I. Drug treatment, the best program is individualized Zhang engineer this unit physical examination was diagnosed with diabetes, to a hospital diabetes department, experts advised him to use “insulin intensive treatment”, Zhang engineer felt unacceptable, back to the office sullen. Ms. Li at the desk across from him comforted him, “How can you use insulin right after you get sick? It doesn’t matter if your blood sugar is high, I’ve been taking XX hypoglycemic drugs with good results. This is not every day with you to work together.” Zhang engineer listened to the reason, also bought XX hypoglycemic drugs “self-diagnosis and self-medication”. In fact, for first-time diabetics, there is no “best” drug, only the most suitable drugs. The newly published “China Type 2 Diabetes Prevention and Control Guidelines” emphasizes that “diet and exercise are the basic measures to control hyperglycemia in type 2 diabetes, if patients have typical symptoms or have severe hyperglycemia, diet and lifestyle changes are difficult to bring blood sugar control up to standard, medication should be used in a timely manner”. Oral hypoglycemic drug treatment for people with newly diagnosed diabetes is mainly divided into two cases according to body weight: ① for people with normal weight, on the basis of “diet + exercise + weight control” treatment, take one or more of the following drugs: a-glucosidase inhibitors (such as bactrim, carboplatin), metformin, thiazolidinediones, glinides, and flavoureas; ② for people with overweight, take one or more of the following drugs For overweight or obese patients, metformin should be taken orally to control blood glucose on the basis of “diet + exercise + weight control” treatment. If the above treatment does not reach the standard for 3 months (glycosylated hemoglobin is still greater than 6.5%), a variety of oral drugs must be used in combination, and if the combined drug does not reach the standard for 3 months, insulin should be used in time to control blood sugar. If the blood glucose control is not satisfactory in 3 months, insulin should be used to control blood glucose as soon as possible. There are also several details that deserve the attention of first-time diabetics: the starting dose of oral hypoglycemic drugs should be small, and the treatment plan should be adjusted according to the blood sugar level at the right time. If you travel frequently, it is more convenient and appropriate to choose medications that are taken once a day, with better compliance. Because elderly patients have poor tolerance for hypoglycemia, they should choose glucose-lowering drugs with mild hypoglycemic effects. Second, protect the pancreas, do not refuse to play insulin like the engineer Zhang at the beginning of this article, when he was first diagnosed with diabetes, experts advised him to use the “insulin intensive therapy” program, mainly based on the situation of his pancreatic islet function. Because type 2 diabetes is a group of diseases characterized by abnormal beta cell function with relative or absolute insulin secretion deficiency, the most reasonable treatment is to compensate for this deficiency or to supplement exogenous insulin. In diabetic patients, β-cell function has already entered an early stage of failure or persistent failure at the time of initial diagnosis. Under the effect of oxidative stress induced by significant hyperglycemia, the number of β-cells has decreased to 50% or less of the original number, and β-cell proliferation has decreased and apoptosis has increased. This trend gradually worsens with the course of diabetes, culminating in β-cell failure. In clinical practice, early insulin therapy can remedy this defect. Early insulin therapy can inhibit the decrease of β-cell number and prevent the progressive deterioration of blood glucose, while protecting β-cell function and reducing the risk of developing diabetic complications. Reference indications for the regulated use of insulin: ①Type 1 diabetes mellitus: As the islet secretion function of such diabetic patients is severely impaired or completely lost, they must rely on exogenous insulin therapy throughout their lives. Late onset immunogenic diabetes mellitus (type 1.5 diabetes mellitus): These diabetic patients also have severely impaired islet function and need to be treated with insulin immediately upon diagnosis in order to protect the remaining beta cells. Insulin therapy should be applied promptly when the following conditions occur in type 2 diabetes: ketoacidosis, non-ketotic hyperosmolar coma, lactic acidosis and other acute complications of diabetes mellitus should be treated with insulin, and after the acute complications are controlled, the original treatment method can be changed depending on the situation. Type 2 diabetic patients with severe heart, brain, liver, kidney, eye and nerve lesions, cirrhosis of the liver and gangrene of the lower extremities should be treated with insulin. type 2 diabetic patients who are not satisfactorily controlled by diet therapy, exercise therapy and oral hypoglycemic drugs or whose treatment fails. type 2 diabetic patients with long duration of disease. If the patient is pregnant or gives birth to a woman with type 2 diabetes, or if she has diabetes or gestational diabetes, the patient should be treated with insulin if she has significant weight loss, malnutrition, growth retardation and wasting. ④ Secondary diabetes such as pituitary diabetes and pancreatogenic diabetes must be treated with insulin. There is always a suitable insulin for you. All patients with type 1 diabetes and some type 2 diabetes need to be treated with insulin. Depending on the needs of the disease, the dosage, dose and frequency of