Matenda a shuga amapezeka chifukwa cha kuwonongeka kwa kagayidwe kazakudya komanso kuwonjezeka kwa ndende yamagazi. Gulu la WHO limakhazikitsidwa, pomwe mitundu yosiyanasiyana ya matenda imasonyezedwa.
Malinga ndi ziwerengero za 2017, anthu opitilira 150 miliyoni amadziwika kuti ali ndi matenda ashuga. M'zaka zaposachedwa, milandu ya matendawa yachulukanso. Kuopsa kwakukulu kwa mapangidwe a matendawa kumachitika patatha zaka 40.
Pali mapulogalamu omwe ali ndi njira zingapo zochepetsera kuchulukana kwa matenda ashuga komanso kuchepetsa chiopsezo cha kufa. Kuchita hemoglobin wa glycosylated kumapangitsa kuzindikira matenda a shuga ndikupatseni dongosolo la mankhwala.
Zolemba zakomwe matendawo ndi njira yake
Kukula kwa zamatenda kumayendetsedwa ndi zinthu zambiri. Ngati pali cholowa chamakubadwa, ndiye kuti mwayi wofanana ndi matenda a shuga ndiwokwera kwambiri. Matendawa amathanso kuchitika chifukwa chofooka m'thupi komanso kupezeka kwa mavuto akulu ndi ziwalo zina. Matendawa ndi omwe amachititsa matenda ambiri owopsa.
Type 1 shuga mellitus imachitika chifukwa cha kusachita bwino kwa maselo a beta. Momwe ma cell a beta amagwirira ntchito amafotokozera mtundu wa matenda. Matenda a shuga ana amakhala ndi zaka zilizonse, kuphatikizanso akhanda.
Kuti muzindikire matendawa, ndikofunikira kukayezetsa magazi, kuchuluka kwa glucose ndizokwera. Dokotala amatha kuyankhula za shuga ya idiopathic yokhala ndi insulin yochepa m'thupi.
Matenda a shuga amtundu woyamba amatha kulipidwa pamene kuchuluka kwa kagayidwe kazakudya kali pafupi ndi munthu wathanzi. Kulipira ngongole kumadziwika ndi nthawi yayifupi ya hypoglycemia kapena hyperglycemia, pomwe kulibe kulumala.
Ndi kuwola, shuga m'magazi amatha kusinthika kwambiri, pakhoza kukhala owoneka bwino komanso osweka. Popita nthawi, acetone amadziwika mkodzo.
Zizindikiro za matenda amtundu 1
- ludzu
- kukodza kwambiri pafupipafupi,
- kulakalaka kwamphamvu
- kuwonda
- kuwonongeka kwa khungu,
- kusachita bwino, kutopa, kufooka,
- mutu ndi kupweteka kwa minofu
- thukuta lalikulu, kuyabwa kwa khungu,
- kusanza ndi mseru
- kukana kwapafupi ndi matenda,
- kupweteka kwam'mimba.
Ma anamnesis nthawi zambiri amakhala ndi mawonekedwe operewera, ntchito ya impso, magazi m'miyendo, komanso kuchepa kwamphamvu kwa miyendo.
Type 2 shuga mellitus nthawi zambiri amawoneka mwa anthu azaka zapakati komanso achikulire. Matendawa amadziwika ndi kusokonezeka kwa malingaliro a insulin. Izi zitha kuchitika chifukwa cha mimba, kunenepa kwambiri, kapena zinthu zina. Matendawa nthawi zina amachitika mwachinsinsi ndipo samakhala ndi zowoneka bwino.
Type 2 matenda a shuga:
- mapapo, omwe amadziwika ndi kukhazikika kwa matendawa kudzera muzakudya kapena kuphatikiza kugwiritsa ntchito mankhwala oyenera,
- pafupifupi momwe kukhazikika kumachitika mutatha kudya mapiritsi angapo a mankhwala ochepetsa shuga. Mavuto ang'onoang'ono a mtima amatha.
- Gawo lowopsa limachitika ngati kukhazikika kumachitika kokha pogwiritsa ntchito mapiritsi ochepetsa shuga ndi insulin, kapena mothandizidwa ndi insulin basi. Mavuto akulu a mtima, nephropathy, retinopathy, ndi neuropathy ndiofala.
Munthu yemwe ali ndi matenda a mtundu 2 amakhala ndi ludzu nthawi zonse. Pali kuyabwa kumeneku komanso m'madzi. Kulemera kwa thupi kumawonjezereka, kutupa, matenda am'madzi a pakhungu amayamba. Kukonzanso minofu yosakwanira kumakhalanso ndi chikhalidwe.
