Treatment of insulin resistance mainly depends on the pathogenetic mechanisms that led to its development. When insulin resistance occurs due to an increase in the titer of circulating antibodies to insulin, porcine (suinsulin, actrapid, etc.) insulin preparations are prescribed. In the complex treatment of insulin-resistant forms of diabetes mellitus, oral sugar-reducing sulfanilamide preparations and biguanides are used. They are prescribed either separately or in combination with insulin and with each other.
To reduce the binding of antibodies to the insulin molecule, antihistamines are used (diphenhydramine, suprastin, pipolfen, etc.). The latter is prescribed in usual doses. To suppress the antigen – antibody reaction, as well as to inhibit the formation of antibodies to insulin, glucocorticoid preparations are prescribed. The initial dose of prednisone is 30 mg per day, sometimes (in the absence of effect) 40 mg. Usually, the effect is observed after 1-2 weeks, after which the dose of prednisone is gradually reduced by 5 mg and transferred to maintenance doses of 5-10 mg per day for 2-3 months. After the abolition of prednisone, the need for insulin usually does not increase. Sometimes prednisone treatments have to be repeated. When insulin resistance is caused by other endocrine and non-endocrine diseases, these diseases are treated.
Treatment of lipoid necrobiosis, until recently, was ineffective. Surrounding areas of lipoid necrobiosis with suinsulin, the administration of lotions with insulin, sea buckthorn oil, caratolin, the ingestion of lipoic acid and vitamins led to only a slight and brief temporary improvement. Encouraging results have been obtained in the treatment of lipoid necrobiosis with the domestic drug dimexide (dimethyl sulfoxide). The drug has the ability to penetrate the skin, mucous membranes and cell membranes without damaging them. A valuable quality is its ability to attach to itself and carry out many drugs through biological barriers. The positive properties of Dimexid also include its analgesic, fibrin
nolytic, selective cytotoxic effects, as well as pronounced antiseptic bacteriostatic, bactericidal and anti-inflammatory effects. In IEE and AMG USSR Academy of Medical Sciences, the treatment of lipoid necrobiosis with dimexide is carried out against the background of the compensation of diabetes mellitus. On the areas of lipoid necro bios, napkins of 4-6 layers are applied, wetted over the course of a day with a 70% solution of dimexide, to which is added
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4 to 18 U of Suinsulin. The skin around lipoid necrobiosis is treated with syntomycin ointment. The course of treatment with dimexidum is 3-4 weeks with a 2-3 week break.