Matenda a shuga - etiopathogenesis, matenda, gulu

Matenda a shuga osadalira insulini (NIDDM, matenda a shuga a 2) - Matenda opatsirana omwe amakhala ndi vuto la insulin kudzikundikira komanso kumva mphamvu ya insulin.

1) cholowa - majini osalongosoka (pa chromosome 11 - kuphwanya katemera wa insulin, pa chromosome 12 - insulin receptor synthesis kusokonekera, zolakwika zamtundu m'dongosolo lodziwika ndi glucose ndi ma β-cell kapena zotumphukira), opatsirana kwakukulu, mapasa onse awiri, NIDDM imayamba 95-100% milandu.

2) kudya kwambiri komanso kunenepa kwambiri - Zakudya zopatsa mphamvu zambiri zopatsa mphamvu zochuluka, maswiti, mowa komanso kuchepa kwa mbewu, komanso moyo wokhazikika, zimathandizira kubisalira insulin komanso kukulitsa insulin

Pathogenesis wa NIDDM chifukwa cha kuphwanya magawo atatu:

1. Kuphwanya insulin - chilema choyambirira cha NIDDM, chomwe chidapezeka ndi matenda oyamba kwambiri:

a) kuphwanya koyenera- ndi NIDDM, kuchuluka kwa insulin kwamwazi kumachepa kwambiri, proinsulin predominates

b) Kusokonezeka kwa kinetic - mwa anthu athanzi, poyankha kutsata kwa shuga, biphasic insulin secretion imawonedwa: pachimake choyamba cha chobisalira chimayamba pambuyo pakukopa kwa glucose, kumatha ndi mphindi ya 10, chifukwa cha kutulutsidwa kwa insulini kuchokera m'migawo ya β-cell, ndipo kuchuluka kwachiwiri kwachitetezo kumayamba pakatha mphindi 10. ndi on / kumayambiriro kapena pambuyo mphindi 30 kapena pambuyo pa kukonzekera kwa kamlomo ka glucose, kwakanthawi, kumawonetsa kubisalira kwa insulin yongopangika kumene poyankha kukondoweza kwa maselo a β-glucose, ndi NIDDM palibe gawo loyamba ndipo gawo lachiwiri la insulin katulutsidwe

c) Zophwanya zochuluka - NIDDM imadziwika ndi insulinopenia yayikulu chifukwa cha kuchepa kwa kuchuluka kwa β-maselo a mabungwe a Langvrhans, kuyika kwa amyloid madipoziti mu ma islets (opangidwa kuchokera ku amylin, omwe amasungidwa ndi maselo a β-cell ndi insulin ndipo amachititsa kuti "glucose acid" asayidigulitis zovuta zamagulu azisumbu za Langerhans ndi kuchepa kwa insulin katulutsidwe), etc.

2. Kutsutsana kwa insulin

a) prereceptor - Zogwirizana ndi genetic zomwe zimasinthidwa kuti zisinthidwe, zopanda ntchito

mamolekyulu a insulin kapena kutembenuka kwathunthu kwa proinsulin kukhala insulin

b) cholandirira - zokhudzana ndi kuchepa kwa kuchuluka kwa ma insulin receptors, kapangidwe ka zinthu zopanda mphamvu zolandilira, mawonekedwe a anticodor antibodies.

c) postreceptor - kuchepa kwa ntchito ya tyrosine kinase ya insulin receptor, kuchepa kwa chiwerengero cha omwe amayendetsa glucose (mapuloteni obisika mkati mwa cell membrane omwe amaonetsetsa kuti mayendedwe a shuga mkati mwa cell),

Popanga insulin kukaniza, kufalikira kwa ma insulin okonda magazi (ma insulin antibodies, mahomoni a insulin: kukula kwa mahomoni, cortisol, mahomoni a chithokomiro, thyrotropin, prolactin, glucagon, CA) ndizofunikanso.

3. Kuchulukitsa shuga - chifukwa cha kuchuluka kwa gluconeogeneis, kuponderezedwa kwa shuga ndikupangidwa ndi chiwindi, kuphwanya gawo la circadian la mapangidwe a shuga (palibe kuchepa pakupanga shuga usiku), ndi zina zambiri.

Mawonetseredwe azachipatala a NIDDM:

1. Zidandaulo zotsatirazi ndizogwirizana:

- kutchulidwa kufooka kwathunthu ndi minofu (chifukwa cha kuchepa kwa mphamvu, glycogen ndi protein m'misempha)

- ludzu - munthawi ya kubwezeredwa kwa DM, odwala amatha kumwa malita atatu kapena kuposerapo patsiku, hyperglycemia yapamwamba, ludzu lotchulidwa, pakamwa louma (chifukwa cha kuchepa madzi m'thupi komanso kuchepa kwa ntchito yamkamwa)

- pafupipafupi komanso kukodza pokonzekera usana ndi usiku

- kunenepa kwambiri - nthawi zambiri, koma osati nthawi zonse

- kuyabwa kwa khungu - makamaka mwa azimayi omwe ali ndi maliseche

2. Moyenerera, mkhalidwe wa ziwalo ndi machitidwe:

a) khungu:

- khungu louma, kutsika kwa turgor ndi elasticity

- zotupa pakhungu, zotupa pafupipafupi, hydroadenitis, epidermophytosis pamapazi

- khungu xanthomas (mapapu ndi timiyendo tachikasu tachikasu, tadzadza ndi ma lipids, opezeka matako, miyendo yam'munsi, bondo ndi malo olumikizirana mafelemu, kutsogolo) ndi xanthelasma (ma lipid achikasu pakhungu la eyelids)

- Rubeosis - kukulira kwa zikopa za pakhungu ndi kuthimbilira kwa khungu m'masaya ndi masaya (kudwala matenda ashuga)

- lipoid necrobiosis ya pakhungu - nthawi zambiri pamiyendo, kumakhala timiyendo tooneka ngati timaso tofiirira kapena tachikasu, khungu lomwe limakhala pamwamba pawo pang'onopang'ono, limakhala losalala, lonyowa, lopanda chikhodzodzo (“zikopa”), nthawi zina zilonda zam'mimba, kuchiritsidwa pang'onopang'ono, kusiya magawo a pigmentation

b) chimbudzi:

- matenda osakhazikika, kumasula ndi kuwononga mano

- alveolar pyorrhea, gingivitis, ulcerative kapena aphthous stomatitis

- aakulu gastritis, duodenitis pang'onopang'ono chitukuko cha atrophy, kuchepa katulutsidwe wa chapamimba madzi,

yafupika ntchito yam'mimba mpaka gastroparesis

- kusokonezeka m'matumbo: kutsekula m'mimba, chiwopsezo cha malabsorption

- mafuta chiwindi hepatosis, cholelystitis wowerengeka, gallbladder dyskinesia, etc.

c) mtima dongosolo:

- chitukuko cha atherosulinosis ndi matenda a mtima okhudzana ndimatenda osiyanasiyana (MI yomwe imayambitsa matenda ashuga imatha kuchitika popanda kupweteka - Cardiac hypesthesia syndrome ya Parishioner, nthawi zambiri yopatsirana, zovuta kuyipeza, limodzi ndi zovuta zingapo)

- ochepa matenda oopsa (nthawi zambiri achiwiri chifukwa cha nephroangiopathies, atherosulinosis ya mitsempha ya impso, etc.)

