资源描述
Click to edit Master title styleline,Click to edit Master text styles,Second level,*,Slides current until 2008,Insulin management,Curriculum Module III-3,Slide,*,of 41,Click to edit Master title style,Click to edit Master text styles,Second level,*,Slides current until 2008,Insulin management,Curriculum Module IV-1,Slide,*,of 41,ACTIVITY,Pharmacological managementInsulin,Section 3|Part 2 of 3,Curriculum Module III-3|Insulin,Slides current until 2008,Insulin,A hormone secreted by the,beta cells,Secreted in response to glucose or other stimuli,such as amino acids,Normal response characterized by low basal levels of insulin,with surges of insulin triggered by a rise in blood glucose,Insulin,60,0,20,40,Breakfast,Lunch,Supper,2,Insulin action,Increases glucose uptake,particularly in muscle,liver and adipose tissue,Suppresses glucose output from the liver,Increases formation of fat,Inhibits breakdown of fats,Promotes amino-acid uptake and prevents protein breakdown,3,Indications for insulin therapy,Type 1 diabetes,Women with diabetes who become pregnant or are breastfeeding,Transiently in type 2 diabetes in special situations,In type 2 diabetes,inadequately controlled on glucose-lowering medicines(secondary failure),4,Insulin therapy,Insulin therapy aims to replicate the normal physiological insulin response,Insulin regimens should be individualized,type of diabetes,willingness to inject,lifestyle,blood glucose monitoring,age,dexterity,glycaemic targets,5,Insulin types and action,Onset(hrs),Peak(hrs),Duration(hrs),Rapid,lispro aspart,-2,3-4,Short,soluble,regular,-1,2-4,6-8,Intermediate,NPH,lente,1-2,1-3,6-12,6-12,18-24,18-24,Long acting,ultralente glargine,detemir,4-6,3-4,1-2,8-20,3-24,3-8,24 or more,24 or more,12-24(dose-dependent),6,International labeling,7,Variability in insulin absorption,8,Factors affecting absorption,Lipohypertrophy,Dose of injection,Site and depth of injection,Exercise,Ambient and body temperature,Insulin type,Incomplete re-suspension,9,What is the most common insulin regimen used in your country?,How well do you think it works?,How do people accept insulin?,ACTIVITY,10,Insulin regimens:once a day insulin,Soluble insulin,Intermediate-acting insulin,Insulin,60,0,20,40,Breakfast,Lunch,Supper,Endogenous insulin,11,Twice a day insulin,Soluble insulin,Intermediate-acting insulin,Insulin,60,0,20,40,Endogenous insulin,Breakfast,Lunch,Supper,12,Three times a day insulin,Soluble insulin,Intermediate-acting insulin,Insulin,60,0,20,40,Endogenous insulin,Breakfast,Lunch,Supper,13,Rapid-acting insulin analogue,Intermediate-acting insulin,Basal-bolus regimen,Insulin,60,0,20,40,Endogenous insulin,Breakfast,Lunch,Supper,14,Long-acting insulin analogue,Long-acting insulin analogues,Rapid-acting insulin analogue,Insulin,60,0,20,40,Endogenous insulin,Breakfast,Lunch,Supper,15,Commencing insulin therapy,Insulin should never be used as a threat,Fear of injecting is common;needle phobia is rare,Healthcare 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!,16,Commencing insulin therapy,Starting dose 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 day,17,Injecting insulin,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 necessary,18,Insulin devices,Syringe and needle,Usually disposable,intended for one injection only,May need to use doses divisible by 5 or 10 if visually impaired,Pens,Easy to use,Loading pen may be difficult for elderly,Disposable pens,19,Insulin devices,Pumps,Insulin delivered every few minutes over 24 hours,Require large commitment,Inhaled insulin,For bolus doses only,Large device,Unknown long-term effects on lungs,20,HbA,1C,Pre-meal,2 hours post-meal,Target for most people with diabetes,7%,4-7mmol/L,*,90-130mg/dl,*1,5-10mmol/L,*,180mg/dl,*1,IDF Global guideline for Type 2 diabetes,*2,6.5%,6.0mmol/L,110mg/dl,8.0mmol/L,145mg/dl,Adjusting insulin what are the targets?,*,CDA 2003,*1,ADA 2004,*2,IDF 2005,Treatment targets should be individualized,especially for very young and very old,Absence of,hypoglycaemia,21,Starting insulin in type 2 diabetes,FINFAT: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,22,Adjusting insulin,Pattern 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 days,23,Adjusting insulin,Flexible dose guideline,Eating more,Exercising mor
展开阅读全文