胰岛素的起始治疗巴俊强PPT.ppt

* * * * 临床试验证明，胰岛素类似物与人胰岛素相比控制血糖的能力相似，但在模拟生理性胰岛素分泌和减少低血糖发生风险方面胰岛素类似物优于人胰岛素 * * In order to recreate as closely as possible the physiological insulin profile seen in non-diabetic individuals, the ideal meal-related insulin should rise rapidly within half an hour of the meal, reaching peak concentrations equivalent to that of a non-diabetic person. Insulin concentration should then decline swiftly, returning to baseline before the next meal. Rapid onset within half an hour of eating affords the best glycaemic control with a minimal amount of insulin (as demonstrated in the previous slide). Rapid decline in insulin concentration following the meal reduces the potential for hypoglycaemia and weight gain secondary to hyperinsulinaemia, whilst the maintenance of near-normal baseline insulin levels improves long-term metabolic control and reduces the risk of late diabetic complications. Compared to soluble human insulin, rapid-acting insulin analogues have a reduced tendency to form hexamers, accelerating their absorption from the injection site. The result is faster onset of action and improved postprandial glucose control. Since insulin analogues are rapidly eliminated via insulin protease metabolism they have a short duration of action, reducing the potential for between-meal and nocturnal hypoglycaemia. * 我们可以看到，各种胰岛素其作用时间与达峰时间都有所不同。 * 胰岛素的起始治疗 遵义市第一人民医院内分泌科 巴俊强 概述 胰岛素起始治疗 胰岛素强化治疗 胰岛素注射装置和技术 使用胰岛素治疗前必须了解以下几点： 1、中国2型糖尿病的控制目标； 2、2型糖尿病高血糖治疗路径； 3、患者的临床特点：糖尿病类型、既往治疗情况、体型等； 4、患者目前血糖、糖化血红蛋白、肝肾功能、胰岛β功能； 5、是否存在特殊情况：酮症？妊娠期？围手术期？严重感染？大剂量糖皮质激素使用中？ 前言 * * 指 标 目标值 血糖（mmol/L） 空 腹 3.9-7.2 非空腹 ≤10.0 HbA1c（%） 7.0 血压（mmHg） 130/80 HDL-C（mmol/L） 男 性 1.0 女 性 1.3 TG（mmol/L） 1.7 LDL-C（mmol/L） 未合并冠心病 2.6 合并冠心病 2.07 体重指数（BMI，kg/m2） 24 尿白蛋白/肌酐比值(mg/mmol) 男 性