Sayansi Yamagetsi Yowerengera Zolemba pa Sayansi Yofalitsidwa ndi nyumba yosindikiza ya Russian Academy of Natural Science
Matenda a shuga amapezeka pamaso pa makolo athu olemala, uwu ndi mtundu wa matenda oyamba ndi achiwiri. Koma ngakhale atakhala kuti ali ndi vuto la chibadwa, kukula kwa matenda oonekeratu kumafunikira zinthu zoyambitsa kukopa. Kukula kwake kumasiyana mitundu 1 ndi 2:
- Mtundu woyamba. Nthawi zambiri ana ndi achinyamata amadwala. Nthawi zambiri, mawonetsedwe oyamba amapezeka pambuyo pa matenda: mumps, chimfine, hepatitis, rubella. Monga cholimbikitsa pakukula, poyizoni ndi mankhwala, poizoni, mankhwala ophera tizilombo atha kukhala. Zina mwazomwe zimayambitsa ndondomeko ya autoimmune. Izi zimawabweretsa kuwonongeka kwawo komanso kuperewera kwenikweni kwa insulin. Kuwonekera kumachitika ndi kuwonongeka kwathunthu kwa magwiridwe antchito.
- Mtundu wachiwiri. Amakhala pafupifupi 90% ya milandu yonse. Kunenepa kwambiri kumayamba. Mwanjira imeneyi, insulin yokwanira imapangidwa, koma minyewa imatha kumverera nayo.
Kuwonongeka kwa kuyankha kwa mahomoni achuma:
- atherosulinosis
- matenda oopsa komanso ochepa matenda oopsa,
- mavuto
- kusowa kwa fiber mu chakudya,
- kuchuluka kwa zakudya zamafuta,
- metabolic mankhwala
- kutupa kwa kapamba,
- polycystic ovary syndrome,
- zosintha zokhudzana ndi zaka mthupi pambuyo pa zaka 50.
Kupitilira Pangozi Zangozi Kwa amayi, chiwopsezo cha matenda a shuga chimawonjezeka panthawi yomwe ali ndi pakati. Matenda a shuga oterewa amatchedwa gestational ndikudziwonekera panthawi yobala mwana, koma ngati kuphwanya malangizo pazakudya ndi zochitika zolimbitsa thupi, kumasintha ndi shuga.
Kupewa matenda ashuga mwa akazi:
- gwiritsitsani chakudya
- sinthani zolimbitsa thupi, ngati mungachulukitse, onetsetsani kuti zachepera
- osachepera kasanu pa sabata kuti muchite zochizira, kuyenda, kusambira, kuthamanga,
- Chotsani nkhawa
- lekani zizolowezi zoyipa.
Muubwana mtundu waukulu wa matenda ndi woyamba - shuga wodalira insulin. Popeza ndi matenda obadwa nawo, Mwana akuwonetsedwa mayeso a:
- antibodies to pancreatic minofu,
- insulin, C-peptide ndi proinsulin,
- kulolerana kwa shuga
- glycated hemoglobin,
- matupi a ketone m'mwazi ndi mkodzo.
Kuwopsa kwa matenda oterewa kwa ana otere. Amawonetsedwa immunoprophylaxis pogwiritsa ntchito interferon ndi ma immunocorreector. Asanaikidwe a immunostimulants, katemera ndi masamu, kuyezetsa kokwanira kumafunikira, kuphatikiza mayeso opsinjika.
Popeza kutupa kwa autoimmune kumabweretsa chitukuko patsogolo, cyclosporin imayikidwa ngati ma antibodies apezeka pamagetsi apamwamba. Ndi kuyamba koyambirira kwa mankhwalawa, nthawi zina zimakhala zotheka kuletsa matendawa kapena kuchedwetsa kuonekera kwa woyamba chizindikiro kwa nthawi yayitali.
Chinanso chomwe chimayambitsa kusokonekera kwa kagayidwe kachakudya ndi kudyetsa ana. Izi ndichifukwa choti protein ya mkaka wa ng'ombe ndi yofanana m'mapangidwe a mapuloteni a pancreatic. Izi zimadzetsa kuti ma cell a chitetezo samazindikira tinthu tating'onoting'ono ngati tomwe timayamba, ndikuyamba kuwononga. Chifukwa chake mkaka wa m'mawere ndi wofunikira kwambiri kwa ana omwe ali ndi vuto lakelo.
Mwa amuna, chofunikira kwambiri popewa matenda Ndi chakudya choletsedwa ndi mafuta zamafuta a nyama, zokazinga, zamafuta ndi zonunkhira, zakumwa zoledzeretsa.
Kupewa matenda ashuga oyamba kumayambaDziwani izi:
- cholowa
- kunenepa kwambiri
- matenda ophatikizika
- zizolowezi zoipa
- zaka
- kukonzekera pakati
- kulolerana kwa shuga.
Ngati wodwalayo ali m'gulu la owopsa, ndiye kuti akuwonetsedwa:
- kupatula mafuta osavuta (shuga ndi ufa woyera), zoletsa zamafuta a nyama,
- zolimbitsa thupi, nthawi yayitali ndi mphindi 150. pa sabata. Makalasi ayenera kuchitika,
- Matenda a kulemera kwa thupi. Kwa iye, muyenera kuwerengera zam'kalori za zakudya, kukumbukira mtengo wake, glycemic index, kuthera tsiku limodzi pa sabata,
- kuchepetsa nkhawa - kudziwa njira zopumira, masewera olimbitsa thupi, yoga,
- kupewa kulumikizana ndi odwala pa miliri,
- kusiya kusuta fodya komanso kumwa mowa.
Prophylaxis yachiwiri imagwira ntchito kwa odwala omwe ali ndi matenda ashuga. Cholinga chake ndikuletsa kapena kuchedwetsa kukula kwa mitsempha ndi mitsempha. Kuti muchite izi, muyenera:
- Magazi amawongolera
Nthawi zonse amayang'anira kuchuluka kwa shuga m'magazi, glycated hemoglobin, - kukulitsa zida zanu zamafuta ndi mafuta momwe zimapangidwira, kukhalabe ndi kuthamanga kwa magazi,
- kutsatira malamulo a zakudya,
- kusintha kwa nthawi ya mlingo wa insulin ndi mapiritsi kuti muchepetse shuga, ndi kuwonongeka kwa matenda ashuga kapena matenda akulu amkati (mosasamala mtundu), insulin yolimbitsa imasonyezedwa.
Kupewa matenda a shuga
- retinopathy (kuwonongeka kwa retina)
- nephropathy (matenda aimpso)
- ma neuropathies (phazi la matenda ashuga, kukanika kwa zinthu),
- angiopathies (magazi achepetsa magazi kupita ku miyendo, ziwalo zamkati ndi ubongo).
Njira zodzitetezera:
- khalani oyang'aniridwa ndi akatswiri a endocrinologist ndi akatswiri okhudzana ndi izi (dokotala wa maopaleshoni, ofufuza za m'mitsempha, wamtima wamatenda, neuropathologist),
- Osati kuphwanya mawu a kukonzedwa bwino ndikudziyang'anira nokha glycemia, kuthamanga kwa magazi,
- amalipira kusintha kwa chakudya chamafuta ndi mafuta metabolism ndi mankhwala,
- kutenga maphunziro a kuchipatala panthawi yake, kuphatikizapo opaleshoni, kukonzanso m'malo opangira ma sanatorium posowa zotsutsana,
- kupatula vuto lililonse pakudya, zizolowezi zoipa.
Zakudya zamatenda a metabolic ndizofunikira kuvomereza. Ngati odwala matenda ashuga ayenera kuganizira kuchuluka kwa chakudya (magawo a mkate) kuti awerenge kuchuluka kwa insulin, index ya glycemic, ndiye kuti kwa odwala ena omwe ali ndi chiyembekezo cha matendawa, ndikokwanira kuchotsa zakudya zoletsedwa pamenyu. Izi zikuphatikiza:
- makeke a batala kapena mkate wowotchera, buledi wochokera ku ufa woyera,
- ma cookie, waffles, mkate kapena makeke,
- shuga, maswiti, wokondedwa,
- zakumwa zoledzeletsa ndi shuga,
- timadziti tambiri, timadzi tokoma, koloko yabwino,
- kupanikizana, kusunga, madzi
- ayisikilimu, mchere,
- zokhwasula-khwasula, zopaka, tchipisi, chakudya chofulumira,
- zipatso, mphesa, mphesa, nkhuyu,
- misika yogula, zakudya zokonzedwa, zakudya zamzitini,
- pasitala, mpunga woyera, semolina,
- nsomba zosambirira, zamchere
- nyama yamafuta, mafuta akunja, masoseji,
- kanyumba tchizi ndizokwera kuposa 9% mafuta, kirimu wowawasa ndi zonona kuchokera 10%.
Gwero la mapuloteni ndi nkhuku komanso nsomba zotsamira. Amaphika kapena kuwotcha, kudyedwa ndi saladi zamasamba atsopano. Analimbikitsa zakumwa za mkaka wowawasa zopangidwa ndi nyumba, tchizi chokoleti cha mafuta ambiri. Zakudya zomanga thupi - kuchokera ku zipatso, mbewu monga chimanga, masamba. Ndi chizolowezi chodzimbidwa, chinangwa chouma chimakhala chothandiza kuphala kapena mkaka.
Werengani nkhaniyi
Mtundu woyamba
Nthawi zambiri ana ndi achinyamata amadwala.Nthawi zambiri, mawonetsedwe oyamba amapezeka pambuyo pa matendawa: mumps, chimfine, hepatitis, rubella. Monga cholimbikitsa pakukula, poyizoni ndi mankhwala, poizoni, mankhwala ophera tizilombo atha kukhala.
Chilichonse mwazinthu izi zimayambitsa dongosolo la autoimmune, chifukwa chomwe ma antibodies amapangidwa m'thupi motsutsana ndi maselo a kapamba awo. Izi zimawabweretsa kuwonongeka kwawo komanso kuperewera kwenikweni kwa insulin. Kuwonetsedwa kwa matendawa kumachitika ndi chiwonongeko chotheratu pafupifupi chogwira ntchito.
Ndipo pali zambiri zokhudza matenda a shuga kwa ana.
Mtundu wachiwiri
Chimakonda odwala ambiri, chimakhala pafupifupi 90% ya milandu yonse. Pakati pazifukwa zonse za kukula kwake, kunenepa kwambiri kumayamba. Kuphwanya carbohydrate ndi mafuta metabolism ndi olemetsa, zomwe zimayambitsa kuwoneka mwachangu kwa zovuta zama mtima.
Njira yayikulu pakuwonekera kwa zovuta za metabolic ndikupeza insulin kukana. Ndiko kuti, insulin yokwanira imapangidwa, koma minyewa imatha kuzindikira. Kuwonongeka kwa kuyankha kwa mahomoni achuma:
- atherosulinosis
- matenda oopsa komanso oopsa oopsa oopsa,
- Nthawi zambiri imakumana ndimavuto
- kusowa kwa CHIKWANGWANI m'zakudya, kuchuluka kwa zakudya zam'matumbo - zopangidwa ndi ufa ndi maswiti,
- ntchito kwa nthawi yayitali mankhwala osokoneza kagayidwe kachakudya - prednisone ndi analogues, okodzetsa, mankhwala ena amapanikizika, levothyroxine, antitumor,
- kutupa kwa kapamba,
- polycystic ovary syndrome,
- zosintha zokhudzana ndi zaka mthupi pambuyo pa zaka 50.
Njira Zopewera Kudwala
Kutengera zaka za odwala komanso jenda, pali zosiyana zina zomwe muyenera kuwunika mukamakonzekera zochitika zopewa matenda ashuga.
Kuphatikiza pa zowopsa zomwe zimachitika kwa azimayi, chiopsezo cha matenda a shuga chimawonjezeka panthawi yomwe ali ndi pakati. Izi ndichifukwa kutulutsidwa kwa placenta ya ma contra-mahormone mahomoni (kuletsa zochitika za insulin). Matenda a shuga oterewa amatchedwa gestational ndikudziwonekera panthawi yobala mwana, koma ngati kuphwanya malangizo pazakudya ndi zochitika zolimbitsa thupi, kumasintha ndi shuga.
Popewa chitukuko chake:
- gwiritsitsani chakudya
- sinthani zolimbitsa thupi, ngati mungachulukitse, onetsetsani kuti zachepera
- osachepera kasanu pa sabata kuti muchite zochizira, kuyenda, kusambira, kuthamanga
- Chotsani nkhawa
- lekani zizolowezi zoyipa.
