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打胰岛素为何还要吃药
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打胰岛素为何还要吃药
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湖北读者吴先生问:我今年57岁,最近查出得了2型糖尿病,医生让我打胰岛素,同时还开了二甲双胍。请问为什么打上胰岛素还要吃口服降糖药呢?
武汉市中心医院后湖院区内分泌科副主任医师丁胜解答:医生建议您打胰岛素治疗,并不代表所有口服降糖药都对您无效。在很多情况下,胰岛素联用口服降糖药效果会优于单用胰岛素。这有以下几方面原因:
1.2型糖友通常存在胰岛素抵抗,单用胰岛素效果可能较差,联用胰岛素增敏剂可事半功倍;2.目前使用的预混胰岛素不能满足所有糖友血糖变化的需求,常常需要在某些时间点联用口服降糖药,以使全天血糖平稳达标;3.部分长期、大剂量使用胰岛素的糖友可能会体重持续增加,继而胰岛素需求量进一步加大,造成恶性循环,这时若及时联用减轻体重或不增体重的降糖药,可降低胰岛素用量、避免增重;4.有的糖友因为血糖波动幅度大,需要每天多次注射胰岛素,非常痛苦,依从性也不好,若换成长效胰岛素联合使用口服降糖药,则可明显减少每日注射次数,使病人更乐于接受和坚持治疗;5.某些使用预混胰岛素治疗的糖友可能出现血糖波动较大情况,此时联合使用阿卡波糖片可起到“削峰去谷”的作用,更容易平稳控糖;6.某些病史较长的糖友,胰岛β细胞功能较差,分泌胰岛素量显著减少,胰岛α细胞分泌胰高糖素相对增多,控制血糖非常困难,此时联用DPP-4抑制剂可辅助抑制胰高糖素分泌,血糖控制更佳。
总之,碰到以上6种情况时,胰岛素联用口服降糖药往往能获得1加1大于2的效果。
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