Matenda A shuga Oyembekezera

Nkhaniyi ikufotokoza mwatsatanetsatane momwe angachitire ngati mayi wapezeka ndi matenda ashuga asanatenge pathupi. Ngati kuchuluka kwa glucose okwera kwapezeka kale panthawi yapakati, ndiye kuti amatchedwa matenda a shuga. Mtundu 1 kapena 2 shuga, monga lamulo, sikuti kuphwanya lamulo kwa kukhala mayi, koma zimachulukitsa zowopsa kwa mai ndi mwana wosabadwayo.

Njira zabwino zopewera zovuta za matenda ashuga mwa amayi apakati ndikuwunika kwambiri magazi anu

Matenda a shuga oyembekezera amafunika kuyang'aniridwa ndi madokotala pafupipafupi. Mayi woyembekezera yemwe ali ndi matenda ashuga amayang'aniridwa ndi katswiri wa matenda am'mimba. Ngati ndi kotheka, amatembenukira kwa akatswiri opapatiza: a ophthalmologist (maso), nephrologist (impso), cardiologist (mtima) ndi ena. Komabe, njira zikuluzikulu ndikuthandizira kuchuluka kwa shuga m'magazi omwe amayandikira.

Ndikwabwino kulipirira matenda ashuga, ndiye kuti, kuti glucose akhale ndi magazi pafupifupi ndi anthu athanzi - ichi ndiye chinthu chachikulu chomwe chikufunika kuchitidwa kuti mwana abadwe bwino komanso kuti mukhale ndi thanzi la mkazi. Kuyandikira kwambiri kwa shuga m'magazi kumakhala kokwanira, kumachepetsa mwayi pamavuto onse ali ndi pakati, kuyambira pakubereka mpaka pakubala.

Kuunika kwa chiopsezo ndi contraindication kwa mimba ndi shuga

Amayi omwe ali ndi matenda a shuga a mtundu woyamba kapena wachiwiri amayenera kumuwunika ndi dokotala wazachipatala, endocrinologist ndi dokotala wamkulu pa gawo lokonzekera kubereka. Nthawi yomweyo, zomwe wodwalayo ali nazo, kuthekera kwa zotsatira zabwino za pakati, komanso zoopsa zomwe zimapangitsa kuti pakhale mayesedwe olimbitsa thupi atheka.

Kodi ndimamayeso ati omwe mayi yemwe ali ndi matenda ashuga amayenera kuwapeza pa nthawi yoyeserera kuti athe kukhala ndi zotsatira zabwino za pakati:

1. Chitani kafukufuku wa magazi a hemoglobin wa glycated.
2. Paokha, yeretsani shuga wa magazi ndi glucometer mara 5-7 patsiku.
3. Pimani kuthamanga kwa magazi kunyumba ndi polojekiti yamagazi, komanso kudziwa ngati pali hypotension ya postural. Uku ndikutsika kwakukulu kwa kuthamanga kwa magazi, komwe kumawonetsedwa ndi chizungulire pakukweza kuchokera pampando kapena pogona.
4. Yesetsani kuyesa impso zanu. Sungani mkodzo watsiku ndi tsiku kuti mupeze kuvomerezeka kwa creatinine ndi mapuloteni. Chitani kafukufuku wa magazi a plasma creatinine ndi urea nayitrogeni.
5. Ngati mapuloteni amapezeka mumkodzo, onetsetsani matenda am'mimbamo.
6. Lumikizanani ndi a ophthalmologist kuti muwone momwe ziwiya zam'mimba zimayendera. Ndikofunikira kuti malongosoledwe ophatikizidwa a fundus aperekedwe ndi zithunzi za utoto. Athandizanso kuyerekezera ndi kuwunika kusintha mukamayesedwanso.
7. Ngati mayi yemwe ali ndi matenda a shuga afika zaka 35, akudwala matenda oopsa a m'magazi, nephropathy, kunenepa kwambiri, cholesterol yamagazi yayikulu, ali ndi mavuto okhudzana ndi zotumphukira, ndiye kuti muyenera kudutsa ECG.
8. Ngati ECG idawonetsa matenda kapena pali zizindikiro za matenda amtima, ndiye kuti ndibwino kuti mupiteko maphunziro ndi katundu.
9. Kuunikira chizindikiro cha zotumphukira za m'mitsempha. Onani kusakhazikika, kuwawa, kutentha ndi kugunda kwa momwe mitsempha imayendera, makamaka pamiyendo ndi kumapazi
10. Onani ngati autonomic neuropathy yapanga: mtima, m'mimba, urogenital ndi mitundu ina.
11. Onaninso chizolowezi chanu cha hypoglycemia. Kodi milandu ya hypoglycemia imayamba? Kodi ndizowlemera motani? Kodi zizindikiro zake ndi ziti?
12. Anayang'aniridwa zotupa za zotumphukira zamitsempha
13. Tengani mayeso a magazi a mahomoni a chithokomiro: mahomoni olimbitsa mtima a chithokomiro (TSH) ndi thyroxine yaulere (T4 yaulere).

