Insulin therapy is a very meticulous technique, and the biggest headache for patients is that they do not know how to calculate and regulate insulin dosage.
1. Q: How to calculate the daily dosage of insulin for the first time?
A: ① fasting blood sugar (mmoI/L) x 1.8 mmol/L. ② fasting blood sugar (mg) ÷ 10 mg. ③Weight x 0.3 or 0.5mmoI/L.
(Note: The dosage calculated above is the dosage for one day.)
2. Q: How is the daily dosage of insulin allocated?
Flogging: ① 3 insulin injections per day: for patients using insulin for the first time, according to the method of “daily amount divided by 3, in minus 2 plus morning”. Such as daily short-acting insulin 30 units, divided by 3 equals 10 units, middle age minus 2 units, added in the morning (the first time), that is, 1 2 units in the morning, 8 units in the middle age, 10 units in the evening. After the blood glucose reached the standard, it was changed to premixed insulin and injected twice a day before breakfast and before dinner. ② 2 injections of insulin per day: 2/3 of the total amount before breakfast and 1/3 of the total amount before dinner. ③ 1 injection of insulin per day: oral hypoglycemic drugs before 3 meals during the day, and one additional injection of long-acting and medium-acting insulin at 0.2 units per kilogram of body weight before bedtime. The long-acting insulin analogue is used at bedtime? The combination treatment of Lysodren with oral hypoglycemic drugs during the day is more in line with the physiological secretion of insulin. Blood sugar control is better and hypoglycemic reactions are less and safer.
3.Q: How to adjust insulin dosage according to blood sugar level?
Flogging: ①Adjustment according to fasting blood sugar: on the basis of the original insulin dosage, insulin dosage should be adjusted according to the fasting blood sugar level due to blood sugar failure or hypoglycemia: when fasting blood sugar is 5.0?7,OmmoI/L, no increase or decrease; when fasting blood sugar is 3.0?5.OmmoI/L, insulin should be reduced by 2?3 units or injected after meals; when fasting blood sugar is >7.0,OmmoI/L, insulin should be injected after meals. OmmoI/L, add 1 unit of insulin for each mmoI/L increase. ②Regulate by postprandial glucose: after 2 hours of postprandial glucose higher than 10.0 mmol/L, add 1 unit of insulin for every 2.0 mmol/L increase, but do not add more than 6 units at a time.
4.Q: How to adjust the insulin dosage according to the urine sugar level?
A: When the renal glucose threshold is normal, add 2 units of insulin for each “+” sign increase in urine glucose and ketone body negativity before meal, and add 3 units for ketone body positivity. Each addition should not exceed 6 units.
5Q: How to adjust insulin dosage during fever or menstruation?
A: Regardless of the cause of fever, if the body temperature exceeds 38°C, the insulin dosage should be increased by 20% on top of the original insulin dosage. For women before each menstruation or during the last 3 months of pregnancy, the insulin dosage should be increased appropriately under the guidance of doctors.
6.Q: How to adjust the dosage when insulin species or dosage form is changed?
A: The dosage of porcine insulin should be reduced by 20% when changing to human insulin; conversely, it should be increased by 20%; when insulin inhalation is changed to injection, the dosage should be increased by 3 or 4 times; 4 units of oral insulin spray is equivalent to 0.73 units of subcutaneous insulin injection.
7.Q: How to adjust the insulin dosage for hyperglycemia in the early morning?
A: The medium-acting insulin is used before going to bed, and early morning blood glucose > 8,Ommol/L can be measured once at 3:00 a.m. If it is ≥ 4.Ommol/L, it is called “dawn phenomenon”, which indicates that insulin is insufficient and the dosage needs to be increased. If it is <4.0mmoI/L, it is called "Sumuj effect", which indicates that the insulin is too much and the dosage should be reduced.
8.Q: How to adjust the insulin dosage for obese or lean patients?
A: If the patient has calculated the calories according to the standard weight and activity, and made a recipe for meals, but the blood sugar is still high, the principle of regulation is: increase insulin for the lean person without reducing the diet; while the obese person does not increase insulin, reduce the amount of diet, increase the amount of exercise, and increase the amount of oral drugs of biguanide. If for some reason temporarily need to eat one or two more staple foods (50 grams), you need to add another 5 units of insulin. Generally 1 unit of insulin can lower the blood sugar raised by 1 0 grams of staple food.
9.Q: How to adjust the dosage of mixed insulin?
A: Mixed insulin is injected twice in the morning and evening. If the blood sugar is high before lunch, it means the short-acting insulin in the mixed insulin is insufficient; if the blood sugar is high before dinner, it means the medium-acting insulin is insufficient; if the blood sugar is high before bedtime, it means the short-acting insulin before dinner is insufficient; if the blood sugar is high in the early morning, it means the long- and medium-acting insulin is insufficient, which can be adjusted according to this principle.
10.Q: How to monitor blood sugar during insulin injection?
A: Insulin regulation is based on the blood glucose levels monitored at different times. Fasting and pre-dinner blood glucose can be measured first, the former reflecting the generation of blood glucose at night and the latter reflecting the utilization of blood glucose during the day, once every 3 to 5 days. When fasting blood glucose is below 7.0 mmol/L and postprandial blood glucose is below 10.0 mmol/L, monitoring can be changed to once a week.