Matenda a shuga: momwe mungazizindikirire pa nthawi yake
Chithandizo chokhudzana ndi matenda osokoneza bongo a shuga ndi matenda a lipid metabolism amafunikira. Okalamba amadziwika ndi zomwe amadziwika kuti orthostatic hypotension, pomwe, akamasuntha kuchoka pamalo omangika kupita kumunsi, kuthamanga kwa magazi kumachepa kwambiri, chifukwa chomwe munthu amatha kulephera ndikugwa. Kupanikizika kuyenera kuyesedwa m'malo atatu: kunama, kukhala ndi kuyimirira.
Matendawa omwe amadziwika kuti ndi osalankhula am'makutu, ndikutukuka komwe kulibe zopweteka, ndi ngozi yayikulu mu shuga kwa okalamba. Mawonekedwe awo akhoza kufotokozedwa mwadzidzidzi kukulira kufooka, kufupika, thukuta.
Matenda amtima kwambiri ndi omwe amatsogolera anthu okalamba omwe ali ndi matenda ashugaChifukwa chake, ndikofunikira kuzindikira zopatuka kuzikhalidwe ndi kuchitira izi mosamala, osadikira madandaulo kuti awonekere.
Choyamba, muyenera kuyika kuti muwoneke magazi ndi ma lipid (cholesterol). Kwa odwala onse omwe ali ndi matenda a shuga, ngakhale ali ndi zaka zingati (kupatula ana aang'ono), pali lingaliro limodzi kuti akhalebe ndi kuthamanga kwa magazi a 130/85 mm Hg. Art.
Ili ndiye gawo lotchedwa chandamale chopanikizika. Zimatsimikiziridwa kuti ndi mauthengawa, zovuta zazikulu za macro- ndi microvascular sizikuyenda. Komabe, mwa odwala okalamba omwe adazolowera kuthamanga kwa magazi, kutsika kwake mofulumira mpaka pamlingo wokulirapo kungayambitse kuphwanya magazi muubongo ndi impso, zomwe zimakhala ndi zotsatirapo zoopsa.
Panjira yopita kukapanikizika, malamulo otsatirawa ayenera kusamalidwa:
- mankhwala ayenera kuyamba ndi yaying'ono Mlingo,
- Mlingo uyenera kuchuluka pang'onopang'ono komanso mosiyanasiyana.
- yeretsani kupanikizika m'malo mokhala, kunama komanso kuyimirira.
Zotsatira zake, zimatha kutenga miyezi ingapo mpaka chaka kuti zitheke kuthana ndi magazi, koma lolani. Sitikuchita changu.
Kuchepetsa kupanikizika, odwala okalamba amapatsidwa mankhwala a thiazide okodzetsa ochepa, omwe samakhudza kagayidwe kazachilengedwe. Awa ndi mankhwala monga chlortiazide, hypothiazide.
Amakhala abwino kwambiri pakukula kwachulukidwe ka kukakamira kwapaderadera kapena mtima (koma systolic), koma angayambitse kuchepa kwa potaziyamu m'magazi ndipo potero angayambitse kusokonezeka kwa miyendo. Kuphatikiza apo, kukodza pafupipafupi komanso kopatsa kumapereka zambiri zosasangalatsa. Pankhaniyi, kugwiritsa ntchito thiazide diuretics ndizochepa.
Kwa matenda amtima wamtima komanso / kapena kulowetsedwa kwam'mnyewa wamtima, opatsirana mwa beta akuwonetsedwa. Mankhwalawa sanalembedwe mitsempha yovuta ya mtima, zotumphukira zamatenda, komanso kulephera kwa mtima, mphumu.
Palinso gulu la mankhwala omwe amachepetsa kuthamanga kwa magazi, omwe amatchedwa ACE inhibitors - malinga ndi momwe amagwirira ntchito. Pamodzi ndi kutetezedwa kwa mtima, amakulolani kuti muwongolere chitukuko cha matenda ashuga, chifukwa chake amawayikira odwala omwe ali ndi vuto la impso.
Otsutsana ndi calcium, monga momwe adakwanitsira, amakulitsa kukakamizidwa, komabe samateteza ku chiopsezo chachikulu cha kufa ndi mtima, chifukwa chake sichiwonetsedwa m'gulu ili la odwala.
Zoyenera kuchita ndi cholesterol yayikulu?
Kuphatikiza pa kuthamanga kwa magazi, ndikofunikira kuyika makulidwe a lipid: magazi a cholesterol ndiofunikira kwambiri popewa zovuta zamtima.
Ngati, mutasintha mankhwalawa kwa miyezi iwiri, mawonekedwe a cholesterol yamagazi samasintha, muyenera kuphatikiza mankhwala oyenera mankhwalawo.
Ngati kuchuluka kwa triglycerides predominates, ma fiber amapatsidwa, ndipo ngati LDL cholesterols (otsika kachulukidwe lipoproteins) apamwamba kwambiri - ma statins.
Kodi muyenera kuyesetsa kuchita chiyani?
Makhalidwe azofunikira: triglycerides - osakwana 2.0 mmol / l, LDL cholesterol - osapitilira 3.0 mmol / l (ngati pali matenda a mtima, ngakhale ochepera: 2.5 mmol / l).
Tsoka ilo, kugwiritsa ntchito magulu awiriwa a mankhwalawa sikophweka monga momwe tikanakondera. Nthawi zambiri, odwala okalamba amawalekerera, koma, momwe mankhwalawa amayendera pakhungu amayenera kuwunikira momwe alili (kuyesa kwa magazi am'magazi kumafunika kamodzi pachaka).
Kuphatikiza apo, muyenera kumwa nthawi zonse, chifukwa mopanda kudya, zotsatira zotsutsana ndizotheka: cholesterol "choyipa" sichingangokhala kuchepa, komanso kukula. Mankhwalawa siotchipa ayi, koma ndi othandiza kwambiri.
Odwala ambiri amawapatsa mankhwala ochepa a aspirin kuti azitha kuthamanga magazi, omwe amachepetsa ndi zaka (chizolowezi chopanga magazi). Zochita zapadziko lonse lapansi zikuwonetsa kuti izi zitha kuchepetsa kwambiri kuchuluka kwa kuphwanya myocardial.
Adanenanso kuti, ngakhale sanatsimikizirebe, kuti asidi acetylsalicylic amatha kuchepetsa kukula kwa matenda ashuga. Ingokumbukirani kuti Asipirin samaphatikizidwa ndi kutenga zoletsa za ACE, chifukwa chake dotolo, pakuwunika zabwino ndi zowonongeka, asankha imodzi mwazomwezi.
Mukamagwiritsidwa ntchito pamodzi ndi mapiritsi ochepetsa shuga, aspirin imathandizira kukulitsa kwa hypoglycemia, chifukwa chake mufunikanso kusamala kwambiri.
Kusamalira miyendo
Musaiwale za chisamaliro cha mapazi. Odwala okalamba ali ndendende gulu la odwala omwe amalidula matumbo am'munsi chifukwa cha zovuta za shuga. Yang'anirani miyendo makamaka tsiku ndi tsiku, makamaka ngati wodwalayo akuyenda yekha. Ndikwabwino ngati izi sizichitika ndi wodwalayo, koma ndi amene amamuthandiza.
Okalamba odwala matenda a shuga nthawi zambiri amafunikira chisamaliro chakunja, komanso chisamaliro chokwanira kwambiri. Mabedi omwe ali pabedi kapena odwala ali pama wheelchair amakhala vuto lalikulu. Kugwiritsa ntchito mapilo apadera, matiresi a decubitus, ma diaper, kusintha kwa nsalu zapafupipafupi, mankhwala a pakhungu ndi mayankho amtundu wa antiseptic - zonsezi ndi njira zofunika kwambiri zochizira, ndipo siziyenera kunyalanyazidwa.
Chofunikira kwambiri kwa okalamba yemwe ali ndi matenda ashuga ndicho chisamaliro kuchokera kwa achibale. Kuzindikira kuti wina amamufuna, kukondana ndi chisamaliro ndizofunikira kwambiri pazamankhwala. Ngati palibe malingaliro abwino am'maganizo, zopambana zonse zamankhwala amakono sizikhala zopanda mphamvu polimbana ndi matendawa.
Gawani positi "Mavuto a Matenda a shuga kwa Okalamba"
Chifukwa chiyani chiwopsezo cha matenda a shuga chimakwera mukakalamba
Kuyambira wazaka 50-60, kulolera glucose kumachepetsedwa mosavomerezeka mwa anthu ambiri. Zochita izi, zikutanthauza kuti pambuyo pa zaka 50 pazaka 10 zilizonse zotsatirazi:
- kuthamanga kwa shuga kwa magazi kumawonjezeka ndi 0,055 mmol / l,
- shuga plasma ndende 2 patatha chakudya chakudya ndi 0,5 mmol / l.
Chonde dziwani kuti izi ndiwongowonetsa "pafupifupi". Mwa munthu aliyense wachikulire, kutsata kwa shuga wamagazi kumasintha mwanjira yawo. Ndipo chifukwa chake, chiopsezo chokhala ndi matenda amtundu wa 2 mwa nzika zina nzokwera kwambiri kuposa ena. Zimatengera mtundu wamakhalidwe omwe munthu wokalamba amatsogolera - pazambiri, pakulimbitsa thupi komanso thanzi.
Postprandial glycemia ndi shuga wamagazi atatha kudya. Nthawi zambiri amayesedwa maola awiri chakudya chitatha. Ichi ndi chizindikiritso chomwe chimakula kwambiri mu ukalamba, zomwe zimabweretsa kukula kwa matenda ashuga amtundu wa 2.Nthawi yomweyo, kudya glycemia sikusintha kwenikweni.
Kodi ndichifukwa chiyani kulekerera kwa shuga kumatha kusokonezeka ndi zaka? Chodabwitsachi chili ndi zifukwa zingapo zomwe zimagwira thupi nthawi imodzi. Izi zikuphatikiza:
- Kuchepetsa kokhudzana ndi zaka.
- Pancreatic insulin secretion,
- Kubisalira ndi kuchitapo kwa ma incretin mahomoni amayamba kufooka.
Kuchepetsa kokhudzana ndi zaka
Kuchepa kwa chidwi chathupi lathupi kupita ku insulin kumatchedwa insulin kukana. Amayamba achikulire ambiri. Makamaka kwa iwo onenepa kwambiri. Ngati simukutenga njira zochizira, ndiye kuti izi zitha kutsogolera matenda a shuga a 2.
Kuchulukana kwa insulin ndi chifukwa chachikulu cha matenda ashuga a 2 okalamba. Ofufuzawo akukangana kuti ngati minyewa ya insulin ikukanika ndi njira yachilengedwe yokalamba. Kapena kodi ndi chifukwa cha moyo wopanda nkhawa mukakalamba?
Pazifukwa zachuma, anthu achikulire amadya, makamaka, zakudya zotsika mtengo, zopatsa mphamvu. Chakudyachi chili ndi mafuta komanso mafakitoreya owopsa ambiri, omwe amatengeka msanga. Nthawi yomweyo, imasowa mapuloteni, michere ndi michere yambiri, yomwe imakamizidwa pang'onopang'ono.
Komanso, anthu achikulire, monga lamulo, ali ndi matenda othandizira komanso amawalandira mankhwala. Mankhwalawa nthawi zambiri amakhala ndi vuto la carbohydrate metabolism. Mankhwala owopsa kwambiri kuonjezera ngozi yanu ya matenda ashuga:
- thiazide okodzeya,
- beta blockers (osasankha),
- ma steroid
- mankhwala a psychotropic.
Matenda omwewa omwe amakukakamizani kuti mumwe mankhwalawa amalepheretsa zochita za okalamba. Amatha kukhala ma pathologies a mtima, mapapu, musculoskeletal system ndi mavuto ena. Zotsatira zake, misa yamisempha imachepetsedwa, ndipo ichi ndiye chifukwa chachikulu chowonjezera cha insulin.
Pochita izi, zikuwonekeratu kuti ngati mutasinthira kukhala ndi moyo wathanzi, chiopsezo chokhala ndi matenda ashuga a 2 mu ukalamba amachepetsedwa, ndiye kuti, pafupifupi. Momwe mungachite izi - muphunziranso zambiri m'nkhaniyi.
Pancreatic insulin secretion
Ngati munthu alibe kunenepa kwambiri, ndiye kuti vuto lalikulu la shuga m'matumbo a insulin ndilobisika. Kumbukirani kuti kwa anthu omwe ali ndi kunenepa kwambiri, kukana insulini ndizomwe zimayambitsa matenda ashuga, ngakhale kuti kapamba amapanga insulin mwachizolowezi.
Munthu akadya chakudya ndi chakudya chamagulutsi, magazi ake amadzuka. Poyankha izi, kapamba amatulutsa insulin. Pancreatic insulin secretion poyankha chakudya "yolemetsa" yamthupi limapezeka m'magawo awiri otchedwa magawo.
Gawo loyamba ndi kuteteza insulin kwambiri, komwe kumatenga mpaka mphindi 10. Gawo lachiwiri ndi kutuluka kwa insulin kulowa m'magazi, koma kumatenga nthawi yayitali, mpaka mphindi 60-120. Gawo loyamba la secretion limafunikira kuti 'lizimitse' kuchuluka kwa glucose m'magazi omwe amapezeka akangodya.
Kafukufuku akuwonetsa kuti mwa anthu okalamba popanda kulemera kwambiri thupi, gawo loyamba la insulin secretion limachepetsedwa kwambiri. Mwambiri, makamaka chifukwa cha izi, glucose okhathamira wamagazi m'magazi 2 pambuyo chakudya amakwera kwambiri, i.e., ndi 0.5 mmol / l pazaka 10 zilizonse pambuyo pa zaka 50 zakubadwa.
Asayansi apeza kuti mwa achikulire omwe ali ndi kulemera kwakanthawi, thupi la glucosinase limachepetsedwa. Mtunduwu umapereka chidwi cha maselo a pancreatic beta ku mphamvu yosangalatsa ya shuga. Kuchepa kwake kungafotokoze kuchepa kwa insulin katulutsidwe poyankha kulowa kwa shuga m'magazi.
Matenda a shuga okalamba: mitundu
Nthenda yotchedwa "shuga" imayankhulidwa pamene kuchuluka kwa shuga m'magazi kumakulitsidwa kwambiri, ndipo matendawa ndi operewera kwa munthu. Kutengera ndi zomwe zidayambitsa matenda, mitundu iwiri ya shuga imasiyanitsidwa.
- Mtundu wa shuga 1 (wodalira insulin). "Matenda a shuga" amtunduwu nthawi zambiri amapezeka ubwana kapena unyamata. Matenda a shuga amtundu 1 amadziwika ndi insulin yopanga thupi. Chifukwa chake, pofuna kulipirira kuchepa uku, kufunikira kwa ma hormone ochita kupanga ndi jakisoni ndikofunikira.
- Mtundu wa shuga wachiwiri (osadalira insulin). Ndi matenda amtunduwu, insulin nthawi zambiri imakhala yabwinobwino kapenanso imachulukanso kuposa momwe imakhalira, koma shuga amawonjezerabe kwambiri. Chithandizo cha mankhwala osokoneza bongo: mapiritsi amitundu yachiwiri ya shuga okalamba amagwiritsidwa ntchito kukhazikitsa vutoli pamodzi ndi zakudya, masewera olimbitsa thupi. Ndi njira yoyenera ndikuyang'aniridwa ndi dokotala, chithandizo cha matenda ashuga amtundu wachiwiri wokhala ndi wowerengeka azitsamba zimaperekanso zotsatira zabwino.
