Malangizo ochepa a momwe mungachepetse shuga

Ngati munthu walandila kuyezetsa magazi ake ndikuwona shuga wokwezeka pang'ono pamenepo, simuyenera kuchita mantha ndikuyamba kuchiza matenda ashuga nthawi yomweyo. Nthawi ndi nthawi shuga pang'ono amatha kuchuluka mwa anthu onse, palibe cholakwika ndi izi. Zambiri zodalirika zokhudzana ndi zovuta za munthu ngati ali ndi matenda a shuga zitha kupezeka kuchokera kuzowunika za shuga. Pokhapokha zotsatira zake pazikhala zifukwa zina.

Mankhwala

Ngati munthu akudwala matenda a shuga omwe amadalira insulin, ndiye kuti sizingatheke kuchepetsa shuga m'magazi ndimankhwala ena kupatula insulin. Ngati wodwala ali ndi matenda a shuga a mtundu wachiwiri, atha kupatsidwa mapiritsi omwe amachepetsa shuga m'magazi ndikuwonjezera shuga. Komabe, ayenera kusankhidwa ndi dokotala okha. Ndizofunikiranso kuti sizingatheke kulimbana ndi matenda ashuga ndimankhwala okha, chifukwa mkhalidwe wabwinobwino wa thupi ndikofunikira kusintha zakudya ndi moyo.

Ngati munthu ali ndi mavuto ndi shuga wambiri, ayenera kusintha menyu ake. Ndikofunika kudziwa kuti sinamoni imathandiza kulimbana ndi matenda ashuga. Iyenera kumwedwa theka la supuni patsiku, ndipo imathandizira thupi kupanga shuga wambiri mu mphamvu yopindulitsa. Kuphatikiza apo, nsomba zam'nyanja yozizira: sardine, nsomba, zimagwira bwino pakachitidwe ka metabolic. Mwa zosankha zosavuta, kudya masamba obiriwira tsiku ndi tsiku ndi zipatso (amachepetsa chiopsezo cha matenda ashuga), komanso anyezi, maapulo, tomato, ndizothandiza. Magalamu 30 okha a minyewa patsiku amathandizira kuwongolera shuga komanso kupewa kudumpha. Ndibwinonso kudya ng'ombe chifukwa cha asidi ake a asidi, omwe amapangidwa kuti asinthe shuga. Momwe mungachepetse shuga? Mutha kuchita izi ndi viniga. Supuni ziwiri za chakudya musanadye chakudya zimathandizira kusintha kulumpha komwe kumayenera kuchitika pambuyo chakudya.

Mankhwala achikhalidwe

Mankhwala achikhalidwe adzakuuzaninso momwe mungachepetse shuga. Ali ndi mitundu yayikulu ya zosankha zingapo zilizonse. Chifukwa, mwachitsanzo, mutha kupanga kulowetsedwa kwa anyezi kapena nthenga za adyo. Pukuta magalamu 50 a chinthu, kutsanulira kapu yamadzi ofunda ndikuyika pamalo amdima kwa maola atatu. Pambuyo pa nthawi yino, mankhwalawa ali okonzeka! Muyenera kumwa pachikhumi chimodzi chagalasi katatu patsiku. Zitsamba zosiyanasiyana zimagwira ntchito bwino kuchepetsa shuga. Izi zitha kukhala kuphika kwa masamba a Bay, maluwa a linden, clover, nettle, masamba a mabulosi. Momwe mungachepetse shuga? Mutha kumwa tiyi kuchokera ku hawthorn, masamba amtundu wakuda kapena m'chiuno. Madzi ochokera mbatata, Yerusalemu artichoke, beets ofiira kapena kabichi yoyera (brine kabichi amathanso kugwira ntchito bwino). Mankhwala ochepetsa magazi awa ayenera kumwedwa kawiri pa tsiku theka la ola musanadye, gawo limodzi mwa magawo atatu a magalasi.

Kodi shuga ndimagazi ndi chiyani?

Choyamba, ziyenera kudziwika kuti zingakhale zolondola kunena kuti "glucose level", chifukwa lingaliro la "shuga" limaphatikizapo gulu lonse la zinthu, ndipo limatsimikizika m'magazi

. Komabe, mawu oti "shuga m'magazi" adayamba kuzika kwambiri kotero kuti amagwiritsidwa ntchito pazilankhulo komanso m'mabuku azachipatala.

Kuchuluka kwa shuga m'magazi (mulingo wa shuga m'magazi) ndi chimodzi mwazinthu zofunika kwambiri zachilengedwe, kuwonetsa kupangika kwa chilengedwe mkati.

Chizindikiro ichi, choyambirira, chimawonetsa mkhalidwe wa kagayidwe kazakudya. Glucose ndi mtundu wamafuta (zinthu zamagetsi) zama cell a ziwalo zonse.

Amalowa m'thupi la munthu makamaka ngati gawo lama chakudya osokoneza bongo, omwe amawonongeka m'mimba, ndikulowa m'magazi. Chifukwa chake, shuga m'magazi amatha kudwala matenda osiyanasiyana am'mimba, momwe mayamwidwe amadzimadzi m'magazi amachepa.

Glucose yemwe amalandila m'mimba ndiye kuti amagwiritsidwa ntchito pang'ono ndi maselo amthupi, koma ambiri amawaika m'magazi a chiwindi.

Kenako, ngati pakufunika (kuwonjezeka kwa nkhawa kapena kukhumudwa, kusowa kwa glucose kuchokera m'mimba), glycogen imasweka ndipo glucose amalowa m'magazi.

Chifukwa chake, chiwindi ndi gawo la shuga m'thupi, kotero kuti ndi matenda ake akulu, misempha ya m'magazi ingasokonekenso.

Dziwani kuti kutuluka kwa glucose kuchokera mu njira yodutsa cell ndi njira yovuta kwambiri, yomwe ikhoza kusokonezedwa m'matenda ena. Ichi ndi chifukwa chinanso cha kusintha kwamatenda am'magazi.

Type 2 matenda a shuga ndi matenda osachiritsika, chifukwa chomwe chiwopsezo cha minofu ya thupi kupita ku insulin chimachepa. Chizindikiro chachikulu chodziwika ndi matendawa ndi kuphwanya kagayidwe kazakudya komanso kuwonjezeka kwa shuga m'magazi.

