Mitundu ya matenda a shuga malinga ndi gulu

Matenda a shuga amapezeka chifukwa cha kuwonongeka kwa kagayidwe kazakudya komanso kuwonjezeka kwa ndende yamagazi. Gulu la WHO limakhazikitsidwa, pomwe mitundu yosiyanasiyana ya matenda imasonyezedwa.

Malinga ndi ziwerengero za 2017, anthu opitilira 150 miliyoni amadziwika kuti ali ndi matenda ashuga. M'zaka zaposachedwa, milandu ya matendawa yachulukanso. Kuopsa kwakukulu kwa mapangidwe a matendawa kumachitika patatha zaka 40.

Pali mapulogalamu omwe ali ndi njira zingapo zochepetsera kuchuluka kwa matenda ashuga komanso kuchepetsa chiopsezo cha kufa. Kuchita hemoglobin wa glycosylated kumapangitsa kuti azindikire matenda a shuga ndikupatseni dongosolo la mankhwala.

Zolemba zakomwe matendawo ndi njira yake

Kukula kwa zamatenda kumayendetsedwa ndi zinthu zambiri. Ngati pali cholowa chamakubadwa, ndiye kuti mwayi wodwala matendawa ndiwokwera kwambiri. Matendawa amathanso kuchitika chifukwa chofooka m'thupi komanso kupezeka kwa mavuto akulu ndi ziwalo zina. Matendawa ndi omwe amachititsa matenda ambiri owopsa.

Type 1 shuga mellitus imachitika chifukwa cha kusachita bwino kwa maselo a beta. Momwe ma cell a beta amagwirira ntchito amafotokozera mtundu wa matenda. Matenda a shuga ana amakhala ndi zaka zilizonse, kuphatikizanso akhanda.

Kuti muwone matendawa, ndikofunikira kukayezetsa magazi, kuchuluka kwa glucose kudzakhala okwera. Dokotala amatha kuyankhula za shuga ya idiopathic yokhala ndi insulin yochepa m'thupi.

Matenda a shuga amtundu wa 1 amatha kubwezeredwa ngati kuchuluka kwa kagayidwe kazakudya kali pafupi ndi munthu wathanzi. Kulipira ngongole kumadziwika ndi nthawi yayifupi ya hypoglycemia kapena hyperglycemia, pomwe kulibe kulumala.

Ndi kuwola, shuga m'magazi amatha kusinthika kwambiri, pakhoza kukhala owoneka bwino komanso osweka. Popita nthawi, acetone imadziwika mkodzo.

Zizindikiro za matenda amtundu 1

ludzu
kukodza kwambiri pafupipafupi,
kulakalaka kwamphamvu
kuwonda
kuwonongeka kwa khungu,
kusachita bwino, kutopa, kufooka,
mutu ndi kupweteka kwa minofu
thukuta lalikulu, kuyabwa kwa khungu,
kusanza ndi mseru
kukana otsika kumatenda,
kupweteka kwam'mimba.

Ma anamnesis nthawi zambiri amakhala ndi mawonekedwe operewera, ntchito ya impso, magazi m'miyendo, komanso kuchepa kwamphamvu kwa miyendo.

Type 2 shuga mellitus nthawi zambiri amawoneka mwa anthu azaka zapakati komanso achikulire. Matendawa amadziwika ndi kusokonezeka kwa malingaliro a insulin. Izi zitha kuchitika chifukwa cha mimba, kunenepa kwambiri, kapena zinthu zina. Matendawa nthawi zina amachitika mwachinsinsi ndipo samakhala ndi zowoneka bwino.

Kukula kwa mtundu 2 shuga

Munthu yemwe ali ndi matenda a mtundu 2 amakhala ndi ludzu nthawi zonse. Pali kuyabwa kumeneku komanso m'madzi. Kulemera kwa thupi kumaonjezera pang'onopang'ono, matenda otupa, fungal a pakhungu amayamba. Kukonzanso minofu yosakwanira kumakhalanso ndi chikhalidwe.

