World Health Organisation yati matenda ashuga ndi vuto la mibadwo yonse ndi mayiko onse. Matenda a shuga ndi omwe amakhalanso wachitatu pazomwe zimayambitsa kufa pambuyo pa mtima ndi khansa.
Ambiri - pafupifupi 90% ya milandu yonse yomwe yapezeka, chifukwa cha mtundu wachiwiri wa matenda a shuga, omwe amalumikizana ndi insulin kukana (kusazindikira mtima). Kuchuluka kwa glucose m'magazi kumachitika chifukwa cha kuthekera kwa insulin yolumikizana ndi zolandilira ndikuyendetsa glucose mu cell.
Popeza kuphatikiza kubadwa, zakudya zofunikira zimayambitsa kukula kwa matenda a shuga a 2 ndipo zotsatira zake - kunenepa kwambiri, zolimbitsa thupi, zimachitika motsutsana ndi maziko a atherosermosis ndi matenda oopsa, ndikofunikira kuchiza matenda a shuga a 2 osangokhala ndi mankhwala omwe mumalandira kuti muchepetse shuga. Koma ndikofunikira kusintha moyo wonse, momwe kudalirana kwa shuga, komanso thanzi, zimadalira.
Kodi matenda a shuga a 2 amatha bwanji?
Kwa mtundu wachiwiri wa matenda a shuga, mankhwalawa amachitidwa ndikuchepetsa shuga m'magazi, pomwe kuli kofunikira kuwunika sizomwe zikuwonetsa pakadali pano monga kukhazikika kwawo kwa nthawi yayitali. Mwa izi, chizindikiro cha hemoglobin wa glycated chimagwiritsidwa ntchito.
Pochepetsa ndi 1%, ndizotheka kuchepetsa zovuta za matenda osokoneza bongo monga nephropathy ndi retinopathy ndi 35-38%. Kuwunika kuchuluka kwa shuga ndi kuthamanga kwa magazi kumalepheretsa kukula kwa matenda amitsempha, matenda a mtima, amachepetsa kuwonekera kwa zotumphukira mu mawonekedwe a phazi la matenda ashuga.
Zinthu zomwe zimasokoneza chithandizo cha mtundu 2 wa matenda a shuga ndi chitukuko chake mwa anthu okhwima komanso okalamba omwe ali ndi mtima wam'magazi, kuchepa kwa kayendedwe ka metabolic m'thupi komanso kuchepetsedwa zolimbitsa thupi ndi zochitika zina.
Popeza ndizosatheka kuchiza matenda ashuga, pulogalamu ya kasamalidwe ka shuga imapangidwa kwa wodwala aliyense. Zimathandiza kukhala ndi moyo wonse, kusunga thanzi komanso kupewa zovuta zoopsa.
Njira zazikulu zamankhwala zodwala matenda a shuga a 2 zimaphatikizaponso:
- Chithandizo cha zakudya.
- Kuchepetsa kupsinjika.
- Zochita zolimbitsa thupi.
- Mankhwala.
Chithandizo cha mankhwala osokoneza bongo chimaphatikizapo mankhwala onse ochepetsa piritsi
Njira zothandizira kubwezeretsa matenda a shuga zimagwiritsidwa ntchito ngati muyezo wamankhwala; zimatha kusiyanasiyana pang'ono kutengera zaka ndi zomwe zimagwirizana ndi matenda. Koma kuti mupeze chitsogozo, ngati chithandizo chokwanira chikuchitika, ndikofunikira kuti muphunzire zomwe zikuwonetsa metabolism kuti muzitsatira magawo (manambala onse a mmol / l):
- Kuthamanga kwa glycemia: magazi a venous (matenda a labotale) ochepera 6, m'magazi a capillary (kudzipenyetsa nokha ndi glucometer kapena mawonedwe oyesa) - osakwana 5.5.
- Glycemia pambuyo maola 2 (magazi a venous ndi capillary) - ochepera 7.5.
- Cholesterol chonse ndi chochepera 4.5
- Lipoproteins: kachulukidwe kochepa - osakwana 2,5; okwera - kwa amuna opitilira 1, ndi kwa akazi opitilira 1.2.
- Triglycerides: zosakwana 1.7.
