糖尿病患者胰岛素注射笔使用现状调查分析

目的：了解糖尿病患者胰岛素注射笔使用现状,指导患者正确使用胰岛素注射笔。方法：自行设计调查问卷,通过询问患者,由临床医生完成问卷。结果：1874例患者中,完全可以正确安装胰岛素笔芯和针头者仅为42.1%;注射胰岛素前,每次都核对胰岛素剂型者仅为39.5%。结论：我国糖尿病患者胰岛素注射笔的正确使用率有待进一步改善和提高,需要强化糖尿病患者教育。     

健康教育对胰岛素笔治疗糖尿病自我管理的影响

目的探讨健康教育对使用胰岛素笔治疗的糖尿病患者自我护理行为的影响。方法采用自行设计的胰岛素笔注射操作及相关知识调查表,对北京市昌平区中医院内分泌科80例使用胰岛素笔治疗的糖尿病患者,实施有针对性个体化健康教育,评估教育前、后患者对胰岛素知识、注射胰岛素技术及自我护理能力的掌握情况,进行各阶段效果分析。结果教育后尤其是在出院前和门诊强化教育后,患者对胰岛素相关知识、胰岛素注射技术、低血糖的预防、识别和处理能力及自我护理能力显著提高(P<0.01)。结论加强各阶段胰岛素笔技能性操作的指导及相关知识的健康教育,可以确保胰岛素笔使用的准确性、安全性,提高患者自我护理的能力。     

糖尿病患者应用胰岛素笔相关知识及行为教育的调查与评价

目的探讨系统教育对应用胰岛素笔治疗的糖尿病患者知识与行为情况的影响。方法采用自行设计的胰岛素笔注射操作及相关知识调查表,评价80例使用胰岛素笔的糖尿病患者知识及注射操作中的薄弱环节,对患者实施有针对性的个体化健康教育,评估教育前、后患者的掌握情况,进行各阶段效果分析。结果教育后35%患者胰岛素笔不能正确保存,有27.5%患者注射前或更换针头时未排气;36.25%患者超长时间、重复使用针头的问题突出;33.75%患者没有掌握正确的皮肤消毒方法;40%患者未做到自我管理,经个体化的强化教育后,患者自我护理能力及对胰岛素注射技术及相关知识的掌握显著提高（P〈0.01）。结论糖尿病教育工作中,对胰岛素笔技能性的指导及相关知识的教育,要更细致、更全面,重视各阶段的强化教育,确保胰岛素笔使用的准确、安全。     

胰岛素笔注射针头更换频次的现状调查

为调查糖尿病患者胰岛素笔注射针头更换频次现状及其相关影响因素,对130例糖尿病住院患者在入院前应用胰岛素笔注射更换针头频次情况及其相关影响因素采用问卷调查。结果表明,胰岛素笔注射不更换针头现象普遍,60.2%的患者每周更换1次,30.1%患者每支笔芯更换1次,仅有6.3%是一次性使用,3.3%不定时更换,不更换针头的原因与注射针头价格、患者病程、文化程度、接受教育频率等因素相关(P<0.05)。结论:在我国糖尿病患者中约30%在接受胰岛素治疗。尽管及时使用胰岛素可提高血糖达标率已成为全球医生的共识,但我国的糖尿病达标率仍只有四分之一,而且已经使用胰岛素的患者血糖达标率只有37%,患者对注射技术掌握不到位可能是一个重要的原因。糖尿病患者重复使用胰岛素注射针头现象严重,糖尿病患者健康教育有待加强。     

教育干预对规范使用胰岛素笔注射针头的影响

目的 了解糖尿病患者胰岛素笔注射针头更换情况,找出患者的误区加以改进.方法 选择内分泌科使用胰岛素笔的糖尿病患者40例,发放自行设计的问卷,了解患者对胰岛素笔用针头的更换情况,在住院期间进行相应的教育措施,出院时再次进行调查.结果 与教育前相比患者对使用针头的认知情况、使用频次有显著进步,差异有统计学意义（P〈0.05）.结论 糖尿病患者重复使用胰岛素笔注射针头现象严重,加强糖尿病教育,规范使用胰岛素笔用针头,减少了注射造成的损害.     

