Chithandizo cha mankhwala othandizira odwala matenda a shuga

(Mtundu woyamba wa shuga)

Matenda a shuga amtundu woyamba amapezeka mwa achinyamata azaka za 18 mpaka 18.

Poyerekeza ndi mbiri yakukula, kulowa moyo wodziyimira pawokha, munthu amakhala ndi nkhawa zambiri, zizolowezi zoyipa zimatengedwa ndipo zimazika mizu.

Chifukwa cha patathogenic (pathogenic) zinthu- kachilombo ka kachilombo, kachidakwa pafupipafupi, kusuta, kupsinjika, kudya,

Chofunikira chake chimakhala chakuti chitetezo cha mthupi chimayamba kulimbana chokha, ndipo ngati pali matenda ashuga, ma cell a beta a kapamba (islets of Langerhans) omwe amapanga insulin amawukira. Ikubwera nthawi yomwe kapamba akaleka kupangira mahomoni ofunikira pawokha kapena amapanga okha osakwanira.

Chithunzithunzi chokwanira chazifukwa zamakhalidwe oteteza thupi sichidziwika bwino kwa asayansi. Amakhulupirira kuti kukula kwa matendawa kumakhudzidwa ndi ma virus komanso ma genetic. Ku Russia, pafupifupi 8% ya odwala onse ali ndi matenda a shuga. Matenda a L-mtundu wa shuga nthawi zambiri amakhala matenda a achinyamata, chifukwa nthawi zambiri amayamba unyamata kapena unyamata.Komabe, matenda amtunduwu amathanso kukula mwa munthu okhwima. Maselo a pancreatic beta amayamba kusweka zaka zingapo zizindikilo zazikulu zisanachitike. Nthawi yomweyo, thanzi la munthu limakhalabe pamlingo wachilendo.

Kukhazikika kwa matendawa nthawi zambiri kumakhala kovuta, ndipo munthu payekha amatha kunena tsiku loyambirira chizindikiro: kusowa ludzu, kusokonekera pafupipafupi, kusowa kwa chakudya komanso, ngakhale kuti mumadya pafupipafupi, kuchepa thupi, kutopa, kusawona bwino.

Izi zitha kufotokozedwa motere. Maselo owononga a pancreatic beta sangathe kupanga insulin yokwanira, cholinga chake chachikulu ndicho kuchepetsa kuchuluka kwa shuga m'magazi. Zotsatira zake, thupi limayamba kudziunjikira glucose.

Glucose- imapereka mphamvu kwa thupi, komabe, kuti ilowe mu cell (ndi fanizo: mpweya ndi wofunikira kuti injini igwire ntchito), imafunikira wopangira -insulin

Ngati palibe insulini, ndiye kuti maselo amthupi amayamba kufa ndi njala (chifukwa chake kutopa), ndipo glucose wochokera kunja ndi chakudya umadzaza m'magazi. Nthawi yomweyo, maselo "omwe ali ndi njala" amapereka ubongo kuzindikiritsa kusowa kwa glucose, ndipo chiwindi chimagwira ntchito, chomwe kuchokera m'magulu ake a glycogen chimatulutsa gawo lina la shuga m'magazi. Kulimbana ndi shuga wambiri, thupi limayamba kuchichotsa mwamphamvu kudzera mu impso. Chifukwa chake kukodza pafupipafupi. Thupi limapangira kuchepa kwa madzimadzi ndi kuthetsa kawirikawiri ludzu. Komabe, pakapita nthawi, impso zimaleka kuthana ndi ntchitoyi, motero kumatha madzi am'mimba, kusanza, kupweteka kwam'mimba, vuto laimpso. Maselo a glycogen m'chiwindi ndi ochepa, kotero zikafika kumapeto, thupi limayamba kukonzekera maselo ake amafuta kuti apange mphamvu. Izi zikufotokoza kunenepa. Koma kusintha kwa maselo amafuta kuti atulutse mphamvu kumachitika pang'onopang'ono kuposa ndi glucose, ndipo kumayendera limodzi ndi mawonekedwe a "zinyalala" zosafunikira.

Matupi a Ketone (i.e. acetone) amayamba kudziunjikira m'magazi, zomwe zimapangitsa kuti thupi likhale ndi mthupi lowopsa - kuchokera ketoacidosisndipoyizoni wa acetone .

Ndizotheka makamaka chifukwa cha kukhalapo kwa ziwonetsero zambiri za matupi a ketone mu mkodzo kuti kuwunika kwa matenda a shuga 1 amapangidwa, chifukwa khungu limatulutsa pachimake mu ketoacidosis. Kuphatikiza apo, nthawi zambiri ena amamva kupuma kwa "acetone".

Popeza kuwonongeka kwa cell ya pancreatic beta kumachitika pang'onopang'ono, kuzindikira koyambirira komanso kolondola kumatha kupangidwa ngakhale pakadalibe zizindikiro zomveka za matenda ashuga. Izi zimayimitsa chiwonongeko ndikupulumutsa unyinji wa maselo a beta omwe sanawonongedwe.

Pali magawo 6 a chitukuko cha matenda a shuga 1:

1. Kutengera kwa chibadwa cha mtundu 1 wa shuga. Pakadali pano, zotsatira zodalirika zitha kupezeka kudzera mu kafukufuku wa majini olembera matendawa. Kupezeka kwa ma antigen a HLA mwa anthu kumachulukitsa chiopsezo cha matenda a shuga 1.

2. Poyamba mphindi. Maselo a Beta amakhudzidwa ndi zinthu zosiyanasiyana za pathogenic (pathogenic) (kupsinjika, ma virus, ma genetic, etc.), ndipo chitetezo cha mthupi chimayamba kupanga ma antibodies. Katemera wa insulin wovunda sanachitikebe, koma kukhalapo kwa ma antibodies kungadziwike pogwiritsa ntchito mayeso a immunological.

3. Gawo la prediabetes.Kuwonongeka kwa ma cell a pancreatic beta ndi autoantibodies of immune immune ayamba. Zizindikiro zake kulibe, koma kusokonezeka kaphatikizidwe ndi katemera wa insulin atha kupezeka kale pogwiritsa ntchito mayeso ololera a glucose. Nthawi zambiri, ma antibodies kuma cell a beta, ma antibodies kupita ku insulin, kapena kupezeka kwa mitundu yonse ya antibodies nthawi imodzi amapezeka.

