Reasons were mainly in international comparison, over-priced new drugs as well as the still popular so-called Regulation Analogpräparate without therapeutic value. The study estimated the potential savings to 3.4 billion euros.

Patented drugs are still disproportionately expensive in Some parts of the world. Thus, the vaccine against cervical cancer in this country would cost 477 euro, in the U.S. for instance, only the equivalent of 247 Euro. Even in Switzerland, the price lies in the central cantons of negotiations with the manufacturer, with only 314 euros.

In the current year, threatening a new cost explosion. According to current statistics, the pharmaceutical expenditures have risen again to July by more than 5 percent.

The drug report is based on 723 million for statutory health insurance regulations that were issued last year by approximately 135 000 registered doctors.

However, this could also take patients. Thus, the head of the doctors’ association of North Rhine, Leonhard Hansen wanted to make a precise assessment of costs and benefits of very expensive specialty drugs, the additional cancer patients, for example, only a few days of life. A discussion of treatment goals was an urgent need, “said Hansen.

He also gave out a line for his own medical colleagues to prescribe a patient, preferably not more than five different preparations. Experience shows that otherwise the “therapy compliance” vanish – the individual patient can be arbitrarily pills away. In part they were discharged from hospitals with up to 14 different drugs for specific diseases, told Hansen.

29.2 billion Euro cost

The cost of drugs to run away all the other health care costs for years. With the increase of 5.3 percent last year, a total of 29.2 billion euros has been achieved – the second largest item of expenditure according to the hospital costs, which rose 3.5 percent to 52.6 billion euros.

Cost according to an analysis of the reports Arzneiverordnung expensive mass-market products such as blood pressure lowering agents and antidiabetic drugs as well as special as immunotherapeutics and tumor drugs. These few groups alone accounted for 65 percent of the cost increase to 1.4 billion euros, “said Report Editor Ulrich Schwabe.

Vaccination costs in the U.S., only half

He also criticized the high prices in Some parts of the world, especially for novel drugs that are still patent, and often have no competition. As an example he cited the vaccine against cervical cancer: In Some parts of the world, a primary immunization would cost 477 euro, in the U.S. for instance, with 247 euros, only about half.

A thorn in the eye are the experts still also called Analogpräparate – funds with no or little added value compared with conventional proven drugs. Here there is a potential savings of 1.7 billion euros.

Savings successes than there are for generic drugs, according to Schwabe – these are cheap imitation after a drug patent. Here are the prices had fallen by four percent. In addition, generic drugs were prescribed more frequently: the number of daily doses increased by eleven percent. Here Schwabe, “criticized the high” distribution costs: While the funds would get themselves often cost only cents amounts to a flat rate regardless of price pharmacist of 8.24 euros.

No “astronomical prices more»

The publishers of reports, and drug doctors and health insurance funds were largely in agreement that further legal costs brakes were required. To prevent “astronomical prices” too had a “legal framework” to be found, “said chief executive Herbert AOK Reichelt. Main thrust: The manufacturers will be forced into price negotiations with the treasury or a “central institution”.

In the antiviral medicine against particularly dangerous virus (HIV), influenza or other viral infection in-patients with weak immune systems are used. For wider application, they are suitable because of its adverse effects are not. The virushemmende effect the immune system can only support. An AIDS patient whose specific immune response through the reduction of CD4 helper cells has collapsed, can also be Therapy virostatischer no longer be saved opportunistic viral infections, in the wake of an effective antiviral therapy against HIV, there is the chance of a recovery of the immune system. Since there currently are no medicines that contain viruses in the body can kill the host organism without significantly burdening, antivirals will be the last option of treatment considered.

Many antiviral effect by inhibiting the enzyme DNA polymerase, the genetic information of the virus. They mimic the shape of DNA building blocks (Pyrimidinanaloga, Purinanaloga, and Pyrophosphatanaloga). In Retroviruses (HIV, HTLV) can also inhibit reverse transcripts, forming an interim step in propagating the viral RNA into DNA sets. Other HIV drugs inhibit the protease, the long protein that HIV is first formed in the smaller proteins with its various functions cut. There are also Uncrating inhibitors, the dropping of the lipid envelope beholder viruses in the host cell into the prevent (influenza, HIV).

Representatives

* Aciclovir against herpes various diseases.
* Valaciclovir as a precursor of aciclovir with improved bioavailability.

* Oseltamivir, the neuraminidase inhibitors for the treatment of influenza (flu)
* Zanamivir, neuraminidase inhibitor for the treatment of influenza

The most commonly used platelet aggregation inhibitors are:

* Aspirin (including ASA, Aspirin ®)
* Clopidogrel (Plavix ®, Iscover ®)
* A combination of aspirin and dipyridamole (Aggrenox ®)
* Ticlopidine (including Ticlyd ®, Desitic ®)

Effect

Act to inhibit ovulation contraceptive in three ways: they prevent exposure to the control system hypothalamus-pituitary – ovary ovulation. They change the mucus in the canal of the cervix (cervix) so that sperm can pass through these difficult and they prevent the uterine lining regelrecht up – a possibly fertilized egg (the zygote) can not nest and to the embryo stage. This threefold approach explains the impact of highly effective to inhibit ovulation: Correctly taking over a year, the pregnancy from 99.1 to 99.9% prevented. (Pearl Index: 0.1 to 0.9).

Composition

The female sex hormones are not in their natural but in a chemically modified form administered. This modification is inevitable: The hormones would otherwise be the host of the stomach and intestines into the liver destroyed.

As a synthetic derivative (descendant) of natural estrogen is usually ethinylestradiol (Abbreviation: EE) is used. There are many different Progestogens used, all with slightly different effects and side effects.

The dose of estrogen has been the premiere of the 1960 to inhibit ovulation always lower because it appeared that security remained high at the same reduced side effects. Most newly prescribed to inhibit ovulation only receive 20 to 35 microgram EE, the höchstdosierten in some parts of the world still available to inhibit ovulation 50 micrograms.

Einphasenpräparate in each pill containing the same amount of estrogen and progestin, in a two-phase specimens is the only progestin in the second half of the package, in the first phase, only the estrogen used.

Two-or three-stage preparations contain two or three different combinations of estrogen and progestin.

Ingestion Pill

In general, a pill pack contains 21 pills. After 21 days of continuous ingestion followed 7 days pause in the menstrual bleeding usually occurs. For packages with 22 pills shall be taking 22 days and 6 days break. Inhibit ovulation with 28 pills per package of 6 or 7 tablets without substance, they should be taking to improve security.

The initial intake is done today, mostly on the first day of the cycle (the first day of menstruation). Compared with the earlier customary 5th Day is thus a protection against pregnancy during the first cycle, but there are also frequent bleeding between periods on.

Inhibit ovulation must be regularly every 24 hours. If the forgotten pill, it may be in single-and 2 – or 3 – stage preparations have taken 12 hours later, without preventing safety. (However, this should not occur multiple times in the cycle.) In two-phase preparations, the time window is only 6 hours big in the mini-pill only 2 hours. If these periods are exceeded, additional contraception, eg condoms are used. The rest of the pack should be in excess of the time and completely forget nonetheless be used in order to avoid Zyklusunregelmässigkeiten.

