Tsoka ilo, matenda ashuga nthawi zambiri amayambitsa zovuta za impso, ndipo ndizowopsa. Kuwonongeka kwa impso ndi matenda a shuga kumamupatsa wodwala mavuto akulu. Chifukwa zochizira kulephera kwa impso, njira za dialysis ziyenera kuchitidwa pafupipafupi. Ngati muli ndi mwayi wopeza wopereka, ndiye kuti amamuchitira impso. Matenda a impso mu shuga nthawi zambiri amayambitsa imfa yopweteka kwa odwala.
Ngati matenda a shuga amawongolera shuga m'magazi, ndiye kuti mavuto a impso amatha kupewedwa.
Nkhani yabwino ndiyakuti, ngati mumasunga shuga m'magazi anu mwachizolowezi, mutha kupewa kupewa kuwonongeka kwa impso. Kuti muchite izi, muyenera kuchita nawo zathanzi lanu.
Mudzakondwereranso kuti njira zoteteza matenda a impso zimathandizanso kupewa zovuta zina za matenda ashuga.
Momwe shuga imayambitsa kuwonongeka kwa impso
Mu impso iliyonse, munthu amakhala ndi mazana mazana otchedwa "glomeruli". Izi ndizosefera zomwe zimatsuka magazi a zinyalala ndi poizoni. Mwazi umadutsa kupanikizidwa kudzera m'makapitilidwe ang'onoang'ono a glomeruli ndipo umasefa. Kuchuluka kwa madzimadzi ndi magawo abwinobwino amwazi amabwerera mthupi. Ndipo zinyalala, pamodzi ndi madzi pang'ono, zimadutsa impso kupita ku chikhodzodzo. Kenako amachotsedwa panja kudzera mu urethra.
Mu shuga, magazi omwe ali ndi shuga wambiri amadutsa impso. Glucose imatulutsa timadzi tambiri, timene timayambitsa kukakamira mkati mwa glomerulus iliyonse. Chifukwa chake, kuchuluka kwa kusefedwa kwa glomerular - ichi ndichizindikiro chofunikira kwambiri cha impso - nthawi zambiri chimachulukanso kumayambiriro kwa matenda ashuga. Glomerulus imazunguliridwa ndi minofu yotchedwa "glomerular basement membrane". Ndipo nembanemba imachulukana, monga zimakhala zina zomwe zimayandikira. Zotsatira zake, ma capillaries omwe ali mkati mwa glomeruli amachoka pang'onopang'ono. Ngati glomeruli itasiya kugwira ntchito, ndiye kuti impso zimasefa magazi. Popeza impso zaumunthu zimakhala ndi gawo losungirako la glomeruli, njira yoyeretsa magazi ikupitirirabe.
Mapeto ake, impso zimatha ndipo zimawonekera Zizindikiro zakulephera kwa impso:
- ulesi;
- mutu
- kusanza
- kutsegula m'mimba
- zikopa;
- kulawa kwazitsulo mkamwa;
- kupuma movutikira, kokumbukira kununkhira kwa mkodzo;
- kupuma pang'ono, ngakhale kuchita zolimbitsa thupi pang'ono komanso kupumula;
- kukokana ndi kukokana m'miyendo, makamaka madzulo, asanagone;
- kutaya chikumbumtima.
Izi zimachitika, monga lamulo, pambuyo pa zaka 15 - 20 za matenda ashuga, ngati magazi a shuga adapitilizidwa, i.e. matenda a shuga sanalandiridwe bwino. Uricemia imachitika - kudzikundikira kwa zinyalala za nayitrogeni m'mwazi zomwe impso zomwe zakhudzidwa sizingathenso kusefa.
Kusanthula ndi kuwunika impso mu shuga
Kuti muone impso zanu ngati muli ndi matenda ashuga, muyenera kuchita mayeso otsatirawa
- kuyezetsa magazi kwa creatinine;
- kusanthula kwa mkodzo kwa albumin kapena microalbumin;
- urinalization wa creatinine.
