胰岛素类似物设计和临床应用__培训课件.ppt

* 由于诺和锐是速效胰岛素类似物，作用时间短，因此它只使用于基础－餐前强化治疗方案，即：三餐前诺和锐加睡前NPH。使用这种治疗方案在体内所形成的胰岛素曲线与正常人生理性胰岛素分泌模式非常相似，可以更好地控制整体血糖水平。 * 由于诺和锐起效迅速，可以更好地模拟生理性胰岛素分泌模式，从而达到良好地血糖控制。 * Relative proportions of basal and bolus insulin will differ between patients. Typically, 50–70% of the total daily insulin dose will be mealtime insulin, divided between meals according to the patient’s dietary pattern. The remaining 30–50% is often provided by NPH insulin, usually divided between two or more injections during the day . ? The basal and bolus (mealtime) components of basal-bolus therapy serve different functions and should ideally act independently: an appropriate basal insulin regimen will satisfy the body’s basal insulin requirements throughout the day, without needing contributions from mealtime insulins to do so, while the mealtime insulins should ideally meet the metabolic demand from each meal. If this is the case, the regimen can achieve considerable flexibility in terms of meal timing and size – it may be possible, for example, to delay a meal without compromising the level of basal insulin replacement. ? The short duration of action of NovoRapid? allows basal-bolus therapy to approximate non-diabetic insulin secretion more closely than soluble human insulin. The rapid action of NovoRapid? is more closely matched to the rise in glucose levels following a meal and, unlike soluble human insulin, the action of one mealtime injection of NovoRapid? is complete before the next mealtime injection Three injections of NovoRapid? with main meals represent 50–70% of total daily insulin dose; basal therapy with NPH insulin may be a single bedtime dose or may be divided between two daily doses. * One or more snacks may be an integral part of the lifestyle of some patients. With a conventional regimen of soluble human insulin, this can prejudice preprandial control at the next mealtime, but with NovoRapid?, adding an additional injection with the snack allows control to be maintained Data show that