胰岛素泵的精细调节.ppt

胰岛素泵的精细调节胰岛素泵的精细调节胰岛素泵的精细调节胰岛素泵的精细调节为什么要进行血糖精细调节为什么要进行血糖精细调节 n n通过与胰岛素需求量相匹配的胰岛素输注以获得最佳的血糖控制n n尽可能将胰岛素泵的作用发挥出来n n让患者感到更满意血糖精细调节的三个步骤血糖精细调节的三个步骤n n准备和学习n n设定血糖目标值n n尝试并调整剂量n n基础率基础率n n餐前大剂量餐前大剂量 n n补充大剂量补充大剂量准备工作准备工作n n基础率和大剂量选项的特征回顾n n大剂量向导大剂量向导n n理解方波和双波大剂量选项对患者的意义理解方波和双波大剂量选项对患者的意义n n血糖测试提醒血糖测试提醒n n0.05 0.05 单位为步长的基础率增加单位为步长的基础率增加设定血糖目标值设定血糖目标值n n将血糖控制的目标转化为具体的值n n在一天的不同时间设定不同的血糖目标在一天的不同时间设定不同的血糖目标n n白天白天90 –110 90 –110 mg/dL mg/dL n n妊娠妊娠60 - 90 60 - 90 mg/dL mg/dL Paradigm®胰岛素泵胰岛素泵 B糖尿病管理迈出新的一步糖尿病管理迈出新的一步基础率基础率1.12 am @ 0.6 u / hr.基础率回顾基础率回顾 缓慢持续的输注缓慢持续的输注Ø 持续输注持续输注 Ø 从设置一个基础率开始调整从设置一个基础率开始调整/增加基础率增加基础率Ø目的目的:模仿一个正常功能的胰腺模仿一个正常功能的胰腺,维持血糖稳定维持血糖稳定0.60.50.60.70.70.60.70.70.7 0.50.50.5 2. 3 am @ 0.7 u / hr. 3. 8 am @ 0.5 u / hr. 大剂量大剂量 进餐进餐 & 高血糖高血糖大剂量大剂量1.进餐进餐 & 零食零食1:102.如何纠正高血糖如何纠正高血糖早餐早餐 60 gms 6 .0 units 午餐午餐 48 gms4.8 units 血糖监测血糖监测 250 mg/dl250 - 100 = + 3 u 50血糖监测血糖监测70 mg/dl70 - 100 = - 0.6 u 50BG - 100 = # Units SF (胰岛素敏感系数) 1:50 6.0 u (meal)+ 3.0 u (high BG) 9.0 u 4.8 u (meal)- 0.6 u (high BG) 4.2 u(1 单位胰岛素 / ? gms 碳水化合物)MiniMedEstimate DetailsEst total: Food intake: BG: Food: Correction: Active ins:ACT to proceed,ESC to back up 大剂量向导大剂量向导大剂量向导大剂量向导为患者自动计算胰岛素大剂量为患者自动计算胰岛素大剂量为患者自动计算胰岛素大剂量为患者自动计算胰岛素大剂量 MiniMed Paradigm胰岛素泵治疗的金标准胰岛素泵治疗的金标准!8.0 U20060 gr 2.0 UICR 1:10 gr200 - 100 u 50 (SF)Paradigm Pump6.0 UFood:Correction:Est total:大剂量向导是个选择性的功能，可以打开，也可以关闭。

大剂量向导是个选择性的功能，可以打开，也可以关闭Paradigm® 胰岛素泵胰岛素泵Press ACT•打开主菜单 MiniMedMain MenuBolusSuspendBasalPrimeUtilities如何使用大剂量向导如何使用大剂量向导 BolusSuspendBasalBolusPrimeUtilitiesParadigm® Pump如何使用大剂量向导如何使用大剂量向导MiniMedBolus MenuSet BolusBolus HistoryBolus Wizard Set UpMax BolusDual/Square BolusEasy BolusBG ReminderBolus Wizard Set UpMiniMedWIZARD SETUPEdit SettingsReview SettingsEdit SettingsMiniMedEdit SettingsWizard:Carb units:Carb Ratios: BG Units:Sensitivity: BG Targets: ongrams 10 mg/dL 50 100MiniMedReview SettingsCarb Ratios: 12:00 A 10 11:30 A 12 6:00 P 15Review SettingsCarb Ratios: offexchanges每餐的碳水化合物每餐的碳水化合物系数可以不同系数可以不同 mmol/L每天克设置多达每天克设置多达8个不同值个不同值Edit Settings如何使用大剂量向导如何使用大剂量向导MiniMedBolus MenuUse Bolus WizardManual BolusBolus HistoryBolus Wizard Set UpMax BolusDual/Square BolusEasy BolusBG ReminderMiniMedEnter BG mg/dL200MiniMedBolus MenuUse Bolus WizardManual BolusBolus HistoryBolus Wizard Set UpMax BolusDual/Square BolusEasy BolusBG ReminderUse Bolus Wizard200MiniMedEnter Food grams060如何使用大剂量向导如何使用大剂量向导MiniMedEstimate DetailsEst