Kudziwa kuchuluka kwa creatinine m'magazi, mutha kuwerengetsa kuchuluka kwa impso. Amapezanso ngati pali microalbuminuria kapena ayi, ndipo kuchuluka kwa albumin kuti apange mkodzo mu mkodzo kumawerengedwa. Kuti mumve zambiri paziyeso ndi zisonyezo za ntchito ya impso, werengani "Mayeso omwe mungadye kuti muwone impso" (amatsegula pazenera lina).
Chizindikiro choyambirira cha mavuto a impso mu shuga ndi microalbuminuria. Albumini ndi puloteni yemwe mamolekyu ake ndi ochepa m'mimba mwake. Impso zathanzi zimadutsa mkodzo pang'ono. Ntchito yawo ikangokulirakulira pang'ono, mumakhala mkodzo kwambiri.
Zizindikiro za albuminuria
| Albuminuria m'mawa mkodzo, mcg / min | Albuminuria patsiku, mg | The kuchuluka kwa albumin mu mkodzo, mg / l | Chiwerengero cha albumin / creatinine mkodzo, mg / mol | |
|---|---|---|---|---|
| Normoalbuminuria | < 20 | < 30 | < 20 | <2.5 kwa amuna ndi <3.5 kwa akazi |
| Microalbuminuria | 20-199 | 30-299 | 20-199 | 2.5-25.0 kwa amuna ndi 3.5-25.0 kwa akazi |
| Macroalbuminuria | >= 200 | >= 300 | >= 200 | > 25 |
Muyenera kudziwa kuti kuchuluka kwa albumin mkodzo mwina sikungachitike chifukwa cha kuwonongeka kwa impso. Ngati dzulo panali zochitika zambiri zolimbitsa thupi, lero albinuria ikhoza kukhala yapamwamba kuposa yachilendo. Izi ziyenera kukumbukiridwa pokonzekera tsiku la kusanthula. Albuminuria imachulukanso: chakudya chama protein ambiri, kutentha thupi, matenda a kwamkodzo, kulephera kwa mtima, pakati. Kuwerengera kwa albumin kuti apange mkodzo mu mkodzo ndi chizindikiro chodalirika kwambiri cha mavuto a impso. Werengani zambiri za izo apa (amatsegula pawindo lina)
Ngati wodwala wodwala matenda a shuga adapezeka ndikutsimikiziridwa kangapo ndi microalbuminuria, izi zikutanthauza kuti ali ndi chiopsezo chowonjezeka osati impso, komanso matenda amtima. Ngati sichichiritsidwenso, ndiye kuti mphamvu za impso zimayamba kuzimiririka, ndipo mapuloteni ena a kukula kwakukulu amapezeka mkodzo. Izi zimatchedwa proteinuria.
Choyipa chachikulu chikagwirira ntchito, impso yake imayamba kuchuluka m'magazi. Pambuyo powerengera kuchuluka kwa kusefedwa kwa khungu, ndizotheka kudziwa kuti kuwonongeka kwa impso kwa wodwalayo kuli pati.
Magawo a matenda a impso, kutengera kuchuluka kwa kusefera kwake
Msana wowonongeka | Mlingo wosefera wa glomerular (GFR), ml / mphindi / 1.73 m2 |
|---|---|
Norm | > 90 |
1 | > 90, ndi mayeso owonetsa umboni wa zovuta za impso |
2 | 60-90 - kuchepa kwa impso |
3-A | 45-59 - Kuwonongeka kwa impso koyenera |
3-in | 30-44 - Kuwonongeka kwa impso koyenera |
4 | 15-16 - kuchepa kwambiri kwaimpso |
5 | <15 kapena dialysis - kulephera kwa impso |
Zolemba pagome. Umboni wa zovuta za impso zomwe zimawonetsa mayeso ndi mayeso. Itha kukhala:
- microalbuminuria;
- proteinuria (kukhalapo kwa mamolekyulu amapezeka mu mkodzo);
- magazi mkodzo (pambuyo poti zifukwa zina zonse zitheka);
- zopangidwanso mwachilengedwe, zomwe zinawonetsa kusintha kwa impso;
- glomerulonephritis, womwe umatsimikiziridwa ndi biopsy ya impso.
