Matenda a shuga ndi m'gulu la matenda amtundu wa endocrine omwe amayamba chifukwa cha kuchepa kwa insulin. Hyperglycemia (kuchuluka kwamphamvu kwa glucose) kumatha kukhazikitsidwa chifukwa chophwanya mgwirizano wa insulin ndi maselo amthupi.
Matendawa amadziwika ndi njira yotsika komanso kuphwanya mitundu yonse ya kagayidwe:
- mafuta;
- chakudya;
- mapuloteni;
- mchere wamadzi;
- mchere.
Chosangalatsa ndichakuti matenda a shuga samakhudza anthu okha, komanso nyama zina, mwachitsanzo, amphaka nawonso amadwala matendawa.
Matendawa amatha kukayikiridwa ndi zizindikiro zake zochititsa chidwi kwambiri za polyuria (kutayika kwa madzi mu mkodzo) ndi polydipsia (ludzu losatha). Mawu akuti "matenda ashuga" adagwiritsidwa ntchito koyamba m'zaka za zana lachiwiri la BC ndi Demetrios waku Apamania. Mawu omasuliridwa kuchokera ku Chigriki amatanthauza "kulowa mkati."
Ili ndi lingaliro la matenda ashuga: munthu amataya madzi nthawi zonse, kenako, ngati pampu, amawonjezeranso mosalekeza. Ichi ndiye chizindikiro chachikulu cha matendawa.
Mkulu shuga
A Thomas Willis mu 1675 adawonetsa kuti ndi kuchuluka kwa mkodzo (polyuria), zamadzimadzi zimatha kukhala zotsekemera, kapena zingakhale "zopanda pake" kwathunthu. Matenda a shuga a Insipid amatchedwa insipid masiku amenewo.
Matendawa amayamba chifukwa cha zovuta za impso (nephrogenic shuga) kapena matenda a pituitary gland (neurohypophysis) ndipo amawonetsedwa ndikuphwanya kwachilengedwenso kapenanso kubisa kwa mahomoni a antidiuretic.
Wasayansi wina, a Matthew Dobson, adatsimikizira dziko lapansi kuti kutsekemera mkodzo ndi magazi a wodwala wodwala matenda ashuga kumachitika chifukwa cha kuchuluka kwa shuga m'magazi. Amwenye amakedzana adawona kuti mkodzo wa munthu wodwala matenda ashuga amakopa nyerere ndi kukoma kwake ndikupatsa matendawa dzina "matenda a mkodzo".
Anzathu achi Japan, China ndi Korea a mawu awa akutengera kuphatikizira kwa zilembo zomwezo ndikutanthauza chimodzimodzi. Anthu ataphunzira kuyesa kuchuluka kwa shuga osati mkodzo yekha, komanso m'magazi, nthawi yomweyo adazindikira kuti koyamba shuga amakwera m'magazi. Ndipo pokhapokha magazi ake atapitirira mulingo wovomerezeka wa impso (pafupifupi 9 mmol / l), shuga amawonekera mkodzo.
Lingaliro lomwe limayambitsa matenda ashuga, liyeneranso kusinthidwa, chifukwa kunapezeka kuti njira yothamangitsira shuga ndi impso sinaswe. Chifukwa chake mawu oti: palibe chinthu monga "shuga kutopa."
Komabe, Paradigm wakale adagwiritsidwanso ntchito ku matenda atsopano a "matenda a shuga a impso." Choyambitsa chachikulu cha matendawa chinali kuchepa kwapang'onopang'ono kwa shuga. Zotsatira zake, pakukhazikika kwa glucose m'magazi, mawonekedwe ake a mkodzo adawonedwa.
Mwanjira ina, monga matenda a shuga insipidus, lingaliro lakale lidakhala likufunikira, koma osati la matenda ashuga, koma matenda osiyana ndi ena onse.
Chifukwa chake, chiphunzitso cha kusowa kwa shuga chinasiyidwa m'malo mokomera lingaliro lina - shuga yambiri m'magazi.
Udindo uwu lero ndi chida chachikulu chothandiza pakuwunikira komanso kuwunika momwe chithandizo chikugwirira ntchito. Nthawi yomweyo, lingaliro lamakono la matenda ashuga silimangokhala chifukwa cha shuga wambiri m'magazi.
