It’s more than 23:30, and suddenly found a message from a diabetic friend: “Is the teacher online?”
There must be something wrong, otherwise who will bother at midnight? Fortunately, I saw it.
“Tonight, 16 units of long-acting insulin detemir were mistakenly made into quick-acting insulin aspart, what can we do?”
I have encountered this problem more than once…
Anxious, how to deal with this?
Because it is easy to have severe hypoglycemia during sleep, this problem must be talked about.
First reminder: eat
When this happens, it is generally a sugar friend who injects 4 needles of insulin a day, because they will have both long-acting and quick-acting (or short-acting).
The insulin we secrete includes basal insulin and mealtime insulin. When using an insulin pump, we will set the basal rate and a large dose before a meal in order to better simulate our own insulin secretion pattern. Use the “three short (speed) one long” four-day insulin injection program, one long-acting insulin is also to simulate basal insulin, and the fast-acting or short-acting injection before three meals is to simulate mealtime insulin.
When diabetic friends mistake the long-acting insulin that should be injected before going to bed into fast-acting (or short-acting), you must know: you have another injection of insulin during the meal, and you can’t take it out.
After the insulin injection is finished, you must eat something later!
(Almost 20 years ago, I distributed gifts for the sugar friends who answered the questions correctly——medication box)
The long-term effect before going to bed often accounts for 40-50% of the total amount of the whole day. Therefore, the four-needle sugar friends, the fast-acting (or short-acting) dose injected during meals is generally significantly less than the long-acting dose before bedtime. For example, 8 units of quick-acting or short-acting each before three meals, long-acting often need to inject about 16 units.
If 16 units of long-acting insulin are mistakenly made into 16 units of fast-acting insulin before going to bed, that is to say, a dose of twice the daily fast-acting dose is injected, the subsequent meals cannot be eaten as usual. If the staple food of each meal is 75g in daily meals, this is matched with 8 units of fast-acting insulin before daily meals. If 16 units of fast-acting insulin are accidentally typed, you cannot eat 75 grams anymore, but you should eat similar Only 150 grams of staple food can cope.
There is a “500 rule” in the use of insulin pumps, that is, 500 divided by the total amount of insulin in a day is for everyone to think about “how many carbohydrates can be dealt with by 1 unit of insulin”, and you can borrow it. It is also possible to divide the grams of staple food per meal by the amount of insulin before a meal, and the conclusion is: how many grams of staple food can a unit of insulin fight. Then look at how many units you hit by mistake, and the result comes out.
Example: Inject 8 units of fast-acting insulin before meals and eat rice made from 80 grams of rice. 80 divided by 8 is approximately equal to 10g. That is to say, 1 unit of insulin can eat 10g of rice. If 16 units are injected, it is necessary to eat rice with 16X10=160g rice.
In our daily diet, in addition to the main food, each meal also has a certain amount of meat, eggs, milk and beans (mainly supplying protein) and vegetables (supplying vitamins, trace elements, dietary fiber, etc.). It seems unrealistic to cook another meal before going to bed. If you use the same amount of carbohydrates as bread, biscuits, etc., due to the lack of dietary fiber and protein, the blood sugar may be much higher if you eat these foods alone, and even some sugar friends cannot eat so much at one time. It is recommended that everyone can consider the use of divided meals. That is, divide the bread of the same amount of carbohydrates into at least two meals, and the time for the second meal can be arranged after insulin injection (fast-acting insulin analogue is 1.5 hours, short-acting insulin is 2-2.5 hours). The purpose is to synchronize the effect of food on blood glucose and insulin action time as much as possible.
Many people may be terrified about eating so much at once. They are afraid that the blood sugar will grow so high that they can continue to look down: monitor blood sugar.
Second reminder: measuring blood sugar
The main purpose of monitoring blood sugar is to prevent hypoglycemia.
Fast-acting insulin has a rapid onset of action, a short duration of action, and the peak of effect generally does not exceed 3h. Therefore, you can monitor it at 1h, 2h, and 3h after injection. If the dose is large, you can add another 4h. Short-acting insulin has a slow onset and a long duration of action. The peak can last up to 4 hours after injection, and the effect can be maintained up to 6 hours. Therefore, to misuse short-acting, to monitor blood glucose 2h, 3h, 4h, or even 5h after injection. The risk of severe hypoglycemia afterwards is relatively low.
As mentioned above, some people may not dare to eat so much, it is more necessary to actively monitor, within the time range of insulin, according to the amount of blood sugar, the appropriate amount of food intake can be increased or decreased.
The injection site of long-acting insulin is generally injected into the buttocks, thighs or upper arms where absorption is slow. If fast-acting or short-acting insulin by mistake is also injected into these relatively slow-absorbing parts, the duration of action may be extended. In that case, blood glucose monitoring 4h after injection of fast-acting insulin and 5h of injection of short-acting insulin is more important.
Here is a sentence. Due to the relatively low amount of dietary fiber and protein in this meal, coupled with emotional excitement, postprandial blood glucose may be high, at this time, do not refrain from chasing fast-acting or short-acting insulin.
Third reminder: long-term effects
Long-acting insulin is for simulating basal insulin. Don’t think that if you mistakenly become quick-acting, you will not dare to inject that long-acting insulin again. Otherwise, the blood sugar of the next morning and even one day will go up due to lack of basal insulin.
Long-acting insulin should not only be administered, but also the dosage should not be reduced. The reason is the same as above. There may be concerns: Does using both needles of insulin increase the risk of hypoglycemia? The problem of hypoglycemia risk must be increased, but the main cause of the increase in hypoglycemia risk is caused by the more rapid-acting (or short-acting) shots. As mentioned in the second reminder above, when the fast-acting or short-acting time elapses, the risk of hypoglycemia returns.
Fourth reminder: prevention first
Most of the wrong injections of insulin are old sugar that is old. What is even more terrible is that the injection is wrong and you may not know, so the risk of hypoglycemia during sleep is very high, and it is very terrible.
In order to avoid this phenomenon, the following measures can be taken:
1). Stick an adhesive tape on the insulin injection pen, and indicate on the adhesive tape the time to be used, whether it is injection before meal or before bed. It can also be distinguished by different colors, with white tape before meals during the day and black tape before going to bed at night.
2). Place them separately. Insulin in use generally does not need to be stored in the refrigerator. For convenience, the insulin pen before the meal is placed on the dining table, and the insulin before bedtime is placed on the bedside table. Someone who injects long-acting insulin is not at bedtime, but at some time in the morning or during the day, it is best to place it separately.
3), develop the habit of taking a look before each injection. Different insulins, the color of the bottle is different, it is relatively easy to distinguish.
4) To have a diabetes specialist as a friend, this is not only the need for “integration of doctors and patients”, but also the patron saint of your health. The one who can protect you for 24 hours is the best! ——What kind of doctor is this?
If there is a doctor who can answer your emergency call 24 hours a day, it is an emergency call, how much will you pay (monthly or yearly)?