Munthu amakhala ndi kufooka kwa minofu nthawi zonse. Miyendo imakhala ikunjenjemera, kukokana si zachilendo. Kuwona pang'ono pang'onopang'ono, tsitsi la nkhope limatha kukula kwambiri, ndipo kumapeto kwake kumatha kutha. Tizilombo tating'onoting'ono timatulutsa thupi, nthawi zambiri pamakhala thukuta lalikulu komanso kutupa kwa khungu.
Insulin yovomerezeka imadziwika kwambiri nthawi zambiri, chifukwa palibe mawonekedwe. Mtunduwu umakwiyitsa matenda amitsempha. Mankhwalawa, zakudya zamagulu azakudya ziyenera kutsatiridwa ndipo mankhwala omwe dokotala amakupatsani ayenera kugwiritsidwa ntchito.
Matenda a shuga amatha kufotokozedwa mosiyanasiyana, ngakhale mtunduwo ndi womwewo. Maonekedwe a zovuta akuwonetsa kuti matendawa ali pang'onopang'ono. Pali magawo azovuta, shuga mellitus, gulu, lomwe lili ndi mitundu yambiri, limasiyana m'mitundu ndi magawo.
Ndi matenda ofatsa, shuga amayamba popanda zovuta. Gawo lapakati likachitika, pakapita kanthawi mavuto amayamba:
- kuwonongeka kwamawonekedwe
- kuwonongeka kwaimpso,
- zolakwika za chapakati mantha dongosolo.
Ndi matenda oopsa a matendawa, matenda amtundu wautali amatha kukula omwe amasokoneza moyo wa tsiku ndi tsiku.
Zotsatira zamachitidwe zomwe zimachitika mthupi, mapangidwe a glycosylated hemoglobin amalimbikitsidwa. Pali kuphatikiza kwa glucose ndi hemoglobin. Kuchuluka kwa mapangidwe a hemoglobin kutengera shuga. Malinga ndi zotsatira za kusanthula, kuchuluka kwa hemoglobin, komwe kuphatikiza ndi shuga kwakanthawi kochepa, kwatsimikizika.
Glycosylated hemoglobin imapezekanso mwa anthu athanzi, koma ochepa. Ndi matenda ashuga, Zizindikiro izi ndizokwera kangapo kuposa zabwinobwino. Ngati kuchuluka kwa shuga kumakhala kwabwinoko, ndiye kuti zimatenga nthawi kuti hemoglobin ibwerere mwakale.
Kugwiritsa ntchito kwamankhwala kumatsimikiziridwa ndi mulingo wa hemoglobin.
Gulu la odwala matenda a shuga
Kutengera kafukufuku wasayansi, akatswiri ochokera ku WHO apanga gulu la anthu odwala matenda ashuga. Bungweli likuti odwala matenda ashuga ambiri ali ndi matenda amtundu 2, 92% yonse.
Mtundu woyamba wa shuga umakhala pafupifupi 7% ya kuchuluka konse kwa milandu. Mitundu ina ya matenda imapangitsa 1% ya milandu. Pafupifupi 3-4% ya amayi apakati amakhala ndi matenda ashuga.
Zaumoyo zamakono zimatchulanso vuto la prediabetes. Izi ndi zofunikira kwambiri pokhapokha muyezo wa glucose m'magazi upitilira kale, koma osakwaniritsa zomwe zili zenizeni zamatenda. Monga lamulo, prediabetes imatsogolera matenda odzaza.
Matendawa amapangika chifukwa cha kukanika kwa thupi, mwachitsanzo, kulephera pokonza shuga. Izi zimawonetsedwa mwa anthu omwe ali ndi thanzi labwino komanso onenepa kwambiri.
Mtundu wina wamatenda umagawika glucose m'thupi, koma chifukwa cha zovuta, zinthu zimatha kusintha ndipo ntchito yake ikasokonekera.
Kuyambira 2003, matenda ashuga apezeka ndi zomwe akufuna kuchita ndi American Diabetes Association.
Type 1 shuga mellitus amawonekera chifukwa cha kuwonongeka kwa maselo, chifukwa chake kusowa kwa insulin kumachitika mthupi. Type 2 shuga mellitus amawonekera chifukwa zotsatira zachilengedwe za insulin zimasokonekera mthupi.
Mitundu ina ya matenda ashuga imawonekera chifukwa cha matenda osiyanasiyana, komanso kusokonezeka kwa maselo a beta. Izi gulu tsopano ndi upangiri wachilengedwe.
M'magulu a WHO omwe adatchulidwa mu 1999, pali zina zomwe zidasintha pamagulu amatenda. Tsopano manambala achiarabu akugwiritsidwa ntchito, osati achi Roma.
