Many sugar lovers know that insulin is the only glucose-lowering hormone in the body, when insulin injection is needed because of high blood sugar, how to maximize its glucose-lowering effect? We need to master the following points:

First, know the type of insulin preparation you are using.Don't make the wrong call, or buy the wrong one.

Second, understand the pharmacokinetic characteristics of the insulin preparation you are using, especially the onset and peak times, to inject insulin at the right time so that the peak rise in blood glucose coincides with the peak of insulin potency.

Third, choosing the correct insulin injection site, theEffective prevention of adverse reactions.

1, injection sites include: upper arms, abdomen, outer thighs, buttocks. Among them, the abdomen absorbs the fastest, the upper arm the next, and the buttocks the slowest.

2. The injection point should avoid 5cm around the navel, and the distance between each injection point should be at least 1cm.

3. Avoid stretch marks, redness, cellulite, cellulite, fat atrophy and other parts of the body.

4、Avoid the parts that need to be exercised within 1 hour after injection.

Fourth, learn the art of rotating injections.

1. Sub-regional, using one region per week and rotating clockwise.

2. Inject the same part of the body at the same time every day, and inject different parts of the body at different times every day. If you need to inject four shots of insulin in a day, you can arrange it in this way, theflank(before breakfast) -outer arm(before lunch) -outer thigh(before dinner) -buttocks(at bedtime).

1、Choose the appropriate type of insulin according to your condition. Insulin can be categorized into mealtime insulin, basal insulin and premixed insulin according to the classification of its action time and effect.

Meals are insulin: including short-acting human insulin and rapid-acting insulin analogs.

Basal insulin: includes long-acting animal insulin (PZI), intermediate-acting human insulin (also known as NPH), and long-acting insulin analogs.

Premixed insulin: a type of insulin with varying proportions of fisetin, which binds to short-acting insulin or rapid-acting insulin analogs, turning a portion of the insulin (75%, 70%, 50%) into an intermediate-acting component.

2. Insulin should be injected under the skin, not into the muscle layer. If diabetic patients accidentally inject insulin into the muscle layer, it will speed up the time for insulin to work, and what needs to be done at this time is to strengthen the blood glucose monitoring and eat some food according to the blood glucose condition to avoid hypoglycemia. To avoid injecting insulin into the muscle layer, you can choose a shorter needle or pinch the skin to inject.

3, insulin injection needle is a disposable consumable, do not reuse, if reused, the needle will be damaged, resulting in increased injection pain.

4, if you use insulin pen, after injection in order to avoid leakage occurs, you need to stay in the withdrawal money for 10 seconds, which can reduce the leakage occurs, if the leakage occurs in the process of insulin injection, it can make the effective functioning of insulin dose is reduced, affecting the blood glucose control.

5, many people in the injection will feel pain, need to do after alcohol sterilization of the skin, to be alcohol evaporation before injection, but also to do to relax, too nervous will also affect the injection pain.

Normal adult pancreatic islets contain about 1 million islets, which is about 2-3% of the total mass of the pancreas. Adult pancreatic islets can range in size from a few cells to thousands of cells. Based on histologic characteristics, human pancreatic islets consist of four different types of cells, mainly α, β, &, and PP cells. Of these, β cells are the most numerous, accounting for 75% of the total. Insulin is secreted by pancreatic beta cells, the only hormone in the body that lowers blood sugar.

Currently commonly used in clinical insulin according to the source classification: animal insulin, human insulin (semi-synthetic insulin and recombinant human insulin), human insulin analogues (1, fast-acting insulin analogues, such as: Novalis, Ulor, 2, ultra-long-acting insulin analogues, such as insulin glargine); in accordance with the rapidity of the onset of action and the duration of maintenance of the action: insulin can be divided into: ultra-short-acting, fast-acting, intermediate-acting, long-acting, and Pre-mixed insulin. Of these, intermediate-acting or long-acting insulins are used to provide basal insulin secretion, while short-acting insulins are used for post-loading blood glucose such as postprandial glucose.

There are various regimens for insulin use and insulin therapy, ranging from 1 injection per day to 4-5 injections per day. Generally speaking, the more frequent the injections, the smoother the glycemic control will be, and the easier the dosage adjustments will be. Of course too many injections can make life inconvenient. Below is a brief description of several insulin treatment options:

1. Supplementary treatment of insulin: On the basis of daily oral hypoglycemic drugs, one injection of intermediate-acting or long-acting insulin is given at night before going to bed, aiming at improving fasting hyperglycemia and strengthening the effect of taking hypoglycemic drugs during the day.

2、Twice daily injection of insulin replacement therapy: every morning and evening before meals 20-30 minutes injection of premixed human insulin (70/30 or 50/50), to control the fluctuation of blood glucose throughout the day, and at the same time to reduce or stop the use of oral medication, the advantages of this treatment is that the number of injections is small, the patient is easy to accept; the disadvantage is that it is difficult to adjust the dosage, and prone to hypoglycemia.

3. Four times a day insulin replacement therapy: short-acting or ultra-short-acting human insulin is injected 20-30 minutes before breakfast, midday and dinner every day, and medium-acting or long-acting insulin is injected once in the evening before going to bed. This treatment obviously has more injections, but it can control the blood glucose at all time points well and avoid hypoglycemia, and it is also the preferred option for patients with type 1 diabetes mellitus.

