‫ﻷﻃﺒﺎء اﻷﻣﺘﯿﺎز و اﺳﺘﻘﺒﺎل اﻟﻄﻮارئ‬

Edited by
3alam el-teb
worldmedicine-mahmoud.blogspot.com
 Preface
In the name of Allah the Merciful
This note contains all the required for house officers& new
GPs about DM from practical point of view
I dedicate this work to everyone involved in the
dissemination of science wherever & to my mother,
family and all my friends.

2 By 3alam el-teb
 ‫ ﺻﻮر ھﻲ‬3 ‫ﻣﺮﯾﺾ اﻟﺴﻜﺮ ﻣﻤﻜﻦ ﯾﺠﻲ ﯾﺸﺘﻜﻲ ﻓﻲ ﺻﻮرة ﻣﻦ‬
1st detection •
Follow up •
Complications •
1st detection :‫أوﻻ‬

‫ﻋﺎﯾﺰك ﺗﻤﺸﻲ ﻣﻌﺎﯾﺎ ﺑﻨﻔﺲ اﻟﺘﺮﺗﯿﺐ دا وأﻧﺖ ﺑﺘﺘﻌﺎﻣﻞ ﻣﻊ اﻟﻌﯿﺎن‬

.‫ﻣﻦ ﺷﻜﻮﺗﮫ‬DM ‫( أﯾﮫ اﻟﻠﻲ ﺣﯿﺨﻠﯿﻨﻲ اﻧﻲ أﺷﻚ ان اﻟﻌﯿﺎن‬1
‫( ﻟﻤﺎ أﺷﻚ أﻋﻤﻞ أﯾﮫ؟‬2
‫( ﻃﯿﺐ و أﺗﺄﻛﺪ أزاي؟‬3

Step1

.‫ﻣﻦ ﺷﻜﻮﺗﮫ‬DM ‫أﯾﮫ اﻟﻠﻲ ﺣﯿﺨﻠﯿﻨﻲ اﻧﻲ أﺷﻚ ان اﻟﻌﯿﺎن‬.1

1) Poly symptoms
2) Vague symptoms
a) Anorexia
b) Abdominal pain
c) Blurred vision
d) Infection
3) Coma
a) Hypoglycemia
b) DKA
c) HHNK(Hyperglycemic Hyperosmolar non Ketotic Coma)

Step 2

‫ﻟﻤﺎ أﺷﻚ أﻋﻤﻞ أﯾﮫ؟‬.2

RBS

200mg ‫ﻟﻮ أﻛﺜﺮ ﻣﻦ أو ﯾﺴﺎوي‬

DM

3 By 3alam el-teb
 ‫‪Step3‬‬

‫‪.3‬ﻃﯿﺐ و أﺗﺄﻛﺪ أزاي؟؟؟‬

‫ﺑﺴﯿﻄﺔ ﺧﺎﻟﺺ أﻋﻤﻞ ﺑﺪون ﺗﻔﻜﯿﺮ أﺧﺘﺒﺎرﯾﻦ ﻣﮭﻤﯿﻦ ﺟﺪااا ﻋﺸﺎن ﺗﺘﺄﻛﺪ‬

‫‪mg/dl‬‬ ‫)‪FBS (fasting blood sugar) PPS(post prandial sugar‬‬

‫‪Normal‬‬ ‫‪110--70‬‬ ‫أﻗﻞ ﻣﻦ ‪140‬‬
‫‪DM‬‬ ‫أﻛﺜﺮ ﻣﻦ أو ﯾﺴﺎوي ‪ 200‬أﻛﺜﺮ ﻣﻦ أو ﯾﺴﺎوي‪126‬‬

‫ﺑﺲ ﺧﺪ ﺑﺎﻟﻚ‬
‫ﯾﺎ دﻛﺘﻮر‬ ‫‪Iifjbdfl,./,‬‬

‫‪Fegviujggn‬‬
‫‪ü If fasting 110-126‬‬ ‫‪impaired fasting glucose‬‬
‫‪ü If PP 140-200‬‬ ‫‪impaired glucose tolerance‬‬

