胰島素泵胰島素劑量設(shè)置和調(diào)節(jié)的基本方法課件

中、長(zhǎng)效胰島素的洗脫期：中效：18—20小時(shí)長(zhǎng)效：至少24小時(shí)上用泵前總量用泵總量基礎(chǔ)量餐前量中每小時(shí)基礎(chǔ)量早晚，需要攝入更用于基礎(chǔ)率。-12pm。慢持的

注0.60.50.60.5基率0.60.70.50.51.

0：00

@

0.6

u

/

hr2.

3

：00

@

0.7

u

/

hr.3.

8

：00

@

0.5

u

/

hr.0.70.70.70.7???、體SkylerJSet，Diabetes素用量6.0

u

(meal)+

3.0

u

(high

BG)9.0

u大量早餐血糖1.餐

&

零食1:106

.0

units250

-

100

=

+

3

u5010血糖午餐2.

如何正高血糖BG

-

1004.8

units70

-

100

=

-

0.6

u501:504.8

u

(meal)-

0.6

u

(high

BG)4.2

u胰素治的金準(zhǔn)大量向算器MiniMed估算程：Esttotal:87..00

UU估算:Foodintake:碳水化合物量:60gr200血糖:Foo食d:估算6.0U:Correction:血糖校正:2.0U1.0UActiveins:活性胰素量:自算胰素大量3個(gè)決定因素?

基率?

碳水化合物比率?

胰素敏感系數(shù)可將正確定夜基率:?保持非餐狀的血糖定

(夜&

兩餐)基率:0:00

@

0.6

u/hBed

TimeNocturnal3

:00Pre-BPost-BTime23:007:00BG12011790Carbs-------------------------MealBolus----------Corr.Bolus----------基率:血糖上升，增加基率良好而定的基率0:00

@

0.6

u/h1st

DayTimeBGBed

TimeNocturnalPre-BPost-B23:001203

:001257

:00188在血糖開始升高或降低的2－3個(gè)小前就開始整基率Carbs---Meal

BolusBasal

Rate:1.

0:002.

3

:003.

7

:00基率一次增加

0.1@@@0.6

u/hCorr.

Bolus0.7

u/hr0.6

u/hrDate:2nd

DayTimeBed

TimeNocturnalPre-BPost-B23:001203

:001257

:0082BGCarbs先行夜基率的整1.

消

除

夜

生低血糖的危üü2.

患者新的一天從良好的血糖開始餐前與餐后2

hr的血糖比基率:0:00

@

0.5

u/hr餐后血糖控制在目范內(nèi)，ICR

是正確的3

:00

@

0.7

u/hr7

:00

@

0.6

u/hrICR:

1:15DateNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTime3

:00122---7

:00909:25136BGNote:

餐后

BG比餐前略高，但不超餐前血糖

50

mg/dlCarbs60

gmsMeal

BolusCorr.

Bolus---4.0

u---DateNocturnalPre-BPost-BPre-LPost-LPre-DPost-DTimeBGCarbsMeal

BolusCorr.

Bolus比餐前和餐后2hr血糖Basal

Rate:0:00

@

0.5

u/hr3

:00

@

0.7

u/hr7

:00

@

0.6

u/hr餐后血糖

>

目降低

ICRDate1st

DayNocturnal3

:00Pre-B7

:0090Post-BPre-LPost-LPre-DPost-DTimeBG9:15202122要確定是否正確算碳水化合物系數(shù)Carbs---60

gmsMeal

BolusCorr.

BolusDate------4.0

u---I:C

1:122ndDayNocturnal3:00I:C

1:15Pre-BPost-B9:15Pre-LPost-LPre-DPost-DTimeBG7:0099178125125122Carbs60

gms5.0

uMeal

BolusCorr.

Bolus比餐前和餐后2hr血糖Basal

Rate:0:00

@

0.5

u/hr3

:00

@

0.7

u/hr7

:00

@

0.6

u/hr餐后血糖

<

目增加

ICRDate1st

DayNocturnal3

:00122Pre-B7

:0090Post-B9:1566Pre-LPost-LPre-DPost-DTimeBGCarbs---60

gms4.0

uMeal

Bolus---Corr.

