HORMON TUYN TY HORMON TUYN TY

V tr ca ty V tr ca ty
Nm sau phuc mc
Sau d day
Nng khong 80g
Hinh hoi thun dai.
Gii phu tuyn ty Gii phu tuyn ty
Tuyn tuy co 2 nhom t bao khac nhau:
TB nang tit ra nhung enzyme tiu hoa.
Nhom TB tp trung o vung do Langerhans co chuc nng khac.
TB (B) sn xut Insulin, Amylin
TB (A) sn xut Glucagon
TB (D) tit somatostatin
PP hay TB F tit polypeptide tuy.
INSULIN
Tng hp Insulin trng T! "#ta Tng hp Insulin trng T! "#ta
Preproinsulin Proinsulin Insulin
Dich m RNA insulin boi ribosom gn vao mng ni bao tuong to thanh chui
don polypeptid gm 110 acid amin goi la Preproinsulin.
Sau khi di chuyn vao li ni sinh cht c ht, chui peptid tin hiu du N tn
gm 24 acid amin cua Preproinsulin bi tach ra thanh Proinsulin.
Proinsulin di chuyn vao tui nho cua phc hp Golgi.
Proinsulin duoc dong goi vao trong nhung ti tit co chua enzyme co vai tro
trong chuyn thanh insulin: Cu ni disulIid duoc hinh thanh va chui peptid C duoc
tach ra to Insulin
Chui peptid C va insulin duoc gii phong vao tun hoan dng mol.
Chui peptid C khng co chuc nng sinh hoc nhung la chi s quan trong
giup danh gia kh nng bai tit insulin cua tuy tng.
Enzymes chuyn tu proinsulin insulin la endopeptidase phu thuc Ca
2
: PC2, PC3
PC2 ct ni giua peptid C va chui A
PC3 ct ni giua peptid C va chui B
$%u tr&c Insulin $%u tr&c Insulin
Phn tu Insulin:
2 chui peptid A va B:
Chui A co 21 acid amin
Chui B co 30 acid amin.
1 cu disulIid trong cung mt chui A (giua acid amin 6 -11)
2 cu disulIid giua 2 chui (aa 7-7, 20-19).
Luu y: Khi 2 chui peptid bi roi ra thi hot tinh cua insulin khng con nua
'i(u h)a s* tit Insulin 'i(u h)a s* tit Insulin
Muc dich: cn bng nng d glucose trong mau khi doi hay no.
Glucose, amino acids, acid beo, va ketone trong co th nh huong su tit insulin
Cht dinh dung, hormon d day-rut, hormon tuy, cht dn truyn TK tu dng.
Glucose co vai tro quan trong trong su tit insulin o nguoi.
Co ch glucose kich thich su tit insulin: do su khu cuc TB cua do
Langerhans:
C glucose huyt tuong glucose duoc vn chuyn vao TB nho co ch vn
chuyn h tro (GLUT 2)
Glucose bi phosphoryl hoa thanh G-6P boi glucokinase.
Glucose va G-6P lam tng sn xut ATP ti l ATP/ADP uc ch knh K

nhy cm voi ATP dn truyn K

E
m
tng mo knh Ca
2
kich thich tit
insulin tu tui du tru.
+h,n "- ./ th0i h1a ca insulin +h,n "- ./ th0i h1a ca insulin
Phn b:
Trong tun hoan o dng monomer tu do.
Vd V dich ngoi bao.
Khi nhin doi, tuy tng tit 40 g (1 don vi 1U) insulin mi gio vao TM cua, C
insulin trong TM cua la 2 to 4 ng/ml (50 to 100 mU/ml) va trong tun hoan ngoi bin
la 0.5 ng/ml (12 U/ml).
Khi no, C insulin tng nhanh trong mau TM cua va tng it hon trong mau ngoi
bin.
Glucose
Acid amin
Acid beo, keton
Cac hormon d day-rut
(gastrin, secretin,
cholecystokinin.)
Cac hormon khac
(glucagon, cortisol,
GH..)
Cht dn truyn TK tu dng (adrenergic,
cholinergic)
S bi tit
Insulin
T 5-6ph (Insulin) ,T 17ph (Proinsulin)
Peptid C duoc tit dng luong voi insulin. C tng do thanh thi o gan thp hon &
T dai hon (30ph) marker chn doan su tit insulin cp.
Thoai bin:
Chu yu o gan, it hon o thn va co do bi ct ni disulIid giua chui A va B boi
insulinase.
Gan: 50 insulin dn gan qua TM cua gan bi pha huy va khng tro li tun hoan
chung.
Thn: insulin duoc loc boi cu thn va tai hp thu boi ng thn, 10 hin din
trong nuoc tiu.
M ngoi bin nhu m m cung bt hot insulin nhung it quan trong.
Enzyme co vai tro trong thoai hoa la thiol metalloproteinase, chu yu o gan, co,
thn, no.
2#c#ptr ca insulin 2#c#ptr ca insulin
Receptor nm trn b mt TB
Hin din o TB cua DV co vu:
TB muc tiu: gan, co, m m.
TB khac: TB mau, TB TK, TB sinh duc.
Bn cht la glycoprotein xuyn mang gm:
2 tiu don vi (135,000 daltons): ngoi bao, co domain gn voi insulin.
