Zovuta za shuga > Matenda a shuga

Matenda a shuga ndi matenda opatsirana omwe nthawi zambiri amayambitsa zovuta zingapo zowopsa. Ngati simukugwiritsa ntchito bwino mankhwalawo ndipo simutsatira zakudya, shuga imabweretsa zovuta zina pakugwira ntchito kwa masomphenya, impso, chiwindi ndi ziwalo zina.

Mavuto a shuga amagawika pachimake komanso chovuta. Mavuto owopsa a shuga amapezeka patapita kanthawi kochepa chifukwa chakuwonjezeka kapena kuchepa kwa shuga m'magazi. Pambuyo pake zovuta zimayamba chifukwa chovulaza cha hyperglycemia pamitsempha yamanjenje ndi mitsempha yamagazi.

Mavuto a shuga amawoneka ndi chithandizo chosayenera kapena chachedwa.

Zovuta zazovuta

Angiopathy, ndiye kuti, zovuta zamagazi a shuga, kutengera kukula kwa ziwiya zowonongeka, zimasiyanitsidwa ndi macroangiopathy ndi microangiopathy.

Mavuto a shuga a Microvascular amachititsa kuwonongeka kwa maso ndi impso. Ngati pali macroangiopathy, mavuto ndi ubongo, mtima, ndi zotumphukira zimakhala.

Coma mu matenda a shuga amayamba chifukwa cha kuchuluka kwa shuga m'magazi. Nthawi zambiri izi zovuta za shuga zimayamba motsutsana ndi maziko a hypoglycemia.

Mavuto owopsa amatha kubweretsa imfa.

Hypoglycemic chikomokere

Minyewa ya glucose ikatsika kwambiri kotero kuti maselo aubongo amakhala ndi vuto la kusowa kwa mphamvu, zizindikiro za kuperewera kwa thupi zimawonekera. Hypoglycemia imadziwika ndi mtengo wa glucose wochepera 3.3 mmol / L.

Choopsa cha chikomokere ndikuti minyewa ya ubongo ikhoza kukhudzidwa. Mwachitsanzo, pamakhala mavuto. Izi zitha kuchitika ngakhale mukuyendetsa galimoto kapena m'malo ena kumene chidwi chofunikira chikufunika.

Hypoglycemia imapangidwa pazifukwa zotsatirazi:

mankhwala osayenera a insulini kapena kugwiritsa ntchito mankhwala osayenera ochepetsa shuga,
mavuto azakudya,
zolimbitsa thupi popanda kuchuluka kwa chakudya,
kusala
kumwa mowa
kumwa mankhwala osiyanasiyana, pakati pawo: kukonzekera kwa lithiamu, sulfonamides, beta-blockers.

Zizindikiro za hypoglycemia zimaphatikizapo:

thukuta
ziwalo zanjenjemera
tachycardia
kumva kwamphamvu njala
dzanzi kuzungulira milomo
nkhawa ndi mantha
nseru

Zonsezi zimatengera ma ubongo a ubongo, motero, njira zochiritsira ziyenera kuchitidwa kuti muchepetse kukomoka. Ngati chithandizo sichinachitike,

kugona
chidwi
chisokonezo
mutu.

Ngati zizindikiro zingapo zikuwoneka, pitani kuchipatala msanga.

Hyperglycemic chikomokere

Coma, yomwe imayambitsidwa ndi kuwonjezeka kwa shuga wamagazi, ikhoza kukhala ketoacidotic (ketoacidosis), komanso hypersmolar ndi lacticidal.

Ketoacidosis imachitika chifukwa cha kuchuluka kwa shuga ndi zinthu za metabolic, ndiye kuti ma ketones, omwe amawononga thupi. Zomwe zimayambitsa zimatha kukhala kachilombo, kusowa kwa chithandizo, kapena zolakwika mmenemo, komanso kuvulala, ntchito ndi zina.

Hyperosmolar coma (dehydrating) imapangika pamene magazi okhala ndi osmolarity "ambiri" amatulutsa "timadzi m'maselo, ndikuwathetsa madzi. Vutoli limachitika chifukwa chosowa insulini.

Zomwe zimayambitsa kukomoka uku ndizofanana ndi zomwe zimayambitsa ketoacidosis, komanso zomwe zimapangitsa kuti madzi azitha kuchepa m'madzi zimatheka chifukwa cha izi.

Zizindikiro zomwe zimayambira kupuma:

kuchuluka kwa mkodzo (mpaka malita 8),
ludzu lalikulu
kutopa, kufooka, migraine,
ndikusintha kwa shuga m'magazi, chizindikirocho ndichoposa 16.5 mmol / l,
ziume zopaka ndi khungu,
Pambuyo pa masiku angapo, kuwoneka kuti ali ndi vuto la kuzizwitsa, kenako kumangokhala.

Zizindikirozi ndizodziwika bwino za hyperosmolar state ndi ketoacidosis. Komabe, ketoacidosis ili ndi zosiyana zotsatirazi:

Kupuma kwa Kussmaul kumachitika (kwamaphokoso, kawirikawiri komanso kuya),
kununkhira kwa "maapulo okoma" kumawoneka
pafupipafupi kupweteka kwam'mimba.

Ndi hyperosmolarity, paresis, ziwalo, kusokonekera kwa malankhulidwe ndi kuyerekezera zinthu m'maganizo kumachitika kawirikawiri. Hyperosmolar coma imadziwika ndi kuwonjezeka kwa kutentha.

Kafukufuku akuwonetsa kuti lactic acidosis chikomokere chokha chimakhala chokha. Chimawonekera chifukwa cha kuchepa kwa kuchuluka kwa mpweya womwe umalowa mu minofu nthawi ya mtima, kupuma kwa dongosolo, kuperewera kwa magazi, kuvulala, kuchepa kwa magazi komanso matenda.

Lactic acid kukomoka kumatha kuchitika chifukwa cholimbitsa thupi, kuledzera kapena pakatha zaka 65.

Zizindikiro zake ndizofanana ndi ma coma ena, koma mulibe ma ketoni mumkodzo ndi hyperglycemia yayikulu.

Machedwe mavuto

Mavuto okhudzana ndi matenda a shuga kapena matenda am'mbuyomu a shuga ndi zotupa zamagazi, i.e., diabetes. Angiopathies.

Diabetes angiopathy ndi zotupa zazing'onoting'ono, zazing'ono komanso zazikulu. Ngati ziwiya zazing'ono (arterioles, capillaries ndi venule) zimakhudzidwa, microangiopathy imapangidwa.

Kugonjetsedwa kwa zombo zazikulu komanso zapakatikati kumatchedwa macroangiopathy. Izi zimayambitsa kuwonongeka kwa maso ndi impso. Zombozi zimakhudzidwanso:

Matenda a shuga

Matenda a diabetes nephropathy ndi kuwonongeka kwa impso mu shuga, komwe kumayambitsa kulephera kwa impso.

Mawonetsero oyamba a nephropathy amawonekera patatha zaka 5-10 pambuyo pa ishuga. Nephropathy ndi mtundu uwu wamavuto omwe nthawi zambiri umayambitsa imfa ya wodwala yemwe ali ndi matenda a shuga 1.

Izi matenda a impso ali ndi magawo angapo:

microalbuminuria,
proteinuria
aakulu aimpso kulephera.

Nephrotic syndrome imabweretsa kuchepa kwamapuloteni voliyumu pa gawo lililonse la magazi. Kuyambira kukhazikitsidwa kwa proteinuria yosalekeza, zizindikilo zonse zomwe zimakhala ndi kulephera kwa aimpu kujowina. Gawoli lili ndi njira yopitira patsogolo mosinthasintha.

Chomwe chimapangitsa kukula kwa aimpso kulephera kumawonedwa ngati matenda oopsa, ndiye kuti magazi amawonjezeka. Monga lamulo, pa nthawi iyi, njira zingapo za kutupa zimawonekera zomwe zimadutsa mu kwamikodzo.

Ndikofunikira kukwaniritsa kuchuluka kwa kuthamanga kwa magazi, sayenera kupitirira 130/85 mm RT. Art. Ngati mankhwalawa Enalapril ndi mankhwala ofananawo apezeka kuti sagwira ntchito, chithandizo chowonjezereka ndi Verapamil kapena Diltiazem ziyenera kukhazikitsidwa.

Kuphatikiza apo, mutha kugwiritsa ntchito diuretics, mwachitsanzo, Furosemide, komanso Atenolol. Therapy mapangidwe aimpso kulephera amatsimikiza ndi gawo la matenda.

Kulephera kwamakina kumatha kukhala kosasangalatsa komanso kudwala.

Matenda a shuga a retinopathy

Vutoli limadziwika ndi kuwonongeka kwa mitsempha ya retina, mitsempha ndi ma capillaries. Mu shuga, njira yochepetsera ziwiya imadziwika. Mwanjira imeneyi, zotengera zimayamba kudwala chifukwa chosowa magazi. Degenerative pathologies zimachitika, mawonekedwe a maselo amawoneka pamatumba, makoma amakhala ochepa mphamvu.

Vuto la kuchepa kwa oksijeni limapezeka kwa nthawi yayitali, lipids ndi mchere wa calcium zimayamba kuyikidwa mu retina. Njira zoterezi zimatsogolera ku malo ena owoneka. Chifukwa cha kuchuluka kwa kusintha kwa ma pathological, zipsera ndi ma infineti zimalowa m'matumbo a retina.

Ngati chithandizo sichinalandiridwe ndipo njirayi yachedwa, kuyambiranso kwam'mimba kungachitike, chifukwa chake, khungu. Kugunda kwamtima ndi kugundika kwa ziwiya zowonongeka kumayambitsa kukhumudwa kwakukuru m'thupi lamaso. Komanso, chiopsezo chokhala ndi glaucoma sichitha.

Kuzindikira matenda ashuga retinopathy, ziyeso zingapo ziyenera kuchitika. Njira zakafukufuku:

kuyang'ana kwamaso
kutsimikiza kwa magawo ndi magonedwe,
kusanthula kwa iris, cornea, komanso ngodya ya chipinda cham'maso cha munthu pogwiritsa ntchito nyali.

Ngati mandala okhathamira ndi makristasi atakhala mitambo, ndiye kuti kuyang'ana kwa diso kuyenera kuchitidwa.

Matenda a shuga

Matenda a shuga ndi matenda opatsirana a shuga. Chifukwa chachikulu cha kupsinjika kumeneku ndi kuchuluka kwa shuga m'magazi.

Pali malingaliro angapo a matenda ashuga a m'mimba. Malinga ndi lingaliro lotchuka kwambiri, chifukwa cha kuchuluka kwa shuga m'magazi, kuchuluka kwakukulu kwa glucose kumachitika m'mitsempha. Popeza shuga m'magulu ambiri sakhala ndi metabolism yathunthu, izi zimathandizira kupanga sorbitol.

