Kodi mchemwali amapanga bwanji matenda ashuga?

Anamwino odwala matenda ashuga. Matenda a shuga ndi matenda osachiritsika omwe amadziwika ndi kuphwanya kupanga kapena insulini ndikupangitsa kuphwanya mitundu yonse ya kagayidwe kazinthu, makamaka kagayidwe kazakudya. Gulu la WHO la matenda ashuga mu 1980:
1. Mtundu wodalira insulini - 1 mtundu.
2. Mtundu wosadzimira-insulin-mtundu wachiwiri.
Mtundu woyamba wa matenda a shuga umafala kwambiri mwa achinyamata, lembani matenda ashuga a 2 anthu achikulire ndi okalamba.
Mu shuga mellitus, zomwe zimayambitsa ndi zomwe zimayambitsa chiopsezo ndizophatikizana kwambiri kotero kuti nthawi zina zimakhala zovuta kusiyanitsa. Chimodzi mwamavuto omwe ali pachiwopsezo ndi cholowa chamtundu wa chibadwa chachiwiri (matenda amtundu wa 2 shuga ndiosavomerezeka), kunenepa kwambiri, kuperewera kwa chakudya, kupsinjika, matenda kapamba, komanso zinthu zoopsa zimathandizanso kwambiri. makamaka mowa, matenda a endocrine ziwalo zina.
Magawo a shuga:
Gawo 1 - prediabetes - mkhalidwe wakudziwitsa matenda ashuga.
Gulu lamavuto:
- Anthu okhala ndi cholowa cholemedwa.
- Amayi omwe abereka mwana wamoyo kapena wakufa wokhala ndi thupi loposa 4.5 kg.
- Anthu omwe ali ndi vuto la kunenepa kwambiri komanso atherosulinosis.
Gawo lachiwiri - matenda ashuga omalizira - ali asymptomatic, kuthamanga kwa glucose ndizobwinobwino - 3.3-5.5 mmol / L (malinga ndi olemba ena, mpaka 6.6 mmol / L). Matenda a shuga amatha kupezeka ndi kuyeserera kwa glucose, pomwe, mutatenga 50 g ya shuga kusungunuka mu 200 ml ya madzi, wodwalayo ali ndi kuchuluka kwa shuga m'magazi: pambuyo pa 1 h pamwamba pa 9.99 mmol / l. ndipo atatha maola 2 oposa 7.15 mmol / L.
Gawo 3 - shuga wodziwika - zizindikiro zotsatirazi ndizodziwika: ludzu, polyuria, kuchuluka kwa chidwi, kuchepa thupi, kuyabwa pakhungu (makamaka mu perineum), kufooka, kutopa. Mukayezetsa magazi, mumapezeka kuchuluka kwa glucose, ndikothekanso kupaka shuga mu mkodzo.
Ndi chitukuko cha mavuto chifukwa cha kuwonongeka kwa ziwiya zapakati mantha dongosolo. fundus. impso, mtima, kutsika kwakumapeto, zizindikiro zowonongeka kwa ziwalo zogwirizana ndi machitidwe zimalumikizana.

Anamwino odwala matenda ashuga:
Mavuto odwala:
A. Zomwe zilipo (zilipo):
- ludzu
- polyuria:
- Kuyabwa pakhungu. khungu lowuma:
- kulakalaka chakudya,
- kuwonda
- kufooka, kutopa, kuchepa kowoneka bwino,
- kupweteka mtima
- kupweteka m'malo otsika,
- kufunafuna kutsatira chakudya nthawi zonse,
- kufunika kopitilira insulin kapena kumwa mankhwala antidiabetes (maninil, matenda ashuga, amaryl, etc.),
Kupanda kudziwa:
- zenizeni za matendawo ndi zomwe zimayambitsa,
- mankhwala
- kudzithandiza ndi hypoglycemia,
- chisamaliro cha kumapazi
- kuwerengera zamkate ndi kukonza menyu,
- kugwiritsa ntchito mita,
- zovuta za matenda ashuga (chikomokere ndi matenda ashuga) komanso kudzithandiza ndekha.
B. Zotheka:
Ngozi yachitukuko:
- okondweretsa ndi maukoma akuti:
- zigawenga zam'munsi,
- infalction wa pachimake wamtima,
- Kulephera kwa aimpso,
- matenda amtundu wa chifuwa komanso matenda ashuga omwe amachititsa khungu,
- matenda apachiwiri, matenda a pakhungu
- zovuta chifukwa cha insulin,
- kuchiritsa kwapang'onopang'ono kwa mabala, kuphatikiza omwe amakhala othandizira.
Kutulutsa Koyambira Koyamba:
Kufunsa wodwala za:
- kutsatira zakudya (zolimbitsa thupi kapena zakudya No. 9), pankhani yazakudya.
- zolimbitsa thupi masana,
- mankhwala omwe akupitilira:
- mankhwala a insulin (dzina la insulin, mlingo, nthawi yayitali, mankhwala a mankhwala),
- mapiritsi antidiabetes (dzina, mlingo, mawonekedwe a makonzedwe awo, kulolerana),
- Maphunziro a magazi ndi mkodzo mayeso a shuga ndikuwunikidwa ndi endocrinologist,
- wodwala ali ndi glucometer, mphamvu yogwiritsira ntchito,
- Kugwiritsa ntchito patebulo la mkate ndi kupanga mndandanda wazakudya,
- kuthekera kugwiritsa ntchito syringe ndi cholembera,
- kudziwa malo ndi njira zoperekera insulin, kupewa zovuta (hypoglycemia ndi lipodystrophy pamalo a jekeseni),
- Kusunga zolemba za wodwala wodwala matenda ashuga:
- kuchezera "School of Diabetesic" yakale komanso yapano
- Kukula zakale za hypoglycemic ndi hyperglycemic coma, zomwe zimayambitsa ndi zizindikiro,
- luso lodzithandiza,
- wodwalayo ali ndi "Diabetes Passport" kapena "Diabetesic Traveling Card",
- chiyembekezo cha matenda obadwa ndi matenda ashuga),
- matenda oyamba (matenda a kapamba, ziwalo zina za endocrine, kunenepa kwambiri),
- madandaulo a wodwala panthawi ya mayeso.
Mayeso Odwala:
- khungu, chinyezi cha pakhungu, kupezeka kwa zipsera:
- kutsimikiza thupi:
- kuchuluka kwa kuthamanga kwa magazi,
- kutsimikiza kwa zimachitika pa radial mtsempha wamagazi ndi mitsempha ya kumbuyo kwake.
Zothandizira anamwino, kuphatikizapo kugwira ntchito ndi banja la wodwalayo:
1. Pangani zokambirana ndi wodwalayo komanso abale ake zokhudzana ndi zakudya, kutengera mtundu wa shuga, zakudya. Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, perekani zitsanzo zingapo kwa tsiku.
2. Kutsimikizira wodwalayo kufunika kachitidwe koti azitsatira zakudya zomwe dokotala wamupatsa.
3. Kutsimikizira wodwala kufunika kochita masewera olimbitsa thupi omwe adokotala amawauza.
4. Yambitsanani zokambirana, zomwe zimayambitsa matendawa komanso zovuta zake.
5. Dziwitsani wodwala zamankhwala a insulin (mitundu ya insulini. Kuyambira ndi kutalika kwa chochita chake, kulumikizidwa ndi chakudya. Zosungirako, zotsatira zoyipa, mitundu ya insulin ndi ma cholembera a syringe).
6. Onetsetsani makulidwe a insulin panthawi yake komanso kuperekera mankhwala a antidiabetes.
7. Kuwongolera:
- khungu
- kulemera kwa thupi:
- zimachitika ndi kuthamanga kwa magazi,
- zimachitika pa mitsempha ya kumbuyo,
- kutsatira zakudya ndi zakudya, kutumiza kwa wodwala kuchokera kwa okondedwa ake,
- amalimbikitsa kuyang'anira kuchuluka kwa shuga m'magazi ndi mkodzo.
8. Tsimikizani wodwala za kufunika kowunikira pafupipafupi ndi endocrinologist, kusungira zolemba zowunikira, zomwe zimawonetsa chizindikiro cha shuga, mkodzo, kuthamanga kwa magazi, chakudya chodyedwa patsiku, kulandira chithandizo, kusintha kwa thanzi.
9. Tsimikizani kuyesedwa kwakanthawi kwa a ophthalmologist, dokotala wa opaleshoni, mtima, nephrologist.
10. Tsimikizani makalasi ku Sukulu ya odwala matenda ashuga.
11. Dziwitsani wodwala za zoyambitsa ndi zizindikiro za hypoglycemia, chikomokere.
12. Kuti mumtsimikizire wodwalayo kufunika kochepa pang'ono pabwino komanso kuwerengera magazi, nthawi yomweyo funsani kwa endocrinologist.
13. Phunzitsani wodwala ndi abale ake:
- kuwerengetsa zamkate,
- kupanga mndandanda wazakudya zamagulu a mkate patsiku, makonzedwe ndi makina a insulin,
- malamulo osamalira mapazi,
- dzithandizeni nokha ndi hypoglycemia,
- kuyeza kuthamanga kwa magazi.
Zinthu zadzidzidzi za matenda ashuga:
A. Hypoglycemic state. Hypoglycemic chikomokere.
Zifukwa:
- Mankhwala osokoneza bongo a insulin kapena mapiritsi a antidiabetes.
- Kuperewera kwa zakudya m'zakudya.
- Zakudya zosakwanira kapena kudumpha zakudya pambuyo povomerezeka ndi insulin.
- Zochita zolimbitsa thupi.
Mikhalidwe ya Hypoglycemic imawonetsedwa ndikumva njala yayikulu, thukuta, miyendo yanjenjemera, kufooka kwakukulu.Ngati mkhalidwewu sunayime, ndiye kuti zizindikiro za hypoglycemia zidzakulirakulira: kunjenjemera kumakulirakulira, kusokonezeka m'malingaliro, kupweteka mutu, chizungulire, kuwona kawiri, kuda nkhawa, mantha, kuchita zamtopola ndipo wodwalayo amagwa kukomoka.
Zizindikiro za hypoglycemic chikomokere: wodwalayo sadziwa kanthu, wotumbululuka, palibe fungo la acetone kuchokera mkamwa. Khungu limanyowa, thukuta lakuzizira kwambiri, kamvekedwe ka minofu kachulukitsidwa, kupuma kumasulidwa. kuthamanga kwa magazi ndi kukoka kwake sikusintha, kamvekedwe ka mawonekedwe amaso sikasinthidwa. Pakuyesedwa kwa magazi, kuchuluka kwa shuga kumakhala m'munsi 3.3 mmol / L. mulibe shuga mkodzo.
Zodzithandiza nokha ndi gulu la hypoglycemic:
Ndikulimbikitsidwa kuti poyamba zisonyezo za hypoglycemia muzidya shuga 4-5, kapena kumwa tiyi wotsekemera, kapena kumwa mapiritsi 10 a glucose a 0 ga 1, kapena kumwa magawo atatu a shuga 40%, kapena kudya maswiti ochepa (caramel ndibwino )
Chithandizo choyamba cha matenda a hypoglycemic:
- Itanani dokotala.
- Imbani othandizira ogwira ntchito.
- Apatseni wodwalayo khola lakhazikika.
- Ikani zidutswa ziwiri za shuga patsaya lomwe wodwalayo wagona.
- Apatseni mwayi wolowera.
Konzani mankhwala:
40 ndi 5% shuga yankho. 0.9% sodium chloride solution, prednisone (amp.), Hydrocortisone (amp.), Glucagon (amp.).
B. Hyperglycemic (matenda ashuga, ketoacidotic).
Zifukwa:
- Musamwe insulin yokwanira.
- Kuphwanya zakudya (chakudya chamafuta ambiri).
- Matenda opatsirana.
- Kupsinjika.
- Mimba.
- Zovulala.
- Opaleshoni.
Harbinger: ludzu lochulukirapo, polyuria. kusanza, kusowa kudya, kusawona bwino, kugona kwambiri modabwitsa, kusokonekera ndikotheka.
Zizindikiro za chikomokere: chikumbumtima sichikupezeka, kununkhira kwa mkamwa kuchokera pakamwa, kuchepa kwa khungu, kupuma mwamphamvu, kutsika kwa minofu kamvekedwe - ma "eye" ofewa. Pulse-ngati, kuthamanga kwa magazi kumatsitsidwa. Pakuwunika kwa magazi - hyperglycemia, pakuwunika mkodzo - glucosuria, matupi a ketone ndi acetone.
Kukhazikika kwa chikomicho kuoneka, nthawi yomweyo funsani kwa endocrinologist kapena mudzamuyimbire kunyumba. Ndi zizindikiro za kukomoka kwa hyperglycemic, kuyimbira mwachangu.
Thandizo loyamba:
- Itanani dokotala.
- Kupatsa wodwalayo khola lakutsogolo (kupewa kupewa lilime, kusilira, kukokoloka).
- Tengani mkodzo ndi catheter kuti muzindikire msanga shuga ndi acetone.
- Apatseni mwayi wolowera.
Konzani mankhwala:
- wosakhalitsa - insulin - actropide (fl.),
- 0,9% sodium chloride solution (fl.), 5% glucose solution (fl.),
- mtima glycosides, mtima othandizira.

Kutenga gawo kwa namwino pakuwazindikira njira za odwala omwe ali ndi matenda ashuga

Choyamba, ndi njira iti ya unamwino? Awa ndiukadaulo waukadaulo komanso wamankhwala wothandiza odwala. Cholinga chake ndikuwongolera moyo wa wodwalayo ndikuthandizira kupeza yankho, lomwe lili kale ndi omwe angatuluke mtsogolo. Kutengera izi, ntchito zina zimakhazikitsidwa.

Pa gawo loyamba, mayeso, anamwino amathandizira kupanga chithunzithunzi chokwanira cha matendawa. Ayenera kukhala ndi mbiri yake ya matendawa, momwe mayesero onse amapangidwa komanso malingaliro ake ndi zomwe ananena zokhudza thanzi la wodwalayo.

Pa gawo lachiwiri, kufufuza kumachitika, ndipo izi sizingafanane ndi mavuto omwe alipo, omwe akuwonekeranso kwa wodwalayo, komanso omwe angadzapeze m'tsogolo. Mwachilengedwe, koyambirira, munthu ayenera kuyankha kuzizindikiro ndi mawonekedwe a matendawa omwe ali oopsa kwambiri pamoyo wa wodwalayo. Tiyenera kudziwa kuti namwino ayenera kudziwa mavuto osiyanasiyana omwe angayambitse zovuta m'moyo wa wodwalayo. Izi sizimangotengera njira zachipatala zokha, komanso kupewa, zamaganizidwe ndi ntchito ndi abale.

Pa gawo lachitatu, zonse zomwe zalandilidwa zimakonzedwa mwadongosolo, ndipo namwino amakhala ndi zolinga, osati zakanthawi kochepa, komanso adapangira nthawi yayitali. Zonsezi zinafotokozedwa mu ndondomeko ya zoyeserera ndipo zalembedwa m'mbiri ya wodwalayo.

Gawo lachinayi, namwino amachita mogwirizana ndi dongosolo lomwe wakonzalo ndikuchita mwatsatanetsatane yokwaniritsa mkhalidwe wa wodwalayo.

Pa gawo lachisanu, mphamvu zakukula kwa matendawa komanso kusintha kwabwino komwe kwachitika m'thupi la wodwalayo kumatsimikizira kugwira ntchito kwa unamwino. Ntchito zamtundu uliwonse zitha kupatsidwa kwa wodwala aliyense. Loyamba ndi pamene mlongoyo amagwira ntchito moyang'aniridwa ndi dokotala ndikutsatira malangizo ake onse. Chachiwiri, namwino ndi dokotala amalumikizana, ndiko kuti, amagwira ntchito limodzi ndikuwongolera njira zonse. Chachitatu, kulowererapo kwa unamwino wodziimira payekha, ndiye kuti, wogwira ntchito pachipatalapo amachita zinthu mosadalira ndipo amapereka thandizo lofunikira pakadali pano popanda chilolezo cha dokotala.

