,,, (CIP) /,,. :, 2004.2 ( ) ISBN 7-81060 - 326-4............... - -. R587.1-44 CIP ( 2003) 067049 : : 818 : 200433 / : 021-65493093 : 787 1092 1/ 32 : 4.5 : 101 2004 2 1 2004 2 1 : 1 3 000 ISBN 7-81060 - 326-4/ R 245 :9.50
, 10 3 000, 2000 1.6 ( W H O) 1997, 2025, 3 1994 1980 3, 3 000, 30 5 000,,,,,,,,,,,, 1
,,,,,,,,,, 2003 11 2
1.? 1 2.? 1 3.? 2 4.? 3 5.? 4 6.? 6 7.? 6 8.? 7 9. 1? 7 10. 2? 8 11.? 9 12.? 10 13.? 10 14.? 11 15.? 11 16.? 11 17.? 12 18.? 13 1
19.? 14 20.? 14 21.? 15 22.? 16 23.? 17 24.? 17 25.? 17 26.? 18 27.? 19 28.? 19 29.? 20 30.? 21 31.? 21 32.? 23 33.? 24 34.? 25 35.? 26 36.? 26 37.? 27 38.? 28 39.? 29 40.? 30 41.? 31 42.? 32 43.? 32 44.? 33 2
45.? 34 46.? 34 47.? 35 48.? 36 49.? 37 50.? 38 51.? 39 52.? 40 53.? 41 54.? 41 55.? 42 56.? 42 57.? 43 58.? 43 59.? 44 60.? 45 61.? 46 62.? 46 63.? 47 64.? 47 65.? 48 66.? 49 67.? 49 68.? 50 69.? 51 70.? 52 3
71.? 53 72.? 54 73.? 55 74.? 55 75.? 56 76.? 57 77.? 57 78.? 58 79.? 59 80.? 62 81.? 63 82.? 64 83.? 65 84.? 65 85.? 67 86.? 67 87.? 68 88.? 69 89.? 69 90.? 70 91.? 71 92.? 71 93.? 72 94.? 72 95.? 73 96.? 73 4
97.? 74 98.? 75 99.? 75 100.? 76 101.? 77 102.? 79 103.? 81 104.? 81 105.? 82 106.? 83 107.? 84 108.? 84 109.? 85 110.? 85 111.? 86 112.? 87 113. -? 87 114. -? 88 115.?? 88 116.?? 89 117.? 90 118.? 90 119.? 92 5
120.? 94 121.? 95 122.? 96 123.? 96 124.? 98 125.,? 98 126.,? 99 127.,? 100 128.? 101 129.,? 102 130.? 102 131.? 103 132.? 103 133.? 104 134.? 104 135.? 105 136.? 106 137.? 107 138.? 107 139.? 108 140.? 109 141.? 109 142.? 109 143.? 110 144.? 111 6
145.? 112 146.? 112 147.? 113 148.? 114 149.? 114 150.? 116 151.? 116 152.? 118 153.? 118 154.? 119 155.? 120 156.? 120 157. 2? 122 158. 2? 122 159. 2? 124 7
IGT IFG 1.? (impired glucose tolerance, IGT ),, :, 2 h 7.8 11.1 mmol/ L 6.1 6.9 mmol/ L,, ( ),, 2.?,, 5 10, 1/ 3, 1/ 3, 1/ 3, 1% 5% 2,,,,, 1
,, 3.?,,,,?,,,,,,,,,,,,,,, 2
4.?,,,,,, : (1 ) (2 ) (3 ) (4 ) (5 ) (6 ) (7 ) ( ) (8 ), (9 ) (10) 3
5.?,,,, (1),!,,,,,,,,,,,,, (2)!,,, :,, (3)!,, 4
,,, (4),! 1,,,, 2,, :,,, 1,, ; 2,,,,,,,? 2,,,,,, 5
6.?,,,? ( ),,,,,,, : (1) (2) (3), ( ) ( ), 7.?,?, 3 :,,,,,,, 6
