2型糖尿病口服药物联合睡前胰岛素治疗体会

目的 观察2型糖尿病空腹血糖经过饮食,运动,口服降糖药长期治疗仍难以控制的患者予以睡前加用不同剂量中效胰岛素(NPH)治疗效果观察.方法 将确诊为2型糖尿病患者40例随机分为两组,对照组为饮食+运动+口服降糖药物治疗,治疗组为饮食+运动+口服降糖药物+睡前中效胰岛素治疗.结果 治疗组降糖效果明显,无一例发生夜间低血糖反应.结论 中国2型糖尿病防治指南(2010年)明确指出,2型糖尿病患者在生活方式和口服降糖药联合治疗的基础上,如果血糖仍为达到控制目标,即可开始口服药和胰岛素联合治疗[1].     

早期、短期的胰岛素强化治疗可使2型糖尿病患者长期获益

胰岛B细胞功能进行性衰竭是2型糖尿病发病和疾病进展的决定性因素。最新的《内科学》（第7版）首次将“B细胞明显衰退者”作为胰岛素治疗指征写入教科书。2007年《中国2型糖尿病防治指南》建议,非超重患者在口服降糖药物治疗3个月后效果不佳即推荐加用胰岛素治疗。     

地特胰岛素治疗2型糖尿病的临床观察

良好的血糖控制可降低糖尿病相关并发症的风险。随着疾病进展,2型糖尿病患者需在口服降糖药物基础上联合胰岛素治疗,以使血糖控制达标。而在口服降糖药物基础上增加基础胰岛素治疗,是2型糖尿病患者起始应用胰岛素治疗的一种有效选择,传统的基础人胰岛素诺和灵N(NPH),多年来在临     

胰岛素个体化治疗

时至今日,新的降糖药物不断涌现,但胰岛素治疗仍是控制高血糖的重要手段,具有不可替代的作用。1型糖尿病患者需要胰岛素维持生命,也必须使用胰岛素控制高血糖。2型糖尿病患者虽然不需要胰岛素来维持生命,但由于口服降     

2型糖尿病患者启动预混胰岛素治疗病例解析

作为糖尿病血糖管理的经典药物，胰岛素一直是降糖达标的最重要选择之一。本文选取了一个口服药控制不佳的2型糖尿病患者启动预混胰岛素治疗的病例，并结合该病例针对2型糖尿病患者的胰岛素起始方案的选择及一些在胰岛素使用中的注意事项进行简要的讨论。     

甘精胰岛素联合阿卡波糖治疗2型糖尿病的疗效观察

目的探讨对于口服降糖药物不能很好控制血糖的2型糖尿病(T2DM)患者,改为甘精胰岛素针联合阿卡波糖片治疗的临床疗效。方法收集口服降糖药物控制不佳的2型糖尿病患者共60例,分为甘精胰岛素治疗组(A组)及预混胰岛素针治疗组(B组)各30例,A组采用甘精胰岛素针联合阿卡波糖治疗,B组采用预混胰岛素针单用治疗,观察两种方法治疗前后血糖的变化、胰岛素用量、血糖达标时间、低血糖发生率。结果两组患者经治疗后血糖均明显下降。A组与B相比较血糖更加容易平稳,血糖达标时间短,胰岛素用量偏少,低血糖发生率低,差异具有统计学意义(P<0.05)。结论甘精胰岛素针联合阿卡波糖片治疗T2DM疗效安全有效,适宜作为口服降糖药物不能良好控制的2型糖尿病患者的首选治疗方法。     

甘精胰岛素联合二甲双胍治疗2型糖尿病的疗效观察

目的:探讨对于2型糖尿病口服降糖药物血糖控制差,改为甘精胰岛素注射液联合二甲双胍片降糖的疗效.方法:收集2014年1月~2016年1月在我院内分泌科住院治疗2型糖尿病患者80例,因口服降糖药物血糖控制差,分为甘精胰岛素组(A组)40例,预混胰岛素治疗组(B组)40例,A组采用甘精胰岛素针联合二甲双胍降糖治疗,B组采用预混胰岛素针降糖治疗,观察甘精胰岛素组与预混胰岛素组治疗前后血糖的变化、血糖达标时间、胰岛素用量及低血糖发生率.结论:甘精胰岛素针联合二甲双胍片治疗2型糖尿病血糖控制平稳,低血糖发生率低,甘精胰岛素联合二甲双胍片对口服药物血糖控制差的2型糖尿病患者是首选治疗方法.     

