Chithandizo cha matenda a shuga amitundu yosiyanasiyana: njira ndi njira

Chithandizo cha matenda a shuga ndi njira zina zochiritsira komanso mankhwala omwe amathandizira kuti matenda a metabolic akhale mthupi la wodwalayo ndi matenda a shuga, kukhazikika m'magazi a glucose, kuchuluka kwa insulini komanso kuchepetsa zizindikiro za matendawa.

Kutengera mtundu wa matenda a shuga, njira zochizira matendawa zimasankhidwa payokha. Ndi mtundu woyamba wa pathology wodalira insulin, jakisoni watsiku ndi tsiku ndi insulin amawonetsedwa kwa onse odwala. Kuti muthane ndi kuopsa kwa zizindikiritso za mtundu wachiwiri wa shuga, mankhwala ochepetsa mphamvu ya mankhwala kapena wowerengeka omwe amaperekedwa, nthawi zina pamakhala matenda osakhazikika, kukhazikika kwa thanzi kumatha kuchitika mwa kusintha kadyedwe ka wodwala. Mulimonsemo, chithandizo cha matenda ashuga ndi njira yovuta kwambiri yomwe imafunikira kuyang'anira pafupipafupi.

Njira ndi njira za mankhwala ovomerezeka

Chithandizo chamankhwala chimawona ngati chithandizo cha matenda osokoneza bongo monga njira yovuta yochiritsira, yomwe iyenera kuthandizidwa ndi mankhwala othandizira komanso othandizira olimbitsa thupi. Kuyang'anira mosamalitsa mankhwala onse azachipatala, ndikosavuta kukwaniritsa chindapusa chonse cha matendawa, kuchotsera zizindikiritso ndi kutonthozedwa kwathunthu m'moyo watsiku ndi tsiku.

Mankhwala othandizira

Chithandizo cha mankhwala osokoneza bongo a matenda amtundu uliwonse amatsimikiziridwa, choyambirira, ndi mtundu wa matenda, gawo lake ndi kukhalapo kwa zovuta ndi matenda opatsirana.

Mtundu woyamba wa matenda a shuga umakhala wodalira insulini, mawonetseredwe ake nthawi zambiri amapezeka ali aang'ono, ndipo wodwalayo amayenera kugwiritsa ntchito jakisoni wa insulin moyo wake wonse kuti akhale ndi mahomoni oyenera, omwe amapangidwa m'thupi lake momwe. Mwa zina mwa mankhwala a matenda amtundu 1 shuga, magulu otere a mankhwala omwe amalumikizana bwino ndi insulin ndiofala.

Ndi mtundu wachiwiri wa matenda ashuga, omwe amadziwika kuti "shuga wamkulu", insulin yakeyo imasiya kugwira ntchito moyenera. Kwa kanthawi kochepa, zimapitilizidwa kupanga zochuluka, koma maselo amaleka kuzizindikira, ndiye kuti mlingo wake umachepetsedwa. Kukhalabe ndi shuga wamagazi ambiri, odwala amalangizidwa kuti azigwiritsa ntchito mankhwala ochepetsa shuga. Kuchita kwawo kungakhale ndi cholinga chokwaniritsa magwiridwe antchito (kukonzekera kwa sulfanilurea, dongo, ma impretins), komanso kupondereza insulin kukana komwe kwachitika m'thupi (makonzedwe a metformin, thiazolinedione).

Pansipa pali zitsanzo za mankhwala a pharmacological omwe nthawi zambiri amagwiritsidwa ntchito ngati mankhwala amakono kuti asinthe kukana kwa insulin komanso shuga m'magazi a anthu odwala matenda ashuga, komanso insulin yomwe imagwiritsidwa ntchito pamitundu yosiyanasiyana ya matenda ashuga.

Maselo a tsinde

Njira yatsopano yamankhwala amakono ndiyo kuchiza matenda ashuga a m'mimba pogwiritsa ntchito tsinde maselo a chiberekero. Autologousness imafotokozedwa koyambira kwa maselo m'thupi la wodwalayo. Njirayi imatha kuthana ndi choyambitsa matenda, kuchepetsa hyperglycemia ndikuchotsa zovuta zomwe zimadzetsa. Njirayi imagwiranso ntchito pothana ndi hypoglycemia, zomwe zimayambitsa kukomoka kapena kudandaula, pomwe kusowa kwa chisamaliro chachipatala nthawi zina kumatha ngakhale kupha odwala.

Njira ya tsinde maselo othandizira amaphatikizapo kuyambitsa kwawo kudzera mu catheter mu mtsempha wamagazi. Ngati catheterization sichingatheke, maselo a stem amatha kutumikiridwa kudzera m'mitsempha.

Pa gawo loyamba la mankhwalawa, m'mafupa mumatuluka fupa la m'chiuno pansi pa mankhwala ogwiritsa ntchito ngati singano yopyapyala. Njira yonse imakhala mpaka theka la ola, kenako wodwalayo amabwerera ku moyo wake wachilendo.

Mu ma labotale, maselo a stem amayamba kutulutsidwa m'mafupa a wodwalayo, kuyesa mawonekedwe awo ndikuwerengera omwe ali oyenera. Maselo oyenerera amasintha amasintha kukhala mtundu wina wamaselo mthupi ndikubwezeretsa kupezeka kwa zomwe zikusowa pazifukwa zina. Chifukwa chake, maselo a stem omwe ali ndi shuga amatha kulowa m'malo mwa "pancreatic beta cell".

Pa gawo lomaliza la njirayi, maselo amtunduwu amaikidwa mu gawo la pancreatic artery pogwiritsa ntchito catheter. Catheter pansi pa opaleshoni yakumaloko imayikidwa mu chotupa cha akazi, ndikugwiritsa ntchito ma x-ray, imatengedwera kupita ku chithokomiro cham'mimba, komwe kumayambitsa maselo a cell.

Njira yonse yodzilimbikitsira imakonda kukhala pafupifupi ola limodzi ndi theka. Akamaliza, wodwalayo amakhala kuchipatala kwa maola angapo. Madokotala amafufuza panthawiyi kuti machiritso a mitsempha atayikidwa kale. Ngati wodwalayo sangathe kugwiritsa ntchito catheter, mwachitsanzo, ndi aimpso, ndiye kuti zonse pamwambapa zimachitika ndi makonzedwe amkati. Mu matenda a diabetes a zotumphukira za m'mitsempha, maselo olowa mkati amalowetsedwa mwa odwalayo kudzera mu jekeseni wamitsempha.

Ndikofunikira kumvetsetsa kuti maselo akuluakulu a stem sangathe kukhala vuto la matenda aliwonse. Ndizovuta kwambiri kuzindikira kuwongolera kochiritsa ngati wodwala wamkulu. Nthawi zina kusintha kumadza mwachangu kwambiri, nthawi zina kumakhala kosawoneka. Chifukwa chake, njira yothanirana ndi matenda ashuga omwe amakhala ndi masinde a stem imawonekerabe ngati yoyesera ndipo imafunikira kuti muphunzire pafupipafupi.

Stem cell therapy tsopano ikuchitika mu zipatala ku America, Israel, Germany, Turkey, Czech Republic, komanso ku Russia ndi Ukraine.

Laser chithandizo ngati chithandizo

Mankhwala a Laser amatengedwa ngati imodzi mwanjira zatsopano zochizira matenda osokoneza bongo a shuga, omwe amathandiza kuchepetsa kwambiri shuga wamagazi ndikuchotsa chizindikiro cha matenda. Kuchita bwino kwa njirayi kumatsimikiziridwa pochita mankhwalawa ambiri odwala matenda ashuga ndi chithandizo chake.

Kuti mugwiritse ntchito mankhwala othandizira ndi laser, ndikofunikira kugwiritsa ntchito zida zapadera zowonjezera zomwe zimakhala ndi mphamvu kwambiri ndi mtanda wa laser pazinthu zothandizira thupi. Mankhwala a Quantum amathandizira kutsika kwa magazi, kumathandizira magwiridwe antchito, chitetezo chokwanira cha minofu, kusinthanso minofu ndikumachepetsa kutupa. Chizindikiro cha mankhwala a laser ndikuthekera kwake kuchitapo kanthu pazomwe zimayambitsa matendawa, osati kungomenya zomwe zikuwoneka, monga mankhwala ambiri a shuga.

Kuti athe kutengera mwachangu madera onse omwe akhudzidwa, mawonekedwe ophatikizira amagetsi ndi ma electromagnetic nozzles amaperekedwa mu zida za quantum:

• pa radiation ya infrared ya LED,
• kupanga maginito osalekeza,
• poizoni wa laser,
• potulutsa kuwala kofiira.

Radiation ya pulse laser kuti ikwaniritse mphamvu yochizira odwala matenda ashuga imatha kulowa masentimita 13 mpaka mu minofu, ndikumakhudza mwamphamvu ma cell a ziwalo zosiyanasiyana, ndikupereka magazi ndi kuwonjezera njira za nembanemba.

Kugwiritsa ntchito mankhwala a laser odwala matenda a shuga kungapereke chiwongolero chachikulu pachithunzi cha odwala. Komanso, musanagwiritse ntchito njira yothandizira mankhwalawa, ndikofunikira nthawi zonse kukonzekera, kuphatikiza mitundu iyi ya diagnostics:

• kuyezetsa komanso kuyesedwa kwa labotale kuti adziwe kukula ndi mtundu wa matenda osokoneza bongo a wodwalayo, komanso zotupa zomwe zimagwirizana ndi ziwalo zamkati ndi machitidwe, zomwe zimathandizira kupanga njira yoyenera yothandizira,
• Kutsimikiza glycemia mlingo kusankha yoyenera insulin mankhwala.

Palibe umboni wa matenda ashuga a ketoacidosis, wodwalayo amapatsidwa chithandizo chamankhwala chomwe chimaphatikizapo zinthu monga:

• maginito infrared laser mankhwala aofatsa mitundu ya matenda,
• maginito infrared laser mankhwala osakanikirana ndi njira zachipatala kuti athetse zifukwa zothandizira - cytomegaloviruses, matenda a herpes, chlamydia ndi zinthu zina - ndi mitundu yayikulu ya matenda a shuga,
• maginito infrared laser mankhwala limodzi ndi mankhwalawa a zovuta (kapamba, gastroduodenitis, mtima pathologies ndi zina) woopsa mitundu ya matenda.

Mukamayang'ana zotsatira za laser mankhwala okhudzana ndi kapamba, kuwonjezereka kwa insulin ndende kunakhazikitsidwa, ngati ziphuphu zimagwira ntchito palokha. Kuti mupeze mphamvu yayikulu, mankhwalawa ayenera kuchitika koyambirira kwa matenda, pomwe shuga yayikulu sikanathetse kusintha kwina m'thupi lonse.

Kuthira mankhwala

Mankhwala ena amaganiza kuti ndizotheka kuchiritsa matenda ashuga mwachangu, mosiyana ndi ma endocrinologists, omwe amawona kuti njira imeneyi ndi yopanda tanthauzo. Akatswiri ofala ndi njala amafotokoza kuti ndi mtundu umodzi wokha wa matenda a shuga womwe ungaganizidwe kuti ndiwachinyengo pa kugwiritsa ntchito njirayi, ndipo odwala omwe ali ndi mtundu wachiwiri wa matenda ena nthawi zina amatha kuchotsa zizindikiro pokana chakudya. Kuphatikiza apo, pamenepa, kusala kudya kwotalikirapo ndi kwapakatikati komwe komwe kungakhale ndi gawo lofunikira, koma kusala kudya kwachiwiri kwamasiku atatu sikungabweretse zotsatira.

Lemberani kuti musafe ndi matenda a shuga muyenera kusamala kwambiri. Ntchito yayikulu pano idzaseweredwa ndi nthawi yokonzekera, pomwe wodwalayo amaphunzira kutsatira zakudya ndikusambitsa njira zina zoyeretsera. Ndikwabwino kufa ndi njala kuchipatala chokhazikitsidwa ndikuyang'aniridwa ndi akatswiri oyenerera. Ndikofunikanso kwambiri kuti musafe ndi njala molondola, ndikuwona kudya komwe kumayikidwa panthawi yonse yochira.

Munthawi yakusala kudya, kagayidwe ka wodwalayo limasintha thupi la wodwalayo, ndipo kuchuluka kwa chiwindi ndi kapamba kumachepa. Njira izi zimathandizanso pa matenda ashuga. Magwiridwe a machitidwe ena mthupi amakhalanso otetezedwa, ma pathologies omwe nthawi zambiri amayambitsa chiwonetsero cha matenda ashuga.

Chifukwa chake, akatswiri pankhani yosala kudya amalimbikitsa kugwiritsa ntchito njirayi poyambira mitundu yachiwiri ya matenda a shuga 2 kuti athandize wodwalayo komanso kuti athetse zonse zomwe zimayambitsa matendawa.

Hirudotherapy mankhwalawa

Hirudotherapy kapena chithandizo ndi leeches sizitaya kufunika kwake kwazaka zambiri. Ichi ndi chifukwa cha zovuta zotere kuchitira wodwalayo matupi, kuphatikizapo kayendedwe ka chitetezo chamthupi, kuthamanga kwamitsempha yamagazi, zotsatira zamagetsi amkati.

Zotsatira zonse zili pamwambazi ndizofunikira kwambiri pochiza matenda ashuga, chifukwa zovuta zake zilizonse zimagwirizanitsidwa ndi mitsempha ya mitsempha, atherosclerosis, komanso mavuto azungulire. Pakugwiritsa ntchito hirudotherapy koyamba, odwala matenda ashuga nthawi zambiri amawona kusinthika kwa thanzi lawo, ndipo chifukwa chake chithandizo chamankhwala chimadziwika ndi kusintha koteroko mu chithunzi cha matenda ashuga, monga:

• kupanikizika matembenuzidwe
• kutsitsa cholesterol
• kuyeretsa kwamitsempha kuchokera ku mawonekedwe a atherosulinotic,
• kutsitsa kwa kulephera kwa ma trophic, kubwezeretsa zakudya za minofu,
• Kutha kwa zizindikiritso zotupa za mtima.

Komabe, ndikofunikira kukumbukira kuti hirudotherapy ya matenda ashuga ingagwiritsidwe ntchito ngati njira yowonjezerapo povuta mankhwala. Mitsempha imayikidwa pa matenda a matenda omwe amafotokozedweratu pama mfundo zazikuluzikulu zingapopi:

• mdera lam'mphepete mwa msana pakati pa 11 ndi 12 thorteti vertebrae, pakati pa 12thoracic ndi 1th lumbar vertebrae ndi malo owonjezera omwe ali masentimita 3-4 kumanzere ndi kumanja kwa zomwe zikuwonetsedwa
• m'dera la xiphoid thoracic process ndi 3-4 centimeter pansi pamunsi oyambira,
• m'dera la chiwindi - mpaka kumunsi kumanzere kwa chifuwa,
• kumtunda kwa coccyx ndi kumtunda kwa sacrum.

Njira ya mankhwalawa a shuga ndi hirudotherapy nthawi zambiri amatenga nthawi 10-15 ndi pafupipafupi 1 ndondomeko 3 masiku. Pa mfundo iliyonse mthupi, ma leeches atatu amafunikira.

Chithandizo cha zitsamba

Ngakhale kuti masiku ano madokotala sangathe kuchiritsiratu matenda ashuga, asing'anga amchikhalidwe amathandizira otsatira awo kuti athetse vuto la mankhwalawa mothandizidwa ndi mankhwala achilengedwe. Komabe, musanachiritsidwe matenda a shuga ndi maphikidwe achikhalidwe, ndibwino kukambirana ndi dokotala za zotheka izi.

Pakati pa maphikidwe odziwika bwino a matenda ashuga, njira zotsatirazi za zitsamba, zipatso ndi mbewu zakhala zikudziwika kale:

• Magawo awiri a mbewu zofiirira,
• Gawo limodzi lamasamba achimbudzi,
• Magawo awiri a zipatso za juniper,
• Magawo 4 a masamba a mabulosi.

Zosakaniza zonse zimasakanizidwa bwino, ndiye supuni ziwiri za kusakaniza izi zimatengedwa ndikutsanulira ndi ma milliliters 400 amadzi otentha. Kuphatikizikako kumayikidwa pamoto yaying'ono ndikuwuphika kwa mphindi 5. Pambuyo pochotsa pamoto kwa mphindi zina 30, kulowetsaku kumalimbikitsidwa, kusefedwa ndikuwotenga katatu pa tsiku musanadye kwa mphindi 15.

Utatu wobiriwira wa Pulofesa Ivanchenko ndiwotchuka motsutsana ndi matenda a shuga. Imagwira bwino osati Zizindikiro zokha, komanso imakhazikitsa njira zomwe zimayambitsa matendawa. Muli ndi maluwa okhathamira (1 gamu), ufa wa clove (0,5 gramu) ndi therere la chowawa (200-300 milligrams). Zosakaniza zake ndizosakanikirana, supuni ya chisakanizo chotere chimatsanulidwa mwachindunji mu supuni ndi madzi kutentha kwa firiji. Uku ndi kusakaniza kwa nthawi imodzi komwe muyenera kumwa patsiku loyamba la mankhwala theka la ola musanadye, patsiku lachiwiri limagwiritsidwa ntchito kale kawiri pa tsiku, ndipo masiku a 3-7, mankhwalawa amamwa asanadye katatu katatu patsiku. Pakatha sabata ntchito, triad ifunika kugwiritsidwa ntchito kamodzi pa sabata kwa chaka chimodzi. Komabe, pakatha mwezi umodzi chithandizo cha maulendo atatu, ndikofunikira kuwunika kuchuluka kwa shuga ndikuwonetsetsa kuti mankhwalawa ndi othandiza. Ndikofunikanso kukumbukira kuti ma cloves amatha kuwonjezera magazi, chifukwa chake kugwiritsidwa ntchito kwa matenda oopsa kuyenera kuvomerezana ndi adokotala.

Komanso, pofuna kuchepetsa shuga, masamba a dandelion ang'ono amagwiritsidwa ntchito, amawonjezeredwa msuzi, saladi, ndi nyama yozama. Ngati masamba sanali achichepere, ndiye kuti amawanyowa m'madzi amchere mpaka kuwawa kutulukire. Mutha kudya masamba a dandelion mu mawonekedwe awo oyera - magalamu 150-200 patsiku.

Mankhwala ena wowerengeka

Kutsitsa shuga, tsamba la bay limagwiritsidwa ntchito. Nthawi yomweyo, masamba 10 a laurel adzakhala okwanira malita awiri amadzimadzi. Madzi okhala ndi timapepala amafunika kuwiritsa, kenako nkuumirizidwa kwa masiku 14 m'malo amdima, kenako kusefa ndi kusungidwa mufiriji. Muyenera kumwa msuzi wa laurel wofunda pamimba yopanda mulingo wa ½ chikho ndi shuga wamagazi ofikira 10 mmol pa lita, kapenanso kuchuluka kwa kapu yonse yokhala ndi zizindikiro za shuga zoposa 10 mmol pa lita. Simungathe kugwiritsa ntchito chikho choposa 1 cha mankhwala mu gawo limodzi.

Njira ya mankhwala ndi laurel decoction ndi miyezi itatu, munthawi yomwe ndikofunikira kuyang'anira mayendedwe a shuga ndikusintha, kutengera iwo, kuchuluka kwa tincture. Kuphatikiza pa kutsitsa shuga, msuzi umathanso kuchotsa mchere wamafuta ndi zinthu zovulaza m'thupi. Kugwiritsa ntchito mankhwalawa pafupipafupi kumachepetsa thukuta, kumapangitsa kuti munthu azikhala wathanzi komanso azikhala bwino ndi odwala matenda ashuga.

Chithandizo chogwiritsa ntchito soda mu shuga mellitus sichimateteza zinthu zambiri zoyipa m'magulu osiyanasiyana ndi machitidwe. Mankhwala amatha kugwiritsidwa ntchito pakamwa ndi madzi kapena kuwongolera makonzedwe ake.

Pankhani ya matenda ashuga, sodium carbonate kapena koloko zimatsuka matumbo bwino, zomwe zimathandiza chiwindi chokhudzidwa ndi matenda a pathology. Ndi zizindikiro za acidity m'thupi pamtunda wa magawo 7.4, mankhwala a koloko ndi abwino kulandiridwa, chifukwa mankhwalawa amachepetsa acidity komanso amateteza mabakiteriya. Mutha kumwa yankho la sodium popewa matendawa, komanso mukamalandira chithandizo. Nthawi yomweyo, kuphika soda nthawi yomweyo kumathandizira chitetezo cha mthupi, kumachotsa kusasangalala m'mimba.

Njira inanso yodziwika bwino yokhudza matenda a shuga ndi sinamoni. Kuchepetsa shuga kumachitika chifukwa cha calcium, mchere, manganese, mavitamini, choline, chitsulo, pantothenic acid ndi pyridoxine mu zonunkhira izi. Mwa zabwino zazikulu za sinamoni mankhwalawa, zinthu zotsatirazi zimatha kusiyanitsidwa:

1. Imachulukitsa kagayidwe kakang'ono ka chakudya, kamene kamayambitsa kudzipatsa shuga m'magazi a wodwalayo.
2. Ili ndi mphamvu yofanana ndi mphamvu ya insulin mthupi, chifukwa cha kupezeka kwa zinthu zopanda moyo - zinthu zina za insulin.
3. Imachepetsa kukula kwa shuga wamagazi mukatha kudya, kuti mutha kuthana ndi matenda otsekula m'mimba, komanso kuwonjezera insulin.
4. Imagwira ngati antioxidant yachilengedwe, imachepetsa kulemera kwa iwo omwe ali ndi vuto lakelo la shuga, ndikumapangitsa insulin.
5. Imatha kusintha zochita za insulin-chifukwa cha kukhalapo kwa michere ya flavonoids mwa kapangidwe kake, komwe kumapangitsa kutsika kwa shuga wamagazi mwa odwala matenda a shuga.

Komanso, sinamoni infusions imakhala ndi anti-yotupa, anti-arthritic, and firming, imapangitsa matumbo kugaya, kuchiza akazi, matenda a mafangasi, ndi zina zambiri. Cinnamon m'magazi amatha kuchepera thupi ndikuthandizira kufalikira kwathanzi. Kuchepetsa shuga kwa sinamoni kumadziwika kwambiri mukamagwiritsa ntchito magalamu awiri patsiku. Kugwiritsa ntchito zonunkhira pafupipafupi kumapatsa wodwala cholozera cha shuga pafupi ndi chizolowezi chathupi.

Ndikulimbikitsidwa kugwiritsa ntchito sinamoni mu shuga mellitus kuphatikiza ndi kefir, zomwe sizikuvulaza dongosolo lamtima ndipo zimakhala ndi zotsatirapo zambiri zabwino mthupi, zimathandizira zotsatira za zonunkhira izi.

Chithandizo choyambirira

Matenda a shuga amakhalanso ndi chidwi chokhala ndi thanzi labwino amathanso kuzindikira pakadali koyambirira, pomwe magazi a magazi afika 6 mmol pa lita. Nthawi zambiri zomwe zimapangitsa kuti munthu akhale wodwala komanso azingokhala. Ngati mungaganizire za zinthu ngati izi ndikuzindikira matenda ashuga koyambirira, zidzakhala zosavuta kuchiza matendawa komanso zomwe zimayambitsa matendawa. Komabe, chithandizo chilichonse cha matendawa chimayenera kuyang'aniridwa ndi endocrinologist malinga ndi chiwembu cha wodwala aliyense. Chofunikira kwambiri pa chithandizo chilichonse chamankhwala odwala matenda ashuga nthawi zonse chimakhala chopatsa thanzi.

Kuchiza matenda ashuga koyambirira nthawi zambiri kumakhala ndi chakudya chopanda chakudya. Kuchuluka kwa chakudya m'zakudya zonse zomwe zimadyedwa kuyenera kuwerengedwa mosamala kuti pasapyole chilolezo cha tsiku lililonse chololedwa ndi akatswiri. Nthawi yomweyo, simungadye muffin, shuga, biringanya, mbatata, zipatso zotsekemera, nyama zosuta, zakudya zam'chitini, zipatso, zokometsera komanso mowa. Kuphika pogwiritsa ntchito kukazinga nkoletsedwa, komanso kusuta.

Zakudya za anthu odwala matenda ashuga ayenera kukhala nyama yochepa-mafuta, zipatso zouma, zipatso zosaphatikizika ndi zipatso, zipatso za mpunga, bulauni, burwheat, mapira, barele wa pearl, wakuda ndi wofiira currants, cranberries, raspberries, blueberries, gooseberries.Monga chakumwa mu matendawa, chakudyacho chimaphatikizapo madzi a patebulo, kefir, compote wosaphatikizidwa, tiyi wakuda kapena wobiriwira, madzi a zipatso, mabulosi ophika omwe amapaka mkaka, chicory, madzi amchere. Ndizovomerezeka kugwiritsa ntchito tchizi tchizi, azungu azira, mafuta a azitona ndi mafuta opaka, yogati yachilengedwe.

Chakudya chomwe chimakhala ndi index yayikulu ya glycemic, chomwe chimawonetsera kuchuluka kwa momwe chakudya chamafuta azikomedwera m'thupi, sichimachotsedwa kwathunthu pazakudya za wodwala. Zakudya zoletsedwa zomwe zimakhala ndi mndandanda wokwanira wa glycemic zimaphatikizapo masiku, mowa, mkate woyera ndi zoseweretsa kuchokera pamenepo, swede, kaloti, chokoleti, semolina.

Kuti mupeze mankhwala othandizira odwala matenda a shuga koyambirira, ndikofunikira kuti musanyalanyaze zolimbitsa thupi zolimbitsa thupi. Chifukwa cha zochitika zolimbitsa thupi, minofu yamatumbo imalowetsa shuga kwambiri, kuchepetsa kuchuluka kwa magazi ake, wodwalayo amakhala ndi mphamvu yolimbitsa thupi, minyewa yamtima imalimbitsa, kunenepa komanso kuthamanga kwa magazi, machitidwe a metabolic amabwereranso kwazomwe zimachitika, komanso kumva kwa ma cell ku zotsatira za kuchuluka kwa insulin. Zochita zolimbitsa thupi ziyenera kusankhidwa ndi dokotala munthawi iliyonse, komabe, pali mitundu yonse ya katundu yemwe amapangidwa kuti azichita mwaukadaulo komanso mwamphamvu kwambiri. Palibe aliyense wa omwe ali ndi matenda ashuga omwe amaphatikizika pakusambira, kuyenda, kapena kupalasa njinga. Pafupipafupi maphunziro azikhala pafupipafupi - wodwalayo ayenera kuchita katatu pa sabata. Poyamba makalasi, ndibwino kuti musamachulukitse thupi ndikuchepetsedwa ndi mphindi 15 zilizonse zochita, pang'onopang'ono kuwonjezera nthawi.

Pogwiritsa ntchito masewera olimbitsa thupi pafupipafupi, anthu omwe amamwa insulini amayenera kuwunika mulingo wake, chifukwa ntchito zolimbitsa thupi nthawi zambiri zimakulolani kuti muchepetse kuchuluka kwa mahomoni omwe amagwiritsidwa ntchito.

Akatswiri ena amakhulupirira kuti magawo oyambirira a shuga 2 omwe amakhala ndi chakudya chamagulu komanso zinthu zofunika kuchita zolimbitsa thupi atha kuchiritsidwa kwathunthu. Uku ndi malingaliro otsutsana, koma kusinthaku kudzabwera, ndipo mtsogolomo wodwalayo akulangizidwa kuti aziyang'anira kuchuluka kwa glucose wogwiritsa ntchito glucometer yonyamula.

Kuwonongeka kwa phazi

Matenda a diabetesic phazi ndi neurotrophic komanso ma microcirculatory kusokonezeka kwa zigawo za m'munsi zam'munsi, zomwe zimayambitsa zilonda zam'mimba zotupa komanso zotupa za khungu, komanso zotupa zam'mimba. Kuvulala kwamiyendo chifukwa cha matenda ashuga kumapezeka kwa anthu odwala matenda ashuga zaka 15-20 patatha chiwonetsero cha matendawa. Mwambiri, pafupifupi 10% ya odwala amakhudzidwa, ndipo enanso 40% ali pachiwopsezo chotenga matenda amtunduwu. Mu milandu 90%, phazi la matenda ashuga limapezeka mwa odwala omwe ali ndi mtundu wachiwiri wa matenda.

Njira zazikulu zochiritsira zotupa za matenda am'mimba za m'munsi zimaphatikizanso kusintha kwa magazi ndi kagayidwe kazakudya m'thupi, kuchepetsa katundu pa mwendo womwe wakhudzidwa, chithandizo cha zilonda zam'deralo, chithandizo chamankhwala omwe ali ndi mankhwala a pharmacological, ndipo, ngati zonsezi sizothandiza, opaleshoni. Kukulitsa glycemia m'thupi la wodwala ndi mtundu woyamba wa matenda, mlingo wa insulin womwe umagwiritsidwa ntchito umasinthidwa. Pankhani yachiwiri ya shuga, tikulimbikitsidwa kuti tichotse mankhwalawa ndi mankhwala a insulin. Matenda a normalization opanikizika amatha kukwaniritsidwa pogwiritsa ntchito beta-blockers, ACE inhibitors, diuretics ndi calcium antagonists.

Ndi zotupa za purulent-necrotic za phazi la matenda ashuga, imayenera kumasula miyendo, kuyimitsa kayendedwe kake ndikugwiritsa ntchito ndodo, zida zamafupa, nsapato zapadera kapena insoles. Pa zolakwika zam'matumbo, zimafunikira kuchiza bala povulaza minofu ya necrotic, ikani ma antibacterial kapena antiseptic dressings, chotsani chimanga, chimanga ndi malo okhala ndi hyperkeratosis kuzungulira bala.

Antibiotic mankhwala a matenda ashuga phazi amachitika ndi mankhwala okhala ndi antimicrobial chiwonetsero chambiri. Antispasmodics, njira zothetsera, ng'ombe seramu hemodialysate, akubic acid amagwiritsidwa ntchito limodzi nawo. Pokhapokha pakufunika kwa chithandizo chamankhwala mosamala kwambiri odwala matenda am'magazi a shuga amagwiritsidwa ntchito. Ndi njira ya ischemic ya pathology, endovascular dilatation, thromboembolectomy, zotumphukira kwa mtsempha wamagazi, kukokoloka kwa mitsempha, kutsika kwa popliteal-handpass ndi njira zina zimagwiritsidwa ntchito. Potseka pulasitiki pazolakwika zazikulu, autodermoplasty imachitika. Nthawi zina pakhoza kukhala kofunikira kuti muchotsekere kokutidwa kwakuya kwa thonje ndi phlegmon. Pankhani ya gangrene kapena osteomyelitis, kudula phazi kapena zala zakumwa kapena kutuluka kunja kungakhale kofunikira.

Gulu la masoka

• T1DM - lembani matenda ashuga 1, kapena odalira insulin. Matenda amtunduwu amakhudza makamaka achinyamata osakwana zaka 30. Zizindikiro zazikulu: ludzu losalekeza, kudya kwambiri, kukodza kwambiri, kuwonda. Matendawa amayambitsidwa ndi kusagwira bwino kwa kagayidwe kazakudya, kamene kamayamba chifukwa cha kuwonongeka kwa maselo a beta m'mapapo. Yotsirizirayi imalephera kutulutsa insulini. Kuwonongeka kwa maselo ake kumatha kubweretsa kukomoka komanso kufa.
  Matenda a shuga a Type 1 amaphatikizapo matenda a shuga a autoimmune ndi LADA.
• T2DM - lembani matenda a shuga a 2, kapena opanda insulin. Makamaka, anthu okalamba komanso omwe ali ndi vuto lakelo amadwala. Insulin m'thupi imapangidwa mosakwanira, pokhapokha ngati mumatsata regimen tsiku lililonse komanso zakudya, ndikukhalabe ndi moyo wogwira, ndizotheka kukhalabe ndi shuga. Odwala atha kukhala ndi kunenepa kwambiri, matenda oopsa, komanso Hyperkalemia. Nthawi zambiri amakhala ndi vuto la mtima, matenda a impso.
• Matenda a shuga, kapena matenda ashuga, amayimilira pagulu lopatula chifukwa chakuti mimba si matenda, koma chilengedwe. Matenda amtunduwu amadziwonekera pa nthawi yomwe ali ndi pakati ndipo pafupifupi onse amachoka pambuyo pake. Asayansi amatcha mtundu uwu wa chizindikiro ndipo amalankhula za ubale wapadera wa matendawa ndi kutenga pakati. Matenda a shuga oterewa amawonjezera mwayi wakufa kapena kubadwa kwa mwana wosabadwa, komanso mwayi wokhala ndi matenda ashuga mwa mkazi wazaka 5-10 atabadwa.
• Mitundu ina ya matenda ashuga. Kuchulukirachulukira kwachitika poti matenda ashuga samatsimikizika, mamembala a bungwe la WHO pankhani yodwala matenda ashuga amalimbikitsa kukhazikitsa mutu watsopano mu gulu la "Matenda osatsimikizika a shuga," omwe ofufuza amakhulupirira kuti angathandizire kwambiri pakufunafuna chithandizo chamatenda.

