Gulu la WHO: matenda ashuga

Gulu la 1999 WHO lazindikiridwa, malinga ndi omwe mitundu yotsatirayi ya shuga imasiyanitsidwa:

I. Mtundu woyamba wa matenda ashuga: A. Autoimmune B. Idiopathic

II. Type 2 shuga

III. Mitundu ina ya shuga mellitus: A. Zofooka zamtundu wa beta-cell ndi kusintha kwotsatira kwa B. Matenda obadwa nawo chifukwa cha insulin C. Matenda a exocrine pancreas

D. Endocrinopathies E. Matenda a shuga omwe amapangidwa ndi mankhwala ndi mankhwala (nicotinic acid, glucocorticoids, mahomoni a chithokomiro, diazoxide, a-adrenergic agonists, thiazides, dilantin, a-interferon, vaccor, pentamidine, etc.)

F. Matenda (congenital rubella, cytomegalovirus, ma virus a Coxsackie)

G. Mitundu yachilendo ya matenda osokoneza bongo omwe amachititsa kuti matenda asamayende bwino

H. Ma gennd syndromes ena omwe amaphatikizidwa ndi matenda a shuga mellitus (Down syndrome, Kleinfelter syndrome, Turner syndrome, Wolfram syndrome, Friedreich ataxia, Huntington's chorea, Lawrence-Moon-Beadle syndrome, porphyria, myotonic dystrophy, etc.).

IV. Kuzindikira (kumachitika panthawi yomwe ali ndi pakati)

(DM I kapena shuga wodalira insulin, IDDM)

matenda enieni a autoimmune omwe amabweretsa kuwonongeka kwa maselo a beta opanga insulin, omwe amawonetsedwa ndi kuperewera kwenikweni kwa insulin. Hyperglycemia imayamba chifukwa cha kuwonongeka kwa maselo a beta, mu 90% ya zochitika izi zimagwirizanitsidwa ndi zochita za autoimmune, chibadwa chathu chomwe chimatsimikiziridwa ndi kunyamula kwa ma genetic. Mu 10% yotsala ya odwala, kuwonongeka ndi kufa kwa maselo a beta kumachitika chifukwa cha zifukwa zosadziwika zomwe sizimakhudzana ndi autoimmune zotsatira (mtundu wa idiopathic mtundu 1 shuga mellitus), mtundu uwu wa maphunziro umawonedwa pokhapokha mwa anthu ochokera ku Africa kapena ku Asia. Matenda a shuga a Type 1 amadziwonetsa pomwe maselo opitilira 80% a beta afa ndikusowa kwa insulin kuyandikira kwathunthu. Odwala amtundu wa shuga 1 amalemba pafupifupi 10% ya odwala omwe ali ndi matenda ashuga

(DM II kapena insulin-wodwala matenda a shuga, NIDDM)

matenda osatha owonetsedwa ndi kuphwanya kagayidwe kachakudya ka thupi ndi kakulidwe ka hyperglycemia chifukwa cha insulin kukokana ndi chinsinsi cha maselo a beta, komanso lipid metabolism ndi chitukuko cha atherosulinosis. Popeza chomwe chimayambitsa kufa ndi kulemala kwa odwala ndi zovuta za systemic atherosulinosis, matenda amtundu wa 2 nthawi zina amatchedwa matenda amtima. Ndi matenda ophatikizika ndi chibadwa chathu. Pamaso pa matenda a shuga II amtundu wina wa makolo, kuthekera kwa kukula kwake kwa ana mu moyo wonse ndi 40%. Mtundu umodzi, polymorphism womwe umatsimikizira tsogolo la matenda ashuga 2, sunapezeke. Chofunika kwambiri pakukhazikitsa njira yankhokwe yolandila chibadwa cha NIDDM ndi zinthu zachilengedwe, makamaka mikhalidwe.

Mitundu ina yapadera ya matenda ashuga

Ogwirizana pagulu Lachitatu, osiyana ndi magulu omwe ali pamwambapa chifukwa cha kuchepa kwa insulini: imatha kuphatikizidwa ndi vuto la genetic mu secretion kapena kanthu ka insulin (subgroups A, B), ndi matenda apamba omwe amawononga chida cha islet apparatus (gulu C) matenda a kagayidwe kachakudya ndi ma syndromes, omwe amaphatikizidwa ndi kuchuluka kwa mahomoni a contrainsular (gulu D), kukhudzana ndi mankhwala ndi mankhwala omwe ali ndi poizoni mwachindunji. ena kapena otsutsa-kanthu (gulu laling'ono E).

Subgroups F, G, H kuphatikiza mitundu yachilendo yamatenda omwe amayambitsidwa ndi matenda obadwa nawo (rubella, cytomegalovirus, kachilombo ka Coxsackie), omwe ali ndi zovuta zachilengedwe zamagulu (autoantibodies to the insulin receptor) kapena genetic syndromes, omwe nthawi zina amaphatikizidwa ndi shuga.

Gulu IV limaphatikizapo matenda a shuga mellitus pa nthawi yomwe ali ndi pakati, omwe amalumikizidwa ndi kuchuluka kwa insulin komanso hyperinsulinemia, nthawi zambiri mavuto awa amathetsedwa pambuyo pobala. Komabe, azimayi awa ali pachiwopsezo, chifukwa ena mwa iwo amayamba kudwala matenda ashuga.

Zizindikiro zakale za matenda amtundu 1 komanso matenda ashuga 2

Matendawa amawonetsedwa makamaka ndi kuchuluka kwa glycemic (kuchuluka kwa shuga / shuga m'magazi). Zizindikiro zake ndi ludzu, kukodza kwambiri, kukodza usiku, kuchepa thupi komanso kulimbitsa thupi, kutopa, kuchepa kwakanthawi kwa chidwi.

Epidemiology

Malinga ndi WHO, pakadali pano ku Europe pafupifupi 7-8% yaanthu onse omwe ali ndi matendawa adalembetsa. Malinga ndi kafukufuku waposachedwa wa WHO, mu 2015 panali odwala opitilira 750,000, pomwe odwala ambiri matendawa sadziwika (opitilira 2%). Kukula kwa matendawa kumawonjezeka ndi ukalamba, chifukwa chake opitilira 20% odwala angayembekezedwe pakati pa anthu azaka zopitilira 65. Chiwerengero cha odwala pazaka 20 zapitazi chawonjezeka kawiri, ndipo kuwonjezeka kumene kwa odwala matenda ashuga pafupifupi 25,000-30,000.

Kuwonjezeka kwa kufalikira, makamaka, kwamatenda a 2 padziko lonse lapansi, kukuwonetsa kuyambika kwa mliri wamatendawa. Malinga ndi WHO, pakadali pano limakhudza anthu pafupifupi 200 miliyoni padziko lonse lapansi ndipo zikuyembekezeka kuti pofika chaka cha 2025 anthu opitilira 330 miliyoni azadwala nthendayi. Metabolic syndrome, yomwe nthawi zambiri imakhala gawo la matenda 2, imatha kukhudza anthu 25% -30%.

Dziwani malingana ndi mfundo za WHO

Kuzindikira kumatengera ndi kukhalapo kwa hyperglycemia pansi pazinthu zina. Kukhalapo kwa zizindikiro zamankhwala siwokhazikika, chifukwa chake kusapezeka sikumapatula kuzindikira koyenera.

Kuzindikirika kwa matendawa komanso kusokonezeka kwa glucose homeostasis kutsimikizika molingana ndi kuchuluka kwa glucose m'magazi (= kuchuluka kwa shuga m'magazi a venous) pogwiritsa ntchito njira zodziwika bwino.

• kusala shuga m'magazi (osachepera maola 8 mutatha chakudya chatha),
• shuga wamagazi osasinthika (nthawi ina iliyonse masana osadya chakudya),
• glycemia pa mphindi 120 za mayeso okhudzana ndi shuga wa pakamwa (PTTG) ndi 75 g shuga.

Matendawa amatha kupezeka ndi mitundu itatu:

• kukhalapo kwa tingachipeze powonetsa zizindikiro za matendawa + glycemia ≥ 11.1 mmol / l,
• kudya glycemia ≥ 7.0 mmol / l,
• glycemia pa mphindi ya 120 ya PTTG ≥ 11.1 mmol / l.

Makhalidwe wamba

Magazi a shuga osachedwa kudya amachokera pa 3,8 mpaka 5.6 mmol / L.

Kulekerera mwachizolowezi kwa shuga kumadziwika ndi glycemia pa mphindi 120 za PTTG

Glycemia yopanda mphuno kuposa 11,0 mmol / L m'magazi a capillary mwa anthu amodzi amatsogolera pakuwunikanso, zomwe zimatengera kufunikira kotsimikizira kupezeka koyambirira mwa kudziwa kuchuluka kwa glucose pamtunda wa 6.9 mmol / L. Ngati palibe zizindikiro, kuyezetsa magazi kwa glycemia kumachitika pokhazikika.

Kusala glycemia nthawi zambiri kutsika kuposa 5.6 mmol / L sikumachotsa matenda ashuga.

Kuthamanga glycemia nthawi zambiri kuposa 6.9 mmol / l kumatsimikizira kuti pali matenda ashuga.

Glycemia kuyambira 5.6 mpaka 6.9 mmol / L (wotchedwa malire a shuga m'magazi othamanga) amafunika kuyesedwa kwa PTTG.

Panthawi ya mayeso ololera a glucose, kuzindikira koyenera kumasonyezedwa ndi glycemia patatha maola 2 kapena wofanana ndi 11.1 mmol / L.

Kuyesedwa kwa shuga m'magazi pakuzindikiritsa kuyenera kubwerezedwa komanso kutengera matanthauzo a 2.

Pozindikira kusiyanasiyana kwa matenda amtundu 1 ndi mitundu yachiwiri ya matenda, C-peptides angagwiritsidwe ntchito ngati chidziwitso cha katemera wa amkati, ngati pali chithunzi chofunikira m'chipatala.Kuyesedwa pamimba yopanda kanthu pakaumbidwe koyambira ndipo mutatha kukondoweza ndi chizolowezi chokhazikika mumavomerezeka. Mtundu woyamba wa shuga, mtundu woyambira nthawi zina umatsitsidwa kufikira zero. Ndi mtundu 2, mtengo wake ndi wabwinobwino, koma ndi insulin, ukhoza kukwezedwa. Ndi kupitirira kwa matenda a mtundu 2, komabe, kuchuluka kwa C-peptides kumachepa.

Magawo azisanja

• Easy 1 degree - Normoglycemia ndi aglycosuria zimatheka ndi zakudya. Kuthamanga shuga m'magazi - 8 mmol l, supretion ya shuga tsiku lililonse mumkodzo - mpaka 20 g l. Pakhoza kukhala magwiridwe antchito (angachite bwino m'mitsempha yamagazi ndi mitsempha).
• Pakati (Gawo 2) - kuphwanya kwa kagayidwe kazakudya kumatha kulipiriridwa ndi insulin ya mankhwala mpaka magawo 0,6 pa kilogalamu patsiku. Kapena kumwa mankhwala ochepetsa shuga. Kuthamanga shuga kuposa 14 mmol l. Glucose mu mkodzo mpaka 40 g / l patsiku. Ndi zigawo za ketosis yaying'ono (mawonekedwe a matupi a ketone m'magazi), angiopathies othandizira ndi ma neuropathies.
• Matenda akulu a shuga (gawo 3) - Mavuto akuwoneka (nephropathy 2, magawo atatu a microangiopathy, retinopathy, neuropathy). Pali magawo a matenda ashuga (kusinthasintha kwa tsiku ndi tsiku mu glycemia 5-6 mmol l). Zambiri ketosis ndi ketoacidosis. Kuthamanga magazi kuposa 14 mmol l, glucosuria patsiku zoposa 40 g l. Mlingo wa insulin ndi woposa 0,7 - 0,8 magawo / kg patsiku.

Mankhwala, dokotala nthawi zonse amafunitsitsa kukhazikika kwa matendawa. Nthawi zina njirayi imatenga nthawi yayitali. Bukuli limakhazikitsidwa pamakhalidwe oyambira. Malinga ndi gawoli, adotolo amawona pamalo omwe wodwalayo adapempha thandizo ndikukonzekera mankhwalawo mwanjira yoti apite pakamwa.

Kugawa pamlingo woyipa

• Kubwezera momwe akwaniritsidwira, mothandizidwa ndi mankhwalawa, shuga wamba wamagazi. Mulibe shuga mkodzo.
• Kulipira - matendawa amatenga ndi glycemia wolimbitsa thupi (glucose osapitirira 13, 9 mmol l, glucosuria osaposa 50 g l) ndipo palibe acetonuria.
• Kubweza - kwambiri matenda, shuga wamagazi pamwamba 13.9 mmol l, mkodzo woposa 50 g l patsiku. Mulingo wosiyanasiyana wa acetonuria (ketosis) umadziwika.

Monga mukuwonera, gulu limakondanso madokotala. Imakhala ngati chida pakuyang'anira odwala. Ndi kulingalira kwake, mphamvu ndi dziko lowona zimawonekera. Tiyerekeze kuti munthu wagonekedwa m'chipatala pachipatala china chovuta kwambiri ndipo amalipiridwa, ndipo ngati ali ndi chithandizo choyenera, amamuthandiza. Momwe mungadziwire kusintha kumeneku? Masanjidwewo ndioyenera pano.
Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri amadziwa bwino kuchuluka kwawo komanso kuwunika momwe alili. Amadziwa chomwe acetonuria, ketosis ndiyofunika komanso kudziletsa. Kwa iwo, ndizosangalatsa kuchokera pamawonekedwe othandiza.

Chithunzi cha kuchipatala

Zizindikiro zake, kuphatikiza ludzu, polydipsia, ndi polyuria (komanso nocturia), zimawoneka ndi matenda opita patsogolo.

Nthawi zina, wodwalayo amawona kuchepa thupi ndi nkhawa komanso kudya mwachangu, kutopa, kusakwanira, malaise, kapena kusinthasintha kwazinthu zowoneka bwino. Kubwezera kwambiri, kumatha kubvulaza. Nthawi zambiri, makamaka kumayambiriro kwa matenda amtundu 2, zizindikiro sizipezeka konse, ndipo tanthauzo la hyperglycemia lingadabwe.

Zizindikiro zina nthawi zambiri zimagwirizanitsidwa ndi kupezeka kwa zovuta za microvascular kapena macrovascular, chifukwa chake zimachitika pokhapokha zaka zingapo za matenda ashuga. Izi zikuphatikiza paresthesia ndi kupweteka kwam'mawa m'miyendo yokhala ndi zotumphukira za m'mimba, matenda am'mimba, matenda am'mimba, kudzimbidwa, kusokonezeka kwa chikhodzodzo, kusokonekera kwa erectile ndi zovuta zina, mwachitsanzo, kuwonetsa kwa autonomic neuropathy ya ziwalo zoyenera, kusawona bwino kwa retinopathy.

Komanso, mawonetseredwe a matenda a mtima (a angina pectoris, zizindikiro za kulephera kwa mtima) kapena kuchepa kwapang'onopang'ono (lameness) ndichizindikiro cha kuthamanga kwa atherosulinosis pambuyo panjira yayitali ya matendawa, ngakhale odwala ena omwe ali ndi zizindikiro zapamwamba za atherosulinosis sangakhale ndi zizindikirozi. Kuphatikiza apo, odwala matenda ashuga amakhala ndi matenda obwereza, makamaka khungu ndi genitourinary system, ndipo periodontopathy ndiofala.

