I. Indications for the use of insulin
(1) Type 1 diabetes mellitus (DM)
(2) Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolarity
(3) Severe acute and chronic complications of DM
(4) Type 2 DM with marked beta cell decompensation
(5) surgery, pregnancy
(6) Some special types of DM.
II. Commonly used insulin brands and dosage forms
The following is mainly classified by the duration of action.
(1) The short-acting marker letter is R (Rapid). Formulations (brands): Novolin R, Novolac, Eugenol R, RI (ordinary insulin) (Note: only write Novolac without the word R is short-acting, more special), insulin only this type can be used intravenously (other medium and long-acting can only be subcutaneous), 0.5h onset of action, 1.5h peak, maintenance 3-6h.
(2) Medium-acting sign letter N. Preparations (brand): Novolin N, Eugenol N. 2h onset of action, lasting 10-18h.
(3) Pre-mixed preparations (brand): Rui and Rui 30, Novolin 30R, Urolene (premixed), of which Novolin 30 is 30% ultra-short-acting + 70% medium-acting, so the effect starts 15′ after use and needs to be played 15′ before meals; and 30R or premixed is short-acting + medium-acting, needs to be played 30′ before meals. 2 -It reaches its peak at 8h and can be maintained for 24h (or 10-18h).
(4) Long-acting – glargine insulin, maintained for 24h. The method of use is subcutaneous injection at bedtime, generally 10U start with the start, and then adjusted according to the blood sugar situation.
Short-acting is fast-acting, short-lasting, and is used for playing before three meals to control post-prandial blood sugar. The medium-acting and long-acting effects last long and are used for playing before bedtime to control blood sugar at night or throughout the day.
Third, how to set the program.
1. The more commonly used combinations are as follows.
(1) Pre-mix (Novalin 30R, Novalin 30, Eugenol pre-mix) once before each of breakfast and dinner
(2) three meals before each play a Novolac 30 (and other premix, such as Novolin 30R generally do not play three times the)
(3) Three short and one medium, three short and one long: one short-acting shot before each of the three meals + one medium-acting or long-acting shot before bedtime.
(4) One long-acting shot before bedtime (alone or + oral hypoglycemic drugs)
(5) Insulin pump: short-acting insulin can be pumped continuously for 24 hours and the amount of each time period is investigated in advance on the pump, which is generally available only for endocrine specialists, more than 100 yuan/day.
2.Dosage and distribution
Total pancreatectomy patients need 40-50U per day, most patients can start with 18-24U/d, and then adjust according to blood sugar. Foreign advocates T1DM according to 0.5-0.8U/kg, not more than 1.0; T2DM according to 0.3-0.8U/kg.
More for breakfast (25-30%), medium for dinner (20-25%), small for bedtime (20%), and less for Chinese food (15-20%).
Insulin pump: 40% as the basal amount of continuous subcutaneous; the other 60%, 20%, 15%, 15%, 10% in the morning and midnight at bedtime.
3, DKA or hyperglycemic hyperosmolar state RI usage
RI: 0.1U/kg.h, 10-20U can be injected first for shock or severe acid replacement. no more than 6mmol/L per hour reduction is appropriate blood sugar <13.9 can be changed to sugar water + RI.
At >33.3, 0.2U/kg.h. (General RI 50U + NS50ml micropump, e.g. this patient 50kg. i.e. need 10U /h. i.e. investigate to 10ml/h)
23.3-33.3 – 0.15 U/kg.h, i.e. investigate to 7.5
13.9-23.3 – 0.1, i.e., to 5
7.8-13.8 – 0.05 i.e. investigate to 2.5
<7.8 if ketosis is not corrected to be used, 1U/h, that is, to 1.
Fourth, control how to count to meet the standard?
Single ground, that is, fasting <7 and postprandial <10 and not hypoglycemia is ideal! Some people think that the older the age should be more lenient: 60 years old 6, 70 years old 7, 80 years old 8.
V. Oral hypoglycemic drugs
1. Pro-insulin secretagogues.
That is, the body is required to have a considerable number of pancreatic ß-cells in order to promote insulin.
(1) Sulfonylureas
Non-fat; disease duration <5 years (to ensure a significant number of islet ß cells). Damacell (Gliclazide extended-release tablets) 30mg-120mg qd Glimepiride 2mg qd before breakfast (Chen: 2mg = 90mg Damacell)
(2) Glinide class
For elderly with high early postprandial.
Novaluron (Repaglinide) often 1mg tid (Chen: diabetes and kidney disease if all to use oral hypoglycemia, only recommended Novaluron)
2.Biguanide
No significant wasting with lipid abnormalities, hypertension first-line drugs, or T1DM combined with insulin.
High fever, cardiopulmonary, hepatic and renal decompensation are contraindicated.
Geva (metformin) 0.5 Tid (extended release tablets 0.5 bid)
Side effects are gastrointestinal symptoms: vomiting, diarrhea. Prepare to inject contrast agent should stop taking it first.
3.Insulin sensitizer (Glitonin)
Can improve blood lipids, vascular endothelial function, improve fibrinolytic activity, etc., and protect the heart and kidney. But edema, weight; heart disease, heart failure tendency or liver disease is not used or used with caution.
Pioglitazone 15-30mg Qd
Rosiglitazone (Vindia) seems to have been prohibited due to a clear increase in the risk of cardiovascular accidents.
4. a Glucomannase inhibitor
For postprandial high.
Adverse effects: abdominal distention exhaustion diarrhea.
Acarbose (Bactrim) 50-100mg Tid first bite after meal.