- "mtima wa shuga" - dysmetabolic myocardial dystrophy

g) dongosolo la kupuma:

- kudziwa kutsogola kwa chifuwa chachikulu cham'mimba kwambiri, kuphatikiza kwachulukidwe, zovuta

- chibayo pafupipafupi (chifukwa cha Microangiopathy yam'mapapo)

- pafupipafupi pachimake bronchitis ndi lingaliro la chitukuko cha matenda opuma

e) dongosolo lamkodzo: kudziwiratu kwamatenda opatsirana ndi otupa a kwamikodzo thirakiti (cystitis, pyelonephritis), etc.

Kuzindikira kwa NIDDM: onani funso 74.

1. Zakudya - iyenera kutsatira izi:

- khalani olimbitsa thupi pakukula ndi kuchuluka kwa zosakaniza zazikulu (60% chakudya, mafuta 24%, mapuloteni 16%), kuthana ndi zovuta zonse zolingana ndi kuchuluka kwa zinthu zolimbitsa thupi ndikuwonetsetsa kuti thupi lanu limakhala labwino kwambiri kuchokera kuwerengera 20-25 kcal pa 1 makilogalamu a thupi / tsiku

- Chakudya chopindulitsa 4-5 chomwe chimagawika pakati pa kudya caloric tsiku lililonse: 30% - chakudya cham'mawa, 40% - kwa nkhomaliro, 10% - chakudya chamadzulo, 20% - chakudya chamadzulo

- Chotsani zopopera zam'mimba mosavuta, zakumwa zoledzeretsa, kuwonjezera zomwe zili ndi fiber

- kuchepetsa mafuta ochokera ku nyama (40-50% yamafuta akhale masamba)

Zakudya monga mawonekedwe a monotherapy zimachitika mpaka, motsutsana ndi momwe zimagwiritsidwira ntchito, ndizotheka kusunga chindapusa chonse cha matenda ashuga.

2. Kuchepetsa thupi, zolimbitsa thupi zokwanira (ndi thupi lolemera, ma anorectics angagwiritsidwe ntchito - kukonzekera kwapakatikati komwe kumalepheretsa kubwezeretsanso kwa catecholamines, meridia (sibutramine) 10 mg 1 nthawi / tsiku, chifukwa mwezi umodzi wa kulemera kwa makilogalamu 3-5 ndi wokwanira

3. Mankhwala osokoneza bongo - mankhwala amkamwa a hypoglycemic (komanso odwala omwe ali ndi insulini ofunikira mtundu wa 2 shuga + insulin mankhwala ophatikizira pamodzi ophatikizika: mixtard-30, humulin mbiri-3, insuman comb-25 GT mndandanda wa makonzedwe a kawiri musanadye kadzutsa ndi chakudya chamadzulo):

a) secretogens - mankhwala omwe amachititsa kuti thupi lizitha kumaliza kupangira insulin ndi ma cell a B:

1) zotumphukira za sulfonylurea - chlorpropamide (m'badwo) 250 mg / tsiku mu 1 kapena 2 waukulu, glibenclamide (maninyl) 1.25-20 mg / tsiku, kuphatikiza mitundu yosiyanasiyana ya mannyl 1.75 ndi 3.5, glipizide, glycoslazide (shuga) 80-320 mg / tsiku, glycidone, glimepiride (amaryl) 1-8 mg / tsiku

2) zotumphukira za amino acid - zoyenera kwambiri pakuyang'anira postprandial hyperglycemia: novonorm (repaglinide) ya 0,5-2 mg musanadye mpaka 6-8 mg / tsiku, Starlix (nateglinide)

b) Biguanides - kuchuluka pamaso pa insulin kugwiritsa ntchito shuga, kuchepetsa shuga.

c) a-glucosidase zoletsa - muchepetse kuyamwa kwa chakudya chamafuta m'mimba: glucobai (acarbose) pa 150-300 mg / tsiku mu Mlingo wachitatu wogawanika ndi chakudya

d) glitazones (thiosalidinediones, insulin sensitizer) - kuonjezera mphamvu ya zotumphukira zimakhala kuti insulin: actos (pioglitazone) 30 mg 1 nthawi / tsiku

4. Kupewa komanso kuchiza kwa zovuta za NIDDM - kuti muthane ndi vutoli muyenera kuchita izi:

a) kulipiritsa kuphwanya kwa chakudya cha metabolism ku Normoglycemia, aglycosuria ndi chithandizo choyenera ndi choyenera cha NIDDM

b) kulipira mafuta kagayidwe kachakudya koyenera lipid-kuchepetsa: zakudya ndi zoletsa mafuta, mankhwala (statins, fibrate, kukonzekera asidi nikotini, etc.)

c) onetsetsani kuchuluka kwa kuthamanga kwa magazi (antihypertensive mankhwala, makamaka ACE zoletsa, zomwe zimathandizanso ndi nephroprotective)

g) Kuonetsetsa momwe magazi akusinthana ndikusakanikirana kwa magazi

Kupewa mochedwa mavuto kumaphatikizapo kukhalabe kulipira kubwezera kwa kagayidwe kazakudya kwa nthawi yayitali komanso kuzindikira koyambirira kwa magawo oyamba a zovuta za shuga:

1) matenda ashuga retinopathy - ndikofunikira kusanthula pafupipafupi kamodzi pachaka kwa zaka zisanu zoyambirira, ndipo kamodzi pamiyezi isanu ndi umodzi, ndikulunjika kwa ziwiya zam'mimba, laser coagulation imasonyezedwa

2) matenda ashuga nephropathy - m`pofunika kudziwa microalbuminuria kamodzi miyezi 6, pamene zizindikiro za matenda aimpso kulephera - chakudya ndi zoletsa mapuloteni nyama (mpaka 40 g patsiku) ndi sodium chloride (mpaka 5 g patsiku), kugwiritsa ntchito ACE zoletsa, detoxification mankhwala, ndi kupitiriza kuwonongeka kwa ntchito impso - hemodialysis ndi zina zovuta.