Kuphatikiza pazomwe tafotokozazi, pali mitundu yambiri ya matenda osokoneza bongo omwe amayamba chifukwa cha endocrinopathies, matenda, chibadwa, kapena chiwonongeko cha pancreatic. Mitundu yamatendawa imayikidwa padera.

• Zovuta za genetic pantchito ya beta zimagwirizanitsidwa ndi zonyansa zamtundu wina. Izi zitha kukhala kusintha kwa mtundu wa glucokinase, jini la insulin yotsatsira, mitochondrial gene. Matenda a shuga amtunduwu amatha kuchitika pachipatala cha T2DM, pomwe "osokoneza bongo" amagwira ntchito mthupi, omwe amakhala ndi zochita za 5-10% zokha.
• Kusintha kwa chibadwa cha insulin kumachitika mu zovuta zamtundu zomwe zimachitika chifukwa cha zotumphukira za insulin, zomwe zimachitika chifukwa cha kusintha kwa mtundu wa insulin receptor gene. Zitsanzo za zoperewera ndi Leprechaunism (Donohue syndrome) ndi Rabson-Mendenhall syndrome, zomwe zimangokhala m'thupi la mwana, komanso kusazindikira (kukana) kuyesa matenda a A insulin ndi lipoatrophic.
• Matenda a exocrine mbali ya kapamba (kapamba, neoplasia, hemochromatosis ndi ena) amapezeka ndi gawo lalikulu la kapamba m'matumbo am'magazi, pomwe ntchito ya endocrine yogwirira ntchito imasokonekera ndipo ntchito ya chinsinsi cha beta imapezeka kuti siyokwanira.
• Endocrinopathies - matenda a endocrine omwe ali ndi zochita za counterinsulin: sintomegaly, glucagon (glucagon wopanga chotupa), hyperthyroidism ndi ena.

Kafukufuku wapano wa World Health Organisation atsutsa mtundu wa matenda ashuga omwe amayambitsidwa ndi kuperewera kwa zakudya m'thupi komwe kunalipo mu gulu la 1985. Kupenda kwaposachedwa kwaposachedwa kwa malo odziyimira kwawonetsa kuti lingaliro lotere ndilopanda tanthauzo, chifukwa kuperewera kwa zakudya m'thupi, mwachitsanzo, kuperewera kwa mapuloteni, kumakhudza chikhalidwe cha carbohydrate metabolism, yomwe ingayambitse matenda osokoneza bongo.

Gulu la mitundu yamavuto

• Kuwonongeka kwa mtima. Micro ndi macroangiopathy mu shuga zimakhudza mitsempha yamagazi, zimakhala zopanda pake. Ndi matenda amtunduwu, zotupa, ma thromboses komanso atherosulinosis ndizotheka.
• Kugonjetsedwa kwa misempha. Matenda a diabetesic polyneuropathy amawonongeratu kutentha. Kuwotcha, kugunda, dzanzi ndi zizindikiro zomveka za polyneuropathy. Makamaka zosangalatsa zimachitika usiku. Chifukwa cha mawonekedwe a matendawa, onyamula mawonekedwe awa nthawi zambiri amalandira kuvulala kosiyanasiyana.
• Kugonjetsedwa kwa masomphenya. Ndi matenda a shuga, ophthalmopathy imachitika, yomwe imakhala ndi zovulaza m'mawonedwe. Poyerekeza ndi matenda am'mimba a shuga, matenda a cataract amakula, balere amakula, omwe satha kusungunuka.
• Matenda a matenda ashuga. Matendawa amadziwonetsera ngati mabala amatsukidwe, kupweteka m'mafupa ndi mafupa a phazi. Njira zotere zimachitika chifukwa cha kusokonezeka kwa zakudya zamitsempha yamagazi, mitsempha komanso minofu yofewa.

Magawo azakudya matenda ashuga

• Chithandizo mawonekedwe owala matenda a shuga a 2 amafunikira poyambira, pamene odwala amva kupweteka pakamwa, kufooka kwa minofu. Nthawi yomweyo, amatha kukhalanso ndi vuto labwinobwino. Zikatero, chithandizo cha insulin sichofunikira.
• Ndi matenda ashuga kuopsa kozama pali vuto lozama la metabolic. Munthu mwadongosolo amafunikira kukhazikitsidwa kwa insulin kapena kugwiritsa ntchito mankhwala a hypoglycemic, njira yokhayo yomwe wodwalayo amatha kuyamwa chakudya mogwirizana ndi zomwe akufuna.
• Fomu yolemetsa The matenda amafunika tsiku ndi tsiku insulin, chifukwa chakudya pafupifupi kwathunthu mu mkodzo. Mukalandira chithandizo choyenera komanso mosamala, matenda oopsa amatha kukhala mtundu wochepa.

Njira zamakono komanso njira zamankhwala othandizira odwala matenda a shuga

Russia, monga taonera pamwambapa, ili pamalo achinayi malinga ndi kuchuluka kwa anthu odwala matenda ashuga. Mamiliyoni atatu aku Russia onyamula matenda a shuga amalembetsedwa mwalamulo. Gawo lalikulu la iwo linapezeka kuti ali ndi matenda ashuga a 2. Kawiri konse anthu ku Russia ali ndi matenda ashuga, ndiye kuti sanapezeka ndi matendawa, koma kuchuluka kwa shuga m'magazi nthawi zonse kumakhala kokwera.

M'mayiko otukuka, 10% ya bajeti yaumoyo imagawiridwa posamalira matenda a shuga. Malinga ndikuwonetseratu kwa International Diabetes Federation, mu 2025 mitengo ya chithandizo komanso kupewa matenda ashuga idzakhala pafupifupi $ 303 biliyoni. Mu Russian Federation, pafupifupi 15% ya ndalama zonse zaumoyo zimaperekedwa - izi ndi pafupifupi ma ruble 300 miliyoni pachaka. Ndikofunika kudziwa kuti 80% ya ndalamayo imagwiritsidwa ntchito polimbana ndi zovuta zomwe zimadza chifukwa cha matendawa.

Masiku ano, anthu akulimbana ndi matenda ashuga m'njira zosiyanasiyana, tidzaziwona mwatsatanetsatane.

Zakudya monga njira yochizira

Zakudya za anthu odwala matenda ashuga zimaphatikizira kuletsa kumwa kwambiri. Ndikofunikanso kugwiritsa ntchito zotsekemera.Intaneti yadzaza ndi mindandanda ya matenda ashuga, koma simuyenera kuilembera. Ndikofunikira kukaonana ndi dokotala yemwe adzakupatseni mankhwala othandizira ndikufotokozera mwatsatanetsatane mfundo zake.

Othandizira kuchepetsa shuga

Mankhwalawa amatchedwa antidiabetic. Mankhwalawa amatchulidwa kuti azikhala ndi shuga m'magazi a anthu omwe insulin yake imapangidwa palokha, koma osakwanira. Nthawi zambiri, mankhwalawa amagwiritsidwa ntchito limodzi ndi zakudya komanso zolimbitsa thupi. Musanayambe chithandizo, kufunsa ndi akatswiri monga katswiri wa zakudya komanso endocrinologist amafunikira.

Chithandizo cha insulin

Insulin nthawi zambiri imayikidwa limodzi ndi othandizira a hypoglycemic. Zizindikiro pakugwiritsa ntchito njirayi ndi kuchepa thupi, ketosis, chithandizo chothandizira, komanso zovuta zilizonse kwa odwala omwe ali ndi matenda a shuga a 2. Palinso zinthu zina zomwe zingachepetse insulin. Izi zikuphatikiza pakati ndi kuyamwa, matenda a hemorrhagic, precoma, chikomokere.

Muyezo wa shuga wamagazi

Mothandizidwa ndi kuwunika kosalekeza misempha ya seramu, ndizotheka kudzichenjeza pang'onopang'ono matendawa ndikuletsa matenda ake. Kuwunikira pafupipafupi - muyezo wa shuga wamagazi kangapo patsiku - kumathandiza dokotala ndi wodwala kuchita bwino. Dokotala amayenera kukhazikitsa kuchuluka kwa shuga, koma muyenera kuganizira kuchuluka kwapakati: musanadye komanso m'mimba yopanda kanthu - osapitirira 6 mmol / l, mutatha kudya (atatha maola 2) - osaposa 8 mmol / l.

Mwa mitundu yodziwika bwino yamatenda, matenda amtundu woyamba komanso wachiwiri amatha kusiyanitsidwa. Njira zawo zochizira zimakhala ndizodziwika bwino. Tilankhulanso izi.

Chithandizo cha matenda a shuga 1

M'moyo wonse, eni mtundu wa shuga amafunika insulin. Potere, mwachidziwikire, nthawi zonse muziyang'anira kuchuluka kwa shuga m'magazi ndikutsatira moyo wokangalika. Kuwunikira pafupipafupi ndi endocrinologist kumafunikiranso. Kuti muchotse matendawa, kufalikira kwa kapamba ndi maselo a islet ndikotheka. Koma sitiyenera kuiwala kuti njirayi ndi yopweteka komanso yokwera mtengo. Kuphatikiza apo, mutatha kusinthanitsa, othandizira a immunosuppress amafunika.

Chakudya chimaperekedwa kwa onse omwe ali ndi matenda ashuga, koma izi sizitanthauza kusiya chakudya chokoma ndi chokondedwa. Mafuta oyipa ayenera kusiyanitsidwa. Zakudya zamapuloteni ziyenera kukhala zosachepera 20% pazomwe zimapangidwa tsiku lililonse pama calories onse, 30% iyenera kuwerengedwa ndi mafuta, ndipo gawo lalikulu limapatsidwa chakudya - 50%. Chepetsa zakumwa zoledzeretsa ndikuwerengera zomwe mumamwa tsiku lililonse.

Type 2 shuga

M'machitidwe apadziko lonse lapansi, magawo angapo a mtundu wa 2 shuga amawongolera amagwiritsidwa ntchito: zakudya zamafuta ochepa, masewera olimbitsa thupi, mankhwala, ndi jakisoni wa mahomoni. Zakudya zimathandizira kuti shuga azikhala bwino. Kuchita masewera olimbitsa thupi kumatha kuchotsa michere yambiri m'magazi. Ndipo pankhani yovuta ya matendawa, mapiritsi ndi insulin onse ndi omwe amapatsidwa.

Ndikofunikira kuphatikiza ma microelements ambiri ndi mavitamini pazakudya, komanso kuchepetsa mchere. Mwa zochitika zathupi, kusambira, kukwera maulendo, kuyendetsa njinga ndiolandilidwa. Zotsatira zamaphunziro akuthupi ndizakanthawi, motero muyenera kutsatira njira zonse.

Palinso njira zina zochizira, pakati pawo zomwe ndi wowerengeka azitsamba kapena njira zina zamankhwala. Komabe, mukamagwiritsa ntchito, ndibwino kufunsa katswiri. Popeza kuti mumazindikira mtundu wamatendawa, ndi akatswiri okha omwe angayezedwe ndikupereka mankhwala ena.

Monga tinazindikira, matenda ashuga ndi matenda oopsa omwe amabweretsa mavuto akulu.Kuti muwonetsetse kuti ngakhale pakagwa ngozi zadzidzidzi, mudzakhala ndi wina woti mupeze thandizo, muyenera kuganizira zakupangana ndi kampani yomwe imapereka chithandizo chamankhwala. Pankhaniyi, nthawi zonse mungadalire chithandizo chamankhwala chodzidzimutsa.

Ochiritsira insulin mankhwala

Chithandizo cha Insulin Therapy (ICU) amatchedwa regimen ya mankhwala ogwiritsidwa ntchito kwambiri, yomwe imapereka jekeseni wa 1-2 patsiku la insulin ya nthawi yayitali yochita zinthu zotere kapena kuphatikiza kwa kachulukidwe kakang'ono kwambiri ka insulin. Ngati cholinga ndikuchepetsa kuchuluka kwa hyperglycemia, ndiye kuti patsogolo pamauperekedwa kwa ochiritsira a insulin, popeza izi zimachepetsa kuchuluka kwa jakisoni patsiku komanso chiopsezo cha hypoglycemia.

Odwala ambiri omwe ali ndi matenda osokoneza bongo omwe samadalira insulin (NARF), yemwe alibe matenda owopsa, ndi bwino kupereka chithandizo chotere kunja kwa chipatala, kuphunzitsidwa ndi odwala komanso kuyang'aniridwa ndi achipatala mosalekeza.

Odwala omwe ali ndi insulin amadalira matenda a shuga (ISDM)nthawi zambiri amayamba kuthandizidwa kuchipatala. Mukamasankha njira yoyenera ya insulin, kuyang'anira mosamala ndikofunikira, ndipo wodwala asanaperekedwe chithandizo kunyumba, wodwalayo komanso omwe amamusamalira ayenera kufotokozera mwatsatanetsatane kufunikira kwa njira zonse zochiritsira ndikuwaphunzitsa njira zonse. Pakumayambiriro kwa chithandizo chakunyumba, thandizo la mlongo wakulera limafunikira nthawi zambiri.

Njira imodzi yotsatsira

Mankhwala a insulin odwala NIDDM Nthawi zambiri amayamba ndi limodzi subcutaneous jakisoni wa insulin pafupifupi nthawi kuchitira tsiku 30-60 Mphindi pamaso kadzutsa. Kwa ana ndi akulu omwe, mankhwala oyamba tsiku lililonse otetezeka nthawi zambiri ndi 0,2-0,5 U / kg.

Odwala omwe ali ndi NIDDM komanso kunenepa kwambiri nthawi zambiri amapatsidwa mankhwala okulirapo, chifukwa nthawi zambiri amakhala ndi insulin.

Akuluakulu, monga lamulo, amayikidwa koyamba kubaya jekeseni imodzi yamagulu 10-25, ndipo masiku angapo pambuyo pake, kutengera mphamvu ya glucose yosala ndi maola 1-2 mutatha kudya, chiwembucho chimasinthidwa. Mlingo wa insulin wa nthawi yayitali nthawi zambiri umachulukitsidwa popanda magawo 5-10. Pakatha masiku owerengeka, kuchuluka kwa shuga kumayendera mobwerezabwereza, ngati pakufunika kutero, malamulowo amasinthidwa.

Kuchepetsa hyperglycemia mukatha kudya kadzutsa, mungafunike insulini yothamanga kwambiri (nthawi zambiri yoposa 5 mayunitsi poyambira, ndikutsatira, ngati pakufunika, kuwonjezeka kwa mayunitsi 2-5), owonjezeredwa ku jekeseni yam'mawa.

Madokotala ambiri amaletsa kupereka dongosolo lachiwiri la mankhwala kwa odwala omwe ali ndi NIDDM mpaka mlingo wokwanira m'mawa kwambiri wa insulin (mwachitsanzo, 50 IU) atasiya kupereka malire ofunikira osinthira tsiku ndi tsiku m'magazi a glucose.

Mlingo wapawiri

Pochiza odwala ambiri omwe ali ndi NIDDM, regimen imodzi imagwiritsidwa ntchito. Komabe, ndi kusala kudya kwambiri kwa hyperglycemia, kuphwanya mankhwala okwanira tsiku lililonse a insulin (35-50) - 2/3 ya mankhwala musanadye chakudya cham'mawa komanso 1/3 ya jekeseni ya mphindi 30-60 musanadye - imatha kusintha glycemia. Komabe, kumwa insulin ya nthawi yayitali madzulo kumawonjezera ngozi ya usiku hypoglycemia. Chifukwa chake, odwala muyezo wachiwiri wa mankhwala, monga lamulo, ayenera kudya pang'ono asanagone. Ngati mlingo wamadzulo wa insulin yomwe imagwiritsa ntchito pakati ikutsimikizira kuti glycemia imasungidwa m'malo omwe mukufuna, koma kuchuluka kwa glucose kumakhalabe kochulukira pambuyo pa chakudya chamadzulo, milingo yaying'ono ya insulin yofulumira imawonjezeredwa jakisoni wamadzulo.

Chiwembu cha insulin mankhwala a insulin amadalira matenda a shuga

Njira ya insulin yothandizira odwala omwe ali ndi IDDM - Uku ndi kugwiritsidwa ntchito kosakaniza ma insulin a nthawi yayitali komanso kudya mwachangu ma jakisoni awiri patsiku. Choyamba, kuchipatala, mapiritsi a insulin amtundu uliwonse amasankhidwa. Amasiyana kwambiri malinga ndi momwe wodwalayo alili, ndipo Mlingo woyamba wa insulin womwe umaperekedwa pansipa sugwira ntchito kwa odwala omwe ali ndi matenda a shuga.

Mlingo woyambirira wa insulin ndi munthu payekha, zomwe amatsatira pazochitika zosiyanasiyana amaperekedwa pansipa. Pambuyo posankha muyeso woyamba, umasinthidwa molingana ndi kukula, mitundu ya insulin ndi nthawi yoyendetsera, kutengera zotsatira za kuwunika pafupipafupi kuchuluka kwa shuga m'magazi. Chotsirizachi chimatsimikiziridwa musanadye chilichonse, nthawi yogona, komanso pakati pa 2 ndi 4 maola m'mawa, kenako tsiku lililonse, "Sinthani" muyeso wa insulini kuti musunge shuga wa plasma musanadye pamiyeso ya 80-150 mg%. Kuwonjezeka kwa mlingo wa insulin nthawi iliyonse, monga lamulo, sayenera kupitilira 10%, zimayesedwa mkati mwa masiku atatu ndipo pambuyo poti mlingowo ukuwonjezekanso. Ndi chiwopsezo cha hypoglycemia, muyenera "kusintha" mlingo wa insulin yokhazikika mwachangu. Kumbukirani kuti mutayamba kulandira chithandizo, kuuma kwa IDDM kumasintha.

Mankhwala a insulin

Kupatula kwakukulu kumalamulo akuti odwala onse omwe ali ndi IDDM koyambirira kwa chithandizo amafunika jakisoni wambiri wa insulin tsiku lililonse ana omwe akuwoneka koyambirira kwa IDDM, omwe amakhala ndi hyperglycemia wopanda ketonuria kapena acidosis. Madokotala ena a ana amakonda kuyamba ndi jakisoni wamkati mwa insulin yochepa kwambiri pa mlingo wa 0,3-0,5 U / kg, chifukwa nthawi zambiri izi ndizokwanira kusunga kusinthasintha kwa tsiku ndi tsiku m'magazi a glucose pafupi ndi malire osakhalitsa. Kupanda kutero, "kusintha" kwa Mlingo wa insulin ndi kutsimikiza kwa glycemia kumachitika monga tafotokozera pamwambapa.

Chithandizo cha ana omwe ali ndi hyperglycemia ndi ketonuria, koma popanda acidosis kapena kutopa amayamba ndi makonzedwe a 0,5-0.7 U / kg wa insulin, ndipo kenaka amawonjezera jakisoni wosavuta wa 0.1 U / kg maola 6 aliwonse. insulin imakhalabe yomweyo monga tafotokozera pamwambapa.

Ngati patadutsa masiku ochepa mphamvu ya wodwalayo singasinthe, ndiye kuti asinthana ndi njira yothandizira jekeseni wothandizila ndi kukonzekera kwa insulini komwe kumachitika asanapange chakudya cham'mawa komanso chakudya chamadzulo. Mlingo wa insulin womwe unakhazikitsidwa kale umaponderezedwa ndikuwupatsa 2/3 isanayambike chakudya cham'mawa komanso 1/3 musanadye chakudya chamadzulo, ndipo 1/3 ya mankhwalawa amayenera kukhala insulin. Kenako, Mlingo wa insulin amasankhidwa mwanjira yoti akhale ndi shuga m'magazi pakati pa 80 ndi 150 mg asanadye, ena madokotala amayesa kusunga glycemia asanadye mkati mwa malire ochepa - pakati pa 80 ndi 120 mg%, koma Mulimonsemo, ntchito yayikulu ikadali yothetsa - hypoglycemia . (Inde, izi sizingagwire ntchito ngati wodwala ali ndi matenda osokoneza bongo komanso kuwonjezeka kwadzidzidzi kwa hyperglycemia, limodzi ndi ketonuria.)

Ketoacidosis

Akuluakulu omwe adadziwika ndi IDDM kale Nthawi zambiri funsani kwa dokotala pakuwonetsa kukhudzana ndi matenda a ketoacidosis. Atayimitsa pachimake komanso kusunga jakisoni wosavuta maola 4 - 2 aliwonse kwa masiku awiri (chithandizo cha matenda ashuga a ketoacidosis, onani pansipa), odwala, ngati mawonekedwe awo a metabolic amakhala okhazikika, amasamutsidwira ku regimen ya jakisoni awiri patsiku la kusakanikirana kwa insulin yothandizira komanso insulin yochita pakati Mfundo zazikuluzikulu zakusankha Mlingo wa m'mawa ndi madzulo ndizofanana ndi zomwe zafotokozedwa kawiri-kawiri wa ICU ya NIDDM.Kusiyana kofunikira kwambiri, komabe, ndikuti, mwa odwala omwe ali ndi IDDM, ngakhale kusintha kwakuchepa kwa mankhwala a insulin kumakhudzanso kuchuluka kwa shuga m'magazi, komwe kumachepetsa mwayi wolandira mankhwalawa chifukwa chakuchepetsa kwambiri kuchuluka kwa glucose komanso kukula kwa hypoglycemia.

Morning syndrome

Morning syndrome amatcha chizolowezi chowonjezeka cha shuga m'mawa kwambiri asanadye chakudya cham'mawa, chomwe nthawi zambiri chimakwezedwa mwa odwala IDDM komanso mwa odwala ena a IDDM. Ndi NIDDM, motsutsana ndi maziko a mankhwala a insulin ochiritsira, kupitilirabe kuchuluka kwa shuga m'magazi nthawi zambiri kumachotsedwa ndikuwonjezera mlingo wa mankhwalawa a insulin a nthawi yayitali kapena poonjezera mlingo wamadzulo. Komabe, mwa odwala ena omwe ali ndi IDDM, kuchuluka kwa insulin yamadzulo kumayambitsa hypoglycemia, kutsatiridwa ndi kusala kwa hyperglycemia (recoil hyperglycemia), komwe kumatha kutsagana ndi kuwonjezeka kwa zomwe zili m'matumbo a ketone, izi zimatchedwa Chochitika cha Somoji. Pafupipafupi momwe zimachitikira izi sizinakhazikike molondola, koma, zikuwoneka, ndizofala kwambiri kwa odwala omwe ali ndi IDDM omwe ali pamulingo wambiri wa insulin (onani pansipa). Chifukwa chake, odwala omwe ali ndi IDDM amayenera kuchepetsa kumwa kwa insulin.

Kwambiri mankhwala a hyperglycemia

Kwambiri mankhwala a hyperglycemia Amayitanitsa chiwembu chotere, chomwe chimapangidwa kuti chizikhala kusinthasintha kwatsiku ndi tsiku m'magazi a glucose pofuna kupewa mavuto. Kwa odwala IDDM, izi zimagwiritsidwa ntchito angapo jekeseni wa insulin wambiri (MPI) tsiku lonse m'njira zosiyanasiyana. Mitundu yotereyi imalumikizidwa ndi chiwopsezo chowonjezereka cha magawo a pafupipafupi komanso ovuta a hypoglycemia. Ayenera kugwiritsidwa ntchito pochiza odwala osankhidwa okha omwe ali ndi chidwi chachikulu, chidziwitso chokwanira chokhudza matenda ashuga, odziwa zoopsa za njirayi komanso kusatsimikizika kwa phindu lomwe amapatsidwa, omwe angathe kudziwa payokha kuchuluka kwa glucose ndipo amayang'aniridwa ndi dokotala yemwe ali ndi chidziwitso chogwiritsira ntchito njira zamankhwala zotere. Kuzindikira wodwalayo, kuphunzitsidwa kwake mokwanira komanso chidaliro kuti wodwalayo adzalandira chithandizo chamankhwala nthawi iliyonse masana ndizofunikira kwambiri pakugwiritsa ntchito njira yofotokozedwayo.

Malinga ndi kusiyanasiyana kwa mtundu wa MPI, pafupifupi 25% ya mlingo wa tsiku ndi tsiku wa insulin imagwiritsidwa ntchito asanayambe kugona, ndipo Mlingo wotsalira, koma kale wa insulin (njira ya 4-piritsi), amapatsidwa chakudya chisanafike. Wodwalayo amasankha mlingo wa tsiku ndi tsiku malinga ndi zotsatira za kudzisankhira kuchuluka kwa glucose musanadye chakudya komanso pogona. Kuphatikiza apo, osachepera kamodzi pa sabata, muyenera kudziwa kuchuluka kwa shuga m'magazi pakati pa 2 ndi 4 koloko m'mawa. Mu regimen yokhala ndi mlingo wa 3, insulin yomwe imagwira ntchito pakapita nthawi yayitali imaperekedwa musanadye chakudya (kuwonjezera kwa insulin yofulumira), komanso insulin yofulumira musanadye chakudya cham'mawa komanso masana. Mlingo wa insulin umasinthidwa tsiku ndi tsiku malinga ndi zotsatira za njira zingapo za shuga, monga tafotokozera pamwambapa 4.

Popitilira kulowetsedwa insulin

Kupitilizabe kosalekeza kwa insulin kulowetsedwa (NPI). Njira iyi yolimbira kwambiri insulin kwa odwala omwe ali ndi IDDM imaphatikizapo kugwiritsa ntchito pampu yolumikizira ma batire yomwe wodwalayo amavala ndipo imapereka kulowetsedwa kosalekeza kwa insulin kudzera mu singano yaying'ono yomwe idalowetsedwa kukhoma. Pompu idapangidwira kulowetsedwa mwachangu liwiro komanso kuwonjezereka kwa liwiro ili musanadye. Kusankha mlingo, ndikofunikira kudziyimira pawokha glucose ambiri patsiku.Kupitiliza kosalekeza koyambira ndi njira yothandiza kwambiri yolimbana ndi glycemia kuposa mankhwala a insulin, koma jakisoni wambiri pamanja aluso amachepetsa mphamvu ya shuga m'magazi. Ndi jakisoni wokhazikika wa subcutaneous, chiopsezo cha hypoglycemia chimawonjezeka, makamaka pakugona, ndipo nthawi zambiri kusokonezedwa kwa pampu kosadziwika kungayambitse kukula kwa matenda ashuga a ketoacidosis. Njira yopangira jakisoni wokhazikika, komanso jakisoni wambiri, uyenera kugwiritsidwa ntchito ndi dokotala wokhazikika kwambiri pochiza odwala osankhidwa mosamala.

Matenda a shuga

Mankhwala a insulin. Odwala omwe ali ndi matenda oopsa a shuga ndi gulu la odwala omwe ali ndi IDDM omwe amasintha pafupipafupi komanso mwachangu pama glucose popanda chifukwa chodziwika bwino, ndipo njira zowongolera kuchuluka kwa shuga m'magazi ndizosakhazikika kotero kuti magawo a hyperglycemia osinthika amalembedwa m'malo omwe amapezeka pafupipafupi a hypoglycemia. Mkhalidwe wa odwala ambiri otere umakhala bwino akasinthana ndi ma jakisoni osinthidwa angapo, pamene gawo lalikulu la tsiku ndi tsiku la insulin limayimiriridwa ndi mankhwala omwe amapezeka mwachangu (mu "kusintha" kwa tsiku ndi tsiku) musanadye chilichonse, ndipo ena onse amakhala ndi insulini yotalikirapo asanaperekedwe chakudya asanadye kapena asanagone. Cholinga chachikulu pankhaniyi sikuti tisunge kusinthasintha kwa tsiku ndi tsiku mu glycemia pafupi ndi masiku onse, koma kukhazikika kwake kusinthasintha motere kungaletse kukula kwa zizindikiro za hyper- ndi hypoglycemia.

Matenda a shuga a labu nthawi zambiri amapezeka mwa odwala omwe alibe inshuwaransi yotsalira ya insulin, momwe insulin yothandizira imakhala chida chosakwanira komanso chosakwanira kubwezeretsanso kubisidwa kwazinthu izi kwa mahomoni. Machitidwe a metabolic omwe insulin imakhudzira shuga wa m'magazi omwe samagwirizanitsidwa ndi albumin yamafuta acids ndi matupi a ketone nthawi zambiri imayendetsedwa ndi kusintha kosaletseka pakati pa zotsatira za insulin ndi zotsatira zotsutsana ndi glucagon (mu chiwindi) ndi adrenergic autonomic system.

Izi kulimbikitsa shuga njira zimakhazikitsidwa modziyimira pawokha, ndipo nthawi zambiri ntchito zawo zimawonjezeka panthawi yanjala, panthawi yolimbitsa thupi komanso nthawi zina chitetezo pochotsa hypoglycemia ndizofunikira (panthawi yolimbitsa thupi, kukoka kwa glucose komwe kumachitika ndi minyewa yamafupa kumawonjezeka kudzera munjira yodziyimira palokha ya insulin). Mlingo wa insulini uyenera kukhala wokwanira kupirira kuwonjezereka kwa ntchito ya njira zowonjezera shuga ndikuletsa kuyambika msanga kwa zizindikiro za hyperglycemia ndi hyperketonemia, koma nthawi zambiri izi zimafunikira insulini yochepa kwakanthawi. Mwa odwala ena omwe ali ndi IDDM yayitali, kuwonjezereka kwa shuga ku hypoglycemia kumayipa, komwe kumachepetsa chizolowezi chochepa kwambiri cha insulin.

"Njira za insulin mankhwala" - nkhani kuchokera ku gawo la Endocrinology

Chithandizo cha mankhwala othandizira odwala matenda a shuga

Kwa zaka zambiri osalimbana ndi ma DIABETES?

Mutu wa Bungwe: “Mudzadabwitsidwa kuti kumakhala kovuta motani kuchiritsa matenda a shuga tsiku lililonse.

Matenda a Endocrine omwe amayambitsidwa ndi zovuta za metabolic komanso zomwe zimabweretsa kuchuluka kwa shuga m'magazi ndizomwe zimachitika ndi matenda monga matenda a shuga.

Kutengera zifukwa zakukwera kwa shuga ndi kufunika kotengera jakisoni wa insulin, odwala omwe amadalira insulin komanso omwe amadalira insulin amadalira.

Zoyambitsa matenda a shuga

Matenda a shuga omwe amadalira insulin ali ndi ICD ya 10 - E 10. Matenda amtunduwu amapezeka makamaka paubwana, pomwe zizindikiro zoyambirira zimapezeka ndikuwonetsa kuti ali ndi mtundu woyamba wa matenda a shuga.

Pankhaniyi, maselo a kapamba, omwe amawonongeka ndi thupi, amasiya kutulutsa insulin. Ichi ndi mahomoni omwe amawongolera momwe mayamwidwe amadzimadzi amachokera ku chakudya kupita ku minofu ndikuwasintha kukhala mphamvu.

Zotsatira zake, shuga amapanga m'magazi ndipo amatha kukhala ndi hyperglycemia. Odwala omwe ali ndi matenda amtundu wa 1 amafunika jakisoni wa insulin nthawi zonse. Kupanda kutero, kukula kwa glucose kumatha kupweteka.

