The first three goals can be achieved through a fast bladders and after meals below the renal threshold that is 10 mmol / l. Since the latter increases with age, these goals can sometimes be achieved in older patients with relatively high levels of 11 mmol / l bladders and 16 mmol / l after eating. In regard to the level of glycemia, which is essential to achieving 4 and 5, there is no clear-cut clinical data. However, the deterioration of the blood found already at the level of higher glucose 11-14 mmol / l. Therefore, it should be recognized to maintain fast below the level of those who had been hospitalized with severe infections. To achieve the goal of 6 to fall fast in line with the latest international recommendations (Table 1). The absolute testimony to insulinoterapii are : ketoatsidoza cases of diabetic coma and need large surgical decompensation SD amidst heavy infections and other acute diseases (heart attack, a breach of cerebral circulation, acute pneumonia), pregnancy. In these cases, the use of insulin may be temporary, and further treatment may return to ODM and diet. Relative to the testimony insulinoterapii are : ineffectiveness ODM in conjunction with diet (primary or secondary resistance), intolerance or other contraindications to receive ODM first detected in SD2 expressed io. In such instances, the insulin may be temporary or permanent. Insulinovyh products to be used exclusively in SD2, no. Sometimes only insuliny median duration. Some patients SD2 to a satisfactory adjustment fast enough bladders are single injection, the other dose should be divided into two injections. In such cases, the most promising approach can be attempted combination of insulin and ODM. In recent years, the most frequently used mixed insuliny (fixed ratio insulinov short and extended action), who are 2 times daily before breakfast and dinner. Finally, in some cases, can be shown the stronger insulinoterapii insulinov using a short-acting before each meal and insulinov average duration of 2 times a day.
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