,,, 8.? 1980 ( W H O),, 1997 ( ADA), 1999 WH O : 1 2 1 B,, ; 2 ; 8, B ( MODY), ;, 9. 1? 1, B, 1 (1 ) 7
B,, H LA,, C, ( LADA ) 2,,, (2 ),,, B, HLA, 1 1 2-1 < 30 ( + ) C ( G AD, ICA, IA-2) 2-1 1 10. 2? 2,, 2,, 2, 8
,, 2,,, 2, 2,, 11.? B B,, < 25, ( MODY),,, DNA,, ( ), B, 9
12.? ( MODY ), 3 : 12, H N F12 ( MODY 3) ; 7, ( MODY 2) ; 20, H NF-4 ( MODY 1) MODY : < 25 ;, 2 ; ;,, B, 13.? 1, 2,,, : (1 ) (2 ), (3 ) (4 ) (5 ), (6 ) (7 ) (8 ) (9 ) 10
14.?,,,,,,,,,,, 15.?,,,,, ;,,, ;,,,,,,,,,,, 16.?, 11
,,,, 2 70% > 14 mmol/ L, 24 h > 25 g,,,,,,,, 17.?,,, 1997 ( ADA) 1999 ( WH O ) ( 2-2) 2-2 [ mmol/ L ( mg/ dl) ] ( ) ( ) ( ) ( ) 6.1 ( 110 ) 6.1 ( 110 ) 7.0 ( 126 ) 2 h 10.0 ( 180 ) 11.1 ( 200 ) 11.1( 200 ) I G T ( ) ( ) < 6.1 ( < 110 ) < 6.1 ( < 110 ) < 7.0 ( < 126 ) 2 h 6.7 ( 120 ) 7.8 ( 140 ) 7.8 ( 140 ) I F T ( ) ( ) > 5.6 ( > 100) > 5.6 ( > 100) > 6.1 ( > 110 ) 12
( ) [ mmol/ L ( mg/ dl) ] ( ) ( ) ( ) < 6.1 ( < 110 ) < 6.1 ( < 110 ) < 7.0 ( < 126 ) 2 h < 6.7 ( < 120 ) < 7.8 ( < 140 ) < 7.8 ( < 140 ) : (1 ),, (2 ),, (3 ),,,, 18.? : (1 ) (2 ) (3 ), (4 ),, (5 ), (6 ) 13
19.?,,,,,,,,,,,,,,,,,,,,,, 20.?,,,, 14
,,,, ( 1 ) (2 ), 2, ( ),,,,, :, 21.?,, 3.3 8.6 mmol/ L ( ) 2.8 mmol/ L( 50 mg/ dl),,,,, 15
?,,,,,,, 22.?,,, ( ) ( ), ( ),,,,,,,,,,,, (, ),, 3.5 mmol/ L,,,,, 3.5 mmol/ L,,, 16
23.?,,,, : ( ),,, 6 h,,, 24.?,,? : ( ), 2 3, 25.? 2, 17
: (1 ) :,, (2 ) :, (3 ) : (4 ), :, -, UK PDS Kumamoto 2,,, 26.?, ;, (1 ) :, ( ),, 24 48 h, (2 ) : 50% 20 ml 0.5 1 mg ; ( ) 18
,, 24 h,, 27.?,, : (1 ), (2 ) ( ) (3 ), (4 ),,,, 1, 2, 1, 60% 1%, 28.?, 19
1, ; 2 : (1 ) (2 ) (3 ) (4 ) (5 ) (6 ) (7 ),,,, 13 mmol/ L,, 29.?,,, :, ;, ;, ( ) ( ) ; 2 h ;, 20
30.? 2, 1,,,,,,,,,,,,, 31.?,, : (1 ) :,,,,, (2 ) :,,,, ;,,,,, (3 ) :,,, 21
(4 ) :,,,,,, (5 ) :,, A,,,, (6 ) :,,,,,,,,, (7 ) :,,, ;,,, (8 ) :,,,,, (9 ) :,, 22
, (10) :,,,,,,, 32.? 1921,,,, 5, 1, 5,2,,, : (1 ) :,, 2,,,, 23
(2 ) :,,,, (3 ) :, ;,,,, (4 ) :,, ( 5% ) 50% 70 %, (5 ) :,,, 33.?,,,,, 2, 75%, 75 %,25%, 24
4 70 %, 80%, 34.?,,, 25,,,,,, ;,, ( ) 1 2,,, 25
35.? : (1 ) :,, (2 ) :,,, (3 ) :,,,, ( ),,,,, 36.?,, : ; ; ;,, 26