Mtundu wachiwiri wa matenda ashuga, mahomoni amapangidwa mokwanira, koma ma cell samazindikiranso mahomoni, chifukwa chake glucose sayamwa ndi kuchuluka kwake. Psychology iyi sikutanthauza jakisoni wa mahomoni ndipo amatchedwa shuga osadalira insulini. Matenda a shuga amtunduwu amakula nthawi zambiri atatha zaka 40 mpaka 45.

Mitundu yonse iwiri yamatendawa ndi osachiritsika ndipo imafunikira kukonza kwa shuga m'magazi kuti mukhale bwino komanso moyo wabwinobwino. Ndi matenda a shuga a 2, chithandizo chimachitika ndi mapiritsi ochepetsa shuga, kuwonjezeka kwa masewera olimbitsa thupi komanso kudya mwamphamvu.

Matenda a shuga a Type 1 amawoneka ngati chizindikiro cha kulumala ndipo ndi owopsa kwambiri pazovuta zake. Kuchuluka kwa shuga osakhazikika kumabweretsa kusintha kowopsa mu genitourinary system komanso kukulitsa kulephera kwa impso. Ichi ndiye chifukwa chachikulu cha kuchuluka kwa kufa kwa odwala matenda ashuga.

Zomwe zimapangitsa kuchepa kwa chidwi cha maselo kuti apange insulin komanso chifukwa chake thupi limayamba kuwononga kapamba likufufuzidwa, koma zinthu zomwe zikuthandizira pakukula kwa matendawa zimatha kusiyanitsidwa:

1. Ghana ndi mtundu. Zinadziwika kuti amayi ndi oimira mtundu wakuda amakonda kwambiri matenda.
2. Zinthu zoyipa. Mwambiri, mwa makolo odwala, mwana adzadwalanso matenda ashuga.
3. Kusintha kwa mahomoni. Izi zikufotokozera kukula kwa matendawa mwa ana ndi amayi apakati.
4. Matenda a chiwindi ndi matenda a kapamba.
5. Kuchita masewera olimbitsa thupi ochepa komanso kuphatikiza mavuto azakudya, kusuta fodya komanso kumwa mowa kwambiri.
6. Kunenepa kwambiri, kuchititsa ma atherosselotic mtima kuwonongeka.
7. Kulandila kwa antipsychotic, glucocorticoids, beta-blockers ndi ena mankhwala.
8. Cushing's syndrome, matenda oopsa, matenda opatsirana.

Matenda a shuga nthawi zambiri amakula mwa anthu pambuyo poti adwala ndipo apezeka ndi matenda amtundu wamatumbo ndi angina pectoris.

Momwe mungazindikire zizindikiro zoyambirira?

Zizindikiro zoyambirira za shuga ndizofanana m'mitundu yonse, zimangotchulidwa mu mtundu woyamba:

• kulephera kuthetsa ludzu - odwala matenda ashuga amatha kumwa mpaka malita 6 a madzi patsiku,
• kulakalaka kwambiri
• kukodza pafupipafupi komanso mkodzo wambiri.

Komanso, ndi matenda amtundu wa 1 shuga, zowonjezera zimawonedwa:

• kununkhira ndi kukoma kwa acetone,
• kamwa yowuma
• kuchepa mphamvu yakukonzanso zotupa za pakhungu,
• kuwonda mwadzidzidzi ndi kufooka kowonjezereka,
• chisokonezo cha kugona ndi kugunda kwa migraine,
• chiwopsezo cha matenda oyamba ndi fungus,
• kusowa kwamadzi
• kuchepa kowoneka bwino,
• kuthamanga kwa magazi
• kuyabwa ndi kusenda kwa khungu.

Ndi matenda amtundu wa 2, zizindikiro zomwezo zimadziwika, kupatula kununkhira kwa acetone. Ndi matenda amtunduwu, matupi a ketone samapanga, omwe amapereka fungo labwino.

Tanthauzo ndi mfundo zachithandizo cha insulin

Mu shuga mellitus, njira yolembera shuga m'maselo imasokonekera, chifukwa insulin m'thupi ndi yaying'ono kapena imanyalanyazidwa ndi maselo. Poyamba, mahomoni amayenera kuperekedwa kwa thupi ndi jakisoni.

Koma mlingo uyenera kufanana ndi kuchuluka kwa glucose yemwe amamasulidwa ku chakudya chomwe wadwedwa. Kuchuluka kwambiri kapena osakwanira insulini kungayambitse hypo- kapena hyperglycemia.

Zakudya zomanga thupi zimapatsa shuga ndipo ndikofunikira kudziwa kuti ndi angati omwe amalowa m'magazi pambuyo pa chakudya chilichonse kuti apeze mlingo woyenera wa timadzi. M'pofunikanso kuyeza kuchuluka kwa shuga m'magazi musanadye chilichonse.

Ndizosavuta kwa odwala matenda ashuga kuti azisungira diabolos mwapadera komanso asanadye, kuchuluka kwa chakudya chambiri komanso kuchuluka kwa insulin.

Kodi gawo la mkate ndi chiyani?

Mlingo wa mahomoni amawerengedwa kutengera kuchuluka kwa chakudya chamagulu omwe amaperekedwa pakudya. Anthu odwala matenda ashuga ayenera kuwerengetsa chakudya kuti azidya.

Zakudya zomanga thupi zokha ndizomwe zimawerengedwa, zomwe zimatengedwa mwachangu ndikuwatsogolera kulumpha kwa glucose. Kuti zitheke, pali zinthu monga "mkate".

Kudya zakudya zopatsa mphamvu pa 1 XE kumatanthauza kugwiritsa ntchito mafuta omwe amapezeka mu theka la mkate 10mm kapena 10 g.

Mwachitsanzo, 1 XE ili ndi:

• kapu yamkaka
• 2 tbsp. l mbatata zosenda
• mbatata imodzi sing'anga
• Supuni 4 za vermicelli,
• 1 lalanje
• kapu ya kvass.

Tiyenera kukumbukira kuti shuga imakulitsa zakudya zamadzimadzi mwachangu kuposa zonenepa komanso kuti 1 XE imakhala ndi zochepa podya zakudya zosaphika (chimanga, pasitala, nyemba) kuposa zophika.

Kuchuluka kovomerezeka kwa XE patsiku kumasiyanasiyana malinga ndi zaka, mwachitsanzo:

• wazaka 7 muyenera 15 XE,
• pa 14 - anyamata 20, atsikana 17 XE,
• wazaka 18 - anyamata 21, atsikana 18 XE,
• achikulire 21 XE.

Simungadye mopitilira 6-7 XE panthawi.

Anthu odwala matenda ashuga ayenera kuyang'ana kuchuluka kwa glucose asanadye chilichonse. Pankhani ya shuga ochepa, mutha kugula chakudya chamafuta ambiri, monga phala lamadzi. Ngati mulingowo ndi wokwera, ndiye kuti muyenera kusankha zakudya zonenepa ndi zochepa (sangweji, mazira osenda).

Kwa 10 g ya chakudya cham'mimba kapena 1 XE, mayunitsi 1.5-4 amafunikira. hormone insulin. Mlingo umasiyanasiyana kutengera nthawi ya chaka komanso nthawi ya tsiku. Chifukwa chake, madzulo, mlingo wa insulin uyenera kukhala wotsika, ndipo m'mawa umayenera kuchuluka. M'chilimwe, mutha kulowa magawo ochepa a mahomoni, ndipo nthawi yozizira mlingo umayenera kuchuluka.

Kutsatira mfundo izi, kufunika kwa jakisoni owonjezera kungapeweke.

Ndi mahomoni ati ali bwino?

Chithandizo cha matenda a shuga ogwirizana ndi insulin amtundu uliwonse amachitidwa pogwiritsa ntchito mahomoni amitundu yosiyanasiyana:

• timadzi ta pancreatic ya anthu,
• mahomoni opangidwa ndi chitsulo cha nkhumba
• mahomoni a bovine.

Mahomoni aumunthu amafunikira kukonza magawo a glucose muzochitika zotere:

• matenda a shuga pa nthawi yomwe ali ndi pakati
• Matenda a shuga
• mtundu 1 wa matenda ashuga oyamba kupezedwa mwa mwana.

Mukamasankha mahomoni omwe mungakonde, ndikofunikira kulabadira kuwerengera kolondola kwa mankhwalawo. Izi zimangotengera chithandizo, osati kutengera zakuchokera.

Ma insulin afupiafupi ndi awa:

Zotsatira za mankhwalawa zimachitika pakadutsa ola limodzi jakisoni, koma osakhalitsa, maola 4-5. Jakisoni wotere amayenera kuchitika asanadye, ndipo nthawi zina pakati pakudya, shuga akamatuluka. Muyenera kusunga insulin nthawi zonse.

Pambuyo mphindi 90, ma insulin omwe amagwiritsa ntchito pakatikati amayamba kuchita:

• Semilong
• Semilent NM ndi MS.

Pambuyo maola 4, pamakhala nsonga pakuchita kwawo bwino. Insulin yamtunduwu ndi yabwino ngati palibe nthawi yokwanira chakudya cham'mawa ndipo chakudya chachedwa ku jekeseni.

Mutha kugwiritsa ntchito njirayi pokhapokha ngati mukudziwa zodalirika komanso zomwe zidzadyedwe komanso kuchuluka kwa zopezeka mu chakudya ichi. Kupatula apo, ngati simunachedwe ndi chakudyacho, ndiye kuti mwina glucose ndi wotsika kuposa mulingo wovomerezeka, ndipo ngati chakudya chamagulu ambiri chakudya, muyenera kubaya jekeseni wina.

Ma insulin omwe amakhala nthawi yayitali amakhala osavuta kuyang'anira m'mawa ndi madzulo.

Izi zikuphatikiza:

• Humulin N,
• Protafan
• Matepi
• Homofan
• Monotard NM ndi MS,
• Iletin Mon

Ma mahomoniwa amagwira ntchito bwino kwa maola opitilira 14 ndipo amayamba kuchita zinthu patatha maola atatu jakisoni.

Amatenga kuti jakisoni ndi nthawi yanji?

Muyezo wowerengetsera odwala matenda amisempha -

Nthawi zambiri, insulin yochepa komanso yayitali imalowetsedwa m'mawa musanadye chakudya cham'mawa, chakudya chotsatira chisanafike, kubweretsanso mwachidule komanso usiku kubayidwa nthawi yayitali.Mwanjira ina, insulin yomwe imagwira ntchito kwa nthawi yayitali imaperekedwa sutra ndipo usiku, ndipo timadzi tating'onoting'ono timabayidwa nthawi iliyonse isanadye.

Pakukhazikitsa insulin, madera 4 agawidwa.

1. Malo am'mimba amatambasuka mbali zonse ziwiri za msomali, ndikugwira mbali. Dera ili limawonedwa ngati lothandiza kwambiri, komanso lopweteka kwambiri. Pambuyo pa jekeseni m'mimba, oposa 90% ya insulin yomwe imalowa. Horm imayamba kuchita mphindi 10-15 pambuyo pa jekeseni, mphamvu yake imamveka pambuyo pa ola limodzi. Kuti muchepetse kupweteka, jakisoni ndi bwino kuchitidwa pakhungu pafupi ndi mbali.
2. Dera lamanja limakhudza gawo lakunja la miyendo kuyambira pachiwuno mpaka phewa. Dera ili ndi losautsa kwambiri pakudziyendetsa pakokha kwa mahomoni ndi syringe. Muyenera kugula cholembera kapena kupempha thandizo kwa abale anu. Koma dera lamanja ndilothandiza kwambiri, jakisoni sangayambitse kupweteka.
3. Malo a ntchafu amapezeka kunja kwa mwendo kuyambira bondo kupita ku groin. M'dera lamikono ndi miyendo, palibenso 75% ya mahomoni omwe amatengedwa ndipo amayamba kuchita pambuyo pa mphindi 60-90 kuyambira nthawi yoyendetsa. Ndikwabwino kugwiritsa ntchito malo awa insulin yayitali.
4. Malo a tsamba ndiwosasangalatsa komanso osakwanira. Pambuyo pa jekeseni kumbuyo, ochepera 40% ya mankhwalawa amatengedwa.

Malo oyenera jakisoni ndi malo omwe ali mkati mwa zala ziwiri zamkati. Simuyenera kumangokhala malo amodzi nthawi zonse. Izi zimapangitsa kuchepa kwa zosanjika za minofu ya adipose pansi pakhungu ndi kudziunjikira kwa insulin, yomwe, itayamba kuchita, imayambitsa hypoglycemia. Magawo a jekeseni amafunika kusinthidwa, mochulukirapo, pangani jakisoni, kuchoka pamalo oyambira kale osachepera 3-4 cm.

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Mtundu wa jakisoni wotere nthawi zambiri umagwiritsidwa ntchito: insulin yochepa imalowetsedwa pamimba, ndipo yayitali imalowetsedwa mu ntchafu. Kapena kukonzekera kwa mahomoni osakanikirana kumagwiritsidwa ntchito, mwachitsanzo, Kusakaniza kwa Humalog.

Phunziro la kanema pamakonzedwe a insulin:

Matenda a shuga ndi matenda oopsa komanso osachiritsika omwe amafunikira kutsatira malangizo onse a dokotala, kuwunika pafupipafupi shuga ndikutsatira molondola ndondomeko ya jakisoni wa insulin. Kuphatikiza konse kwa zinthu zonsezi kumapangitsa kuti matendawa azilamulidwa, aletse kukula kwa zovuta ndikukulitsa chiyembekezo cha moyo.

Bwanji kuchepetsa thupi kwambiri ndi matenda ashuga?

Kulemera kwa munthu kumatengera zaka zake, thanzi komanso thanzi labwino. Pambuyo pofika zaka 40, kulemera kwa thupi kumakhazikika. Kutayika kapena phindu pachaka cha ma kilogalamu angapo zimawoneka ngati zabwinobwino ngati munthu ali wathanzi. Koma lakuthwa mopitirira muyeso (zoposa 4 makilogalamu) ndi kuchepa thupi pafupipafupi kumawonetsa matenda akulu. Tikulankhula za kuchepetsa thupi popanda zakudya zapadera kapena masewera olimbitsa thupi. Chimodzi mwazomwe zimapangitsa kuti muchepetse kunenepa kwambiri ndi matenda ashuga.

Zoyambitsa kuchepetsa thupi

Nthawi zambiri, zizindikiro za matenda ashuga zimatha kunenepa kwambiri komanso kudya kwambiri. Koma osati ndi matenda ashuga, kuchuluka kwa thupi, anthu ambiri, m'malo mwake, amachepetsa thupi msanga. Pankhaniyi, funso limabuka, bwanji anthu amachepetsa thupi ndi matenda ashuga? Kuchepetsa thupi kwambiri kumayambitsa kutsika kwa thupi, kupweteka kwakuthwa, komanso mankhwala a cachexia.

Tiona zomwe zimapangitsa kuti matenda ashuga apangidwe ndipo ndi njira yanji yothandizira matendawa. Munthu akadya, chakudya chopatsa thanzi, cholocha m'matumbo, amalowa m'magazi. Kuti mafuta azakudya azitha kumizidwa, mumafunikira insulini ya mahomoni, yomwe kapamba amatulutsa. Koma vuto likayamba m'thupi, mankhwalawo amapangika pang'ono, kapena maselo samayankha ndipo mafutawo amasungidwa m'magazi, zomwe zimakhudza makoma a ziwiyazo.M'maselo a thupi, njala komanso kusowa mphamvu kumayambira, zizindikiro za matenda ashuga zimawoneka: mumamva ludzu nthawi zonse, mumadya, mumakonda kukodza, mumakhala mukutopa, mumakhala maso, mumachita kunenepa kwambiri.

Chifukwa chakuti kapamba sangathe kutulutsa insulin, odwala matenda a shuga amachepetsa thupi. Pali zifukwa ziwiri.

1. Thupi laumunthu limasiya kuzindikira maselo omwe ali ndi vuto lopanga insulin. Popeza pali shuga wokwanira m'magazi, samalowa m'maselo, koma amasiya thupi ndi mkodzo, chifukwa cha izi wodwalayo amakhala ndi kumverera kwanjala, kutopa, kukwiya, kugona, ndi mutu. Izi ndi mtundu wa odwala matenda ashuga amtundu 1.
2. Kuperewera kwa insulini kumalepheretsa thupi kugwiritsa ntchito glucose ngati mphamvu; imafunikira mwachangu gwero lina la glucose lomwe limabwezeretsa kuchuluka kwa shuga m'maselo kufikira gawo lofunikira. Minofu ndi mafuta minofu imangokhala mphamvu yotere. Thupi limatentha mafuta, zomwe zimapangitsa kuti thupi lizitha kuchepa. Kuchokera apa zikuwonekeratu chifukwa chake odwala matenda a shuga amachepetsa thupi.

Odwala amachepetsa thupi, chifukwa ali ndi vuto la metabolic, ndipo kuchepa kwambiri kwa thupi kumawerengedwa kuti ndi chimodzi mwazizindikiro za matenda ashuga.

Ngati sanalandiridwe pa nthawi yake

Ngati sanalandire kwa nthawi yayitali, ndizotheka kuwonjezera kuchuluka kwa ma ketoni komanso kukula kwa ketoacidosis. Zinthu izi zimachulukitsa magazi, omwe amavulaza ziwalo zambiri ndipo amatha kupha.

Zoyenera kuchita ndi kuwonda kwambiri? Choyamba, muyenera kupita kuchipatala, kukayezetsa mayeso ofunikira ndikuonana ndi dokotala. Adzapereka malangizo ofunikira, kupereka mankhwala.

Kuchepetsa thupi popanda chifukwa chodziwikiratu kumakhala ndi zotsatira zoyipa zaumoyo!

Kubwezeretsa kulemera kwam'mbuyomu, mutha kuchita izi:

1. Pitani pa zakudya zonse zopatsa mphamvu zopatsa mphamvu.
2. Zakudya zomwe zimakulitsa kupanga insulin: adyo, zikumera za tirigu wophukira, kuphukira kwa Brussels, mafuta a linse, uchi ndi mkaka wa mbuzi ndizothandiza kwambiri.

Phunzirani kudya pafupipafupi, idyani chakudya osati katatu patsiku, koma 4-5, koma m'magawo ang'onoang'ono, ndipo thanzi lanu lidzakhala labwino.

Chofunika chokhudzana ndi matenda a shuga a shuga

Insellitus yodalira matenda a shuga ndi matenda amtundu woyamba. Ndi mawonekedwe awa omwe amatha kuchitika osati mwa akulu okha, ngakhale okalamba, komanso mwa ana. Kuphatikiza apo, gawo lalikulu la mtundu wa matenda omwe aperekedwa liyenera kuganiziridwa ngati kudalira kwathunthu kapena pang'ono pang'onopang'ono pa mahomoni monga insulin, omwe amapezeka mumalalanje. Za izi ndi mochedweranso malembawo.

Akatswiri adawona kuti matenda a shuga omwe amadalira insulin amapangidwa asanafike zaka 40. Pankhaniyi, matendawa ali pachimake. Anthu odwala matenda ashuga amakumana ndi ludzu kwambiri, kukodza mopitirira muyeso, kuchuluka kwa chilakolako cha chakudya, ngakhale mapinema apamwamba kwambiri samapulumutsa. Zonsezi zimayamba kudziwonekera m'masiku ochepa, pambuyo pake pamachepa thupi.

Werengani zambiri za matenda ashuga.

Mwa odwala ena omwe alipo, zizindikiro monga ketoacidosis, zomwe zimachitika pambuyo pa chithandizo cha opaleshoni, zimawonedwa. Kuwerengeka kwa mahomoni mu plasma kumakhalabe otsika kapena sikudziwika konse, koma kuchuluka kwa glucagon, m'malo mwake, kumakwezedwa, koma mothandizidwa ndi insulin ndi quince imayamba kuchepa. Komabe, zizindikiro za mtundu uwu wa shuga ndizosiyanasiyana komanso zophatikizika, chifukwa chake ziyenera kutchulidwa mwatsatanetsatane.

Matenda a shuga a retinopathy

Matenda a shuga a retinopathy amatanthauza kuwonongeka kwa retina chifukwa cha kuchuluka kwa matendawo. Izi zimachepetsa kuwona kwakuthupi mpaka kukwaniritsa khungu. Kukula kwa kupangidwaku kumayamba pang'onopang'ono, pang'onopang'ono mitsempha yamagazi m'maso imakhala yosalimba, zomwe zimabweretsa kutaya kwa magazi mu retina.

Thandizo la retinopathy limadalira kwathunthu.Odwala onse omwe ali ndi matenda osokoneza bongo opanda zizindikiro za retinopathy ayenera kumawunikidwa nthawi ndi nthawi ndi ma retinologists, kuyang'anira shuga wa magazi, glycosylated hemoglobin, kupanikizika.

Pofuna kukhalabe ndi maonedwe pazochitika za retinopathy, njira zochizira monga laser coagulation, mankhwala osokoneza bongo ndi opaleshoni ziyenera kutembenukidwanso. Ndikofunika kumvetsetsa kuti retinopathy ndiyosavulaza konse, koma kuchuluka kwa laser koyambirira kwamavuto kumathandizira kuti wodwalayo asakhale wakhungu. Vitibleomy nthawi zambiri imagwiritsidwa ntchito kukonza mawonekedwe. Uku ndikuchotsa kwamaso a khungu la diso. Komabe, pakukula kwa matendawa, kugwiranso ntchito palinso zina.

M'magawo owonjezera komanso osapatsirana a shuga omwe samatulutsa nthawi yayitali, laser retinal coagulation imagwiritsidwa ntchito. Kuchita opaleshoni yopweteka kumene kumangokulitsa wodwalayo kumva kupweteka kwa maso. Cholinga cha mankhwalawa ndikuletsa kupitiliza kwa retinopathy, kupewa kuchulukana kwa minofu yolumikizana komanso ziwiya zatsopano zomwe zimapangika mu thupi la retina ndi vitreous.

Kutupa kwa laser kwa retina panthawi yowonjezereka ya retinopathy, pamene zotengera ndi ziwalo za ma membrane amaso zikula, zimatha kugwira ntchito. Pankhaniyi, vit sahihiomy imagwiritsidwanso ntchito, pomwe ma vitreous amachotsedwa pamaso ndikuchita opaleshoni. Izi zimabweretsa kuchotsedwa kwa gawo lapansi pakukula kwa zimimba za zotumphukira, zotupa zamagazi.

Zakudya zamankhwala

Mankhwala othandizira odwala omwe ali ndi NIDDM adapangidwa kuti azikumbukira zomwezo komanso zoletsa zomwezo kwa odwala omwe ali ndi IDDM. Zofunikira kwambiri ndizotsatirazi.

1. Kuwerengera moyenera komanso mwadongosolo mphamvu ya chakudya cha tsiku ndi tsiku, kuchuluka kwa mapuloteni, mafuta ndi chakudya m'menemu. Ngati wodwalayo alibe kunenepa kwambiri, mphamvu, shuga komanso kuchuluka kwa zakudya zofunika kwambiri ziyenera kukhala zolimbitsa thupi. Zakudya ziyenera kukhala zokwanira mu mavitamini asanafike komanso mafuta, komanso mchere wamchere, kupatula mchere wamtundu, kuchuluka kwake komwe sikayenera kupitilira 10 g / tsiku, ndipo pakakhala zovuta ndi zovuta zina, mcherewo uyenera kukhala wochepa malinga ndi momwe amavomerezera ambiri Malangizo pa izi.

2. Kupatula kosafunikira kwa chakudya cham'mimba chazakudya mosavuta. Wodwala amatha kuloledwa kutenga m'malo mwa shuga (sorbitol, xylitol, fructose) mokulira, poganizira kuchuluka kwa mphamvu.

3. Kuchepetsa kwa kuchuluka kwa mafuta a nyama, kuchuluka kwa mafuta ndi mafuta osakwaniritsidwa mu chakudya kuyenera kukhala 1: 2.

4. Kugwiritsa ntchito ponseponse pazinthu zamafuta zomwe zimakhala ndi CHIKWANGWANI cholimba.

5. Kudya pafupipafupi ndi zakudya 5-6 patsiku.

6. Kumaliza mowa kwambiri popanda mowa, komanso kusuta.

Kuwona mfundo zamankhwala a NIDDM, ziyenera kukumbukiridwa kuti pafupifupi 80% (malinga ndi magwero osiyanasiyana, kuyambira 60 mpaka 90 Uo) odwala ndi onenepa kwambiri. Kunenepa kwambiri ndi chimodzi mwazinthu zofunika kwambiri za NIDDM, ndikuchepetsa thupi komanso kubwerera

Kulemera kwakuthupi kwamthupi - nthawi zambiri kumakhala kofunika kwambiri. Ndi kukula kwa kulemera kwa thupi, monga momwe kafukufuku wambiri akuwunikira, chidwi chazomwe zimagwira m'magazi kuti insulin ibwezeretsedwe, zomwe zimapangitsa insulini yogwira ntchito m'magazi zimachepa, glycemia ndi lipidemia zimachepa, ndipo nthawi zina kulolera kwa glucose kumachitika.

Zakudya zokhwima, zogwirizana ndi sayansi zimalola odwala kuti azikwanira kulipiritsa zovuta za metabolic popanda kuchepetsa shuga. Njira yotere ya matenda ashuga osapezekanso microangiopathy, monga tanena kale, imatchedwa mapapu. Nthawi zina, chakudyacho chimakhalabe chithandizo chofunikira, chomwe mankhwala ena amawonjezerapo (shuga yochepa komanso yayikulu).

Chizolowezi chodwala chomwe wodwala amakhala nacho nthawi yayitali, mothandizidwa ndi mabanja, miyambo ya dziko, kulekerera pang'ono zoletsa chakudya chifukwa cha vuto lalikulu la Hyperinsulinism, ndipo, pomaliza, kusamvetsetsa bwino kufunika kochepa thupi chifukwa chofunikira kwambiri chamankhwala - zonsezi zimatha kukhala chopinga pa chithandizo chokwanira komanso chothandiza cha NIDDM, kuphatikiza kunenepa.

Chifukwa chake, chithandizo cha NIDDM mu onenepa kwambiri ndicho chothandizira kunenepa kwambiri.

Cholakwika chachikulu ndikuika kwa odwala insulin, mlingo womwe chifukwa cha kukana insulini uyenera kukulitsidwa pang'onopang'ono mpaka magawo 60-80 kapena kupitirira apo. Bwalo lozunza lachilendo limapangidwa: ndi insulin mankhwala, chidwi cha wodwalayo chimakulirakulira, insulin yachilendo imakulitsa lipogenesis, wodwalayo akupitilizabe kunenepa, kutsutsana ndi insulin kumawonjezereka, ndipo mlingo wa insulini uyenera kuchuluka kwambiri kuti muchepetse hyperglycemia, etc.

Njira yayikulu yothandizira zakudya zamatenda a shuga, kuphatikiza kunenepa kwambiri, ndi kuchepa kwa mphamvu ya chakudya komanso zoletsa zamafuta, mafuta, koma zokwanira zama protein ndi mavitamini. Kuchepetsa mphamvu ya chakudya kumadalira kutha kwa kunenepa kwambiri, kuopsa kwa matenda ashuga, zaka za wodwalayo, kupezeka kwa matenda okhudzana ndi zovuta za matenda ashuga, ndi zina zambiri. Zakudya zambiri zimaperekedwa ndi kuchepetsa mphamvu kwa 800-1,200 kcal / tsiku. Zochitika zimawonetsa, komabe, kuti zoletsa zovutazi sizilekeredwa bwino ndi odwala chifukwa cha zovuta zaumoyo, kutsika kwakuthwa

mphamvu ndi magwiridwe. Odwala osawerengeka amatha kupilira zakudya zotere kwa nthawi yayitali.

Ndiyenera kunena kuti pazifukwa zosiyanasiyana m'maiko onse, odwala matenda a shuga satsatira zakudya zabwino. Chifukwa chake, malinga ndi National Health Committee yaku United States, theka la anthu omwe ali ndi matenda ashuga okha ndi omwe amakhala ndi zakudya zomwe zimakwaniritsa zofunikira zawo zochizira. Choyipa chachikulu ndi momwe zimakhalira pakudya kunenepa kwambiri. Malinga ndi F Figig (1985), ndi 20% yokha ya odwala onenepa m'mbuyomu omwe amakhalanso ndi thupi lochepa kwakanthawi.

Zikuwoneka kuti kuchepa kwamphamvu kwa chakudya chamunthu wodwala matenda ashuga, ngakhale kuli koyenera, sikuchitika kwenikweni. Ndikofunika kuyang'ana wodwala osati kuthandizira kuwonda komanso kuwonda pang'ono pang'onopang'ono, koma pang'onopang'ono, koma kukonzanso mosinthasintha kwa moyo wake, zizolowezi zake za tsiku ndi tsiku kuti athandizire bwino matenda ngati matenda oopsa.

Zomwe zimapangitsa munthu kuthana ndi kunenepa mwina ndizofunikira kwambiri komanso zovuta. Kupambana kwamankhwala kumatsimikiziridwa ndi momwe wodwala amathandizira ndi dokotala. Chizolowezi chodzuka patebulo ndikuwona ngati kuli ndi njala pang'ono, kupondereza kulakalaka chakudya chokoma, ndizovuta kwambiri kwa odwala.

Mukamawerengera zakudya zamagetsi zoperewera, zomwe zimapangitsa kuti pakhale mphamvu zamagetsi, ndiye kuti, kuwononga mphamvu zamagetsi pazakudya zamagetsi, munthu akhoza kuyamba kuchokera ku chakudya chofunikira kuti akhalebe ndi metabolism yayikulu - 20-25 kcal / (kg-day) yochulukitsidwa ndi yabwino kulemera kwa thupi m'mililogalamu. Izi zikutanthauza kuti chakudya cha wodwala chofika kutalika kwa 160-180 masentimita chiyenera kukhala ndi 1200-2000 kcal / tsiku. Kapangidwe ka kadyedwe ka 1500 kcal / tsiku kwa odwala omwe ali ndi NIDDM palimodzi ndi kunenepa kwambiri, onani Zakumapeto. Pankhaniyi, wodwala sayenera kuchepera 0,5-1 makilogalamu pa sabata. Ndi zakudya zotere, odwala omwe amatha kupirira ziletso za tsiku limodzi popanda kudya kwambiri tsiku lotsatira atha kulimbikitsa masiku osala kudya kumapeto kwa sabata (makamaka Loweruka): tchizi cha kanyumba (0.5 makilogalamu a tchizi chamafuta ochepa), zipatso (1-1,5 kg maapulo kapena malalanje), masamba (1.5 makilogalamu kabichi, radish, nkhaka, phwetekere), nyama ndi masamba (300 g ya nyama yophika, 200-300 g ya masamba atsopano), kefir-curd (250 g ya tchizi chokhala ndi mafuta ochepa komanso botolo 1 la kefir) etc.

Zosankha zamagetsi zamagetsi zopanda mphamvu

Zakudya za soya (chakudya chochepa, zamafuta ochepa, olemeretsedwa, mapuloteni ambiri, etc.) zilibe phindu lililonse pamlingo woyenera. Kuphatikiza apo, regimens yopanda chakudya mosasamala siyabwino mu shuga chifukwa cha zotsatira zake za ketogenic. Sichikusonyeza chiwonetsero cha matenda onenepa kwambiri komanso chithandizo cha njala.

Zakudya za wodwala yemwe ali ndi NIDDM kuphatikiza kunenepa kwambiri ziyenera kukhala ndi mapuloteni 1 g / (kg) tsiku, omwe amapereka 16-20% ya mphamvu yake. Nthawi zambiri kuwonjezedwa kwa kuchuluka kwa mapuloteni mpaka 1.5-2 g / kg, potengera mphamvu yake, ndi osatheka. Posachedwa, zawonetsedwa kuti "kupulumutsa njoka yamapuloteni osinthika" kumayendetsedwa ndi kuwonjezereka kwa cholesterolemia, uricemia, pafupipafupi cholelithiasis, komanso kuwonjezeka kwa kufa mwadzidzidzi. Mphamvu yotsalira ya chakudya iyenera kuphimbidwa mu 50% chakudya ndi mafuta 30% (makamaka osati zochuluka).

