Matenda a shuga kwa Okalamba

Kuchiza matenda a shuga pakukalamba ndi vuto lofunika kwambiri kwa owerenga athu ambiri patsamba. Chifukwa chake, takonzekera nkhani yatsatanetsatane pankhaniyi, yolembedwa mchilankhulo chofikirika. Odwala ndi akatswiri azachipatala amatha kudziwa zonse zomwe akufuna pano kuti athe kudziwa bwino komanso kuchiza odwala matenda ashuga okalamba.

Momwe wodwala wokalamba angalandire chithandizo chodwala kwambiri zimadalira kwambiri kuthekera kwazandalama ndi iye komanso abale ake, komanso, amadwala matenda osokonezeka maganizo kapena ayi. Ngakhale zili choncho, zida zomwe zili m'nkhaniyi zikuthandizira kwambiri polimbana ndi matenda a shuga, zomwe zimatheka momwe munthu wokalamba aliri.

Chifukwa chomwe chiopsezo cha matenda a shuga chimakwera mukakalamba

Kuyambira wazaka 50-60, kulolera glucose kumachepetsedwa mosavomerezeka mwa anthu ambiri. Zochita izi, zikutanthauza kuti pambuyo pa zaka 50 pazaka 10 zilizonse zotsatirazi:

• kuthamanga kwa shuga m'magazi kumawonjezeka ndi 0,055 mmol / l;
• shuga plasma ndende 2 patatha chakudya chakudya ndi 0,5 mmol / l.

Chonde dziwani kuti izi ndiwonetsero chabe "wapakati". Mwa munthu aliyense wachikulire, kutsata kwa shuga wamagazi kumasintha mwanjira yawo. Ndipo chifukwa chake, chiopsezo chokhala ndi matenda ashuga a 2 mwa nzika zina nzokwera kwambiri kuposa ena. Zimatengera mtundu wamakhalidwe omwe munthu wokalamba amatsogolera - kwakukulu, pakulimbitsa thupi komanso thanzi.

Postprandial glycemia ndi shuga wamagazi atatha kudya. Nthawi zambiri amayesedwa maola awiri chakudya chitatha. Ichi ndi chizindikiritso chomwe chimakula kwambiri mu ukalamba, zomwe zimabweretsa kukula kwa matenda ashuga amtundu wa 2. Nthawi yomweyo, kudya glycemia sikusintha kwambiri.

Kodi ndichifukwa chiyani kulekerera kwa shuga kumatha kusokonezeka ndi ukalamba? Chodabwitsachi chili ndi zifukwa zingapo zomwe zimagwira thupi nthawi imodzi. Izi zikuphatikiza:

• Kuchepa kwokhudzana ndi zaka.
• Kukula kwa katemera wa pancreatic;
• Kubisalira ndi kuchitapo kwa ma incretin mahomoni amayamba kufooka.

Kuchepetsa kokhudzana ndi zaka

Kuchepa kwa chidwi chathupi lathupi kupita ku insulin kumatchedwa insulin kukana. Amayamba achikulire ambiri. Makamaka kwa iwo onenepa kwambiri. Ngati simukutenga njira zochizira, ndiye kuti izi zitha kutsogolera matenda a shuga a 2.

Kuchulukana kwa insulin ndi chifukwa chachikulu cha matenda ashuga a 2 okalamba. Ofufuzawo akukangana kuti ngati minyewa ya insulin ikukanika ndi njira yachilengedwe yokalamba. Kapena kodi ndi chifukwa cha moyo wopanda nkhawa mukakalamba?

Pazifukwa zachuma, anthu achikulire amadya, makamaka, zakudya zotsika mtengo, zopatsa mphamvu. Chakudyachi chili ndi mafuta ochulukirapo a mafakitale ndi zakudya zamafuta, omwe amazimidwa msanga. Nthawi yomweyo, imasowa mapuloteni, michere ndi michere yambiri, yomwe imapangidwa pang'onopang'ono.

Komanso, anthu achikulire, monga lamulo, ali ndi matenda othandizira komanso amawalandira mankhwala. Mankhwalawa nthawi zambiri amakhala ndi vuto la carbohydrate metabolism. Mankhwala owopsa kwambiri kuonjezera ngozi yanu ya matenda ashuga:

• thiazide okodzetsa;
• beta blockers (osasankha);
• ma steroid;
• mankhwala a psychotropic.

Matenda omwewa omwe amakukakamizani kuti mumwa mankhwalawa amachepetsa zochita za achikulire. Amatha kukhala ma pathologies a mtima, mapapu, musculoskeletal system ndi mavuto ena. Zotsatira zake, misa yamisempha imachepetsedwa, ndipo ichi ndiye chifukwa chachikulu cha kuwonjezeka kwa insulin.

Pochita izi, zikuwonekeratu kuti ngati mutasinthira kukhala ndi moyo wathanzi, chiopsezo chokhala ndi matenda ashuga a 2 mu ukalamba amachepetsedwa, ndiye kuti, pafupifupi. Momwe mungachite izi - muphunziranso zambiri m'nkhaniyi.

Pancreatic insulin secretion

Ngati munthu alibe kunenepa kwambiri, ndiye kuti vuto lalikulu la shuga m'matumbo a insulin ndilobisika. Kumbukirani kuti kwa anthu omwe ali ndi kunenepa kwambiri, kukana insulini ndizomwe zimayambitsa matenda ashuga, ngakhale kuti kapamba amapanga insulin mwachizolowezi.

Munthu akadya chakudya ndi chakudya chamagulugi, magazi ake amadzuka. Poyankha izi, kapamba amatulutsa insulin. Pancreatic insulin secretion poyankha chakudya "yolemetsa" yamthupi limapezeka m'magawo awiri otchedwa magawo.

