Matenda a shuga amakhalapo nthawi zambiri amatuluka ndipo amakhala ndi mavuto osiyanasiyana. Pofuna kupewa matenda, ndimafunikira maphunziro ena. Kuti mudziwe mayeso ofunikira, muyenera kufunsa dokotala kuti mudziwe kuchuluka kwa mayeso amachapidwe amawu a shuga.
Magawo asanu ndi limodzi a shuga amadziwika ndi zamankhwala. Kukhazikika kwa khungu kumawonedwa ngati kuphatikiza kwapadera kwamtundu.
Zolemba zonse zamatenda amtundu woyamba zimagawidwa mu immunological, genetic ndi metabolic.
Kuyesa Matenda a shuga
Chipatala chamakono chimalimbikitsa kuyesa matenda a shuga m'magulu ena a anthu. Choyamba, ndikofunikira kwa anthu omwe afika zaka 45 kapena kupitirira. Ngati zotsatirapo zake zili zoipa, kusanthula kumachitika zaka zitatu zilizonse.
Odwala akadali achichepere amayenera kuchitidwa ndi:
- onenepa kwambiri
- cholowa chofananira,
- mtundu kapena fuko la gulu linalake,
- matenda ashuga
- matenda oopsa
- zakubadwa zolemera kuposa makilogalamu 4.5,
- glycemia wamkulu pamimba yopanda kanthu.
Pakuwunika ndi kuwunika kwapakati, ndikulimbikitsidwa kudziwa kuchuluka kwa shuga ndi hemoglobin A1c. Ichi ndi hemoglobin, pomwe molekyulu ya glucose imalumikizana ndi molekyu ya hemoglobin.
Glycosylated hemoglobin imagwirizana ndi shuga wamagazi. Zimagwira ngati chisonyezo cha kuchuluka kwa kagayidwe kazakudya kwa miyezi itatu tisanawunike. Kukula kwa mapangidwe a HbA1c kumadalira kukula kwa hyperglycemia. Matenda a mtundu wake m'magazi amapezeka pakatha masabata 4-5 kuchokera ku euglycemia.
Kuchuluka kwa HbA1c kumatsimikiziridwa ngati pakufunika kuwongolera kagayidwe kazakudya ndikuwatsimikizira kufupikitsa kwa odwala matenda ashuga omwe akhala akudwala kwanthawi yayitali.
Mawonekedwe Ozindikira
Kuti mupeze matenda ndikuwunika matenda onse, muyenera kudutsa njira zingapo zodziwonera.
Choyamba, awa ndi malembedwe apamwamba a labotale, monga kuphunzira shuga ndikuwunika mkodzo ndi magazi, komanso kuyesa ma ketones ndi mayeso a kulolerana ndi shuga.
Kuphatikiza apo, kusanthula kumachitika pa:
- HbA1c;
- fructosamine;
- microalbumin;
- kwamikodzo creatinine;
- mbiri ya lipid.
Pali njira inanso yowerengera kafukufuku wa matenda ashuga, omwe amachititsa kuti chiwongolero cha matenda ashuga chikule,
- C peptide
- ma insulin antibodies
- antibodies to islets of Langengars ndi tyrosine phosphatase,
- glutamic acid decarboxylase antibodies,
- ghrelin, raschistina, leptin, adiponectin,
- Kulemba kwa HLA.
Kuti mudziwe zamatendawa kwa zaka makumi angapo, madokotala adalimbikitsa kupenda shuga. M'zaka zaposachedwa, zapezeka kuti pali kulumikizana bwino pakati pa misempha ya magazi, zotupa zomwe zilipo zam'mimba ndi msinkhu wawo; sichizindikirika ndi chizindikiro cha kusala kudya, koma ndi kuchuluka kwa kuchuluka kwake mutatha kudya. Izi zimatchedwa postprandial hyperglycemia.
Zoyimira matenda amtundu 1 wa shuga zitha kugawidwa motere:
- chibadwa
- immunological
- kagayidwe.
Kulemba kwa HLA
Matenda a shuga a mellitus, malinga ndi lingaliro lamankhwala amakono, ali ndi poyambira, koma amakhala nthawi yayitali. Magawo asanu ndi limodzi amadziwika pakupanga kwa matenda awa. Yoyamba mwa izi ndi gawo la kubadwa mwatsopano kapena kusapezeka kwa majini omwe amayenderana ndi matenda a shuga 1.
Ndikofunikira kunena kuti kupezeka kwa ma antigen a HLA, makamaka kalasi yachiwiri: DR 3, DR 4, DQ, ndikofunikira. Chiwopsezo cha mapangidwe a matenda amtunduwu pamenepa chimakulanso kangapo. Pakadali pano, cholowa chamtsogolo cha mawonekedwe amtundu woyamba wamatenda amawaphatikiza ngati kuphatikiza pamagulu angapo abwinobwino.
