Kupewa matenda a mtima, stroke, atherosulinosis ndi mtima kulephera

Pazaka 20 zapitazi, kafukufuku wazotsatira watipatsa chidziwitso chatsopano chazomwe zimayambitsa matenda amtima. Asayansi ndi madotolo aphunzira zambiri pazomwe zimapangitsa kuti magazi awonongeke m'matumbo a m'magazi komanso momwe zimayendera ndi matenda a shuga. Pansipa m'nkhaniyi muwerenga zinthu zofunika kwambiri zomwe muyenera kudziwa kuti muchepetse kugunda kwa mtima, kugunda ndi mtima.

C cholesterol chokwanira = cholesterol “chabwino” + cholesterol “yoipa”. Kuti mupeze kuwopsa kwa zochitika zamtima zokhudzana ndi kuchuluka kwamafuta (lipids) m'magazi, muyenera kuwerengera kuchuluka kwa cholesterol yonse. Kuthamanga kwa magazi triglycerides kumathandizidwanso. Zikhala kuti ngati munthu ali ndi cholesterol yayikulu, koma mafuta ambiri, ndiye kuti chiwopsezo chake chitha kufa ndi vuto la mtima atha kutsika kuposa wina yemwe ali ndi cholesterol yotsika mtengo chifukwa cha cholesterol yabwino. Zatsimikizidwanso kuti palibe mgwirizano pakati pakudya mafuta a nyama zokhazokha ndi chiwopsezo cha ngozi yamtima. Mukadakhala kuti simunadye zomwe zimatchedwa "trans mafuta", zomwe zimakhala ndi margarine, mayonesi, makeke am'mafayilo, masoseji. Opanga zakudya amakonda mafuta a trans chifukwa amatha kusungidwa m'mashelefu kwa nthawi yayitali osakoma. Koma ndizovulaza mtima ndi mitsempha yamagazi. Pomaliza: Idyani zakudya zosakonzedwa, ndikuphika kwambiri.

Monga lamulo, odwala matenda ashuga omwe samatha kuwongolera matenda awo bwino amakhala ndi shuga. Chifukwa cha izi, ali ndi cholesterol yambiri “yoyipa” m'magazi awo, ndipo "zabwino" sizokwanira. Izi zili choncho ngakhale kuti odwala matenda ashuga ambiri amatsata zakudya zamafuta ochepa, zomwe madokotala amawalimbikitsa. Kafukufuku waposachedwa adawonetsa kuti tinthu tating'onoting'ono ta cholesterol "koyipa", omwe adatulutsa kapena glycated, ndiye kuti, wophatikizidwa ndi glucose, amakhala ovuta kwambiri m'mitsempha. Poyerekeza ndi kuchuluka kwa shuga, pafupipafupi izi zimachulukana, ndichifukwa chake kuchuluka kwa cholesterol kowopsa m'magazi kumakwera.

Momwe mungawerengere moyenera kuopsa kwa matenda a mtima komanso sitiroko

Zinthu zambiri zapezeka m'magazi a anthu pambuyo pazaka za 1990s, kugwiritsidwa ntchito kwake komwe kumawonetsa chiwopsezo cha kugunda kwa mtima ndi sitiroko. Ngati pali zinthu zambiri izi m'magazi, ngozi yake imakhala yayitali, ngati sikokwanira, chiopsezo ndichochepa.

Mndandanda wawo ukuphatikizapo:

cholesterol yabwino - lipoproteins yapamwamba (ndizambiri zake),
cholesterol yoyipa - lipoproteins otsika,
cholesterol yoipa kwambiri - lipoprotein (a),
triglycerides
fibrinogen
homocysteine
Mapuloteni othandizira (osasokonezeka ndi C-peptide!),
ferritin (chitsulo).

Kuchuluka kwa insulini m'magazi komanso mtima

Kafukufuku adachitika pomwe apolisi 70 Paris aku Paris adatenga zaka 15. Mapeto pazotsatira zake: chizindikiro choyambirira cha chiwopsezo cha matenda amtima ndi kuchuluka kwa insulin m'magazi. Pali maphunziro ena omwe amatsimikizira kuti insulin yochulukirapo imawonjezera kuthamanga kwa magazi, triglycerides, ndikuchepetsa kuchuluka kwa cholesterol m'magazi. Izi zidatsimikizika kotero kuti zidawonetsedwa mu 1990 pamsonkhano wapachaka wa madokotala ndi asayansi ochokera ku American Diabetes Association.

Pambuyo pa msonkhanowu, chigamulo chinavomerezedwa kuti "njira zonse zomwe zilipo zothandizira odwala matenda ashuga zimapangitsa kuti kuchuluka kwa insulin ya magazi kumakwezedwa mwadongosolo, pokhapokha wodwala akangotsatira chakudya chochepa kwambiri." Amadziwikanso kuti kuchuluka kwa insulini kumapangitsa kuti ma cell a makoma a mitsempha yamagazi (ma capillaries) ataya kwambiri mapuloteni awo ndikuwonongeka. Iyi ndi imodzi mwanjira zofunika kwambiri zopezera khungu ndi kulephera kwa impso mu shuga.Komabe, zitatha izi, American Diabetes Association imatsutsa zakudya zamafuta ochepa ngati njira yolembera matenda a shuga a mtundu woyamba wa 2.

Maphikidwe a chakudya chamafuta ochepa a mtundu 1 ndi matenda ashuga 2 amapezeka pano.

Kodi atherosulinosis imayamba bwanji mu shuga

Kuchuluka kwa insulin m'magazi kumatha kuchitika ndi matenda a shuga 2, komanso ngati pakadalibe matenda ashuga, koma insulin kukana ndi metabolic syndrome akupanga kale. Insulin yochulukirapo ikamazungulira m'magazi, cholesterol yoipitsitsa imapangidwa, ndipo maselo omwe amaphimba makhoma amitsempha yamagazi kuchokera mkati amakula ndikuyamba kukhala owuma. Izi zimachitika mosasamala kanthu za zovuta zomwe shuga ya magazi imakhala nayo. Zowononga za shuga wambiri zimakwaniritsa zovuta zomwe zimadza chifukwa cha kuchuluka kwa insulin m'magazi.

Nthawi zina, chiwindi chimachotsa cholesterol "yoyipa" m'magazi, ndikulepheretsanso kupangika kwake ngati kuchuluka kwake kumakhala kochepa kuposa koyenera. Koma glucose amamangilira tinthu tating'onoting'ono ta cholesterol, ndipo pambuyo pake zolandirira m'chiwindi sizitha kuzizindikira. Mwa anthu omwe ali ndi matenda ashuga, tinthu tambiri ta cholesterol yoyipa timalumikizidwa (yolumikizidwa ndi glucose) motero imapitilirabe kuzungulira magazi. Chiwindi sichingazindikire ndikuzisefa.

Kulumikizana kwa shuga ndi tinthu tating'onoting'ono ta cholesterol titha kutha ngati shuga m'magazi tatsika ndipo sipanathe maola opitilira 24 kuchokera pamene izi zidalumikizidwa. Koma patatha maola 24 pali kukonzanso kwa ma cell a ma elekitirodi mu molekyulu wolumikizira wa glucose ndi cholesterol. Pambuyo pake, izi glycation zimasinthika. Kulumikizana kwa shuga ndi cholesterol sikungathe, ngakhale shuga atayamba kulowa bwino. Ma cell cholesterol amatchedwa "glycation end product". Amadziunjikira mumwazi, kulowa m'makoma a mitsempha, pomwe amapanga zolembera za atherosrance. Pakadali pano, chiwindi chimapitiliza kupangira lipoprotein yotsika kwambiri chifukwa ma receptor ake sazindikira cholesterol, yomwe imalumikizidwa ndi glucose.

Mapuloteni omwe amapanga m'maselo a mitsempha ya magazi amathanso kukhala ndi glucose, omwe amawapangitsa kukhala omata. Mapuloteni ena omwe amayendayenda m'magazi amawamatira, motero mapangidwe a atherosulinotic amakula. Mapuloteni ambiri omwe amayenda m'magazi amamangidwa ku glucose ndikukhala glycated. Maselo oyera oyera - macrophages - amatenga mapuloteni amtundu wa glycated, kuphatikizapo glycated cholesterol. Zitatha izi, macrophages amatupa, ndipo m'mimba mwake mumachulukanso. Ma macrophages okhala ndi magazi ambiri odzaza ndi mafuta amatchedwa ma cell of foam. Amamatira ku zolembedwa za atherosclerotic zomwe zimakhala pamakoma amitsempha yamagazi. Chifukwa cha njira zonse zomwe zafotokozedwera pamwambapa, m'mimba mwake mwa mitsempha yomwe ilipo yoyenda ndi magazi imayamba kuchepa.

Danga lamkati lamakoma amitsempha lalikulu ndi maselo osalala. Amawongoletsa zolembera za atherosulinotic kuti zikhazikike. Ngati mitsempha yomwe imawongolera minofu ya minyewa imadwala matenda a diabetes, ndiye kuti maselo iwonso amafa, calcium imayikidwamo, ndikuuma. Pambuyo pake, sangathenso kulamulira kukhazikika kwa cholembera cha atherosselotic, ndipo pali chiwopsezo chowonjezereka chakuti zolembazo zitha kugwa. Zimachitika kuti chidutswa chimachokera ku cholembera cha atherosclerotic pansi pa kukakamizidwa kwa magazi, komwe kumayenda m'chiwiya. Imatseka mitsempha kwambiri kotero kuti magazi amayenda, ndipo izi zimayambitsa vuto la mtima kapena sitiroko.

Kodi ndichifukwa chiyani chizolowezi chowonjezereka cha magazi kuopsa?

M'zaka zaposachedwa, asayansi azindikira mapangidwe amisempha yamagazi m'mitsempha yamagazi ngati chifukwa chachikulu chotsekera kwawo komanso kugunda kwa mtima. Kuyesedwa kumatha kuwonetsa kuchuluka kwa maselo anu - maselo apadera omwe amapereka magazi - amaphatikizana ndikupanga ziwalo zamagazi. Anthu omwe ali ndi vuto la kuchuluka kwa magazi kuundana amakhala pachiwopsezo chachikulu cha kugwidwa ndi matenda a mtima, kapena kugunda kwamitsempha yomwe imadyetsa impso.Limodzi mwa mayina azachipatala omwe ali ndi vuto la mtima ndi coronary thrombosis, i.e., chotsekera m'matumbo amodzi mwa mitsempha yayikulu yomwe imadyetsa mtima.

Amaganiziridwa kuti ngati chizolowezi chopanga magazi amawonjezereka, ndiye kuti izi zikutanthauza kuti ngozi yayikulu kwambiri yakufa chifukwa cha kugunda kwa mtima kuposa kuchokera ku cholesterol yayikulu. Ngoziyi imakupatsani mwayi wofufuza magazi pazinthu zotsatirazi:

Lipoprotein (a) amalepheretsa magazi kuwonongeka mpaka atakhala ndi nthawi yoti atembenuke yayikulu ndikupanga zoopseza zokhudzana ndi ziwiya zamagetsi. Zomwe zimayambitsa chiwopsezo cha thrombosis mu shuga chifukwa cha shuga okwanira. Zatsimikiziridwa kuti m'mapuloteni a anthu odwala matenda ashuga amamatirana kwambiri komanso amatsatira makhoma amitsempha yamagazi. Zomwe zimayambitsa matenda a mtima omwe tawalemba pamwambapa sizingachitike ngati wodwala matenda ashuga akhazikitsa pulogalamu ya chithandizo cha matenda ashuga kapena mtundu wa matenda a matenda ashuga a 2 ndikusunga shuga.

Kulephera kwa mtima mu shuga

Odwala a shuga amwalira ndi vuto la mtima nthawi zambiri kuposa anthu omwe ali ndi shuga wabwinobwino. Kulephera kwa mtima ndi vuto la mtima ndi matenda osiyanasiyana. Kulephera kwamtima ndi kufooka kwamphamvu kwa minofu ya mtima, ndichifukwa chake sangathe kupopa magazi okwanira kuti athandizire ntchito zofunika kwambiri mthupi. Vuto la mtima limachitika modzidzimutsa pomwe magazi amawaza imodzi mwa mitsempha yofunika yomwe imapereka magazi kumtima, pomwe mtima pawokha umakhalabe wathanzi.

Ambiri omwe ali ndi matenda ashuga omwe saatha kuthana ndi matenda awo amakhala ndi mtima. Izi zikutanthauza kuti maselo a minofu ya mtima amasinthidwa pang'onopang'ono ndi minyewa yaying'ono pazaka zambiri. Izi zimafooketsa mtima kwambiri mpaka kusiya kugwira ntchito yake. Palibe umboni kuti cardiomyopathy imagwirizanitsidwa ndi kudya zamafuta ochepa kapena magazi a cholesterol. Ndipo mfundo yoti imachuluka chifukwa cha shuga wambiri ndi yotsimikizika.

Glycated hemoglobin komanso chiopsezo cha matenda a mtima

Mu 2006, kafukufuku adamalizidwa pomwe anthu 7321 opeza bwino adatenga nawo mbali, palibe m'modzi mwa iwo adadwala matenda ashuga. Zinapezeka kuti pakukula kwina kulikonse kwa 1% ya hemoglobin ya glycated pamwamba pa 4.5%, pafupipafupi matenda opatsirana pamtima amadzuka ka 2.5. Komanso, pakuwonjezeka kulikonse kwa 1% mu index ya glycated hemoglobin pamtunda wa 4,9%, chiopsezo cha imfa pazomwe zimayambitsa chikuwonjezeka ndi 28%.

Izi zikutanthauza kuti ngati muli ndi hemoglobin ya 5.5%, ndiye kuti chiopsezo chogundidwa ndi mtima ndichulukiridwe ka 2.5 kuposa munthu wochepa thupi wokhala ndi 4.5% glycated hemoglobin. Ndipo ngati muli ndi hemoglobin ya glycated m'magazi a 6.5%, ndiye kuti chiopsezo chanu chodwala mtima chikuwonjezeka kwambiri ngati nthawi 6.25! Komabe, zimawerengedwa kuti shuga imayendetsedwa bwino ngati kuyezetsa magazi kwa glycated hemoglobin kuwonetsa zotsatira za 6.5-7%, ndipo m'magulu ena a odwala matenda ashuga amaloledwa kukhala okwera.

Mwazi wamagazi kapena cholesterol - womwe umakhala wowopsa kwambiri?

Zambiri kuchokera ku maphunziro ambiri zimatsimikizira kuti shuga wokwera ndi chifukwa chachikulu chomwe chimapangitsa kuchuluka kwa cholesterol yoyipa ndi triglycerides m'magazi kumawonjezeka. Koma si cholesterol yomwe imakhala pachiwopsezo choopsa cha mtima. Shuga wokwanira palokha ndiye chiopsezo chachikulu cha matenda amtima. Kwa zaka zambiri, mtundu 1 komanso matenda ashuga oyeserera akhala akuyesera kuti azichiza “pogwiritsa ntchito chakudya chamafuta ambiri.” Zinapezeka kuti kuchuluka kwa zovuta za matenda ashuga, kuphatikiza kugwidwa mtima ndi stroko, motsutsana ndi maziko azakudya zamafuta ochepa zimangokulira. Mwachidziwikire, kuchuluka kwa insulini m'magazi, kenako ndikuwonjezera shuga - awa ndiye oyambitsa zenizeni zoyipa. Yakwana nthawi yosinthira mtundu wa chithandizo cha matenda a shuga 1 kapena mtundu wachiwiri wa chithandizo cha matenda ashuga womwe umachepetsa chiopsezo cha zovuta za matenda ashuga, kutalikitsa moyo, ndikuwongolera mawonekedwe ake.

Wodwala matenda ashuga kapena munthu amene ali ndi matenda a metabolic atayamba kudya zakudya zamagulu ochepa, shuga yake imatsika ndikufikira yachilendo.Pakadutsa miyezi yochepa ya "moyo watsopano", kuyezetsa magazi kwa zinthu zomwe zimayambitsa matenda a mtima kuyenera kuchitika. Zotsatira zawo zidzatsimikizira kuti chiwopsezo cha matenda a mtima ndi stroke chikuchepa. Mutha kubweretsanso mayesowa m'miyezi yochepa. Mwinanso, zizindikiro za mtima ndi ziwopsezo zamtsogolo zitha kusintha.

Mavuto a chithokomiro komanso momwe angachitire

Ngati, motsutsana ndi maziko osamalira mosamalitsa zakudya zamagulu ochepa, zotsatira za kuyesedwa kwa magazi pazinthu zowopsa zamtima zimayamba kukhala zowopsa, ndiye kuti nthawi zonse (!) Zikutheka kuti wodwalayo ali ndi kuchepa kwa mahomoni a chithokomiro. Izi ndiye zoyambitsa zenizeni, osati chakudya chokwanira ndi mafuta a nyama. Vuto la mahomoni a chithokomiro lifunika kuthetseka - kuti muwonjezere msinkhu wawo. Kuti muchite izi, imwani mapiritsi otchulidwa ndi endocrinologist. Nthawi yomweyo, musamvere malingaliro ake, ndikuti muyenera kutsatira zakudya zabwino.

Gland yofooka yofooka imatchedwa hypothyroidism. Awa ndi matenda otchedwa autoimmune omwe nthawi zambiri amapezeka mwa odwala omwe ali ndi matenda a shuga 1 komanso abale awo. Chitetezo cha mthupi chimatsutsa kapamba, ndipo nthawi zambiri chithokomiro cha chithokomiro chimayamba kugawidwanso. Nthawi yomweyo, hypothyroidism imatha kuyamba zaka zambiri kale kapena mtundu woyamba wa matenda ashuga. Sichimayambitsa shuga m'magazi. Hypothyroidism palokha ndiyo chiopsezo chachikulu cha matenda a mtima komanso sitiroko kuposa matenda a shuga. Chifukwa chake, ndikofunikira kuichiza, makamaka popeza sizovuta. Chithandizo nthawi zambiri chimakhala ndi kumwa mapiritsi atatu patsiku. Werengani ziwonetsero zomwe mahomoni a chithokomiro amafunikira. Zotsatira zamayesowa zikakhala bwino, zotsatira za kuyesedwa kwa magazi pazinthu zowopsa zamtima zimakhalanso bwino.

Kupewa matenda a mtima matenda ashuga: mawu omaliza

Ngati mukufuna kuchepetsa chiwopsezo cha matenda a mtima, stroko, ndi kulephera kwa mtima, chidziwitso m'nkhaniyi ndichofunika kwambiri. Munaphunzira kuti kuyezetsa magazi kwathunthu kwa cholesterol sikulola kulosera kwodalirika kwa ngozi ya mtima. Hafu ya matenda amtima imachitika ndi anthu omwe ali ndi cholesterol yathanzi yonse. Odwala odziwitsa amadziwa kuti cholesterol imagawidwa kukhala "yabwino" komanso "yoyipa", ndikuti pali zisonyezo zina zakuopsa kwa matenda amtima wodalirika kuposa cholesterol.

Munkhaniyi, tanena za kuyesedwa kwa magazi kwa omwe angapangitse matenda a mtima. Awa ndi triglycerides, fibrinogen, Homocysteine, mapuloteni a C-reactive, lipoprotein (a) ndi ferritin. Mutha kuwerenga zambiri za iwo mu nkhani ya "Kuyesa kwa Matenda a shuga". Ndikulimbikitsa kuti muziphunzire mosamala, kenako mumayesedwa pafupipafupi. Nthawi yomweyo, mayeso a Homocysteine ndi lipoprotein (a) ndi okwera mtengo kwambiri. Ngati kulibe ndalama zowonjezera, ndiye kuti ndikokwanira kumayesanso magazi a "cholesterol" abwino "ndi" oyipa ", triglycerides ndi protein-C.