Kupewa kwa NIDDM: Kukhala ndi moyo wathanzi (kupewa hypodynamia ndi kunenepa kwambiri, osamwa mowa kwambiri, kusuta fodya, zina zotere, kuthana ndi nkhawa) + kuwongolera mokwanira machitidwe a kadyedwe kapena magawo oyamba a hyperglycemia, wotsatiridwa ndi kuwunika kwamisempha yamagazi pafupipafupi.

Mavuto obwera chifukwa cha matenda obwera ndi matenda am'mbuyomu: michereopathies (diabetesic retinopathy, matenda ashuga nephropathy), macroangiopathy (matenda ashuga a m'mimba), polyneuropathy.

Matenda a shuga - zotupa zotupa za m'matenda a shuga, kufalikira ku ziwiya zazing'ono (microangiopathy) ndi mitsempha yayikulu komanso yapakatikati (macroangiopathy).

Matenda a shuga a shuga - mtundu wa shuga wokhudzana ndi matenda a shuga :

1. Matenda a shuga a retinopathy - chomwe chimayambitsa khungu m'maso mwa odwala omwe ali ndi matenda ashuga, osachulukana (kukhalapo kwa micaneurysms, hemorrhages, edema, exudates yolimba mu retina), prolliferious (+ kusintha kwamitsempha yam'mimba: kufotokozera bwino, kutsitsa, malupu, kusiya, kusinthasintha kwa mitsempha yamagazi) komanso kuchuluka (+ mawonekedwe a ziwiya zatsopano) , zotupa zotuluka pafupipafupi mu retina ndi mawonekedwe ake komanso mapangidwe ofunikira a minofu yolumikizika), zodandaula za ntchentche zosazima, mawanga, kumverera kwa chifunga, zinthu zopanda pake zomwe zikupita patsogolo. S zithunzi acuity.

Kuyeza matenda a shuga a retinopathy.

Kujambula kwa "Gold Standard" ndi kujambula zithunzi za fundus, fluorescence angiography ya retina, ndipo ophthalmoscopy mwachindunji ndiwofikira kwambiri kuwunika pakali pano.

Kuyesedwa koyambirira pambuyo pa zaka 1.5-2 kuyambira tsiku lopezeka ndi matenda ashuga, kupezeka kwa matenda ashuga, kuwunika kamodzi 1 zaka 1-2, ngati kupezeka - osachepera 1 pachaka kapena kuposerapo, komanso kuphatikiza kwa matenda ashuga a retinopathy. , AH, CRF - ndandanda yowunikira payekha, kuchepa kwadzidzidzi kwamawonekedwe owoneka - kuyezetsa kwakanthawi ndi ophthalmologist.

Mfundo zochizira matenda ashuga retinopathy:

1. Mankhwala

2. photocoagulation ziwiya retinal mu magawo oyambirira ashuga retinopathy (Local - laser coagulation foci ntchito m'dera la ndondomeko pathological kapena kukha magazi preretinal, focal - coagulates ntchito mizere angapo paramakulyarnoy ndi parapapillyarnoy m'madera panretinal - ntchito retinopathy proliferative, kuyambira 1200 mpaka 1600 laser zoyang'ana zimagwiritsidwa ntchito ngati cheke patoni ya retina, njira zonse kuchokera kumadera okongola ndi parapapillary mpaka ku equatorial zone ya retina).

3. Cryocoagulation - yowonetsedwa kwa odwala omwe ali ndi kuchuluka kwa matenda ashuga retinopathy, ophatikizika ndi kukokoloka pafupipafupi m'thupi lamatupi, kuwonjezeka kwamphamvu kwa minyewa komanso kuchuluka kwa minyewa, kumachitika koyamba m'magawo am'maso, ndipo pakatha sabata kumapeto kwenikweni, zimathandizira kusintha kapena kukhazikitsa masomphenya otsalira. khungu.

4. Vitrectomy - chikuwonetsedwa pakubowolezera kwamatumbo am'mimba ndikukula kwa kusintha kwa fibrotic mu vitreous ndi retina

2. Matenda a shuga - chifukwa nodular kapena kupukusa nephroangiosulinosis a aimpso glomeruli.

Matenda azachipatala komanso a labotale a matenda a shuga.

1. M'magawo oyamba, mawonekedwe owonekera samakhalapo, munthawi yomwe akuwoneka kuti ali ndi matenda, akuwonjezera proteinuria, ochepa matenda oopsa, nephrotic syndrome, chipatala chopita patsogolo cha matenda aimpso sichitha.

2. Microalbuminuria (kwamikodzo albin extretion, wopitilira muyeso wa proteinuria: 30-300 mg / tsiku) - chizindikiro choyambirira cha matenda ashuga, ndi mawonekedwe a pafupipafupi a microalbuminuria, gawo lomwe lafotokozedwatu limatengera zaka zisanu ndi ziwiri.

3. Hyperfiltration (GFR> 140 ml / min) - zotsatira zoyambirira za zotsatira za hyperglycemia pantchito ya impso mu shuga, zimapangitsa kuwonongeka kwa impso, ndikuwonjezereka kwa nthawi ya matenda ashuga, GFR imayamba kuchepa pang'ono pang'ono pofanana ndi kuchuluka kwa proteinuria komanso kuopsa kwa kuchuluka kwa matenda oopsa.

Omaliza magawo a matenda ashuga nephropathy proteinuria yosalekeza, kuchepa kwa GFR, kuchuluka kwa azotemia (creatinine ndi urea wamagazi), kuchuluka ndi kukhazikika kwa matenda oopsa, komanso kukula kwa matenda a nephrotic.

Gawo lachitukuko cha matenda ashuga nephropathy:

1) Hyperfunction a impso - kuchuluka kwa GFR>

Sanapeze zomwe mukuyang'ana? Gwiritsani ntchito kusaka:

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Etiopathogenesis ndi matenda a shuga

Malinga ndi akatswiri a WHO (1999), matenda ashuga amafotokozedwa ngati vuto la metabolic la etiology zingapo, zomwe zimadziwika ndi matenda a hyperglycemia omwe ali ndi vuto la mafuta, mafuta ndi mapuloteni a metabolism omwe amalumikizidwa ndi vuto la insulin secretion, zotsatira za insulin, kapena zonse ziwiri.

