Mitundu ya odwala matenda ashuga, kusiyana kwawo ndi chiyani, koopsa ndi momwe mungapewere kukula

Matenda a matenda ashuga amamveka ngati mkhalidwe wakuipa pamene madigiri a matenda awamba kale kudutsa mzere wobwezeredwa. Kodi munthu angagwe kwa ndani ngati michere ya metabolic imaphwanyidwa kwambiri. Matenda a shuga akhoza kukhala amodzi mwa mitundu yonse ya matenda ashuga. Choopsa chachikulu ndi vuto ili mwa munthu yemwe ali ndi matenda osokoneza bongo, omwe achibale ake saganiza momwe angakhalire zovuta.

Kodi chimayambitsa matenda a shuga ndi chiyani?

Nthawi zambiri, chikomokere chimayamba pamene thupi sililandira jakisoni wotsatira wa insulin. Pafupipafupi, kuchuluka kwa insulin kumawerengeredwa molakwika, ndipo mankhwalawo sikokwanira kukwaniritsa zosowa za thupi. Vuto linanso lomwe lingayambitse chikomokere ndi kusinthira ku mankhwala ena, omwe sanayenere kudwala matenda ashuga.

Ndi mtundu 2 wa matenda ashuga, kukomoka kumatha kuchitika ngati munthu wadula kwambiri pulogalamu yazakudya, mwachitsanzo, kudya zakudya zabwino kwambiri. Kukwiyitsa wodwala wofooka kumatha kukhala ndi pakati, matenda opatsirana, kupsinjika, kubereka mwana, opaleshoni.

Kodi kuperewera kwa matenda ashuga kumawonekera bwanji?

Khomalo lisanayambe, munthuyo amakhala kwa nthawi yayitali. Choyamba, panthawiyi amakhala ndi ludzu lamphamvu, kupweteka kwamutu ngati migraine kumayamba, munthu amamva kufooka, kupweteka kwam'mimba, nseru, komanso kusanza. Ngati mumayeza kuyimba ndi kuthamanga, ndiye kuti zimachepa, komanso kutentha kwa thupi. Nthawi zina zimachitika mwachangu.

Kugona, kutopa kwambiri kukupitilirabe, kusintha kwamatenda amkati mwa ntchito yamanjenje kumaonekera - kukomoka kapena kusakomoka boma, chisokonezo, kamvekedwe ka minofu. Ndi zizindikiro zoterezi, muyenera kumangomvera osati pakumverera, komanso kuwunika kukoma mkamwa mwanu: ngati ili ndi "zolemba" za acetone (zikuwoneka ngati fungo la maapulo omwe ali ndi mphamvu), ichi ndi chizindikiro chotsimikizika cha chikomokere chomwe chikubwera. Popanda thandizo kuchokera kwa okondedwa, komanso kukhazikitsa mankhwala apadera, munthu amatha kufa msanga. Kutalika kwa boma la precomatose kumatha kusiyanasiyana mpaka ola limodzi mpaka maola 24.

Mawonekedwe a chikomokere

Ngati chikomokere chikuyamba kupezeka, ndiye kuti wodwala ali ndi ketoacidosis. Zizindikiro zake ndi ludzu, pakamwa pouma, mkodzo wowonjezera, womwe umadutsa pakalibe mkodzo, komanso kuyabwa kwambiri kwa thupi. Zizindikiro zambiri zowonongeka kwa thupi zimachepetsedwa kukhala kufooka kwambiri, kupweteka mutu, nthawi zina kosalephera, zizindikiro zazikulu za dyspeptic. Kuyambiranso koyamba kukomoka kumabwerezedwa, koma kupumula sikumachitika pambuyo potiwukira. Odwala ambiri amakhala ndi matenda otsegula m'mimba, owawa m'mimba. Fungo la acetone limayamba kutchulidwa, khungu limakhala lotuwa, louma, tachycardia limayamba, stupor, lomwe limasandulika chikomokere.

Kodi ndi chiyani chomwe chikuopseza matenda a shuga?

Popeza kukomoka kumachitika chifukwa cha kuchuluka kwa shuga m'magazi, minofu ndi ziwalo zimagwedezeka, chifukwa chotsatira zimasintha kwambiri. Kuchulukitsa kwa kuchuluka kwa mkodzo wotulutsidwa, kusanza, ndi kutsegula m'mimba kumabweretsa thupi, ndipo madzi wamba sangabweze kufooka kwa chinyezi. Kuchuluka kwa magazi ozungulira m'matumbo kumatsikanso, kotero pali hypoxia lakuthwa, kuphwanya kwa magazi kumaselo onse. Ndizowopsa kwambiri kuti minyewa ya ubongo imavulala kwambiri ndi mpweya.

