Joslin糖尿病中心幻灯-关于胰岛素泵 .ppt

Relative Risk of Progession of Diabetes Complications (DCCT) Hypoglycemia: the price of improved diabetes control Challenges in maintaining long term adherence Practical Considerations with Intensive Insulin Therapy DCCT Retinopathy Data:Conventional vs Intensive Insulin Therapy At the same A1C level, intensive insulin therapy leads to less eye disease Physiologic Insulin Secretion Profile Transitioning to Intensive Insulin Therapy Intensive Insulin Therapy Intensive Insulin Therapy Intensive Insulin Therapy Intensive Insulin Therapy MDI vs CSII: Individualizing the choice Physiologic considerations - Dawn phenomenon Advantages of pump for insulin delivery - Extended bolus temporary basal Minimizing complications of intensive therapy - Hypoglycemia - Weight gain Practical Implications For some patients: Physiologic benefit of CSII over MDI in covering variable nocturnal basal requirements Increased bedtime insulin sensitivity – Less insulin to correct highs at bedtime Less insulin to cover carbohydrates at bedtime Reduced morning insulin sensitivity – More insulin to correct highs at breakfast More insulin to cover carbohydrates at breakfast Randomized, Trial in Children:CSII vs MDI with Glargine Overlapping boluses: common cause for hypoglycemia with pump therapy The potential role of Correction Bolus Calculators in minimizing the risk for hypoglycemia with pump therapy Smart pump reduces risk for hypos from overlapping boluses Additional advantages of the pump for basal bolus insulin delivery 3 meals + 3 snacks with long-acting insulin = 6-7 injections/day Eating at restaurants and on social occassions Optimizing postprandial insulin coverage for higher fat, complex carbohydrate, and/or larger meals Extended, combination bolus, temporary basal Gastroparesis Additional advantages of the pump for basal bolus insulin delivery Diurnal changes in insulin sensitivity (e.g. chronic steroids) Dosing precision