2 4, 45 10 20, ( > 90 / ),, ;, ;, ;,,, < 17.3/ 11.3 kpa( 130/ 85 mmhg ),,, ( ) ( ),, 37.?,,,,,,,,,,, ( 27
),,, B,, H DL-C,,,,,,,,,,,,,, 38.?, 2 4,, : 10% 23%,,,,, 28
4,,,,,,,,, ( ), 39.?, 1 50 %, 2 5% 10%,, 5 : (1 ) :,, (2 ) :,, ( > 20 g/ min), (3 ) :,, 20 200 g/ min, ( ) (4 ) : > 200 g/ min, 24 h > 300 mg, > 0.5/ 24 h,,,, ( ) (5 ) :,, 29
40.?, 24 h, 1 2,,,,,, ( ),,,,,,,,, 1,, 2,,,, 1,, 10 20,,,,,,,,,,, 30
,,,,,,,,, 75%,, 41.?, ;, (,, ), (, ), (,, ), (, ),,,, 31
42.?, 5 10,,,,, ;,,,,,,,, 43.?,, :,, : ( 32
, ), (, ), ( ), (,, ), ( ) ( ),, 44.?,,, :,,, ( 40 C),,,,,,, 5 10 min,,,,,,,,,,,,,,,,,,,, 33
,,,,, 30 60 min,,,,,,, ( ),,,,, 2 3 d, 45.?, 0.1 % 0.2 %,,,, X,,, 46.?, 34
,,, B1, B1,,,,,,,,,,,,,,, 47.? - -,, ( ED) 80%,, 40% 50%, 5 %, 20%, 70%, 10% 20%,, 35
,,,,,,,,, ( ),,,,,,,,,, 48.?,,,,,,,,,, ;,,,,, ;,,, ; 36
49.?,,, (1 ) : 2, ;, 5.4 mg, 3 4, 10 (2 ) ( ) : : 1 3 mg, 30 40 mg (3 ) :,,,,,, :1 3 mg, 3, 1 mg,, 1 3 mg,, 1 (4 ) : 0.5 1, (5 ) :,, 50 mg,, 1, (6 ) : 37
50.?, ;,,,,,, : (1 ), (2 ),, ;, B, ; (3 ),, 3 :,,,,,,,,,,,, 38
51.?, (1 ) : 150, 39 35, (2 ) :, (3 ) :,,,,,,,,,,,,, (4 ) : 7%, (5 ) :,,, (6 ) :,, (7 ),, 39
52.?,,, ( 10 mmol/ L ),,,, : (1 )24 h : 24 h,,,,, 24 h < 1 g (2 ) :,,,,, (3 ) :, ( ),, ( ),,,,, 40
53.?, (1 ) : ; (2 ) 1 2 d (3 ), : (1 ) (2 ) (3 ) (4 ) (5 ),, 54.? 1970,,,,,,, 41
,,, 12%, 10%, 10%,,,,,, 55.?,,,,,,,,,, 2 h, 1 2,, 56.?,,,,,, 42
2 4% 6%, 1% 1.6 mmol/ L 7 % 57.?,,,,,, 40% 10%, 2 30%,,, 58.?,,,, ( ) :, 1,, 43
1, 2 3 1, 1 ( ), 1, 1,,,,, 2-3 2-3 [ m mol/ L ( m g/ dl) ] < 6.7 ( < 120 ) < 7.8 ( < 140 ) > 7.8 ( > 140 ) 2 h [ mm ol/ L ( mg/ dl ) ] < 7.8 ( < 140 ) < 11.1 ( < 200 ) > 11.1 ( > 200 ) ( % ) < 6.0 < 8.0 > 10.0 ( C H ) [ mm ol/ L ( m g/ dl ) ] 5.2 ( < 200 ) < 6.24 ( < 240 ) > 6.24 ( > 240 ) ( T G ) [ m mol/ L ( mg/ dl) ] 1.7 ( < 150 ) < 2.75 ( < 250 ) > 2.75 ( > 250 ) ( H DL ) [ m mol/ L ( m g/ dl) ] > 1.17 ( > 45 ) 0.93 1.17 ( 36 45 ) 0.91 ( 35 ) ( B P ) [ kp a ( mm H g ) ] < 18.7/ 12 18.7 21.4/ 12 > 21.4/ 12.6 ( < 140/ 90 ) 12.6 ( 140 160/ 90 95 ) ( > 160/ 90 ) 59.?,, 2-4 2-4 * ( mmol/ L ) 4.4 6.1 7.0 > 7.0 44
