http://tw.news.yahoo.com/article/url/d/ ... 2ich4.html
英國糖尿病前瞻性研究（UKPDS）發現，積極控制血糖可以減少心血管疾病的併發症。但是，不論使用哪一種降血糖藥物，血糖的控制都會每況愈下，主要是由於胰島細胞分泌胰島素的功能逐漸衰退。
國內糖尿病臨床照護指引建議，第二型糖尿病已使用最大劑量口服抗糖尿病藥，但仍無法達到理想血糖控制目標者，若再加上每日一次中或長效胰島素，或一日2次「預混型胰島素」，或一日3次「餐前速效胰島素皮下注射」，都能增進糖化血色素與血糖的控制。
口服降血糖藥物中的胰島素增敏劑，包括雙胍類（Biguanides）和Thiazolidinedione類，可以增強胰島素的功能。雙胍類可藉由增加肝臟對胰島素的反應，減少空腹時，肝臟葡萄糖的產生。Thiazolidinedione類可藉由增加肝臟和周邊組織對胰島素的反應，改善空腹和飯後的血糖。合併使用胰島素和胰島素增敏劑，可以在較低的胰島素劑量下，達到相同的血糖控制，如此一來也可以減少胰島素的副作用。
動物實驗發現，高血糖會增加氧化游離基的產生，增加氧化壓力，使得胰島細胞分泌胰島素的功能受損，也就是所謂的葡萄糖毒性。胰島素治療可以迅速而有效地緩解嚴重高血糖造成的葡萄糖毒性和周邊胰島素阻抗，搶救胰島細胞的分泌功能。越快將血糖控制在正常範圍內，胰島細胞的分泌功能恢復得越好。
有兩項針對華人的研究也證實，短期的積極胰島素治療，對新診斷出的第二型糖尿病患控制血糖有幫助。
所以，國內糖尿病臨床照護指引建議，新診斷的第二型糖尿病，可先使用胰島素治療一段時間，以增進日後血糖控制。
（作者為彰化基督教醫院鹿基分院內分泌新陳代謝科主治醫師）
胰島素治療 有助血糖控制
版主: 版主021
-
TSGHCGH
- V1
- 文章: 1629
- 註冊時間: 週日 11月 23, 2008 9:09 pm
-
chenyuhung
- Intern
- 文章: 83
- 註冊時間: 週六 2月 20, 2010 10:17 am
-
jyuan
- V1
- 文章: 1034
- 註冊時間: 週四 12月 06, 2007 12:09 am
-
poki
- V4
- 文章: 4516
- 註冊時間: 週一 11月 13, 2006 5:24 am
Re: 胰島素治療 有助血糖控制
我不同意這篇,
初患病的, 血糖越早控制好, 預後越好, 是沒錯, 我同意,
但用胰島素嚴格治療糖尿病, 很早把血糖搞好就會更好我不同意
我實際看到的是: 有些患者對藥反應很好的, 比較好治療, 血糖容易控制好,
也有些對藥反應不好的, 不好治療, 血糖很難控制好的,
所以我看是疾病本身的嚴重度的很有關係, 並不是早晚控制好的關係,
以我的解讀, 難搞的, 不會用胰島素馬上把血糖控制好就會比較好, 換口服藥同樣會有問題,
畢竟糖尿病通常很晚才發現, 不會差一個月控制好, 就會有預後好壞之分
初患病的, 血糖越早控制好, 預後越好, 是沒錯, 我同意,
但用胰島素嚴格治療糖尿病, 很早把血糖搞好就會更好我不同意
我實際看到的是: 有些患者對藥反應很好的, 比較好治療, 血糖容易控制好,
也有些對藥反應不好的, 不好治療, 血糖很難控制好的,
所以我看是疾病本身的嚴重度的很有關係, 並不是早晚控制好的關係,
以我的解讀, 難搞的, 不會用胰島素馬上把血糖控制好就會比較好, 換口服藥同樣會有問題,
畢竟糖尿病通常很晚才發現, 不會差一個月控制好, 就會有預後好壞之分
-
joelin
- 指導教授
- 文章: 9364
- 註冊時間: 週六 4月 14, 2007 11:12 pm
-
poki
- V4
- 文章: 4516
- 註冊時間: 週一 11月 13, 2006 5:24 am
Re: 胰島素治療 有助血糖控制
他第一段不就寫了, "不管用什麼藥" 胰島細胞分泌胰島素的功能逐漸衰退,joelin 寫:(咦)
他的意思是
及早使用 insulin
減少使用 刺激胰島素分泌的藥物
保存 胰臟功能
所以不是那個意思
-
GEORGE
- R1
- 文章: 101
- 註冊時間: 週五 3月 07, 2008 5:57 pm
Re: 胰島素治療 有助血糖控制
口服或吸入型INSULIN最好
大部分DM不太接受注射型INSULIN
但會有CANCER 的高風險
請教諸先進
Oral Insulin (Swallowed) and Rectal Insulin Suppository for Diabetics: Panacea or Evolving Future Health DisasterPart IIby T.R. Shantha, MD, PhD, FACAand Jessica G. Shantha Townsend letter 2009-JanIn Part I of this article, we discussed diabetes treatments and the dangers of alternative inhalation insulin delivery systems when used as a replacement for insulin shots.1,2 In recent times, we have seen the research we discussed supported. Pfizer Pharmaceuticals has reported six lung cancer cases resulting from the use of their FDA-approved Exubera, an inhalation insulin product. Pfizer consequently withdrew the drug from the market, taking a 2.5 billion-dollar loss.3,4 The FDA still has not withdrawn their approval. Pharmaceutical giants Amlyin and Eli Lilly have reported six deaths and 