2 tiu don vi (95,000 daltons): xuyn mang, hot dng cua insulin protein
kinase.
4 tiu don vi duoc ni li voi nhau bng cu ni disulIide d hinh thanh ---
heterotetramer.
$0c ch%t .3n chuy4n glucs# $0c ch%t .3n chuy4n glucs#
Glucose nhp vao t bao bng su khuch tan thun loi nho vao cac cht vn
chuyn glucose (glucose transporters - GLUT).
GLUT 1 co o moi m, dc bit la hng cu va no
GLUT 5 co o t bao cua tuy, o gan, thn, rut
GLUT 3 co o no, thn, rau thai
GLUT 6 co o co va m m
GLUT 5 co o rut va thn
S* h7t h1a th th4 T! 8ch ca Insulin S* h7t h1a th th4 T! 8ch ca Insulin
Khi insulin gn voi tiu don vi tiu don vi li vao trong TB duoc phosphoryl hoa
tu dng hot hoa hot tinh cua tyrosine kinase voi cac co cht khac trong TB (Insulin
response substrate-IRS) bao gm IRS-1, IRS-2, IRS-3 tac dung trn TB.
Mang TB co tinh thm cao voi glucose, dc bit la TB gan, co va m m (tr
neuron no), xy ra nhanh giyphut:
Co ch: su chuyn vi cua tui nho trong bao tuong dn gn voi mang TB. Tui nho
co phn tu protein vn chuyn Glucose trn mang (GLUT4). Su chuyn vi co tinh
thun nghich.
Kt qu: Glucose duoc vn chuyn qua mang nho co ch khuych tan h tro.
Diu hoa su chuyn hoa glucose:
Trong TB,Glucose duoc phosphoryl hoa thanh G-6-P boi hexokinase (I IV)
Hexokinase IV (glucokinase): co lin h voi GLUT 2 o gan va TB tuy
Hexokinase II co lin h voi GLUT4 o co xuong , co tim va TB m m.
G-6-P vao nhiu con duong khac nhau:
Dng phn hoa thanh G-1-P va chuyn thanh glycogen o gan
Di vao con duong duong phn tng hop ATP
Di vao con duong pentose phosphat cung cp NADPH cho pu khu va chuyn hoa
cht l boi CYP, duy tri hot dng cua Glutathion dng khu.
Tng tinh thm voi acid amin, cac ion kali, phosphat.
Thay di hot tinh cua nhiu men chuyn hoa trong TB, chu yu do su
phosphoryl hoa enzyme (10-15ph)
Tng dich m cua mRNA o ribosom to thanh protein moi & tng muc sao m
cua DNA trong nhn TB (nhiu giongay)
T0c 89ng sinh l: ca insulin T0c 89ng sinh l: ca insulin
Trn chuyn hoa glucid
Dy mnh chuyn hoa glucose o co:
Tng vn chuyn glucose qua mang vao trong TB co d sinh nng luong.
Glucose thua duoc du tru trong co duoi dng glycogen.
Dy mnh thu thp, du tru, su dung glucose o gan
Su thu nhn va su dung glucose o no:
Thm voi glucose va su dung glucose khng cn qua trung gian insulin.
( 2 co ch: insulin va co ch thm thu khng qua insulin)
Chi su dung glucose cho nng luong
Muc duong huyt phi duy tri trn muc chun
Nu gim duoi 50 mg/dl co th shock h duong huyt (kich thich TK, co git , hn m, thm chi
tu vong (4 nguoi tiu duong duoi 50t))
Trn chuyn hoa lipid: Du tru lipid trong TB m
Insulin tng vn chuyn glucose vao trong TB m:
Glucose pyruvat acetyl CoA acid beo TG du tru
1 s lon glucose -glycerolphosphat acid beo TG du tru
Insulin hot hoa lipoprotein lipase o vach mao mch cua m m ct TG thanh acid beo
hp thu vao TB m TG du tru
Insulin uc ch lipase trong TB m
Trn chuyn hoa protein va su phat trin:
insulin ;
;
insulin <
Insulin lam tng vn chuyn acid amin (!aline, leucine, isoleucine, t"rosine,va
phen"lalanine) vao TB (r nht o co va gan)
Insulin tng su dich m cua mRNA
c ch su thoai bin protein nn gim acid amin huyt
gan, gim tn to duong moi tu acid amin
Din gii: K

va phosphat
GLU$=G>N GLU$=G>N
uan trong trong su diu hoa chuyn hoa keton va glucose nhung chi duoc su dung d kim soat
duong huyt ngn hn
$%u tr&c?
La mt chui polypeptide don gm 29 acid amin
S* tng hp glucagn S* tng hp glucagn
Preproglucagonproglucagonglucagon
$h@ 8nh tr liAu?
Tri h duong huyt nng:
Ngun glucagon : chit tu tuy bo, heo
IV, IM, SC 1mg (IV,IM: cp cuu)
Tac dung h duong huyt thoang qua va khng du nu su luu tru glycogen o gan
cn sau dap ung voi glucagon, BN nn su dung glucose hay bt n vao.
Su dung trong chup -quang do tac dung uc ch co tron rut:
Lam gin co tron rut thun loi chup -quang duong GI trn va duoi.