Tsatirani mosamala pulogalamu ya mtundu wa matenda a shuga 1 kapena mtundu wachiwiri wa matenda a shuga. Iyi ndi njira yabwino kwambiri yochepetsera ngozi ya mtima. Ngati kuyezetsa magazi kwa seramu ferritin kukuwonetsa kuti muli ndi chitsulo chochuluka mthupi, ndiye kuti ndikofunikira kukhala wopereka magazi. Osangothandiza iwo omwe amafunikira magazi, komanso kuchotsa chitsulo chowonjezera mthupi lawo ndipo potero amachepetsa chiopsezo cha matenda a mtima.

Kuwongolera shuga m'magazi a shuga, mapiritsi amatenga gawo lachitatu poyerekeza ndi zakudya zamagulu ochepa, masewera olimbitsa thupi, komanso jakisoni wa insulin. Koma ngati wodwala yemwe ali ndi matenda ashuga kale ali ndi matenda amtima komanso / kapena kuthamanga kwa magazi, ndiye kuti kutenga michere ndi zina zina zamtima ndizofunikira monga kutsatira chakudya.Werengani nkhani yakuti: “Kuthandiza anthu osowa magazi osokoneza bongo.” Imalongosola momwe mungathandizire matenda oopsa komanso okhudza mtima ndi mapiritsi a magnesium, coenzyme Q10, L-carnitine, taurine, ndi mafuta a nsomba. Mankhwala achilengedwe awa ndiofunikira kwambiri popewa kugunda kwa mtima. M'masiku ochepa chabe, mudzamva muumoyo wanu kuti amasintha ntchito yamtima.

Moni Dzina langa ndine Inna, ndili ndi zaka 50. Mu Julayi 2014, kuyezetsa komweko kunawululira shuga mutatha kudya 20, pamimba yopanda 14, osadandaula. Sindinakhulupirire kwenikweni, ndinapita kutchuthi, kukalembetsa upangiri wa endocrinologist. Kulemera ndiye kunali 78 kg ndi kutalika kwa 166 cm.
Ulendo wolipira kwa dotolo unayambitsa kukambirana kosangalatsa poti mukufunikiradi kupatsa insulin, koma popeza palibe zodandaula ... Zakudya zamafuta ochepa, masewera olimbitsa thupi ndipo ambiri sindimawoneka ngati wodwala matenda ashuga. Komabe, kutumiza koyesa magazi mwatsatanetsatane kunalembedwa ndipo mawu akuti "Siofor" adatchulidwa. Nthawi yomweyo komanso zamatsenga zinanditsogolera patsamba lanu! Popeza odwala matenda ashuga angapo, omwe ankamvetsera madokotala mwachangu, anali kufa m'maso mwanga, ndinali wokondwa kwambiri ndi zomwe mumapereka. Kupatula apo, palibe chomwe chimakulepheretsani kuwona mita ndi glucometer m'manja mwanu.
Kafukufuku woyamba: HDL cholesterol 1.53, LDL cholesterol 4.67, cholesterol yathunthu 7.1, shuga wa plasma -8.8, triglycerides-1.99. Ntchito za chiwindi ndi impso siziphwanya. Kusanthula kunadutsa tsiku la 5 la chakudya chochepa chamafuta osamwa mankhwala aliwonse. Potengera zakudyazo, adayamba kumwa mapiritsi a glucophage 500 mpaka 4 patsiku, ndikuwongolera shuga pogwiritsa ntchito gulu la Accucek asset glucometer. Panthawiyo (nthawi ya masika ndi chilimwe) zolimbitsa thupi zinali zapamwamba - zikuyenda mozungulira kuntchito, maekala 20 a munda wamasamba, madzi m'matumba kuchokera pachitsime, thandizo pamalo omanga.
Patatha mwezi umodzi, adataya makilogalamu 4 mwakachetechete, m'malo abwino. Masomphenyawo adabwezeretseka, kugwa komwe kumachitika chifukwa cha ukalamba. Apanso ndidawerenga ndikulemba popanda magalasi. Mayeso: plasma glucose-6.4, cholesterol-7.4 yonse, triglycerides-1.48. Kuchepetsa thupi kwambiri kumapitirirabe.
Kwa miyezi 2,5 ndinaphwanya zakudya kawiri: kwa nthawi yoyamba m'masiku 10 ndinayesa chidutswa cha mkate wofanana ndi paketi ya ndudu - panali kulumpha kwa shuga kuyambira 7.1 mpaka 10.5. Kachiwiri - pa tsiku lobadwa, kuwonjezera pa zinthu zovomerezeka, chidutswa cha apulo, kiwi ndi chinanazi, mkate wa pita, supuni ya saladi ya mbatata. Momwe shuga 7 analiri, idatsalira, ndipo patsikulo sizinatenge glucophage konse, idayiwalika kunyumba. Ndizabwinoinso kuti tsopano ndine wamwano komanso wokalipira confectionery. Ndimayenda, osayatsa, kupyola maswiti ndi makeke pamazenera ndi mawu oti: "Simulinso ndi mphamvu pa ine!" Ndipo ndikusowa zipatso ...
Vuto ndilakuti ndi shuga wamagazi tsiku ndi tsiku kuyambira pa 5 mpaka 6, mutatha kudya, kuchuluka kumakhala kochepa, mwa 10-15%, m'mawa, mosasamala kanthu chakudya chamadzulo, shuga osala kudya ndi 7-9. Mwina mukufunikirabe insulini? Kapena penyani miyezi ina 1-2? Tsopano ndilibe wina woti nditha kukambirana naye, wachigawo chathu cha endocrinologist patchuthi chachikulu. Inde, ndipo ine ndili kumudzi osati kumalo kolembetsera. Zikomo kwambiri isanakwane yankho lanu, koposa zonse, chifukwa cha tsamba lanu. Munandipatsa chiyembekezo chokhala ndi moyo wautali komanso wachimwemwe komanso chida chabwino kwambiri kuti mukwaniritse izi.

> Mwina mukufunabe insulin?

Ndiwe owerengera wachitsanzo komanso wotsatira tsambali. Tsoka ilo, adandipeza kuti ndachedwa. Chifukwa chake, ndi kuthekera kwakukulu, kudzakhala kofunikira kuti mupeze insulin pang'ono kuti musinthe shuga m'mawa pamimba yopanda kanthu.

Momwe mungachite izi, werengani apa ndi apa.

> Kapena penyani miyezi ina 1-2?

Werengani kuchuluka kwa mankhwalawa a Lantus kapena Levemir, jekeseni, kenako yangani momwe mungasinthire usiku wotsatira kuti shuga yanu yamawa ikhalebe yokhazikika.

Kuti matenda abwinobwino m'mawa m'mimba yopanda kanthu, tikulimbikitsidwa kupaka jekeseni wa Levemir kapena Lantus pa 1-2 am. Koma mutha kuyesa kuwombera insulin musanagone. Mwina m'malo mwanu osavuta mudzakhala okwanira. Koma zitha kuonekeratu kuti mukuyeneranso kukhazikitsa alamu, kudzuka usiku, kupanga jakisoni ndikugonanso nthawi yomweyo.

> Tsopano ndilibe wina woti ndifunane naye,
> endocrinologist wathu wachigawo patchuthi

Ndi zinthu zingati zofunika zomwe endocrinologist adakulangizani nthawi yatha? Chifukwa ninji kupita kumeneko?

Ndili ndi zaka 62. MuFebruary 2014, adalemba matenda a shuga a 2. Kuthamanga shuga kunali 9,5, insulini nayo idakwezedwa. Mapiritsi olembedwa, zakudya. Ndinagula glucometer. Pezani tsamba lanu, linayamba kutsatira zakudya zamagulu ochepa. Anachepa thupi kuchokera ku 80 mpaka 65 makilogalamu ndikukula kwa masentimita 156. Komabe, shuga satsika pansi 5.5 mutatha kudya. Ikhoza kufikira 6.5 mukatsata chakudya. Kodi mayeso okwera a insulin amafunikiranso?

> Kodi ndikufunikiranso kuyesedwa?
> pakuonjezera insulin?

Poyamba zonse zidakulakwirani kale, mudatipeza mochedwa. Kuthamanga shuga kunali 9,5 - zomwe zikutanthauza kuti mtundu 2 wa shuga ndiwotsogola kwambiri. Mu 5% ya odwala kwambiri, zakudya zamafuta ochepa sizimalola kuti muziwongolera matendawa popanda insulin, ndipo awa ndi milandu yanu. Shuga 5.5 mukatha kudya ndilabwinobwino, ndipo 6.5 wafika kale wabwinobwino. Mutha kuyesedwanso pamatumbo a m'matumbo opanda kanthu, koma koposa zonse - yambani pang'onopang'ono jakisoni wambiri. Onani nkhani iyi. Padzakhala mafunso - afunseni. Endocrinologist adzanena kuti zonse zili bwino ndi inu, insulin siyofunikira. Koma ndikunena - ngati mukufuna kukhala ndi moyo wautali popanda zovuta, ndiye kuti yambanani kubayitsa Lantus kapena Levemir mumadontho ang'onoang'ono. Osakhala aulesi kuchita izi. Kapena yesani kuthamangira, mwina m'malo mochita insulini.

Masana abwino Poyamba - zikomo chifukwa chantchito yanu, zabwino zonse ndi inu!
Tsopano nkhaniyi, si yanga ayi, koma mwamunayo.
Mwamuna wanga ndi wazaka 36, kutalika 184 cm, 80 makilogalamu.
Kwa zaka zopitilira ziwiri, kuyambira mu Ogasiti 2012, adakhala ndi zizindikiro, monga momwe tikudziwira tsopano, za matenda a shuga. Izi zidatitsogolera ku neuropathologist. Palibe amene ankakayikira matenda ashuga. Atamuunika mozama, dokotalayo ananena kuti matendawa sanadziwike pamtunda, ndipo adapereka magazi, mkodzo, ndi kuyesa kwa ultrasound ya chithokomiro, impso, chiwindi, ndi Prostate. Zotsatira zake, madzulo a chaka chatsopano, tinaphunzira kuti shuga m'magazi ndi 15, mkodzo ndi acetone ++ ndipo shuga ndi 0.5. The neuropathologist adati muyenera kusiya maswiti ndikuthamangira kwa endocrinologist ngati simukufuna kupita kuchipatala. M'mbuyomu, mwamunayo sanali kudwala kwambiri ndipo samadziwa komwe chipatala chake chimakhala. Neuropathologist anali wozindikira kuchokera mumzinda wina. Kuzindikira kunali ngati chitsulo chamtambo. Ndipo pa Disembala 30, ndi kusanthula uku, mwamunayo adapita kwa endocrinologist. Anatumizidwa kuti akapereke magazi ndi mkodzo kachiwiri. Sizinakhale pamimba yopanda kanthu, shuga wamagazi anali 18.6. Panalibe acetone mu mkodzo chifukwa chake anati sakanayikidwa kuchipatala. Tebulo nambala 9 ndi piritsi la Amaril 1 m'mawa. Pambuyo pa tchuthi mudzabwera. Ndipo lino ndi Januware 12th. Ndipo, zoona, sindingadikire Madzulo oyamba ndinapeza tsamba lanu, kuwerenga usiku wonse. Zotsatira zake, mwamunayo adayamba kutsatira zomwe mumadya. Thanzi lake lidayenda bwino, ndikutanthauza miyendo yake, asadakhale kuti adagona, "goosebumps" usiku sizinamulole kuti agone kwa miyezi ingapo. Amamwa Amaril kamodzi kokha, kenako ndidakuwerengera zamapiritsi awa ndikuwathetsa. Glucometer idagulidwa kokha pa Januware 6 (tchuthi - zonse ndizotseka). Kugula OneTouch Select. Sitinapatsidwe mayeso m'sitolo, koma ndinazindikira kuti zinali zodalirika.
Zizindikiro za shuga 7.01 m'mawa pamimba yopanda 10.4. Tsiku lisanafike chakudya chamadzulo 10.1. Pambuyo pa chakudya chamadzulo - 15.6. Maphunziro akuthupi mwina anathandizira kale kuchuluka kwa shuga. Patsiku lomwelo komanso izi zisanachitike, ma acetone ndi glucose amawoneka kapena kuchepa mkodzo. Zonsezi ndi chakudya cholimba kwambiri (nyama, nsomba, zitsamba, tchizi cha Adyghe, sorbitol pang'ono ndi tiyi) mosalekeza kuyambira Januware 2.
8.01 m'mawa pa chopanda kanthu m'mimba shuga 14.2, ndiye 2 maola mutatha kadzutsa 13.6. Sindikudziwa zambiri; mwamuna wanga sanayimbire ntchito.
Malinga ndi mayeso: m'magazi, zizindikiro zotsalazo ndizabwinobwino,
Palibe mapuloteni mumkodzo
mtima ndi wabwinobwino,
Ultrasound ya chiwindi ndi chizolowezi,
ndulu ndiye chizolowezi,
chithokomiro ndimazololedwa,
Prostate gland - Matenda a fibrous prostatitis,
kapamba - echogenicity ukuwonjezeka, Wirsung duct - 1 mm, Thupi: mutu - 2.5 cm, thupi - 1.4 cm, mchira - 2.6 cm.
Ndiyeneranso kunenanso kuti kuchepa kwambiri kwa thupi (kuchokera pa makilogalamu 97 kufika pa 75 makilogalamu osakwana miyezi isanu ndi umodzi) popanda zakudya ndi zifukwa zina zomveka zomwe zinachitika zaka 4 zapitazo ndipo kuyambira pamenepo (chilimwe 2010) ludzu la m'magazi linayamba (oposa malita 5 patsiku) . Ndipo ndimafuna kumwa madzi amchere amchere (glade of kvasova). Mwamuna wake amakonda maswiti ndipo amadya kwambiri. Kutopa, kusakwiya, kupanda chidwi kwa zaka zingapo. Tinalumikiza izi ndi ntchito yamanjenje.
Nditawerenga nkhani yanu yokhudza mayeso ofunikira, ine, monga dokotala waluso, ndidamuwuza mayeso otere kwa amuna anga: glycated hemoglobin, C-peptide, TSH, T3 ndi T4 (mawa ndichita). Chonde ndiuzeni china chomwe chikufunika kuchitika.
Sindikumvetsa. Kodi ali ndi matenda a shuga a 2 kapena mtundu 1 wa shuga? Alibe kunenepa kwambiri. Tikuyembekezera yankho, zikomo.

> Kugula OneTouch Select. Yesani pamsika
> sanatipatse, koma ndikumvetsa kuti ndi wodalirika

> Amaril adamwa kamodzi, ndiye ndidawerenga
> uli ndi mapiritsi awa ndipo udawafafaniza

Uzani mwamuna wanu kuti anali ndi mwayi wokwatiwa bwino.

> ali ndi matenda ashuga a 2 kapena mtundu 1 wa shuga?

Izi ndi 100% mtundu 1 shuga. Onetsetsani kuti mwabayira insulin, kuwonjezera pa zakudya.

> Zina zomwe zikufunika kuchitika

Yambani kubayitsa insulini, osakoka. Phunzirani mosamala nkhaniyi (chiwongolero chakuchita) ndi iyi monga zitsanzo cholimbikitsa.

Onani dotolo wanu kuti apindule ndi matenda a shuga 1.

Mupatseni C-peptide ndi hemoglobin wa glycated kamodzi pa miyezi itatu.

> aakulu fibrous prostatitis

Mwina muyenera kufunsa dokotala za izi. Zingakhale zothandiza kutenga zowonjezera za zinc ndi mafuta a mbewu dzungu, monga tafotokozera pano, kuwonjezera pa zomwe dokotala wakupatsani.

M'malo mwanu, izi zowonjezera zimapindula nthawi zambiri pokonza moyo wanu. Mutha kutenga ndi amuna anu - zinc imalimbitsa tsitsi, misomali ndi khungu.

Vladislav, wazaka 37, Type 1 shuga kuyambira 1996. Malinga ndi kusanthula kwakukulu kwamwazi wamagazi, cholesterol ndi 5.4, hemoglobin ya glycated ndi 7.0%.
The endocrinologist adapereka chosindikiza cha zinthu zomwe zimayenera kukhala zochepa - mazira nawonso amalowamo. Ndili ndi funso la wolemba tsamba - ndimotani momwe mafuta ochepa otsika zimapatsa cholesterol? Ndimatsata izi, ndimakonda chilichonse. Koma mazira ndiye chinthu chachikulu chokhala ndi mtundu uwu wa michere. Nthawi zambiri ndimadya mazira awiri tsiku lililonse pachakudya cham'mawa, nthawi zina 3. Ndimadyanso tchizi, komanso pamndandanda wazakudya zoletsedwa za cholesterol yayikulu. Ndiuzeni, ndichitenji, ndikusinthira kubalanso? Mwinanso zilinso chimodzimodzi, koma yesani kutsitsa hemoglobin wa glycated kukhala 5.5-6%? Tili othokoza kwambiri yankho.

Kodi zakudya zamagulu ochepa zimachepetsa bwanji cholesterol?

Sindikudziwa bwinobwino, koma izi zikuchitika.

Tsatirani zakudya, idyani nyama, tchizi, mazira, modekha, werengani nkhani yoletsa komanso kuchiza matenda a atherosclerosis, ili ndi tebulo lowona - zikhulupiriro ndi chowonadi.

Wantchito wanu wonyozeka amadya mazira 250-300 pamwezi, osati chaka choyamba. Ndili ndi khungu langa pamzerewu. Zitachitika kuti mazirawo ndi ovulaza, ndiye kuti ndiyamba kuvutika makamaka koposa zonse. Pakadali pano, mayeso a cholesterol - osachepera chiwonetsero.

Tithokoze chifukwa cha nkhaniyi komanso malangizo apadongosolo a zakudya! Ndinawerenga za mafuta a nsomba kwanthawi yayitali, ndimamwa ndi mavitamini.

masana! Ndili ndi zaka 33. Td1 wazaka 29. zikomo patsamba lanu! zothandiza kwambiri! miyezi itatu akuyesera kutsatira zakudya zamafuta ochepa! M'miyezi itatu iyi, zinali zotheka kuchepetsa hemoglobin wa glycated kuyambira pa 8 mpaka 7, adayang'ana impso (zonse zili m'ndondomeko yake), mapuloteni olimbitsa thupi ndi abwinobwino, triglycerides, (0.77), apolipoprotein a 1.7 (wabwinobwino), cholesterol yabwino ndiyabwino, koma mkati mwachizolowezi 1.88), cholesterol yathunthu 7.59! masikono oyipa opitilira 5, 36! miyezi itatu yapitayo anali 5.46! ndiuzeni momwe amachepera! ndipo ndikoyenera kuda nkhawa ndi chizindikiro ichi? ndipo chifukwa chiyani nud sichidakhudze chiwonetserochi? cholowa cha ma atherogenic chaumboni wotsiriza pamlingo wapamwamba wa zikhalidwe (3), miyezi itatu yapitayi chinali 4,2! zikomo

Zotsatira za kuchepa kwa insulin pamtima

Mtundu woyamba 1 ndi matenda a shuga a 2 ndi matenda osiyana kwambiri pazifukwa ndi njira zopititsira patsogolo.Amalumikizidwa ndi zikhalidwe ziwiri zokha - cholowa cham'tsogolo komanso kuchuluka kwa shuga m'magazi.

Mtundu woyamba umatchedwa kudalira insulin, umapezeka mwa achinyamata kapena ana motsogozedwa ndi ma virus, kupsinjika, ndi mankhwala osokoneza bongo. Mtundu wachiwiri wa matenda a shuga umadziwika ndi pang'onopang'ono, odwala okalamba, monga lamulo, onenepa kwambiri, matenda oopsa oopsa, cholesterol yayikulu m'magazi.

Type 2 shuga

Zomwe zimachitika pokhudzana ndi vuto la mtima

Mu mtundu woyamba wa matenda, zochita za autoimmune zimayambitsa kufa kwa maselo a pancreatic omwe amapanga insulin. Chifukwa chake, odwala alibe mahomoni awo m'magazi kapena kuchuluka kwake ndi kochepa.

