Matenda a shuga > Zizindikiro

Matenda a shuga ndi matenda a metabolic omwe amadziwika chifukwa cha kuchuluka kwa shuga m'magazi.

Matendawa amapezeka chifukwa cha zoperewera pakupanga insulin, chilema pochita insulin, kapena zonsezi. Kuphatikiza pa shuga wokwezeka wamwazi, matendawa amawonetsedwa ndikutulutsidwa kwa shuga mumkodzo, kukodza mopitirira muyeso, ludzu lochulukirapo, mafuta osokonekera, mapuloteni komanso mchere wa mineral komanso kukula kwa zovuta.

1. Type 1 shuga mellitus (autoimmune, idiopathic): chiwonongeko cha maselo a pancreatic beta omwe amapanga insulin.

2. Type 2 shuga mellitus - okhala ndi minyewa yambiri ya insulin kapena vuto lalikulu pakupanga insulin kapena popanda kusazindikira minofu.

3. Matenda amtundu wa shuga amatenga nthawi yapakati.

zolakwika zakubadwa
matenda osokoneza bongo omwe amayamba chifukwa cha mankhwala osokoneza bongo ndi mankhwala ena,
matenda oyambitsidwa ndi matenda ashuga
kapamba, kuvulala, kuchotsedwa kwa kapamba, kukometsa, Matenda a Itsenko-Cushing, thyrotooticosis ndi ena.

Kusintha

Inde: palibe zovuta.
kuopsa kochitika: kumakhala kuwonongeka kwa maso, impso, mitsempha.
okhwima Inde: zovuta za shuga.

Zizindikiro za matenda a shuga

Zizindikiro zazikulu za matendawa zimaphatikizapo mawonetsedwe monga:

Kukodza kwambiri ndi ludzu,
Kuchulukitsa chilakolako
Zofooka zambiri
Zilonda zamkhungu (mwachitsanzo vitiligo), nyini ndi kwamkodzo nthawi zambiri zimawonedwa mwa odwala osapatsidwa kanthu chifukwa chakufooka,
Kuwona koperewera kumachitika chifukwa cha kusintha kwa makina azowonera mumaso.

Matenda a shuga amtundu woyamba nthawi zambiri amayamba ali aang'ono.

Mtundu wachiwiri wa matenda ashuga nthawi zambiri umapezeka mwa anthu opitirira zaka 35 mpaka 40.

Kuzindikira matenda ashuga

Kuzindikira matendawa kumachitika potsatira magazi ndi mkodzo.

Pazindikiritso, kuchuluka kwa shuga m'magazi kumatsimikizika (chochitika chofunikira ndikudziwikanso kwa kuchuluka kwa shuga pamasiku ena).

Zotsatira za kusanthula ndizabwinobwino (popanda matenda a shuga)

Pamimba yopanda kanthu kapena patatha maola awiri mutayesedwa:

magazi a venous - 3.3-5.5 mmol / l,
magazi othandizira - 3,3-55 mmol / l,
venous magazi am'madzi - 4-6.1 mmol / L.

Zotsatira zakuyesa matenda ashuga

magazi a venous oposa 6.1 mmol / l,
magazi a capillary oposa 6.1 mmol / l,
venous magazi am'madzi opitilira 7.0 mmol / L.

Nthawi iliyonse patsiku, ngakhale nthawi yakudya:

magazi a venous kuposa 10 mmol / l,
magazi a capillary oposa 11.1 mmol / l,
venous magazi am'madzi opitilira 11.1 mmol / L.

Mlingo wa hemoglobin wa glycated mu shuga mellitus umaposa 6.7-7.5%.

The kuchuluka kwa insulin yogwira inshuwaransi amachepetsa mtundu 1, wabwinobwino kapena kuchuluka mu mtundu 2.

Kutsimikiza kwa kuchuluka kwa shuga m'magazi a matenda opatsirana a shuga sikumachitika motsutsana ndi maziko a matenda omwe ali pachimake, kuvulala kapena kuchitira opaleshoni, motsutsana ndi kugwiritsidwa ntchito kwakanthawi kwamankhwala omwe amalimbikitsa kuchuluka kwa shuga m'magazi (mahomoni a adrenal, mahomoni a chithokomiro, thiazides, beta-blockers, etc.), odwala matenda a chiwindi.

Glucose mumkodzo wokhala ndi matenda a shuga amawoneka pambuyo pochulukitsa "cholumikizira cha impso" (pafupifupi 180 mg% 9.9 mmol / L). Kusinthasintha kwofunikira kwambiri komanso chizolowezi chowonjezereka ndi zaka ndizikhalidwe, chifukwa chake kutsimikiza kwa shuga mumkodzo kumawerengedwa kuti ndi mayeso osaneneka komanso osadalirika. Kuyesedwa kumakhala chitsogozo chovuta kupezeka kapena kusapezeka kwa kuchuluka kwa shuga m'magazi (glucose) ndipo, nthawi zina, amagwiritsidwa ntchito kuyang'anira mphamvu za matendawa.

