A. Drug therapy, the best program is individualized
In fact, for first-time diabetic patients, there is no “best” drug, only the most suitable drugs. The newly published “China Type 2 Diabetes Prevention and Control Guide” emphasizes that “diet and exercise are the basic measures to control hyperglycemia in type 2 diabetes, such as patients with typical symptoms or severe hyperglycemia, diet and lifestyle changes are difficult to make blood glucose control standards, should promptly use drug therapy”. Oral hypoglycemic drug treatment for people with first diagnosed diabetes is mainly divided into two cases according to weight.
1, normal weight, on the basis of “diet + exercise + weight control” treatment, take one or more of the following drugs: a-glucosidase inhibitors (such as bactrim, carboplatin), metformin, thiazolidinediones, gliadin, flavopiridol.
2, overweight or obese patients, “diet + exercise + weight control” treatment based on the choice of metformin oral, in order to control blood sugar. If the above treatment does not reach the standard for 3 months (glycosylated hemoglobin is still greater than 6.5%), a variety of oral drugs must be used in combination, and if the combined drug does not reach the standard for 3 months, insulin should be used in time to control blood sugar.
If the blood glucose control is not satisfactory in 3 months, insulin should be used to control blood glucose as soon as possible.
There are also several details that deserve the attention of first-time diabetics: the starting dose of oral hypoglycemic drugs should be small, and the treatment plan should be adjusted according to the blood sugar level at the right time. If you travel frequently, it is more convenient and appropriate to choose medications that are taken once a day, with better compliance. Because elderly patients have poor tolerance for hypoglycemia, they should choose glucose-lowering drugs with mild hypoglycemic effects.
Second, protect the pancreas, do not refuse to play insulin
The expert advised him to use the “insulin intensive therapy” program when he was first diagnosed with diabetes, mainly based on his pancreatic islet function. Because type 2 diabetes is a group of diseases characterized by abnormal beta-cell function with relative or absolute insulin secretion deficiency, the most reasonable treatment is to compensate for this deficiency or to supplement exogenous insulin. At the time of initial diagnosis, diabetic patients have already entered the stage of early or persistent loss of beta-cell function. Under the effect of oxidative stress induced by significant hyperglycemia, the number of beta-cells has decreased to 50% or less of the original number, and the proliferation of beta-cells has decreased and apoptosis has increased. This trend gradually worsens with the course of diabetes and eventually β-cell failure occurs. In clinical practice, early insulin therapy can remedy this defect. Early insulin therapy can inhibit the decrease of β-cell number and prevent the progressive deterioration of blood glucose, while protecting β-cell function and reducing the risk of diabetic complications. Reference indications for the standardized use of insulin.
1.Type 1 diabetes mellitus
Because of the severe impairment or complete loss of pancreatic islet secretion function in such diabetic patients, they must rely on exogenous insulin therapy for life.
2.Late onset immunogenic diabetes mellitus (type 1.5 diabetes mellitus)
Such diabetic patients also have severely impaired islet function, once diagnosed, need to immediately use insulin therapy to protect the still remaining beta cells.
3, type 2 diabetes should be promptly applied insulin therapy when the following conditions occur
If ketoacidosis, non-ketotic hyperosmolar coma, lactic acidosis and other acute complications of diabetes occur, insulin therapy should be used, and after the acute complications are controlled, the original treatment method can be changed depending on the situation. Type 2 diabetic patients with severe heart, brain, liver, kidney, eye and nerve lesions, liver cirrhosis and lower limb gangrene should be treated with insulin. type 2 diabetic patients with unsatisfactory control or treatment failure by diet therapy, exercise therapy and oral hypoglycemic drugs. type 2 diabetic patients with long duration of disease and low insulin and c-peptide release curve. type 2 diabetic women with pregnancy and childbirth; pregnant women with diabetes mellitus. Type 2 diabetic patients with significant weight loss, with malnutrition, growth retardation, wasting obvious, it is appropriate to use insulin therapy, if accompanied by tuberculosis and other long-term wasting disease must be combined with anti-TB treatment.
4, secondary diabetes such as pituitary diabetes, pancreatic diabetes, etc. must be treated with insulin.
There is always one of the ten uses of insulin that suits you. All patients with type 1 diabetes and some type 2 diabetes need to be treated with insulin. Depending on the needs of the disease, the dosage, dose and frequency of insulin use vary from patient to patient. We would like to recommend ten types of insulin usage summarized by experts for you to choose.
