Zowopsa mu shuga

Mosasamala mtundu, odwala omwe ali ndi matenda a shuga amatha kupezeka ndi matenda oopsa. Imawonjezera kuchuluka kwa wodwala, kumawonjezera mwayi wokhala ndi mtima. Kuti muchepetse vutoli, muyenera kumwa mankhwala otsimikiziridwa ndikusintha moyo wanu. Pazomwe zimayambitsa kupezeka kwa matenda oopsa mu shuga mellitus, njira zopezeka ndi chithandizo chake, werengani mopitirira mu nkhani yathu.

Werengani nkhaniyi

Zoyambitsa Hypertension ku shuga

Matenda awiriwa ndiogwirizana kwambiri, amathandizana ndi kulimbikitsana wina ndi mnzake. Ndikofunikira kudziwa kuti matenda oopsa chifukwa cha kuwonongeka kwa impso mu shuga kapena kukhazikitsidwa ndi maziko a shuga okwanira.

Mtundu woyamba wa matenda ashuga, njira yoyamba ndi yopambana. Matenda a shuga a nephropathy amachititsa kuti impso ziwonjezeke, zomwe zimayambitsa mndandanda wazinthu zingapo. Zotsatira zake, kamvekedwe ka mtima kamakulirakulira, mulingo wa sodium m'magazi, madzimadzi amasungidwa.

Mu mtundu wachiwiri wa matenda, matenda oyamba, ofunika kwambiri amakhala ndi vuto la matenda ashuga. Itha kuchitika kapena kuchitika ndi matenda ashuga a metabolism. Monga chifukwa chachikulu, kukana insulini kumaganiziridwa.

Wodwalayo amatulutsa insulini yocheperako, koma maselo amalephera kuyankha. Gluu m'magazi amakhala wokwezeka, ndipo thupi limasowa mphamvu. Zikondazo zimatulutsa insulini yochulukirapo kuti imalize.

Vutoli limapezeka kawirikawiri kwa odwala omwe ali ndi thupi lochulukirapo. Zowopsa zake ndizophatikizira:

• kuchuluka kwa mafuta m'mimba,
• chibadwire
• zolimbitsa thupi zochepa,
• kudya kwambiri, nyama yamafuta kwambiri ndi shuga pamenyu,
• kumwa mowa mwauchidakwa, kuphatikizapo mowa.

Adipose minofu amatha kubisa mankhwala osokoneza bongo. Imatchedwa mtundu wa endocrine organ. Zomwe zimaphunziridwa kwambiri ndi: angiotensinogen, leptin, adiponectin, prostaglandins, insulin-like grow factor.

Amawonjezera nthawi yomweyo kukana minofu ndi insulin. Ndi kutenga nawo mbali, momwe mitsempha yam'magazi imachitikira ku adrenaline, cortisol (mahomoni opsinjika) amawonjezereka, sodium ndi madzi zimasungidwa, kuchuluka kwa minofu mu khoma la mtima kumakulirakulira, komwe kumalepheretsa kupumula kwake. Izi zikufotokozera kuphatikiza kwa insulin, kunenepa kwambiri komanso kunenepa kwambiri, cholesterol yowonjezera, yotchedwa quartet yakufa.

Ndipo izi ndizambiri pazakudya za matenda ashuga amitundu iwiri.

Zizindikiro za kuthamanga kwa magazi

Kuti muchepetse kuthamanga kwa magazi, kudandaula kwakukulu kumutu. Zimaphatikizidwa ndi chizungulire, kufooka kwathunthu, kufalikira kwa mfundo patsogolo pa maso, tinnitus. Palibe chilichonse mwazizindikiro izi, ndipo odwala ambiri samamva kuwonjezeka kwa kukakamizidwa, makamaka ndi kuchuluka kwakutali kwa nthawi yayitali.

Chifukwa chake, munthu sangayang'ane kwambiri ndi zomverera, koma muyeso wa zizindikiro ndi wofunikira. Kwa odwala matenda ashuga, siwofunikira kwenikweni monga shuga. Chifukwa chakuti anthu odwala matenda ashuga amatha kusokonekera kamvekedwe ka minyewa, ndikofunikira kuwunika kuthamanga kwa magazi kamodzi pa sabata - ola limodzi musanadye chakudya, maola awiri mutatha, m'mawa mutagona komanso madzulo maola awiri musanachitike. Kamodzi patsiku, miyeso imayenera kuchitika mutayimirira, ndikukhala ndikugona pa mkono uliwonse.

Pamene matenda ashuga ndi matenda oopsa akupita patsogolo, kuwonongeka kwa ziwonetsero kumachitika: kupweteka mumtima, kukulitsidwa ndi kuwonjezereka kwa kupsinjika, kupsinjika. Mosiyana ndi angina pectoris, samalumikizidwa ndi kupsinjika kwakuthupi ndipo samachotsedwa ndi Nitroglycerin. Ndi kulephera kwa mtima, kupuma movutikira, kutupira miyendo, komanso kugunda kwamtima kwamphamvu kumaonjezedwa kwa iwo.

Pazovuta zamisala, kuiwalaiwala, kusakwiya komanso kugona. Kutha kwa ntchito zaluso kumachepa, kugona kugona kumawonekera masana, kunjenjemera poyenda, kukhumudwa komanso manja akunjenjemera.

Ndi kupsinjika kowonjezereka, chifunga kapena chophimba chimawonekera pamaso. Chifukwa cha kusintha kwakumasulira mu retina, masomphenya amachepetsedwa, kuwonekera kawiri kumachitika, pali kuwonongeka kwakukulu kapena ngakhale kutaya kwamaso.

Zotheka kukhala ndi vuto la anthu odwala matenda ashuga

Kuphatikizidwa kwa matenda ashuga komanso kuthamanga kwa magazi kumapangitsa kuti zikhale zowoneka bwino komanso izi:

• atherosulinosis - myocardial ischemia (angina pectoris, kugunda kwa mtima), ubongo (discirculatory encephalopathy, stroke), miyendo (kufooketsa chotupa chokhala ndi vuto la kuchepa kwapang'onopang'ono),
• kulephera kwa mtima ndi kusayenda kwa magazi m'mapapo, chiwindi,
• matenda oopsa komanso odwala matenda ashuga nephropathy omwe amachititsa kulephera kwa impso,
• retinopathy (kusintha m'matumbo a retina), glaucoma, zotupa za m'mimba mu retina, kutuluka kwake ndikuwonongeka.
• kufooka kwa kugonana kwa amuna, kunachepetsa kukopa m'magulu onse awiri.

Zomwe mapiritsi oti amwe kuchokera kukakamizidwa

Malinga ndi kafukufuku, gawo limodzi lokha mwa magawo atatu a odwala omwe ali ndi shuga amawongolera kuthamanga kwa magazi, ndipo ochepera 17% adakwaniritsa momwe akufunira. Vutoli limakulirakulira chifukwa maukonde omwe ali ndi mankhwala ali ndi ma bioadditives ambiri ndi mankhwala ofunika kwambiri. Popeza matenda oopsa komanso matenda ashuga ndiofala, pali zotsatsa zoposa zokwanira zotulutsa nthawi yomweyo mothandizidwa ndi "njira zozizwitsa".

Ndikofunikira kumvetsetsa kuti mutha kumwa mapiritsi aliwonse, koma owerengeka omwe ali ndi vutoli adatsimikiziridwa. Mwachitsanzo, sulfure yokhala ndi amino acid Taurine imapangidwira kuti idzagwiritse ntchito matenda a shuga, matenda oopsa komanso kulephera kwa mtima.

Mankhwala amateteza matenda kagayidwe, kusintha mayendedwe a ubongo, ndipo anticonvulsant ntchito. Zotsatira zake pakuthamanga kwa magazi kulinso, koma sizingachitike chifukwa cha wothandizira. Kuyesa konse kwaumoyo, mankhwala omwe amadzipangira nokha amathera pamavuto.

ACE inhibitors ndi angiotensin receptor antagonists

Angiotensin-converting enzyme (ACE) imalimbikitsa kupangika kwa angiotensin 2. Katunduyu wokhala ndi zinthu zamphamvu za vasoconstrictor, pamene kuchuluka kwake kumawonjezera magazi. Gulu la ACE inhibitors limaletsa izi, ndipo olimbana nawo samalola kuti angiotensin 2 apangidwe kale.

Magulu awiriwa a mankhwalawa ndi ofunikira kwambiri pochiza matenda a shuga ndi matenda oopsa. Izi ndichifukwa choti:

• Tetezani minofu ya impso ku chiwonongeko osati chifukwa cha matenda oopsa, komanso kukulitsa mitsempha ya impso, kuchepetsa kuthamanga mkati mwa glomerulus, kutaya mapuloteni, kusintha mawonekedwe a mkodzo kusefedwa,
• thandizani kuchepetsa katundu pamtima ndi kulephera kwazungulira,
• kusintha mphamvu ya minofu kumva insulin.

