2024/7/2012024/7/20 Terminology 2Combining form prefix and suffixmeaningterminologymeaningaden/ogland腺adenitisadenomaadenopathy腺炎腺瘤腺病crin/osecrete分泌endocrinologyhypercrinecrinogenic内分泌学内分泌机能亢进的促分泌的hormon/ohormone激素hormonalhormonogenesishormonology激素的，激素性激素生成内分泌学adren/oadrenal glands肾上腺adrenitisadrenolyticadrenopathy肾上腺炎抗肾上腺素的肾上腺病22024/7/20 Terminology 3Combining form prefix and suffixmeaningterminologymeaningpancreat/opancreas胰腺pancreaticpancreatinpancreatogram胰腺，胰脏的胰酶胰造影摄片gluc/osugar糖glucagonglucogenesisglucolysis胰高血糖素葡萄糖生成糖酵解glyc/osugar糖glycopeniaglycosuriahyperglycemia低糖，糖过少糖尿高血糖症insulin/oinsulin胰岛素insulinaseinsulomahyperinsulinism胰岛素酶胰岛素瘤高胰岛素血症32024/7/20 Terminology 4Combining form prefix and suffixmeaningterminologymeaningendo-within内endodermendoscopeendoplasm内胚层内镜内质thyroid/othyroid甲状腺thyroiditisthyroidectomyhypothyroidism甲状腺炎甲状腺切除术甲状腺功能减退ovari/oovary卵巢ovariotomyovaritisovariopathy卵巢切开术卵巢炎卵巢病-trophicnutrition,growth,nourishment营养（的）neurotrophicthymotrophicadrenotrophic神经营养性的促胸腺的促肾上腺的401BriefIntroduction02Classification03Themajorfactors04Pathogenesis05ClinicalManifestations06Complications07Diagnosis08Antidiastole09TherapycontentsFigure1：Main symptom of diabetes5 6Diabetesmellitus,orsimplydiabetes,isagroupofmetabolicdiseasesinwhichapersonhashighbloodsugar,eitherbecausethepancreasdoesnotproduceenoughinsulin,orbecausecellsdonotrespondtotheinsulinthatisproduced.Thishighbloodsugarproducestheclassicalsymptomsofpolyuria(frequenturination),polydipsia(increasedthirst),andpolyphagia(increasedhunger).01BriefIntroduction 702Classification2.1Type1diabetesThepancreasundergoesanautoimmuneattackbythebodyitself,andisrenderedincapableofmakinginsulin.Abnormalantibodieshavebeenfoundinthemajorityofpatientswithtype1diabetes.Antibodiesareproteinsinthebloodthatarepartofthebodysimmunesystem,thepatientwithtype1diabetesmustrelyoninsulinmedicationforsurvival. 02Classification2.2Type2diabetesItpreviouslyreferredtoasnon-insulindependentdiabetesmellitus,oradultonsetdiabetesmellitus.patientscanstillproduceinsulin,butdosorelativelyinadequatelyfortheirbodysneeds,particularlyinthefaceofinsulinresistanceasdiscussedabove.Inmanycasesthisactuallymeansthepancreasproduceslargerthannormalquantitiesofinsulin.Amajorfeatureoftype2diabetesisalackofsensitivitytoinsulinbythecellsofthebody.8 02Classification2.3Othertypeofdiabetesgestationaldiabetes,occurswhenpregnantwomenwithoutapreviousdiagnosisofdiabetesdevelopahighbloodglucoselevel.Itmayprecededevelopmentoftype2DM.Otherformsofdiabetesmellitusincludecongenitaldiabetes,whichisduetogeneticdefectsofinsulinsecretion,cysticfibrosis-relateddiabetes,steroiddiabetesinducedbyhighdosesofglucocorticoids,andseveralformsofmonogenicdiabetes.9 2024/7/20meta-变化的变化的metabolismn.新陈代谢metaboliten.代谢物metabolizev.使新陈代谢metabolicadj.变化的，新陈代谢的poly-多的，多个的，聚合的多的，多个的，聚合的polydipsia多饮polyuria多尿polyphagia多食 Word Analysis102024/7/20uri-尿的，与尿有关的尿的，与尿有关的urinen.尿polyuria多尿uricadj.尿的urinaln.尿壶urinatev.小便urinationn.