糖尿病口服用药的指导-5.pptVIP

噻唑烷二酮类常用剂量药物 常用剂量罗格列酮4-8mg(1-2次/天)吡格列酮15－45mg(1-2次/天）临床应用适用于胰岛素抵抗为突出表现的2型糖尿病患者，即肥胖／超重的患者；可与SU、二甲双胍和胰岛素合用；显示降糖作用需较长时间，一般2－4周开始起效，6－12周出现明显疗效。*分成两张**因那格列奈在国内尚未上市，仅重点介绍瑞格列奈*根据大量临床试验和医生经验总结出了以上的用药方法，需要注意的是以上用量是我们推荐的起始剂量，医生可根据具体情况适当增减药量。诺和龙的最大剂量为：4mg/次，16mg/日。?*综合大量的临床试验，研究者发现：与安慰剂比较，诺和龙?平均降低餐后血糖5.7mmol/l，空腹血糖4.1mmol/L，HbA1c1.8%。*Slide6-40INSULINTACTICSCombinationOralAgents+InsulinSynergisticorComplementaryEffectsTheoralagentscanbedividedintotwogeneralcategories:thoseaugmentingthesupplyofinsulinbyincreasingthesecretionofinsulinintotheportalcirculationandthoseenhancingtheeffectivenessofinsulin.Injectedinsulin,inturn,increasesinsulininthesystemiccirculation.Becausethemechanismsofactionfortheseclassesoforalagentsdiffer,theymayhavecomplementaryoradditiveeffectsandcanhelpmeettheindividualizedneedsofpatients.Thesulfonylureasareoralagentsthataugmentthesupplyofportalinsulin.Theyincreasehepaticlevelsofendogenousinsulinandenhancemeal-mediatedinsulinrelease.Metforminandtheglitazonesareoralagentsthatenhancetheeffectivenessofinsulin.Metforminimprovesinsulinsensitivityattheliverandreduceshepaticglucoseproduction.Theglitazonesimproveinsulinactioninperipheraltissuesandenhanceglucoseuptake.Thea-glucosidaseinhibitorshaveadifferentmechanismofaction,decreasingpostprandialglucoseabsorptionbyinhibitingdigestionofcomplexcarbohydratesanddisaccharides,therebyretardinggastrointestinalglucoseabsorption.*Slide6-40INSULINTACTICSCombinationOralAgents+InsulinSynergisticorComplementaryEffectsTheoralagentscanbedividedintotwogeneralcategories:thoseaugmentingthesupplyofinsulinbyincreasingthesecretionofinsulinintotheportalcirculationandthoseenhancingtheeffectivenessofinsulin.Injectedin