‫و اﻟﺤﺎﻟﺘﯿﻦ دول ﻣﻌﻨﺎھﻢ ان اﻟﻤﺮﯾﺾ‬

‫‪Prediabetic‬‬
‫ﻃﺐ دا ﯾﻔﯿﺪك ﻓﻲ أﯾﮫ ؟!!‬
‫ﺣﯿﺪﯾﻠﻠﻚ اﻟﻤﻌﻠﻮﻣﺎت دي‬
‫‪ü Blood glucose level is higher than normal but not high‬‬
‫‪enough to cause DM‬‬
‫‪ü Many people of prediabetic develop type 2 DM within 2‬‬
‫‪years‬‬
‫& ‪ü Prediabetic patients with high risk of heart diseases‬‬
‫‪stroke‬‬
‫‪Low or modest body weight with moderate physical‬‬
‫ﻟﺤﺪ ﻛﺪه اﻧﺖ ﺗﻤﺎم أوي ﺑﺲ أﻧﺖ ﻧﺎﺳﻲ أھﻢ ﺣﺎﺟﺔ وھﻲ ﻃﺮﯾﻘﺔ اﻟﻌﻼج و ﺣﺘﻘﻮل ﻟﻠﻌﯿﺎن اﯾﮫ و‬
‫اﻷدوﯾﺔ اﻟﻠﻲ ﻻزم ﯾﺄﺧﺬھﺎ و اﻟﻨﺼﺎﺋﺢ اﻟﻠﻲ ﻻزم ﯾﺘﺒﻌﮭﺎ اﻟﻤﺮﯾﺾ‪.‬‬
‫ﺑﺲ ﻗﺒﻞ دا ﻛﻠﮫ ﻻزم ﺗﻜﻮن ﻋﺎرف اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﺎﻟﯿﺔ ﻗﺒﻞ ﻛﻞ ﺷﺊ‬
‫ﻟﺴﺒﺐ ﺑﺴﯿﻂ ﻣﺶ ﻷﻧﻚ دﻛﺘﻮر وﺑﺲ و ﻟﻜﻦ ﻋﺸﺎن ﺗﻌﺮف ﺗﺘﻌﺎﻣﻞ ﻣﻊ أي ﺷﺊ ﻏﺮﯾﺐ أو أي‬
‫أﻋﺮاض ﺟﺪﯾﺪة ﺣﺼﻠﺖ ﻟﻠﻌﯿﺎن ﻷن اﻻﺳﻜﯿﻢ دا ﻋﺸﺎن ﯾﻮﺟﮫ ﺗﻔﻜﯿﺮك ﻣﻊ اﻟﺤﺎﻟﺔ ﺑﺴﺮﻋﺔ وﻟﯿﺲ ھﻮ‬
‫ﻛﻞ اﻟﻄﺐ‬
‫ودا اﻟﻠﻲ ﺑﯿﻤﯿﺰ دﻛﺘﻮر ﻋﻦ اﻟﺘﺎﻧﻲ‪ ...‬أﻧﺎ ﺟﻤﻌﺘﻠﻜﻢ ﺑﻌﺾ اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﮭﻤﺔ ﺟﺪا ﻓﻲ ﺻﻮرة ﺟﺪاول‬
‫ﻣﺒﺴﻄﺔ و ﺳﮭﻠﺔ ﺟﺪا ﺑﺲ واﷲ ﺣﺘﻔﺮق ﻣﻌﺎك ﺟﺪا ‪....‬‬

