1.Patients with type 1 diabetes.
Because Hugh can not produce insulin or have insulin amount can not meet the needs of the body, and must be lifelong insulin injection treatment. If not injected, it will surname acute complications such as ketoacidosis, which is life-threatening.
2.Gestational diabetes :
Certain oral hypoglycemic drugs may endanger the health of the fetus, such as sulfonylurea hypoglycemic drugs can lead to fetal hypoglycemia through the placenta, and there is a risk of teratogenicity and fetal death in utero. Therefore, diabetic women must stop using oral hypoglycemic drugs and change to insulin therapy before and during pregnancy.
3. Patients with type 2 diabetes.
However, insulin injection is required in the following cases.
(1) Acute metabolic disorders (most short-term)
(2) Acute stress: perioperative period, perinatal period, severe infection, severe mental stress (short-term)
(3) by OHA treatment, metabolism can not be controlled normal (FBS> 7.8 mmol / L or HbA1C> 7% when)
(4) Severe ocular, renal, neurological, cardiovascular and skin complications
(5) wasting type 2 patients with complications (insulin may be used first)
(6) With chronic wasting diseases: tuberculosis, cancer and cirrhosis of the liver, etc.
(7) With severe liver and kidney insufficiency
(8) Initial diagnosis of type 2 diabetes with HbA1c greater than 8.5% or 9.0%, short-term intensive Studies have found that two weeks of intensive insulin therapy for newly diagnosed type 2 diabetic patients can enable some patients to maintain ideal blood glucose levels without any medication for up to 3 years through diet control and exercise alone.
(9) If HbA1c is still greater than 7.0% after 3 months of oral medication for first diagnosis of type 2 diabetes, basal insulin can be combined
(10) Diabetic patients with long duration of disease: Long-term observation of diabetic patients reveals that most of them cannot control blood glucose by oral hypoglycemic drugs alone after 8-10 years of disease, and at this time, if insulin is not used, it is difficult to get satisfactory control of blood glucose, and diabetic complications caused by high blood glucose will appear. Therefore, from the perspective of reducing complications and prolonging the life of patients, when the disease progresses to a certain stage, insulin must also be used.
In conclusion, there are no absolute contraindications to the use of insulin in diabetic patients, but it should be used in a timely manner and early use is recommended to facilitate stable control of blood glucose and prevention of complications.
As for the insulin dose, an appropriate amount can be set according to the blood glucose test results and adjusted in time.
There are several methods to calculate the total daily dose when starting insulin therapy.
1.Calculated by body weight: 0.5-1U/(kg.d) for type 1 diabetes; 0.2-0.6U/(kg.d) for newly diagnosed type 1 diabetes; 1.0-1.5U/(kg.d) for type 1 diabetes in adolescence, the need increases because of rapid growth and development in adolescence; 0.1-0.2U/(kg.d) for type 2 diabetes.
2.According to the physiological requirement: normal people secrete 30-40U insulin per day, and start insulin can start from 24-40U/d.
3.Estimated by fasting blood glucose (FPG): 0.25U/(kg.d) is given when fasting blood glucose is 8-10mmol/L. When fasting blood glucose >10mmol/L, insulin increases by 4U/d for every 1mmol/L increase. After calculating the total amount of insulin required daily, we have to divide it reasonably before three meals, generally the dosage before breakfast is greater than that before dinner, and the dosage before dinner is greater than that before The dosage before breakfast is generally greater than that before dinner, and before dinner is greater than that before lunch.
The initial dose of most patients is small and needs to be gradually increased, generally adjusted once every 3-4 days, and each increase or decrease should be 2-4 U until the goal of blood glucose control is achieved. Thereafter, the dose adjustment interval should be extended and the adjustment range should be further reduced, and the insulin dose should be kept in a relatively stable and dynamic balance with diet and exercise. If the fasting blood sugar is high in the morning, after excluding the reactive hyperglycemia caused by nighttime hypoglycemia, the medium-acting dose before dinner should be increased; the short-acting dose before breakfast should be increased if the blood sugar is high after breakfast and/or before Chinese meal; the medium-acting dose before breakfast or the short-acting dose before lunch should be increased if the blood sugar control is unsatisfactory after Chinese meal or before dinner. Conversely, if blood glucose is low at each of the above time signs, the insulin dose should be reduced at the corresponding time points. In addition, diabetic patients are affected by many living conditions that cause blood sugar fluctuations, and insulin dose should be changed at any time, such as banquets, sports, competitions, examinations, emotional stress, exertion, stress, pregnancy, childbirth, surgery, infection, trauma, etc. We should pay attention to adjust the dose and record the condition.