Kuzindikira matendawa kumayambitsidwa ndi nthawi yayifupi (yokhala ndi mtundu 1) kapena yayitali (ndi mtundu 2), womwe ndi asymptomatic. Pakalipano, hyperglycemia imayambitsa mapangidwe ochepetsetsa, ndipo amatha kupezeka, makamaka odwala omwe ali ndi matenda a mtundu 2, kale panthawi yodziwitsa.

Pankhani ya zovuta zazikulu za m'magulu a shuga a 2, ngozi iyi imachulukidwa kangapo ndikuchulukitsidwa kwa ziwopsezo za atherosulinotic (kunenepa kwambiri, matenda oopsa, dyslipidemia, hypercoagulation) yotsatana ndi chikhalidwe chokhala ndi insulin kukana, ndipo amatchedwa angapo metabolic syndrome (MMS), metabolic syndrome X kapena Riven syndrome.

Mtundu woyamba wa shuga

Matanthauzidwe a WHO amadziwika kuti matendawa ndi mtundu wodziwika bwino wa matenda ashuga, komabe, mwa anthu ndizochulukirapo kuposa mtundu wofala wofanana wa matenda 2. Zotsatira zazikuluzikulu za matendawa ndi kuchuluka kwa shuga m'magazi.

Matendawo alibe chifukwa chodziwika bwino komanso amakhudza achinyamata, mpaka nthawi ino, anthu athanzi. Chinsinsi cha matendawa ndikuti pazifukwa zina zosadziwika, thupi la munthu limayamba kupanga ma antibodies motsutsana ndi ma cell a pancreatic omwe amapanga insulin. Chifukwa chake, matenda amtundu wa 1, kwakukulu, ali pafupi ndi matenda ena a autoimmune, monga multiple sclerosis, systemic lupus erythematosus, ndi ena ambiri. Maselo a pancreatic amafa chifukwa cha ma antibodies, zomwe zimapangitsa kuchepa kwa insulin.

Insulin ndi mahomoni ofunikira kutengera shuga m'maselo ambiri. Pakakhala kuchepa kwake, shuga, m'malo mopatsa mphamvu yama cell, amadziunjikira m'mwazi ndi mkodzo.

Mawonekedwe

Matendawa amatha kupezeka mwangozi ndi dokotala panthawi yopima wodwalayo popanda chizindikiro chodziwika, kapena zizindikiro zosiyanasiyana zitha kuwoneka, monga kumva kutopa, thukuta la usiku, kuchepa thupi, kusintha kwa malingaliro ndi kupweteka m'mimba. Zizindikiro zapamwamba za shuga zimaphatikizapo kukodza pafupipafupi ndi mkodzo wambiri, kutsatiridwa ndi madzi am'madzi komanso ludzu. Mwazi wamagazi ndi ochulukirapo, impso imawanyamula kuti ichite mkodzo ndikudziyimira yokha. Zotsatira zakuchepa kwamadzi, kusowa kwamadzi kumachitika. Ngati izi sizichiritsidwenso, ndipo kuchuluka kwa shuga m'magazi kumafika pamlingo wambiri, kumayambitsa kusokonezeka kwa chikumbumtima komanso chikomokere. Matendawa amadziwika kuti hyperglycemic coma. Odwala omwe ali ndi matenda a shuga 1, matupi a ketone amatuluka mthupi mwanjira imeneyi, ndichifukwa chake mkhalidwe wa hyperglycemic wotchedwa diabetesic ketoacidosis. Matupi a Ketone (makamaka acetone) amachititsa kupuma komanso mkodzo winawake.

Matenda a shuga a LADA

Pa mfundo yomweyi, pali mtundu wina wa matenda ashuga amtundu wa 1, omwe amadziwika kuti LADA (Latent Autoimmunity Diabetes in Adults - matenda a shuga a autoimmune. Kusiyana kwakukulu ndikuti LADA, mosiyana ndi mtundu wa matenda a shuga a "classical" 1, imachitika munthu wamkulu, chifukwa chake imatha kusinthidwa ndi mtundu wachiwiri.

Mwa kufananizira ndi matenda amtundu wa 1 shuga, chomwe chimapangitsa kuti chidutswachi sichidziwika.Maziko ndi matenda a autoimmune momwe chitetezo chathupi chimawononga maselo a kapamba omwe amapanga insulin, kuchepa kwake kenako kumayambitsa matenda a shuga. Chifukwa chakuti matenda amtunduwu amayamba mwa anthu okalamba, kusowa kwa insulin kumatha kukulitsidwa ndi kuyamwa kwabwino kwa minyewa, komwe kumachitika kwa anthu onenepa kwambiri.

Zowopsa

Wodwala wamba yemwe ali ndi matenda a shuga a 2 amakhala munthu wachikulire, nthawi zambiri amakhala wonenepa kwambiri, nthawi zambiri amakhala ndi kuthamanga kwa magazi, kutsika kwa cholesterol komanso mafuta ena m'magazi, amadziwika ndi kukhalapo kwa matenda ashuga amtundu wina m'mabanja ena (ma genetics).

Type 2 shuga mellitus amakula pafupifupi motere: pali munthu yemwe ali ndi vuto la chibadwidwe chokulitsa matendawa (matendawa amapezeka mwa anthu ambiri). Munthuyu amakhala ndikudya zopanda thanzi (mafuta a nyama ndi oopsa kwambiri), sasuntha kwambiri, nthawi zambiri amasuta fodya, amamwa mowa, ndichifukwa chake amayamba kunenepa kwambiri. Njira zophatikizira kagayidwe kazinthu zimayamba kuchitika. Mafuta omwe amasungidwa m'mimba amatha kukhala ndi katundu wochotsa mafuta acid. Shuga sangathenso kusamutsidwa mosavuta kuchokera m'magazi kupita ku maselo ngakhale pakupanga insulin yokwanira Glycemia atatha kudya amachepetsa pang'onopang'ono komanso mosasamala. Pakadali pano, mutha kuthana ndi vutoli popanda kubaya insulin. Komabe, kusintha kadyedwe ndi kadyedwe kofunikira ndikofunikira.

Mitundu ina yapadera ya matenda ashuga

Magulu a WHO a shuga mellitus amawonetsa mitundu iyi:

• matenda ashuga achiwindi am'matenda a kapamba (kapamba wambiri ndi kuphipha, chotupa cham'mimba),
• matenda a shuga omwe ali ndi vuto la mahomoni (Cushing's syndrome, acromegaly, glucagonoma, pheochromocytoma, Conn syndrome, chithokomiro, matenda oopsa (hypothyroidism),
• matenda a shuga omwe amakhala ndi insulin yolandila mu maselo kapena mamolekyulu a insulin.

Gulu lapadera limatchedwa kuti MODI shuga mellitus, ndipo ndi matenda obadwa nawo omwe ali ndi ma subtypes angapo omwe amapezeka pamatenda amtundu umodzi wokha.

Gulu la matendawa

Anthu ambiri amangodziwa za mtundu woyamba ndi wachiwiri wa matenda, koma owerengeka amadziwa kuti gulu la matenda ashuga limaphatikizanso mitundu ina ya matendawa. Izi zikuphatikiza:

• matenda a mtundu 1 kapena mitundu yodalira insulin,
• matenda a mtundu 2,
• matenda osokoneza bongo
• matenda a shuga (omwe amapezeka nthawi ya gestation),
• matenda obwera chifukwa cha kulolera kwa glucose,
• shuga yachiwiri, yomwe imayamba motsutsana ndi maziko a matenda ena.

Mwa mitundu yonseyi, mitundu yodziwika bwino ya matenda ashuga ndiyo yoyamba komanso yachiwiri.

Gulu la WHO

Gulu la WHO la mellitus ya shuga lidapangidwa ndikuvomerezedwa ndi oimira World Health Organisation. Malinga ndi izi, matenda ashuga agawidwa m'mitundu iyi:

• matenda 1
• matenda 2,
• mitundu ina ya matenda.

Kuphatikiza apo, malinga ndi gulu la WHO, madigiri oterewa amasiyanitsidwa ndi matenda ofatsa, olimbitsa komanso oopsa. Digili yofatsa nthawi zambiri imakhala ndi chikhalidwe chobisika, sichimayambitsa zovuta komanso zizindikiro zokulirapo. Wapakati umakhala limodzi ndi zovuta mu mawonekedwe a kuwonongeka kwa maso, impso, khungu ndi ziwalo zina. Pa gawo lotsiriza, zovuta zazikulu zimawonedwa, nthawi zambiri zimayambitsa zotsatira zakupha.

Matenda a shuga omwe amadalira insulin

Mtundu woyamba wa matenda a shuga umayamba motsutsana ndi maziko a kusakwanira kwathunthu kwa insulin ya mahomoni mwa maselo a beta mu kapamba. Ndili chifukwa cha insulin ya mapuloteni yomwe glucose imatha kulowa kuchokera m'magazi kulowa m'thupi lathu.Ngati insulini singapangidwe mulingo woyenera kapena mulibe, chiwonetsero cha shuga m'magazi chimakwera kwambiri, chomwe chimabweretsa zovuta zambiri. Glucose samapangidwira mphamvu, ndipo kuwonjezereka kwa shuga kwa nthawi yayitali, makoma amitsempha yamagazi ndi ma capillaries amataya kamvekedwe, mphamvu, ndikuyamba kuwonongeka. Zingwe zam'mitsempha zimavutikanso. Nthawi yomweyo, thupi limakhala ndi mphamvu yanjala, ilibe mphamvu zokwanira kuchitira zochita za metabolic. Kuti athe kulipirira kusowa kwa mphamvu, amayamba kuphwanya mafuta, kenako mapuloteni, chifukwa chomwe matendawo amakula.

Chifukwa chiyani izi zikuchitika

Choyambitsa chachikulu cha matenda okhala ndi njira yodalira insulin ndi cholowa. Ngati kholo limodzi kapena onse akuvutika ndi matendawa, mwayi wokuka kwake mwa mwana umachulukirachulukira. Izi zikufotokozedwa ndikuti kuchuluka kwa maselo a beta omwe amayambitsa kuphatikizira kwa insulin amachokera pachibadwa. Pankhaniyi, zizindikiro za matenda ashuga zimatha kuchitika kuyambira masiku oyamba amoyo, komanso patatha zaka makumi.

Zomwe zimayambitsa matendawa ndi monga izi:

• kumangokhala. Ndi kulimbitsa thupi kokwanira, glucose amasinthidwa kukhala mphamvu, njira za metabolic zimayatsidwa, zomwe zimakhudza kugwira ntchito kwa kapamba. Ngati munthu sasuntha kwambiri, glucose amasungidwa ngati mafuta. Kapamba samatha kugwira ntchito yake, yomwe imayambitsa matenda a shuga.
• kudya zakudya zambiri zopatsa mphamvu komanso maswiti ndi chinthu chinanso chomwe chimayambitsa matenda ashuga. Shuga wambiri akangolowa mthupi, kapamba amakumana ndi vuto lalikulu, kupanga insulin kumasokonezeka.

Mwa amayi ndi abambo, matendawa nthawi zambiri amapezeka chifukwa cha kupsinjika kwakutali kwa malingaliro ndi nkhawa. Kupsinjika ndi zokumana nazo zimapangitsa kupangika kwa mahomoni noradrenaline ndi adrenaline m'thupi. Zotsatira zake, chitetezo chamthupi chimadzaza, chimafooketsa, chomwe chimayambitsa kukula kwa matenda ashuga. Mwa akazi, njira za metabolic ndi mahomoni olimbitsa thupi nthawi zambiri amasokonezedwa pa nthawi yapakati.

Gulu la odwala matenda a shuga

Kugawidwa kwa matenda amtundu wa 1 kumagawa matendawa malingana ndi njira zingapo. Kusiyanitsa Kubwezeretsa:

• kulipidwa - apa kuchuluka kwa wodwala kagayidwe kazakudya kamene kali pafupi kwambiri,
• zophatikiza - limodzi ndi kuchuluka kwakanthawi kapena kuchepa kwa magazi m'magazi,
• kuwola - pano glucose m'magazi sachepetsedwa ndi mankhwala komanso mothandizidwa ndi zakudya. Odwala otere nthawi zambiri amakhala ndi chikomokere, chomwe chimayambitsa imfa.

Mwa chikhalidwe cha zovuta, mitundu ya shuga yokhala ndi njira yodalira insulin imasiyanitsidwa ngati yosavuta komanso yovuta. Poyambirira, tikulankhula za shuga wolipidwa popanda zovuta. Njira yachiwiri imatsatiridwa ndimatenda osiyanasiyana a mtima, ma neuropathi, zotupa za pakhungu ndi ena. Autoimmune (chifukwa cha ma antibodies ku minofu yawo) ndi idiopathic (chifukwa chosadziwika) amasiyanitsidwa ndi chiyambi.

Zizindikiro zamatsenga

Kufotokozera kwa chizindikiro cha mtundu wa matenda amtundu wa insulin kumatengera zizindikiro zotsatirazi:

• polydipsia kapena ludzu losalekeza. Chifukwa chakumwa madzi ambiri, thupi limayesetsa "kuchepetsa" shuga wamwazi,
• polyuria kapena kukodza kwambiri chifukwa chakumwa madzi ambiri, komanso kuchuluka kwa shuga mkodzo.
• kumangokhalira kumva njala. Anthu omwe ali ndi matenda am'mimba amakhala ndi njala nthawi zonse. Izi zimachitika chifukwa cha kufa ndi mphamvu kwa minofu, chifukwa glucose sangalowe mkati mwake,
• kuwonda kwambiri. Chifukwa cha njala yamphamvu, kuwonongeka kwa mafuta ndi mapuloteni amthupi kumachitika. Izi zimatsitsa thupi la wodwala,
• khungu lowuma,
• thukuta kwambiri, pakhungu loyera.

Kwa nthawi yayitali ya matenda a zam'mimba, kuchepa kwa thupi kukana matenda a bakiteriya ndi bakiteriya ndi chikhalidwe. Odwala nthawi zambiri amadwala matendawa, thukuta, chimfine.

Zochizira

Ndikosatheka kuchiritsa matenda amtundu woyamba wa shuga, koma mankhwala amakono amapereka odwala njira zatsopano zomwe zingathandize kukhazikika kwawo, kuchepetsa shuga, komanso kupewa zovuta zoyambira matenda.

Njira zopewera matenda ashuga zikuphatikizapo izi:

• kugwiritsa ntchito mankhwala okhala ndi insulin,
• kudya
• olimbitsa thupi
• physiotherapy
• maphunziro omwe amalola anthu odwala matenda ashuga kuti azitha kuyang'anira kuchuluka kwa shuga, kudzipereka mwaokha ngati mankhwala ali kunyumba.

Kugwiritsa ntchito mankhwala okhala ndi insulin ndikofunikira pafupifupi 40 - 50% ya milandu. Mankhwala a insulini amakulolani kuti mukhale ndi thanzi labwino la munthu, kukhazikitsa kagayidwe kazakudya, ndikuchotsa zovuta za matenda. Nthawi zambiri, ndimatenda, njira ya physiotherapeutic monga electrophoresis imagwiritsidwa ntchito. Kuphatikizidwa kwa magetsi amakono, mkuwa, zinki ndi potaziyamu kumakhala ndi zotsatira zabwino pakupanga njira ya thupi.

