Matenda ashuga ndi gawo la endocrinology yomwe imaphunzira matenda a shuga, kupezeka kwake ndi chitukuko, zovuta zomwe zimadza chifukwa chake - matenda asekondale.

Kuwerenga momwe zinthu zasinthira komanso kuwonongeka kwa ziwalo zaumunthu ndi machitidwe, komanso kuphunzira komanso kukonza kupewa matenda a shuga, tinakhazikitsa njira zodziwira ndi kuchiza matenda osokoneza bongo komanso zovuta zake.

Diabetesology idadziwika kuchokera ku endocrinology yodziwika bwino chifukwa cha zovuta zamatenda komanso mawonekedwe osiyanasiyana a shuga, zovuta zakuwongolera kwa matenda ashuga komanso kufunika kwa vuto la matenda ashuga. Matenda a shuga ndi matenda ofala kwambiri a endocrine system ndipo amapezeka ndi matenda osapatsirana.

Chiwerengero chokwanira cha odwala chimakhala chovuta kudziwa chifukwa cha kusawerengeka kwa njira zodziwira, mwina kuchuluka kwa odwala kuli pafupifupi 1% ya anthu ndipo chiwerengero cha odwala chikuchulukirachulukira. Odwala omwe ali ndi zovuta samakhala gulu lowerengeka; ena, magulu angapo apadera odwala matenda ashuga amatha kusiyanitsidwa.

Masiku ano diabetesology ndi imodzi mwamipanda ya sayansi komanso gawo lapadera la zamankhwala malinga ndi zomwe akatswiri amapeza pa biology, immunology, ndi genetics.

Matenda a shuga - cholowa kapena matenda omwe amapezeka chifukwa cha kuperewera kwa thupi kapena insulin. Mawonekedwe: kuchuluka kwa shuga mumagazi, kuwonjezeka kowopsa kwamkodzo wokhala ndi shuga, ludzu, kuchepa thupi, kufooka, kuyabwa.

Gawo lapadera la matenda ashuga ndi kukhazikitsidwa kwa matenda ashuga a ana.

Diabetesology imathandizira kuphunzira matenda a shuga mellitus mokwanira, poganizira zovuta zomwe zilipo za metabolic, zomwe cholinga chake ndikuchotsa kapena kufupikitsa kuchepa kwa insulini, kusintha njira za metabolic, kubwezeretsa kuchepa kwa thupi ndi malingaliro, kuletsa kusintha kwakukulu kwa ziwalo zamkati, ophthalmic, matenda amitsempha, komanso kuwonetsetsa kukula kwabwino kwa ana ndi kukula kwawoko.

Yemwe akutsogolera kuthetsa mavuto awa ndimasewera opangidwa ndi zakudya, mankhwala omwe amachepetsa shuga la magazi, njira zamankhwala zolimbitsa thupi, kuphatikizapo masewera olimbitsa thupi apadera komanso njira yoyendetsera masewera olimbitsa thupi. Zakudya zomwe zimagwiritsidwa ntchito zimakhala pafupi ndi thupi, kuchepa pang'ono kwa chakudya chamafuta ndi mafuta, kupatula pazogulitsa zomwe zimatenga mafuta ambiri.

Kugwiritsa ntchito physiotherapy zolimbitsa thupi povuta kumathandizira kulimbitsa thupi mwachangu komanso kagayidwe, komwe kumalumikizidwa ndi zonse ziwiri zosangalatsa komanso zolimbitsa thupi zolimbitsa thupi kwa ana. Mothandizidwa ndi zochitika zolimbitsa thupi, kugwiritsa ntchito minofu ya m'magayidi, mafuta acids ndi matupi a ketone kumawonjezera, zomwe zimachepetsa zomwe zimapezeka m'thupi, zimasinthasintha kagayidwe, komanso zimachepetsa chiopsezo chokhala ndi vuto la matenda ashuga.

Mu ana omwe ali ndi vuto la kukula ndi kukula, kugwiritsa ntchito masewera olimbitsa thupi ndikofunikira ngati njira yotithandizira kuphatikiza mphamvu - chinthu chofunikira pakukhazikitsa lamulo lamphamvu kuti mutukutse minofu yamatumbo. Izi ndizofunikira kuti thupi la mwana lizisinthasintha kuchuluka kwake, poganizira zolimbitsa thupi ndi zochita zake zingapo zolimbitsa thupi, kulimbikitsa mphamvu ya anaerobic mphamvu (glycolysis, kuphulika kwa glycogen) ndipo zimapangitsa kudzikundikira kwa lactic acid ndi metabolic acidosis, osakhudza kuchuluka kwa shuga m'magazi. Ntchito yamakalasi amenewo ndikupititsa patsogolo kubwezerera kwa njirayo ndikusunga magawo omwe akukwaniritsidwa kuti athane ndi nkhawa yakukula kwa thupi la mwana.

Chimodzi mwazinthu zofunika kwambiri pakukonzekera ntchito ya matenda ashuga ndikusunga, kukonza ndi kuphunzitsa antchito atsopano omwe ali ndi maphunziro ambiri.

Kuyambitsidwa kwa ntchito yapadera ya katswiri wa matenda ashuga kukhala njira zothandiza paumoyo kumathandiza kukulitsa chisamaliro chachipatala kwa odwala omwe ali ndi matenda a shuga, komanso kusintha moyo wawo.

Ndikosavuta kuyanjananso ndi chowonadi cha matenda osachiritsika, popeza munthu amasintha moyo wake wonse, makamaka kwa odwala matenda a shuga. Odwala akudziwa kuti atha kukhala ndi zovuta zamtsogolo zomwe zingachitike pambuyo pake, ndipo chiyembekezo cha moyo chitha kuchepa, moyo ungasinthe nawonso.

