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【PPT】糖尿病的胰島素治療與低血糖的預防PPT課件 - 醫學資源下載
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糖尿病的胰島素治療與低血糖的預防PPT課件 胰島素治療的適應癥 1型DM 2型DM 急性并發癥時，如創傷、手術、酮癥酸中毒、高滲綜合征、感染等 伴發嚴重的慢性并發癥 肝、腎功能嚴重損害 不能耐受口服降糖藥或藥物原發失效 口服降糖藥療效減弱，藥物繼發失效 糖尿病合并妊娠或妊娠糖尿病 其它因素引起的糖尿病，如繼發性胰腺疾病、內分泌疾病、伴糖尿病的一些遺傳性疾病糖尿病的胰島素治療與 低血糖的預防 PPT課件 2型糖尿病中進行胰島素治療的新概念 隨著病程的進展，胰島?細胞功能逐年減低 可以通過降低高糖毒性提高胰島素的敏感性 不增加心血管疾病的死亡率，可以降低一切與糖尿病相關的死亡風險 ADA建議：無論是1型還是2型糖尿病均需嚴格控制血糖（包括使用胰島素），使糖尿病患者的血糖水平正常或接近正常糖尿病的胰島素治療與 低血糖的預防 PPT課件 Slide 6-15 BARRIERS TO INSULIN THERAPY Reassurance About Common Concerns The preceding slides have presented findings that offer reassurance about the risk-benefit ratio of using insulin for type 2 diabetes. Slide 9 shows that intensive treatment with insulin actually improves the insulin sensitivity of pe**heral tissues, at least in the short term, by reducing the glucotoxic effects of hyperglycemia. Slide 10 shows that insulin treatment improves triglyceride levels, fosters a trend toward better HDL levels, and has no effect on LDL levels or blood pressure. Slide 11 shows an impressively reduced mortality with immediate and sustained intensive insulin treatment following myocardial infarction, suggesting that in this setting the benefits outweigh any theoretical cardiovascular hazards. Slide 12 shows the weight gain found in the UKPDS with various treatments, confirming that insulin causes the most weight gain but also that the mean gain is relatively modest, about 10 lb during 10 years for both less obese and more obese patients. Slide 13 shows that concurrent use of metformin markedly reduces weight gain when insulin treatment is started or intensified. Slide 14 shows more data from the UKPDS confirming that both mild and severe hypoglycemia are more common with insulin treatment than with other treatments, but that the rate of severe hypoglycemia is quite low. Buse JB. Overview of current therapeutic options in type 2 diabetes. Diabetes Care. 1999;22(suppl 3):C65-C70; Berger M, Jorgens V, Mühlhauser I. Rationale for the use of insulin therapy alone as the pharmacological treatment of type 2 diabetes. Diabetes Care. 1999;22(suppl 3):C71-C75; UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.糖尿病的胰島素治療與 低血糖的預防 PPT課件 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 associated decrease in b-cell function. b-Cell function deteriorated in the patients who were allocated to and remained on diet therapy, with a significant decrease from 1 to 6 years (53% to 26%; P < .0001). Those on sulfonylurea therapy displayed an increase in b-cell function during the first year of therapy (46% to 78%) that subsequently decreased significantly to 52% (P < .0001) by year 6. Patients who were allocated to metformin therapy also had an increase in b-cell function in the first year that deteriorated at 6 years (66% to 38%), which was similar to that seen in the patients treated with diet alone. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study 16: Overview of 6 years’ therapy of type II diabetes: A progressive disease. Diabetes. 1995;44:1249-1258.糖尿病的胰島素治療與 低血糖的預防 PPT課件

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