Mavuto a shuga

Matenda a shuga ndi matenda am'mthupi, omwe amawonetsedwa ndi kupanga insulin yokwanira kapena kuphwanya zochita zake. Matendawa amatha kuthandizidwa ndi zinthu zingapo zomwe zimagawika m'magulu awiri akuluakulu: pathologies apakati komanso aakulu (mochedwa) pathologies. Zimachokera munjira zotere zomwe zimakambidwa munkhaniyi kuti kutalika kwa moyo wa wodwala zimadalira.

Matenda a shuga ketoacidosis

Mavuto a shuga akuphatikizira matenda ashuga a ketoacidosis - kuwonongeka kwa njira za kagayidwe kachakudya komwe kamayambitsa matenda omwe akuwoneka ndi mfundo izi:

• Mtheradi (wokhala ndi matenda a shuga 1 kapena wachibale (wokhala ndi mtundu wa 2 matenda) kuchepa kwa insulin;
• kuchuluka kwa shuga m'magazi (pamwamba pa 14 mmol / l);
• kupezeka kwa matupi acetone m'mwazi ndi mkodzo;
• kusintha kwa magazi pH potengera acidosis (pH yochepera 7.2);
• kusazindikira wodwalayo.

Tsoka ilo, zotsatira zakupha sizachilendo ndi ketoacidosis. Malinga ndi data yosasindikizika, tikulankhula za 7%% yamatenda onse azachipatala. Chiwopsezocho chimawonjezeka kangapo ngati wodwalayo ndi wokalamba yemwe akuvutika ndi kuthamanga kwa magazi, komanso ngati pali matenda angapo okhudzana.

Kununkhira kwa acetone mkamwa - chofunikira chofufuzira chazovuta

Zomwe zimayambitsa zovuta za ketoacidotic mu shuga ndi:

• matenda opatsirana;
• yotupa njira ya pachimake chikhalidwe;
• kuwonongeka kwamakina;
• othandizira opaleshoni;
• kumwa mankhwala a mahomoni (glucocorticosteroids, mahomoni ogonana) kapena okodzetsa;
• nthawi yobala mwana.

Komabe, chochititsa chovuta kwambiri pamavuto chimawoneka kuti ndi chosayenera cha odwala matenda ashuga okha. Tikuyankhula zodumphira jakisoni wa insulini, kuwerengera kolakwika kwa mankhwalawa, kugwiritsa ntchito mankhwala omwe atha, njira yolakwika yoyendetsera mahomoni.

Zizindikiro ndi chithandizo

Matenda a shuga a ketoacidosis amakula kwa maola angapo, ndipo amatha masiku angapo. Ludzu lachilengedwe, kukodza pokoka, khungu louma, kuchepa kwa odwala, ndi kufooka kowonjezereka kukukulira. Pambuyo pake, kusanza kumachitika, kupweteka kwam'mimba, kununkhira kwa acetone mu mpweya wotulutsidwa. Zizindikiro zooneka.

Pozindikira mwadzidzidzi, shuga ndi acetone mu mkodzo amatsimikiza pogwiritsa ntchito zingwe zowonekera. Njirayi imagwiritsidwa ntchito pofotokoza momwe wodwalayo alili kunyumba kapena kuchipinda chadzidzidzi kuchipatala. Gome ili pansipa likuwonetsa njira zomwe matenda ashuga a ketoacidosis (DKA) amatsimikiza.

Chithandizo chimaphatikizapo:

• insulin makonzedwe;
• kukonza madzi osankhidwa a electrolyte;
• kuthetsa kusintha kwa magazi pH;
• mankhwalawa ochizira matenda.

Hyperosmolar hyperglycemia

Uku ndi kuwonongeka kwamphamvu kwa "matenda okoma", omwe amadziwika kuti kulibe matupi a acetone mkodzo ndi magazi a wodwalayo, koma amakhala ndi shuga wambiri (amatha kufikira 50 mmol / l), madzi am'madzi am'mimba komanso kuthamanga kwamadzi. Izi ndi zitsanzo zapamwamba za kapangidwe ka matenda a shuga a 2.

