What is insulin? Insulin is secreted by the B-cells of the human pancreas, the only substance in the body that lowers blood sugar and helps the cells use glucose to keep blood sugar in the normal range. It is like a key that opens the door for glucose to enter the cells, and only the glucose that enters the cells can power the cells and give the body its normal various physiological functions. Insufficient insulin secretion, whether absolute lack or relative deficiency (although some patients have normal amount of insulin secreted by the pancreas, the quality is bad and equivalent to waste products, so it is called relative deficiency), will cause blood glucose to rise and cause diabetes, so many diabetic patients need insulin supplementation to maintain normal blood glucose range. Which diabetic patients need insulin?Type 1 diabetes, who must receive exogenous insulin continuously; Type 2 diabetes, who are ineffective or allergic to oral medication; acute complications such as ketoacidosis, hyperosmolar coma, etc.; combined with serious infections: trauma, surgery, myocardial infarction, cerebrovascular accident; combined with chronic serious complications: such as diabetic nephropathy, foot gangrene or diabetic retinopathy; liver and kidney insufficiency Significant wasting with malnutrition; pregnancy and lactation. Insulin can be classified according to its source: animal insulin, human insulin and human insulin analogues. According to the duration of action, it can be divided into: ultra-short-acting insulin, short-acting insulin, medium-acting insulin and premixed insulin. The development of insulin has gone through two leaps, one from animal insulin to human insulin and the second, from human insulin to insulin analogues, human insulin is good while insulin analogues are better, why is the overall trend of insulin therapy now is to apply insulin analogues? Once a normal person eats, the body immediately secretes insulin directly into the blood and directly into the portal vein into the liver to directly inhibit hepatic glycogen output. The secretion process of insulin is synchronized with the process of blood glucose elevation, thus controlling blood glucose well. Although the molecular structure of human insulin is exactly the same as that of human insulin, it is injected subcutaneously and needs to go through the process of disintegration from the form of hexamer in vitro and then slowly absorbed into the blood, and after entering the blood, it needs to reach the corresponding tissues before it can function. In this way, human insulin therapy needs to be injected half an hour in advance, otherwise it will affect the glucose-lowering effect, and the insulin dosage will be large and increase the incidence of late hypoglycemia. Human insulin analogs overcome these disadvantages by shortening the process of slow absorption of insulin into the blood after its dissociation from the form of hexamer in vitro, thus mimicking the normal insulin secretion pattern very well, thus making it easier to use and more effective. Why insulin analogs should be developed, as explained above, reminds patients that speed is important and that truly fast insulin secretion like normal is currently dependent on analogs. In the face of gourmet human insulin cannot work immediately. And there are also long-acting insulin analogues on the market that simulate the human insulin secretion pattern from another aspect. That is, insulin secretion in normal human includes basal insulin secretion (stable output for 24 hours) and rapid insulin secretion at mealtime (rapid output at mealtime). Fast-acting insulin analogues simulate physiological secretion during meals. Long-acting insulin analogues simulate physiological secretion of basal insulin. From the history of insulin injection system, the development of insulin from the initial bottle insulin + syringe, to pen insulin + pen insulin syringe, to the current new generation insulin injection system – special filling injection device, are two leaps of insulin and its injection system. Insulin is by far the most ideal drug for treating diabetes and the safest form of treatment. With the right dosage, the disease can be controlled. Early use of insulin allows your blood sugar to be controlled early and delays or reduces the occurrence of complications. If you wait until all other medications fail to control your blood sugar before using insulin, the complications may have already severely damaged your health. The traditional treatment of type 2 diabetes is first maintained with oral hypoglycemic drugs, which have served to control blood sugar for some time. However, these drugs, especially the long-acting sulfonylureas, work by stimulating insulin secretion from the residual pancreatic B cells. In the early stage of type 2 diabetes, the number of B cells in the body is already half of normal people, and after several years, the residual pancreatic B cells in the patient’s body eventually fail completely, and then it will be too late to use insulin treatment. If insulin is used early to relieve the burden of B cells and give them a chance to recuperate, then the desire to maintain the residual physiological B cell function for the rest of the survival period cannot be replaced by any exogenous artificial factors. Moreover, more and more studies have shown that insulin not only controls blood glucose, but also dilates blood vessels, improves circulation and anti-inflammatory response, and early and long-term use is beneficial to the body. The goal of type 2 diabetes treatment is to achieve satisfactory control of blood glucose. This is the only way to prevent or delay the occurrence of various complications. The cost of complications, once they occur, is much higher than the cost of controlling the blood glucose itself. Moreover, many chronic complications are irreversible. Therefore, in the long run, type 2 diabetic patients should be treated with insulin as early as possible and reasonably, and