Muubwana, matenda oyamba ndi matenda a shuga omwe amadalira insulin. Popeza zimawoneka m'mabanja omwe kholo limodzi kapena onse ali ndi matenda ashuga, kapena pali matenda omwe ali pachibale. kenako mwana akuwonetsedwa kuti ayese:
- antibodies to pancreatic minofu,
- insulin, C-peptide ndi proinsulin,
- kulolerana kwa shuga
- glycated hemoglobin,
- matupi a ketone m'mwazi ndi mkodzo.
Kuwopsa kwa matenda oterewa kwa ana otere. Amawonetsedwa immunoprophylaxis pogwiritsa ntchito interferon ndi ma immunocorreector. Asanaikidwe a immunostimulants, katemera ndi masamu, kuyezetsa kokwanira kumafunikira, kuphatikiza mayeso opsinjika.
Popeza kutupa kwa autoimmune kumabweretsa chitukuko patsogolo, cyclosporin imayikidwa ngati ma antibodies apezeka pamagetsi apamwamba. Ndi kuyamba koyambirira kwa mankhwalawa, nthawi zina zimakhala zotheka kuletsa matendawa kapena kuchedwetsa kuonekera kwa woyamba chizindikiro kwa nthawi yayitali.
Chinanso chomwe chimayambitsa kusokonekera kwa kagayidwe kachakudya ndi kudyetsa ana. Izi ndichifukwa choti protein ya mkaka wa ng'ombe ndi yofanana m'mapangidwe a mapuloteni a pancreatic. Izi zimadzetsa kuti maselo oteteza chitetezo samazindikira tinthu tating'ono tating'ono ngati tomwe timayamba ndikuwononga. Chifukwa chake, kwa ana omwe ali ndi vuto lobadwa ndi matenda ashuga, mkaka wamawere ndichofunikira kwambiri.
Kuyamwitsa
Chofunika kwambiri popewa matenda ndichakudya chopatsa thanzi zamafuta a nyama, yokazinga, mafuta onunkhira komanso zakudya zazonunkhira, komanso zakumwa zoledzeretsa. Mowa wa Ethyl samangosintha momwe thupi limayankhira kwa zakudya zomwe zimatengedwa, komanso limasokoneza chiwindi, chomwe ndi chiwalo chomwe chitha kukhudzanso kuchuluka kwa shuga m'magazi.
Ngozi yapadera imakhalapo mukamamwa vinyo wotsekemera, zakumwa zoledzeretsa, ndi zakumwa zokhala ndi shuga. Amabweretsa kusintha kwakukuru mu glucose, zovuta pakusankha kuchuluka kwa mankhwala ochepetsa shuga. Ngati mumamwa mowa, chiwopsezo cha zovuta za mitsempha cha matendawa chimakula kwambiri.
Mitundu ya njira zodzitetezera
Pofuna kupewa kukula kwa matenda ashuga, zotsatira zake, magawo angapo a kupewa apangidwa.
Cholinga chake ndi kuchepetsa ngozi ya matenda ashuga. Kwa iye, zinthu zoyesereratu zimadziwika:
- cholowa
- kunenepa kwambiri
- matenda ophatikizika
- zizolowezi zoipa
- zaka
- kukonzekera pakati
- kulolerana kwa shuga.
Ngati wodwalayo ali m'gulu la owopsa, ndiye kuti akuwonetsedwa:
- kupatula mafuta osavuta owonjezera m'zakudya (shuga ndi ufa woyera) ndi kuletsa kwa mafuta a nyama,
- kuchita zolimbitsa thupi. Kutalika kochepa kwamitolo sabata limodzi ndi mphindi 150. Makalasi ayenera kuchitika, ndi kulolera bwino, kulimba pang'onopang'ono,
- Matenda a kulemera kwa thupi. Kuti mupeze izi, muyenera kuwerengera zakudya zomwe mumadya, ndikuganizira kuchuluka kwa mphamvu zamagetsi, gwiritsani ntchito cholembera cha glycemic (kuthekera kochulukitsa kwambiri kuchuluka kwa shuga), konzekerani tsiku losala kudya kamodzi pa sabata.
- kuchepetsa nkhawa - kudziwa njira zopumira, masewera olimbitsa thupi, yoga,
- kupewa kulumikizana ndi odwala pa miliri,
- kusiya kusuta fodya komanso kumwa mowa.
Onani vidiyo yokhudza kupewa matenda ashuga:
Ntchito kwa odwala omwe kale ali ndi matenda ashuga. Cholinga chake ndikuletsa kapena kuchedwetsa kukula kwa mitsempha ndi mitsempha. Kuti muchite izi, muyenera:
- Nthawi zonse amayang'anira kuchuluka kwa shuga m'magazi, glycated hemoglobin,
- kukulitsa zida zanu zamafuta ndi mafuta momwe zimapangidwira, kukhalabe ndi kuthamanga kwa magazi,
- kutsatira mosamalitsa malamulo a zakudya, popeza mukamadya zakudya zoletsedwa, shuga amapezeka mofulumira, ndipo zotsatira za mankhwala zimachitika pakapita kanthawi,
- kusintha kwa nthawi ya mlingo wa insulin ndi mapiritsi kuti muchepetse magazi, ndi kuwonongeka kwa matenda ashuga kapena matenda oopsa a ziwalo zamkati (mosasamala mtundu), insulin yimalimbikitsidwa.
Amagwiritsidwa ntchito ngati vuto la matenda:
- retinopathy (kuwonongeka kwa retina)
- nephropathy (matenda aimpso)
- ma neuropathies (phazi la matenda ashuga, kukanika kwa zinthu),
- angiopathy (kuchepa kwa magazi kufikira miyendo, ziwalo zamkati ndi ubongo).
Zina mwazonse zomwe zimachitika chifukwa cha matenda ashuga zimatha kukhala ndizovuta kusintha. Kuti mupewe izi, muyenera:
- khalani oyang'aniridwa ndi akatswiri a endocrinologist ndi akatswiri okhudzana ndi izi (dokotala wa maopaleshoni, ofufuza za m'mitsempha, wamtima wamatenda, neuropathologist),
- Osati kuphwanya mawu a kukonzedwa bwino ndikudziyang'anira nokha glycemia, kuthamanga kwa magazi,
- amalipira kusintha kwa chakudya chamafuta ndi mafuta mothandizidwa ndi zovuta mankhwala othandizira,
- kutenga maphunziro a kuchipatala panthawi yake, kuphatikizapo opaleshoni, kukonzanso m'malo opangira ma sanatorium posowa zotsutsana,
- kupatula vuto lililonse pakudya, zizolowezi zoipa.
Zakudya Zopewera Matendawa
Zakudya zamatenda a metabolic ndizofunikira kuvomereza. Ngati odwala matenda ashuga ayenera kuganizira kuchuluka kwa chakudya (magawo a mkate) kuti awerenge kuchuluka kwa insulin, index ya glycemic, ndiye kuti kwa odwala ena omwe ali ndi chiyembekezo cha matendawa, ndikokwanira kuchotsa zakudya zoletsedwa pamenyu. Izi zikuphatikiza:
- makeke a batala kapena mkate wowotchera, buledi wochokera ku ufa woyera,
- ma cookie, waffles, mkate kapena makeke,
- shuga, maswiti, wokondedwa,
- zakumwa zoledzeletsa ndi shuga,
- timadziti tambiri, timadzi tokoma, koloko yabwino,
- kupanikizana, kusunga, madzi
- ayisikilimu, mchere,
- zokhwasula-khwasula, zopaka, tchipisi, chakudya chofulumira,
- zipatso, mphesa, mphesa, nkhuyu,
- misika yogula, zakudya zokonzedwa, zakudya zamzitini,
- pasitala, mpunga woyera, semolina,
- nsomba zosambirira, zamchere
- nyama yamafuta, mafuta akunja, masoseji,
- kanyumba tchizi ndizokwera kuposa 9% mafuta, kirimu wowawasa ndi zonona kuchokera 10%.
Zomwe zimapanga mapuloteni ndi nkhuku komanso nsomba zotsamira. Amaphika kapena kuwotcha, kudyedwa ndi saladi zamasamba atsopano. Analimbikitsa zakumwa za mkaka wowawasa zopangidwa kunyumba (kuchokera ku zikhalidwe zamkaka ndi mkaka), tchizi chochepa kwambiri cha kanyumba. Zakudya zomanga thupi zimayenera kupezeka pazipatso, chimanga kuchokera ku mbewu zonse, masamba. Ndi chizolowezi chodzimbidwa, chinangwa chouma chimakhala chothandiza kuphala kapena mkaka.
Kupewa matenda ashuga kumatanthawuza kuzindikira kwa omwe ali pachiwopsezo cha odwala. Ngati pali vuto lotsogola, zakudya, zolimbitsa thupi, kupenda pafupipafupi, kukana zizolowezi zoyipa tikulimbikitsidwa. Mu ana, kuzindikira koyambirira kwa ma antibodies a pancreatic zimakhala ndikuwongolera chitetezo chofunikira ndikofunikira.
Ndipo pali zambiri za mankhwala a Metformin a shuga.
Makanda amafunikira kuyamwitsa kokha. Kwa mtundu wachiwiri wa matenda, cholinga chachikulu ndicho kudya bwino, kuchepetsa kunenepa kwambiri. Pofuna kupewa zovuta za matenda ashuga komanso kupita patsogolo kwawo ndizotheka ndi kukonza magazi.
Kuchita chithandizo cha matenda ashuga mwachizolowezi amaloledwa kwa onse amtundu 1 ndi mtundu 2. Komabe, pokhapokha pakupitiliza mankhwala. Kodi ndi njira ziti zomwe zingagwiritsidwe ntchito? Ndi chithandizo chiti chomwe amalimbikitsa kwa okalamba?
Matenda a matenda ashuga amapewedwa mosasamala mtundu wake. Ndikofunikira mu ana panthawi yomwe ali ndi pakati. Pali zovuta zoyambira ndi sekondale, pachimake komanso mochedwa mu mtundu 1 ndi matenda ashuga 2.
Metformin imakonda kutumikiridwa ndi matenda a shuga a mtundu wachiwiri. Komabe, kugwiritsa ntchito mapiritsi kumaloledwa ngakhale chifukwa chopewa. Mlingo wa mankhwalawa amasankhidwa payekha. Za mphamvu ya mankhwala a Metformin, nthawi yochuluka motani, werengani munkhaniyi.
Nthawi zambiri kubadwa kwa ana kuchokera kwa makolo omwe ali ndi matenda osokoneza bongo kumabweretsa kuti akudwala matenda. Zomwe zimatha kukhala mu matenda a autoimmune, kunenepa kwambiri. Mitundu imagawidwa pawiri - yoyamba ndi yachiwiri. Ndikofunikira kudziwa zomwe zili mu achinyamata ndi achinyamata kuti muzindikire ndikuthandizira panthawi. Pali kuletsa kubadwa kwa ana omwe ali ndi matenda ashuga.
Ngati matenda amtundu wa 2 akhazikika, chithandizo chimayamba ndikusintha kwa zakudya ndi mankhwala. Ndikofunikira kutsatira malingaliro a endocrinologist, kuti muchepetse vutoli. Ndi mankhwala ndi mankhwala atsopano ati amtundu wa shuga omwe mwakumana nawo?
Mutu 10: DIABETES MellITUS: EPIDEMIOLOGY, ZINSINSI ZABWINO, KULAMBIRA
Matenda a shuga mellitus (DM) ndi gulu la matenda a metabolic (metabolic) omwe amadziwika ndi hyperglycemia, akupanga chifukwa cha kuperewera kwa insulin kapena wachibale komanso kuwonetseredwa ndi glucosuria, polyuria, polydipsia, lipid (hyperlipidemia, dyslipidemia), mapuloteni (dysproteinemia) ndi mineral. ) Kusinthana ndi kukula kwa zovuta.
Matenda a shuga ndi vuto lachipatala komanso chikhalidwe cha anthu ndipo ndi chimodzi mwazomwe zakhazikitso zakutsogolo kwa mayiko onse padziko lapansi.Malinga ndi bungwe la akatswiri la WHO, mpaka pano, anthu opitilira 60 miliyoni padziko lonse lapansi ali ndi matenda ashuga, chiwerengerochi chikuchulukanso ndi 6-10% pachaka, ndipo kuwonjezereka kuyenera kuyembekezedwa zaka khumi ndi zisanu mpaka khumi. Pakufunika kwake, matendawa amatenga matenda amtima komanso matenda a oncological.
