胰岛素泵联合速效胰岛素类似物治疗糖尿病酮症酸中毒临床疗效分析

目的分析速效胰岛素类似物联合胰岛素泵对酮症酸中毒(DKA)的临床疗效情况。方法 2011年2月—2013年2月选择该院64例DKA患者行分组研究,按随机数字表将其分为对照组和观察组,每组32例。对照组静脉输注诺和灵R,观察组应用诺和锐联合胰岛素泵;对比两组临床疗效情况。结果治疗后,观察组FBG及2h BG明显低于对照组,CO2CP明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。与对照组相比,观察组尿酮体阴转时间更早,胰岛素用量更少,低血糖发生次数更少,差异有统计学意义(P<0.01)。结论应用速效胰岛素类似物联合胰岛素泵治疗DKA具有胰岛素用量少、起效快、不良反应少、临床疗效好等优点。     

胰岛素泵和多次胰岛素皮下注射治疗糖尿病酮症酸中毒患者临床疗效观察

目的探讨胰岛素不同给药方法治疗糖尿病酮症酸中毒(DAK)的临床效果。方法将糖尿病酮症酸中毒患者120例随机分为胰岛素泵治疗组(实验组)和多次胰岛素皮下注射治疗组(对照组),每组60例。观察比较两组患者治疗后平均血糖水平,二氧化碳结合力,胰岛素平均用量以及尿酮体转阴时间、低血糖发生情况。结果治疗后两组患者血糖水平显著降低,二氧化碳结合力显著升高,与治疗前比较差异有统计学意义(P0.01)。两组患者治疗前后血糖水平、二氧化碳结合力比较,差异无统计学意义(P0.05)。实验组患者尿酮转阴时间、低血糖发生率以及平均胰岛素用量均显著短于或小于对照组患者,两组比较差异有统计学意义(P0.05)。结论胰岛素泵治疗比多次胰岛素皮下注射治疗糖尿病酮症酸中毒临床疗效更好,不良反应发生率低。     

持续皮下注射人胰岛素类似物对糖尿病酮症酸中毒68例疗效评价

目的 观察人胰岛素类似物(Insulin Aspart)与人普通胰岛素 (Novolin R)经胰岛素泵持续皮下注射治疗糖尿病酮症酸中毒患者的临床疗效.方法 68例糖尿病酮症酸中毒病人, 随机分为两组, Insulin Aspart组32例, Novolin R组36例, 对血糖达标、血pH值恢复正常时间、尿酮转阴时间、胰岛素用量以及低血糖发生情况进行对比分析(目标值空腹血糖＜7.0 mmol/L,餐后2 h血糖＜10.0 mmol/L). 结果 两组均可使血糖明显下降.两组的血糖达标时间差异无统计学意义(t=0.262 6, P＞0.05); Insulin Aspart组尿酮体转阴时间和血pH值恢复正常时间均明显少于Novolin R组(t=19.454 0, P＜0.05);Insulin Aspart组胰岛素用量亦少于Novolin R组(t=2.007 0, P＜0.05);Insulin Aspart组的血糖水平更平稳, 低血糖发生率明显低于Novolin R组(t=12.244 0, P＜0.01). 结论 Insulin Aspart持续皮下注射能有效模拟人生理胰岛素分泌,对糖尿病酮症酸中毒的治疗是更为安全、有效的.     

胰岛素泵治疗糖尿病酮症酸中毒的疗效观察

36例DKA患者，随机分为胰岛素泵治疗组（CSII组，20例）和常规小剂量胰岛素静脉滴注治疗组（对照组，16例），分别观察两组血糖、血酮、尿酮和pH值的变化及低血糖的发生率。结果：CSII组血糖恢复时间、胰岛素用量、血酮、尿酮和pH值恢复时间均较对照组明显缩短（P〈0．01），低血糖发生率明显低于对照组（P〈0．01）。结论：CSII能模拟人生理胰岛素分泌，更有效更安全地治疗DKA。     

胰岛素泵治疗糖尿病酮症酸中毒的疗效观察

36例DKA患者,随机分为胰岛素泵治疗组(CSII组,20例)和常规小剂量胰岛素静脉滴注治疗组(对照组,16例),分别观察两组血糖、血酮、尿酮和pH值的变化及低血糖的发生率.结果CSII组血糖恢复时间、胰岛素用量、血酮、尿酮和pH值恢复时间均较对照组明显缩短(P＜0.01),低血糖发生率明显低于对照组(P＜0.01).结论CSII能模拟人生理胰岛素分泌,更有效更安全地治疗DKA.     

