胰岛素治疗策略和胰岛素泵.pptVIP

* The introduction of basal insulin into the treatment regimen of a patient with type 2 diabetes can be done with a single daily injection. The availability of insulin glargine (LANTUS?) addresses fasting blood glucose levels and overall glycemic control and can be administered in one injection daily. This may help overcome patient anxiety over injections. The international consensus group recommends that basal insulin is administered either at bedtime or in the morning and should be started at a dose of 10 units per day or 0.2 units/kg. Then basal insulin needs to be titrated by monitoring fasting blood glucose levels daily. The dose should be increased by 2 units every 3 days until fasting blood glucose levels are in range (3.89–7.22 mmol/L; 70–130 mg/dL). If the fasting blood glucose value is 10 mmol/L ( 180 mg/dL), 4 units of insulin may be used instead of 2 units. In the event of hypoglycemia or inappropriate fasting blood glucose levels, the insulin dose should be reduced by ≥ 4 units or 10% if the dose is 60 units. The regimen should then be continued and HbA1c levels checked every 3 months. Some countries use other algorithms, the most important being to titrate basal insulin guided by the fasting blood glucose level. Nathan DM, et al. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2006;49:1711–21. * * Insulin therapy should be intensified if HbA1c levels are ≥ 7% after 2–3 months or if the fasting blood glucose level is within target but overall glycemic control is still inadequate. In such cases, prandial insulin may be required and pre-meal blood glucose levels should be checked. If mealtime insulin is required, then it should be added at a dose of approximately 4 units per day and adjusted by 2 units every 3 days until pre-meal blood glucose values are