Matenda a shuga ndi njira yothandizira kagayidwe kachakudya komwe kamachitika chifukwa chophwanya kapangidwe ka insulin kapena kusagwira bwino ntchito kwake mthupi la munthu. Chowonetsera chachikulu cha mitundu yonse yamatendawa ndimatenda a glycemia (glucose wamagazi). Matendawa amapangitsa kuti pakhale zovuta komanso zovuta zovuta, zomwe zimayambitsa kufa pakati pa odwala.
Matenda a shuga 1 amtundu wa matenda. Zimachitika chifukwa chosakwanira kupanga mahomoni amtundu wa kapamba. Pali milandu yovuta kukhazikitsa mtundu woyenera wa matendawa, koma pochita ndichofunika kwambiri kuti musadziwitse mtundu wake ndendende, koma kuti mupeze zabwino zomwe zimachitika mwa wodwalayo.
Physiology ya kagayidwe kazakudya
Kuphatikiza pa insulin, kapamba amapanga glucagon, somatostatin ndi pancreatic polypeptide. Zonsezi ndizolumikizana: glucagon amadziwika kuti amalimbikitsa kupanga insulin, ndipo somatostatin imakhala ndi zoletsa.
Pambuyo poti zinthu zokhala ndi ma carbohydrate azilowa m'matumbo am'mimba, zimagwera ku monosaccharides ndikulowa m'magazi. Zotsatira zake ndi hyperglycemia. Insulin imayankha m'magawo awiri. Kuchuluka kwa mahomoni omwe amapezeka m'maselo mkati mwa chakudya amaperekedwa nthawi yomweyo kulowa m'magazi. Zikondwererozo zimapitilizabe kuphatikiza thunthu mpaka kuwerenga kwa glucose kufikira malire ovomerezeka.
Etiology ya matenda a shuga 1
Matenda a endocrine dongosolo lino amatha kukhala ndi zaka zilizonse, koma nthawi zambiri amakhudza achinyamata. Mtundu woyamba wa matenda a shuga ndi njira yomwe imakhala ndi tsogolo, koma njira za autoimmune zimapereka malo olemekezeka mu pathogenesis.
"Matenda okoma" - matenda ophatikizidwa ndi glycemia yayikulu
Pali malingaliro omwe mtundu 1 wa shuga umatha kuchitika chifukwa cha pathological zochita za enteroviruses, kachilombo ka rubella, chithandizo cha nthawi yayitali pancreatic yoyipa ndi cytostatics.
Matenda a shuga a Mtundu woyamba amapezeka nthawi zambiri limodzi ndi matenda ena:
- matenda a adrenal glands;
- alopecia;
- vitiligo;
- autoimmune chithokomiro;
- Matenda a Crohn;
- rheumatism.
Njira yopititsira patsogolo
Zizindikiro zazikulu za matenda amtundu 1 zimawonekera pomwe njira ya autoimmune idawononga oposa 75-80% ya maselo otulutsa insulin. Achichepere amadziwika ndi chitukuko chofulumira, ndipo kuyambira pomwe chiwonetserocho chikufika mpaka pakayamba zovuta, pakatha milungu yochepa chabe.
Milandu imadziwika, m'malo mwake, imadziwika ndi boma laulesi kwa odwala okalamba. Anapezeka kuti ali ndi matenda a shuga a 2, mankhwalawa adachitika ndi mankhwala a hypoglycemic, koma patatha zaka zochepa, zizindikiro za kuperewera kwa insulin kwathunthu zidawonekera.
Pathogenesis ya mtundu wodwala matenda a insulin 1 imachokera ku kuperewera kwathunthu kwamafuta. Chifukwa cha kuperewera, njira ya glucose yomwe imatenga minofu imasokonekera, ndipo mphamvu yanjala imayamba. M'magawo oyambilira, njira zamagetsi zomwe zimapangidwira mawonekedwe a gluconeogenesis zimakhazikitsidwa, momwe thupi limayeserera palokha kuti lipange glucose popanda kulandira mphamvu zamagetsi. Izi zimakweza mayendedwe ake kwambiri m'magazi.