Kodi ndi chifukwa chiyani anthu okalamba amakhudzidwa kwambiri ndi matenda ashuga a 2?
Ndi zaka, pafupifupi anthu onse amawona kuchuluka kwa shuga m'magazi. Izi zimadziwika makamaka pakuwunika komwe kumachitika maola awiri mutatha kudya. Malinga ndi izi, mwa amuna ndi akazi achikulire ambiri, kuchuluka kwa shuga kumawonjezeka ndi 0.5 mmol / l pakatha zaka 10 zilizonse. Kuphatikiza apo, pakatha zaka zinazake, kuchuluka kwa insulin komwe kapamba amatulutsa kumatha kuchepa. Mwa anthu ena, izi zimatchulidwa kwambiri, mwa ena - mwayi wokhala ndi matendawa umatsika kwambiri. Zonse zimatengera chibadwa, kulemera kwa thupi, moyo, thanzi lathunthu.
Chithunzi cha kuchipatala
Vuto lalikulu la matenda ashuga a mtundu wa okalamba kwa anthu okalamba ndikuti matendawo nthawi zambiri amatuluka. Zizindikiro zachikhalidwe, monga ludzu lalikulu, kuchepa thupi, kukodza pokoka, sikuvutitsa odwala. Nthawi zambiri, amadandaula za mavuto a kukumbukira, kutopa, kuchepa kwa chitetezo chamthupi. Komabe, izi ndi zizindikiro za matenda ena ambiri, omwe zotsatira zake zimapangitsa kwambiri kuzindikira kwa matenda ashuga.
Mavuto a shuga okalamba
Nthawi zambiri, kudziwika kwa mtundu wachiwiri wa shuga mwa anthu okalamba kumatheka pokhapokha atayamba zovuta zamtundu uliwonse. Nthawi zambiri, tikulankhula zam'mapazi zotupa zam'munsi komanso matenda a mtima. Komanso chidziwitso chofala chokhudzana ndi matenda a shuga a 2 ndi retinopathy ndi mitundu yonse ya neuropathies. Retinopathy ndimavuto am'maso am'maso. Mu matenda ashuga, kumvetsetsa kwamaso kuyenera kuyang'aniridwa. 
Matenda a shuga a polyneuropathy ndi matenda angapo amanjenje ndipo amodzi mwa zovuta kwambiri. Nthawi zambiri imayamba zaka 10-15 atapezeka matenda ashuga, koma pakhala pali zovuta pakapita zaka 5-6.
Zisonyezo za ma labotale
Ngati munthu wokalamba akuganiziridwa kuti ali ndi matenda a shuga, wina ayenera kukumbukira kuti nthawi zambiri palibe kuwonjezeka kwa kusala kwa glucose wamagazi mukamawunikira. Ichi sichiri chifukwa chotsutsira matendawa. Zikatero, kuyesedwa kowonjezereka kuyenera kudziwa kuchuluka kwa glucose 2 maola atatha kusaka.
Komanso, kupezeka kwa matenda a shuga a mtundu wachikazi mwa okalamba sikuyenera kutengera kudziwa kuchuluka kwa shuga mkodzo. M'mibadwo yakale, gawo la glucose nthawi zambiri limachulukitsidwa ndipo limafikira 13 mmol / L, pomwe mwa achinyamata limatsika kwambiri - 10 mmol / L. Izi zikutanthauza kuti ngakhale vutoli likuipiraipira mwa okalamba, glycosuria singaoneke.
Malingaliro am'maganizo ndi chikhalidwe cha matendawa
Kulipira anthu okalamba omwe ali ndi matenda okalamba nthawi zambiri kumafuna njira zina. Zilibe monga zikhalidwe za thupi, komanso kukhazikika kwa machitidwe a malingaliro. Kufooka kwa kukumbukira ndi ntchito zazidziwitso nthawi zambiri kumayambitsa kukhumudwa kwa okalamba. Vutoli likukulirakulira chifukwa cha umphawi wakuthupi komanso kusayankhulana. Ichi ndichifukwa chake chithandizo cha matenda a shuga 2 kwa anthu okalamba ziyenera kukhala zokwanira ndikuganizira mbali zonse za zosowa za anthu.
Zoyambitsa matenda ashuga okalamba: ndani ali pachiwopsezo?
Masiku ano, madokotala amalankhula zazinthu zingapo zomwe zimayambitsa chitukuko cha matenda a shuga 2:
- Mitundu Mwa anthu omwe achibale awo akudwala matendawa, mwayi wodwala umawonjezeka kangapo.
- Kunenepa kwambiri Kuwonjezeka kwakukulu kwa kulemera kwa thupi sikuti kumangotitsogolera pakukula kwa matendawa, komanso kumapangitsa zovuta zake. Mutha kusintha zinthu pokhapokha ngati muchepa thupi.
- Mkhalidwe wa kapamba. Ngati munthu nthawi zambiri amakhala ndi kapamba kapena ali ndi mbiri ya khansa ya kapamba, ali pachiwopsezo chotenga "matenda a shuga" muukalamba.
- Matenda a virus. Matenda opatsirana monga chikuku, rubella, mumps, ndi chimfine chokha sizingayambitse matenda ashuga. Komabe, amakhala ngati chothandizira chomwe chimayambitsa kuyambika kwa matendawa, ngati chinali choyambirira.
- M'badwo. Pomatha chaka chilichonse, mwayi wodwala matenda a shuga ukuwonjezeka.
- Kupsinjika Zovuta zamphamvu, monga matenda a virus, nthawi zambiri zimathandizira kukula kwa matenda ashuga a mtundu 2. Pazifukwa izi, matendawa nthawi zambiri amapezeka kuti amwalira wokondedwa kapena vuto lina.
- Khalidwe labwino. Madotolo adazindikira kuti ndi kuchuluka kwa kutukuka kwa mizinda, kuchuluka kwa odwala matenda a shuga kwawonjezeka kwambiri. Choyamba, asayansi amati izi zimapangitsa chitukuko, kusinthasintha kwa moyo, kupangitsa kwa luntha kuchita zolimbitsa thupi.
Mungamvetse bwanji kuti ndili ndi matenda ashuga? Zizindikiro ndi okalamba
Ngakhale kuti matenda ashuga amtundu wa 2 amapezeka mwa oyimira mibadwo yakale popanda chizindikiro, ndikofunikira kudziwa bwino lomwe zomwe zikuphatikizana:
- ludzu lamphamvu lomwe silimatha ngakhale mutamwa madzi,
- kutopa,
- polaciuria (kukodza mwachangu, nthawi zambiri kuphatikiza ndi kutulutsira mkodzo wambiri),
- kuchepa thupi kosasinthika, komwe nthawi zambiri kumayendetsedwa ndi chidwi;
- kuchiritsa kovuta kwa mabala, zikanga ndi kuwonongeka kwina pakhungu.
- kuwonongeka kwamawonekedwe.
Kukhalapo kwa chimodzi mwazizindikiro zomwe zalembedwa ndi nthawi yolankhula ndi dokotala nthawi yomweyo.
Njira zakuzindikira za matenda a shuga a 2 omwe akuwakayikira
Pozindikira matenda ashuga, madokotala amakono amatsogozedwa ndi malamulo ozindikira omwe adatengedwa ndi WHO kumbuyo mu 1999. Malinga ndi iwo, njira zamankhwala zodziwonera ndizo:
- kuchuluka kwa shuga wam'madzi m'mapulogalamu am'mimba yopanda kanthu kumakhala kwakukulu kuposa 7.0 mmol / l,
- shuga wamagazi a capillary ndi wamkulu kuposa 6, 1 mmol / l (kusanthula kumachitika pamimba yopanda kanthu),
- kuchuluka kwa shuga pambuyo pa maola awiri mutadya
Pazindikiritsi womaliza, kutsimikiziridwa kawiri kwa zomwe zikufotokozedwa ndikofunikira.
Palinso zomwe amadziwika kuti ndi malire. Chifukwa chake, ngati munthu akusala kudya magazi ndi 6.1 - 6.9 mmol / L, ndiye kuti mfundoyi imatchedwa hyperglycemia. Kuphatikiza apo, pali matenda omwe amadziwika kuti "kulolera glucose". Amayikidwamo ngati maola awiri mutatha kudya (kapena kudya shuga) kuchuluka kwa shuga m'magazi ndi 7.8 - 11.1 mmol / L.
Funso lapadera lokonzedwa ndi American Diabetes Association limagwiritsidwanso ntchito kuwunika kuopsa kwa matenda ashuga. Momwemo, anthu amafunsidwa kuti atsimikizire kapena kutsutsa mfundo zotsatirazi:
- Ndinkakhala ndi mwana yemwe kulemera kwake kupitilira 4.5 kg.
- Ndili ndi mchimwene wanga yemwe amapezeka ndi matenda ashuga a 2.
- M'modzi mwa makolo anga ali ndi matenda ashuga a 2.
- Kulemera kwanga sikwachilendo.
- Kwa ine, moyo wopanda ntchito.
- Ndili ndi zaka 45-65.
- Ndili ndi zaka zopitilira 65.
Ngati mwayankha mogwirizana ndi mafunso atatu oyamba, dziwerengereni mfundo imodzi pa lililonse. Yankho labwino la funso 4-6 likuwonjezera ma point 5, ndipo kwa a 7 - monga momwe 9 alili. Chiwopsezo chowonjezeka cha matenda a shuga chilipo pamene kuchuluka kwazinthu kumaposa 10, odziletsa - lintlha 4-9, otsika - 0-3 mfundo.
Anthu omwe ali pachiwopsezo amalimbikitsidwa kusamala kwambiri zaumoyo wawo. Kuti muwone kuchuluka kwa shuga, sayenera kungoyesa pamimba yopanda kanthu, komanso onetsetsani kuti mwayang'ana chizindikiro chikatha kudya. Kuphatikiza apo, mndandanda wa mayeso ofunikira umaphatikizanso kudziwa kuchuluka kwa kulolera kwa glucose, hemoglobin wa glycated ndi glucosuria.
Njira zochizira matenda amitundu iwiri okalamba
Chithandizo cha odwala matenda amtundu wa 2 okalamba nthawi zambiri chimakhala chovuta chifukwa cha kuchuluka kwa matenda opatsirana. Pachifukwa ichi, gulu ili la odwala limasowa njira imodzi posankha njira zamankhwala. Masiku ano, mankhwala ovomerezeka amapereka njira zingapo zochizira matenda a shuga 2:
- kugwiritsa ntchito mankhwala ngati mapiritsi,
- mankhwala a jakisoni a insulin,
- mankhwala ndi zakudya zapadera komanso kuchita masewera olimbitsa thupi osagwiritsa ntchito mankhwala.
Kusankhidwa kwa njira imodzi kapena chimodzi kumadalira zinthu zambiri: kukhala ndi moyo, kukhalapo kwa chizolowezi cha hypoglycemia, kupezeka kwa mtima ndi mtima. Mulimonsemo, mankhwalawa amathandizidwa ndi adokotala okha. Komanso, ngati vuto la wodwalayo likuipiraipira, katswiriyo amatha kusintha njira zamankhwala kapena kuphatikiza zosankha zosiyanasiyana.
Monga lamulo, mankhwalawa a matenda a shuga a 2 amaphatikizidwa ndi kuchuluka kwa mankhwalawa. Kwa okalamba ambiri, zovuta zimatha kukumbukira mitundu yosiyanasiyana ya mankhwala ndikugwiritsa ntchito pafupipafupi. Ngati magwiridwe antchito a malingaliro samakuthandizanso kuti muzidziyang'anira nokha, muyenera kuthandizidwa ndi abale kapena akatswiri othandiza.
Chinanso chomwe chimapangitsa kuti matenda ashuga a mtunduwu akhale nawo mbadwo wakale ndi kuchuluka kwa anthu amtunduwu. Ichi ndichifukwa chake kutsika kwa mishuga kumayenera kuchitika pang'onopang'ono, popanda kusinthasintha kwakuthwa. Nthawi zambiri, kukhazikika kwa zizindikiro kumawonedwa pakangotha miyezi ingapo chichitikireni chithandizo.
Lemberani mankhwala a shuga a 2 okalamba
Masiku ano, mankhwalawa odwala achikulire a mitundu iwiri amagwiritsidwa ntchito.
- Metformin. Mankhwalawa amalimbikitsa chiwopsezo cha maselo a mthupi kupita ku insulin ndipo potero amathandizira shuga. Amagwiritsidwa ntchito kwambiri pochiza matenda a shuga 2 okalamba. Chofunikira kuti a Metformin akhazikitsidwe ndi kusowa kwa matenda omwe amaperekedwa ndi hypoxia kapena kuchepa kwa kusefedwa kwa impso. Nthawi zambiri, mankhwalawa amalekeredwa bwino. Mwa zina zoyipa, ndikuyenera kuwunikira chisangalalo ndi matenda otsegula m'mimba, omwe nthawi zambiri amawonedwa m'masabata oyambilira ovomerezedwa, kenako nkuwonongeka popanda kufufuza. Kuphatikiza pa kuchuluka kwa shuga, Metformin imathandizira kuchepetsa kunenepa. M'mafakisi, amathanso kupezeka pansi pa dzina la malonda la Siofor ndi Glyukofazh.
- Glitazones (thiazolidinediones). Awa ndi mankhwala atsopano omwe ali ndi mfundo zofanana ndi Metformin. Haimakulitsa katulutsidwe ka insulini ndipo sikufafaniza kapamba, koma nthawi yomweyo imathandizira kukula kwamisempha. Zoyipa za glitazone zimaphatikizapo zovuta zambiri zoyipa. Mankhwala amatha kupangitsa kuti munthu azitupa komanso azikhala wonenepa. Sitikulimbikitsidwa kuti mutenge zovuta ndi mtima kapena impso, komanso mafupa. Popeza anthu okalamba nthawi zambiri amadwala matenda otere, ma glitazones amalembedwa kawirikawiri.
- Zothandiza kuchokera ku sulfonylureas. Kukonzekera kwa gululi tsopano kwawoneka kuti kwatha. Zochita zawo zimayang'aniridwa ndi kapamba, yemwe motsogozedwa ndi iwo amayamba kupanga insulini m'njira yopitilira muyeso. Poyamba, izi zimapereka zotsatira zabwino, koma pakapita nthawi, chiwalocho chimachepa ndikuleka kugwira ntchito zake mwachindunji. Kuphatikiza apo, zotumphukira za sulfonylurea zimadzetsa kulemera ndipo zimakulitsa chiwopsezo cha hypoglycemia. Kugwiritsa ntchito mankhwalawa pochiza anthu achikulire omwe ali ndi matenda a shuga a 2 ndikosayenera.
- Meglitinides. Mfundo zake zimawathandiza kukhala ndi mwayi wofanana ndi wochokera ku sulfonylurea. Meglitinides imatha kuchepetsa msanga shuga wokwera chifukwa cha zakudya zina. Komabe, ndikamadya, kufunikira kwa mankhwalawa kumatha.
