Patients with diabetes often ask when they visit their doctor: Do I have to apply insulin? When should I apply insulin? These questions may seem simple, but they are not easy to answer. A brief description of these common questions is as follows.
Who must use insulin?
Type 1 diabetes: lifelong application
Type 1 diabetes was also known as “insulin-dependent diabetes” because patients with this type of diabetes completely lose the function of insulin secretion and must rely on insulin to maintain their lives. Some patients are prone to take the meaning of the word “insulin-dependent” and think that insulin dependence is as terrible as drug addiction, which makes them afraid to start insulin therapy easily. In this regard, patient education should be strengthened.
Tip: “Insulin-dependent diabetes” does not refer specifically to type 1 diabetes, but also includes type 2 diabetes with a long history of islet beta cell failure. Some community physicians say that Latent Immune Diabetes Mellitus in Adults (LADA) also belongs to “insulin-dependent diabetes”, which is correct, but it should be noted that LADA itself is a subtype of type 1 diabetes.
Type 2 diabetes mellitus: It should be applied to those with long duration of disease and poorly controlled disease.
Type 2 diabetes includes 2 conditions: one is a significant decrease in insulin level in the body; the other is a relative lack of insulin due to insensitivity to insulin. Since the body can still secrete insulin, this type of diabetes was also called “non-insulin-dependent diabetes” in the past. However, insulin therapy is also necessary for the overall course of type 2 diabetes.
Most patients with “long-standing” type 2 diabetes require insulin therapy. As the disease progresses, both fasting blood glucose and postprandial blood glucose gradually increase, while beta cell function as a whole gradually decreases. Therefore, insulin supplementation therapy is always needed in the later stages as long as the duration of diabetes is long enough. Long-term observation of type 2 diabetic patients reveals that most patients cannot control blood glucose by oral hypoglycemic drugs alone after 8 to 10 years of illness, and at this time, if insulin is not used, blood glucose will be difficult to be satisfactorily controlled, and diabetic complications caused by high blood glucose will progress significantly. Therefore, from the perspective of reducing complications and prolonging the patient’s life, insulin must also be used when the disease progresses to a certain stage.
Tips: Patients may have endogenous insulin deficiency in.
①Low-weight patients who are thin.
(ii) Patients who were originally fat or normal weight and have recently experienced significant weight loss.
(iii) Significant hyperglycemia.
④Highly fluctuating blood glucose.
⑤ Non-starvation ketosis.
”Patients with “multiple diseases
This includes two conditions: first, other diseases or conditions that may cause fatal metabolic disturbances, such as those requiring major surgery, severe trauma, or severe infections, who may develop ketosis, ketoacidosis, or non-ketotic hyperosmolar coma, which can be life-threatening. Second, other diseases can cause oral hypoglycemic drug accumulation poisoning. For example, patients with hepatic or renal insufficiency or severe hypoxia f such as heart failure), because oral hypoglycemic drugs are not metabolized properly in the body, they can cause drug accumulation and aggravate adverse reactions. Insulin is a natural substance in living organisms and is the safest drug among all hypoglycemic drugs available. Diabetic patients should not hesitate to receive insulin therapy when it is needed. Although oral hypoglycemic drugs can control high blood sugar in pregnant women with diabetes, there is no evidence from clinical trials on whether the drugs have adverse effects on the fetus. Insulin, on the other hand, is a natural hormone in living organisms, and its safety is reliable. Therefore, when the blood sugar of pregnant women with diabetes is so high that it cannot be controlled by diet and exercise, insulin must be used to control the blood sugar and ensure the safety of mother and baby.
When to start insulin application?
Recommendations of our guidelines for insulin initiation
The 2010 edition of our diabetes prevention and control guidelines gives the following recommendations on when to start insulin therapy.
1. Patients with type 1 diabetes require insulin therapy at the onset of the disease and need lifelong insulin replacement therapy.
2.Patients with type 2 diabetes start the combination of oral medication and insulin therapy if their blood glucose is still not controlled to the standard based on the combination of lifestyle and oral hypoglycemic medication. In general, after a larger dose of a variety of oral drug combination therapy, HbA1c>7.0%, you can consider starting insulin therapy.
3.Insulin should be used as the first-line treatment drug for diabetic patients with new onset and wasting that are difficult to identify with type 1 diabetes.
4.Insulin therapy should be used as early as possible when significant weight loss without obvious cause occurs during the course of diabetes (including newly diagnosed type 2 diabetes).
Some “alternative” manifestations of hypoglycemia
Insulin therapy has many advantages, but one should be alert to the occurrence of hypoglycemia. Some of the “alternative” hypoglycemia are shared as follows
1. Hypoglycemia causes heart failure and persistent shortness of breath in patients with coronary artery disease.
2. Hypoglycemia causes limb movement disorder and hemiplegia.
3. Hypoglycemia causes cognitive impairment similar to psychosis, such as hitting the wall with the head.
4. the appearance of epileptic-like reactions such as clenching of teeth.
5.The appearance of inability to understand others’ words and the total forgetfulness of what happened during hypoglycemia.