Nkhani yokhudza kudya kwa impso kwa anthu odwala matenda ashuga ndi imodzi mwazofunikira kwambiri patsamba lathu. Zomwe mwawerenga pansipa zikuthandizira tsogolo lanu la matenda ashuga komanso zovuta zake, kuphatikizapo matenda ashuga. Zakudya za anthu odwala matenda ashuga zomwe timayesa kuti muyesere ndizosiyana kwambiri ndi malingaliro azikhalidwe. Mankhwala amatha kuchedwetsa gawo lomaliza la kulephera kwa impso, dialysis ndi kupatsirana kwa impso kwa zaka zingapo. Koma izi sizabwino kwambiri, makamaka kwa odwala omwe ali ndi matenda ashuga amtundu wa 1 kapena a zaka zapakati. Werengani njira ina komanso yothandiza yazakudya pochiza matenda a impso a shuga omwe ali pansipa.
Chithandizo cha matenda osokoneza bongo chimalimbikitsa kudya "moyenera" zakudya. Werengani mayeso omwe muyenera kutenga kuti muone impso zanu. Ngati mayesowa akukuwonetsani microalbuminuria, makamaka proteinuria, ndiye kuti dokotala wanu angakulangizeni kuti muzidya mapuloteni ochepa. Chifukwa amakhulupirira kuti zinthu zopangira mapuloteni zimadzaza impso ndipo zimathandizira kukulitsa kulephera kwa impso. Dokotala adzanena ndikulemba pa khadi kuti kudya mapuloteni ayenera kutsitsidwa mpaka 0,7-1 magalamu pa 1 kg ya kulemera kwa thupi patsiku. Muyesanso kudya mafuta ochepa a nyama momwe mungathere, kuyembekezera kuti muchepetse cholesterol yanu ndi triglycerides m'magazi. Mafuta okhathamiritsa amawonedwa ngati owopsa m'mitsempha yamagazi: batala, mazira, mafuta anyama.
Komabe, chinthu chachikulu chomwe chimakhudza impso mu shuga sichakudya zama protein, koma shuga wambiri. Ngati munthu wadwala kwambiri shuga, ndiye kuti kusintha kwa matenda a impso kumayambika patatha zaka zitatu. Madotolo amalimbikitsa kuti odwala matenda ashuga achepetse kudya kwawo mapuloteni chifukwa iwo amawonetsa kuti mapuloteni azakudya amathandizira kukulitsa kulephera kwa impso. M'malo mwake, zomwe zimapangitsa kuti matenda ashuga nephropathy akhale ndi shuga wambiri, ndipo mapuloteni azakudya alibe kanthu, kupatula pama milandu ovuta kwambiri. Tiyeni tiwone momwe impso imagwirira ntchito kuti zitsimikizire izi.
Kodi impso zamunthu zimapangidwa bwanji ndikugwira ntchito
Impso zimasefa madzi, glucose owonjezera, mankhwala osokoneza bongo, ndi zinthu zina zomwe zingakhalepo m'magazi, ndiye kuti zinyalalazo zimathiridwa mkodzo. Impso ndi chiwalo momwe mkodzo umapangidwira. Nthawi zambiri, impso iliyonse imakhala ndi zosefera miliyoni miliyoni zomwe magazi amadutsa akapanikizika. Zosefera izi zimatchedwa glomeruli. Magazi amalowa mu glomerulus kudzera mumtsempha waung'ono wotchedwa afferent (womwe ukubwera) arteriole. Arteriole uyu amathera ndi unyinji wazombo zing'onozing'ono kwambiri zotchedwa capillaries. Mu capillaries muli ma microscopic mabowo (pores) omwe amakhala ndi magetsi osafunikira.
Mapeto am'munsi mwa capillary iliyonse amayenda mu arteriole (momwemo) yemwe mulifupi mwake umakhala wocheperako kawiri kuposa womwe wakubwera. Chifukwa cha kufupika kumeneku, kuchuluka kowonjezereka kumachitika pamene magazi akuyenda mtunda wa capillaries. Mothandizidwa ndi kuchuluka kowonjezereka, gawo lamadzi kuchokera m'magazi limatulutsa kudzera m'matumba. Madzi omwe adayikiramo amayenda kupita kumalifesi oyandikana ndi gulu lambiri, ndipo kuchokera pamenepo nkufika pamachubu.
