药理学 第32章 胰岛素口服降糖药.ppt

第三十二章胰岛素及口服降糖药
糖尿病(diabetes mellitus,DM):胰岛素分泌绝对或相对不足, 引起糖、脂肪、蛋白质代谢紊乱的疾病。
糖尿病诊断标准被确定为
任何时候血糖≥(≥200毫克/分升),
和(或)空腹血糖≥(≥126毫克/分升),
则可以诊断为糖尿病
胰腺 pancreas
糖尿病
分类
Ⅰ型(insulin-dependent diabetes mellitus, IDDM)
自身免疫性疾病–细胞破坏,胰岛素分泌缺乏
Ⅱ型(non-insulin-dependent diabetes mellitus, NIDDM) 细胞功能低下,胰岛素相对缺乏、胰岛素抵抗(INR)
Type I or insulin-dependent diabetes mellitus is the result of a frank deficiency of insulin. The onset of this disease typically is in childhood. It is due to destruction pancreatic B cells, most likely the result of autoimmunity to one or ponents of those cells. Many of the acute effects of this disease can be controlled by insulin replacement therapy. Maintaining tight control of blood glucose concentrations by monitoring, treatment with insulin and dietary management will minimize the long-term adverse effects of this disorder on blood vessels, nerves and an systems, allowing a healthy life.
Type II or non-insulin-dependent diabetes mellitus begins as a syndrome of insulin resistance. That is, target tissues fail to respond appropriately to insulin. Typically, the onset of this disease is in adulthood. Despite monumental research efforts, the nature of the defect has been difficult to ascertain - in some patients, the insulin receptor is abnormal, in others, one or more aspects of insulin signalling is defective, and in others, no defect has been identified. Because there is not, at least initially, an inability to secrete adequate amounts of insulin, insulin injections are not useful for therapy. Rather the disease is controlled through dietary therapy and hypoglycemic agents.
糖尿病治疗方法及展望
Ⅰ型糖尿病
普通胰岛素替代疗法( 猪、牛胰岛素注射)
普通胰岛素结构改造( 猪胰岛素链第 30 位的丙氨酸用苏氨酸代替)
重组 DNA 技术利用大肠杆菌合成胰岛素
Ⅱ型糖尿病
控制饮食
药物治疗
常用药物种类
磺酰脲类
双胍类
- 葡萄糖苷酶抑制剂
胰岛素增敏剂(罗格列***、吡格列***)
餐时血糖调节剂(瑞格列奈)
胰岛素治疗