Oposa 3 miliyoni odwala matenda ashuga adalembetsedwa ku Russia, komabe, zotsatira zakuwongolera ndi kafukufuku wamatenda akuwonetsa kuti chiwerengero chawo sichotsika ndi 9-10 miliyoni. Izi zikutanthauza kuti kwa wodwala mmodzi yemwe sakudziwika samapezeka. Zoposa 130 miliyoni za matenda a shuga zimapezeka ku Russia chaka chilichonse. Kuphatikiza apo, anthu pafupifupi 6 miliyoni aku Russia ali mdziko la prediabetes. Izi zikutanthauza kuti munthuyo sanadwale, koma magazi ake ndi apamwamba kale. Izi zimawonjezera mwayi wokhala ndi matenda ashuga komanso mtima ndi mtima poyerekeza ndi anthu omwe ali ndi shuga. Mtengo wothana ndi matenda ashuga komanso zovuta zake m'maiko otukuka ndizosachepera 10-15% yazabelomali zaumoyo. Malinga ndi IDF, mtengo wochizira komanso kupewa matenda ashuga padziko lonse lapansi mu 2007 udafika 232 biliyoni US dollars, ndipo pofika chaka cha 2025 ukweza mpaka 302,5 biliyoni US dollars. Ku Russia, pafupifupi 15% ya ndalama zonse zaumoyo zimagwiritsidwanso ntchito pakulimbana ndi matenda a shuga, omwe amakhala pafupifupi ma ruble 300 miliyoni pachaka. Nthawi yomweyo, 80% ya ndalama zimagwiritsidwa ntchito polimbana ndi zovuta za matenda ashuga, omwe amatha kupewedwa poyang'ana msanga komanso chithandizo chokwanira cha matendawa. Mtengo wosadziwika wa matenda ashuga - kutayika kwa zokolola, kulumala kwakanthawi, kulumala, kupuma pantchito, komanso kufa msanga - ndizovuta kuyesa. Komanso, matendawa “akucheperachepera” chaka chilichonse, akukhudza anthu ochulukirapo osakwana zaka 40.
Kuchulukana msanga kwa matenda ashuga a mtundu 2 ndi zotsatira zoyipa zakutukuka kwa chitukuko chathu. Kudalirana kwa mayiko padziko lonse lapansi kwadzetsa kusintha kwakukulu mu moyo wamayiko onse popanda izi, chifukwa chafalitsa katundu womalizidwa komanso malo ogulitsa zakudya ponseponse, kusokoneza kapangidwe ka zakudya zopatsa thanzi kwa anthu. Kupitilira patsogolo kwa moyo, kuwonjezereka kwa nkhawa kumapangitsa kuti anthu azikhala ndi nkhawa nthawi zonse, zomwe sizimangokhudza thupi, komanso zimafunikira kuti nthawi zonse "azingidwa" ndi ma calorie ena. Munthu amakono amakhala ndi masewera olimbitsa thupi ochepa, chofunikira kwambiri popewa mavuto ambiri azaumoyo. Panthawiyo, pakufunika kugwirizanitsa mphamvu zamagulu a boma, madotolo, asayansi, ndi ena. kuthana ndi mavuto ambiri omwe amabwera popewa matenda ashuga.
Mtundu I shuga - matenda osachiritsika omwe amayamba chifukwa cha kuperewera kwa insulin kwathunthu chifukwa cha kuperewera kwa kapamba (RV), komwe kumayambitsa kupitirira kwa hyperglycemia komanso kukula kwa zovuta. Pafupipafupi kudziwika ndi 15: 100000 ya anthu. M'badwo womwe ulipo ndi ana ndi achinyamata. Gulu lina la matenda a shuga a Type I limayimiridwa ndi odwala omwe adakwanitsa zaka 35-75 ndipo amadziwika ndi kukhalapo kwa autoantibodies osiyanasiyana ma antigen a pancreatic islet. Poganizira zamankhwala zamtunduwu wa shuga komanso kupezeka kwa ma cytoplasmic ndi ma antibodies ena mu seramu yamagazi mwa odwala oterewa, amatchedwa mtundu wa CDI latent (LADA, latentautoimmunediabetesinadults). LADA imadziwika ndi kuwonongeka pang'onopang'ono kwa mawonekedwe a metabolic komanso kupezeka kwa seramu yamagazi, kuwonjezera pa ma antibodies a cytoplasmic, a autoantibodies kuti glutamate decarboxylase.
Matenda a shuga a II - matenda osachiritsika omwe amayamba chifukwa cha kuchepa kwa insulin (mphamvu ya insulin yotengera insulin yafupika ku insulini yafupika) ndikuwonetsedwa ndi hyperglycemia yopanda chitukuko cha zovuta zovuta.Matenda a shuga a Type II amakhala 90% ya matenda onse a shuga. Pafupipafupi zochitika - 300: 100000 aanthu. M'badwo wopambana ndi zaka zopitilira 40. Wodziwika bwino wamkazi ndi wamkazi. Zomwe zimayambitsa ngozi ndizabadwa komanso kunenepa kwambiri. Matendawa amadziwika ndi kukhalapo kwa zolakwika ziwiri zazikulu za pathophysiological: insulin kukana ndi kusakwanira kwa ntchito ya β-cell kuti athetse kukana kwa insulini pakukulitsa kuchuluka kwa insulin.
Mawu akuti "prediabetes," omwe amagwiritsidwa ntchito kale m'mabuku a Chingerezi, amaphatikiza utsi wofanana ndi vuto la kusala kudya kwa glucose (5.5-6.9 mmol / L), kulolerana kwa glucose (7.8-11.0 mmol / L), ndi metabolic syndrome, molingana ndi muyezo wa Third National Cholesterol Education Program NCEP ndi ATPIII (Adult Treatment Panel).
Kuzindikira kwa metabolic syndrome kumakhazikitsidwa ndi kuphatikiza njira zitatu kapena zingapo, zomwe zimaphatikizapo:
- Kunenepa kwambiri, komwe kumawoneka kuti m'mimba mozungulira (chiuno) kukakhala kwa amuna> 102cm, kwa akazi> 88cm,
- kutsitsa cholesterol ya HDL (mwa amuna 135 / 85mmrt.st kapena kumwa mankhwala a antihypertensive,
--- ndi mulingo wa venous plasma glycemia> 6.1 mmol / l.
Kuti mumvetsetse bwino za matenda ashuga, zotsatirazi ziyenera kumvetsedwa bwino:
1. SD ndi chilengedwe chake ndiwosintha, si imodzi, koma gulu lonse la matenda a metabolic omwe amasiyana kwambiri pakupezeka, etiology, pathogeneis ndi mawonetsedwe azachipatala.
2. Ngakhale kupezeka kwa heterogeneity, matenda onse a shuga amakhala ndi mawonekedwe amodzi - a hyperglycemia wodziwika bwino, yemwe, pakalibe chithandizo choyenera, amakhala ndi chikhalidwe cholimba, chokhazikika. Mosiyana ndi zomwe zimadzetsa nkhawa (nkhawa) ya hyperglycemia, kuchotsedwa kwa chinthu chodzetsa nkhawa (kuchira matenda osachiritsika kapena kuvulala, kukwaniritsidwa kwa chikhululukiro cha matenda a concomitant aakulu, ndi zina zotere) sizibwezera shuga la magazi ku chikhalidwe chathupi.
3. shuga akamaphwanyidwa, osati chakudya chokha, komanso mitundu yambiri ya kagayidwe (mafuta, mapuloteni, mchere, etc.). Izi zimabweretsa kuwonongeka kwakatundu kwa mitsempha yamagazi, zotumphukira zam'mitsempha, chapakati chamanjenje (CNS), komanso kusintha kwa zam'mimba pafupifupi ziwalo ndi ziwalo.
Zomwe zimayambitsa matenda a shuga
Ngakhale kuti palibe zovuta zapadera za matenda ashuga zomwe zidadziwika mpaka pano, pali zomwe zimadziwika kuti ndizoyambitsa matenda. Zomwe zimayambitsa chiopsezo ndi kuphatikiza kwa zinthu zomwe zimawopseza. Kuzidziwa kumathandizira nthawi zina kupanga chithunzithunzi cha matendawa ndi kukula kwa matendawa, ndipo nthawi zina kuchedwa kapena kupewa kuyambika kwa matenda ashuga. Pakalipano, ndikofunikira kulingalira padera pazomwe zingayambitse ngozi za mitundu ya matenda a shuga.
Zomwe Zimayambitsa Matenda A shuga a Type 1
Mtundu woyamba wa matenda a shuga umakhala pafupifupi 5 - 10% ya anthu onse omwe amadziwika ndi matenda ashuga. Mwambiri, adotolo akumana ndi matenda amtundu wa 1.
Pathogenesis wa mawonekedwe okhazikika chitetezo cha mtundu 1 shuga:
2. Kuyambitsa (kuyambitsa) autoimmune njira.
3. Gawo la magwiridwe olimbitsa thupi.
4. Kutsika kwapang'onopang'ono kwa glucose-kolimbikitsidwa ndi insulin secretion (kupeza msomali pachimake mu shuga). Komabe, zovuta izi ndizochulukirapo, ndipo kukula kwa glycemia ndi glucose kulolerana ndi odwala pakadali pano matendawa amakhalanso oyenera.
5. Kwambiri kapena kuwonetsera matenda osokoneza bongo. Ndi chiwonongeko choposa 90% cha ma cell a pancreatic beta, kuchepa kwakukulu kwa insulin katulutsidwe kamakhala thupi, zomwe zimatsogolera ku chiwonetsero (chiwonetsero chazachipatala) cha matenda amtundu 1. Kuwonetsedwa kwa matenda a shuga nthawi zambiri kumakhala kukwiya ndi zowonjezera zomwe zimapangitsa kuti pakhale kupsinjika (matenda okhudzana, zoopsa, ndi zina).
6. Kuwonongedwa kwathunthu kwa maselo a beta.
Zomwe zimayambitsa matenda a shuga 1
● Udindo wa chibadwidwe chokulitsa chitetezo cha mtundu woyamba wa shuga umadziwika bwino. Kudalira kotsimikizika kwazidziwitso za chiopsezo chotenga matenda amtunduwu pa kukhalapo kwa ma antigen ena a histocompatability wodwala (B8, B15, DR3, DR4, etc.) kuwululidwa. Komabe, ziyenera kutsimikiziridwa kuti pamenepa sikuti ndi matenda omwe amabadwa, koma mawonekedwe a chitetezo cha mthupi omwe amatha, pazochitika zina, zimayambitsa (trigger) autoimmune reaction zomwe zimawononga maselo a beta a islets a Langerhans ndikupangitsa kukula kwa matenda ashuga. Ndiye chifukwa chake mapasa okondweretsa, ngakhale atakhala kuti ndi amtundu wathunthu, mwa 50-60% yokha mwa omwe amakhala ndi matenda a shuga 1. Mwanjira ina, popanda zina zoyambitsa (zoyambitsa, zoyambitsa), zovuta zakubereka sizingatheke mu mtundu wa matenda a shuga.
Ngakhale ataphunzira zaka zambiri, palibenso zomwe zimayambitsa zovuta za shuga 1, zomwe zimaphatikizapo zinthu izi:
● Matenda opatsirana ndi ma virus (ma virus a rubella, Coxsackie B, mumps). Chofunika kwambiri ndi matenda omwe amayambitsidwa ndi mwana m'mimba (ubale pakati pa kukula kwa T1DM ndi rubella wobadwa nawo wakhazikitsidwa - ichi ndi chinthu chokhacho chomwe chimagwirizana ndi mtundu wa matenda ashuga 1). Ma virus sangangokhala ndi cytolytic mwachindunji pamaselo a beta a kapamba, komanso (chifukwa cha kulimbikira kwa kachilombo komwe kuli m'maselo), kumayambitsa chitukuko cha zochita za autoimmune zomwe zimawononga zilumba za Langerhans. Kuphatikiza apo, ndikofunikira kudziwa kuti katemera, mosiyana ndi malingaliro omwe alipo, samakulitsa chiopsezo chotenga DM1, monga momwe nthawi yodziwika bwino ya katemera muubwana sichikhudza kukula kwa matenda ashuga a mtundu woyamba.