Zizindikiro zodziwika bwino za matenda amtundu woyamba ndi ma antigen a HLA. Mitundu yodziwika bwino ya matenda ashuga 1 amapezeka mwa anthu 77% odwala matenda ashuga. 6: ili ndi ma henephypes omwe amawonedwa ngati oteteza.
Ma antibodies a Langerhans Islet Cell
Chifukwa chopanga ma autoantibodies ku ma cell a zilumba za Langerhans, omalizawa amawonongeka, zomwe zimayambitsa kuphatikizika kwa insulin kapangidwe ndi mawonekedwe a chithunzi chotchulidwa cha matenda ashuga 1.
Njira zoterezi zimatha kutsimikizika mwabadwa kapena kuwonekera chifukwa cha zinthu zosiyanasiyana.
Zina mwazodziwika ndi:
- ma virus
- machitidwe a poizoni
- zovuta zosiyanasiyana.
Mtundu woyamba wa matenda amadziwika ndi gawo la prediabetes popanda zizindikiro, itha kukhala zaka zingapo. Kuphatikizika ndi katulutsidwe wa insulin panthawiyi kumatha kuwonetsedwa pokhapokha pakuphunzira shuga.
Mankhwala, milandu yokhudza kupezeka kwa ma antibodies zaka eyiti kapena kupitilira apo isanayambike chithunzithunzi cha matenda. Tanthauzo la ma antibodies amenewa tiyenera kugwiritsidwa ntchito ngati matenda a shuga 1.
Mwa anthu omwe ali ndi ma antibodies oterewa, ntchito ya islet cell imatsika mwachangu, yomwe imawonetsedwa ndi kuphwanya insulin. Ngati gawo lawonongedwa kwathunthu, ndiye kuti matenda a shuga amtunduwu amachitika.
Kafukufuku wowerengeka akuwonetsa kuti ma antibodies amenewa amapezeka 70% ya omwe akuyankha omwe ali ndi mtundu woyamba wa shuga. Mu gulu lopanda odwala omwe ali ndi matenda ashuga pali 0,1,5,5% yokha ya milandu yokhudza kupezeka kwa antibodies.
Ma antibodies amenewa amathanso kupezeka mwa abale a odwala matenda ashuga. Gulu la anthu lino lili ndi kuthekera kwakukulu pamatenda. Kafukufuku ambiri akuwonetsa kuti abale omwe ali ndi antibodies amapanga matenda a shuga 1 pakapita nthawi.
Zolemba zamtundu uliwonse wa mtundu wa 2 matenda a shuga zimaphatikizaponso kafukufukuyu. Asayansi atsimikizira kuti kudziwa mulingo wa ma antibodies amenewa mu mtundu wa matenda ashuga omwe ali ndi mtundu wachiwiri wa matenda kumathandizira kufotokozera bwino ngakhale chithunzi chachipatala chisanachitike, ndikuthandizira kukhazikitsidwa kwa Mlingo wa insulin. Chifukwa chake, mu odwala matenda ashuga omwe ali ndi mtundu wachiwiri wa matenda, ndizotheka kulosera kupangika kwina kwa kudalira kwa insulin ya mahomoni.
Ma antibodies kupita ku insulin amapezeka pafupifupi 40% ya anthu omwe ali ndi matenda ashuga 1. Pali lingaliro lokhudza kuphatikiza pakati pa ma antibodies kupita ku insulin ndi ma antibodies kuti maselo a islet.
Zoyambazo zitha kukhala gawo la prediabetes komanso kumayambiriro kwa matenda amtundu 1 shuga.
Glutamic acid decarboxylase
Posachedwa, asayansi adziwa antigen yayikulu, yomwe ndi chandamale cha autoantibodies yomwe imalumikizidwa ndikupanga mawonekedwe a shuga omwe amadalira insulin. Ndi decarboxylase ya glutamic acid.
Asidi awa ndi michere ya nembanemba yomwe biosynthesate ya neurotransmitter CNS-gamma-aminobutyric acid. Enzyme yoyamba idapezeka mwa anthu omwe ali ndi vuto lamanjenje.
Ma antibodies kupita ku GAD ndiye chidziwitso chodziwitsa kwambiri za boma la matenda ashuga. Chifukwa chake, ndizotheka kuzindikira chiopsezo chachikulu chokhala ndi matenda ashuga amtundu woyamba. Ndi mapangidwe a asymptomatic a matenda, ma antibodies opita ku GAD amatha kupezeka mwa anthu zaka zisanu ndi ziwiri musanawonekere matendawa.
Chodalirika komanso chothandiza kwambiri pakati pa asayansi chimawerengedwa kuti ndi kusanthula kofananira kwa zilembo zingapo mumagazi. Chizindikiro 1 chimayimira 20% chidziwitso, zolembera ziwiri zikuwonetsa 44% ya zomwe zidawerengedwa, ndipo zolembedwa zitatu zikuyimira 95% chidziwitso.
