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    Home > Active Ingredient News > Endocrine System > "Talking about sugar control internally and externally"-How to choose the initial insulin treatment plan for newly diagnosed type 2 diabetes patients?

    "Talking about sugar control internally and externally"-How to choose the initial insulin treatment plan for newly diagnosed type 2 diabetes patients?

    • Last Update: 2021-04-23
    • Source: Internet
    • Author: User
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    This article shares a case of a newly diagnosed type 2 diabetes patient who initiated insulin therapy, and invited Shan Chunyan, director of the Department of Nephrology, Zhu Xianyi Memorial Hospital (Metabolic Disease Hospital) of Tianjin Medical University, to comment on the case.

    Professor Shan Chunyan from Zhu Xianyi Memorial Hospital of Tianjin Medical University Case: A middle-aged male with new-onset diabetes was admitted to the hospital for treatment, and intensive insulin pump (CSII) treatment was used to help relieve high glucose toxicity, effectively control blood sugar, improve β-cell function, and follow up after discharge Treatment takes into account both efficacy and safety.

    Case narrator, Zheng Miaoyan, Department of Nephrology, Zhu Xianyi Memorial Hospital, Tianjin Medical University.
    The patient's data slides upward to view the male, 53-year-old chief complaint: polydipsia, polyuria, polyphagia, weight loss for 2 months, blood sugar increased for 1 week, urine ketone body positive for 1 day Medical history: 2 months before admission, the patient had no obvious causes of polydipsia, polyuria, polyphagia, weight loss (approximately 15kg in 2 months), no palpitations, fear of heat, hyperhidrosis, no irritability, irritability, anxiety, no I like cold drinks, but I didn't pay much attention to it.

    Self-tested fasting blood glucose 16mmol/L and postprandial blood glucose 32mmol/L one week ago.
    I went to our clinic one day ago and found urine ketone body 2+, fasting blood glucose 15.
    3mmol/L, no obvious discomfort such as nausea and vomiting, and the patient ignored blurred vision.
    , Occasionally left fingertip numbness, no lower limb edema; both lower limb weakness, no intermittent claudication, no obvious chest tightness, suffocation and precordial pain; both lower limbs anterior tibia skin gradually darkened, since the onset of the onset, diet, lack of sleep good.

    Past history: previous physical fitness; denied history of hypertension, coronary heart disease, denied history of cerebrovascular disease, history of mental illness, denied history of hepatitis, history of tuberculosis, history of malaria, history of calf trauma 20 years ago.