Chovuta chachikulu cha metabolic mu shuga chimapangitsa kuti shuga asamayende bwino komanso ma amino acid kudzera mu ziwalo za cytoplasmic. Kuletsa kwa transmembrane kayendedwe ka zinthu izi kumayambitsa kusintha kwina konse kwa metabolic.

M'zaka zaposachedwa, lingaliroli lidayambitsa kuti matenda ashuga ndi chibadwa komanso matenda am'thupi kwambiri, omwe ndi mitundu yayikulu ya matenda a shuga a II ndi II. Nthawi zambiri, zomwe zimapangitsa kuti matendawa athe kutukuka sizingasiyanitsidwe.

Popeza ndi mawonetseredwe azachipatala a matenda opatsirana a shuga ndi magawo amomwe amatsimikizidwe a biochemical mu gawo la anthu ambiri, zovuta zambiri za mochedwa zamankhwala zosakwiya (kuwonjezereka komwe kumachitika ndi kutalika kwa matenda a metabolic kwazaka zopitilira 5-7) kuwululidwa, ndiye mu 1999 akatswiri a WHO anaganiza za matendawo komanso matendawo atsopano. zasayansi matenda a matenda a shuga (tebulo. 33.1).

Akufunsidwa kuti asagwiritse ntchito mawu akuti "amadalira insulin" komanso "osadalira insulini" komanso kungosiya mayina "mtundu woyamba wa II ndi II". Ichi ndichifukwa cha pathogenesis ya mitundu iyi, osaganizira chithandizo chomwe chikuchitika. Kuphatikiza apo, kuthekera kwa kusintha kwa mawonekedwe a insulin-odziyimira kuti athe kudalira kungachitike pamagawo osiyanasiyana a moyo wa wodwalayo (Table 33.3).

Tebulo 33.3. Matenda a glycemic: mitundu ya etiological ndi magawo azachipatala (WHO, 1999)

Mitundu yodziwika bwino ya matenda a shuga a I ndi II, omwe amapitilira 90% ya matenda onse a shuga.

Type Iabetes mellitus imaphatikizanso zovuta za kagayidwe kazakudya zomwe zimakhudzana ndi kuwonongeka kwa β-cell of pancreatic islets mu genetically genis genetic genisically and the background of immune immunological.

Odwala amadziwika ndi zaka mpaka zaka 30, kuperewera kwenikweni kwa insulin, chizolowezi cha ketoacidosis komanso kufunikira kwa kuperekera insulin.

Nthawi zomwe chiwonongeko komanso kuchepa kwa maselo a b kumachitika chifukwa cha chitetezo cha mthupi kapena autoimmune, matenda a shuga amatengedwa ngati autoimmune. Type Iabetes mellitus imadziwika ndi kukhalapo kwa autoantibodies osiyanasiyana.

Kukhazikika kwa izo kumaphatikizidwa ndi mitundu ya HLA tata DR3, DR4 kapena DR3 / DR4 ndi zofunikira zina za HLA DQ locus. Ikutsimikizidwa kuti mtundu wa matenda a shuga (autoimmune) ungadutse magawo osatukuka popanda kufunika kwa makulidwe a insulin kuti amalize kuwononga maselo a b. Kuchepa kapena kutha kwathunthu kwa maselo a b kumabweretsa kudalira kwathunthu kwa insulin, popanda wodwalayo kukulitsa chizolowezi cha ketoacidosis, chikomokere. Ngati etiology ndi pathogenesis sizikudziwika, ndiye kuti milandu yodwala matenda amtundu wa shuga imatchedwa "idiopathic" shuga.

Type II shuga mellitus imaphatikizanso zovuta za kagayidwe kazakudya, kamene kamayendetsedwa ndi kuphatikizana kosiyanasiyana pakati pa zovuta za insulini komanso chilema pakubisala kwa insulin. Monga lamulo, mu mtundu II matenda ashuga, zinthu ziwiri izi zimakhudzidwa ndi pathogenesis yamatenda, mwa wodwala aliyense amakhala otsimikiza mosiyanasiyana.

Matenda a shuga a Type II nthawi zambiri amadziwika pambuyo pa zaka 40. Nthawi zambiri, matendawa amakula pang'onopang'ono, pang'onopang'ono, popanda kudzipatula kwa matenda ashuga a ketoacidosis. Kuchiza, monga lamulo, sikutanthauza kuperekera insulin mwachangu kuti mupulumutse moyo. Popanga mtundu w II wa matenda a shuga (pafupifupi 85% ya matenda onse a shuga), chibadwa (banja) ndichofunikira kwambiri.

Nthawi zambiri, cholowa chimatengedwa ngati polygenic. Matenda a shuga kwa odwala olemedwa kwambiri amayamba ndi zaka, ndipo kwa anthu opitilira zaka 50 afika 100%.

Odwala omwe ali ndi matenda amtundu wa II nthawi zambiri amathandizidwa ndi insulin chifukwa cha hyperglycemia yayikulu, koma mwa kuchoka kwa insulin kungodzipangitsa ketoacidosis sikuchitika.

Metabolic syndrome

Mu genesis a mtundu II matenda ashuga, gawo lofunikira loyambitsa chidwi limasewera ndi kunenepa kwambiri, makamaka kwam'mimba.

Matenda a shuga amtunduwu amayanjana ndi hyperinsulinemia, kuchuluka kwa insulin kukana, kuchuluka kwa shuga wama chiwindi, komanso kulephera kwapang'onopang'ono kwa b-cell.

Kukana insulini kumayamba mu minyewa yovuta kwambiri ya insulin, yomwe imaphatikizapo minofu yamatumbo, minofu ya adipose, ndi chiwindi. Ubwenzi wapakati pa insulin ndi kunenepa kwambiri umadziwika.

Mu zochitika za hyperinsulinism mu kunenepa kwambiri, kuchuluka kwa magazi a somatostatin, corticotropin, mafuta ache azipere, uric acid ndi zinthu zina zotsutsana zomwe zimapezeka, zomwe mbali imodzi zimakhudza kuchuluka kwa glucose ndi insulin m'magazi am'magazi, komanso, kupangika kwa "thupi" njala. Izi zimabweretsa kutsogoloku kwa lipogenesis pa lipolysis. Kukaniza kwa insulin kwa kunenepa kumagonjetsedwa ndi kuchuluka kwa plasma insulin.