Matenda a shuga a ana amaonedwa kuti ndi matenda a systemic omwe ndi ovuta kuchiza. Pali mitundu iwiri yamatenda.

Matenda a shuga 1 amtundu wa ana amaphatikizidwa ndi kuperewera kwa maselo omwe amapanga insulin ya chilengedwe. Zotsatira zake, kuchuluka kwa mahomoni awa m'magazi amatsika kwambiri, ndipo shuga yomwe imabwera kuchokera ku chakudya sichigwiritsidwa ntchito ndi thupi.

Matendawa amatchedwa insulin- amadalira.

Matenda a shuga a mtundu wachiwiri mwa ana amatchedwa insulin-Independent. Pankhaniyi, insulin yokwanira imapangidwa, koma sizizindikirika ndi maselo amthupi, chifukwa chomwe glucose yemwe amalowa m'magazi samamwetsa. Zomwe zimayambitsa matenda a shuga kwa ana ndizosiyanasiyana. Matenda amayambitsa chinthu chimodzi kapena zingapo zoyambitsa.

Makamaka

Chinthu chobadwa nacho chimachita mbali yofunika kwambiri. Makolo omwe ali ndi matenda a shuga nthawi zambiri amakhala ndi ana omwe ali ndi vuto lofanana la chibadwa. Pankhaniyi, zamatsenga zimatha kudziwoneka nthawi yomweyo kuyambira wakhanda kapena zaka makumi angapo. Chiwerengero cha maselo omwe amapanga insulin adapangidwa mu DNA ya munthu. Ngati makolo akudwala matenda ashuga, chiwopsezo chotenga nthendayo mwa mwana ndi pafupifupi 80%.

Zimakhala zowopsa ngati magazi omwe ali m'magazi akwezedwa ndi akazi. Glucose imadutsa mosavuta potuluka, imalowa m'magazi a mwana. M'mimba, kufunika kwa shuga kwa mwana ndi kochepa, kotero, zochulukirapo zimayikidwa mu minofu ya adipose. Zotsatira zake, ana omwe ali ndi thupi lolemera (5 makilogalamu ndi kupitilira) amabadwa.

Khalidwe labwino

Zochita zolimbitsa thupi ndizofunikira kwambiri pakugwira bwino ntchito kwa ziwalo zonse ndi machitidwe. Ndi kusayenda, mwana amalemera kwambiri, zomwe sizabwino kwambiri mwana. Kuphatikiza apo, ndizochita zolimbitsa thupi zomwe zimapangitsa kuti kagayidwe kazinthu zonse ka thupi kagwiridwe ntchito, kuphatikizapo kupanga insulini, komwe ndikofunikira kuchepetsa kuchuluka kwa shuga m'magazi.

Zakudya Zosavomerezeka ndiku Zakudya Zambiri

Kudya zakudya zamafuta ambiri othamanga kumayambitsa kuchuluka kwa maselo aana omwe amapanga insulin. Kutsika kwa maselo amenewa kumabweretsa kusokonezeka kwa ntchito yawo, kuchuluka kwa shuga m'magazi.

Zakudya zamafuta othamanga zimaphatikizapo zakudya, pambuyo pake shuga m'thupi limakwera mofulumira. Izi ndi shuga, uchi, chokoleti, makeke okoma.

Kuphatikiza pa chiwopsezo chokhala ndi matenda ashuga, kudya zakudya zotere kumapangitsa kuti muchepetse thupi.

Kukhala moyo wongokhala komanso kudya mokwanira kumayambitsa matenda ashuga.

Zoyambitsa matenda a shuga ana

Nthawi zambiri, chomwe chimayambitsa shuga m'magazi ndichakuti munthu amayamba kudwala matenda a shuga a 2 kapena a 1. Ndikofunikira kuti mupite mayeso, kukayezetsa kuchipatala.

Mukapezeka kuti mwapezeka ndi matenda a shuga, shuga wanu amatsika. Simuyenera kutaya nthawi kuchedwetsa kupita kwa dokotala ndikuyembekeza kuti shuga ya magazi idzachepa yokha.

Kunyalanyaza vutoli kumangotengera zovuta za matenda ashuga, ambiri omwe sangasinthe. Amayambitsa kufa msanga kapena amapangitsa kuti wodwala akhale wolumala.

Chithandizo choyenera cha matenda a shuga chimachepetsa shuga. Komanso, imathanso kusungidwa bwino, ngati anthu athanzi.

Komabe, nthawi zina shuga amawonjezeka kwakanthawi ngakhale odwala matenda ashuga omwe amathandizidwa bwino komanso molimbika. Zomwe zimayambitsa kwambiri izi ndi matenda opatsirana, komanso kupsinjika kwambiri, monga kuwopa kuyankhula pagulu.

Kuzizira, komanso vuto logaya chakudya, komwe kumayendetsedwa ndi kutsekula m'mimba, kusanza ndi kusowa kwamadzi, kumakulitsa shuga. Werengani nkhani ya Momwe Mungachiritsire Kuzizira, Kupumira, ndi Kutsegula m'mimba mwa Odwala Odwala.

Zimachitika kuti wodwala matenda ashuga amaiwala kupanga jakisoni wa insulin kapena kumwa mankhwala munthawi yake. Insulin ikhoza kuwonongeka chifukwa cha kuphwanya kosungirako.

Mwachidule, yankho la funso loti "ndi chiyani - mtundu wachiwiri wa matenda a shuga" lingachitike motere: ndi matenda amtunduwu, kapamba amakhalabe olimba, koma thupi silingayamwa insulin, popeza ma cell a insulini amawonongeka.

Ndi matenda amtunduwu, maselo amthupi samatenga shuga, zomwe ndizofunikira pantchito zawo zofunikira ndikuchita bwino. Mosiyana ndi matenda amtundu wa 1 shuga, kapamba amatulutsa insulin, koma samagwira ndi thupi pama cellular.