4. Kukula kwa insulin.Kuyesedwa kwa kupsinjika kungathe kuwululakuphwanyakuloleranakutishuga(NTG) ndikusala kwam'madzi shuga(NGPN).

5. Kukwatira.Pakadali pano, chithunzi cha matenda ashuga chimawonetsedwa ndi zonsezi. Kuwonongeka kwa maselo a beta a kapamba amafika 90%. Katemera wa insulin amachepetsa kwambiri.

6. Kuwonongedwa kwathunthu kwa maselo a beta. Insulin siipangidwa.

Ndikothekanso kudziimira palokha kudziwika kwa matenda amtundu wa 1 pokhapokha zizindikiro zonse zilipo. Amadzuka nthawi yomweyo, ndizosavuta kuchita. Kukhalapo kwa chizindikiro chimodzi chokha kapena kuphatikiza kwa 3-4, mwachitsanzo, kutopa, ludzu, kupweteka mutu komanso kuyabwa, sizitanthauza matenda ashuga, ngakhale, zikuwonetsa matenda ena.

Kuti mupeze matenda a shuga,mayeso a labotale amafunikirashuga ndi mkodzo,zomwe zitha kuchitika kunyumba komanso kuchipatala. Iyi ndiyo njira yoyamba. Komabe, muyenera kukumbukira kuti kuwonjezeka kwa shuga m'magazi pazokha sikutanthauza kukhalapo kwa matenda osokoneza bongo. Itha kuyambitsidwa ndi zifukwa zina.

Mwamaganizidwe, si aliyense amene ali wokonzeka kuvomereza kupezeka kwa matenda a shuga, ndipo munthu amakopeka ndi omaliza.Ndipo komabe, mutazindikira chizindikiro chovuta kwambiri - "mkodzo wokoma", ndibwino kupita kuchipatala. Ngakhale asanayesedwe mayeso a labotale, madotolo aku England ndi akatswiri akale aku India ndi Kummawa adawona kuti mkodzo wa odwala matenda ashuga umakopa tizilombo, ndikuwutcha shuga "matenda a mkodzo".

Pakadali pano, zida zamankhwala zingapo zikupangidwira cholinga chodziyimira pawokha ndi munthu wa msinkhu wamagazi - magazi shuga mitandizingwe zoyesererakwa iwo.

Zingwe zoyesererachifukwa chowongolera chowoneka chikugulitsidwa ku malo ogulitsa mankhwala, osavuta kugwiritsa ntchito ndipo aliyense angathe kuwapeza.Pogula chingwe choyesera, onetsetsani kuti mwatchera khutu kutha kwa nthawi yake ndikuwerenga malangizo.Musanagwiritse ntchito mayesowo, muyenera kusamba m'manja ndikawapukuta. Pukutani khungu ndi mowa sikufunika.

Ndikwabwino kutenga singano yotayika yokhala ndi mtanda wopingasa kapena gwiritsani ntchito lancet yapadera, yomwe imamangidwa pamayeso ambiri. Kenako bala limachira msanga komanso kukhala lopweteka. Ndi bwino kubaya pilo, chifukwa uku ndikugwira ntchito kwa chala ndikusakhudzidwa nthawi zonse sikuthandizira kuchiritsa kwa bala, ndipo malowo ali pafupi ndi msomali. Musanalowetse jakisoni, ndibwino kutisa chala chanu. Ndiye kuti mukulumpe ndikuyesa dontho la magazi pamenepo. Ndikofunika kulabadira kuti simukuyenera kukumba magazi kapena kumayambitsa mkwapulo. Muyenera kudikirira mpaka madontho akukwanira kuti atenge mbali ziwiri za munda woyeserera. Kuti muchite izi, muyenera wotchi yachiwiri ndi dzanja. Pambuyo pa nthawi yomwe yatchulidwa mu malangizowo, pukutani magazi pachiwonetsero ndi ubweya wa thonje. Pakuunikira bwino, fanizirani mtundu wosintha wa mzere woyezera ndi muyeso womwe umapezeka kawirikawiri pabokosi loyesa.

Njira yowoneka ngati yodziwira kuchuluka kwa shuga m'magazi imatha kuwoneka yolondola kwa ambiri, koma zomwe amachitazo ndizodalirika komanso zokwanira kuti azindikire kuti shuga ndi wokwera, kapena kukhazikitsa mlingo woyenera wa insulin kwa wodwala.

Ubwino wakuyesa wopindika pa glucometer ndiwotsika mtengo.Komabeglucometer ali ndi maubwino angapo kuyerekeza ndi zingwe zoyeserera.Ndiwosunthika, opepuka. Zotsatira zake zimawoneka mwachangu (kuchokera pa 5 s mpaka 2 min). Dontho la magazi likhoza kukhala laling'ono. Sikuti pakufunika kuti muchepetse magazi ku mzere. Kuphatikiza apo, glucometer nthawi zambiri imakhala ndi kukumbukira zamagetsi momwe zotsatira za miyeso yam'mbuyomu zimalowetsedwera, kotero uwu ndi mtundu wa zolemba zamankhwala zovomerezeka.

Pakadali pano pali mitundu iwiri ya glucometer.Awo ali ndi kuthekera kofanana ndi maso aumunthu kuti athe kuwona kusintha kwa malo oyeserera.

Ndipo yachiwiri, yopangitsa chidwi, ntchito imakhazikitsidwa ndi njira ya electrochemical yomwe kupezeka kwa mphamvu ya glucose m'magazi yokhala ndi zinthu zomwe zimayikidwa pa mzere kuyesedwa. Mamita ena a shuga m'magazi nawonso amayeza magazi m'thupi, omwe ndi ofunika kwa odwala matenda ashuga. Chifukwa chake, ngati muli ndi mtundu wopambana wa hyperglycemic triad: kukodza mwachangu, ludzu losatha komanso njala yosatheka, komanso mtundu wamtundu, aliyense angathe kugwiritsa ntchito mita kunyumba kapena kugula mzere kuchipatala. Pambuyo pake, mwachidziwikire, muyenera kukaonana ndi dokotala. Ngakhale ngati zizindikirozi sizikunena za matenda ashuga, mulimonse sizinachitike mwangozi.

Popanga matenda, mtundu wa shuga umayamba kutsimikizika, ndiye kuwopsa kwa matendawa (ofatsa, odziletsa komanso owopsa). Chithunzi cha chipatala cha matenda amtundu woyamba 1 chimakhala limodzi ndi zovuta zingapo.

