I can see the status bar

Chapter 679 LADA (September 9, 30th update)
The huge amount of insulin used in the hospital may be just a matter of the doctor prescribing two more orders, and then flirting with the pharmacists in the pharmacy and the nurses in the ward.But people can't live in the ward forever. Patients in the inpatient department have only two different destinations, returning to their families or entering the end of their lives.No matter what kind it is, there must always be a place to go.

Diabetic patients with severe insulin resistance can still return to family life after controlling their blood sugar.And after going home, a large number of daily insulin injections have become the main factor reducing the quality of life of patients.

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 the patient can afford the consumption of about two sticks of insulin a day, an injection of more than 100 units three times a day is enough to cause headaches—since subcutaneous injections need to be absorbed locally through fat tissue, this dosage of 100 units Patients are also required to inject in divided doses.Roughly speaking, the patient himself needs about ten injections a day to complete the injection of [-] units... Any doctor knows that this is basically impossible.Generally speaking, patients with chronic diseases have poor compliance.This also determines that it is absolutely impossible for an old diabetic patient to stab himself more than ten times a day to control blood sugar.

To let this old man go back, he must adjust his blood sugar control plan.All in all, try to reduce the number of times patients need to inject themselves every day, so that it is possible for patients to persist.

In order to prevent the patient's quality of life from dropping too much after discharge, the Department of Endocrinology of the Fourth Hospital conducted several internal consultations and adjustments, but the blood sugar monitoring results were not satisfactory.Finally, Director Li Jinfang decided to ask the Department of Rheumatology and Immunology to come up with an idea. Starting from the positive IAA antibody, there may be some unexpected effects.

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

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"What happened to that patient?" Professor Zhang Zhifu was very interested in the 80-year-old patient with severe insulin resistance. He asked, "What plan did you use to control blood sugar?"

"I prescribed methylprednisolone for him." Dr. Pascal just walked out of the comprehensive diagnosis center, and he nodded at Professor Zhang Zhifu with a smile, "Actually, the treatment plan is very simple, but the Endocrinology Department of the Fourth Hospital Doctors are taking this a little too seriously."

"They may be worried that after the use of hormones, the wounds that were difficult to heal will develop further." Sun Lien explained for the Department of Endocrinology, "It is not easy to judge the dosage of methylprednisolone treatment, after all, the acute phase usually requires 40~ 80mg dosage, but in the case of lung infection and old age, finally decided to take 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 Nobel Prizes in the future." Professor Zhang Zhifu shook hands with Dr. Pascal while sighing, "Are you...?"

"Go to the cafeteria for lunch." Dr. Pascal raised the aluminum lunch box full of Chinese characteristics in his hand to Professor Zhang Zhifu. It's not worth it... isn't it going to go to the cafeteria to solve the problem?"

The lunch box with Chinese characteristics, the appellation with Chinese characteristics, and the reasons for not going home to eat with Chinese characteristics.The three factors are superimposed together, and Professor Zhang Zhifu vaguely feels that he has returned to the era of the reform and opening up.

"Are you..." After introducing himself, Dr. Pascal asked politely, "Are you ready to leave work?"

"We just picked up a patient from the ICU." Sun Lien explained, "It's a hyperosmolar coma with insulin resistance."

Dr. Pascal suddenly realized, "No wonder you are talking about the patient before..." He raised his head and asked with some doubts, "This patient also has a severe lung infection?"

"This kind of thing is generally unavoidable." Professor Zhang Zhifu nodded and said, "The blood sugar is so high that ketosis plus hyperosmolar coma, such a patient will inevitably have various infections - at present, it is only indicated that there is a lung infection, which is considered lucky."

"Imipenem has been used in the ICU, and it seems that at least it has not deteriorated further these days." Sun Lien added, "There should be no problem with the infection, otherwise the first thing to take over this patient is the Department of Respiratory Medicine or Infection department."

Dr. Pascal smiled and waved the lunch box in his hand and said, "It's not that the two departments haven't consulted with us." He thought for a while and added, "Actually, to fight against IAA-positive insulin resistance, Not only methylprednisolone can be used—plasma exchange and immunoglobulin shock methods are also possible, but the previous patient’s economic situation and compliance were not very good, so this method was not used.”

"Other immunosuppressive regimens will take effect slowly, and it usually takes 4 to 6 weeks to suppress the immune system to an appropriate level." Sun Li'en continued to explain following Dr. Pascal's words, "so it is right to consider all factors That patient took a small dose of methylprednisolone orally, and combined with some sugar-controlling drugs with different mechanisms of action, the blood sugar was lowered."

"Finally, we suggested diagnosing that patient as Latent Adult Autoimmune Diabetes Mellitus. That is LADA." Dr. Pascale concluded, "Although there is a lack of fasting C-peptide follow-up results, the patient's symptoms perfectly meet the relevant diagnostic criteria. We After communicating with the endocrinology department several times, I made this diagnosis..." He glanced at his watch, and quickly said to Professor Sun Li'en and Zhang Zhifu, "The cafeteria has already started working, I'll go to get some food first - I'll go later, roast duck rice But it was sold out." As soon as he finished speaking, Dr. Pascal hurriedly left the gate of the diagnostic center.

"Our department really... has a lot of wonderful people." Professor Zhang Zhifu shook his head with a smile, and said to Sun Li'en, "I won't delay Dr. Sun's meal time, I'll talk to the doctors in the treatment team about the patient's condition Let's communicate." He paused, a little embarrassed, "We just arrived today, and many things in the process are not very clear..."

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

"Then I'm relieved." Professor Zhang Zhifu patted Sun Li'en on the shoulder, "When they are all done, I will treat everyone to dinner."

　Sorry for the dove yesterday.

　　Tomorrow... I will try not to dove.

　　
　
(End of this chapter)