In addition, there is also insulin pump therapy: insulin pump, also known as Continuous Subcutaneous Insulin Injector System (CSII), which allows continuous subcutaneous delivery of small doses to mimic basal insulin secretion, and pre-programmed to deliver large doses of insulin before each meal, as needed, to control postprandial blood glucose. This is the best of all insulin regimens to mimic the physiologic insulin secretion pattern, so blood glucose can be better controlled, hypoglycemia incidence is low, and the quality of life of glucose users can be improved even more.

Jing Yun Zhang Unit: Beijing Fengtai Hospital Member of the Pharmacy Network September 29, 2018

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

The discovery of insulin is a milestone in the history of diabetes treatment, which directly gives the insulin that the human body lacks, so that the blood sugar can be fully utilized by the body, not only to maintain the normal operation of the body's various functions, but also to keep the blood sugar in the blood sugar at a normal level, to avoid damage to the blood vessels and other damages, which can be regarded as one of the most direct, most effective and safest ways to lower the blood sugar of diabetic patients.

As research on insulin continues to deepen, many types of insulin have been developed to meet the different needs of patients for insulin, in response to the different conditions of their blood glucose and the progression of their disease.

• Ultra-short-acting insulin: It takes effect 10-15 minutes after injection and lasts for 1-1.5 hours, commonly used ones are Novo Nordisk and Uroxin, etc. It can be injected before or immediately after meal.

• Rapid-acting insulin: It takes effect 20-30 minutes after injection and lasts for 5-8 hours, commonly used insulin with R such as Novolin R, Ulorin R, Gansulin R, etc. It needs to be injected 15-30 minutes before meal.

• Intermediate-acting insulin: It takes effect 1.5 to 4 hours after injection and lasts for 12 to 14 hours, commonly used insulin with N such as Novolin N, Ulorin N and Gansulin N. It needs to be injected every night before bedtime.

• Long-acting insulin: It takes effect 3 to 4 hours after injection and lasts for 20 to 24 hours, commonly used ones are NovoPeace, Lysol, Changxulin, etc. It needs to be injected every night before going to bed.

• Premixed insulin: It is a mixture of rapid-acting insulin and intermediate-acting insulin, such as 30% rapid-acting plus 70% intermediate-acting is called 30R, and rapid-acting and intermediate-acting each accounts for 50% is called 50R, and the commonly used ones are Novalurin 30R, 50R, Gansolin 30R, 50R, etc., most of them are injected 15-30 minutes before breakfast and dinner.

For the choice of insulin, it is generally categorized into insulin replacement therapy and insulin supplementation therapy.

• alternative treatment: It is suitable for patients with poor or basic loss of pancreatic islet function, as well as in the event of major events such as trauma, surgery, and serious infections. The so-called substitution means relying on exogenous insulin injections to meet the needs, and the common method is to inject fast-acting insulin before meals to reduce postprandial blood glucose, and to inject long-acting insulin at night before bedtime to control fasting blood glucose.
• complementary therapy: For patients with wasting diabetes mellitus who still have some insulin secretion but have poor glycemic control or are willing to accept insulin therapy. The general method used is premixed insulin once in the morning and once in the evening, and oral hypoglycemic drugs at noon or additional hypoglycemic drugs in the morning and evening if necessary.

In addition, insulin can also be used according to patients with different conditions. If the blood glucose is still high and fasting blood glucose control is poor after oral hypoglycemic drugs, a long-acting insulin can be injected at night before going to bed, and if it is difficult to control insulin after meal, ultra-short-acting insulin can be injected before meal, and so on.

In summary, depending on the patient's different blood glucose profiles, different insulin regimens can be developed with the goal of keeping blood glucose at target levels at all times throughout the day.

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The efficacy of insulin is not only related to the treatment regimen, but also whether the insulin injection apparatus and injection method are correct, and whether the insulin is properly preserved are also important factors, and these problems in the use of these operations can directly affect the performance of the insulin effect, which in a way is related to the success of blood glucose control.

Apparatus to be prepared for insulin injection

Sterilizers

Skin disinfection should be done with 75% alcohol or alcohol pads, not with iodine or iodophor, because insulin is a protein and its activity will be affected if it is disinfected with iodophor or iodine.

Injection device

It is not only inconvenient to extract and inject insulin with ordinary syringes, but also difficult to ensure the accuracy of the injected dose. It is recommended that patients use insulin pens for insulin injection as much as possible, which has the advantages of accurate dosage adjustment, easy to use, easy to carry, etc., and is easier to operate and master. Moreover, the needles of insulin pens are very small and almost painless when injecting, which greatly reduces the pain of diabetic patients when using ordinary needles to inject insulin.

insulin preparation

Before injection, check whether the insulin preparation is within the expiration date and whether the seal is undamaged. Short-acting insulin has a clarified appearance and should not be used if it is turbid, while turbidity is normal for medium- and long-acting insulin. When using intermediate- and long-acting insulin, the insulin should be mixed well by turning, rolling or slowly rubbing, and should not be shaken up and down vigorously.

People with diabetes should be aware of three things when taking insulin

First, confirm whether the patient needs to use insulin therapy and how to choose insulin; second, master the correct injection method when injecting insulin. Including pre-injection preparation, disinfectant as well as the preparation of the needle, insulin pen, insulin, the preparation of the injection site, the angle of the injection, the depth of stay, etc.; Third, master the basic knowledge of insulin injection. Clockwise or counterclockwise direction, in order to change the injection site; Fourth, the temperature of insulin storage, the disposal of sharp objects waste and adverse reactions.