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1、MAN 212 PATHOPHYSIOLOGICAL CONCEPTS,Bilibili 我有小菜你要不要 2020/6/21,CONTENTS,Definition,Epidemiology,Mechanism,Pathophysiology,Etiology,Diagnosis,Signs and symptoms,Treatment,Risk factors,Nursing management,Definition,Classification,American Diabetes Association ,2020, Classification and diagnosis of di
2、abetes : standards of medical care in diabetes : 43(1), 14,Main 4 types of diabetes,Epidemiology,Top ten countries for number of people aged 2079 years with diabetes in 2018,China has the largest number of people with diabetes.,Adults with diabetes,In 2018 Almost 11.6%, 114.4 million adults had diab
3、etes in China,11.6%,News Rx Health The Lancet Diabetes glucose load test. OGTT,oral glucose tolerance test. *American College of Obstetricians and Gynecologist notes that one elevated value can be used for diagnosis,Prediabetes,“Prediabetes” is the term used for individuals whose glucose levels do n
4、ot meet the criteria for diabetes but are too high to be considered normal . Patients with prediabetes are defined by the presence of IFG and/or IGT and/or A1C5.76.4% (3947 mmol/mol) Prediabetes should not be viewed as a clinical entity in its own right but rather as an increased risk for diabetes a
5、nd cardiovascular disease (CVD). Prediabetes is associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.,Prediabetes,Criteria for testing for diabetes or prediabetes in asymptomatic adults is outlined in Ta
6、ble 2.3.,Prediabetes,Criteria for testing for diabetes or prediabetes in asymptomatic adults,Treatment,Diabetes education,Dietary therapy,Exercise,Pharmacy therapy,self-monitoring,Oral hypoglycemic drugs （OAD）,Insulin,OAD,Pharmacology of available Oral antidiabetic agents,American Diabetes Associati
7、on (2020). Pharmacologic Approaches to Glycemic Treatment: 41(5), 78-79,For type 1 diabetes,Insulin,Because the hallmark of type 1 diabetes is absent or near-absent b-cell function, insulin treatment is essential for individuals with type 1 diabetes. Most people with type 1 diabetes should be treate
8、d with multiple daily injections of prandial and basal insulin, or continuous subcutaneous insulin infusion,Insulin Syringe,Insulin Pen,Insulin pump,90o,Insulin injection,Insulin,Mainly For type 1 diabetes,Insulin,Mainly For type 1 diabetes,Successful pancreas and islet transplantation can normalize
9、 glucose levels and mitigate microvascular complications of type 1 diabetes. patients receiving these treatments require lifelong immunosuppression to prevent graft rejection and/or recurrence of autoimmune islet destruction.,For type 1 diabetes,Pancreas and islet transplantation,Diabetic Ketoacidos
10、is treatment: KING UFC,K+(Potassium) Insulin Nasogastric tube: If comatose Glucose: once serum levels drop Urea: monitoring Fluids: Crystalloids Creatinine: monitor and catheterize,Restore perfusion by giving fluids, which will increase glucose use in the periphery, restore GFR, and reverse the prog
11、ressive acidosis.,Administration of short-acting (soluble) insulin, which will reverse proteolysis and lipolysis, and stimulate glucose uptake and processing, normalize blood glucose, and reverse acisis.,Potassium replacement: correct electrolyte losses by electrolyte supplementation.,Administration
12、 of antibiotics if infection is present,0.9% saline (NaCl) i.v. 1 litre over 30 minutes -1 litre over 1 hr -1 litre over 2 hrs -1 litre over next 2- 4 hrs When blood glucose 15 mmol/l (270 mg/dl),Switch to 5% dextrose, 1 litre 8-hourly If still dehydrated, continue 0.9% saline and add 5% dextrose 1
13、litre per 12 hrs Typical requirement is 6 litres in first 24 hrs but avoid fluid overload in elderly patients Subsequent fluid requirement should be based on clinical response including urine output,50 units soluble insulin in 50 ml 0.9% saline i.v. via infusion pump 6 units/hr initially 3 units/hr
14、when blood glucose is 15 mmol/l (270 mg/dl) 2 units/hr if blood glucose declines to 5.0 mmol/l, or patient is anuric, give no added potassium Bicarbonate: Its use is controversial. It can be used in severely acidotic patient (pH 7.8mmol/ L, postpranational blood glucose 11，1mmol/l -Prevention of HHS and DKA： - Regular blood glucose testing, rational drug use, and adequate water intake - closely observe and record the patients condition, and actively cooperate with doctors in rescue,Complication prevention,MAN 212 PATHOPHYSIOLOGICAL CONCEPTS,Bilibili 我有小菜你要不要 2020/6/21,
