Matenda a shuga okalamba

Pambuyo zaka 50 pazaka 10 zotsatirazi:

Kuthamanga kwa glycemia kumawonjezeka ndi 0.055 mmol / l

Glycemia patatha maola 2 chakudya chiziwonjezeka ndi 0,5 mmol / L

Zochitika kuchipatala cha odwala matenda ashuga okalamba

-Kuchotsa madandaulo osakhala achindunji (kufooka, kutopa, chizungulire, kusokonezeka kwa kukumbukira ndi kusazindikira kwina)

- Kuphatikizidwa kwa matenda a shuga mwamwayi pakafunsidwa matenda ena oyambanso

- Chithunzi cha chipatala cha ma micro- ndi macroangiopathies panthawi yopezeka ndi matenda ashuga

Kukhalapo kwa ziwalo zingapo za ziwalo

- Kuzindikira matenda a shuga 2 amakhazikitsidwa munthawi yomweyo ndi chizindikiritso cha zovuta zam'mimba

Kuzindikira kosokoneza kwa hypoglycemia

Zizindikiro zodziwikitsa za labotale

- Kusowa kwa kudya kwa hyperglycemia mu 60% ya odwala,

- Kuwonekera kwa malo otalikirana a postprandial hyperglycemia mu 50-70% ya odwala,

- Timakulitsa impso poyipa kwa glucose excretion ndi zaka.

-Zida zakuthupi

- Kuphwanya ntchito zazidziwitso (kuiwala kukumbukira, luso la kuphunzira, ndi zina).

Njira zoyenera kulipira mtundu wa 2 sd okalamba komanso / kapena wokhala ndi chiyembekezo chokhala zaka zosakwana zisanu

Palibe chiopsezo choopsa

komanso / kapena chiwopsezo cha hypoglycemia

Kuchuluka kwa mphamvu zofunika

(kulemera kwenikweni) patsiku, kcal / kg

kuchepa kwa thupi

25ґ kulemera kwenikweni

kuchuluka kwa thupi

20ґ kulemera kwenikweni

kunenepa I -II Art.

17ґ kulemera kwenikweni

kunenepa III tbsp.

15ґ kulemera kwenikweni

Mu matenda a shuga, kudya masentimita 5-6 masana kumalimbikitsidwa, komwe kumalola kuchuluka kwa insulin ndi shuga m'magazi molingana ndi zizindikiro zomwe zimapezeka mwa munthu wathanzi.

Zakudya, makamaka ndi matenda a shuga a 1 amaphatikizira kuwerengera kwa XE (ma calorie ofanana), ndikofunikira kudziwa kuchuluka kwa insulin yomwe imaperekedwa musanadye. Mwambiri, imakhudzana ndi kulimbitsa insulin. Ma tebulo owerengera apangidwe omwe mumatha kudziwa kuchuluka kwa chakudya chamagulu mu XE, kuchuluka kwa chinthu chimodzi, ndikuwona zomwe zingachitike.

Muyezo (1 XE) umawerengedwa kuti ndi 12 g wamafuta - chidutswa cha mkate wakuda wolemera 25. 1 XE imakulitsa glycemia ndi 1.5-2.2 mmol / L. 1 XE = 12 g wama chakudya owonjezera = 48 kcal.

Kufunika kwa insulini pa 1 XE kumatha kusiyanasiyana malinga ndi momwe wodwalayo alili (matenda omwe akukhalapo, kupezeka kapena kusowa kwa chipukutiro), komanso zaka. Mmawa kwambiri 1 XE - 2 ZITHUNZI za insulin, pa nkhomaliro - 1.5 ZINSINSI za insulin, chakudya chamadzulo - 1 PISCES ya insulin.

Pa chakudya chimodzi, sikulimbikitsidwa kuti muthe zoposa 6,7 ​​XE.

Kulingalira za mawonekedwe a unamwino wosamalira okalamba omwe ali ndi matenda ashuga. Udindo wa namwino. Kuzindikiritsa zovuta zazikulu za okalamba komanso odwala omwe ali ndi vuto la matenda a shuga mellitus pogwiritsa ntchito chitsanzo cha zochitika zina.

Kutumiza ntchito yanu yabwino pamaziko azidziwitso ndikosavuta. Gwiritsani ntchito mawonekedwe pansipa

Ophunzira, ophunzira omaliza, asayansi achichepere omwe amagwiritsa ntchito chidziwitso m'maphunziro awo ndi ntchito adzayamika kwambiri.

Wolemba http://www.allbest.ru/

unamwino okalamba matenda ashuga

1. The thettical gawo la zochitika za matenda ashuga

1.1 Zolemba za shuga mwa anthu okalamba

1.2 Zomwe zimachitika posamalira ana okalamba omwe ali ndi matenda ashuga

2. Kupenda ntchito ya namwino posamalira odwala okalamba omwe ali ndi matenda ashuga

Kutanthauzira kwa zovuta zazikulu za odwala okalamba omwe ali ndi matenda osokoneza bongo pa chitsanzo cha zochitika zina

2.2 Kuphatikiza kwa algorithm posamalira odwala okalamba omwe ali ndi matenda ashuga

Mndandanda wazidziwitso

Matenda a shuga masiku ano ndi amodzi mwa mavuto azachipatala komanso azikhalidwe. Anthu mamiliyoni ambiri padziko lonse lapansi akudwala matendawa. Ngakhale atafufuza kwambiri, matenda ashuga amakhalabe matenda osatha omwe amafunika kuwunikidwa nthawi zonse kuti apewe zovuta komanso kulumala zisanachitike.

