Odwala odwala matenda a shuga amadzifunsa: Matenda a matenda ashuga: ndi chiyani? Kodi munthu wodwala matenda ashuga amayembekezera chiyani ngati simumamwa insulin panthawi yake komanso kupewa? Ndipo funso lofunika kwambiri lomwe limadetsa nkhawa madipatimenti opanga ma endocrine m'makiriniki: Ngati magazi ndi 30, ndichitenji? Kodi malire oti akhale ndi malire ndi otani?
Sichikhala cholondola kunena za matenda okhudzana ndi matenda ashuga, chifukwa mitundu inayi ya chikomokere imadziwika. Atatu oyambayo ndi hyperglycemic, omwe amaphatikizidwa ndi kuchuluka kwa shuga m'magazi.
Ketoacidotic chikomokere
Ketoacidotic chikomachi ndi mawonekedwe a odwala omwe ali ndi matenda a shuga 1. Mkhalidwe wovuta uwu umachitika chifukwa cha kuchepa kwa insulin, chifukwa chomwe kugwiritsidwa ntchito kwa glucose kumachepetsedwa, kagayidwe kake kamakhala kodetsedwa pamilingo yonse, ndipo izi zimabweretsa kulakwitsa kwa ntchito ya machitidwe onse ndi ziwalo zamunthu aliyense. Chofunikira kwambiri cha ketoacidotic chikomachi ndi kusakwanira kwa insulini komanso kulumikizana kowopsa m'magazi a magazi. Hyperglycemia imafika - 19-33 mmol / l ndi kukwera. Zotsatira zake ndi kukomoka kwakukulu.
Nthawi zambiri, vuto la ketoacidotic limakula mkati mwa masiku 1-2, koma pamaso pazinthu zopsetsa mtima, zimatha kuyamba msanga. Mawonetseredwe oyamba a mtundu wa matenda ashuga ndi chizindikiro cha kuchuluka kwa shuga m'magazi: kuonjezera mphamvu, kufuna kumwa, polyuria, kupuma kwa acetone. Khungu ndi mucous zimasokonezeka, kupweteka kwam'mimba, kupweteka kwa mutu kumawonekera. Pamene chikomacho chikukula, polyuria ikhoza kulowa m'malo mwa anuria, kuthamanga kwa magazi, kugunda kwamkati, kuchuluka kwa minofu kumawonedwa. Ngati magazi a ndende ali pamwamba pa 15 mmol / l, wodwalayo amayenera kuyikidwa kuchipatala.
Ketoacidotic coma ndiye digiri yomaliza ya matenda ashuga, owonetsedwa ndi kuwonongeka kotheratu, ndipo ngati simukuthandiza wodwala, kufa kumatha kuchitika. Thandizo ladzidzidzi liyenera kutchedwa yomweyo.
Kwa insulin yosakwanira kapena yosakwanira insulin, zifukwa zotsatirazi zimagwira ntchito:
- Wodwalayo sakudziwa za matenda ake, sanapite kuchipatala, chifukwa chake matenda a shuga sanawapezeke munthawi yake.
- Insulin yomwe ili ndi vuto losakwanira kapena imatha;
- Kuphwanya zakudya kwathunthu, kugwiritsa ntchito zakudya zamafuta m'mimba, mafuta ambiri, mowa, kapena njala yayitali.
- Kufuna kudzipha.
Odwala ayenera kudziwa kuti ndi matenda amtundu wa 1 shuga, kufunikira kwa insulin kumawonjezera pazochitika zotsatirazi:
- pa mimba
- ndi matenda ophatikizika,
- pavuto komanso opaleshoni,
- ndi okhazikika a glucocorticoids kapena okodzetsa,
- panthawi yochitachita zolimbitsa thupi, psychoemotional zinthu zovuta.