Chithandizo cha zakudya cha NIDDM ziyenera kuphatikizidwa ndi zolimbitsa thupi. Kukula kwake kumadalira msinkhu wa wodwalayo, kuchuluka kwambiri kwa thupi, zovuta komanso zovuta zamatenda. Titha kulimbikitsa kuchita masewera olimbitsa thupi, kuyenda, komanso osagwirizana ndi mtima, impso, ziwalo zamawonedwe - kusambira, kuthamanga, kugwedezeka, kusamalira maluwa ndi kukonza dimba, masewera.

Wodwala ayenera kudziwa kugwiritsa ntchito mphamvu mu zochitika zosiyanasiyana zapakhomo ndi zamasewera (onani zowonjezera).

Chithandizo cha mankhwala amkamwa hypoglycemic

Kukhazikitsidwa kwakanthawi kachipatala komwe kumachepetsa mankhwala osokoneza bongo mu 50s m'zaka za XX kunali gawo lofunikira kwambiri pothandizira matenda a shuga. Omwe amathandizira odwala othandizira odwala matenda a shuga omwe ali ndi NIDDM, ngati zikuwoneka kuti zatsimikiziridwa kuti zatsimikizika, ayenera kuti ali ndi maubwino angapo pa insulini.

Choyamba, ndi standardo- ndi hyperinsulinemia, kugwiritsidwa ntchito kwawo kumakhala koyenera komanso koyenera kuposa mankhwala a insulin. Kachiwiri, kuyamwa kwa ekapcstv ndikosavuta kwambiri kuposa jakisoni wokhazikika kotero kuti wodwala aliyense yemwe ali ndi insulin ayenera kufotokozera chifukwa chake sayenera

"Mankhwalawa." Chachitatu, mankhwala amkamwa chifukwa chofatsa komanso pang'ono pang'onopang'ono pamagazi a sdhara, nthawi zambiri kuposa insulin, amayambitsa machitidwe a hypoglycemic. Chachinayi, kumwa mankhwalawa pakamwa pafupipafupi (poyerekeza ndi mankhwala a insulin) kumayendera limodzi ndi zotsatira zoyipa ndipo sikumapereka zovuta zosasangalatsa monga lipodystrophy.

Magulu awiri a mankhwala amkamwa a hypoglycemic okhala ndi mitundu yosiyanasiyana ya mankhwala amagwiritsidwa ntchito: sulfonamides ndi biguanides.

U n f i n i l i m id s

Othandizira a Sulfanilamide hypoglycemic ndi zotumphukira za sulfonylurea. Kupatula kwake ndi glycodiazine, womwe ndi wochokera ku sulfapyrimidine, womwe sugwiritsidwa ntchito m'dziko lathu. Malinga ndi olemba osiyanasiyana, amatengedwa kuchokera 20 mpaka 40% mwa odwala onse omwe ali ndi matenda ashuga. Titha kunena molimba mtima kuti m'zaka za 80s, pafupifupi wodwala aliyense wachitatu yemwe ali ndi matenda a shuga amathandizidwa ndi mankhwala a sulfonylurea.

Lingaliro logwiritsa ntchito mankhwala a sulufanilamide pochiza matenda ashuga lidabadwa kuchokera kuzowonera zokhazokha za zovuta za hypoglycemic za sodiumfanfanamides zomwe zimagwiritsidwa ntchito pochiza matenda a bakiteriya. Pambuyo pake, zoyesayesa za ambiri ofufuza, makamaka asayansi aku France a Laubauers, adapanga kukonzekera kwa sulfonylurea ndi kutchulidwa kochepetsa shuga, koma pang'onopang'ono kapena ayi. Mu 1955, kugwiritsa ntchito kwambiri mankhwala ochokera ku sulfonylurea komweko kunayamba.

Zaka 30 zonse zamankhwala ogwiritsa ntchito mankhwala a antidiabetesic sulfonamide akhala nthawi imodzi yophunzira kwambiri momwe amagwirira ntchito.Komabe, ngakhale masiku ano zikuwoneka zovuta kwambiri ndipo samamvetsetsa bwino.

Zigawo za pancreatic ndi extrapancreatic zimatha kusiyanitsidwa mumayendedwe a shuga omwe amachepetsa mphamvu ya zotumphukira za sulfonylurea.

Ofufuza oyamba adatsimikiza kale kuti poyesayesayo, sulfonamides amatha kupanga chotsitsa chokhacho pokhapokha nyama ikakhala ndi gawo lazinthu zopangira inshuwaransi. Palibe endo native

insulin komanso poyesa, komanso kwa wodwala matenda ashuga, ndi osathandiza. Chifukwa chake, malingaliro ofunikira okhudza mwachindunji a sulfanilamides pama cell a beta a islets a Langerhans, polimbikitsa kutulutsa kwa insulin, adayamba. Mphamvu ya beta-cytotropic yamachokera ku sulfonylurea alandila maumboni angapo osiyanasiyana. Atangoyambitsa kukonzekera kwa sulufanamide kwa nyamayo, kuchepa kwama cell a beta kumatha kuwonekera ndi ma elekitirofoni a elekitironi, omwe akuwonetsa kutulutsidwa kwa insulin. M'magazi nthawi yomweyo, kuchuluka kwa insulin kumawonjezeka, ndipo kuchuluka kwa shuga kumachepa. Pambuyo pake, kuwonjezeka kwa kukula kwa zisumbu, kuchuluka kwa granules m'maselo a beta, komanso kuchuluka kwa zomwe zili mu DNA ndi mapuloteni mkati mwake zimadziwika. Zonsezi zimatilola kuganiza kuti zochokera ku sulfonylurea zimangokhala ndi beta-cytotropic (pancreatotropic) komanso zotsatira za beta-cytotrophic (pancreatotrophic).

Zinapezeka kuti sulfonamides imalimbikitsa kutulutsa kwa insulin kuchokera ku kapamba, osati kokha komanso osati kwambiri mwakuchita mwachindunji ma cell a beta, koma pobwezeretsa chidwi chawo ku glucose. Chowonadi ndi chakuti mwa odwala NIDDM, chidwi cha beta-cell receptors ku mphamvu yosinthika ya glucose ndi secretogens ena achilengedwe amachepetsa kwambiri. Amakhulupirira kuti kuwonjezeka kwa kutulutsa kwa insulin mgawo loyamba kumachitika chifukwa cha zochita za sulfonylureas pama cell a beta. Kupititsa patsogolo gawo lachiwiri la insulin katulutsidwe kumalumikizidwa ndi kusinthidwa, pafupi ndi kwabwinobwino mothandizidwa ndi sulfonamide mankhwala zotsatira za hyperglycemia. Kuphatikiza kumwa mankhwalawo ndi chakudya kumawonjezera kuchuluka kwakukulu kwa insulin m'magazi kuposa kumwa popanda kudya. Vutoli liyenera kukumbukiridwa mu chipatala ndipo kukonzekera kwa sulfonylurea kuyenera kuikidwa mosamalitsa pokhudzana ndi kudya.

Zinapezeka kuti kuwonjezeka kwa insulin katulutsidwe pansi pa zochita za sulfonamides kumawonedwa pokhapokha magawo oyamba omwe amagwiritsidwa ntchito. Mankhwalawa akatha miyezi ingapo kapena zaka, zinthu zomwe zimakhala m'magazi m'magazi zimayamba kubwereranso pamlingo womwe unali chisanachitike chithandizo kapena kuchepera. Komabe, nthawi yomweyo, malipiro omwe amapezeka chifukwa cha matenda ashuga, i.e., matenda a glycemia, amakhalabe. Ili

Zikuwoneka kuti ofufuza amakono akufotokozera zenizeni izi motere.

Mphamvu ya pancreatotropic ya sulfonamides imaphatikizidwa ndi zochita zowonjezera zowonjezera, zomwe, malinga ndi malipoti ena, ndizofunikira kwambiri. Monga momwe amadziwika, NIDDM imadziwika ndi kuchepa kwamphamvu kwa zotumphukira zimakhala mpaka insulin. Zimatengera kuchepa kwa kuchuluka kwa insulin receptors pamitsempha yama cell, komanso kuchepa kwa mgwirizano wa ma receptors a mahomoni. Mothandizidwa ndi sulfonylurea, kuchuluka kwa malo omwe amalandila ma membrane a khungu kumawonjezeka, kuyanjana kwa mahomoniwo kumatulutsa, kenako, chifukwa cha kuchepa kwa insulini komanso kufunikira kwakaposachedwa kwambiri kwa insulini ndi inshuwaransi, insulinemia imabwereranso koyambirira kwa Balabolkin M. I. et al, 1983 Chifukwa chake, kufalikira kwa insulin receptor mogwirizana ndi njira imodzi yofunika kwambiri yolumikizirana ndi zochitika za pancreatic of sulfonylurea.Ofufuza ena samatsutsa kuthekera kwa zotsatira za-receptor zotsatira za sulfonamides, zomwe zimalimbikitsa kuyendetsa kwa glucose mkati mwa cell Nowak et al., 1983.

M'zaka zaposachedwa, lingaliro lakhala likukambidwa kuti kufunikira kwakukulu mu pathogenesis ya NIDDM sikukuvomerezeka kwa insulin kumangiriza ma cell membrane receptors, koma zolakwika zina zomwe sizikudziwika bwino pakukonzekera kwina kwa insulin sign Truglia et al., 1985. Kusamutsira chidziwitso kuchokera ku receptor kupita ku processor Mitundu yama enzyme yonyamula ndi kugwiritsa ntchito glucose ndiyovuta kwambiri komanso osiyanasiyana. Amanenanso zowonongeka zosiyanasiyana, zomwe zimafotokozera za heterogeneous zotsatira za NIDDM. Zina mwa zotupa izi zimakonzedwa ndi kukonzekera kwa sulfonylurea, pomwe zina sizili, ndipo ndi izi, ndizotheka kuti kukana kwakukulu kwa sulufanilamide kumakhala kofanana pang'ono (onani pansipa).

Njira zomwe zingapangidwire sulfonamides pa insulin zimakambirana. Amakhulupirira kuti amathandizira pang'onopang'ono kwa michere ya proteinolytic (kuphatikizapo hepatic insulinase) yomwe imawononga insulin, kuletsa kumangiriza kwa insulin kwa mapuloteni a antibodies ndi mapuloteni a plasma kapena kumasula ku kulumikizana uku. Komabe, nkhaniyi siyinathetsedwebe pamapeto pake.

Mwa kuwonjezera mayamwidwe a shuga ndi chiwindi ndi minofu minofu, zotumphukira za sulfonylurea zimawonjezera kaphatikizidwe ndi kudzikundikira kwa glycogen. Nthawi yomweyo

koma kuchuluka kwachilengedwe kwa gluco-neogeneis chikhalidwe cha matenda a shuga kumachepa. Mphamvu ya antilipolytic ya sulfonamides ndiyofunikira kwambiri, chifukwa chomwe zimapangitsa kuti ma triglycerides, mafuta aulere acids, cholesterol, matupi a ketone amachepetsedwa m'magazi. Olemba ena amati izi ndi mawonetseredwe a insulin, pomwe ena amati sulfonamides mwachindunji ndi antilipolytic effect.

Posachedwa, mphamvu ya sulfonylureas pazobisika zam'mimba za m'mimba, komanso glucagon wa pancreatic, adaphunzira kwambiri. Umboni wachindunji komanso wotsimikizika wokhudzana ndi kuphatikizika kwa ma hormonal machitidwe a gastroentero-insular axis mu zotsatira za insulin-tropic sulfonamides sanapezekepo Poltorak V.V., Gladkikh A. I, 1985, koma zida zina ndizosangalatsa. Zinawonetsedwa, makamaka, kuti makonzedwe a sulfonamides amathandizira kubisalira kwa somatostatin ndi kapamba. Zokhudzana ndi kubisala kwa glucagon, zimakhala ngati makulidwe amtundu wa sulfonylurea amalepheretsa zonse zoyambira komanso zotsutsa chakudya zomwe zimatulutsa shuga m'magazi. Nkhani izi, komabe, siziri yankho lomaliza.

Zizindikiro ntchito sulfonylurea kukonzekera. Chotsatira motengera malingaliro amakono onena za njira ya kuchepetsa mphamvu ya shuga ya sulufilamides, chisonyezo chachikulu chogwiritsira ntchito chiyenera kuwonedwa ngati NIDDM yocheperako, komanso zikhalidwe pakati pa NIDDM yocheperako, pomwe chakudya, chomwe kale chidalipira kusokonezeka kwa metabolic, chidasiya kupereka mawonekedwe okhazikika a glycemia.

Odwala otere, munthu amatha kudalira chithandizo chochita bwino cha sulfonylurea, choperekedwa ndi beta-cytotropic, beta-cytotrophic zotsatira, komanso kuthana ndi vuto la kusokonezeka kwa insulin-receptor mogwirizana. Nthawi zambiri awa amakhala odwala okulirapo kuposa zaka 35-40, onenepa wamba kapena wonenepa pang'ono, wokhala ndi njira yokhazikika ya matenda ashuga, osakonda ketoacidosis. Nthawi zina odwala otere amayenera kuchoka ku insulin chithandizo kupita kuchipatala. Kubwezeretsedwa kwathunthu kwa insulini ndi sulfanilamides ndikotheka pamene tsiku ndi tsiku mlingo wa insulini sungadutse 40-50 magawo. Mwayi wakuchita bwino ndiwokwera, wafupikitsa nyengo yamankhwala ndi insulin. Komabe, ngakhale ndi insulin yokwanira yazaka zambiri

mankhwala, mutha kuyesa kusamutsa wodwala kuti alandire sulfonamides.Mwa anthu onenepa kwambiri, chifukwa cha kutengera kwa insulin, kusintha kwa insulin yambiri kwambiri kumachitika bwino. Ngakhale kusinthitsa kwathunthu kwa insulini sikungatheke, ndiye kuti kuphatikiza kwa mankhwalawa kumathandizira pakufunika kwina tsiku lililonse (onani tsamba 160).

Pazifukwa izi, zotumphukira za sulfonylurea zimagwiritsidwa ntchito limodzi ndi insulin mwaukali mawonekedwe a NIDDM, makamaka chifukwa cha insulin, pomwe tsiku ndi tsiku insulin imapitilira mayunitsi a 50-60. Chifukwa chake, pakuwona kwa E. A. Vasyukova, A. M. Granovskaya-Tsvetkova (1975), kuphatikiza kwa glibenclamide ndi insulin mwa anthu odwala matenda ashuga kwambiri kunapangitsa kuti athe kuchepetsa kufunika kwa insulin kuyambira mayunitsi 102 mpaka 64.

Ngati monotherapy yokhala ndi sulfonamides omwe ali ndi shuga wambiri sangakwanitse kulipira mokwanira zovuta zama metabolic, tikulimbikitsidwa kuti muwonjezere chithandizo cha biguanides. Pokhapokha ngati izi zakuphatikiza mankhwalawa, insulini imamangiriridwa, ndipo kufunikira kwake ndikochepa poyerekeza ndi monotherapy yokhala ndi insulin.

Komanso Mwa zomwe zikuwonetsedwa pakugwiritsa ntchito kukonzekera kwa sulfonylurea, akadali matenda zinthu ndi Zizindikiro zosadziwika zoika sulfonamides. Kusagwirizana pakuwunika kwa ena umboni Zotsatira zawo monga choncho akatswiri akunja.

Kulankhula tikulankhula zakusankhidwa kwa sulfonamides a NIDDM wofatsa, komanso matenda a shuga a latent (latent), malinga ndi gulu lamakono, ndi kusokonekera kwa shuga.

V. G. Baranov, L. Sh. Orkodashvili (1973) amakhulupirira kuti ndi matenda ashuga omwe amalipidwa ndi chakudya chimodzi, ngakhale "ndi mankhwala abwino kwambiri azakudya, ndikofunika kugwiritsa ntchito kwambiri mankhwala opatsirana pakamwa". Kukhazikikaku kumagwira ntchito pazochitika zonse za kulekerera kwa glucose, pomwe glycemia malinga ndi kuyesedwa kwa glucose imafika 1 mg pambuyo pamtolo wa 200 mg% (11 mmol / L), ndipo pambuyo maola 2 - 150 mg% (8.25 mmol / L) Baranov V. G., Gasparyan E. G., 1983. Maziko a mfundo yotereyi ndi lingaliro lamatanthauzidwe achilengedwe a sulfonylurea kuchokera pazinthu zapamwamba za kapamba, chifukwa chomwe pali kuwonjezeka kwa kaphatikizidwe ndi chimbudzi.

insulin imaphatikizidwa ndi beta-cell hyperplasia. Pankhani ya shuga wofatsa komanso kulekerera kwa glucose, butamide imalimbikitsidwa pa 0,5 ga 2 pa tsiku kwa zaka 1-1 Wa. Ngati zitachitika izi kuphwanya glucose malinga ndi kuyesedwa kwa glucose kumapitirira, ndiye kuti mankhwalawo amawonjezeranso chaka chimodzi. Mkhalidwe wofananawo amatengedwa ndi olemba achilendo angapo omwe amalimbikitsa prophylactic sulfanilamidotherapy kwa anthu omwe ali ndi vuto la glucose, komanso odwala omwe ali ndi shuga wambiri, pofuna kupewa kupititsa patsogolo kwa matenda a metabolic, makamaka makulidwe a matenda a shuga a Carlstrom et al., 1979, Ratzmann et al., 1983 .

Ofufuzawo ena amakayikira za kufunikira kwa kugwiritsa ntchito prophylactic sulfonamides. Mu ntchito zingapo pankhaniyi, palibe zopindulitsa za sulufanilamidotherapy pa mankhwala othandizira zakudya omwe adapezeka popewa kupitilira kwa shuga wodwala matenda ashuga, komanso kukonza kukhuthala kwa shuga Paroz et al., 1978, Magyar, 1978. A. S. Efimov et al. (1983) akuwonetsa mantha kuti koyambirira kwambiri, koyambirira, makonzedwe a sulfonylurea angapangitse kukulira ndi kufooka kwa maselo a beta kudzera mu kukondoweza kwambiri. Tikukhulupirira kuti kugwiritsa ntchito sulfonylureas mu shuga kumabwezedwa ndi zakudya komanso kulekerera shuga ndizopanda phindu.

Contraindication Mankhwala a Sulfonylurea ali otsutsana kwathunthu chifukwa cha ketoacidosis, ketoacidemic precoma ndi chikomokere, komanso hyperosmolar ndi lactic acid comas.Amagawidwanso chimodzimodzi pakubadwa kwa nthawi yayitali komanso nthawi yonse ya mkaka wonsewo. Ziribe kanthu kuti chiwongola dzanja cha anthu odwala matenda a shuga ndi sulfonamides bwanji, ndi isanayambike mimba, wodwalayo ayenera kusamutsidwira ku insulin. Zizindikiro zina zakukhazikitsidwa kwakanthawi kwa insulin (nthawi zina ndi kufowoka kwa sulfonamides, nthawi zina motsutsana ndi maziko azakudya zawo) ndizofunikira zakuchita opaleshoni yam'mimba, matenda apachimake, kufalikira kwamphamvu kwa matenda osachiritsika (pyelonephritis yayitali, matenda opuma, ndi zina.). Sitikulimbikitsidwa kugwiritsa ntchito mankhwala a sulfonylurea mu cytopenic zinthu (leukopenia, thrombocytopenia) ya genesis iliyonse.

Gulu lotsatira la contraindication kwambiri parenchymal kuwonongeka kwa chiwindi ndi impso (pachimake komanso matenda achangu a chiwindi, matenda a chiwindi, matenda onse a impso omwe ali ndi kuchepa kwakukulu kwa kusefedwa kwa glomerular ndipo, makamaka ntchito ya nayitrogeni excretion). Olemba ena amati chisamaliro chapadera chimayenera kuthandizidwa pochiza odwala omwe ali ndi zilonda zam'mimba komanso duodenum ndi sulfonamides. Balabolkin M.I., Gavri-lyuk L.I., 1983. Pakadali pano, kukonzekera kwa sulfonylurea sikugwiritsidwa ntchito kwenikweni ngati IDDM.

Kutchulidwa kwapadera kuyenera kupangidwa malinga ndi momwe zotupa zam'mimba za shuga zimasokonezera mankhwala a sulfonamide. Chotsutsana kwathunthu ndi mankhwala awo ndi matenda am'mimba a chiwindi, komanso kupweteka kwambiri kwa nephroangiopathy ndi nephrotic syndrome kapena kuwonongeka kwa nayitrogeni. Ndi angiopathy kwina kwina komanso kuwuma kosiyanasiyana, kubwezeretsa kwakukulu kwa shuga ndikofunikira kwambiri. Mlingo wofunikira wa mankhwalawa amasankhidwa molingana ndi malamulo onse.

Zotsatira zoyipa ndi zovuta mankhwala a hypoglycemic sulfonamides nthawi zambiri samapezeka mu 3-5% ya milandu. Malinga ndi Haupt, Schoffling (1977), amapezeka pogwiritsa ntchito carbamide mu 5.4%, chloropropamide mu 4.1%, glibenclamide mu 1.2% ya milandu. Malinga ndi kwina, chlorpropamide nthawi zambiri imapereka zotsatira zoyipa.

Zotsatira zoyipa zoyambitsidwa ndi sulfonyl-urea nthawi zambiri zimakhala zosadziwika - dyspepsia kapena khungu. Zizindikiro za Dyspeptic (nseru, kupweteka kwa epigastric, kusanza, kutsegula m'mimba) nthawi zambiri zimatha ngati mumagwiritsa ntchito Mlingo wa tsiku ndi tsiku Mlingo wosiyanasiyana, mutamwa mankhwalawa mukatha kudya. Thupi lawo siligwirizana nthawi zambiri limangokhala ndi zotupa za urticaria, nthawi zina kumangoyabwa. Popereka mpumulo, ma antihistam adziwonetsa bwino. Nthawi zambiri, pakapita kanthawi kochepa kokana kukomoka, ndizotheka kupitiliza kukonzekera chimodzimodzi, koma nthawi zina ndikofunikira m'malo mwake ndi ina. Osowa kwambiri, zomwe thupi limakhala nazo limakhala ndi vuto lodziwika bwino la dermatitis (nthawi zina limakhala lodziwika bwino - matenda a Lyell) kapena limakhala lodziwika bwino ndi kutupa komanso kufiira khungu, limachepetsa kuthamanga kwa magazi, kufupika, ndi zina zambiri.

Ngati allergenic mankhwala ayenera anasiya yomweyo, kukana kugwiritsa ntchito sulfonamides, mankhwala a glucocorticoids kwa wodwala.

The poizoni mphamvu ya sulfonyl urea zotumphukira m`mafupa ndi kukula kwa leukopenia, thrombocytopenia ngakhale agranulocytosis akufotokozedwa. Mavutowa ndi osowa kwambiri, koma chifukwa cha kuwopsa kwawo, ayenera kukumbukiridwa nthawi zonse. Ndikulimbikitsidwa kuyang'anira nthawi ndi nthawi mankhwala a sulfanilamide ndi kuyesedwa kwa magazi ndi matenda am'magazi.

Chifukwa chakuti mankhwalawa ndi chlorpropamide nthawi zina amakhala ovuta chifukwa cha cholestatic jaundice, m`pofunika kuti muwonetsere mkodzo wa urobilin kamodzi pamwezi ndikuwunika bilirubin komanso ntchito ya magazi a phosphatase.Ngati sulfonamides amalembedwa kwa wodwala yemwe ali ndi matenda osapatsika a chiwindi, hepatostatosis, ndiye kuti ndi bwino kutsimikizira kusowa kwa poizoni wa hepatocytes mwa kukonzanso ntchito ya serum aminotransferases.

Mukamamwa mankhwala ochepetsa shuga a sulfonamide, makamaka chlorpropamide ndi glibenclamide, kukula kwa zinthu za hypoglycemic ndikotheka. Amaonedwa kuti ndi opepuka. Komabe, ziyenera kukumbukiridwa kuti odwala omwe amatenga sulfonamides nthawi zambiri amakhala achikulire kuposa zaka 40-50, ndipo ambiri a iwo amadwala matenda a mtima ndi ubongo. Olemba ena a Balabolkin M.I., Gavrilyuk L.I., 1983, Petrides P. et al., 1980 moyenerera amagogomezera kuopsa kwakukulu kwa hypoglycemia yoyambitsidwa ndi mankhwala a sulfonylurea mwa okalamba. Pakuwona, Asplund et al. (1983) avereji ya odwala 57 omwe matenda a hypoglycemia adachitika atatenga glibenclamide anali ndi zaka 75, pomwe 20% anali ndi zaka 85 kapena kupitirira. The hypoglycemic state mwa zotere zimayamba pang'onopang'ono, popanda zachiwonetsero zamasamba ankhanza, ndipo nthawi zina zimakhazikika ndi mawonekedwe owoneka bwino amitsempha, kutsata kuphwanya kwakukulu kwa kufalikira kwa ziwalo. Malinga ndi zomwe tawona, hypoglycemia imadziwika kwambiri kwa odwala omwe ali ndi vuto lotchedwa lacunar bongo. Mothandizidwa ndi hypoglycemia, akuwoneka ngati akutsitsimutsanso kuwonongeka kwakumbuyo kwa ubongo, ndikupereka chithunzi chogwirira mobwerezabwereza cha kutanthauzira komweko ngati koyambirira. Tiyeneranso kukumbukira kuti chifukwa cha nthawi yayitali yochitapo kanthu

chlorpropamide hypoglycemia, zikafika, zimatha kubwerezedwa tsiku lomwelo.

Kupezeka kwa hypoglycemia, monga lamulo, kukuwonetsa kuwonjezereka kwa mankhwalawa ndipo kumafuna kuchepetsa kuchepa kwa mankhwalawo kapena kuwunikiranso zomwe zimachitika pakadyekedwe ka zakudya kufikira nthawi ya tsiku pamene kuchepa kwambiri kwa shuga m'magazi kumadziwika. Kuphatikiza apo, muyenera kuonetsetsa kuti wodwalayo sanamwe mowa, komanso mankhwala ena omwe amatha kupangitsa shuga kuchepa kwa shuga. Awa ndi acetylsalicylic acid, ma pyra-zolone zotumphukira, anticoagulants mkamwa, tuberculostatic othandizira (LASK, ethionamide), tetracycline, cyclophosphamide, antimicrobial sulfanilamides (sulfadimethoxin, etc.), akupikisana ndi plasma sulfonylureasatives.

Nthawi zina chomwe chimayambitsa hypoglycemia ndi kudzikundikira kwa mankhwala a sulufanilamide chifukwa cha kuwonongeka kwaimpso. Pafupifupi 100% ya carbutamide, 90% ya glipizide, 80-90% ya chlorpropamide, 80-85 U wa tolbutamide, 65% ya glyclazide ndi pafupifupi 50% ya glibenclamide imatulutsidwa mkodzo. Muzochitika zamankhwala, kuperewera kwaimpso nthawi zambiri kumaweruzidwa ndi kusungidwa kwa nitrogenous slag (yotsalira wa nitrogen) kapena creatinine. Pakadali pano, kuchuluka kwa creatinine m'magazi kumapitilira muyeso wokhazikika pokhapokha kusefera kwa glomerular kutsika mpaka 25-30 ml / min, ndipo osaposa 30% ya kuchuluka kwa ntchito ya glomeruli. Kukulumikizidwa kwa zinthu zina nthawi zina kumachitika asanafike ma laboratoria zizindikiro za kukhalabe kwa nayitrogeni. Mulingo wabwinobwino wopanga magazi samatsimikizira kuti khungu lidzakhala lopanda vuto lililonse.

Zina mwa zovuta za zovuta zamankhwala zimaphatikizapo kukulira kwa sulfonamide kukana. Siyanitsani pakati pa pulayimale yachiwiri ndi sekondale yotsutsa. Kusazindikira kwenikweni kwa sulfonamides kumapezeka pakayesera koyamba kuwagwira ndi wodwala pafupifupi pafupifupi chilichonse. Chifukwa chake sichimamveka bwinobwino. Pali lingaliro kuti limagwirizanitsidwa ndi kusapezeka kapena kuphwanya komwe kulandiridwa kwa zotengera za sulfonyl-m-h: kudziimba mlandu.

Second sulfonamide kukana kumayamba pang'onopang'ono, patapita nthawi yayitali kugwiritsa ntchito bwino. Malinga ndi A.S. Efimova (1984), 40-50% ya odwala, azaka 6 mpaka 10, omwe amathandizidwa ndi mankhwala a sfofo

nylurea, chifukwa cha kutayika kwa iwo, amasamutsidwa ku insulin. Nthawi zina sekondaleamide yachiwiri imayamba pakangodutsa miyezi yochepa itatha mankhwala, koma nthawi zambiri itatha zaka 3-6. Komabe, nthawi zina odwala amathandizidwa bwino ndi sulfonylureas wazaka 15-18.

M'mabukuwo, funso lidafunsidwa kwa nthawi yayitali: kodi sichomwe chimayambitsa kukana kwachiwiri kwa sulfonamides kutsika kwa ma cell a beta chifukwa cha kukondweretsedwa kwakutali? Ofufuza ena amakhulupirira kuti "njira yotsimikizika mochedwa ya sulfanilamide" ndiyotheka ndipo imangopezeka mwa 4% ya odwala Mehnert H., 1980. V.V. Poltorak, A. I. Gladkikh, atasanthula bwino lomwe mabuku a nkhaniyi, anazindikira kuti umboni wotsimikizika ukutha. zotsatira za sulfonylurea pazida zamtundu wa beta kulibe.

Kafukufuku wokhudzana ndi milandu ya kukana kwa sulfonamide nthawi iliyonse akuwulula zolakwika zingapo mu gulu la mankhwalawa (kutsimikiza molondola, zikuwonetsa kusankha kosayenera kwa mankhwalawo kapena mlingo wake, kuphwanya zakudya, kusakhazikika pakumwa mankhwala, etc.). Odwala omwe ali ndi mbiri yapafupi, kuvulala kwamaganizidwe, matenda opatsirana omwe amathandizira kulephera kulipidwa kwa shuga amapezeka. Ndizodziwikanso kuti poyambanso kukana mankhwalawo, kuonjezera mlingo wake kapena kusintha wina, wamphamvu kwambiri, nthawi zambiri amakhala wogwira mtima. Ofufuza ena amakhulupirira kuti kusasamala kwenikweni kwa mankhwala a sulfonylurea kuyenera kuwonedwa ngati chifukwa cha kupitirira kwa matenda ashuga chifukwa cha kulipidwa bwino kwake (V. Baranov, 1977.) Pofuna kupewa kapena kuchedwetsa kukula kwa kukana kwa sulfonamide, malamulo angapo ayenera kuyang'aniridwa, omwe akukambirana pansipa (onani tsamba 149).

Mu 1970-1971 lipoti lochokera ku gulu la anthu odwala matenda ashuga ku University la 12 ku makoleji khumi ndi awiri aku US zokhudza vuto linanso la sulfanyl amidotherapy. Izi zikadali kukambirana ndi kupereka ndemanga ndi akatswiri ashuga ochokera kumayiko osiyanasiyana. Mu ntchito ya ofufuza aku America, zidawonetsedwa kuti odwala omwe amathandizidwa ndi tolbutamide amwalira ndi matenda a mtima nthawi zambiri kuposa anthu omwe adalandira insulin kapena placebo osakanikirana ndi kadyedwe monga antidiabetesic therapy. Olembawo m'magulu adalemba kuti kukonzekera sulfonylurea kumawonjezeka

imfa ya odwala matenda ashuga kuwonongeka kwa mtima dongosolo.