Dotolo ayenera kufotokozera ndikuchita zonse kuti wodwalayo azindikire bwino, akumuchitira zabwino, ndipo amakhala ndi matenda ashuga osataya mtima. Vutoli limakhala lalikulu kwambiri kwa ana ndi achinyamata. Koma zovuta zambiri zitha kudziwikiratu ndikugonjetsedwa ngati lingaliro wamba limaphatikizidwa ndi malingaliro oyenera kwa wodwalayo komanso kulimba mtima pakulimbana ndi omwe akufuna. Pakufunika chiyembekezo kuti mtsogolomo padzakhala bwino kuposa momwe ziriri pano ndi mankhwala.

Ekaterina Nailevna Dudinskaya

Ekaterina Dudinskaya: "Chimodzi chofunikira - pa zamankhwala zamakono, machitidwe ena, ma algorithms ndi malingaliro apadziko lonse lapansi amagwiritsidwa ntchito, malinga ndi momwe madokotala padziko lonse lapansi amagwirira ntchito. Amakhazikitsa zomwe akufuna kukhala ndi shuga, magazi, mzere woyamba komanso wachitatu. Ngati mankhwala sanapange kafukufuku woyenera malinga ndi chiwembu china chake, sichinaphatikizidwe pamagwirizano ndi ma algorithms, ndipo ndizoletsedwa kuzigwiritsa ntchito kuti muchepetse malingaliro awa. editsiny, ndipo panopa mfundo zimenezi ayenera kutsata lonse. "

1. Kodi pali njira zina zothandizira odwala matenda ashuga zomwe sizigwirizana ndi kupatsidwa insulin pafupipafupi?

Chomwe chimapangitsa kukula kwa shuga ndikusakwanira kwa insulin ya mahomoni m'thupi la munthu. Zosakwanira izi zitha kukhala mtheradi kapena wachibale. Ndi kusakwanira kwa wachibale (nthawi zambiri ndi mtundu wa 2 shuga) mankhwala ochepetsa shuga amagwiritsidwa ntchito. Komabe, nthawi zina, sikokwanira kuti muchepetse shuga. Kenako adotolo amawonjezerera jakisoni wa insulin mankhwalawo. Odwala otere amatha kuchepetsedwa mtsogolo insulin kapena ngakhale kusiya. Koma adotolo amapanga chisankho ichi payekhapayekha, poganizira momwe matendawa akuonekera komanso zomwe wodwala aliyense ali nazo.

Zomwe tafotokozazi zikukhudzana ndi kuchepa kwa insulin. Ndi kusakwanira kotheratu (mtundu 1 shuga ndi mitundu ina yake) kukana kupatsa insulin kumatha kubweretsa zotsatira zosasinthika - ngakhale imfa. Kupatula apo, thupi lilibe kwina kulikonse komwe lingatenge Hormone iyi. Mankhwala amakono amatha kutengera momwe magwiridwe antchito a kapamba amapangidwira, kusintha shuga m'magazi ndikuthandizira kupewa kukula kwa zovuta. Chifukwa chake, chithandizo chokhacho cha mtundu woyamba wa matenda a shuga chimakhalabe ndi insulin. Tsoka ilo, kafukufuku wasayansi kuzungulira padziko lonse lapansi akuwonetsa kuti pakanthawi kochepa, sipangakhale chithandizo china chazomwe zachitika m'zaka zapitazi.

2. Kodi pali chithandizo chothandiza kwambiri cha matenda a shuga 1 kuposa chimbudzi?

Pampu ya insulini limodzi ndi ma syringes ndi zolembera za syringe ndi amodzi mwa njira zolembetsera insulin. Pampu imalowetsa ma insulin microdoses mthupi, chifukwa chake njirayi ndiyofunika kwambiri pantchito yopanga thupi ya kapamba ndipo imalola wodwala kupewa jakisoni angapo. Pakupopa mankhwalawa, ndi insulin yochepa kapena yochepa yokha yomwe imagwiritsidwa ntchito, chifukwa chake, chifukwa cha pampu, wodwalayo amachotsa kufunika kotsatira ndondomeko yokhwima ya chakudya. Kuphatikiza apo, ndi chithandizo chake ndikotheka kukonza mitundu yosiyanasiyana ya kayendetsedwe ka mankhwala - kutengera mtundu wa chakudya chomwe wodwala azidya ndi mtundu wa zochita zomwe ayenera kuchita. Chifukwa chake wodwala ndi insulin pump samangoyang'anira kuchuluka kwa shuga, komanso imathandizira kwambiri pamoyo wanu.

3. Kodi ma insulins apanyumba ndiosiyana ndi omwe amafesedwa, ndipo nkhawa yomwe wodwala akuwasamutsa kupita kwa ma insulins apanyumba ndioyenera?

M'makampani amakono azachipatala, ma genetic amagwiritsidwa ntchito kwambiri - mankhwala omwe amapangidwa ndi opanga osiyanasiyana, koma ali ndi molekyulu yomweyo. Zomwe molekyulu iyi ikufanana kwathunthu ndi mankhwala oyambirirawo. Bioequivalence iyi, poyamba, imatsimikiziridwa pamayeso angapo ndipo, kachiwiri, imagwira ntchito ngati chofunikira pakugulitsa zamagetsi. Zamakono zapakhomo insulin analogues opanga achilendo mu kapangidwe ka mankhwala ndi katundu sizosiyana nkomwe ndi mankhwala oyambirirawo ndipo atsimikizira motsimikiza kugwira ntchito kwawo komanso chitetezo.

5. Kodi ndizowopsa kumwa maantibayotiki?

Maantibayotiki ena amadziwika kuti amalimbikitsa zovuta za insulin ndipo amatha kutsogolera hypoglycemia. Kumbali ina, matenda otupa amawonjezera njira ya matenda a shuga ndikuwonjezereka shuga m'magazi. Chifukwa chake, munthawi ya chithandizo cha maantiotic.