● Chakudya chopatsa thanzi (mwachitsanzo, kuyambitsa mkaka wa ng ombe ku chakudya chamwana). Mwina izi zikuchitika chifukwa cha ntchito ya protein ya mkaka wa ng'ombe, yomwe ndi gawo la formula wakhanda, komanso kusakhazikika kwazinthu za m'mimba mwa khanda, zomwe sizimalola kupereka cholepheretsa mapuloteni akunja.
● Chinanso chomwe chimapangitsa ndi kupsinjika. Udindo wake pakupanga matenda ashuga amtundu 1 sizodziwikiratu. Chodabwitsa cha kuchepa (i.e. chosakhalitsa) hyperglycemia (kuchuluka kwa shuga m'magazi) mwa ana motsutsana ndi maziko omwe ali ndi vuto lalikulu. Kupitilira apo, pakuchotsa zovuta, kuchuluka kwa shuga m'magazi kumabweranso kwawoko, ndikuwunikira kowonjezereka (kutsimikiza kwa kuchuluka kwa ma antibodies enieni) sikuwululira kupatuka kwina kulikonse. Koma ndikofunikira kukumbukira kuti kumayambiriro kwa matenda ashuga a mtundu woyamba, kupsinjika kungathe kuwonetsa matendawa, kotero kuyezetsa koyenera ndikofunikira.
Sianthu onse omwe ali ndi kachilombo ka HIV kapena odyetsa makanda omwe amakhala ndi mtundu woyamba wa matenda ashuga. Kuti izi zitheke, kuphatikiza zinthu zingapo koyenera ndikofunikira, kupezeka kwa kubadwa mwatsopano.
Zowopsa Zamatenda a 2 A shuga
Chimodzi mwamagetsi omwe ali pachiwopsezo cha matenda a shuga a mtundu wachiwiri ndi chibadwa. Kupezeka kwa matenda ashuga amtundu wa 2 mwa achibale (makolo, abale ake) kumawonjezera mwayi wokhala ndi matendawa kwa anthu. Chifukwa chake, pamaso pa T2DM m'modzi mwa makolo, mwayi wokhala cholowa chamwana ndi 40%.
Zina zambiri zowopsa pakukula kwa matendawa zimapezeka munthu moyo wonse. Mulinso:
● Azaka 40 zakubadwa ndi kupitirira. Ngakhale matenda ashuga amtundu wa 2 amatha kuchitika pazaka zilizonse, odwala ambiri amadwala atatha zaka 40. Kuphatikiza apo, chifukwa cha kukalamba, kuchuluka kwa matenda ashuga a 2 kumakulirakulira.Chifukwa chake, ngati pakati pa azungu ambiri kuchuluka kwa matenda ashuga a 2 ndi 5-6%, ndiye kuti pakati pa odwala azaka zopitilira 75 matenda awowa amapezeka pafupifupi 20% ya milandu. Izi zimafotokozedwa mosavuta, chifukwa wokalamba wodwalayo, amatha kutopa kwambiri komanso apoptosis wa maselo a beta ake kapamba komanso kupangika kwa insulin.
● matenda a prediabetes - kusokonezeka kwa magazi m'thupi, kusungunuka kwa shuga,
● ochepa matenda oopsa - zizindikiro za kuthamanga kwa magazi - 140 / 90mmrt.st. komanso zokwera, ngakhale munthu atamwa mankhwala omwe amachepetsa magazi kapena ayi,
● kunenepa kwambiri kwa thupi ndi kunenepa kwambiri (index ya body more than 25kg / m2) - kuphatikiza pa BMI, chiopsezo chotenga matenda amtundu wa 2 ndichizindikiro chachikulu cha m'chiuno (choyesedwa pansi pamphepete m'mphepete pamwamba pa navel). Amuna: chiopsezo cha matenda ashuga chimakhala chachikulu ndi m'chiuno kuzungulira kwa 94-102 masentimita, ngati chiwerengerochi ndichoposa 102 masentimita, ndiye kuti chiwopsezo ndichokwera kwambiri. Amayi: chiopsezo cha matenda ashuga ndiwofika mchiuno pafupifupi 80-88cm, ngati chizindikirocho ndi chachikulu kuposa 88cm, ndiye kuti chiwopsezo kwambiri ndi Kulemera kwambiri komanso kunenepa kwambiri ndizomwe zimapangitsa kuti pakhale matenda osokoneza bongo komanso matenda oopsa.
● zakudya za diabetogenic - gawo la kudya kwambiri, kugwiritsa ntchito malo odyera mwachangu pokonza matenda ashuga a 2 ndikudziwika bwino. Komabe, kuyamwa kwazakudya ndizofunikanso. Chifukwa chake, poyesa nyama, mphamvu ya diabetogenic yazakudya zamafuta (lipotoxicity) imatsimikiziridwa. Kuchuluka kwa mafuta acids m'misumbu ya kapamba kumayambitsa kupititsa patsogolo kwa apoptosis m'maselo a beta, ndipo njira zina za lipotoxicity ndizotheka. Kudya wocheperako kwa fiber, kuchuluka kwakukulu pazofunikira za tsiku ndi tsiku zopatsa mphamvu, kuchuluka kwambiri kwa glycemic kungayambitse kukula kwa matenda a shuga,
● Polycystic ovary syndrome (PCOS) imapezeka mu 1% ya azimayi amsinkhu wobala ndipo imachulukitsa chiopsezo cha zovuta za carbohydrate metabolism: 30% ya amayi omwe ali ndi GDM ali ndi NTG ndipo pafupifupi 10% amakhala ndi matenda a shuga a 2. Kuphatikiza apo, kupezeka kwa PCOS katatu nthawi kumakulitsa chiopsezo cha GDM,
● matenda a mtima a atherosseloticotic,
● kuchuluka kwa triglycerides m'magazi (≥2.82 mmol / L) ndi kuchepa kwa milingo ya lipoproteins yapamwamba (≤0.9 mmol / L),
● anasamutsira matenda a shuga (GDM) - matenda ashuga, omwe amawonekera koyamba panthawi yoyembekezera kapena kubadwa kwa mwana wolemera makilogalamu anayi,
● kuchita masewera olimbitsa thupi ochepa,
● zochitika zamatenda zomwe zimakhudzana ndi kukana kwambiri kwa insulin (mwachitsanzo, kunenepa kwambiri, kuchepa kwa khungu) -
● kusokonezeka kwa kugona - kutalika kwa kugona kumakhala kochepera maola 6, ndipo maola opitilira 9 akhoza kuphatikizidwa ndi chiopsezo chowonjezereka cha matenda a shuga,
● matenda ashuga omwe amapangidwa ndi mankhwala osokoneza bongo kapena mankhwala omwe amachititsa kuti hyperglycemia ikule kapena kulemera:
Alfa ndi beta adrenomimetics
-Alpha-interferon, etc.
● kukhumudwa - Kafukufuku wina wawonetsa chiopsezo chotenga matenda amtundu wa 2 anthu omwe ali ndi nkhawa,
● Otsika kwambiri pazachuma (SES) - akuwonetsa kuyanjana pakati pa SES ndi kuopsa kwa kunenepa kwambiri, kusuta, CVD ndi matenda ashuga,
● Matenda amakulidwe a intrauterine - anthu onse okhala ndi kulemera kwakukulu (> 4000 g) ndi otsika (94 cm mwa amuna ndi> 80 cm mwa akazi), mbiri yakale yokhudza matenda ashuga, zaka> zaka 45, matenda oopsa a mtima ndi matenda ena amtima , shuga ya gestational, kugwiritsa ntchito mankhwala omwe amachititsa hyperglycemia kapena kuwonda.
● Mutha kugwiritsa ntchito mafunso osavuta.
Kuyesa kwa ngozi
Kuunika zowopsa kumachitika motengera:
● Kuyeza kuchuluka kwa glucose (pofuna kutsimikizira mwina shuga kapena matenda ena a hyperglycemia),
- kutsimikiza kusala glycemia,
- mayeso a shuga wa pakamwa a glucose (PGTT) okhala ndi 75 g shuga ngati pakufunika (makamaka ndi shuga 6.1 - 6.9 mmol / l pamimba yopanda kanthu).
● Kuwunika zina zomwe zimayambitsa matenda a mtima, makamaka mwa anthu omwe ali ndi matenda ashuga.
Kuchepetsa ngozi
-Machitidwe akusintha:
● Kuchepetsa thupi: Zakudya zopatsa thanzi kwambiri zomwe zimapangitsa kuti mafuta azikhala ndi mafuta osavuta. Zakudya zama calorie ochepa kwambiri zimapereka zotsatira zakanthawi ndipo sizilimbikitsidwa. Njala ndizotsutsana. M'misewu yokhala ndi kubetcha koyamba, chandamale ndi kutsika kwa thupi ndi 5-7% yoyamba ija.
● Kuchita masewera olimbitsa thupi pafupipafupi (kuyenda pang'ono, kusambira, kuyendetsa njinga, kuvina) kwa mphindi zosachepera 30 masiku ambiri a sabata (osachepera mphindi 150 pa sabata).
--- Mankhwala osokoneza bongo ndi otheka ngati sizotheka kukwaniritsa kuchepetsa thupi komanso / kapena kusintha kwa kagayidwe kazachilengedwe ndi kusintha kwina.
- Pakalibe contraindication mwa anthu omwe ali pachiwopsezo chachikulu, kugwiritsa ntchito Metformin 250-850 mg 2 kawiri pa tsiku (kutengera kulekerera) kumatha kuganiziridwa - makamaka mwa anthu ochepera zaka 60 ndi BMI> 30kg / m2 komanso kusala glucose> 6.1mmol / l.
- Mukafuna kulolera bwino, kugwiritsa ntchito Acarbose kungathenso kuganiziridwa (mankhwalawa amavomerezedwa ku Russian Federation popewa T2DM).
Zindikirani Ku Russia, kupewa T2DM monga chisonyezo chogwiritsa ntchito mankhwalawa Metformin sikunalembetsedwe.
Kupewera Kwambiri Cholinga chake ndi kupewa komanso kulepheretsa kukula kwa zovuta za matenda ashuga. Cholinga chake chachikulu ndikupewa kulumala komanso kuchepetsa imfa.
Pansi pazomwe zikuchitika Katswiri wothandizira odwala matenda ashuga ayenera kupereka mwayi kwa wodwala aliyense kuti athe kulipira matenda ake moyenera. Izi ndizotheka pokhapokha ngati kudziletsa kumayambitsa matenda. Pokhudzana ndi izi, wodwala aliyense yemwe ali ndi matenda ashuga (mwa ana aang'ono - makolo) ayenera kuphunzitsidwa njira yodziyang'anira pawokha pasukulu yapadera ya odwala matenda ashuga. Chifukwa chake, vuto lofunikira la ntchito zamakono za matenda ashuga ndi kutumizidwa kwa masukulu otere m'dziko lonselo. Zaka zaposachedwa, m'dziko lathu, ntchito yopanga masukulu otere yakhala yogwira ntchito kwambiri.
Ntchito zoyeserera kwa odwala omwe ali ndi matenda ashuga:
● Kuthandizira kupanga njira yodwala yamasiku onse kwa wodwala, kuphatikizapo njira zonse zochiritsira komanso yoyenera kwambiri malinga ndi moyo wabanja.
● Kuwunika mwadongosolo odwala omwe ali ndi matenda ashuga komanso kayendetsedwe ka machitidwe azachipatala.
● Kugwiritsa ntchito moyenera njira zochiritsira komanso njira zodzitetezera kuti pakubwezeretsanso thanzi la odwala.
● Kuthandizidwa pakuwongolera ntchito, malingaliro a ntchito kwa odwala, malinga ndi zikuwonetsa - kuchititsa mayeso pantchito.
● Kupewa zovuta zadzidzidzi.
● Kupewa komanso kudziwa nthawi ya angiopathies, neuropathies, zovuta zina za matenda ashuga ndi chithandizo chawo.
Tikuyenera kunena kuti kukhazikitsa mosamala malangizo oyambira kupewa matenda ashuga kumatilola kudalira mphamvu zawo mu 80-90% ya milandu mwa anthu omwe ali ndi matenda a shuga. Chithandizo chokwanira cha matenda a shuga chimakulitsa kuchepa kwa zovuta kwa odwala kwazaka zambiri ndikuwonjezera chiyembekezo chokhala moyo wawo mwa kuchuluka kwa zaka zakukhalira kwa anthu okhala mdziko lino.