Njira zamtundu uliwonse wa unamwino zomwe zochita zake zimayenera kukhala, ziyenera kuyang'anira nthawi zonse ndikuyembekeza chitukuko. Mosasamala kanthu kuti amagwira ntchito motsogozedwa ndi dokotala kapena ngati chilichonse chachitika mosadalira, katswiriyu wamankhwala ndi 100% wamoyo ndi wodwala. Uwu ndi udindo wawukulu.

Monga momwe zalembedwera pamwambapa, anamwino amathetsa mavuto ambiri a odwala, amawathandiza kuti azolowere "zenizeni za moyo wawo wamakono." Izi zikuphatikiza kuphatikiza kwa menyu, ndi chidziwitso choyambirira pakuwerengera kwa XE, chakudya chamthupi ndi zopatsa mphamvu, komanso kulumikizana ndi abale kuti muwaphunzitse momwe angathandizire wodwala. Ngati odwala matenda ashuga amadalira insulin, ndiye kuti nkhani yokhudza jakisoni, mankhwala omwe amagwiritsidwa ntchito komanso kuwongolera koyenera kumagweranso. Mlingo watsiku ndi tsiku amasankhidwa ndi adotolo, namwino amangowonetsa komwe angayikemo jakisoni ndi momwe angalandire mankhwalawo.

Njira zomwe mlongo amachita mu shuga zimathandiza kwambiri. Kupatula apo, namwino uyu ndi munthu yemwe mungolankhula naye, pezani chithandizo ndi kufunsira. Onsewa ndi akatswiri amisala ochepa omwe amathandizira kuvomereza matendawa, amaphunzitsa momwe angakhalire moyo wathunthu ndikufotokozera zamtundu wanji zomwe ziyenera kuchitidwa. Chifukwa chake ntchito yawo nthawi zina imakhala yofunika kwambiri kuposa dokotala yemwe amangopereka mankhwala.

Chifukwa chake, tiona momwe mlongo akuchitira ndi shuga:

A. Zomwe zilipo (zilipo):

- Kuyabwa pakhungu. khungu lowuma:

- kufooka, kutopa, kuchepa kowoneka bwino,

- kupweteka m'munsi,

- kufunafuna kutsatira chakudya nthawi zonse,

- kufunika kopitilira insulin kapena kumwa mankhwala antidiabetes (maninil, matenda ashuga, amaryl, etc.),

Kupanda kudziwa:

- zenizeni za matendawo ndi zomwe zimayambitsa,

- kudzithandiza ndi hypoglycemia,

- chisamaliro cha kumapazi

- kuwerengera zamkate wopanga ndi kukonza menyu,

- zovuta za matenda ashuga (chikomokere ndi matenda ashuga) komanso kudzithandiza ndekha.

- okondweretsa ndi maukoma akuti:

- zigawenga zam'munsi,

- infalction wa pachimake wamtima,

- Kulephera kwa aimpso,

- zopatsirana ndi matenda a shuga

- matenda oyamba, matenda apakhungu a pakhungu,

- zovuta chifukwa cha insulin,

- kuchiritsa kwapang'onopang'ono kwa mabala, kuphatikiza omwe amakhala othandizira.

Kutolere zidziwitso kumayeso oyamba:

Kufunsa wodwala za:

- kutsatira zakudya (zolimbitsa thupi kapena zakudya No. 9), pankhani yazakudya.

- zolimbitsa thupi masana,

- mankhwala a insulin (dzina la insulin, mlingo, nthawi yayitali, mankhwala a mankhwala),

- mapiritsi a antidiabetesic (dzina, mlingo, mawonekedwe a makonzedwe awo, kulolerana),

- Maphunziro a magazi ndi mkodzo mayeso a shuga ndikuwunikidwa ndi endocrinologist,

- wodwala ali ndi glucometer, mphamvu yogwiritsira ntchito,

- Kugwiritsa ntchito patebulo la mkate ndi kupanga mndandanda wazakudya,

- kuthekera kugwiritsa ntchito syringe ndi cholembera,

- kudziwa malo ndi njira zoperekera insulin, kupewa zovuta (hypoglycemia ndi lipodystrophy pamalo a jekeseni),

- Kusunga zolemba za wodwala wodwala matenda ashuga:

- kuchezera "School of Diabetesics" yakale komanso yapano

- Kukula zakale za hypoglycemic ndi hyperglycemic coma, zomwe zimayambitsa ndi zizindikiro,

- luso lodzithandiza,

- wodwalayo ali ndi "Diabetes Passport" kapena "Diabetesic Traveling Card",

- chiyembekezo cha matenda obadwa ndi matenda ashuga),

- matenda oyamba (matenda a kapamba, ziwalo zina za endocrine, kunenepa kwambiri),

- madandaulo a wodwala panthawi ya mayeso.

- khungu, chinyezi cha pakhungu, kupezeka kwa zipsera:

- kutsimikiza thupi:

- kuchuluka kwa kuthamanga kwa magazi,

- kutsimikiza kwa zimachitika pa radial mtsempha wamagazi ndi mitsempha ya kumbuyo kwake.

Zothandizira anamwino, kuphatikizapo kugwira ntchito ndi banja la wodwala:

1. Pangani zokambirana ndi wodwalayo komanso abale ake zokhudzana ndi zakudya, kutengera mtundu wa shuga, zakudya. Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, perekani zitsanzo zingapo kwa tsiku.

2. Kutsimikizira wodwalayo kufunika kachitidwe koti azitsatira zakudya zomwe dokotala wamupatsa.

3. Kutsimikizira wodwala kufunika kochita masewera olimbitsa thupi omwe adokotala amawauza.

4. Yambitsanani zokambirana, zomwe zimayambitsa matendawa komanso zovuta zake.

5. Dziwitsani wodwala zamankhwala a insulin (mitundu ya insulini. Kuyambira ndi kutalika kwa chochita chake, kulumikizidwa ndi chakudya. Zosungirako, zotsatira zoyipa, mitundu ya insulin ndi ma cholembera a syringe).

6. Onetsetsani makulidwe a insulin panthawi yake komanso kuperekera mankhwala a antidiabetes.

- khungu

- zimachitika ndi kuthamanga kwa magazi,

- zimachitika pa mitsempha ya kumbuyo,

- kutsatira zakudya ndi chakudya, kufalitsa kwa wodwalayo kuchokera kwa abale ake, - amalimbikitsa kuyang'anira kuchuluka kwa shuga m'magazi ndi mkodzo.

8. Tsimikizani wodwala za kufunika kowunikira pafupipafupi ndi endocrinologist, kusungira zolemba zowunikira, zomwe zimawonetsa chizindikiro cha shuga, mkodzo, kuthamanga kwa magazi, chakudya chodyedwa patsiku, kulandira chithandizo, kusintha kwa thanzi.

9. Tsimikizani kuyesedwa kwakanthawi kwa a ophthalmologist, dokotala wa opaleshoni, mtima, nephrologist.

10. Tsimikizani makalasi ku Sukulu ya odwala matenda ashuga.

11. Dziwitsani wodwala za zoyambitsa ndi zizindikiro za hypoglycemia, chikomokere.

12. Kuti mumtsimikizire wodwalayo kufunika kochepa pang'ono pabwino komanso kuwerengera magazi, nthawi yomweyo funsani kwa endocrinologist.

13. Phunzitsani wodwala ndi abale ake:

- kuwerengetsa zamkate,

- kupanga mndandanda wazakudya zamagulu ambiri patsiku, makonzedwe a insulin ndi syringe ya insulin,

- malamulo osamalira mapazi,

- zithandizeni ndi hypoglycemia,

- kuyeza kuthamanga kwa magazi.

Mavuto azadzidzidzi a matenda ashuga:

A. Hypoglycemic. Hypoglycemic chikomokere.

- Mankhwala osokoneza bongo a insulin kapena mapiritsi a antidiabetes.

- Kuperewera kwa zakudya m'zakudya.

- Zakudya zosakwanira kapena kudumpha zakudya pambuyo povomerezeka ndi insulin.

- Zochita zolimbitsa thupi.

Mikhalidwe ya Hypoglycemic imawonetsedwa ndikumva njala yayikulu, thukuta, miyendo yanjenjemera, kufooka kwakukulu. Ngati mkhalidwewu sunayime, ndiye kuti zizindikiro za hypoglycemia zidzakulirakulira: kunjenjemera kumakulirakulira, kusokonezeka m'malingaliro, kupweteka mutu, chizungulire, kuwona kawiri, kuda nkhawa, mantha, kuchita zamtopola ndipo wodwalayo amagwa kukomoka.

Zizindikiro za hypoglycemic chikomokere: wodwalayo sadziwa kanthu, wotumbululuka, palibe fungo la acetone kuchokera mkamwa. Khungu limanyowa, thukuta lakuzizira kwambiri, kamvekedwe ka minofu kachulukitsidwa, kupuma kumasulidwa.kuthamanga kwa magazi ndi kukoka kwake sikusintha, kamvekedwe ka mawonekedwe amaso sikasinthidwa. Pakuyesedwa kwa magazi, kuchuluka kwa shuga kumakhala m'munsi 3.3 mmol / L. mulibe shuga mkodzo.

Zodzithandiza nokha ndi gulu la hypoglycemic:

Ndikulimbikitsidwa kuti poyamba zisonyezo za hypoglycemia muzidya shuga 4-5, kapena kumwa tiyi wotsekemera, kapena kumwa mapiritsi 10 a glucose a 0 ga 1, kapena kumwa magawo atatu a shuga 40%, kapena kudya maswiti ochepa (caramel ndibwino )

Chithandizo choyamba cha matenda a hypoglycemic:

- Apatseni wodwalayo khola lakhazikika.

- Ikani zidutswa ziwiri za shuga patsaya lomwe wodwalayo wagona.

- Apatseni mwayi wolowera.

40 ndi 5% shuga yankho. 0.9% sodium chloride solution, prednisone (amp.), Hydrocortisone (amp.), Glucagon (amp.).

B. Hyperglycemic (matenda ashuga, ketoacidotic).

- Osakwanira mlingo wa insulin.

- Kuphwanya zakudya (chakudya chamafuta ambiri).

Harbinger: ludzu lochulukirapo, polyuria. kusanza, kusowa kudya, kusawona bwino, kugona kwambiri modabwitsa, kusokonekera ndikotheka.

Zizindikiro za chikomokere: chikumbumtima sichikupezeka, kununkhira kwa acetone kuchokera mkamwa, Hyperemia ndi kuyanika pakhungu, kupuma mwamphamvu, kutsika kwamvekedwe ka minofu - "zofewa" zamaso. Pulse-ngati, kuthamanga kwa magazi kumatsitsidwa. Pakuwunika kwa magazi - hyperglycemia, pakuwunika mkodzo - glucosuria, matupi a ketone ndi acetone.

Kukhazikika kwa chikomicho kuoneka, nthawi yomweyo funsani kwa endocrinologist kapena mudzamuyimbire kunyumba. Ndi zizindikiro za kukomoka kwa hyperglycemic, kuyimbira mwachangu.

- Kupatsa wodwalayo khola lakutsogolo (kupewa kupewa lilime, kusilira, kukokoloka).

- Tengani mkodzo ndi catheter kuti muzindikire msanga shuga ndi acetone.

- Apatseni mwayi wolowera.

- wosakhalitsa - insulin - actropide (fl.),

- 0,9% sodium chloride solution (fl.), 5% glucose solution (fl.),

- mtima glycosides, mtima wothandizira.

shuga unamwino chisanachitike mankhwala hypoglycemic

Kuphwanya zosowa.

Pali (stomatitis, kuletsa zakudya).

Kumwa (ludzu, kusowa kwamadzi).

Kupuma (ketoacidotic chikomokere).

Chabwino (kuwonongeka kwa impso).

Amayendetsa zogonana (kusabala).

Kukhala woyera (matenda a pustular, matenda am'mimba mwa khungu).

Sungani momwe zinthu ziliri (zovuta, kuwonongeka).

Kuvala, kusasokoneza (chikomokere).

Sungani kutentha (zovuta zodwala).

Gona, kupuma (kubwezeretsa).

Kusuntha (phazi la matenda ashuga, zovuta zina).

Lumikizanani (kuchipatala, kuwonongeka kwa mawonekedwe, ndi zina).

Kupeza kupambana, mgwirizano.

Khalani ndi mfundo zofunika pamoyo (kupsinjika, mantha, kulephera kuzolowera matendawa chifukwa cha kuwopsa kwa matendawa komanso kukula kwa zovuta).

Sewerani, phunzirani, ntchito (kulemala, kusintha kwa moyo).

Mitundu ndi mitundu ya matenda a shuga, matenda ndi zizindikiro zake. Chikhalidwe, zomwe zimayambitsa ndi zomwe zimayambitsa matendawa. Thandizo lodzidzimutsa la odwala matenda ashuga. Kuzindikira, kupewa komanso kuchiza matendawa. Odwala anamwino wodwala.

Shuga mellitus ndi gulu la matenda a metabolic (metabolic) omwe amadziwika ndi hyperglycemia, omwe ndi zotsatira za kuperewera kwa katulutsidwe ka insulini, zotsatira za insulin, kapena zonsezi. Chiwopsezo cha matenda a shuga chikukulirakulira mosalekeza. M'mayiko otukuka, anthu okwanira 6-7% onse. Matenda a shuga amapezeka lachitatu pambuyo pamatenda a mtima ndi oncological.

Matenda a shuga ndi vuto lachipatala lapadziko lonse lapansi, chikhalidwe cha anthu komanso zothandiza anthu m'zaka za m'ma 2000 zino zomwe zakhudza dziko lonse lapansi masiku ano. Zaka makumi awiri zapitazo, chiwerengero cha anthu padziko lonse lapansi omwe adwala matenda a shuga sichidaposa 30 miliyoni. Mu nthawi yonse ya moyo wam'badwo umodzi, kuchuluka kwa matenda ashuga kumawonjezeka kwambiri.Masiku ano, anthu odwala matenda ashuga ali ndi anthu oposa 285 miliyoni, ndipo pofika chaka cha 2025, malinga ndi kunena kwa International Federation of Diabetes (MFD), kuchuluka kwawo kudzakwera mpaka 438 miliyoni. Kuphatikiza apo, matenda a shuga akucheperachepera, akukhudza anthu ochulukirapo.

Matenda a shuga ndi matenda oopsa osakhazikika omwe amafunikira chisamaliro chachipatala moyo wonse wa odwala ndipo ndi chimodzi mwazomwe zimayambitsa kufa msanga. Malinga ndi World Health Organisation (WHO), masekondi 10 aliwonse padziko lapansi, wodwala m'modzi mwa odwala matenda a shuga amafa, ndiye kuti, pafupifupi mamiliyoni 4 odwala amafa chaka chilichonse - kuposa matenda a Edzi ndi hepatitis.

Matenda a shuga amadziwika ndi kukula kwamavuto akulu: kulephera kwamtima komanso aimpso, kuchepa kwa masomphenya, zigawenga zam'munsi. Imfa ya nthenda ya mtima ndi mikwingwirima mwa odwala matenda ashuga ndi katatu, kuwonongeka kwa impso ndi nthawi 1215, khungu limakhala k 10, kudula kwam'mphepete mozungulira kuli pafupifupi ka 20 kuposa anthu ambiri.

Mu Disembala 2006, bungwe la United Nations lidatengera chisankho chapadera cha nambala 61/25 pa matenda a shuga.

Matenda a shuga ndi matenda okwera mtengo kwambiri. Ndalama zowongolera mwachindunji polimbana ndi matenda ashuga komanso zovuta zake m'maiko otukuka zimachepetsa gawo limodzi mwa magawo khumi a khumi ndi anayi aumoyo. Nthawi yomweyo, 80% ya mtengo umapita kukamenya nkhondo ya matenda ashuga.

