Insulin therapy as an important means of blood sugar control has been widely used clinically, from animal insulin to recombinant human insulin, to human insulin analogs, insulin The preparation has brought the gospel to the lives of the majority of diabetic patients.
However, like other medicines, insulin will also have some adverse reactions during the treatment process. When adverse reactions occur, how should we deal with them? Let’s find out together.
1
Hypoglycemic Response
For diabetic patients, when the blood glucose value is ≤3.9 mmol/L, hypoglycemia can be diagnosed. Generally manifested as sweating, hunger, palpitation, trembling, pale complexion, etc., and even coma in severe cases.
Common reasons
1. Too strict blood sugar control goal setting or one-sided pursuit of short-term achievement.
2. The treatment plan or insulin dose adjustment is unreasonable.
3. Improper dietary structure, low calorie intake or excessive exercise without timely adjustment of insulin dose.
4. The time point of blood glucose monitoring is wrong or the frequency is insufficient.
5. At the same time, use drugs that can increase insulin levels or enhance its effect, such as sulfonamides and salicylic acid preparations.
6. Combined with special conditions affecting glucose homeostasis, such as vomiting, diarrhea, postpartum, hypothyroidism, adrenal insufficiency, hepatic insufficiency, renal function Not all equal.
7. Inappropriate selection of premixed insulin preparations, insufficient shaking of premixed preparations before use, etc.
countermeasures
1. For the above-mentioned causes of hypoglycemia, blood sugar should be measured immediately to confirm the diagnosis when hypoglycemia is suspected.
2. Dealing with low blood sugar
Those who are clearly conscious should be given 15~20 g of sugar food (glucose is preferred) );
patients with impaired consciousness were given intravenous injection of 50% glucose solution 20-40 ml or intramuscular injection of glucagon 0.5-1.0 mg; re-measurement of the fingers after 15 minutes Spike blood sugar until it returns to >3.9 mmol/L;
Patients on insulin pump therapy should suspend the pump, check that the pump is working properly, set the program correctly, check the insulin Infusion time, basal infusion rate, pre-prandial high dose, daily total; check the status screen and the drug reservoir, if the amount of insulin in the drug reservoir is less than the amount displayed on the status screen, it may be an insulin pump infusion excess.
3. Adjust insulin dosage
Patients with hypoglycemia may consider temporarily reducing basal insulin or even stopping the pump. Adjust insulin doses based on timing of hypoglycemia and its relationship to meals, exercise, and insulin infusion.
4. Precautions for insulin dose setting and adjustment
Basic and mealtime insulin doses should be within the recommended range Start with a small dose and gradually increase the dose until the blood sugar level is reached.
Insulin sensitivity can be improved to some extent after correcting hyperglycemia toxicity, especially some newly diagnosed T2DM patients are more prone to hypoglycemia after intensive insulin therapy, and insulin should Timely reduction.
Choose insulin analog therapy with less risk of hypoglycemia.
Before intensive therapy, if a long-acting hypoglycemic drug is used, such as long-acting sulfonylureas, basal insulin, insulin sensitizers, etc., the starting basal rate on the day It should be considered to reduce the dose by 10% to 30%, and the dose should be adjusted again according to the blood glucose monitoring situation the next day to avoid the risk of hypoglycemia caused by overlapping hypoglycemic effects.
2
Weight Gain
Common Causes
1. In untreated diabetic patients, glucose is excreted from the body through urine, and the body will use protein and fat to decompose for energy; after insulin injection, insulin promotes the synthesis and storage of body fat and protein, which may increase body weight. possible.
2. The diet is too large, the structure is unreasonable, and high-sugar and high-fat foods are eaten.
3. Insufficient physical activity.
Countermeasures
Increase the frequency and time of exercise: exercise at least 30 minutes a day and 150 minutes a week.