The pathogenesis of ketoacidosis
Kuperewera kwa insulin ndi chifukwa cha kuchuluka kwa mahomoni a corticoid - glucagon, cortisol, catecholamines, adrenocorticotropic ndi mahomoni a somatotropic. Glucose ndi woletsedwa kulowa m'chiwindi, m'maselo a minofu ndi minyewa ya adipose, mulingo wake m'magazi umakwera, ndipo mkhalidwe wa hyperglycemia umachitika. Koma nthawi imodzimodzi, maselo amakhala ndi vuto la mphamvu. Chifukwa chake, odwala matenda a shuga amakhala ndi vuto lofooka, lopanda mphamvu.
Pofuna kubwezeretsanso njala, thupi limayambitsa njira zina zopangira mphamvu - zimayambitsa lipolysis (kuwonongeka kwamafuta), zomwe zimapangitsa kuti pakhale mafuta acidule, mafuta osavomerezeka a asidi, triacylglycerides. Ndi kuchepa kwa insulini, 80% ya mphamvu yomwe thupi limalandira mkati mwa makutidwe a michere yamafuta aulere, imadziunjikira pazinthu zomwe zimawonongeka (acetone, acetoacetic ndi β-hydroxybutyric acid), omwe amapanga matupi omwe amatchedwa ketone. Izi zikufotokozera kuchepa thupi kwa odwala matenda ashuga. Kuchuluka kwa matupi a ketone m'thupi kumatenga mphamvu zamchere, chifukwa chomwe ketoacidosis imayamba - matenda oopsa a metabolic. Imodzi ndi ketoacidosis, kagayidwe kazinthu kamadzi kamasokoneza.
Hyperosmolar (non-ketoacidotic) chikomokere
Hyperosmolar coma imakonda kwambiri odwala omwe ali ndi matenda ashuga a 2. Mtundu uwu wa chikomokere m'matenda a shuga umachitika chifukwa chosowa insulini, ndipo umadziwika ndi kufinya thupi, hyperosmolarity (kuchuluka kwa sodium, glucose ndi urea m'magazi).
Hyperosmolarity ya plasma yamagazi imabweretsa kusokonezeka kwakukulu kwa ntchito za thupi, kuchepa kwa chikumbumtima, koma pakalibe ketoacidosis, yomwe imafotokozedwa ndikupanga insulin ndi kapamba, komwe sikokwanira kuthana ndi hyperglycemia.
Kutha kwa thupi, komwe ndi chimodzi mwazomwe zimayambitsa matenda a diabetesic hyperosmolar coma
- kugwiritsa ntchito kwambiri okodzetsa,
- kutsuka ndi kusanza kwa matenda amtundu uliwonse,
- amakhala m'malo okhala ndi nyengo yotentha, kapena wogwira ntchito kutentha;
- kusowa kwa madzi akumwa.
Zotsatirazi zimakhudzanso kuyambika kwa chikomokere:
- Kuperewera kwa insulin;
- Wodwala matenda ashuga;
- Mankhwala osokoneza bongo omwe amakhala ndi chakudya chamagulu, kapena milingo yayikulu ya jekeseni wa glucose;
- kapena peritoneal dialysis, kapena hemodialysis (njira zokhudzana ndi kuyeretsa impso kapena peritoneum).
- Kutuluka magazi kwa nthawi yayitali.
Kukula kwa hyperosmolar coma kumakhala ndi zizindikiro wamba ndi ketoacidotic chikomokere. Kutalika kwa boma kumatenga nthawi yayitali bwanji malinga ndi kapamba, kutulutsa bwino kwa insulin.
Hyperlactacidemic chikomokere ndi zotsatira zake
Hyperlactacidemic coma imachitika chifukwa cha kudzikundikira kwa lactic acid m'mwazi chifukwa chosowa insulini. Izi zimapangitsa kuti pakhale kusintha kwamomwe magazi amapangidwira ndikuwonongeka kwa chikumbumtima. Zinthu zotsatirazi zimayambitsa kukhumudwitsa hyperlactacidemic coma:
- Osakwanira kuchuluka kwa mpweya m'magazi chifukwa cha mtima ndi kupuma kulephera komwe kumakhalapo pamaso pa pathologies monga mphumu ya bronchial, bronchitis, circulatory cholephera, mtima;
- Matenda otupa, matenda;
- Matenda a impso kapena chiwindi;
- Zakumwa zoledzeretsa;
Pathogenesis
Choyambitsa chachikulu cha hyperlactacidemic coma ndikusowa kwa mpweya m'magazi (hypoxia) pazosowa insulin. Hypoxia imathandizira anaerobic glycolysis, yomwe imapanga kuchuluka kwa lactic acid. Chifukwa chosowa insulini, ntchito ya enzyme yomwe imalimbikitsa kutembenuka kwa pyruvic acid kukhala acetyl coenzyme yafupika. Zotsatira zake, asidi a pyruvic amasinthidwa kukhala lactic acid ndipo amadziunjikira m'magazi.