Kuchotsa kwa ma electrolyte - potaziyamu, magnesium ndi mchere wina kumayambitsa kuphwanya kwa mulingo wamchere, womwe umaphatikizidwanso ndi kuchepa kwa madzi. Izi zimatithandizanso pakusintha kwachilengedwe cha ziwalo ndi machitidwe. Mlingo wa shuga ukakwera, thupi limayesa kuthana ndi glucose ochulukirapo pophwanya mafuta ndi minofu ya glycogen. Zotsatira zake, kuchuluka kwa matupi a ketone kumawonjezeka, acetone ndi lactic acid zimawonekera m'magazi, mkhalidwe monga hyperacidosis umayamba.

Momwe mungaperekere thandizo kwa odwala matenda ashuga?

Ngati wodwalayo mwiniyo ndi abale ake akudziwa momwe mkhalidwe wowopsa umawonekera - chikomokere - amatha kuthana ndi mavuto. Mlingo wofulumira wa insulin uyenera kuperekedwa nthawi zonse, womwe umayenera kukhala wokonzekera odwala matenda ashuga. Madokotala nthawi zambiri amachenjeza munthu yemwe ali ndi matenda ashuga za zovuta zake komanso njira zake zochizira. Pambuyo pa isanayambike chikomaso, mumafunikanso kumwa potaziyamu, kukonzekera kwa magnesium, kumwa madzi amchere, mwachangu, asani zakudya zam'magazi mwachangu (pakanthawi kochepa). Mukamakonza matendawo, muyenera kudziwitsa adokotala za nthawi yomwe akukonzekera. Ngati thanzi lanu silikuyenda bwino mkati mwa ola limodzi, muyenera kuyitanitsa ambulansi mwachangu.

Mitundu ya Matenda A shuga

Kuti zisamayende bwino pankhaniyi, ndikofunikira kugawika magawo awiri akuluakulu awa omwe ali ndi vuto lalikulu.

Coma agawidwa kukhala:

Monga ambiri amaganiza kale, hyperglycemic imasiyanasiyana chifukwa ikakhwima m'magazi a munthu, kuchuluka kwa glucose kumakwera kwambiri, komwe kumatha kudumpha 30.0 mmol / lita.

Ndi chifuwa cha hypoglycemic, chofala kwambiri pakati pa odwala omwe ali ndi matenda a shuga 1, m'malo mwake, msambo wake umagwera kwambiri pansi pa 3.0 mmol / lita.

Ndizofunikira kudziwa pasadakhale kuti munthu aliyense azikhala ndi bar yake!

Anthu odwala matenda ashuga omwe akhala ndi matenda ashuga kwa zaka zopitilira 7-10 ndipo amadwala kwambiri chifukwa cha mtundu wake wa insulin osadalira inshuwaransi amakhala omasuka kwambiri ndi glycemia wokwera kwambiri kuposa mamol ochepa. Kwa iwo, "hypoglycemic shock" imatha kuchepa kwambiri m'magazi m'munsi mwa 4.0 - 5.0 mmol / L.

Zonse zimatengera mulingo wa thanzi ndi kuthekera kwa kusintha kwa thupi.

Zomwezi zimayendera kuthamanga kwa magazi. Achinyamata ambiri osakwana zaka 30 (makamaka atsikana) amakhala ndi vuto lomwe nthawi zambiri limakhala pansi. Ndi zaka, pali chizolowezi chowonjezera kukakamizidwa.

Komabe, mosiyana ndi hypoglycemia, hyperglycemia imatha kutukuka malinga ndi zochitika zingapo, zomwe zimachitika chifukwa cha kukhalapo kwa mitundu ingapo yamaphunziro.

Hyperglycemic coma, imagawidwa m'magulu atatu:

Kodi pali kusiyana kotani pakati pa odwala matenda ashuga

Pofuna kuti musapange tsatanetsatane, koma kuti tifotokoze mwachidule zomwe talemba, tikukupemphani kuti muzidziwitsa izi: Zomwe takambirana m'nthawi yochepa kwambiri.