Vomiting and diarrhea can be reduced to inhibit ovulation safety. Some antibiotics (eg ampicillin, tetracycline), but also anti-free sale St John’s Wort preparations including can inhibit ovulation, the effectiveness of performance.

Maniple and free estrogen to inhibit ovulation

The mini pill is only a progestin, the estrogen portions missing. Mini pills inhibit only one part of the women’s ovulation, so they are not to inhibit ovulation in the strict Sense. You contraceptive effect in which the cervical mucus for sperm impassable and the regular structure of the uterus (the endometrium) hamper. Mini pills are not so sure that they protect only 97 to 99.5% per year prior to application of an unwanted pregnancy. In addition, mini pills lead to very frequent bleeding between periods. Mini pills are designed especially for breastfeeding women (estrogens inhibit breast milk production) and for women, the result of an illness not estrogen may receive suitable. An exception to the progestin pills is a pill based on Desogestrel (Cerazette ®) in 97% of case leads to ovulation and the safety of combined pills achieved.

Hormone implants and three syringe

The hormone implant is available since 2000 in Germany. A small Gestagenhaltiges swab is placed under the skin of the upper arm planted. Over the period of 3 years is from the depot progestin released. The safety and side effects are similar to those of others to inhibit ovulation. More often, however, are irregular bleeding, in 20% of the women has to amenorrhea (absence of menstruation). There is a lack of long-term experience, studies of women under 18 years, have not yet been carried out. Hormone implants are especially suitable for women who have difficulties with the regular intake of have to inhibit ovulation.

Similarly, the three syringe. A long progestin is effective in the thigh muscles injected every three months. Especially if they are in young women, can this form of inhibit ovulation later lead to osteoporosis? After discontinuation of the top three, it takes very long until the normal cycle of women and fertility is restored.

Vaginal ring and preventing pavement

The vaginal ring has been operational since February 2003 in Germany for contraception admitted. It consists of a flexible plastic, with the estrogen and progestin is impregnated. The vaginal ring is used by the woman introduced into the vagina and remains there for three weeks. After a week break in which the menstrual period occurs, a new ring in the same way. Estrogen and progestin are the vaginal ring on the Vaginalschleimhaut, which corresponds to the effect of combination of conventional drugs. The low estrogen dose (15 microgram EE) will include as an advantage of the very safe method, even here are still missing long-term experience.

The patch will prevent once a week on the skin such as the upper arm stuck. After three patches follows one weeks break with the menstrual period. The patch is preventing estrogen and progesterone released by the skin is absorbed. The effectiveness and safety in accordance with the conventional Einphasenpräparate Prevention patch mainly in chronic intestinal diseases in question, in which the absorption of conventional inhibit ovulation, is not safe.

Side effect Sources

This article or section is not, or by inadequate source information (literature, websites, etc.) have been documented, making the content in question threatens to delete. Please help Wikipedia by making good evidence for the information call.

Non-smoking, healthy women can inhibit ovulation until the onset of menopause (the beginning of menopause) is taking. Pill breaks have a rather negative effect on cycle regulation and are now no longer recommended.

For women who smoke or women with other serious risk factors for Herzkeislauferkrankungen (eg, poorly controlled high blood pressure) heart attacks and strokes occur more frequently.

Women, who after taking to inhibit ovulation headache, speech disturbances, disturbances of consciousness or other symptoms from the central nervous system develop, should immediately send to inhibit ovulation.

Increases in blood pressure are the estrogen component ascribed. Bring a change of the preparation there is no improvement inhibit ovulation deductible. The blood is then normalized in most cases. According to the current expression, women who have 35 years of age and smoke do not apply to inhibit ovulation.

Breakthrough bleeding can be a change to a product with a higher estrogen dose remedied. Nausea, feeling of tension in the chest and water storage can be reconciled with a lower estrogen dose avoided. Acne, nervousness, and weight gain are the progestin component ascribed possibly help a change to a product with a low dose of progestin or a progestin with others Wirkprofil. Some specifically inhibit ovulation by progestin to be effective even in young women with acne Kontrazeptionswunsch successfully.

Taking inhibit ovulation do not lead to a reduction in fertility (fertility), accidental ingestion by inhibit ovulation does not result in abnormalities of the embryo.

Complications due to thrombosis and embolism in women under about 4 times more likely to inhibit ovulation than women who do not take hormones. Before and after a (planned) surgery should inhibit ovulation for that reason be dismissed. Inhibit ovulation does not solve from diabetes mellitus, but may be the development of diabetes or accelerate the setting worsen diabetes and vascular complications in diabetics promote. Inhibit ovulation do not lead to a new formation of gallstones, but may promote growth.

Depression and sleep disorders are at 1-2% of women who are taking to inhibit ovulation, triggered.

The Chloasma, a skin disorder characterized by increased pigmentation, may inhibit ovulation occur. This rare adverse event requires the immediate discontinuation of inhibits ovulation, because a treatment is very difficult is possible.

The risk of a cancer of the ovaries or the uterus (corpus Carcinoma) cancer is taking to inhibit ovulation presumably by up to 50% less.

The risk of a carcinoma of the cervix to develop is perhaps increased. The causal connection is not secured, since this tumor in sexually active women, regardless of the type of contraception to occur more frequently.

Breast cancer occurs among long-time intake of slightly more likely to inhibit ovulation, benign changes in the mammary gland rare.

Active liver disease should not be used to inhibit ovulation. Very rare (1:30.000 to 1:50:000) can inhibit ovulation benign liver tumors produce.

Inflammation of the fallopian tubes, Extrauteringravidität (pregnancy outside the uterus), anemia by iron deficiency, Premenstrual syndrome and ovarian cysts occur under rare to inhibit ovulation. According to American studies will be 50.0000 inpatient admissions per year in the U.S. avoided. According to the current state of knowledge can be assumed that inhibit ovulation does not lead to a reduced life expectancy.

Menstrual shift

A menstrual shift is possible to inhibit ovulation. In Einphasenpräparate the following pack after the first without pause used. The contraceptive effect is not hindered. Subject of clinical studies, long-term ingestion of inhibits ovulation over a period of 12 weeks. The long-term ingestion could provide benefits for women, especially in the pill break complain about complaints.

Name =11-Dehydro-17-hydroxycorticosteron
Molecular Formula = C21H28O5
Other names = cortisone, compound E, cortisone
Short = Glucocorticoids
CAS number = 53-06-5
Melting point = 222 ° C
Water solubility = 280 mg / l at 25 ° C
Vapor pressure = 5,80-13 mm Hg at 25 ° C
Molar mass = 360.45 g / mol

The name of cortisone (from the Latin cortex “bark”) was the first in the adrenal cortex of the human substance where found. Cortisone is the inactivated form of the Glucocorticoids cortisol. It neither binds the Glucocorticoids receptor or the receptor Mineralcorticoid and by the enzyme β-hydroxy steroid dehydrogenase or formed from cortisol in this transformed. Linguistically is dealing drugs with cortisol effect often referred to as “cortisone” means?

