الأربعاء، 24 أغسطس 2016

من مقابلة قديمة للدكتور برنستين : مفهومه الخاص عن الانسولين القاعدي وملاحظات على أنواع الانسولين القديمة والحديثة

الخلاصات مضللة :)
And for lunch?

Lunch, I got up late today so I'm skipping lunch. On a regimen where you're taking insulin for meals, you don't have to eat every meal. That's unlike the ADA regimen where you get one or two shots of insulin a day and you have to eat all day the insulin to avoid hypoglycemia.

My wife and I had a big problem when she was you know in a Lantus while eating to combat low blood sugars. Just continuously whether you're hungry or not eating which was a very frustrating experience.

We don't use Lantus for a variety of reasons but we do use Levemir.

Do you split doses?

We split it three ways. None of the long-acting insulins last the night and it leads to dawn phenomenon. People already making substantial amounts of insulin may get away with it. For many years, we had type 1 diabetics use two shots of Ultralente: one on arising and one at bedtime. And found that the one at bedtime doesn't last. So we tried to get people to get up four hours after their bedtime shot for a second shot. That's what I do. I take one-and-a-half units of Levemir at bedtime and one-and-a-half units four hours later. It's a pain in the neck, and it wouldn't be necessary if Lily had not discontinued their insulin

Lily's earlier insulins had different active insulin graphs?

Yes. Levemir and Lantus were put through the FDA as once-a-day insulins by what I call fraudulent clinical trails. They gave people mega doses of insulin, larger than they needed, forcing them to eat all day. 

30 years ago, John Galloway of Eli Lily did an experiment where he gave a non-diabetic man an injection of 70 units of regular insulin into his arm. They gave the patient an IV drip of glucose and checked the blood sugar every half hour. If his blood sugar was going down, Galloway would increase the drip. And it were going up, he'd slow the drip. And that way, he'd clamp his blood sugar to 90. 

How long do you think he had to keep dripping in glucose to prevent this guy from getting hypoglycemia?

Remember, this was the fastest acting insulin we had.

I couldn't even guess.

He had to do it for a week. He demonstrated that the length of time that the shot lasts is dependent upon how much you inject in one place



. The drug manufacturers of this new line acting insulins wanted to pretend that their insulins last 24 hours. So they gave them real big labs of insulin, more than was needed to keep people's blood sugars level. But enough, so that it's absorption would last 24 hours. They were not getting true basal insulin. Basal insulin is supposed to cover only the fasting state. These people got enough insulin to cover much of their meals and snacks also.

That sounds like too much insulin if you're on a basal bolus regime.


الدكتور برنستين يرى أن وظيفة الانسولين القاعدي هي تغطية ساعات الليل ما قبل الاستيقاظ وبالتالي فالانسولين القاعدي أو طويل المفعول مسؤول عن قيمة سكر صائم بينما مصانع الانسولين تنتج انسولينات جديدة وتوصي بجرعات أكبر من حاجة الشخص وبجرعة انسولين قاعدي تغطي فترة النوم وما بين الوجبات وحتى الوجبات تغطيها وزيادة ...
يعني يلمح لكون المصانع تدفع بالمستهلك لاستهلاك أكبر من حاجته من الانسولين وذلك لتبيع منتوجاتها بشكل أكبر وتحقق ربحا أكبر ...



By the way, this is not the only sleazy thing that's going on in the diabetes industry. Almost anywhere you turn, there's something that's not to the benefit of the patient going on. I'll give you an example. 


The American Association of Clinical Endocrinologists are now recommending that regular and NPH insulin be taken off the market as unnecessary and that diabetics are only entitled now to the analog insulins. The insulins that are not true human insulins. There are at least two big disadvantages to this. 

Number one, regular insulin is far more predictable and its effects on blood sugar than any of the analog rapid-acting insulins. It's more reliable. 

Number two, it's less potent than HumaLog, NovoLog, and possibly Apidra. If you want to get two units, it's harder to measure. It's easier to measure with regular because it's a weaker insulin. If you want to measure a unit and a half, you can. But if you did a unit and a half of HumaLog, it would have two-and-a-half times the effect would be like, measuring three units of regular. So you get more precision in your measurements in regular because it's more diluted. 

Another problem is that, for little kids, full strength of any of the content insulins is far too potent. For example, one unit of regular will lower my blood sugar by 40 but in a 20-pound kid, it will lower him 240. Half of a unit will lower him 120. How could you give him a precise dose of insulin? Even with the weakest insulin we have, regular, you can't measure it. But you can dilute it. We have diluting solution for regular. We don't have diluting fluid for Lantus and Apidra. We have diluting for NPH. For little kids, even though NPH is only in intermediate acting insulin, I'll give them three or four shots of NPH a day and we'll dilute it so that we can give them precisely what they need for there basal insulin. Not all of the analog insulins are dilutable. We can dilute Humalog and NovoLog. I don't think they have it for Apidra. They don't have it for the longer acting insulins Lantus and Levemir. So, with little kids, we are stuck with giving them industrial doses of insulin that are exceedingly dangerous and make meticulous blood sugar control impossible

توجد على الأقل مشكلتان كبيرتان بخصوص أنواع الانسولين الشبيه (Insulin analogues).
  • انسولين الصافي (الريقيولار) وهو انسولين بشري (Human insulin) أكثر قابلية للتنبؤ بطريقة عمله أكثر من أي انسولين  شبيه إنه أكثر واقعية  .
  • انسولين الصافي أقل قوة من الهيومالوج ، النوفولوج ، وممكن حتى من الابيدرا إنه مخفف أكثر 
** مشكلة تتعلق بالصغار ، كل أنواع الانسولين تكون قوتها مضااااااعفة إذا أعطيت لهم . مثال: 1 وحدة من انسولين الريقيولار أو الصافي تخفض سكر دمي بمقدار 40 وعند طفل يزن 20 باوند فإنها تخفض سكر دمه بمقدار 240 والحل هو بتخفيف الانسولين حتى أضعف أنواع الانسولين ( الريقيولار ) من الممكن تخفيفه عند استعماله لدى الصغار بواسطة محاليل التخفيف .

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