Diabetes is how to get on? How to prevent

Diabetes is how to get on? How to prevent diabetes can be prevented, mainly three lines of defense is to good: the primary prevention of eating a correct view to take reasonable way of life. Diabetes, although there are some genetic factors, but the key is lifestyle factors and environmental factors. Excessive calorie intake, nutrition, obesity, lack of exercise is an important reason for morbidity. Adequate caloric intake, low salt, low sugar, low fat, high fiber, adequate vitamins, diet is the best compatibility. Regular measurement of blood glucose secondary prevention, early detection of asymptomatic diabetes. Blood glucose should be included in the old routine physical examination items, even a normal, still regularly determined. Clues to be found where those who have diabetes and, if paresthesias, sexual dysfunction, poor vision, polyuria, cataracts, but also to the determination of timely and careful identification of the earliest possible diagnosis and gain valuable time for early treatment. It is easy to tertiary prevention of diabetes complicated by other chronic diseases, patients with multiple life-threatening due to complications. Therefore, to strengthen the monitoring of chronic complications of diabetes, so early detection, early prevention, and to the late, efficacy is often poor. Early diagnosis and early treatment can often prevent the occurrence of complications, so patients can live a long life close to normal. Reference: question/3575159.html? Fr = qrl3 Diabetes is a group characterized by high blood sugar a metabolic endocrine disease. Its characteristics as a result of the absolute or relative deficiency of insulin and target cells less sensitive to insulin, causing carbohydrates, proteins, fats, electrolytes and water metabolism. Higher incidence of diabetes, the incidence rate of 1-2% of the general population, the incidence of the elderly is more higher. Since the liberation of people's living standards with, and the increasing number of less than 1% of urban residents liberation (Beijing), is now 1-2%, more than 40 years of age was 3-4%, individual reports of up to 12% of retired cadres . Rural and mountainous areas than cities. Western industrial countries, the incidence rate of 2-4%. No obvious early symptoms of diabetes, difficult to detect, in China and Western industrial countries have a large number of diabetic patients unable to obtain timely diagnosis and treatment. Because many complications of diabetes, is also a lack of effective preventive measures, such as left unchecked, will be irreversible changes that can lead to disability or death of patients, therefore, to improve awareness of diabetes, importance of early diagnosis and effective prevention and treatment and incidence of problems worthy of attention today. Type of diabetes, according to the World Health Organization in Geneva in 1980 decided that exemplar of 7-2-1 type of diabetes. In order to facilitate access to literature, to avoid confusion in terms of diabetes classification, similar to the old days of the basic list of terms as follows (7-2-2). Table 7-2-1 diabetes and other categories of a classification of impaired glucose tolerance, clinical type (a) of the insulin-dependent diabetes mellitus (ie, type �� diabetes) non-insulin-dependent diabetes mellitus (ie, type �� diabetes) non-obese obesity-related malnutrition Other types of diabetes, including other conditions and syndromes associated with diabetes (1) pancreatic disease; (2) endocrine diseases; (3) drug-induced or caused by chemicals, (4) abnormal insulin or other receptor; (5 ) Some genetic syndromes; (6) Other (b) impaired glucose tolerance in non-obese or obese syndrome associated with other conditions, with the other types (c) gestational diabetes * Second, the statistical risk of type (normal glucose tolerance ) (a) had impaired glucose tolerance ** (b) has the potential for impaired glucose tolerance in gestational diabetes means **** will arise in pregnancy or discovery of diabetes, female patients have diabetes after the pregnancy does not include included. Gestational diabetes is different outcome after delivery, to be re-check to make sure. Most patients (about 70%) normal glucose tolerance after delivery, can be included in the \** There have been impaired glucose tolerance or gestational diabetes or diabetes, natural or after treatment, glucose tolerance is normal. *** Tendency previously named as diabetes, no history of impaired glucose tolerance or diabetes. Table 7-2-2 the active control of diabetes category name category name category name in the past adopted young insulin-dependent diabetes mellitus onset diabetes non-insulin-dependent diabetes mellitus adult-onset diabetes, adult-onset diabetes of young people (MODY), following other types onset diabetes, impaired glucose tolerance of asymptomatic diabetes, chemical diabetes, subclinical diabetes, gestational diabetes gestational diabetes * had latent diabetes, abnormal glucose