Chifukwa cha kuchepa kwa mitsempha, chidwi chogwira ntchito poyamba chimalephera. Kuzindikiritsa kuphwanya kumeneku kumachitika pogwiritsa ntchito foloko yomaliza maphunziro, amayikidwa pamutu pa fupa loyamba la tarsus.

Chizindikiro chodziwika bwino cha matenda ashuga awa ndi mawonekedwe a dzanzi ndi kupumira m'miyendo. Mu shuga mellitus, zotsatira za kuwonongeka kwamanjenje zimawonedwa kuti ndizosazungulira kumadera akumunsi, komwe kumatsutsana.

Matendawa akamakula, kusakhazikika kumawoneka m'mimba, pachifuwa komanso m'manja. Ndi nthawi yayitali ya matenda ashuga, minyewa yaying'ono ya ululu imayamba kufa, yomwe imadziwoneka ngati kuchepa kwakumapeto kwa miyendo.

Sensomotor neuropathy nthawi zambiri imayendera limodzi ndi kuchepa kwa chidwi. Makamaka, kumverera kumatsika pamiyendo ndi mikono pakati.

Kuphatikiza apo, zovuta zoyenda komanso kusayenda bwino kwa kayendedwe kazitha kuwoneka. Popeza pali kuphwanya kwamamvedwe, nthawi zambiri munthu samazindikira kuwonongeka kwa mapazi, omwe mtsogolomo ali ndi kachilombo.

Mtima ndi mawonekedwe amitsempha yama mtima, omwe amadziwika ndi kuwonjezeka kwa kugunda kwa mtima kupuma, ndiye kuti, popanda kuchita masewera olimbitsa thupi.

Kutumphuka kapena mawonekedwe am'mimba mwa matenda am'mimba am'mimba amayamba chifukwa cha mantha am'mimba. Chakudya chadutsa m'mphepete chimasokonekera, kutupa kwa khomalo kumayamba.

Chifukwa cha kusokonekera kwamatumbo, kumadzimbidwa komanso kutsegula m'mimba. Kuphatikiza apo, kuphwanya kapangidwe ka madzi am'mimba ndi kapamba amalembedwa. Professhene salivation ndi bysary dyskinesia nthawi zambiri amakula, zomwe zimapangitsa kuti miyala ipangidwe mumiyendo ya bile.

Nthawi zambiri mwa abambo kumakhala kuchepa kwa ntchito zogonana, mwa akazi mumakhala kuphwanya ma hydrate amisala.

Matenda a diabetes a neuropathy amaphatikizidwa ndi kuchepa kwa ntchito ya ana, kusintha masinthidwe mumdima ndikodwala.

Matenda a shuga

Matenda a shuga a matenda ashuga ndi njira ya phazi mu matenda ashuga, omwe amapangidwa chifukwa cha kuwonongeka kwa mitsempha yotupa, minofu yofewa, khungu, mafupa ndi mafupa. Pathology imafotokozedwera zilonda zam'mimba komanso zowawa, zotupa za m'mafupa komanso puritis-necrotic.

Kapangidwe ka mitsempha ya phazi la matenda ashuga kumayendera limodzi ndi kusintha kwa ziwiya zamiyendo. Chifukwa cha kuchuluka kwa ziwiya za phazi, edema ndi kuwonjezeka kwa kutentha kumachitika. Chifukwa cha kuchepa kwa magazi, ziwiyazi zimayamba kudwala chifukwa chosowa mpweya womwe umalowa m'zigawo za phazi.

Phazi limayamba kutupira komanso kutundana. Kusintha kwa zinthu mu fupa-ligamentous kungakhale kwa nthawi yayitali.

Zochizira matenda ashuga, njira ziyenera kutengedwa kuti matenda a metabolic asinthike, komanso:

maantibayotiki
chilonda
kumasula ndi kupumula phazi,
kuchotsa kwa malo amaloza khungu,
kuvala nsapato zapadera.

Khungu kumapazi limakhala lotumbululuka kapena lacyanotic. Nthawi zina chifukwa cha kukulira kwa capillaries, khungu limakhala lofiirira.

Pazifukwa zodziwitsa:

Njira yofikira
mbiri yamiyendo yamiyendo,
makina ophatikizika ndi maginito oyesa,
kupanga kwa ultrasound kwamitsempha yamagazi.

Kupewa

Chithandizo cha zovuta za mtundu 1 ndi matenda amtundu wa 2 makamaka chimaphatikizapo prophylaxis. Ndikofunikira kutsatira mwatsatanetsatane malingaliro onse azachipatala kuti tipewe kupangika kwa zovuta za shuga ndikuwongolera kusinthasintha kulikonse kwa shuga wamagazi.

Popanga zovuta zilizonse, njira ziyenera kutengedwa mwachangu kuti matenda a shuga a m'magazi akhale ochepa, popeza njira ya shuga yomweyi, komanso zomwe zimabweretsa, zimadalira izi.

Njira zodzitetezera zimaphatikizapo:

mwadongosolo madokotala
magazi shuga
kutsatira malamulo azakudya,
tsiku lililonse
zolimbitsa thupi ndi kupuma,
zaukhondo komanso zaukhondo m'nyumba,
thandizo la chitetezo chamthupi ndi munthawi yake chithandizo cha matenda ndi chimfine.

Kutsatira malangizowa kumapangitsa kuti matendawa akhazikike bwino komanso kuti muchepetse zovuta.

Ndi zovuta ziti zomwe zingayambike ndi matenda a shuga zomwe akufotokozedwa ndi katswiri kuchokera mu kanema munkhaniyi.

Zovuta za Matenda a shuga

Matenda a shuga ndi vuto lalikulu lazachipatala komanso chikhalidwe lomwe likukula kwambiri chaka chilichonse. Chifukwa cha kufala, matendawa amatengedwa ngati mliri wosapatsirana.

Palinso chizolowezi chowonjezera kuchuluka kwa odwala omwe ali ndi vutoli lomwe limalumikizidwa ndi ntchito ya kapamba.

Mpaka pano, malinga ndi WHO, matendawa amakhudza anthu pafupifupi 246 miliyoni padziko lonse lapansi. Malinga ndi kuneneratu, kuchuluka kumeneku kumatha pafupifupi kuwirikiza.

Kufunika kwa chidziwitso pamavuto kumatheka chifukwa chakuti matendawa amayambitsa kulumala msanga komanso kufa chifukwa cha kusintha kosasintha komwe kumawonekera m'thupi. Kodi kuchuluka kwa matenda ashuga kukuwonjezeka motani?

Chiwerengero cha matenda ashuga padziko lonse lapansi

Matenda a shuga ndi matenda oopsa a hyperglycemia.

Pakadali pano, chomwe chimayambitsa matendawa sichikudziwika. Itha kuwoneka ngati zolakwika zilizonse zimapezeka zomwe zimasokoneza magwiridwe antchito a cellular cell.

Zomwe zimapangitsa kupezeka kwa matendawa zimatheka chifukwa cha: zilonda zazikulu komanso zowopsa zamankhwala am'mimba, matenda oopsa a chithokomiro cha endocrine (pituitary, adrenal gland, chithokomiro cha chithokomiro), zotsatira za poizoni ndi matenda. Kwa nthawi yayitali, matenda ashuga amadziwika kuti ndiwo chinthu chachikulu choopsa cha matenda a mtima.

Chifukwa cha mawonekedwe owonekera a mtima, mtima, ubongo kapena zotumphukira zochokera kumbuyo kwa ulamuliro wapamwamba wa hypoglycemic, matenda a shuga amawoneka ngati matenda enieni a mtima.

Matenda a shuga nthawi zambiri amayambitsa matenda a mtima

M'mayiko a ku Europe, muli anthu pafupifupi 250 miliyoni omwe ali ndi matenda ashuga. Kuphatikiza apo, kuchuluka kodabwitsa sikukayikiranso kuti kudwala kudwala palokha.

Mwachitsanzo, ku France, kunenepa kumachitika mwa anthu pafupifupi mamiliyoni 10, chomwe ndi chinthu chofunikira kwambiri kuti mtundu wa shuga wachiwiri ukhale. Matendawa amakwiya kwambiri chifukwa cha zovuta zina, zomwe zimangokulitsa vutolo.

Ziwerengero Zamatenda Padziko Lonse:

zaka.Kafukufuku wochitidwa ndi asayansi akuwonetsa kuti kuchuluka kwa matenda ashuga kwambiri kuposa momwe zalembedwera ndi nthawi 3.3 kwa odwala okalamba, nthawi 4.3 - kwausinkhu wazaka, nthawi 2.3 - kwa nthawi yachilimwe komanso nthawi 2.7 - kwa zaka,
jenda Chifukwa cha kuthupi, amayi amadwala matenda a shuga nthawi zambiri kuposa abambo. Mtundu woyamba wa matendawa umapezeka mwa anthu ochepera zaka 30. Kwambiri, ndi azimayi omwe amavutika nawo pafupipafupi. Koma mtundu wachiwiri wa matenda ashuga umapezeka nthawi zambiri mwa anthu omwe ali onenepa kwambiri. Monga lamulo, amadwala anthu azaka zopitilira 44,
kuchuluka kwa zochitika. Ngati tilingalira za ziwerengero zam'mayiko athu, titha kunena kuti kuyambira chaka cha 2000 ndi kumatha mu 2009, kuchuluka kwa anthu kwatsala pang'ono kuwirikiza. Monga lamulo, nthawi zambiri pamakhala mtundu wachiwiri wodwala womwe umadwala. Padziko lonse lapansi, pafupifupi 90% ya onse odwala matenda ashuga ali ndi vuto lachiwiri lolumikizidwa ndi ntchito yopanda pancreatic.

Koma kuchuluka kwa odwala matenda ashuga kumayambira ku 0,04 mpaka 0,24%. Izi zikuchitika chifukwa cha kuwonjezeka kwa amayi onse apakati mokhudzana ndi ndondomeko zamayiko, zomwe cholinga chake ndikuwonjezera kuchuluka kwa kubereka, ndikuyambitsa kuwunika koyambirira kwa matenda apadera a shuga.

Ngati tilingalira za ziwonetsero za kuonekera kwa matendawa kwa ana ndi achinyamata, titha kupeza ziwopsezo: nthawi zambiri matendawa amakhudza ana kuyambira azaka 9 mpaka 15.

Kuchuluka kwa zovuta kwa odwala matenda ashuga

Matenda a shuga ndi vuto osati la dziko lathu lokha, komanso la dziko lonse lapansi. Chiwerengero cha odwala matenda ashuga chikuwonjezeka tsiku ndi tsiku.

Ngati tiwona ziwerengero, titha kunena kuti padziko lonse lapansi, pafupifupi anthu 371 miliyoni ali ndi matenda. Ndipo izi, kwa sekondi imodzi, ndizofanana ndi 7.1% ya anthu padziko lonse lapansi.

