Njira zamakono zochizira matenda amtundu wa 2 shuga

* Zowonjezera mu 2017 malinga ndi RSCI

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Werengani mu magazini yatsopano

Malinga ndi akatswiri a World Health Organisation: “Matenda a shuga ndi vuto la zaka zonse ndi mayiko onse.” Pakadali pano, matenda a shuga a mellitus (DM) amatenga malo achitatu pakati pa zomwe zimayambitsa imfa pambuyo pamatenda amtima komanso a oncological, chifukwa chake, mavuto ambiri okhudzana ndi matendawa adayankhulidwapo ku maboma ndi feduro m'maiko ambiri padziko lapansi.

Malingaliro anga, International Expert Committee on the Diagnosis and Classization of Diabetes Mellitus (1997), matenda ashuga ndi gulu la zovuta za metabolic zomwe zimadziwika ndi hyperglycemia, zomwe zimachitika chifukwa cha zolakwika pakubisika kwa insulin, insulin, kapena kuphatikiza zonsezi.

Kuwongoleramtundu 2 shuga

Umboni tsopano wakwanira padziko lonse lapansi kuti kuwongolera odwala matenda ashuga kumatha kuchepetsa kapena kulepheretsa zovuta zambiri zomwe zimakhudzana nawo.

Ponena za kasamalidwe koyenera ka matenda ashuga, pali umboni wokwanira kuti kusintha glycemic kungathandize kuchepetsa chiopsezo chokhala ndi microangiopathy.

Kuwunikira kwa kafukufuku wazaka 10 za DCCT (Kuwongolera matenda ashuga ndi zovuta zake) kunawonetsa kuti pakuchepetsa kulikonse kwa hemoglobin wa glycated, chiopsezo chokhala ndi zovuta zam'magazi (retinopathy, nephropathy) zidachepetsedwa ndi 35%. Kuphatikiza apo, zotsatira za phunziroli zikuwonetsa bwino kuti kuwongolera glycemic koopsa, komanso kuthamanga kwa magazi, kumachepetsa kwambiri vuto la matenda amtima, matenda amitsempha, komanso zotumphukira za odwala omwe ali ndi matenda a shuga a 2. Kutengera izi, cholinga chachikulu cha mankhwalawa ndicho chindapusa chokwanira pa zovuta za kagayidwe kazakudya. Kugwiritsa ntchito mankhwala ovuta komanso okhwimitsa zinthu kwambiri, poganizira momwe matendawa angapangidwire, kuchepa kwa matenda a metabolic, kuchepa kwapang'onopang'ono kwa β-cell misa, zaka za odwala komanso chiopsezo cha hypoglycemia, komanso kufunika kobwezeretsa zovuta za insulin komanso kukwaniritsa kuyendetsa bwino glycemic kwakanthawi.

Masiku ano, ndizosatheka kuchiritsa matenda a shuga a 2, koma amatha kuwongoleredwa ndikukhala ndi moyo wonse.

Pulogalamu yachiwiri yosamalira matenda a shuga imaphatikizapo njira zotsatirazi zamavuto akulu:

• Kusintha kwamachitidwe (chithandizo cha zakudya, zolimbitsa thupi, kuchepetsa nkhawa),

• mankhwala (pakamwa hypoglycemic mankhwala, incretinomimetics, insulin).

Ngakhale pali zofalitsa zambiri zaposachedwa pa kagwiritsidwe ntchito ka matenda a shuga 2, omwe adafalitsidwa posachedwapa, si madokotala onse omwe ali ndi njira yochizira matenda oyambawa. Harmonised Regulation ya American Diabetes Association (ADA) ndi European Association for the Study of Diabetes (EASD) yokhudza kayendedwe ka hyperglycemia mu mtundu 2 wa shuga ikupangidwa ndikufalitsidwa.

Tebulo 1 limapereka njira zingapo zamakono zothandizira odwala matenda ashuga, poganizira momwe zimagwirira ntchito, zabwino ndi zovuta.

Chofunikira kwambiri ndikutsimikiza momwe digito imaperekera matenda a shuga. Mu 1999, malangizo osamalira odwala 2 a shuga adasindikizidwa, omwe amapereka njira zothandizira kulipirira matendawa. Ndikofunika kulipira chidwi makamaka pakufunika kwa kuwongolera kwambiri osati kagayidwe kazakudya kokha, komanso zamadzimadzi a lipid, komanso zofunikira zamagazi kudzera mu prism yokhala ndi vuto la mtima, kapena chiopsezo chotenga zovuta za mtima zamtundu wa 2 shuga mellitus (Gome la 2-4).

Kusankha kwamankhwala ndi ntchito yake pochiza matenda amtundu wa 2

Kafukufuku wambiri padziko lonse lapansi amayang'ana kwambiri kupeza chithandizo chokwanira cha matenda ashuga. Komabe, musaiwale kuti kuphatikiza pazithandizo zamankhwala, malingaliro pazakusintha pa moyo ndiosafunanso.

