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*For medical professionals only
Diarrhea and poor feeding occur after infection, also pay attention!
AuthorZhang Taisheng
, Qionghai People's Hospital, affiliated to Hainan Medical College, many patients infected with the new crown will have a variety of different symptoms, such as cough, sputum, fever, joint pain, muscle pain and other discomfort
.
At present, most of the drugs purchased in pharmacies are drugs for respiratory infections, but the digestive symptoms caused by the new crown - diarrhea and poor food - are often ignored
.
These symptoms can affect blood sugar, resulting in abnormal
blood sugar.
Among the patients recently admitted by the author, many patients with positive diarrhea are accompanied by diabetic ketoacidosis, which is one of the common acute complications of diabetes, although the rate of successful treatment is high at today's medical level Factors such as worsening degree of persistent dehydration and infection can induce this complication and seriously affect the patient's prognosis
.
In the state of diarrhea and dehydration, hypoglycemic drugs are carefully selected
If patients with diarrhea or dehydration discomfort after infection with the new crown have symptoms of discomfort, the priority is to replenish water, and a certain amount of saline intake can be appropriately increased on the basis of more water intake to supplement sodium ions
.
Water can increase blood volume to a certain extent, dilute the concentration of blood sugar in the blood, play a hypoglycemic effect, and also have the effect
of preventing dehydration from aggravating.
Secondly, because the patient has diarrhea, try to choose hypoglycemic drugs
that do not affect the digestive tract in drug selection.
If the patient is accidentally infected with the new coronavirus, and the patient not only has digestive symptoms, but also has catarrhal symptoms, the potential effect of drugs should be used with caution: *SGLT-2i:
sodium-glucose co-transporter-2 inhibitor ； DDP-4i: dipeptidyl peptidase-4 inhibitor; GLP-1RA: glucagon-like peptide-1 receptor agonist
.
In particular, SGLT-2i drugs, the use of the drug in severe dehydration of the body is easy to cause urinary tract infections, and patients with type 1 diabetes are banned, which can induce "non-hyperglycemic diabetic ketoacidosis"
.
Insulin replacement therapy
insulin therapy has certain advantages, insulin has no gastrointestinal adverse reactions, obvious hypoglycemic effect, conducive to tissue repair, maximizes the protection of β cell function, and is not subject to liver and kidney function contraindications, etc.
May be used as the treatment of choice after coronavirus infection
.
And during the infection of the drug treatment effect is not good, it is difficult to achieve the effect of the drug, the burden of liver and kidney metabolic pressure is large, insulin has a strong hypoglycemic effect, can stabilize blood sugar as much as possible in a short time, reduce the negative impact
caused by excessive blood sugar and fluctuations.
At present, in clinical practice, insulin subcutaneous pump continuous infusion and four-shot insulin intensive blood glucose
control are mostly chosen.
It is recommended that the insulin selection scheme mimics the "physiological secretion" pattern as much as possible:
1.
Supplement the insufficiency of basal insulin with medium- and long-acting insulin; 2.
Fast-acting or short-acting insulin supplementation of insulin deficiency during meals
.
While advocating the simulation of physiological mode for insulin selection, the best recommendation: fast-acting or short-acting before meals + medium- or long-acting insulin control before
bedtime.
This regimen can be combined with the meal situation, the dose can be flexibly adjusted, and the risk of hypoglycemia is smaller, more operable, and blood glucose is easier to maintain than
premixed insulin alone.
During the intensive control of blood glucose in the above program, it can protect the activity of β cells to a certain extent, and use the characteristics of insulin to promote fat synthesis and inhibit the decomposition of fat, avoid excessive ketone body production, and have certain preventive significance
while treating ketoacidosis.
▎ Pay attention to these small details during the use of insulin: 1.
If the previous long-term insulin therapy is infected with the new coronavirus, and the patient's symptoms are significantly aggravated, or there are obvious digestive tract discomfort symptoms, the original insulin dose is recommended to be increased by 10%~30% on the basis of the original, and the blood glucose control plan and target range are formulated according to the general condition of the patient;
2.
If you have not received insulin therapy before, but in order to avoid hypoglycemia, and it is not clear how sensitive the patient is to insulin, it is recommended to start treatment with low-dose basal insulin, such as 6 IU, combined with blood glucose, increase the dose, but because fast-acting or short-acting insulin has a faster onset and is easy to cause hypoglycemia, it is directly related to meals.
It is recommended to adjust the starting dose and reasonably allocate the therapeutic dose of three meals under the guidance of a physician;
3.
If the patient has obvious digestive symptoms, poor feeding, too little food and no eating, insulin should be suspended or used
with caution.
Because insulin is the most common drug for inducing hypoglycemia, it should be considered after
prompt monitoring of blood glucose.
If the patient is severely dehydrated, it is difficult to stabilize blood sugar with insulin alone to control blood sugar, and there is still a risk of ketoacidosis, and the main treatment of the disease is: rehydration + hypoglycemia;
4.
In addition to hypoglycemic drugs that affect the digestive tract, there are still other drugs to choose to use, but it should be noted that sulfonylureas and non-sulfonylureas should be avoided in combination with insulin, which will increase the risk of hypoglycemia;
5.
Insulin as the ultimate weapon to control blood sugar, can not blindly add the dose, when adding a larger dose of insulin and blood sugar still has no significant improvement, should pay attention to the risk of insulin resistance, timely go to the hospital under the guidance of a specialist to adjust the hypoglycemic program;
6.
Basic combined mealtime insulin adjustment program: when using the basic combined mealtime insulin regimen, adjust the amount of insulin before breakfast, lunch and dinner according to the blood glucose levels before lunch, dinner and bedtime; Adjust bedtime basal insulin dosage according to fasting blood glucose; Adjust once every 3~5 days, adjust 1~4 IU each time until the blood sugar reaches the standard
.
The patient's blood glucose standard value before three meals can be set with reference to the individualized fasting blood glucose standard value
.
At the same time, basal insulin should account for 40%-60% of the total amount of insulin, and the remaining part of the insulin should be distributed before meals in a ratio of 1/3, 1/3, 1/3 or 1/5, 2/5, 2/5
.
▲Individualized fasting postprandial blood glucose standard (blood sugar: mmol/L)
References:
[1] Chinese Association of Research Hospitals, Expert advice on the use of insulin in patients with novel coronavirus infection and diabetes, Chinese Journal of Diabetes, 2020, 28(3): 161-166[2]Chinese Medical Association Diabetes Branch .China Guidelines for the prevention and treatment of type 2 diabetes (2020 edition).
Chinese Journal of Diabetes, 2021, 13(4): 315-409 [3] Editorial Board of Chinese Medical Association, Expert consensus on insulin application in type 2 diabetes mellitus at the grassroots level, Chinese Journal of General Practitioners, 2021, 20(7): 723-736[4] Chinese endocrinology related expert group, Clinical rational application of sodium-glucose co-transporter 2 inhibitors, Chinese expert recommendations, Chinese Journal of Diabetes, 2016, 24(10): 865-870 [5] China Endocrine Related Expert Group, Expert guidance on the clinical application of rapid-acting insulin analogues, Drug Evaluation, 2016, 13(12):13-18[6] Corresponding drug inserts
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