- Ma giliki. Amakhala m'gulu laomwe timadzi timene timatchedwa ma insretin. Ntchito yawo yayikulu ndikuphwanya glucagon ndikuwalimbikitsa kupanga insulin. Kusiyanitsa pakati pa meglitinides ndi sulfonylurea zotumphukira ndi ma glisitins ndikuti zomaliza zimangokhala ndi kuchuluka kwa shuga. Adziyambitsa okha chida chodalirika pothandiza matenda ashuga mwa anthu amisinkhu yosiyanasiyana. Mwa zabwino zazikulu za ma gliptins: samathetsa kapamba, samayambitsa kuthothoka kwamisempha, musakhudze kulemera kwamunthu. Kuphatikiza apo, amaphatikizidwa bwino ndi mankhwala ena, mwachitsanzo, ndi Metformin.
- Zamatsenga. Ili ndi gulu la mankhwala omwe amakhala ngati glyptins. Komabe, kusiyana ndikuti amawonetsedwa ngati makapisozi ogwiritsira ntchito pakamwa, osati majekiseni. Mimetics adatsimikizira okha momwe amathandizira okalamba. Amakhala othandiza makamaka mu kunenepa kwambiri kuchipatala kuphatikiza ukalamba.
- Acarbose. M'mafakitala, mankhwala omwewo atha kupezekanso pansi pa dzina la Glucobay. Chachilendo cha mankhwalawa ndikuti amasokoneza mayamwidwe azopaka. Komabe, madotolo ambiri amati mwanjira imodzimodziyo, ndikokwanira kutsatira zakudya zamafuta ochepa.
Kodi insulin ikufunika liti?
Mwachikhalidwe, insulini imagwiritsidwa ntchito pochiza odwala omwe ali ndi matenda a shuga a 2. Komabe, nthawi zina, kugwiritsidwa ntchito kwake kumakhala koyenera. Izi makamaka ndizochitika pomwe mankhwala ochepetsa shuga ndi njira zina zamankhwala samaloleza kuti magazi achepe. Pankhaniyi, jakisoni wa insulin akhoza kuphatikizidwa ndi kumwa mapiritsi kapena kuwagwiritsa ntchito pawokha. Njira zotsatirazi zamankhwala ndizodziwika masiku ano:
- Jekeseni wa insulin kawiri patsiku (m'mawa pamimba yopanda kanthu komanso musanagone).
- Jakisoni imodzi ya insulin ngati shuga ili pamimba yopanda kanthu imaposa zokhazo. Kubaya kuyenera kuchitidwa usiku. Pankhaniyi, ndikofunikira kugwiritsa ntchito insulin yopanda chopanda nthawi yayitali, yomwe imadziwika bwino kuti "tsiku ndi tsiku", kapena "insulin" yapakati.
- Zingwe zomwe zimagwiritsa ntchito kuphatikiza insulin: 30% "yochita mwachidule" ndi 50% "akuchita pang'ono". Jakisoni amachitika kawiri patsiku: m'mawa ndi madzulo.
- Chikhazikitso cha maziko a insulin.Zimatanthawuza kusintha kwina kwa insulin yocheperako musanadye komanso kungokhala pakati kapena insulin yayitali nthawi yogona.
Zolimbitsa thupi kwa okalamba omwe ali ndi matenda ashuga a 2
Zolimbitsa thupi pakuzindikiritsa izi zimagwira ntchito yofunika kwambiri:
- otsika insulin kukana,
- kumawonjezera mphamvu
- amathandiza kupewa atherosulinosis,
- kulimbana ndi kuthinitsidwa kwambiri.
Kuphatikiza apo, masewera amathandizira kuchepetsa thupi, zomwe ndizofunikira kwa odwala matenda ashuga ambiri. Mukakalamba, pulogalamu yolimbitsa thupi imasankhidwa mosiyanasiyana payekha komanso pokhapokha mukaonana ndi dokotala. Zokumana nazo zawonetsa kuti kuyenda panja ndikothandiza kwambiri.
Ngakhale mapindu osaneneka a kusewera masewera, nthawi zina akhoza kukhala otsutsana. Izi ndi izi:
- ketoacidosis
- matenda ashuga osawerengeka,
- retinopathy mu gawo la kuchuluka,
- kulephera kwambiri kwa aimpso ndi njira yovuta,
- angina mu mawonekedwe osakhazikika.
Matenda a shuga ndi matenda owopsa omwe, ngati sanapatsidwe, angayambitse mavuto ena. Matendawa ndi ovuta makamaka kwa anthu okalamba. Ndiye chifukwa chake, patatha zaka 50, madokotala amalimbikitsa prophylactically kuyang'ana kuchuluka kwa glucose, ndipo ngati pali zizindikiro zowopsa, funsani dokotala nthawi yomweyo. Kuzindikira kwa matendawa pa nthawi yake komanso chithandizo chokwanira chamankhwala chitha kutsimikizira kukhala ndi moyo wabwino kwazaka zambiri.
Kodi kubisala ndi zochita za ma impretins zimasintha bwanji mwa okalamba
Kuchulukitsa ndi mahomoni omwe amapangidwa m'mimba m'mimba chifukwa cha chakudya. Amathandizanso kupanga insulin ndi kapamba. Kumbukirani kuti chachikulu chodzetsa chinsinsi cha insulin chiri ndi kuchuluka kwa shuga m'magazi.
Kuchita kwa ma impretins kunayamba kuphunziridwa mozama kokha kumayambiriro kwa zaka za zana la makumi awiri ndi limodzi. Zinapezeka kuti nthawi zambiri, akamamwa pakamwa (pakamwa), mafuta a insulini amapangidwa pafupifupi kawiri kuposa momwe amachitidwira kukonzekera kwa kufanana kwa shuga.
Asayansi amati pakudya komanso pambuyo pudya, zinthu zina (mahomoni) zimapangidwa m'mimba zomwe zimapangitsanso ziphuphu kuti zipange insulini. Ma hormone amenewa amatchedwa maretretins. Kapangidwe kawo ndi kapangidwe kake ka zinthu zimamveka bwino.
Ma insretins ndi mahomoni okhala ndi glucagon-ngati peptide-1 (GLP-1) ndi insulinotropic polypeptide (HIP) ya glucose. Zinapezeka kuti GLP-1 imakhudza kwambiri kapamba. Zimangowonjezera kubisika kwa insulin, komanso zimalepheretsa kupanga glucagon, "wotsutsana naye" wa insulin.
Kafukufuku awonetsa kuti mwa okalamba, kupanga mahomoni GLP-1 ndi GUI kumakhalabe pamlingo wofanana ndi wa ang'ono. Koma mphamvu ya ma cell a pancreatic beta ku zochitika za ma insretin amachepetsa ndi zaka. Iyi ndi imodzi mwamakina a shuga, koma osafunikira kuposa kukana insulini.
Anthu athanzi amalangizidwa pambuyo pa 45 kuti ayesedwe matenda a shuga kamodzi pazaka zitatu. Dziwani ndi ziti. Chonde dziwani kuti kuyesa kwa shuga m'magazi sikoyenera kuyezetsa matenda a shuga. Chifukwa mwa odwala ambiri omwe ali ndi matenda ashuga, kusala kudya shuga m'magazi kumakhalabe kwachilendo. Chifukwa chake, tikulimbikitsa kuyeserera magazi.
Kuti mumvetse za matenda a shuga, werengani kaye za nkhaniyi. Ndipo apa tikambirana zomwe zidzachitike pakukhudzidwa kwa matenda ashuga okalamba.
Kuzindikira mtundu wachiwiri wa matenda ashuga okalamba ndi kovuta chifukwa matendawa nthawi zambiri amapezeka popanda chizindikiro. Wodwala wachikulire sangakhale ndi madandaulo a shuga, ludzu, kuwonda, komanso kukodza pafupipafupi.
Ndizodziwika kwambiri kuti okalamba odwala matenda ashuga samakonda kudandaula za ludzu.Izi ndichifukwa choti pakati pomwe pakumva ludzu laubongo kunayamba kugwira ntchito kwambiri chifukwa cha zovuta ndi zotengera. Okalamba ambiri amakhala ndi ludzu lofooka ndipo chifukwa cha izi, samabweza madzi mokwanira m'thupi. Chifukwa chake, amapezeka ndi matenda ashuga akafika kuchipatala ali ndi vuto lothodomola chifukwa cha kuchepa mphamvu kwa madzi m'thupi.
Odwala okalamba, osakhala achindunji, koma madandaulo ambiri amakhala ambiri - kufooka, kutopa, chizungulire, mavuto amakumbukiro. Achibale angadziwe kuti demilea ya demokalase ikupita. Pozindikira zotere, dokotalayo nthawi zambiri samazindikira kuti munthu wokalamba akhoza kukhala ndi matenda a shuga. Chifukwa chake, wodwalayo samalandira chithandizo chake, ndipo zovuta zimapita.
Nthawi zambiri, odwala matenda ashuga amapezeka mwangozi kapena atha kale, munthu akapimidwa amafufuza mwamphamvu. Chifukwa chakuperewera kwa matenda ashuga okalamba, odwala opitilira 50% omwe ali ndi vutoli amakhala ndi mavuto akulu: mavuto amtima, miyendo, mawonekedwe amso komanso impso.
Mwa anthu okalamba, cholowa chaimpso chimakwera. Tiyeni tiwone kuti ndi chiyani. Mwa achichepere, shuga amapezeka mu mkodzo pomwe kuchuluka kwake m'magazi kuli pafupifupi 10 mmol / L. Pambuyo pa zaka 65-70, "cholumikizira impso" chimasinthira ku 12-13 mmol / L. Izi zikutanthauza kuti ngakhale ndi chindapusa chochepa kwambiri cha matenda ashuga mwa okalamba, shuga samalowetsa mkodzo, ndipo pali mwayi wochepa woti adzapezeka ndi nthawi.
Hypoglycemia okalamba - zoopsa ndi zotsatirapo zake
Kuwonetsedwa kwa hypoglycemia mwa okalamba odwala matenda ashuga amasiyana ndi "mawonekedwe" apamwamba omwe amawonekera mwa achinyamata. Zambiri za hypoglycemia mwa okalamba:
- Zizindikiro zake zimachotsedwa ndipo sinafotokozedwe bwino. Hypoglycemia mwa odwala okalamba nthawi zambiri "imatchinjika" ngati chiwonetsero cha matenda ena, motero, sichidziwika.
- Mu okalamba, kupanga mahomoni adrenaline ndi cortisol nthawi zambiri kumavuta. Chifukwa chake, zizindikiro zowoneka bwino za hypoglycemia zitha kupezeka: palpitations, kunjenjemera, ndi thukuta. Kufooka, kugona, chisokonezo, amnesia abwera.
- Mthupi la okalamba, njira zopewera dziko la hypoglycemia ndizoperewera, i.e., makina olimbana nawo sagwira ntchito bwino. Chifukwa cha izi, hypoglycemia imatha kukhala ndi gawo lotuluka.
Chifukwa chiyani hypoglycemia mu ukalamba ndiowopsa? Chifukwa zimayambitsa zovuta zamtima zomwe odwala matenda ashuga okalamba amalekerera makamaka. Hypoglycemia imachulukitsa mwayi woti ungafe ndi matenda a mtima, sitiroko, kulephera kwa mtima, kapena kutsekeka kwa chotengera chachikulu ndi magazi.
Ngati wodwala matenda ashuga okalamba ali ndi mwayi wokwanira kudzuka ali ndi moyo pambuyo pa hypoglycemia, ndiye kuti akhoza kukhalabe wolumala chifukwa chakuwonongeka kwa ubongo kosasinthika. Izi zimatha kuchitika ndi matenda ashuga akadali achichepere, koma kwa anthu okalamba mwayi wazotsatira zoyipa ndizofunikira kwambiri.
Ngati wodwala wachikulire wodwala matenda ashuga ali ndi hypoglycemia pafupipafupi komanso mosakonzekera, ndiye kuti izi zimabweretsa, zomwe zimatsatiridwa ndi kuvulala. Kugwa ndi hypoglycemia ndizomwe zimapangitsa kuti mafupa aphulike, kusunthika kwamalumikizidwe, kuwonongeka kwa minofu yofewa. Hypoglycemia mu kukalamba kumawonjezera chiopsezo cha kukhumudwa kwa m'chiuno.
Hypoglycemia mu odwala matenda ashuga okalamba nthawi zambiri amapezeka chifukwa chakuti wodwalayo amatenga mankhwala osiyanasiyana osiyanasiyana, ndipo amalumikizana. Mankhwala ena atha kuwonjezera zotsatira za mapiritsi a shuga, zotumphukira za sulfonylurea. Ena - amalimbikitsa kubisika kwa insulini kapena kuwonjezera mphamvu ya maselo pakuchitapo kanthu.
Mankhwala ena amatseketsa thupi kuzindikira kwa zizindikiro za hypoglycemia ngati mbali imodzi, ndipo wodwala akulephera kuyimitsa nthawi. Kulingalira zilizonse zomwe zingachitike ndi mankhwala kwa odwala okalamba omwe ali ndi matenda ashuga ndi ntchito yovuta kwa dokotala.
Tebulo likuwonetsa zina mwazomwe zimachitika ndi mankhwala omwe nthawi zambiri amapangitsa hypoglycemia:
| Kukonzekera | Limagwirira a hypoglycemia |
|---|---|
| Aspirin, mankhwala ena osapweteka a antiidal | Kulimbikitsa machitidwe a sulfonylureas powachotsa pakulumikizana ndi albin. Kuchulukitsa kwa zotumphukira za minofu |
| Allopurinol | Impso sulfonylurea kuchotsa |
| Warfarin | Kuchepetsa kwa mankhwala a sulfonylurea ndi chiwindi. Kutalikirana kwa sulfonylurea kuchokera kumagwirizana ndi albumin |
| Beta blockers | Blockade wa kumverera kwa hypoglycemia mpaka odwala matenda ashuga |
| ACE inhibitors, angiotensin-II receptor blockers | Kuchepa kwa zotumphukira minofu insulin kukana. Kuchulukana kwa insulin |
| Mowa | Kuletsa kwa shuga (glucone) |
Munthu wodwala matenda ashuga amatha kusungabe magazi ake pafupipafupi, sipamakhala zovuta zina komanso kumva bwino. Koma vuto ndi loti kuchuluka kwa shuga m'magazi kumatha kulamulidwa mothandizidwa ndi “chizolowezi” cha matenda ashuga, nthawi zambiri hypoglycemia imachitika. Ndipo kwa odwala okalamba, ndizowopsa.
Umu ndi momwe zinthu ziwirizi sizabwino. Kodi pali njira ina yabwino? Inde, pali njira yomwe imakulolani kuti muchepetse shuga la magazi komanso nthawi yomweyo ndikukhalabe ndi hypoglycemia. Njira iyi - kudya makamaka mapuloteni komanso mafuta achilengedwe othandiza pamtima.
Zakudya zamafuta zochepa zomwe mumadya, zimachepetsa kufunika kwa mapiritsi a insulin kapena shuga kuti muchepetse shuga. Ndipo, motere, ndiye kuti simungathe kuchita hypoglycemia. Chakudya, chomwe chimakhala ndi mapuloteni, mafuta achilengedwe achilengedwe komanso CHIKWANGWANI, chimathandiza kuti shuga wamagazi azikhala pafupi ndi nthawi yochepa.