Gawo loyamba ndilobisika kwambiri la insulin, lomwe limatenga mphindi 10. Gawo lachiwiri ndi kutuluka kwa insulin kulowa m'magazi, koma kumatenga nthawi yayitali, mpaka mphindi 60-120. Gawo loyamba la secretion limafunikira kuti 'lizimitse' kuchuluka kwa glucose m'magazi omwe amapezeka akangodya.

Kafukufuku akuwonetsa kuti mwa anthu okalamba popanda kulemera kwambiri thupi, gawo loyamba la insulin secretion limachepetsedwa kwambiri. Mwambiri, makamaka chifukwa cha izi, shuga wa m'magazi a m'magazi 2 pambuyo chakudya amakwera kwambiri, i.e., ndi 0.5 mmol / l pazaka 10 zilizonse pambuyo pa zaka 50 zakubadwa.

Asayansi apeza kuti mwa achikulire omwe ali ndi kulemera kwakanthawi, thupi la glucosinase limachepetsedwa. Mtunduwu umapereka chidwi cha maselo a pancreatic beta ku mphamvu yosangalatsa ya shuga. Kuchepa kwake kungafotokoze kuchepa kwa insulin katulutsidwe poyankha kulowa kwa shuga m'magazi.

Kodi kubisala ndi zochita za ma impretins zimasintha bwanji mwa okalamba

Ma insretins ndi mahomoni omwe amapangidwa m'matumbo am'mimba poyankha kudya. Amathandizanso kupanga insulin ndi kapamba. Kumbukirani kuti chachikulu chodzetsa chinsinsi cha insulin chiri ndi kuchuluka kwa shuga m'magazi.

Kuchita kwa ma insretins kunayamba kuphunziridwa mozama kokha kumayambiriro kwa zaka za zana la makumi awiri ndi limodzi. Zinapezeka kuti nthawi zambiri, akamamwa pakamwa (pakamwa), mafuta a insulini amapangidwa pafupifupi kawiri kuposa momwe amachitidwira kukonzekera kwa kufanana kwa shuga.

Asayansi amati pakudya komanso pambuyo chakudya, zinthu zina (mahomoni) zimapangidwa m'mimba zomwe zimapangitsanso ziphuphu kuti zipange insulini. Ma hormone amenewa amatchedwa maretretins. Kapangidwe kawo ndi kapangidwe kake ka zinthu zimamveka bwino.

Ma insretins ndi mahomoni okhala ndi glucagon-ngati peptide-1 (GLP-1) ndi insulinotropic polypeptide (HIP) ya glucose. Zinapezeka kuti GLP-1 imakhudza kwambiri kapamba. Zimangowonjezera kubisika kwa insulin, komanso zimalepheretsa kupanga glucagon, "wotsutsana naye" wa insulin.

Kafukufuku akuwonetsa kuti mwa okalamba, kupanga mahomoni GLP-1 ndi GUI kumakhalabe pamlingo wofanana ndi wa ang'ono. Koma mphamvu ya ma cell a pancreatic beta kuchitira ma insretin amachepetsa ndi zaka. Ichi ndi chimodzi mwazinthu zopangira matenda a shuga, koma osafunikira kuposa kukana insulini.

Kupeza matenda ashuga okalamba

Anthu athanzi amalangizidwa pambuyo pa 45 kuti ayesedwe matenda a shuga kamodzi pazaka zitatu. Dziwani momwe miyezo ya shuga ya magazi ilili. Chonde dziwani kuti kuyesa kwa shuga m'magazi sikoyenera kuyezetsa matenda a shuga. Chifukwa odwala ambiri omwe ali ndi matenda ashuga, kusala kudya shuga m'magazi kumakhalabe kwachilendo. Chifukwa chake, tikulimbikitsa kuyezetsa magazi a glycated hemoglobin.

Kuti mumvetsetse matenda omwe amadziwika ndi matenda ashuga, werengani kaye nkhani yokhudza nkhaniyi. Ndipo apa tikambirana zomwe zidzachitike pakukhudzidwa kwa matenda ashuga okalamba.

Kuzindikira mtundu wachiwiri wa shuga mwa odwala okalamba kumakhala kovuta chifukwa matendawa nthawi zambiri amapezeka popanda zizindikiro. Wodwala wachikulire sangakhale ndi madandaulo a shuga, ludzu, kuwonda, kapena kukodza pafupipafupi.

Ndizodziwika kwambiri kuti okalamba odwala matenda ashuga samakonda kudandaula za ludzu. Izi ndichifukwa choti pakati pomwe pakumva ludzu laubongo kunayamba kugwira ntchito kwambiri chifukwa cha zovuta ndi zotengera. Okalamba ambiri amakhala ndi ludzu lofooka, ndipo chifukwa cha izi, amabwezeretsa mosamalitsa madzi osungirako m'thupi. Chifukwa chake, amapezeka ndi matenda ashuga akafika kuchipatala ali ndi vuto lothodomola chifukwa cha kuchepa mphamvu kwa madzi m'thupi.

Odwala okalamba, osati mwachindunji, koma madandaulo ambiri amakhala ambiri - kufooka, kutopa, chizungulire, mavuto amakumbukiro. Achibale angadziwe kuti demilea ya demokalase ikupita. Pozindikira zotere, dokotalayo nthawi zambiri samazindikira kuti munthu wokalamba akhoza kukhala ndi matenda a shuga. Chifukwa chake, wodwalayo samalandira chithandizo, ndipo zovuta zimapita.

Nthawi zambiri, odwala matenda ashuga amapezeka mwangozi kapena atachedwa, munthu akapimidwa amafufuza mwamphamvu. Chifukwa chakupezeka kwa matenda ashuga okalamba, odwala opitilira 50% omwe ali ndi vutoli amakhala ndi mavuto akulu: mavuto amtima, miyendo, mawonekedwe amso komanso impso.

