With the improvement of people’s quality of life, superior living conditions and bad habits have led to an increasing incidence of diabetes, which has now exceeded 40 million patients in China alone. For such a huge number of patients, how to choose the right treatment method is undoubtedly the hot spot of their concern. The principles of diabetic patients based on diet control and physical exercise, with the addition of oral hypoglycemic drugs when necessary, have been recognized by everyone. However, there is no consensus on whether diabetic patients need to receive insulin therapy, when to start receiving it, and what matters need to be noted after receiving it, and there are still some misunderstandings especially among a considerable part of diabetic patients. In clinical work, it is common to see some diabetic patients who are alarmed when their doctors suggest that they should be treated with insulin: “I am non-insulin dependent, and I will become dependent once I use it.” Some patients even believe that daily insulin injections are like drug addiction, and these beliefs are not justified. A series of studies have confirmed that diabetic patients should be treated with insulin as early as possible.
1. Proper understanding of insulin.
In the human body, next to the duodenum, there is a long organ called the pancreas. In the pancreas there are many small, scattered cell clusters, which are gathered together and scattered in the pancreas like islets, which are called “islets”. The beta cells in the islets secrete a substance that lowers blood glucose levels, which has been named “insulin”. Insulin is a protein-based hormone, which is like a golden key that allows glucose in the blood to enter the cells of various organs and tissues and provide them with energy. Also insulin promotes the synthesis of protein fats and inhibits their breakdown. Type 1 diabetes occurs when human pancreatic islet cells are destroyed and the cells lose their ability to synthesize and secrete insulin; in addition, when patients develop insulin resistance or delayed peak insulin secretion after meals, causing an increase in postprandial blood glucose, it is called type 2 diabetes. Therefore, both type 1 and type 2 diabetic patients have absolute or relative deficiency of insulin secretion, so type 1 diabetic patients and some type 2 diabetic patients need to receive insulin therapy to supplement their own insulin deficiency or insufficiency.
2. Benefits of receiving insulin therapy early.
Type 1 diabetic patients, due to the absolute shortage of insulin secretion, once diagnosed, must be treated with insulin replacement therapy for life to strictly control blood sugar and achieve the purpose of delaying or even avoiding the occurrence of acute and chronic complications of diabetes, so it was commonly known as “insulin-dependent diabetes”. In contrast, the onset of type 2 diabetes is related to pancreatic islet cell hypofunction and insulin resistance, which used to be called “non-insulin-dependent diabetes”. This has caused some type 2 diabetes patients to form the misconception that they cannot be treated with insulin. In fact, whether a patient is insulin dependent or not is determined by the condition and has nothing to do with whether or not to take insulin. On the contrary, for type 2 diabetic patients, insulin injection at the appropriate time of the condition can avoid the use of some drugs that promote insulin secretion and let the residual functional pancreatic beta cells rest, which can instead delay the time when the patient needs insulin therapy. At present, it has been clinically proven that a considerable number of type 2 diabetic patients can have their residual pancreatic beta cells repaired and their insulin resistance reduced after receiving a certain course of insulin therapy after the first diagnosis of diabetes, and the patients can maintain their blood glucose at a normal level for a long period of time without any medication and relying only on lifestyle changes. In addition, for type 2 diabetic patients with long duration of disease, if the blood sugar is not well controlled, the patient’s body will be in a long-term hyperglycemic state, and chronic complications of diabetes will appear earlier; on the contrary, after using insulin therapy, the blood sugar and glycated hemoglobin can be better controlled in the ideal range, so as to delay the occurrence and development of complications. In addition, for some patients who apply several hypoglycemic drugs in combination, the use of insulin therapy is not only effective, but also low cost and cost-effective.
3. Indications for insulin use.
Patients with type 1 diabetes have absolute insulin deficiency in their bodies and must therefore receive insulin therapy, but what kind of patients with type 2 diabetes need to receive insulin therapy? When type 2 diabetic patients cannot control their blood glucose through strict dietary control, exercise therapy and adequate oral hypoglycemic drugs, then there are indications for insulin. However, it must be noted that obese and leaner patients must be treated differently. Thin patients are more sensitive to insulin and need to regain weight, so insulin should be used actively. In contrast, the use of insulin in obese patients tends to be conservative, emphasizing weight loss measures, and can start with biguanides and byproterenol or insulin sensitizers. When the efficacy of adequate oral hypoglycemic drugs is still poor, insulin can be added. After the blood glucose control is ideal, insulin can be reduced, and many patients can remove insulin and use oral medication again.
