673 ( )2015 ( ) ( ) doi:10.3969/j.issn.1006-6187.2015.08.001 Handbookofpreventionandtreatmentofnon-communicabledisease-diabetes partmentof Endocrinology,Peking University People s Hospital,Beijng100044,China,T1DM,T2DM FPG 75gOGTT2hPG, IGT ( FPG( ),,,, FPG, 1999 WHO 2003ADA 1999 8h WHO, IGT IFG, HbA 1c [1] (1) JI Li-nong,CHEN Li-ming,GUO Xiao-hui,etal.De- 1 1999WHO ( [mmol/l(mg/dl)] ) * 7.0(126) 11.1(200) 11.1(200) ) <6.1(110) 75gOGTT2hPG 7.8(140)<11.1(200) IFG 6.1(110)<7.0(126) 75gOGTT2hPG( ) <7.8(140) *, ; ;, :100044 ( ), ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ( ); ( ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( ); ( 306 ( ); ( ); ( ); ( ); ( ( )
674 OGTT ; ; ; 8~10h OGTT DKAT2DM ; ; 75g ( 1 ;, ; 82.5g; 1.75g/kg, DKA(2) 75g) 300ml,5 min 3. :,2h C-P ; 3~7 2 T1DM T2DM ;3 150g/d T1DM T2DM,,,, 1999WHO, T1DM T2DM 4. : T1DM T2DM, 1.,, 25 C-PGADAb T1DM, 2. GDM 3. <30; >40; ;, ; ; T2DM DKA C-P / / (ICA,GADAb),,,GADAb ICA 2 (IA-,,, 2A) 4.,, T1DM T2DM 1. :T1DM 1. : β!,, T2DM (MODY) ;, ;, (IR)! ; / ;, α- 2. : T1DM T2DM ; ; DKA T1DM,T2DM, ; T1DM <30 ; ; Wolfram
675 2.GDM:GDM, OGTT (1)GDM : 2011 71 GDM 24~28 OGTT,1 [2-3] (3) 75gOGTT FPG 1hPG 2hPG 3 GDM [mmol/l(mg/dl)] 5.1( 92) 10.0( 180) 8.5( 153) (2) GDM : ; IGT GDM 24~28 OGTT GDM,GDM IGT T2DM T2DM GDM MS 150~159 8 160 10 ( ), 1. : 40 ;IGR ; 6 0 (BMI 24kg/m 2 ) (BMI 28kg/m 2 )/ 2 (WC 90cm, 85cm); 0 ; T2DM ; ( 4kg) GDM ;SBP 140 mmhg /DBP 90 mmhg, ; T2DM HDL-C 0.91 mmol/l( 35 mg/dl) TG 2.22 :(1) BMI mmol/l( 200mg/dl), ;24kg/m, 5% ~10%;(2) ; 400~500kcal;(3) ; ; 30% ;(4) /, 150min/ IGR T2DM, 25 4 () 20~24 0 25~34 4 35~39 8 40~44 11 45~49 12 50~54 13 55~59 15 60~64 16 65~74 18 BMI(kg/m 2 ) <22.0 0 22.0~23.9 1 24.0~29.9 3 30.0 5 WC (cm) <75.0,<70.0 0 75.0~79.9,70.0~74.9 3 80.0~84.9,75.0~79.9 5 85.0~89.9,80.0~84.9 7 90.0~94.9,85.0~89.9 8 95.0, 90.0 10 SBP (mmhg) <110 0 110~119 1 120~129 3 130~139 6 140~149 7 T2DM 2., : (4),
676, 2.HbA 1c: 2~3, 3. (GA): 2~3, HbA 1c 4. (CGM):,, 3d,,,, 4 (5), 1. (SMBG): 5 SMBG,, HbA1c 2~3 ; GA 2~3,, CGM,, ; 5~15min ;, 03:00)FPG, 8~10h FPG, 2hPG, 2h,,,,,,,, 02:00~04:00,,, SMBG ( ),, ( ),, 2h (02:00~ (6) FPG 2hPG 6 SMBG,,, ( ) FPG,HbA1c ;,,FPG ; ;