Mwa anthu okalamba, cholowa chaimpso chimakwera. Tiyeni tiwone kuti ndi chiyani. Mwa achichepere, shuga amapezeka mu mkodzo pomwe kuchuluka kwake m'magazi kuli pafupifupi 10 mmol / L. Pambuyo pa zaka 65-70, "cholumikizira impso" chimasinthira ku 12-13 mmol / L. Izi zikutanthauza kuti ngakhale ndi chindapusa chovuta kwambiri cha matenda ashuga mwa okalamba, shuga samalowetsa mkodzo, ndipo pali mwayi wochepa woti adzapezeka ndi nthawi.

Hypoglycemia okalamba - zoopsa ndi zotsatirapo zake

Choyamba, tikulimbikitsa kuwerenga nkhani "Hypoglycemia in shuga." Hypoglycemia ukalamba ndi owopsa kwambiri. Chifukwa nthawi zambiri imabweretsa imfa, yomwe imawoneka ngati imfa yochokera mu mtima.

Kuwonetsedwa kwa hypoglycemia mwa okalamba odwala matenda ashuga amasiyana ndi "mawonekedwe" apamwamba omwe amawonekera mwa achinyamata. Zambiri za hypoglycemia mwa okalamba:

• Zizindikiro zake zimachotsedwa ndipo sinafotokozedwe bwino. Hypoglycemia mwa odwala okalamba nthawi zambiri amakhala "obisala" ngati chiwonetsero cha matenda ena, motero, sadziwika.
• Mwa anthu achikulire, kupanga mahomoni adrenaline ndi cortisol nthawi zambiri kumavuta. Chifukwa chake, zizindikiro zowoneka bwino za hypoglycemia zitha kupezeka: palpitations, kunjenjemera, ndi thukuta. Kufooka, kugona, chisokonezo, amnesia abwera.
• Mthupi la okalamba, njira zopewera dziko la hypoglycemia ndizoperewera, i.e., makina olimbana nawo sagwira ntchito bwino. Chifukwa cha izi, hypoglycemia imatha kukhala ndi gawo lotuluka.

Chifukwa chiyani hypoglycemia mu ukalamba ndiowopsa? Chifukwa zimayambitsa zovuta zamtima zomwe odwala matenda ashuga samalola makamaka. Hypoglycemia imachulukitsa mwayi woti ungafe ndi matenda a mtima, sitiroko, kulephera kwa mtima, kapena kutsekeka kwa chotengera chachikulu ndi magazi.

Ngati wodwala matenda ashuga okalamba ali ndi mwayi wokwanira kudzuka ali ndi moyo pambuyo pa hypoglycemia, ndiye kuti akhoza kukhalabe wolumala chifukwa chakuwonongeka kwa ubongo kosasinthika. Izi zitha kuchitika ndi matenda ashuga akadali achichepere, koma kwa anthu okalamba mwayi wazotsatira zoyipa ndizofunikira kwambiri.

Ngati wodwala wachikulire wodwala matenda ashuga ali ndi hypoglycemia pafupipafupi komanso mosakonzekera, ndiye kuti izi zimabweretsa, zomwe zimatsatiridwa ndi kuvulala. Kugwa ndi hypoglycemia ndizomwe zimapangitsa kuti mafupa aphulike, kusuntha kwamalumikizidwe, kuwonongeka kwa minofu yofewa. Hypoglycemia mu kukalamba kumawonjezera chiopsezo cha kukhumudwa kwa m'chiuno.

Hypoglycemia mu odwala matenda ashuga okalamba nthawi zambiri amapezeka chifukwa chakuti wodwalayo amatenga mankhwala osiyanasiyana osiyanasiyana, ndipo amalumikizana. Mankhwala ena atha kuwonjezera zotsatira za mapiritsi a shuga, zotumphukira za sulfonylurea. Ena - amalimbikitsa kubisika kwa insulini kapena kuwonjezera mphamvu ya maselo pakuchitapo kanthu.

Mankhwala ena amatseketsa thupi kuzindikira kwa zizindikiro za hypoglycemia ngati mbali imodzi, ndipo wodwalayo akulephera kuyimitsa nthawi. Kuwona zonse zomwe zingachitike ndi mankhwala kwa odwala okalamba omwe ali ndi matenda ashuga ndi ntchito yovuta kwa dokotala.

Tebulo likuwonetsa zina mwazomwe zimachitika ndi mankhwala omwe nthawi zambiri amapangitsa hypoglycemia:

Munthu wodwala matenda ashuga amatha kusungabe magazi ake pafupipafupi, sipamakhala zovuta zina komanso kumva bwino. Koma vuto ndi loti kuchuluka kwa shuga m'magazi kumatha kulamulidwa mothandizidwa ndi “chizolowezi” cha matenda ashuga, nthawi zambiri hypoglycemia imachitika. Ndipo kwa odwala okalamba, ndizowopsa.

Umu ndi momwe zinthu ziwirizi sizabwino. Kodi pali njira ina yabwino? Inde, pali njira yomwe imakulolani kuti muchepetse shuga la magazi komanso nthawi yomweyo ndikukhalabe ndi hypoglycemia. Njira iyi ndikuchepetsa chakudya chamagulu a anthu odwala matenda ashuga, kudya mapuloteni komanso mafuta achilengedwe othandiza pamtima.

Zakudya zochepa zomwe mumadya, zimachepetsa kufunika kwa mapiritsi a insulin kapena shuga kuti muchepetse shuga. Ndipo, motere, ndiye kuti simungathe kuchita hypoglycemia. Chakudya, chomwe chimakhala ndi mapuloteni, mafuta athanzi achilengedwe komanso CHIKWANGWANI, chimathandiza kuti magazi azikhala pafupi ndi abwinobwino.

