Mavuto am'mbuyo amayamba m'mitundu yonse iwiri ya matenda ashuga. Makamaka, zovuta zisanu zomaliza za matenda ashuga zimasiyanitsidwa: macroangiopathy, nephropathy, retinopathy, neuropathy, ndi matenda ashuga odwala matenda ashuga. Kusakhala kwachilendo kwa zovuta za mochedwa zamitundu ina ya shuga kumatsimikiziridwa ndikuti kulumikizana kwakukulu kwa pathogenetic ndi hyperglycemia yosachiritsika. Pankhani imeneyi, pa nthawi yowonetsera CD-1, zovuta za mochedwa mwa odwala sizimachitika konse, zikukula pambuyo pa zaka ndi makumi, kutengera mphamvu ya mankhwalawa. Mtengo wapamwamba kwambiri wa matenda ashuga-1, monga lamulo, umapeza matenda a shuga a shuga (nephropathy, retinopathy) ndi neuropathy (diabetesic phazi syndrome). Mu DM-2, m'malo mwake, zovuta zakumapeto nthawi zambiri zimapezeka kale panthawi yazidziwitso. Choyamba, izi zimachitika chifukwa chakuti SD-2 imadziwonekera kale nthawi yayitali isanakhazikitsidwe. Kachiwiri, atherosulinosis, yowonetsedwa ndi macroangiopathy, ali ndi maulalo ambiri a pathogenesis ofanana ndi matenda a shuga. Mu shuga mellitus-2, wodwala matenda ashuga macroangiopathy, omwe panthawi yodziwikiratu amapezeka odwala ambiri. Munthawi zonsezi, kukhazikika kwa kuwonongeka kwa munthu mochedwa kumasiyana chifukwa cha kusakhalapo kwathunthu, ngakhale kutalika kwa matendawa, kuphatikiza kwa njira zonse zomwe zingatheke mu mawonekedwe osaneneka.

Mavuto apambuyo pake chachikulu choyambitsa imfa odwala matenda ashuga, ndikulingalira kuchuluka kwake - vuto lofunika kwambiri lazachipatala ndi chikhalidwe cha anthu m'maiko ambiri. Pankhaniyi cholinga chachikulu cha chithandizo ndikuwonanso kwa odwala omwe ali ndi matenda ashuga ndi kupewa (koyambirira, kwachiwiri, kwachiwiri) kwa zovuta zake.

7.8.1. Mashuga a macroangiopathy

Mashuga a macroangiopathy - lingaliro limodzi lomwe limaphatikizira zotupa za atherosulinotic zam'mitsempha yayikulu m'magazi a shuga, omwe amawonetsedwa ndi matenda a mtima (CHD), kuwononga ma atherosulinosis a ziwiya zaubongo, malekezero, ziwalo zamkati ndi matenda oopsa a magazi (Gome 7.16).

Tab. 7L6. Mashuga a macroangiopathy

Etiology ndi pathogenesis

Hyperglycemia, ochepa matenda oopsa, kukomoka, kunenepa, insulini, Hypercoagulation, kusokonekera kwa endothelial, kupsinjika kwa oxidative

Chiwopsezo chotenga matenda a mtima ndi matenda a shuga 2 ndiwokwera kasanu ndi umodzi kuposa misewu yopanda matenda a shuga. Matenda oopsa a arterial amapezeka mu 20% ya odwala omwe ali ndi matenda amtundu woyamba 1 komanso mwa 75% ya odwala omwe ali ndi matenda a shuga a 2. Peripheral arteriosulinosis mu zotumphukira zotengera zimayambira 10%, ndipo ubongo thromboembolism mu 8% ya odwala matenda ashuga

Mawonetseredwe akulu azachipatala

Zofanana ndi zomwe zimapezeka mwa anthu opanda shuga. Ndi shuga myocardial infarction mu 30% yaopanda zopweteka

Zofanana ndi zomwe zimapezeka mwa anthu opanda shuga.

Matenda ena amtima, matenda oopsa a matenda oopsa, dyslipidemia yachiwiri

Mankhwala othandizira antihypertensive, kukonza dyslipidemia, antiplatelet mankhwala, kuwunika ndi kuchiza matenda a mtima

Matenda amtima amwalira 75% ya odwala omwe ali ndi matenda a 2 a shuga komanso 35% ya odwala matenda a shuga 1

Etiology ndi pathogenesis

Mwinanso, etiology ndi pathogenesis ya atherosulinosis yamisewu yopanda matenda a shuga ndi ofanana. Madera a atherossteotic samasiyana pakapangidwe kakang'ono ka misewu yokhala ndi opanda shuga. Komabe, mu shuga, zina zowonjezera zimatha kudziwikiratu, kapena shuga imakulitsa zinthu zosadziwika. Omwe ali ndi matenda ashuga ayenera kuphatikizapo:

1. Hyperglycemia. Ndi chiopsezo cha chitukuko cha atherosulinosis. 1% kuchuluka kwa HbAlc mwa odwala matenda a shuga a 2

Pali chiopsezo 15% chokhala ndi infracation ya myocardial. Kupanga kwa atherogenic mphamvu ya hyperglycemia sikumveka kwathunthu; kumatha kuphatikizidwa ndi glycation ya zomaliza za metabolic zopangidwa ndi LDL ndi collagen khoma lamitsempha.

Matenda oopsa (AH). Mu pathogenesis, kufunikira kwakukulu kumalumikizidwa ndi gawo la impso (diabetesic nephropathy). Matenda oopsa mu shuga-2 siwofunikira kwambiri pakulimbana ndi matenda a mtima komanso sitiroko kuposa hyperglycemia.

Dyslipidemia. Hyperinsulinemia, yomwe ndi gawo lothandizira kukana insulini ku DM-2, imayambitsa kuchepa kwa HDL, kuchuluka kwa triglycerides ndi kuchepa kwa kachulukidwe, i.e. kuchuluka kwa atherogenicity kwa LDL.

Kunenepa kwambiri, komwe kumakhudza odwala ambiri omwe ali ndi matenda amtundu wa 2, ndimtundu wodziyimira pawokha wa atherosulinosis, myocardial infarction, and stroke (onani gawo 11.2).

Kukana insulini. Hyperinsulinemia komanso kuchuluka kwambiri kwa mamolekyulu a insulin-proinsulin kumawonjezera mwayi wokhala ndi atherosulinosis, yomwe imatha kuphatikizidwa ndi endothelial dysfunction.

Kuphwanya magazi. Mu matenda a shuga, kuwonjezereka kwa kuchuluka kwa fibrinogen, activator wa cholester inhibitor ndi von Willebrand factor, amatsimikiza, chifukwa chomwe prothrombotic mkhalidwe wamagazi owundana amayamba.

Endothelial kukanika, yodziwika ndi kufalikira kwa plasminogen inhibitor activator ndi maselo omatira a cell.

Kupanikizika kwambiri, zikupangitsa kuwonjezeka kwa oxidized LDL ndi P2-isoprostanes.