8. Kodi ndizowona kuti zovuta za matenda amtundu woyamba zimatulukira ngakhale matendawo atibwezera?

Zabwino kulipira shuga - Ichi ndiye maziko a kupewa zovuta. Wodwala ayenera kukumbukira kuti mtundu wa matenda osokoneza bongo sukusokoneza kuthamanga ndi kuuma kwa kukula kwa zovuta. Chithandizo matenda ashuga ogwira ntchito kwambiri poyambira kukula kwawo, motero, ndikofunika kuti odwala onse omwe ali ndi matenda ashuga azipimidwa pachipatala chapadera cha endocrinological.

9. Kodi ana omwe ali ndi matenda ashuga 1 amathanso kuphunzira kusukulu?

Masiku ano diabetesology ndi lingaliro lomwe moyo wa mwana wokhala nawo mtundu 1 shuga sayenera kukhala osiyana kwambiri ndi moyo wa anzawo. Ngati mwana alipira chindapusa cha matenda ashuga, palibe zovuta, adaphunzitsidwa kusukulu ya matenda ashuga, amadziwa zomwe zimapangitsa kuti insulin ichitike panthawi yolimbitsa thupi, mfundo za kupewa ndi kupumula hypoglycemia, kenako kutengera izi, mutha kuchita maphunziro olimbitsa thupi kusukulu. Komabe, zikuwonetsa ndi kuwonetsa zolimbana ndi zochitika zolimbitsa thupi munthawi iliyonse yoyenera kuyenera kutsimikiziridwa ndi wopezeka ndi matenda ashuga. Kuphatikiza apo, gulu la endocrinological limawona kuti ndikofunikira kuyambitsa maphunziro apadera pazolumikizana ndi ana ndi achinyamata omwe ali ndi matenda ashuga mu pulogalamu yophunzitsira aphunzitsi a ukadaulo uliwonse. Kupatula apo, ophunzira ndi matenda ashuga Ambiri mwa moyo wawo sakhala ndi makolo omwe amadziwa zovuta za ana awo, koma ndi aphunzitsi omwe nthawi zina samatha kupereka thandizo kwa mwana.

10. Ndi malamulo ati omwe akuyenera kutsatidwa ndi omwe ali m'malire (matenda ashuga)?

Lingaliro la "prediabetes" limaphatikizapo zinthu monga kusokonezeka kwa glycemia komanso kulekerera shuga. Mikhalidwe yonseyi imapezeka pamaziko a mayeso apadera, omwe, pakukayikira pang'ono kwa matenda ashuga kapena onenepa kwambiri, ayenera kudutsa kuchipatala. Madokotala amagwiritsa ntchito mawu oti prediabetes ngati wodwala ali ndi chiopsezo chachikulu chotukuka mtundu 2 shuga. Ngati, pa matenda a prediabetes, munthu ayamba kuchita zathanzi limodzi (kudya moyenera, masewera olimbitsa thupi, kusintha matendawa), ndiye kuti pali mwayi uliwonse wopewa kapena kuchedwetsa kukula kwa matendawa. Mwachitsanzo, kafukufuku wasonyeza kuti kuchepa thupi kwa 5-7%, kudya zakudya zopatsa thanzi, zochepa zopatsa mphamvu, kuchita masewera olimbitsa thupi kwa mphindi 30 katatu pa sabata, kumachepetsa chiopsezo cha matenda ashuga ndi 58%.

12. Mu 2000, ma Russia omwe adaletsa ma cell a "kapamba" m'malo operekera m'malo mwa owononga (Russia) adaletsedwa ku Russia. Kodi pali ntchito zina panjira iyi yakuchizira matenda ashuga komanso kupewa zovuta zake? Kodi njira zamankhwala zodwala matenda a shuga a mtundu wachiwiri zitha kugwiritsidwa ntchito pogwiritsa ntchito njira yake yodya insulin?

Asanayambe kugwiritsidwa ntchito muzochitika zamankhwala zamasiku onse, njira zilizonse zoyesera zolimbana ndi matenda ashuga zimayesedwa zowawa zasayansi ndi zamankhwala, zomwe zimatenga zaka. Ndipo ngati njira imodzi kapena ina ndi yoletsedwa ndi lamulo, ndiye kuti ntchito zonse m'derali ndi "mazira". Chifukwa chake, nkovuta kwambiri kuyankha funso lanu mwachindunji komanso molondola.

13. Kodi kuponderezedwa kwa cell kuchokera kwa wachibale wapamtima wochitidwa pochiza matenda osokoneza bongo kwa ana omwe ali ndi minyewa komanso kuyenderana gulu? Zotsatira zake ndi chiyani? Kodi ndizothandiza motani?

Maselo a stem akuphunziridwa lero ndi akatswiri padziko lonse lapansi. Komabe, zotsatira za kafukufuku wozama komanso wokulirapo pa thupi la munthu sizinapezekebe. Pali chidziwitso pakukhazikitsa maselo a stem kwa odwala omwe ali ndi matenda ashuga, kuphatikiza m'dziko lathu, koma palibe njira yogwiritsira ntchito izi pakadali pano - kutsatira kwanthaŵi yayitali komanso kuchuluka kwa maphunziro ndikofunikira. Kuti mudziwe momwe njirayi imagwirira ntchito komanso chitetezo chake, zimatenga nthawi yambiri, chifukwa chake, kuyankhula za kufalikira kwa maselo a tsinde pochizira matenda ashuga, makamaka ana, sanatero.

14. Kodi ndichifukwa chiyani ma hormone onse obwezeretsa amayi omwe amakakamizidwa amachepetsa kuphatikiza mankhwala a estrogen-progestogen okha ndipo palibe amene amatchulapo kuti amayi amafunikiranso kukhala ndi androgens?

Mpaka pano, kafukufuku wokhudza kugwiritsidwa ntchito kwa androgens mwa azimayi mu kusintha kwa thupi ndi ochepa kwambiri, zotsatira zawo ndizotsutsana ndipo amafuna kuwongolera kwakukulu ndikuwonetsetsa kwa nthawi yayitali. Padziko lonse lapansi, kukonzekera kwa estrogen-progestogen kokha komwe kumalimbikitsidwa kuti kugwiritsidwe ntchito - mumitundu yosiyanasiyana. Komabe, pali chifukwa chilichonse chokhulupirira kuti kugwiritsa ntchito androgens mu HRT ndi nkhani yamtsogolo kwambiri.

