Zimayambitsa Polydipsia ku matenda ashuga

Matenda a shuga (monga kufotokozedwera ndi WHO) ndi mkhalidwe wa matenda oopsa (hyperglycemia) omwe amayamba chifukwa cha zochita za majini ambiri, omwe nthawi zambiri amathandizana. Hyperglycemia imatha kukhala chifukwa chosowa insulini, kapena zinthu zina zomwe zimatsutsana ndi ntchito yake.

Etiology

Insulin imapangidwa ndi β-cell ya islet zida za kapamba. Zotsogola zama insulin ndi prroinsulin ndi proinsulin. Kuchokera kumapeto, C-peptide ikapukusidwa, insulin imapangidwa, yomwe imasungidwa m'magazi. Insulin ndi mahomoni apuloteni omwe zotsatira zake zathupi zimachitika mukamacheza ndi ma cell receptors.

Mtundu wa insulini umapezeka pang'onopang'ono pa chromosome 11, ndipo mtundu wa insulin receptor uli pa chromosome 19. Kuphwanya kubisika, kaphatikizidwe kapena kumanga insulini ku ma receptors kumabweretsa chitukuko cha matenda a shuga. Nthawi zambiri, mavutowa amakhudzana ndi kusintha kwa majini. Ndi masinthidwe amtundu, monga lamulo, hyperinsulinism imachitika.

Mtundu wachiwiri wa matenda ashuga, chomwe chimayambitsa matenda a carbohydrate metabolism ndi kuchepa kwa kumanga kwa insulin kwa ma receptors komanso kuchepa kwa chiwerengero cha ma receptors. Mtundu wa 1 wa matenda ashuga, chomwe chimayambitsa kusowa kwa insulin ndi kuchepa kwa kaphatikizidwe ndi katemera wa insulin chifukwa cha insulin yomwe ikupita patsogolo. Maziko a insulin ndi kuwonongeka kwa maselo a β, omwe amayamba chifukwa cha kachilombo ka virus kapena kuwonongeka kwa autoimmune.

Genetics ndi immunology ya matenda ashuga

Cholowa cha mtundu 1 wa shuga chimakhala chamtopola. Odwala ambiri omwe ali ndi matenda amtundu wa 1, mitundu yosiyanasiyana ya mitundu yosiyanasiyana ya antigen of the main histocompatibility complex ya kalasi II HLA-DQ ndi HLA-DR imatha kupezeka. Cholowa cha mtundu wachiwiri wa matenda ashuga ndiwofala kwambiri. Mukazindikira mtundu woyamba wa matenda ashuga kumayambiriro kwa matendawa, ukadali wokhazikika pamankhwala, ma autoantibodies a and-cell ndi insulin amatha kupezeka. Maonekedwe a antibodies amadziwika kale kusanachitike chiwonetsero cha matenda ashuga.

Zolemba za matenda a shuga 1

Mitundu: HLA DR3, DR4 ndi DQ

Immunological: autoantibodies to glutamate decarboxylase (GAD), insulin (IAA) ndi alpha-cell antigen (ICA), othandizira kukonza ma antibodies a plasma

Pathogenesis

Pathogenesis ya matenda osokoneza bongo ndi zovuta kwambiri, koma zimakhazikitsidwa chifukwa cha kuperewera kwathunthu kwa insulin. Kuchepa kwa wachibale kumachitika chifukwa cha kuchuluka kwama mahomoni otsutsana, osagwirizana ndi mahomoni a insulin, kapena kusokonezeka kwa chidwi cha insulin receptors. Insulin ndi mahomoni a anabolic, i.e. m'mikhalidwe yokhazikika, zimathandizira kuti glucose iwonjezeke mwanjira ya glycogen, imawonjezera kuchuluka kwa mapuloteni, kumapangitsa glycogeneis, kumabweretsa kudzikundikira kwa mphamvu mu mawonekedwe a mamolekyulu a ATP. Chifukwa chake, ndizosavuta kulingalira kuti pakalibe insulin kanthu njira zomwe zimapangitsa kuti mapuloteni a protabolism achuluke, masitolo a glycogen amatha, lipolysis imalimbikitsidwa, nkhokwe za ATP zimachepa, i.e. pamakhala vuto lamagetsi.

Kuwonjezeka kwa shuga wamagazi chifukwa cha glycogenolysis ndi neoglucogeneis kumabweretsa kuwonjezeka kwa plasma osmolarity, komwe kumayambitsa kuphwanya mphamvu kagayidwe ka madzi ndi osmotic diuresis.

Kuchulukitsa kwa lipolysis ndi kusowa kwa glycogen m'chiwindi kumayendetsedwa ndi kupangika kwa matupi a ketone, omwe amaphatikizidwa ndi chitukuko cha ketosis ketoacidosis. Chifukwa chake, mawonekedwe a asidi omwe amakhazikika pamthupi amasokonezeka. Kuperewera kwa mphamvu kumabweretsa kukuchepa kwa potaziyamu mu zimakhala.

Matenda a shuga amaphatikizidwa ndi zovuta zamitundu yonse ya kagayidwe.

Gulu la anthu odwala matenda ashuga (WHO, 1999)

Type 1 shuga mellitus (chiwonongeko cha β-cell, zomwe nthawi zambiri zimayambitsa kufooka kwathunthu kwa insulin)

Type 2 shuga mellitus (kuchokera pakulimbana kwambiri ndi insulin chifukwa cha kuchepa kwa insulin kufikira chinsinsi chachikulu chokhala ndi insulin kapena popanda kukana insulini)

Mitundu ina yapadera ya matenda ashuga

Zofooka zamtundu wa β cell cell

Matenda obadwa nawo chifukwa cha insulin

Matenda a exocrine kapamba

Mankhwala kapena Matenda a Chemical

Mitundu yachilendo ya matenda ashuga olimbana ndi matenda

Mitundu ina ya ma genetic syndromes nthawi zina imagwirizanitsidwa ndi matenda a shuga

Matenda a shuga

Zizindikiro

Mellitus yowonjezera kapena yowonekera imakhala ndi chipatala chofotokozedwa bwino: polydipsia, polyuria, kuwonda. Pa kuyesedwa kwa magazi, kuchuluka kwa glucose amadziwika m'menemo, mkodzo - glucosuria ndi aceturia. Ngati palibe zizindikiro za matenda a hyperglycemia, koma kuwonjezeka kwa glucose mwangozi akupezeka m'mayeso a shuga, pamenepa, kuyesedwa kwa glucose kumachitika pofuna kutsimikizira matendawo kapena kupatula shuga.