Matenda a shuga ndi limodzi mwamavuto apadziko lonse lapansi. Amakhala pa 13 mndandanda wazomwe zimayambitsa kufa pambuyo pa mtima, matenda a oncological ndipo amakhazikika malo oyamba pakati pazomwe zimayambitsa khungu komanso kulephera kwa impso.

Malinga ndi WHO, pakadali pano pali odwala pafupifupi 100 miliyoni omwe ali ndi matenda ashuga padziko lapansi. Ndizodziwika bwino kuti shuga ndi amuna ndi akazi nthawi zambiri amakula zaka zapakati pa 50-60 ndi kupitirira. Zomwe zikuchitika panozi zikuchulukanso kotero kuti chiwerengero cha okalamba padziko lapansi chakwera kwambiri. Izi ndiye zomwe amati ukalamba. Ndi chifukwa cha kutsutsana kwa anthu okalamba kuti kuchuluka kwa odwala matenda a shuga kumachulukirachulukira, chifukwa chake matenda amtunduwu amawonedwa ngati vuto la zaka. Zomwe zimathandizira kukulitsa shuga m'matenda okalamba ndikuchepa kwa kaphatikizidwe ndi katemera wa insulin, kuchepa kwa mphamvu zamagwiritsidwe ntchito ka glucose ndi zotumphukira, kuwonongeka kwa mtima wamitsempha, komanso kusintha kwa kupezekanso kwa nembanemba kwamaselo. Tiyenera kudziwa kuti anthu opitilira 60 amakhala ndi vuto pakati pa kuchepa kwa mphamvu zamagwiritsidwe ntchito amthupi ndi kudya zakudya, zomwe zimapangitsa kunenepa kwambiri. Pachifukwa ichi, okalamba ndi anthu osachedwa kuchepa amachepetsa kulimba kwa chakudya chamthupi ndipo, ndi zovuta zingapo (matenda amtundu wamabala ndi chiwindi, kapamba, zoopsa, matenda, kupsinjika kwa malingaliro ndi mitundu ina ya kupsinjika), amadwala matenda a shuga. Chifukwa chake, mutu wa ntchito yophunzirayo - kuphunzira za machitidwe a chisamaliro cha odwala omwe ali ndi matenda ashuga okalamba ndikofunikira kwambiri.

Cholinga cha maphunzirowa: kuzindikira mawonekedwe a chisamaliro cha unamwino kwa okalamba omwe ali ndi matenda ashuga.

Kutengera ndi zomwe ophunzira anena, werengani zomwe zimayambitsa matenda a shuga kwa okalamba.

Dziwani zambiri zomwe zimapangitsa kuti odwala azikhala ndi matenda ashuga okalamba komanso a senile.

Kuti adziwe ntchito ya namwino posamalira odwala omwe ali ndi matenda osokoneza bongo okalamba ndi a senile.

Kupanga malingaliro oyang'anira chisamaliro cha odwala omwe ali ndi matenda oopsa a shuga ndi okalamba.

1. The thettical gawo la zochitika za matenda ashuga

1.1 Zolemba za shuga mwa anthu okalamba

Matenda a shuga ndi matenda osachiritsika omwe amabwera chifukwa cha kuperewera kwathunthu kapena insulin ya insulin. Ndikofunikira kubweretsa glucose m'maselo a thupi, omwe amalowa m'magazi kuchokera ku chakudya ndikupereka minofu ndi mphamvu. Ndi kusowa kwa insulin kapena kusagwirizana ndi minyewa ya thupi, kuchuluka kwa glucose m'magazi kumakwera - izi zimatchedwa hyperglycemia. Ndiowopsa pafupifupi mthupi lonse. Type 1 shuga mellitus ndi mkhalidwe womwe, pazifukwa zilizonse, maselo a beta a kapamba amafa. Ndi ma cell omwe amapanga insulin, motero kufa kwawo kumabweretsa kufooka kwathunthu kwa timadzi tambiri. Matenda a shuga otere amapezeka nthawi zambiri kuubwana kapena unyamata. Malingana ndi malingaliro amakono, kukula kwa matendawa kumalumikizana ndi kachilombo ka virus, kugwira ntchito mokwanira kwa chitetezo cha mthupi ndi zomwe zimabweretsa cholowa. Koma osati matenda ashuga eni ake obadwa nawo, koma lingaliro lakelo.

Type 2 shuga mellitus nthawi zambiri amakula patatha zaka 30 mpaka 40 anthu onenepa kwambiri. Nthawi yomweyo, kapamba amatulutsa insulin, koma maselo amthupi sangayankhe molondola, chidwi chawo cha insulin chimachepa. Chifukwa cha izi, glucose sangathe kulowa mu minofu ndikuwunjikana m'magazi. 14, p. 24

Popita nthawi, ndi matenda ashuga amtundu wa 2, kupanga insulin kumathanso kuchepa, popeza kuchuluka kwa glucose komwe kumakhalapo kwanthawi yayitali kumakhudza maselo omwe amapanga.