Njira mwadongosolo polimbana ndi matenda ashuga ndi chizindikiritso cha mfundo zaumoyo wa ku Russia. Komabe, momwe zinthu ziliri ndikuti kuwonjezeka kwa vuto la kusakhazikika ku Russia, komanso mdziko lonse lapansi, lero kuli patsogolo pa njira zonse zomwe zatengedwa.

Akuluakulu, pafupifupi 3 miliyoni odwala amalembetsedwa mwalamulo mdziko muno, koma malinga ndi zotsatira za maphunziro owongolera ndi miliri, kuchuluka kwawo sikotsika ndi 9-10 miliyoni. Izi zikutanthauza kuti kwa wodwala mmodzi yemwe sakudziwika samapezeka. Kuphatikiza apo, anthu pafupifupi 6 miliyoni aku Russia ali mdziko la prediabetes.

Malinga ndi akatswiri, pafupifupi ma ruble 280 biliyoni amawonongedwa pachaka polimbana ndi matenda ashuga ku Russia. Ndalamazi ndi pafupifupi 15% ya bajeti yonse yazaumoyo.

Anamwino odwala matenda ashuga.

Anamwino odwala matenda ashuga.

Kusanthula njira yolerera matenda ashuga.

Kuti izi zitheke, ndikofunikira kuphunzira:

Etiology ndi zomwe zikuwonetseratu zovuta za matenda ashuga,

· Chithunzi chazachipatala ndi mawonekedwe a matenda a shuga,

· Mfundo za chisamaliro chachikulu cha matenda ashuga,

· Njira za Kafufuzidwe ndi kuzikonzekera,

· Mfundo za mankhwalawa ndi kupewa matendawa.

Kuti izi zitheke, ndikofunikira kusanthula:

· Milandu iwiri yosonyeza njira za namwino pakukhazikitsa njira ya unamwino kwa odwala omwe ali ndi matenda awa.

· Zotsatira zazikulu za kuyesedwa ndi chithandizo cha odwala omwe afotokozedwatu kuchipatala ndizofunikira kuti mudzaze zolemba zina zothandizira unamwino.

· Kusanthula kwa sayansi ndi malingaliro a mabuku azachipatala pamutuwu,

· Zothandiza - zowunikira, njira zowonjezera zowerengera:

- Njira (poyerekeza, yophatikiza),

- njira yogwiritsira ntchito yoyeserera wodwala (mbiriyakale),

- njira zofunika zowunikira wodwala (mwakuthupi, zothandizira, zasayansi),

· Kulemba mbiri yakale, kusanthula kwa zolembedwa zamankhwala,

Ubwino wotsatira maphunziro:

Kuwulura mwatsatanetsatane zakuthupi pamutuwu kukonza bwino ntchito ya unamwino.

matenda a matenda a shuga

1. ZOPHUNZITSA ZA SUGAR

Matenda oyambitsidwa ndi insulin yokwanira kapena achibale a insulin mthupi ndipo amadziwika chifukwa cha kuphwanya mitundu iyi ya kagayidwe kake komanso makamaka kagayidwe kazakudya.

Pali mitundu iwiri ya matenda ashuga:

wodwala insulini (mtundu wa matenda A shuga) NIDDM,

osadalira insulini (mtundu II shuga) IDDM

Type Iabetes mellitus imakhazikika nthawi zambiri mwa achinyamata, ndipo lembani matenda ashuga II okalamba.

Matenda a shuga amayamba kwambiri chifukwa cha kuchepa kwa insulin,

Cholinga chachikulu cha insell -us shuga yodalira shuga ndi kuwonongeka kwa makina a b-cell a islet zida za kapamba, zomwe zimabweretsa kuperewera kosakwanira kwa insulin. Kusowa kotereku kumatha kuchitika pambuyo pancreatic resection, yomwe, ndi mtima sclerosis ndi pancreatic virus kuwonongeka, kapamba, pambuyo pa kuvulala kwamisala, ndikugwiritsa ntchito zinthu zomwe zili ndi poizoni zomwe zimakhudza maselo a b, etc. Matenda a shuga II - osadalira insulin - atha kukhala chifukwa cha kusintha kwa ntchito (hyperfunction) ya tiziwalo timene timatchedwa endocrine timene timatulutsa timadzi timene timakhala ndi timene timagwira. Gululi limaphatikizapo mahomoni a adrenal cortex, chithokomiro cha chithokomiro, mahomoni a pituitary (thyrotropic, mahomoni okula, corticotropic), glucagon. Matenda a shuga amtunduwu amatha kukhala m'matenda a chiwindi akayamba kupanga kwambiri insulinase - insulin inhibitor (wowononga). Zomwe zimapangitsa kwambiri kuti pakhale matenda osokoneza bongo omwe samadalira insulin ndizovuta kunenepa komanso kusokonezeka kwa metabolic. Anthu onenepa kwambiri amakhala ndi matenda a shuga mellitus pafupipafupi kasanu ndi kawiri kuposa anthu omwe ali ndi thupi lolemera.

Mu pathogenesis ya matenda a shuga, pali maulalo awiri omwe adadziwika:

1. Kupanga kwa insulin kokwanira kwa maselo a endocrine a kapamba,

2. Kuphwanya kulumikizana kwa insulin ndi maselo a minofu ya thupi chifukwa cha kusintha kwa kapangidwe kake kapena kuchepa kwa chiwerengero cha zolandilira zenizeni za insulini, kusintha kapangidwe ka insuliniyake kapena kuphwanya njira zamkati mwa kufala kwa chizindikirocho kuchokera ku ma receptors kupita ku cell cell.

Pali cholowa chamtundu wa matenda ashuga. Ngati m'modzi mwa makolo adwala, ndiye kuti kuthekera kwa kulandira matenda ashuga 1 ndi 10%, ndipo mtundu 2 wa matenda ashuga ndi 80%.

Mtundu woyamba wa chisokonezo ndi mtundu wa matenda amtundu 1. Chomwe chimayambira pakupanga mtundu wamitundu iyi ndi chiwonongeko chachikulu cha maselo a pancreatic endocrine (ma Langerhans islets) ndipo, chifukwa chake, kutsika kwakukulu kwamankhwala a insulin.

Imfa yambiri yamankhwala am'mimba a pancreatic endocrine imatha kupezeka ndi matenda opatsirana ndi ma virus, khansa, kapamba, kuwonongeka kwa kapamba, nkhawa, matenda osiyanasiyana a autoimmune momwe ma cell a chitetezo cha mthupi amatulutsa antibodies motsutsana ndi ma cell a pancreatic b, amawawononga. Mtundu uwu wa matenda ashuga, nthawi zambiri, umakhala wa ana ndi achinyamata (mpaka zaka 40).

Mwa anthu, matendawa nthawi zambiri amatsimikizika kuti amachokera ku ma genetic omwe amapezeka pa 6 chromosome. Izi zopunduka zimapangitsa kudziwika kwa autoimmune kupsinjika kwa maselo a pancreatic ndikusokoneza masoka a maselo a b.

Maziko a kuwonongeka kwa autoimmune m'maselo ndikuwonongeka kwawo ndi ma cytotoxic othandizira. Kutupa kumeneku kumayambitsa kutulutsa kwa maantiantigens, omwe amachititsa ntchito za ma macrophages ndi ma T-akupha, omwe amachititsa kuti apange ndikupanga magazi a ma interleukins omwe amakhala ndi poizoni m'maselo a pancreatic. Maselo amawonongeka ndi ma macrophages omwe amapezeka m'matumbo a gland.

Zomwe zimapangitsanso chidwi zimatha kukhala kwa nthawi yayitali pancreatic cell hypoxia ndi chakudya chambiri, chokhala ndi mafuta ochepa komanso zakudya zochepa zama protein, zomwe zimapangitsa kuchepa kwa ntchito zachinsinsi za maselo a islet komanso pakapita nthawi yayitali kuti afe. Pambuyo pachimake chachikulu cha kufa kwa cell, makina awo owonongeka a autoimmune akuyamba.

Matenda a shuga 2 amadziwika ndi zovuta zomwe zafotokozedwa m'ndime 2 (onani pamwambapa). Mu mtundu uwu wa matenda ashuga, insulin imapangidwa mwanjira yabwinobwino kapenanso kuchuluka kwake, komabe, momwe limagwirira ntchito insulin ndi maselo amthupi limasokonekera.

Cholinga chachikulu cha kukana insulini ndikuphwanya ntchito za insulin membrane receptors mu kunenepa kwambiri (chinthu chachikulu chowopsa, 80% ya odwala matenda ashuga ndi onenepa kwambiri) - ma receptors amalephera kuyenderana ndi mahomoni chifukwa cha kusintha kwawo kapangidwe kake kapena kuchuluka kwake. Komanso, ndi mitundu yina ya matenda a shuga a 2, kapangidwe ka insulin palokha (zolakwika zamtundu) kumatha kusokonezeka. Kuphatikiza kunenepa kwambiri, ukalamba, kusuta, kumwa mowa, matenda oopsa, kudya kwambiri masewera olimbitsa thupi, kukhalanso ndi moyo wokhala pachiwopsezo ndi zinthu zomwe zingayambitse matenda a shuga a 2. Mwambiri, mtundu uwu wa matenda a shuga umakonda kukhudza anthu azaka zopitilira 40.

Kudziwiratu kwamtundu wa matenda ashuga 2 kumatsimikiziridwa, monga momwe zasonyezedwera ndi 100% ya kukhalapo kwa matendawa m'mapasa osakhalitsa. Mtundu wachiwiri wa matenda ashuga, nthawi zambiri pamakhala kuphwanya kwa mapangidwe a insulin kapenanso kusakhalapo kwa nthawi yayitali kwa kusintha kwa maumbidwe am'mimba.

Zomwe zimayambitsa matendawa ndi kuthamanga kwa insulin inactivation kapena kuwonongeka kwina kwa insulin zolandila pama cell a insulin.

Kuthamanga kwa chiwonongeko cha insulin nthawi zambiri kumachitika pamaso pa portocaval anastomoses ndipo, chifukwa chake, kulowa mwachangu kwa insulin kuchokera ku chiwindi, komwe imawonongeka mwachangu.

Kuwonongeka kwa insulin receptors ndi zotsatira za njira ya autoimmune, pomwe ma autoantibodies amawona ma insulin receptors ngati ma antigen ndikuwawononga, zomwe zimapangitsa kuchepa kwakukulu kwa chidwi cha insulin cha maselo odalira insulin. Kuchita kwa insulin pazomwe zimachitika m'magazi kumakhala kosakwanira kuonetsetsa kuti kagayidwe kake kamphamvu m'thupi.

Chifukwa cha izi, zovuta zoyambirira komanso zachiwiri zimakhala.

Kuchepetsa glycogen kaphatikizidwe,

Kuchepetsa kuchepa kwa gluconidase,

Kuthamanga kwa shuga mu chiwindi,

· Kuchepa kwa kulolera kwa shuga,

Chepetsani kapangidwe kazakudya zomanga thupi

Kuchepetsa kaphatikizidwe wamafuta acid,

Kuthamanga kwamasulidwe a mapuloteni ndi mafuta ochulukirapo ku depot,

· Gawo la secretion mwachangu insulin mu b-maselo amasokonezeka ndi hyperglycemia.

Chifukwa cha kusokonezeka kwa kagayidwe kazakudya m'maselo a kapamba, mapangidwe a exocytosis amasokonezeka, omwe, amatsogolera kukuwonjezeka kwa zovuta za kagayidwe kazakudya. Kutsatira kuphwanya kwa kagayidwe kazakudya, zovuta zamafuta ndi mapuloteni kagayidwe kamayambira zimayamba.

Choyambirira ndicho chibadwa, chomwe chimatchulidwa kwambiri mu matenda ashuga II (mwina mitundu ya matenda ashuga). Zithandizirani pakukula kwa matenda ashuga:

Kumwa kwambiri.

Mu shuga mellitus, zomwe zimayambitsa ndi zomwe zimayambitsa matenda ndizomwe zimapangidwira kwambiri kotero kuti nthawi zina zimakhala zovuta kusiyanitsa.

Kwenikweni, mitundu iwiri ya shuga imadziwika:

Insulin yotengera matenda a shuga a insulin (IDDM) imakula makamaka mwa ana, achinyamata, anthu azaka zosaposa 30 - nthawi zambiri mwadzidzidzi komanso zowala, nthawi zambiri nthawi yophukira-nyengo yachisanu chifukwa cha kulephera kapena kupendekera kwapadera kwa insulin ndi kapamba, kufa kwa maselo ambiri mu zilumba za Langerhans. Uku ndikusowa kwathunthu kwa insulin - ndipo moyo wa wodwalayo kwathunthu umadalira insulin.Kuyesa kugonjera ndi insulin kapena kuchepetsa mlingo womwe dokotala wakupatsani kungayambitse mavuto ena osaneneka, mpaka kutha kwa ketoacidosis, ketoacidotic chikomokere ndikuopseza moyo wa wodwalayo.

Sewero la insulin losadalira insulini (NIDDM) nthawi zambiri limakula mwa anthu okalamba, omwe nthawi zambiri amakhala onenepa kwambiri, ndipo amakhala otetezeka kwambiri. Nthawi zambiri amatanthauzidwa kuti mwangozi. Anthu omwe ali ndi matenda amtunduwu nthawi zambiri safuna insulin. Cancreas yawo imatha kutulutsa insulin yofananira; sikuti imapanga insulini yomwe imalephera, koma mtundu wake, mawonekedwe omasulidwa ku kapamba, komanso chiwopsezo cha minofu yake. Uku ndikusowa kwa insulin. Kukhalabe ndi chakudya chofunikira cha kagayidwe kazakudya, mankhwala othandizira pakudya, masewera olimbitsa thupi, zakudya, ndi mapiritsi ochepetsa shuga amafunikira.

1.4 Chithunzi chachipatala

Pa shuga pali magawo atatu:

Matenda a shuga ndi gawo lomwe silimadziwika ndi njira zamakono. Gulu la prediabetes limakhala ndi anthu omwe ali ndi vuto lobadwa nalo, amayi omwe abereka mwana wamoyo kapena wakufa wokhala ndi thupi lolemera makilogalamu 4.5 kapena kuposerapo, odwala omwe ali ndi kunenepa kwambiri,

Matenda a shuga opezeka amadziwika panthawi yoyesedwa ndi shuga (mayeso a kulolera shuga), wodwala akakhala ndi shuga m'magazi atatha kumwa 50 g ya madzi osungunuka mu 200 ml ya madzi: pambuyo pa ola limodzi - pamwamba pa 180 mg% (9, 99 mmol / L), ndipo patatha maola awiri - oposa 130 mg% (7.15 mmol / L),

Matenda osokoneza bongo amapezeka pamaziko a data ndi ma labotale. Kuyamba kwa matenda ashuga kumachitika pang'onopang'ono nthawi zambiri. Ndizosatheka kudziwa nthawi zonse zomwe zimayambitsa matendawa kuonekera, komanso zovuta kudziwa zomwe zimapangitsa odwala omwe ali ndi vuto lobadwa nalo. Kuyambika kwadzidzidzi kwa chitukuko cha chithunzithunzi m'masiku ochepa kapena milungu yochepa kwambiri ndipo, monga ulamuliro, paunyamata kapena ubwana. Mwa anthu achikulire, matenda a shuga nthawi zambiri amakhala asymptomatic ndipo amadziwika mwamwayi panthawi yoyesedwa. Komabe, mwa odwala ambiri omwe ali ndi matenda a shuga, matendawa amawonekera.

Ndi njira komanso kuopsa kwa zizindikilo, kusintha kwa mankhwalawo, chithunzi cha matenda ashuga chimagawika:

Chofunikira cha matendawa ndi kuphwanya mphamvu ya thupi yopeza shuga kuchokera ku chakudya cha m'ziwalo ndi minyewa, pakulowa kwa shuga wosafunikaku m'magazi ndikuwonekera mkodzo. Kutengera izi, mwa odwala omwe ali ndi matenda ashuga zotsatirazi zimadziwika:

- polydipsia (ludzu lambiri),

- polyphagy (kuchuluka chakudya),

- polyuria (kukodza kwambiri),

- glucosuria (shuga mkodzo),

- hyperglycemia (kuchuluka kwa shuga).