Kuunika mosamalitsa kwa zinthuzi kunawonetsa phunziroli zolakwika zazikulu zamachitidwe zomwe zimapangitsa kuti ma endocrinologists ambiri asakhulupirire zotsatira ndi zomwe ananena. Choyamba, ndizokayikitsa kuti odwala onse adapatsidwa mlingo womwewo wa tolbutamide - 1.5 g. Tolbutamide idagwiritsidwa ntchito pochiza odwala omwe ali ndi zovuta zamtundu wosiyanasiyana, wokhala ndi malire komanso ngakhale magonedwe abwinobwino a glucose. Olembawo sanakwaniritse mtundu wa carbohydrate ndi lipid metabolism, ndipo ichi ndiye chikhalidwe chofunikira kwambiri chothandizira kuti matenda a antiidiabetes asathe kuchita bwino komanso kukhala ndi mwayi wopindulitsa masinthidwe a matenda a shuga. Zotsatira zamaboma osiyanasiyana ochizira pamtima pazoyenda ndi mtima zimatha kufananizidwa pokhapokha aliyense wa iwo akapatsa wodwala aliyense chindapusa chodalirika cha matenda ashuga. Kupanga magulu oyerekeza a odwala, olemba ananyalanyaza kusiyana komwe kumayambira ku IHD ya amuna ndi akazi, sanalingalire kukhalapo kwa ziwopsezo, zotchulidwa za insulin yemweyo muyezo, ndi zina zambiri.

Muzolemba za olemba ntchito zapakhomo, zidawonetsedwa kuti kusowa kwa chindapusa cha matenda a shuga sikofunikira pakukula kwa mtima wamatenda, ziribe kanthu chithandizo chochepetsa shuga chomwe wodwala amalandira.Ngati chiphuphu cha zovuta za metabolic chimaperekedwa, ndiye kuti kusiyana kwa pafupipafupi kwa matenda ashuga angiopathy ndi sulfanilamide mankhwala ndi chithandizo cha insulin sikupezeka. Palibe chifukwa chofotokozera za kupita patsogolo kwa matenda a mtima monga kuponderezedwa kwa sulfanilamidotherapy a shuga mellitus.

Mwa mankhwala ochepetsera shuga omwe amagwiritsidwa ntchito masiku ano, ine ndi II mibadwo ndife osiyana. Ma sulfanilamides a m'badwo woyamba adayamba kugwiritsidwa ntchito kuyambira 1955; Mlingo wawo wogwira ntchito amawerengedwa mu ma decigram. Awa ndi tolbutamide, carbamide, chlorpropamide. Kukonzekera kwa m'badwo P zidapangidwa pambuyo pake; zakhala zikugwiritsidwa ntchito kuyambira 1966. Zimagwira kwambiri komanso sizinapweteke. Glibenclamide, glurenorm, nyama zakutsogolo zimayikidwa mu Mlingo wa ma milligram angapo kapena makumi a milligram (Table 9).

Butamide - 1 ”1- (para-Methylbenzenesulfonyl) -M'-n-butylurea ndi mankhwala omwe amakhala ndi vuto lalikulu la hypo-glycemic, komanso kawopsedwe kotsika kwambiri pakati pa m'badwo wa sulfonamides I. Mokwanira

Gome 9 Pharmacotherapeutic mawonekedwe a mankhwala ogwiritsira ntchito kwambiri a sulfa ndi isanayambike pambuyo pa 1/1 mpaka 1 ora

Zochita malire, h

Kutalika kwa ntchito, h

Pazipita mlingo tsiku lililonse

Migwirizano yowonetsera kwathunthu

Njira yokonza, g

Butamide, diabetesod, mpaka

lipol, orabet, orinaza,

Oberben, Rastinon, wandiweyani-

chisankho, kulingalira, chisankho,

kudandaula, kufuula, talente

wopanda zochita za antibacterial. Chifukwa cha kuyamwa msanga, imayamba kutulutsa mphamvu ya hypoglycemic 1 ora pambuyo pa kuperekera, zotsatira zazikulu zimawonedwa pakati pa ola la 5 ndi 7, mwa odwala ena - pakati pa ola la 4 ndi la 8. Kutalika kwa kuchitapo kanthu - osaposa maola 12. Amapangidwa ku USSR m'mapiritsi a 0,5 ndi 0,25 g (phukusi la mapiritsi 50).

Pali malingaliro awiri ogwiritsira ntchito butamide V. G. Baranov (1977) akuvomereza kuti akhazikitse 2 kawiri patsiku 1 ora musanadye ndi gawo la maola 10-12 (m'mawa ndi madzulo). Mlingo umodzi woyamba ndi wokhazikika - 1 g (tsiku ndi tsiku 2 g). Kuchulukitsa kwa mankhwalawa sikukweza mphamvu ya mankhwalawa, koma kumawonjezera chiopsezo cha mavuto. Nthawi zambiri, zotsatira zake zimadziwika ndikuchepetsa glycemia ndi glucosuria kale sabata yoyamba ya chithandizo, koma ndizotheka kuti pamapeto pake mawunikidwe ake ochepetsa shuga pambuyo pakatha masabata awiri. Pokhapokha ngati standardoglycemia ndi aglucosuria zimatheka pambuyo pa nthawi, mlingo wamadzulo umachepetsedwa kukhala 0,5 g, ndipo pakatha milungu ina iwiri, mlingo umachepa ndi m'mawa. Ngati ndi kotheka (kuwoneka kwa machitidwe a hypoglycemic), njira yokonzanso imatha kuchepera (0,5 g m'mawa ndi 0,25 g madzulo kapena 0,25 g kawiri pa tsiku).

Ambiri odwala matenda ashuga amawona kuti ndikwanzeru kuyamba chithandizo ndi butamide ndi 0,5 g katatu patsiku atatha kudya. Ngati mankhwalawa ali osakwanira, amatha kuwonjezereka m'masiku ochepa, ndikuwukitsa mpaka 2.0-2.5 g / tsiku komanso mpaka 3 g / tsiku. Pambuyo masiku 10 mpaka 14, mlingo umachepetsedwa pang'onopang'ono. Mankhwala okonza amatha kusiyanasiyana kuchokera pa 025 g mpaka 1 g, nthawi zina mpaka 1.5 g.

Mukasamutsa wodwala yemwe ali ndi NIDDM kuchokera ku insulin therapy kupita ku sulufanilamide mankhwala, zimaganiziridwa kuti kusintha kwathunthu ndi insulin butamide kumatha kuchitika ngati mlingo wake mwa anthu omwe ali ndi kulemera kwa thupi pafupi ndi osaposa 20-30 PIECES Pafupifupi 0.5-1 uyenera kubwezeretsanso 10 PESCES ya insulin g butamide. Ndikofunika kusintha mankhwalawa pang'onopang'ono. Butamide imayikidwa motsutsana ndi maziko am'mbuyomu mlingo wa insulin, ndipo, ndikuwonetsetsa kuti ikuyenda bwino, mlingo wa insulin umachepetsedwa ndi 6-10 IU / tsiku.

Cyclamide - N- (na / ”a-methylbenzenesulfonyl) - N 1 -cyclohexylurea. Malinga ndi machitidwe a pharmacodynamic ndi pharmacokinetic, mankhwalawa ali pafupi ndi butamide, koma ndiwothandiza kwambiri. Amagwiritsidwa ntchito pa Mlingo osapitirira 1.5 g / tsiku. Ndondomeko zochizira ndizofanana ndi butamide. Amapangidwa ku USSR pama mapiritsi a 0,25 g, phukusi la mapiritsi 20.

Chlocyclamide - 1 ' l/ g- h pambuyo makonzedwe, pazipita - pambuyo maola 2-4. Kutalika kwa zochita kumakhala pafupifupi maola 24, nthawi zina motalikirapo (pomwe kuthekera kwawerengeredwe ndikukula kwa zochitika za hypoglycemic kumalumikizidwa), nthawi zina kumakhala kochepa (hyperglycemia imachitika usiku ndi m'mawa tsiku lotsatira).

Mankhwala amatengedwa 1 nthawi patsiku, asanadye chakudya cham'mawa, nthawi zambiri

atatha kadzutsa. Mlingo woyambirira wa 0,25 kapena 0,5 g, kutengera mlingo wa glycemia.Kwa kanthawi kochepa, mlingowo umatha kuwonjezeredwa mpaka 0,75 g, koma kenako umagawidwa mu 2 Mlingo - kadzutsa ndi nkhomaliro. Kuchulukitsa kwakukulu nthawi zina kumapezeka pakatha masabata 2-3 chiyambireni chithandizo, ndiye kuti mlingo umachepetsedwa ndikukonzanso (kuyambira 0,125 g mpaka 0,5 g).

Ngati kuchotsedwa kwa chlorpropamide kuchokera m'thupi kwapita patsogolo, ndiye kuti, pofika kumapeto kwa tsiku mphamvu yake yotsika shuga imafooka, ndiye kuti m'mawa mumamwa mankhwalawo amaphatikizidwa ndi kudya kwamadzulo kwa butamide kapena bucarban. Ndi chidwi chachikulu ndi chlorpropamide, pamene mlingo wothandizira ulibe kupitirira 0.25 g, mutha kuyesa kusintha kuti musatenge mankhwala osagwira a m'badwo woyamba. Mwambiri, chlorpropamide imagwiritsidwa ntchito bwino pakukaniza koyambirira kapena kwachiwiri kwa butamide, cyclamide, ndi bukarban.

Chlorpropamide, monga othandizira omwe atchulidwa pamwambapa, angagwiritsidwe ntchito limodzi ndi insulin kukonzekera ndi biguanides. Kusintha kwa mankhwala a insulini ndi chlorpropamide, akuganiza kuti pafupifupi 0,25 g ya chlorpropamide ndi ofanana 20 magawo a insulin.

Chlorpropamide imapezeka ku USSR mapiritsi a 0,25 g, phukusi la mapiritsi 20.

Maninyl - 1 ^ -SH2- (5-Chloro-2-methoxybenzamido) ethyl phenylsulfonyl> -M'-cyclohexylurea. Mankhwalawa ndi m'badwo wachiwiri. Chimodzi mwazomwe zikuwonetsa kuti amagwiritsidwa ntchito ndi kukana koyamba komanso kwachiwiri kwa mankhwala a m'badwo woyamba.

Imayamba kugwira ntchito 1 ola limodzi pambuyo pa utsogoleri, mphamvu yayikulu imakhala pakati pa 4th ndi 8 ora. Amakhulupirira kuti mannilol ndi mankhwala ogwiritsidwa ntchito tsiku ndi tsiku, mwakutero, zikuwoneka kuti nthawi yayitali yokhala ndi shuga ndikucheperachepera-maola 18-18, ndipo malinga ndi malingaliro a olemba pawokha, sichidutsa maola 12.

Maninil amatengedwa m'mawa, atatha kadzutsa, kuyambira ndi 1/2 mpaka piritsi limodzi patsiku. Ndi osakwanira kwenikweni, mlingo umakulitsidwa ndikuwonjezera 1 masiku onse a 5-7/2 mapiritsi. Mlingo waukulu ndi mapiritsi atatu (15 mg / tsiku). Mlingo wa tsiku ndi tsiku, ngati sunapitirire 10 mg, utha kutengedwa mu 1 kapena 2 (m'mawa ndi madzulo). Ngati ndi 15 mg, ndiye kuti nthawi zonse amatengedwa pang'ono (pakudya cham'mawa ndi chakudya chamadzulo kapena chamasana).

Ngati monotherapy ndi mannil silipereka chipukuta misozi, nthawi zina imaphatikizidwa ndi biguanides kapena insulin kukonzekera:

Maninil amapangidwa mu GDR m'mapiritsi a 0,005 g, phukusi la mapiritsi 120.

Predian - 1-methyl-4-phenylsulfonyl (3) perydropentane (c) pyrrolyl-21-urea. Mankhwala posachedwapa adalowa kuchipatala. Ikuphatikiza kutsitsa kwa shuga kwa zotsatira za sulfonylurea zochokera mu mbadwo wa II ndikuthandizira pa hemostasis. Predian amachepetsa mphamvu ya kupatsidwa zinthu za m'magazi, motero, amachepetsa ntchito ya kupatsidwa zinthu za m'magazi komanso kuopsa kwa kuperewera kwa magazi m'magazi. Omaliza amakhala ndi kufunikira kwakukulu pamavuto a kusokonekera kwa shuga, komanso matenda ashuga angiopathy. Kuphatikiza apo, pali umboni kuti kulosera kumayambitsa fibrinolysis. Amakhulupirira kuti mankhwalawo pachokha amachititsa zotsatira za hypoglycemic, ndipo zotsatira za vasoprotective zimagwirizanitsidwa ndi imodzi mwazinthu zake metabolites.

Predian amayamba kugwira ntchito 1 ora pambuyo pa utsogoleri, mphamvu yayikulu ikuwonekera pakati pa 4th ndi 8th, nthawi yayitali imakhala yochepa kuposa maola 20. Kuteteza kwa angio kumawonekera pambuyo pa miyezi 3 ya chithandizo komanso momveka bwino pambuyo pa miyezi 6-12.

Kuchiza ndi nyama zam'mimba kumayamba ndi kumwa mapiritsi a U2 panthawi ya kadzutsa. Mlingowo umakulitsidwa pang'onopang'ono mpaka 2-3, mapiritsi 4 ambiri. Mlingo wa tsiku ndi tsiku umagawidwa pawiri, kawiri kawiri mumagawo atatu (mwachitsanzo, mapiritsi awiri pakudya kadzutsa, piritsi limodzi pakudya).

Kuwonjezeka kwina kwa mlingo sikuti kumathandizira kuchepetsa kutsika kwa shuga.

Popeza kuthekera kwa prediana nthawi imodzi kukhala ndi hypoglycemic ndipo angioprotective zotsatira ndizopadera, malo ake mankhwalawa a shuga pakati pa ena omwe amapezeka kuchokera ku sulfonylurea samadziwika bwino.

Mankhwalawa amapezeka mu SFRY (yotchedwa dia-micron - ku France) m'mapiritsi 80 mg, mapiritsi 60 pa paketi iliyonse.

Glurenorm - 1-cyclohexyl-3-para-2- (3,4-dihydro-7-methoxy-4,4-dimethyl-1,3-dioxo-2 (1H) -isoquinolyl) ethyl! phenyl sulfonyl urea. Mankhwala a Generation II sulfonylurea, omwe amasiyana ndi kukonzekera kwina kwa sulufilamu chifukwa 5% yokha ya metabolites yomwe imatuluka m'thupi ndi impso. Ambiri a iwo (95%) amabisika ndi chiwindi kulowa mu bile ndikuchotsedwa m'matumbo. Izi zimapangitsa glurenorm mankhwala osankhidwa.

ndi matenda a shuga kapena matenda a impso.

Kutsitsa kwa shuga kumayamba mu ola limodzi, kumafika pakapita maola atatu mutatha kumwa mankhwalawa ndipo kumatenga pafupifupi maola 10. Ndikulimbikitsidwa kuti muzimwa glurenorm kumayambiriro kwa chakudya katatu patsiku. Yambirani chithandizo ndi piritsi la 1/2 m'mawa, ngati kuli kotheka, pang'onopang'ono muwonjezere mlingo, ndikuwonjezera piritsi 1/2. Mlingo wamba watsiku lililonse ndi mapiritsi a 11 / 2-2 ndipo sayenera kupitirira 90 mt.

Kukonzekera kwakanthawi kwamapiritsi 4 a glurenorm amaloledwa.

Amapezeka mu SFRY m'mapiritsi 30 mg, phukusi la mapiritsi 30.

Minidiab ndi N-4-2- (5-MeTHunnipa3iffl-2-Kap6oKCHaMnao) ethylbenzenesulfonyl-g4'-cyclohexylurea. Mankhwalawa ndi mbadwo wa II, womwe umayamba msanga m'matumbo. Zowonjezera kutsitsa kwa shuga mu 1/2 - 1 h pambuyo makonzedwe, okwanira kanthu - pambuyo 4-8 maola, nthawi ya ntchito - maola 24

Olemba ena amalimbikitsa kuyamba ndi mankhwala a minidiab okhala ndi piritsi 1/2 m'mawa, kenako ndikuwonjezeka kwa pang'onopang'ono kwa mlingo. Ena amapereka mankhwala oyambira kutengera glycemia woyambira (2.5-10 mg / tsiku). Pazipita tsiku lililonse mapiritsi 4, othandizira - 2,5 mpaka 15 mg. Zotsatira za mankhwalawa zimadziwulula zokha mkati mwa masabata awiri. Malinga ndi zotsatira za hypoglycemic, minidiab ndiyofanana ndi glibenclamide.

Amapangidwa ku Italy m'mapiritsi a 0,005 g, phukusi la mapiritsi 50.

Zovuta za matenda ashuga, zomwe zimagwirizana kwambiri ndi kuchepetsa shuga wa sulfamylamides, komanso mwayi woti akhale nawo osagwirizana nawo, zikuwonetsa kuti zimatenga nthawi yayitali komanso Kugwiritsa ntchito bwino ndi sulfonylureas kumatheka pokhapokha potsatira zochitika zotsatirazi.

1. Mankhwala a Sulfanilamide angagwiritsidwe ntchito pokhapokha pochita zowerengera zowonetsa ndi ma contraindication ake. Izi sizikutanthauza kutsimikizira mtundu wa matenda ashuga ndi kuwunika kwamankhwala ake, komanso kafukufuku wokwanira wamatenda ophatikizika, magwiridwe antchito a impso ndi chiwindi, etc.

2. Fotokozerani za sodfanilamides kwa wodwala posachedwa, dokotala atakhutira chifukwa cha kuperewera kwa chithandizo chamankhwala. Kutalika komwe kulibe-

Zakudya zamankhwala hyperglycemia amachepetsa mwayi wopambana wa sulfonamide mankhwala.

3. Odwala omwe ali ndi matenda osokoneza bongo nthawi zina amakhulupirira kuti mankhwala a sulufanilamide amachotsera kufunika kotsatira zakudya, poganiza kuti zotsatira zoyipa za zolakwika zamatumbo zimatha kuthetsedwa mosavuta piritsi limodzi la Uy-1. Izi sizabodza konse: ndikamadya osokoneza, kulipira anthu omwe ali ndi matenda osokoneza bongo omwe ali ndi sulfonylurea sangakhale okhazikika komanso osatha.

4. Mphamvu yayikulu yochepetsera shuga ya sulfanilamides ingachedwe, chifukwa chake, lingaliro lomaliza pakukhudzidwa kapena kukana kwa wodwala ku mankhwala ena ake sikuyenera kuperekedwa pasanadutse milungu iwiri kutangoyamba kumene kukhazikitsa. Kukana kupitiliza kulandira chithandizo chamankhwala koyambirira koyambirira, motengera malonjezo asanakwane ponena za kufera kwake (zomwe zimachitika kawirikawiri), ndi zopanda nzeru.

5. Odwala onse ayenera kupeza chindapusa chonse cha matenda ashuga. Palibe amene ayenera kukhala wokhutira ndi zosokoneza za kagayidwe kachakudya, monga zimachitidwira muzochita zapaulendo. Ngati monotherapy yokhala ndi kukonzekera kulikonse kwa sulfonylurea sikuperekera chindalama chonse, ndiye kuti ena omwe ali ndi vuto lalikulu la hypoglycemic ayenera kuyesedwa nthawi yomweyo.

Kuperewera kwa mankhwalawa ndi chisonyezo cha kusintha kwa mankhwalawa ophatikizira mankhwala (sulfonamides ndi biguanides, sulfonamides ndi insulin), insulin.

Njira yomweyo imalimbikitsidwa kuti ikulitseni kwachiwiri kwa sulfonamide, ngakhale odwala oterewa, chifukwa chosafuna kusinthana ndi insulin, nthawi zambiri amapitiliza kumwa mankhwala omwe akhala osagwira ntchito kwa zaka zambiri. Kukhala pakubowoleza ndalama kwanthawi yayitali (ngakhale hyperglycemia ili yocheperapo), amalipira ndikulimbikira kwa matenda ashuga a shuga. Tiyenera kudziwa kuti kusamutsa kwa wodwalayo jakisoni wa insulin nthawi zina kumakuthandizani kuti mubwezeretsenso chidwi cha sulfonamides.

Ngati chindapusa chodalirika cha matenda ashuga chitha kupezeka pogwiritsa ntchito Mlingo wa insulin osapitilira mayunitsi 3040, ndiye kudzera 3—4 miyezi mungayesenso kubwerera ku sulfonamide mankhwala.

Hypoglycemic zotsatira za zotumphukira za guanidine zimadziwika ngakhale asanapezeke insulin ndi Watanabe, 1918. Komabe, kuyesera kuzigwiritsa ntchito pochiza matenda osokoneza bongo sikunathandize chifukwa cha kuwopsa kwa mankhwala omwe amagwiritsidwa ntchito a diguanide mfululizo (syntalin A ndi B). Kungoyambira 1957, pamene phenethyl biguanide idapangidwa koyamba, kenako dimethyl biguanide ndi butyl biguanide, kukhazikitsidwa kwa gululi la mankhwalawa kukhala machitidwe azachipatala kunayamba.

Makina a zochita za greatuanides sakudziwika bwinobwino. Zinakhazikitsidwa kuti ma biguanides, monga zotumphukira za sulfonylurea, amakhala ndi vuto la hypoglycemic pokhapokha ngati pali insulin kapena exo native insulin m'thupi. Komabe, mosiyana ndi sulfonamides, zida za beta-cell za kapamba siziwonetsero zakuchita kwawo: sizikhudza kubisika ndi kutulutsidwa kwa insulin.

Biguanides amatha kukhala ndi insulin, kukulitsa kupezeka kwa minyewa yam'mimba minofu ya glucose, kuyendetsa kayendedwe kake mu cell, kutengera kukhalapo kwa insulin. Chifukwa choletsa kuyamwa kwa shuga ndi ma guru m'magawo am'mimba, komanso kukondoweza kwa lipolysis, kufunika kowonjezereka kwa insulin ndi kapamba kumachepa. Zotsatira zake, hyperinsulinemia yoyambirira ya wodwala NIDDM wodwala imachepetsedwa. Chifukwa chake, kuchepa kwa insulin-synthesizing ndi insulin-kumasula zochitika za ma islet maselo kumawonjezera kumangiriza kwa insulin kwa ma receptor, ngakhale kuchuluka kwa zolandilira pamenepa zikuchulukira kwambiri poyerekeza ndi mankhwala a sulfanilamide M. Balabolkin et al., 1983. Malinga ndi ofufuza ena, biguanides onjezani kuchuluka kwa insulin zolandilira mu zotumphukira, osasinthika kwambiri mulingo wa insulinemia Trischitta et al., 1983. Monga momwe Lord et al. (1983), motsogozedwa ndi metformin, chiwerengero chokha cha ma receptor omwe ali ndi mgwirizano wotsika kuti insulin iwonjezeke.

Biguanides amaletsa kukhathamiritsa kwa glucose, kolimbikitsa anaerobic glycolysis, komwe kumapangitsa kudzikundika mu minyewa ndi magazi ochulukitsa a pyruvic acid makamaka lactic acid. Nthawi yomweyo, gluconeogenesis mu chiwindi ndi minofu imaletseka, kuwonjezera, malinga ndi deta ina,

Zambiri phenethylbiguanide zimalepheretsa kupanga kwa glucose makamaka kuchokera ku alanine ndi glutamic acid, ndi dimethylbiguanide kuchokera ku lactate ndi pyruvate. Biguanides amalimbikitsa glycogenization a chiwindi, kuchepetsa glycogenolysis, komanso kupewa mafuta hepatocyte kulowa.

Mtengo wina pakuzindikira kwa zotsatira za hypoglycemic wa biguanides umaperekedwa mwa kuthekera kwawo koteteza khungu, komanso amino acid ndi mafuta acids m'matumbo.

Zotsatira za biguanides pa metabolism yamafuta ndizosiyana kwambiri ndi zochita za insulin pa izo. Amaletsa lipogenesis, yomwe imawonetsedwa ndi kuchepa kwa kaphatikizidwe wamafuta acid, cholesterol, triglycerides ndi beta-lipoproteins.Amakhulupirira kuti zotsatira za antilipidogenic za biguanides zimaphatikizidwa molunjika ndi lipolytic. Ndikofunikira kuti, pamodzi ndi izi, Biguanides akhale ndi katundu wa anorexigenic.

Kuphatikizidwa kwa zotsatira za antilipidogenic ndi lipolytic ndi kukakamiza kwa mayamwidwe am'magazi ndi mafuta achilengedwe m'matumbo, kuchepa kwa hyperinsulinemia mu odwala omwe ali ndi matenda osokoneza bongo, komanso kuchepa kwawo pakudya kumakhala kopindulitsa kwambiri. Biguanides amathandizira kuchepetsa thupi, kubwezeretsa chidwi cha zotumphukira zama insulin.

Biguanides amachita mapuloteni a anabolic, amalimbikitsa kayendedwe ka amino acid mu cell ndi kapangidwe ka mapuloteni kuchokera kwa iwo motsogozedwa ndi insulin.

Mwa zina zopindulitsa za biguanidotherapy, kutsegula kwa fibrinolysis kuyenera kuzindikirika, komwe, kuphatikiza ndi matenda a shuga a lipid metabolism, ndikofunikira kwambiri mwa anthu omwe ali ndi matenda a mtima.

Ndizosangalatsa kuti Biguanides amawonetsa kuchepa kwa shuga kokha mwa odwala omwe ali ndi matenda ashuga, ndipo mwa anthu athanzi amachepetsa glycemia kokha ndi nthawi yayitali yanjala.

Zisonyezo za biguanidotherapy. Biguanides amagwiritsidwa ntchito pochiza NIDDM, yonse monga monotherapy komanso kuphatikiza ndi sulfonamides ndi insulin.

Zingatheke bwanji amatsatira njira zomwe akuwonetsa kuti ndi ma biguanides, pakuchepetsa kwawo shuga ndizomveka kuwerengetsa ndi NIDDM ndi insulin yopanga insulin, makamaka pamene matenda ashuga aphatikizidwa ndi kunenepa Direct chisonyezo cha monotherapy

biguanides ndi NIDDM yolimbitsa thupi (onenepa kuposa 120% yabwino kapena kupitirirapo) popanda chizolowezi cha ketoacidosis. Biguanides amathandizidwanso kuti azikhala ndi shuga wambiri, makamaka ngati chithandizo cha zakudya sichitha hyperlipidemia. Olemba ena amagwiritsa ntchito ma gluuanides okhala ndi vuto la kusokonekera kwa shuga (matenda am'mbuyomo, malingana ndi mawu akale) mwa akulu ndi ana, poganiza kuti ndizotheka kuteteza chitukuko cha matenda ashuga Vasyukova EA, Kasatkina EP, 1975, Baranov V. G. , 1977 Komabe, kuchokera pamalingaliro a ofufuza ena A. Efimov et al., 1983, chithandizo ndi biguanides pankhaniyi ilibe phindu lililonse lotsimikizika pazamankhwala. Tikugawana malingaliro awa.

Chizindikiro chotsatira chogwiritsa ntchito biguanides ndichofunikira kapena kukhazikitsa kwachiwiri kwa sulfonamide, komanso kusalolera kukonzekera sulfonylurea.

Kuphatikiza ndi sulfanilamides ndi insulin kukonzekera, ma biguanides amagwiritsidwa ntchito nthawi zambiri kuposa momwe amapangidwira monotherapy. Sulfanilamides amawonjezeredwa ku biguanides (kapena mosemphanitsa) mwa odwala NIDDM, ngati monotherapy yokhala ndi mankhwala amodzi kapena gulu lina silipira chipukuta misozi kapena chifukwa chachikulu kwambiri. Kuphatikiza mankhwala kumapangitsa kuti muzochitika zotere mukhale ochepa Mlingo wocheperako omwe samayambitsa mavuto. Kuti mupeze kuphatikiza kwa Biguanides, sulfonamides ndi insulin omwe amadalira shuga omwe amadalira insulin, onani p. 160

Biguanides mwamtheradi zotsutsana ndi ketoacidosis, chikomokere ndi precomatose zikhalidwe za matenda ashuga, pakati ndi mkaka wa m`mawere, matenda pachimake ndi kuchulukitsa matenda opatsirana otupa ndi kutupa, pachimake opaleshoni matenda.

Ndi kuwonjezeka kwa chiwindi, biguanides ikhoza kulembedwa ngati izi zikuwonetsa matenda a chiwindi. hepatitis wolimba amagwiritsidwa ntchito mosamala, ndipo chifukwa cha matenda oopsa a hepatitis ndibwino kuti musawaletse

Zowopsa za impso ndi hematopoietic ntchito m'mafupa, mosiyana ndi zotumphukira zake

Biguanide sulfonylureas satero.Komabe, m'matenda a impso zomwe zimatsogolera kuchepa kwa kusefukira kwa glomerular, ndipo makamaka kuti asunge poizoni wa nayitrogeni komanso kuchepa magazi kwambiri, amatsutsana chifukwa cha vuto la lactacidemia (onani pansipa). Kuwopseza kwa lactic acidosis kumalumikizidwa ndi kuletsa kugwiritsa ntchito mankhwala am'magazi pazinthu zina zambiri zamatenda - matenda a mtima, omwe amachititsa kuti magazi azitha kuchepa kapena kuchepa kwa ziwalo zina. Kusintha kwa khungu), matenda oyamba ndi kupuma kapena kupuma kwamphamvu. Pazifukwa zomwezi, sizikulimbikitsidwa kupatsa biguanides kwa odwala omwe ali ndi zaka zopitilira 60, anthu omwe amagwira ntchito zolimbitsa thupi, amamwa mowa.Mankhwala angapo amadziwika, kugwiritsa ntchito komwe, akagwiritsidwa ntchito ndi biguanides, kumakulitsa chizolowezi cha lactic acidosis. Awa ndi ma salicylates, ma antihistamines, barbiturates, fructose, teturams.

Zotsatira zoyipa ndi zovuta. Zotsatira zoyipa kwambiri za biguanides ndi dyspepsia, zomwe nthawi zambiri zimayamba ndi kulawa kwazitsulo mkamwa, kugwedezeka, kupweteka. m'mimba. Imatha kupita patsogolo, kutsogoza kusanza mobwerezabwereza, kutsegula m'mimba, asthenia ya wodwala. Gysrointestinal dyspepsia imachitika atasiya kumwa mankhwalawa, pambuyo pake zimatha kupitiliza kulandira chithandizo chamankhwala ochepa kapena pogawa tsiku lililonse mu Mlingo wa 2-3.

Biguanides si mankhwala allergenic kwambiri, koma zimachitika pakhungu. Hypoglycemia pochizira ndi biguanides ndi osowa kwambiri, monga lamulo, akaphatikizidwa ndi sulfonamides kapena insulin.

Ngati monotherapy yokhala ndi biguanides mwa odwala onenepa omwe ali ndi NIDDM, omwe nthawi yomweyo amalandila chakudya chochepa mphamvu, ketoacidosis imatha kuchitika, nthawi zambiri popanda hyperglycemia yofunika. Amakhulupirira kuti iyi ndi yotchedwa ketosis yanjala, yomwe imalumikizidwa ndi lipolysis komanso kusowa kwa chakudya mu chakudya. Poterepa, kuchuluka kwa zakudya zophatikiza chakudya mu chakudya kumachotsa acetonuria. Ngati ketoacidosis wapezeka mwa wodwala amalandira ndi biguanides nthawi yomweyo ndi insulin, ndiye ichi ndichizindikiro cha insulin yokwanira. Mwa kuletsa biguanides ndikuwonjezera milingo yamagawo ochepa omwe amaperekedwa

insulin yosavuta, ndikofunikira kukwaniritsa kulipira kosalekeza kwa kusokonezeka kwa metabolic ndi kuthetseratu kwathunthu kwa ketosis.

Mavuto osowa kwa nthawi yayitali biguanidotherapy amaphatikizanso kuchepa kwa magazi m'thupi mwa Biz-folic folic acid chifukwa cha kufinya kwamatumbo a vitamini Bi2 ndi folic acid

Chovuta kwambiri komanso chowopsa chogwiritsa ntchito ma biguanides ndiko kudzikundikira kwa lactic acid m'mwazi ndi minyewa ndi kukhazikitsidwa kwa lactic acidosis, koyamba kufotokozedwa ndi Walker, Lintin mu 1959. Izi zimapangitsa kugwiritsidwa ntchito kwa maagigine, kukakamiza ofufuza ambiri kuchepetsa malingaliro awo pazolinga zawo mopitilira apo.