Munthu amakhala ndi kufooka kwa minofu nthawi zonse. Miyendo imakhala ikunjenjemera, kukokana si zachilendo. Kuwona pang'ono pang'onopang'ono, tsitsi la nkhope limatha kukula kwambiri, ndipo kumapeto kwake kumatha kutha. Tizilombo tating'onoting'ono timatulutsa thupi, nthawi zambiri pamakhala thukuta lalikulu komanso kutupa kwa khungu.

Insulin yovomerezeka imadziwika kwambiri nthawi zambiri, chifukwa palibe mawonekedwe. Mtunduwu umakwiyitsa matenda amitsempha. Mankhwalawa, zakudya zamagulu azakudya ziyenera kutsatiridwa ndipo mankhwala omwe dokotala amakupatsani ayenera kugwiritsidwa ntchito.

Matenda a shuga amatha kufotokozedwa mosiyanasiyana, ngakhale mtunduwo ndi womwewo. Maonekedwe a zovuta akuwonetsa kuti matendawa ali pang'onopang'ono. Pali magawo azovuta, shuga mellitus, gulu, lomwe lili ndi mitundu yambiri, limasiyana m'mitundu ndi magawo.

Ndi matenda ofatsa, shuga amayamba popanda zovuta. Gawo lapakati likachitika, pakapita kanthawi mavuto amayamba:

kuwonongeka kwamawonekedwe
kuwonongeka kwaimpso,
zolakwika za chapakati mantha dongosolo.

Ndikadwala kwambiri, matendawa amatha kukula omwe amasokoneza kwambiri moyo watsiku ndi tsiku.

Zotsatira zamachitidwe zomwe zimachitika mthupi, mapangidwe a glycosylated hemoglobin amalimbikitsidwa. Pali kuphatikiza kwa glucose ndi hemoglobin. Kuchuluka kwa mapangidwe a hemoglobin kutengera shuga. Malinga ndi zotsatira za kusanthula, kuchuluka kwa hemoglobin kumatsimikiziridwa, omwe amaphatikizidwa ndi shuga kwakanthawi.

Glycosylated hemoglobin imapezekanso mwa anthu athanzi, koma ochepa. Ndi matenda ashuga, Zizindikiro izi ndizokwera kangapo kuposa zabwinobwino. Ngati kuchuluka kwa shuga kumakhala kwabwinoko, ndiye kuti zimatenga nthawi kuti hemoglobin ibwerere mwakale.

Kugwiritsa ntchito kwamankhwala kumatsimikiziridwa ndi mulingo wa hemoglobin.

Gulu la odwala matenda a shuga

Kutengera kafukufuku wasayansi, akatswiri ochokera ku WHO adapanga gulu la anthu odwala matenda ashuga. Bungweli lanena kuti ambiri odwala matenda ashuga ali ndi matenda amtundu 2, 92% yonse.

Mtundu woyamba wa shuga umakhala pafupifupi 7% ya kuchuluka konse kwa milandu. Mitundu ina ya matenda imapangitsa 1% ya milandu. Pafupifupi 3-4% ya amayi apakati amakhala ndi matenda ashuga.

Zaumoyo zamakono zimatchulanso vuto la prediabetes. Izi ndi zofunikira kwambiri pokhapokha muyezo wa glucose m'magazi ulipo kale, koma osakwaniritsa zomwe zili zenizeni zamatenda. Monga lamulo, prediabetes imatsogolera matenda odzaza.

Matendawa amapangika chifukwa cha kukanika kwa thupi, mwachitsanzo, kulephera pakukonza shuga. Izi zimawonetsedwa mwa anthu omwe ali ndi vuto komanso onenepa kwambiri.

Mtundu wina wa matenda umagawidwa ngati glucose umakonzedwa m'thupi, koma chifukwa cha zovuta, vutoli limatha kusintha ndipo ntchito yaphatikizidwe ikasokonekera.

Kuyambira 2003, matenda ashuga apezeka ndi zomwe akufuna kuchita ndi American Diabetes Association.

Type 1 shuga mellitus amawonekera chifukwa cha kuwonongeka kwa maselo, chifukwa chake kusowa kwa insulin kumachitika mthupi. Type 2 shuga mellitus amawonekera chifukwa zotsatira zachilengedwe za insulin zimasokonekera mthupi.

