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目的探讨老年2型糖尿病患者胰岛素强化治疗的安全性。方法选择63例老年2型糖尿病患者,对患者使用短效R三餐前和甘精胰岛素睡前21点皮下注射,每日监测指末血糖4~9次。结果全部患者均在2周内达标,胰岛素用量11~76 U/d,平均体重增加1.3 kg。低血糖14例21例次,低血糖并发心律失常5例,心肌梗死1例,脑梗死1例,未发现恶性心律失常及肝肾功能不全加重。结论胰岛素强化治疗能够短期达到满意的血糖控制效果,对于老年2型糖尿病患者,迅速消除高糖毒性作用非常必要,但是由于肝肾功能低下,药物排泄不稳定,饮食、运动依从性差,在治疗中血糖波动幅度大,低血糖发生率高。因此,老年2型糖尿病患者胰岛素强化治疗,应从小剂量开始,遵循个体化原则,密切监测血糖,调整剂量,制定应急预案,尽量避免低血糖相关损害。
Objective To investigate the safety of intensive insulin therapy in elderly type 2 diabetic patients. Methods Sixty-three elderly patients with type 2 diabetes mellitus (T2DM) were selected and treated with short-acting R before meals and insulin glargine subcutaneously at 21:00 before bedtime. The final blood glucose was monitored 4 to 9 times daily. Results All patients reached the standard within 2 weeks, insulin dosage 11 ~ 76 U / d, the average weight gain of 1.3 kg. Hypoglycemia in 14 cases 21 cases, hypoglycemia complicated by arrhythmia in 5 cases, 1 case of myocardial infarction, 1 case of cerebral infarction, no malignant arrhythmia and liver and kidney dysfunction worsened. Conclusions Insulin intensive therapy can achieve satisfactory blood sugar control effect in the short term. It is necessary for the elderly patients with type 2 diabetes to rapidly eliminate the toxic effects of high glucose. However, due to poor liver and kidney function, unstable excretion of drugs, poor diet and exercise compliance, Fluctuation of blood glucose, high incidence of hypoglycemia. Therefore, elderly patients with type 2 diabetes insulin therapy should be started from a small dose, follow the principle of individualism, close monitoring of blood glucose, adjust the dose, the development of contingency plans to avoid hypoglycemia-related damage.