Akatswiri a WHO pa lingaliro la "gestational matenda ashuga" samaphatikizira matendawa pokhapokha ngati ali ndi pakati, komanso zovuta zina za kagayidwe kazakudya. Mwa izi timatanthawuza kuphwanya komwe kumachitika pakubala kwa mwana, komanso pambuyo.
Zomwe zimayambitsa matenda a shuga gestational sizikudziwika mpaka pano. Kafukufuku akuwonetsa kuti matendawa nthawi zambiri amapezeka mwa amayi omwe ali onenepa kwambiri, matenda a shuga a 2, kapena ovarian polycystic.
Mwa amayi, panthawi yoyembekezera, kuchepa kwa minofu kukayamba insulin kumayamba, komwe kumathandizidwa ndikusintha kwa mahomoni ndi cholowa chamtsogolo.
Mtundu 3 sunasankhidwe pamndandanda wamatenda, omwe amatha kuwoneka chifukwa cha kuperewera kwa zakudya.
Anazindikira kuti izi zimatha kukhudza mapuloteni, komabe, sizingakwiyitse mawonekedwe a shuga.
Kugawidwa Kwa Matenda a shuga Padziko Lonse
Ambiri odwala matenda ashuga amatha kugawidwa m'magulu awiri: odwala omwe ali ndi vuto la matenda a shuga 1 mellitus (DM 1), omwe amaphatikizidwa ndi kuperewera kwa insulin, komanso odwala omwe ali ndi mtundu wa 2 shuga mellitus (DM 2), omwe amagwirizana ndi thupi kukana insulin.
Nthawi zambiri zimakhala zovuta kudziwa mtundu wa matenda ashuga, chifukwa chake gulu lina la shuga likupangidwanso kumene, lomwe silinavomerezedwe ndi WHO. Mu gulu lagululi pali gawo la "Matenda a shuga ndi mitundu".
Chiwerengero chokwanira cha mitundu yosowa ya shuga yomwe imakwiya idalembedwa:
- matenda
- mankhwala
- endocrinopathy
- kusowa kwa kapamba,
- zolakwika zakubadwa.
Mitundu iyi ya shuga siyogwirizana ndi matenda, imasiyanitsa mosiyana.
Kugawidwa kwa shuga kumeneku malinga ndi chidziwitso cha WHO kumaphatikiza mitundu inayi ya matenda ndi magulu, omwe amatchulidwa ngati kuphwanya malire a glucose homeostasis.
Matenda a shuga a mtundu woyamba 1
- immuno-mkhalapakati
- chidziwitso.
Type 2 shuga mellitus ali ndi gulu:
- malire zosokoneza za shuga homeostasis,
- kulolerana kwa shuga
- glycemia wamkulu pamimba yopanda kanthu,
- matenda a shuga
- mitundu ina ya matenda.
Matenda a kapamba:
- zotupa
- kapamba
- kuvulala
- cystic fibrosis,
- fibrosing kuwerengetsa kapamba,
- hemochromatosis.
Endocrinopathies:
- Cushing's syndrome
- glucagonoma
- somatostatinoma
- thyrotoxicosis,
- aldosteroma,
- pheochromocytoma.
Matenda obadwa nawo a insulin:
- shuga wa lipoatrophic,
- lembani kukana kwa insulini,
- leprechaunism, Donohue syndrome (mtundu wachiwiri wa matenda ashuga, kupindika kukula kwa mitsempha, dysmorphism),
- Rabson-Mendenhall syndrome (acanthosis, shuga mellitus ndi pineal hyperplasia),
- Zophwanya zina.
Mitundu yovuta yoteteza matenda ashuga:
- Rigid human syndrome (mtundu 1 matenda a shuga, kufooka kwa minofu, mikhalidwe yopweteka),
- Ma antibodies kuma insulin receptors.
Mndandanda wa syndromes wophatikizidwa ndi matenda ashuga:
- Turner syndrome
- Down syndrome
- Lawrence-Moon-Beadle syndrome,
- Getore'sore,
- tungsten syndrome
- Klinefelter syndrome
- ataxia of Friedreich,
- porphyria
- Prader-Willi matenda,
- myotonic dystrophy.
Matenda:
- cytomegalovirus kapena amkati rubella,
- mitundu ina ya matenda.
Mtundu wina ndi shuga ya amayi apakati. Palinso mtundu wa matenda omwe amayamba ndi mankhwala kapena mankhwala.
Matenda molingana ndi mfundo za WHO
Njira zozindikiritsa zimakhazikitsidwa ndi kukhalapo kwa hyperglycemia pansi pazinthu zina. Mitundu ya matenda ashuga imawonetsa zizindikiro zosiyanasiyana. Ndiosagwirizana, kotero, kusapezeka kwa matendawa sikukusiyitsa kuwonekera.