Chithandizo cha matenda ashuga

Zochita zolimbitsa thupi ndi zakudya zoyenera pakumwa

Mu gawo lofunikira la odwala omwe ali ndi matenda a shuga, kuwona momwe amalimbikitsira kudya komanso atakwanitsa kuchepa kwakukulu kwa kulemera kwa thupi ndi 5-10% kuyambira koyamba, ziwonetsero za shuga zamagazi zimapitilira mpaka pofika masiku onse. Chimodzi mwazinthu zazikulu ndizokhazikika zolimbitsa thupi (mwachitsanzo, kuyenda tsiku lililonse kwa mphindi 30, kusambira kwa ola limodzi katatu pa sabata. Pa magazi a shuga a> 13-15 mmol / L, zolimbitsa thupi sizikulimbikitsidwa.

Ndi masewera olimbitsa thupi opepuka komanso osakhalitsa osaposa ola limodzi, kudya zakudya zowonjezera zam'mimba ndizofunikira musanayambe kuchita masewera olimbitsa thupi (15 g ya chakudya chosakanikirana pakatha mphindi 40 zolimbitsa thupi). Ndi masewera olimbitsa thupi omwe amapitilira ola limodzi ndi masewera ambiri, ndikofunikira kuchepetsa ndi 20-50% ya kuchuluka kwa insulini yomwe imagwira ntchito panthawi yotsatira ndi 6 - 12 pambuyo pochita masewera olimbitsa thupi.

Zakudya mankhwalawa matenda a shuga mellitus (tebulo Na. 9) umalimbana ndi kusintha kagayidwe kazachilengedwe komanso kupewa mafuta osokoneza bongo.

Werengani zambiri za mfundo za zakudya zopezeka mu shuga munkhani yathuyi.

Chithandizo cha insulin

Kukonzekera kwa insulin kwa matenda a shuga kumagawika m'magulu anayi, malinga ndi nthawi yayitali:

Ultrashort kanthu (isanachitike kanthu - pambuyo mphindi 15, nthawi yochitapo - maola 3-4): insulin LysPro, insulini aspart.
Kuchitapo kanthu mwachangu (kuyamba kwa zochita ndi pambuyo pa mphindi 30 - 1 ora, nthawi yayitali ndi maola 8-8).
Nthawi yayitali yochitapo (koyamba kwa zochita ndi pambuyo pa maola 1-2; nthawi yayitali ndi maola 14 - 20).
Kutenga nthawi yayitali (kuyamba kwa maola 4, nthawi yochita mpaka maola 28).

Njira zopangira insulin sizothandiza munthu aliyense payekhapayekha ndipo zimasankhidwa kwa wodwala aliyense yemwe ali ndi matenda ashuga kapena endocrinologist.

Makulidwe a insulin

Insulin ikalowetsedwa pamalo a jakisoni, ndikofunikira kupanga khola kuti khungu lifike pansi pakhungu, ndipo lisalowe m'matumbo a minofu. Khola lazikopa liyenera kukhala lokwera, singano iyenera kulowa pakhungu pakhungu la 45 °, ngati makulidwe a khungu lanu ndi ochepa kuposa kutalika kwa singano.

Mukamasankha jakisoni wambiri, khungu lolemedwa liyenera kupewa. Masamba obayira sangasinthidwe mwachisawawa. Musati mupeze pansi pa khungu la phewa.

Kukonzekera kwanthaŵi yochepa ya insulin kuyenera kubayidwa mu minofu yamafuta am'mimba khoma lamkati lamkati 20-30 asanadye.
Kukonzekera kwa insulin kwakanthawi kumalowetsedwa m'matumbo a matako kapena matako.
Jakisoni wa Ultrashort insulin (humalog kapena novorpid) amachitika musanadye chakudya, ndipo ngati kuli kotheka, mutadya kapena atangotha kumene.

Kutentha ndi masewera olimbitsa thupi kumawonjezera kuyamwa kwa insulin, ndipo kuzizira kumachepetsa.

Dziwani >> Matenda a shuga

Matenda a shuga - Ichi ndi chimodzi mwa matenda ofala kwambiri amtundu wa endocrine. Chikhalidwe chachikulu cha matenda a shuga ndi kuchuluka kwazowonjezera shuga m'magazi, chifukwa cha kuperewera kwa glucose metabolism.

Njira zoyendetsera thupi lathupi zimadalira glucose metabolism. Glucose ndiye mphamvu yayikulu yopanga thupi la munthu, ndipo ziwalo zina ndi ma cell (ubongo, ma cell ofiira) amagwiritsa ntchito glucose ngati zida zopangira mphamvu. Zomwe zimasokonekera ndimagazi zimagwira ntchito monga kuphatikizika kwa zinthu zingapo: mafuta, mapuloteni, zinthu zovuta za organic (hemoglobin, cholesterol, etc.). Chifukwa chake, kuphwanya kagayidwe ka shuga mu shuga mellitus mosavomerezeka kumabweretsa kuphwanya mitundu yonse ya kagayidwe (mafuta, mapuloteni, mchere wamchere, acid-base).

