第三十二章胰岛素及口服(kǒufú)降糖药糖尿病（（diabetesmellitusdiabetesmellitus，，DMDM））：胰岛素分泌绝对或相对不足,引起糖、脂肪、蛋白质代谢紊乱(wěnluàn)的疾病。糖尿病诊断标准被确定为任何时候血糖≥11.1毫摩尔/升(≥200毫克/分升)，和(或)空腹血糖≥7.0毫摩尔/升(≥126毫克/分升)，第一页，共五十一页。胰腺(yíxiàn)pancreas第二页，共五十一页。分类Ⅰ型(insulin-dependentdiabetesmellitus,IDDM)自身免疫性疾病–细胞破坏，胰岛素分泌缺乏Ⅱ型(non-insulin-dependentdiabetesmellitus,NIDDM)细胞功能低下，胰岛素相对(xiāngduì)缺乏、胰岛素抵抗(INR)第三页，共五十一页。•TypeIorinsulin-dependentdiabetesmellitusistheresultofafrankdeficiencyofinsulin.Theonsetofthisdiseasetypicallyisinchildhood.ItisduetodestructionpancreaticBcells,mostlikelytheresultofautoimmunitytooneormorecomponentsofthosecells.Manyoftheacuteeffectsofthisdiseasecanbecontrolledbyinsulinreplacementtherapy.Maintainingtightcontrolofbloodglucoseconcentrationsbymonitoring,treatmentwithinsulinanddietarymanagementwillminimizethelong-termadverseeffectsofthisdisorderonbloodvessels,nervesandotherorgansystems,allowingahealthylife.第四页，共五十一页。•TypeIIornon-insulin-dependentdiabetesmellitusbeginsasasyndromeofinsulinresistance.Thatis,targettissuesfailtorespondappropriatelytoinsulin.Typically,theonsetofthisdiseaseisinadulthood.Despitemonumentalresearchefforts,thenatureofthedefecthasbeendifficulttoascertain-insomepatients,theinsulinreceptorisabnormal,inothers,oneormoreaspectsofinsulinsignallingisdefective,andinothers,nodefecthasbeenidentified.Becausethereisnot,atleastinitially,aninabilitytosecreteadequateamountsofinsulin,insulininjectionsarenotusefulfortherapy.Ratherthediseaseiscontrolledthroughdietarytherapyandhypoglycemicagents.第五页，共五十一页。第六页，共五十一页。Ⅰ型糖尿病普通胰岛素替代疗法普通胰岛素替代疗法((猪、牛胰岛素注射猪、牛胰岛素注射))普通胰岛素结构改造普通胰岛素结构改造((猪胰岛素猪胰岛素链第链第3030位的丙氨酸用苏氨酸代替位的丙氨酸用苏氨酸代替))重组重组DNADNA技术利用大肠杆菌技术利用大肠杆菌(dàchánɡɡǎ...