Mayeso a kulolera a glucose:
Tisanayesedwe, ndikofunikira kupereka mankhwala osachiritsika kwa mwana asanadutse masiku atatu. Kuyesedwa kumachitika m'mawa pamimba yopanda kanthu. Glucose imayikidwa pa mulingo wa 1.75 g / kg wolemera, koma osapitirira 75. Glucose amasungunuka mu kapu yamadzi ndikupatsidwa kamodzi. Kuyesedwa kwa shuga kumachitika pamimba yopanda kanthu kamphindi 120 mutamwa shuga.

Njira zoyenera kudziwa matenda ashuga komanso zovuta zina za kagayidwe kazakudya (WHO, 1999)

Kuzungulira kwa shuga, mmol / l (mg /%)

▪ ndi b / w maola awiri atatha GTT

▪ kapena h / s patatha maola awiri kuchokera pa GTT

▪ kapena maola awiri mukatha kudya (pambuyo pa chakudya cham'mimba)

▪ kapena kungosankha glycemia mwachisawawa nthawi iliyonse masana, mosasamala nthawi yakudya

Kulekerera kwa shuga

▪ ndi b / w maola awiri atatha GTT

Matenda othamanga a glycemia

Kusiyanitsa mitundu

Kudziwitsa koyenera kumapangidwa malinga ndi zikhalidwe zotsatirazi zamatenda ochulukirapo: polydipsia ndi polyuria. Zizindikiro zofananira zimadziwika ndi shuga insipidus - matenda a shuga insipidus, komanso mu gawo loyambirira la kulephera kwa aimpso, komwe kumadziwika ndi polydipsia ndi polyuria.

Urinary syndrome imadziwika ndi glucosuria wa digiri imodzi kapena zingapo, wodziwika bwino wa tubulopathies onse: De Tony-Debre-Fanconi syndrome, matenda a shuga a impso.

Acetonuria imayendera limodzi ndi mikhalidwe yonse yodziwika ndi njala yayitali ya thupi, komanso imawonongeka ndi chiwindi.

Kuchepetsa thupi kwa nthawi yayitali kumadziwika ndi ma endocrinopathies monga kuphatikiza poyizoni, hypocorticism.

Mukukulira mavuto a shuga

Diabetesic ketoacidosis (DKA II-III)
Vuto lalikulu la matenda ashuga komanso lochititsa chidwi kwambiri limayambitsa matenda ashuga a ketoacidosis. Vutoli limadziwika ndi kuphatikiza kwathunthu komanso kuperewera kwa insulin, komwe kumayambika chifukwa cha kuwonjezeka kwa thupi la onse omwe amatsutsana ndi insulin.

Ketoacidosis amadziwika ndi:

mkulu hyperglycemia ndi osmotic diuresis ndi

kuchepa kwakuthwa m'magazi a magazi chifukwa cha

Kupha kwa ma bicarbonates, kuphatikizira kusintha kwa acid acid m'mayendedwe akuwonetsa kwambiri metabolic acidosis

Kukula kwa vuto lalikulu la metabolic ndi kusowa kwa insulin koperewera kumabweretsa hypovolemia, kutchulidwa kotsalira kwa potaziyamu m'misempha, ndi kudzikundikira kwa β-hydroxybutyric acid pakatikati kwamanjenje. Zotsatira zake, matenda azachipatala amadziwika ndi vuto lalikulu la hemodynamic, prerenal pachimake aimpso kulephera, kusokonezeka kwa chikumbumtima, komanso matenda a hemostasis.

Nthawi zina, mwa ana pali:

posungira

Lactatecedemic coma ndiyo chosowa kwambiri mu ana, nthawi zambiri pakukula kwake kumakhala kwambiri minofu hypoxia yokhala ndi lactate m'magazi.

Matenda a shuga a ketoacidosis

Kuwongolera kuchepa kwa insulin

Asanayambe kulandira chithandizo, wodwalayo amapakidwa mapiritsi otenthetsera, chubu cha nasogastric, catheter mu chikhodzodzo amayikidwa m'mimba.

Madzimadzi amawerengedwa malinga ndi zaka:

mwa ana oyamba 3 zaka - 150-200 ml / kg kulemera / tsiku, malingana ndi kuchuluka kwa madzi m'thupi

mwa ana okulirapo - 3-4 l / m2 / tsiku

Mu mphindi 30 zoyambirira za 1/10 tsiku lililonse mlingo. Mu maola 6 oyambilira, 1/3 ya tsiku ndi tsiku mlingo, m'maola 6 - 1/4 ya mlingo wa tsiku ndi tsiku, kenako wogawana.

Ndikofunikira kubaya madzimadzi ndi infusomat, ngati mulibe, werengani mosamala kuchuluka kwa madontho pamphindi. Njira ya 0.9% sodium chloride imagwiritsidwa ntchito ngati yankho. Saline sayenera kuperekedwa kuposa maola awiri. Kenako ndikofunikira kusinthira yankho la glucose 10% osakanikirana ndi yankho la Ringer m'njira 1: 1. Madzi onse omwe amayambitsidwa kudzera m'mitsempha amatenthedwa ndi kutentha kwa 37 ° C. ngati mwana wachepa kwambiri, timagwiritsa ntchito njira ya 10% ya albumin tisanayambe makonzedwe a makristalo pamiyeso ya 5 ml / kg, koma osapitirira 100 ml, chifukwa Ma colloids amasunga bwino magazi m'magazi.

Mankhwala a insulin

Insulin yofikira mwachidule imagwiritsidwa ntchito. Ndikwabwino kuperekera insulini kudzera mu lineamate mu njira ya 10% ya albumin; ngati mulibe Lineomat, insulin imalowetsedwa jet ola lililonse. Mlingo woyambirira wa insulin ndi 0,2 U / kg, ndiye pambuyo pa ola la 0,1 U / kg / ola. Ndi kuchepa kwa shuga m'magazi mpaka 14-16 mmol / l, mlingo wa insulin umatsika mpaka 0,05 U / kg / ola. Ndi kuchepa kwa shuga m'magazi mpaka 11 mmol / L, timasinthira kukonzekera kwa insulin maola 6 aliwonse. Kufunika kwa insulini mutachotsedwa mu chikomokere ndi mayunitsi 1-2 / kg / tsiku.
Yang'anani! Kuchepa kwa shuga m'magazi sikuyenera kupitirira 5 mmol / ola! Kupanda kutero, kukula kwa edema ya ubongo kumatha.

