特殊人群的胰岛素应用.ppt

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1、特殊人群的胰岛素应用EtiologicclassificationofdiabetesmellitusI.Type1diabetes(-celldestruction,usuallyleadingtoabsoluteinsulindeficiency)A.ImmunemediatedB.IdiopathicII.Type2diabetes(mayrangefrompredominantlyinsulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwi

2、thinsulinresistance)III.OtherspecifictypesA.Geneticdefectsof-cellfunction1.Chromosome12,HNF-1(MODY3);2.Chromosome7,glucokinase(MODY2);3.Chromosome20,HNF-4(MODY1);4.Chromosome13,insulinpromoterfactor-1(IPF-1;MODY4);5.Chromosome17,HNF-1(MODY5);6.Chromosome2,NeuroD1(MODY6);7.Mi

3、tochondrialDNA;8.OthersB.Geneticdefectsininsulinaction1.TypeAinsulinresistance;2.Leprechaunism;3.Rabson-Mendenhallsyndrome;4.Lipoatrophicdiabetes;5.OthersC.Diseasesoftheexocrinepancreas1.Pancreatitis;2.Trauma/pancreatectomy;3.Neoplasia;4.Cysticfibrosis;5.Hemochromatosis;6.Fi

4、brocalculouspancreatopathy;7.OthersDIABETESCARE,SUPPLEMENT1,2009哪些糖尿病患者需要胰岛素治疗？D.Endocrinopathies1.Acromegaly;2.Cushing’ssyndrome;3.Glucagonoma;4.Pheochromocytoma;5.Hyperthyroidism;6.Somatostatinoma;7.Aldosteronoma;8.OthersE.Drug-orchemical-induced1.Vacor;2.Pentamidine;3.Nic

5、otinicacid;4.Glucocorticoids;5.Thyroidhormone;6.Diazoxide;7.-adrenergicagonists;8.Thiazides;9.Dilantin;10.-Interferon11.OthersF.Infections1.Congenitalrubella;2.Cytomegalovirus;3.OthersG.Uncommonformsofimmune-mediateddiabetes1.“Stiff-man”syndrome;2.Anti–insulinreceptorantibod

6、ies;3.OthersH.Othergeneticsyndromessometimesassociatedwithdiabetes1.Down’ssyndrome;2.Klinefelter’ssyndrome;3.Turner’ssyndrome;4.Wolfram’ssyndrome;5.Friedreich’sataxia;6.Huntington’schorea;7.Laurence-Moon-Biedlsyndrome;8.Myotonicdystrophy;9.Porphyria;10.Prader-Willisyndrome;1

7、1.OthersIV.Gestationaldiabetesmellitus(GDM)Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease.Suchuseofinsulindoesnot,ofitself,classifythepatient.DIABETESCARE,SUPPLEMENT1,2009那些糖尿病患者需要胰岛素治疗？糖尿病血糖的控制标准及个体化治疗Summaryofglycemicrecommendationsfornon-

8、pregnantadultswithdiabetesA1C7.0%*Preprandialcapillaryplasmaglucose70–130mg