Insulin therapy is a core treatment for patients with diabetes, primarily aimed at mimicking the body's natural insulin secretion to regulate blood glucose levels. This therapy is suitable for patients with Type 1 diabetes (due to β-cell damage preventing insulin secretion), as well as for patients with Type 2 diabetes when oral medications fail to control blood sugar. Additionally, pregnant women with gestational diabetes or patients with severe metabolic disturbances may require short-term or long-term insulin use.
Insulin therapy is classified into four main types based on action duration: rapid-acting (e.g., Aspart), short-acting (e.g., Regular insulin), intermediate-acting (e.g., NPH), and long-acting (e.g., Glargine). Its mechanism involves subcutaneous or intravenous injection, allowing insulin to bind to receptors on cell surfaces, promoting glucose uptake into the liver, muscles, and adipose tissue, thereby lowering blood glucose levels.
Main indications include: Type 1 diabetes (completely dependent on exogenous insulin), Type 2 diabetes when oral medications are ineffective or in cases of hyperglycemic crises, gestational diabetes requiring intensified blood sugar control, and blood glucose management before and after surgery. Additionally, emergencies such as diabetic ketoacidosis or hyperosmolar hyperglycemic state also require immediate insulin administration.
Insulin is typically administered via subcutaneous injection, with injection sites including the abdomen, thighs, or buttocks, which should be rotated regularly to prevent lipodystrophy. Dosage calculation is based on factors such as patient weight, diet intake, physical activity, and blood glucose monitoring results. For example, basal insulin may be administered once daily, while mealtime insulin is injected 15 minutes before meals. Dose adjustments must strictly follow medical instructions, avoiding self-increase or decrease.
Initial doses are usually lower than standard and are gradually adjusted based on blood glucose monitoring results. Patients using insulin pumps (Insulin Pump) may adopt a basal-bolus regimen combined with continuous glucose monitoring systems (CGM) for increased precision. Special populations such as the elderly or those with renal impairment should have their doses adjusted to prevent hypoglycemia.
The most serious side effect is hypoglycemia (blood glucose below 70 mg/dL), which may cause dizziness, palpitations, and in severe cases, coma. Long-term use may lead to lipodystrophy or hypertrophy at injection sites, and some patients may develop insulin antibodies or allergic reactions. Overdose injections can also cause hyperosmolar hyperglycemic state (HHS).
Contraindications include allergy to insulin components or a history of severe hypoglycemia. During use, attention should be paid to avoid exercise on an empty stomach, alcohol intake, and irregular meals. Patients need to monitor blood glucose daily, keep injection sites clean to prevent infection, and store insulin in a cool place away from freezing or high temperatures.
Concurrent use with β-blockers may mask hypoglycemia symptoms, requiring careful monitoring. Oral hypoglycemic agents (such as sulfonylureas) or GLP-1 receptor agonists may enhance insulin effects, necessitating dose adjustments. Anticoagulants (such as warfarin) may have altered metabolism due to insulin therapy, requiring coagulation monitoring.
Clinical studies show that regular insulin use can reduce HbA1c (glycated hemoglobin) by 1-2%, significantly decreasing the risk of retinopathy, nephropathy, and neuropathy. The basal-bolus insulin regimen in Type 2 diabetes patients can keep hypoglycemia risk within acceptable ranges.
Oral medications such as Metformin, SGLT2 inhibitors (e.g., Dapagliflozin), or DPP-4 inhibitors can be used as initial treatments for Type 2 diabetes. Injectable GLP-1 receptor agonists (e.g., Liraglutide) are also available for some patients. However, patients with Type 1 diabetes, due to lack of insulin secretion, require lifelong insulin therapy.
How should insulin be properly stored to ensure its efficacy?
Unopened insulin should be stored in the refrigerator (2°C to 8°C), avoiding freezing. Opened insulin pens can be kept at room temperature (not exceeding 25°C) for 4 to 6 weeks, away from direct sunlight and temperature fluctuations. Expired or spoiled insulin may affect blood glucose control; check for cloudiness or precipitates before use.
What should I do if I experience hypoglycemia after using insulin?
If symptoms such as sweating, trembling, or palpitations occur, immediately consume 15 grams of fast-acting carbohydrates, such as 15 glucose tablets or 150 ml of fruit juice. Measure blood glucose after 15 minutes; if not improved, repeat once. Long-term, adjustments to dosage or injection timing should be made with a doctor, and carry a medical ID for emergency situations.
How should insulin doses be adjusted during exercise to prevent blood sugar fluctuations?
Exercise accelerates glucose metabolism; it is recommended to check blood sugar before exercise and consult a doctor for dose adjustments. Choose times when insulin action is weaker for exercise, and carry sugary snacks to cope with potential hypoglycemia. After high-intensity exercise, close monitoring of blood glucose for the next 24 hours is necessary.
Does long-term insulin use lead to drug resistance?
Insulin itself does not cause resistance, but weight gain or β-cell function decline may increase the required dose. This is related to the natural progression of the disease, not drug failure. Regular evaluation by a doctor, combined with oral medications or dose adjustments, can delay disease worsening. Maintain close communication with the healthcare team.
How to choose different types of insulin based on lifestyle?
Rapid-acting insulin is suitable for injection before meals, aligned with mealtime; intermediate- and long-acting insulins provide background control and require fixed injection times. Patients should develop a personalized plan with their doctor based on daily eating habits, activity levels, and blood glucose fluctuations to avoid mismatches between dose and lifestyle.
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