15. Kodi njira zabwino kwambiri zothandizira kunenepa kwambiri ndi ziti?

Choyamba, ichi ndi mankhwala othandizira pakudya limodzi ndi masewera olimbitsa thupi okwanira. Mankhwala ochizira kunenepa sagwiritsidwa ntchito "m'malo" "zakudya zoyenera, koma kuwonjezera pamenepo. Mankhwala aliwonse amakhala ndi zotsutsana zake. Chifukwa chake, zakudya, ndi masewera olimbitsa thupi, ndi mankhwala osankhidwa ndi mankhwala ndizosankhidwa bwino pamodzi ndi dokotala yemwe azilingalira zonse zaumwini, komanso ziwonetsero ndi contraindication pochizira kunenepa.

Diabetesology: Gawo Lamakono pa Phunziro la matenda a shuga

Matenda ashuga ndi gawo la endocrinology. A Diabetesology akuphunzira zinthu zomwe zimakhudza kudwala matenda monga matenda ashuga.

Akatswiri pankhani zamankhwala m'derali akuphunzira zinthu zokhudzana ndi matenda ashuga:

1. Zomwe zimayambitsa matenda a pathological.
2. Njira zochizira matenda amitundu yosiyanasiyana.
3. Njira zopewera matenda ashuga.

Madokotala omwe amagwira ntchito pophunzira za matenda ashuga, zomwe zimapangitsa kuti pakhalepo komanso kupewa amatchedwa akatswiri ashuga. Madokotala omwe amaphunzira shuga ndi njira zake zamankhwala ndi akatswiri oyenerera a endocrinology.

Matenda a shuga ndi matenda omwe amapezeka chifukwa cha chitukuko cha magwiridwe antchito omwe amapanga ma insulin.

Zomwe zimayambitsa matendawa zimathandizanso kuchepa kwa chidwi cha ma membrane am'mimba omwe amapezeka ndi insulin.

Mtundu wofala kwambiri wa matenda ashuga ndi mtundu 2 shuga.

Matenda a shuga amayamba chifukwa cha zovuta zonse za endocrine, zomwe zimadziwika ndi kuchepa kwathunthu kwa insulin m'thupi. Kuphatikiza apo, kukula kwa matenda ashuga kumatha kuyambitsidwa ndi kuwonekera kwa kusokonezeka mu mitundu yonse ya njira za metabolic.

Njira zoterezi mthupi la munthu ndi izi:

• mapuloteni kagayidwe
• lipid
• madzi ndi mchere
• mchere
• chakudya.

Mitundu yodziwika bwino ya shuga ndi iyi:

1. Wodalira insulin - lembani matenda a shuga 1.
2. Mtundu wa matenda ashuga a 2 osagwirizana ndi insulin.
3. Matenda a shuga.

Kuphatikiza apo, odwala matenda ashuga amawonetsa mkhalidwe wapadera wa thupi lotchedwa prediabetes. Ndi prediabetes mwa anthu, kuchuluka kwa glucose m'thupi kumadziwika kuti kumasiyana ndi chizolowezi chotsimikizika mwakuthupi, koma osafika pachizindikiro chomwe chikhalidwe cha munthu chitha kugawidwa ngati matenda ashuga.

Zizindikiro zofunsidwa kwa katswiri wa matenda ashuga

Ngati zodwala zikugwira ntchito m'thupi mwapezeka, muyenera kulumikizana ndi kuchipatala kuti mupeze malangizo ndi kupatsidwa chithandizo chamankhwala ngati pakufunika kutero.

Pali zizindikiro zingapo, mawonekedwe ake omwe angasonyeze kukula kwa matenda a shuga m'thupi la munthu.

Ngati chimodzi kapena zingapo mwazizindikirozi zapezeka, muyenera kufunsa chithandizo cha matenda ashuga.

Zizindikiro zazikulu zomwe zikuwonetsa kukula kwa matenda ashuga ndi izi:

• zosokoneza pantchito yam'munsi,
• kuwoneka kwa kufooka kowonjezereka ndi kusweka kwakukulu,
• kutuluka kwa ludzu lamphamvu ndi losasinthika,
• kuchuluka kukopa kukodza
• maonekedwe akuwonjezera kutopa kwa thupi,
• kuchepa kwakukulu kwa thanzi la thupi,
• kusintha kwa kulemera kwa thupi popanda kuchitika kwa prerequisites omwe akuwonekera pamenepa.

Kulumikizana ndi katswiri wa matenda ashuga ndikuwunika thupi la wodwalayo momwe zizindikirozi zimadziwikitsira zimapangitsa kudziwika koyambirira kwa shuga m'thupi komanso njira zochiritsira panthawi yake.

Cholinga cha zochitika ngati zotere ndikuwongolera mndandanda wa glycemic mthupi ndikuletsa kupezeka kwa zovuta zomwe zingachitike ndikupitirirabe kwa mtundu womwe wazidziwika wa matenda ashuga.

Kodi kuonana ndi katswiri wa matenda ashuga ndi kotani?

Ulendo woyamba wa odwala matenda ashuga siwosiyana ndi odwala omwe amayendera madotolo ena.

Pakuchezera koyamba kwa odwala matenda ashuga, dokotala amachita kafukufuku woyambayo wa wodwalayo.

Mukuchita kafukufuku woyamba, adotolo amafufuza mafunso angapo omwe amakupatsani lingaliro lenileni lokhudza kukhalapo kapena kusapezeka kwa wodwala yemwe ali ndi vuto la metabolic lomwe limachitika mthupi.

