In clinical practice, we often encounter a case in which a diabetic patient is treated with 4 U of insulin while using 5% glucose injection 250 ml as the diluent (infusion medium) for the therapeutic drug. The patient asked the doctor, “Why is insulin added to the glucose injection at this time? The answer is that it is to mix the glucose. Is this the right way to administer the drug? Why not choose an infusion solution other than glucose as the solvent? If a patient is taking oral hypoglycemic drugs, do they still need to continue taking the drugs at this time? Why do we have to use glucose? To know the answers to these questions, we must first understand how the drug solvents are selected for clinical treatment. Generally, we will consider the stability of the drug after dissolution and the patient’s disease contraindications. For example, patients with cardiovascular disease and hypertension need to control the intake of sodium salt. Some therapeutic drugs are only suitable for dissolution with glucose injection; physicians usually choose sugar infusion as the dissolving medium. For example, the addition of insulin to glucose infusion is a therapeutic necessity. For example, the combination of insulin, glucose and potassium chloride (GIK) has a stabilizing effect on cell membranes and is clinically known as polarizing fluid. It can correct intracellular potassium deficiency and provide energy, reduce free fatty acids in ischemic myocardium, and is used to prevent arrhythmias during myocardial infarction. Can insulin be applied to diabetic patients? But what people need to know is that diabetics are not completely unable to use glucose, they just cannot consume it in excess. We can do an arithmetic problem: for a normal adult diet, 100 g of rice (converted to sugar at 75%) is about 75 g of glucose, while a 250 ml bottle of 5% glucose injection contains only 12.5 g of sugar. Therefore, diabetic patients do not need to be too concerned about the use of glucose injection, they should use it as usual if they need to use it for treatment. The only thing you need to do is to pay attention to your glucose intake and blood sugar changes. How should insulin be mixed? When a diabetic patient must use glucose injection as a soluble medium, the clinical practice is to add insulin to the glucose used in the infusion without changing the patient’s regular treatment and diet. Generally, the ratio of glucose to insulin is about 5:1, and the conventional usage is to add 5 U of insulin to a 500 ml bottle of 5% glucose injection. However, individualized medication is now advocated, so it is best to determine the patient’s current blood glucose level first, and the amount of insulin to be added is different for different blood glucose levels. The principle is to put more insulin in the sugar solution for patients with high blood sugar, and less insulin for those with low blood sugar. For example: 5% GS 250ml + RI (normal insulin) 4 units, 500ml with 8 units of insulin; 2. If the blood sugar is higher, we need to put more, the ratio can be up to 2:1; 3. If the blood sugar is very high, use NS + insulin to lower the blood sugar first. If the blood sugar is very high, use NS + insulin to lower the blood sugar first. However, for patients who have never used insulin before (including subcutaneous and intravenous), the addition of insulin to the first bottle of glucose (blood glucose > 13.9 mmol/L with saline) should be conservative. Generally, 1 U of insulin should be added to 4 g of glucose and blood glucose should be measured once an hour. If blood glucose falls slowly, additional insulin can be added; if it falls rapidly, the titration rate can be lowered. The relationship between insulin and other drugs As for insulin added to glucose solution for intravenous infusion, it is not recommended to mix with other drugs for drip. Since insulin is a peptide structure, it is easily affected by chemical factors and has contraindications with many drugs; moreover, the material of the infusion bottle may cause adsorption to insulin, and the actual amount of insulin entering the body will be reduced. For diabetic patients, in order to avoid excessive intake of glucose, non-glucose infusion solutions such as fructose and xylitol can be chosen as solvents. However, because these infusions are more expensive and have contraindications with many drugs, they are not routinely recommended as solvents in drug instructions, so they are rarely used in clinical practice. It should be noted that the metabolites of glucose are carbon dioxide and water, while the metabolites of fructose are lactic acid, which may cause life-threatening lactic acidosis when used in excessive amounts, so it is not suitable for energy supply in parenteral nutrition.