Tri dau tht co co lin quan dn vim rut thua cp tinh va ri lon o ng dn mt
va co vong Oddi
Su dung chn doan phn bit tc nghn tu vang da do gan
DI THO DNG DI THO DNG
Bh0i niAC? dai thao duong xy ra do thiu insulin hoc su hin din cua cac tac nhn
di khang tac dung cua insulin. Kt qu la gia tng nng d cua glucose trong mau, tu do dn
dn nhiu bt thuong trong chuyn hoa.
'0i th0 8DEng ty l/ h9i chFng 8Gc trDng "Hi?
Tng duong huyt.
Ri lon chuyn hoa cua carbohydrat, lipid va protein
Gia tng nguy co bin chung trn tim mch: bin chung mch mau lon, mch mau nho
va TK.
Mt moi va 4 nhiu
TiIu chuJn chJn 80n 80i th0 8DEng th# KL>?
Triu chung cua dai thao duong nng d glucose do o tnh mch (do ngu nhin) 200
mg/dl. Triu chung din hinh cua dai thao duong la n nhiu, ung nhiu, gim cn nhanh. (Do
ngu nhin la do bt cu luc nao khng chu y dn thoi gian k tu bua n cui)
Glucose huyt luc doi (Iasting plasma glucoseFPG) 126 mg/dl. (doi duoc dn la khng
co nng luong hp thu trong it nht 8g).
Glucose huyt sau bua n 2h 200 mg/dl. Do la glucose huyt sau 2 gio ung 75g
glucose trong thu nghim dung np glucose (oral glucose tolerance test OGTT).
Chn doan DTD khi co 1 trong 3 tiu chi trn
T#st Mung n7p glucs#: ung 75g glucose trong 250-350ml nuoc (tr em 1-75 g/kg ti
da la 75g),
Test duoc thuc hin vao bui sang.
BN d yn tnh va khng hut thuc.
BN n binh thuong 3 ngay truoc do, khng nn n king.
Nng d glucose mau do luc bung doi sau 1 va 2 ting sau khi ung glucose.
NOt nghiAC L"=P$ NOt nghiAC L"=P$
Hemoglobin kt hop glucose HbA1C:
Binh thuong chim 4-6 tng Hb
Tn ti sut doi sng hng cu la 120 ngay phn anh luong duong huyt 8 tun
truoc khi dogiup danh gia su kim soat DH trong vong 2-3 thang:
5-7: n dinh duong huyt tt trong 2-3 thang truoc
10: DH khng kim soat tt
Khi HbA1C tng 1, nng d glucose tng 1.7 mmol/l (30 mg/dl)
Khng dung d chn doan bnh
Do mi 3-6 thang
Phn loi bnh dai thao duong:
Dai thao duong typ 1 (10 dn s): do TB do tuy bi phn huy do pu tu min
mt kh nng bai tit insulin
4 biu hin lm sang mt moi
Glucose:
Ngu nhin 200 (2 ln) khng dinh
Doi 8&ng 8g 126 (2 ln) 200: tiu duong
126glu200: RL dung np Glu (nguy co TD, TM)
Dai thao duong typ 2 (90 dn s): do su d khang insulin
S s0nh 80i th0 8DEng typ# P ./ typ# 5
Tuyp 1 Tuyp 2
- et nghim:
Ceton
Khang th khang tiu do tuy
Khang nguyn bch cu
- S luong thu th
Co

khng

Nhom dai thao duong thu 3:

do di truyn dt bin MODY
Dt bin gen HNR-1 xy ra 2/3 tinh trng tiu duong di truyn:
Dao, Claiphento, Tocno, khim khuyt glucokinase
Thai k: xy ra o ln du tin mang thai, giai don cui cua thai k, chi 30
chuyn qua tiu duong tht
$0c "in chFng ca 'T'
#in chng cp #in chng cp
Nhim keton acid la bin chung ph thng nht cua bnh TD type 1 va khoi su bng
thiu insulin tuyt di hay tuong di va tng nhung hormon di khang (glucagon,
adrenalin) dua dn gan sn xut du thua duong va cht keton.
Hn m tng ap luc thm thu co dc tinh phat trin ngm cao duong huyt qua d, cao
d osmol, mt nuoc va tng ur huyt truoc thn ma khng co cao ketone huyt hay
nhim acid.
Hn m h duong huyt: H duong huyt thuong xy ra khi dung insulin hay thuc h
duong huyt, h duong huyt qua d dn dn hn m
#in chng mn $ !i mch #in chng mn $ !i mch
Bin chung vi mch (bnh vng mc, bnh thn, bnh thn kinh) dc bit cho bnh TD
va lin quan truc tip voi muc duong kho kim soat voi su dong gop 1 phn nho %o cao
&' !( lon lipi% hu"t.
Bnh TD la nguyn nhn dn du chung mu mt o Hoa-k.Trong 10 nm bnh TD, khong
90 nguoi bnh vng mc o mt muc d nao do.
Bnh vng mc la 1 bin chung co th phong ngua o bnh TD. Kham mt mi nm 1 ln
cho phep phat hin nguoi co bnh vng mc tin trin.
Phu vt dat, loet giac mc, cao nhn ap va duc thuy tinh th la nhung bin chung mt
thm vao trong bnh TD.
#in chng su" th)n?
