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Objective To observe the effect of self-practice-oriented teaching method on injection skills, psychological status and blood glucose control of type 2 diabetes mellitus patients receiving pen insulin injection for the first time. Methods A total of 105 patients with type 2 diabetes mellitus who received insulin injection for the first time were divided into the control group and the observation group according to admission sequence. The control group adopted the method of one-to-one bedside health education of primary nurses. Insulin injection demonstration and disease-related knowledge education were conducted on the day of the medical order to start insulin treatment. Health education was conducted once a day for 3-5 minutes each time for a total of 5 days. The observation group adopted centralized health education, which insulin injection teaching desk, video and other teaching aids, combined with the guidance and correction of primary nurses were used, focusing on the use of teaching aids and self-injection as early as possible during hospitalization. The levels of fasting and postprandial blood glucose, insulin injection skills and anxiety and depression scale (HADS) were compared between the two groups. Results There was no statistically significant difference in blood glucose level, anxiety scores and depression scores between the two groups before the intervention (P>0.05). Two weeks after the hospital discharge, the anxiety and depression scores of the observation group was 7.31 ± 1.78, 7.00 ± 1.73, significantly lower than the anxiety and depression points of the control group 9.33 ± 2.21, 8.61 ± 1.79 (t=2.492, 3.097, P<0.05);The insulin injection skills assessment score of patients in the observation group was (90.90 ± 4.15) points, significantly higher than the points of the control group (83.74 ± 6.22) (t=-6.593,P<0.01);In the observation group, fasting blood glucose and postprandial 2-hour blood glucose were (7.56 ± 1.86) mmol/L and (10.61 ± 2.25) mmol/L, respectively Compared with the control group (8.55 ± 1.96) mmol/L ,(12.91 ± 2.95) mmol/L, there was statistically significant difference between the two groups(t=2.542, 4.301, P<0.05). Conclusion The self-practice-oriented teaching method can effectively alleviate the negative emotions of the patients with the first insulin injection, improve their insulin injection skills to better control blood glucose.
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Objective:To evaluate the short-term economic effects of four kinds of premixed insulin in newly diagnosed type 2 dia-betes mellitus. Methods:A total of 120 newly diagnosed patients with type 2 diabetes mellitus were divided into four groups according to the kind of premixed insulin, group A was treated with insulin aspart 30 injection, group B was treated with insulin lispro 25 injec-tion, group C was treated with isophane protamine biosynthetic human insulin injection and group D was treated with protamine zinc re-combinant human insulin injection. The course of treatment was three months. The therapy efficacy was assessed by the remission rate in three months. The short-term economic effect was evaluated by the cost-minimization analysis method. Results:The remission rate of group A, B, C and D respectively was 48. 39%, 48. 28%, 51. 61% and 51. 72% without significant difference (P>0. 05). The average cost per person of the four groups was 1195. 52, 1202. 41, 1220. 69 and 1258. 84 yuan, and the average medicine cost per person was 750. 52, 689. 41, 754. 69 and 764. 34 yuan, respectively. There was no significant difference in cost among the four groups (P >0. 05). Conclusion:All the four kinds of premixed insulin can be used for the starting treatment with the similar total cost, and in relative terms, aspart 30 injection and insulin lispro 25 injection are better for the initial treatment of diabetes.
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Based on the 4th Injection Technique Questionnaire results, new insulin injection technique recommendations were announced at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, on October 23 and 24, 2015, in which 183 physicians, nurses, educators, and allied healthcare professionals from 54 countries attended. Through these new recommendations, we hope to identify and localize the new insulin injection technique recommendations that could be applicable in local clinical settings. It is recommended to use a pen needle with a wider inner diameter when its gauge remains the same. Also, recommended injection sites such as the abdomen, upper arms, thighs, and buttocks are well described based on anatomical landmarks. The insulin absorption rate is the fastest at the abdomen, upper arms, thighs and buttocks in the case of human insulin; however, there is no difference in absorption rate in the case of insulin analog, regardless of site selection. Also, air-shooting is not necessary if drops are observed as soon as the needle is attached to the pen. Diabetes educators should be familiar with new insulin injection technique recommendations, not only to keep themselves updated with new knowledge, but also so they can educate patients to assure patient safety and achieve better outcomes.