Pa kafukufukuyu, adokotala adapeza mafunso otsatirawa:

1. Zodandaula zomwe wodwala ali nazo ndi zomwe ali.
2. Imafufuza kupezeka kwa zizindikiro zomwe zimayambitsa matenda a shuga kapena matenda a prediabetes.
3. Imafotokoza nthawi yomwe zizindikiritso zimapezeka ngati zilipo mwa wodwala.

Pambuyo pa kufufuza koyambirira, dokotala yemwe amapezekapo amayesa kuchuluka kwa glucose m'thupi la wodwalayo kapena akuwonetsa kuti alumikizane ndi labotale yachipatala yothandizira magazi kuti ipangike mafuta a m'magazi a plasma.

Ngati pakufunika maphunziro owonjezera, urinalysis ingathe kutumizidwa:

Kuphatikiza apo, kuyang'anira wodwala plasma glucose wodwala tsiku lililonse atha kutumikiridwa.

Atalandira zotsatira zonse zoyesedwa ndikuwunika zofunikira zonse, wodwala matenda ashuga amapenda matenda ndipo ngati kuli kotheka, amakonza njira imodzi yochizira.

Kusankhidwa kwa njira zochizira kumatengera zotsatira za kusanthula ndi momwe munthu wodwala akuvutikira ndi mtundu wina kapena shuga.

Njira zothanirana zomwe zimagwiritsidwa ntchito pochiza matenda a shuga sizimangomwa mankhwala omwe amachepetsa shuga m'magazi am'magazi.

Njira zochizira zingaphatikizeponso kusintha kwa kadyedwe ndi nthawi ya chakudya, ndandanda ndi kutsatiridwa kwa mankhwala.

Kuwongolera ndi kuwononga mphamvu kwa thupi la wodwalayo, kusintha kwakhalidwe, kusiya zinthu zoyenera, monga kusuta fodya komanso kumwa mowa.

Kodi wodwala matenda ashuga amatani?

Dokotala wa matenda ashuga ndi katswiri yemwe akuchita nawo njira zoperekera mankhwala komanso kupewa matenda a shuga komanso zovuta zomwe zimakhudzana ndi kufalikira kwa matendawa m'thupi la wodwalayo.

Chofunikira kwambiri pakulimbana bwino ndi matendawa ndikuwonetsetsa matendawa panthawi yake ndikuletsa kupitilira kwake kufikira magawo omwe zovuta zimayamba.

Mavuto a mtundu wachiwiri wa matenda ashuga komanso mtundu wa matenda ashuga 1 amakhudza kwambiri magwiridwe antchito ndi ziwalo zawo mokwanira.

Pofuna kupewa zovuta zomwe zimayenderana ndi kupitilira kwa mtundu uliwonse wa matenda osokoneza bongo, muyenera kupita kukaonana ndi katswiri wa matenda ashuga kuti mupeze malangizo komanso kusintha kwa mankhwalawo.

Kulumikizana ndi katswiri wa matenda ashuga nthawi zonse ndikumayendera pafupipafupi kumakupatsani mwayi wowerengeka kuti musinthe shuga mu thupi komanso kusintha kagayidwe kachakudya.

Kuwona pafupipafupi ndi adotolo kumapewetsa chitukuko m'thupi la matenda oopsa omwe amayambitsidwa ndi matenda a shuga, omwe amakhudza kugwira ntchito kwa mtima ndi mantha ena.

Mutha kuphunzirapo zatsopano za matenda ashuga mwa kuwonera kanema munkhaniyi.

Zinthu zamakono

Matenda a shuga amadziwika ndi madokotala kuyambira nthawi zakale. Kufotokozera kachipatala koyamba za matenda awa kunaperekedwa ndi sing'anga waku Roma a Areteus m'zaka za zana la 2 A.D. e., adayambitsanso mawu oti "shuga" machitidwe azachipatala. Kafotokozedwe ka matendawa amaperekedwanso m'mabuku akale a ku Egypt (pafupifupi 1000 BC), ku Galen (130-200), mu Tibetan canon Chjud-shek (VIII century), pa Mchiritsi waku Arab Avicenna (980-1037 gg.) komanso kwina.

Mu 1776, dokotala wa ku England, a Matthew Dobson (1731-1784), anapeza kuti mkodzo wa odwala uli ndi kuchuluka kwa shuga (glucose), chifukwa chake matendawa adayamba kudziwika kuti matenda a shuga.

Paul Langerhans (1847-1888), katswiri wazamapazi wa ku Germany yemwe adasanthula kapangidwe kake, adafotokoza kuchuluka kwa maselo apadera mu minyewa ya gland, yomwe tsopano imadziwika kuti ipanga insulin. Pambuyo pake, maguluwa amatchedwa zisumbu za Langerhans. Dokotala waku Russia Yarotsky (1866-1944) anali wasayansi woyamba yemwe ananena mu 1898 lingaliro lakuti zipolopolo za Langerhans zimatulutsa chinsinsi chamkati chomwe chimakhudza kagayidwe kazakudya m'thupi. Oscar Minkowski (1858-1931) ndi Joseph von Mehring (1849-1908) adayambitsa "kuyesa shuga" mu agalu pochotsa ziphuphu mu 1889 ndikuwona kuti panali kulumikizana pakati pa kuchotsedwa kwa ndulu ndi kukula kwa matenda ashuga. Pomaliza, wasayansi wina waku Russia, Leonid Sobolev (1876-1919) m'mabuku ake omwe adafotokozedwa mu 1901 adatsimikiza kuti zipilala za Langerhans zimapanga mahomoni ena apadera omwe amayang'anira shuga.

Zaka makumi awiri pambuyo pake, ofufuza aku Canada Frederick Bunting (1891-1941) ndi Charles Best (1899-1978) adadzilekanitsa mahomoni awa, omwe amatchedwa insulin, ndipo mu 1922 "nthawi ya insulin" idayamba pochiza matenda ashuga. Bunting ndi Pulofesa MacLeod, omwe amayang'anira ntchitoyi, adalandira Mphotho Nobel Chifukwa cha zomwe apezazi.