*ao &' !( cao +,ng hu"t la nhung yu t chinh dn dn bnh thn o nguoi bnh TD.
Binh thuong hoa HA va muc duong s lam chm dang k tu khi phat hin
microalbuminuria cho dn khi bnh thn r rang. Tt c BN TD phi co HA 130/80
mm Hg va thp hon cang tt. Kim soat mnh cao duong huyt va HA cho thy lam
chm tin trin bnh thn o BN TD.
#-nh th.n /inh
la bin chung ph thng bnh TD tac dng hon 50 BN voi thoi gian.
Dng ph thng nht thuong tn thn kinh la bnh +a th.n /inh +0i 1ng o xa, xy ra
o vung mang vo va gng tay, co th dau hay khng dau.
Kiu bnh thn kinh nay t2ng ngu" c3 g4" th3ng t5ch ch4n !( ca ch4n (don chi).
Nhung dng bnh thn kinh khac gm bnh h thn kinh tu dng (tng nguy co tu
vong tim mch va khng bit h duong thai qua), vim 1 dy thn kinh o mch mau
va teo co do bnh TD (thn kinh mt lop myelin)
#in chng mn6 mch m7u ln #in chng mn6 mch m7u ln
Bnh tim mch: Ph bin nht trong bnh TD va la nguyn nhn dn du tu vong.
77 ca nhp vin va 80 ca tu vong trong bnh TD do bnh tim mch.
Bnh TD la 1 yu t dc lp cho bnh tim mch. T l sinh bnh tim mch rt cao o bnh
TD nn bnh TD xem la yu t nguy co tuong duong voi bnh tim mch.
Bnh tim mch gm thiu mau cuc b co tim, dt qu, bnh mch mau ngoi vi.
Bnh mch vanh: Nguoi bnh TD cung tng t s sinh bnh suy tim.
Sau khi bi nhi mau co tim cp, nguoi bnh TD nng hon nhom kim chung, nhung co
th ci thin khi kim soat cht ch muc duong.
Nghin cuu can thip chung minh h lipid huyt gim dang k tu sut va su c tim mch
o nguoi bnh TD.
Statin to ra co loi. Tin cuu chung minh gim tu sut tim mch khi kim soat huyt
ap.Khng co du liu chung minh kim soat k muc duong nh huong dn bnh sut va tu sut
ngoi tru BN TD type 1.
#in chng mn6 mch m7u ln #in chng mn6 mch m7u ln
Bnh TD cung lin quan dn hong mau luu thng ngoi bin va hong cm giac o du tu
chi.
Dy la nguyn nhn dn du thuong tich co hoc va bin chung nhim trung, dua dn cua
chn va nm bnh vin, nguyn nhn chinh cua chn khng do chn thuong.
Bin chung nay co th phong ngua nu mang giay vo, kham chn du dn va giao duc
bnh nhn.
'IQU T2R
NGUYEN TAC IEU TR T
Che o an dnh dng
Tap uyen the c van ong
Thuoc
MC TIEU IEU TR T
- Ngan nga tru chng tang dung huyet
- G cn nang tuong
- Nga v m chm ben chng (bnh on dung huyet)
L tng Chp nhn
'DEng huyt l&c 81i STUP5T CgVMl WP6T CgVMl
'DEng huyt sau Xn STUPYT CgVMl WPST CgVMl
L"=P$ Z!T ? [\]U]\] ^_ W ` ^ `US ^
Che o an
- Xac nh so can nang ly tng (cong thc Lorenz)
Can nang y tng (kg) = T100 (T150)/K
| v T cheu cao (cm); K=2,5 cho n va 4 cho nam|
- Tnh so Calo can th!et trong nga"y

So Cao/kg can nang y
tng
Gay Trung bnhMap
Lao ong nhe 35 30 25
Lao ong va 40 35 30
Lao ong nang 45 40 35

- #han $ho! %&a a'n (a" cho)n loa)! thc a'n
1.200 1.600 Cao : cha 3 ba
2.000 2.500 Cao : cha 4 ba
3.000 Cao : cha 5-6 ba
30-35% E c cung cap d dang pde (dau m)
45-60% E c cung cap d dang gucde (ng phc va chat x)
15-20% E c cung cap d dang protde (tht ca, am thc vat)
INSULIN INSULIN
- Insun co nguon goc t ong vat c trch tnh t tuy tang bo - Insun co nguon goc t ong vat c trch tnh t tuy tang bo
hoac heo. Hen nay khong con dung nheu. hoac heo. Hen nay khong con dung nheu.
- Insun ban tong hp: thay thanh phan acd amn khac nhau bo - Insun ban tong hp: thay thanh phan acd amn khac nhau bo
hay heo bang thanh phan acd amn tng t nsun ng. hay heo bang thanh phan acd amn tng t nsun ng.
- Insun snh tong hp bang cong nghe d truyen hoan toan gong - Insun snh tong hp bang cong nghe d truyen hoan toan gong
nsun ng (ta to hp t DNA cua nsun ng (ta to hp t DNA cua *+ Col! *+ Col!). ).
Insun do te bao Insun do te bao cua ao Langerhans tuy tet ra d dang cua ao Langerhans tuy tet ra d dang
pronsun. Sau o, pronsun b phan ga thanh nsun va C- pronsun. Sau o, pronsun b phan ga thanh nsun va C-
peptd. peptd.