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Humans , Abdomen , Absorption , Arm , Buttocks , Delivery of Health Care , Education , Hope , Insulin , Italy , Needles , Patient Safety , ThighABSTRACT
Lipohypertrophy refers to the phenomenon of subcutaneous fatty tissue becoming either softer or firmer than normal so that it becomes thickened. The presence of lipohypertrophy is associated with not rotating injection sites correctly, injecting into the same sites repeatedly, using smaller injection zones, and reusing needles. Injecting into lipohypertrophy sites can cause unexplained hypoglycemia because insulin absorption is delayed or erratic, thus potentially worsening glucose levels and even diabetes management. Therefore, developing a lipohypertrophy checklist for patients who inject insulin is necessary to detect lipohypertrophy as soon as possible in order to avoid repeatedly injecting into lipohypertrophy sites. A lipohypertrophy checklist will help patients maintain stable glucose levels by minimizing the risk of glycemic variability.
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Humans , Absorption , Adipose Tissue , Checklist , Glucose , Hypoglycemia , Insulin , NeedlesABSTRACT
Objective To explore the effect of insulin injection and protamine biosynthetic human insulin injection on basal insulin level in pregnant women with diabetes mellitus.Methods Retrospective analysis of 89 cases of pregnant women with diabetes mellitus from January 2013 to May 2016 in department of obstetrics and gynecology,tianjin red bridge hospital,the patients were divided into group A (n=38 cases) and group B (n=51 cases),the group A treatment with insulin injection,the group B treatment with protamine biosynthetic human insulin injection,compare the two groups of patients before and after treatment of three meals a day rate of blood glucose compliance, treatment compliance and satisfaction.Results Before treatment, there was no significant difference in the blood glucose compliance rate between the two groups before and after treatment;After treatment,the blood glucose compliance rate of two groups was significantly higher than before treatment ( P<0.05 ) , there was no significant difference in the compliance rate of fasting blood glucose between two groups,the compliance rate of blood glucose before dinner in group A was 81.58%,significantly higher than that in group B 60.78%(P<0.05).Conclusion Both insulin injection and protamine biosynthetic human insulin injection can maintain the basic insulin levels of pregnant women with diabetes mellitus,insulin injection can better control the blood glucose levels before dinner,with higher compliance and satisfaction.The compliance rate and satisfaction rate of pregnant women in group A were 97.37% and 97.37%,which were significantly higher than those in group B 82.35% and 80.39%(P<0.05).
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Objective To investigate the insulin injection-related knowledge of the registered nurses in first-class general hospitals in Shanghai and look into its influence factors. Methods Totally 331 nurses in the hospitals were enrolled in this study. Univariate and multivariate stepwise regression were used to analyze the factors which influenced the insulin injection-related . Results The aggregate score of insulin injection-related knowledge was 54.20 ± 7.64, and the score index was 67.75%. Multiple linear regression analysis showed that such factors as professional title and nursing experience and training in the endocrinology department were the main factors of insulin injection-related knowledge (all P<0.05). Conclusion We should enhance the training to promote the injection skills so that they can assist the patients to effectively control blood sugar and improve the quality of life.
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Objective To explore the effect of the improved abdominal rotation card method in insulin injection. Methods A total of 100 hospitalized diabetes patients were randomly divided into control group (n=50) and observational group (n=50) according to the random number method. In the control group, insulin was injected to the subcutaneous tissue of abdomen with traditional method annular rotating method. Insulin was injected using improved abdominal rotation card method in the observational group. Compare accuracy and mastery rate of injection site rotation between the two groups. Compare fasting blood glucose (FBG), postprandial 2H blood glucose (PBG), HbA1c, the incidence of hypoglycemia and endermic induration between the two groups after three months. Results The nurses in the observation group had higher accuracy rate of the injection site rotation compared to the control group [98.6%(690/700) vs. 38.6%(270/700),χ2=584.66, P<0.01]. Mastery rate of the injection site rotation for the patients in the observation group were significantly higher than the control group [70.0% (35/50) vs. 20.0% (10/50), χ2=25.74, P < 0.01]. The incidence of endermic induration were significantly lower in observation group compared to the control group [2.0% (1/50) vs.16.0% (8/50), χ2=5.98, P < 0.01]. The incidence of hypoglycemia were significantly lower in observation group compared to the control group [4.0%(2/50) vs. 16.0%(8/50),χ2=4.00, P<0.01]. Conclusions The new abdominal rotation method in insulin injection can be a safe and effective therapy in patients with type 2 diabetes.
