糖尿病-坜新医院.pdfVIP

壢新醫院畢業後一般醫學內科訓練課程教 糖尿病 陳惠珍醫師 學習目標 糖尿病的定義 糖尿病的併發症 糖尿病的治療 內容 Definition Classification 　Type 1 diabetes: pancreatic islet beta-cell destruction and prone to DKA 　Type 2 diabetes: insulin resistance with an insulin secretory defect 　Other specific types: 　Monogenetic defects of beta-cell function (MODY) 　Genetic defects in insulin action 　Disease of exocrine pancreas 　Endocrinopathy: acromegaly, Cushing’s syndrome, glucagonoma, pheochromocytoma, hyperthyroidism, stomatostatinoma, aldosteronoma 　Drug- or chemical-induced: glucocorticoid, thyroid hormone, thiazide, dilantin, nicotinic acid 　Infection:congenital rubella, CMV, others 　Gestational diabetes mellitus (GDM) 壢新醫院畢業後一般醫學內科訓練課程教 Clinical features: 　Polyuria, nocturia 　Polydipsia 　Polyphagia 　Rapid weight loss 　Glycosuria, ketonuria 　Fatigue 　Recurrent infection, vaginitis 　Growth retardation 　Blurred vision 　Numbness Acute complications 　Diabetic ketoacidosis (DKA) 　Hyperosmolar hyperglycemic syndrome (HHS) or non-ketotic hyperglycemic syndrome (NKHS) 　Hypoglycemia Insulin therapy for hyperglycemic crisis 　0.15 units/kg iv bolus after hypokalemia excluded (not recommended in pediatric patients) 　0.1 unit/kg/h (5-7 units/h in adults) continuous infusion 　decreased plasma glucose at rate 50-75 mg/dl/h, may double insulin infusion if 50 mg/dl/h 　Goal: 250mg/dl in DKA 300 mg/dl in HHS 　Decreased insulin rate:0.05-0.1 units/kg/h (3-6 units/h) and add dextrose (5-10%) Fluid supplement 　Determine hydration status 0.9% NaCl 0.45% NaCl 　In the absence of cardiac compromise 15-20 ml/kg/h (1-1.5 l in average adult ) during first hour 　Change in serum osmolality: 3 mosmo/kgH2O/h 　Avoid iatr