‫‪4‬‬ ‫‪By 3alam el-teb‬‬

 ‫أوﻻ ‪ :‬اﯾﮫ اﻟﻔﺮق ﺑﯿﻦ ‪type 1 & type 2‬‬

‫ﺛﺎﻧﯿﺎ ‪ :‬اﯾﮫ ﻋﻼﻗﺔ ﻧﻘﻒ اﻻﻧﺴﻮﻟﯿﻦ ﻓﻲ اﻟﺠﺴﻢ ﺑﺎﻷﻋﺮاض اﻟﻠﻲ‬

‫ﺑﯿﺸﺘﻜﻲ ﻣﻨﮭﺎ اﻟﻌﯿﺎن وﻋﻼﻣﺎت اﻟﻤﺮض ﻏﯿﺮ ﻧﻘﻒ اﻟﺴﻜﺮ‬

‫‪5‬‬ ‫‪By 3alam el-teb‬‬

 ‫ﺛﺎﻟﺜﺎ‪ :‬اﯾﮫ ﺧﻄﻮرة ال ‪Hypoglycemic coma‬‬

‫راﺑﻌﺎ‪ :‬اﯾﮫ اﻟﻠﻲ ﻻزم ﺗﺸﻮﻓﮫ ﻋﻨﺪ ﻋﯿﺎن اﻟﺴﻜﺮ ﻛﻞ ﻣﺮة ﻟﻤﺎ ﯾﺠﻲ ﯾﻌﻤﻞ زﯾﺎرة‬
‫ﻣﺘﺎﺑﻌﺔ أو ﯾﺠﻲ ﯾﻜﺸﻒ ﻋﺸﺎن ﻣﺮض ﺗﺎﻧﻲ ﺧﺎﻟ ﻒ ﻏﯿﺮ اﻟﺴﻜﺮ‬

‫‪6‬‬ ‫‪By 3alam el-teb‬‬

‫ﺧﺎﻣﺴﺎ ‪ :‬أﺧﺮ ﻣﻌﻠﻮﻣﺔ ﺑﺠﺪ ﻟﻮ ﻋﺮﻓﺘﮭﺎ ﺗﺒﻘﻲ أﺳﺘﺎذ و ﺣﺘﻔﺮق ﻣﻌﺎك ﺟﺪا ﻓﻲ اﻟﺘﺸﺨﯿﺺ‬
‫وھﻲ )‪Metabolic syndrome ( syndrome X‬‬

‫و أﺧﺮ ﺣﺎﺟﺔ أوﻋﻲ أﺑﺪا ﺗﻨﺴﺎھﺎ أﻣﺎم ﻣﺮﯾﺾ اﻟﺴﻜﺮ اﻟﺸﻜﻞ اﻟﺘﺎﻟﻲ‬

‫‪7‬‬ ‫‪By 3alam el-teb‬‬

 ‫ﺑﻌﺪ ﻛﺪه ﺣﻨﺪﺧﻞ ﻓﻲ اﻟﻌﻼج و أول ﺣﺎﺟﺔ ﻓﻲ اﻟﻌﻼج ھﻲ ﺗﻐﯿﺮ ﻧﻈﺎم‬
‫ﺣﯿﺎة اﻟﻤﺮﯾﺾ زي ﻣﺎ ﺣﻨﻮﺿﺢ دﻟﻮﻗﺘﻲ و دي أول ﺣﺎﺟﺔ ﺗﻘﻮﻟﮭﺎ‬
‫ﻟﻠﻌﯿﺎن ﻷﻧﮭﺎ أھﻢ ﻣﻦ اﻷدوﯾﺔ ﻧﻔﺴﮭﺎ‪.‬‬
‫‪Life style‬‬
‫‪modification‬‬

