University of Kentucky, 900 S. Limestone, Lexington, KY 40536, USA.
Postgrad Med. 2010 Jan;122(1):163-71. doi: 10.3810/pgm.2010.01.2110.
The prevalence of obesity and diabetes is epidemic. Severe insulin resistance (defined as the need for > or = 200 units of insulin per day to achieve glycemic control) is commonly seen with obesity and can complicate diabetes management. The management of patients with diabetes who have severe insulin resistance is difficult, and at times frustrating, and requires a multifaceted approach. Weight loss is the best treatment option, which can be a challenging task for patients to achieve and maintain. Medications that decrease insulin needs like metformin, thiazolidinediones, or pramlintide may help, but some patients also need high doses of insulin. This article reviews these different treatment options and provides practical advice on weight loss, use of insulin sensitizers, and use of U-500 insulin.
肥胖症和糖尿病的流行是一种 epidemic（可译为“ epidemic”）。严重的胰岛素抵抗（定义为需要每天 > 或 = 200 单位的胰岛素来实现血糖控制）在肥胖症中很常见，并且会使糖尿病的管理复杂化。患有严重胰岛素抵抗的糖尿病患者的管理既困难又令人沮丧，需要采取多方面的方法。减轻体重是最佳治疗选择，但对于患者来说，实现和维持体重减轻是一项具有挑战性的任务。像 metformin、thiazolidinediones 或 pramlintide 这样可以降低胰岛素需求的药物可能会有所帮助，但有些患者还需要高剂量的胰岛素。本文综述了这些不同的治疗选择，并就减轻体重、使用胰岛素增敏剂和使用 U-500 胰岛素提供了实用建议。