Mitundu ina ya matenda ashuga imawonekera chifukwa cha matenda osiyanasiyana, komanso kusagwira bwino kwa maselo a beta. Izi gulu tsopano ndi upangiri wachilengedwe.

M'magawo a WHO omwe adachitika mu 1999, pali zina zomwe zasintha pamayeso amitundu. Tsopano manambala achiarabu akugwiritsidwa ntchito, osati achi Roma.

Akatswiri a WHO pa lingaliro la "matenda a shuga gestational" samaphatikizira matendawa pokhapokha pakati komanso zovuta zina za kagayidwe kazakudya. Mwa izi timatanthawuza kuphwanya komwe kumachitika pakubala kwa mwana, komanso pambuyo.

Zomwe zimayambitsa matenda a shuga gestational sizikudziwika mpaka pano. Kafukufuku akuwonetsa kuti matendawa nthawi zambiri amawonekera mwa amayi omwe ali onenepa kwambiri, matenda a shuga a 2, kapena ovarian polycystic.

Mwa akazi, panthawi yoyembekezera, kuchepa kwa chiwopsezo cha minyewa kupita ku insulin kumayamba, komwe kumayendetsedwa ndi kusintha kwa mahomoni ndi chibadwa chobadwa nacho.

Mtundu 3 sunasankhidwe pamndandanda wamatenda, omwe amatha kuwoneka chifukwa cha kuperewera kwa zakudya.

Anazindikira kuti izi zimatha kukhudza mapuloteni, komabe, sizingakwiyitse mawonekedwe a shuga.

Kugawidwa Kwa Matenda A shuga

Anthu ambiri omwe ali ndi matenda ashuga amatha kugawidwa m'magulu awiri: odwala omwe ali ndi matenda a shuga 1 a mellitus (DM 1), omwe amalumikizidwa ndi kuperewera kwa insulin, komanso odwala omwe ali ndi mtundu wa 2 shuga mellitus (DM 2), amagwirizana ndi thupi kukana insulin.

Nthawi zambiri zimakhala zovuta kudziwa mtundu wa matenda ashuga, chifukwa chake magulu ena atsopano a shuga akupangidwa, omwe sanavomerezedwe ndi WHO. Pagululi pali gawo la "Matenda a shuga a mtundu wosatsimikizika".

Mitundu yambiri yosowa ya shuga imayambitsidwa, yomwe imakwiya:

matenda
mankhwala
endocrinopathy
kusowa kwa kapamba,
zolakwika zakubadwa.

Mitundu ya matenda ashuga iyi siyokhudzana ndi zachilengedwe;

Kugawidwa kwa shuga kumeneku malinga ndi chidziwitso cha WHO kumaphatikiza mitundu inayi ya matenda ndi magulu, omwe amatchulidwa ngati kuphwanya malire a glucose homeostasis.

Matenda a shuga a 1 omwe amadalira insulin atha kukhala:

Type 2 shuga mellitus ali ndi gulu:

kuyanʻanila za glucose homeostasis,
kulolerana kwa shuga,
glycemia wamkulu pamimba yopanda kanthu,
matenda a shuga
mitundu ina ya matenda.

Matenda a kapamba:

zotupa
kapamba
kuvulala
cystic fibrosis,
fibrosing kuwerengetsa kapamba,
hemochromatosis.

Cushing's syndrome
glucagonoma
somatostatin
thyrotoxicosis,
aldosteroma,
pheochromocytoma.

Matenda amtundu wa insulin:

shuga wa lipoatrophic,
lembani kukana kwa insulini,
leprechaunism, Donohue syndrome (mtundu wachiwiri wa matenda ashuga, kupindika kukula kwa mitsempha, dysmorphism),
Rabson - Mendenhall syndrome (acanthosis, shuga mellitus ndi pineal hyperplasia),
Zophwanya zina.

Mitundu yovuta yoteteza matenda ashuga:

"Rigid person" syndrome (mtundu 1 wa matenda a shuga, kukomoka kwa minofu, mikhalidwe yopweteka),
Ma antibodies kuma insulin receptors.