( ) 4.4 8.0 10.0 > 10.0 H ba * * 1c ( % ) < 6.5 6.5 7.5 > 7.5 ( mm H g) < 130/ 80 130/ 80 140/ 90 140/ 90 BMI * * * ( kg/ m 2 ) < 25 < 27 27 < 24 < 26 26 T C * * * ( mmol/ L ) > 4.5 4.5 6.0 HD L- T C * * * ( mm ol/ L ) > 1.1 0.9 1.1 < 0.9 T G * * * ( mmol/ L ) > 1.5 < 2.2 2.2 * * *, H ba l c < 6.0 %, DC CT * * *, BMI 60.?,,,,,,,,,,,,,,,,,,,,, 45
61.?,,,,,,,,,,,,,,,,,,,,,, 62.? (DCC T ) ( U KPDS ),,,? 1999 2, 4.4 6.1 mmol/ L, 46
4.4 8.0 mmol/ L, 1 2 mmol/ L,,, 63.?, ( ), ;,,,,,,,,, ;,,, 64.?,,, : (1 ), 7.8 mmol/ L( 140 mg/ dl) (2 ) (3 ) (4 ) (5 ) 47
, 200 ml,70 ml 25 g 25 g, 335 kj( 80 kcal),, 65.?,,,,,,, 2 h,,,,,,,,,,,,, ;, ;,,,,,,, 48
,, 66.?,,,,,,,,,,,,, 67.?,,,,,, 49
,, 68.?,,,, 3 000, 60%,,,,,,,,,,,,,,,,,,,, 50
,,,,,, 1 2,, 8, 5,,,,, B :, 1,,, 69.?, C,, :,,,,,,,, 200 g, 200 g, 51
200 g, 200 g, 500 g, 200 g, 200 g, 200 g, 150 g 25 g,,, 70.?, : :,,,,, :,,,,,,,,,,,,,, : 0.5 1 h,,,,,, < 6 mmol/ L(110 mg/ dl) 20 g,,,, 52
71.?,,, : (1 ) :,,,,, (2 ) :,,,,, (3 ) :,,, ;,, ;, (4 ) :,,,,,,,,,,,, (5 ) :,,,,,,,,, 53
45 C 15 min,,,,, (6 ) :,,,,,,, 72.?,,,, B, B B,,, B, B, B,,,,, B, 1,, 54
73.?,,,,,, : :,, 20%, :, 300,, :,,,, :,,,,,,, 74.? ; 2,,,, 1, 55
, 2 2,,, 75.? : (1 ) (2 ) 25% 30%, 1/ 3, (3 ) 55% 65% (4 ) 15% (5 ), (6 ), (7 ) ( ), ( ) (8 ) ( ) (9 ), 10 g/ d, 56
: ( ) ; : ; : 76.? : ( kcal), 80 ( -1 ), -2-3,,, :, 200 250 g, 250 300 g, 300 400 g, 400 g 150 g, 250 500 g, ( ) 3 4 77.?,,,,, : 30 % 50% 57
, 100 150 g ( ), (50 g ), (250 g ),, : = 1 1 1, 10%,,, 20 25 g,,, :,,, 150 g 500 g,,,, 100 g 25 g 200 g, 25 g 78.?,,,,,,,,,,,, 58
,,,,,,,, 79.?,, : (1 ), :,,,,,,,, (2 ), :,,, (3 ) :,,,,, (4 ) :,,,,,,,,,, (5 ) :,, 59
( ),,,, B12,,,, (6 ) :,,,,, 5 6 g (7 ) :,,,, (8 ) :,,,, (9 ) :,, (10) : ( 20%, ),,,, (11) :,,,, 60
, (12), :,,,,, (13) :,,,,,, (14), :, 100 g 2 093 kj (500 kcal), 1/ 4 1/ 3, (15), :,, (16) :,,, (17) :,, (18) :,, (19) :,,, ( ) 50 g (20), :, 10 mmol/ L,,, 61
80.?,,,,, 50 g,,,,,,, 1 g,, 1.2 1.5 g 60 kg, 60 g 70 90 g, 1/ 3, 15 % 20% 2 3 g, 4, 15 25 g,,, 80 100 g,,, 0.6 0.8 g,,,,,,,,,,,, 62
,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 81.?,,,,,, 40 % 10 %,, 63