SAMPLE TEST TASKS
Sonyezani yankho limodzi lolondola
1. Zotsatira zabwino zolimbitsa thupi kupewa matenda a shuga zimachitika chifukwa cha chilichonse kupatula:
a) amakulolani kutaya chakudya cham'madzi mwachangu
b) amathandizira kuti kagayidwe kazachulukidwe
c) Amachepetsa kumva kwa pancreatic minofu kuti insulin
g) Amathandizira kuchepetsa kunenepa kwambiri
2. Zowopsa za mtundu wachiwiri wa matenda ashuga ndizonse:
b) kuchepa kwa milingo ya ma lipoprotein otsika kwambiri
d) Kuchita masewera olimbitsa thupi ochepa,
3. Njira zoyenera kupewera matenda a shuga a 2 sizikuphatikizira:
a) chizindikiritso cha matenda oyamba a kagayidwe kazakudya
b) Kuchepetsa thupi mwa anthu onenepa kwambiri
d) Kuchulukitsa zolimbitsa thupi
CHOLINGA CHAKUTI
Mkazi wazaka 47, kutalika kwake 167cm, ali ndi thupi lolemera 82kg. Kuchokera kwa anamnesis amadziwika kuti nthawi zonse amakhala wathanzi. Makolo ndi onenepa kwambiri, mayi ali ndi matenda oopsa komanso matenda ashuga. Ali ndi mwana m'modzi, yemwe pobadwa anali wolemera 4,900g. Amayesetsa kuchepetsa chakudya chamafuta, koma samatsata chakudya. Amakhala ndi pododerma wosenda.
Cholinga: mafuta mawonekedwe makamaka pamimba, m'chiuno. Mapapu - palibe matenda omwe adapezeka. Mawu amitima akumveka bwino. Kokani 66 kumenyedwa / mphindi, nyimbo, zodzaza. HELL - 125 / 85mmrt.st. Mimba pamimba yake ndi yofewa, yopweteka.
Kusanthula kwa biochemical kwa magazi: shuga m'magazi - 5.1 mmol / L, cholesterol yathunthu - 5.8 mmol / L.
CHITSANZO
1. Tanthauzirani mbiri yachipatala, zakuthupi, ndi zolemba zam'makalata zoyesedwa wodwala.
2. Kodi wodwalayo ali ndi chiopsezo cha matenda ake a shuga? Zowopsa zake ndi chiani?
Kupewa matenda ashuga
Mtundu woyamba wa shuga umakhala wochepera 9-10%. Ku Russia, chiwopsezo chawo ndi milandu 14.7 kwa aliyense zana limodzi.
Momwe mungapewere matenda a shuga omwe amadalira insulin: kupewa matenda kumagawika m'magulu oyambira, a sekondale, apamwamba.
Gome 1: Magawo a njira zopewera kupewa matenda a shuga-1:
| Mulingo | Gawo lachitukuko cha matenda a zam'tsogolo | Cholinga |
| Poyamba | Chiwopsezo chachikulu cha hyperglycemia pamlingo wamtundu | Pewani kukula kwa zowonongeka za autoimmune |
| Sekondale | Njira ya Autoimmune yama cell a pancreatic beta | Pewani chiwonetsero cha matendawa |
| Tertiary | Ngongole, zidziwitso zatsatanetsatane | Pewani zovuta, ngati nkotheka mubwezeretse insulin |
Kupewera kwa matenda ashuga ndi koyenera kwambiri kwa ana ndi achinyamata omwe ali pachiwopsezo chachikulu cha matenda.
Itha kuyesedwa ndi:
- akatswiri azachipatala,
- kuyimira kwa HLA haplotypes,
- kupezeka kwa CD-1 m'magazi.
Kuyesedwa kwapadera kukuwonetseratu tsogolo la matenda ashugaTcherani khutu! Chiwopsezo chokhala ndi IDDM pamaso pa chiphunzitsochi mwa m'modzi mwa makolo kapena abale nthawi zambiri sichidutsa 5-6%. Kuphatikiza apo, achibale omwe ali ndi matenda amtundu wa 2 samalandiridwa, chifukwa mitundu iyi ya hyperglycemia imangobadwa palokha.
Kuvuta kwa njira zonse zodzitetezera kumagona chifukwa chosowa chidziwitso cha zomwe zimayambitsa dongosolo la autoimmune mthupi. Zotsatira zambiri zakusaka (TEDDY, TRIGR, TrialNet Nip, ndi zina) ndizolimbikitsa mwachilengedwe.
Chifukwa chake, chitetezo choyambirira ndi chiyani - matenda a shuga 1 angathe kupewedwa ngati:
- Chepetsani kuthekera kwa kutenga kachilombo ka Coxsackie B mavairasi, chikuku, nthomba, mumps, CMVI (pali umboni kuti matendawa amatha kukhala oyambitsa njira ya autoimmune).
- Pewani mapuloteni amkaka wa ng ombe kuchokera pazakudya za ana osakwana zaka ziwiri.
- Anamwitsa mwana wochepera miyezi isanu ndi umodzi.
- Musachotse zakudya zokhala ndi chakudya chokwanira cha ana osakwana chaka chimodzi.
- Pakati pa mimba ndi mkaka wa m`mawere, kudya okwanira kuchuluka kwa polyunsaturated omega-3 GIC.
Kuyamwitsa kumateteza mwana ku matenda ambiriKupewera kwachiwiri kwa matenda ashuga kuyenera kuchitika ndi odwala omwe matupi awo a autoimmune omwe amapanga kale zokhudzana ndi zisumbu za pancreatic za Langerhans.
Zitha kutsimikizika ndi kukhalapo kwa chikhazikitso pakayesedwe ka magazi:
- ICA - antibodies to pancreatic islet cell,
anti-GAD65 - AT wa glutamate decarboxylase, - IAA - AT kwa hormone insulin,
- IA-2beta - AT kwa tyrosine phosphatase ya kapamba, etc.
Magazi achilengedwe amatha kutsimikiza mu labotale.Zofunika! Ma antibodies a pathological amawonekera m'magazi a matendawa zaka zingapo kusanachitike kuwonekera kwa matendawa.
Pali maphunziro angapo azachipatala pamakonzedwe a insulin kwa anthu omwe ali ndi vuto lalikulu la ma antibodies azaka za 3-45 kuti athetse kuwonongeka kwa autoimmune kwa kapamba.
Kuletsa kwamtunduwu kwamatenda kumagwiritsidwa ntchito kwambiri ngati mankhwala. Kuti muchite bwino, ziyenera kuyamba milungu isanu mutatha kuzindikira.
Amadziwika kuti atatha kuwonetsa matendawa, pafupifupi 10-20% ya maselo a pancreatic beta amakhalabe ndi ntchito zawo. Ntchito ya njira zachipatala ndiyoti ipulumutse zinthu zotsala ndipo, ngati zingatheke, yambitsitsanso kukonzanso kwake.
Ndikofunikira kukhazikitsa bwino kapamba
Pakadali pano, kupewa matenda ashuga apamwamba kumaphatikizapo madera angapo:
- Mankhwala apadera a Antigen ophatikizana ndi kugwiritsa ntchito maantiantigenia omwe amathandizira kuwononga maselo a pancreatic.
- Antigen-enieni mankhwala, omwe amaphatikizapo mankhwala omwe amaletsa oyimira pakati pa autoimmune ndondomeko. Ena mwa iwo ndi Rituximab, Anakindra, etc.
Pomaliza, ziyenera kudziwidwa kuti ngakhale atakwaniritsa sayansi ya zamankhwala, njira zodalirika komanso zotetezeka zoteteza chitukuko cha matenda 1 a shuga kwa odwala omwe ali ndi vuto lobadwa nazo sizinapangidwebe.
Jekeseni wa Insulin - Pakadali pano Njira Yokhayo Yogwirira Ntchito Molimbika Glycemia ku IDDM
Kupewa kwa T2DM
Mtunduwu umakhala mpaka 90-95% yamilandu yonse yamatenda. Zina mwazifukwa zakuchulukirachulukira kwa kuchuluka kwake ndi izi:
- kufalikira kumizinda
- machitidwe amunthu wokhala mumzinda,
- kuperewera kwa zakudya m'thupi
- kuchuluka kwa kunenepa kwambiri.
"Sofa"Mbali ya chipatala ya NIDDM, yomwe imadziwika ndi madokotala onse, ndi njira yayitali komanso yotsika. Odwala ambiri sadziwa ngakhale kusintha kwamthupi ndipo amaphunzira mwangozi.
Kodi mukudziwa mtundu wanu wa glycemia?
Izi ndizosangalatsa. Malinga ndi ziwerengero, kwa aliyense wodwala yemwe ali ndi T2DM pali anthu ena awiri omwe ali ndi hyperglycemia omwe sazindikira mavuto amtundu wa carbohydrate.
Ichi ndichifukwa chake kuyesa mayeso ofunikira ndikofunikira pakuwunika matenda a endocrinology.
Dziyeseni: Magulu Oseketsa A shuga
Makamaka omvera thanzi lawo ayenera kukhala anthu omwe ali pachiwopsezo cha NIDDM.
Zinthu zomwe zimalola wodwala kukhala m'gulu lino ndi izi:
- zaka zopitilira 40-45,
- BMI yayikulu, kunenepa kwambiri pamimba,
- Mbiri yakubadwa kwachikhalidwe cha anthu odwala matenda ashuga,
- kusowa kwa masewera olimbitsa thupi
- kulolerana kwa shuga,
- Mbiri ya matenda ashuga kapena kubadwa kwa mwana wosabadwa (> 4.5 kg),
- Matenda oopsa, matenda a CVD,
- dyslipidemia,
- PCOS mwa akazi.
Monga momwe ziliri ndi CD-1, kupewa ndi kuchiza matenda a shuga 2 mwa amuna ndi akazi kuli magawo atatu.
Gome 2: Magawo a njira zopewera kupewa matenda a shuga-2:
| Mulingo | Gawo lachitukuko cha matenda a zam'tsogolo | Cholinga |
| Poyamba | Kukhalapo kwa zinthu zomwe zikuwonetseratu | Kuteteza kwa Normoglycemia |
| Sekondale | Matenda a shuga | Kupewa kwa chiwonetsero cha matenda |
| Tertiary | Dziwa SD-2 | Kusungidwa kwa magwiridwe antchito a kapamba, kuletsa kukula kwa zovuta |
Popeza mu etiology ya CD-2 zomwe zimapangitsa kuti chibadwa chidayambike komanso zinthu zachilengedwe zimasiyanitsidwa, ndizotheka kupewa (kapena kuchedweratu) matendawa posintha moyo wawo.
Maupangiri othandizira anthu omwe ali pachiwopsezo akuphatikizapo:
- Makhalidwe a Moyo ndi Thanzi (malingaliro onse a adotolo akuyenera kuwonedwa ndi wodwala kwa moyo wonse):
- Matenda a kulemera kwa thupi
- Zakudya zama hypocaloric
- choletsa chakuthwa cha chakudya cham'mimba mosavuta ndi mafuta m'zakudya,
- kupezeka kwa zakudya zamasamba atsopano, zipatso,
- chakudya chamagulu 4-5 r / tsiku.,
- kutafuna chakudya,
- kutsatira zakudya zokwanira,
- kukula kwa mulingo wakuchita zolimbitsa thupi,
- thandizo kwa okondedwa ndi ogwira ntchito kuchipatala.
- Malinga ndi adotolo - kukonza mankhwala kunenepa. Mankhwala osankhidwa ndi:
- Sibutramine,
- Orlistat
- Metformin.
- Chithandizo cha mankhwala a atherosulinosis ndi dyslipidemia. Othandizidwa masiku ano ndi ma statins (Atorvastatin, Simvastatin).
- Antihypertensive mankhwala:
- Beta blockers
- Zodzikongoletsera
- ACE zoletsa,
- Otsutsa a calcium.
Timatenga mapiritsi mosamalitsa malinga ndi malangizoIzi ndizosangalatsa. Njira zochiritsira zosagwiritsidwa ntchito masiku ano zatsimikiziranso kuti zili bwino. Mankhwala ozikidwa pa Yerusalemu artichoke akhazikika Noto amadziwika kwambiri: matenda a shuga amaletsedwa ndikuchepetsa shuga, kulimbitsa chitetezo chokwanira, kupewetsa magazi, kusintha kagayidwe, komanso kusintha matumbo.