Odwala ambiri omwe ali ndi matenda ashuga a 2, kuphatikiza okalamba, atasinthira ku chakudya chochepa chamafuta amatha kusiyiratu mapiritsi a insulin ndi shuga. Pambuyo pa izi, hypoglycemia sichingachitike konse. Ngakhale ngati simungathe kulumpha kuchokera ku insulin, ndiye kuti kufunika kwake kumachepa kwambiri. Ndipo kupatula insulin ndi mapiritsi omwe mumapeza, kumachepetsa mwayi wa hypoglycemia.
Maphikidwe a chakudya chamafuta ochepa a mtundu 1 ndi matenda ashuga 2
Chithandizo cha matenda amtundu wa 2 okalamba
Kuthandiza odwala achikulire a mtundu wachiwiri a shuga nthawi zambiri kumakhala kovuta kwambiri kwa dokotala. Chifukwa nthawi zambiri imakhala yovuta chifukwa cha kuchuluka kwa matenda opatsirana mwa anthu odwala matenda ashuga, chikhalidwe cha anthu (kusungulumwa, umphawi, kusowa thandizo), kuphunzira odwala osawerengeka, komanso chifukwa cha kuchepa kwa maganizo.
Dokotala nthawi zambiri amayenera kupereka mankhwala ambiri kwa odwala okalamba omwe ali ndi matenda ashuga. Zitha kukhala zovuta kuganizira momwe amathandizirana wina ndi mnzake. Anthu okalamba odwala matenda ashuga nthawi zambiri amawonetsa kuti amatsata chithandizo chochepa, ndipo amangosiya kumwa mankhwalawa ndikuwathandiza.
Ambiri mwa odwala okalamba odwala matenda ashuga amakhala m'malo ovuta. Chifukwa cha izi, nthawi zambiri amakhala ndi vuto la kugona kapena kukhumudwa kwambiri. Odwala omwe ali ndi matenda ashuga, kukhumudwa kumabweretsa kuti amaphwanya njira zamankhwala ndikuwongolera shuga lawo bwino.
Zolinga za chithandizo cha matenda ashuga kwa aliyense okalamba ziyenera kukhazikitsidwa. Zimatengera:
- chiyembekezo chamoyo
- amakonda kwambiri hypoglycemia,
- kodi pali matenda amtundu uliwonse wamtima
- ali ndi zovuta za shuga zomwe zidayamba kale
- momwe mkhalidwe wamaganizidwe a wodwala umaloleza kuchita zomwe dokotala amafunikira
Ndi chiyembekezo choyembekezeka cha moyo (chiyembekezo chamoyo) cha zaka zoposa 10-15, cholinga chothandizira matenda a shuga pakukalamba chizikhala kukwaniritsa glycated hemoglobin HbA1C, sitipangira kumwa mapiritsi olimbikitsira insulin katulutsidwe! zitaye! ),
Mwayi wothandizira bwino matenda a shuga wawonjezereka kuyambira theka lachiwiri la 2000s, ndikubwera kwa mankhwala atsopano kuchokera ku gulu la incretin. Izi ndizoletsa za dipeptidyl peptidase-4 (gliptins), komanso mimetics ndi analogues a GLP-1. Tikukulangizani kuti muphunzire mosamala zambiri zokhudzana ndi mankhwalawa patsamba lathu.
Timalimbikitsa kuti odwala okalamba asinthire, kuwonjezera pazithandizo zina zonse. Zakudya zopatsa mphamvu zopatsa mphamvu zimaphatikizidwa m'thupi kwambiri. Muzochitika zina zonse, zimathandiza kuti shuga akhale ndi magazi pafupipafupi, kupewa "kulumpha" kwake ndikuchepetsa mwayi wa hypoglycemia.
Zochita zolimbitsa thupi kwa okalamba odwala matenda ashuga
Kuchita masewera olimbitsa thupi ndi gawo lofunikira pothandizira pa matenda ashuga. Kwa wodwala aliyense, makamaka okalamba, zolimbitsa thupi zimasankhidwa payekhapayekha, poganizira matenda opatsirana. Koma ayenera kufunikira. Mutha kuyamba ndi kuyenda kwa mphindi 30-60.
Chifukwa chiyani zolimbitsa thupi kumathandiza kwambiri matenda ashuga:
- zimawonjezera kukhudzika kwa zimakhala kuti insulin, i.e., imachepetsa kukana kwa insulin,
- maphunziro olimbitsa thupi amaletsa kukula kwa atherosulinosis,
- zolimbitsa thupi kumachepetsa magazi.
Nkhani yabwino ndiyakuti odwala matenda ashuga okalamba amakonda kwambiri kuchita masewera olimbitsa thupi kuposa achichepere.
Mutha kusankha nokha zolimbitsa thupi zomwe zingakusangalatseni. Tikupangira chidwi chanu.
Ili ndi buku labwino kwambiri pankhani ya maphunziro ophunzitsira zaumoyo komanso moyo wokalamba wachikulire. Chonde gwiritsani ntchito zomuyimira motengera momwe muliri. Dziwani zambiri popewa kuchita masewera olimbitsa thupi.
Kuchita masewera olimbitsa thupi a shuga amatsutsana zotsatirazi:
- ndikulipirira odwala matenda ashuga,
- mu ketoacidosis,
- ndiina wosakhazikika,
- ngati muli ndi retinopathy yowonjezereka,
- woopsa matenda aimpso kulephera.
Mankhwala a shuga a Odwala Okalamba
Pansipa muphunzira za mankhwala a shuga komanso momwe amathandizira odwala okalamba. Ngati muli ndi matenda a shuga a 2, tikulimbikitsani kuchita izi:
- Pofuna kuti muchepetse shuga komanso magazi kuti akhale pafupi ndi masiku onse, yesani kaye.
- Komanso, samalani mphamvu zanu komanso zosangalatsa zanu. Tangokambirana funso pamwambapa.
- Pafupifupi 70% ya odwala omwe ali ndi matenda a shuga a 2 amakhala ndi chakudya chokwanira chokhala ndi zopatsa mphamvu komanso amachita masewera olimbitsa thupi kuti akhale ndi shuga. Ngati izi sizikukwanira, yesetsani kuti muwone ngati impso yanu ikuyendera ndi kukaonana ndi dokotala ngati mungathe kutumizidwa. Osatengera Siofor popanda kuvomerezedwa ndi dokotala! Ngati impso sizigwira ntchito bwino, mankhwalawa amapha.
- Ngati muyamba kumwa metformin - osayimitsa kudya zakudya zamagulu ochepa komanso kuchita masewera olimbitsa thupi.
- Mulimonsemo, kanizani kumwa mankhwala omwe amachititsa kuti insulin itulutsidwe! Awa ndi sulfonylurea zotumphukira ndi meglitinides (dongo). Zili zovulaza. Kupanga jakisoni wa insulin ndikwabwino kuposa kumwa mapiritsi awa.
- Samalani mwapadera ndi mankhwala atsopano kuchokera ku gulu la incretin.
- Omasuka kusinthira ku insulin ngati pakufunikira izi, i.e. chakudya chamagulu ochepa, kuchita masewera olimbitsa thupi komanso mankhwala kuti mupeze shuga wanu sikokwanira.
- Werengani "".
Metformin - mankhwala a matenda a shuga a 2 pakukalamba
Metformin (wogulitsidwa pansi pa mayina a Siofor, glucophage) ndi mankhwala oyamba kwa odwala matenda ashuga okalamba. Amasankhidwa ngati wodwala wateteza kutsegula kwa impso (kuchuluka kwa kusefera kwa madzi pamtunda wa 60 ml / min) ndipo palibe matenda ophatikizana omwe amakhala ndi chiwopsezo cha hypoxia.
Meglitinides (Clinids)
Monga zotumphukira za sulfonylurea, mankhwalawa amalimbikitsa maselo a beta kuti apange insulin kwambiri. Meglitinides (glinids) amayamba kuchita zinthu mwachangu kwambiri, koma zotsatira zake sizikhala motalika, mpaka mphindi 30-90. Mankhwalawa amapatsidwa chakudya musanadye.
Meglitinides (glinides) sayenera kugwiritsidwa ntchito pazifukwa zomwezi sulfonylureas. Amathandizira "kuzimitsa" kuchuluka kwamphamvu kwa glucose akangodya. Mukasiya kudya zakudya zamafuta zomwe zimamwa mwachangu, ndiye kuti simudzakhala ndi chiwonjezerochi.
Dipeptidyl Peptidase-4 Inhibitors (Gliptins)
Kumbukirani kuti glucagon-like peptide-1 (GLP-1) ndi amodzi mwa mahomoni a insretin. Amathandizira kapamba kuti apange insulin ndipo nthawi yomweyo amalepheretsa kupanga glucagon, "wotsutsana naye" wa insulin. Koma GLP-1 imagwira ntchito pokhapokha kuchuluka kwa shuga m'magazi kumakhalabe kokwezeka.
Dipeptidyl peptidase-4 ndi enzyme yomwe imawononga mwachilengedwe GLP-1, ndipo machitidwe ake amathetsa. Mankhwala kuchokera pagulu la dipeptidyl peptidase-4 zoletsa amaletsa enzyme iyi kuwonetsa ntchito yake. Mndandanda wa kukonzekera kwa glyptin ukuphatikizapo:
- sitagliptin (Januvia),
- saxagliptin (osamveka).
Amaletsa (zoletsa) ntchito ya enzyme yomwe imawononga mahomoni GLP-1. Chifukwa chake, kuphatikizidwa kwa GLP-1 m'magazi motsogozedwa ndi mankhwalawa kumatha kuwonjezeka mpaka nthawi 1.5-2 kuposa kuchuluka kwa thupi. Chifukwa chake, imalimbikitsa kwambiri kapamba kuti atulutse insulin m'magazi.
Ndikofunikira kuti mankhwala ochokera ku gulu la dipeptidyl peptidase-4 inhibitors amagwiritsa ntchito mphamvu zawo pokhapokha magazi a m'mwamba atakwezedwa. Ikayamba kukhala yokhazikika (4.5 mmol / L), mankhwalawa amatsala pang'ono kusiya kutulutsa insulin ndikuletsa ntchito yopanga glucagon.
Ubwino wowonjezera matenda a shuga a mtundu wachiwiri ndi mankhwala ochokera ku gulu la dipeptidyl peptidase-4 inhibitors (gliptins):
- siziwonjezera chiopsezo cha hypoglycemia,
- osayambitsa kulemera,
- Zotsatira zake zoyipa - sizichitika kawirikawiri poyerekeza ndi kutenga placebo.
Odwala omwe ali ndi matenda a shuga opitilira zaka 65, mankhwala omwe ali ndi DPP-4 zoletsa osagwiritsa ntchito mankhwala ena amachititsa kutsika kwa hemoglobin HbA1C ya glycated kuchokera ku 0.7 mpaka 1.2%. Chiwopsezo cha hypoglycemia ndi chocheperako, kuyambira 0 mpaka 6%. Pagulu lolamulira la odwala matenda ashuga omwe adatenga placebo, chiopsezo cha hypoglycemia chinachokera ku 0 mpaka 10%. Izi zimapezeka pambuyo pofufuza zazitali, kuyambira masabata 24 mpaka 52.
Mankhwala kuchokera pagulu la dipeptidyl peptidase-4 inhibitors (gliptins) amatha kuphatikizidwa ndi mapiritsi ena a shuga, popanda chiwopsezo chowonjezereka. Chosangalatsa chake ndi mwayi wopereka mankhwala ndi metformin.
Kafukufuku wa 2009 adayerekeza kuthandizira komanso chitetezo pochiza odwala matenda ashuga okalamba opitilira 65 pogwiritsa ntchito mitundu iyi:
- metformin + sulfonylurea (glimepiride 30 kg / m2), ngati wodwalayo ali wokonzeka kudzipweteka.
Ndi mankhwala omwe amayeserera ndi ma fanizo a GLP-1 omwe amagwiritsa ntchito ngati njira yomaliza ngati wodwala akufuna kuti achedwetse kuyamba kwa matenda a shuga. Osati sulfonylureas, monga nthawi zambiri zimachitikira.
Acarbose (glucobai) - mankhwala omwe amalepheretsa kuyamwa kwa glucose
Mankhwalawa a shuga ndi alpha glucosidase inhibitor. Acarboro (glucobai) amalepheretsa kugaya kwa zovuta zam'mimba, poly- ndi oligosaccharides m'matumbo. Mothandizidwa ndi mankhwalawa, shuga wocheperako amalowetsedwa m'magazi.Koma kugwiritsidwa ntchito kwake nthawi zambiri kumayambitsa kutulutsa, kutsegula m'mimba, kutsekula m'mimba, ndi zina zambiri.
Kuti muchepetse kuopsa kwa mavuto, tikulimbikitsidwa kuti muchepetse zakudya zovuta m'thupi mukamamwa acarbose (glucobaya). Koma ngati mungagwiritse ntchito monga tikufunsira, palibe chifukwa chomwa mankhwalawa.
Chithandizo cha matenda osokoneza bongo okalamba ndi insulin
Insulin ya matenda a shuga a mtundu wachi 2 imayikidwa ngati chithandizo chamankhwala, mapiritsi olimbitsa thupi komanso mapiritsi a shuga sichitha mokwanira shuga. Matenda a 2 a shuga amathandizidwa ndi insulin kuphatikiza kapena mapiritsi. Ngati pali kuchuluka kwambiri kwa thupi, ndiye kuti jakisoni wa insulin akhoza kuphatikizidwa ndi kugwiritsa ntchito metformin (siofor, glucophage) kapena DPP-4 inhibitor vildagliptin. Izi zimachepetsa kufunika kwa insulin, motero, zimachepetsa chiopsezo cha hypoglycemia.
Nthawi zambiri zimakhala kuti odwala matenda ashuga okalamba amayamba kumva bwino mkati mwamasiku atatu atayamba jakisoni wa insulin. Amaganiziridwa kuti izi zimayambitsidwa osati ndi kuchepa kwa shuga m'magazi, komanso chifukwa cha anabolic zotsatira za insulin ndi zotsatira zake zina. Chifukwa chake, funso lakubwereranso ku matenda a shuga mothandizidwa ndi mapiritsi limazimiririka lokha.
Kwa odwala okalamba, mitundu ingapo ya mankhwala a insulin ingagwiritsidwe ntchito:
- Jakisoni imodzi ya insulin nthawi yogona - ngati shuga imakwezedwa kwambiri pamimba yopanda kanthu. Insulin ya tsiku ndi tsiku yopanda peak yogwiritsidwa ntchito kapena "sing'anga" imagwiritsidwa ntchito.
- Jekeseni wa insulin pafupifupi nthawi ya zochita 2 pa tsiku - pamaso kadzutsa komanso asanagone.
- Jekeseni wa insulin yosakaniza 2 pa tsiku. Mankhwala osakanikirana a insulin "yifupi" ndi "sing'anga" amagwiritsidwa ntchito, pafupifupi 30:70 kapena 50:50.
- Chikhazikitso cha maziko a matenda a shuga a insulin. Awa ndi jakisoni wa insulin yochepa (ultrashort) musanadye, komanso insulin ya nthawi yayitali kapena “yowonjezeredwa” nthawi yogona.
