Diabetes is becoming more and more common in our lives, and according to last year's data, one in every 10 people may be diabetic.
In order to lower blood sugar, many patients are inseparable from insulin, but for the use of insulin, many sugar friends also have many questions.
For example, how do I choose the type of insulin? What time of day should I get my injections? Am I going to poke my stomach every time? Can I play anywhere else? How much insulin should I take per day?
"Ask the doctor" to answer for you one by one.
1. Which one to play?
(1) Divided by source: Insulin can be divided into animal insulin and human insulin according to the source.
Animal insulin is insulin extracted from the pancreatic cells of animals. Although the price is cheap, it is easy to cause an immune response, and even symptoms such as rash, itching, hypotension, and shock may occur;
Human insulin is safer and generally does not cause an immune response.
(2) According to the length of the action: ultra-short effect, short effect, medium effect, long effect and pre-mixed five categories.
Ultra-short-acting insulin: injected immediately before meals, can effectively control postprandial blood glucose, flexible dosage, adjusted according to the amount of meals. Usually used in combination with medium- and long-acting insulin.
Short-acting insulin: injected 30 minutes before a meal, usually used in the rescue of patients with various acute complications and infections.
Moderate-acting insulin: the drug can be released slowly, suitable for mild sugar friends, sugar friends with large blood sugar fluctuations.
Long-acting insulin: more stable release, longer action time, mainly suitable for glucose friends with poor fasting blood sugar control. However, the effect of lowering blood sugar after a meal is not good, so it is often used in combination with short-acting insulin.
Premixed insulin: Is a mixture of short-acting/ultra-short-acting insulin and medium-acting insulin in a fixed proportion. Often used as the starting treatment for type 2 diabetes, it can balance basal blood glucose with postprandial blood glucose. However, premixed insulin works for a long time and has a higher risk of developing nocturnal hypoglycemia.
Sugar friends can choose the type of insulin that suits them according to their economic level and blood sugar status, and discuss with their doctors.
2. When to play? How many times?
(1) Ultra-short-acting insulin: 3 times a day, injected immediately before meals. It mainly acts on reducing postprandial blood sugar, so it is only beaten before meals, and it is beaten several times a day after eating a few meals (generally three meals so it is beaten three times).
(2) Short-acting insulin: 3 times a day, 30 minutes before meals. Like ultra-short-acting insulin, patients use short-acting insulin mainly to lower blood sugar after meals, and eat several meals a day (usually three meals so three times)
(3) Moderate-acting insulin: 1 to 2 times a day (according to the dose, if the daily dosage exceeds 40 units, it will be injected in two doses), 0.5 to 1 hour subcutaneous injection before breakfast every day, 1.5 to 4 hours after injection, the efficacy is maintained for 12 to 14 hours, it is best to choose to inject at the same time point every day.
(4) Long-acting insulin: 1 injection per day can be used. Generally, it is injected subcutaneously 0.5 to 1 hour before breakfast every day, and the effect is onset 3 to 4 hours after injection, and the peak is reached in 12 to 20 hours, and the hypoglycemic effect lasts for 24 to 36 hours.
(5) Premixed insulin: generally 2 times a day, two timed injections in the morning and evening.
3. Where to hit?
Will the different locations of insulin be injected, what is the impact?
Most people choose to inject insulin in the abdomen because it is visible and easy to operate, and insulin injections work most quickly in the abdomen (the injection site should be at least 5 cm from the navel).
In addition to the abdomen, insulin can also be injected on the outside thigh, the outside of the upper arm, and the lateral upper side of the arm. Different parts of the effect is different, see the following figure:
However, if you prick your stomach every day, it is also unbearable, and continuing to inject in the same area will lead to prolonged absorption time of drugs, decreased absorption rates, and fluctuations in blood sugar. Therefore, the injection site needs to be rotated regularly, and the principle is as follows:
At the same time every day, inject the same part: for example, a needle before breakfast every day is injected into the abdomen;
At different times of the day, injections of different parts: such as the first injection in the abdomen in one day, the second injection in the thigh;
Left-right rotation: for example, injection in the left abdomen in the morning, injection in the right abdomen the next morning.
4. How much to play?
When starting insulin, everyone's sensitivity to insulin is different, so it is best to start with a small dose, generally 24 to 30 U/day, and adjust the dose every 2 to 3 days until the blood sugar is well controlled.
The amount of insulin suitable for yourself can be calculated by referring to this formula:
Daily insulin dose = [fasting blood glucose (mmol/L) × 18-100] × 10 × body weight (kg) × 0.6 ÷ 1000 ÷ 2
100 is the normal value of blood glucose (mg/dl); 18 is the coefficient of mmol to mg/dl; 10 is to convert the amount of blood glucose higher than normal blood sugar per liter of body fluids; 0.6 is 60% of the total body fluid; 1000 is to convert blood glucose mg into grams; 2 is 2 grams of blood glucose using 1μ insulin.
If it is troublesome, the rough calculation formula is:
Fasting blood glucose mmol/L × 1.8 = daily insulin volume.
Fasting blood glucose mg/dl ÷ 10 = daily insulin volume.
According to the above estimates, injections are given 15-30 minutes before three meals a day, and the dosage is distributed > before breakfast> before dinner> before lunch.
Because the body antagonizes insulin hormone secretion more before breakfast, so the dosage is large; the peak time of short-acting insulin action is 2-4 hours, so the dosage before lunch is small; most people do not use insulin before going to bed, so the amount to be used before dinner is larger than before lunch; if it is used once before bedtime, it is reduced before dinner, and the amount used before bedtime is less to prevent low blood sugar at night.