Type 2 shuga

Matenda a shuga ndimatenda a endocrine matenda osachiritsika omwe amapezeka motsutsana ndi maziko a kuperewera kwa mphamvu ya insulin. Timadzi timene timapangidwa ndi kapamba, zotchedwa islets of Langerhans.

Pathology imathandizira kuti pakhale zovuta zama metabolic (pali kusowa kwamafuta, mapuloteni, kaphatikizidwe kabwino). Insulin ndi mahomoni omwe amalimbikitsa kuthothoka ndi kuthamanga kwa shuga, koma akakhala wochepa kapena woperewera, njirayi imasokonekera, zomwe zimapangitsa kukula kwa shuga m'magazi.

Mavuto owopsa kwambiri amatha kudzetsa matenda a shuga, kuperekera malangizo kwa odwala kuyenera kuwonedwa mosamalitsa pamoyo wonse. Tilankhula za iwo mu ofesi yathu.

Matenda a shuga ndi matenda ofala.

Mitundu ya matenda ashuga

Endocrine matenda amagawidwa m'mitundu iwiri:

• Mtundu I shuga
• mtundu II matenda a shuga.

Tebulo 1. Mitundu ya matenda ashuga:

Mtundu wa matenda ashuga	Insulin mankhwala osokoneza bongo	Kufotokozera	Gulu lamavuto
Mtundu I shuga	Wodalira insulin	Imfa yathunthu ya β-maselo a masumbu a Langerhans. Kufupika kwenikweni kwa insulin.	Magawo achichepere aanthu osakwana zaka 30.
Matenda a shuga a II	Osagwiritsa ntchito insulin	Kuperewera kwa insulin. Kupanga kwakachulukidwe kwa mahomoni kumatha kuzindikiridwanso, koma chidwi cha minofu pazovuta zake chimachepa.	Anthu azaka zopitilira 30, nthawi zambiri, onenepa kwambiri.

Ndikofunikira. Ngakhale kuti mtundu wachiwiri wa matenda ashuga umapezeka mwa anthu atatha zaka 30, madotolo awonetsa matendawa kale odwala, onenepa kwambiri.

Mankhwala, pali mtundu wina wa matenda monga gestationalabetes mellitus, malingaliro othandizira amathandizika ndikugwirizana ndi malingaliro a shuga oona.

Choyamba, izi ndi:

• zakudya zoyenera
• moyo wathanzi
• kuyenda pafupipafupi mu mpweya watsopano,
• kuyang'anira kuchuluka kwa shuga m'magazi.

Matendawa amapezeka mwa azimayi munthawi ya bere. Kuchuluka kwa shuga kumatha kuchuluka kwa amayi oyembekezera panthawi zosiyanasiyana za kubereka, ndipo pamakhala mwayi waukulu wodwala matenda ashuga amtundu wa II pambuyo pobereka.

Kuchita masewera olimbitsa thupi pafupipafupi kumathandizira kuchepetsa mwayi wokhala ndi matenda ashuga enieni.

Chidwi Matenda a shuga angabisike autoimmune mwachilengedwe. Kuwonetsera kowonekera bwino kwa matendawa kapena kukula kwapang'onopang'ono kwa matenda a zam'mimba kumadziwika mu magawo ofanana.

Chithunzi cha kuchipatala

Zizindikiro zoyambitsa matenda a shuga zikayamba kuonekera, wodwalayo amapita kwa dokotala, komwe amamufufuza kuti adziwe matenda ake.

Zizindikiro zotsatirazi zikuwonetsa alarm:

• kukodza pafupipafupi,
• ludzu losatha
• kamwa yowuma, pakhosi,
• kulemera kosalamulirika kapena kuwonda kwake,
• kufuna kwambiri chakudya kapena kusapezeka kwathunthu,
• kugunda kwa mtima
• kuwona kwakachepera
• kumva kuyabwa mu malo oyandikira.

Chidwi Matenda a shuga ndi matenda opatsirana omwe amafunikira kuwunika thanzi lanu nthawi zonse. Kuti thupi lizigwira bwino ntchito, WHO yakhala ikuyambitsa malingaliro a matenda a shuga, omwe amakupatsani mwayi wodwala ndikuchepetsa zizindikiro zotsatana ndi matenda.

Diagnostic Algorithm

Monga tonse tikudziwa, kuyezetsa magazi koyenera kumakupatsani mwayi wodziwa zakupezeka kwa matenda ashuga.

Potsimikizira zizindikiro za glycemia, algorithm ya diagnostic imakhala motere:

• kuyezetsa magazi pafupifupi 4 pa tsiku,
• kuyezetsa magazi kuti mupeze hemoglobin ya glycated iyenera kuchitika kamodzi 1 peresenti (imakuthandizani kudziwa kuchuluka kwa glucose kwa nthawi yayitali - mpaka miyezi itatu),
• kudziwa kuchuluka kwa shuga mkodzo 1 nthawi pachaka,
• perekani magazi kwa biochemistry nthawi imodzi mu miyezi 12.

Choyimira chachikulu pakupezeka kwa matenda ashuga ndi kuyesa magazi kwa shuga.

Kafukufuku wopangidwa ndi World Health Organisation akutsimikizira kuti matenda ashuga ndi vuto lapadziko lonse lapansi ndipo yankho lawo ndiudindo wothandiza osati wodwala yekha, komanso Boma lonse. Ichi ndichifukwa chake WHO yakonza malangizo kwa odwala omwe ali ndi matenda a shuga, onsewa 1 ndi mtundu 2.

