Matenda a shuga - matenda a metabolic

Kuperewera kwenikweni kwa insulin kapena vuto losakwanira la metabolism mu shuga) kumayambitsa kusokonezeka kwa mitundu yonse ya kagayidwe, ndipo koposa zonse - chakudya:

kuchuluka kwa gluconeogeneis chifukwa cha kutayika kwa kuponderezedwa kwa insulin pazinthu zazikulu za gluconeogenesis,

kuchuluka kwa glycogenolysis mothandizidwa ndi glucagon, kuchuluka kwa gluconeogeneis ndi glycogenolysis kumapangitsa kuchuluka kwa shuga m'magazi, ndipo

kusamutsa kudzera zimagwira mu minofu yodalira insulin imalephera chifukwa cha kusowa kwa insulin.

Chifukwa chake, chodabwitsa chodabwitsapamene thupi limva njala yamphamvu ndikulimbitsa kwambiri mphamvu yamagetsi m'magazi.

Hyperglycemia - chizindikiro chachikulu cha matenda ashuga - chikuwonjezeka plasma osmolarityndipo zimatsogolera kukuchepa kwa madzi m'thupi. Mtundu wa impso utangoyambika (8-10 mmol / L) utaposa, umawonekera mkodzo, ndikupangitsaglucosuriandipolyuria(Zizindikiro za kubwezeretsa kwa DM). Polyuria imalumikizidwa ndi kuphwanya kwam'madzi madzi ndi ma electrolyte chifukwa cha osmolarity yayikulu ya mkodzo woyamba. Polyuria ndi hyperosmia zimayambitsaludzundipolydipsiakomansonocturia(Zizindikiro za kubwezeretsa kwa DM).

Osmotic diuresis imabweretsa kwambiri kutopa konsekonsendiedselectrolytemia. Zotsatira zakutha kwamadzi ndihypovolemia, kuchepa kwa kuthamanga kwa magazi, kuchulukitsa kunenepa kwa ubongo, impso, kutsika kwosefera,oliguria(mpaka pakukula kwa impso kulephera). Kuphatikiza apo, chifukwa cha kusowa kwamadzi, kuchulukitsa kwa magazi kumachitika, kuzimiririka, ICE imayamba, ndipo vuto la ma microcirculation limabweretsahypoxiazimakhala.

Hyperglycemia imathandizanso kutsegula polyol kuzungulira(kudzera kutsegula kwa aldoreductase). Ndi kagayidwe kachakudya kagayidwe kachakudya ka shuga kamene kamapangidwa ndi sorbitol ndi fructose. Zinthuzi zimadziunjikira minyewa yosadalira insulini (ma lens, minyewa yamitsempha, maselo ofiira, maselo ofiira, makhoma am'mimba, basophilic insulocytes) ndipo, kukhala osmotic, kukopa madzi, omwe amatsogolera kuwonongeka kwa zimakhalazi.

Hyperglycemia kudzera mu kuchuluka kwa sorbitol (ndipo, motero, kufooka kwa malo osungirako NADPH₂), komanso chifukwa chakuchepa kwa ntchito ya protein kinase C, kumabweretsa kuchepa kwa kaphatikizidwenitric oxide (endothelial relaxation factor), yomwe imabweretsa vasoconstriction ndi minofu ischemia,

Hyperglycemia imatsogolanso hyalinosisndi kukula kwa makoma amitsempha yamagazi (hyalinosis - mapangidwe a glycoproteins, omwe, akamadutsa chapansi chamapangidwe a capillaries, amatha kugwa mosavuta ndipo amalimba hyalinized).

Hyperglycemia Imayambitsa Ndondomeko mapuloteni glycosylation(glycosylation ndi njira yolumikizira glucose yopanda enzymatic yokhala ndi magulu a amino mapuloteni). Zotsatira zake, zinthu zokhazikika za glycosylation zimapangidwa:

glycosylated hemoglobin. Kukhala ndi chiyanjano chachikulu cha okosijeni, samapatsa minofu, hypoxia imayamba,

glycosylated apoproteins a LDL ndi HDL, zomwe zimabweretsa kuwonjezeka kwa chiŵerengero cha LDL / HDL.

glycosylation wa mapuloteni a coagulation ndi anticoagulation system, omwe amatsogolera pakuwonjezeka kwa thrombosis,

glycosylation wa mapuloteni oyambira a membrane wapansi ndi collagen,

glycosylation wa myelin, womwe umapangitsa kusintha kwa mapangidwe ake,

glycosylation wa mapuloteni a mandala, omwe amatsogolera pakupanga kwati,

glycosylation wa mapuloteni amtundu wa insulin, omwe amatsogolera kukana insulin, etc.