,, :, ;, ; ; 82.?,,,,,, : (1) :, 125.6 134.0 kj (30 32 kcal), 104.7 kj ( 25 kcal) 146.5 kj (35 kcal) (2 ) :, 15 % 20%, 1.2 g, 50% 150 g, 50 100 g (3 ) :,,, (4 ) : A D B2,,,, 64
, 5 6,,,, 83.?, : (1 ) :,,,,,,,,,,,,, (2 ) :,,, ( ),, (3 ) :, 84.?, 420 mol/ L 65
,,,,, : (1 ) : : ( ) : : (2)B C: 2 500 3 000 ml, 2 000 ml,, (3 ) :, 50 60 g,,, 1 kg,,,, (4 ) :,,,, 66
85.?,, :,,,,,, ;,,,,,,,,,,,,,,,,,, ;,, 86.?,, : (1 ) : 67
(2 ), :,, (3 ) :,, (4 ) :,,,, (5 ), :,,, (6 ) :, 87.?,,,,,,,,,,,,,,,,,,,, 68
,,?,,, ;,,,, 88.?, 100 g 5 min, 2 h, 0.5 h 11.1 mmol/ L,,,,,,,,, 89.?,,,,,,?,,,,, 69
,,, 90.?,, ( - 105) kg,, 104.7 125.6 kj/ kg( 25 30 kcal/ kg ) 50%, 15 % 20 %,, 1 g/ kg,,, 100 g, 25 g,,,,,,,, : 175 cm : 8 792 kj( 2 100 kcal), 350 g, 150 g,, 250 g, 500 g, 25 g, 25 g 175 cm, 175 cm : 7 117.6 kj(1 700 kacl), 275 g, 100 g,, 250 g, 500 g, 25 g, 20 g 175 cm : 6 699 kj( 1 600 kcal), 250 g, 100 70
g,, 250 g, 500 g, 25 g, 20 g : 5 862 kj( 1 400 kcal), 200 g, 100 g,, 250 g, 500 g, 250 g, 15 g 91.?,,,,,,,,,,,,, 92.?,,,,,,,,?,, 71
,,,,,,,, 93.?,?,,,,,,,,,,,,, 94.?,,,,,, :,, ; ; ; ; ; ; ;, ;, 72
;,,, 95.? 2,, 30 min, ( ) ( ) 2,,,,,,,,, ( ), 96.?, 73
,,,,,,,,,,,,,,,,,,, ;,,, 97.?,, : (1 ) (2 ), 14 mmol/ L 10% (3 ) (4 ) (5 ) (6 ), (7 ) 74
98.?,,,,,,, : ( 3, 1 h ), ( 0.5 1 h ),,,,,,,,,,, 99.?,,,,,,,30 40 110 115 /, 40 50 105 110 /, 50 60 100 105 /, 60 100 / : ( 200 - ) 0.8 (180 - ),,, 45 75
,, 1 h,,, 20 30 min, ; 40 min,,, 100.? :,,,,,,,,, 1,, 1,,,,,,,,, 76
,, ( ) 9,,,,,,, 101.? 2, : (1 ) : 2,, 60 % 70 %,, 10%,,,, 1,, ;,, 5 mg 77
4 mg, 1, 5 mg, 5 10 mg, 30 mg, 2 3,,,,, 0. 5 h (2 ) :, 2,,,, ( TG) ( H DL) -1( P AI-1 ),, 500 800 mg/ d, 1 500 2 500 mg/ d,,,,, (3 ) - : -,,,, ( H ba1 c ),,, 78
,, ;,, 25 50 mg, 1,, 50 mg/ d, 50 100 mg, 3,, (4 ) :,, 2,,,,, 200 600 mg/ d,,, 1 4, 6 8, 20%, 30% 102.?, : :,,,, 79
2,,,,,,, 7.8 mmol/ L ; ; ; 7.8 11.0 mmol/ L ( ) ( ), :,,,,, HbA1c,,, 80
103.?,,,,,,, :, ( ),,, ( ) ( ) ( ), ( ),,,, 104.?,,,,,,,,,, ( ) ( ),,,,,,, 81
,,,,,,,,,, ( ) ( ),,,,,,,,,,,, 1 ( ),,,,,,,, 105.?,,,,, 82
,,, : ; ; ; ; ; ( ), ( ) ;, ; ( ), ; ( ), ; ( ),,,,,, 106.?, : 2, 3 2 40 U,, 40 2, 5,, 83
, 107.?,,,, :, : ( ) ( ) ( ),,, 108.?,, : :,,, 84