Amakhala ndi algorithm yodziwitsa matenda, malangizo othandizira kukhazikika kwa shuga m'magazi, ndi njira zoperekera thandizo kwa odwala matenda ashuga.

Zosangalatsa. Mu 2017, gulu la azachipatala la WHO linapanga ndikulemba pulogalamu ya 8 ya "Malangizo operekera chithandizo chapadera cha odwala omwe ali ndi matenda ashuga."

Kuphatikiza pa kuphunzira komanso kutsatira malangizo azachipatala omwe amapangidwa ndi WHO, odwala akuyenera kumvera ndikutsatira malangizo akuchipatala a endocrinologist. Kuchiza matendawa kumaphatikizapo kuwunikira wodwala pafupipafupi, chifukwa nthawi zambiri mawonetseredwe am'magazi ndi zizindikiro za matenda omwe amafunikira chithandizo chamankhwala.

Monga matenda owonjezera, adalembedwa:

• Ultrasound yam'mimba
• electrocardiogram
• kuyang'anira magazi
• kuzindikira kwamasamba
• Pitani kwa dokotala wazamankhwala kapena gologist.

Maphunziro a odwala matenda ashuga

Odwala onse omwe ali ndi matenda a shuga amafunikira kuphunzitsidwa ndi magulu apadera.

Makalasi amagawidwa m'mizere iwiri:

Tebulo nambala 2. Zolinga za maphunziro a odwala matenda ashuga:

Maphunziro asukulu	Cholinga
Poyamba	Kuzindikira koyamba kwa munthu ndi matenda ake. Akatswiri amalankhula zakusintha komwe odwala matenda ashuga amayembekeza m'moyo wawo wamtsogolo: zakudya, zochita za tsiku ndi tsiku, kufufuza kuchuluka kwa shuga, kumwa mankhwala.
Kubwereza	Kubwereza malamulo a kosi yoyamba ndikuwonjezera atsopano poganizira kusintha kwa thupi.

Mwa odwala matenda ashuga, magulu awa ndi amodzi:

• anthu odwala matenda amtundu wa I,
• anthu odwala matenda ashuga a II,
• ana aang'ono
• woyembekezera.

Maphunziro adzawonetsedwa ngati opindulitsa ngati magulu a ophunzira agawidwa moyenera komanso mbali zonse zokhudzana ndi thanzi lawo zimaganiziridwa.

Kuphunzitsa odwala matenda ashuga ndi gawo lofunikira mu pulogalamu ya chithandizo cha matenda amisempha.

Aphunzitsi a maphunziro ophunzitsira ayenera kukhala ndi maphunziro othamangitsa komanso maphunziro azachipatala, ndipo apereke zokambirana malinga ndi mfundo za WHO.

Nkhani zofunika kukambirana

• mitundu ya matenda ashuga
• chakudya
• achire masewera olimbitsa
• kuopsa kwa glycemia ndi njira zopewera,
• mankhwala omwe amathandiza kutsitsa shuga m'magazi,
• tanthauzo la mankhwala a insulin ndi kufunikira kwake
• zovuta zomwe zingachitike chifukwa cha matenda ashuga
• maulendo oyenera kwa akatswiri azachipatala.

Maphunzirowa akuyenera kukuwuzani momwe mungabayire bwino insulin ndikuwonetsetsa kuchuluka kwa shuga. Chidziwitso chomwe chapezeka panthawi yophunzirira chimapangitsa kuti odwala matenda ashuga achepetse kuopsa kwa matenda a hypoglycemic ndi hyperglycemic, ndikupitilizabe kukhala ndi zotsatira zochepa za matendawa kwathunthu pa thanzi.

Malangizo a shuga

Munthu aliyense yemwe ali ndi matenda okhumudwitsa, endocrinologist payekhapayekha amapereka mwayi wokhala chithandizo chokwanira cha matenda ashuga, malingaliro ndi malingaliro pazomwe zimayikidwa. Upangiri wonse wapadera umatengera mtundu wamatenda, njira yake ndi kupezeka kwa ma concomitant pathologies.

Zakudya za matenda ashuga

Choyamba, mwa odwala omwe ali ndi matenda a shuga, pulogalamu ya chithandizo imayamba ndikusintha kwa zakudya.

• osadumpha chakudya
• idyani zakudya zazing'ono
• kudya pafupipafupi (nthawi 5-6 patsiku),
• wonjezerani michere
• osapatula muzakudya zonse zoletsedwa, makamaka, zopatsa shuga.

Malinga ndi malingaliro a WHO, tebulo 9 limaperekedwa kwa odwala matenda ashuga, pulogalamu yopatsa thanzi imapangidwa kuti izikhala ndi shuga nthawi yayitali m'magazi.

Chakudya choyenera komanso chopatsa thanzi ndichinsinsi chamankhwala abwino a shuga.

Ndikofunikira. Odwala omwe ali ndi matenda ashuga amafunika kuwunika kawirikawiri kalori. Voliyumu yawo yatsiku ndi tsiku iyenera kufanana ndi kugwiritsa ntchito mphamvu kwa thupi, poganizira momwe amakhalira, kulemera, jenda komanso zaka.

Zotsatirazi ziyenera kupezeka pakudya kwa odwala matenda ashuga:

Zakudya zatsiku ndi tsiku zimayenera kugawidwa malinga ndi mfundo iyi:

• mapuloteni - osapitilira 20%,
• mafuta - osaposa 35%%
• chakudya - osapitirira 60%
• mafuta achilengedwe a polyunsaturated - osapitirira 10%.