Mndandanda wama syndromes ophatikizidwa ndi matenda ashuga:

Turner syndrome
Down syndrome
Lawrence - Mwezi - Beadle syndrome,
Getore'sore,
tungsten syndrome
Klinefelter syndrome
ataxia of Friedreich,
porphyria
Prader-Willi matenda,
myotonic dystrophy.

cytomegalovirus kapena amkati rubella,
mitundu ina ya matenda.

Mtundu wina ndi shuga ya amayi apakati. Palinso mtundu wa matenda omwe amayamba ndi mankhwala kapena mankhwala.

Kuzindikira ndi mfundo za WHO

Njira zakuzindikira zimatengera kupezeka kwa hyperglycemia pansi pazinthu zina. Mitundu ya matenda ashuga imawonetsa zizindikiro zosiyanasiyana. Ndizosagwirizana, kotero, kusapezeka kwa matendawa sikukusiyitsa kuwonekera.

WHO Worldwide Diagnostic Standard imalongosola zodwala zam'mphepete mwa glucose homeostasis potengera kuchuluka kwa shuga m'magazi pogwiritsa ntchito njira zina.

Matenda a shuga angapezeke m'njira zitatu:

kukhalapo kwa zizindikiro zamatenda zam'mimba + glycemia yoposa 11.1 mmol / l,
glycemia pamimba yopanda 7.0 mmol / l,
glycemia pa mphindi ya 120 ya PTTG yoposa 11.1 mmol / l.

Kwa glycemia wowonjezera, kuchuluka kwina kwa glucose m'madzi amadzi am'mimba yopanda kanthu, ndi 5.6 - 6.9 mmol / L.

Kulekerera kwa shuga wambiri kumadziwika ndi kuchuluka kwa glucose wa 7.8 - 11.0 mmol / L pa mphindi 120 za PTTG.

Makhalidwe Abwino

Mwazi wamagazi mwa munthu wathanzi uyenera kukhala 3,8 - 5.6 mmol / l pamimba yopanda kanthu. Ngati glycemia mwangozi yoposa 11.0 mmol / L m'magazi a capillary, kudziwikanso kwachiwiri ndikofunikira, komwe kuyenera kutsimikizira matendawa.

Ngati palibe symptomatology, ndiye kuti muyenera kuphunzira kusala glycemia monga mwa nthawi zonse. Kusala glycemia kwambiri osakwana 5.6 mmol / L sikumaphatikizapo matenda ashuga. Ngati glycemia apamwamba kuposa 6.9 mmol / l, ndiye kuti matenda a shuga amatsimikiziridwa.

Glycemia m'gulu la 5.6 - 6.9 mmol / L imafuna kuphunzira PTG. Poyeserera kulolera kwa shuga, shuga imawonetsedwa ndi glycemia pambuyo maola awiri kuposa 11.1 mmol / L. Phunziroli likuyenera kubwerezedwa ndipo zotsatira ziwiri poyerekeza.

Pozindikira bwino matenda amtundu 1 komanso mtundu wa matenda ashuga a 2, C-peptides amagwiritsidwa ntchito ngati chidziwitso cha katemera wa amkati wa insulin, ngati pali chosatsimikizika mu chithunzi cha chipatala. Mu matenda oyamba 1, mfundo zoyambira nthawi zina zimatsika mpaka zero.

Ndi mtundu wachiwiri wa matenda, phindu limatha kukhala labwinobwino, koma kukana insulin, kumawonjezeka.

Ndi kukula kwamatenda amtunduwu, kuchuluka kwa C-peptides kumawonjezeka.

Zovuta zotheka

Matenda a shuga angayambitse kuwonongeka kwakukuru m'moyo. Poyerekeza ndi matendawo, matenda ena amomwe amapezeka, ngakhale atakhala kuti ali ndi shuga. Zizindikiro zimawonekera pang'onopang'ono ndipo ndikofunikira kudutsa m'magawo onse a mayeso kuti mupeze kuwunika koyenera. Kukula kwa zovuta ndi chithandizo cholakwika cha matenda ashuga kumatha.

Mwachitsanzo, retinopathy imawoneka nthawi zambiri, ndiye kuti, kufalikira kwa retina kapena kuwonongeka kwake. Ndi matenda awa, kukha magazi m'maso kumatha kuyamba. Ngati sanachiritsidwe, wodwalayo amatha kukhala wakhungu kwathunthu. Matendawa amadziwika ndi:

fragility yamitsempha yamagazi
maonekedwe a magazi.