tolerance, pre-diabetes have impaired glucose tolerance, diabetes, the potential tendency of a part of pre-diabetes * Department of non-insulin-dependent diabetes mellitus. Only that the above classification of clinical types, does not prompt the difference between etiology and pathogenesis, but there are changes in non-insulin-dependent potential for the insulin-dependent diabetes. Some patients difficult to distinguish. Clinical identification of two types of diabetes Table (7-2-3) 7-2-3 and non-insulin-dependent differential insulin-dependent diabetes mellitus insulin-dependent diabetes mellitus non-insulin-dependent diabetes mellitus First, the main light condition significantly reduced plasma insulin degree of reduction, normal or high response to lower insulin release test showed a delayed response or no response to insulin resistance occasionally, and antibodies related to regular, and the insulin receptor or postreceptor defects, two more secondary conditions, age of onset40 years of age acute illness, heavy slow, light weight and more weight loss more than about 0.2% of obesity prevalence of about 2.0% of ketosis common complication rare metabolic disorders to infections and chronic complications, mainly to anti-islet cell antibody-based blood more positive more often negative oral hypoglycemic agents are ineffective and more effective insulin therapy requires only about 25% of patients need to etiology and pathogenesis of diabetes is complex interaction of many factors often cause disease. First, the genetic in some people with diabetes have genetic factors clearly influence disease, for example, in the case of diabetes in the twin, the other patients had 50% chance of disease. The case of monozygotic twins, is more of the same disease. According to statistics, if the parent suffering from non-insulin-dependent diabetes mellitus, the risk of child morbidity rate is about 10-5%, if the parents are suffering from non-insulin-dependent diabetes, the child's cancer risk is higher. If a brother, non-insulin-dependent diabetes occurs, then the other brother's cancer risk was 10-15%. However, human insulin-dependent diabetes mellitus Non-insulin-dependent diabetes mellitus children, the incidence rate was not higher than the general population. Has confirmed that insulin-dependent diabetes mellitus with special HLA related to a high-risk DR3; DR4; DW3; DW4; B8; B15 and so on. Now that part of the multi-gene genetic diseases, diabetes, multiple lines, not by a genetically determined, but the genes reached or exceeded the threshold only the possibility of disease. Second, the virus infection occurred in a number of diabetes after viral infection, such as rubella virus, mumps virus, coxsackie virus, adenovirus, etc., may be related to viral insulitis. Of course, every case of viral infection have diabetes. Third, some autoimmune diabetes found in human serum antibodies against pancreatic �� cells, to experimental animals injected with anti-��-cell antibodies may cause impaired glucose tolerance, and pathology can be seen in islet cells, lymphocytes and eosinophils infiltration phenomenon . Also reported in the early onset of insulin-dependent diabetes mellitus treated with immunosuppressive get good results, even \Fourth, secondary diabetes, such as the destruction of most of the pancreatic islets and pancreas for the fiber bundle of changes, adrenal cortex hyperfunction, functional pituitary adenoma, pheochromocytoma, etc. can cause secondary diabetes, or symptomatic diabetes. Hydrochlorothiazide long-term use of urinary plug, corticosteroids, adrenergic drugs of staff may cause or contribute to diabetes increased. Certain genetic diseases such as Turner syndrome, diabetes is also easy. V. Other incentives (a) diet and high carbohydrate diet had no significant relationship, the phase related to food composition, such as refined foods and sugar can make a high incidence of diabetes. From the epidemiological analysis, high-protein diet and high fat diet may be more important risk factors. (B) Obesity and non-insulin-dependent diabetes related to obesity are food calories than the body needs due. Eating too much can cause hyperinsulinemia, and reduce the number of obese insulin receptor, may trigger diabetes. Reduce the number of pathological ��-cell nuclei stained cytoplasm was scarce degranulation. relative increase in �� cells, capillaries adjacent islet fibrosis, severe fibrosis can be seen widely, intimal thickening, insulin-dependent diabetes often obvious pathological changes of islets, �� cells can be only 10% of normal, non- human pancreatic islet insulin-dependent diabetes mellitus less lesions in the optical microscope, about 1 / 3 of the cases are certainly no histological lesions in the early insulin-dependent diabetes, about 50-70% of cases seen in and around islets and single cells nuclear cell infiltration, known as \About 70% of diabetic patients with systemic small-vessel and microvascular disease appears, known as diabetic microangiopathy. Common in the