Ku France, pa Nkhondo Yachiwiri Yapadziko Lonse, madokotala Zhanbon ndi Lubatier adafufuza momwe insulini imasungidwira mankhwala osokoneza bongo omwe amachepetsa shuga. Zotsatira zake, chifukwa cha kuyesa kwa asayansi angapo (Chen, 1946, Savitsky ndi Mandryka, 1949, Usse, 1950), mkati mwa makumi asanu, njira zapakamwa za gulu la sulfamide - tolbutamide, carbutamide, chlorpropamide, adalowa ntchito zachipatala. Titha kuganiza kuti kuyambira nthawi imeneyi mu sayansi ya matenda ashuga inayambira nyengo yamakono yoperekera matenda ashuga.

Zinthu zamakono

Kupita patsogolo pakulamulira kwa matenda ashuga kumaphatikizapo: kugwiritsa ntchito mitundu yambiri ya insulini komanso kukonzekera kwa piritsi yamlomo, zakudya zopangidwira mosamalitsa ndi mndandanda wazogulitsa, odwala omwe amadziyang'anira okha ndi ma glucometer, ndi malingaliro pazokhudza zolimbitsa thupi.

Mitundu ya Matenda A shuga

Malinga ndi tanthauzo la WHO, matenda ashuga ndi gulu la matenda a metabolic omwe amapezeka ndi hyperglycemia yosatha yomwe imachitika chifukwa cha kubisala kwa insulini, kusintha kwa machitidwe ake, kapena chifukwa cha zonsezi.

Insulin ndi timadzi tomwe timapangidwa ndi ma cell a pancreatic beta. Imayang'anira kagayidwe kazakudya kokha, komanso mitundu ina ya kagayidwe - mapuloteni, mafuta, amakhudzidwa ndi magawidwe a maselo osiyanasiyana.

DM amatanthauza matenda omwe amadziwika ndi njira yodwala komanso kuwonongeka kwa ziwalo zosiyanasiyana za thupi.

Pamaso pa matenda a shuga, komanso ngakhale mutalandira chithandizo chokwanira, zimakhala zovuta kupewa zovuta zomwe zimayenderana ndi matendawa. Mavuto ambiri a shuga ndi angiopathies (diabetesic angiopathy) ndi polyneuropathy. Nawonso, zovuta izi zimabweretsa kuwonongeka kwa ziwalo zambiri - impso, mitsempha ya mtima, mantha, khungu, kukula kwa retinopathy ndi matenda a shuga.

Kwambiri, matenda a shuga amawagawika m'magulu angapo.

• Matenda a shuga a Type 1 (mtundu 1 wa matenda ashuga), kapena mtundu wotsika ndi insulin, samangophatikizidwa ndi autoimmune kapena idiopathic kuwonongeka kwa maselo a pancreatic beta, komanso zifukwa zina zomwe zimapangitsa kuwonongeka kwa maselo opanga insulin (mwachitsanzo, poyizoni). Izi zimabweretsa lakuthwa kapena pafupifupi kutsirizika kwa kupanga kwa insulin. Matenda a shuga a Type 1 nthawi zambiri amakula mwa achinyamata.
• Mtundu wa shuga wosadalira insulini (T2DM) umakula nthawi zambiri msinkhu wokhwima (nthawi zambiri umakhala wamkulu kuposa zaka 40-50) mwa anthu omwe ali ndi vuto lobadwa nalo. Kukula kwake kumakhalapo ndi kupezeka kwa majini komanso zinthu zakunja. Prerequisites ya genetic imakhulupirira kuti ili ndi gawo lofunikira kwambiri pakukula kwa matenda amtundu wa 2 kuposa mtundu woyamba wa matenda ashuga.

Matenda a 2 a matenda ashuga

Kutengera kwa chibadwa chokhala ndi matenda a shuga a 2 kumatsimikiziridwa ndi kafukufuku wazamitundu yambiri. Pafupifupi mitundu 100 yapezeka, ma polymorphisms omwe (majini amasiyanasiyana) amawonjezera mwayi wokhala ndi matenda ashuga. Nawonso, majiniwa amagawika m'magulu momwe zinthu zamtunduwu zimakhudzira magawo a cell a pancreatic beta omwe amapanga insulin, zolakwika zamtunduwu pakugwira ntchito kwa insulin ndi ma receptors ake, komanso kukula kwa insulin. Mitundu yophunziridwa kwambiri ya matenda a shuga a mtundu wa 2 omwe amawongolera magwiridwe antchito a cell a pancreatic beta akuphatikiza mitundu ya PRAG, KCNG11, KCNQ1, ADAMTS9, HNF1A, TCF7L2, ABCC8, GCK, SLC30A8 ndi ena angapo.

Pali zinthu ziwiri zomwe zimakhudzidwa ndi matenda a shuga a mtundu 2 - insulin kukana ndi kusintha magwiridwe antchito a maselo a beta. Sizikudziwika nthawi zonse kuti ndi ziti zomwe zimayambira.

Mkhalidwe womwe umayambitsidwa ndi kuchepa kwa chidwi cham'maselo kuti insulin, motsutsana ndi kumbuyo kwa chiwerengero chake chokwanira kapena kupitirira malire apamwamba a chizolowezi, chimatchedwa insulin kukana. Hyperinsulinemia yolumikizira imayamba m'magawo a shuga ndipo ndi chimodzi mwazizindikiro za kunenepa kwambiri.

Pakalipano, matenda a shuga a mtundu wa 2 amafotokozedwa ngati kuphwanya kagayidwe kazakudya, kamayamba makamaka chifukwa cha kuchepa kwa insulini komanso kuchepa kwa insulini kapena kuwonongeka kwapadera kwa chinsinsi cha mahomoni nawo kapena popanda kutsutsana ndi insulin.

Kuperewera kwa minofu ya insulin kumafotokozedwa ndi kuchepa kwa chidwi cha insulin receptors kapena kusokoneza kwa ma enzymes omwe amapanga insulin.