insulin use vary from patient to patient. We would like to recommend ten types of insulin usage summarized by experts for you to choose: ① Use medium-acting insulin once a day: The duration of the effect of medium-acting insulin is about 12 hours, so generally diabetic patients need to inject twice a day. However, if the patient’s pancreatic islet function is less damaged, only the blood sugar is higher after three meals during the day, and the fasting blood sugar is better controlled at night without eating, you can inject medium-acting insulin once before breakfast. On the contrary, if the patient’s blood glucose is well controlled during the day and only fasting blood glucose is high, such as obese patients, those who have eaten too much at dinner or those whose blood glucose is obviously elevated in the early morning, they can have one injection of intermediate-acting insulin before bedtime, and the dose of injection is calculated as 0.2 units per kilogram of body weight. Patients can inject medium-acting insulin before bedtime so that the peak of insulin action occurs just before breakfast. This is beneficial for patients to control early morning hyperglycemia. ②One medium-acting insulin before bedtime and oral hypoglycemic medication during the day: diabetic patients who are overweight tend to gain weight after insulin injection. If such patients have not too high blood sugar, they can take three times of oral hypoglycemic drugs of biguanide during the day to lower sugar, lipid and weight, and then inject once more medium-acting insulin before going to bed to combat early morning hyperglycemia caused by insulin resistance. ③Two times a day with intermediate-acting insulin: for patients with mildly elevated fasting and postprandial blood glucose. After using insulin in this way, if the patient’s fasting blood sugar is better controlled and postprandial blood sugar is still high, Novolin 30R can be used instead, injected twice a day. ④Two times a day with Novolin 30R or 50R: This use is suitable for most diabetic patients with fasting blood sugar and postprandial blood sugar elevation as the main symptoms. The preparation is human insulin, and its advantages are: good absorption performance and strong action. Patients can increase or decrease the proportion of insulin R appropriately according to the postprandial blood glucose, and generally this preparation only needs to be injected twice a day. However, it also has shortcomings, that is, the high blood sugar control after lunch is not good, so patients with high blood sugar after lunch need to add an oral hypoglycemic drug at the same time when using Novolin. ⑤ 3 times a day with short-acting insulin: This usage is suitable for diabetic patients with very high blood glucose and first time insulin use, or with severe infection and just had surgery. The advantages are: patients can adjust the amount of insulin according to the blood sugar before meals and the amount of food eaten, and patients are less likely to have hypoglycemia after taking the drug; the disadvantages are: poor control of high blood sugar at night and early morning. (6) Short-acting insulin before breakfast and lunch, and Novolin 30R before dinner: This use is suitable for those with poor glycemic control who use Novolin 30R twice a day. The advantages of this usage are: it can reduce the dosage of insulin, improve the efficacy and avoid hypoglycemia of patients. The use of short-acting insulin before breakfast and Chinese meal can control the blood sugar after two meals, and the use of Novolin 30R to control the blood sugar after dinner and at night is more in line with the physiological condition of human insulin secretion. (7) Use short-acting insulin before three meals and medium-acting insulin before bedtime: This usage is suitable for the elderly or diabetic patients with heavy workload and irregular diet, or those with poor blood sugar control in the early morning who use short-acting insulin before breakfast and lunch and Novolin 30R before dinner. The use of short-acting insulin before three meals to control postprandial blood glucose and medium-acting insulin or long-acting genetically recombinant insulin (glargine insulin, arginine insulin) before bedtime can maintain patients’ basal insulin secretion at night, which is more in line with the law of insulin secretion in human body and can effectively inhibit the conversion of glycogen into glucose in the liver and reduce the decomposition of fat, keeping patients’ blood glucose stable at night and less likely to cause hypoglycemia. (8) Short-acting insulin is used four times a day: that is, insulin is injected before three meals and at bedtime. This use is suitable for diabetic patients who are using insulin for the first time or who have ketosis and cannot be hospitalized temporarily. However, the dose of insulin injected before bedtime should preferably not exceed 10 units.9 Once a day insulin analogue glargine insulin (Lysine): Glargine insulin has stable absorption properties, which can prevent patients from hyperglycemia due to the use of traditional long-acting suspensions with unstable absorption properties, and can effectively control basal blood glucose and reduce the chances of hypoglycemia in patients. Injecting once a day with Lysine and using fast-acting insulin eugenol before three meals can mimic the secretion of human physiological insulin, and its glucose-lowering effect can be comparable to insulin pump. ⑩6 times a day with short-acting insulin: This usage is suitable for patients with type 1 diabetes who have special needs. In the 2000 Sydney Olympics, American short-course swimmer Hall was the Olympic champion with six injections of insulin in one day.