Pakadali pano, madokotala ndi asayansi sangathe kuzindikira chomwe chimayambitsa insulin. Popita kafukufuku, adazindikira zinthu zingapo zomwe zimawonjezera chiwopsezo cha matenda a shuga a 2. Zina mwa izo ndi:

kusintha kwa mahomoni m'zaka za kutha. Kusintha kowopsa kwa kuchuluka kwa mahomoni mu 30% ya anthu kumayendetsedwa ndi kuwonjezeka kwa shuga m'magazi. Akatswiri akukhulupirira kuti kuwonjezeka kumeneku kumagwirizana ndi kukula kwa mahomoni,
kunenepa kwambiri kapena kunenepa kwambiri kwakanthawi kambiri kuposa kwakhalidwe. Nthawi zina zimakhala zokwanira kuchepetsa thupi kotero kuti shuga m'magazi amatsika pamtengo wofunikira,
jenda ya munthu. Amayi amatha kukhala ndi matenda a shuga a mtundu wachiwiri,
liwiro. Zawonedwa kuti mamembala amtundu waku Africa American ali ndi 30% yambiri yamatenda a shuga,
chibadwa
kuphwanya chiwindi,
mimba
zolimbitsa thupi.

Matenda a shuga ndi matenda opatsirana a endocrine omwe amadziwika ndi kuchuluka kwa shuga (shuga). Matendawa, kamodzi adawonekera, samadutsanso. Kuchiza kumatenga moyo wonse, koma mankhwala a insulin amalola odwala kukhala ndi moyo wonse.

Amaganiziridwa molakwika kuti matendawa amayambitsa zakudya zowonjezera shuga. Zoyambitsa zenizeni ndi chilengedwe cha chibadwa komanso zinthu zachilengedwe. 80% yamatenda amayamba chifukwa cha chibadwa chamunthu. Muli mitundu yapadera yamtundu womwe umatha kubereka.

Mukamayang'ana kuchuluka kwa kuchuluka kwa shuga m'magazi, ndi chizolowezi kuyang'ana malingaliro a World Health Organisation. Amaganizira za msinkhu wa wodwalayo, kupezeka kwake kwa pakati komanso momwe amadya.

Shuga wamagazi ovomerezeka

Malire a shuga

ana kuyambira masiku 2 mpaka 30: 2.8 - 4.4 mmol / l,
ana kuyambira mwezi umodzi mpaka zaka 14: 3.3 - 5.6 mmol / l,
abambo ndi akazi kuyambira wazaka 14 mpaka 50: 3.9-5.8 mmol / l,
abambo ndi amayi akulu kuposa zaka 50: 4.4-6.2 mmol / l,
abambo ndi amayi kuyambira zaka 60 mpaka 90: 4.6-6.4 mmol / l,
abambo ndi amayi opitilira zaka 90: 4.2-6.7 mmol / l,

Ola limodzi mutatha kudya, chithunzi chosakwana 8.9 mmol / L chimawonedwa ngati chabwinobwino, ndipo pambuyo pa maola 2 osakwana 6.7 mmol / L.

Chizolowezi cha shuga m'magazi

Kuchuluka kwa shuga m'magazi kwa amayi kumatha “kulephera” nthawi ya kusamba, komanso nthawi yomwe ali ndi pakati. Kuchuluka kwa glucose kwa 8-10 mmol / L ndizomwe zimachitika kwa azimayi munthawi imeneyi, komabe, ngati chizindikirochi ndiwokwera kwambiri kwatha chaka chatha kusiya kusamba, ndi nthawi yoti mawu amvekere ndikuwunikira mayeso a matenda ashuga.

Gulu la anthu odwala matenda ashuga

Matenda a shuga ali ndi mitundu iwiri yayikulu:

Insulin (1 mtundu) - kukanika kwa pancreatic komwe kumachitika chifukwa chogwiritsa ntchito chitetezo chamthupi molakwika.
Osadalira insulini (mtundu 2) - osawoneka kwambiri mwa ana. Koma amatha kudwala ana onenepa kwambiri. Ndi matenda amtundu 2, insulin imapangidwa pang'onopang'ono ndipo siimva thupi.

Ana amatha kukhala ndi matenda ashuga amtundu woyamba.

Odwala a ana, odwala matenda ashuga nthawi zambiri amayenera kuthana ndi mtundu 1 wa matenda a shuga (wodalira insulin), omwe amachokera ku kuperewera kwathunthu kwa insulin.

Mtundu woyamba wa shuga 1 wa ana amakhala ndi mawonekedwe a autoimmune, amadziwika ndi kupezeka kwa autoantibodies, kuwonongeka kwa maselo, kuyanjana ndi majini a histocompatability tata HLA, kudalira kwathunthu kwa insulini, chizolowezi cha matenda a ketoacidosis, etc. pathogenesis nthawi zambiri imalembetsedwa mwa anthu omwe si a ku Europe.

Kuphatikiza pa mtundu woyamba wa matenda ashuga 1, mitundu yovuta yamatendawa imapezeka mwa ana: mtundu wachiwiri wa matenda ashuga, matenda a shuga ogwirizana ndi genetic syndromes, mtundu wa AYO matenda a shuga.

Kuzindikira ndi kuchuluka kwa matenda ashuga

Nthawi zambiri, munthu sangakayikire kuti ali ndi matenda otere. Nthawi zambiri, kuchuluka kwa shuga kwamwazi kumapezeka mukamachiza matenda ena kapena mukamayesa magazi ndi mkodzo.

Ngati mukukayikira kuchuluka kwa shuga m'magazi, muyenera kuonana ndi endocrinologist ndikuwunika kuchuluka kwa insulin. Ndiye amene, malinga ndi zotsatira za dindolo, azindikire kukhalapo kwa matendawo ndi kuuma kwake.

Kukhalapo kwa shuga okwanira mthupi kumatsimikiziridwa ndi izi:

Kuyesa kwa magazi. Magazi amachotsedwa kuchokera ku chala. Kusanthula kumachitika m'mawa, pamimba yopanda kanthu. Magawo a shuga pamtunda wa 5.5 mmol / L amawonedwa ngati owonjezera akuluakulu. Pakadali pano, endocrinologist amapereka mankhwala oyenera. Ndi mulingo wa shuga wopitilira 6.1 mmol / L, kuyesedwa kwa glucose kumayikidwa.
Mayeso a kulolera a glucose. Chinsinsi cha njira iyi yowunikira ndikuti munthu amamwa yankho la glucose ya ndende ina pamimba yopanda kanthu. Pambuyo pa maola awiri, msambo wamagazi amamangidwanso. Chosazungulira ndi 7.8 mmol / l, ndi matenda a shuga - oposa 11 mmol / l.
Kuyesa kwa magazi kwa glycogemoglobin. Kusanthula kumeneku kumakupatsani mwayi wodziwa kukula kwa matenda ashuga. Ndi matenda amtunduwu, kuchepa kwa mulingo wa chitsulo m'thupi. Kuwerengeka kwa glucose ndi chitsulo m'magazi kumatsimikiza kukula kwa matendawa.
Urinalysis kwa shuga ndi acetone.