Polyneuropathy ndikutaya kuzindikira kwa kutentha ndi kupweteka. Nthawi yomweyo, zilonda zam'manja ndi miyendo zimayamba kuoneka. Zomverera zonse zosasangalatsa zimawonjezeka usiku. Mabala samachiritsa kwa nthawi yayitali, ndipo pali mwayi wovuta wamatenda.

Matenda a diabetes a nephropathy amatchedwa matenda a impso, omwe amachititsa kuti mapuloteni amitsekedwe. Nthawi zambiri, kulephera kwa impso kumayamba.

Kodi ndi mitundu iti ya shuga yomwe ilipo yomwe ingauze katswiri wa kanemayu munkhaniyi.

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.

Gulu la WHO la matenda ashuga

Kugawidwa kwa shuga kumeneku malinga ndi WHO kuphatikiza mitundu 4 ndi magulu omwe amatchulidwa ngati kuphwanya malire a glucose homeostasis.

Mtundu woyamba wa matenda a shuga a mellitus (omwe amadalira matenda a shuga): immune-mediated, idiopathic.
Type 2 shuga mellitus (omwe kale ankatchedwa mtundu wa senile - shuga osadalira insulini).
Mitundu ina yapadera ya matenda ashuga.
Gestational matenda a shuga mellitus (panthawi yoyembekezera).
Boundary matenda a glucose homeostasis.
Kukwezedwa (kolowera) kwa glycemia.
Kulekerera kwa shuga.

Gulu la odwala matenda a shuga ndi ziwerengero za WHO

Malinga ndi ziwerengero zaposachedwa kwambiri zopangidwa ndi WHO, anthu ambiri odwala ali ndi matenda amtundu 2 (92%), matenda amtundu 1 amapanga pafupifupi 7% ya omwe adapezeka. Mitundu ina imakhala pafupifupi 1% ya milandu. Matenda amishuga amakhudza 3-4% azimayi onse oyembekezera. Akatswiri a WHO nthawi zambiri amatchula mawu oti prediabetes. Imaganizira dziko lomwe miyezo ya shuga m'magazi imadutsa kale, koma pakadali pano sizikufika pamiyeso ya matenda. Matenda a shuga nthawi zambiri amatsogolera matendawa atayamba kale.

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 kwachilendo kwa glucose kumadziwika ndi glycemia pa mphindi 120 za PTTG

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 latsopano

Ma endocrinologists aku Sweden sagwirizana ndi gulu la asayansi omwe ali ndi matenda ashuga. Zomwe zimayambitsa kukayikira ndizotsatira za kafukufuku wochitidwa ndi asayansi ochokera ku Yunivesite ya Lund. Pafupifupi odwala 15,000 odwala matenda osiyanasiyana a shuga adatenga nawo mbali mu maphunziro akulu. Kupenda kwa maumboni kunatsimikizira kuti mitundu ya shuga yomwe ilipo simalola madokotala kuti apereke chithandizo choyenera. Mtundu womwewo wa matenda a shuga ungayambitsidwe pazifukwa zosiyanasiyana, kuphatikiza apo, umatha kukhala ndi maphunziro osiyanasiyana, motero pamafunika njira yodziwira chithandizo.

Asayansi aku Sweden apanga mtundu wawo wa matenda ashuga, womwe umapereka gawo la matendawa m'magulu asanu:

Matenda ofooketsa omwe amayamba chifukwa cha kunenepa,
Mitundu yofatsa ya zaka
matenda ashuga oopsa a autoimmune
matenda osowa kwambiri a insulin,
shuga wambiri wosagwira inshuwaransi.

Anthu aku Sweden amakhulupirira kuti gulu lotere la matenda ashuga limalola wodwala kukhazikitsa njira yolondola yozindikirira, yomwe imawunikira mwachindunji kapangidwe ka mankhwala a etiotropic ndi pathogenetic. Kuyambika kwa kagawidwe katsopano ka shuga, malinga ndi omwe akupanga, zipangitsa kuti mankhwalawo akhale amodzi komanso ogwira ntchito.

