型糖尿病及其药物治疗.ppt

* * 当发展至2型糖尿病时， ?细胞功能仅剩50%，患者从餐后高血糖进展至空腹高血糖，此时胰岛素分泌不足则更为显著，在第6年后?细胞功能减至25%。当由IGT发展至糖尿病阶段时，胰岛素抵抗并无进一步的发展，此时主要是胰岛?细胞受到损害，餐后高血糖加重胰岛素功能衰竭是疾病进展的重要驱动力。 总结从NGT ?胰岛素抵抗?IGT?糖尿病各项指标的演变过程，在所有指标中餐后高血糖是预测胰岛?细胞分泌功能的指标，餐后血糖越高，胰岛?细胞储备能力越低，越易转变为糖尿病。 * * 餐后胰岛素分泌高峰是机体对餐后血糖升高的正常反应，当?细胞分泌胰岛素的功能开始减退时，最初仅在餐后出现胰岛素不足的表现，这是因为餐后对胰岛素的需求量最大。餐后胰岛素分泌不足的主要表现为进食后胰岛素第一时相分泌消失，餐后血糖升高，也就是糖耐量低减(IGT)状态，其后可发展至显性餐后高血糖。因此餐后高血糖是2型糖尿病发病的最早期表现，最早反映胰岛素抵抗和分泌之间的失衡。 无糖尿病着的2型糖尿病患者血浆胰岛素对静脉注射20g葡萄糖（如箭头所示）的反应。结果显示2型糖尿病患者的第一相分泌反应缺乏，而第二相分泌反应相对保存尚好。以上结果表明，高血糖损害胰岛?细胞分泌胰岛素的功能，加重2型糖尿病胰岛素分泌缺陷。 * * * * * * The AERx iDMS compensates for poor patient technique through a system called Breath Control. The device senses the breathing pattern. When the speed of inhalation and moment of inhalation is optimal for deep lung delivery the patient has entered the trigger box and sees a green light. (This is low flow rate and low inhaled volume) If he breathes too fast he receives a red light prompting him to slow down. Too slow breathing produces a yellow light. It is only when the trigger box is entered that the aerosol is released to ensure precision dosing with each activation. Once the aerosol is released the patient receives a continuous green light to ensure that he breathe until his lungs feel full, to encourage the largest chaser volume possible. In summary, partial dosing because of poor breathing technique is not possible with AERx. The patient is reassured that he either receives all his dose or none of it and should try again. * * What is Glucagon-Like Peptide-1? Glucagon-like peptide-1 (GLP-1) is a 30 amino acid peptide. It is an incretin hormone that is secreted from L-cells in the gastrointestinal system in response to calorie intake, causing the glucose dependent secretion of insulin. Incretins are chemical excitants that promote pancreatic sections (glucose-dependent insulinotropic polypeptide [GIP] is another example). 2021/3/14 * 历史上第一位接受胰岛素注射的患者 14岁的男孩,处于死亡边缘 1922年1月1日接受胰岛素注射----注射部位形成脓肿