Gulu (mitundu) ya matenda ashuga

Pazina "shuga" limabisa matenda angapo ofanana. Zomwe zimapangidwira kuti akwaniritse njira zawo komanso njira zamankhwala ndizosiyana. Umoyo wa wodwala makamaka umatengera kuzindikira koyenera, chifukwa chake, gulu la matenda ashuga limawunikiridwa mobwerezabwereza komanso zovuta. Kwa mitundu yodziwika kale 1 ndi 2, mitundu yopitilira khumi ndi awiri tsopano akuwonjezeredwa, chifukwa chilichonse chomwe chatsimikizika ndichochiritsira.

Tsopano anthu opitilira 400 miliyoni akudwala matenda ashuga, chifukwa chake mavuto amtundu, kuzindikira koyambirira, komanso chisankho chamankhwala chothandiza kwambiri chakhala chimodzi mwazofunikira kwambiri padziko lonse lapansi.

Mitundu yofala kwambiri ya shuga

Mwa mitundu yonse ya matenda a shuga, lembani 1% pafupifupi 7% ya matenda onse. Chomwe chikuwonjezera shuga ndikuwonongeka kwa maselo a beta omwe amapezeka m'matumbo. Matendawa amakula mwachangu, pamapeto pake, kupanga insulin kwa wodwalayo kumayima kwathunthu. Mwazi wamagazi umayamba kukula pamene maselo osaposa 20% atsala. Mtundu uwu wa matenda ashuga amaonedwa ngati matenda a achinyamata, chifukwa umakula kwambiri mwa ana ndi achinyamata munthawi ya kukula msanga komanso kusasitsa. Chifukwa cha kuchepa kwa matendawa, cholowa chake sichimayilandira bwino. Odwala alibe zizindikiritso zakunja zomwe munthu angaganize kuti amakonda kulemba matenda ashuga 1.

Tsopano pali mayeso apadera omwe mungawone mtundu wamatenda amtunduwu wa matenda ashuga. Zimaphatikizidwa ndi majini ena amtundu wa HLA - anti leukocyte antigen. Tsoka ilo, mayesowa sanapeze ntchito yeniyeni, popeza ngakhale kudziwa kukhalapo kwa majini owopsa, asayansi sangalepheretse kuwonongeka kwa maselo.

Matenda a Type 1 nthawi zambiri amagawidwa m'magulu awiri a 2: autoimmune ndi idiopathic:

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

• Matenda a shuga -95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%

1. Matenda A shuga a Autoimmune kumakwiyitsa chitetezo chaanthu. Pakawonongeka maselo ndi miyezi isanu ndi umodzi atachotsa kuphatikizira kwa insulin, ma autoantibodies amapezeka m'magazi omwe amalimbana ndi maselo a thupi lawo. Monga lamulo, chitetezo chokwanira chimayambitsidwa ndi zinthu zakunja. Pakadali pano, ena mwa iwo adapezeka: chikuku, chikuku, gawo la enterovirus, matenda a CMV, mwa ana osakwana chaka chimodzi - mkaka wa ng'ombe.
2. Matenda a shuga a Idiopathic ochulukirachulukira oimira amitundu ya Asia ndi Negroid. Chithunzi cha chipatala cha odwala ndi chimodzimodzi: maselo a pancreatic amawonongeka mwachangu, shuga amakula, insulini imachepa, koma ma antibodies sangapezeke.

Ambiri mwa anthu odwala matenda ashuga (malinga ndi kuyerekezera kosiyanasiyana kuchokera pa 85 mpaka 95%), omwe amapezeka ndi matenda a shuga 2. Kukula kwa matendawa kumatanthauzanso za kubadwa, ndipo ndizosavuta kutsata: odwala ambiri ali ndi abale apamtima omwe ali ndi matenda ashuga. Choipa chobadwa nacho chimayesedwa kuti ndichizolowezi cha zimakhala kuti tisamamve insulin. Komabe, mitundu yeniyeni yomwe imayambitsa matenda ashuu sichinakhazikitsidwebe.

Zinthu zakunja ndizofunikira kwambiri: zaka (zambiri zopitilira 40), kunenepa kwambiri, kusayenda bwino, zakudya zopanda thanzi. Kubweretsa shuga mumatipi ndizovuta. Maselo a pancreatic pansi pazinthu zotere amakakamizidwa kuti azisungabe kupanga kwa insulin pamlingo wokhazikika. Ngati sangapambane, glycemia imakulanso. Popita nthawi, kupanga insulini kumayamba kutsika, ndiye kuchuluka kwake kapangidwe kake kumacheperachepera.