Kuyambira 1965, gulu la American obstetrician-gynecologist R. White lagwiritsiridwa ntchito kuwunika chiopsezo cha kusokonezeka kwa fetus mu fetus. Ngozi zimatengera:

• kutalika kwa matenda ashuga mwa mkazi;
• Kodi matendawa adayamba zaka zingati?
• Mavuto azovuta za shuga alipo kale.

Mlingo wa chiwopsezo cha matenda ashuga mwa mayi wapakati malinga ndi P. White

Ndemanga:

• DR - matenda ashuga retinopathy; DN - matenda a shuga a nephropathy; CHD - matenda a mtima; CRF - kulephera kwa impso.
• Kalasi A - chiopsezo chotsika kwambiri cha zovuta, kalasi RF - zapamwamba kwambiri pazotsatira za pakati.

Kugawikaku ndikwabwino kwa madotolo ndi amayi omwe ali ndi matenda amtundu woyamba kapena 2 omwe akukonzekera kutenga pakati.

Kodi chiwopsezo cha matenda ashuga chimayi kwa mayi ndi mwana wosabadwa ndi chiani?

Chiwopsezo cha kukhala ndi matenda amtundu woyamba m'miyoyo ya mwana ndi:

• pafupifupi 1-1,5% - wokhala ndi matenda amtundu 1 m'mayi ;;
• pafupifupi 5-6% - omwe ali ndi matenda a shuga 1 a bambo;
• opitilira 30% - ngati mtundu 1 wa shuga mu makolo onse.

Mzimayi ndi madotolo omwe amamufunsa pakukonzekera zakubereka ayenera kupatsidwa mayankho owunikira a mafunso:

• Kodi matenda ashuga angakhudze bwanji thanzi komanso kubereka? Ndi mwayi uti wokhala ndi pakati komanso kubereka mwana wathanzi?
• Kodi mimba imakhudza bwanji matenda ashuga? Kodi zimathandizira kukula kwapang'onopang'ono kwa zovuta zake zowopsa?

Contraindication wa amayi apakati omwe ali ndi matenda ashuga:

• kwambiri nephropathy (serum creatinine> 120 μmol / L, gloperular kusefa kwa 2 g / tsiku);
• matenda oopsa omwe sangatengere kuyang'aniridwa, i.e., kuthamanga kwa magazi pamwamba pa 130-80 mm RT. Art., Ngakhale kuti mkazi amamwa mankhwala oopsa;
• proliferative retinopathy ndi maculopathy, laser retinal asanagundike;
• matenda a mtima, osakhazikika angina pectoris;
• matenda owopsa kapena otupa komanso otupa (chifuwa chachikulu, pyelonephritis, etc.);
• matenda a matenda ashuga - m'nthawi yoyamba ya mimba ndi chizindikiro cha kutha kwake.

Kukonzekera Mimba Kwa Amayi Ani Matenda A shuga

Chifukwa chake, mudawerengapo gawo lapitalo, komabe, mwatsimikiza kukhala ndi pakati ndikukhala ndi mwana. Ngati ndi choncho, ndiye kuti kwa mayi yemwe ali ndi matenda ashuga, gawo lokonzekera kutenga pakati limayambira. Pamafunika kuyesetsa kwakukulu komanso kumatenga nthawi yayitali, koma ndikofunikira kuidalitsa kuti mbewu ikhale yathanzi.