Kuwongolera kwa Acidosis

Pofuna kukonza acidosis, njira yofunda, yatsopano yokonzedwa ya 4% ya 4 ml / kg imagwiritsidwa ntchito. Ngati BE angadziwike, ndiye kuti bicarbonate ndi 0,3-BE x kulemera kwa mwana pa kg.
Kukonzanso kwa Acidosis kumachitika pakatha maola 3-4 a chithandizo osati kale, chifukwa kuchita insulin mankhwala motsutsana maziko a madzi okwanira bwino limaphatikizira ketoacidosis.
Zomwe zimayambitsa koloko ndi:

kusuntha kwa khungu

kupuma kwamphamvu

Mankhwalawa a matenda ashuga acidosis, ochepa Mlingo wa heparin ndi mankhwala 100 mg / kg / tsiku 4 jakisoni. Mwana akabwera ndi kutentha, anti -amu wodziwika bwino amapatsidwa mankhwala. Mwana akabwera ndi zizindikiro zoyambirira za ketoacidosis (DKAI), i.e. ngakhale metabolic acidosis, yodziwika ndi kudandaula kwa dyspeptic (nseru, kusanza), kupweteka, kupuma kwambiri, koma kudziwa ndikofunikira:

Tsuka m'mimba ndi yankho la 2% koloko.

Ikani kuyeretsa, kenako enema wakuchipatala yemwe ali ndi yofunda yankho la 2% koloko mu voliyumu ya 150-200 ml.

Kuchita kulowetsedwa, komwe kumaphatikizapo yankho la albin, njira yamoyo, ngati kuchuluka kwa glucose sikupitilira 14-16 mmol / l, ndiye kuti mayankho a 10% glucose ndi Ringer mu gawo la 1: 1 amagwiritsidwa ntchito. Mankhwala a kulowetsedwa pamenepa nthawi zambiri amawerengedwa kwa maola 2-3 kutengera zomwe zimafunikira tsiku lililonse, chifukwa Pambuyo pake, mutha kusinthanso kutsitsimutsa pakamwa.

Mankhwala a insulin amachitika pamlingo wa 0,1 U / kg / h, pomwe glucose ndi 14-16 mmol / L, mlingo ndi 0,05 U / kg / h ndipo pamlingo wa glucose wa 11 mmol / L timasinthira ku subcutaneous management.

Njira zoyendetsera mwana atayima ketoacidosis

Kwa masiku atatu - kudya No. 5 popanda mafuta, ndiye 9 tebulo.

Imwani madzi ambiri, kuphatikizapo njira zamchere (madzi amchere, yankho la 2% koloko), timadziti timene timakhala ndi utoto wofiirira, chifukwa zimakhala ndi potaziyamu yambiri.

Pakamwa, 4% potaziyamu chloride yankho, tebulo limodzi. - 1 tebulo. supuni 4 pa tsiku kwa masiku 7-10, chifukwa kukonza hypokalisthia ndi nthawi yayitali.

Insulin imayikidwa jakisoni 5 m'njira zotsatirazi: 6 koloko m'mawa, kenako musanadye kadzutsa, nkhomaliro, chakudya chamadzulo ndi usiku. Mlingo woyamba ndi mayunitsi a 1-2, mlingo wotsiriza ndi magawo 2-6, theka loyamba la tsiku - 2/3 ya mlingo wa tsiku ndi tsiku. Mlingo wa tsiku ndi tsiku ndi wofanana ndi mlingo wochotsera ketoacidosis, nthawi zambiri 1 U / kg thupi. Mankhwala a insulini oterewa amachitika kwa masiku awiri, kenako mwana amusamutsira ku chithandizo choyambira cha bolus.

Zindikirani Ngati mwana yemwe akukhala ndi ketoacidosis amatha kuchuluka kwa kutentha, mankhwala opangira ma piritsi amodzi amalembedwa. Pokhudzana ndi mavuto a heestasis omwe amayamba chifukwa cha hypovolemia ndi metabolic acidosis, heparin imafotokozedwa tsiku lililonse la 100 U / kg ya kulemera kwa thupi pofuna kupewa kufalikira kwa mtima. Mlingo umagawidwa zoposa 4, jakisoni amaperekedwa motsogozedwa ndi coagulogram.

Chithandizo cha matenda ashuga
Zakudya
Kalori yonseyi imatsimikiziridwa ndi msinkhu wa mwana, komanso kuchuluka kwambiri kapena kuchepa thupi. Kuwerengera kumachitika malinga ndi formula: 1000 kcal + 100 • n (n ndi kuchuluka kwa zaka kuposa chaka). Mochulukitsa, kuchuluka kwa calorie kumachepera 10 - 15%, ndipo ndikusowa kwake kumakula ndi 10 - 15%. Zakudya za tsiku ndi tsiku zopatsa mphamvu za mwana mpaka chaka zimatsimikiziridwa ndi zaka komanso mtundu wa chakudya ndipo zimagwirizana kwathunthu ndi zakudya za mwana wathanzi. Ziyenera kudziwitsidwa kuti zakudya zimakhala ndi 50-60% chakudya, 15-20% mapuloteni ndi mafuta 30-35%.

Zakudya zomanga thupi zimawerengeredwa m'magawo a mkate - 1 XE = 10 - 12 magalamu a chakudya. Mu chakudya, pazikhala chakudya chamagulu owonjezera, ndipo chakudya azikhala ndi index yotsika ya glycemic. Tiyenera kukumbukira kuti mphamvu yamphamvu ya 1 gr. Mapuloteni ndi 1 gramu yamafuta = 4 kcal, ndi 1 gramu yamafuta = 9 kcal. Zakudya zomanga thupi mosavuta sizipezeka muzakudya. Aspartame ikhoza kugwiritsidwa ntchito ngati aspartame, osapitilira mapiritsi atatu patsiku. Mafuta amayimiriridwa ndi 50% mafuta abodza achinyama ndi masamba 50%. Kuchuluka kwa zakudya zimatengera zaka komanso mawonekedwe a mwanayo. E.P.Kasatkina imapereka mitundu iwiri ya zakudya kwa ana okulirapo:

Ana aang'ono osakwana chaka chimodzi, kuwerengera kwa zakudya ndi kuchuluka kwa zakudya, kuphatikizapo zakudya zowonjezera, zimachitika ndi mtundu wa kudyetsa (wochita kupanga, wosakanizika, wachilengedwe). Tiyenera kudziwa kuti ndibwino kupitiriza kuyamwitsa mpaka zaka 1.5. Malinga ndi deta yathu, makolo amalimbikitsidwa kwambiri ndi mtundu uwu wa chakudya.

Mitundu ya Insulin
Ultrashort analogues a insulin - Novorapid, Humalog (Nova-Nordisk, Ellie-Lily firms).
Mwachidule - Actrapid, Humulin R.