Odwala ambiri omwe ali ndi matenda ashuga a 2, kuphatikiza okalamba, atasinthira ku chakudya chochepa chamafuta amatha kusiyiratu mapiritsi a insulin ndi shuga. Pambuyo pa izi, hypoglycemia sichingachitike konse. Ngakhale ngati simungathe kulumpha kuchokera ku insulin, ndiye kuti kufunika kwake kumachepa kwambiri. Ndipo kupatula insulin ndi mapiritsi omwe mumapeza, kumachepetsa mwayi wa hypoglycemia.

Chithandizo cha matenda amtundu wa 2 okalamba

Kuthandiza odwala matenda a shuga a mtundu wachinayi nthawi zambiri kumakhala kovuta kwambiri kwa dokotala. Chifukwa nthawi zambiri imakhala yovuta chifukwa cha kuchuluka kwa matenda opatsirana mwa odwala matenda ashuga, chikhalidwe cha anthu (kusungulumwa, umphawi, kusowa chithandizo), kuphunzira odwala osawerengeka, komanso chifukwa cha kuchepa kwa maganizo.

Dokotala nthawi zambiri amayenera kupereka mankhwala ambiri kwa odwala okalamba omwe ali ndi matenda ashuga. Zitha kukhala zovuta kuganizira momwe amathandizirana wina ndi mnzake. Anthu okalamba odwala matenda ashuga nthawi zambiri amawonetsa kuti amatsata chithandizo chochepa, ndipo amangosiya kumwa mankhwalawa ndikuwathandiza.

Ambiri mwa odwala okalamba odwala matenda ashuga amakhala m'malo ovuta. Chifukwa cha izi, nthawi zambiri amakhala ndi vuto la kugona kapena kukhumudwa kwambiri. Odwala omwe ali ndi matenda ashuga, kukhumudwa kumabweretsa kuti amaphwanya njira zamankhwala ndikuwongolera shuga lawo bwino.

Zolinga za chithandizo cha matenda ashuga kwa aliyense okalamba ziyenera kukhazikitsidwa. Zimatengera:

• nthawi yamoyo;
• chizolowezi chachikulu cha hypoglycemia;
• kodi pali matenda amtundu uliwonse wamtima;
• Matenda a shuga adayamba kale?
• kufikira momwe madokotala amagwirira ntchito zimakupatsani mwayi wotsatira malangizo a dokotala.

Ndi chiyembekezo choyembekezeka cha moyo (chiyembekezo chamoyo) cha zaka zoposa 10-15, cholinga cha chithandizo cha matenda a shuga pakukalamba chizikhala kukwaniritsa glycated hemoglobin HbA1C <7%. Ndi chiyembekezo chokhala ndi moyo wochepera zaka 5 - HbA1C <8%. Kuchepetsa shuga m'magazi odwala matenda ashuga ayenera kukhala bwino, pang'onopang'ono.

Kafukufuku amene adachitika mu 2000s adatsimikizira motsimikiza kuti kugwiritsa ntchito njira zamphamvu zopewera shuga wamagazi, izi zimachulukitsa kwambiri zovuta za hypoglycemia komanso kufa pakati pa odwala okalamba omwe ali ndi matenda a shuga a 2. Chifukwa chake, ndikofunikira kutulutsa shuga m'magazi pang'onopang'ono, koposa miyezi ingapo.

Pochiza odwala matenda ashuga okalamba, ndikofunikira kuwongolera osati shuga wamagazi, komanso cholesterol, triglycerides ndi kuthamanga kwa magazi. Zizindikiro zonsezi ziyenera kusungidwa munthawi yochepera kuti muchepetse zovuta. Ngati apatuka pazomwe zimachitika, ndiye kuti dokotala amakupatsani chithandizo choyenera: zakudya, mankhwala kuchokera ku gulu lama statins, mankhwala oopsa (onani tsamba lathu pa chithandizo cha matenda oopsa).

Pakadali pano, mankhwala othandizira ali ndi njira zotsatirazi zochizira odwala matenda a shuga a 2, kuphatikizapo okalamba:

• mankhwala osokoneza bongo a matenda osokoneza bongo (kudya ndi kuchita zolimbitsa thupi);
• mankhwala a shuga (mapiritsi);
• mankhwala a insulin.

Mapiritsi a shuga ndi jakisoni wa insulin azikambidwa mwatsatanetsatane pansipa. Kuchita kwawo ndikulingalira kukonza njira zingapo zakukhudzira matendawa:

• kuchuluka kwa chidwi cha zimakhala mpaka insulin (kuchepa insulin kukana);
• kukondoweza kwa katemera wa insulini, makamaka gawo lake loyambirira (sitipangira izi kumwa mapiritsi omwe amalimbikitsa katemera wa insulin! akanani!);
• kubwezeretsa kwina kosangalatsa kwa mahomoni a ma insretins pa kapamba.

Mwayi wothandizira bwino matenda a shuga wawonjezereka kuyambira theka lachiwiri la 2000s, ndikubwera kwa mankhwala atsopano kuchokera ku gulu la incretin. Izi ndizoletsa za dipeptidyl peptidase-4 (gliptins), komanso mimetics ndi analogues a GLP-1. Tikukulangizani kuti muphunzire mosamala zambiri zokhudzana ndi mankhwalawa patsamba lathu.

Timalimbikitsa kuti odwala okalamba asinthe kudya chamafuta ochepa a shuga, kuphatikiza pazithandizo zina zonse. Zakudya zopatsa mphamvu zopatsa mphamvu zimaphatikizidwa m'thupi kwambiri. Muzochitika zina zonse, zimathandiza kuti shuga akhale ndi magazi pafupipafupi, kupewa "kulumpha" kwake ndikuchepetsa mwayi wa hypoglycemia.

Zochita zolimbitsa thupi kwa okalamba odwala matenda ashuga

Kuchita masewera olimbitsa thupi ndi gawo lofunikira pothandizira pa matenda ashuga. Kwa wodwala aliyense, makamaka okalamba, zolimbitsa thupi zimasankhidwa payekhapayekha, poganizira matenda opatsirana. Koma ayenera kufunikira. Mutha kuyamba ndi kuyenda kwa mphindi 30-60.

