重塑早相.ppt

2型糖尿病的两种缺陷 2型糖尿病一级亲属的B细胞功能缺陷 早相胰岛素分泌的意义 抑制脂肪酸从脂肪组织流出 抑制肝糖产生 空腹血糖和1相胰岛素释放的关系 早期胰岛素分泌缺失能减轻对肝糖生成抑制作用 诺和龙? 能恢复T2DM患者Ⅰ相分泌 诺和龙?降糖可兼顾“有效性”与“安全性” 大型德国研究结论：使用诺和龙?低血糖的发生率极低 诺和龙?刺激胰岛素分泌具有血糖依赖性 诺和龙?独特的药代动力学减少低血糖发生 诺和龙?极少经肾脏代谢，不易发生低血糖 小结：诺和龙?罕见严重低血糖，安全性高 而较严重的T2DM组，胰岛素不仅高峰延迟，且分泌低平，胰高血素水平维持在一个较高水平，从而导致整体的餐后高血糖状态。 ? Excessive amounts of glucose enter the systemic circulation when patients with non-insulin-dependent diabetes mellitus (NIDDM) eat a carbohydrate-containing meal. To determine the contribution of hepatic glucose cycling (defined as the net effect of glucose/glucose-6-phosphate cycling and uptake and release of glucose from hepatic glycogen) to postprandial hyperglycemia, diabetic, glucose-intolerant, and nondiabetic subjects were fed mixed meals. The meal contained both [2-3H]glucose (an isotope that is extensively detritiated during hepatic glucose cycling) and [6-3H]glucose (an isotope that is not detritiated during hepatic glucose cycling). Of the 50 g of carbohydrate contained in the meal, approximately 4-8 g underwent hepatic glucose cycling. Although total cycling of ingested glucose did not differ between diabetic, glucose-intolerant, and nondiabetic subjects (361 +/- 67 vs. 494 +/- 106 vs. 322 +/- 44 mumol.kg-1.5 h-1, respectively), the data suggested that hepatic cycling was increased in the diabetic and glucose-intolerant individuals but not in the nondiabetic subjects during the first 2 h after eating. Hepatic cycling during the first 2 h after eating was correlated with the prevailing glucagon concentration (r = 0.6, P less than 0.01) and increased (P less than 0.05) as hepatic glucose release increased. Hepatic glucose cycling had a marked effect on the measurement of so-called initial splanchnic glucose uptake. Nevertheless, however measured, initial splanchnic glucose uptake was not decreased and, if anything, was increased in diabetic and glucose-intolerant patients. Integrated postprandial hepatic glucose release increased (r less than 0.01) with