Kuphatikiza pa malangizo omwe ali pamwambawa a zakudya, odwala amafunika kuwonjezera kumwa kwa mbewu zomwe zimapangitsa kuchepetsa kwambiri shuga. Amalimbikitsidwa kuti atengedwe mu mawonekedwe a decoctions kapena infusions, mankhwala azitsamba adzakhala malo oyenera othandizira mankhwala okwera mtengo.

Izi zikuphatikiza:

• zipatso ndi masamba a nati,
• sitiroberi
• mabuluni
• phulusa laphiri
• elecampane
• oats
• clover
• nyemba nyemba
• lingonberry
• chipukutira.

Mndandandawu ndiwowonjezereka ndipo ukhoza kupitilizidwa kwanthawi yayitali, kuphatikiza apo, m'masitolo mumatha kupeza mankhwala azitsamba omwe amachititsa kuti shuga azitha kulowa m'magazi. Ndizofunikira kudziwa kuti izi zimangopanga shuga kapena ayi, komanso zimakhudza thanzi lathunthu.

Mankhwala azitsamba ndi imodzi mwamagawo ofunikira a njira yothandizira odwala matenda ashuga.

Chifukwa chakuti matenda a shuga a mtundu wa 2 akupanga motsutsana ndi kunenepa kwambiri, kulimbikitsa kwa zakudya zokhudzana ndi zakudya kumayenderana ndi kuwerengera kwa zakudya zomwe zimapezeka m'magawo a mkate (XE). Kwa odwala matenda ashuga osati kokha pali patebulo lopangidwa ndi mkate, lomwe ndi losavuta kuphunzira kugwiritsa ntchito. Pambuyo pakugwiritsa ntchito kwa nthawi yayitali, ambiri amadziwa kuchuluka kwa XE pa diso limodzi.

Mwachitsanzo, 1 XE ili ndi:

• kapu ya mkaka, kefir, yogati kapena yogurt (250 ml),
• kanyumba tchizi wokhala ndi zoumba wopanda shuga (40 magalamu),
• msuzi wa Zakudyazi (3 tbsp),
• phala lililonse yophika (2 tbsp.spoons),
• mbatata zosenda (2 tbsp.spoons).

Ndikofunikira. Anthu odwala matenda ashuga amaletsedwa kumwa mowa, koma nthawi zina amaloledwa kumwa vinyo wofiira wopanda magawo 150.

Mankhwala a insulin a matenda a shuga a mtundu I

Monga mukudziwa, matenda a shuga a mtundu woyamba amakhala ngati amadwala matenda a shuga, njira zazikulu za matenda 1 a shuga zimakhudzana ndi kapangidwe ka jakisoni wa insulin. Malangizo a insulini ayenera kukhala oganiza bwino komanso otsimikiza mogwirizana ndi machitidwe a thupi.

Mlingo wa insulin amawerengedwa kokha ndi adokotala, pomwe amatenga zinthu zofunika, monga:

• kulemera
• zaka
• kuchuluka kwa kusowa kwa kapamba,
• kuchuluka kwa shuga m'magazi.

Mlingo wa insulin womwe umawerengeka tsiku lililonse umagawidwa majakisoni angapo, muyenera kukumbukira kuti gawo limodzi la jakisoni liyenera kugwiritsa ntchito kuchuluka konse kwa glucose omwe akubwera.

Zindikirani kuti mu mawerengeredwe, mtundu wa mankhwalawo umafunikanso, malinga ndi chikhalidwe chowonekera, umagawidwa:

• kwenikweni insulin
• yochepa kuchita insulin
• zochita zapakati
• lalitali
• zochita zapamwamba.

Kuchita bwino kwambiri pobwezeretsa insulin kumawonedwa ndikukhazikitsa insulin yayifupi komanso yochepa. Nthawi zambiri, mitundu iyi ya mankhwalawa imaperekedwa popanda kulephera musanadye kapena mutangodya. Mankhwala ogwirira ntchito nthawi yayitali nthawi zambiri amaperekedwa m'mawa ndi madzulo asanagone.

Kubayira insulin m'mimba kumapangitsa kuti mankhwalawo athe msanga.

Komanso, powerengera mlingo, kuchuluka kwa XE kumawerengedwa, ndiye kuti, nthawi zosiyanasiyana masana komanso kuchuluka kosiyanasiyana kwa chakudya ndi 1 XE, kuchuluka kwa insulin kumafunika. Timanenanso, kuwerengetsa kwamtundu uliwonse wa mankhwalawa kumapangidwa mosamalitsa ndi adokotala. Kusintha mlingo nokha osavomerezeka.

Chidwi Majakisoni amachitika pogwiritsa ntchito cholembera cha syringe, ndi yabwino kwambiri kuti angagwiritse ntchito pawokha. Kupereka odwala matenda ashuga ndi zinthu zofunika pobayira jakisoni (cholembera, insulin) zimabweretsa ndalama kwa anthu.

Mankhwala a insulin a matenda a shuga a mtundu II

Type II matenda a shuga, monga tafotokozera pamwambapa, si mtundu wodwala womwe umadalira matendawa, koma nthawi zina, njira yokhazikitsidwa ndi chithunzi cha chipatala iyamba, pakhoza kukhala ndi jakisoni.

