常见的胰岛素治疗方案.pptVIP

The natural history of type 2 diabetes is illustrated more graphically in this slide. In the period preceding the onset of frank diabetes – characterized by impaired glucose tolerance – macrovascular risk is already very pronounced. Microvascular risk begins after the onset of hyperglycemia. The two lower lines illustrate fasting and postprandial glycemia; the earliest abnormality in patients with type 2 diabetes is mostly observed in the postprandial state. This abnormality remains more significant than the fasting plasma glucose abnormality for the duration of the disease. The fasting plasma glucose concentration begins to rise after the postprandial rise in glucose and is coincident with the increase in hepatic glucose production, which, in turn, is coincident with the decline of endogenous insulin secretion (yellow). Insulin resistance, which is fully expressed in the stage of impaired glucose tolerance, tends not to change very much over the course of disease. From this pathophysiologic scheme of progressive beta-cell failure, it is clear that over time all patients will require either increased endogenous insulin production or exogenous insulin therapy. 生理性胰岛素的释放包括两个部分： 持续的基础胰岛素分泌，抑制肝糖原的输出，抑制两餐间和夜间血糖的产生；水平几乎保持不变；全天约占总量的50% 餐时胰岛素分泌，促进葡萄糖的利用和储存，并抑制肝糖原输出，控制餐后高血糖；1小时出现胰岛素尖锐峰值 ；每餐剂量占全天总量的10% to 20% 胰岛素治疗的目的在于模拟生理性胰岛素释放：基础加餐时胰岛素。 Hans Christian Hagedorn 1923 胰岛素第一次用于治疗糖尿病， 1938鱼精蛋白锌胰岛素（诺和公司）， 1953lente长效胰岛素，由于动物胰岛素存在提纯不好，抗体反应等缺点， 1973单组分胰岛素被纯化，但是仍不能解决动物胰岛素存在的根本问题；到1987第一支人胰岛素问世，并于同年应用于人，因为与人的天然胰岛素氨基酸序列完全相同，所以抗原性大大降低，但是直到1996年才上市。从动物胰岛素到人胰岛素是胰岛素历史的极大进步，但是由于外源性胰岛素与内源性胰岛素的吸收途径不同，在临床应用上仍然存在缺点：提前给药，高峰延迟，所以胰岛素类似物概念应运而生。 Hans Christian Hagedorn was apparently the first to use insulin in humans in (although Lilly would have it first used in 1922); however Lilly would also have their first commercially available insulin in 1923 so the data can stand. Lilly source: /Products/InsulinMilestones.cfm. Zinc protamine insulin was first marketed by Novo in. Lente insulin follo