Kuphatikiza apo, adotolo omwe amawerengera amawerengera kuchuluka kwa hemoglobin ya glycated - sayenera kupitirira 6.5% ndipo kuthamanga kwa magazi chifukwa chotsika kwa angiopathy sikuyenera kupitirira 130/80 mm Hg. Art.
Zakudya zamankhwala zamtundu wachiwiri wa shuga
Ndi onenepa kwambiri, chofunikira chakudya chimachepa. Kudya zakudya zopatsa mphamvu za calorie sayenera kupitirira 1800 kcal. Mu sabata muyenera kuchepetsa kulemera ndi 500 g - 1 kilogalamu.
Ngati chizindikirochi chili chotsika, ndiye kuti zikuwonetsedwa kuti kusinthana kwanyengo limodzi ndi sabata, nsomba, mkaka kapena masamba omwe amakhala ndi zopatsa mphamvu mpaka 1000 kcal. Mfundo zazikuluzikulu za kadyedwe ndikukana mafuta osavuta, opukusa chakudya komanso mafuta azinyama.
Chakudya chimakhala chovomerezeka pa nthawi yofananira, chakudya chambiri, kangapo 6 pa tsiku pazigawo zochepa. Kukula kwakanthawi kacakudya kameneka kumathandizira kuti thupi likhale lolimba komanso kuti shuga azikhazikika popanda kudumpha mwadzidzidzi, chifukwa, popeza wodwalayo adziwa za matenda ashuga, njira yodziwira odwala iyenera kuonedwa mosamalitsa.
Kuti muthane ndi vuto la matenda ashuga amtundu wa 2, muyenera kupatula kwathunthu zinthu zomwe zalembedwa:
- Zopangira: mikate yoyera, makeke, makeke amphika, maffini, ma cookie, ma waffle.
- Shuga, maswiti, kupanikizana, ayisikilimu, koloko, mchere, uchi.
- Mpunga, semolina ndi pasitala
- Nyama yamafuta ndi Yopanda
- Mafuta, amchere komanso osuta, nsomba zamzitini.
- Mphesa, mphesa zamphesa, madeti, nthochi, nkhuyu, misuzi yazipatso za mafakitale.
Shuga amasinthidwa ndi fructose, sorbitol, xylitol, aspartame, kapena stevia. Amakonzekera kuchepetsa mchere mpaka 3-5 g patsiku. Tiyenera kukumbukira kuti mu zopangidwa ndi zakudya zabwinobwino zimakhala pafupifupi 1 - 2 g. Ndi kuthamanga kwa magazi kapena ndi nephropathy, chakudya sichowonjezeredwa.
Pazakudya za matenda a shuga a 2, payenera kukhala ndizakudya zokwanira kuchokera kumizere yatsopano kapena yophika, kuchuluka kwathunthu kwa fiber sikuyenera kupitirira 40. Nthambi zitha kugwiritsidwa ntchito mu chakudya kuchepetsa index ya glycemic.
Zamasamba ziyenera kukhala zatsopano monga momwe mungathere masaladi ndi masamba amasamba. Kaloti owiritsa, beets ndi mbatata ndizochepa.
Tsiku lililonse mapuloteni azikhala 0,8 -1 g pa kilogalamu ya kulemera kwa odwala. ndi kukula kwa matenda a impso, amachepa. Mapuloteni amakonda kubadwa kuchokera ku nsomba, zakudya zamafuta ochepa, nyama yotsika. Njira yabwino yophika ndikuphika, kuwaza ndi bwino osagwiritsa ntchito.
Monga magwero a vitamini, mutha kugwiritsa ntchito rosehip decoction, msuzi kapena chakumwa cha zipatso kuchokera ku cranberries, blueberries, blueberries, decoction of aronia, mavitamini osonkhanitsa. M'nyengo yozizira ndi masika, multivitamini amasonyezedwa.
Kugwiritsa ntchito zolimbitsa thupi mu shuga
Kupanga malangizidwe pamalamulo olimbitsa thupi kumachitika poganizira zaka, kulimba, mkhalidwe wa wodwalayo. Kukhalapo kwa zovuta za matenda ashuga ndi matenda okhudzana nawo amawerengedwa.
Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, kuchita masewera olimbitsa thupi ndi mtundu womwewo ndikulimbikitsidwa. Asanakhale makalasi, komanso pambuyo pawo, ndikofunikira kuyeza shuga, kuthamanga kwa magazi ndi kugunda kwa mtima.