Kutupa kwamatenda momwe mukuwonjezekera kwa kufotokozera kwa fibrinogen ndi mapuloteni a C-reactive.

Zowopsa zazikulu zomwe zimayambitsa matenda a mtima wapamtima omwe ali ndi matenda a shuga a 2 amakwezedwa LDL, HDL yotsika, matenda oopsa, hyperglycemia, ndi kusuta. Chimodzi mwazosiyana muzochitika za atherosselotic mu shuga ndizofala vuto lobisika i.e. Mitsempha yaying'ono kwambiri nthawi zambiri imathandizira pochita opaleshoniyo, ndipo imawonjezera matendawa.

Chiwopsezo chotenga matenda a mtima chapamtima mwa anthu omwe ali ndi matenda ashuga 2 ndiwochulukirako kasanu ndi kawiri kuposa mwa anthu omwe alibe shuga, pomwe izi ndizofanana kwa amuna ndi akazi. Matenda oopsa a arterial amapezeka mu 20% ya odwala omwe ali ndi matenda amtundu woyamba 1 komanso mwa 75% ya odwala omwe ali ndi matenda a shuga a 2. Mwambiri, mwa odwala matenda ashuga, zimachitika kangapo kawiri kuposa misewu popanda iwo. Peripheral arteriosulinosis obliterans amakula mu 10% ya odwala matenda ashuga. Thromboembolism yamatumbo amadzimadzi amapezeka mu 8% ya odwala omwe ali ndi matenda ashuga (kawiri kawiri kuposa anthu omwe alibe shuga).

Kwenikweni, sizimasiyana ndi misewu yopanda matenda a shuga. Pachithunzi cha chipatala cha CD-2, zovuta za macrovascular (kulowerera kwam'mimba, sitiroko, zotupa zam'miyendo) nthawi zambiri zimawonekera, ndipo ndi nthawi yomwe akukula kuti wodwala amapezeka koyamba ndi hyperglycemia. Mwina, chifukwa cha concontitant autonomic neva

Mfundo zopezeka ndi zovuta za atherosulinosis (CHD, ngozi ya ubongo, chotupa cha m'mitsempha yamiyendo) sizisiyana ndi za anthu opanda matenda a shuga. Kuyeza kuthamanga kwa magazi (BP) ziyenera kuchitika pakuyendera kulikonse kwa wodwala yemwe ali ndi matenda ashuga kwa dokotala, ndi kutsimikiza kwa zizindikiro lipid mawonekedwe magazi (cholesterol yathunthu, triglycerides, LDL, HDL) ya matenda ashuga iyenera kuchitika kamodzi pachaka.

Matenda ena amtima, matenda oopsa a matenda oopsa, dyslipidemia yachiwiri.

♦ Kuyendetsa magazi. Mulingo woyenera wa kuthamanga kwa magazi mu matenda a shuga ndi ochepera 130 MMHg, ndipo a diastolic ndi 80 MMHg (Gome 7.3). Odwala ambiri amafunikira mankhwala ambiri a antihypertensive kuti akwaniritse cholinga ichi. Mankhwala osankha antihypertensive chithandizo cha matenda ashuga ndi ACE inhibitors ndi angiotensin receptor blockers, omwe amathandizidwa ndi thiazide diuretics, ngati pakufunika. Mankhwala osankhidwa kwa odwala omwe ali ndi matenda ashuga pambuyo poyambitsa myocardial infarction ndi P-blockers.

Kukonza kwa dyslipidemia. Zisonyezo zakulembedwera kwa zizindikiro za lipid zimawonetsedwa pagome. 7.3. Mankhwala osankhidwa a hypolipidemic therapy ndi zoletsa za 3-hydroxy-3-methylglutaryl-CoA reductase (statins).

Antiplatelet mankhwala. Aspirin mankhwala (75-100 mg / tsiku) akuwonetsedwa kwa odwala omwe ali ndi zaka zoposa 40 omwe ali ndi chiopsezo chowonjezereka cha matenda a mtima (mbiri yakale, matenda oopsa, kusuta, dyslipidemia, microalbuminuria), komanso odwala onse omwe ali ndi chiwonetsero cha matenda a atherosulinosis kupewa kwachiwiri.

Kuunika ndi kuchiza matenda a mtima. Kuyesedwa kwa kupsinjika kupatula matenda amkati amtima kumaonetsedwa kwa odwala omwe ali ndi matenda amtima komanso kupezeka kwa matenda am'mimba ndi ECG.

Kuchokera pamatenda amtima, 75% ya odwala omwe ali ndi matenda a 2 a shuga komanso 35% ya odwala omwe ali ndi matenda amtundu woyamba 1 amamwalira, pafupifupi 50% ya odwala omwe ali ndi matenda a 2 amwalira chifukwa cha matenda amtima, komanso 15% ya matenda a m'magazi. Imfa yakufa kwa myocardial infaration mwa anthu odwala matenda ashuga imaposa 50%.

7.8.2. Matenda a shuga a retinopathy

Matenda a shuga a retinopathy (DR) - retinal vascular microangiopathy, yodziwika ndi kukula kwa micaneurysms, zotupa m'mimba, kusintha kwachulukidwe komanso kuchuluka kwa zombo zomwe zangopangidwa kumene, zomwe zimatsogolera pakuwonongeka kwakanthawi kapena kawonedwe kotheratu (Gome 7.7).

Chofunikira kwambiri pakukula kwa DR ndi matenda a hyperglycemia. Zina zomwe (matenda oopsa, ochepa, kusuta, kubereka, ndi zina zambiri) ndizosafunika.

Maulalo apamwamba mu pathogenesis waku DR ndi:

retinal vascular microangiopathy, zomwe zimatsogolera kuchepa kwa lumen ya ziwiya ndi kukula kwa hypoperfusion, kusintha kwamitsempha ndi mapangidwe a micaneurysms, hypoxia yomwe ikupita patsogolo, kukulitsa mtima wa mtima ndikupangitsa kuti mafuta achulukidwe ndikuthanso kwamchere wamchere mu retina,

Microinfarction ndi exudation, zomwe zimapangitsa kuti pakhale "mawanga" a thonje ofewa,

Tab. 7.17. Matenda a shuga a retinopathy

Etiology ndi pathogenesis

Matenda a hyperglycemia, michereopathy yam'mimba, retic ischemia ndi neovascularization, mapangidwe a arteriovenous shunts, vitreoretinal traction, retinal detachment ndi ischemic retinal degeneration

Choyambitsa chachikulu cha khungu pakati pa anthu ogwira ntchito. Pambuyo pazaka 5, CD-1 imapezeka mu 8% ya odwala, ndipo patatha zaka 30 mu 98% ya odwala. Panthawi yodziwitsa, CD-2 imapezeka mu 2040% ya odwala, ndipo patatha zaka 15 - mu 85%. Ndi CD-1, retinopathy yowonjezereka imakhala yofala kwambiri, ndipo CD-2, maculopathy (75% ya milandu ya maculopathy)

