Thomas Willis医生 (1621-1675)
希腊医生第一次使用Diabetes这个词来描述尿多症。直到1675年,英国医生Thomas Willis才正式运用Diabetes Mellitus描述糖尿病。
Diabetes mellitus (DM) comprises a group of metabolic disorders that share the common phenotype of hyperglycemia. DM is currently classified on the basis of the pathogenic process that leads to hyperglycemia.
Diagnosis
A person is considered to be diabetic if he or she has one or more of the following:
●Symptoms of diabetes and a random blood sugar of 200 mg/dL (11.1 mmol/L) or higher
●A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher
●A blood sugar of 200 mg/dL (11.1 mmol/L) or higher two hours after an oral glucose tolerance test
●An A1C of 6.5 percent or higher
The blood tests must be repeated on another day to confirm the diagnosis of diabetes.
Two intermediate categories have also been designated:
· Impaired fasting glucose (IFG) for a fasting plasma glucose level of 5.6– 6.9 mmol/L (100–125 mg/dL)
· Impaired glucose tolerance (IGT) for plasma glucose levels of 7.8–11.1
mmol/L (140–199 mg/dL) 2 h after a 75-g oral glucose load
Individuals with IFG or IGT do not have DM but are at substantial risk for developing type 2 DM and cardiovascular disease in the future.
Clinical features
polyuria, polydipsia, weight loss, fatigue, weakness, blurred vision, frequent superficial infections, and poor wound healing.
Acute complications of DM:Diabetic ketoacidosis (DKA),Hyperglycemic hyperosmolar state
The chronic complications of DM :
· Ophthalmologic: nonproliferative or proliferative diabetic retinopathy, macular edema
· Renal: proteinuria, end-stage renal disease (ESRD), type IV renal tubular acidosis
· Neurologic: distal symmetric polyneuropathy, polyradiculopathy, mononeuropathy, autonomic neuropathy
· Gastrointestinal: gastroparesis, diarrhea, constipation
· Cardiovascular: coronary artery disease, congestive heart failure, peripheral vascular disease, stroke
· Lower extremity: foot deformity (hammer toe, claw toe, Charcot foot), ulceration, amputation
Diabetes Mellitus
Optimal treatment of DM requires more than plasma glucose management.Comprehensive diabetes care should also detect and manage DM-specific complications and modify risk factors for DM-associated diseases. The pt with type 1 or type 2 DM should receive education about nutrition, exercise,care of diabetes during illness, and medications to lower the plasma glucose.
Insulin
Short-acting (Lispro,Regular,Aspart)
Long-acting(NPH,Detemir,Glargine)
Insulin combination
Oral glucose-lowering agents
Biguanide
Metformin
Sulfonylurea
Glimepiride
Non-sulfonylurea secretagogue
Repaglinide
A-glucosidase inhibitor
Acarbose
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