1. Kulimbikira kwa hyperglycemia- Chizindikiro chachikulu cha matenda ashuga, ndikukhalabe ndi shuga m'magazi kwa nthawi yayitali. Nthawi zina, osakhala wodwala matenda ashuga, ochedwa hyperglycemia amatha kupezeka mwa anthu nthawizopatsiranamatendamunthawi yotsiriza yopsinjikakapena mavuto azakudya, monga bulimia, pomwe munthu samalamulira kuchuluka kwa chakudya chodyedwa.

Chifukwa chake, ngati kunyumba mothandizidwa ndi Mzere wa mayeso kunali kotheka kuzindikira kuwonjezeka kwa shuga m'magazi, osathamangira kuti mukuganiza. Muyenera kuwona dokotala - zithandiza kudziwa chifukwa chenicheni cha hyperglycemia. Kuchuluka kwa shuga m'mayiko ambiri a dziko lapansi kumawerengeredwa mamiligalamu pa desilita (mg / dl), komanso ku Russia m'mililita lita imodzi (mmol / l). Zomwe zimapangitsa kutembenuka kwa mmol / L mu mg / dl ndi 18. Gome ili pansipa likuwonetsa zomwe ndizofunika.

Mwazi wamagazi (mol / L)

Mwazi wamagazi (mg / dl)

Kuopsa kwa hyperglycemia

Zoyambitsa matenda a shuga

Matenda a shuga omwe amadalira insulin ali ndi ICD ya 10 - E 10. Matendawa amapezeka makamaka ali mwana, pamene zizindikilo zoyambirira zimapezeka ndikuzindikira matenda - a 1 shuga.

Pankhaniyi, maselo a pancreatic owonongedwa ndi thupi amasiya kutulutsa insulin. Ichi ndi mahomoni omwe amawongolera momwe mayamwidwe amadzimadzi amachokera ku chakudya kupita ku minofu ndikuwasintha kukhala mphamvu.

Zotsatira zake, shuga amapanga m'magazi ndipo amatha kukhala ndi hyperglycemia. Odwala omwe ali ndi matenda amtundu wa 1 amafunika jakisoni wa insulin nthawi zonse. Kupanda kutero, kukula kwa glucose kumatha kupweteka.

Mtundu wachiwiri wa matenda ashuga, mahomoni amapangidwa mokwanira, koma ma cell samazindikiranso mahomoni, chifukwa chake glucose sayamwa ndi kuchuluka kwake. Psychology iyi sikutanthauza jakisoni wa mahomoni ndipo amatchedwa shuga osadalira insulini. Matenda a shuga amtunduwu amakula nthawi zambiri atatha zaka 40 mpaka 45.

Mitundu yonse iwiri yamatendawa ndi osachiritsika ndipo imafunikira kukonza kwa shuga m'magazi kuti moyo ukhale wabwino komanso wabwinobwino. Ndi matenda a shuga a 2, chithandizo chimachitika ndi mapiritsi ochepetsa shuga, kuwonjezeka kwa masewera olimbitsa thupi komanso kudya mwamphamvu.

Matenda a shuga a Type 1 amawoneka ngati chizindikiro cha kulumala ndipo ndi owopsa kwambiri pazovuta zake. Kuchuluka kwa shuga osakhazikika kumabweretsa kusintha kowopsa mu genitourinary system komanso kukulitsa kulephera kwa impso. Ichi ndiye chifukwa chachikulu cha kuchuluka kwa kufa kwa odwala matenda ashuga.

Zomwe zimapangitsa kuchepa kwa chidwi cha maselo kuti apange insulin komanso chifukwa chake thupi limayamba kuwononga kapamba likufufuzidwa, koma zinthu zomwe zikuthandizira pakukula kwa matendawa zitha kusiyanitsidwa:

1. Ghana ndi mtundu. Zinadziwika kuti amayi ndi oimira mtundu wakuda amakonda kwambiri matenda.
2. Zinthu zoyipa. Mwambiri, mwa makolo odwala, mwana adzadwalanso matenda ashuga.
3. Kusintha kwa mahomoni. Izi zikufotokozera kukula kwa matendawa kwa ana ndi amayi apakati.
4. Matenda a chiwindi ndi matenda a kapamba.
5. Kuchita masewera olimbitsa thupi ochepa komanso kuphatikiza mavuto azakudya, kusuta fodya komanso kumwa mowa kwambiri.
6. Kunenepa kwambiri, kuchititsa ma atherosselotic mtima kuwonongeka.
7. Kulandila kwa antipsychotic, glucocorticoids, beta-blockers ndi ena mankhwala.
8. Cushing's syndrome, matenda oopsa, matenda opatsirana.

Matenda a shuga nthawi zambiri amakula mwa anthu pambuyo poti adwala ndipo apezeka ndi matenda amtundu wamatumbo ndi angina pectoris.

Momwe mungazindikire zizindikiro zoyambirira?

Zizindikiro zoyambirira za shuga ndizofanana m'mitundu yonse, zimangotchulidwa mu mtundu woyamba:

• kulephera kuthetsa ludzu - odwala matenda ashuga amatha kumwa mpaka malita 6 a madzi patsiku,
• kulakalaka kwambiri
• kukodza pafupipafupi komanso mkodzo wambiri.

Komanso, ndi matenda amtundu wa 1 shuga, zowonjezera zimawonedwa:

• kununkhira ndi kukoma kwa acetone,
• kamwa yowuma
• kuchepa mphamvu yakukonzanso zotupa za pakhungu,
• kuwonda mwadzidzidzi ndi kufooka kowonjezereka,
• chisokonezo cha kugona ndi kugunda kwa migraine,
• chiwopsezo cha matenda oyamba ndi fungus,
• kusowa kwamadzi
• kuchepa kowoneka bwino,
• kuthamanga kwa magazi
• kuyabwa ndi kusenda kwa khungu.

Ndi matenda amtundu wa 2, zizindikiro zomwezo zimadziwika, kupatula kununkhira kwa acetone. Ndi matenda amtunduwu, matupi a ketone samapanga, omwe amapereka fungo labwino.

Tanthauzo ndi mfundo zachithandizo cha insulin

Mu shuga mellitus, njira yolembera shuga m'maselo imasokonekera, chifukwa insulin m'thupi ndi yaying'ono kapena imanyalanyazidwa ndi maselo. Poyamba, mahomoni amayenera kuperekedwa kwa thupi ndi jakisoni.