Ngati shuga m'magazi ndi apamwamba kuposa 14 mmol / l, simungathe kuchita masewera olimbitsa thupi, mmalo mwakuchepetsa, amatha kuwonjezera glycemia ndikuwonjezera ketoacidosis. Komanso, simungathe kuthana ndi shuga m'magazi otsika kuposa 5 mmol / L.
Kuti muwonjezere zochitika zatsiku ndi tsiku, ndikulimbikitsidwa:
- Tsiku lililonse: kupaka magalimoto kapena poyenda ndi mayendedwe a anthu kupita kumamita 300 kupita 500 kuchokera komwe mukupita, osagwiritsa ntchito kukweza, kuyenda galu, kuyenda kupita kumalo ogulitsira akutali, mankhwala kapena positi ofesi kuti muthe kuchita zambiri tsiku lililonse.
- Kawiri pa mlungu, gwiritsani ntchito m'munda, muchotse, yoga, gofu kapena mawondo.
- Katatu pa sabata: kuyenda, kuthamanga, kusambira, kuyendetsa njinga, kuvina.
- Chepetsani kuwonera TV, kuwerenga kapena kuluka mpaka theka la ola, kenako kuchita masewera olimbitsa thupi.
Kuchita masewera olimbitsa thupi kumathandizira kuti shuga agwiritsidwe ntchito, ndipo izi zimachitika kwa maola angapo kumapeto kwa gawo, komanso zimachepetsa zomwe zili m'magazi a triglycerides m'magazi, zomwe zimayambitsa kuwonongeka kwa mtima, komanso zimachulukitsa lipoproteins yapamwamba. Zinthu izi zimachepetsa mwayi wa kuchuluka kwa mafuta m'thupi.
Kuchita kwa magazi kwa fibrinolytic kumachulukanso, mamasukidwe ake ndi kuphatikiza kwa maselo othandiza magazi kumachepa, ndipo mulingo wa fibrinogen umachepa. Uku ndikothandiza kupewa matenda a thrombosis, kugunda kwa mtima komanso sitiroko.
Zowoneka bwino pamitsempha yamtima zili m'machitidwe otere:
- Kuthamanga kwa magazi kumachepa.
- Mu myocardium, kugwiritsa ntchito mpweya kumakulira.
- Neuromuscular conduction bwino.
- Kutulutsa kwamtima kumawonjezera.
- Kugunda kwa mtima kukukhazikika.
Kuphatikiza pa kukhudza minofu ndi mtima wam'magazi, zolimbitsa thupi zimapereka mphamvu yotsutsana ndi kupsinjika, kuchepetsa kuchuluka kwa adrenaline, cortisol, ndikuwonjezera kutulutsidwa kwa endorphins ndi testosterone.
Chofunikira kwambiri kwa odwala matenda ashuga ndikuti kugwiritsa ntchito zinthu zolimbitsa thupi kumachepetsa mphamvu ya kutsutsa ndi kukhudzana ndi hyperinsulinemia.
Mtundu wa 2 wa mankhwala a shuga
Ndikotheka kukhala wathanzi ndimitundu yovuta ya shuga komanso m'magawo oyamba ndikudya komanso kumwa mankhwala azitsamba. Momwe mungapangire mankhwala ndi mulingo wa hemoglobin wa glycated wofanana kapena woposa 7%.
Mankhwala oyamba omwe angafotokozedwe kuti adziwe matenda a shuga ndi metformin. Zotsatira zake pakuchepetsa shuga m'magazi sizimasowetsa nkhokwe m'mimbayo, nthawi zambiri zimalekerera komanso sizimabweretsa mavuto.
Ubwino wofunikira ndikupezeka kwake komanso kusowa kwa mphamvu pa kulemera. Chifukwa chake, magawo oyamba a chithandizo cha matenda a shuga, icho, limodzi ndi kuchepa thupi komanso kuwonjezereka zolimbitsa thupi, zimathandizira kukhazikika kwamisempha ya glucose mkati mwa zigawo zomwe mukufuna.
Machitidwe a metformin pamagulu a shuga amawonetsedwa ndi zotulukapo:
- Zimawonjezera chidwi cha maselo a chiwindi kupita ku insulin, yomwe imachepetsa kupanga shuga.