Malonda onse a glycosylation ali ndi mawonekedwe osinthika, zomwe zikutanthauza kuti amatha kupeza katundu wa antigenic, chifukwa chomwe autoimmune imawononga ku ziwalo zomwe zimafanana ndi ziwalo.

Kuperewera kwa insulin kumabweretsanso chitukuko lactic acidosis. Njira zake:

Kuperewera kwa insulin kumabweretsa zoletsa za pyruvate dehydrogenase, chifukwa chake PVA sichitembenukira ku AcCoA (kuwotcha mu c. Krebs). Pankhaniyi, kuchuluka kwa PVC kumasintha kukhala lactate,

kuchepa kwa insulini kumathandizira kupatsirana kwa mapuloteni, komwe kumabweretsa kupangika kwa magawo ochulukirapo opanga pyruvate ndi lactate,

minofu hypoxia, komanso kuwonjezeka kwa ntchito ya mahomoni opanga (makamaka adrenaline ndi STH) kumabweretsa kutseguka kwa anaerobic glycolysis, zomwe zikutanthauza kuwonjezeka kwa mapangidwe a lactate.

Mafuta kagayidwendi mtundu 1 shuga mellitus, zimagwirizanitsidwa ndi kusowa kwathunthu kwa insulin komanso kuwonjezeka kwa zochitika za mahomoni otsutsana. Izi zimabweretsa kuchepa kwa kugwiritsidwa ntchito kwa glucose ndi adipose minofu pamene akuchepetsa lipogeneis ndikuwonjezera lipolysis. (odwala matenda ashuga amtundu woyamba ndi owonda).

Zotsatira zake, ketogenic amino acids (leucine, isoleucine, valine) ndi FFA amalowa m'chiwindi, pomwe amakhala gawo logulitsa kwambiri matupi a ketone (acetoacetic, b-hydroxybutyric, acetone). NdikupangaHyperketonemia.

Kuzungulira kwa poizoni a matupi a ketone:

letsa kuphatikizira kwa insulin ndikuyambitsa,

sungunulani ma membrane a ma membrane okhala ndi mawonekedwe, omwe amalimbikitsa kuwonongeka kwa maselo,

letsa ntchito za ma enzyme ambiri,

letsa ntchito zamkati wamanjenje,

yambitsa chitukuko cha ketoacidosis,

chifukwa chitukuko cha zopweteketsa mtima,

kuphwanya hemodynamics: inhibit myocardial contractility ndikuchepetsa kuthamanga kwa magazi chifukwa cha kukula kwa ziwiya zotumphukira.

Mavuto a kagayidwe ka proteinndi matenda a shuga amakhala ndi:

zoletsa zophatikizika zamapuloteni (insulin imayambitsa michere synthesis) ndi

kuwonjezeka kwa kuwonongeka kwake kwa minofu (insulin inhibits michere yama gluconeogeneis, ndikusowa kwa insulin, AK akupanga mapangidwe a shuga),

Kuphatikiza apo, AK conduction kudzera mmimba a cell imasokonekera.

Zotsatira zake, kusowa kwa mapuloteni kumapangidwa m'thupi, zomwe zimatsogolera:

kukula kwa ana

kusakwanira kwa njira zamapulasitiki,

kuchiritsa bala

kuchepetsa katundu wa Ati

kuchepa kukana matenda,

Kuphatikiza apo, kusintha kwa ma antigenic omwe amapanga mapuloteni amthupi amatha kuyambitsa zochitika za autoimmune.

Mavuto a shugaamagawidwa pachimake komanso chovuta. Zovuta za matenda ashuga - chikomokere. Matenda - angiopathies ndi neuropathies.

Matenda angiopathies a shuga amagawika ma micro- ndi macroangiopathies.

Matenda a shuga a shuga - kusintha kwa ziwiya zamagetsi.

kudzikundikira kwa sorbitol ndi fructose mu khoma la chotengera,

glycosylation zopangidwa ndi mapuloteni am'munsi membrane,

hyalinosis wa chotengera chotengera,

Zotsatira zake, kapangidwe kake, kagayidwe kake ndi kakhoma ka chotengera kamenyedwa, ischemia yamatenda imayamba. Mitundu yayikulu ya micangiopathies: retinopathy ndi nephropathy.