Angiotensin 2 antagonists amalekeredwa bwino, popeza amasankha thupi, komanso amachepetsa makulidwe amomwe minofu yamtima yamitsempha yamanzere. Zoletsa kwambiri za ACE:

Zogwiritsa ntchito kwambiri ma receptor blockers:

Mankhwala osokoneza bongo

Zochizira pogwiritsa ntchito diuretic pagulu la thiazides - Hypothiazide yaying'ono. Nthawi zambiri, amawagwiritsa ntchito ngati mankhwala ophatikiza antihypertensive. Pa mlingo wa 25 mg pa tsiku, sizisokoneza kusinthana kwa glucose ndi cholesterol, celts kwamikodzo, komanso kuchuluka kwa mchere. Anaphatikizidwa mu nephropathy. Kukonzekera ngati Thiazide Arifon, Indapamide amaloledwa bwino ndikuteteza impso kuti zisawonongeke. Zotsatira za okodzetsa ena mu shuga sizikutsimikiziridwa.

Beta blockers

Chowonetsedwa ndi kulephera kwa mtima, angina pectoris, pambuyo pa vuto la mtima. Ndikofunika kulingalira kuti kugwiritsa ntchito kwawo kumaphimba kuwonekera kwa dontho la shuga m'magazi. Chifukwa chake, wodwala matenda ashuga akhoza kuphonya chiyambi cha matenda a hypoglycemia, makamaka masabata oyamba ovomerezeka. Mankhwala a mtima amatenga mwayi. Izi zikutanthauza kuti amatseka ma receptor mu minofu ya mtima ndipo alibe mphamvu iliyonse pa ziwalo zina.

Ndi diabetesic cardiomyopathy (kuwonongeka kwa mtima), Nebival, Carvedilol, ndiye otetezeka kwambiri.

Otsutsa a calcium

Ubwino wawo ndi kuperewera kwa kagayidwe. Anthu odwala matenda ashuga amawonetsedwa ngati amagwira ntchito kwa nthawi yayitali, amathandiza kupeweteroko. Amagwiritsidwa ntchito nthawi zambiri mu zovuta kuchitira matenda oopsa. Odwala adalembedwa Norvask, Nimotop, Lerkamen, Adalat retard. M'malo ochepetsa thupi kapena kulephera kwa mtima, mapiritsi ochita kupanga mwachidule amaletsedwa.

Ndi nephropathy, amagwiritsidwa ntchito zochepa, nthawi zambiri Cinnarizine ndi Diacordin retard.

Agonists (zolimbikitsa) za imidazoline receptors

Chifukwa cha zomwe zimachitika pa tsinde laubongo, zochitika za machitidwe amanjenje amachepetsa: amapumula khoma lamitsempha, kukhazikika, ndikulimbitsa mtima. Amawerengedwa kuti ndi gulu labwino la matenda ashuga, chifukwa amachepetsa kukana kwa insulin ndikuyambitsa kuwonongeka kwa mafuta. Mankhwala odziwika bwino ndi Physiotens, Albarel.

Alfa oletsa

Kuchepetsa magazi, kusintha kagayidwe kazakudya ndi mafuta. Koma ali ndi katundu wofunikira - amachititsa kupendekera kwakukulu (kukomoka, kugwa kwa mtima). Chifukwa chake, ndi matenda ashuga, ndikosayenera kuzigwiritsa ntchito. Ndiowopsa kupatsa mankhwala patatha zaka 55, pamaso pa neuropathy. Kardura ndi Setegis nthawi zambiri amalimbikitsidwa ndi kukulitsa kukula kwa kukula kwa gland.

Kodi zakudya zimakhudza bwanji magazi

Ngati wodwala wodwala matenda a shuga akupezeka kuti akuwonjezera kuthinikizidwa (mpaka 145-150 / 85-90 mm Hg) kwa nthawi yoyamba, ndiye kuti mwezi ungalimbikitsidwe kuchepetsa thupi ndikuchepetsa mchere muzakudya mpaka 3 g patsiku. Izi ndichifukwa choti nthawi zambiri matenda oopsa amakhala ndi njira yodalira mchere. Ngati wodwala wodwala matenda ashuga a 2 atha kuchepetsa kulemera ndi 5% kuchokera koyambirira, ndiye kuti:

• 25% yotsika ya zovuta zakupha,
• zisonyezo zidzatsitsidwa ndi avareji ya magawo 10,
• shuga wa m'magazi amatsika ndi 35-45% ndi hemoglobin wa glycated ndi 15%,
• mbiri ya lipid imasintha.

Malamulo a zakudya pa matenda oopsa komanso matenda ashuga

Mtundu woyamba wa matenda ashuga, matenda oopsa amakhala ndi nephropathy. Chifukwa chake, ndikofunikira kusinthira kuphika popanda mchere, ndipo 2-3 g imaperekedwa kwa wodwala m'manja mwake kuti ayambe mchere. Chalangizidwa kuti muphatikizidwe pazosankha:

• masamba mafuta
• zamasamba maphunziro oyamba
• nyama yophika, msuzi uyenera kuthiridwa. Mitundu yamafuta ochepa okha ndi yomwe imaloledwa,
• nsomba zampweya kapena zophika, zomata ndi zotchinga nyama,
• tchizi chamafuta ochepa, zakumwa zoziziritsa kukhosi,
• masamba ophika, masasseru,
• Buckwheat ndi oatmeal
• Zipatso zopanda zipatso ndi zipatso.

Zakudya siziyenera kukhala zamzitini, tchizi, nyama zosuta, soseji, zonunkhira zotentha, confectionery.

Ndi kunenepa kwambiri komanso matenda oopsa, zakudya zopatsa mphamvu zochepa zimayikidwa. Zakudya zamatumbo ndizofunikira kusankha ndi index yotsika ya glycemic. Zothandiza masamba atsopano komanso owiritsa osaphika - kabichi, nkhaka, zukini, tomato, biringanya, amadyera a saladi. Kuchuluka kwa mkate ndi phala ndizochepa. Zakudya monga mandimu ndi nyemba zimangogwiritsidwa ntchito ngati msuzi.

Pansi zoletsedwa:

• shuga, maswiti,
• misuzi yopaka okonzeka, timadziti, msuzi wokoma,
• kudya mwachangu zokometsera
• mowa
• nyama yamafuta, imandipatsa nyama,
• pickles, kusuta, marinade,
• mbatata yosenda kapena msuzi,
• pasitala, mpunga oyera, zopatsa, bulgur,
• kaloti wowiritsa ndi beets,
• zipatso zokoma
• kirimu, tchizi chokoleti kuchokera 5% mafuta.

Khalidwe la wodwala

Ngati m'mbuyomu, malire apamwamba a chizolowezi amawonedwa kuti ndi 140/90 mm RT. Art., Ndiye mu 2017, American Heart Association idalimbikitsa kuti nthawi yayitali pakati pa 130/80 mpaka 140/90 ikhale yofanana ndi matenda oopsa. Kwa odwala matenda ashuga, ngakhale izi zisanachitike, mulingo wa 130/80 sunalimbikitsidwe kuti upitirire. Popita nthawi, mwina chitsimikizochi chidzachepa.

Kusintha koteroko kumachitika chifukwa cha zomwe zatsimikiziridwa: kuthamanga kwa systolic pakati pa 120 ndi 130 mm Hg. Art. ngozi ya mitsempha ya mtima imacheperachepera. Chifukwa chake, tikulimbikitsidwa kuti ngakhale odwala omwe kupsinjika kwawo kuli pafupi ndi kwabwinobwino kusintha m'moyo wawo. Zowonjezera pa 130/80 mm RT. Art. Malamulowa amafunikira:

• kusiyiratu kusuta fodya ndi kumwa mowa mwauchidakwa,
• kusiyanitsidwa ndi zakudya zamafuta, makamaka zomwe zimakhala ndi mafuta ochulukirapo (nyama yamafuta, mafuta akunja, mankhwala omalizidwa), maswiti ndi makeke, mchere wa tebulo kuposa 3-5 g,
• zolimbitsa thupi tsiku lililonse pafupifupi theka la ola,
• kuyang'anira magazi,
• kugwiritsa ntchito mankhwala kuchiza matenda oopsa,
• kutsatira boma la tsikulo, kukana ntchito za usiku,
• kudziwa luso la zopumira mutapanikizika (masewera olimbitsa thupi, yoga, kusinkhasinkha, kuyenda mwachilengedwe, nyimbo zodekha, aromatherapy), acupressure (kumapeto kwa nsidze, malo opweteka kwambiri pansi pa occiput, pakati pa korona).

Ndipo nazi zambiri za mitundu ya matenda ashuga.

Matenda a shuga ndi matenda oopsa amathandizira ziwonetsero za wina ndi mnzake. Mtundu woyamba wa matenda ashuga, nephropathy ndi omwe amachititsa kuthamanga kwa magazi, ndipo matenda amtundu wa 2, kunenepa kwambiri ndi kukana insulini ndizomwe zimayambitsa. Mawonekedwe nthawi zambiri sakhala achindunji, kotero ndikofunikira kuyeza zisonyezo pafupipafupi. ACE inhibitors ndi angiotensin 2 receptor antagonists, kuphatikiza chithandizo ndizoyenera kwambiri pakuchepetsa kwawo shuga.

