With the aggravation of renal impairment, oral hypoglycemic drugs gradually lost their hypoglycemic effect and effectiveness in candida nephropathy due to its own limitations, such as the excretion problem of sulfonylureas and the lactic acidosis problem of biguanides. In its place, insulin is used for treatment. Today we have a review of the considerations in insulin application.
I. Types of insulin.
1, short-acting: commonly used for ordinary insulin R, Novolin R, Urolim R
2, medium-acting: low fish essence egg zinc insulin (NPH) common insulin N, Novolin N, Eugenol N
3.Long-acting: PZI
4.Ultra-short-acting: Aspart (NovoRel), Eugenol (Lispro)
5.Ultra-long-acting：Glucomannan insulin, Lexapro, Detemir
Second, precautions
1, hypoglycemic reaction: manifested as dizziness, weakness, palpitations, sweating, drowsiness, inability to move, coma and even convulsions.
Causes: overdose or improper ratio of insulin.
Untimely or insufficient amount of diet.
Excessive activity.
Brittle diabetes.
Hepatic and renal insufficiency.
Alcohol consumption.
Elderly patients.
2. Allergic reactions.
3, edema.
4, Refractive error.
5, obesity.
Third, fasting hyperemia phenomenon
1, dawn phenomenon: good blood sugar control before bedtime and at night, only in the pre-dawn (4-7) appears hyperglycemia. The reason is that glucocorticoid and growth hormone are elevated at this time, not related to diet; treatment: add medium-acting or long-acting insulin before bedtime or add ordinary insulin at 3:00 in the morning.
2.Insufficient insulin action: poor blood sugar control at bedtime and at night, no hypoglycemia at night, continuous blood sugar increase with thirst phenomenon; treatment: add insulin.
3. Somoyi phenomenon: rebound hyperglycemia, good blood glucose control before bedtime and at night, hypoglycemic reaction at 0-3; treatment: reduce the medium and long-acting dose, monitor blood glucose before bedtime, and inject regular insulin before dinner instead.
Fourth, the effect of hemodialysis on insulin-prone to hypoglycemia
1, insulin accumulation, insulin molecular weight of 5734, difficult to pass the dialysis membrane.
2.Insulin resistance is reduced and receptor activity is increased.
3.Glucose is permeated off.
Treatment: Appropriate increase in blood glucose concentration has even been proposed as 8-11 mmol/l fasting and 11-16 mmol/l postprandial.