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Ⅱ型糖尿病的治疗药物如何选择？

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2018-08-06

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Ⅱ型糖尿病患者根据体重可分为肥胖和非肥胖两种，肥胖型患者呈明显的胰岛抵抗和胰岛素血症，因此在治疗方面两者不同。饮食与运动疗法对于肥胖Ⅱ型糖尿病患者尤为重要。肥胖的Ⅱ型糖尿病患者应首选能增加胰岛素的药物如二甲双胍，拜糖平，罗格列酮等，尽量少用磺脲类药物和胰岛素，否则会造成胰岛素血症，加重胰岛素抵抗，形成恶性循环。当以上处理后血糖未达标时可加用磺脲素，用量宜偏小。当磺脲素用量较大时，血糖仍不能控制，应
       Ⅱ型糖尿病患者根据体重可分为肥胖和非肥胖两种，肥胖型患者呈明显的胰岛抵抗和胰岛素血症，因此在治疗方面两者不同。饮食与运动疗法对于肥胖Ⅱ型糖尿病患者尤为重要。肥胖的Ⅱ型糖尿病患者应首选能增加胰岛素的药物如二甲双胍，拜糖平，罗格列酮等，尽量少用磺脲类药物和胰岛素，否则会造成胰岛素血症，加重胰岛素抵抗，形成恶性循环。当以上处理后血糖未达标时可加用磺脲素，用量宜偏小。当磺脲素用量较大时，血糖仍不能控制，应该考虑用胰岛素治疗。此外还可以加一些减肥药。
 
       对肥胖型患者如经饮食控制和适当运动后血糖控制不佳时，可选用磺脲类药物，如血糖仍不能控制，可以加用二甲双胍或γ-葡萄糖苷酶抑制剂。症状严重者尽早使用胰岛素治疗。
 
       在选择药物治疗时还应注意患者年龄，肝肾功能。如年龄较大者（大于65岁）不宜使用半衰期长，作用强的药如优降糖，应选择格列吡嗪避免低血糖的发生，肝功能异常者勿口服降糖药，应注射胰岛素，待肝功能恢复后再改用口服液，肾功能不好者可选用糖适平、诺和灵。餐后血糖增高者，可选用γ-葡萄糖苷酶抑制剂或诺和灵治疗。
 
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为什么说Ⅱ型糖尿病患者应广泛使用他汀类药物？

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