total: Food intake: BG: Food: Correction: Active ins:ACT to proceed,ESC to back up The Bolus WizardThe Bolus Wizard自动计算胰岛素大剂量自动计算胰岛素大剂量自动计算胰岛素大剂量自动计算胰岛素大剂量 MiniMed Paradigm® Pump胰岛素泵治疗的金标准胰岛素泵治疗的金标准8.0 U20060 gr 2.0 U6.0 UFood:Correction:Est total:Active ins:7.0 U1.0 UFood intake:ACT tp proceedMiniMedSET BOLUSEstimate 7.0 u用用“大剂量向导大剂量向导”进行大剂量输注进行大剂量输注.1 u.2 u.3 u.4 u.5 u.6 u7.0 u胰岛素泵的精细调节胰岛素泵的精细调节3个决定因素个决定因素• 基础率基础率• 碳水化合物比率碳水化合物比率• 胰岛素敏感系数胰岛素敏感系数基础率基础率:12 AM @ 0.6 u/h调整夜间基础率调整夜间基础率 稳定而良好稳定而良好的基础率的基础率 Bed TimeBed TimeNocturnalNocturnalPre-BPre-BPost-BPost-BTimeTimeBGBGCarbsCarbs------------------------------Meal Meal BolusBolus------------------------------Corr. Corr. BolusBolus------------------------------11 PM1203 AM1177AM90Ø 保持非进餐状态的血糖稳定保持非进餐状态的血糖稳定 (夜间夜间 & 两餐间两餐间)正确设定夜间基础率正确设定夜间基础率:稳定而良好稳定而良好的基础率的基础率 血糖上升，应血糖上升，应 增加基础率增加基础率Bed TimeBed TimeNocturnalNocturnalPre-BPre-BPost-BPost-BTimeTimeBGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. BolusDate:Date:Bed TimeBed TimeNocturnalNocturnalPre-BPre-BPost-BPost-BTimeTimeBGBGCarbsCarbs基础率基础率:12 AM @ 0.6 u/h11 PM1203 AM1257 AM188Basal Rate:1. 12 am @ 0.6 u/h 2. 3 am @ 0.7 u/hr3. 7 am @ 0.6 u/hr11 PM1203 AM1257 AM82---基础率一次增加 0.1 单位良好而稳定良好而稳定的基础率的基础率夜间基础率调节不好夜间基础率调节不好 黎明现象黎明现象在血糖开始升高或降低的2－3个小时前就开始调整基础率1. 消除夜间发生低血糖的危险消除夜间发生低血糖的危险 ü 患者可以整晚安然而睡患者可以整晚安然而睡ü 提高患者的依从性提高患者的依从性2. 患者新的一天从良好的血糖开始患者新的一天从良好的血糖开始 先进行夜间基础率的调整先进行夜间基础率的调整确认确认/调整夜间基础率调整夜间基础率DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAMBGBG1221229090CarbsCarbs------Meal BolusMeal Bolus------Corr. BolusCorr. Bolus------DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTimeBGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. Bolus基础率基础率:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 7 AM @ 0.6 u/hr60 gmsICR: 1:154.0 u餐后血糖控制在目标范围内，餐后血糖控制在目标范围内，ICR 是正确的是正确的9:25 AM136Note: 餐后餐后 BG应比餐前略高，但不超过餐应比餐前略高，但不超过餐前血糖前血糖 50 mg/dl 确认确认/调整碳水化合物系数调整碳水化合物系数 餐前与餐后餐前与餐后2 hr的血糖对比的血糖对比餐后血糖餐后血糖 > 目标目标 降低降低 ICRDateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:15BGBG1221229090CarbsCarbs------60 60 gmsgmsMeal BolusMeal Bolus------4.0 4.0 u uCorr. BolusCorr. Bolus------------DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTimeBGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. Bolus202I:C 1:123AM1227AM60 gms5.0 u9:15要确定患者是否正确计算碳水要确定患者是否正确计算碳水化合物系数化合物系数尝试尝试 I:C 1:10确认确认/调整碳水化合物系数调整碳水化合物系数99125 178 125比较餐前和餐后比较餐前和餐后2hr血糖血糖Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 7 AM @ 0.6 