糖尿病急性并发症2012.ppt

我们几下来分别看看低血糖是如何影响各个系统的 我们看到近期低血糖发生，CNS脱敏就是阈值下降的另一种说法，直接的损伤就是知觉下降，此时自主神经过渡反应，选择性收缩血管，减少肾脏血流，促进糖尿病肾病的发展，连续的作用，使得自主神经衰竭，导致无意识性低血糖，最终导致心肌梗死风险增加；死亡率增加不过是个附属品。 低血糖时肾血流减少约22%，肾小球滤过率降低19%，再加上糖尿病本身的肾脏损害，可以说肾功能不全的帽子永远也摘不掉。 当肾功能不全发生时，胰岛素的清除率降低，直接增加低血糖的风险，这样就形成了恶性循环。 低血糖的负面情绪是指对低血糖的而恐惧，焦虑，以及应激反应。 可以说它几乎影响了生活中的各个方面，其结果就是进一步加重自主神经衰竭。 * Frequency of Hypoglycemic Symptoms Among Patients With Type 2 Diabetes Lundkvist et al1 compared the frequency of hypoglycemic symptoms among 309 patients with type 2 diabetes who were receiving oral agents only or insulin. Symptoms of hypoglycemia were reported by 115 patients during the previous month, representing a 37% incidence of hypoglycemia (24% of patients experienced symptoms once during the month, 11% every week, and 2% every day).1 The results demonstrated that the frequency of hypoglycemic symptoms in 1 month was lower for patients with type 2 diabetes using only oral agents than in patients taking insulin, as seen on this chart.1 Other studies in Asia and Europe have shown similar prevalence of self-reported hypoglycemia in patients with type 2 diabetes treated with oral agents.2,3 Purpose To compare the frequency of hypoglycemic symptoms among patients with type 2 diabetes using only oral agents or insulin. TakeawayFor patients with type 2 diabetes, those receiving oral agents only have a lower frequency of hypoglycemic symptoms than those taking insulin. References 1. Lundkvist J, Berne C, Bolinder B, J?nsson L. The economic and quality of life impact of hypoglycemia. Eur J Health Econom. 2005;6(3):197–202. 2. Sheu WH, Ji L, Balk SH, Chan SP, Nitiyanank W: on Behalf of Asia RECAP-DM Study Group. Hypoglycemic experience is assoicated with lower quality of life (QoL) in Asian patients with type 2 diabetes mellitus (T2DM) treated with oral antihyperglycemic agents (OHA). Poster presented at: 7th IDF Western Pacific Region Congress; March 30-April 3, 2008; Wellington, New Zealand. 3. álvarez Guisasola F, Tofé Povedano S, Kris