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*For medical professionals to read and reference, it is recommended for doctors and patients to collect! Some diabetic patients receiving insulin therapy are inconvenient to go to the hospital for follow-up visits due to various reasons, so they try to adjust the insulin dose by themselves
.
However, if the patient can master the adjustment method of insulin dose through learning, and has the conditions for self-monitoring of blood sugar, it will not only greatly improve the level of self-blood sugar management to a certain extent, but also bring great convenience to their life
.
A classification and use of insulin Insulin secretion under physiological conditions includes continuous "basal insulin secretion" and meal-induced "prandial insulin secretion"
.
Under normal conditions, basal insulin is secreted about 1 unit per hour, with a daily total of about 24 units; mealtime insulin is secreted after eating, with a daily total of about 24 units
.
In other words: a normal person secretes about 48 units of insulin per day, of which basal insulin and prandial insulin each account for 50%
.
The main role of basal insulin is to control fasting and preprandial blood glucose levels, and the primary role of prandial insulin is to control postprandial blood sugar
.
Insulin can be divided into fast-acting, short-acting, intermediate-acting, long-acting insulin analogs, premixed insulin, premixed insulin analogs and other specifications according to the speed of onset of action and the duration of action
.
"Rapid-acting insulin" and "short-acting insulin" belong to mealtime insulins, which are usually injected before meals and are mainly used to control postprandial blood sugar; "intermediate-acting insulin" and "long-acting insulin analogs" belong to basal insulins, which are usually injected in Inject at night before going to bed, mainly used to control basal blood sugar (mainly refers to fasting and pre-prandial blood sugar); "premixed insulin" and "premixed insulin analog" belong to long-acting and short-acting mixed insulin, usually injected before morning and dinner, It can also take into account the control of fasting and postprandial blood sugar
.
Two commonly used insulin treatment programs Insulin treatment programs are mainly divided into two categories: "complementary therapy" and "replacement therapy"
.
1 Complementary therapy, also known as "combination therapy", is the combination of oral hypoglycemic drugs and insulin, mainly for those patients with type 2 diabetes who are difficult to achieve blood sugar control with oral hypoglycemic drugs alone
.
Scheme 1.
Oral hypoglycemic drugs during the day + injection of medium and long-acting insulin before bedtime
.
By supplementing the patient's basal insulin deficiency, the patient's fasting blood sugar can be effectively controlled, and as the fasting blood sugar decreases, the postprandial blood sugar will also be improved accordingly, so as to achieve the purpose of controlling blood sugar throughout the day
.
The specific method is: inject basal insulin before going to bed, the initial amount is 0.
2U/kg•d, and the patient's fasting blood glucose value can also be used as the initial amount of insulin
.
Adjust every 3 to 5 days according to the fasting blood sugar level
.
For the sake of safety, the adjustment range of each dose should not be too large.
When the fasting blood sugar is more than 10.
0mmol/L, it can be increased by 3 to 4 units each time.
When the fasting blood sugar is less than 10.
0mmol/L, it can be increased by 1 to 2 units each time.
unit
.
Clinical example: Wang XX, a 48-year-old male, weighs 70 kg and is 175 cm tall.
He has been suffering from type 2 diabetes for 8 years and has been taking oral hypoglycemic drugs
.
Metformin 0.
5 mg three times a day, repaglinide 2 mg three times a day, and pioglitazone 15 mg once a day
.
The recent blood glucose profile showed that the fasting blood glucose was 11-13 mmol/L, the 2-hour postprandial blood glucose was 15-17 mmol/L, and the glycated hemoglobin was 9.
6%
.
On the basis of maintaining the original oral hypoglycemic drugs, the patient was injected with 12 units of long-acting insulin before going to bed (9 to 10 o'clock) every night.
Three days later, the fasting blood glucose was measured at 8.
6 mmol/L, and the blood glucose 2 hours after three meals was 12 ~14mmol/L
.
Although blood sugar has dropped, it is still not ideal
.
Considering that the patient's fasting blood glucose has dropped below 10.
0mmol/L, for the sake of safety, the adjustment range of insulin should not be too large, and increase by 2 units before going to bed, that is, inject 14 units of long-acting insulin every night
.