持续皮下输注速效胰岛素类似物治疗急诊糖尿病酮症酸中毒的临床价值分析

目的 研究持续皮下输注速效胰岛素类似物治疗急诊糖尿病酮症酸中毒的临床效果。方法 选取2021年1月—2023年8月安溪县医院收治的急诊糖尿病酮症酸中毒患者60例,按照随机双盲法分为对照组(30例)和观察组(30例)。对照组采用静脉滴注速效胰岛素治疗,观察组采用持续皮下输注速效胰岛素类似物治疗。对比两组的临床治疗效果、临床恢复指标、血糖指标、酸中毒指标、血钠及血浆渗透压指标、不良反应情况。结果 观察组总有效率为96.67%,高于对照组,差异有统计学意义(χ²=4.027,P=0.039)。观察组患者血糖达标时间、尿酮转阴时间、纠正酸中毒所需时间、空腹血糖、饭后2 h血糖、糖化血红蛋白、β-羟丁酸、乳酸、血酮体、血钠、血浆渗透压均优于对照组,差异有统计学意义(P<0.05)。观察组低血糖、呼吸衰竭不良反应总发生率为6.67%,低于对照组,差异有统计学意义(χ²=8.203,P=0.018)。结论 持续皮下输注速效胰岛素类似物治疗急诊糖尿病酮症酸中毒的临床效果显著优于静脉滴注速效胰岛素治疗。     

胰岛素泵治疗2型糖尿病酮症酸中毒观察

2型糖尿病酮症酸中毒患者随机分为胰岛素泵皮下输注组（CSⅡ组，39例）和常规小剂量胰岛素静脉滴注组（对照组，45例），观察治疗后血糖、尿酮体的变化及低血糖的发生率。结果：CSⅡ治疗组血糖达标时间、尿酮体转阴时间较常规治疗组明显缩短（P〈0．01）；胰岛素用量少于常规治疗组（P〈0．05）。CSⅡ低血糖发生率明显降低（P〈0．01）。结论：治疗较常规小剂量胰岛素静脉滴注短期疗效更安全、有效。     

胰岛素泵治疗2型糖尿病酮症酸中毒观察

2型糖尿病酮症酸中毒患者随机分为胰岛素泵皮下输注组（CSⅡ组，39例）和常规小剂量胰岛素静脉滴注组（对照组，45例），观察治疗后血糖、尿酮体的变化及低血糖的发生率。结果：CSⅡ治疗组血糖达标时间、尿酮体转阴时间较常规治疗组明显缩短（P〈0．01）；胰岛素用量少于常规治疗组（P〈0．05）。CSⅡ低血糖发生率明显降低（P〈0．01）。结论：治疗较常规小剂量胰岛素静脉滴注短期疗效更安全、有效。     

胰岛素泵治疗糖尿病伴冠心病患者酮症酸中毒

糖尿病合并冠心病患者发生酮症酸中毒病人100例，随机分为CSII组和对照组，CSII组输注诺和灵R，对照组予小剂量胰岛素持续静点，酮体消失后于三餐前皮下注射诺和灵R和睡前注射诺和灵N。结果两组均能显著降低血糖水平。但CSII组酮体转阴快（P〈0．05），两组达到相同的血糖水平，CSII组所需的治疗时间、胰岛素用量以及低血糖发生率明显减少（P〈0．05），心衰、心绞痛的发生率降低（P〈0．05）。     

持续皮下胰岛素注射在糖尿病酮症酸中毒早期应用的合理性探讨

目的:比较持续皮下胰岛素注射(CSⅡ)和持续静脉胰岛素输注(CVⅡ)在合并糖尿病酮症酸中毒(DKA)患者早期治疗中的有效性和合理性.方法:比较两组血糖达标时间、胰岛素用量、酮体和酸中毒纠正的时间、低血糖发生率及治疗前5 d血糖水平波动情况.结果:两组血糖达标的时间类似,但CSⅡ组前5 d血糖稳定于靶目标值(11.1±2.0 mmol/L)比例更高,且血糖的波动更小,前3 d胰岛素的用量更小(P均＜0.05);两组在酮体转阴、酸中毒纠正的时间以及低血糖的发生上无显著性差异(P均＞0.05).结论:CSⅡ和CVⅡ都能纠正DKA早期的代谢紊乱,但CSⅡ能使血糖更平稳、波动更小,临床使用须根据病情而定.     