Ndikulimbikitsidwanso kusintha zakudya, kuchepetsa thupi ndi kusiya zizolowezi zoyipa.

Mitundu ya matenda oopsa

Kuwonjezeka kwa kupsinjika kwa kama wamitsempha pansi pa zovuta za shuga kumafotokozedwa ngati kuthamanga kwa magazi sy 140 mmHg. ndi kuthamanga kwa magazi kwa diastolic ≥ 90 mmHg Pali mitundu iwiri ya kuthamanga kwa magazi (BP) mu shuga:

• Kutalikirana kwa matenda oopsa chifukwa cha matenda ashuga,
• Matenda oopsa chifukwa cha matenda ashuga,

Matenda a diabetes ndi nephropathy ndi imodzi mwazovuta zazikulu za matenda ashuga ndipo ndimayambira yomwe imayambitsa kulephera kwa impso ku Western world. Komanso chinthu chachikulu chodwala komanso chodwala mwa odwala omwe ali ndi matenda amtundu wa 2. Nthawi zambiri, matenda amtundu wa 1 amawonetseredwa ndi matenda oopsa chifukwa cha kukula kwa matenda a m'mitsempha ya impso. Odwala omwe ali ndi matenda a shuga a 2, kuchuluka kwa magazi nthawi zambiri kumakhalapo pamaso pa chiwonetsero chachikulu cha impso. Kafukufuku wina, 70% ya odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga omwe kale anali ndi matenda oopsa.

Zoyambitsa matenda oopsa mu shuga

Padziko lonse lapansi, anthu pafupifupi 970 miliyoni amadwala matenda oopsa. WHO imaganiza kuti matenda oopsa ndi chimodzi mwazofunikira kwambiri zomwe zimapangitsa kuti anthu azifa msanga mdziko lapansi, vutoli likufalikira. Mu 2025, akuyerekezeredwa kuti padzakhala anthu 1.56 biliyoni omwe azikhala ndi kuthamanga kwa magazi. Hypertension imayamba chifukwa cha zinthu zofunika kwambiri zomwe zimakhalapo palokha kapena palimodzi:

• Mtima umagwira ntchito ndi mphamvu yayikulu, kupopa magazi kudzera m'matumbo.
• Veseli (arterioles) spasmodic kapena womata ndi ma atherosulinotic malo omwe amatsutsana ndi magazi.

Kuchuluka kwa shuga wamagazi ndi matenda oopsa okhala ndi njira zodziwika bwino za pathogenesis, monga pulogalamu yamanjenje yomvera, renin-angiotensin-aldosterone dongosolo. Njirazi zimalumikizana ndikuthandizira wina ndi mnzake ndikupanga kuzungulira koyipa. Hypertension ndi matenda ashuga ndizotsatira zomaliza za metabolic syndrome. Chifukwa chake, amatha kupangika wina ndi mnzake mwa munthu yemweyo kapena popanda wina aliyense.

Zowopsa ndi Zizindikiro

Malinga ndi American Diabetes Association, kuphatikiza mitundu iwiri ya matenda ndi kupha kwambiri ndipo kumawonjezera mwayi wolimbana ndi matenda a mtima kapena sitiroko. Matenda a shuga a Type 2 komanso matenda oopsa amathandizanso kuti chiwopsezo cha ziwalo zina ndi machitidwe, monga kuwonongeka kwa ziwiya zamitsempha cha nephron ndi retinopathy (matenda a ziwongo zamaso). 2.6% khungu limatha kuwona matenda ashuga retinopathy. Matenda osagwirizana ndi shuga sichinthu chokhacho chokhudza thanzi chomwe chimawonjezera chiopsezo cha kuthamanga kwa magazi. Mwayi wa mtima minofu necrosis kapena ubongo hemorrhage ukuwonjezeka ngati pali zochuluka mwa izi:

• kupsinjika
• kudya kwambiri mafuta, mchere,
• moyo wongokhala, adynamia,
• ukalamba
• kunenepa
• kusuta
• kumwa mowa
• matenda osachiritsika.

Monga lamulo, matenda oopsa alibe matendawa ndipo amakhala ndi mutu, chizungulire, komanso kutupa. Ndi chifukwa chake muyenera kuyang'ana magazi anu pafupipafupi. Dokotala amayeza kuyeza pakulabwera kulikonse, ndikuthandizanso kuti mudzayang'ane kunyumba tsiku lililonse. Zizindikiro zodziwika bwino za matenda ashuga ndi izi:

• kukodza pafupipafupi
• ludzu lalikuru ndi njala
• kunenepa kwambiri kapena kuwonda msanga,
• kusala kwachimuna,
• dzanzi ndi kumangika mikono ndi miyendo.

Kodi kuchepetsa kupanikizika?

Pamaso pa shuga wambiri, ndikofunikira kuti magazi azitha kuthamanga mpaka 140/90 mm Hg. Art. ndi pansipa. Ngati manambala opanikizika ndi apamwamba, chithandizo cha mankhwala a antihypertensive iyenera kuyamba. Komanso, mavuto ndi impso, kupenya kwamaso kapena kupezeka kwa sitiroko m'mbuyomu ndizizindikiro zachindunji zakuchira. Kusankha kwa mankhwalawa kumasankhidwa payekha ndi adotolo kutengera zaka, matenda osachiritsika, matendawa, kulolerana ndi mankhwalawo.

Mankhwala osokoneza bongo omwe amapezeka munthawi yomweyo

Chithandizo cha matenda oopsa mu shuga ziyenera kukhala zokwanira. Mankhwala a antihypertensive a mzere woyamba amaphatikizapo magulu asanu. Mankhwala oyamba omwe amagwiritsidwa ntchito nthawi zambiri ngati concomitant shuga ndi mankhwala kuchokera ku gulu la angiotensin kutembenuza enzyme inhibitors (ACE inhibitors). Mopanda tsankho kwa zoletsa za ACE, gulu la angiotensin 2 receptor blockers (sartans) limayikidwa. Kuphatikiza pazotsatira za hypotensive (kuthamanga-kutsitsa), mankhwalawa amatha kupewa kapena kuchepetsa kuwonongeka kwa ziwiya za impso ndi retina mwa anthu omwe ali ndi matenda ashuga. AnCE inhibitor sayenera kuphatikizidwa ndi angiotensin 2 receptor antagonist pothandizira. Pofuna kukonza zotsatira za mankhwala a antihypertensive, okodzetsa amawonjezeredwa kuti athandizidwe, koma pokhapokha akuvomerezedwa ndi adokotala.

Zakudya monga njira ya moyo

Chinsinsi chake pachakudya cha anthu odwala matenda ashuga komanso matenda oopsa ndi kuwerengera kuchuluka kwa chakudya chamafuta, shuga ochepa, komanso kuchepa kwa mchere womwe umamwetsa mu chakudya. Malangizo awa athandiza kutsatira izi:

1. Mchere wochepa umatanthawuza zonunkhira zina.
2. Mbale yazakudya ili ngati wotchi. Hafu ya mbaleyo imapangidwa ndi masamba ndi zipatso, kotala ndi chakudya cha mapuloteni ndipo chotsalira ndi chakudya (mbewu zonse).
3. Chepetsa zakumwa zanu za khofi. Imawonjezera kuthamanga kwa magazi ndikuwonjezera mafuta m'thupi.
4. Idyani zakudya zonse zomwe zili ndi mavitamini, michere yambiri, ndi fiber.
5. Osakana mowa. Mowa, vinyo, ndi mitundu yambiri ya ma smoothie amakhala ndi shuga, omwe angapangitse kuchuluka kwa shuga m'magazi. Mowa umathandizanso kuti ukhale ndi chidwi chofuna kudya komanso ungayambitse kudya kwambiri.
6. Chakudya chokhala mu uvuni kapena kuphika. Pewani zakudya zokazinga.
7. Chotsani mafuta "oyipa".

Kupewa matenda oopsa komanso matenda ashuga

Kukhathamiritsa kwaumoyo amakhalabe chimwala popewa matenda ashuga komanso matenda oopsa. Kuchita zolimbitsa thupi moyenera mpaka mphindi 30 tsiku lililonse, kudya mokwanira, kuwongolera kuthamanga kwa magazi, milomo yamagazi ndi milomo ya magazi, kukana zizolowezi zoipa - kumachepetsa mwayi wowonjezereka wamagazi pamaso pa anthu odwala matenda ashuga.

Kuwunika kuchuluka kwa shuga m'magazi kumachepetsa mwayi wamatenda amtima ndi 42% komanso kuopsa kwa vuto la mtima, kugunda kapena kufa chifukwa cha matenda amtima ndi 57%. Kuwongolera kwa lipids m'mwazi kumachepetsa zovuta zamatenda amtima ndi 20-50%. Kuchepetsa thupi komanso kukonza, komanso kukhala ndi moyo wathanzi sikungangokulitsa maphunziro a shuga, komanso thanzi.