排尿glucosuria糖尿 Word Analysis112024/7/20Birth weight:FatIrregular menses (menstruation)InflammationObesityand a sedentarylifestyleSmokingMetabolic syndrome 03Themajorfactors1203Themajorfactors3.1BirthweightThereisarelationshipbetweenbirthweightanddevelopingdiabetes.Thehigherthebirthweightthehighertheriskoftype2diabetes.Attheotherendofthespectrum,averyhighbirthweight(over8.8poundsor4kg)alsoisassociatedwithanincreasedrisk.Additionally,mothersofinfantswhohadahigherbirthweight(over9pounds)areatincreasedriskfordevelopingdiabetes.13 03Themajorfactors3.2FatThedistributionoffatisimportant.Theclassicpearshapeperson(smallerwaistthanhips)hasalowerriskofdevelopingdiabetesthantheappleshapeperson(largeraroundthewaist).Theexactreasonforthisdifferenceisunknown,butitisthoughttohavesomethingtodowiththemetabolicactivityofthefattissueindifferentareasofthebody.14 03Themajorfactors3.3Irregularmenses(menstruation)Thereisanassociationbetweenthelengtheningofthemenstrualcycleandtheriskfordevelopingdiabetes,particularlyinobesewomen.thosewhohadacyclelengthofgreaterthan40daysweretwiceaslikelytodevelopdiabetesthanthosewhocycledevery26to31days.Theassociationisthoughttobelinkedwithpolycysticovariansyndrome(PCOS)whichisalsoknowntobeassociatedwithinsulinresistance.Insulinresistancemaybeaprecursorfortype2diabetes.15 03Themajorfactors3.4inflammationInrecentyearswehavebeguntounderstandtheimportanceofinflammationandheartdisease.Wenowknowthatinflammationmayplayanimportantroleinthedevelopmentofdiabetesaswell.AninflammationmarkerknownasC-reactiveproteinhasbeenshowntobeincreasedinwomenatriskfordevelopingthemetabolicsyndrome,andinbothmenandwomenatriskfordevelopingtype2diabetes.16 03Themajorfactors3.5ObesityandasedentarylifestyleObesityandasedentarylifestylearethebiggestriskfactorsthatarecontrollable.Thisisinpartduetothefactthatobesityincreasesthebodysresistancetoinsulin.Studieshaveshownthatreversalofobesitythroughweightreductionimprovesinsulinsensitivityandregulationofbloodsugar.17 03Themajorfactors3.6smokingSmokingisharmfulinmanywaysincludingincreasingtheriskofcancerandheartdisease.Italsoincreasestheriskofdevelopingtype2diabetes.18 2024/7/20men/o与月经有关的与月经有关的menstruationn.月经menstrualadj.月经的dysmenorrhean.menstrualpainamenorrhea/Menopausen.nomenstruationmetr/o子宫子宫metrorrhagian.uterinebleedingmetrostaxisn.Smalluterinebleeding Word Analysis192024/7/20metabolic代谢的代谢的metabolicsyndrome代谢综合征lipidmetabolism脂代谢glucosemetabolism糖代谢metabolicacidosis代谢性酸中毒basalmetabolicrate基础代谢率precursor:prodromalsymptomsofdiseaseC-reactiveprotein：Itisasharplyrisedprotein，whentissuesinjuryandinfect. Word Analysis2004Pathogenesis4.1ThePathogenesisofType1Isrelatedtogeneticfactors,environmentalfactorsandautoimmunity1）geneticpredisposition2）startautoimmuneresponse3）immumologicalabnormalities4）progressivelossofisletBcellfunction5)clinicaldiabetes6）isletBcellsdestroyed,diabetesclinicalmanifestations21 04Pathogenesis4.2ThePathogenesisofType2Itsoccurrenceanddevelopmentcanbedividedintofourstages1）Geneticsusceptibility2）Hyperinsulinism,and/orinsulinresistance3）Glucotoxicity(糖尿病毒性),lipotoxicity(脂毒性)4）Clinicaldiabetes22 