Kutha kuyang'anira glycemia kumatanthauza chimodzi mwazowonetsera zakukhalabe mkati mwa thupi. Nthawi zambiri, mafuta obwera kuchokera ku chakudya amasinthidwa kukhala glucose, omwe insulin imadutsa mu cell, pomwe imapereka mphamvu kwa thupi kudzera m'magulu a glycolysis.
Mu shuga mellitus, kuchepa kwa insulin kumabweretsa kuti glucose amakhalabe m'magazi ndipo amawonongera mitsempha yamagazi, mitsempha ndi ziwalo zamkati, ndipo thupi limasinthira ku gwero lina lamphamvu - mafuta.
Kuopsa kwanjira ina yopezera zida zamphamvu ndikuti amapanga matupi a ketonic omwe ali ndi poizoni m'thupi. Popeza amakhala ndi magazi ambiri, amatha kudwala matenda ashuga a ketoacidotic. Munthawi imeneyi, pamakhala chiopsezo chachikulu cha kufa pokhapokha ngati mulandira chithandizo msanga.
Zifukwa zolipirira shuga
Njira ya matenda ashuga imadalira momwe thanzi la glucose limakhalira. Mulingo wapamwamba, pambuyo pake zovuta za mawonekedwe a chikomokere zimayamba kapena zisonyezo zowonongeka kwa minyewa yamitsempha, mitsempha yamagazi, impso ndi gawo lachiwonetsero likuwonjezeka - iyi ndi 7.8 mmol / l mukayeza asanadye.
Ngati shuga atakwera kwambiri, chiwopsezo chokhala ndi matenda ashuga chikuwonjezeka, ndipo ngati shuga m'magazi ndi 20, kodi izi zikutanthauza chiyani kwa thupi? Ndi hyperglycemia yotere, kupangika kwa matupi a ketone mosavomerezeka kumachitika, chifukwa izi zikutanthauza kuchepa kwa insulin mu mtundu 1 wa shuga kapena njira yotalikilapo ya matenda a shuga a 2.
Pa kagayidwe kabwinobwino, insulini imateteza minofu ya adipose pakuwonjezeka ndi kusalola kuchuluka kwa mafuta acids, komwe matupi a ketone amapangidwira. Ndi kuchepa kwa maselo, kufa ndi njala, komwe kumayambitsa ntchito ya mahomoni otsutsana, zomwe zimapangitsa kuti shuga ya magazi ikhale yoposa 20 mmol / l.
Mtundu wachiwiri wa matenda ashuga, kuwonjezereka kwa kuchuluka kwa glucose ochulukirapo 20 mmol pa 1 lita imodzi ya magazi sikungayambitse kupangika kwa matupi a ketone, bola ngati pali insulin yokwanira m'magazi yoteteza minofu ya adipose. Nthawi yomweyo, maselo sangapangitse shuga wa glucose ndipo khungu la hyperosmolar limayamba kukhala mthupi mpaka nthawi ya chikomokere isanayambike.
Zomwe zimatsogolera ku ngozi yakuwonjezeka kwa shuga mpaka makumi awiri mmol / l:
- Kudumpha makina kapena makonzedwe ochepetsa shuga - mapiritsi kapena insulin.
- Kuchotsa kosavomerezeka kwa chithandizo chamankhwala (mwachitsanzo, chithandizo cha mankhwala wowerengeka kapena zowonjezera pazakudya).
- Njira yolakwika yoperekera insulin komanso kusowa kwa glycemic control.
- Kuwona kwa matenda kapena zina:
- Mimba
- Kuchuluka kwa chakudya chamagulu m'zakudya.
- Chitani masewera olimbitsa thupi ndi hyperglycemia.
- Mowa.
Mukamamwa mankhwala ena motsutsana ndi maziko osakwanira olimbitsa thupi, mungakhale magazi okwanira 20 mmol / L kapena apamwamba: mankhwala a mahomoni, nicotinic acid, diuretics, Isoniazid, Difenin, Dobutamine, Calcitonin, beta-blockers, Diltiazem.
Kukhazikika kwa matenda a shuga 1 amatha kuwonetseredwa ndi hyperglycemia (shuga wamagazi 20 ndi pamwambapa), ketoacidosis. Kusiyanaku kwamatenda kumawonedwa pafupifupi pafupifupi kotala la odwala omwe amazindikira mochedwa komanso kusowa kwa chithandizo ndi insulin.