Iliyonse ya matenda a shuga imakhala ndi nthawi yake komanso momwe imapangira chitukuko, ndipo, osaphunzitsidwa nthawi zonse ndi asayansi, ena a iwo amakhala osiyana kwambiri mu matenda, ndipo ena amadzetsa zovuta zowopsa zomwe zimafunikira chithandizo chamanthawi yomweyo.

Hypoglycemic

• seramu glucose> 30 mg% mwa akhanda (nthawi zambiri masiku 2 kapena 3 atabadwa)
• 55 - 60 mg% mwa akulu

Amakula msanga (m'mphindi zochepa) chifukwa cha kutaya kwa glucose.

Khalidwe lina la odwala matenda ashuga omwe amadalira insulin.

Mu nthawi yayitali, chisamaliro chadzidzidzi ndi chisamaliro chimafunika. Ngati simuthandiza munthu pakapita nthawi, amatha kufa mwachangu chifukwa cha zovuta za hypoglycemic kapena kuwonongeka kosasintha kwa dongosolo lamakhalidwe abwino kumatsata, pomwe wodwalayo akadakhalabe olumala mpaka kalekale. Milandu yotere imachitika kawirikawiri pomwe, pambuyo pakupuma kwa hypoglycemic, wodwalayo amatha kusintha umunthu wake, umunthu wake udasinthika chifukwa cha kuwonongeka kwa maselo aubongo ndi dongosolo lamanjenje lambiri.

Vuto lowopsa kwambiri ndi matenda a edema kapena sitiroko, omwe amayambitsa mavuto.

Ngati mwana nthawi zambiri amakhala ndi vuto la hypoglycemia, ndiye kuti zimakhudza luntha lake komanso kukula kwina.

Ketoacidotic

• shuga wa seramu ukufika 300 - 700 mg% (19.0 - 30.0 mmol / lita ndi apamwamba)
• kuchepa kwa bicarbonate anion m'magazi
• anionic plasma kusiyana
• kuchuluka kwa magazi a β-hydroxybutyran, acetate ndi acetone kuchuluka
• mkodzo wa glucose ndi acetone
• magazi osmolarity mpaka 300 mosmol / l
• Hyperketonemia
• pali lipids zambiri m'magazi (cholesterol yathunthu ndi triglycerides)
• ndende ya potaziyamu m'magazi imagwera
• kutsika kwa magazi pH

Amawola pang'onopang'ono mkati mwa 1.5 - masiku awiri. Mu odwala matenda ashuga, okalamba amatha kukhwima m'miyezi ingapo. Mathamangitsidwe, matenda opatsirana, gawo lotsiriza la matenda ashuga nephropathy, infarction ya myocardial imathandizira patsogolo.

Chifukwa chachikulu chachitukuko ndi kusowa kwa insulini, momwe maselo akumwalira kwambiri ndipo chifukwa chake, kuchuluka kwa shuga m'magazi kumakwera (chifukwa cha kulolera kwa glucose, kukana insulini, ndi zina zotere).

Kubwezera kufooka kwa shuga wabodza komwe kwayambika, njira ina yotetezera yopangira mphamvu kuchokera ku lipid nkhokwe imayambitsa - lipolysis. Chifukwa cha kagayidwe kamafuta, komwe kumatheka chifukwa cha njala ya maselo, kuchuluka kwa zinthu zowola - matupi a ketone - kumawonjezeka chifukwa cha oxidation wamafuta achilengedwe am'magazi.

Matupi a ketone - omwe amakhumudwa kwambiri ndi mantha amunthu.

Nthawi yomweyo, pali kuphwanya kwakukulu kwa kagayidwe ka madzi-electrolyte, kamene kamawonjezeranso osmolarity wa magazi (magaziwo amakhala okhuthala).

Zowononga zakumwambazi zimakulitsidwa ndi kusowa kwamadzi - kusowa kwamadzi m'thupi. Glucosuria (glucose mumkodzo) imawoneka ndi munthawi yomweyo polyuria (mapangidwe a mkodzo wowonjezera).

Ma electrolyte ambiri amachotsedwa mu mkodzo, makamaka potaziyamu ndi sodium.

Kuti zinthu zisinthe, ndikofunikira kusintha glycemia, madzi osungika a electrolyte pakulowetsa ma insulin ofupika aanthu osungunuka muzitsulo zamadzimadzi ndi kuchuluka kwa ma elekitirodi.