Prophylaxis yachiwiri imalimbikitsa onse odwala:
- glycemia wolowa - wokhala ndi shuga wamagazi a 5.6-6.0 mmol / l mu capillary (zotumphukira, kuchokera pa chala) magazi,
- NTG - ndi shuga pamtunda wa 7.8 mmol / l 2 patadutsa pakamwa pakukonza shuga.
Kuphatikiza pa malamulo apadera okonza njira, omwe afotokozedwera m'ndime iyi pamwambapa, zolinga 4 zakonzedwa kwa anthu omwe ali ndi prediabetes:
- Kuchepetsa thupi (zopitilira 5% zoyambirira),
- kuchepetsa mafuta m'zakudya (ziyenera kukhala zosakwana 30% ya caloric ya tsiku ndi tsiku, yamafuta azinyama - osakwana 10%),
- kumwa pafupipafupi masamba ndi zipatso (zopitilira 15 g za fiber / 1000 kcal),
- Chitani masewera olimbitsa thupi osachepera 4 r / sabata.
Kupeza kwawo kumalola kuti muchepetse zoopsa za kupangika kwa matenda a hyperglycemia.
Kuphatikiza apo, malinga ndi zomwe dokotala akuwonetsa, Metformin itha kutumizidwa chifukwa cha prophylactic.
Kupewa mavuto a shuga mellitus ndi kukonza kwa matenda a hyperglycemia, dyslipoproteinemia, matenda oopsa komanso zina. Mitengo yomwe mukufuna igwiritsidwe ntchito pagawo lantchito.
Gawo 3: Magulu owunikira zomwe CD-2 ikuyang'ana:
| Dzinalo | Chizindikiro, mmol / l | |||||
| Mwazi wamagazi | Kusala - 4-7 | Pambuyo 2 maola p / chakudya - 1 | Mwa akazi -> 1.2 | |||
| TG |  Nkhaniyo ikuthandizani kuti muphunzire zambiri za mawonekedwe othandizira kupewa matenda.Chifukwa chake, njira zopewera kukula kwa matenda ashuga zimaphatikizapo maphunziro owunikira, komanso kukonza moyo, zochita zolimbitsa thupi ndi zakudya. Matenda a mliri wa CD-2 akuwonetsa kufunikira kwa kuyambitsa kuzindikira koyambirira ndikupewa matendawa ku boma. Kuperewera kwa mawonetseredwe azachipatala
Moni Mwinanso, mwayamba kudwala matenda ashuga. Kutsitsimuka kwakukulu kwa matendawa kumachitika m'njira yayitali kwambiri: odwala ambiri amaphunzira za kusintha kwamomwe kumachitika m'thupi pokhapokha atakula kwambiri. Ndinu mwayi - mumapezeka ndi matendawa nthawi yake. Onetsetsani kuti mwalumikizana ndi endocrinologist wanu kuti mumve zambiri. Mwina cholowa
Moni SD-1 imatengera zonse mzimayi ndi wamkazi. Kuthekera kwa kufala kwa matendawa kuchokera kwa mayi kupita kwa ana obwera sikupitirira 3-7%. Mutha kuwerenga zambiri za njira zodzitetezera pamwambapa. Kupewa Koyamba ndi Matenda A shuga: Kupewa Matenda A shuga ndi Zoopsa Za Moyo
Matenda a shuga ndi matenda ovuta omwe amakhudza dongosolo la endocrine la anthu. Chizindikiro cha odwala omwe ali ndi matenda ashuga amawaganizira kuti ndi shuga wambiri m'magazi, omwe amawerengedwa ngati zotsatira za kusakhalapo kwathunthu kapena kusowa kwa insulin, komanso kusachita bwino pakulimbana ndi maselo amthupi. Insulin ndi mahomoni opangidwa ndi kapamba. Imayankha ndipo imayang'anira metabolism, i.e. chakudya, mafuta ndi mapuloteni. Komabe, zochuluka zake zonse zimafikira ndendende kusinthana kwa shuga. Kuphatikiza apo, shuga amawoneka ngati gwero lalikulu lamphamvu.
Kupanga shuga kumachitika pafupifupi minyewa yonse ndi ziwalo zonse zomwe zimagwira ntchito ya insulin. Ngati munthu ali ndi vuto la insulin, adotolo amafufuza matenda am'mimba a matenda oyamba, ngati pali zifukwa zotsutsana ndi insulin ndi maselo ena - iyi ndi matenda a shuga a mtundu wachiwiri. Komabe, mulimonsemo, zenizeni za matendawa amakhalabe amodzi. Mwa anthu odwala matenda ashuga, shuga ochulukitsa amadzaza m'magazi osalowa m'maselo a thupi. Zinafika kuti ziwalo zonse, kupatula zomwe zimadziimira palokha, zimangokhala zopanda mphamvu. Mosasamala mtundu wa matenda a shuga omwe akuwganiziridwa, kuyambika kwa matendawa kungathe kupewedwa. Gulu lamavuto limaphatikizapo magulu otsatirawa a anthu:
Mtundu wachiwiri wa matenda a shuga ndi waukulu. Ndiamene amapezeka mu 95 peresenti ya milandu. Podziwa zomwe zimayambitsa ngozi, ndikofunikira kumvetsetsa kuti kupewa koyambirira komanso kwachiwiri kwa matenda ashuga kumawerengedwa kuti ndi mwayi wopewa matendawa komanso zovuta zake zonse. Ma phylactics amasiyana wina ndi mnzake chifukwa chakuti choyambirira ndi kuteteza matendawa kuti asayambenso, ndipo cholinga chachiwiri ndi kuteteza kuti pasadzakhale zovuta. Poyamba, ndikofunikira kudziwa kuti masiku ano pali zida zofufuzira zokhudzana ndi chitetezo cha mthupi zomwe zimalola munthu wathanzi kwathunthu kuti azindikire mu magawo oyamba chizolowezero cha matenda ashuga 1. Chifukwa chake, ndikofunikira kudziwa zovuta za njira zomwe zingalolere kwa nthawi yayitali kuti muchepetse kukula kwa matenda omwe amafunsidwa. Kupewera kwa matenda ashuga a mtundu woyamba kumatanthauza kukhazikitsa njira izi:
Kupewera kwa matenda ashuga a mtundu woyamba kumayambira ndi kudya kwapadera. Pakadali pano, pakulimbikitsidwa kuti aliyense adye zakudya zoyenera, chifukwa kuwonjezerapo zovuta zamafuta ndi mafuta omwe amapezeka muzinthu zambiri kumabweretsa mavuto ambiri azaumoyo. Zakudya zimawerengedwa kuti ndi gawo lofunikira la njira zopewera matenda, kuphatikiza, ndizofunikanso zomwe zimapangitsa kuti matenda ayambe kuyenda bwino. Cholinga chachikulu cha chakudyachi chimatchedwa kuchepetsa kuchuluka kwa zakudya zomwe zili ndi chakudya. Komabe, imathandizanso kumwa nyama zamafuta, zomwe zimasinthidwa ndi mafuta azamasamba. Zakudya za munthu wodwala matenda ashuga ayenera kukhala ndi masamba ambiri ndi zipatso zowawasa, zomwe zimakhala ndi fiber yambiri, zomwe zimalepheretsa chakudya cham'mimba. Komabe, zakudya zilizonse sizingagwire ntchito ngati munthu wakhazikika, amangokhala. Ngati sizotheka kukaona malo ochitira masewera olimbitsa thupi, muyenera kungopatula ola limodzi la nthawi yoyenda tsiku lililonse ndi zinthu zamasewera, masewera olimbitsa thupi, kusambira kapena kupalasa njinga. Kuphatikiza apo, kupewera koyambirira kwa matenda ashuga kumathandizanso kuti pakhale mkhalidwe wamaganiza a munthu. Ichi ndichifukwa chake anthu omwe ali mdera lachiwopsezo amafunika kulumikizana ndi anthu abwino okha, amachita zomwe amakonda ndikuyesera kupewa zovuta. Matenda a shuga ndi matenda amtundu wa endocrine omwe amafunika njira yabwino yochizira komanso kupewa mwadzidzidzi. Ziwerengero za World Health Organisation zaka 15 zilizonse zimawonedwa zikuwonjezeka kawiri pa chiwerengero cha anthu omwe akudwala matendawa. Kuti muchepetse chizindikiro ichi, odwala onse komanso anthu athanzi ayenera kupewa matenda ashuga. Monga momwe anthu ambiri amadziwira, kupewa matenda ndi njira yabwino kwambiri yochizira. Izi ndizowona ndi pancreatic pathology. Vuto lamakono, komanso la anthu onse - njira yolakwika yathanzi lawo. Nthawi zambiri anthu amatsogolera njira za moyo watsiku ndi tsiku, amayamba kukhala ndi mavuto akulu, ndipo matenda ena atayamba, amafunika kulipira ndalama zambiri kuchipatala, kupilira njira zaumoyo komanso kudwala. Zonsezi zitha kupewedwa. Pofuna kupewa kupitirira kwa matenda aliwonse, pali kupewa, komwe kungagawike mu: Kupewera kwa matenda ashuga koyambirira kumakhala kopewa kupezeka kwa matendawa. Lachiwiri likulimbana ndi zovuta komanso kuyesa kukhalabe ndi shuga m'thupi. Kusiyanitsa kotsiriza kwa njira yodzitetezera sikofunikira kwa odwala omwe ali ndi matenda ashuga, popeza matenda awa amakhala osachiritsika pakadali pano. Njira imeneyi ingathe kugwiritsidwa ntchito, mwachitsanzo, kwa odwala omwe ali ndi matenda amitsempha, mukatha matendawa pamafunika kuchita jekeseni wa penicillin kuti muchepetse ngozi yakuyambiranso. Muyenera kuyamba kaye ndi kuzindikiritsa magulu omwe ali pachiwopsezo. Anthu omwe angadwale matenda ashuga ndi awa:
Anthu oterewa akuyenera kuyang'anitsitsa thanzi lawo. Kupewera kwa matenda ashuga a mtundu woyamba kuyenera kukhala maziko a moyo wawo. Mfundo zazikuluzikulu zopewera matendawo: Kupewa matenda ashuga ndi gawo lofunikira kwambiri kwa anthu omwe ali pachiwopsezo komanso kwa anthu wamba. Pakadali pano, matendawa amakhala osachiritsika, choncho kupewa kwake kungakhale njira yabwino kwambiri. Palibe amene samatetezedwa kuyambira pachiwopsezo cha mahomoni ndi kapamba, koma kutsatira malamulo osavuta omwe ali pamwambawa kungakulitse kukana kwa thupi kutuluka kwamatenda oopsa ngati amenewo. Pa mndandanda wa matenda a endocrine system, matenda a shuga amakhala patsogolo. Matendawa ndi osasinthika, ndikosatheka kuyambitsanso njira zamachitidwe akusintha kwina ndikuchiritsa matenda ashuga. Ngozi yayikulu imakumana ndi zovuta zomwe zimayambitsa kulumala ndi kufa. Motere, kupewa matenda ashuga kumayang'ana mitundu iwiri yayikulu:
Malinga ndi gulu la azachipatala, matenda ashuga ali ndi mitundu iwiri yayikulu (yoyamba ndi yachiwiri) ndi zingapo zowonjezera. Kufanizira kwa matendawa ndi chifukwa:
Kupewa matenda ashuga oyambilira kumayang'ana kwambiri kuchepetsa kuopsa kwa matenda a shuga amtundu woyamba 1. Ndikosatheka kusintha kwathunthu zomwe zimayambitsa matendawa, komabe, ambiri mwa odwala omwe ali ndi matenda ashuga sangathe kupatula. Mtundu wa nthendayi umatchedwa insulin-wate (IDDM mtundu 1), kapena mwana. Pathology nthawi zambiri imakhudza ana amasukulu aang'ono ndi achinyamata. Tizilombo toyambitsa matenda tofotokozeratu zakuphwanya kwa kapangidwe ka kapamba popanga insulin. Hormoni iyi imayendetsa ma glucose ku seli, monga gwero lalikulu lamphamvu. Ndi kuchepa kwa insulin, shuga ndi zinthu zopangidwa ndi poizoni (ma ketones) ake zimadziunjikira m'magazi. Kuti muzitsatira kapangidwe ka insulin, odwala amamuika mankhwala a insulin, omwe amathandiza kuti thupi likhale losamalidwa bwino. Pali zifukwa ziwiri zazikuluzikulu zomwe zimayambitsa matenda ashuga. Amayamba chifukwa cha kusagwira bwino ntchito mthupi, komwe, m'malo mochita zoteteza, amawononga maselo a thupi lake. Zoyambitsa (zoyambitsa) zokhudzana ndi zochitika za autoimmune zimachitika mosiyanasiyana, matendawa osagwirizana ndi ma virus (makamaka ma Coxsackie ma virus ndi mtundu wa herpes mtundu 4 (Epstein-Barr), cytomegalovirus), zakudya zopanda thanzi komanso kunenepa kwambiri, njira yolakwika ya mahomoni. Zimayambitsidwa ndi kufunitsitsa kwachilengedwe kwa thupi kutengera majini ake amtundu wake (mtundu woyamba wa shuga umalandira kwa makolo kapena abale ake apafupi). Mtundu wa achinyamata matenda amatha kubereka, amafunikira chithandizo cha insulin ana kuyambira kale wakhanda. Kupewera kwapadera kwa matenda amtundu wa 1 kumaphatikizapo:
Ngakhale kuti ndizosatheka kupewa majini opanga majini, kutsatira malangizo azachipatala kungalepheretse chitukuko komanso kukula kwa matendawa. Mtundu wa matenda osadalira insulini (mtundu 2 NIDDM) umapangidwa, nthawi zambiri, mwa akulu pambuyo pazaka makumi atatu. Chizindikiro cha matendawa ndi kukana insulini - kuchepa kapena kusazindikira kwenikweni kwa maselo a thupi kupita ku insulin.Mosiyana ndi matenda ashuga achinyamata, kapamba samaletsa kaphatikizidwe ka glucose wama glucose, koma pamaselo a cellular, minyewa imatha kuizindikira bwino ndikuyigwiritsa ntchito. Choyambitsa chachikulu chitukuko chimawonedwa kuti ndi onenepa kwambiri (kunenepa kwambiri). Zina mwa mawonekedwe a matenda ashuga ndi izi:
Mwa abambo, gawo loyambira chitukuko cha NIDDM ndimakonda kumwa mwauchidakwa, chifukwa choyambitsa kulumala kwa kapamba. Mwa azimayi, zinthu zomwe zimayambitsa ngozi zimakhala zovuta kutenga pakati (gestationalabetes mellitus in the peratatal nthawi) ndi kusintha kwa mahomoni m'thupi nthawi yakusamba. Njira yayikulu yodzitetezera pakukula kwa matenda amtundu wa insulin ndikukhazikitsa BMI (index ya body mass). Malamulo othandizira kuthetsa zoopsa za matenda amtundu wa 2 ndi mtundu wa 2:
Achibale (wachibale) omwe amayambitsa kukula kwa matenda a shuga amatha kupsinjika (kupsinjika kwa neuropsychological) komanso hypovitaminosis ya cholecalciferol ndi ergocalciferol (mavitamini a gulu D). Anthu omwe amakonda matendawa amalangizidwa kuti apewe zovuta, kudya zakudya zokhala ndi vitamini D, komanso ngati nkotheka kukhala padzuwa. M'mabanja omwe ali ndi vuto la matenda ashuga, njira zodzitetezera ziyenera kutengedwa kuyambira pomwe mwana wabadwa. Kutsatira kwambiri mankhwala omwe mumalandira kungakuthandizeni kupewa matenda oopsa, ndipo nthawi zina, kunyenga matendawa. Ngati cholowa sichimawoneka usanakwanitse zaka 25-30, mwayi wokhala ndi matenda oyamba a shuga umachepetsedwa kangapo. Maupangiri amakolo akuphatikizira malangizo owongolera ana.