Mitundu ya matenda

Mulingo wokwezeka wa shuga mu shuga umawonongera mkati mwa bedi lamitsempha. Izi zikuphwanya kupanga kwa vasodilating zinthu mmenemo, kumachepetsa mphamvu ya mitsempha ndipo kumabweretsa kukula kwa matenda oopsa.

Ndi kuwonongeka kwa ziwiya za impso, zomwe zimadziwika ndi matenda ashuga, matenda a shuga a nephropathy amapezeka. Impso zimayamba kubisa zinthu zambiri za vasoconstrictor zomwe zimayambitsa matenda ochepa.

Kuwonjezeka kwa kuthamanga komwe kumalumikizidwa ndi matenda othandizira (ofunika) amaonedwa mu 80% ya odwala. 20% yotsala imavutika chifukwa cha matenda oopsa. Mwa magawo ochepa a odwala, kuwonjezeka kwa kupanikizika kumachitika chifukwa cha kufinya kwamitsempha yamafupa, pyelonephritis, glomerulonephritis.

Matenda oopsa a sekondale omwe amaphatikizidwa ndi matenda a shuga a nephropathy nthawi zambiri amapezeka motsutsana ndi maziko a matenda a shuga a mtundu woyamba. Matendawa amatenga achinyamata ndipo amathandizana ndi kuwonongeka kwa minyewa. Zaka 10 patadutsa matendawa, theka la odwalawa limakulitsa kupanikizika.

Chifukwa chake matenda oopsa a shuga amakhala oopsa makamaka

Kuphatikizidwa kwa kuthamanga kwa magazi ndi matenda amtundu wa 2 kumawonjezera chiopsezo cha kugwidwa ndi matenda a mtima. Kuchepa kwa kulephera kwa impso kumawonjezeka. Kuwonongeka kwapang'onopang'ono kwa zombo zothandizira kumatha kubweretsa khungu.

Retinopathy yokhala ndi matenda oopsa komanso matenda ashuga amapita patsogolo kwambiri ndipo zimatha kuyambitsa khungu

Hypertension imathandizira kuyambika kwa matenda okhudzana ndi ukalamba, monga matenda a Alzheimer's ndi dementia (senile dementia).

Kuopsa kwa kuphatikiza kwa matenda awiriwa ndikwabwino kwambiri makamaka pakakumana ndi zinthu zina.

• milandu yolakwika pakati pa abale ndi abale,
• kupsinjika
• Zakudya zamafuta ndi mchere.
• kusowa kwa masewera olimbitsa thupi
• ukalamba
• onenepa kwambiri
• kusuta
• kusowa kwa potaziyamu kapena vitamini D,
• uchidakwa
• matenda obwera ndi impso, kugona tulo tambiri.

Zolinga zazikulu zamankhwala

Zowopsa komanso matenda ashuga zimasokonekera. Kupita patsogolo kwa matenda am'mimba kumayendera limodzi ndi chiwopsezo chowonjezeka cha zovuta (kugunda kwa mtima, stroke, kulephera kwa mtima) ndi kulephera kwa aimpso.

Mankhwalawa matenda oopsa mu shuga mellitus ali ndi zifukwa zazikulu izi:

• kuchepetsa chiopsezo cha zovuta za mtima ndi mtsempha wamagazi,
• Kuchepetsa kufa kwa izi,
• kupewa kulephera aimpso,
• kukonza moyo wabwino wodwala,
• kukhalabe ndi shuga wamagazi ambiri (kusatengera mphamvu ya kagayidwe kazinthu).

Kusankhidwa kwa mankhwala

Chithandizo cha matenda oopsa a shuga mellitus uyenera kuyamba ndi kusintha kwa ma enitime a angiotensin (ACE inhibitors). Kuchita kwawo kwatsimikiziridwa ndi maphunziro apadziko lonse lapansi.

Ndi mphamvu yokwanira ya ACE inhibitors, calcium antagonists (amlodipine, felodipine) amawonjezeredwa pamankhwala. Kuphatikizikako kumateteza mtima ku zotsatira zoyipa za glucose owonjezera.

Ngati ndi kotheka, ACE inhibitors ikhoza kuphatikizidwa ndi diuretics. Zokonda ziyenera kuperekedwa kwa indapamide, monga mankhwala osagwirizana kwambiri azakudya zonse zofunikira.

Ngati ochepa matenda oopsa mu odwala matenda a shuga kuphatikizika ndi matenda a mtima (angina pectoris, kugunda kwa mtima), beta-blockers akuyenera kuwonjezeredwa ku mankhwalawo. Muyenera kusankha zomwe sizimakhudza kagayidwe kazakudya. Mankhwalawa amaphatikizapo mtima wa beta-blockers, makamaka, bisoprolol, carvedilol, nebivolol. Mankhwalawa ayenera kugwiritsidwa ntchito kupewa matenda a mtima komanso kufa mwadzidzidzi.

Kusankhidwa kwa mankhwala kumadaliranso momwe zimakhudzira impso. Zatsimikiziridwa kuti ACE inhibitors ndi indapamide amachepetsa kuchuluka kwa mapuloteni mumkodzo ndipo potero amateteza kukula kwa kulephera kwa impso, ndipo otsutsana ndi calcium (verapamil ndi diltiazem) ali ndi zotsatira zofananazo. Mankhwalawa amatha kugwiritsidwanso ntchito pakuchizira kovuta kwa matenda oopsa mu shuga. Pankhani ya kulekerera kwa ACE zoletsa, angiotensin II receptor blockers - sartans (valsartan) ndi mankhwala.

Zotsatira za mankhwala pa ambiri

Mankhwala ena oopsa amawononga kagayidwe kazakudya, motero osavomerezeka kuti azigwiritsidwa ntchito pa matenda ashuga. Izi zikugwira ntchito kwa thiazide diuretics ndi beta-blockers.

Thiazide diuretic yomwe imagwiritsidwa ntchito kwambiri ndi hypothiazide. Amatha kuyambitsa kuthamanga kwa shuga wamagazi komanso kuchuluka kwa hemoglobin ya glycosylated. Poyerekeza zakumbuyo kwake, kulolerana kwa glucose kumakulirakulira. Milandu amadziwika pamene non-ketonemic hyperosmolar coma ikayamba panthawi ya makonzedwe a hypothiazide. Izi ndichifukwa chokakamira kubisalira kwa insulini komanso kuchepa kwa chidwi cha minyewa iyi.

Zotsatira zoyipa za anthu odwala matenda ashuga komanso a beta-blockers. Mankhwalawa:

• ziletsa kupanga insulin,
• kuwonjezera minofu kukana (insulin kukana),
• letsa kulowetsa shuga m'maselo,
• kuonjezera secretion wa kukula mahomoni - insulin wotsutsana.

Zotsatira zake, shuga yofulumira imadzuka itatha kudya. Nkhani za chitukuko cha matenda ashuga zanenedwapo.

Beta blockers amalimba zizindikiro za kusowa kwa glucose m'magazi, zimapangitsa kuti zikhale zovuta kudziwa hypoglycemia. Zimathandizanso kutulutsidwa kwa chakudya chamthupi kuchokera pachiwindi, mwachitsanzo, pakuchita masewera olimbitsa thupi. Izi zimabweretsa kukula pafupipafupi kwa machitidwe a hypoglycemic.

Kafukufuku wasonyeza kuti ngakhale kwa anthu omwe ali ndi shuga wabwinobwino wamagazi okhala ndi chithandizo chazitali ndi thiazides ndi beta-blockers, chiopsezo chokhala ndi matenda ashuga ndichokwera kuposa ndi chithandizo cha ACE zoletsa.

Kupewa matenda oopsa mu shuga

Popewa zovuta zovuta zamatendawa, wodwalayo ayenera kuchepetsa mchere wa patebulo ndikuwonjezera zolimbitsa thupi. Kuyenda kumalimbikitsidwa kwa mphindi 20 kapena 30 patsiku, kapena ntchito zilizonse zakunja kwa mphindi 90 pa sabata. Ndikofunika kuti musiye pamalo okwera ndi kugwiritsa ntchito galimoto komwe mungayende.

Ndikofunikira kutsatira zakudya zama calorie otsika, choletsa mu zakudya zamchere, shuga, nyama ndi mafuta a mkaka. Njirazi ndizolinga zochizira kunenepa kwambiri. Kukhala wonenepa kwambiri ndikofunikira kwambiri pakuyamba komanso kukula kwa matenda ashuga. Naturalization kulemera kwa thupi kumathandiza kuyamwa kwa glucose ndi minofu ndipo kumapangitsa kuchepa kwakukulu kwa magazi.

Malangizo oyenera kwa odwala omwe ali ndi matenda oopsa komanso matenda ashuga:

• idyani zipatso ndi masamba ambiri
• ingodya mafuta amkaka ochepa,
• Pewani zakudya zamchere komanso zophika, nthawi zambiri muzigwiritsa ntchito kofira kapena kuphika,
• kudya mkate wathunthu, mpunga wa bulauni, pasitala wa tirigu wokoma yekha,
• kuchepetsa kudya,
• onetsetsani kuti mwadya

Nthawi zambiri anthu omwe ali ndi matenda ashuga "amasintha" matenda oopsa, omwe sawoneka ndi miyeso yocheperako, koma amakhala ndi zotsatira zoyipa pama sitimayo. Chifukwa chake, odwala onse omwe ali ndi matenda ashuga ayenera kuchita pafupipafupi kuyang'anira magazi. Chithandizo cha mankhwala osokoneza bongo ziyenera kuyamba kale ndikuwonjezera pang'ono manambala.

