胰岛素剂量设置 和调节的基本方法美敦力公司湖南技术代表美敦力公司湖南技术代表 龙军龙军首先确定血糖控制目标l为每个病人确定个人的血糖控制目标。 l成年病人的一般控制目标：餐前：80-110mg/dl (4.4-6.1mmol/l)餐后2小时： 90mg/dl (5mmol/l)若反复出现低血糖，适当提高控制目标：餐前：100-160mg/dl (5.6-8.9mmol/l)若怀孕，适当减低目标血糖值：餐后： 目标标 降低 ICRDate1st DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTime3 :007 :009:15BG12290Carbs-60 gmsMeal Bolus-4.0 uCorr. Bolus-Date2nd DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTimeBGCarbsMeal BolusCorr. Bolus202I:C 1:153:001227:0060 gms5.0 u9:15要确定是否正确计计算碳水化合 物系数尝试尝试 I:C 1:12确认认/调调整碳水化合物系数99125178 125比较较餐前和餐后2hr血糖Basal Rate:0:00 0.5 u/hr 3 :00 0.7 u/hr7 :00 0.6 u/hr餐后血糖 50 mg /dl Date1st DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTime5 :007 :009:1513:0015:2518:00BG2501101367912888Carbs-60 gms-45gm60gmMeal Bolus_6.0 u_4.5 u6.0Corr. Bolus3.0 u_Date2nd DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTime3 :007 :009:1513:0015:2518:0020:10BG12090136132128188Carbs60 gms45gmMeal Bolus6.0 u3.0 u7.5 uCorr. Bolus当患者纠纠正他的高血糖时时，应应在2hr内进进行血糖监监 测测，以确定血糖是否达标标75 gm+1.8 u125188 100 = 1.8 u 509.3 u当前BG - 目标 BG (100) = # U ISF (50) 250 100 50 = 3.0 units补补充大剂剂量Basal Rate:0:00 0.5 u/hr 3 :00 0.7 u/hr9 :00 0.5 u/hrICR: 1:10ISF: 50胰岛岛素敏感系数 补补充大剂剂量胰岛岛素敏感系数 1. 确定ISF，需要对对比: 输输注补补充大剂剂量前的血糖与输输注补补充大剂剂量后的血糖2. 当符合下列条件时时，ISF已被正确调调整 : 调调整后2 hr血糖不超过过目标值标值 30 mg/d (目标值标值 : 100 mg/dL 120 mg/dL)1. 3小时时内再测测一次血糖以确认认血糖在目标标范围围内确定胰岛岛素敏感系数(ISF)将学到的应应用在实实践中 !优优化血糖管理 系统的调节过程从夜间基础率开始调节调整血糖的过程中尽量进食低脂肪，碳水化合物含量恒定的食物当碳水化合物系数已经确定后再进食高脂肪餐进食高脂肪餐时应考虑使用“双波大剂量”的选项 学习治疗的逻辑 鼓励患者自己学习调整血糖的规律 血糖的精细调细调 整:如何将血糖的精细调节应细调节应 用于胰岛岛素泵泵治疗疗患者: 22 岁岁 MDI = 52 u / 天无法感知的低血糖时时而发发生体重: 138 lb. HbA1c = 7.7 ICR: 1:12 ISF = 40Date1st DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DHSTime12:00 14:15 17:55 18:3023:15BG 72 131 56 112 88Carbs 37 gm - 0 - 60 gm - 0 - 12 gmMeal Bolus3.0 u - 0 - 5.0 u - 0 -1.0uCorr. Bolus - 0 - - 0 - 1.1 u + 3.9 u- 0 - Date2nd DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DHSTime 3:107:15 9:3612:30 14:44 18:35 20:5523:30BG 90 68 125 55 142 61 106 92Carbs - 0 54 gm - 0 - 75 gm - 0 - 66 gm - 0 - - 0 -Meal Bolus4.5 u 6.2 u 5.5 uCorr. Bolus-0.8 u3.7 u- - 1.1 - 5.1用泵泵前7pm Changed BR 0:00 0.5 u/hrBasal Rate:0:00 0.6 u/hr 调调整基础础率患者: 22 岁岁 MDI = 52 u / 天无法感知的低血糖时时而发发生体重: 138 lb. HbA1c = 7.7 ICR: 1:12 ISF = 40125 128 86 129 74 126 88 124BGCorr. Bolus- 0 - 6.0 u 5.7 u 5.0 uMeal Bolus- 0 - - 0 - 72gm 