1.How to deal with bleeding at the injection site after the patient injects GH?
(1) When there is only extracutaneous bleeding at the eye of the needle after the syringe is pulled out, it means that the small capillaries of the skin were pierced during the injection; parents and patients should not be nervous because it will not cause any harm to the child’s body and will not affect the efficacy of GH.
(2) When there is extra- and subcutaneous bleeding at the eye of the needle after the syringe is pulled out, it means that the small capillaries of the skin were pierced during the injection,
The next day, use a warm towel to apply hot compress for 5-10 min (no need to apply hot compress in summer), it will disappear in 3-5 consecutive days, and avoid the subcutaneous bleeding area for the next GH injection; parents and patients should not be nervous, because it will not cause harm to the child’s body and will not affect the GH efficacy.
(3) Because the tip of BD needle is thicker and longer than that of Novo and pen, so the bleeding of the injection site is slightly more when BD needle is injected, but it is less common.
(4) After the injection, pull out the needle too slowly, easy to bleed, should be quickly pull out the needle.
2.How to deal with the bulging bag when the patient injects GH into the skin?
(1) When the patient injects GH, because the angle of the needle is too small, the drug is injected into the skin, there is no need to deal with it, let the skin absorb the drug by itself, it will not affect the efficacy of GH and will not cause harm to the child’s body.
(2) The correct angle of injection of GH is 45 degrees, and the needle is injected under the skin.
(3) The needle enters into the skin, but the speed of GH injection is too fast and easy to bulge the bag, each injection takes 3-5 minutes.
3.Mistake the check date of the product manual as the production date?
The product specification check date is not the production date of GH, the production date of GH is on the outer package.
4.When injecting with water, it will cause pain or numbness after injection due to low temperature (common in autumn/winter)?
(1) Take it out of the refrigerator 30 minutes before injection; warm it up with your hands;
(2) Pain may be caused by fast injection speed, so inject slowly;
(3) If the sharp pain is caused by the injection stimulating the peripheral nerves of the skin, you can pull out the needle and change the injection site;
(4) Relax the child’s spirit before injection to avoid painful injection.
5.After a period of injection, joint pain or myalgia?
(1) It may occur after strenuous exercise or sudden increase in exercise, so you should reduce the amount of exercise and exercise in moderation.
(2) It may be caused by the strong physiological effect of sodium and water retention of growth hormone. The milder pain does not need to be dealt with, and the symptoms will disappear after a few days, while the heavier ones can reduce the dose of growth hormone or stop using it for two days, and continue to use it after the symptoms disappear.
6.What is hypothyroidism and how to deal with it when it occurs during GH treatment?
The diagnosis of subclinical hypothyroidism is made based on laboratory tests, when the patient has not yet shown obvious clinical symptoms or signs. Subclinical hypothyroidism is defined as serum thyroid stimulating hormone (TSH) levels exceeding the upper limit of normal (0.45-4.5 mlU/L) while serum free T4 (FT4) concentrations are normal. The need for treatment depends on the specific laboratory values of the child. Treatment is mostly oral levothyroxine sodium, and thyroid function will return to normal after discontinuation of GH.
The thyroid function will return to normal after stopping GH.
7.What is the increase in blood sugar during GH treatment?
If the blood glucose is higher than 10mmol/l, insulin treatment is needed. If the blood glucose cannot be effectively controlled with 150IU/d insulin, GH should be stopped.
8.What is edema during GH treatment?
(1) Symptoms of edema: edema of eyelids, face, back of hands, back of feet, lower limbs, intracranial hypertension (such as headache, nausea, vomiting);
(2) If you can tolerate it, continue to use GH, generally the symptoms will disappear within 3-7 days; if you can’t tolerate it, you need to reduce the dose of growth hormone or stop the drug, and resume the drug after the symptoms disappear.
9.Does GH treatment accelerate bone age?
The relevant medical institutions and literature at home and abroad report that GH treatment will not accelerate bone age.
10.Will GH treatment affect the fertility of children?
Because GH is secreted by the normal human body itself, which is necessary for human growth and development; for women in the reproductive period, GH has the effect of promoting ovulation; for men in the reproductive period, GH has the effect of promoting sperm maturation; therefore, GH treatment will not affect fertility.
11.Will GH make children fat?
GH is a protein, not a glucocorticoid, and will not cause obesity; moreover, it has the effect of local fat reduction.
12.Why should each injection point be two centimeters apart from the previous injection point when injecting growth hormone?
GH treatment can locally degrade subcutaneous fat, especially the fat in the abdomen and large intestinal omentum is sensitive to catecholamine-mediated lipolysis (e.g. GHD has increased subcutaneous fat, especially abdominal fat accumulation, and GH treatment can make abdominal fat ablate). Growth hormone increases muscle tissue at the same time as fat reduction. Because GH can degrade subcutaneous fat, the injection site should be changed frequently.
13.Will GH treatment cause diabetes?
At present, the relevant literature at home and abroad reports that GH treatment does not cause diabetes.
14.Does GH treatment increase the risk of tumor recurrence?