Zomwe zimathandizira kukulitsa shuga m'matenda okalamba ndikuchepa kwa kaphatikizidwe ndi katemera wa insulin, kuchepa kwa mphamvu zamagwiritsidwe ntchito ka glucose ndi zotumphukira, kuwonongeka kwa mtima wamitsempha, komanso kusintha kwa kupezekanso kwa nembanemba kwamaselo. Tiyenera kudziwa kuti anthu opitilira 60 amakhala ndi vuto pakati pa kuchepa kwa mphamvu zamagwiritsidwe ntchito amthupi ndi kudya zakudya, zomwe zimapangitsa kunenepa kwambiri. Pachifukwa ichi, okalamba ndi anthu osachedwa kuchepa amachepetsa kulimba kwa chakudya chamthupi ndipo, ndi zovuta zingapo (matenda amtundu wamabala ndi chiwindi, kapamba, zoopsa, matenda, kupsinjika kwa malingaliro ndi mitundu ina ya kupsinjika), amadwala matenda a shuga. Udindo wofunikira kwambiri mu pathogenesis ya matenda a shuga a shuga ndi a kuchepa kwa insulin - mtheradi kapena wachibale. Kukwanira kwathunthu kumadziwika ndi kuchepa kwa kaphatikizidwe ndi katemera wa insulin ndi kuchepa kwa zomwe zili m'magazi. 10, p. 227

Mu genesis yokhudzana ndi insulin kuchepa, kufunikira kwakukulu kumakulimbikitsidwa kumangiriza mapuloteni a plasma ndikusintha kwake kupita ku mawonekedwe otsika, kukopa kwa insulini mu insulin palocyma, kuwonongeka kwa insulin yambiri, makamaka mafuta ndi minyewa. Mitundu ya matenda a shuga a senile imalamulira, monga lamulo, mwa izi zowonjezera pancreatic ndikupanga insulin kuchepa.

Odwala okalamba komanso osakhazikika (mtundu wakale wa matenda oopsa a shuga), matendawa amakhala osakhazikika, oopsa - nthawi zambiri amakhala ofatsa kwambiri. Mu 60-80% ya odwala, kumayambiriro kwa matendawa, kunenepa kwambiri kumawonedwa. Kukhazikika kwa matendawa kumachitika pang'onopang'ono, zizindikiro zamatenda ndizochepa, ndipo mwakutero, pakati pakukhazikika kwa matendawa ndikuwonekera kumatenga miyezi ingapo mpaka zaka zingapo. Mwa odwalawa, kuchuluka kwa insulin m'magazi sikungakhale kw Sabata kokha, komanso kuchuluka (kuchepa kwa insulin). Kulipira matenda a shuga m'matumbo mwa iwo kumatheka mosavuta - odwala omwe ali ndi kunenepa kwambiri chakudya chimodzi ndikokwanira, odwala amachitapo kanthu pakalandira chithandizo chamlomo.

Malo apadera kuchipatala cha odwala okalamba komanso odwala omwe ali ndi matenda osokoneza bongo ndi zovuta zake zam'mimba komanso zam'mimba. Ngati odwala achinyamata achinyamata chitukuko cha enieni (microangiopathy) ndi nonspecific (Microangiopathy - imathandizira kukula kwa atherosulinosis) zovuta za matenda a shuga chifukwa cha matenda okha komanso kuphwanya chakudya, lipid ndi mapuloteni kagayidwe kachakudya. kale motsutsana ndi zomwe zilipo atherosulinotic zotupa zamagazi a malo osiyanasiyana: zamkati, chithokomiro, zotumphukira. Pachifukwa ichi, chithunzi chachipatala mwa odwalawa chimayang'aniridwa ndi madandaulo okhudzana ndi zovuta za matenda ashuga. Uku ndi kuwonongeka m'maso, kupweteka m'dera la mtima, kupweteka ndi kupweteka kwamiyendo, kuyabwa, kutupa kwa nkhope, mafupa amkhungu komanso mafinya a pakhungu, matenda amkodzo thirakiti, ndi zina. Coronary atherossteosis odwala omwe ali ndi matenda osokoneza bongo kuwirikiza kawiri mwa amuna komanso kangapo mwa akazi. Nthawi zambiri odwala matenda ashuga, myocardial infarction imakulanso, ndipo imasokoneza njira ya matenda ashuga. Atherosulinotic zotupa za ziwiya zam'munsi zimawonetsedwa ndi kuzizira kwawo, kupweteka m'miyendo monga kupanikizana kwapakati, paresthesias, kugunda komwe kumayambira kumbuyo kwa tibial ndi mafupa am'mimba a phazi kumakhala kofooka kapena kosatsimikiza. Odwala okalamba omwe ali ndi matenda osokoneza bongo, nthawi zambiri mwa akazi ndi nthawi makumi asanu nthawi zambiri mwa amuna poyerekeza ndi gangren athanzi am'munsi. Zilonda zam'mimba zam'mimba ("diabetesic nephropathy") ndizosiyanasiyana. Ichi ndi atherosclerosis a impso mitsempha ndi chitukuko cha kukonzanso kwamitsempha yamagazi, arteriolossteosis, glomerulossteosis. Ndi kuwonongeka kwa matendawa, kuwonongeka kwamitsempha ya impso kumayenda mofulumira, zomwe zimayambitsa kukula kwa aimpso kwa okalamba komanso odwala a senile. 15, p. 139

Matenda amitsempha yam'mimba ndiwofala kwambiri (pafupifupi 1/3 ya odwala) - nthawi zambiri amakhala pachimake kapena matenda a pyelonephritis. Mavuto okhudzana ndi matenda ashuga amaphatikizapo matenda ashuga, komanso matenda amitsempha “omwe amakhala ndi matenda ashuga omwe amayambitsidwa mofulumira kuposa omwe ali ndi thanzi labwino. Kuwonongeka kwa zotumphukira zam'mitsempha - matenda a shuga - amawonedwa mu okalamba odwala, nthawi zambiri mwa amayi omwe ali ndi vuto lochepa koma lalitali. Mwachizolowezi, chimadziwoneka ngati ululu m'mphepete (makamaka miyendo imakhudzidwa), imakulirakulira usiku, paresthesias (kuwotcha, kugwedeza), kugwedezeka kwamphamvu, kusamva bwino komanso kupweteka.

