基础胰岛素与血糖控制王庆开ppt课件.pptVIP

* The prolonged action of Lantus? (insulin glargine) is based on a slow dissolution of a microprecipitate1,2 After injection into subcutaneous tissue, the acidic Lantus solution is neutralised, leading to formation of microprecipitates from which small amounts of Lantus are slowly released1,2 The presence of zinc in the Lantus preparation is required for formation of microprecipitates in the subcutaneous tissue and extends the activity by reducing the absorption rate from the injection site3 1. Kramer W. New approaches to the treatment of diabetes. Exp Clin Endocrinol Diabetes. 1999;107(suppl 2):S52-S61. 2. Lantus? (insulin glargine) EMEA Summary of Product Characteristics. Bridgewater, NJ: Aventis Pharmaceuticals; 2002. 3. McKeage K, Goa KL. Insulin glargine: a review of its therapeutic use as a long-acting agent for the management of type 1 and type 2 diabetes mellitus. Drugs. 2001;61:1599-1624. 当呈酸性的、澄清的来得时溶液注射入体内后，由于酸碱中和，胰岛素分子呈微沉淀析出。 来得时由于分子结构的改变，其胰岛素六聚体内部的稳定性增强，因此从六聚体分解为二聚体、单聚体吸收的过程延缓，从而能注射一次维持24小时。 * 这是来得时与NPH相比的作用曲线。在1型糖尿病患者中利用葡萄糖钳夹技术，通过测定葡萄糖的利用率来反映胰岛素的作用。 与NPH在注射后4－6小时有一个明显的峰值相比，来得时注射后约2－3小时达到一个稳定的作用，并具有平稳、无峰值的特点。 与NPH作用时间约14－16小时相比，来得时注射一次就能维持24小时的作用。 来得时的这种平稳、无峰值，注射一次维持24小时的作用特点，能很好地模拟生理性基础胰岛素的分泌。 1. Lepore M, Kurzthals R, Pampanelli S, Fanelli CG, Bolli GB. Pharmacokinetics and dynamics of s.c. injection of the long-acting insulin glargine (HOE1) in T1DM. Diabetes. 1999;48(suppl):A97. Abstract 416. 2. Lantus? (insulin glargine) EMEA Summary of Product Characteristics. Bridgewater, NJ: Aventis Pharmaceuticals; 2002. 3. Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA, and the US Study Group of Insulin Glargine in Type 1 Diabetes. Less hypoglycaemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care. 2000;23:639-643. 4. McKeage K, Goa KL. Insulin glargine: a review of its therapeutic use as a long-lasting agent for the management of type 1 and type 2 diabetes mellitus. Drugs. 2001;61:1599-1624. 5. R