Palibe zakudya za diabetogenic zenizeni, koma kuchuluka kwamafuta ndi mafuta osakwanira a fiber kungapangitse kuchepa kwa insulin.

Kuchepa kwa thupi la 5-10%, ngakhale kunenepa kwambiri kumapitilizabe, kumabweretsa kukonzanso kwa zolakwika za receptor, kuchepa kwa kuchuluka kwa insulini mu plasma, kuchepa kwa msana wa glycemia, lipoproteins atherogenic komanso kusintha kwazomwe zimachitika pakati pa odwala.

Kukula kwa matenda ashuga mwa odwala ena onenepa kwambiri kukuwonjezeka chifukwa cha kuchepa kwa insulin kuyambira pachibale mpaka kumtheradi. Chifukwa chake, kunenepa kwambiri, kumayambitsa vuto la matenda a shuga, ndipo kumbali ina, kuwonekera kwake koyambirira. Mtundu Wachiwiri wa matenda osokoneza bongo amachokera ku tizilombo toyambitsa matenda.

Lipoti la 1999 WHO linabweretsa lingaliro la metabolic syndrome monga chinthu chofunikira kwambiri pamavuto a mtima.

Ngakhale kusowa kwa tanthauzo la metabolic syndrome, lingaliro lake limaphatikizapo zinthu ziwiri kapena zingapo zotsatirazi:

- kuphwanya shuga kagayidwe kapenanso kukhalapo kwa matenda ashuga,
- kukana insulini,
- kuwonjezeka kwa kuthamanga kwa magazi kuposa 140/90 mm RT. Art.,
- kuchuluka kwa triglycerides ndi / kapena cholesterol yotsika otsika kachulukidwe lipoprotein(LDL),
- kunenepa kwambiri,
- microalbuminuria zoposa 20 mcg / min.

Kugwiritsa ntchito njira zopewera zakudya zomwe cholinga chake ndi kuchepetsa kunenepa kwambiri kwa odwala onenepa, kukhudzana ndi zinthu zomwe zimayambitsa matenda a metabolic syndrome nthawi zambiri kumapangitsa kuti matenda asokonezeke kapena kuchepetsedwa kwa glycemia komanso kuchepa kwa zovuta.

Mavuto a shuga

Odwala angapo (pafupifupi 5%) amakhala ndi vuto lalikulu lokhudza zovuta, mosasamala kanthu kuchuluka kwa chipukuta cha carbohydrate metabolism; m'gawo lina la odwala (20-25%), zovuta sizimawonedwa kawirikawiri chifukwa cha kuchepa kwa chibadwa.

Odwala ambiri (70-75%), kuchuluka kwa masinthidwe amtundu wamtundu wamunthu kumatha kusinthasintha, ndipo mwa odwalawa mumatha kubwezeretsanso zabwino za kagayidwe kazakudya kamene kamayambitsa matenda a angiopathy ndi neuropathy.

Diabetesic angiopathy (macro- ndi microangiopathy) ndi neuropathy ndi zina mwazowonetsa kwambiri za matenda ashuga, osayang'ana mtundu wake. Pakukula kwamatenda amenewa, amafunika kufunikira kwamapuloteni (kumanga kwawo molekyu ya glucose chifukwa chosapanga enzymatic ndipo, pamapeto pake, kusintha kosagwirizana ndi ma cell kusintha kwa ma cell mu ma cell osagwirizana ndi insulin), komanso kusintha kwazosintha m'magazi.

Kutsekeka kwa mapuloteni a hemoglobin kumayambitsa kusokonezeka kwa kayendedwe ka mpweya. Kuphatikiza apo, pali kukula kwa michere yapansi panthaka chifukwa kuphwanya kapangidwe ka mapuloteni am'mimba. Odwala omwe ali ndi matenda ashuga, njira yowonjezera kuphatikizira shuga m'mapuroteni a magazi seramu, lipoproteins, mitsempha yotumphukira, ndi zida zophatikizika zam'mimba zidapezeka.

Mlingo wa glycation umagwirizana mwachindunji ndi kuchuluka kwa shuga. Kudziwika kwa glycosylated hemoglobin (HbA1b, HbA1c) monga peresenti ya zonse za hemoglobin yakhala njira yabwino yowunika boma pobwezeretsanso kagayidwe kazakudya kwa odwala matenda a shuga. Ndi hyperglycemia yokhazikika komanso yapamwamba kwambiri, mpaka 15-20% ya hemoglobin yonse imatha kupanikizika. Ngati zomwe zili mu HbA1 zidutsa 10%, ndiye kuti matenda a shuga a retinopathy ndiwotsimikizira.

Zoyenera kuchitidwa ndi angio- ndi neuropathy imawonedwanso kuti kuphatika kwa glucose kumatenga maselo osaloledwa a insulin. Izi zimabweretsa kudzikundikira mwa iwo ma cyclic mowa sorbitol, omwe amasintha kuthinana kwa osmotic m'maselo ndipo potero amathandizira kukulira edema ndi vuto la ntchito. Kuphatikizika kwachilengedwe kwa sorbitol kumachitika mu minyewa yamanjenje, retina, mandala, komanso makhoma a ziwiya zazikulu.

Njira za pathogenetic za mapangidwe a microthrombi mu shuga ndizosokoneza za homeostasis, mamasukidwe amwazi, kuthana: kuchuluka kwa kupatsidwa zinthu za m'magazi, thromboxane A2, kufooka kwa prostacyclin kaphatikizidwe ndi ntchito ya magazi.

Odwala ambiri omwe ali ndi matenda ashuga amakhala ndi nephropathy. Mulinso diabetesic glomerulossteosis, nephroangiosulinosis, pyelonephritis, etc. Micro- ndi macroangiopathy zimakhudzanso kukula kwa zovuta izi. M'zaka zaposachedwa, mgwirizano wowonekera wawoneka pakati pa kukhalapo kwa mapuloteni mumkodzo ndi chiyembekezo chomaliza cha impso mwa odwala matenda a shuga.

Ndikofunikira kuzindikira microalbuminuria, kupatula matenda omwe amalowerera. Mulingo wambiri wa albumin woposa 20 μg / min ndi chizindikiro cha microalbuminuria, kuchuluka kwa albumin ndi milingo ya creatinine yopitilira 3 kumakupatsani mwayi wolosera zakudzichotsera kwausiku kuposa mphindi 30 μg / mphindi.