30 cases of pancreatitis resulting from the use of the anti-hypoglycemic agent Byetta (Exenatide: oral and injectable forms). These are good examples of the deadly adverse effects of newly introduced, FDA-approved anti-diabetic drugs. Fear of needles and a resistance to the inconvenience of administering insulin injections have created a burgeoning demand for alternative methods of treating diabetes. An apparent breakthrough arrived with the development of insulin inhalation preparations. While the FDA deemed this novel insulin preparation safe and effective, Pfizer, as mentioned, withdrew their inhalation insulin product after publication of our article detailing its dangers.1 Oral and nasal spray insulin preparations are not much different than inhalation insulin, which increases the incidence of cancers and other diseases, hence none of these preparations should be approved for public use.
大部分DM不太接受注射型INSULIN
但會有CANCER 的高風險
請教諸先進
Oral Insulin (Swallowed) and Rectal Insulin Suppository for Diabetics: Panacea or Evolving Future Health DisasterPart IIby T.R. Shantha, MD, PhD, FACAand Jessica G. Shantha Townsend letter 2009-JanIn Part I of this article, we discussed diabetes treatments and the dangers of alternative inhalation insulin delivery systems when used as a replacement for insulin shots.1,2 In recent times, we have seen the research we discussed supported. Pfizer Pharmaceuticals has reported six lung cancer cases resulting from the use of their FDA-approved Exubera, an inhalation insulin product. Pfizer consequently withdrew the drug from the market, taking a 2.5 billion-dollar loss.3,4 The FDA still has not withdrawn their approval. Pharmaceutical giants Amlyin and Eli Lilly have reported six deaths and 30 cases of pancreatitis resulting from the use of the anti-hypoglycemic agent Byetta (Exenatide: oral and injectable forms). These are good examples of the deadly adverse effects of newly introduced, FDA-approved anti-diabetic drugs. Fear of needles and a resistance to the inconvenience of administering insulin injections have created a burgeoning demand for alternative methods of treating diabetes. An apparent breakthrough arrived with the development of insulin inhalation preparations. While the FDA deemed this novel insulin preparation safe and effective, Pfizer, as mentioned, withdrew their inhalation insulin product after publication of our article detailing its dangers.1 Oral and nasal spray insulin preparations are not much different than inhalation insulin, which increases the incidence of cancers and other diseases, hence none of these preparations should be approved for public use.