Kuchita kwapakatikati - Protafan, Humulin N (Nova-Nordisk, Elli-Lily Firm).
Pakadali pano, machitidwe a katswiri wa matenda ashuga akuphatikiza ma insulin omwe sakhala pachimake - Detemir (firm Nova-Nordisk), Lantus (firm Aventis).

Mankhwalawa amagwiritsidwa ntchito ngati basal insulin limodzi ndi bolus makonzedwe a ultrashort insulin.

Kupititsa patsogolo kwaposachedwa kwambiri kwa mankhwala a insulin kunali kuyambitsa mapampu a insulin (mapampu), omwe amapereka tsiku lililonse kukonza kwa glycemia m'mapampu awa pogwiritsa ntchito insulin yochepa kwambiri.

Insulin yothandizira mwachidule yakhala ikudziwitsidwa ngati madokotala akunja; palibe chidziwitso pakugwiritsa ntchito kwa ana.

Mankhwala a insulin
Malangizo othandizira olimbitsa thupi akugwiritsidwa ntchito pano, omwe akuphatikizira kuwunika kwa glycemia pogwiritsa ntchito mawonedwe oyesa kapena glucometer komanso kusintha kwa insulin. Pakadali pano, ma insulin okha omwe amapanga ma genetically amagwiritsidwa ntchito mwa ana, omwe ndi ma ultrashort (maola 2), afupikitsa (maola maola 6-8) komanso apakatikati (maola 16). Ndondomeko ya kupangira insulini imasankhidwa ndi endocrinologist poganizira mawonekedwe a mwana uyu, njira yoyambira imagwiritsidwa ntchito, i.e.masana, munthawi yomweyo ndikuyambitsa basal insulin (yapakati ntchito), insulin yochepa imayendetsedwa musanadye. Insulin-in-insulin ikhoza kutumikiridwa kuyambira 1 mpaka 4 pa tsiku, insulin yochepa - kuyambira 4 mpaka 6 pa tsiku, chilichonse chimatsimikiziridwa ndi katswiri.

Phindu la ultrashort insulin

Amaperekedwa nthawi yomweyo asanadye, osafunikira kudikirira mphindi 30 mpaka 40 ngati akufotokozera insulin yocheperako, akapatsidwa mankhwala, chiopsezo cha hypoglycemia chimachepa, mwana amapeza ufulu panthawi yakudya. Posachedwa takhala tikugwiritsa ntchito ma insulin amafupiafupi kwa achinyamata omwe ali ndi chidwi chachikulu komanso kudziletsa kwabwino kwa glycemic komanso kudziletsa. Mlingo wa insulin wa tsiku ndi tsiku umatsimikiziridwa payekhapayekha, kawirikawiri mchaka choyamba cha matenda ndi kulemera kwa thupi la 0.5 U / kg, pambuyo pa zaka 5 - 1 U / kg thupi. Mu ana aang'ono, Mlingo amawerengedwa kukumbukira glycemia ndi kuchuluka kwa thupi, komwe kumafunikira kusintha kwapafupipafupi kwa mlingo, komabe sayenera kupitirira 0,25 - 0,5 U / kg ya kulemera kwa thupi. Mu achinyamata, chifukwa cha kuchuluka kwa insulini, kufunika kwa insulini kungakhale kuchokera pa 1 mpaka 2 U / kg thupi.

Matenda a Insulin Overdose Syndrome

Pankhani ya insulin yokwanira, kusintha kwa zotsatira za Somogy ndikotheka. Zotsatira zake zimadziwika chifukwa cha kuchuluka kwa insulin, poyankha ku nocturnal hypoglycemia, kumasulidwa kwa mahomoni otsutsana (glucogon, cortisol, adrenaline, kukula kwa timadzi), komwe kumapangitsa kukula kwa shuga m'magazi.

Mawonetseredwe azachipatala:

Kukwiya m'mawa

Mu gawo lalikulu la hypoglycemia yam'mawa, chifukwa chake chimatha kukhala kukokana kwa insulin m'mawa (m'mawa kwambiri kuyambira 5 mpaka 9 m'mawa), zomwe zimatchedwa Down phenomenon, zomwe zimachitika mbandakucha. Amayambitsidwa ndi kubisa kwachisangalalo kwa mahomoni amodzi omwe amapanga-mahomoni - kukula kwamafuta.

Kuti muzindikire, ndikofunikira kudziwa shuga 3 m'mawa. Ngati 3 koloko shuga ndizabwinobwino, ndipo m'mawa hyperglycemia ndimachitika mu Down. Pankhaniyi, ndi bwino kuchedwetsa jakisoni wa insulin yapakatikati kwa maola 23.

Chithandizo cha matenda a shuga a mtundu wachiwiri ndi matenda ashuga a MOD

Kutsimikizira matendawa, ana asanachitike komanso pambuyo pa carbohydrate katundu akuphunzira IRI kapena C-peptide, chomalizachi ndi chothandiza kwambiri. Mlingo wa hemoglobin wa glycated umayesedwa. Pakadali pano, chithandizo cha matenda a shuga a MODI chimatengera mtundu wake, i.e. onse Biguanides (metformin) ndi insulin angagwiritsidwe ntchito.

Masewera olimbitsa thupi komanso masewera olimbitsa thupi
Kuchita masewera olimbitsa thupi pafupipafupi komanso okwanira kumawonjezera chidwi cha insulin komanso kumachepetsa kufunika kwake. Nthawi zambiri, anthu amapita kumasewera osachepera ola limodzi atatha kudya. Ndikofunika kupenda shuga m'magazi musanayambe kuchita masewera olimbitsa thupi, omwe angakuthandizeni kusintha mlingo wa insulin. Sizovomerezeka kuti mwana azichita nawo masewera othamanga komanso otsika kwambiri. Poyambirira, mwana ayenera kudya 1-2 XE pamaso pa kalasi, ndipo chachiwiri, kulipira chakudya cha metabolism kumakhala kofunikira, kenako kuvomereza masewera. Kutalika kwa katunduyo kumayenera kukhala pafupifupi mphindi 30 mpaka 40. Ngati masewerawa amatha kumapeto kwa chakudya chamadzulo, muyenera kuchepetsa mlingo wa mankhwalawa a insulin yapakatikati mwa magawo awiri kuti mupewe usiku.

