糖尿病教育权威英文3-2Insulin课件.ppt
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- 糖尿病 教育 权威 英文 _2Insulin 课件
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1、Slides current until 2008Pharmacological managementInsulinSection 3|Part 2 of 3Curriculum Module III-3|InsulinInsulin managementCurriculum Module III-3 Slide 2 of 41Insulin A hormone secreted by the beta cells Secreted in response to glucose or other stimuli,such as amino acids Normal response chara
2、cterized by low basal levels of insulin,with surges of insulin triggered by a rise in blood glucoseInsulin6002040BreakfastLunchSupperInsulin managementCurriculum Module III-3 Slide 3 of 41Insulin actionIncreases glucose uptake,particularly in muscle,liver and adipose tissueSuppresses glucose output
3、from the liverIncreases formation of fatInhibits breakdown of fatsPromotes amino-acid uptake and prevents protein breakdownInsulin managementCurriculum Module III-3 Slide 4 of 41Indications for insulin therapy Type 1 diabetes Women with diabetes who become pregnant or are breastfeeding Transiently i
4、n type 2 diabetes in special situations In type 2 diabetes,inadequately controlled on glucose-lowering medicines(secondary failure)Insulin managementCurriculum Module III-3 Slide 5 of 41Insulin therapy Insulin therapy aims to replicate the normal physiological insulin response Insulin regimens shoul
5、d be individualized type of diabetes willingness to inject lifestyle blood glucose monitoring age dexterity glycaemic targetsInsulin managementCurriculum Module III-3 Slide 6 of 41Insulin types and actionOnset(hrs)Peak(hrs)Duration(hrs)Rapidlispro aspart-23-4Shortsolubleregular-12-4 6-8IntermediateN
6、PHlente1-21-36-12 6-12 18-24 18-24Long actingultralente glarginedetemir4-63-41-28-20 3-243-8 24 or more24 or more 12-24(dose-dependent)Insulin managementCurriculum Module III-3 Slide 7 of 41International labelingwww.idf.orgInsulin managementCurriculum Module III-3 Slide 8 of 41Variability in insulin
7、 absorptionInsulin managementCurriculum Module III-3 Slide 9 of 41Factors affecting absorption Lipohypertrophy Dose of injection Site and depth of injection Exercise Ambient and body temperature Insulin type Incomplete re-suspensionInsulin managementCurriculum Module III-3 Slide 10 of 41 What is the
8、 most common insulin regimen used in your country?How well do you think it works?How do people accept insulin?ACTIVITYInsulin managementCurriculum Module III-3 Slide 11 of 41Insulin regimens:once a day insulinSoluble insulinIntermediate-acting insulinInsulin6002040BreakfastLunchSupperEndogenous insu
9、linInsulin managementCurriculum Module III-3 Slide 12 of 41Twice a day insulinSoluble insulinIntermediate-acting insulinInsulin6002040Endogenous insulinBreakfastLunchSupperInsulin managementCurriculum Module III-3 Slide 13 of 41Three times a day insulinSoluble insulinIntermediate-acting insulinInsul
10、in6002040Endogenous insulinBreakfastLunchSupperInsulin managementCurriculum Module III-3 Slide 14 of 41Rapid-acting insulin analogueIntermediate-acting insulinBasal-bolus regimenInsulin6002040Endogenous insulinBreakfastLunchSupperInsulin managementCurriculum Module III-3 Slide 15 of 41Long-acting in
11、sulin analogueLong-acting insulin analoguesRapid-acting insulin analogueInsulin6002040Endogenous insulinBreakfastLunchSupperInsulin managementCurriculum Module III-3 Slide 16 of 41Commencing insulin therapy Insulin should never be used as a threat Fear of injecting is common;needle phobia is rare He
12、althcare professionals attitude is key to acceptance People should be praised and encouraged to promote a positive attitude Blood test is more painful than insulin injection Forget the oranges;just do it!Insulin managementCurriculum Module III-3 Slide 17 of 41Commencing insulin therapy Starting dose
13、 will depend on many factors age weight type and duration of diabetes glycaemic targets In type 2 diabetes,consider continuing maximum tolerated oral glucose-lowering medicines 10 units of intermediate-acting insulin once a dayInsulin managementCurriculum Module III-3 Slide 18 of 41Injecting insulin
14、 Should be given into subcutaneous tissue Skin of a very thin person may have to be gently pinched Insulin at room temperature less painful Needle can be inserted at 45-90 45 for very thin people 90 for overweight people or when using short needle Swabbing with alcohol is not necessaryInsulin manage
15、mentCurriculum Module III-3 Slide 19 of 41Insulin devicesSyringe and needle Usually disposable,intended for one injection only May need to use doses divisible by 5 or 10 if visually impairedPens Easy to use Loading pen may be difficult for elderly Disposable pensInsulin managementCurriculum Module I
16、II-3 Slide 20 of 41Insulin devicesPumps Insulin delivered every few minutes over 24 hours Require large commitmentInhaled insulin For bolus doses only Large device Unknown long-term effects on lungsInsulin managementCurriculum Module III-3 Slide 21 of 41HbA1CPre-meal2 hours post-mealTarget for most
17、people with diabetes7%4-7mmol/L*90-130mg/dl*15-10mmol/L*180mg/dl*1IDF Global guideline for Type 2 diabetes*26.5%6.0mmol/L110mg/dl8.0mmol/L145mg/dlAdjusting insulin what are the targets?*CDA 2003,*1ADA 2004,*2 IDF 2005 Treatment targets should be individualized,especially for very young and very old
18、Absence of hypoglycaemiaInsulin managementCurriculum Module III-3 Slide 22 of 41Starting insulin in type 2 diabetesFINFAT:start small dose intermediate-acting insulin at night Aim for target fasting levels first Adjust by 2-4 units or 10%Second injection only added once fasting targets reached Insul
19、in managementCurriculum Module III-3 Slide 23 of 41Adjusting insulinPattern management Watch levels for 2-3 days Address hypoglycaemia first Aim for target fasting levels next Adjust by 2-4 units or 10%Wait 2-3 daysInsulin managementCurriculum Module III-3 Slide 24 of 41Adjusting insulin Flexible do
20、se guideline Eating more Exercising more Insulin to carbohydrate ratio Evaluate with next blood glucose Tailored to individual needsInsulin managementCurriculum Module III-3 Slide 25 of 41Which insulin to adjust when?Blood glucoseInsulin to be changedFastingBedtime or supper intermediate-or long-act
21、ingPost-breakfastMorning short-or rapid-acting insulin Pre-lunchMorning intermediate-acting insulinPost-lunchMorning intermediate-acting insulin or lunchtime short-or rapid-acting insulin Pre-supper(dinner)Morning intermediate-acting insulinPost-supper(dinner)Supper-time short-or rapid-acting insuli
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