Professional Documents
Culture Documents
1
)
(Aretaeus 200
. "" "
"Diabetes .
" "
. ,
2
,
. 1910
"" .
, " "Langerhans
. ) (Bating
1920 .
1922.
, , .
%8-5
. 2006
171 .
2030
, %75 ,
%44 ,
, %30
286
. ,
, , ,
%17.3 %12.18
) .( 2000 ,
%5-4 .
2000
2030
2030 2000
99.000 37.000
6.726.000 2.623.000
2.009.000 668.000
680.000 195.000
319.000 104.000
378.000 146.000
245.000 88.000
1.138.000 427.000
343.000 113.000
88.000 38.000
2.523.000 890.000
331.000 97.000
1.277.000 447.000
2.313.000 627.000
684.000 350.000
1.286.000 327.000
1.203.000 426.000
: 2006.
.( ( WHO,1999
___________________________________________________
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40 40-59
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7-3 .
12
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13
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14
) (
, , .
) impaired
( fasting glucose
* 126 100 / 7 ) 3 /(
, ,
15
) (Renal Sugar Threshold .
100/ ) 3/(
(6.1)110
(6.1-7) 125 -110
) (
* (7 )126
* .
* 126100/ 3
. ,
16
,
, .
AIC
17
* ) (
75
. 30 .
* 75
140100 / 7.80 ) 3 / (
* 75
" "
* 75
18
75 ) /
100 ) 3/(
(7.80 ) 140
(7.80-11.1) 200 -140
) (
* ) 200 (11.1
) A1c (HbA1c
19
A1c
. ((Kuzuya etal.,2002
,(glycated haemoglobin . ,
) , , ,
, ( ,
%1
,%12
,%25
. %16
A1c .%6-4
%7
) .( %6 .5
20
%4 60100 / 3
3 %5 90 100/
3 %6 120 100/
3 %7 150100/
3 %8 180100/
%1 30 100/ . 3
A1c .
A1c
21
. %25
45
%20 .
) 140/90 (.
) (HDL )
35/( )
250/( ) 2.83/(.
10
22
23
: ) ( Type 1
, ) ( Type 2
24
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)) .IDDM
11
13 , .
25
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) ( Antibodies
26
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27
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28
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29
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30
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) (% 90
2001 85.000 ,
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2000
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) ( .
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() .( Rosenbloom, 2001
38
,
,
,
20-30%
39
: )(Secondary
). (Pheochromocytoma
: ) (acromegaly
, ) (Hyperthyroidism
, Cushing's Syndrome
Thyroid hormone
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40
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) .( WHO, 1999
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47
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48
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49
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58
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59
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60
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61
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62
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%30 ,%60
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12.000 24.000
63
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20-15 .
64
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111
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112
)
(.
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Cartridge
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, , .
113
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114
.
Insulin
115
) ,( insulin aspart (Novolog,
).Novorapid
))
cartridge .
15-5 .
15
, 5-3
116
monomeric
) 5 (
Hexameric
117
45-30 .
)-3
4( ) 8-6(.
Short acting
insulin
118
, ) (Humulin R, Novolin R
, .
30 .
45-30
. 4-2
8-6 .
119
Intermediate acting
insulin
NPH Humulin
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120
2.5-1 ,
10-4
16 .
%30
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12-4
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121
Long acting
insulin
ultralente )
(Humulin U .
10-6 , 20
, .
Glargine ) (Lantus
24 .
122
24 .
(.
, .
)(
123
2-1 .
30
25 .
6 .
% 4-3 , , , ,
124
Insulin mixtures
) (NPH
125
%70 %30
30/70 30/70 .
%50 %50
50/50.
126
3-5 30-90 5-15
)(
1-3 )(
2-5 5-8 30-60
) ,
(
14-24 8-14 1-2.5
) ,
(
8-12 1-2.5 ) (
20-36 10-18 4-6
) (
24 1-2 )(
No peak
7-12 30 , 25/75
50/50 , 30/70
127
.
128
90-45.
, ,
129
.
130
.
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131
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1.5 3( .
132
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Humulin, Humalog.
12 .
133
134
. :
) ( Reservoir .
( (Pump .
.1000
135
) soft cannula
( .
136
.
137
. 24
138
.
AIC
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139
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aerosol
) .(FDA
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).(Oralin
140
Oralin
141
142
.
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%70 .
( 5
143
2007
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( 6 ) ( Insulin
jet injectors
144
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( 8
145
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146
10-5
147
, .
148
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149
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150
,
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50-20 ) (%50
3-2 .
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5 .
15
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151
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152
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153
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injection sites
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154
.
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8-2 )-36
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156
-8
157
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158
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Insulin secretagogues )
( , ) ( .
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sensitizer ) (,
) ( .
159
.