Pali magawo atatu a chitukuko cha matenda a shuga 2:

prediabetes. Munthu samamva kusokonezedwa kulikonse ndi ntchito ya thupi ndikupatuka pantchito yake. Zotsatira zoyeserera sizikuwonetsa kupendekeka kwa glucose kunthawi zonse,
matenda ashuga. Munthu alibe zodziwikiratu za matendawa. Mwazi wamwazi uli mkati moyenera. Matendawa amatha kutsimikizika ndi kuyesedwa kwa glucose,
kuthana ndi matenda ashuga. Chizindikiro chimodzi kapena zingapo za matendawo zilipo. Milingo ya shuga imatsimikiziridwa ndi kuyesa kwa magazi ndi mkodzo.

Pankhani yakuya, shuga imagawidwa m'magawo atatu: wodekha, wambiri, wowopsa, chithandizo cha aliyense payekhapayekha.

Mu gawo lofatsa la matendawa, kuchuluka kwa shuga m'magazi sikupitirira 10 mmol / L.Shuga mumkodzo kulibe. Palibe zizindikiro zodziwika za matenda ashuga, kugwiritsa ntchito insulin sikuwonetsedwa.

Gawo lapakati la matendawa limadziwika ndi mawonekedwe a matenda oopsa a shuga: munthu wowuma pakamwa, ludzu lalikulu, njala yosalekeza, kuchepa thupi kapena kunenepa kwambiri. Mulingo wa glucose woposa 10 mmol / L. Mukamayang'ana mkodzo, shuga amapezeka.

Mu gawo lovuta la matendawa, njira zonse mthupi la munthu zimasokonezeka. Shuga amatsimikizika onse m'magazi ndi mkodzo, ndipo insulini sangathe kupewa, mankhwalawo ndiwotalikirapo. Kwa zizindikiro zazikulu za matenda ashuga, kuphwanya kachitidwe ka minofu ndi mitsempha kumawonjezeredwa. Wodwalayo atha kudwala matenda ashuga kuchokera ku Dibet yachiwiri.

Kutengera ndi chithunzi cha matenda ashuga, matendawa amagawidwa m'magawo angapo. Kusiyanaku kumathandizira madokotala kudziwa ndendende zomwe zikuchitika mthupi la wodwalayo, ndikuzindikiranso mtundu wa chithandizo chomwe chikufunika kwa wodwala wina. Pali magawo anayi a matenda:

Choyamba chimadziwika ndi kuwonjezeka pang'ono kwa shuga. Kudziwitsa matendawa panthawi imeneyi ndikovuta. Shuga wokhala ndi mkodzo sathiridwa, poyesa magazi, magazi a glucose sakhala apamwamba kuposa 7 mmol / L.
Chachiwiri - chimatsatiridwa ndi kukhazikitsidwa kwa zizindikiro zoyambira. Apa otchedwa ziwalo chandamale (impso, maso, ziwiya) akuvutika. Nthawi imodzimodzi, matenda a shuga amachepetsa.
Chachitatu ndi zovuta kwambiri pamatendawa, osakwaniritsidwa kuti mumalize. Glucose amamuchotsa ndi mkodzo wambiri, zovuta zambiri zimayamba, kupenya kumatsika, zotupa za pakhungu la manja ndi miyendo zimadziwika, kuthamanga kwa magazi kumakwera.
Gawo lachinayi komanso lovuta kwambiri. Ndende ya shuga pamilandu iyi yachokera 25 mmol / L. Glucose amamuchotsa mkodzo, ndipo kuchuluka kwa mapuloteni amakwera kwambiri. Odwala omwe ali ndi matenda amtunduwu amadwala zovuta zomwe sizingagwiritsidwe ntchito pachipatala (kulephera kwaimpso, kukula kwa zilonda zam'mimba, matenda osokoneza bongo).

Ndi chitukuko cha matendawa, shuga wamagazi a mwana amawonjezereka

Zofunika! Madigiri omaliza a shuga nthawi zambiri amabweretsa zovuta zomwe zimabweretsa kudwala. Kuti tipewe zotsatirapo zoopsa zotere, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi.

Matenda a shuga ana

Mwa ana aang'ono, pamakhala chizolowezi chomanga thupi chochepetsa shuga la magazi. Zizindikiro za chizindikirochi

Chitetezo ndi kufunika kwa enalapril mwa ana sichinakhazikitsidwe.

Matenda a shuga ana amakhala ndi zaka zilizonse. Kusokonezeka kwa endocrine kumachitika mwa makanda, ana amasukulu, ndi achinyamata.

Pathology imayendera limodzi ndi kuchuluka kwamphamvu kwa shuga m'magazi, zomwe zimayambitsa zizindikiritso zamatendawa. Matenda a shuga aana, monga achikulire, nthawi zambiri amayambitsa zovuta kwambiri, motero ndikofunikira kuzindikira matenda a munthawi yake komanso kuchitapo kanthu poyenera kupewa zovuta zowopsa za matendawa.

Zomwe zimachitika ndi matenda ashuga mwa ana ndizovuta zake komanso zomwe zimachitika pafupipafupi. Mankhwala osiyanitsa ana amasiyanitsa zoterezi mu diabetics yaying'ono monga hyperglycemia ndi hyperglycemic coma, hypoglycemia ndi hypoglycemic coma, ndi ketoacidotic chikomokere.

Hyperglycemia

Kuti mudziwe shuga wamagazi, kuyezetsa magazi a magazi ndi mkodzo kumafunika. Magazi amaperekedwa m'mawa, pomwe saloledwa kudya ndi kumwa. Chakudya chotsiriza chikuyenera kukhala 8-10 maola asanafike pakupereka magazi. Nthawi zina mungafunike kuyesanso mayeso. Zambiri zimalembedwa mu bulletin ya mwana kuti afananize zisonyezo.

Makhalidwe abwinobwino a shuga m'magazi sayenera kupitirira 2.7-5,5 mmol / L. Zizindikiro zopitilira muyeso zimawonetsa hyperglycemia, zilembo pansipa zomwe zikuwonetsa hypoglycemia.

