Bolli Geremia B
Department of Medicine, University of Perugia, Italy.
Endocr Pract. 2006 Jan-Feb;12 Suppl 1:105-9. doi: 10.4158/EP.12.S1.105.
To present key aspects and strategies for use of insulin therapy in patients with type 1 diabetes mellitus.
Limitations and advantages of various insulin regimens are discussed, and issues pertaining to insulin analogues are reviewed.
Rapid-acting insulin analogues provide better and safer postprandial glucose coverage than does human regular insulin. Premixed insulin preparations do not provide the flexibility to address the individual needs of patients adequately to control postprandial glucose excursions. Because of its peak, short duration, and high variability, NPH insulin is inappropriate for patients with type 1 diabetes and patients with type 2 diabetes who require continuous basal coverage. Continuous infusion of soluble insulin by means of an insulin pump is currently the most physiologic approach available for treatment of type 1 diabetes. Use of insulin glargine or insulin detemir with a rapid-acting insulin analogue at meals is an effective and reasonable alternative to insulin pump therapy.
Both rapid-acting and long-acting insulin analogues improve glycemic control. This improvement involves controlling hemoglobin A1c levels, reducing glucose excursions, and decreasing hypoglycemia, particularly during the night. Clinicians should prescribe insulin regimens that yield physiologic results in patients with type 1 diabetes.
介绍1型糖尿病患者胰岛素治疗的关键要点和策略。
讨论了各种胰岛素治疗方案的局限性和优势，并对胰岛素类似物相关问题进行了综述。
速效胰岛素类似物比人常规胰岛素能提供更好、更安全的餐后血糖覆盖。预混胰岛素制剂不能充分灵活地满足患者个体需求以控制餐后血糖波动。由于中效胰岛素（NPH胰岛素）作用高峰、持续时间短且变异性高，不适用于1型糖尿病患者及需要持续基础胰岛素覆盖的2型糖尿病患者。通过胰岛素泵持续输注可溶性胰岛素是目前治疗1型糖尿病最符合生理需求的方法。餐时使用甘精胰岛素或地特胰岛素加速效胰岛素类似物是胰岛素泵治疗的有效且合理替代方案。
速效和长效胰岛素类似物均能改善血糖控制。这种改善包括控制糖化血红蛋白水平、减少血糖波动以及降低低血糖风险，尤其是夜间低血糖。临床医生应为1型糖尿病患者制定能产生符合生理需求结果的胰岛素治疗方案。
