The dosage and adjustment of insulin usage is a good summary!

Master the dosage of insulin

1.

The daily synthetic amount of insulin for adults is about 48 units, 1 unit per hour (basal secretion, 24 hours secretion 24 units), and about 8 units per meal for three meals

The study found that when the total removal of the adult pancreas, insulin daily physical requirements about 48U

2.

For people who are sensitive to insulin, 1 unit of insulin can lower blood sugar by 2.

1 unit of insulin can digest 10 to 15 grams of sugar.

3.

Diabetes patients always use short-acting insulin when they start insulin therapy

1.

Daily insulin dosage (μ)=[fasting blood glucose (mmol/L)*18-100]*10*weight (kg)*0.

100 is the normal blood glucose value (mg/dl);

*18 is the coefficient of converting mmol to mg/dl;

x10 converts the amount of blood sugar per liter of body fluid that is higher than normal;

x0.

÷1000 is to convert blood glucose mg into grams;

÷2 is 1μ insulin for 2 grams of blood sugar

Simplified formula: daily insulin dosage (μ) = (FBS grams-0.

Example 1 FBS 300mg/dl (0.

To avoid hypoglycemia, actually use 1/2--1/3 of the amount

Rough formula:

Fasting blood glucose mmol/L×1.

Fasting blood glucose mg/dl÷10=daily insulin amount
.

2.
Estimated based on 24-hour urine sugar:

Patients with mild disease, no diabetic nephropathy, and normal renal glucose threshold should be given 1μ insulin for every 2 grams of urine glucose
.

How to allocate insulin dosage

According to the above estimation, the injection is taken 15-30 minutes before three meals a day, and is allocated according to the amount before breakfast> before dinner> before lunch
.

Because the body secretes more hormones that antagonize insulin before breakfast, the amount of insulin should be larger; and the peak time of short-acting insulin action is usually 2 to 4 hours, so the amount before lunch is the smallest;

Most patients no longer use insulin before going to bed and use it again in the morning of the next day, so the amount before dinner is larger than that before lunch
.

If you use it once before going to bed, you should reduce it before dinner and use less before going to bed to prevent low blood sugar at night
.

How to adjust the insulin dose

After observing the initial estimated dosage for 2-3 days, further adjust the dosage according to the condition, blood sugar, and urine sugar
.

1.
Qualitative adjustment based on 4 urine glucose:

It is only suitable for patients with unconditional blood glucose measurement and normal renal glucose threshold
.
Qualitatively adjusted based on the 4 urine glucose levels in the previous 3-4 days: the pre-breakfast insulin dosage is based on the pre-lunch urine glucose, the pre-lunch insulin dosage is based on the pre-dinner urine glucose, and the pre-dinner insulin dosage is based on the urine before bedtime or the next morning (including Urine that morning)
.

2.
Adjust according to blood sugar:

Diabetics, especially those with type I diabetes and abnormal renal glucose threshold, should adjust their insulin dosage according to their blood glucose levels before meals and before going to bed
.

After fasting blood glucose>7mmol/L, for every 1mmol/L increase in blood glucose, 1.
4 units of insulin are added; 2 hours postprandial blood glucose>10mmol/L, for every 2mmol/L increase in blood sugar, 1 unit of insulin is added
.
A "+" urine sugar increases insulin by 2 to 4 units
.

Dose calculation when changing from short-acting insulin to 30R:

The total daily dose remains the same.
Put 2/3 of the total before breakfast and 1/3 before dinner
.

Insulin dosage algorithm

1.
Intensive treatment of ITT

Determination of the initial dose

①Daily amount = (FBS grams-0.
1) × 2～3 × body weight Kg

Example 1 FBS 300mg/dl (0.
3g), body weight 50Kg, the calculation result is 20-30 units per day
.

②Calculate quantitatively based on 24-hour urine glucose

Daily insulin dosage=grams of urine glucose in 24 hours ÷ 2～3

③ Estimate according to the severity of the disease: patients with pancreatectomy need 40-50 units per day, and patients can start from 18-24 units per day
.

④Foreign countries advocate that type 1 patients should be 0.
5～0.
8u/Kg body weight, not exceeding 1.
0; type 2 initial dose should be 0.
3～0.
8u/Kg body weight

2.
Routine treatment

①Inject once a day: Patients who need less than 20 units a day should inject PZI, or NPH, or premixed insulin (Novoline 30R or 50R) before breakfast; or inject NPH before going to bed
.