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Objective To explore the influence of continuity care model on how to deal with medical waste of insulin injections among domestic patients Methods Consecutive diabetes patients using the home insulin injections were recruited as the the members of our Diabetes Education Classfrom September 2014 to March 2015. The home medical waste disposal was brought into the content of diabetes education;problems were intervened through the continuity care model. Using the questionnaire survey to investigate the cognitive and disposal of patients on medical waste, to compare the difference of results of questionnaire before and after the intervention. Results The cognitive rate of medical waste after intervention was 97.70%(212/217),while the cognitive rate before intervention was 3.69%(8/217), the difference was significant (χ2=383.63,P<0.01). Disposal of diabetes patients using the home insulin injections had improved after the continuity care, the rate of dealing with medical waste according to specification after the intervention was 91.24% (198/217),while the rate before the intervention was 3.23%(7/217), the difference was significant (χ2=337.26,P<0.01). Conclusions The continuity care model standardized the behavior of patients for disposal of medical waste, reduced the environment pollution of medical waste and decreased the spread of disease.
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OBJECTIVE:To improve the safety management level of high-risk drug Insulin injection in our hospital. METH-ODS:The standard management of Insulin injection(400 u/injection)was conducted by using PDCA(plan-do-check-action). The application of Insulin injection in wards was compared before and after six months of management. RESULTS:By strengthening training,improving ward baseline insulin management register system,adjusting the specification of insulin in information system, etc.,the application and storage of insulin became more standard;no expired drugs occurred;the rate of waste drug decreased from 95.06% before management to 22.00% after management,decreasing by 73.06%. CONCLUSIONS:PDCA cycle can im-prove the safety management of Insulin injection in wards effectively.
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OBJECTIVE:To provide reference for the understanding of quality status of Insulin injection and improvement of related standards. METHODS:The statutory methods of Insulin injection were adopted to test 32 batches of samples(including ap-pearance,identification,capacity,visible foreign matter,sterility and potency determination of biological method). Consulting specification of other similar products,RP-HPLC was conducted to determine the related impurities,content and phenol in sam-ples;HPSEC was conducted to determine the high molecular weight proteins and atomic absorption spectrophotometry was conduct-ed to determine the Zn content. RESULTS:Results of all the 32 batches of samples were qualified by the test of statutory methods. According to the method of other similar products,the determination result of A21 desamido insulin was 15.6%-39.2% and general-ly greater than 5.0%, which was the highest limit of similar products;insulin was 93.2%-102.7%;protein polymer was 0.5%-0.6%;phenol was 2.34-2.51 mg/ml and Zn was 12.3-14.8 μg/100 U. CONCLUSIONS:The statutory specification of Insulin injection is short of many key specification items such as impurities and content determination;the contents of protein polymer, phenol and Zn were in good control;the contents of A21 desamido insulin are generally high,and stability of insulin main peak is relatively poor.
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Objective To explore the effect of the transtheoretical model of health behavior change on initial insulin injection in elderly patients with type 2 diabetes mellitus. Methods Thirty elderly patients with type 2 diabetes, receiving traditional training of insulin injection , were recruited as control group ( n = 30 ) between December 2013 and March 2014 . Another 30 elderly patients with type 2 diabetes, who received an education program based on the transtheoretical model of health behavior change for insulin injection training ( 30 minutes for each time and 4 times in total ) , were recruited as experiment group ( n=30 ) between April 2014 and July 2014. The knowledge of insulin injection and the operational skills in the two groups were compared between the two groups. Result Both the knowledge and operational skills at insulin injection in the experiment group were significantly better than those in the control group (P<0.01). Conclusion The transtheoretical model of health behavior change can be significant for improving the operational skills at insulin injection and therefore it can be effective in controling of blood sugar.