1.Use medium-acting insulin once a day
The effect of medium-acting insulin lasts for about 12 hours, so generally diabetic patients need to inject twice a day. However, if the patient’s pancreatic islet function is less damaged, only the blood sugar is higher after three meals during the day, and the fasting blood sugar is better controlled at night without eating, you can inject medium-acting insulin once before breakfast. On the contrary, if the patient’s blood glucose is well controlled during the day and only fasting blood glucose is high, such as obese patients, those who have eaten too much at dinner or those whose blood glucose is significantly elevated in the early morning, they can have one injection of intermediate-acting insulin before bedtime, and the dose of injection is calculated as 0.2 units per kilogram of body weight. Patients can inject medium-acting insulin before bedtime, so that the peak of insulin action occurs just before breakfast. This is good for patients to control early morning hyperglycemia.
2. One medium-acting insulin before bedtime and oral hypoglycemic drugs during the day
Overweight diabetic patients are prone to gain weight after insulin injection. If the blood sugar of such patients is not too high, they can take three times of oral hypoglycemic drugs of biguanide during the day to lower sugar, lipid and weight, and then inject once more medium-acting insulin before going to bed to fight the early morning hyperglycemia caused by insulin resistance.
3.Two times a day with medium-acting insulin
It is suitable for patients with mildly elevated fasting and postprandial blood glucose. After using insulin in this way, if the fasting blood sugar of the patient is well controlled, but the postprandial blood sugar is still high, Novolin 30R can be used instead, injected twice a day.
4.Two times a day with Novolin 30R or 50R
This usage is suitable for most diabetic patients with fasting blood glucose and postprandial blood glucose elevation as the main symptoms. The preparation is human insulin, the advantages of which are: good absorption performance and strong action. Patients can increase or decrease the proportion of insulin R appropriately according to the postprandial blood glucose level, and generally this preparation only needs to be injected twice a day. However, it also has shortcomings, that is, the high blood sugar control after lunch is not good, so patients with high blood sugar after lunch need to add an oral hypoglycemic drug at the same time when using Novolin.
5.3 times a day with short-acting insulin: This usage is suitable for diabetic patients with very high blood sugar and first time insulin use, or serious infection and just had surgery. Its advantages are.
Patients can adjust the amount of insulin according to the pre-meal blood sugar and the amount of food eaten, and there are less hypoglycemia after medication; its disadvantage is: poor control of high blood sugar at night and early morning.
6. Use short-acting insulin before breakfast and lunch, and use Novolin 30R before dinner
This use is suitable for those who use Novolin 30R twice a day with poor blood sugar control. The advantages of this usage are: it can reduce the dosage of insulin, improve the efficacy and avoid hypoglycemia in patients. The use of short-acting insulin before breakfast and Chinese meal can control the blood sugar after two meals, and the use of Novolin 30R to control the blood sugar after dinner and at night is more in line with the physiological condition of human insulin secretion.
7. Use short-acting insulin before three meals and medium-acting insulin before bedtime
This usage is suitable for the elderly or diabetic patients with heavy workload and irregular diet, or those who use short-acting insulin before breakfast and lunch and Novolin 30R before dinner with poor blood sugar control in the early morning. The use of short-acting insulin before three meals to control postprandial blood glucose and medium-acting insulin or long-acting genetic recombinant insulin (glargine insulin, arginine insulin) before bedtime can maintain patients’ basal insulin secretion at night, which is more in line with the law of insulin secretion in human body, can effectively inhibit the conversion of glycogen into glucose in the liver, reduce the decomposition of fat, keep patients’ blood glucose stable at night, and is less likely to make patients Hypoglycemia.
8. Use short-acting insulin four times a day
In other words, insulin should be injected before three meals and at bedtime. This usage is suitable for diabetic patients who are using insulin for the first time or have ketosis and cannot be hospitalized temporarily. However, the dose of insulin injected before bedtime should preferably not exceed 10 units
9.Use insulin analogue glargine insulin once a day (Lysine)
Glargine insulin has stable absorption properties, which can avoid hyperglycemia of patients due to the use of traditional long-acting suspensions with unstable absorption properties, effectively control basal blood sugar and reduce the chance of hypoglycemia in patients. Injecting once a day with Lysine and using fast-acting insulin eugenol before three meals can simulate the secretion of human physiological insulin, and its glucose-lowering effect can be comparable to insulin pump.
10. Use short-acting insulin 6 times a day
This usage is suitable for patients with type 1 diabetes who have special needs. In the 2000 Sydney Olympics, American short-course swimmer Hall was the Olympic champion with six injections of insulin in one day.