两种胰岛素治疗方案对2型糖尿病患者骨折围手术期效果的比较

将234例2型糖尿病合并骨折患者按胰岛素的使用方案分为Ⅰ、Ⅱ两组,Ⅰ组162例,三餐前30min皮下注射优泌林R,晚10：00皮下注射优泌林N;Ⅱ组72例,三餐前30min皮下注射优泌林R,早餐前30min和晚10：00两次皮下注射优泌林N。术前血糖达标时间Ⅰ组（9．1±3．3）d,Ⅱ组（7．0±2．6）d（P〈0．01）;Ⅱ组术后血糖控制更好;影响术前血糖达标时间的因素与入院空腹血糖、短效／中效胰岛素比例相关。Ⅱ组的胰岛素治疗方案对患者术前血糖达标更为有效。     

甘精胰岛素在糖尿病治疗中的多种应用方法临床观察

目的探讨甘精胰岛素在糖尿病患者治疗中的多种应用方法的临床疗效观察。方法将80例糖尿病患者分为"三短一长"组、"二短一长"组、"一中一长"和"一长"组,比较治疗后4组血糖达标时间、平均空腹血糖、血糖漂移、胰岛素用量、低血糖发生率。结果"三短一长"组在血糖达标时间、治疗后空腹血糖、日内血糖漂移、糖化血红蛋白、果糖胺水平下降方面均优于其他组(P<0.05)。结论糖尿病患者应用甘精胰岛素治疗时,"三短一长"组降糖效果最显著。     

甘精胰岛素在糖尿病治疗中的多种应用方法临床观察

目的探讨甘精胰岛素在糖尿病患者治疗中的多种应用方法的临床疗效观察。方法将80例糖尿病患者分为“三短一长”组、“二短一长”组、“一中一长”和“一长”组，比较治疗后4组血糖达标时间、平均空腹血糖、血糖漂移、胰岛素用量、低血糖发生率。结果“三短一长”组在血糖达标时间、治疗后空腹血糖、日内血糖漂移、糖化血红蛋白、果糖胺水平下降方面均优于其他组（P〈0．05）。结论糖尿病患者应用甘精胰岛素治疗时，“三短一长”组降糖效果最显著。     

甘精胰岛素+瑞格列萘治疗预混胰岛素疗效不佳2型糖尿病患者的临床研究

目的 评估预混胰岛素联合口服降糖药物疗效不佳的2型糖尿病,改为甘精胰岛素 瑞格列萘联合治疗后的血糖控制效果和治疗满意度.方法 18例口服降糖药失效已改为预期混胰岛素优泌林70/30 口服降糖药物治疗,但血糖控制仍不满意患者,改为甘精胰岛素 瑞格列萘治疗,原来应用胰岛素增敏剂(罗格列酮)或二甲双胍的患者继续应用,4周为调整期,16周后测血糖、糖化血红蛋白,并报告证实的症状性低血糖发作次数.结果更改治疗方案16周后,所有患者空腹血糖(5.96±0.17mmol/L),更接近正常上限,血糖波动小,糖血红蛋白HbAlc下降(治疗前7.84±0.21,治疗后6.52±0.13),症状性低血糖发生人次明显减少.结论一部分应用预混胰岛素治疗血糖控制不佳的患者,更改为甘精胰岛素 瑞格列萘治疗后可以获得良好的血糖控制.     

Reversal of insulin resistance in type I diabetes after treatment with continuous subcutaneous insulin infusion

Insulin responsiveness was studied with the euglycaemic glucose clamp technique in seven patients with type I diabetes and in six control subjects matched for age and weight. The glucose disposal rate was significantly reduced in the diabetic subjects when they were receiving conventional insulin treatment compared with the control group, showing insulin resistance in the diabetics. The diabetic patients were again studied after eight days of intensified metabolic control achieved with continuous subcutaneous insulin infusion. During the infusion a more physiological insulin regimen was used compared with their regular treatment, less of the total insulin dose being given as continuous infusion and more as bolus doses before meals. The insulin resistance in the diabetics was largely reversed after this improved metabolic control. Dose response studies showed an increased glucose disposal rate at all plasma insulin concentrations, including the maximum insulin concentration, indicating a predominant effect of the continuous infusion regimen at the postreceptor level. The improved insulin effect seen with continuous subcutaneous insulin infusion could be due to the improved metabolic control achieved as well as the more physiological regimen.     

