低血糖和糖尿病足 ppt课件.ppt

* * * * * * 所有低血糖事件中，一半都是在糖尿病患者睡眠中发生的，其余的事件虽在清醒状态，但也有一半的患者未感觉低血糖的发生，也就没有采取任何保护措施。许多患者对低血糖的恐慌远远超过了对慢性并发症的惧怕，这样，就动摇了患者及其家庭，甚至医生对胰岛素强化治疗的信心。 * 现在我们来回顾一下前面讨论的危险是怎样炼成的的答案： 偶尔的低血糖发作危害可能并不大。但危害禁不住近期内的反复，通过我们前述的3个大方面的作用，糖尿病患者的感知阈值不断的下调，终于在无前驱症状的情况下迅速进入昏迷，这种情况学术界称作无意识性低血糖，或者叫作无症状性低血糖，而它有确凿的证据表明预后不良。 Hypoglycemia unawareness tends to happen to people who have had diabetes for many years.? Hypoglycemia unawareness does not happen to everyone.? It is more likely in people who have neuropathy (nerve damage), people on tight glucose control, and people who take certain heart or high blood pressure medicines. * * * If you feel the symptoms of hypoglycemia: 1. Check your blood sugar immediately. If your sugar is below 3.9 mmol/L (70 mg/dL ) or you can NOT check you blood sugar, eat one serving of one of the foods listed. Avoid foods with high fat content, such as chocolate, since the fat content slows down the absorption of the glucose. 2. Wait 15 minutes and recheck blood sugar level. 3. If it is still 3.9 mmol/L or you still have symptoms and cannot test, eat a second serving of one of the foods on the list. 4. Wait 15 more minutes, if glucose is still 3.9 mmol/L or symptoms still persist and you are unable to test, eat a third serving of one of the foods on the list and notify the doctor. 5. If the hypoglycemia resolves and it is more than 30 minutes before the next meal, eat a snack. Half a sandwich with some protein such as meat or cheese is good. Analyze why the hypoglycemia happened NOTE: Never give anything by mouth to an unconscious or incoherent patient If a person is unable to eat anything because of altered mental status, a family member may give the patient an injection of glucagon. Glucagon is a hormone that raises the blood sugar. It is injected like insulin. * * * * * * * * * * * * * 应激状态或抑郁状态 饮酒后12小时 没有生活自理能力或自理能力很差的人 某些药物影响：如β受体阻滞剂（心得安、倍他乐克、氨酰心安等）药物 * 补充葡萄糖 立即给予葡萄糖，轻者口服，重者静脉注射。如无葡萄糖，可予口服甜果汁、糖水，要注意观察患者。(15:15指摄入15g碳水化合物然后过15分钟再次监测血糖，如果还是低血糖，再摄入15g碳水化合物