Amamenxpowerlite 110315105826-phpapp02/ by michel47mw chuang
El documento es una canción de amor que expresa los sentimientos del cantante hacia su amada. Pide que lo amen, que se acerquen y que le entreguen su calor y amor sin miedo. Dice que vivirá enamorado de esa persona y que solo quiere ser de ella.
Amamenxpowerlite 110315105826-phpapp02/ by michel47mw chuang
El documento es una canción de amor que expresa los sentimientos del cantante hacia su amada. Pide que lo amen, que se acerquen y que le entreguen su calor y amor sin miedo. Dice que vivirá enamorado de esa persona y que solo quiere ser de ella.
This slide is about diabetes care I presented on April 9th, 2015. My audience is a group of elder people who has interest in this topic, some of them are patients, some are family members. Most of the slides are Chinese because my audience use Chinese most. My targets are to let people understand what are their sugar-control medicine do their jobs and what they should be aware while using them.
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探索愛身健麗如何改變您的健康、財富、以及最重要的,您的一生。
Discover how Isagenix can transform your health, your wealth, and ultimately your life.
-----> http://www.RoadToWELLTH.isagenix.com
This slide is about diabetes care I presented on April 9th, 2015. My audience is a group of elder people who has interest in this topic, some of them are patients, some are family members. Most of the slides are Chinese because my audience use Chinese most. My targets are to let people understand what are their sugar-control medicine do their jobs and what they should be aware while using them.
Brought to you by 由 http://www.facebook.com/RoadToWELLTH 提供
('Like 讚', SHOP 購物 & Get FREE Gifts 拿免費贈品!!)
Online Shopping:
http://bit.ly/wsenshp
網上即時購物盡在:
http://bit.ly/wszhshp
探索愛身健麗如何改變您的健康、財富、以及最重要的,您的一生。
Discover how Isagenix can transform your health, your wealth, and ultimately your life.
-----> http://www.RoadToWELLTH.isagenix.com
Michael and Inessa Garmash are Ukrainian artists who met while Michael was serving in the army. Michael saw Inessa at a bus station and spent the night painting images of her all over the surrounding city. They later married and began creating paintings together. They work with their daughter as a model and include themselves in compositions. Their collaborative works have been exhibited internationally.
5. 470
學 術 T AIWAN M EDICAL J OURNAL
metformin與第二種藥物未能將血糖控制下來,則應開 後,葡萄糖毒性的現象可望改善,β細胞功能可能恢
始使用胰島素或加強胰島素治療。若HbA1c不是太高 復;在血糖控制良好之後,可改回口服藥物。糖尿病
(<8.0%)可考慮加上第三種口服降血糖藥物,但這種治 患者合併有急性疾病(例如心肌梗塞、感染、手術前
療效果較差、花費較高。若使用三種口服藥物或基礎 後)時也要使用胰島素。
胰島素仍無法將HbA1c控制於7%以下,則應使用加強
胰島素治療 – 除給與基礎胰島素外,再加上控制飯後
結 語
血糖的短效或速效胰島素,以解決飯後血糖過高的問 治療糖尿病的主要目標在避免急性或長期的併發
題。注射胰島素患者仍可持續使用口服降血糖藥物, 症,要達到此目標最重要的做法為將血糖控制到接近
胰島素與metformin或胰島素與TZD合併使用可促進其 正常。要降低血糖最基本的仍是飲食、運動等生活形
降血糖的效果,可減少所需的胰島素劑量 (18)。若開始 態的改變,但多數患者仍需降血糖藥物治療。近年有
飯前注射短效或速效胰島素,應停用或逐漸減少刺激 很多新的口服降血糖藥物上市,雖然它們有些個別好
胰島素分泌的藥物(sulfonylurea或glinide),這些藥物與 處,但降血糖的效果不見的比傳統藥物更好。目前
胰島素合併使用不會產生協同作用。 的觀點認為若單一藥物未能達成血糖目標值(HbA1c
使用胰島素可有幾種不同的方式(19): <7%),應盡快加上其他藥物或換新的治療;若口服
(1)每天於睡前注射一次的基礎胰島素(NPH或glargine 藥物未能達到目標,應盡早使用胰島素。與傳統的
、detemir胰島素,開始時每天給10 U 或0.2 U/kg), regular與NPH胰島素比起來,新發明的胰島素類似物