Zilumba za Langerhans-Sobolev - malo omwe amapezeka ndi maholide otulutsa zikondamoyo
Kuchita kwa chiwindi kumapanikizidwa, ndipo mulingo wa matupi a ketone (acetone) m'magazi umakwera, zomwe zimapangitsa kuti pakhale zovuta za mtundu 1 shuga mellitus - ketoacidosis.
Magawo a matenda
Popanga matenda a shuga 1, komanso mitundu yonseyo, pali magawo atatu:
- prediabetes;
- gawo latent;
- gawo lowonekera.
Matenda a shuga ndi nthawi yoyambirira pomwe thupi la munthu limakonzedweratu kuti lipange chithunzi chowoneka bwino cha matendawa. Magulu omwe ali pachiwopsezo amaphatikizapo omwe amadziwika ndi izi:
Mchere wa shuga mu shuga- kukhalapo kwa kholo limodzi kapena onse odwala;
- kubadwa kwa mwana wokhala ndi mbiri ya macrosomia;
- kukhalapo kowonjezera thupi;
- atherosulinosis;
- kagayidwe kachakudya matenda obadwa nawo chikhalidwe;
- kukhalapo kwa zotupa;
- mankhwala a steroid a nthawi yayitali.
Gawo lotsiriza limadziwika ndi kusowa kwa zizindikiro, kuchuluka kwa magazi ndi mkodzo pofuna kudziwa kuchuluka kwa shuga kungakhalenso kwabwinobwino. Komabe, popanga mayeso ololera a glucose (kusanthula ndi "katundu"), ndizotheka kumveka bwino za kukhalapo kwa matenda.
Gawo lowonekera limatsatiridwa ndi mawonetseredwe owoneka bwino amatenda ndikuwatsimikiziridwa ndi maphunziro a labotale.
Miyezo yamatenda
Madigiri atatu a zovuta zovuta:
- Kuwala - zizindikiro za shuga zosakwana 10 mmol / l, kusowa kwa glucosuria, chithunzi cha chipatala sichinafotokozeredwe bwino.
- Wapakatikati - shuga wambiri pamtunda wa 10-12 mmol / l, glucosuria, zizindikiro zotchulidwa.
- Zambiri - njira zonse za metabolic zimalephera, kuchuluka kwa shuga m'magazi ndi mkodzo, chiopsezo chokhala ndi vuto la matenda ashuga komanso zovuta kuchokera ku zowonera, impso, mtima ndi mitsempha yamagazi.
Zizindikiro
Insulin-wodwala matenda a shuga a mellitus (IDDM) amasiyana ndi mitundu ina yamatendawa pakuwonetsa kwake. Odwala amadandaula za kuyabwa kwa khungu, matenda a m'matumbo, kuphipha kwamkodzo. Anthu odwala matenda ashuga amatha kumwa malita oposa 7 a madzi patsiku.
Ludzu lalikulu ndi chimodzi mwazizindikiro zazikulu za matendawa.
Chizindikiro chofunikira chazachipatala cha mtundu 1 wa matenda a shuga (kudalira-insulin) ndicho kuchepa kwambiri kwa thupi. Odwala amatha kutaya 8-10 kg m'miyezi ingapo. Pali ulesi, kugona mosalekeza, kutsika kwapang'onopang'ono. M'magawo oyamba, kulakalaka kwambiri kumachitika, koma kumasinthidwa ndi zizindikiritso zakusowa kudya chakudya, mawonekedwe a fungo la acetone kuchokera mkamwa, kupumira mseru, ndipo nthawi zina ngakhale kusanza.
Zizindikiro zosonyeza matendawa:
- mabala osachiritsika osachiritsika ndi zithupsa pakhungu;
- dermatomycosis;
- kutsika kwa khungu;
- "matenda a shuga" ana;
- mthunzi wachikasu wambale, miyendo ndi manja;
- pafupipafupi kutupa kwa mano, kutuluka kwawo magazi.
Mavuto
Kusintha kwadzidzidzi kwa shuga m'magazi kumapangitsa kuti pakhale zovuta komanso zovuta zovuta. Comas amadziwika kuti ndiowopsa kwambiri, chifukwa amafunika chithandizo chamankhwala kwa odwala. Kuperewera kwakanthawi kovomerezeka kumabweretsa imfa.
