（實用課件）2型糖尿病

1、Management of Type 2 Diabetes in the New Millennium 黃中研 Management of Type 2 Diabetes Starvation diet 處方 病人早上7點入院，晚上7點出院 每隔2小時輪流給病人1杯咖啡和 威士忌 Starvation diet Egyptian medicine1550 BC Ebers papyrus provides the following remedy to “eliminate too plentiful urine” * Water from the bird pond 鳥塘的水* Elderb

2、erry 接骨木的果實* Fibers of the asit plant 植物纖維* Fresh milk 新鮮牛奶* Beer swill 喝剩的啤酒* Flower of the cucumber 胡瓜花* Green dates 綠棗Egyptian medicine（實用課件）2型糖尿?。▽嵱谜n件）2型糖尿病Greek medicine Aretaeus (130 200 AD) continued “Hence the disease appears to me to have got the name of diabetes (a siphon), because the flu

3、id does not remain in the body, but uses the mans body as a ladder, whereby to leave it” Greek medicine Hindu medicine Samhitas (written in Sanskrit) described Iksumeha sugar cane urine Madhumeha honey urine Hindu medicine Hindu medicine continued “The patient gradually loses strength, flesh and hea

4、lthy glow of complexion” “Advanced cases were complicated with abscesses, carbuncles, bad smelling breaths, and even loss of consciousness” Hindu medicine continued Hindu medicine continued “An idle man who indulges in day-sleep or is in the habit of taking sweet liquids or fat- making food, will er

5、e long fall an easy victim of the disease” Hindu medicine continued Type 2 diabetes mellitus hyperglycemiaType 2 diabetes mellitus(dys) Metabolic syndrome WHO definition by 1998 Type 2 diabetes orImpaired fasting glucose / impaired glucose tolerance orNormal glucose tolerance with insulin resistance

6、 plus any two of the following Hypertension Dyslipidemia Obesity Microalbuminuria(dys) Metabolic syndrome It is never too late to learn,but sometimes it is too earlyIt is never too late to learn,治療第一型糖尿病的新發(fā)展 三餐前注射超短效胰島素配合睡前注射超 長效胰島素 吸入型粉末性胰島素 使用新型胰島細胞分離術(shù)和免疫抑制劑的 經(jīng)皮穿肝胰島細胞移植 利用對stem cell 的研究製造更多的胰島 細胞治

7、療第一型糖尿病的新發(fā)展 The Triumvirate: -cell, Muscle, and Liver 第二型糖尿病病因的三巨頭 -cell : 病程初期胰島素分泌過多，後期 分泌不足 Muscle: 胰島素阻抗性大 Liver : 製造太多葡萄糖至血液裡The Triumvirate:兩架各載滿250名乘客的客機在空中相撞，死亡500人 兩架各載滿250名乘客的客機在空這空中相撞意外每天發(fā)生 這空中相撞意外每天發(fā)生 Both DCCT Diabetes Control and Complications Trial and UKPDS United Kingdom Prospective

8、 Diabetes Study show that good glycemic control within or near normal range effectively delays the onset and slows the progression of diabetic triopathyBoth DCCT Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Trea

9、tment of High Blood Cholesterol in Adults (Adult Treatment Panel ) 2486 JAMA, May 16, 2001-Vol 285, No. 19 Executive Summary of the Third（實用課件）2型糖尿?。▽嵱谜n件）2型糖尿病Diabetic Nephropathy Stage1 HyperfiltrationStage2 MicroalbuminuriaStage3 Hyperfiltration stops, persisted microalbuminuriaStage4 Hypofiltrati

10、onStage5 Hypofiltration, gross proteinuria ( 300mg/day ) 3 to 8 years ESRD Diabetic Nephropathy 3 to 8 yeThe Forgotten Complication Diabetic neuropathy The Forgotten Complication Damaged nerves just under or in the skin cause dysesthesia Burning Tingling Damaged nerves just under or iTreatment of Dy

11、sesthesia Capsaicin cream Gabapentin Treatment of Dysesthesia Deeper damaged nerves cause paresthesia Pins and needles Electric-like Numb and achy Like my feet in ice water Knife-like, shootingDeeper damaged nerves cause paTreatment of paresthesia Anti-depressants Anti-seizure medicines MexiletineTr

12、eatment of paresthesia Damaged nerves to the muscles cause cramping Dull aches Night cramping Spasms Toothache-like deep achesDamaged nerves to the muscles Treatment of Cramps Proper footwear Stretching exercises Treatment of Cramps Painful diabetic neuropathyPainful diabetic neuropathy（實用課件）2型糖尿病 糖

13、尿病患住院注意事項1. 病患病史及藥物史清楚，且血糖控制小於200mg/dl時 繼續(xù)服藥，當(dāng)血糖高時，再p.r.n注射RI2. 病患病史及藥物史清楚，但血糖控制大於200mg/dl時 停掉口服藥，put the patient on insulin based on sliding scale3. 病患服用大劑量藥物，不管血糖控制良否 停掉口服藥，put the patient on insulin based on sliding scale4. 病患病史及藥物史不清楚時，不管血糖控制良否 停掉口服藥，put the patient on insulin based on sliding scale 糖尿病患住院注意事項 Sliding scal150 F/S 200mg/dL RI 3u, sc, stat200 F/S 250mg/dL RI 5u, sc, stat250 F/S 300mg/dL RI 8u, sc, stat300 F/S 350mg/dL RI 10u, sc, stat350 F/S RI 10u, iv, stat ,recheck in 30 min 睡前改用NPH, sc Sliding scal研究第2型糖尿病病因的新發(fā)展Loss of peroxisome proliferator activated receptors (PPAR