Chifukwa cha kuchepa kwa mpweya, chiwindi chimalephera kugwiritsira ntchito lactate owonjezera. Mwazi wosinthika umayambitsa kuphwanya kwa contractility ndi kusangalala kwa minofu ya mtima, kuchepetsa ziwiya zotumphukira, zomwe zimayambitsa kukomoka
Zotsatira zake, komanso, munthawi yomweyo, zizindikiro za hyperlactacidemic coma ndi kupweteka kwa minofu, angina pectoris, nseru, kusanza, kugona, kugona tulo.
Pozindikira izi, mutha kupewa kukomoka, komwe kumayamba patapita masiku ochepa ngati muyika wodwala kuchipatala.
Mitundu yonse pamwambapa ya ma com ndi hyperglycemic, ndiye kuti, ikukula chifukwa cha kuwonjezeka kwambiri kwa shuga m'magazi. Koma kusintha koteroko ndikothekanso, pamene shuga achepetsa kwambiri, kenako kukomoka kwa hypoglycemic kumatha kuchitika.
Hypoglycemic chikomokere
Hypoglycemic coma mu matenda a shuga imakhala ndi njira yosinthira, ndipo imatha kukhazikika pomwe kuchuluka kwa glucose m'magazi kumachepetsedwa kwambiri kotero kuti kuperewera kwa mphamvu mu ubongo kumachitika.
Izi zimachitika mu milandu yotsatirayi:
- Ngati bongo wa insulin kapena shuga wochepetsa magazi amaloledwa;
- Wodwalayo sanadye pa nthawi atamwa insulin, kapena zakudya zake zinali zoperewera mu chakudya;
- Nthawi zina ntchito ya adrenal, mphamvu ya insulin-yolepheretsa chiwindi imachepa, chifukwa chake, chidwi cha insulin chimawonjezeka.
- Pambuyo kwambiri zolimbitsa thupi;
Kuchepa kwa glucose kuubongo kumadzetsa hypoxia ndipo, chifukwa chake, kusokonekera kwa maproteni ndi michere m'maselo a chapakati mantha.
Zizindikiro za hypoglycemia:
- Kuchuluka kwachuma;
- utachepa thupi ndi malingaliro;
- kusintha kwa machitidwe ndi mkhalidwe wosayenera, womwe ungafotokozedwe mwaukali kwambiri, kumverera kwa nkhawa;
- kugwirana chanza;
- tachycardia;
- womvera
- Kuchulukitsa kwa magazi;
Ndi kuchepa kwa shuga m'magazi mpaka 3.33-2.77 mmol / L (50-60 mg%), zochitika zofooka zoyambirira zimachitika. Munthawi imeneyi, mutha kuthandiza wodwalayo pomupatsa kuti amwe tiyi kapena madzi otsekemera ndi magawo anayi a shuga. M'malo mwa shuga, mutha kuyikamo uchi, kupanikizana.
Ndi shuga wamagazi a 2.77-1.66 mmol / L, zizindikiro zonse za hypoglycemia zimawonedwa. Ngati pali munthu pafupi ndi wodwala yemwe angapereke jakisoni, shuga amatha kulowa m'magazi. Koma wodwalayo amayenera kupita kuchipatala kuti akalandire chithandizo.
Ndikusowa kwa shuga kwa 1.66-1.38 mmol / L (25-30 mg%) ndi kutsika, chikumbumtima nthawi zambiri chimatha. Mwachangu muyenera kuyimba ambulansi.