Insulin mankhwala a mtundu II matenda a shuga amadziwika kuti:

• kuyezetsa magazi kwa hemoglobin ya glycated imatsimikiziridwa ndi chisonyezo cha 9% kapena kupitirira (motsatana ndi mawonetsedwe owoneka bwino a matenda amtundu II shuga),
• munthawi ya mankhwala kwa odwala kwa nthawi yayitali palibe njira zabwino zochira,
• mbiri yotsutsana yopereka mankhwala a hypoglycemic,
• kuyezetsa magazi ndi mkodzo kukuwonetsa kwambiri matupi a ketone ndi shuga,
• wodwala akuwonetsedwa kuchitapo kanthu.

Ngati wodwala matenda ashuga akuwonetsa za insulin, dokotalayo ayenera kukambirana naye za chiopsezo cha hypoglycemia ndikumupatsa malangizo pazomwe angachite panthawi yoyamba kuwonekera kwa matenda.

Ndikofunikira. Nthawi zina, mankhwala a insulin samapereka zotsatira zabwino, ndiye kuti dokotala amawona kufunika kwake. Ndiye kuti, tsiku ndi tsiku mlingo wa insulin kwa wodwala aliyense umawonjezeka mpaka kagayidwe kazakudya m'thupi kamakhala m'thupi.

Zina za jakisoni wa insulin

Monga taonera pamwambapa, insulin imagawidwa m'mitundu ingapo kutengera mphamvu zake. Jakisoni wa aliyense wa iwo ali ndi mawonekedwe awo mayankho ndi momwe amathandizira.

Gawo No. 3. Mitundu ya insulin ndi zotsatira zake:

Mtundu wa insulin	Zochitika
Ultrashort	Ma insulin a Ultrashort ali ndi gawo lodziwika bwino - amaperekedwa nthawi yomweyo asanadye kapena atangodya. Ma insulin omwe amapanga pang'ono-pang'ono amaphatikizapo: Humalog, Novorapid. Njira iyi yophera jakisoni ndioyenera kwa odwala matenda ashuga, sizimayambitsa chisokonezo ndi kuwerengera kwakanthawi kochepa kwa jekeseni womaliza.
Mwachidule	Kukonzekera kwa insulin kokhazikika kumatumikiridwanso chakudya chisanafike kapena mutatha, koma kumakhalitsa pakatha mphindi 30, chifukwa ndi pambuyo pake kuti mankhwalawa ayamba kugwira ntchito yake. Dziwani kuti mtundu waifupi wa insulin uli ndi mawonekedwe kotero kuti pamene kuchuluka kwa mankhwalawo kumatha, mphamvu zake zimakhala pang'ono. Nthawi yayikulu yoyambira kuchitapo kanthu ndi mphindi 90, kutalika kwa zotulukazo ndi maola 4-6.
Kuchita motalika	Insulin yotalika nthawi yayitali imasiyana ndi mitundu yochepa chifukwa imathandizira kutsanzira kwa insulin kaphatikizidwe. Amayilowetsedwa kawiri pa tsiku ndi nthawi ya maola 12-14. Jakisoni woyamba ali m'mawa asanadye chakudya cham'mawa, chachiwiri - madzulo asanagone. Mankhwala amtunduwu amakhala ndi zinthu zomwe zimamangiriza mahomoni ndikulepheretsa mayendedwe ake kupita ku magazi.

Ziyenera kunenedwa padera kuti kudakalipo mtundu wa insulini wambiri. Mankhwala oterowo amakhala ndi insulini yayitali komanso yochepa.

Mukamagwiritsa ntchito mtundu uwu wa mankhwalawa, sikofunikira kupereka jekeseni m'mawa musanadye chakudya chamadzulo komanso madzulo musanadye chakudya chamadzulo, chifukwa imayikidwa mu zovuta kamodzi patsiku. Koma musaiwale kuti kuwerengera kuchuluka kwa mankhwalawa ndizovuta.

Kuwerengera kwa kuchuluka kwa insulin kumachitika ndi dokotala.

Mankhwala othandizira odwala matenda ashuga

Matenda a 2 a shuga amasiyana ndi matenda amtundu wa 1 chifukwa sikuti amayambitsa jakisoni wa insulin, ndipo, motero, ndi matendawa, wodwalayo ayenera kuyang'ana kwambiri za moyo ndi zakudya.

Inde, chifukwa cha zolimbitsa thupi zolimbitsa thupi, munthu akhoza kukwaniritsa zotsatirazi:

• yambitsa kagayidwe kazakudya,
• kuonda
• sinthanso ntchito ya mtima.

Katundu ndi mtundu wa zolimbitsa thupi zimayikidwa ndi adokotala. Mukamasankha, amatsogozedwa ndi magawo otsatirawa:

• kulemera kwa odwala
• zaka
• kuchuluka kwa mawonekedwe a matenda,
• Zaumoyo
• kukhalapo kwa matenda oyanjana.

Nthawi yayitali yamakalasi imayamba kuchokera pa mphindi 30 mpaka ola limodzi, ndipo kuchuluka kwa zolimbitsa thupi pamlungu ndi katatu.

Chidwi Kuchita masewera olimbitsa thupi kwamtundu uliwonse ndizoletsedwa kwa odwala matenda ashuga omwe ali ndi vuto la kupuma kwamthupi ndi vuto la mtima. Asanapereke mankhwala opatsa mphamvu, dokotalayo amapatsa wodwalayo mwayi wopita ku electrocardiogram.