Sulfonylureas
160
30-20 .
10-7 .
161
2000
. 1 First Generation
,,
,.
.2 Second Generation
,,
162
,
(1 -
(2
163
(3
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164
(FDA
Tolbutamide
165
. )-6
8( , ( (Half-life 5-4.
) (
250 500.
166
) 500
( .
Acetohexamide
16-10 .
8-6 .
167
250 500 .
1.5-0.25
, .
Tolazamide
) 14-12( , .
. 7
500
. 1000
168
Chlorpropamide
. , %30-20
32 ,
100 250 .
250 .
500
169
7 6-8 4-5
20-60 ) ( ) ( ) (
) ( ) (
1-2 ) (
170
, ,
) ( ,
) ( Glyburide
)(Glibenclamide
171
.
) 3( ,
5 ,.
2.5
. 10-5 ,
20 .
172
Glipizide
%90
, %10
. ) 4-2(
. 16-10
173
15 -5
40 ,
20-15.
Glimperide
9-5
24-12 .
174
8 . ,
175
5-9 2-4 )( 3
12-24 10-16 12-24 )(
1-8 2.5-40 2.5-20 )(
1 1-2 1 /
176
.
%30
, .
. .1
177
.
.depolarization
.alloxan
.2 Glucagon
somatostatin
178
) (A cells . ,
,Streptozacin
.3 :
179
, .
. :
180
.
, , ,
, , 1/10
Vasopressin
%1 .
181
.
%3-1
)-(NSAIDS
, , -
182
Fluconazole
chloramphenicol
183
,Corticosteroids
(A
Thiazide
Furosemide
,Phenytoin
,Phenobarbital
184
185
100
186
187
Meglitinides
Repaglinide
Natiglinide Mitiglinide
55 .
4-3
188
4-0.25 ) 16 (.
, ,
189
, ,
: Biguanides
Metformin
3 -1.5.
190
,,
) (.
191
,
)(LDL
).(%14
192
Polycystic
. ovaries
500
850 .
500 850
. 2550
500
. 500
2000
. .
193
16-10 ,
500 , 500
2000 .
. , ,,
, .
%20
. %5-3
194
12 .
12
) (Lactic acidosis .
30000 %50 .
: ,
, ,
, , , .
195
, Congestive heart
,failure ,.
, .
, ,
Alpha- glucosidase
inhibitors
Acarbose
)(
. )(
)(
) (
196
.
" "
, .
" " .
1000
. "
"
197
,(duodenum ) ,(Jejunum ).(ileum
198
) (FDA
, , .
) (
A1C
100-25 ,
199
%2
, .
Thiazolidinediones
Rosiglitazon
Pioglitazone
200
) ,(%99
) 7( ,
) 150 , 24
( .
201
.
.%30
, ,
202
) ) Troglitazone
, .
) , ,
, ( ,
203
) , , , ,
, , (.
204
)( .
4-1
12-6 .
205
, 2-3
)
(,
1-2
) (.
1-2
, 1
1
1-2
1-2
1-2
1-2
3
3
1
,
)( 1-2
, 3
3
206
Vildagliptin
) .(incretin
207
.
.( FDA
. .
208
, .
100-50 .
100
50
209
Exinatide
210
, ,
211
Glucagone , adrenaline
212
213
. 90-30
68
214
.
215
, ,
. ,
, ,
216
.
"" .
) (
217
,
200 .
metformin .valsartan
218
. ,
219
220
. . 1. ,
. , 1997 ,
. . 2.
. , , 2000 ,
. . 3. ,
. , 2003 ,
221
4. - - - . -
, . 6
2004, , , .
ENGLISH REFERENCES
389
S20
222
3. Atkinson MA. and Eisenbarth GS: Type 1 diabetes: new
12(7): RA130-147
223
8. Gale, E and Anderson, J.: Diabetes mellitus and other
224
subjects with impaired glucose tolerance. N Eng J Med,
Geneva, 1999
5 :
6
7
8
8
8
11
12
225
13 :
14
15
17
19 A1C
21
23 :
24
24
25
27
28
30
31
37
37
39 :
39 :
43
44
44
45
49 :
51
55
58
60
62
62
64
67
68
226
69
70
70
70
71
71
72
74
75
77 :
78
78
78
81
83
85
85
86
87
87
88
89
89
91
93
93
93
94
95
95
97
98
99
101
102
103
105
107
108
108
227
109
110
110
111
113
117
119
120 ) (
120
121
121
125
128
129
130
131
133
135
135
137
137
137
138
138
138
139
139
139
141
141 ) (
142
142
143
143
144
145
148
151
152
154
228
154
154
154
155
156
156
156
157
158
159
160
160
161
162
162
164
164
166
166
166
169
169
170
170
171
171
172 :
173
174
176 , ,
177
177
178
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