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Objective To investigate the clinical efficiency of Isophane Protamine Biosynthetic Human Insulin Injection (pre‐mixed 30R)(Novolin 30R) combined with insulin pump therapy in patients with diabetes mellitus complicated with pulmonary in‐fection ,and to analyze the detection indexes .Methods From Jan .2010 to Feb .2013 ,90 cases of patients with diabetes mellitus com‐plicated with pulmonary infection were selected and divided into the observation group and control group .The control group re‐ceived Novolin 30R treatment and conventional treatment ,the observation group were given insulin pump therapy based on the treatment of control group .The clinical efficiency and detection indexes were compared and analyzed .Results The cure rate and to‐tal effective rate were 51 .11% and 82 .22% respectively in the control group ,and were 84 .44% and 100 .00% in the observation group respectively .There were significant differences of both cure rate and total effective rate between the two groups (P<0 .05) . There were statistically significant differences of hospitalization time ,the time for reaching target of glucose ,insulin dose ,recovery time of body temperature ,hospital costs ,incidence rate of complications ,serum levels of sodium ,potassium and urea nitrogen ,os‐molality and PH value between the two groups(P<0 .05) .Conclusion The combination of Novolin 30R and insulin pump therapy could provide satisfactory clinical efficiency in patients with diabetes mellitus complicated with pulmonary infection .
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Objective To evaluate the efficacy and safety of acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection in the treatment of elderly patients with type 2 diabetes.Methods 170 elderly patients with type 2 diabetes were randomly divided into the observation group and the control group.85 cases in the observation group were given acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection,85 cases in the control group received aspart 30.The patients were followed up for 12 weeks,the blood glu cose levels,blood glucose fluctuation,glycosylated hemoglobin (HbAlc),the incidence of hypoglycemia and insulin dosage were observed.Results' The level of fasting plasma glucose (FPG) (t =9.92,P ＜ 0.05),2h postprandial blood glucose(2hPG) (t =18.18,P ＜0.05),the mean blood glucose within 4h(t =13.62,P ＜0.05),days of average blood glucose fluctuations (t =14.56,P ＜ 0.05) of observation group dropped significantly compared with that before treatment;HbAlc achieved rate(6.5％)of the observation group and control group were 35.29％,28.23％,re spectively,HbAlc achieved rate (7.0％) of observation group and control group were 57.64％,52.94％,the differences were not statistically significant(all P ＞ 0.05).The dose of insulin was significantly lower in the observation group(20.11 ±3.36) u/d than(35.78 ±4.68) u/d in the control group(t =25.08,P ＜0.01).There were 2 cases of hypoglycemic events and 3 cases in the control group.Conclusion Protamine zinc recombinant insulin lispro injection combined with acarbose has reliable clinical efficacy and safety.
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Objective To compare the anterior-posterior decade glycemic control with improvement of diabetes management and evaluate the influence of socioeconomic factors on glycemic control.Methods This cross-sectional clinical-based survey enrolled 158 with type 1 diabetes mellitus (T1DM) children from Sep.2011 to May 2012 (group A) in Beijing Children's Hospital of more than 1 year management and compared with 123 children with T1DM who were recruited in Asia and the West Pacific Region T1DM Study from Sep.2001 to May 2002 (Group B) in Beijing Children's Hospital.Normally distributed data were reported,linear correlation and regression analysis were performed for glycemic control.Results There was no complication in the both groups.The average of hemoglobin A1C(HbA1C) in group A was (8.50 ± 1.53) ％,better than that of group B [(9.90 ± 1.85) ％,P =0.000].The ratio of optimal and suboptimal HbA1C in group A and group B were 15.0 ％ vs 10.6％,while the ratio of suboptimal HbA1C in group A and group B were 52.5 ％ vs 25.2％,respectively,there were significantly statistical differences (all P =0.000).The ratio of insulin injection twice daily in group A and group B were 43.0％ vs 92.6％,respectively and the ratio of multiple daily injection and continuous subcutaneous insulin injection were increasing significantly 10 years after.The frequency of self-monitoring blood glucose(SMBG) between 60-120 times per month and over 120 times per month in group A was 45.5％ and 37.8％,while 0.8％,0 in group B,respectively,there was significant statistical difference (P =0.000).HbA 1C was positively correlated with age,duration,insulin dosage per day while inversely correlated with frequency of SMBG in liner correlation and regression analysis.It was showed that duration was the most important factor for HbA1C.Conclusions There were younger with T1DM in Beijing Children's Hospital.The frequency of SMBG and the ratio of multiple daily injection and continuous subcutaneous insulin injection were increasing significantly after 10 years.Duration was the most important factor for glycemic control.There was no complication in children with T1DM.Glycemic control would be better due to improvement of SMBG and increase of the frequency of insulin injection.