之後視空腹血糖值每隔3天增加2U,調整劑量至達 的好處為血糖控制更好、發生血糖過低機率減少。圖1
成目標(空腹血糖<110 mg/dL)為止,若其間發生空 之標準化治療流程可應用於大多數的病患,但有時仍
腹血糖<60 mg/dL,則將胰島素減2U。這種胰島素 應依個別狀況而改變處置方式。
的用法的好處為簡單、有效、病人接受性良好,且
體重增加不會太多。
(2)在每天最大一餐時(通常是晚餐)注射預混型胰島
素。開始時於晚餐前打10U,每隔 2天增加2U,至
達成空腹血糖<110 mg/dL為止。
參考文獻
(3)早餐與晚餐前注射預混型胰島素。若上述每日注射 1.Nathan DM, Buse JB, Davidson MB, et al.: Management of
一次預混型胰島素未能控制血糖,則加上第二劑預 hyperglycemia in type 2 diabetes mellitus: a consensus algorithm
混型胰島素,開始時於早餐前給6U,若晚餐前血糖 for the initiation and adjustment of therapy. Diabetologia
2008;51:8-11.
>110 mg/dL,則每隔2天增加早餐前預混型胰島素
2U。 2.Fowler MJ: Diabetes treatment, part 2: Oral agents for glycemic
management. Clin Diabetes 2007;25:131-134.
(4)加強胰島素治療:中效或長效之基礎胰島素(NPH、
3.Cheng AY, Fantus IG: Oral antihyperglycemic therapy for type 2
detemir或glargine胰島素)加上每餐前之速效或短效
diabetes mellitus. Can Med Assoc J 2005;172:213-226.
胰島素。此法最合乎生理變化、效果最好,但每天
4.Inzucchi SE: Oral antihyperglycemic therapy for type 2 diabetes.
需要多次注射。通常中效胰島素或detemir可分兩次
JAMA 2002;287:360-372.
在早餐前與睡前注射;長效胰島素(glargine)則於睡
5.American Diabetes Association: Standards of medical care in
前注射一次即可。 diabetes – 2008. Diabetes Care 2008;31: S12-S54.
特殊狀況 6.AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical
嚴重血糖過高(空腹血糖>250 mg/dL、隨機血糖 guidelines for clinical practice for the management of diabetes
mellitus. Endocr Pract 2007;13(S1):3-69.
>300 mg/dL、HbA1C>10%或有酮尿症)或有多尿、多
喝、體重下降等典型糖尿病症狀者,應使用胰島素治 7.Riddle MC, Rosenstock J, Gerich J: On behalf of the Insulin Glargine
4002 Study Investigators: The Treat-to-Target Trial. Randomized
療。這類患者使用胰島素一段時間將血糖嚴格控制
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addition of glargine or human NPH insulin to oral therapy of type
2 diabetes patients. Diabetes Care 2003;26:3080-3086.
8.Bell DSH: Type 2 diabetes mellitus: what is the optimal treatment
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9.Nissen SE, Wolski K: Effect of rosiglitazone on the risk of
myocardial infraction and death from cardiovascular causes. N
Engl J Med 2007;356:2457-2471.
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11.Lago RM, Singh PP, Nesto RW: Congestive heart failure and
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diabetes given thiazolidinediones: a meta-analysis of randomized
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12.Home PD, Pocock SJ, Beck-Nielsen H: for the RECORD Study
Group: Rosiglitazone evaluated for cardiovascular outcome – an
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13.Dormandy JA, Charbonnel B, Eckland DJA, et al.: PROactive
Investigators: Secondary prevention of macrovascular events in
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14.Lincoff AM, Wolski K, Nicholls SJ, et al.: Pioglitazone and risk of
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15.Schwartz AV, Sellmeyer DE, Vittinghoff E, et al.: Thiazolidinedione
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16.Garber AJ, Larsen J, Schneider SH, et al.: Glyburide/Metformin
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of initial combination therapy with nateglinide and metformin in
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