- Kuphatikiza kwa Glycogen kumawonjezeka ndipo kuchepa kwake kumachepa.
- Mu adipose ndi minofu minofu, kuyanjana kwa insulin receptors kumawonjezeka.
- Kugwiritsidwa ntchito kwa glucose mu minofu kumawonjezeka.
- Kumwazidwa kwa glucose m'matumbo kumachepetsedwa, komwe kumachepetsa kutuluka kwake m'magazi mutatha kudya.
Chifukwa chake, metformin sikuchepetsa glucose, koma zambiri zimaletsa kuchuluka kwake. Kuphatikiza apo, amachepetsa triglycerides ndi cholesterol m'mwazi, amachepetsa chiopsezo cha kuundana kwa magazi. Ili ndi malo ochepetsa chakudya.
Zotsatira zoyipa zimagwirizanitsidwa ndi kuchepa kwamphamvu kwa glucose m'matumbo ndipo zimatha kuchitika m'mimba, kutsekemera, ndi mseru. Izi zitha kugwiritsidwa ntchito ngati mugwiritsa ntchito milingo yoyamba yotsika ndikukula pang'onopang'ono.
Poyamba, 500 mg imayikidwa kamodzi kapena kawiri pa tsiku, ndipo mutatha masiku 5-7 kuti muwonjezere ngati pakufunika 850-1000 mg, muyenera kumwa mapiritsi mukatha kudya chakudya cham'mawa komanso mukatha kudya.
Kukonzekera kwa Sulfonylurea kumalimbikitsa kutulutsa insulin. Amakhala pama cell a beta m'masukulu a Langerhans. Amayamba kugwiritsidwa ntchito ndi mitundu yotsika yotsika, ndikukula kamodzi pakapita masiku 5-7. Ubwino wake ndi mtengo wotsika komanso kuthamanga kwa kuchitapo kanthu. Zotsatira zoyipa - kusakwanira kwa hyperinsulinemia, kunenepa kwambiri, pafupipafupi hypoglycemia. Mankhwalawa akuphatikizapo: Glibenclamide, Glimepiride, Gliclazide MV, Glycvidon.
Pofuna kupewa komanso kuchiza matenda a shuga a 2, mankhwalawa Acarbose (Glucobai) amagwiritsidwanso ntchito. Pansi pa kuchitapo kwake, chakudya chamafuta sichimamwa, koma chimatulutsidwa ndimatumbo. Chifukwa chake, chakudya chikatha palibe kulumpha kwakuthwa mu shuga. Mankhwala enieniwo samalowa m'magazi.
Acarbose sichikhudza insulin katulutsidwe, chifukwa chake, sichimayambitsa hypoglycemia. Zikondazo zimatsitsidwa. Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumakhudza kagayidwe kazakudya:
- Kukana kwa insulin kumachepetsedwa.
- Amachepetsa kudya glycemia.
- Kuchepetsa kuchuluka kwa hemoglobin wa glycated.
- Amaletsa zovuta za matenda ashuga.
Kumwa mankhwala osokoneza bongo a acarbose amachepetsa mwayi wokhala ndi 37%. Poyamba, 50 mg imayikidwa madzulo pakudya chamadzulo, mlingo umakulitsidwa mpaka 100 mg katatu patsiku. Ndemanga za odwala omwe adagwiritsa ntchito chida ichi akuwonetsa kusokonezeka kwamatumbo, bloating, kupweteka m'matumbo ndi flatulence.
Magulu atsopano a mankhwala ochepetsa shuga
Glitazones - gulu latsopano la antidiabetic mankhwala limagwira ma receptors mu adipose ndi minofu minofu, kukulitsa chidwi chawo ku insulin. Kuchita izi kumachitika ndikuwonjezera kuchuluka kwa majini omwe amapanga mapuloteni pokonza shuga ndi mafuta acids.
Pankhaniyi, chiwindi, minofu ndi adipose minofu imatha shuga ochulukirapo m'magazi, komanso triglycerides ndi mafuta achilengedwe aulere. Mankhwalawa ndi monga rosiglitazone (Avandia, Roglit) ndi pioglitazone (Pioglar, Amalvia, Diab-standard, Pioglit).
Mankhwalawa amadziwikiratu mtima kulephera, ndikuwonjezeka kwa ntchito ya chiwindi transaminases, mkaka wa m'mawere ndi pakati.