Matenda a shuga nthawi zambiri amakhala ovuta chifukwa cha matenda oopsa kapena matenda oopsa. Kuphatikizidwa kwa matenda awiriwa kumawonjezera chiopsezo cha zovuta kuchokera mumtima, impso, maso, ubongo ndi ziwalo zina. Kuti mupewe izi, ndikofunikira kuwunika momwe ntchito ikuyendera, zakudya, kuyesedwa pa nthawi ndi kumwa mankhwala omwe dokotala wakupatsani.

Ndizomveka kutenga mavitamini oopsa, chifukwa zimatsimikiziridwa kuti amachepetsa kuthamanga kwa magazi. Ndi ati omwe ali ofunika kumwa? Kodi magnesium B6 ndi mayendedwe ake athandiza?

Sartani ndi kukonzekera komwe kuli nako kumayikidwa, ngati kuli koyenera, kuchepetsa kupanikizika. Pali mitundu yapadera yamankhwala, ndipo imagawidwanso m'magulu. Mutha kusankha m'badwo wophatikizidwa kapena waposachedwa kutengera vuto.

Osati zowopsa kwa anthu athanzi, arrhythmia yokhala ndi matenda osokoneza bongo imatha kukhala owopsa kwa odwala. Ndizowopsa makamaka kwa matenda ashuga amtundu wa 2, chifukwa amatha kudwala matenda a stroko komanso mtima.

Nthawi yomweyo, matenda ashuga ndi angina pectoris amawopseza thanzi lathu. Kodi kuchitira angina pectoris ndi mtundu 2 shuga? Kodi ndi kusokonezeka kwa mtima wamitima komwe kumachitika?

Zakudya zoyenera za matenda a mtima sizithandiza kuti zinthu zizikhala bwino. Zakudya zopatsa thanzi komanso zopatsa thanzi kwa angina pectoris ndi mtima ischemia zimathandizira thupi.

Matenda oopsa mu ukalamba amatha kuwononga kwambiri moyo. Pali njira zingapo zothanirana ndi mavutowo.

Pafupifupi palibe amene wakwanitsa kupewa chitukuko cha matenda a shuga. Izi ziwiri pathologies zimagwirizana, chifukwa kuchuluka kwa shuga kumakhudza mitsempha ya magazi, zomwe zimapangitsa kuti pakhale kusintha kwa atherosulinosis ya m'munsi kwambiri mwa odwala. Chithandizo chimachitika ndi chakudya.

Anthu odwala matenda ashuga ali pachiwopsezo cha matenda amtima. Kulowerera m'matenda a shuga kumatha kupha munthu. Vuto lalikulu la mtima limathamanga. Ndi mtundu 2, chiwopsezocho ndi chachikulu. Kodi chithandizo chikuyenda bwanji? Kodi zake ndi ziti? Kodi ndi zakudya zamtundu wanji zofunika?

Ngati matenda a angina okhazikika atakhazikitsidwa, chithandizo chizitsogozedwa koyambirira pazomwe zimayambitsa vuto, mwachitsanzo, matenda a mtima. Mankhwala othandizira khola la angina pectoris amachitika kuchipatala.

Pathogenesis wa matenda oopsa a mtundu 1 shuga

Mtundu woyamba wa shuga, mtundu wa matenda oopsa ndi 80-90% wogwirizana ndi kukula kwa DN. Amawonedwa mu 35-40% ya odwala omwe ali ndi matenda amtundu wa 1 ndipo amadutsa pamitundu ingapo: gawo la MAU, gawo la PU ndi gawo la kulephera kwa impso. Kuwonjezeka kwa kuthamanga kwa magazi (> 130/80 mm Hg) kumapezeka mu 20% ya odwala omwe ali ndi MaU, mu 70% pa siteji ya PU, komanso mu 95-100% pachiwopsezo cha matenda aimpso. M'maphunziro athu, kuphatikizika kwapamwamba kumawonedwa pakati pamlingo wa mapuloteni ochulukitsa mu mkodzo komanso kuchuluka kwa kuchuluka kwa magazi. Kuphatikiza kwamphamvu kwa kuthamanga kwa magazi ndi MAU kunali 0.62 (p 160/95 mm RT. Art.),
- 63% ya anthu omwe ali ndi hyperuricemia (zotupa za seramu uric acid> 416 μmol / L mwa amuna ndipo> 387 μmol / L mwa akazi),
- 84% ya anthu omwe ali ndi hypertriglyceridemia (TG> 2.85 mmol / L),
- 88% ya anthu omwe ali ndi cholesterol yotsika ya HDL (7.8 mmol / L ndi 2 maola atatha kuthira shuga> 11.1 mmol / L).

Ndi kuphatikiza kwa matenda a shuga a mtundu 2 (kapena NTG) omwe ali ndi dyslipidemia, hyperuricemia ndi matenda oopsa, i.e., ndi zigawo zikuluzikulu za metabolic syndrome, kuchuluka kwa IR kunali 95%. Izi zikusonyeza kuti, kwenikweni, njira yopititsa patsogolo kukula kwa metabolic syndrome ndi IR.

Udindo wa IR pakukula kwa matenda ashuga a mtundu 2

Peripheral minofu IR imayambitsa kukula kwa matenda a shuga a mtundu wa 2. Chofunika kwambiri pakuchipatala ndicho kutayika kwa insulin, minofu, adipose ndi chiwindi.IR yamitsempha yama minofu imawonekera mu kuchepa kwa kudya kwa glucose kuchokera m'magazi kupita m'magulu am'magazi komanso kugwiritsa ntchito kwake m'maselo am'misempha, adipose minofu - pokana motsutsana ndi zotsatira za insulin, zomwe zimapangitsa kuti pakhale mafuta acids aulere (FFA) ndi glycerol. FFAs amalowa m'chiwindi, komwe amakhala gwero lalikulu la mapangidwe a atherogenic lipoproteins of low lowens (VLDL). Matenda a chiwindi IR amadziwika ndi kuchepa kwa glycogen kaphatikizidwe ndi kutseguka kwa glycogen kupita ku glucose (glycogenolysis) ndi devovo glucose synthesis kuchokera ku amino acids, lactate, pyruvate, glycerol (gluconeogeneis), chifukwa chake glucose wochokera ku chiwindi amalowa m'magazi. Njira izi m'chiwindi zimayendetsedwa chifukwa cha kuchepa kwa kuponderezana kwawo ndi insulin.

Peripheral mineral IR isanayambitse kukula kwa matenda a shuga a 2 ndipo imatha kupezeka m'mabanja apafupi ndi odwala omwe ali ndi matenda a shuga a 2 popanda matenda a carbohydrate metabolism. Kwa nthawi yayitali, IR imalipidwa ndi kuphatikiza kwa insulin kwambiri ndi ma pancreatic β-cell (hyperinsulinemia), omwe amathandiza kagayidwe kazachilengedwe. Hyperinsulinemia imakhala yofanana ndi chikhomo cha IR ndipo imawerengedwa ngati matenda a shuga a mtundu wa 2. Pambuyo pake, pakuwonjezeka kwa kuchuluka kwa IR, maselo β-maselo amasiya kuthana ndi kuchuluka kwa glucose, komwe kumapangitsa kutsika pang'ono kwa luso la insulin mobisa komanso kuwonekera kwa matenda ashuga. Choyamba, gawo la 1 la insulin secretion (yachangu) limavutika poyankha katundu, gawo la 2 (gawo la basal insulin secretion) limayambanso kuchepa.

Hyperglycemia yokhazikika imathandizanso kupuma kwamatumbo IR ndikumachepetsa insulin-secretory function ya β-cell. Makinawa amatchedwa kuti glucose toxity.

Amakhulupirira kuti chodabwitsa cha IR chimakhala ndi maziko olimba a chibadwa, chokhazikitsidwa pakusintha. Malinga ndi kunena kwa "zachuma genotype" yoyambitsidwa ndi V. Neel mu 1962, IR ndi njira yokhayo yopulumukira muzovuta, pomwe nthawi zochuluka zimakhala ndi nthawi yanjala. Kupezeka kwa IR kunathandizira kudziunjikira kwamphamvu m'njira yamafuta, omwe amasungidwa anali okwanira kupulumuka panjala. Pakusankha kwachilengedwe, majini omwe amapatsa IR ndi kusungirako mphamvu anali okhazikika monga oyenera. Kuyesereraku kumatsimikiziridwa pakuyesera kwa mbewa zomwe zimadwala nthawi yayitali. Makoswe okhawo ndi omwe anapulumuka omwe anali atagwirizana pamtundu wa IR. M'masiku ano, mayiko omwe ali ndi moyo wathanzi wambiri komanso wopanda mphamvu zopatsa mphamvu, njira za IR zomwe zimasungidwa m'maganizo zimapitiriza "kugwira ntchito" pakusunga mphamvu, zomwe zimapangitsa kunenepa kwambiri, dyslipidemia, matenda oopsa ndipo, pamapeto pake, mtundu 2 shuga.

