糖尿病英文PPT课件

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

2、r 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,2021/2/2,Beijing Xuanwu Hospital,4,Definition,A metabolic condition characterised by high plasma glucose

3、levels and chronic vascular complications A vascular disease affecting small and large arteries with coexistent metabolic disturbance particularly high plasma glucose levels,2021/2/2,Beijing Xuanwu Hospital,5,Diabetes Mellitus,definition types symptoms diagnosis Laboratory findings treatment complic

4、ations,2021/2/2,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 predomi

5、nantly 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 syndrom

6、es sometimes associated with diabetes Gestational diabetes,2021/2/2,Beijing Xuanwu Hospital,7,Type 1 diabetes,Previously known as IDDM(Insulin dependent diabetes) Ketosis prone:Usually diagnosed in younger age group(30 years) (Peak incidence 11-13 yr) Prevalence highly variable but approximately 0.2

7、0% with an incidence of 15-20 per 100000 population aged less than 21 Seasonal variation- with lowest rate in spring and summer,2021/2/2,Beijing Xuanwu Hospital,8,Type 1 diabetes mellitus,Immune-mediated type 1 diabetes acute LADA latent autoimmune diabetes in adults Idiopathic type 1 diabetes melli

8、tus,2021/2/2,Beijing Xuanwu Hospital,9,Type 1 diabetes mellitus,Genetics Environmental factor Viruses Chemical agents Autoimmune Auto-antibodies: islet cell cytoplasm antibody (ICCA) islet cell surface antibody (ICSA) glutamic acid decarboxylase antibody GADA(64KD) Insulin antibody (IAA,2021/2/2,Bei

9、jing Xuanwu Hospital,10,Type 1 diabetes,This presentation is the end point of recent and continuing beta cell function resulting in near total loss of Insulin production Hyperglycaemia itself begets further beta cell destruction as treatment with insulin often results in a “honeymoon” period when th

10、e patient can often manage without insulin,2021/2/2,Beijing Xuanwu Hospital,11,Type 1 diabetes mellitus usually autoimmune destruction of insulin-producing pancreatic islet cellsover months absolute insulin deficiency rapid presentation withthirst, polyuria, weight loss, blurred visionthrush, lethar

11、gy, dizziness. nausea, vomiting, abdominal cramps, and superficial infection usually thin and ketotic at presentation Auto-antibodies identified: anti islet cell (ICCA. ICSA), anti GAD(64KD), anti Insulin (IAA,2021/2/2,Beijing Xuanwu Hospital,12,A progressive metabolic disordercharacterised by,Insul

12、in resistance,Type 2 diabetes,cell dysfunction,2021/2/2,Beijing Xuanwu Hospital,13,Type 2 diabetes,Previously known as NIDDM Non ketosis prone: , diagnosis 30 years 1 in 1000 population as new cases each year Insidious presentation with symptoms of polyuria, polydipsia, lethargy, weight loss, nausea

13、, 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 (90-100%) concordance in Twins Reavans syndrome or Syndrome X Insulin r

14、esistance,2021/2/2,Beijing Xuanwu Hospital,14,Type 2 diabetes Underlying insulin resistance genetic and ethnicity Obesity BMI WHR inactivity / low physical fitness intrauterine recommended to check LFTs q 2 mo for 1st year of use. Advantages No hypoglycemia Possible improvement in vascular function,

15、2021/2/2,Beijing Xuanwu Hospital,53,Thiazolidinedione toxicity,Metabolism: hepatic conjugation by the CYP450 system Excretion: biliary Hepatotoxic, especially troglitazone, and contraindicated in cases of hepatic dysfunction Can cause edema and hypoglycemia when used in combination with other hypogl

16、ycemics,2021/2/2,Beijing Xuanwu Hospital,54,Treating hyperglycaemia in type 2 diabetes,dietary change exercise,metformin the rate of formation exceeds the capacity for their peripheral utilization and renal excretion leading to accumulation of ketoacids, and therefore metabolic acidosis With progres

17、sive dehydration, acidosis, hyperosmolality, and diminished cerebral oxygen utilization, consciousness becomes impaired, and the patient ultimately becomes comatose,2021/2/2,Beijing Xuanwu Hospital,79,Clinical Manifestations,early manifestations are mild and include vomiting, polyuria, and dehydrati