Scientific diet, control the total calories, should calculate the daily total calories according to the standard body weight, activity level, age, etc., and distribute them reasonably. Breakfast, lunch and dinner each account for 1/3 , Appropriately increase the intake of whole grains and vegetables rich in crude fiber.
Monitor your weight.
Under the guidance of a doctor, combined use of acarbose, metformin, GLP-1 receptor agonists (such as: liraglutide, semaglutide, Laglutide), DPP-4 inhibitors (such as sitagliptin, saxagliptin) and other drugs, these drugs can reduce blood sugar while reducing weight.
3
Allergic reactions
Insulin allergy has local and systemic manifestations, local allergic manifestations For skin itching, redness, subcutaneous induration, rash or blisters, etc.; systemic allergies include urticaria, wheals, and severe cases can lead to anaphylactic shock.
With the continuous improvement of insulin pharmaceutical technology, allergy phenomenon has been relatively rare.
Common Causes
Impurities contained in insulin preparations, certain added components such as Zinc, protamine) and insulin itself can cause allergies;
The patient has a special constitution, such as allergic constitution.
Countermeasures
Change to a different type or manufacturer of insulin.
Adjustment of the treatment plan: There are currently many types of oral hypoglycemic drugs, some of which have few side effects, and can be changed to oral hypoglycemic drugs.
If an allergic reaction occurs only to the local injection of insulin, and the symptoms are mild,It will go away on its own after a while, and no special treatment is required.
If the allergic reaction persists, topical or oral anti-allergic drugs can also be used.
4
insulin-induced edema
some patients have good blood sugar control with insulin , but may be accompanied by facial and lower extremity edema.
Insulin-induced edema is generally mild and resolves spontaneously within a few weeks. Therefore, mild edema does not require special treatment and does not require discontinuation of insulin.
Common Causes
After the use of insulin, the blood sugar in the body is controlled, the serum glucagon decreases, and the effect of aldosterone is inhibited decreased, and sodium excretion decreased.
Insulin promotes the reabsorption of sodium in the renal tubules, causing water and sodium retention in the body to cause edema.
Countermeasures
When there is edema, pay attention to a low-salt diet to avoid eating too salty and cause edema to worsen. The amount of salt is 3-6 grams.
Appropriately limit the amount of water you drink.
In individual patients with severe edema, low-dose diuretics (such as hydrochlorothiazide) can be added to prevent heart failure.
5
Lipodystrophy
Lipodystrophy has two diametrically opposed manifestations:
1. Subcutaneous lipoatrophy, that is, the local depression of the skin at the injection site, which is mainly related to the impurity of insulin preparations;
2. Subcutaneous fat hyperplasia, that is, the hyperplasia of the subcutaneous tissue Or lumps, because insulin has the effect of stimulating localized fat hyperplasia.
Countermeasures
The site of each injection should be changed. Do not inject twice in the same site within 1 week, and the two injection sites should be at least 1 cm apart.
At the end of each injection, a new needle should be replaced to reduce irritation to local tissues and promote repair.
Physical therapy such as hot compress and massage is used to promote the tissue to slowly return to its original state.
6
Blurred vision
Blurry vision can sometimes occur during insulin therapy. It is especially common in diabetic patients who are newly treated with insulin.
Common Causes
Due to insulin treatment, blood sugar drops rapidly, which affects the osmotic pressure of the lens and vitreous, and causes water in the lens. The overflow and the refraction decrease, resulting in hyperopia.
Countermeasures
Don’t worry if this happens, after the human body gradually adapts to the lowered blood sugar, the vision will be in the gradually recovered within a few weeks.
If the blood sugar control is stable, but the blurred vision does not recover, you should go to the ophthalmologist to check the fundus in time.
Although insulin has these adverse reactions, it can help diabetic patients significantly reduce and delay the occurrence and development of diabetic complications, and is still a very effective anti-diabetic drug in the treatment of diabetes. sugar pills.
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Medicine Huitong
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