Cholinga chachikulu chofalitsira kwa matenda amtundu wa endocrine iyi ndi kusintha kwakukuru m'moyo. Malinga ndi asayansi, ngati zinthu sizisintha kukhala zabwino, ndiye pofika chaka cha 2030 chiwerengero cha odwala chidzawonjezeka kangapo.

Mndandanda wamayiko omwe ali ndi chiwerengero chachikulu cha odwala matenda ashuga akuphatikizapo izi:

India Pafupifupi 51 miliyoni milandu
China - 44 miliyoni
United States of America - 27,
Russian Federation - 10,
Brazil - 8,
Germany - 7.7,
Pakistan - 7.3,
Japan - 7,
Indonesia - 6.9,
Mexico - 6.8.

Achinyamata ambiri ku United States amapezeka ku United States. M'dzikoli, pafupifupi 21% ya anthu onse ali ndi matenda ashuga. Koma mdziko lathu, ziwerengero ndizochepa - pafupifupi 6%.

Komabe, ngakhale atakhala kuti mdziko lathu mulingo wa matendawa siwokwera kwambiri ngati ku United States, akatswiri amalosera kuti posachedwa kwambiri zizindikiro zingayandikire ku US. Chifukwa chake, matendawa amatchedwa mliri.

Matenda a shuga 1, monga tanena kale, amapezeka mwa anthu ochepera zaka 29. M'dziko lathu, matendawa ayamba kuchepa: pakadali pano amapezeka mwa odwala kuyambira azaka 11 mpaka 17.

Manambala okhumudwitsa amaperekedwa ndi ziwerengero zokhudzana ndi anthu omwe apambana mayeso.

Pafupifupi theka la anthu onse okhala padziko lapansi sadziwa kuti matendawo awadikirira kale. Izi zikugwirizana ndi cholowa. Matendawa amatha kukhala asymptomatic kwa nthawi yayitali, osayamba kuwonetsa kuti alibe khungu. Komanso, m'maiko ambiri otukuka padziko lapansi matendawa samapezeka konse bwino.

Ngakhale kuti kuchuluka kwa matenda ashuga kumawerengedwa ngati kotsika kwambiri m'maiko aku Africa, pano ndipakuti kuchuluka kwakukulu kwa anthu omwe sanadye mayeso apadera. Chifukwa chonse chagona mu kuperewera kwa kusaphunzira ndi kusazindikira za matendawo.

Kuchulukana kwa zovuta mu anthu omwe ali ndi mitundu yonse ya matenda a shuga

Monga mukudziwa, ndizovuta zovuta zomwe zingabweretse mavuto ambiri.

Zimakhala pachiwopsezo chachikulu kwambiri pamoyo wamunthu. Izi zikuphatikiza mayiko omwe chitukuko chake chimachitika munthawi yayitali.

Ikhoza kukhala maola ochepa. Nthawi zambiri, mawonekedwe oterewa amatsogolera kuimfa. Pazifukwa izi, ndikofunikira kupereka chithandizo choyenerera nthawi yomweyo. Pali zosankha zingapo zodziwika zovuta zamtundu uliwonse, zomwe zimasiyana ndi yapita.

Mavuto owawa kwambiri amakhala ndi: ketoacidosis, hypoglycemia, hyperosmolar coma, lactic acidosis chikomokere, ndi ena. Zotsatira zamtsogolo zimawonekera patatha zaka zochepa zodwala. Kuvulala kwawo sikuwonetsedwa, koma poti zimachedwetsa momwe munthu aliri.

Ngakhale chithandizo cha akatswiri sichimathandiza nthawi zonse. Amaphatikizapo monga: retinopathy, angiopathy, polyneuropathy, komanso phazi la matenda ashuga.

Mavuto a mkhalidwe wosakhazikika amadziwika m'zaka zomaliza za moyo.

Ngakhale kupenda mosamalitsa zonse zofunikira za mankhwalawa, mitsempha yamagazi, ziwalo zam'mimba, khungu, dongosolo lamanjenje, komanso mtima umavutika. Oyimira amuna ogonana mwamphamvu amakhala ndi zovuta zomwe zimawoneka motsutsana ndi zomwe zimachitika m'mbuyomu matenda a shuga, amapezeka pafupipafupi kuposa azimayi.

Omalizirawo amavutika kwambiri chifukwa cha matenda obwera chifukwa cha endocrine. Monga taonera kale, matendawa amayambitsa kuwoneka kwa mavuto owopsa omwe amayambitsidwa ndi kugwira ntchito kwa mtima ndi mitsempha yamagazi. Anthu azaka zopuma pantchito nthawi zambiri amapezeka kuti ali ndi khungu, lomwe limawonekera chifukwa cha kupezeka kwa matenda ashuga.

Koma mavuto a impso amatsogolera pakulephera kwa impso. Zomwe zimayambitsa matendawa zimathanso kukhala ndi matenda ashuga retinopathy.

Pafupifupi theka la onse odwala matenda ashuga ali ndi zovuta zomwe zimakhudza dongosolo lamanjenje. Pambuyo pake, neuropathy imadzetsa kuwoneka ngati kuchepa kwa chidwi komanso kuwonongeka kumadera akumunsi.

Chifukwa cha kusintha kwakukuru komwe kumachitika mumanjenje, kupsinjika monga phazi la matenda ashuga kumatha kuwonekera mwa anthu omwe ali ndi vuto la kupweteka kwa kapamba. Izi ndizowopsa koma zomwe zimakhudzana ndikuphwanya kwamtima. Nthawi zambiri zimatha kudula miyendo.

Matenda a shuga amawopa mankhwalawa, ngati moto!

Ndikofunikira kutsatira.

Kanemayu akufotokoza zofotokozera, mitundu, njira zamankhwala, Zizindikiro ndi Matenda a shuga:

Ngati muli ndi matenda ashuga, simuyenera kunyalanyaza mankhwalawo, omwe samangokhala mankhwala apadera, komanso zakudya zoyenera komanso zopatsa thanzi, kuchita masewera olimbitsa thupi komanso kukana zosokoneza bongo (zomwe zimaphatikizapo kusuta fodya komanso kumwa mowa mwauchidakwa). Nthawi ndi nthawi muyenera kupita ku endocrinologist ndi cardiologist kuti mudziwe zenizeni zaumoyo wanu.

Imakhazikika pamisempha ya shuga kwa nthawi yayitali
Imabwezeretsa kapangidwe ka insulin

Matenda a shuga: ziwerengero zamatenda

Matenda a shuga mellitus (DM) ali ndi vuto la "hyperglycemia" Chomwe chimayambitsa matenda ashuga sichikudziwika. Matendawa amatha kuwonekera pamaso pa zilema zomwe zimasokoneza magwiridwe antchito a maselo kapena kusokoneza insulin.

Zomwe zimayambitsa matenda a shuga zimaphatikizanso zotupa zopweteka za kapamba, kuchepa kwa ziwalo zina za endocrine (pituitary, gren adrenal, chithokomiro cha chithokomiro), zotsatira za poizoni kapena matenda.

Kwa nthawi yayitali, matenda ashuga amadziwika kuti ndi chinthu chofunikira kwambiri chobweretsera matenda a mtima (SS).

Chifukwa chakuwonetsa kwakanthawi kovuta kwamankhwala am'mimba, mtima, ubongo kapena zotumphukira zomwe zimachitika motsutsana ndi maziko a kayendetsedwe kabwino ka glycemic, matenda a shuga amawoneka ngati matenda enieni a mtima.

Ziwerengero za matenda ashuga

Ku France, chiwerengero cha odwala matenda ashuga ndi pafupifupi 2.7 miliyoni, mwa iwo 90% ndi odwala matenda a shuga 2. Odwala omwe ali pafupi ndi anthu (10-15%) omwe ali ndi matenda ashuga samakayikira ngakhale pang'ono matendawa. Komanso, kunenepa kwam'mimba kumachitika pafupifupi mamiliyoni 10.

munthu, chomwe ndi chofunikira pakukula kwa T2DM. Mavuto a SS amadziwika kawiri ndi 2.4 mwa anthu odwala matenda ashuga.

Amazindikira zakukula kwa matenda ashuga ndipo amathandizira kuchepa kwa chiyembekezo chamoyo wodwalayo pofika zaka 8 kwa anthu azaka zakubadwa komanso zaka 4 kwa magulu azaka zaka.

Pafupifupi 65-80% ya milandu, chomwe chimayambitsa kufa kwa odwala matenda ashuga ndimatenda amtima, makamaka myocardial infarction (MI), stroke. Pambuyo pa kusinthika kwa myocardial, zochitika zamtima nthawi zambiri zimapezeka mwa odwala omwe ali ndi matenda ashuga.

Kuthekera kwa kupulumuka kwa zaka 9 pambuyo polowera pulasitiki m'matumbo ndi 68% kwa odwala matenda ashuga ndi 83,5% kwa anthu wamba, chifukwa cha stenosis yachiwiri komanso kukwiya kwa atheromatosis, odwala omwe ali ndi matenda ashuga amakumana ndi kubwerezabwereza kwa myocardial infarction.

Kuchuluka kwa odwala omwe ali ndi matenda ashuga m'madipatimenti amtima kumakulirakulira nthawi zonse ndipo amapanga oposa 33% mwa odwala onse. Chifukwa chake, matenda ashuga amadziwika kuti ndi chinthu chofunikira pangozi yopanga matenda a SS.

Zovuta komanso zopweteka za mtundu 1 ndi mtundu wa 2 wodwala matenda a shuga, kupewa kwawo

Mu shuga mellitus, zovuta zitha kukhala zowawa kwambiri, nthawi yayitali komanso kuwonekera m'tsogolo.

Kupewa zotulukazi ndikosavuta kusiyana ndikumawathandiza kapena, moyipa kwambiri, kukhala olumala chifukwa chophwanya malamulo.

Chifukwa chake, tikulimbikitsidwa kuti tidziwe mwatsatanetsatane matenda a shuga mellitus, kudziwa zonse zokhudzana ndi chizindikiro, mawonekedwe a mankhwalawa komanso kupewa.

Mitundu ya zovuta za shuga

Mavuto a shuga amatha kufotokozedwa mwamphamvu - kuyambira ochepa kwambiri mpaka ovuta kwambiri. Kuphatikiza apo, zovuta zoyambirira komanso mochedwa zimasiyanitsidwa, gulu lawo silovuta. Ndikofunikira kutchera khutu makamaka kuti akatswiri adziwe:

michere yamavuto a shuga,
opaleshoni yamatenda a shuga
mavuto kwa ana
milandu yovuta komanso yopweteka.

Poganizira zovuta za gawoli, ndikofunikira kulingalira pazochitika zonse, kuphatikizapo zovuta za matenda ashuga a 2.

Zotsatira zoyipa

Mavuto aakulu amatchedwanso mochedwa. Amapangidwa ndimphamvu yayitali ya mafuta a shuga pamagulu ndi machitidwe a odwala matenda ashuga. Mavuto a matenda a shuga a mtundu wachiwiri amakhudza ziwalo zamkati kwambiri, zomwe zimakhala mtundu wa matenda.