Mawonetseredwe akulu azachipatala

Osatulutsa, proliferious, wambiri retinopathy

Kupimidwa kwa Ophthalmological kumasonyezedwa kwa odwala omwe ali ndi matenda amtundu wa 1 wazaka 3-5 pambuyo pakuwonekera kwa matendawa, komanso kwa odwala omwe ali ndi matenda a mtundu wa 2 atangopezeka ndi matendawa. M'tsogolomu, maphunziro otere ayenera kubwerezedwa pachaka

Matenda ena amaso kwa odwala matenda ashuga

Kubwezeredwa kwa DM, kuwala kwa laser

Khungu limalembedwa mu 2% ya odwala omwe ali ndi matenda ashuga .. Kufalikira kwa zatsopano zokhudzana ndi DR ndi milandu 3.3 pa anthu 100,000 pachaka. Ndi DM-1, kuchepa kwa HbAlc mpaka 7.0% kumabweretsa kutsika kwa 75% pangozi yakukulira D P ndikuchepera 60% pangozi yakukula kwa DR. Ndi DM-2, kutsika kwa 1% kwa HbAlc kumabweretsa kutsika kwa 20% pachiwopsezo chotenga DR

lipid deposition ndi mapangidwe wandiweyani exudates, kuchuluka kwa zochulukitsa ziwiya mu retina ndi mapangidwe shunts ndi aneurysms, zikubweretsa mtsempha kdilatation ndi kukulitsa kwa retinal hypoperfusion,

chochitika chakuba ndikupita patsogolo kwa ischemia, chomwe ndichomwe chimapangira mapangidwe amkati ndi zipsera,

retina chakumapeto chifukwa cha ischemic disintegration ndi mapangidwe a patreoretinal traction,

vitreous hemorrhage chifukwa cha hemorrhagic mtima, kugunda kwamitsempha yayikulu komanso kupasuka kwa aneurysms, kuchuluka kwa ziwiya za iris (diabetesic rubeosis), zomwe zimapangitsa kuti pakhale yachiwiri ya glaucoma, maculopathy yokhala ndi edema.

DR ndiye chifukwa chachikulu cha khungu pakati pa anthu otukuka a maiko otukuka, ndipo chiopsezo chotenga khungu kwa odwala omwe ali ndi matenda ashuga ndiochulukirapo ka 10-20 kuposa anthu ambiri. Panthawi yodziwitsa CD-1, DR sapezeka pafupifupi m'magulu aliwonse, pambuyo pa zaka 5, matendawa amapezeka 8% ya odwala, komanso ali ndi zaka makumi atatu a matenda ashuga - mu 98% ya odwala. Panthawi yodziwitsa CD-2, DR imapezeka mu 2040% ya odwala, komanso pakati pa odwala omwe ali ndi zaka fifitini azidziwa za CD-2, 85%. Ndi CD-1, retinopathy yowonjezereka imakhala yofala kwambiri, ndipo ndi CD-2, maculopathy (75% ya milandu ya maculopathy).

Malinga ndi magulu omwe amavomerezedwa, magawo atatu a DR amadziwika (Gawo 7.18).

Kufufuza kwathunthu kwa maso, kuphatikiza maso ndi maso mwachindunji, kumawonekera kwa odwala omwe ali ndi matenda amtundu wa 3 - 3-5 pambuyo pakuwonekera kwa matendawa, komanso kwa odwala omwe ali ndi matenda a shuga a 2 atangodziwikiratu. M'tsogolomu, maphunziro otere ayenera kubwerezedwa pachaka.

Tab. 7.18. Gulu la odwala matenda a shuga a retinopathy

Microaneurysms, hemorrhages, edema, exudative foci mu retina. Mitsempha yam'mimba imakhala ndi madontho ang'onoang'ono, mikwingwirima, kapena malo amdima a mawonekedwe ozungulira, opangidwira pakatikati pa fundus kapena m'mphepete zazikuluzikulu zazitali za retina. Ma exudates olimba komanso ofewa nthawi zambiri amakhala mkati mwa fundus ndipo amakhala achikasu kapena oyera. Chofunikira pa siteji iyi ndi edema ya retinal, yomwe imapezeka m'deralo kapena m'matumba akuluakulu (mkuyu. 7.11 a)

Zotsatira zosavomerezeka: lakuthwa, kuzungulira, kuzungulira, kubwereza komanso kutulutsa kusinthasintha kwa mawonekedwe amitsempha yamagazi. Chiwerengero chambiri cha "thonje" yolimba ndikuthothoka. Intraretinal microvascular anomalies, zotupa zambiri zam'mimba zam'mimba (mkuyu. 7.11 b)

Neovascularization ya optic disc ndi magawo ena a retina, vitreous hemorrhage, mapangidwe a minyewa ya fibrous m'dera la preretinal hemorrhages. Zombo zatsopano zomwe zimapangidwa ndizochepa kwambiri komanso zosalimba, chifukwa cha zomwe zimatulutsa pafupipafupi kutulutsa magazi. Vuto la Vitreoretinal limayambitsa kuyamwa. Zombo zatsopano zopangidwa ndi iris (rubeosis) nthawi zambiri zimayambitsa kukula kwa glaucoma yachiwiri (mkuyu. 7.11 c)

Matenda ena amaso kwa odwala matenda ashuga.

Njira yayikulu yothandizira matenda ashuga retinopathy, komanso zovuta zina zakuchedwa, ndiye malipiro oyenera a matenda a shuga. Chithandizo chothandiza kwambiri cha matenda ashuga retinopathy komanso kupewa khungu ndi laser Photocoagulation. Cholinga

- zotupa zolimba

1 - mapangidwe zofewa exudative foci, 2 - kukoka kwa mitsempha, 3 - zofewa exudative foci, 4 - retinal kukha mwazi

1 - papillary neoplasms m'chigawo cha optic disc, 2 - zotupa za m'mimba, 3 - kukula kwa neoplasms, 4 - mitsempha yamtengo wapatali

Mkuyu.7.11. Matenda a shuga

a) yosachulukirachulukira, b) yowonjezera, c) yochulukirapo

Laser Photocoagulation ndi kutha kwa kugwira ntchito kwa zombo zomwe zangopangidwa kumene, zomwe zimabweretsa chiwopsezo chachikulu pakukula kwa zovuta zazikulu monga hemophthalmus, traction retinal detachment, iris rubeosis ndi yachiwiri glaucoma.

Khungu limalembedwa mu 2% ya odwala matenda ashuga (3-4% ya odwala matenda a shuga 1 ndi 1.5-2% ya odwala matenda a shuga a 2). Ziwerengero zatsopano za khungu zatsopano zokhudzana ndi DR ndi milandu 3.3 pa anthu 100,000 pachaka. Ndi CD-1, kutsika kwa HbAlc mpaka 7.0% kumabweretsa kutsika kwa chiwopsezo cha DR ndi 75% ndikuchepera kwa chiwopsezo cha DR ndi 60%. Ndi DM-2, kutsika kwa 1% kwa HbAlc kumabweretsa kutsika kwa 20% pachiwopsezo chotenga DR.

