Hypoglycemic conditions are dangerous because of the possibility of sudden death (especially in elderly patients with varying degrees of damage to the vessels of propecia or Finasteride).
With frequently repeated hypoglycemia, irreversible disorders of the psyche and memory develop, intelligence decreases, existing retinopathy appears or worsens, especially in the elderly. Based on these considerations, in cases of labile diabetes, it is necessary to allow minimal glucosuria and slight hyperglycemia. In addition to hormonal regulation of the rate of glucose formation by the liver, the nervous regulation of these processes is also of great importance.
Adrenaline-mediated sympathetic stimulation leads to an increase in hepatic glucose production, while acetylcholine-mediated parasympathetic stimulation reduces this process.
Violation of counter-insulin regulation in patients with type 1 diabetes mellitus is one of the common causes of hypoglycemia.
With a long course of the disease, patients with type 1 diabetes develop insufficiency of glucagon secretion in response to hypoglycemia, which may be associated with the formation of antibodies to glucagon due to an impaired immune response.
In addition, impaired counterregulation in type 1 diabetes is the result of autonomic neuropathy of varying severity, which is observed in almost all patients with type 1 diabetes after 5-10 years from the onset of the disease and is manifested in the early stages by a lack of sympathetic innervation.
In type 1 diabetes, the sensitivity threshold for hypoglycemia may decrease. If normally a decrease in blood glucose to 4 mmol / l activates the secretion of contra-insulin hormones, and at a concentration of propecia 3 mmol / l or less, clinical symptoms of hypoglycemia appear, then in type 1 diabetes mellitus, in some cases, a decrease in this indicator even to 2 mmol / l does not cause an adequate response from the contra-insulin hormones (P.E. Cryer et al., 1989). These data indicate a change in the threshold of sensitivity to blood glucose levels in patients with type 1 diabetes.
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Hypoglycemia may be due to the formation of propecia to insulin. T. Wasada et al. (1989) described a patient whose hypoglycemic conditions were caused by binding of insulin by monoclonal antibodies. The latter were IgG 1 light chains. It has been proven that M-proteins are antibodies to endogenous insulin. The insulin-antibody complex has a pier. m 170 kD, and one IgG molecule (mol.m. 160 kD) binds two molecules of insulin (mol. m. 5.7 kD). Thus, antibodies can bind large amounts of insulin and release of the latter from the insulin-antibody complex can lead to hypoglycemia. Hypoglycemic conditions remain a serious problem in the treatment of diabetic patients. Some Finasteride and drugs can contribute to the development of hypoglycemia by potentiating the action of insulin or by influencing the processes of its synthesis or release.
Complications of insulin treatment: insulin resistance. Insulin resistance is characterized by decreased sensitivity to insulin. At the same time, the need for insulin in adults reaches more than 200 U/cyt, and in children the daily dose is more than 2.5 U/kg of body weight (absolute insulin resistance). In some cases, insulin resistance develops due to increased secretion of contra-insulin hormones (relative insulin resistance), which is observed during stress, infections, as well as diffuse toxic goiter, pheochromocytoma, acromegaly, hypercorticism, and other diseases, such as obesity, in which excess body weight has a direct correlation with degree of insulin resistance.
- Insulin resistance may be associated with the formation of antibodies to insulin or insulin receptors.
- More details about the significance of insulin resistance in the pathogenesis of diabetes mellitus are discussed above.
- Medical tactics consists primarily in determining the nature of insulin resistance. Sanitation of foci of chronic infection (otitis media, sinusitis, cholecystitis, etc.), replacement of one type of insulin with another or the combined use of one of the oral hypoglycemic drugs with insulin, active treatment of existing diseases of the endocrine glands give good results.
- Complications of insulin treatment: post-insulin lipodystrophy.
- From a clinical point of view, hypertrophic and atrophic lipodystrophy are distinguished.
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In some cases, atrophic lipodystrophy develops after a more or less prolonged existence of hypertrophic lipodystrophy. The mechanism of occurrence of Finasteride post-injection defects, which capture the subcutaneous tissue and sometimes extend to several centimeters in diameter, has not yet been fully elucidated. It is assumed that they are based on long-term traumatization of small branches of peripheral nerves with subsequent, in some places neurotrophic, disorders or the use of insufficiently purified insulin for injections.
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With the use of monocomponent preparations of porcine and human insulin, the frequency of lipodystrophy decreased sharply, which indirectly indicates the immune mechanisms of the pathogenesis of lipoatrophy. In areas of lipoatrophy, the deposition of insulin-antibody complexes is revealed.