Historic Sites

Cortisone in the years 1936-1940 by several working groups isolated and different names: as “compound F” winter Steiner as a “family matter” through Reichstein and as “compound E” by the Working Group to Kendall. The subsequent cortisol or hydrocortisone 1937/38 was produced by Reichstein. Later, it turned out that a precursor of cortisone actual hormone cortisol (hydrocortisone) is. Synthetic cortisone variants include prednisone, prednisolone, methylprednisolone, betamethasone, dexamethasone, triamcinolone, Paramethason and Fludrocortison. Prednisone and prednisolone in the body can be transformed into each other and are equally effective. Their effect is approximately five times the effect of cortisone.

Physiological effect

Diseases for which cortisone is applied

Internal application

* Addis’s Disease
* Andrenogenital Syndrome
* Autoimmune diseases (eg giant cell arthritis)
* Autoimmune hepatitis
* Asthma
* Hives
* Crohn’s Disease
* Hörsturz
* Ulcerative colitis
* Multiple Sclerosis
* Leukemia
* Pulmonary Fibrosis
* Rheumatoid Arthritis
* Sciatica / lumbalgia (for herniated disc)
* Cluster Headache
* Sarcoidosis
* Optic neuritis
* Eosinophilic Gastroenteropathie

External application

* Psoriasis
* Seborrhea Dermatitis
* Slight phimosis
* Sunburn
* Neurodermatitis

Do not use in any of these diseases, the efficacy of cortisone been scientifically proven.

Side effects

Continuous application of cortisone

* Muscle and bone:
* Muscle weakness or muscle atrophy (muscle atrophy)
* Osteoporosis and aseptic Knochennekrosen (head of the upper arm and thigh bone)

* Skin:
* Stretch marks (striae rubra)
* Dünnwerden of the skin (atrophy)
* Punctiform skin bleeding (petechiae), bruise
* Steroid
* Delayed wound healing

* Eyes:
* Increasing the eye (glaucoma)
* Lens opacity (cataract)

* Metabolism:
* Elevated blood glucose levels, diabetes, diabetes mellitus (type III.E.4)
* Water storage in the tissue, full face
* Increased potassium excretion
* Growth disorders in children
* Disorders of Sexualhormonsekretion (absence of menstrual bleeding, abnormal hair growth, impotence)
* “Bull neck”

* Blood, immune system:
* Changes in blood count (leukocytosis, lymphopenia, Eosinopenie, Polyglobulie)
* Increasing the risk of infection, immune deficiency

Short-term, high application

There are mainly neuro-psychiatric symptoms, such as

* Convulsions,
* Dizziness,
* Headache,
* Insomnia,
* Euphoria
* Depression,
* Psychosis,
* Manifestation of a latent epilepsy.

Chemical Fundamentals

It divides the calcium antagonists because of their chemical structure and their attack point on the calcium channel in three types:

* Dihydropyridine (nifedipine-type)
* Phenylalkylamine (verapamil type)
* Benzothiazepine (diltiazem type)

Mechanism

The concentration of calcium ions in the cell interior is usually about ten thousand times smaller than in Extrazellularraum. Through external stimuli calcium channels can be opened, making the influx of calcium ions causes. The concentration change inside the muscle cell causes a muscle contraction (electromechanical coupling).
This leads to a constriction and thus a higher pressure in the vessels, or the heart to an increase in strength. In the specialized cells responsible for the agitation spread to the heart are responsible, this causes a more rapid transition of the stimulus.

Calcium channel blockers bind to the α1-subunit of the calcium channels of L-type, and thus reduce the influx of calcium. This decreases them (depending on the type, to varying degrees) the above-mentioned effects. A reduced calcium ion influx, therefore, on heart muscle leads to a reduction in force (negative inotropic effect) and the stroke rate (negative chronotropic effect). This will relieve the heart, the oxygen demand and blood pressure decrease. In the vascular wall leads to a diminished Kalziumeinstrom vasodilation (widening of vessel). A larger lumen of the blood has less resistance (reduction of peripheral vascular resistance) and it comes to the fall in blood pressure. By far the vessel position in the coronary vessels to the heart muscle more oxygen-rich blood for his work available.

Effects and application areas

All calcium antagonists lower blood pressure, although this happens on a different path: the Dihydropyridine (nifedipine-type) through the vascular expansion, in the Phenylalkylamine (verapamil type) by the slowdown and weakening of the heartbeat, the Benzothiazepine (diltiazem type) by a combination of both mechanisms.

The most commonly used are the Dihydropyridine. These blood pressure-reducing effect primarily through direct relaxation of the vascular smooth muscle and only marginally on the conduction of the heart. Important representatives of this type are nifedipine, Nitrendipin, Felodipine and amlodipine.

The Phenylalkylamine only minimal effect on blood vessels, but have a strong impact on the strength and spread the excitement of the heart. They are therefore in particular for the treatment of cardiac arrhythmias (atrial fibrillation tachykardes) is used. The most important representative of this type is verapamil.

An intermediate positions, the Benzothiazepine that both gefässerweiternd and thus reducing blood pressure as well as inhibit the conduction in the cardiac effects. The lead of this type is diltiazem. The Benzothiazepine do not have the clinical value of the other two groups.

In addition to the treatment of hypertension, chronic coronary heart disease (stable angina) and heart rhythm disturbances of calcium antagonists are also used at:

* Vasospastic angina (Prinz Metal Angina)
* High pulmonary arteries (pulmonary hypertension)
* Raynaud’s syndrome
* Achalasia (tension of the lower esophagus muscle Schliemann)

Uptake and distribution in the body (pharmacokinetics)

In all calcium antagonists are usually administered as a tablet and in the small intestine (in enteral or oral application). Intravenous (parenteral) administration is also applied.

The individual ingredients are used in the absorption from the intestine to varying degrees into the blood. This is especially problematic when verapamil (changing and generally low oral bioavailability).

The substances differ in terms of their half-life remains. In the treatment of high blood pressure is a long half-life effectively, so that the tablet only once a day should be. This is especially true for amlodipine, restricted to Nitrendipin and Felodipine. The reduction of calcium antagonists is done mainly in the liver.

Adverse effects (side effects)

Frequent and important side effects of calcium antagonists are:

* Swelling of the legs (edema, particularly in Dihydropyridinen)
* Slow heart beat (bradycardia, when Phenylalkylaminen and Benzothiazepinen)
* Fast heartbeat (Reflextachykardie in Dihydropyridinen)
* Allergic reactions
* Flushing (flush) and general warm feeling
* Dizziness
* Headache
* Impotence
* Constipation (constipation, especially in Phenylalkylaminen and Benzothiazepinen)

Interactions with other drugs

Calcium antagonists of Phenylalkylamintyp and Benzothiazepintyp may not or only under extreme caution while using beta-blockers are administered, because it is too dangerous a slowing of the heartbeat may occur (bradycardia, AV block).

The blood pressure lowering effect of other medicines will be strengthened.

The Wirkspiegel many other medications, which are also in the liver, can be influenced.

The consumption of grapefruit juice inhibits the degradation of nifedipine, so that there is an amplification effect comes. It is not recommended under a permanent treatment with nifedipine grapefruit juice to drink.