Kukonzekera kwa glitazone kuyenera kumwedwa mu 4 ndi 8 mg (wa roxiglitazone) ndi 30 mg patsiku la pioglitazone. Izi zimakuthandizani kuti muchepetse matenda a glycemia ndi glycated hemoglobin ndi 0.6 - 0.7%.
Mankhwalawa Repaglinide ndi Nateglinide amachita mwakuchulukitsa kwambiri kutulutsa kwa insulin, komwe kumakupatsani mwayi wowonjezera kuchuluka kwa shuga mutatha kudya. Amayesa maselo a beta potsegulira njira za calcium.
Zomwe zimandilonjeza kwambiri pakuchiza matenda a shuga a mtundu wachiwiri ndi mankhwala atsopano - Baeta. Zochita zake zimawonetsedwa kudzera mumahomoni opangidwa m'matumbo am'mimba - ma insretins. Mothandizidwa ndi Baeta, kaphatikizidwe kamatumbo awa kamawonjezeka, komwe kumakupatsani mwayi wobwezeretsa gawo loyambirira la insulin, kuti muchepetse kupanga kwa glucagon ndi acid acid.
Byeta amachepetsa kutsanulira kwam'mimba, potero amachepetsa kudya. Zotsatira zake sizimadalira kuopsa kwa matenda ashuga. Mlingo woyambirira wa 5 mcg kawiri - ola limodzi musanadye chakudya cham'mawa komanso musanadye. Pakatha mwezi umodzi, mutha kuwonjezera mpaka 10 mcg.
Zotsatira zoyipa - mseru pang'ono, zizindikiro za matenda am'mimba, omwe nthawi zambiri amatha sabata yoyamba yamankhwala.
Dipeptidyl peptidase-IV-sitagliptin inhibitor anali womaliza mwa mapulani a incretin. Mankhwalawa amagwira ngati Bayeta Koma pa enzyme ina, yolimbikitsa kapangidwe ka insulin poyankha pakudya zamafuta ambiri. Nthawi yomweyo, chizindikiro monga glucagon secretion imapanikizidwa.
Sitagliptin imagulitsidwa pansi pa dzina lamalonda Janouvia. Anaphatikizidwanso ndi metformin mu mankhwala a Yanumet, omwe amasintha mankhwalawa amtundu wa 2 shuga, chifukwa mankhwala osokoneza bongo oterewa amachepetsa shuga m'magazi mwachangu.
Pochita maphunziro azachipatala, zotsatirazi zidapezeka ndikugwiritsa ntchito Januvia:
- Khola ndi kuonekera kuchepa kwa glycemia.
- Kuchepa kwa kudumpha kwa shuga pambuyo pakudya.
- Kuchepetsa kwakukulu kwa hemoglobin wa glycated.
- Kutalika kwa ntchito, kulola kugwiritsa ntchito kamodzi patsiku
- Kuperewera kwa thupi.
Type 2 matenda a shuga a insulin
Chimodzi mwa malingaliro olakwika okhudzana ndi matenda amtundu wa 2 ndichakuti mitundu iyi ndiosavuta ndipo sifunikira chithandizo chachikulu. Wodwala akamvetsetsa kuti "Ndilinso ndi mtundu wina wa matenda ashuga," amakhala ndi lingaliro loti matenda ndi omwe amaphatikizira chithandizo cha mapiritsi opanda insulin.
Mlingo wa glycemia panthawi yayitali matenda ashuga nthawi zambiri sungasungidwe ndi mapiritsi, chifukwa chake, ngati mankhwalawo samatha komanso mankhwala okwanira osokoneza bongo, monga ngati glycated hemoglobin imaposa 7.5%, glucose yothamanga ndiwotsika kuposa 8 mmol / l, index yamasamba ambiri kuposa 25 kg / m2 mankhwala a insulin akuwonetsedwa.
Chithandizo cha matenda a shuga 2 amtundu wa insulin amagwiritsidwa ntchito ketoacidosis, kuchitapo kanthu kwa opaleshoni, kukulitsa matenda opatsirana ndi zovuta za matenda a shuga mellitus mu mawonekedwe a neuropathy komanso matenda akulu a mtima. Kanemayo munkhaniyi ayankhula za zazikulu komanso chithandizo cha matenda ashuga.