Hyperosmolar non-acidotic

• shuga wa seramu 600 - 4800 mg% (oposa 30.0 mmol / l)
• kuchuluka kwa matupi a ketone m'mwazi ndi mkodzo sikokwanira
• magazi osmolarity amapitilira 350 mosmol / l
• m'magazi kumachulukitsa kuchuluka kwa creatinine, nayitrogeni, urea
• hypernatremia

Amakula pang'onopang'ono (pang'onopang'ono kuposa ketoacidotic) masiku 10 mpaka 15.

Chopezeka kwambiri mwa anthu achikulire omwe ali ndi matenda a shuga a 2 omwe ali ndi vuto la impso.

Amadziwika ndi kusowa kwa ketoacidosis, hyperosmolarity, hyperglycemia yayikulu motsutsana ndi maziko am'mimba kwambiri.

Sizikudziwikabe bwinobwino momwe mtundu wamtunduwu wa matenda ashuga umakhalira, chifukwa glycemia ndiwokwera kwambiri kuposa ketoacidosis weniweni, koma matupi a ketone sapezeka m'magazi. Kuphatikiza apo, insulini imakhalabe m'magazi a munthu (ngakhale siyikwanira, koma ndi yokwanira!). Sitinganene kuti pali ketoacidotic coma, momwe muli kuperewera kwa insulin kotsimikizika.

Asayansi adavomereza kuti magazi a hyperosmolarity amachepetsa lipolysis ndikutulutsa mafuta acids, ndipo hyperglycemia imachuluka chifukwa cha kulephera kwa impso, popeza impso sizingathenso kuyeretsa magazi chifukwa chakuchepa kwa ntchito yawo yobowoka.

Vuto lomwe limafala kwambiri pa chikomachi ndi matenda otupa.

Lactic acidosis

• kusiyana kwakukulu kwa lactic acid

Ngati tikufanizira ma comas awa, ndiye kuti omwe amasunthika kwambiri ndi awiri:

Poyamba, kuchuluka kwa kayendedwe kumachitika chifukwa cha kufa kwachilengedwe kwamaselo. Maselo abongo amamva makamaka kuchepa kwa shuga. Ngati sikokwanira m'magazi, ndiye kuti ubongo wa munthu "umazungulira" njira zonse zamagetsi. Imachepetsa kugona kwake kosungika ndi kuchitika kwa maselo a ziwalo zonse. Pachifukwa ichi, "hypoglycemic shock", monga lamulo, imatha ndi kukomoka kwadzidzidzi, komwe kumachitika pakatha ola limodzi.

Ngati wodwala matenda ashuga salandila madzi am'magazi mu nthawi (40% yagwiritsidwa ntchito), ndiye kuti kufa mu mkhalidwewu kumachitika pokhapokha maola ochepa, popeza necrosis yayikulu ya maselo aubongo iyamba (imfa).

Mtundu wachiwiri wa chikomokere ndi osowa kwambiri, koma sizipangitsa kuti akhale oopsa. Ngati munthu ali ndi vuto laimpso komanso kwa chiwindi ndi kuphwanya mtima, ndiye kuti nthawi zambiri pamakhala kukomoka chifukwa cha kuwonjezeka kwa lactate ya magazi kumabweretsa kufa. Ndikofunikira kwambiri kuti lactic acidosis iwone momwe wodwalayo akupumira, chifukwa chifukwa chosowa mpweya (ngakhale woipitsitsa - pulmonary edema) zimakhala zovuta kwambiri kuchotsa munthu ku chikomokere.

Ma asidi amatha kukhala osasunthika komanso osasinthasintha. Ngati munthu akupuma movutikira, kumasulidwa kwa ma asidi osakhazikika kumakhala kovuta ndipo vuto la wodwalayo limakulirakulira msanga. Zinthu zotsalira za metabolic zimatha kuwatulidwa kudzera mu impso. Muzovuta kwambiri, hemodialysis imagwiritsidwa ntchito kuteteza magazi ndi impso, koma njirayi ndi yovuta kwambiri ndipo imakhala ndi zotsutsana zambiri.