Timasiyanitsa mitundu iwiri yayikulu yamatenda a shuga, omwe ali ndi kusiyana kwakukulu pambiri pa etiology, pathogenesis ndi chitukuko cha zamankhwala, komanso pankhani ya chithandizo.

Mtundu woyamba wa shuga (wodalira insulini) amadziwika ndi odwala achichepere (nthawi zambiri ana ndi achinyamata) ndipo zimachitika chifukwa cha kusowa kwathunthu kwa insulin mthupi. Kuperewera kwa insulin kumachitika chifukwa cha kuwonongeka kwa maselo a pancreatic endocrine omwe amapanga mahomoni awa. Zomwe zimayambitsa kufa kwa maselo a Langerhans (maselo a endocrine a kapamba) zitha kukhala matenda oyambitsidwa ndi matenda, matenda a autoimmune, zochitika zopsinja. Kuperewera kwa insulin kumakula kwambiri ndipo kumawonetsedwa ndi zizindikiro zapamwamba za matenda ashuga: polyuria (kutulutsa mkodzo), polydipsia (ludzu losatha), kuchepa thupi. Matenda a shuga a Type 1 amathandizidwa pokhapokha pokonzekera insulin.

Type 2 shuga m'malo mwake, ndi chikhalidwe cha odwala okalamba. Zambiri za kukula kwake ndi kunenepa kwambiri, kumangokhala, kugona m'thupi. Udindo wofunikira kwambiri mu matenda amtunduwu amatengedwa ndi chibadwire. Mosiyana ndi matenda amtundu woyamba wa shuga, momwe muli kuperewera kwa insulin (onani pamwambapa), matenda amtundu wa 2, kuperewera kwa insulini kumachitika, ndiye kuti, insulini m'magazi imakhalapo (nthawi zambiri pamatenda apamwamba kuposa thupi), koma kudziwa minofu ya thupi kupita ku insulin imatayika. Matenda a 2 a mtundu wa 2 amadziwika ndi kukula kwakanthawi kochepa (asymptomatic nyengo) komanso kuwonjezereka pang'onopang'ono kwa zizindikiro. Nthawi zambiri, matenda amtundu wa 2 amayenderana ndi kunenepa kwambiri. Pochiza matenda amtunduwu a shuga, mankhwalawa amagwiritsidwa ntchito omwe amachepetsa kukana kwa minofu ya thupi ku glucose ndikuchepetsa kuyamwa kwa shuga m'matumbo am'mimba. Kukonzekera kwa insulini kumagwiritsidwa ntchito ngati chida chowonjezera pobwera chifukwa cha kuperewera kwa insulin (kutopa kwa pancreatic endocrine zida).

Mitundu yonse iwiri yamatendawa imachitika ndi zovuta zazikulu (zowopsa kwambiri).

Njira zodziwira matenda ashuga

Kuzindikira matenda ashuga zimatanthawuza kukhazikitsidwa koyenera kwa matendawa: kukhazikitsa mtundu wa matendawa, kuwunika momwe zinthu zilili m'thupi, kudziwa zovuta zomwe zikubwera.

Kuzindikira matenda ashuga kumatanthauza kukhazikitsa matenda moyenera: kukhazikitsa mtundu wa matendawa, kuwunika momwe thupi liliri, komanso kudziwa zovuta zina.
Zizindikiro zazikulu za matenda ashuga ndi:

Polyuria (kutulutsa mkodzo kwambiri) nthawi zambiri ndiye chizindikiro choyamba cha matenda ashuga. Kuwonjezeka kwa kuchuluka kwa mkodzo komwe kumachitika chifukwa cha glucose kusungunuka mkodzo, zomwe zimalepheretsa kuyamwa kwamadzi kuchokera mu mkodzo woyamba pamlingo wa impso.
Polydipsia (ludzu lakuya) - ndizomwe zimachitika chifukwa cha kuchuluka kwa madzi mu mkodzo.
Kuchepetsa thupi ndi chizindikiro cha matenda a shuga, okhala ndi matenda amtundu woyamba 1. Kuchepetsa thupi kumawonedwa ngakhale ndikukula kwa odwala ndipo ndizotsatira zakulephera kwa minofu kukonza glucose popanda insulin. Poterepa, minofu yokhala ndi njala imayamba kukonza yawo yamafuta ndi mapuloteni.

Zizindikiro zomwe zili pamwambazi ndizofala kwambiri pamtundu wa matenda ashuga 1. Pankhani ya matendawa, zizindikiro zimayamba msanga. Wodwalayo, monga lamulo, akhoza kupereka tsiku lenileni la chizindikiritso. Nthawi zambiri, zizindikiro za matendawa zimayamba pambuyo pa matenda a virus kapena kupsinjika. Ukalamba wa wodwala umadziwika kwambiri ndi matenda amtundu wa 1.

