Kings College London, Weston Education Centre, London, UK.
Diabet Med. 2018 Mar;35(3):306-316. doi: 10.1111/dme.13525. Epub 2017 Nov 6.
The inability to achieve optimal diabetes glucose control in people with diabetes is multifactorial, but one contributor may be inadequate control of postprandial glucose. In patients treated with multiple daily injections of insulin, both the dose and timing of meal-related rapid-acting insulin are key factors in this. There are conflicting opinions and evidence on the optimal time to administer mealtime insulin. We performed a comprehensive literature search to review the published data, focusing on the use of rapid-acting insulin analogues in patients with Type 1 diabetes. Pharmacokinetic and pharmacodynamic studies of rapid-acting insulin analogues, together with postprandial glucose excursion data, suggest that administering these 15-20 min before food would provide optimal postprandial glucose control. Data from clinical studies involving people with Type 1 diabetes receiving structured meals and rapid-acting insulin analogues support this, showing a reduction in post-meal glucose levels of ~30% and less hypoglycaemia when meal insulin was taken 15-20 min before a meal compared with immediately before the meal. Importantly, there was also a greater risk of postprandial hypoglycaemia when patients took rapid-acting analogues after eating compared with before eating.
糖尿病患者无法实现最佳血糖控制是多因素的，但一个原因可能是餐后血糖控制不足。对于接受多次每日胰岛素注射治疗的患者，与进餐相关的速效胰岛素的剂量和时间都是关键因素。关于何时给予餐时胰岛素，存在着相互矛盾的观点和证据。我们进行了全面的文献检索，以审查已发表的数据，重点是 1 型糖尿病患者使用速效胰岛素类似物的情况。速效胰岛素类似物的药代动力学和药效学研究，以及餐后血糖漂移数据表明，在进食前 15-20 分钟给药将提供最佳的餐后血糖控制。涉及接受结构化膳食和速效胰岛素类似物的 1 型糖尿病患者的临床研究数据支持这一点，与进餐前即刻给药相比，餐前 15-20 分钟给予餐时胰岛素可使餐后血糖水平降低约 30%，且低血糖发生更少。重要的是，与餐前相比，患者在用餐之后使用速效类似物时发生餐后低血糖的风险更大。