Kuphunzitsa
Cholinga cha maphunzirowa ndikudziwitsa makolo ndi ana zonse za matendawa. Ana ndi makolo amalowetsedwa mu njirayi kuti azichita bwino kudziletsa, ndipo ngati kuli kotheka, amayankha molondola kusintha komwe kungachitike m'boma. Maphunzirowa amachitidwa ndi adotolo, namwino-mphunzitsi ku Sukulu ya Matenda a shuga. Mukamaphunzitsidwa, malo ofunikira amatenga kukonzekera kwa mwana ndi makolo za vuto lomwe limachitika, lomwe limachitika limodzi ndi psychologist.

Cholinga cha mankhwala ndi kuwongolera

Chithandizo cha shuga cholondola ndicholinga chopewa kuwonongeka kwa matendawa, kupewa matenda obwera pang'onopang'ono.

Cholinga chachikulu: Kupatsa mwana kukula kwakuthupi ndi kwamaganizidwe, machitidwe ake opambana.

Kuti mukwaniritse cholinga ichi, kulipira kwathunthu kagayidwe kazakudya, i.e. Normoglycemia ndi aglucosuria, wabwinobwino glycosylated hemoglobin. Kudziletsa ndi kudziletsa pakuthandizira izi, zomwe zimapereka lingaliro: kuwerengera sabata sabata iliyonse ya zakudya, kuwongolera panthawi yolimbitsa thupi nthawi zonse.

Chofunika kwambiri ndi kuphunzira kwa glycosylated hemoglobin kamodzi pakapita miyezi iwiri iliyonse. Munjira yamankhwala, kuphunzira za kulemera ndi kutalika ndikofunikira.

Ngati matenda ashuga amatenga zaka zopitilira 5, kuwunika mosamala kuthamanga kwa magazi, urinalysis ya albuminuria, kufunsidwa kwa pachaka kwa odwala omwe ali kuchipinda chazachipatala cha chipatala cha maso kuti adziwe ngati retinopathy ndiyofunikira. Kawiri pachaka, mwanayo amayenera kuwunikidwa ndi dokotala wamano komanso dokotala wa ENT.

Milandu yolipirira kagayidwe kazakudya zamafuta a shuga mu mtundu I shuga

Kudziyang'anitsitsa kwa shuga m'magazi a capillary, mmol / l (mg%)

Glycemia asanagone

Hypoglycemia

Hypoglycemia imayamba ngati mlingo wa insulin umaposa kuchuluka kwa chakudya choperekedwa ndi chakudya. Chifukwa china cha hypoglycemia ndi insulin mankhwala osachiritsika pochotsa wodwala ku ketoacidosis komanso / kapena osakwanira a glucose auberal.
Hypoglycemia imayendera limodzi ndi izi:

Kuwunikira ndi kuwonera

Zizindikiro zonsezi ndizowonetsera za neurohypoglycemia komanso zomvera chisoni-adrenal poyankha kuchepa kwa shuga wamagazi. Komanso, ana okulirapo amakhala ndi njala, ndipo ochepa, m'malo mwake, amakana kudya.

Ngati chithandizo sichiperekedwa, hypoglycemic coma ikhoza kukhala, i.e. Kutha kukumbukira komwe kumachitika chifukwa cha kukhumudwa kwa kagayidwe kazakudya mkati mwa mtima. Ndi chikomokere chozama, ubongo wa edzi umayamba, womwe nthawi zambiri umadziwoneka ngati wodwala matenda opatsirana.

Ndi hypoglycemia wofatsa, muyenera kudya mkate kapena zipatso, ndi hypoglycemia, shuga, maswiti, kupanikizana. Ndi kutaya kwa chikumbumtima, 20 mpaka 40% yankho la glucose imalowetsedwa m'mitsempha pafupifupi 20,0 mpaka 40.0. Ngati palibe zotsatira, mlingo ungathe kubwerezedwa. Ngati hypoglycemia ikukula kunyumba kapena kusukulu ndikuzindikira kumadziwika, ndikofunikira kuyendetsa 1 mg ya glucagon mu / minofu dokotala asanafike (Glucagen, kampani ya Novo-Nordisk).

Maukadaulo aukadaulo apadera

Matenda apakati
Panthawi ya matendawa, kufunika kwa insulini kumawonjezeka, komabe, chidwi chimatha kusintha, nthawi zambiri chimachepa. Chifukwa chake, pamatenda oyanjana, ndikofunikira kuyang'anitsitsa shuga wamagazi, komanso glucose ndi mkodzo acetone. Pankhani ya hyperglycemia, mlingo wa insulin ungathe kuchuluka chifukwa cha kufupika kwa insulin. Pankhaniyi, kusintha kwa mankhwalawa kumachedwa: ngati mwana alandira 20 PESCES / tsiku - onjezani 2 PISCES, ngati alandila zoposa 20 PIECES / tsiku - 4 PISCES. Koma kwakukulu, kuchuluka kwa tsiku ndi tsiku pa nthawi ya matenda sikuyenera kupitirira 20% ya mlingo woyambirira.
Ngati chilakolako cha matenda chikuchepa, ndiye kuti mlingo umachepetsedwa ndi 2 kapena 4 PIERES malingana ndi oyambayo, kapena kusintha kwake panjira yochepetsera kumadalira glucose wamagazi ndi hypoglycemia.

Malangizo a dokotala pakukulitsa matenda a shuga: kuwoneka kwa zizindikiro za polydipsia, polyuria.
Pankhaniyi, ndikofunikira kuwonjezera kuchuluka kwa insulin tsiku lililonse chifukwa lalifupi mwa 10-20% ya tsiku lililonse mlingo, ndikuwonjezera kuchuluka kwa magawo asanadye kwambiri. Mlingo wofananawo watsiku ndi tsiku uyenera kuperekedwa kwa masiku 2-3 kuti athe kulipirira kagayidwe kazakudya. Munthawi imeneyi, ndikofunikira kupeza chifukwa chamawu olakwika kotero kuti saloledwa kupitiliza.

Opaleshoni ya insulin

Ntchito zing'onozing'ono zomwe zimachitika pansi pa mankhwala oletsa ululu. Zakudya zokhazokha komanso mtundu wanthawi zonse wa insulin. Ndikofunika kuchita opareshoni m'mawa.

