胰岛素怎样计算用量（How dose insulin be calculated）

胰岛素怎样计算用量（How dose insulin be calculated） 胰岛素怎样计算用量(How dose insulin be calculated) How dose insulin be calculated? - normal fasting blood glucose maintained at 3.3~6.1mmol/L (60~110mg/dl), the meal in half an hour to 1 hours in general 10.0mmol/L (180mg/dl), a maximum of no more than 11.1mmol/L (200 mg/dl), 2 hour after the meal back to 7.8mmol/L (140 mg/dl). - How dose insulin be calculated? (I) how to estimate its initial consumption: - Patients with diabetes should be treated with short acting insulin at the start of insulin use. In addition, the initial dosage should be estimated according to the following methods on the basis of relative stability of diet and exercise, and then adjusted according to the condition monitoring result. - 1, according to fasting blood sugar estimation: - The daily dosage of insulin (U N) fasting blood glucose (mg/dl) -100]x10x weight (kg) / 1000 / 2 - x0.6 100 for normal blood glucose; - X 10 is higher than normal blood sugar per liter of body fluid; - X 0.6 is the total body fluid volume of 60%; - "1000 is converted to glucose Mg - G; 2 / 2 grams of glucose using 1 insulin. - In order to avoid hypoglycemia, the actual amount of 1/2--1/3 is used. - 2, according to 24 hour urine estimation: no light condition, diabetic nephropathy, renal glucose threshold of normal, per 2 grams of glucose to 1 mu insulin. - 3, according to weight calculation: blood sugar is high, the condition is heavy, 0.5--0.8 mu /kg; the condition is light, 0.4--0.5 mu /kg; the condition is heavy, stress state should not exceed 1 mu /kg. - 4, according to 4 estimates: no glycosuria diabetic nephropathy, renal glucose threshold is basically normal, according to the qualitative urine before each meal "+" estimated. Generally, a "+" requires 4 insulin. - 5, comprehensive estimation: there are many factors in vivo effects of insulin action, individual differences, the calculation may not be consistent with the actual condition, it should be comprehensive, blood glucose and urine glucose, first to a certain amount, and then according to the condition changes gradually adjust. - (two) how to allocate insulin dosage - According to the above estimate, take the 15--30 minutes before meals, and distribute it before breakfast > before dinner > before lunch. Due to the hormone before breakfast in antagonizing insulin secretion is more, so the amount of insulin should be larger; and the general effect of short acting insulin peak time of 2--4 hours before lunch, so the smallest amount; most of the patients sleep no longer use insulin, and then to the next morning, so before dinner and lunch than before a large amount of. Such as before going to bed once, then before dinner to reduce, and before bedtime use less, in case of nocturnal hypoglycemia. - (three) how do you adjust your insulin dose? In the estimation of initial amount of observation for 2--3 days, further adjust the dosage according to the disease, blood glucose and urine glucose to. - 1, according to the 4 qualitative urine adjustment: apply only to non conditional blood glucose and renal glucose threshold in patients with normal. Adjusted on the basis of the 4 qualitative urine 3--4 days before the amount of insulin before breakfast before lunch before lunch on urine glucose, insulin dosage according to urine before dinner, dinner according to the amount of insulin before bedtime or the next morning urine (including the urine). - 2, according to blood sugar adjustment: diabetic patients, especially those with type I diabetes and abnormal renal sugar threshold, should adjust the dosage of insulin according to the blood sugar before and after the meal - glycemic index (mmol/l), mg/dl, pre prandial insulin increment, other treatments <2.8 <50 reduces 2--3 Mu meal immediately 2.8--3.9 50--70 reduces 1--2 Mu 3.9--7.2 70--130 primary dose 7.2--8.3 130--150 plus 1 mu 8.3--11.1 150--200 plus 2 mu 11.1--13.9 200--250 plus 3 mu 13.9--16.6 250--300 plus 4--6 Mu 16.6--19. 4 300--350 plus 8--10 per mu, pre meal activity increased by minus 1--2, or added meal - pre meal activity decreased by 1--2 Mu I. preparation of pump for insulin pump: - Knowledge of history, history of diabetes mellitus, history of insulin use, past medical history, age, sex, height, weight, obesity, etc.. - Use short and ultra short acting insulin: in 18-72 hours use of long-acting insulin, use short acting multiple insulin injection, blood sugar instability as soon as possible with the pump. - Insulin preparation: insulin is placed at room temperature 6 hours earlier. - Set up procedures: set the basis of the pump with large doses, clocks and other related data. - Dress up insulin and make sure it is released normally. - Skin treatment installation: avoid the navel and belt parts. - Two. Set the amount of insulin used in the pump 1. initial pump insulin usage - Before starting the insulin pump treatment, the most important thing is to determine how many doses of insulin are needed throughout the day, that is, the daily amount of insulin. - Calculation basis: - Calculate the dosage of insulin and the blood glucose of the patient before the pump - 2. determine the starting dose of insulin pump (used in patients who have never been injected with insulin) according to the patient's condition and the actual weight - Three basic rate and