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1、DiabetesMellitus Zhao xiaojuan Introduction Diabetesmellitusisaheterogeneousgroupofmetabolicdiseasescharacterizedbyhyperglycemiaresultingfromdefectsininsulinsecretion insulinaction orboth Introduction Thechronichyperglycemiaofdiabetesisassociatedwithlong termdamage dysfunction andfailureofvariousorg
2、ans especiallytheeyes kidneys nerves heart andbloodvessels Symptoms PolyuriaPolydipsia thirst WeightlossWeaknessPolyphagiaBlurredvisionRecurrentinfectionImpairmentofgrowth Criteriafordiagnosisofdiabetes WHO1999 Symptomsofdiabetes Casualplasmaglucose 11 1mmol l 200mg dl OrFPG 7 0mmol l 126mg dl Or2 h
3、PG 11 1mmol l DiagnosticCriteriaWHO1999 IGT FPG 7mmol L 2 hPG 7 8mmol Land 11 1mmol LIFG FPG 6 1mmol Land 7 0mmol L LaboratoryFindings UrinaryglucoseUrinaryketoneBloodglucose FPGand2 hPG HbA1candFA fructosamine OGTTInsulin CPreleasingtest Classification 1 Type1diabetes celldestruction usuallyleading
4、toabsolutedeficiencyImmune mediateddiabetesIdiopathicdiabetesType2diabetesRangingfrompredominantlyinsulinresistancewithrelativeinsulindeficiencytopredominantlyaninsulinsecretorydefectwithinsulinresistance Classification 2 OtherspecifictypesofdiabetesDuetoothercauses e g geneticdefectsininsulinaction
5、 diseasesoftheexocrinepancreas drugorchemicalinducedGestationaldiabetesmellitus GDM diagnosedduringpregnancy Etiologicclassificationofdiabetesmellitus 1 I Type1diabetes celldestruction usuallyleadingtoabsoluteinsulindeficiency A immunemediatedB IdiopathicII Type2diabetes mayrangefrompredominantlyins
6、ulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwithinsulinresistance III OtherspecifictypesA geneticdefectsof cellfunction1 Chromosome12 HNF 1 MODY3 2 Chromosome7 glucokinase MODY2 3 Chromosome20 HNF 4 MODY1 4 MitochondrialDNA5 OthersB Geneticdefectsininsulinaction1 TypeAi
7、nsulinresistance2 Leprechaunism3 Rabson Mendenhallsyndrome4 Lipoatrophicdisease5 OthersC Diseasesoftheexocrinepancreas1 Pancreatitis2 Trauma pancreatectomy3 Neoplasia4 Cysticfibrosis5 Hemochromatosis6 Fibrocalculouspancreatopathy7 Others Etiologicclassificationofdiabetesmellitus 2 D Endocrinopathies
8、1 Acromegaly2 Cushing ssyndrome3 Glucagonoma4 Pheochromocytoma5 Hyperthyroidism6 Somatostatinoma7 Aldosteronoma8 OthersE Drud orchemical induced1 Vacor2 Pentamidine3 Nicotinicacid4 Glucocorticoid5 Thyroidhormone6 Diazoxide7 adrenergicagonists8 Thiazides9 Dilantin10 Interferon11 OthersF Infections1 C
9、ongenitalrubella2 Cytomegalovirus3 Others Etiologicclassificationofdiabetesmellitus 3 G Uncommonformsofimmune mediateddiabetes1 Stiff man syndrome2 Anti insulinreceptorantibodies3 OthersH Othergeneticsyndromessometimesassociatedwithdiabetes1 Down ssyndrome2 Klinefelter ssyndrome3 Turner ssyndrome4 W
10、olfram ssyndrome5 Friedreich sataxia6 Huntington schorea7 Laurence moon Biedlsyndrome8 Myotonicdystrophy9 Porphyria10 Prader Willisyndrome11 OthersIV Gestationaldiabetesmellitus GDM Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease Suchuseofinsulindosenot ofitself clas
11、sifythepatient Type1DM Generally 30yearsRapidonsetModeratetoseveresymptomsSignificantweightlossLeanKetonuriaorketo acidosisLowfastingorpost prandialC peptideImmunemarkers anti GAD ICA IA 2 Type2DM Generally 40yearsSlowlyonsetNotseveresymptomsObesityKetoacidosisseldomoccurNonketotichyperosmolarsyndro
12、meNormalorelevatedC peptidelevelsGeneticpredisposition PathophysiologicalmodelfordevelopmentofobesityandT2DM Beta celldefect Intra uteringrowthretardation InsulinResistancegenes Obesitygenes InsulinResistance Intraabdominalobesity IGT T2DM Westernlifestyle Glucosetoxicity MetabolicInsulinResistance
13、FFA 0 80 40 20 60 Year Disorderofglycemia etiologicaltypesclinicalstages Stages Types NormoglycemiaHyperglycemia Diabetesmellitus Type1Type2OtherspecifictypesGestationaldiabetes Normalglucosetolerance IGTand orIFG Notinsulinrequiring Insulinrequiringforcontrol Insulinrequiringforsurvival Acute life
14、threateningconsequences HyperglycemiawithketoacidosisNonketotichyperosmolarsyndrome Microvascularcomplications RetinopathyNephropathyPeripheralneuropathyAutonomicneuropathy Macrovascularcomplications AtheroscleroticcardiovasculardiseasePeripheralvasculardiseasecerebrovasculardisease Others Hypertens
15、ionAbnormalitiesoflipoproteinmetabolismPeriodontaldisease PotentialchroniccomplicationsofelevatedHbA1c good poor control RISK MicroalbuminuriaMildRetinopathyMildNeuropathy AlbuminuriaMacularEdemaProliferativeRetinopathyPeridontalDiseaseImpotenceGastroparesisDepression FootUlcersAnginaHeartAttackCoro
16、naryBypassSurgeryStrokeBlindnessAmputationDialysisKidneyTransplant TheAimsofTreatment ReliefofhyperglycemicsymptomsCorrectionofhyperglycemia ketonuriaandhyperlipidemiaEstablishmentandmaintenanceofadesirablebodyweight andinchildrennormalgrowthanddevelopmentAvoidanceofacutemetabolicdisturbancePreventordelaytheonsetofthelong termcomplications Targetsforcontrol Management EssentialsofmanagementMonitoringofglucoselevelsFoodplanningPhysicalactivityTreatmentofhyperglycemia 2 MonitoringofGlucoseLevels B