Muthanso kunena molimba mtima kuti chiphunzitso cha "shuga wambiri" chimatsiriza mbiri yakale ya sayansi yamatenda, yomwe imafikira pamalingaliro okhudzana ndi shuga zomwe zimapezeka zakumwa.
Kuperewera kwa insulin
Tsopano tikambirana za mbiri yakale ya zonena za asayansi pankhani ya matenda ashuga. Asayansi asanadziwe kuti kuperewera kwa insulin m'thupi kumabweretsa matendawa, adatulukira.
Oscar Minkowski ndi a Joseph von Mehring mu 1889 adapereka sayansi ndi umboni kuti galu atachotsa kapamba, nyama idawonetsa bwino matenda ashuga. Mwanjira ina, etiology ya matenda mwachindunji imatengera magwiridwe antchito a chiwalocho.
Wasayansi wina, a Edward Albert Sharpei, mu 1910, adanena kuti pathogenesis ya shuga ili pakusowa kwa makemikolo omwe amapangidwa ndi ma islets a Langerhans omwe amapezeka mu kapamba. Wasayansiyo adatcha dzina lake - insulin, kuchokera ku Latin "insula", lotanthauza "chilumba".
Hypothesis iyi ndi mawonekedwe a endocrine a kapamba mu 1921 adatsimikiziridwa ndi asayansi ena awiri a Charles Herbert Best ndi Frederick Grant Buntingomi.
Matchulidwe lero
Mawu amakono "mtundu 1 wa shuga" amaphatikiza malingaliro awiri omwe analipo kale:
- shuga wodalira insulin;
- matenda a shuga a ana.
Mawu akuti "mtundu wachiwiri wa matenda ashuga" alinso ndi mawu ena akale:
- shuga wosadalira insulin;
- matenda okhudzana ndi kunenepa;
- Akuluakulu a AD.
Miyezo yapadziko lonse lapansi imagwiritsa ntchito terminology "1st" ndi "2nd". M'mabuku ena, mutha kupeza tanthauzo la matenda a shuga a mtundu 3
- shuga ya amayi apakati;
- "matenda a shuga kawiri" (matenda osokoneza bongo a insulin 1);
- Type 2 shuga, yomwe inayamba kufunika kwa jakisoni wa insulin;
- "Type 1.5 matenda ashuga", LADA (autoimmune latent shuga mu akulu).
Gulu la matenda
Matenda a shuga a Type 1, pazifukwa mwadzidzidzi, amagawidwa kukhala idiomatic ndi autoimmune. Umboni wa matenda a shuga 2 umayambitsa zochitika zachilengedwe. Mitundu ina yamatendawa imatha kuchokera ku:
- Kulephera kwamtundu wa insulin.
- Ma genetic matenda a beta cell ntchito.
- Endocrinopathy.
- Matenda a endocrine dera la kapamba.
- Matendawa amakwiya chifukwa cha matenda.
- Matendawa amayambitsidwa ndi kugwiritsa ntchito mankhwala osokoneza bongo.
- Mitundu yosiyanasiyana ya matenda oletsa kuthana ndi matenda ashuga.
- Herederal syndromes omwe amaphatikiza ndi shuga.
Etiology ya gestational kishuga, gulu la zovuta:
- Matenda a shuga.
- Nephropathy
- Retinopathy
- Matenda a shuga a polyneuropathy.
- Matenda a shuga a shuga komanso microangiopathy.
Kuzindikira
Polemba matenda, dokotala amayamba kuyambitsa mtundu wa matenda ashuga. Pankhani ya shuga osadalira insulini, khadi la wodwalayo limawonetsa chidwi cha wodwalayo kwa othandizira a hypoglycemic othandizira (kukana kapena ayi).
Udindo wachiwiri umakhazikika ndi boma la metabolism ya carbohydrate, ndikutsatira mndandanda wazovuta za matenda omwe amapezeka mwa wodwala.
Pathogenesis
Pathogenesis ya shuga imadziwika ndi mfundo zazikulu ziwiri:
- Maselo a pancreatic alibe insulin yopanga.
