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Practical Diabetes Care - part 2

Nếu ai đó là insulin thiếu hoặc nhu cầu insulin. Nếu ai đó đã thêm một căn bệnh cấp tính chủ yếu, đặc biệt là nhiễm trùng, người ta thường cần insulin. Nếu không có bằng chứng của sự cố mô lớn hoặc nhiễm trùng lớn, đặc biệt là nếu một người có tuổi và thói quen cho thấy bệnh tiểu đường loại | 22 I THE FIRST STEPS experience and trial and error. If someone is insulin deficient he or she needs insulin. If someone has an additional acute major illness especially infection he or she usually needs insulin. If there is no evidence of major tissue breakdown or major infection especially if the person is of an age and habit suggesting Type 2 diabetes the treatment is diet for all patients and oral hypoglycaemic therapy for many. These options will succeed only if the patient is making insulin. Many people with newly diagnosed diabetes are convinced that they will need regular injections this may be a terrifying thought. As soon as it has become apparent that the patient does not need insulin they should be told. Otherwise the patient may be so worried about the prospect of the needle that everything else you say will be forgotten. In many cases the treatment decision can be made in the first few minutes of a consultation. Insulin People who usually need insulin have most of the following characteristics under 40 years old thin severe diabetic symptoms marked weight loss profuse urinary ketones serious infection another major acute illness Insulin treatment should be started within 24 hours of diagnosis preferably immediately. It is vital that the diabetes specialist nurse or other teacher has sufficient protected time to teach the patient the necessary skills. If possible the patient should give the first injection. Otherwise a subcutaneous injection of 4-10 units of soluble insulin for example Actrapid Humulin S can be given immediately and the diabetes specialist nurse can visit the patient at home or see him her separately to teach the technique p. 82 . Insulin regimens are discussed in detail in Chapter 9. A simple starting regimen to use at home is a fixed proportion mixture such as Mixtard 30 g.e. Mixtard 30 pen or Humulin M3 giving 4-10 units s.c. twice daily. The disposable pre-loaded pens containing Mixtard 30 are easiest for most new patients. Oral .