Akapezeka ndi matenda am'mimba, endocrinologists amalangizidwa mwamphamvu kuti apite ku Sukulu ya Matenda a shuga, komwe makalasi apadera a odwala akuluakulu, ana ndi achinyamata amapangidwa. Cholinga chachikulu chakusukulu ndikusinthika kopweteka kwa odwala kuti akhale odwala matenda ashuga. Magulu a sukulu amapangidwa molingana ndi zaka za odwala. Gulu 1 limaphatikizapo ana ang'ono ndi makolo awo. Makalasi amachitika ndi madotolo (endocrinologists, akatswiri azakudya, akatswiri ashuga). Akatswiri azachipatala amaphunzitsa njira zamatenda a insulini mu makanda (kuwerengera koyenera kwa mankhwalawa ndi maluso othandizira mankhwala). Mabuku apadera a makolo amalimbikitsidwa kuti aziwerenga (zolemba popatsa mwana zovuta komanso kukula kwina). Gulu Nambala 2 limaphatikizapo ana a sekondale komanso zaka zoyambira kusukulu. Kuti muwongolere kuzindikira kwa zomwe mukuphunzira, zithunzi zimagwiritsidwa ntchito. Amawafotokozera ana mwa njira yomwe ingapezeke kufunika kwa chakudya ndi masewera, amaphunzitsa zoyambira zodziyang'anira za kuchuluka kwa shuga m'magazi (pogwiritsa ntchito glucometer yonyamula).Maphunziro ogwira mtima amaperekedwa mwa kusewera makalasi ndi kutenga nawo gawo kwa makolo a odwala ochepa. Pagulu nambala 3, ana asukulu amene akutha msinkhu akuphunzitsidwa. Zokambirana zimachitika ndi achinyamata pazokhudza kugonana, kupanga njira yodyetsera tsiku ndi tsiku komanso zakudya, komanso kupewa kukula kwa mavuto asanakwane komanso matenda ashuga owopsa. Makalasi omwe amakhala ndi moyo wathanzi amayenda ndi timapepala ta odwala komanso zikwangwani zoonera. Chidwi chachikulu chimaperekedwa ku ntchito zamaganizidwe ndi achinyamata kuti apange zofunika kwambiri pakukhala ndi thanzi, makamaka, kupewa mowa ndi kusuta. Gulu 4 limaphatikizapo amuna ndi akazi achikulire omwe ali ndi matenda ashuga a 2. M'masukuluwo, mfundo zakudziyang'anira ndi moyo wa wodwala wodwala matenda ashuga zimafotokozedwa mwatsatanetsatane. Ntchentche payekha ikuphatikiza:
Njira yayikulu yothandizira kupewa kwachiwiri ndikupewa kuthamanga kwa matenda a shuga. Njira zodzitetezera zimaphatikizapo:
Ngati ndi kotheka, odwala matenda a shuga ayenera kulangizidwa kukaonana ndi akatswiri azakudya zopatsa thanzi (ngati pali zovuta pakupanga menyu watsiku ndi tsiku), psychotherapist (ngati zingakhale zovuta kuti munthu akhale ndi matenda ashuga). Kutsatira malamulo opewera ndiye udindo woyamba wodwala matenda ashuga. Kuwongolera koyambirira matendawa kumapangitsa kuti moyo ukhale wabwino, ndikuchepetsa kukula kwa zotsatira zoyipa za matenda. Matenda a shuga asanduka matenda ofala kwambiri kotero kuti munthu aliyense amene amadziwa kuwerenga ndi amene amasamala zaumoyo wawo ayenera kudziwa chomwe kupewa. Kupewa shuga Njira zoyambirira kupewa matenda ashuga zimakhazikitsa malamulo angapo omwe angathandize kuti munthu asadwale. Kuti muchite izi, muyenera kuyang'anira kulemera kwanu, idyani pomwe, momwe mungathere kuyenda. Zachidziwikire, pali zinthu zomwe palibe amene angatulutse - izi ndi zomwe zimabadwa kale, zaka komanso mawonekedwe a chitukuko m'mimba, koma kumvetsetsa kuti izi zimatha kubweretsa matenda, chilichonse chikuyenera kuchitidwa kuti izi zisachitike. Kupewa kwa matenda ashuga a 2 kuyenera kuyamba, choyamba, ndi chakudya. Kutsatira zakudya zopatsa thanzi kumakhudza aliyense pakadali pano.Kuchuluka kwamafuta ndi mafuta osavuta omwe amapezeka muzinthu zomwe zimaperekedwa pakona iliyonse mosavuta kumabweretsa zovuta zosiyanasiyana akadya. Izi zimawonekera chifukwa chakuti mavuto am'matumbo amatukuka, chitetezo chamthupi chimachepa, mapaundi owonjezera amapezeka, kulekerera kwa thupi ku glucose kumavulala, ndipo matenda a shuga amawonekera. Zakudya zopewera matenda ashuga ndizofunika kwambiri, ndipo ndizofunikira osati kupewa matenda, komanso chithandizo chamankhwala. Kupewera kwa matenda ashuga a mtundu wachiwiri sikumangokhala kuchepetsa zakudya zamafuta, komanso kuchepetsa mafuta a nyama ndikuzisintha ndi mafuta a masamba. Chakudyacho chimayenera kulamuliridwa ndi masamba atsopano ndi zipatso za acidic zomwe zimakhala ndi fiber yambiri, zomwe zimachepetsa kuyamwa kwa matumbo m'matumbo. Koma palibe zakudya zomwe zingakuthandizeni ngati mukukhalabe ndi moyo. Ngati ndizosatheka kuchita masewera olimbitsa thupi, mutha kungoyenda tsiku ndi tsiku mwachisawawa, kuchita masewera olimbitsa thupi m'mawa, kusambira, kukwera njinga, kupita ku masewera olimbitsa thupi. Muyenera kuchita bizinesi yosangalatsa komanso kulankhulana ndi anthu abwino. Izi zipulumutsa thupi ku zochulukitsa zama psychoemotional, zomwe zimatha kupangitsa kuti matenda ashuga kapena akuipiraipira pakhale ndi matendawa. Kupewera kwa matenda a shuga a mtundu wachiwiri kwa ana kumakhala ndi malamulo omwewo monga akulu, ndikofunikira kuti muwatsatire mosamala ngati pali chibadwa cha mwana chodzetsa kagayidwe kazakudya. Zokonda zomwe zimapangidwa zimapangidwa mudakali aang'ono kwambiri, ndipo ngati mwanayo adya mosiyanasiyana, ndiye kuti chiopsezo cha matenda amatsika nthawi zambiri. Ndibwino kuti mwana akakhale nawo pamasewera, nthawi zambiri amayenda mumsewu. Nthawi yomwe imagwiritsidwa ntchito patebulo komanso kompyuta iyenera kuchepetsedwa. Kupewera kwa matenda ashuga mwa azimayi kumaphatikizanso mwayi wokhala ndi matenda ashuga omwe ali ndi amayi omwe ali ndi pakati, omwe amatha kusinthika pambuyo pobereka. Chifukwa chake, pamaso pa abale omwe akudwala matendawa, vuto la kuchuluka kwa thupi, kusachita bwino tsiku lililonse komanso kudya zakudya zopatsa thanzi, mimba iyenera kukonzekereratu. Ndikofunikira kudutsa mayeso onse, kudziwa kuchuluka kwa ngozi, kubwereza zakudya ndikuchita masewera olimbitsa thupi apadera. Pakupaka magazi, muyenera kupereka magazi pafupipafupi. Kupewera kwa matenda ashuga amtundu woyamba kuyenera kuyamba pakubadwa. Njira zake zikuphatikiza: 1. Kuyamwitsa yoyamwitsa. Kupewa matenda a shuga kwa ana kumaphatikizapo kugwiritsa ntchito mkaka wa amayi, monga chaka choyamba cha moyo mwana amakhala gwero la chitetezo chathupi, chomwe chimathandiza kupewa matenda opatsirana ndi tizilombo. Kuphatikiza apo, zosakaniza zosakanikirana zimakhala ndi mkaka wa ng'ombe, zomwe zimatha kusokoneza ntchito za kapamba. 2. Nthawi zina, pofuna kupewa kukula kwa njira yotupa yoyambitsidwa ndi tizilombo tating'onoting'ono tomwe timayambitsa matenda ndi ma virus, ana akulimbikitsidwa kuti atenge ma immunomodulating othandizira a mtundu wa interferon. Choopsa kwambiri ndi matenda ashuga ndi kukula kwa zovuta. Amatha kukhala owawa kwambiri, okhala ndi vuto laukoma, komanso osakhazikika (pomwe akukhudza ziwalo zamkati). Nthawi zambiri, zovuta pachimake zimachitika ndi fomu yodalira insulin. Chifukwa chake, kupewa zovuta za matenda ashuga kumatanthawuza kuphatikiza shuga wamagazi, kuchezera pafupipafupi kwa endocrinologist, kutsatira malangizo onse, kugwiritsa ntchito insulin ndi hypoglycemic agents. Mwa zotupa zamkati zimapezeka nthawi zambiri: 1. Matenda a mtima ndi mitsempha yamagazi, komanso zovuta zamagazi.Malinga ndi ziwerengero, kufa kwa matenda a mtima komanso kukonza kwa ziwengo zam'magazi a anthu odwala matenda ashuga kumakhala kwambiri kuposa anthu ena. Chifukwa chake, chizindikiro chachiwiri chofunikira kwambiri chomwe chimayenera kuyang'aniridwa mosalekeza ndi cholesterol yamagazi. M'pofunikanso kuyang'anira kuchuluka kwa kuthamanga kwa magazi, osagwiritsa ntchito mafuta ochokera ku nyama kuti adye, kukana mowa ndi kusuta.
