The huge amount of insulin in the hospital may just be a matter of the doctor prescribing two more orders and then fighting with the pharmacists in the pharmacy and the nurses in the ward. But people can't always live in a hospital room forever, and patients in the inpatient department have only two different destinations, to return to their families, or to enter the end of their lives. Either way, there's always going to be somewhere.

Diabetic patients with severe insulin resistance are able to return to family life after their blood sugar has been controlled. After returning home, the large number of daily insulin injections is a major factor in reducing the patient's quality of life.

A commonly used biosynthetic insulin prefill pen contains 300 units of insulin, and the price generally ranges from 40 to 60 yuan. Regardless of how much the patient can afford to consume about two insulins a day, the injection of more than 100 units each time just three times a day is enough for headaches – because the subcutaneous injection needs to be locally absorbed through the adipose tissue, the 100 units of the injection also need to be divided into injections. Roughly speaking, the patient himself needs to take about a dozen injections a day to complete the 400 unit injection...... As any doctor knows, this is basically an unlikely thing. In general, compliance is poor in patients with chronic diseases. This also determines that an old diabetic patient will never prick himself more than ten times a day to control his blood sugar.

If you want to let this old man go back, you have to adjust your blood sugar control regimen. All in all, try to minimize the number of times a patient needs to self-inject each day so that it is possible for the patient to stick with it.

In order to prevent the quality of life of the patients from declining too much after discharge, the endocrinology department of the fourth hospital has made many internal consultations and adjustments, but the blood glucose monitoring results are not ideal. In the end, Director Li Jinfang decided to ask the Department of Rheumatology and Immunology to come up with an idea, starting from the positive IAA antibody, which may have some unexpected effects.

The doctors from the Department of Rheumatology and Immunology didn't even come after seeing the consultation list, they just called Director Li Jinfang and recommended Dr. Pascal.

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"What happened to that patient?" Professor Zhang Zhifu was interested in the 80-year-old patient with severe insulin resistance, and he asked, "What protocol did you use to control your blood sugar?"

"I prescribed him methylprednisolone. Dr. Pascal just walked out of the comprehensive diagnosis center, and he nodded to Professor Zhang Zhifu with a smile and said, "Actually, the treatment plan is very simple, but the endocrinologists in the four hospitals think about this problem too seriously. ”

"They may be worried that the use of hormones will lead to further development of wounds that are already difficult to heal. Sun Lien explained for the endocrinology department, "The dosage of methylprednisolone treatment regimen is not easy to judge, after all, the acute stage generally requires a dosage of 40~80mg per day, but in the case of lung infection and older age, it was finally decided to use 4mg methylprednisolone orally three times a day - this dosage is much lower than the reference value." ”

"Immunosuppression is a science, and it is a science that can produce at least two more Nobel Prizes in the future. Professor Zhang Zhifu sighed and shook hands with Dr. Pascal, "...... are you?"

"Go to the cafeteria to get food. Dr. Pascal raised the aluminum lunch box full of Chinese characteristics in his hand to Professor Zhang Zhifu, "My wife is traveling with two children today, and it's not worth it for me to start a group at home alone...... Aren't you going to go to the cafeteria to solve the problem? ”

Lunch boxes with Chinese characteristics, names with Chinese characteristics, and ...... The reason not to go home for dinner with Chinese characteristics. The three factors are superimposed, and Professor Zhang Zhifu vaguely feels that he has returned to the era of reform and opening up.

"What are you ......" Dr. Pascal asked politely after introducing himself, "Getting ready for work?"

"We just got back from picking up a patient in the ICU. "It was a hyperosmolar coma with insulin resistance. ”

"No wonder you were talking about that patient ......before," he asked, looking up with some doubt, "this patient also has a serious lung infection?"

"This is generally unavoidable. Professor Zhang Zhifu nodded, "High blood sugar to ketosis and hyperosmolar coma, such patients will inevitably have various infections - at present, it only indicates that there is a lung infection, which is already considered lucky." ”

"Imipenem has been given to the ICU, and it doesn't seem to have deteriorated further these days. Sun Lien added, "There should be no problem with the infection, otherwise the first person who should take over this patient is the respiratory medicine department or the infectious disease department." ”

Dr. Pascal smiled and waved the lunch box in his hand and said, "It's not like those two departments haven't consulted with us. He thought for a moment and added, "Actually, against IAA-positive insulin resistance, not only methylprednisolone can be used - plasmapheresis and immunoglobulin pulse methods can also be used, but the previous patient's economic situation and compliance were not very good, so this regimen was not used." ”

"Other immunosuppressive regimens will take effect more slowly, and it generally takes 4~6 weeks to suppress the immune system to an appropriate level. Sun Lien continued to explain to Dr. Pascal's words, "So after comprehensive consideration, a small amount of oral methylprednisolone was used on that patient, and then combined with some anti-glycemic drugs with different mechanisms of action, the blood sugar was lowered." ”

"Finally, we recommend that the patient be diagnosed with occult adult autoimmune diabetes. That is, LADA. Dr. Pascal concluded, "Although there is a lack of fasting C-peptide tracking results, the patient's own symptoms perfectly meet the relevant diagnostic criteria, and we have communicated with the endocrinology department several times to make this diagnosis......" He looked at his watch and hurriedly said to Professor Sun Lien and Professor Zhang Zhifu, "The canteen has already started to work, I will go to eat first—if I go later, the roast duck rice will be sold out." As soon as he finished speaking, Dr. Pascal hurried out of the entrance of the diagnostic center.

"Our department is really ...... There are a lot of wonderful people. Professor Zhang Zhifu shook his head with a smile and said to Sun Lien, "I won't delay your meal time Dr. Sun, I'll go and communicate with the doctors in the treatment team about this patient's situation." He paused, a little embarrassed, "We just arrived today, and many things on the process are not particularly clear......

"Don't worry, if you have any questions, just call me or the other doctors in the group. Sun Lien rushed in front of Professor Zhang Zhifu and said, "We must know everything, and we must say everything." ”

"Then I'm relieved. Professor Zhang Zhifu patted Sun Lien on the shoulder, "When they are all ready, I will invite everyone to dinner." ”