Zosintha kuchokera kumadera am'munsi ndizodziwika bwino mu matenda ammimba a shuga. Kuchepetsa malekezero am'munsi kumachitika mwa odwala matenda a shuga nthawi 15 nthawi zambiri kuposa kuchuluka kwa anthu.

Kuchulukana kwa matenda ashuga phokoso kumagwirizana ndi zaka, matendawo, matendawa, kusuta, kuopsa kwa matenda oopsa. Matenda a diabetesic phazi amalumikizidwa osati kwambiri ndi microangiopathy monga polyneuropathy, osokoneza ma atherosclerosis a ziwiya zazikuluzikulu komanso zapakati zamagawo apansi (macroangiopathy), kapena kuphatikiza kwa zinthuzi.

Kutsekemera kwa shuga kwa nthawi yayitali kumapangitsa kuti matenda asamayende bwino, kumapangitsa kuchepa kwa chitetezo chokwanira, kupezeka kwa matenda opatsirana ndi kutupa, komanso kusakhazikika kwawo.

Dziwani kuti madokotala ambiri a matenda amtundu wachiwiri wa shuga amawona ngati matenda omwe amakhalapo pang'ono. European Bureau ya International Federation of Diabetesologists ndi WHO European Bureau mu 1998 inapanga njira zatsopano zowalipirira kagayidwe ndi chiwopsezo cha zovuta za odwala omwe ali ndi matenda amtundu wa II matenda a shuga, omwe amaperekedwa mu Table. 33.4.

Tebulo 33.4. Malangizomatenda ashugamtundu II

Pamimba yopanda kanthu / musanadye mmol / L (mg / dL) 6.1 (> 110)> 7.0 (> 126)

Etiology ya matenda

Mtundu woyamba wa shuga ndi matenda obadwa nawo, koma chibadwa chimatsimikizira kukula kwake ponga gawo limodzi lokha. Kuthekera kwa matenda mu mwana yemwe ali ndi amayi odwala matenda ashuga sadzaposa 1-2%, bambo wodwala - kuyambira 3 mpaka 6%, m'bale - pafupifupi 6%.

Chizindikiro chimodzi kapena zingapo zochititsa manyazi zotupa zam'mimba, zomwe zimaphatikizapo ma antibodies kupita ku ma isanger a Langerhans, zitha kupezeka mu 85-90% ya odwala:

• ma antibodies kuti glutamate decarboxylase (GAD),
• ma antibodies a tyrosine phosphatase (IA-2 ndi IA-2 beta).

Pankhaniyi, kufunikira kwakukulu pakuwonongeka kwa maselo a beta amaperekedwa pazinthu zomwe zimapangitsa chitetezo cha cellular. Matenda a shuga a Type 1 nthawi zambiri amagwiritsidwa ntchito ndi HLA haplotypes ngati DQA ndi DQB.

Nthawi zambiri zamtunduwu zimaphatikizidwa ndi zovuta zina za autoimmune endocrine, mwachitsanzo, matenda a Addison, autoimmune chithokomiro. Etiology ya non-endocrine imakhalanso ndi gawo lofunikira:

• vitiligo
• rheumatic pathologies
• alopecia
• Matenda a Crohn.

Pathogenesis wa matenda ashuga

Matenda a shuga amtundu 1 amadzipangitsa kumverera kwake pamene njira ya autoimmune iwononga 80 mpaka 90% ya masamba a pancreatic beta. Komanso, kuchuluka ndi kuthamanga kwa njirayi. Nthawi zambiri, m'mbuyomu matenda a ana ndi achinyamata, maselo amawonongeka msanga, ndipo matenda a shuga amawonekera mofulumira.

Kuyambira kumayambiriro kwa matendawa ndi zizindikiro zake zoyambirira zamankhwala mpaka kukulira kwa ketoacidosis kapena ketoacidotic chikomokere, sipangadutse milungu ingapo.

Nthawi zina, odwala osaposa zaka 40, matendawa amatha kuchitika mobisa (latent autoimmuneabetes mellitus Lada).

Komanso, panthawiyi, madokotala adazindikira mtundu wachiwiri wa matenda a shuga ndikuwalimbikitsa kwa odwala awo kuti athe kulipira insulin chifukwa cha kukonzekera kwa sulfonylurea.

Komabe, pakupita nthawi, zizindikiro za kuchepa kwathunthu kwa mahomoni zimayamba kuonekera:

1. ketonuria
2. Kuchepetsa thupi
3. Hyperglycemia yodziwika bwino poyambira kugwiritsa ntchito mapiritsi pafupipafupi kuchepetsa shuga.

Tizilombo toyambitsa matenda a shuga 1 amtundu wathupi umatengera kuperewera kwathunthu kwa mahomoni. Chifukwa cha kuthekera kwa kudya kwa shuga mu minofu yodalira insulin (minofu ndi mafuta), kuchepa kwa mphamvu kumayamba ndipo, monga chotulukapo, lipolysis ndi proteinolysis zimakulirakulira. Njira yofananira imayambitsa kuchepa thupi.

Ndi kuwonjezeka kwa glycemia, hyperosmolarity imachitika, limodzi ndi osmotic diuresis ndi kufooka kwa thupi. Ndi kuchepa kwa mphamvu ndi timadzi tambiri, insulin imatulutsa chinsinsi cha glucagon, cortisol ndi kukula kwa timadzi.

Ngakhale glycemia yomwe ikukula, gluconeogenesis imatheka. Kuthamanga kwa lipolysis mu minofu yamafuta kumapangitsa kuwonjezeka kwakukulu kwa kuchuluka kwamafuta acid.

Ngati pali kuchepa kwa insulin, ndiye kuti mphamvu ya liposynthetic ya chiwindi imapanikizika, ndipo mafuta achepetsa amafuta amathandizira ku ketogenesis. Kudzikundikira kwa ma ketones kumayambitsa chitukuko cha matenda ashuga komanso zotsatira zake - matenda ashuga a ketoacidosis.

Poyerekeza ndi kuwonjezereka kwapang'onopang'ono kwa kusowa kwamadzi ndi acidosis, kukomoka kumayamba.

Iyo, ngati palibe chithandizo (chokwanira cha insulin mankhwala komanso kupatsanso madzi m'thupi), pafupifupi pafupifupi 100% ya milandu imayambitsa imfa.

Zizindikiro za matenda a shuga 1

Matenda amtunduwu ndi osowa - osapitirira 1.5-2% ya milandu yonse yamatenda. Chiwopsezo chodzachitika m'moyo wonse chidzakhala 0.4%. Nthawi zambiri, munthu amapezeka ndi matenda a shuga ali ndi zaka 10 mpaka 13. Kuchuluka kwa chiwonetsero cha matenda kumachitika mpaka zaka 40.

