胰岛素门诊治疗的临床应用改__培训课件.pptVIP

糖尿病患者门诊使用胰岛素的剂量调整 根据血糖逐渐增加到估算的总量或实际需要量 剂量增加1－2U/次（T1DM）或2－8U/次(T2DM) 门诊胰岛素治疗的基本策略 人群界定 时机确认 方案选择 制剂选用 疗效判定 方案调整 * * NEXT SLIDE: Important aspect of this is the loss of beta cell mass due to increased rate of apoptosis * 患者一旦诊断后，我们首先应考虑生活方式干预。但2型糖尿病是一种进展性疾病，很多患者在诊断一段时间以后，饮食控制失败，Belfast饮食研究中也观察到这一现象，研究中观察胰岛素抵抗与β细胞功能的变化，如右图所示我们发现胰岛素抵抗没有发生明显的变化，胰岛素抵抗从开始到结束保持一个水平，而左图所示的β细胞功能在进行性发展，导致2型糖尿病进展，导致2型糖尿病继发治疗失败的根本原因是β细胞功能的进行性减退。 * Beta cell function progressively declines UKPDS shows that at the time of diagnosis ?-cell function is already markedly compromised by up to 50%, with ?-cell function continuing to deteriorate in the years following diagnosis. Furthermore, extrapolation of these data tells us that ?-cell function in UKPDS patients may have been suboptimal for 10 years prior to diagnosis. Reference UKPDS population: UKPDS 16. Diabetes 1995;44:1249–58 * * 这项来自Butler的研究，收集了一百四十多个胰腺组织标本，来评估β细胞的数量，结果非常具有说服力。 在左侧深色柱所示健康肥胖人群与右侧深色柱所示健康消瘦人群相比，β细胞的量是增加的。这一点与前面所讲一致，可以明确体现机体的代偿机制。但是无论肥胖还是消瘦者，随着糖代谢异常，2型糖尿病发生后，β细胞的数量明显减少。 这张幻灯告诉我们两件信息，第一机体是可以代偿的，第二代偿是有限度的。 In humans, ?-cell mass increases with obesity and decreases with type 2 diabetes In this study, pancreatic tissue from 124 autopsies was examined to assess whether obesity (BMI 27 kg/m2) and type 2 diabetes are related to ?-cell mass (as assessed by relative ?-cell volume). Frequency of ?-cell apoptosis and replication, and new islet formation were also examined to provide possible explanations for alterations in ?-cell mass. Relative ?-cell volume was the ratio of ?-cell area/exocrine area from a representative area of pancreas section. In people without diabetes, increased ?-cell volume was observed in obese people (n = 31) relative to lean people (n = 17; by 34%, p = 0.05). This increase is suggested to be in response to obesity-related insulin resistance and appeared to result primarily from an increase in new islet formation. In contrast, in people with type 2 diabetes, ?-cell mass was significantly decrease