Analysis of Insulin Therapy for Type 2 Diabetes: How to Manage it in Conjunctive with Scientific Weight Loss?

Insulin Therapy:

1. Indications
Currently, there are various insulin preparations available. Classified by composition, they include insulin extracted from pig and bovine pancreas, semi-synthetic insulin, and artificially biosynthesized insulin, with the latter showing the best efficacy. Based on the duration of pharmacological action, they can be divided into short-acting, intermediate-acting, and long-acting categories.

The indications for insulin use in patients with type 2 diabetes are as follows:

(1) Complicated by ketoacidosis or hyperosmolar coma.

(2) Complicated by pregnancy.

(3) Accompanied by active liver or kidney disease, or significant chronic complications of diabetes.

(4) Accompanied by malnutrition, delayed growth and development, or long-term wasting diseases (such as tuberculosis), or stress states (such as infection, surgery), etc.

(5) Patients whose blood sugar is not well controlled by diet and oral hypoglycemic agents.

2. Treatment Plans

Insulin therapy for type 2 diabetes can be divided into two plans:

(1) Combination Therapy: Continue oral hypoglycemic agents and inject intermediate-acting insulin once before bedtime at a dose of 0.2 U/kg body weight. The insulin dosage can be adjusted according to fasting blood glucose. If a dosage of more than 30 U is required to achieve good blood glucose control, oral hypoglycemic agents may be discontinued and replaced with insulin therapy.

(2) Insulin Therapy: Depending on the condition and treatment effect, the following methods can be selected:

① Use short-acting insulin before breakfast, lunch, and dinner, and intermediate-acting insulin before bedtime;

② Use a combination of intermediate-acting and short-acting insulin, applying 2/3 of the daily dose before breakfast and 1/3 before dinner;

③ Use intermediate-acting plus short-acting insulin before breakfast, short-acting insulin before lunch, and intermediate-acting plus short-acting insulin before dinner.

The insulin dosage should be determined based on blood glucose, the condition, and the body's sensitivity to insulin.

After adopting an insulin therapy plan, fasting blood glucose may sometimes be very high in the morning. Possible reasons include:

Insufficient nighttime insulin effect. ② "Dawn Phenomenon": Blood glucose control is good at night, but hyperglycemia occurs shortly before dawn, possibly due to increased secretion of insulin-antagonistic hormones.

③ "Somogyi Phenomenon": Hypoglycemia occurs at night, followed by reactive hyperglycemia.

Continuous monitoring of blood glucose changes at night is helpful in identifying the cause of hyperglycemia.

3. Side Effects of Insulin
The main side effect of insulin is hypoglycemia, which is related to excessive dosage and/or dietary disorders. In addition, insulin can cause allergic reactions, including itching and rash at the injection site, as well as gastrointestinal symptoms such as nausea, vomiting, and diarrhea.

Prognosis: The main cause of death in type 2 diabetes is chronic complications, among which vascular disease (including coronary heart disease, cerebrovascular disease, and kidney disease) is the leading cause of death. The incidence of coronary heart disease and cerebrovascular accidents in type 2 diabetes patients is 3 times higher than in non-diabetic patients, leading to amputation 10 times higher, and blindness and end-stage renal disease 15 times higher. Vision loss caused by diabetic proliferative retinopathy has an extremely poor prognosis; 50% of patients will become blind within 5 years. Diabetic patients with elevated urinary albumin excretion rates have a significantly higher incidence of proliferative retinopathy and coronary heart disease compared to those with normal urinary albumin excretion rates. Without treatment, 50% of patients will die after developing diabetic nephropathy. Early administration of angiotensin-converting enzyme inhibitors can effectively reduce glomerular pressure and prevent or delay the onset of diabetic nephropathy. Strict blood glucose control and early diagnosis and treatment of chronic diabetic complications are essential for diabetic patients.