Three days later, the fasting blood glucose was measured at 7.
4 mmol/L, and the blood glucose 2 hours after three meals was 9.
8-11.
2 mmol/L.
The blood glucose was still not fully up to the standard.
Then, increase the long-acting insulin by 1 unit before going to bed to reach 15 units, and measure after three days.
The fasting blood sugar was 6.
4 mmol/L, and the blood sugar 2 hours after three meals was 7.
8-9.
0 mmol/L.
After the above adjustments, the patient's blood sugar was basically controlled to the standard
.
Option 2.
Inject premixed insulin (or premixed insulin analogs) in the morning and before dinner
.
This program can supplement both mealtime insulin and basal insulin, and is mainly used for type 2 diabetes patients who are poorly treated by a variety of oral hypoglycemic drugs
.
In principle, insulin secretagogues must be discontinued when using this regimen
.
The specific method is: inject pre-mixed insulin before breakfast and dinner each day.
The initial dose is generally 0.
2-0.
4U/kg·d, and it is usually allocated to morning and dinner at a ratio of 2:1 (Note: if the injected insulin is It is a premixed insulin analog and can also be distributed in a 1:1 ratio before breakfast and dinner)
.
Adjust the insulin dosage before breakfast according to the blood sugar after breakfast and blood sugar before dinner, adjust the insulin dosage before dinner according to the blood sugar after dinner and fasting blood sugar, and adjust it every 3 to 5 days.
until the blood sugar level is reached
.
Clinical example: Li XX, female, 49 years old, weight 62 kg, height 165 cm, history of type 2 diabetes for 5 years
.
Oral metformin 0.
5mg, three times a day, glimepiride 4mg, once a day, α-glucosidase inhibitor 50mg, three times a day, the recent poor blood sugar control
.
Fasting blood sugar is 10-12 mmol/L, and 2 hours postprandial blood sugar is 14-16 mmol/L
.
Readjust the treatment plan: stop glimepiride (belonging to insulin secretagogue), keep metformin 0.
5, 3 times a day, change α-glucosidase inhibitor to 1 tablet (50 mg) at noon every day, take two tablets in the morning and evening sub-premixed insulin regimen
.
The initial dose of insulin was calculated at 0.
4 U/kg•d, 16 units were injected half an hour before breakfast, and 8 units were injected half an hour before dinner
.
3 days later, the fasting blood glucose was 9.
6 mmol/L, and the blood glucose 2 hours after breakfast was 12.
3 mmol/L
.
According to the patient's blood sugar, the insulin dose before breakfast and dinner was increased by 2 units (ie 18U in the morning and 10U in the evening)
.
3 days later, the fasting blood glucose was 8.
2 mmol/L, and the blood glucose 2 hours after breakfast was 11.
2 mmol/L, and the blood glucose was still high
.
Adjust the insulin dose again, add 2 units before dinner, that is, 10 units, add 1 unit before breakfast, or 19 units, measure the fasting blood sugar 6.
6mmol/L the day after three, and 8.
2mmol/L 2 hours after breakfast, and the blood sugar control is up to standard
.
Patients who inject premixed insulin twice a day in the morning and evening often experience hyperglycemia after lunch.
In response to this situation, 1-2 tablets (50-100 mg) of α-glucosidase inhibitors can be added at lunch.
It can effectively control high blood sugar after lunch
.
2Replacement therapy usually refers to the "three short and one long" insulin intensive treatment plan, that is, inject short-acting (or fast-acting) insulin before three meals, and inject medium and long-acting insulin before going to bed.
This plan can supplement basal and mealtime insulin.
It simulates physiological insulin secretion well, and has the advantages of safety and effectiveness, convenient adjustment, small fluctuation of blood sugar, and high blood sugar compliance rate.
It is especially suitable for patients with type 1 diabetes and advanced type 2 diabetes with pancreatic islet failure
.
The specific method is: inject short-acting (or fast-acting) insulin before three meals, inject medium and long-acting basal insulin before going to bed, adjust the amount of basal insulin before going to bed according to the fasting blood sugar level, and adjust the short-acting insulin before three meals according to the blood sugar level after three meals.