Kusiyanitsa kosiyanasiyana kumachitika pofuna kupatula matenda ena okhala ndi zizindikiro zofananira, kusiyanitsa shuga ndi mtundu wina. Mwachitsanzo, ndi mtundu 1 wa matenda a shuga, kulemera kwamthupi la wodwalayo kumachepetsedwa, ndi matenda amtundu wa 2, kulemera kumachulukitsidwa.

Kusiyanako kumawonedwa ndi kuchuluka kwa C-peptides. Mtundu woyamba wa matenda ashuga, amachepa.

Ndi matenda a shuga a 2, Zizindikiro zimayamba pang'onopang'ono, mkati mwa matenda a matenda amtundu 1, zizindikiro za matenda zimawoneka mwachangu. Odwala omwe ali ndi matenda amtundu woyamba amafunika Mlingo wambiri wa insulin, ndipo mtundu 2 suyenera.

Matenda a shuga m'magazi a ana ndi kuphwanya kwa zakudya zamagulu ndi mitundu ina ya kagayidwe, kamene kamadalira kuperewera kwa insulin komanso / kapena kukana insulin, komwe kumayambitsa matenda a hyperglycemia. Malinga ndi WHO, mwana aliyense wa 500 ndi wazaka 200 aliyense amakhala ndi matenda ashuga.

Kuphatikiza apo, m'zaka zikubwerazi, kuchuluka kwa matenda ashuga pakati pa ana ndi achinyamata 70% akuyerekeza. Popeza kufala kofala, chizolowezi cha "kukonzanso" matenda, njira yopita patsogolo komanso kutha kwa zovuta, vuto la matenda ashuga mu ana limafunikira njira yophatikizirana ndi akatswiri pazolowetsa ana.

endocrinology ya ana. zamkati.

zamitsempha. ophthalmology, etc.

Kuwonetsedwa kwa matenda osokoneza bongo kwa mwana kumatha kukula nthawi iliyonse. Pali nsonga ziwiri mu chiwonetsero cha matenda a shuga kwa ana - pa zaka 5-8 ndi kutha msinkhu, i.e. munthawi ya kukula kwambiri ndi kagayidwe kakang'ono.

Nthawi zambiri, chitukuko cha insulin chodalira matenda a shuga chimachitika mwa ana chimayambitsidwa ndi matenda opatsirana ndi ma virus: mumps. chikuku, SARS.

matenda a enterovirus, matenda a rotavirus, hepatitis, ndi ena. Mtundu woyamba wa matenda ashuga wa ana amadziwika ndi kuyamba kwambiri, nthawi zambiri amakhala ndi vuto la ketoacidosis ndi chikomokere matenda ashuga.

Kuyambira pomwe zizindikiro zoyambirira zimakhazikika, zimatha kutenga miyezi 1 mpaka 2-3.

Ndizotheka kukayikira kukhalapo kwa matenda ashuga mwa ana ndi zizindikiro za pathognomonic: kukodza kwambiri (polyuria), ludzu (polydipsia), kuchuluka kwa chilakolako (polyphagy), kuchepa thupi.

Njira ya matenda ashuga mwa ana ndi yovuta kwambiri ndipo amadziwika ndi chizolowezi chokhala ndi vuto la hypoglycemia, ketoacidosis ndi ketoacidotic chikomokere.

Hypoglycemia imayamba chifukwa cha kuchepa kwambiri kwa shuga m'magazi. chifukwa cha kupsinjika, kuchita masewera olimbitsa thupi mopitirira muyeso, kuchuluka kwa insulin, kudya kwambiri, ndi zina zambiri. Hypoglycemic coma nthawi zambiri imatsatiridwa ndi kupunduka, kufooka, thukuta.

mutu, kumva kuda kwambiri, kunjenjemera miyendo. Ngati simukuthandizira kuwonjezera shuga, mwana amakula.

chisangalalo, chotsatira kuponderezana kwa chikumbumtima. Ndi chifuwa cha hypoglycemic, kutentha kwa thupi ndi kuthamanga kwa magazi ndizabwinobwino, palibe fungo la acetone kuchokera mkamwa, khungu limakhala lonyowa, ndipo shuga m'magazi ilipo.

Pozindikira matenda ashuga, gawo lofunikira ndi la dotolo wazachipatala. amene amayang'anitsitsa khanda.

Pachigawo choyamba, kupezeka kwa zizindikiro zamatenda zam'mbuyomu (polyuria, polydipsia, polyphagia, kuchepa thupi) ndi zizindikilo za cholinga ziyenera kukumbukiridwa. Mukamayang'ana ana, kupezeka kwa matenda ashuga pamasaya, pamphumi ndi pachifuwa, lilime la rasipiberi, komanso kuchepa kwa khungu kumabweretsa chidwi.

Ana omwe ali ndi mawonekedwe a shuga ayenera kutumizidwa kwa madokotala a endocrinologist kuti awongolere kwambiri.

Kuzindikira kotsiriza kumayesedwa ndi kuyezetsa magazi kwa mwana bwinobwino. Maphunziro akulu a shuga kwa ana amaphatikizapo kutsimikiza kwa kuchuluka kwa shuga m'magazi (i.e.

kuphatikiza pa kuwunika tsiku ndi tsiku), insulin.

glycosylated hemoglobin. kulolerana kwa shuga.

Magazi a CBS, mkodzo - minofu ya glucose ndi ketone. / Njira zofunika kwambiri zodziwitsira ana za shuga ndi ana a hyperglycemia (pamwambapa 5.5 mmol / L), glucosuria, ketonuria, acetonuria.

Kuti mupeze mtundu woyamba wa matenda ashuga 1 m'magulu omwe ali pachiwopsezo chachikulu cha matenda obadwa nawo kapena chifukwa cha matenda osiyanitsa a mtundu woyamba wa 2, tanthauzo la At to β-cell of the pancreas and At to glutamate decarboxylase (GAD) akuwonetsedwa.

Kujambula kwa ultrasound kumapangidwa kuti athe kuwona momwe amapangidwira kapamba.

Zomwe zikuluzikulu za mankhwalawa zimayambira matenda a shuga 1 kwa ana ndi insulin, zakudya, moyo woyenera komanso kudziletsa. Njira zopewera zakudya zimaphatikizira kuphatikiza shuga ku chakudya, kuletsa zakudya zamafuta ndi mafuta a nyama, zakudya zopatsa thanzi nthawi zisanu ndi zisanu ndi zisanu ndi chimodzi patsiku, komanso kuganizira za zosowa zamphamvu za munthu payekha.