Matenda a shuga a retinopathy ndiwo chikhalidwe choyamba pamndandanda. Ndiwofala kwambiri ndipo amapezeka pafupifupi 90% ya odwala.

Retinopathy imapangidwa chifukwa cha nthawi yayitali ya matendawa ndipo imachulukitsidwa ndimatumbo a retina. Kuphwanya malamulo nthawi zambiri kumayambitsa kulumala kwa odwala matenda ashuga.

Malinga ndi akatswiri, zovuta ngati izi za matenda obwera chifukwa cha matenda ashuga zimawonjezereka 25 kuposa momwe zimakhalira ndi anthu athanzi.

Matenda a shuga ndi nephropathy ndi zovuta kuzitsatira, monga mitsempha, glomeruli, tubules ndi arterioles. Pathology imapangidwa mchikakamizo cha zinthu zopuwala kagayidwe kazakudya zam'mimba ndi lipids. Kuchuluka kwa nephropathy pakati pa odwala matenda ashuga kufika 75%.

Mavuto a mtundu 1 ndi mtundu wachiwiri wa matenda osokoneza bongo amatha kukhala neuropathy. Tikulankhula za kuwonongeka kwa mitsempha yotumphera, yomwe ndiyotembenukira pafupipafupi.

Vutoli limakulirakulira chifukwa chakuti pakuwonongeka mbali zingapo zamanjenje zimatha kukhudzidwa.

Kuphatikiza apo, neuropathy ndi chimodzi mwazomwe zimatsogolera ku kuwoneka ngati phazi la matenda ashuga.

Chotsatira, muyenera kulabadira matenda a diabetes a encephalopathy, akuti:

Uku ndikuphimba kwaubongo kopita patsogolo,
Amapangidwa mothandizidwa ndi minyewa yayikulu komanso yamphamvu, komanso matenda a metabolic.
Symbomatology ya pathology imalumikizidwa ndi kufooka, kuchuluka kwa mphamvu yogwira ntchito, kuchuluka kwa kutopa, kusakhazikika pamalingaliro, ndi zizindikiro zina,
Ngati chithandizo sichikupezeka, zotsatirapo zake zitha kukhala zowopsa, kuphatikizapo imfa ya wodwala matenda ashuga.

Matenda a 2 a shuga komanso matenda opatsirana amatha kugwirizanitsidwa ndi zotupa zapakhungu.

Zosintha kapangidwe ka khungu, ma follicle ndi tiziwiti thukuta zimadziwika chifukwa cha kuwonongeka kwa kagayidwe kazakudya, komanso kuchuluka kwa zinthu za metabolic. Munthu wodwala matenda ashuga amakhala ndi zotupa, zilonda zam'mimba, matenda a msana komanso ngakhale zovuta za purcin-septic.

Pazowopsa kwambiri zamatenda, khungu limakhala loyipa, kusenda, kusakonda, komanso ming'alu yambiri, kupindika kwa misomali kumapangidwa.

Mndandanda wazovuta zovuta umakwaniritsa matenda a shuga ndi dzanja. Pakuyankhula izi, amatanthauza kusintha kosavuta kwa kagwiritsidwe ntchito kake ndi kagwiritsidwe kake. Amapezeka mu 30% ya odwala omwe ali ndi matenda ashuga.

Nthawi zambiri zimawoneka ngati mawanga a bulauni kumiyendo yakumunsi, zilonda zam'mbuyo kumbuyo kwa mwendo wapansi, komanso phazi kapena phalanges zala.

M'mikhalidwe yovuta kwambiri, khansa ya m'magazi imapangidwa, zomwe zimapangitsa kuti miyendo yake idulidwe.

Zoyambitsa matenda ashuga

Chifukwa chachikulu chowonekera cha matendawa chimatha kutchedwa kuti endocrine. Pankhani ya kuperewera kwa mahomoni ndi kapamba, kuchuluka kwa glucose m'thupi kumachulukirachulukira, njira za metabolic zimasokonekera. Njira yoyenera ya chimbudzi sichimachitika, zinthu zopangidwira zimadziunjikira m'magazi.

Chifukwa chotsatira ndikubadwa. Banja likakhala kale ndi omwe ali ndi chidziwitso cha matenda amtunduwu, chiopsezo chotenga matenda ashuga ndiochulukirapo nthawi zambiri. Munthu wathanzi yemwe alibe zinthu zobadwa nazo amatinso amatha kutenga matendawa chifukwa:

kugwiritsa ntchito zakudya zopanda pake, zinthu zambiri zokhala ndi shuga,
kunenepa kwambiri
matenda oopsa,
kupsinjika
zosokoneza chiwindi.

Matendawa amatenga modabwitsa osati akulu okha, komanso ana. Amakonda kuchitika chifukwa cha matenda omwe amakhala nawo pafupipafupi, chitetezo chochepa. Kulemera kwambiri kumapangitsanso ngozi yakugwa mgulu la predisposition.

Kuchulukitsa kwa matenda ashuga

Zizindikiro zilizonse za matendawa zimafunikira kuchipatala. Izi ndizofunikira popewa kufalikira ndi zovuta za matenda ashuga. Dokotala amasankha chithandizocho chofunikira, amamulembera mankhwala kuti azilamulira.

Kuzindikira kwa shuga - ingomwani tsiku lililonse.

Mtundu wa mankhwalawa umatengera mtundu wamatenda, omwe ndi:

Mtundu 1. Matenda a shuga amakula ali aang'ono, matendawa amakhala pachimake. Insulin siyipangidwa m'mavoliyumu ofunikira, shuga amadziunjikira m'magazi, pomwe maselo sawalandira. Poona izi, ma metabolic a thupi amasokonezeka, ndipo zimayambitsa njira zomwe zimakulitsa vutolo. Maselo amasiya kupeza mafuta ndi mapuloteni okwanira, zomwe zimayambitsa matenda atsopano. Kenako pamakhala kuledzera kwa chamoyo chonse, kusowa kwamadzi. Popanda kukonza mawonekedwe ndi chithandizo chokwanira, kulumala ndi kufa ndizotheka.
Mtundu 2 - mkhalidwe womwe kuchuluka kwa insulini ndikokwanira, koma kuzindikira kwa maselo kumakhala nako. Nthawi zambiri amapezeka kuti amalemera kwambiri, pamene sizingatheke kupanga insulini yamafuta onse amthupi. Mosiyana ndi mtundu 1, kuyambaku sikunatchulidwe, Zizindikiro zake ndi zopanda pake. Matenda akumapeto akadali akuchulukirachulukira ndipo amadzetsa kudumpha kowopsa, kugunda kwamtima ndi kugunda kwamtima. Ngati poyamba matenda amtunduwu amatha kuwongoleredwa ndi zakudya, ndiye kuti pambuyo poti mupewe mankhwala simungathe kupewedwa.

Nthawi zowonjezereka za shuga yodwala zimapezeka mwa odwala onse.

Hyperglycemia

Ichi ndi chizindikiro chomwe kuchuluka kwa shuga mumagazi kumatsimikiziridwa poyerekeza ndi zizindikiro zabwinobwino (3.3 - 5.5 mmol / lita). Mtunduwu umapezeka m'mitundu yonse iwiri yamatenda. Zimachitika ndi vuto la kuperewera kwa zakudya m'thupi, kusefukira kwama calories ndi mafuta, kudya kwambiri. Kugwedezeka kwamatenda am'maganizo, kusokonezeka kwa mitsempha kungayambitsenso kuchuluka kwa matenda a shuga a mitundu yonse 2 ndi mtundu 1. Kupezeka kwa ketoacidosis kumawerengedwa ngati vuto lalikulu la matenda ashuga ndi hyperglycemia.

Ketoacidosis

Mkhalidwe momwe matupi a ketone mumkodzo wa munthu amayamba kudziunjikira mopitilira muyeso. Zimachitika ndi insulin yokwanira m'magazi, kapena matenda a shuga a 2. Kutupa, njira zam'mbuyomu zochitira opaleshoni, kutenga pakati, komanso kugwiritsa ntchito mankhwala oletsedwa ndi odwala matenda ashuga kumatha kupangitsa kuchuluka. Nthawi yomweyo, chizindikiro cha shuga chamagazi chikukula pang'onopang'ono (pamwamba pa 14.9 mmol / lita), zinthu za acetone komanso acidity yamagazi zimakulanso.

Mavuto aakulu

Mavuto a shuga sikuti amangokhala kwambiri, komanso osachiritsika.

Izi zikuphatikiza:

atherosulinosis
matenda ashuga nephropathy,
matenda a shuga a shuga
matenda a shuga
matenda opatsirana
mtima

Ili ndiye mndandanda wachidule wa zovuta za matenda ashuga. Ndikofunika kuganizira iliyonse ya izo mwatsatanetsatane.

Atherosulinosis

Amatengera zovuta za mtundu 2 shuga. Ndi matenda amtunduwu, vasoconstriction imachitika, kufalikira kwa magazi kumakulirakulira ndikuchepa.

Odwala amadandaula za kupweteka m'miyendo atatha ntchito, atagona. Chifukwa cha kusokonezeka kwa magazi kufalikira m'mapazi amiyendo, kuzizira, kutsekemera kumachitika pafupipafupi. Arterial pulsation imasiya kupezeka, mtima wamagazi ndi thrombosis imayamba.

Matenda a shuga

Pathology ndikuphwanya magwiridwe antchito amanjenje yonse.

Pali kufalitsa kwamphamvu kwa ziwalo zina zaubongo, wodwalayo amamva kugugudika, thupi lonse. Kumva kupweteka kumatha, koma osakhudza khungu.

M'tsogolomu, kutayika kwathunthu kwa miyendo. Kufooka kwa minofu, kusayendayenda, kusokonezeka kwa gawo logaya chakudya m'mimba ndi mtima ndizotsatira zonse zakusokonekera uku,

Matenda opatsirana

Zotsatira zoyipa komanso zovuta kwa odwala matenda ashuga.

Kugwira ntchito molakwika kwa chitetezo cha m'thupi kumapangitsa wodwalayo kutetezedwa kumatenda ambiri oyamba ndi bakiteriya. Chiwopsezo cha kutenga mabala chikukulirakulira, pali chiwopsezo choduladula miyendo (ndi zilonda zam'mimba zosachiritsa), imfa. Mankhwala othandizira antioxotic samapereka zotsatira zoyenera, chitetezo chamthupi chimayamba. Kupsinjika kotere kwa matenda ashuga a 2 kumafunikira chithandizo cha insulin limodzi ndi chithandizo cha matenda akulu.

Mavuto a Matenda Ashuga Ana ndi Achinyamata

Mlingo wamatendawa mu ana ndiwowopsa chifukwa cha zovuta zomwe zimawopseza moyo wa mwana. Nthawi zambiri makolo amafunsa kuti ana ndi achinyamata amakumana ndi vuto liti.