Lamulo lalikulu: mutha kuyamba kubereka pokhapokha kuchuluka kwanu kwa hemoglobin HbA1C kutsika mpaka 6,0% kapena kutsika. Ndipo miyeso yambiri yamagazi omwe mumatenga ndi mita ya shuga wamagazi iyeneranso kukhala yachilendo. Zolemba zamagulu owonera za shuga ziyenera kusungidwa ndikuwunikiridwa ndi dokotala sabata iliyonse iliyonse ya 1-2.

Komanso, kuthamanga kwa magazi kuyenera kukhala pansipa 130/80, ngakhale mutakhala kuti simumamwa mankhwala. Dziwani kuti mapiritsi amakanema “amisala” amawononga thanzi la fetus. Chifukwa chake, pa nthawi yomwe ali ndi pakati amayenera kuti aletsedwe. Ngati simungathe kuwongolera matenda oopsa osaneneka ngakhale musanakhale ndi pakati, ndi bwino kusiya amayi. Chifukwa chiopsezo cha zotsatira zoyipa za pakati ndi chachikulu kwambiri.

Kuti akwaniritse chindapusa chabwino cha shuga, pokonzekera kutenga pakati, mkazi ayenera kuchita izi:

• tsiku lililonse kuyeza shuga wamagazi ndi glucometer osapweteka pamimba yopanda kanthu ndi ola limodzi mutatha kudya;
• nthawi zina ndikofunikira kuyeza shuga komanso 2 kapena 3 m'mawa - onetsetsani kuti palibe usiku hypoglycemia;
• kudziwa ndi kugwiritsa ntchito njira yoyambira ya insulin;
• ngati mutamwa mapiritsi ochepetsa shuga a matenda ashuga 2, achotseni ndikusinthira ku insulin;
• masewera olimbitsa thupi ndi matenda ashuga - osagwiritsa ntchito kwambiri, mosangalatsa, pafupipafupi;
• tsatirani zakudya zomwe zimachepa m'makina, omwe amazimidwa msanga, idyani kangapo ka 5-6 patsiku m'magawo ang'onoang'ono

Zochita zina pokonzekera kutenga pakati ndi matenda ashuga:

• kuyeza magazi pafupipafupi;
• ngati pali matenda oopsa, ndiye kuti akuyenera kuthandizidwa, ndipo “ndi malire”, chifukwa panthawi yoyembekezera mankhwalawa a matenda oopsa ayenera kuyezedwa;
• kuonedwa pasadakhale ndi ophthalmologist ndikuchiritsa retinopathy;
• imwani folic acid pa 500 mcg / tsiku ndi ayodini wa potaziyamu pa 150 mcg / tsiku, ngati palibe contraindication;
• kusiya kusuta.

Mimba ya Matenda a shuga: Momwe Mungakhalire ndi Mwana Wathanzi

Pa nthawi yobereka ndi matenda ashuga, mkazi ayenera kuyesetsa kwambiri kuti shuga yake ya magazi ikhale pafupi ndi momwe zimakhalira. Komanso, samalani kwambiri ndi mafuta a shuga a 1 ndi 2 pambuyo pudya. Chifukwa ndi omwe amatha kuchuluka, ndipo kusala kudya kwamwazi kumatha kukhalanso kwabwinobwino kapenanso kutsika.

M'mawa, muyenera kuyesa ketonuria ndi zingwe zamayeso, i.e. ngati ma ketoni awonekera mkodzo. Chifukwa amayi apakati omwe ali ndi matenda ashuga amatha kutchukanso kwa zochitika zausiku za hypoglycemia. Ndime izi zimawonetsedwa ndi maonekedwe a ma ketones mumkodzo wam'mawa. Malinga ndi kafukufuku, ketonuria imalumikizidwa ndi kuchepa kwa luntha la luntha mu ana amtsogolo.