Chithunzi cha chipatala cha lactic acidosis chiribe zizindikiro za pathognomonic, kuzindikira kwake koyambirira kumakhala kovuta ndipo kumafuna kutsimikiziridwa kwa Laborator-kuphunzira zomwe zili lactic acid m'magazi, zomwe, mwatsoka, zimapezeka kokha kuzipatala zachilendo. Milandu yayikulu, vutoli limatha kubweretsa lactacidemic coma (onani mutu 7) ndi kufa kwa 50%.

Kuchepetsa kwa matenda ashuga kumayendera limodzi ndi kuwonjezeka kwa seramu lactate. Malinga ndi kuchuluka kwa G. G. Baranov ndi E. G. Gasparyan (1984), kuchuluka kwa lactic acid kumachulukitsa mochulukirapo kuposa momwe shuga ilili pamlingo wa 8.25 mmol / l, ndikuwonjezereka kwa glycemia, lactacidemia imakulanso. Ndikubwezeretsanso kwa chipukuta cha carbohydrate metabolism, zomwe zili lactate ndizofanana.(1985) mu theka la odwala omwe ali ndi glycemia wokhutiritsa ndi glucosuria adapeza zomwe zili ndi lactate. Kukondoweza kwa anaerobic glycolysis ndi biguanides ngati insulin ikuperewera kumakulitsa chiopsezo chokhala ndi lactic acid ambiri. Biguanides ndi owopsa makamaka kwa odwala omwe matenda ashuga amaphatikizidwa ndi zina zomwe zimapangitsa kukulitsa maphunziro kapena kuchedwa kugwiritsa ntchito lactate

Chifukwa chowopsa chodzikundikira lactic acid, G. Baranov ndi E. G. Gasparyan (1984) amaika malire a matenda a greatuanide monotherapy pokhapokha ngati ali ndi shuga yovuta kwambiri komanso yaposachedwa, komanso ngakhale ndi shuga wambiri, amawona kuti ndiofunikira kuphatikiza mankhwala a Biguanides ndi mankhwala a sulfonylurea. Kuphatikiza apo, ikani

ndi shuga wowola, amaonedwa ngati olondola pokhapokha kusala glycemia kutsika kuposa 8.25 mmol / L. Ngati idapitilira mulingo uwu, ndiye kuti ndibwino kuti mupeze chipukuta misozi pogwiritsa ntchito mitundu ina ya mankhwala ndipo pokhapokha ndi pomwe ingasinthidwe ndi Biguanides kapena kuwonjezera biguanides kapena sulfa

nilamides, kapena insulin.

Kukonzekera kwa Biguanide. Pakadali pano, Biguanides a magulu awiri, osiyana mu kapangidwe ka mankhwala, amagwiritsidwa ntchito (Gome 10). Mankhwala a gulu lachitatu phenethylbiguanide (ma syonyms a phenformin, dibotin), omwe amagwiritsidwa ntchito kale, monga momwe zinanenedwera, ali ndi kuthekera kwambiri kolimbikitsa mapangidwe a lactate pakati pa biguanides. M'zaka zaposachedwa, zachotsedwa ntchito.

Glibutide (1-Butyl Biguanide Hydrochloride). Kukhazikika kwa mankhwala 1 / 2-1 mawola pambuyo makonzedwe, nthawi ya yogwira hypoglycemic ndi maola 6-8. Tsiku tsiku lililonse la magawo awiri kapena atatu. Pofuna kupewa zovuta, yambani kulandira mankhwala piritsi limodzi m'mawa kapena mapiritsi awiri mukatha kudya chakudya cham'mawa komanso chakudya chamadzulo. Glibutide iyenera kumwa kumapeto kwa chakudya kapena mukatha kudya, kutsukidwa ndi madzi, osamwetsa mapiritsi. Olemba ena amalemba kuti adye mphindi 30 mpaka 40 asanadye kuti athandizire anorexigenic. Mothandizidwa ndi glycemia ndi glucosuria, mlingo wa glibutide umachulukitsidwa ndi piritsi limodzi pakapita masiku atatu aliwonse. Mulingo waukulu kwa nthawi yochepa ndi mapiritsi a 5-6. Mphamvu ya mankhwalawa imatha kuyesedwa modalirika pakatha masiku 10 mpaka 14 itayamba kugwiritsa ntchito. Mlingo wokonza suyenera kupitilira mapiritsi awiri ndi atatu. Ngati zingakhale zokwanira kulipira matenda ashuga, ndiye kuti muyenera kusinthira ku regimen yina ya mankhwalawa (kulowetsedwa kwa biguanides ndi sulfanilamides kapena kuphatikiza zonsezi). Ndi kuphatikiza kwa insulin ndi adebit, mlingo wotsirizira ndi mapiritsi 1-2.

Njira ina yothandizira imakhudzanso kupezeka kwa mapiritsi 2-3 kuyambira pachiyambipo. Ngati ndi kotheka, mlingo umachepetsedwa.

Glibutide imapangidwa ku USSR, adigit yake ya analogue imapangidwa ku Hungary m'mapiritsi a 0,05 g, mapiritsi 50 mu phukusi.

Buformin retard (mawu ofanana ndi silubin retard) ndimakonzedwe okhalitsa 1-butylbiguanide hydrochloride. Kukhazikika kwa kanthu pambuyo maola 2-3, nthawi ya maola 14-16, mogwirizana ndi momwe mankhwala amalembedwera piritsi 1 mpaka 1-2 patsiku. Kutalika kwa kutsitsa kwa shuga kumachitika ndi kuphatikiza pang'onopang'ono mankhwala

m'matumbo. Biguanides okhazikika osakhazikika amalephera kuyambitsa dyspepsia ndipo amavomerezedwa bwino ndi odwala kuposa mankhwala omwe amangotsatira.

Mankhwala amapezeka mu GDR m'mapiritsi a 0.17 g, phukusi la mapiritsi 50.

Glyph Ormin - 1,1-Dimethyl Biguanide Hydrochloride. Kuyambika kwa Ug-1 h pambuyo pa kukhazikitsa, kutalika kwa maola 6-8. Chithandizo chimayamba ndi gawo limodzi la mapiritsi awiri m'mawa musanadye kapena mutangomaliza kudya. M'tsogolomu, mlingo umakulitsidwa pang'onopang'ono mpaka mapiritsi 2-3 katatu patsiku. Mphamvu ya hypoglycemic kwathunthu imawonetsedwa m'masiku 10-14. Kukonzekera mlingo 1-2 mapiritsi 2-3 patsiku.

Amapangidwa ku USSR mapiritsi a 0,25 g, phukusi la mapiritsi 50.

Dformin retard - 1,1-Dimethylbiguanide hydrochloride. Monga mankhwala a butylbigua-nida omwe amakhala nthawi yayitali, mphamvu ya hypoglycemic imayamba pambuyo pa maola awiri awiri ndipo imathaatha mawola 14-16 mutatha kutsata. Yambani chithandizo ndi piritsi limodzi m'mawa, kumwa kapena mutadya. Ngati ndi kotheka, onjezani mlingo wa piritsi limodzi lililonse 3—4 cha tsikulo. Mulingo waukulu womwe umaperekedwa kwa nthawi yochepa, mapiritsi atatu. Njira yokonza - piritsi limodzi (m'mawa) kapena 2 pakudya yam'mawa komanso chakudya chamadzulo. Mphamvu ya mankhwalawa imawunikira pambuyo pa masiku 10-14 a mankhwala.

Ndi kuphatikiza kwa diformin retard ndi kukonzekera kwa insulin, mlingo wake wa tsiku ndi tsiku ndi mapiritsi 1-2. Ngati wodwala amalandira mapiritsi a insulin 40 kapena kuchepera, ndiye kuti mlingo wake umayamba kuchepetsedwa kuchokera tsiku loyamba ndi 2 PESCES tsiku lina lililonse. Ndi mlingo wa insulin wa tsiku ndi tsiku wopitilira 40 PISCES, poika khungu la diformin, mlingo wake umachepetsedwa nthawi yomweyo ndi 1 / 3-1 / 2, ndipo pambuyo pake, ngati zingatheke, umapitilizidwa kuchepetsedwa ndi 2-4 PIECES tsiku lina lililonse Perelygin-A. et al., 1984.

Zimapangidwa ku Finland m'mapiritsi a 0,5 g, mapiritsi 100 pa paketi iliyonse.

Mankhwala a insulin amadziwika kuti akutsimikiziridwa mosamala. Nthawi zina, tikulankhula zakusintha kwakanthawi kothandizidwa ndi insulin, ndikutsatira njira yakale, mwa ena - insulin monotherapy kapena mankhwala osakanikirana ndi omwe amaperekedwa

insulin yokhala ndi makamwa a hypoglycemic wothandizira. Ndi chithandizo cha insulin, malangizo onse azakudya ndi zoletsa zokhudzana ndi odwala omwe ali ndi NIDDM amakhalabe oyenera.

Zizindikiro. Chizindikiro chokwanira komanso chofunikira kwambiri poika insulin, monga IDDM, ndi matenda ashuga a ketoacidosis, kukula kwa ketoacidemic, hyper-rosmolar ndi hyperlactacidemic precoma ndi chikomokere. Insulin imalembedwa kwa azimayi onse oyembekezera omwe ali ndi matenda ashuga, ngakhale ngati kufunikira kwawo kwa insulin kuli kochepa kwambiri, komanso nthawi yonse yoyamwitsa.

M'pofunika kutembenukira ku insulin chithandizo mukamwa mankhwala a hypoglycemic omwe akupangika wodwala: ndi chifuwa kwa iwo, kuwonongeka kwambiri kwa chiwindi ndi impso, cytopenic zinthu. Mankhwala a insulin ndi njira yosankhira zovuta zamatenda a shuga: gawo lachitatu retinopathy, nephroangiopathy yokhala ndi vuto laimpso, kupweteka kwamitsempha yamagazi, kuchepa kwa mitsempha ya minyewa yam'munsi yotupa komanso kusintha kwa khungu.

Kusintha kwakanthawi kantchito ya insulini ndikofunikira kwa matenda owopsa a chifuwa chachikulu (fuluwenza, chibayo, chimbudzi cha chakudya, etc.), kuchuluka kwa matenda oyamba ndi matenda a pyelonephritis, cholecystitis, ndi ena otero. Nthawi zina ndikofunikira kupereka insulini kwakanthawi chifukwa cha matenda osapatsirana (myocardial infarction, pachimake cerebrovascular ngozi) ngati atayambitsa kuwonongeka kwa matenda ashuga.

Mankhwala a insulin amasonyezedwa kwa odwala omwe ali ndi kukana kwakukulu kwa sulfonamides, omwe amapanga 15-20% ya anthu omwe angopezeka kumene NIDDM Boden, 1985, ngati m'malo mwa sulfonylureas ndi biguanides sikuthandiza. Asanapange chigamulo pa zakusagwirizana kwenikweni kwa zotumphukira za sulfonylurea, ndikofunikira kuonetsetsa kuti odwala amatsatira malangizo a zakudya, komanso ngati palibe chifukwa chilichonse chomwe chimathandizira kuwonongeka kwa matenda ashuga (latent pyelonephritis, suppurative otitis media, sinusitis, etc.).

Monga tanena kale, odwala omwe amathandizidwa kwa nthawi yayitali ndi kukonzekera kwa sulfonylurea, amakumana nawo.

Mankhwalawa amathandizira odwala, monga kuzindikira kwa sulufilamides kumachepa, ndikofunikira kusintha m'malo mwa mankhwala omwe amachepetsa shuga ndi omwe amagwira ntchito, kuphatikiza kwa sulufilideside ndi biguanides. Ngati mulingo wovomerezeka wa sulfonamides (kapena kuphatikiza kwawo ndi biguanides) munthawi yovomerezeka yopeza chakudya popanda matenda ndi zina zovuta zomwe zimapangitsa kusiya kupereka chindapusa cha matenda ashuga, ndiye kuti wodwalayo ndi mankhwala a insulin.Panthawi imeneyi, sikulakwa kusiya anthu ogwiritsa ntchito pakamwa nthawi zonse, makamaka kwa anthu onenepa kwambiri omwe amafunikira kuchuluka kwa insulini ndi zotsatirapo zake zonse. Mwa odwala ena, kuchuluka kwa insulini kofunikira kuti mukwaniritse chindapusa cha shuga kuyenera kuwonjezeredwa kwa kalendala ya mankhwala. Monga kafukufuku wapadera wasonyeza, nthawi zotere, kuchuluka kwa insulin ndi C-peptide m'magazi ndikwabwinobwino, koma kuchuluka kwa maselo a beta a islet pancreatic zida kumachepetsedwa. Odwala awa amatchedwa "insulin-subtype" yofunika ya NIDDM Balabolkin M. I., 1986.

Sitinganene kuti kukondwerera kwachiwiri kwa sulufanamu kumakhala koopsa. Nthawi zina, zimatengera kuchepa kwa insulin. Mwa odwala, pali kuchepa kwapang'onopang'ono pazomwe C-peptide ili m'magazi, ma antibodies kuti islet pamwamba antigen ndi cytoplasm akatsimikiza, matendawa amatengera mawonekedwe ena a IDDM. Zikatero, ngati dokotalayo akuwona kuti kutayika konse kwa shuga kwa sulfonamides kuyenera, m'malo mwake muyenera kukonzekera insulin. Olemba amakono a Rendell, 1983, Hsieh et al., 1984 amalimbikitsa kuti, pakuchotsa chithandizo cha insulin pamlomo, ayenera kuyang'ana kwambiri zomwe zili C-peptide m'magazi, ngati zingatheke. Mitundu ya insulin Therapy ndi yofanana ndi ya IDDM.

KUTHENGA KWA DIABETIC ANGIOPATHIES

Chinthu chachikulu pakuchiza komanso kupewa matenda a shuga angiopathies ndi kubwezeretsa okhazikika kwa shuga mellitus mosasamala mtundu wake wamankhwala. Choyamba, chakudya choyenera, chopatsa munthu payekha. Kusankha koyenera kwa insulin ndikofunikira kwa IDDM.

ochita zinthu zazifupi. Pankhani ya NIDDM, ngati sizingatheke kulandira chipukutamisozi ndi zakudya komanso masewera olimbitsa thupi, kugwiritsa ntchito mankhwala ochepetsa shuga a mibadwo yotsatira kumavomerezeka. Kugwiritsa ntchito kwa Biguanides kuyenera kukhala ndizowonetsa kwambiri chifukwa cha mwayi wa lactic acidosis.

Pakuwona, kuphunzitsidwa bwino kwa odwala pakudziletsa ndikofunikira kwambiri. Choyamba, uku ndi kuphunzitsa kwa odwala omwe amakhala ndi chakudya chokwanira, poganizira kuchuluka kwa mphamvu ndi chithandizo cha mankhwala a insulin komanso mkamwa a hypoglycemic. Mutha kugwiritsa ntchito metres ya chakudya chamagulu, makamaka, cholembera cha "Vation" cha Vorobyov, kutengera mzere wotsogola, kuwerengera mphamvu yamagetsi ndi kapangidwe kazakudya. Lingaliro la chakudya chamagulu koyenera siliyenera kukhala odwala kokha, komanso abale ake. Kunyumba, wodwalayo amagwiritsa ntchito chizindikiro kuti azindikire glucose (glucotest) mkodzo ndi magazi. Wodwala amayenera kutsatira zonse zomwe dokotala wamupatsa, kuti azitha kumwa molondola komanso kupereka insulin, komanso kudziwa nthawi yake yayitali kuteteza hypoglycemia ngati chinthu chofunikira kwambiri pakubwera kwa matenda a shuga.

Chofunika kwambiri ndikukhazikika kwa kulemera kwa thupi, komwe kumathandizira kulipira shuga ndipo potero kupewa matenda ashuga a shuga.

Udindo wa matenda oopsa oopsa monga chiopsezo cha matenda a shuga a shuga atsimikiziridwa, chifukwa chake kuthamanga kwa magazi ndichimodzi mwazinthu zofunika kwambiri pothandizira ndi kupewa matenda anghuopathies a matenda ashuga.

Odwala omwe ali ndi matenda ashuga sayenera kusuta, chifukwa kusuta kumathandizira kukulitsa ndi kupitilira kwa angiopathies. Ntchito ina iyenera kuchitika mwa iwo.

Mimba imatha kuyambitsa kupitirira kwa retinopathy ndi angionephropathy. Amayi omwe ali ndi matenda ashuga ayenera kuchenjezedwa kuti asatenge pakati.

Chofunikira popewa phazi la matenda ashuga ndikukhazikika kwa khungu.Iyenera kuphatikizapo kusambitsa mapazi ndi madzi ofunda tsiku ndi tsiku ndi sopo wosalowerera kenaka ndikukupukuta, makamaka m'mphepete mwa chikopa komanso m'mabedi amisomali. Odwala amaletsedwa kuyenda osavala nsapato. Ndikofunikira kupewa kuvulala, ngakhale pang'ono, kuvala nsapato zofewa: ndikosavomerezeka kugwiritsa ntchito kulowetsedwa kwa ayodini, zothetsera zowonjezera za potaziyamu permanganate, plasters ya keratolytic popanda chilolezo chapadera kuchokera kwa dokotala. Mutha kuchepetsa misomali mukatha kusamba, kupewa kudula ndi kuvulala, kupewa kuyaka ndi kutentha, osagwiritsa ntchito kutentha, osagwiritsa ntchito zinthu zakuthwa kuyeretsa malo osaneneka, kuchitira nthawi yake misomali, zotupa ndi zotupa zina zapakhungu.

vuto kuvulala, nthawi yomweyo funsani kwa dokotala, osachita nawo pawokha mankhwala a chimanga ndi chimanga.

Chofunikira popewa matenda ashuga angiopathies ndi chithandizo cha matenda opatsirana komanso matenda ophatikizika omwe amachititsa kuti matenda ashuga awonongeke.

Mukamayang'anira odwala, ndikofunikira kuwunikira zizindikiro za kupatsidwa zinthu za m'magazi ndi maselo ofiira am'magazi, zomwe zimagwirizana mwachindunji ndi chitukuko cha matenda a shuga.

Mankhwalawa angiopathies a shuga, kugwiritsa ntchito angioprotectors (ethamsilate, dicinone, dobesilate, doxium, trental, divascan, parmidin, prodectin), anabolic steroids (nerobol, retabolil, methandrostenolone, silabolil), hypocholesteroibic mankhwala nicotinic acid (nicoshpan, kutsatira, teonikol), mavitamini (ascorutin, mavitamini a B, retinol), komanso mankhwala azitsamba (ngamira yam ngamira - lagohilus, eleutherococcus, masamba a bloeberry, nettle).

Mankhwalawa ali ndi mankhwalawa, monga akuwonera ndi zomwe zidachitika mu IEEiHG wa Academy of Medical Science of the USSR, ndizothandiza kwambiri pokana mawonetsedwe ambiri azachipatala a angiopathies. Komabe, ziyenera kuchitika makamaka pakubwezeredwa kwa shuga. Kugwiritsa ntchito kwawo kumatilola kukwaniritsa osati chithunzi cha ophthalmoscopic fundus (kutsitsa edema, hemorrhage,

exudates), komanso kuwonjezeka kowoneka bwino Mazowieckiy A. G., 1983, 1984. Komabe, kugwiritsa ntchito mankhwalawa kuyenera kukhala kotenga nthawi yayitali, kumene ndikuwongolera mosamala. Ngati anthu osapitirira patsogolo a matenda ashuga retinopathy amaphatikizidwa ndi retinal edema kapena okhwima komanso akuchulukira pang'onopang'ono, ndiye kuti titha kuganiza za zisonyezo za Photocoagulation.

Pogwiritsa ntchito njira yowonjezereka komanso yowonjezera prinositive retinopathy, kugwiritsa ntchito njira yodziwika bwino kwambiri imagwiritsidwa ntchito kwambiri ndipo, malinga ndi ofufuza ena, ili njira yokhayo yothandizira. Zisonyezero za laser Photocoagulation (nthawi zambiri amagwiritsidwa ntchito pagaloni ya xonon kapena xenon): 1) kuchepa kwamitsempha kapena kuchepa kwamitsempha yama cell ku disc ya optic disc, 2) kuchepa kwamphamvu kapena kuvuta kwamphamvu m'malo ena a retina ogwirizana ndi preretinal hemorrhages kapena vitreous hemorrhages, 3) vascularization zolimbitsa optic nerve disc ndi vitreous hemorrhage kapena preretinal hemorrhage. Komabe, kuwala kwa laser kungathenso kuchitika ngati pakufunika kuchedwetsa kupititsa patsogolo kwa matenda ashuga retinopathy, nthawi zambiri pamlingo wa prerolopative retinopathy. Komabe, nthawi zina, kukhazikitsa kwake kumalangizidwanso koyambirira. Chofunikira kwa laser Photocoagulation ndi fluorescence angiography, yomwe imalola kudziwa zovuta zam'mimba mu retina, momwe zimakhalira ndi zovuta. Fluorescence angiography ya retina imakhazikitsa oyambirira kusintha kwa minyewa ya retina motero imatsimikizira mawonekedwe a laser Photocoagulation.

Mwaukadaulo wa laser m'zaka zaposachedwa, panretinal Photocoagulation Esperance, 1978, komanso Photocoagulation yam'deralo kapena yozungulira, yakhala ikugwiritsidwa ntchito nthawi zambiri.Mitundu yonse ya lasers yomwe imagwiritsidwa ntchito imayambitsa kuyaka pamlingo wa epinal pigment epithelium ndikuwonongeka kwa retina komanso gawo la membrane wa choroidal m'deralo. Poyamba, tsamba loyaka limawoneka ngati doti loyera, patatha milungu ingapo limasamba. Nthawi zambiri, pali kusintha kwamitsempha yamagazi ndikusintha kwa magazi kupita ku retina. Zotsatira zoyipa za Photocoagulation mukamagwiritsa ntchito njira ya panretinal ndikuchepa kwa mawonekedwe owoneka ndi kuchepa kwachiwiri kwa masomphenya ausiku chifukwa cha kuwonongeka kwa zotumphukira za photoreceptors. Zotsatira izi sizitchulidwa pang'ono mukamagwiritsa ntchito lason laser.

Mu vitreous hemorrhages ndi retinal detachment, vitlimomy yakhala ikugwiritsidwa ntchito m'zaka zaposachedwa, zomwe zimagwiritsidwa ntchito pochotsa thupi la vitreous ndikusintha ndi isotonic sodium chloride solution. Zisonyezero za vitibleomy zikukuyendetsa thupi la vitreous chifukwa cha kukoka kwa magazi m'magazi onse awiri, kutsika kwamatumbo tambiri chifukwa cha kukha magazi m'diso limodzi ndi kuchepa kwakukulu kwa kuwona kwamphamvu m'mbali inayo, kufinya kwamkati mobwereza thupi. Zochitika pa ntchito ngati izi zikuwonetsa kuthekera kokukulira kowonekera, koma ndikofunikira kuphunzira zotsatira zazitali.

Chithandizo cha matenda ashuga angionephropathy chimadaliranso pamalipiro a matenda ashuga. Ndikofunika kusunga chilipiritso chokhazikika nthawi zonse za matenda ashuga. Gawo la nephrotic lili ndi zinthu zomwe zimakhudzana ndi kuchuluka kwa chidwi cha insulin. Pali kuchepa kwa shuga wamagazi, kuchepa kwa kufunika kwa insulin. Ichi ndi chifukwa cha kuchepa kwa kuwonongeka kwa insulin mu impso, kuchepa kwa mapangidwe a shuga mu chiwindi. Kwa nthawi yoyamba kusintha koteroko mu chakudya kwa carbohydrate kufotokozedwa ndi Zubrod (Zubrod-Dan phenomenon). Nthawi yomweyo, munthawi ya odwala omwe ali ndi matenda a shuga omwe ali ndi vuto la Zubrod-Dan, insulin siyenera kuchoka kwathunthu. Zikatero, insulin imayikidwa mu tizigawo, kaŵirikaŵiri mankhwala osakhalitsa.

Chofunikira pakuthandizira matenda a shuga ndi nephropathy ndi zakudya. M'mbuyomu chikadakhala chizolowezi kuchepetsa kuchuluka kwa mapuloteni muzakudya za odwala omwe ali ndi matenda ashuga nephropathy pomwe akukhalabe ndi mphamvu yokwanira ya chakudya. Chifukwa chake, akatswiri a matenda ashuga aku America adawona kuti ndikofunikira kuti achepetse zomwe zili mu 30-50 g / tsiku. Nthawi yomweyo, adalimbikitsidwa kuchepetsa kuyambitsa kwamadzimadzi mpaka 1200-1500 ml / tsiku. Kuletsedwa kwa mapuloteni kumadalira kuti kutembenuka kwa 1 g mapuloteni kumawonjezera kuchuluka kwa magazi ndi 0,3 g .Mapuloteni osachepera pomwe wamkulu amatha kukhalabe woyambira kagayidwe ka metabolism ndipo kuyika kwake m'magazi kumakhalabe kwapafupi ndi 0.3 g / (kg-day), izi zikufanana ndi 21 g kwa munthu wolemera 70 kg. Komabe, kuchepa kwa mapuloteni ndi proteinuria yosatha kumabweretsa Hypoalbuminemia ndi kuchepa kwa mapuloteni, ndipo kuperewera kwa magazi komwe kumapezeka kumapezekanso. Pankhaniyi, kuletsa mapuloteni kuyenera kuganiziridwanso

mosamala. Kuletsedwa kwa mapuloteni sikofunikira ngati urea wamagazi sikukwera kuposa 25 mmol / L (150 mg%). Tiyeneranso kudziwa kuti ndi protein sodium chloride imalowa m'thupi la wodwalayo. Chifukwa chakuti mukudya kwa wodwala nthawi yoyamba ya nephrotic ndi nephropathy ya matenda ashuga sayenera kupitirira 2 g ya sodium chloride patsiku, kuletsa mapuloteni kumlingo wina kumatanthauzanso kuletsa mchere. Chithandizo cha edema chimachitika osati pochepetsa mchere ndi mapuloteni, komanso pogwiritsa ntchito diuretics (furosemide, ethacosterone acid kukonzekera, brinaldix). Mlingo wawukulu wa okodzetsa samakonda kugwiritsidwa ntchito, amangokhala ndi edema yolimba. Kutupa kwa sodium mu mkodzo kumatha kukhala chisonyezo cha mphamvu ya saluretics ndi kukonza kotheka kwawo.Furosemide nthawi zambiri zotchulidwa muyezo wa 40 mg 2-3 kawiri pa tsiku mpaka 500 mg 2 kawiri pa tsiku ndi zosagwira edema motsogozedwa ndi exretion wa sodium mu mkodzo. Nthawi zambiri muyenera kusintha mankhwala osokoneza bongo. Pamodzi ndi okodzetsa, ma infusions ndi ma decoctions a mankhwala azitsamba amagwiritsidwa ntchito (bearberry, zipatso za juniper, munda wamahatchi, orthosiphon, masamba a lingonberry). Ndibwinonso kugwiritsa ntchito mankhwala a lespinephril, omwe amapezeka kuchokera ku zimayambira ndi masamba a chomera chamiyendo cha caprate lesdesa ndipo amapangidwa mwa njira yothetsera vuto la mowa kapena la lyophilized for jekeseni. Amapereka diuretic kwambiri, komanso, amachepetsa azotemia.

Chithandizo cha ochepa matenda oopsa imagwiridwa pogwiritsa ntchito mankhwala amakono a antihypertensive. Chithandizo cha matenda oopsa chikuwonetsedwa kwa kuthamanga kwa magazi kwa diastolic pamtunda wa 95 mm Hg. Art. ndi systolic pamtunda wa 160 mm Hg. Art.

Ndikupangizanso kugwiritsa ntchito angioprotectors (trental, prodectics, dicinone, doxium). Nthawi zina, amasintha nitrogenin ndi mpweya wotsalira, amachepetsa proteinuria. Odwala omwe ali ndi matenda ashuga a nephropathy, makamaka pa nthawi ya pre-nephrotic ndi nephrotic, nthawi zambiri amakhala ndi vuto la mtima, motero kugwiritsa ntchito mtima glycosides ndikofunikira.

Pankhani ya kuchepa magazi, kukonzekera chitsulo, kuthiridwa magazi kapena maselo ofiira amasonyezedwa. Munthawi zonse, ndikofunikira kupatsa mavitamini.

Chithandizo cha matenda a shuga a nephropathy ayenera kukhala ochulukirapo ndipo amafunika kumvetsetsa bwino zomwe wodwalayo ali nazo kuchokera kwa dokotala.

Kugwiritsa ntchito mankhwala amkamwa hypoglycemic (kupatulapo glurenorm, komwe kumachitika kudzera m'matumbo

nick) imatsutsana chifukwa cha kuthekera kwawo ndikukula kwa hypoglycemia yayikulu.

Panthawi ya kulephera kwa chithandizo cha mankhwala ndikuwonjezeka kwa aimpso, odwala amapita padera. Kuphatikizika kwa impso kwa odwala omwe ali ndi matenda ashuga nephropathy amakhudzana ndi zovuta zambiri. Nthawi yayitali yomwe odwala amakhala ndi impso yowazidwa imasiyanasiyana, malinga ndi zipatala zingapo zakunja, kuyambira miyezi isanu ndi umodzi mpaka itatu. Komabe, kukulira kwa dialysis ndi njira zolerera ndikupitilizabe ndipo kumapereka chiyembekezo chakuchita bwino.

Pazizindikiro

Pankhani yokhudza kumvetsetsa bwino kwamatenda aliwonse, pali chizindikiritso chodziwika bwino cha zonse zomwe zimadziwika. Izi zimapangitsa kuti pasakhale poyambira kuletsa matenda aliwonse, makamaka matenda a shuga, komanso kumvetsetsa bwino zachilengedwe. Nanga ndi ziti zomwe ndizodziwika za matenda amtundu 1, omwe amasiyana pakudalira kwa insulin ndipo kodi mapeyala angathandize?

Zizindikiro izi ndi izi:

• kumva kuwuma mkamwa ndi ludzu,
• polyuria yayikulu komanso kuchepa kwa cholozera cha thupi,
• kufooka ndi kuchepa mphamvu yogwira ntchito,
• kulakalaka
• kuyabwa pakhungu ndi perineum, momwe mapeyala sangapulumutse.

Ena amadandaula za zizindikiro monga pyoderma ndi furunculosis. Mutu, kusokonezeka kwa tulo, kusakwiya msanga, kupweteka m'dera lamtima ndi minofu ya ng'ombe nthawi zambiri kumawonedwa. Chifukwa cha kuchepa kwa chitetezo chokwanira komanso kuthekera kuthana ndi matenda, matenda amtunduwu amakhala ndi chifuwa chachikulu, matenda opatsirana a impso ndi njira zina. Tikuyankhula za pyelitis ndi pyelonephritis. Izi zimadziwika chifukwa chakuti kuchuluka kwa glucose kumawonekera m'magazi, ndipo mkodzo, m'malo mwake, glucosuria.

Pofika nthawi yomwe matenda ashuga, omwe amadalira insulin, atadziwika, maselo ambiri am'mimba a beta sangathe kubwezeretsedwanso.

Izi ndi zizindikiro za matenda omwe aperekedwa, omwe akuwonetsa kuti matenda amtundu wa 1 shuga adayamba kale.

Amayambitsa ndi mawonekedwe a insellin wodwala matenda a shuga

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Ngakhale kukonzekera kwa insulin nthawi zina kumayeneretsedwa kwa odwala omwe ali ndi matenda a shuga a 2, madokotala amati mtundu wa 1 umadalira matenda a shuga, popeza nthendayi m'thupi imaleka kupanga yayo insulin. M'mapancreas a anthu omwe amapezeka ndi insulin yodalira matenda a shuga, kulibe maselo ena aliwonse omwe amapezeka kuti apange mahomoni aproteni awa.

Kudziwika kwa mtundu wachiwiri wa matenda ashuga a 2 kumatanthawuza kuti kapamba amatulutsa insulini, koma mwina ndizosafunikira kapena maselo amthupi alibe kuchuluka kwa mahomoni ena. Metabolism yokhala ndi matenda amtundu wa 2 shuga nthawi zambiri amathandizidwa kokha ndi chakudya ndikuchita kusankha bwino zolimbitsa thupi, ndipo insulin siyofunikira kwa odwalawo. Chifukwa chake, akukhulupirira kuti mtundu 2 wa matenda ashuga ndi shuga osadalira insulini. Ngati muyenera kupereka insulin, akuti shuga 2 yayamba kudalira insulini. Koma izi sizichitika mwa odwala onse.

