Insulin

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVII, Issue 4, 1 October 1924, Page 151

Insulin

(Extracts from a Lecture given at Nurses' Club, Auckland, by Dr. Johnson.)

Insulin is an additional factor m the modern treatment of Diabetes. Ten years ago, it was thought that to cut out sugar and starch m the diet was all that was necessary, but this only ameliorated the symptoms. With Insulin we have much happier results. When we examine the pancreas we find a glandular organ formed of a series of cells which pour a secretion m the duct between which leads away and joins up with the main duct. In the pancreas is a ferment trypsin which is important m the digestion of food. Between the glands are found curious groups of little cells which are different and do not stain. These are called islets. It was discovered that, m post-mortem examinations of diabetic patients, these islets were absent. For many years Dr. Banting worked on this discovery. It was found that dogs fed on the pancreas developed diabetes, while when given an extract of the islet diabetes was prevented. Further experiments proved conclusively that when the islets were out of action the secretions of the pancreas caused diabetes, while an extract of the islets counteracted it. This extract was called Insulin. We eat three kinds of foods: carbohydrates, proteids, and fats. In the process of digestion carbohydrates are absorbed as glucose; proteid is absorbed as 58% glucose, 48% fat. Fat is absorbed as 10% glucose and the rest fat. Thus we find that these three foods must be balanced carefully. If we have too little carbohydrate and too much fat, we get a condition of aeidosis causing coma. Fats must be balanced by carbohydrates. Proteids are essential to life, are found not only m meats but m all vegetables, and it is impossible to exclude them. Next we must realise what actually takes place and causes the difference between diabetic and ordinary patients. The

blood of a healthy individual before a meal shows .1% of glucose or blood sugar. After a meal it rises rapidly to .18%, but does not exceed this limit, at the end of an hour it has returned to .1%. In diabetics it is always high, about .2%, and rises slowly and may reach .6%, and returns slowly again tc .2%. Kidneys will allow blood containing .18% to pass above, toleration ceases, and an excess of sugar is thrown off m the urine. Hence sugar is passed all the time. In a healthy person the glucose m the blood coming from the liver stimulates the islets, which pour out insulin into the blood. When it comes back to the liver the cells pick out the sugar and store it for future use. In diabetics insulin is not made, cells arc not stimulated, sugar is not picked up and goes on through the blood. So we have to supply insulin m correct doses and fix dietary. Value of foodstuffs may be estimated m calories. As an example the case of a farmer patient was quoted. For his work he required 2,400 calories, but food assimilated provided only a total of 800. His dosage was worked out to regulate the difference. At the end of a month he had gained 10 lb m weight; at the end of another month 7 lb; and at the end of the third month had gained normal. So this person continued his usual work; all that was necessary was a dietary and dosage of insulin to check sugar at intervals. In giving insulin, certain factors are important and require careful watching on the part of the nurse. A large dose given to a patient fasting may (bring the blood sugar down dangerously low. In adults this danger is not so much, as they may be instructed m what symptoms may develop ; but children must be watched and symptoms noted. First symptom is hunger. Patient complains of being ravenously hungry; may feel weak and tremble and sweat ; sometimes hysterical. In children condition

is apt to be well advanced before being noticed. The remedy is simple. A little sugar given promptly will cause an improvement m ten minutes and can do no harm. It is the first few doses that are dangerous; after that the proper dosage is established. This is why it is necessary to have the patient under observation at commencement of treatment. Should the condition be so far advanced when discovered that patient is unconscious and cannot swallow, adrenalin m. xv--xx, subcutaneously, acts instantly on the liver m a directly opposite way to insulin and liberates sugar into the blood stream. Or a subcutaneous injection of glucose, any strength, may be given. It, is very necessary for the nurse to be on the alert and act quickly for this reason. Subcutaneous injections are recommended as being more quickly prepared than intravenous. This is the only danger m the use of insulin. A Pew Results. — Boy aged 12 years, so weak he had to be carried from the. train

and full of acidosis. Had five weeks' treatment ; dosage worked out m units, 12 units of insulin twice a day and diet of 900 callories. At the start he weighed 4 st 3 lb. In five weeks he gained 6or 7 lb. He goes to school; his mother gives him a dose of insulin half an hour before breakfast and half an hour before the evening meal. At end of four months his weight had gone up 3 st. 4 lb. Decreased insulin to 10 units, diet 930 callories. Gained Ilb a week m weight. Decreased to 8 units, 960 callories, and urine still remained free of sugar. In young patients (which is the most serious form of diabetes) it is sometimes possible to decrease the dose and gradually stop it altogether, showing that the islets m the pancreas were not dead, probably only inflamed. The insulin eased their work, and they recovered their vitality. Tn a diabetic of 60 or 70 years the cells are dead, and it is necessary to continue the insulin m the same quantities.