Matenda a shuga a retinopathy- microangiopathy yamatumbo am'mimba, mu gawo lothamangitsa lomwe limatsogolera pakuwonongeka kwathunthu kwa masomphenya. Microaneurysms, maculopathy, vitreous hemorrhages. Mavuto - retinal detachment, yachiwiri glaucoma.

Matenda a shuga- kuwonongeka kwa microvasculature ya ziwiya impso, limodzi ndi mapangidwe a nodular kapena kupukusa glomerulossteosis ndi CRF mu gawo lodana.

Mashuga a macroangiopathy- kuwonongeka kwamitsempha yamagetsi apakatikati.Njira zake:

glycosylation wa pansi mapuloteni oyambira,

kudzikundikira kwa sorbitol ndi fructose mu khoma la chotengera,

Zonsezi zimabweretsa kukula, kutsika kwa khoma la chotengera, kuchuluka kwa mpweya, kuchepa kwa ma heparin receptors, kuchuluka kwa zomatira, komanso kusangalatsa kwa minofu yosalala ya minyewa, zomwe zikutanthauza kuti mpaka kale komanso zopitilira muyesochitukukoatherosulinosis. Mitundu yayikulu ya odwala matenda ashuga macroangiopathies:

kuwonongeka kwa coronary, motero, matenda a mtima komanso kulephera kwa mtima chifukwa chake,

kuwonongeka kwa ziwiya zamkati mwa mawonekedwe a mikwingwirima, kusokonezeka kwapang'onopang'ono kwa kufalikira kwa ubongo

zotupa zokhudzana ndi ziwiya zamagawo am'munsi mwa mawonekedwe amtundu wamkati, necrosis, gangore.

Matenda a shuga- kuwonongeka kwa dongosolo lamanjenje mu shuga.

zotumphukira zamitsempha yamagazi za m'magazi,

kapangidwe ka ma antibodies kuma protein osinthika ndi autoaggression poyerekeza ndi ma antigen a minofu yamanjenje,

kuphatikiza kwa sorbitol ndi fructose mu ma neurons ndi ma cell a Schwann,

adachepetsa NO synthesis mu chotengera chotengera.

Zonsezi zimayambitsa kusokonezeka kwa magazi amkati, kuchepa kwa kapangidwe ka myelin, komanso kuchepa m'machitidwe azokondweretsa. Mitundu ya matenda a shuga

Zowonongeka kwa CNS (encephalopathy, myelopathy),

kuwonongeka kwa mitsempha ya mitsempha (polyneuropathy, mononeuropathy): zovuta zamagalimoto ndi zam'mutu,

kuwonongeka kwa mitsempha yodziyimira payokha (mauronomic neuropathy): kusokonezeka kwa kayendedwe ka mtima, mtima wamatenda, chikhodzodzo, m'mimba.

Angiopathies ndi neuropathies zimatha kubweretsa zovuta za shuga monga phazi la matenda ashuga.

Matenda a shuga- Matenda a phazi mu matenda ashuga, amadziwika ndi kuwonongeka pakhungu ndi minofu yofewa, mafupa ndi mafupa ndikuwonetseredwa mu mawonekedwe a zilonda zam'mimba, kusintha kwa mafupa ndi njira zosakanikirana ndi purulent-necrotic (mpaka gangrene).

Zovuta za matenda ashuga - chikomokere.

Matenda a shuga. Choyambitsa chachindunji cha chitukuko cha matenda ashuga okomoka (DC) mu matenda ashuga sichimodzimodzicho, chifukwa maphunzirowa samakhudzidwa ndi kukula kwa chikomokere, komakubwezera.

Matenda a shuga- mkhalidwe womwe kusokonezeka kwa metabolic ndi ziwalo zogwirizana ndi matendawa zimafika pachimake ndipo zimayendera limodzi ndi zovuta za homeostasis: hyperosmolarity ndi kuchepa kwa madzi, dyselectrolythemia, ketoacidosis, lactic acidosis, hypoxia yayikulu, zina.sokoneza ubongo, zomwe zimatanthawuza kutsogolera kukukoma mtima.

