[临床医学]改善血糖控制_门诊胰岛素的应用.ppt

您在门诊使用胰岛素么? 使用何种胰岛素? 不使用 使用基础胰岛素 使用预混胰岛素 问题2 优泌乐25夜间低血糖发生率发生率低 是 不是 优泌乐? Mix25 (BID)加二甲双胍与Lantus?每日一次加二甲双胍相比： 低血糖 问题三 关于优泌乐25 轻松开始,全面达标的理想的起始胰岛素 它更适合口服药治疗不达标的患者 优泌乐25配合优伴经典,提高患者生活质量 谢 谢! Case 3 在维持目前治疗方案不变的基础上，睡前加用 NPH10U 注射，根据FBG监测结果逐渐增加剂量至20U/晚，FBG控制在5.8-7.3mM。 3月后复查HbA1c: 7.6% CGMS: 早餐前 午餐前 晚餐前 睡前 血糖(mM) 6.9 8.1 8.7 9.4 血糖水平(mmol/L) 6am 10am 2pm 6pm 10pm 2am 6am 时间 5 10 15 早餐 中餐 晚餐 NPH CGMS 示意图 Case 3 继续二甲双胍治疗，停用格列奇特及NPH，改为早晚餐前优泌乐(25)12U皮下注射，后根据血糖监测结果逐渐增加剂量至20U，24U， 但餐后血糖仍在10.0 mM左右。 鉴于患者存在明显的胰岛素抵抗，故加用吡格列酮30mg/日。1月后复查血糖控制满意，FBG: 5.4mM, 2h BG: 7.2mM, 餐前偶有低血糖反应。 逐渐减少胰岛素用量至16U，18U。 3月后复查HbA1c 6.4%. Case 3 Highlights 对于胰岛素作用与胰岛素分泌均存在明显障碍的患者，应注意在改善胰岛素抵抗的同时使用胰岛素补充治疗。 联合使用二甲双胍与胰岛素是这类患者的最佳选择。 * Normally, insulin secretion can be divided into two basic components, basal and stimulated. Basal insulin is secreted continuously between meals and throughout the night, reduces hepatic glucose production. In diabetic patients, treatment with intermediate-acting or long-acting insulin attempts to mimic the basal secretory pattern. Stimulated insulin secretion occurs in response to a meal and results in insulin concentrations of 60 to 80 mU/L from just before to 30 minutes after the meal. Concentrations return to basal levels in 2 to 4 hours. Regimens of regular insulin attempt to mimic the stimulated insulin secretory pattern. * Normally, insulin secretion can be divided into two basic components, basal and stimulated. Basal insulin is secreted continuously between meals and throughout the night, reduces hepatic glucose production. In diabetic patients, treatment with intermediate-acting or long-acting insulin attempts to mimic the basal secretory pattern. Stimulated insulin secretion occurs in response to a meal and results in insulin concentrations of 60 to 80 mU/L from just before to 30 minutes after the meal. Concentrations return to basal levels in 2 to 4 hours. Regimens of regular insulin attempt to mimic the stim