Mtundu wachiwiri wa matenda ashuga, odwala nthawi zambiri amafunsira dokotala chifukwa cha zovuta za matendawa. Matendawa pawokha (makamaka m'magawo oyambawo) amakula pafupifupi asymptomatic. Komabe, nthawi zina, zizindikiro zotsatirazi zosadziwika zimadziwika: kuyabwa kwamkati, matenda amkhungu otupa omwe ndi ovuta kuchiza, pakamwa owuma, kufooka kwa minofu. Choyambitsa chachikulu chofunafuna chithandizo chamankhwala ndi zovuta za matendawa: retinopathy, matenda amkati, angiopathy (matenda a mtima, matenda a ubongo Monga tafotokozera pamwambapa, matenda a shuga a 2 amapezeka kawirikawiri kwa akuluakulu (azaka zopitilira 45) ndipo amatsutsana ndi kunenepa kwambiri.

Mukamayang'ana wodwala, dokotalayo amatchulanso momwe khungu limafunsira (kutupa, kukanda) ndi mafuta osakanikirana (kuchepa kwa matenda a shuga 1, komanso kuchuluka kwa matenda ashuga amtundu wa 2).

Ngati matenda a shuga akukayikiridwa, njira zowonjezerazo zimayesedwa.

Kudziwitsa magazi ndende. Ichi ndi chimodzi mwazeso zoyesa kwambiri za matenda ashuga. Kuphatikizika kwabwinobwino kwa shuga m'magazi (glycemia) pamimba yopanda kanthu kuchokera pa 3.3-5,5 mmol / L. Kuwonjezeka kwa ndende ya glucose pamwamba pamwambowu kumawonetsa kuphwanya kwa kagayidwe kazakudwala. Pofuna kukhazikitsa matenda a shuga, ndikofunikira kukhazikitsa kuwonjezeka kwa ndende yamagazi m'magawo awiri motsatizana omwe amachitika masiku osiyanasiyana. Kusintha kwa magazi posanthula kumachitika m'mawa. Musanalembedwe magazi, muyenera kuwonetsetsa kuti wodwalayo sanadye chilichonse mawa la mayeso. Ndikofunikanso kupatsa wodwalayo nkhawa zamagetsi panthawi ya mayeso kuti apewe kuchuluka kwa shuga m'magazi poyankha pamavuto.

Njira yodziwika kwambiri yodziwira matenda kuyeserera kwa shuga, yomwe imakuthandizani kuti mupeze zovuta zosagwirizana (zobisika) za glucose metabolism (minofu yolumikizira minofu). Kuyesedwa kumachitika m'mawa kutatha maola 10-14 osala kudya. Madzulo a mayeso, wodwalayo amalangizidwa kuti azisiyiratu mphamvu zolimbitsa thupi, mowa ndi kusuta, komanso mankhwala osokoneza bongo omwe amalimbikitsa kuchuluka kwa shuga m'magazi (adrenaline, caffeine, glucocorticoids, njira zakulera, ndi zina). Wodwala amapatsidwa chakumwa chomwe chimakhala ndi magalamu 75 a shuga. Kutsimikiza kwa kuchuluka kwa shuga m'magazi kumachitika pambuyo pa ola limodzi ndi 2 pambuyo pa kugwiritsa ntchito shuga. Zotsatira zabwinobwino ndizoti shuga azikhala wochepera 7.8 mmol / L maola awiri atatha kudya shuga. Ngati ndende ya glucose imayambira pa 7.8 mpaka 11 mmol / l, ndiye kuti mkhalidwe wamutuwu umawonedwa ngati kuphwanya chikhalidwe cha glucose (prediabetes). Kuzindikira kwa matenda ashuga kumakhazikitsidwa ngati kuchuluka kwa glucose kupitirira 11 mmol / l maola awiri atatha kuyesedwa. Onse kutsimikiza kosavuta kwa shuga komanso kuyeserera kwa glucose kumapangitsa kuyesa mkhalidwe wa glycemia kokha panthawi yophunzira. Kuti mupeze kuchuluka kwa glycemia kwa nthawi yayitali (pafupifupi miyezi itatu), kuwunikira kumachitika kuti mupeze mulingo wa glycosylated hemoglobin (HbA1c). Kapangidwe kameneka kamadalira glucose m'magazi. Zomwe zili pompopompo sizipitilira 5.9% (zonse za hemoglobin). Kuwonjezeka kwa HbA1c pamitengo yokhazikika kumawonetsa kuwonjezeka kwakanthawi kwa shuga m'magazi miyezi itatu yapitayo. Kuyeza kumeneku kumachitika makamaka pofuna kuwongolera chithandizo cha odwala omwe ali ndi matenda ashuga.

Kuyesa kwa mkodzo. Nthawi zambiri, mumkodzo mulibe shuga. Mu shuga mellitus, kuchuluka kwa glycemia kumakwaniritsidwa pazomwe zimapangitsa glucose kudutsa chotchinga cha impso. Kudziwa shuga wamagazi ndi njira inanso yozindikirira matenda ashuga.