Chifukwa chiyani zolimbitsa thupi kumathandizira kwambiri matenda ashuga:

• kumawonjezera chidwi cha zimakhala mpaka insulin, ndiko kuti, kumachepetsa kukana insulini;
• maphunziro olimbitsa thupi amaletsa kukula kwa atherosulinosis;
• zolimbitsa thupi kumachepetsa magazi.

Nkhani yabwino: Anthu okalamba odwala matenda ashuga amakonda kwambiri kuchita masewera olimbitsa thupi kuposa achichepere.

Mutha kusankha nokha zolimbitsa thupi zomwe zingakusangalatseni. Tikukulimbikitsani kuti muwerenge buku lolemba Chris Crowley ndi Henry Lodge "Wamng'ono chaka chilichonse."

Ili ndi buku labwino kwambiri pankhani ya maphunziro ophunzitsira zaumoyo komanso moyo wachikulire. Chonde gwiritsani ntchito zomuyimira motengera momwe muliri. Onani mutu wankhani woletsa hypoglycemia mukamachita masewera olimbitsa thupi.

Kuchita masewera olimbitsa thupi a shuga amatsutsana zotsatirazi:

• ndi chindapusa chosakhutiritsa cha matenda ashuga;
• mu mkhalidwe wa ketoacidosis;
• ndiina wosakhazikika;
• ngati muli ndi retinopathy yowonjezereka;
• woopsa matenda aimpso kulephera.

Musanayambe maphunziro akuthupi, pitani kuchipatala. Werengani nkhani yathu yatsatanetsatane "Ntchito zolimbitsa thupi za anthu odwala matenda ashuga."

Mankhwala a shuga a Odwala Okalamba

Pansipa, muphunzira za mankhwala a shuga komanso momwe amathandizira odwala okalamba. Ngati muli ndi matenda a shuga a 2, tikulimbikitsani kuchita izi:

1. Kuti muchepetse shuga ndi magazi anu kuti akhale pafupi ndi masiku onse, yesani kudya zakudya zopanda mafuta.
2. Komanso muzichita masewera olimbitsa thupi omwe mutha kuchita ndikusangalatsa. Tangokambirana funso pamwambapa.
3. Pafupifupi 70% ya odwala omwe ali ndi matenda a shuga a 2 amakhala ndi chakudya chokwanira chokhala ndi zopatsa mphamvu komanso amakhala ndi zinthu zochepa zolimbitsa thupi kuti azichulukitsa shuga. Ngati izi sizikukwanira - yesetsani kuyesa impso ndikuwonana ndi dokotala ngati mungathe kukupatsani mankhwala a metformin (siofor, glucophage). Osatengera Siofor popanda kuvomerezedwa ndi dokotala! Ngati impso imagwira ntchito molakwika, mankhwalawa amapha.
4. Ngati muyamba kumwa metformin - osayimitsa kudya zakudya zamagulu ochepa komanso kuchita masewera olimbitsa thupi.
5. Mulimonsemo, kanizani kumwa mankhwala omwe amachititsa kuti insulin itulutsidwe! Awa ndi sulfonylureas ndi meglitinides (dongo). Zili zovulaza. Kupanga jakisoni wa insulin ndikwabwino kuposa kumwa mapiritsi awa.
6. Samalani mwapadera ndi mankhwala atsopano kuchokera ku gulu la incretin.
7. Khalani omasuka kusinthira ku insulin ngati pakufunikira izi, i.e. Chakudya chamagulu ochepa, kuchita masewera olimbitsa thupi komanso mankhwala othandizira matenda a shuga sikokwanira.
8. Werengani "njira yachiwiri yothandizira odwala matenda ashuga."

Metformin - mankhwala a matenda a shuga a 2 pakukalamba

Metformin (wogulitsidwa pansi pa mayina a Siofor, glucophage) ndi mankhwala oyamba kwa odwala matenda ashuga okalamba. Amasankhidwa ngati wodwala wateteza ntchito ya kuwonongeka kwa impso (kuchuluka kwa kusefera kwa madzi pamtunda wa 60 ml / min) ndipo palibe matenda opatsirana omwe amakhala ndi chiwopsezo cha hypoxia.

Werengani nkhani yathu metformin (siofor, glucophage). Metformin ndi mankhwala odabwitsa omwe samangoyesa shuga m'magazi, komanso amakhalanso ndi phindu ku thupi. Zilibe zotsatira zoyipa (zopezeka pano), monga mapiritsi ena ambiri a shuga.

Metformin siziwononga kapamba, sichulukitsa chiopsezo cha hypoglycemia, ndipo sichimapangitsa kuti munthu akhale wonenepa. M'malo mwake, kumapangitsa kuti muchepetse kunenepa. Mutha kuyembekezera kuti mudzataya 1-3 kg kapena kuposa kuchokera mukutenga metformin. M'masiku ambiri a anthu odwala matenda ashuga, amayambitsa kubwadamuka ndi kudzimbidwa, koma pakapita nthawi thupi limasinthika ndipo mavuto amachoka.

Pangamira (glitazones)

Thiazolidinediones (glitazones) adayamba kugwiritsidwa ntchito pochiza matenda ashuga kumapeto kwa zaka za zana la 20 - 21. Monga metformin, amachititsa chidwi cha minofu (minofu, maselo amafuta, chiwindi) kupita ku insulin. Mankhwalawa samalimbitsa katemera wa insulin, chifukwa chake musakulitse mwayi wa hypoglycemia.

Thiazolidinediones pa monotherapy amachepetsa kuchuluka kwa hemoglobin HbA1C ndi 0.5-1.4%. Koma zimagwira pokhapokha ngati kapamba akupitiliza kupanga insulini. Chifukwa chake, ndizopanda ntchito kwa odwala omwe ali ndi matenda ashuga a 2 kwa nthawi yayitali, ndipo kapamba amatha.