Ngati vutoli ndi lachilendo, makamaka kwa ana ndi unyamata, ndiye kuti matendawa adziwonetsa ngati chizindikiro chowoneka bwino. Itha kuyamba m'miyezi yochepa kapena masabata. Matenda opatsirana komanso matenda ena opatsirana amatha kudzutsa chiwonetsero cha matenda ashuga.

Zizindikiro zake ndizazikhalidwe zamitundu yonse:

• polyuria
• kuyabwa pakhungu,
• polydipsia.

Zizindikirozi zimatchulidwa makamaka ndi matenda amtundu 1. Masana, wodwala amatha kumwa ndikuwatsitsa madzi osachepera 5-10 malita.

Zapadera zamatenda amtunduwu zimakhala zowonda kwambiri, zomwe mu miyezi 1-2 zimatha kufika 15 kg. Kuphatikiza apo, wodwala adzadwala:

• kufooka kwa minofu
• kugona
• kuchepa kwa magwiridwe.

Poyambirira, amatha kusokonezedwa ndi kuchuluka kwamphamvu kwa chikhumbo, chomwe chimasinthidwa ndi anorexia pomwe ketoacidosis imachuluka. Wodwalayo amamva fungo la acetone kuchokera pamlomo wamkamwa (pamakhala fungo la zipatso), nseru ndi pseudoperitonitis - kupweteka kwam'mimba, kuchepa thupi, komwe kumayambitsa kukomoka.

Nthawi zina, chizindikiro choyamba cha matenda ashuga amtundu 1 chikhala chovuta kwambiri m'thupi. Itha kunenedwa kuti mwakuthupi la concomitant pathologies (opaleshoni kapena yopatsirana), mwana akhoza kugwa.

Nthawi zambiri, pamene wodwala ali ndi zaka zakubadwa 35 zokhala ndi matenda a shuga (omwe ali ndi matenda ashuga a autoimmune), matendawa sangadzimveke bwino kwambiri, ndipo amadziwika kuti mwangozi amapezeka poyesa shuga.

Munthu sangachepetse thupi, polyuria ndi polydipsia adzakhala ochepa.

Choyamba, adotolo amatha kudziwa mtundu wachiwiri wa matenda ashuga ndikuyamba kulandira mankhwalawa kuti muchepetse shuga m'mapiritsi. Izi, pakapita kanthawi, zitsimikizirani kuti chiphuphu chidzalandiridwa. Komabe, patatha zaka zochepa, kawirikawiri patatha chaka chimodzi, wodwalayo amakhala ndi zizindikiro zomwe zimayamba chifukwa cha kuchepa kwathunthu kwa insulin:

1. kuwonda mwadzidzidzi
2. ketosis
3. ketoacidosis
4. kulephera kusunga shuga pamlingo wofunikira.

Mikhalidwe yodziwira matenda ashuga

Popeza mtundu wa 1 wa matendawa umadziwika ndi zizindikiro zowoneka bwino ndipo ndi njira yochepa, kafukufuku wowunika kuti adziwe kuchuluka kwa shuga m'magazi sikuchitika. Kuopsa kokhala ndi matenda ashuga amtundu woyamba kwa abale ake ndi kocheperako, komwe, posapezekapo njira zabwino zodziwira matendawa, zimapangitsa kuti asamaganize mozama za matenda omwe amapezeka mwa iwo.

Kuzindikirika kwa matendawa kuchulukitsa kwamilandu kudzakhazikitsidwa pakupanga magazi ochulukirapo kwa odwala omwe ali ndi vuto losowa insulin kwenikweni.

Kuyesa kwamlomo kuti mupeze matendawa ndikosowa kwambiri.

Osati malo omaliza kuzindikira kusiyanasiyana. Ndikofunikira kutsimikizira kuti matendawa ndiwokayikitsa, kuti mupeze glycemia osafunikira omveka bwino a mtundu wa matenda a shuga 1, makamaka ndi mawonekedwe ali aang'ono.

Cholinga chakudziwunika kotereku ndikutha kusiyanitsa matendawa ndi mitundu ina ya matenda ashuga. Kuti muchite izi, gwiritsani ntchito njira yodziwira mulingo woyambira C-peptide ndi maola awiri mutatha kudya.

Njira zakuzindikiritsa mosazindikira mwatsatanetsatane ndikutsimikiza kwa chidziwitso cha matenda amiseche 1:

• antibodies to islet zovuta za kapamba,
• glutamate decarboxylase (GAD65),
• tyrosine phosphatase (IA-2 ndi IA-2P).

Malangizo

Chithandizo cha matenda amtundu uliwonse wa shuga chimakhazikika pa mfundo zitatu izi:

1. kutsitsa shuga wamagazi (m'malo mwathu, mankhwala a insulin),
2. chakudya
3. maphunziro odwala.

Kuchiza ndi insulin ya matenda a mtundu 1 ndi amalo olowa m'malo. Cholinga chake ndikukulitsa kutsitsa kwachilengedwe katemera wa insulini kuti mulandire njira zovomerezeka zolipirira. Chithandizo cha insulin kwambiri chimayenderana kwambiri ndi kupangika kwa mahomoni.

Chofunikira chatsiku ndi tsiku cha mahormoni chikugwirizana ndi kuchuluka kwa kubisika kwake. 2 jakisoni wa mankhwala a nthawi yayitali akukhudzana kapena 1 jakisoni wautali wa insulin Glargin ikhoza kupatsa thupi insulin.

Kuchuluka kwathunthu kwa mafuta a basal sayenera kupitirira theka la zomwe tsiku lililonse limafunikira.

Kubisirana (kwa thanzi) kwa insulin kudzasinthidwa ndi jakisoni wa mahomoni amunthu nthawi yayitali kapena yopitilira muyeso yomwe imapangidwira asanadye. Pankhaniyi, mlingo amawerengedwa potengera zotsatirazi:

• kuchuluka kwa mafuta omwe amayenera kudya nthawi ya chakudya,
• kuchuluka kwa shuga m'magazi, komwe kumapangidwira jakisoni aliyense wa insulin (poyesedwa pogwiritsa ntchito glucometer).

Atangowonetsa mtundu wa matenda ashuga a mtundu woyamba 1 ndipo chithandizo chake chikangoyamba kwa nthawi yayitali, kufunika kwa kukonzekera kwa insulin kungakhale kochepa ndipo kudzakhala kochepa kuposa 0.3-0.4 U / kg. Nthawi imeneyi imatchedwa "kukwatirana ndi ukwati" kapena gawo lokakamira kukhululuka.

