8-病例讨论B女士 2型糖尿病口服药治疗血糖控制不佳.pptVIP

2型糖尿病患者基础胰岛素的启用与优化 2型糖尿病患者起始基础胰岛素治疗 当口服降糖药不能使糖化血红蛋白达标时，就需要使用胰岛素治疗.1 ‘首先控制空腹血糖’ –可以在口服降糖药的基础上加用基础胰岛素首先使得空腹血糖达标 .2 基础胰岛素应该模拟生理性的胰岛素分泌模式，从而达到无峰值，并能够覆盖24小时的作用. 一针基础甘精胰岛素注射可以提供几乎无峰值覆盖24小时的胰岛素作用3，并且将低血糖的风险降至最低. 早期加用胰岛素能够优化血糖控制 阶梯式强化治疗持久达标 * Key Points Mrs. B is a 47-year-old woman you have followed for the past few years. She was diagnosed as having type 2 diabetes three years ago on a routine screen. After her diagnosis, Mrs. B went from leading a very unhealthy, sedentary lifestyle to adopting a very healthy one. She is currently a very motivated patient, and has made an effort to become very well-educated about diabetes prevention and management. After her diagnosis, Mrs. B went from leading a very unhealthy, sedentary lifestyle to adopting a very healthy one. She is currently a very motivated patient, and has made an effort to become very well educated about diabetes prevention and management. * Key Points She was initially started on metformin 500 mg twice daily. The dose has been gradually increased to 1000 mg twice daily. One year ago, rosiglitazone 4 mg once daily was added. She leads a reasonably active lifestyle, including power walking with a friend for 45 minutes, four times a week. Other health issues include dyslipidemia treated with atorvastatin 40 mg daily. * Key Points When you ask Mrs. B why she is so upset, she tells you that she feels like all her efforts aren’t amounting to anything. She is frustrated by a 2-kg weight gain/year over the past year. Also, her blood glucose tests have shown, lately, that her blood sugar is too high. * Key Points Analysis of the results of her self-blood glucose monitoring reveals elevated fasting plasma glucose. There is a small glucose rise in the day with lower plasma glucose readings pre- and post-meals. This glucose profile is designed to illustrate the profile of a patient who should be started on a basal insulin at bedtime as outlined by Hirsch. The fasting glucose is high with, however, mini