Contraindications

* Low blood pressure (hypotension)
* Advanced heart failure (NYHA stage IV)
* Unstable angina pectoris and acute myocardial infarction
* Pregnancy
* AV-block II ° and III ° (Phenylalkylanmine, Benzothiazepine)
* WPW syndrome

Clinical significance

Nifedipine was formerly a very popular drug for the treatment of high blood pressure. It has in its unretardierten form of this importance, however, is largely wasted as the action is too short to give it a rapid and fatal blood waste can and the counter-regulation mechanisms (eg Reflextachykardie) of the body especially in structural heart disease in this mass are not desirable.

Today, most long-acting calcium antagonists are used against high blood pressure, which only once a day to be (prototype amlodipine). In this form, the once very popular in the 1990s, then almost deuced calcium antagonists in the last few years, a small renaissance. Studies have a positive effect especially in combination with ACE inhibitors in-patients with kidney damage caused by diabetes mellitus (diabetic nephropathy) is shown. In addition, the incidence of stroke in elderly people significantly reduced, while regarding the prevention of heart attacks other drugs are clearly superior (beta blockers, ACE inhibitors).

The main disadvantage is an increased incidence of heart attacks and heart failure in comparison to high-pressure treatment with other medications (especially beta-blockers and ACE inhibitors).

Overall, the benefits of calcium antagonists as a single drug (monotherapy) for hypertension controversial. However, they have their firm place in the combination therapy, when treatment with other drugs (ACE inhibitors, beta-blockers, and diuretics) is not at a sufficient blood pressure reduction leads.

Verapamil and diltiazem are still used for the treatment of atrial fibrillation tachykardes used, although its importance compared with beta-blockers resigned. Also in the treatment of chronic coronary heart disease (stable angina) are the calcium antagonists of other medications (beta blockers, nitrate preparations retadierten and Molsidomin) were partially suppressed.

Disadvantages of insulin therapy is the relatively high cost, the need for the injection treatment, the need for blood glucose measurement and should not be underestimated the risk of hypoglycemia (hypoglycemia). An absolute lack of insulin, especially in the type 1 diabetes mellitus and diabetes mellitus pankreopriven is reported. Here is the insulin therapy very beneficial and allows today a nearly normal life span of the Type-1-diabetics.

The insulin therapy is the first time by chemical isolation and clean presentation of insulin from the pancreas of pigs and cattle have become possible. Meanwhile in Some parts of the world, but is almost exclusively genetically produced human insulin (human insulin) is used. More Articles in Forschungsgeschichte des Insulin’s and insulin preparation.

Insulin types

For insulin therapy are different insulin’s available, usually after their action as appropriate.

Distinction as to the action

* Quick and short-acting insulin’s (also eating meals or correction insulin refers)
* Human insulin, also known as alt or normal insulin (duration 4-6 hours at 7 units)
* Insulin analogues (2-3 hours of action at 7 units)
+ Glulisin (Apidra)
+ Lispro (Humalog)
+ Aspart (NovoRapid)

* Slow and long-acting insulins
* Intermediärinsuline (duration approximately 12-18 hours)
+ NPH insulin (neutral protamine Hagedorn by delayed-acting human insulin)
+ Zinkinsuline
* long and uniformly acting insulin analogues (duration approximately 24 hours)
+ Glargine (Lantus)
+ Detemir (Levemir)

* Mixed insulins – they consist of a fast effective insulins and a delay of insulin in various mixing ratios. Mixtures are usually 10 / 90%, 25 / 75%, 30 / 70%, 50 / 50% (eg Insuman comb 50/50).

Other options

Another possibility is the distinction of origin or manufacture. In addition too animal insulins derived from cattle and pigs there are biochemical manufactured insulin. The human insulin chemically identical insulin is human insulin, which variants of these insulin analogues.

Further differentiation: concentration: U100, U40

* Inhaled insulin – which can be described as crystalline human insulin, which has been reworked (amorphous), and through the application device is inhaled. Since early 2006, it is also available in Some parts of the world. This type of Insulin still has some disadvantages, for example, the dose effect at each different income, the 10-fold compared with the injection dose is required. Furthermore, inhaled insulin is not permitted for smokers.

Ways of insulin injection

Until recently, the only way to effectively allocated to insulin injection, usually into the sub-cutaneous fat, rarely intravenously. The path through the digestive tract is virtually impossible, because the insulin as the body digests protein, before it is effective. A recently available option is the inhalation.

Injection aids

* Syringes

These had since the start of insulin therapy is the norm. Older Diabetics know yet the reusable syringes and reusable needles the thick, long time for the horrors of insulin therapy were responsible. For some time, disposable syringes with very thin needles usual. Length of needles: 6 / 5 mm in children and adults, very slender, 8-12 mm in adults. Syringes are no longer the tool of choice, as emergency equipment, they are still important.

* Pens

Pens look thicker pens and can be similar to an insulin cartridge equip. The insulin dose can just grab a wheel set. There are different sizes of cartridges; the usual volume is 3 ml

* Fertigpens

Fertigpens or Einwegpens with an insulin cartridge equipped and disposal will be disposed of insulin.

* Insulin pumps

Forms of therapy

Conventional insulin therapy (CT)

When insulin therapy is conservative at fixed times of a certain quantity of compound injected insulin. These CT gil in type-1-diabetes considered obsolete, but is still of some doctors.

After the discovery of insulin was only ‘fast’ insulin is available. The Urtherapie therefore consisted in several injections – each with meals. After discovering a way to Insulin resorption to delay (by HAGEDORN of NPH NORDISK, Denmark) were mixed insulins on the market. This led to the current form of CT. In most cases, is a mixed twice daily insulin injection, but which in the absence of insulin Eigensekretion needs only partially met? This form of therapy requires the prompt administration of defined quantities of meals.

Because this therapy is a practical remote schematic nutrition behavior presumes is not a very flexible design of the daily meals possible. Moreover, in elderly people without missing insulin dose reduction in appetite, vomiting, or even establish a food hypoglycemia (hypoglycemia) is imminent.

Intensified conventional insulin therapy (ICT)

The intensive insulin therapy is generally for type 1 diabetics and applied in a modified form of increasingly in type 2-diabetic patients. It consists of a two-spray treatment, ie, one is rapidly effective insulin with meals injected (bolus), the other needs of the body, independent of the carbohydrates fed a basic insulin, with delays of insulin should be guaranteed (base). This basic-bolus principle enhanced insulin secretion of healthy pancreas. The baseline insulin, depending on the kind of one to three times a day injected; the Bolusinsulin with meals.

The intensive insulin therapy in Some parts of the world is a broad term. As a therapy can be intensified already apply when only the more frequent blood glucose control and the affected diabetics draws conclusions that to them in its concept (adjustment of insulin schema, carbohydrate intake, put a correction, alteration of BE-factors, or. KE-factors, the basal etc).

The ICT consists of at least 2 insulins with different functions. The basal insulin delay ensures that distributed from the liver glucose into the cells and thus to save the universal, regardless of food intake to make sure that is the organ supply and the efficiency of the body on a basis.

The meal-related (fast effective) insulin will ensure that from the gastrointestinal tract anflutende glucose in the liver and other Glykogenspeicher (muscles, liver) wegzuspeichern. There are more details of the body (probably a satiety signal to the brain); the individual still must be further explored.