large dose setting - The normal insulin secretion of pancreatic islets is based on secretion and after eating hypersecretion is composed of two parts, including basic secretion accounted for 50% of the total production all day long (40% - 60%), postprandial insulin secretion also accounted for about 50% (40% - 60%). - The insulin pump simulates the physiological secretion of the human pancreas to the maximum, and it pumps the basal secretion of the pancreas and the insulin secreted after eating into the pump. They are basal dose and high dose before meal. - (1) basal dose: the manner in which insulin is administered under the condition that the pump is unique and simulates non feeding. - 1 Calculation of basic quantities - 2 how to set the foundation on the pump - 3, the foundation of the pump is set correctly or not to be tested, and its detection is carried out in the following four periods: - A sleep - get up early in the morning (do not sleep before meals, fasting overnight) B after getting up - before lunch (without breakfast) - C before lunch - before dinner (without lunch) - D dinner - before going to bed - (without dinner) - 4 set the correct standard for the base amount: - A. fasting plasma glucose 5.6 - 7.2mmol/l - B. No hypoglycemia - Blood sugar stable or only slightly decreased the number of hours C any one meal in the range of less than 30% or less than 1.7mmol/l. - 5, too many basic signs: - Without eating, blood sugar drops - Meals are often added without increasing the amount of exercise, or hypoglycemia will occur Hypoglycemia in the middle of the night - Hypoglycemia before breakfast - Low blood sugar during the day - 6 signs of too little base Without eating, blood sugar rises too It's basically high blood sugar Often increase pre - prandial or large doses to correct hyperglycemia - 7 principle of adjustment of basic quantity Baseline rates should be adjusted between 2 and 3 hours (short acting insulin) or 1 hours (ultra short acting insulin) before blood sugar fluctuations - - The base rate should be increased or decreased by 0.1u/ hours (especially for type 1 patients) at each adjustment For example: the patient (the use of short acting insulin glucose in the morning) began to decline in 1, then in 10 point and 11 point to set a lower rate, the base rate per hour decreased gradually to achieve 0.1U target. - 60%, there will be "dawn" phenomenon, if this phenomenon can be doubled basis, especially 5am - 7am - On the basis of the clinical rate from 3-5 to - (two) large doses: insulin pumps simulate the rapid mass production of insulin in B cells after eating. That is, before the intake of the basic quantity of the food, the insulin pump is added to the button to add a certain amount of insulin. We call it a large dose. - High dose calculations - The sum of the large doses before meals equals 50% of the total insulin dose throughout the day - Total dose before total meal = 1 days total * 50%- Method A assigned according to the amount of meal per meal - Before breakfast, large dose = 1 days total * 20%- Before lunch, large dose = 1 days total * 15%- Before dinner, large dose = 1 days total * 15%- Method B calculated according to carbohydrates - As individuals differ in their insulin sensitivity, about 1 grams of insulin is needed per 12-15 grams of carbohydrates, and large body sizes are needed. - Determine the appropriateness and safety of additional doses before meals: - The patients treated with short acting insulin restored the blood glucose to the level of the target blood glucose before meal and the target blood glucose was slightly higher than 30mg/dl (1.7mmol/l), which was 4-5 times higher than that of the target blood glucose. - The patients treated with ultrashort acting insulin restored the blood glucose level to the target blood glucose range before meal or to the target blood glucose level by 30mg/dl (1.7mmol/l) at 3 - 3.5 hours. - Four installation and opening of insulin pumps - (a) steps - Step 1: load the battery. - The second step: boot - The third step: setting the clock - Fourth step: extract the insulin and fill the pump special storage device. - The fifth step: to store the medicine into the pump ---- install the medicine storage device. - The sixth step: connect the storage device to the upper passage. - The seventh step: to set up the basic amount (usually decided by the doctor) and set a high dose before meals. - The eighth step: filling infusion catheter - The ninth step: "buried needle" skin disinfection (injection sites: the abdomen: the absorption of insulin is the fastest, more predictable, the effect of the less parts replacement: other optional parts including hip, thigh and upper arm, a front distance Part 3 - 5cm) to the front end of the conduit the needle subcutaneously and fixed with adhesive film. - (two) notes on installation of [/B] insulin pump - (the following installation notes are limited to individual self - Installation consumables) - After the purchase of insulin pump need to be installed, while the installation steps each kind of insulin pump supplies are similar, but one thing is the same, is in every re charge to replace the injection site all need to pay attention to the following points, following one by one that in turn to the following: - 1, installation of blood glucose detection before: this point here I don't have too