Mbali yofunika kwambiri yothandizira odwala matenda ashuga mwa ana ndi kudziletsa koyenera: kuzindikira kuopsa kwa matenda awo, kudziwa kuchuluka kwa shuga m'magazi, ndikusintha mlingo wa insulin poganizira kuchuluka kwa glycemia, zochitika zolimbitsa thupi, komanso zolakwika pakudya.

Njira zodziyang'anira zokha za makolo ndi ana omwe ali ndi matenda a shuga amaphunzitsidwa m'masukulu a shuga.

Kuthandizira kwa ana omwe ali ndi matenda ashuga kumachitika ndi ma insulin omwe amapangidwa ndi anthu. Mlingo wa insulin umasankhidwa payekha poganizira kuchuluka kwa hyperglycemia komanso msinkhu wa mwana.

Baseline bolus insulin therapy yatsimikizira mu machitidwe a ana, kuphatikiza kuyambitsa insulin yayitali m'mawa ndi madzulo kukonza basal hyperglycemia komanso kugwiritsa ntchito insulin yocheperako musanadye chakudya chachikulu chilichonse kukakonza postprandial hyperglycemia.

Njira yamakono yogwiritsira ntchito mankhwala a insulin kwa ana m'mimba ndimatumbo a insulin, omwe amakupatsani mwayi woperekera insulin mosalekeza (kutsanzira secretion ya basal) ndi njira ya bolus (kutsanzira pambuyo pobwezeretsa pakudya).

Zofunikira kwambiri pa mankhwalawa a mtundu wa 2 matenda a shuga kwa ana ndi chithandizo cha zakudya, zolimbitsa thupi, komanso mankhwala osokoneza bongo.

Ndi chitukuko cha matenda ashuga ketoacidosis, kulowetsanso madzi, kukhazikitsa mlingo wowonjezera wa insulin, poganizira kuchuluka kwa hyperglycemia, ndi kukonza acidosis ndikofunikira. Pofuna kukhazikika kwa boma la hypoglycemic, ndikofunikira kuti mwanayo apatse mankhwala omwe ali ndi shuga (chidutswa cha shuga, msuzi, tiyi wotsekemera), ngati mwana sazindikira, kuyika kwamphamvu kwa shuga kapena kutsekeka kwa glucagon ndikofunikira.

Ubwino wamoyo wa ana omwe ali ndi matenda ashuga umatsimikiziridwa makamaka ndi mphamvu ya kubwezeretsa matenda. Kutengera ndi zakudya zomwe zimalimbikitsidwa, regimen, njira zochizira, chiyembekezo chamoyo chikufanana ndi avareji yaanthu.

Pankhani ya kuphwanya kwakukulu zomwe dokotala wakupatsani, kuwonongeka kwa matenda ashuga, zovuta zina za matenda ashuga zimayamba msanga. Odwala omwe ali ndi matenda osokoneza bongo amawonera amoyo wa endocrinologist-diabetesologist.

Kusankhidwa kwa Kokor Kora pochiza ana osakwana zaka 18 kumatsutsana chifukwa cha kuchuluka kwa mankhwalawa kwa odwala.

Munkhaniyi, mutha kuwerengera malangizo a kugwiritsa ntchito mankhwala a Bisoprolol. Amapereka ndemanga kuchokera kwa alendo omwe amabwera patsamba lino - ogwiritsa ntchito mankhwalawa, komanso malingaliro a akatswiri azachipatala pakugwiritsa ntchito Bisoprolol pochita zawo.

Chopempha chachikulu ndikuti muwonjezere ndemanga zanu za mankhwalawa: mankhwalawo adathandizira kapena sanathandizire kuchotsa matendawa, ndizovuta ziti zomwe zimawoneka ndi zotsatirapo zake, mwina sizinalengezedwe ndi wopanga.

Bisoprolol analogues kukhalapo kwa masanjidwe ena okhala. Gwiritsani ntchito mankhwalawa angina pectoris ndikuchepetsa kupsinjika kwa akuluakulu, ana, komanso panthawi yoyembekezera komanso mkaka wa m`mawere.

The zikuchokera ndi mogwirizana ndi mankhwala ndi mowa.

Ndi kuchuluka kwa mlingo, imakhala ndi beta2-adrenergic blocking.

Kutumphukira kwathunthu kwa mtima kumayambiriro kwa kugwiritsa ntchito kwa beta-blockers, mu maola 24 oyamba, kumawonjezeka (chifukwa cha kubwereza kowonjezereka kwa zochitika za alpha-adrenergic receptors ndi kuchotsedwa kwa beta2-adrenoreceptor kukondoweza, komwe kumabwerera ku chiyambi chake pambuyo masiku 1-3, ndikuchepera pakukhazikika kwa nthawi yayitali.

Mphamvu ya antihypertensive imalumikizidwa ndi kuchepa kwa miniti yamagazi, kukondoweza kwachisoni kwa ziwiya zotumphukira, kuchepa kwa ntchito ya renin-angiotensin-aldosterone dongosolo (kofunika kwambiri kwa odwala omwe ali ndi hypersecretion ya renin), kubwezeretsa chidwi cha aortic arch baroreceptors (palibe kuchepa kwa kuthana ndi magazi awo ) ndi zotsatira zamagulu amanjenje.

Ndi ochepa matenda oopsa, zotsatira zake zimachitika pambuyo masiku 2-5, zotheka - pambuyo pa miyezi 1-2.

Mphamvu ya antianginal imatheka chifukwa cha kuchepa kwa mphamvu ya okosijeni wam'mnyewa chifukwa chakuchepa kwa kugunda kwa mtima komanso kuchepa kwa mgwirizano, kutalika kwa diastole, ndikusintha kwa myocardial perfusion.

Mwa kuwonjezera kukanikizika komaliza kwa diastolism mu minyewa yamanzere ndikukulitsa kutalika kwa minofu yamitsempha yama ventricles, imatha kuwonjezera kuchuluka kwa mpweya wa myocardium, makamaka kwa odwala omwe ali ndi vuto la mtima (CHF).

Mosiyana ndi osagwiritsa ntchito beta-blockers, akagwiritsidwa ntchito pakatikati Mlingo wowonjezera, imakhala yovuta kutchula ziwalo zomwe zili ndi beta2-adrenergic receptors (kapamba, minofu yolimba, minofu yosalala ya zotumphukira m'mitsempha, bronchi ndi chiberekero) ndipo sizimayambitsa kusungika kwa sodium ion (Na) m'thupi.