Mndandanda wazinthu zokhudzana ndi matenda apakati a shuga

1. Zakudya za mayi wapakati siziyenera kukhala zowonda kwambiri, zopatsa mphamvu zokwanira "zochedwa" kuteteza ketosis. Zakudya zamafuta ochepa a shuga omwe ali ndi pakati sizoyenera.
2. Kuyeza kwa shuga ndi magazi ndi glucometer - osachepera 7 pa tsiku. Pamimba yopanda kanthu, musanadye chakudya chilichonse, musanadye, usiku, komanso nthawi zina usiku. Mlingo wa insulin uyenera kusinthidwa kwa shuga m'magazi osati pamimba yopanda kanthu, koma mukatha kudya.
3. Mankhwala a shuga a insulin omwe ali ndi pakati amafotokozeredwa mwatsatanetsatane pansipa.
4. Lamulirani kuwoneka kwa ma ketones (acetone) mumkodzo, makamaka ndi gestosis yoyambirira komanso pambuyo pa masabata a 28-30 oyembekezera. Pakadali pano, kufunika kwa insulin kumawonjezeka.
5. Kuyesedwa kwa magazi kwa hemoglobin ya glycated kuyenera kumwedwa kamodzi pa trimester imodzi.
6. Tengani folic acid pa 500 mcg / tsiku mpaka sabata la 12 la mimba. Potaziyamu iodide pa 250 mcg / tsiku - pakalibe contraindication.
7. Kuunika kwa Ophthalmologist ndi mayeso a fundus - 1 nthawi imodzi. Ngati kuchuluka kwa odwala matenda ashuga retinopathy atakula kapena kufalikira kwamphamvu kufalikira kwamkati kumachitika msanga, kuthandizira kwamasamba a laser kumachitika nthawi yomweyo, apo ayi, khungu lathunthu limatha.
8. Kuyendera pafupipafupi kwa katswiri wa matenda am'mimba-gynecologist, endocrinologist kapena matenda ashuga. Kufikira milungu 34 ya mimba - milungu iwiri iliyonse, pakatha masabata 34 - tsiku lililonse. Pankhaniyi, muyeso wa kulemera kwa thupi, kuthamanga kwa magazi, kuyesa kwamkodzo kwamkati kumatengedwa.
9. Ngati matenda a mkodzo apezeka ndi matenda ashuga, azimayi oyembekezera amayenera kumwa maantibayotiki monga momwe dokotala wanenera (!). Zikhala mu trimester ya I - penicillin, mu II kapena III trimesters - penicillins kapena cephalosporins.
10. Madokotala ndi mayi wapakati amayang'anira kukula kwa mwana wosabadwayo. Ultrasound imachitidwa monga adanenera ndi obstetrician-gynecologist.

Kodi mapiritsi amakakamizidwa ndi madokotala panthawi yotenga pakati:

• Kambiranani ndi dokotala wanu kuti muyenera kupatsidwa mankhwala a magnesium-B6 ndi taurine kuti muchiritsidwe matenda oopsa popanda mankhwala.
• Mwa mankhwala "am'mankhwala", methyldopa ndi mankhwala osankha.
• Ngati methyldopa sithandiza mokwanira, oletsa calcium calcium kapena or1-kusankha adrenergic blockers atha kulembedwa.
• Mankhwala okodzetsa - kokha pazisonyezo zoopsa (kusungidwa kwa madzimadzi, edema ya m'mapapo, kulephera kwa mtima).

Pa nthawi yoyembekezera, mapiritsi onse okhudzana ndi magulu otsatirawa amakhala otsutsana:

• magazi kuchepetsa magazi;
• kuchokera ku matenda oopsa - ACE inhibitors ndi angiotensin-II receptor blockers;
• zigawenga zotchinga;
• maantibayotiki (aminoglycosides, tetracyclines, macrolides, etc.);
• ma statin kukonza magazi a cholesterol.

Zakudya za odwala matendawa

Patsamba lino, timalimbikitsa odwala onse kuti athandizidwe pa matenda a shuga a 2 komanso ngakhale mtundu 1 kuti asinthe kukhala ndi zakudya zamagulu ochepa. Zakudya izi sizoyenera:

• pa mimba;
• ndi kulephera kwambiri kwa aimpso.