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Objective To discuss the application value of insulin pump in the perioperative nursing of cataract diabetic patients. Methods 25 diabetic patients used the insulin pump for continuous subcutaneous insulin injection (CSII) during perioperative period were taken as the CSII group, the other 25 patients used multiple subcutaneous insulin injection (MSII) at the same time were taken as the MSII group.The patients' blood sugar undulations, the time of reaching the goal blood sugar, hospital stay, incidence of hypoglycemia, patient satisfaction degree were compared between the two groups. Results Blood sugar at various time points of the two groups reduced effectively, and the time of controlling the blood sugar, the incidence of hypoglycemia, hospital stay, patient satisfaction degree in the CSII group were obviously lower than the MSII group. Conclusions The insulin pump could control the blood glucose effectively, safely,rapidly and smoothly, which guarantees the safety of operation with standard nursing.
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BACKGROUND: The long term complications of diabetes lead to diminished quality of life. As a means to avoid these complicationss, insulin therapy had evolved into a specialized regimen to achieve physiologic control of blood glucose, the so-called Multiple Daily Insulin (MDI) regimen which is a relatively new technique in the Philippines. OBJECTIVE: To study the efficacy of Multiple Daily Insulin regimen in controlling plasma glucose and to evaluate patient's satisfaction with MDI regimen among Filipino type 2 diabetics who have been on MDI for at least 2 months. RESEARCH DESIGN AND METHODS: Filipino patients (n=107) with uncontrolled diabetes were included in the study protocol. The majority were male, more than 60 years old and had been diabetic for more than 6 years. The mean body mass index was 27 kg/m2 and the mean baseline HbA1c was 9.2% + 2.65. This prospective cohort study was conducted between January 2006 to September 2008 at Cebu Doctors University Hospital Out-Patient Department. Efficacy was evaluated by HbA1c and treatment satisfaction was assessed with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Enrolled patients were followed up at week 12, 24 and 48. RESULTS: Mean HbA1c fell by 2.43 + 2.68 at week 12, 2.03 + 2.35 at week 24 and 1.73 + 2.23 at week 48 showing a statistically significant decrease of HbA1c among the 3 groups was not statistically significant (p = 0.52). The proportion of patients achieving an HbA1c of CONCLUSION: Multiple Daily Insulin Regimen is an effective treatment modality based on a significant lowering of HbA1c among the study population with uncontrolled type 2 diabetes mellitus. Patients were satisfied with the ragimen based on the positive treatment satisfaction. This, however, is contrary to popular belief that patients' quality of life is affected by insulin administration. Keywords: Multiple Daily Insulin Injection, Type Diabetes Mellitus, Treatment Satisfaction.
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Humans , Male , Female , Aged , Middle Aged , Adult , Blood Glucose , Diabetes Mellitus, Type 2 , Insulin , Insulin Infusion Systems , Outpatients , Philippines , Physician-Patient Relations , Prospective Studies , Quality of Life , Treatment OutcomeABSTRACT
Objective To evaluate the recovery of island ?-cell function through different terms of continuous subcutaneous insulin infusion(CSII)in diabetic patients with failure of oral hypoglycemic agents(OHA).Methods The 48 diabetic patients with OHA failure were divided into group A(10 cases,7-day CSII),group B(18 cases,14-day CSII)and group C(20 cases,28-day CSII).Results Compared with group A,the daily administration of basic dose and premeal supplementary dose of insulin at targeted glucose level were decreased in group B and C(P