Kuphwanya malamulo a kumwa ndi chimodzi mwazomwe zimayambitsa chitukuko cha hyperosmolar coma

Zomwe zimayambitsa kukula kwa hyperosmolar state:

• matenda opatsirana omwe amakhala ndi hyperthermia, kusanza;
• pulmonary embolism;
• pachimake kutupa kwa kapamba;
• thrombosis yamatumbo a mesenteric;
• magazi
• kutentha;
• kulephera kwa impso;
• peritoneal dialysis;
• kutentha kwa stroko kapena hypothermia.

Kuwonetsedwa kwa kupsinjika ndi chithandizo chake

Matenda a shuga ndi matenda ake

Hyperosmolar complication imayamba pang'onopang'ono kuposa mkhalidwe wa ketoacidosis. Zizindikiro zoyambirira zimawonekera masiku angapo, kapena ngakhale masabata, chithunzi chakuwala chisanachitike. Pakufufuzidwa, wodwalayo amakhala wopanda madzi: khungu lake ndi minyewa yake imakhala youma, turgor yafupika, palpation imazindikira kuti mawonekedwe amaso adakhala ofewa.

Pambuyo pake, kuthamanga kwa magazi kumachepa, pambuyo pokodza kwambiri, nthawi yochepetsetsa mkodzo kapena kusakhalapo kwathunthu kumachitika. Palibe fungo la acetone mu mpweya wotuluka komanso matupi a acetone m'magazi ndi mkodzo (zizindikiritso zapadera zomwe zimaloleza kusiyanitsa zovuta).

Zizindikiro zamitsempha za phokoso la matenda a shuga 2:

• kukokana
• kusokonekera kwa mawu;
• nystagmus (kusinthasintha kwa maso kopangika);
• paresis ndi ziwalo;
• khungu awiri mkati mwa kotala kapena theka la gawo lowonekera.

Chithandizo cha matenda a pathology ndizofanana ndi kuchititsa mankhwala a ketoacidosis, koma ali ndi mawonekedwe ena. Kukonzanso madzi kumayambira ndi njira ya glucose, pambuyo pake amasinthana ndi hypotonic, kenako ndikupanga yankho la thupi la sodium chloride. Mafuta ochulukirapo m'thupi amachepa pang'onopang'ono, monganso hyperosmolarity.

Lactic acidosis (lactic acidosis)

Awa ndimatenda omwe ali ndi vuto lalikulu la matenda ashuga. Amadziwika ndi metabolic acidosis komanso kuchuluka kwa lactic acid m'magazi. Tsoka ilo, lactic acidosis mu milandu yambiri yamankhwala imakhalabe yopanda chidziwitso, zotsatira zakupha zimapezeka mu 80% ya odwala.

Vutoli limawonekera mwa kuchotsedwa pang'onopang'ono kwa lactic acid m'thupi. Itha kuchitika motsutsana ndi mbiri yakukula kwa minofu hypoxia panthawi yazinthu zosiyanasiyana, motsutsana ndi kufooka kwa mtima, ndi poyizoni kaboni.

Zomwe zimayambitsa zovuta za matenda ashuga:

• chiwindi kapena kulephera kwa impso;
• kuchepa magazi
• zotupa njira;
• kapamba
• kuperewera kwa adrenal;
• kutentha kwa sitiroko;
• kugwiritsa ntchito mankhwala (salicylates, ethanol, biguanides).

Lactic acid molekyulu - chinthu chomwe chimadziunjikira m'thupi motsutsana ndi lactic acidosis

Kuti mupeze vuto la pathological moyenera, ndikofunikira kumveketsa kuchuluka kwa lactate m'magazi. Monga lamulo, zizindikiro zake zimaposa 2.2 meq / l, nthawi zambiri - 5 meq / l. Ndikosavuta kudziwikitsa moyenera, chifukwa zizindikirazo sizotsimikizika. Amatha kupanga mtundu wa poizoni wa biguanide. Chizindikiro chokha chomwe chimakupangitsani kuganiza ndi kupweteka kwa minofu. Zimachitika motsutsana ndi maziko a kudzikundikira kwa lactic acid m'thupi.

Chithandizo chimakhala poika oxygen mankhwala, mtsempha wa magazi makonzedwe osakhalitsa insulin, kuyambitsa ochepa Mlingo wa sodium bicarbonate, ndi hemodialysis.