Zakudya zamafuta ochepa a amayi apakati omwe ali ndi matenda ashuga ndizoletsedwa, chifukwa zimatha kuvulaza kukula kwa mwana wosabadwayo.

Kuletsedwa kwa chakudya m'zakudya kumapangitsanso kuti thupi limasinthira ku chakudya ndi mafuta ake. Izi zimayamba ketosis. Matupi a Ketone amapangidwa, kuphatikiza acetone, yomwe imatha kupezeka mu mkodzo komanso fungo la mpweya wotuluka. Mtundu wachiwiri wa matenda ashuga, izi zitha kukhala zopindulitsa kwa wodwala, koma osati panthawi yomwe ali ndi pakati.

Mukamawerenga nkhani ya "Insulin ndi Zopanga: Choonadi Muyenera Kudziwa", zakudya zochepa zomwe mumadya, ndizosavuta kukhala ndi shuga wamagazi. Koma pa mimba - kupewa kukula kwa ketosis ndikofunikira kwambiri. Kukweza kwa magazi kwa magazi kumatha kubweretsa zovuta za kutenga pakati komanso kubereka. Koma ketonuria ndiyowopsa kwambiri. Zoyenera kuchita?

Zakudya zomanga thupi, zomwe zimamwe nthawi yomweyo, sizoyenera kudya shuga. Koma mukakhala ndi pakati, mutha kulola kudya masamba okoma (kaloti, beets) ndi zipatso, zomwe m'moyo wabwinobwino ndikofunika kupatula zakudya. Ndipo yang'anirani mosamala maonekedwe a ma ketoni mumkodzo ndi zingwe zoyeserera.

Mankhwala ovomerezeka anali atalimbikitsa kale zakudya zazimayi kwa amayi apakati omwe amakhala ndi 60% yamafuta. M'zaka zaposachedwa, azindikira zabwino zochepetsera kuchuluka kwa chakudya cham'madzi ndipo tsopano alimbikitsa chakudya chomwe 40-45% chakudya, 35-40% mafuta ndi mapuloteni 20-25%.

Amayi oyembekezera omwe ali ndi matenda ashuga amalangizidwa kuti azidya zakudya zazing'ono kangapo kamodzi pa tsiku. Awa ndi zakudya zitatu zazikuluzikulu komanso zowonjezera zitatu, kuphatikiza usiku kuteteza hypoglycemia yausiku. Ofufuza ambiri amakhulupirira kuti zakudya zopatsa mphamvu za anthu odwala matenda ashuga ziyenera kukhala zabwinobwino, ngakhale mayi atakhala wonenepa kwambiri.

Jakisoni wa insulin

Pa nthawi yoyembekezera, chidwi cha minyewa kuchitira insulin chimachepetsa m'thupi la mkazi mothandizidwa ndi placental mahomoni, i.e, insulin kukana kumayamba. Kuti amalize izi, kapamba amayamba kupanga insulini yambiri. Kusala kudya kwa magazi kumakhalabe kwachilendo kapena kumachepetsa, ndipo mukatha kudya kumakula kwambiri.

Zonsezi ndizofanana ndi chitukuko cha matenda ashuga amtundu wa 2. Koma izi ndi zinthu zachilengedwe zomwe zimasintha mu thupi kuti zitsimikizike. Ngati kapamba asanayambe kugwira ntchito molingana ndi mphamvu zake, ndiye kuti panthawi yoyembekezera mayi amatha kudwala matenda ashuga, chifukwa tsopano sangathe kuthana ndi kuchuluka kwachulukidwe.

Amayi oyembekezera amakhala ndi mankhwala othandizira insulin osati mtundu 1 wokha, komanso mtundu wachiwiri wa matenda ashuga ndi matenda osokoneza bongo, ngati sizotheka kukhala ndi shuga wabwinobwino kudzera mu chakudya komanso masewera olimbitsa thupi.