Kuchita kwakanthawi pansi pa opaleshoni wamba. Patsiku la opareshoni, 50% ya tsiku lililonse ya insulin yovomerezeka yolandiridwa ndi wodwalayo imalowetsedwa. Nthawi yomweyo, shuga 5% imayambika kugaya mkati, nthawi zambiri imakhala yofanana ndi thupi la madzi tsiku lililonse - 60 ml / kg / tsiku. 7.5% yankho la potaziyamu mankhwala enaake amawonjezera glucose pamlingo wa 2 ml / kg / tsiku. Mwazi wa magazi umapimidwa pakuchita opareshoni, pambuyo pake, kenako maola 2 onse tsiku lonse. Pambuyo pakuchita opaleshoni, insulin imayendetsedwa mosavomerezeka maola 6 aliwonse poyerekeza 0,25 U / kg thupi.
Mukangodyetsedwa, siyani kulowetsedwa ndikusinthana ndi njira yokhazikika ya insulin. Kulowetsedwa mankhwala nthawi zambiri kuchitidwa 12, osachepera 24 maola.

Opaleshoni yayitali yayitali pansi pa anesthesia kapena opaleshoni yodzidzimutsa pazifukwa zaumoyo.
Kulowetsedwa mankhwala kuyenera kuchitika malinga ndi zofunika tsiku lililonse madzimadzi: 5% shuga ndi kuwonjezera kwa 1-3 ml / kg kulemera / tsiku 7.5% yankho la potaziyamu mankhwala ena.
Kutengera ndi glycemia, insulin imayendetsedwa kudzera m'magazi. Ngati shuga m'magazi ndi 8.3 mmol / l, ndiye kuti insulini imathandizidwa pa 1 IU pa magalamu anayi a shuga owuma, kuyambira 8.3 - 11.1 mmol / l - 1 IU - 3 magalamu a shuga owuma, oposa 11.1 mmol / l - 1 ED - 2 g wa shuga owuma.
Pambuyo pa opareshoni, glucose imapitilizidwa kutumikiridwa kudzera m'mitsempha mpaka itatha kudya ndi kumwa, ndipo insulin imayendetsedwa pamlingo wa 0,25 U / kg thupi lililonse pakatha maola 6 s / cutaneous.

Zolemba za maphunziro a shuga kwa ana

Mwa kuchuluka kwa ana, pakatha milungu 2-4 kuyambira pomwe akhazikitsa matendawa komanso kulandira chithandizo choyenera, matendawa amayambiranso ngakhale chikhululukiro ndikotheka, pomwe kufunika kwa insulin kumachepa kwambiri. Gawoli limatenga milungu ingapo kapena miyezi yambiri. Kenako, kufunika kwa insulin kumawukanso ndikufikanso zaka 3-5 kuyambira kumayambiriro kwa matendawa 0.8-1 U / kg thupi. Munthawi yakutha msinkhu, kuchuluka kwa mahomoni opikisana kumawonjezeka, kufalikira kwamkati ndi kuwonjezeka kwa thupi kumachitika. Njira ya matenda osokoneza bongo nthawi imeneyi imadziwika ndi kulumikizidwa ndipo imafunikira kuwunikira mosamala kwambiri. Pambuyo pa kutha msinkhu, matenda a shuga amakhalanso okhazikika. Mlingo wa insulin mu unamwali ukhoza kuchuluka kuchokera ku 1 mpaka 2 mayunitsi / kg pa tsiku / tsiku. Tiyenera kukumbukira kuti shuga nthawi zambiri imakhala yodziwika ya polyendocrinopathies. Pambuyo pake, ana amatha kukhala ndi matenda a autoimmune a endocrine glands, makamaka chithokomiro.
Kubwezeretsedwa koyipa kwa matenda ashuga kumayambitsa kuphwanya mitundu yonse ya kagayidwe kazakudya, makamaka mapuloteni, omwe amatsatira limodzi ndi kuchepa kwa chitetezo chosagwirizana ndi chitetezo. Zotsatira zake, pafupipafupi kukulira zotupa zopweteka pakhungu ndi mucous nembanemba mwanjira ya matenda a pyoderma ndi fungus, njira yochiritsira ndiyovuta.

Pang'onopang'ono zovuta za matenda ashuga

Zimakhazikitsidwa ndi zotumphukira mu mtima mwa ana - ma microangiopathies, kukula komwe kumatengera chibadwa cha mwana komanso chindapusa cha kagayidwe kazakudya. Nthawi zambiri microangiopathies amakula pambuyo pazaka 5 kuyambira kumayambiriro kwa matendawa.

Matenda a shuga
Popita nthawi, pafupifupi 1/3 ya odwala omwe ali ndi matenda amtundu woyamba amakhala ndi matenda aimpso, omwe amachokera ku matenda ashuga a glomerulossteosis. Ndi chipukutiro chabwino cha matenda a shuga, kuyamba kwa aimpso kulephereka. Kuzindikira koyambirira kwa matenda ashuga nephropathy kumachitika pogwiritsa ntchito kuyesa kwa microalbuminuria. Kuzindikira kwa microalbuminuria kumafuna kulimbitsa kudziletsa, kuyang'anira glycemia, kuyang'anira kuthamanga kwa magazi. ACE inhibitors (Monopril, Diroton, Enalapril, Renitek) kapena angiotensin II receptor inhibitors (Cazaar) amagwiritsidwa ntchito kale ngati mankhwala achire pakadali pano. Kuyambira pomwe gawo la matenda ashuga nephropathy akhazikitsidwa, kuyang'anira mwana kumakhala kokwanira.

Matenda a shuga a retinopathy
Matenda a shuga a retinopathy amadziwika ndi kuwonongeka kwa retina ndi kukula kwa khungu. Pa matenda a matenda ashuga retinopathy, ndikofunikira patatha zaka 5 kuchokera ku zovuta za matenda ashuga, kuwunika kwathunthu kosintha mu fundus mu chipatala chofufuza zamankhwala amaso ndi chipatala chotsatira ndikuwatsata kawiri pachaka ndi opaleshoni yamaso ndi cholinga chokonzanso panthawi yake ya matenda ashuga a retinopathy.

Polyneuropathy
Izi zovuta za shuga zimapangidwa koyambirira. Kusiyanitsa:

Peripheral polyneuropathy, yomwe imadziwonetsa yokha mu vuto losazungulira komanso lakuya kwambiri. Pazotsatira zake, maphunziro a electromyographic akugwiritsidwa ntchito kwambiri. Mankhwalawa, makonzedwe a α-lipoic acid (Espa-lipon, Thioctacid, Berlition) ndi mafuta osungunuka a vitamini B1 ndi B6 (Milgamma) amagwiritsidwa ntchito.

Autonomous, komwe iwo amasiyanitsa: mtima wa matenda ashuga, gastropathy, matenda ashuga enteropathy, matenda a shuga a neurogenic. Kuzindikira kwawo kumatengera ndi zamankhwala komanso zofunikira zothandizira. Ma Cardiotrophs, prokinetics, physiotherapy amagwiritsidwa ntchito pochiritsa.