Hypoglycemia

Chitsanzo cha zovuta za shuga kwa ana ndi akulu. Mkhalidwe umakhala wodziwika ndi kuchepa kwa kuchuluka kwa shuga m'magazi ochepera 2.7 mmol / L, komwe kumayendetsedwa ndi chithunzi cha chipatala, kapena pansi pa 2.2 mmol / L, ngakhale zizindikiro zilipo. Hypoglycemia ili ndi mitundu iwiri:

• wofatsa - wodwalayo amatha kudzipulumutsa mwaokha popanda kuwonetsa zovuta;
• kwambiri - matenda akuphatikizidwa ndi kusokonezeka kwa chikumbumtima, munthu sangathe kuyima payokha payokha.

Izi ndi zinthu zazikulu zomwe zimapangitsa kuti pakhale zovuta za matenda ashuga a mtundu woyamba kapena wachiwiri. Zomwe zimaphatikizidwa ndi mankhwala a hypoglycemic mankhwala zimagawidwa m'magulu atatu akulu:

1. Mankhwala osokoneza bongo a insulin kapena mapiritsi ochepetsa shuga - wodwalayo adasankha molondola mankhwalawo (wogwiritsidwa ntchito kuposa momwe amafunikira), zolakwika pakugwiritsidwa ntchito kwa cholembera cha insulin, mita yolakwika ya glucose (manambala kuposa momwe ilili), malingaliro osokoneza bongo oyambira zolinga za kudzipha.
2. Zosintha pakuchitika kwa insulin kapena mapiritsi a othandizira a hypoglycemic - kusintha kwa mankhwalawa kupita kwina, kuchedwa kuchotsedwa kwa mankhwalawo motsutsana ndi kulephera kwa impso, kukhalapo kwa ma antibodies ku mahomoni a pancreatic, njira yolakwika yoyendetsera, kuphatikiza mitundu yambiri ya hypoglycemic.
3. Kuchuluka kwa chidwi cha mahomoni - zochitika zolimbitsa thupi, nthawi pambuyo pobadwa kwa mwana pakuwala, ku adrenal kapena chiwindi.

Pali zinthu zomwe zimagwirizanitsidwa ndi thanzi la anthu. Mwachitsanzo, wodwala amatha kuphonya nthawi yakudya kapena chakudya chachikulu, zolimbitsa thupi zomwe mwina sizinawerengeredwe muyezo wa mankhwalawa, kumwa mowa, masabata 12 oyamba ali ndi pakati komanso nthawi yobereka.

Shuga wochepa wamagazi - mkhalidwe wa hypoglycemia womwe umafuna kukonzedwa kwachipatala msanga

Zizindikiro ndi chithandizo

Munthawi yapadera, zovuta za matenda a shuga (mtundu 1, mtundu wachiwiri, mawonekedwe a mawonekedwe) odwala amadandaula kutuluka kwambiri, kupweteka mutu, chizungulire, kunjenjemera, nseru ndi njala yayikulu.

Pambuyo pake zizindikiro za gulu la neuroglycopenic la zizindikiro zimalowa. Izi zimaphatikizapo kufooka, kusokonezeka khungu, kumva mantha, kusokonezeka m'malo ndi nthawi, kuiwalika kwakanthawi. Mndandandandawu umaphatikizaponso kusokonezeka kwa chikumbumtima komanso kugona.

Njira zothetsera vuto la hypoglycemic ziyenera kuyambitsidwa kwa odwala omwe ali ndi matenda ashuga, pamene kuchuluka kwa glucose kuli 3.3-3.7 mmol / L. Ili ndiye njira yabwino kwambiri yomwe siyingalole shuga kutsikira. Hypoflycemia yofatsa imachotsedwa pakumatula chinthu chokoma. Mwachitsanzo, maswiti, masikono, tiyi wowotcha otentha, kupanikizana. Anthu odwala matenda ashuga omwe ali ndi mankhwala a insulin ayenera kukhala ndi chinthu chokoma pafupi.