with long-term economy. More and more studies show that insulin can not only control blood glucose, but also dilate blood vessels, improve circulation and anti-inflammatory response, and early and long-term use is beneficial to the body. Because insulin is a protein molecule, it is quickly degraded and destroyed in the digestive tract just like the food we eat, and cannot be absorbed into the bloodstream to take effect. Therefore, insulin can only be supplemented by direct injection. Although there are reports that oral insulin is being developed abroad, there is still a long way to go before it is actually successfully put into clinical use. Insulin is a protein hormone produced by the body itself, which the body cannot be without, and must be supplemented when there is an absolute or relative lack of insulin in the body in case of illness. In other words, insulin is not a “medicine”, but a natural substance in the body, so there is no need to worry about the saying that “it is a medicine that is three times more toxic”. Insulin is not a drug, it is not addictive, and withdrawal does not occur after stopping use. After using insulin for a period of time, the exogenous insulin supplementation can make the pancreatic B-cells rest, and at the same time, the toxic effect of high glucose on pancreatic B-cells can be relieved, and the disease can be controlled. A small number of patients can achieve blood glucose control through diet and exercise alone combined with oral medication after discontinuing insulin. And most patients can be adjusted to a smaller insulin dose (e.g., an optimal twice-daily treatment regimen) to achieve delayed islet B-cell failure, prevent or slow down the occurrence and development of complications, and truly improve the patient’s quality of life. Different injection sites have different absorption rates of insulin, which are classified according to the speed from fast to slow: abdomen, upper and lateral arm, anterior and lateral thigh, and buttocks. Since the muscle layer absorbs quickly and is prone to hypoglycemia, insulin should be paid attention to the subcutaneous tissue layer, not the muscle layer. The correct method is: pinch up the skin to inject while using a short and thin needle. The injection site should be changed, because the same place will cause atrophy of the subcutaneous tissue and poor absorption. The injection sites and areas should be rotated regularly, possibly according to the principle of symmetrical rotation between left and right. Injection procedure: select the site, disinfect: wait for the alcohol to evaporate completely, make the skin of the injection site tight, insert the needle (keep it vertical), inject quickly, count to 5 and pull out the needle, compress the injection site (do not massage). Pinch up the skin for injection: use a short fine needle to ensure the correct subcutaneous injection as effective as possible, the injection should be ensured under the skin to avoid accidentally entering the muscle layer, otherwise, the insulin absorption curve will not match the peak blood glucose absorption and the blood glucose fluctuates greatly. However, before the injection, it is better to put it in room temperature to let the insulin warm up (remove the insulin from the refrigerator 30 minutes before the injection), which can avoid an uncomfortable feeling when injecting. Never put it in the freezer to avoid the drug activity being destroyed and affecting the efficacy. Hypoglycemia can be completely avoided by strictly mastering the use of insulin. Although the use of insulin is very safe, there are still a small number of patients with hypoglycemia due to improper use or unreasonable meal intake because of the relatively high requirements for the use technique. If there are symptoms such as false sweat, weakness, palpitation, hunger and irritability, we should consider the possibility of hypoglycemia, and then patients who have the conditions should use blood glucose meter to measure blood glucose to confirm, and blood glucose <2.8mmol/L is hypoglycemia, however, many people have hypoglycemia symptoms (symptomatic hypoglycemia) when their blood glucose is still in the normal range, and if we consider the possibility of continued lowering of blood glucose, we can eat immediately. Patients with blood sugar between 2.8~3.8 mmol/L can also eat sugary foods such as sugar cubes, fruit juice, bread, cookies, etc. to relieve hypoglycemia symptoms if they have symptoms. Patients who do not have the condition should not tolerate it and can eat sugary foods directly. Carry insulin, injection pen, needle, alcohol cotton ball, blood glucose meter and blood glucose test paper with you when you travel, and take medication, injections and sterilization of injection equipment on time. Don't forget to add meals in time. Generally, when you go out, especially when climbing mountains, playing, long-distance travel and other activities, the amount of staple food should be increased accordingly. Pay attention to the combination of work and rest. If you are tired when you go out, you should pay attention to proper rest and ensure sleep. In conclusion, the determination and adjustment of insulin dose must be carried out under the guidance of a doctor, and inexperienced diabetic patients should not prematurely adjust insulin on their own. In order to avoid hypoglycemic reactions caused by insulin, it is necessary to maintain a regular, quantitative and timed diet and normal and regular activities every day. It is very important to closely monitor the control of blood sugar during insulin use and keep detailed records, which is a prerequisite for insulin dose adjustment. The time of eating and the time of injection must be coordinated; the content of carbohydrates must be guaranteed in the diet, and not only protein and fatty foods instead of carbohydrates, and the amount of diet should be increased regularly to prevent hypoglycemic reactions due to increased activity or labor intensity.