‫‪Diet‬‬ ‫‪Exercise‬‬ ‫‪Health‬‬ ‫‪Medication‬‬

‫‪Education‬‬

‫‪1. Diet‬‬

‫ﻻزم ﺗﻮﺿﺢ اﻟﻌﯿﺎن ﻧﻮع اﻻﻛﻞ ﺑﺎﻟﺘﻔﺼﯿﻞ اﻟﻤﻤﻞ و ﻛﺄﻧﻚ ﻃﺒﺎخ ﺑﺮﯾﻤﻮ‬
‫ﯾﻌﻨﻲ ﻣﺜﻼ ﻣﺘﻘﻠﺶ ﻓﻮل وﺧﻼص أو زﺑﺎدي و ﺧﻼص ﻻزم ﺗﺤﺪد ﻧﻮع اﻟﻔﻮل واﻟﺰﺑﺎدي‬
‫زي ﻣﺎ ﺣﻨﻮﺿﺢ دﻟﻮﻗﺘﻲ‪.‬‬
‫أوﻻ اﻟﻔﻄﺎر وھﻮ زي اﻟﻌﺸﺎء‪:‬‬
‫رﻏﯿﻒ ﻋﯿﺶ ﺑﻠﺪي‬ ‫•‬
‫زﺑﺎدي ﻣﻨﺰوع اﻟﺪﺳﻢ‬ ‫•‬
‫ﺟﺒﻦ ﻗﺮﯾﺶ‬ ‫•‬
‫ﻓﻮل ﻣﺪﻣﺲ ﻣﻦ ﻏﯿﺮ زﯾﺖ‬ ‫•‬
‫ﺑﯿﺾ )ﺑﺲ ﻣﺴﻠﻮق(‬ ‫•‬
‫ﺛﺎﻧﯿﺎ اﻟﻐﺪاء‪:‬‬
‫• ‪ 6‬ﻣﻼﻋﻖ أرز أو ﻣﻜﺮوﻧﺔ ﻣﺴﻠﻮﻗﺔ أو ‪ 2‬رﻏﯿﻒ ﻋﯿﺶ ﺑﻠﺪي‬
‫• ﺳﻤﻚ)ﻣﺸﻮي(‬
‫• رﺑﻊ ﻓﺮﺧﺔ )أﺷﯿﻞ اﻟﺠﻠﺪ(‬
‫• ﻟﺤﻤﺔ)ﻣﺴﻠﻮﻗﺔ(‬
‫• ﺧﻀﺎر)ﻣﺶ ﻣﺴﺒﻚ(‬
‫اﻟﻤﻤﻨﻮﻋﺎت ‪ :‬ﻃﺒﻌﺎ زي اﻟﺤﻠﻮﯾﺎت و اﻟﺠﺎﺗﻮھﺎت و اﻟﺒﻠﺢ و اﻟﺘﯿﻦ و اﻟﻌﻨﺐ‬

‫‪8‬‬ ‫‪By 3alam el-teb‬‬

 ‫ﻃﺮﯾﻘﺔ اﻷﻛﻞ ﻟﻤﺮﯾﺾ اﻟﺴﻜﺮ‬
‫‪Type 1 DM ü‬‬
‫• ﻣﺎﺗﺤﺮﻣﮭﻮش ﻣﻦ اﻷﻛﻞ ﻷﻧﮫ ﻣﺤﺘﺎﺟﺔ ﻋﻠﺸﺎن ﯾﻜﺒﺮ و ﻋﻠﺸﺎن ﺑﯿﺄﺧﺬ أﻧﺴﻮﻟﯿﻦ ﻛﺘﯿﺮ‬
‫ﻓﻤﻤﻜﻦ ﯾﺪﺧﻞ ﻓﻲ ‪hypoglycemia‬ﻟﺤﺪ ﻣﺎ ﯾﻮﺻﻞ ﻟﺴﻦ ‪ 18‬ﺳﻨﺔ ﺣﯿﻤﺸﻲ ﺑﻌﺪھﺎ زي‬
‫‪type2‬‬
‫‪Type 2 DM‬‬ ‫‪ü‬‬
‫‪As above‬ﺑﺲ ﺧﺪ ﺑﺎﻟﻠﻚ ﻣﻦ اﻷﺗﻲ‬
‫• اﻟﻤﺮﯾﺾ ھﯿﺄﺧﺪ ‪ 6‬وﺟﺒﺎت ﯾﻮﻣﯿﺎ‬
‫§ ‪3 main meals‬‬
‫ﻋﺒﺎرة ﻋﻦ أي ﺣﺎﺟﺔ ﻓﯿﮭﺎ‬ ‫§ ‪3 snack in between‬‬
‫‪ fibers‬زي اﻟﺨﯿﺎر و اﻟﻄﻤﺎﻃﻢ و اﻟﺠﺰر )ﻣﺶ ﺷﯿﺒﺴﻲ و ﺣﻠﻮﯾﺎت(‪.‬‬

‫‪2. Exercise‬‬

‫اﻟﻤﻘﺼﻮد ﺑﺎﻟﺮﯾﺎﺿﺔ ھﻨﺎ ان اﻟﻌﯿﺎن ﻣﺶ ﯾﻨﺰل ﯾﻠﻌﺐ ﻛﺮة و ﻟﻜﻦ ﻣﺎ ﯾﻘﻌﺪش‬

‫ﻃﻮل اﻟﯿﻮم ﻓﻲ اﻟﺒﯿﺖ‬
‫ﯾﻌﻨﻲ ﻧﻨﺼﺢ اﻟﻌﯿﺎن اﻧﮫ ﯾﻤﺸﻲ ﻛﻞ ﯾﻮم ﻣﻦ ﺛﻠﺚ اﻟﻲ ﻧﺼﻒ ﺳﺎﻋﺔ ﯾﻮﻣﯿﺎ‬