Ikagwiritsidwa ntchito mu Mlingo waukulu, imakhala yolepheretsa ma subtypes onse a beta-adrenergic receptors.

Bisoprolol fumarate excipients.

Shuga wapakati pamimba

mthupi la mkazi, kukonzanso kwina kumachitika, komwe kumayambitsa kukana kwa thupi. Kukula kwa izi mwachilengedwe kumathandizira kukula kwambiri kwa ovari ndi placental

(mahomoni obisika

Chithandizo chachikulu cha shuga kwambiri panthawi yomwe muli ndi pakati ndi zakudya. Mapiritsi ambiri omwe odwala matenda ashuga amatenga nthawi zambiri amakhala oletsedwa.

Zimatsimikiziridwa kuti jakisoni wa insulin panthawi yomwe ali ndi pakati alibe vuto lililonse kwa mwana wosabadwayo. Chifukwa chake, ngati mukufuna kubayira insulini kuti muchepetse shuga m'magazi, muchite bwino.

Musaope zotsatira zoyipa za mwana. Sadzatero, ngati muwerenga molondola mlingo wa insulin.

Komabe, nthawi zambiri, ndikokwanira kuti azimayi azitsatira zakudya kuti azikhala ndi shuga pakapita nthawi yayitali. Insulin ndiyofunikira mukakhala ndi pakati mukadali ndi matenda a shuga a mtundu woyamba kapena a 2.

Chithandizo cha boma chimalimbikitsa kuti amayi apakati omwe ali ndi shuga wambiri amachepetsa mafuta ochulukirapo kuchokera ku 50-60% mpaka 30-40% ya zakudya zopatsa mphamvu tsiku lililonse. Tsoka ilo, izi nthawi zambiri sizokwanira.

Zakudya zamafuta ochepa, zomwe nkhaniyo yakhazikitsidwa, ikuwonetsa kuletsa kwakukulu kwa chakudya - osapitirira 20 g patsiku, ndipo kuchokera pazogulitsa zomwe zili pamndandanda wololedwa. Komabe, sizikudziwikabe ngati chakudya chochepa chama-carbohydrate chomwe chimayambitsa kupangika kapena ayi.

Chifukwa chake, kufikira pano, kuyamikiridwa kwa zakudya kwa amayi apakati omwe ali ndi shuga yayikulu m'magazi ndi motere. Idyani zakudya zomwe zili pagulu lololedwa.

Idyani kaloti, beets ndi zipatso, kuti mulibe matupi a ketone m'magazi ndi acetone mu mkodzo.

Werengani apa mwatsatanetsatane za acetone mu mkodzo. Sizowopsa kwa odwala matenda ashuga wamba ndipo nthawi zambiri zimakhala zothandiza.

Koma kwa amayi oyembekezera - sichikudziwika. Chifukwa chake, zakudya zololeza pakukonzekera kuti achepetse shuga pamimba.

Osamadya nthochi.Zipatso zina, kaloti ndi beets, musatengeke.

Azidye ndendende monga momwe angafunikire kuti mu mkodzo mulibe acetone. Ndi kuthekera kwakukulu, izi zimakupatsani mwayi kuti musunge shuga wabwinobwino popanda insulini, kuti mupirire ndi kubereka mwana wathanzi.

Pambuyo pobadwa, shuga mwa akazi nthawi zambiri amabwerera mwakale. Komabe, ngati panali shuga ochulukirapo panthawi yomwe ali ndi pakati, ndiye kuti izi zikutanthauza kuti akhoza kukhala ndi matenda ashuga pambuyo pake - wazaka zopitilira 35-40.

Phunzirani nkhani ya “Matenda a shuga M'm akazi” - dziwani zambiri za kupewa.
.

Kugwiritsidwa ntchito kwa Concor Bark pa nthawi ya bere kumachitika padera pokhapokha ngati chithandizo chamankhwala cha mayi chikupitirira chiwopsezo cha mavuto obwera chifukwa cha mwana wosabadwayo.

Popeza beta-blockers amachepetsa kutuluka kwa magazi mu placenta, omwe angakhudze kukula kwa mwana wosabadwayo, chithandizo chiyenera kutsagana ndi kuyang'anira mosamala kayendedwe ka magazi mu placenta ndi chiberekero, kukula ndi kukula kwa mwana wosabadwayo.

Pakachitika zovuta, njira zina zothandizira zimafunikira. Pambuyo pobadwa, mwana wakhanda amayenera kupendedwa mosamala chifukwa choopsa chokhala ndi bradycardia ndi hypoglycemia m'masiku atatu oyamba amoyo.

Mankhwala ndi contraindicated mu nthawi ya mkaka wa m`mawere, chifukwa chake, ngati n`koyenera kugwiritsa ntchito Concor Bark 2.5 mg, kuyamwitsa kuyimitsidwa.

Zizindikiro za matenda a shuga kwa ana

Kusiyana kwakukulu pakati pa matenda ashuga amtundu 1 ndi nthenda yofanana yachiwiri ndikuti poyamba, kudzipanga kwa insulin kuli pafupi kutha.

Mitundu yonse iwiri yamatenda, muyenera kutsatira zakudya zosamalitsa.

Zakudya zoyenera zamatenda a 2 shuga zimachepetsa kuchuluka kwa zakudya zophatikiza ndi chakudya.

Koyamba, zizindikiro zazikuluzikulu za matenda amitundu iwiri ndizofanana ndi matenda a shuga a mtundu woyamba.

Kutulutsidwa kwa mkodzo wambiri usana ndi usiku,
ludzu ndi kamwa yowuma
Chizindikiro china cha matenda amtundu wa 2 chikukula kwambiri: kuchepa thupi nthawi zambiri sikuonekera, popeza poyamba odwala ndi onenepa kwambiri,
Khungu loyipa, kuyabwa mu khungu, kutupa kwa khungu.
kufooka kopanda tanthauzo, thanzi lathanzi.

Koma pali kusiyana kofunikira - kuchepa kwa insulini sikokwanira, koma wachibale. Kuchuluka kwake komabe kumalumikizana ndi ma receptors, ndipo kagayidwe kake kamachepa pang'ono.