WHO Worldwide Diagnostic Standard imalongosola zodwala zam'mphepete mwa glucose homeostasis potengera kuchuluka kwa shuga m'magazi pogwiritsa ntchito njira zina.
Gawani:
- shuga wa m'magazi pamimba yopanda kanthu (pafupifupi maola eyiti atatha kudya),
- shuga wamagazi (nthawi iliyonse masana, kupatula zakudya),
- glycemia pa mphindi 120 za kuyesedwa kwa glucose pakamwa ndi 75 g shuga.
Matenda a shuga atha kupezeka ndi njira zitatu izi:
- kukhalapo kwa zizindikiro zamatenda zam'mimba + glycemia yoposa 11.1 mmol / l,
- glycemia pamimba yopanda 7.0 mmol / l,
- glycemia pa mphindi ya 120 ya PTTG yoposa 11.1 mmol / l.
Kwa glycemia wowonjezera, kuchuluka kwina kwa glucose m'madzi amadzi am'mimba yopanda kanthu, ndi 5.6 - 6.9 mmol / L.
Kulekerera kwa shuga wambiri kumadziwika ndi kuchuluka kwa glucose wa 7.8 - 11.0 mmol / L pa mphindi 120 za PTTG.
Makhalidwe Abwino
Magazi a shuga mwa munthu wathanzi ayenera kukhala 3,8 - 5.6 mmol / l pamimba yopanda kanthu. Ngati glycemia mwangozi yoposa 11.0 mmol / L m'magazi a capillary, kudziwikanso kwachiwiri ndikofunikira, komwe kuyenera kutsimikizira matendawa.
Ngati palibe Symbomatology, ndiye kuti muyenera kuphunzira kusala glycemia monga mwa nthawi zonse. Kuthamanga glycemia kwambiri osakwana 5.6 mmol / L kumachotsa matenda ashuga. Ngati glycemia apamwamba kuposa 6.9 mmol / l, ndiye kuti matenda a shuga amatsimikiziridwa.
Glycemia m'gulu la 5.6 - 6.9 mmol / l amafuna kafukufuku pa PTTG. Poyeserera kulolera kwa shuga, shuga imawonetsedwa ndi glycemia pambuyo maola awiri kuposa 11.1 mmol / L. Phunziroli likuyenera kubwerezedwa ndipo zotsatira ziwiri poyerekeza.
Pozindikira bwino matenda amtundu 1 komanso mtundu wa matenda ashuga a 2, C-peptides amagwiritsidwa ntchito ngati chidziwitso cha katemera wa amkati, ngati chithunzi cha chipatala sichidziwika bwino. Mu matenda 1, mitundu yoyambira nthawi zina imatsika mpaka zero.
Ndi mtundu wachiwiri wa matenda, phindu limatha kukhala labwinobwino, koma kukana insulin, kumawonjezeka.
Ndi kukula kwamatenda amtunduwu, kuchuluka kwa C-peptides kumawonjezeka.
Zovuta zotheka
Matenda a shuga angayambitse kuwonongeka kwakukuru m'moyo. Poyerekeza ndi matendawo, matenda ena amomwe amapezeka, mosasamala kanthu za shuga. Zizindikiro zimawonekera pang'onopang'ono ndipo ndikofunikira kudutsa m'magawo onse a mayeso kuti mupeze kuzindikira koyenera. Kukula kwa zovuta ndi chithandizo cholakwika cha matenda ashuga kumatha.
Mwachitsanzo, retinopathy nthawi zambiri imawoneka, ndiko kuti, kufalikira kwa retinal kapena kusinthika kwake. Ndi matenda awa, kukha magazi m'maso kumatha kuyamba. Ngati sanachiritsidwe, wodwalayo amatha kukhala wakhungu kwathunthu. Matendawa amadziwika ndi:
- fragility yamitsempha yamagazi
- maonekedwe a magazi.
Polyneuropathy ndikutaya kuzindikira kwa kutentha ndi kupweteka. Nthawi yomweyo zilonda zam'manja ndi miyendo zimayamba kuoneka. Zomverera zonse zosasangalatsa zimawonjezeka usiku. Mabala samachiritsa kwa nthawi yayitali, ndipo pali mwayi wokulira.
Matenda a diabetes a nephropathy amatchedwa matenda a impso, omwe amachititsa kuti mapuloteni amitsekedwe. Nthawi zambiri, kulephera kwa impso kumayamba.
Ndi mitundu iti ya shuga yomwe ilipo yomwe ingauze katswiri muvidiyoyi.
