echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Endocrine System > Optimal insulin treatment plan to help Chinese diabetic patients effectively control their sugar!

    Optimal insulin treatment plan to help Chinese diabetic patients effectively control their sugar!

    • Last Update: 2022-04-28
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com
    *Only for medical professionals to read and reference, combine with clinical, formulate a personalized hypoglycemic plan! Case introduction ▌Patient characteristics: Male, 56 years old, was admitted to the hospital due to "discovery of elevated blood sugar for half a year"
    .

     ▌History of current illness: The patient found that his blood sugar was elevated half a year ago, and the fasting blood glucose (FPG) was 10.
    24mmol/L.
    He had no other special discomfort, and he did not pay attention to and treated it.
    Included in our department with "type 2 diabetes"
    .

     ▌Past history: denying the history of hypertension and family history
    .

    Swipe left to see more ▌Diagnosis: 1.
    Type 2 diabetes diabetic ketosis 2.
    Formulation of blood glucose treatment plan for mixed hyperlipidemia 1) Improve individualized treatment ideas Combined with the specific situation of the patient, firstly administer insulin intravenous infusion to eliminate ketones, wait for ketones After the body turned negative, an insulin pump was given to intensify hypoglycemic for 1 week, and a conversion plan was subsequently formulated
    .

     2) Formulate individualized blood glucose management goals combined with patient laboratory examinations, consider the treatment goal of FPG 4.
    4-7.
    0 mmol/L, non-fasting blood glucose < 10.
    0 mmol/L, and adjust lipids at the same time
    .

     3) Hypoglycemic treatment ■Phase 1: Intravenous insulin infusion to eliminate ketones combined with the relevant examination results when the patient was admitted to the hospital, low-dose insulin intravenous infusion to lower blood sugar, and fluid replacement to promote the excretion of ketone bodies, until the ketone bodies turned negative
    .

     ■Phase 2: Intensive hypoglycemic with insulin pump Table 1 Adjustment of blood sugar level and insulin dosage (12-segment method) Continuous blood glucose monitoring (9.
    23-9.
    25) ■Phase 3: Adjustment period of pump withdrawal, metformin 1.
    0g twice a day before discharge times (BID), dapagliflozin 10mg once a day (QD), subcutaneous injection of dexamethasone aspart 14U before lunch, fenofibrate 0.
    1g BID (dose adjustment period)
    .

     The specific program and blood glucose monitoring results are as follows: Phase 4: Out-of-hospital maintenance treatment with subcutaneous injection of Degu aspart double insulin, 16U before lunch, metformin 1.
    0g BID, dapagliflozin 10mg QD, fenofibrate 0.
    1 BID, and the Diabetes dietary guidance, the results are as follows: The patient's compliance is good, blood sugar is stable, and the treatment plan is maintained
    .

     Treatment analysis summary and management experience: The prevalence of diabetes in China is high, and the time for diagnosis and initiation of treatment is late; for patients with newly diagnosed type 2 diabetes, early and short-term intensive insulin therapy can quickly relieve glucotoxicity and improve islet β-cell function.
    ;Due to the dietary structure and ethnic characteristics, Chinese patients with type 2 diabetes are characterized by postprandial hyperglycemia, and the treatment strategy should take into account FPG and PPG; degludec aspart is a new generation of basal insulin combined with mealtime insulin.
    The preparation is a non-co-crystallized, non-mixed basal and prandial dual insulin compound preparation.
    Both insulin analogs maintain their respective chemical stability and can be used without mixing.
    Acupuncture supplements basal and mealtime insulin requirements at the same time to provide a more optimized strategy for blood sugar management in Chinese patients with type 2 diabetes
    .

    Doctor sharing Q1 In this case, what are the considerations for the choice of treatment options after pump withdrawal? ▌ Dr.
    Mei Zhengqin: First of all, let’s look at the characteristics of the patient’s medical records.
    The patient is a male, 56 years old, with a short course of disease.
    He belongs to an untreated newly diagnosed type 2 diabetes mellitus patient.
    Ketosis
    .

    From blood glucose monitoring, postprandial hyperglycemia is an obvious feature, especially after lunch and dinner, and the peak of C-peptide disappears 2 hours after sugar load
    .

     According to the 2017 edition of the "Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes" [1], for newly diagnosed type 2 diabetes patients with HbA1c≥9.
    0% or FPG≥11.
    1mmol/L with obvious symptoms of hyperglycemia, short-term intensive insulin therapy can be implemented, and the treatment time It is suitable for 2 weeks to 3 months.
    After the insulin pump is used to intensify hypoglycemia in the hospital, it is necessary to formulate a conversion and intensive hypoglycemic program
    .

     Based on the blood sugar characteristics of this case, a single injection of double insulin aspart before lunch is a very suitable treatment option
    .

    At the same time, based on the characteristics of sodium-glucose co-transporter-2 inhibitor (SGLT-2i), which can not only lower blood sugar, but also take into account the effects of cardio-renal protection and weight control [2], we chose to use dapagliflozin in combination for the patient
    .

    In addition, the patient's blood lipids were significantly elevated, requiring lipid-lowering therapy
    .

     After the hyperglycemia toxicity of the patient is relieved, although the blood glucose rises mainly after lunch and dinner, whether it is from peripheral blood glucose monitoring or continuous blood glucose monitoring, we can see that the patient's blood glucose shows a gradual downward trend, and it has already begun to decrease.
    Conditions of low blood sugar
    .

    In order to avoid the occurrence of hypoglycemia, in the case of adding two suitable oral antidiabetic drugs (OAD), we started the treatment with double insulin degludec aspart QD, and continued to monitor the blood sugar to observe the changes
    .

