Can't stop using it? Can you eat and drink when you hit it? Have you been caught up in these misconceptions about insulin?

Crack the misconceptions about the use of insulin

Member of the Diabetes Prevention and Control Committee of the Chinese Preventive Medicine Association

Akizuki Wang, Department of Endocrinology, First Clinic, China Medical University

Insulin is a protein hormone in the human pancreas that mainly acts as a hypoglycemic agent. So if you have diabetes, you can choose to inject insulin to lower blood sugar. But in the clinic, it is often heard that sugar friends say some rumors about insulin. In order to let sugar friends use insulin with peace of mind, some unreliable rumors are now clarified to sugar friends.

rumor

There are roughly two aspects:

"Demonizing" insulin Some sugar friends believe that insulin is addictive and dependent, and it cannot be stopped. Some sugar friends believe that the doctor lets insulin use to show that diabetes is very serious, diabetes is in the late stage of the disease and so on.

Some sugar friends believe that oral hypoglycemic drugs hurt the liver and kidneys, and insulin has no side effects, once found that the best way to reduce diabetes is to hit insulin. There are also diabetics who use insulin on the grounds that they can eat and drink without restricting their diet after taking insulin.

So in reality, how should diabetics choose insulin?

Let's take a look at the typing of diabetes. According to the latest "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)", the classification of diabetes still adopts the Etiology Classification System of the World Health Organization (1999). Based on the etiological evidence, diabetes mellitus is divided into 4 types, namely type 1 diabetes, type 2 diabetes, special type diabetes and gestational diabetes. Common types of diabetes are type 1 diabetes and type 2 diabetes.

Type 1 diabetes

Type 1 diabetes refers to the destruction of β cells in the islets, often resulting in an absolute lack of insulin in the body, resulting in an increase in the concentration of glucose in the blood, and the hypoglycemic regimen is the need for lifelong supplemental insulin therapy.

Type 2 Diabetes

Type 2 diabetes refers to early islet β cells can secrete or hypersecrete insulin normally, but insulin sensitivity decreases, resulting in an increase in glucose concentration in the blood. There may be a decrease in insulin secretion in the later stages.

Question 1

WEBTI1

Is insulin addictive?

Once used, is it lifelong?

The Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) recommend the timing of initiation of insulin therapy:

(1) Patients with type 1 diabetes mellitus require insulin therapy at the onset of the disease and require lifelong insulin replacement therapy.

(2) If the newly diagnosed patients with type 2 diabetes have obvious symptoms of hyperglycemia, ketosis or ketoacidosis, insulin therapy is preferred. After the blood glucose is well controlled and the symptoms have improved significantly, a follow-up treatment plan is determined according to the condition.

(3) When newly diagnosed diabetic patients have difficulty classifying and are difficult to distinguish from type 1 diabetes, insulin therapy can be preferred. After the blood glucose is well controlled, the symptoms are significantly improved, and the classification is determined, then a follow-up treatment plan is formulated according to the classification and specific condition.

(4) On the basis of lifestyle and oral hypoglycemic drug therapy, patients with type 2 diabetes can start the combination of oral hypoglycemic drugs and insulin if the blood glucose has not reached the control goal. Initiation of insulin therapy may usually be considered when glycosylated hemoglobin ≥ 7.0% after 3 months of adequate oral hypoglycemic therapy.

(5) In the course of diabetes mellitus (including newly diagnosed type 2 diabetes), when there is significant weight loss without obvious inducements, insulin therapy should be used as soon as possible.

In summary, it is not difficult to see that patients with type 1 diabetes need lifelong insulin therapy; when patients with type 2 diabetes appear in the above situation, according to the needs of the disease, some sugar friends can only use insulin to lower diabetes, and some sugar friends need insulin combined with oral hypoglycemic drug regimen. For patients with type 2 diabetes, due to the timely activation of exogenous insulin, it can reduce the secretion of insulin by their own islet β cells, so that the β cells of the islet can be rested, the load of the islet β cells is reduced, and finally the secretion function of the islet β cells is restored, and the amount of exogenous insulin injection will gradually decrease or even stop, and the use of oral hypoglycemic drugs alone can control blood sugar well.

