Insulin Replacement Therapy 5

Insulin replacement therapy has the following 5

Injection of 2 times a day before breakfast and dinner, two injections of insulin or premixed insulin + short-acting self-mixing, the long-acting insulin. This approach has the advantage of simple operation, can reduce the inconvenience of injections before lunch, patient compliance is easy; to control blood glucose after breakfast and dinner, before dinner, the long-acting insulin can control blood glucose. More applicable to the remaining part of the function of endogenous insulin in type 1 diabetes and most type 2 diabetes. Lack of such programs are 1) the day only in the early injection of premixed insulin before dinner, when the 2h after breakfast or after dinner when blood sugar control standard (for example: 2h postprandial blood glucose <8mmolL), can easily result in lower fasting low blood sugar reactions [Medical Education Network finishing Release]. The reason is premixed preparations of NPH 1.5h after injection, began to absorb, 3h after the blood concentration has increased, 5 ~ 6h began to peak, together with preparation of the residual effect of short-acting insulin, blood insulin levels and postprandial the formation of blood glucose decline curve opposite phase. If seven or eight points for the morning breakfast, breakfast, half an hour before injection of premixed insulin hypoglycemia before lunch time. Similarly, injection of premixed insulin before dinner, before going to bed to Qianban Ye are prone to low blood sugar time. To overcome the low blood sugar reactions, and to ensure satisfactory postprandial blood glucose control, postprandial 2h generally require patients to a small amount of snacks, and avoid vigorous activity and delay the next meal before a meal. (2) no insulin injections before lunch, just before breakfast premixed NPH insulin in controlling blood sugar after lunch, after lunch blood glucose control is difficult to satisfaction. Because NPH before and after the lunch peak absorption curve only slightly, can not sync with the peak blood glucose after meals. Glycemic control approach is to allow the patient to lunch, Dining, or combined with oral hypoglycemic agents, such as α-glucosidase inhibitor or biguanide drugs. To take advantage of the convenience of two injections, but also make satisfactory blood glucose control throughout the day, reducing the frequency of hypoglycemia, should this time of insulin injection method, the time of hypoglycemia and the need for the knowledge of the United oral medication completely inform patients Meanwhile, regular monitoring of blood glucose in order to avoid weaknesses. Two injections of premixed insulin preparations are generally used 30R and 50R. Specific use is generally of the total dose before breakfast dose of 23 or so days, multi-30R (30% short-acting +70% NPH); dinner before the dose of the total dose of 13 days or so, multi-30R or 50R (50% short-acting + 50% NPH). Adjusted according to individual needs.

Injection 3 times a day before breakfast and lunch were injected short-acting insulin or short acting insulin, injected before dinner, and in the short-acting, long-acting insulin. Such programs are close to the physiological state of insulin secretion, blood glucose control throughout the day compared with 2 injections a day program satisfaction, reduce hypoglycemia. However, NPH and short acting insulin injected before dinner joint, the dose had caused the General Assembly at night (00:00 ~ 03:00) Low blood sugar, fasting blood glucose is too small dose of poor control. Therefore, NPH dose adjustments need to pay attention. Source: Medical Education Network

Given 4 times a day before meals were injected short-acting insulin or short acting insulin, injected before going to bed, the long-acting insulin. It is commonly used in clinical treatment, it can better mimic physiological insulin secretion pattern, easy to adjust the insulin dose every time, leading to better blood glucose control. Is clinically intensive insulin therapy program in one of the most commonly used for type 1 diabetes and the need for most of intensive insulin therapy in type 2 diabetic patients. Note that, when the endogenous type 1 diabetes NPH insulin function and the role of poor time can not be covered by 24h, before dinner, low blood levels of exogenous insulin, blood sugar may be increased.

5 times a day injected short-acting insulin injections before meals, or ultra-short acting insulin, injected before breakfast and bedtime NPH. NPH twice a day dose of the total dose of 30% to 50% and the remaining dose short-acting insulin or short acting insulin at meals before the injection, subcutaneous injection is the way most physiological secretion patterns of the program. For type 1 diabetes and type 2 diabetes, endogenous insulin function in patients with very poor.

Insulin pump insulin pump therapy, also known as continuous subcutaneous insulin infusion system (CSII). Will be placed a short (short) acting insulin with the needle container through the catheter and pump were connected to needles placed in abdominal subcutaneous tissue, with micro-adjustable computer program control insulin infusion to simulate the secretion of insulin on an ongoing basis (usually h 0.5 ~ 2U), and pulsed release of meals, insulin dose and injection time pulse can be adjusted by a computer program to control. Replacement of 1 at the injection site the next day to avoid infection and needle plugging. Strict aseptic technique, self-monitoring of blood glucose and close the correct adjustments and timely procedures to maintain good blood sugar control is a prerequisite. With intensive insulin therapy, may increase the incidence of hypoglycemia should be taken to avoid, early identification and treatment. Children under 2 years of age, elderly patients, who had late complications of intensive insulin therapy should not be used. Part of type 1 diabetes and insulin treatment in a period of time after partial or complete disease remission, then you can reduce the insulin dose or completely disabled, known as diabetic honeymoon period, but this relief is temporary, its duration from several weeks to to months, not more than 1 year. Honeymoon period of the mechanism is unclear, suggesting that residual islet function and patients resume spontaneously. Artificial pancreas by the glucose sensors, micro-computer and the insulin pump. Glucose sensor to sense blood glucose levels can be sensitive to the dynamic changes of the information to the computer, the command output of insulin pump insulin, insulin secretion from islet β cell simulation model. Due to technical and economic reasons, not widely used. It can be a small dose of continuous subcutaneous insulin infusion administered to simulate basal secretion, and the root tree need to be pre-configured, so that high-dose infusion of insulin before each meal to control postprandial hyperglycemia. This is most of all insulin treatment can simulate the physiological pattern of insulin secretion in the program, it can control blood sugar better, the frequency of hypoglycemia lower quality of life of patients can be greatly improved. The initial dose of insulin pump therapy, usually on the basis of the subcutaneous injection, to enable relatively satisfactory blood sugar control 80% of insulin dose throughout the day as starting dose of insulin pump therapy, 40% of the amount of insulin as a basis to conduct continuous subcutaneous low speed, control, fasting and fasting blood glucose levels; Also in the meal before the fast even insulin injections to simulate the human body after a meal to stimulate the secretion of insulin in order to effectively control the outbreak of postprandial blood glucose.