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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Diabetes Mellitus,Diabetes Mellitus,1,Introduction,Diabetes mellitus,is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion,insulin action,or both.,Introduction Diabetes mellitus,2,Introduction,The chronic hyperglycemia of diabetes,is associated with long-term damage,dysfunction,and failure of various organs,especially the eyes,kidneys,nerves,heart,and blood vessels,.,IntroductionThe chronic hyper,3,Symptoms,Polyuria,Polydipsia,(,thirst),Weight loss,Weakness,Polyphagia,Blurred vision,Recurrent infection,Impairment of growth,SymptomsPolyuria,4,Criteria for diagnosis of diabetes,(,WHO1999),Symptoms of diabetes,+,Casual plasma glucose 1.1mmol/l(200mg/dl),Or,FPG 7.0mmol/l(126mg/dl),Or,2-hPG 11.1mmol/l,Criteria for diagnosis of dia,5,Diagnostic Criteria WHO1999,IGT,-,FPG7mmol/L,-,2-h PG7.8mmol/L and 11.1mmol/L,IFG,-,FPG6.1mmol/L and 7.0mmol/L,Diagnostic Criteria WHO1999IG,6,Laboratory Findings,Urinary glucose,Urinary ketone,Blood glucose(FPG and 2-hPG),HbA1c and FA(fructosamine),OGTT,Insulin/CP releasing test,Laboratory FindingsUrinary glu,7,Classification(1),Type 1 diabetes,-cell destruction,usually leading to absolute deficiency,Immune-mediated diabetes,Idiopathic diabetes,Type 2 diabetes,Ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance,Classification(1)Type 1 diabe,8,Classification(2),Other specific types of diabetes,Due to other causes,e.g.,genetic defects in insulin action,diseases of the exocrine pancreas,drug or chemical induced,Gestational diabetes,mellitus(GDM),diagnosed during pregnancy,Classification(2)Other specif,9,Etiologic classification of diabetes mellitus(1),I.Type 1diabetes,(,-cell destruction,usually leading to absolute insulin deficiency),A.immune mediated,B.Idiopathic,II.Type 2diabetes,(may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance),III.Other specific types,A.genetic defects of,-cell function,1.Chromosome 12,HNF-1,(MODY3),2.,Chromosome 7,glucokinase,(MODY2),3.,Chromosome 20,HNF-4,(MODY1),4.Mitochondrial DNA,5.Others,B.Genetic defects in insulin action,1.Type A insulin resistance,2.Leprechaunism,3.Rabson-Mendenhall syndrome,4.Lipoatrophic disease,5.Others,C.Diseases of the exocrine pancreas,1.Pancreatitis,2.Trauma/pancreatectomy,3.Neoplasia,4.Cystic fibrosis,5.Hemochromatosis,6.Fibrocalculous pancreatopathy,7.Others,Etiologic classification of di,10,Etiologic classification of diabetes mellitus(2),D.Endocrinopathies,1.Acromegaly,2.Cushings syndrome,3.Glucagonoma,4.Pheochromocytoma,5.Hyperthyroidism,6.Somatostatinoma,7.Aldosteronoma,8.Others,E.Drud-or chemical-induced,1.Vacor,2.Pentamidine,3.Nicotinic acid,4.Glucocorticoid,5.Thyroid hormone,6.Diazoxide,7.,-adrenergic agonists,8.Thiazides,9.Dilantin,10.,-Interferon,11.Others,F.Infections,1.Congenital rubella,2.Cytomegalovirus,3.Others,Etiologic classification of di,11,Etiologic classification of diabetes mellitus(3),G.Uncommon forms of immune-mediated diabetes,1.“Stiff-man”syndrome,2.Anti-insulin receptor antibodies,3.Others,H.Other genetic syndromes sometimes associated with diabetes,1.Downs syndrome,2.Klinefelters syndrome,3.Turners syndrome,4.Wolframs syndrome,5.Friedreichs ataxia,6.Huntingtons chorea,7.Laurence-moon-Biedl syndrome,8.Myotonic dystrophy,9.Porphyria,10.Prader-Willi syndrome,11.Others,IV.Gestational diabetes mellitus(GDM),Patients with any form of diabetes may require insulin treatment at some stage of their disease.Such use of insulin dose not,of itself,classify the patient.,Etiologic classification of di,12,Type 1 DM,Generally 30 years,Rapid onset,Moderate to severe symptoms,Significant weight loss,Lean,Ketonuria or keto-acidosis,Low fasting or post-prandial C-peptide,Immune markers(anti-GAD,ICA,IA-2),Type 1 DMGenerally 7.0,10.0,HbA1c(%),6.2,8.0,Blood pressure,(mmHg),130/80-160/95,BMI,(kg/m,2,),Male,female,25,24,27,26,27,26,Total cholesterol,(mmol/L),1.1,1.1-0.9,0.9,Triglycerides,(mmol/L),1.5,2.2,2.2,LDL-cholesterol,(mmol/L),4.4,Targets for controlOptimal Fai,23,Management,Essentials of management,Monitoring of glucose levels,Food planning,Physical activity,Treatment of hyperglycemia,ManagementEssentials of manage,24,2.,Monitoring of Glucose Levels,Blood glucose levels,-before each meal,-at bedtime,Urine glucose testing,Urine ketone tests,(should be performed during illness or when blood glucose is,20mmol/L,),2.Monitoring of Glucose Levels,25,3.,Food Planning,Weight control.,50-60%of the total dietary energy should come from complex carbohydrates.,20-25%form fats and oils.,15-20%from protein.,Restrict alcohol intake.,Restrict salt intake to below 7g/d.,3.Food PlanningWeight control.,26,4.,Physical Activity,Physical activity play an important role in the management of diabetes particularly in T2DM.Physical activity improves i
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