Insun a 1 poypeptd gom 2 chuo :chuo A co 21 acd amn, chuo B Insun a 1 poypeptd gom 2 chuo :chuo A co 21 acd amn, chuo B
co 30 acd amn, ha chuo nay no v nhau bang cau no co 30 acd amn, ha chuo nay no v nhau bang cau no
dsufur. dsufur.
Insun b phan huy chu yeu b gan (50%), than. Do o, khong Insun b phan huy chu yeu b gan (50%), than. Do o, khong
the dung nsun bang ng uong. the dung nsun bang ng uong.
TC TC D D NG SINH LY NG SINH LY
,an - ,an -
Gam phong thch gucose Gam phong thch gucose
Gam snh the ceton Gam snh the ceton
Tang tong hp trgycerdes va VLDL Tang tong hp trgycerdes va VLDL
Tang bat g ka. Tang bat g ka.
C - C -
Tang bat g va s dung gucose Tang bat g va s dung gucose
Tang tong hp proten Tang tong hp proten
Gam y ga proten Gam y ga proten
Tang bat g ka Tang bat g ka
.o /&- .o /&-
Tang tong hp m t acd beo Tang tong hp m t acd beo
Gam y ga m thanh acd beo Gam y ga m thanh acd beo
Tang men poproten pase Tang men poproten pase
Tang tong hp gycogen Tang tong hp gycogen
Tang y ga gucose Tang y ga gucose
Tha0n Tha0n: :
Tang ta hap thu Natr. Tang ta hap thu Natr.
PHAN LO PHAN LO I INSULIN I INSULIN
Mau Mau
sac sac
Kh au Kh au
tac tac
dung dung
(g) (g)
Nnh Nnh
(g) (g)
Th Th
gan gan
tac tac
dung dung
(g) (g)
Tac 12)ng nhanh Tac 12)ng nhanh
- Insun thng - Insun thng
(reguar, (reguar,
actrapde) actrapde)
- Insun spro - Insun spro
- Insun aspart - Insun aspart
Trong Trong
Trong Trong
Trong Trong
TM: 5 phut TM: 5 phut
TDD: 30 TDD: 30
phut phut
< 15 phut < 15 phut
15-20 phut 15-20 phut
1-3 1-3
0,5-1,5 0,5-1,5
1-3 1-3
6-8 6-8
4-6 4-6
3-5 3-5
Tac 12)ng Tac 12)ng
tr2ng %3nh tr2ng %3nh
(NPH, Lent) (NPH, Lent) Nuc Nuc 2- 2 g 30 2- 2 g 30 4- 12 4- 12 24 24
Tac 12)ng 1a"! Tac 12)ng 1a"!
(Utraent, PZI) (Utraent, PZI) Nuc Nuc 4 g 4 g 8- 24 8- 24 28- 36 28- 36
4o5n h)$ 4o5n h)$ (pha 2 (pha 2
oa nhanh va oa nhanh va
trung bnh, ty trung bnh, ty
e co the e co the
30/70, 20/80, 30/70, 20/80,
50/50) 50/50)
Nuc Nuc 30 phut- 1 30 phut- 1
g g
7- 8 7- 8 24 24
M Ma aT S T Sb b D Dc cNG INSULIN NG INSULIN
6 7ns2l!n l!s$ro 6 7ns2l!n l!s$ro ( Humaog) (1995): ( Humaog) (1995):
Thuoc oa nsun ng, cho tac dung nhanh, tang toc o hap Thuoc oa nsun ng, cho tac dung nhanh, tang toc o hap
thu va ch can tem va phut trc an so v 30 phut neu thu va ch can tem va phut trc an so v 30 phut neu
tem nsun thng. tem nsun thng.
6 7ns2l!n as$art (8999) 6 7ns2l!n as$art (8999)
Thuoc oa nsun cho tac dung nhanh tng t nsun spro, khac Thuoc oa nsun cho tac dung nhanh tng t nsun spro, khac
nsun ng do s thay the aspartc acd v tr B28, cung c nsun ng do s thay the aspartc acd v tr B28, cung c
san xuat bang ky thuat ta to hp DNA. san xuat bang ky thuat ta to hp DNA.
+ + 7ns2l!n glarg!ne 7ns2l!n glarg!ne (Lantus) (1999): (Lantus) (1999):
Thuoc oa nsun ng, co tac dung cham keo da 24 g, cho Thuoc oa nsun ng, co tac dung cham keo da 24 g, cho
phep benh nhan ch can tem 1 an trong ngay, co nh tac phep benh nhan ch can tem 1 an trong ngay, co nh tac
dung nhe khoang 12 en 14 g sau tem. dung nhe khoang 12 en 14 g sau tem.
6 7ns2l!n 1a)ng $h2n 6 7ns2l!n 1a)ng $h2n ( Inhaed nsun) (1999): ( Inhaed nsun) (1999):
Nc phun vao meng nh dang kh dung va c hap thu qua Nc phun vao meng nh dang kh dung va c hap thu qua
mang nem mac hong, pha s dung v eu cao. Con ang mang nem mac hong, pha s dung v eu cao. Con ang
c nghen cu. c nghen cu.