Mtundu woyamba wa matenda a shuga umayamba msanga, nthawi zambiri ubwana kapena achinyamata, chifukwa chake dzina lake lina ndi "mwana". Mutha kuchiza pokhapokha pochotsa zikondamoyo kwa odwala, koma atachitapo opaleshoniyo anthu amamwa mankhwala moyo wawo wonse kuti apewe chitetezo kuti chisatheretu. Kukhazikitsa insulini ndi jakisoni kumakhala ndi zotsatira zochepa paumoyo, komanso ndi chithandizo choyenera cha insulin, odwala matenda ashuga omwe ali ndi matenda amtundu wa 1 amatha kukhala ndi moyo wathanzi.

Arthropathy ngati complication

Arthropathy mu matenda a shuga imachitika m'thupi la wodwalayo ndimomwe zimayambira matenda, zomwe zimachitika kawirikawiri zaka 25 25-30. Pokhapokha njira yothandizira matenda a shuga, matenda ashuga arthropathy amatha kukula m'thupi la wodwalayo pokhapokha zaka 5-8 atatha kufotokozera za matenda.

Ndi kuphwanya kagayidwe kazakudya, komwe ndi mnzake wa matenda ashuga, kukhathamiritsa kwa machitidwe ambiri mthupi kumayamba, kuphatikiza mafupa ndi minyewa ya m'mimba. Mafupa a mafupa amayamba kukhazikika pamaziko a acidosis komanso njira yopititsira patsogolo mchere wamchere kuchokera mthupi la munthu.

Popeza kuti arthropathy imachitika ngati mitundu yovuta kwambiri ya matenda ashuga, chithandizo chonse chamankhwala chiyenera kuyang'aniridwa mosamalitsa ndi endocrinologist. Njira zochizira zimaphatikizira onse mankhwala a insulin komanso kugwiritsa ntchito mankhwala oletsa kutupa.

Pazifukwa

Palibe chosasangalatsa komanso chofunikira ndi funso la zomwe zimapangitsa kuti matenda ashuga a mtundu wina wodwala azidalira insulin. Choyamba, kudziwiratu kwamtunduwu kuyenera kuzindikirika. Izi ndizomwe zimayambitsa dongosolo lalikulu, lomwe m'njira zambiri ndilofunikira kwambiri. Komanso, kupanga kwamtundu wamatenda kumeneku kumayendetsedwa ndi zinthu zingapo zachilengedwe.

Ndiwo omwe ali ndi chidziwitso chotsimikiza kuti mwa anthu omwe ali ndi chibadwa chakutali kwambiri, kudalira kwa mahomoni kumawonekera kwathunthu. Kuphatikiza apo, Zizindikiro zina zimawonetsa kuti zovuta zakupatsirana ndi ma virus zingakhale zoyambitsa.

Kuopsa kwa mapangidwe a shuga 1 amtundu wa ana, pamene kudwala kumeneku kwadziwika mwa wina kuchokera kubanja lamaphunziro a ubale wapachibale, ndi magawo asanu mpaka 10%. Kukhalapo kwa matenda osokoneza bongo a mellitus osagwirizana ndi insulin mwa makolo kumapangitsa mwayi wazidziwitso za odwala omwe ali ndi insulin omwe amadalira ana.

Chifukwa chake, ndibwino kunena kuti kachilombo komwe kamene kamayambitsa matenda a beta nthawi zambiri ndizomwe zimayambitsa chilengedwe. Matendawa amatenga matendawa m'njira ziwiri zotsatirazi:

1. chifukwa chakuwonongeka kochitidwa ndi kutupa kwa zisumbu mu kapamba,
2. chifukwa chakuchepetsa mayankho a chitetezo mthupi.

Chifukwa chake, ndikofunikira kulabadira zonse zomwe zimachitika kuti muthane ndi matenda amtunduwu mwachangu.

Ndi pang'onopang'ono matendawa, kuwoneka kwa ma antibodies ena kuti atulutse maselo panthawi yomwe kuchuluka kwa shuga m'magazi sikuli pamwamba pazomwe akuwonetsa kuyenera kuwonedwa ngati chizindikiro choyambirira cha kusintha.

Pambuyo pa izi, gawo lotsatira limayamba, pomwe kusintha kosiyanasiyana mwa metabolism kumawonedwa ngati kuchepa kwakukulu kwa kulolera kwa shuga, koma kuchuluka kwa shuga m'magazi kupita m'mimba yopanda kanthu kumakhalabe koyenera.

Potsatira - gawo lachitatu - mawonekedwe oopsa a hyperglycemia pamimba yopanda kanthu, koma ketosis sichinawonedwe.

Kuchokera pamalingaliro azachipatala, mawonekedwe awa ndi umboni wa matenda osokoneza bongo omwe samadalira insulin. Pambuyo pakupita nthawi yayitali mumikhalidwe yovuta, pakhoza kukhala kudalira kwa insulin ya mahomoni ndi ketoacidosis yeniyeni. Odwala ambiri omwe ali ndi matenda osokoneza bongo osadalira insulin ndi kunenepa kwambiri, gawo la matendawa lomwe silinakonzedwe limayamba. Nthawi yomweyo, ma antibodies amakumana ndi kuphwanya kubisala ngakhale cell ya beta isanawonongeke. Pofika nthawi yomwe matendawa awonekera kale, kuchuluka kwakukulu kwa ma cell omwe amapanga insulini ali kale malo owonongeka.

Chifukwa chake, magawo atatu amatha kusiyanitsidwa, zomwe zikuwonetsa kuti kupangika kwa kudalira insulin kumachitika. Ndikofunikira kudziwa kuti nthawi zambiri izi zimachitika mosiyanasiyana, chifukwa chake ndizosatheka kuzindikira kudalira kwathu kwa 100% pazinthu zilizonse komanso mawonekedwe.

About insulin mankhwala

Njira yokhayo komanso yothandiza kwambiri pakadali pano ikuyenera kuganiziridwa ngati insulin, yomwe ilinso ndi malamulo ake. Choyamba, muyenera kudziwa bwino zosowa patsiku pazowerengera zama kalori. Izi zimachitika molingana ndi kulemera kwa thupi, momwe mumafunikira kuchuluka kwa chakudya chamafuta, mafuta ndi mapuloteni. Zakudya zapadera zimapangidwira, poganizira dongosolo la ofanana ndi zakudya ndi zakudya kwa akulu, pomwe kuchepetsa kuchuluka kwa zopatsa mphamvu kudzakhala kofunikira.

Udindo wa chakudya mankhwalawa zimadalira mtundu wa matenda.

Chifukwa chake, kwa iwo omwe ali ndi matenda ashuga ndikutenga insulin, ndikofunikira kugawa zopatsa mphamvu kuti muchepetse hypoglycemia.

Mahomoniwa amafunikira onse omwe akumana ndi matenda ashuga amtundu woyamba, koma ngakhale atayambitsidwa ndi insulin yokhazikika, zimakhala zovuta kukhala ndi chiwopsezo cha shuga tsiku lonse.

Malangizo a insulin othandizira apangidwa:

• muyezo
• jakisoni wambiri pansi pakhungu,
• kulowetsedwa kosalekeza kwa insulin pansi pa khungu.

Palinso mitundu ingapo ya insulini, yomwe imasiyana mosiyanasiyana nthawi yayitali: kukhudzana mwachangu, nthawi yowonekera, nthawi yayitali. Ndikofunikira kuti ntchito yayitali isanachitike mu ndege yachilengedwe.

Pakadali pano, monga momwe masewera akuwonetsera, ambiri mwa anthu odwala matenda ashuga amatha kudziyimira pawokha pazovuta za insulin. Amadzipaka okha, akukonza zinthu. Chifukwa chake, katswiri amatenga nawo gawo pokhapokha poika ndi kuyang'anira mayendedwe a mahomoni. Komabe, nthawi zina, ngati munthu sangathe kuchita izi payekha, thandizo lina likufunika.

Kudalirika kwa matenda a shuga - mtundu woyamba wa matenda - ndizoposa vuto lalikulu lomwe likufunika yankho mwachangu kwambiri komanso labwino kwambiri. Pachiyanjano ichi, muyenera kukumbukira za zisonyezo zonse zomwe zimayambitsa izi ndikukumbukira kuti pali zinthu zingapo zomwe zingakhale zothandizira pakubweretsa kudalira kwa mahomoni.

Momwe simuyenera kuphonya zizindikiro za matenda ashuga

Matenda a mtundu woyamba 1 akapezeka mwa mwana kapena mwana, zizindikiro za matendawa sizitengedwa mosavuta. Mwachitsanzo, mu kutentha kwa chilimwe, si makolo onse omwe samvera chidwi chakuti mwana amakhala ndi ludzu pafupipafupi. Kutopa kochulukirachulukira ndikuwonongeka kowonekera, makamaka ana a sukulu mpaka grade 2 ndi ophunzira aku sekondale, nthawi zambiri amadziwika kuti amawonjezera katundu, komanso kuchepa thupi kusintha kwa kusintha kwa ma horoni, kugwira ntchito kwambiri, ndi zina zambiri.

Ngati zizindikiro zowopsa za kuyambika kwa matenda ashuga 1 sizingadziwike, mwa anthu ena chizindikiro cha matenda mwadzidzidzi ndi ketoacidosis. Poyamba amafanana ndi poyizoni: pamakhala nseru, kusanza, kupweteka kwam'mimba. Koma mosiyana ndi poyizoni wa chakudya, ndi ketoacidosis imakonda kugona kapena kusokoneza chikumbumtima. Chizindikiro chake chachikulu ndi kupuma kwa acetone. Ketoacidosis imathanso kudwala mtundu wachiwiri wa matenda ashuga, koma odwala ndi abale awo amadziwa momwe izi zimachitikira. Ndi chiwonetsero choyamba cha matenda a shuga 1, amatha kukhala osayembekezeka, ndipo izi ndizowopsa.

Tanthauzo ndi mfundo za insulin

Mfundo zachithandizo cha insulin ndizosavuta. Mwa munthu wathanzi, kapamba ukatha kudya umapereka gawo lofunikira la insulin m'magazi, maselo amatenga glucose m'magazi, ndipo mulingo wake umachepa. Mwa anthu omwe ali ndi matenda ashuga amtundu 1 komanso mtundu wa matenda ashuga 2, njira imeneyi imasweka, ngakhale pazifukwa zosiyanasiyana, ndipo iyenera kupangidwa pamanja. Kuti musankhe kuchuluka kwa mahomoni, muyenera kudziwa kuchuluka kwamafuta omwe timapeza ndi zinthu zosiyanasiyana, komanso kuchuluka kwa insulini yomwe ingafunike pokonzekera.

Zakudya zama calorie sizimakhudzana ndi kuchuluka kwa chakudya chamagalasi m'matumbo, chifukwa chake, zopatsa mphamvu ziyenera kuganiziridwa kokha ngati mtundu 1 kapena mtundu wa 2 wa shuga umatsagana ndi kunenepa kwambiri. Mosiyana ndi iwo omwe ali ndi mtundu wachiwiri wa insulini wosadalira insulin, matenda ashuga safunika nthawi zonse ndi matenda amtundu 1.

Mwa kuwongolera kuchuluka kwa shuga m'magazi ndikusankha mtundu woyenera wa insulin, wodwala matenda ashuga amatha kudya ngati anthu athanzi. Komabe, ayenera kudziwa kuti palibe mtundu wina wolondola wa insulin kwa onse omwe amapezeka ndi matenda a shuga. Kuchuluka kwa shuga m'magulu osiyanasiyana kumasiyanasiyana malinga ndi nthawi ya tsiku ndi nthawi ya chaka, zochitika zolimbitsa thupi za munthu, zimatha kusintha ndi kutentha kwakukulu, mwachitsanzo, ndi chimfine.

Ichi ndichifukwa chake wodwala aliyense wa mtundu woyamba wa shuga ayenera kudziwa payekha kuchuluka kwa shuga m'magazi awo ndikuwerengera insulin. Diary yodziyang'anira imafunikanso kwa anthu odwala matenda ashuga a 2 omwe samabayira insulin. Nthawi yayitali yowonerera, zimakhala zosavuta kuti wodwalayo aziganizira zonse za matenda ake. Cholemba chimawathandiza kuwongolera zakudya zawo, moyo wawo, komanso osaphonya nthawi yomwe shuga yosadalira insulin ikhoza kukhala mtundu 2 wodwala insulin.

Kodi insulin ndiyiti yabwino?

Ndi matenda a shuga 1 amtundu wa 2 komanso matenda a shuga a mtundu wa 2, mitundu itatu ya mahomoni apancreatic amagwiritsidwa ntchito: anthu, bovine ndi porcine (ili pafupi kwambiri ndi anthu). Ndizosatheka kunena kuti ndi yani "yabwinoko" ndi iti yomwe ili yoyenera kwa wodwala wina. Kuchita bwino kwa mankhwala a insulin nthawi zambiri sikudalira magawo a mahomoni, koma mlingo wake woyenera. Insulin yokha yamunthu ndi yomwe imalembedwa:

• ana omwe amapezeka ndi matenda a shuga 1,
• woyembekezera
• anthu omwe ali ndi vuto la porcine ndi mahomoni a pancreatic,
• omwe ali ndi matenda osokoneza bongo otchedwa mellitus.

Pofika nthawi ya insulin ndi "yochepa", yapakatikati komanso yayitali.Zachidule (Humalog, Actropid, Iletin P Homorap, Insulrap, etc.) amayamba kugwira ntchito mphindi 15-30 pambuyo pa jekeseni, ndipo zotsatira zake zimatha pambuyo pa maola 4-6, kutengera mlingo. Jekeseni limachitika nthawi iliyonse chakudya chisanachitike, komanso ngati shuga ya magazi ikwera kuposa yokhazikika. Nthawi zambiri, anthu omwe ali ndi vuto la matenda amtundu woyamba amakhala ndi ma piritsi a jakisoni wowonjezera.

Ma insulin omwe amagwira ntchito yapakatikati (Semilong, Semilent MS ndi NM) "amatembenuka" pambuyo pa ola limodzi ndi theka mpaka maola awiri, kuchuluka kwake kumachitika pambuyo pa maola 4-5. Amagwiritsidwa ntchito mosavuta, mwachitsanzo, kwa iwo omwe alibe chakudya cham'mawa osati kunyumba koma kuntchito, koma sangafune jakisoni konse. Mwachitsanzo, ngati mupanga jakisoni kunyumba nthawi zisanu ndi zitatu m'mawa, ndiye kuti muyenera kukhala ndi kadzutsa pasanafike masana.

Koma zindikirani kuti ngati simukudya panthawi, shuga m'magazi anu amatsika kwambiri, ndipo ngati pali chakudya chambiri m'm'mawa chanu kuposa momwe zimakhalira, chiwuka, ndipo muyenera "kuyimitsa" insulin yochepa. Chifukwa chake, mahomoni ochita kupanga pang'ono amakulimbikitsidwa okhawo omwe angadye kunyumba nthawi yomweyo ndikudziwa zomwe azidzakhala.

Amakhala akuchita masewera olimbitsa thupi kwa nthawi yayitali (Iletin PN, Protofan, Monotard MS ndi NM, Lente, Humulin N, Homofan, ndi ena) amayamba kugwira ntchito pambuyo pa maola 3-4, kwa nthawi yayitali magazi ake amakhala osakwana maola onse . Mtundu woyamba wa matenda ashuga, ma insulini nthawi zambiri amalowetsedwa kawiri patsiku kuti maselo amatha kuyamwa glucose, omwe chiwindi chimatulutsa mosasamala kanthu ndi chakudya.

Kodi jekeseni wa insulin ndi liti?

Matenda a shuga a mtundu woyamba 1 amachokera ku mitundu yosiyanasiyana ya kuphatikiza kwa insulin ndi nthawi yayitali. Cholinga cha njira zonsezi ndikutsanzira kugwira ntchito kwa kapamba wathanzi molondola momwe zingathere. Chifukwa chake, zimatengera momwe moyo wa wodwalayo umakhudzidwira komanso masiku ake, matenda omwe ali kale, zaka zambiri ndi zina zambiri. Njira yodziwika kwambiri yokhala ndi zakudya ndizotsatira: M'mawa amapaka jakisoni “wamfupi” komanso “wautali” wa kapamba, asanadye - osakhalitsa ", komanso asanagone -" kutalika "kokha. Chiwembucho chikhoza kukhala chosiyana: mwachitsanzo, m'mawa ndi madzulo "ndikutali", musanadye chakudya chilichonse masana - "chifupi".

Insulin iliyonse ya shuga 1 ndi shuga 2 imayendetsedwa m'malo angapo thupi. Am'baya pakhungu lam'mimba, pansi pa scapula, pakhungu panja pa ntchafu, matako, phewa. Kuti jekeseni wam'mimba, pafupifupi nkhope yake yonse imagwiritsidwa ntchito. Jekeseni sachitidwa pokhapokha pakati pamimba (m'lifupi mwa pristine khungu lanu ndi masentimita 3-4). Ndikofunikira kuduladula, kusinthanitsa mbali yakumanzere ndi yamanzere yam'mimba, mtunda pakati pa malo a jekeseni ndi pafupifupi ma 4 sentimita.

Komwe ungatengere jakisoni zimatengera mtundu wa insulin komanso kuchuluka kwa shuga m'magazi, chifukwa amakamizidwa mwachangu kwambiri pamankhwala osiyanasiyana a jakisoni. Chifukwa chake, "kufupikitsika" ndikofunikira kubaya m'mimba, chifukwa kuchokera apa imalowa m'magazi mwachangu, ndipo "yayitali" - ntchafu kapena phewa, pomwe imamwiririka pang'onopang'ono. Mukayika mankhwala otenthetsera kuti mupeze jakisoni, "pang'onopang'ono" amayamba mwachangu. Kutalika kwa mahomoni sikusintha.

Pampu ya insulin imathandizira kuti moyo ukhale wosavuta kwa iwo omwe ali ndi matenda a shuga 1 kapena mtundu wa 2 mellitus. Ili ndi gawo lamagetsi, chosungira chokhala ndi insulin, chubu ndi singano yomata pansi pa khungu. Odwala achikulire amatha kudzipanga okha, kwa ana adokotala amapanga pampu. Pompo imapereka insulini m'magazi, ndikutsata magwiridwe antchito a kapamba.

Momwe mungaphunzirire kukhala ndi matenda a shuga

Matenda a shuga, makamaka matenda amtundu 1, amatchedwa si matenda, koma njira ya moyo. Zimakhala zovuta kuti anthu omwe amadwala matenda ashuga 2 akadzakula kapena achikulire asinthe zizolowezi zawo, chizolowezi cha tsiku lililonse, kapenanso kusiya zakudya zina. Koma iwo omwe adadwala kuyambira ali mwana ndipo amakonda kuyeza shuga wamagazi, kuwerengera XE ndikusamala zomwe zingachitike "zazing'ono" kwambiri atha kukhala moyo wofanana ndendende ndi anthu opanda matenda a shuga.

Pakuwunika kuchuluka kwa shuga m'magazi ndikujambulitsa zotsatira zake, munthu aliyense azitha kudziwa nthawi yomwe chizindikirochi chili chokwanira komanso chotsika, komanso zomwe zimatengera iye.Mwachitsanzo, mwa azimayi ena, kuwonjezera pa kusinthasintha kwa m'mawa ndi nyengo, zimasiyanasiyana kutengera masiku omwe amasinthasintha pamwezi, mwa ena amatha "kudumpha" ndi nkhawa yayitali, kugwira ntchito kwambiri, kusowa tulo, ndi zina zotere. thupi lake ndipo munthawi yake amakwaniritsa kapena kuchepetsa mlingo wa insulin.

Njira imodzi yokhazikitsira kuchuluka kwa shuga m'magazi ndi kuchotsedwa kwina. Kuchepetsa maphunziro akuthupi kumathandiza kuchepetsa kuchuluka kwa insulin mu mtundu woyamba, ndipo kwa iwo omwe apanga mtundu wachiwiri wa matenda ashuga, amatha kutero popanda jakisoni kwakanthawi ndipo nthawi zina amathetsa insulin.

Kuchita masewera olimbitsa thupi a shuga

Matenda a shuga ndi limodzi mwa matenda “akale” omwe amadziwika ndi anthu, koma insulin yochita kupanga yaonekera zaka pafupifupi 80 zapitazo. Zakudya ndi masewera olimbitsa thupi adathandizira anthu kutsitsa shuga m'magazi a 1 mtundu wa shuga ndikulemba matenda ashuga a 2 panthawi ya insulin isanakwane. Tikalemetsa minofu yathu, imayamba kutaya mphamvu. Koma thupi limazipeza kuchokera ku glucose! Pochita opaleshoni, minofu imatenga glucose kuchulukitsa ka 50-70 kuposa kupuma, ndiye kuti shuga ya magazi imatsika popanda mankhwala. Anthu ena, chifukwa cha maphunziro akuthupi, amachepetsa insulin yawo tsiku lililonse 20-30%.

Matenda a shuga a Mtundu Wachiwiri amatha kupezeka kuti ali ndi chidwi chambiri. Mwa anthu onenepa kwambiri, zomwe zimachitika kawirikawiri kwa odwala omwe ali ndi matenda ashuga a mtundu woyamba 1 komanso shuga yachiwiri, kuchuluka kwa shuga m'magazi ndi kuthamanga kwa magazi zimachepetsa pakatha mphindi 40 mpaka 44 zolimbitsa thupi. Kuphatikiza pa chakuti maphunziro olimbitsa thupi amathandizanso kuletsa matenda ashuga, kulimbitsa mtima ndi mapapu ndi magazi ndi mpweya, komanso zonyamula sitima zapamtunda.

Maphunziro sayenera kukhala opanikizika kwambiri, ndipo ndi mtundu wanji womwe mumaloledwa kukaonana ndi dokotala. Kuphunzitsa modekha kumatha kuchitika ngakhale kwa iwo omwe ali ndi zovuta za mtundu wa 2 shuga. Ndikokwanira kuchita pafupifupi ola limodzi patsiku, ndipo ngakhale kukhala kuphunzira ola limodzi, theka la ola limodzi kapena kupumira kwakanthawi kwa mphindi 15, kutengera njira yanu, moyo wanu ndi mwayi wanu.

Mutha kupeza nthawi yanokha ngakhale mutakhala wotanganidwa kwambiri. Aliyense amatha kuchita masewera olimbitsa thupi m'mawa kwa mphindi 10, osachepera theka la msewu wopita kuntchito, kuyenda, kutsika masitepe popanda kukweza, ndipo nthawi ndi nthawi kusiya tebulo yantchito kuti uzigwada ndi kuwotcha. Madzulo, koma osati asanagone, ndikofunikira kuchita nthawi yayitali - 20-25 mphindi.

Matenda a shuga ndi akatswiri

Mtundu woyamba wa matenda a shuga kapena matenda ashuga osayembekezeka 2 nthawi zina samalola achinyamata kusankha ntchito imodzi kapena ina, pomwe akulu ndi achikulire amawapangitsa kusintha moyo wawo. Osapeputsa shuga. Koma "kuthetsa" moyo wathunthu komanso ntchito yabwino kwa anthu ambiri omwe ali ndi matendawa sikofunikira!

Ndi matenda a shuga 1 amtundu wa 2 komanso mtundu wovuta wa matenda ashuga 2, simungasankhe maudindo omwe amafunikira chidwi chachikulu, kusintha kwakukuru m'malingaliro ndi thupi. Imeneyi si ntchito yoyendetsa okha, woyendetsa ndege, wothandizira, komanso ogwira ntchito yoyendetsa ndege. Matendawa omwe mumawagwiritsa ntchito kuwongolera mwadzidzidzi amathanso kudumpha m'magazi ndikuwasiya kudziwa. Lamulo linanso kwa odwala matenda ashuga: ayenera kukhala ndi mwayi wopeza insulin, kumwa mapiritsi, kudya nthawi yabwino, kotero odwala matenda ashuga sawazindikira kugwira ntchito kowonjezerapo ndi nthawi yosinthira, ngakhale mutafunikira kupita kunja masana osati kosintha usiku.

Maulendo azabizinesi amakhalanso ovomerezeka: Kusintha magawo kumafunikira "kukonza" Mlingo wanu wa insulin (tsiku lomwe limatalikirana kuchokera kummawa kupita kumadzulo). Ndi mtundu wocheperako wa matenda ashuga, simungathe kugwira ntchito mobisa komanso m'malo otentha. Ndipo ngati mtundu wa 1 wa matenda a shuga kapena mtundu wa 2 wodwala matenda a shuga uli woopsa, mutha kugwira ntchito kunyumba kokha.

Njira ndi njira zochizira matenda amtundu I

Ndi kusowa kwa insulin m'thupi mwa odwala omwe ali ndi mtundu woyamba wa matenda a shuga, amafunika kugwiritsa ntchito moyo wawo wonse ngati majekesheni am'mimba. Komabe, ngakhale abwezeretsanso matupi am'madzi a cell, metabolism ya cell imakhalabe yolakwika, motero moyo wa wodwala wodwala matenda amtunduwu uyenera kusintha kwa moyo wake wonse.

M'dziko lamasiku ano lapamwamba kwambiri, kusamalira odwala omwe ali ndi matenda ashuga kumayamba mosavuta. Mwachitsanzo, kuyambira mu 2016, mandala okhala ndi masensa a Google akhala akuthandiza odwala kuyeza glucose mu madzi osalala. Nthawi yomweyo, ngati mulingo wovomerezeka mu mandala oterowo, ma bulbs apadera a LED akuwala, kudziwitsa wodwalayo nthawi yakubaya jakisoni wotsatira wa insulin. Kapenanso, kuti tizijambulitsa insulin yosowa m'magazi, asayansi aku Swiss adapanga pampu, momwe magwiridwe antchito amachepetsa kwambiri moyo wa odwala matenda ashuga.

Njira yayikulu yothandizira matenda a shuga 1 ndi ma insulin. Zabwino kwambiri zimatengedwa ngati njira zamankhwala zomwe zimapindulitsa kagayidwe kazakudya ndipo nthawi yomweyo zimasintha moyo wa wodwalayo. Cholinga chachikulu cha insulin yothandizira mtundu wa 1 matenda ndi kufananizira kwake ndi zotsatira za insulin. Njira zabwino kwambiri zamankhwala ndizomwe zimatsata kwathunthu kuzungulira kwa mahomoni m'thupi la munthu ndi maselo a beta a kapamba. Kuti mukwaniritse zotsatira zofananira, kukonzekera kwa insulin yaumunthu kumagwiritsidwa ntchito ngati kuphatikiza kwa mankhwala osakhalitsa ndi mankhwala osakhalitsa.

Mankhwala othandizira insulin osakanikirana ndi njira zamakono zopangira mankhwala. Nthawi zambiri m'mawa, kukhazikitsidwa kwa insulin yayitali kwa thupi kumafunika, ndipo pambuyo pa chakudya chilichonse, poyerekeza ndi zochita za thupi, mlingo wa mahomoni umathandizidwa ndi mankhwala.

Mawonekedwe a chithandizo cha matenda a mtundu II

Zinthu zofunika kwambiri pochiza matenda amtundu wa 2 shuga ndi kudya komanso kuchita masewera olimbitsa thupi. Komabe, kutalika kwa mphamvu yogonjetsa hyperglycemia kumachitika chifukwa chophatikiza zinthu izi ndi mankhwala. Magawo oyamba a matenda a shuga a 2 amaphatikizanso kugwiritsa ntchito mankhwala a metformin, omwe amavomerezedwa pafupifupi m'maiko onse padziko lapansi pochiza matenda ashuga. Kupitilira apo, ndikukula kwa matendawa, madokotala nthawi zambiri amapereka mankhwala a sulfonylurea kwa odwala awo, njira yofunika kwambiri yomwe imathandizira kutulutsa insulin. Kukonzekera kwa Sulfonylurea kumatha kulumikizana ndi ma receptors omwe ali pamwamba pa maselo a pancreatic beta. Kuchiza ndi mankhwalawa kumayamba ndi Mlingo yaying'ono ndikuwonjezera pang'onopang'ono nthawi 1 pa sabata ndikuthandizira achire. Pogwiritsa ntchito mankhwala oopsa a glucose mwa odwala, mankhwalawa amamulembera mwachangu kwambiri, ndipo matendawa akaperekedwe, mankhwalawo amachepetsa.

Gulu lotsatira la mankhwala omwe amalembera odwala omwe ali ndi kupitirira kwa mtundu wa 2 matenda a shuga ndi glitazones kapena thiazolidinediones, omwe amachepetsa kukana kwa insulini pakukulitsa kuchuluka kwa omwe amayendetsa glucose ndikuwonjezera mphamvu ya minofu yogwiritsira ntchito shuga, komanso kuchepetsa kuchuluka kwamafuta acid, triglycerides m'magazi, ndi kulepheretsa kwa ntchito ya chiwindi kubereka kwa shuga. Mankhwala a Thiazolidinedione ali ndi zotsatira zabwino pazochitika zambiri za odwala omwe ali ndi matenda a shuga a 2.

Komanso, kuwonjezera pa magulu omwe ali pamwambawa, pochiza matendawa, akatswiri amagwiritsa ntchito magulu ngati awa monga:

• Ma Clinid
• alpha glucosidase zoletsa
• incretinomimetics
• dipeptidyl peptidase-IV zoletsa.

Othandizira a Hypoglycemic samathandizira nthawi zonse kuthetsa vuto lakukhazikika kwa glycemia yoyenera. Chithandizo chabwino kwambiri cha matenda ashuga amtundu wachiwiri chadzitsimikizira chokha, momwe mankhwala amkamwa a hypoglycemic osakanikirana ndi mankhwala a insulin, akagwiritsidwa ntchito zaka 6 zoyambirira za matenda, amateteza kupangika kwakukulu. Kuwongolera kwapamwamba kwambiri kwa hypoglycemia kumatha kuchitika pakakhala kusintha kwa insulin ndi kukhazikika kwa maselo a beta.

Malinga ndikuwona kwachipatala, ndi kusakhazikika kwa ma hypoglycemic othandizira amtundu wachiwiri wa matenda ashuga, muyenera kuyamba kugwiritsa ntchito insulin. Chifukwa chake, ndizotheka kuti muchepetse mavuto ambiri obwera chifukwa cha kuchuluka kwa mankhwala ochepetsa shuga, komanso kuchepetsa magazi.

Chifukwa cha kuchepa kwa ntchito ya beta-cell panthawi ya monotherapy ya mtundu 2 matenda a shuga, posakhalitsa, odwala onse omwe akudwala matenda osinthika ophatikizira chithandizo. Njira zophatikiza mankhwalawa zomwe zimagwiritsa ntchito metformin ndi sulfonylurea kapena exenatide ndi sulfonylurea zimadziwika kuti ndizothandiza kwambiri. Komabe, kuphatikiza kwabwino kwambiri masiku ano kumadziwika kuti ndi metformin ndi insulin. Pankhaniyi, osachepera Mlingo wa mankhwalawa amaletsa kupezeka kwa mavuto, komanso kuphatikiza kwa mankhwala ophatikizika.

Zomwe zimagwiritsidwa ntchito pochiritsa pamimba

Padziko lonse lapansi tsiku lililonse pamakhala odwala ambiri omwe ali ndi pakati omwe amadwala matenda a shuga. Matenda a shuga a gestational ndi kupatsirana kwa shuga m'magazi, chifukwa choti shuga ya m'magazi imakwera, yomwe imayamba mwa mkazi panthawi ya bere. Nthawi zambiri izi zimachitika zokha pakubala. Mankhwala mukamawonetsa zizindikiro, tikulimbikitsidwa kusintha moyo wanu, kutsatira zakudya komanso kugwiritsa ntchito nthawi yambiri kuchita zinthu zolimbitsa thupi zofunika. Amayi ena oyembekezera amapatsidwa mankhwala opatsirana pakamwa, makamaka, glibenclamide ndi metformin, omwe ndi njira ina ndipo amavomerezedwa kuti agwiritsidwe ntchito panthawi yoyembekezera komanso insulini kuti muchepetse shuga.