个体化的健康教育对糖尿病患者规范胰岛素笔注射及强化相关知识的效果调查

目的：通过对刚入院的正在使用或曾经使用过胰岛素治疗患者在家中使用胰岛素笔现状调查,了解患者使用胰岛素笔的规范化程度以及对胰岛素相关知识掌握程度,为制定有针对性的健康教育提供依据,从而进一步规范患者胰岛素笔的注射方法,强化胰岛素的相关知识。方法102例正在使用或曾经使用过胰岛素治疗的患者,通过责任护士对患者入院及出院时的问卷调查,了解针对性的健康教育对患者胰岛素笔规范化操作的影响及患者对胰岛素相关知识掌握的增长情况。结果102例患者经个体化健康教育胰岛素笔的使用情况及相关知识掌握程度均明显提高。结论个体化针对性的健康教育对规范患者胰岛素笔的使用,增加胰岛素的相关知识具有明显的效果。     

示范教育在糖尿病胰岛素自我注射中的应用

目的探讨示范教育对自我注射胰岛素的糖尿病患者的影响。方法将56例使用胰岛素笔型注射器自我注射治疗的患者随机分为2组。一般指导组27例采用传统的普通教育,示范教育组29例采用示范教育,对2组患者自我管理的效果进行评价并分析比较。结果示范教育组基本知识知晓率为86.21%显著高于一般指导组的44.44%,差异有统计学意义（P〈0.01）;示范教育组操作能力合格率高于一般指导组,差异有统计学意义（P〈0.01）。结论示范教育能提高患者自我注射胰岛素的正确性,更能保证患者院外注射的安全性,从而提高了治疗效果。     

糖尿病患者自行注射胰岛素常见问题分析

目的 了解糖尿病患者自我注射胰岛素时存在的问题.方法 采用自行设计的问卷对80例院外自行注射胰岛素的糖尿病患者进行问卷调查.结果 胰岛素注射过程中81.2％(65例)的糖尿病患者未按照无菌原则进行操作.胰岛素笔使用过程中最为突出的缺陷在于:97.5％(78例)的糖尿病患者重复使用胰岛素注射针头;61.2％(49例)的糖尿病患者没有按要求正确轮换注射部位;56.2％(45例)的糖尿病患者外出未携带救助卡和糖块.结论 糖尿病患者自我注射胰岛素的行为存在不规范现象,有必要进一步加强胰岛素注射知识和常见问题的健康指导,提高患者自行注射胰岛素的规范性.     

胰岛素笔应用盲区及注意事项

<正>通过对96例应用胰岛素笔的门诊糖尿病患者进行调查,旨在了解其对胰岛素笔应用的掌握程度。1对象与方法收集2009—2010年使用胰岛素笔的我院门诊糖尿病患者96例,其中男性39例,女性57例,年龄14～76岁;1型糖尿病6例,2型糖尿病90例;胰岛素笔注射史2个月至6个月。     

院外患者胰岛素注射笔管理缺陷调查与分析

目的:胰岛素笔已成为治疗糖尿病的常用工具,了解院外糖尿病患者胰岛素笔使用情况,找出主要缺陷,分析原因,利用住院期间进行宣教,纠正错误。方法:自行设计胰岛素使用情况调查表,对73例入院时已使用胰岛素笔的患者进行调查。结果:重复使用胰岛素笔用针头,无菌观念差,操作不正规,胰岛素笔保存错误,部位轮换不规范等是胰岛素笔使用中的主要问题。结论:应利用住院期间,加强对使用胰岛素笔的糖尿病患者进行规范教育,规避风险,提高疗效,增强胰岛素注射的安全性和依存性。     