Mfundo zoyambirira za mankhwala azakudya

• kuphatikiza zakudya zopatsa thanzi maulendo 6 pa tsiku, m'malo ochepa, panthawi yomweyo, zomwe zimathandizira kuchepetsa kulemera kwazomwe zimalepheretsa kusintha kwakanthawi kwam'magazi a glycemia

• wonenepa kwambiri, zakudya zamafuta ochepa zimasonyezedwa (≤1800 kcal)

• Kuletsa zakudya zosavuta kugaya (shuga ndi zopangidwa zake, uchi, misuzi yazipatso)

• kudya zakudya zamafuta ambiri (20 mpaka 40 g patsiku)

• Kuletsa kudya kwakhuta kwa mafuta okwanira 7.5%, kusala kudya glycemia> 8.0 mmol / l ndi BMI Literature

Makhalidwe a matenda a shuga

Matenda a shuga ndi kagayidwe kachakudya ka matenda omwe amafunikira njira yophatikizira. Chithandizo cha matenda a shuga chimakhudzana makamaka ndi jakisoni wa insulin wa tsiku ndi tsiku.

Zizindikiro za matenda ashuga.

Iyi ndi njira yayikulu komanso yokhayo yolimbana ndi zovuta zomwe zidachitika kuyambira pachiyambidwe cha matenda a shuga 1. Ndi mtundu wachiwiri wa matenda ashuga a mellitus, chithandizo chachikulu, kuphatikiza osagwiritsa ntchito mankhwalawa i.e. Zakudya, kuchepa thupi komanso kuchita masewera olimbitsa thupi nthawi zonse, ndikugwiritsa ntchito mankhwala opatsirana pakamwa.

Chithandizo cha insulin chimagwiritsidwanso ntchito pagulu la odwala omwe ali ndi matenda a shuga a 2, komabe, kufunika kogwiritsa ntchito kwake kumachitika, monga lamulo, kumapeto kwa mankhwalawa.

Mpaka mankhwalawa a shuga iyenera kuphatikizapo:

Chithandizo cha zakudya
zolimbitsa thupi
opareshoni
maphunziro achire.

Iyenera kutsimikiziridwa kuti chithandizo chosagwiritsa ntchito mankhwala ndizofunikira monga mankhwala. Nthawi zina koyamba mtundu wachiwiri wa matenda a shuga, kudya ndi kuchita masewera olimbitsa thupi ndizokwanira kuchepetsa glycemia (glucose level) popanda kugwiritsa ntchito mankhwala ndi insulin.

Pazaka zochepa zokha, pamene zida zamkati (zomwe zimapangidwa ndi kapamba) zitatha, mudzayenera kupita ku pharmacotherapy.

Chofunikira pakuchiza matenda amtundu uliwonse a shuga ndikusintha zizolowezi zanu. Cholinga cha masinthidwe awa ndi:

kusintha kagayidwe kazakudya zamafuta ndi mafuta,
kupewa kukula kwa mavuto, mwachitsanzo, matenda ashuga,
Kuchepetsa chiopsezo cha atherosulinosis (hyperinsulinemia imathandizira kukulitsa kwa atherosulinosis).

Kuti muwone zomwe akuwayimbira, kufunikira kwa wodwala aliyense ndikuwunika momwe alili zenizeni ndikofunikira.

Chithandizo cha matenda a shuga 1

Matenda amtunduwu amakhudza kwambiri ana ndi achinyamata. Choyambitsa chake ndikuwonongeka kwa ziphuphu za kapamba zomwe zimapanga insulin ndi chitetezo chawo chamthupi. Zizindikiro za matenda ashuga zimawonekera pokhapokha 80-90% ya maselo a beta (kumasula mahomoni) awonongeka.

Chithandizo chokhacho ndikuti mudzaze kuchepa kwa mahomoni mwa kubaya insulin kwa moyo wanu wonse. Ntchito yofunikira kwambiri imapangidwanso ndi zakudya zosankhidwa bwino komanso zolimbitsa thupi.

Type 1 matenda a shuga a insulin

Matendawa amayambitsa kufooka kwa nkhokwe zachilengedwe, makonzedwe a insulin ayenera kuyikiridwa kuyambira pachiyambi ndikupitilira mpaka kumapeto kwa moyo. M'pofunikanso kusintha mlingo wa mankhwalawa, malinga ndi zosowa za wodwala (poyambira pali chinsinsi cha insulin, kotero kuchuluka kwa mankhwala kungakhale kochepa). Kuphatikiza apo, machitidwe ena (matenda, kutentha thupi, masewera olimbitsa thupi) amasintha kufunikira kwa thupi kwa insulin.

Pali zingapo mitundu ya insulin. Zomwe zimasiyana pakanthawi kogwira ntchito ndikukwaniritsa kuchuluka kwambiri kwa ndende yamagazi. Insulin yothamanga kwambiri imayamba kugwira ntchito pasanathe mphindi 15 kuchokera pakukhazikitsa, ikufika pamlingo wambiri pambuyo pa maola 1-2, ndipo zotsatira zake zimapitirira pafupifupi maola 4.

