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がんと糖尿病を併発している患者さんを受けもつすべての医療従事者に読んでほしい 新たな道しるべとなる“腫瘍糖尿病学”の書籍が登場  最新知識やエビデンスを可能な限り踏まえつつ、実地臨床でどのようにすればよいのか、第一線で活躍する医師のエキスパート・オピニオンを通して、がん治療中の糖尿病管理に関するベスト・プラクティスをQ&A形式で一冊に集約。若手医師はもちろん、糖尿病専門医のいないがん専門施設で糖尿病管理に奮闘されているがん専門医の先生方にとっても「今日から使える」内容です! *目次 Ⅰ がんと糖尿病の基礎知識 第1章 がんと糖尿病の関係 Q 糖尿病患者さんはがんになりやすいのか? Q 糖尿病患者さんのがんを早期発見するにはどのようなことに注意したらよいか? Q 糖尿病を合併していることでがんの予後に影響はあるのか? Q 膵がんと糖尿病の関係は? Q NASHからの肝がん発症と糖尿病の関係は? 第2章 糖尿病治療薬 Q がんのリスクを増やす糖尿病治療薬はあるのか? Q “ がん治療に併用する” という観点では,各種糖尿病治療薬の特徴をどのように とらえたらよいか? 第3章 がん患者さん特有の問題 Q 糖尿病患者さんで特に注意すべき感染症はどのようなものがあるのか? Q がん患者さんに特有の心理とは? Q がん患者さんの栄養管理をどのように行うのか? 第4章 糖尿病専門医へのコンサルテーション Q がん患者さんに未治療糖尿病が発見された場合,糖尿病専門医への紹介は全例 行うべきか? 紹介する場合,事前にやっておくべきことは何か? 第5章 食事療法 Q 食事療法として糖質制限食を行ってもよいか?(がん患者さんが自己判断で糖質を減ら してしまうこともしばしばあるが,どうか?) Q がん患者さんについては糖尿病の食事療法を緩和すべきか? 第6章 薬物療法 Q 糖尿病が非専門であるがん治療医でも比較的安全に使える糖尿病治療薬はどの ようなものがあるか? Q がん治療で用いられる薬剤で,副作用として血糖値を上昇させるものには何が あるか? Q 強化インスリン療法とはどのような治療か? Q いわゆるスライディングスケールはどのような場面で使ってよいのか? Q 中心静脈栄養を行う際に,インスリンはどのような経路で投与するべきか? 第7章 検査 110 Q ビグアナイド内服中の症例で,緊急な場合は造影CTを施行してもよいか? Q FDG-PETを行う際の血糖管理や使用する糖尿病治療薬の注意点は? Ⅱ 周術期の血糖管理 第8章 手術前の血糖管理 Q 手術可能なHbA1c,血糖値の目安はどのくらいか? Q 手術の前に行っておくべき糖尿病合併症検査は? Q 手術を行う症例に対してどのようにインスリン治療を行うか? Q 血糖コントロールが悪い場合,手術可能なレベルに持っていくまでどれくらいの 期間が必要か? Q 経口糖尿病薬のみで血糖コントロールが良好な場合,どの薬剤を内服していても すぐに手術可能か? それとも必ずインスリン導入をしないといけないのか? Q 尿糖陽性は術前血糖コントロールの指標としてどう判断するか? (SGLT 2 阻害薬使用例も今後増えることが予想されるため) Q 緊急手術が必要な症例が血糖コントロール不良だった場合,そのまま手術を施行し てよいのか? Q 糖尿病の重症度と周術期リスクに関連はあるのか? 第9章 手術後の血糖管理 Q 胃・食道切除後の血糖コントロールはどのように行うのか? Q 膵切除後の血糖管理はどのように行うのか? Q 糖尿病患者さんに経腸栄養を使用する際,糖質制限経腸栄養製品(グルセルナ®など) を使用することがあるが,尿ケトンの上昇はどれくらいまで許容できるか? Q 胃瘻や腸瘻を使用する際にインスリンはどのように使うのか? また経口糖尿病薬 は使えないのか? Q 術後早期から厳格な血糖コントロールを目指すべきか? 術後早期に使う薬剤と して,インスリン以外に経口薬を使用してもよいか? Q ICU管理が必要な重症患者において,Harris-Benedictの式ではストレス度が高い場 合エネルギー必要量が増えるが,どのようにエネルギー量の設定を行うか? Ⅲ がん化学療法中の血糖管理 第10 章 ステロイド投与時の血糖管理 Q ステロイド投与による高血糖に対してどのようにインスリン治療を行うか? Q がん化学療法中の血糖コントロールを厳密にしたほうがよいというエビデンスは あるか? Q ステロイドを含むレジメンを短期間だけ行うときでも,必ずインスリン注射によ る厳格な管理が必要か? 第11章 消化器症状が出たときの対応 Q 糖尿病症例にオランザピン(制吐剤)を使用してよいか? Q 抗がん剤治療後に食欲がなくなったときの血糖管理はどのように行うか? Q 外来化学療法を行っている糖尿病患者さんにシックデイ対応としてどのような 指導を行うか? 第12章 その他の副作用関連 Q 糖尿病をもつ症例に,末梢神経障害の副作用を起こし得る抗がん剤を使用してよ いか? Q 血管新生阻害薬で,心血管イベントなど糖尿病内科医が注意すべきことはあるか? Q インスリン自己注射や,自己血糖測定が抗がん剤の副作用である皮膚障害と関連 することはあるか? 第13章 免疫チェックポイント阻害薬と(劇症)1型糖尿病 Q 免疫チェックポイント阻害薬を投与する症例では,どのような検査を行うことで 1 型糖尿病(劇症1 型を含む)の早期発見につながるか? また患者さんに注意し てもらう自覚症状などはあるか? Q 元来2型糖尿病のある症例に免疫チェックポイント阻害薬を投与することで,劇 症1型糖尿病を含む1型糖尿病のような病態をさらに発症することはあるのか? Q 1型糖尿病以外の内分泌異常にはどのようなものがあるか? Ⅳ がんサバイバー,長期のがん治療が必要なケース 第14章 がんサバイバー Q がんが一旦治癒,寛解した症例では,どのくらいの目標値で血糖を管理するべき か? 使用してよい糖尿病治療薬は? Q 乳がん,前立腺がんなど比較的長期間のがん治療を行う場合の血糖コントロール の目標は? 第15章 終末期 Q 終末期では血糖値の目標をどこにおくのか? Q 終末期では食事療法をどこまで行うべきか? 血糖上昇を緩やかにできる食事内容 は? Q 終末期でも安全に使える糖尿病治療薬は? Q 食事が食べられなくなった場合の血糖降下薬の減量,中止の判断は? Q インスリン治療を行っていた症例はどのように管理するか? 【Column】 調整困難な交絡因子 がん検診の功罪 血管合併症の評価はどこまで必要か? 血糖測定方法の差異 refeeding症候群 糖尿病がある症例ではステロイドを減量もしくは抜いたレジメンにした方が良いか? スピリチュアルケアとしての血糖コントロール.
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