看图对话工具对糖尿病患者胰岛素治疗的效果

目的探讨"糖尿病看图对话"工具对胰岛素治疗2型糖尿病患者的效果。方法将260例使用胰岛素进行降血糖治疗的2型糖尿病患者,随机分成两组,对照组进行说教式糖尿病健康教育,实验组运用"糖尿病看图对话"工具进行教育。比较两组宣教前和出院前1天胰岛素相关知识的掌握,比较两组住院时和出院3个月时糖化血红蛋白水平。结果实验组出院前1天胰岛素知识掌握明显好于对照组(P<0.001);实验组患者出院3个月时的糖化血红蛋白明显好于对照组(P<0.001)。结论运用"糖尿病看图对话"工具在提高2型糖尿病患者胰岛素治疗效果中作用显著,是一种较好的糖尿病健康教育工具。     

护理干预在糖尿病患者应用胰岛素泵治疗中的运用研究

目的 探讨胰岛素泵强化治疗糖尿病( Diabetes mellitus)的护理要点.方法 将120例糖尿病患者随机分为观察组与对照组,各60例,对照组行常规护理,观察组实施综合护理干预,给予患者心理护理和糖尿病教育.对比两组患者血糖控制效果、焦虑程度.结果 与对照组比较,观察组血糖控制情况更好,患者对使用胰岛素泵的焦虑心理大大减轻.结论 经过心理护理、糖尿病教育、携泵治疗等相关措施的落实,不仅有效地将用泵患者血糖控制在理想范围,减少低血糖发生率,缩短了住院日,还进一步提高了患者生活质量     

运用胰岛素泵治疗糖尿病的临床研究

目的：对胰岛素泵强化治疗糖尿病的意义进行探讨。方法：回顾性分析本院2008年9月～2010年9月收治的32例糖尿病患者。随机将两组分为观察组（16例）和对照组（16例）,两组均给予常规治疗,观察组在常规治疗的基础上运用胰岛素泵治疗进行干预,对两组患者心理状态及血糖控制情况进行检验以及比较。结果：观察组在健康知识的得分及对健康教育的满意度方面均高于对照组;装泵后14d观察组患者焦虑、抑郁分值下降均较对照组明显,血糖控制满意度显著高于对照组。结论：胰岛素泵治疗能够更符合生理胰岛素分泌,可更快更有效地控制高血糖,健康教育和心理护理对血糖的稳定有积极的作用。     

电话随访对出院后居家注射胰岛素糖尿病患者的效果分析

目的 了解电话随访对居家注射胰岛素糖尿病患者的效果.方法 选择2013年1月至12月本院78例糖尿病出院患者为对照组,进行常规糖尿病健康教育.2014年1月至2015年5月在本院出院后的102例为随访组,以电话随访的形式进行追踪,两组患者自我管理情况及血糖控制情况比较.结果 随访组患者重复使用针头、轮换部位不规范、低血糖发生情况、注射部位疼痛出血发生率分别为22.55％、31.37％、15.69％、8.82％,均较对照组的71.79％、61.54％、28.21％、21.80％低,差异有统计学意义(P＜0.05);随访组患者FBG、PPG、HbA1c、TG检验结果均有明显下降,并经t检验差异有统计学意义(P＜0.01).结论 电话随访能提高患者自我管理能力,降低胰岛素注射不良反应,值得推广应用.     