Hypoglycemia. Amadziwika ndi kuchepa kwakukulu kwa mishuga m'thupi, pakapanda kuchitapo kanthu, kupweteka, kukomoka kumatha kuchitika.
Ketoacidosis. Kukula koopsa kwa matupi a ketone m'magazi m'masiku ochepa kumayamba kukhala ketoacidotic coma.

Matenda enanso a m'matumbo (zovuta zina za matenda a shuga) amatha: nephropathy, microangiopathy, neuropathy, cardiomyopathy, cataract, ndi ena.

Kodi mavuto amathandizidwa bwanji?

Kwa zovuta za matenda ashuga, chithandizo ndi mankhwala zimakhazikitsidwa kutengera mtundu wa matenda. Mwachitsanzo, zovuta zokhudzana ndi matenda am'mimba a shuga 2 ndizofala kwambiri mwa anthu opitilira zaka 40. Ketoacidosis, hypoglycemia imachitika chifukwa chosagwirizana ndi chithandizo chamankhwala, kutopa kwamankhwala komanso kusankha kosayenera kwa mankhwala.

Mavuto obwera chifukwa cha matenda ashuga, monga amkhazikika, nthawi zambiri amapezeka chifukwa cha kuwonongeka kwa magazi. Ziphuphu ndi minyewa zimasiya kugwira ntchito yawo mokwanira; matenda atsopano amatuluka. Chimodzi mwazovuta za mtundu wa matenda ashuga a chithokomiro ndi chithokomiro (chotupa chotupa cha chithokomiro).

Retinopathy ndimkhalidwe womwe umapezeka mwa theka milandu. M'pofunika kuganizira mwatsatanetsatane kuchuluka kwa matenda ashuga amtundu wa 2 ndi zizindikiro zake.

Kumayambiriro kwa matendawa, kugwira ntchito kwa ziwiya zamkati mwa diso kumasokonezeka, kuwonekeranso kwa khungu. Chithunzi cha chitukuko chimakhala chosalala nthawi zonse, chiyambi chimayamba pang'onopang'ono. Zizindikiro zake zimaphatikizira: Kuchepa kwa mawonekedwe, kuwona kwa "ntchentche" patsogolo pa maso, kuvuta kuwerenga. Chimakula pa liwiro la mphezi, chimayikidwa mgulu la shuga, chomwe chimavuta kuchiza.

Zina mwazovuta za shuga zomwe zimachitika kumapeto kwake ndi monga: kuwonongeka kwa ziwiya zaubongo, mtima, nephropathy. Chithandizo cha zonsezi zonsezi cholinga chake ndicho kuchepetsa mawonetseredwe akuchipatala. Chithokomiro chimakonzedwa mothandizidwa ndi mahomoni, retinopathy - mothandizidwa ndi mankhwala komanso kulowererapo kwa laser, ndi zina zambiri.

Mavuto obwera chifukwa cha matenda ashuga ndiwotsika kwambiri, poganiza za kukula kosasintha komanso zotsatira zosasintha.

Matenda okhudza masomphenya, impso ndi miyendo ndi zina mwazovuta zina za matenda ashuga. Ngati mtima ndi mitsempha yamagazi ili ndi vuto, ndiye kuti osavomerezeka.

Mavuto akulu a shuga

Padziko lapansi pali anthu opitilira 100,000 omwe akudwala matenda ashuga, ndipo ofanana ndi omwe ali mgulu la prediabetes. Matendawa amatengedwa kuti ndi amodzi mwa matenda oopsa kwambiri a endocrine, posakhalitsa amabweretsa mawonekedwe ambiri ovuta. Mavuto a shuga amakula chifukwa cha kuchuluka kwa shuga m'magazi.

Kusintha kwachidziwitso kumatha kuwona kuchokera m'maso, mitsempha yamagazi, mitsempha, impso, khungu, magazi, ndi zina zambiri. Mavuto onse okhudzana ndi matenda ashuga amatha kugawidwa m'njira yayikulu komanso yovuta. Mtundu uliwonse umakhala ndi zake zomwe zimapangitsa komanso kukula.

Mavuto owopsa a shuga amawoneka kuti ndi owopsa kwambiri, chifukwa amatha kupangitsa wodwalayo kuwonongeka msanga, ndipo kufa sikumatha. Mavuto ambiri owopsa amawonedwa ndi matenda amtundu 1 wokha. Matenda owopsa kwambiri omwe amayamba chifukwa cha matenda ashuga ndi awa:

Hypoglycemia. Awa ndi mkhalidwe wa m'matumbo womwe umadziwika ndi kuchepa kwakukuru m'magazi a plasma. Mothandizidwa ndi izi, odwala satenga chidwi cha mwana wawo akamawala, kutuluka thukuta kwambiri, kusiya kuzindikira, komanso kukhudzika kumachitika. Ndikangokhala ndi vuto linalake, matendawa amatha. Nthawi zina, vutoli limatha kukhala osati mwa anthu omwe ali ndi matenda a shuga 1, komanso kwa iwo omwe ali ndi matenda a shuga a 2.
Ketoacidosis. Vutoli limadziwika ndi kuchuluka kwa zinthu zowola m'magazi, zomwe zimapangitsa kuti munthu asamadziwe, komanso kusokonezeka kwamphamvu kwa ziwalo zamkati. Matenda amtunduwu nthawi zambiri amapezeka mwa anthu omwe ali ndi matenda ashuga 1. Nthawi zina, ketoacidosis imabweretsa kudwala matenda ashuga.
Lactacidotic chikomokere. Vutoli limayamba chifukwa cha kuchuluka kwa lactic acid m'magazi. Pakusowa chithandizo chamankhwala choyenera komanso chapanthawi yake, odwala amayamba kuchepa chikumbumtima, kupuma movutikira, kuvuta kuchotsa mkodzo, kudumphadumpha mu kuthamanga kwa magazi ndi zizindikiro zina zowopsa m'moyo. Nthawi zambiri, matendawa amawonedwa mwa anthu achikulire omwe ali ndi matenda osokoneza bongo kwa zaka zopitilira 35.
Hyperosmolar chikomokere. Vutoli limawonedwa ngati loopsa kuposa matenda ashuga omwe adayamba chifukwa cha ketoacidosis. Kukomoka kumeneku nthawi zambiri kumawonekera mwa anthu achikulire omwe ali ndi matenda ashuga a 2. Kuwonetsedwa kwa vutoli kumawonjezeka masiku angapo. Munthu amakhala ndi zizindikiro za polydipsia, polyuria, komanso kufooka kwambiri minofu, kukokana, komanso kusazindikira. Munjira zambiri, madandaulo a odwala ali ofanana ndikuwonetsa ketoacidosis. Zotsatira zakufa chifukwa cha vutoli zili pafupifupi 30%, koma ngati wodwalayo akumana ndi zovuta zina, ngozi ya imfa imawonjezeka mpaka 70%.

Mavuto owopsa a matenda ashuga amatha kuchitika mwa ana ndi akulu, komabe amapezeka kwambiri mwa anthu achikulire. Ndi kukula kwa pathological mkhalidwe, nthawi zonse pamakhala zizindikiro zomwe zimaloleza ngakhale isanayambike gawo lovuta kudziwa kuyambika kwa gawo lazovuta.

Ngati muli ndi vuto la vuto linalake, ndikofunikira kulumikizana ndi achipatala kuti akuthandizeni.

Kudziyang'anira nokha kungakulitse vutolo. Chidziwitso ndichakuti nthawi zonse kukafika kwa dokotala pamakhala mwayi woletsa kupweteketsa mtima asanapange mphamvu.

Kupewa matenda ashuga

Tiyenera kudziwa kuti okhawo omwe amatsatira maulamuliro awo mosamala ndi omwe ali ndi mwayi wopewa zovuta zazikulu. Anthu ambiri omwe ali ndi matenda ashuga samatenga matenda awo moyenera, amaphwanya zakudya zawo, samayang'anira kuchuluka kwa shuga m'magazi awo ndipo samatsata malangizo onse a dokotala pokhudzana ndi chithandizo. Mwayi wokhala ndi zovuta zovuta za matenda osokoneza bongo a mamellitus osinthasintha osiyanasiyana akuyandikira 100%.

Pofuna kuthana ndi zovuta za matenda ashuga, odwala ayenera kutsatira mosamalitsa malangizo a madokotala, azikhala moyo wakhama ndikutsatira zakudya. Kuphatikiza apo, ndikofunikira kwambiri kuwona kuchuluka kwa glucose m'magazi ndikuchitapo kanthu kuti muchepetse.

ACUTE MALANGIZO A ZIWANDA

Matenda a shuga ndi oopsa osati ndi shuga wambiri, omwe amatha kukhala ndi chithandizo chokwanira, koma ndi zovuta zake zam'mimba, zomwe ndizomwe zimayambitsa kulumala komanso kufa pakati pa odwala matenda ashuga.

Kuzindikira mwadzidzidzi kapena kulandira chithandizo mosayenera kumabweretsa zovuta zomwe zimakhalapo pakanthawi kochepa (pachimake) kapena zaka zapitazo (mochedwa).

Mavuto apambuyo pake amaphatikizapo zotupa zazing'onoting'ono za maso, impso, ndi miyendo. Mavutowa amakula pang'onopang'ono, pakupita zaka ndi zaka, motero amatchedwa kuti zovuta zakuchedwa. Ndi chithandizo chabwino cha matenda ashuga, chikaperekedwa, ndiye kuti, shuga amasungidwa mwachizolowezi motsogozedwa ndi mankhwala, zovuta izi sizimakhalapo konse. Mavutowa ayankhidwa mu mutu wotsatira. Pakadali pano, timangoganizira zovuta za matenda ashuga.

Pazovuta zamphamvu, simungataye mphindi - muyenera kuthandiza wodwalayo, chifukwa zovuta kwambiri zimayamba mwachangu, nthawi zina mkati mwa masekondi angapo, mphindi kapena maola. Ngati thandizo siliperekedwa munthawi yake, zotsatirapo zake zingakhale zazikulu kwambiri, ngakhale kufa.

Pali zovuta zisanu zovuta za shuga. Awa ndi hypoglycemia (kutsika kwa shuga m'magazi), hyperglycemia (kukwera kwa shuga), ketoac-Mlingo (kuchuluka kwa acidity), glucosuria (kupezeka kwa shuga mumkodzo) komanso chikomokere shuga. Tiyeni tikambirane chilichonse mwatsatanetsatane.