677 SMBG 5 ; 1. SMBG :(1), 1, 1 5 (3) 2, 5~7 3FPG, 3,2 1, 1 ; 5 ; 3,,, 1, 1 2~4(2) 5 (7) 3FPG,2 1, 7 SMBG A A B A B A A A A A A 3d A 1 A A A A A 1 A A A 1 A A A A A 2 3d A A 1 A A A A A 3 A A A 1 A A A A A A: ;B: 2. SMBG : 7d (1),, (2),, 3d,,HbA 1c,,, [4], (8), SMBG, 8 SMBG A A B A A A B A A B A A A B A A B A A A B A A A A A A A A A A A A A A A A ( ) A A A A A: ;B:
678 3. SMBG : HbA 1c <8.0%;, 1d 5, 3.3~5.3 mmol/l,1hpg HbA 1c 7.8mmol/L,2hPG 6.7mmol/L;HbA 1c FPG5.0~7.2 mmol/l, 5.0~ 8.3mmol/L,HbA 1c<7.5%,, ; HbA 1c 7.0% ; SMBG HbA 1c HbA 1c,, SMBG :(1) 1.,,, HbA 1c ; B 12,, HbA 1c ; 2. C E 12%, HbA 1c ; (2),HbA 1c, (3),HbA 1c C ; HbA 1c CGM HbA 1c 2~3,,, 4 ( ), HbA 1c (<5 min) CGMS,, HbA 1c, HbA 1c CGMS 4%~6%, 3 6 1 1, GDM 6.0% T1DM HbA 1c, CGMS, X CT MRI,, T2DM HbA 1c <7%,FPG 4.4~7.0 T2DM mmol/l,ppg<10.0mmol/l;,
679 1. :, ),, ;,, ;, 1 ( ) (, ), (1): 3. : T2DM, ; ;IGT (1) :,,,,, 30~90min, 45 10 T2DM, min, 4h T2DM (2) : 2000mg/d T2DM, (2) :Scr >1.5 mg/dl(133 β μmol/l),>1.4 mg/dl(124μmol/l),gfr< T2DM ;,, 45ml/(min 1.73m 2 ); 3 ; ;,, ;, ; ; 4.α- : ; (, α-,α- );,DKA; ;,, (3) : ;, (1) : ; 2. : β, ;,, α- ; IGT (3) : (D860) ( ; ; ),Scr>177μmol/L(2mg/dl); (1) : ; (18 );, β ; ;, (, ( ), ) (2) : ( α- (2): (4) :,
680, ; T1DM ; α-,, ; T2DM,, ;, ;,, HbA 1c 1.5%;, α-,, 3, 3, ; 2 5.TZDs: PPAR, [1], IR (1) (1) :TZDs, IR, IR (2) :, ; TZDs, ; (NYHA Ⅲ ) ; ; 1 T2DM 2.5 6. -4(DPP-4) : DPP-4 GLP-1, ( GLP-1, ) (, ) B 12 (1) :DPP-4 ;, DPP-4, GLP-1, GLP-1 ( ) ; α- (2) :DPP-4 ( ), 1,,,,, TZDs, ; HbA 1c0.4% ~0.9%,, ; DPP-4, ; ;,,,
681, (2)DPP-4 CKD : (9) 30~49 ml/(min 1.73 m 2 ) 50 mg/d,egfr< 30ml/(min 1.73m 2 ) 25mg/d(, 1. (CKD):CKD ); egfr 50ml/(min 1.73m 2 ),egfr30~50ml/(min 1.73m 2 ),eg-, FR<30 ml/(min 1.73 m 2 ) ; egfr, 50 ml/(min 1.73 m 2 ),egfr<50 ml/(min 1.73m 2 ) ; egfr, > 15ml/(min 1.73 m 2 ),egfr <15 [5] 5.0mmol/L (10) ml/(min 1.73 m 2 ) ( ); (1) CKD :egfr egfr 60ml/(min 1.73m 2 ),egfr 60 ml/(min 1.73 m 2 ) ;egfr45~59 ml/(min 1.73m 2 ) ;egfr<45ml/(min 1.73m 2 ) egfr 50ml/(min 1.73m 2 ),egfr 30~59 ml/(min 1.73 m 2 ),egfr<30 ml/(min 1.73m 2 ) 1/4 9 (mg) (mg/d) 250,500,850 500~2000 2~3, 500 500~2000 1~2, 2.5 2.5~15.0 1~3 2.5,5.0 2.5~30.0 1~3 5 5~20 1 80 80~320 1~2 30 30~120 1 30 30~180 1~3 1,2 1~8 1 0.25( 5~30(1.25~ 1~3 ( ) /) 7.5mg ) 0.5,1.0,2.0 1~16 2~3 120 120~360 2~3 10 30~60 2~3 α- 50 100~300 2~3 0.2 0.2~0.9 2~3 50 100~300 2~3 DPP-4 100 100 1 5 5 1 50 100 2 5 5 1 25 25 1 TZDs 4 4~8 1~2, 15 15~45 1, (3) CKD :3a,3b,4~5 CKD1~2,3~5 ; ; CKD1~3,4 CKD1~2,3a,3b~5 ; CKD1~2,3,,5 (4) CKD 4~5 ; CKD1~2, :,
682 (5)α- CKD :FDA,Scr 2 mg/dl, egfr 30 ml/(min 1.73 m 2 ), egfr<30 ml/(min 1.73 m 2 ) ; (5) : ALT AST> egfr 30 ml/(min 1.73 m 2 ), 3 egfr<30ml/(min 1.73m 2 ) 2. :, α-, (1) : (7) :, (2) :, (3) : ALT 2.5, (4) : (6) : ; (8) : 10 CKD egfr egfr egfr egfr egfr [ml/(min 1.73m 2 )] [ml/(min 1.73m 2 )] [ml/(min 1.73m 2 )] [ml/(min 1.73m 2 )] [ml/(min 1.73m 2 )] 60 45~59 <45 60 <59 60 30~59 29 60 45~59 30~44 29 30 15~29 <15 60 45~59 44 α- 30 <30 30 <30 DPP-4 50 30~49 <30 ( 25mg/d) 50 30~49 <30 50 <50 15 <15 60 30~59, <30 1/4 TZDs T2DM, β,, T1DM ( ),,,,, β,,,,,,
683 β,, :(1) T2DM,,,, IR β, ;(2) ;(3) T1DM, ;(4),DKA T2DM ;(5),, CKD ;(6), ;(7) T1DM,, ( T2DM ) (11), [1,6] 11 (h) 15~60min 2~4 5~8 ( ) 10~15min 1~2 4~6 ( ) 10~15min 1.0~1.5 4~5 ( ) 10~15min 1~2 4~6 (NPH) 2.5~3.0h 5~7 13~16 (PZI) 3~4h 8~10 20 ( ) 2~3h 30 ( ) 3~4h 3~14 24 (30R,70/30) 30min 2~12 14~24 (50R,50/50) 30min 2~3 10~24 ( 30) 10~20min 1~4 14~24 ( 25) 15min 0.50~1.17 16~24 ( 50, 50) 15min 0.50~1.17 16~24 (h) FPG HbA 1c, (12) ( ) 12 ; * >6 T2DM * >2 (R) ( ) # (NPH) 25,50 30 >10 * ; #,,, ;,, FPG,, HbA 1c FPG, HbA 1c,,,1 /d 1. : 0.1~0.2U/(kg d) FPG,, 3~5 1,, 3 1~4U, FPG
684 2. : 1~2/d,, 2/d,, 2. T2DM, : HbA 1c>9.0% FPG>11.1 mmol/l 30min, T2DM 2 3, FPG 1 /d 4.4~7.0 mmol/l,2hpg 10.0 mmol/l, 0.2U/(kg d), FPG HbA 1c, 3~5d 1,, [1,8] 1~4U FPG 2/d 0.2~0.4 U/(kg d),1 1, FPG,,, (3 ) ; 3~5d 1,,FPG >7.0 mmol/l 2 hpg >10.0 [7] 1~4U, mmol/l 3. : -, 4. - : -, T1DM = (0.4~ FPG 0.5U);T2DM = (0.5~1.0 / U) 40%~60%, 1/3,1/3,1/3 1/5,2/5,2/5,, FPG, /,3~5 1, 1~4U, FPG,,3~5, [9] 1, 1~4 U,,T1DM 1. (1) :T1DM,,, ( T2DM ; ), T2DM,, ( ;T2DM ;GDM ), ;, (2) :T1DM ; 1. : T1DM T2DM, ;GDM ;T2DM,
