术中静脉使用胰岛素对女性脂肪伴胰岛素抵抗患者糖代谢的影响

目的 了解女性肥胖伴胰岛素抵抗患麻醉和手术中血糖和血浆胰岛素水平的变化,以及术中静脉滴注胰岛素对其影响。方法 20例女性肥胖伴胰岛素抵抗的择期手术患,ASAⅠ-Ⅱ级,随机分成2组,B组术中静脉滴注无糖溶液;C组使用含糖溶液加胰岛素静脉滴注,每4g葡萄糖用1U胰岛素,胰岛素总量控制在20u,其余液体使用无糖溶液;另设10例无胰岛素抵抗患作为对照组（A组）,分别于麻醉前、麻醉后、术中（手术进行30min)和术毕测定血糖和血浆胰岛素水平。结果 女性肥胖患均存在胰岛素抵抗现象,表现为空腹血糖水平和血浆胰岛素水平较对照组明显升高,麻醉和手术应激均使血糖和血浆胰岛素水平升高,术中静脉滴注胰岛素可防止血糖升高。结论 女性肥胖患存在胰岛素抵抗现象。术中适当使用胰岛素可纠正手术应激对其糖代谢的影响。     

硬膜外麻醉对糖尿病患者血液流变学和血浆胰岛素及血糖水平的影响

目的:探讨硬膜外麻醉对糖尿病患者血液流变学、血浆胰岛素及血糖水平的影响。方法:选择2015年10月—2016年10月住院的2型糖尿病行腹部手术治疗的患者160例,分为硬膜外阻滞麻醉组和全身麻醉组,每组80例,对比两组麻醉前后血液流变学指标、血浆胰岛素及血糖水平。结果:两组麻醉前全血低切黏度、全血高切黏度、血浆黏度、红细胞聚集指数比较,差异无统计学意义(P>0.05)。硬膜外麻醉组麻醉后相关指标水平明显低于全身麻醉组,差异有统计学意义(P<0.05);两组手术30min、术后即刻及术后4h血浆胰岛素水平明显高于麻醉前(P<0.05),与全身麻醉组比较,硬膜外麻醉组血浆胰岛素水平增高更明显;硬膜外麻醉组手术30 min、术后即刻血糖水平均明显高于麻醉前(P<0.05),在术后4 h血糖水平恢复至麻醉前水平。全身麻醉组手术30 min、术后即刻及术后血糖水平均明显高于麻醉前(P<0.05)。组间比较,硬膜外麻醉组手术30 min、术后即刻、术后4 h血糖水平低于全身麻醉组(P<0.05)。结论:对糖尿病患者采用硬膜外麻醉方式可以使血液流变学相关参数降低,改善胰岛素分泌,保持血糖水平的相对稳定。     

肥胖伴高血压患者的胰岛素抵抗研究

目的　本研究旨在讨论肥胖伴高血压患者的血清胰岛素水平 ,探讨肥胖伴高血压患者的胰岛素抵抗问题。方法　肥胖伴高血压患者 2 2例 ,健康对照组 13例 ,两组具有可比性 ,然后所有病例采用OGTT和胰岛素释放试验 ,对比两组空腹、1h、2h、3h血糖值、血清胰岛素及胰岛素 /血糖比值。结果　发现肥胖伴高血压患者OGTT试验 1h和 2h血清胰岛素水平较对照组显著升高 (P <0 0 5 ) ,但未发现空腹及 3h血清胰岛素水平有差异 (P >0 0 5 )。结论　肥胖伴高血压患者较健康对照组存在着明显的胰岛素抵抗。     

上海市儿童肥胖症原因分析

目的探讨肥胖儿童青少年血脂异常、瘦隶抵抗与胰岛索抵抗的关系。方法检测201例肥胖无糖代谢异常儿童，40例肥胖伴糖代谢异常儿童和230例正常体重儿童的空腹血糖、空腹血胰岛素、血脂、血瘦素水平，以胰岛紊抵抗指数评价胰岛素抵抗。结果肥胖无糖代谢异常组空腹血糖、瘦素显著高于对照组；血甘油三脂、载脂蛋白B、低密度脂蛋白．胆固醇水平以及空腹血胰岛素水平、胰岛素抵抗指数在对照组、肥胖无糖代谢异常组、肥胖伴耱代谢异常组三组间均呈显著上升趋势；甘油三脂、瘦素与胰岛素抵抗指数呈显著正相关。结论肥胖儿童青少年具有明显的脂代谢紊乱、高瘦素血症和瘦素抵抗状态，并与胰岛素抵抗密切相关。     

持续静脉注射小剂量利多卡因对胃肠道肿瘤患者胰岛素抵抗的影响

目的研究持续静脉注射小剂量利多卡因对胰岛素抵抗的影响。方法60例患者,分为利多卡因组和对照组,每组30例。分别于麻醉前、后不同时段测定血糖、胰岛素、C-肽、生长激素(GH)和皮质醇水平,并计算胰岛素敏感性(ISI)。结果2组血糖水平于术后24h达最高,此后逐渐下降。术后24h对照组血糖、胰岛素、ISI、血清C肽、GH、皮质醇水平较利多卡因组明显升高(P<0.05);对照组术后24h血糖、胰岛素、ISI、血清C肽、GH、皮质醇水平与麻醉前比较差异有统计学意义(P<0.05),而治疗组上述指标与麻醉前比较差异无统计学意义(P>0.05)。结论持续静注小剂量利多卡因能降低胃肠肿瘤手术患者应激反应,减轻术后胰岛素抵抗的程度。     

