糖尿病英文PPT课件

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1、2021-7-30 Beijing Xuanwu Hospital 1Diabetes Mellitus 2021-7-30 Beijing Xuanwu Hospital 2 Diabetes Mellitus definition types symptoms diagnosis Laboratory findings treatment complications 2021-7-30 Beijing Xuanwu Hospital 3 Definition-WHO (4/2000)The term diabetes mellitus describes a metabolic disor

2、der of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both 2021-7-30 Beijing Xuanwu Hospital 4 Definition A metabolic condition characterised by high plasma gluco

3、se levels and chronic vascular complications A vascular disease affecting small and large arteries with coexistent metabolic disturbance particularly high plasma glucose levels 2021-7-30 Beijing Xuanwu Hospital 5 Diabetes Mellitus definition types symptoms diagnosis Laboratory findings treatment com

4、plications 2021-7-30 Beijing Xuanwu Hospital 6 Aetiological Classification of Disorders of Glycaemia Type 1 (betacell destruction, usually leading to absolute insulin deficiency) : Autoimmune: Idiopathic Type 2 (may range from predominantly insulin resistance with relative insulin deficiency to a pr

5、edominantly secretory defect with or without insulin resistance) Other specific types Genetic defects of betacell function Genetic defects in insulin action Diseases of the exocrine pancreas Endocrinopathies Drug or chemicalinduced Infections Uncommon forms of immunemediated diabetes Other genetic s

6、yndromes sometimes associated with diabetes Gestational diabetes 2021-7-30 Beijing Xuanwu Hospital 7 Type 1 diabetes Previously known as IDDM(Insulin dependent diabetes) Ketosis prone:Usually diagnosed in younger age group( 30 years 1 in 1000 population as new cases each year Insidious presentation

7、with symptoms of polyuria, polydipsia, lethargy, weight loss, nausea, vomiting, abdominal cramps, blurred vision and superficial infection. Often discovered at routine medical This presentation is the end point of the gradual loss of beta cell function in the setting of Insulin resistance Strong (90

8、-100%) concordance in Twins Reavans syndrome or Syndrome X Insulin resistance 2021-7-30 Beijing Xuanwu Hospital 14 Type 2 diabetesUnderlying insulin resistance genetic and ethnicity Obesity BMI WHR inactivity / low physical fitness intrauterine Casual is defined as any time of day without regards to

9、 time since last meal. The classic symptoms of diabetes include polyuria, polydipsia and unexplained weight lossor FPG more than or equal to 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 hours or 2 hour PG more than or equal to 200mg/dl(11.1 mmol/l) during an OGTT. T

10、he test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g glucose dissolved in water 2021-7-30 Beijing Xuanwu Hospital 34 WHO diagnostic criteriawhole blood plasmaDiabetes mellitus (fasting)2 hour post glucose loadIGT (fasting) recommended to check LFTs

11、q 2 mo for 1st year of use.Advantages No hypoglycemia Possible improvement in vascular function 2021-7-30 Beijing Xuanwu Hospital 53 Thiazolidinedione toxicity Metabolism: hepatic conjugation by the CYP450 system Excretion: biliary Hepatotoxic, especially troglitazone, and contraindicated in cases o

12、f hepatic dysfunction Can cause edema and hypoglycemia when used in combination with other hypoglycemics 2021-7-30 Beijing Xuanwu Hospital 54 Treating hyperglycaemia in type 2 diabetesdietary changeexerciseobesemetformin not obesesulphonylureametformin the rate of formation exceeds the capacity for

13、their peripheral utilization and renal excretion leading to accumulation of ketoacids, and therefore metabolic acidosis With progressive dehydration, acidosis, hyperosmolality, and diminished cerebral oxygen utilization, consciousness becomes impaired, and the patient ultimately becomes comatose 202

14、1-7-30 Beijing Xuanwu Hospital 79 Clinical Manifestations early manifestations are mild and include vomiting, polyuria, and dehydration More severe cases include Kussmaul respirations, odor of acetone on the breath abdominal pain or rigidity may be present and mimic acute appendicitis or pancreatiti