Otsiriza omaliza a mndandanda wa insulin mankhwala amatha kugwiritsidwa ntchito pokhapokha ngati wodwalayo amatha kuphunzira ndikuchita komanso nthawi iliyonse molondola. Izi zimafuna kuti munthu wokalamba yemwe ali ndi matenda ashuga azikhala ndi chizolowezi chokhazikika chofuna kukhazikika komanso kuphunzira.
Matenda Aakulu Kwa Okalamba: Zopeza
Akakula munthu, ndiye kuti akhoza kukhala ndi matenda ashuga amitundu iwiri. Izi zimachitika chifukwa cha kukalamba kwachilengedwe, koma makamaka chifukwa chamakhalidwe oyipa a anthu okalamba. Pa zaka 45 ndi kupitilira - pimayesedwe matenda a shuga zaka zitatu zilizonse. Ndikwabwino kuyezetsa magazi osati chifukwa cha kusala kudya, koma kuyezetsa.
Chida chothandiza kwambiri komanso chothandiza popewa matenda a shuga a 2, kuphatikiza odwala okalamba, ndi. Yesani zakudya zabwino komanso zopatsa chidwi zamagulu a shuga! Zambiri zofunika zili patsamba lathu, kuphatikizapo mindandanda yazakudya za anthu odwala matenda ashuga - zololedwa komanso zoletsedwa. Zotsatira zake, shuga wanu wamagazi ayamba kutsika pambuyo pake patatha masiku ochepa. Inde, muyenera kukhala ndi mita ya shuga wamagazi ndikuigwiritsa ntchito tsiku lililonse.
Ngati zakudya zamagetsi ochepetsa thupi komanso kuchita masewera olimbitsa thupi sizithandiza kuchepetsa shuga m'magazi anu kuti akhale abwinobwino, yesani kuyezetsa magazi anu ngati mukuyenera kumwa. Osathamangira ku pharmacine chifukwa cha siofor, yambani mumayesa mayeso ndikuonana ndi dokotala! Mukayamba kugwiritsa ntchito metformin, izi sizitanthauza kuti tsopano mutha kuyimitsa zakudya komanso maphunziro akuthupi.
Ngati zakudya, masewera olimbitsa thupi ndi mapiritsi sizithandiza kwambiri, zikutanthauza kuti mukuwonetsedwa jakisoni wa insulin. Yambani mwachangu kuzichita, osawopa. Chifukwa pamene mukukhalapo popanda kubayidwa insulin ndi shuga wambiri - mukupanga zovuta za matenda ashuga. Izi zimatha kudula phazi, khungu, kapena kufa chifukwa cha kulephera kwa impso.
Ukalamba umakhala wowopsa kwambiri. Koma wodwala matenda ashuga amatha kuchepetsa kuthekera kwathu ngati zero pogwiritsa ntchito njira zitatu:
- Osamwa mapiritsi a shuga omwe amayambitsa hypoglycemia. Awa ndi sulfonylurea zotumphukira ndi meglitinides (dongo). Mutha kusintha shuga yanu popanda iwo.
- Idyani zakudya zazing'ono monga momwe mungathere. Zakudya zamafuta zilizonse, osati zokhazo zomwe zimatengeka mwachangu. Chifukwa chakudya choperewera m'zakudya zanu, mumafunikira jakisoni wa insulin. Ndipo ochepera insulin - amachepetsa mwayi wokhala ndi hypoglycemia.
- Dokotala akapitiliza kunena kuti mutenge mapiritsi ochokera ku sulfonylureas kapena meglitinides (glinides), pitani ndi katswiri wina. Chimodzimodzi ngati akutsimikizira kuti muyenera kudya “moyenera”. Osatsutsana, ingosintha adotolo.
Tidzakhala okondwa ngati mutalemba za kupambana kwanu ndi mavuto anu ochizira matenda a shuga muukalamba pamawu a nkhaniyi.
Matenda a shuga ndi matenda omwe amapezeka motsutsana ndi maziko a zovuta m'machitidwe a endocrine. Amadziwika ndi shuga yayikulu yamagazi. Matendawa amapezeka ndi zaka zilizonse, koma nthawi zambiri amakhudza anthu pambuyo pa zaka 40.
Zomwe zimachitika mu shuga kwa okalamba ndikuti nthawi zambiri njira yake siyakhazikika komanso yofatsa. Koma chizindikiritso cha matendawo ndicho kulemera kowonjezera kumene oposa theka la openshoni ali nawo.
Popeza pali zovuta zambiri zaumoyo mukakalamba, anthu ochepa amalabadira kunenepa kwambiri. Komabe, ngakhale atadwala kalekale komanso matendawa, zotsatira zake zitha kupha.
Pali mitundu iwiri ya matenda ashuga:
- Mtundu woyamba - umayamba ndi kuchepa kwa insulin. Nthawi zambiri amapezeka ali aang'ono. Uku ndi shuga wodalira insulin, yemwe amapezeka mwamphamvu. Potere, kusowa kwa chithandizo kumayambitsa kudwala matenda ashuga ndipo odwala matenda ashuga amatha kufa.
- Mtundu wachiwiri - umawonekera ndi insulin yochuluka m'magazi, koma kuchuluka kwa mahomoni sikokwanira kutulutsa shuga. Matenda amtunduwu amapezeka patatha zaka 40.
Popeza matenda amtundu wa 2 amadwala makamaka odwala okalamba, ndikofunikira kuganizira zomwe zimayambitsa, zizindikiro ndi chithandizo cha matenda amtunduwu mwatsatanetsatane.
Zinthu zopatsa komanso zoyambitsa chitukuko
Kuyambira azaka makumi asanu, anthu ambiri adachepetsa kulolera kwa glucose. Komanso, munthu akadzakalamba, zaka khumi zilizonse kuchuluka kwa shuga m'magazi kumawonjezeka, ndipo ndikatha kudya kumachulukanso. Chifukwa, mwachitsanzo, muyenera kudziwa kuti ndi chiyani.
Komabe, chiopsezo cha matenda ashuga chimatsimikiziridwa osati ndi zokhudzana ndi msinkhu, komanso ndi mulingo wa zolimbitsa thupi ndi kudya tsiku ndi tsiku.
Kodi nchifukwa chiyani anthu okalamba amatenga matenda a postprandial glycemia? Izi ndichifukwa cha zinthu zingapo:
- kuchepa kwokhudzana ndi zaka insulin
- kufooka kwa chochita ndi kubisalira kwa mahomoni a insretin muukalamba,
- kupanga kosakwanira kwa inshuwaransi.
Matenda a shuga amakalamba ndi okalamba komanso osakhazikika chifukwa chobadwa nawo. Chinthu chachiwiri chomwe chimathandizira kuti matendawa ayambe kudwala chimawonedwa ngati wonenepa kwambiri.
Komanso, matenda am'mimbayo amayamba chifukwa cha zovuta m'mapamba. Izi zitha kukhala zolakwika m'matumbo a endocrine, khansa kapena kapamba.
Ngakhale matenda osokoneza bongo omwe ali ndi matenda osokoneza bongo amatha kukula motsutsana ndi maziko a matenda oyambitsidwa ndi ma virus. Matendawa ndi monga fuluwenza, rubella, hepatitis, nthomba ndi ena.
Kuphatikiza apo, zovuta za endocrine nthawi zambiri zimawonekera pambuyo pamavuto amanjenje. Inde, malinga ndi ziwerengero, ukalamba, wophatikizidwa ndi zochitika zam'maganizo, zimangokulitsa mwayi wofanana ndi matenda a shuga a 2 kwa okalamba, komanso umapangitsa zovuta zake.
Kuphatikiza apo, mwa odwala omwe akuchita ntchito zaluso, shuga wambiri amadziwika nthawi zambiri kuposa omwe amagwira ntchito yolimbitsa thupi.
Kuzindikira ndi kulandira mankhwala
Matenda a shuga okalamba ndizovuta kuzindikira. Izi zikufotokozedwa ndikuti ngakhale shuga atakhala m'magazi akachuluka, ndiye kuti shuga sangakhale mumkodzo.
Chifukwa chake, kukalamba kumapangitsa munthu kuti azimufufuza chaka chilichonse, makamaka ngati ali ndi nkhawa ya atherosulinosis, matenda oopsa, matenda a mtima, matenda a nephropathy komanso matenda a pakhungu. Kukhazikitsa kukhalapo kwa hyperglycemia amalola kuonetsa - 6.1-6.9 mmol / L., Ndipo zotsatira za 7.8-11.1 mmol / L zikuwonetsa kuphwanya kulekerera kwa shuga.
Komabe, maphunziro ololera a glucose sangakhale olondola. Izi ndichifukwa choti ndi zaka, chidwi cha maselo mpaka shuga chimachepa, ndipo mulingo wazomwe umapezeka m'magazi umakhala wambiri kwa nthawi yayitali.
Kuphatikiza apo, kudziwika kuti ali ndi vuto mukomanso kumakhala kovuta, chifukwa zizindikiro zake ndizofanana ndi kuwonongeka kwa mapapo, kulephera mtima, komanso ketoacidosis.
Zonsezi nthawi zambiri zimabweretsa chakuti shuga wapezeka kale kumapeto. Chifukwa chake, anthu azaka zopitilira 45 ayenera kukhala ndi mayeso a shuga wamagazi patatha zaka ziwiri zilizonse.
Kuthandizira odwala matenda ashuga okalamba ndi ntchito yovuta, chifukwa ali kale ndi matenda ena owonda komanso kunenepa kwambiri. Chifukwa chake, kuti athetse vutoli, dokotalayo amapereka mankhwala osiyanasiyana ochokera m'magulu osiyanasiyana kupita kwa wodwala.
Chithandizo cha mankhwala osokoneza bongo okalamba odwala matenda ashuga chimaphatikizapo kumwa mitundu ya mankhwala monga:
- Metformin
- glitazones
- zochokera sulfonylurea,
- Ma Clinid
- glyptins.
Shuga wokwera nthawi zambiri amachepetsedwa ndi Metformin (Klukofazh, Siofor). Komabe, imayikidwa pokhapokha kusefa kwa impso ndipo ngati palibe matenda omwe amachititsa hypoxia. Ubwino wa mankhwalawa ndikuthandizira njira zama metabolic, sizimathetsanso kapamba ndipo sizimathandizira pakuwoneka kwa hypoglycemia.
Glitazones, monga Metformin, imatha kukulitsa chidwi cha maselo amafuta, minofu ndi chiwindi kuti insulini. Komabe, ndi pancreatic depletion, kugwiritsa ntchito thiazolidatediones kulibe tanthauzo.
Glitazones imaphatikizidwanso m'mavuto ndi mtima ndi impso. Komanso, mankhwala ochokera ku gululi ndi owopsa chifukwa amathandizira kuti calcium ikhale m'mafupa. Ngakhale mankhwalawa samachulukitsa chiopsezo cha hypoglycemia.
Amachokera ku sulfonylureas amagwira ntchito pama cell a beta a kapamba, chifukwa amayamba kupanga insulin mwachangu. Kugwiritsa ntchito mankhwalawa ndizotheka mpaka kapamba atatha.
Koma zochokera ku sulfonylurea zimabweretsa zotsatirapo zingapo zoyipa:
- kuchuluka kwa hypoglycemia,
- Mtheradi komanso kusasinthika kwa kapamba,
- kunenepa.
Nthawi zambiri, odwala amayamba kutenga mankhwala ochokera ku sulfonylurea ngakhale atakumana ndi zoopsa zilizonse kuti asayambitse insulin. Komabe, machitidwe oterewa amakhala ovulaza thanzi, makamaka ngati zaka za wodwalayo zikufika zaka 80.
Ma Clinides kapena meglitinides, komanso zotumphukira za sulfonylurea, amachititsa kupanga insulin. Ngati mumamwa mankhwalawa musanadye, ndiye kuti nthawi yawo yokhala pakulimbitsa kuchokera kwa mphindi 30 mpaka 90.
Zoyipa zotsutsana ndi kugwiritsa ntchito meglitinides ndizofanana ndi sulfonylureas. Ubwino wa ndalama zotere ndikuti amatha kuchepetsa shuga m'magazi ndikatha kudya.
Gliptins, makamaka Glucagon-ngati peptide-1, ndi mahomoni a insretin. Maepeptidyl peptidase-4 zoletsa amachititsa kapamba kuti apange insulin, zoletsa zobisika za glucagon.
Komabe, GLP-1 imagwira ntchito pokhapokha shuga ikakwezedwa. Mu kapangidwe ka gliptins pali Saxagliptin, Sitagliptin ndi Vildagliptin.
Ndalama izi zimasokoneza chinthu chomwe chimawononga kwambiri ku GLP-1.Mutatha kumwa mankhwalawa, kuchuluka kwa mahomoni m'magazi kumawonjezeka pafupifupi kawiri. Zotsatira zake, kapamba amayambitsa, omwe amayamba kupanga insulin mwachangu.
Mankhwala othandizira pakudya ndi njira zopewera
Matenda a shuga okalamba amafuna zakudya zina. Cholinga chachikulu cha zakudya ndi kuchepa thupi. Kuti muchepetse kudya mafuta m'thupi, munthu amafunika kusintha zakudya zopatsa mphamvu.
Chifukwa chake, wodwalayo ayenera kulemeretsa chakudya ndi masamba atsopano, zipatso, mitundu yochepa yamafuta ndi nsomba, mankhwala amkaka, chimanga ndi chimanga. Ndipo maswiti, makeke, batala, ma broths olemera, tchipisi, zonunkhira, nyama zosuta, zakumwa zoledzeretsa komanso zotsekemera zimayenera kutayidwa.
Komanso, kudya matenda a shuga kumaphatikizapo kudya magawo osachepera 5 pa tsiku. Ndipo chakudya chamadzulo chikuyenera kukhala maola 2 asanagone.
Kuchita masewera olimbitsa thupi ndi njira yabwino yodzitetezera ku matenda ashuga omwe amapuma pantchito. Ndi masewera olimbitsa thupi nthawi zonse, mutha kukwaniritsa zotsatirazi:
- kuthamanga kwa magazi
- letsa kuwoneka kwa atherosulinosis,
- Sinthani chidwi chathu.
Komabe, katunduyo ayenera kusankhidwa malinga ndi thanzi la wodwalayo komanso mikhalidwe yake. Njira yabwino ikhoza kukhala yoyenda kwa mphindi 30-60 mu mpweya wabwino, kusambira komanso kuyenda njinga. Muthanso kuchita masewera olimbitsa thupi m'mawa kapena kuchita masewera olimbitsa thupi apadera.
Koma kwa okalamba, pali zotsutsana zingapo zolimbitsa thupi. Izi zimaphatikizapo kulephera kwambiri kwa impso, kubwezeretsedwa bwino kwa shuga, gawo lochulukirachulukira la retinopathy, angina pectoris ndi ketoacidosis wosakhazikika.
Ngati matenda a shuga apezeka mzaka 70-80, ndiye kuti kudwala kumeneku ndi koopsa kwambiri kwa wodwalayo. Chifukwa chake, angafunike chisamaliro chapadera munyumba yolumikizana, yomwe ingalimbitse thanzi la wodwalayo ndikuwonjezera moyo wake momwe angathere.