Maphunziro a Cardio mwadongosolo molumikizana ndi masewera olimbitsa thupi amatha kukwaniritsa zoyesayesa zabwino za matenda ashuga amtundu wa I komanso mtundu wa matenda a shuga a II, komanso kuthandizira kuchepetsa kuopsa kwa chikomokere.

Moyo wokangalika umatha kusintha zochita za matenda ashuga.

Ngati wodwala sakusintha pamalingaliro osintha, ndiye kuti dokotalayo amasintha zomwe akutsimikiza pazokhudza kuchuluka kwa katundu ndi kuchuluka kwa maphunziro pasabata.

Mankhwala azitsamba

Phytotherapy ya matenda ashuga ipereka zotsatira zabwino kuphatikiza ndi chithandizo chachikulu cha mankhwala. Dziwani kuti kugwiritsa ntchito mankhwala aliwonse a mankhwala azikhalidwe muyenera kukambirana ndi dokotala.

Zomera zothandiza kwambiri za matenda ashuga:

• dandelion
• ananyamuka m'chiuno
• mabuluni
• phulusa laphiri
• elecampane
• oats
• tsamba
• Kukhota tambala.

Mankhwala azitsamba amatha kuchepetsa shuga.

Mankhwala wowerengeka, pali maphikidwe ambiri omwe amathandizira kuti shuga asungidwe.

Tidziwitsa owerenga angapo a iwo:

1. Mizu ya Dandelion - 3 tbsp. spoons, madzi otentha - magalasi awiri. Wiritsani kulowetsedwa kwa mphindi 6, ndikusiya kuti mupange. Tengani 1 chikho cha msuzi mkati mphindi 30 musanadye.
2. Kukhazikika msona - 1 tbsp. supuni, madzi otentha - 1 chikho. Thirani mbewuyo ndi madzi otentha ndikusiya kwa mphindi 30. Tengani pakamwa pa 1 tbsp. supuni 3 pa tsiku 20 mphindi musanadye.
3. Plantain - 1 tbsp. supuni, madzi otentha - 1 chikho. Thirani masamba owuma a plantain ndi madzi otentha ndikusiya kwa mphindi 20. Tengani pakamwa 1 supuni katatu pa tsiku musanadye.

Kufotokozera kwapfupi

Matenda a shuga Ndi gulu la matenda a metabolic (metabolic) omwe amadziwika ndi matenda osachiritsika a hyperglycemia, omwe ndi zotsatira za kubisala kwa insulin, zotsatira za insulin, kapena zonsezi.

Khodi (ma) ICD-10:

ICD-10
Code	Mutu
E 11	Matenda a shuga osagwirizana ndi insulin
E 11.0	ndi chikomokere
E 11.1	ndi ketoacidosis
E 11.2	ndi kuwonongeka kwa impso
E 11.3	ndi kuwonongeka kwa maso
E 11.4	ndi zovuta zamitsempha
E 11.5	ndi kuwonongeka kwa kufalikira kwapamadzi,
E 11.6	ndi zovuta zina zomwe zidatchulidwa,
E 11.7	ndi zovuta zingapo
E 11.8	ndimavuto osadziwika.

Kukula kwa protocol / kukonzanso: 2014 (kusinthidwa 2017).

Zifupikitso zomwe zimagwiritsidwa ntchito pa protocol:

Ag	–	ochepa matenda oopsa
HERE	–	kuthamanga kwa magazi
ACE	–	angiotensin-kutembenuza enzyme
mu / mu	–	kudzera m'mitsempha
DKA	–	matenda ashuga ketoacidosis
Ine / U	–	insulin / chakudya
ICD	–	ochita zinthu zazifupi
HDL	–	mkulu osachulukitsa lipoprotein
LDL	–	otsika osalimba lipoproteins
NPII	–	mosalekeza subcutaneous insulin kulowetsedwa
Jab	–	kuyezetsa magazi konse
OAM	–	urinalysis
Lifespan	–	chiyembekezo chamoyo
RCT	–	mayeso olamulidwa mwachisawawa
SD	–	matenda ashuga
VTS	–	odwala matenda ashuga phazi
SCF	–	kuchuluka kusefera gawo
SMG	–	kuyang'anira tsiku ndi tsiku shuga
TG	–	thyroglobulin
TVET	–	thyroperoxidase
TTG	–	thyrotropic globulin
Ultrasound	–	ultrasound dopplerography
Makina a Ultrasound	–	kuyesa kwa ultrasound
USP	–	insulin
FA	–	zolimbitsa thupi
XE	–	buledi
XC	–	cholesterol
ECG	–	electrocardiogram
ENG	–	electroneuromyography
Hbalc	–	glycosylated (glycated) hemoglobin
IA-2, IA-2 β	–	tyrosine phosphatase antibodies
IAA	–	ma antibodies a insulin

Ogwiritsa Ntchito Protocol: madotolo azadzidzidzi, akatswiri azachipatala, othandizira, opanga ma endocrinologists, othandizira.

Gulu la Odwala: akuluakulu.