Mkhalidwe uwu umadziwika ndi kutsika kwa shuga m'magazi poyerekeza ndi mulingo womwe wodwala anali nawo kale: kwa chilichonse, izi zimatha kukhala zosiyana. Ngati mulingo wa shuga unkasungidwa bwino, ndiye kuti kuchepa kwake kufika 3,3 mmol / L ndi kutsika kumakhudza thanzi la wodwalayo ndipo kumatchedwa hypoglycemia. Chofunika kwambiri ndilinso mlingo wa kugwa kwa shuga. Ndi kuchepa kwakuthwa, ngakhale 5.5 mmol / L imawoneka yotsika kwambiri kwa wodwala, ndipo amamva kusasangalala kwambiri. Mosiyana, ngati shuga atachepa pang'onopang'ono, ndiye kuti wodwalayo sangazindikire momwe kuchuluka kwa shuga kumafikira 2,8 mmol / l - pomwe angamve bwino. Chifukwa chake, kuchuluka kwa shuga m'magazi kumathandizira kwambiri pakukula kwa hypoglycemia kuposa chizindikiro cha shuga palokha.

Hypoglycemia ndi mkhalidwe womwe umatha kuwonekera ngakhale mwa anthu athanzi utatha kugwira ntchito yambiri yamisempha, ngati sakanabweza kumwa kwa glucose ndi chakudya cham'mimba mosavuta. Kutsika kwa shuga m'magazi kumatha kuwonedwa pakuwonongeka kwakukulu kwa mphamvu. Pankhaniyi, muyenera kudya chidutswa cha shuga, ndipo mkhalidwe wopanda pake umasowa. Mkhalidwe wa hypoglycemia mwa anthu athanzi ukhoza kutchulidwa kapena kuchepera, ndipo anthu ambiri atha kuzindikira izi.

Chochititsa cha hypoglycemia ndi kuchepa kwa shuga m'magazi. Komabe, zimatha kuchitika osati chifukwa chakuchepa, komanso chifukwa cha chakudya chambiri chamafuta. Mwachitsanzo, bambo amadya makeke atatu nthawi imodzi, ndipo adayamba kufooka kwambiri ndipo thukuta lidabuka pamphumi pake. Izi zikusonyeza kuti kapamba adayankha pakudya zamafuta ambiri ndikumasula kuchuluka kwa insulin, komwe kumatsitsa shuga mpaka malire. Zotsatira zake, munthu wathanzi lathunthu adakumana ndi vuto la hypoglycemia.

Zina zomwe zimayambitsa hypoglycemia ndi monga: chakudya chosakwanira chomwe munthu watenga (kufooka chifukwa cha njala), kuchita zolimbitsa thupi kwambiri, matenda ena am'mapapo ndi ziwengo za endocrine.

Mankhwala ena amatha kuthandizira kukulitsa kwa hypoglycemia, monga tetracycline, oxytetracycline, terramycin, sulfamides, anticoagulants, acetylsalicylic acid, anaprilin, reserpine, clonidine, komanso anabolic steroid ndi mowa.

Matendawa amakula msanga, pakapita mphindi zochepa. Amadziwika ndi kumva kwamphamvu kwa njala ndi kufooka kwakukulu, komwe kumakulira ndikufika pachimake, kotero kuti munthu akaphwanya thukuta lamphamvu, akuyamba kugunda kwamtima komanso kunjenjemera kwamkati mwamkati, kuwona kawiri, komanso ngakhale chisokonezo.

Momwe mungathandizire kuukira kwa hypoglycemia

Muyenera kudya chakudya cham'mimba chambiri: chidutswa chaching'ono cha mkate, zidutswa zingapo za shuga, kumwa kapu ya tiyi wokoma. Pakatha mphindi zochepa, ngati vutolo silikuyenda bwino, tenganinso shuga. Ndikwabwino kusalowetsa m'malo ndi maswiti, makeke kapena chokoleti, chifukwa shuga omwe amapezeka mumalowedwe amakhala wowonda komanso pang'onopang'ono, mkati mwa mphindi 15-20. Ndipo simungathe kudikira motalika kwambiri. Chifukwa chake, ngati munthu ali ndi vutoli, ndibwino kuti nthawi zonse azikhala ndi shuga pang'ono.

Hypoglycemic shock ndi kuchepa kwambiri kwa shuga m'magazi, omwe amapezeka ndi kuchuluka kwakukulu komwe kumayambitsidwa kapena kubisidwa ndi insulin ya kapamba. Matendawa ndi owopsa, amakula msanga ndikusintha chikomokere. Gawo loyamba ndikutulutsa kwa chapakati mantha, gawo lachiwiri ndikumverera kofowoka, kugona ndi kugona, nthawi zina kumayendetsedwa ndi kusalingalira kwakutali kwamalingaliro, ndipo pamapeto pake, gawo lachitatu (ndi kutsika kwa glucose wamagazi mpaka 40% kapena kutsika) - kunjenjemera, kukokana, kusazindikira.

Pothana ndi vuto la hypoglycemic, munthu amafunika thandizo mwachangu - jekeseni 20-60 ml ya shuga 40% kapena 1 mg ya glucagon pansi pa khungu kupita mu mtsempha, womwe umapereka zotsatira zabwino kwambiri. Zachidziwikire, njira zonsezi ziyenera kuchitidwa ndi adotolo, ndipo anthu oyandikana ndi adokotala asanafike angathandize wodwala motere: kuvala lilime kapena kupukutira kena kena kake kamkamwa - shuga kapena uchi.

Zomverera monga ndi hypoglycemia weniweni - kunjenjemera m'malire, kufooka, thukuta lozizira. Komabe, kuchuluka kwa shuga m'magazi ndikwabwinobwino, koma kumatsika kwakhazikika pakapita nthawi yayitali hyperglycemia (shuga yayikulu), ndiye kuti pambuyo pa insulin.Kuti munthu asamve kusasangalala, ayenera kudya kapena kumwa kanthu.

Mkhalidwe wofatsa wa hypoglycemic samasiya chizindikiro, koma kukomoka kwa hypoglycemic kumakhala koopsa chifukwa cha kusinthika kosasintha kwa maselo muubongo, komwe kumawonetsedwa mwaukadaulo, nzeru, khunyu, ndi zina zambiri.

Ngati magazi a shuga akwera kotero kuti amapitilira zovomerezeka, ndiye kuti hyperglycemia imachitika. Kuonjezera shuga kumawonjezera ntchito ya impso, yomwe imafuna kupaka shuga mu mkodzo, kotero munthu nthawi zambiri amakodza (pambuyo pa maola 1-2). Zotsatira zake, thupi limataya madzi ambiri ndi ludzu lamphamvu ndikukamwa kowuma. Ngakhale usiku, munthu amatha kudzuka kuzizindikiro izi. Zonsezi zimayenda limodzi ndi kufooka wamba komanso kuchepa thupi, ndipo munthu akayamba kuchepa thupi, ndiye kuti ali ndi vuto lalikulu.

Komabe, ngati magazi a magazi akwera pang'onopang'ono, ndiye kuti munthu sangazindikire. Kutsika kwapang'onopang'ono kwa shuga kumapangitsa kusintha koopsa mthupi, ndipo wodwalayo amawazolowera ndipo samadziona ngati wodwala. Uku ndiye kuchepa kwa hyperglycemia.

Hyperglycemia imatha kuchitika nthawi yomweyo hypoglycemia itatha. Izi zimachitika motere: chiwindi chimayankha mwachangu kuchepa kwa shuga m'magazi ndikutulutsa shuga m'magazi, chifukwa, shuga wamagazi amakwera pamwamba pazomwe zimachitika. Nthawi zambiri, hyperglycemia yotere imachitika m'mawa, ngati usiku tulo tulo timachepetsa shuga. Chifukwa chake, chizindikiritso chowonjezereka cha shuga m'mawa, ndi shuga wabwinobwino masana, chimatha kukhala chiphokoso.

Kutengera ndi kuchuluka kwa shuga m'magazi, hyperglycemia imagawidwa m'magawo atatu - ofatsa, odziletsa komanso owopsa (Gawo 6).

Kusala magazi m'magawo osiyanasiyana a hyperglycemia

Ketoacidosis imawonetsedwa ndi zizindikiro zotsatirazi: kusanza, kupweteka kwam'mimba, kununkhira kwa acetone kuchokera mkamwa, kukoka pafupipafupi ndi kufooka, kuthamanga kwa magazi, komanso kununkhira ndi mawonekedwe a asetoni mumkodzo. Zotsirizazo zimatha kukhala zowopsa - ketoacidotic chikomokere.

Kodi ketoacidosis ndi chiyani ndipo imachitika bwanji? Wodwala yemwe ali ndi matenda ashuga, magazi a m'magazi nthawi zambiri amadzuka, ndipo thupi limayankha izi ndikamachotsa shuga mumkodzo. Zotsatira zake, maselo amayamba kufa ndi njala, ndipo chiwindi chimathamangira kukawathandiza, ndikuponya glucose wophatikizidwa ndi iye m'magazi ndikukweza shuga m'magazi kwambiri. Koma izi sizikwaniritsa maselo, chifukwa palibe insulini. Kenako thupi limayesetsa kuthana ndi vutolo m'njira ina: limadzithira mafutawo kuti ipatsenso mphamvu. Mwanjira imeneyi, poizoni wa asidi amapangidwa, yemwe amadetsa thupi. Poizoni amatchedwa matupi a ketone. Zimalowa m'magazi kudzera m'magazi, ndikusokoneza acid yake. Ketosis imapezeka m'thupi - momwe matupi a ketone amadzisonkhanira. Akamapangidwa kwambiri, magaziwo amasintha moyenera kwambiri. Ndi poizoni wamphamvu ndi matupi a ketone, ketoacidosis imachitika, yomwe imatha kulowa mu ketoacidotic coma.

Kutsika kwambiri m'munsi mwa asidi kumatha kupha.

• Mulingo woyenera wa acid-base balance ndi 7.38-7.42 pH.

• Mulingo wowopsa - 7.2 pH.

• Coma imabwera - 7.0 pH.

• Wofera - 6.8 pH.

Ndi ketoacidosis, chithandizo chamankhwala chofunikira ndichofunikira. Dokotala amalowetsa insulin m'mitsempha ya wodwalayo ndikuwononga acetone mothandizidwa ndi mayankho a mtsempha wa magazi. Izi zimachitika kawirikawiri kuchipatala. Wodwalayo sangathe kupirira vuto lakelo, ngati muli ndi vuto la ketoacidosis, itanani dokotala nthawi yomweyo.

Ili ndiye vuto linanso lalikulu la matenda ashuga omwe shuga amapezeka mkodzo. Nthawi zambiri, shuga amalowa mkodzo pomwe magazi ake amapitilira zomwe zimadziwika kuti aimpso - 8-11 mmol / l (160-170 mg%). Koma zimachitika kuti shuga mkodzo umawonekera, ngakhale umakhala wabwinobwino m'magazi. Izi zimachitika ngati shuga ndi mkodzo wathiridwa kwa nthawi yayitali ndipo impso zayamba kale "kugwiritsidwa ntchito" panjira iyi, chifukwa chake shuga amathandizidwabe ngakhale atakhala oyenera m'magazi. Matendawa ndi matenda a shuga a impso.