Matenda a shuga
Pankhani yopanga matenda a shuga osalipidwa bwino, mutha kusintha zomwe zimachitika mu kaganizidwe ndi kakhalidwe - encephalopathy.

Zovuta zapakati pakukonzekera zimaphatikizapo:

Lipodystrophy pamalo a jakisoni a insulin.

Mafuta chiwindi hepatosis chifukwa cholipira bwino chakudya ndi mafuta kagayidwe.

A shuga a chiropathy - kagayidwe kachakudya matenda ofooka ochepa manja.

Lipoid necrobiosis ndi mtundu wa vasculitis, panniculitis.

Pakadali pano, sitimakumana ndi mtundu wa Moreak ndi Nobekur, wodziwika bwino chifukwa cha kukula komanso chidwi cha kugonana.

Polydipsia - ndi chiyani?

Ngakhale mawu oti "polydipsia" ali ndi mizu yaku Latin ngati "ana" (poto ՛ m - kulumikizana ndi madzi, motero American Potomac ndi mvuu), kusiyana pakati pawo ndikokulira.

Psychiatric mania imatanthawuza "kuyendetsa galimoto", pomwe polydipsia (kwenikweni: kumwa kwambiri) ndikofunikira kwa madzi.

Kupezeka kwa polydipsia yoyamba kumayambitsa mwachindunji kusokonezeka kwa ntchito zam'malo a ludzu (kapena malo akumwa) ndi kutsegulidwa kwake chifukwa cha kupezeka kwa matenda a pituitary-hypothalamic dera kapena chifukwa cha kusokonezeka kwa m'malingaliro - pakuwoneka kwachiwiri, kupatuka pakupanga magazi ozungulira kumafunikira, komwe kumayambitsa zomwe zimachitika pakadali pano.

Kuphatikiza pazifukwa za dongosolo lamalingaliro - schizophrenia ndi zinthu zina, pali mtundu wotere wa polydipsia (idiopathic), mafotokozedwe omwe sayansi singapereke.

Kukhalapo kwa lingaliro la misala: psychogenic polydipsia imalumikizidwa ndi chikhulupiriro chosaneneka chofunikira pakufuna kumwa madzi ambiri (kapena kumwa pafupipafupi, mu Mlingo wochepa).

Odwala nawonso amalimbikitsa paradigm yawo ngati akufuna "kutsuka" ziphe ndi "kuwononga" m'thupi, kapena mwa kukhazikitsa mphatso, yomwe idabweretsa "madzi amoyo" omwe amachiritsa matenda onse ndikuwonjezera nthawi yayitali.

Kuopsa kwa polydipsia ya psychogenic etiology kuli pothekera kuchepetsa ma electrolyte (sodium) kukhala pachiwopsezo chopatsa moyo, chodzala ndi kuyamba kwa kukomoka komanso kutsekeka pambuyo pake.

Kanema kochokera kwa Dr. Malysheva:

Zokhudza thupi komanso matenda

Zomwe zimapangitsa kuti pakhale ludzu lamalingaliro zimatha kugwira ntchito ngati chilengedwe (kuthupi) kutaya kwa magazi ndi mchere wamchere chifukwa cha thukuta:

• kuchokera kutentha
• mtundu wa magwiridwe antchito ofunikira,
• machitidwe a munthu wamanjenje (thukuta chifukwa chamanyazi, kudziimba mlandu, mkwiyo), ndi zifukwa zina.

Zomwe zimapangitsa kuti katundu wa pathological awonjezeke ndikuwonjezereka kwa kuphatikizika kwa mankhwala m'ziwopsezo zopatsa moyo, ngakhale pakhale kuchuluka kwamadzi (madzi) m'magazi pakadali pano.

Chifukwa chake, nthawi zina kuwonjezera kuchuluka kwa shuga m'magazi sikufunikira kuchepa kwa kuchuluka kwa madzimadzi ozungulira - kumawonjezera pazifukwa zina.

Mwachitsanzo, polydipsia mu shuga mellitus, komanso hyperglycemia ya munthawi yomweyo, imalongosola kuchepa kwa mahomoni - kusowa kwa insulini, zomwe zimapangitsa kuti pakhale limodzi ndi ludzu losatha la chizindikiro china chofunikira cha matenda - polyuria (kutulutsa mkodzo mwachangu mumiyeso yayikulu, kumabweretsa wodwalayo kuti athetse ntchito mawu oti shuga amatanthauza shuga.

China chomwe chimapangitsa ludzu losagonjetseka la kukhalapo kwa matenda ena omwe amabwera chifukwa cha kusalinganika kwa mahomoni - komanso matenda ashuga, koma matenda a shuga.

Zizindikiro ndi zomwe zikugwirizana

Popeza madzi akumwa pamatendawa amapitilira kuchuluka kwa mphamvu zolimbitsa thupi kwa nyengo yofunda komanso kugwiritsa ntchito mphamvu kawiri (kupitilira 2 l / tsiku), hemodilution (dilution ya magazi ndi madzi) kumayambitsa kusalinganika mu kapangidwe kake ka electrolyte - chifukwa chake, kusokonezeka kumawonekera pakuchitika kwa machitidwe onse amthupi:

Kuwonongeka kwa minofu yolimbitsa thupi pang'onopang'ono kumayamba ndi ma minyewa osagwirizana, osagwirizana; pakusinthika kwambiri (ndi kuwonda kwambiri kwa magazi), kugwidwa kofanana ndi khunyu.

Poona kuti lingaliro la "musculature" limangokhala osati chigoba, komanso minyewa yosalala, pali kupititsa patsogolo ntchito:

• mtima (ndi kukula kwa arrhythmias, mphamvu zosakwanira zamkati zamtima),
• ziwalo zopanda pake.

Mitundu yamitsempha yamagazi imasinthika (ndi predominance ya hypertonicity koyambirira ndi kutsika kwake kumapeto kwa vuto) - zidziwitso zamkati zamitsempha ndi kuthamanga kwa magazi zimayamba kuchuluka, ndiye kugwa.

Zomwe zimachitikanso ndi m'mimba, matumbo, endocrine ndi ma gland a exocrine - ma ducts awo amapangidwanso ndi minofu yosalala.

Kudzikundikira kwa madzi mthupi kumabweretsa edema syndrome, yomwe imafotokozedwa koyamba pakuphatikizidwa kwamadzi mkati mwa thupi (makamaka, ascites), kenako - mawonekedwe a edema yakunja.