Ndondomeko zomwe zimachitika mu kuperewera kwa insulin kwathunthu:

kuchepa kwamafuta kumayambitsa,
zomwe zili ndi mafuta acids ndi triglycerides m'magazi zimakwera
popeza glucose simalowa m'maselo, mafuta amakhala gwero lamphamvu,
mafuta makutidwe ndi okosijeni zimachitikira kumabweretsa zowonjezera ma ketones m'magazi.

Izi zimabweretsa kuwonongeka m'magazi kwa ziwalo, zomwe zimakonda kwambiri zoperewera - mtima ndi ubongo.

Kodi ndichifukwa chiyani pali chiopsezo chachikulu cha kudwala mtima?

Mu matenda a shuga amtundu wachiwiri, kapamba amapanga insulin mwanjira zabwinobwino komanso kuchuluka. Koma chidwi cha maselo kwa icho chimatayika. Vutoli limatchedwa insulin kukana. Kuwonongeka kwa mtima kumachitika mothandizidwa ndi zinthu izi:

shuga wamagazi - amawononga makoma amitsempha yamagazi,
cholesterol owonjezera - amapanga ma atherosselotic zolembera, zotsekera kuunikira kwamitsempha,
matenda obanika magazi, chiopsezo cha thrombosis,
kuchuluka kwa insulini - kumapangitsa secretion ya contrainsular mahomoni (adrenaline, kukula mahomoni, cortisol). Amathandizira kutsitsa kwamitsempha yamagazi ndi kulowa kwa cholesterol mwa iwo.

Myocardial infarction imakhala yoopsa kwambiri mu hyperinsulinemia. Kukumana kambiri kwa timadzi timeneti kumathandizira kukula kwa atherosulinosis, monga kupangika kwamafuta a cholesterol ndi chiwindi cha chiwindi kumathandizira, minofu ya makoma a ziwiya zimakulira, ndikuwonongeka kwa magazi kumalepheretsa. Chifukwa chake, odwala omwe ali ndi matenda a shuga 2 amakhala pachiwopsezo cha matenda owopsa a coronary kuposa odwala ena.

Pezani momwe IHD ndi myocardial infarction ku matenda a shuga zimawonera, onani vidiyo iyi:

Zinthu Zowonjezera kwa Munthu wa Matenda A shuga

Pafupipafupi matenda a mtima pakati pa odwala matenda ashuga ndiwofanana mwachindunji pakubwezeretsa matendawa. Kutalikirana kwambiri ndi zomwe zikuwonetsa kuchuluka kwa shuga m'magazi, nthawi zambiri odwala oterewa amakhala ndi zovuta za matenda ashuga komanso mtima. Zomwe zingakhudze kukula kwa vuto la mtima ndi izi:

uchidakwa
zolimbitsa thupi zochepa,
mavuto osaneneka
chizolowezi cha chikumbumtima,
kudya kwambiri, nyama zochuluka zamafuta ndi chakudya chamagulu m'zakudya,
ochepa matenda oopsa.

Zomwe zimayambitsa matenda a mtima mwa odwala omwe ali ndi matenda ashuga

Choyambitsa chachikulu cha matenda amtima mwa anthu omwe ali ndi matenda ashuga ndi kuumitsa makoma amitsempha yama coronary or atherosulinosis. Zimachitika chifukwa cha kupangika kwa cholesterol plaque m'mitsempha yamagazi omwe amapereka okosijeni ndikuthandizira minofu ya mtima.

Kuchuluka kwa cholesterol pamakoma amitsempha yamagazi, monga lamulo, kumayamba ngakhale kuwonjezeka kwa shuga kwa odwala omwe ali ndi matenda a shuga a 2. Mwanjira ina, matenda a mtima nthawi zambiri amakhala asanapezeke mtundu wa matenda a shuga 2. shuga yamtunduwu imapangidwa pang'onopang'ono komanso posachedwapa.

Cholesterol chikasweka kapena kupasuka, zimayambitsa ma magazi kuti aletse magazi kulowa m'mitsempha. Izi zitha kuchititsa kudwala mtima. Njira imodzimodziyo imatha kuchitika m'mitsempha ina yonse mthupi - kutuluka kwa magazi kupita ku ubongo kumayambitsa kugwedezeka, ndipo mavuto omwe magazi amayenda mpaka m'miyendo kapena mikono amapangitsa matenda otumphukira.

Odwala omwe ali ndi matenda a shuga samangokhala ndi mwayi wowonjezereka wamatenda amtima, amakhalanso pachiwopsezo chachikulu chotenga kulephera kwa mtima - vuto lalikulu lazachipatala lomwe mtima sutha kupopa magazi moyenera. Izi zimatha kubweretsa kukulira kwamadzi m'mapapu, ndikupangitsa kupuma movutikira kapena kusungunuka kwa madzi m'zigawo zina za thupi (makamaka m'miyendo), zomwe zimayambitsa kutupa.

Kodi ndi matenda ati a mtima omwe akudwala matenda a shuga?

Zizindikiro za vuto la mtima:

Kupuma pang'ono, kufupika.
Kumva kufooka.
Chizungulire
Kutuluka thukuta kwambiri komanso kusasinthika.
Ululu m'mapewa, nsagwada, kapena mkono wamanzere.
Kupweteka pachifuwa kapena kukakamizidwa (makamaka panthawi yolimbitsa thupi).
Kuchepetsa mseru.

Kumbukirani kuti sianthu onse omwe akumva ululu kapena zizindikiro zina zamatenda a mtima. Izi ndizowona makamaka kwa amayi omwe ali ndi matenda ashuga.

Ngati mukukumana ndi chilichonse mwazizindikirozi, muyenera kuwona dokotala nthawi yomweyo kapena kuyitanira ambulansi kunyumba.

Matenda a m'mitsempha yamapapo ali ndi zizindikiro zotsatirazi:

Mwendo kukokana mukayenda (kwapakati pang'onopang'ono) kapena kupweteka m'chiuno kapena matako.
Mapazi ozizira.
Kutsitsa kapena kusowa kwa miyendo kapena mapazi.
Kutayika kwamafuta onunkhira pamiyendo yakumunsi.
Kutayika kwa tsitsi pamapazi apansi.

Chithandizo ndi kupewa matenda a mtima mwa odwala matenda ashuga

Pali njira zingapo zochizira matenda amtima mwa odwala omwe ali ndi matenda ashuga, kutengera kuopsa kwa matendawa:

Kutenga aspirin kuti muchepetse ziwopsezo zamagazi, zomwe zimayambitsa matenda amtima komanso minyewa. Mlingo wocheperako wa aspirin umalimbikitsidwa kwa amuna ndi akazi omwe ali ndi matenda a shuga 2 opitilira zaka 40, omwe ali pachiwopsezo chachikulu chotenga matenda amtima komanso zotumphukira zamitsempha. Lankhulani ndi dokotala wanu kuti mudziwe ngati mankhwala a aspirin ndi oyenera.

Zakudya zamafuta ochepa. Werengani nkhani: 10 mafuta otsitsa cholesterol a odwala matenda ashuga ndi Zogulitsa Zapamwamba za Cholesterol - Maupangiri a Amayi Awagulitsi Kuti Awasinthe.
Zochita zolimbitsa thupi, osati kungochepetsa thupi, komanso kuchepetsa shuga, kuthamanga kwa magazi ndi cholesterol, komanso kuchepetsa mafuta am'mimba, chomwe ndi chiwopsezo chowonjezereka pakukula kwa matenda amtima.
Kumwa mankhwala ofunikira.
Kuthandizira opaleshoni.

Kodi kuchitira zotumphukira zamtima mavuto?

Matenda otumphukira a minyewa amapewa ndipo amathandizidwa motere:

Kuyenda tsiku lililonse mu mpweya watsopano (mphindi 45 patsiku, ndiye kuti mutha kuwonjezera).
Kuvala nsapato zapadera ngati zovuta zake zili zazikulu komanso pali ululu poyenda.
Kusunga hemoglobin HbA1c glycated pamlingo wotsika ndi 7%.
Kuchepetsa kuthamanga kwa magazi pansipa 130/80.
Kusunga cholesterol "yoyipa" ya LDL pansi pa 70 mg / dl ( Source:

1. Matenda a shuga ndi matenda amtima // American Mtima Association.

KUGWIRITSA NTCHITO KWA SUGAR NDI KUGWIRA MTIMA

Kulephera kwamtima ndi matenda ofala kwambiri kwa odwala omwe ali ndi matenda ashuga a 2.Mwakanthawi, kukana insulini kumapangitsa kuti CH59 chiziwonjezereka. Patsamba lalikulu la UK General Practice Research Database, kugwiritsa ntchito njira zochizira matenda a mtima kumachepetsa kufa. Koma metformin inali mankhwala okhawo a protiglycemic omwe amalumikizidwa ndi kuchepa kwaimfa (osamvetseka 0,72, nthawi yolimba 0.59-0.90) 60. Thiazolidisediones sanagwiritsidwe ntchito kawirikawiri pochita, ili ndiye gulu lokhalo la mankhwala opatsirana omwe ali ndi vuto logwiritsa ntchito mankhwalawa. CH

HDL cholesterol, niacin ndi thiazolidinediones

HDL cholesterol nthawi zambiri imachepa ndi T2DM, ndipo zotsatira zake zachizolowezi za vasoprotective zimapumulanso11. Nicotinic acid (niacin) uyenera kukhala chithandizo cha kusankha, koma mankhwalawa salekerera bwino. Fomu yomwe yakhazikitsidwa posachedwa (Niashpan) imawonjezera cholesterol ya HDL mu T2DM ndipo ili ndi zotsatira zoteteza11.

Ma thiazolidcediones awo amatchedwanso "glitazones" omwe amathandizira pulogalamu ya PPAR-gamma transcriptor, yolimbikitsira kagayidwe ka glucose. Kuphatikiza apo, ali ndi katundu wolimbikitsa mwachindunji pa PPAR alpha receptors, omwe amachepetsa glycemia ndi zomwe zili triglycerides, pomwe akuwonjezera cholesterol12 ya HDL. Rosiglitazone ndi pioglitazone kuchuluka okwanira LDL cholesterol, ndi rosiglitazone kukulitsa kuchuluka kwa LDL cholesterol tinthu, ndi pioglitazone kutsitsa 13. Pioglitazone adakulitsa kuchuluka kwa ndende ya HDL, pomwe rosiglitazone adachepetsa, onse mankhwalawa adakulitsa cholesterol ya HDL. Poyeserera, pioglitazone inachepetsa kukula kwa vuto lakukhudza mtima14. Monotherapy yokhala ndi rosiglitazone (koma osati ndi mankhwalawa) adalumikizidwa ndi kuwonjezereka kwa pafupipafupi kwa kuphwanya kwa myocardial mu ma script ena a 15, 16.

Masiku ano, kuchepa kwambiri kwa cholesterol ya LDL mwa ma statins ndikadali chinsinsi cha kutsitsa kwa lipid, ngakhale lipoti la zovuta zina. Kuti muchepetse kuchuluka kwa triglyceride komanso / kapena muchepetse kukula kwa retinopathy, umboni wabwino kwambiri umapezeka kuchokera ku fenofibrate kuwonjezera ma statins.

Lamulira HELL: BWANANI KUTI?

Kutsutsana: Kodi ndi gawo liti labwino la kuthamanga kwa magazi kwa mtundu wa shuga?

Mu kafukufuku wowonera cohort kuchokera ku UKPDS mndandanda, omwe adalimbikitsa kuchuluka kwa magazi a systolic pafupifupi 110-120 mm RT. , kuchepa kwa magazi a systolic kuchokera> 160 kupita ku Mwina insulin akadali ofunikira?

Momwe mungachite izi, werengani apa ndi apa.

> Kapena penyani miyezi ina 1-2?

Werengani kuchuluka kwa mankhwalawa a Lantus kapena Levemir, jekeseni, kenako yangani momwe mungasinthire usiku wotsatira kuti shuga yanu yamawa ikhalebe yokhazikika.

> Tsopano ndilibe wina woti ndifunane naye,

> endocrinologist wathu wachigawo patchuthi

Ndi zinthu zingati zofunika zomwe endocrinologist adakulangizani nthawi yatha? Chifukwa ninji kupita kumeneko?

Lyudmila Seregina 11/19/2014

admin Post wolemba 11/22/2014

> Kodi ndikufunikiranso kuyesedwa?

> pakuonjezera insulin?

Poyamba zonse zidakulakwirani kale, mudatipeza mochedwa. Kuthamanga shuga kunali 9,5 - zomwe zikutanthauza kuti mtundu 2 wa shuga ndiwotsogola kwambiri.Mu 5% ya odwala kwambiri, zakudya zamafuta ochepa sizimalola kuti muziwongolera matendawa popanda insulin, ndipo awa ndi milandu yanu. Shuga 5.5 mukatha kudya ndilabwinobwino, ndipo 6.5 wafika kale wabwinobwino. Mutha kuyesedwanso pamatumbo a m'matumbo opanda kanthu, koma koposa zonse - yambani pang'onopang'ono jakisoni wambiri. Onani nkhani iyi. Padzakhala mafunso - afunseni. Endocrinologist adzanena kuti zonse zili bwino ndi inu, insulin siyofunikira. Koma ndikunena - ngati mukufuna kukhala ndi moyo wautali popanda zovuta, ndiye kuti yambanani kubayitsa Lantus kapena Levemir mumadontho ang'onoang'ono. Osakhala aulesi kuchita izi. Kapena yesani kuthamanga. mwina thandizirani m'malo mwa insulin.

Masana abwino Poyamba - zikomo chifukwa chantchito yanu, zabwino zonse ndi inu!

Tsopano nkhaniyi, si yanga ayi, koma mwamunayo.

Mwamuna wanga ndi wazaka 36, kutalika 184 cm, 80 makilogalamu.

Kwa zaka zopitilira ziwiri, kuyambira mu Ogasiti 2012, adakhala ndi zizindikiro, monga momwe tikudziwira tsopano, za matenda a shuga. Izi zidatitsogolera ku neuropathologist. Palibe amene ankakayikira matenda ashuga. Atamuunika mozama, dokotalayo ananena kuti matendawa sanadziwike pamtunda, ndipo adapereka magazi, mkodzo, ndi kuyesa kwa ultrasound ya chithokomiro, impso, chiwindi, ndi Prostate. Zotsatira zake, madzulo a chaka chatsopano, tinaphunzira kuti shuga m'magazi ndi 15, mkodzo ndi acetone ++ ndipo shuga ndi 0.5. The neuropathologist adati muyenera kusiya maswiti ndikuthamangira kwa endocrinologist ngati simukufuna kupita kuchipatala. M'mbuyomu, mwamunayo sanali kudwala kwambiri ndipo samadziwa komwe chipatala chake chimakhala. Neuropathologist anali wozindikira kuchokera mumzinda wina. Kuzindikira kunali ngati chitsulo chamtambo. Ndipo pa Disembala 30, ndi kusanthula uku, mwamunayo adapita kwa endocrinologist. Anatumizidwa kuti akapereke magazi ndi mkodzo kachiwiri. Sizinakhale pamimba yopanda kanthu, shuga wamagazi anali 18.6. Panalibe acetone mu mkodzo chifukwa chake anati sakanayikidwa kuchipatala. Tebulo nambala 9 ndi piritsi la Amaril 1 m'mawa. Pambuyo pa tchuthi mudzabwera. Ndipo lino ndi Januware 12th. Ndipo, zoona, sindingadikire Madzulo oyamba ndinapeza tsamba lanu, kuwerenga usiku wonse. Zotsatira zake, mwamunayo adayamba kutsatira zomwe mumadya. Thanzi lake lidayenda bwino, ndikutanthauza miyendo yake, asadakhale kuti adagona, "goosebumps" usiku sizinamulole kuti agone kwa miyezi ingapo. Amamwa Amaril kamodzi kokha, kenako ndidakuwerengera zamapiritsi awa ndikuwathetsa. Glucometer idagulidwa kokha pa Januware 6 (tchuthi - zonse ndizotseka). Kugula OneTouch Select. Sitinapatsidwe mayeso m'sitolo, koma ndinazindikira kuti zinali zodalirika.

Zizindikiro za shuga 7.01 m'mawa pamimba yopanda 10.4. Tsiku lisanafike chakudya chamadzulo 10.1. Pambuyo pa chakudya chamadzulo - 15.6. Maphunziro akuthupi mwina anathandizira kale kuchuluka kwa shuga. Patsiku lomwelo komanso izi zisanachitike, ma acetone ndi glucose amawoneka kapena kuchepa mkodzo. Zonsezi ndi chakudya cholimba kwambiri (nyama, nsomba, zitsamba, tchizi cha Adyghe, sorbitol pang'ono ndi tiyi) mosalekeza kuyambira Januware 2.

8.01 m'mawa pa chopanda kanthu m'mimba shuga 14.2, ndiye 2 maola mutatha kadzutsa 13.6. Sindikudziwa zambiri; mwamuna wanga sanayimbire ntchito.

Malinga ndi mayeso: m'magazi, zizindikiro zotsalazo ndizabwinobwino,

Palibe mapuloteni mumkodzo

mtima ndi wabwinobwino,

Ultrasound ya chiwindi ndi chizolowezi,

chithokomiro ndimazololedwa,

Prostate gland - Matenda a fibrous prostatitis,

kapamba - echogenicity ukuwonjezeka, Wirsung duct - 1 mm, Thupi: mutu - 2.5 cm, thupi - 1.4 cm, mchira - 2.6 cm.

Ndiyeneranso kunenanso kuti kuchepa kwambiri kwa thupi (kuchokera pa makilogalamu 97 kufika pa 75 makilogalamu osakwana miyezi isanu ndi umodzi) popanda zakudya ndi zifukwa zina zomveka zomwe zinachitika zaka 4 zapitazo ndipo kuyambira pamenepo (chilimwe 2010) ludzu la m'magazi linayamba (oposa malita 5 patsiku) . Ndipo ndimafuna kumwa madzi amchere amchere (glade of kvasova). Mwamuna wake amakonda maswiti ndipo amadya kwambiri. Kutopa, kusakwiya, kupanda chidwi kwa zaka zingapo. Tinalumikiza izi ndi ntchito yamanjenje.

Nditawerenga nkhani yanu yokhudza mayeso ofunikira, ine, monga dokotala waluso, ndidamuwuza mayeso otere kwa amuna anga: glycated hemoglobin, C-peptide, TSH, T3 ndi T4 (mawa ndichita). Chonde ndiuzeni china chomwe chikufunika kuchitika.

Sindikumvetsa. Kodi ali ndi matenda a shuga a 2 kapena mtundu 1 wa shuga? Alibe kunenepa kwambiri. Tikuyembekezera yankho, zikomo.

admin Post wolemba 01/12/2015

> Kugula OneTouch Select. Yesani pamsika

> sanatipatse, koma ndikumvetsa kuti ndi wodalirika

> Amaril adamwa kamodzi, ndiye ndidawerenga

> uli ndi mapiritsi awa ndipo udawafafaniza

Uzani mwamuna wanu kuti anali ndi mwayi wokwatiwa bwino.

> ali ndi matenda ashuga a 2 kapena mtundu 1 wa shuga?

Izi ndi 100% mtundu 1 shuga. Onetsetsani kuti mwabayira insulin, kuwonjezera pa zakudya.

> Zina zomwe zikufunika kuchitika

Yambani kubayitsa insulini, osakoka. Phunzirani mosamala nkhaniyi (chiwongolero chakuchita) ndi iyi monga zitsanzo cholimbikitsa.

Onani dotolo wanu kuti apindule ndi matenda a shuga 1.

Mupatseni C-peptide ndi hemoglobin wa glycated kamodzi pa miyezi itatu.