much on, but at this time of blood glucose detection is to replace parts and replacement supplies after you determine whether you should add the appropriate amount of insulin. - Through 2, the installation of the liquid reservoir and supplies exhaust pipe: because the insulin pump use reservoir storage in advance of insulin, so we must make the exhaust reservoir before installation, to avoid gas retention; at the same time, because the pump piping is connected with the needle body, so the change with the new when the pipe are required special functions provided by the accumulator or insulin pump through the pipeline (see about one or two drops of insulin through the needle), in order to avoid gas pipeline caused by residue in the subcutaneous injection of insulin can not produce normal, high blood sugar can not be avoided. - 3, after the installation of new supplies, you should usually check the situation of blood sugar to confirm whether the injection of insulin is normal. - Because under normal circumstances if the hospital installed insulin pump, daily blood glucose test 7-8 times: before meals, two hours after meals, at bedtime and evening 2-3 o'clock at night; and if the family needs replacement supplies depends on your new supplies of the time, generally detected before and after the installation of the blood sugar should be arbitrary in this 7-8 points in two points, so the general can determine whether the normal properly installed. - 4, all instructions are pointed out in the insulin pump supplies the available period for 7-10 days, but usually 6-7 days for a limit of stay, otherwise easy to produce subcutaneous induration, while insulin also due to subcutaneous induration and elevated blood glucose absorption is not good, caused by unknown reasons (and I had this situation the number of the same sugar from each other on), it is proposed to replace supplies intervals up to 7 days, and on the day of the replacement supplies should pay more attention to the fluctuation of blood sugar, avoid the increase because of other external causes blood sugar. - Five. Experience of using insulin pump 1, the use of insulin pump insulin for short or short acting (if the Novo Nordisk products for Novolin R or Nuo Herui), and do not use premixed or long-acting insulin, in order to avoid the damage of equipment. Using the difference is smaller and Novolin novorapid Novolin basic amount, large amount and additional; novorapid and its opposite (the situation encountered in the hospital outpatient service), but because the current novorapid is still at the expense and the price is expensive and therefore has not yet been fully Novolin, popularization. - 2, because of long-term and low-dose insulin pump continuous subcutaneous injection, so the use of injections and two daily needle, three pin, four pin compared to less insulin dosage, generally can be identified by all day long by needle injection dose of 75%-85% as insulin pump use day dosage of insulin, which 50% as a continuous injection of small dose (we usually use all day long called for the foundation, the same below); and the other 50% as a temporary injection of three meals a day before the amount (we call it the additional quantity, the same below). The general situation in the installation of pump in hospitalized patients, the doctor is the patient adjusted base quantity and amount of time, this volume in patients after discharge is generally not easily adjusted, in order to avoid the occurrence of accidents such as ketosis (this was encountered in the hospital outpatient cases, patients after hospital rear adjustment improve symptoms again); the additional amount is before breakfast "before dinner. Before lunch, the amount of patients can be adjusted, but the principle can not be changed, otherwise it is easy to produce hypoglycemia and other unforeseen circumstances. - 3, in the process of using insulin pump may occur, accidents such as leakage plugging, thus requiring patients in use should be familiar with the exclusion of the relevant circumstances, if the troubleshooting device itself, the possibilities are as follows: (1) if the needle into the skin when the blood flows back to the counter pipeline; (2) if the needle into the skin when the hole; (3) if the needle into the subcutaneous fat layer is shallow, it may happen (about this once and other sugar friends summed together on), in this case should replace the supplies and the injection site in a timely manner, to avoid high blood sugar. - How to use insulin pens Insulin pen is a compact and convenient insulin injection device. It is easy and quick to operate under subcutaneous injection. The dosage is easy to control, and the accuracy is high. At present, the domestic market sales of "and", "yummy (Lilly)" and "when" brand in 3. No matter which brand of insulin injection you choose, you should remember the following rules. However, the instructions accompanying the product should be carefully read before actual use. Many diabetic patients are not familiar with the use of insulin pens in clinical work. Here are some instructions for the use of insulin pens, for your reference. 1. Install the refill: check that the pen is intact before the installation. If there is any breakage, replace it. Turn on the lead frame, a cartridge. 