Chofunika kwambiri kuthandizira matendawa ndichakudya choyenera komanso masewera. Madokotala amalimbikitsa kupatula zakudya zovuta komanso zakudya zopatsa shuga kuchokera menyu. Zakudya izi zimathandiza kupewa shuga a magazi, omwe amapewa zovuta zambiri. Njira ina yothandizira ndi kuchita zolimbitsa thupi tsiku ndi tsiku. Kuchita masewera olimbitsa thupi kumapereka kukhazikitsidwa kwa kagayidwe, kamene kamakhudza ntchito ya kapamba. Mukamasankha masewera, makonda ayenera kuperekedwa ku zinthu monga kuyenda, kusambira, kuyendetsa njinga, kuyendetsa mopepuka.

Matenda osagwirizana ndi insulin

Matenda a shuga osagwirizana ndi insulin - NIDDM kapena matenda amtundu wa 2 ndi endocrine pathology, omwe amatsatana ndi kuchepa kwa chidwi cha minofu ya thupi kupita ku insulin ya mahomoni. Potengera kufala, matendawa amakhala m'gulu lotsogola pakati pa matenda onse; matenda a oncological okha ndi matenda a mtima omwe ali patsogolo pake.

Zomwe zimayambitsa matendawa

Kusiyana pakati pa matenda ashuga amtundu wa 2 ndi oyamba ndikuti pamenepa insulin imapangidwa moyenera, koma mahomoni sangathe kuthana ndi shuga, omwe amachititsa kuti glycemia ipitirire.

Asayansi sangadziwe chomwe chimayambitsa matenda obwera ndi insulin, koma panthawi imodzimodziyo amatcha zinthu zina zowopsa. Mulinso:

• cholowa
• onenepa kwambiri
• moyo wosachita bwino
• zoyambira za endocrine,
• matenda a chiwindi
• nthawi yapakati
• kusokonezeka kwa mahomoni
• kupsinjika, chimfine ndi matenda opatsirana.

Amakhulupirira kuti pachiwopsezo ndi anthu atatha zaka 50, achinyamata onenepa kwambiri, komanso odwala omwe ali ndi vuto lalikulu la chiwindi ndi kapamba.

Zolemba zamatenda

Mitundu yoyamba ndi yachiwiri ya matenda ashuga ali ndi zizindikiro zofananira, chifukwa muzochitika zonse ziwiri chithunzi cha chipatala chimakhala chifukwa cha kuchuluka kwa shuga mumkodzo ndi magazi.

Mawonekedwe amtundu wa matenda amtundu wa 2:

• ludzu ndi kuuma kwa mucosa wamlomo,
• maulendo pafupipafupi kupita kuchimbudzi, kukodza kumadziwika ngakhale usiku,
• kunenepa
• kubuma kwa manja ndi miyendo,
• mabala amachiritso a nthawi yayitali ndi zipsera,
• njala yosalekeza
• kuwonongeka kwa mawonekedwe, mavuto a mano, matenda a impso.

Odwala ambiri amakhala ndi nseru, kupweteka kwa epigastric, thukuta, komanso kusowa tulo. Kwa akazi, mawonekedwe monga thrush, brittleness ndi kuchepa kwa tsitsi, kufooka kwa minofu ndi kakhalidwe. Kwa amuna, kuchepa kwa zochitika zolimbitsa thupi, kuphwanya potency, ndikudziwika. Muubwana, ndikofunikira kulabadira zizindikiro monga mawonekedwe a mawanga amdima pansi pa mikondo, kuthamanga, kulemera, zotupa, zomwe nthawi zambiri zimayendetsedwa ndi supplement.

Njira zochizira

Monga chithandizo cha matenda amtundu wa 1, matenda omwe amadzimira payekhapayekha amafunika njira yophatikizira chithandizo. Pakati pa mankhwala, mankhwala omwe amalimbikitsa kupanga insulin amagwiritsidwa ntchito, chifukwa mahomoni opangidwa sangathenso kuthana ndi kupatsanso shuga m'thupi lonse. Kuphatikiza apo, othandizira omwe amachepetsa kukana, ndiye kuti, kukana minyewa, amagwiritsidwa ntchito. Mosiyana ndi chithandizo cha matenda a shuga omwe amadalira insulin, mtundu wa 2 matenda samapangidwira kuti ubweretse insulin yowonjezera m'magazi, koma pakuwonjezera kukhudzika kwa minofu ndikusitsa kuchuluka kwa shuga m'thupi.

Kuphatikiza pa chithandizo chamankhwala, odwala onse amapatsidwa zakudya zapadera za carb. Chofunikira chake ndikuchepetsa kugwiritsa ntchito zakudya zomwe zili ndi index yayikulu ya glycemic, kusintha kwa mapuloteni komanso zakudya zamasamba. Mtundu wina wa zamankhwala ndi masewera. Kubwezera kumapangitsa kumwa kwa shuga ndikuchepetsa minofu kukana insulin. Pogwiritsa ntchito masewera olimbitsa thupi, kufunikira kwa minofu ya minofu mu glucose kumachulukitsa, komwe kumayambitsa mayamwidwe abwino a mamolekyulu a shuga.

Mavuto a mtundu 1 ndi matenda ashuga 2

Mavuto obwera chifukwa cha matenda ashuga komanso zotsatira zake zimachitika mwa odwala, mosasamala mtundu wamatenda. Pali zovuta za mtundu woyambirira komanso mochedwa. Poyambira:

• ketoacidosis ndi ketoacidotic chikomokere - izi zimachitika mwa odwala omwe ali ndi mtundu woyamba wamatenda, amayamba chifukwa cha kusokonekera kwa kagayidwe kachakudya ka maziko a insulin,
• hypoglycemic chikomokere - kuchuluka kwake sikudalira mtundu wa shuga, kamayamba chifukwa cha kuchuluka kwa shuga m'magazi,
• Hyperosmolar coma - vutoli limachitika chifukwa cha kuchepa madzi m'thupi komanso kusowa kwa insulin. Nthawi yomweyo, munthu amamva ludzu lamphamvu, kuchuluka kwa mkodzo kumawonjezeka, kukhudzika, kupweteka kwa peritoneum kumawonekera. Pomaliza, wodwalayo wafoka, akomoka.
• hypoglycemic coma - imapezeka mwa anthu omwe ali ndi mtundu woyamba komanso wachiwiri wa matenda, zimachitika chifukwa cha kuchepa kwambiri kwa misempha ya shuga mthupi. Nthawi zambiri, matendawa amakula chifukwa cha kuchuluka kwa insulin.

Kutenga kwakutali kwa matendawa, odwala matenda ashuga amataya msanga. Mu tebulo mutha kuwona kuti ndi iti yomwe imakhala yokhudzana ndi mitundu yamatenda amisala.

Matenda amtima mwa odwala omwe ali ndi insulin-yodziimira payekha samakula pafupipafupi kuposa anthu opanda matenda a shuga.

Matenda a shuga

Mtundu wina wa matenda omwe amatsatana ndi glycemia ndi gestationalabetes mellitus (GDM). Matendawa amapezeka mwa azimayi panthawi yoyembekezera. Nthawi zambiri, matendawa amachoka mwana akangobadwa mwa iye yekha, koma ngati matendawa sanaperekedwe chisamaliro choyenera, vutoli limatha kukhala matenda a shuga a mtundu wachiwiri.

Zolinga za maonekedwe

Malinga ndi kafukufuku, azimayi oterewa ali pachiwopsezo chotenga matendawa:

• ndi cholowa chamtsogolo
• onenepa kwambiri
• ndi ma ovarian pathologies,
• azimayi ovutikira atatha zaka 30,
• azimayi omwe adapezeka ndi matenda ashuga.

Zomwe zili pamwambapa ndizinthu zopsetsa mtima zomwe zimayambitsa matenda a pancreatic. Thupi silingathe kupirira ndi katundu wambiri, silingatulutse insulin yokwanira, yomwe imayambitsa kuchuluka kwa shuga, kuchepa kwa kukhulupirika kwa glucose.

Kodi mungadziwe bwanji matenda a shuga? The Symbomatology ya matendawa ndi ofanana mawonetseredwe amtundu wa 2 shuga. Mwa akazi, zizindikiro zotsatirazi zimawonekera:

• ludzu
• njala yosalekeza
• kukodza pafupipafupi
• nthawi zina mavuto amakwera
• zithunzi zowoneka zimatayika.

Pozindikira matendawa panthawi yake, azimayi onse munthawi yobereka mwana amafunika kuyezetsa magazi, kuyeza magazi pafupipafupi, komanso kusamala ndi matupi awo. Kuphatikiza pa chiwopsezo ku thanzi la amayi, GDM imayambitsa chiopsezo cha fetal pathologies. Poterepa, pali chiopsezo cha matenda ashuga a m'mimba, omwe amachititsa kuti mwana apangidwe m'mimba.

Chithandizo ndi kupewa

Popeza GDM imayendera limodzi ndi kuchuluka kwa shuga m'thupi, chithandizo chachikulu komanso kupewa matendawa ndikuwonjezera matenda a shuga. Mkazi yemwe ali ndi udindo amayenera kumayesa pafupipafupi, kutsatira zakudya zapadera. Ntchito yayikulu ndikukana zakudya zotsekemera komanso zopatsa mphamvu kwambiri, kugwiritsa ntchito masamba okwanira, mapuloteni, fiber. Kuphatikiza apo, pofuna kusintha njira zama metabolic, mkazi nthawi zambiri amalimbikitsidwa kuyenda mu mpweya wabwino, kuchita masewera olimbitsa thupi. Izi sizingothandiza shuga wochepera, komanso kusintha thanzi lathunthu.

Matenda a shuga a sekondale

Mtundu woyamba 1 ndi matenda ashuga 2 ndiwo mtundu woyamba wa matenda. Kugawidwa kwa shuga kumakhalanso ndi mtundu wina wa matenda. Fomu yachiwiri imatchedwa shuga, yomwe imachitika chifukwa cha matenda ena aliwonse. Nthawi zambiri mawonekedwe achiwiri amakula chifukwa cha matenda kapamba kapena chifukwa cha zovuta za endocrine.

Zizindikiro zamakhalidwe

Chithunzi cha chipatala cha matendawa ndi chofanana ndi chiwonetsero cha matenda amtundu 1, nthawi zambiri chimapezeka mwa odwala athunthu, amakhala ndi pang'onopang'ono. Zina mwazina ndi izi:

• kamwa yowuma
• ludzu losalekeza
• kumverera kwadzidzidzi kwanjala
• kukodza pafupipafupi
• kufooka wamba, kusakonda, kulumala.

Popanda chithandizo chofunikira, matenda amtundu wa cell amapita ku mawonekedwe otseguka omwe amafuna insulin.

Chithandizo cha matendawa ndikufuna kuchiza matenda omwe amayambitsa matenda ashuga. Posankha njira zamankhwala, wodwalayo ayenera kukayezetsa mchipatala, ndikuwapatsa mayeso onse ofunikira.

Chofunikanso kwambiri ndikukonzanso moyo ndi zakudya. Wodwala amapatsidwa zakudya zapadera komanso zolimbitsa thupi tsiku lililonse. Njira zoterezi zimathandizira kukonza kagayidwe, kubwezeretsa kugwira ntchito kwa kapamba ndi ziwalo zina zomwe zimakhudzidwa ndi matendawa.

Fomu labala

Mwa mitundu ya matenda ashuga, pali mtundu wapadera wamatendawa monga matenda am'mbuyomu kapena mtundu wa latent. Madokotala ambiri amavomereza kuti matenda amtunduwu ndiowopsa kwambiri kwa anthu, chifukwa nthawi zambiri sizotheka kudziwa nthawi yoyambira matenda. Nthawi yomweyo, mapangidwe amtundu wamatenda amapezeka m'thupi la wodwalayo.

Chifukwa

Monga mitundu ina ya matenda ashuga, mitundu yamtunduwu imatha kukhala ndi izi:

• kukalamba kwa thupi
• chibadwire
• kunenepa
• nthawi yapakati
• matenda a bacteria ndi bacteria.

Anthu omwe ali pachiwopsezo amalimbikitsidwa kuti azicheza ndi dokotala pafupipafupi, kutenga mkodzo ndi kuyesa magazi kwa shuga.

Nthawi zambiri, matendawa amatuluka posachedwapa, ndiye kuti, popanda zizindikiro zotchulidwa. Pofuna kuti musaphonye kuyambika kwa matenda ashuga, muyenera kulabadira mawonekedwe:

• khungu louma, zotupa za purulent pafupipafupi,
• ludzu ndi kamwa yowuma
• kusintha kwa kulemera - kuwonda kapena kulemera msanga,
• kuchepa kwathunthu thanzi, kugona tulo, kusakwiya.

Makhalidwe azizindikiro zakumapeto zimaphatikizapo ma pathologies osiyanasiyana a dermis, matenda amkamwa, kuchepa kwa libido yaimuna, matenda a mtima ndi mitsempha yamagazi, komanso kuphwanya kwamtundu wa tactile.

Pomaliza

Matenda a shuga ndi matenda ofala a endocrine omwe amadzichitikira okha komanso motsutsana ndi mitundu ina ya matenda. Ngakhale dzina lodziwika bwino, matendawa ali ndi mitundu ingapo, iliyonse yomwe imakhala yoopsa chifukwa cha zovuta zake.Pofuna kupewetsa zovuta ndikuyambitsa matenda oyang'aniridwa, ndikofunikira kuzindikira matenda ashuga munthawi yake ndikuchita zonse zofunika pakuchiritsa.

Kusintha kwa Madzi

Mafotokozedwe oyamba a mkhalidwe wa pathological awa adawonetsa makamaka zozizwitsa zake kwambiri - kutayika kwa madzimadzi (polyuria) ndi ludzu losagonjetseka (polydipsia). Mawu akuti "matenda a shuga" (lat. Diabetes mellitus) adagwiritsidwa ntchito koyamba ndi sing'anga wachi Greek Demetrios wa Apamania (m'ma 2000 BC. E.), amachokera ku Greek wina. δδββίίω, zomwe zikutanthauza "kudutsa."

Zomwe zinali choncho panthawiyo zinali lingaliro la matenda ashuga - mkhalidwe womwe munthu umangotaya madzimadzi ndi kuumiriranso, "ngati siphon", womwe umatanthauzira chimodzi mwazizindikiro zazikulu za matenda ashuga - polyuria (kutulutsa mkodzo kwambiri). M'masiku amenewo, matenda a shuga amawoneka ngati mkhalidwe womwe thupi limatha kutaya madzi.

Glucose Incinuence Kusintha

Mu 1675, a Thomas Willis adawonetsa kuti ndi polyuria (kuchuluka kwa mkodzo), mkodzo ukhoza kukhala "wokoma" kapena "wopanda pake". Poyambirira, adawonjezera liwu loti shuga. mellitus, lomwe m'Chilatini limatanthawuza "wokoma ngati uchi" (mellitus shuga wachi Latin), ndipo chachiwiri - "insipidus", zomwe zikutanthauza "zopanda pake." Matenda a shuga a Insipid amatchedwa insipid - matenda omwe amayamba chifukwa cha matenda a impso (nephrogenicabetes insipidus) kapena nthenda ya gland (neurohypophysis) yodziwika ndi kubowoka kwa secretion kapena zochita za thupi la antidiuretic.

Matthew Dobson adatsimikizira kuti kukoma kwamkodzo ndi magazi a odwala omwe ali ndi matenda ashuga ndi chifukwa cha shuga wambiri. Amwenye akale adazindikira kuti mkodzo wa odwala matenda ashuga umakopa nyerere, ndipo amatcha matendawa "matenda okoma a mkodzo." Akanani aku Korea, China, ndi Japan amawu amodzi amachokera ku ideogram yomweyo ndikuti amatanthauzanso "matenda otentha mkodzo."

