1. Type of insulin
Animal insulin (pig, cow) and genetically recombinant human insulin are classified by source. The human insulin preparation immune response is lighter, is not easy to produce the antibody.
According to the onset of time into different types of preparations.
1 short-acting insulin takes effect quickly, but the action time is short. Routine is short-acting insulin. Preparation transparency.
2 medium-acting insulin, the onset time, the peak value and the action time are shorter than the effective islets. The most common is the NPH.
3 premixed insulin: 50R: 50% NPH insulin and 50% regular insulin mixture; 30R: 70% NPH insulin and 30% regular insulin mixture
4 ultra short acting Insulin analog: synthetic Insulin analog, injectable, short acting. Thanks to insulin and Insulin Aspart.
5 long acting Insulin analog: synthetic Insulin analog, long acting, as a supplement to a basal dose of insulin. Such as insulin glargine and insulin Dieter.
6 ultra long acting Insulin analog: synthetic Insulin analog, such as tegu insulin, that last longer.
2. Start with insulin
Type 1 diabetes requires lifelong insulin replacement therapy.
When HbA1c is still above 7.0% in patients with type 2 diabetes after a large dose of multiple oral medications, insulin therapy may be considered.
Insulin should be used as a first-line treatment for emaciated diabetic patients who are newly diagnosed and have difficulty in differentiating from type 1 diabetes.
Insulin therapy should be used as early as possible when weight loss occurs without apparent cause in the course of diabetes.
Use of insulin under special circumstances:
Hyperglycemia, perioperative period, infection, pregnancy in newly diagnosed diabetic patients
3. Use of insulin:
Short-acting insulin can be used for intravenous drip treatment of severe diabetes such as ketoacidosis. Once diagnosed, type 1 diabetes requires lifelong subcutaneous insulin therapy. Type 2 diabetes can be treated with insulin replacement or replacement therapy. There are several steps.
1 for patients with oral hypoglycemic drug failure or partial failure, continue to take oral hypoglycemic drug, and subcutaneous injection of medium-acting or long-acting insulin before sleep, the initial dose is 0.1ー0.2 u/kg, monitor blood glucose, adjust the dose 3 days later, 2U-4U per adjustment.
2 daily injection of premixed insulin twice in the morning and evening. The initial insulin dose is typically 0.4-0.6 units/kg BW/day, distributed on a 1:1 basis before breakfast and before dinner. The utility model has the advantages of convenience, reducing the inconvenience of the pre-lunch injection, but the lunch blood sugar fluctuates greatly and is not easy to control.
3 on the basis of the above initial insulin treatment, after sufficient dose adjustment, if the patient’s blood sugar level is still not up to the standard or there is repeated hypoglycemia, the treatment plan needs to be further optimized. You can use meal time + basal insulin: adjust the amount of insulin before bed and before three meals, according to the blood sugar level before bed and three meals, respectively.
4 insulin pump treatment. The main target groups are: people with type 1 diabetes; women with diabetes who plan to conceive and are already pregnant; and people with type 2 diabetes who need intensive insulin treatment.
4. Side effects: mostly hypoglycemia.
Glucagon 1(Glp-1) analogue or agonist
These drugs work by activating GLP-1 receptors and have significant weight-loss effects. GLP-1 receptor agonists enhance insulin secretion in a glucose-dependent manner, inhibit Glucagon secretion, delay gastric emptying, and reduce food intake through central appetite suppression. Can be used alone or in combination with other oral hypoglycemic agents. Clinical trials, including in Chinese patients with type 2 diabetes, showed that Aïssey reduced HbA1c by 0.5 to 1.0 percent. The GLP-1 agonists currently on the market in China are Aïssey and Liraglutide, both of which require subcutaneous injection. The most common gastrointestinal side effects of GLP-1 receptor agonists are seen at the beginning of treatment and decrease with the duration of treatment.
Surgical treatment of diabetes mellitus
China’s 2010 guidelines for the prevention and treatment of type 2 diabetes recommend laparoscopic weight loss surgery III. There are two main surgical procedures: (1) adjustable gastric banding. (2) gastric bypass. The indications of operation were obesity with type 2 diabetes and the following conditions were met: (1) BMI ≥35kg/m2, with type 2 diabetes; (2) BMI 32-34.9 kg/m2, with type 2 diabetes, with HbA1c ≥7% more than 6 months after oral medication combined with insulin; (3) age between 18 and 60 years; (4) course of type 2 diabetes less than 5 years; (5) islet autoantibody test negative, C peptide level not less than 0.3 mg/l; (6) no other contraindications for abdominal surgery.
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