Ma pores omwe amapezeka m'makutuwo ndi ochulukirapo kotero kuti mamolekyulu ang'onoang'ono, monga urea ndi glucose owonjezera, omwe amapanga mkodzo, amatuluka kuchokera m'magazi ndi madzi. Nthawi yachilengedwe, mamolekyulu akulu a ma protein sangathe kudutsa ma pores. Mapuloteni ambiri amwazi amakhala ndi magetsi osafunikira. Amathamangitsidwa kuchokera ku ma pillaries, chifukwa amakhalanso ndi vuto. Chifukwa cha izi, ngakhale mapuloteni ang'ono kwambiri samasefa ndi impso ndipo sanatulutsidwe mkodzo, koma amabwezeretsanso magazi.
Kuchulukitsa kwa kusefera kwa khungu la glomerular (GFR) ndikuwonetsa kuchuluka kwa kusefera kwa magazi komwe impso zimagwira nthawi yayitali. Itha kuwerengedwa ndikudutsa kuyesa kwa magazi kwa creatinine (momwe mungachitire izi, mwatsatanetsatane). Pamene kulephera kwa impso kukukwera, kuchuluka kwa kusefera kwa madzi kumachepa. Koma mwa anthu omwe ali ndi matenda ashuga omwe akukweza shuga m'magazi, pomwe impso zikugwirabe ntchito moyenera, choyamba kuchuluka kwa kusefedwa kwamphamvu kumawonjezeka. Zikatero, zimakwezeka kuposa zabwinobwino. Izi ndichifukwa choti glucose wambiri m'magazi amatunga madzi kuzinthu zoyandikana. Chifukwa chake, kuchuluka kwa magazi kumachulukanso, kuthamanga kwa magazi ndi kuchuluka kwa magazi ake kudzera mu impso kumakulanso. Odwala omwe ali ndi matenda ashuga, kumayambiriro kwa matendawa, matenda a impso asanayambe kukula, kuchuluka kwa kusefedwa kwa mano kumatha kukhala 1.5-2 kuchulukirapo kuposa kwawonekera. Masana, anthu otere ngati mkodzo amatulutsa magawo angapo a shuga.
Chifukwa chachikulu chomwe chimawopseza impso ndi shuga wambiri
Glucose owonjezera m'magazi amakhala ndi poizoni machitidwe osiyanasiyana amthupi, chifukwa mamolekyu a glucose amamangirira kumapuloteni ndikusokoneza ntchito yawo. Izi zimatchedwa reaction glycosylation. Asayansi asanaphunzire mosamalitsa izi, adaganiza kuti kuthamanga, i.e., kuthamanga kwa kusefukira kwa glomerular ndikuwonjezera kupsinjika kwa impso, ndizomwe zimayambitsa matenda ashuga. Mukawerenga gawo lakale la nkhaniyi, tsopano mukudziwa kuti kukhathamiritsa kwa kusefera kwa glomerular sikuti chifukwa, koma zotsatira zake. Zomwe zimapangitsa kukula kwa impso ndizovuta zakumaso zomwe zimawonjezera shuga m'magazi.
Mukugwiritsa ntchito mapuloteni azakudya mthupi, zinthu zotayidwa zimapangidwa - urea ndi ammonia, zomwe zimakhala ndi nayitrogeni. Kumbuyoku chakumapeto kwa zaka za m'ma 25, asayansi ananena kuti kuchuluka kwa kusefera kwa impso kumawonjezereka chifukwa chofunikira kuyeretsa magazi kuchokera ku urea ndi ammonia. Chifukwa chake, odwala matenda a shuga adalimbikitsa ndipo amalimbikitsabe kudya mapuloteni ocheperako kuti muchepetse nkhawa pa impso. Koma kafukufuku yemwe asayansi aku Israel adachita adawonetsa kuti mwa anthu athanzi popanda matenda ashuga, kuchuluka kwa kusefedwa kwa impso ndi chimodzimodzi pa zakudya zomwe zimakhala ndi mapuloteni komanso zakudya zamasamba. Kwa zaka zambiri, zapezeka kuti zomwe zimapangitsa kuti ana asamadye masamba ndi omwe amadya nyama sizachilendo kwenikweni. Zikuwonetsedwanso kuti kuchuluka kwa kusefedwa kwa glomerular sikofunikira kapena kokwanira kuti pakhale matenda a shuga.