肥胖伴高血压患者的胰岛素抵抗研究

目的 本研究旨在讨论肥胖伴高血压患者的血清胰岛素水平，探讨肥胖伴高血压的胰岛素抵抗问题。方法 肥胖伴高血压患者22例，健康对照组13例，两组具有可比性，然后所有病例采用OGTT和胰岛素释放试验，对比两组空腹，1h,2h,3h血糖值，血清胰岛素及胰岛素／血糖比值。结果 发现肥胖伴高中层得OGTT试验1h和2h血清胰岛素水平较对照组显著升高（P＜0．05），但未发现空腹及3h血清胰岛素水平有差异（P＞0．05）。结论 肥胖伴高血压患者较健康对照组存在着明显的胰岛素抵抗。     

丙泊酚对糖尿病患者手术中血糖和胰岛素的影响

目的观察丙泊酚对糖尿病患者手术中血糖和胰岛素的影响。方法ASAⅠ～Ⅱ级择期老年糖尿病眼科手术病人100例随机分为2组,观察组术中采用丙泊酚静脉麻醉;对照组术中采用利多卡因局麻。分别于麻醉前、手术后1h采血测定血糖和血浆胰岛素。结果观察组术后血糖和胰岛素与术前相比无统计学意义（P〉0．05）,对照组术后血糖和胰岛素与术前相比差异有统计学意义（P〈0．05）。结论丙泊酚可明显抑制病人手术中的应激反应,减轻术后糖代谢紊乱,促进病人恢复。     

隐匿性高血压和肥胖与血浆胰岛素、C肽水平的关系探讨

目的:探讨隐匿性高血压(MH)和肥胖与血浆胰岛素、C肽水平的关系。方法:在诊室血压正常者行24h动态血压监测的患者中,选取健康对照(N)组60例、单纯肥胖(OB)组63例、MH不伴肥胖(MH)组59例和MH伴肥胖(HO)组58例为研究对象。所有入选者均空腹采血测定血脂、尿酸、空腹血糖(FINS)、C肽及血浆胰岛素,并采用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。结果:(1)血浆胰岛素水平、C肽、HOMA-IR、胆固醇、甘油三酯、低密度脂蛋白及血尿酸测值OB组、MH组和HO组的均显著高于N组,HO组又显著高于OB组及MH组(均P0.01-0.05)。(2)相关性分析:各因素中除尿酸与血压无明显相关外,余体重指数、血脂、血糖、胰岛素及胰岛素抵抗均与血压明显相关,其中胰岛素抵抗与血压之间的关系最密切。结论:MH与多种危险因素相关,高胰岛素血症及胰岛素抵抗可能是MH的重要机制之一。     

氟比洛芬酯超前镇痛对直肠癌根治术患者血浆IL-6和胰岛素抵抗的影响

目的 研究氟比洛芬酯超前镇痛对直肠癌患者血浆白细胞介素6(IL-6)和胰岛素抵抗的影响.方法 直肠癌择期手术患者30例,随机分为氟比洛芬酯组(F)和对照组(C),分别于麻醉前(T0)、手术开始后2 h(T1)、术后第6h(T2)检测静脉血糖(BG)、血胰岛素(Ins)、Ⅱ-6,并计算胰岛素抵抗指数(IRI).结果 两组T1和T2时的BG、Ins、IL-6水平和IRI都较T0明显增加(P<0.05),但F组患者T1、T2时的BG、Ins、IL-6水平和IRI均低于C组(P<0.05).结论 直肠癌手术患者术中和术后有BG、Ins和IL-6水平升高,胰岛素抵抗增加.氟比洛芬酯超前镇痛可减轻这些变化.     

寒冷应激对大鼠血糖、胰岛素水平的影响初探

目的 探讨寒冷应激对大鼠血糖、胰岛素水平的影响.方法 在一定时间的寒冷应激环境下,观察A组大鼠(常温正常喂养4周)、B组大鼠[每天置于(4±2)℃环境下喂养5h,连续4周]的血糖与Ins水平.结果 实验前两组血糖差异无统计学意义(P＞0.05).受寒冷应激4周后,B组血糖、Ins值高于A组,差异有统计学意义(P＜0.01).结论 受寒应激后大鼠血糖、Ins水平升高,说明寒冷应激一定程度上可影响大鼠的血糖、胰岛素水平.而血糖和胰岛素水平同时升高,提示寒冷应激后出现有胰岛素抵抗的可能性.     

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.     

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。     

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.     

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.     

Intermediate and long-acting insulins: a review of NPH insulin,insulin glargine and insulin detemir

ABSTRACT

Objective: To review intermediate- and long-acting insulins with specific emphasis on the newer insulin analogs.

Methods: A MEDLINE search, in English, was conducted with a cut-off of June 30, 2006, using the terms ‘NPH insulin’, ‘insulin analogs’, ‘insulin glargine’, ‘insulin detemir’ and ‘long-acting insulins’. All clinical trials from within the search period were included.

Results: The insulin analogs, insulin glargine and insulin detemir, were introduced in an attempt to improve glycemic control among patients with diabetes, without increasing the risk of hypoglycemia. This review indicates that both insulin analogs demonstrate better glycemic control than NPH insulin, based on measurements of HbA_1c, fasting glucose and intra-subject variability in blood glucose. This was accomplished with similar or reduced risk of hypoglycemia. Also, insulin detemir appears to be associated with less body weight increase than NPH insulin or insulin glargine.

Conclusion: The newer long-acting insulin analogs, insulin detemir and glargine, appear to provide better glycemic control than NPH insulin without increasing the risk of hypoglycemia.