Vuto lalikulu la matenda ashuga limakhala ketoacidotic chikomokere, zimachitika nthawi zambiri ndimatenda aubwana chifukwa chakusintha pang'ono panjira yachipatala, zotsatira zoyipa pang'ono. Matenda opatsirana, kuchulukitsa kwa cholecystitis, kapamba, pyelonephritis, matenda opatsirana (carbunges, phlegmon, gangrene), kuvulala kwamtima kwambiri , kugwiritsa ntchito mankhwala angapo (okodzetsa, makamaka hypothiazide, glucocorticoids, chithokomiro, etc.).

Kuzindikira matenda ashuga okalamba ndi okalamba nthawi zambiri kumakhala kovuta. Pokhudzana ndi kusintha kwokhudzana ndi zaka za impso, chikhumbo chambiri chimawonedwa pakati pa hyperglycemia ndi glycosuria (kusowa kwa shuga mumkodzo ndi kuchuluka kwa magazi). Popeza madandaulo okalamba ndi odwala okalamba ndi osowa ndipo nthawi zambiri amakhudzana ndi zovuta za matenda ashuga, ndikofunikira kuphunzira shuga m'magazi onse opitilira zaka 60 ndi matenda oopsa, matenda amtima, zotupa za matenda a m'mimba komanso zotumphukira, matenda a pyelonephritis, a pustular ndi fungal. Kumbali ina, ziyenera kukumbukiridwa kuti muukalamba ndi zaka za senile pali overdiagnosis ya shuga. Chifukwa chake, mwa anthu opitirira zaka 60, kulekerera kwa zakudya zamafuta kumatsika, chifukwa chake, akamapanga kuyesa kwa glucose, kuchuluka kwa shuga kwamisinkhu yawo kumatanthauziridwa ngati chizindikiro cha matenda obwera chifukwa cha matenda ashuga. Monga lamulo, mwa okalamba komanso odwala a senile, matenda ophatikizika amapezeka, mogwirizana ndi omwe amamwa mankhwala omwe amakhudza kagayidwe kazakudya. Izi zimabweretsa zotsatira zabodza zabodza kapena zabodza mukamayesa anthu opitirira zaka 60.Mwachitsanzo, glucocorticoids, hypothiazide, estrogens, nicotinic acid amawonjezera shuga m'magazi, pomwe antidepressants, antihistamines, beta-blockers ndi acetylsalicylic acid, m'malo mwake, amachepetsa. Mu odwala okalamba komanso a senile, kuzindikira kwa hyperglycemic coma ndikovuta: , ndi kupitilira kwa ketoacidosis, maonekedwe a mseru, kusanza, kupweteka kwam'mimba kumatha kutengera chithunzi cham'mimba komanso kungayambitse matenda oyipa. Dyspnea chifukwa cha acidosis imatha kuwonetsedwa ngati chiwonetsero cha kulephera kwa mtima kapena kufalikira kwa matenda osapatsirana a m'mapapo. Chifukwa chake, mukazindikira kuti muli ndi vuto la matenda ashuga, munthu sayenera kuiwala kuti ingayambike pang'onopang'ono chifukwa cha ngozi ya mtima kapena matenda amtima. 15, p. 139

Chofunikira kwambiri pa matenda a shuga kwa anthu okalamba ndi okalamba ndi chakudya. Popeza ambiri mwa odwala omwe ali ndi kunenepa kwambiri, kuchepa thupi kokha ndi njira yolondola mwa iwo, nthawi zambiri kumapangitsa kukula kwa shuga m'magazi. Monga chithandizo chodziimira payekha, zakudya zake zimagwiritsidwa ntchito pa matenda osokoneza bongo. Liperekeni potengera "thupi" labwino (limatsimikizika molingana ndi matebulo apadera) komanso kuchuluka kwa ntchito yomwe yachitika. Amadziwika kuti m'malo abata, mphamvu zamagetsi patsiku ndi 25 kcal pa kilogalamu imodzi ya kulemera kwa thupi, ndi ntchito yamaganizidwe - pafupifupi 30 kcal, yopepuka thupi - 35 - 40, zolimbitsa thupi - 40-45, kulimbikira zolimbitsa thupi - 50 - 60 kcal / kg Kalori amatchulidwa ngati chida cha thupi "choyenera" komanso chogwiritsa ntchito mphamvu pa 1 makilogalamu amalemu. Zakudya za calorie za tsiku ndi tsiku zimaperekedwa ndi 50% chifukwa cha chakudya, 20% - mapuloteni ndi 30% - mafuta. Anthu achikulire ayenera kukonda zakudya zamkaka ndi zakudya. Ndi kunenepa kwapakati, kudya kwa calorie tsiku ndi tsiku kumachepetsedwa kukhala 1500-1700 kcal, makamaka chifukwa cha chakudya chamafuta. Zakudya zamafuta, nsomba, tchizi, zonona, zonona, mafuta amanyama, zakudya zabwino komanso zokometsera, mkate wa tirigu, pasitala, maapulo otsekemera, mphesa, nthochi, mavwende, mapeyala, zoumba, uchi, shuga, ndi masitolo a makeke sizikulimbikitsidwa kwa odwala omwe ali ndi matenda ashuga. malonda. Nyama yokhala ndi mafuta ochepa komanso nsomba, mazira, masamba ndi zipatso (kupatula zotsekemera), mkaka ndi mkaka, mafuta a masamba, mkate wakuda kapena wapadera wa matenda ashuga, phala la oatmeal ndi buckwheat, kukonzekera m'malo mwa shuga - xylitol, sorbitol ndikulimbikitsidwa. Popeza mphamvu ya choleretic yotsirizira, kugwiritsa ntchito kwawo kumawonetsedwa makamaka kwa odwala omwe ali ndi vuto limodzi la cholecystitis, cholecystoangiocholitis. Chithandizo cha odwala chimayamba ndi zakudya zochepa zopatsa mphamvu, zomwe zimapangidwa pang'onopang'ono ndi matenda a shuga komanso kufooka kwa zizindikiro zamatenda. Ngati chakudyacho sichikwaniritsidwa, mankhwala amathandizidwanso.