Therefore, "insulin is addictive and dependent, and it cannot be stopped when it is used", which is a wrong understanding; "the doctor lets insulin use to show that diabetes is very serious, diabetes is in the late stage of the disease", which is also a wrong view; "once diabetes is diagnosed, only take hypoglycemic drugs, do not take insulin" The view is also wrong.

Question 2

WEBTI2

Oral hypoglycemic drugs have side effects,

Should I take insulin when diabetes is diagnosed?

Once diabetes is diagnosed, even type 2 diabetes uses insulin instead of oral medications, on the grounds that oral hypoglycemic drugs hurt the liver and kidneys. Sugar friends should be clear that no matter which drug in the clinic has certain side effects, including insulin. Indeed, most oral hypoglycemic drugs need to be degraded by the liver and excreted by the kidneys. Many oral hypoglycemic drug descriptions are marked with the words "disabled for patients with liver and kidney insufficiency" or "cautious use", which means that the drug should be used with caution when the liver and kidney function is problematic, but this does not mean that the hypoglycemic drug will hurt the liver and the kidneys.

The hypoglycemic drugs that have been listed so far have been approved for application after large-scale clinical studies and have high safety. If liver and kidney function is impaired, it may affect drug metabolism and excretion. Therefore, before and after taking hypoglycemic drugs, doctors will instruct patients to regularly monitor liver and kidney function, adjust the treatment plan in time according to the monitoring results, and avoid adverse consequences.

Most patients with new diagnosis of type 2 diabetes can control blood glucose within the target range with oral hypoglycemic drugs alone.

Question 3

WEBTI3

Can I not control my diet with insulin?

There are "five carriages" for the management of diabetes:

Diet, exercise, medication, blood glucose monitoring, and health education.

Diet and exercise are the foundation, and insulin is only one of the hypoglycemic drugs. Therefore, even if insulin is applied, it is also necessary to control the diet. Therefore, the idea that insulin can not control the diet is wrong.

In short, insulin should be activated in a timely manner to prevent the "demonization" or "deification" of insulin. All drugs used in the clinic have advantages and disadvantages, and insulin also has its advantages and disadvantages.

merit:

No damage to the liver and kidneys, no effect on pregnant women, no toxic effect, can supplement the lack of insulin in the body, has a certain protective effect on islets.

shortcoming:

Hypoglycemic reactions, allergic reactions, lipodystrophy or hyperplasia at the injection site, may cause weight gain, subcutaneous injection is required, and insulin insensitivity may occur more and more during application. It is precisely because insulin has the above shortcomings that diabetes cannot be diagnosed and blindly use insulin to lower diabetes. Doctors will reasonably choose hypoglycemic drugs or insulin according to the condition of the sugar friend and the function of the islets.

Insulin-related precautions:

After the doctor prescribes insulin, he will explain the use of insulin and precautions in detail, and the sugar friend himself must read the drug instructions of insulin in detail. For example, unopened insulin should be placed in a refrigerator refrigerator refrigerator at 2 ° C ~ 8 ° C, not frozen, avoid putting it in the sun or in a place with a higher temperature, otherwise it will cause insulin inactivation. Travel by air insulin should be carried with you, not checked in, to prevent insulin freezing and inactivation. Insulin that has been applied in an insulin pen should be placed at room temperature with the pen, and can generally be stored below 25 ° C for 28 days. When starting the injection, accurately adjust the dose recommended by the doctor, and after the injection is completed, stay for a while to allow the insulin to be fully absorbed. The injection needle is changed one at a time, and the injection site should be changed one at a time to avoid fat atrophy or hyperplasia at the injection site.

The pictures in this article are from the Internet

Edit || Dong Chao Wan Tao

The duty director || Fan Hongbo