68 gm60gm - 0 -Carbs23:15 21:25 19:00 16:00 13:45 10:308:12 3:08TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturn al4th DayDateWalkingCorr. Bolus6.0 u 5.0 u 4.0 uMeal Bolus- 0 - - 0 - 71gm - 0 - 60 gm48 gmCarbs122 120 78 138 84 134 66 117BG23:00 20:14 18:06 15:1212:45 9:227:03 3:05TimeHSPost-DPre-DPost-L Pre-LPost-BPre-B Nocturnal3rd DayDate12am 0.5 u/hr.3am 0.4 u / hr.7am 0.5 u/hrBasal Rate:0:00 0.5 u/hr调调整基础础率患者: 32 岁岁: Type 1, G4 P2 A1,怀怀孕11周. MDI = 96 u dayWT: 182 lb. HbA1c = 8.21.6 u_ 1.2 u+0.22.51.5 u+0.3 u7.3 uCorr. Bolus_ 9.0 u 2.3 u_ 7.0 u Meal Bolus- 0 - - 0 - 74 gm - 0 - 18 gm - 0 -49 gm - 0 Carbs104 171 71 158 105 168 108 106BG23:00 20:35 18:25 15:40 13:30 9:157:05 3:10TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal2nd DayDate2.0 u 1.7 u+4.48.5Corr. Bolus- 0 - 8.0 u - 0 -4.3 uMeal Bolus- 0 - 56 gm - 0 -30 gmCarbs102 183 97 172 210BG23:15 20:00 17:4014:5512:45TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal1st DayDate用泵泵前洗脱期ICR = 1:6Basal Rate:0:00 1.2 u/hr ICR = 1:7ISF = 1:25餐后高血糖调调整碳水化合物系数患者: 32 岁岁: Type 1, G4 P2 A1,怀怀孕11周. MDI = 96 u dayWT: 182 lb. HbA1c = 8.21.8 u Corr. Bolus7.5 u 8.4 u 7.5 uMeal Bolus112 12 9 95 118 69 154 89 115BG23:00 20:12 18:00 15:1012:45 9:287:22 3:05TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal3rd DayDateICR 1:6Corr. Bolus7.5 u 8.4 u 9.0 uMeal Bolus- 0 - 45 gm - 0 - 51 gm45 gmCarbs101 105 83 101 84 126 88 108BG0:15 20:00 17:45 15:30 13:15 10:008:12 3:08TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal4th DayDateICR = 1:5 Breakfast (only)ICR = 1:6 (L & D)Basal Rate:0:00 1.2 u/hr ISF: 1:25调调整碳水化合物系数Hx: 44 岁岁: Type 2: 胰岛岛素抵抗，高血糖 MDI = 200 u day WT: 260 lb. HgA1c 16.55.0u17 u14.0 uCorr. Bolus12 u-Meal Bolus60 gm -Carbs238 177 312BG9:44 7:30 3:15TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnalDate-7.5 u13.5 u9.5 u27.5 u7.5 u14.5 30.5 u2nd DayCorr. Bolus- 6.0 u 18 u - 16 uMeal Bolus- 0 - 30 gm 90 gm - 0 - 80 gmCarbs250 210 245 218 315BG23:35 20:20 17:45 14:1211:48TimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal1st DayDatePre-Pump StartBR = 2.2 ICR 1:4 SF = 1014.0 u12:00108 80 gms20 u14:30 14517:55 188 45gm11 u9.0 u20:30 13823:00 192Basal Rate:0:00 2.0 u/hr ICR: 1:5ISF: 15全面调节调节 血糖Corr. BolusMeal BolusCarbsBGTimeHSPost-DPre-DPost-LPre-LPost-BPre-BNocturnal4th DayDate9u26 u11u26 u17 u29 uCorr. Bolus1