Kuphatikiza apo, wodwalayo ali ndi nkhawa:

џ ntchito yochepera,

it kuyabwa pakhungu (makamaka mu perineum).

Madandaulo ena atha kukhala chifukwa cha zovuta zoyambirira: kusawona bwino, kuwonongeka kwa impso, kupweteka pamtima komanso kutsika pang'ono chifukwa cha kuwonongeka kwa mitsempha yamagazi ndi mitsempha.

Mukamayang'ana wodwalayo, kusintha khungu kumadziwika kuti ndi kouma, kouma, kumatuluka mosavuta, wokutidwa ndi mikwingwirima yomwe imayambitsa kuyabwa, zithupsa, zilonda zam'mimba, zilonda zam'mimba kapena zotupa zina. Pa jakisoni wa insulin, mankhwala a subcutaneous mafuta wosanjikiza kapena kutha kwake (insulin lipodystrophy) ndi kotheka. Izi zimadziwika kawirikawiri ndi odwala omwe amathandizidwa ndi insulin. Mafuta amchere am'mimba nthawi zambiri samawonetsedwa mokwanira. Kusiyana kwake ndi odwala (nthawi zambiri okalamba), omwe shuga imayamba chifukwa cha kunenepa kwambiri. Muzochitika izi, mafuta a subcutaneous amakhalabe akuwonetsedwa. Nthawi zambiri pamakhala chifuwa, chibayo, chifuwa chachikulu cha m'mapapo.

Matenda a shuga amadziwika ndi zotupa za mtima. Tizilombo tating'onoting'ono tomwe timayang'aniridwa mozungulira kwambiri (ma capillaries, komanso arterioles ndi venule). Makamaka kuwonongeka kwakukulu kwa ziwiya za aimpso glomeruli, retina ndi distal m'munsi (mpaka kukula kwa gangrene).

Kugonjetsedwa kwa ziwiya zazikulu (macroangiopathy) ndi kuphatikiza kwa atherosulinosis ndi macroangiopathy a diabetes. Chomwe chikutsimikizira ndikuwonongeka kwamitsempha yaubongo ndikulimbana ndi kugunda kwamitsempha yamagazi ndi mtima ndikupanga matenda amtima.

Zizindikiro zomwe zafotokozedwayi zimachitika kawirikawiri kwa anthu odwala matenda ashuga kwambiri. Pa matenda akulu a shuga, ketoacidosis imayamba ndipo pamatha kukhala matenda obwera ndi matenda ashuga. Mitundu ikuluikulu komanso yambiri ya matenda ashuga imapezeka mwa anthu odwala matenda a shuga. Kwa odwala omwe ali ndi matenda osokoneza bongo omwe samadalira insulin, njira yofatsa komanso, yocheperako kwambiri, imakhala yodziwika.

Zizindikiro zazikulu za matenda ashuga, malinga ndi kafukufuku wa labotale, ndikuwonekera kwa shuga mkodzo, kuchuluka kwa mkodzo komanso kuchuluka kwa shuga m'magazi. M'mitundu ikuluikulu ya matenda ashuga, matupi a ketone (acetone) amawonekera mumkodzo, ndipo kuwonjezereka kwa gawo lawo kumawonedwa m'magazi, zomwe zimayambitsa kusintha kwa pH kwa magazi kupita kumbali ya acid (acidosis).

- kuwonongeka kwaimpso,

- kupweteka m'malo otsika,

- phazi la matenda ashuga, (onani Zakumapeto 2.)

1.6 Kusamalira mwadzidzidzi matenda a shuga

Coma mu matenda a shuga ndi zovuta kwambiri.

Ketoacidotic (matenda ashuga) chikomokere.

Ndizovuta kwambiri za shuga. Kunena kuti, ambiri amagwiritsa ntchito mawu akuti "matenda ashuga."

Coma chikuwonekera chifukwa cha:

o mochedwa wayamba kuchitidwa zinthu molakwika,

o Kuphwanya zakudya,

o matenda opweteka ndi kuvulala kwambiri,

o mantha amanjenje,

Mawonetseredwe azachipatala a coma awa ndi omwe amachitika chifukwa cha poyizoni wakuthupi (makamaka dongosolo lamanjenje lamkati) ndi matupi a ketone, kuchepa kwa madzi ndi kusunthika kwa acid-base balance to acidosis. Nthawi zambiri, kuwonetsa kowopsa kumawonjezeka pang'onopang'ono, ndipo kukomoka kumayendetsedwa ndi ena mwa otsogola (boma lokondweretsa). Kuwoneka: ludzu lalikulu, polyuria, kupweteka m'mimba, kupweteka m'mimba, kusanza, kawirikawiri kutsegula m'mimba, kusowa kwa chakudya kumatha. Mlengalenga wokhathamira mumatha kununkhiza ma acetone (amafanana ndi fungo la maapulo oola). Mphamvu yayikulu yamanjenje imangokhala, kusowa tulo, kukomoka kumawonekera. Mpweya umakhala pa Kussmaul. Pambuyo pake, kuletsa kumalowedwa m'malo ndi kuponderezedwa, kufotokozeredwa kugona, kusayang'anira chilengedwe, ndikuthanso kuzindikira.

Ndi chikomokere, wodwala wagontha, khungu limakhala louma, mamvekedwe a minofu ndi mawonekedwe amaso amachepetsedwa, amakhala ofewa, ana ndi ochepa. Kutali kwenikweni, "kupumira" kwakukulu kwa Kussmaul kumveka. Kupsinjika kwa magazi kumachepetsedwa kwambiri. Kuchuluka kwa shuga kumatsimikiziridwa mu mkodzo, matupi a ketone amawoneka.

Ketoacidotic coma iyenera kusiyanitsidwa ndi hyperosmolar ndi hyperlactacidemic coma, yomwe imatha kupangidwanso m'matenda a shuga, ndipo, monga momwe zimakhalira ndi chikomokere chilichonse, wodwalayo amakhala wosazindikira.

Amayamba ndi kuperewera kwamphamvu kwam'mimba chifukwa cha kusanza, kutsegula m'mimba.

Mosiyana ndi ketoacidotic coma yokhala ndi hyperosmolar coma, kupuma kwa Kussmaul kulibe, palibe fungo la acetone kuchokera mkamwa, pali zizindikiro zamitsempha (minofu hypertonicity, chizindikiro cha Babinsky's pathological).

Hyperglycemia yokhazikika imakhala yofala, koma chizindikirocho ndi mkulu wa plasma osmolarity (mpaka 350 mosm / l kapena kuposa) wokhala ndi mulingo wabwinobwino wa matupi a ketone.

Ndi zosowa kwambiri. Atha kupezeka mukumwa Mlingo waukulu wa gluuanides chifukwa cha hypoxia yamtundu uliwonse wamtima komanso kupuma, kuchepa kwa magazi m'thupi mwa wodwala matenda a shuga.

Kupezeka kwa chikomachi kumawonetsedwa ndi kuchuluka kwa lactic acid m'magazi pakalibe ketosis, kununkhira kwa acetone kuchokera mkamwa ndi hyperglycemia yayikulu.

Njira zofunika kwambiri pochizira ketoacidotic diabetesic coma ndi precoma ndimankhwala omwe ali ndi Mlingo wambiri wosavuta kuchitira insulin komanso kuyambitsa madzi okwanira (isotonic sodium chloride solution ndi 25% sodium bicarbonate solution).

Wodwala wokhala ndi mawonekedwe oyamba a precoma, komanso wodwala wodwala, akumayang'aniridwa kuchipatala chamankhwala. Kuzindikiritsa kwa precoma kapena chikomokere chamtunduwu kumafuna kukhazikitsidwa kwa insulin kwa 40-60 IU isanachitike mayendedwe, omwe akuyenera kuwonetsa m'ndondomeko yomwe ikuphatikizira. Njira zina zochizira wodwalayo zikomoka zimachitika pamalo pokhapokha kukakamiza kunyamula.

Zimachitika chifukwa chakuchepa kwambiri kwa shuga m'magazi (hypoglycemia), nthawi zambiri mwa odwala matenda a shuga omwe amalandila insulin.

Chochulukitsa chomwe chimayambitsa matenda a hypoglycemic coma ndi mankhwala osokoneza bongo ambiri chifukwa cha kuchuluka kwa mankhwalawa kapena osakwanira pakudya pambuyo pakukhazikitsidwa. Chiwopsezo cha kukhala chikomokere mu hypoglycemic chimakulirakudya mukamayesera kuperekera mankhwala a insulin ndi chakudya. Pafupipafupi, chomwe chimayambitsa hypoglycemia ndi chotupa cha pulogalamu ya kapamba (insulinoma), yomwe imapanga insulin yambiri.

Odwala omwe ali ndi matenda a shuga mellitus, mikhalidwe yofatsa ya hypoglycemic imatha kuwoneka, yomwe nthawi zambiri imawoneka ngati kumverera kwa njala yakuthwa, kunjenjemera, kufooka mwadzidzidzi, thukuta. Kulandila chidutswa cha shuga, kupanikizana, maswiti kapena 100 g mkate nthawi zambiri kumaletsa izi. Ngati, pazifukwa zingapo, izi sizikumalizika, ndiye ndikuwonjezereka kwa hypoglycemia, nkhawa zambiri, mantha amawoneka, akunjenjemera, kufooka kumakulirakulira ndipo ambiri agwa pansi chifukwa cha kusazindikira, kukhumudwa. Mlingo wa kukula kwa kuchepa kwa hypoglycemic ndiwofulumira: mphindi zochepa zokha zimadutsa kuchokera kuzizindikiro zoyambirira mpaka kukomoka.

Odwala omwe ali mu chikho cha hypoglycemic, mosiyana ndi odwala omwe ali ndi vuto la ketoacidotic, amakhala ndi khungu lonyowa, minofu kamvekedwe imawonjezeka, clonic kapena kupweteka kwa tonic nthawi zambiri. Ophunzirawo ndiotakata, mamvekedwe amaso awo ndi abwinobwino. Palibe fungo la acetone lochokera mkamwa. Kupumira kumasintha. Mwazi wa shuga wamagazi ambiri umatsikira pansi 3.88 mmol / L. Mu mkodzo, shuga samapezeka kawirikawiri, momwe ma acetone amayambira.

Zizindikiro zonsezi ziyenera kudziwika kuti zitsatire bwino njira zochizira. 40-80 ml ya glucose 40% yothetsera shuga iyenera kuyilidwa nthawi yomweyo kudzera m'mitsempha yofunikira. pakakhala kuti palibe, makonzedwe a shuga amabwerezedwa. Ngati chikumbumtima sichibwezeretsedwa, amasinthira kukapanda kuleka kwa 5% shuga. kuthana ndi hypoglycemia, hydrocortisone imagwiritsidwanso ntchito - 125-250 mg kudzera kudzera m'mitsempha kapena intramuscularly. Chithandizo chotere chimachitika kuchipatala ndipo nthawi zambiri chimakhala chothandiza: wodwalayo amachoka.

Zikachitika kuti wodwala akangofunika kuchitapo kanthu, wodwalayo azikhalanso pomwepo, atagonekedwa kuchipatala, chifukwa nthawi zambiri amafunika kusintha mankhwalawo ndi insulin m'masiku otsatirawo.

- Kuyesa kwa magazi (chonse),

- Kuyesedwa kwa magazi pakulola kwa shuga:

Kutsimikiza kusala shuga ndipo pambuyo 1 ndi 2 pambuyo kumwa 75 g shuga kusungunuka 1.5 makapu a madzi owiritsa. Zotsatira zoyesa (zosatsimikizira matenda a shuga mellitus) zimaganiziridwa pama sampuli: pamimba yopanda 6.6 mmol / l poyesera koyamba ndi> 11.1 mmol / l 2 patatha maola atatu kutulutsa shuga,

- Kusanthula kwa mkodzo pamatupi a shuga ndi ketone.

Mfundo yayikulu komanso yovomerezeka yochizira matenda a shuga ndi njira yabwino kwambiri yolipirira minofu njira, monga momwe titha kuwonera ndi shuga wamagazi ndi kuchepa kwake kwamkodzo (kuchotsedwa kwa glucosuria).

Njira zazikulu zochiritsira odwala omwe ali ndi matenda a shuga ndi njira yothandizira pakudya, chithandizo cha insulini komanso makonzedwe a othandizira othandizira a shuga (sulfonamides, biguanides). Chithandizo cha mankhwala a insulin ndi hypoglycemic ndi ufulu.

Zakudya ndizovomerezeka zamankhwala zamatenda amitundu yonse. Monga njira yodziyimira payekhapayekha (ndiye kuti, chithandizo chokhacho chokhala ndi chakudya), chithandizo chamankhwala chimagwiritsidwa ntchito kokha ndi mtundu wofatsa wa shuga.

Chakudya chimapangidwa, monga lamulo, payekhapayekha, koma magome a odwala matenda ashuga (zakudya No. 9) ayenera kupereka kuchuluka kwa mapuloteni (16%), mafuta (24%) ndi chakudya (60%) m'zakudya. Mukamawerengera chakudyacho, munthu sayenera kuchokera kulemera lenileni la wodwala, koma kuchokera pazomwe amayenera kukhala nazo, kutalika ndi msinkhu. Mtengo wamagetsi wazakudya umachokera ku 2,800 kcal (11,790 kJ) kwa odwala omwe ali ndi ntchito yayitali komanso zamaganizo, mpaka 4,200 kcal (17,581 kJ) chifukwa chogwira ntchito molimbika. Mapuloteni ayenera kukhala athunthu, makamaka nyama. Zakudya zamtundu uliwonse zimaperekedwa ndi kuphatikiza zamasamba azakudya zochepa koma zopatsa mavitamini. Kuti mupewe kusinthasintha kwa shuga m'magazi, zakudya za odwala omwe ali ndi matenda ashuga zimayenera kukhala zopindika, osachepera kanayi pa tsiku (makamaka ka 6). Kuchuluka kwa zakudya kumadaliranso kuchuluka kwa jakisoni wa insulin.

Mankhwala a insulin amachitika ndi odwala omwe ali ndi matenda a shuga. Pali kukonzekera kwapafupifupi, kwapakatikati ndi nthawi yayitali kumakhala kukonzekera insulin.

Mankhwala osokoneza bongo achidule amakhala ndi insulini yodziwika bwino (yosavuta) yotalika maola 4-6 ndi insulin ya nkhumba (suinsulin) yokhala ndi nthawi ya maola 6-7.

Gulu la ma insulin apakati limaphatikizapo kuyimitsidwa kwa amorphous zinc-insulin (Semilent) ndi nthawi ya maola 10-12, insulin B, yomwe imatenga maola 10-18, etc.

Kukonzekera kwa insulin kwa nthawi yayitali kumaphatikizapo protamine-zinc-insulin (yovomerezeka kwa maola 24-36), kuyimitsidwa kwa zinc-insulin ("Ribbon", kovomerezeka mpaka maola 24), kuyimitsidwa kwa crystalline zinc-insulin (kapena "Ultralent") yovomerezeka ya 30 -36 h).

Odwala ambiri omwe ali ndi matenda ashuga amatenga nthawi yayitali mankhwala osokoneza bongo, popeza amathandizanso chimodzimodzi tsiku lonse ndipo samayambitsa kusinthasintha kowopsa m'magazi a magazi. Mlingo wa tsiku lililonse wa insulin amawerengedwa ndi glucosuria tsiku lililonse. Mukapereka mankhwala a insulin, ndiye kuti 1 DB ya insulin imalimbikitsa kuyamwa kwa pafupifupi 4 g shuga. Zosowa zathupi la munthu ndi 40-60 IU ya insulin patsiku, wokhala ndi mankhwala osokoneza bongo osagwirizana ndi insulin. Zokhudza thupi masana ndi usiku Mlingo wa insulin ndi 2: 1. Mlingo wa tsiku ndi tsiku ndi mankhwalawa amasankhidwa payekha. Kusankhidwa koyenera ndi kufalitsa kwa mankhwalawa masana kumayendetsedwa ndikuwunika kuchuluka kwa shuga m'magazi (glycemic curve) ndi mkodzo (mbiri ya glucosuric).