Chiwopsezo cha maselo a beta mu mtundu 2 wa matenda ashuga ndi munthu payekha: odwala ena kale ali ndi zaka 10 akukakamizidwa kubaya insulin, pomwe ena amatulutsa insulin yawo moyo wawo wonse. Mu gulu la mtundu wachiwiri wa matenda, mawonekedwe awomwe adawonetsedwa: matenda opatsirana a shuga komanso kuchuluka kwa insulini kapena kupatsirana kwakukulu kwa insulin.

Gulu la Russia

Kuyambira 1999, mankhwala aku Russia akhala akugwiritsa ntchito magulu padziko lonse lapansi ovomerezeka padziko lonse lapansi. Zizindikiro kuchokera pagawoli zimasungidwa muzolemba zamankhwala, tchuthi chodwala, chogwiritsidwa ntchito zolemba zamakalata, kupereka lipoti. Tsopano mtundu wachikhumi wa gulu lagwira - ICD-10. Muli mitundu 6 ya matenda ashuga:

1. E10 imaperekedwa kwa odwala omwe ali ndi shuga omwe amadalira insulin, ndiye kuti, iwo omwe, pazifukwa zaumoyo, ayenera kubaya insulin. Pochita, gululi limaphatikizapo matenda a shuga 1.
2. E11 ndiye nambala ya matenda osokoneza bongo omwe amadalira insulin, ndiye kuti, mitundu iwiri. Ngakhale wodwalayo atadwala kwa nthawi yayitali, kaphatikizidwe ka insulin ndi kochepa kwambiri, ndipo amalandira insulin ndi jakisoni, kachidindo ka matenda sikusinthidwa.
3. E12 - gawoli liyenera kuperekedwa kwa odwala omwe matenda a shuga amayamba chifukwa cha zakudya zomwe zimatha. Kugwirizana pakati pa vuto la kuperewera kwa zakudya m'thupi ndi matenda a shuga pakadali pano ndikukaika, kotero manambala awa sagwira ntchito.
4. E13 - mitundu ina ya matenda ashuga, mitundu ya Mody yachilendo imatumizidwa ku code.
5. E14 - matenda ashuga, mtundu wa omwe sanatchulidwe. Codeyo imagwiritsidwa ntchito pamene mtundu wa matenda udakali kukayikira, ndipo chithandizo chiyenera kuyambika nthawi yomweyo.
6. O24 ndi matenda omwe amapezeka pa nthawi ya pakati (matenda a shuga). Ndi gawo limodzi, popeza pambuyo pobadwa shuga amamera.

Mavuto ochepa a metabolic omwe sangatchulidwepo chifukwa cha matenda ashuga ali ndi R73.

Gulu la anthu odwala matenda ashuga lidayamba kugwiritsidwa ntchito mdziko la 1994. Mpaka pano, nthawi yayitali. Matendawa adawulula mitundu yatsopano, njira zamakono zowunikira zawonekera. Tsopano WHO ikugwira ntchito yatsopano ya ICD-11, kusintha kwa iyo kukuyembekezeka mu 2022. Mwambiri, mawonekedwe a matenda ashuga asinthidwa. Mawu oti "wodalira insulin" ndi "insulini -yokha" nawonso sadzaphatikizidwa.

Gulu la WHO

Kugawidwa kofunikira kwambiri tsopano malinga ndi WHO 2017. Idapangidwa mu 1999, pambuyo pake idasinthidwanso mobwerezabwereza.

Mu gulu lino, matenda ashuga satengedwa ngati matenda osiyana, koma ngati matenda. Mchere wapamwamba umawerengedwa kuti ndi imodzi mwazowonetsa za matenda aliwonse mthupi, zomwe zimayambitsa kuphwanya kapangidwe ka insulin. Zifukwa zake zimaphatikizapo njira ya autoimmune, kukana insulini, matenda a kapamba, zolakwika zamtundu.