Magawo a Ketoacidosis
Gawo loyamba la matenda a shuga a mellitus limafanana ndi ketoacidosis wokwanira ndipo limawonekera mu mawonekedwe ofooka, kusasangalala, kutopa kwambiri, kugona, tinnitus komanso kuchepa kwa chilimbikitso. Kukhala bwino kwa odwala kumakulirakulira pang'onopang'ono, pali mseru ndi m'mimba kupweteka, kuchuluka kwa ludzu komanso kutulutsa kwamkodzo mkodzo, kuchepa thupi, kununkhira kwa acetone kuchokera mkamwa.
Gawo lachiwiri limatanthawuza kukula kwa precoma. Odwala amakhala osayanjana ndi ena, kuwonjezereka kwa kufooka, kusanza ndi kupweteka kwam'mimba, kupenya kwamaso kumasokonezeka, kupuma movutikira kumawonekera, khungu limayima pakukhudza, khungu silikuwongoka kwa nthawi yayitali, milomo imakhala yowuma, yolumikizidwa, lilime limakhala louma, ndipo mawonekedwe amaso amawonetsedwa.
Pa nthawi yopuma, wodwalayo amayamba kupuma mwamphamvu, kutsika kwa magazi, kusamva bwino, kugunda kwamphamvu, kusungika kwamikodzo, komanso khungu lomwe limakhala lozizira komanso louma.
Ketoacidotic coma yodziwitsa matenda osayenera komanso kusowa kwa chithandizo chokwanira kungayambitse zovuta izi:
- Pulmonary embolism.
- Mitsempha yakuya kwambiri.
- Matenda a mtima.
- Cerebrovascular ngozi.
- Chiwopsezo cha chibayo, edema ya m'mapapo.
- Cerebral edema.
- Colcinitis ndi gastritis
Chithandizo cha Ketoacidosis
Kupereka insulin kwa odwala omwe ali ndi vuto la ketoacidosis ndiyo njira yayikulu yothandizira, koma kuyang'anira kuyenera kuyendetsedwa ndikuwunika glycemia komanso kufananizira kukonzekera kwa potaziyamu kuti apewe hypokalemia, yomwe ingaphe.
Kuyamba kwa kukonza kosunthira kwa asidi m'magazi ndi njira yotsekemera ndi chinthu china chosavomerezeka, popeza mpweya wambiri womwe umapangidwira umawonjezera acidosis mkati mwa khungu ndikupita ku matenda a bongo, ndikayamba kuyambitsa bicarbonate, hypokalemia imatha kuchitika.
Insulin imaperekedwa kwa odwala okhawo intramuscularly, mlingo woyambirira umatha kuyambira 20 mpaka 40, kutengera kuchuluka kwa hyperglycemia. Sitikulimbikitsidwa kupaka insulin mosakwiya chifukwa chachedwa mayamwidwe ndi njira yolowerera, popeza mankhwalawa amagwira ntchito kwa mphindi 15 mpaka 20 ndipo amachotsedwa msanga.
Zina mwa chithandizo cha odwala ndi:
- Insulin iyenera kuperekedwa ngakhale wodwala sangadye yekha.
- Mtsempha wa magazi a shuga amayamba pang'onopang'ono kuposa kukhazikika kwa glycemia pa 11 mmol / L.
- Insulin yochepa imayendetsedwa kangapo 6 pa tsiku.
- Kuti muwonjezere kupsinjika, mankhwala a vasoconstrictor sayenera kutumikiridwa.
- M'njira zonse zam'mimba zopweteka kapena zizindikiro za vuto la odwala omwe ali ndi matenda ashuga, shuga yamagazi ndi ma ketoni a mkodzo amayenera kuyesedwa.
Kubwezeretsa madzi otaika ndikofunikira. Chifukwa cha izi, kuyambira maora oyamba azindikiritso wa ketoacidosis, kutsekeka kwa mtsempha wamthupi kumayikidwa.
Maantibayotiki atha kulimbikitsidwa kuti ateteze matenda, komanso heparin kuti muchepetse mtima.
Kuwononga Matenda A shuga A 2
Kukula kwa hyperosmolar coma kumayendera limodzi ndi kuchuluka kwa glycemia (pamwambapa 20-30 mmol / l), kuchepa mphamvu kwa magazi, hypernatremia komanso kusapezeka kwa matupi a ketone. Matendawa amakula nthawi zambiri mwa okalamba omwe ali ndi vuto la matenda a shuga 2.
Kukana chithandizo, kuphwanya kwambiri zakudya, matenda obwera, mankhwala, Hypothermia, kusowa kwamadzi, kuwotcha, kutsekula m'mimba, kusanza kwambiri, hemodialysis kumatha kuyambitsa matenda a hyperglycemia.