Magazi Akuluakulu

Kubwera kwa luso lotha kuzindikira kuchuluka kwa glucose osati mkodzo, komanso seramu yamagazi, zinapezeka kuti mwa odwala ambiri, kuwonjezeka kwa shuga m'magazi poyamba sikutanthauza kuti mkodzo wapezeka. Kuwonjezeka kwina kwa shuga m'magazi kumapitilira kuchuluka kwa impso (pafupifupi 10 mmol / L) - glycosuria imayamba - shuga imapezekanso mkodzo. Kafotokozedwe ka zomwe zimayambitsa matenda ashuga kuyenera kusinthidwanso, popeza kunapezeka kuti njira yogwiritsira ntchito shuga posungidwa ndi impso sinaswidwe, zomwe zikutanthauza kuti palibe "shuga kulowa" monga choncho. Nthawi yomweyo, malongosoledwe apitawa "amayenera" mkhalidwe watsopano wamatenda, omwe amatchedwa "matenda a impso" - kuchepa kwa njira yolembedwera magazi a shuga (kuzindikira shuga mumkodzo m'magazi abwinobwino a shuga). Chifukwa chake, monga momwe zimakhalira ndi matenda a shuga a insipidus, paradigm yakaleyo sinali yoyenera kwa matenda ashuga, koma mkhalidwe wosiyana kotheratu wa matenda.

Chifukwa chake, "shuga kulowetsa" paradigm anali kusiyidwa m'malo mokomera "shuga wamagazi" kwambiri. Paradigm lero ndi chida chokhacho chokhacho chothandiza pofufuzira ndikuwunika momwe mankhwalawo alili. Nthawi yomweyo, paradigm yamakono yokhudza matenda a shuga sikuti imangokhala chifukwa cha shuga wambiri. Komanso, sizabwino kunena kuti paradigm "shuga wambiri" imatsiriza mbiri ya sayansi ya matenda osokoneza bongo omwe amachepetsa malingaliro okhudzana ndi kuchuluka kwa shuga mu zakumwa.

Kuperewera kwa insulin

Zambiri zomwe zapezedwa zapangitsa kuti pakhale paradigm yatsopano ya zomwe zimayambitsa matenda ashuga monga insulin. Mu 1889, Joseph von Mehring ndi Oscar Minkowski adawonetsa kuti atachotsa kapamba, galu amakhala ndi matenda ashuga.Ndipo mu 1910, a Sir Edward Albert Sharpei-Schaefer adanenanso kuti matenda ashuga adayamba chifukwa cha kuchepa kwa mankhwala omwe amachokera ku zisumbu za Langerhans mu kapamba. Amadzitcha insulin, kuchokera ku Latin insulazomwe zikutanthauza kuti "islet". Ntchito ya pancreatic endocrine komanso gawo la insulin pakukula kwa matenda ashuga zidatsimikiziridwa mu 1921 ndi Frederick Bunting ndi Charles Herbert Best. Adabwereza kuyesa kwa von Mehring ndi Minkowski, kuwonetsa kuti zisonyezo za matenda ashuga mu agalu okhala ndi kapamba wakutali zitha kuchotsedwa mwa kuwapereka kuchotsera kwa magalimoto amtundu wa Langerhans agalu athanzi, a Bunting, Best ndi antchito awo (makamaka chemist Collip) adatsuka insulini yokhayokha kuchokera ku zikondwerero zazikulu ng'ombe, ndikugwiritsa ntchito pochiza odwala oyamba mu 1922. Kuyesaku kunachitika ku Yunivesite ya Toronto, nyama zothandizira ndi zida zoyesera zinaperekedwa ndi John MacLeod. Chifukwa cha zomwe apezazi, asayansi adalandira Mphoto ya Nobel mu zamankhwala mu 1923. Kupanga kwa insulini komanso kugwiritsa ntchito mankhwalawa matenda a shuga kunayamba kukula mwachangu.

Atamaliza kugwira ntchito yopanga insulin, a John MacLeod adabwerera ku maphunziro potsatira kukhazikitsidwa kwa gluconeogenesis, komwe adayamba mu 1908, ndipo mu 1932 adazindikira kuti dongosolo lamatsenga la parasympathetic limagwira ntchito yayikulu mu chiwindi.

Komabe, atangopanga njira yowerengera insulin m'magazi, zidapezeka kuti mwa odwala ambiri omwe ali ndi matenda osokoneza bongo kuchuluka kwa insulin m'mwazi sikunangochepetsedwa, komanso kunawonjezeka kwambiri. Mu 1936, a Sir Harold Percival Himsworth adasindikiza ntchito momwe mtundu 1 komanso matenda amitundu iwiri yoyamba adanenedwa ngati matenda osiyana. Izi zinasinthanso magawo a shuga, ndikugawa m'magulu awiri - ndikusowa kwathunthu kwa insulini (mtundu 1) ndi kuperewera kwa insulin (mtundu 2). Zotsatira zake, matenda a shuga asintha kukhala matenda omwe amatha kupezeka ndi matenda osachepera awiri: matenda a 1 kapena a 2 matenda a shuga. .

Ngakhale kupita patsogolo kwa matenda ashuga m'zaka makumi angapo zapitazi, kuzindikira kwa matendawa kumadalirabe pakuphunzira magawo a carbohydrate metabolism.

Kuyambira Novembara 14, 2006, mothandizidwa ndi UN, World Diabetes Day yakondwerera; November 14 yasankhidwa pamwambowu chifukwa chakuzindikira kuyenerera kwa Frederick Grant Bunting pakuphunzira za matenda a shuga.

Mawu akuti "mtundu 1 wa matenda a shuga" amagwiritsidwa ntchito kutanthauza gulu la matenda omwe amapezeka chifukwa cha kuwonongeka kwapang'onopang'ono kwa maselo a pancreatic beta, omwe amatsogolera pakuchepa kwa kapangidwe ka proinsulin ndi hyperglycemia, amafunikira chithandizo chamankhwala. Mawu akuti "mtundu wachiwiri wa matenda ashuga" amatanthauza matenda omwe amapezeka mwa anthu omwe amakhala ndi zotumphukira kwambiri za adipose omwe amatsutsana ndi insulin, chifukwa chake pamakhala kuphatikizika kwakukulu kwa proinsulin, insulin ndi amylin mwa maselo a beta a kapamba, omwe amatchedwa "kuchepa kwa abale". Kukonzanso kwaposachedwa kwambiri kwakugawidwa kwa matenda ashuga kunapangidwa ndi American Diabetes Association mu Januware 2010. Kuyambira 1999, malinga ndi gulu lomwe livomerezedwa ndi WHO, mtundu wa 1 matenda ashuga, mtundu wachiwiri wa shuga, matenda ashuga apakati komanso "mitundu ina ya matenda ashuga" yasiyanitsidwa. Mawu akuti latent autoimmune shuga mu akulu (LADA, "mtundu wa 1.5 matenda ashuga") komanso mitundu yosiyanasiyana ya matenda ashuga ndiosiyananso.

Kuchuluka kwa anthu odwala matenda ashuga, pafupifupi, ndi 1-8.6%, kuchuluka kwa ana ndi achinyamata kuli pafupifupi 0,1-0.3%. Poganizira mitundu yosadziwika, chiwerengerochi m'mayiko ena chitha kufika 6%. Pofika chaka cha 2002, anthu pafupifupi mamiliyoni 120 amadwala matenda a shuga mdziko lapansi. Malinga ndi kafukufuku owerengera, zaka khumi ndi zisanu zilizonse kuchuluka kwa anthu odwala matenda ashuga kumawonjezera, motero matenda a shuga amakhala vuto lazachipatala komanso chikhalidwe. Malinga ndi a Russian Diabetes Association, potchula bungwe la International Diabetes Federation en, kuyambira pa Januware 1, 2016, anthu pafupifupi mamiliyoni 415 azaka zapakati pa 20 mpaka 79 padziko lapansi ali ndi matenda ashuga, ndipo theka la iwo sadziwa za matenda awo.

Tiyeneranso kudziwa kuti popita nthawi, kuchuluka kwa anthu omwe akudwala matenda amtundu wa 1 kumawonjezeka.Izi zikuchitika chifukwa cha kuwongolera kwa chisamaliro chachipatala kwa anthu komanso kuchuluka kwa moyo wa anthu odwala matenda ashuga a mtundu woyamba.

Kuyenera kudziwitsidwa Heterogeneity ya zochitika za matenda a shuga, kutengera mtundu. Mtundu wachiwiri wa matenda ashuga ndiwofala kwambiri pakati pa a Mongoloid, mwachitsanzo, ku UK, pakati pa anthu amtundu wa Mongoloid azaka zopitilira 40, 20% akudwala matenda a shuga 2, anthu a mtundu wa Negroid ali m'malo achiwiri, pakati pa anthu azaka zopitilira 40, gawo la odwala matenda a shuga 17% Pafupipafupi pamavuto ena pamakhalanso zovuta. Kukhala mu mpikisano wa a Mongoloid kumawonjezera mwayi wokhala ndi matenda a shuga ndi matenda a mtima, koma kumachepetsa chiopsezo cha matenda ammimba a shuga. Anthu amtundu wa Negroid nthawi zambiri amakhala ndi matenda oopsa oopsa, oopsa komanso ochepa.

Malinga ndi deta ya 2000, kuchuluka kwakukulu kwa odwala kunawonedwa ku Hong Kong, iwo anali 12% ya anthu. Ku USA, kuchuluka kwa milandu kunali 10%, ku Venezuela - 4%, chiwerengero chochepa kwambiri cha odwala omwe adalembetsa chinawonedwa ku Chile, chinali 1.8%.

Zakudya zimakhala ndi mitundu yosiyanasiyana yamafuta. Zina mwa izo, monga glucose, zimakhala ndi mphete imodzi ya heterocyclic imodzi ya sikisi ndipo zimamizidwa m'matumbo osasinthika. Zina, monga sucrose (disaccharide) kapena wowuma (polysaccharide), zimakhala ndi zolumikizana ziwiri kapena zingapo zolumikizika ndi heterocycle zisanu kapena zisanu ndi chimodzi. Zinthu izi zimapukutidwa ndi ma michere osiyanasiyana am'matumbo kuti amolekyu a glucose ndi shuga ena osavuta, ndipo pomaliza amaphatikizidwa m'magazi. Kuphatikiza pa shuga, mamolekyulu osavuta monga fructose, omwe m'chiwindi chimasandulika shuga, amalowanso m'magazi. Chifukwa chake, shuga ndiye chakudya chachikulu m'magazi ndi thupi lonse. Ali ndi gawo limodzi lofunikira mu kagayidwe kamunthu: ndiye gwero lenileni komanso lamphamvu kwa chilengedwe chonse. Ziwalo zambiri ndi minyewa (mwachitsanzo, ubongo) zimagwiritsa ntchito shuga makamaka mphamvu (kuwonjezera pamenepo, matupi a ketone amatha kugwiritsidwa ntchito).

Udindo waukulu mu kayendedwe ka chakudya kagayidwe kamthupi umaseweredwa ndi mahomoni a kapamba - insulin. Ndi puloteni wopangidwa mu β-maselo a islets of Langerhans (kudzikundikira kwa maselo a endocrine m'matumba a pancreatic) ndipo amapangidwira kuti azithandizira kukonzanso kwa glucose ndi maselo. Pafupifupi minofu yonse ndi ziwalo (mwachitsanzo, chiwindi, minofu, minofu ya adipose) zimatha kukonza shuga pokhapokha. Tiziwalo ndi ziwalo zimatchedwa wodwala insulin. Tizilombo tina tating'onoting'ono (monga ubongo) safuna insulini kuti pokonza shuga, chifukwa chake amatchedwa insulin yodziyimira payokha .

Glucose wosasunthika amayikidwa (kusungidwa) m'chiwindi ndi minofu mu mawonekedwe a glycogen polysaccharide, yomwe imatha kusinthidwa kukhala glucose. Koma pofuna kusintha glucose kukhala glycogen, insulin imafunikiranso.

Nthawi zambiri, kuchuluka kwa shuga m'magazi kumasiyana kwambiri: kuyambira 70 mpaka 110 mg / dl (milligrams pa desilita) (3.3-5.5 mmol / l) m'mawa atagona komanso kuyambira 120 mpaka 140 mg / dl atatha kudya. Izi ndichifukwa choti kapamba amatulutsa insulin yochulukirapo, kuchuluka kwambiri kwa shuga m'magazi.

Pakakhala vuto la insulin (mtundu 1 wa matenda ashuga mellitus) kapena kuphwanya kwa njira yogwirira ntchito ya insulin ndi maselo amthupi (mtundu 2 shuga mellitus), glucose imadziunjikira m'magazi ambiri (hyperglycemia), ndi maselo amthupi (kupatula ziwalo zosagwirizana ndi insulin) mphamvu.

Pali magawo angapo a shuga m'magulu osiyanasiyana. Pamodzi, zimaphatikizidwa ndikuwunika kwake komanso zimapereka kulongosola kolondola kwa zomwe wodwala ali ndi matenda ashuga.

Masanjidwe amasinthidwe

I. Mtundu woyamba wa matenda ashuga kapena Matenda a shuga, komabe, anthu azaka zilizonse amadwala (Chiwonongeko cha β-cell chotsogolera ku kukulira kwa insulin ya moyo wonse)

Zindikirani: Magulu: "Mwa anthu onenepa kwambiri 'komanso" mwa anthu onenepa kwambiri "adathetsedwa ndi WHO mu 1999 gwero silinatchulidwe masiku 2148 .

1. zolakwika zamtundu (zonyansa) za insulin ndi / kapena zolandilira,
2. Matenda a pancreas exocrine,
3. matenda a endocrine (endocrinopathies): Itsenko-Cushing's syndrome, acromegaly, amaika poizoni woopsa, pheochromocytoma ndi ena,
4. matenda osokoneza bongo omwe amayambitsa matenda osokoneza bongo
5. matenda oyambitsa matenda a shuga
6. mitundu yachilendo ya matenda osokoneza bongo okhudzana ndi matenda,
7. ma gennd syndromes ophatikizidwa ndi shuga.

IV. Matenda a shuga - pathological yodziwika ndi hyperglycemia yomwe imachitika mwa amayi ena ndipo nthawi zambiri amangozilala atangobereka.

* Chidziwitso: ziyenera kusiyanitsidwa ndi pakati pa odwala omwe ali ndi matenda ashuga.

Malinga ndi malingaliro a WHO, mitundu yotsatirayi ya shuga mwa amayi apakati ndiosiyanitsidwa:

1. Matenda a shuga a Type 1 omwe adapezeka asanatenge pathupi.
2. Type 2 shuga mellitus wapezeka asanakhale ndi pakati.
3. Matenda a shuga oyembekezera - mawuwa amaphatikiza zovuta zilizonse za kulekerera kwa glucose komwe kunachitika panthawi yapakati.

Kuyenda kosavuta Sinthani

Matenda ofatsa (I degree) amadziwika ndi glycemia wocheperako, osapitirira 8 mmol / l pamimba yopanda kanthu, pomwe palibe kusinthika kwakukulu mu shuga mumagazi tsiku lonse, osafunikira tsiku lililonse glucosuria (kuyambira zovuta mpaka 20 g / l). Malipiro amasamalidwa kudzera mu chakudya. Ndi mtundu wofatsa wa shuga, angioeuropathy a preclinical ndi magawo othandiza amatha kupezeka mwa wodwala yemwe ali ndi matenda osokoneza bongo.