Mpaka pano, umboni wokwanira wapezeka kuti unena kuti IR ndi concomitant hyperinsulinemia ndi zinthu zomwe zimayambitsa chiwopsezo cha atherogeneis komanso kupha anthu ambiri kuchokera ku matenda a mtima. Kafukufuku wamkulu wa IRAS (Insulin Resistance Atherosulinosis Study) adamalizidwa posachedwa, omwe cholinga chake chinali kuyesa mgwirizano pakati pa IR (yotsimikiziridwa ndi kuyesedwa kwa mayeso a glucose) ndi ziwopsezo zamtima mu kuchuluka kwa anthu opanda matenda ashuga komanso odwala omwe ali ndi matenda amtundu wa 2. zotengera zinayeza khoma la carotid artery. Kafukufukuyu adawonetsera mgwirizano womwe ulipo pakati pa kuchuluka kwa IR komanso kuopsa kwa kunenepa kwambiri pamimba, kuthamanga kwa magazi a m'magazi, kupangika kwa njira yozizira, komanso khoma la chotupa cha carotid m'magulu onse omwe alibe shuga komanso odwala omwe ali ndi matenda a shuga a 2. mitsempha ya carotid imachuluka ndi ma microns 30.

Pali umboni wambiri wazachipatala kuti hyperinsulinemia ndi chiopsezo chodziyimira cha matenda a mtima kwa anthu opanda mtundu wa 2 matenda ashuga: Maphunziro aku Paris (pafupifupi 7000 anayesedwa), Busselton (woposedwa 1000) ndi Helsinki Policemen (982) (kusanthula kwa meta ndi B. Balkau et al. ) M'zaka zaposachedwa, kudalira kofananako kwadziwika kwa odwala omwe ali ndi matenda a shuga a 2. Pali umboni woyesera pazambiri izi. Ntchito ya R. Stout ikuwonetsa kuti insulini imakhudza mwachindunji makoma amitsempha yamagazi, ndikupangitsa kuchuluka ndi kusuntha kwa minofu yosalala, kapangidwe ka lipids mkati mwake, kuchuluka kwa fibroblasts, kutseguka kwa dongosolo la magazi, komanso kuchepa kwa ntchito ya fibrinolysis.

Chifukwa chake, IR ndi hyperinsulinemia amathandizira kwambiri pakukula kwa atherosulinosis onse mwa anthu omwe ali ndi chiyembekezo chakukula kwa matenda ashuga komanso kwa odwala omwe ali ndi matenda a shuga 2.

Udindo wa IR pakukula kwa matenda oopsa

Chiyanjano cha hyperinsulinemia (chikhomo cha IR) komanso chofunikira kwambiri pa matenda oopsa chimakhala cholimba kwambiri chifukwa chokhala ndi insulin yambiri m'magazi, ndizotheka kulosera za chitukuko cha matenda oopsa mwa iye posachedwa. Komanso, ubale uwu umatheka chifukwa cha odwala omwe ali ndi kunenepa kwambiri komanso kwa anthu omwe ali ndi thupi labwino.

Pali njira zingapo zomwe zimafotokozera kuchuluka kwa kuthamanga kwa magazi mu hyperinsulinemia. Insulin amalimbikitsa kutsegulira kwa mtima wamanjenje, kuwonjezereka kwa Na ndi madzimadzi mu mafupa a mphutsi, kuchuluka kwa Na ndi Ca, insulin monga chinthu chogwira mtima kumapangitsa kuti minyewa yamagazi ikhale yosalala.

Hypertension?

Mankhwala, matendawa amafotokozedwa ngati kuwonjezeka kwa kuthamanga kwa magazi kuchokera ku 140/90 mm Hg. Art. ndi mmwamba. Chofunikira pa matenda oopsa ndi pafupifupi 90-95% ya milandu. Amawoneka ngati matenda odziyimira pawokha ndipo amadziwika ndi matenda amtundu wa 2 shuga. Matenda oopsa mu 70-80% ya milandu amatsogolera matenda awa, ndipo ndi 30% yokha ya odwala omwe amapezeka pambuyo pakuwonongeka kwa impso. Pali yachiwiri matenda oopsa (chizindikiro). Amayamba ndi matenda ashuga amtundu woyamba.

Zomwe zimayambitsa kuthamanga kwa magazi kwa matenda ashuga

Zomwe zimayambitsa chitukuko cha matenda oopsa zimatsimikizika kutengera mtundu wa shuga. Mtundu 1, 80% ya milandu yokhudza matenda oopsa imayamba chifukwa cha matenda ashuga, ne.e. chifukwa cha kuwonongeka kwa impso. Pankhani ya matenda a shuga a 2, kupanikizika kumakula ngakhale kusanachitike. Zimayambitsa matenda oyambawa, monga gawo la metabolic syndrome.

Kusiyana pakati pa matenda a shuga 1 a mellitus (DM 1) ndikofunikira kwa wodwalayo jakisoni wa insulin - chinthu chomwe chimathandiza kuti glucose alowe m'maselo, omwe amawonetsetsa kuti akufunika. Imasiya kupangidwa mthupi lokha. Zomwe zimayambitsa matenda ambiri ndi imfa yoposa 90% yama cell a kapamba. Mtundu wa matenda amtunduwu umadalira insulin, umabadwa, ndipo sunatengedwe nthawi ya moyo. Mwa zina zomwe zimapangitsa kuti asamadye matenda oopsa,

• matenda a endocrine dongosolo - 1-3%,
• systolic matenda oopsa - 5-10%,
• matenda oopsa - 10%,
• matenda a shuga a nephropathy ndi mavuto ena a impso - 80%.

Palinso mtundu wa shuga wodziyimira pawokha (mtundu wachiwiri wa matenda ashuga). Imakhala yodziwika pakati pa akulu zaka 40, koma nthawi zina imawonedwa mwa ana. Choyambitsa matendawa ndi chosakwanira kupanga insulini ndi kapamba. Zotsatira zake, njira za metabolic sizingachitike mwachizolowezi. T2DM imapezeka pa moyo wonse. Zimakonda makamaka kwa odwala omwe ali ndi kunenepa kwambiri kapena onenepa kwambiri.

Matenda oopsa motsutsana ndi maziko a mtunduwu wa shuga amayamba chifukwa cha:

• matenda a endocrine dongosolo - 1-3%,
• aimpso ziwiya patency - 5-10%,
• matenda ashuga nephropathy - 15-20%,
• systolic matenda oopsa - 40-45%,
• matenda oopsa (mtundu woyamba) - 30-35%.

Kodi matenda oopsa amawonetsedwa bwanji mu shuga

Ndi mtundu uliwonse wa matenda ashuga, mitsempha yayikulu ndi ziwiya zazing'ono mthupi la munthu zimakhudzidwa. Chifukwa cha kuchepa kwa kutanuka kwawo, madontho akukumana akuyamba. Mwa anthu ambiri odwala matenda ashuga, magazi amawazungulira amatenda chifukwa cha kuthamanga kwa magazi. Chithandizo cha matenda oopsa mu shuga zimatengera mawonetseredwe ake. Mu matenda 1 a shuga, amalumikizidwa ndi matenda a shuga a nephropathy, omwe amakhudza mitsempha ya zotumphukira zamitsempha yamagazi ndi magawo a impso, zomwe zimayambitsa:

1. Maonekedwe a mkodzo wa albumin ndi microalbuminuria. Amachita ngati chizindikiro choyambirira cha kuthamanga kwa magazi.
2. Proteinuria Amabweza kuchepa kwa kuchuluka kwa impso. Zotsatira zake ndikuwonekera kwa mapuloteni athunthu mumkodzo. Ndi proteinuria, chiopsezo chokhala ndi matenda oopsa chimakwera mpaka 70%.
3. Kulephera kwa impso. Pakadali pano, kusokonekera kwa impso kumayang'aniridwa, chomwe ndi chitsimikizo cha 100% cha kukula kwa matenda oopsa.

Matenda a 2 a shuga nthawi zambiri amakumana ndi vuto la kunenepa kwambiri. Ngati matendawa aphatikizidwa ndi matenda oopsa, ndiye kuti zimachitika chifukwa cha kulekerera kwa chakudya kapena kuchuluka kwa glucose m'magazi. Zimatsogolera kagayidwe kazakudya kagayidwe kakang'ono m'thupi. Matendawa amatchedwa "metabolic syndrome." Kuwongolera kukana kwa insulin kumachitika pogwiritsa ntchito chakudya chochepa cha thupi.