Chinthu china chofunikira chomwe chimachedwetsa kukula kwa kudalira kwa insulini ndikusungidwa kwa malingaliro abwino. Kupatula apo, kupanikizika kumawonjezera kukakamiza, komwe kumayambitsa vuto mu chakudya cha metabolism. Chifukwa chake, ndikofunikira kukhala wodekha, ndipo ngati kuli kotheka, tengani masisitere potengera timbewu tating'onoting'ono, valerian ndi zina. Kanemayo munkhaniyi ayankhula za zomwe zimachitika munthu akamadwala matenda ashuga.
Matenda a shuga okalamba
5 (100%) adavotera 1
Mu okalamba, uyu ndi mdani wodekha wodekha, yemwe amapezeka nthawi ikachedwa ... Lero ndikufuna kukweza mutu wofunikira kwa ambiri, ndipo, makamaka, kwa ine. Kupatula apo, abale anga nawonso adakumana ndi chisoni chifukwa chobisalira matenda ashuga.
Matenda a shuga okalamba - mawonekedwe
Nthawi zambiri amalembera kuti odwala okalamba njira yamatendawa ndi yokhazikika komanso yoyipa (yofatsa). Ndipo mavuto akulu amakumana ndi izi, chifukwa:
- Chizindikiro chachikulu cha matenda ashuga mwa anthu okalamba, onenepa kwambiri, chili pafupifupi 90% mwa okalamba.
- Mwa mwambo wachisoni, anthu omwe ali pambuyo pa Soviet Union sakonda kuwona madokotala, chifukwa chake, pakakhala kuti palibe zoonekeratu, matenda ashuga amatha kupitilira zaka zambiri.
Ndi zovuta zonsezi, kudwala kwa anthu okalamba kumatha kuwonongera moyo chifukwa chosafuna chithandizo komanso kusowa kwa chithandizo. 90 peresenti ndi mtundu 2 wa okalamba omwe ali okalamba. Mtundu woyamba ndi wosowa kwambiri, ndipo umagwirizanitsidwa ndi matenda a kapamba.
Mavuto mu odwala matenda ashuga okalamba
Vuto la mtima ndi trophic. Zilonda zam'mimba za atherosulinotic zingayambitse matenda ashuga komanso ndizovuta zake. Zizindikiro zake zazikulu ndi kupenya kwamaso, kupweteka kwa mtima, kutupa kwa nkhope, kupweteka kwa mwendo, matenda am'mimba, ndi matenda amtundu.
Coronary atherosulinosis mu matenda ashuga amapezeka katatu konse mwa amuna ndi kanayi mwa akazi kuposa mwa anthu opanda matenda a shuga. Odwala omwe ali ndi matenda a shuga, nthawi zambiri amakula. Izi ndi zomwe zidachitikira agogo anga aakazi.
Ndipo owopsa kwambiri alibe ngakhale kukhudzanso mtima, koma kuti ndi matenda a shuga simungathe kukokomeza glucose - chithandizo chachikulu chokhalira ndi mtima. Chifukwa chake, chithandizo ndi kuchira ndizovuta kwambiri, ndipo nthawi zambiri matenda a shuga ndi omwe amafa.
Okalamba odwala matenda ashuga a mtundu 2 amapezeka kwambiri mwa akazi ndipo nthawi 60 mwa amuna amakhala ndi gangrene NK (malekezero otsika).
Vuto linanso la matenda ashuga ndi matenda amkodzo thirakiti (1/3 ya odwala).
Mavuto a m'matumbo a m'mimba amaphatikizapo matenda ashuga a retinopathy ndi "senile", omwe amadwala matenda ashuga amakula msanga kwambiri kuposa anthu athanzi.
Kupeza matenda a shuga muukalamba
Kuzindikira matenda ashuga okalamba ndi okalamba ndi kovuta. Chifukwa cha kusintha kwazaka za impso, ubale wobisika pakati pa hyperglycemia ndi glycosuria (kusowa kwa shuga mumkodzo ndi zomwe zili m'magazi) nthawi zambiri kumawonedwa.
Chifukwa chake, kuyezetsa magazi nthawi zonse kwa anthu onse azaka zopitilira 55, makamaka ndi matenda oopsa komanso matenda ena kuchokera pamndandanda wazovuta, ndikofunikira.
Kuyenera kudziwidwa kuti mu ukalamba pali overdiagnosis ya matenda ashuga. Chifukwa chake, kwa anthu ambiri opitilira 55, kulekerera kwa zakudya zamafuta kumachepetsedwa kwambiri, kotero poyesa, shuga wokwanira amatanthauziridwa ndi madokotala ngati chizindikiro cha matenda ashuga.
Pali malo okalamba, pomwe odwala matenda ashuga amawagwiritsa ntchito nthawi zonse okalamba, ndipo matenda ashuga amapezeka kale. Mukuwongolera nyumba zokwerera ndi malo osungirako okalamba noalone.ru mupeza mabungwe opitilira 800 m'mizinda 80 ya Russia, Ukraine ndi Belarus.
Matenda a shuga okalamba - mankhwala
Odwala okalamba ambiri amamvera mankhwala ochepetsa shuga a pakamwa.
- sulfonamide (butamide, etc.) Kutsitsa kwa shuga kwa mankhwalawa kumachitika chifukwa cha kukondoweza kwa insulin komwe kumapangidwa ndi maselo a pancreatic. Amawonetsedwa kwa matenda ashuga kuposa zaka 45.
- khwawa (adebit, phenformin, etc.). Amasintha zochita za insulin mthupi chifukwa chakuchulukana kwakukulu kwa kuphatikizika kwa minyewa yamthupi ya glucose. Chizindikiro chachikulu ndi matenda ashuga ochulukirapo okhala ndi kunenepa kwambiri.
Odwala a zaka za senile ndi mankhwala, shuga yokhazikika iyenera kumakhazikika pena paliponse pokhapokha ngati sichoncho. Inde, ndi kuchepa kwambiri kwa shuga, njira ya adrenaline imayatsidwa, yomwe imakweza magazi ndikuyambitsa tachycardia, yomwe motsutsana ndi maziko a atherosulinosis ingayambitse zovuta za thromboembolic, infarction ya myocardial kapena stroko.
Matenda a shuga - gulu la matenda a metabolic (metabolic) omwe amadziwika ndi hyperglycemia, yomwe imayamba chifukwa cha zolakwika pakubisika kwa insulin, kanthu ka insulin, kapena zonsezi.
Mwa anthu okalamba komanso osakhazikika, mtundu wachiwiri wa matenda ashuga (mellitus) sofala kwambiri.
Mtundu wachiwiri wa matenda ashuga, chibadwa chimagwira ntchito. Thandizani kuchitika kwa kunenepa kwambiri kwa matenda a shuga, zochitika zodetsa nkhawa, moyo wokhala pakungokhala, zakudya zopanda thanzi. Matenda a shuga a Mtundu Wachiwiri amachokera pazinthu zomwe zimapangitsa kuti insulin ikane komanso ntchito yovuta ya β-cell.
Kukana insulini - kuchepa kwa chidwi cha minofu ku insulin.
Odwala omwe ali ndi zaka zopitilira 60 omwe akudwala matenda a shuga akweza ma mahomoni okhala ndi zotsutsana - STH, ACTH, cortisol.
Mavuto
Kwa anthu okalamba, zovuta zam'mimba zimafotokozedwa. Pali macroangiopathies (kuwonongeka kwa ziwiya zazikulu ndi zapakatikati zama caliberi) ndi ma microangiopathies (kuwonongeka kwa ma arterioles, capillaries ndi venule).
Atherosulinosis ndiye mwala wapangodya wa macroangiopathy. Pali pang'onopang'ono njira ya mtima yamatenda, mtima wokonda kulowetsedwa, kuwonongeka kwamitsempha yaubongo, kuwononga ma atherosulinosis a ziwiya zamagawo akumunsi.
Microangions khazikitsani mwa anthu achikulire m'mbuyomu kuposa achinyamata. Masomphenya amachepetsa, njira zowonongera mu retina (diabetesic retinopathy) ndi ma opacity a lens amapangika. Impso zimakhudzidwa (nephroangiopathy, yomwe imakonda kuyenda ndi pyelonephritis). Zombo za microvasculature zam'munsi zam'munsi zimakhudzidwa.
Matenda a matenda ashuga - motsutsana ndi kumbuyo kwa kuchepa kwa chidwi, ma cellcracks amawoneka pakhungu la phazi, khungu limakhala louma, limatayika, ndipo kutupa kumawonekera.
Mawonekedwe a phazi asintha ("mapazi a kiyubiki"). M'magawo aposachedwa, kuwonongeka kwambiri kwa phazi kumawonedwa, zilonda zosapola zimapangidwa. Pazinthu zapamwamba, kudula dzanja ndikofunikira.
Matenda a shuga a Noleuropathy - Chimodzi mwazomwe zikuwonetsa kuwonongeka kwa dongosolo lamanjenje mu shuga. Pali zowawa m'miyendo, dzanzi, kumverera kwa "kukwawa ndi nyerere", kuchepa kwa chidwi, kuzizira.
Zovuta.
Matenda a shuga a ketoacidosis okalamba sichisowa. Ketoacidosis imatha kudwala odwala omwe samadalira insulin omwe amadalira matenda osokoneza bongo omwe ali ndi nkhawa komanso matenda opatsirana omwe amabweretsa kuwonongeka kwa matenda a shuga.
Hypoglycemia mwa okalamba sizachilendo kwenikweni kuposa achinyamata.
Zifukwa - zolimbitsa thupi (kuchuluka kwa shuga), kuledzera, kuchuluka kwa insulin, kutenga β-blockers. Amatengera mphamvu yakufa kwa maselo mumagazi a magazi ochepa. Amakula mwachangu.
Zizindikiro kufooka wamba, thukuta, kunjenjemera, kamvekedwe ka minofu kukulira, njala, odwala amatha kusokonezeka, kukwiya, pali tachycardia, kuthamanga kwa magazi, ndi chitukuko chowonjezereka - kutaya chikumbumtima, kutsika minofu kamvekedwe, magazi.
Hypoglycemic zinthu khalani milingo yosiyanasiyana ya glycemia (nthawi zambiri imakhala yochepera 3.3 mmol / l).
Kuzindikira matenda ashuga.
Kafukufuku wobwereza wa glucose wamagazi, kuyesa kwamkodzo kwa glucose, acetone, kutsimikiza kwa glycated hemoglobin m'magazi (gulu la glucose lomwe lili ndi hemoglobin likuwonetsa kuchuluka kwa glycemia m'miyezi itatu yapitayi), fructosamine (glycated albin), kuzindikira kwa ntchito ya impso, kufufuza kwa maso, ndikofunikira. katswiri wamitsempha, kuwerenga kayendedwe ka magazi m'mitsempha ya ubongo, m'munsi mwake.
Chithandizo ndi chisamaliro.
Odwala omwe ali ndi matenda ashuga amalembedwa tebulo D. Mosavuta chakudya chambiri (shuga, confectionery) samachotsedwa, m'malo mwa shuga, m'malo mwake amalimbikitsidwa: xylitol, fructose, zukini. Mafuta a nyama ndi ochepa. Chakudyacho chimaphatikizapo zinthu zomwe zimatenga pang'onopang'ono chakudya chamafuta (bulawuni, burwheat, oatmeal, masamba).
Kuchuluka kwa zolimbitsa thupi kuyenera kufanana ndi momwe wodwalayo alili. Kuchita minofu kumawonjezera minofu ya m'magazi.
Chithandizo cha mankhwala osokoneza bongo chimagwiritsidwa ntchito ndi mankhwala otsatirawa a hypoglycemic:
- biguanides (pakadali pano metformin ikufunika kuchokera pagululi, odwala okalamba ndi omwe amalembedwa mosamala),
- Kukonzekera kwa sulfonylurea (glyclazide, gl6enclamide, glurenorm),
- thiaglitazone (rosiglitazone) ndi gulu latsopano la antidiabetesic mankhwala.
Mankhwala a insulin odwala omwe ali ndi matenda a shuga a 2 angagwiritsidwe ntchito ketoacidosis, mitsempha ya mtima, njira zochitikira opaleshoni, ndi matenda ena, kulephera kwa chithandizo.
M.V. Shestakova
State Endocrinological Research Center (dir. - Acad. RAMS, prof .II.Dedov) RAMS, Moscow
M'zaka makumi awiri mphambu chimodzi, vuto la matenda a shuga (DM) lasanduka mliri wapadziko lonse lapansi womwe ukukhudza kuchuluka kwa mayiko onse padziko lapansi, mayiko ndi mibadwo yonse. Chiwerengero chofulumira kwambiri cha odwala matenda a shuga a m'badwo wachikulire (zaka 65 ndi akulu). Malinga ndi kukonzanso kachitatu kwa US National Health Register (NHANES III), kuchuluka kwa matenda ashuga a mtundu wa 2 (T2DM) kuli pafupifupi 8% ali ndi zaka 60 ndipo akufika pamlingo wake wokwanira (22-24%) azaka zopitilira 80. Zinthu ngati izi zikuwonekeranso ku Russia. Kuwonjezeka kwakukulu kwa matenda ashuga okalamba kumalumikizidwa ndi zinthu zingapo zomwe zimawonetsa kusintha kwachilengedwe kwa kagayidwe kazachilengedwe pakukalamba.
Njira zosintha zokhudzana ndi zaka-zaka mu kulolera kwa shuga
Kusintha kokhudzana ndi zaka mu kulekerera kwa glucose kumadziwika ndi izi:
Pambuyo zaka 50 pazaka 10 zotsatirazi:
- Kuthamanga kwa glycemia kumawonjezeka ndi 0.055 mmol / L (1 mg%)
- Glycemia patatha maola 2 chakudya chiziwonjezeka ndi 0,5 mmol / L (10 mg%)
Monga mukudziwa, kakulidwe ka matenda a shuga a 2 kamakhazikitsidwa pamayendedwe atatu:
- kuchepa kwamphamvu kwa minyewa ya insulin (kukana insulin),
- chinsinsi chokwanira cha insulin chifukwa cha nkhawa,
- Hyperproduction wa shuga ndi chiwindi.
Zilonda zam'mimba kwa insulin
Kuchepa kwa minofu kumverera kwa insulin (insulin kukana) ndiye njira imodzi yofunika kwambiri yopezera matenda a metabolism. Mu okalamba, mothandizidwa ndi hyperglycemic clamp, kuchepa kwa chidwi cha zotumphukira kwa insulin ndipo, motsatana, kuchepa kwa glucose komwe kumachitika ndi zotumphukira. Vutoli limapezeka makamaka mwa anthu onenepa kwambiri. Ukalamba umabweretsa zina zambiri zomwe zimakulitsa kukana kwa insulin. Izi ndizochepa zochitika zolimbitsa thupi, komanso kuchepa kwa minofu yambiri (zotumphukira zazikulu zomwe zimagwiritsa ntchito shuga), komanso kunenepa kwambiri pamimba (kumawonjezera pazaka za 70, ndiye, monga lamulo, kumachepa). Zinthu zonsezi zimaphatikizana.
Katemera wa insulin wacheperachepera ndiye vuto lalikulu lomwe limapangitsa kuti matenda ashuga amtundu wa 2 akhale munthu wopanda kunenepa kwambiri. Monga tikudziwika, insulin katulutsidwe poyambira kukhudzika kwa glucose kumachitika m'magawo awiri (magawo awiri): gawo loyamba limakhala lolimba kwambiri la insulin, limatenga mphindi 10 zoyamba, gawo lachiwiri ndilotalikirapo (mpaka 60-120 min) ndipo silinatchulidwe kwenikweni. Gawo loyamba la insulin katulutsidwe ndikofunikira pakuwongolera kwa postprandial glycemia.