(1) For those whose tumors have been cured, the current data do not indicate that GH treatment will increase the risk of tumor recurrence.
(2) For those who are suffering from tumor and are receiving treatment, the incidence of primary tumor and secondary tumor is significantly increased.
(3) Risk of de novo tumor development: There is no increase in the incidence of new tumors such as leukemia.
15.What is the weight gain of the child after GH treatment?
(1) Whether there is occult edema (with occult edema weight gain >500g/w).
(2) Because GH promotes anabolic metabolism, height growth will be accompanied by weight gain.
16.Can GH be vaccinated during treatment? Can the drug be used in the treatment of general medical diseases?
Because GH is secreted by the normal human body itself, it can be used for vaccination during GH treatment, and it can also be used during the treatment of general medical diseases.
17.Do I need to stop taking GH during cold treatment?
The general medicine for cold and flu does not affect the efficacy of GH.
18.What is the use of GH for children with asthma or allergic rhinitis?
The dosage of glucocorticoids must be adjusted under the guidance of a professional pediatric endocrinologist. Note: Glucocorticoids are GH antagonist drugs, which will affect the efficacy of GH.
19.Will the efficacy of GH be affected if the child forgets to inject GH one day? Do I have to make up for the missed GH injection?
No. Forgetting to inject GH once in a while for one day will not affect the efficacy, and there is no need to make up the missed amount of GH; try to avoid interruption of medication.
20.How long does it take for GH to take effect?
GH treatment takes 3 months as a course of evaluation, so after 3 months of GH treatment, you should go to the hospital to review your height, weight, nail function and blood sugar, etc., in order to evaluate the efficacy.
21.Cause of the poor efficacy of GH treatment?
(1) Whether the dose of GH is sufficient.
(2) GH powder produces antibodies.
(3) low thyroid function.
(4) use of glucocorticoids
(5) epiphyseal plate closure.
(6) inaccurate measurements.
(7) systemic chronic diseases.
(8) Ineffective GH treatment.
(9) whether or not the resident child adheres to G H.
22.How old can GH treatment be discontinued at the age of bone?
When girls BA 14 years old, boys BA 15-16 years old, the general growth rate is less than 2cm/y, in order to reduce the economic burden of parents can stop using GH.
23.What is the age of bone that can not use GH?
At the first visit, when girls BA 14 years old and boys BA 15 years old, the growth rate is less than 2cm/y; at this time, the child’s growth space is very limited and GH treatment is generally not recommended.
24.Will growth hormone inhibit its own secretion?
For children who cannot secrete or under-secrete growth hormone, exogenous supplementation is needed; secondly, since the amount of supplementation is 0.1-0.15IU/kg/d, which is the smallest effective dose, it will not form a negative feedback effect and inhibit its own GH secretion; 0.15-0.2IU/kg/d will not inhibit its own GH secretion either.
25.When to stop using GnRHa in combination with GH in children with CPP?
If BA ≥ 12.5 years old for girls and 13.5 years old for boys, GnRHa should be stopped and only GH should be used.
26, the first diagnosis of CPP children should not use GnRHa situation?
(1) Bone age ≥ 12.5 years for girls and BA ≥ 13.5 years for boys;
(2) After menarche in girls or 1 year after ejaculation in boys; GH alone should be used in the above cases.
27, the child injection site appears red, painful, feverish, scratchy, the area varies between peanut to egg size?
(1) rhGH is produced by secretory gene expression technology of E. coli, and the purity of GH is very high, and there is usually no allergic reaction;
(2) Most of the above cases are caused by allergic reaction to alcohol or iodine volt, so the solution is to change the sterilization method which is not allergic.
28.Why does the child have low fever when GH is injected?
(1) Foreign literature reports that GH treatment may predispose a very small number of children to upper respiratory tract infection and otitis media, and low fever may occur, but the symptoms are generally mild;
(2) The fever will disappear with the prolongation of the drug, and these children are sensitive to GH and the treatment effect is ideal.
29.Why do children with GH injections show symptoms of nail resistance?
(1) It is reported in foreign literature that a very small number of children with hyperthyroidism in GH treatment have symptoms of autoimmune disease, such as Job’s thyroiditis, which is one of the physiological effects of GH to enhance the immunity of the body (strengthening humoral and cellular immunity), and is related to the appearance of thyroid resistance symptoms, but it is not caused by GH.
(2) The treatment plan for such children should be carried out under the guidance of an endocrinologist.
30.Can children with hepatitis B and C who are short be treated with GH?
(1) Hepatitis B and C are at high risk of hepatocellular carcinoma, and IGF-I has the effect of promoting mitosis and inhibiting apoptosis, so GH therapy is generally not recommended.
(2) Hepatitis B and C are in the active stage and must not be treated with GH.
(3) If hepatitis B and C are in the stable stage, with normal AST and ALT, GH treatment can be used.
Conclusion: More than ninety-five percent of the growth hormone on the market is produced by the fifth generation of growth hormone technology, and its molecular weight and spatial structure are exactly the same as the growth hormone secreted by itself.