> aakulu fibrous prostatitis

Mwina muyenera kufunsa dokotala za izi. Zingakhale zopindulitsa kutenga zowonjezera za zinc ndi mafuta a mbewu dzungu, monga tafotokozera apa. kuphatikiza pazomwe dokotala adzalembera.

M'malo mwanu, izi zowonjezera zimapindula nthawi zambiri pokonza moyo wanu. Mutha kutenga ndi amuna anu - zinc imalimbitsa tsitsi, misomali ndi khungu.

Imelo yanu sidzasindikizidwa. Zofunika minda zidalembedwa *

Matenda a shuga

Kodi matenda ashuga a ketoacidosis, hyperglycemic coma ndi njira zopewera zovuta kwambiri - onse odwala matenda ashuga ayenera kudziwa. Makamaka kwa odwala matenda a shuga 1, komanso okalamba omwe ali ndi matenda a shuga a 2.

Ngati vutoli lafika poti zovuta zayamba, ndiye kuti madotolo amayenera kulimba kuti "atulutse" wodwalayo, ndipo chiwopsezo chaimfa ndichokwera kwambiri, ndi 15-25%. Komabe, ambiri odwala matenda ashuga amakhala olumala ndipo amafa msanga osati chifukwa cha zovuta, koma chifukwa cha zovuta zina. Kwenikweni, awa ndi mavuto ndi impso, miyendo ndi mawonekedwe amaso, zomwe nkhaniyi idadzipereka.

Ngati wodwala wokhala ndi matenda amtundu wa 2 kapena mtundu wa 2 sagwiriridwa bwino ntchito ndipo ali ndi shuga yayikulu magazi, izi zimapweteketsa mitsempha ndikuwonetsa kuyipa kwa mitsempha. Vutoli limatchedwa diabetesic neuropathy.

Mitsempha imatumiza zizindikiritso kuchokera ku thupi lonse kupita ku ubongo ndi chingwe cha msana, komanso chizindikiritso chochokera kumbuyo uko. Kuti mufikire pakatikati, mwachitsanzo, kuyambira pachala mpaka kumapazi, chidwi cha mitsempha chimayenera kupita kutali.

Munjira imeneyi, mitsempha imalandira chakudya komanso mpweya kuchokera ku mitsempha yaying'ono yotchedwa capillaries. Kuchuluka kwa shuga mu shuga kungawononge ma capillaries, ndipo magazi adzaleka kuyenda kudzera mwa iwo.

Matenda a mitsempha ya shuga samachitika nthawi yomweyo, chifukwa kuchuluka kwa mitsempha m'thupi kumachulukanso. Umu ndi mtundu wa inshuwaransi, womwe umabadwa mwa ife mwachilengedwe. Komabe, peresenti inayake yamitsempha ikawonongeka, zizindikiro za neuropathy zimawonekera.

Kutalikirana kwambiri kwa mitsempha, ndizotheka kuti mavuto amabwera chifukwa cha shuga wambiri. Chifukwa chake, sizosadabwitsa kuti matenda a shuga a diabetes nthawi zambiri amayambitsa mavuto ndi kumva kwamiyendo m'miyendo, zala, komanso kusabala kwa amuna.

Kuwonongeka kwamanjenje m'miyendo ndikowopsa kwambiri. Ngati wodwala matenda ashuga aleka kumva khungu la kumapazi ake ndi kutentha ndi kuzizira, kupsinjika ndi kupweteka, ndiye kuti chiopsezo chovulala mwendo chidzawonjezeka kambirimbiri, ndipo wodwalayo sadzalabadira pakapita nthawi.

Chifukwa chake, odwala matenda a shuga nthawi zambiri amayenera kudula miyendo. Kuti mupewe izi, phunzirani ndikutsatira malamulo oyang'anira matenda ashuga. Mwa odwala ena, matenda ashuga a m'mimba sayambitsa kuwonongeka kwa manjenje, koma m'malo mwake kupweteka kwamatumbo, kumva kulira ndi miyendo.

Matenda a shuga ndi matenda a shuga. Monga mukudziwa, impso zimasefa zinyalala m'magazi, ndikuzichotsa ndi mkodzo. Impso iliyonse imakhala ndi maselo apadera pafupifupi miliyoni, omwe ndi mafayilo amwazi.

Magazi amayenda kudzera mwa anzawo. Zosefera za impso zimatchedwa glomeruli. Mu odwala matenda ashuga, aimpso glomeruli amawonongeka chifukwa cha kuchuluka kwa glucose m'magazi omwe amayenda kudzera mwa iwo.

Choyamba, kuthothoka kwa mamolekyulu amapulogalamu ochepa kwambiri. Shuga wambiri akamawononga impso, kukulira kwa molekyulu kupezeka mu mkodzo. Pa gawo lotsatira, sikuti shuga ya magazi yokha imakwera, komanso kuthamanga kwa magazi, chifukwa impso sizitha kuthana ndi kuchotsedwa kwamadzi ambiri mthupi.

Ngati simumamwa mapiritsi omwe amachepetsa kuthamanga kwa magazi, ndiye kuti matenda oopsa amathandizira kuwonongeka kwa impso. Pali bwalo loipa: kuchuluka kwa matenda oopsa, impso zimawonongeka msanga, komanso kuti ziphuphu zowonongeka kwambiri, magazi ake amawonjezeka, ndipo amayamba kugonjetsedwa ndi mankhwala.

Monga matenda a shuga a m'mbuyomu amakula, mapuloteni ochulukirapo ofunikira m'thupi amatulutsidwa mkodzo. Pali kuchepa kwa mapuloteni m'thupi, edema imawonedwa mwa odwala. Mapeto ake, impso zimasiya kugwira ntchito.

Padziko lonse lapansi, anthu masauzande ambiri amatembenukira ku mabungwe othandiza chaka chilichonse chifukwa amalephera impso chifukwa cha matenda ashuga. Ambiri mwa "makasitomala" ambiri a madokotala ochita opaleshoni ya impso, komanso malo opangira dialysis, ndi odwala matenda ashuga.

Kuthandiza kulephera kwa impso ndikokwera mtengo, kupweteka, ndipo sikupezeka ndi aliyense. Mavuto a shuga a impso amachepetsa nthawi yomwe wodwalayo amakhala ndi moyo komanso amachepetsa mphamvu yake. Njira zoyendetsera matenda osokoneza bongo ndizosasangalatsa kotero kuti 20% ya anthu omwe amawatsatira, pamapeto pake, amawakana mwakufuna kwawo, podzipha.

Matenda a shuga ndi impso: zolemba zothandiza

Ngati matenda oopsa ayambika ndipo sangathe kuyang'aniridwa popanda mapiritsi a "mankhwala", ndiye muyenera kuwona dokotala kuti akupatseni mankhwala - ACE inhibitor kapena angiotensin-II receptor blocker.

Werengani zambiri zamankhwala othandizira odwala matenda ashuga matenda ashuga. Mankhwala ochokera m'makalasi amenewa samangochepetsa kuthamanga kwa magazi, komanso ali ndi chotsimikizika choteteza impso. Amakulolani kuti muchepetse gawo lomaliza la kulephera kwa impso kwa zaka zingapo.

Kusintha kwawonekera kwa odwala omwe ali ndi matenda amtundu wa 2 komanso amtundu wa 2 ndiwothandiza kwambiri kuposa mankhwala chifukwa amachotsa zomwe zimayambitsa kuwonongeka kwa impso, osati "kungodumphitsa" zizindikirazo. Ngati mungalangize pulogalamu yanu yothandizira odwala matenda ashuga kapena mtundu wachiwiri wa matenda ashuga komanso kukhalabe ndi shuga, ndiye kuti matenda ashuga sangakuopsezeni, komanso mavuto ena.

Matenda a mtima ndi sitiroko

Stroke ndi matenda oopsa kwambiri pakokha. Nthawi zambiri, mukasankha chithandizo cholakwika, zotsatira zakupha ndizotheka. Ichi ndichifukwa chake ndikofunikira kuyandikira nkhaniyi ndiudindo wonse.

Ngati muchiza matendawa molondola, ndiye kuti mutha kubwerera kumoyo wabwino pakapita nthawi.

Komanso, ngati matenda ashuga aphatikizana ndi sitiroko, ndiye kuti matendawo amafunika njira yophatikizira. Nthawi zina shuga imatha kukhala ngati complication. Mulimonsemo, chithandizo choterechi chimakhala ndi zovuta zake.

Stroke ndi matenda ashuga - izi maupangiri eni ake ndi owopsa ku moyo wa munthu. Ngati zikuchitika pamodzi, ndiye kuti zotsatirapo zake zingakhale zovutirapo ngati simukuyamba munthawi yake.

Malinga ndi ziwerengero, kudwala pakati odwala omwe ali ndi matenda ashuga kuli pafupifupi nthawi 4-5 kuposa anthu ena (ngati tiwunikanso zikhalidwe zomwezo, magulu azaka zofanana zomwe zikudziwikiratu mtsogolo komanso zangozi).

Ndizofunikanso kudziwa kuti ndi anthu 60% okha omwe amatha kugunda. Ngati mwa anthu omwe alibe matenda ashuga ,imfa ndi 15% yokha, ndiye pankhaniyi ,imfa ifika 40%.

Pafupifupi nthawi zonse (90% ya milandu), ischemic stroke imayamba, osati hemorrhagic stroke (mtundu wa atherothrombotic). Nthawi zambiri, mikwingwirima imachitika masana, pomwe kuchuluka kwa shuga m'magazi ndikokwera kwambiri.

Ndiye kuti, tikapenda chibwenzi chathu, titha kunena kuti: nthawi zambiri kumakhala kubaya komwe kumachitika motsutsana ndi maziko a matenda ashuga, osati motsutsana.

Zomwe zimapangitsa kuti matenda a matenda ashuga akhale ndi shuga ndi monga:

chizindikiro choyamba chikhoza kukhala chopanda tanthauzo, zizindikilo zimachulukirachulukira,
Nthawi zambiri sitiroko imayamba chifukwa cha kuthamanga kwa magazi. Chifukwa cha izi, khoma lam'mimba limakhala laling'onoting'ono, lomwe lingayambitse kuwombana kapena kusintha kwa necrotic,
kuchepa kwa chidziwitso ndi zina mwazovuta zachilengedwe,
hyperglycemia ikukula msanga, nthawi zambiri imayambitsa kukomoka kwa matenda ashuga,
Intral ya infaration ya ubongo ndiyokulirapo kuposa anthu opanda matenda a shuga,
Nthawi zambiri limodzi ndi sitiroko, kulephera kwa mtima kumakula kwambiri, komwe kumatha kuyambitsa kuphwanya kwa myocardial.

Nthawi zina matenda a shuga amathanso kukulira pambuyo stroko, koma nthawi zambiri, sitiroko imakhala chifukwa cha matenda ashuga. Cholinga chake ndikuti kuli ndi shuga kuti magazi sangathe kuzungulira bwino kudzera m'mitsempha. Zotsatira zake, hemorrhagic kapena ischemic stroke imatha kuchitika chifukwa cha kupsinjika.

Pankhaniyi, kupewa ndikofunika kwambiri. Monga mukudziwa, matenda aliwonse ndiosavuta kupewa kuposa kuwachotsa.

Mu matenda a shuga, ndikofunikira kuyang'anira kuchuluka kwa shuga, kuwunika zakudya zanu, kutsatira malangizo onse a dotolo wanu kuti musasokoneze chithunzi chamankhwala ndikupewanso zovuta zina zoyipa.

Sitiroko si chiganizo. Ndi chithandizo choyenera, wodwalayo mwina akhoza kubwerera ku moyo wabwinoko posachedwa. Koma ngati mumanyalanyaza malangizo omwe dokotala amakupatsani, ndiye kuti kulemala ndi kupuma pantchito ndizo zomwe zimayembekezera munthu.

Aliyense wodwala matenda ashuga amadziwa momwe thanzi limafunira ndi matendawa. Ngati matenda a shuga apezeka, ndiye kulosera kwa anthu angati omwe angakhale ndi moyo komanso zomwe zimapangitsa kuti matenda akhale ndi moyo wabwino kutengera ndi momwe zakudya zimatsatidwira.

Kudya wodwala, ngati ali ndi matenda opha ziwopsezo komanso matenda ashuga, ayenera kugwira ntchito zotsatirazi:

sinthanso shuga, kupewa kuchulukitsa kwake, komanso ndikofunikira kuti magazi a cholesterol azikhala bwino,
letsa mapangidwe a atherosselotic plaques pamitsempha yamitsempha,
zoletsa kuchuluka magazi.

Zogulitsa zina zomwe zimakhala zovulaza thanzi la wodwala omwe ali ndi matenda amtunduwu zimayambitsidwa kuti ndizoletsedwa mu shuga. Koma mndandandawu udzakulitsidwa ndi mayina owonjezerapo kuti musapweteke kapena kuwongolera mkhalidwe wa wodwalayo pambuyo poti adwala.

Nthawi zambiri, odwala oterewa amapatsidwa zakudya Na.10 - amapangidwira anthu omwe ali ndi matenda amtima. Malamulo omwewo amakhala a odwala omwe ali ndi stroke. Koma nthawi yomweyo, ngati chithunzi chachipatala chikulemedwa ndi matenda a shuga, ndiye kuti zingakhale zofunikira kuchepetsa kuchuluka kwa zakudya zamagulu ena ambiri.

Kuphatikiza apo, mndandanda wa malamulo omwe ali ndi zakudya za odwala omwe ali ndi matenda otere ayenera kuwunikidwa:

muyenera kudya m'magawo ang'onoang'ono 6-7 patsiku,
ndibwino kugwiritsa ntchito zinthu zilizonse zoyeretsedwa, zotsukidwa ndi madzi okwanira, kuti musapange katundu wina pamimba.
simungadye kwambiri,
zinthu zilizonse ziyenera kudyedwa mu mafuta owiritsa, owotcha kapena owira, owotcha, osuta, komanso amchere, zonunkhira ndizoletsedwa.
ndibwino kupereka zokonda pazachilengedwe zomwe zimakhala ndi zinthu zochepa zoyipa kuti muchepetse zotsatira zoyipa mthupi.

Ndi chizolowezi kutulutsa mndandanda wachakudya chilichonse, chomwe chiyenera kukhala chakudya cha odwala omwe ali ndi matenda ofananawo, komanso zakudya zoletsedwa. Kusungidwa kwa malamulowa kudzatsimikizira zakukula ndi mtundu wina wa moyo wa munthu.

Malonda omwe analimbikitsidwa ndi awa:

Tiyi yazitsamba, ma compotes, infusions ndi decoctions.Amalimbikitsidwanso kumwa timadziti, koma kuchepetsa kumwa kwa makangaza, chifukwa zimathandizira kuwonjezeka kwa magazi.
Supu yophika masamba, msuzi wosenda.
Zowaka mkaka wowonda. Kefir, tchizi tchizi ndizothandiza kwambiri, koma ndibwino kusankha zakudya zamafuta ochepa.
Masamba, zipatso. Ndi ndiwo zamasamba zomwe ziyenera kukhala maziko a zakudya za odwala. Koma kumwa nyemba ndi mbatata kuyenera kuchepetsedwa. Njira yayikulu ikakhala masamba kapena zipatso zosenda. Pakumayambika kuchira, mbatata zosenda nthawi zonse ndizoyenera ana omwe amazigwiritsa ntchito podyetsa.
Porridge. Zabwino kwambiri ngati mkaka. Mpunga, buluwheat, oat ndizabwino.

Ngati tikulankhula za zakudya zoletsedwa, muyenera kupatula zomwe zimapangitsa shuga, komanso mafuta m'thupi. Izi zikuphatikiza:

Zakudya zamafuta (tsekwe, nkhumba, mwanawankhosa). Afunika kusintha nkhuku, nyama ya kalulu, nkhuku. Zomwezi zimafunanso nsomba - nsomba iliyonse yamafuta siyoletsedwa kudya.
Chiwindi, chiwindi ndi zinthu zina zofananira.
Nyama zakusuta, soseji, nyama zam'chitini ndi nsomba.
Mafuta a nyama (batala, mazira, kirimu wowawasa). Ndikofunikira m'malo ndi mafuta a masamba (maolivi ndi abwino).
Maswiti aliwonse, makeke. Ngakhale pakadali pano shuga ali pamlingo woyenera, ndiye kuti mafuta ochulukirapo amakhalanso m'magazi.

Kuti mupewe ma spikes m'magazi, muyenera kupatula khofi, tiyi wamphamvu, cocoa ndi zakumwa zina zilizonse.

Nthawi zambiri kwa odwala omwe akungoyamba kudya okha pambuyo poti amenyedwe, ndikulimbikitsidwa kugwiritsa ntchito mankhwala osakaniza opangidwa kale. Amagwiritsidwa ntchito ngati odwala adyetsedwa kudzera mu chubu.

Zotsatira zake

Ngati munthu nthawi yomweyo akudwala matenda ashuga ndipo akuvutika ndi stroko, ndiye kuti zotsatirapo zake zimakhala zoipa kwambiri kuposa zotsalazo. Chifukwa choyamba ndikuti nthawi zambiri mwa anthu oterewa sitiroko imakhala yoopsa.

ziwalo
kusowa chonena
kutaya ntchito zambiri zofunika (kumeza, kuwongolera pokodza),
kukumbukira kwambiri kusokonezeka, ntchito za ubongo.

Ndi chithandizo choyenera, ntchito za moyo zimabwezeretseka pang'onopang'ono, koma mwa odwala, nthawi yokonzanso imatenga nthawi yayitali. Kuphatikiza apo, chiwopsezo cha kubwerezedwa kawiri kawiri kapena kuphwanya kwa myocardial ndichachikulu kwambiri.

Malinga ndi ziwerengero, odwala ambiri omwe ali ndi matenda ashuga atatha sitiroko amakhala osaposa zaka 5-7. Pankhaniyi, gawo limodzi mwa magawo atatu a odwala sangathe kubwereranso ku moyo wabwinobwino, atagona.

Palinso zovuta za impso, chiwindi, zomwe zimachitika motsutsana ndi maziko akumwa kwambiri.

Ngati munthu wapezeka ndi matenda a shuga, koma nthawi yomweyo pamakhala lingaliro lakukhazikika kwa vuto la stroke, dokotala amamuwonetsa njira zina zowonjezera zopewa kuti ziwonjezeke.

Kuti muchite izi, muyenera kusintha osati zakudya zanu, komanso moyo wanu. Nkhaniyi iyenera kufikiridwa ndi udindo wonse, chifukwa ndi izi chifukwa moyo wabwino udzadalira.

Malangizo akulu aphatikizire:

Kuchita masewera. Ngakhale mkhalidwe wazachipatala uli wovuta bwanji, komabebe mungathe kusankha masewera olimbitsa thupi omwe angakuthandizeni kukhalabe olimba. Zosankha zabwino zingakhale kuyenda, kusambira. Kukhala moyo wongokhala pamilandu imeneyi kumatsutsana.
Kuchepetsa thupi. Kunenepa kwambiri ndi chimodzi mwazinthu zoyipa kwambiri zomwe zimayambitsa stroko. Ichi ndichifukwa chake muyenera kuwunika kulemera kwanu, ngati kuli kowonjezera, muyenera kuibwezeretsanso ku nthawi yomweyo.
Kukana zizolowezi zoipa. Kusuta fodya ndi uchidakwa ndizoletsedwa. Ndikofunikira kwambiri kusiya kumwa kwa vinyo wofiira, chifukwa zimawonjezera magazi.
Kupitiliza kosalekeza shuga.
Moyo. Nthawi yokwanira yomwe muyenera kugona, kutsatira njira zina zonse. Komanso, kupsinjika, kugwiritsa ntchito kwambiri, kuchita masewera olimbitsa thupi mopitirira muyeso kuyenera kupewedwa momwe mungathere.
Zakudya Zakudyazo zikuyenera kuvomerezedwa ndi dokotala. Cholinga chake ndikuti ndizakudya zomwe nthawi zambiri zimapangitsa kusankha pankhaniyi. Pokhala ndi zakudya zosayenera, chiopsezo chokhala ndi stroke chikukulira kwambiri.
Mankhwala Tsiku lililonse muyenera kumwa Aspirin - kumalepheretsa kukhathamiritsa kwamphamvu kwa magazi. M'pofunikanso kutsatira malangizo onse a dokotala. Ngati pali woyamba chizindikiro cha matenda oopsa, ndiye kuti ndikofunikira kumwa mankhwala pafupipafupi kuteteza kukakamiza.

