Xiao Chen, a 20-year-old student at a certain college, suffers from diabetes and needs to inject insulin every day, but he is worried about being discriminated against after being discovered by his classmates, and always takes time to hide in the toilet to inject himself, and even does not inject when it is inconvenient. Unexpectedly, this irregular injection caused severe poisoning.
On this day, Xiao Chen suddenly had abdominal pain during class, and then fell unconscious and was rushed to the hospital. At the hospital, he was diagnosed with diabetic ketoacidosis, the condition was very serious, and he was immediately transferred to the intensive care unit for treatment. After rescue, he was finally released from danger and transferred to a general ward. Xiao Chen told the doctor that on the eve of the onset of illness, he had stopped injecting insulin for several days, "sometimes he couldn't find the opportunity, so he just played more points the next day and tried to balance it."
Doctors pointed out that such irregular injection of insulin will not only aggravate the condition of diabetic patients, but also easily induce complications, if not taken in time, the consequences are extremely dangerous!
To date, insulin is still the strongest and most effective hypoglycemic drug, and many diabetics need to receive insulin therapy. But "how to ensure the regularity of insulin use" is a problem.
There are mainly the following reasons for the regular injection of insulin:
The first is cognitive factors. On the one hand, the course of diabetes is long, the treatment is cumbersome, and patients do not feel the serious complications caused by the disease in the short term, which is inevitable to take lightly; on the other hand, patients do not have a comprehensive systematic understanding of the disease itself, and believe that insulin injection time and meal time are not enough to affect the fluctuation of blood sugar.
The second is environmental factors. Due to the increase in work, study or social activities (out to eat, business trips), the large number of items to be carried for out-of-home injections, etc., the fear of using insulin pens in public, destroying their health image in the eyes of others, there will be insulin injections on their own early, postponed, or even stopped, resulting in insulin injection time is difficult to form a regularity.
The third is the body factor. Diabetes is a chronic disease, for elderly patients with a long course of illness, with the decline of the body's physiological functions, memory, comprehension and audio-visual power will be weakened, resulting in the patient's own lack of systematic understanding and attention to the number of medications taken per day and the injection time. As a result, there will be inaccuracies in the timing of insulin injections, and even forgetting insulin injection behavior.
The fourth is psychological factors. In the early stage of the onset of type 2 diabetes, the treatment of the disease is not taken seriously, and there will be irregular insulin injections when injecting at home. Some diabetics who are in school age will avoid the peak of class, the eyes of classmates, discrimination and ridicule, and there will be behaviors such as early, postponed or even no insulin injection.
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If insulin is missed, what remedies are available?
Different specifications of insulin, its onset time and maintenance time are not the same. Therefore, insulin must be injected regularly and quantitatively according to the requirements, and after different specifications of insulin are missed, the remedy is also different.
1. Long-acting insulin
Long-acting insulin is injected once a day, and if you miss a shot, you can make it up as soon as possible. However, the next time the injection is still at the original time, the hypoglycemic reaction should be noted, because the interval between the two injections is likely to be less than 24 hours. It is also possible to change the injection time from this point to adjust the injection time to the make-up time (such as 7 a.m. insulin injection, and then insulin injection at 7 a.m.).
2. Fast-acting, short-acting insulin
Rapid-acting insulin or short-acting insulin is injected before a meal, and if you forget to hit before a meal, you can make up for it immediately after a meal, which has little effect on the efficacy. Pay attention to monitoring blood glucose to prevent hypoglycemic reactions.
3. Premixed insulin
For patients who inject premixed insulin (such as Novolin 30R, 50R) or premixed insulin analogues (such as Novoran 30, Yomile 30, 50) before breakfast, if they forget to take insulin before breakfast, they can make up immediately after the meal, during which time they should pay attention to monitoring blood glucose, and if necessary, add meals in the middle; do not combine the morning and evening premixed insulin into one injection before dinner. If insulin can not be used in time after a meal, to remember that it is noon, blood glucose before lunch should be measured, when more than 10mmol / L, a small amount of short-acting or rapid-acting insulin (4 to 10 units); 1 to 2 hours after the recheck of blood glucose, if still high, subcutaneous injection of small doses of insulin; repeated multiple times can make blood glucose close to normal, but need to pay attention to hypoglycemia response, timely treatment (such as eating), and routinely apply insulin before the next meal.
For people with type 2 diabetes whose blood sugar is not very high, the problem of missing insulin is not too big, and the doctor's acarbose, metformin, or repaglione can be taken immediately after a meal.
For people with type 1 diabetes, gestational diabetes, special types of diabetes, type 2 diabetes with poor islet function, and some secondary diabetes, remedial measures need to be actively taken, and only insulin can be selected.
In order to ensure the regularity of insulin use, health education centered on diabetics should be strengthened. For elderly patients who do not understand the regular injection time of insulin, do not pay attention to and memory loss and other factors, simply preaching once or twice, patients are easy to forget, if necessary, let the family participate together. At the same time, the insulin injection pen can be placed in a more eye-catching position, such as a dining table, a bedside table, etc. (provided that the room temperature is below 30 ° C), or an alarm clock with the same number of insulin injections according to the number of insulin injections, and these methods can be used to remind patients to inject insulin on time and regularly before meals or bedtime. Patients who travel for business or eat out more should carry insulin with them, and if the temperature exceeds 30 ° C or below 0 ° C, prepare a portable incubator to ensure regular insulin injection.
In the face of diseases, juvenile patients are prone to show depression, anxiety, fear, anger and disappointment and other bad emotions, and should carry out effective psychological communication of these bad emotions; at the same time, actively carry out education, so that they have an objective and rational understanding of insulin treatment, and avoid irregular insulin injection time. Students who are in school can contact the school infirmary to find a suitable injection room and try their best to eliminate the influencing factors.
In short, according to the specific conditions of patients, through different educational paths and tools, so that they fully understand and be familiar with the importance of regular injection of insulin for blood glucose control, and gradually form a regular injection time, to avoid irregular injection time, affecting blood glucose fluctuations, resulting in irreversible serious consequences.
The author | Zhang Haiwei, pharmacist of the Pharmacy Department of Hami Central Hospital
Source| Family Medicine
Editor| Zhou You Pang Zuliang (Intern)
Zhang Yue, | second instance
Final Trial | Liu Huiying Zhang Ruxian