Thomas Willis醫(yī)生 （1621-1675）

Diabetes Mellitus 糖尿病 來自醫(yī)圃 00:00 17:49

Diabetes mellitus (DM) comprises a group of metabolic disorders that share the common phenotype of hyperglycemia. DM is currently classified on the basis of the pathogenic process that leads to hyperglycemia.

Diagnosis

A person is considered to be diabetic if he or she has one or more of the following:

    ●Symptoms of diabetes and a random blood sugar of 200 mg/dL (11.1 mmol/L) or            higher

    ●A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher

    ●A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after an oral glucose      tolerance test

    ●An A1C of 6.5 percent or higher

The blood tests must be repeated on another day to confirm the diagnosis of diabetes.

Two intermediate categories have also been designated:

     · Impaired fasting glucose (IFG) for a fasting plasma glucose level of 5.6–                        6.9 mmol/L (100–125 mg/dL)
     · Impaired glucose tolerance (IGT) for plasma glucose levels of 7.8–11.1
      mmol/L (140–199 mg/dL) 2 h after a 75-g oral glucose load
Individuals with IFG or IGT do not have DM but are at substantial risk for developing type 2 DM and cardiovascular disease in the future.

Clinical features

polyuria, polydipsia, weight loss, fatigue, weakness, blurred vision, frequent superficial infections, and poor wound healing.

Acute complications of DM:Diabetic ketoacidosis (DKA),，Hyperglycemic hyperosmolar state

The chronic complications of DM :

   · Ophthalmologic: nonproliferative or proliferative diabetic retinopathy, macular edema

   · Renal: proteinuria, end-stage renal disease (ESRD), type IV renal tubular acidosis

   · Neurologic: distal symmetric polyneuropathy, polyradiculopathy, mononeuropathy,        autonomic neuropathy
   · Gastrointestinal: gastroparesis, diarrhea, constipation
   · Cardiovascular: coronary artery disease, congestive heart failure,                                   peripheral vascular disease, stroke
   · Lower extremity: foot deformity (hammer toe, claw toe, Charcot foot), ulceration,            amputation

 Diabetes Mellitus

Optimal treatment of DM requires more than plasma glucose management.Comprehensive diabetes care should also detect and manage DM-specific complications and modify risk factors for DM-associated diseases. The pt with type 1 or type 2 DM should receive education about nutrition, exercise,care of diabetes during illness, and medications to lower the plasma glucose.

Insulin

Short-acting (Lispro,Regular,Aspart)

Long-acting(NPH,Detemir,Glargine)

Insulin combination

Oral glucose-lowering agents

Biguanide

  Metformin

Sulfonylurea

  Glimepiride

Non-sulfonylurea secretagogue

   Repaglinide

A-glucosidase inhibitor

   Acarbose