BolusDate------ICR:

1:15ICR:

1:182nd

DayNocturnalPre-BPost-B9:15Pre-LPost-LPre-DPost-DTimeBG3:001227:009911923050Carbs60

gmsMeal

Bolus3.3

uCorr.

Bolus1.

確定ICR

，需要比:??2.

ICR

估算正確的表:?*牢，早，中，晚餐的ICR可能會(huì)有所不同，并短效胰島素超短效胰島素Basal

Rate:如果餐前BG很低，考降低白天基率ICR:

1:100:00

@

0.5

u/hr3

:00

@

0.7

u/hr7

:00

@

0.6

u/hrDate1st

DayNocturnal3

:00Pre-B7

:00Post-BPre-L13:0050Post-LPre-D18:00Post-DTimeBG9:15136----15:2512812211062Basal

Rate:Carbs---60

gms45gm3.0

u1.2.3.0：00

@0.5

u/hrMeal

Bolus___4.0

u____3：00

@7：00

@0.7

u/hr0.6U/hrNote:可能需要整白天基____

____Corr.

BolusDate____率的起始2nd

DayNocturnal3

:oo4.9

：00

@Pre-D0.5

u/hrPost-DPre-B7

:0099Post-B9:15Pre-L13:0082Post-L15:25128TimeBG18:0020:3012213678125Carbs60

gms6.0

u45

gm75

gm5.0

uMeal

BolusCorr.

Bolus3.0整后要糖Basal

Rate:如果餐前血糖高于餐后血糖，增加白天基率ICR:

1:100:00

@

0.5

u/hr3

:00

@

0.7

u/hr9

:00

@

0.5

u/hrDate1st

DayNocturnal3

:00Pre-B7

:00Post-B9:15136Pre-L13:00188Post-L15:25128Pre-D18:00172Post-DTimeBG122110Carbs---60

gms----45gmBasal

Rate:1.

0:002.

3

:003.

9

:00Meal

Bolus___4.0

u____________3.0

u@@@0.5

u/h0.7

u/hr0.6

u/hrCorr.

BolusDate____2nd

DayNocturnal3

:00Pre-B7

:0099Post-B9:15Pre-L13:0090Post-LPre-D18:0088Post-D20:30125TimeBG15:25128122136Carbs60

gms45

gm75

gmMeal

Bolus6.0

u3.05.0

uCorr.

Bolus1.?2.??3.?胰素敏感系數(shù)ICR:

1:10ISF:

50Basal

Rate:0:00

@

0.5

u/hr3

:00

@

0.7

u/hr9

:00

@

0.5

u/hr當(dāng)患者正他的高血糖，在2hr內(nèi)行血糖，以確定血糖是否達(dá)Date1st

DayNocturnal5

:00250Pre-B7

:00Post-B9:15136Pre-L13:0079Post-L15:25128Pre-D18:0088Post-DTimeBG110Carbs---60

gms6.0

u----45gm4.5

u60gm6.0Meal

BolusCorr.

Bolus____3.0

u______當(dāng)___前BG

-

目__B_G_

(100)

=#UISF(50)Date2nd

DayNocturnal3

:00250

–

100Pre-B7

:0090Post-BPre-L13:00132Post-L15:25128Pre-D18:00188Post-D20:1050=

3.0

unitsTimeBG9arbs60

gms45gm75

gm7.5

uMeal

BolusCorr.

Bolus6.0

u3.0

u+1.8

u9.3

u188

–

100

=

1.8

u50確定胰素敏感系數(shù)(ISF)1.?2.?3.內(nèi)將學(xué)到的用在踐中

!患者:

22MDI

=

52

u

/

天無法感知的低血糖而生體重:

138

lb.

HbA1c

=

7.7ICR:

1:12

ISF

=

40Basal

Rate:整基率0:00

@

0.6

u/hr1st

DayDateNocturnalPre-BPost-BPre-L12:0072Post-L14:15131Pre-D17:5556Post-D18:30112HSTime23:1588BGCarbsMeal

Bolus37

gm-

0

-60

gm-

0

-12

gm用前3.0

u-

0

--

0

--

0

-5.0

u-

0

--

0

-1.0u-

1.1

u+

3.9

uCorr.