探析在糖尿病患者中应用胰岛素泵连续皮下注射的临床治疗效果

目的 探究在糖尿病患者中应用胰岛素泵连续皮下注射的临床治疗效果.方法 于2018年7月—2019年6月以该院收治的60例糖尿病患者为对象,30例患者采用胰岛素皮下注射治疗,为参照组;30例患者采用胰岛素泵连续皮下注射治疗,为研究组.对比两组患者的血糖情况、血糖改善有效率.结果 研究组患者治疗后的空腹血糖(6.12±0....     

Practical Experience with Continuous Subcutaneous Insulin Infusion Therapy in a Pediatric Diabetes Clinic

Continuous subcutaneous insulin infusion therapy (CSII) is an increasingly popular form of intensive insulin administration in pediatric patients. The use of CSII commenced at our large tertiary referral diabetes clinic as recently as 2002. In the intervening years, demand and enthusiasm from both patients and physicians alike have resulted in a steady ongoing increase in CSII use at our clinic. We currently have >200 active patients using insulin pump therapy. This article reviews our experience with CSII and outlines our current multidisciplinary approach to optimizing glycemic control and outcomes in this patient group.     

综合急救处理对糖尿病酮症酸中毒患者的应用价值

目的研究急诊综合急救治疗方法在糖尿病酮症酸中毒治疗上的临床价值。方法将2017年3月—2020年3月于该院急诊科接受治疗的100例糖尿病酮症酸中毒患者作为主要对象,用随机数字表法对其分组,各50例。对照组采用急诊常规急救方法,观察组在常规急救基础上使用胰岛素泵治疗,对比两种处理方法的临床疗效。结果相比于对照组,观察组的治疗总有效率更高,差异有统计学意义(P<0.05);观察组治疗后的空腹血糖和餐后2 h血糖均显著低于对照组,差异有统计学意义(P<0.05);观察组的血酮转阴时间、尿酮转阴时间和血糖达标时间更短,差异有统计学意义(P<0.05)。结论对糖尿病酮症酸中毒患者开展综合急救处理更有利于提高救治有效率,可缩短患者的血酮和尿酮转阴时间,使血糖在短时间内达标,优势显著,值得进一步推广应用。     

Insulin Kinetics in Type I Diabetic Patients Treated by Continuous Intraperitoneal Insulin Infusion: Influence of Anti-insulin Antibodies

Continuous intraperitoneal insulin infusion (CIPII) is a promising therapy of patients with Type 1 (insulin-dependent) diabetes mellitus (IDDM), since it improves metabolic control and decreases frequency of severe hypoglycaemia. This could be due to more appropriate insulin kinetics. Our aim, therefore, was to compare plasma free insulin levels achieved in patients with Type 1 diabetes chronically treated with CSII or CIPII. Furthermore, as anti-insulin antibodies increase with this treatment, we wanted to assess their influence upon insulin kinetics. Plasma free insulin profiles were obtained during the night and then after the bolus for breakfast and the bolus for lunch in 11 patients with Type 1 diabetes treated successively by CSII and CIPII. In another group of 16 patients with long-term Type 1 diabetes, treated by CIPII, we examined the influence of anti-insulin antibody level on insulin kinetics after a bolus. During the night, plasma free insulin levels were lower with CIPII than with CSII (12:00 am: 10.1 ± 1.7 vs 18.5 ± 2.6 mU l⁻¹; 4:00 am: 9.1 ± 2 vs 15 ± 3 mU l⁻¹), p < 0.01. After the bolus, CIPII lead to an earlier (1h vs 3h) and higher (25.8 ± 3.3 vs 18 ± 2.7, p < 0.05) plasma free insulin peak than CSII. With CIPII, the return to baseline level was observed within 3 h. Conversely, during CSII, insulin levels did not return to baseline until the next meal. After the bolus, high insulin-antibody levels were associated with a reduced maximal value of plasma free insulin peak. Taken together, these findings suggest that CIPII provides plasma free insulin profiles which are much closer to physiology than CSII. This could explain the lower rate of severe hypoglycaemia observed with this type of treatment. But in long-term CIPII treated patients with high anti-insulin antibody level, insulin profile could be moderately modified. This emphasizes the need for a less immunogenic insulin preparation.     