Matenda omwe amadwala matenda ashuga

Kuphatikiza pa matenda ashuga amtundu woyamba komanso wachiwiri, mitundu yeniyeni ya matenda osokoneza bongo omwe amapezeka m'matenda ena / syndromes ndi mikhalidwe imasiyana.

Matenda ena a endocrine ndi autoimmune amatha kuphatikizidwa ndi matenda ashuga: Matenda a Graves (amafalitsa poyizoni woipa), Itsenko-Cushing's (hypercorticism), pheochromocytoma (adrenal gland tumor), acromegaly, glucagonoma, anemia woopsa, hypothyroidism, hepatitis yayitali.

Matenda a shuga angayambike ndi matenda a kapamba: kapamba, cystic fibrosis, chotupa, hemochromatosis. Matenda a shuga a pakati pama immunological amatha okha chifukwa cha kupezeka kwa IPEX syndrome, komanso pambuyo pakuwonekera kwa ma antibodies ku insulin ndi ma insulin receptors. IPEX syndrome imadziwika ndi kuchepa kwa chitetezo cha m'thupi, polyendocrinopathy (shuga mellitus, hypothyroidism) ndi autoimmune enteropathy, yomwe imadziwonetsa ngati malabsorption syndrome. Kupezeka kwake kumalumikizidwa ndi kusintha kwa mtundu wa FOXP3, momwe mndandanda wamapuloteni amafupika, womwe umayang'anira magwiridwe antchito a T-lymphocyte ndipo, motero, kukulitsa kwa kusakwanira kwa chitetezo chokwanira cha anti antiviral and antibacterial. Matenda a shuga omwe amadalira insulin omwe amayamba ndi matendawa amawonekera, monga lamulo, m'miyezi isanu ndi umodzi yoyambirira ya moyo wa mwana.

Mitundu ina ya shuga imaphatikizapo shuga, yomwe imayamba chifukwa cha kusokonekera kwa maselo a beta komanso kusokonezeka kwa chibadwa cha insulin (MODY-1-6, masinthondrial DNA mutation, leprechaunism, mtundu wa A insulin kukana, ndi zina).

Ubale wapakati pa chitukuko cha matenda ashuga komanso kachilombo komwe kachilombo kamayambitsa (kukhalapo kwa cytomegalovirus, kachilombo ka Coxsackie B3 ndi B4, mtundu wa reovirus 3, kobadwa nako). Zinapezeka kuti pambuyo pa mliri wa mumps pambuyo pa zaka 2, kuchuluka kwa odwala omwe adapezeka ndi matenda ashuga pakati pa ana kunawonjezeka.

Kukula kwa matenda ashuga kumatheka ndi kupezeka kwa zovuta zina zamtundu zomwe zimaphatikizidwa ndi shuga. Izi zikuphatikiza ndi syndromes: Down, Klinefelter, Turner, Prader-Willi ndi Huntington's chorea.

Zovuta za chiwopsezo cha shuga

Monga tawonera pamapepala angapo asayansi, chimodzi mwazinthu zomwe zimapangitsa kuti njira za autoimmune zithandizire ndikukula kwa shuga ndikugwiritsa ntchito mkaka wa ng'ombe ndi akhanda. Zawonetsedwa kuti kudya mkaka wa ng'ombe ndi chakudya chofukizira kumawonjezera mwayi wokhala ndi matenda amtundu woyamba. Amakhulupirira kuti njira yotsogola iyi imagwirizanitsidwa ndi kukhalapo kwa mapuloteni angapo omwe ali ndi vuto la matenda ashuga mkaka.

Kugonjetsedwa kwa maselo a beta omwe amapanga insulini ndikotheka ndikuwopsa kwa maselo awa, mwachitsanzo, mutatha kutenga streptozotocin (mankhwala opha mabakiteriya omwe amagwiritsidwa ntchito pochiza khansa ina).Mankhwala ena amaphatikizapo glucocorticoids, nicotinic acid, mahomoni a chithokomiro, beta-blockers, pentamidine, vaccor, alpha-interferon, komanso zinthu zopezeka mkaka wa ng'ombe (bovine serum albin peptide). Zinthu zopangidwa ndi utsi wokhala ndi mankhwala a nitroso zimatha kukhala ndi vuto.

Matenda a gestational omwe amapezeka nthawi yapakati (shuga yapakati) amaperekedwa ku gulu lapadera.

Mfundo zoyambitsa matenda a shuga

Mulimonsemo, mosasamala mtundu wa shuga ndi zomwe zimayambitsa, kusintha kwa kagayidwe kazinthu zam'mimba kumachitika m'thupi, komanso kuphwanya kagayidwe ka mafuta ndi mapuloteni, omwe amafunika kuwonekera kachipatala.

Pokhudzana ndi kufunikira kwakukulu kwa matendawa, funso limabuka chifukwa cha matenda ake oyambirirawo kuti apereke chithandizo chanthawi yake komanso njira zodzitetezera zomwe zimapangitsa kuti mavuto abuke.

Mu shuga mellitus, poyamba, kusintha kwa kagayidwe kazakudya kumawonetsedwa bwino. Chifukwa chake, kuyesa kwakukulu kwachipatala ndi ma labotale pakuwunika kwa matenda ashuga ndiko kutsimikiza kwa shuga m'magazi. Kuyeza kwa shuga kumachitika mu venous komanso m'magazi a capillary omwe amachokera ku chala.

Njira zakuzindikira za matenda ashuga zapangidwa ndi akatswiri kwanthawi yayitali. Pomwe kuchuluka kwazinthuzi, zimasinthidwa nthawi ndi nthawi ndikukonzedwa.

Kuzindikira kwamakono kwa matenda ashuga ndi kuwunika kwa glycemic kumakhazikitsidwa ndi malingaliro a WHO kuyambira 1999 ndi zowonjezera zina (kuyambira 1999 mpaka 2015).

