糖皮质激素与高血糖.ppt

概述 流行病学 机制 诊断 治疗 概述 流行病学 机制 诊断 治疗 Prevalence of Steroid Diabetes in Hospitalized Patients 50% or more of patients Less than half of these patients will have had a history of diabetes Endocr Pract. 2006:12:358-362 概述 流行病学 机制 诊断 治疗 概述 流行病学 机制 诊断 治疗 TYPICAL PATTERN OF SDM Elevated glucose after meals Decrease to normal glucose overnight Diagnosing Steroid Diabetes 25 patients with neurological disease treated with 30-60mg of prednisolone orally after breakfast for 2 weeks No prior history of DM, family history of DM, or medications that might affect blood sugar (thiazides, B-blockers, etc.) Pharmacotherapy 2004;24(4):508-514 NORMAL IMPAIRED SDM* SENSITIVITY AC BREAKFAST 24 1 0 0% PC BREAKFAST 17 4 4 30.8% PC LUNCH 2 10 13 100.0% PC DINNER 7 7 10 76.9% *Fasting or = 126 mg/dl; Random or = 200 mg/dl 概述 流行病学 机制 诊断 治疗 Oral Diabetes Medications In general minimal benefits Long acting agents like glyburide and glimiperide will have minimal effect on post prandial hyperglycemia and increase risk of fasting hypoglycemia. The use of repaglinide, nateglimide, acarbose, TZDs, and metformin all make physiological sense but in clinical practice often are ineffective. Incretins (?) INSULIN Most effective Peak action of the insulin needs to correspond to the post absorptive state - the primary affect of steroids is on glucose disposal following the meal. Rapid acting analog insulin before the meals AM: R/NPH Supper: R Cautious use of long acting insulin Ratio prandial:basal 70:30 CHALLENGES Steroid dosing AM Multiple daily doses Potency (prednisone, dexamethasone)