The dosage is adjusted every 3 to 5 days, and the adjustment range is 1 to 4 units each time according to the blood sugar level, until the blood sugar control reaches the standard
.
3.
Precautions for adjusting insulin dose 1.
Insulin adjustment should mainly be based on the results of blood glucose monitoring and with reference to the target value of blood sugar control for each patient, and clinical symptoms are only for reference; 2.
First adjust non-drugs that affect blood sugar such as diet, exercise, mood, sleep If the effect is not good, adjust the insulin dosage; 3.
It will take some time to reach a new steady state after adjusting the dosage.
Therefore, the insulin adjustment should not be too frequent, and it can be adjusted once every 3 to 4 days; 4.
For safety, every 5.
Beware of hypoglycemia; when pre-meal blood sugar is less than 3.
9mmol/L, you should eat immediately, delay insulin injection time appropriately, and reduce the injection dose 2 units; when the blood sugar before going to bed is lower than 6.
0mmol/L, an appropriate meal should be added before going to bed to prevent hypoglycemia at night; injection of premixed insulin is prone to hypoglycemia before the next meal.
A small amount of food is added between meals; for patients receiving intensive insulin therapy, with the decline of blood sugar and the release of "glucotoxicity", the patient's own pancreatic islet function will be significantly improved.
At this time, the dosage of insulin should be reduced in time, otherwise hypoglycemia is likely to occur; 6.
Insulin dosage should be adjusted flexibly with changes in food intake and exercise volume
.
For example, if you occasionally want to eat a little more, you can temporarily add 2 units of insulin before meals; to temporarily increase the amount of exercise after meals (such as playing ball), you need to increase the amount of meals or reduce the amount of insulin before meals by 2 units
.
To sum up, the dose adjustment of insulin is a very complex and professional issue, involving a series of issues such as the type of insulin selected, dosage form, treatment plan, and blood sugar control goals.
Adjust the insulin dose under the guidance
of
However, if it is really inconvenient for patients to go to the hospital frequently, it is not absolutely impossible to adjust insulin by themselves.
The premise is to master the relevant knowledge of insulin adjustment, and at the same time, pay attention to strengthening blood sugar monitoring
.
If the effect of self-adjustment is not good, and the blood sugar remains high or fluctuates, please go to the hospital for help in time
.
.
However, if the patient can master the adjustment method of insulin dose through learning, and has the conditions for self-monitoring of blood sugar, it will not only greatly improve the level of self-blood sugar management to a certain extent, but also bring great convenience to their life
.
A classification and use of insulin Insulin secretion under physiological conditions includes continuous "basal insulin secretion" and meal-induced "prandial insulin secretion"
.
Under normal conditions, basal insulin is secreted about 1 unit per hour, with a daily total of about 24 units; mealtime insulin is secreted after eating, with a daily total of about 24 units
.
In other words: a normal person secretes about 48 units of insulin per day, of which basal insulin and prandial insulin each account for 50%
.
The main role of basal insulin is to control fasting and preprandial blood glucose levels, and the primary role of prandial insulin is to control postprandial blood sugar
.
Insulin can be divided into fast-acting, short-acting, intermediate-acting, long-acting insulin analogs, premixed insulin, premixed insulin analogs and other specifications according to the speed of onset of action and the duration of action
.
"Rapid-acting insulin" and "short-acting insulin" belong to mealtime insulins, which are usually injected before meals and are mainly used to control postprandial blood sugar; "intermediate-acting insulin" and "long-acting insulin analogs" belong to basal insulins, which are usually injected in Inject at night before going to bed, mainly used to control basal blood sugar (mainly refers to fasting and pre-prandial blood sugar); "premixed insulin" and "premixed insulin analog" belong to long-acting and short-acting mixed insulin, usually injected before morning and dinner, It can also take into account the control of fasting and postprandial blood sugar
.
Two commonly used insulin treatment programs Insulin treatment programs are mainly divided into two categories: "complementary therapy" and "replacement therapy"
.
1 Complementary therapy, also known as "combination therapy", is the combination of oral hypoglycemic drugs and insulin, mainly for those patients with type 2 diabetes who are difficult to achieve blood sugar control with oral hypoglycemic drugs alone
.
Scheme 1.
