[临床医学]糖尿病的胰岛素治疗-卜石.pptVIP

* Slide 6-58 PRACTICAL GUIDELINES Combination Therapy Regimens For the usual patient with type 2 diabetes, the recommendation is for early use of combination therapy involving an insulin secretagogue and an insulin sensitizer. The simplest and most cost-effective approach consists of either a once-daily, low-dose or eventually full-dose sulfonylurea in combination with increasing doses of metformin. For patients with type 2 diabetes who show marked insulin resistance, a combination of metformin + glitazone can be recommended. If the target HbA1c 7% is not achieved, triple oral therapy can be attempted, or basal insulin can be added while continuing oral therapy. * Slide 6-23 INSULIN TACTICS Twice-daily Split-mixed Regimens Twice-daily mixtures of NPH and regular insulins have been widely used for type 2 diabetes for many years. In some cases, premixed 70/30 insulin is used for this purpose. Patient profiles of insulin levels resulting from this method, as shown in this figure, do not come close to matching the normal endogenous secretory pattern, shown in the shaded background. Patients with type 1 diabetes using this “split-mixed” regimen rarely achieve reasonably good glycemic control by present standards, since they lack endogenous insulin to supplement the partially adequate profile of injected insulin. Type 2 diabetes patients who have substantial endogenous insulin may fare much better with this regimen, but may experience late morning or nocturnal hypoglycemia because of excessive levels of insulin at these times. Berger M, Jorgens V, Mühlhauser I. Rationale for the use of insulin therapy alone as the pharmacological treatment of type 2 diabetes. Diabetes Care. 1999;22(suppl 3):C71-C75; Edelman SV, Henry RR. Insulin therapy for normalizing glycosylated hemoglobin in type II diabetes: applications, benefits, and risks. Diabetes Reviews. 1995;3:308-334. * Slide 6-24 INSULIN TACTICS Multiple Daily Injections (MDI) NPH + Regular Another strategy, shown in this