Matenda a matenda ashuga kumbuyo kwa matenda ashuga a ketoacidosis amakula pang'onopang'ono kuposa awiri omwe ali pamwambapa. Itha kusiyanitsidwa mosavuta ndi ena onse ndi kupezeka kwa fungo la zipatso kuchokera mkamwa kapena acetone, kuchuluka kwa matupi a ketone m'magazi, acetone mumkodzo limodzi ndi glucosuria (glucose wotupa mumkodzo), komanso ululu wam'mimba wotchedwa "m'mimba" wam'mimba. Chifukwa cha chisonyezo chomaliza kuchokera pamndandandandawu, madokotala nthawi zina amapangira matenda olimbitsa thupi ndikuwapatsa odwala kuchipatala cholakwika. Kuphatikiza apo, ali mkati mwa kukomoka mwa munthu, ophunzirawo amakhala ochepa thupi, pomwe kutsutsana ndi maziko a lactic acidosis ndi hyperosmolar non-ketoacidosis coma, amakhalanso abwinobwino, ndipo ndi hypoglycemia amakula.

Kukhalapo kapena kusapezeka kwa kukomoka kungatithandizenso ngati chidziwitso pakuzindikira mtundu wa matenda a shuga. Amadziwika kwambiri chifukwa cha kukomoka kwa hypoglycemic ndipo nthawi zambiri (30% ya odwala) amapezeka mu hyperosmolar non-ketoacidosis coma.

Kuthamanga kwa magazi kumakhala kwakukulu ndi hypoglycemic ndipo kumachepetsedwa kwambiri ndi hyperosmolar coma. M'mawonekedwe ena, nthawi zambiri imakhala yotsika pang'ono kuposa yachilendo.

Zoyeserera zasayansi zowunika

Pa matenda aliwonse okhudzana ndi matenda ashuga, wodwalayo amayesedwa mwachangu, malinga ndi zotsatira zake:

ketoacidosis: leukocytosis, kuchuluka kwa ESR (erythrocyte sedimentation rate), kuchuluka kwa shuga m'magazi kumachulukitsidwa, kuchepa kwa ma bicarbonates ndi pH ya magazi, urea wambiri, mwina kuchepa kwa kusowa kwa sodium, potaziyamu

Hyperosmolar coma: kukula kwa magazi mwamphamvu (kuchuluka osmolality), kuchuluka kwa ESR, kuchuluka kwa maselo ofiira am'magazi ndi Hb (hemoglobin), hyperglycemia wambiri, urea wambiri, sodium yayikulu, potaziyamu

lactic acidosis: leukocytosis ndi kuchuluka kwa ESR, kuchulukitsa pang'ono kwa glycemia, otsika kwambiri a bicarbonates ndi pH, urea itha kupitilira kapena kukhala yabwinobwino

hypoglycemia: shuga wotsika kwambiri

ketoacidosis: proteinuria, cylindruria, micromaturia, kupezeka kwa acetone

Hyperosmolar coma: proteinuria, cylindruria

lactic acidosis: mogwirizana

hypoglycemia: kusanthula kwabwinobwino

Wodwala matenda ashuga wovomerezeka m'chipinda choperekera odwala alinso ndi ECG.

Ma electrocardiogram amakupatsani mwayi wowunika bwino minofu yamtima. Onsewo ketoacidotic ndi hyperosmolar coma (omaliza kufikira kwakukulu) amakhala ndi zotsatira zoyipa kwa myocardium.

Mwazi wakuda kwambiri (wokhala ndi osmolality yayitali) umasokoneza ntchito ya mtima, yomwe imakhudza kuthamanga kwa magazi ndi mkhalidwe weniweni wamitsempha yonse. Pambuyo pake, ngati magazi sanasungunuke ndipo magazi ake sanachepetsedwe, chiopsezo chokhala ndi mitsempha yayikulu, mitsempha ndi tsamba la ma capillaries ochepa limawonjezeka. Chifukwa chake, nthawi zambiri ukatha chikomokere, wodwalayo amayenera kutsatira zotsatirazi: ziwalo za ziwalo zomwe zikukhudzidwa ndi ziwiya zawo, ma radiology, ndi zina zambiri.

Mavuto a matenda ashuga amakula. Zonse zimatengera kusatetezeka, kuchuluka kwa kagayidwe, matenda omwe alipo kapena osakhalapo (matenda opatsirana amatengera kukhazikitsidwa kophatikizana kwamagulu angapo a antibayotiki kwa wodwalayo), komanso zaka zomwe zimatengedwa panthawi yamankhwala okondweretsa.

Zida zazikulu za chandamale ndi izi: mtima, mapapu, ubongo, impso, chiwindi. Kuphwanya kwa ziwalo izi kumakulitsa kwambiri osati chithandizo cha wodwalayo, komanso kumawonjezera nthawi ya kukonzanso atasiya matenda a shuga.

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