内分泌糖尿病幻灯片.pptVIP

* Agenesis of hand * * * * * * * Indication type 2 DM with insulin resistance Adverse reaction Edema Contraindication heart failure Hepatic or renal impairment * Classic drugs Troglitazone Pioglitazone * 4.Insulin Therapy Indication (1) type 1 DM (2) Diabetic ketoacidosis , hyperosmolar nonketotic diabetic coma , Lactic acidosis (3)with infection, severe chronic complication * (4) trauma or surgery (5)pregnancy (6) Pancreatic excision (7)type 2 diabetic patients whose hyperglycemia does not respond to diet therapy combined with oral drugs * Adverse reaction Hypoglycemia Edema Hypersensitive response pruritus , skin rashes * diabetic ketoacidosis * General Considerations 1.The initial manifestation of type 1 diabetes 2.during the course of infection , trauma, myocardial infarction, or surgery, gestation * Clinical finding 1.Symptoms and signs polyuria, polydipsia associated with marked fatigue , nausea vomiting, and finally mental stupor that can progress to coma * rapid deep breathing and a fruity breath odor of acetone dehydration and hypotension abdominal pain and tenderness may be present in the absence of abdominal disease * 2.Laboratory finding Hyperglycemia 13.9mmol/L Acidosis with blood PH7.35 Serum bicarbonate15meq/L Urine positive for ketones * Serum potassium is normal or high despite total body potassium depletion resulting from polyuria or vomiting . Serum creatinine and urea nitrogen may be mild high Leukocytosis may occur with or without associated infecction * Treatment 1. Prevention Education of diabetic patients to recognize the early symptoms and signs of ketoacidosis * Urine ketones should be measured in patients with signs of infection or blood glucose is unexpectedly and persistently high. The patient should be