Kusintha kozama

Ndi kukula kwamagulu (II digiri) matenda osokoneza bongo a shuga, kuthamanga kwa glycemia kumadzuka, monga lamulo, mpaka 14 mmol / l, kusinthasintha kwa glycemic tsiku lonse, glucosuria tsiku ndi tsiku nthawi zambiri simapitilira 40 g / l, ketosis kapena ketoacidosis imayamba. Kulipira shuga kumachitika ndi kadyedwe komanso kayendetsedwe ka mankhwala ochepetsa mphamvu ya pakamwa kapena mwa kuphatikiza insulin (pankhani ya kukana kwachiwiri kwa sulfamide) pa mlingo womwe umapitilira 40 OD patsiku. Mu odwalawa, odwala matenda ashuga angioneuropathies osiyanasiyana kutanthauzira ndi magawo zinchito angathe kupezeka.

Sinthani Yovuta Pano

Matenda akulu a shuga (III digiri) amadziwika ndi kuchuluka kwa glycemia (pamimba yopanda 14 mmol / l), kusinthika kwakukulu mu shuga m'magazi tsiku lonse, glucosuria yayikulu (kupitilira 40-50 g / l). Odwala amafunikira chithandizo cha insulin nthawi zonse pa 60 OD kapena kupitilira apo, awululira osiyanasiyana anguduuropathies a matenda ashuga.

Kuzindikira

Pakupezeka matenda, mtundu wa shuga umayikidwa pamalo oyamba, matenda a shuga a 2, kuzindikira kwa othandizira pakamwa (mosakanika kapena osagwirizana), kuwopsa kwa matendawa, kenako boma la metabolism ya carbohydrate, ndipo mndandanda wazovuta za matenda a shuga umawonetsedwa.

Malinga ndi ICD 10,0, kupezeka kwa matenda a shuga, kutengera malo omwe adagawikidwako, akulemba ndi magawo E 10-14 a zovuta za matendawa akuwonetsedwa ndi zigawo zitatu kuchokera pa 0 mpaka 9.

.0 Ndi chikomokere .1 Ndi ketoacidosis .2 Ndi kuwonongeka kwa impso .3 Ndi zotupa za m'maso .4 Ndi mavuto amitsempha .5 Ndi zotumphukira zamagazi .6 Ndi zovuta zina .7 Ndi zovuta zingapo .8 Ndi zovuta zosafotokozeredwa .9 Palibe zovuta .9

Kutengera kwa chibadwa cha matenda ashuga pakali pano kumawerengedwa.Kwa nthawi yoyamba, malingaliro oterewa adawonetsedwa mu 1896, pomwe amatsimikiziridwa pokhapokha potsatira zotsatira zakuwona. Mu 1974, a J. Nerup et al., A. G. Gudworth ndi J. C. Woodrow, adapeza ubale pakati pa B-locus of histocompatibility leukocyte antigens ndi mtundu 1 wa shuga komanso kusapezeka kwawo mwa anthu omwe ali ndi matenda ashuga a 2.

Pambuyo pake, mitundu ingapo yamitundu yosiyanasiyana idadziwika, yomwe imakhala yofala kwambiri pamtundu wa odwala omwe ali ndi matenda ashuga kuposa anthu ena onse. Chifukwa, mwachitsanzo, kupezeka kwa B8 ndi B15 mu genome munthawi yomweyo kunawonjezera chiopsezo cha matendawa pafupifupi nthawi 10. Kupezeka kwa chikhomo cha Dw3 / DRw4 kumawonjezera chiopsezo cha matendawa ndi 9,4. Pafupifupi 1.5% yamilandu ya matenda a shuga imagwirizanitsidwa ndi mtundu wa A3243G masinthidwe a MT-TL1 mitochondrial gene.

Komabe, ziyenera kudziwidwa kuti ndi mtundu wa 1 shuga, genetic heterogeneity imawonedwa, ndiye kuti, matendawa amatha chifukwa cha magulu osiyanasiyana amitundu. Chizindikiro chakuchipatala cha Laborator chomwe chimakupatsani mwayi kudziwa mtundu woyamba wa matenda ashuga ndicho kupezeka kwa ma antibodies kupita ku ma cell a pancreatic cells -magazi. Mtundu wa cholowa pakadali pano sunadziwike bwinobwino, kuvuta kulosera zam'magazi kumalumikizidwa ndi genetic heterogeneity ya matenda a shuga mellitus, ndipo kupanga mtundu wokwanira cholowa kumafunikira zowerengera zowerengera ndi ma genetic.

Mu pathogenesis ya matenda a shuga, pali maulalo awiri omwe adadziwika:

1. osakwanira kupanga insulin ndi maselo a endocrine a kapamba,
2. kusokonekera kwa kayendedwe ka insulin ndi maselo a minofu ya thupi (insulin kukana) chifukwa cha kusintha kwa kapangidwe kapena kuchepa kwa chiwerengero cha zolandirira insulin, kusintha kapangidwe ka insuliniyake kapena kuphwanya magawo a intracellular njira yotumizira mauthenga kuchokera kuma receptors kupita ku cell organelles.

Pali cholowa chamtundu wa matenda ashuga. Ngati m'modzi mwa makolo adwala, ndiye kuti kuthekera kwa kulandira matenda ashuga 1 ndi 10%, ndipo mtundu 2 wa matenda ashuga ndi 80%.

Kuperewera kwa kapamba (mtundu 1 wa shuga)

Mtundu woyamba wa chisokonezo umakhala mtundu wa matenda ashuga 1 (dzina lakale ndi matenda a shuga a insulin) Chomwe chimayambira pakupanga mtundu wamitundu iyi ndi chiwonongeko chachikulu cha maselo a pancreatic endocrine (ma Langerhans islets) ndipo, chifukwa chake, kutsika kwakukulu kwamankhwala a insulin.

Imfa yambiri yamankhwala am'mimba a pancreatic endocrine imatha kupezeka ndi matenda opatsirana ndi ma virus, khansa, kapamba, kuwonongeka kwa kapamba, nkhawa, matenda osiyanasiyana a autoimmune omwe ma cell a chitetezo cha mthupi amatulutsa antibodies motsutsana ndi ma pancreatic β-cell, amawawononga. Mtundu uwu wa matenda ashuga pamilandu yambiri amakhala ndi ana ndi achinyamata (mpaka zaka 40).

Mwa anthu, matendawa nthawi zambiri amatsimikizika kuti amachokera ku ma genetic omwe amapezeka pa 6 chromosome. Zovala izi zimapanga kutsimikizika kwa autoimmune kupsinjika kwa maselo a pancreatic ndikuwononga kwambiri kubwezeretsa kwa ma cell a β.

Maziko a kuwonongeka kwa autoimmune m'maselo ndikuwonongeka kwawo ndi ma cytotoxic othandizira. Kutupa kumeneku kumayambitsa kutulutsa kwa maantiantigens, omwe amachititsa ntchito za ma macrophages ndi ma T-akupha, omwe amachititsa kuti pakhale kupanga ndi kutulutsa kwa ma interleukin m'magazi pazinthu zomwe zimakhala ndi poizoni m'maselo a pancreatic. Maselo amawonongeka ndi ma macrophages omwe amapezeka m'matumbo a gland.

Zomwe zimapangitsanso chidwi zimatha kukhala kwa nthawi yayitali pancreatic cell hypoxia ndi chakudya chambiri, chokhala ndi mafuta ochepa komanso zakudya zochepa zama protein, zomwe zimapangitsa kuchepa kwa ntchito zachinsinsi za maselo a islet komanso pakapita nthawi yayitali kuti afe.Pambuyo pachimake chachikulu cha kufa kwa cell, makina awo owonongeka a autoimmune akuyamba.

Kukwanira kowonjezera (mtundu wa 2 shuga) Sinthani

Kwa matenda a shuga a 2 (dzina lotha ntchito - shuga wosadalira insulin) yodziwika ndi kuphwanya komwe kwatchulidwa m'ndime 2 (onani pamwambapa). Mtundu wa matenda amtunduwu, insulin imapangidwa mwanjira wamba kapena ngakhale zochulukirapo, koma njira yolumikizirana ndi insulin ndi maselo amthupi (insulin resistance) imasokonekera.

Cholinga chachikulu cha kukana insulini ndikuphwanya ntchito za insulin membrane receptors mu kunenepa kwambiri (vuto lalikulu, odwala 80% a shuga ndi onenepa kwambiri) - ma receptor amalephera kuyenderana ndi mahomoni chifukwa cha kusintha kwawo kapangidwe kake kapena kuchuluka kwake. Komanso, ndi mitundu yina ya matenda a shuga a 2, kapangidwe ka insulin pawokha (zolakwika zamtundu) kumatha kusokonezeka. Kuphatikiza kunenepa kwambiri, zinthu zomwe zingayambitse matenda a shuga a 2 ndiyonso: kukalamba, kusuta, kumwa mowa, matenda oopsa, kudya kwambiri, moyo wosakhalitsa. Mwambiri, mtundu uwu wa matenda a shuga umakonda kukhudza anthu azaka zopitilira 40.

Kudziwiratu kwamtundu wa matenda ashuga 2 kumatsimikiziridwa, monga momwe zasonyezedwera ndi 100% ya kukhalapo kwa matendawa m'mapasa a homozygous. Mtundu wachiwiri wa matenda a shuga, kuphwanya maphindikidwe a insulin kapenanso kusakhalapo kwakutali kwa kusintha kwa maumbidwe a pancreatic nthawi zambiri kumawonedwa.

Zomwe zimayambitsa matendawa ndi kuthamanga kwa insulin inactivation kapena kuwonongeka kwina kwa insulin zolandila pama cell a insulin.

Kuthamanga kwa chiwonongeko cha insulin nthawi zambiri kumachitika pamaso pa portocaval anastomoses ndipo, chifukwa chake, kulowa mwachangu kwa insulin kuchokera ku chiwindi, komwe imawonongeka mwachangu.

Kuwonongeka kwa insulin receptors ndi zotsatira za njira ya autoimmune, pomwe ma autoantibodies amawona ma insulin receptors ngati ma antigen ndikuwawononga, zomwe zimapangitsa kuchepa kwakukulu kwa chidwi cha insulin cha maselo odalira insulin. Kuchita kwa insulin pazomwe zimachitika m'magazi kumakhala kosakwanira kuti kagayidwe kake kazigwiritsa ntchito.

Zotsatira zake, zovuta zoyambirira komanso zachiwiri zimakhala:

Poyamba

• Kuchepetsa kapangidwe ka glycogen
• Kuchepetsa kuchepa kwa gluconidase reaction
• Kupititsa patsogolo kwa shuga mu chiwindi
• Glucosuria
• Hyperglycemia

• Kulekerera kwa shuga
• Kuchepetsa kuphatikiza mapuloteni
• Kuchepetsa mafuta achilengedwe
• Kuthamanga kwa kutulutsidwa kwa mapuloteni komanso mafuta acids kuchokera ku depot
• Gawo la katemera wa insulin mwachangu mu β-cell amasokonekera ndi hyperglycemia.

Chifukwa cha kusokonezeka kwa kagayidwe kazakudya m'maselo a kapamba, mapangidwe a exocytosis amasokonezeka, omwe, amatsogolera kukuwonjezeka kwa zovuta za kagayidwe kazakudya. Kutsatira kuphwanya kwa kagayidwe kazakudya, zovuta zamafuta ndi mapuloteni kagayidwe kamayambira zimayamba.

Zovuta Pathogeneis Sinthani

Mosasamala kanthu za njira zopangira chitukuko, gawo lodziwika la mitundu yonse ya matenda ashuga ndilowonjezereka wa glucose wamagazi ndi kusokonekera kwa metabolic m'thupi zomwe zimalephera kuyamwa glucose ochulukirapo.

• Kulephera kwa minofu kugwiritsa ntchito glucose kumabweretsa chiwonjezeko cha mafuta ndi mapuloteni omwe amapanga chitukuko cha ketoacidosis.
• Kuwonjezeka kwa kuchuluka kwa shuga m'magazi kumabweretsa kuchuluka kwa magazi a osmotic m'magazi, omwe amachititsa kuti madzi atheretu ndi ma electrolyte mkodzo.
• Kuchulukirachulukira kwa magazi a shuga m'magazi kumakhudza kwambiri ziwalo zambiri zamankhwala ndi minyewa, zomwe zimapangitsa kuti pakhale zovuta zambiri, monga matenda ashuga, neopropathy, neuropathy, ophthalmopathy, micro- ndi macroangiopathy, mitundu yosiyanasiyana ya matenda a shuga komanso ena.
• Odwala omwe ali ndi matenda ashuga, pali kuchepa kwa kukonzanso chitetezo chathupi komanso njira yoopsa ya matenda opatsirana.
• Ziwalo zopumira. Matenda a shuga amaphatikizika ndi chifuwa chachikulu cha m'mapapo. Odwala omwe ali ndi matenda ashuga, chifuwa chachikulu chimatha kuchitika chifukwa cha matenda kapena kupatsirana kwakanthawi kwa chinthu chobisika. Kukana kwa thupi kumachepetsedwa, ndipo chifuwa chachikulu cha m'mapapo nthawi zambiri chimayamba kupezeka mwa odwala omwe ali ndi matenda osokoneza bongo akadali aang'ono.
• Njira yakulera. Ndi matenda ashuga, kumaliseche kumakhudzidwanso. Mwa amuna, chilakolako chogonana chimatha kuchepa kapena kutha, kusabereka kumakhalapo, azimayi amakhala ndi vuto losabereka, kuchotsa mimba mosabereka, kubereka msanga, kubadwa kwa mwana wosabadwayo, amenorrhea, vulvitis, vaginitis.
• Mitsempha yamitsempha yam'mimba B. M. Geht ndi N. A. Ilyina amasiyanitsa mitundu yotsatirayi ya kusokonezeka kwa mitsempha mu matenda a shuga: 1) symmetric polyneuropathies, 2) single kapena angapo neuropathies, 3) amyotrophyil a shuga. Kuwonongeka kofala kwambiri komanso kwatsimikizika kwa dongosolo lamanjenje m'matenda a shuga ndi zotumphukira za matenda ashuga, kapena matenda ashuga polyneuritis (symmetric polyneuropathies).

Matenda a shuga, komanso, mwachitsanzo, matenda oopsa, ndimtundu, pathophysiologically, matenda opatsirana.

Pachithunzi cha matenda ashuga, ndimakonda kusiyanitsa magulu awiri azizindikiro: choyambirira komanso chachiwiri.

Zizindikiro zazikulu zikuphatikiza:

1. Polyuria - kuwonjezeka kwa mkodzo chifukwa cha kuwonjezeka kwa osmotic kukakamiza kwa mkodzo chifukwa cha shuga wosungunuka m'mimba mwake (mwachizolowezi, palibe glucose mu mkodzo). Imadziwonetsa lokha kukodza kawirikawiri, kuphatikiza usiku.
2. Polydipsia (ludzu losagonjetseka) - chifukwa cha kutayika kwakukulu kwamadzi mu mkodzo komanso kuwonjezeka kwa magazi a osmotic.
3. Chipolyphagy ndi njala yosatha. Chizindikiro ichi chimayamba chifukwa cha kusokonekera kwa kagayidwe kachakudya matenda ashuga, ndiko kulephera kwa maselo kuyamwa ndikuwonjezera glucose popanda insulin (njala yambiri).
4. Kuchepetsa thupi (makamaka mawonekedwe a matenda a shuga 1) ndi chizindikiro chofala cha matenda ashuga, chomwe chimayamba ngakhale odwala omwe ali ndi chidwi chambiri. Kuchepetsa thupi (komanso kutopa) kumayambika chifukwa cha kuchuluka kwa mapuloteni ndi mafuta chifukwa chakutseka kwa glucose kuchokera ku mphamvu ya metabolism ya maselo.

