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INSULINOTERAPIA

INSULINOTERAPIA. Alberto Ramos UNIVERSIDADE FEDERAL DE CAMPINA GRANDE CENTRO DE ENDOCRINOLOGIA E METABOLOGIA. I Encontro Campinense de Consenso em Diabetes e Gravidez Campina Grande, 13.11.14. Colomiere et al., Journal of Molecular Endocrinology, 2010.

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INSULINOTERAPIA

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  1. INSULINOTERAPIA Alberto Ramos UNIVERSIDADE FEDERAL DE CAMPINA GRANDE CENTRO DE ENDOCRINOLOGIA E METABOLOGIA I Encontro Campinense de Consenso em Diabetes e Gravidez Campina Grande, 13.11.14

  2. Colomiere et al., Journal of Molecular Endocrinology, 2010

  3. Colomiere et al., Journal of Molecular Endocrinology, 2010

  4. INDICAÇÕES PARA INSULINOTERAPIA • Glicemia de jejum superior a 105 mg/dl • Pós-prandial superior a 120 mg/dl • Crescimento fetal acima do percentil 75 Forti et al., Diabetes gestacional, 2009 • Glicemia de jejum superior a 95 mg/dl • Pós-prandial superior a 120 mg/dl • Crescimento fetal acima do percentil 75 Diretrizes SBD, 2009

  5. DOSE • Inicial • O,5 U/Kg/di • 2/3 manhã • 1/3 ao deitar • Ajuste de acordo com a resposta • Geralmente entre 0,7 e 0,8 U/Kg/dia

  6. Perfis de ação das insulinas Aspart, lispro, glulisina, 2-5 h Regular, 6-8 h NPH, 13-16 h Detemir 0,2UI/kg 1x/d Glargina, 24 h Nível de insulina plasmática 0 2 4 6 8 10 12 14 16 18 20 22 24 Tempo (h)

  7. Insulinoterapia: 2 doses/dia REG NPH REG NPH • 1/2 NPH • 1/2 REG • 1/3 da dose total Desjejum Almoço Jantar Deitar • 2/3 da dose total • 2/3 NPH • 1/3 REG

  8. Insulinoterapia: 2 doses/dia Lispro NPH Aspart Lispro NPH Aspart Desjejum Almoço Jantar Deitar • 1/2 NPH • 1/2 L/A • 1/3 da dose total • 2/3 da dose total • 2/3 NPH • 1/3 L/A

  9. QUE INSULINA USAR • Diabética que engravida • Planejada • Não planejada • Diabetes na gravidez • NPH e Regular

  10. QUE INSULINA USAR • 138 pacientes – 56 pré • Glargina x NPH • Piora das alterações da retina e rins, pré-eclampsia, hipoglicemias e Apgar <7 no grupo de NPH Negrato et al., Diabetes research and clinical practice, 2010 • Metanálise de 8 estudos com 702 pacientes • Não houve diferença entre NPH e Glargina Pollex et al., Annalsofpharmacotherapy, 2011

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