In the previous article, we talked about the basics of insulin use: how to choose, how to beat, how to beat, how many times, how much to hit.
Diabetics use insulin, mostly due to drugs, diet to control blood sugar effect is not good to use, so a dozen insulin is a long-term thing, rarely one or two injections will not be shot.
When many sugar friends use insulin, they will have doubts about dose control, for example, when insulin is effective in controlling blood sugar, should they reduce the dose? According to what criteria should the amount be reduced? How long does it take to stop insulin?
Today, "Ask the Doctor" will answer these follow-up questions for you.
1. How to increase the dose
First question: When is the dose increased? How much to add?
(1) Look at the fasting blood glucose situation
If the injection of medium and long-acting insulin before bedtime, the morning fasting blood glucose is > 8.0 mmol/L, at this time the blood glucose should be measured once at 3 a.m., if the ≥ 4.0 mmol/L, indicating that the patient is not enough insulin before bedtime, and needs to increase by 1 unit.
(2) Look at the blood glucose after the meal
When the blood glucose > 10.0 mmol/L 2 hours after a meal, for every 2.0 mmol/L increase in blood glucose, insulin increases by 1 unit, but the amount should not exceed 6 units at a time.
(3) When human insulin is changed to animal insulin
Animal insulin is not exactly the same as human insulin in chemical structure, not only is it immunogenic, but also has a lower potency than human insulin, and human insulin should be increased by 15% to 20% to animal insulin.
(4) When short-acting insulin is administered before meals
For insulin-sensitive people, 1 unit of insulin can lower blood sugar by about 2.7 mmol/L. 1 unit of insulin can reduce the blood sugar of 10 grams of staple foods, so when eating one or two (50 grams) of staple foods, you need to add 5 units of insulin.
(5) When you have a fever
Patients with a body temperature above 38°C, regardless of the fever, should increase the original dosage by 20%.
2. How to reduce the dose
Second question: When is the dose reduction required? How much to subtract?
(1) Nocturnal hypoglycemia
If the injection of medium- and long-acting insulin before bedtime, the blood glucose < 4.0 mmoI/L in the middle of the night, indicating that the patient's insulin dosage before going to bed is too large and the dose should be reduced. If fasting blood glucose is between 3.0 and 5.0 mmol/L, insulin should be reduced by 2 to 4 units before bedtime.
(2) Animal insulin is changed to human insulin
When animal insulin is switched to human insulin, the dose must be reduced by 15% to 20% compared to the original dose.
(3) Acute gastroenteritis
When vomiting, diarrhea, and loss of appetite occur in acute gastroenteritis, the amount of insulin should also be reduced as appropriate.
(4) According to the blood glucose control situation
When fasting blood glucose or preprandial blood glucose is 3 to 5 mmol/L, the amount of insulin is reduced by 2 to 3 units, and 5 to 7 mmol/L does not increase or decrease.
If the blood glucose fluctuates more than 10mmol/L on a day, it indicates an excess of insulin and needs to be reduced.
3. How long do you want to fight?
The third question: How long does insulin take? When can I deactivate?
The following five indications need to be met:
(1) Not type 1 diabetes
Patients with type 1 diabetes mellitus should not stop insulin.
(2) Blood glucose control standards
The patient's daily insulin dose does not exceed 24 to 28 units, and the blood glucose control is up to standard, the criteria are:
Fasting blood glucose 4.4 to 7.0 mmol/L
Non-fasting blood glucose ≤ 10.0 mmol/L
Glycosylated hemoglobin <7.0%
(3) The function of islets is acceptable
Fasting C peptide level should be measured, and the fasting Cpeptide level should be > 0.4 nmol/L, and the Cpeptide > 0.8 nmol/L after the standard glucose tolerance test.
The normal value of c-peptide reflects the secretion function of islet β cells, and is of guiding significance for the identification of diabetes mellitus and hypoglycemia.
Reference range for normal c-peptide values: CLIA method: 0. 9～7. 1μg/L ( 298～2350pmol/L）。 ECLIA method: serum or plasma on an empty stomach1. 1~4. 4μg/L ( 0.37~1. 47nmol/L), 24-hour urine 17. 2～181μg/24h ( 5. 74～60. 3nmol/24h)。 TrFIA method: on an empty stomach 0. 33～3. 76μg/L 。
(4) No complications and abnormal liver and kidney function
Patients do not have severe acute and chronic complications of diabetes mellitus, abnormal liver function, renal insufficiency and other manifestations.
(5) No stress situation
There are no major surgeries, severe trauma, serious infections, etc., or the stress has been eliminated, and the condition is currently stable and the blood sugar is well controlled.
Only after the above conditions are met, it is possible to consider discontinuing insulin, switching to oral hypoglycemic drugs, and discussing with your doctor how to discontinue it.