1.Multiple subcutaneous insulin injections After adequate dose adjustment based on the choice of basal or 1 to 2 times daily premixed insulin initiation therapy, if the patient’s blood glucose level still does not reach the standard or recurrent hypoglycemia occurs, the treatment plan needs to be further optimized. Intensive insulin therapy can be performed with mealtime + basal insulin or 3 times daily premixed insulin analogues. The usage is as follows: 1) Mealtime + basal insulin: Adjust the insulin dosage before bedtime and before three meals according to the level of blood glucose before bedtime and three meals respectively, and adjust the dosage every 3-5 days, and the dosage is 1-4 U each time according to the blood glucose level until the blood glucose reaches the standard.
When starting a mealtime + basal insulin regimen, a regimen of adding mealtime insulin to basal insulin only before one meal (such as the main meal) can be used. After that, it is decided whether to add mealtime insulin before other meals according to the glycemic control.
(2) Premixed insulin analogues three times a day: Insulin dose adjustment is made according to the blood glucose level before bedtime and three meals, and is adjusted every 3 to 5 days until the blood glucose standard is reached.
2. Continuous subcutaneous insulin infusion (CSII) CSII is a form of insulin intensive therapy, which requires the use of an insulin pump to implement the treatment. The pharmacokinetic profile of insulin administered via CSII in vivo is closer to the physiological insulin secretion pattern. The risk of hypoglycemia in CSII therapy is reduced compared to intensive insulin therapy with multiple subcutaneous insulin injections. Only short-acting insulins or rapid-acting insulin analogues can be used in insulin pumps.
The main populations for CSII are: patients with type 1 diabetes; women with diabetes who are planning to conceive and are pregnant or who have gestational diabetes requiring insulin therapy; and patients with type 2 diabetes requiring intensive insulin therapy.