6 7ns2l!n 2ong- 6 7ns2l!n 2ong- kha nang ha ng huyet yeu nen pha dung kha nang ha ng huyet yeu nen pha dung
eu cao, b teu huy b men teu hoa nen pha co vo boc. eu cao, b teu huy b men teu hoa nen pha co vo boc.
6 7ns2l!n 1a)ng to)a 1)c- 6 7ns2l!n 1a)ng to)a 1)c- ngam vao mau c, nhng eu pha ngam vao mau c, nhng eu pha
manh gap 10 an bnh thng do o hap thu trc trang rat manh gap 10 an bnh thng do o hap thu trc trang rat
kem. kem.
CH CHd d 'R 'RNH INSULIN NH INSULIN
:) ;T; ty$e : :) ;T; ty$e :
8) ;T; ty$e 8- 8) ;T; ty$e 8-
- S dung ngan han: kh co cac ben chng cap, nhem trung, - S dung ngan han: kh co cac ben chng cap, nhem trung,
benh nang; s dung nhng thuoc co kha nang am tang NH benh nang; s dung nhng thuoc co kha nang am tang NH
(nh Cortcod); co tha, chuan b mang tha. (nh Cortcod); co tha, chuan b mang tha.
- S dung da han: chong ch nh thuoc ha NH uong nh suy than - S dung da han: chong ch nh thuoc ha NH uong nh suy than
man., theu Insun ro, eu tr that ba v thuoc ven ha NH man., theu Insun ro, eu tr that ba v thuoc ven ha NH
th phat, khong dung nap thuoc ha NH uong, NH khong kem th phat, khong dung nap thuoc ha NH uong, NH khong kem
soat c du a s dung eu to a va co pho hp nheu soat c du a s dung eu to a va co pho hp nheu
oa thuoc ha NH uong. oa thuoc ha NH uong.
- No v benh nhan that ba v thuoc ha NH uong, thng c - No v benh nhan that ba v thuoc ha NH uong, thng c
s dung oa Insun tac dung keo da vao uc trc ngu nham s dung oa Insun tac dung keo da vao uc trc ngu nham
c che san xuat gucose t gan vao ban em. c che san xuat gucose t gan vao ban em.
<) ;T; tha! =y" <) ;T; tha! =y"
CH CHe e PH PHf fM INSULIN M INSULIN
+ Bao quan o nsun: + Bao quan o nsun:
- 2-8oC, trong to - 2-8oC, trong to
(25-30oC trong 4-6 tuan) (25-30oC trong 4-6 tuan)
- Ne thang ng, khong ac manh o - Ne thang ng, khong ac manh o
+ Cach s dung cac oa nsun : + Cach s dung cac oa nsun :
- Loa tac dung nhanh: tem tnh mach, tem d da (TDD) - Loa tac dung nhanh: tem tnh mach, tem d da (TDD)
(Insun Lspro : ch TDD). (Insun Lspro : ch TDD).
- Loa tac dung trung bnh va da : TDD - Loa tac dung trung bnh va da : TDD
- Insun c hoa tan pH toan (pH 3-5): tang ben vng y hoc - Insun c hoa tan pH toan (pH 3-5): tang ben vng y hoc
(nhng de kh amn) va khong mat tac dung snh hoc (gam (nhng de kh amn) va khong mat tac dung snh hoc (gam
20% sau 500 ngay). 20% sau 500 ngay).
- Insun hoa tan pH 7,4 t b mat tac dung snh hoc nhng o ben - Insun hoa tan pH 7,4 t b mat tac dung snh hoc nhng o ben
vng y hoc a kem vng y hoc a kem
- Trong dung dch pH kem nsun b thoa hoa nen khong the pha - Trong dung dch pH kem nsun b thoa hoa nen khong the pha
chung chung
- Cac dung dch co the pha nsun: NaC 0,9%, Gucose 5%, Gucose - Cac dung dch co the pha nsun: NaC 0,9%, Gucose 5%, Gucose
10%, Rnger actate 10%, Rnger actate
- Cac dd khong the pha chung v nsun : dd kem hoac co acd - Cac dd khong the pha chung v nsun : dd kem hoac co acd
amn, amnophyn, barbturc, chorothazde, dobutamn, cortcod, amn, amnophyn, barbturc, chorothazde, dobutamn, cortcod,
ntrofuranton, novobocn, sufamde. ntrofuranton, novobocn, sufamde.
geU Tb hNL LijNG Tk$ lmNG INSULIN geU Tb hNL LijNG Tk$ lmNG INSULIN
+ Yeu to am tang teu thu nsun: + Yeu to am tang teu thu nsun:
Tac nhan ta cho: Tac nhan ta cho:
Bung: n hap thu Insun nhanh nhat, ke en a canh tay, u Bung: n hap thu Insun nhanh nhat, ke en a canh tay, u
Tem sau d da Tem sau d da
Xoa bop hoac chm nong cho tem Xoa bop hoac chm nong cho tem
Van ong c n tem Van ong c n tem
Tac nhan toan the: Tac nhan toan the:
Nhet o mo trng cao Nhet o mo trng cao
Tac nhan en quan en nsun: Tac nhan en quan en nsun:
Loa Insun co pH trung tnh, oa gong nsun ng Loa Insun co pH trung tnh, oa gong nsun ng
Nam o oang Nam o oang
Tem ng t, eu thap Tem ng t, eu thap
+ Yeu to am cham teu thu nsun: + Yeu to am cham teu thu nsun:
Tac nhan ta cho: Tac nhan ta cho:
Canh tay, u Canh tay, u
Tem nong d da Tem nong d da
Co oan dng m, x n tem Co oan dng m, x n tem
Tac nhan en quan en Insun: Tac nhan en quan en Insun:
Loa Insun co pH toan, oa nsun chet xuat (bo, heo) Loa Insun co pH toan, oa nsun chet xuat (bo, heo)
Nam o cao (U100) Nam o cao (U100)
Tem ng nheu, eu cao Tem ng nheu, eu cao
+ Tnh trang c the: + Tnh trang c the:
Thay o s hap thu va teu thu nsun. Thay o s hap thu va teu thu nsun.