Asayansi akukhulupirira kuti gulu lamakono lisintha kangapo. Mwachiwonekere, njira yodwala matenda ashuga a 2 ikusinthidwa. Chisamaliro chochulukirapo chidzaperekedwa pazomwe zimapangitsa kunenepa kwambiri ndi moyo wawo. Kugawidwa kwa matenda a shuga a mtundu 1 kudzasinthanso. Mwanjira yomweyo momwe majini omwe amayambitsa mitundu ya Mody 1-6 amawerengedwa, zolakwika zonse zamtundu zomwe zimayambitsa mtundu wa 1 matenda zimapezeka. Zotsatira zake, idiopathic subtype ya shuga idzatha.

Gulu lina

Matenda a shuga a Mtundu Wachiwiri amagawidwanso m'magawo malinga ndi kuopsa kwa matendawa:

Kugawidwa ndi gawo la chiphuphu cha shuga kumagwiritsidwa ntchito kuwunika kupambana kwa chithandizo. Njira yabwino kwambiri yochitira izi ndikugwiritsa ntchito mayeso a glycated hemoglobin (HG), omwe amakupatsani mwayi kuwona kusintha kulikonse kwa shuga kupitirira miyezi itatu.

Pokhapokha ndikotheka kuti matenda ashuga azikhala nawo m'malo ochepera, ndiye kuti sangakhale ndi zovuta zatsopano zomwe zingachitike. Mwachitsanzo, ndi mtundu woyamba wa 1, chiopsezo cha retinopathy chimatsitsidwa ndi 65%, neuropathy ndi 60%. Ubale wolunjika pakati pamalipiro ndi zovuta unapezeka 75% ya odwala matenda ashuga. Pafupifupi 20% ya omwe ali ndi mwayi nthawi zambiri samakumana ndi vuto lililonse la glycemia, madokotala amati izi zimachitika chifukwa cha majini. Mu 5% ya odwala, zovuta zimayambika ngakhale ndi shuga wofupikiratu.

Maiko apakati

Pakati pamagulu abwinobwino a carbohydrate metabolism ndi mtundu 2 shuga, pali mkhalidwe wina wapakatikati, womwe nthawi zambiri umatchedwa prediabetes. Matenda a shuga ndi matenda osachiritsika omwe sangachiritsidwe kamodzi. Matenda a shuga ndi omwe amatha kusintha. Ngati muyamba mankhwala panthawiyi, pang'onopang'ono, matenda a shuga amatha kupewedwa. Mayiko apakati a WHO akuphatikizapo:

1. Kulekerera kwa shuga. NTG imapezeka ngati shuga amalephera pang'onopang'ono ndi wodwala kuposa munthu wathanzi. Kuwunikira koyang'anira pamkhalidwewu ndi kuyesa kwa glucose.
2. Kuthamanga glycemia. Ndi NGN, shuga m'mawa adzakhala pamwamba pamakhalidwe abwino, koma pansi pamalire omwe amakupatsani mwayi wofufuza matenda ashuga. NTG imatha kupezeka kuti imagwiritsa ntchito njira yoyesera ya glucose.

Zovuta izi sizikhala ndi chizindikiro chilichonse, kuzindikira kwake kumachitika kokha chifukwa cha zotsatira za mayeso a shuga. Kuyesedwa kumayesedwa kwa anthu omwe ali pachiwopsezo chachikulu cha mtundu wachiwiri. Ziwopsezo zimaphatikizapo kunenepa kwambiri, cholowa cholakwika, kukalamba, matenda oopsa, masewera olimbitsa thupi, chakudya chopanda thanzi komanso mafuta ochulukirapo komanso mafuta ambiri.

Njira zoyenera zodziwira matenda ashuga

WHO idalimbikitsa njira zodziwira matenda ashuga:

1. Zizindikiro wamba: kukodza mwachangu, ludzu, matenda apafupipafupi, kuyesa kamodzi kwa shuga pamalire a shuga. Border tsopano yavomerezedwa: shuga yothamanga ili pamwamba pa 7; mutatha kudya pamwambapa 11.1 mmol / L.
2. Zizindikiro palibe, koma pali deta kuchokera mayeso awiri kuposa zodziwika, zotengedwa nthawi zosiyanasiyana.

