治疗型糖尿病怎样选用胰岛素.pptVIP

* 如图所示：在2型糖尿病患者中，由于早期胰岛素分泌不足，使内源性葡萄糖生成及血浆胰高糖素的分泌不被抑制，最终导致血浆血糖的增高 进食后早期胰岛素释放不足－胰高糖素不能被抑制－内源性葡萄糖生成不下降－餐后高血糖 * Bruttomesso D et al., Diabetes 48: 99, 1999 Caspary WF, Am J Clin Nutr 55 (suppl 1): 299S, 1992 Lefebvre PJ et al, Eur J Clin Invest 29 (suppl 2): 1, 1999 * Time course of the rate of systemic appearance of ingested glucose (A), rate of systemic utilization of glucose (B), and rate of endogenous glucose production (C) after the ingestion of 50 g of glucose preceded by the subcutaneous injection of equivalent dose (0.075 U/kg lean body mass) of regular ( ) and lispro ( ) insulin. Kinetic parameters were estimated either by noncompartmental S t e e l e ’s equation or two-compartment analysis (23,24). Because the two approaches gave similar results, only data obtained with the twocompartment analysis are shown. *P 0.05. * 由于诺和锐在药物动力学方面的改善，使其在临床治疗当中显示了非常好的作用。在一项有90例1型糖尿病患者参与的多中心随机双盲交叉研究中，患者注射诺和锐与常规人胰岛素相比，血浆胰岛素水平能迅速达到峰值，且明显高于常规人胰岛素，而在两餐之间恢复基础水平，夜间诺和锐的浓度低于常规人胰岛素。由此在血糖水平上我们可以得到以下结果： * 患者注射诺和锐后，其白天及晚上的血糖水平都明显低于常规人胰岛素，而夜间的血糖水平高于常规人胰岛素，使患者在获得良好的血糖控制的同时不会发生夜间严重低血糖事件。 * 诺和锐与常规人胰岛素相比，夜间严重低血糖事件减少72%. * * * ANA 031 The soluble fraction of NovoMix? 30 was absorbed significantly faster than that of BHI 30 (p 0.0001), and reached higher peak concentration (p 0.0001). Pharmacokinetic data from the 033 study similarly demonstrated faster absorption and greater peak serum concentration reached in a shorter time with NovoMix? 30 than BHI 30, and corroborated the equivalent pharmacokinetic behaviour of the intermediate-acting protaminated fraction of both insulins. * * ANA 038 Summary: At 12 weeks, mean prandial glucose excursion was significantly less (p 0.02) in the NovoMix 30 group compared with the BHI 30 group. Postprandial glycaemic control was significantly better with NovoMix? 30 when analysed on the basis of mean prandial blood glucose increment - mean increment (post-meal minus pre-meal blood glucose) over the three meals including lunch, when no insulin was