- Matenda a mgwirizano wa mahomoni ndi maselo amthupi. Kutsutsa kwa insulin ndi chifukwa cha kusintha kwa kapangidwe ka zinthu kapena kuchepa kwa chiwerengero cha zolandilira, inshuwaransi ya chizindikiro cha ma cell kuchokera ku ma cell a cellel, komanso kusintha kwa kaperekedwe ka cell kapena insulin yokha.
Matenda a shuga 1 amadziwika ndi mtundu woyamba wamatenda.
Pathogenesis yakukula kwa matendawa ndikuwonongeka kwakukulu kwa maselo a pancreatic beta (islets of Langerhans). Zotsatira zake, kuchepa kwakukulu kwa kuchuluka kwa insulin kwamwazi kumachitika.
Tcherani khutu! Imfa ya chiwerengero chachikulu cha maselo a pancreatic amathanso kuchitika chifukwa cha zovuta zamavuto, matenda a ma virus, matenda a autoimmune, momwe ma cell a chitetezo cha mthupi amayamba kupanga ma antibodies motsutsana ndi ma cell a beta.
Matenda amtunduwu a shuga amadziwika ndi achinyamata osakwana zaka 40 ndi ana.
Matenda a shuga omwe samadalira insulin amadziwika ndi zovuta zomwe zafotokozedwa m'ndime 2 pamwambapa. Ndi matenda amtunduwu, insulin imapangidwa wokwanira, nthawi zina ngakhale yokwezeka.
Komabe, kukana kwa insulini (kuphwanya kugwirana kwa maselo amthupi ndi insulin) kumachitika, chifukwa chachikulu chomwe ndi kusakhazikika kwa ma membrane receptors a insulin kwambiri kunenepa kwambiri.
Kunenepa kwambiri ndi chiopsezo chachikulu cha matenda ashuga amtundu wa 2. Receptor, chifukwa cha kusintha kwa kuchuluka kwawo ndi kapangidwe kake, amalephera kulumikizana ndi insulin.
M'mitundu ina ya shuga osadalira insulini, kapangidwe ka mahomoni pawokha kamatha kusintha maselo. Kuphatikiza kunenepa kwambiri, palinso zinthu zina zowopsa za matendawa:
- zizolowezi zoipa;
- kudya kwambiri;
- ukalamba;
- moyo wongokhala;
- ochepa matenda oopsa.
Titha kunena kuti mtundu uwu wa matenda ashuga nthawi zambiri umakhudza anthu patatha zaka 40. Komanso pali kutengera kwa chibadwa cha matendawa. Ngati mwana ali ndi wachibale wake amene akudwala, kuthekera kwa kuti mwana alandire matenda amtundu wa 1 ali pafupi 10%, ndipo odwala osadwala insulin amatha kupezeka mwa 80% milandu.
Zofunika! Ngakhale limagwirira kukula kwa matenda, mitundu yonse ya anthu odwala matenda ashuga pali kuchuluka kwamisempha yamagazi ndimatenda a metabolic mu minofu, omwe amalephera kutenga glucose kuchokera m'magazi.
Kuchepetsa kotereku kumabweretsa chiwonetsero chachikulu cha mapuloteni ndi mafuta ndikupanga ketoacidosis.
Chifukwa cha shuga wambiri, kuwonjezeka kwa mapangidwe a osmotic kumachitika, zomwe zimapangitsa kuti kutaya kwakukulu kwamadzi ndi ma electrolyte (polyuria). Kuwonjezeka kwamphamvu kwa shuga m'magazi kumakhudzanso matupi athu ambiri ndi ziwalo, zomwe, pamapeto pake, zimayambitsa kukula kwakukuru kwa matendawa:
- matenda ashuga;
- nephropathy;
- retinopathy
- polyneuropathy;
- macro- ndi microangiopathy;
- wodwala matenda ashuga.
Anthu odwala matenda ashuga ali ndi matenda oopsa komanso kuchepa kwa kukonzanso chitetezo chathupi.
Zizindikiro zamatenda a shuga
Chithunzi cha chipatala cha matendawa chikuwonetsedwa m'magulu awiri azizindikiro - yoyamba komanso yachiwiri.
Zizindikiro zazikulu
Polyuria
Vutoli limadziwika ndi kuchuluka kwa mkodzo. Tizilombo toyambitsa matenda tomwe timatulutsa madzi ndikuwonjezera kuthamanga kwa madzi osokoneza bongo chifukwa cha kusungunuka kwa shuga m'matumbo mwake (mwachizolowezi mulibe shuga mkodzo).