3. Kukula kwa matenda ashuga a m'mimba kungathe kuyimitsidwa pokhapokha kuyang'anitsitsa shuga wamagazi ndi kuyesayesa kopitilira muyeso. 4. Pathology ya impso. Ngati nephropathy ikachitika, kuwunika kwa chakudya kumalimbikitsidwa, ndi kuchepa kwa mapuloteni. 5. Matenda. Pofuna kupewa kupitirira kwa mabala owoneka pamtunda, ndikukula kwa njira yowonjezera, tikulimbikitsidwa kusamalira mosamala kuwonongeka kulikonse ndi antiseptic agents. Onetsetsani kuti mukuyenderanso dotolo wamano, komanso kukonza magwiridwe antchito amthupi. Kupewa matenda a shuga a mellitus + a 2 shugaMatenda a shuga ndi matenda osachiritsika komanso ovuta kwambiri. Zitha kuyambitsa zovuta pamtima komanso m'mitsempha ndipo zimatha kupha. Koma kodi ndizotheka kuletsa kukula kwa maselo amthupi? Kupewa matenda ashuga a mellitus + mtundu wachiwiri wa matenda a shuga kutha kuteteza matendawa kapena kuchedwetsa kuyambika kwake ndi cholowa cham'tsogolo. Shuga uyenera kukhala wabwinobwino! Kuti timvetsetse ngati kupewa matenda obwera chifukwa cha matenda ashuga kuli kotheka, tiyeni tikambirane tsatanetsatane wa matendawa. Mankhwala, mitundu iwiri imasiyanitsidwa - yoyamba ndi yachiwiri.
Mtundu wamatendawa umadziwika ndi kuyambika kwadzidzidzi, koopsa komanso kusinthika kwapang'onopang'ono kwa zovuta. Glycemia mwa odwala imayendetsedwa ndi jakisoni wokhazikika wa insulin. Tcherani khutu! Nthawi zambiri, CD-1 imapezeka mwa ana ndi achinyamata, koma imatha kuchitika zaka zilizonse. Matenda a shuga a DM-2 (osadalira insulini) amatha kukulitsa motsutsana ndi maziko a kuchepa pang'ono kwa katulutsidwe ka insulin. Chinthu chachikulu mu pathogenesis ya matendawa ndikupanga kukana (kusazindikira mtima) kwa zotumphukira za cell cell zolandila mahomoni. Makina amakono a CD-2 ndi osiyana Kuphatikiza pa kubadwa kwa cholowa, mphamvu zomwe sizitchulidwa kawirikawiri kuposa mtundu woyamba wa matenda ashuga, zotsatirazi zoopsa za matendawa zimasiyanitsidwa:
Kupewa kumathandizira kupewa matenda owopsa a mahomoni: mtundu wachiwiri wa matenda ashuga umayambiranso. Mtundu woyamba wa shuga umakhala wochepera 9-10%. Ku Russia, chiwopsezo chawo ndi milandu 14.7 kwa aliyense zana limodzi. Momwe mungapewere matenda a shuga omwe amadalira insulin: kupewa matenda kumagawika m'magulu oyambira, a sekondale, apamwamba. Gome 1: Magawo a njira zopewera kupewa matenda a shuga-1: Kupewera kwa matenda ashuga ndi koyenera kwambiri kwa ana ndi achinyamata omwe ali pachiwopsezo chachikulu cha matenda. Itha kuyesedwa ndi:
Kuyesedwa kwapadera kukuwonetseratu tsogolo la matenda ashuga Tcherani khutu! Chiwopsezo chokhala ndi IDDM pamaso pa chiphunzitsochi mwa m'modzi mwa makolo kapena abale nthawi zambiri sichidutsa 5-6%. Kuphatikiza apo, achibale omwe ali ndi matenda amtundu wa 2 samalandiridwa, chifukwa mitundu iyi ya hyperglycemia imangobadwa palokha. Kuvuta kwa njira zonse zodzitetezera kumagona chifukwa chosowa chidziwitso cha zomwe zimayambitsa dongosolo la autoimmune mthupi. Zotsatira zambiri zakusaka (TEDDY, TRIGR, TrialNet Nip, ndi zina) ndizolimbikitsa mwachilengedwe. Chifukwa chake, chitetezo choyambirira ndi chiyani - matenda a shuga 1 angathe kupewedwa ngati:
Kuyamwitsa kumateteza mwana ku matenda ambiri Kupewera kwachiwiri kwa matenda ashuga kuyenera kuchitika ndi odwala omwe matupi awo a autoimmune omwe amapanga kale zokhudzana ndi zisumbu za pancreatic za Langerhans. Zitha kutsimikizika ndi kukhalapo kwa chikhazikitso pakayesedwe ka magazi:
Magazi achilengedwe amatha kutsimikiza mu labotale. Zofunika! Ma antibodies a pathological amawonekera m'magazi a matendawa zaka zingapo kusanachitike kuwonekera kwa matendawa. Pali maphunziro angapo azachipatala pamakonzedwe a insulin kwa anthu omwe ali ndi vuto lalikulu la ma antibodies azaka za 3-45 kuti athetse kuwonongeka kwa autoimmune kwa kapamba. Kuletsa kwamtunduwu kwamatenda kumagwiritsidwa ntchito kwambiri ngati mankhwala. Kuti muchite bwino, ziyenera kuyamba milungu isanu mutatha kuzindikira. Amadziwika kuti atatha kuwonetsa matendawa, pafupifupi 10-20% ya maselo a pancreatic beta amakhalabe ndi ntchito zawo. Ntchito ya njira zachipatala ndiyoti ipulumutse zinthu zotsala ndipo, ngati zingatheke, yambitsitsanso kukonzanso kwake. Ndikofunikira kukhazikitsa bwino kapamba Pakadali pano, kupewa matenda ashuga apamwamba kumaphatikizapo madera angapo:
Pomaliza, ziyenera kudziwidwa kuti ngakhale atakwaniritsa sayansi ya zamankhwala, njira zodalirika komanso zotetezeka zoteteza chitukuko cha matenda 1 a shuga kwa odwala omwe ali ndi vuto lobadwa nazo sizinapangidwebe. Mtunduwu umakhala mpaka 90-95% yamilandu yonse yamatenda. Zina mwazifukwa zakuchulukirachulukira kwa kuchuluka kwake ndi izi:
"Sofa" Mbali ya chipatala ya NIDDM, yomwe imadziwika ndi madokotala onse, ndi njira yayitali komanso yotsika. Odwala ambiri sadziwa ngakhale kusintha kwamthupi ndipo amaphunzira mwangozi. Kodi mukudziwa mtundu wanu wa glycemia? Izi ndizosangalatsa. Malinga ndi ziwerengero, kwa aliyense wodwala yemwe ali ndi T2DM pali anthu ena awiri omwe ali ndi hyperglycemia omwe sazindikira mavuto amtundu wa carbohydrate. Ichi ndichifukwa chake kuyesa mayeso ofunikira ndikofunikira pakuwunika matenda a endocrinology. Makamaka omvera thanzi lawo ayenera kukhala anthu omwe ali pachiwopsezo cha NIDDM. Zinthu zomwe zimalola wodwala kukhala m'gulu lino ndi izi:
Monga momwe ziliri ndi CD-1, kupewa ndi kuchiza matenda a shuga 2 mwa amuna ndi akazi kuli magawo atatu. Gome 2: Magawo a njira zopewera kupewa matenda a shuga-2: Popeza mu etiology ya CD-2 zomwe zimapangitsa kuti chibadwa chidayambike komanso zinthu zachilengedwe zimasiyanitsidwa, ndizotheka kupewa (kapena kuchedweratu) matendawa posintha moyo wawo. Maupangiri othandizira anthu omwe ali pachiwopsezo akuphatikizapo:
Timatenga mapiritsi mosamalitsa malinga ndi malangizo Izi ndizosangalatsa. Njira zochiritsira zosagwiritsidwa ntchito masiku ano zatsimikiziranso kuti zili bwino. Mankhwala ozikidwa pa Yerusalemu artichoke akhazikika Noto amadziwika kwambiri: matenda a shuga amaletsedwa ndikuchepetsa shuga, kulimbitsa chitetezo chokwanira, kupewetsa magazi, kusintha kagayidwe, komanso kusintha matumbo. Prophylaxis yachiwiri imalimbikitsa onse odwala:
Kuphatikiza pa malamulo apadera okonza njira, omwe afotokozedwera m'ndime iyi pamwambapa, zolinga 4 zakonzedwa kwa anthu omwe ali ndi prediabetes:
Kupeza kwawo kumalola kuti muchepetse zoopsa za kupangika kwa matenda a hyperglycemia. Sankhani nokha masewera abwino Kuphatikiza apo, malinga ndi zomwe dokotala akuwonetsa, Metformin itha kutumizidwa chifukwa cha prophylactic. Kupewa mavuto a shuga mellitus ndi kukonza kwa matenda a hyperglycemia, dyslipoproteinemia, matenda oopsa komanso zina. Mitengo yomwe mukufuna igwiritsidwe ntchito pagawo lantchito. Gawo 3: Magulu owunikira zomwe CD-2 ikuyang'ana:
Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito.Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusayiti, kukambirana ndi akatswiri ndizofunikira nthawi zonse. Kupewa koyamba
Kupewera kwa matenda ashuga a mtundu woyamba kumatanthauza kukhazikitsa njira izi:
Zakudya zimawerengedwa kuti ndi gawo lofunikira la njira zopewera matenda, kuphatikiza, ndizofunikanso zomwe zimapangitsa kuti matenda ayambe kuyenda bwino. Cholinga chachikulu cha chakudyachi chimatchedwa kuchepetsa kuchuluka kwa zakudya zomwe zili ndi chakudya. Komabe, imathandizanso kumwa nyama zamafuta, zomwe zimasinthidwa ndi mafuta azamasamba. Zakudya za munthu wodwala matenda ashuga ayenera kukhala ndi masamba ambiri ndi zipatso zowawasa, zomwe zimakhala ndi fiber yambiri, zomwe zimalepheretsa chakudya cham'mimba. Komabe, zakudya zilizonse sizingagwire ntchito ngati munthu wakhazikika, amangokhala. Ngati sizotheka kukaona malo ochitira masewera olimbitsa thupi, muyenera kungopatula ola limodzi la nthawi yoyenda tsiku lililonse ndi zinthu zamasewera, masewera olimbitsa thupi, kusambira kapena kupalasa njinga. Kuphatikiza apo, kupewera koyambirira kwa matenda ashuga kumathandizanso kuti pakhale mkhalidwe wamaganiza a munthu.
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Poyamba, ndikofunikira kudziwa kuti masiku ano pali zida zofufuzira zokhudzana ndi chitetezo cha mthupi zomwe zimalola munthu wathanzi kwathunthu kuti azindikire mu magawo oyamba chizolowezero cha matenda ashuga 1. Chifukwa chake, ndikofunikira kudziwa zovuta za njira zomwe zingalolere kwa nthawi yayitali kuti muchepetse kukula kwa matenda omwe amafunsidwa.
Kupewera kwa matenda ashuga a mtundu woyamba kumayambira ndi kudya kwapadera. Pakadali pano, pakulimbikitsidwa kuti aliyense adye zakudya zoyenera, chifukwa kuwonjezerapo zovuta zamafuta ndi mafuta omwe amapezeka muzinthu zambiri kumabweretsa mavuto ambiri azaumoyo.