Nthawi zina, zovuta zingachitike ndi chithandizo cha insulin. Kuphatikiza pa lipodystraphy ndi insulin kukana, kukula kwa hypoglycemia ndi zinthu zina zamkati (kuyabwa, zotupa, kutentha thupi, nthawi zina kuwopsa kwa anaphylactic) ndikotheka. Ndi chitukuko cha momwe thupi lanu siligwirizana ndi insulin, liyenera m'malo mankhwala ena.

Pochita jakisoni wa insulin, namwino amayenera kuonetsetsa nthawi yomwe mankhwalawo amathandizira ndi mankhwalawa.

Chitsogozo chotsimikizika mu insulin yothandizira odwala matenda ashuga ndi kugwiritsa ntchito mankhwala apadera - "ma pancreas" ndi "cell-yokumba", yomwe ingafanane ndi kubisika kwa insulini ndi kapamba.

Chithandizo cha mankhwala ochepetsa shuga chimatha kuchitika padera kapena molumikizana ndi insulin.

Mankhwalawa amalamulidwa kwa odwala omwe ali ndi zaka zopitilira 40-45 ndi njira yokhazikika ya matendawa, omwe ali ndi matenda osokoneza bongo omwe amadalira insulin, mitundu yofatsa yamatenda, etc. Mankhwala ochepetsa shuga a sfanfanamide akuphatikiza bukarban, oranil, maninil, glurenorm, etc. Gulu la greatuanides ndi silubin, silubin retard, buformin, adebit, etc. Amagwiritsidwa ntchito kwambiri pothandizira matenda a shuga.

Odwala onse omwe ali ndi matenda ashuga amayang'aniridwa ndi dokotala wa polyclinic, ndipo ngati vutoli likukulira, amathandizidwa kuchipatala.

Chithandizo cha insulin ndi njira yothandizira insulini: kachipangizo kakang'ono komwe kamavulaza insulin pansi pa khungu, kutsanzira kugwira ntchito kwa kapamba wathanzi. Mapampu a insulini ndi oyenera kwa anthu onse omwe ali ndi matenda ashuga omwe amafunikira insulin kuti apatsidwe chithandizo, mosasamala za zaka, kuchuluka kwa chipukutirozo cha kagayidwe kazachilengedwe, monga matenda a shuga.

Pampu imatha kusintha zotsatira za mankhwala:

Ngati wodwala ali ndi chindapusa chosasangalatsa cha kagayidwe kazakudya:

- glycated hemoglobin pamwamba pa 7.0% (> 7.6% mwa ana),

- wanena kusinthasintha kwa magazi m'thupi,

- pafupipafupi hypoglycemia, kuphatikiza usiku, kwambiri kutayika kwa chikumbumtima,

- chodabwitsa cha "m'bandakucha."

Ngati Mlingo wa insulin woperekedwa ndi syringe ndiwosayembekezereka,

Pa nthawi yakukonzekera komanso panthawi yomwe muli ndi pakati, komanso mukabereka mwana,

Mu ana omwe ali ndi matenda ashuga.

Mapampu amakono sangangoyendetsa insulini pokhapokha malinga ndi mawonekedwe a ogwiritsira ntchito:

ma microdoses a insulin amaperekedwa mpaka magulu a 0,025. (Chofunika makamaka kwa ana)

amathandiza kuwerengera mulingo woyenera wa insulini pazakudya kapena kukonza kwa hyperglycemia kofunikira kuti magazi azikhala ndi magazi ambiri,

Kutha kudziyimira pawokha magazi m'thupi, kuchenjeza za kuopsa kokhala ndi hyper- and hypoglycemia,

imatha kupulumutsa wogwiritsa ntchito kwambiri pa hypoglycemia ndi hypoglycemic coma, kusiya kuyimitsidwa kwa insulin kwakanthawi,

Amakulolani kuti musunge zonse zokhudzana ndi kuchuluka kwa insulin, kusunga shuga m'magazi ndi zina zambiri kwa miyezi itatu.

Zakudya nambala 9, tebulo nambala 9

1) wofatsa wofatsa wodwala matenda a shuga: odwala omwe ali ndi vuto labwinobwino kapena onenepa kwambiri salandira insulin kapena kuilandira yaying'ono (20-30 unit), 2) kuti apangitse kulekerera kwa zakudya ndi kusankha mitundu ya insulin kapena mankhwala ena.

Cholinga cha kuperekedwa kwa zakudya No. 9:

amathandizira kuti matenda a kagayidwe kazachilengedwe atetezedwe komanso kuti muchepetse vuto la mafuta metabolism, tsimikizani kupirira kwa chakudya, i.e. kuchulukachakudya cham'thupi chimagwidwa. Zakudya 9:

Zakudya zokhala ndi zakudya zochepa zopatsa mphamvu zama calorie chifukwa chomanga thupi komanso nyamamafuta. Mapuloteni amayendera zikhalidwe zathupi. Shuga ndi maswiti samachotsedwa. Zinthu za sodium chloride, cholesterol, zinthu zina zowonjezera zimakhala zochepa. Zomwe zili ndi lipotronic zinthu, mavitamini, zakudya zamafuta (tchizi tchizi, nsomba zamafuta ochepa, nsomba zam'madzi, masamba, zipatso, chimanga chokwanira, mkate wa wholemeal) zimachuluka. Zakudya zophika ndi zophika zimakonda, sizokazinga komanso zopaka. Zakudya zotsekemera ndi zakumwa - xylitol kapena sorbitol, zomwe zimaganiziridwa muzakudya za calorie. Kutentha kwa mbale ndi kwabwinobwino.

Zakudya No. 9 chakudya:

5-6 pa tsiku ndi kugawa yunifolomu chakudya.

Kuphwanya kwa zosowa za wodwala.

Gome 1. Kufunika kwa zakudya zoyenera

Kunyalanyaza mfundo zachakudya zabwino

Wodwalayo amadziwa mfundo za zakudya zabwino

Nenani za mfundo za zakudya zopatsa thanzi

Gome 2. Kusamalira Matenda a shuga

Ntchito Zaunamwino

2. Kuchulukitsa chilakolako

4. Kuchepetsa kufooka

5. Kuchepetsa thupi

7. Ululu mumtima

8. Ululu m'munsi

10.Nthawi zina furunculosis

11. Coma

1. Kufotokozera wodwala zakufunika kwakudya. Kuphunzitsa mu mfundo za kusankha ndi kukonza zinthu

2. Kuyang'anira kusamutsidwa kwa abale

3. Kuphunzitsa odwala malamulo a aseptic ndi antiseptic ndi makina oyang'anira kukonzekera insulin kunyumba

4. Kufotokozera kwa odwala malamulo otengera mkodzo wa tsiku ndi tsiku wa shuga

5. Kusamalira khungu pakudwala odwala kwambiri kupewa matenda apakhungu ndi zironda

6. Kuwongolera kunenepa kwambiri

7. Kuwongolera kutulutsa mkodzo

8. Kusintha kwa kuthamanga kwa magazi ndi kugunda kwa mtima

9. Thandizo loyamba pakukweza mtima.

1.9 Kupewa, kudalirika

Kupewera kunenepa kapena chithandizo chake,

Kupatula pazakudya zomwe zili ndi chakudya chamafuta, komanso zakudya zamafuta amnyama,

Kuthana ndi boma labwino la ntchito ndi moyo,

Kugwiritsa ntchito mankhwala moyenera panthawi yake.

Pakadali pano, matenda ashuga ndi osachiritsika. Kutalika kwa moyo komanso kudwala kwa wodwala kugwira ntchito kumadalira nthawi yayitali yodziwira matendawa, kuuma kwake, zaka za wodwalayo komanso chithandizo choyenera. Matendawa akamayamba matendawa, amachepetsa miyoyo ya odwala. Kukula kwa matenda ashuga kumatsimikiziridwa makamaka ndi kuchuluka kwa kuwonongeka kwa mtima.

Odwala omwe ali ndi matenda osokoneza bongo amatha kugwira ntchito. Pokulira kwambiri matenda a shuga oledzera, kuchuluka kwa ntchito kumayesedwa payekha kutengera ndi matendawa ndi matenda ena okhudzana nawo.

2. KULAMBIRA KWA SEREERE MU DIABETES MellITUS

Njira ya unamwino ndi njira yochokera kwa sayansi komanso machitidwe a namwino othandizira odwala.

Cholinga cha njirayi ndikuwonetsetsa kuti moyo ukhale wovomerezeka m'matendawa popatsa wodwalayo matonthozo amthupi, malingaliro komanso zauzimu, poganizira chikhalidwe chake komanso zauzimu.

Kuchita njira ya unamwino kwa odwala matenda ashuga, namwinoyo pamodzi ndi wodwalayo amapanga dongosolo la njira zoyamikirira, chifukwa ayenera kukumbukira izi:

1. Pa kuyezetsa koyambirira (kumuyesa wodwalayo) ndikofunikira:

Pezani zidziwitso zaumoyo ndikuzindikira zomwe wodwala akufuna kuti azisamalira, komanso mwayi wodzithandizira nokha.

Gwero lazidziwitso ndi:

- kucheza ndi wodwalayo komanso abale ake,

Chotsatira, muyenera kufunsa wodwalayo ndi abale ake za zomwe zingachitike:

l uchidakwa,

l chakudya choperewera,

l Matenda a Neuro

Kupitiliza kucheza ndi wodwalayo, muyenera kufunsa za kuyamba kwa matendawa, zomwe zimayambitsa, njira zoyeserera:

l Kuyesedwa kwa magazi, kuyesa kwamikodzo.

Potengera kuyang'ana kwa odwala omwe ali ndi matenda a shuga, ndikofunika kulabadira:

l khungu ndi kuuma kwa khungu,

l Kusalala kapena kunenepa kwambiri.

1. Pazakudya (ndikofunikira kudziwa zomwe wodwalayo akufuna, kaya azitha kudya yekha kapena ayi, katswiri wazakudya pazomwe akuyenera kudya, mupezanso ngati amamwa mowa komanso kuchuluka kwake),

2. Mukuchita zolimbitsa thupi (pafupipafupi pachimpando),

3. Mukugona ndikupumula (kudalira kugona tulo pa mapiritsi ogona),

4. Mu ntchito ndi kupumula.

Zotsatira zonse za kuyesa kwa unamwino zalembedwa ndi namwino mu "Mapepala Othandizira Anamwino" (onani zowonjezera).

2. Gawo lotsatira mu ntchito za namwino ndi kapangidwe ndi kusanthula kwa zomwe adalandira, pamomwe amamuganizira. Omaliza amakhala mavuto a wodwala komanso nkhani ya unamwino.

Chifukwa chake, mavuto a wodwala amayamba pakakhala zovuta pazosowa.

Kuchita ntchito ya unamwino, namwino amazindikira mavuto oyamba a wodwalayo:

Ululu m'miyendo yam'munsi

3. Njira yakulera.

Kupanga dongosolo la chisamaliro pamodzi ndi wodwalayo komanso abale, namwino ayenera kuzindikira zovuta aliyense payekhapayekha, akhazikitse zolinga zenizeni ndikupanga dongosolo lokhala ndi chisamaliro lenileni lomwe limapangitsa gawo lililonse.

4. Kukwaniritsidwa kwa pulani ya unamwino. Namwino amakwaniritsa mapulani osamalira omwe anakonza.

5. Kutembenukira ku kuwunika bwino kwa chithandizo cha unamwino, ndikofunikira kuganizira malingaliro a wodwala ndi banja lake.

1. Zomwe zimachitika ndi namwino.

- Amayang'ana momwe madzi alili,

- amagawa mankhwala, amawalembera ku magazini yolemba,

- amasamalira odwala odwala kwambiri,

- amakonzera odwala njira zosiyanasiyana zofufuzira,

- amaperekeza odwala pakufufuza,

2.1 Kuchenjeretsa kwa Anamwino

Subcutaneous insulin

Zida: syringe yotayika ya insulin yokhala ndi singano, imodzi yowonjezera yotaya, mabotolo okhala ndi kukonzekera kwa insulin, matayala osawoneka bwino, thireyi ya zinthu zogwiritsidwa ntchito, matuza osawoneka bwino, 70 pa mowa kapena mankhwala ena okonzanso khungu, mipira ya thonje (yopukutira), ma pulosha njira), muli ndi mankhwala ophera tizilombo toyambitsa matenda,

I. Kukonzekera njirayi

1. Fotokozani chidziwitso cha wodwalayo zamankhwala komanso kuvomereza kwake kwa jakisoni.

2. Fotokozani cholinga ndi njira yomwe ikubwera.

3. Fotokozerani kupezeka kwa zovuta kwa mankhwalawo.

4. Sambani ndikusamba m'manja.

5. Konzani zida.

6. Chongani dzina, tsiku lotha ntchito.

7. Chotsani thalauza wosabala ndi ma pulasitiki kuchokera kumayikidwe.

8. Sungani thumba la insulin lotayika.

9. Konzani mipira ya thonje ya 5-6, ndi kuwapukutira ndi antiseptic yapakhungu mumkaka, kusiya mipira iwiri yowuma.

10. Tsegulani chivundikiro chovala chotsekera pachoteracho ndi kukonzekera kwa insulin ndi ma tonne osalimba.

11. Ndi mpira wa thonje wokhala ndi antiseptic, pukutani chivundikiro ndikuchiwumitsa kuti chiume kapena kupukuta chivindikiro cha botolo ndi mpira wowuma wosabala (thonje).

12. Tayani mpira wakuthonje m'matayala zinyalala.

13. Ikani mankhwala mu syringe mu mlingo woyenera, sinthani singano.

14. Ikani syringe mu thireyi yosalala ndikuyipititsa kuchipinda.

15.Muthandizeni wodwala kuti atengere bwino jakisoni.

II. Ndondomeko kuphedwa

16. Valani magolovesi.

17. Chitani jakisoni wambiri ndi 3 thonje swatch (zopukutira), 2 wothira khungu antiseptic: choyamba, malo akulu, kenako malo a jekeseni pawokha, 3 youma.

18 .. Lowetsani mpweya mu syringe mu chipewa, ndikusiya mankhwalawa muyezo woperekedwa ndi adotolo, chotsani kapu, tengani khungu pakapaka jakisoni mu crease.

19. Lowetsani singano pamalo a 45? m'munsi mwa khungu, (2/3 ya kutalika kwa singano), gwiritsani singano ndi singano ndi chala chanu cholozera.

20. Tumizani dzanja lamanzere kwa wochita pulawo ndikuwapatsa mankhwalawo. Palibe chifukwa chosuntha syringe kuchokera m'manja ndi dzanja.

3. GAWO LOPHUNZITSA

3.1 Kuyang'anira 1

Wodwala Khabarov V.I., wazaka 26, akuthandizidwa ku dipatimenti ya endocrinology ndi matenda a mtundu 1 wa matenda a shuga, kuvuta mwamphamvu, kuwonongeka. Kufufuza kwamwino kunavumbula madandaulo osatha ludzu, pakamwa kowuma, kukodza kwambiri, kufooka, khungu, kupweteka m'manja, kutsika kwamphamvu minofu, dzanzi komanso miyendo. Ali ndi matenda a shuga pafupifupi zaka 13.