Low- and high-dose intravenous insulin therapy for diabetic ketoacidosis.

We compared low-dose, continuous insulin infusion with a conventional high-dose intravenous bolus method of insulin administration in 18 episodes of diabetic ketoacidosis. The average rate of reduction in serum glucose concentration was 9.5 +/- 3.8%/hr in the continuous infusion group and 10.7 +/- 4.7%/hr in the bolus group. Arterial blood pH was corrected to 7.35 by 9.9 +/- 2.6/hours in the continuous infusion group and by 10.4 +/- 3.2/hours in the bolus group. The above means are not significantly different between groups. By the time pH was corrected to 7.35, patients in the continuous infusion group had received 121 +/- 44 units of insulin, whereas those in the bolus group had received 326 +/- 152 units. The continuous low-dose insulin infusion method is as safe and efficacious as the conventional high-dose intravenous bolus method.     

预混胰岛素剂型和剂量量化选择探讨

目的探讨胰岛素治疗糖尿病时预混胰岛素的量化选择。方法研究以我院收治的需要换用胰岛素治疗但无急性并发症的2型糖尿病住院患者为研究对象。随机分为5次皮下胰岛素注射组（Fi组）和4次皮下胰岛素注射组（Fo组）各60例,比较两种治疗方法预混胰岛素选择预混胰岛素剂型和估算剂量的准确性以及5次皮下胰岛素注射餐前普通胰岛素（RI）和中性胰岛素（NPH）用量及其比值（RI/NPH）对预混胰岛素剂型选择和剂量估算的影响。结果 5次胰岛素注射方案控制血糖,选择预混胰岛素剂型时出现错误Fi组为2例（3.3%）明显少于Fo组9例（15%）（=4.90,P〈0.05）。估计预混胰岛素剂量Fi组准确率和较准确率（69.1%）均明显高于Fo组（30.8%）（=33.75,P〈0.01）。选择30%短效预混胰岛素时RI/NPH在0.41~0.51,而选择50%短效预混胰岛素RI/NPH在0.63~0.81（t=5.56,P〈0.01）,预混胰岛素的估计剂量与该餐前RI和NPH用量之和的比值接近1（t=0.16,P〉0.05）。结论五次胰岛素注射方案能够量化选择适合糖尿病患者的预混胰岛素剂量和剂型。     

Insulin analogues: new dimension of management of diabetes mellitus

Insulin is one of the fundamental tools for the management of diabetes mellitus. All type 1 diabetic patients and most of the type 2 require the appropriate support of insulin for good glycemic control, long term healthy outcome and also to overcome the acute crisis. It is almost impossible to mimic the endogenous physiological insulin secretion curve by external administration of short acting human insulin and conventional intermediate acting insulin, neutral protamin Hagedorn (NPH), the so called basal insulin. Short acting human insulin has got a delayed onset of action, late peak and a long tail leading to postprandial hyperglycemia and late hypoglycemia. The so called basal insulin (NPH) is not truly a basal or peakless insulin. Its onset of action takes about 2 - 4 hours with a peak action and a tail. It can not maintain a constant basal level leading to premeal and fasting hyperglycemia and chance of hypoglycemia during peak action, particularly after night injection. To overcome the limitations of human insulin, during the last decade, three ultrashort acting and two long acting basal analogues have been developed by modifications of primary molecule of human insulin. The ultrashort acting analogue insulins are insulin lispro, insulin aspart and insulin glulisine. The basal analogues are insulin glargin and insulin detemir. The pharmacokinetic profiles of novel analogue molecules provide a better opportunity to mimic a physiological pattern of insulin administration, better glycemic control, less chance of hypoglycemia, greater flexibility and a healthy longterm outcome.     