Kutengera mtundu wa shuga mellitus ndi mawonekedwe a zomwe zimapangitsa, mwina ketoacidosis, kapena hyperosmolarity, kapena lactic acidosis imatha kupezeka mwa wodwala winawake. Pankhani iyi, pali njira zitatu za DC:

ketoacidotic hyperglycemic coma,

Hyperosmolar hyperglycemic coma,

Izi zitatu zitatu za DC zimakhala ndi pathogenesis yofananira yomwe imakhudzana ndi kuwonongeka kwa matenda ashuga, koma ndi predominance ya matenda ena mwanjira iliyonse.

Matenda A shuga a Mtundu 1 (IDDM)

Thupi silitulutsa insulin. Anthu ena amati mtundu uwu ndi shuga wodalira insulin, shuga mwana kapena matenda asanakwane. Matenda a shuga a mtundu woyamba amakhala nawo asanakwanitse zaka 40, nthawi zambiri akamakula kapena kutha msinkhu. Matenda a shuga a Type 1 siofala ngati mtundu wachiwiri. Pafupifupi 10% ya anthu onse odwala matenda ashuga ndi amtundu 1. Odwala omwe ali ndi matenda amtundu woyamba amayenera kubayila insulin moyo wawo wonse. Ayeneranso kutsimikizira kuchuluka kwa shuga m'magazi mwakuchita kuyezetsa magazi pafupipafupi ndikutsatira zakudya zapadera. Tsoka ilo, matenda ashuga amtundu wa 1 samachiritsidwabe, popanda insulini mu matendawa, kulumala kwamphamvu kumachitika msanga, kenako ndikufa. Mavuto abwinobwino a mtundu woyamba wa matenda ashuga (zotsatira za matenda ashuga a shuga) amathanso kukhala: khungu, vuto la mtima, kulephera kwa impso, kuchepa kwa mano, kuchepa kwa magazi, zilonda zam'mimba.

Matenda a 2 a shuga (NIDDM)

Thupi silipanga insulini yokwanira kugwira ntchito yoyenera, kapena maselo m'thupi samayankha insulin (insulin kukana). Pafupifupi 90% ya anthu onse odwala matenda ashuga padziko lapansi ali ndi matenda ashuga 2.

Anthu ena amatha kuwongolera zizindikiro za matenda ashuga amtundu wa 2, kuchepa thupi, kudya mokwanira, kuchita masewera olimbitsa thupi komanso kuwongolera kuchuluka kwa shuga m'magazi. Komabe, mtundu 2 nthawi zambiri umakhala matenda opita patsogolo - amayamba kuvuta - ndipo wodwalayo pamapeto pake amwe mapiritsi ochepetsa shuga, kapenanso jakisoni wa insulin.

Anthu onenepa kwambiri komanso onenepa kwambiri ali pachiwopsezo chachikulu chotenga mtundu 2 poyerekeza ndi anthu omwe ali ndi thupi labwino. Anthu omwe ali ndi mafuta ambiri amkati, omwe amatchedwanso kunenepa kwambiri, mafuta am'mimba, kapena kunenepa kwambiri pamimba, ali pachiwopsezo chachikulu.

Chiwopsezo cha kukhala ndi matenda amtundu wa 2 chikukulanso tikamakula. Akatswiri satsimikiza kwenikweni chifukwa chake, koma akunena kuti pamene tikukalamba, timakonda kuvala zolemetsa ndikuyamba kuchita masewera olimbitsa thupi. Anthu omwe achibale awo omwe akudwala kapena ali ndi mtundu wachiwiri ali pachiwopsezo chotenga matendawa.

Matenda a shuga panthawi yapakati

Mtunduwu umakhudza azimayi panthawi yoyembekezera. Amayi ambiri amakhala ndi shuga wambiri m'magazi, matupi awo amalephera kupanga insulin yokwanira kusungitsa glucose onse kumaselo, zomwe zimapangitsa kukula kwa glucose pang'onopang'ono. Matenda a gestational amadziwika nthawi yapakati.

Odwala ambiri omwe ali ndi matenda ashuga panthawi yoyembekezera amatha kuwongolera matenda awo mwakuchita masewera olimbitsa thupi komanso kudya. Komabe 10% -20% ya iwo amayenera kumwa mankhwala kuti achepetse magazi. Matenda a shuga osawoneka bwino kapena osasamala panthawi yomwe ali ndi pakati amatha kukulitsa zovuta za nthawi yobereka. Mwana amabadwa wamkulu.