In addition, when type 2 diabetic patients are in the following conditions such as severe infection, surgery, trauma, pregnancy, ketoacidosis, hyperosmolar coma, lactic acidosis and use of adrenocorticotropic hormone, insulin therapy must be applied for a short period of time. Before using insulin, insulin function should be checked and the dosage should be adjusted by choosing insulin formulations under the guidance of doctors for reasonable use.
4. Precautions in the use of insulin.
Since insulin is a protein, after oral administration, digestive enzymes in the gastrointestinal tract will break it down and make it ineffective, therefore, insulin can only be administered by injection at present. In the process of insulin administration, the following issues must be noted.
(1) Insulin preparation should be stored in a cool place away from light, the best method is to store it in the refrigerator at 2-8℃, avoid freezing or overheating. Half an hour before the injection by the refrigerator, up to room temperature state after injection, cold insulin will affect the absorption, cause more local reactions, and may lead to fat atrophy of the injection site.
(2) There are many kinds of insulin preparations, so before injection, we should pay attention to the type of preparation (especially for some patients who use more than one form), expiration date and potency, extract insulin accurately, inject insulin every day according to the specified time, and pay attention to the time of insulin injection and meal time.
(3) Before taking insulin injection, the vial should be repeatedly turned upside down several times so that the suspension is well mixed; however, strong shaking is strictly forbidden so that the amount of extracted medicine is not accurate due to foam.
(4) When injecting insulin, it should be pumped back before injection to prevent hypoglycemic reactions caused by inadvertent entry into the vein. After the injection, press the eye of the needle for 2 to 3 seconds, but do not massage.
(5) Insulin injection sites should be chosen to alternate between multiple sites and should not be injected multiple times in a short period of time at the same injection site to minimize tissue damage, swelling and subcutaneous fat atrophy.
(6) Treatment should not be interrupted at will during the treatment period with insulin. When adjusting the insulin dosage or changing the insulin dosage form and variety, it should be done under the guidance of a doctor to avoid loss of control or hypoglycemic reactions.
(7) During the insulin treatment period, pay attention to monitoring and inform patients and their families to observe hypoglycemic reactions. Once fatigue, sleepiness, weakness and sweating appear, food should be given and sugar water and fruit juice can be drunk, etc. If it is not relieved or aggravated within 30 minutes, contact with the doctor. Patients should prepare some candies and cookies when they go out and carry the disease card with them so that they can get help from others in time.
(8) Patients should pay attention to personal hygiene and keep their mouth and skin clean. Regularly check blood sugar, urine sugar and ketone body to determine and adjust insulin dose and pay attention to dose individualization.
In addition, it is worth mentioning that there are many factors other than insulin that can affect blood glucose level, and the fluctuation of blood glucose cannot be attributed to the improper injection dose of insulin alone. Factors affecting blood sugar include frequency and intensity of exercise, the amount and type of food eaten, whether or not other diseases are combined and the rate of insulin absorption by the body, etc. Therefore, meals and exercise should be eaten regularly and quantitatively according to the requirements of diet therapy and exercise therapy, and additional meals should be added when additional exercise is performed.
With the rapid development of medical technology, the treatment of diabetes has also made a welcome progress, the introduction of insulin pumps, so that the injection of insulin better simulates the physiological state of people, diabetic patients installed insulin pump is like the installation of an “artificial pancreas”, in a better control of blood sugar at the same time, so that the patient from repeated injections of suffering. In addition, oral and inhalation insulin pumps can be used as a way to control blood sugar. In addition, oral and inhalation insulin is also under development. As long as diabetic patients, under the guidance of doctors, eat reasonably, exercise, use insulin treatment early and strictly control blood sugar, life will be sweeter than honey.