胰岛素泵联合微量泵治疗糖尿病酮症酸中毒120例临床观察

目的:探讨应用胰岛素泵联合微量泵治疗糖尿病酮症酸中毒临床效果。方法:2010年1月至2011年7月收治糖尿病酮症酸中毒患者120例随分为观察组及对照组各60例,观察组用胰岛素泵联合微量泵治疗,未正常进食前胰岛素泵使用基础量,微量泵以普通胰岛素0.1U(/kg.h)持续静脉输注,依据每小时监测血糖调整输注速度,控制血糖在10mmol/L左右;正常进食后胰岛素泵全日用量的40%～50%为基础量,余下的作为餐前负荷量,依据血糖情况调整基础量及餐前量,同时微量泵停用。对照组未正常进食前微量泵以普通胰岛素0.1U(/kg.h)持续静脉输注,依据每小时监测血糖调整输注速度,控制血糖在10mmol/L左右;正常进食后停用微量泵,三餐前和睡前使用普通胰岛素皮下注射,按三餐30%、20%、20%、30%分配。结果:与对照组比较观察组血酮转阴时间短,血糖达标时间短、住院时间短,每日维持胰岛素量少、低血糖发生率低(P<0.05)。结论:胰岛素泵联合微量泵治疗糖尿病酮症酸中毒疗效显著,值得推荐。     

异体颜面复合组织移植患者术后糖尿病个体化降糖治疗一例

对国内首例颜面部复合组织异体移植术及行不同免疫抑制剂和糖皮质激素治疗后出现血糖升高（14．3～33．3mmol／L）患者,在术后不同时期分别采用中效胰岛素（中性精蛋白胰岛素）10U、每日2次皮下注射方案治疗,空腹血糖为3．6～9．4mmol／L;持续皮下输注胰岛素方案,门冬胰岛素用量为21～96U／d,窄腹血糖为3．9—4．6mmol／L;口服降糖药物加每晚基础胰岛素10U补充治疗方案,空腹血糖为4．2～5．5mmol／L;口服二甲双胍、瑞格列奈治疗方案,空腹血糖为4．3—5．9mmol／L。血糖得到良好控制,避免了高血糖引发的各种急、慢性并发症。     

护理干预对拒绝胰岛素治疗糖尿病患者的影响

目的探讨不同护理干预对2型糖尿病患者接受胰岛素治疗的影响。方法将120例拒绝使用胰岛素治疗的2型糖尿病患者随机分成试验组和对照组,每组60例。对照组给予常规的健康教育,试验组对其拒绝使用胰岛素的原因进行分析,并采取针对性的护理干预措施。统计2组干预后接受胰岛素治疗情况。结果两种护理干预措施效果比较差异有统计学意义（P〈0.005）,试验组接受胰岛素治疗的患者明显高于对照组。结论针对性护理干预可让2型糖尿病患者尽早接受胰岛素治疗。     

Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis. Use in patients without extreme volume deficit

The optimal rate of fluid administration to correct the volume deficit associated with diabetic ketoacidosis remains undefined. Thus, this study evaluates prospectively in adult patients without extreme volume deficit two regimens of therapy that differed exclusively in the rate of fluid infusion. In protocol 1 (12 patients), normal saline was infused at 1000 mL/h (approximately 14 mL/kg per hour) in the initial 4 hours and 500 mL/h (approximately 7 mL/kg per hour) during the subsequent 4 hours. In protocol 2 (11 patients), normal saline was infused at half the rates of protocol 1. For plasma bicarbonate level, the increment from admission levels at 2, 4, 8, 16, and 24 hours after admission was greater with protocol 2 at all times, attaining a statistically significant difference at 4 hours (3.7 vs 0.7 mmol/L) and at 24 hours (13.2 vs 8.4 mmol/L). These data support cautious restraint in the volume of fluid replacement used in the therapy of diabetic ketoacidosis, since prompt recovery, lack of any harmful effects, and a significant reduction in the overall cost of medical therapy are achieved with lower rates of saline infusion.     

A method for maintaining normoglycemia during labour and delivery in insulin-dependent diabetic women.