Mulingo wambiri:

A	Kusanthula kwapamwamba kwambiri kwa meta, kuwunika mwadongosolo ma RCTs kapena ma RCT akulu kwambiri okhala ndi mwayi wocheperako (++) wolakwitsa mwatsatanetsatane, zotsatira zake zomwe zimatha kufalikira kwa anthu omwe amagwirizana.
Mu	Maphunziro apamwamba kwambiri (++) cohort kapena maphunziro owongolera milandu kapena maphunziro apamwamba kwambiri (++) kapena maphunziro owongolera milandu omwe ali ndi chiopsezo chochepa kwambiri cholakwika mwadongosolo kapena ma RCT omwe ali ndi chiopsezo chotsika (+) cholakwika mwatsatanetsatane, zotsatira zake zomwe zimatha kuperekedwa kwa anthu ofanananira .
Ndi	Kafukufuku wowerengeka kapena wowongolera zochitika kapena kafukufuku wotsogozedwa popanda kusinthaku ndi chiopsezo chochepa cha kukondera (+). Zotsatira zomwe zimatha kugawidwa kwa anthu omwe amagwirizana kapena ma RCT omwe ali ndi chiwopsezo chochepa kwambiri kapena chotsika kwambiri cha zolakwika mwadongosolo (++ kapena +), zotsatira zake zomwe sizingagawidwe mwachindunji kwa anthu omwe amagwirizana.
D	Kufotokozera kwamilandu yotsatizana kapena kafukufuku wosalamulirika kapena lingaliro laukatswiri.
GPP	Zochita zabwino kwambiri zamankhwala.

Gulu

Gulu:

Gome 1. Gulu la matenda ashuga

Mtundu woyamba wa shuga	Kuwonongeka kwa pancreatic β-cell, nthawi zambiri kumabweretsa kuchepa kwathunthu kwa insulin
Type 2 shuga	Kuphwanya kwapang'onopang'ono kwa insulin katulutsidwe kumbuyo kwa insulin
Mitundu ina yapadera ya matenda ashuga	- zolakwika zamtundu mu ntchito ya cells-cell, - zolakwika zamtundu wa insulin, - matenda a exocrine mbali ya kapamba zotupa - ophatikizidwa ndi mankhwala osokoneza bongo kapena mankhwala (mankhwalawa HIV / Edzi kapena pambuyo ponyamula chiwalo), - endocrinopathies, - matenda - ma gennd syndromes ena ophatikizidwa ndi shuga
Matenda a shuga	Imachitika nthawi yoyembekezera

Zizindikiro

MITUNDU YA DIAGNOSTIC, APPROACHES NDIPO ZOFUNIKIRA 1,3,6,7

Njira zoyambira:
Zofooka
Malaise
Kuchepetsa magwiridwe
Chisoni
Khungu ndi kuyabwa
Polyuria
Polydipsia
Masomphenya osokoneza nthawi
Kumva kutentha m'mapazi
Kukokana m'malire am'munsi ndi paresthesia usiku,
Kusintha kwa Dystrophic pakhungu ndi misomali.
* Madandaulo ngati mwazindikira mwangozi Hyperglycemia atha kusapezeka.

Anamnesis
Matendawa nthawi zambiri amawonekera pa zaka zopitilira 40, amatsogozedwa ndi kukhalapo kwa zigawo za metabolic syndrome (kunenepa kwambiri, matenda oopsa, zina).

Kuyeserera kwakuthupi
Odwala matenda a shuga a Mtundu Wachiwiri ali ndi:
Zizindikiro za IR: kunenepa kwambiri, matenda oopsa, acanthosis nigrikans,
Kuchuluka kwa kukula kwa chiwindi,
Zizindikiro za kuchepa madzi m'thupi (khungu lowuma, khungu, khungu lochepa),
Zizindikiro za neuropathy (paresthesia, kusintha kwamphamvu pakhungu ndi misomali, zilonda zam'mapazi).

Kafukufuku wa Laborator:
· Kuyesa kwamwazi wamagazi: hyperglycemia (gome. 2),

Gome 2. Kupeza njira za matenda a shuga 1, 3

Nthawi yodziwitsa	Ndondomeko ya glucose, mmol / l *
	Magazi onse a capillary	Vuto la plousma
NORM
Pamimba yopanda kanthu ndi maola awiri pambuyo PGTT
	Matenda a shuga
Kusala ** kapena 2 maola atatha PGTT kapena tanthauzo lachilendo	≥ 6,1 ≥ 11,1 ≥ 11,1	≥ 7,0 ≥ 11,1 ≥ 11,1

* Kuzindikira kumakhazikitsidwa pa mayeso a labotale
** Kuzindikirika kwa matenda ashuga kumayenera kutsimikiziridwa nthawi zonse ndikudziwitsanso glycemia m'masiku otsatirawa, kupatula milandu ya hyperglycemia yopanda pake ndi kuwonongeka kwachuma kapena mawonekedwe apadera.

OAM: glucosuria, ketonuria (nthawi zina).
· C-peptide ndi chizindikiro chotsalira cha insulin katulutsidwe (yabwinobwino 0.28-1.32 pg / ml). Kuyesa kwa C-peptide nkhokwe: monga lamulo, lomwe lili ndi T2DM, mulingo wa C-peptide umakulitsidwa kapena wabwinobwino, kuwonekera ndi insulin defence syndrome kumachepa.
Glycated hemoglobin (HvA1c) - ≥ 6.5%.