Odwala okalamba ambiri komanso osachiritsika amamva mankhwala a hypoglycemic - sopfanilamide (butamide, cyclamide, chlorpropamide, chlorocyclamide, bucurban, maninyl, etc.) ndi biguanides (adebite, phenformin, silubin, glucophagus, etc.). Chachikulu cha hypoglycemic cha mankhwala a sulfa chimachitika chifukwa cha kukondoweza kwa insulin yotchinga ndi ma cell a beta ya islet pancreatic. Amawonetsedwa ngati odwala matenda ashuga okalamba (opitilira zaka 40). Biguanides, mosiyana ndi sulfanilamides, amagwira ntchito pazinthu zowonjezera - amapanga insulin pakukulitsa kuchuluka kwa maselo a minofu ya minofu ya minofu ya glucose ndikuwonjezera kugwiritsidwa ntchito kwake. Chizindikiro chachikulu cha kuikidwa kwa biguanides ndi shuga wambiri, makamaka ngati akuphatikizidwa ndi kunenepa kwambiri. Biguanides amalembedwanso kukana mankhwala a sulfa. Mankhwala ochepetsa shuga a pakamwa amatsutsana ndi matenda oopsa a shuga, ketoacidosis, matenda a chiwindi ndi impso, magazi, matenda opatsirana. Mankhwala a Oral hypoglycemic amagwira ntchito molumikizana ndi insulin.

Insulin ndi kukonzekera kwake pochiza odwala okalamba ndi omwe ali ndi vuto lalikulu, sagwiritsa ntchito kwenikweni, popeza pakati pa zaka zino, zovuta zamatenda ndizosowa. Insulin imalembedwa kwa odwala omwe ali ndi kukana kapena kutsika pang'ono kwa mankhwala amkamwa a hypoglycemic, munthawi ya matenda oopsa a shuga - motsutsana ndi matenda opatsirana, kulowerera m'mitsempha, kupweteka kwam'mimba, ziwalo zam'mimba, uremia, ndi ketoacidosis, nthawi ya opaleshoni etc.).

Odwala okalamba omwe ali ndi mankhwala osokoneza bongo a shuga mellitus, kuchuluka kwa shuga kumakhazikika pamwambo wapamwamba kwambiri kapena pang'ono. Izi ndichifukwa choti kuchepa kwambiri kwa shuga, kusintha kwa adrenaline kumadziwika, komwe kumadziwonetsa pakukwera kwa kuthamanga kwa magazi, tachycardia, yomwe, motsutsana ndi maziko a mtima wamatumbo, imatha kubweretsa zovuta zingapo za thromboembolic, kuphatikizapo kulowerera m'mitsewa yam'mimba, stroko.

Mankhwalawa okalamba komanso odwala omwe ali ndi vuto lalikulu, amalipidwa kwambiri polimbana ndi zovuta za matenda ashuga. Pankhani imeneyi, mankhwala omwe amapangitsa kuti kagayidwe kazachulukidwe kachulukidwe kakhazikike - mavitamini a gulu B, C, nicotinic acid, metabolism yamafuta - miskleron, cetamiphene, kukonzekera kwa ayodini, lipocaine, lipoic acid, methionine, metabolism ya protein - retabolil, mapuloteni am'magazi, mineral metabolism - potaziyamu orotate , panangin, etc. Amagwiritsanso ntchito mankhwala omwe amawongolera kamvekedwe ka mtima, kuchuluka kwa mtima, kuphatikizika kwa magazi: heparin, syncumar, pelentan, hexonium, tetamon, papaverine, dibazole, no-shpu, ATP, angiotrophin, depot-padutin, depot-kallikrein, , dicinone, trypsin, chemotrypsin, lidase, ronidase, cocarboxylase. Mankhwala othandizira okosijeni ndi masewera olimbitsa thupi amasonyezedwa.

Maphunziro a Epidemiological apangitsa kuti azindikire anthu omwe ali ndi vuto lalikulu la matenda ashuga. Awa ndi anthu onenepa kwambiri, odwala atherosulinosis ndi ochepa matenda oopsa, anthu azaka zapamwamba komanso zofooka. Popeza atherosulinosis, matenda oopsa, komanso kunenepa kwambiri ndizofala kwambiri mwa anthu opitilira zaka 60, ndizodziwikiratu kuti ali pachiwopsezo chachikulu cha matenda a shuga. Kupewera kwa matenda ashuga kuyenera kuphatikiza, maphunziro onse azaumoyo pakati pa okalamba ndi a senile: ayenera kudziwa zomwe zimayambitsa, chithunzi cha chipatala, komanso chithandizo cha matenda osokoneza bongo, kuyang'ana kuopsa kwa kudya kwambiri zakudya zomwe zili ndi zakudya zamafuta, mafuta, komanso kufunika koziyang'anira thupi, kupititsa patsogolo zinthu zolimbitsa thupi zomwe zimathandizira kuphatikiza mafuta ochulukirapo, poganizira zaka komanso luso la munthu payekha.