Insulin yokhala ndi nthawi yayitali yogwira ntchito, yomwe imayamba kugwira ntchito pafupifupi maola 2-4 pambuyo pake, imafika pachimake patatha maola 4-6 pambuyo pa utsogoleri, imawonetsa mikhalidwe yomweyo. Panthawi ya insulin yomwe yakhala nthawi yayitali, zotsatirapo zake zimawonekera pokhapokha maola 4-5, ndende yozizira imadza pambuyo maola 10, ndipo imaleka kuchitira kanthu pambuyo maola 16-20.

Posachedwa, otchedwa zopanda pake insulin analogueszomwe zimayamba kugwira ntchito pafupifupi maola awiri pambuyo pa kukhazikitsidwa ndipo nthawi yotsalira ikuyandikira nthawi.

Kukhalapo kwa mitundu yambiri ya insulin kumapangitsa kuti athe kusankha mtundu wa chithandizo mogwirizana ndi zosowa ndi moyo wa wodwalayo. Pali mitundu ingapo ya mankhwala a insulin. Komabe, ndibwino kutsanzira mawonekedwe achilengedwe a kupuma kwa mahomoni.

Muli ndikugwiritsa ntchito Mlingo wocheperako wa insulin kapena analogopanda zopanda pake zomwe zimasunga shuga kuzungulira wotchi. Ndipo musanadye chakudya chilichonse, mankhwala opatsirana mwachangu amayenera kuperekedwa mokwanira kuchuluka kwa chakudya.

Chachikulu kupambana kwa matenda a shuga Kunali kulenga mapampu a insulini, kulola kuwongolera kwakanthawi kwamadzi masana popanda kufunika kwa jakisoni. Chifukwa cha izi, odwala adalandira ufulu wambiri pankhani yazakudya ndi masewera.

Mtundu wa 1 shuga wodwala

Zakudya za anthu odwala matenda ashuga zimakhazikitsidwa ndi malamulo omwewo ngati zakudya zathanzi lililonse za munthu wathanzi. Chakudya chizikhala chokhazikika, ndipo zopatsa mphamvu zake zimagawidwanso chimodzimodzi. Yang'anirani magawo oyenera a michere.

Nthawi mankhwala a insulin wokhala ndi ndondomeko yokhazikika ya jekeseni, odwala ayenera kudya zakudya zosachepera 5 pa tsiku zomwe zili ndi makonzedwe okonzedweratu ndi chiyezo choyenera cha mapuloteni, dzuwa ndi mafuta.

Zofunikira zambiri za tsiku ndi tsiku (50-60%) ziyenera kukhala chakudya cham'madzi, popeza ndizomwe zimapatsa mphamvu anthu. Koma muyenera kudya, choyamba, zovuta za chakudya zopezeka m'mimba, masamba ndi zipatso. Ndipo pafupifupi kuthetseratu sucrose, yomwe ndi chakudya chambiri cholimbitsa thupi ndipo zimayambitsa zovuta kusamalira hyperglycemia mukatha kudya.

Osachepera 15% ya mphamvu iyenera kuchokera kumapuloteni. Mu chakudya cha odwala matenda ashuga ndikofunikira kuphatikiza, choyambirira, mapuloteni athunthu (achinyama) omwe ali ndi mitundu yonse ya ma amino acid, mosiyana ndi mapuloteni ambiri azomera.

Zakudya zamafuta zimayenera kuchepetsedwa mpaka 30% ya mphamvu ya tsiku ndi tsiku yofunikira. Ndikofunikira kuti mafuta (nyama) zokhala ndi mafuta osapitilira 10% zamagetsi. Mafuta osagundika omwe amapezeka muzakudya zam'mera ndizopindulitsa kwambiri.

Kuchita masewera olimbitsa thupi ndi mtundu 1 shuga

Zochita zolimbitsa thupi zimagwira ntchito yayikulu pakuwathandiza odwala matenda ashuga, koma amathanso kuyambitsa mikhalidwe yoopsa ya glycemic. Chifukwa chake, ndikofunikira kumvetsetsa momwe masewera amakhudzira kagayidwe kazinthu. Katunduyo amachititsa kuti maselo azigwira chidwi ndi zochita za insulin - chifukwa chake mamolekyulu ambiri a shuga amalowa m'maselowo, ndipo, chifukwa chake, kuchuluka kwake m'magazi kumachepa.

Ngati simusintha mankhwalawo, kuchuluka kwa glucose, komwe ndi komwe kungapangitse mphamvu ya ubongo, kumatha kuchepa moopsa, komwe kumayambitsa kukomoka. Chifukwa chake, zolimbitsa thupi ziyenera kukonzekera.

Musanayambe kulimbitsa thupi, muyenera kumwa zowonjezera zamagazi, komanso kuchepetsa mlingo wa insulin. Ngati zolimbitsa thupi ndizitali, muyenera kuganizira za chakudya chowonjezera panthawi yophunzitsira.

Zambiri zokhudzana ndi matenda a shuga ndi gawo limodzi lofunika kwambiri pa zamankhwala. Kumvetsetsa za matendawo ndi wodwala kumawonjezera mwayi wa chithandizo choyenera. Wodwala akuyenera kusintha mlingo wa mankhwalawa malinga ndi moyo komanso zakudya. Izi zimakhala ndi gawo lalikulu pochedwezera pakupanga zovuta zomwe zimawononga kwambiri moyo.