‫‪3. Health education‬‬

‫ﻻزم أﻋﺮف اﻟﻤﺮﯾﺾ ﻛﻞ ﺣﺎﺟﺔ ﻋﻦ ﻣﺮﺿﺔ‬
‫‪Nature of disease ü‬‬
‫‪Emergency ü‬‬
‫‪Diet & drug ü‬‬
‫‪Follow up ü‬‬

‫‪9‬‬ ‫‪By 3alam el-teb‬‬

 4. Medications
Insulin secretions Insulin sensitizers
(Biguanides)
Increase insulin release Metformin
from B cell (mainly) ‫ﻓﻲ اﻟﺴﻮق‬
Glucophage ü
‫ﻣﻦ اﻷﺧﺮ ھﻤﺎ دواﯾﯿﻦ ﺑﯿﺘﻜﺘﺒﻮا‬ Cidophage ü
Diamacron Amaryl ‫ﺗﺮﻛﯿﺰ‬ 500,850,1000
‫اﻟﺠﺮﻋﺔ‬ 1500-2000
ü 30,60‫ﺗﺮﻛﯿﺰ‬ ü 1,2,3,4‫ﺗﺮﻛﯿﺰ‬ Max 2500 ‫أزود ﺗﺪرﯾﺠﯿﺎ اﻟﻲ‬
‫ ﻣﺮات‬3 ‫ﯾﻌﺘﻲ أﻋﻄﻲ‬
dose ‫ وﺳﻂ اﻷﻛﻞ‬500 ‫ﯾﻮﻣﯿﺎ ﻟﻮ‬
ü ‫ﯾﺆﺧﺬ ﻣﺮﺗﯿﻦ‬ ü ‫ﯾﺆﺧﺬ ﻣﺮة‬
‫ﯾﻮﻣﯿﺎ‬ S/ E Metallic taste
‫واﺣﺪة ﯾﻮﻣﯿﺎ‬ GIT upset
Lactic acidosis
ü Max dose ü Max dose 8
120 C/I Organ failure
infection

‫أزاي ھﻌﺎﻟﺞ‬
!‫اﻟﻤﺮﯾﺾ؟‬

Golden rules

ü DM is not curable but controllable

ü Target of treatment (‫)أوﺻﻞ ﻟﻤﺴﺘﻮي اﻟﺴﻜﺮ اﻟﻄﺒﯿﻌﻲ و ھﻮ‬
• ‫ ﺻﺎﯾﻢ‬110
• ‫ ﻟﻠﻔﺎﻃﺮ‬140
‫ﺑﺲ ﺧﺪ ﺑﺎﻟﻚ‬

Hyperglycemic side ‫ﻓﻲ ﺑﻌﺾ اﻷﺣﯿﺎن أﺧﻠﻲ اﻟﻤﺮﯾﺾ ﻋﻠﻲ‬

10 By 3alam el-teb
 !‫ﻟﯿﮫ؟‬
ü Old age
hypoglycemia ‫ ﺑﺘﺎﻋﮫ ﻟﻼﻧﺴﻮﻟﯿﻦ ﻣﺶ ﻣﻈﺒﻮط ﻓﻤﻤﻜﻦ ﯾﺪﺧﻞ ﻣﻨﻲ ﻓﻲ‬tolerance ‫ﻋﻠﺸﺎن ال‬

ü Any organ failure

As (liver-kidney-lung)
Due to decreases insulin degradation by these organs)
hypoglycemia ‫وﺑﺎﻟﺘﺎﻟﻲ ﻛﺪه اﻻﻧﺴﻮﻟﯿﻦ ﺣﯿﻔﻀﻞ ﻓﻲ اﻟﺪم ﻣﺪة أﻃﻮل ﻓﺎﻟﻤﺮﯾﺾ ﺣﯿﺪﺧﻞ ﻓﻲ‬