Matendawa shuga

Dziwani kuti kuchepetsa thupi (osachepera 5 mpaka 10 peresenti ya kulemera kwanu koyambira) kumatha kuletsa kapena kuchedwetsa matenda ashuga kapenanso kuchiritsa matenda asanakwane. Onani: Mankhwala Oletsa Kupewa Kunenepa kwambiri

Ambiri mwa odwala omwe ali ndi mtundu 2 poyamba anali ndi matenda ashuga. Anthu ambiri omwe ali ndi matenda apamwamba a shuga alibe zizindikiro. Dokotala angayang'anitseni magazi anu kuti awone ngati kuchuluka kwa glucose anu ndikwambiri kuposa zabwinobwino. Mu matenda ashuga asanafike, kuchuluka kwa shuga m'magazi sikwabwinobwino, koma osakwera kwambiri kuti adziwe matenda a shuga. Maselo amthupi amayamba kugonjetsedwa ndi insulin. Kafukufuku wasonyeza kuti ngakhale gawo la matenda ashuga, kuwonongeka kwa mtima ndi mtima kwachitika kale.

* Kuti mugwiritse ntchito mphamvu za tizilombo tating'onoting'ono topanga mankhwala popanga mankhwala opangira mankhwalawa komanso kupewa matenda a shuga, onani tanthauzo la "Bifikardio" wofufuza:

KUKHALA, INSULIN NDI CarBOHYDRATES

KAPENA ZINSINSI 12 Panjira YOLANDIRA

Popeza kunenepa kwambiri ndi chimodzi mwazomwe zimayambitsa kukula kwa matenda ashuga, zingakhale zofunikira kumvetsetsa momwe njirayi imachitikira mthupi komanso zomwe zimapangitsa.

Kunenepa kwambiri Itha kuyimilidwa motere: 1. Mumaganizira za chakudya, 2. mumayamba kumasula insulin, 3. insulini imapatsa thupi chizindikiro kuti asunge mafuta acids osawawotcha, akumasula mphamvu, 4. mumamva njala, 5. magazi a magazi amatuluka, 6. Zakudya zosavuta zamafuta zimalowa m'magazi anu m'magazi a shuga; 7. mumayamba kuphatikiza insulin yambiri; kukhala onenepa kwambiri

Mafuta Nthawi zonse amabwera kuchokera ku ma cell a thupi. Ndipo tikuchira ku mafuta omwe adatsala m'thupi. Mafuta amasungidwa mu khungu la mafuta mu mawonekedwe a triglycerides. Triglycerides amapangidwa kuchokera ku mafuta acids atatu omwe amalumikizidwa ndi molekyulu imodzi ya glycerol mkati mwa selo lamafuta. Akulu kwambiri kuti atuluka kudzera m'matumbo a ma cell amafuta, mosiyana ndi mafuta acids, omwe amatuluka mosavuta. Ine.e. tikachulukitsa kwambiri, timuyo tikamakula, timayamba kukula.

Zakudya zomanga thupi pali zosavuta (zachangu) komanso zovuta. Zakudya zamafulumira kapena zosavuta ndizophatikiza zomwe zimakhala ndi mamolekyulu amodzi kapena awiri a monosaccharide, ndipo ndizovulaza kwambiri poyambitsa kunenepa kwambiri.

Zakudya zamafuta osavuta zimagawika m'magulu awiri:

• Monosaccharides (shuga, fructose, galactose),
• Disaccharides (sucrose, lactose, maltose)

Zakudya zamafuta osavuta amatengedwa nthawi yomweyo ndikubaya shuga m'magazi. Izi zimathandizanso kupanga insulini.

Insulin - Uyu ndiye woyang'anira metabolism. Zimatengera mulingo wake ngati maselo amafuta adzapangidwa kapena kugawanika. Miyezi ya insulin ikachuluka, enzyme lipoprotein lipase - (LPL) imayambitsa, yomwe imayang'anira kuchuluka kwa mafuta kulowa mu cell. Ine.e. tikamapanga insulin kwambiri, LPL yomwe imagwira kwambiri ikupukuta maselo ndi mafuta.

Chifukwa chake, kupanga isulin kumayambitsidwa ndi chakudya chamagulu. Kuchuluka kwake ndi kuchuluka kwa chakudya chamafuta kumadalira kuchuluka kwa mafuta omwe adayikidwa.

Ndipo zikutanthauza

chakudya zimachulukitsa insulin -

- insulin imalimbikitsa kuyika mafuta

Pamutuwu, onaninso:

Khalani athanzi!

ZOCHITITSAZOKHUDZA MALO OTSOGOLA