The effectiveness of combining the subcutaneous administration of short- and intermediate-acting insulin with the intravenous infusion of glucose in maintaining normoglycemia during labour and delivery in insulin-dependent diabetic women was tested. Fifty women were given intermediate-acting insulin twice daily in doses that were fractions of their usual dose, based on the projected duration of labour. In addition, they were given regular (i.e., short-acting) insulin every 6 hours, the dose being 1% of their total daily insulin dose for every increase of 10 mg/dl above 100 mg/dl (5.6 mmol/l) in the plasma glucose level 1 hour previously; the levels were measured every 3 hours. All the patients were fasting and received a basal intravenous infusion of 6 g/h of glucose; the rate of infusion was increased by 1 g/h for every decrease of 10 mg/dl in the plasma glucose level below 100 mg/dl. The mean plasma glucose levels (+/- standard deviation) were 90 +/- 46 mg/dl after 3 hours of labour, 92 +/- 35 mg/dl after 6 hours, 97 +/- 49 mg/dl after 9 hours and 107 +/- 65 mg/dl after 12 hours. With only one exception, in a premature infant, the 5-minute Apgar scores were identical to those of the infants of nondiabetic women.     

诺和锐30与诺和灵30R对2型糖尿病血糖控制研究

目的比较诺和锐30与诺和灵30R控制2型糖尿病餐后血糖的差异.方法 采用随机临床对照试验的方法,将40例2型糖尿病患者分为诺和锐30组和诺和灵30R组,分别皮下注射诺和锐30胰岛素和诺和灵30R胰岛素,监测两组患者餐后血糖控制情况,并进行分析比较.结果两组患者治疗前空腹血糖、餐后血糖值无明显差异,治疗后两组患者空腹血糖值无差异,餐后血糖值差异有统计学意义(P＜0.05).结论诺和锐30控制早餐后血糖的作用优于诺和灵30R.     

持续胰岛素输注在体外循环冠状动脉搭桥术中应用价值的评估

目的：评估非糖尿病与糖尿病患者在体外循环冠状动脉搭桥术（CABG）中应用Portland胰岛素输注方案的可行性和必要性。方法：将择期行CABG的30名非糖尿病和30名糖尿病患者各随机分为试验组与对照组。试验组诱导后按照Portland胰岛素输注方案控制血糖;对照组每1h检测一次血糖,若血糖值超过10mmol/L。静脉给予胰岛素10U。分别对患者术中相应时间点血糖、乳酸等指标值进行检测,同时监测自动复跳、术中知晓、术后感染和术后认知功能障碍等情况,并进行统计学分析和比较。结果：无论是非糖尿病组或是糖尿病组,试验组在体外循环前、体外循环后和关胸后的血糖值均明显低于对照组（P〈0．05）,乳酸值也在体外循环后和关胸后与对照组相比有显著性差异（P〈0．05）,自动复跳率也高于对照组。非糖尿病对照组有2例术后脱管困难,糖尿病对照组术后出现肺部感染3例。结论：Portland胰岛素输注方案用于CABG中,可有效控制术中血糖,平稳乳酸代谢,明显改善预后状况。     

胰岛素泵联合速效胰岛素类似物治疗糖尿病酮症酸中毒疗效观察

目的分析胰岛素泵联合速效胰岛素类似物治疗糖尿病酮症酸中毒（diabeticketoacidosis,DKA）的临床疗效。方法选择36例DKA患者,随机选择18例为观察组,给予胰岛素泵皮下注射,余18例患者为对照组,给予常规胰岛素静脉注射治疗治疗,观察两组控制血糖〈13．8mmol／L所需时间及所需胰岛素剂量、纠正DKA所需时间及所需要的胰岛素剂量、患者住院时间,低血糖发生例数。对两组结果进行对比分析。结果观察组纠正DKA的时间明显低于对照组（P〈0．01）,控制血糖到低于13．8mmol／L所耗时间及胰岛素的剂量、纠正DKA所需要的剂量、住院时间、不良事件发生率两组之间比较无明显差异（P〉0．05）。结论使用胰岛素泵皮下连续输注方式治疗DKA与传统的小剂量静脉胰岛素降糖效果及所用胰岛素剂量基本相仿。     

Insulin subcutaneous application vs. continuous infusion for postoperative blood glucose control in patients with non-insulin-dependent diabetes mellitus