Ichi ndi chiopsezo chowopsa cha wodwalayo, chomwe chimadziwika ndi kutaya mtima kwathunthu, kusayankha kuyang'ana kwakunja ndi kusokonezedwa kwa ntchito zofunika kwambiri za thupi. Ndi chikomokere, kuletsa ntchito za chapakati mantha dongosolo kumachitika. Coma imachitika ndikusowa kwambiri kwa insulin, imagwirizanitsidwa ndi hyperglycemia ndi ketoacidosis pagawo lovuta kwambiri.

Zomwe zimayambitsa kudwala matenda ashuga zimatha kukhala nkhawa kwambiri, matenda opatsirana kapena mtima, kuwonongeka kwa insulin.

Odwala omwe ali ndi matenda ashuga ayenera kuyesa kuwongolera momwe akumvera kuti asakhumudwitse malingaliro a thupi pazinthu zosokoneza, onani mtima, kupsa mtima ndikuyesera kudziteteza ku matenda opatsirana, onani mosamala masiku a insulin.

Matenda a shuga ketoacidosis

Matenda a shuga a ketoacidosis amakula mwa odwala omwe ali ndi matenda a shuga 1 okhala ndi vuto la insulin komanso wachibale. Vutoli limayamba chifukwa cha kupuma kwa jakisoni wa insulin. Ndizothekanso motsutsana ndi maziko a insulin yothandizira pazochitika zamatenda, chithandizo cha opaleshoni, kupsinjika kwa mtima ndi kumwa kwambiri mowa, zomwe zimapangitsa kufunika kwa insulin.

Ngati kuchepa kwa insulin kumayambitsa kuchuluka kwa glucagon, ndiye kuti muvutike mtima zomwe zili ndi glucagon zimayamba chifukwa cha kupsinjika kwa mahomoni (adrenaline, norepinephrine, cortisol ndi STH), omwe amachititsa secretion ya glucagon ndikuletsa insulin secretion. Zotsatira zake, kugwiritsidwa ntchito kwa glucose ndi zotumphukira zimakhala ndikuwonongeka ndipo mapangidwe a shuga mu chiwindi amachulukitsidwa chifukwa cha kukondoweza kwa gluconeogeneis, glycogenolysis ndi kuletsa kwa glycolysis.

Gawo laling'ono la gluconeogenolysis ndi ma amino acid omwe amapangidwa pakuwonongeka kwa mapuloteni mu zotumphukira zimakhala. Anayamba kwambiri hyperglycemia amachititsa osmotic diuresis, yomwe imayendetsedwa ndi hypovolemia, kuchepa kwa magazi ndi kutaya magazi, potaziyamu, phosphate ndi zinthu zina mkodzo. Nthawi yomweyo, mapangidwe a matupi a ketone (ketogenesis) kuchokera ku mafuta achilengedwe omasuka kuchokera ku depot kupita mu minofu ya adipose amayamba m'chiwindi. Chiwindi chimapereka mphamvu zochulukirapo za β-hydroxybutyric ndi acetoacetic acid, kugwiritsa ntchito komwe kumatulutsa ndi zotumphukira.

Mu pathogenesis ya ketogeneis, glucagon ndi wofunikira kwambiri. Glucagon imakulitsa kuchuluka kwa chimanga m'chiwindi, zomwe zimapangitsa kuti mafuta achulukane kulowa mu mitochondria, komwe amapanga β-oxidation ndikupanga matupi a ketone. Glucagon, kuwonjezera, imachepetsa zomwe zimakhala m'chiwindi cha mafuta oxidation inhibitor, malonyl-CoA. Zithunzizi zimayambitsa kutsegula kwa carnitine Palmitoyltransferase I ndikukula ketogene. M'magazi, kuphatikiza kwa ma hydrogen ions a matupi a ketone okhala ndi bicarbonate kumachitika, komwe kumayendetsedwa ndi kuchepa kwa zomwe zili serum buffer ndi pH. Kukula kwa Hyperventilation kumachepetsa kuchuluka kwa mpweya woipa m'magazi am'magazi, ndipo ma ro-hydroxybutyric ndi acetoacetic acids amathandizira kusiyana kwa anionic. Zotsatira zake, metabolic acidosis imayamba kuphatikizira ndi kusiyana kwa anionic.

Zizindikiro Matenda a shuga a ketoacidosis amatha kudwala mwadzidzidzi, kwa maola angapo, kapena pang'onopang'ono, kwa masiku angapo. Odwala, chilimbikitso chimachepa, kukomoka kumawonjezera, nseru, kusanza ndi kupweteka kwam'mimba kumawonekera, komwe kumatulutsa ndipo sikumadziwika kwawokha.

Sever acidosis imapangitsa hyperventilation (kupuma kwa Kussmaul), komwe kumakhala kotsatira, chifukwa kumathandizira kutulutsa kwa kaboni dayokisi komanso kumachepetsa metabolic acidosis. Mlengalenga wotulutsa, fungo la acetone nthawi zambiri limatsimikiziridwa.

Pakufufuzidwa, khungu louma ndi mucous nembanemba, kuchepa kwa khungu la turgor ndi kamvekedwe ka minofu, kosonyeza mkhalidwe wamadzi, kumawululidwa. Kutentha kwa thupi ndikwabwinobwino kapena kochepa. Kuchuluka kwa magazi ozungulira kumachepa, orthostatic hypotension imachitika, koma kugwedezeka sikumayamba. Ndi kupitilira kwa ketoacidosis, chikumbumtima chodwala, 10% ya odwala amayamba kudwala matenda ashuga.

Zizindikiro Minyewa ya m'magazi a Plasma imachulukirachulukira, pafupifupi 22 mmol / L (400 mg%). Magazi a glucose okwera kwambiri amapezeka mu Kimillstil-Wilson syndrome. Serum β-hydroxybutyric ndi acetoacetic acids ndi milingo ya acetone imakwezedwa. Mlingo wa Serum bicarbonate ndi wocheperako 10 meq / l, kusiyana kwa anionic kumakulitsidwa. Mlingo wa potaziyamu wa seramu poyamba ndi wabwinobwino kapena wapamwamba (chifukwa cha kayendedwe kake kuchokera mu intracellular mpaka kumalo a extracellular). Pambuyo pake, ndende ya potaziyamu imachepa. The kuchuluka kwa seramu sodium nthawi zambiri amachepetsa chifukwa kuchotsedwa kwa osmotic gradient kuchokera m'maselo kupita ku plasma. Serum osmolality nthawi zambiri imakhala yoposa 300 mosmol / kg. Mkodzo wakweza minyewa ya glucose komanso matupi a ketone.

Zizindikiro zodwala za wodwala yemwe ali ndi mtundu wa matenda a shuga 1, mawonetsedwe azachipatala, hyperglycemia, hyperketonemia, glucosuria ndi ketonuria zimapangitsa kuti azindikire mosavuta komanso molondola matenda ashuga a ketoacidosis.

The kusiyanasiyana matenda a matenda ashuga ketoacidosis ikuchitika:

ndi lactic acidosis, uremia ndi njala, momwe metabolic acidosis imayamba ndi nthawi yayitali ya anionic. Mosiyana ndi matenda ashuga a ketoacidosis, m'mikhalidwe iyi, matupi a glucose ndi ketone palibe mkodzo.
ndi chidakwa cha ketoacidosis, chomwe nthawi zambiri chimayamba kudya. Mowa ketoacidosis imayendera limodzi ndi vuto la dyspeptic, kupweteka kwam'mimba, koma kuchuluka kwa glucose kotsika. Hyperglycemia imapezeka mwa odwala pawokha ndipo osapitilira 15 mmol / L. Zakumwa zoledzeretsa za ketoacidosis, mosiyana ndi matenda ashuga, zimathetsedwa mosavuta ndi kulowetsedwa kwa iv ndikuyambitsa matenda a thiamine ndi mavitamini enanso osungunuka ndi madzi.

Chithandizo. Kuphatikiza mankhwala a insulin, kuchepa madzi m'thupi, kubwezeretsa kuchepa kwa michere ndi ma elekitiroma ndi chithandizo cha zovuta ndi zovuta zina.

Pa matenda ashuga a ketoacidosis, insulini iyenera kuperekedwa. Mlingo woyambirira wa insulin yochepa ya 0.1 U / kg imayendetsedwa kudzera mkati, ndikutsatira kulowetsedwa kwa 0.1 U / kg / h, i.e. pafupifupi 4 mpaka 8 mayunitsi / h mpaka kuthetsedwa kwa ketoacidosis. Ngati msambo wa glycemia suchepa 2 mpaka 3 maola atayamba insulin, mlingo wa insulini umachulukitsidwa kawiri ola lotsatiralo. Kuchepa kwa kuchepa kwa glycemia sikupitilira 5.5 mmol / l / h ndipo osatsika kuposa 13-14 mmol / l tsiku loyamba. Ndi kuchepa kwapang'onopang'ono, pamakhala ngozi ya osmotic imbalance syndrome ndi edema yam'mimba.

Mankhwala othandizira kulowetsedwa nthawi zambiri amakhala maola angapo mpaka plasma glucose itatsikira mpaka 5.5 mol / L (75-100 mg%), matupi a ketone ndi pH imachulukana. Koma odwala ena alibe okwanira pamankhwala awa, omwe mwina chifukwa cha kukana kwambiri kwa insulini, ndikofunikira kuperekera Mlingo wambiri wa insulin pamtunda wa 20 mpaka 50 PIECES / h, mothandizidwa ndi milingo yayikulu ya insulin machulukitsidwe a insulini amapezeka mosavuta pakakhala ma autoantibodies ndipo zina zomwe zimapangitsa insulin kukana. Ngati ndizosatheka kuchita insulin mankhwala a insulin, ndi kotheka kupaka insulin molingana ndi chiwembu chotsatira: mlingo woyambirira ndi magawo 20 a insulin yochepa i / m, jakisoni wotsatira ndi magawo 6 a insulin yochepa kamodzi pa ola limodzi.

Atayimitsa hyperglycemia ndi acidosis ndi kuchepa kwamatumbo a mkodzo, amasinthana ndi kulandira chithandizo chamankhwala ochepa kwambiri kwa maola 4 mpaka 5, malinga ndi kuchuluka kwa glycemia. Kuyambira tsiku loyamba atasinthira subcutaneous insulin mankhwala, n`zotheka kuperekanso insulin kuwonjezera pakanthawi kochepa insulin Mlingo ya 10 - 12 PIECES 2 kawiri pa tsiku.

Kuthetsa magazi kumakonzedwa ndi kulowetsedwa mankhwala. Kusowa kwamadzi mu ketoacidosis ndi malita 3-5, kumalipidwa ndi mayankho a saline. M'mawola awiri oyambilira atagonekedwa kuchipatala, mavitamini 1-2 a isotonic 0.9% sodium chloride solution amaperekedwa mwachangu iv. Ndi kuwonjezeka kwa ndende ya sodium ku 155 meq / l, yankho la hypotonic (0.45%) la NaCl limayambitsidwa pamlingo wotsika (300-500 ml ya saline m'maola otsatira).