②Twice daily injection: suitable for patients with a daily requirement of 20-30 units or more
.
Inject 2/3 of the daily amount before breakfast and 1/3 of the daily amount before dinner; use NPH or premix insulin, such as Novoline 30R or 50R; you can also mix PZI and RI by yourself, the general ratio is 1: 2～4,

③For those with severe illness and large insulin requirements, RI or Novoline R should be injected before meals

④For those who cannot be controlled satisfactorily with conventional treatment, if there is no contraindication to intensive treatment, ITT can be used if possible

3.
Intravenous insulin therapy

① In ketosis: continuous intravenous infusion of RI, 0.
1 unit per kilogram of body weight per hour, glucose + RI should be infused when the blood sugar drops to 250 mg/dl: the ratio of sugar to RI is about 3-6 grams: 1 unit of RI, Urinary ketone has not turned negative, and the RI dose is the same as above.
Urinary ketone has turned negative.
You can inject 2 to 3 units of RI every hour and 1 to 2 units every hour at night.

②If the diabetic patient hangs the bottle with sugar: insulin 1:3 or 4 cancellation

How to adjust the insulin dose

How to adjust the insulin dose is a problem that is difficult for patients to grasp, and needs to be explained to patients repeatedly
.

(1) When FBG (fasting blood glucose) or pre-meal blood glucose is 3～5mmol/L, insulin dosage will be reduced by 2～3U, 5～7mmol/L will not increase or decrease; >7mmol/L will increase insulin by 1U for every increase of 1.
4mmol/L
.

PBG (postprandial blood glucose)>10mmol/L, add 1U insulin for every 2mmol/L increase
.

When the renal glucose threshold is normal, the pre-meal urinary glucose (+) and insulin increase by 2U, and when the urine ketone body is positive, the insulin increases by 4U.
Different calculation methods can be selected according to the severity of the disease.
The dose should not exceed 6U once, and the large amount should be divided.
Joined times
.

If the blood glucose level fluctuates more than 10mmol/L on a day, it means insulin is overdone
.

(2) In patients with fever, the original dose of insulin is increased by 20%
.

(3) Smoking patients should quit smoking when injecting insulin, otherwise the insulin dosage will increase by 20%
.

(4) For women before menstruation and 3 months at the end of pregnancy, the insulin dose needs to be increased
.

(5) When porcine insulin is switched to human insulin, the dosage should be reduced by 20%
.

(6) The amount of insulin inhaled is 3 to 4 times higher than the amount of injection
.

(7) If intermediate-acting insulin is used before going to bed, and the blood sugar in the morning is >8mmol/L, the blood glucose at 3 am can be measured once.
If the blood glucose is ≥4mmol/L, it indicates insufficient insulin, which is called "dawn phenomenon"; blood glucose <4mmol/L indicates Overdose of insulin is called Su Mujie reaction
.
The mantra "test blood sugar at 3 o'clock, Susanlisi can tell"
.

(8) Insulin cannot replace diet control, especially for patients who are obese and eat less and eat more.
If they do not change their life>
.
For those who eat according to the standard weight and labor amount and the blood sugar is still high, the principle of adjustment is: increase the insulin without reducing the diet for the weight loss; while the obese people do not increase the insulin, reduce the diet and add biguanide drugs
.

(9) If you temporarily need to eat 1 tael of staple food (50g) for some reason, you need to increase insulin by 5U
.

(10) Oral hypoglycemic drugs combined with intermediate-acting insulin can reduce the dose of insulin, reduce the side effects of oral hypoglycemic drugs, and improve the efficacy
.
Available insulin 0.
2U/kg, 1 injection before dinner or before going to bed, plus oral hypoglycemic drugs during the day
.
The advantage is that intermediate-acting insulin can inhibit the early morning liver glucose output, effectively control fasting hyperglycemia, and conform to the physiological secretion mode of insulin, with less insulin consumption and less weight gain
.

Through patient and correct guidance, most diabetic patients can grasp the essentials and actively cooperate to make the disease better controlled
.
The patient suffers little pain and the curative effect is satisfactory
.