(A) Indications for the use of insulin
(1) Type 1 diabetes mellitus (DM)
(2) Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolarity
(3) acute and chronic complications of severe DM
(4) Type 2 DM with marked beta cell decompensation
(5) surgery, pregnancy
(6) Some special types of DM.
(B) Commonly used brands and dosage forms of insulin
The following is mainly classified by the duration of action.
(1) Short-acting marker letter R (Rapid). Formulations (brands): Novolin R, Novolac, Eugenol R, RI (common insulin) (Note: only write Novolac without the R word is short-acting, more special), insulin only such can be used intravenously (other medium and long-acting can only be subcutaneous), 0.5h onset of action, 1.5h peak, maintenance 3-6h.
(2) Medium-acting marker letter N. Preparations (brand): Novolin N, Utrolin N. 2h onset of action, lasting 10-18h.
(3) Pre-mixed preparations (brand): Rui and Rui 30, Novolin 30R, Urolene (premixed), of which Novolin 30 is 30% super short-acting + 70% medium-acting, so the effect starts 15′ after use and needs to be played 15′ before meals; and 30R or premixed for short-acting + medium-acting, needs to be played 30′ before meals. 2 -8h peak, can maintain 24h (or 10-18h).
(4) Long-acting glargine insulin, maintained for 24h. The method of use is subcutaneous injection at bedtime, generally 10U to start with, and then adjusted according to the blood sugar situation.
Short-acting is fast-acting and short-lasting, and is used before three meals to control post-prandial blood sugar. The medium-acting and long-acting effects last long and are used to be given before bedtime to control blood sugar at night or throughout the day.
(C) How to set the program
1) The more commonly used combinations are as follows.
(1)One pre-mix before breakfast and dinner (Novaline 30R, Novaline 30, Eugenolide pre-mix)
(2)One shot of Novaline 30 before each of the three meals (and other premixes, such as Novaline 30R generally do not play three times)
(3) three short and one medium, three short and one long: one short-acting shot before each of the three meals + one medium or long-acting shot before bedtime.
(4) one long-acting shot before bedtime (alone or + oral hypoglycemic drugs)
(5) Insulin pump: short-acting insulin can be pumped continuously for 24 hours and the amount of each time period is investigated in advance on the pump, which is usually available only for endocrine specialists, more than 100 yuan/day.
2) Dosage and distribution
Total pancreatectomy patients need 40-50U per day, most patients can start with 18-24U/d, and then adjust according to blood sugar. Foreign advocates T1DM by 0.5-0.8U/kg, not more than 1.0; T2DM by 0.3-0.8U/kg.
More for breakfast (25-30%), medium for dinner (20-25%), small for bedtime (20%), and less for Chinese food (15-20%).
Insulin pump: 40% as basal amount continuously subcutaneously; other 60%, 20%, 15%, 15%, 10% at bedtime in the morning, midday and evening respectively.
3) Usage of RI in DKA or hyperglycemic hyperosmolar state
RI: 0.1U/kg.h, 10-20U can be injected first for shock or severe acid replacement. no more than 6mmol/L per hour reduction is appropriate blood sugar <13.9 can be changed to sugar water + RI.
At >33.3, 0.2U/kg.h. (General RI 50U + NS50ml micropump, e.g. this patient 50kg. i.e. need 10U /h. i.e. investigate to 10ml/h)
23.3-33.3 , 0.15 U/kg.h, i.e. investigate to 7.5
13.9-23.3 – 0.1, i.e. tuned to 5
7.8-13.8 – 0.05 i.e. investigate to 2.5
<7.8 if ketosis is not corrected to be used, 1U/h, that is, to 1.
(D) control how to count to meet the standard
Single ground, that is, fasting <7 and postprandial <10 and not hypoglycemia is ideal! Some people think that the older the age should be more lenient: 60 years old6, 70 years old7, 80 years old8.
(E) Oral hypoglycemic drugs
1, pro-insulin secretagogues: that is, the body is required to have a considerable number of pancreatic ß-cells in order to promote insulin.
(1) Sulfonylureas
Non-fat; disease duration <5 years (to ensure a significant number of islet ß cells?) .
Damacell (Glipizide extended release tablets) 30mg-120mg qd before breakfast
Glimepiride 2mg qd (Chen: 2mg = 90mg of Damectin)
(2)Glinide class
For elderly people with high early postprandial
Novaluron (Repaglinide) often 1mg tid (Chen: diabetes and kidney disease if all to use oral hypoglycemia, only recommended Novaluron)
2.Biguanide
No significant wasting with lipid abnormalities, hypertension first-line drugs, or T1DM combined with insulin.
High fever, cardiopulmonary, hepatic and renal decompensation are contraindicated.
Geva (metformin) 0.5 Tid (extended release tablets 0.5 bid)
Side effects are gastrointestinal symptoms: vomiting, diarrhea. Prepare to inject contrast agent should stop taking it first.
3.Insulin sensitizer (Glitonin)
Can improve blood lipids, vascular endothelial function, improve fibrinolytic activity, etc., and protect the heart and kidney. But edema, weight; heart disease, heart failure tendency or liver disease is not used or used with caution.
Pioglitazone 15-30mg Qd
Rosiglitazone (Vindia) seems to have been banned due to a clear increase in the risk of cardiovascular accidents.
4.Glucocerebrosidase inhibitor
For postprandial high.
Adverse effects: abdominal distention exhaustion diarrhea.
Acarbose (Bactrim) 50-100mg Tid first bite after meal.