【正文】 十五頁，共四十六頁。,Diabetes Management Algorithm,第三十六頁，共四十六頁。,Oral Hypoglycaemic Medications,第三十七頁，共四十六頁。,In elderly nonobese patients, short acting insulin secretagogues can be started but long acting Sulphonylureas are to be avoided. Renal function should be monitored. Oral antidiabetic agent s are not recommended for diabetes in pregnancy Oral antidiabetic agents are usually not the first line therapy in diabetes diagnosed during stress, such as infections. Insulin therapy is recommended for both the above Targets for control are applicable for all age groups. However, in patients with comorbidities, targets are individualized When indicated, start with a minimal dose of oral antidiabetic agent, while reemphasizing diet and physical activity. An appropriate duration of time (216 weeks depending on agents used) between increments should be given to allow achievement of steady state blood glucose control,General Guidelines for Use of Oral AntiDiabetic Agent inDiabetes,第三十八頁，共四十六頁。,Shortterm use: Acute illness, surgery, stress and emergencies Pregnancy Breastfeeding Insulin may be used as initial therapy in type 2 diabetes in marked hyperglycaemia Severe metabolic decompensation (diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, severe hypertriglyceridaemia) Longterm use: If targets have not been reached after optimal dose of combination therapy or BIDS, consider change to multidose insulin therapy. When initiating this,insulin secretagogues should be stopped and insulin sensitisers e.g. Metformin or TZDs, can be continued.,C. Insulin Therapy,第三十九頁，共四十六頁。,The majority of patients will require more than one daily injection if good glycaemic control is to be achieved. However, a oncedaily injection of an intermediate acting preparation may be effectively used in some patients. Twicedaily mixtures of short and intermediateacting insulin is a commonly used regimen. In some cases, a mixture of short and intermediateacting insulin may be given in the morning. Further doses of shortacting insulin are given before lunch and the evening meal and an evening dose of intermediateacting insulin is given at bedtime. Other regimens based on the same principles may be used. A regimen of multiple injections of shortacting insulin before the main meals, with an appropriate dose of an intermediateacting insulin given at bedtime, may be used, particularly when strict glycaemic control is mandatory.,Insulin regimens,第四十頁，共四十六頁。,Overview of Insulin and Action,第四十一頁，共四十六頁。,第四十二頁，共四十六頁。,Patients should be educated to practice selfcare. This allows the patient to assume responsibility and control of his / her own diabetes management. Selfcare should include: Blood glucose monitoring Body weight monitoring Footcare Personal hygiene Healthy lifestyle/diet or physical activity Identify targets for control Stopping smoking,SelfCare,第四十三頁，共四十六頁。,National Diabetes Fact Sheet 2003, DEPARTMENT OF HEALTH AND HUMAN SERVICES Centres for Disease Control and Prevention World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of WHO. Department of Noncommunicable Disease Surveillance. Geneva 1999 Academy of Medicine. Clinical Practice Guidelines. Management of type 2 diabetes mellitus. MOH/P/PAK/87.04(GU), 2004 NHS. Diabetes insulin initiation University Hospitals of Leicester NHS Trust Working in partnership with PCTs across Leicestershire and Rutland, May 2008.,References,第四十四頁，共四十六頁。,Thank You,第四十五頁，共四十六頁。,內(nèi)容(n232。ir243。ng)總結(jié),Diabetes Mellitus。αglucosidase inhibitor (acarbose)。Thank You,第四十六頁，共四十六頁。,