Moyenerera: zinthu zomwe sizinachitike ndi zazikulu. Kutentha kwa thupi 36.3 ° C, kutalika 178 cm, kulemera kwa makilogalamu 72. Khungu ndi mucous nembanemba ndi oyera, otumbululuka, owuma. Tsitsani pamasaya. Minofu yomwe ili m'manja imatukuka, mphamvu ya minofu imachepetsedwa. NPV 18 mphindi. Thirani ma 96 mphindi iliyonse. HELL 150/100 mm RT. Art. Mwazi wa Magazi: 11mmol / L. Urinalysis: kumenya. kulemera 1026, shuga - 0,8%, kuchuluka kwa tsiku lililonse - 4800 ml.

Zosokoneza zosowa: kukhala wathanzi, chokwanira, kugwira ntchito, kudya, kumwa, kuyankhulana, kupewa ngozi.

Zenizeni: pakamwa pouma, ludzu losalekeza, kukoka kwambiri, kufooka, kuyabwa kwa khungu, kupweteka m'manja, kuchepa mphamvu kwa minofu m'manja, dzanzi komanso kuzizira m'miyendo.

Kuthekera: Chiwopsezo cha kukhala ndi hypoglycemic ndi hyperglycemic coma.

Cholinga: kuchepetsa ludzu.

Tebulo 3. Dongosolo la chisamaliro:

Onetsetsani kuti mukumamatira kwambiri pa zakudya No. 9, chotsani zokometsera, zotsekemera ndi mchere

Kusintha kagayidwe kachakudya mthupi, kuchepetsa shuga

Chitani khungu, pakamwa, chisamaliro cha crotch

Kupewa Matenda Opatsirana

Onetsetsani kuti kukhazikitsa pulogalamu yothandizirana zolimbitsa thupi

Kusintha njira zama metabolic ndikukwaniritsa chitetezo chamthupi

Apatseni mpweya wabwino pofundira kwa mphindi 30 katatu patsiku

Kupangitsa mpweya kukhala ndi okosijeni, kusintha njira zopopera m'thupi

Onetsetsani kuwunika kwa wodwala (zambiri, NPV, kuthamanga kwa magazi, zimachitika, kulemera kwa thupi)

Kuyang'anira momwe zinthu ziliri

Amachita panthawi yake komanso molondola malangizo a dokotala

Mankhwala othandiza

Thandizani wodwala nkhawa

Kukonda: kusowa ludzu.

3.2 Kuyang'anira 2

Wodwala Samoylova E.K., wazaka makumi asanu ndi limodzi ndi zisanu ndi chimodzi, adatengedwa kupita kuchipinda chachipatala chazachipatala chodwala kwambiri.

Moyenera: namwino amapatsa wodwala chithandizo chanthawi yoyamba komanso amathandizira kuchipatala.

Zosokoneza zosowa: kukhala wathanzi, kudya, kugona, ntchito yabwino, kugwira ntchito, kuyankhulana, kupewa ngozi.

Zenizeni: ludzu lochulukirapo, kusowa kwa chakudya, kufooka, kuchepa kwa ntchito, kuchepa thupi, khungu loyabwa, fungo la acetone kuchokera mkamwa.

Zotheka: hyperglycemic chikomokere

Kuika patsogolo: mkhalidwe wa prekomatoznoe

Cholinga: kuchotsa wodwalayo pamawonekedwe ambiri

Tebulo 4. Dongosolo la chisamaliro:

Itanani dokotala nthawi yomweyo

Kupereka chithandizo choyenera chamankhwala

Monga adanenera dokotala: gwiritsani ntchito intaneti kwa 50 IU yosavuta kuchitira insulin ndipo isotonic yankho la 0,9% sodium kolorayidi.

Kupititsa patsogolo shuga,

Kubwezeretsani mulingo wamadzi

Yang'anirani ntchito zofunikira za thupi

Kuyang'anira momwe zinthu ziliri

Chipatala mu dipatimenti ya endocrinology

Zamankhwala apadera

Kuwunikira: wodwalayo adatuluka wodwala.

Ndilingalira za milandu iwiri, ndidazindikira kuti mwa iwo mumakhala, kuwonjezera pa zovuta zenizeni za wodwalayo, mbali yamalingaliro yamatenda.

Poyamba, ludzu lidakhala vuto lalikulu kwa wodwalayo. Popeza ndidaphunzitsa wodwalayo zamadyedwe, ndidakwanitsa cholinga.

Mlandu wachiwiri, ndidaona vuto ladzidzidzi lomwe lili ndi kukomoka kwa matenda oopsa. Kukwaniritsa cholinga ichi chinali chifukwa cha kuperekedwa kwa chisamaliro chanthawi yake mwadzidzidzi.

Ntchito ya wogwira ntchito zachipatala ili ndi mawonekedwe ake. Choyamba, zimakhudzana ndi zochitika pakati pa anthu. Makhalidwe ndi gawo lofunikira pantchito yanga yamtsogolo. Mphamvu yothandizira odwala imadalira momwe anamwino amawonera eni. Kuchita ndondomekoyi, ndikukumbukira lamulo la Hippocracy "Musachite zopweteka" ndipo ndimachita chilichonse kuti ndikwaniritse. Pamaso pakupita patsogolo kwamakono mu zamankhwala ndikuwonjezereka kwa zipatala ndi zipatala ndi zida zatsopano zamakono zamankhwala. Udindo wa njira zowonjezera kuzindikira ndi njira zakuchiritsi zidzakulira. Izi zimapangitsa anamwino kuti aphunzire mosamala njira zamakono zopezekera komanso zatsopano, njira zophunzitsira zomwe amagwiritsa ntchito, komanso kuwunika mfundo zodziwikiratu zogwira ntchito ndi odwala pamigawo yosiyanasiyana yodziwira matenda.

Kulemba pepala la maphunzirowa kunandithandizira kumvetsetsa bwino zomwe zinali zofunikira ndipo ndinakhala gawo lina lothandizira luso langa ndi chidziwitso.Ngakhale zovuta pantchito komanso kusowa nzeru, ndimayesetsa kugwiritsa ntchito zomwe ndimadziwa komanso luso langa, komanso kugwiritsa ntchito njira ya unamwino pochita ndi odwala.

1. Makolkin V.I., Ovcharenko S.I., Semenkov N.N. - Nursing in medical - M: - Medical Information Agency LLC, 2008. - 544 tsa.

1. Davlitsarova K.E., Mironova S.N. - Zipangizo zogwirira ntchito, M: - Forum infra 2007. - 480 p.

2. Koryagina N.Yu., Shirokova N.V. - Gulu la oyang'anira apadera a unamwino - M: - GEOTAR - Media, 2009. - 464 p.

3. Lychev V. G., Karmanov V. K. - Malangizo pakuwongolera machitidwe olimbitsa thupi pamutu wakuti "Unursing in Therapy with course of basic basic medical": - Zipangizo zophunzitsira M: - Forum infra, 2010. - 384 p.

4. Lychev V.G., Karmanov V.K. - Zoyambira unamwino pakubala - Rostov n / D Phoenix 2007 - 512 p.

5. Mukhina S.A., Tarnovskaya I.I. - Theoretical maziko a Nursing - 2 ed., Chiv. ndi zina zowonjezera - M .: - GEOTAR - Media, 2010. - 368 p.

6. Mukhina SA, Tarnovskaya I.I. - Buku Lothandiza pa mutu wakuti "Fundamentals of Nursing", 2nd edition isp. onjezerani. M.: - GEOTAR - Media 2009. - 512 p.

7. Obukhovets T.P., Sklyarov T.A., Chernova O.V. - Zoyambira unamwino - ed. 13th kuwonjezera. siyani. Rostov n / a Phoenix - 2009 - 552s

Gome 1. Mbiri ya anamwino azachipatala

Mapepala Aunamwino Oyambirira a Khadi Lopititsa Nambala 68

Dzina la wodwala Khabarov V.I.

Adilesi yakunyumba st. Straitley, 3

Foni 8 499 629 45 81

Dotolo O.Z. Lavrova

Matenda a 1 Matendawa

Yalandilidwa pa Marichi 14, 2012, 11:00 a.m.

ambulansi nokha

kumasulira kowongolera

Njira yoyendera kupita ku dipatimenti

pa gurney pamipando yapansi

omvera omasuka

chisokonezo chosokonekera

Kufunika kopumira

Chiwonetsero cha 18 pa mphindi.

Kuthamanga kwa mtima 96 min.

AD150 / 100 mmHg Art.

Chiwerengero cha ndudu 14

inde owuma ndi sputum

Kufunika kwa zakudya zokwanira ndi zakumwa

Kulemera kwa thupi makilogalamu 72 kg 178cm

Amadya ndi Zakumwa

muyenera kudzithandiza nokha

Chikhumbo chabwinobwino chotsika

Kodi matenda ashuga

Ngati inde, amawongolera bwanji matendawa?

insulin hypoglycemic zakudya mapiritsi

Palibe mano omwe adapulumutsidwa

Kodi mano okuchotsa alipo?

inde pamwamba mpaka pansi

zochepa mokwanira

kuwonda, kusapeza pamimba

Kutha kuvala, kuvula, kusankha zovala, ukhondo

Etiology, zizindikiro zamankhwala ndi mitundu ya matenda ashuga. Chithandizo ndi njira zothandizira matenda a endocrine okhala ndi matenda a hyperglycemia. Zochita zochitidwa ndi namwino pomwe akusamalira wodwala.

Kutumiza ntchito yanu yabwino pamaziko azidziwitso ndikosavuta. Gwiritsani ntchito mawonekedwe pansipa

Ophunzira, ophunzira omaliza, asayansi achichepere omwe amagwiritsa ntchito chidziwitso m'maphunziro awo ndi ntchito adzayamika kwambiri.

Wolemba http://www.allbest.ru/

State Autonomous Education Institution

Maphunziro apamwamba a sekondale mdera la Saratov

Saratov Regional Basic Medical College

Phunziro: Njira yaunamwino pochiritsa

mutu: Kusamalira anamwino odwala matenda ashuga

Karmanova Galina Maratovna

1. Matenda a shuga

4. Zizindikiro zamankhwala.

8. Njira zopewera

9. Unamwino ndi matenda ashuga

10. Kuchepetsa Mankhwala

11. Kuyang'anira Na. 1

12. Kupenyerera No. 2

Matenda a shuga mellitus (DM) ndi matenda a endocrine omwe amakhala ndi matenda osachiritsika a hyperglycemia, omwe amachitika chifukwa chosakwanira kupanga kapangidwe ka insulin, komwe kumayambitsa kuphwanya mitundu yonse ya kagayidwe kachakudya, kuwonongeka kwa mitsempha (angiopathy), dongosolo lamanjenje (neuropathy), komanso ena ziwalo ndi machitidwe. Pofika chakumapeto kwa zaka za zana lino, matenda a shuga a mellitus (DM) adatenga mkhalidwe wamatsenga, kukhala chimodzi mwazomwe zimayambitsa kulumala ndi kufa. Imaphatikizidwa mu triad yoyamba pamagulu a matenda akuluakulu: khansa, sclerosis, shuga. Pakati pa matenda oopsa a ana, matenda a shuga amakhalanso malo achitatu, motero amapuma mphumu ndi matenda ammimba.Chiwerengero cha odwala matenda a shuga padziko lonse lapansi ndi mamiliyoni 120 (2,5%). Zaka khumi ndi zinayi zilizonse, kuchuluka kwa odwala kumawirikiza. Malinga ndi International Institute for Diabetes (Australia), podzafika chaka cha 2010 padzakhala odwala miliyoni miliyoni padziko lapansi. Ku Ukraine, kuli odwala pafupifupi 1 miliyoni, omwe 10-15% amadwala kwambiri matenda a shuga omwe amadalira insulin (mtundu I). M'malo mwake, kuchuluka kwa odwala kumakulirako kawiri ndi kawiri chifukwa cha mitundu yosadziwika. Kwenikweni, izi zimanena za matenda a shuga a mtundu wachi II, owerengera 85-90 a matenda onse a shuga.

Mutu waphunziro: Njira yaunamwino mu shuga.

Cholinga chophunzirira: Njira yaunamwino mu shuga.

Cholinga cha phunziroli: Kuphunzira njira ya unamwino mu shuga. chisamaliro cha shuga

Kuti mukwaniritse cholinga ichi, kafukufuku amafunika kuphunzira.

· Etiology komanso zomwe zimayambitsa matenda ashuga.

· Pathogenesis ndi zovuta zake

· Zizindikiro zamatenda a shuga momwe zimakhalira kusiyanitsa magulu awiri azizindikiro: choyambirira komanso chachiwiri.

· Manesi ogwiritsa

Kuti izi zitheke, ndikofunikira kusanthula:

· Kulongosola maluso a namwino pakukhazikitsa njira ya unamwino wodwala amene ali ndi matendawa.

Pa phunziroli pogwiritsa ntchito njira zotsatirazi.

· Kusanthula kwa sayansi ndi malingaliro a mabuku aza zamankhwala pa matenda ashuga

· Biographical (kuwerenga zolemba zamankhwala)

Kuwululidwa mwatsatanetsatane kwa zinthu zomwe zachitika pantchito yophunzirayo: "Njira ya unamwino mu shuga" zipititsa patsogolo ntchito ya unamwino.

1. Matenda a shuga

Matenda a shuga amadziwika mu Egypt Egypt kale mu 170 BC. Madokotala anayesera kupeza njira zamankhwala, koma sanadziwe chomwe chimayambitsa matendawa, ndipo anthu odwala matenda ashuga amayenera kufa. Izi zidachitika kwazaka zambiri. Kumapeto kwa zaka zana zapitazi, madokotala adayesera kuchotsa ziphuphu mu galu. Pambuyo pa opareshoni, nyamayo idayamba matenda a shuga. Zinkawoneka kuti zomwe zimayambitsa matenda ashuga zimamveka, koma zinali zaka zambiri zisanachitike, mu 1921, mumzinda wa Toronto, dotolo wachinyamata komanso wophunzira zachipatala, adadzipatula chinthu chapadera cha zikondwerero za galu. Zinapezeka kuti chinthuchi chimachepetsa shuga m'magalu omwe ali ndi matenda ashuga. Izi zimatchedwa insulin. Kale mu Januware 1922, wodwala woyamba wodwala matenda a shuga adayamba kulandira jakisoni wa insulin, ndipo izi adapulumutsa moyo wake. Zaka ziwiri atapezeka insulini, dokotala wina wachichepere wochokera ku Portugal, yemwe anali kuchiritsa odwala matenda ashuga, adaganiza kuti matenda a shuga si matenda, koma moyo wapadera kwambiri. Kuti mumvetsetse, wodwalayo amafunika kudziwa bwino matenda ake. Kenako sukulu yoyamba padziko lapansi kwa odwala matenda a shuga idawonekera. Tsopano pali masukulu ambiri otere. Padziko lonse lapansi, odwala matenda ashuga ndi abale awo ali ndi mwayi wolandila za matendawa, ndipo izi zimawathandiza kukhala anthu onse m'gululi.

Matenda a shuga ndi matenda ochitika kalekale. Wodwala akuyenera kuwonetsa kupirira komanso kudziletsa, ndipo izi zitha kusokoneza aliyense mwamaganizidwe ake. Pochiza ndi kusamalira odwala omwe ali ndi matenda a shuga, kulimbikira, umunthu, chiyembekezo chanzeru ndichofunikanso, apo ayi sizingatheke kuthandiza odwala kuthana ndi zopinga zonse m'moyo wawo. Matenda a shuga amapezeka ndi kuchepa kapena kuphwanya kwa insulini. M'magawo onse awiri, kuchuluka kwa glucose kumayambaM'njira zonse, matenda a shuga amadziwika chifukwa chazomwe zimayambitsa kuchuluka kwa shuga m'magazi mu Laborator yovomerezeka.

