·糖尿病胰岛素治疗·

　　【摘要】 目的 探讨住院短期使用胰岛素泵输注速效胰岛素类似物(诺和锐)强化治疗的剂量调节方法。方法 将124例利用胰岛素泵强化治疗的糖尿病患者分为A、B两组。A组从异常的餐前血糖点前2 h起，每小时增减0.1 IU至下一餐前2 h;B组从异常的餐前血糖点前一次餐前血糖为起点，按照公式(实测血糖值-目标血糖值)×0.2÷间隔小时数，得出每小时需增减的剂量。餐前大剂量胰岛素两组均据餐后血糖情况，调整胰岛素用量至血糖达标。比较两组血糖达标所需天数及平均每日胰岛素用量、低血糖发生率，选择适合的剂量调整方法。 结果 两组3餐前、睡前血糖下降及低血糖发生率间差异无统计学意义(P>0.05)。B组血糖控制达标快于A组(P<0.05)，且胰岛素用量低于分段组(P<0.05)。 结论 胰岛素泵持续皮下输注利用公式法调整泵入基础剂量不增加低血糖发生率，且血糖达标时间更短，易于掌握，适合临床推广使用。

　　【关键词】糖尿病，2型;胰岛素泵;调节方法;速效胰岛素类似物

Discussion on the dose adjustment in insulin pump intensive therapy CHEN Ying, BEI Hong-xia. Department of Endocrinology, Zhejiang Quhua Hospital, Quhua 324004, China

　　【Abstract】Objective To discuss the dose adjustment method of intensive therapy in hospitalized short-term insulin pump infusion of rapid-acting insulin analogues (Insulin Aspart). Methods One hundred and twenty-four diabetics treated with insulin pump intensive therapy were divided into Group A and Group B. The dose adjustment for Group A: started from 2 hours before the abnormal preprandial blood glucose time point, increase/decrease 0.1 IU per hour till 2 hours before the next meal. The dose adjustment for Group B: taking the last time preprandial blood glucose of the abnormal preprandial blood glucose time point as a starting point, calculated according to the following formula to get the requested dose that needs to increase/decrease per hour: (measured blood glucose level – target blood glucose level) × 0.2 ÷ the number of hours between. For both groups, the preprandial big dose of insulin was adjusted according to the state of postprandial blood glucose. The number of days needed for the targeted level of blood glucose, the average daily insulin doses, and the incidence of hypoglycemia events of the two groups were compared with each other for selecting the best dose adjustment method. Results In the comparison between the two groups, there was no significant difference in statistics in the decrease of blood glucose before three meals and bedtime and the incidence of hypoglycemia events (P>0.05). The number of days needed for the targeted level of blood glucose in Group B was less (quicker) than that in Group A (P<0.05), and the insulin dose was lower than in subgroups (P<0.05). Conclusion Using the formula method to adjust the pumped basic dose in continuous subcutaneous insulin pump infusion of insulin is not only without increasing the incidence of hypoglycemia events, but also achieving a shorter time to get the targeted level of blood glucose, and what is more, it is easy in application. It is worthy spreading.

　　【Key words】 Diabetes mellitus, type 2; Insulin pump; Adjusting method; Fast-acting insulin analogues