2024/7/20immune免疫免疫autoimmunity自身免疫immumological免疫学的hyper-高高Hyperinsulinism高胰岛素症Hyperglycemia高血糖toxic毒的，中毒的，有毒的毒的，中毒的，有毒的Glucotoxicity糖尿病毒性lipotoxicity脂毒性 Word Analysis2305Clinical Manifestations5.1Type1DiabetesMellitusPolyuriaPolydipsiaPolyphagiaWeightloss24 05Clinical Manifestations5.2Type2DiabetesMellitusNon-specificsymptomsFatigueRecurrentinfectionsProlongedwoundhealingVisualchanges25 2024/7/20proteolysis蛋白质水解蛋白质水解lipolysis脂类分解脂类分解arthrolysis关节松解术关节松解术-lysis松解术，分解，溶解prote-蛋白质lipo-脂肪的arthro-关节 Word Analysis2606Complications6.1DiabeticKetoacidosis(DKA)Itisthemostcommonacutecomplicationofdiabetesmellitus.TheearlymanifestationsofDKAisthatthesymptomsbeingmoreserve,suchaspolydipsia、polyuria、polyphagiaandsoon.TheDKAischaracterizedbydifferentdegreesofdisturbanceconsciousnessintheadvancedstage.27 06Complications6.2Hyperglycemichyperosmolarstatus(HHS)Mainclinicalfeatures:hyperglycemiacrisis(高血糖危象),higherplasmaosmoticpressure(高血浆渗透压),dehydration(脱水).Minorclinicalmanifestation:varyingdegreesofdisturbanceconsciousnessorcoma,unconspicuousDKA.28 06Complications6.3InfectiouscomplicationsPyogenicinflammation:furuncle,carbuncle,pustule,etc.Fungalinfection:tineapedis,tineacorporis,etc.PulmonarytuberculosisFigure2： Infectious complications 29 06Complications6.4Macroangiopathy:Themainhistopathologicalchangeisatherosclerosis(AS).Itismostliketoaccompanywithaorta,coronaryartery,cerebralartery,renalartery,peripheralartery,etc.TheASleadstoischemicchangesofheart,brain,kidneysandlimbs.30 06Complications6.5MicroangiopathyItisthespecificcomplicationsofDM.Itstypicalhistopathologicalchangesaremicrocirculationdisturbancesandthethicknessofbasalmembraneofvessel.Themicroangiopathymostliketoaffectsretina,nerves，nephridium,andmyocardium31 06Complications6.6Neurologicalcomplications:1)central nervous system complication(CNSC):alteredmentalstatus,ischemicstroke,seniledementia.2)peripheralneuropathy:paresthesia,decreasedofmuscle,areflexia3)autonomicneuropathy:gastroparesis,diarrhea,astriction,abnormalsweating.32 06Complications6.7DiabeticfootRelatedtodistallowerneurologicaldisorderanddifferentlevelsperipheralvasculardisease.Symptomsoflight:footabnormal,skincold,high-riskfootSeveresymptoms:footulcer,necrosisDiabeticfootisthemainreasonofdisabilityandamputation33 06Complications6.8Otherdiseaseseyecomplications：suchasretinalmaculardisease,cataracts,glaucoma,Iridocyclitisskinlesions:likeSkininfections,skinitch,chappedskin,rash.Figure4： skin lesions Figure3： eye complications34 2024/7/20Macroangiopathy大血管病变大血管病变macro-largemicro-smallangi-arteries动脉血管-pathythesuffixof“diseases”Athersclerosis动脉粥样硬化动脉粥样硬化ather/oplaqueoffattysubstance动脉粥样-sclerosishardening硬化 Word Analysis352024/7/20Peripheralangiopathy周围血管病周围血管病Peri-surrounding周angi-meansvessel-pathymeansdiseaseNeurological神经病学的神经病学的Neur-meansnerve-ologicaldiscipline学科的Dementia痴呆痴呆De脱，去，减，除，离-mentiaspirit Word