Kutsimikiza kwa acetone mu mkodzo (acetonuria) - matenda ashuga nthawi zambiri amakhala ovuta chifukwa cha kusokonezeka kwa kagayidwe kachakudya ka ketoacidosis (kudzikundikira kwa michere yapakati yapakati pa mafuta a metabolism m'magazi). Kudziwitsa matupi a ketone mu mkodzo ndi chizindikiro cha kuopsa kwa mkhalidwe wa wodwala ndi ketoacidosis.

Nthawi zina, kuti mudziwe chomwe chimayambitsa matenda ashuga, kachigawo kakang'ono ka insulini ndi zinthu zake za m'magazi zimatsimikiza. Matenda a shuga a Type 1 amadziwika ndi kuchepa kapena kusapezeka kwathunthu kwa kachilombo ka insulin kapena peptide C yaulere m'magazi.

Kuti mupeze zovuta za matenda a shuga ndikupanga matchulidwe a matendawa, mayeso owonjezera amachitika: kufufuza kwa fundus (retinopathy), electrocardiogram (matenda a mtima), excretory urography (nephropathy, kulephera kwa impso).

Matenda a shuga. Chipatala diagnostics, mochedwa zovuta, chithandizo: Textbook.-njira .pindulitsa, M .: Medpraktika-M, 2005
Dedov I.I. Matenda a shuga kwa ana ndi achinyamata, M .: GEOTAR-Media, 2007
Lyabakh N.N. Matenda a shuga: kuwunika, kutsatsa, kusamalira, Rostov n / A, 2004

Tsambali limapereka chidziwitso pazachidziwitso chokha. Kuzindikira ndi kuchiza matenda kuyenera kuchitika moyang'aniridwa ndi katswiri. Mankhwala onse ali ndi contraindication. Kufunsira kwa akatswiri ndikofunikira!

Zolemba zaukadaulo wazachipatala

Malinga ndi tanthauzo la matenda a shuga monga matenda a matenda oopsa a hyperglycemia omwe aperekedwa ndi WHO ku B981, kuyesa kwakukulu kotsimikiza ndiko kutsimikiza kwamagazi a shuga.

Mlingo wa glycemia mwa anthu athanzi umawonetsa momwe amapangidwira pancreas ndipo zimatengera njira yoyesera shuga, mawonekedwe a magazi omwe amatengedwa phunziroli (capillary, venous), zaka, chakudya cham'mbuyomu, nthawi isanadye, komanso kuchuluka kwa mahomoni ena ndi mankhwala.

Pofuna kuphunzira shuga wamwazi, njira ya Somoji-Nelson, orthotoluidine, oxidase, imakulolani kuti muzindikire zomwe zili m'magazi popanda kuchepetsa zinthu. Zizindikiro zachilendo za glycemia pamenepa ndi 3.33-5,55 mmol / l (60-100 mg%). (Kuti muthandizenso kudziwa kuchuluka kwa shuga m'magazi, kapena mu mmol / l, gwiritsani ntchito njira: mg% x 0.05551 = mmol / l, mmol / l x 18.02 = mg%.)

Kudya usiku kapena pokhapokha phunzirolo lisanakhudze kuchuluka kwa basal glycemia, zakudya zomwe zimakhala ndi mafuta ambiri, kumwa mankhwala a glucocorticoid, zoletsa kulera, estrogens, magulu a diuretic a dichlothiazide, salicylates, adrenaline, morphine, nikotini acid amathandizira kuwonjezeka kwa shuga wamagazi. Dilantin.

Hyperglycemia imatha kupezeka motsutsana ndi maziko a hypokalemia, acromegaly, matenda a Itsenko-Cushing, glucosteromas, aldosteromas, pheochromocytomas, glucagonomas, somatostatinomas, goiter yoopsa, kuvulala ndi zotupa za mu ubongo, matenda a chifuwa, matenda a chiwindi komanso matenda a impso.

Kwa misa yomwe imazindikira kuchuluka kwa hyperglycemia, pepala lotsozera limagwiritsidwa ntchito yolowetsedwa ndi shuga oxidase, peroxidase ndi mankhwala omwe amapezeka pamaso pa shuga. Pogwiritsa ntchito chipangizo chowoneka - glucometer yomwe imagwira ntchito pamtundu wa Photocalorimeter, ndi pepala loyesedwa, mutha kudziwa zomwe zili m'magazi m'magawo kuyambira 50 mpaka 800 mg%.

Kuchepa kwa shuga wamagazi mwanjira yokhazikika kumawonedwa m'matenda oyambitsidwa ndi hyperinsulinism yamphumphu, kuchuluka kwa nthawi yayitali ndi kudya kwambiri, uchidakwa.

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Mayeso amkamwa omwe amagwiritsidwa ntchito pofuna kudziwa kulekerera kwa glucose

Zomwe zimagwiritsidwa ntchito kwambiri ndi mayeso olimbitsa mtima a glucose okhala ndi kulemera kwa 75 g shuga ndikuwasintha kwake, komanso kuyesa kadzutsa kadzutsa (postprandial hyperglycemia).