Kafukufuku wa Harvard adawonetsa zotsatirazi. Gulu la makoswe a labotale adasungira shuga wamwazi pamlingo pafupifupi 14 mmol / L. Matenda a diabetes nephropathy anakula mwachangu mu makoswe onsewa. Ngati mapuloteni ochulukirapo adawonjezeredwa ku zakudya zawo, ndiye kuti kukula kwa aimpso kunathandizira. Pagulu loyandikana ndi makoswe, shuga wamagazi anali 5.5 mmol / L. Onse ankakhala bwinobwino. Palibe m'modzi wa iwo amene ali ndi matenda ashuga, ngakhale atadya kwambiri. Ndizosangalatsanso kuti ntchito ya impso inachira patatha miyezi yochepa kuchokera pomwe shuga wawo wapezeka kuti wabwinobwino.
Momwe shuga imawonongera impso: chiphunzitso chamakono
Lingaliro lamakono la kukhazikitsidwa kwa matenda a diabetes ndi nephropathy ndikuti nthawi yomweyo zinthu zingapo zimakhudza ma capillaries mu glomeruli a impso. Kuchulukana kwamapuloteni chifukwa cha shuga m'magazi, komanso ma antibodies a mapuloteni onenepa, kuchuluka kwa mapuloteni m'magazi ndi kufalikira kwa ziwiya zazing'onoting'ono zozungulira magazi. Kumayambiriro kwa matenda a impso a shuga, mphamvu zamagetsi zamagetsi m'matumba a capillaries zimatsika. Zotsatira zake, mapuloteni osokoneza bongo a m'mimba yaying'ono kwambiri, makamaka, albumin, amayamba kutuluka kuchokera m'magazi kulowa mkodzo. Ngati urinalysis iwonetsa kuti ili ndi albumin, ndiye kuti amatchedwa microalbuminuria ndipo amatanthauza ngozi yowonjezereka ya kulephera kwa impso, kugunda kwa mtima, ndi sitiroko.
Mapuloteni omwe amayambitsidwa ndi glucose amatuluka kudzera m'matumbo a impso mosavuta mosavuta kuposa mapuloteni abwinobwino. Kuchulukitsa kwa magazi, komanso kuchuluka kwambiri kwa insulin m'magazi, imathandizira kusefera kwa impso, mwakutero mapuloteni ochulukirapo amalowa kudzera pazosefera. Ena mwa mapuloteni awa, omwe amaphatikizidwa ndi glucose, amatsatira mesangium - uwu ndiye minofu pakati pa capillaries. Zambiri zokhala ndi ma protein a glycated ndi ma antibodies kwa iwo zimapezeka mu impso glomeruli ya anthu odwala matenda ashuga, pamakoma a capillaries komanso mesangium. Masango awa amakula pang'onopang'ono, mesangium imakulitsidwa ndikuyamba kufinya capillaries. Zotsatira zake, m'mimba mwake mwa ma pores mumawonjezereka, ndipo mapuloteni ochulukitsa m'mimba amatha kutuluka m'magazi kudzera mwa iwo.
Njira yowonongera impso imathandizira, chifukwa mapuloteni ochulukirachulukira amakakamira mu mesangium, ndipo akupitilirakulira. Mapeto ake, mesangium ndi capillaries amasinthidwa ndi minofu yaying'ono, chifukwa chomwe aimpso glomerulus amasiya kugwira ntchito. Kutupa kwa mesangium kumawonedwa mwa odwala omwe samatha kuyendetsa bwino matenda ashuga, ngakhale albin ndi mapuloteni ena asanayambe kuwonekera mkodzo.