Pancreas kapena islet transplantation

Ndi njira ina chithandizo chamakono cha matenda ashuga. Zikondamoyo zonse zimayikidwa nthawi zambiri ndi impso, mwa anthu omwe matendawa amayambitsa matenda a impso.

Izi zimathandizira kudziyimira pawokha ku zolemetsa zaku dialysis ndi insulin. Choyipa chake ndikufunika kopewa kukana ziwalo zomwe zayatsidwa, zomwe zimakhala ndi zotsatila zambiri.

Kuyika kokha ndi komwe kumalumikizidwa ndi chiwopsezo chochepa. Komabe, patapita nthawi, maselo amenewa amayamba kufooka ndipo amafunikiranso kuwaika.

Type 2 shuga

Umu ndi mtundu wa matenda ashuga. Zikutanthauza 5% ya anthu mdziko lathu. Pankhaniyi, vutoli limakhudzana ndi zonse za insulin komanso momwe zimabisalira. Mothandizidwa ndi chinthu (kunenepa kwambiri), maselo amthupi amakhala osagwirizana ndi insulin, yomwe imapangitsa kuti chidziwitso chake chiwonjezeke.

Kuchiza matenda a shuga ndizovuta kwambiri ndipo kumafuna njira yophatikizira.

Zikondazo zimatulutsa timadzi tambiri mpaka mphamvu zake zimatha, ndipo zilumbazo zimawonongeka. Pali vuto latsopano - kusowa kwa insulini ndi kulimbikira kwa insulin. Kagayidwe kazakudya kamasamba amasokonekera ndipo hyperglycemia imayamba.

Ndi matenda a shuga a 2, zinthu zachilengedwe zimagwira ntchito yayikulu - iyi ndi moyo, kadyedwe, thupi ndi kuchuluka kwam'mimba. Chithandizo chimayamba ndikusintha kwa zinthuzi. Ndi kusintha kwawo koyenera, mutha kuchira matenda oyipawa.

Ngati izi sizingatheke, othandizira odwala matenda am'mimba amagwiritsidwa ntchito. Pancreas pokhapokha akataya mwayi wake wopanga mahomoni pomwe insulin mankhwala imayamba.

Mtundu wachiwiri wa matenda ashuga

Chithandizo cha zakudya ndizofunikira pakulimbana ndi matenda a shuga a mtundu wachiwiri. Kunenepa kwambiri, makamaka kunenepa kwambiri pamimba, ndiye chinthu chofunikira kwambiri chotsogolera matenda a shuga. Akuti anthu opitilira 75% omwe apezeka ndi matenda a shuga a 2 ndi onenepa kapena onenepa kwambiri.

Pankhaniyi, gawo lofunikira chithandizo cha matenda ashuga ndizakudya zopatsa mphamvu zama calorie, zomwe zimabweretsa kuwonda.Kudya kumakuthandizani kuti muchepetse shuga komanso kukutetezani ku mavuto obwera chifukwa cha kunenepa kwambiri, monga kuthamanga kwa magazi, kuwonongeka kwa mgwirizano, koposa zonse, atherosclerosis.

Kuchepa kwa kulemera kwa thupi kokwanira 5-10% kumabweretsa kusintha kwa kagayidwe kazakudya zamafuta ndi mafuta. Lingaliro la chithandizo cha zakudya ndilofunikira kwambiri ndipo liyenera kuvomerezedwa ndi matenda a shuga. Komabe, kuyambitsidwa kwa zinthu zonse zamankhwala othandizira kudya m'moyo watsiku ndi tsiku kumakhala kovuta kwambiri, ndipo nthawi zina nkosatheka. Vutoli limakhudza kwambiri anthu omwe ali ndi matenda a shuga a mtundu wachiwiri omwe amapezeka akalamba kapena pakati.

Mfundo zazikuluzikulu za “zakudya za anthu odwala matenda ashuga” zimaphatikizapo:

kufunika kwa kudya pafupipafupi
zama calorie zamagulu onse pachakudya chilichonse,
calorie choletsa (anthu onenepa),
kapangidwe kazakudya zomwe zimasankhidwa bwino, zomwe zimateteza ku kukula kwa zovuta za matenda a shuga, mwachitsanzo, atherosulinosis.

Monga mukuwonera, pansi pa mawuwo Zakudya za matenda ashuga Ndikofunika kukhala ndi moyo wathanzi komanso kudya moyenera zakudya zopanda mphamvu. Asanayambitse chakudyacho, ndikofunikira kudziwa ngati wodwalayo akhoza kukhala ndi kulemera koyenera kwa thupi. Mwa anthu onenepa kwambiri, muyenera kuchepetsa kuchuluka kwa zopatsa mphamvu zomwe zimatengedwa, mwa anthu onenepa kwambiri, kuchuluka.

Vuto lalikulu mwa anthu omwe amapezeka ndi matenda a shuga a 2 ndi onenepa kwambiri. Ndikofunikira kuwerengera molondola kulemera kwa thupi komwe muyenera kumenyera (okwanira 2 kg pa sabata).