Momwe mungachiritsire matenda oopsa mu shuga

Chithandizo chapadera chimasankhidwa kwa odwala omwe ali ndi matenda otere. Afunika kuchuluka kwa kuthamanga kwa magazi, apo ayi, malinga ndi akatswiri amtima, chiopsezo chokhala ndi mtima wamtima ndizambiri: matenda a mtima (CHD), kugunda kwa mtima, sitiroko. Zotsatira zoopsa ndi vuto lalikulu la matenda oopsa. Chithandizo chake ndi chokwanira. Mulinso:

1. Zakudya zochepa za carb. Kuti mupewe kusinthasintha kwa magazi, ndikofunikira kuti muchepetse zomwe zili ndi micoprotein otsika ndi glucose muzakudya.
2. Mapiritsi opanikizika a matenda ashuga amaphatikiza mitundu yosiyanasiyana yamankhwala yomwe imagwira ntchito m'njira zina zochepetsera kuthamanga kwa magazi.
3. Njira za anthu. Amabwezeretsanso kagayidwe kachakudya, potero amachepetsa kuthinana. Musanagwiritse ntchito mankhwala ena, ndikofunikira kukaonana ndi endocrinologist kuti musankhe payekha mankhwala azitsamba kapena maphikidwe.

Zakudya zochepa za carb

Njira imodzi yothankula shuga m'magazi ndikuchepetsa magazi ndichakudya chochepa kwambiri. Zakudya zonse zomwe zimagwiritsidwa ntchito ziyenera kukhala zophika pakuphika. Kuti muchite izi, gwiritsani ntchito kuphika, kuphika, kuwongolera ndi kuwotcha. Njira zoterezi sizimakwiyitsa makoma amitsempha yamagazi, yomwe imachepetsa chiopsezo chokhala ndi matenda oopsa.

Zakudya za tsiku ndi tsiku ziyenera kuphatikizapo mavitamini ndi michere yomwe imathandizira kuti magazi azituluka. Mukamakonza menyu, muyenera kugwiritsa ntchito mindandanda yazovomerezeka ndi zoletsedwa. Gulu loyamba lili ndi:

• nsomba zam'nyanja
• odzola zipatso
• skim mkaka,
• tiyi wazitsamba
• marmalade
• buledi
• mazira
• nyama ndi nsomba,
• msuzi wamasamba
• amadyera
• zipatso zouma
• masamba.

Kugwiritsa ntchito zinthu izi pang'onopang'ono kumakhazikika pamlingo wamagazi. Zakudya zoyenera za matenda a shuga a 2 omwe ali ndi matenda oopsa zimachepetsa kuchuluka kwa mankhwala othandizira antihypertensive. Sikokwanira kuphatikiza chakudya chabwino muzakudya zanu. Ndikofunikanso kusiya zinthu zingapo:

• tchizi chokometsera
• marinade
• mowa
• zinthu zophika mkate
• chokoleti
• msuzi wamafuta
• khofi ndi zakumwa zoledzeretsa,
• nyama yamafuta ndi nsomba,
• maapulo
• masoseji, ndinasuta nyama.

Mankhwala

Mankhwala enieni a matenda oopsa mu shuga mellitus amasankhidwa mosamala kwambiri, chifukwa mankhwalawa ambiri amatsutsana ndi matenda. Zofunikira zazikulu za mankhwalawa ndi izi:

• kuthekera kutsitsa magazi ndi zotsatira zoyipa zochepa,
• kusowa kwamphamvu pa kuchuluka kwa shuga m'magazi, kuchuluka kwa cholesterol "yoyipa" ndi triglycerides,
• kukhalapo kwa mphamvu yoteteza impso ndi mtima ku kuphatikiza kwa matenda ashuga ndi matenda oopsa.

Masiku ano, magulu angapo azachipatala amadziwika. Agawidwa m'magulu awiri: yayikulu komanso yothandizira. Mankhwala ena amagwiritsidwa ntchito popereka mankhwala kwa wodwala. Mapangidwe a magulu omwe amagwiritsidwa ntchito ngati mankhwalawa akuwonetsedwa patebulopo:

Angiotensin II receptor blockers

Diuretics (okodzetsa)

Omwe akutsutsana ndi calcium

Imidazoline receptor agonists (mankhwala omwe ali ndi vuto lapakati)

Rasilez - zoletsa mwachindunji za renin

Njira zina zochizira

Mankhwala ena omwe mumagwiritsidwa ntchito popanga mankhwala amachepetsa thupi, amathandizira kuchepetsa mavuto komanso kuthamangitsa zovuta zamankhwala. Osangodalira zithandizo zachikhalidwe, ndipo musanagwiritse ntchito, muyenera kufunsa dokotala. Pakati pa maphikidwe othandiza kuthana ndi kuthamanga kwa magazi, zotsatirazi ndi izi:

1. Kutola nambala 1. Konzani 25 g ya therere la herwort, 20 g nyemba za katsabola, 25 g la maluwa a hawthorn. Sakanizani zosakaniza ndi pogaya ndi chopukusira cha khofi. Tengani 500 ml ya madzi otentha kuwerengeka kwa zitsamba. Kokani chisakanizo kwa mphindi 15 pa kutentha kochepa. Sulirani kudzera cheesecloth musanagwiritse ntchito. Musagwiritse ntchito magalasi opitilira 4 pa tsiku kwa masiku anayi.
2. Kutola nambala 2. Pa 1 lita imodzi ya madzi otentha, tengani masamba 30 a currant masamba, 20 g wa oregano ndi maluwa a chamomile, 15 g ya marashi angapo. Kusakaniza kumayesedwa pamoto wotsika kwa mphindi 10-15. Gwiritsani ntchito theka la ola musanadye katatu pa tsiku.
3. Pafupifupi zipatso za 100 g za hawthorn zimatentha ndimadzi otentha, ziphikeni pamoto wochepa kwa pafupifupi kotala la ola. Kenako, lolani msuzi kuti uzizirira kutentha. Vutani cheesecloth musanagwiritse ntchito. Imwani decoction m'malo mwa tiyi wokhazikika tsiku lonse.

Mankhwala a antihypertensive

Njira zachikhalidwe zochizira matenda ashuga ndi kumwa mankhwala a antihypertensive. Pali mitundu yosiyanasiyana ya ndalama zotere. Kusiyana kwawo kumagona mu kachitidwe kachitidwe. Dokotala atha kukulemberani mankhwala amodzi, i.e. monotherapy. Nthawi zambiri, chithandizo chimagwiritsidwa ntchito ngati mitundu yophatikiza - ndi mitundu kapena mapiritsi angapo nthawi imodzi. Izi zimathandiza kuchepetsa Mlingo wa yogwira zosakaniza ndikuchepetsa zotsatira zoyipa. Mapiritsi angapo amakhudza njira zosiyanasiyana za matenda oopsa.

Beta blockers

Awa ndi mankhwala osokoneza mtima. Ndi matenda oopsa, amapatsidwa mankhwala oletsa kupuma, tachycardia, pambuyo pa vuto la mtima, angina pectoris komanso matenda a mtima osalephera. Zotsatira za mankhwalawa ndikuletsa beta-adrenergic receptors yomwe ili m'malo osiyanasiyana, kuphatikiza mtima ndi mitsempha yamagazi.

Zotsatira zoyipa za beta-blockers ndikubisa kwa zizindikiro za hypoglycemia. Njira yotulutsira boma lino ikuchepera. Pachifukwa ichi, beta-blockers amatsutsana mwa odwala omwe amamva kuyambika kwa zizindikiro za hypoglycemia. Zinthu zonse zogwira ntchito za beta-blockers zimathera "-ol". Pali magulu angapo a mankhwalawa: lipophilic ndi hydrophilic, popanda ntchito ya kindathomimetic kapena nayo. Malinga ndi gulu lalikulu, beta-blockers ndi:

1. Osasankha. Amatchinga beta1 ndi beta receptors, amathandizira kukana insulin. Mankhwala a Anaprilin okhala ndi propranolol pamapangidwe amamasulidwa pano.
2. Kusankha. Kutsekereza kwa beta2 receptors kumayambitsa zotsatira zosafunikira, monga bronchospasm, kuyambitsa mphumu, vasospasm. Pachifukwa ichi, osankha beta blockers adapangidwa. Amadziwika kuti amatchedwa mtima ndipo amatchinga beta1 receptors okha. Zinthu zofunikira bisoprolol (Concor), metoprolol, atenolol, betaxolol (Lokren) zimasulidwa pano. Zimathandizanso kukana insulin.
3. Beta-blockers ndi vasodilating kwenikweni. Awa ndi mapiritsi amakono komanso otetezeka a matenda oopsa mu shuga.Amadziwika ndi zoyipa zochepa, amakhala ndi phindu pamapulogalamu a carbohydrate ndi lipid, komanso amachepetsa kukana kwa insulin. Mankhwala oyenera kwambiri kwa odwala matenda ashuga m'gululi ndi Dilatrend (carvedilol) ndi Nebilet (nebivolol).

Calcium calcium blockers

Mwachidule, mankhwalawa amatchedwa LBC. Amatseka njira pang'onopang'ono m'mitsempha yamagazi ndi minofu yamtima, yomwe imatseguka mchikakamizo cha norepinephrine ndi adrenaline. Zotsatira zake, calcium yochepa imaperekedwa ku ziwalo izi, ma microelement omwe amachititsa njira zambiri za bioenergetic m'maselo a minofu. Izi zimabweretsa vasodilation, yomwe imachepetsa kuchuluka kwa mtima.