LiU n BLI lmNG INSULIN LiU n BLI lmNG INSULIN
- OAng tem nsun pha that phu hp v oa nsun ma benh - OAng tem nsun pha that phu hp v oa nsun ma benh
nhan ang dung nhan ang dung
- V tr tem nsun pha thay o. Cac v tr dung e tem nsun - V tr tem nsun pha thay o. Cac v tr dung e tem nsun
thng a canh tay, bung va u. thng a canh tay, bung va u.
- Leu kh au a 0,25- 0,5 n v/ kg can nang. Co the thay o - Leu kh au a 0,25- 0,5 n v/ kg can nang. Co the thay o
eu sau 5- 10 ngay, mo an thay o khong qua 5 n v. eu sau 5- 10 ngay, mo an thay o khong qua 5 n v.
Tk$ lmNG +Lm Tk$ lmNG +Lm
- Ha ng huyet - Ha ng huyet
- D ng (phan ng vem n tem, choang phan ve) - D ng (phan ng vem n tem, choang phan ve)
- Loan dng m (ph a mo m, teo mo m d da) - Loan dng m (ph a mo m, teo mo m d da)
- Khang nsun (kh s dung qua 200 n v /ngay trong 2-3 ngay - Khang nsun (kh s dung qua 200 n v /ngay trong 2-3 ngay
ma ng huyet van khong ha) ma ng huyet van khong ha)

TLUb$ Lc 'ioNG LUgeT lpNG UbNG TLUb$ Lc 'ioNG LUgeT lpNG UbNG
Cac nhom thuc diu tri tiu duong type 2 dung ung Cac nhom thuc diu tri tiu duong type 2 dung ung
- - Nhom kich thich insulin tu t bao Nhom kich thich insulin tu t bao tuy tuy
- SulIamide h duong huyt (sulIonylurea): 03 th h
- Nhom Glinide
- - Nh Nho om m t t ng ng nhy nhy cm cm voi voi insulin insulin ti ti m m su su dung dung
- Nhom biguanides
- Nhom Thiazolidinedione
- BenIluorex
- - Nhom uc ch hp thu glucose tu rut Nhom uc ch hp thu glucose tu rut
- Nhom uc ch enzym glucosidase - Nhom uc ch enzym glucosidase
- Cac thuc lam gim di chuyn thuc n xung rut - Cac thuc lam gim di chuyn thuc n xung rut
SulIonylurea SulIonylurea
- - Co ch Co ch
Kich thich t bao tuy tng tit insulin
- - Duoc dng hoc Duoc dng hoc
- Chuyn hoa qua gan, dao thi qua gan thn
- ua duoc nhau thai
Thn trong o bnh nhn co bnh ly gan thn, dc bit o nguoi cao tui.
Khng dung cho phu nu co thai
Hm uong
(vn)
Kh nng h DH T
(go)
Tho
gan
tc
dung
(go)
Lu/ngy
THEA HE 1
Tobutamde
(Dopo,Ornas
e)
Carbutamde
(Gucdora)
Chorpropamd
e (Dabnese)
500mg
500mg
250mg
4-6
40
36
6-12
nheu
nga
y
60
1000mg-
3000mg
100mg-
500mg
100mg-
500mg
THEA HE 2
Gcazde
(Damcron,
Predan)
80mg
30mg *
Trung
bnh
10- 12 6-12 1-4v
1-4v
Gbornurde (Gutr) 25mg Trung
bnh
8-12 8-12 0,5- 4v
Gpzde
(Mndab)
5mg Trung
bnh
3-5 12-14 0,5-4v
Gbencamde
(Daon)
5mg, 2,5mg,
1,25mg
Manh 5 16-24
24 **
1-4v
THEA HE 3
Gmeprde (Amare) 1-2-3-4mg Manh 5 24-48-60 1-6mg
8mg
The he 1 The he 2 The he 3
- Ham ng tnh
bang n v
gam
- Pha dung
nheu
an/ngay
- Hoat c ha
ng huyet tng
o yeu
- Khong co cac
tac ong
ngoa tuy
- t kh gay ha
ng huyet
nang
- Nheu tac
dung phu va d
ng
- Ham ng tnh
bang n v
mgam
- Pha dung nheu
an/ngay
- Hoat c ha
ng huyet
manh
- Khong co cac
tac ong ngoa
tuy
- Thng gay ha
ng huyet
nang
- t tac dung phu
va d ng
- Ham ng tnh bang
n v mgam
- Ch dung
1 an/ngay
- Hoat c ha ng
huyet manh
- Tac ong ngoa tuy
ang ke
- t kh gay ha ng
huyet nang
- t tac dung phu va
d ng
Tac dung phu Tac dung phu
H duong huyt qua muc (tac dung cang dai, nguy co h duong huyt cang cao)
Tng cn
Da : hng ban da dng
H natri huyt khi ung Chlorpropamide
Hiu ung antabuse khi ung Chlorpropamide: Ruou to nn mt t l bt thuong
acetaldehyd tich luy o m (uc ch enzym) keo theo cac du hiu lam tng nhu con vn mch,
gin mch nng, nhip tim nhanh, thn nhit tng cao, bun nn, nn, phat ban da, co th gy h
huyt ap, truy tim mch co th dua dn tu vong)
Thuong ung truoc bua n (khong 30 phut)
Cac thuc co thoi gian ban huy ngn (nhu Tolbutamide) nn ung ngay truoc cac bua n.