retina, kidney, heart, muscle, nerve, skin and other tissues. PAS positive material basic lesion is calm in the microvascular endothelial basement membrane caused by the next, this disease has a high specificity, diabetic, medium and large arteries, including cerebral artery, vertebral artery, renal artery and heart table artery. Lesions can also be found for the same non-diabetics, so the lack of specificity. Diabetic neuropathy and a longer duration of disease more common in poorly controlled patients, degeneration of peripheral nerve fibers were axes, followed by diffuse segmental demyelination, nerve nutrition blood blood blood micro-lesions can occur, sometimes involving the nerve lesions root, paravertebral sympathetic ganglia, spinal cord, cranial nerves and brain parenchyma, the infection ratio of motor nerve damage nerve damage significantly. Calm and liver fatty degeneration, severe cirrhosis of the liver was similar to the change. Myocardium by the cloudy swelling, degeneration of the development of diffuse fibrosis. Early clinical manifestations of non-insulin-dependent diabetes have no symptoms, more health checks, screening or treatment of other diseases found. According to the WHO-funded survey in Daqing in northeast China and 3 years after the review of data, about 80% of undetected diabetes and treatment before the census, noted in the statistics, about 25% of Japan's newly diagnosed diabetic kidney function has been changed, suggest a longer period of cases. First, the acute onset of insulin-dependent diabetes, often sudden polyuria, polydipsia, polyphagia, weight loss significantly. Hypoinsulinemia significantly glucagon and high viremia, clinical prone to ketoacidosis, the merger of various acute and chronic infections. Some patients blood glucose fluctuations, frequent high blood sugar and low blood sugar, treatment more difficult, that in the past the so-called brittle diabetes. Many patients with sudden onset of symptoms can be alleviated, some patients also returned to endogenous insulin secretion, do not need and only need a small dose of insulin yarn treatment. Remission can be maintained for several months to 2 years. Intensive therapy can promote remission. Still need insulin therapy after relapse. Second, non-insulin-dependent diabetes mellitus polyuria and polydipsia lighter, not significantly more food, but fatigue, weakness, weight loss. Many patients with chronic complications and treatment, such as decreased vision, blindness, limb numbness, pain, precordial pain, heart failure, renal failure, etc., more patients in the health examination or treatment for other diseases was found . Third, the secondary to primary disease, diabetes and more the main clinical manifestations. Fourth, the clinical manifestations of chronic complications (a) change of cardiovascular disease, diabetes, heart disease characterized by typical angina (lasting a long time, less pain, dilate coronary drug ineffective), myocardial infarction, and mostly painless refractory heart failure. Gangrene. The incidence of cerebrovascular disease is also higher, diabetes deaths are an important factor. (B) renal disease and basal thickening of the glomerular system, the early glomerular filtration rate and blood flow, decreased gradually after that. Intermittent proteinuria occurred, found to be persistent proteinuria, hypoalbuminemia, edema, azotemia, and renal failure. Normal renal glucose threshold in order to ensure elevated blood sugar will not be serious, if the blood sugar can often more than 28mmol / L (504mg/dL) is bound to suggest kidney damage permanent or temporary, in the present conditions, the progressive kidney disease is difficult to reverse. (C) more common in middle-aged neuropathy patients, accounting for 4-6% of diabetes population, electricity physiology examination, can be found in more than 60% per capita of diabetes have different degrees of nervous system lesions. Clinical peripheral neuropathy can be seen (including the sensory nerve, motor and autonomic), spinal cord lesions, (including spinal muscular atrophy, pseudo-tabes, amyotrophic lateral sclerosis syndrome; posterior sclerosis syndrome, spinal cord softening ), brain lesions (such as cerebrovascular disease, cerebral softening, etc.). Timely and effective treatment of diabetic neuropathy often have a good effect, but sometimes, even more satisfied in the case of diabetes control, the diabetic neuropathy may still occur and development. (D) of ocular complications were more common, especially in the course of more than 10 years, the incidence rate of over 50%, and more serious, such as retinopathy are capillary hemangioma, hemorrhage, exudation, angiogenesis, machine compounds hyperplasia, retinal exfoliation and vitreous hemorrhage. Others include conjunctival vascular changes, iritis, iris rose rash, regulate muscle paralysis, hypotension, hemorrhagic glaucoma, cataracts, transient refractive error, optic neuropathy, extraocular muscle paralysis, mostly slow progress, a few rapid