Makampani Otsatsa Matenda a shuga a Autoimmune
Mu diabetes, mbiri ya autoantibodies imadalira jenda komanso zaka. Ma antibodies kuma antijeni ndi ma antibodies kuti ma islet cell, monga lamulo, ali mwa ana kuposa akuluakulu. Ma antibodies ku glutamic acid decarboxylase, nthawi zambiri, amapezeka mwa akazi.
Kukhazikika kwa mapangidwe a mitundu yama autoantibodies makamaka kumatsimikiziridwa ndi mitundu yosiyanasiyana ya dongosolo la HLA, chifukwa ma autoantibodies ku insulin, maselo a islet ndi islet antigen 2 amapezeka kwambiri mwa anthu omwe ali ndi HLA - DR 4 / DQ 8 (DQA 1 * 0301 / DQB 1 * 0302). Nthawi yomweyo, ma antibodies to glutamic acid decarboxylase amapezeka mwa anthu omwe ali ndi HLA genotypes - DR 3 DQ 2 (DQA 1 * 0501 / DQB 1 * 0201).
Mitundu ingapo yama autoantibodies nthawi zambiri imakhalapo mwa anthu odwala matenda ashuga, pomwe anthu omwe ali ndi matenda osokoneza bongo a autoimmune ali ndi mtundu umodzi wokha wa autoantiever.
Ma antibodies a glutamic acid decarboxylase ndi ena mwa anthu odwala matenda ashuga omwe ali ndi mtundu woyamba wa matenda, komanso pafupipafupi amakhala ambiri mwa anthu omwe ali ndi phenotypes amtundu wachiwiri wamatenda.
Kutsimikiza kwa ma antibodies amenewa kumapangitsa kuti zidziwike nthawi zambiri za autoimmunity, ngati ichi ndichokhacho chokhazikitsira anthu akuluakulu.
Mtengo wa kusanthula
Anthu omwe ali ndi matenda omwe amawaganizira kuti ali ndi matenda ashuga nthawi zambiri amasamala kuchuluka kwa kusanthula kwa anthu odwala matenda ashuga. Pali mapulogalamu ena omwe akuwonetsedwa ndi kusanthula zingapo.
Kafukufuku wambiri wotchedwa "kuchepetsa matenda a shuga" akuphatikiza shuga wamagazi ndi mayeso a creatinine.
Kuphatikiza apo, mbiri ili ndi:
- glycated hemoglobin
- triglycerides
- cholesterol yathunthu
- HDL cholesterol,
- LDL cholesterol,
- kwamikodzo albumin
- kumakumakumma,
- Mayeso a Reberg,
- shuga mumkodzo.
Mtengo wa kusanthula kwathunthu koteroko ndi pafupifupi ma ruble 5,000.
Kusanthula kumaphatikizapo:
- kusanthula kwa shuga m'magazi
- glycated hemoglobin.
Mtengo wowunikira ndi pafupifupi ma ruble 900.
Chizindikiro cha Autoimmune:
- ma antibodies a insulin
- ma antibodies kwa tyrosine phosphatase.
- glutamate decarboxylase antibodies,
- ma antibodies kwa tyrosine phosphatase.
Kusanthula koteroko kumawononga ndalama mpaka ma ruble 4,000.
Chiyeso cha insulin chingagule pafupifupi ma ruble 450, mayeso a C-peptide atenga ma ruble 350.
Kuzindikira pa nthawi yapakati
Kuyesedwa kwa shuga m'magazi kumatengedwa pamimba yopanda kanthu. Mantha adzayambitsidwa ndi chisonyezo cha 4.8 mmol / kuchokera pachala ndi 5.3 - 6.9 mmol / l kuchokera mu mtsempha. Asanayambe kuyesa, mkazi sayenera kudya chakudya pafupifupi maola 10.
Mukakhala ndi mwana wosabadwa, kuyesedwa kwa glucose kumatha kuchitika. Pa izi, mkazi amamwa magalamu 75 g m'magalasi amadzi. Pambuyo pa maola awiri, kuyesedwa kwa magazi kumabwerezedwa. Musanapendeketsedwe, simukuyenera kudziletsa pakudya. Zakudya ziyenera kukhala zodziwika.
Ngati zizindikiro za matenda ashuga zikupezeka, simuyenera kuchedwetsa kuonana ndi dokotala. Kuzindikira matendawa kumayambiriro kumathandizira kuti matendawo asapitilire komanso kukula kwa zovuta zowopsa m'moyo. Zotsatira zakufufuza ziyenera kukhala zolondola, chifukwa muyenera kutsatira malamulo onse okonzekera kusanthula.
Kodi matenda a shuga amapezeka bwanji? Katswiri adzanena mu kanema munkhaniyi.