Koma mlingo uyenera kufanana ndi kuchuluka kwa glucose yemwe amamasulidwa ku chakudya chomwe wadwedwa. Kuchuluka kwambiri kapena osakwanira insulini kungayambitse hypo- kapena hyperglycemia.

Zakudya zomanga thupi zimapatsa shuga ndipo ndikofunikira kudziwa kuti ndi angati omwe amalowa m'magazi pambuyo pa chakudya chilichonse kuti apeze mlingo woyenera wa timadzi. M'pofunikanso kuyeza kuchuluka kwa shuga m'magazi musanadye chilichonse.

Ndizosavuta kwa odwala matenda ashuga kuti azisungira diabolos mwapadera asanadye, kuchuluka kwa zakudya zomwe zimadyedwa komanso mlingo wa insulin.

Kodi gawo la mkate ndi chiyani?

Mlingo wa mahomoni amawerengedwa kutengera kuchuluka kwa chakudya chamagulu omwe amaperekedwa pakudya. Anthu odwala matenda ashuga ayenera kuwerengetsa chakudya kuti azidya.

Zakudya zomanga thupi zokha ndizomwe zimawerengedwa, zomwe zimatengedwa mwachangu ndikuwatsogolera kulumpha kwa glucose. Kuti zitheke, pali zinthu monga "mkate".

Kudya zakudya zopatsa mphamvu pa 1 XE kumatanthauza kugwiritsa ntchito mafuta omwe amapezeka mu theka la mkate 10mm kapena 10 g.

Mwachitsanzo, 1 XE ili ndi:

• kapu yamkaka
• 2 tbsp. l mbatata zosenda
• mbatata imodzi sing'anga
• Supuni 4 za vermicelli,
• 1 lalanje
• kapu ya kvass.

Tizikumbukira kuti shuga imachulukitsa zakudya zamadzimadzi mwachangu kuposa zonenepa komanso kuti 1 XE ili ndi zakudya zosaphika (chimanga, pasitala, nyemba) mwakulemera kuposa zophika.

Kuchuluka kovomerezeka kwa XE patsiku kumasiyanasiyana malinga ndi zaka, mwachitsanzo:

• wazaka 7 muyenera 15 XE,
• pa 14 - anyamata 20, atsikana 17 XE,
• wazaka 18 - anyamata 21, atsikana 18 XE,
• akulu 21 XE.

Nthawi imodzi simungadye kuposa 6-7 XE.

Anthu odwala matenda ashuga ayenera kuyang'ana kuchuluka kwa glucose asanadye chilichonse. Pankhani ya shuga ochepa, mutha kugula chakudya chamafuta ambiri, monga phala lamadzi. Ngati mulingowo ndi wokwera, ndiye kuti muyenera kusankha zakudya zonenepa ndi zochepa (sangweji, mazira osenda).

Kwa 10 g ya chakudya cham'mimba kapena 1 XE, mayunitsi 1.5-4 amafunikira. hormone insulin. Mlingo umasiyanasiyana kutengera nthawi ya chaka komanso nthawi ya tsiku. Chifukwa chake, madzulo, mlingo wa insulin uyenera kukhala wotsika, ndipo m'mawa umayenera kuchuluka. M'chilimwe, mutha kulowa magawo ochepa a mahomoni, ndipo nthawi yozizira mlingo umayenera kuchuluka.

Kutsatira mfundo izi, kufunika kwa jakisoni owonjezera kungapeweke.

Ndi mahomoni ati omwe ali bwino?

Chithandizo cha matenda a shuga ogwirizana ndi insulin amtundu uliwonse amachitidwa pogwiritsa ntchito mahomoni amitundu yosiyanasiyana:

• timadzi ta pancreatic ya anthu,
• mahomoni opangidwa ndi chitsulo cha nkhumba
• mahomoni a bovine.

Mahomoni aumunthu amafunikira kukonza magawo a glucose muzochitika zotere:

• matenda a shuga pa nthawi yomwe ali ndi pakati
• Matenda a shuga
• mtundu 1 wa matenda ashuga oyamba kupezedwa mwa mwana.

Mukamasankha mahomoni omwe mungakonde, ndikofunikira kulabadira kuwerengera kolondola kwa mankhwalawo. Izi zimangotengera chithandizo, osati kutengera zakuchokera.

Ma insulin afupiafupi ndi awa:

Zotsatira za mankhwalawa zimachitika pakadutsa ola limodzi jakisoni, koma osakhalitsa, maola 4-5. Jakisoni wotere amayenera kuchitika asanadye, ndipo nthawi zina pakati pakudya, shuga akamatuluka. Muyenera kusunga insulin nthawi zonse.

Pambuyo mphindi 90, ma insulin omwe amagwiritsa ntchito pakatikati amayamba kuchita:

Pambuyo maola 4, pachimake pakubwera bwino kwawo kumadza. Insulin yamtunduwu ndi yabwino ngati ikusowa nthawi yam'mawa komanso kudya kwakanthawi kwakanthawi.

Mutha kugwiritsa ntchito njirayi pokhapokha ngati mukudziwa zodalirika komanso zomwe zidzadyedwe komanso kuchuluka kwa zopezeka mu chakudya ichi. Kupatula apo, ngati simunachedwe ndi chakudyacho, ndiye kuti mwina shuga ali wotsika kuposa mulingo wovomerezeka, ndipo ngati chakudya chamafuta ambiri, mudzafunika kubaya jekeseni wina.

Ma insulin omwe amakhala nthawi yayitali amakhala osavuta kuyang'anira m'mawa ndi madzulo.

Izi zikuphatikiza:

• Humulin N,
• Protafan
• Matepi
• Homofan
• Monotard NM ndi MS,
• Iletin Mon.

Ma mahomoniwa amagwira ntchito bwino kwa maola opitilira 14 ndipo amayamba kuchita zinthu patatha maola atatu jakisoni.

Amatenga kuti jakisoni ndi nthawi yanji?

Muyezo wowerengetsera odwala matenda amisempha -

Nthawi zambiri, insulin yochepa komanso yayitali imalowetsedwa m'mawa musanadye chakudya cham'mawa, chakudya chotsatira chisanafike, kubweretsanso mwachidule komanso usiku kubayidwa nthawi yayitali. Mwanjira ina, insulin yomwe imagwira ntchito kwa nthawi yayitali imaperekedwa sutra ndipo usiku, ndipo timadzi tating'onoting'ono timabayidwa nthawi iliyonse isanadye.