Ochulukirapo ofufuza adapeza kuchepa kwakukulu mu gawo loyamba la insulin katemera mwa okalamba popanda kunenepa kwambiri.
Mwina izi zikuchitika chifukwa cha kuchuluka kwa mankhwalawa kwa postprandial glycemia (mwa 0,5 mmol / l) zaka khumi zilizonse atatha zaka 50.
Kupanga shuga
Mu maphunziro ambiri omwe adachitika mu 1980-1990s. zidawonetsedwa kuti kupanga kwa shuga ndi chiwindi sikusintha kwenikweni ndi zaka. Komanso, mphamvu yolepheretsa insulini pakupanga shuga wa chiwindi sichitha. Chifukwa chake, kusintha kwa kagayidwe kakang'ono ka chiwindi mu chiwindi sikungatanthauze kusintha kokhudzana ndi zaka pakukweza kwa shuga.Umboni wosadziwika womwe ukunena za kupezeka kwa shuga kwa chiwindi mwa okalamba ndi chakuti kusala kudya kwamphamvu kwa glycemia (komwe kumadalira mphamvu ya chiwindi usiku) kumasiyana pang'ono ndi zaka.
Chifukwa chake, muukalamba, kagayidwe kazakudya kamatsimikiziridwa ndi zinthu ziwiri zazikulu: chidwi cha insulin komanso insulin. Choyambirira, kukana insulin, kumanenedweratu mwa anthu okalamba omwe onenepa kwambiri. Chachiwiri - kuchepetsedwa kwa insulin - imakhala yolamulira anthu okalamba popanda kunenepa kwambiri. Kudziwa njira zazikulu za chitukuko cha matenda ashuga a mtundu 2 kumalola njira yosiyanikirana pakusankhidwa kwa odwala okalamba.
Kupeza matenda ndi kuwunika kwa matenda ashuga a 2 okalamba
Njira zodziwira matenda osokoneza bongo okalamba sizosiyana ndi zomwe anatengera a WHO (1999) kwa anthu onse.
Njira zoyenera kudziwa matenda ashuga:
- kusala kudya kwa plasma glucose> 7.0 mmol / L (126 mg%)
- kusala kwa magazi m'magazi a shuga> 6.1 mmol / L (110 mg%)
- glucose wa m'madzi am'magazi (magazi a capillary) maola 2 mutatha kudya (kapena kulongedza shuga wa 75 g)> 11.1 mmol / L (200 mg%)
Ngati glucose wothamanga wapezeka pakati pa 6.1 ndi 6.9 mmol / L, hyperglycemia yofulumira imapezeka. Ngati glycemia wapezeka patatha maola awiri kuchokera pakubadwa kwa glucose pakati pa 7.8 ndi 11.1 mmol / L, kulekerera kwa glucose kumadziwika.
Mukakalamba, matenda a shuga samangotchulapo zizindikiro zamankhwala (polyuria, polydipsia, etc.). Nthawi zambiri matendawa amakhala osakhazikika, osakhazikika, komanso osapezeka mpaka zovuta za matenda ashuga zikuwoneka bwino m'chipatala - vuto la kuwonongeka (retinopathy), matenda a impso (nephropathy), zilonda zam'mimba kapena matenda am'mimba am'munsi. kugunda kwa mtima kapena sitiroko. Chifukwa chake, matenda ashuga 2 okalamba ayenera kupezeka mwachangu, i.e. Nthawi zambiri imayang'ana shuga m'magulu omwe ali pachiwopsezo chachikulu.
American Diabetes Association (ADA) yatulutsa tsamba loyesa mafunso kuti liwone kukula kwa chiwopsezo chotenga matenda amtundu wa 2. Yankho labwino ku funso lililonse limaperekedwa.
Kuyesa kwa ADA kuti mupeze kuchuluka kwa chiwopsezo cha matenda ashuga 2:
- Ndine mkazi yemwe adabereka mwana wolemera oposa 4.5 kg 1 point
- Ndili ndi mlongo / m'bale amene akudwala ndi 2 2 1 point
- Kholo langa akudwala matenda a shuga 2 1
- Kulemera kwanga kwamthupi kupitilira pazovomerezeka 5
- Ndimakhala moyo wongokhala
- Zaka zanga zili pakati pa 45 ndi 65 zaka 5 mfundo
- Zaka zanga zatha 65 zaka 9 mfundo
Kudziwa zoopsa zomwe zingachitike kuti munthu akhale ndi matenda ashuga 2 amafunika kuyesa mozama kuti adziwe matenda a shuga. Palibenso mgwirizano womwe ungayesere kuyesa matenda a shuga a 2: kusala kudya glycemia? glycemia atatha kudya? kuyeserera kwa glucose? glucosuria? HBA1s? Kuwunika odwala omwe ali ndi chiopsezo chachikulu chokhala ndi matenda a shuga pokhapokha ngati akusala kudya glycemia sikuti nthawi zonse amatha kudziwa odwala omwe ali ndi postprandial hyperglycemia (omwe, monga akhazikitsidwa m'zaka zaposachedwa, ali ndi chiwopsezo chachikulu cha kufa kwamtima). Chifukwa chake, m'malingaliro athu, kugwiritsa ntchito glycemia wokhazikika basi ngati kuyezetsa koyambirira kwa matenda amtundu wa 2 sikokwanira. Kuyeza kumeneku kuyenera kuphatikizidwa ndi kafukufuku wokakamizidwa wa glycemia 2 maola atatha chakudya.
Zolemba za shuga 2 pakukalamba
DM 2 mu okalamba ili ndi mawonekedwe ake azachipatala, a labotale komanso amalingaliro omwe amatsimikiza momwe njira zochiritsira zimagwiritsidwira ntchito m'gulu lino la odwala.
Zovuta zazikulu pakupezeka kwa T2DM kwa odwala okalamba nthawi yayitali chifukwa cha asymptomatic ("chete") matendawa - palibe zodandaula za ludzu, shuga, kuyabwa, kuchepa thupi.
Chizindikiro cha matenda ashuga 2 muukalamba ndicho chidziwitso cha madandaulo osafunikira a kufooka, kutopa, chizungulire, kusokonezeka kwa kukumbukira ndi kusazindikira kwina komwe kumapangitsa dotolo kutali kuti mwina sangakayikire kupezeka kwa matenda ashuga. Nthawi zambiri, DM 2 imadziwika mwamwayi panthawi yoyesedwa ngati pali matenda enanso. Njira yotsiriza, yopanda kudziwa bwino za matenda okhudzana ndi matenda okalamba imadzetsa kuonetsetsa kuti matenda ashuga 2 amapangidwa nthawi imodzi ndi chizindikiritso cha zovuta za mtima zamatenda. Malinga ndi kafukufuku wamatenda owopsa, zidapezeka kuti panthawi yolembetsa matenda a T2DM, opitilira 50% odwala kale ali ndi zovuta zazing'ono kapena zazikulu:
- matenda a mtima apezeka 30%,
- kuwonongeka kwa ziwiya zam'munsi - 30%,
- kuwonongeka kwa ziwiya zamaso (retinopathy) - 15%,
- kuwonongeka kwa dongosolo lamanjenje (neuropathy) - 15%,
- microalbuminuria - 30%,
- proteinuria - mu 5-10%,
- aakulu aimpso kulephera - 1%.
Chofunikira kuchipatala cha mtundu 2 wa matenda ashuga okalamba ndimomwe amalephera kuzindikira zochitika za hypoglycemic, zomwe zimapangitsa kukhala ndi vuto lalikulu la hypoglycemic. Kwambiri, m'gulu ili la odwala, kukula kwa zizindikiro za kudziyimira payekha kwa hypoglycemia (palpitations, kunjenjemera, njala) kumayipa, zomwe zimachitika chifukwa chakuchepa kwa mphamvu yamahomoni olimbana nawo.
Kuzindikira matenda ashuga 2 okalamba kumakhala kovuta osati chifukwa cha chithunzi chofufutidwa cha matenda, komanso chifukwa cha atypical mawonekedwe a diagnostics a labotale. Izi zikuphatikiza:
- kusala kudya kwa hyperglycemia mu 60% ya odwala,
- kuchuluka kwa okhazikika postprandial hyperglycemia mu 50-70% ya odwala,
- kuchuluka kwa aimpso kwa glucose excretion ndi zaka.
Mukakalamba, mukazindikira matenda a shuga kapena kuwunika kwake, munthu sangayang'anenso kuchuluka kwa glucosuria. Ngati mwa achinyamata chitseko cha impso cha glucose (mwachitsanzo, kuchuluka kwa glycemia komwe glucose amawonekera mkodzo) ndi pafupifupi 10 mmol / L, ndiye kuti patatha zaka 65-70 izi zadutsa mpaka 12-13 mmol / L. Chifukwa chake, ngakhale chindapusa chovuta kwambiri cha matenda a shuga sichingayende limodzi ndi mawonekedwe a glucosuria.
Odwala a misala yakale nthawi zambiri amakhala osungulumwa, kudzipatula, kusowa thandizo, umphawi. Zinthu izi nthawi zambiri zimabweretsa kukula kwa vuto la psychoemotional, kukhumudwa kwambiri, matenda a anorexia. Njira yamatenda oyamba pano, monga lamulo, imakhala yovuta chifukwa cholumikizika kwa kuzindikira (kusokonezeka kukumbukira, chidwi, kuphunzira). Chiwopsezo chokhala ndi matenda a Alzheimer's chikuwonjezeka. Kwa odwala okalamba ndi zaka zocheperako, ntchito yopewetsa chindapusa cha shuga, koma kuwapatsa chisamaliro chofunikira ndi chisamaliro chazachipatala zambiri, zimadzafika patsogolo.
Gome 1.
Kuchepetsa chiyembekezo chokhala ndi matenda a shuga a 2, kutengera ndi zaka zowonjezera za matenda a shuga a 2 (malinga ndi Verona Diabetes Study, 1995)
Gawo 2.
Njira zoyenera zothandizira kulipira mtundu wa matenda ashuga a 2 okalamba
Gawo 3.
Zofanizira mawonekedwe a mbiri ya zochita za sulfonylureas
Kutalika
chochita (h)
Kuchulukitsa
kudya tsiku lililonse
50% chiwindi 50% impso ngati metabolites yogwira
70% chiwindi, 30% impso mu mawonekedwe a metabolites osagwira
40% chiwindi, 60% impso ngati metabolites yogwira
30% chiwindi, 70% impso mu mawonekedwe a metabolites osagwira
95% chiwindi, 5% impso
Zolinga zakuthandizira odwala omwe ali ndi matenda a shuga a 2 atakalamba
Mayeso awiri akulu kwambiri osasinthika azaka za zana la makumi awiri zapitazo - DCCT (Diabetes Control and Complication T kesi, 1993) ndi UKPDS (United Kingdom Prospective Diabetes Study, 1998) - atsimikizira motsimikiza phindu la kuyang'anira mwamphamvu kagayidwe kachakudya popewa kukula ndi kusokonekera kwa zovuta za microvascular komanso mwina zazikulu za shuga. matenda a shuga kwa odwala omwe ali ndi matenda amtundu woyamba 1 komanso mtundu wa shuga wa 2. Komabe, odwala okalamba komanso a senile sanaphatikizidwe m'maphunzirowa. Chifukwa chake, funso la chosowa ndipo, koposa zonse, chitetezo chokwanira kukwaniritsa njira yoyendetsera kagayidwe kachakudya ka shuga m'gulu lino la odwala amakhalabe lotseguka.
Chikhumbo chofuna kubwezera anthu odwala matenda ashuga mosavutikira chimayika pachiwopsezo chachikulu chotenga matenda a hypoglycemic. Potengera hypoglycemia, thupi limayendetsa mahomoni oletsa kukakamira (glucagon, adrenaline, norepinephrine, cortisol), omwe amabweza glycemia kuzinthu zofunikira. Komabe, kuwonjezera pakukhazikika pamlingo wa glycemia, mahomoni omwewo ali ndi zotsatirapo zingapo mwatsatanetsatane: hemodynamic, hemorheological, neurological. Mukakalamba, kusintha kotereku kumatha kubweretsa zotsatira zosasinthika: kulowerera kwam'mimba, sitiroko, thromboembolism, mtima arrhythmias, ndipo pomaliza pake, mwadzidzidzi kufa.
Posankha njira zoyenera zolipirira matenda ashuga okalamba, ndikofunikanso kukhala ndi lingaliro la momwe kuchuluka kwa matenda ashuga, omwe amapangidwa pamlingo wina, kungakhudze chiyembekezo cha moyo wa wodwalayo. Mu 1995, kafukufuku wamkulu (The Verona Diabetes Study) adamalizidwa, momwe zimafotokozedwera momwe pafupifupi moyo wamunthu wodwala matenda a shuga a 2 amafupikitsidwira, kutengera zaka zomwe adadwala matenda a shuga (Table 1).
Kuchokera pazomwe zafotokozedwazi zikutsatira kuti ngati T2DM ikuwonongeka ali mwana komanso okhwima, ndiye kuti nthawi ya moyo imachepetsedwa ndi 1.5-2 nthawi. Komabe, ngati DM 2 imayamba kukhala ndi zaka zopitilira 75, ndiye kuti chiyembekezo cha moyo pa izi sichisintha. Izi zili choncho mwina chifukwa chakuti kwakanthawi kochepa, zovuta za shuga komanso zovuta zazikulu za shuga sizikhala ndi nthawi yakukula kapena kufikira magawo ofala. Matenda ophatikizika (a mtima, oncological, ndi ena otero) amakhudzanso chiyembekezo cha moyo.
Pofuna kudziwa zolinga zoyenera za matenda a shuga okalamba, ndikofunikira kulingalira za zochitika za kuzindikira - kukumbukira, kuphunzira, kuzindikira koyenera kwa malingaliro.
Chifukwa chake njira zoyenera kulipira anthu odwala okalamba omwe ali ndi chiyembekezo chotalikirapo (zoposa zaka 10-15) komanso luntha lotetezeka zikuyandikira mfundo zabwino, popeza cholinga chachikulu chothandizira odwala chotere ndikupewa kukula kwa zovuta zam'mimba mwa iwo. Odwala a senile omwe amakhala ndi moyo wocheperako (osakwana zaka 5) komanso nkhawa yayikulu yozindikira, cholinga chachikulu cha chithandizo ndikuwachotsa kapena kuthetsa zizindikiro za hyperglycemia (ludzu, polyuria, ndi zina) ndikutchingira kukula kwa matenda a hypoglycemic, omwe amakwaniritsidwa popanda kuwongolera kwambiri kuchuluka kwa shuga m'magazi . Chifukwa chake, mwa odwala kwambiri glycemic indices amaloledwa (Gome 2).