BolusDate2nd

DayNocturnalPre-B7:1568Post-B9:36125Pre-L12:3055Post-L14:44142Pre-D18:3561Post-D20:55106HSTimeBG3:109023:3092Carbs-

054

gm-

0

-75

gm-

0

-66

gm-

0

--

0

-Meal

Bolus4.5

u6.2

u5.5

u7pm

Changed

BR0:00

@

0.5

u/hrCorr.

Bolus-0.8

u3.7

u-

-

1.1-

5.1患者:

22MDI

=

52

u

/

天無法感知的低血糖而生體重:

138

lb.

HbA1c

=

7.7ICR:

1:12

ISF

=

40Basal

Rate:整基率0:00

@

0.5

u/hr3rd

DayDateNocturnalPre-BPost-BPre-LPost-LPre-DPost-DHSTimeBG3:051177:03669:2213412:458415:1213818:067820:1412023:00122Carbs48

gm4.0

u60

gm5.0

u-

0

-71gm6.0

u-

0

--

0

-Meal

BolusCorr.

Bolus12am

@

0.5

u/hr.3am

@

0.4

u

/

hr.7am

@

0.5

u/hrDate4th

DayNocturnalPre-BPost-BPre-LPost-LPre-DPost-DHSTimeBG3:08124-

0

-8:128810:3012613:457416:0012919:008621:2512823:15125Carbs60gm68

gm72gm-

0

--

0

-Meal

BolusCorr.

Bolus5.0

u5.7

u6.0

u-

0

-患者:

32:

Type

1,

G4

P2

A1,孕11周.MDI

=

96

u

dayWT:

182

lb.

HbA1c

=

8.2整碳水化合物系數(shù)Basal

Rate:ICR

=

1:7ISF

=

1:250:00@

1.2

u/hrDate1st

DayNocturnalPre-BPost-BPre-L12:45210Post-L14:55172Pre-D17:4097Post-D20:00183HS23:15102TimeBG餐后高血糖Carbs30

gm-

0

-56

gm-

0

-Meal

Bolus4.3

u-

0

-8.0

u-

0

-用前洗脫期+4.48.5Corr.

BolusDate1.7

u2.0

u2nd

DayNocturnal3:10Pre-B7:05Post-B9:15Pre-L13:30Post-L15:40Pre-D18:25Post-D20:35HSTime23:00BG106-

010849

gm7.0

u168-

0

-10518

gm2.3

u158-

0

-71171-

0

-104-

0

-Carbs74

gm9.0

uMeal

Bolus__________+0.3

u7.3

u+0.22.5Corr.

Bolus1.5

u1.2

u_____1.6

uICR

=

1:6患者:

32:

Type

1,

G4

P2

A1,孕11周.MDI

=

96

u

dayWT:

182

lb.

HbA1c

=

8.2整碳水化合物系數(shù)Basal

Rate:ISF:

1:25ICR

1:60:00

@

1.2

u/hrDate3rd

DayNocturnal3:05Pre-BPost-B9:28Pre-L12:45Post-L15:10Pre-D18:00Post-D20:12HSTimeBG7:228923:00115154691189512

9112Meal

Bolus7.5

u8.4

u7.5

uCorr.

BolusDate1.8

u4th

DayICR

=

1:6

(L

&

D)ICR

=

1:5

Breakfast

(only)NocturnalPre-BPost-BPre-LPost-LPre-DPost-DHSTimeBG3:081088:128810:0012613:158415:3010117:458320:001050:15101Carbs45

gm9.0

u51

gm8.4

u-

0

-45

gm7.5

u-

0

-Meal

BolusCorr.Bolus全面血糖Basal

Rate:ICR:

1:5ISF:

150:00

@

2.0

u/hrDate1st

DayNocturnalPre-BPost-BPre-L11:48315Post-L14:12218Pre-D17:45245Post-D20:20210HSTimeBG23:35250Carbs80

gm16

u-

0

-90

gm18

u30

gm6.0

u-

0

-Pre-Pump

StartMeal-------------BolusBR

=

2.2ICR

1:4

SF

=

1014.530.5

u7.5

u13.5

uCorr.Bolus2nd

Day7.5

u9.5

u27.5

u-------DateNocturnal3:15Pre-BPost-B9:44Pre-LPost-LPre-DPost-DHSTimeBG7:3017712:0014:3014517:5518820:3013823:00192312238108Carbs-----60

gm80

gms45gmMealB