Chifukwa chake, wodwalayo sangakayikire za matenda ake kwa nthawi yayitali. Amamva pakamwa pouma pang'ono, kumva ludzu, kuyabwa, nthawi zina matendawa amatha kudzikhuthula pakhungu ndi mucous nembanemba, zotupa, matenda a chingamu, mano komanso kuwonda.

Izi zikufotokozedwa ndikuti shuga omwe salowa m'maselo amalowa m'makoma amitsempha yamagazi kapena kudzera m'matumba a pakhungu. Ndipo mabakiteriya a shuga ndi bowa amachulukana bwino kwambiri.

Zizindikiro za mtundu wachiwiri za matenda a shuga zikawoneka, mankhwalawa amaperekedwa pokhapokha atayesa mayeso. Ngati muyeza shuga m'magazi mwa odwala, kungowonjezera pang'ono 8-9 mmol / l pamimba yopanda kanthu ndi komwe kumapezeka. Nthawi zina pamimba yopanda kanthu timapezanso shuga m'magazi, ndipo pokhapokha katundu wazakudya zochuluka umawonjezeka. Shuga amathanso kuoneka mkodzo, koma sizofunikira.

Ndi mayeso ati omwe amachitika pofuna kudziwa shuga?

Pali njira ziwiri zodziwika za kuyeza shuga wamagazi m'mankhwala am'chipatala: m'mawa pamimba yopanda kanthu (yopuma pakudya ndi madzi akumwa kwa maola osachepera 8), ndikatha kutsitsa shuga (kotchedwa glucose kulolerana mayeso, OGTT).

Chiyeso chololera pakamwa cha glucose chimakhala chakuti wodwalayo amatenga magalamu 75 a shuga amasungunuka mu 250-300 ml ya madzi mkati, ndipo atatha maola awiri shuga yotsimikiza mtima.

Zotsatira zolondola kwambiri zimatha kuphatikiza mayeso awiri: pambuyo pa masiku atatu a chakudya chokwanira m'mawa pamimba yopanda kanthu, kuchuluka kwa shuga kumatsimikizika, ndipo pakatha mphindi zisanu, yankho la glucose limatengedwa kuti muyeze chizindikiro ichi pambuyo pa maola awiri.

Nthawi zina (shuga mellitus, kulolerana kwa shuga), kuyang'anitsitsa kuchuluka kwa shuga m'magazi ndikofunikira kuti musaphonye kusintha kwakukuru komwe kumakhala koopsa ndi moyo komanso thanzi.

Chithandizo cha matenda ashuga

Chenjezo liyenera kuchitika mwa odwala:

Mphumu ya bronchial,
anaphylaxis,
matenda ashuga
kuwononga atherosulinosis kapena endarteritis,
atrioventricular blockade wa 1 degree.

Kuchita opaleshoni kungafune kutha kwa mankhwalawa masiku ochepa ntchito isanachitike, chifukwa chake muyenera kudziwitsa wodwala kuti atenge Concor.

Pa mankhwala, ndikofunikira kuwonjezera pang'onopang'ono mlingo, mpaka pakufunika kwa kuchepa. Simungaleke mwadzidzidzi kumwa mankhwalawa, kuchoka kwa Concor kuyenera kukhala pang'onopang'ono.

Chidacho chapangidwira chithandizo chanthawi yayitali. Kuwona kuchuluka kwa Concor komwe kungatengedwe kwa matenda oopsa, kumawerengedwa:

matenda oopsa;
kusintha kwa kusintha
Zochita zina zamankhwala.

Ndi kulekerera bwino komanso kuwongolera koyenera, Concor imatha kutengedwa nthawi yayitali, nthawi zina kwa moyo wonse. Pakulephera kwa mtima, Concor imayikidwa mu njira yamaphunziro, mu izi, nthawi ya Concor idzakhala masabata angapo kapena miyezi.

Mankhwalawa amatha kugwiritsidwa ntchito mwa anthu odwala matenda a shuga a mitundu yonse, chifukwa chake n`zotheka kutenga Concor ndi insulin. Ndikofunikira kuganizira mphindi ngati izi:

bisoprolol imawonjezera mphamvu ya hypoglycemic ya mankhwala ochepetsa shuga ndi insulin,
ndizotheka kuyambitsa mawonekedwe a hypoglycemia pochepetsa ntchito ya mtima.

Pochiza odwala matenda a shuga, yang'anani mosamala kuchuluka kwa shuga m'magazi.

Kugwiritsa ntchito bisoprolol pochiza matenda oopsa kuli ndi phindu lalikulu kwa odwala. Anachita maphunziro ofananizira a mankhwalawa ndi ena a beta-blockers.

Zinapezeka kuti zotsatira zawo zikufanana, kuweruza ndi kuchuluka kwa kutsika kwa magazi. Komabe, popenda zisonyezero zowunikira tsiku ndi tsiku, zinaoneka kuti bisoprolol idagwirabe ntchito m'mawa wa tsiku lotsatira.

Pomwe ena amabeta beta sakanakhoza kunyadira izi. Anachepetsa kapena kusiya kuyimitsa thupi lawo pakatha maola 2-4 asanamwe mankhwalawa.

Bisoprolol imakupatsani mwayi wowongolera kuthamanga kwa magazi komanso kugunda kwa mtima osati pokhapokha, komanso panthawi yolimbitsa thupi. Kafukufuku wa gulu la odwala adawonetsa kuti pamenepa amachita bwino kuposa metoprolol. Chifukwa chake, ndizotheka kutsindika mawonekedwe amtundu wa zotsatira za bisoprolol monga kukhazikika komanso kufanana pakanthawi masana.

Kuwunikira kuthamanga kwa magazi masana kumatsimikizira kuti bisoprolol imasungabe ntchito yake yotsutsa-usana ndi usiku, osapotoza kusiyanasiyana kwa magazi a magazi (tsiku ndi tsiku).

Zotheka kuti kuchepa kwa kukwezedwa kwa usiku kukhale ndi gawo lofunikira pochepetsa kumanzere kwamitsempha yama mtima ndi 14-15%, yomwe imawonedwa munthawi ya bekoprolol yoyang'anira miyezi 6.

Chifukwa chake, bisoprolol ngakhale popanda kuphatikiza ndi mankhwala ena imapereka zotsatira zomwe zimafunidwa mwa odwala ambiri omwe ali ndi vuto lochepa kwambiri kapena lotha kusintha magazi. Kupanikizika kwa diastolic (kutsika)