Kafukufuku wambiri mwa anthu awonetsa kuti ngati kusintha kwa shuga m'magazi kumakhazikika, ndiye kuti m'magawo a matenda ashuga, nephropathy, kuchuluka kwa kusefera kwa m'magazi kumatsika kumakhala koyenera, ndipo kuchuluka kwa mapuloteni mumkodzo kumacheperanso. Ngati shuga adakwezedwa kwambiri, ndiye kuti kuwonongeka kwa impso kumapitirirabe. Pofufuza makoswe a matenda ashuga, asayansi adawona kuti ngati achepetsa shuga la magazi awo kuti akhale abwinobwino ndikukhalanso labwinobwino, ndiye kuti glomeruli yatsopano imawonekera impso m'malo mwa yowonongeka.
Kodi cholesterol imakhudza impso?
Kuchulukana kwa cholesterol “yoyipa” komanso mafuta a triglycerides (m'magazi) kumathandizira kuti magazi azitsekeka chifukwa cha magazi. Aliyense amadziwa kuti izi zimayambitsa matenda oopsa a mtima. Likukhalira kuti ziwiya zomwe zimapereka magazi ku impso zimadutsa atherosulinosis chimodzimodzi ndi mitsempha yayikulu. Ngati ziwiya zomwe zimadyetsa impso zilephereka ndi zolembedwa za atherosselotic, ndiye kuti impso imayamba kufa ndi mpweya. Izi zimatchedwa stenosis (kuchepa) kwa mitsempha ya impso ndipo zimatanthawuza kuti kulephera kwa impso mu shuga kumayamba mofulumira. Pali njira zina zomwe mafuta “oyipa” omwe amapezeka m'magazi amawononga impso.
Mapeto ake ndikuti muyenera kuyang'anira cholesterol yanu ndi triglycerides m'magazi, ndiye kuti, mumakayezetsa matenda ashuga nthawi zonse. Kuti azisungabe pamlingo woyenera, madokotala akhala akupereka mankhwala kwa gulu la ma statins kwazaka zambiri. Mankhwalawa ndi okwera mtengo ndipo ali ndi zovuta zake zingapo: amawonjezera kutopa ndipo amatha kuwononga chiwindi. Nkhani yabwino: chakudya chamafuta ochepa sichimangokhala shuga, komanso cholesterol ndi triglycerides. Tengani ma statin pokhapokha ngati mayeso obwereza pambuyo pa masabata 6 akuwonetsa kuti chakudya chopatsa thanzi sichithandiza. Izi ndizokayikitsa kwambiri ngati mumalangizidwa kutsatira kadyedwe komanso kupewa zakudya zoletsedwa.
Kusankha pakati pa chakudya chamafuta ochepa komanso ochepa
Ngati mwaphunzira mtundu wa 1 wa chithandizo cha matenda ashuga kapena mtundu wachiwiri wa chithandizo cha matenda ashuga ndikuyesera kutsatira malangizowo, mukudziwa kuti kudya zakudya zamagulu ochepa kumakupatsani mwayi wochepetsa shuga wamagazi kuti ukhale wabwinobwino komanso wosakhalitsa, monga momwe zimakhalira ndi anthu athanzi popanda matenda a shuga. Werengani mwatsatanetsatane njira yanji yazotengera yaying'ono. Munadzionera nokha kuti kudya "mokwanira", komanso zakudya zama protein ochepa komanso zamafuta ochepa, osalola shuga kusintha. Amadzaza ndi chakudya, motero shuga m'magazi wodwala matenda a shuga amalumpha ndipo mavuto amakula msanga.
Komabe, madokotala akupitiliza kulimbikitsa kudya zakudya zama protein ochepa omwe amalepheretsa kukula kwa impso ndikuchepetsa kuyambika kwa dialysis. Pazakudya izi, zochuluka za mapuloteni azakudya zimasinthidwa ndi chakudya. Amakhulupirira kuti njirayi imachepetsa nkhawa pa impso, ngakhale kuti sizilola shuga kukhala ndi shuga wabwinobwino. Kodi mungasankhe bwanji zakudya zabwino kwambiri kwa impso? Ndi zakudya ziti zomwe zili bwino - mapuloteni ochepa kapena ochepa mafuta? Yankho: zimatengera gawo lomwe matenda anu a matenda ashuga ali nawo.
