Insulin
therapy in the treatment of pulmonary tuberculosis patientswith preclinical
glycemia disturbances
Preclinical glycemia disturbances appear to be important medical problem
because of their negative influence on clinical cource of tuberculosis,
and the risk of their transformation into diabetes mellitus.
Methods.Therapeutical effect
of insulin (pharmaceutical name-Humodarum R) was investigated in 27 active
pulmonary tuberculosis patients with different carbohydrate metabolism
disturbance (with the exception of diabetes mellitus). A small doses of insulin
(0,2 ED\kg of body mass) was used for 90 days at the same time with combined
antituberculosis treatment. The daytime dose of insulin was divided into 3
reception: 20 minutes before breakfast, dinner and supper in correlation 2:3:1.
Insulin was used hipodermically.
Carbohydrate metabolism state was researched with the help of standard
oral glucose tolerance test with 75g of glucose and studied glycosylated
hemoglobin concentration. Carbohydrate metabolism transgression was diagnosed,
when indexes of glycemia corresponded to impaired glucose tolerance or else
impaired glycemia on an empty stomach (definition WHO, 1999). Control group
comprised of 27 patients with analogous tuberculosis form, age/sex structure,
with preclinical glycemia transgression, but not used insulin therapy.
Results. Insulin therapy proved to be effective in
normalization of glucose tolerance test results in 65,3% patients (in the
control group-17,3%). Moreover, statistically significant average level of
glycosylated hemoglobin concentration was noted: from 7,3% to 5,8%.
The positive influence of insulin on clinico-raentgenologic parameters
and tolerance of anti-tuberculosis drugs were observed during complex treatment
of tuberculosis. In patients, who used insulin marked increase of body mass
index from (19,7±1,3) kg/m2
to (24,4±1,8) kg/m2;
that bear witness about activation anabolic
processes in organism upon the whole.
In comparison with 27 patients, who didn receive insulin, adverse
reaction of antituberculosis drugs was discovered in 3 times rarely. The employment
of insulin show maximum positive effect in prevention of toxic adverse
reaction; allergic reaction was marked equally often in both of group. The
application of insulin called no complications and unnecessary reactions in and
case.
The protective possibilities of insulinotherapy, its positive influence
for prevent toxic adverse reactions of antituberculosis grugs we can explain as
increase of glucose utilization, normalize of carbohydrate and other types of
metabolism, improvement of hepatic detoxication function. Therefore, in our
opinion these things can explein expressed influence insulin toxic
manifestation of adverse reactions. It was marked also positive influence of
insulin therapy on clinical course of tuberculosis. Period of medical treatment
in hospital and cessation of bacterial discharde, cavern closing in patients,
who received insulin were on 15-20% less, than in patients of control group.
These results necessitate further study of effectiveness of insulin
therapy in complex treatment of patients with hyperglycemia disturbances, which
is risk factor of diabetes mellitus.
Conclusion. The use of diagnostic
criterions of diabetes mellitus
and other types of
hyperglycemia(definition WHO, 1999) in interpretation of glucose tolerance test promotes improvement of
diagnostics efficacy of carbohydrate metabolism disturbances.
The inclusion in complex of medical measures in pulmonary tuberculosis
patients with preclinical glycemia insulin transgression promotes normalization
of carbohydrate homeostasis. Therefore, use of insulin in phthysyology practice
will be able to increase safety of antituberculosis therapy, widen of
possibility elections and substitution of antituberculosis drugs and raise
efficacy of treatment in patients with pulmonary tuberculosis. The data
received by used in the given work, will be used for methods of diabetes
mellitus preventions in pulmonary tuberculosis patients.
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