Oral hypoglycemic drugs during the day + injection of medium and long-acting insulin before bedtime
.
By supplementing the patient's basal insulin deficiency, the patient's fasting blood sugar can be effectively controlled, and as the fasting blood sugar decreases, the postprandial blood sugar will also be improved accordingly, so as to achieve the purpose of controlling blood sugar throughout the day
.
The specific method is: inject basal insulin before going to bed, the initial amount is 0.
2U/kg•d, and the patient's fasting blood glucose value can also be used as the initial amount of insulin
.
Adjust every 3 to 5 days according to the fasting blood sugar level
.
For the sake of safety, the adjustment range of each dose should not be too large.
When the fasting blood sugar is more than 10.
0mmol/L, it can be increased by 3 to 4 units each time.
When the fasting blood sugar is less than 10.
0mmol/L, it can be increased by 1 to 2 units each time.
unit
.
Clinical example: Wang XX, a 48-year-old male, weighs 70 kg and is 175 cm tall.
He has been suffering from type 2 diabetes for 8 years and has been taking oral hypoglycemic drugs
.
Metformin 0.
5 mg three times a day, repaglinide 2 mg three times a day, and pioglitazone 15 mg once a day
.
The recent blood glucose profile showed that the fasting blood glucose was 11-13 mmol/L, the 2-hour postprandial blood glucose was 15-17 mmol/L, and the glycated hemoglobin was 9.
6%
.
On the basis of maintaining the original oral hypoglycemic drugs, the patient was injected with 12 units of long-acting insulin before going to bed (9 to 10 o'clock) every night.
Three days later, the fasting blood glucose was measured at 8.
6 mmol/L, and the blood glucose 2 hours after three meals was 12 ~14mmol/L
.
Although blood sugar has dropped, it is still not ideal
.
Considering that the patient's fasting blood glucose has dropped below 10.
0mmol/L, for the sake of safety, the adjustment range of insulin should not be too large, and increase by 2 units before going to bed, that is, inject 14 units of long-acting insulin every night
.
Three days later, the fasting blood glucose was measured at 7.
4 mmol/L, and the blood glucose 2 hours after three meals was 9.
8-11.
2 mmol/L.
The blood glucose was still not fully up to the standard.
Then, increase the long-acting insulin by 1 unit before going to bed to reach 15 units, and measure after three days.
The fasting blood sugar was 6.
4 mmol/L, and the blood sugar 2 hours after three meals was 7.
8-9.
0 mmol/L.
After the above adjustments, the patient's blood sugar was basically controlled to the standard
.
Option 2.
Inject premixed insulin (or premixed insulin analogs) in the morning and before dinner
.
This program can supplement both mealtime insulin and basal insulin, and is mainly used for type 2 diabetes patients who are poorly treated by a variety of oral hypoglycemic drugs
.
In principle, insulin secretagogues must be discontinued when using this regimen
.
The specific method is: inject pre-mixed insulin before breakfast and dinner each day.
The initial dose is generally 0.
2-0.
4U/kg·d, and it is usually allocated to morning and dinner at a ratio of 2:1 (Note: if the injected insulin is It is a premixed insulin analog and can also be distributed in a 1:1 ratio before breakfast and dinner)
.
Adjust the insulin dosage before breakfast according to the blood sugar after breakfast and blood sugar before dinner, adjust the insulin dosage before dinner according to the blood sugar after dinner and fasting blood sugar, and adjust it every 3 to 5 days.
until the blood sugar level is reached
.
Clinical example: Li XX, female, 49 years old, weight 62 kg, height 165 cm, history of type 2 diabetes for 5 years
.
Oral metformin 0.
5mg, three times a day, glimepiride 4mg, once a day, α-glucosidase inhibitor 50mg, three times a day, the recent poor blood sugar control
.
Fasting blood sugar is 10-12 mmol/L, and 2 hours postprandial blood sugar is 14-16 mmol/L
.
Readjust the treatment plan: stop glimepiride (belonging to insulin secretagogue), keep metformin 0.
5, 3 times a day, change α-glucosidase inhibitor to 1 tablet (50 mg) at noon every day, take two tablets in the morning and evening sub-premixed insulin regimen
.
The initial dose of insulin was calculated at 0.
