重庆医科大学：《内科学》课程授课教案（七年制）糖尿病 - 龙敏

重庆医科大学第二临床学院教案 2008年11月4日 Course title:Diabetes mellitus Teachers:龙敏 Obeject:2004级七年制 Teacher hours:160minuts Goal:1.Know of classification and pathogeneses of DM 2.Know of the clinical manifestation and complication of DM 3.Master the diagnosis reference,treatment of DM 4.Know of the pathogeneses of diabetic ketoacidosis,master the diagnosis and treatment Emphasis:1.clinical manifestation and diagnostic criteria of DM 2oral blood glucose lowering drugs and insulin therapy 3.diagnosis and therapy of diabetic ketoacidosis Difficulty:therapy of DMand diabetic ketoacidosis Teaching aid:multimedia Teaching Contents,method and time-assignment: Outline:(5minutes)Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to insulin resistance and inadequate insulin secretion to compensate.The metabolic disturbance cause multisystemic tissue damage,seen clinically as diabetic complications. Classification (15minutes) 1.Type 1diabetes mellitus 2.Type 2 diabetes mellitus 3.Gestational diabetes Mellitus 4.Other Specific Types of Diabetes Pathogenesis (20minutes) 1)Type 1 DM 1.Genetic susceptibility

重庆医科大学第二临床学院教案 2008 年 11 月 4 日 Course title：Diabetes mellitus Teacher：龙敏 Obeject：2004 级七年制 Teacher hours：160minuts Goal: 1. Know of classification and pathogeneses of DM 2.Know of the clinical manifestation and complication of DM 3.Master the diagnosis reference，treatment of DM 4.Know of the pathogeneses of diabetic ketoacidosis，master the diagnosis and treatment Emphasis: 1、clinical manifestation and diagnostic criteria of DM 2、oral blood glucose lowering drugs and insulin therapy 3、diagnosis and therapy of diabetic ketoacidosis Difficulty：therapy of DM and diabetic ketoacidosis Teaching aid：multimedia Teaching Contents、method and time-assignment： Outline：（5minutes）Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to insulin resistance and inadequate insulin secretion to compensate. The metabolic disturbance causes multisystemic tissue damage, seen clinically as diabetic complications. Classification（15minutes） 1.Type 1diabetes mellitus 2.Type 2 diabetes mellitus 3.Gestational diabetes Mellitus 4. Other Specific Types of Diabetes Pathogenesis（20minutes） 1）Type 1 DM 1.Genetic susceptibility

2.Autoimmune response 3.Immunologic abnormality 4.Progressive functional incapacitation of B cell 5.Clinical DM 2)Type 2 DM 1.Genetic and Environmental factors 2.insulin resistance and B cell function defection 3.Glucotoxicity and lipotoxicity 4.Clinical diabetes mellitus Clinical manifestation (20minutes 1.Symptoms and Signs 2.Complication of diabetes A.Chronic complication (1)large vessel (2)Small vessel disease Diabetic retinopathy Diabetic nephropathy Diabetic neuropathy B.Acute complication Laboratory Findings (10minutes) 1 Glucosuria 2.Plasma glucose 4.Glycosylated hemoglobin(HbAIC) 5.Plasma insulin and cpeptide assay Diagnosis and Differential diagnosis(10minutes) Treatment:(40minutes) Goal oftreatment of diabetes Diabetes mellitus requires ongoing medical care as well as patients and family education both to prevent acute illness and to reduce the risk of long-term complications. 1.Diet(5m nutes) 2.Exereise(5minutes) 3.Oral drug(15minutes) Sulfonylureas Meglitinide analogs Biguanides

2.Autoimmune response 3.Immunologic abnormality 4.Progressive functional incapacitation of B cell 5.Clinical DM 2）Type 2 DM 1.Genetic and Environmental factors 2. insulin resistance and B cell function defection 3.Glucotoxicity and lipotoxicity 4.Clinical diabetes mellitus Clinical manifestation （20minutes） 1.Symptoms and Signs 2. Complication of diabetes A. Chronic complication (1) large vessel disease (2) Small vessel disease Diabetic retinopathy Diabetic Nephropathy Diabetic neuropathy B. Acute complication C. Diabetic foot Laboratory Findings（10minutes） 1.Glucosuria 2. Plasma glucose 3.Oral glucose tolerance test 4.Glycosylated hemoglobin (HbA1C) 5.Plasma insulin and cpeptide assay Diagnosis and Differential diagnosis(10minutes) Treatment：(40minutes) Goal of treatment of diabetes Diabetes mellitus requires ongoing medical care as well as patients and family education both to prevent acute illness and to reduce the risk of long-term complications. 1.Diet (5minutes) 2.Exercise(5minutes) 3.Oral drug (15minutes) Sulfonylureas Meglitinide analogs Biguanides

Alpha-glucosidase inhibitors Thiazolidinediones 4.Insulin Therapy(15minutes) Diabetic ketoacidosis (40minutes) Outline(5minutes) Exciting cause(5minutes) 1.The initial manifestation of type 1 diabetes 2.during the course of infection,trauma,myocardial infarction,or surgery,gestation Clinical finding(10minutes) 1.Symptoms and signs 2.Laboratory finding Hyperglycemia >13.9mmol/L Acidosis with blood PH<7.35 Serum bicarbonate<18mmol/L Urine positive for ketones Serum potassium is normal or high despite total body potassium depletion resulting from polyuria or vomiting.Serum creatinine and urea nitrogen may be mild high Leukocytosis may occur with or without associated infection Treatment(20minutes) 1.Prevention 2.Emergency Measures therapeutic flow sheet insulin replacement fluid replacement electrolyte replacement treatment of complication

Alpha-glucosidase inhibitors Thiazolidinediones 4.Insulin Therapy(15minutes) Diabetic ketoacidosis (40minutes) Outline(5minutes) Exciting cause(5minutes) 1.The initial manifestation of type 1 diabetes 2.during the course of infection , trauma, myocardial infarction, or surgery, gestation Clinical finding(10minutes) 1.Symptoms and signs 2.Laboratory finding Hyperglycemia >13.9mmol/L Acidosis with blood PH<7.35 Serum bicarbonate<18mmol/L Urine positive for ketones Serum potassium is normal or high despite total body potassium depletion resulting from polyuria or vomiting .Serum creatinine and urea nitrogen may be mild high Leukocytosis may occur with or without associated infection Treatment(20minutes) 1. Prevention 2.Emergency Measures therapeutic flow sheet insulin replacement fluid replacement electrolyte replacement treatment of complication