ü IHD
As hypoglycemia precipitates angina & infarction
‫ﻃﯿﺐ ﻟﺤﺪ أﯾﮫ أﺧﻠﻲ اﻟﻌﯿﺎن ﻋﻠﻲ ال‬
‫ ؟‬hyperglycemic side

300 ‫ أو‬200 ‫ﻣﺶ ﻣﻔﺘﻮﺣﺔ ﯾﻌﻨﻲ ل‬

‫أو‬
normal ‫ أﻋﻠﻲ ﻣﻦ ال‬30-50 ‫ﻣﻤﻜﻦ ارﻓﻌﺔ‬

Insulin
Indications
Type 2 DM
‫اﻣﺘﻲ؟؟‬
ü Uncontrolled
ü Operation
Type 1 DM ü Pregnancy
ü Ischemia
ü Infection
ü Trauma
ü Organ failure

type2 ‫ ﻓﻲ ﺣﺎﻟﺔ‬oral ‫أرﺟﻊ ﺗﺎﻧﻲ ﻟﻞ‬ ‫أول ﻣﺎ اﻟﺤﺎﻻت دي ﺗﺮوح‬

11 By 3alam el-teb
 ‫اﺳﺘﺨﺪاﻣﺎت اﻻﻧﺴﻮﻟﯿﻦ ﻓﻲ ﻏﯿﺮ ﻋﻼج اﻟﺴﻜﺮ‬
‫‪1) Hyperkalemia‬‬
‫‪2) DKA, HHNK‬‬
‫‪3) Insulin test in hypothalamic hypophyseal adrenal axis‬‬
‫‪4) Insulin stimulation test for GH assessment‬‬

‫أﻧﻮاع اﻻﻧﺴﻮﻟﯿﻦ اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﺴﻮق؟‬

‫اﻟﻨﻮع‬ ‫‪Ultra short Short acting intermediate‬‬

‫اﻻﺳﻢ اﻟﺘﺠﺎري‬ ‫‪Apadra‬‬ ‫‪Humalin R‬‬ ‫‪Humalin N‬‬
‫)ﻓﻲ اﻟﺴﻮق(‬ ‫‪Crystalloid‬‬ ‫اﻟﻌﻜﺮ‬
‫اﻟﺮاﯾﻖ اﻟﻤﺎﺋﻲ‬
‫ﺑﯿﺸﻐﻞ ﻓﻲ ﺧﻼل دﻗﺎﺋﻖ و‬ ‫ﺑﯿﺸﺘﻐﻞ ﻓﻲ ﺧﻼل ‪20‬‬ ‫ﻗﺒﻞ اﻻﻛﻞ ﺑﺴﺎﻋﺘﯿﻦ ﻣﺮﺗﯿﻦ‬
‫ﻃﺮﯾﻘﺔ‬ ‫ﯾﻨﺘﮭﻲ ﻣﻔﻌﻮﻟﺔ ﺧﻼل‬ ‫دﻗﯿﻘﺔ وﺑﺴﺘﺨﺪﻣﺔ ﻗﺒﻞ‬ ‫ﻓﻲ اﻟﯿﻮم‬
‫ﺳﺎﻋﺎت )‪ 3‬ﺳﺎﻋﺎت(‬ ‫اﻷﻛﻞ ‪ 4‬ﻣﺮات ﻓﻲ اﻟﯿﻮم‬
‫اﻻﺳﺘﺨﺪام‬ ‫ﻋﻠﺸﺎن ﻛﺪه ﺑﻈﺒﻂ ﺑﯿﮫ‬
‫ﺣﺎﺟﺔ ﺑﺴﺮﻋﺔ‬
‫)‪(child, pregnant‬‬
‫‪7‬ﺷﻜﺎت ﻓﻲ اﻟﯿﻮم ﻗﺒﻞ‬
‫اﻷﻛﻞ‬