7.8.3.Matenda a shuga

Matenda a shuga (DNF) amafotokozedwa kuti ndi albuminuria (oposa 300 mg a albumin patsiku kapena proteinuria yoposa 0,5 g ya mapuloteni patsiku) komanso / kapena kuchepa kwa kusefedwa kwa impso mwa anthu omwe ali ndi matenda osokoneza bongo pakakhala kuti alibe matenda amkodzo, matenda a mtima kapena matenda ena a impso. Microalbuminuria imatanthauziridwa ngati chowonjezera cha albumin 30-300 mg / tsiku kapena 20-200 μg / min.

Etiology ndi pathogenesis

Zomwe zimayambitsa chiwopsezo chachikulu cha DNF ndi kutalika kwa matenda ashuga, matenda oopsa a hyperglycemia, matenda oopsa oopsa, dyslipidemia, ndi matenda a impso mwa makolo. DDF ikakhudzidwa makamaka zida zama glomerular impso.

Limodzi limagwirira lomwe hyperglycemia zimathandizira kukulitsa kuwonongeka kwa glomerular, ndiko kudzikundikira kwa sorbitol chifukwa cha kutsegulidwa kwa njira ya polyol ya metabolism ya glucose, komanso zinthu zingapo zomaliza za glycation.

Matenda a hemodynamic, intracranial ochepa matenda oopsa (kuthamanga kwa magazi mkati mwa glomeruli la impso) ndi gawo lofunikira la pathogenesis

Cholinga cha intracubular matenda oopsa ndikuphwanya kamvekedwe ka ma arterioles: kukulitsa mayendedwe ndi kupendekera kwa ogwira ntchito.

Izi, zimachitika mchikakamizo cha zinthu zingapo zochititsa manyazi, monga angiotensin-2 ndi endothelium, komanso chifukwa chophwanya malamulo a electrolyte a membrane apansi a glomerular. Kuphatikiza apo, matenda oopsa oopsa, omwe amatsimikizika mwa odwala ambiri omwe ali ndi DNF, amathandizira kuti azitha kukhala ndi matenda oopsa. Chifukwa cha kutsekeka kwa magazi mkati, kuwonongeka kwapansi panthaka ndi kusefera kwa pores kumachitika, kudzera dutsani (microalbuminuria), kenako kuchuluka kwa albumin (proteinuria). Kukula kwa zigawo zapansi kumapangitsa kusintha kwa zinthu zamagetsi, zomwe zimayambitsa kukopeka kwa albumin yambiri mu ultrafiltrate ngakhale pakakhala kusintha kwa kukula kwa mafesedwewo.

Tab. 7.19. Matenda a shuga

Etiology ndi pathogenesis

Matenda a hyperglycemia, intracubic komanso systemic ochepa matenda oopsa, chibadwa

Microalbuminuria imatsimikiziridwa mu 6-60% ya odwala omwe ali ndi matenda amtundu wa 1 pambuyo pa zaka 5-15 atatha kuwonekera. Ndi CD-2, DNF imakhazikika mu 25% mpikisano waku Europe komanso 50% ya mpikisano waku Asia. Kuchuluka kwa DNF mu CD-2 ndi 4-30%

Mawonetseredwe akulu azachipatala

Mu magawo oyambilira kulibe. Ochepa matenda oopsa, nephrotic matenda, aimpso kulephera

Microalbuminuria (albumin excretion 30-300 mg / tsiku kapena 20-200 μg / min), proteinuria, imakulanso kenako kutsika kwa kusefukira kwa glomerular, zizindikiro za nephrotic syndrome ndi kulephera kwa aimpso.

Matenda ena a impso komanso zomwe zimayambitsa matenda a impso

Kubwezeretsa shuga ndi matenda oopsa, ACE inhibitors kapena angiotensin receptor blockers, kuyambira gawo la microalbuminuria, mapuloteni otsika komanso zakudya zochepa zamchere. Ndi chitukuko cha matenda aimpso kulephera - hemodialysis, peraloneal dialysis, kupatsirana kwa impso

Mwa 50% ya odwala matenda ashuga amtundu 1 ndi 10% ya shuga 2 amtundu womwe amapezeka ndi proteinuria, CRF imayamba zaka 10 zikubwerazi. 15% ya imfa zonse mwa odwala omwe ali ndi matenda a shuga 1 amsinkhu wazaka 50 amagwirizanitsidwa ndi matenda a impso chifukwa cha DNF

3.Makamaka.Achibale a odwala ndi DNF ndi kuchuluka pafupipafupi ochepa matenda oopsa kumachitika. Pali umboni wa ubale pakati pa DNF ndi ACE gene polymorphism. Kuunika kwa Microscopic kwa DNF kumavumbula kukula kwa mbali zamkati mwa glomeruli, kukulira kwa mesangium, komanso kusintha kwa mafupipafupi pobweretsa ndi kunyamula arterioles. Pamapeto omaliza, omwe amagwirizana ndi matenda kulephera kwa aimpso (CRF), focal (Kimmelstyle-Wilson) imatsimikiza, kenako ndikupatsanso glomerulossteosis.

Microalbuminuria imatsimikiziridwa mu 6-60% ya odwala omwe ali ndi matenda amtundu wa 1 pambuyo pa zaka 5-15 atatha kuwonekera. DNF imatsimikizika mu 35% ya anthu omwe ali ndi matenda a shuga 1, nthawi zambiri mwa amuna ndi anthu omwe ali ndi matenda ashuga 1 osakwana zaka 15. Ndi CD-2, DNF imakhazikika mu 25% mpikisano waku Europe komanso 50% ya mpikisano waku Asia. Kuchuluka kwa DNF mu CD-2 ndi 4-30%.

Kuwonekera kwakanthawi kachipatala komwe kumagwirizanitsidwa mosadziwika ndi DNF ndi ochepa matenda oopsa. Zowonekera zina zamankhwala zachedwa. Izi zikuphatikiza mawonetseredwe a nephrotic syndrome ndi kulephera kwaimpso.

Kuyeza kwa DNF mwa anthu omwe ali ndi matenda ashuga kumaphatikizapo kuyezetsa pachaka microalbuminuria ndi DM-1 5 patatha chiwonetsero cha matendawa, komanso ndi DM-2 - atangozipeza. Kuphatikiza apo, mukufunikira kutsimikiza kwakanthawi kochuluka kwa kuchuluka kwa mitundu ya creatinine kuti muwerenge mitengo yosefera (SCF). SCF ikhoza kukhala kuwerengetsa kugwiritsa ntchito mitundu yosiyanasiyana, mwachitsanzo, malinga ndi njira ya Cockcroft-Gault:

koma x (140 - zaka (zaka)) x kulemera kwa thupi (kg)

magazi creatinine (μmol / L)

Kwa abambo: a = 1.23 (chizungulire cha GFR 100 - 150 ml / mphindi) Kwa akazi: a = 1.05 (wamba wa GFR 85 - 130 ml / mphindi)

Pa magawo oyamba a DNF, kuwonjezeka kwa GFR kumatha kupezeka, komwe kumachepera pang'onopang'ono ndikukula kwa matenda aimpso. Microalbuminuria imayamba kupezeka zaka 5-15 pambuyo pa isanayambike shuga-1, ndi matenda ashuga-2 mu 8-10% ya milandu, imapezeka mwadzidzidzi itapezeka, mwina chifukwa cha njira yayitali ya asymptomatic matenda asanatulukire. Kuchuluka kwa mapangidwe a proteinuria kapena albuminuria wodwala 1 matenda a shuga kumachitika pakati pa zaka 15 mpaka 20 pambuyo pake. Proteinuria akuwonetsa kusasinthika DNF, yomwe posakhalitsa ingayambitse matenda a impso. Uremia amakula pafupifupi zaka 7-10 patatha kuonekera kwa proteinuria yambiri. Tiyenera kudziwa kuti GFR siimakhudzana ndi proteinuria.