Siphon Effects on Continuous Subcutaneous Insulin Infusion Pump Delivery Performance

Background

The objective was to quantify hydrostatic effects on continuous subcutaneous insulin infusion (CSII) pumps during basal and bolus insulin delivery.

Methods

We tested CSII pumps from Medtronic Diabetes (MiniMed 512 and 515), Smiths Medical (Deltec Cozmo 1700), and Insulet (OmniPod) using insulin aspart (Novolog, Novo Nordisk). Pumps were filled and primed per manufacturer''s instructions. The fluid level change was measured using an inline graduated glass pipette (100 μl) when the pipette was moved in relation to the pump (80 cm Cosmo and 110 cm Medtronics) and when level. Pumps were compared during 1 and 5 U boluses and basal insulin delivery of 1.0 and 1.5 U/h.

Results

Pronounced differences were seen during basal delivery in pumps using 80–100 cm tubing. For the 1 U/h rate, differences ranged from 74.5% of the expected delivery when the pumps were below the pipettes and pumping upward to 123.3% when the pumps were above the pipettes and pumping downward. For the 1.5 U/h rate, differences ranged from 86.7% to 117.0% when the pumps were below or above the pipettes, respectively. Compared to pumps with tubing, OmniPod performed with significantly less variation in insulin delivery.

Conclusions

Changing position of a conventional CSII pump in relation to its tubing results in significant changes in insulin delivery. The siphon effect in the tubing may affect the accuracy of insulin delivery, especially during low basal rates. This effect has been reported when syringe pumps were moved in relation to infusion sites but has not been reported with CSII pumps.     

Long-term Use of Intramuscular Insulin Therapy in a Type I Diabetic Patient with Subcutaneous Insulin Resistance

We studied a 26-year-old Type 1 diabetic patient who experienced recurrent episodes of ketoacidosis and who was unresponsive to subcutaneous insulin, but normally responsive to intravenous insulin as demonstrated by insulin challenge test. Attempts at intravenous and intraperitoneal insulin administration were complicated by recurrent septicaemia. We therefore investigated the hypoglycaemic effect of intramuscular insulin administration in this patient. After intramuscular injection of NPH and Ultralente human insulin (0.1 U kg^?1), the lowest plasma glucose levels occurred 1 and 7h later, respectively; the hypoglycaemic effect lasted approximately 2 and 12 h, respectively. We based insulin therapy on intramuscular NPH as a fast-acting insulin and Ultralente as an intermediate-acting insulin using four injections a day. During the next 24 months, the patient was hospitalized for 4 weeks versus 56 weeks in the 20 months preceding intramuscular insulin administration, and was able to resume full-time work. HbA_1c decreased from 11.7 % to 8.7 % (normal range: 4.2–5.9 %). Thus, long-term intramuscular insulin therapy is a feasible alternative to intravenous or intraperitoneal insulin in patients with well-demonstrated resistance to subcutaneous insulin.     

糖尿病酮症酸中毒患者ICU护理效果

目的 对糖尿病酮症酸中毒患者ICU护理效果进行分析.方法 2018年7月—2019年7月之间于该院接受ICU病房治疗的110例糖尿病酮症酸中毒患者为研究对象,根据患者入院接受治疗的时间对患者进行分组处理,实验组中55例患者,对照组中55例患者.两组患者所应用的治疗方法相同,且护理方法不同,实验组患者应用综合护理干预,对...     

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Objective:The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures.Methods:Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation.Results:We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group (P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed.Conclusions:This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.