Kupewa matenda ashuga ndi njira yothandiza kwa okalamba komanso odwala omwe ali ndi vuto losamala, kuwunikira mosamala kugwiritsa ntchito mankhwala a hypoglycemic.

Kukhazikitsidwa moyenera kwa odwala omwe ali ndi matenda osokoneza bongo ndiko kuletsa kukula ndi kupitilira kwa matenda ashuga a m'matumbo, atherosulinosis ndi mavuto ena a matenda awa.

1.2 Zomwe zimachitika posamalira ana okalamba omwe ali ndi matenda ashuga

Njira ya unamwino ndi njira yochokera kwa sayansi komanso machitidwe a namwino othandizira odwala.

Cholinga cha njirayi ndikuwonetsetsa kuti moyo ukhale wovomerezeka m'matendawa popatsa wodwalayo matonthozo amthupi, malingaliro komanso zauzimu, poganizira chikhalidwe chake komanso zauzimu.

Kusamalira okalamba kumachitika m'njira yoti kuwunika bwino munthu wokalamba, makamaka pakakhala zovuta zina. Chimodzi mwa matenda omwe amafunika kusamalira achikulire ndiwosamala kwambiri, ndi matenda a shuga.

Kodi matendawa amatanthauza chiyani ndipo tingazindikire bwanji? Monga mukudziwa, glucose ndiye gwero lalikulu lamphamvu kwa maselo ambiri mthupi lathu. Glucose amalowa m'maselo mothandizidwa ndi mahomoni apadera - insulin. Matenda a shuga ndi matenda omwe magazi a shuga amakhalanso okwanira ndipo shuga simalowa m'maselo a thupi.

Mitundu iwiri yayikulu ya matenda a shuga nthawi zambiri imakhala yosiyanitsa: mtundu wa shuga, wodwala matenda ashuga, shuga wocheperako) ndi shuga.

Matenda a 2 a mtundu wa shuga nthawi zambiri amapezeka mwa anthu azaka zopitilira 40.

Izi ndi zizindikiro zazikulu zomwe zingawonetse kukula kwa matenda ashuga: ludzu lochulukirapo, kuchuluka kwa mkodzo, chizolowezi cha matenda, matenda a pustular, khungu loyenda, kuwonda msanga. Mwa amuna, matenda a shuga amabweretsa kuchepa kwa potency.

Chithandizo chachikulu cha matenda a shuga ndikuchepetsa shuga. Mwazi wokwera wamagazi umayambitsa zovuta zosiyanasiyana - matenda a impso, maso, mtima, mitsempha yamitsempha ndi mitsempha yamagazi m'miyendo, etc. Tiyenera kukumbukira kuti kuchuluka kwambiri kwa shuga m'mawa, chifukwa chake ndibwino kudziwa nokha pogwiritsa ntchito glucometer kapena zingwe zoyeserera.

Kodi anthu okalamba omwe ali ndi matenda a shuga amathandizidwa bwanji? Ngati tizingolankhula za matenda amtundu woyamba, ndiye kuti, ndi matendawa, ndikofunikira kupaka jakisoni mthupi (mlingo wake umawerengeredwa ndi endocrinologist). Ngati timalankhula za matenda amtundu wachiwiri, ndiye kuti chithandizo chake chimaphatikizanso kusintha kwa zizolowezi zomwe zimawononga thupi lomwe lakhudzidwa ndi matendawa. Izi ndi izi: kudya kwambiri, kusachita masewera olimbitsa thupi, uchidakwa, kusuta fodya, ndi zina zambiri. Kumbukirani: matenda ashuga si sentensi, ndi njira yosiyana chabe ya moyo poyerekeza ndi yomwe ambiri amavomereza.

Mukamasamalira odwala okalamba komanso okalamba, kutsatira mfundo zamankhwala ndi deontology ndikofunikira kwambiri. Nthawi zambiri, namwino amakhala wodwala, makamaka wosungulumwa, munthu yekhayo wapamtima. Wodwala aliyense amafunikira chithandizo payekha, poganizira umunthu wa wodwalayo ndi momwe amawonera matendawa. Kuti akhazikitse kulumikizana, namwino azilankhula mokweza komanso mofatsa, onetsetsani kuti mwapereka moni kwa odwala. Ngati wodwalayo ali wakhungu, ayenera kuyambitsa tsiku lililonse, kulowa mu wadi m'mawa. Odwala ayenera kuthandizidwa ndi ulemu, dzina ndi patronymic. Sizovomerezeka kuyitanitsa wodwala kuti "agogo", "agogo", ndi ena.

Kupewa kuvulala. Iyenera kuwonedwa makamaka popewa kuvulala komwe kungayambitse zovuta za matenda ashuga, omwe amatchedwa "phazi la shuga."

Ndi matenda a shuga, mitsempha ya ziwalo zonse ndi zopatsika zimakhudzidwa. Microangiopathy imawonedwa mu 100% ya odwala omwe ali ndi matenda a shuga a 2, ndipo mu 30% ya milandu, zovuta za purcin necrotic zimachitika.

