抗糖尿病药：胰岛素与口服降血糖药（PPT课件讲稿）Antidiabetis Drugs－Insulin and Oral Antisiabetis Drugs

Antidiabetic Drugs-Insulin and Oral Antisiabetis Drugs Department of Pharmacology Liming zhou Emailzhou108a163.com 2018.10

Antidiabetis Drugs－Insulin and Oral Antisiabetis Drugs Department of Pharmacology Liming zhou Email: zhou108@163.com 2018.10

Overview a diabetes mellitus a chronic condition associated with abnormally high blood sugar Results from either deficiency of or a resistance to insulin-a hormone produced by the pancreas whose function is to lower blood sugar

Overview ◼ diabetes mellitus A chronic condition associated with abnormally high blood sugar. Results from either deficiency of or a resistance to insulin- a hormone produced by the pancreas whose function is to lower blood sugar

Overview a morbidity 300,000 people-→>0.67% 40 years old-→2.53 >19942564 years old-→2.51% 19962075 years old-→3.21% 1997-→13,500,000 people (all over the word ■2015全球糖尿病成年患者达4.15亿,中国占 1.1亿

Overview ◼ morbidity： ➢ 300,000 people－→>0.67％ ➢ 40 years old―→2.53％ ➢ 1994 25~64 years old－→2.51％ ➢ 1996 20~75 years old－→3.21％ ➢ 1997―→13,500,000 people (all over the word) ◼ 2015全球糖尿病成年患者达4.15亿, 中国占 1.1亿

Overview Cause by many of reasons -chronic hyperglycemia → metabolic disorder a Hyperglycemia --a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both ■ Insulin: B cells=- - synthesis=→丶 secretion-- blood circulation -target cells--binding with insulin receptor --intracellular substance metabolism a any link going wrong -diabetes mellitus

Overview ◼ Cause by many of reasons ――chronic hyperglycemia －→metabolic disorder ◼ Hyperglycemia ―― a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. ◼ Insulin: B cells ――synthesis－→secretion ――blood circulation－→target cells－→binding with insulin receptor －→intracellular substance metabolism ◼ any link going wrong －→diabetes mellitus

Overview Diabetes mellitus --long-term disease multisystem damage --functional defect and failure Severe --dia betic ketoacidosis --coma a Etiopathogenisis --heredity, autoimmunity, environmental factor a Diagnosis blood glucose

Overview ◼ Diabetes Mellitus ――long-term disease ――multisystem damage－→functional defect and failure ◼ Severe－→diabetic ketoacidosis－→coma ◼ Etiopathogenisis ――heredity, autoimmunity, environmental factor ◼ Diagnosis：blood glucose

Overview Therapy: early treatment, long term therapy, combined therapy and therapeutic measure individualization Purpose: blood glucose -normal, to correct metabolic disorder increase in life span, decrease death a Principle: persevere(cannot cure

Overview ◼ Therapy: early treatment, long term therapy, combined therapy and therapeutic measure individualization ◼ Purpose：blood glucose－→normal, to correct metabolic disorder, increase in life span, decrease death ◼ Principle：persevere (cannot cure)

Overview a Drink and food: gross calorific value >kg=height -105 Daily kg=-1051255K (25~30Kcal)(25~40Kca) a Therapy: before meals

Overview ◼ Drink and food：gross calorific value ➢ Kg＝height－105 ➢ Daily Kg＝105～125.5K ➢ （25～30Kcal） (25～40Kcal) ◼ Therapy：before meals

Substance metabolic disorder and Clinical situation of Diabetic glucose utilization disorder-glucose decomposition decrease energy insufficient-starvation condition → polyphagia(多食) hyperglycemia -glucosuria hypertonicity diuresis→ polyuria(多尿) protein degradation dehydration thirst→ polydipsia(多饮) accentuation athrepsy(消瘦) lipolysis excessive hyperosmolar non ketotic diabetic coma ketonuria lipolysis excessive -ketoplasia excessive→ Ketonemia→ acidosis coma

Substance Metabolic Disorder and Clinical Situation of Diabetic ◼ glucose utilization disorder→glucose decomposition decrease→energy insufficient→starvation condition →polyphagia(多食） hyperglycemia →glucosuria →hypertonicity diuresis →polyuria（多尿） ◼ protein degradation↓dehydration thirst→polydipsia（多饮） accentuation┤ athrepsy （消瘦） lipolysis excessive hyperosmolar nonketotic diabetic coma ketonuria lipolysis excessive →ketoplasia excessive→Ketonemia→acidosis coma

Classification of Diabetes Mellitus(WHO 1998) ype l insulin dependent diabetes mellitus, IDDM ype ll non-insulin dependent diabetes mellitus, NIDDM a Others: secondary diabetes

Classification of Diabetes Mellitus (WHO 1998) ◼ TypeⅠ: insulin dependent diabetes mellitus，IDDM ◼ TypeⅡ: non-insulin dependent diabetes mellitus，NIDDM ◼ Others： secondary diabetes

Diabetes Mellitus Type I Diabetes a Type 2 Diabetes cells that produce insulin are blood glucose levels rise due to destroved 1) Lack of insulin results in insulin dependence production commonly detected before 30 2)Insufficient insulin action(resistant cells) commonly detected after 40 effects >90% Pancrea eventually leads to B-cell failure (resulting in insulin dependence) killed to lymph nodes Gestational Diabetes(妊娠糖尿病) 3-5% of pregnant women in the US Lymph node develop gestational diabetes

Diabetes Mellitus ◼ Type 1 Diabetes - cells that produce insulin are destroyed - results in insulin dependence - commonly detected before 30 ◼ Type 2 Diabetes - blood glucose levels rise due to 1) Lack of insulin production 2) Insufficient insulin action (resistant cells) - commonly detected after 40 - effects > 90% - eventually leads to β-cell failure (resulting in insulin dependence) Gestational Diabetes （妊娠糖尿病） 3-5% of pregnant women in the US develop gestational diabetes