Pakukhazikitsa insulin, madera 4 agawidwa.

1. Malo am'mimba amatambasuka mbali zonse ziwiri za msomali, ndikugwira mbali. Dera ili limawonedwa ngati lothandiza kwambiri, komanso lopweteka kwambiri. Pambuyo pa jekeseni m'mimba, oposa 90% ya insulin yomwe imalowa. Horm imayamba kuchita mphindi 10-15 pambuyo pa jekeseni, mphamvu yake imamveka pambuyo pa ola limodzi. Kuti muchepetse kupweteka, jakisoni ndi bwino kuchitidwa pakhungu pafupi ndi mbali.
2. Dera lamanja limakhudza gawo lakunja la miyendo kuyambira pachiwuno mpaka phewa. Dera ili ndi losautsa kwambiri pakudziyendetsa pakokha kwa mahomoni ndi syringe. Muyenera kugula cholembera kapena kupempha thandizo kwa abale anu. Koma dera lamanja ndilothandiza kwambiri, jakisoni sangayambitse kupweteka.
3. Malo a ntchafu amapezeka kunja kwa mwendo kuyambira bondo kupita ku groin. M'dera lamikono ndi miyendo, palibenso 75% ya mahomoni omwe amamwetsedwa ndipo amayamba kuchita pambuyo pa mphindi 60-90 kuyambira nthawi yoyendetsa. Ndikwabwino kugwiritsa ntchito malo awa insulin yayitali.
4. Malo a tsamba ndiwosasangalatsa komanso osakwanira. Pambuyo pa jekeseni kumbuyo, ochepera 40% ya mankhwalawa amatengedwa.

Malo oyenera jakisoni ndi malo omwe ali mkati mwa zala ziwiri zamkati. Simuyenera kumangokhala malo amodzi nthawi zonse. Izi zimapangitsa kuchepa kwamtundu wa adipose minofu pansi pa khungu komanso kuchuluka kwa insulin, yomwe, ikayamba kuchita, imayambitsa hypoglycemia. Magawo a jekeseni amafunika kusinthidwa, mopitirira muyeso, pangani jekeseni, kuchoka pamalo omwe anapangidwira kale osachepera 3-4 cm.

Mtundu wa jakisoni wotere nthawi zambiri umagwiritsidwa ntchito: insulin yochepa imalowetsedwa pamimba, ndipo yayitali imalowetsedwa mu ntchafu. Kapena kukonzekera kwa mahomoni osakanikirana kumagwiritsidwa ntchito, mwachitsanzo, Kusakaniza kwa Humalog.

Phunziro la kanema pamakonzedwe a insulin:

Matenda a shuga ndi matenda oopsa komanso osachiritsika omwe amafunikira kutsatira kwambiri malangizo onse a dokotala, kuwunika pafupipafupi shuga ndikutsatira molondola ndondomeko ya jakisoni wa insulin. Kuphatikiza konse kwa zinthu zonsezi kumapangitsa kuti matendawa azilamulidwa, ateteze kukula kwa zovuta ndikukulitsa chiyembekezo cha moyo.

Zizindikiro za matenda ashuga

Pali njira zingapo zopangira matenda. Endocrinologists muzochitika zamankhwala zamasiku onse zimasiyanitsa mitundu yayikulu yayikulu ya matenda ashuga: insulini-wodalira (I) komanso osagwirizana ndi insulin-II (II). Poyambirira, matendawa amapezeka chifukwa kapamba amapanga insulini yochepa kwambiri. Kachiwiri - chifukwa maselo sangathe kuzigwiritsa ntchito komanso amakumana ndi vuto la shuga.

Mitundu yonse iwiri ya matenda ashuga imakhala ndi zofananira zambiri. Amasiyana makamaka mu kuuma. Zizindikiro za matenda amtundu wa I ndizowonjezereka, zowala ndipo zimawonekera mwadzidzidzi, mwachangu. Anthu omwe akudwala matenda amtundu II nthawi zambiri sazindikira kwa nthawi yayitali kuti akudwala. General malaise imatha kubisa mosavuta kuzindikiraku. Komabe, matenda ashuga amadziwika chifukwa cha mitundu itatu yazizindikiro. Izi ndi:

• ludzu losatha
• kuchuluka kwamikodzo,
• kumverera kwamuyaya kwanjala.

Matendawa amatha kuwonetsa zina. Matenda awa ndi ochulukirapo, ndipo nthawi zambiri achikulire amapezeka:

• zilonda zapakhosi,
• "Iron" kulawa mkamwa,
• Kuuma ndi kusenda kwa khungu, matenda oyamba ndi fungus,
• mabala amachiritso aatali
• Kuchepetsa kuyamwa m'mapiri,
• mutu
• kupsinjika kumatsika
• kusowa tulo
• kuchepa kwa masomphenya
• kuthana ndi chimfine
• Kuchepetsa thupi
• kufooka kwa minofu
• kusweka.

Kodi nchifukwa chiyani kapamba amaleka kupanga mahomoni ofunikira? Insulin yomwe imadalira matenda a shuga imachitika chifukwa cha zochita za chitetezo cha m'thupi. Amawona kuti ma cell a gland ndi achilendo ndikuwawononga. Matenda a shuga omwe amadalira insulin akukulira msanga muubwana, achinyamata, achinyamata. Matendawa amapezeka mwa amayi ena apakati, koma amadutsa mwana akangobadwa. Komabe, azimayi otere amatha kukhala ndi matenda amtundu II.

Kodi zifukwa zake ndi ziti? Pakadali pano, pali ma hypotheses okha. Asayansi akukhulupirira kuti zifukwa zazikulu zomwe zimayambitsa matenda omwe amadalira insulin atha kukhala:

• matenda opatsirana ndi ma virus
• matenda a autoimmune
• matenda oopsa a chiwindi
• chibadwire
• kusuta kwa maswiti
• onenepa kwambiri
• kupsinjika, kupsinjika.

Kuzindikira matenda a shuga a mtundu I

Kufotokozera za mtundu wina wa matenda omwe amadalira insulin ndi ntchito yosavuta kwa endocrinologist. Madandaulo a wodwala, mawonekedwe a khungu amapereka chifukwa chodziwitsira matenda, omwe, kenako, monga lamulo, amatsimikiziridwa ndi mayeso a labotale. Kuzindikira matendawa kumachitika pogwiritsa ntchito mayeso ndi magazi ndi mkodzo.

