Bởi vì khởi đầu của insulin là một bước tiến quan trọng trong điều trị bệnh tiểu đường, nó có thể hữu ích để xem xét với bệnh nhân và gia đình một số nguyên tắc cơ bản về chăm sóc và các loại bệnh tiểu đường | TYPE 2 DIABETES IN CHILDREN AND ADOLESCENTS 185 Insulin therapy Because initiation of insulin is a major step in diabetes therapy it may be helpful to review with the patient and the family some key principles of care and the Type 2 Diabetes Master DecisionPath for Children and Adolescents see Figure . It is important to note that patients starting insulin may need a revised food plan and exercise program synchronized to insulin action and referral to a dietitian is strongly encouraged. Hyperinsulinemia hypoglycemia and weight gain. Introducing exogenous insulin to improve glycemic control raises concerns about hypoglycemia and weight gain. While hyperglycemia may indeed be rectified if insulin is introduced too rapidly at high doses patients may experience symptoms of relative or true hypoglycemia. It is not uncommon to lower blood glucose by 100 mg dL mmol L when high-dose insulin is used. In SDM insulin is started at the lowest safe dose and is adjusted slowly so that HbA1c decreases at a rate of per cent HbA1c per month or average SMBG of 15-30 mg dL mmol L . At this rate of improvement there is time to address weight gain issues. For newly diagnosed patients with severe hyperglycemia prior to the initiation of insulin there may have been modest weight loss both by volume of fluid loss and glucose excretion . Using insulin to restore near-normal glycemia is often accompanied by a 3-10 lb kg weight gain. This is normal and can be minimized by modifying diet or increasing exercise activity at the start of insulin therapy. As part of an intensive regimen the exogenous insulin may cause some hunger . There is a tendency to chase the insulin with food which results in added caloric intake. This can be prevented by maintaining the same carbohydrate intake and moving the carbohydrate to synchronize with insulin action and or adjusting the insulin regimen. For example if due to the peak action of intermediate-acting insulin the patient .