685 ; ;, ;, ;, ;, ( ) 2. : ; DKA ; ; ;, ;, ; ;, (2) 1. : 2. :,, 3. :,,,,,,, 4. :,,,,, 5. : 2. :,,, 6. :, 7. :, 2 ~8, 2,,,, [10],,,, 3. :,, 0, ; 25,, 1. :,,,, 2~3, ;,
686, 5~10min, :(1) ;(3),,T2DM, 2~10cm ;(4), 30min, ;(5), 25, ;, ; (6),, ;(7),, ; (, (8), );(2) [,, ( 10-6 ) ]; (3) ;(4) ;(5), ;(6),, 1. (1) : (, 5cm ),,,,,,, (2) : 1/4 (, ) (50 U 50 ml (3) :,, 300 ), (, ) (4) : 10cm ( ), (, ),,,, 10s, ;, ; (, ), : ; ; ( ),( ) 2. : ; 1. :,, ; ;, 2U,,, 1, 1; 1,1, 1cm 2. :(1) 75%,, ( 1 );(2) 15~30 min (3)
687 A: :B: 2. ( <25) <3.9 mmol/l(70 mg/dl)>16.7 mmol/l(300 mg/dl),, [12], 1.DKA (1) :DKA, 3 DKA T1DM,T2DM, [11] 1., (2) :DKA 3. ; 4. 16.7 mmol/l, DKA, ; ( ; DKA DKA (DKA ), ),,,HCO - 3 10 mmol/ldka,, DKA (HHS,,, ( ) );, 5. ; 6. /, 7.FPG 2hPG HbA 1c,, DKA 3~6 HbA 1c>8.0%,,pH /, 3, DKA >130/80 mmhg,, (3) :, 6 LDL-C>2.6mmol/L, 8. (DR CKD DPN 1 :, 13.9 ) mmol/l(250 mg/dl) 5%, 1 U 9. 10%, 2h ( ;CKD 1000~2000ml, ;DR ;,3~6h ; ) 1000~2000ml 24h 4000~ 10., 6000ml, 11. 2 :,0.1U/(kg h), 1h, 1~2h, 13.9mmol/L, DKA HHS, 0.05~0.10U/(kg h)
688 3 :,, 5.2 mmol/l 5% 5%, 40 16.7mmol/L(300mg/dl) 5% ml/h, (<3.3mmol/L), 10%, 2h 1000~2000 ml,12h, 1/2+, 24h ph6.9, 7.0 DKA,, 16.7 mmol/l, <330mOsm/L,,,, DKA 13.9~16.7mmol/L, DKA, 5% DKA 2.HHS 3. (1) :HHS (1) :,,,,, DKA; { ( 5.0 mmol/l) ph [, =2(Na + +K + )+ ]};,,,GFR,,,, (, ) HHS ; DKA,, 50% (2) : HHS, ( );,,,, (, (2) :, IS ); 1 ;,,,, (, (, );2 );, ;,,,,, (3) : 33.3mmol/L; 320 mosm/l;hco - 3 18 mmol/l,ph 7.30; :1,,,, (4) :, ; ;2, ;3,, ;4,
689,,, ;5,,, ;6 4. (13,4), <2.8 mmol/l 13 3.9 mmol/l, 4 [1]
690,, (3) :,,, IFG /IGT,, ;, (, ), (CKD DR DPN),,, T2DM (4) : 140/80 mmhg, 5 [1] ;, ; ;, 1. (1) :, (5) :T2DM TG, HDL-C,,, ( LDL-C ),, (6) :, (2) :, IR 75~150mg/d 5 T2DM 2.CKD -0.176 BUN (mg/dl) -0.170 (1)CKD :CKD (g/dl) 0.318 ( 0.762)Cockcroft-Gault(C-G), egfr,,gfr= (140- ) (kg) 1.23/ (MDRD),eG- Scr( μ mol/l)( 0.85)CKD FR[ml/(min 1.73m 2 ]=170 Scr(mg/dl) -0.999 14