Analysis3607diagnosis1)Fastingbloodglucosegreaterthanorequalto7mmol/L.2)Twohourspostprandialbloodglucosegreaterthanorequalto11.1mmol/L3)Thesymptomsofdiabetesandanytimeplasmaticglucosegreaterthanorequalto11.1mmol/L37 07diagnosis7.1Type1diabetesmellitus1.Theageofonsetisyoung,theage30yearsold.2.Thesymptomscomeonabruptly3.ThesymptomsofPolydipsia,PolyphagiaandPolyuriaareobvious.4.Thebloodglucoselevelishigh,andmanypatientswithketosisacidtoxicasthefirstsymptom.LowserumlevelofinsulinandThelowlevelofCpeptide38 07diagnosis7.2Type2diabetesmellitus1.Thecommonintheelderly,highincidenceofobesity,oftenaccompaniedbyhypertension,dyslipidemia,atherosclerosisandotherdiseases.2.Insidiousonset,hasnoearlysymptoms,oronlymildfatigue,thirst,hyperglycemiaisnotobvious.3.Glucosetolerancetesttoconfirmthediagnosis4.Seruminsulinlevelinearlynormalorincreased,Theadvancedislow39 2024/7/20Plasmatic血浆的血浆的plasm-血浆-atic性质的Dyslipidemia血脂异常血脂异常dys-不良的，困难lip-脂肪的-emia血症Gluc(o)葡萄糖葡萄糖glucagon胰高血糖素glucokinase葡萄糖激酶glucocorticoids糖皮质激素enteroglucagon肠高血糖素 Word Analysis4008Antidiastole8.1Liverdiseases:Livercirrhosispatientsoftenhaveabnormalglucosemetabolism,thefastingbloodglucoseofthetypicalpatientisnormalorlow,postprandialbloodglucoseriserapidly.Thedurationoftheelderly,thefastingplasmaglucosecanalsobeelevated.41 2024/7/20Diabets health educationMedical nutrition therapyCondition monitoringDrugs therapy09Therapy4209Therapy9.1MedicalnutritiontherapyCalculatethetotalquantityofheat;Nutrientcontent;Reasonabledistribution;Follow-up43 09Therapy9.2conditionmonitoringRegularchecksbloodsugartoadjustthetreatmentplanProperexerciseregularlyEveryyearortwocomprehensivereview,complications,earlydetectionandtreatment44 09Therapy9.3DiabetshealtheducationMedicaistaffadheretofollowup,accordingtotheneedtoadjustthetreatmentplan;Lifeshouldberegular,quitsmokinganddring;Topreventinfection.45 09Therapy9.4Drugstherapy:Alphaglucosidaseinhibitor（AGI）AGIdefersabsorptionofcarbohydrationbymeansofinhibiting-glucosidasesactivity,therebydebasingpostprandialhyperglycemia.Indication:AGIisusefulinpatientshavingcarbohydrationdietdailyandthosewhosebloodsugararenormalorslightlyhigheronemptystomachbutrisingsignificantlyaftermeal.Contraindication:pregnantandlactantwomen,childrenandpatientswithgastrointestinaldysfunction.Representativedrugs:acarbose,voglibose,miglitol46 09Therapy9.4Drugstherapy：Insulintherapyl Insulin is an important and effective medicine of controlling hyperglycemia.lInsulin promotes the oxidation , composition and storage of glucose to reduce the blood sugar, and helps fat and protein synthetising and inhibits their decomposing as well .Indication: (1) T1DM ; (2) Apply to the acute and chronic complication of diabetes (3) surgery, pregnant and accouchment; (4) some special type of diabetes etc.47 2024/7/20Gluco-glucosidase葡萄糖苷酶Post-postprandial 餐后的Carbo-carbohydration碳水化合物Contra-contraindication禁忌症indication适应症Gastro-gastrointestinal胃肠道的Dys-dysfunction功能紊乱De-decompose分解 Word Analysis48