    In the observation, it was found that 1 injection plus two oral drugs can achieve satisfactory results, so continue to use this program
    .

    The final total dose of the patient using the pump was 32U, of which the basal rate was 16U.
    Insulin degludec contains 30% insulin aspart to provide the prandial dose and 70% insulin degludec to provide the basal part
    .

    The Onishi study [3] showed that in the case of a 30% dose reduction, insulin degludec in degludec aspart was able to achieve the same effect as insulin glargine in the control group, while still taking into account that the patient had already taken the addition of two In order to find a suitable OAD, considering the efficacy and efficacy of insulin degludec to avoid hypoglycemia, we decided to reduce the dose of degludec aspart.
    From the follow-up blood sugar monitoring, the desired treatment goal can also be achieved
    .

    Q2 How to adjust the dose when switching from an insulin pump to a dual insulin regimen of Degu-Aspart? Could you please share the dosage adjustment method of Degu aspart double insulin in the ward? ▌ Dr.
    Mei Zhengqin: According to the Onishi study [3], when the dose is reduced by 30%, insulin degludec in double insulin degludec can achieve the same glucose control effect as insulin glargine.
    When switching to the Degu-Aspart dual insulin regimen, the prandial dose and basal dose of the original pump, as well as the patient's fasting and PPG, should be comprehensively considered.
    Generally, the large dose of the pump during the main meal plus the basal rate of the whole day should be considered.
    The total dose, according to the ratio, is converted to the starting dose of one injection
    .

    If it is a two-injection program, the total dose originally used by the pump is divided into pre-breakfast and pre-dinner injections in a ratio of 1:1
    .

     Since the steady-state serum concentration of basal components can be reached after 2-3 days of double insulin aspart administration, the blood glucose and average value of the following 3 days should be monitored, and the dose should be adjusted according to the blood glucose level
    .

     Specifically, for patients with stable blood sugar control and no significant fluctuations, it can be adjusted once a week; for patients with poor blood sugar control, hypoglycemia or hyperglycemia in urgent need of treatment, it can be adjusted twice a week or more
    .

    For those with higher blood sugar fragility, it can be adjusted more than twice a week or daily
    .

    For the dose, it is necessary to use the "2-0-2" simple dose adjustment method according to the fasting and pre-meal blood glucose: if the target value is exceeded, gradually increase by 2U; if the individualized target is reached, the dose will remain unchanged; if it is lower than the target value, the dose will remain unchanged.
    Then it gradually decreases by 2U [4]
    .

    After the blood glucose before breakfast and before dinner reached the target, the dose was fine-tuned by monitoring PPG
    .

    Department Director Comments Q1 What is your opinion on the handling of this case? ▌Director Su Yingsi: The patient in this case is a newly diagnosed type 2 diabetes patient.
    For such patients, after intensive insulin therapy, we recommend continuing insulin therapy for 1-3 months, which is beneficial for the recovery of pancreatic β-cell function
    .

    Then, according to the patient's blood sugar control after 3 months, the need to continue to use insulin is reassessed, and the patient is given a simple and suitable hypoglycemic plan
    .

    In this case, the patient's blood sugar was well controlled after insulin therapy, which is also beneficial in preventing future complications
    .

    Q2 Please share with you, how should the dose of the QD or BID scheme be set when switching from an insulin pump to dual insulin Degu-aspart? ▌Director Su Yingsi: During hospitalization, we will start insulin therapy with 0.
    3-0.
    5U/kg/d for patients.
    When switching from insulin pump to double insulin degludec, if it is a BID program, then the total dose of insulin pump for one day It is equivalent to the total amount of 2 injections of Degu aspart double insulin, which is usually allocated to the injection before breakfast and dinner according to 1:1
    .

    If it is a QD regimen, 50% of the total dose of the insulin pump can be used as the starting dose, and it can be used with the main meal of the day, and the other two meals can be treated with oral hypoglycemic drugs
    .

    Q3 Please share with you the application of Degu aspart double insulin in newly diagnosed patients with type 2 diabetes
    .

        ▌Director Su Yingsi: Many studies have shown that the function of pancreatic β-cells in the Chinese population is worse than that in the Western population, and the increase in PPG is more obvious
    .

    In addition, from the perspective of dietary habits, the diet of Asians is dominated by carbohydrates, which is also a major reason for the increase in PPG
    .

    Therefore, we need solutions that can both control FPG and reduce PPG
    .

    Degulfaspart double insulin is a real double insulin, including fast-acting insulin that can effectively reduce PPG, and long-acting insulin that has an action time of more than 24 hours, and can also control FPG well
    .

    In addition, when formulating a treatment plan for newly diagnosed type 2 diabetes patients, factors such as the number of injections and the risk of hypoglycemia need to be considered, so that patients have higher compliance and satisfaction
    .

    Degulo aspart double insulin meets these clinical needs and is ideal for newly diagnosed patients
    .

      References: [1] Jia Weiping, et al.
    Chinese Journal of Diabetes.
    2018;10(1):2-67.
    [2] Diabetes Branch of Chinese Medical Association.
    Chinese Journal of Diabetes.
    2021;13(4):315-409.
    [3]Onishi Y, et al.
    Diabetes Obes Metab.
    2013;15:826–832.
    [4]Mehta R, et al.
    Diabetes Obes Metab.
    2020;22(11):1961-1975.
    -End-“This This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position.
    " For contributions/reprints/business cooperation, please contact: pengsanmei@yxj.
    org.
    cn  
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.