1、 Normal PancreasSimplest level - a small amount of glucose, measurable in millimoles, circulates in the blood continually. After eating, the normal pancreas secretes insulin in response to glucose need. In the diabetic state, the balance of insulin and glucose is disrupted, putting patients at risk
2、for hyperglycemia. 每天4次注射 更符合生理的方式. 在进餐和运动方面获得更队的自由度 生活自由，控制水平有所提高 但是每天4-获5次注射非常不方便. 病人的依从性成为很大的问题 问题的原因是试图用不符合生理模式的方法来解决生理问题 解决这个难题的关键是控制胰岛素作用的差异性 REF: Diabetes Care 22 Supplement 2 1999 p b43Basal/Bolus Insulin Absorption Pattern With Standard InsulinPreparations This graph demonstrates insulin de
3、livery patterns with standard insulin preparations. In the commonly used basal/bolus approach, the goal is to maintain a steady state of insulin with a long-acting insulin taken at bedtime, and bolus doses of regular insulin prior to each meal. In this pattern, regular insulin is taken before meals
4、at 8:00 AM, noon, and 5:00 PM. NPH/lente insulin is then taken at bedtime. NPH/lente is an intermediate-acting insulin with a duration that does not cover a full 24 hours. Regular insulin has the disadvantage of peaking somewhat later than the peak for glucose uptake following a meal. Further, even
5、though it is short-acting, insulin levels are sustained following meals, and this may lead to hypoglycemic episodes between meals. 每天4次注射 更符合生理的方式. 在进餐和运动方面获得更队的自由度 生活自由，控制水平有所提高 但是每天4-获5次注射非常不方便. 病人的依从性成为很大的问题 问题的原因是试图用不符合生理模式的方法来解决生理问题 解决这个难题的关键是控制胰岛素作用的差异性 REF: Diabetes Care 22 Supplement 2 1999
6、p b43Slide 3-22关于GDM的血糖控制标准：中国2型糖尿病防治指南（2007年版）：空腹或餐前血糖小于5.6mmol/L(100mg/dl),餐后2小时血糖小于等于6.7mmol/L（120mg/dl）；HbA1c尽可能控制在6.0%一下。（P17）ADA发表在2009年1月Diabetes Care上面的新指南“Standards of Medical Care in Diabetes-2009“对空腹及餐后1、2小时毛细血管血糖值均有明确规定：餐前血糖小于等于5.3mmol/L(95mg/dl),餐后1小时血糖小于等于7.8mmol/L（140mg/dl）；餐后2小时血糖小于等于6.7mmol/L（120mg/dl）。（S22）现临床上首选国内指南，用ADA标准加以补充。