progress of patients in the short term blindness. Good control of diabetes and eye complications have delayed the possibility of the occurrence and development. (E) other subcutaneous tissue hypoxia caused vasodilation, induced by the tide looking. Due to the small arteries and microvascular disease, often subcutaneous bleeding and ecchymosis. Poor blood supply to the site can appear purpura, and ischemic ulcers, there Juteng, more common in the foot. Malnutrition can also affect nerve joints, that Charcot joints occur in the lower extremity joints. Involved joints may have extensive bone destruction and deformity. A laboratory examination, blood glucose, capillary blood and venous blood glucose level of 0-1.1mmul / L (0-20mg) difference is more obvious after the meal, blood generally prevail. Glucose levels as low red blood cell, so the whole blood glucose values than plasma or serum glucose value of about 15% lower. Determination of the specificity of glucose oxidase as a reliable, normal fasting plasma glucose concentration of 3.9-6.1mmol / L (70-110mg/dl). Reduction method previously used, because blood glucose with unsteady nature of the non-reducing substances, so the high value of determination results. Blood glucose oxidase per hour at room temperature can decrease blood glucose concentrations of about 0.9mmol / L (17mg/dl), so the blood samples immediately after the determination or to the protein solution into cold storage. If the fasting glucose insulin secretion capacity of not less than 25% of normal, fasting plasma glucose more than normal or mildly elevated, so many times higher than the fasting plasma glucose 7.7mmol / L (140mg/dL) to diagnose diabetes, but not normal fasting blood glucose rule out diabetes. 2-hour postprandial blood glucose generally as the monitoring of diabetes control, if higher than 11.1mmol / L (200mg/dl) to diagnose diabetes, if only 9.5mmol / L (190mg/dl) glucose tolerance should be checked to confirm the diagnosis. Second, the urine of normal renal glucose threshold of approximately 8.9mmol / L (160mg/dl) but there are individual differences, not only confirmed positive urine sugar diabetes. Non-insulin dependent diabetes fasting urine often negative, so for the initial screening of diabetes, urine glucose should be measured 3 hours after the meal. If the reduction method should be noted that false positive, such as taking salicylates, chloral hydrate, vitamin C and other drugs later. Third, oral glucose tolerance test method (CGTT) an important method for the diagnosis of diabetes, regular testing procedure for the first fasting blood glucose after oral glucose 75g (12 years of age is 1.75g/kg), 1,2,3 hours after the serving of sugar Repeat blood glucose. The World Health Organization Expert Committee on Diabetes advice, any time blood glucose �� 11.1mmol / L (200mg/dL) and / or fasting blood glucose �� 7.8mmol / L (140mg/dl) to diagnose diabetes. For glucose tolerance test results are reliable, attention should be fasting before the test �� 10-16 hours. �� the week before the test must eat right and drink food calories and carbohydrates. �� test should be conducted between the hours of 7-11 am. �� at least 8 hours before the test began smoking, alcohol, coffee and excitatory drugs. �� quiet rest as much as possible during the test. �� disabling impact of glucose metabolism drugs. �� variety of acute and chronic diseases have different effects, determine the measurement results must be considered. �� artery in the service of sugar blood sugar blood sugar faster than the vein, restoring diffuse, about 3 hours after the arterial and venous blood glucose gradually consistent, high-blood of its peak value of about 1.1-3.9mmol / L (20-70mg/dl), with Table 7-2-4. Table 7-2-4 provisional World Health Organization diagnostic criteria of diabetes glucose mmol / L (mg / dl) diabetic venous whole blood and venous plasma fasting �� 6.7 (120) �� 7.8 (140) 2 hours after glucose load �� 10.0 (180) �� 11.1 (00) impaired glucose tolerance of fasting25) 146 125 83 ~ 104 62 Schedule for male diabetic patients required total calories, reduce it 10% of women over 55 patients because of reduced physical activity, but also a corresponding reduction in total calories 10-25%. trend of body weight and physical strength as a major factor in the final adjustment. (b) carbohydrate should be about 65% of total calories, avoid simple sugars and disaccharides, should include a variety of glycan 8-10g / d. absorbed too quickly carbohydrates glucose concentration peaked early and is not conducive to control and absorb too slow, especially in people with diabetes delayed gastric emptying time, will make the late postprandial hyperglycemia can be used to promote gastric emptying Motilium or Cisaprid and use a longer hypoglycemic effect of drugs is appropriate. as low carbohydrate diet, will reduce the reserve function of pancreatic �� cells, unfavorable to the patient. (c) weight of the protein should 0.7g/kg/d is appropriate, although diabetes mostly negative