Defining the role of insulin detemir in Basal insulin therapy

Insulin detemir is a novel long-acting insulin analogue with a unique mechanism underlying its prolonged duration of action. Unlike neutral protamine Hagedorn (NPH) insulin (insulin suspension isophane) and insulin glargine, which precipitate after administration, insulin detemir remains soluble after it is injected. The prolonged duration of action of insulin detemir is a result of the ability to self-associate into hexamers and dihexamers, and to bind reversibly to albumin. This mechanism of protraction provides a more prolonged, consistent and predictable glycaemic effect in patients with type 1 or type 2 diabetes mellitus compared with NPH insulin. Clinical studies have demonstrated that insulin detemir administered once or twice daily is at least as effective as NPH insulin and insulin glargine in achieving glycaemic control. Most trials have also shown that insulin detemir exhibits less intrapatient variability in glycaemic control compared with NPH insulin and insulin glargine. One of the benefits of insulin detemir is its favourable effect on bodyweight. Insulin detemir has shown weight neutrality in patients with type 1 diabetes and is associated with less weight gain than NPH insulin in clinical studies. Patients with type 2 diabetes using insulin detemir gain less weight than patients using NPH insulin and insulin glargine. In addition, a reduced risk of hypoglycaemia, particularly nocturnal hypoglycaemia, has been reported with insulin detemir compared with NPH insulin in patients with type 1 and type 2 diabetes. A reduced risk of major and nocturnal hypoglycaemia compared with insulin glargine in patients with type 1 diabetes has also been observed. Together, these data indicate that insulin detemir is a valuable new option for basal insulin therapy in patients with type 1 or type 2 diabetes.     

农村糖尿病患者使用胰岛素存在的问题与护理对策

目的了解农村糖尿病患者使用胰岛素时存在的问题,并提出对策。方法自行设计糖尿病患者调查表,对60例农村糖尿病患者使用胰岛素的状况进行调查。结果农村糖尿病患者在使用胰岛素中存在不进行血糖监测、未正确掌握胰岛素注射技术、不按要求更换针头及注射部位、经常漏注胰岛素以及储存方法不正确等问题。结论医护人员应该对农村糖尿病患者加大健康教育力度,社区、乡镇卫生院对农村糖尿病患者应进行规范管理,定期上门访视,提高治疗依从性,从而提高生活质量。     

PHARMAC and long-acting insulin analogues: a poor man's insulin pump--but to the poor man

Insulin glargine is a long-acting insulin analogue providing a more predictable and reproducible circulating insulin profile than other available basal insulin products. Hypoglycaemia is one of the main limiting factors to patients with diabetes requiring insulin, in achieving tight glycaemic control and reduced rates of complications. Evidence from randomised controlled clinical trials demonstrates reduced rates of hypoglycaemia in patients with type 1 and type 2 diabetes using insulin glargine compared with other basal insulin. Insulin glargine has been registered for use in New Zealand since June 2001, but currently remains unsubsidised by PHARMAC. Reducing the incidence and impact of diabetes is one of the stated aims in the New Zealand Health Strategy and the complete lack of funding for pharmaceutical agents such as insulin glargine severely limits its accessibility to patients with diabetes and would seem in contradiction to this aim.     

Inhaled human insulin

The benefit of subcutaneous insulin therapy in patients with diabetes is frequently limited due to difficulty in convincing patients of the importance of multiple daily insulin injections to cope effectively with meal-associated glycemic changes. Thus, the aim of achieving tight glycemic control, which is critical for reducing the risk of long-term diabetes-related complications, frequently remains elusive. The successful development of an inhalable insulin as a noninvasive alternative promises to change the management of diabetes. The first product to become available to patients is inhaled human insulin, a dry-powder formulation packaged into discrete blisters containing 1 or 3 mg of dry-powder human insulin and administered via a unique pulmonary inhaler device. It has recently been approved in both the United States and the European Union for the control of hyperglycemia in adult patients with type 1 or type 2 diabetes. The pharmacokinetic profile of inhaled human insulin closely mimics the natural pattern of insulin secretion, and resembles that of rapid-acting subcutaneous analogs. Similarly to rapid-acting subcutaneous analogs, inhaled human insulin has a more rapid onset of glucose-lowering activity compared to subcutaneous regular insulin, allowing it to be administered shortly before meals. It has a duration of glucose-lowering activity comparable to subcutaneous regular insulin and longer than rapid-acting insulin analogs. Inhaled human insulin effectively controls postprandial glucose concentrations in patients with type 1 or type 2 diabetes without increasing the risk of hypoglycemia, and even improves fasting glucose levels compared to subcutaneous insulin. Inhaled human insulin has an overall favorable safety profile. There are small reductions in lung function (1-1.5% of total lung forced expiratory volume in the first second [FEV1] capacity) after onset of treatment that are reversible in most patients if treatment is discontinued. Inhaled human insulin is associated with an increase in insulin antibody titers, especially in patients with type 1 diabetes. These increases are not associated with any clinical sequelae. Patient satisfaction data have shown that inhaled human insulin is associated with greater treatment satisfaction relative to subcutaneous insulin in patients with type 1 or type 2 diabetes. This review summarizes the current data on the clinical efficacy and safety of inhaled human insulin in patients with type 1 or type 2 diabetes.     