691 1 2 14 CKD egfr [ml/(min 1.73m 2 )], GFR 90, GFR / (UACR) (<2.5 mg/mmol, <3.5mg/mmol); (GBM) 60~89 3,,UACR 2.5~30.0mg/mmol,3.5~ 30.0mg/mmol; GBM, 3a GFR 45~59 3b GFR 30~44 4,,UACR>30 mg/mmol; ; GFR, 15~29 5 15 CKD: ; (3) : ; ; DR; UACR,, 3 ; ; 3 2 (UACR 3 mg/mmol),, (2)CKD :1, 24h 2 UAER,, ( ) 0.8 3.DR g/(kg d);gfr, 0.6~0.8 (1)DR (15) g/(kg d); 0.6g/(kg d), 15 DR (2002) α- 3,,, ( )4 >18 140/80 mmhg ACEI ARB, 5 6 ( ), RAS (ACEI ARB ), GFR, 1~2 Scr Scr>3mg/dl 7 RAS (NPDR), NPDR (PDR), PDR : 20 ; ; (2)DR : DR GFR 15~20 ml/(min 1.73 m 2 )Scr>442 ;,NPDR μmol/l - PDR [1]
692 1 :, 3, 4,,,,, 5, L 2 L 3, DR L 4, 6 (DAN),,,,, (2)DPN (16), 1 : ; 2 : DR ; ( );5, ( ), 1 ;,5 2, ;, 2 :,,, ; 1, 2 (2 3 : ) ;, 1 ;, 4 : 16 DPN,,,; 3 ; ;, ;,α- ;, 4. :, [1] (1) (DPN) :1 DPN ; DPN E2 (PGE2);, (ARI) ;, ( ) ( ) ( ) 5. 2 (LEAD), 6,
693 6 LEAD [1] (1) : (ABI) 0.90,,, LEAD; ABI 0.90,, ABI 15% ~20%, LEAD; ABI< 0.40 <50 mmhg <30mmHg, (CLI) (2) :, ; ;,,,, LEAD LEAD ;, LEAD ;, (7) 6. 7 LEAD ;,, (2) :, ;,,,DPN,, ;, ;,, ;, ;, ; ( ), ; ; ; (3) :,,,,, (1) :,, /,,
694,,,,,,,, (4) :,,, ( / ),,,,HbA 1c <7% ; IR,,,, HbA 1c 7.5% ~8.0%,,, SBP DBP (PP), T2DM,SBP PP,,DBP,SBP,, SBP, IR 2 (2013), <140/80 mmhg 120/80 mmhg,,,,, 140/80mmHg, SBP 160 mmhg, ACEI ARB β,,aceiarb
695, TG<1.7mmol/L,HDL-C>1.0mmol/L ACEIARB, >1.3mmol/L, β TG, HDL-C, T2DM TG 11.1 mmol/l,, TG ( ) TG LDL-C HDL-C,,,,, T2DM T2DM BMIWHR,,,,,,,,,, 30 min/d, 50%,, LDL-C 2 (2013 ), LDL-C, :(1) ( ) P2Y12 (,LDL-C <1.8 mmol/l (2), 40 1 ) ( ),LDL-C <2.6 mmol/l(3)ldl-c>2.6 mmol/l,ldl-c 1 <2.6 mmol/l,,ldl-c 30% ~ 40% 17~18) T2DM,, IR, ) Ⅱb/Ⅲa (, [1] (
696 (mg) 17 (mg/d) Captopril 12.5 25~100,, Enalapril 10 5~40,, Cilazapril 2.5 2.5~5.0,, Fosinopril 10 10~40,, Perindopril 4 4~8,, Ramipril 2.5 1.25~20.00,, Lisinopril 10 5~40,, Benazepril 10 10~40,, Imidapril 5 2.5~10.0,, Losartan 50 25~100, ( ) Valsartan 80 80~160, ( ) Irbesartan 150 150~300, ( ) Candesartan 8 8~32, ( ) Telmisartan 80 20~80, ( ) Olmesartan 40 20~40, ( ) Nifedipine 10 10~20,, Nifedipine 30 30~60,, Amlodipinebesylate 5 2.5~10.0,, Felodipine 5 2.5~20.0,, Lacidipine 