Matenda a shuga osachiritsika

Mavuto ena obwera chifukwa cha matenda ashuga amatenga matenda osagwiritsidwa ntchito bwino kapena moyenera, koma osakhala oyipa kwambiri kuti ketoacidosis kapena hyperglycemic chikomokere. Kodi chifukwa chiyani zovuta za matenda ashuga zimakhala zowopsa?

Chifukwa amakula pakadali pano popanda zizindikiro ndipo samayambitsa kuwawa. Palibe zizindikiro zosasangalatsa, wodwala matenda ashuga sayenera kukulimbikitsani kuthandizidwa mosamala. Zizindikiro za zovuta za matenda ashuga ndi impso, miyendo ndi maso zimachitika nthawi ikachedwa kwambiri, ndipo munthuyo amwalira. Mavuto osautsa a shuga ndi omwe muyenera kuwopa kwambiri.

Mavuto a matenda a shuga a impso amatchedwa "diabetesic nephropathy." Mavuto amaso - matenda a shuga a retinopathy. Amadzuka chifukwa shuga wokwera amawononga mitsempha yayikulu komanso yayikulu.

Madzi amatuluka kupita kwa ziwalo ndi ma cell amasokonekera, chifukwa chomwe chimafa ndi njala. Kuwonongeka kwa dongosolo lamanjenje kumakhalanso kofala - matenda ashuga a m'mimba, omwe amachititsa zizindikiro zosiyanasiyana.

Matenda a diabetes a nephropathy ndiwo amachititsa kwambiri kulephera kwaimpso. Anthu odwala matenda ashuga amapanga "makasitomala" ambiri opezekanso, komanso madokotala omwe amathandizanso impso. Matenda a shuga a shuga ndi omwe amayambitsa khungu chifukwa cha achikulire omwe amagwira ntchito padziko lonse lapansi.

Neuropathy imapezeka mwa 1 mwa 3 odwala panthawi yopezeka ndi matenda a shuga, ndipo pambuyo pake mwa 7 mwa 10 odwala. Vuto lodziwika bwino lomwe limayambitsa ndikutayika kwa miyendo. Chifukwa cha izi, odwala matenda ashuga ali ndi chiopsezo chachikulu cha kuvulala kwamiyendo, gangore yodula komanso kuduladula matimu otsika.

Type 1 ndi matenda ashuga 2, ngati sawongolera bwino, ali ndi zotsatira zoyipa pa moyo wapamtima. Mavuto a matenda ashuga amachepetsa chilakolako chogonana, amachepetsa mwayi, ndikuchepetsa kukhutitsidwa.

Kwambiri, abambo amakhala ndi nkhawa ndi zonsezi, ndipo zambiri zomwe zidziwitso pansipa ndi za iwo. Komabe, pali umboni kuti azimayi omwe ali ndi matenda ashuga amakhala ndi matenda a anorgasmia chifukwa cha kuwonongeka kwamitsempha.

Takambirana za zovuta za matenda obwera chifukwa cha matenda ashuga pa moyo wa abambo ndi momwe mungachepetse mavuto. Kukonzekera kwa mbolo yachimuna ndikovuta motero. Kuti chilichonse chitha bwino, zinthu zotsatirazi ziyenera kuchitika nthawi imodzi:

kuchuluka kwa testosterone m'mwazi,
Zida zomwe zimadzaza mbolo ndi magazi ndizopanda zoyera,
Mitsempha yomwe imalowa mu autonomic mantha system ndikuwongolera erection imagwira ntchito nthawi zambiri,
kutsitsa kwa mitsempha yomwe imapereka malingaliro okhutitsidwa pogonana sikusokoneza.

Matenda a shuga a shuga amawonongeka mitsempha chifukwa cha shuga wambiri. Itha kukhala yamitundu iwiri. Mtundu woyamba ndi kusokonezeka kwamanjenje yamatenda amanjenje, yomwe imapereka mayendedwe osazindikira.

Mtundu wachiwiri ndi kuwonongeka kwa mitsempha yomwe imalowa mu autonomic mantha system.Dongosololi limawongolera machitidwe ofunikira kwambiri osadziwika bwino m'thupi: kugunda kwa mtima, kupuma, kuyenda kwa chakudya kudzera m'matumbo ndi ena ambiri.

Dongosolo lamanjenje la autonomic limayendetsa kukonzekera kwa mbolo, ndipo dongosolo la somatic limayendetsa makutu amasangalalo. Njira zamanjenje zomwe zimafika kudera lamtunduwu ndizitali kwambiri. Ndipo atakhala nthawi yayitali, amakhala pachiwopsezo cha kuwonongeka kwawo mu shuga chifukwa cha shuga wambiri.

Ngati magazi akuyenda m'mitsempha ali ndi vuto, ndiye kuti, kumangika kumakhala kofooka, kapenanso palibe chomwe chingagwire ntchito. Takambirana pamwambapa momwe matenda ashuga amawonongera mitsempha yamagazi komanso momwe imayambira. Atherosclerosis nthawi zambiri imawononga mitsempha yamagazi yomwe imadzaza mbolo ndi magazi kale kuposa mitsempha yomwe imadyetsa mtima ndi ubongo.

Chifukwa chake, kuchepa kwa potency kumatanthauza kuti chiopsezo cha matenda a mtima ndi stroke chikuwonjezereka. Tengani izi mozama momwe mungathere. Yesetsani kuletsa matenda a atherosulinosis (momwe mungachitire izi). Ngati pambuyo vuto la mtima ndi sitiroko muyenera kusintha kulumala, ndiye kuti mavuto omwe ali ndi potency akuwoneka kuti akukuuzani zopanda pake.

Testosterone ndi mahoni ogonana amuna. Kuti bambo achite zogonana ndikusangalala, payenera kukhala muyezo wina wa testosterone m'mwazi. Mlingowu umachepa pang'onopang'ono ndi zaka.

Kusowa kwa testosterone ya magazi nthawi zambiri kumapezeka mwa anthu azaka zapakati komanso akulu, komanso makamaka odwala matenda ashuga. Posachedwa, zimadziwika kuti kusowa kwa testosterone m'mwazi kumawonjezera maphunziro a shuga, chifukwa amachepetsa chidwi cha maselo kuti apange insulin.

Pali bwalo loipa: shuga imachepetsa kuchuluka kwa testosterone m'mwazi, ndipo testosterone yocheperako, imakhala yolimba kwambiri shuga. Pomaliza, mahomoni omwe ali m'magazi a munthu amasokonezeka kwambiri.

Chifukwa chake, matenda ashuga amakakamiza kugonana amuna m'njira zitatu nthawi imodzi:

amalimbikitsa zotsekera zombo zokhala ndi zolembedwa za atherosulinotic,
zimabweretsa mavuto ndi testosterone m'mwazi,
imasokoneza kuchepa kwa mitsempha.

Chifukwa chake, sizosadabwitsa kuti amuna omwe ali ndi matenda ashuga nthawi zambiri amakumana ndi zolephera m'miyoyo yawo. Oposa theka la amuna omwe ali ndi matenda ashuga a 2 kwa zaka 5 kapena kupitilira amadandaula za zovuta za potency. Ena onse amakumananso ndi mavuto omwewo, koma samadziwika ndi madokotala.

Za chithandizo, nkhani ndi zabwino ndi zoyipa. Nkhani yabwino ndi chakuti ngati mumatsatira pulogalamu ya matenda a shuga a mtundu woyamba kapena pulogalamu yachiwiri ya shuga, ndiye kuti pakapita nthawi, kudzitsekera kwa mitsempha kumabwezeretseka.

Kutembenuza mtundu wa testosterone m'mwazi kumakhala zenizeni. Gwiritsani ntchito ntchito imeneyi njira zomwe dokotala wamuuza, koma musagulitse katundu “mobisa” ku malo ogulitsira. Nkhani yoyipa ndiyakuti ngati mitsempha ya magazi idawonongeka chifukwa cha atherosulinosis, ndiye kuti ndizosatheka kuchiritsa lero. Izi zikutanthauza kuti potency sangathe kubwezeretsedwa, ngakhale akuyesetsa.

Werengani nkhani yatsatanetsatane, "Matenda a shuga ndi Kulephera Kwa Amuna." Mumaphunzira kuti:

momwe mungagwiritsire ntchito moyenera Viagra ndi "abale" ake osadziwika,
njira zothetsera matenda a testosterone m'magazi,
penile prosthetics ndi njira yomaliza ngati zonse zalephera.

Ndikukulimbikitsani kuti mutenge kuyesedwa kwa magazi a testosterone, ndipo, ngati kuli koyenera, funsani dokotala momwe mungapangire kuchuluka kwake. Izi ndizofunikira kuti zisangobwezeretsanso potency, komanso kuwonjezera kuchuluka kwa maselo kuti apange insulin ndikuwongolera njira ya matenda ashuga.

Kulephera ndi Mtima Kulephera

Kulephera kwa mtima ndi imodzi mwazinthu zazikulu za thupi. Munthawi imeneyi, mtima sugwira ntchito yonse yofunikira, chifukwa chake zimakhala ndi thupi limakhala ndi vuto la oxygen.

Kulephera kwa mtima pachimake ndi vuto lomwe limachitika nthawi yomweyo. Uwu ndi mkhalidwe wakuda womwe ungayambitse imfa.Ndikofunikira kudziwa zizindikiro za vutoli ndikutha kuzipewa ndikupereka thandizo lofunikira panthawi.

Zomwe zimayambitsa kuperewera kwa mtima kwambiri zimatha kukhala kulowerera m'mitsempha, magazi m'magazi, mtima tamponade, pericarditis, matenda, ndi zina zambiri.

Vutoli limadzuka ndikukula patangopita mphindi zochepa. Pakadali pano, wodwalayo akumva kusowa kwenikweni kwa mpweya, pamakhala kupsinjika pachifuwa. Khungu limakhala cyanotic.

Ngati muzindikira kuti munthu ali ndi zoterezi, muyenera kumuthandiza. Choyambirira kuchita ndikuyitanira ambulansi. Ndikofunikira kuwonetsetsa kuti mpweya wabwino ukuyenda kwa wodwalayo, kuti amumasule zovala zovomerezeka.

Kusintha kwa okosijeni kumathandizidwa ndi kukhazikitsidwa kwa mawonekedwe ena ndi odwala: ndikofunikira kuwabzala, kutsitsa miyendo yanu pansi, ikani manja anu pamipango. Mwanjira imeneyi, mpweya wambiri umalowa m'mapapu, omwe nthawi zina amathandizira kuimitsa kuukira.

Ngati khungu silinapeze tint yowala ndipo palibe thukuta lozizira, mutha kuyesa kuyimitsa ndi piritsi la nitroglycerin. Izi ndi zochitika zomwe zitha kuchitidwa ambulansi isanafike. Lekani kuukira ndikuletsa zovuta zomwe zingakhale akatswiri okhawo oyenerera.

Chimodzi mwazomwe zimachitika chifukwa cha kupsinjika kwa mtima kwambiri imatha kukhala stroke. Stroko ndi chiwonongeko cha minofu ya muubongo chifukwa chakukomoka kwapakati kapena kuchepa kwa magazi. Kutuluka kwa magazi kumatha kuchitika pansi paubongo, kulowa mkati mwake ndi malo ena, komweko kumapita kwa ischemia. Kukula kwina kwa thupi la munthu kumatengera malo a hemorrhage kapena ischemia.

Zinthu zosiyanasiyana zimatha kubweretsa sitiroko. Ngati sitiroko limayambitsa kukha magazi, ndiye kuti stroko yotere imatchedwa hemorrhagic. Zomwe zimayambitsa matenda amtunduwu zimatha kukhala kuwonjezereka kwa kuthamanga kwa magazi, matenda amitsempha yamagazi, matenda ammagazi, kuvulala koopsa kwamaubongo, ndi zina zambiri.

Ischemic stroke ikhoza kuyambitsa thrombosis, sepsis, matenda, rheumatism, DIC, kuchepa kwakukulu kwa kuthamanga kwa magazi chifukwa cha mtima wovuta, ndi zina zambiri. Koma, mulimonse, zifukwa zonsezi zimagwirizanitsidwa ndi kusokonezeka kwa dongosolo la mtima.

Ngati magazi a wodwala akwera kwambiri, kuthamanga kwa magazi mpaka kumutu kumakulirakulira, thukuta pamphumi likuwonekera, ndiye kuti titha kulankhula za kupezeka kwa stroke ya hemorrhagic. Zonsezi zimayendera limodzi ndi kusazindikira, nthawi zina kusanza ndi ziwalo mbali imodzi ya thupi.

Ngati wodwalayo akumana ndi chizungulire, kupweteka mutu, kufooka, ndiye kuti izi zitha kukhala zizindikiro za kugundidwa kwa ischemic. Ndi matenda amtunduwu, mwina simungataye chikumbumtima, ndipo ziwalo zimayamba kukula pang'onopang'ono.

Ngati mukuzindikira zizindikiro zotere, itanani ambulansi nthawi yomweyo. Ikani wodwalayo pamalo opingasa, onetsetsani kuti akupuma mwaulere. Mutu wa wodwalayo uyenera kutembenukira mbali yake - kupewa kutulutsa lilime ndi kusanza ndi masanzi.

Mapazi ndikulangizidwa kuyika pepala lotenthetsera. Ngati ambulansi isanafike muyenera kuti mukupuma komanso kuti muli ndi mtima womangika wodwala, ndikofunikira kuti mugwiritse ntchito kutulutsa mtima kosalunjika komanso kupuma movutikira.

Kulephera kwamtima kwambiri, kugwidwa ndi mikhalidwe yoopsa kwambiri. Ndikosatheka kutsata maonekedwe awo ndipo amawalandira bwino. Chifukwa chake, ntchito yofunika kwambiri yomwe tikukumana nayo ndikupewa izi.

Khalani ndi moyo wathanzi, osagwiritsa ntchito mankhwala osokoneza bongo, pewani kupsinjika ndikuwunika thanzi lanu.

Kulephera kwa mtima - mkhalidwe momwe minofu yamtima singathe kulimbana ndi ntchito yake - kupopa magazi. Malinga ndi ziwerengero, 10-24% ya odwala sitiroko kale anali ndi vuto la mtima.

Nthawi zambiri tikulankhula za ischemic stroke.Chifukwa chakuti mtima sugwirizana ndi ntchito yake, magazi amayendayenda m'zipinda zake, izi zimapangitsa kuti pakhale magazi. Kachidutswa kakang'ono ka thrombus (embolus) kamatha kuchoka ndikuyenda m'mitsempha mu ubongo.

Pali mitundu iwiri ya kulephera kwa mtima:

Lakuthwa. Amakula msanga, mkhalidwe wodwala umakulirakulira, zomwe zimawopseza moyo wake. Kulephera kwa mtima komanso kugunda kwamphamvu ndi zinthu zoopsa zomwe zingayambitse imfa ya munthu.
Matenda Kuphwanya ndi zizindikilo kumawonjezeka pang'onopang'ono.

Odwala amene ali ndi matenda opha ziwalo nthawi zambiri amakhala ndi vuto la mtima komanso matenda ena amtima. Zoyambitsa izi:

Matenda a stroko ndi mtima amakhala ndi zinthu zina zomwe zimayambitsa ngozi: kuthamanga kwa magazi, matenda ashuga, matenda a m'matumbo, arrhythmias.
Pambuyo pa sitiroko, zinthu zimatha kutulutsidwa kuchokera ku minyewa ya ubongo ndikulowetsa m'magazi zomwe zimasokoneza ntchito zamtima.
Pakulumwa, kuwonongeka kwakatikati kwa mitsempha kumatha kuchitika, komwe kumakhudza kupweteka kwa mtima. Ndi kuwonongeka kwa gawo lakumaso la ubongo, kusokonezeka kwa miyambo ya mtima kumadziwika.

Zizindikiro zazikulu zakulephera kwa mtima pambuyo povulala: kupuma movutikira (kuphatikizapo kupuma), kufooka, chizungulire, kutupa m'miyendo, muzovuta kwambiri - kuwonjezeka pamimba (chifukwa cha kuchuluka kwa madzimadzi - ascites).

Kulephera kwamtima kwachilengedwe ndi njira yopitira patsogolo. Nthawi ndi nthawi mkhalidwe wa wodwalayo umakhazikika, kenako kutulutsa kwatsopano kumachitika. Njira yamatendawa imasiyanasiyana kwambiri m'magulu osiyanasiyana, zimatengera zinthu zosiyanasiyana.

Giredi I: Kugwira ntchito kwa mtima kumakhala kolemala, koma osatsagana ndi zizindikiro komanso kuchepa kwa moyo.
Kalasi II: Zizindikiro zimachitika pokhapokha pakuchita khama kwambiri.
Giredi III: Zizindikiro zimachitika nthawi zonse.
Giredi IV: Zizindikiro zowopsa zimachitika pakupuma.

Kulephera kwa mtima pambuyo pa sitiroko kumakulitsa chiopsezo cha arrhasmia. Ngati 50% ya odwala pamapeto pake amwalira chifukwa cha kupita patsogolo kwa kulephera kwa mtima lokha, ndiye kuti 50% yotsalayo chifukwa cha kusokonezeka kwa mtima. Kugwiritsa ntchito ma defibrillators a implantable Cardio Converter kumathandizira kuwonjezera kupulumuka.

Kwa munthu aliyense, ndikofunikira kuti athe kupereka moyenera PHC molakwika mu mtima komanso pakhungu - nthawi zina zimathandiza kupulumutsa moyo. Kulephera kwamtima kwambiri nthawi zambiri kumachitika usiku.

Munthu amadzuka chifukwa choti ali ndi vuto losowa mpweya, wokhutira. Kupuma pang'ono, chifuwa, pomwe pamatuluka thonje laza, ndipo nthawi zina limasakanikirana ndi magazi. Kupuma kumakhala kaphokoso, kopepuka.

Imbani ambulansi.
Mugonereni wodwalayo, mpatseni malo ochepa.
Patsani mpweya watsopano kuchipindacho: tsegulani zenera, chitseko. Ngati wodwala wavala malaya, samasuleni.
Pukuta madzi ozizira pankhope pa wodwalayo.
Wodwalayo akayamba kuzindikira, mugonekeni kumbali yake, yang'anirani kupumira komanso kupumira.
Wodwala akapuma, mtima wake sugunda, muyenera kuyamba kutulutsa thupi mosalunjika komanso kupuma movutikira.

Koma metformin inali mankhwala okhawo a protiglycemic omwe amalumikizidwa ndi kuchepa kwaimfa (osamvetseka 0,72, nthawi yolimba 0.59-0.90) 60. Thiazolidisediones sanagwiritsidwe ntchito kawirikawiri pochita, ili ndiye gulu lokhalo la mankhwala opatsirana omwe ali ndi vuto logwiritsa ntchito mankhwalawa. CH

HDL cholesterol, niacin ndi thiazolidinediones

Rosiglitazone ndi pioglitazone kuchuluka okwanira LDL cholesterol, ndi rosiglitazone kukulitsa kuchuluka kwa LDL cholesterol tinthu, ndi pioglitazone kutsitsa 13. Pioglitazone adakulitsa kuchuluka kwa ndende ya HDL, pomwe rosiglitazone adachepetsa,

mankhwala onsewo adakulitsa cholesterol ya HDL. Poyeserera, pioglitazone inachepetsa kukula kwa vuto lakukhudza mtima14. Monotherapy yokhala ndi rosiglitazone (koma osati ndi mankhwalawa) adalumikizidwa ndi kuwonjezereka kwa pafupipafupi kwa kuphwanya kwa myocardial mu ma script ena a 15, 16.