Mankhwala a shuga a Glitazone amachita chimodzimodzi ndi metformin, koma, mosiyana, ali ndi zovuta zoyipa. Mndandanda wazinthu zosasangalatsa izi ukuphatikiza:

• kusungunuka kwa madzi mthupi;
• kulemera;
• imathandizira kukulitsa kulephera kwa mtima.

Thiazolidinediones (glitazones) amatsutsana mu edema kapena mtima kulephera kwa kalasi iliyonse yogwira ntchito. Kwa odwala okalamba omwe ali ndi matenda ashuga, kugwiritsa ntchito mankhwalawa kumakhala kovuta pazifukwa zotsatirazi:

• Anthu okalamba odwala matenda ashuga nthawi zambiri amakhala ndi vuto la mtima losiyanasiyana, chifukwa cha zochitika zamtima zam'mbuyomu (vuto la mtima).
• Thiazolidinediones (glitazones) amathandizira pakukula kwa mafupa, mwachitsanzo, kuyambitsidwa kwa calcium kuchokera m'mafupa. Amawonjezera chiopsezo cha fractures mwa odwala okalamba nthawi ziwiri mwamphamvu kuposa mapiritsi ena a shuga. Ngozi imeneyi imakulanso kwa azimayi atasiya kusamba.

Ubwino wogwiritsa ntchito thiazolidinediones ku matenda ashuga ndikuti sawonjezera ngozi ya hypoglycemia. Ngakhale kupezeka kwakukulu uku, ma glitazones sakhala mzere woyamba wa chithandizo cha matenda a shuga mukalamba.

Sulfonylureas

Mankhwala a shuga m'gululi agwiritsidwa ntchito kuyambira zaka 50s za zana la makumi awiri. Amakwapula maselo a pancreatic beta kuti apange insulin yambiri. Kugwira ntchito mpaka thupi lithe kutulutsa yake insulin yonse.

Chifukwa chomwe timalimbikitsa onse odwala matenda ashuga kusiya kumwa mankhwalawa:

• Amayambitsa hypoglycemia. Njira zina zochepetsera shuga zamagazi sizabwino kuposa zotumphukira za sulfonylurea, ndipo musachulukitse chiopsezo cha hypoglycemia.
• Mankhwalawa amatha "kumaliza" kapamba. Ngakhale zingakhale zothandiza kwa wodwalayo kuti azitha kutulutsa zina mwa insulin yake
• Amayambitsa kuwonjezeka kwa thupi. Njira zina zosamalira matenda a shuga zimachepetsa shuga m'magazi sizipweteka, ndipo nthawi yomweyo musachulukitse kunenepa kwambiri.

Mutha kusinthanso modabwitsa magazi anu, popanda mankhwala a gululi komanso popanda zotsatirapo zake. Nthawi zambiri, odwala matenda ashuga amayesera kutenga zotumphukira za sulfonylurea monga njira yomaliza, kuti asapereke jakisoni wa insulin. "Chithandizo" choterechi chimadzetsa zovulaza thanzi lawo. Khalani omasuka kuyambitsa mankhwala a insulin, ngati pali zisonyezo zake. Werengani "njira yachiwiri yothandizira odwala matenda ashuga."

Meglitinides (Clinids)

Monga zotumphukira za sulfonylurea, mankhwalawa amalimbikitsa maselo a beta kuti apange insulin kwambiri. Meglitinides (glinids) amayamba kuchita zinthu mwachangu kwambiri, koma zotsatira zake sizikhala motalika, mpaka mphindi 30-90. Mankhwalawa amapatsidwa chakudya musanadye.

Meglitinides (glinides) sayenera kugwiritsidwa ntchito pazifukwa zomwezi sulfonylureas. Amathandizira "kuzimitsa" kuchuluka kwamphamvu kwa glucose akangodya. Mukasiya kudya zakudya zamafuta zomwe zimamwa mwachangu, ndiye kuti simudzakhala ndi chiwonjezerochi.

Dipeptidyl Peptidase-4 Inhibitors (Gliptins)

Kumbukirani kuti glucagon-ngati peptide-1 (GLP-1) ndi amodzi mwa mahomoni a insretins. Amathandizira kapamba kuti apange insulin ndipo nthawi yomweyo amalepheretsa kupanga glucagon, "wotsutsana naye" wa insulin. Koma GLP-1 imangochita bola bola kuchuluka kwa shuga m'mwazi kukhale kokwezeka.

Dipeptidyl peptidase-4 ndi enzyme yomwe imawononga mwachilengedwe GLP-1, ndipo machitidwe ake amathetsa. Mankhwala kuchokera pagulu la dipeptidyl peptidase-4 zoletsa amaletsa enzyme iyi kuwonetsa ntchito yake. Mndandanda wa kukonzekera kwa glyptin ukuphatikizapo:

• vildagliptin (galvus);
• sitagliptin (Januvia);
• saxagliptin (osamveka).

Amaletsa (zoletsa) ntchito ya enzyme yomwe imawononga mahomoni GLP-1. Chifukwa chake, kuphatikizika kwa GLP-1 m'magazi motsogozedwa ndi mankhwalawa kumatha kuwonjezeka mpaka nthawi 1.5-2 kuposa kuchuluka kwa thupi. Chifukwa chake, zithandiza kwambiri kapamba kuti atulutse insulin m'magazi.

Ndikofunika kuti mankhwala ochokera ku gulu la dipeptidyl peptidase-4 inhibitors amagwiritsa ntchito mphamvu zawo pokhapokha shuga akakwezedwa. Ikayamba kukhala yabwinobwino (4.5 mmol / L), mankhwalawa amatsala pang'ono kusiya kutulutsa insulin ndikuletsa ntchito yopanga glucagon.

