Different forms of diabetes mellitus Different Forms of Diabetes mellitus General-genetic and other factors not precisel sely Diabetes secondary to pancreatic disease defined Chronic pancreatitis Type 1 diabetes mellitus(formerly called insulin Su urger dependent diabetes mellitus, or IDDM) Tropical diabetes(chronic pancreatitis associated Autoimmune type 1 diabetes mellitus(type 1A) with nutritional and/or toxic factors) Non-autoimmune or idiopathic type I diabetes Diabetes secondary to other endocrinopathies mellitus(type 1B) Cushing' s disease ype 2 diabetes mellitus(formerly called non-insulin- Glucocorticoid administration dependent diabetes mellitus or NIDDM) Acromegaly Specific-defined gene mutations Diabetes secondary to immune suppression Maturity-onset diabetes of youth MODY) Diabetes associated with genetic syndromes; e.g MODY 1 hepatic nuclear factor 4a gene mutations Prader-Willi syndrome ModY 2 glucokinase gene mutations MODY 3 hepatic nuclear factor la gene mutations Diabetes associated with drug therapy (see Table 61-5) MODY 4 pancreatic determining factor x gene mutations MODY X unidentified gene mutation(s) Maternally inherited diabetes and deafness Midd) Mitochondrial leucine tRNa gene mutations Insulin gene mutations Insulin receptor gene mutations
Complications of diabetes mellitus Acute complications a Diabetic ketoacidosis Hyperosmotic nonketotic coma a Chronic complications C ardiovascuar dseases Renal damage Retinal damage Nerve degeneration Infection Myopathy
Antidiabetic drug classification 表32-1降血糖药物的分类 药物分类 代表药 短效人胰岛素、结晶锌胰岛素、中性精蛋白锌胰岛素、鱼精 胰岛素 胰岛素相关药物 蛋白锌胰岛素 胰岛素类似物 门冬胰岛素、赖脯胰岛素、甘精胰岛素 磺酰脲类:甲苯磺丁脲、氯磺丙脲、格列本脲、格列吡嗪、格 作用于KAp通道药 列美脲、格列齐特等 促胰岛素分泌药 氯茴苯酸类/苯丙氨酸行生物瑞格列奈那格列奈 胰高血糖素样肽1激动剂依克那肤igt 二肽基肽酶Ⅳ抑制剂 磷酸西他列汀, Alogliptin*, Linagliptin* 双胍类 二甲双胍,苯乙双胍5 胰岛素增敏剂噻唑烷二酮类化合物 罗格列酮、吡格列酮、环格列酮、曲格列酮3 脂肪酸代谢干扰剂 依托莫司 α-葡萄糖苷酶抑制剂 阿卡波糖,米格列醇,伏格列波糖 胰淀粉样多肽类似物 醋酸普兰林肽 其他 「葡萄糖钠吸收转运蛋白2抑制剂|dgnt 醛糖还原酶抑制剂 依帕司他 注:*表示药物正处于临床实验阶段;5表示药物已撤市
10 s·S- 出9964651234567891011213141516110ooH 234567891011213141516171819( B chain )57 A. Insulin and related agents Connecting peptide 27 4948474645444342414039383736353433323130 PPXGGOLXEXYXOGYXOLXDXEXA③① 30 30
P0、的R即的的55545352515049B418A凶 处唤吧唤吧购吧 43 42 41 PC2 78910111213716少如98 C OH 39 S-S A chal 37 PHE GLU ER LEU TYR GLM UGSN SP 36 VAL c THR SER 56 35 s-S 5 LEU 6901121311516171819202122329、录以 6 S SER chain THR ALA TYR PC3 LEU VAL Structure of insulin