- shuga (pamimba yopanda kanthu komanso maola awiri mutatha kudya),

- kulolera kwa glucose (shuga yodalira insulini iyenera kusiyanitsidwa ndi prediabetes),

Mavuto

Matendawa amasokoneza chitetezo cha mthupi. Wodwala amakhala pachiwopsezo chotenga matenda. Zotsatira za matendawa zimatha kukhala zowawa, koma zosakhalitsa, komanso zoperewera. Mavuto owawa kwambiri ndi ketoacidosis, hypoglycemia. Pofufuza gwero lamphamvu, maselo amaphwanya mafuta m'malo mwa glucose. Kukula kwa kuchuluka kwa magazi m'magazi chifukwa cha kusowa kwamadzi kumayambitsa matenda ashuga - mpaka kufa ketoacid. Wodwalayo amavutitsidwa ndi chizungulire, ludzu, kusanza, ndi fungo la acetone kuchokera mkamwa mwake.

Ngati kuchuluka kwa zakudya zomwe zimatengedwa komanso kuchuluka kwa insulin m'thupi sikokwanira, kuchuluka kwa glucose m'magazi kumatsika kwambiri (m'munsi 3.3 mmol / L). Pankhaniyi, kukula kwa matenda oopsa a hypoglycemic sinditha. Thupi limaperewera mphamvu ndipo limachita bwino kwambiri. Wodwalayo azunzidwa ndi kuwukiridwa ndi njala yayikulu, amaponyedwa thukuta, thupi lake likunjenjemera. Ngati simudya maswiti nthawi yomweyo, chikomokere chimabwera.

Mavuto osakhalitsa amatha kupewedwa. Zotsatira zoyipa ndizovuta kuchiza. Komabe, ngati singasiyidwe, mtundu wina wa matenda obwera ndi insulin ungafupikitse moyo wa munthu. Mavuto omwe nthawi zambiri amakhala nawo:

• atherosulinosis
• matenda oopsa
• sitiroko
• myocardial infaration
• zilonda zam'mimba zam'mimba, phazi la matenda ashuga, matenda am'miyendo,
• ngozi, zowonongeka zam'mbuyo,
• kusokonezeka kwa impso.

Momwe mungachiritsire matenda ashuga

Munthu yemwe wapezeka ndi izi ayenera kuzindikira: ndizosatheka kuchiritsa kwathunthu kutengera komwe kumadalira matenda. Mankhwala okhawo sangathandize - chakudya choyenera chofunikira. Chithandizo chiyenera kukhala njira yatsopano ya moyo. Chofunika kwambiri ndikusunga kuchuluka kwa shuga mulingo woyenera kwambiri (osapitirira 6.5 mmol / l), apo ayi mavuto ambiri sangathe kupewedwa.

Muyenera kuwunika momwe mulili ndi glucometer kangapo patsiku. Kuwongolera shuga kumathandiza kusintha msanga wa mankhwala ndi zakudya. Poyamba magawo a shuga omwe amadalira insulin, chithandizo nthawi zambiri chimayamba ndi mapiritsi ochepetsa shuga. Komabe, pakapita nthawi, mumayenera kusinthira jakisoni wa mahoni kapena kuphatikiza zonse ziwiri.

Mankhwala a insulin

Malangizo pochiza matenda amtundu II shuga amasankhidwa yekha. Masiku ano, mankhwala a insulin ndi njira yothandiza yolepheretsera matenda a m'magazi chifukwa cha mankhwala othandiza. Awa ndi mapiritsi a hypoglycemic Glyformin, Glucobay, Dibikor ndi Eslidin. Insulin ya jakisoni - Actrapid, Rinsulin, Insuman ndi ena - amapezeka m'njira zamkati mwachangu. Wodwalayo ayenera kuphunzira kudzipweteka. Jakisoni amatha kulowetsa pampu ya insulin. Kukhazikika kwa kayendedwe ka timadzi mu subatheaneous catheter ndikosavuta.

Zinthu Zololedwa

Mfundo ya chakudyacho ndikupeza kuchuluka kwama calories ambiri ndi mafuta, kudya mafuta ochepa. Kenako kusinthasintha kwa glucose mu shuga wodalira insulin sikudzakhala lakuthwa. Kuletsedwa kotheratu kwa zakudya zonse zopatsa thanzi komanso zotsekemera. Ngati mutsatira lamulo ili la zakudya, matendawa amakula pang'onopang'ono.

Muyenera kudya pang'ono, koma nthawi zambiri, mumapikisano a 5-6. Zakudya zotetezeka komanso zopatsa thanzi ndizophatikiza:

• masamba msuzi kabichi, supu, msuzi wa beetroot, borscht, okroshka,
• phala (yochepa)
• nyama yokonda, nkhuku,
• nsomba ndi nsomba zam'nyanja,
• masamba (mbatata),
• mkaka wopanda mafuta ndi mkaka,
• mankhwala osalala
• zipatso zabwino ndi wowawasa,
• zakumwa - ndi zotsekemera,
• wokondedwa

Zithandizo za anthu

Maphikidwe a mankhwala achikhalidwe komanso mankhwala othandizira kunyumba atha kukhala othandiza:

1. Yerusalemu artichoke amagwira ntchito molimbikitsa odwala matenda a shuga. Tubers ndi bwino kudya zosaphika.
2. Dzira la nkhuku, limenyedwa ndi msuzi wa mandimu 1 (pamimba yopanda kanthu).
3. Kulowetsedwa masamba a mtedza (Bavaria ngati tiyi wokhazikika).
4. Mapira, pansi mu chopukusira khofi. Supuni ya ufa imatsukidwa ndi mkaka pamimba yopanda kanthu (njira yodziwika bwino kwambiri ndi odwala omwe ali ndi matenda a shuga).

Zochita zolimbitsa thupi

Matenda a shuga omwe amadalira insulin amachepetsa pamaso pa anthu omwe amakhala ndi moyo wamphamvu. Chifukwa cha ntchito ya minofu, glucose imagwiritsidwa ntchito bwino ndi maselo. Kuthamanga, kusambira, kuyenda kapena kuyenda, kulima dimba, kulima minda kumatha kukulitsa chidwi cha maselo kuti apange insulin, ndipo mulingo wa jakisoni udzachepa. Komabe, popeza "plume" yogwira ntchito imakhala maola ambiri, munthu sangathe kupitirira pamenepo kotero kuti palibe vuto la hypoglycemia. Mitundu ya katundu wovomerezeka iyenera kuthandizidwa ndi dokotala.