    Denial of history of surgery, blood transfusion, history of food and drug allergy, history of vaccination is unknown.
    Family history: family history of diabetes (aunt, cousin); denial of other family history of genetic diseases.
    Swipe up to read physical examination TPRBP 36.
    4℃ 72 times /Min 18 times/min 134/78 mmHgHWBMI Waist circumference (WC) 185cm103 kg30.
    1Kg/m2109 cm Laboratory examination HbA1c: 13.
    10% fasting blood glucose (FPG): 12.
    13mmol/L fasting insulin 4.
    85mIU/L fasting C peptide: 1.
    97ug /L Urine routine: glucose 4+, ketone body 2+ other laboratory tests and auxiliary examinations.
    Blood lipids: triglycerides (TG) 1.
    32mmol/L; total cholesterol (TC) 4.
    64mmol/L; high-density lipoprotein cholesterol (HDL) ) 0.
    91mmol/L↓; Low-density lipoprotein cholesterol (LDL) 3.
    4mmol/L↑Urine albumin/creatinine: 5.
    59 (mg/g) 24h urine albumin quantitative: 9.
    44mg/24h; 24h urine protein quantitative: 0.
    06g /24h ophthalmoscope: roughly normal abdominal B-ultrasound: fatty liver, multiple liver cysts, intrahepatic calcified plaques.
    Arterial ultrasound: enlarged left atrium, aortic valve calcification, decreased left ventricular diastolic function, pulmonary valve regurgitation, lower extremity vascular color Doppler ultrasound: double Lower extremity arteriosclerosis with multiple mural plaque formation Diabetic macrovascular/microvascular complications Screening for macrovascular complications: with microvascular complications: no clinical diagnosis Slide up to view the main diagnosis of type 2 diabetes with diabetic ketosis diabetic peripheral vascular disease Patients with obesity and hyperlipidemia are characterized by type 2 diabetes; patients with middle-aged onset, obesity, slow onset, typical "three more and one less" symptoms, high blood sugar in patients with family history of diabetes, urinary ketone positive obesity (BMI: 30.
    1kg/ m2) Treatment goals: Correct diabetic ketosis, relieve the "high glucose toxicity" of diabetes, control blood sugar to reach the standard, and avoid hypoglycemia hospitalization plan.
    Swipe up to read the hypoglycemic treatment plan.
    Short-term CSII intensive treatment, and then give insulin glargine U300 and risna Peptides and metformin sustained-release tablets.
    Therapeutic drugs after stopping the pump: insulin glargine U300 (starting at 20U, adjust the dose according to blood sugar), risenatide (starting at 10μg, increasing to 20μg after adaptation), metformin sustained-release tablets plan basis The combination of basal insulin and risnatide can simultaneously improve FPG and PPG, improve blood sugar comprehensively, and take into account the benefits of lowering blood sugar [1]. In-hospital treatment, scroll up to read the discharge treatment plan and discharge follow-up to read other hypoglycemic drugs: risenatide 20ug subcutaneously injected qd; metformin 1.
    0 bid ■Clinical thinking 1.
    The choice of insulin treatment plan should be patient-centered, with full consideration.
    In terms of the situation, scientifically and rationally determine feasible insulin varieties and medication plans under the premise of minimizing the risk of hypoglycemia; 2.
    Basic insulin is the cornerstone of individualized diabetes treatment and should run through the entire course of treatment; 3.
    Basic insulin + Liss The therapeutic combination of that peptide has complementary mechanisms, which can improve fasting and postprandial blood glucose at the same time, and achieve comprehensive hypoglycemia; 4.
    Insulin glargine U300 can achieve stable glucose control, low risk of treating hypoglycemia, and flexible and convenient dosage adjustment, starting from insulin Initial treatment is more ideal.

    Experts comment on Professor Shan Chunyan from Zhu Xianyi Memorial Hospital of Tianjin Medical University.
    The case described in this issue is a newly diagnosed type 2 diabetes patient.
    After short-term insulin intensive hypoglycemic therapy during the hospitalization period, he switched to basal insulin combined with GLP-1RA and metformin combined with hypoglycemic treatment.
    In the follow-up treatment after discharge from the hospital, the insulin dose is adjusted to make the patient's fasting and postprandial blood sugar reach the standard as soon as possible.

    Basal insulin is the first choice for the initial insulin therapy recommended by domestic and foreign guidelines, and it should run through the individualized treatment of diabetes.

    The new generation of insulin glargine U300 better balances efficacy and safety, achieves stable glucose control without increasing the risk of hypoglycemia, and is flexible in dosage adjustment.

    The results of the BRIGHT study showed that insulin glargine U300 has the same efficacy as insulin degluargine, but the risk of hypoglycemia during the initial dose adjustment period of insulin glargine is significantly reduced [2].

    CGM studies have confirmed that compared with insulin deglu, insulin glargine U300 has lower blood glucose variability [3].

    In addition, insulin glargine U300 uses subcutaneous reservoir microprecipitation technology to achieve prolonged action time.
    It mainly exerts a slow-release effect under the skin, rather than prolonging the time in blood metabolism.
    It needs to be combined with albumin in the blood circulation.
    The second sustained-release insulin dete/glucoside is closer to the process of physiological insulin absorption into the blood, and more mimics the physiological insulin action mode, helping patients with type 2 diabetes to control glucose smoothly.
    It has unique advantages for patients with chronic kidney disease/renal failure.
    . On September 2, 2020, insulin glargine U300 was officially approved for marketing by the National Medical Products Administration (NMPA) of China, and has been included in the National Medical Insurance Catalogue.

    Therefore, for newly diagnosed diabetic patients, insulin glargine U300 is a more ideal choice for initial insulin therapy.

    References: [1]Giorgino F, et al.
    Diabetes Metab Res Rev, 2016, 32(6): 497-511[2]Rosenstock J, et al.
    Diabetes Care 2018, 41(10):2147-2154[3 ]Kawaguchi Y, et al.
    J Diabetes Investig.
    2019;10(2):343-51.
    MAT- CN-2105063
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