Maphunziro a zida (molingana ndi zolemba):
· ECG - kuzindikira zotheka kusokonekera, myocardial ischemia, zizindikiro za kumanzere kwamitsempha yamagazi koziziritsa kukhosi, ma systolic ochuluka,
· Echocardiography - kuti mupeze zizindikiro za dystrophy ya zigawo za myocardium, kuchepa kwamatumbo, hypertrophy ya myocardial, zigawo za ischemia, kuwunika kwa magawo andende,
Ultrasound yam'mimba - mawonekedwe a concomitant matenda
· UZDG ya ziwiya zamagawo am'munsi - kuti muwone kusintha kwa kayendedwe ka kuthamanga kwa magazi mu mitsempha ndi mitsempha ya kumapazi
· Kuwunikira kwa Holter - kuti mupeze kuwuka kwobisika mu magazi,
Njira ya SMG - njira yowunikira glycemia posankha ndi kukonza chithandizo chochepetsa shuga, kuphunzitsa odwala ndikuwaphatikizira chithandizo.
X-ray ya mapazi - kuwunika kukula ndi kuya kwa kuwonongeka kwa minyewa yodwala matenda ashuga,
· Kuunika kwamankhwala osokoneza bongo a zotupa ndi zotupa zamiyendo - munthawi yantchito yothandizira maantibayotiki,
· Electroneuromyography ya malekezero - chifukwa matenda a matenda ashuga polyneuropathy.

Zowonetsera kufunsira kwa akatswiri opapatiza:
Tebulo 6. Zizindikiro za mayankho aukatswiri 3, 7

Katswiri	Zolinga za kukambirana
Kufunsira kwa Ophthalmologist	Pa matenda ndi matenda a matenda ashuga - malinga ndi zikuwonetsa
Kufunsira kwa neurologist	Kwa matenda ndi matenda a matenda ashuga - malinga ndi zikuwonetsa
Kufunsira kwa Nephrologist	Kwa matenda ndi matenda a matenda ashuga - malinga ndi zikuwonetsa
Kufunsa kwamtima	Kwa matenda ndi matenda a matenda ashuga - malinga ndi zikuwonetsa
Kufunsira kwa Angiosurgeon	Kwa matenda ndi matenda a matenda ashuga - malinga ndi zikuwonetsa

Kusiyanitsa mitundu

Kusiyanitsa kosiyanitsa ndikulungamitsidwa kwa maphunziro owonjezera

Tebulo 4. Njira zoyenera zodziwikitsa za matenda amishuga amitundu 1 ndi matenda ashuga 2

Mtundu woyamba wa shuga	Type 2 shuga
Aubwana, pachimake pachimake (ludzu, polyuria, kuchepa thupi, kupezeka kwa acetone mu mkodzo)	Kunenepa kwambiri, matenda oopsa, kugona chabe, kupezeka kwa matenda ashuga m'mabanja apafupi
Kuwonongeka kwa autoimmune kwama β-cell a pancreatic islets	Kukana kwa insulini kuphatikizidwa ndi kukayika kwa β-cell

Mankhwala (zinthu zogwira ntchito) zomwe zimagwiritsidwa ntchito pochiza

Acarbose (Acarbose)

Vildagliptin (Vildagliptin)

Glibenclamide (Glibenclamide)

Gliclazide (Gliclazide)

Glimepiride (Glimepiride)

Dapagliflozin (Dapagliflozin)

Dulaglutide (Dulaglutide)

Insulin

Insulin aspart biphasic (Insulin aspart biphasic)

Insulin glargine

Insulin glulisine (Insulin glulisine)

Insulin degludec (Insulin degludec)

Chithandizo cha insulin

Insulin lispro (Insulin lispro)

Lyspro insulin biphasic (Insulin lispro biphasic)

Soluble insulini (waumunthu wopangidwa) (Insulin sungunuka (biosynthetic)

Insulin-isophan (umisiri wa chibadwa cha anthu) (Insulin-isophan (biosynthetic)

Kanagliflozin (Kanagliflozin)

Lixisenatide (Lixisenatide)

Linagliptin (Linagliptin)

Liraglutide (Liraglutide)

Metformin (Metformin)

Nateglinide (Nateglinide)

Pioglitazone (Pioglitazone)

Repaglinide (Repaglinide)

Saxagliptin (Saxagliptin)

Sitagliptin (Sitagliptin)

Empagliflozin (Empagliflozin)

Chithandizo (chipatala chakunja)

MALANGIZO OTHANDIZA KWA ATSOGOLO A LEU 2,3,7,8,11:
Odwala omwe ali ndi matenda amtundu wa 2 wopanda zovuta zowonjezera amatha kulandira chithandizo..

Zolinga za Chithandizo:
· Kukwaniritsa kwa chandamale cha glycemia ndi HvA1s,
Matenda a kuthamanga kwa magazi
Matenda a lipid metabolism,
Kupewa matenda a shuga.

Tebulo 5. The algorithm ya kusankha payekha zolinga za chithandizo chaHbalc2,3

Makhalidwe	ZAKA
	achichepere	pafupifupi	Kukalamba ndi / kapena chiyembekezo cha moyo zaka 5
Palibe zovuta ndi / kapena chiopsezo cha hypoglycemia
Pali zovuta zovuta komanso / kapena chiwopsezo cha hypoglycemia

* Chiyembekezo cha moyo - chiyembekezo chamoyo.

Gawo 6.Popeza magawo a chandamaleHbalcmfundo zotsatirazi za kuchuluka kwa glucose a pre / postprandial plasma azigwirizana ndi 2.3

Hbalc**

Madzi a m'magazi a Plasma nZomatira / chakudya musanadye, mmol / L

Madzi a m'magazi a Plasma hatatha maola 2 mutadya, mmol / l

*Izi zofunika sizikugwira ntchito kwa ana, achinyamata komanso amayi apakati. Magulu olamulira a glycemic pazotsatira zamtunduwu wa odwala amakambidwa m'zigawo zoyenera.
** Mulingo wamba malinga ndi mfundo za DCCT: mpaka 6%.

