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1、抗糖尿病药－胰岛素与口服降血糖药(AntidiabetisDrugs－InsulinandOralAntisiabetisDrugs)北京协和医学院基础医学院药理学系Overview糖尿病(diabetesmellitus)Achronicconditionassociatedwithabnormallyhighbloodsugar.Resultsfromeitherdeficiencyoforaresistancetoinsulin-ahormoneproducedbythepancreaswhosefunctionistolowerblo
2、odsugar.Overviewmorbidity:300,000people－→>0.67％40yearsold―→2.53％199425~64yearsold－→2.51％199620~75yearsold－→3.21％1997―→13,500,000people(allovertheword)Prediction:2025―→>30,000,000peopleOverviewCausebymanyofreasons――chronichyperglycemia－→metabolicdisorderHyperglycemia――agroup
3、ofdiseasescharacterizedbyhighlevelsofbloodglucoseresultingfromdefectsininsulinproduction,insulinaction,orboth.Insulin:Bcells――synthesis－→secretion――bloodcirculation－→targetcells－→bindingwithinsulinreceptor－→intracellularsubstancemetabolismanylinkgoingwrong－→diabetesmellitus
4、OverviewDiabetesMellitus――long-termdisease――multisystemdamage－→functionaldefectandfailureSevere－→diabeticketoacidosis－→comaEtiopathogenisis――heredity,autoimmunity,environmentalfactorDiagnosis:urineglucose,bloodglucoseOverviewTherapy:earlytreatment,longtermtherapy,combinedth
5、erapyandtherapeuticmeasureindividualizationPurpose:bloodglucose－→normal,tocorrectmetabolicdisorder,increaseinlifespan,decreasedeathPrinciple:persevere(cannotcure)OverviewDrinkandfood:grosscalorificvalueKg＝height－105DailyKg＝105～125.5K(25～30Kcal)(25～40Kcal)Therapy:beforemeals
6、SubstanceMetabolicDisorderandClinicalSituationofDiabeticglucoseutilizationdisorder→glucosedecompositiondecrease→energyinsufficient→starvationcondition→polyphagiahyperglycemia→glucosuria→hypertonicitydiuresis→polyuriaproteindegradationaccentuation┤↓athrepsydehydrationthirst→
7、polydipsia↓lipolysisexcessivehyperosmolarnonketoticdiabeticcomaketonurialipolysisexcessive→ketoplasiaexcessive→Ketonemia→acidosiscomaClassificationofDiabetesMellitus(WHO1998)TypeⅠ:insulindependentdiabetesmellitus,IDDMTypeⅡ:non-insulindependentdiabetesmellitus,NIDDMOthers:se
8、condarydiabetesDiabetesMellitusType1Diabetes-cellsthatproduceinsulinaredestroyed-r