Kuyeserera kwa glucose nthawi zambiri sikugwiritsidwa ntchito mwachizolowezi, koma kumachitika kokha ndi matenda okayika mwa odwala achinyamata kapena kutsimikizira matendawa mwa amayi apakati. Kuti mupeze zotsatira zodalirika, kuyezetsa kwa glucose kuyenera kuchitika m'mawa pamimba yopanda kanthu, wodwalayo ayenera kukhala phee nthawi yayitali pakamapukusidwa magazi, amaletsedwa kusuta fodya, ayenera kutsatira njira yabwinobwino, osati yopanda chakudya kwa masiku atatu mayeso asanachitike. Panthawi yodwala pambuyo podwala komanso kupumula kwa nthawi yayitali, zotsatira zoyeserera zimakhala zabodza. Kuyesaku kumachitika motere: pamimba yopanda kanthu iwo amayeza kuchuluka kwa shuga m'magazi, mpatseni munthu woyeserera 75 g shuga wosungunuka mu 250-300 ml ya madzi (kwa ana - 1.75 g pa 1 kg wolemera, koma osapitirira 75 g, kuti musangalale kwambiri kulawa, mutha kuwonjezera, mwachitsanzo, mandimu achilengedwe), ndikubwereza muyeso wa shuga m'magazi pambuyo pa maola 1 kapena 2. Kuyesa kwamikodzo kumatengedwa katatu - musanatenge njira yothetsera shuga, 1 ora ndi 2 mawola atatha. Kuyeserera kwa glucose kumavumbulanso:

1. Mkulu glucosuria - kukula kwa glucosuria motsutsana maziko abwinobwino a m'magazi m'magazi, vuto limakhala losavulaza ndipo nthawi zambiri limayamba chifukwa cha matenda a impso. Ndikofunika kuti odwala apatsidwe satifiketi yokhudza kukhalapo kwa aimpso a glucosuria kuti asayesenso kuyesa mayeso okhudzana ndi glucose pambuyo pakuchita urinalysis m'mabungwe ena azachipatala.

2. Piramidi yokhotakhota yogwiritsa ntchito shuga - mkhalidwe womwe kuchuluka kwa glucose m'magazi pamimba yopanda kanthu ndipo patatha maola awiri atamwa yankho la glucose ndikwabwinobwino, koma pakati pa mfundo izi hyperglycemia imayamba, kupangitsa glucosuria. Vutoli limadziwikanso kuti limakhala lodetsa nkhawa, nthawi zambiri limachitika pambuyo pa matenda am'mimba, koma amathanso kuwoneka mwa anthu athanzi. Dokotala amawona kufunikira kwa chithandizo cha kulekerera kwa glucose payekha. Nthawi zambiri, odwala okalamba samalandira chithandizo, pomwe odwala ang'onoang'ono amalimbikitsidwa kudya, kuchita masewera olimbitsa thupi, komanso kuchepetsa thupi. Pafupifupi theka la milandu, kulolerana kwa glucose kumapangitsa kuti munthu akhale ndi matenda osokoneza bongo kwa zaka 10, kotala limatha osawonongeka, kotala limazimiririka. Amayi oyembekezera omwe ali ndi vuto loleza shuga amathandizidwanso chimodzimodzi ndi matenda a shuga.

Kutengera kwa chibadwa cha matenda ashuga pakali pano kumawerengedwa. Kwa nthawi yoyamba, malingaliro oterewa adawonetsedwa mu 1896, pomwe amatsimikiziridwa pokhapokha potsatira zotsatira zakuwona. Mu 1974, a J. Nerup et al., A. G. Gudworth ndi J. C. Woodrow, adapeza ubale pakati pa B-locus of histocompatibility leukocyte antigens ndi mtundu 1 wa shuga komanso kusapezeka kwawo mwa anthu omwe ali ndi matenda ashuga a 2. Pambuyo pake, mitundu ingapo yamitundu yosiyanasiyana idadziwika, yomwe imakhala yofala kwambiri pamtundu wa odwala omwe ali ndi matenda ashuga kuposa anthu ena onse. Chifukwa, mwachitsanzo, kupezeka kwa B8 ndi B15 mu genome munthawi yomweyo kunawonjezera chiopsezo cha matendawa pafupifupi nthawi 10. Kupezeka kwa chikhomo cha Dw3 / DRw4 kumawonjezera chiopsezo cha matendawa ndi 9,4. Pafupifupi 1.5% yamilandu ya matenda a shuga imagwirizanitsidwa ndi mtundu wa A3243G masinthidwe a MT-TL1 mitochondrial gene. Komabe, ziyenera kudziwidwa kuti ndi mtundu wa 1 shuga, genetic heterogeneity imawonedwa, ndiye kuti, matendawa amatha chifukwa cha magulu osiyanasiyana amitundu. Chizindikiro chakuchipatala cha Laborator chomwe chimakupatsani mwayi kudziwa mtundu woyamba wa matenda ashuga ndicho kupezeka kwa ma antibodies kuma cell a pancreatic b m'magazi. Mtundu wa cholowa pakadali pano sunadziwike bwinobwino, kuvuta kulosera zam'magazi kumalumikizidwa ndi genetic heterogeneity ya matenda a shuga mellitus, ndipo kupanga mtundu wokwanira cholowa kumafunikira zowerengera zowerengera ndi ma genetic.

Mu pathogenesis ya matenda a shuga, pali maulalo awiri omwe adadziwika:

Kupanda insulin yokwanira ndi ma cell a endocrine a kapamba,

Kuphwanya kulumikizana kwa insulin ndi maselo amthupi (insulin kukana) chifukwa cha kusintha kwa kapangidwe kake kapena kuchepa kwa chiwerengero cha zolandirira insulini, kusintha kapangidwe ka insulin, kapena kuphwanya ma intracellular njira yotumizira mauthenga kuchokera kuma receptors kupita ku cell cell.

Pali cholowa chamtundu wa matenda ashuga. Ngati m'modzi mwa makolo adwala, ndiye kuti kuthekera kwa kulandira matenda ashuga 1 ndi 10%, ndipo mtundu 2 wa matenda ashuga ndi 80%.

Mosasamala kanthu za njira zopangira chitukuko, chochitika chazonse zamitundu yonse ya shuga ndikuwonjezereka kwa glucose wamagazi ndi kusokonekera kwa metabolic m'thupi zomwe zimalephera kuyamwa shuga kwambiri.

· Kulephera kwa minofu kugwiritsa ntchito glucose kumapangitsa kuti mafuta ndi mapuloteni awonjezeke ndi ketoacidosis.

· Kuwonjezeka kwa kuchuluka kwa shuga m'magazi kumabweretsa kuchuluka kwa magazi a osmotic m'magazi, omwe amachititsa kuti madzi atheretu ndi ma electrolyte mkodzo.

Kuchulukirachulukira kwa kuchuluka kwa shuga m'magazi kumakhudza kwambiri ziwalo zambiri zamankhwala ndi minyewa, zomwe zimapangitsa kuti pakhale zovuta zambiri, monga matenda ashuga nephropathy, neuropathy, ophthalmopathy, micro- ndi macroangiopathy, mitundu yosiyanasiyana ya matenda a shuga komanso ena.

Odwala omwe ali ndi matenda ashuga, pali kuchepa kwamphamvu kwa chitetezo chathupi komanso njira yayikulu ya matenda opatsirana.

Matenda a shuga, komanso, mwachitsanzo, matenda oopsa, ndimtundu, pathophysiologically, matenda opatsirana.

4. Zizindikiro zamankhwala

Madandaulo akulu a odwala ndi awa:

· Kutopa konsekonse ndi minofu,

· Mumakonda kukokota mobwerezabwereza usana ndi usiku,

Kuchepetsa thupi (kawirikawiri kwa odwala matenda a shuga 1),

Chilimbikitso chowonjezereka (ndi kuwonongeka kwamatenda kwambiri, matenda amachepa kwambiri),

Khungu loyenda (makamaka pamtundu wa azimayi).

Madandaulo awa nthawi zambiri amawonekera pang'onopang'ono, komabe matenda amtundu 1, zizindikiro za matendawa zimatha kuoneka mwachangu. Kuphatikiza apo, odwala amapereka madandaulo angapo omwe amayamba chifukwa cha kuwonongeka kwa ziwalo zamkati, zamanjenje ndi mtima.

Khungu ndi minofu

Munthawi yowola, khungu louma, kuchepa kwa turgor ndi elasticity ndizodziwika. Odwala nthawi zambiri amakhala ndi zotupa pakhungu, zotulutsira mankhwalawa, hydradenitis. Otchulidwa kwambiri ndi zotupa za khungu la fungal (epidermophytosis ya mapazi). Chifukwa cha hyperlipidemia, xanthomatosis ya pakhungu imayamba. Xanthomas ndi mapapu ndi mafinya amtundu wachikasu, odzaza ndi ma lipids, omwe amapezeka m'matako, miyendo yotsika, bondo ndi molowera, ndi manja.

Mu 0,1 - 0,3% ya odwala, lipoid necrobiosis ya khungu imawonedwa. Imasanjidwa makamaka pamiyendo (imodzi kapena zonse). Poyamba, timabowo tofiyira totuwa kapena taso kutulutsa timawoneka, titazunguliridwa ndi malire a ma erythematous. Kenako chikopa pamalo pang'onopang'ono, chimakhala chosalala, chonyezimira ndi kutulutsa mawu (chikufanana ndi zikopa). Nthawi zina madera omwe amakhudzidwa ndi zilonda, amachira pang'onopang'ono, kusiya malo omwe anali ndi mitundu. Kusintha kwa misomali kumawonedwa nthawi zambiri, kumakhala kofinya, kosalala, mtundu wachikasu.

Matenda a shuga amtundu wa 1 amadziwika ndi kuchepa kwambiri, kuwonda kwambiri kwa minofu, komanso kuchepa kwamisempha.

Njira yogaya chakudya.

Zosintha zotsatirazi ndizodziwika bwino:

Matenda a pontontal, kumasula ndi kuwononga mano,

· Matenda a gastritis, duodenitis ndi kuchepa kwapang'onopang'ono kwa chinsinsi cha ntchito yam'mimba (chifukwa cha kuchepa kwa insulin - cholimbikitsa kutulutsa katumbu)

· Inachepetsa mphamvu ya m'mimba,

Matumbo owonongeka

· Fat hypotheses (diabetesic hepatopathy) amakula mu 80% ya odwala matenda ashuga, mawonekedwe awowa amawonjezera chiwindi komanso kupweteka pang'ono.

Dyskinesia wa ndulu.

Mtima wamtima.

DM imathandizira pakuphatikizika kwakukulu kwa atherogenic lipoproteins ndi chitukuko choyambirira cha atherosulinosis ndi IHD. IHD mwa odwala matenda a shuga amakula m'mbuyomu ndipo izi zimawonjezera zovuta.

"Matenda a shuga" ndi dysmetabolic myocardial dystrophy kwa odwala matenda a shuga osakwanitsa zaka 40 popanda chizindikiro chapadera cha coronary atherossteosis. Mawonetsedwe akulu azachipatala a matenda a shuga ndi awa:

· Dyspnea yaying'ono pakuchita masewera olimbitsa thupi, nthawi zina amatuluka ndi kusokonezedwa mumtima.

· Mitundu yosiyanasiyana ya phokoso la mtima komanso zosokoneza.

Hypodynamic syndrome, yowonetsedwa mu kuchepa kwa kuchuluka kwa magazi m'magawo amanzere ammimba,

Kuchepetsa masewera olimbitsa thupi.

Njira yothandizira.

Odwala omwe ali ndi matenda a shuga amakhala ndi chifuwa chachikulu cha m'mapapo. Microangiopathy yamapapu ndi khalidwe, lomwe limapanga zofunikira zoyambirira za chibayo. Odwala omwe ali ndi matenda ashuga nawonso nthawi zambiri amadwala bronchitis.

Mu matenda ashuga, matenda opatsirana ndi zotupa a kwamikodzo nthawi zambiri amakula, omwe amapezeka mwanjira zotsatirazi:

Asymptomatic kwamikodzo matenda

Phala loyenda la pyelonephritis,

Pachimake kukhathamiritsa kwa impso

Woopsa hemorrhagic cystitis.

Malinga ndi chikhalidwe cha kagayidwe kazakudya, magawo a shuga awa ndiosiyanitsidwa:

· Malipiro - njira ya matenda ashuga, pamene Normoglycemia ndi aglycosuria zimatheka motsogozedwa ndi mankhwala,

Chuma - kuchuluka kwa hyperglycemia (osapitirira 13.9 mmol / l), glucosuria, osapitilira 50 g patsiku, kusowa kwa acetonuria,

· Kubwezera - magazi a glycemia oposa 13.9 mmol / l, kukhalapo kwa magawo osiyanasiyana a acetonuria

5. Mitundu ya matenda a shuga

Matenda A shuga A Type:

Type Iabetes mellitus imayamba nthawi ya kuwonongeka kwa ma p-cell a pancreatic islets (ma Langerhans islets), omwe amachititsa kuchepa kwa insulin. Kuwonongeka kwa maselo a p kumachitika chifukwa cha zochita za autoimmune zomwe zimakhudzana ndi kuphatikiza kwa zochitika zachilengedwe komanso zinthu zobadwa mwathupi mwathupi. Kukhazikika kovuta kotereku kwamatenda kumatha kufotokoza chifukwa chake pakati pa mapasa ofanana ndimatenda a shuga omwe amapezeka pafupifupi 30% ya milandu, ndikulemba matenda ashuga II pafupifupi 100% milandu. Amakhulupirira kuti kuwonongedwa kwa zisumbu za Langerhans kumayamba ali mwana kwambiri, zaka zingapo zisanachitike chitukuko cha matenda ashuga.

HLA dongosolo.

Ma antigen of the main histocompatability tata (HLA system) amawonetsera kutengera kwa munthu kumitundu yosiyanasiyana yazinthu zomwe zimachitika mthupi. Mtundu woyamba wa shuga I mellitus, mu 90% ya milandu, ma antigen a DR3 ndi / kapena DR4 amapezeka, antigen ya DR2 imalepheretsa chitukuko cha matenda a shuga.

Autoantibodies ndi ma cell chitetezo chokwanira.

Nthawi zambiri, panthawi yodziwira mtundu wa matenda a shuga a I, odwala amakhala ndi ma antibodies ku ma cell a Langerhans, omwe madigiri awo amayamba kuchepa, ndipo patatha zaka zochepa amayamba kutha. Posachedwa ma antibodies kuma protein ena apezanso - glutamic acid decarboxylase (GAD, 64-kDa antigen) ndi tyrosine phosphatase (37 kDa, IA-2, nthawi zambiri amaphatikizidwa ndikupanga matenda a shuga). Kuzindikira ma antibodies> Mitundu itatu (kupita ku ma cell a Langerhans islet, anti-GAD, anti-1A-2, kupita ku insulin) posowa matenda a shuga akuphatikizidwa ndi chiopsezo cha 88% cha chitukuko chake m'zaka 10 zikubwerazi. Maselo otupa (cytotoxic T-lymphocyte ndi macrophages) amawononga maselo a p, chifukwa chomwe insulin imayamba m'magawo oyamba a matenda a shuga a I. Kuphatikiza kwa Lymphocyte kumachitika chifukwa cha kupanga ma macrophage kwa ma cytokines.Kafukufuku woletsa kukula kwa mtundu wa matenda ashuga a shuga I akuwonetsa kuti immunosuppression ndi cyclosporin imathandizira kuti magawo a mabungwe a Langerhans asungikebe. Kuletsa kwa matenda a shuga a mtundu woyamba i nicotinamide, komwe kumachepetsa zochitika za macrophages, sikunapezekenso umboni. Kusunga pang'ono kwa ntchito ya maselo a zilumba za Langerhans kumathandizidwa ndikukhazikitsa insulini; ziyeso zamankhwala pano zikuchitika kuti ziwunje momwe chithandizo chikugwirira ntchito.