Popeza kudalira kwa magazi kumabweretsa ku ubongo pamitsempha yamagazi, kusokonekera kwake kumayambitsa chisokonezo pakuchitika kwa ziwalo zonse ndi machitidwe, ndi kuvutika kwake kwakukulu kumachitika.

Chifukwa cha kupezeka kwa zovuta izi, potengera kusunthika kwa kuchuluka kwa shuga m'magazi, kusintha kumachitika mwachangu kwambiri, kumatenga nthawi yayitali ndipo kumafunikira kulimbitsa thupi kwakukulu ndi onse ogwira ntchito zamankhwala kulipirira.

Zizindikiro

Kukhalapo kwa matenda ashuga - onse shuga ndi opanda shuga (kapena kuganiza kwa kukhalapo kwawo) kumawonetsedwa ndi zizindikiritso zomwe zimadziwika kwa wodwalayo, komanso kuchuluka kwawogwiritsa ntchito.

Gulu loyamba lili ndi polydipsia kumbuyo:

• polyuria
• polyphagy (chakudya chosakwanira),
• Zomwe zimapangitsa kuti muchepetse kunenepa,
• zochitika za poizoni (kutopa kwambiri, kufooka, kusokonezeka kwa malingaliro ndi ntchito zamaganizidwe),
• Zizindikiro zakusowa kwam'madzi (kuchokera pakamwa pouma - mpaka pakusokonekera kwa khungu: kuyabwa, kupendama, zotupa, zilonda, magazi),
• glucosuria (maswiti a kukoma kwa mkodzo).

Zizindikirozi zimatsimikiziridwa ndi mayeso azachipatala:

• kuyesa kwamkodzo ndi shuga (kuphatikizapo kutsimikiza kwa kuchuluka kwa hemoglobin ndi njira zina),
• mawonekedwe a glycemic mbiri,
• kutsimikiza kwa kuchuluka kwa mahomoni m'magazi,
• kuwunika kwa ntchito zamagulu amthupi ndi madotolo apadera (endocrinologist, neuropathologist, Optometrist).

Ndi matenda a shuga a insipidus (nephrogenic kapena pituitary), matendawa amasiyana mu zovuta zina zamankhwala am'mimba popanga madzi achilengedwe.

Malangizo othandizira

Chithandizo chimatengera chifukwa cha polydipsia.

Ndi genesis yake ya matenda ashuga, kukonza mavuto kumachitika:

• maziko amakulu
• dongosolo ndi chiwalo
• kagayidwe kachakudya minofu,
• zakudya odwala komanso kusintha kwa moyo wake.

Kukwaniritsa cholinga choyamba ndikotheka kupereka mankhwala ochepetsa shuga kapena ma insulin, ndikutsatira kusintha kwa mankhwalawa molingana ndi magazi ndi mkodzo magawo.

Kuchita lachiwirili kumafuna kugwiritsa ntchito mitundu yambiri ya othandizira: kuphatikiza okodzetsa (Lasix ndi ena) pogwiritsa ntchito njira zopetsanso madzi (kuyambitsa mayankho ndi njira yotsitsa pomwe sikutheka kumwa madzi omwe mumamwa).

Kubwezeretsanso kwa mchere wamchere ndi chiyambi cha kubwezeretsa ntchito za ziwalo ndi machitidwe a thupi, ngati kuli kotheka, mankhwala ogwirira ntchito amagwiritsidwa ntchito:

• antispasmodic (Magnesium sulfate, Papaverine),
• analgesic kuphatikizapo antihistamine (Analgin ndi diphenhydramine),
• sedative ndi antispastic (Radedorm) ndi zina.

Kugwiritsa ntchito Riboxin ndi othandizira ena omwe amasintha kagayidwe kamatenda, kuyambitsa mphamvu ya antihypoxic, kumatha kusintha magawo onse a ziwalo ndi minofu, ndikuwukweza kamvekedwe ka thupi. Ngati ndi kotheka, chithandizo cha vitamini chimayikidwa pazomwezi.

Poganizira za mantha achibadwa a wodwala matenda ashuga kuchoka kwawo osatha kuchitapo kanthu kuti athetse vuto lake, ndikofunikira kuti amuphunzitse zikhulupiriro zatsopano zokhudzana ndi matenda ake, kuwunikira mozama njira yatsiku ndi tsiku pang'onopang'ono yowonjezera pang'onopang'ono yolimbitsa thupi ndi zochitika zina.

Zakudya za anthu odwala matenda ashuga siziyenera kusamalidwa pang'ono (ndikofunikira kuwononga zikhulupiriro zina zokhuza zabwino kapena zovuta za zakudya zina).

Ndi matenda omwe apezeka munthawi yake, kupeza zomwe zimayambitsa polydipsia ndikukwaniritsa malingaliro a dokotala wodziwa bwino, ndikwabwino; ngati atanyalanyazidwa, pali mwayi wokhala ndi vuto lomwe silinayembekezere.

Zifukwa zathupi

Choyamba, ndikufuna kudziwa polydipsia yokhudzana ndi zachilengedwe. Kuchulukitsa zolimbitsa thupi, kutentha kwambiri mkati kapena kunja, zochitika zopsinjika, zimatha kuyambitsa chizindikiro ichi, koma sichisonyeza matenda aliwonse. Komanso, ludzu lochulukirapo lingawonedwe mwa amayi apakati, omwe amakhalanso abwinobwino.

Chifukwa china cha polydipsia achilengedwe ndi chakudya. Zakudya zamchere, zotsekemera kapena zonunkhira zimatha kuyambitsa ludzu, komanso mowa.

Funso lina ndi pamene pali ludzu popanda kutengera zinthu zakunja. Chifukwa, mwachitsanzo, kufunikira kowonjezereka kwamadzi kungalankhule:

• malungo
• kuchepa kwa magazi
• kutupa
• hydrothorax (kuphatikizika kwa chifuwa chamkati),
• ascites (kulowetsedwa kwam'mimba).

M nyota mumunthu imathanso kuchitika ndi m'mimba kapena kusanza.

Psychogenic Polydipsia

Kusintha kwina ndi psychogenic polydipsia yomwe imagwirizanitsidwa ndi mavuto amisala.

Komanso, chizindikiro cha ludzu losatha chingasonyeze kukhalapo kwa matenda angapo, choyambirira, ngati wodwalayo adandaula chifukwa chosowa madzi osafunikira, dokotala amakayikira chitukuko cha matenda ashuga. Ndipo pankhaniyi, kudziwika koyenera ndikofunikira, chifukwa pali matenda ashuga komanso matenda a shuga. Chithandizo cha matenda awa, monga zoyambitsa chitukuko, ndizosiyana, koma mawonetseredwe amatha kufanana.