"Talking about sugar control internally and externally"-the optimal plan for insulin initiation therapy for type 2 diabetic patients, see here

This article shares a case of initiation of insulin therapy for a type 2 diabetic patient, and invited Shao Hailin, director of the Department of Endocrinology, Tianjin Fourth Central Hospital, to comment on the case.

Chief Physician Shao Hailin, Tianjin Fourth Central Hospital Case: middle-aged male, 10-year history of diabetes, combined with high blood pressure, through intensive inpatient insulin therapy and discharge follow-up treatment to help him relieve glycotoxicity, effectively control sugar while controlling arteriosclerosis Risk factors related to cardiovascular and cerebrovascular diseases.

Case narrator, Zhu Xianyi Memorial Hospital of Tianjin Medical University.
Patient Xu Jie, Department of Integrated Traditional Chinese and Western Medicine, scrolls upwards to view the data of the male, 49 years old.
Chief complaint: polydipsia, polydipsia, polyuria for 10 years, aggravated with weight loss.
February present medical history: Type 2 diabetes for 10 years Before admission, repaglinide and acarbose were used for oral hypoglycemic therapy, and blood sugar control can be achieved.

Two months before admission, the patient had symptoms of polydipsia, polydipsia, and polyuria aggravated with increased foam in the urine, weight loss was about 5 kg, no blurred vision in his eyes, and no numbness or coldness in his limbs.

The usual diet control is not strict and exercise is minimal.

Past history: A history of hypertension for more than 10 years, up to 170/100mmHg, taking enalapril, blood pressure controlled at about 140/90, denying history of coronary heart disease and cerebrovascular disease.

Denies the history of infectious diseases such as hepatitis and tuberculosis.

Denied history of surgery, history of trauma, and history of blood transfusion.

Personal history: Nature of work: light physical strength.

Smoking history: For more than 30 years, he smoked about 60 cigarettes a day.

Drinking history: more than 30 years, drinking about 1 catty of white wine a day, 8 months of abstinence.
Family history: a mother suffering from diabetes, sliding upwards to read the physical examination TPRBP36.
4℃ 72 beats/min 18 beats/min 170/100 mmHgHWBMI waist circumference (WC) 172 cm72 kg24.
34Kg/m289 cm laboratory examination HbA1c: 9.
8%FPG: 9.
97mmol/L fasting random insulin: 11.
21mIU/L fasting C peptide: 3.
1ng/L urine routine: GLU: 3+, PRO: -Other laboratory examinations and auxiliary examinations, blood routine, normal renal function, liver function: ALT: 51.
29U/L, GGT: 91.
27U/L, remaining normal blood lipids: TC: 5.
97mmol/L, LDLc: 3.
75mmol/L, remaining Normal urine albumin/creatinine: 4.
58mg/mmol Arterial ultrasound: right common carotid artery, bilateral common femoral arteriosclerosis with multiple plaque formation, the right vertebral artery is slender throughout (considering dysplasia) Others: fundus arteriosclerosis, prostate volume Slightly enlarged Diabetic Macrovascular/Microvascular Complications Screening for Macrovascular Complications: Peripheral Arterial Disease Microvascular Complications: Diabetic Nephropathy Phase III Clinical Diagnosis Slide up to view the main diagnosis of Type 2 Diabetes with Diabetic Nephropathy and Peripheral Vascular Disease Hypertension Level 2 (Extremely high risk) Hyperlipidemia, liver function abnormalities, middle-aged male, 10 years history of type 2 diabetes, satisfactory early blood sugar control, poor blood sugar control in the past two months, family history of diabetes, poor drinking and drinking habits with high blood pressure , Diabetes complications have already existed laboratory examinations suggesting mild abnormalities in liver function, hyperlipidemia treatment goals control glucose toxicity, control the risk factors of arteriosclerotic cardiovascular and cerebrovascular diseases.
Individualized control goals for patients: HbA1c<7%, FBG< 6.
1mmol/L, 2hBG<10mmol/L inpatient treatment plan Swipe up to read the hypoglycemic treatment plan.
Stop repaglinide and acarbose, start CSII intensive treatment, and then add empagliflozin; use after stopping the pump: Insulin Glargine U300 + Enpagliflozin + Gliquidone regimen is based on insulin as the preferred method of glucose control for hospitalized patients with hyperglycemia; Insulin Glargine U300 has excellent hypoglycemic effect and less hypoglycemia, and does not increase the risk of cardiovascular events.
Hospitalization After sliding up to read the discharge treatment plan and discharge follow-up, scroll up to read the hypoglycemic treatment plan: insulin glargine U300 12IU (starting dose 16IU,Follow-up dose 12IU) Empagliflozin 10mg qd gliquidone 60mg tid Follow-up: FPG: 6.
1 mmol/L PPG: 9.
5 mmol/L ■ Clinical thinking 1.
Insulin is the first choice for inpatients with hyperglycemia, and insulin treatment plan The selection should be patient-centered, with full consideration of many aspects; 2.
Fasting blood glucose is the key to reaching the standard throughout the day, fasting blood glucose reaching the standard of 6.
1 mmol/L can achieve blood glucose reaching the standard HbA1c<7%1,2; initial treatment of basal insulin can be It can effectively improve fasting blood glucose and has been unanimously recommended by major authoritative guidelines; 3.
Insulin glargine U300 can achieve stable glucose control, low risk of treating hypoglycemia, and more flexible dosage adjustment to meet the individual needs of patients, which is more effective for initial insulin therapy Ideal choice.

Experts commented that the case described by Chief Physician Shao Hailin, Tianjin Fourth Central Hospital is a patient with type 2 diabetes.
The patient has diabetes for up to 10 years, combined with diabetic macrovascular and microvascular disease, and combined with hypertension; the patient’s symptoms of glycotoxicity should be Intensive insulin therapy is preferred to control glucose toxicity.

While controlling blood sugar to reach the target, attention should also be paid to controlling the risk factors of arteriosclerotic cardiovascular and cerebrovascular diseases (such as the use of statins to regulate lipids) in order to delay the progression of diabetic complications.

For T2DM patients with a certain course of disease, after short-term intensive insulin therapy, a treatment plan of basal insulin combined with oral hypoglycemic drugs can be initiated.

Studies have confirmed that, compared with premixed insulin, the sequential treatment plan of basal insulin combined with oral hypoglycemic drugs can further improve β-cell function while maintaining the FPG level.

In the follow-up treatment plan for hospitalization and discharge, basal insulin is the cornerstone, which should run through the individualized treatment of diabetes.

Insulin glargine U300's unique subcutaneous reservoir micro-precipitation technology enables it to have a longer-lasting and more stable PK/PD, and achieve stable sugar control 4-7.

In addition, the dosage adjustment of insulin glargine U300 is more flexible and can meet the individual needs of patients.
Compared with other long-acting insulins, it is more efficient and can save insulin consumption.
It is the best choice for blood glucose management in diabetic patients.


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