Need to know aggressive insulin therapy

This is an automatically translated article.

The article was consulted professionally with MSc. Doctor Vu Thi Duyen - Doctor of Nephrology - Endocrinology, Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.
There are many treatments available to control blood sugar in people with diabetes, but insulin injections are the most common treatment. In which, aggressive insulin therapy is being used very well and often

1. What is aggressive insulin therapy?

Intensive insulin therapy is a regimen of insulin injections several times a day (4 injections/day) consisting of both long-acting insulin and rapid-acting insulin before meals or insulin injections to coincide with the physiological rhythm of normal insulin secretion. usually of the pancreas. It is one of the best comprehensive diabetes treatments for very tight blood sugar control. This method of treatment has advantages but also disadvantages such as the patient having to have many injections/day or automatic insulin pump every day, need to test capillary glucose before each injection, which takes a lot of time for the patient. .

2. Important elements of intensive insulin therapy

In order to control blood sugar well in diabetic patients with intensive insulin therapy, it is necessary to combine many factors to achieve good results:
The patient must test capillary glucose many times / day at least 4 times / day. Have a plan and set blood sugar control goals. Adjustment of insulin dose should be based on daily glucose testing with daily insulin therapy. Build a healthy reasonable diet, especially the daily carbohydrate content. Daily energy in and out and physical activity and daily insulin dose should be controlled. Control the carbohydrate-insulin ratio according to the diet. Adjust insulin dose based on daily capillary glucose test results. Create good motivation for patients to best interact between patients and medical staff.

3. Intensive insulin therapy

3.1. Id meals during the day. At this time, it is necessary to switch to a regimen of rapid insulin injection or short insulin before meals according to physiology to be able to control postprandial blood sugar well.
3.2. Injections in intensive insulin therapy Combine short- or rapid-acting insulin injections before meals with injections of slow-acting insulin (NPH) or long-acting insulin analogue. This therapy is divided into 2 regimens:
Regimen 1: Inject 1 injection of basal insulin with 1 or 2 injections of rapid or short insulin at 1 or 2 meals without postprandial blood sugar control such as breakfast and dinner. . This therapy is proposed as partial supplemental insulin therapy
Regimen 2: Inject 1 injection of basal insulin with 3 quick or short injections before 3 main meals without control of postprandial blood sugar (morning). , noon, evening). This therapy has been proposed as total add-on insulin therapy.
3.3. Dose of insulin injection in active therapy Type 1 diabetes
The dose can range from 0.5 - 1.0 UI/kg body weight. Initial dose: from 0.4 - 0.5 UI/kg/day. Usual dose: 0.6 UI/kg/day. Type 2 diabetes
Injection dose: Starting from 0.2 UI/kg/day. The usual dose is 0.3 - 0.6 UI/kg/day. Basal insulin dose: 0.1 - 0.2 UI/kg. 3.4 . Intensive insulin regimens

There are different aggressive insulin regimens that are used depending on the individual patient.
Type 1 diabetes: Usually use a regimen of 2-4 injections/day. Type 2 diabetes: In addition to the same regimen as type 1 diabetes, it is possible to use a regimen of 1 dose of basal insulin in combination with pills. Gestational diabetes: Usually 1 - 4 injections/day injection regimen is used, depending on the patient's blood glucose concentration. One-shot insulin regimen: Combine antidiabetic tablets with 1 shot of intermediate- or mixed-acting insulin before dinner or 1 shot of intermediate-acting insulin or Glargine in the evening before bedtime. Dosage: 0.1 - 0.2 UI/kg; Two-shot insulin regimen: Usually 2 injections of intermediate-acting insulin or mixed insulin are injected before breakfast and dinner. Divide the dose by 2/3 before breakfast and 1/3 before dinner. Multiple insulin injection regimen: When the above treatment regimens are not effective (ie fail) but have well controlled the patient's diet and daily activities. At this time, the patient needs to closely control blood sugar (due to pregnancy or serious complications), then it is necessary to switch to another treatment regimen with many insulin injections a day. If the 3-time-daily injection regimen is applied, it is recommended to inject 2 injections of rapid insulin - 1 injection of semi-slow insulin or 2 injections of semi-slow insulin or basal insulin. If a 4-times-daily injection regimen is used, 3 injections of rapid-acting insulin should be applied before 3 meals and 1 base dose of NPH or Glargine type before bedtime (approximately 21-22 hours). 3.5 Some notes on intensive insulin therapy for patients Hypoglycemia is the most common complication when injecting rapid or short-acting insulin, even slow-acting insulin. The majority of cases of hypoglycaemia occur when insulin overdose is not determined, because the syringe does not match the vial, skipping meals or eating later than the prescribed time after injection. , exercise a lot,... Therefore, before injecting intensive insulin therapy, doctors need to instruct diabetics and caregivers how to detect early symptoms of complications of hypoglycemia and how to manage them. in place. Check the electrocardiogram to assess for cardiac complications from hypoglycemia with a QTc ≥ 440 ms if hypoglycemia is suspected or at each follow-up visit. Evaluate dementia scores or brain function MRI if signs of dementia secondary to hypoglycemia are suspected. Beware of the risk of insulin pump therapy that diabetic ketoacidosis due to pump or injection site problems can disrupt insulin delivery. Intensive insulin therapy is an effective method of blood sugar control. To ensure effective diabetes treatment of this therapy, patients need to absolutely follow the doctor's instructions during the treatment.

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