Monga lamulo, zizindikiro zimayamba kuwonekera pokhapokha gawo 4 la matenda a impso. Ndipo magawo onse oyambirirawo amapita popanda mawonekedwe akunja. Ngati zitapezeka kuti zazindikira mavuto a impso kumayambiriro ndikuyamba kulandira chithandizo pakanthawi, ndiye kuti kulephera kwa impso nthawi zambiri kumapeweka. Apanso, tikukulimbikitsani kuti mudzayezetsa mayeso anu pafupipafupi kamodzi pachaka, monga tafotokozera m'gawo lino "Kuyesa kotani kuti mufufuze impso zanu." Nthawi yomweyo, mutha kuyang'ananso magawo a urea ndi uric acid m'magazi.
Lembani mapiritsi a shuga a 2 omwe amaloledwa kugwiritsidwa ntchito pamagulu osiyanasiyana a matenda a impso
| Mankhwala | Magawo a kuwonongeka kwa impso, pomwe amaloledwa kugwiritsa ntchito |
|---|---|
| Metformin (Siofor, Glucofage) | 1-3a |
| Glibenclamide, kuphatikiza ma micronized (Maninyl) | 1-2 |
| Gliclazide ndi Gliclazide MV (Glidiab, Actos) | 1-4* |
| Glimepiride (Amaryl) | 1-3* |
| Glycvidone (Glurenorm) | 1-4 |
| Glipizide, kuphatikiza yayitali (Movogleken, Glibens retard) | 1-4 |
| Repaglinide (NovoNorm, Diagninid) | 1-4 |
| Nateglinide (Starlix) | 1-3* |
| Pioglitazone (Aactos) | 1-4 |
| Sitagliptin (Januvius) | 1-5* |
| Vildagliptin (Galvus) | 1-5* |
| Saxagliptin (Onglisa) | 1-5* |
| Linagliptin (Trazhenta) | 1-5 |
| Exenatide (Baeta) | 1-3 |
| Liraglutid (Victoza) | 1-3 |
| Acarbose (Glucobai) | 1-3 |
| Insulin | 1-5* |
Zindikirani patebulopo.
* Pa magawo 4-5 a kuwonongeka kwa impso, muyenera kusintha mlingo wa mankhwalawo. Komanso, matenda a impso akamakula, kuwonongeka kwa insulin m'thupi kumachepa. Izi zimawonjezera chiopsezo cha hypoglycemia. Chifukwa chake, mankhwalawa a insulin amafunika kusinthidwa kutsikira.
Odwala omwe ali pachiwopsezo cha matenda a impso.
| Magulu a odwala | Ayenera kuonedwa kangati |
|---|---|
| Odwala matenda ashuga amtundu woyamba omwe amadwala adakali achichepere kapena atatha msinkhu | Zaka 5 atatha matenda ashuga, ndiye pachaka |
| Odwala a matenda ashuga amtundu 1 omwe amadwala kutha msinkhu | Mwadzidzidzi pa matenda, ndiye pachaka |
| Odwala a 2 Matenda A shuga | Mwadzidzidzi pa matenda, ndiye pachaka |
| Amayi oyembekezera omwe ali ndi matenda ashuga kapena amisala | 1 nthawi pa trimester |
Kupewa kuwonongeka kwa impso mu shuga
Matenda a impso amakula pafupifupi 1/3 ya odwala omwe ali ndi matenda amtundu woyamba 1, kutanthauza kutali ndi onse. Momwe mungakhalire ndi zisonyezo zakulephera kwa impso zimatengera zotsatira za mayeso omwe tafotokozera m'gawo lakale. Yesetsani kukambirana ndi dokotala.