Zomwe zimayambitsa proteinuria ndi kulephera kwaimpso mwa anthu omwe ali ndi matenda ashuga. Nthawi zambiri, DNF imaphatikizidwa ndi matenda oopsa, matenda ashuga retinopathy kapena neuropathy, pakufunika kuti matendawo azindikirane kwambiri. Mu 10% ya anthu odwala matenda ashuga a mtundu woyamba 1 ndi 30% ya odwala matenda ashuga a mtundu 2, proteinuria siimayenderana ndi DNF.

♦ Zinthu zazikuluzikulu za pulayimale ndi sekondale kupewa

DNF ndi chindapusa cha matenda ashuga ndikusungabe kwachilendo magazi ake. Kuphatikiza apo, prophylaxis yoyamba ya DNF imatanthawuza kuchepa kwa mapuloteni othandizira chakudya - osakwana 35% ya kudya tsiku lililonse kwa calorie.

M'magawo microalbuminuria ndi proteinuria Odwala amatsogolera ACE inhibitors kapena angiotensin receptor blockers. Ndi conceritant ochepa matenda oopsa, amaikidwa antihypertensive Mlingo, ngati n`kofunika limodzi ndi antihypertensive mankhwala. Ndi magazi abwinobwino, mankhwalawa amadzipaka mu Mlingo womwe sutsogolera kukula kwa hypotension. Onse ACE inhibitors (amtundu wa matenda ashuga 1 ndi mtundu 2 matenda ashuga) ndi angiotensin receptor blockers (mtundu 2) amathandizira kupewa microalbuminuria kutembenukira ku proteinuria. Nthawi zina, motsutsana ndi maziko a mankhwalawo omwe akuwonetsedwa, kuphatikiza kulipidwa kwa shuga ndi magawo ena, microalbuminuria imachotsedwa. Kuphatikiza apo, kuyambira pa siteji ya microalbuminuria, kuchepetsa mapuloteni ochepera 10% a calorie kudya tsiku lililonse (kapena osachepera 0,8 magalamu pa kilogalamu ya kulemera) ndi mchere wochepera magalamu atatu patsiku ndikofunikira.

Stage Pa siteji CRF, kukonza hypoglycemic mankhwala nthawi zambiri amafunikira. Odwala ambiri omwe ali ndi matenda osokoneza bongo a mellitus-2 amafunika kusamutsidwa kupita ku insulin, popeza kutsegula kwa TSP kumakhala ndi chiopsezo chokhala ndi hypoglycemia yoopsa. Odwala ambiri omwe ali ndi matenda amtundu 1 amakhala ndi vuto la insulin chifukwa impso ndi amodzi mwa malo akuluakulu a kagayidwe kake. Ndi kuwonjezeka kwa serum creatinine mpaka 500 μmol / L kapena kupitilira apo, ndikofunikira kubweretsa funso lokonzekera wodwalayo chifukwa cha extracorporeal (hemodialysis, peritoneal dialysis) kapena njira ya opaleshoni (yopatsirana impso) chithandizo. Kupatsirana kwa impso kukuwonetsedwa pamlingo wa creatinine mpaka 600-700 μmol / L ndi kuchepa kwa kusefukira kwa glomerular osakwana 25 ml / min, hemodialysis - 1000-1200 μmol / L ndi ochepera 10 ml / min, motsatana.

Mwa 50% ya odwala matenda ashuga amtundu 1 ndi 10% ya matenda a shuga a mtundu 2, omwe amapezeka kuti ali ndi vuto laubongo m'zaka 10 zikubwerazi. 15% ya imfa zonse mwa odwala omwe ali ndi matenda a shuga 1 amsinkhu wazaka 50 amagwirizanitsidwa ndi matenda a impso chifukwa cha DNF.

7.8.4. Matenda a shuga

Matenda a shuga (NU) ndi kuphatikiza kwa syndromes yowonongeka kwamanjenje, yomwe imatha kuwerengedwa kutengera kutengera kwakukulu pantchito zake m'madipatimenti ake osiyanasiyana (sensorimotor, autonomous), komanso kufalikira ndi kusakhazikika kwa zotupa (Table 7.20).

Zovuta zakutsogolo za matenda ashuga: kupewa ndi kuchiza

Matenda a shuga ndi matenda oopsa omwe njira za metabolic, kuphatikizapo kagayidwe kazakudya zimasokonekera. Matendawa ali ndi matenda osachiritsika, ndipo sangathe kuthandizidwa kwathunthu, koma amalipiridwa.

Kuti musakhale ndi zovuta za matenda ashuga, ndikofunikira kupita pafupipafupi ndi endocrinologist ndi akatswiri othandizira odwala. Ndikofunikira kuyang'anira kuchuluka kwa glucose, omwe amayenera kukhala kuyambira 4 mpaka 6.6 mmol / l.

Aliyense wodwala matenda ashuga ayenera kudziwa kuti zotsatira za matenda a hyperglycemia nthawi zambiri zimayambitsa kulumala ngakhale kufa kumene, mosasamala mtundu wa matenda. Koma ndi zovuta ziti za matenda ashuga zomwe zingayambike ndipo chifukwa chiyani zimawonekera?

Matenda a shuga: njira zopititsira patsogolo

Mwa munthu wathanzi, shuga amayenera kulowa m'maselo ndi mafuta ndi minofu, kuwapatsa mphamvu, koma mu shuga amakhalabe mumtsinje wamagazi. Ndi shuga wambiri wambiri, chomwe ndi chinthu cha hyperosmolar, makoma a mtima ndi ziwalo zamagazi zowonongeka zimawonongeka.

Koma awa ndi mavuto obwera chifukwa cha matenda ashuga kale. Ndi kuperewera kwambiri kwa insulin, zotsatira zoyipa zimawoneka zomwe zimafuna chithandizo chamanthawi, chifukwa zimatha kupha.

Mtundu woyamba wa matenda ashuga, thupi limasowa insulin. Ngati kuchepa kwa mahomoni sikulipilitsidwa ndi insulin tiba, ndiye kuti zotsatira za matenda ashuga zimayamba kukula kwambiri, zomwe zimachepetsa kwambiri chiyembekezo cha moyo wa munthu.