18、on More severe cases include Kussmaul respirations, odor of acetone on the breath abdominal pain or rigidity may be present and mimic acute appendicitis or pancreatitis cerebral obtundation and coma ultimately ensue,2021/2/2,Beijing Xuanwu Hospital,80,Laboratory findings,Laboratory findings include

19、glucosuria, ketonuria, hyperglycemia, ketonemia, and metabolic acidosis. Serum amylase may be elevated. Leukocytosis is common,2021/2/2,Beijing Xuanwu Hospital,81,Diagnosis,DKA exists when there is hyperglycemia ( 300 mg/dL), ketonemia, acidosis, glucosuria, and ketonuria,2021/2/2,Beijing Xuanwu Hos

20、pital,82,DKA must be differentiated from acidosis and coma due to other causes: hypoglycemia, uremia, gastroenteritis with metabolic acidosis, lactic acidosis, salicylate intoxication, encephalitis,2021/2/2,Beijing Xuanwu Hospital,83,Treatment,Treatment is divided into 3 phases treatment of ketoacid

21、osis transition period continuing phase and guidance Goals of treatment of DKA intravascular volume expansion correction of deficits in fluids, electrolytes, and acid-base status initiation of insulin therapy to correct catabolism, acidosis,2021/2/2,Beijing Xuanwu Hospital,84,Ketoacidosis,Treatment

22、Administer insulin Rehydrate Replace electrolytes Treat acidosis with bicarbonate,2021/2/2,Beijing Xuanwu Hospital,85,Intravascular volume expansion dehydration is most commonly in the order of 10% initial hydrating fluid should be isotonic saline this alone will often slightly lower the blood gluco

23、se 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 administration of insulin will cause a decrease in serum K,2021/2/2,Beijing Xuanwu Hospital,86,Maintenance” IV fluid at a rate of 2000 - 2400 c

24、c/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,2021/2/2,Beijing Xuanwu Hospital,87,Insulin Therapy continuous infusion of low-dose insulin IV ( 0.1 U/kg/hr) is effective, simple, and physiolo

25、gically sound goal is to slowly decrease serum glucose ( 100 mg/dL/hr frequent laboratory and blood gas analyses are obtained to ensure ongoing resolution of metabolic acidosis Insulin is used to treat acidosis, not hyperglycemia insulin should never be stopped if ongoing acidosis persists When the

26、acidosis is corrected, the continuous insulin infusion may be discontinued and subcutaneous insulin initiated With the regimen, DKA usually is usually fully corrected in 36 to 48 hours,2021/2/2,Beijing Xuanwu Hospital,88,subclinical cerebral edema occurs in the majority of patients treated with flui

27、ds and insulin for DKA Cerebral edema is the major life-threatening complication seen in the treatment of children with DKA usually develops several hours after the institution of therapy manifestations include headache, alteration in level of consciousness, bradycardia, emesis, diminished responsiv

28、eness to painful stimuli, and unequal or fixed, dilated pupils,2021/2/2,Beijing Xuanwu Hospital,89,Nonketotic Hyperosmolar Dibetic Coma(NHDC,Hyperosmolality as a result of progressive hyperglycemia Serum osmolality: Serum Na+ + K+ x 2 + glucose/18 + BUN/2.8,2021/2/2,Beijing Xuanwu Hospital,90,Occurs

29、 primarily in Type 2 diabetics Often brought on by stressful events and/or major illness Hyperglycemic diuresis dehydration severe dehydration coma No keto acids, lipolysis inhibited by insulin,2021/2/2,Beijing Xuanwu Hospital,91,Pathophysiology,Results in blood glucose levels up to 1000mg/dL. Insul

30、in activity prevents buildup of ketones. Sustained hyperglycemia results in marked dehydration. Often related to dialysis, infection, and medications. Very high mortality rate,2021/2/2,Beijing Xuanwu Hospital,92,Signs need supplemental insulin c. 25-50 % twin concordance, suggesting both environmental and genetic factors d. Usually individuals are lean and young e. Genetic link: lactalbumin of cows milk bears epitope matching that of b-islet