, :,,, :, :, 109.?,, 1995 9 B,, 2, 1 2 mg/ d, 2 mg, 1 2 2 mg, 4 mg/ d, 8 mg,,,, 110.? ( ),,,,, 85
, 2,,, ATP,, B,,,, 40 80 mg, 1 2, 80 240 mg, 111.? :,, 1,, ( ),, 1,,,,,,,,, 3 : 86
112.? : 2, 1,, ( 20 U ),,, 2,, 2 ; 2 1, ; ; 20 U ; ; 113. -? -, - :, ( IGT ) -IGT, 2 87
,, - 1, -, - -, -,,,, 18-114. -? -, :,, -,,, -,,, - ( ) ( ) 115.?? 2,, 20 80, 88
,,, PPAR- ( ),,,, ( ) 1999, 5 500 2,,, 200 600 mg/ d 4 8 mg/ d -Lilly ( ) 1999 7 FDA,, 15 30 mg/ d,, 116.??,,, 15 min, 1 h,, 1 h,, P4 50 CY P3A4 96 h 98%, 90%, 8% 89
,,, 2 117.? B,,, : 1,, 2,,,,, :,,, 118.?, : (1 ) : : 90
,, 20 30 min, 2 4 h, 5 8 h, R R :,, 1.5 4 h, 6 10 h, 12 14 hn N :,, 3 4 h, 14 20 h, 24 36 h :, ( R N ), 30 R 50R 70/ 30 30R 30% R 70% N ; 50 R R N 50% (2 ) : :, 3,,, :,,, :,,,, (3 ) : U-40: 40 U/ ml U-100: 100 U/ ml, 40 U/ ml, 91
, 119.?,, 24 h,,, Lispro N N304 H OE901 (1 )Lispro: Lispro ( RI) :,, 5 15 min, RI 2, 15 min, 30 60 min, RI 4 ;, 60 90 min, RI 1/ 2, 1 3 h, 4 5 h, Lispro, 30 min 1 h,,,,,, 92
, Lispro,, Lispro, (2 ): :,,, : ( NP H Lent e) N P H ( ultralente PZI ), :, ; ultralente PZI 24 h,, 24 h,, 24 h,,,,,,,, 93
,, 120.?,,,, Protein Delivery P rotein Delivery Generex Oralin, Cortecs Macrulin, Elar, Auto Immune 8 1, Protein Delivery M2 P rotein Delivery, M2, M2 4 h 10 min, 90 min,, Generex Oralin Oralin, ( Auto Imune ) 3 1 94
,, 121.?,,,,,,,,, 1,, 2,,,,,,,,, :, 2, 2 1,, 95
122.? ( ),,,,,,,,,,,,,,,,,,,,,, 123.? ( ), ( ),,,,, 96
,,,,,,,,,,,,,,,,,, 45,, 5 8 s,,,, :,,,,,,,,,,, 97
124.?, ( ) 2 8 C ( ),,, ( 25 C), 6, 4,, 3, 4,,,, 125.,?,,,,,,, < 3 mmol/ L, 10 g 10 15 98
min, 2 U, 30 min 3 8 mmol/ L,, 20 30 min 8 11 mmol/ L, 2 U, 30 40 min 11 14 mmol/ L, 2 4 U, 1 h 14 20 mmol/ L, 2 4 U, 1 h > 20 mmol/ L, 4 6 U,, 1 h,,,,,,, 11 mmol/ L,, 6 mmol/ L, 126.,?,,,? (1 ):,,, 99
, (2 ):,,,,,, 2 4 U 127.,? 2,, ( 10 ) 2 6.0 11.0 mmol/ L, 6.0 8.0 mmol/ L,, : ; ;, ( ),,, 2,, 100
, 128.? : (1 ), (2 ) (3 ) (4 ) ( ) (5 ), 1,,, 10, 0.5 1.0 U, 20 U, 3 15 30 min 8 U, 4 U, 6 U, 1 2 d 11 18, 1.0 1.5 U, 40 U, 3 15 30 min, 2 3 d 1,, 2,,,,, < 11.0 mmol/ L ( 200 md/ dl), < 13.9 mmol/ L ( 250 mg/ dl), 20 30 U, 3 11.0 16.7 mmol/ L( 200 300 mg/ dl ), > 16.7 mmol/ L (300 mg/ dl), 30 40 U, 3 101
