胰岛素及其类似物在慢性肾功能不全患者中的应用.pptVIP

Rapidly acting analogues like lispro and aspart are active within minutes and peak in about 1 h, may not only facilitate the correction of hyperglycemia but also decrease the risk of late hypoglycemic episodes. Long-acting analogues, such as glargine, provide a peak-less, continuous insulin release over 24 h that approximates a normal basal pattern and their role in CKD is under evaluation.Some suggest thatshould be avoided, while other support that such agents should be used. * 第五十八页，共75页。 RENAL FAILURE With increasing doses, duration of action of regular insulin increases. This increases the risk for late-postprandial hypoglycemia Nosek et al (2003): Aspart unlike regular human insulin does not show a significant prolongation in its duration of action with higher doses. * 第五十九页，共75页。 * 第六十页，共75页。 Kinetics of Insulin Aspart were comparable among diabetes with various degrees of renal dysfunction. * 第六十一页，共75页。 * 第六十二页，共75页。 胰岛素剂量的调整 Use of Insulin in CKD ? No dose adjustment with GFR 50ml/min ? Reduce dose to 75% with GFR 10 to 50m/min ? Reduce dose to 50% when GFR 10ml/min * 第六十三页，共75页。 * 第六十四页，共75页。 肾功能不全者不同治疗阶段的血糖控制 * 第六十五页，共75页。 CKD patient on peritoneal dialysisThe objective of is to maintain euglycemia during the dwell time, to prevent postprandial or post-PD hyperglycemia, and to avoid delayed hypoglycemia. However, controversy exists about the route of insulin administration. Subcutaneous (SC) and intraperitoneal (IP) insulin therapy are both acceptable in PD.  * 第六十六页，共75页。 IP Insulin use in Peritoneal Dialysis Advantages: ? Provides continuous infusion ? Eliminates need for injections ? Physiologic Route: absorbed into portal vein decrease fluctuations of blood glucose decrease hyperinsulinemia decrease insulin antibodies Disadvantages: ? Source of bacterial contamination ? increase in insulin requirement and Variable absorption ? Fibroblastic proliferation and hepatic steatosis * 第六十七页，共75页。 Q1：