Chizindikiro kwa munthu wathanzi ndizotsatira za kusanthula kwa 6.1 pamimba yopanda kanthu, mpaka 7.8 mutatha kudya. Ngati zomwe zapezedwa ndizapamwamba, koma m'malire mwa matenda a shuga, wodwalayo amapezeka ndi prediabetes. Ngati shuga adayamba kukula kuchokera pa 2nd trimester ya kutenga pakati ndipo ali pakati pa 6.1 mpaka 7 pamimba yopanda kanthu, pamwamba pa 10 atatha kudya, matenda a shuga a gestational amadziwika.

Pakusiyanitsa mitundu 1 ndi 2, njira zowonjezera zimayambitsidwa:

Nthawi zina, njirazi sizokwanira, ndipo madotolo amayenera kukhwimitsa ubongo musanapange chidziwitso choyenera ndi kupereka mankhwala oyenera. Matenda a shuga amadziwika ndi kuchuluka komwe kumachitika nthawi zambiri. Izi zawonekera kwambiri m'zaka 20 zapitazi. Kuphatikiza apo, gulu la anthu amtundu wa shuga likukulira.

M'mbuyomu, anthu ankakhulupirira kuti achinyamata amatha kukhala ndi mtundu umodzi wokha wa matenda, komanso achikulire atatha 40 - 2 mtundu. Tsopano kapangidwe kazomwe zidachitikazo zasintha kwambiri. Odwala ambiri omwe ali ndi shuga wamkulu wazaka 20 mpaka 40 ali ndi zizindikiro zamtundu 2. Mwachitsanzo, ku United States pazaka 8 zapitazi mu zaka zakubadwa izi adayamba kuzindikira mtundu wachiwiri pa 21% pafupipafupi. Pali milandu yodziwitsa ana izi. Zomwezi zikuchitika mmaiko onse otukuka, ndiye kuti, pali kuphatikizanso kwatsopano kwa matenda a shuga.

Ana ndi unyamata amadziwika ndi chitukuko chachikulu cha matenda ashuga. Akuluakulu, pakati pa isanayambike NTG ndi matenda ashuga, pafupifupi zaka 10 zimadutsa, mwa achinyamata pafupifupi 2.5. Komanso, 20% momveka bwino ali ndi mtundu wosakanizika wa matenda ashuga, popeza matenda awo amakula pang'onopang'ono, koma ndizotheka kudziwa autoantibodies omwe amapezeka mu mtundu 1 m'magazi.

Mtundu woyamba wa shuga "wopanda". M'mbuyomu, zidawululidwa mpaka zaka 35-40. Tsopano pali milandu ya matenda mpaka zaka 50. Chizindikiro chodziwika ngati kunenepa kwambiri sichimathandizira kutsimikiza mtima kwa mtundu. M'mbuyomu, mwa kukhalapo kwake kapena kusakhalapo, zinali zotheka kudziwa mtundu wa shuga molondola kwambiri. Tsopano onenepa kwambiri mwa anthu ndiwofala kwambiri, chifukwa chake madokotala amangoganizira za kunenepa kwambiri: ngati kulemera kuli koyenera, matenda a shuga a 2 amakayikiridwa.

Zovuta zambiri

Choyambitsa chachikulu ndimavuto a glycation omwe amapezeka mu minofu polumikizana ndi shuga wamagazi ambiri. Mapuloteni amamangidwa molekyulu ya glucose, chifukwa chake, maselo sangathe kugwira ntchito zawo. Makoma amitsempha yamagazi omwe amalumikizana mwachindunji ndi shuga amatha kugwidwa ndi glycation. Potere, wodwala matenda ashuga amakula angiopathies a magawo osiyanasiyana.

Kusokonezeka m'matumbo akuluakulu omwe ali ndi matenda a shuga kumawopseza ndi matenda amtima. Ma Microangiopathies amatsogolera kuphwanyidwa kwamagazi kumisempha yakutali ndi mtima, nthawi zambiri mapazi a wodwalayo amavutika. Zimakhudzanso impso, zomwe zimasefa shuga m'magazi miniti iliyonse ndipo zimakonda kuzichotsa mkodzo.

Chifukwa cha glycation wa hemoglobin, kuperekera kwa oksijeni ku minofu kumasokonekera. Woopsa milandu, mpaka 20% ya hemoglobin amasiya kugwira ntchito. Mafuta ochulukirapo mwa mtundu wa sorbitol amawaika m'maselo, chifukwa cha momwe zosmotic zimasinthira mwa iwo, zimakhala. Zowonjezera za sorbitol mu minyewa ya mitsempha, retina ndi mandala ndizowopsa.