Izi ndiye zomwe amati thupi labwino kwambiri:

Ulamuliro wa Brock: (kutalika masentimita - 100). Mwachitsanzo, kwa odwala omwe ali ndi kutalika kwa masentimita 170, mulingo woyenera kwambiri ndi 70 kg,
Lorentz ulamuliro: (kutalika masentimita - 100 - 0,25 * (kutalika masentimita - 150) Mwachitsanzo, kutalika kwa masentimita 170 - 65 kg.

Kutengera kulemera kwa thupi ndi mtundu wa ntchito yomwe mwachita, zotsatirazi za calorie zotsatirazi zimakhazikitsidwa:

kwa anthu omwe amakhala moyo wongokhala: 20-25 kcal / kg thupi,
kwa anthu omwe amagwira ntchito ndi katundu wamba: 25-30 kcal / kg,
kwa anthu omwe ali ndi katundu wolemera 30-40 kcal / kg.

Anthu omwe ali ndi matenda ashuga komanso onenepa kwambiri ayenera kukhala ndi calorie yochepetsedwa tsiku lililonse ya 250-500 kcal / tsiku. Moyenerera, chakudyacho chimayenera kuphatikizidwa ndi masewera olimbitsa thupi komanso olimbitsa thupi.

Pakadali pano, zakudya zomwe zimachepetsa kwambiri zopatsa mphamvu, mwachitsanzo, ndi 700 kcal kapena 1000 kcal patsiku, sizilimbikitsidwa. Zakudya zoterezi nthawi zambiri zimatha kulephera chifukwa chokhala ndi ziletso zochulukirapo zomwe zimalepheretsa wodwalayo kukhala ndi chiyembekezo komanso zimapangitsa kuti asamakhulupirire zomwe amadya.

Anthu omwe ali ndi matenda a shuga a mtundu wachiwiri, omwe amathandizidwa ndi zakudya kapena zakudya ndi mankhwala amkamwa, amatha kudya pafupifupi zakudya 3-4 patsiku. Anthu omwe amalandira chithandizo cha insulin ayenera kudya osachepera 5 pa tsiku. Izi ndizofunikira kwambiri insulin mankhwala.

Jakisoni wambiri wa insulin amafunika kutetezedwa koyenera mwa mitundu ya zakudya. Chifukwa cha izi, pangozi yoopsa ya hypoglycemia ikhoza kupewedwa.

Chiwerengero cholondola cha zakudya zazikulu za matenda ashuga:

Mapuloteni azakudya monga zomera, nsomba ndi nkhuku ndizofunikira.

Mafuta sayenera kupitirira 30% ya tsiku ndi tsiku ma calories. Izi ndizofunikira kwambiri kwa anthu omwe ali onenepa kwambiri komanso omwe ali ndi zovuta za matenda a shuga mwanjira ya atherosulinosis. Pakadali pano, akukhulupirira kuti mafuta odzola (owononga) omwe ali mu nyama ndi mkaka sayenera kupitilira 10% ya zakudya za tsiku ndi tsiku. Kugwiritsa ntchito mafuta kuchokera ku mafuta a maolivi, mbewu ya mphesa, koma zochepa ndizofunikira.

Zakudya zomanga thupi akhale 50-60% ya kuchuluka kwa mphamvu. Kwambiri, chakudya chovuta cham'mimba chomwe chimapezeka mu chimanga ndi zina zam'mera ndizofunikira.

Kugwiritsa ntchito kuchuluka kwa chakudya chamafuta osadya fiber nthawi imodzi kumatha kuyambitsa kuchuluka kwa hyperglycemia (kuchuluka kwa shuga). Ziphuphu monga sucrose (gawo la shuga yoyera), fructose (shuga wokhala ndi zipatso) zimatha kudyedwa pang'ono kapena kusiyidwa kwathunthu ndi zakudya.

Zotsatira zakumwa zoledzeretsa pamaphunziro ndi chithandizo cha matenda ashuga zimatha kukhala zabwino kapena zoyipa. Phindu lokhala ndi kumwa mowa pang'ono lili ndi zotsatirapo zake zabwino pamtima.

Zotsatira zabwino zimawonetsedwa ngati kuchuluka kwa zigawo za HDL za cholesterol, kuchepa kwa magazi magazi, kuchepa kwa insulini yamagazi ndi kuchuluka kwa insulin.

Zotsatira zoyipa za kumwa mowa zimayenderana ndi zakumwa zambiri za calorie (7 kcal / g mowa), komanso chiopsezo chachikulu cha hypoglycemia mukatha kumwa. Chofunika, hypoglycemia imatha kuchitika pakumwa mowa wambiri, nthawi zambiri ngakhale pakumatha maola ochepa pakumamwa, ndipo zizindikiro za kuledzera ndizofanana kwambiri ndi zizindikiro za hypoglycemia ndipo zonsezi zimasokonezeka mosavuta. Vuto lalikulu la kumwa mowa ndi chiopsezo cha kuzolowera.