Kuchuluka kwa shuga m'magazi kumatha kubweretsa zovuta zapakati, zomwe zimakhala zowopsa kwa mwana wosabadwa ndi mkazi. A shuga fetopathy - kuwonetseredwa mwana wosabadwayo ndi edema wa subcutaneous mafuta, mkhutu ntchito ambiri ziwalo. Zitha kuyambitsa mavuto ambiri kumapeto kwa nthawi yobereka.

Macrosomy ndi phindu lochulukirapo kwa mwana wosabadwayo, mothandizidwa ndi kuchuluka kwa shuga m'magazi a amayi. Zimayambitsa zovuta pamene kudutsa mu ngalande yobadwa, kubadwa msanga, kumabweretsa kuvulaza kwa mwana kapena mkazi pakubadwa.

Chifukwa chake, musazengereze kuyambitsa jakisoni wa insulin ndi shuga mwa amayi apakati, ngati kuli kotheka. Malangizo a insulin amathandizidwa ndi adokotala. Mayi ayenera kuganizira kugwiritsa ntchito pampu ya insulin m'malo mwa jakisoni achikhalidwe ndi syringes kapena zolembera.

Chonde dziwani kuti theka lachiwiri la kubereka, kufunikira kwa insulin kumatha kuwonjezeka kwambiri. Mlingo wa jakisoni wa insulin ungafunike kuwonjezeka chifukwa cha 2-3 poyerekeza ndi kuchuluka komwe adabayira jekeseni asanachitike. Zimatengera zikwangwani za shuga wamagazi mutatha kudya, zomwe mkazi nthawi iliyonse amayeza mopanda gluceter.

Matenda a shuga oyembekezera ndi nephropathy (mavuto a impso)

Matenda a diabetes ndi nephropathy ndimtundu wovuta wa zotupa zosiyanasiyana za impso ndi mitsempha yawo yamagazi yomwe imachitika mu shuga. Izi ndizovuta zowopsa zomwe zimakhudza 30%% ya odwala matenda a shuga ndipo nthawi zambiri zimayambitsa kulephera kwa impso.

Monga tafotokozera kumayambiriro kwa nkhaniyi, kupanikizana kwambiri ndi nephropathy. Koma azimayi ambiri omwe ali ndi vuto la matenda ashuga a nephropathy a "kufatsa" kapena "pang'ono" amakhala ndi pakati ndikubereka.

Nthawi zambiri odwala matenda ashuga nephropathy, kubadwa kwa mwana wodalirika kungayembekezeredwe. Koma, moyenera, nthawi ya kubereka imakhala yovuta, kuyang'anira akatswiri ndi chithandizo champhamvu chofunikira. Mwayi wowopsa ndi wa amayi omwe ali ndi vuto la impso, chifukwa chochepetsetsa kupezeka kwa creatinine komanso kuchuluka kwa creatinine m'madzi a m'magazi (pitani mayeso - chekeni!).

Matenda a diabetes a nephropathy amawonjezera mwayi wokhala ndi zotsatirapo zovuta zapakati pazifukwa izi:

• Kangapo mobwerezabwereza, mimba imakhala yovuta ndi preeclampsia. Makamaka mwa azimayi omwe ali ndi matenda ashuga nephropathy omwe anali ndi kuthamanga magazi ngakhale asanakhale ndi pakati. Koma ngakhale mkaziyo poyambapo atakhala ndi magazi abwinobwino, preeclampsia akadali yotheka.
• Kubadwa musanabadwe ndi matenda ashuga nephropathy kumachitika kawirikawiri. Chifukwa mkhalidwe wa mayiyo ungakulire, kapena pakhoza kukhala chiwopsezo kwa mwanayo. Mu 25-30% ya milandu, kubala mwana kumachitika sabata la 34 litatha, mu 50% ya milandu - mpaka sabata la 37.
• Mimba, motsutsana ndi maziko a nephropathy, mu 20% ya milandu pamakhala kufooka kapena kukula kwa mwana wosabadwayo.