Matenda ofala okhudzana ndi kunenepa kwambiri

Kukula kwa matenda amtunduwu kumakhudzana mwachindunji ndi kuchuluka kwa kunenepa kwambiri: kukwera kwake, kumakhala koipitsitsa kusintha kwa matenda m'thupi. Kunenepa kwambiri ndi matenda omwe amayenda ndi matenda a metabolic m'thupi. Choyambitsa chachikulu cha kunenepa kwambiri ndicho kudya kwambiri komanso kudya zakudya zamafuta ndi mafuta ambiri osavuta. Kukula kosalekeza kwamphamvu m'magazi a shuga kumapangitsa mkwiyo wa insulin.

Ntchito yayikulu ya insulin m'thupi ndikugwiritsa ntchito shuga m'magazi: kuwonjezera kuchuluka kwa maselo a cell a glucose, insulin imathandizira kulowa kwake m'maselo. Kuphatikiza apo, insulini imalimbikitsa kutembenuka kwa glucose kukhala glycogen, komanso ndi owonjezera - mu adipose minofu. Chifukwa chake, "bwalo loipa" limatseka: kunenepa kumayambitsa hyperglycemia, ndipo hyperglycemia yomwe imatenga nthawi yayitali imabweretsa kunenepa kwambiri.

Popita nthawi, izi zimabweretsa kukula kwa insulin kukokana ndi zotumphukira za thupi la munthu, chifukwa chomwe ngakhale kuchuluka kwambiri kwa insulini m'magazi sikupangitsa kuti hypoglycemic ikuyembekezeka. Popeza minyewa ndi imodzi mwazogula za shuga m'thupi, kusachita masewera olimbitsa thupi, zomwe zimadziwika ndi odwala onenepa kwambiri, zimachulukitsa zovuta za odwala.

Kufunika kopatula mtundu wa matenda amtunduwu m'magulu osiyana chifukwa cha umodzi wa pathogenesis wa matenda ashuga komanso kunenepa kwambiri. Popeza njira zomwe zimapangidwira matendawa awiriwa, ndikofunikira kuti tionenso njira yochizira matenda ashuga, omwe adayamba chifukwa cha kunenepa kwambiri. Odwala onenepa kwambiri omwe ali ndi matenda ashuga amathandizidwa mosiyanasiyana ndi othandizira pakamwa. Ngakhale, mankhwala okhwima othandizira kudya limodzi ndi dosed komanso masewera olimbitsa thupi angathandize kuthana ndi matenda a shuga komanso kunenepa kwambiri mwachangu komanso moyenera.

Matenda ofatsa

Uwu ndi mtundu “wofewa”, wodabwitsa wa matenda ashuga. Ndi zaka, thupi la munthu limasintha mosasintha. Kwa anthu achikulire, kukana insulin kwa zotumphukira pang'onopang'ono kumawonjezeka ndi zaka. Zotsatira zake ndikuwonjezera kusala kwa magazi a glucose komanso nthawi yayitali pambuyo pochita kudya (hyperglycemia). Komanso, kuchuluka kwa insulin kwa okalamba, monga lamulo, kumachepa.

Zomwe zimayambitsa kukana kwa insulin okalamba ndikulimbitsa thupi, komwe kumayambitsa kuchepa kwa minofu, kupsinjika kwam'mimba, zakudya zopanda thanzi. Pazifukwa zachuma, anthu ambiri okalamba amadya zakudya zotsika mtengo, zotsika mtengo zomwe zimakhala ndimafuta ambiri ophatikizika ndi zakudya zamafuta osavuta. Zakudya zotere zimakhumudwitsa hyperglycemia, hypercholesterolemia ndi triglyceridemia, ndizowonetsero woyamba wa matenda ashuga okalamba.

Vutoli limakulirakulira ndi ma concomitant pathologies komanso kuchuluka kwa mankhwalawa. Chiwopsezo chokhala ndi matenda a shuga mwa okalamba chimawonjezeka ndikugwiritsira ntchito mankhwala a thiazide diuretics, mankhwala a steroid, osasankha beta-blockers, psychotropic mankhwala.