BACKGROUND: Frequently, the use of insulin is considered for metabolic control in postoperative patients with non-insulin-dependent diabetes mellitus (NIDDM). We sought to determine the best method for control of glucose in NIDDM non-insulin patients during postoperative care. METHODS: Two algorithms were developed: subcutaneous administration of insulin (SC), and continuous intravenous infusion (IV). A randomized, controlled clinical trial was designed. In addition, both experimental groups were compared with a non-concurrent routinely managed group (RM) with insulin administration under no predetermined algorithm. Eligible patients were those subjected to major surgery under general anesthesia or spinal blockade. They were followed for 48 h after surgery. Target variables were capillary and central blood glucose, insulin dose administered, urine glucose and ketone strip determination, and development of hyper- or hypoglycemia. RESULTS: A total of 62 patients were studied (RM = 25, SC = 19, IV = 18). Results for both experimental algorithms were similar except for the IV group that required less insulin per hour compared to SC (0.64 vs. 0.34 U/h; p = 0.0003). The RM control group showed poor control in all capillary glucose measurements (194.9 +/- 26.8 mg/dL) compared with the two experimental algorithms (SC = 129.9 +/- 21; IV = 131.6 +/- 20.4) (p <0.05). More hyperglycemia events appeared in the RM group (p = 0.016). Only one hypoglycemia event occurred in the IV group. CONCLUSIONS: Postoperative control of NIDDM is similar with both tested methods. The use of any of the algorithms studied improves metabolic control substantially because it standardizes postoperative management of the diabetic patient with timely determination of capillary blood glucose and insulin administration. However, IV administration has the advantage of accomplishing adequate control with a smaller insulin dose.     

磺脲类继发失效糖尿病患者加用胰岛素疗效观察

目的 探讨磺脲类药物继发性治疗失效的2型糖尿病患者加用甘精胰岛素（IG）或中效胰岛素（NPH）后的疗效.方法 2006-05～2006-11,对我院56例磺脲类药物继发性失效的糖尿病患者,改用格列美脲控释片,并分别睡前注射甘精胰岛素（24例）或中效胰岛素（32例）,观察16周内多点血糖变化及16周前后HbAlc,空腹及餐后血糖.结果 两组均有显著的降血糖效果,且疗效及所用剂量相近,但IC组低血糖事件明显少于NPH组.结论 睡前注射甘精胰岛素或中效人胰岛素对磺脲类继发性失效者均有较高的达标率.     

睡前中效胰岛素与格列美脲联合治疗2型糖尿病磺脲类继发失效的疗效观察

目的：观察磺脲类继发失效（SFS）的2型糖尿病（T2DM）患者在改用格列美脲联合中效胰岛素（NPH）治疗后的临床疗效。方法：30例SFS的T2DM患者,在控制饮食基础上,停用原口服降糖药,改用口服格列美脲,睡前皮下注射NPH,观察治疗前后血糖、糖化血红蛋白（HbAlc）、胰岛素（Ins）、甘油三酯（TG）,体质量指数（BMI）。结果：口服格列美脲联合睡前皮下注射NPH,治疗后FBG、2hBG、Ins较治疗前明显下降（P〈0．01）,HbAlc、TG较治疗前下降（P〈0．05）。结论：格列美脲联合NPH治疗2型糖尿病磺脲类继发失效,可起到显著改善糖代谢及胰岛B细胞功能的作用．值得临床应用。     

诺和锐30与诺和灵30R对2型糖尿病血糖控制观察

目的 比较诺和锐30与诺和灵30R控制2型糖尿病餐后血糖的差异。方法采用随机临床对照试验的方法,将40例2型糖尿病患者随机分为诺和锐30组和诺和灵30R组,分别皮下注射诺和锐30胰岛素和诺和灵30R胰岛素,监测两组患者空腹及餐后血糖控制情况,并进行分析比较。结果两组患者治疗前空腹血糖、餐后血糖值无明显差异,治疗后两组患者空腹血糖值无差异,餐后血糖值差异有统计学意义（P〈0．05）。诺和锐30胰岛素组低血糖发生率少。结论诺和锐30控制餐后血糖的作用优于诺和灵30R,低血糖发生率少。