Features of insulin therapy in combination of long-term type 1 diabetes mellitus and metabolic syndrome

Type 1 diabetes mellitus (T1DM) continues to struggle with medical and social problems due to its high prevalence, polymorphism, development of severe diseases and irreversibility of changes. Despite four options for algorithms and choice of insulin therapy, the difficult task of switching to the insulin resistance (IR) scheme due to the impossibility of using drugs from the biguanide and glitazone group, since their use in T1DM is not provided for by the instructions. The presented observation shows the clinical picture of IR against the background of metabolic syndrome and prolonged hyperglycemia in patients with T1DM and special attention is paid to the importance of prescribing adequate insulin therapy and an individual approach to patient management. The main strategy in this case is a gradual increase in the insulin dose until the target glycemic indicators are achieved. At the same time, after achieving adequate doses and the patient staying within the near-target indicators for a certain period of time, it is possible to use insulin restrictions against the background of neutralizing the effect of glucotoxicity on peripheral tissues.