胰岛素强化治疗和csii临床应用ppt课件.ppt

* How Diabetes Specialists Treat Their Own Type 1 Diabetes 一项对美国糖尿病协会（ADA）和美国糖尿病教育者联合会（AADE）中患糖尿病的专家成员的研究发现，其中接近60％患者应用胰岛素泵治疗糖尿病。 Study by Graff There is a failure to achieve broader usage of CSII amongst the general population of the United States that has type 1 disparity between pump usage of that group compared to people with diabetes in the professional sections of the ADA and AADE The difference between these groups was 6% in the general population and over 50% in the ADA and AADE (usage in the calendar year 1998) REF: Graff M. Diabetes Educator 46:460-467, 2000 recently reported by Industry Estimates that CSII therapy in people diagnosed with diabetes has risen to 12% of the general population If the standard for adoption is that of the professional sections of diabetes organizations than this still falls 80% short of target Graff et. al, Diabetes educator 2000, 46:460-467. ? * * * * 难题： 黎明现象是指糖尿病人在凌晨时分血糖升高。 大约89%的1型糖尿病患者有黎明现象。常规注射 方法很难控制黎明现象，因为夜间胰岛素需要量减少，如果在睡前输注中长效胰岛素，其吸收难以预见，如果胰岛素波峰前移会导致危险的夜间低血糖。 * 3 Normal Pancreas Simplest level - a small amount of glucose, measurable in millimoles, circulates in the blood continually. After eating, the normal pancreas secretes insulin in response to glucose need. In the diabetic state, the balance of insulin and glucose is disrupted, putting patients at risk for hyperglycemia. * 4 2 Injections Per Day The Manichean view: that intensive therapy is “good on one hand, but bad on the other” that it necessarily carries the risk for more frequent hypoglycemia that it is in principle, not applicable to the vast majority of type 1 diabetic patients Difficult to achieve ideal balance between hyper- hypoglycemia with exogenous insulin - barrier to the generalization of intensive treatment to all patients. Challenge has been to design a therapeutic regimen that provides: adequate flexibility. meeting the changing metabolic needs throughout the day. freedom to enjoy a relatively normal lifestyle. Regular and