7. The lower this figure, the better. There are people for whom this indicator is only 1, this is what you should strive for, and the pump gives you maximum opportunities for this,”summed up the lesson Ekaterina Malysheva.
Video recording of the lecture is available here. The next session, the Medtronic Pump Diabetes School, will take place next Saturday, January 30th.
Recall that since 2019, the Interregional Endocrinology Center of the PIMU University Clinic has been operating in Nizhny Novgorod, on the basis of which insulin pumps are installed for children and adults.