Kuyesedwa kwa glucose koyenera (SPT), malinga ndi lingaliro la WHO (1980), ndikuwunika kudya glycemia ndi ora lililonse kwa maola 2 mutatha gawo limodzi la 75 g ya glucose. Kwa ana omwe adawunikiridwa, katundu wa glucose amalimbikitsidwa, kutengera 1.75 g pa 1 kg ya kulemera kwa thupi (koma osapitirira 75 g).

Chofunikira pakuyesa ndikuti odwala omwe ali ndi chakudya ayenera kudya osachepera 150-200 g wamafuta tsiku lililonse kwa masiku angapo asanalembetsedwe, popeza kuchepa kwakukulu kwa kuchuluka kwa chakudya chamafuta (kuphatikiza chotseguka mosavuta) kumathandizira kupindika shuga, komwe kumapangitsa kuti chizindikirocho chizindikirike.

Kusintha kwa kuchuluka kwa magazi mwa anthu athanzi omwe ali ndi vuto la glucose, komanso zotsatira zoyipa mukamagwiritsa ntchito mayeso a glucose olimbirana amaperekedwa pagome.

Patatha maola awiri mutachita masewera olimbitsa thupi

Popeza kuchuluka kwa shuga m'magazi 2 patadutsa shuga ndikofunikira kwambiri pakuwunika mayeso a glycemia panthawi yoyeserera pakamwa kwa glucose, Komiti ya Katswiri ya WHO pa matenda a shuga inapanga mtundu wofupikitsidwa wamafukufuku ambiri. Amachitidwa chimodzimodzi monga mwachizolowezi, komabe, shuga wamagazi amayesedwa kamodzi pakatha maola awiri pambuyo pobweza shuga.

Kuphunzira kulekerera kwa glucose kuchipatala komanso pazotsatira zakumwa, kuyezetsa kokhala ndi zovuta zamatumbo kumatha kugwiritsidwa ntchito. Pankhaniyi, phunziroli liyenera kudya chakudya cham'mawa chomwe chimakhala ndi mafuta osachepera 120 g, 30 g omwe ayenera kugaya mosavuta (shuga, kupanikizana, kupanikizana). Kuyesedwa kwa shuga kwa magazi kumachitika maola awiri pambuyo pa chakudya cham'mawa. Kuyesaku kukuwonetsa kuphwanya kwa kulolera kwa glucose pokhapokha glycemia ipitirire 8.33 mmol / l (kwa shuga weniweni).

Mayeso ena okweza glucose alibe phindu lozindikira, malinga ndi akatswiri a WHO.

Mu matenda am'mimba thirakiti pamodzi ndi kuphwanya shuga mayamwidwe (pambuyo-resection gastric syndrome, malabsorption), mtsempha wamagazi amayesedwa.

Njira zodziwira matenda a glucosuria

Mkodzo wa anthu athanzi lili ndi shuga wambiri - 0.001-0.015%, womwe ndi 0,01-0.15 g / l.

Kugwiritsa ntchito njira zambiri zasayansi, kuchuluka kwa shuga kwamkodzo kumene sikumadziwika. Kukula pang'ono kwa glucosuria, kufika 0,025-0.070% (0.25-0.7 g / l), kumawonedwa mwa akhanda m'masabata awiri oyambira komanso achikulire opitilira zaka 60. Kutulutsa kwa shuga mumkodzo mwa anthu amasiye sikudalira kuchuluka kwa chakudya chamagulu m'thupi, koma kumatha kuwonjezeka ndi katatu poyerekeza ndi kudya kwakatundu kathonje pambuyo poyeserera kwa nthawi yayitali kapena kuyesa kwa glucose.

Pakawunika kuchuluka kwa anthu kuti adziwe matenda a shuga, iterates imagwiritsidwa ntchito kuti ipeze shuga. Pepala lotsozera la Glukotest (kupanga kwa chomera cha Reagent, Riga) lili ndi mawonekedwe apadera komanso chidwi. Pepala lotsogolera lofananalo limapangidwa ndi makampani akunja pansi pa dzina la mtundu woyesa, zipatala, glucotest, biofan, ndi zina zotero. Pepala lotsogolera limaphatikizidwa ndi kapangidwe kokhala ndi glucose oxidase, peroxidase, ndi ortholidine. Mzere wa pepala (wachikasu) umatsitsidwa mkodzo; pamaso pa glucose, pepalalo limasintha utoto kuchokera ku buluu wopepuka kukhala wamtambo patatha masekondi 10 chifukwa cha oxidation wa ortholidine pamaso pa glucose. Zomverera zamitundu yomwe ili pamwambapa yazisonyezero zimachokera ku 0,05 mpaka 0,1% (0.15-1 g / l), pomwe glucose yekha amapezeka mumkodzo popanda kuchepetsa zinthu. Kuti muzindikire glucosuria, muyenera kugwiritsa ntchito mkodzo wa tsiku ndi tsiku kapena kusonkhanitsidwa patangotha maola awiri itatha kadzutsa.