Matenda a shuga a II

Pali zifukwa zambiri zomwe zimapangitsa kuti mtundu wachiwiri ukhale ndi matenda osokoneza bongo, chifukwa mawuwa amatanthauza matenda osiyanasiyana omwe amapezeka pamaphunziridwe ake. Amalumikizidwa ndi pathogenesis wamba: kuchepa kwa insulin katemera (chifukwa cha kukomoka kwa ma isanger a Langerhans kuphatikiza kuwonjezeka kwa kukana kwa insulin, komwe kumapangitsa kuchepa kwa glucose chifukwa cha zotumphukira za minofu) kapena kukulira kwa kupanga kwa shuga ndi chiwindi. Mu 98% ya milandu, zomwe zimayambitsa kukula kwa matenda a shuga II sichingadziwike - pamenepa, amalankhula za matenda osokoneza bongo a "idiopathic". Ndi iti mwa zotupa (kuchepa kwa insulin secretion kapena insulini kukaniza) ndizoyambirira, sizikudziwika, mwina pathogenesis ndi yosiyana mwa odwala osiyanasiyana. Kukana kwambiri kwa insulin chifukwa cha kunenepa kwambiri, zomwe zimayambitsa kawirikawiri chifukwa cha insulin. Nthawi zina, odwala opitirira zaka 25 (makamaka posowa kunenepa kwambiri) samakhala ndi mtundu wachiwiri wa matenda ashuga, koma matenda a shuga a autoentmune a akulu LADA (Latent Autoimmune Diabetes of Adulthood), omwe amadalira insulin, komanso ma antibodies ena enieni amapezeka nthawi zambiri. Matenda a shuga a Type II amapita patsogolo pang'onopang'ono: katulutsidwe ka insulin kamacheperachepera zaka makumi angapo, mwakachetechete kumabweretsa kuwonjezeka kwa glycemia, komwe kumakhala kovuta kwambiri kutulutsa matenda.

Kunenepa kwambiri, kukana insulini kumachitika, mwina chifukwa cha kuponderezedwa kwa mawu a insulin zolandilira chifukwa cha hyperinsulinemia. Kunenepa kwambiri kumakulitsa chiopsezo chokhala ndi mtundu wachiwiri wa matenda a shuga, makamaka ndi mtundu wa android wa adipose minofu yogawana (kunenepa kwambiri, "mtundu wa apulo" kunenepa kwambiri, chiwopsezo chazovuta zokhudzana ndi gawo la 0.9) ndikuchepera pang'ono ndi mtundu wa gynoid wamtundu wa adipose pogawa ( kunenepa "mwa mtundu wa peyala", mulingo woyenera kuloza m'chiuno kuzungulira makilogalamu 4

Posachedwa kwawonetsedwa kuti kulemera kotsika kumayendetsedwa ndi chitukuko cha akuluakulu a insulin, mtundu II matenda a shuga, ndi matenda a mtima. Kuchepetsa thupi pobadwa ndipo kumachulukitsa kuposa momwe zimakhalira ndi chaka chimodzi, ndiye kuti pamakhala chiwopsezo chachikulu. Pakukula kwa mtundu wachiwiri wa matenda ashuga, zinthu zongobadwa nazo zimagwira ntchito yofunika kwambiri, yomwe imawonetsedwa ndi kukula kwamodzimodzi munthawi yomweyo mumapasa ofanana, kuchuluka kwa milandu yamabanja chifukwa cha matendawa, komanso kusakhazikika kwina m'maiko ena. Ofufuzawo akupeza zolakwika zatsopano za majini zomwe zimapangitsa kuti pakhale mtundu wa shuga wachiwiri wa shuga, zomwe zinafotokozedwa pansipa.

Type II shuga mellitus mwa ana akufotokozedwa kokha m'maiko ena ochepa komanso m'mitundu yocheperako ya MODY-syndromes (onani pansipa). Pakadali pano, m'maiko otukuka, kuchuluka kwa matenda ashuga amtundu wachiwiri kwachulukirachulukira: Ku United States, kuchuluka kwa matenda ashuga kwa ana ndi achinyamata kukukulirakulira. Nthawi zambiri, achinyamata azaka zapakati pa 12 ndi 13 amadwala, makamaka atsikana, nthawi zambiri amasemphana ndi kunenepa kwambiri, kuchita masewera olimbitsa thupi komanso kupezeka kwa matenda ashuga amtundu wa II m'mbiri ya mabanja.Mwa odwala achinyamata omwe sanali onenepa kwambiri, matenda a shuga a mtundu wa LADA, omwe amayenera kuthandizidwa ndi insulin, samaphatikizidwa. Kuphatikiza apo, pafupifupi 25% ya milandu yokhala ndi matenda a shuga a mtundu wachiwiri ali aang'ono kwambiri amayamba chifukwa cha kuperewera kwamtundu wa MANY kapena ma syndromes ena osowa. Matenda a shuga amathanso kuchitika chifukwa cha kukana insulin. Ndi mitundu ina yachilendo ya kukana insulini, kupereka ma insulin mazana kapena masauzande ambiri sikugwira ntchito. Zochitika zoterezi nthawi zambiri zimakhala ndi lipodystrophy, hyperlipidemia, acanthosis nigricans. Mtundu A kukana insulini kumachitika chifukwa cha kusokonezeka kwa majini mu insulin receptor kapena ma post-receptor intracellular signachingms. Kukana kwa insulin kwa mtundu wa B kumachitika chifukwa chopanga ma autoantibodies kuma insulin receptors, ndipo nthawi zambiri amaphatikizidwa ndi matenda ena a autoimmune, mwachitsanzo, systemic lupus erythematosus (makamaka mwa akazi akuda). Izi njira za shuga ndizovuta kwambiri kuzichiza.

Matendawa ndi gulu lovuta kwambiri la matenda oopsa kwambiri obwera chifukwa cha majini, zomwe zimabweretsa kuwonongeka kwa chinsinsi cha pancreatic b-cell. Matenda A shuga ambiri amapezeka pafupifupi 5% ya odwala matenda ashuga. Zimasiyanasiyana kuyambira paubwana. Wodwala amafunikira insulin, koma, mosiyana ndi odwala omwe ali ndi matenda amtundu wa 1, omwe ali ndi vuto lochepa la insulin, amakwaniritsa chipukutirozo. Zizindikiro za C-peptide ndizabwinobwino, palibe ketoacidosis. Matendawa atha kukhala amodzi mwa mitundu ya "matenda apakatikati" a shuga: ili ndi mawonekedwe a mtundu 1 ndi matenda ashuga a 2.

Mfundo zazikuluzikulu zochizira matenda a shuga ndi izi:

2) Zochita panokha,

3) Mankhwala ochepetsa shuga:

B) mapiritsi a shuga, kuchepetsa mankhwala,

4) Maphunziro aaleza mtima m'masukulu a shuga.

Zakudya Zakudya ndizo maziko omwe chithandizo chovuta kwambiri cha odwala omwe ali ndi matenda ashuga chimakhazikika. Zakudya zamitundu mitundu za matenda ashuga amtundu 1 komanso mitundu yachiwiri ya shuga ndi zosiyana. Mu DM 2, ndimankhwala ochiritsira, cholinga chachikulu chomwe ndi kuphatikiza kulemera kwa thupi, ndiye mfundo yofunika kwambiri yochizira DM 2. Mu DM 1, funso limafunsidwa mosiyanasiyana: zakudya pankhaniyi ndizoletsa zomwe zimakhudzana ndi kulephera kutengera kuthekera kwathunthu kwa insulin . Chifukwa chake, uku si chithandizo chamankhwala, monga momwe zilili ndi T2DM, m'zakudya ndi moyo, zomwe zimathandizira kusunga chindapusa cha matenda ashuga. Zolondola, chakudya cha wodwalayo pamankhwala owonjezera a insulin amawoneka kuti ali ndi ufulu wonse, i.e. amadya ngati munthu wathanzi (zomwe akufuna, pomwe akufuna, kuchuluka momwe angafunire). Kusiyana kwake ndikuti amadzivulaza ndi insulin, polingalira bwino kusankha kwa mlingo. Monga chabwino chilichonse, kumasula zakudyazo kwathunthu ndikosatheka ndipo wodwalayo amakakamizidwa kutsatira malamulo ena. Kuwerengera kwa mapuloteni, mafuta ndi chakudya chamagulu omwe amalimbikitsa odwala matenda ashuga => 50%:

Njira yaunamwino: tanthauzo, tanthauzo

Pochiza matenda a shuga, namwino amapatsidwa ntchito kuti aziwunika zaumoyo, zomwe ndi zabwino kwa madokotala. Wodwala aliyense amamuwona ngati mnzake, yemwe amamugwiritsa ntchito ndipo amathandizidwa payekha. Uwu ndi udindo wa namwino mukudwala matenda ashuga.

Magawo a ntchito ya unamwino

Kusamalira anamwino a matenda a shuga amtundu 1 ndi mtundu wa 2 amakhala magawo angapo. Izi zikuphatikiza:

• kufufuza kwa wodwalayo
• kuzindikira
• kusamalira chisamaliro
• Kukwaniritsidwa kwa dongosolo la chisamaliro
• kuwunika kwa chisamaliro cha wodwala.

Pokonzekera unamwino, pamodzi ndi wodwala, namwino amapanga mndandanda wazinthu zomwe angatsatire potsatira malingaliro onse a dokotala.Kuti mankhwalawa akhale ndi zotsatira zabwino, magawo oyambilira a unamwino, namwino adziwe zonse zokhudzana ndi thanzi la wodwalayo, kufunika kwa chithandizo chamankhwala, komanso kuthekera kwa wodwalayo kudzisamalira.

Mavuto a unamwino a shuga

Kusamalira anamwino kumaphatikizapo ntchito zingapo zomwe zimayang'ana kuti wodwalayo azolowere mwachangu. Zina mwa izo ndi:

• Kupereka njira zokwanira zothetsera mavuto amakono azachipatala,
• Kuchotsa kwa zoipa, nkhawa,
• kupewa mavuto.

Pamaziko a mayeso a zamankhwala, zolinga ndi zolinga, komanso madandaulo kuchokera kwa wodwalayo, abale ake, mapu atsatanetsatane a njira ya unamwino apangidwa.

Wodwalayo amaphunzira malamulo a kudziletsa pa shuga ndi mkodzo wa magazi. Namwino amaphunzitsa makonzedwe a insulin, amathandizanso kusintha mlingo

Udindo wa paramedic popewa zovuta za matenda ashuga umateteza kumatenda obwera chifukwa cha matenda ashuga, kupewa kusintha kwaumoyo pakubadwa kwamatenda opuma kwambiri, kusintha nyengo ya chaka, ndi zina zambiri. Pofotokozera kwa wodwala zomwe zimayambitsa matenda obwera chifukwa cha matenda ashuga, othandizira amafunikanso kufotokoza momwe angapewere kuwonongeka komanso zomwe zimachitika pachitukuko chake.

Mukafuna chithandizo, mapu a unamwino wa matenda ashuga amapangidwa. Mulinso:

• Kuyesedwa kwa wodwala kuti adziwe zonse zomwe matendawa atengera. Mbiri yazachipatala payokha imapangidwa, momwe amasanthula, zowonera ndi mayankho onse amapangidwa pazifukwa zaumoyo.
• Kuzindikira zovuta zowonekera, komanso mavuto omwe akuwoneka kuti atha chifukwa cha kupitirira kwa shuga. Wodwalayo akuchenjezedwa za kuwonekera kwa zizindikiro zowopsa zomwe zimawopseza thanzi ndi moyo. Matenda omwe amapangitsa kuti matenda ashuga akhazikike. Njira zopewera komanso zamaganizidwe zimachitika ndi wodwalayo, abale.
• Kusintha kwazidziwitso zokhudzana ndi wodwalayo, pamaziko omwe namwino amakhazikitsa zolinga ndi zolinga zothandizira wodwalayo. Zochita zonse zimayikidwa mu khadi la wodwala. Zimatengera njira yoyamwitsa. Ndi mavuto ati omwe adadziwika ndikuwathetsa?

Zokhudza kugwiritsa ntchito insulin

Chimodzi mwazinthu zofunika za namwino ndikuwongolera moyenera insulin, komanso kuphunzitsa wodwalayo kuti azichita yekha mogwirizana ndi mlingo womwe dokotala wakhazikitsa. Namwino ndi odwala amafunika kutsatira izi:

1. Iwowona mlingo ndi nthawi ya makonzedwe a mankhwala omwe adokotala adalandira.
2. Onetsetsani kuti mwawerengera malangizo a mankhwalawo.
3. Onetsetsani kuti wodwalayo amatenga chakudya pasanathe mphindi 30 kuchokera pakumwa.
4. Gwedezani kuyimitsidwa kwa insulin musanayambe makonzedwe.
5. Nthawi zina, mankhwalawa amayenera kugwiritsidwa ntchito nthawi imodzi, koma osavomerezeka kuti asakanikize mu syringe imodzi chifukwa choopsa chomangidwa ndi insulin yosavuta.
6. Kutsatira malamulo a kusakhazikika, ndipo simungathe kufinya tsamba la jakisoni.

Kusamalira ana omwe ali ndi matenda ashuga kumafuna udindo waukulu. Izi zimakhudzana ndi chiwopsezo chachikulu cha zovuta, kukula kwa sayanjana, lipodystrophy, lipohypertrophy, komanso hypoglycemia. Mwana akhoza kumatuluka thukuta, njala, chizungulire, komanso zizindikiro zina. Ndikofunika kuphunzitsa mwana kuti afotokozere za zovuta zathanzi komanso mavuto azaumoyo munthawi yake.

Kusamalira odwala a shuga

Unamwino umayamba nthawi yomweyo ndikuika mankhwala. Namwino ayenera kukhazikitsa:

1. Kuwongolera komaliza kwa insulin, kaya chithandizo chachitika kale, ndi mankhwala ati omwe amatengedwa, mlingo wake.
2. Cholinga cha zakudya.
3. Kuphunzira kugwiritsa ntchito mita.
4. Kuwona njira yolandirira insulin, kusintha.
5. Chenjezo la zovuta.

Pochitira ana, penshoni, kukambirana ndi abale kapena makolo ndikofunikira.

Kuphatikiza apo, mawonekedwe a unamwino wa odwala omwe ali ndi matenda ashuga amaphatikizapo njira zotsatirazi:

• Kuyendera kozungulira. Yang'anani ndi kusintha kwa momwe wodwalayo aliri, chenjezo kwa adotolo.
• Kupenda bwino khungu, mucous nembanemba.
• Kuyeza kutentha kwa thupi, kupuma, kuchuluka kwa zimachitika, kuyesa kwa adokotala.

Pamapeto pa mayeso, namwino amapanga mbiri ya unamwino wamatendawa, pomwe mavuto azachipatala amalembedwa mogwirizana ndi kuyambika kwa matenda ashuga. Kuphatikiza apo, chidziwitso pakuwoneka kwa neurosis, ma pathologies ena, kuthekera kwodzithandiza nokha, ndi zina zambiri. Mavuto omwe angakhalepo mtsogolo amakhazikitsidwa popanda zolephera.

Kupanga kusowa kwa chidziwitso cha matendawa

Ndikofunika kwambiri kuphunzitsa wodwala yemwe ali ndi njira yodziletsa yatsopano. Namwino amakakamizidwa kufotokozera zomwe zimayambitsa matenda a shuga, kuonetsa kusokonezeka komwe kumatha kuchitika chifukwa cha matendawa, kudziwa mawonekedwe a chisamaliro, ukhondo. Tsimikizani wodwala kuti azitsatira zonse zofunika monga dokotala.

Luso loyamba lomwe munthu wodwala matenda ashuga amaphunzira ndi kuyendetsa shuga ndi mkodzo, komanso njira zoyendetsera insulin. Kuphatikiza pa kuperekera mankhwala, wodwalayo ayenera:

• kumvetsetsa zovuta za insulin
• kudziwa za zovuta zotheka
• kudziwa malo oyendetsera insulin pa thupi,
• kutha kusintha nokha.

Kusamalira ana omwe ali ndi matenda ashuga kumaphatikizapo kukambirana osati ndi mwana, komanso ndi makolo, kuwaphunzitsa luso lodziletsa, komanso kukhoza kuthandiza mwachangu. Namwino amauza dokotala zambiri za zomwe akutenga, kusintha kwa wodwala.