中山医科大学内科学PPT课件-糖尿病.ppt

乳酸酸中毒 透析治疗 血液或腹膜透析—清除乳酸或引起乳酸酸中毒药物，如苯乙双胍 预防 严格掌握双胍类药物的适应症，尤其是苯乙双胍，长期使用双胍者要定期检查肝、肾功能、心肺功能，如有不适宜者应及时停药 2603 Mod 06 糖尿病人妊 娠时 不要使用口服降糖药 每天测定4次血糖 尽可能使血糖接近正常 如餐后血糖仍6.7mmol/L，给予每日2次或多次胰岛素注射 2603 Mod 06 糖尿病治疗 饮食 运动 药物 监测 教育 2603 Mod 06 重点要求 糖尿病的病因分型 糖尿病的诊断标准 糖尿病的症状 1型和2型糖尿病的鉴别 糖尿病由哪些慢性并发症和急性并发症 糖尿病治疗的代谢控制目标 降糖药物的种类和主要机制及主要副作用 胰岛素应用的适应症 低血糖的表现、诊断、处理原则 糖尿病酮症酸中毒的治疗原则，小剂量胰岛素的应用，及注意事项 2603 Mod 06 * * * * Slide 6-6 TYPE 2 DIABETES…A PROGRESSIVE DISEASE Natural History of Type 2 Diabetes The natural history of type 2 diabetes shows the progressive emergence of the disorder. Well before diagnosis, patients may have had significant hyperglycemia for years, perhaps more than a decade. Patients with type 2 diabetes have altered islet b-cell function and impaired insulin action in varying degrees. Plasma glucose may rise above normal in early adulthood, and as age-related declines in b-cell function occur—together with less physical activity and increases in adipose tissue mass—plasma glucose continues to rise. By the time diabetes is diagnosed, plasma glucose may range from 180 to 220 mg/dL. It has been estimated that only about one third of the population has acceptable glycemic control by current standards. Based on the progressive nature of diabetes, complications that may take years to develop are often already present at the time of diagnosis. Riddle MC. Tactics for type II diabetes. Endocrinol Metab Clin North Am. 1997;26:659-677; Skyler JS. Insulin therapy in type 2 diabetes mellitus. In: DeFronzo RA, ed. Current Therapies of Diabetes Mellitus. St Louis, Mo: Mosby-Year Book Inc; 1998:108-116. * Slide 6-4 TYPE 2 DIABETES…A PROGRESSIVE DISEASE Progressive Decline of b-Cell Function in the UKPDS In 1996, results of 6 years of follow-up of the patients in the UK Prospective Diabetes Study were reported. Although the patients who received intensive treatment maintained significantly better glycemic control, all groups showed progressive hyperglycemia over the 6 years, with a