The more adjustments by different physical burdens are necessary, the shorter, the basal effect to the Muskelauffülleffekt prevent the heavy strain on even after the works by Glykogenspeicher increasingly depleted glucose from the blood and therefore relates to a decrease in blood glucose levels. Is the physical burden but sporadic or spontaneous, is an adaptation of insulin to delay hours in advance complicated and questionable. Rather, it is advisable, just before, during and after the effort of additional carbohydrates to get too. Since the successful absorption of the fast and effective insulin accelerates the effect, it can also be helpful when zeitnächsten bolus to reduce the quantity. One should however not quite to insulin, since an absolute insulin deficiency to hyperglycemia and may lead to a fast metabolism derailment.

The ICT provides a variable life than conventional therapy, because it better adapted to the current situation in life (exercise, rest, work, sports, etc.) can be made. In connection with metabolic control (blood glucose measurement) and the logging of all the glucose metabolic factors can be a rapid implementation of changing results and adjustment.

The limit of ICT, however, lies in the nightly supply of insulin (Dawn Phenomenon: need for insulin increases from about 3-4 clock hormoninduziert at night) and fluctuations (injected insulin is not easy to eliminate sports, but responded to a multiple increased efficiency for several hours to days after the event).

Functional insulin therapy (FIT)

A good diabetic at the highest possible autonomy supportive therapy is the functional variant form of therapy after Kinga Howorka (Austria). Although there are differences in comparison to Some parts of the world to give evidence (eg, missing in October 2002, the daily time-dependent BE-factors), but it is the most consistent and simplest method to calculate diabetes, at least tend to be able to make effective inferences for the next day to be made. This corresponds to the currently applied ICT.

In FIT, the functions of insulin are clearly separated in

1. Basal
2. Meal-related insulin and
3. Correction insulin.

There are basically no mixing insulin used.

FIT is syringe, pen or pump. The protocol for management of diabetes management needs a special attention. The protocols are compact and portable (one week to fit a DIN A4 page).

Meaning and purpose of the FIT protocol is the systematic down of events in a small table (per hour is provided for a column), so that by the reduction of events to a maximum of 24 columns is a good overview. Through the daily balancing of values (total FA, total insulin) can be targeted here BE-factors, and other high Basalratenanteile compute and display.

FIT is a form of ICT.

Supplementary insulin therapy (SIT)

The Supplementary insulin therapy is aimed primarily at diabetics who still have their own Sekretionsrate to have insulin. In type 2 diabetics, we are primarily faced with the problem that exists Wirkstörung insulin and thus far too much insulin is present. Insulin also plays a role in fat metabolism and it also stores fats away and – since it is too much – nor do thicker (so currently – even supplementary – Treatment with metformin instead of eg Euglucon favored, because this is less about the phenomenon of weight gain without eating “leads). Depending on the cooperation and understanding of the patient are in the SIT are two application forms:

a) The patient is given a basal to more effective insulin and Restsekretionsrate provides the meals and similar fluctuations in the supply of insulin. This is but the removal more difficult. Therefore, the SIT in combination with tablets, known as sensitizes, the receptors make insulinempfindlicher be prescribed. Other combinations are possible.

b) To prevent overweight type II diabetics, a weight loss easier, we recommend the use of sensitizer to the quantity supplied and already available in abundance to insulin and thus reduce the layers of fat-based effect of insulin to push back. So, the patient is basal for the night and not for the day (when the remaining Eigensekretionsrate enough) and injected only with meals. This implies in turn requires that the patient about the relationship between the effect of food (Glycämischer BE-index and quantity) but also on the amount of insulin per certificate BE white, and can react accordingly (ie, blood glucose measurements).

Basal supported oral therapy (BOT)

The patient is administered orally with metformin, Sulfonylurea Acarbose and supplies and injects only 1x basal insulin (NPH or Lantus).

Continuous subcutaneous insulin infusion: pump therapy (CSII)

The pump therapy is primarily for type 1 diabetics in question and can be seen as the most advanced form of therapy to be making it today.

The advantages over other forms of therapy are:

* Low insulin depot in the sub-cutaneous fat (lower Unterzuckerungsrisiko);
* Better adjustability of movement differences by lowering or raising the basal;
* Precise metering of the basal as well as meal-related insulin;
* Better control of a Dawn Phenomenon (morning twilight phenomenon = morning hormonal increase in insulin resistance);
* Better ways (especially less) fluctuations in metabolism;
* Ideal insulin reduction opportunities before sporting events with a much smaller increase in weight through meal-related carbohydrate forced to compensate an increased efficiency of basal insulin and effect improvements to the receptors (basal leaves are off or reduce);

* Less Hypoglykämieepisoden by reducing the current injected insulin while low in the body already existing insulin depots which are now no longer protected by the inclusion of additional (made bold) must be absorbed carbohydrates.

Thus, the insulin pump in Some parts of the world than in pregnancies always indicated, as particularly during organ genesis in the first three months of fetal blood is not more than 110 mg / dl. Should be achieved, otherwise the training institution is delayed or even prevented.

* Sometimes when determining support amounts of insulin for a meal with supporting documentation, not all pumps.

Other reasons may be indicated:

* Highly fluctuating blood sugar levels and high insulin sensitivity,
* Dawn and Dusk-Phenomenon (strong increase of blood glucose also Mahlzeiteninduziert)
* Lower insulin needs (infants, persons with high physical activity during the day),
* Shift,
* Insufficient adjustable to high blood glucose with HbA1c <6,5-7>.

Beginning and end of late existing stopped and can partially be reversed, if it means a normalization of blood glucose (normwertig must then be held) can be achieved;

Insulin pumps are reliable and can be adapted to individual needs.

Detailed information on pump therapy (pros and cons as well as indication factors)

Important aspects

In all forms of therapy are certain common aspects to be considered for the therapy successfully applied?

Protocol guide

The protocol is feasible in a framework containing all the data, leading to a

a) Legally secure documentation (eg, recognition before the court) and

b) Assessment of metabolic development for future days can lead.

This is in the rules only if all the factors influencing glycemic noted. These include time, blood sugar, exercise, bread units, insulin (meal-related, corrections, basal) and observations for unusual events (eg acetone, illness, catheter alarm, motion-intensive period , dance, feast at a wedding, competition, stress , violent disputes, accident…). The better these records are more secure and reliable are the conclusions from such a protocol can be drawn (BE-factors Basalratenveränderungen, estimates of food)

The best way this is done in tabular form, including the possible events is in focus. If the space for events, because the event density is so great that this framework is beyond the Protocol, so plants should be on the protocol / back are kept.

Shift and uneven rhythms

… Again represent a higher degree of difficulty in the insulin therapy (see also sleep!).

Alternating rhythms makes insulin therapy, particularly if these sleep disturbances. This can cause the body insulinunempfindlicher is (up to about 40%). In particular shift can – if you sleep disorders result – increased problems with the metabolism leadership entails. An even more precise and detailed protocol (at least for the period until the clear is whether classifications stuck behind the problems) is recommended.

This would be noted in particular a shifted Dawn and Dusk phenomenon (caused by Tageszeitrythmik, increased blood sugar spikes hormononelle).

Hypoglycemia

See also hypoglycemia, and hypoglycemia (a value below 60 mg / dl.) at a sensible and well-accepted form of leadership normal metabolism. Up to 3 light Hypos per week (excluding foreign aid) were normal. Individual differences need to be made. Required foreign assistance should ALWAYS an opportunity to be the insulin scheme to rethink and possibly the basal to redesign. In general, this means that the basal slope, repeat the same day in the section to be lowered.