Continuous subcutaneous insulin infusion therapy: A primer on insulin pumps

Data sourcesA literature search was conducted in Medline (1996 to July 2008) using the search terms intensive insulin therapy, insulin pump, and continuous subcutaneous insulin infusion. Reference lists from comprehensive review articles were also used to identify additional original research publications.Study selectionReview articles and studies evaluating the role, benefits, and risks of CSII.Data synthesisMore than 300,000 individuals use CSII to treat diabetes. Many experts believe that CSII is the best insulin delivery method for highly motivated patients with type 1 diabetes who are technologically savvy and have the means to pay for the device and infusion sets. CSII is also useful for patients with type 2 diabetes who require multiple daily injections and experience wide fluctuations in blood glucose throughout the day or who experience severe hypoglycemia. A variety of CSII systems are currently available. All CSII systems provide precise insulin delivery throughout the day and improve the accuracy of bolus dose calculations, thereby achieving improved glycemic control with less frequent and severe hypoglycemic episodes. Patients who choose CSII report improved quality of life. Potential risks associated with CSII include mechanical problems leading to diabetes ketoacidosis, infections at the infusion site, hypoglycemia, and lipodystrophy.ConclusionCSII is an attractive treatment option for many patients with diabetes. Given the widespread use of CSII, all health professionals should be familiar with the basic features of insulin pump technology, the potential risks and benefits of CSII, and how to troubleshoot common problems.     

Effect of switching medically vulnerable patients with uncontrolled diabetes from isophane insulin human to insulin glargine.

PURPOSE: The purpose of this observational study was to determine if switching from isophane insulin human (NPH) to insulin glargine would improve glycemic control in a medically vulnerable population with uncontrolled diabetes. METHODS: A retrospective cohort review of patients' medical records was performed that recorded events occurring between January 1, 2001, and December 31, 2003. The cohort consisted of patients with diabetes in an adult medicine clinic at a county hospital. Patients were included if they were receiving NPH insulin for a minimum of six months and subsequently switched to insulin glargine for a minimum of six months. RESULTS: The study included 43 patients. There was no significant difference in mean glycosylated hemoglobin (HbA(1c)) between NPH insulin (9.6%) and insulin glargine (9.7%) regimens (p = 0.78, 95% confidence interval, -0.62%, 0.82%). Neither was there a significant difference in the frequency or severity of hypoglycemic episodes between the two treatments. Patients experienced significantly fewer diabetes-associated visits over six months while on insulin glargine. Refill frequency did not differ significantly when patients were receiving NPH insulin versus insulin glargine. When analyzing patient characteristics, those of Hispanic ethnicity experienced HbA(1c) values significantly higher than white patients. Several characteristics were associated with refill frequency. CONCLUSION: The results of our study indicate that both NPH- and glargine-based basal insulin regimens result in similar levels of glycemic control in a medically vulnerable population with diabetes, without significant differences in the number or severity of hypoglycemic episodes or in refill frequency.