‫ﻛﻞ ﻣﺎ ﺳﺒﻖ ﺑﯿﺴﺘﺨﺪم ﻓﻲ اﻟﻤﺴﺘﺸﻔﻲ ﻋﻠﺸﺎن ال ‪strict control‬‬

‫ﯾﻌﻨﻲ ﻣﺶ ﺣﺴﺘﺨﺪﻣﮫ ﻓﻲ اﻟﻌﯿﺎدة أو اﻟﻌﯿﺎن ﯾﻤﺸﻲ ﻋﻠﯿﮫ ﻓﻲ اﻟﺒﯿﺖ‬
‫اﻷﻧﻮاع اﻟﻠﻲ ﺑﺘﺘﻮﺻﻒ ﻟﻠﻌﯿﺎن ﯾﻤﺸﻲ‬
‫ﻋﻠﯿﮭﺎ ﻓﻲ اﻟﺒﯿﺖ‬

‫‪mixed‬‬ ‫‪Long acting‬‬

‫‪Mixtard 30/70‬‬ ‫)‪(Lantos-levimore‬‬
‫‪30‬‬ ‫‪70‬‬
‫‪Short acting‬‬ ‫‪Intermediate‬‬ ‫ودا ﻃﺒﻌﺎ ﻣﺤﺪش‬
‫‪R‬‬ ‫‪N‬‬ ‫ﺑﯿﻮﺻﻔﮫ ﻛﺘﯿﺮ ﻋﺸﺎن ﻏﺎﻟﻲ‬

‫ﻣﻦ اﻷﺧﺮ أﻛﺘﺮ ﻧﻮع ﺑﯿﻮﺻﻔﮫ اﻟﺪﻛﺎﺗﺮه ﻋﻨﺪﻧﺎ ﻓﻲ ﻣﺼﺮ ھﻮ ‪Mixtard 30/70‬‬

‫‪12‬‬ ‫‪By 3alam el-teb‬‬

 ‫ﻃﯿﺐ ھﻘﻮل ﻟﻠﻌﯿﺎن ﯾﺴﺘﺨﺪم اﻻﻧﺴﻮﻟﯿﻦ ازاي؟‬ ‫ﻃﯿﺐ دﻟﻮﻗﺘﻲ اﯾﮫ اﻟﺒﺮوﺗﻮﻛﻮل ؟ و اﻟﺠﺮﻋﺔ؟‬
‫‪ ü‬ھﻘﻮل ﻟﻠﻌﯿﺎن ﯾﻌﯿﻦ اﻻﻧﺴﻮﻟﯿﻦ ﻓﻲ ﺑﺎب اﻟﺜﻼﺟﺔ‬ ‫‪Start with low dose ü‬‬
‫‪ ü‬ﯾﻄﻠﻌﮭﺎ ﻗﺒﻞ اﻻﺳﺘﺨﺪام ﺑﺮﺑﻊ ﺳﺎﻋﺔ‬
‫‪Rough method Accurate method‬‬
‫‪Fasting/5‬‬ ‫‪0.3- 0.8 Unit/Kg‬‬
‫)اﻟﻤﺘﻮﺳﻂ ‪(0.5‬‬