Kuchepetsa shuga kwa odwala matenda ashuga 2 okalamba
Kuthandizira odwala okalamba omwe ali ndi matenda a shuga 2 nthawi zambiri kumakhala ntchito yovuta kwambiri, chifukwa kumakhala kovuta chifukwa cha kuchuluka kwa matenda okhudzana, kufunikira kwa mankhwala ambiri (polypharmacy), chikhalidwe cha anthu (kusungulumwa, kusowa thandizo, umphawi), kusazindikira kwanzeru, kusaphunzira pang'ono komanso kusamatira kwachithandizo (kutsata pang'ono) )
Mfundo zamakono pankhani ya matenda ashuga 2 okalamba zimakhalabe chimodzimodzi:
- kudya + masewera olimbitsa thupi,
- mankhwala akumwa a hypoglycemic,
- insulin kapena kuphatikiza mankhwala.
Mfundo zazikuluzikulu za zakudya za odwala omwe ali ndi matenda a shuga a 2 pakukalamba sizisiyana ndi zomwe zimalimbikitsidwa kwa odwala achinyamata - kuletsa kudya kwa caloric kupatula zakudya zamafuta ochepa. Koma ngati wodwalayo sangathe kutsatira malangizo a kadyedwe chifukwa cha msinkhu kapena chikhalidwe cha anthu (chomwe chatchulidwa pamwambapa), ndiye kuti simuyenera kukakamira izi.
Kuchita masewera olimbitsa thupi ndi gawo lofunikira pothandizira odwala omwe ali ndi matenda amtundu wa 2, popeza amathandizira kudziwa zotumphukira kwa insulin, kuchepetsa insulin, kuchepetsa kuchepa kwa magazi a seramu, komanso kutsitsa magazi. Magulu olimbitsa thupi amasankhidwa kwa wodwala aliyense payekhapayekha, poganizira zovuta zake komanso zovuta za matenda ashuga. Malangizo omwe amakonda kwambiri ndi kuyenda kwa mphindi 30-60 tsiku lililonse kapena tsiku lililonse. Mitengo yotalikirapo siyikulimbikitsidwa chifukwa chowopsa cha matenda amtima kapena matenda a hypoglycemia.
Mankhwala a Oral hypoglycemic
- Kukonzekera kwa Sulfonylurea (glyclazide, glycidone, glipizide, glimepiride, glibenclamide)
- Meglitinides (repaglinide) ndi ma phenylalanine (nateglinide)
- Biguanides (metformin)
- Pangamira (pioglitazone, rosiglitazone)
- Zoletsa za a-glucosidase (acarbose)
Mukamasankha mtundu umodzi kapena umodzi wa mankhwala, ndikofunikira kulingalira zomwe zimapangitsa kuti matenda ashuga amtundu wa 2 azikhala ndi wodwalayo.
Mankhwala ochepetsa shuga kwambiri mwa okalamba omwe ali ndi matenda a shuga a 2 ayenera kukwaniritsa zofunikira zingapo, zomwe sizoyenera kuvulaza.
Zofunikira za mankhwala ochepetsa shuga mwa okalamba omwe ali ndi matenda a shuga a 2:
- Chiwopsezo chochepa cha hypoglycemia
- Kuperewera kwa nephrotoxicity
- Kuperewera kwa hepatotoxicity
- Kuperewera kwa mtima
- Kupanda kuyanjana ndi mankhwala ena
- Kugwiritsa ntchito bwino (nthawi 1-2 patsiku)
Njira yayikulu yogwiritsira ntchito gululi la mankhwalawa ndikulimbikitsa chinsinsi cha maselo a pancreatic beta. Gulu lokonzekera sulfonylurea lolembetsedwa ndikugwiritsidwa ntchito ku Russia limayimilidwa ndi zinthu zisanu zosasunthika, chilichonse chomwe chili ndi mawonekedwe ake ndi niche yogwiritsira ntchito (Table 3).
Zotsatira zoyipa kwambiri za kukonzekera kwa sulfonylurea kwa okalamba ndi kukula kwa hypoglycemia. Kuopsa kwa kukhala ndi hypoglycemia kumatengera nthawi yomwe mankhwalawo ali ndi mphamvu komanso magwiritsidwe ake a kagayidwe. Kutalika kwa theka la moyo wa mankhwalawo, kumakhala pachiwopsezo chachikulu chotenga hypoglycemia Mosakayikira, kukonzekera kwa sulfonylurea komwe kumapangidwira makamaka ndi chiwindi (glycvidone) kapena kuchotseredwa ndi impso ngati metabolites (glyclazide) yomwe ili ndi chiopsezo chochepa chokhala ndi machitidwe a hypoglycemic. Matenda amtunduwu samawopseza kuchuluka kwa mphamvu ya shuga ndipo motero, chitukuko cha hypoglycemia ngakhale ndi kuchepa kwapang'onopang'ono kwa kusefukira kwa impso. Chifukwa chake, makonzedwe akuti "Gliclazide" ndi "Glicvidon" angagwiritsidwe ntchito mwa okalamba ngakhale pakhale kulephera kwapakati pamiyendo (serum creatinine mpaka 300 μmol / l). Zowonjezera zina mwa odwala okalamba adalandira mawonekedwe atsopano a mankhwalawa - gliclazide-MV (kumasulidwa pang'onopang'ono).Kukhala ndi machitidwe omwewo a pharmacokinetic monga gliclazide yachilendo (kuchotsa hafu ya moyo, mawonekedwe a metabolic), gliclazide-MB, chifukwa cha kudzazidwa kwina kwa hydrophilic kwa membrane wamankhwala, amamasulidwa pang'onopang'ono ndikulowetsedwa m'magazi kwa maola 24, potero amakhala akusungidwa kosalekeza kwa mankhwala m'magazi masana. Chifukwa chake, mankhwalawa amatha kumwa kamodzi kokha patsiku, osawopa chitukuko cha hypoglycemic. Mayeso a khungu la multicenter-blind-gliclazide-MB, omwe mankhwalawa adalandiridwa kwa miyezi 10 kwa odwala pafupifupi 1 miliyoni ndi odwala matenda a shuga a 2, adawonetsa chitetezo chokwanira komanso kuthamanga kwa gliclazide-MB mwa okalamba. Pafupipafupi zochitika za hypoglycemic mwa odwala azaka zopitilira 75 sizinapitirire milandu 0.9 mwa odwala 100 pamwezi (P. Drouin, 2000). Kuphatikiza apo, kugwiritsidwa ntchito kamodzi kwa mankhwalawa masana kumawonjezera kutsatira (kutsatira) kwa odwala okalamba omwe ali ndi matenda a shuga a mtundu wachiwiri.
Ili ndi gulu latsopanoli la mankhwala okhudzana ndi zopatsirana za insulin. Mu gululi, pali mitundu ina ya benzoic acid - repaglinide komanso zochokera ku amino acid phenylalanine - nateglinide. Makhalidwe apamwamba a pharmacokinetic a mankhwalawa amayambira mwachangu kwambiri (mkati mwa mphindi zoyambirira pambuyo pa utsogoleri), kuchotsedwa kwakanthawi theka (moyo wa 30-60) ndi nthawi yayifupi (mpaka maola 1.5). Ndi mphamvu ya zotsatira za hypoglycemic, amafanana ndi kukonzekera kwa sulfonylurea. Cholinga chawo chachikulu ndikuchotsa nsonga za hyperglycemia, kotero dzina lina la gululi ndiwowongolera glycemic. Kuyamba mwachangu kotereku komanso nthawi yayitali yogwiritsira ntchito mankhwalawa imapangitsa kuti azitenga nthawi yomweyo musanadye kapena nthawi yodyera, ndipo kudya kwawo kumakhala kofanana ndi kuchuluka kwa zakudya.
Poganizira za matenda a matenda a shuga a mtundu wachiwiri okalamba, monga, kuchuluka kwambiri kwa matenda a postprandial glycemia, zomwe zimayambitsa kufa kwakukulu kwa odwala chifukwa cha zovuta zamtima, kukhazikitsidwa kwa mankhwala a gululi ndikoyenera kwa odwala okalamba. Komabe, wodwala yemwe amalandila chithandizo ndi mankhwalawa ayenera kuphunzitsidwa bwino ndikusunga ntchito zomwe zingamuthandize kupewa zolakwa pakugwiritsa ntchito mankhwalawa.
Metformin ndi mankhwala okhawo a biguanide ovomerezeka kuti agwiritsidwe ntchito kwachipatala. Njira yotsogola yogwiritsira ntchito mankhwalawa ndikuchepetsa mphamvu ya gluconeogeneis m'chiwindi, motero, kuchepetsa kutulutsa kwa glucose chiwindi (makamaka usiku). Metformin imawonetsedwa makamaka kwa odwala onenepa kwambiri omwe amakhala ndi hyperglycemia yofulumira. Metformin siimapangidwa ndi chiwindi ndikuwachotsa impso osasinthika. Kwa odwala okalamba, metabolism ya metformin imachedwetsedwa chifukwa cha kuchepa kwapakati paubongo. Metformin siyimayambitsa kutengeka kwa hypoglycemic - iyi ndi mwayi wake pamankhwala omwe amalimbikitsa kutulutsa insulin. Choopsa chachikulu chokhudzana ndi kugwiritsa ntchito metformin ndikuthekera kwa kukhazikitsidwa kwa lactic acidosis. Chifukwa chake, mikhalidwe yonse yotsatana ndi kuchuluka kwa mapangidwe a lactate (kusakhazikika kwa angina, kulephera kwa mtima, kulephera kwa impso ndi chiwindi, kulephera kupuma, kuchepa magazi, matenda opatsirana pachimake, kumwa mowa mwauchidakwa) ndi kutsutsana kugwiritsa ntchito metformin. Mu okalamba omwe ali ndi zaka zopitilira 70, chifukwa cha kuchepa kwa ntchito kwa aimpso, kugwiritsa ntchito metformin sikofunikira.
Ili ndi gulu latsopanoli la mankhwala omwe limagwirira ntchito yake ikufuna kuthana ndi zotumphukira insulin ndipo, choyamba, kukulitsa chidwi cha insulin m'misempha ndi minofu ya adipose. Pakadali pano, mankhwala awiri ochokera pagululi aloledwa kugwiritsa ntchito kuchipatala - pioglitazone ndi rosiglitazone. Thiazolidinediones simalimbikitsa kubisika kwa insulini ndi kapamba, chifukwa chake, samayambitsa mikhalidwe ya hypoglycemic.Kuchita bwino kwa mankhwalawa kumawonetsedwa mwa odwala omwe ali ndi zizindikiro zosavuta za insulin. Ubwino wowonjezera wa glitazone mankhwala ndi kuchepa kwa serum atherogenicity chifukwa kuchepa kwa triglycerides komanso kuwonjezeka kwa kachulukidwe kakakulu kwa choleopolotein.
Thiazolidinediones imapukusidwa mu chiwindi ndikuchotseredwa kudzera m'mimba. Kutsutsana kwa kagwiritsidwe ntchito ka gulu la mankhwalawa ndi matenda a chiwindi (kuwonjezeka kwa hepatic transaminases nthawi zopitilira 2). Mankhwalawa ndi glitazones, kuwunika kuyenera kwa ntchito ya chiwindi (transaminases) kumafunika kamodzi pachaka.
Kwa odwala okalamba, phindu la glitazone mankhwala ndi kusowa kwa hypoglycemia, kusintha kwa mawonekedwe a serum lipid komanso kuthekera kwa mlingo umodzi masana.
Kapangidwe kake ka mankhwalawa ndikutchinga matenda am'mimba a glucosidase, omwe amasokoneza kuwonongeka kwa polysaccharides ku chakudya kupita ku monosaccharides. Mwanjira yama polysaccharides, ma carbohydrate sangatengeke m'matumbo ang'onoang'ono, chifukwa chomwe amalowa m'matumbo ndikuchotsedwa osadziwikanso. Chifukwa chake, kuchuluka kwa glycemia kwa postprandial kumalepheretsedwa. Mankhwala a gululi amaphatikizapo acarbose ndi miglitol. Mankhwalawa amayikidwa nthawi zambiri ndi zakudya, chifukwa samachita "pamimba yopanda kanthu". Ubwino wa gululi la mankhwalawa umaphatikizapo chitetezo chogwiritsidwa ntchito - kusowa kwa hypoglycemia, zotsatira zoyipa ku chiwindi ndi impso. Komabe, odwala ambiri amawona kulekerera kosapatsa chithandizo kwakanthawi yayitali ndi mankhwalawa. Odwala amakhudzidwa ndi kuphwanyika, kutsegula m'mimba, ndi kuwonetsa kwina kwam'mimba komwe kumachitika chifukwa cha kulowa kosagwirizana ndi chakudya chamafuta osagonjetseka m'matumbo akulu. Kuchita bwino kwa gululi la mankhwalawa sikokwanira kwambiri ngati agwiritsidwa ntchito ngati monotherapy. Chifukwa chake, kulekerera kosavomerezeka kwa a-glucosidase inhibitors ndi kufunika kwa Mlingo wambiri samalola kuti mankhwalawa agwiritsidwe ntchito ngati chisankho choyambirira chothandizira odwala okalamba omwe ali ndi matenda a shuga a mtundu wachiwiri.
Ngati mankhwala omwe ali ndi mankhwala amkamwa a hypoglycemic ndi osathandiza, ndikofunikira kuti mupereke insulin, kaya ndi monotherapy, kapenanso mapiritsi.
Njira za insulin mankhwala zingakhale zosiyanasiyana:
- jekeseni imodzi ya insulin ya sing'anga nthawi yayitali musanagone - ndi kusala kudya kwambiri kwa hyperglycemia,
- Malangizo angapo a jakisoni wafupikitsa insulin musanadye chakudya chachikulu komanso nthawi yayitali insulin musanagone - ndi kudya kwambiri kwa hyperglycemia,
- awiri jekeseni wa insulin - asanadye chakudya cham'mawa komanso asanagone,
- jakisoni awiri a ma insulin osakanikirana omwe amakhala osakanikirana pakanthawi kochepa komanso pakati pa insulini poyerekeza 30:70 kapena 50:50,
- Malangizo angapo a jakisoni wafupikitsa insulin musanadye chakudya chachikulu komanso nthawi yayitali insulin musanagone.
Odwala okalamba omwe ali ndi zotsalira zobisika zamkati wa insulin (C-peptide ndizabwinobwino), koma monotherapy yokhala ndi mankhwala a piritsi satha, ndikofunikira kupaka kuphatikiza kwa insulin ndi othandizira am'mlomo.
Odwala okalamba omwe ali ndi matenda a shuga a mtundu wachiwiri ndi ambiri odwala omwe wodwala matenda ashuga amakumana nawo.Kudziwa mawonekedwe a chipatalachi, kuwunika ndi kuwachiritsa omwe ali m'gulu ili la odwala ndikofunikira kuti apereke chithandizo choyenera kwa odwala awa, omwe chiwerengero chawo chikukula chaka ndi chaka. Kuwerenga mavuto a okalamba, wodwala matenda ashuga amakhala katswiri pofalikira, popeza panthawi imodzimodziyo amawongolera zovuta za metabolic, amadziwa mavuto a mtima, neurology, nephrology ndi madera ena azachipatala. Tsoka ilo, ngakhale pakadali pano pali mipata yambiri pakumvetsetsa mawonekedwe a chiwalo chokalamba, chidziwitso chomwe chingathandize bwino kupereka chithandizo chamankhwala kwa okalamba, kuthana ndi kusintha kwokhudzana ndi zaka ndikukhalitsa miyoyo ya anthu.
Fomu (metformin) - Mlingo wa mankhwala
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