Matenda a shuga a insulin

Matenda a shuga omwe amadalira insulini (monga achinyamata kapena ana a shuga) - awa ndi maina ophera matenda a shuga 1 - Ndizomwe matendawa amatchedwa pano. Zimachitika pamene kapamba amasiya kupangira insulin chifukwa cha kuwonongeka kwa maselo a beta. Ndikosatheka kumwa insulin pakamwa ngati mapiritsi, motero wodwalayo amakakamizidwa kudzipeza yekha ndi insulin. Insulin iyenera kuchitidwa mosalekeza, kwa moyo wonse, kupewa shuga yambiri.

Ntchito yayikulu ya insulini ndikutsitsa maselo kulola kuti shuga azilowa - gwero lamphamvu zomwe zimapangidwa kuchokera ku chakudya chomwe chafika m'thupi lathu. Zakudya zomwe zimapatsa chakudya, kamodzi m'thupi, zimawonongeka ndikupanga glucose, ndipo insulin imapereka shuga m'maselo.

Ndi mtundu wodwala wa shuga womwe amadalira insulin, odwala amagwiritsa ntchito mitundu yosiyanasiyana ya mankhwala a insulin. M'mbuyomu, otchedwa setso insulin Therapy anali otchuka, momwe ma insulin amapangira katatu patsiku musanadye. Mlingo wa insulin anali womwewo, odwala ankangolimbikitsidwa kudya zakudya zomwe zimasungidwa nthawi iliyonse kuti azitha kusunga mankhwalawo.

Popita nthawi, njira yothandizira odwala matenda ashuga (yolimbitsa) idapangidwa pomwe odwala amagwiritsa ntchito mitundu iwiri ya insulini - yochepa komanso yayitali.

Anthu odwala matenda a shuga omwe amadalira odwala insulin amakhala ndi insulini yokhazikika (yokhazikika kapena yaposachedwa) asanadye (kuti "amaphimbira" chakudya), ndipo mlingo wake umasiyana malinga ndi kuchuluka kwa chakudya chambiri.

Kuchita insulin kwa nthawi yayitali kumathandiza kwambiri kwa odwala omwe amadalira insulin, monga imatsutsana ndi ntchito ya kapamba wabwino wathanzi, yemwe amapanga insulin yaumunthu. Odwala amapaka jekeseni 1-2 patsiku kuti apange "maziko" oyambira (insal) a insulin mthupi, omwe amateteza ku kulumpha ndi kuchepa kwa shuga m'magazi.

Matenda a shuga a insulin

Amayi oyembekezera omwe sanakhalepo ndi matenda ashuga koma omwe amapezeka kuti ali ndi shuga m'magazi panthawi yoyembekezera amapezeka ndi matenda a shuga.

Matenda a shuga amtunduwu amawonekera mu 3-9% ya mimba zonse, kutengera chiwerengero cha owerengera. Nthawi zambiri, zimachitika lachitatu trimester. Matenda a shuga amtunduwu amakhudza 1% yokha mwa azimayi ochepera zaka 20, koma 13% mwa omwe amakhala ndi pakati pazaka 44.

Matenda a shuga a Gestational amathandizidwa m'njira zambiri. Poyambirira chakudya, masewera olimbitsa thupi komanso mankhwala pakamwa, ndipo ngati izi sizokwanira kuthana ndi magazi, mankhwala a insulin ndi omwe amapatsidwa. Mwanjira imeneyi odwala omwe ali ndi vuto la matenda amisala amatha kukhalanso ndi matenda a shuga, ngakhale kwakanthawi.

Kusiyana pakati pa matenda ashuga azimayi apakati pamitundu yake 1 ndi 2 ndikuti mwana akabadwa, matendawa amayamba ndipo mankhwalawa amaletsa insulin.

Titha kunena kuti kusakwaniritsidwa kwa mawu akuti "matenda a shuga omwe amadalira shuga" kumawonekera chifukwa chakuti mitundu yoyamba komanso yachiwiri ya matenda ashuga, ndi matenda osiyanasiyana, koma odwala amtundu uliwonse omwe ali odalira insulin. Amayi oyembekezera omwe ali ndi matenda osokoneza bongo amathandizidwanso ndi insulin. Chifukwa chake, polankhula za odwala omwe amadalira insulin, munthu sangamvetse nthawi yomweyo mtundu wa shuga womwe umakhudzidwa.

Ana odalira insulin

Matenda a shuga a Type 1 amakhudza makamaka ana, achinyamata komanso achinyamata. Nthawi zina matenda ashuga amapezeka kuyambira pakubadwa, pomwe milandu ngati imeneyi ndiyosowa.

Mwana wodwala matenda a shuga ayenera kuphunzira kuvala insulin

Kulera mwana wodalira insulin - mayeso ovuta osati kwa wodwala okha, komanso kwa makolo ake. Makolo ayenera kuphunzira kwambiri za matendawa kuti aphunzitse mwana wawo njira yoyenera yobayira insulini, kuwerengetsa chakudya chamagulu ndi mikate ya mkate, kuyeza shuga lawo lamwazi ndikusintha ndi moyo wabwinobwino.

Makolo a ana omwe amadalira insulin ayenera kukambirana mafunso ofunika otsatirawa ndi endocrinologist wawo:

• Kodi ndi kangati pamene mwana amayeza shuga wawo wamagazi?
• Kodi ndibwino kuchitira mankhwala a insulin: gwiritsani ntchito pulogalamu ya bolus kapena pampu ya insulin?
• Momwe mungazindikire ndikuchiza hypoglycemia ndi shuga wambiri?
• Momwe mungadziwire kupezeka kwa ketonuria mwa mwana ndikuyimitsa?
• Kodi zakudya zimagwira bwanji m'magazi?
• Momwe amawerengera magawo a mkate?
• Kodi zolimbitsa thupi zimakhudza bwanji shuga wa magazi kwa mwana wodalira insulin?
• Momwe mungaphunzirire kukhala wopanda zowawa ndi matenda ashuga - pitani kusukulu, lekani kuchita manyazi ndi kukhalapo kwa matendawa, pitani kumisasa yachilimwe, pitani kumisasa, etc.
• Kodi ndimapita kangati kwa endocrinologist ndi akatswiri ena othandizira odwala matenda ashuga?