nitrogen balance, and often loss of protein from the kidneys, but a significant increase in food such as protein, will damage the kidneys, very bad. it should be noted that in early diabetes control in the food protein, and even lost a lot of protein in the kidney should also be cautious of excessive complement proteins. should be the main animal protein, plant protein ratio of the amino acids required for protein and body are not identical, so the use of incomplete exclusion of waste will increase out of the body, particularly the burden on the kidneys, detrimental . (d) total fat and carbohydrate calories in addition to protein, fat provided by the Chinese people about the 0.5kg/kg/d fat diet around too much fat in their remaining ketone trend. because the body metabolism, self- adjustment ability is poor, it should be with the fat of more than 25% of total fatty acids, cholesterol, due to a reduction. (e) diet advocates precise computation of the previous count of food composition, carbohydrate and protein per g by heat production is about 16.7Kj (4.5 kcal per g fat, heat about 32.6Kj (9.0 kcal). by calculating the daily food composition table of food composition. This method is more scientific, but there are still many deficiencies, such as the strong flour, the standard powder are flour, but the composition varies widely, there are differences between different places of origin, the same as the carbohydrates, the main polysaccharide konjac, mainly for sugar cane in its effect on diabetes is completely different. In addition, even if the patients are scientists , it is not possible to measure strictly enforced. generally fixed by the calculation of basic staple food of the amount of pay adjustment in a relatively stable food, to pay for food species varied to meet the living requirements, on a regular basis according to blood sugar, urine sugar changes, weight and working life ability to adjust. many countries the use of local food prepared food exchange table, you can use stevia glycosides sweeteners, saccharin is not easy too. should be noted that the national diet and rough food is appropriate, you can eat sugar or two-sugar containing more than one However, pectin rich fruits such as apples, pears, etc., but not excessive. IV, oral hypoglycemic agents, type �� diabetes diet alone does not effectively control the metabolic pathways to maintain normal blood sugar and can be used when oral hypoglycemic agents, In particular, frequent blood glucose less than 13.9mmol / L (250mg/dl) were. Some have argued combination with insulin therapy. an oral hypoglycemic drugs ineffective or failure can try another, maybe it will work. taking oral hypoglycemic drugs After a few months or years for various reasons, secondary failure to appear, should be replaced with other oral hypoglycemic agents. �� diabetes, about 10-20% of oral hypoglycemic drugs ineffective, required insulin treatment. commonly used oral and diabetic agents have the following two categories: (a) of the Department of sulfonylurea hypoglycemic agents, sulfur compounds in acid urea, can promote the secretion of pancreatic islet �� cells, in addition to insulin by influencing some ways outside the receptor and post-receptor processes, such as reduced blood sugar. If used improperly, it may be unexpected death in heart and low blood sugar. indications most �� �� diabetes; �� were normal or low weight; �� still maintain a certain ��-cell function. non-indication or contraindication Card �� �� diabetes mellitus; �� acute metabolic disorders such as ketoacidosis, lactic acidosis, non-ketotic hyperosmolar coma sex; �� serious infection, trauma, surgery and other stress conditions; �� severe liver and kidney dysfunction, pharmacokinetics were affected; �� pregnancy (a teratogenic risk and cause fetal and neonatal hypoglycemia). �� side effects low blood sugar reactions, the slow onset of more insulin, but the duration of up to 1-5 days, can cause death; �� secondary failure, mostly in administration in January to several years later. for its use of the sulfonylurea may still be effective; �� small number of patients with gastrointestinal reactions and allergic reactions such as skin rash; �� occasional bone marrow suppression. commonly used oral hypoglycemic drug glibenclamide ��, characterized by strong, and mainly affects the ��-phase insulin secretion. absorbs about 40%, the peak time of blood 2-4 hours, mean serum half-reduction of 4.8 hours. Dose 2.5-15mg / d. �� sulfonyl chloride C urea (especially pancreatic secretion), the role of strong, low blood sugar reactions were more common. As the role of a long time, possible accumulation phenomenon. the strongest time of 8-10 hours, the blood half-life for the 30-36 hour duration of action is 22-65 hours, 10-14 days 100% in the renal excretion. dose of 250-500mg, every morning an oral dose. �� suitable level of sugar (sugar kidney level), now on the market The only mainly by the liver, gallbladder removal of oral hypoglycemic agents for patients with renal