Otsutsa a calcium a calcium nthawi zina amayambitsa kupweteka kwa mutu, kutulutsa, kutupa, kudzimbidwa. Pazifukwa izi, m'malo mwake mumakhala kukonzekera kwa magnesium. Amangochepetsa kukakamiza, komanso zimathandizira matumbo ntchito, kutsitsa misempha. Ndi diabetesic nephropathy, muyenera kufunsa dokotala. Mitundu ya LBC imagawidwa kutengera ndi njira zomwe oletsedwa:

1. Gulu la Verapamil. Mankhwalawa amakhudza minofu ya m'mitsempha yamagazi ndi mtima. Izi zimaphatikizira mankhwala ochokera ku gulu la omwe samapanga dihydropyridine: phenylalkylamines (Verapamil), benzothiazepines (Dilziatem). Amaletsedwa kugwiritsa ntchito limodzi ndi beta-blockers chifukwa choopsa cha kusokonezeka kwa miyeso. Zotsatira zake zingakhale kutsekedwa kwa atrioventricular block ndi mtima. Verapamil ndi Dilziatem ndi njira yabwino yosinthira beta akabedwa koma akufunika.
2. Gulu la nifedipine ndi dihydropyridine BBK (kutha ndi "-dipin"). Mankhwalawa sakukhudza kugwira ntchito kwa mtima, chifukwa chake amaloledwa kuphatikizidwa ndi beta-blockers. Zowonjezera zawo ndizochulukitsa kwamtima, kuposa mtima amayesera kupanikizika utachepa. Kuphatikiza apo, onse a BBK alibe ntchito za nephroprotective. Contraindication kuti agwiritse ntchito ndi hyperglycemia ndi angina wosakhazikika. Mu gulu lino, ma subtypes angapo am'magulu a dihydropyridine amadziwika:
   • nifedipine - Corinthfar, Corfard Retard,
   • felodipine - Adalat SL, nimodipine (Nimotop),
   • lercanidipine (Lerkamen), lacidipine (Sakur), amlodipine (Norvask), nicardipine (Barizin), isradipine (Lomir), nitrendipine (Bypress).

Mu odwala matenda ashuga, mumakhala chidwi chamchere komanso kuchuluka kowonjezereka kwa magazi. Zotsatira zake, kuthamanga kwa magazi kumakwera. Kuti muchepetse, gwiritsani ntchito diuretics (diuretics). Amachotsa madzi ochulukirapo ndi mchere m'thupi, amachepetsa kuchuluka kwa magazi, zomwe zimathandiza kuchepetsa kupanikizika kwa systolic ndi diastolic.

Poyerekeza ndi maziko a matenda ashuga, ma diuretics nthawi zambiri amaphatikizidwa ndi beta-blockers kapena ACE inhibitors, chifukwa mawonekedwe a monotherapy amawonetsa kusakwanira kwawo. Pali magulu angapo a okodzetsa:

Dzinalo la gulu la okodzetsa

Ngati ndi kotheka, vasodilation, kusintha kagayidwe. Chalangizidwa gout, shuga ndi ukalamba.

Torasemide, Furosemide, Ethacrine Acid

Ndi kulephera kwa aimpso. Gwiritsani ntchito mosamala ndi glucophage ndi mankhwala ena a shuga chifukwa chowopsa chokhala ndi lactic acidosis.

Triamteren, Amiloride, Spironolactone

Matenda a shuga sagwiritsidwa ntchito.

DM ndi yotsutsana ndi kugwiritsa ntchito ma diuretics awa, chifukwa amatha kuzama acidosis.

ACE zoletsa

Chithandizo cha matenda oopsa mu shuga sichokwanira popanda angiotensin-kutembenuza ma enzyme inhibitors, makamaka pakakhala zovuta za impso. Contraindated awo ntchito ndi mimba, hyperkalemia ndi kuchuluka seramu creatinine. Odwala omwe ali ndi matenda a shuga a mtundu woyamba 1, 2 inhibitors ndi mankhwala oyambira. Amalembera proteinuria ndi microalbuminuria.

Kuchita kwa mankhwalawa ndikuwonjezera chidwi cha minofu kuti insulin. Izi zimathandiza kupewa matenda ashuga amtundu 2. ACE inhibitors amachepetsa mitsempha yamagazi, ndi sodium ndi madzi, chifukwa cha iwo, amasiya kudzikundikira minofu. Zonsezi zimabweretsa kutsika kwa kupanikizika. Mayina a ACE zoletsa amamaliza "-pril." Mankhwala onse agawidwa m'magulu otsatirawa:

1. Sulfhydryl. Izi zikuphatikizapo benazepril (Potenzin), Captopril (Kapoten), kufenopril (Zokardis).
2. Carboxyl. Mulinso perindopril (Prestarium, Noliprel), ramipril (Amprilan), enalapril (Berlipril).
3. Phosphinyl. Mu gululi, Fosicard ndi Fosinopril amawonekera.

Mankhwala othandizira

Ngati wodwala wayikidwa mankhwala ophatikiza, kuphatikiza pa mankhwala akuluakulu, mankhwala othandizira amagwiritsidwa ntchito. Amagwiritsidwa ntchito mosamala chifukwa cha zovuta zoyipa. Chizindikiro cha kuperekedwa kwa othandizira othandizira ndikulephera kwa chithandizo ndi mankhwala oyambira. Mwachitsanzo, kwa odwala omwe ali ndi ACE inhibitors, chifuwa chowuma chimapezeka mwa odwala ena. Zikakhala choncho, dokotala woyenera amasamutsa wodwalayo kuchipatala cha angiotensin receptor antagonists. Mlandu uliwonse umawunikidwa payekhapayekha kutengera momwe wodwalayo alili.

Direct renin inhibitor

Resiles ndi renin inhibitor mwachindunji ndi ntchito yotchulidwa. Kuchita kwa mankhwalawa cholinga chake ndikulepheretsa kusintha kwa angiotensin kuchokera ku mawonekedwe I kupita II. Vutoli limapangika m'mitsempha yamagazi ndipo limapangitsa kuti ma adrenal glands apange mahomoni aldosterone. Kuthamanga kwa magazi kumachepa pambuyo pakugwiritsidwa ntchito kwa nthawi yayitali. Ubwino wa mankhwalawa ndikuti kupambana kwake sikudalira kulemera kapena msinkhu wa wodwala.

Zowonazo ndizopanda kulephera kugwiritsa ntchito panthawi yomwe muli ndi pakati kapena kukonzekera kwake posachedwa. Zina mwazotsatira zoyipa mutatha kutengapo gawo ndi:

• kuchepa magazi
• kutsegula m'mimba
• chifuwa chowuma
• zotupa pakhungu,
• kuchuluka kwa potaziyamu m'magazi.

Ndikofunikira kudziwa kuti maphunziro a Rasilez a nthawi yayitali sanachitike. Pazifukwa izi, madokotala amangopereka lingaliro kuti mankhwalawo ali ndi mphamvu yoteteza impso. Rasilez nthawi zambiri imaphatikizidwa ndi angiotensin II receptor blockers ndi ACE zoletsa. Potengera momwe adadyera, mankhwalawa amathandizira chidwi chamtundu wa insulin ndikuwongolera magazi. Rasilez ndiwotsutsana mu:

• Kukonzanso kwamphamvu kwamphamvu
• ana ochepera zaka 18,
• pafupipafupi hemodialysis
• nephrotic syndrome
• Hypersensitivity pamagawo a mankhwala,
• kukanika kwambiri kwa chiwindi.

Imidazoline receptor agonists

Ili ndiye dzina la mankhwala apakati. Zimakhudza zolandirira ubongo. Kuchita kwa agonists kufooketsa ntchito yamachitidwe amanjenje amanjenje. Zotsatira zake ndikuchepa kwa kugunda kwa mtima ndi kupanikizika. Zitsanzo za imidazoline receptor agonists ndi:

• rilmenidine - Albarel,
• moxonidine - Physiotens.

Zoyipa zomwe zimachitika chifukwa chogwiritsa ntchito mankhwalawa ndizotsimikizika mwa 50% ya odwala. Kuphatikiza apo, ali ndi zoyipa zingapo, monga:

Ubwino wa mankhwala omwe ali ndi mankhwalawa ndi kusapezeka kwa kulera komanso kulolera. Ndiwo oyamba kulembedwa kwa anthu okalamba, makamaka ndi concomitant pathology, kuphatikizapo matenda a shuga. Imidazoline receptor agonists amatsutsana mu:

• Hypersensitivity
• kwambiri mtima arrhythmias,
• kuphwanya sinotrial ndi AV conduction II-III degree,
• bradycardia osakwana 50 kumenya pamphindi,
• kulephera kwa mtima
• angina wosakhazikika,
• kuphwanya kwambiri impso ndi chiwindi,
• mimba
• glaucoma
• mavuto
• kusokonekera kwa kufalikira kwazungulira.