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Long -acting, short -acting, premix, and analogy, how to choose so many insulin?A literature!

Lecturer | Liu Jun Fifth People’s Hospital affiliated to Fudan University

Wen | Jade Sauce

Source | Medicine Endocrine Channel

Insulin is one of the greatest medical discoveries in history. Before the insulin was discovered in the early 1920s, diabetes was almost terminally ill. Patients could only barely extend their lives by “hunger therapy” for several months. Since 1923, pure animal insulin, insulin has been updated many times, and its efficiency has been increasing. Patients with diabetes can also obtain a life span and quality of life similar to ordinary people after receiving regular treatment.

01

Insulin classification

According to the source of species

It can be divided into three categories: animal insulin, genetic restructuring human insulin and insulin analogs.

Actual time

It can be divided into fast -acting insulin analogs, short -acting insulin, medium -effective insulin, long -acting insulin (including long -acting insulin analogs), premix insulin (including premix insulin analogs).

Characteristic

It can be divided into insulin (fast -acting insulin analogy and short -acting insulin), basic insulin (long -acting insulin analogy and Chinese -effective insulin), and premix insulin (premissive insulin category and pre -insulin).

Human insulin characteristics

Human insulin is synthesized by yeast cells, E. coli, etc., which is completely consistent with the insulin structure secreted by the human body. It also has the characteristics of low immunogenicity, low side reactions, small dosage (converted from animal insulin to human insulin, with an average dose of 15%~ 30%), and high safety.

Human insulin secretion has obvious appearance characteristics. After meals, insulin secretion first appears a low peak (that is, the first secretion of the first time), and then there is a peak (that is, the second time), and then gradually reduce the secretion (but always secrete). Essence But existing human insulin preparations cannot simulate the secretion of physiological insulin.

The invention of insulin analogs solves the problem of simulating physiological insulin secretion patterns.

Table 1 The characteristics of insulin preparations and role

02

Insulin individualized treatment

The timing of the initial insulin therapy

Type 2 diabetes (T2DM) blood glucose control target: empty blood glucose 3.9 ~ 7.2 mmol/L, non -fasting <10.0 mmol/L, and glycated hemoglobin (HBA1C) <7.0%. Patients with diabetes with a short course of disease, long life expectancy, and no various complications are recommended to meet the long -term standards of early and comprehensively controlling blood glucose. Adjust the sugar control target according to the individual conditions, and should not be cut in one blade.

The traditional T2DM treatment method is based on controlling symptoms. Insulin treatment is launching late, blood glucose control is not ideal, and now it is not advocated. At present, the starting treatment of insulin incense is: T1DM patients should start and continue for life; after T2DM patients have a combination of lifestyle and multi -dose of multiple oral hypoglycemic drugs, HBA1C is still greater than 7.0%; the initial issuance is issued. Type 2 diabetes HBA1C is greater than or equal to 9%; new hair diabetes and T1DM have difficulty in thin diabetic patients; and those who have no obvious cause of weight induction during diabetic disease (including new diagnostic T2DM) should be treated as soon as possible.

The special circumstances of insulin therapy need to be used in time

Severe chronic complications: severe diabetic nephropathy, diabetic foot, etc.;

Severe acute complications such as hypertonic hyperglycemia and keto acid poisoning and acute infections, which need to be temporarily replaced by insulin through the danger period;

Gestational diabetes;

Secondary diabetes and specific diabetes;

Combined other severe diseases, such as coronary heart disease, cerebrovascular disease, liver disease, etc.

Insulin therapy mode

Ideally, insulin therapy should simulate physiological secretion mode in order to effectively control blood glucose throughout the day. Insulin pumps can be done, but currently not popularized. Insulin treatment path that maintains the long -term standards of blood sugar is shown in Figure 2:

Figure 2 Insulin treatment path

See Table 2, commonly used insulin treatment solutions:

Table 2 Starting insulin treatment plan

Premix insulin 2 times a day can provide basic and insulin at the same time, so it can fully control blood sugar, reduce the number of injections, and balance the efficacy and convenience, as shown in Figure 3.

Figure 3 Premixing Inticardinin therapy can simulate physiological insulin secretion

Example of premix insulin therapy: premix insulin such as seminal protein biomestin 30r/50R, starting dose 0.4 ~ 0.6 units/kg weight/day, 30 minutes before breakfast, about 1/2 or 2/3 days before breakfast Dose, the dose 30 minutes before dinner is about 1/2 or 1/3.

There are also shortcomings of the injection method of pre -mixed insulin types a day:

1. After lunch, blood sugar is not easy to control. Solution: Add gernen, α-glucosidase inhibitors or dual-dual-dual-in-laws during lunch; injection speed-effect insulin analogs or premissive insulin categories before lunch.

2. Excessive efficiency before dinner leads to hypoglycemia in the middle of the night, which causes the empty blood glucose to be dissatisfied the next day. Solution: Monitor the blood sugar before bedtime, reduce the amount of insulin, and control the blood sugar at 5 ~ 6mmol/L.

On the basis of the initial treatment of insulin, after sufficient dose adjustment, if the patient’s blood glucose level has not yet reached the standard or repeated hypoglycemia, it is necessary to further optimize the treatment plan. Patients with type 2 diabetes or islets with severe hyperglycemia can adopt multiple subcutaneous injections (3 pre -mixed insulin analogs or meals+basic insulin therapy) or continuous subcutaneous infusion. Based on the blood glucose level before and three meals, adjust the amount of insulin before bed and three meals, adjust every 3 to 5 days, and adjust the dose of 1 to 4 per unit according to the blood glucose level until the blood sugar meets the standard.

Common foundation+insulin scheme for meals:

Start dose: Those who have not been applied, 0.5 units/kg weight/day;

Those who are applying other insulin therapy plans, the total insulin is unchanged throughout the day.

Dose distribution:

30 minutes before breakfast, 20%of the total amount of day;

30 minutes before lunch, 20%of the total amount of day;

30 minutes before dinner, 20%of the total amount of day;

30min before going to bed, 40%of the total amount of day.

summary

Patients with T2DM are combined with lifestyle and oral hypoglycemic drugs. If HBA1C still does not reach the standard (> 7%), insulin therapy should be started.

Insulin therapy simulation physiological insulin secretion mode, selects good control of blood sugar by selecting an individualized solution from beginning to strengthening. Premix insulin while improving insufficient secretion of meals and basic insulin, good control of empty stomach and postprandial blood sugar, a preparation, a injection pen, simple, convenient and effective, and an ideal insulin starting treatment plan. Insulin analogs can better simulate physiological insulin secretion and make insulin therapy more flexible and rich.

02

Insulin use disorder

Not all circumstances to strengthen blood sugar control can bring benefits. The following situations are not recommended to strengthen blood glucose control, but should be appropriately relaxed.

It is not advisable to strengthen the treatment

The following situation is not of great significance to strengthen the treatment

End -term cancer, severe mental function;

There have been end -stage diabetes complications, such as proliferative retinopathy, renal failure, etc.

Increased risk of strengthening treatment in the following situation

There is a history of severe hypoglycemia (not self -care);

Hypoglycemia within 1 year or more;

Low blood sugar cannot be perceived;

Coronary heart disease or cerebrovascular disease;

Merge use of certain drugs to affect hypoglycemia (such as β-receptor blockers, etc.);

Patients who cannot act or live alone;

Patients with severe hypoglycemia, such as addison disease, low pituitary function, etc.

<!-2586: Diabetic terminal page

Alcohol poisoning and drug addiction;

Those with mental illness or mental retardation.

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