Njira zazikulu zodziwira matenda ogwiritsira ntchito matenda a shuga zimaphatikizapo kudziwa kuchuluka kwa shuga, glycosylated (glycated) hemoglobin komanso kuyesa mayeso okhudzana ndi shuga wa pakamwa kutsimikizira matenda. Mukukonzekera kuphunzira kagayidwe kazakudya, tinatsimikiza magawo a shuga m'magazi a zotumphukira (venous) ndi magazi a capillary (kuchokera pa chala), zisonyezo za glycated hemoglobin, zomwe zimadziwika komanso zimagwiritsa ntchito shuga.

Mwazi wamagazi

Mukamayang'ana kuchuluka kwa glucose, ndikofunikira kulingalira zakusiyana kwazomwe zimakhazikika m'magazi a venous ndi capillary yonse. Izi zimatengera, mwachitsanzo, kukula kwa hematocrit. Chifukwa chake, poyang'anira wodwala mwamphamvu, ndibwino kugwiritsa ntchito ukadaulo umodzi wofufuzira.

Kusala glucose kumatanthauza kuti glucose wotsimikizika m'mawa utatha kudya osachepera maola eyiti komanso osapitilira maola khumi ndi anayi. Nthawi zambiri, shuga sayenera kupitirira 5.6 mmol / L kwa magazi a capillary komanso osakwana 6.1 mmol / L m'magazi a venous. Zomwe zapezazi ndizoposa kapena zofanana ndi 6.1 mmol / l ndipo ndizochulukirapo kapena zofanana ndi 7.0 mmol / l, motere, zimatipatsa chifukwa chakuwunikiranso komanso kuyesa kwa glucose. Kuzindikira kwa matenda a shuga, omwe adadziwika kwa nthawi yoyamba, kuyenera kutsimikiziridwa ndi kusanthula mobwerezabwereza kuti zitsimikizire kuchuluka kwa kuchuluka kwa glycemia.

Glucose pamtunda wa 5.6 - 6.1 mmol / L pamimba yopanda magazi m'matumbo athunthu ndi 6.1 - 7.0 mmol / L m'magazi a venous angasonyeze kuphwanya kwa glycemia.

Iyenera kutsimikizidwanso kuti popeza zotsatira za kusanthula zimakhudzidwa ndi zinthu zingapo (kumwa mankhwala ena, kuchuluka kwa mahomoni, mkhalidwe wamalingaliro, kapangidwe ka chakudya), shuga iyenera kutsimikizika kangapo.

Kudziwa hemoglobin wa glycated

Kuyambira 2011, Potsatira kuvomerezedwa ndi WHO, kutsimikiza mtima kwa kuchuluka kwa glycated hemoglobin (HbA1c) kwagwiritsidwa ntchito ngati umboni wotsutsa matenda a shuga.

Zabwinobwino zimawonedwa ngati ndende yopanda 6.0%. Kuphatikizika kwa HbA1c kokulirapo kapena wofanana ndi 6.5% kumawerengedwa ngati chitsulo cha matenda ashuga. Pakalibe zizindikiro zotchulidwa, mfundo imapangidwa pambuyo poyerekeza maphunziro awiri - matchulidwe awiri a hemoglobin wa glycated kapena pambuyo pa kutsimikiza kwa HbA1c ndi glucose.

Mayeso a kulolera a glucose

Chiyeso chololera pakamwa cha glucose (PHTT) chimachitika pofuna kufotokoza bwino za kupezeka kwa matenda a glycemia.

Kuyesedwa kumawoneka ngati kwabwino (chitsimikiziro cha kupezeka kwa matenda osokoneza bongo) ngati kuchuluka kwa shuga m'magawo 2 mutatha magalamu 75 a shuga mwa munthu ndi wamkulu kuposa kapena wofanana ndi 11.1 mmol / L.

Kuyesedwa kwa glucose pakamwa kumakhala ndi malamulo okhwima. Mwachitsanzo, mwa ana, kuwerengera kwa glucose ndi 1.75 gm ya glucose pa kilogalamu ya thupi ndipo osapitirira 75 magalamu. Ntchito ya adotolo ndikukhazikitsa malamulo onse panthawi yoyesedwa.

Kafukufuku Wotsogola

Pamaso pa zodandaula zogwirizana ndi kukhalapo kwa matenda ashuga, ndipo nthawi zina ngati mwangozi (mwachitsanzo, mayeso owunika) kupezeka kwa kuchuluka kwa glucose, ngati kuli kotheka, njira zozama za labotale zitha kuchitidwa pofufuza matenda ashuga. Kuyesedwa koteroko kumaphatikizapo: maphunziro a biochemical a magazi ndi mkodzo (kusanthula kwachuma kwazinthu zam'magazi, kutsimikiza kwa C-peptide ndi insulin, kuwerengetsa kwa insulin kukana, microalbuminuria), kuwunika kwa maola 24 kosalekeza (CGMS), immunological (kuwunika kwa ma antibodies m'magazi), genetic.

Kugwiritsa ntchito magazi shuga

Kunyumba, glucometer amagwiritsidwa ntchito kuwunika kuchuluka kwa glucose. Zipangizozi zimadziwika ndi kulondola lokwanira pakupanga zomwe zili m'magazi a capillary (magazi kuchokera pachala) ndikupanga zotsatira zake. Popeza kutsimikiza kwa glucose kumachitika ndi wodwala iyemwini, izi zimafunikira maluso angapo ndi njira zowunikira kuti zitsimikizire mtundu wa chosinkhanira (kuwongolera kwapamwamba pamizere yoyesera, betri). M'm zipatala ndi malo ochitira malonda akuluakulu, glycemia nthawi zambiri imayesedwa pogwiritsa ntchito biochemical kusanthula kwambiri, momwe ziyenera kuyang'aniridwa mwadongosolo, malamulo ake omwe amakhazikitsidwa ndi madongosolo a Unduna wa Zaumoyo wa Russian Federation kuti atsimikizire kuyang'anira bwino mayeso a labotale.