u/hr餐后血糖餐后血糖 < 目标目标增加增加 ICRDateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:15BGBG12212290906666CarbsCarbs------60 60 gmsgmsMeal BolusMeal Bolus------4.0 4.0 u uCorr. BolusCorr. Bolus------------DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTimeBGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. BolusICR: 1:183AM1227AM9960 gms3.3 u9:15 130确认确认/调整碳水化合物系数调整碳水化合物系数比较餐前和餐后比较餐前和餐后2hr血糖血糖Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 7 AM @ 0.6 u/hr 90ICR: 1:20 1251. 确定确定ICR ，，需要比较需要比较: •餐前血糖与餐后餐前血糖与餐后2小时血糖小时血糖•在开始调整阶段，应保持进食低脂肪餐在开始调整阶段，应保持进食低脂肪餐/碳水化合物碳水化合物 含量较为固定的食物含量较为固定的食物2. ICR 估算正确的表现估算正确的表现:• 血糖在餐后血糖在餐后2小时没有显著的升高或降低：小时没有显著的升高或降低： 不超过不超过50 – 70 mg/dl * 请牢记，早，中，晚餐的请牢记，早，中，晚餐的ICR可能会有所不同可能会有所不同确认确认/调整碳水化合物系数调整碳水化合物系数DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:00BGBG12212211011013613650501281286262CarbsCarbs------60 60 gmsgms--------4545gmgmMeal BolusMeal Bolus______4.0 4.0 u u________3.0 3.0 u uCorr. BolusCorr. Bolus________________________DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:008:308:30BGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. Bolus如果餐前如果餐前BG很低，应考虑降低很低，应考虑降低白天基础率白天基础率Basal Rate:1. 12 am @ 0.5 u/hr 2. 3 am @ 0.7 u/hr3. 9 am @ 0.5 u/hr12260 gms6.0 u1368245 gm1287875 gm5.0 u125Note:可能需要调整白天基础可能需要调整白天基础率的起始时间率的起始时间确认确认/调整白天基础率调整白天基础率99调整后要测试血糖调整后要测试血糖Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 7 AM @ 0.6 u/hrICR: 1:10DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:00BGBG122122110110136136188188128128172172CarbsCarbs------60 60 gmsgms--------4545gmgmMeal BolusMeal Bolus______4.0 4.0 u u________3.0 3.0 u uCorr. BolusCorr. Bolus________________________DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:008:308:30BGBG122122999913613690901281288888125125CarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. Bolus如果餐前血糖高于餐后血糖，应增加白天基础率如果餐前血糖高于餐后血糖，应增加白天基础率Basal Rate:1. 12 am @ 0.5 u/h 2. 3 am @ 0.7 u/hr3. 9 am @ 0.6 u/hr60 gms6.0 u45 gm75 gm5.0 u确认确认/调整白天基础率调整白天基础率Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 9 AM @ 0.5 u/hrICR: 1:10确认确认/调整白天基础率调整白天基础率1.让患者遵照他们的饮食习惯进餐让患者遵照他们的饮食习惯进餐: Ø但不要在两餐之间进食但不要在两餐之间进食2.将餐后将餐后2hr血糖与下一餐的餐前血糖进行对比血糖与下一餐的餐前血糖进行对比; Ø如果血糖升高如果血糖升高  增加基础率增加基础率Ø如果血糖降低如果血糖降低  降低基础率降低基础率3. 