Zochita pazovuta zazikulu (zokhala ndi matenda a shuga 1, 2, mawonekedwe a mawonekedwe)

1. Ikani munthuyo pambali pake, kuti pakalibe kuzindikira komanso kusanza, kusanza sikutsikire mu bronchi.
2. Chotsani zinyalala zonse za chakudya pamlomo wamkamwa. Simungadzaze munthu ndi zakumwa zotsekemera pakamwa pake ngati sakudziwa.
3. Njira yothetsera shuga imalowetsedwa m'mitsempha kufikira wodwala atazindikira.
4. Glucagon amalowetsedwa pansi pakhungu kapena minofu. Izi zimaperekedwa mu syringe chubu.
5. Kugonekedwa ku dipatimenti ya chipatala cha endocrinology kapena dipatimenti yokhazikitsanso chisamaliro chachikulu.

Ngati munthu ali ndi nkhawa kwa maola opitilira 4-6, chiopsezo chotenga matenda am'mimba komanso zotsatira zake zimatha kuwonongeka kangapo.

Mavuto aakulu

Kutalika ndi moyo wa anthu odwala matenda ashuga pakadali pano zimatengera kuti zovuta za matenda ashuga zayamba bwanji komanso momwe amapitira patsogolo. Mavuto onse obwera chifukwa cha matenda ashuga amagawika m'magulu akulu akulu: micvasvas, macrovascular pathology, diabetesic neuropathy.

Mavuto osokonezeka - pathologies omwe sangathe kuchiritsidwa

Gulu la ma microvascular pathologies limaphatikizapo retinopathy (kuwonongeka kwa mawonedwe ophatikizira) ndi nephropathy (kuwonongeka kwa impso). Mavuto a macrovascular amaimiridwa ndi matenda a mtima, ubongo ndi mtsempha wamagazi am'munsi. Matenda a diabetesic neuropathy potengera malo omwe amawonongeka amagawika padera ndi kudziyimira pawokha.

Matenda a shuga

Chimodzi mwazosiyanasiyana za kuwonongeka kwa mtima pamaso pa matenda a shuga, omwe amadziwika chifukwa chokhudzana ndi matenda a impso. Pali mitundu iwiri:

• nodular glomerulosulinosis;
• glomerulosulinosis ya mtundu wa kupukusa.

Zotsatira zake ndi kulephera kwa aimpso. Nephropathy imapezeka mwa wodwala aliyense wachitatu yemwe ali ndi mtundu umodzi wa matenda, komanso mwa wachinayi aliyense wamankhwala omwe amadzimvera pawokha. Monga lamulo, kuvutikaku kumachitika zaka 10-15 pambuyo poyambika kwa matenda ashuga.

Matenda a diabetes a nephropathy amakhala ngati kulibe magazi okwanira, kuthamanga kwa magazi, chifukwa cha cholowa cham'tsogolo. Chizindikiro chachikulu chachipatala cha kuwonongeka kwa impso ndi microalbuminuria (mawonekedwe a mapuloteni ochepa mkodzo), omwe amadutsa mu proteinuria (mapuloteni ambiri mumkodzo wamkodzo).

Glomerulosclerosis - matenda a impso, limodzi ndi ma protein a mkodzo

Microalbuminuria imadziwika ndi ziwerengero zotsatirazi: 20-199 mg / ml ya albumin mumkodzo, 30-299 mg yopangidwa patsiku. Mu proteinuria, ziwerengero zimaposa 200 mg / ml ndi 300 mg, motsatana.

Mfundo zoyambira:

• glycemic control;
• ACE zoletsa;
• ma statin ndi ma fibrate (pakalibe kutenga pakati);
• Kuletsa kudya mapuloteni pakudya.

Matenda a shuga a retinopathy

Kugonjetsedwa kwa choroid kumbuyo kwa matenda ashuga. Amakhala pambuyo pa zaka 5-7 kuyambira pachimake matenda ena aliwonse odwala matenda ashuga, patatha zaka 20 - mwa 85% milandu.