dysfunction. the strongest time of 2-3 hours, the main side effects except allergic dermatitis and low blood sugar, there are teratogenic risk, it is during pregnancy . because of intense and focused, it can not be used for automobile drivers and other employees. commonly used dose of 45-90mg / d, up to 120mg / d, divided doses. �� Diamicron major role in insulin secretion of �� phase, and the role of the more obvious outer islets, anti-clotting effect is strong. strongest 2-6 hours duration of action, which lasted for 24 hours, primarily by renal excretion. dose of 40-320mg / d, for breakfast, lunch hours service. Low glucose response is rare, but lighter. �� pyrazole of the United States (U.S. Trinidad), in addition to �� cells, the effect of stronger foreign islets. no accumulation phenomenon, low blood sugar reactions were transient. can inhibit platelet aggregation phenomenon, dissolved fiber effect. strongest reaction time 1-2.5 hours, in the first days of discharge from the kidney 97%. Side effects limiting the foregoing, the occasional headache, dizziness, fatigue, etc., dose 5-30 mg / d, oral dose of 1-3 points . �� grams of sugar profits, in addition to increased insulin secretion, but can reduce glucagon secretion, improve microcirculation, reduce red blood cell adhesion, etc., absorb about 95%. side effects with the former, you can make weight gain, but low blood sugar reactions light. dose of 12.5-100mg / d, orally every morning, before lunch, when necessary, add services 12.5-37.5mg. (b) of the biguanide hypoglycemic mechanism of drug action is not entirely clear, known to reduce the absorption of glucose, promote the fermentation of glucose solutions and enhance the role of insulin, because of its side effects (lactic acidosis) and high mortality, can not restore normal glucose metabolism, so in some countries has been banned. the domestic use of phenformin (phenformin), dose 25-150mg / d, by the liver break down, which lasted for 8-12 hours. Indications: �� �� diabetes, especially obese; �� type �� diabetes mellitus may have a role of adjuvant therapy, non-indications or contraindications: �� serious liver and kidney dysfunction; �� acute metabolic complications such as ketoacidosis, lactic acidosis, non-ketotic hyperosmolar coma. �� who combined hypoxia, such as heart failure, emphysema, shock ; �� with severe infection, trauma, surgery, those who stress. �� pregnancy. Side effects: �� renal dysfunction in the elderly, and lactic acidosis-prone. �� gastrointestinal reactions such as loss of appetite, nausea, vomiting, abdominal pain, diarrhea other. �� After some sick sense of long-term use fatigue, weakness, weight loss, headache, dizziness. �� cardiovascular mortality. Fifth, the role of insulin treatment of insulin at the time can be divided into different types (Table 7-2-6 ) insulin dose must be individualized, the difference is very poor. about once every 3-5 days to adjust. the beginning of regular insulin of about 20u / d, three times a bolus. In stable renal glucose threshold before the urine-positive patients can eat estimate the degree of insulin dose, each \insulin secretion, long-acting insulin should be added or night with an additional 10-12 hours of insulin injections. dawn in order to maintain blood glucose within normal range. Recently, a single set of high purity peak and semi-synthetic human insulin to reduce insulin resistance insulin antibody, and its role slightly earlier time than regular insulin. alter insulin peptide chains of amino acids arranged in order of speed made the role of insulin, can be injected after the meal. the dose by eating the amount of flexibility. You can also order by changing the sequence of amino acids ways to change the isoelectric point of insulin, delayed absorption, which does not contain additional protein in islet long-term stability. Another type of foreign countries have insulin nasal drops, absorbing less stable. Table 7-2-6 several times the role of insulin and its role Class action time of injection channels * (h) continuing injection of the strongest available time to start normal (regular) insulin (regular insulin) IV skin instantly 1 / 2 ~ 11/22 ~ 426 ~ 8, by condition of patients before a meal 1 / 2 hours, a Day 3 to 4 times zinc crystalline insulin (crystallini zincinsulin) subcutaneous veins immediately 1 / 2 ~ 11/24 ~ 626 ~ 8, by condition of patients before a meal 1 / 2 hour, half day 3 to 4 times slower insulin zinc suspension (semlentc insalin) subcutaneously 1 ~ 2 4 ~ 6 12 ~ 16 Ibid, day 2 or 3 times in the slow onset of insulin zinc suspension (lentc insulin) subcutaneously 2 ~ 38 ~ 12 18 ~ 24 Breakfast (D) 1 hour before, a Day 1 or 2 times the neutral protamine zinc insulin (neutral protamineHagedone, NPH) subcutaneously 3 4 8 12 18 24 Ibid long-acting insulin zinc suspension particularly slow (ultralente insulin) subcutaneously 5 ~ 7 16 ~ 18 30 ~ 1 hour 36 breakfast or dinner, day 1 protamine zinc insulin (protamine zinc insulin) subcutaneously 3 ~ 4 14 ~ 20 24 ~ 36 Ibid