Pakadali pano, kugwiritsa ntchito kwambiri ndikuloledwa:

20-30 g mowa (mayunitsi 2-3) patsiku kwa amuna,
10-20 g ya mowa (mayunitsi 1-2) patsiku kwa akazi malinga ndi ethanol yoyenera.

Gawo limodzi (10 g) la mowa wabwino lili ndi 250 ml ya mowa, 100 ml ya mowa ndi 25 g ya mowa wamphamvu.

Kulephera kusuntha ndi chimodzi mwazinthu zomwe zikuwonetseratu kukula kwa matenda ashuga. Ndipo kuchita masewera olimbitsa thupi nthawi zonse kumachepetsa chiopsezo chotenga matendawa mpaka 60%. Kuchita masewera olimbitsa thupi kumakhala ndi phindu pa kagayidwe kazakudya, kuonjezera mphamvu ya minofu ku insulin. Kuphatikiza apo, panthawi yochita masewera olimbitsa thupi, kumwa kwa shuga kumawonjezeka, ndipo, chifukwa chake, kuphatikiza kwake m'magazi kumachepa.

Mitundu ya Matenda A shuga

Pali mitundu iwiri yayikulu yamatenda - mtundu 1 ndi matenda ashuga 2.

Mitundu ina ikuphatikiza:

LADA - shuga ya autoimmune mwa akulu,

mitundu yachilendo, yotsimikizika pamtundu wa matenda ashuga - MODY,

Matenda a shuga - amatha kupezeka nthawi yapakati.

Zimayambitsa komanso zowopsa za matenda ashuga

Mtundu woyamba wa shuga

Matenda a shuga a Type 1 amadziwika ndi kuperewera kwake konse kwa insulin. Cholinga chake ndi chiwonongeko cha autoimmune cha ma cell a pancreatic beta omwe amapanga insulin. Nthawi zambiri, matendawa amapezeka ubwana (wazaka za 6 ndi zaka 10 mpaka 10), koma amatha kuchitika nthawi iliyonse yamoyo.

Pakadali pano, zifukwa zomwe zimayambira kukula kwa matenda ashuga mwa munthu aliyense sizikudziwika kwathunthu. Nthawi yomweyo, vaccinations, nkhawa, ma virus ndi bakiteriya sizomwe zimayambitsa matenda a shuga 1, nthawi zina zimagwirizana panthawi yodziwika ndi matenda a shuga. Kutengera kwa njira za autoimmune kumatha kuphatikizidwa ndi genetics, koma sikufotokozedwa 100%.

Type 2 shuga

Matenda a shuga a Type 2 ndi chitsanzo chochititsa chidwi cha zovuta za metabolic, zomwe, kuphwanya mayamwidwe a chakudya chamagulugi (glucose). Mtundu wachiwiri wa matenda osokoneza bongo a mellitus, kupanga kwa insulini kumakhala kwachilendo kwa nthawi yayitali, koma kuthekera kwa minofu kunyamula ma insulin ndi glucose m'maselo kumasautsika, zomwe zimayambitsa hyperglycemia - kuchuluka kwa ndende yamagazi.

Mosiyana ndi matenda amtundu wa 1 shuga, momwe kuperewera kwa kupanga insulin kumakhala kwakukulu, mu mtundu wachiwiri wa shuga mumakhala insulin yokwanira m'magazi. Nthawi zina insulin imatha kupangidwira kwambiri, chifukwa cha kuyesera kwa thupi kuthetsa vuto lakusokonekera kwa "kayendedwe kazinthu", ndikuwonjezera kupanga kwa conductor wa glucose.

Kunenepa kwambiri komanso kuphatikizidwa kwamtundu. Monga lamulo, kuphatikiza kwa zinthu ziwiri izi ndikofunikira. Pankhaniyi, kulemera kochulukirapo kungakhale kochepa kwambiri, koma makamaka kumakhala m'chiuno. Kutengera kwakubadwa kwa munthu aliyense kumawerengeredwa payekhapayekha, kutengera mtundu wake wamtundu komanso kupezeka kwa abale apamtima omwe ali ndi matenda ashuga.

Mu 2017, lingaliro la kukhululukidwa ndikuchira matenda ashuga amtundu woyamba lidayambitsidwa ku United States, Europe, ndi Russia. Poyamba anthu ankakhulupirira kuti izi sizingatheke. Tsopano, akatswiri ofufuza zamankhwala padziko lonse lapansi azindikira kuti nthawi zina kuchira kokwanira kwa matenda ashuga a 2 ndikotheka. Njira yopita ku izi ndizofanana ndi kulemera kwa thupi.

Chipatala cha EMC chapanga njira yodalirika yodwala odwala matenda a shuga komanso kunenepa kwambiri. Poyerekeza ndi maziko a kupezeka kwa mankhwala osokoneza bongo a shuga, makalasi amachitika pofuna kukonza zizolowezi zodyera molumikizana ndi akatswiri azakudya ndi akatswiri azamisala.

Chifukwa cha njira yophatikizika, timatha kukwanitsa zotsatira zokhazikika - kuteteza kulemera ndi shuga kwa wodwalayo.