Zizindikiro zazikulu ndizofala kwambiri pa matenda amtundu 1. Akukula bwino. Odwala, monga lamulo, akhoza kuwonetsa moyenera tsiku kapena nthawi yomwe akuwonekera.

Zizindikiro zachiwiri zimaphatikizapo zizindikiro zapadera zamankhwala zomwe zimayamba pang'onopang'ono pakapita nthawi. Zizindikiro izi zimadziwika ndi matenda ashuga amitundu yoyamba ndi yachiwiri:

• mucous nembanemba,
• kamwa yowuma
• kufooka kwa minofu
• mutu
• zotupa pakhungu zomwe zimakhala zovuta kuchiza,
• kuwonongeka kwamawonekedwe
• kukhalapo kwa acetone mu mkodzo ndi mtundu 1 wa shuga. Acetone ndizotsatira zamafuta oyaka amafuta.

Kuzindikira matenda amtundu 1 komanso matenda amtundu wa 2 amathandizidwa ndi kupezeka kwa zizindikiro zazikulu: polyuria, polyphagia, kuchepa thupi. Komabe, njira yayikulu yodziwira matenda ndikuwonetsetsa kuchuluka kwa shuga m'magazi. Kuti muwone kukula kwa kuwonongeka kwa kagayidwe kazakudya, kuyeserera kwa glucose kumagwiritsidwa ntchito.

Kuzindikirika kwa matenda ashuga kumakhazikitsidwa ngati zingachitike zomwezi zizindikiro:

• kuchuluka kwa shuga (glucose) posala kudya capillary magazi kupitilira 6.1 mmol / l (millimol pa lita), ndipo maola awiri atatha kumeza (postprandial glycemia) amaposa 11.1 mmol / l,
• Chifukwa cha mayeso ololera a glucose (munthawi zosakayikitsa), kuchuluka kwa shuga kumadutsa 11.1 mmol / l (mobwerezabwereza),
• kuchuluka kwa hemoglobin ya glycosylated imaposa 5.9% (5.9-6.5% - mosakayika, oposa 6.5% ali ndi matenda a shuga),
• shuga amapezeka mkodzo
• mkodzo umakhala ndi acetone (Acetonuria, (acetone imatha kupezeka popanda matenda a shuga).

Mtundu wachiwiri wa matenda ashuga kwambiri (mpaka 90% ya anthu onse). Mtundu woyamba wa matenda a shuga umadziwika bwino, umadziwika ndi kudalira kwathunthu kwa insulin, kuwonekera koyambirira, komanso maphunziro olimbitsa thupi. Kuphatikiza apo, pali mitundu ingapo ya matenda ashuga, koma onsewa amawonekera ndi hyperglycemia ndi matenda a shuga.

Mtundu woyamba wa shuga

Njira ya pathogenetic yokhazikitsira kukula kwa matenda ashuga amtundu wa 1 imatengera kuperewera kwa kaphatikizidwe ndi katetezedwe ka insulin ndi maselo a endocrine a kapamba (of-cell of the pancreas), omwe amayamba chifukwa cha kuwonongeka kwawo chifukwa cha zomwe zimachitika chifukwa cha zinthu zina (tizilombo toyambitsa matenda, kupsinjika, kukwiya kwa autoimmune ndi zina). Kuchuluka kwa matenda ashuga amtundu 1 kumawonjezeka ndi 10-15% ya matenda onse a shuga. Matendawa amadziwika ndi kuwonetsera kwa zizindikiro zazikulu muubwana kapena unyamata, kukula msanga kwa zovuta motsutsana ndi maziko a kuwonongeka kwa kagayidwe kazakudya. Njira yayikulu yochizira ndi jakisoni wa insulin yemwe amateteza kagayidwe ka thupi. Insulin imayendetsedwa pang'onopang'ono pogwiritsa ntchito syringe ya insulin, cholembera kapena pampu yapadera. Ngati sichichiritsidwa, matenda a shuga 1 amayamba msanga ndipo zimabweretsa zovuta zazikulu monga ketoacidosis ndi matenda a shuga. .

Type 2 shuga

Pathogenesis yamtunduwu wamatenda imachokera pakuchepa kwa chidwi cha insulin chodalira insulin mpaka kuchitidwe cha insulin (insulin kukana). Mu gawo loyambirira la matendawa, insulin imapangidwa modabwitsa kapena ngakhale kuchuluka. Zakudya komanso kuwonda kwa wodwala m'magawo oyamba a matendawa kumathandizira kagayidwe kazakudya, kumabwezeretsa chidwi cha minofu ndi insulin ndikuchepetsa kaphatikizidwe ka shuga pamagazi a chiwindi. Komabe, pakukula kwa matendawa, biosynthesis ya insulin yokhala ndi β-cell ya kapamba amachepetsa, zomwe zimapangitsa kuti pakhale zofunika kupereka mankhwala othandizira am'mimba ndi kukonzekera kwa insulin.

Matenda a 2 a shuga amafika 85-90% ya matenda onse a shuga mwa anthu akuluakulu ndipo nthawi zambiri amawonekera pakati pa anthu azaka zopitilira 40, nthawi zambiri amakhala ndi kunenepa kwambiri. Matendawa amakula pang'onopang'ono, maphunzirowo ndi ofatsa. Zizindikiro zofananira zimakhazikika mu chithunzi cha chipatala, ketoacidosis sichimakula. Kulimbikira kwa hyperglycemia pazaka kumabweretsa kukula kwa micro- ndi macroangiopathy, nephro- ndi neuropathy, retinopathy ndi zovuta zina.

Dongosolo la shuga-shuga

Matendawa ndi gulu lovuta kwambiri la matenda oopsa kwambiri obwera chifukwa cha majini omwe amatsogolera kuwonongeka kwa chinsinsi cha pancreatic β-cell. Matenda A shuga ambiri amapezeka pafupifupi 5% ya odwala matenda ashuga. Zimasiyanasiyana kuyambira paubwana. Wodwala amafunikira insulin, koma, mosiyana ndi odwala omwe ali ndi matenda amtundu wa 1, omwe amafunikira kwambiri insulin, amakwanitsa kulipidwa. Zizindikiro za C-peptide ndizabwinobwino, palibe ketoacidosis. Matendawa atha kukhala amodzi mwa mitundu ya "matenda apakatikati" a shuga: ili ndi mawonekedwe a mtundu 1 komanso matenda a shuga a 2.

Matenda a shuga

Zimachitika pa nthawi ya pakati ndipo zimatha kutha kapena kukhala zosavuta pambuyo pobadwa mwana. Njira zamatenda a gestational shuga ndizofanana ndi zomwe zimayambitsa matenda a shuga a 2. Chiwopsezo cha matenda osokoneza bongo pakati azimayi apakati ndi pafupifupi 2-5%. Ngakhale kuti mwana akabadwa mtunduwu wa shuga umatha kutha, panthawi yomwe ali ndi pakati matendawa amayamba kuvulaza thanzi la mayi ndi mwana.Amayi omwe ali ndi matenda ashuga pakatikati amakhala pachiwopsezo chachikulu chotenga matenda amtundu wa 2 pambuyo pake. Zotsatira za matenda ashuga mwana wosabadwayo zikuwonetsedwa mu kuchuluka kwa mwana panthawi ya kubadwa (macrosomia), zoperewera zosiyanasiyana komanso kusokonezeka kwa kubereka. Chizindikiro ichi chimafotokozedwa kuti ndi matenda a shuga.

Limbitsani

Mavuto owopsa ndi omwe amapezeka pakangotha ​​masiku ochepa kapena maola ochepa pamaso pa odwala matenda a shuga:

• Matenda a shuga ketoacidosis - Mkhalidwe woopsa womwe umayamba chifukwa chodzikundikira magazi a zinthu zamagulu a mafuta a metaboloni (matupi a ketone). Zimachitika ndimatenda opatsirana, makamaka matenda, kuvulala, ntchito, ndi kuperewera kwa zakudya m'thupi. Zimatha kuchititsa kuti musamaiwale komanso kuphwanya ntchito zofunika kwambiri za thupi. Ndichizindikiro chofunikira kwambiri chogonekedwa kuchipatala mwachangu.
• Hypoglycemia - kuchepa kwa shuga m'magazi pansi pazokwanira bwino (nthawi zambiri pamakhala 3.3 mmol / l), kumachitika chifukwa cha kuchuluka kwa mankhwala ochepetsa shuga, matenda opatsirana, masewera olimbitsa thupi osazolowereka kapena chakudya chokwanira, kumwa kwambiri mowa. Thandizo loyamba limakhala popatsa wodwalayo yankho la shuga kapena chakumwa chilichonse chotsekemera mkati, kudya zakudya zopatsa mphamvu zamkati (shuga kapena uchi zitha kusungidwa pansi pa lilime kuti azichotse mwachangu), ngati kukonzekera kwa glucagon kumalowetsedwa mu mtsempha (kale kukhazikitsidwa kwa njira ya shuga 40% kuyenera kuperekedwa mwachangu ndi vitamini B₁ - kupewa kwa kuphipha kwa minofu yakumaso).
• Hyperosmolar chikomokere. Imapezeka makamaka mwa odwala okalamba omwe ali ndi matenda amtundu wa 2 omwe ali ndi mbiri kapena alibe mbiri yake ndipo nthawi zonse amakhudzidwa ndi kuchepa thupi. Nthawi zambiri pamakhala polyuria ndi polydipsia kuyambira masiku angapo mpaka milungu isanayambike. Anthu achikulire amakhala ndi vuto la kukomoka, chifukwa nthawi zambiri amakhala akusemphana ndi ludzu. Vuto lina zovuta - kusintha kwa ntchito ya impso (yomwe nthawi zambiri imapezeka mwa okalamba) - kumalepheretsa kuwonekera kwa glucose owonjezera mumkodzo. Zinthu zonsezi zimathandizira kuchepa kwa madzi m'thupi komanso chizindikiro cha hyperglycemia. Kusowa kwa metabolic acidosis kumakhalapo chifukwa cha kupezeka kwa insulini m'magazi komanso / kapena kuchepa kwa mahomoni a antiinsulin. Zinthu ziwiri izi zimalepheretsa lipolysis ndi kupanga kwa ketone. Hyperglycemia yomwe yayamba kale kumabweretsa glucosuria, osmotic diuresis, hyperosmolarity, hypovolemia, mantha, ndipo, pakalibe chithandizo, mpaka kufa. Ndichizindikiro chofunikira kwambiri chogonekedwa kuchipatala mwachangu. Pa gawo la prehospital, hypotonic (0,45%) sodium kolorayidi amapezeka kudzera m'mitsempha kuti achulukitse kuthinana kwa osmotic, komanso kuchepa kwambiri kwa kuthamanga kwa magazi, mesatone kapena dopamine imayendetsedwa. Amathandizanso (monga ndi coma ena) mankhwala a oxygen.
• Lactacidotic chikomokere mwa odwala matenda a shuga, amayamba chifukwa cha kudzikundikira kwa lactic acid m'magazi ndipo nthawi zambiri amapezeka mwa odwala omwe ali ndi zaka zopitilira 50 motsutsana ndi mtima, chiwindi ndi kulephera kwaimpso, kuchepa kwa mpweya wambiri m'matupi athu. Chifukwa chachikulu chomwe chitukuko cha lactic acidotic chikomano chimasunthira m'mbali mwa asidi-acid, kuperewera kwa madzi, monga lamulo, sikuwoneka ndi vuto la mtundu uwu. Acidosis imayambitsa kuphwanya kwa microcirculation, kukula kwa mtima kugwa. Clouding imawonedwa mwachipatala (kuyambira kugona tulo mpaka kutsokomola kwathunthu), kulephera kupuma komanso mawonekedwe a kupuma kwa Kussmaul, kuchepa kwa kuthamanga kwa magazi, mkodzo wochepa kwambiri (oliguria) kapena kusakhalapo kwathunthu (anuria). Fungo la acetone kuchokera mkamwa mwa odwala omwe ali ndi lactacidic coma nthawi zambiri sizichitika, acetone mu mkodzo satsimikizika. Kuchuluka kwa shuga m'magazi ndikwabwinobwino kapena kuwonjezeka pang'ono.Tiyenera kukumbukira kuti lactacidic coma nthawi zambiri imayamba kumadwala omwe amalandila mankhwala ochepetsa shuga kuchokera ku gulu la Biguanide (phenformin, buformin). Pa prehospital siteji, amathandizidwa ndi mafupa 2% koloko yothetsera (ndi kukhazikitsidwa kwa saline, hemolysis yacute imatha kupezeka) ndipo chithandizo cha okosijeni chimachitika.

Chedwetsani

Iwo ndi gulu lamavuto, kukula komwe kumatenga miyezi yambiri, ndipo nthawi zambiri zaka za matendawo.

• Matenda a shuga a retinopathy - kuwonongeka kwa retina mu mawonekedwe a ma micaneurysms, kutsina ndi ma hemorrhages, ma exudates olimba, edema, mapangidwe a ziwiya zatsopano. Zimatha ndi zotupa mu fundus, zimatha kuyambitsa kuyamwa kwina. Magawo oyamba a retinopathy amatsimikiza 25% ya odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga. Kuchulukana kwa retinopathy kumawonjezeka ndi 8% pachaka, kotero kuti, patatha zaka 8 kuchokera pachiwonetsero cha matendawa, retinopathy imapezeka mu 50% ya odwala onse, ndipo patatha zaka 20 pafupifupi odwala 100%. Ndiwofala kwambiri ndi mtundu 2, momwe kukula kwake kumalumikizana ndi kuopsa kwa nephropathy. Choyambitsa chachikulu chakhungu m'makutu ndi okalamba.
• Matenda a shuga a micro- ndi macroangiopathy ndikuphwanya kwachulukidwe kwamitsempha, kuwonjezereka kwa kusokonekera kwawo, chizolowezi cha thrombosis ndi chitukuko cha atherosulinosis (zimachitika koyambirira, makamaka ziwiya zazing'ono zimakhudzidwa).
• Diabetesic polyneuropathy - nthawi zambiri mu mawonekedwe a kuphatikizana kwamitsempha yama neropathy ya mtundu wa magolovesi ndi masheya, kuyambira kumapeto kwa miyendo. Kuwonongeka kwa kupweteka komanso kutentha kwa kutentha ndizofunikira kwambiri pakukula kwa zilonda za neuropathic ndikutulutsa kwa mafupa. Zizindikiro za zotumphukira neuropathy ndi dzanzi, kumva kuwotcha, kapena paresthesia, kuyambira malekezero a distal. Zizindikiro zimakulitsidwa usiku. Kuwonongeka kwatsitsi kumabweretsa kuvulaza kwapang'onopang'ono.
• Matenda a shuga - nephropathy - kuwonongeka kwa impso, koyamba mwa mawonekedwe a microalbuminuria (kuchotsedwa kwa mapuloteni a albumin mkodzo), ndiye proteinuria. Zimabweretsa kukula kwa matenda aimpso.
• Matenda a shuga - matenda opatsirana, "kupindika", kusunthika pang'ono, kuchepa kwamadzi amadzimadzi komanso kukweza kwamaso.
• Matenda a shuga a ophthalmopathy, kuphatikiza pa retinopathy, akuphatikizanso kukula koyambitsidwa ndi matenda amtundu wa khungu (ma lens
• Matenda a shuga - matenda osokoneza bongo - kusintha kwa psyche ndi maganizo, kutengeka mtima kapena kukhumudwa, matenda ashuga a m'mimba.
• Matendawa odwala matenda ashuga - kuwonongeka kwa mapazi a wodwala yemwe ali ndi matenda osokoneza bongo mwa njira zoperekera-necrotic, zilonda zam'mimba ndi zotupa zomwe zimachitika motsutsana ndi maziko amasinthidwe amitsempha yamagazi, mitsempha yamagazi, khungu komanso minofu yofewa. Ndiye chifukwa chachikulu cha kudulidwa kwa odwala matenda a shuga.