Mankhwala a insulin amachepetsa shuga m'magazi ngakhale isanathetse ketoacidosis. Mkulu wa glucose akatsika mpaka 11-12 mmol / l (200-250 mg%), yankho la glucose 5% limatumizidwa kuteteza hypoglycemia. Ngati shuga woyambirira wa plasma ndi wochepera 20 mmol / L (400 mg%), shuga amayamba kutumizidwa kuyambira pachiyambire chithandizo. Nthawi zina kukonzanso madzi am'magazi kumachepetsa shuga m'magazi chifukwa chochulukitsa, motero, glucosuria ndi kuchepa kwa makatekolamaines ndi cortisol popanda kugwiritsa ntchito insulin.

Lingaliro lofunika pa mankhwalawa a matenda ashuga acidosis ndikusintha kwa potaziyamu, omwe malo ake m'thupi ndi otsika. Kumayambiriro kwa metabolic acidosis, ndende ya potaziyamu imachuluka. Koma motsutsana ndi maziko a mankhwala a insulin, kuchepa kwa potaziyamu kumayamba, ndikuwopseza moyo wa wodwalayo. Chifukwa chake, ndikofunikira pambuyo pa maola 2 kuchokera pachiyambireni chithandizo kuyambira pomwe mukuwonjezeka diuresis panthawi yokhazikika kapena yotsika ya potaziyamu mu seramu, kukhazikitsidwa kwa yankho la potaziyamu chloride pa liwiro la 15-20 meq / h pokhapokha m'mitsempha yamapapo. Ndi kuyambitsa kwa potaziyamu, kuyang'anira mosamala ECG ndikulimbikitsidwa.

Ndi mankhwala a insulin, phosphate imatha kulowa m'maselo ndikuchepetsa plasma. Kuwonongeka kwa phosphates kumalipidwa ndi kuyambitsidwa kwa potaziyamu phosphate pamlingo wa 10-20 mmol / h pa mlingo wonse wa 40-60 mmol / l. Bicarbonate imayendetsedwa pamene magazi a pH ochepa agwera pansi pa 7.1. Koma ngati matenda ashuga a ketoacidosis amatsatiridwa ndi kukhumudwa kapena chikomokere, kapena matenda oopsa kwambiri, a bicarbonate amatha kutumikiridwa kumayambiriro kwa chithandizo. Sungunulani sodium bicarbonate pa mlingo wa 88 meq (2 ampoules) mu 1 litre ya 0,45% NaCl ndi jekeseni m'malo mwa saline yanyama.

Matenda a shuga a ketoacidosis amatha kuthandizidwa ndi matenda a kwamikodzo, chizindikiritso ndi chithandizo chomwe chiyenera kuchitika ndi kuyamba kwa mankhwala a ketoacidosis. Mwina kukula kwa edema yam'mimba, yowonetsedwa ndi mutu, chisokonezo komanso kusokonezeka kwa malingaliro. Mukamayang'ana fundus, edema ya optic nerve imapezeka. Imfa mu ubongo wa edema ndizambiri. Vutoli limafunikira chithandizo chapadera. Arterial thrombosis (ma stroke, myocardial infarction, limb ischemia) amathandizidwa ndi anticoagulants ndipo thrombectomy imachitidwa.

Hyperosmolar chikomokere

Hyperosmolar non-ketoacidotic chikomaso chochepa kwambiri ngati ketoacidotic chikomokere, nthawi zambiri mwa odwala okalamba omwe ali ndi matenda a shuga a 2. Hyperosmolar syndrome imatha kuyamba kupsinjika kwambiri, kuwonda, komanso kumwa kwambiri mafuta osokoneza bongo. Zomwe zimayambitsa kukonzekera zimatha kukhala matenda, kuchepa kwamadzi mukamayamwa okodzetsa, komanso matenda achilengedwe.

Mu pathogenesis ya matenda, kuwonongeka kwa impso glucose ndikofunikira mu nephroangiosulinosis yovuta ndi pachimake aimpso kulephera kapena aimpso azotemia. Hyperglycemia imachulukitsa masiku angapo kapena masabata, limodzi ndi osmotic diuresis ndi kusowa kwamadzi. Koma kuchuluka kwa insulini ndikokwanira, ketogenesis mu chiwindi imalepheretsedwa ndi iyo. Chifukwa chake, mapangidwe ambiri a matupi a ketone samachitika. Ketoacidosis imakhalapo kapena yofatsa.

Zizindikiro Mkhalidwe wa odwala nthawi zambiri umakhala woipa, wowonda kapena ukomoka, womwe umadziwika ndi kusowa kwamadzi. Monga lamulo, matenda ophatikizika amapezeka.Ndi kuwonjezeka kwa madzi m'thupi komanso kuchepa kwa thupi, odwala amasiya kuzindikira, kukomoka ndi zizindikiro zam'deralo zomwe zingayambike.

Zizindikiro M'maphunziro a labotale, hyperglycemia yotchulidwa imaposa 35 mmol / l, ma serum osmolality okwanira (320 msmol / kg), matupi a ketone amakhala abwinobwino kapena okwera pang'ono. Hypovolemia imatha kuyambitsa azotemia komanso lactic acidosis, zomwe zimakulitsa kwambiri matendawa.

Chithandizo. Wochita chimodzimodzi ndi matenda ashuga a ketoacidosis. Ntchito zazikulu ndikutsitsimutsa kwa hyperglycemia ndikubwezeretsa kwa BCC.

Mankhwala a insulin amachitika motsogozedwa ndi glucose wa plasma molingana ndi mfundo zomwezo monga matenda a shuga a ketoacidotic. Poganizira kwambiri insulin yamtunduwu wa chikomokere, insulin iyenera kutumikiridwa kumayambiriro kwa kulowetsedwa kwamankhwala ochepa (2 mayunitsi a insulin ochepa pa ola limodzi / /). Ngati matenda oopsa a hyperglycemia apitilira pambuyo pa maola 4-5 atatha kusunganso madzi pang'ono komanso kuchepa kwa gawo la Na +, amasinthana ndi njira ya insulin yolimbikitsidwa yochizira matenda ashuga a ketoacidotic.

Kuthanso madzi amthupi kumachitika ndi saline yakuthupi mwachangu (1 l / h kapena mwachangu) mpaka bcc ikabwezeretsedwa. Kulowetsa chithandizo cha okalamba odwala omwe ali ndi matenda okhudzana ndi mtima kumachitika mokwanira komanso mosamala kwambiri kuti muchepetse kukula kwa mtima. Kukonzanso kukonza kumachitika mwachangu kwa 100 - 250 ml / h.

Matenda achikopa

Matenda a shuga amatha kuphatikizidwa ndi matenda osiyanasiyana apakhungu (lipoid necrobiosis ndi dermatopathy ya matenda ashuga). Lipoid necrobiosis amakhudza mbali yakumaso ya miyendo ndipo amawonetsedwa ndi zikwangwani, chikasu kapena lalanje pakati komanso bulauni pamtunda. Dermatopathy ya matenda ashuga nthawi zambiri imawoneka kutsogolo kwa miyendo, imakhala ndi mawonekedwe ang'onoang'ono ozungulira omwe ali ndi m'mphepete. Zilonda zimatha kupanga pakatikati pa malopo, ndipo ziphuphu zimatha kupanga m'mphepete.

Mavuto a shuga kwa ana

Njira ya matenda osokoneza bongo kwa mwana imawerengedwa kuti ndiyolemetsa kwambiri. Amadziwika ndi chizolowezi chopanga mayiko ovuta a hypoglycemia, ketoacidosis, komanso ketoacidotic chikomokere.

Hypoglycemia imapangidwa chifukwa cha kutsika kwadzidzidzi komanso kwakukulu kwa shuga m'magazi. Izi zitha kukhala chifukwa cha kupsinjika, kuchita masewera olimbitsa thupi, komanso kuchuluka kwa insulin, kudya kwambiri komanso zina. Hypoglycemic coma imayambitsidwa ndi mndandanda wazizindikiro, mwachitsanzo:

ulesi ndi kufooka
thukuta lachilendo
mutu
kumverera kwa njala yayikulu
kunjenjemera miyendo.

Ngati simukuchita zomwe zimapangitsa kuti shuga azikhala ndi magazi munthawi yake, mwana amakomoka, amakwiya kwambiri, ndipo m'malo mwake mumakhala chikumbumtima champhamvu.

Ndi chifuwa cha hypoglycemic, kutentha kwa thupi ndi kuthamanga kwa magazi kumakhalabe kosakwanira. Ndizodziwikanso kuti palibe fungo la acetone kuchokera kumkamwa wamkamwa, khungu limakhalabe lonyowa, ndipo zomwe zimakhala m'magazi ndizosakwana mamilimita atatu.

Ketoacidosis imayenera kudziwidwa ngati harbinger wovuta kwambiri kwa matenda ashuga mwa mwana, wotchedwa ketoacidotic coma. Izi zimachitika chifukwa cha kutseguka kwa lipolysis ndi ketogeneis, ndikutsatiridwa ndikupanga kuchuluka kwakukulu kwa matupi a ketone.

Muubwana, pamenepa, kufooka ndi kuwodzera kumawonjezereka, ndipo chilakolako chimakulanso. Zizindikiro monga mseru, kusanza ndi kupuma movutikira, kumakhala kununkhira kwa acetone kuchokera mkamwa. Pokhapokha njira zochizira panthawi yake, ketoacidosis imatha kusintha kukhala ketoacidotic coma m'masiku ochepa.

Mkhalidwe womwewo umagwirizanitsidwa ndi kusokonezeka kwathunthu kwa chikumbumtima, chidwi cha hypotension, komanso kupweteka kwapafupipafupi komanso kufooka. Zizindikiro zina zimaphatikizira kupuma kosagwirizana ndi kuperewera kwa mkodzo.

Zotsatira zasayansi za ketoacidotic chikomanda mu ana ziyenera kuonedwa ngati hyperglycemia yoposa 20 mmol, acidosis, komanso glucosuria ndi acetonuria.

Mavuto a shuga a ana ali ndi mwayi wovuta (wokhala ndi vuto lakukalamba kapena losakwanitsidwa) angalumikizidwe ndi hyperosmolar kapena lacticacidemic (lactic acid). Kuphatikiza apo, kupangika kwa matenda kwa mwana kuyenera kuganiziridwa ngati chinthu chowopsa malinga ndi mndandanda wonse wazovuta zazitali:

matenda a shuga a shuga
nephropathy
mitsempha
cardiomyopathy
retinopathy.

Mndandanda womwe waperekedwa ukhoza kuthandizidwa ndi matenda amtundu wa m'matumbo, matenda a atherosulinosis, komanso matenda a mtima (matenda a mtima) komanso kulephera kwaimpso.