tailieunhanh - Diagnosis and Management of Pituitary Disorders - part 5

Kết hợp các chất tương tự insulin tác dụng nhanh và insulin tác động trung gian được sản xuất với công thức insulin trộn. Chế độ trộn không thích hợp cho bệnh nhân với bệnh tiểu đường loại 1 và mỏng nhất, | Chapter 12 Intensive Insulin Therapy in T2DM 185 insulin without significant hypoglycemia but at the expense of progressive weight gain 7 . All these studies clearly demonstrate the efficacy of various insulin regimens and the adverse consequences of such therapy. PREMIXED INSULIN REGIMENS Combinations of rapid-acting insulin analogs and intermediate acting insulins are manufactured as premixed insulin formulations. Premixed regimens are not appropriate for patients with type 1 diabetes and for most thin insulin sensitive patients with T2DM however they can be effective for obese insulin resistant patients with T2DM. One such insulin preparation is Humalog Mix 75 25 which is a fixed-ratio mixture of 25 rapid-acting insulin lispro and 75 novel protamine-based intermediate-acting insulin called neutral protamine lispro NPL . NPL was developed to solve the problem of instability with prolonged storage that occurs with NPH combined with short acting insulin. Studies of the pharmacokinetic and pharmacodynamic profiles of NPL show they are comparable to those of NPH insulin 8 . Humalog Mix 75 25 was compared to premixed human insulin 70 30 in patients with T2DM in a 6-mo randomized open-label 2-period crossover study 9 . Twice-daily injections of Humalog Mix 75 25 resulted in improved postprandial glycemic control after the morning and evening meals reduced rate of nocturnal hypoglycemia similar overall glycemic control and the added convenience of administration immediately before meals. Humalog Mix 50 50 is also now available for those patients whose post prandial glucose values are not adequate on the 75 25 and 70 30 combinations. Insulin aspart another rapid-acting insulin analog is available in a premixed formulation with a protamine-retarded insulin aspart called Novolog Mix 70 30 70 insulin aspart protamine suspension and 30 insulin aspart . A comparison study 10 of the pharmacokinetic and pharmacodynamic parameters of the Novolog Mix 70 30 and human insulin 70 30