Pali mfundo yoti palibe kubwerera. Ngati mungadutse, glomeruli imakhala yowonongeka kwambiri kotero kuti shuga mumagazi silimakupatsaninso mwayi wobwezeretsa kapena kukonza impso. Dr. Bernstein akuwonetsa kuti mfundo iyi yobwererayi ndi kuchuluka kwa impso pafupifupi 40 ml / min. Ngati kuchuluka kwa kusefera kwa m'munsi kumatsika, ndiye kuti chakudya chamafuta ochepa chokhala ndi mapuloteni sichingathandizenso, koma kungathandizire kuyambika kwa gawo la kudwala kwa aimpso. Ngati kuchuluka kwa kusefera kwa glomerular ndi 40-60 ml / min, ndiye kuti kukula kwa shuga m'magazi ochepetsa chakudya chochepa kumathandizira kukhazikika kwa impso kwa nthawi yayitali. Pomaliza, ngati kuchuluka kwa kusefera kwa glomerular kupitirira 60 ml / min, ndiye, motsogozedwa ndi chakudya chamafuta ochepa, impso zimabwezeretsedwa mokwanira ndikugwira ntchito, monga momwe zimakhalira ndi anthu athanzi. Dziwani momwe mungawerengere kuchuluka kwako kwa kusefera kuno.
Kumbukirani kuti chakudya chamafuta ochepa sichimagwira impso. Mosakayikira, zimathandizira kukhala ndi shuga wabwinobwino m'magazi a shuga. Amaganiziridwa kuti chifukwa cha izi, ntchito ya impso imabwezeretseka ngati mfundo yoti palibe kubwerera siyidaperekedwe. Kuti mukhale ndi shuga wabwinobwino, ngakhale pakudya kwamafuta ochepa, muyenera kutsatira boma mosamalitsa. Muyenera kukhala osalolera zakudya zosavomerezeka monga Asilamu okhulupirika ali oleza nkhumba ndi mizimu. Pangani shuga ndi glucometer osachepera 5 pa tsiku, khalani mu boma la kudziletsa kwathunthu la shuga. Khama lomwe mukufunikira kuti lipindule nthawi zambiri ngati muonetsetsa kuti shuga yanu ikhazikika. Pakatha miyezi yochepa, mayeso amawonetsa kuti ntchito ya impso ndiyokhazikika kapena ikusintha. Mavuto ena a matenda ashuga adzathanso.
Dialysis Impso Zakudya Zam'magazi
Odwala omwe ali ndi matenda ashuga omwe amayamba kulephera a impso mu gawo lotsiriza amathandizira miyoyo yawo kudzera mu njira za dialysis. Munthawi izi, zinyalala zomwe zimakhala ndi nayitrogeni zimachotsedwa m'mwazi. Kutsetsereka ndi njira yodula komanso yosasangalatsa, yokhala ndi chiwopsezo chachikulu chotenga kachilomboka. Kuti achepetse kuchuluka kwake, odwala amalimbikitsidwa kuti achepetse kuchuluka kwa mapuloteni ndi madzi. Pakadali pano kulephera kwa impso, zakudya zamagulu ochepa, zama protein ambiri sizabwino. Nthawi zambiri, mapuloteni azakudya amakalowa chakudya. Madera ena a Western dialysis tsopano amalimbikitsa kuti odwala awo odwala matenda ashuga azitha kuthira mafuta a azitona m'malo mwa chakudya. Ili ndi mafuta ambiri athanzi.
Mapeto
Kuledzera kwa mapuloteni muzakudya sikuti kumayambitsa chitukuko cha impso, kuphatikiza odwala omwe ali ndi matenda ashuga. Pokhapokha ngati poti palibe kubwerera kwapita kale ndipo impso zawonongeka kale, pokhapokha, mapuloteni a chakudya amatha kuthamanga kukulitsa kulephera kwa impso.Matenda a diabetes a nephropathy samayamba ngati wodwala agwiritsa ntchito mtundu wina wa chithandizo cha matenda ashuga kapena mtundu wachiwiri wodwala matenda ashuga, amamuwongolera komanso amamuwonjezera shuga. Zakudya zamapuloteni sizikhala ndi mphamvu iliyonse pa impso. Shuga wokwezeka kwambiri amawonongeratu impso ngati matenda ashuga sawayendetsa bwino.
