糖尿病的胰岛素治疗讲义课件.ppt

注意事项 (4) 联合应用药物 血中胰岛素增加：氯喹、奎尼丁、奎宁等延缓降介 改变糖代谢、血糖上升：钙通道阻滞剂、可乐定、二氮嗪、GH、肝素、α受体拮抗剂、大麻、吗啡、尼古丁、β受体阻滞剂(普萘洛尔可阻止肾上腺素升高血糖的反应) 降低血糖：(ACEI、溴隐停、氯贝特、酮康唑、锂、甲苯咪唑、茶碱、大量酒精、奥曲肽) * Slide 6-39 INSULIN TACTICS Starting With Basal Insulin Combination Oral Agents + Evening Basal Insulin The next group of slides explores the synergistic or complementary effects of this type of combination. Different strategies for combining oral agents with basal insulin are discussed. * Slide 6-40 INSULIN TACTICS Combination Oral Agents + Insulin Synergistic or Complementary Effects The oral agents can be divided into two general categories: those augmenting the supply of insulin by increasing the secretion of insulin into the portal circulation and those enhancing the effectiveness of insulin. Injected insulin, in turn, increases insulin in the systemic circulation. Because the mechanisms of action for these classes of oral agents differ, they may have complementary or additive effects and can help meet the individualized needs of patients. The sulfonylureas are oral agents that augment the supply of portal insulin. They increase hepatic levels of endogenous insulin and enhance meal-mediated insulin release. Metformin and the glitazones are oral agents that enhance the effectiveness of insulin. Metformin improves insulin sensitivity at the liver and reduces hepatic glucose production. The glitazones improve insulin action in peripheral tissues and enhance glucose uptake. The a-glucosidase inhibitors have a different mechanism of action, decreasing postprandial glucose absorption by inhibiting digestion of complex carbohydrates and disaccharides, thereby retarding gastrointestinal glucose absorption. * 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 th