4 4~6,, Perdipine 40 60~90,, Nitrendipine 10 20~60,, Lercanidipine 10 10~20,, Verapamil 120 120~240, Metoprolol 25,50 50~100, Bisoprolol 5 2.5~10.0, Atenolol 25 12.5~50.0, Propranolol 10 30~90, Betaxolol 20 5~20, Labetalol 100 200~400, Carvedilol 10 12.5~50.0, Arotinolol 10 10~20, Furosemide 20 20~80 Hydrochlorothiazide 25 6.25~25.00,, Indapamide 2.5 0.625~2.500,, Indapamide 1.5 1.5,, Amiloride 2.5 5~10 Triamterene 50 25~100 Spironolactone 20 25~50 Terazosin 2 1~20 Doxazosin 2 1~16 Prazosin 2 2~20 Urapidil 20 40,, <35% <10% >10% >40g,,
697 18 (mg) Fenofibrate 200,, Gemfibrozil 1200,, Lovastatin 20,, Simvastatin 20~40,, Pravastatin 40,, Fluvastatin 40~80,, Atorvastatin 10~20,, Rosuvastatin 10,, Pitavastatin 2,, Nicotinicacid 500~2000,,, Cholestyramine 4000~16000, Colestipol 5000~20000, Ezetimibe 10 Policosanol 5~20 Xuezhikang 1200, TG; LDL-C ;DKA ;,DR CKD, (, ); ; ; (2) : BMI WC; ;, ; ; ( ); ( ; ) (3) :3 ; HbA 1c;1 ; Cr,ScreGFR ; 2. ;SMBG ( (1), ), FPG 2hPG HbA 1c ;SMBG (2), ; ; (3), ; (4) 2, ; HbA 1c; [13] 1HbA 1c (5), 1., (1) :, DKA ;, ; ; ( ; HbA 1c ),, ; ; ; [14]
698 1. (4) :, (1) : (kg)= 1 (90kcal) (21) (cm)-105 20% ; 20% ; ±10% 21 (2) : 25g 25g 35g = 25g 37.5g 25g, 167cm, 75kg, 125g, 167-105=62(kg), 25g 25g 25g 35g 25g 20%, ; 62 30= 500g 500g 250g 1860kcal(19) 500g 500g 500g 19 250g 500g 500g [kcal/ (kg)] 200g 500g 500g 500g 500g 400g 400g 500g 70g 20~25 35 40 40~45 250g 500g 15~20 30 35 40 15 20~25 30 35 80g 80g 20g (3) : 60g 50g 50g (20) 50g :,56,170cm,85kg, 160g 130g 15g 170-105=65kg; 85kg, 10g 15g 25g 30%, ; ; 19, 15g 15g 30g 20~25kcal/kg, 150g 50g 100g 65 20~25=1300~1625kcal 1400kcal 200g 500g 200g 200g 200g 200g 20 250g 250g 300g 200g 1200kcal : ; 50g; 250ml 1 ; 75g; 50g; 250g; 1 ; 1 75g; 75g; 250g; 1 1400kcal 2. 50g; 250ml (1) : 100g; 50g; 250g; 1 100g; 75g; 250g; 1 50%~60%1g 1600kcal 4kcal 75g; 250ml; 1 100g; 50g; 250g; 1 (2) : 25%~30%, 100g; 75g; 250g; 1 300mg/d 1g 9kcal 1800kcal 2000kcal 2200kcal 75g; 250ml; 1 125g; 50g; 250g; 1 100g; 75g; 250g; 1 75g; 250ml; 1 125g; 75g; 250g; 1.5 125g; 100g; 250g; 1.5 75g; 250ml; 1 150g; 100g; 250g; 1.5 150g; 150g; 250g; 1.5 (3) : 10% ~15%,, 50%, 50% 0.8g/(kg d)1g 4kcal (4) : :14g/kcal, (5): 6g/d,