Mtundu wachiwiri wa matenda ashuga, kapamba amapanga insulin, koma maselo amthupi pazifukwa zosiyanasiyana sakudziwa. Pankhaniyi, mankhwala ochepetsa shuga amalembedwa, komanso mankhwala omwe amalimbikitsa kukana kwa insulin, omwe angapangitse kuti kagayidwe kazinthu kazikhala nthawi yayitali.

Nthawi zambiri, mavuto akulu a matenda a shuga 2 samawonekera kapena amawoneka osavuta. Koma nthawi zambiri, munthu amangodziwa za kukhalapo kwa matenda ashuga akamakula, ndipo zotsatirapo zake sizisintha.

Chifukwa chake, zovuta za shuga zimagawika m'magulu awiri:

Zovuta zazovuta

Zotsatira zoyambirira za matenda ashuga zimaphatikizapo zochitika zomwe zimachitika motsutsana ndi maziko a kuchepa kwambiri (hypoglycemia) kapena hobby (hyperglycemia) pamagulu a glucose m'magazi. Matenda a hypoglycemic ndi owopsa chifukwa akamayimitsidwa mosazindikira, minyewa ya ubongo imayamba kufa.

Zomwe zimawonekera ndizosiyanasiyana: kuchuluka kwa insulini kapena othandizira a hypoglycemic, kupanikizika kwambiri mthupi komanso m'maganizo, kudumphadumpha chakudya, ndi zina zambiri. Komanso, kuchepa kwa shuga kumachitika panthawi yapakati komanso ndi matenda a impso.

Zizindikiro za hypoglycemia ndi kufooka kwambiri, manja akunjenjemera, khungu lotumbululuka, chizungulire, dzanzi la manja ndi njala. Ngati panthawiyi munthu satenga chakudya chambiri (zotsekemera, zotsekemera), ndiye kuti akutenga gawo lotsatira, lomwe lili ndi zizindikiro zotsatirazi:

zamkhutu
kulumikizana bwino
ulesi
masomphenya apawiri
nkhalwe
palpitations
"tsekwe" pamaso pake,
kukoka mwachangu.

Gawo lachiwiri silikhala lalitali, koma ndizotheka kumuthandiza wodwala mukamamupatsa njira yotsekemera. Komabe, chakudya cholimba pamenepa chimapangidwa, chifukwa wodwala amatha kutsekedwa.

Kuwonetsa mochedwa kwa hypoglycemia kumaphatikizapo thukuta lochulukirapo, kukokana, khungu lotumbululuka, ndi kusazindikira. Mwanjira imeneyi, ndikofunikira kuyimba ambulansi, ikafika pomwe adokotala adzabayira jekeseni ya m'magazi m'mitsempha ya wodwalayo.

Pakapanda chithandizo chakanthawi, munthuyo amasintha chikumbumtima. Ndipo pakukula kwa chikomokere, amatha kumwalira, chifukwa mphamvu yamagetsi imabweretsa kutumphuka kwa maselo aubongo ndikutuluka kwa magazi mkati mwake.

Mavuto otsatirawa a matenda ashuga ndi mikhalidwe ya hyperglycemic, yomwe imaphatikizapo mitundu itatu ya ma com:

ketoacidotic,
lacticidal,
hyperosmolar.

Izi zokhudzana ndi matenda ashuga zimawoneka pakukwera shuga. Chithandizo chawo chimachitika kuchipatala, kuchipatala chachikulu kapena kuchipatala.

Ketoacidosis mu mtundu 1 wa shuga amawoneka mokwanira. Zomwe zimachitika ndizambiri - kudumpha mankhwala, kapena Mlingo wawo wolakwika, kupezeka kwa njira zotupa zolowerera mthupi, kugunda kwa mtima, stroke, kufalikira kwa matenda osachiritsika, zochitika zina zonse.

Ketoacidotic chikomaso chimakula malinga ndi mawonekedwe ake. Chifukwa chosowa insulini mwadzidzidzi, shuga simalowa m'maselo ndipo amadziunjikira m'magazi. Zotsatira zake, "njala ya mphamvu" imayamba. Poyankha, thupi limayamba kutulutsa mahomoni opsinjika monga glucagon, cortisol ndi adrenaline, omwe amathandizanso hyperglycemia.

Mwakutero, kuchuluka kwa magazi kumawonjezeka, chifukwa glucose ndi chinthu cha osmotic chomwe chimakopa madzi. Zitachitika izi, impso zimayamba kugwira ntchito mwamphamvu, pomwe ma elekitiroliti, omwe amakumbidwa ndi madzi, amayamba kulowa mkodzo ndi shuga.

Zotsatira zake, thupi limakhala lopanda madzi, ndipo ubongo ndi impso zimavutika ndi magazi osakwanira.

Ndi njala ya oxygen, lactic acid imapangidwa, chifukwa chomwe pH imakhala acidic. Chifukwa chakuti glucose sasintha kukhala mphamvu, thupi limayamba kugwiritsa ntchito mafuta, chifukwa chomwe ma ketoni amawoneka m'magazi, omwe amachititsa magazi a HH kukhala acic acid kwambiri. Izi zimasokoneza ntchito ya ubongo, mtima, m'mimba komanso ziwalo zopumira.

Ketosis - khungu louma komanso mucous nembanemba, ludzu, kugona, kufooka, mutu, kusowa kudya, kuchuluka kukodza.
Ketoacidosis - fungo la acetone kuchokera mkamwa, kugona, magazi ochepa, kusanza, mtima.
Precoma - kusanza, kupuma, kupuma pamasaya, kupweteka kumachitika pakhungu pamimba.
Coma - kupuma kwamkokomo, kutsekeka kwa khungu, kuyerekezera zinthu m`maganizo, kuwonongeka.

Hyperosmolar coma nthawi zambiri imawoneka mwa anthu achikulire omwe ali ndi mtundu wodziyimira payekha wa matenda. Kuphatikizika kwa shuga kumeneku kumachitika motsutsana ndi maziko am'madzi othamanga, pomwe mumagazi, kuwonjezera pa shuga wambiri, kuchuluka kwa sodium kumawonjezeka. Zizindikiro zake zazikulu ndi polyuria ndi polydipsia.

Lactic acidosis chikomokere nthawi zambiri chimapezeka mwa odwala azaka 50 ndi kupitirira ndi aimpso, chiwindi, kapena matenda amtima. Ndi vutoli, kuchuluka kwa lactic acid kumadziwika m'magazi.

Zizindikiro zikuluzikulu ndizo hypotension, kupuma, kulephera.

Machedwe mavuto

Poyerekeza ndi matenda a shuga a shuga a nthawi yayitali, mavuto obwera mochedwa amakumana omwe sangathe kuthandizidwa kapena amafuna chithandizo chambiri. Ndi mitundu yosiyanasiyana ya matendawa, zotsatirapo zake zingathenso kusintha.

Chifukwa chake, ndi mtundu woyamba wa matenda ashuga, matenda ammimba a shuga, matenda amitsempha, nephropathy, khungu chifukwa cha retinopathy, kusokonezeka kwa mtima ndi matenda a mano.Ndi IDDM, odwala matenda ashuga, retinopathy, retinopathy amapezeka kawirikawiri, ndipo ma mtima ndi ma mtima a pathologies sakhala achilendo ku mtundu uwu wa matenda.