Magawo a retinopathy (zithunzi zokhala ndi gawo losinthika la fundus zitha kuwoneka patsamba lodziwika bwino):

• Fomu yosavuta - pakaunikiridwa imatsimikiziridwa ndi kukhalapo kwa aneurysms ang'ono ndi othandizira okhazikika, palibe zodandaula kuchokera kwa wodwala.
• Maculopathy - hemorrhages ndi kukhalapo kwa olimba exudates mu macula zimawonedwa, zowona acuity zimakhalabe zachilendo.
• Preproliferation - mawonekedwe a ofewa exudates, mitsempha imakhala yodziwika, zovuta zam'mimba zimachitika.
• Kupitilira patsogolo - neoplasms, kuchepa kwamphamvu kuwona mpaka khungu, khungu.

Zofunika! Mankhwala, kukonza glycemia adalembedwa, mu gawo la kukonzekera - laser Photocoagulation (imalola kuchepetsa kutaya kwamaso), pang'onopang'ono - gawo.

Zosintha zomwe zimawonedwa pakuyang'ana kwa fundus ya wodwala kumbuyo kwa retinopathy

Matenda a shuga

Kupsinjika kosasintha komwe kumadziwika chifukwa cha kuwonongeka kwa manjenje. Patatha zaka 15 chitukuko cha matenda ashuga chikuwoneka mu 80% ya odwala. Zimachitika motsutsana ndi maziko a kuwonongeka kwa mtima, kusintha kwa njira zowonera.

Peripheral neuropathy imayendera limodzi ndi zodandaula za kupweteka kwambiri, kupweteka kwam'munsi, dzanzi, kumva kuwawa. Pali kuphwanya kwamtundu wa kutentha kwa boma, kuchepa kwa tactile, kumva kupweteka (nthawi zambiri odwala matenda ashuga samva kuwoneka kwa chimanga, mabala pamiyendo, zomwe zimatsogolera kumatenda komanso kukula kwa matenda ammimba a matenda ashuga). Pali kukokana usiku, kulephera kuyenda mtunda wautali, kusakhazikika kumachitika mu gait.

Potsutsana ndi kukhazikika mkati mwa ziwalo zamkati, tikulankhula za autonomic neuropathy:

• matenda mbali imodzi ya mtima - chizungulire, kuthamanga kwa magazi, palpitations mtima;
• chikhodzodzo neuropathy - mkodzo kukodza, kwamikodzo kugona;
• kuwonongeka m'mimba - kuukira kwa mseru komanso kusanza, gastroparesis;
• khungu neuropathy - kuuma kapena thukuta.

Mfundo za mankhwalawa zimaphatikizapo kukwaniritsa ziwerengero zabwino za glycemic, kutenga ma antidepressants ndi anticonvulsants, kukonzekera kwa thioctic acid, mavitamini a B, komanso physiotherapy.

Mankhwala othandizira a Thioctic - gulu la mankhwala omwe amagwiritsidwa ntchito kwambiri mu shuga

Matenda a matenda ashuga

Kupsinjika koteroko kumadziwika ndi kukhalapo kwa matenda, zilonda kapena kuwonongeka kwa timinofu tating'onoting'ono ta kumapazi, komwe kumachitika motsutsana ndi maziko a kuphwanya magazi chifukwa chakuwonongeka kwa ziwiya zam'munsi. Amapezeka mu kotala odwala matenda ashuga. Njira ya pathological yomwe imachitika ndi odwala imatha kuwonekera pazithunzi zomwe zalembedwa pamasamba apadera.

Magulu omwe ali pachiwopsezo chotenga matendawa ndi monga:

• odwala matenda ashuga okhala ndi zotumphukira polyneuropathy;
• kukhalapo kwa matenda aliwonse a mitsempha;
• kupunduka kwa phazi kwa komwe kunachokera;
• kukhalapo kwa zovuta zina za matenda ashuga;
• kusuta fodya ndi kumwa mowa kwambiri;
• ukalamba.

Kuchiza kumakhazikitsidwa ndi mankhwala a insulin, kutenga maantibayotiki, heparin, antiplatelet othandizira, venotonics, kulimbikitsa mankhwala, antispasmodics ndi NSAIDs.
Matenda a shuga ndi zovuta zake ndi mawu awiri omwe, mwatsoka, sangakhalepo padera. Ndikofunikira kuti muchepetse kukula kwa zikhalidwe za pathological, chifukwa ndizosatheka kuzichiritsa pakadali pano.