Choyambitsa chachikulu cha zovuta zovuta ndimatenda a mitsempha yamagazi ndi mitsempha, yomwe imadziwika ndi matenda a shuga. Hyperglycemia imatha kuwononga makoma a mtima ndi mafupa am'mitsempha, amasintha magwiridwe antchito awo. Kuwongolera kwa mitsempha yayikulu ndi yaying'ono kumachepetsedwa, zomwe zimayambitsa kuphwanya kwamphamvu kwa magazi kumisempha ndi kupititsa patsogolo kwa hypoxia mpaka gangore.
Zingwe zam'mitsempha zimadwala kuwonongeka kwa ziwiya za epineural. Masinthidwe abwinobwino otulutsa, maselo amitsempha amwalira. Zotsatira zake ndikuphwanya kwa innervation ndi matenda a mitundu yonse yamvekedwe.
Mavuto akulu a matenda ashuga amtundu woyamba alembedwa pagome.
Mavuto a matenda oopsa komanso osachiritsika ndi omwe amayambitsa kufa kwakukulu pakati pa odwala matenda ashuga.
Zizindikiro
Kuzindikiridwa kwa "matenda a shuga a insulin" kumapangidwa pamaziko a zizindikiro wamba ndi hyperglycemia yotsimikiziridwa ndi labotale. Katswiri amasiyanitsa ndi izi:
- matenda ashuga;
- polydipsia ya chikhalidwe cha psychogenic;
- Hyperfunction wa parathyroid tiziwopsezo;
- aakulu aimpso kulephera.
Kuyesa kwa magazi
Kuphatikiza pa kuwunika kofotokozera, komwe kumawonetsa dziko lamunthu pamaziko a zinthu zomwe zimapangidwa, hemoglobin, ESR, kuphatikizika kwa magazi, endocrinologist imapereka njira zotsimikizira izi:
- Kuyesedwa kwa magazi kwa glucose - komwe kumapangitsa magwiridwe ake mu magazi a capillary, kumaperekedwa pamimba yopanda kanthu kuchokera pachala.
- Biochemistry ndi njira yowerengera magazi a venous. Mmenemo, kuchuluka kwa shuga kumasiyana ndi 10-12% kuchokera pazomwe zili m'magazi a capillary.
- Kutsimikiza kwa kulolerana - kumakupatsani mwayi wofotokozera kuchuluka kwa shuga ndi insulin m'magazi musanayambe komanso pambuyo pa "katundu" wazakudya.
- Glycated hemoglobin - kusanthula komwe kumatsimikizira kuchuluka kwa shuga masiku 60-90 apitawa.
- Fructosamine - Yambitsani shuga m'masiku 14-21 apitawa.
Kuwerengera mkodzo
Pakuwunika kambiri, glucosuria sayenera kukhala yabwinobwino (mfundo zovomerezeka ndizovomerezeka za 0.8 mmol / l). Kusanthula kwa tsiku ndi tsiku, kuphatikiza ndi kukhalapo kwa shuga, kumakupatsani mwayi kuti muwone kuchuluka kwa mkodzo wotulutsidwa komanso kumveketsa kupezeka kwa polyuria kapena oliguria wodwala.
Zida zoyesa kutsimikiza kwa matupi a acetone mu mkodzo - njira yofotokozera yomwe imagwiritsidwa ntchito kunyumba ndi ma labotale
Dokotala atha kuyitanitsa mayeso apadera kuti adziwe matupi a ketone mu mkodzo. Izi ndi zinthu za metabolic, mawonekedwe ake omwe amawonetsa kuphwanya kwa lipid ndi carbohydrate metabolism.
Zochizira
Ndizosatheka kuchiritsa matenda ashuga ndi njira zamakono, makamaka poganizira kuti odwala ambiri amapita kwa dokotala ndi zizindikiro zowonekeratu za matendawa. Pazakudya za matenda amtundu 1, tinganene kuti chithandizo cha insulin ndiye maziko a chithandizo. Iyi ndi njira yochotsera insulin ndi mapangidwe ake.