Ndi matenda a shuga, pamakhala chiwopsezo chokulirapo kwa matenda amisala - kukhumudwa, nkhawa zamavuto komanso vuto la kudya. Kupsinjika kumachitika mwa odwala omwe ali ndi mtundu woyamba komanso wachiwiri wa matenda a shuga kawiri kawiri kuposa kuchuluka kwa anthu. Matenda okhumudwa komanso mtundu wa 2 shuga zimapangitsa kuti mzaka wina ubwere. Ogwira ntchito pafupipafupi nthawi zambiri samachepetsa chiopsezo cha kusokonezeka m'maganizo m'matenda a shuga, omwe angayambitse zotsatira zoyipa, makamaka kwa achinyamata achinyamata.

Mfundo zachikhalidwe Sinthani

Pakadali pano, chithandizo cha matenda ashuga m'milandu yambiri ndizachidziwitso ndipo cholinga chake ndikuwachotsa zomwe zilipo popanda kuthetsa zomwe zimayambitsa matendawa, chifukwa chithandizo chokwanira cha matenda ashuga sichinayambike. Ntchito zazikulu zomwe dokotala amathandizira pa matenda ashuga ndi:

• Kubwezera kwa kagayidwe kazakudya.
• Kupewa komanso kuchiza zovuta.
• Matenda a kunenepa kwambiri.
• Kuphunzitsa wodekha.

Kulipiritsa kwa kagayidwe kazakudya kumapangidwira m'njira ziwiri: popereka maselo ndi insulin, m'njira zosiyanasiyana kutengera mtundu wa matenda ashuga, komanso mwakuwonetsetsa kuti pali chakudya chofanana komanso chomanga thupi, chomwe chimakwaniritsidwa potsatira kudya.

Udindo wofunikira pakulipira matenda ashuga ndi maphunziro a odwala. Wodwalayo ayenera kudziwa chomwe shuga ndi, imakhala yoopsa, zomwe akuyenera kuchita pazochitika za hypo- ndi hyperglycemia, momwe angapewere, athe kudziyimira pawokha kuchuluka kwa glucose m'magazi ndikuzindikira mtundu wa zakudya zomwe zili zovomerezeka kwa iye.

Mitundu ya matenda a shuga (mtundu)

Gulu la anthu odwala matenda ashuga chifukwa:

1. Mtundu woyamba wa matenda a shuga a mellitus - wodziwika ndi kuperewera konse kwa insulin m'magazi
   1. Autoimmune - ma antibodies amagwira β - maselo a kapamba ndikuwawononga kwathunthu,
   2. Idiopathic (popanda chifukwa chomveka)
2. Type 2 matenda a shuga ndi kuperewera kwa insulini m'magazi. Izi zikutanthauza kuti kuchuluka kwa ma insulin komwe kumakhalabe komwe kumakhala kosavuta, koma kuchuluka kwa ma cell a ma cell ku cell cell membrane (ubongo, chiwindi, minofu ya adipose, minofu) kumachepa.
3. Matenda a gestational ndi matenda owopsa kapena osachiritsika omwe amadziwonetsa okha mu mtundu wa hyperglycemia mkazi akamabereka mwana wosabadwayo.
4. Zina (zodwala) zomwe zimayambitsa matenda osokoneza bongo a shuga ndi kulekerera kwa glucose komwe kumachitika chifukwa cha zomwe sizikugwirizana ndi matenda a pancreatic. Zitha kukhala zakanthawi komanso zamuyaya.

Mitundu ya matenda ashuga:

• mankhwala
• zopatsirana
• zolakwika zachilengedwe za molekyulu ya insulin kapena zolandilira,
• amagwirizana ndi endocrine pathologies:
  • Matenda a Itsenko-Cushing,
  • adrenal adenoma,
  • Manda matenda.

Kugawidwa kwa matenda ashuga mwamphamvu:

• Mawonekedwe Opepuka - yodziwika ndi hyperglycemia yosaposa 8 mmol / l, kusinthasintha pang'ono kwa tsiku ndi tsiku m'magawo a shuga, kusowa kwa glucosuria (shuga mumkodzo). Sifunika kukonza mankhwala ndi insulin.

Nthawi zambiri, pakadali pano, matendawa akuwonekeranso kuti sanapezekepo, komabe, munthawi yanthawi yofufuzira za matenda, mawonekedwe oyamba amomwe akuwonongeka ndi mitsempha yapang'onopang'ono, ziwiya zazing'ono za retina, impso, ndi mtima zimapezeka kale.

• Wofatsakuchuluka kwa shuga m'magazi ukufika 14 mmol / l, glucosuria amawoneka (mpaka 40 g / l), akubwera ketoacidosis - kuchuluka kwakukulu kwa matupi a ketone (mafuta ogawa metabolites).

Mitembo ya Ketone imapangidwa chifukwa cha njala yam'maselo. Pafupifupi glucose yonse imazungulira m'magazi ndipo simalowa mu cell, ndipo imayamba kugwiritsa ntchito masitolo amafuta kuti ipange ATP. Pakadali pano, kuchuluka kwa shuga kumayendetsedwa pogwiritsa ntchito mankhwala othandizira kudya, kugwiritsa ntchito mankhwala a hypoglycemic (metformin, acarbose, etc.).

Zowonetsedwa bwino ndi kuphwanya impso, mtima, kuwona, mitsempha.

• Njira zingapo - shuga wamagazi amapitilira 14 mmol / l, ndikusinthasintha mpaka 20 - 30 mmol, glucosuria wopitilira 50 mmol / l. Kudalira kwathunthu pantchito ya insulin, zovuta zamagazi, mitsempha, ziwalo zamagulu.

Kugawa pamlingo wokulipiritsa kwa hyperglycemia:

Kubwezera - Awa ndi mawonekedwe abwinobwino a thupi chifukwa cha matenda osachiritsika. Matendawa ali ndi magawo atatu:

1. Kubwezera - Zakudya kapena mankhwala a insulin amatha kukwaniritsa kuchuluka kwa shuga m'magazi. Angiopathies ndi ma neuropathies sizikuyenda. Nthawi zambiri wodwala amakhala wokhutira kwa nthawi yayitali. Palibe kuphwanya kagayidwe ka shuga mu impso, kusowa kwa matupi a ketone, acetone. Glycosylated hemoglobin sapitilira mtengo wa "5%",
2. Ndikubwezera - chithandizo sichimakonza kuchuluka kwa magazi ndi chiwonetsero cha matenda.Mafuta a m'magazi siapamwamba kuposa 14 mmol / l. Ma mamolekyulu a shuga amawononga maselo ofiira am'magazi ndipo glycosylated hemoglobin amawoneka, kuwonongeka kwa microvascular mu impso kumawoneka ngati kuchuluka kwa glucose mkodzo (mpaka 40 g / l). Acetone mu mkodzo sapezeka, komabe, chiwonetsero chofatsa cha ketoacidosis ndichotheka,
3. Kubwezera - Gawo lovuta kwambiri la odwala matenda a shuga. Nthawi zambiri zimachitika kumapeto kwa matenda kapena kuwonongeka kwathunthu kwa kapamba, komanso maselo a insulini. Amadziwika ndi vuto lalikulu la wodwalayo mpaka kukomoka. Mkulu wa glucose sangathe kukonza mothandizidwa ndi famu. kukonzekera (kupitirira 14 mmol / l). Shuga wambiri wa mkodzo (wopitilira 50g / l), acetone. Glycosylated hemoglobin imachuluka kwambiri kuposa momwe zimakhalira, hypoxia imachitika. Ndi njira yayitali, izi zimapangitsa kuti mukhale ndi vuto komanso kufa.

Zakudya Zosintha Har

Zakudya za anthu odwala matenda ashuga ndi gawo lofunikira la chithandizo, komanso kugwiritsa ntchito mankhwala ochepetsa shuga kapena insulin. Popanda chakudya, kulipiritsa kagayidwe kazakudya sikungatheke. Dziwani kuti nthawi zina matenda a shuga a 2, zakudya zokha ndizokwanira kulipirira kagayidwe kazakudya, makamaka koyambirira kwa matendawa. Ndi matenda amtundu wa 1 shuga, kudya ndikofunikira kwa wodwalayo, kuphwanya zakudya kungayambitse matenda a hypo- kapena hyperglycemic, ndipo nthawi zina mpaka kumwalira kwa wodwalayo.

Cholinga cha mankhwala othandizira odwala matenda ashuga ndikuwonetsetsa kuti mayendedwe azinthu zofunikira m'thupi la wodwala. Zakudya ziyenera kukhala zamagulu a mapuloteni, mafuta ndi zopatsa mphamvu. Zakudya zopatsa mphamvu mosavuta ziyenera kusiyidwa kwathunthu ndi zakudya, kupatula milandu ya hypoglycemia. Ndi matenda 2 a shuga, nthawi zambiri pamafunika kukonza thupi.

Lingaliro lalikulu mu chithandizo chamankhwala a shuga ndi gawo la mkate. Chipinda cha mkate ndi muyezo wofanana ndi 10-12 g wa chakudya chamafuta kapena 20-25 g wa mkate. Pali magome omwe akuwonetsa kuchuluka kwa magawo a mkate mu zakudya zosiyanasiyana. Masana, kuchuluka kwa mkate womwe amadya wodwala kumayenera kukhalabe kosatha, pafupifupi 12-25 mkate amadyedwa patsiku, kutengera kulemera kwa thupi ndi zolimbitsa thupi. Pa chakudya chimodzi chomwe sichikulimbikitsidwa kudya magawo opitilira mkate 7, ndikofunika kukonza chakudya kuti kuchuluka kwa zigawo zosiyanasiyana za chakudya ndizofanana. Tiyeneranso kudziwa kuti kumwa mowa kumatha kudzetsa hypoglycemia, kuphatikizapo hypoglycemic coma.

Mkhalidwe wofunikira pakupambana kwa chithandizo cha zakudya ndikusunga diary yodwala kwa odwala, zakudya zonse zomwe zimadyedwa masana zimawonjezeredwa kwa iyo, ndipo kuchuluka kwa magawo omwe amadyedwa pakudya chilichonse komanso ambiri patsiku amawerengedwa.

Kusunga diary ya chakudya chotere kumapangitsa kuti nthawi zambiri muzindikire zomwe zimayambitsa matenda a hypo- ndi hyperglycemia, zimathandizira kuphunzitsa wodwalayo, zimathandiza dokotala kusankha mlingo woyenera wa mankhwala ochepetsa shuga kapena insulin.

Zoyambitsa matenda ashuga

Matenda a shuga mellitus (ofupikitsidwa ndi matenda ashuga) ndi matenda ophatikizira mungu.

Palibe chilichonse chomwe chingayambitse matenda ashuga kwa anthu onse omwe ali ndi matenda amtunduwu.

Zomwe zimayambitsa kwambiri matendawa:

Matenda A shuga A Type:

• Zomwe zimayambitsa matenda ashuga:
  • kuperewera kwa β maselo a kapamba,
  • masinthidwe obadwa nawo mu majini omwe amachititsa insulin,
  • kutengera kwa chibadwa chofuna kuzizira kwa chitetezo cha on - maselo (achibale omwe ali ndi matenda ashuga),
• Zoyambitsa matenda ashuga:
  • Ma virus a pancreatotropic (akuwononga kapamba): rubella, herpes mtundu 4, mumps, hepatitis A, B, C.Katemera wa munthu amayamba kuwononga maselo a kapamba limodzi ndi ma virus, omwe amayambitsa matenda ashuga.

Matenda a shuga a Type II ali ndi izi:

• cholowa (kukhalapo kwa matenda ashuga abale ake enieni),
• kunenepa kwambiri
• Zaka (nthawi zambiri zimakhala zaka zopitilira 50-60)
• kudya kwakanthawi kochepa kwamphamvu kwambiri komanso mafuta ambiri ophika bwino komanso zakudya zamafuta ochepa,
• matenda oopsa
• atherosulinosis.

Zoyambitsa

Gulu lazinthu izi sizimayambitsa matenda, koma limachulukitsa mwayi wa chitukuko chake, ngati pali chibadwa.

• kusachita masewera olimbitsa thupi (
• kunenepa
• kusuta
• kumwa kwambiri
• kugwiritsa ntchito zinthu zomwe zimakhudza kapamba (mwachitsanzo, mankhwala osokoneza bongo),
• mafuta ochulukirapo komanso mafuta osavuta m'zakudya.

Zizindikiro za matenda a shuga

Matenda a shuga ndi matenda osachiritsika, chifukwa chake sizimachitika mwadzidzidzi. Zizindikiro mwa akazi komanso zizindikiro mwa amuna zimakhala zofanana. Ndi matendawa, mawonetseredwe amtundu wazotsatira zamatenda ndizotheka kusiyanasiyana.

• Kufooka kosalekeza, kuchepa kwa ntchito - amakula chifukwa cha kuperewera kwamphamvu kwa mphamvu ya maselo aubongo ndi mafupa am'mimba,
• Khungu lowuma komanso loyera - chifukwa cha kuchepa kwamadzi mumkodzo,
• Chizungulire, kupweteka mutu - Zizindikiro za matenda ashuga - chifukwa cha kusowa kwa glucose m'magazi oyenda ndi ziwalo zamkati,
• Kuyamwa mwachangu - imayamba kuchokera kuwonongeka kwa capillaries a glomeruli of the nephrons of impso,
• Kuchepetsa chitetezo chokwanira (pafupipafupi pachimake matenda opatsirana a ma virus, kuchiritsa kwa nthawi yayitali pakhungu) - ntchito ya T - ma chitetezo a pakhungu amalephera, zopindika za khungu zimagwira ntchito yolepheretsa,
• Polyphagy - kumangokhalira kumva njala - izi zimayamba chifukwa cha kuchepa msanga mumkodzo komanso kusakwanira kwake kupita kumaselo.
• Mawonedwe akuchepera - chifukwa — kuwonongeka kwa ziwiya zazikuluzikulu za retina,
• Polydipsia - ludzu losalekeza lomwe limayamba chifukwa cha kukoka pafupipafupi,
• Kuchuluka kwa miyendo - hyperglycemia yomwe imatenga nthawi yayitali imabweretsa polyneuropathy yeniyeni - kuwonongeka kwa mitsempha yamthupi mthupi lonse,
• Ululu mumtima - Kuchepetsa ziwiya zam'mimba chifukwa cha atherosulinosis kumabweretsa kuchepa kwa magazi ndi kupweteka kwam'mimba.
• Kuchepa kwa kugonana - zokhudzana mwachindunji ndi kusayenda bwino kwa magazi mu ziwalo zomwe zimapanga mahomoni ogonana.