Regarding the importance of low blood glucose levels with a simultaneous presence of cancer is that the blood glucose levels as low as possible, but not in the range of hypoglycemia should be kept. Why? There are meanwhile studies that suggest that cancer cell by increasing their energy needs “hunger periods” (for example, by low blood glucose levels) are less well informed about. In contrast, high blood glucose levels promote the growth of cancer tissues.

Überzuckerung (hyperglycemia)

See also hyperglycemia; short-term hyperglycemia (here Überzuckerungen under two hours with values above 160 mg / dL) can – according to current knowledge – no damage to be expected be tolerated. However, there are indications that, although no vascular damage due to hyperglycemia can be expected, however,

* If more frequent occurrence of neuropathic damage and favors
* In the phase of organ genesis (pregnancy) abnormalities favors (see also diabetes or pregnancy Gestationsdiabetes or Type-4-diabetes, and ‘forecast improvement’ in diabetes mellitus.

Metabolic fluctuations

An insulin therapy without metabolic fluctuations is not executable. The blood sugar can – depending on the intensity and influence within an hour of serious transformations. In general, these fluctuations but by the diabetics themselves explicable, and over a certain period and therefore predictable within certain ranges (expectations) predictable.

Insulin therapy in type 2 diabetes

In type-2-diabetes is usually not a true insulin deficiency, but a Wirkstörung of insulin (insulin resistance), so that insulin therapy is rarely useful. There can be no doubt that a type-2-diabetic blood sugar closely with standards setting is required. Due to the often-belated discovery of the disease (sometimes in excess of ten years, incidence of late) it meets their particular cascade. Everyone leaves little elevated blood sugar, but in the non-negligible amount of damage.

Due to the insulin therapy of type 2 diabetes mellitus leads to an improvement of blood glucose levels, but often also leads to an increase in body weight and a further increase in the average insulin levels are already elevated. Elevated insulin levels affect gefässschädigend. To this extent, the type-2-diabetics, if he is able to

* Mainly to normalize body weight and caloric intake radically reduced, so that an energy-saving effect,
* Injected his insulin doses reduced (if not already Eigensekretion has become too small) and
* Insulin sensitivity by sufficient exercise and by drugs improves.

Also in type 2-diabetes early can be a (relative) insulin deficiency demonstrated. Unlike the Type-1-diabetes patients with absolute insulin deficiency, this initially primarily the first phase of insulin secretion after food intake.

The first insulin peak seems to have an important role in the regulation of food intake and for the emergence of consequential damages such as coronary Herzkranheit (CHD). Increases in visceral body fat, hypertension, vascular damage (micro-and Makroangiopathien), kidney failure (nephropathy), and eye damage (retinopathy, blindness) and nerve damage (neuropathy) to play.

The insulin therapy differs in type 2 diabetics compared to type-1-diabetics. They talk instead of better ICT Multi-therapy injections. Because insulin resistance is at least in the early days still enough insulin present, so that the Langzeit-/Basalinsulin often omitted or only at night is given.

Corrections with insulin

The correction factor indicates how many units of insulin the body needs to require higher blood glucose on a destination to reach. The target range for most diabetics, 80 to 120 mg / dl, is expected to target 100 mg / dl, and sometimes (for example, disorders of perception of hypoglycemia or in children) but also higher. Often, a fixed correction factor gives, but its effect fails, if the energy of the body was converted to fat (fasting or starvation by absolute insulin deficiency) and a lot of blood ketone bodies in a fast effect of insulin prevented.

Most of the correction factor is 20 to 80 mg / dl. For smaller people and children are the correction factor is higher (lower blood volume of distribution) and for larger and thicker lowers Persons (insulin resistance, high blood volume of distribution) and can also go beyond.

The higher the blood sugar is, the more likely it is a natural growth for the correction of the required amount of insulin observed in practice. Thus one can conclude that the correction factor is also an exponential development, like many other growth processes in biology.

Thus, a change of the correction factor at 10 mg / dl per 100 mg appropriate, but should be – like everything else – by confirmatory tests to try and not be un-acceptable.

When acidification of the blood (in this case due to the change of the metabolism of glucose to fat metabolism, see ketoacidosis), the 2 – to 4-times the amount of insulin needed for the other corrections needed. Since this reaction but from human to human is different, should corrections with insulin (statistically speaking, these with good attitude much less common) are always in the safe area (eg, blood glucose = 400 mg / dl. With a correction factor of 50 target and 100 md / dl: (400 – 100) / 50 = 6 units of insulin correction).

Will you have a correction intravenously; one should bear in mind with low doses to start. Given intravenous insulin acts differently and more quickly (within seconds) and thus could be errors in any such correction to be very fatal. Although the liver is compensatory to insulin and sugar surpluses, but everybody else in particular, alcohol and exercise (after-effects!) Can dramatically reduce capacity.

Finding the right dose of insulin

The correct dose of insulin must be found individually. Without a log management with information on time, bread units, and each dose of insulin remains in the determination of inaccuracy and is more or less by (individual) experience provides. The protocol provides clues about the general requirements and ideally contains information about the likelihood as to how far the overall needs of the “standard” differs (illness requires more, less insulin more movement). For several days it is an overall need to define and make a statement about how the basal compared with the meal-related insulin determine. This includes the BE factors.

The need for insulin fluctuates during the day. After getting up is the need for insulin because of the preceding resting phase at the highest (BE-factor up to 2.5 IU / BE. At the pump therapy is usually from 3:00 clock to 6:00 clock by up to 50% rise in basal programmed ). This corresponds with the insulin needs of a healthy metabolism. At noon, the average insulin requirements at the lowest (BE-factor up to 1.0 IU / BE), and then again in the evening (BE-factor of up to 2.0 IU / BE). This is also reflected in the basal again, usually as compared to morning lower basic needs. Evening decrease insulin requirements further down and then from 3:00 clock at night again. The long-term therapy with insulin resulting oversupply clock between 0:00 and 3:00 clock can, for example, by Spätmahlzeit compensated.

At normal (here: on average, and without special charges) can move with a ratio of approximately 50% basal and 50% reckon Mahlzeitenbezogenem food. Is the movement more pronounced, so the profile is “contaminated sites”, ie the basal may be less than 30% of the total dose amount. As basal insulin, the amount that is required for the metabolism of sugars about eight hours to maintain a stable, without anything to eat. Most commons is the basal those no longer than eight hours Basalratentests reviewed. The cached in liver glucose (as glycogen) is responsible for the basal supply of the other institutions, which (with a battery comparable) performance increases after eight hours, so a Basalratentest that is longer than this time, is no longer meaningful. The duration of eight hours from patient to patient and is a disorder of liver function in terms of reduced glucose storage. In such cases, the basal without Basalratentests over several days approximated to be identified, which means that the basal even with longer periods of abstinence from food (maybe 4-5 hours) without passing through exceptional situations (motion) justifiable Hypoglykämieen stable.