Matenda a shuga ndi matenda amtima

Matenda a mtima nthawi zambiri amapezeka mwa odwala omwe ali ndi matenda ashuga. Zambiri zomwe zidafalitsidwa mu National Diabetes Newsletter (USA) zidawonetsa kuti mchaka cha 2004, 68% ya anthu omwe amafa ndi matenda ashuga, azaka 65 ndi kupitilira, adachitika chifukwa cha matenda osiyanasiyana amtima, kuphatikizira kuphwanya myocardial . 16% ya odwala matenda ashuga omwe adutsa zaka 65 adamwalira ndi stroke.

Mokulira, chiopsezo cha kufa chifukwa chomangidwa mwadzidzidzi ndi mtima, kulowetsedwa kwa m'mitsempha kapena matenda opha ziwopsezo kwa odwala omwe ali ndi matenda osokoneza bongo ndi pafupipafupi ndi kawiri kuposa mwa anthu wamba.

Ngakhale onse odwala matenda ashuga ali ndi mwayi wopezeka ndi matenda a mtima, matendawa amapezeka kawirikawiri kwa odwala omwe ali ndi matenda ashuga a 2.

Framingham Mtima Study (kafukufuku wautali wa matenda amtima pakati pa okhala ku Framingham, Massachusetts, USA) ndiumboni umodzi woyamba kuwonetsa kuti anthu omwe ali ndi matenda ashuga ali pachiwopsezo chachikulu cha matenda amtima kuposa anthu opanda matenda a shuga. Kuphatikiza pa matenda ashuga, matenda amtima amayambitsa:

kuthamanga kwa magazi
kusuta
cholesterol yayikulu
mbiri ya banja yamayambiriro a matenda amtima.

Zowopsa zomwe munthu amakhala nazo chifukwa cha matenda a mtima, zimakhala zambiri kuti atha kudwala matenda amtima, omwe amatha kupha. Poyerekeza ndi anthu wamba omwe ali ndi chiopsezo chowonjezereka cha matenda amtima, odwala matenda ashuga amakonda kufa ndi matenda amtima.

Mwachitsanzo, ngati munthu amene ali pachiwopsezo chachikulu chotenga magazi kwambiri atakhala ndi mwayi wokufa ndi nthenda ya mtima, ndiye kuti wodwala matenda a shuga ali ndi chiopsezo chawiri kapena kufa pang'ono chifukwa cha mavuto amtima kuyerekeza ndi iye.

Mu umodzi mwazofufuza zambiri zamankhwala, zidapezeka kuti odwala matenda ashuga omwe analibe zoopsa zina zokhudzana ndi thanzi la mtima ndizochulukirapo ka 5 kufa ndi matenda amtima kuposa anthu opanda matenda a shuga.

Akatswiri a Cardio amalimbikitsa mwamphamvu kuti anthu odwala matenda ashuga azisamalira thanzi lawo mozama komanso mosamala, monganso anthu omwe adakumana ndi vuto la mtima.

M'nkhani ya lero, tikambirana za zovuta za matenda ashuga zomwe zimachitika chifukwa cha shuga wambiri. Tsoka ilo, matenda omwe amakhalanso nthawi zambiri amawonetsedwanso, omwe si zotsatira za matenda ashuga, koma amaphatikizidwa nawo.

Monga mukudziwa, chomwe chimayambitsa matenda a shuga 1 ndikuti chitetezo cha mthupi chimagwira molakwika. Imagunda ndikuwononga maselo a pancreatic beta omwe amapanga insulin. Kuphatikiza apo, odwala matenda a shuga a mtundu woyamba amakhala ndi vuto la autoimmune pamafuta ena omwe amapanga mahomoni osiyanasiyana.

Mu mtundu woyamba wa matenda ashuga, chitetezo cha mthupi chimakonda kuthana ndi chithokomiro "cha kampani", lomwe ndi vuto la pafupifupi ⅓ odwala. Matenda a shuga amtundu wa 1 amathandizanso kutenga chiwopsezo cha matenda a autoimmune a gren adrenal, koma chiwopsezo akadali otsika kwambiri.

Anthu onse omwe ali ndi matenda amtundu wa 1 ayenera magazi awo kuwayezetsa mahomoni a chithokomiro kamodzi pachaka. Timalimbikitsa kutenga kuyesedwa kwa magazi osati kwa mahomoni oyambitsa chithokomiro (thyrotropin, TSH), komanso kuyang'ana mahomoni ena.

Ngati mukuyenera kuthana ndi zovuta ndi chithokomiro cha chithokomiro mothandizidwa ndi mapiritsi, ndiye kuti mlingo wawo suyenera kukhazikika, koma masabata onse 6-12 ayenera kusinthidwa molingana ndi zotsatira za kuyesedwa mobwerezabwereza kwa mahomoni.

Matenda ofala omwe ali ndi matenda a shuga a 2 amakhala ochepa matenda oopsa, mavuto amafuta a m'magazi a cholesterol ndi gout. Pulogalamu yathu yachiwiri ya matenda a shuga imathandizira kuti shuga azikhala ndi magazi, komanso kuthamanga kwa magazi ndi cholesterol.

Maziko a mtundu wathu 1 ndi mitundu yachiwiri ya matenda othandizira odwala matenda ashuga ndi chakudya chochepa kwambiri. Amakhulupirira kuti zimawonjezera zomwe zili uric acid m'magazi. Ngati mukuvutika ndi gout, imatha kukulira, komabe, zopindulitsa za ntchito zomwe timalimbikitsa pochiza matenda a shuga ndizoposa izi. Amaganiza kuti zotsatirazi zimatha kuthetsa gout:

Imwani madzi ambiri ndi tiyi ya zitsamba - 30 ml amadzimadzi pa 1 makilogalamu a thupi patsiku,
onetsetsani kuti mumadya fiber yokwanira ngakhale mutakhala ndi zakudya zamafuta ochepa
Zakudya zopanda zakudya - yokazinga, yosuta, mankhwala omalizidwa,
Imwani antioxidants - vitamini C, vitamini E, alpha lipoic acid ndi ena,
kumwa mapiritsi a magnesium.

Pali chidziwitso, chomwe sichidatsimikiziridwe kale kuti choyambitsa gout si kudya nyama, koma kuchuluka kwa insulin m'magazi. Madzi a insulin ambiri akamazungulira m'magazi, ndiye kuti impso zake zimaphatikizanso uric acid, motero zimadziunjikira.

Pankhaniyi, zakudya zamagulu ochepa sizikhala zovulaza, koma zothandiza kwa gout, chifukwa zimapangitsa kuchuluka kwa insulin. Gwero lazambiri izi (mu Chingerezi). Zikuwonetsanso kuti kuukira kwa gout kumakhala kovuta ngati simukudya zipatso, chifukwa zimakhala ndi shuga wabwino wodya - fructose.

Tikukulimbikitsani aliyense kuti asadye zakudya za shuga zomwe zimakhala ndi fructose. Ngakhale lingaliro la Gary Taubes silitsimikiziridwa, matenda ashuga komanso zovuta zake, zomwe zakudya zamafuta ochepa zimathandizira kupewa, ndizowopsa kuposa gout.

Maphikidwe a chakudya chamafuta ochepa a mtundu 1 ndi matenda ashuga 2 amapezeka pano.

Kutupa kwa tulo ndi sitiroko

Fibrillation ya Atrial, kapena fibrillation ya atria, ndi mkhalidwe womwe mgwirizano wa atria mwachangu kwambiri (350-700 ukugunda pamphindi) komanso mwamwayi. Itha kuchitika mosiyanasiyana mosiyanasiyana monga kugwirira kwakanthawi kapena kotalika, kapena kupitiliza mosalekeza. Ndi fibrillation ya atgency, chiopsezo cha kugwidwa ndi matenda a mtima chikuwonjezeka.

Zoyambitsa zazikulu za atria fibrillation:

Kuthamanga kwa magazi.
IHD ndi myocardial infarction.
Zolimba za mtima wazotsatira komanso zopeza.
Chithokomiro chodwala.
Kusuta kwambiri, khofi, mowa.
Opaleshoni yamtima.
Matenda owopsa a m'mapapo.
Wogona Apnea.

Pakadutsa ululu wamankhwala, pamakhala kumverera kuti mtima umagunda kwambiri, "mokwiya", "kugwedezeka", "kudumpha kuchokera pachifuwa". Munthu amamva kufooka, kutopa, chizungulire, "chifunga" m'mutu mwake. Kupuma pang'ono, kupweteka pachifuwa kumatha kuchitika.

Chifukwa chiyani chiwopsezo cha matenda a sitiroko ndi atrion fibrillation ukuwonjezeka? Pakusintha kwa khungu, magazi samayenda moyenera m'zipinda za mtima.Chifukwa cha izi, magazi amaphatikizika mumtima. Chidutswa chake chimatha kuchoka ndikuyenda ndi mtsinje wamagazi.

Ngati ingalowe m'matumbo a ubongo ndikutchinga kuunikira kwa imodzi mwaiwo, sitiroko imayamba. Kuphatikiza apo, fibrillation ya atria imatha kubweretsa kulephera kwa mtima, ndipo izi ndizowopsa zomwe zingachitike chifukwa cha stroke.

Choopsa	Malangizo
Sitiroko yapambuyo kapena kufupika kwakanthaŵi kwa ischemic	2
Kuthamanga kwa magazi	1
Zaka 75 kapena kupitilira	1
Matenda a shuga	1
Kulephera kwa mtima	1

Mfundo zazikuluzikulu pamlingo wa CHADS2	Chiwopsezo cha stroke chaka chonse
1,9%
1	2,8%
2	4,0%
3	5,9%
4	8,5%
5	12,5%
6	18,2%

Njira yayikulu yolepheretsa kukonzanso sitiroko ndi ma fibrillation atria ndiko kugwiritsa ntchito maanticoagulants, mankhwala omwe amatchinga magazi:

Warfarin, ndiye Dzhantoven, ndiye Kumadin. Ichi ndi cholimba cholimba. Zitha kuyambitsa magazi kwambiri, choncho ziyenera kutengedwa momveka bwino malinga ndi malingaliro a dokotala ndikuwunika magazi pafupipafupi kuti awunikire.
Dabigatran etexilate, aka Pradax. Poyerekeza ndi warfarin pogwira ntchito, koma yotetezeka.
Rivaroxaban, aka Xarelto. Monga Pradax, ndi ya m'badwo watsopano wa mankhwala. Komanso osati otsika pogwira ntchito ku Warfarin. Imwani kamodzi patsiku, mosamalitsa malinga ndi zomwe dokotala wakupatsani.
Apixaban, aka Elikvis. Zikugwiranso ntchito ku mibadwo yatsopano ya mankhwala. Amatengedwa kawiri patsiku.

Kutupa kwamatenda ndi sitiroko kumakhala ndi zinthu zambiri zoopsa: kuthamanga kwa magazi, matenda a mtima, zizolowezi zina, zina zotere.

Matenda a matenda ashuga

Matenda a shuga a retinopathy ndimavuto amaso ndi maonekedwe omwe amapezeka chifukwa cha shuga wokwezeka wamwazi. Milandu yayikulu, imayambitsa kutayika kwakukulu kwa kuwona kapena khungu lathunthu.

Chofunika koposa, ndi matenda ashuga, kuwonongeka kowopsa m'masomphenya kapena khungu lathunthu kumatha kuchitika mwadzidzidzi. Kuti izi zisachitike, odwala omwe ali ndi matenda amtundu woyamba 1 amayenera kuyesedwa ndi a ophthalmologist kamodzi pachaka, makamaka kamodzi pamiyezi isanu ndi umodzi.

Komanso, sikuyenera kukhala wamba ophthalmologist ku chipatala, koma akatswiri a matenda a shuga a retinopathy. Madotawa amagwira ntchito kumalo osamalirira odwala matenda ashuga. Amachita zoyeserera zomwe ophthalmologist kuchokera ku chipatala sangathe kuchita ndipo alibe zida za izi.

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri ayenera kuyesedwa ndi a ophthalmologist panthawi yodziwitsa, chifukwa nthawi zambiri anali ndi matenda a shuga "mwakachetechete" omwe amapangidwa kwa zaka zambiri. Ndi matenda amtundu wa 1 shuga, tikulimbikitsidwa kuti mudzayendere katswiri wa ophthalmologist patatha zaka 3-5 atatha matendawa.

Dokotala wamaso akuwonetsa kuti muyenera kumuyang'anitsanso kangati kuchokera kwa iye, kutengera ndi momwe maso anu adzakhalire. Izi zitha kukhala zaka ziwiri zilizonse ngati matenda a retinopathy sanapezeke, kapena pafupipafupi, mpaka kanayi pachaka ngati chithandizo chofunikira chikufunika.

Chifukwa chachikulu chomwe chimapangidwira matenda a shuga a shuga ndi shuga wambiri. Poyeneranso, chithandizo chachikulu ndikugwiritsa ntchito bwino mtundu wa chithandizo cha matenda a shuga 1 kapena mtundu wachiwiri wa chithandizo cha matenda ashuga.

Zina ndizomwe zimakhudzidwa ndikupanga izi. Udindo wofunikira umachitika ndi chibadwidwe. Ngati makolo anali ndi matenda a shuga a retinopathy, ndiye kuti ana awo ali pachiwopsezo chowonjezereka. Pankhaniyi, muyenera kudziwitsa ophthalmologist kuti akhale wogalamuka makamaka.

Type 1 and 2 diabetesics nthawi zambiri amasiya kumva m'miyendo chifukwa cha matenda ashuga. Ngati izi zikuwonekera, ndiye kuti munthu wokhala ndi khungu la kumapazi sangamvekenso kuchepa, kuziziritsa, kuzizira, kuwotcha, kufinya chifukwa cha nsapato zosavomerezeka komanso mavuto ena.

Zotsatira zake, wodwala matenda ashuga amatha kukhala ndi mabala, zilonda zam'mimba, zilonda zam'mimba, kuwotcha kapena frostbite pamiyendo yake, yomwe sangaikayikira mpaka gangore iyamba. M'malo ovuta kwambiri, odwala matenda a shuga samalabadira ngakhale mafupa osweka a phazi.

Mu shuga, matenda nthawi zambiri amakhudza mabala amiyendo omwe samachiritsidwa.Mwanjira zambiri, odwala adadwalitsa mitsempha yodutsitsa ndipo, nthawi yomweyo, kuthamanga kwa magazi kudzera m'mitsempha yodyetsa miyendo yam'munsi ndikovuta. Chifukwa cha izi, chitetezo cha mthupi sichitha kukana majeremusi ndipo mabala amachiritsidwa.

Zilonda zokhazokha za matenda ammimba am'mimba

Poizoni wamagazi amatchedwa sepsis, ndipo matenda amfupa amatchedwa osteomyelitis. Ndi magazi, tizilombo tating'onoting'ono timatha kufalikira thupi lonse, ndikupatsira matupi ena. Izi zikuopseza moyo kwambiri. Osteomyelitis ndizovuta kuchiza.

Matenda a shuga angayambitse kuphwanya kwamiyendo ya phazi. Izi zikutanthauza kuti pakuyenda, kukakamizidwa kumayikidwa m'malo omwe sanapangidwire izi. Zotsatira zake, mafupawo ayamba kuyenda, ndipo chiwopsezo cha kufalikira chidzakulanso.

Komanso, chifukwa cha kupanikizika kosaneneka, chimanga, zilonda ndi ming'alu zimawoneka pakhungu la miyendo. Pofuna kupewa kudula phazi kapena mwendo wonse, muyenera kuphunzira malamulo osamalira odwala ashuga ndikuwatsata mosamala.

Ntchito yofunikira kwambiri ndikutsata mtundu wa chithandizo cha matenda a shuga 1 kapena mtundu wa 2 wodwala matenda a shuga kuti muchepetse shuga lanu lamagazi ndikulisunga bwino. Zotsatira zake, mitsempha yodutsika komanso kumva kukoka m'miyendo kudzachira patatha milungu ingapo, miyezi kapena zaka, kutengera zovuta zakukula kumene. Pambuyo pa izi, matenda ammimba a shuga sangathenso kuopsezedwa.

Mutha kufunsa mafunso mu ndemanga zokhudzana ndi zovuta za matenda ashuga, oyang'anira tsamba samayankhidwa mwachangu.

Mphamvu zachilengedwe zamankhwala olimbitsa thupi

Kupewa mankhwala othandizira odwala sitiroko kumatha kuchitika kokha monga kuwonjezera kwa mankhwala omwe adokotala adawadziwitsa.

Mankhwala achikhalidwe amatha kuletsa kukula kwa sitiroko, makamaka ndikulimbitsa khoma lamitsempha ndikuyeretsa thupi la mafuta ambiri.

Kupereka zombo mphamvu ndikubwezeretsa kutanuka, Japan sophora ingathandize. Tengani masamba ake owuma ndikumuthira 70% yankho la zakumwa zamankhwala pa supuni 1 ya zosaphika za supuni 5 zamadzimadzi. Kuumirira masiku 2-3, osaloleza kusungirako. Tengani madontho 20 mukatha kudya kamodzi (katatu pa tsiku).

Chinsinsi ichi chithandiza kutsitsa cholesterol ndikuyeretsa mitsempha yamagazi. Sambani ndimu imodzi, 1 lalanje bwino ndi burashi ndikusenda mu chopukusira nyama limodzi ndi peel. Madzi ochuluka kwambiri kuti mumenye. Unyinji ukhale wonenepa. Pazotsatira zomwe mukutsata, onjezani supuni 1 ya uchi wamtali wakuda ndi kusakaniza. Zotsatira zake zimatheka pomatenga 1 tsp. nikani pambuyo pa chakudya chilichonse.

Limbitsani ziwiya ndikuletsa kuchuluka kwa cholesterol pa iwo kungathandize udzu wa colza vulgaris. Zinthu zouma zimatsimikizira madzi otentha mu mbale yagalasi kwa ola limodzi. Pa kulowetsedwa, gawo limodzi la udzu ndi magawo 20 amadzi amatengedwa. Imwani kapu theka 4 pa tsiku.

Kuti tisunge thanzi komanso chisangalalo chofika pakukalamba kwambiri, ndikofunikira kukumbukira kuti kupewa ndi kuchiza matenda opha ziwopsezo zitha kugwira ntchito pokhapokha atachitidwa limodzi ndi dokotala komanso odwala.

Ngati matenda a shuga sawongoleredwa bwino, chifukwa chomwe wodwalayo amakhala ndi shuga wambiri kwa miyezi ndi zaka, izi zimawononga makoma amitsempha yamagazi kuchokera mkati. Amakutidwa ndi ma atherosselotic zolembera, m'mimba mwake mwake, kutaya kwa magazi kudzera m'matumbo kumasokonekera.

Odwala omwe ali ndi matenda a shuga a 2, nthawi zambiri pamakhala kuchuluka kwa shuga m'magazi, komanso kunenepa kwambiri komanso kusachita masewera olimbitsa thupi. Chifukwa chokhala moyo wopanda thanzi, amakhala ndi mavuto a cholesterol yamagazi komanso kuthamanga kwa magazi.

Izi ndi zinthu zina zowopsa zomwe zimawononga ziwiya. Komabe, shuga wokwezeka wamwazi chifukwa cha matenda amtundu 1 kapena 2 amathandizira pakukula kwa atherosclerosis. Ndiowopsa nthawi zambiri kuposa kuyesa matenda oopsa kapena kuyesa kolesterol koyenera.

Chifukwa chiyani atherosulinosis ndiyowopsa ndipo iyenera kuyang'aniridwa kuti isawononge chitukuko chake? Chifukwa mtima, mikwingwirima ndi mavuto m'miyendo mu matenda ashuga zimayamba ndendende chifukwa zotengera zimatsekeka ndi zolembedwa za atherosclerotic, ndipo magazi amayenda kudzera mwa iwo akusokonezedwa.