4 U/kg•d, 16 units were injected half an hour before breakfast, and 8 units were injected half an hour before dinner
.
3 days later, the fasting blood glucose was 9.
6 mmol/L, and the blood glucose 2 hours after breakfast was 12.
3 mmol/L
.
According to the patient's blood sugar, the insulin dose before breakfast and dinner was increased by 2 units (ie 18U in the morning and 10U in the evening)
.
3 days later, the fasting blood glucose was 8.
2 mmol/L, and the blood glucose 2 hours after breakfast was 11.
2 mmol/L, and the blood glucose was still high
.
Adjust the insulin dose again, add 2 units before dinner, that is, 10 units, add 1 unit before breakfast, or 19 units, measure the fasting blood sugar 6.
6mmol/L the day after three, and 8.
2mmol/L 2 hours after breakfast, and the blood sugar control is up to standard
.
Patients who inject premixed insulin twice a day in the morning and evening often experience hyperglycemia after lunch.
In response to this situation, 1-2 tablets (50-100 mg) of α-glucosidase inhibitors can be added at lunch.
It can effectively control high blood sugar after lunch
.
2Replacement therapy usually refers to the "three short and one long" insulin intensive treatment plan, that is, inject short-acting (or fast-acting) insulin before three meals, and inject medium and long-acting insulin before going to bed.
This plan can supplement basal and mealtime insulin.
It simulates physiological insulin secretion well, and has the advantages of safety and effectiveness, convenient adjustment, small fluctuation of blood sugar, and high blood sugar compliance rate.
It is especially suitable for patients with type 1 diabetes and advanced type 2 diabetes with pancreatic islet failure
.
The specific method is: inject short-acting (or fast-acting) insulin before three meals, inject medium and long-acting basal insulin before going to bed, adjust the amount of basal insulin before going to bed according to the fasting blood sugar level, and adjust the short-acting insulin before three meals according to the blood sugar level after three meals.
The dosage is adjusted every 3 to 5 days, and the adjustment range is 1 to 4 units each time according to the blood sugar level, until the blood sugar control reaches the standard
.
3.
Precautions for adjusting insulin dose 1.
Insulin adjustment should mainly be based on the results of blood glucose monitoring and with reference to the target value of blood sugar control for each patient, and clinical symptoms are only for reference; 2.
First adjust non-drugs that affect blood sugar such as diet, exercise, mood, sleep If the effect is not good, adjust the insulin dosage; 3.
It will take some time to reach a new steady state after adjusting the dosage.
Therefore, the insulin adjustment should not be too frequent, and it can be adjusted once every 3 to 4 days; 4.
For safety, every 5.
Beware of hypoglycemia; when pre-meal blood sugar is less than 3.
9mmol/L, you should eat immediately, delay insulin injection time appropriately, and reduce the injection dose 2 units; when the blood sugar before going to bed is lower than 6.
0mmol/L, an appropriate meal should be added before going to bed to prevent hypoglycemia at night; injection of premixed insulin is prone to hypoglycemia before the next meal.
A small amount of food is added between meals; for patients receiving intensive insulin therapy, with the decline of blood sugar and the release of "glucotoxicity", the patient's own pancreatic islet function will be significantly improved.
At this time, the dosage of insulin should be reduced in time, otherwise hypoglycemia is likely to occur; 6.
Insulin dosage should be adjusted flexibly with changes in food intake and exercise volume
.
For example, if you occasionally want to eat a little more, you can temporarily add 2 units of insulin before meals; to temporarily increase the amount of exercise after meals (such as playing ball), you need to increase the amount of meals or reduce the amount of insulin before meals by 2 units
.
To sum up, the dose adjustment of insulin is a very complex and professional issue, involving a series of issues such as the type of insulin selected, dosage form, treatment plan, and blood sugar control goals.
Adjust the insulin dose under the guidance
of
However, if it is really inconvenient for patients to go to the hospital frequently, it is not absolutely impossible to adjust insulin by themselves.
The premise is to master the relevant knowledge of insulin adjustment, and at the same time, pay attention to strengthening blood sugar monitoring
.
If the effect of self-adjustment is not good, and the blood sugar remains high or fluctuates, please go to the hospital for help in time
.