15、s cerebral obtundation and coma ultimately ensue 2021-7-30 Beijing Xuanwu Hospital 80 Laboratory findings Laboratory findings include glucosuria, ketonuria, hyperglycemia, ketonemia, and metabolic acidosis. Serum amylase may be elevated. Leukocytosis is common 2021-7-30 Beijing Xuanwu Hospital 81 Di

16、agnosis DKA exists when there is hyperglycemia ( 300 mg/dL), ketonemia, acidosis, glucosuria, and ketonuria 2021-7-30 Beijing Xuanwu Hospital 82 DKA must be differentiated from acidosis and coma due to other causes:hypoglycemia, uremia, gastroenteritis with metabolic acidosis, lactic acidosis, salic

17、ylate intoxication, encephalitis 2021-7-30 Beijing Xuanwu Hospital 83 Treatment Treatment is divided into 3 phases treatment of ketoacidosis transition period continuing phase and guidance Goals of treatment of DKA intravascular volume expansion correction of deficits in fluids, electrolytes, and ac

18、id-base status initiation of insulin therapy to correct catabolism, acidosis 2021-7-30 Beijing Xuanwu Hospital 84 Ketoacidosis TreatmentAdminister insulinRehydrateReplace electrolytesTreat acidosis with bicarbonate 2021-7-30 Beijing Xuanwu Hospital 85 Intravascular volume expansion dehydration is mo

19、st commonly in the order of 10% initial hydrating fluid should be isotonic saline this alone will often slightly lower the blood glucose Treatment of electrolyte abnormalities serum K+ is often elevated, though total body K+ is depleted K+ is started early as resolution of acidosis and the administr

20、ation of insulin will cause a decrease in serum K+ 2021-7-30 Beijing Xuanwu Hospital 86 “ Maintenance IV fluid at a rate of 2000 - 2400 cc/m2/day consists of 2/3 NS (0.66%) or NS NS is added to IVF when blood glucose is 250 mg/dL 5% Dextrose or 5% GNS is added when blood glucose is 250 mg/dL 2021-7-

21、30 Beijing Xuanwu Hospital 87 Insulin Therapy continuous infusion of low-dose insulin IV ( 0.1 U/kg/hr) is effective, simple, and physiologically sound goal is to slowly decrease serum glucose ( dehydration severe dehydration coma No keto acids, lipolysis inhibited by insulin 2021-7-30 Beijing Xuanw

22、u Hospital 91 Pathophysiology Results in blood glucose levels up to 1000mg/dL. Insulin activity prevents buildup of ketones. Sustained hyperglycemia results in marked dehydration. Often related to dialysis, infection, and medications. Very high mortality rate 2021-7-30 Beijing Xuanwu Hospital 92 Sig

23、ns need supplemental insulinc. 25-50 % twin concordance, suggesting both environmental and genetic factorsd. Usually individuals are lean and younge. Genetic link: lactalbumin of cows milk bears epitope matching that of b-islet cells Body may subsequently mistake b-islet protein for foreign invader

24、Is a propensity for certain transplantation antigens 2021-7-30 Beijing Xuanwu Hospital 101 Non-Insulin-Dependent Diabetes Mellitus (NIDDM)a. Serum insulin levels normal or elevatedb. Metabolism does not respond properly to insulin = insulin resistancec. 100% twin concordance, suggesting strong genet

25、ic linkaged. Usually individuals are obese (60-90%) and oldere. Losing weight frequently brings glucose levels and insulin sensitivity back under controlf. Many have mutations / losses in genes regulating energy metabolism Glucokinase, GLUT4, Insulin receptor, Tyrosine kinase 2021-7-30 Beijing Xuanw

26、u Hospital 102 Causes of type 2 diabetesUnderlying insulin resistance genetic (90% identical twin concordance) ethnicity (thrifty genotype hypothesis) obesity inactivity / low physical fitness intrauterine malnutrition (Barker hypothesis) smoking & drugsImpaired insulin secretion genetic environmental Insulin secretion worsens with time