Kuzindikira matenda a shuga

Kuzindikira matenda a shuga nthawi zambiri sikubweretsa zovuta kwa katswiri woyenera. Dokotala amatha kukayikira matenda kutengera zinthu izi:

• Wodwala matenda ashuga amadandaula polyuria (kuchuluka kwa mkodzo wa tsiku ndi tsiku), polyphagia (njala yosalekeza), kufooka, kupweteka mutu, ndi zina zodwala matenda.
• Pa kuyesa kwa prophylactic kwa glucose, chizindikirocho chinali chachikulu kuposa 6.1 mmol / L pamimba yopanda kanthu, kapena maola 11.1 mmol / L 2 patatha kudya.

Ngati chizindikiro ichi chikuwoneka, mayeso angapo amachitika kutsimikizira / kukana kuwunika ndikuzindikira zomwe zimayambitsa.

Laboratory matenda a shuga

Mayeso a kulolerana a glucose (PHTT)

Chiyeso chodziwika kuti mupeze mphamvu yogwira ntchito ya insulini kuti mumange glucose ndikusunga magawo ake abwinobwino m'magazi.

Chinsinsi cha njirayi: m'mawa, ndikusala kudya kwa maola 8, magazi amatengedwa kuti athe kuyesa kuchuluka kwa glucose. Pambuyo pa mphindi 5, adokotala amapatsa wodwalayo kumwa 75 ga shuga osungunuka mu 250 ml ya madzi. Pambuyo maola 2, kuyezetsa magazi mobwerezabwereza kumachitika ndipo mulingo wa shuga umatsimikizidwanso.

Munthawi imodzimodziyo, zizindikiro zoyambirira za matenda a shuga zimawonetsedwa.

Njira zoyeserera kusanthula kwa PHT

Mokulira, momwe ma antibodies ena amathandizira, matendawa amatenga matendawa mosavuta, ndipo ma cell a beta amawonongeka ndipo mulingo wa insulin m'magazi umachepa.Mu odwala matenda ashuga, nthawi zambiri amapitilira 1:10.

Norma - Caption: zosakwana 1: 5.

• Ngati antibody titer ikhalabe yoyenera, koma kuthamanga kwa glucose kumakhala kwakukulu kuposa 6.1, kupezeka kwa matenda a shuga a 2 amapangidwa.

Mlingo wa ma antibodies kuti insulin

Kusanthula kwina kwatsatanetsatane. Amagwiritsidwa ntchito pozindikiritsa odwala odwala matenda ashuga (mtundu 1 shuga ndi matenda a shuga a 2). Pankhani ya kulolerana kwa glucose, magazi amatengedwa ndipo kuyesedwa kwa serological kumachitika. Zitha kutchulanso zomwe zimayambitsa matenda ashuga.

Chikhalidwe cha AT pakupanga insulin ndi 0 - 10 PIECES / ml.

• Ngati C (AT) ikhale yapamwamba kuposa yachilendo, matenda ake ndi matenda amtundu 1 shuga. Matenda a shuga a Autoimmune
• Ngati C (AT) ili mkati mwazidziwitso, matendawo ndi matenda amtundu wa 2 shuga.

Mulingo woyesama antibodies kutiGadi(Glutamic acid decarboxylase)

GAD ndi michere yapadera yamkati yamanjenje. Malumikizidwe oyenera pakati pa kuchuluka kwa ma antibodies ku GAD komanso kukula kwa matenda a shuga 1 sikudziwikabe bwino, koma mu 80% - 90% ya odwala ma antibodies awa atsimikiza mu magazi. Kusanthula kwa AT GAD kumalimbikitsidwa m'magulu omwe ali pachiwopsezo chofufuza matenda a prediabetes komanso kukhazikitsidwa kwa zakudya zothandizira kupewa komanso kupatsirana mankhwala.

Chikhalidwe cha AT GAD ndi 0 - 5 IU / ml.

• Zotsatira zabwino zokhala ndi glycemia wabwinobwino zimawonetsa chiopsezo cha matenda amtundu 1,
• Zotsatira zoyipa zomwe zili ndi kuchuluka kwa shuga m'magazi zimasonyeza kukula kwa matenda ashuga a mtundu 2.

Kuyesa kwa insulin

Insulin - mahomoni okangalika kwambiri a endocrine kapamba, ophatikizidwa mu beta - maselo a timisamba ta Langerhans. Ntchito yake yayikulu ndikutumiza glucose m'maselo a cell. Mitengo ya insulini yomwe ikuchepa kwambiri ndiye cholumikizira chofunikira kwambiri cha pathogenesis yamatenda.

Chizindikiro cha insulin ndende ndi 2.6 - 24,9 μU / ml

• Pansi pa chizolowezi - kukula kwa matenda ashuga ndi matenda ena,
• Kuposa kwabwinobwino, chotupa cha inshuwaransi (insulinoma).

Kupeza chida cha matenda ashuga

Ultrasound ya kapamba

Njira yofufuzira ya ultrasound imakuthandizani kuti muzindikire kusintha kwazinthu zina m'thupi lathu.

Nthawi zambiri, mu shuga mellitus, kuwononga kuwonongeka kumatsimikizika (malo a sclerosis - m'malo maselo omwe amagwira ntchito ndi minofu yolumikizana).

Komanso, kapamba ukhoza kuchuluka, kukhala ndi zizindikiro za edema.

Zojambula zazingwe zam'munsi

Mitsempha ya m'munsi malekezero - chandamale matenda a shuga. Hyperglycemia ya nthawi yayitali imayambitsa kuwonjezeka kwa cholesterol yamagazi ndi atherosclerosis, zomwe zimapangitsa kuchepa kwa minofu mafuta.

Chinsinsi cha njirayi ndi kuyambitsa gawo losiyanitsa magazi ndi kuyika nthawi imodzi pamanja pa kompyuta.

Ngati magazi amachepetsedwa kwambiri pamiyendo yamiyendo yam'munsi, omwe amatchedwa "shuga phazi" amapangidwa. Kuzindikira matenda ashuga kutengera njira yakufufuzira iyi.

Ultrasound a impso ndi ECHO KG wamtima

Njira zoyezetsa impso, kulola kuwunika kuwonongeka kwa ziwalozo pamaso pa kupezeka kwa matenda a shuga.

Microangiopathies amakula mu mtima ndi impso - kuwonongeka kwa mtima ndi kuchepa kwakukulu kwa lumen, motero kuwonongeka mu magwiridwe antchito. Njira imathandiza kupewa zovuta za matenda ashuga.

Retinografia kapena angiography yamadzi am'madzi

Mitsempha yama microscopic ya retina yamaso imakonda kwambiri hyperglycemia, kotero, kupanga kuwonongeka mwa iwo kumayambira ngakhale zizindikiritso zoyambirira za matenda ashuga.

Pogwiritsa ntchito kusiyanasiyana, kuchuluka kwa sitimayi kapena kutsimikizira kwathunthu kwa ziwiya zatsimikizika. Komanso, kupezeka kwa microerosion ndi zilonda mu fundus kudzakhala chizindikiro chofunikira kwambiri cha matenda ashuga.

Kuzindikira matenda a shuga ndi njira yayikulu, yozikidwa pa mbiri ya zamankhwala, kufufuza kwa akatswiri, mayeso a labotale ndi maphunziro othandizira. Kugwiritsa ntchito njira imodzi yokha yophunzitsira, sizotheka kukhazikitsa kuzindikira koyenera kwa 100%.

Ngati muli pachiwopsezo, onetsetsani kuti mwawonana ndi dokotala kuti mudziwe zambiri: matenda ashuga ndi zomwe ziyenera kuchitidwa ndi izi.

Chithandizo cha matenda ashuga ndi njira zingapo zowongolera glycemia, cholesterol, matupi a ketone, acetone, lactic acid, amalepheretsa kukula kwazovuta ndikuwongolera moyo wamunthu.

Mu shuga mellitus, kugwiritsa ntchito njira zonse zamankhwala ndikofunikira kwambiri.

Njira zomwe zimagwiritsidwa ntchito pochiza matenda a shuga

• Pharmacological mankhwala (insulin mankhwala),
• Zakudya
• Chitani masewera olimbitsa thupi pafupipafupi
• Njira zodzitetezera kuteteza kupitirira kwa matendawa ndi kukula kwa zovuta,
• Thandizo laubongo.

Kukonzekera kwa pharmacological ndi insulin

Kufunika kwa jakisoni wa insulin kwa odwala omwe ali ndi matenda ashuga, mtundu wake komanso pafupipafupi pakuwongolera ndi amodzi payekha ndipo amasankhidwa ndi akatswiri (akatswiri a zamankhwala, a endocrinologist, a mtima, akatswiri a matenda amitsempha ya m'mimba, a chiwindi. Nthawi zonse amakhala ndi chidwi ndi zomwe zimayambitsa matenda ashuga, amayambitsa matenda osiyanasiyana, amawunika ndikuwunika magwiridwe antchito a mankhwala.

Mitundu ya Insulin:

• Kuthamanga kwambiri (ultrashort action) - amayamba kugwira ntchito atangoyendetsa ntchito ndipo amagwira ntchito kwa maola atatu mpaka anayi. Kugwiritsidwa ntchito musanadye kapena nthawi yomweyo. (Insulin - Apidra, Insulin - Humalog),
• Zochita zazifupi - yogwira mphindi 20-30 pambuyo kukhazikitsa. Ndikofunikira kugwiritsa ntchito mosamalitsa mphindi 10 - 15 musanadye chakudya (Insulin - Actrapid, Humulin Regular),
• Kutalika kwapakati - amagwiritsidwa ntchito mosagwiritsa ntchito ndipo ndi ovomerezeka kwa maola 12 mpaka 18 atabayidwa. Imalola kuti muchepetse zovuta za matenda a shuga (Protafan, Humodar br),
• Wochedwa insulin - imafuna kugwiritsa ntchito tsiku lililonse. Zovomerezeka kuyambira maola 18 mpaka 24. Sikugwiritsidwa ntchito kutsitsa shuga m'magazi, koma imangoyang'anira kukhudzidwa kwake tsiku ndi tsiku ndipo siyilola kupitilira zomwe zili bwino (Tujeo Solostar, Basaglar),
• Kuphatikizidwainsulin - ili ndi mitundu yambiri yolumikizira wa ultrashort ndi kuchitapo kanthu nthawi yayitali. Imagwiritsidwa ntchito posamalira kwambiri matenda a shuga 1 (Insuman Comb, Novomiks).

Mankhwala othandizira odwala matenda ashuga

Zakudya - 50% bwino pakuwongolera glycemia wodwala wodwala matenda a shuga.

Ndi zakudya ziti zomwe zimayenera kudyedwa?

• Zipatso ndi ndiwo zamasamba zokhala ndi shuga wochepa komanso kuchuluka kwa mavitamini ndi michere (maapulo, kaloti, kabichi, beets
• Nyama yokhala ndi mafuta ochepa a nyama (ng'ombe, nkhuku, zinziri)
• Mbewu za chimanga ndi chimanga (mphaka, tirigu, mpunga, barele, barele wa ngale)
• Nsomba (zam'madzi zabwino)
• Mwa zakumwa, ndibwino kuti musankhe tiyi wopanda mankhwala, zipatso za zipatso.

Zomwe ziyenera kutayidwa

• Maswiti, pasitala, ufa
• Madzi Okhazikika
• Nyama yamafuta ndi zinthu zamkaka
• Zonunkhira komanso zautsi
• Mowa

Mankhwala ochepetsa shuga

• Glibenclamide - mankhwala othandizira kupanga insulini mu kapamba.
• Repaglinide - imapangitsa maselo a beta kuti apange insulin
• Acarbose - imagwira ntchito m'matumbo, imalepheretsa ntchito ya michere yaying'ono yamatumbo yomwe imaphwanya ma polysaccharides ku glucose.
• Peoglitazone - mankhwala kupewa polyneuropathy, yaying'ono - macroangiopathy a impso, mtima ndi retina.

Njira zochizira odwala matenda ashuga

Njira zachikhalidwe zimaphatikizira kukonzekera kwa mankhwala osiyanasiyana azitsamba, zipatso ndi ndiwo zamasamba, mpaka pamlingo wina uliwonse kuwongolera glycemia.

• Krythea Amur - wotulutsidwa kuchokera ku moss. Kugwiritsa ntchito Krythea kumayambitsa kuwonjezeka kwa kapangidwe ka mahomoni a pancreatic: lipases, amylases, proteinases. Ilinso ndi anti-allergic and immunomodulating effect, imachepetsa zizindikiro zazikulu za matenda ashuga.
• Muzu wa Parsley + ndimu zest + adyo- malonda awa amakhala ndi kuchuluka kwa vitamini C, E, A, selenium ndi zinthu zina zofunikira. Zonse ndi ndikofunikira kupera, kusakaniza ndi kukakamira pafupifupi masabata awiri. Gwiritsani ntchito pakamwa supuni imodzi musanadye.
• Oak acorns- imakhala ndi tannin, yothandiza kwambiri matenda a shuga. Izi zimathandizira chitetezo cha mthupi, zimakhala ndi zotsutsana ndi kutupa komanso mphamvu, zimalimbitsa makoma amitsempha yamagazi, komanso zimathandizira mitundu yotchulidwa. Ma acorn amayenera kuphwanyidwa kukhala ufa ndikuyamwa supuni 1 musanadye chilichonse.

Kupewa matenda

Ndi chibadwa chamunthu, matendawa sangathe kupewedwa. Komabe, anthu omwe ali pachiwopsezo ayenera kuchita zingapo kuti athetse glycemia komanso kuchuluka kwa chitukuko cha zovuta za matenda ashuga.

• Ana omwe ali ndi vuto losautsa (makolo, agogo awo amadwala matenda ashuga) ayenera kuunika magazi a shuga kamodzi pachaka, komanso kuwunika momwe alili komanso kuwonekera kwa zizindikiro zoyambirira za matendawa. Komanso, kufunsira kwa pachaka kwa a ophthalmologist, neuropathologist, endocrinologist, zamtima, kudziwa zoyamba za matenda ashuga, kupewa zovuta za matenda a shuga, ndichofunika kwambiri.
• Anthu opitilira 40 ayenera kuwunika kuchuluka kwa glycemia pachaka kuteteza matenda ashuga 2,
• Onse odwala matenda ashuga ayenera kugwiritsa ntchito zida zapadera kuti azitha kuwongolera shuga m'magazi - glucometer.

​Muyeneranso kudziwa zonse zokhudzana ndi matenda ashuga, zomwe mungathe komanso zomwe simungathe kuchita, kuyambira mtundu ndikumaliza ndi zomwe zimayambitsa matendawa, chifukwa mukafuna kukambirana ndi dotolo, adzakulangizani, kukuthandizani mayeso ofunikira ndikukupatsani chithandizo chamankhwala.

Kubwezeretsa zakutsogolo

Matenda a shuga ndi matenda osachiritsika, chifukwa matendawo amayambitsidwa bwino. Komabe, kupita patsogolo kwamakono mu mankhwala a cellacological omwe ali ndi insulin kungakulitse kwambiri moyo wa anthu odwala matenda ashuga, ndipo kuwunika pafupipafupi matenda amisempha kumapangitsanso kuti wodwalayo akhale ndi moyo wabwino.