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 one diabetic to another. The following are several uses of insulin: 1. Once a day with medium-acting insulin: The duration of the effect of medium-acting insulin is 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 white? If the patient’s blood glucose is high after three meals during the day and fasting blood glucose is well controlled at night without eating, medium-acting insulin can be injected once before breakfast. On the contrary, if the patient’s blood sugar is well controlled during the day, only the fasting blood sugar is high, such as obese, eating too much at dinner or diabetic patients with significantly higher blood sugar in the early morning, one injection of medium-acting insulin can be given 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. It is beneficial for patients to control early morning high blood . 2, once before bedtime with medium-acting insulin, oral hypoglycemic drugs during the day: overweight diabetic patients are prone to gain weight after insulin injection. Such patients, if their blood sugar is not too high, can take three times during the day oral biguanide hypoglycemic drugs, lowering sugar, lowering weight, lowering fat . Then inject insulin once more before bedtime to counteract early morning hyperglycemia caused by insulin resistance 3, twice a day with medium-acting insulin: This usage is suitable for patients with mildly elevated fasting and postprandial blood sugar. After using insulin in this way, if the fasting blood glucose of the patient is well controlled, but the postprandial blood glucose 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 sugar and postprandial blood sugar 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, 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 the patients with high blood sugar after lunch in the use of Novolin, but also need to add an oral hypoglycemia . 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 recent surgery. The advantages are: patients can adjust the amount of insulin according to the pre-meal blood sugar and the amount of food eaten, and patients are less likely to have hypoglycemia after using the drug; the disadvantage is: poor control of high blood sugar at night and early morning. 6. Short-acting insulin before breakfast and lunch, and Novolin 30R before dinner: This usage is suitable for those who use Novolin 30R twice a day with poor glycemic 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. Short-acting insulin before three meals and medium-acting insulin before bedtime – intensive treatment: This usage is suitable for the elderly or diabetic patients with high labor intensity and irregular diet, or those with poor blood sugar control in the early morning who use short-acting insulin before breakfast and lunch and Novolin 30R before dinner. Short-acting insulin is used before three meals to control postprandial blood sugar, and medium-acting insulin or long-acting genetically recombinant insulin (glargine insulin, arginine insulin) is used at bedtime to maintain medical education. It can effectively inhibit the conversion of glycogen into glucose in the liver and reduce the decomposition of fat, so as to keep the patient’s blood sugar stable at night, and it is not easy for the patient to have hypoglycemia. 8, once a day insulin analogue glargine insulin (Lysine): Glargine insulin has stable absorption, which can avoid hyperglycemia of patients due to the use of traditional long-acting suspension with unstable absorption performance, effectively control basal blood sugar and reduce the chance of hypoglycemia of patients. The once-a-day injection of Lysodren and the use of fast-acting insulin eugenol before three meals can simulate the secretion of human physiological insulin, and its glucose-lowering effect is comparable to that of insulin pumps. How to calculate the dosage of insulin (a) How to estimate its initial use: When starting insulin therapy for diabetic patients, short-acting insulin is always used. Moreover, the initial dosage must be estimated according to the following methods on the basis of relatively stable diet and exercise, and then adjusted according to the results of disease monitoring. 1. Estimation according to fasting blood sugar: daily insulin dosage (μ) = [fasting blood sugar (mg/dl) – 100] x 10 x body weight (kg) x 0.6 ÷ 1000 ÷ 2 100 is the normal value of blood sugar; x 10 is the amount of higher than normal blood sugar per liter of body fluid; x 0.6 is the amount of body fluid of the whole body is 60%; ÷ 1000 is the conversion of blood sugar mg to grams; ÷ 2 is 2 grams of blood sugar using 1 μ insulin. To avoid hypoglycemia, the actual use of its 1/2 – 1/3 amount. 2.Estimated by 24-hour urine glucose: Those with mild disease, no diabetic nephropathy and normal renal glucose threshold are given 1μ insulin for every 2 grams of urine glucose. 3.According to body weight: 0.5–0.8μ/kg for high blood glucose and severe disease; 0.4–0.5μ/kg for mild disease; no more than 1.0μ/kg for severe disease and stress. 4.Estimated by 4 times urine sugar: Without diabetic nephropathy and with a normal renal sugar threshold, estimate the amount of qualitative “+” urine sugar before each meal. Generally a “+” requires 4μ insulin. 5. Comprehensive estimation: There are many factors affecting insulin action in the body, and individual differences are large, so the above calculation may not be in line with reality. (B) How to allocate insulin to the above estimated situation, the daily injection 15-30 minutes before three meals, the dosage before breakfast > before dinner > before lunch to allocate. Since the body secretes more hormones that antagonize insulin before breakfast, the amount of insulin should be larger; while the peak time of short-acting insulin is generally 2–4 hours, so the amount before lunch is the smallest; most patients do not use insulin before bedtime, and use it again the next morning, so the amount before dinner is larger than before lunch. If you still use it once before bedtime, the dosage should be reduced before dinner and even less before bedtime to prevent hypoglycemia at night. (C) How to adjust insulin dosage After the initial estimated dosage is observed for 2 – 3 days, the dosage will be further adjusted according to the condition, blood sugar and urine sugar. 1. Qualitative adjustment according to 4 times of urine glucose: Only for patients who have no condition to measure blood glucose and have normal renal glucose threshold. Adjustment is made according to the 4 times urine sugar qualitative in the first 3-4 days: insulin dosage before breakfast is based on urine sugar before lunch, insulin dosage before lunch is based on urine sugar before dinner, insulin dosage before dinner is based on urine before bedtime or the next morning (including the morning urine of the same day). 2. Adjustment according to blood glucose: diabetic patients, especially type I diabetes and patients with abnormal renal sugar threshold, should adjust insulin dosage according to the blood glucose value before three meals and before bedtime.