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Insulin treatment of diabetes

INS to use alternative treatment in general. Advantages are: (1) 3 can control the postprandial glucose and FPG satisfaction, dose adjustments easy. (2) used properly, is not easy to hypoglycemia. Drawback: INS extreme lack of basic INS are required to supplement the day, bedtime NPH not cover 24h, so the blood concentration after injection 16hNPH very low, the need to add another dose of NPH combined coverage of the treatment of INS-day basis. 4.5 insulin program: the R + NPH-R-R + NPH, before breakfast and before bedtime injection of NPH and R 3 meal plan. 2 times (8:00 or so, before going to bed around 22:00) NPH injection of additional basic coverage 24h INS, 3 INS peak postprandial fasting R added, is the simulation of physiologic intensive therapy INS secretion patterns of the best programs. Advantages are: secretion and physiological mode of the nearest INS, 2 NPH injections, 24h INS-based and control preprandial and overnight fasting blood glucose, 3 R control fasting blood glucose peaks after meals. Disadvantages are: number of injections are more poor patients. Specific methods: (1) 2 times the amount of NPH based on the amount of supplement as a day, usually accounting for 30% of the amount at INS to 50%. (2) the remaining amount allocated to the three fasting INS, meal and postprandial blood glucose levels under appropriate adjustments. Although this method is cumbersome, but type 1 diabetes with stable blood glucose when blood glucose fluctuations, reducing postprandial blood glucose fluctuations better. IV insulin therapy of type 1 diabetes pathogenesis of type 1 diabetes patients will ultimately be the decision of the INS such glycemic control and survival. Therefore, the strongest indication INS application, although late-onset autoimmune diabetes mellitus in adults (LADA) Early surviving part of the endogenous islet function, but the early use of exogenous INS injection, the protection of the residual B cells useful, so long as 1 claim diagnosed with diabetes should be treated early with INS. l type B cells destroyed, a serious lack of endogenous insulin secretion, which normally takes INS replacement therapy. However, if the patient had no obesity or type 2 diabetes and IR, genetic background, its IR is not obvious, are often very sensitive to exogenous INS, the INS general daily dose less than that of type 2 diabetes. Type 1 diabetes, a dose of exogenous INS 0.5 ~ 1.0U · l 【different d ~, 2 diabetes who need alternative treatment up to 1.0 ~ 1.2U · kg · d ~. Usage: usually 3 to 5 times injection, in particular those based on lack of significant INS,[link widoczny dla zalogowanych], INS also need to simulate physiological supplement, starting dose may be from 0.4-0.6U · ks_l · dI1 start. 1. Based on the amount of added: the basis of the amount of type 1 diabetes up to 40% of INS at 50% of the dose, supplementary method bedtime NPH, NPH before breakfast,[link widoczny dla zalogowanych], 2 injection, and NPH3 injection method, as far as possible based on the amount of peak tends to flat. 2.3 General INS injection before a meal: approach with replacement therapy of type 2 diabetes, except that patients with type 1 diabetes susceptibility to the good INS, INS except for low blood sugar should be adjusted upward after the INS,[link widoczny dla zalogowanych], the amount of each dose adjustment should start small. Fifth, lR-based INS obese type 2 diabetes, IR-based obesity treatment to type 2 diabetes, oral hypoglycemic drugs if treatment + diet,[link widoczny dla zalogowanych], blood glucose control are not satisfied, they may jointly exogenous INS treatment. One biguanide hypoglycemic agent treatment can reduce the weight of the joint INS continued upward trend, a glucosidase inhibitor treatment also reduces the INS INS dosage thiazolidinedione joint INS INS can enhance the sensitivity, decreased glucose in the clear while INS to reduce the amount of exogenous, these programs have more clinical studies are in this state is no longer tired. Sixth, the development of new insulin analogues insulin to overcome the current animal and human insulin preparations in solution,[link widoczny dla zalogowanych], easy-to-end accumulation of defects exist in the form of monomer solution, rapidly absorbed after injection, peak fast, half-life is short, clear fast, and postprandial hyperglycemia synchronization better than the current regular insulin, it is better postprandial blood glucose decreased, the next lower rate of fasting hypoglycemia, regular insulin is expected in the future replace the current product. Similarly, in the molecular structure of insulin by adding certain substances in the blood after it injection significantly longer half-life, absorption, blood concentrations of relatively flat, can cover 24h, to overcome the current peak of NPH absorption and short half-life of the shortcomings is the ideal base INS agents added in the near future, will enter clinical use.
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