Pambuyo pagawo la hyperglycemia ndi ketoacidosis, momwe kupanga kwa insulin kumalimbikitsidwa ndi maselo a beta omwe atsalira, zovuta za mahomoni ndi metabolic zimalipiridwa ndi jakisoni wa insulin. Mankhwalawa amabwezeretsa kugwira ntchito kwa maselo a pancreatic, omwe amayamba kuteteza insulin pang'ono.

Nthawi imeneyi imatha kupitilira milungu ingapo mpaka zaka zingapo. Mapeto ake, komabe, chifukwa cha chiwonongeko cha autoimmune cha zotsalira za beta-cell, gawo lazikhululukiro limatha ndipo chithandizo chachikulu chikufunika.

Mellitus wosadalira insulin (mtundu 2)

Matenda amtunduwu amakula pamene minyewa yathupi singathe kuyamwa bwino shuga kapena kuichita mosakwanira. Vuto lofananalo liri ndi dzina lina - kuperewera kwa extrapancreatic. The etiology ya izi zitha kukhala zosiyana:

• Kusintha kwa kapangidwe ka insulin ndi kukhazikika kwa kunenepa kwambiri, kudya kwambiri, moyo wongokhala, matenda oopsa, pakukalamba ndi pamaso pa anthu osokoneza bongo,
• cholakwika mu ntchito za insulin zolandila chifukwa kuphwanya chiwerengero chawo kapena kapangidwe kake,
• kuperewera kwa shuga kwa chiwindi,
• intracellular matenda, momwe kufalitsa kwa chikoka kwa cell organelles kuchokera ku insulin receptor kumakhala kovuta,
• kusintha kwa insulin katemera mu kapamba.

Gulu la matenda

Kutengera ndi kuopsa kwa matenda ashuga a 2, agawidwa m'magulu:

1. digiri yofatsa. Amadziwika ndi kuthekera kolipira chifukwa cha kusowa kwa insulin, malinga ndi kugwiritsa ntchito mankhwala komanso zakudya zomwe zimakupatsani mwayi wochepetsera shuga
2. digiri yapakatikati. Mutha kulipilira kusintha kwa kagayidwe kamene mankhwala osachepera 2-3 amagwiritsidwa ntchito pochepetsa shuga. Pakadali pano, zolephera za metabolic zimaphatikizidwa ndi angiopathy,
3. siteji yayikulu. Kuti matenda asinthe matendawa pamafunika kugwiritsa ntchito njira zingapo zochepetsera shuga ndi kubaya insulin. Wodwala pakadali pano nthawi zambiri amakhala ndi zovuta.

Kodi matenda ashuga a 2 ndi otani?

Chithunzi chapamwamba cha matenda ashuga chizikhala magawo awiri:

• gawo mwachangu. Kuthira pompopompo insulin chifukwa cha shuga,
• wodekha gawo. Kutulutsidwa kwa insulini kuti muchepetse shuga yotsalira yochepa pang'onopang'ono. Imayamba kugwira ntchito mukangotha ​​gawo lomathamanga, koma chifukwa cha kusakhazikika kwa chakudya.

Ngati pali matenda a masoka a beta omwe amakhala osaganizira zomwe zimachitika chifukwa cha timadzi ta pancreatic, kusamvana mu kuchuluka kwa chakudya m'magazi kumayamba kukula. Mtundu wachiwiri wa matenda ashuga, magawo othamanga samakhalapo, ndipo gawo lang'onopang'ono limakhazikika. Kupanga kwa insulini ndikosafunikira ndipo pachifukwa ichi sikutheka kukhazikitsa njirayi.

Pakakhala zosakwanira insulin zolandila kapena njira za receptor, hyperinsulinemia imayamba. Ndi insulin yayikulu kwambiri m'magazi, thupi limayambitsa kupangidwira kwake, komwe cholinga chake ndikukhazikitsa mphamvu ya mahomoni. Chizindikiro chodziwika bwino ichi chimawonedwa ngakhale kumayambiriro kwa matendawo.

Chithunzi chodziwikiratu cha matenda am'mimba chimayamba pambuyo pa hyperglycemia wolimba kwa zaka zingapo. Mwazi wambiri wamagazi umakhudza maselo a beta. Ichi chimakhala chifukwa chakuchepa kwawo ndi kuvala, kupangitsa kuchepa kwa insulin.

Kwambiri, kuchepa kwa insulin kudzawonetsedwa ndi kusintha kwa kulemera ndikupanga ketoacidosis. Kuphatikiza apo, zizindikiro za matenda amhuga zamtunduwu ndizikhala:

• polydipsia ndi polyuria. Metabolic syndrome imayamba chifukwa cha hyperglycemia, yomwe imayambitsa kuwonjezeka kwa magazi a osmotic. Pofuna kukonza njirayi, thupi limayamba kuchotsa madzi ndi ma elekitirodi.
• kuyabwa kwa khungu. Khungu limatulutsa chifukwa cha kuwonjezeka kwambiri kwa urea ndi ma ketoni m'magazi,
• onenepa kwambiri.

Kukana kwa insulin kumayambitsa zovuta zambiri, zonse zoyambirira komanso zachiwiri. Chifukwa chake, gulu loyamba la madokotala limaphatikizapo: hyperglycemia, kuchepetsa kuchepa kwa glycogen, glucosuria, zoletsa zamtundu wa thupi.

Gulu lachiwiri lazovuta liyenera kuphatikizapo: kukondoweza kwa kutulutsa kwa lipids ndi mapuloteni chifukwa cha kusinthika kwawo kukhala chakudya, kuletsa kupanga mafuta acids ndi mapuloteni, kutsika kwa kulolera kwa zakudya zam'mimba, zotupa zobwera mwachangu za mahomoni a kapamba.

Matenda a 2 a shuga ndi ofala mokwanira. Mokulira, zizindikiritso zenizeni za kuchuluka kwa matendawa zimatha kupitilira pafupipafupi katatu konse.

Komanso, odwala amapita kuchipatala pokhapokha atakumana ndi zovuta zowopsa. Pachifukwa ichi, ma endocrinologists amalimbikitsa kuti ndikofunikira kuti usaiwale za mayeso azachipatala nthawi zonse. Athandizira kuzindikira vutoli mwachangu momwe angayambire ndikuyamba chithandizo.