The amount of carbohydrate consumed affects on the liver to the basal from. If this quantity is low, then the only basal low. Find a place Kohlenhydratmast (celebration, feasting…), it is often the case that in the subsequent night basal equally needed is increased (sometimes up to 40% higher!).

Influenced the basal as well as protein and fat. Evening too much protein is consumed on a metabolic process that takes about eight hours, converted into glucose. This is also why, for example, Eskimos, with its predominantly protein diet do not suffer from lack of glucose. The relatively late conversion to glucose leads naturally to a Stoffwelchselproblem in the basal, which is difficult with traditional insulins to grips with is, as the most basal in the early morning hours and not before it needs to be increased (see also Dawn and Dusk Phenomenon -Phenomenon). Bold picks are also included in the metabolism; as well fats are converted into glucose. MAY protein over a period of approximately 8 hours to be converted into glucose.

If there is a distinct (not necessarily induced protein) Dawn Phenomenon, it should be with basal NPH insulin before 24 clock verarbreicht be. Failing Seemliest can also be used (which is only a comparatively small amount of the increase can compensate morning). A pronounced Dawn phenomenon is difficult to do not with Lantus or other long-term insulin to treat because of the increase between 3-6 o ‘clock and usually the only one in Dieren time (every morning!) Applied correction can be controlled. To make a useful also discharge the patient to achieve is, therefore, in some cases a pump therapy inevitable.

The basal is currently required by factors such as exercise, rest and also heat (a hot bath can be the blood sugar of 200 mg% decrease), illness, stress (adrenaline raises blood sugar)-dependent. It can – if the money supply needed calories and lose weight steer in the direction would like – a slight influence basal necessary. Long-term insulin can – depending on the constitution – with a lot more movement to combat hypoglycemia require carbohydrates necessary – so that removal is difficult and only increased with slow moving loads can be used.

History of insulin therapy

History of diabetes and is usually based on facts. In the background often remains as the patient with the prescribed therapy was and is rightly the effects and limitations for the conduct of his life has meant.

The history of insulin therapy inevitably begins with the discovery of insulin and thus the initial availability of a substance, the type I diabetics it has retained, simply abzumagern and die.

At the beginning of the availability of insulin, there was usually only animal insulin with a maximal effect of the so-called Alt-insulin (insulin-rule today), so max. 4 p.m. to 7 p.m. hours. Furthermore, blood glucose self hardly feasible or not. Due to the short duration of effect of insulin is sought after, a simplification for diabetics to achieve. Years later – the early 60s – was the first long-term insulin (neutral protamine Hagedorn, or NPH insulin) and found it started, “the long-term diabetics on insulin” switch. This was one (the physicians) still up in the late’80s “convinced”.

Skyler, Katsch and others were already in the’50s discovered that for the insulin diabetics was better, one with the current ICT to carry out similar treatment, but these met with little heard colleagues in circles. We knew too little, or better: “nothing” about the late and grabbed the daily routine in a corset timely food, reasonable amount of movement and a fixed insulin doses.

However, there is still cases of diabetes, characterized by a consistent metabolic setting (usually in opposition to doctors in this time) even after 40-years duration of diabetes than type I diabetics without significant late have laid back. The measurement was made of sugar, for example, on a “Oechslemeter”, as for example in the wine for the determination of sugar content also still used.

The return to the ICT can therefore only be a “rediscovery” apply. Because there is a publication of Charles Stolte from 1929, one of the ICT related insulin therapy started. Even then it was very controversial form of therapy. Found on: “Adequate insulin therapy with the free meals” (The contribution of Charles Stolte clinical diabetology. Kirchheim 1999).

The thus detected at an early stage ICT vanished into the oblivion of therapy with NPH insulin. Because of the long duration of therapy but also because of improved living conditions after the 2nd World War have been reinforced in the literature of “late” is described. It was however believed that these were unavoidable. In the 70s and 80s have been strengthened voices that are a form of self-regulation of insulin-treated diabetes is needed, but this resistance is not in the least cost carriers joined.

Ultimately, the DCCT study and other studies and the availability of easy to use self-control were proof that the benefits of ICT in the development of late offered.

Today, self-regulation in the insulin therapy can not imagine. At the same time endeavor, and the other basal insulin doses physiologically possible to administer, because you know that this crucial factors for performance are derived.

Herbal sleeping pills

Among the herbal sleeping pills include valerian preparations on the base. They are usually weak or not effective and prescription-free. In addition, often a combination of valerian, hops, St. John’s wort, mulberry and lemon balm is used. Chamomile is also easy to sleep. Herbal sleeping pills are generally well tolerated. They have their reason in comparison to most synthetic means low dosage drug side effects also correspondingly lower. The ability to participate in the road and to operate machinery is, of course, however limited, when a sleep dose is taken. Also the dependence potential, which in many chemical agents is available, is the use of mild prescription phytopharmaceuticals lower. Medicines of plant origin are not generally harmless, such as the preparations of the poppies (morphine) show.

Chemical sleeping

In addition to the herbal sleeping pills, there are several chemical soporifics. They fall into several categories:

* Chloralhydrat (Trichloracetaldehyd) is due to the accumulation of its metabolites with a half-life of 3-4 days and the resulting Hangover hardly used. It is also typical of halitosis a possible cause, that this drug has little significance.
* Paraldehyde
* 4-Hydroxybutansäure (GHB), was approved in 2005 under the brand name Xylem (R). It acts within minutes, is rapidly degraded, but has severe side effects and a high addiction potential. For long-term use in narcolepsy patients, it reduces their tendency to Cataplexy (Main Indication).
* Antihistamines older type that was actually used as antiallergics cause fatigue as a side effect. This fact makes it to use and uses some of them as sleeping pills, such as diphenhydramine. They are not prescription and the risk of dependence is less than that of other chemical sleeping pills. By lowering the sun protection factor is the preparation in summer with extreme caution (sun protection cream of factor 50 and higher) to apply. The increased risk of sunburn is largely underestimated. The antihistamines are strong despite the most widely used sleeping pill side effects, since it leads to the cheapest drugs ever count.
* Tranquilizers equivalent effect are frequently used sleeping pills, as they are to reduce anxiety and relaxation are what the actual cause of the dependence of potential. First, put to sleep, says the consumer is often much too late that he is increasingly taking tranquilizers from everyday stress medication attenuation and thus a need to deal with existing problems cut. Some tranquilizers therefore include an increased risk of addiction. An excessive dose sometimes leads to the opposite (paradoxical) effect (agitation, restlessness).
* Benzodiazepines are a group of substances with calming, angstlösenden, spasmolytic and sleep effects in different duration of action, strength and combination. These include the now most commonly used sleeping pill. They are subject to the requirement, in part (highly concentrated) and the Narcotics Act. Deaths from improper use are rare. The danger is considered elevated (mentally, sometimes physically, so after a prolonged consumption should necessarily ausgeschlichen and not be abruptly discontinued). Commonly used agents are eg Diazepam, Triazolam, Flurazepam and temazepam.
* Barbiturate sleeping pills are dangerous when used in combination with alcohol can be deadly. Because they possess relatively high half-life, they have unwanted side-and after-effects such as fatigue the following day (“Hangover”). Furthermore, they express the major recovery REM sleep. Barbiturates are therefore hardly used today.
* Tryptophan is an essential amino acid and a precursor of the neurotransmitter serotonin. It is prescription, but because of the high price rarely used.
* Other: see thalidomide.