Mtundu woyamba wa 2 komanso wa matenda ashuga 2, kuwongolera kwa atherosclerosis ndi njira yachiwiri yofunika kwambiri mutakhala ndi shuga. Myocardial infaration ndi pamene gawo la minofu ya mtima limamwalira chifukwa chosakwanira magazi.

Mwambiri, nthawi zambiri mtima wa munthu usanayambike, mtima wake umakhala wathanzi. Vutoli silili mumtima, koma m'mitsempha lomwe limadyetsa magazi. Momwemonso, chifukwa chosokonezeka m'magazi, ma cell a ubongo amatha kufa, ndipo izi zimatchedwa stroke.

Kuyambira 1990s, zapezeka kuti shuga ndi magazi kwambiri zimakwiyitsa chitetezo cha mthupi. Chifukwa cha izi, zinthu zambiri zozungulira zotupa zimachitika mthupi, kuphatikiza mkati mwake khoma lamitsempha yama magazi.

Mafuta a cholesterol amamatira kumadera omwe akhudzidwa. Izi zimapanga mapangidwe a atherosclerotic pamakoma amitsempha yamagazi, omwe amakula kwakanthawi. Werengani zambiri za "Momwe matenda a matenda a shuga amapezekera mu shuga."

Tsopano mutha kukayezetsa magazi pazifukwa za mtima komanso kuunika moyenera kuopsa kwa vuto la mtima ndi sitiroko kuposa momwe mayeso a cholesterol angachitire. Palinso njira zoponderezera kutukusira, motero kuletsa atherosulinosis ndikuchepetsa chiopsezo cha ngozi yamtima. Werengani zambiri "Kuthana ndi vuto la mtima, kugunda kwa mtima ndi matenda a mtima."

Mwa anthu ambiri, shuga wamagazi samakhazikika, koma amawuka patangotha maola ochepa chakudya chilichonse. Madokotala nthawi zambiri amatcha kuti prediabetes. Shuga amatha ndikatha kudya amawononga kwambiri mtsempha wamagazi.

Makoma a mitsempha amakhala amtengo ndikuwotcha, zolembera zamtundu wa atherosclerotic zimamera pa iwo. Kutha kwa mitsempha yamagazi kupumula ndikukulitsa m'mimba mwake kuti kayendedwe ka magazi akuwonongeka. Matenda a shuga amatanthauza chiopsezo chowopsa cha matenda a mtima ndi sitiroko.

Kuti mum'thandize bwino komanso kuti musakhale ndi matenda a shuga, muyenera kumaliza magawo awiri oyamba a pulogalamu yachiwiri ya matenda ashuga. Izi zikutanthauza - kutsatira zakudya zamafuta ochepa komanso kuchita masewera olimbitsa thupi mosangalala.

Matenda a shuga komanso vuto la kukumbukira

Matenda a shuga amasokoneza kukumbukira ndi ntchito zina za ubongo. Vutoli limapezeka mwa achikulire ngakhale kwa ana omwe ali ndi matenda a shuga a mtundu woyamba 1. Chifukwa chachikulu chomwe chimapangitsa kuti anthu azikumbukira matenda ashuga ndi kusawerengera bwino shuga.

Komanso, ntchito yabwinobwino yaubongo imasokonezedwa osati ndi shuga wowonjezereka, komanso nthawi zambiri za hypoglycemia. Ngati ndinu aulesi kwambiri kuchitira wodwala wanu shuga ndi chikhulupiriro chabwino, ndiye musadabwe zikakhala zovuta kukumbukira zakale komanso kukumbukira zatsopano.

Nkhani yabwino ndiyakuti ngati mutatsatira mosamala pulogalamu ya matenda a shuga 1 kapena mtundu wa 2 wodwala matenda ashuga, ndiye kuti kukumbukira kwakanthawi kochepa komanso kwanthawi yayitali kumakhala bwino. Izi zimamvekanso ngakhale ndi anthu okalamba.

Kuti mumve zambiri, onani nkhani yakuti “Zolinga zakuchiritsira matenda amtundu 2 komanso matenda ashuga a 2. Zomwe ungayembekezere shuga wako ukayamba kuchita bwino. ” Ngati mukuwona kuti kukumbukira kwanu kwakulirakulira, ndiye kuti muziyamba kuwongolera shuga kwa masiku atatu kapena atatu.

Izi zikuthandizani kudziwa komwe mudalakwitsa komanso chifukwa chake matenda anu ashuga adachoka. Nthawi yomweyo, odwala matenda ashuga ndi okalamba, monga anthu onse. Ndipo ndi ukalamba, kukumbukira kumatha kufooka ngakhale mwa anthu opanda shuga.

Njira yothetsera vutoli imatha kuchitika chifukwa cha mankhwala, omwe mbali yake imakhala yotopetsa, kugona. Pali mankhwala ambiri otere, mwachitsanzo, mainkinkiller, omwe amaperekedwa kwa matenda a shuga. Ngati ndi kotheka, khalani ndi moyo wathanzi, yesani kumwa mapiritsi ochepera "mankhwala".

Kusunga kukumbukira kwazaka zambiri, samalani ndi zoletsa za matenda a atherosclerosis, monga tafotokozera m'nkhaniyi "Kupewa matenda a mtima, sitiroko komanso mtima kulephera".Atherosulinosis imatha kudzetsa ubongo mwadzidzidzi, ndipo izi zisanachitike pang'onopang'ono zimapangitsa kukumbukira.

Zomwe zimayambitsa kulowerera m'matenda a shuga

Matenda a mtima amakhala ovuta kwambiri kwa odwala matenda ashuga. Amakhala ochulukirapo, omwe nthawi zambiri amakhala ovuta chifukwa cha kusakwanira kwa contractile ntchito ya mtima, mpaka kuthetseratu kwa mtima, ntchito. Poyerekeza ndi kuwonjezeka kwa kuthamanga kwa magazi ndi njira ya dystrophic mu myocardium, aneurysm yamtima ndi kupasuka kwake kumachitika.

Fomu yovuta

Kwa odwala matenda ashuga, mitundu iyi ya kusowa kwamphamvu kwa coronary imadziwika:

kupweteka kwapafupipafupi (kwanthawi yayitali ya kupweteka pachifuwa),
m'mimba (Zizindikiro zam'mimba zopweteka),
zopanda pake (mawonekedwe apamwamba),
arrhythmic (kuukira kwa atrive fibrillation, tachycardia),
ubongo (kusowa kwa chikumbumtima, paresis kapena ziwalo).

Nthawi ya pachimake imatha masiku 7 mpaka 10. Pali kuwonjezeka kwa kutentha kwa thupi, kutsika kwa magazi. Kulephera kuzungulira kwa pachimake kumayambitsa mapapu a edema, kugunda kwa mtima, komanso kuchepa kwa mafupa am'mimba, komwe kungakhale kovulaza kwa wodwalayo.

Kulephera kwamtima kosalekeza

Amatchula zovuta zakumapeto kwa myocardial infarction, kukula kwake kwa odwala omwe ali ndi matenda osokoneza bongo kumabweretsa zotsatirazi:

kupuma movutikira, kutsokomola, nthawi zina hemoptysis,
kupweteka mtima
kugunda kwamtima kawiri kawiri
kupweteka ndi kulemera mu hypochondrium yoyenera,
Kutupa kwa m'munsi,
kutopa.

Kutupa kwamiyendo

Kodi zingakhale asymptomatic

Kupweteka kwapafupipafupi kwanthawi yayitali kapena kozunza ndi chizindikiro chachikulu cha vuto la mtima. Zimaphatikizidwa ndi thukuta, kuopa kufa, kupuma movutikira, kutsekeka kapena kufiyira kwa khungu la kolala. Zizindikiro zonsezi mwina siziri ndi matenda ashuga.

Izi ndichifukwa choti odwala matenda ashuga amakhudzidwa ndi ma capillaries ang'onoang'ono komanso ulusi wamitsempha mkati mwa myocardium chifukwa cha systemic microangiopathy ndi neuropathy.

Vutoli limachitika ndi nthawi yayitali chifukwa cha kuchuluka kwa shuga m'magazi. Dystrophy ya minofu ya mtima imachepetsa kuwona kwa zopweteka.

Kusokonezeka kwakasokonezeka kwama cell kumapangitsa kuti magazi azikhala ndi magazi, zomwe zimayambitsa kubwereza, kugunda kwamtima kwambiri, aneurysms, kugunda kwa minofu yamtima.

Njira yopanda kumva yopweteka imaphatikizira kuzindikiritsa kwa matenda kumayambiriro, kumawonjezera ngozi ya kufa.

Dziwani za matendawo kuti mutsimikizire kuti mwazindikira

Pazindikiritso, njira yophunzitsira kwambiri ndiyo kuphunzira kwa ECG. Zosintha monga:

nthawi ya ST ili pamwamba pa contour, ili ndi mawonekedwe a utoto, imadutsa mu T wave, yomwe imakhala yolakwika,
Kutalika koyamba poyamba (mpaka maola 6), kenako kutsika,
Q wave wave matalikidwe.

ECG ya kulowerera m'mitsewa yam'mimba komanso matenda a shuga - kovuta kwambiri

Pakayezetsa magazi, creatine kinase imakulitsidwa, aminotransferases ndi apamwamba kuposa abwinobwino, ndipo AST ndi yapamwamba kuposa ALT.

Chithandizo cha matenda a mtima mu odwala matenda ashuga

Chomwe chimapangitsa kuti shuga azikhala ndi matenda a shuga ndi kukhazikika kwa kuwerenga kwa shuga wamagazi, chifukwa popanda izi mtima uliwonse ukadakhala wopanda tanthauzo.

Pankhaniyi, kuponya kwakuthwa mu glycemia sikuloledwa, nthawi yayitali ndi 7.8 - 10 mmol / l. odwala onse, mosasamala mtundu wa matenda komanso chithandizo chamankhwala chomwe chatsimikiziridwa musanakumane ndi vuto la mtima, amasamutsidwira kuchipatala cholimbikitsidwa ndi insulin.

Magulu awa a mankhwala amagwiritsidwa ntchito pochiza matenda a mtima:

anticoagulants, thrombolytics,
beta-blockers, nitrate ndi othandizira calcium
antiarrhythmic mankhwala
mankhwala ochepetsa cholesterol.

Zakudya pambuyo myocardial infarction ndi shuga

Mu gawo la pachimake (masiku 7-10), phwando lokhazikika la chakudya chosenda bwino limasonyezedwa: msuzi wamasamba, mbatata zosenda (kupatula mbatata), phala la oatmeal kapena lophika la buwheat, nyama yophika, nsomba, kanyumba tchizi, mafuta omwera, mapuloteni otentha, kefir kapena yogati.Kenako mndandanda wazakudya ungakulidwe pang'onopang'ono, kupatula:

shuga, ufa woyera ndi zinthu zonse zomwe zilimo,
semolina ndi mpunga
mankhwala osuta, marinade, zakudya zamzitini,
chakudya chamafuta,
tchizi, khofi, chokoleti,
mafuta kanyumba tchizi, wowawasa kirimu, kirimu, batala.

Ndikosatheka kuthira mbale pophika chakudya, ndipo 3 mpaka 5 g (masiku 10 atachitika vuto la mtima) mchere umaperekedwa kwa wodwala. Mafuta sayenera kumwa osaposa 1 lita imodzi patsiku.

Kupewa matenda amtima wamatenda a shuga

Popewa kukula kwa matenda oopsa a coronary circulatory, tikulimbikitsidwa:

Kuwunikira mosamala shuga ndi mafuta m'thupi, kukonza kosemphana ndi nthawi.
Kuyeza kwa tsiku ndi tsiku kwa kuthamanga kwa magazi, mulingo woposa 140/85 mm Hg suyenera kuloledwa. Art.
Kusiya kusuta, zakumwa zoledzeretsa komanso zakumwa zina za tiyi, zakumwa zamphamvu.
Kugwirizana ndi chakudya, kupatula mafuta a nyama ndi shuga.
Zochita zolimbitsa thupi.
Chithandizo cha mankhwala othandizira.

Chifukwa chake, kukulitsa kwa vuto la mtima kwa odwala omwe ali ndi matenda amtundu wa 1 ndi mtundu wa 2 amatha kukhala asymptomatic, omwe amachititsa kuti adziwe bwino komanso kuti azikhala ndi zovuta. Mankhwala, muyenera kusintha shuga m'magazi ndikuchita mokwanira. Monga prophylaxis, momwe mungakhalire ndi kusintha kwamafuta akulimbikitsidwa.

Nthawi yomweyo, matenda ashuga ndi angina pectoris amawopseza thanzi lathu. Kodi kuchitira angina pectoris ndi mtundu 2 shuga? Kodi ndi kusokonezeka kwa mtima wamitima komwe kumachitika?

Pafupifupi palibe amene wakwanitsa kupewa chitukuko cha matenda a shuga. Izi ziwiri pathologies zimagwirizana, chifukwa kuchuluka kwa shuga kumakhudza mitsempha ya magazi, zomwe zimapangitsa kuti pakhale kusintha kwa atherosulinosis ya m'munsi kwambiri mwa odwala. Chithandizo chimachitika ndi chakudya.

Zomwe zimayambitsa infarction yaying'ono yokhazikika yofanana ndi mitundu ina yonse. Ndikosavuta kuzindikira kuti ECG yovuta kwambiri imakhala ndi chithunzi. Zotsatira zakuchira kwake komanso kukonza kwakanthawi ndizosavuta kuposa kukhala ndi vuto la mtima.

Osati zowopsa kwa anthu athanzi, arrhythmia yokhala ndi matenda osokoneza bongo imatha kukhala owopsa kwa odwala. Ndizowopsa makamaka kwa matenda ashuga amtundu wa 2, chifukwa amatha kudwala matenda a stroko komanso mtima.

Ndikosavuta kuzindikira, chifukwa nthawi zambiri njira yonyansa ya subendocardial myocardial infaration imakhala nayo. Nthawi zambiri zimapezeka pogwiritsa ntchito ECG ndi njira zoyeserera zasayansi. Matenda a mtima owopsa amawopseza kuti afe.

Matenda oopsa a arterial ndi matenda a shuga amawonongeka chifukwa cha ziwiya zambiri. Mukamatsatira malangizo a dokotala, mutha kupewa zotsatirapo zake.

Kupewa kulephera kwa mtima ndikofunikira konsekonse, pamafungo, kumbuyo, komanso asanabadwe amayi ndi abambo. Choyamba muyenera kuchiritsa matenda amtima, kenako kusintha moyo wanu.

Kuzindikira posachedwa koyambira kwapansi sikophweka chifukwa chazomwe zikuchitika. ECG yokha siyingakhale yokwanira, ngakhale zizindikiritso zoyenera zimatchulidwa. Kodi kuchitira myocardium?

Pali ischemia yopanda ululu, mwamwayi, osati kangapo. Zizindikiro zake ndizofatsa, mwina sipangakhale angina pectoris. Njira zowonongeka pamtima zidzatsimikiziridwa ndi dokotala malinga ndi zotsatira za kupezeka kwake. Chithandizo chimaphatikizapo mankhwala ndipo nthawi zina amachitidwa opareshoni.

Ubale wa patathogenetic wa matenda ashuga komanso mtima

Mgwirizano wodziwika bwino wa matenda ashuga komanso kulephera kwa mtima utha kufotokozedwa ndi njira zingapo zowonekeratu. Mwa odwala omwe ali ndi matenda ashuga, kuchuluka kwa zinthu zomwe zimayambitsa vuto la mtima kulephera ndi kwakukulu - ochepa matenda oopsa (AH) ndi IHD. Chifukwa chake, malinga ndi Gosregister ya matenda ashuga ku Russian Federation, pakati pa odwala omwe ali ndi matenda ashuga a 2, matenda oopsa amalembedwa mu 37.6% ya milandu, matenda ashuga a macroangiopathy - mu 8,3%. Kusintha kwazomwe zimachitika mu myocardium mwa odwala omwe ali ndi matenda ashuga osagwirizana ndi matenda amtima wabwino kungakhale chifukwa chachindunji cha zovuta zovuta zomwe zimayenderana ndi matenda a shuga.

Zikatero, ndi zizindikiro zakuya kwa mtima ndi kusapezeka kwa matenda amtima, matenda a mtima, matenda oopsa, obadwa nako, matenda obwera pamtima, ndizovomerezeka kunena za kupezeka kwa matenda ashuga a mtima (DCMP). Zoposa zaka 40 zapitazo, mawuwa adayamba kuperekedwa ngati tanthauzo la chithunzi cha odwala omwe ali ndi matenda osokoneza bongo, ogwirizana ndi dilated cardiomyopathy (CMP) yokhala ndi kachigawo kakang'ono ka ejection (CH-NFV). Komabe, malinga ndi kuonera kwamakono, mawonekedwe ofala kwambiri a wodwala omwe ali ndi DCMP ndi wodwala (nthawi zambiri amakhala wokalamba wokhala ndi matenda a shuga komanso matenda onenepa kwambiri) yemwe ali ndi zizindikiritso za CMP: kachigawo kakang'ono ka mbali ya kumanzere kwamitsempha, makulidwe a malinga kuchuluka kwa kukhuta kwa kudzazidwa kwa ventricle yamanzere, kuwonjezeka kwa atrium (LP) yamanzere, yomwe ikufanana ndi CH-SPV. Ofufuza ena amakhulupirira kuti mu shuga, monganso kuchuluka kwa anthu, CMP / CH-PPS yokhazikitsidwa ndi gawo lomwe lakhazikitsidwa kale CMP / CH-PFV 9, 10, pomwe ena amalungamitsa kudziimira pawokha kwa mitundu iwiriyi ya DCMP, kusiyana kwazachipatala ndi matenda (tabu 1).

Amaganiziridwa kuti njira zochitira autoimmune zimagwira gawo lalikulu pathogenesis ya dilated DCMP, ndipo kusiyanasiyana kwa DCMP kumeneku kumakhala kofanana ndi matenda amtundu 1 wa shuga, mosiyana ndi mtundu wa CMP wochepetsetsa kwambiri womwe umakhala mtundu wa matenda ashuga a 2.

Mbali inayo yamavuto ndi chiwopsezo chowonjezereka cha matenda a shuga kwa odwala omwe ali ndi vuto la mtima, omwe amafotokozedwanso ndi zinthu zingapo zomwe zakhazikitsidwa masiku ano: kupangika kwa insulin, mu genesis yomwe kulephera kwamtima kumayambitsa gawo la hyperactivation la system yacifundo yamanjenje, motero, kukuwonjezeka kwa lipolysis mu minofu ya adipose ndipo, motero Miyezo ya FFA, kuchuluka kwa gluconeogenesis ndi glycogenolysis m'chiwindi, kunachepetsa kuthamanga kwa glucose ndi minofu yamifupa, kuchepa kwa insulini, komanso kuchepa mphamvu zolimbitsa thupi, isfunktsiey endothelium chikoka cytokines (leptin, chotupa necrosis chinthu α), imfa ya minofu misa.

Ngakhale zovuta za mgwirizano wa pathogenetic pakati pa matenda ashuga ndi kulephera kwa mtima, chithandizo chazabwino cha matenda ashuga ndi zovuta zake zimachepetsa kwambiri chiopsezo chokhala ndi mtima kulephera (kalasi IIA, mulingo wa umboni A). Komabe, popewa kuyambika kwa kulephera kwa mtima komanso kuletsa kukula kwa zotsatira zoyipa, palibe umboni wazotsatira zabwino zolamulira glycemic. Zokhudza chitetezo chamtima cha mankhwala a hypoglycemic ndizofunikira kwambiri. Poganizira mgwirizano wapakati pa matenda ashuga komanso kulephera kwa mtima, womwe umatsimikiziridwa ndi deta yamatenda, kulephera kwa mtima, ngati vuto lapadera lazotsatira zamtima, siziyenera kunyalanyazidwa pakuwunika chitetezo cha matenda a shuga.