Kukondwerera kwa mtundu woyamba wa shuga kapena kutembenuka kwa wodwala wodalira insulin kuti akhale wodziyimira payekha

Mu mtundu woyamba wa matenda a shuga a mellitus, zinthu zitha kuchitika pamene maselo apancreatic atayamba kupanga insulin kwambiri, zomwe zimapangitsa kuti kuthetsedwe kapena kuchepetsedwa kwakukulu kwa chithandizo cha insulin. Odwala ambiri panthawiyi amaganiza kuti achira matenda ashuga, koma, mwatsoka, nthawi ya "chikwati" cha shuga ndiyosakhalitsa.

Kodi nchifukwa chiyani pali kuchotsedwa kwakanthawi kwa matenda ashuga? Type 1 shuga mellitus amakumana motsutsana ndi maziko akuwonongeka kwa maselo ake omwe amapanga insulin. Wodwala akayamba kubaya insulin (amadalira insulini), gawo lina la katundu pa zomwe amapanga payekha amachotsedwa m'matumbo. Nthawi yopumulayi, yoperekedwa ndi jakisoni wa insulin, imapangitsa kuti kapamba apange insulin kuchokera ku maselo a beta otsala.

Komabe, m'miyezi yochepa, ambiri mwa ma cell a beta awa adzawonongedwa. Nthawi ya chikondwererochi imatha pamene kapamba amasiya kupanga insulin yokwanira kuti akhalebe ndi shuga wokwanira wamagazi.

Kafukufuku "Wokondedwa wa ana omwe ali ndi matenda a shuga 1: pafupipafupi, nthawi yayitali komanso zotsatira zake zosiyanasiyana" adachitidwa. (PubMedPMID: 16629716). Ikulemba kuti nthawi yaukwati wa mtundu 1 wa shuga imadziwika ndi kuchepa kwa insulini poyang'anira zabwino za glycemic. Kufunika kwachipatala kwa gawoli ndikulowerera kwakanthawi kwamankhwala kuti muchepetse kapena kusiya kudziwononga kosalekeza kwama cell a beta.

Gulu la ana 103 omwe ali ndi matenda ashuga osakwana zaka 12 adawerengedwa, chifukwa cha momwe pafupipafupi, nthawi ndi zinthu zomwe zimakhudza kuchotsedwa kwina kwa matenda ashuga. Malinga ndi zotsatira za kafukufukuyu, zidawululidwa kuti ana 71 ali ndi chikhululukiro choperewera cha matenda a shuga, komanso athunthu - atatu. Kutalika kwachikhululukiro kuyambira pa 4.8 mpaka miyezi 7.2.

Shuga yosadalira insulin (shuga ya "okalamba" kapena mtundu 2)

Tiyenera kudziwa kuti palinso shuga wosadalira insulinomwe madokotala masiku ano amatcha matenda a shuga. Mu mtundu uwu wa matenda ashuga, kapamba amachititsa insulini kukhala yayitali, koma maselo sangathe kuigwira bwino.

Vuto lalikulu la anthu omwe ali ndi mtundu wachiwiri wa matenda a shuga ndi onenepa kwambiri komanso kukana insulin (metabolic syndrome), yomwe imalepheretsa kuti maselo azigwirizana bwino ndi insulin.

Mosiyana ndi mtundu wa matenda a shuga omwe amadalira insulin, odwala okhawo omwe ali ndi mtundu wachiwiri wa nthendayi ndi omwe angathe kukhala osadziletsa payekha (kupatula milandu yakachotsedwa kwa matenda a shuga 1). Pali insipidus wa matenda ashuga, koma nthenda iyi ndi yosiyana kwambiri ndi yomwe siyikugwirizana ndi matenda ashuga.

Mawu oti "kudalira insulin" komanso "osadalira insulini" shuga ndi olakwika komanso achikale. Osati odwala omwe ali ndi matenda a shuga 1, komanso a 2 odwala matenda ashuga, komanso azimayi omwe ali ndi matenda osokoneza bongo, amatha kudalira insulin. Ngakhale omwe amadalira insulin sangakhale anthu omwe ali ndi matenda a shuga a 2, komanso anthu omwe ali ndi matenda amtundu wa 1 kwa nthawi yocheperako (munthawi ya tchuthi).

Matenda a shuga osagwirizana ndi insulin

Matenda a shuga a 2 osadalira insulin amakula motsatizana, nthawi zambiri pazaka zingapo. Wodwala sangathe kuwona zomwe akuwonetsa konse. Zizindikiro zowopsa kwambiri zikuphatikiza:

• kutopa
• akuchiritsa mabala pang'onopang'ono
• kusokonezeka kwa kukumbukira
• utachepa kowoneka ntchito.

M ludzu umatha kutchulidwa kapena kuwonekera pang'ono. Zomwezo zimagwiranso pokodza mwachangu. Tsoka ilo, matenda a shuga a 2 amapezeka mwangozi. Komabe, ndimatenda otere, kuzindikira koyambirira ndikofunikira kwambiri. Kuti muchite izi, muziyesa magazi nthawi zonse kuti mupeze shuga.

Matenda a shuga omwe amadalira insulin amawonetsedwa ndimavuto a pakhungu ndi mucous nembanemba. Izi nthawi zambiri:

• kuyabwa, kuphatikizapo ukazi,
• matenda oyamba ndi fungus
• kuyanika
• Kuchiritsa kwakanthawi kwamankhwala opangira opaleshoni.

Ndi ludzu lotchulidwa, wodwalayo amatha kumwa mpaka malita 3-5 patsiku. Nthawi zambiri usiku kupita kuchimbudzi.

Ndikupita patsogolo kwa matenda ashuga, dzanzi ndi kumva kuwawa kumapeto zimawonekera, miyendo imapweteka poyenda. Mwa akazi, candidiasis yosasinthika imawonedwa. Pambuyo pake magawo azikhala:

• kuwonda
• mavuto a impso
• zigawenga
• kugunda kwamtima mwadzidzidzi
• sitiroko.

Zizindikiro zoopsa zomwe zili pamwambapa mu 20-30% ya odwala ndiye zizindikiro zoyambirira za matenda ashuga. Chifukwa chake, ndikofunikira kwambiri kuyesa mayeso chaka chilichonse kuti mupewe izi.