Matenda a shuga - zotsatira za kuphatikiza kwa polyneuropathy, michere ndi macroangiopathy, dermo ndi arthropathy

* Kuuma komanso matenda oopsa

* Kusintha kwamphamvu mu khungu (pigmentation, kupatulira, kusatetezeka)

* Kufooka kapena kuzimiririka kwa kupukusika kwa mitsempha

* Maonekedwe a zilonda zam'mimba

Mkuyu 1. Matenda a shuga a shuga

Zowopsa zake ndizophatikizira:

* kukhalapo kwa neuropathy ndi angiopathy,

* Kusintha kwa zala, kuchepa kwa kuyanjana kwamphamvu ndi kutupa kwa phazi,

* Mbiri ya zilonda zam'mimba zotupa,

* diabetesic retinopathy ndi nephropathy,

* kusuta fodya komanso kumwa mowa mwauchidakwa,

* kukhalapo kwa matenda amodzimodzi, kuwuma kwake komanso ubale wake ndi zomwe zimayambitsa matenda.

* Kuwonongeka kwamaso chifukwa cha retinopathy,

* Kuperewera kwa zamankhwala zoyenerera.

Mukamayang'ana wodwala, namwino ayenera kulabadira mfundo zotsatirazi

. * khungu (makulidwe, khungu, kupezeka kwa zilonda, zipsera, zipsera, ma calluse),

* Kusintha kwa zala ndi mapazi,

* chikhalidwe cha misomali (hyperkeratosis),

* kupweteka popuma komanso poyenda,

Kuphatikiza apo, pamafanizo onse, miyendo yonse iyenera kupendedwa.

Kupewa komanso kuchiza matenda ashuga

* Kufunsidwa wa podologist (katswiri wa matenda ashuga)

- nsapato zofewa

* Kuyang'ana kwamapazi tsiku ndi tsiku

* Kuwonongeka kwakanthawi kwamankhwala

Kuyankhulana kuyenera kuchitika ndi wodwalayo za kugula nsapato zabwino, tsopano pali nsapato za odwala matenda am'badwo watsopano monga Chithunzi 1 kuchokera neopreone wokhala ndi velcro fastener. Yosavuta kusamalira, khalani mwangwiro pamapazi aliwonse ndikukhala ndi mawonekedwe osokonekera. Amapangidwa mwachindunji kwa anthu omwe ali ndi matenda ashuga poganizira momwe zinthu zimayendera. Amakhala ndi kukwana bwino kwambiri, chopingasa chachikulu mu uta, kupendekera kofewa, kuchulukitsa kutsindana, ndikukweza kusintha ndikusoka kwapadera. Chifukwa cha chopendekera chofewa chokha ndi kufinya kofewa, kukakamira kwa chala kumachepa ndipo magazi amatuluka. Pewani kuvulala kwa malekezero am'munsi ndikupereka zomatira zolimba pamtunda. Yambitsirani njira yovalira ndi kuchotsa ndikuchepetsa katundu wonse pamiyendo.

Nsapato za mkuyu. 2 popewera phazi la matenda ashuga.

Gawo lopatula, lofunikira kwambiri lothandizira masewera olimbitsa thupi ndi odwala omwe ali ndi matenda ashuga ndizochita zolimbitsa thupi kumapazi kwamapazi. Malinga ndi njirayi, kuyenda mwachangu tsiku lililonse kwa ola limodzi ndikulimbikitsidwa, pomwe wodwalayo amayenera kuyimilira mpaka kupweteketsa ng'ombe, kupuma kwa mphindi zochepa ndikupitilizanso kuyenda. Kawiri pa tsiku kwa mphindi 10-15 ndikofunikira kuchita ma squats, kupumira mwamphamvu ndi kutalika kokwanira kwa khoma lamkati lam'mimba, yendani zala zakumaso zowonjezera pang'onopang'ono kuchuluka kwa masewera olimbitsa thupi.

M'madongosolo ophatikizidwa ndi kufalikira kwazinthu zilizonse, katundu wambiri ndiwothandiza (volleyball, njinga, ski, makampu, kupalasa, kusambira).

Kuchita bwino kwa lumbar dera kapena kumbuyo. Kugundika kwa wodwala miyendo akuwonetseredwa munthawi ya chikhululukiro cha matenda osachiritsika.

Physiotherapy. Zisonyezo zoika physiotherapeutic njira za matenda ashuga macroangiopathy ndi magawo oyamba a matendawa mgawo la subsidence yotupa komanso mu gawo la chikhululukiro cha matenda.

Mafunde oyenda bwino kwambiri, mafunde, mankhwala a laser, mafunde a diadynamic omwe amapatsidwa gawo lumbar komanso molumikizana ndi mtolo wam'manja ndi ntchafu yotsika.

Mankhwala othandizira amagwiritsidwa ntchito pamodzi ndi physiotherapy. Pa magawo oyamba a matendawa, ngati palibe zovuta za trophic komanso kufalikira, imakhala ndi njira ziwiri zochiritsira - chifukwa cha kusintha kwazomwe zimachitika, nyengo, malo okhala komanso chifukwa chogwiritsa ntchito njira za balneological. Zothandiza kwambiri ndi malo osambira a radon, hydrogen sulfide, narzan, ma iodine-bromine.

Resorts yomwe ili pakatikati pa Russia ndi Caucasus (Pyatigorsk, Mineralnye Vody, Kislovodsk, etc.) akulimbikitsidwa.

Kutsiliza: pamavuto onse a shuga, imodzi mwazovuta kwambiri ndi phazi la anthu odwala matenda ashuga. Matenda a shuga a matenda am'mimba ndi omwe amayambitsa kudula kwamiyendo mu matenda ashuga. Chifukwa chake, chizindikiritso cha zoopsa zomwe zimatha kutsogolera ndikuchotsedwa kwake kwakanthawi kumathandizira kupewa kwake. Udindo waukulu mu izi ndioyenereradi namwino, popeza iye ndiamwino amasamalira.

