,

Age-adjusted death rate

relative to 1980

140

130
120

110
100
90

80
70
60
1980

1982

1984

1986

1988

1990

1992

1994

1996



70
60
50
40
30
20
10
0

Geiss LS et al., 1995

1.

2.
3.

 1

-,
-
5
,

 (pmol/min)

24-
1
800

700

600
500
400
300
200
100
0
0600 1000

1400

1800

2200

0200

0600

Banting
Best
1921

ActRapid/ Humulin R/ Insuman Rapid

Insulatard / Humulin N/ Insuman Basal


Mixtard 10, 20 , 30, 40, 50


...

s.c.

:
-
/
- /

-

- -


-

- NovoRapid
(Novo Nordisk)
(28)

- Humalog
(Eli Lilly)
(28 - B29)
-


NovoRapid
Pro
Asp

Phe

Phe

Tyr

Gly

Arg
Glu

Thr

Gly

Asp

B30

Cys

B28

Lys
Thr

A21

Asn

Cys

Val
Tyr
Leu

Gly

Asn
Tyr

Ile

Glu
Leu

Val

Leu
Ala

Glu

Gln
Glu

Gln

Tyr

Cys

Val

Leu
Cys

Thr

Ser

Ile

Ser

Cys

Leu
His
Ser
Gly

B1

Phe

Val

Asn

Gln

His

Leu

Cys

-
-
- QL

GLARGINE - Lantus
(Aventis)
-

-

DETEMIR - Levemir
(Novo Nordisk)
- B30
, 29 14
( -),


,

 Detemir


NPH

-
-

-

. (M)

10-4

10-3

10-5

10-6

2.3 nm

()

Zn2+

1.2 nm

Zn2+

(.)

1.2 nm

1 nm

1 nm

Zn2+

HumaMix 25

NovoMix 30


NovoMix

30

1-2

40%

(mU/l)

70

+ NPH

60
50

NovoRapid + NPH

40
30

20
10
0
0600 0900

1200

1500

1800

2100

2400 0300

Polonsky et al. 1988

NPH

0600

Innovo

3
1
70

DANADIABCARE
-

- 61g
3 U-100

INJEX

U-40 U-100

VISION


2 ?
:

( )


2

1.
2.
3.



BMI ( 26, 24)
50-55% ,

,
<15%,
(< 0,8//)
<10%, <10%,



:

2.

3.

:

30 ./

1 3

30-60

1.

NB!

Metformin
Glitazones

.
(
)

- Maninil, Glibenclamide, Minidiab,

Glucotrol XL, Diaprel,Diaprel MR,
Diabrezide, Amaryl

(NovoNorm)

1.

2.

3.



,
20-30 . ,
.

- 1 ./ 2 . Glibenclamid(Maninil) 3,5; 5 mg

1./ - Diaprel MR, Amaryl,

Glucotrol XL

- Glibenclamid(Maninil) (4 . 3,5; 5 mg) = 14-20 .

- Diaprel MR(4. 30 mg) = 120 .
- Amaryl(4. 2 mg) = 8 .

- Glucotrol XL(2. 10 mg) = 20 .



,



-

Metformin, Metfogamma, Siofor, Metformin BMS,
Glucophage

Troglitazone, Pioglitazone, Rosiglitazone (Avandia)

1929 (Hesse,Taubmann, )

(, , )
1957 - ( 50
- )

1977 -
1978 - , , ,

1982 -
1993 -

-

2



ACANTHOSIS NIGRICANS

(20%)

3-9 100 000

/


500, 850, 1000 mg
- 2.55-3.0g



:
( )

3 . Siofor850, Metfogamma 850
2 x .Glucophage 1000 .

3 1 . Siofor850, Metfogamma 850

2 1 . Glucophage


PPAR (PEROXISOME PROLIFERATOR
ACTIVATED RECEPTOR)


21.03.2000 - FDA
Troglitazone
25.05.1999 FDA Rosiglitazone
16.06.1999 FDA Pioglitazone
03.2000 Rosiglitazone

PPAR

-
, ,
, ,

(PPAR),
,

PPAR


GLUT 4

RSG -
GLUT4
*

RSG

de novo

*
,
14 days
RSG 1 mg/kg

PPAR

-

( - )

,
,

,
HDL-



PAI-1
,
RP

(Rosiglitazone)
(PCO)

-
Acarbose (Glucobay)

:
, - -
, -

:
, - 15 .
250 , . 3100 .

 2
( )
2

1- 3

 2
( )
2


BMI < 25 kg/m2

BMI > 25 kg/m2

 2
( )
.. 2

( )
.. II



BMI > 25 kg/m2

BMI < 25 kg/m2


- DF

HbA1c

> 6.5

> 7.5

> 6.0
(mmol/l)

> 7.0

. K
(mmol/l)

> 9.0

> 7.5

European Diabetes Policy Group. Diab Med 1999;16:716