Liu php tng cng insulin

Ca lm sng
Ca lm sng

Bnh nhn nam, 68 tui, c tin cn i tho ng

mi nm.
Bnh nhn ngh hu v c li sng tnh ti.
Ngoi ra bnh nhn cn c chn on THA, RLCH
lipid v bnh mch vnh.
Bnh nhn c chiu cao 1,67m v nng 74 kg. Bnh
nhn n khm nh k v c tin hnh cc xt
nghim theo di.
Xt nghim cn lm sng c bn

- Glucose huyt i: 267 mg%

- HbA1c: 10,8%
- Creatinin huyt thanh: 0,92 mg%
- SGOT: 34U/L SGPT: 45U/L
- Cholesterol ton phn: 298 mg% - HDL: 56 mg%
- LDL: 108 mg% - TG: 222 mg%
- T s A/C niu: 58 mg/g
- Chp y mt: bnh l vng mc khng tng sinh
- in tm khi ngh: bnh thng
Cc thuc bnh nhn ang s dng

Metformin 850 mg x 2 vin

Gliclazide MR 60 mg x 1 vin
Rosuvastatin 20 mg x 1 vin
Amlodipine 5 mg x 2 vin
Lisinopril 20 mg x 1 vin
Bisoprolol 2,5 mg x 1 vin
Aspirin 81 mg x 1 vin
X tr tip theo ci thin kim
sot ng huyt

Cng c ch n tp luyn th lc V
Cc ty chn

1. Kt hp thm mt loi thuc vin ung

2. Kt hp thm insulin nn
3. Chuyn sang insulin trn sn hai ln mi ngy
4. Kt hp thm ng vn th th GLP-1 (GLP-1
RA)
 Bnh nhn c t vn v ng tim insulin nn
(glargine insulin) vi liu khi u 10 n v tim di da
trc khi i ng.
Bnh nhn c hng dn t theo di ng huyt i
mi hai ngy v chnh liu ti nh, c th t vn vi bc s
khi cn qua in thoi. Kt qu glucose huyt i sau 2
tun iu tr insulin nn
Glucose huyt (mg%)
Sng N1 N3 N5 N7 N9 N 11 N 13 N 15
i
202 188 168 162 154 147 140 132
Chnh +6 U +6 U +4 U +4 U +4 U +2 U +2 U +2 U
liu
C nn tip tc chnh liu insulin nn v
u l gii hn quyt nh dng
insulin tng cng?
Bnh nhn c cng c ch n v tp luyn
th lc, hng dn cch nhn bit v t x tr
nu c h ng huyt nh
Sau ba thng iu tr vi insulin nn, glucose
huyt i t mc tiu < 120 mg%, nhng
HbA1c l 9,1%. Lc ny, bnh nhn ang s
dng 40 n v insuln glargine bui ti trc khi
ng
Cc ty chn

1. Tip tc tng liu insulin nn cho n khi t

mc tiu HbA1c
2. Tng cng insulin bng mt mi insulin
analogue ngn trc ba n (basal plus)
3. Ngng insulin nn v chuyn hn sang insulin
trn sn hai ln mi ngy
 Bnh nhn c tng cng insulin bng ch tim
mt mi insulin analogue ngn trc ba n chiu. Liu
khi u ca insulin analogue ngn trc ba n l
10% tng liu insulin nn (4 n v)
Khai thc ch n cho thy bnh nhn hay n bui
chiu nhiu hn cc thi im khc trong ngy do c
nhiu thnh vin trong gia nh.
Bnh nhn c khuyn co gim bt 20% liu insulin
nn v t theo di ng huyt sau n chiu. Bnh
nhn cng c ngh gim gliclazide MR xung cn
30 mg trc n sng
 Nht k glucose huyt ca bnh nhn
trong tun u thm insulin analogue
ngn trc ba n chiu

Glucose huyt (mg%)

N1 N2 N3 N4 N5 N6 N7

Glucose 144 133 112

huyt i
Glucose 235 221 184 176
huyt
sau n
chiu
Chnh 4U +2 U +2 U +2 U
liu (khi
insulin u)
ngn
Sau mt thng
Bnh nhn ang s dng insulin glulisine 10 n v trc n
chiu, insulin glargine 26 n v trc khi ng, gliclazide MR
30 mg 1 vin sng trc n v metformin 850 mg 2 vin sau
n sng chiu.
Cn nng bnh nhn gim 2 kg (72 kg) v khng c cn h
ng huyt.
C th cn nhc tng liu insulin analogue ngn trc n
chiu v ngng SU gim bt vic dng nhiu thuc cho
bnh nhn.
Hai thng sau
Xt nghim HbA1c 8,2%. Glucose huyt i 113 mg%