Other sleeping pills

In addition to the chemical plant and sleeping pills, there are other substances that promote sleep. So, besides the consumption of alcohol and antidepressants or analgesics (painkillers) affect sleep. It is important to note that this is a kind of abuse involved.

Some people work alongside the so-called sheep include physical exertion (evening stroll) to sleep. Also continue to help relaxation methods such as Autogenic training falling asleep, sleep problems because of stress transported, without that it is a disease.

For people with a shifted sleep-wake rhythm may be bright light known as light therapy to a normalization of the internal clock lead.

Medication use

Medication sleeping are referred to as “Hypnotics” means.

Many are related to the sedatives, the sedatives. They thus facilitate the onset. Frequently used for substances, which are only briefly, and after 1 to 4 hours are reduced.

Increased resources and especially those with a longer duration of action are used to Durchschlafen possible.

In higher doses is short acting barbiturate used to a patient in an unpleasant investigation (for example, stomach or intestinal Mirroring) calmly, without him by an anesthetic to make quite unconscious.

Treatment with medication sleep funds if the patient over time sleeping problems. This is the supervision by a doctor urgently needed, since otherwise an abuse easily arises.

Abuse

There are several reasons and forms of abuse of sleeping pills. Over a longer period of time consumed sleeping pills often lead to addiction or be deliberately used as a drug.

There are also cases where physical congestion symptoms (insomnia, etc.) are treated by barbiturate. However, this is little sense, since only the symptoms controlled, but the actual cause no attention.

A criminal nature of the abuse of sleeping pills is called K. -o. -Tropfen.

The body’s own insulin is therefore in a position again, elevated blood glucose levels. Since both the market drugs Rosiglitazone (Avandia ®) and Pioglitazone (Actos ®) only relative short time available. There are professionals in lively discussion about the benefits and advantages over other anti diabetic agents, especially as the first drug of this group (Troglitazon). Due to hepatic effects in some countries from the market in Some parts of the world and never has been admitted.

Effect

Insulin sensitizer differ in their principle of operation of the other representatives of the so-called oral anti diabetic agents, their joint application area of type 2 diabetes. In general, it is diabetes, a disorder of sugar metabolism in the human organism to understand where the body’s own hormone insulin a supporting role. In contrast to Type 1, where the body no longer able to meet his need for insulin to cover themselves and this is in the form of injections must be artificially produced by type 2 diabetes; the body concerned certain amounts of insulin. This may; however, its functions in the body no longer perceive the extent required. Often we see in connection with this form of diabetes, obesity and poor dietary habits, which become a cause of this disease is viewed. Apparently, however, also plays a role in the genome, especially regarding the so-called insulin resistance, the condition that the tissue is not properly respond to insulin. Insulin resistance is often even before the symptoms of diabetes to determine a preventive therapy would be conceivable. See also: Metabolic Syndrome. Apart from the everyday complaints that diabetes brings with it, you write her a whole series of secondary diseases, the quality of life and significantly affect life expectancy, to (damage to large and small blood vessels). Studies indicate a positive development of these diseases among insulin sensitizers out. Clearly indicated are insulin sensitizers in patients whose blood sugar levels (or the HbA1c value) by treatment with metformin or Sulfonylurea, as well as through weight reduction and diet control is not adequate can be reduced. Due to the different point of attack of the insulin sensitizers are added to the effect in combination with other oral anti diabetic agents. Meanwhile, the drugs in this group also admitted to monotherapy.

Strategy

What idea is behind the use of insulin sensitizers for the treatment of diabetes? Oral anti diabetics of the Sulfonylurea type improve the distribution of insulin, metformin in turn causes the organism to better utilization of glucose. With the help of insulin sensitizers, a fundamentally different way of diabetes therapy trod. This practice varied effects in the body, which ultimately lead to a decrease in insulin resistance. Your body is insulin in order to re-enable those metabolic processes set in motion, which resulted in a decrease in blood glucose levels rise. Logically, the organism must they still be able to produce insulin in the body.

Which way are insulin sensitizers through the organism? The two approved drugs as active ingredients are in the form of tablets on the market. From the gastrointestinal tract, they are almost completely into the blood and then to 99% bound to plasma proteins. The active ingredients are distributed in the body and bring it to their destination within the body cells. Looking into the interior of such a cell, then push it to a whole set of transactions associated with insulin sensitizers is related. Key to its effectiveness is that they are likely to interact with a protein that is often in the nucleus of fat cells is encountered. It is a nuclear receptor of the type of peroxisomes Proliferator Activated Receptors, in short: PPARγ. If the receptor of a ligand and is then filled with a second from its natural ligand occupied receptor protein a complex, then this triggers the transcription of certain genes. Several of these effects can be derived. Thus, even the differentiation of immature fat cells produce adipocytes promoted. This increases the capacity to absorb free fatty acids and triglycerides in the adipose tissue. In addition, the effect of proteins, which are emitted from the adipose tissue, as Adipsin, Leptin, Resistin alfa and tumor associated with insulin resistance are related to it, antagonisiert. Through gene expression is also the formation of glucose transport molecules significantly increased, leading to a direct glucose-lowering effect results. Together with enhanced glucose utilization in muscle cells leads to an overall reduction of insulin resistance. As a result of these effects, there is a lower glucose and insulin level in the blood determined. Even a slight reduction in triglycerides, with increasing HDL and LDL levels and a slight decrease of blood pressure is observed. Certain effects can only individual representatives of this group are ascribed. These will be for the respective drugs mentioned. It is also not yet completely clear whether certain observations, such as effects on blood vessels and decrease the aggregation tendency of blood platelets, the drug itself or the improved glucose and fatty acid metabolism are attributable from the body

Rosiglitazone and Pioglitazone are both highly lipophilic compounds. The human body must be only slightly converted in order to be able to leave again. Enzymes of the type of cytochrome P450, which in high concentrations in the liver can be found, do this. The metabolism sets in, when one of these substances in the body is located within several hours. It is more than half of the injected amount of drug in the blood evidence; however, looking after the converted compound (Rosiglitazone metabolites such as p-hydroxysulfat, which is also a certain effect of exercise), so you can find this much longer time. The excretion of drugs and metabolites is finally done both on the kidney as well as on the chair. Unlike other drugs, for diabetes therapy is available, the effect of Insulin sensitizer not directly but only after two weeks or later.

Costs and Benefits

The expenditure for the treatment of diabetes and its effects amount to about 30 billion euros per year in Some parts of the world. Until 2010, the number of diabetics in Some parts of the world at 10 million, experts estimate. The blood glucose levels can be reduced with metformin. But came up with this medication only about half as many to prevent diseases like diabetes by a shift in lifestyle. Pill swallowing is certainly less cumbersome than the daily half-hour movement, the doctors deem necessary to prevent diabetes. A study of Rosiglitazone showed that this drug amongst the most vulnerable people the risk of diabetes significantly reduces. In a period of three years with Rosiglitazone-treated group infected not even half as many participants as in a comparison group who only received a sham treatment. One must also ask that whether such a “medicalisation” of a health problem would be that you just as well with a change of lifestyle in the grips could.