Ubwino wowonjezera matenda a shuga a mtundu wachiwiri ndi mankhwala ochokera ku gulu la dipeptidyl peptidase-4 inhibitors (gliptins):

• samachulukitsa chiopsezo cha hypoglycemia;
• osayambitsa kulemera;
• Zotsatira zake zoyipa - sizichitika kawirikawiri poyerekeza ndi kutenga placebo.

Odwala omwe ali ndi matenda a shuga opitilira zaka 65, mankhwala omwe ali ndi DPP-4 zoletsa osagwiritsa ntchito mankhwala ena amatsogolera kutsika kwa msana wa hemoglobin HbA1C kuchokera ku 0.7 mpaka 1.2%. Chiwopsezo cha hypoglycemia ndi chocheperako, kuyambira 0 mpaka 6%. Pagulu lolamulira la odwala matenda ashuga omwe adatenga placebo, chiopsezo cha hypoglycemia chimachokera ku 0 mpaka 10%. Izi zimapezeka pambuyo pofufuza zazitali, kuyambira 24 mpaka 52 milungu.

Mankhwala kuchokera pagulu la dipeptidyl peptidase-4 inhibitors (gliptins) amatha kuphatikizidwa ndi mapiritsi ena a shuga, popanda chiopsezo chowonjezeka. Chosangalatsa chachikulu ndi mwayi wakulembera iwo ndi metformin.

Kafukufuku wa 2009 adayerekeza kuthandizira komanso chitetezo pochiza matenda odwala matenda ashuga okalamba opitilira 65 pogwiritsa ntchito mitundu iyi:

• metformin + sulfonylurea (glimepiride <6 mg patsiku);
• metformin + vildagliptin (galvus) pa mlingo wa 100 mg patsiku.

Kutsika kwa kuchuluka kwa hemoglobin HbA1C mu diabetics m'magulu onsewa kunali kofanana. Koma mwa odwala a gulu loyamba, 16.4% ya hypoglycemia inalembedwa, ndi 1.7% yokha mu metformin mankhwala omwe ali ndi galvus. Likukhalira kuti m'malo mwa sulfonylurea ofanana ndi DPP-4 zoletsa kumachepetsa pafupipafupi hypoglycemia nthawi 10, kwinaku mukumathandizira kutsitsa shuga.

Mimetics ndi fanizo la GLP-1

Mankhwala otsatirawa akuphatikizidwa ndi gulu ili la matenda atsopano a shuga:

• exenatide (bayeta);
• liraglutin (wozunzidwa).

Makina a zochita za mankhwalawa ali ofanana ndi momwe dipeptidyl peptidase-4 inhibitors (glyptins) amachitira. Koma mankhwalawa alibe mapiritsi, koma amapaka jekeseni mosazindikira.

Zatsimikiziridwa kuti mimetics ndi analogues a GLP-1 amathandizira kuchepetsa thupi komanso amakhala ndi chiopsezo chochepa kwambiri chokhala ndi hypoglycemia. Itha kugwiritsidwa ntchito mwa odwala okalamba omwe ali ndi vuto la kunenepa kwambiri (minofu index> 30 kg / m2), ngati wodwalayo ali wokonzeka kupereka jakisoni.

Ndiwo mimetics ndi ma fanifilimu a GLP-1 omwe amagwiritsidwa ntchito ngati njira yomaliza ngati wodwala akufuna kuti achedwetse kuyamba kwa matenda a shuga. Osati sulfonylureas, monga nthawi zambiri zimachitikira.

Acarbose (glucobai) - mankhwala omwe amalepheretsa kuyamwa kwa glucose

Mankhwalawa a shuga ndi alpha glucosidase inhibitor. Acarboro (glucobai) amalepheretsa kugaya kwa zovuta zam'mimba, poly- ndi oligosaccharides m'matumbo. Mothandizidwa ndi mankhwalawa, shuga wocheperako amalowetsedwa m'magazi. Koma kugwiritsidwa ntchito kwake nthawi zambiri kumayambitsa kutulutsa, kutsegula m'mimba, kutsekula m'mimba, ndi zina zambiri.

Kuti muchepetse kuopsa kwa mavuto, tikulimbikitsidwa kuchepetsa zovuta zopezeka m'zakudya tikamamwa acarbose (glucobaya). Koma ngati mumagwiritsa ntchito zakudya zamafuta ochepa, monga momwe timapangira, kusintha shuga m'magazi, ndiye kuti palibe chifukwa chomwa mankhwalawa.

Chithandizo cha matenda osokoneza bongo okalamba ndi insulin

Insulin ya matenda a shuga a mtundu wachi 2 imayikidwa ngati chithandizo chamankhwala, masewera olimbitsa thupi komanso mapiritsi a shuga sichitha mokwanira shuga. Matenda a 2 a shuga amathandizidwa ndi insulin kuphatikiza kapena mapiritsi. Ngati pali kuchuluka kwambiri kwa thupi, ndiye kuti jakisoni wa insulin akhoza kuphatikizidwa ndi kugwiritsa ntchito metformin (siofor, glucophage) kapena DPP-4 inhibitor vildagliptin. Izi zimachepetsa kufunika kwa insulin, motero, zimachepetsa chiopsezo cha hypoglycemia.

Anthu achikulire omwe ali ndi matenda ashuga nthawi zonse amaganiza kwambiri pamene dotolo amayesa kupereka jakisoni wa insulin.Komabe, ngati izi zikuwonetsedwa, dokotala ayenera kunena kuti wodwalayo "ayesere" kwakanthawi, mwina miyezi iwiri. Khalani omasuka kuyamba kuchiza matenda ashuga okalamba ndi insulin, ngati pali umboni wa izi. Werengani "Njira Yachiwiri ya Matenda Awa Atsopano"

Nthawi zambiri zimakhala kuti odwala matenda ashuga okalamba amayamba kumva bwino mkati mw masiku atatu atayamba jakisoni wa insulin. Amaganiziridwa kuti izi zimayambitsidwa osati ndi kuchepa kwa shuga m'magazi, komanso chifukwa cha anabolic zotsatira za insulin ndi zotsatira zake zina. Chifukwa chake, funso lakubwereranso ku matenda a shuga mothandizidwa ndi mapiritsi limazimiririka lokha.