Preeclampsia ndi vuto lalikulu la pakati lomwe limabweretsa kusakwanira kwa magazi kwa placenta, kusowa kwa michere ndi okosijeni kwa mwana wosabadwayo. Zizindikiro zake ndi:

• kuthamanga kwa magazi;
• kutupa
• kuchuluka kwa mapuloteni mumkodzo;
• mzimayi akuwonjezereka msanga chifukwa chosungidwa ndi madzimadzi mthupi.

Ndikosavuta kuneneratu pasadakhale ngati pakati kungathandizire kukulitsa zovuta za matenda a impso. Pali zinthu zinayi zomwe zingakhudze izi:

1. Nthawi zambiri, pakakhala pakati, msambo wa kusefera kwa glomerular umawonjezeka ndi 40-60%. Monga mukudziwa, matenda ashuga nephropathy amachitika chifukwa cha kuchuluka kwa kusefera kwa thupi. Chifukwa chake, kutenga pakati kumatha kukulitsa zovuta za matenda ashuga awa.
2. Kuthamanga kwa magazi ndichofunikira kwambiri pakuwonongeka kwa impso. Chifukwa chake, matenda oopsa komanso preeclampia, omwe nthawi zambiri amapezeka mwa amayi apakati omwe ali ndi matenda ashuga, amatha kukhala ndi vuto pa impso.
3. Pa nthawi yomwe mayi ali ndi pakati, chakudya cha mayi chimayenera kukhala ndi mapuloteni ambiri, chifukwa mwana wosabadwayo amafunikira kwambiri. Koma kuchuluka kwa mapuloteni ambiri m'zakudya kumawonjezera kuchuluka kwa kusefedwa kwa glomerular. Izi zimathandizira nthawi yachilengedwe cha matenda a shuga a nephropathy.
4. Mu matenda a diabetes nephropathy, odwala nthawi zambiri amapatsidwa mankhwala - ACE zoletsa - omwe amachepetsa kukula kwa kuwonongeka kwa impso. Koma mankhwalawa amakhudza kwambiri chitukuko cha mwana wosabadwayo, motero amathetsedwa panthawi yomwe ali ndi pakati.

Kumbali inayo, pa nthawi yomwe ali ndi pakati, azimayi omwe ali ndi vuto la shuga amalangizidwa kuti azisamala kwambiri momwe magazi awo alili. Ndipo izi zitha kukhala ndi phindu lalikulu pantchito ya impso.

Zizindikiro za mavuto a impso nthawi zambiri zimawonekera kale kumapeto kwa matenda a shuga. Izi zisanachitike, matendawa amapezeka malinga ndi kusanthula kwa mkodzo wa mapuloteni. Choyamba, albumin imawonekera mkodzo, ndipo imatchedwa microalbuminuria. Pambuyo pake, mapuloteni ena, akulu, amawonjezeredwa.

Proteinuria ndiye kuchotsa kwa mapuloteni mumkodzo. Nthawi yapakati, azimayi omwe ali ndi matenda ashuga nephropathy nthawi zambiri amawonjezera proteinuria. Koma atabereka mwana, akuyenera kukana mpaka kale. Nthawi yomweyo, zovuta zoyipa zomwe zimabweretsa pakati pa ntchito ya impso zimatha kuchitika pambuyo pake.

Kubala kwa mwana pamaso pa matenda a shuga mwa mayi wapakati

Kwa amayi apakati omwe ali ndi matenda ashuga, funso loti ndi nthawi yayitali bwanji yobereka limasankhidwa payekha. Pankhaniyi, madokotala amaganizira izi:

• mkhalidwe wa mwana wosabadwayo;
• kukula kwa mapapu ake;
• kukhalapo kwa mavuto apakati;
• chikhalidwe cha matenda ashuga.

Ngati mayi ali ndi pakati amakhala ndi matenda ashuga, ndipo nthawi yomweyo amakhala ndi shuga wa magazi, ndiye kuti mwina, amabweretsa mwana ku nthawi yakubereka.

