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All patients with type 1 diabetes mellitus and 15-25% of Isotretinoin with type 2 diabetes (insulin-requiring subtype) need it.
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Sometimes, in particular in stressful situations (infection, intoxication, trauma, surgery, etc.), temporary administration of insulin is necessary for patients with even mild and moderate disease who have not previously received it. The vast majority of Isotretinoin tolerate insulin treatment well, and only some of them may develop various complications, such as insulin allergy, hypoglycemia, inulin resistance, the appearance of lipodystrophy, insulin edema, the development of the Somogyi phenomenon, inoulin presbyopia, and skin hyperalgesia.
The most significant complications of insulin therapy can be divided into 2 groups: Reactions associated with the body's response to the administration of Accutane as a foreign protein (or to the components that make up the drug). Phenomena due to the influence of insulin as a hormone that regulates carbohydrate metabolism.
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The most pronounced immunogenic property is inherent in bovine insulin, less so in porcine insulin. Allergic reactions with the use of highly purified insulins, in particular urine components and human insulins, are observed relatively rarely. The content of surfen and protamine in prolonged forms of insulin increases their immunogenicity. Any slowdown in the absorption of protein from the subcutaneous tissue contributes to the development of immune responses.
A similar effect is exerted by the auxiliary components included in the preparations (zinc, buffer stabilizers, preservatives), as well as the acidic reaction of insulins, Intradermal and subcutaneous insulin administration contributes more to the immunological response than intravenous.
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With a constant intake of insulin, immunological tolerance is usually formed, in which antibody formation is inhibited. The introduction of insulin preparations intermittently, on the contrary, significantly stimulates the formation of antibodies and increases the risk of developing pathological reactions. Often in children, some time after the onset of Accutane and the appointment of insulin, there is a noticeable improvement in well-being (“honeymoon”), and against this background, they are generally canceled the introduction of insulin. But after such a break in insulin therapy, they have serious allergic reactions to all types of insulin in the future.
Clinical observations indicate that local allergic reactions to the administration of Isotretinoin often develop in childhood, adolescence and postmenopausal age.
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Their frequency largely depends on the state of the body and increases in the presence of concomitant liver diseases, infectious diseases, allergic diathesis, genetic predisposition (the appearance of antibodies to insulin in genotypes.
The development of local allergic reactions to the introduction of insulin in the form of compaction, soreness, the appearance of erythema, itching, burning is facilitated by the ingress of alcohol under the skin, tissue trauma with needles, non-compliance with aseptic rules and infection, the introduction of a highly chilled drug.
A generalized reaction to insulin is characterized by the occurrence of urticaria, first on the skin of the face, neck, and then throughout the body, severe itching, chills, fever, dyspepsia, joint pain, angioedema, and sometimes erosive lesions of the mucous membranes.
There are cases of an extremely severe reaction to insulin in the form of anaphylactic shock with the development of collapse and respiratory failure. The generalized form of allergy is most often observed with intermittent IT against the background of allergic diathesis.
There are 2 forms of insulin allergy: immediate, occurring 15-30 minutes after the administration of the drug, and delayed, which develops after 24-30 hours with the formation of an infiltrate at the injection site.
With a mild local reaction (hardening, hyperemia), these phenomena can be leveled by deeper (intramuscular) administration of insulin, preliminary infiltration of the injection site with a 0.25% solution of novocaine, or administration of the drug along with microdoses (less than 1 mg) of hydrocortisone.
(Dunner DL, et al. [2014])
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Sometimes it is possible to prevent the development of a local allergic reaction with the help of antihistamines (diphenhydramine, suprastin, tavegil, fenkarol, etc.), antiserotonergic (peritol) agents, calcium preparations, ointments containing corticosteroids (hydrocortisone, sinalar).