观察金芪降糖片联合吡格列酮片治疗2型糖尿病高胰岛素血症的临床疗效

目的探讨金芪降糖片联合吡格列酮片对2型糖尿病高胰岛素血症患者的临床疗效。方法 70例2型糖尿病高胰岛素血症患者,随机分为对照组和试验组。对照组单纯使用吡格列酮片口服治疗,试验组在此基础上加用金芪降糖片。比较治疗后两组空腹血糖、空腹胰岛素、餐后2 h血糖、餐后2 h胰岛素和药物不良反应发生率。结果治疗后,试验组患者的空腹血糖,空腹胰岛素,餐后2 h血糖,餐后2 h胰岛素均显著低于对照组,差异具有统计学意义(P<0.05),药物不良反应发生率无显著性差异,(P>0.05)。结论对2型糖尿病高胰岛素血症患者使用金芪降糖片与吡格列酮片联合口服的药物治疗方案,能够更好地减轻患者的胰岛素抵抗,降低血糖,是一种治疗2型糖尿病高胰岛素血症的理想药物联合使用方案。     

甘精胰岛素联合二甲双胍治疗2型糖尿病的疗效观察

目的探讨对于口服降糖药物不能很好控制血糖的2型糖尿病(T2DM)患者,改为甘精胰岛素针联合二甲双胍片治疗的临床疗效。方法收集2010年1月至2011年10月期间我院收治的口服降糖药物控制不佳的2型糖尿病患者共60例,分为甘精胰岛素治疗组(A组)及预混胰岛素针治疗组(B组)各30例,A组采用甘精胰岛素针联合二甲双胍片治疗,B组采用预混胰岛素针单用治疗,观察两种方法治疗前后血糖的变化、胰岛素用量、血糖达标时间、低血糖发生率。结果两组患者经治疗后血糖均明显下降。A组与B相比较血糖更加容易平稳,血糖达标时间短,胰岛素用量偏少,低血糖发生率低,并且部分患者有体质量减轻,差异具有统计学意义。结论甘精胰岛素针联合二甲双胍片治疗T2DM疗效安全有效,适宜作为口服降糖药物不能良好控制的2型糖尿病患者的首选治疗方法。     

预混胰岛素在糖尿病治疗中的应用

预混胰岛素是最为常用的降糖药物之一.文章对预混胰岛素在2型糖尿病治疗中的适应证、作用机制、使用方法、注意事项等作了具体说明,以便社区医生掌握最新知识,提高糖尿病的社区管理水平.     

Human insulin genome sequence map,biochemical structure of insulin for recombinant DNA insulin

Insulin is a essential molecule for type I diabetes that is marketed by very few companies. It is the first molecule, which was made by recombinant technology; but the commercialization process is very difficult. Knowledge about biochemical structure of insulin and human insulin genome sequence map is pivotal to large scale manufacturing of recombinant DNA Insulin. This paper reviews human insulin genome sequence map, the amino acid sequence of porcine insulin, crystal structure of porcine insulin, insulin monomer, aggregation surfaces of insulin, conformational variation in the insulin monomer, insulin X-ray structures for recombinant DNA technology in the synthesis of human insulin in Escherichia coli.     

Intentional overdose with insulin glargine and insulin aspart

Reports of intentional massive overdoses of insulin are infrequent. A review of the literature revealed no reports of overdose attempts with either insulin glargine or insulin aspart. We report the case of a 33-year-old woman without diabetes mellitus who intentionally injected herself with an overdose of both products, which belonged to her husband. She arrived at the emergency department 15 hours after her suicide attempt, which took place the night before. Her husband had checked her blood glucose level throughout the night and had given her high-carbohydrate drinks and foods. The patient had a history of obsessive-compulsive disorder, major depression, and numerous suicide attempts. She recovered from the resulting hypoglycemia after 40 hours of dextrose infusion and was transferred to a mental health facility. The main danger associated with insulin overdose is the resultant hypoglycemia and its effects on the central nervous system; hypokalemia, hypophosphatemia, and hypomagnesemia also can develop with excess insulin administration. Dextrose infusion, with liberal oral intake when possible, and monitoring for electrolyte changes, making adjustments as needed, are recommended for the treatment of intentional insulin overdose.     