Zizindikiro zomwe zingathandize kuzindikira matendawa ndi kuchuluka kwa ludzu, kukodza kwambiri, tachycardia, kukokana, komanso kutsika kwa magazi. Chimodzi mwa chithunzi cha chipatala mu boma la hyperosmolar ndicho kuphatikizika kwa matenda amisala ndi mitsempha, yomwe imatha kuonedwa ngati zizindikiro za psychosis yayikulu:
- Bullshit.
- Zizindikiro.
- Kuyenda kwachilendo.
- Kuyankhula zopanda pake kapena zosamveka.
- Kuphulika kwa kuzindikira ndi chidwi.
Machitidwe a hyperosmolar amakula pang'onopang'ono kuposa ketoacidosis. Zizindikiro zake zimachuluka kuyambira masiku 5 mpaka milungu iwiri.
Kuwonetsedwa kwa kuchepa kwamadzi kumatchulidwa kwambiri, koma palibe fungo la matupi a acetone ndi ketone mumkodzo.
Chithandizo cha Hyperosmolar
Kufunika kwa kayendetsedwe ka insulini mwa odwala nthawi zambiri kumakhala kotsika, kumachokera magawo awiri mpaka anayi pa ola limodzi ndikuwunika kuyang'anira shuga. Chofunikira kwambiri pochiza matenda ashuga awa ndi kuwonjezerekanso madzi m'thupi.
Pankhaniyi, kuchuluka kwa mayankho kuyenera kukhala kotsika kuti kusayendetse magazi. Kuphatikiza apo, ndikofunikira kuyeza mulingo wa sodium m'magazi. Ngati aposa 150 mmol / l, ndiye kuti yankho la sodium chloride mu hypotonic concentration ya 0.45% imagwiritsidwa ntchito.
Malita osachepera 8 amadzimadzi amatumizidwa kwa odwala otero, omwe akuyenera kuchitidwa mpaka osmolarity amachepetsedwa ndi magawo a 7000 patsiku.
Mukamveketsa mulingo wa sodium m'magazi, gwiritsani ntchito njira yofananira yamchere.
Matenda a shuga amawononga
Zoyenera kuchita kuti muchepetse zovuta za mtundu 1 ndi matenda ashuga a 2? Mkhalidwe waukulu ndi chithandizo choyenera cha matendawa. Izi zikutanthauza kugwiritsa ntchito mlingo wokwanira wa insulin kapena mankhwala ochepetsa shuga komanso chakudya chomwe chimakhala ndi zinthu zambiri zokhala ndi chisonyezo chochepa cha hypoglycemic.
Izi zikuphatikiza masamba obiriwira, biringanya, mtedza, nthangala, zipatso zamchere, maapulo osavomerezeka, komanso njere zonse - buwheat, oatmeal. Kuphatikiza apo, zakudya zama protein zopanda mafuta ndizothandiza - zakumwa za mkaka, tchizi cha kanyumba, nyama ndi nsomba, nkhuku. Masamba amakonda kudyedwa mwatsopano mumasaladi okolere ndi mafuta a masamba.
Mukamagwiritsa ntchito maswiti okonzedwera m'malo mwa shuga, muyenera kuwongolera kapangidwe kake, chifukwa nthawi zambiri amaphatikiza ufa woyera, mafuta amafuta, maol. Chifukwa chake, zakudya zilizonse muyenera kudya mothandizidwa ndi shuga.
Zopanda mphamvu:
- Maswiti aliwonse ndi zinthu zopangidwa ndi ufa.
- Phula yokhazikika.
- Zakudya zokazinga, nyama yamafuta kapena nsomba.
- Senti yogula, zakudya zamzitini.
- Mbatata, mpunga wa peeled, nthochi, ayisikilimu, zipatso zouma, mchere.
- Zapaketi zokhazikitsidwa ndi zakumwa zilizonse zotsekemera.
Chithandizo cha odwala omwe ali ndi kusinthasintha kwakukulu pamlingo wa glycemia imachitika mu chipatala, komwe mlingo wa insulin kapena mapiritsi ochepetsa shuga ayenera kusankha. Ngati ndi kotheka, mlingowo uwonjezedwa kapena jakisoni wowonjezera wa insulin akapatsidwa mtundu wa matenda ashuga 1, komanso mtundu wachiwiri wa matenda ashuga, insulini kapena mankhwala osakanikirana akhoza kutumikiridwa.
Zizindikiro za hyperglycemia zidzafotokozedwa mwatsatanetsatane ndi katswiri mu kanema munkhaniyi.
