Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids

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...

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Autores principales:	Alisa V. Vitebskaya, Anastaiya V. Popovich, Elena Y. Afonina, Yuliya O. Kostina, Karina V. Aleksanyan, Mariya I. Grammatopulo, Ekaterina A. Yablokova, Olga V. Shpitonkova
Formato:	article
Lenguaje:	EN RU
Publicado:	Endocrinology Research Centre 2019
Materias:	diabetes mellitus children glucocorticoids Nutritional diseases. Deficiency diseases RC620-627
Acceso en línea:	https://doaj.org/article/95a794e28bc04cdc8fadbd55762b001c
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spelling	oai:doaj.org-article:95a794e28bc04cdc8fadbd55762b001c2021-11-14T09:00:22ZCharacteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids2072-03512072-037810.14341/DM10042https://doaj.org/article/95a794e28bc04cdc8fadbd55762b001c2019-08-01T00:00:00Zhttps://www.dia-endojournals.ru/jour/article/view/10042https://doaj.org/toc/2072-0351https://doaj.org/toc/2072-0378BACKGROUND: 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 3–6 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 patient’s 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.Alisa V. VitebskayaAnastaiya V. PopovichElena Y. AfoninaYuliya O. KostinaKarina V. AleksanyanMariya I. GrammatopuloEkaterina A. YablokovaOlga V. ShpitonkovaEndocrinology Research Centrearticlediabetes mellituschildrenglucocorticoidsNutritional diseases. Deficiency diseasesRC620-627ENRUСахарный диабет, Vol 22, Iss 3, Pp 263-273 (2019)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	diabetes mellitus children glucocorticoids Nutritional diseases. Deficiency diseases RC620-627
spellingShingle	diabetes mellitus children glucocorticoids Nutritional diseases. Deficiency diseases RC620-627 Alisa V. Vitebskaya Anastaiya V. Popovich Elena Y. Afonina Yuliya O. Kostina Karina V. Aleksanyan Mariya I. Grammatopulo Ekaterina A. Yablokova Olga V. Shpitonkova Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
description	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 3–6 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 patient’s 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.
format	article
author	Alisa V. Vitebskaya Anastaiya V. Popovich Elena Y. Afonina Yuliya O. Kostina Karina V. Aleksanyan Mariya I. Grammatopulo Ekaterina A. Yablokova Olga V. Shpitonkova
author_facet	Alisa V. Vitebskaya Anastaiya V. Popovich Elena Y. Afonina Yuliya O. Kostina Karina V. Aleksanyan Mariya I. Grammatopulo Ekaterina A. Yablokova Olga V. Shpitonkova
author_sort	Alisa V. Vitebskaya
title	Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
title_short	Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
title_full	Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
title_fullStr	Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
title_full_unstemmed	Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
title_sort	characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids
publisher	Endocrinology Research Centre
publishDate	2019
url	https://doaj.org/article/95a794e28bc04cdc8fadbd55762b001c
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Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids

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