Chizindikiro cha matenda okhudzana ndi matenda a shuga ndi chipatala cha atypical. Nthawi zina, kuchuluka kwa shuga m'magazi kumatha kukhala kosakwanira. Kuti "mupeze" kuyambika kwa shuga kwa anthu okalamba omwe amagwiritsa ntchito njira zasayansi, simuyenera kudziwa kuchuluka kwa shuga m'magazi ndi mkodzo pamimba yopanda kanthu, koma kuchuluka kwa hemoglobin wa glycosylated ndi kuchuluka kwa mapuloteni amkodzo, omwe ndi zizindikiro zowopsa.

Matenda akulu a autoimmune

Madokotala nthawi zambiri amatcha matenda a shuga a autoimmune shuga a "amodzi ndi theka", chifukwa munthawi yamankhwala zizindikiro za mitundu yoyamba komanso yachiwiri "yapamwamba" zimaphatikizidwa. Ichi ndi matenda apakatikati omwe amapezeka kwambiri mwa akuluakulu. Zomwe zimapangidwira ndikufa kwa maselo a insulin islet ya kapamba kuti asawonongedwe ndi ma cell a immunocompetent cell (autoantibodies). Nthawi zina, iyi ndi njira yotsimikizika pamtundu wina, mwa zina imachitika chifukwa cha matenda oyambitsidwa ndi ma virus, mwa ena ndikutheka kwa chitetezo chathupi chonse.

Kufunika kopatulira shuga ya autoimmune mu mtundu wina sikufotokozedwa kokha ndi mawonekedwe a zamankhwala omwe amatengera matendawa, komanso ndi zovuta za kupezeka kwa matenda ndi chithandizo cha matenda. Kuchita kwaulesi kwa "mtundu umodzi ndi theka" wa shuga ndi koopsa chifukwa kumawonekanso pomwe kusintha kwa m'matumbo ndi ziwalo zomwe zakulandidwa kwayamba kale kusintha.

Matenda akulu a shuga a insulin

Malinga ndi gulu lamakono, mtundu wa matenda osowa insulin umatchedwa shuga 1, kapena wodwala. Nthawi zambiri, amakula ubwana. Chovuta chachikulu cha matendawa ndi matenda amtundu wa chibadwa, omwe amadziwika ndi underdevelopment kapena patsogolo pa microsis ya insulin pancreatic islets.

Matendawa ndi oopsa ndipo nthawi zonse amafunikira chithandizo chamankhwala cha insulin. Mankhwala a Oral hypoglycemic omwe ali ndi mtundu wa diabetes ine samapereka tanthauzo. Kuthekera kopatula matenda osakwanira a insulin monga gawo lina lodziwika bwino ndikuti ndi mtundu wofala kwambiri wamatendawa.

Matenda oopsa a insulin

Matenda a shuga a pathogenetically omwe amalumikizana ndi mtundu wa 2 shuga malinga ndi gulu lomwe lilipo. Ndi matenda amtunduwu, insulin m'thupi la munthu imapangidwa, komabe, maselo sawaganizira.Mothandizidwa ndi insulin, shuga wa m'magazi amayenera kulowa m'maselo, koma sizichitika ndi insulin. Zotsatira zake, hyperglycemia yosalekeza imawonedwa m'magazi, ndi glucosuria mkodzo.

Ndi mtundu uwu wa matenda ashuga, kudya zakudya zamagulu ochepa komanso kuchita masewera olimbitsa thupi ndizothandiza. Maziko a mankhwala othandizira odwala matenda a insulin omwe ali ndi vuto la pakamwa ndi hypoglycemic.

Poganizira za kusiyanasiyana kwa chilengedwe, kusiyana kwa pathogenetic pamitundu iyi ya shuga ndi kusiyana kwa njira yachipatala, zomwe asayansi aku Sweden akuwonetsa zikuwatsimikizira. Kuwunikanso kwa kagawidwe kam'chipatala kungatithandizire kusintha njira zamakono za odwala omwe ali ndi mitundu yosiyanasiyana ya matenda a shuga, ndikuwongolera zomwe zimapangitsa kuti akhale othandizira komanso mawonekedwe osiyanasiyana pakupanga njira ya pathological.