Small insulin, injected with care This is how insulin is secreted in normal people: when there is no food, the beta cells of the pancreas slowly secrete a small amount of insulin every moment to process the glucose that comes from the breakdown of liver glycogen; during meals, in order to process the abundant glucose absorbed from the intestine, the beta cells will suddenly secrete a large amount of insulin accordingly. Therefore, in this case, the body’s blood sugar always fluctuates within a normal range. In children with type 1 diabetes, the function of insulin secretion is almost lost. Therefore, ideally, insulin injections should mimic the pattern of insulin secretion in normal people. Therefore, the injectable insulin used is divided into mealtime insulin and basal insulin accordingly. Basal insulin: It is used to simulate the secretion of pancreatic insulin in children who have not eaten or eaten food without carbohydrates, to process glucose from hepatic glycogenolysis, and to maintain stable blood glucose between meals and at night when the patient is sleeping. There are also two types of basal insulins currently available: low-argin zinc insulin (medium-acting); and long-acting insulin analogs. Their duration of action is different. The latter has a more moderate and longer duration of action than the former. Mealtime insulin: It is used to mimic insulin secretion when children eat and drink, and to process the large amount of glucose absorbed through the intestine. There are two types of mealtime insulins available: short-acting recombinant human insulin and rapid-acting insulin analogs, the latter of which has a rapid increase in blood concentration and a shorter duration of action after injection compared to the former. How to inject insulin Children with type 1 diabetes require insulin supplementation from outside sources. Unfortunately, insulin is not currently available in pill form for children to swallow. Most insulin is injected into people under the skin through a syringe that looks like a pen. The injection site may be the skin of the abdomen, outer upper arm, or outer thigh. To inject, sterilize the skin, gently pinch the skin at the injection site, insert the small needle of the insulin pen into the pinched skin, then slowly press the button at the end of the insulin pen, slowly count to ten, and then release the skin. A regimen using basal-meal-time high-dose insulin injections, also known as the multiple injections in a day (MDI) regimen, is now the common approach to treating type 1 diabetes worldwide. This regimen usually involves basal insulin injections in the morning and/or at bedtime (usually 30%-50% of the total daily insulin) and high-dose mealtime insulin injections before or during meals. Among them, the application of long-acting insulin analogues and fast-acting insulin analogues together with the program has been hailed as the revolution of MDI and the “gold standard treatment program” for type 1 diabetes. However, multiple injections a day have a greater impact on the quality of life of children, especially since many of them have needle phobia, and this method can sometimes cause hypoglycemia, especially after exercise. With the development of technology, insulin injection methods are also evolving day by day. Some children are starting to be treated with insulin pumps. Insulin pumps, also known as continuous subcutaneous insulin injections. This is a device similar to the size of an ipod player that is used to infuse insulin 24/7. The dose can be set in advance or adjusted at any time, and the amount of insulin before a meal is simply entered and a large dose can be infused at mealtime with a simple press of a button. Such an infusion method is closer to the physiological function of the pancreas. Current clinical trials have confirmed that its control of blood glucose is similar to the MDI regimen, but with a lower incidence of hypoglycemia and less impact on life. However, it is currently expensive and not covered by health insurance, so it requires good financial conditions for families of children with the disease. Adjustment of daily insulin injection dose Mealtime insulin: It should be adjusted according to the amount of carbohydrates contained in each meal. Therefore, you should know the amount of carbohydrates in your child’s diet and the insulin-to-carbohydrate ratio before injecting. The former can be obtained by looking up the food composition table and weighing, while the latter is determined by each child’s insulin-to-carbohydrate sensitivity and is not set in stone. For most children, each unit of insulin is comparable to 10-15 grams of carbohydrate, up to 5g/unit for overweight or obese, and 20g/unit for lethargic individuals. In post-school children, the carbohydrate factor corresponding to each unit of insulin can be estimated by the formula = 500 (or 450)/total insulin for the whole day, using 500 for the denominator of rapid-acting and 450 for short-acting. if the injection amount is appropriate, the fluctuation range of blood sugar 2 hours after meal compared to before meal is within 2.8 mmol/L. Basal insulin: It is mainly adjusted according to the blood sugar in the morning and before bedtime every day. For example, when the blood glucose is between 6-8mmol/L before bedtime and the morning fasting blood glucose is between 4.5-7mmol/L every day, it means that the amount of basal insulin for children is appropriate. If the blood sugar is higher or lower than this value, then the basal insulin dosage needs to be increased or decreased accordingly. The amount of each adjustment should not be too large, and the smaller the child’s weight, the smaller the amount of each adjustment. After adjusting the basal insulin dosage for the day, you should test the blood sugar at 2-3 a.m. to make sure the blood sugar is normal at night. Another important point is that when fasting blood sugar increases in the morning, the basal insulin amount should not be increased first, but the blood sugar in the early morning should be monitored first, and if no hypoglycemia occurs, then the basal amount should be increased, otherwise the basal insulin amount should be reduced. Insulin sensitivity factor: This represents the number of mmol/L reduction in blood glucose in 2-5 hours per unit of insulin injected. 1500 (or 1800)/(total daily insulin x 18), 1500 for short-acting insulin and 1800 for rapid-acting insulin. when there is hyperglycemia, the insulin dose for a temporary injection can be calculated by this method to reduce blood glucose. However, if the blood sugar is too high, or if there are more ketone bodies in the urine, the best method is to drink more light saline and then seek help from a doctor instead of injecting a large amount of insulin by yourself.