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There are many insulin initial treatment schemes, how to choose?How to adjust the dose?One article clear!

Text | Bio Bio

Source | Medicine Endocrine Channel

Insulin therapy is an important means to control high blood sugar.

Patients with type 1 diabetes (T1D) need to rely on insulin to maintain their lives, and they must also use insulin to control high blood sugar and reduce the risk of complications of diabetes. When oral hypoglycemic drugs have poor effect or taboos are used in oral drugs, patients with type 2 diabetes (T2D) also need to use insulin treatment as soon as possible.

How to choose the three categories of schemes?

How to adjust the insulin dose?

Clinical trials have proved that insulin analogs are similar to human insulin control blood sugar, but they are better than human insulin in simulating physiological insulin secretion and reducing the risk of hypoglycemia. According to the specific situation of the patient, basic insulin or premix insulin can be selected as the initial treatment.

1

Option One

Basic insulin + oral hypoglycemic drug

The basic insulin currently applies in clinical applications includes medium -effective human insulin and long -acting insulin analogs (such as di special insulin and glycosylin insulin).

The starting dose of basic insulin therapy is 0.1 ~ 0.3 u/(kg · d). Inject it once before going to bed.

Adjust the amount of insulin according to the level of the patient’s an empty blood glucose (FPG) level, usually adjust every 3 to 5 days, and adjust the blood glucose 1 to 4 U until the empty blood glucose is up to the standard according to the blood glucose level. If long -acting insulin analogs, the FPG target can be set to 5.6 mmol/L.

Advantages and disadvantages

Advantages of this starting treatment plan:

The advantage of basic insulin is simple and easy to follow, patients with good compliance, good control in FPG, and less hypoglycemia.

Among them, the action time of Chinese -effect human insulin is generally 12-18 hours, with peak absorption, low blood glucose (especially at night hypoglycemia) is relatively large; while long -acting insulin analogy (such as di special insulin, glycry insulin) The effect of lasting for up to 24 hours, the risk of severe hypoglycemia and hypoglycemia at night is lower than that of medium -effect insulin.

Disadvantages of this starting treatment:

Poor blood sugar control after meals;

Patients with poor islag function and high (HBA1C) baseline (> 9%) of patients with higher treatment effects are not as good as pre -mixed insulin.

2

Option II

Insulin or premixing insulin category

Premix insulin is an insulin preparation pre -mixed in a certain proportion of fast -acting and medium -effective insulin, which can meet the needs of meals and basic insulin at the same time.

According to the patient’s blood glucose level, you can choose an injection plan 1 to 2 a day. When HBA1C is relatively high, use the injection scheme twice a day.

Premier insulin once a day:

The initial isletin dose is generally 0.2 U/(kg · d), and the injection before dinner. Adjust the amount of insulin according to the patient’s FPG level, usually adjust every 3 to 5 days, and adjust 1 to 4 U each time the blood glucose level is adjusted to the FPG standard.

Premier insulin twice a day:

The initial isletin dose is generally 0.2 ~ 0.4 u/(kg · d), and assigned before breakfast and before dinner at a ratio of 1: 1. Adjust the amount of insulin before and before dinner blood glucose before dinner, and adjust the dosage of each 3 to 5 days. The dose adjusted at a time according to the blood glucose level is 1 to 4 U until the blood glucose meets the standard.

Notice

This scheme should not be used for long -term blood glucose control of patients with T1D; T2D patients need to discontinue the use of this scheme to promote insulin secretion (mainly refers to the isletin promotion agent taken before and before dinner).

Advantages and disadvantages

Advantages of this starting treatment plan:

At the same time, it can take into account the empty stomach and postprandial blood glucose. The overall sugar control effect (especially the blood sugar after meals) is better, especially for patients with high HBA1C (> 9%) and poor β cells.

The cost of treatment is relatively low (compared to long -acting insulin analogs).

Disadvantages of this starting treatment:

The risk of hypoglycemia at night is relatively high;

It usually needs to be injected twice in the morning and evening (of course, it can also be injected once or 3 times a day according to the specific situation), and the treatment compliance is not as good as the basic insulin scheme.

If the above treatment has not yet reached the standard for blood glucose, you can use an enhanced insulin treatment plan.

3

third solution

“Meal+Basic” insulin strengthening treatment plan

The current commonly used insulin intensive therapy schemes, namely: short -acting/fast -acting+basic insulin (medium -effect/long -term) before bedtime.

Adjust the amount of insulin before bedtime and pre -meal blood glucose, and adjust the amount of insulin before meals, respectively, once every 3 to 5 days, and the dose of each adjustment according to the blood glucose level is 1 to 4 U until the blood glucose meets the standard.

This solution is mainly suitable for new diagnostic T2D patients with T1D and FPG> 11.1 mmol/L, HBA1C> 9%. Instead of using this solution, insulin secretions are no longer taken.

In addition to the common ones, there are two kinds of insulin reinforcement treatment schemes worth trying:

1. Premix insulin 2 to 3 times a day:

The ballogin dose is adjusted according to the blood glucose level before bed and three meals, and pre -hybrid insulin 2 times a day, and pre -mixed insulin analogs 2 to 3 times a day. Adjust every 3 to 5 days until the blood sugar meets the standard.

2. Use insulin pump:

Continuous subcutaneous insulin infusion (CSII) is a form of insulin strengthening therapy and needs to be implemented using insulin pumps. The blood glucose monitoring scheme requires at least 3 days a week, at 5 to 7 points per day of blood sugar monitoring. Adjust the dose according to the blood glucose level until the blood glucose meets the standard. These 5 types of patients need to enable insulin therapy as soon as possible

1. Patients with T1D need to immediately use insulin replacement treatment when they occur. As of now, such patients need to accept this method for life.

2. Patients with new onset T2D can choose insulin therapy for obvious hyperglycemia symptoms, ketone or keto acid poisoning.

3. New diagnosis of patients with diabetes is difficult to type. When it is difficult to identify with T1D, insulin therapy can be preferred.

4. On the basis of the treatment of lifestyle and oral hypoglycemic drugs for T2D, if the blood sugar has not reached the control target, it can start oral hypoglycemic drugs to add joint insulin.

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5. In the course of diabetes (including the new diagnosis of T2D), insulin therapy should be used as soon as possible when the weight of no obvious causes decreases significantly.

In short, clinicians should choose the patient’s condition.

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