Kuchita kwakeko kunawonetsedwa ndi regimen yozama kwambiri ya insulin, yomwe imafanana ndi kubisala kwachilengedwe kwa chinthu chopanga mahomoni. Kufunika kwake kumaperekedwa ndi majakisoni awiri a mankhwala apakati kapena nthawi yayitali. Kuchuluka kwa ma analogi omwe agwiritsidwa ntchito sikuyenera kupitirira 50% ya zomwe zikufunika patsiku.
Kupanga zakudya zopatsa mphamvu kwa mahomoni kumaloledwa ndi kuyambitsidwa kwa insulin yochepa kapena ya ultrashort musanadye. Kuchuluka kwa mankhwalawa amawwerengedwa kutengera kuchuluka kwa chakudya chambiri chomwe mumalandira pakudya komanso zizindikilo za shuga panthawiyi.
Kukonzekera kwa insulin kumatumizidwa mosakakamiza. Kuti muchite izi, gwiritsani ntchito syringe ya insulin, pampu kapena cholembera. Njira yodziwika kwambiri ndi cholembera, chifukwa palibe chosasangalatsa ndikamayambitsa bizinesiyo, njira ya jakisoni ndiyosavuta komanso yabwino.
Mndandanda wa ma insulins omwe agwiritsidwa ntchito:
- Humalog, Aspart - zochita za ultrashort;
- Insuman Rapid, Humulin P - zochita zazifupi;
- Protafan NM, Insuman Bazal - nthawi yayitali;
- Levemir, Lantus - kuchitapo kanthu kwa nthawi yayitali.
Cholembera cha syringe - njira yosavuta komanso yosavuta yothandizira kuperekera mahomoni
Malamulo a zopatsa thanzi
Zosankha za odwala matenda ashuga zimakhazikitsidwa pakutsatira malamulo a zakudya zochepa. Kafukufuku watsimikizira kuyenera kwa zakudya zotere, chifukwa zimakupatsani mwayi woperekera chipukutitso cha matendawa ndikuwasunga nthawi yayitali.
Malamulo oyambira:
- Kuchepetsa kuchuluka kwa chakudya chambiri chomwe chimaperekedwa ku 50-60 g patsiku.
- Kusintha zinthu ndi ma digestible saccharides ndi omwe ali ndi fayilo yambiri pakuphatikizika.
- Sinthani shuga kuti mulowe m'malo (fructose, sorbitol) kapena gwiritsani ntchito zotsekemera zachilengedwe (stevia, mapulo manyowa).
- Chakudya chilichonse chimayenera kukhala ndi mapuloteni ofunikira.
- Zipatso, mtedza, chokoleti chakuda, uchi - zakudya zomwe ziyenera kukhala zochepa, koma zimatha kudyedwa ndi "matenda okoma".
- Ganizirani kuchuluka kwa mndandanda wamalonda a glycemic popanga zinthu menyu.
- Muyerekeze kuchuluka kwa shuga m'magazi lachiwiri komanso mkati mwa ola lachiwiri chakudya chikamalowa m'thupi, kujambula zambiri mu diary.
Zochita zolimbitsa thupi
Zochita zolimbitsa thupi zazing'ono ndizothandiza kwa odwala matenda ashuga. Ndi zochitika zilizonse, pali kuwonjezeka kwa chidwi cha maselo ndi minyewa kuti ipangire insulin, magawo a magazi a magazi amapita patsogolo, kulemera kwa thupi kumachepetsedwa, ndipo mtima umalimbitsidwa.
Kupanga masewera olimbitsa thupi kumathandizira dokotala. Katundu wofunikira sasowa, koma theka la ola la masewera olimbitsa thupi limangopindulitsa.
Ngakhale matenda ashuga amawerengedwa kuti ndi matenda owoneka bwino, si chifukwa chololera. Chithandizo chokwanira, kutsatira malamulo a zakudya komanso kuchita masewera olimbitsa thupi ndikofunikira kuti muthe kubwezeretsanso ndalama komanso kupewa kutulutsa zovuta.