Kukhala ndi gawo la cesarean kapena kubereka kwachilengedwe ndi chisankho choyenera. Kudzipeleka kokha mwa mayi yemwe ali ndi matenda ashuga ngati nkotheka kuchita zotsatirazi:

• shuga imayendetsedwa bwino;
• palibe zovuta zoletsa;
• kulemera kwa mwana wosabadwayo ndi kochepera 4 kg ndipo mukukhala bwino;
• madokotala amatha kuyang'anira mkhalidwe wa mwana wosabadwayo ndikuwunika kuchuluka kwa shuga m'magazi a amayi panthawi yobereka.

Iwo adzakhala ndi gawo la cesarean ngati:

• mayi woyembekezera ali ndi khungu lozungulira kapena chotupa pa chiberekero;
• mayi amadwala matenda a shuga.

Tsopano mdziko lapansi, magawo a magawo anayi a caesarean ndi 15.2% mwa azimayi athanzi ndi 20% mwa odwala omwe ali ndi matenda a shuga, kuphatikizanso mimbulu. Mwa azimayi omwe adapezeka ndi matenda ashuga asanabadwe, gawo la caesarean limakulitsidwa mpaka 36%.

Pa nthawi yobereka, madokotala amayang'anira kuchuluka kwa shuga m'magazi a capillary 1 pa ola limodzi. Ndikofunika kwambiri kusungitsa shuga ya magazi a amayi pa nthawi yovomerezeka kudzera mu mtsempha wamagazi mkati komanso inshuwaransi yochepa ya insulin. Kugwiritsa ntchito pampu ya insulin kumaperekanso zotsatira zabwino.

Ngati wodwala, pamodzi ndi madotolo, asankha gawo laeses, ndiye kuti akonza m'mawa kwambiri. Chifukwa m'masiku awa mlingo wa "sing'anga" kapena insulin yowonjezera, womwe umaperekedwa usiku, upitiliza. Chifukwa chake zidzakhala zotheka kuti musabare jakisoni kapena insulin mukamayamwa fetal.

Nthawi yobereka

Apa tikulingalira momwe zinthu zimakhalira mzimayi atadwala matenda a shuga omwe amadalira insulin asanabadwe. Ngati matenda ashuga adapezeka koyamba ali ndi pakati, werengani nkhani yokhudza matenda a shuga kwa mayi woyembekezera.

Pambuyo pobadwa, placenta imasiya kukhudza kagayidwe kachakudya mthupi la mayi wokhala ndi mahomoni ake. Momwemo, chidwi cha zimakhala kuti insulin iwonjezeke. Chifukwa chake, Mlingo wa insulin wa jakisoni uyenera kuchepetsedwa kwambiri kuti muchepetse hypoglycemia yayikulu.

Pafupifupi kuchuluka kwa insulin kumatha kuchepetsedwa ndi 50% pambuyo pobadwa mwa njira yachilengedwe komanso ndi 33% pazochitika za cesarean. Koma ndi mankhwala a insulin, mutha kungoyang'ana zomwe wodwala akuonetsa, osati zambiri za anthu wamba. Kusankha mulingo woyenera wa insulini kungachitike pokhapokha ngati magazi a magazi atuluka.

Zaka zingapo zapitazo, kuyamwitsa kwa amayi omwe ali ndi matenda ashuga kunali kovuta. Izi zidalepheretsedwa ndi:

• kuchuluka kwakukulu kwa kubadwa asanachitike;
• zovuta pakubala;
• kuvuta kwambiri kwa metabolic mwa akazi.

Izi tsopano zasintha. Ngati matenda ashuga amalipiridwa bwino ndipo kuperekera kunatsirizidwa panthawi yake, kuyamwitsa ndikotheka ndipo ngakhale ndikulimbikitsidwa. Potere, kumbukirani kuti zigawo za hypoglycemia zimachepetsa kutuluka kwa magazi kupita ku chithokomiro cha mayi ndikupanga mkaka wa m'mawere. Chifukwa chake, muyenera kuyesetsa kuti musawalole.

Ngati wodwala azilamulira matenda ake a shuga, ndiye kuti mkaka wake udzakhala wofanana ndi azimayi athanzi. Pokhapokha ngati glucose akhoza kuchuluka. Zimakhulupililidwa kuti maubwino oyamwitsa amakulitsa vutoli.