胰岛素治疗九讲解课件.pptVIP

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2018-02-09 发布于天津
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胰岛素治疗九讲解课件.ppt

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Subcutaneous insulin: 16 U regular + 31 U long-acting Inhaled insulin: 12 mg inhaled + 25 U ultralente Inhaled Insulin in Type 1 Diabetes Skyler JS et al. Lancet. 2001;357:331-335 10 Weeks A1C (%) 0 4 8 12 73 Patients Taking Inhaled Insulin tid in Addition to Injected Long-Acting Insulin 9 8 7 6 Δ A1C (%)(mean baseline, 8.7%) 2 Baseline Week 8 Week 12 Week 4 Inhaled Insulin in Type 2 Diabetes Cefalu WT et al. Ann Intern Med. 2001;134:203-207 26 Patients With Subcutaneous Regular Replaced by Inhaled Insulin tid, in Addition to Long-Acting Insulin Baseline mean dose: 19 U regular + 51 U long-acting Week 12 mean dose: 15 mg inhaled + 36 U ultralente 1 0 -1 Inhaled Insulin in Type 2 Diabetes Weiss SR et al. Diabetes. 1999;48(suppl 1):A12 10 8 6 4 0 Baseline 12 weeks Baseline 12 weeks –2.3% P0.001 2 A1C (%) Oral agents alone Oral + inhaled insulin 69 Patients With Inhaled Insulin tid Added to Sulfonylurea and/or Metformin 11 A1C (%) Baseline 60 days 90 days 30 days Buccally Absorbed Insulin in Type 2 Diabetes Schwartz S et al. Diabetes. 2001;50(suppl 2):A130 Oral insulin Placebo 33 Patients With Oral Insulin tid Added to DietChange from baseline -1.7%Placebo-subtracted difference -2.2% 10 9 8 7 SummaryInsulin Therapy Replaces complete lack of insulin in type 1 diabetes Supplements progressive deficiency in type 2 diabetes Basal insulin added to oral agents can be used to start Full replacement requires a basal-bolus regimen Hypoglycemia and weight gain are the main medical risks New insulin analogues and injection devices facilitate use * Therapeutic OptionsInsulins Insulin Preparations Class Agents Human insulins Regular, NPH, lente, ultralente Insulin analogues Aspart, glulisine, lispro, glargine Premixed insulins Human 70/30, 50/50 Humalog mix 75/25 Novolog mix 70/30 Human Insulin A-chain B-chain Zn++ Zn++ Self-aggregation in solution Monomers Dimers Hexamers 21 amino acids 30 amino acids Modified Human Insulin Regular Insulin Short acting H