Panthawi yokhala ndi matenda ashuga, ndikofunikira kuphunzira kudziyimira palokha glycemia kuti muwongolere munthawi yake. Nthawi zambiri, kudya ndikokwanira. Mfundo zamankhwala akudya zimatanthawuza kuti mu nkhani iyi kuphwanya zakudya za tsiku ndi tsiku muzakudya zomwe zimakhala ndi 35-40% chakudya, mafuta 35-40% ndi mapuloteni 20-25%. Pamaso pa kulemera kwakukulu, kuchuluka kwa caloric kwa chakudya sikuyenera kupitirira malire a 25 kilocalories pa kilogalamu ya kulemera kwa thupi, ndipo ndi kulemera kwabwinobwino, kuyenera kukhala mkati mwa kilogalamu 30-35 kilogalamu. Pankhaniyi, kuchepa kwa zopatsa mphamvu za calorie kuyenera kuchitika bwino, popanda mawonekedwe akuthwa.

Maswiti (chakudya chofiyira mosavuta) saloledwa pamenyu ya mayi woyembekezera yokhala ndi matenda osokoneza bongo, mafuta omwe amamwetsedwa amachepetsa, ndipo kuchuluka kwa fiber ndi mapuloteni kumachulukitsidwa mpaka magalamu imodzi ndi theka pa kilogalamu ya thupi.

Pokhapokha pali mphamvu zambiri pamlingo wa glycemia panthawi ya mankhwala, odwala amapatsidwa mankhwala a insulin kufikira omwe adokotala amawerengera komanso kusintha.

Momwe mungachepetse shuga kunyumba

Pali malamulo angapo ochepetsa glucose wamagazi kwanu. Ndikofunikira kugula glucometer yomwe ingatengedwe, yang'anani kuti muwone ngati ikuyenda bwino komanso mumayezera shuga kuti mudziwe momwe imakhalira tsiku lonse. Kuyambira nthawi yanji mulingo wa shuga m'magazi a wodwala ndiwopamwamba kwambiri, chithandizo, zakudya ndi ntchito zovomerezeka zolimbitsa thupi zimadalira.

Ndikofunika kukumbukira kuti kuchepetsa kwambiri zamagulu azakudya m'zakudya, momwemonso chakudya chokwanira chimayendetsa shuga. Chifukwa chake, ngakhale dokotala atakufotokozerani zakudya zopatsa thanzi, mutha kuchepetsa kuchuluka kwa chakudya chamafuta mkati mwake. Izi sizidzaipiraipira pakapita nthawi ya matenda ashuga komanso zithandizira kubweza msanga shuga msanga. Cholinga cha kayendetsedwe ka magazi kunyumba ndikukwaniritsa chidziwitso chosasinthika cha mamililita 4.0-5,5 pa lita. Pakutha kugwira bwino ntchito yazakudya izi, metformin mu mawonekedwe a Glucofage kapena Siofor kwa odwala onenepa kwambiri imalumikizidwa. Ndi kuwonda, mankhwalawa sangagwire ntchito, sangathe kudyedwa.

Ndikofunikira kusintha insulin yomwe imapangidwa mthupi, kuwonjezera zochita zolimbitsa thupi. Chothandiza kwambiri kwa matenda ashuga ndikuthamanga, kuyenda, kusambira. Kuchita masewera olimbitsa thupi kumatha kupindulitsa wathanzi, koma sikungakhale ndi vuto lililonse pa matenda ashuga.

Jakisoni wa insulin ndi njira yopulumutsira odwala omwe ali ndi matenda ashuga omwe ayesa kale mankhwala onse, koma sanabweretse zotsatira zoyenera. Ngati mukutsatira zakudya, masewera olimbitsa thupi oyenera komanso kugwiritsa ntchito metformin, mulingo wa insulin, monga lamulo, ndi wofunikira kwambiri.

Kodi ndizotheka kuchira kwathunthu?

Aliyense wodwala matenda ashuga nthawi zonse amakhala ndi nkhawa ngati zingatheke kuti athetse matenda onse omwe abuka. Komabe, madokotala saiwalika - mtundu wachiwiri wa matenda ashuga ndi njira yokhazikika yomwe imakhalabe mthupi lonse ndipo nthawi zina imangokulira, kapena kukhululuka. Kuti musungebe chindapusa cha matendawa, muyenera kutsatira malangizo onse a dotolo ndikumwa mankhwala oyenera. Mukangosiya kugwiritsa ntchito mankhwala osokoneza bongo, matenda am'mimba amatha kuyamba kuyenda mwachangu, ndikupangitsa zovuta zambiri limodzi. Chifukwa chake, muyenera kusamala ngati chipatala china chamankhwala ena chitha kuchiritsa matenda a shuga pogwiritsa ntchito njira:

• kuyeretsa ku poizoni
• kugwedeza kwa zida zosagwirizana,
• mankhwala azitsamba popanda kugwiritsa ntchito mankhwala a pharmacological ndi jakisoni wa insulin,
• mphamvu pachikumbumtima,
• ovala ma medallions ndi zovala zapadera.

Ndikofunikira kumvetsetsa kuti magawo oyambirira a matenda amtundu wachiwiri amathandizidwadi mosavuta ndi chakudya komanso masewera olimbitsa thupi, koma izi sizitanthauza kuti wodwalayo adachiritsidwa kwathunthu. Pakadutsa matendawa, kusiya mankhwalawo kumangokhala kupha, popeza matenda onsewo komanso zovuta zake zambiri zimatha kupita patsogolo. Chifukwa chake, phytotherapy ndi masewera zimatha kukhala zosavuta, koma pokhapokha mutazigwiritsa ntchito ngati mankhwala a insulin komanso chithandizo chachikulu.

Matenda oyamba a shuga a mtundu wa 1 kapena 2 sangathe kuchiritsidwa, koma kugwiritsa ntchito njira zosiyanasiyana ndizotheka kuchotsa wodwalayo Zizindikiro za matendawa, kusunga kagayidwe kake mthupi lake nthawi yayitali, kupewa kupezeka kwamavuto komanso kusintha moyo wamunthu. Pankhaniyi, kudzipereka pakokha pankhaniyi ndizoletsedwa. Mukayamba kuyesedwa ndi kuthandizidwa munthawi yake, funso lochotsa matenda osokoneza bongo limatha kudera nkhawa wodwalayo, chifukwa moyo wake ndi matendawa sungakhale wovuta mulimonsemo.

Zotsatira za kusalandira chithandizo

Ngati matenda a shuga sangalandiridwe, matenda oopsa mu thanzi lanu amatha kuyembekezeredwa, ngakhale kuti shuga yeniyeniyo siziwopseza moyo wa munthu. Matenda osasinthika amachititsa zovuta zambiri zomwe zimakhudza machitidwe ndi ziwalo zilizonse mthupi. Kunyalanyaza njira zochizira kumatha kubweretsa kulumala, ngakhale kufa.Ichi ndichifukwa chake matenda ashuga amatchuka ngati "wakupha mwakachetechete" - matenda sangadziwonetse okha komanso osasokoneza munthu mwanjira iliyonse, koma angayambitse zovuta zomwe sizikugwirizana ndi moyo.

Mu 2007, asayansi adachita kafukufuku yemwe adawonetsa momwe shuga imakhudzira moyo ndi thanzi la anthu malinga ndi jenda. Zinapezeka kuti kwa amayi izi matenda oopsa ndiowopsa kwambiri. Kucheperachepera kwa kuchuluka kwa moyo mwa abambo omwe ali ndi matenda ashuga nthawi yayitali zaka 7, pomwe mwa amayi ambiri amaposa zaka zisanu ndi zitatu. Kukhazikika kwa mtima zamatenda am'mimba chifukwa cha matenda ashuga mwa amuna kumachitika kawiri kawiri, ndipo mwa akazi nthawi 6. Komanso, ndimatenda a mtima omwe amachititsa kupha anthu ambiri odwala matenda ashuga.

Matenda a shuga ndi matenda a kukhumudwa amakhala ogwirizana kwambiri ali aang'ono. Mikhalidwe iwiriyi mumakina nthawi zambiri imakakamiza achinyamata kuti azichita mwachangu, chifukwa chake, mukazindikira njira zoyambira zam'mbuyomu, zingakhale bwino kulangizidwa pafupipafupi.

Mwambiri, pakalibe chithandizo cha matenda ashuga, matendawa amatha kuchulukana, kuyambitsa zovuta, kuyambitsa kulumala ngakhale kufa.

Kupita kwa asing'anga

Dokotala kapena dokotala wabanja (katswiri) amatha kudziwa matenda a shuga mwa wodwala kapena angaganize kuti matendawa alipo. Pakangokhala chizindikiro chodwala, wodwalayo amapatsidwa mayeso oyenera, ndipo malinga ndi zotsatira zawo, wodwalayo amapititsidwa kukakambirana ndi endocrinologist. Ngati matenda a shuga atsimikiziridwa, ndiye kuti wodwala mu endocrinology amaika mbiri yokhazikika.

Ndi endocrinologist yemwe amatha kupeza yankho lolondola la wodwala winawake kuti asankhe ndikusintha kuchuluka kwa mahomoni ndi shuga m'magazi. Katswiriyu amachititsa maphunziro omwe amawonetsa kupezeka kwa zovuta mu magwiridwe a endocrine system, amawunika ma pathologies, amasankha chithandizo chamankhwala, ndikuchotsa zofooka. Nthawi zambiri, ndalama zimasankhidwa kuti ziwongolere kuchuluka kwa mahomoni m'thupi, kubwezeretsa kagayidwe, kuthetsa endocrine yomwe imakwiyitsa kubereka, ndi ena. Kutengera ndi zotsatira za kafukufuku, kufufuza koyenera kumapangidwa, zakudya ndi mankhwala ena amasankhidwa.

Ma Sanatorium a odwala matenda ashuga

Masiku ano, odwala matenda a shuga amathandizidwa mokwanira komanso kubwezeretsedwa m'magulu apadera omwe amapangidwa kuti athane ndi vuto la kugaya chakudya m'mimba. Komabe, odwala matenda ashuga nthawi zambiri amafunikira chithandizo cha spa cha matenda ena a shuga. Chifukwa chake, pamaziko a malo ambiri aku Russia, pali "Sukulu Yophatikiza Matenda a shuga", yomwe imaphunzitsa odwala omwe ali ndi chithandizo chilichonse chazachipatala kuti azitha kuyang'anira nthawi yomwe akuchira, asankhe zakudya komanso masewera olimbitsa thupi, malinga ndi mbiri yakale ya matenda ashuga.

Odziwika kwambiri kwa odwala matenda ashuga ndi malo ena aku Russia omwe amakhala ku Altai, Krasnodar Territory, Essentuki, Pyatigorsk, Goryachiy Klyuch, Zheleznovodsk, Kislovodsk ndi ena.

Zomwe zimachiritsa pazilumba za Belokurikha ku Altai Territory ndikuchiritsa matope, madzi amamineral ndi malo ochiritsa. Apa, odwala amapatsidwa chithandizo cha mankhwala okhala ndi nitric siliceous otsika pang'ono a bicarbonate-sodium sodium pang'ono radon yamafuta am'madzi ndi silicic acid. Pano, akuti odwala amagwiritsa ntchito madzi ochepera-mineralized sulfate-chloride magnesium-calcium-sodium medical-tebulo lamadzi kuchokera pagome la Berezovsky, lomwe Altai Territory ili nawo, ngati mankhwala akumwa.

Pamalo abwino kwambiri a Russia ku Anapa (Krasnodar Territory), kumapezeka madzi amchere ambiri omwe amagwiritsidwa ntchito mkati ndi panja.Ku Kuban konse kulibe madipoziti ambiri amadzi amchere oti ungagwiritsidwe ntchito kunja. Koma zofunikira kwambiri ndi madzi ogwiritsa ntchito zapakhomo, zomwe zimasungidwa zomwe zili mwachindunji mumzinda wa Anapa. Apa, odwala amatha kuthandizidwa ndimitundu iwiri yamadzi - otsika-nayitrogeni mineralized (3.2-4.9 magalamu pa lita) hydrocarbonate-chloride-sulfate ndi sulfate-hydrocarbonate-chloride sodium, osagwirizana ndi alkaline. Komanso madzi am'madzi am'madzi a Semigorsk omwe amapezeka ndi mpweya wambiri amaperekedwa tsiku lililonse ku malo osungirako malo a Anapa. Awa ndimadzi a nayitrogeni-kaboni dioksidi-methane, ayodini wa calcium sodium-hydrocarbonate wokhala ndi pH yolephera ya 7.6 ndi mineralization ya magalamu 10-11 pa lita.

Goryachiy Klyuch ndiye malo okhawo achi Russia komwe mungathe kukumana ndi madzi osakanikirana ndi madzi osambira a Essentuki ndi ma hydrogen sulfide, pomwe madzi aku mchere wa hydrogen sulfide chloride-hydrocarbonate calcium-sodium mafuta am'madzi otentha okhala ndi kutentha kwa madigiri 60 amagwiritsidwa ntchito pano. Kutentha kochepa kwa madzi ngati kumeneku kumagwiritsidwa ntchito pakumwa mankhwalawa osiyanasiyana a m'matumbo.

M'madera a Zheleznovodsk, mankhwalawa amachitika popanda kufanana ndi dziko la madzi a "Slavyanovskaya" ndi "Smirnovskaya", omwe ndi othandiza kwambiri pakam'gaya thupi lonse, chifukwa cha matenda a impso, matenda a kwamikodzo komanso matenda andrological. Amathandizira odwala matenda ashuga omwe ali ndi nthenda zam'mimba zam'mimba, minofu yam'mimba, minofu ya ENT, matenda am'mimba.

Zambiri pazoyambira Essentuki ndi mchere wamadzi amchere wamchere wamchere - amadziwika ndi onse a Essentuki №17 ndi Essentuki №4. Pamaziko a Kalinin sanatorium, momwe matenda a shuga adathandizira zaka 10, lero Center ya kukonzanso odwala omwe ali ndi matenda ashuga omwe ali ndi zinthu zachilengedwe ikugwira ntchito. Pano, odwala amatsogozedwa ndikuyang'aniridwa ndi pulofesa wa endocrinology, madokotala a sayansi mu gawo la endocrinology. Pano matenda a shuga amathandizidwa pafupifupi m'magulu onse ogwira ntchito.

Kislovodsk ndi malo otchuka a narzans.

Onsewa ali ndi zofanana ndipo amagwiritsidwa ntchito ngati balneotherapy. Zothandiza kwambiri kwa odwala matenda ashuga ndi Dolomite narzan, yomwe imakonza njira za metabolic, imathandizira kukodza ndikuchotsa zoopsa, komanso Sulphate narzan, zomwe zimawonjezera katulutsidwe ka m'mimba, zimakongoletsa chimbudzi ndi ntchito ya chiwindi. Pamalo achitetezo a Kislovodsk, odwala matenda ashuga okhala ndi concomitant pathologies a musculoskeletal system, dongosolo lozungulira ndi m'mimba amathandizidwa.

Kuposa mayina 40 a magwero a Pyatigorsk amagwirizanitsa pafupifupi mitundu yonse yamadzi amadzi padziko lapansi. Apa, akuwonetsedwa kuthandiza odwala matenda a shuga, mbiri yomwe imapangidwa ndi hepatic, chapamimba, matumbo a matumbo, matenda a zotumphukira zamitsempha, zotupa zam'mitsempha yam'munsi, matenda a musculoskeletal, matenda a khungu, endocrine dongosolo, matenda ogwira ntchito ndi ena.

Mankhwala a pancreatic kuti achulukitse kuchuluka kwa insulin

Lembani mapiritsi a shuga a 2

Insulin yolimbikitsa mankhwala

Kukonzekera kwa mankhwalawa a mtundu wa 2 shuga sikumakhudzanso kapamba, koma kumapangitsa ntchito ya insulin, kuchepetsa kufinya kwa shuga, mafuta ochokera m'matumbo, ndikuwonetsetsa kuti maselo amamuyamwa. Mankhwala osokoneza bongo a shuga amateteza hypoglycemia, okhala ndi metformin.

Mankhwala osokoneza bongo omwe amakhudza kuyamwa kwa glucose

Mankhwala ochepetsa shuga a mtundu wachiwiri wa shuga amathandizira kuyamwa kwa shuga, kuchepetsa kuchuluka kwa glucose omwe amapangidwa panthawi ya chakudya. Mankhwala a matenda a shuga a 2 amakhala ndi zotsatirapo: Mankhwala okhala ndi vutoli amachititsa kukula kwa cholecystitis, dysbiosis, njira yotupa m'mimba ndi matumbo.

Lembani mapiritsi a shuga a 2

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Mankhwala osakanikirana

Mndandanda wa mapiritsi a 2 a shuga 4: Amari, Glibomet, Yanumet. Mapiritsi ophatikizidwa amachepetsa kukana kwa insulin, amalimbikitsa mapangidwe a insulin.

Matenda a shuga okalamba

Kodi ndi mapiritsi ati omwe amalembedwa pa matenda a shuga 2 okalamba? Mtundu wachiwiri wa matenda ashuga, kuti shuga asatulutse, mankhwala omwe ali ndi metformin adalembedwa.

• matendawa amalemedwa ndi ma matenda osiyanasiyana omwe amapezeka ndi m'badwo uno,
• mavuto azachuma a owapa penshoni sawalola kulandira chithandizo chokwanira,
• Zizindikiro za matenda amishuga 2 zimasungidwa ndi ma pathologies ena,
• Nthawi zambiri wodwala amapeza kuti adayamba kudwala matendawa atayamba kale.

Chofunikira: Kuti musaphonye kuyambika kwa matendawa, kuyambira wazaka 45-55, muyenera kuperekera magazi pafupipafupi. Matenda a 2 a shuga ndi oopsa pa thanzi limodzi ndi zovuta zambiri - zam'mitsempha, matenda a impso, chiwindi, khungu, kudula miyendo.

Kodi mapiritsi a shuga ndi othandiza?

Madokotala atanena nthabwala kuti odwala matenda ashuga amatha kudya chilichonse chomwe mukufuna, makamaka, amwe mapiritsi abwino a shuga 2. Koma muyenera kukumbukira kuti ayi, ngakhale mankhwala abwino kwambiri a matenda ashuga a 2 angakupatseni mpumulo ngati simukutsatira zakudya . Ngati mumadya zakudya zoletsedwa, zopanda zakudya nthawi zonse, mutha kukhetsa kapamba - palibe mndandanda wa mankhwala omwe angakuthandizeni, simudzamwa mapiritsi okha, komanso jekeseni wa insulin.

Mankhwala ambiri amakono a shuga amakhala ndi zoyipa zambiri komanso contraindication, kuwonjezera kufa, motero muyenera kusankha mosamala mankhwala a shuga. Njira yabwino yothandizira ndi Metformin. Anthu amati palibenso mankhwala ena othandiza, othandizanso pano.

Forsiga: Ubwino ndi Kuwonongeka

Forsiga ndiye mankhwala atsopano kwambiri a matenda ashuga. Mankhwala amathandizira kupukusa kwa shuga mumkodzo. Amakhulupirira kuti chithandizo ndi mapiritsi a Forsig ali ndi zotsutsana zambiri kuposa momwe amasonyezera - zimayambitsa matenda a kwamikodzo pambuyo pake kulephera kwa impso.

Pa intaneti mutha kupeza ndemanga zamankhwala ena zokhudzana ndi matenda ashuga, omwe amalonjeza kuchira msanga. Musakhulupirire zonena zotere. Tsopano palibe mankhwala ngati omwe angachiritse matenda a kapamba. Chifukwa chake, khulupirirani mankhwala ena ovomerezeka.

Kutsitsa mankhwala a zitsamba

Kodi ndi mankhwala ati omwe dokotala amakupatsani kuchokera ku zachilengedwe? Dokotala atha kulimbikitsa kuti odwala omwe ali m'magawo oyamba a matendawa alibe mankhwala a shuga, koma othandizira. Mtundu wachiwiri wa matenda ashuga, kuti shuga asakwere, tikulimbikitsidwa kuti mutenge Insulin. Insulin imalimbikitsa insulin, imasintha kagayidwe kachakudya. Khola, kugwiritsa ntchito mankhwalawa kwakanthawi kumathandiza wodwalayo, kumachepetsa shuga.

Pomaliza

Zakudya, zolimbitsa thupi ndi mankhwala osokoneza bongo ndi zovuta zitatu zomwe zingakuthandizeni kukhala ndi thanzi, kupewa zovuta, komanso kukhala ndi moyo wautali. Kuti mukwaniritse zochizira komanso kupewa mavuto, mankhwalawa ayenera kuyikidwa ndi endocrinologist. Mankhwala omwe mumalandira.

Mankhwala A shuga: Kubwereza Kwa Mankhwala Osokoneza bongo

Mankhwala ali gawo lachitatu pochiza matenda a shuga a mtundu wachiwiri. Magawo awiri oyambawa akutanthauza chakudya chamafuta ochepa komanso zolimbitsa thupi. Akapanda kupirira, mapiritsi amagwiritsidwa ntchito.

Koma zimachitika kuti mapiritsiwa ndi osagwira, pakadali pano, wodwalayo amapatsidwa jakisoni wa insulin. Tilankhule mwatsatanetsatane za mndandanda wamankhwala omwe angapatsidwe lero kwa odwala matenda ashuga.

Magulu a Mankhwala Osokoneza bongo

Malinga ndi zomwe anachita, mankhwala a shuga amawagawa m'magulu awiri:

1. Mankhwala omwe amachititsa chidwi cha maselo kupita ku insulin ya mahomoni.
2. Zinthu zamankhwala zomwe zimapangitsa kapamba kuti achulukitse kuchuluka kwa insulin.

Kuyambira pakati pa 2000s, mankhwala atsopano a shuga adamasulidwa, omwe amaphatikizapo mankhwala omwe ali ndi zotsatira zosiyana, motero mwanjira ina sizotheka kuphatikiza. Ngakhale awa ali magulu awiri a mankhwalawa omwe ali ndi ntchito ya insretin, koma, zowonadi, ena adzawonekera pakapita nthawi.

Pali mapiritsi monga acarbose (glucobai), amaletsa kuyamwa kwa glucose m'mimba yamagetsi, koma nthawi zambiri amayambitsa kukhumudwa. Koma ngati wodwalayo atsatira zakudya zamafuta ochepa, ndiye kuti kufunika kwa mankhwalawa kumatha.

Ngati wodwala sangathe kuthana ndi vuto la njala ndipo sangathe kutsatira zakudya zamafuta ochepa, ayenera kumwa mankhwala a shuga, omwe muthane nawo kuti muchepetse chidwi chanu. Kuchokera ku glucobaia, mawonekedwe apadera samayang'aniridwa, chifukwa chake, kukambirana kwake kopitilira sikumveka. Pansipa pali mndandanda wamapiritsi.

Mapiritsi a shuga

Mapiritsi a shuga awa ndiwotchuka kwambiri masiku ano, amachiritsa kapamba ndi maselo a beta.

Monga mankhwala am'mbuyomu, amathandizira kapamba ndi maselo a beta, koma otsika kwambiri kuposa oyamba mwamphamvu. Komabe, diabetesone imalimbikitsa kuchuluka kwachilengedwe kwa insulin.

Mankhwalawa odwala matenda ashuga amagwiritsidwa ntchito ndi odwala omwe ali ndi vuto la impso kapena matenda ena oyanjana.

Mankhwala ndi a m'badwo watsopano wa mankhwala. Zotsatira zake zimaphatikizidwa ndi kukondoweza kwa kutulutsidwa kwa insulin ya ma cell ku ma cell a beta a gland. Amaryl nthawi zambiri amagwiritsidwa ntchito limodzi ndi insulin.

Kodi mankhwala a insulin ndi ati?

Shuga mellitus mtundu 1 ndi 2 amatanthauza matenda a metabolic, chifukwa chake, mankhwala, choyamba, ayenera kukhala ndi cholinga chobweretsa zomwe zimachitika mthupi.

Chifukwa chakuti chifukwa chomwe chimayambitsa matenda ashuga a 1 ndi kufa kwa maselo a beta omwe amapanga insulin, timadzi timeneti timayenera kutumizidwa kuchokera kunja. Kutuluka kwa insulin mthupi kumatha kutsimikiziridwa ndi jakisoni kapena potembenukira pampu ya insulin. Ndi matenda a shuga omwe amadalira insulin, mwatsoka, palibenso njira ina yothandizira mankhwala a insulin.

Pochiza matenda a shuga a 2, madokotala amatipatsa mankhwala osiyanasiyana omwe amathandiza kuchepetsa shuga. Palibe chifukwa chobwera ndi insulin m'gululi la odwala matenda ashuga.

Lemberani mankhwala a shuga atatu

Mankhwala a shuga a Type 2 amatha kugawidwa m'magulu angapo. Ngakhale zili zofunikira kukhazikikapo kuti palibe njira yeniyeni yothetsera matenda ashuga. Munjira zambiri, kupambana kwa chithandizo cha matenda a shuga kumatengera:

• kuchokera kufunitsitsa kwa wodwala kuthana ndi matendawa mosalekeza,
• kuchokera pa moyo wa wodwala.

Ngati zolimbitsa thupi ndi kadyedwe sizinakhale ndi zotsatira zabwino, katswiri amapanga mankhwala a shuga, omwe amagawidwa m'magulu angapo. Dokotala atha kukulemberani mankhwala ena aliwonse kapena kuphatikiza mitundu yamagulu osiyanasiyana.

M'magawo oyamba a shuga, a-glucosidase inhibitors ndi othandiza kwambiri, amathandizira kuchepetsa kuyamwa kwa matumbo. Zotsatira za sulfonylureas zotchulidwa, monga lamulo, zikafunika zolimbikitsa kubisirana kwa insulin ndi maselo a beta.

Koma mankhwalawa ali ndi zotsutsana zingapo, zomwe zimaphatikizapo:

1. opaleshoni yam'mimba
2. kapamba wa shuga kapena matenda a shuga 1
3. Mimba ndi kuyamwa
4. kuvulala
5. matenda opatsirana
6. mitundu yonse yamawonekedwe owoneka.

Ngati magazi a wodwalayo ali ndi insulin yokwanira, endocrinologist imatha kupereka wodwala ndi gulu la Biguanide. Mankhwalawa a shuga samalimbikitsa kupanga insulin, koma amalimbikitsa mphamvu yake paziphuphu.

Biguanides amachepetsa kupanga kwa shuga ndi chiwindi, mayamwidwe ake ndi matumbo, kuperewera kwa chidwi. Koma posankha iwo, zingapo zosokoneza zosiyana ziyenera kukumbukiridwa:

• hypoxia dziko
• kuwonongeka kwaimpso,
• zovuta za matenda ashuga, etc.

Kugwiritsa ntchito zakudya zamagulu amishuga amtundu wa 2

Kumwa mapiritsi omwe amachepetsa shuga m'magazi a shuga sikulephera. Chifukwa chake, wodwalayo adzayenera kuzindikira kuti kugwiritsa ntchito mankhwala tsiku lililonse mosavomerezeka kumawononga m'mimba, chiwindi ndi magazi.

Komabe pali mwayi wosintha mtundu wa antidiabetesic chemistry, ngati mumapereka ntchito yochepetsa shuga ndi zachilengedwe. Izi, zachidziwikire, zimakhudza matenda a shuga a 2 omwe samadalira insulini. Apa ndikofunikira kugwiritsa ntchito magazi a glucose mita TC, mwachitsanzo.

Nthawi zambiri, adotolo amatha kuthandizira mankhwalawa pogwiritsa ntchito zakudya pomuthandiza pazakudya (zowonjezera zakudya), zomwe zimathandizira kuchepetsa kuchuluka kwa shuga m'magazi. Omwe amaganiza kuti zopatsa mphamvu zowonjezera popewa matenda a shuga amalakwitsa.

Monga tafotokozera pamwambapa, padakali pano palibe amene angachiritse matendawa. Komabe, zowonjezera zakudya zimangokhala ndi zinthu zachilengedwe zokha, zomwe mankhwalawa amachititsa mtundu wa 2 matenda a shuga.

Mwachitsanzo, "Insulat" ndichakudya chowonjezera, chomwe:

1. Amachepetsa kuchuluka kwa shuga m'magazi mwakuchepetsa mayamwidwe ake.
2. Amasintha njira zama metabolic.
3. Imayendetsa katulutsidwe wa kapamba.
4. Amathandizira kuchepetsa kulemera komanso kusintha kagayidwe kachakudya.

Zowonjezera zitha kutumikiridwa ngati mankhwala amodzi popewa matenda amtundu wa 2, ndipo zitha kukhala gawo limodzi pazovuta zakuchiritsira. Pogwiritsa ntchito kwa nthawi yayitali "Insulin" mwa odwala pali kuchepa kwamtundu wa glycemic.

Kutsatira kwambiri zakudya zowonjezera komanso zakudya zomwe mumadya, chiwopsezo cha kuchuluka kwa shuga m'magazi chikuyandikira.

Mulingo woyenera kwambiri wa shuga

Kufunika kwa jakisoni wa insulin

Nthawi zambiri, ngati zovuta za matenda ashuga zikupita zaka 5 mpaka 10, kudya komanso kumwa mankhwala sikokwanira. Pali kale mankhwala a insulin kapena osakhalitsa. Koma adotolo atha kukupatsirani insulini kale kwambiri ngati njira zina sizingawongolere kuchuluka kwa shuga m'magazi.

Insulin, monga chithandizo cha matenda a shuga a mtundu wachibiri, m'mbuyomu ankawawona ngati njira yomaliza. Masiku ano, madokotala amatsatira malingaliro osiyana ndi amenewo.

M'mbuyomu, odwala ambiri omwe amadziwa zakumwa za matenda a shuga anali ndi chidziwitso cha glycemic kwa nthawi yayitali, zomwe zimabweretsa ngozi yayikulu pamoyo, ndipo panthawi ya insulin, odwala anali ndi zovuta zambiri za matenda ashuga.

Zochita zamakono zochizira matenda a shuga zawonetsa kuti insulin ndi imodzi mwazomwe amathandizira kuchepetsa shuga. Kusiyana kwake kuchokera pamapiritsi kumangokhala mu njira yoyendetsera (jakisoni) ndi mtengo wokwera.

Mwa odwala omwe ali ndi matenda a shuga a 2, 30-40% ya odwala amafunikira insulin. Kodi kuyamba ndi mankhwala a insulin kungagwiritsidwe ntchito bwanji ndi endocrinologist, chifukwa zonse zimatengera umunthu wa thupi.

Kodi ndingakhale ndi shuga?

Masiku ano, wodwala matenda ashuga ali ndi mwayi uliwonse wopewa kukulira zovuta zosiyanasiyana ndikukhalanso moyo wabwino. Odwala ali ndi mankhwala opangidwa ndi mankhwala ochokera ku zitsamba, kukonzekera kwa insulin, othandizira kudziletsa komanso njira zingapo zoyendetsera.

Kuphatikiza apo, "masukulu a shuga" atsegulidwa, omwe amaphunzitsa anthu odwala matenda ashuga ndi mabanja awo. Ntchitoyi cholinga chake ndikuwonetsetsa kuti wodwalayo amadziwa momwe angathere pokhudzana ndi matenda ake ndipo amatha kupirira nawo payekha, kwinaku akusunga chisangalalo cha moyo wamba.

Vuto lalikulu lomwe limachepetsa njira yochepetsera shuga ndizovuta za hypoglycemia. Chifukwa chake, kwa odwala ena ndikulimbikitsidwa kuti azikhala ndi glycemia pamalo okwera, mpaka 11 mmol / l masana.Kusamala kumeneku kungathandize kuti shuga yambiri isagwere.

Mwambiri, mantha a hypoglycemia amakokomeza ndipo satha kuganiza, koma kuchuluka kwa shuga komwe kumalepheretsa nthawi zambiri kumakwera mpaka 10-15 mmol / l masana, komwe ndi kowopsa kwambiri.