699 :,56,170cm,85kg,,, 1860kcal 2. (22) 50%~60%,1860 (50% ~60%)=930~1116 kcal; 15%~20%,1860 (15%~20%)= 279~372 kcal; 30%,1860 30% =558 kcal 3 g,, (930~1116) (2) : 4=232~279g; (279~372) 4=70~93g ( ); 558 9=62g 3. :, (3) : 20~,1g 7kcal 15g/d, 25g/d(15g 450 ml 150 ml 50ml ) 2, 4. ( ) : T2DM IS, IR,, ;, IS, ; : (110~120m/min), TG ;,, ; ), ; :30min/d, ; :5d/, 8 HbA 1c 0.66%; 12~14 [15] 1. (1) : IGT T2DM ( DPN), ;DKA T1DM,, (2) :FPG>16.7 mmol/l,,dka,,pdr, CKD, ( ) (1) : T2DM <(170 );,, ;, 60min (4) : 3~7, 1~2d (5) : /, : :,,, : ( 22 90kcal ( ) (min) (3.6km/h) 30 (4.5km/h) 27 (5.4km/h) 21 (7.2m/h) 12 (9.6km/h) 10 10 (5.4km/h) 21 (320m/min) 30 10 10 (50m/min) 9 (60/min) 10 15 ( ) 7.5 ( ) 9 ( ) 9 ( ) 9 ( ) 6 ( ) 25
700 3. :,,, ; ;,, :, ; :, (FPG 7.0 mmol/l 11.1 mmol/l),, :,,, >7.8 mmol/l,, 1, /,1~2/d,,, DR, 2h, 1~2h,, 1,,,4~6h 1 CKD,,, 4. : 1~2h1,,, /,,, 7,, 1~2h1,, ICU,30 min 2h 1,,, ; (23) 23 [ (2013)] [16] (mmol/l) FPG8~10/ PPG8~12 FPG6~8/ 2hPG8~10 FPG4.4~6.0/ 2hPG6.0~8.0, ( ) ICU ICU(SICU) ICU(MICU) 80 <5,
701 24,, BG >7.8mmol/L, ( ) ; (24) 1. : (FPG 2hPG) X, 1~2h 1, 1~2U/h BG 4h 1 BG BG3.3~4.4mmol/L 1h BG2.2~3.3mmol/L, 1h 1 BG <2.2mmol/L, 10g 1h 1, 1~4h 1, 1h 1, <3.5mmol/L>20.0mmol/L, 1h 1; <6.1mmol/L, 2h/; >6.1mmol/L,4h/,,FPG<7.8mmol/L,2hPG<10.0mmol/L, [1], ).,2014,30:893-942., 3,.,,2011. 2. :,,2014,49:561-569. [4] ).,2011,03:13-21. [5] ;,, 5.0~11.0 mmol/l,,2011. [6] 5% 100~125ml/h,,2013. 3. : FPG<7.8 mmol/l, (2014).,2014,8:3. [8] <10.0 mmol/l,,2013,10:33-38., [9].. [10] > 10.0mmol/L,.,2011. [11] 7.8~10.0mmol/L (2012 ).,2013,5:1-3. [12]. ).,2013,8:36-38.,, 2mmol/L, 1U/h, <0.1 U/(kg h),, 1~2U/h [14] [15],2012., [16]. 2 (2013 [2],. : [3],. (2014).. (2011,. (2010 ). :. 1. : [7],,.. 2,2013,93:1524-1526.. :. 2 ( [13]AmericanDiabetesAssociation.Standardsof MedicalCarein Diabetes-2015.DiabetesCare2015,38(Suppl1):S1-S90.. 2 (2010 )[EB/OL].(2015-06-10).htp://www.cma.org.cn/.. :..,2013,29:189-195. ( :2015-06-18) ( : )