分类方面常犯的错误ClassificationofDM-马偕医院.ppt

內分泌暨新陳代謝科 李淳權醫師 馬偕紀念醫院 Therapeutic Classification Etiologic Classification Normal Physiology of Glucose Homeostasis Types of Diabetes Type 1: Cellular-mediated autoimmune destruction of B-cells, usually leading to absolute insulin deficiency Type 2: Insulin resistance with relative insulin deficiency or insulin secretary defect with insulin resistance Types of Diabetes 2~3 % of people with diabetes have type 1 Most frequently developed in children adolescents, but now also increasingly found in adults Insulin is a life-sustaining medication Important management components ? diabetes education, a controlled diet physical exercise Types of Diabetes ~ 97% of people with diabetes have type 2 Occurs mainly in adults but is becoming more common in young people To manage hyperglycaemia, oral medication may be required For metabolic control, insulin may be required Important management components ? diabetes education, a controlled diet physical exercise DIAMICRON MR tablets The hydrophilic matrix Fast-on for control;Fast-off for safety!  The “Ideal” Long-Acting Insulin The first available long-acting insulin analogue 24-hour peakless profile Once daily Subcutaneous administration Safe no toxins, mitogenic or immunogenic effects Low intrasubject and intersubject variability Good glycaemic control Structure Insulin Glargine Mechanism of Action THE END HHS (HHNK) Hyperosmolar Hyperglycemia State/ Hyperosmolar Hyperglycemic Nonketotic Coma 高血糖高滲透壓症候群/高血糖高滲透壓非酮體性昏迷 Severe hyperglycemia, hyperosmolarity, dehydration, no acidosis Occurs in middle aged elderly patients Lack of ketosis Insulin levels high enough to prevent lipolysis ketogenesis, not high enough to prevent hyperglycemia Calculation of serum osmolality 2 (Na) + GLUCOSE 18 N = 285 + 5 mOsm/L effective serum osmolality HHS 320 治療方面常犯的錯誤 水份的給予方面 胰島素的給予方面 酸血症的治療方面 電解質的治療方面 Management of DKA Fluids Determine hydration status Hypovolemic sho