Ku EMC Genomic Medicine Center, kafukufuku wa majini akuchitika pangozi ya matenda a shuga. Nthawi zambiri matendawa amakula chifukwa cha majini osakanikirana a insulin chifukwa chogwiritsa ntchito zakudya zamafuta ambiri. Kudziwa chiopsezo chanu kumakupatsani mwayi wopewa ngakhale mawonekedwe oyamba asanapange magazi.

Kwa odwala onenepa kwambiri, ndikofunikira kudziwa njira zawo zachilengedwe zomwe zimapangitsa kuti azidya. Nthawi zambiri, kafukufuku wa majini amatipatsa yankho la chifukwa cholephera kudya zakudya zambiri komanso njira, zomwe zimatithandizira kuti aliyense payekha azigwiritsa ntchito njira zawo.

LADA - Matenda A shuga a Autoimmune

Mtundu wa matenda ashuga amadziwika ndi chithunzi chophatikizika cha mtundu 1 ndi matenda ashuga a 2. Matendawa amatuluka pang'onopang'ono ndipo m'magawo oyambilira amatha kudziwonetsa ngati ali ndi matenda a shuga a 2. Odwala omwe akuwaganizira kuti LADA amafunika kuwazindikira mozama komanso chithandizo cha munthu payekha, zomwe ndizosiyana ndi chithandizo cha matenda ashuga amtundu wa 2.

ZOONA -shuga "wachichepere"

Uku ndi mtundu wa matenda osokoneza bongo a mtundu wa monogenic, omwe amapezeka nthawi yaunyamata kapena azaka 20 mpaka 40. Odwala omwe ali ndi IMODI nthawi zambiri amakhala ndi mbiri ya banja la anthu odwala matenda ashuga pafupifupi m'badwo uliwonse, ndiye kuti, mabanja otere anali ndi matenda ashuga ali achichepere ndi agogo awo, amayi ndi abale ndi alongo.

Kuzindikira matenda ashuga

Njira yayikulu yodziwira matenda a shuga ndi mayeso a labotale. Nthawi zambiri, shuga m'magazi a venous amatsimikizika. Nthawi zina, kuti afotokozere za matendawa, dokotala atha kuyitanitsa mayeso ena, mwachitsanzo, mayeso okhudzana ndi shuga wa pakamwa, kuyang'anitsitsa kosalekeza kwa glucose (CGMS sensor).

Ngati mtundu wa matenda amtundu wa kashiamu ukayikiridwa, Center for Genomic Medicine EMC imawunika ma genetic diagnostics, omwe amakupatsani mwayi wodziwikitsa ndikuwunika zakutsogolo kwa ana mtsogolo pokhudzana ndi matendawa. Komanso, odwala amatha kumayesedwa mosamalitsa kuti amvetsetse chibadwa chawo chazomwe zimayambitsa matenda ashuga komanso zovuta zake (mwachitsanzo, matenda a shuga).

Kwa anthu omwe ali ndi matenda opatsirana a matenda a shuga, ndikofunikira kwambiri kudziwa kuopsa kwa majini pamatenda ena, mwachitsanzo, matenda a impso kapena mtima, chifukwa matenda ashuga amatha kupangitsa kuti ziwonjezeke. Chifukwa cha kufufuza kwa majini, ndizotheka kukonzekera kuchuluka kwa mayeso pafupipafupi mu nthawi ndikupeza malingaliro pawokha pazokhudza moyo ndi zakudya.

Kuzindikira matenda ashuga m'makiriniki a EMC kumachitika mofulumira, malinga ndi mapuloteni apadziko lonse komanso kuyang'aniridwa ndi endocrinologist.

Chithandizo cha Matendawa ku EMC

EMC imapereka chithandizo chokwanira cha matenda ashuga, pomwe odwala omwe ali ndi zovuta zosiyanasiyana nthawi zonse amatenga nawo mbali poyang'anira odwala. Pambuyo pakuzindikira, wodwala amatha kupatsidwa mwayi wofunsa akatswiri awa: endocrinologist, ophthalmologist, cardiologist. Izi ndizofunikira chifukwa cha kuthamanga kwa matendawo komanso zovuta zake. Choyamba, kupindika kwamisempha mu impso ndi maso. Kuphatikiza apo, kulumikizana kowonjezereka ndi akatswiri okhudzana ndi muyezo wapadziko lonse pakuperekedwa kwa chisamaliro chachipatala kwa omwe apezeka ndi matenda ashuga.

Chithandizo chamakono cha matenda ashuga sichimakhudzidwa nthawi zonse, chomwe nthawi zambiri chimakhala chovuta kwambiri kwa odwala onenepa kwambiri. Ndikofunikira kusintha mtundu wa chakudya, yambitsani maphunziro apamasewera omwe akatswiri amawatsimikizira. Kuthandizidwa ndi madokotala kumagwira ntchito yofunika kwambiri pa gawo lino: katswiri wa endocrinologist komanso katswiri, ndipo, ngati pakufunika, katswiri wazakudya, wodwala zamtima, akatswiri azamankhwala, ndi akatswiri ena. Popanda kuwongolera njira yamoyo, kugwiritsa ntchito bwino mankhwalawa kumatha kuchepetsedwa.