确认血糖的变化确认血糖的变化 Ø调整的调整的2－－3天内进行多次血糖监测天内进行多次血糖监测 - 观察血糖的变化趋势观察血糖的变化趋势Goal: 餐后餐后2hr血糖与餐前血糖比较，相差不应血糖与餐前血糖比较，相差不应> 50 mg /dl DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime5 5 AMAM7 7 AMAM9:159:151:001:003:253:256:006:00BGBG25025011011013613679791281288888CarbsCarbs------60 60 gmsgms--------4545gmgm6060gmgmMeal BolusMeal Bolus________6.0 6.0 u u________4.5 4.5 u u6.06.0Corr. BolusCorr. Bolus3.0 3.0 u u________________DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:008:108:10BGBG1201209090136136132132128128188188CarbsCarbs60 60 gmsgms4545gmgmMeal BolusMeal Bolus6.0 6.0 u u3.0 3.0 u u7.5 7.5 u uCorr. BolusCorr. Bolus当患者纠正他的高血糖时，应在当患者纠正他的高血糖时，应在2hr内进行血糖监内进行血糖监测，以确定血糖是否达标测，以确定血糖是否达标75 gm+1.8 u125188 – 100 = 1.8 u 50 9.3 u当前BG - 目标 BG (100) = # UCF (50) 250 – 100 50 = 3.0 units补充大剂量补充大剂量Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 9 AM @ 0.5 u/hrICR: 1:10 SF: 50胰岛素敏感系数胰岛素敏感系数 补充大剂量补充大剂量胰岛素敏感系数胰岛素敏感系数 1. 确定确定ISF，，需要对比需要对比: Ø 输注补充大剂量前的血糖与输注补充大剂量后的血糖输注补充大剂量前的血糖与输注补充大剂量后的血糖2. 当符合下列条件时，当符合下列条件时，ISF已被正确调整已被正确调整 :Ø 调整后调整后2 hr血糖不超过目标值血糖不超过目标值30 mg/d (目标值目标值 : 100 mg/dL – 120 mg/dL)3. 3小时内再测一次血糖以确认血糖在目标范围内小时内再测一次血糖以确认血糖在目标范围内确定胰岛素敏感系数确定胰岛素敏感系数(ISF)1.选择一个患者情绪和血糖都较为稳定的日子进行调节选择一个患者情绪和血糖都较为稳定的日子进行调节2.让患者在某一餐禁食让患者在某一餐禁食Ø每每2小时监测一次血糖小时监测一次血糖 Ø观察血糖变化观察血糖变化 - 如果血糖升高如果血糖升高  增加基础率增加基础率 - 如果血糖降低如果血糖降低  降低基础率降低基础率 3.进行适当的调整进行适当的调整4.确认调整是正确的确认调整是正确的 – 反复测试血糖反复测试血糖 确定确定/精细调节白天基础率精细调节白天基础率 如果发生低血糖：如果发生低血糖：Ø及时治疗低血糖及时治疗低血糖Ø适当调整基础率适当调整基础率Ø重复测试重复测试DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:151:001:003:253:256:006:00BGBG122122909086867878CarbsCarbs----------------------4545gmgmMeal BolusMeal Bolus______________________3.0 3.0 u uCorr. BolusCorr. Bolus________________________DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DTimeTime3 3 AMAM7 7 AMAM9:159:1511:3011:301:301:304:004:006:306:30BGBGCarbsCarbsMeal BolusMeal BolusCorr. BolusCorr. Bolus 当禁食后的血糖保持稳定，证明基础率的设定当禁食后的血糖保持稳定，证明基础率的设定是正确的是正确的1229060 gms6.0 u1361188882如果血糖保持稳定，说明如果血糖保持稳定，说明基础率调节是正确的基础率调节是正确的Skip BreakfastSkip Lunch确定确定/精细调节白天基础率精细调节白天基础率应选择一天餐前血糖在正常范围应选择一天餐前血糖在正常范围内开始进行基础率调节内开始进行基础率调节 Basal Rate:12 AM @ 0.5 u/hr 3 AM @ 0.7 u/hr 7 AM @ 0.6 u/hrICR: 1:10将学到的应用在实践中将学到的应用在实践中 !优化血糖管理优化血糖管理 患者患者: 22 岁岁 MDI = 52 u / 天天无法感知的低血糖时而发生无法感知的低血糖时而发生体重体重: 138 lb. HbA1c = 7.7 ICR: 1:15 SF = 40DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DHSHSTimeTime12:0012:00 2:15 2:15 5:55 5:55 8:30 8:3011:1511:15BGBG 72 72 131 131 56 56 112 112 88 88CarbsCarbs 37 37 gmgm - 0 - - 0 - 60 60 gmgm - 0 - - 0 - 12 12 gmgmMeal BolusMeal Bolus3.0 3.0 u u - 0 - - 0 - 5.0 5.0 u u - 0 - - 0 -11:3511:35Corr. BolusCorr. Bolus - 0 - - 0 - - 0 - - 0 -- 1.1 - 1.1 u u+ 3.9 u+ 3.9 u - 0 - - 0 - 135 135DateDateNocturnalNocturnalPre-BPre-BPost-BPost-BPre-LPre-LPost-LPost-LPre-DPre-DPost-DPost-DHSHSTimeTime 3:10 3:107:157:15 9:36 9:3612:3012:30 2:44 2:44 6:35 6:35 8:55 8:5511:3011:30BGBG 90 90 68 68 125 125 55 55 142 142 61 61 106 106 92 92CarbsCarbs - 0 - 0 54 54 gmgm - 0 - - 0 - 75 75 gmgm - 0 - - 0 - 66 66 gmgm - 0 - - 0 - - 0 - - 0 -Meal BolusMeal Bolus 4.5 4.5 u u 6.2 6.2 u u 5.6 5.6 u uCorr. BolusCorr. Bolus-1.2 -1.2 u u 3.3 u 3.3 u- - - - 1.1 1.1- - 5.1 5.1用泵前用泵前7pm Changed BR 12 AM @ 0.5 u/hrBasal Rate:12 AM @ 0.6 u/hr 调整基础率调整基础率患者患者: 22 岁岁 MDI = 52 u / 天天无法感知的低血糖时而发生无法感知的低血糖时而发生体重体重: 138 lb. HbA1c = 7.7 ICR: 1:15 SF = 40 125 125 128 128 86 86 129 129 74 74 126 126 88 88 124 124BGBG 2.2 2.2 u u Corr. BolusCorr. Bolus - 0 - - 0 - 6.0 6.0 u u 5.7 5.7 u u 5.0 5.0 u uMeal BolusMeal Bolus - 0 - - 0 - - 0 - - 0 - 72 72gmgm 68 68 gmgm6060gmgm - 0 - - 0 -CarbsCarbs 11:15 11:15 9:25 9:25 7:00 7:00 4:00 4:00 1:45 1:45 10:30 10:308:128:12 3:08 3:08TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnNocturnalalDateDateWalkingCorr. BolusCorr. Bolus 6.0 6.0 u u 5.0 5.0 u u 4.0 4.0 u uMeal BolusMeal Bolus - 0 - - 0 - - 0 - - 0 - 71 71gmgm - 0 - - 0 - 60 60 gmgm48 48 gmgmCarbsCarbs 122 122 120 120 78 78 138 138 84 84 134 134 66 66 117 117BGBG11:0011:00 8:14 8:14 6:06 6:06 3:12 3:1212:4512:45 9:22 9:227:037:03 3:05 3:05TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-L Pre-LPre-LPost-BPost-BPre-BPre-B NocturnalNocturnalDateDate12am @ 0.5 u/hr. 3am @ 0.4 u / hr. 7am @ 0.5 u/hrBasal Rate:12 AM @ 0.5 u/hr调整基础率调整基础率患者患者: 32 岁岁: Type 1, G4 P2 A1,怀孕怀孕11周周. MDI = 96 u day WT: 182 lb. HbA1c 1.5 1.5 u u__________ 1.8 1.8 u u +0.2 +0.2 2.5 2.5 1.8 1.8 u u+.2 +.2 u u 7.3 u 7.3 uCorr. BolusCorr. Bolus _____ _____ 9.0 9.0 u u 2.3 2.3 u u__________ 7.0 7.0 u u Meal BolusMeal Bolus - 0 - - 0 - - 0 - - 0 - 74 74 gmgm - 0 - - 0 - 18 18 gmgm - 0 - - 0 -49 49 gmgm - 0 - 0 CarbsCarbs 104 104 171 171 71 71 158 158 105 105 168 168 108 108 106 106BGBG11:0011:00 8:35 8:35 6:25 6:25 3:40 3:40 1:30 1:30 9:15 9:157:057:05 3:10 3:10TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDate 1.5 1.5 u u 1.1 1.1 u u 4.1 4.1u uCorr. BolusCorr. Bolus - 0 - - 0 - 8.0 8.0 u u - 0 - - 0 -4.3 4.3 u uMeal BolusMeal Bolus - 0 - - 0 - 56 56 gmgm - 0 - - 0 -30 30 gmgmCarbsCarbs 102 102 183 183 97 97 172 172 210 210BGBG11:1511:15 8:00 8:00 5:40 5:402:552:5512:4512:45TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDate用泵前洗脱期用泵前洗脱期ICR = 1:6Basal Rate:12 AM @ 1.2 u/hr ICR = 1:7SF = 1:25餐后高血糖餐后高血糖调整碳水化合物系数调整碳水化合物系数患者患者: 32 岁岁: Type 1, G4 P2 A1,怀孕怀孕11周周. MDI = 96 u day WT: 182 lb. HbA1c 1.8 1.8 u u Corr. BolusCorr. Bolus 7.5 7.5 u u 8.4 8.4 u u 4.0 4.0 u uMeal BolusMeal Bolus 112 112 12 9 12 9 95 95 118 118 69 69 154 154 89 89 115 115BGBG11:0011:00 8:12 8:12 6:00 6:00 3:10 3:1012:4512:45 9:28 9:287:227:22 3:05 3:05TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDateICR 1:6 Corr. BolusCorr. Bolus 7.5 7.5 u u 8.4 8.4 u u 4.0 4.0 u uMeal BolusMeal Bolus - 0 - - 0 - 45 45 gmgm - 0 - - 0 - 51 51 gmgm45 45 gmgmCarbsCarbs 101 101 105 105 83 83 101 101 84 84 126 126 88 88 108 108BGBG 12:15 12:15 8:00 8:00 5:45 5:45 3:30 3:30 1:15 1:15 10:00 10:008:128:12 3:08 3:08TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDate ICR = 1:5 Breakfast (only) ICR = 1:6 (L & D)Basal Rate:12 AM @ 1.2 u/hr SF: 1:25调整碳水化合物系数调整碳水化合物系数Hx: 44 岁岁: Type 2: 胰岛素抵抗，高血糖胰岛素抵抗，高血糖 5.05.0u u 17 u 17 u 14.0 14.0 u uCorr. Corr. BolusBolus 12 12 u u ----- -----Meal Meal BolusBolus 60 60 gmgm ----- -----CarbsCarbs 238 238 177 177 312 312BGBG 9:44 9:44 7:30 7:30 3:15 3:15TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDate ------- ------- 7.5 7.5 u u 13.5 u 13.5 u 9.5 9.5 u u 7.5 7.5 u u 14.514.5 30.5 30.5 u uCorr. Corr. BolusBolus ------- ------- 6.0 6.0 u u 18 18 u u ------ ------ 16 16 u uMeal Meal BolusBolus - 0 - - 0 - 30 30 gmgm 90 90 gmgm - 0 - - 0 - 80 80 gmgmCarbsCarbs 250 250 210 210 245 245 218 218 315 315BGBG11:3511:35 8:20 8:20 5:45 5:45 2:12 2:1211:4811:48TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDatePre-Pump Start ICR 1:4 SF = 1014.0 u12:0010880 gms20 u2:301455:5518845gm11 u9.0 u8:3013811:00192Basal Rate:12 AM @ 2.0 u/hr ICR: 1:5SF: 15全面调节血糖全面调节血糖Corr. BolusCorr. BolusMeal BolusMeal BolusCarbsCarbsBGBGTimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalDateDate9 9 u u11 11 u u17 17 u uCorr. BolusCorr. Bolus17 17 u u15 15 u u1212u uMeal BolusMeal Bolus69 69 gmgm60 60 gmgm48 48 gmgmCarbsCarbs166166155155198198150150212212142142267267228228BGBG10:4810:488:268:266:006:002:302:3012:1012:109:189:186:506:503:143:14TimeTimeHSHSPost-DPost-DPre-DPre-DPost-LPost-LPre-LPre-LPost-BPost-BPre-BPre-BNocturnalNocturnalHx: 44 岁岁: Type 2: 胰岛素抵抗，高血糖胰岛素抵抗，高血糖 8:30 pm Increased BR12 am @ 2.5 u / hr.3:061447:00130403.0 u9:22 14012:309868 gm17 u2:441466:0011244 gm11 u1.0 u8:1512811:0012610 uBasal Rate:12 AM @ 2.2 u/hr ICR = 1:4 SF = 10全面调节血糖全面调节血糖。