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1、Management of Type 2 Diabetes inthe New Millennium,黃中研,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,Egyptian medicine 1550 BC Ebers papyrus provides the following remedy to “eliminate too plentiful urine” * Water from the bird pond 鳥塘的水 * Elderberry 接骨木的果實 * Fibers of the asit plant 植物纖維 * Fr
2、esh milk 新鮮牛奶 * Beer swill 喝剩的啤酒 * Flower of the cucumber 胡瓜花 * Green dates 綠棗,Greek medicine Hippocrates (460 - 377 BC) “ The amount of urine passed was great; it wasnot proportional to the amount drunk but considerably in excess the urine wasalso markedly bad in most cases thesesigns signified som
3、e wasting”,Greek medicine Aretaeus (130 200 AD)“Diabetes is a wonderful affection, being a melting down of the flesh and limbs into urine the patient is short-lived, for the melting is rapid, the death speedy. Life is disgusting and painful; ”,Greek medicine Aretaeus (130 200 AD) continued “Hence th
4、e disease appears to me to have got the name of diabetes (a siphon), because the fluid does not remain in the body, but uses the mans body as a ladder, whereby to leave it”,Hindu medicine Samhitas (written in Sanskrit) describedIksumeha sugar cane urine Madhumeha honey urine,Hindu medicine continued
5、 “The patient gradually loses strength, flesh and healthy glow of complexion” “Advanced cases were complicatedwith abscesses, carbuncles, badsmelling breaths, and even loss ofconsciousness”,Hindu medicine continued “An idle man who indulges in day-sleep or is in the habit of taking sweet liquids or
6、fat- making food, will ere long fall an easy victim of the disease”,Type 2 diabetes mellitus hyperglycemia,(dys) Metabolic syndrome WHO definition by 1998 Type 2 diabetes or Impaired fasting glucose / impaired glucose tolerance or Normal glucose tolerance with insulin resistance plus any two of the
7、following Hypertension Dyslipidemia Obesity Microalbuminuria,It is never too late to learn,but sometimes it is too early,治療第一型糖尿病的新發展 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和免疫抑制劑的經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,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M
8、uscle: 胰島素阻抗性大Liver : 製造太多葡萄糖至血液裡,兩架各載滿250名乘客的客機在空中相撞，死亡500人,這空中相撞意外每天發生,Both DCCT Diabetes Control and Complications Trial and UKPDS United Kingdom Prospective Diabetes Study show that good glycemic control within or near normal range effectively delays the onset and slows the progression of diabet
9、ic triopathy,Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel )2486 JAMA, May 16, 2001-Vol 285, No. 19,Diabetic Nephropathy Stage1 Hyperfiltration
10、 Stage2 Microalbuminuria Stage3 Hyperfiltration stops,persisted microalbuminuria Stage4 Hypofiltration Stage5 Hypofiltration, grossproteinuria ( 300mg/day ),3 to 8 years,ESRD,The Forgotten Complication Diabetic neuropathy,Damaged nerves just under or in the skin cause dysesthesia Burning Tingling,Tr
11、eatment of Dysesthesia Capsaicin cream Gabapentin,Deeper damaged nerves cause paresthesia Pins and needles Electric-like Numb and achy Like my feet in ice water Knife-like, shooting,Treatment of paresthesia Anti-depressants Anti-seizure medicines Mexiletine,Damaged nerves to the muscles cause crampi
12、ng Dull aches Night cramping Spasms Toothache-like deep aches,Treatment of Cramps Proper footwear Stretching exercises,Painful diabetic neuropathy, 糖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 繼續服藥，當血糖高時，再p.r.n注射RI 2. 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 onsliding scale 3.
13、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 onsliding scale 4. 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 onsliding scale, Sliding scal150 F/S 200mg/dL RI 3u, sc, stat 200 F/S 250mg/dL RI 5u, sc, stat 250 F/S 300mg/dL RI 8u, sc, stat 300 F/S 350mg/dL RI 10u, sc, stat 350 F/S RI 10u, iv, stat,recheck in 30 min 睡前改用NPH, sc,研究第2型糖尿病病因的新發展 Loss of peroxisome proliferator activated receptors (PPARs) gene expression leads toInsulin resistance HypertensionHyperglycemiaDyslipidemiaObesity,糖尿病是不是一種新發現的疾病？,糖尿病是不是很可怕?,糖尿病人血脂異常特徵TGHDLLDL不變，但是small dense LDL比例ApoB,