2. Check the amount of insulin in your pen and shake it well: check if there is enough insulin in the injection pen. If insulin or premixed insulin is used, hold it in your hands and gently shake it up and down until the insulin is shaken. 3. Install the needle: use 75% alcohol to sterilize the front membrane of the refill, take out the needle, open the package, tighten the needle clockwise and take off the needle cap. To ensure safety, please use a new needle at a time. 4, exhaust: Zero display unit dose knob dial to the 2~3 unit, tip upright, finger flick pen core frames several times, so that the air gathered in the upper part, a key press to have a drop of injection of insulin from the needle overflow, said drive rod and has full contact in the core and the pen refill bubble has been discharged as far as. Otherwise, this operation must be repeated. 5, dosage choice: rotating dose adjustment knob, adjusted to the required number of injection units. 6 injection methods: injection site routine disinfection, the left thumb, forefinger pinch abdominal fat layer, right hand holding fast vertical needle, right thumb button injection injection, after injection in subcutaneous continue to stay 6 to 10 seconds, and then along the direction of the needle quickly pull the needle, do not use cotton swab rub the injection site remove the needle, discarded, replacement of the next injection needle. 7, reduce the pain on injection techniques: insulin at room temperature; the alcohol evaporates after injection; bubble free refills; the needle into the needle and faster; when the needle does not change the direction; muscle relaxation; replacement of parts of needle injection; don't reuse; avoid the scar or induration at the site of injection. 8, after the injection of insulin: the insulin pen can not save the fridge, insulin in the unopened case, the best method of storage is 2 to 8 DEG C to the refrigerator, in this case the insulin and insulin refill bottled can be preserved for two and a half years. Therefore, many patients in the clinical practice of insulin and injection refills are placed in the refrigerator to save. It has been used in insulin pen in insulin is not in favor of the refrigerator, because it will have some effects on insulin pen, so the unused insulin pen and the inside of the insulin should be placed in the refrigerator preservation. Insulin can also be kept for 4~6 weeks at room temperature at 25, and the insulin in the pen will run out quickly, so patients don't have to worry about the insulin in their insulin pens. If the temperature is really over 30 degrees, you can use a vacuum bag to keep it. The insulin in the cartridge can not be frozen, and the insulin solution after freezing can easily lose its biological activity. Insulin pens are not exposed to the sun. Using insulin pens is skillful Although the insulin injector has undergone a "four step" development, significant progress has been made in terms of convenience and accuracy, but there are still several points that require special attention when the patient is injected with insulin: First of all, be prepared before injection: 1. decide when to eat and make sure you have dinner within 30-45 minutes of the injection. 2. prepare tampons, needles, insulin pens, and insulin. Note that insulin pens and insulin must be produced by the same manufacturer, so as not to fail. 3. check the dosage form of insulin again. 4. carefully examine the appearance of insulin, medium effect, long-acting insulin, or premixed 50/50 and 70/30 insulin, which appear to be homogeneous suspensions, gently shaken, such as milk. If gently shake, the bottom of the bottle has sediment, the liquid has small clumps of objects precipitation or suspension, there is a layer of "frost" like object adhered to the bottle wall, it can not be used. Then select the appropriate injection area: the commonly used insulin injection sites include the upper arm, the abdomen, the thighs, and the hips. An injection area of 2 cm2 is used, and each injection site can be divided into a number of injection zones. The injection zone means that each injection should be in one zone. Each injection site should be rotated instead of being injected several times in an injection zone. The abdomen is the preferred site of insulin injection, abdominal insulin absorption rate can reach 100%, absorption speed and subcutaneous tissue hypertrophy, can reduce the risk of injection to the muscle layer, the most easily self injection. Next, the injection must be checked for adequate doses of insulin before each injection. When the left hand gently pinch the injection injection parts of the skin, the right hand holding the needle directly into the insulin pen pinch the skin, injection, after injection, the thumb away from the dose knob, the needle stay for more than 10 seconds in the skin, then pull out the needle, With a dry cotton press needle for 3 minutes. After injection should be set on the nail cap, unscrew the needle, the needle will waste away, put back the cap. At the same time to pay attention to the preservation of insulin, in general, insulin refill unopened can be stored at 2 C and 8 c environment (refrigerator), after the opening of insulin loaded inside the pen refill at room temperature (< 25; c) can be preserved for 1 months. Patients should pay special attention to insulin. The pen core can not be frozen or exposed to sunlight.