Varanauskiene Egle, Varanauskaite Indre, Ceponis Jonas
Department of Endocrinology, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2006;42(9):770-9.
Achieving and maintaining glycemic control (glycated hemoglobin--HbA(1c)< or =7.0% according to American Diabetes Association and < or =6.5% according to International Diabetes Federation) is the primary goal in treating diabetes, which lowers the risk for diabetes-related complications. Insulin therapy is essential for type 1 diabetes treatment. Insulin therapy in type 2 diabetes is initiated when glycemic control is inadequate despite the combination of antihyperglycemic drugs. The type of insulin therapy is selected according to the patient's lifestyle and needs. Multiple insulin injection therapy and premixed insulin therapy are usually administered. In multiple insulin injection therapy, basal insulin is administered one or two times a day, and regular human insulin or rapid-acting insulin analog is administered with each meal. The duration of action of regular insulin is 6-8 hours; therefore, the risk for postprandial hypoglycemia is increased. The action of novel insulin analogs (rapid- and long-acting) closely mimics physiological insulin secretion. Three rapid-acting insulin analogs are currently available: insulin lispro, insulin aspart, and insulin glulisine. Insulin glulisine is the most recently approved rapid-acting insulin analog. It is safe, flexible, and effective in achieving target postprandial glycemic control. Moreover, the pharmacokinetics of insulin glulisine does not depend on the amount of subcutaneous fat. Basal insulins include intermediate-acting human insulins (neutral protamine Hagedorn) and long-acting insulin analogs (insulin glargine, insulin detemir). The latter are the optimal choice covering basal insulin requirement. Compared to neutral protamine Hagedorn insulin, long-acting insulin analogs have no pronounced concentration peak and reduce nocturnal hypoglycemia risk and weight gain.
实现并维持血糖控制（糖化血红蛋白——根据美国糖尿病协会标准，糖化血红蛋白≤7.0%；根据国际糖尿病联盟标准，糖化血红蛋白≤6.5%）是糖尿病治疗的首要目标，这可降低糖尿病相关并发症的风险。胰岛素治疗对1型糖尿病治疗至关重要。2型糖尿病患者在联合使用降糖药物后血糖控制仍不佳时，应开始胰岛素治疗。胰岛素治疗方案根据患者的生活方式和需求来选择。通常采用多次胰岛素注射疗法和预混胰岛素疗法。在多次胰岛素注射疗法中，基础胰岛素一天注射一到两次，每餐注射常规人胰岛素或速效胰岛素类似物。常规胰岛素的作用持续时间为6 - 8小时；因此，餐后低血糖风险增加。新型胰岛素类似物（速效和长效）的作用能紧密模拟生理性胰岛素分泌。目前有三种速效胰岛素类似物：赖脯胰岛素、门冬胰岛素和谷赖胰岛素。谷赖胰岛素是最近获批的速效胰岛素类似物。它在实现餐后血糖控制目标方面安全、灵活且有效。此外，谷赖胰岛素的药代动力学不依赖于皮下脂肪量。基础胰岛素包括中效人胰岛素（中性鱼精蛋白锌胰岛素）和长效胰岛素类似物（甘精胰岛素、地特胰岛素）。后者是满足基础胰岛素需求的最佳选择。与中性鱼精蛋白锌胰岛素相比，长效胰岛素类似物没有明显的浓度峰值，可降低夜间低血糖风险和体重增加。
