胰岛素治疗方案应用.ppt

*关于GDM的血糖控制标准：中国2型糖尿病防治指南（2007年版）：空腹或餐前血糖小于5.6mmol/L(100mg/dl),餐后2小时血糖小于等于6.7mmol/L（120mg/dl）；HbA1c尽可能控制在6.0%一下。（P17）?ADA发表在2009年1月DiabetesCare上面的新指南StandardsofMedicalCareinDiabetes-2009对空腹及餐后1、2小时毛细血管血糖值均有明确规定：餐前血糖小于等于5.3mmol/L(95mg/dl),餐后1小时血糖小于等于7.8mmol/L（140mg/dl）；餐后2小时血糖小于等于6.7mmol/L（120mg/dl）。（S22）?现临床上首选国内指南，用ADA标准加以补充。*DiabetesResClinPract.2005Jul;69(1):14-21.Epub2004Dec22.LinksCharacteristicsofbasalinsulinrequirementsbyageandgenderinType-1diabetespatientsusinginsulinpumptherapy.ScheinerG,BoyerBA.IntegratedDiabetesServices,333E.LancasterAvenue,Suite204,Wynnewood,PA19096,USA.garyscheiner@prodigy.netEstablishmentofappropriatebasalinsulinlevelsisanessentialcomponentofintensiveinsulintherapy.Whiletheexistenceofadawnphenomenoniswidelyrecognized,thepresentstudysoughttoestablishwhetherdiurnalbasalinsulinpatternsexistinType-1diabetes,andwhetherthesepatternsvarybyageandgender.Participantdatawasdrawnfrom322Type-1insulinpumpuserstreatedataprivatediabeteseducationpracticeinsuburbanPhiladelphia.Allparticipantscompletedabatteryoffastingtestsdesignedtomatchbasalinsulinlevelstoendogenousglucoseproductionandinsulinsensitivity.Analysisofresultantbasalpatternsrevealedsignificantdifferencesbetweenjuvenile(ageor=20)andadult(age20)basalinsulinpatterns.Theyoungergroupexhibitedamorepronouncedandsustainednight-timepeak;theoldergroupexhibitingabrieferandlesspronouncedearly-morningpeak.Loweroverallbasalinsulinrequirementswerefoundintheyoungest(ageor=10)andoldest(age60)groups.Nonoteworthygenderdifferenceswerefound.Resultscanserveasaguideforclinicianswheninitiatingandfine-tuningpatientswhoutilizebasal/bolusinsulintherapy.PMID:[PubMed-indexedforMEDLINE]设定合适的基础胰岛素水平是强化胰岛素治疗的一个必要组分。在广泛意识到黎明现象的存在时，本研究为了明确1型糖尿病患者中是否存在双相基础胰岛素形式，以及这些形式是否随着年龄和性别而