Kuchiza nthawi zonse kumaphatikizapo chithandizo cha insulini komanso kuyang'anira kuchuluka kwa shuga m'magazi. Malinga ndi umboni, adotolo atha kukuwuzani kuti mugwiritse ntchito galasi la glucose kapena kuwunikira kosalekeza kwa tsiku ndi tsiku masiku angapo. Potsirizira pake, ndikotheka kudziwa ndikusanthula zomwe zimayambitsa kupatika kwamlingo wama glucose pazinthu zosiyanasiyana. Izi ndizofunikira kwambiri kwa odwala omwe ali ndi matenda osakhazikika a glucose kapena pafupipafupi hypoglycemia, kwa amayi apakati omwe ali ndi matenda ashuga. Chida chonyamula (chaching'ono) chimayeza glucose mphindi zisanu zilizonse kwa masiku 7; kuvala sikukhudza moyo wazomwe amachita (mutha kusambira ndikusewera naye). Zambiri mwatsatanetsatane zimalola adotolo kuti azitha kupeza zotsatira za mankhwalawo ndipo ngati kuli koyenera, sinthani mankhwalawo.

Mankhwala

Chithandizo chimaphatikizaponso mankhwala osokoneza bongo omwe amachepetsa shuga, omwe amayenera kuyang'aniridwa ndi dokotala nthawi zonse.

Insulin yokhala ndi matenda a shuga a mtundu wachi 2 ndiyo mankhwala othandizira kuti ziwonongeke za cell pancreatic beta. Ili ndi gawo loyenera kupewa mavuto osiyanasiyana. Nthawi zina, mankhwala a insulin amadziwitsidwa kwakanthawi, kwakanthawi kochepa. Mwachitsanzo, musanachite opareshoni kapena nthawi yovunda, pamene kuchuluka kwa shuga pazifukwa zina kumakwezeka. Atadutsa "nsonga", munthuyo amabwereranso ku chithandizo chamanthawi zonse chamankhwala.

Chithandizo cha matenda a shuga gestational amakhala ndi kuwongolera zakudya komanso moyo wa mayi woyembekezerayo, komanso kuwongolera mwamphamvu kuchuluka kwa shuga. Nthawi zina pokhapokha mankhwala a insulin angafotokozedwe. Madokotala ndi anamwino a EMC amaphunzitsa komanso amapereka chithandizo cha nthawi yonse kwa odwala omwe ali ndi insulin.

Mapampu ndi njira zamakono zoyezera shuga wa magazi

Mapampu a insulini amakupatsani mphamvu zowongolera matenda anu ashuga. Therapy mothandizidwa ndi mapampu amakupatsani mwayi kulowa insulin mu Mlingo ndi regimen pafupi kwambiri kuntchito yachilengedwe ya kapamba wathanzi. Kuwongolera glucose kumafunikabe, koma kusinthasintha kwake kukuchepa.

Mapampu amatha kuchepetsa kuchuluka kwa insulin, kuchuluka kwa jakisoni ndikuchepetsa gawo, lomwe ndilofunika kwambiri kwa ana ndi odwala omwe ali ndi chidwi chachikulu ndi insulin. Pampu za insulini ndizochepa kwambiri komanso chosungira chodzaza ndi insulin, yomwe imalumikizidwa ndi thupi la wodwalayo. Mankhwala omwe amapezeka m'mapampu amaperekedwa popanda kupweteka: insulin imaperekedwa kudzera mwa micro-catheter wapadera. Chofunikira ndi kuphunzitsa wodwalayo kapena makolo malamulo owerengera kuchuluka kwa insulin, kudziyang'anira pawekha wamagazi. Kufunitsitsa kwa wodwalayo kuphunzira momwe angayendetsere pampu ndikuwunika zotsatira ndizofunikira kwambiri.

Chithandizo cha matenda ashuga kuchipatala cha EMC ku Moscow chikuchitika molingana ndi mapuloteni apadziko lonse oyang'aniridwa ndi madokotala odziwa kuchokera ku Russia, Germany, ndi USA.

Omwe amamwa antidiabetes

Ngati chakudya cha odwala matenda ashuga ndi zolimbitsa thupi, sizothandiza, kapena, monga momwe zimakhalira nthawi zambiri, zimakhala zovuta kukakamiza, kuyang'ana ku pharmacotherapy.

Pali magulu awiri akuluakulu am'magazi a shuga a m'mlomo: amathandizira kupanga insulin mu kapamba ndikuchepetsa kuchuluka kwa glucose m'magazi. Amasankhidwa kutengera zomwe zimapezeka mthupi: kukana insulini kapena kuperewera kwa mahomoni.

Mankhwala osokoneza bongo a magulu osiyanasiyana amatha kuphatikizidwa wina ndi mnzake kuti azitha kuyang'anira glycemic. Akasiya kugwira ntchito, insulin imaperekedwa. Poyamba, Mlingo wocheperako ungagwiritsidwe ntchito mukumwa mapiritsi. Komabe, pamapeto pake amasinthira kukhala ndi insulin yokwanira.