Kwa odwala okalamba, mutha kugwiritsa ntchito njira zosiyanasiyana za insulin:

• Jakisoni imodzi ya insulin musanagone - ngati shuga imakwezedwa kwambiri pamimba yopanda kanthu. Insulin ya tsiku ndi tsiku yopanda peak yogwiritsidwa ntchito kapena "sing'anga" imagwiritsidwa ntchito.
• Jekeseni wa insulin pafupifupi nthawi ya zochita 2 pa tsiku - pamaso kadzutsa komanso asanagone.
• Jekeseni wa insulin yosakaniza 2 pa tsiku. Mankhwala osakanikirana a insulin "yayifupi" ndi "sing'anga" amagwiritsidwa ntchito, pafupifupi 30:70 kapena 50:50.
• Chikhazikitso cha maziko a matenda a shuga a insulin. Awa ndi jakisoni wa insulin yochepa (ultrashort) musanadye, komanso insulin ya nthawi yayitali kapena mutangowonjezera nthawi yogona.

Otsiriza omaliza a mankhwalawa a insulin mankhwala amatha kugwiritsidwa ntchito pokhapokha ngati wodwalayo amatha kuphunzira ndikuwunika pawokha shuga ndipo nthawi iliyonse asankhe kuchuluka kwa insulin. Izi zimafuna kuti wokalamba yemwe ali ndi matenda ashuga akhalebe ndi chidwi chokhazikika komanso kuphunzira.

Matenda Aakulu Kwa Okalamba: Zopeza

Akakula munthu, ndiye kuti akhoza kukhala ndi matenda ashuga amtundu wa 2. Izi zimachitika chifukwa cha kukalamba kwachilengedwe, koma makamaka chifukwa chamakhalidwe oyipa a anthu okalamba. Pa zaka 45 ndi kupitilira - pimayesedwe matenda a shuga zaka zitatu zilizonse. Ndikofunika kuyezetsa magazi osati chifukwa cha kusala kudya, koma ndi hemoglobin ya glycated.

Chida chothandiza kwambiri komanso chothandiza popewa matenda ashuga amtundu wa 2, kuphatikiza odwala okalamba, ndichakudya chamafuta ochepa. Yesani zakudya zabwino komanso zopatsa chidwi zamagulu a shuga! Zambiri zofunika zili patsamba lathu, kuphatikizapo mindandanda yazakudya za anthu odwala matenda ashuga - zololedwa komanso zoletsedwa. Zotsatira zake, shuga wanu wamagazi ayamba kutsika pambuyo pake patatha masiku ochepa. Inde, muyenera kukhala ndi mita ya shuga wamagazi ndikuigwiritsa ntchito tsiku lililonse.

Kuchita masewera olimbitsa thupi kumathandizanso. Pezani masewera olimbitsa thupi omwe amakusangalatsani. Izi zikuthandizira buku la Chris Crowley "Wachichepere chaka chilichonse."

Ngati zakudya zamagetsi ochepetsa mphamvu ya thupi komanso kuchita masewera olimbitsa thupi sizithandiza kuchepetsa kuchepa kwa shuga m'magazi, ndiye yesetsani kuyeserera ndikuonana ndi dokotala ngati mukuyenera kudya metformin (siofor, glucophage). Osathamangira ku pharmacine chifukwa cha siofor, yambani mumayesa mayeso ndikuonana ndi dokotala! Mukayamba kugwiritsa ntchito metformin, izi sizitanthauza kuti tsopano mutha kuyimitsa zakudya komanso maphunziro akuthupi.

Ngati zakudya, masewera olimbitsa thupi ndi mapiritsi sizithandiza, ndiye kuti mwawonetsedwa jakisoni wa insulin. Fulumira, yambani kupanga, osawopa. Chifukwa pamene mukukhalapo popanda kubayidwa insulin ndi shuga wambiri - mukupanga zovuta za matenda ashuga. Izi zimatha kudula phazi, khungu, kapena kufa chifukwa cha kulephera kwa impso.

Hypoglycemia ukalamba ndi owopsa kwambiri. Koma wodwala matenda ashuga amatha kuchepetsa kuthekera kwathu ngati zero pogwiritsa ntchito njira zitatu:

• Osamwa mapiritsi a shuga omwe amayambitsa hypoglycemia. Awa ndi sulfonylureas ndi meglitinides (dongo). Mutha kusintha shuga yanu popanda iwo.
• Idyani zakudya zazing'ono monga momwe mungathere. Zakudya zamafuta zilizonse, osati zokhazo zomwe zimatengeka mwachangu. Chifukwa chakudya choperewera m'zakudya zanu, mumafunikira jakisoni wa insulin. Ndipo ochepera insulin - amachepetsa mwayi wokhala ndi hypoglycemia.
• Dokotala akapitiliza kunena kuti mumwa mapiritsi ochokera ku sulfonylureas kapena meglitinides (glinides), pitani ndi katswiri wina. Chimodzimodzi ngati akutsimikizira kuti muyenera kudya "moyenera". Osatsutsana, ingosintha adokotala.

Tidzakhala okondwa ngati mutalemba za kupambana kwanu ndi mavuto anu ochizira matenda a shuga muukalamba pamawu a nkhaniyi.

Werengani nkhani:

• Kupweteka kwa mwendo mu shuga - chochita;
• Matenda a shuga ndi impso;
• Yemwe mita kuti musankhe yoyenera kwambiri.