60,,,,,, 129.,?,, 2 U ;, 2 U,,,, 2 U,,,, 2 U 130.?,,,,,,,,,,, 102
,,,, U-100, 100 U/ ml( U-40, 40 U/ ml, 400 U/ ), 300 U/ 131.?, :,,,,,, 1 U, 2 U,,, 132.?, :,,,,, 1 2 U 103
, 1,, 6 s, 133.? :,, 5 6 30 R 50R,,, 6 s,,, U-100, 300 U, 1 70 U, 4 8 C, 1 134.?,, 104
,,,,,,,,,,,, 45,,,,,,,,,,,,,,,,, 135.?,, 105
24 h ;,,,,,,,, 136.?,,,,,,,,, 0.1 U, :, 1, 1,,, 106
, :,,,,, 137.?,,,,,,,,,,,,,,,,, 138.? 24 h,, : :,,, 107
,,,,,,,,,, 1 h,,,,, : 3 d,,,,, :,,,,,,,,,, 139.?,,,, 108
,,, /, 140.?,,, -,, 141.? ( ), -,, ( ) - ( ), 142.? 1 B, 109
,,,,,,,, 143.?,,,,,,,,,,,,, 110
144.? :,, ; 30 ; : 120%, BMI 27 kg/ m 2 ; ; ; ; ;, 24 28, 24 28, 32 34 50 g 1 h, < 7.2 mmol/ L, 7.2 mmol/ L, 75 g 100 g 3 h 3-1 3-1 [mmol/ L(mg/ dl) ] 100 g 75 g 0 h 5.0 ( 90 ) 5.8 (105 ) 5.5 ( 100 ) 1 h 9.2 ( 165 ) 10.6 (190 ) 10.4 ( 187 ) 2 h 8.0 ( 145 ) 9.2 (165 ) 8.6 ( 155 ) 3 h 6.9 ( 125 ) 8.0 (145 ) 6.6 ( 119 ), 2 111
145.?,, (3 ),,,,,,,,,,,,,,,,3,,,,, 4 7 mmol/ L, 7%, 40,38 146.?,,, : : 112
, 1 2,,,,,, :,,,, 147.?,,, : : 13 % 30 %, : 10% 25%, 20 30,, : 10%, :, ;,, 2 3,, :,,,,,,,,, 113
148.?,,,, 1 3 1,,, 4 6 2, 7 9 3, 2 3, 837.36 k J( 200 kcal), 15 25 g, 144.5 183.0 k J (30 38 kcal), 8 670 10 597 kj (1 800 2 200 kcal), 10 12 kg ( ), 28, 0.5 kg, 1 2 kg,, 80 100 g ( 50 % ), 250 400 g 5 6,, 149.??,,,, 114
,,, ( GDM ) ; GDM 2, : (1 ) :,, (2 ) :, ( Vmax O2 ) Vmax O2, 50%, 4 1 : = ( 220 - ) 70 % (3 ) :, 45 min, 3 15 min, 5 min ( ), 3, 20 min,, 3 (4 ) :, 115
,, 129.6 mg( 2 ) 129.6 mg (2 ),, 5,, 20 min 20 min,,,,,,, 150.?,,,,,,,,, 151.?, 116
,,,,,,,,,,, 117
152.? 1,,,,,,,,,,,,, 153.?,,,,, 118
,,,,,,,,,,,,,,,, 154.?,,,,,,,,,,,,,,,,,,, :,,, 119
,, 155.?,,, B,, 1,, 5,,,,,,,,,,,,, 156.?,,,, 120
,,,,,,, > 16.65 mmol/ L ( 300 mg/ dl),,, ph, 50%,,,5 9, 8.0 %,10 14 25.2 %, 15 33.8%,, (30 300 mg/ 24 h 20 200 g/ min), ( 0.5 g/ 24 h ),, 10 15,, 5 50%,,,,,,,, 121
,,,, X,,,,, 157. 2? 2,,, 2 ( ) 2,,,,,, 2, 2, 2 : ; 2 ; > 6 ; ; ; ; ; ; 158. 2? 2, ( BMI) 20% 122
65% 80%, BMI 10% 20%, 90 %,,, 53% 55% 30% 15% 17%, 10% 1 3,,, -,,,, 3% 5 %,,,,,,,, 2 -,,,,,,,, 2, < 0.2 U/ ( kg d ),, 123
159. 2? :,, 2, 2,,,, ( ),,,,,, 124