Di voi dng thuc phong thich chm (Gliclazide 30mg MR) : nn ung duy nht 1
ln/ngay vao bui n sang hay ngay truoc bua n sang.
Dung lu ngay gim hiu qu khong 10 mi nm
GLINIlq GLINIlq
Bao gm Bao gm Repaglinide Repaglinide (NOVONORM), (NOVONORM), Methiglinide Methiglinide, , Nateglinide Nateglinide
Co ch Co ch
Kich thich t bao tuy tng tit insulin nhung gn ln cac thu th khac voi thu th cua
SU.
Luu y Luu y
Dung ngay truoc bua n hay 15-30phut truoc bua n
ONE MEAL-ONE DOSE, NO MEAL-NO DOSE
Co th kt hop voi MetIormin hay Thiazolodonetione.
!IGU=NIlqS !IGU=NIlqS
Hin chi con su dung MetIormin (Glucophage) Hin chi con su dung MetIormin (Glucophage)
Co ch Co ch
Tng su nhy cm voi insulin o m ngoi bin
c ch qua trinh tn to duong ti gan
Ngoai ra, thuc con co kh nng ci thin chuyn hoa lipid
Duoc dng hoc Duoc dng hoc
Chuyn hoa gn nhu hoan toan ti gan
Tac dung phu Tac dung phu
Nhim acid lactic
Luu y Luu y
Khng gy h duong huyt qua muc va khng lam ln cn uu tin su dung o bnh
nhn beo phi
Khng dung cho bn suy thn va suy t bao gan nng.
Thn trong trn cac di tuong : suy tim sung huyt, nghin ruou, nhim toan chuyn hoa
Dung mt minh hay phi hop (sulIonylurea, acarbose, insulin), ung trong hoc sau khi
n
TLI=r>LIlINqlI>Nq ZTrl_ TLI=r>LIlINqlI>Nq ZTrl_
Bao gm: Bao gm: Pioglitazone Pioglitazone (ACTOS), (ACTOS), Rosiglitazone Rosiglitazone (AVANDIA), (AVANDIA), Englitazone Englitazone
Co ch Co ch
tn to glucose o gan,
thu nhn va su dung glucose o co
thu nhn glucose va gim phong thich acid beo tu m m
duong huyt, triglyceride, HDL-cholesterol
nhy cm voi insulin, d khang insulin
Phu thuc su hin din cua insulin d hot dng
Luu y Luu y
- Tac dung phu hay gp nht la phu n, co th dua dn suy tim sung huyt chng chi dinh
cho bn suy tim d III va d IV theo phn loi cua NYHA.
- Nn thu chuc nng gan trong thoi gian moi diu tri. Nu transaminase tng gp 2,5 ln
chng chi dinh
- Co th phi hop thuc voi sulIonylurea, insulin
- Dung 1 ln/ngay, trong hoc ngoai bua n
Nh1C Fc ch Nh1C Fc ch s sUglucsiMas# UglucsiMas#
Bao gm: Bao gm: Acarbose Acarbose (GLUCOBAY), (GLUCOBAY), Voglibose Voglibose (BASEN), (BASEN), Miglitol Miglitol
Co ch Co ch
c ch -amylase va -glucosidase trong ng tiu hoa lam chm bin di carbohydrate
thanh glucose chm hp thu glucose
Tac dung phu: Tac dung phu: Chu yu trn duong tiu hoa: sinh bung, dy hoi, tiu chy
Chng chi dinh: Chng chi dinh: Cac bnh ly d day-rut gy kem hp thu
Cac bnh ly tng to gas trong duong tiu hoa. Loet rut
Luu y Luu y
Dung thuc ngay khi bt du n
Thuc lm gim di chuyn thc n xung rut Thuc lm gim di chuyn thc n xung rut
Lam gim duong huyt sau n
Dang thu nghim amylin antagonist
TLUb$ tuI
Thuc dng vn peptid-1 ging glucagon (GLP-1) la thuc tim moi.
Thuc uc ch dipeptidyl-4 (DPP4) la enzym lam mt hot dng cua GLP-1.
Hai nhom thuc trn dang duoc cac bac s chuyn khoa tiu duong o cac nuoc u M su
dung d giup kim soat muc duong o nguoi d khang