2. Kupenda ntchito ya namwino posamalira odwala okalamba omwe ali ndi matenda ashuga

Kutanthauzira kwa zovuta zazikulu za odwala okalamba omwe ali ndi matenda osokoneza bongo pa chitsanzo cha zochitika zina

Onani zovuta za wodwalayo monga chitsanzo cha zochitika zina. Mzimayi adalandiridwa kumalo osungirako odwala kwambiri - zaka: 62 zaka.

Madandaulo ofooka, kufooka mwachangu, chizungulire, nthawi zina amadandaula za ludzu, kuyabwa pakhungu, khungu lowuma, dzanzi la miyendo.

Amadziona kuti ndi wodwala kuyambira Meyi 2005. Matendawa matenda a shuga adapezeka koyamba kwa nthawi ya kuphedwa kwa odwala, pomwe adalandira chithandizo cha infaration ya myocardial, ndipo shuga yake yamwazi idakwezedwa. Kuyambira Meyi 2005, wodwalayo adatengedwa kupita ku dispensary, chithandizo adamulembera (shuga 30 mg). Mankhwala a Hypoglycemic amalolera bwino.

Kuphatikiza pa matenda ashuga, wodwalayo ali ndi matenda amitsempha yamagazi: matenda oopsa kwa zaka 5, mu Meyi 2005 adakumana ndi myocardial infarction.

Adabadwa mwana wachiwiri. Anakula ndikukula malinga ndi zaka. Ali mwana, adadwala matenda onse aubwana. Adagwira ntchito yowerengera ndalama, ntchito yokhudzana ndi kupsinjika kwa malingaliro. Panalibe njira zochitira opareshoni. Ndimakonda kuzizira. Pakati pa abale odwala odwala matenda a shuga si. Banja limakhala lopuma. Palibe zizolowezi zoyipa. Msambo kuyambira zaka 14, zimachitika pafupipafupi. Moyo wokhala ndi chuma. Amakhala m'nyumba yabwino.

Kuyendera General (inspectio)

General mkhalidwe wa wodwala: wokwanira.

Msinkhu 168 cm, kulemera 85 kg.

Nkhope: zothandiza

Khungu: khungu labwinobwino, chinyezi cholimbitsa thupi. Turgor yafupika.

Mtundu wa tsitsi: mtundu wachikazi.

Pinki yowoneka bwino ya mucous, chinyezi chokwanira, lilime - loyera.

Minofu yamafuta a subcutaneous: Yotukuka kwambiri.

Minyewa: kukula kwake ndikokhutiritsa, kamvekedwe kamasungidwa.

Mafupa: zopweteka palpation.

Mapeto a zamitsempha: osakulitsidwa.

- mawonekedwe a chifuwa: Normosthenic.

- Phungwa: loyera.

- The m'lifupi mwa malo okhala ndi ochepa.

- Kona ya epigastric ndi yowongoka.

- Mapewa ndi kolala ndizofooka.

- Mtundu wa kupuma pachifuwa.

- Chiwerengero cha mayendedwe azipumira miniti: 18

- Kukhazikika kwa chifuwa: chifuwa ndi chopanikizika, kunjenjemera kwamawu kumodzimodzimodzimodzimodzimodzu, opanda kupweteka.

Kuwunikira: Mitima yamtima imasokonekera, nyimbo, kugunda kwamtima-kumenyedwa / mphindi. Kutulutsa kokhutiritsa kokwanira komanso mavuto. HELL.-140/100 mm. Hg Trophic wa minofu ya m'munsi malekezero amadwala chifukwa cha matenda ashuga macroangiopathy.

- chidwi cha apical chikupezeka mu 5thostostal space 1.5-2 masentimita ofananira ndi lamanzere midclavicular mzere (mphamvu yochepa, yochepa).

Milomo ndi yotuwa pinki, yonyowa pang'ono, yopanda ming'alu kapena zilonda. Zomwe zimapanga mucous zimakhala zotumbululuka pinki, zonyowa, komanso za m'magazi sizinadziwike. Lilime lake ndi pinki, lonyowa, lokhala ndi duwa loyera, papillae amapangidwa bwino. Zitsamba zotuwa ndizopaka utoto, wopanda magazi komanso zilonda.

Mimba ndilabwinobwino, mawonekedwe, osatupa, palibe zotchingira, kupumira, kuwoneka kwapukutira. Khoma lam'mimba limagwira ntchito yopumira, palibe zipsera, palibe peristalsis wowoneka.

Ndi palpation yapamwamba, kusokonezeka kwa khoma lam'mimba kulibe, zilonda sizidziwika, palibe kuphatikiza.

Mpando: Nthawi imodzi m'masiku awiri ndi atatu. Kudzimbidwa nthawi zambiri kumazunza.

Chonde: palibe kuchuluka kowoneka.

Kutengera madandaulo, zowunika zamankhwala ndi zasayansi, matenda adapangidwa: mtundu wachiwiri wa matenda a shuga, pang'ono, subcompensated, polyneuropathy.

1. Kusanthula kwamkaka ndi mkodzo ndi magazi

2. Kuyesa kwa magazi a BH

3. Kafufuzidwe kakang'ono ka magazi a shuga - tsiku lililonse lililonse. Mbiri ya Glycemic

4. Pesi x-ray.

6. Kuyang'ana kwa akatswiri opapatiza: ophthalmologist, neuropathologist, dermatologist.