抗糖尿病药-胰岛素与口服降血糖药.ppt

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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叶菜英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――agroupofd

3、iseasescharacterizedbyhighlevelsofbloodglucoseresultingfromdefectsininsulinproduction,insulinaction,orboth.Insulin:Bcells――synthesis－→secretion――bloodcirculation－→targetcells－→bindingwithinsulinreceptor－→intracellularsubstancemetabolismanylinkgoingwrong－→diabetesmellitusOvervi

4、ewDiabetesMellitus――long-termdisease――multisystemdamage－→functionaldefectandfailureSevere－→diabeticketoacidosis－→comaEtiopathogenisis――heredity,autoimmunity,environmentalfactorDiagnosis：urineglucose,bloodglucoseOverviewTherapy:earlytreatment,longtermtherapy,combinedtherapyandt

5、herapeuticmeasureindividualizationPurpose：bloodglucose－→normal,tocorrectmetabolicdisorder,increaseinlifespan,decreasedeathPrinciple：persevere(cannotcure)OverviewDrinkandfood：grosscalorificvalueKg＝height－105DailyKg＝105～125.5K（25～30Kcal）(25～40Kcal)Therapy：beforemealsSubstanceMet

6、abolicDisorderandClinicalSituationofDiabeticglucoseutilizationdisorder→glucosedecompositiondecrease→energyinsufficient→starvationcondition→polyphagiahyperglycemia→glucosuria→hypertonicitydiuresis→polyuriaproteindegradationaccentuation┤↓athrepsydehydrationthirst→polydipsia↓lipo

7、lysisexcessivehyperosmolarnonketoticdiabeticcomaketonurialipolysisexcessive→ketoplasiaexcessive→Ketonemia→acidosiscomaClassificationofDiabetesMellitus(WHO1998)TypeⅠ:insulindependentdiabetesmellitus，IDDMTypeⅡ:non-insulindependentdiabetesmellitus，NIDDMOthers：secondarydiabetesDia

8、betesMellitusType1Diabetes-cellsthatproduceinsulinaredestroye