Zomwe mungachite kuti muchepetse kuwonongeka kwa impso mu shuga:
- sungani shuga m'magazi pafupi kwambiri - ichi ndiye chinthu chofunikira kwambiri
- phunzirani nkhani yakuti “Zakudya za impso ndi matenda a shuga”;
- kuyeza kuthamanga kwa magazi kunyumba ndi tonometer (momwe mungachitire moyenera kuti zotsatira zake ndizolondola);
- kuthamanga kwa magazi kwanu kuyenera kukhala kwabwinobwino, pansipa 130/80;
- imani mayeso omwe amayesa ntchito ya impso osachepera 1 pachaka;
- chitani chilichonse chofunikira kuti muchepetse shuga, kuthamanga kwa magazi, cholesterol ndi mafuta amthupi, kuphatikiza kumwa mankhwala omwe dokotala amakupatsani;
- gwiritsitsani chakudya chabwino cha anthu odwala matenda ashuga (pankhaniyi, malingaliro a "official" ndiosiyana kwambiri ndi athu, werengani pansipa mu nkhaniyi);
- kuchita masewera olimbitsa thupi nthawi zonse, yesani kuchita masewera olimbitsa thupi ndi ma dumbbells opepuka, omwe ndi otetezeka impso;
- kumwa mowa “mophiphiritsa,” osadakwa;
- kusiya kusuta;
- pezani dokotala wabwino yemwe "azitsogolera" matenda anu a shuga, ndipo pitani kwa iye pafupipafupi.
Kafukufuku adatsimikizira motsimikiza kuti kusuta palokha ndikofunikira kwambiri kumawonjezera mwayi wokhala ndi vuto la impso ku matenda ashuga. Kusiya kusuta si malingaliro wamba, koma chofunikira mwachangu.
Chithandizo cha Matenda a Impso
Dokotalayo amalembera chithandizo cha matenda a impso, monga kutengera kwa khungu lawo. Udindo waukulu wopanga nthawi yogona ndi wodwala. China chake chimadaliranso anthu am'banja lake.
Tikulemba mndandanda wa malo othandizira matenda a impso mu shuga:
- kwambiri magazi shuga;
- kutsitsa kuthamanga kwa magazi mpaka kufika pamlingo wa 130/80 mm RT. Art. ndi pansipa;
- kukhalabe ndi chakudya choyenera cha mavuto a impso;
- kayendedwe ka cholesterol ndi triglycerides (mafuta) m'magazi;
- kuyimba;
- kupatsidwa impso.
Nkhani ya "Diabetesic Nephropathy" imafotokoza kwambiri za matenda a impso. Wonaninso "Zakudya za impso ndi matenda a shuga."
Matenda a shuga ndi impso: zomwe muyenera kukumbukira
Ngati pali zovuta ndi impso, ndiye kuyesa kwa magazi kwa creatinine ndi mkodzo wa microalbuminuria kumatha kuwazindikira msanga. Ngati mankhwala ayambitsidwa pa nthawi yake, zimawonjezera mwayi wopambana. Chifukwa chake, mayeso omwe amafotokozedwa pano (amatsegula pawindo lina) ayenera kutumizidwa pafupipafupi kamodzi pachaka. Ganizirani kugwiritsa ntchito zakudya zamagulu ochepa kuti muchepetse shuga. Werengani zambiri mu nkhani "Zakudya za impso ndi shuga."
Kwa odwala matenda ashuga ambiri omwe ali ndi kuthamanga kwa magazi, kuwonjezera pa mankhwala, kuchepetsa mchere pazakudya zawo kumathandiza. Yesetsani kuchepetsa kudya kwanu kwa sodium chloride, i.e. mchere wamtembo, ndikuwunika zomwe mumapeza. Munthu aliyense amakhala ndi chidwi chake ndi mchere.
Vuto linanso, la matenda a shuga, limatha kuwononga mitsempha yomwe imayendetsa chikhodzodzo. Poterepa, ntchito yotsanulira chikhodzodzo imasokonekera. Mkodzo, womwe umakhala nthawi zonse, matenda omwe amawononga impso amatha kuchuluka. Nthawi yomweyo, odwala matenda ashuga omwe amatha kusintha shuga m'magazi awo, ma neuropathy nthawi zambiri amakhala osinthika, i.e., amadutsa kwathunthu.
Ngati mukuvutikira kukodza kapena zizindikiro zina zamatenda amkodzo, onani dokotala wanu nthawi yomweyo. Mavutowa amatha kuthandizira kwambiri kukula kwa zovuta za impso mu shuga.