Glucosuria wopezedwa ndi njira imodzi pamwambapa sikuti nthawi zonse umakhala chizindikiro cha matenda ashuga. Glucosuria imatha kukhala chifukwa cha matenda a shuga a impso, pakati, matenda a impso (pyelonephritis, pachimake ndi nephritis, nephrosis), Fanconi syndrome.

Glycosylated hemoglobin

Njira zomwe zimathandizira kuzindikira kuchepa kwa hyperglycemia zimaphatikizapo kutsimikiza kwa mapuloteni a glycosylated, nthawi ya kukhalapo kwa yomwe thupi limayambira milungu iwiri mpaka 12. Kulumikizana ndi glucose, amatero, monga momwe, akuimira mtundu wa makumbukidwe omwe amasunga kuchuluka kwa shuga m'magazi ("glucose memory"). Hemoglobin A mwa anthu athanzi amakhala ndi kachigawo kakang'ono ka hemoglobin A_1s, zomwe zimaphatikizapo shuga. Peresenti (Glycosylated Hemoglobin (HbA)_1s) ndi 4-6% ya kuchuluka kwa hemoglobin. Odwala omwe ali ndi matenda osokoneza bongo omwe amakhala ndi hyperglycemia yosalekeza komanso amalekerera glucose (osakhalitsa hyperglycemia), njira yophatikiza glucose mu molekyulu ya hemoglobin imayendera limodzi ndi kuwonjezeka kwa gawo la HLA_1s. Posachedwa, tizigawo tating'onoting'ono ta hemoglobin - A_1a ndi A_1bZomwe zimatha kulumikizanso glucose. Odwala odwala matenda a shuga, hemoglobin A yonse₁ m'mwazi uposa 9-10% - kufunika kwa anthu athanzi. Hyperglycemia yocheperako imayendera limodzi ndi kuchuluka kwa hemoglobin A.₁ ndi A_1s pakatha miyezi iwiri iwiri (munthawi yamoyo wama cell ofiira) komanso pambuyo pamagulu a shuga. Column chromatography kapena njira zopangira calorimetry zimagwiritsidwa ntchito kuti mudziwe glycosylated hemoglobin.

Kutsimikiza kwa fructosamine mu seramu yamagazi

Fructosamines ali m'gulu la mapuloteni amadzi a glycosylated ndi protein. Amatuluka munthawi yama protein osapanga enzymatic glycosylation pakupanga aldimine, kenako ketoamine. Kuwonjezeka kwa zomwe zili ndi fructosamine (ketoamine) mu seramu yamagazi kumawonjezera kuchuluka kapena kusakhalitsa kwa glucose wamagazi kwa masabata 1-3. Chochita chomaliza ndichopanga, chomwe chatsimikizika modabwitsa. Mitsempha yamagazi ya anthu athanzi ili ndi 2-2.8 mmol / L fructosamine, ndipo ngati vuto la kusokonekera kwa glucose - zina.

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Kutsimikiza kwa peptide

Mlingo wake mu seramu yamagazi amatilola kuti tiwone momwe magwiridwe antchito a P-cell amberekera. C peptide imatsimikiza kugwiritsa ntchito zida zoyesera za radioimmunological. Zomwe zili bwino mwa anthu athanzi ndi 0.1-1.79 nmol / L, malinga ndi kuyesa kwa kampani ya Hoechst, kapena 0.17-0.99 nmol / L, malinga ndi kampani ya Byk-Mallin-crodt (1 nmol / L = 1 ng / ml x 0,33). Odwala omwe ali ndi matenda amtundu wa shuga I mellitus, kuchuluka kwa C-peptide kumachepa, mu mtundu II matenda a shuga amakhala abwinobwino kapena okwera, ndipo kwa odwala omwe ali ndi insulinoma amawonjezereka. Mwa mulingo wa C-peptide, munthu akhoza kuweruza zamkati za insulin, kuphatikiza motsutsana ndi maziko a insulin.

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Mayeso a Tolbutamide (wolemba Unger ndi Madison)

Pambuyo poyesa shuga m'mimba yopanda kanthu, 20 ml ya 5% yankho la tolbutamide imaperekedwa kwa wodwalayo ndipo pambuyo mphindi 30 shuga imayesedwanso. Mwa anthu athanzi labwino, kuchepa kwa shuga m'magazi ndi oposa 30%, ndipo mwa odwala omwe ali ndi matenda ashuga - osakwana 30% oyambira. Odwala omwe ali ndi insulinoma, shuga m'magazi amatsika ndi oposa 50%.

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Ngati matendawa adayamba kuubwana kapena unyamata ndipo kwa nthawi yayitali adalipidwa ndi kuyambitsa kwa insulin, ndiye kuti funso la kukhalapo kwa matenda a shuga a shuga ndilosakayikitsa. Zomwezi zimachitikanso pakupezeka mtundu wa shuga wachiwiri, ngati matendawa amalipiridwa ndi zakudya kapena mankhwala a mkamwa ochepetsa shuga. Mavuto nthawi zambiri amabwera pamene wodwala yemwe kale anali ndi matenda amtundu wa II ayenera kusamutsidwa kupita ku insulin. Pafupifupi 10% ya odwala omwe ali ndi matenda amtundu wachiwiri omwe ali ndi mtundu wa autoimmune lesion wa kapangidwe kake kapamba, ndipo funso la mtundu wa shuga limathetsedwa mothandizidwa ndi mayeso apadera. Njira yolola pankhaniyi kukhazikitsa mtundu wa shuga ndi kuphunzira kwa C-peptide. Makhalidwe abwinobwino kapena okwera mu seramu yamagazi amatsimikizira kupezeka kwa mtundu II, ndipo kutsika kwakukulu - mtundu I.