Hypoglycemic mankhwala ndi kulephera kwa mtima

Metformin

Metformin ndi woyamba kusankha mankhwala ochizira matenda amishuga amtundu wa 2 padziko lonse lapansi komanso mankhwala akumwa kwambiri a hypoglycemic, omwe amagwiritsidwa ntchito ndi pafupifupi anthu miliyoni 150 padziko lonse lapansi. Ngakhale zoposa theka la zaka ntchito yachipatala, magwiridwe antchito a metformin adayamba kuonekera bwino mchaka cha 2000s, atapezeka kuti mankhwalawa amaletsa ma oxidation am'magawo a mitochondrial kupuma kwa ine, zomwe zimapangitsa kuchepa pakupanga kwa ATP komanso kuphatikizana kwa ADP ndi AMP. zomwe zimatsogolera ku activation ya AMP-amadalira kinase (AMPK), puloteni yofunikira ya protein protein yomwe imayang'anira metabolism cell. Zotsatira za kafukufuku waposachedwa zikuwonetsa kuti metformin ikhoza kukhala ndi njira zingapo, AMPK yodziyimira payokha machitidwe, omwe amathandizira chidwi chachikulu mufunso la genesis yayikulu hypoglycemic zotsatira za mankhwalawo, komanso zotsatira zake zokondweretsa.Mu ntchito zoyesera pamitundu ya zinyama za DCMP, komanso kulowetsedwa kwa myocardial (kuphatikizapo kuvulala koyipa), zidawonetsedwa kuti metformin imasintha ntchito yamtima ndi AMPK-mediated up-regulation of autophagy (njira yofunika kwambiri yotsutsana ndi DCMP), imayendetsa bungwe la mitochondrial, kusokonezeka kwa kupumula kudzera mu kusintha kwa amadalira a tirizine kinase, kumachepetsa kukonzanso kwa pambuyo, kumachepetsa kukula kwa mtima ndipo kumathandizanso kapangidwe ka mtima ndi ntchito.

Umboni woyamba wazachipatala wa zotsatira za mtima wa metformin anali mu kafukufuku wa UKPDS, omwe adawonetsa kuchepa 32% pachiwopsezo cha mapeto ogwirizana ndi matenda a shuga, kuphatikizapo kulephera kwa mtima. Pambuyo pake (2005–2010), ntchito zingapo zinaonetsa zotsatira zabwino za mtima wa metformin: kuchepa kwa vuto la mtima mu gulu la metformin poyerekeza ndi mankhwala a sulfonylurea (SM), osawonjezereka pachiwopsezo cha kulephera kwa mtima ndi kuwonjezeka kwa mlingo wa mankhwalawo, kuchepa kwapafupipafupi kwa kugundidwa kwa mtima chifukwa cha kulephera kwa mtima, kuchepa kufa kwa zoyambitsa zonse pakati pa odwala omwe ali ndi vuto la mtima. Komabe, kwanthawi yayitali, chifukwa chakuwonjezereka kwa chiwopsezo cha lactic acidosis, metformin idapangidwa pamaso pa HF. Zambiri zaposachedwa, komabe, zikuwonetsa kusatheka kwa zoletsa zoterezi, motero, chitetezo cha mankhwalawa kwa odwala omwe ali ndi matenda osokoneza bongo komanso kulephera kwa mtima, kuphatikizira omwe ali ndi kuchepa kwa impso. Chifukwa chake, pakuwonetsedwa kwa meta-zotsatira, zotsatira za kafukufuku 9 (odwala 34,504 odwala matenda ashuga ndi mtima) adawunikiridwa, omwe anaphatikiza odwala 6,624 (19%) omwe amathandizidwa ndi metformin. Zinawonetsedwa kuti kugwiritsa ntchito mankhwalawa kumalumikizidwa ndi kuchepetsedwa kwa 20% yaimfa pazifukwa zonse poyerekeza ndi mankhwala ena ochepetsa shuga, sizikugwirizana ndi phindu kapena kuvulaza kwa odwala omwe ali ndi EF yochepetsedwa (mtundu 4 (IDP4))

Posachedwa, zotsatira za kafukufuku yemwe akuyembekezeredwa kwa placebo wolamulira zamitima ya Saxagliptin - SAVOR-TIMI, yomwe idaphatikizapo odwala 16,492 omwe ali ndi matenda a shuga 2 (saxagliptin - n = 8280, placebo - n = 8212), omwe anali ndi mbiri ya zochitika zam'mtima, adasindikizidwa posachedwa kapena chiwopsezo chachikulu cha kukulitsa. Poyamba, 82% ya odwala anali ndi matenda oopsa, 12,8% anali ndi vuto la mtima. Malinga ndi zotsatira za kafukufukuyu, palibe kusiyana komwe kunapezeka pakati pa gulu la saxagliptin ndi gulu la placebo la canonical pulayimale yolumikizana yophatikizika (MACE: kufera kwamtima, infarction ya nonfatal myocardial, sitiroko ya nonfatal) ndi sekond endpoint (MACE +), yomwe idaphatikizanso zipatala zina za angina osakhazikika / coronary revascularization / HF. Nthawi yomweyo, kuwonjezereka kwa pafupipafupi kwa zipatala chifukwa cha kulephera kwa mtima kwapezeka kuti ndi 27% (3.5% m'gulu la saxagliptin ndi 2.8% mu gulu la placebo, p = 0.007, RR 1.27, 95% CI: 1.07-11 , 51) popanda kuchuluka kwaimfa. Olosera zamphamvu kwambiri za kuchipatala chifukwa cha kulephera kwa mtima zinali zam'mbuyo zam'mbuyo, GFR 2, ndi kuchuluka kwa albumin / creatinine. Kuphatikiza apo, kulumikizana mwachindunji kunakhazikitsidwa pakati pa mulingo wa NT-brain natriuretic peptide ndi chiwopsezo cha mtima kulephera ndi saxagliptin. Palibe kusiyana komwe kunapezeka pakati pa maguluwa pamlingo wa troponin T ndi C-protein yogwira, yomwe imawerengedwa kuti ndi umboni wa kusowa kwa kuchitapo kwa kutupa ndi chiwongola dzanja mwachindunji cha saxagliptin. Njira zomwe zingapangitse chiwopsezo cha kuwonongeka kwa HF kutengera zakumapeto kwa saxagliptin zikadali kutsutsana; akuti IDP4 ikhoza kusokoneza kuchepa kwa ma peptides ambiri oyipa, makamaka ubongo wa natriuretic peptide, momwe amawonjezeka kwambiri odwala omwe ali ndi HF. Nthawi yomweyo, ziyenera kudziwika kuti poyamba mu gulu la saxagliptin poyerekeza ndi gulu la placebo panali odwala ochulukirapo omwe amatenga thiazolidinediones (6.2% ndi 5.7%, motsatana), omwe, mwina, angakhudze zotsatira zake pokhudzana ndi kulephera kwa mtima.

Kafukufuku woyamba wopangidwa ndi anthu ambiri azotsatira zamatenda a 2 omwe amachitidwa ndi sitagliptin (kafukufuku wobwezeretsanso cohort, odwala 72,738, zaka zapakati pa 52, 11% adalandira sitagliptin) adawonetsa kusowa kwa mtundu uliwonse wa mankhwalawa pangozi yakugonekedwa komanso kufa. Komabe, kafukufuku yemwe anachitika pagulu linalake - pagulu la odwala matenda amtundu wa 2 ndipo adakhazikitsa HF, adawonetsa zotsutsana. Zambiri kuchokera pa kafukufuku woyamba wokhuza kuchuluka kwa anthu odwala matenda ashuga a 2 komanso matenda a mtima adalembedwa mchaka cha 2014. Mu kafukufuku wa cohort yemwe cholinga chake chinali kuwunika zotsatira za sitagliptin (kuphatikizapo kuchipatala chifukwa cha kulephera kwa mtima ndi kufa chifukwa cha kulephera kwa mtima), adaphatikiza odwala 7820 ( wazaka zapakati pa 54, 58% ya abambo), zidapezeka kuti kugwiritsa ntchito sitagliptin sikugwirizana ndi kuwonjezereka kwa zipatala pazifukwa zonse kapena kuchuluka kwaimfa, koma odwala omwe amalandila mankhwalawa anali okwera kwambiri chiopsezo chogonekedwa m'chipatala chifukwa cha mtima (12,5%, aOR: 1.84, 95% CI: 1.16-2.92). Maphunziro onsewa omwe akukambirana, openyerera, anali ndi zoyambirira zingapo, kutanthauza kumasulira mosamala kwa zotsatirazo. Mwakutero, zotsatira za kafukufuku waposachedwa wa TECOS RCT, khungu lofufumitsa kawiri, losasinthika, lolowerera pamatenda a mtima ndi misgliptin pagulu la odwala 14 671 omwe ali ndi matenda a shuga a 2 omwe ali ndi matenda amtundu wamtima (kuphatikizapo HF (18%)) komanso zowopsa pamtima. Zotsatira zake, panalibe kusiyana pakati pa gulu la sitagliptin ndi gulu la placebo mu pulayimale (nthawi yakumwalira kwamtima, infarction yopanda kufooka, sitiroko yakupha, kuchipatala kwa angina pectoris osakhazikika) ndi mapeto apamwamba. Palibe kusiyana mu pafupipafupi kwa zipatala za mtima zomwe zalephera. Mu kafukufuku wa TECOS, sitagliptin nthawi zambiri amawonetsa kuti satenga nawo mbali (wofanana ndi placebo) pokhudzana ndi chitukuko cha zochitika zamtima.

Kafukufuku wotsogozedwa woyesedwa ndi placebo wa alogliptin (EXAMINE, alogliptin n = 2701, placebo n = 2679) mwa odwala omwe ali ndi vuto lodana ndi kupweteka kwa msana kapena osakhazikika angina (pafupifupi 28% ya odwala m'magulu onsewa anali ndi vuto la mtima) nawonso sanatchule zovuta zina za mankhwalawo Zokhudza zochitika zokhudzana ndi CH pakuwunika positi hoc. Mosiyana ndi SAVOR-TIMI, palibe ubale womwe unapezeka pakati pa kuchuluka kwa ubongo wa cholera wa bongo ndi kulephera kwa mtima mu gulu la alogliptin. Posindikizidwa posachedwapa meta-kusanthula kwa maphunziro a vildagliptin (40 RCTs) ndi linagliptin (19 RCTs) sizinawonetse kusiyana pakubwereza kosavuta kwa zipatala chifukwa cha kulephera kwa mtima pakati pa magulu a IDP4 ndi magulu ofanananira. Mu 2018, zotsatira za kafukufuku awiri woyembekezeredwa kwa chitetezo cham'magazi a linagliptin mwa odwala omwe ali ndi matenda a shuga a 2 akuyembekezeka: CAROLINA (NCT01243424, n = 6,000, kufananizira mankhwala glimepiride) ndi CARMELINA (NCT01897532, n = 8300, kuwongolera kwa placebo) .

Ngakhale zotsatira za kafukufuku yemwe tafotokozazi, munthu sanganyalanyaze zotsutsana za meta zomwe zikuwonetsa mgwirizano pakati pa gulu la IDP4 ndi chiopsezo chowonjezeka cha kulephera kwa mtima, milandu yatsopano, kulephera kwa mtima, komanso kuchipatala chifukwa cha kulephera kwa mtima 52-55. Chifukwa chake, zikuwoneka zomveka kukana mfundo zomaliza zokhuza chitetezo cha IDP4 pa HF, mpaka njira zothetsera izi zikhazikike.

Empagliflozin

Chofunikira pa chitetezo chamtima ndichinthu chatsopano pakuwongolera kugwiritsa ntchito kwa othandizira a hypoglycemic m'magawo oyambawo a mankhwalawa atsegulidwa pamsika. Popeza kulandira zatsopano, nthawi zina zosayembekezeka pazomwe zili zabwino, zosagwirizana ndi zovuta kapena zovuta zamankhwala zomwe zimagwiritsidwa ntchito pochiza matenda amtundu wa 2, kumvetsetsa kwa magulu atsopano a mankhwala ndikomveka. Kuyambira 2012mdziko lapansi odwala matenda ashuga, mankhwala a gulu la kusankha rehibulosis wa sodium-glucose cotransporter a mtundu 2 (SGLT2) ayamba kugwiritsidwa ntchito mu monotherapy komanso kuphatikiza mankhwala a matenda ashuga amtundu wa 2. Mu 2014, mankhwala atsopano a kalasi iyi, empagliflozin, adalowa mdziko lonse lapansi komanso kuchipatala. Empagliflozin ndi SGLT2 inhibitor yowonetsa mu vitro mokhudzana ndi SGLT2,> 2500 kuchuluka kwakukulu poyerekeza ndi SGLT1 (kofotokozedwa mozama mu mtima, komanso matumbo, trachea, ubongo, impso, testicles, prostate) ndi> nthawi 3500 poyerekeza ndi SGLT4 (ofotokozedwa m'matumbo, trachea impso, chiwindi, ubongo, mapapu, chiberekero, kapamba). Empagliflozin imachepetsa kugwiranso kwina kwa glucose ndikuwonjezera kuchuluka kwa shuga kwam'mimba, potero kuchepetsa hyperglycemia, komwe kumayenderana ndi osmotic diuresis, kumachepetsa kuthamanga ndi kuthamanga kwa magazi popanda kuwonjezeka kugunda kwa mtima, kumachepetsa kuuma komanso kutsutsana ndi minyewa, komanso kumapangitsa kusintha kwa albuminuria ndi hyperuricemia. Chitetezo chamtima cha empagliflozin adaphunziridwa mu multicenter, akhungu awiri, gawo lachitatu la EMPA-REG Outcome (NCT01131676). Kafukufukuyu anakhudza maiko 42, zipatala 590. Momwe mungaphatikizire: odwala omwe ali ndi matenda a shuga a 2 ≥ zaka 18, BMI ≤ 45 kg / m 2, HbA_1c 7-10% (pafupifupi HbA_1c 8.1%), eGFR ≥ 30 ml / mphindi / 1.73 m 2 (MDRD), kupezeka kwa matenda amtima wotsimikizika (kuphatikizapo matenda a mtima, matenda oopsa, mbiri yakale ya myocardial infarction kapena stroke, matenda opatsirana m'mitsempha. Ofufuzawo adapanga gulu la odwala omwe ali ndi chiwopsezo chachikulu cha mtima (zaka zapakati pa 62.1 zaka, zokumana nazo za matenda a shuga 2 - zaka 10) ndipo adasanjidwa m'magulu atatu: gulu la placebo (n = 2333), gulu la empagliflozin 10 mg / tsiku (Koma10) (n = 2345) ndi gulu la empagliflozin 25 mg / tsiku (Koma25) (n = 2342). Poyamba, mpaka 81% ya odwala adalandira eniotensin-converting enzyme inhibitor kapena angiotensin receptor blocker (ACE / ARB), 65% - β-blockers, 43% - diuretics, 6% - mineralocorticoid receptor antagonist (AMP). Kafukufukuyu adakhalapo mpaka patadutsa zochitika 691 zogwirizana ndi zigawo za pulayimale yotsiriza (MACE, kufa kwamtima, kusafa ndi vuto la mtima kapena kusapha koopsa) - chithandizo chapakatikati pa zaka 2.6, kutsatiridwa kwapakati pa zaka 3.1. Zotsatira zamtima zonse zimayesedwa mosakayikira ndi makomiti awiri aukadaulo (a mtima ndi zochitika zamitsempha). Zotsatira zomwe zaphatikizidwazo zinaphatikizaponso zipatala za odwala matenda amtima, chonse - zipatala za mtima kapena kufa kwamtima (kupatula kuwonongeka kwa mtima), zipatala mobwerezabwereza chifukwa cha kulephera kwa mtima, milandu yakulephera kwamtima yolembetsedwa ndi wofufuzayo, kuyika ziwalo zotupa, kufa chifukwa cha kulephera kwa mtima, kuchipatala kwa onse zifukwa (kuchipatala chifukwa cha kuyambika kwa zovuta zilizonse). Kuwunikira kowonjezera kunachitika m'magulu ang'onoang'ono omwe amapangidwa pamaziko a zoyambirira, kuphatikiza kukhalapo / kusowa kwa HF lolembetsedwa ndi wofufuzayo.

Malinga ndi zotsatira zake, zidawonetsedwa kuti poyerekeza ndi placebo, chithandizo cha odwala omwe ali ndi matenda a shuga 2 omwe ali ndi empagliflozin kuwonjezera pa chithandizo chamankhwala amachepetsa pafupipafupi kuyambika kwa mfundo yayikulu (MACE), kupha kwamtima ndi kufa kwa zifukwa zonse. Empagliflozin inachepetsanso kuchuluka kwa zipatala pazifukwa zonse, kuchuluka kwa zipatala chifukwa cha kulephera kwa mtima ndi zifukwa zina (Table 2).

Chiwopsezo chotsika chakufunika kwa ma loop okodzetsa m'gulu la empagliflozin adadziwika. Mankhwalawa adachepetsa pafupipafupi zotsatira zaziphatikizidwe: zipatala chifukwa cha kulephera kwa mtima kapena kutseguka kwa ziwalo zotayirira (HR 0.63, 95% CI: 0.54-0.73, p 2, mbiri yakale ya myocardial infarction kapena atration fibrillation, nthawi zambiri ankalandira insulin, okodzetsa, β -Blockers, ACE / ARB, AWP.Odwala onse omwe ali ndi HF yoyamba (gulu la placebo ndi gulu la empagliflozin) adalemba zochitika zambiri zowopsa (AE), kuphatikizapo omwe amafuna kusiya chithandizo, poyerekeza ndi odwala opanda HF. Nthawi yomweyo, m'gulu la empagliflozin, poyerekeza ndi placebo, panali pafupipafupi ma AE onse, ma AE akuluakulu ndi ma AE omwe amafuna kuti mankhwala athetse.

Chifukwa chake, malinga ndi kafukufuku wa EMPA-REG OUTCOME, empagliflozin, kuwonjezera pa chithandizo chamankhwala, amachepetsa chiopsezo chogonekedwa kuchipatala chifukwa cha mtima kapena kufa kwamtima ndi 34% (kuteteza kuchipatala chimodzi chifukwa cha kulephera kwa mtima kapena kufa kwamtima, odwala 35 ayenera kulandira chithandizo 3 zaka). Kugwiritsa ntchito kwa empagliflozin mwa odwala omwe ali ndi vuto la mtima makamaka pankhani yachitetezo sikotsika kwa placebo.

Pomaliza, kupewa kukula kwa chizindikiro cha mtima kulephera, kuchepetsa kuchepa kwa matendawa, kuchepetsa kuchuluka kwa kuchipatala ndikusinthira kudwala kwa odwala ndizofunikira zamankhwala omwe amachititsa kuti mtima usafooke. Kugwiritsa ntchito mankhwala a hypoglycemic omwe ali otetezeka pazotsatira zamtima ndi ntchito ina yowonjezera pochiza odwala omwe ali ndi matenda a shuga a 2 komanso a 2 matenda a shuga. Pochiza matenda a shuga a mtundu wa 2 kuchokera kumbuyo kwa HF, kuletsa kugwiritsa ntchito pamlingo wina kapena kwinanso (nthawi zambiri, osatsimikiza kwathunthu) kumagwira pafupifupi mankhwala onse ochepetsa shuga.

Empagliflozin ndi mankhwala okhawo omwe ali ndi antiidiabetes omwe adawonetsa pakufufuza kwakukulu osati chitetezo chokha, komanso maubwino ogwiritsa ntchito - kusintha zotsatira zomwe zimakhudzana ndi kulephera kwa mtima kwa odwala omwe ali ndi matenda a shuga a 2 ndikuyambitsa matenda a mtima.

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