Ndi diabetesic retinopathy, mitsempha, mitsempha yam'mimba komanso ma capillaries a retina amakhudzidwa, chifukwa motsutsana ndi matenda a hyperglycemia, ziwiya zimachepa, ndichifukwa chake samalandira magazi okwanira. Zotsatira zake, kusintha koipa kumachitika, ndipo kuchepa kwa mpweya kumapangitsa kuti lipids ndi mchere wamchere zizungulidwe mu retina.

Kusintha kwa zamatenda kotereku kumayambitsa mapangidwe ndi zipsera, ndipo ngati pakukulirakulira kwa matenda a shuga, ndiye kuti retina imayamba ndipo munthu amatha kukhala wakhungu, nthawi zina amakhala ndi vuto lotupa kapena khungu lotupa.

Mavuto azachilengedwe nawonso si achilendo mu shuga. Neuropathy ndiyowopsa chifukwa imathandizira kuwoneka ngati phazi la matenda ashuga, omwe angayambitse kudula dzanja.

Zomwe zimayambitsa mitsempha yowonongeka m'matenda a shuga sizikumveka bwino. Koma pali zinthu ziwiri zomwe zimasiyanitsidwa: choyambirira ndikuti shuga wambiri amachititsa kuwonongeka kwa edema ndi mitsempha, ndipo chachiwiri kuti ulusi wamitsempha umavutika ndi michere chifukwa cha kuwonongeka kwa mtima.

Insell -us wodalira matenda a shuga omwe amakhala ndi vuto la mitsempha amatha kuwonekera m'njira zosiyanasiyana:

Sensory neuropathy - yodziwika ndi kuwonongeka kwamiyendo m'miyendo, kenako mikono, chifuwa ndi m'mimba.
Fomu ya Urogenital - imawoneka pomwe mitsempha ya sacral plexus itawonongeka, zomwe zimakhudza kuyendetsa bwino kwa chikhodzodzo ndi ureters.
Mtima neuropathy - yodziwika ndi pafupipafupi palpitations.
Matumbo am'mimba - amadziwika ndi kuphwanya gawo la chakudya kudzera m'mphepete, pomwe pali kulephera kwam'mimba.
Khungu neuropathy - yodziwika ndi kuwonongeka kwa thukuta, chifukwa khungu limakhala louma.

Neurology mu shuga ndi yowopsa chifukwa pakatha kukula kwake wodwalayo amasiya kumva zizindikiro za hypoglycemia. Ndipo izi zimatha kubweretsa kulumala kapena ngakhale kufa.

Chizindikiro cha dzanja ndi phazi la matenda ashuga kumachitika ndi kuwonongeka kwa mitsempha yamagazi ndi zotumphukira zama minofu yofewa, mafupa ndi mafupa. Zovuta zotere zimachitika mosiyanasiyana, zonse zimatengera mawonekedwe. Fomu ya neuropathic imapezeka mu 65% ya milandu ya SDS, zowonongeka zamitsempha zomwe sizimatulutsa zikhumbo. Pakadali pano, pakati pa zala ndi zokhazokha, khungu limakulirakulira ndikuyatsidwa, kenako zilonda zam'mimba zimapangidwira.

Kuphatikiza apo, phazi limatupa ndikutentha. Ndipo chifukwa cha kuwonongeka kwa minyewa yam'mimba komanso mafupa, chiopsezo cha ma fronttures amasachedwa kumawonjezeka.

Fomu ya ischemic imayamba chifukwa chosayenda bwino m'mitsempha yama phazi. Vuto la mitsempha iyi limapangitsa phazi kuzizira, kukhala zilonda zam'mimba, zotuwa komanso zopweteka.

Kuchuluka kwa nephropathy mu matenda ashuga ndi okwera kwambiri (pafupifupi 30%). Vutoli ndi loopsa chifukwa ngati silinapezeke kale kuposa momwe likupitira, ndiye kuti lidzatha ndikukula kwa impso.

Mtundu 1 kapena mtundu wa matenda ashuga 2, kuwonongeka kwa impso ndi kosiyana. Chifukwa chake, ndimafupa omwe amadalira insulin, matendawa amakula kwambiri komanso nthawi zambiri ali aang'ono.

Poyamba, zovuta za shuga zotere nthawi zambiri zimachitika popanda zizindikiro zowoneka bwino, koma odwala ena amakhalinso ndi zizindikiro monga:

kugona
kutupa
kukokana
kulephera kwa mtima
kunenepa
kuyuma ndi kuyabwa kwa khungu.

Chowonetserako chapadera cha nephropathy ndi kupezeka kwa magazi mkodzo. Komabe, chizindikiro ichi sichimachitika nthawi zambiri.

Matendawa akamakula, impso zimasiya kuchotsa poizoni m'magazi, ndipo zimayamba kudziunjikira m'thupi, pang'onopang'ono poizoni. Uremia nthawi zambiri imayendera limodzi ndi kuthamanga kwa magazi komanso chisokonezo.

Chizindikiro chotsogola cha nephropathy ndicho kukhalapo kwa mapuloteni mumkodzo, kotero onse odwala matenda ashuga ayenera kuyesa mkodzo kamodzi pachaka. Kulephera kuthana ndi vuto lotere kumadzetsa kulephera kwa impso, pomwe wodwalayo sangakhale moyo wopanda dialysis kapena kumuika impso.

Mtima ndi mtima zamatenda a shuga sizachilendo. Chochititsa chachikulu kwambiri cha ma pathologies oterewa ndi atherosulinosis yamitsempha yama coronary yomwe imadyetsa mtima. Matendawa amapezeka pamene cholesterol imayikidwa pamitsempha yamitsempha, yomwe imatha kubweretsa vuto la mtima kapena sitiroko.

Anthu odwala matenda ashuga amakonda kwambiri kulephera kwa mtima. Zizindikiro zake ndi kupuma movutikira, kupindika, ndi kutupa m'miyendo.

Kuphatikiza apo, mwa anthu omwe ali ndi matenda ashuga, vuto lomwe limachitika nthawi zambiri ndi matenda oopsa.

Ndizowopsa chifukwa zimachulukitsa chiopsezo cha zovuta zina, kuphatikizapo retinopathy, nephropathy, ndi kulephera mtima.

Kupewa komanso kuchiza matenda ashuga

Mavuto oyambilira komanso mochedwa amathandizidwa m'njira zosiyanasiyana. Chifukwa chake, kuti muchepetse vuto la matenda obwera chifukwa cha matenda ashuga koyambira, ndikofunikira kuyang'anira kuchuluka kwa glycemia, komanso ngati pali vuto la hypoglycemic kapena hyperglycemic state, tengani njira zoyenera zochizira nthawi.