Njira zodziwitsira kulekerera kwa shuga wa glucose (NTG)

Anthu omwe ali ndi vuto la NTG amadziwika kuti akuphatikiza ana a makolo awiri omwe ali ndi matenda ashuga, amapasa athanzi omwe ali ndi chizindikiritso chofanana, ngati wachiwiri akudwala matenda ashuga (makamaka mtundu II) amayi omwe abereka ana olemera makilogalamu 4 kapena kupitilira apo, komanso odwala omwe ali ndi chizindikiro cha chibadwa cha shuga lembani matenda ashuga. Kukhalapo kwa histocompatability mu kuphatikiza kosiyanasiyana kwa ma antigen omwe amapezeka ndi matenda a shuga a HLA mu kuphatikiza kosiyanasiyana kumawonjezera chiopsezo cha mtundu wa matenda a shuga. Kukhazikika kwa mtundu wa shuga wachiwiri wa shuga kungathe kufotokozedwanso pakhungu pambuyo pa kumwa kwa 40-50 ml ya vinyo kapena vodika, ngati kumayambiriro (maola 12 m'mawa) potenga 0,25 g ya chlorpropamide. Amakhulupirira kuti anthu omwe amakhala ndi vuto loti azikhala ndi matenda a shuga, mothandizidwa ndi chlorpropamide ndi mowa, kutsegula kwa enkephalin komanso kukulitsa mitsempha ya magazi pakhungu kumachitika.

Kugundidwa kwa kulolera kwa glucose kuyeneranso kukhala ndi "matenda osakwanira insulin secretion", omwe amawonekera nthawi ndi nthawi kuwonekera kwa hypoglycemia wokhazikika, komanso (kuwonjezeka kwa thupi la wodwalayo, komwe kungayambitse kukula kwa NTG kapena matenda ashuga azaka zingapo. Zowonetsa za GTT muzochitika panthawiyi amadziwika ndi mtundu wa hyperinsulinulin popanga shuga.

Kuzindikira matenda ashuga a shuga, njira zofunika kwambiri, zofunika kwambiri pakhungu, minofu, chingamu, m'mimba, matumbo, ndi impso zimagwiritsidwa ntchito. Ma microscopy opepuka amalola kuti muwone kuchuluka kwa endothelium ndi perithelium, kusintha kwa dystrophic m'makoma otanuka ndi argyrophilic a arterioles, venriers ndi capillaries. Pogwiritsa ntchito ma maikulosikopu a elekitironi, makulidwe amkati mwa capillary chapansi amatha kupezeka ndikuwayeza.

Kuti mudziwe zamomwe thupi limayendera, malinga ndi malingaliro a Unduna wa Zaumoyo wa RSFSR (1973), ndikofunikira kudziwa zovuta komanso mawonekedwe. Kugwiritsa ntchito biomicroscopy ya gawo lakunja la diso, kusintha kwamitsempha yama cell mu conjunctiva, nthambi, ndi iris kumatha kupezeka. Direct ophthalmoscopy ndi fluorescence angiography zimapangitsa kuti ziwonetsedwe zamatumbo am'mimba ndikuwonetsa zizindikiro ndi kuopsa kwa matenda ashuga a retinopathy.

Kuzindikira koyambirira kwa matenda a shuga a nephropathy kumachitika pofufuza microalbuminuria ndi punop biopsy ya impso. Kuwonetsedwa kwa matenda a shuga a nephropathy ayenera kusiyanitsidwa ndi matenda osagwirizana ndi a pyelonephritis. Zizindikiro zodziwika bwino za izi ndi: leukocyturia kuphatikiza ndi bacteriuria, asymmetry ndi kusintha kwa gawo lazinsinsi la renogram, kuchulukitsidwa kwa beta₂-microglobulin ndi mkodzo. Kwa anthu odwala matenda ashuga nephromicrocangiopathy popanda pyelonephritis, kuwonjezeka kwa kotsirizira sikumawonedwa.

Kuzindikira kwa matenda a diabetesic neuropathy kumakhazikika paziwonetsero zakuwunika kwa wodwala wamatsenga pogwiritsa ntchito njira zothandizira, kuphatikizapo electromyography, ngati pakufunika. Autonomic neuropathy imadziwika ndi kuyerekeza kosiyana kwa ma Cardio ma intervals (omwe amachepetsedwa mwa odwala) ndikupanga mayeso a orthostatic, maphunziro a index ya autonomic, etc.