Polydipsia
Wodwalayo amavutitsidwa ndi ludzu losalekeza, lomwe limayambitsidwa ndi kuchepa kwakukulu kwa madzimadzi komanso kuwonjezeka kwa kuthamanga kwa magazi a osmotic.
Polyphagy
Njala yosaletseka yosatha. Chizindikirochi chimachitika chifukwa cha kusokonezeka kwa metabolic, kapena, kulephera kwa maselo kugwira ndikuphwanya glucose pakalibe insulin ya mahomoni.
Kuchepetsa thupi
Kuwonetsera kumeneku kumadziwika kwambiri ndi matenda a shuga omwe amadalira insulin. Komanso, kuchepa thupi kumachitika motsutsana ndi maziko a chidwi cha odwala.
Kuchepetsa thupi, ndipo nthawi zina, kufooka kumafotokozedwa ndikuwonjezereka kwa mphamvu ya mafuta ndi mapuloteni chifukwa cha kupatula kwa glucose ku metabolism yamphamvu m'maselo.
Zizindikiro zazikulu za matenda a shuga omwe amadalira insulin ndi pachimake. Nthawi zambiri, odwala amatha kufotokoza molondola nthawi kapena tsiku lomwe zinachitika.
Zizindikiro zazing'ono
Izi zimaphatikizapo mawonetseredwe apadera azachipatala omwe amakula pang'onopang'ono komanso kwa nthawi yayitali. Zizindikiro izi zimadziwika ndi mitundu yonse iwiri ya matenda ashuga:
- kamwa yowuma
- mutu;
- masoka operewera;
- kuyabwa kwa mucous nembanemba (malungo kuyabwa);
- kuyabwa kwa khungu;
- kufooka kwa minofu;
- zovuta kuchitira zotupa pakhungu;
- ndi matenda a shuga omwe amadalira insulin, kupezeka kwa acetone mkodzo.
Mellitus wodwala matenda a shuga
Tizilombo toyambitsa matenda tomwe timagona ndimapangidwe osakwanira a insulin omwe amapangidwa ndi maselo a beta a kapamba. Maselo a Beta amakana kugwira ntchito yawo chifukwa cha chiwonongeko chawo kapena chifukwa cha chilichonse cha pathogenic:
- matenda a autoimmune;
- kupsinjika
- kachilombo.
Mtundu woyamba wa matenda ashuga umakhala 1-15% ya anthu onse odwala matenda ashuga, ndipo nthawi zambiri matendawa amakula ubwana kapena unyamata. Zizindikiro za matendawa zimapita patsogolo mwachangu ndipo zimayambitsa zovuta zingapo zazikulu:
- ketoacidosis;
- chikomokere, chomwe nthawi zambiri chimathera pakufa kwa wodwala.
Matenda a shuga osagwirizana ndi insulin (mtundu 2)
Matendawa amapezeka chifukwa chakuchepa kwa chidwi chathupi lathupi kupita ku insulin ya mahomoni, ngakhale kuti amapangidwa mokwera komanso ngakhale mopitirira muyeso m'mayambiriro a shuga.
Kudya moyenera ndikuchotsa mapaundi owonjezera nthawi zina kumathandizira kagayidwe kazachilengedwe ndikuchepetsa kupanga shuga ndi chiwindi. Koma matendawa akamapitilira, katulutsidwe ka insulin, kamene kamapezeka m'maselo a beta, kumachepa ndipo pakufunika chithandizo cha insulin.
Mtundu 2 wa matenda ashuga umakhala ndi 85-90% ya matenda onse a shuga, ndipo nthawi zambiri matendawa amapezeka mwa odwala omwe ali ndi zaka zopitilira 40 ndipo nthawi zambiri amayamba chifukwa cha kunenepa kwambiri. Matendawa amayenda pang'onopang'ono ndipo amakhala ndi zachiwiri. Matenda a shuga a ketoacidosis omwe ali ndi shuga omwe amadalira insulin ndi osowa kwambiri.
Koma, pakupita nthawi, ma pathologies ena amawonekera:
- retinopathy
- neuropathy;
- nephropathy;
- macro ndi microangiopathy.