Chithandizo cha zovuta za matenda amtundu 1 amachokera pazifukwa zitatu zamankhwala. Choyamba, ndikofunikira kuwongolera kuchuluka kwa glucose, omwe amayenera kuchokera ku 4,4 mpaka 7 mmol / l. Kuti izi zitheke, amamwa mankhwala ochepetsa shuga kapena amagwiritsa ntchito mankhwala a insulin.

Ndikofunikanso kulipira njira za metabolic zomwe zimasokonezeka chifukwa cha kuchepa kwa insulin. Chifukwa chake, odwala amawapatsa mankhwala a alpha-lipoic acid ndi mankhwala a mtima. Ndipo vuto la atherogenicity yayikulu, adokotala amatipatsa mankhwala omwe amachepetsa cholesterol (fibrate, statins).

Kuphatikiza apo, zovuta zilizonse zimathandizidwa. Chifukwa chake, ndi retinopathy yoyambirira, mawonekedwe a laser a retina kapena kuchotsedwa kwa thupi la vitreous (vitrectomy) akuwonetsedwa.

Ngati nephropathy, mankhwala othandizira matenda oopsa agwiritsidwa ntchito, wodwalayo ayenera kutsatira zakudya zapadera. Mu mawonekedwe osalephera a impso, hemodialysis kapena kupatsirana impso kumatha kuchitika.

Chithandizo cha matenda ashuga omwe amawonongeka ndi kuwonongeka kwa mitsempha zimaphatikizapo kumwa mavitamini a B. Mankhwalawa amathandizira kukonzekera kwa mitsempha m'misempha. Zochita zolimbitsa thupi monga carbamazepine, pregabalin kapena gabopentin zimasonyezedwanso.

Pankhani ya matenda obanika kudwala matenda ashuga, ntchito zotsatirazi zimachitika:

Kuchita masewera olimbitsa thupi,
mankhwala a antiotic
kuvala nsapato zapadera
chithandizo cha mabala.

Kupewa zovuta zamatenda a shuga ndi njira yowunikira ya glycated hemoglobin ndi glucose m'magazi.

Ndikofunikanso kuwunika kuthamanga kwa magazi, komwe sikuyenera kukhala kwakukulu kuposa 130/80 mm Hg.

Komabe, kuti tisakulitse matenda a shuga omwe ali ndi zovuta zingapo, ndikofunikira kuchititsa maphunziro. Izi zikuphatikizapo dopplerography yamitsempha yamagazi, kusanthula kwamkodzo, magazi, kufufuza kwa fundus. Kufunsidwa kwa katswiri wa zamitsempha, wamtima ndi dokotala wamankhwala opaleshoni amasonyezedwanso.

Kuti muchepetse magazi komanso kupewa mavuto a mtima, muyenera kumwa Aspirin tsiku lililonse. Kuphatikiza apo, odwala amawonetsedwa masewera olimbitsa thupi a shuga mellitus komanso kutsatira zakudya zapadera, kukana zizolowezi zoyipa.

Kanemayo munkhaniyi akukamba za zovuta za matenda ashuga.

Chifukwa chiyani zovuta zimayambika mu shuga

Zomwe zimayambitsa kuwoneka kwa zovuta zodwala zimatengera mtundu wamatenda. Mtundu wa I wa matenda a shuga ndimakomoka, mavuto amakula pomwe wodwala sakupereka insulin panthawi yake.

Njira zopangira zovuta:

Kuchuluka kwa insulin m'magazi kumachepa, ndipo shuga amawonjezeka.
Pali kumverera kwamphamvu kwa ludzu, polyuria (kuchuluka kwa mkodzo).
Kuchuluka kwamafuta m'magazi kumachuluka chifukwa cha lipolysis yayikulu (kuwonongeka kwamafuta).
Njira zonse za anabolic zimachepetsedwa, minofu sikulinso kutha kuwonongeka kwa matupi a ketone (acetone opangidwa m'chiwindi).
Pali kuledzera kwa thupi.

Ndi mtundu II matenda a shuga a mellitus (osadalira insulin), mavuto amayamba chifukwa chakuti odwala safuna kutsatira zakudya ndipo samamwa mankhwala ochepetsa shuga. Kuwongolera zakudya ndizovomerezeka pochiza matenda a hyperglycemia (kuchuluka kwa shuga m'magazi) ndi insulin kukana (kuchepa kwamphamvu kwa maselo otengera insulini).

Mavuto a matenda a shuga a mtundu wachiŵiri amatuluka motere:

Mwazi wamagazi pang'onopang'ono umachuluka.
Chifukwa cha kuchuluka kwa shuga, ntchito ya ziwalo zamkati imayamba kuwonongeka.
Intracellular hyperglycemia imayamba, zomwe zimapangitsa kuti gluoto azindikire (kusokonekera kwa dongosolo lamanjenje) ndi matenda ena.

Zinthu zomwe zimawonjezera chiopsezo cha zovuta

Matenda a wodwala samakonda kuvuta popanda chifukwa. Zinthu zomwe zimawonjezera chiopsezo cha zovuta za matenda ashuga:

Makamaka. Chiwopsezo chokhala ndi zovuta mwa wodwala chimawonjezera nthawi 5-6 ngati m'modzi mwa makolo ake adadwala kwambiri matenda ashuga.
Kulemera kwambiri. Izi ndizowopsa makamaka kwa matenda amtundu 2. Kuphwanya kawirikawiri zakudya kumabweretsa kukuwonjezeka kwa mafuta m'thupi. Ma cell receptor enieni sangathenso kulumikizana ndi insulin, ndipo pakapita nthawi kuchuluka kwawo kwamankhwala am'mimba kumachepa.
Kumwa mowa. Anthu omwe ali ndi matenda amtundu uliwonse a shuga ayenera kusiya mowa. amachititsa hypoglycemia, amachepetsa mamvekedwe a mtima.
Kulephera kudya. Ndi matenda a shuga a mtundu wachiwiri, ndizoletsedwa kudya zipatso zotsekemera komanso zakudya zokhala ndi chakudya chamafuta othamanga komanso mafuta amkati (ayisikilimu, chokoleti, margarine, ndi zina). Ndi matenda amtundu uliwonse, simungathe kudya chakudya mwachangu. Anthu odwala matenda a shuga a "Insulin" ayenera kuthetseratu maswiti pazakudya. Ngati zakudya sizitsatiridwa, shuga msanga amadzuka ndikugwa kwambiri.
Kulephera kuchita zolimbitsa thupi. Kunyalanyaza zolimbitsa thupi ndi physiotherapy kumayambitsa kutsika kwa kagayidwe. Zinthu zowola zimakhala zazitali kwambiri m'thupi ndipo zimayambitsa poizoni.
Matenda a mtima. Ndi matenda oopsa, matenda a mtima, kuchepa kwa mitsempha, chiwopsezo cha minyewa mpaka insulin chimachepa.
Kupsinjika, kupsinjika kwamphamvu kwamaganizidwe. Adrenaline, noradrenaline, glucocorticoids zimawononga kwambiri ntchito kapamba ndi insulin.
Mimba Tizilombo ta thupi la akazi timalandira zochepa insulin yawo chifukwa cha mahomoni opanga nawo.