‫‪ 2/3 ü‬اﻟﺠﺮﻋﺔ ﻗﺒﻞ اﻻﻓﻄﺎر و ‪ 1 /3‬ﻗﺒﻞ اﻟﻌﺸﺎء‬

‫ھﻘﻮل ﻟﻠﻌﯿﺎن ﯾﺄﺧﺬه أزاي؟‬ ‫أﻣﺎﻛﻦ أﺧﺬ اﻟﺤﻘﻨﺔ؟‬

‫‪S.C‬‬ ‫‪Arm‬‬
‫ب ‪ 90‬درﺟﺔ‬ ‫‪Thigh‬‬
‫‪Lower abdomen‬‬

‫ﻃﯿﺐ دﻟﻮﻗﺘﻲ ﻟﻮ ﻟﻘﯿﺖ ﺳﻜﺮ‬

‫اﻟﻌﯿﺎن ﻣﺶ ﻣﺘﻈﺒﻂ؟‬
‫ﻻزم ﺗﺠﺎوب ﻋﻠﻲ ﺳﺆاﻟﯿﻦ ﻣﮭﻤﯿﻦ‬

‫أزود ﺟﺮﻋﺔ اﻟﺼﺒﺢ و ﻻ ﺟﺮﻋﺔ اﻟﻠﯿﻞ؟‬ ‫أزود اﻷﻧﺴﻮﻟﯿﻦ أزاي؟‬

‫‪ ü‬أزود ﺟﺮﻋﺔ اﻟﻠﯿﻞ ﻟﻮ ‪ FBS‬ﺑﺎﯾﻆ‬ ‫ال ‪ range‬ﺑﺘﺎﻋﻲ ﻣﻦ ‪ 5‬اﻟﻲ ‪ 10‬وﺣﺪات‬
‫‪ ü‬ازود ﺟﺮﻋﺔ اﻟﺼﺒﺢ ﻟﻮ ‪ PPS‬ﺑﺎﯾﻆ‬ ‫واﻷﻓﻀﻞ أزود ‪ 5‬ب‪ 5‬ﻣﺶ ال ‪ 10‬ﻣﺮة واﺣﺪة‬

‫اﻟﻌﯿﺎن اﻟﻠﻲ ﻣﺎﺷﻲ ﻋﻠﻲ اﻧﺴﻮﻟﯿﻦ‬

‫ﻣﻤﻜﻦ ﯾﺸﺘﻜﻲ ﻣﻦ اﯾﮫ؟‬
‫‪1.Hypoglycemia‬‬ ‫)‪(most common‬‬
‫‪2.Insulin lipodystrophy‬‬ ‫)أﻏﯿﺮ ﻣﻜﺎن اﻟﺤﻘﻦ(‬
‫‪3.Insulin allergy‬‬ ‫)ﻏﯿﺮ اﻟﻨﻮع و اﺳﺘﺨﺪم ‪(antihistaminic‬‬
‫‪4. Somogi effect‬‬
‫ﻋﯿﺎن ﺑﯿﺸﺘﻜﻲ ﻣﻦ‪morning hyperglycemia‬‬
‫ودا ﻟﺰﯾﺎدة ‪ counter regulatory hormones‬ودا ﻧﺘﯿﺠﺔ ﻟﺰﯾﺎدة ‪ nocturnal insulin‬ﻓﯿﻌﻤﻞ‬
‫‪ hypoglycemia‬واﻟﻠﻲ ﺑﺘﺤﻔﺰ ﺑﺪورھﺎ ال ‪ counter regulatory hormones‬ﻓﺘﺮﻓﻊ اﻟﺴﻜﺮ‬
‫اﻟﻌﻼج ﻗﻠﻞ ﺟﺮﻋﺔ اﻷﻧﺴﻮﻟﯿﻦ‬

‫‪13‬‬ ‫‪By 3alam el-teb‬‬

 5.Insulin resistance
‫أزاي أﻋﺮف اﻧﮫ ﺣﺼﻞ ؟‬
Increase serum insulin level
With
Increase or normal blood glucose

‫ﻃﯿﺐ أزاي ﺣﺼﻞ؟‬ ‫وأﺗﻐﻠﺐ ﻋﻠﯿﮫ أزاي؟‬

‫ﻣﻮﺟﻮد‬ ‫ﻋﻼﺟﮭﺎ‬
insulin AB immunosuppressive(corticosteroids)
obesity Biguanides ‫ﻗﻠﻞ اﻟﻮزن ﻣﻊ‬
Organ failure
‫ﻋﺎﻟﺞ اﻟﺴﺒﺐ‬
infection
surgery

‫ﻓﻲ اﻷﺧﺮ دي ﺑﻌﺾ اﻟﺤﺎﺟﺎت‬

‫اﻟﻤﮭﻤﺔ ﻻزم ﺗﻌﺮﻓﮭﺎ‬
...‫ﻷﻧﻚ ﻣﻤﻜﻦ ﺗﺘﻌﺮﺿﻠﮭﺎ‬

Acute therapy of hypoglycemia

14 By 3alam el-teb
Management of DKA

15 By 3alam el-teb
Algorithm approach to patient
Suspected or documented
With hypoglycemia

16 By 3alam el-teb
 ‫ﺣﻘﻮق اﻟﻄﺒﻊ واﻟﻨﺸﺮ ﻣﺤﻔﻮﻇﺔ‬
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17 By 3alam el-teb