Inhaled insulin

Inhalation of regular insulin for meal time glucose control has been found to be safe, efficacious and reliable in Type I and Type II diabetics. The administration of regular insulin through the human lungs by inhalation has been conducted in at least 14 short studies in both normal and diabetic subjects beginning as early as 1925. In all studies, significant insulin absorption and lowering of blood glucose was observed in the absence of penetration enhancers. Although a concern of variable dosing was raised in early studies, the development of new reproducible delivery systems has ensured that the variability of aerosol insulin can be as good, if not better, than subcutaneous (SC) injection. In the longest controlled studies in humans to date, both Type I and Type II insulin-dependent diabetics used a novel inhaled dry powder insulin delivery system for 3 months for meal time glucose control. The study results indicate that inhaled insulin provides equivalent glucose control, measured by hemoglobin A1c, when directly compared to SC injection. Interim results from an additional study with Type II diabetics who were failing oral hypoglycemic agents suggest that adjunctive therapy with inhaled insulin markedly improved glycemic control with a low risk of hypoglycemia. In all the 3 month studies the system was efficacious, well tolerated, well liked, and resulted in reproducible results. A potential advantage of aerosol insulin is that it is more rapidly absorbed (serum peak at 5-60 min) and cleared than SC injection (peak at 60-150 min), which provides a more relevant and convenient therapy for meal time glucose control. The relative efficiency of insulin delivery by aerosol, compared to SC injection, has been estimated from the dose measured at the exit point of the aerosol device, and found to range between 8 and 25% of SC, depending on the study.     

胰岛素泵诺和锐治疗2型糖尿病胰岛素抵抗的临床观察

目的:比较基因重组人胰岛素与人胰岛素类似物以胰岛素泵为输入载体时对于2型糖尿病胰岛素抵抗的疗效.方法:34例2型糖尿病胰岛素抵抗的患者随机分为两组:诺和锐治疗组及诺和灵对照组各17例,均为使用胰岛素强化治疗血糖控制不佳的胰岛素抵抗患者.根据毛细血糖监测结果调整胰岛素用量,比较两组血糖达标后每日药量及达标所需时间.结果:治疗组达标后每日药量及达标所需时间均显著少于对照组.结论:胰岛素泵诺和锐治疗2型糖尿病胰岛素抵抗的疗效明显优于胰岛素泵诺和灵.     

赖脯胰岛素联合甘精胰岛素在模拟胰岛素泵强化治疗糖尿病中的效果

目的比较赖脯胰岛素联合甘精胰岛素与胰岛素泵在2型糖尿病强化治疗中的疗效和安全性。方法将2型糖尿病病人随机分成两组,A组的病人采用三餐前赖脯胰岛素联合甘精胰岛素治疗,B组的病人采用胰岛素泵（使用赖脯胰岛素）降糖治疗。监测两组病人治疗前后全天血糖谱的变化,观察并比较血糖达标所需要的时间、胰岛素用量、低血糖发生率等情况。结果A组与B组相比,在血糖达标所需的时间、胰岛素用量及低血糖发生率等方面没有显著性差异（P〉0.05）。结论赖脯胰岛素联合甘精胰岛素治疗2型糖尿病患者,在疗效、安全性方面接近胰岛素泵,在治疗费用方面则具有一定的优势。     

Stability of insulin mixtures in disposable plastic insulin syringes

The miscibility of short and long acting porcine, human and bovine insulins has been investigated using HPLC. Soluble insulin is rapidly lost from solution when mixed with both isophane and zinc insulin, although the mechanism may be different in these two cases. The time for up to 50% or more to be lost is often less than 2 min. The percentage lost is dependent upon the ratio of the mixture and the type and origin of the insulin. In the case of soluble: zinc mixtures it is greatest for porcine and least for bovine, in the case of soluble: isophane mixtures it was least for human and greatest for bovine. The greater the original amount of soluble insulin present the less the loss. The results help explain recent clinical reports that mixtures of soluble and zinc insulins fail to achieve satisfactory control of post-prandial blood sugar levels.