Gome 7. Target lipid metabolism kwa odwala omwe ali ndi matenda ashuga 2,3

Zizindikiro	Zofunika pa Target, mmol / L *
	amuna	azimayi
General cholesterol
Cholesterol
HDL cholesterol	> 1,0	>1,2
triglycerides

Pwopereka	Tsmfundo za sprucemmHg Art.
Kuthamanga kwa magazi a systolic	> 120 * ndi ≤ 130
Kuthamanga kwa magazi kwa diastolic	> 70 * ndi ≤ 80

* Poyerekeza ndi maziko a mankhwala a antihypertensive
Kuyeza kwa kuthamanga kwa magazi kuyenera kuchitika pakapita kulikonse kwa endocrinologist. Odwala omwe ali ndi systolic magazi (SBP) ≥ 130 mm Hg. Art. kapena diastolic magazi (DBP) ≥ 80 mm Hg. Art., Iyenera kukhala muyeso wachiwiri wa kuthamanga kwa magazi tsiku lina. Ngati mfundo za kuthamanga kwa magazi zimawonedwa pobwereza, kuzindikira matenda oopsa amaonedwa kuti ndi otsimikizika (zochizira matenda oopsa, onani protocol "Arterial hypertension").

Chithandizo chosamwa mankhwala:
Zakudya nambala 8 - chakudya chocheperako chopatsa mphamvu. Kwa odwala omwe amalandira chithandizo cha insulin, chakudya chopatsa thanzi
· Makonda onse,
- Zochita zolimbitsa thupi - poganizira momwe mtima wamunthu ulili,
Kuwerenga kusukulu ya matenda ashuga
· Kudziletsa.

Mankhwala

Mndandanda wa mankhwala ofunikira (wokhala ndi mwayi wothandizika kwa 100%):

Gome 9. Mankhwala ochepetsa shuga omwe amagwiritsidwa ntchito pochiza matenda a shuga a 2

Gulu la mankhwala	Dzina losakhala la padziko lonse la mankhwala osokoneza bongo	Njira yogwiritsira ntchito	Mulingo waumboni
Kukonzekera kwa SM	gliclazide	Pakamwa	A
	gliclazide		A
	glimepiride		A
	glibenclamide		A
Ma glinids (meglitinides)	kubwezera	Pakamwa	A
	* nateglinide		A
Biguanides	metformin	Pakamwa	A
TZD (glitazones)	pioglitazone	Pakamwa	A
Α-glucosidase zoletsa	acarbose	Pakamwa	A
aGPP-1	akusglutide	Mosasunthika	A
	liraglutide		A
	lixisenatide		A
IDPP-4	sitagliptin	Pakamwa	A
	vildagliptin		A
	saxagliptin		A
	linagliptin		A
INGLT-2	empagliflozin 10-12	Pakamwa	A
	dapagliflozin 8-9		A
	canagliflozin 13-15		A
Ultrashort insulins (insulin waumunthu)	Lyspro insulin	Subcutanely kapena kudzera m'mitsempha. Subcutanely kapena kudzera m'mitsempha.	A
	Insulin		A
	Insulin glulisin		A
Kuchita zinthu mwachidule	Soluble waumunthu wopanga insulin	Subcutaneally, kudzera m'mitsempha	A
Ma Insulin Yapakatikati	Isofan Insulin Human genetic Engineering	Mosasunthika.	A
Kuchita insulin kwa nthawi yayitali (ma insulin analogues)	Insulin glargine 100 PIECES / ml16-20	Mosasunthika.	A
	Chithandizo cha insulin 21-23		A
Ma Insulin Owonjezera Ogwira Ntchito (Ma insulin a Anthu	Insulin degludec 24-28	Mosasunthika.	A
	Insulin glargine 300 PIECES / ml29-35		A
Zosakaniza zopangidwa mwakapangidwe ka insulin yochepa ndi NPH-insulin	Biphasic insulin umisiri wamtundu wa anthu	Mosasunthika.	A
Zosakaniza zosakanika zosakanizika za ultra-yochepa zimachita insulin analogue ndi zovomerezeka kopitilira muyeso wodwala	Lyspro insulin biphasic 25/75	Mosasunthika.	A
	Lyspro insulin biphasic 50/50		A
	Insulin aspart 2-gawo		A
Kuphatikiza komwe kumapangidwa insulin analogues wapamwamba kwambiri machitidwe ndi fanizo kwenikweni insulin	Insulindegludec + Insulinaspart muyezo wa 70 / 3036-37	Mosasunthika.	A
Mankhwala osakanikirana ophatikizika a insulin yayitali komanso yowonjezera ndi aHPP-1	Insulin Glargine + Lixisenatide (Nthawi imodzi patsiku) 38-39	Mosasunthika.

Mosasunthika.
A Insulin degludec + liraglutide
(Nthawi imodzi patsiku)
40-43A

Malinga ndi Consensus of the Public Association "Association of Endocrinologists of Kazakhstan" pakuwazindikira ndi kuchiza matenda a shuga 2, mu 2016, posankha njira yoyambira ndikuthandizira kuchepetsa shuga kwa mtundu wachiwiri wa shuga, Algorithm yotsatira iyenera kutsatiridwa:

* - kupatula glibenclamide
Dongosolo la mankhwalawa silikuwonetsa patsogolo posankha

Chithandizo: ayi.

Kuwongolera kwina

Tebulo 10. Mndandanda wa magawo a labotale omwe amafunikira kuwongolera mwamphamvu kwa odwala omwe ali ndi matenda a shuga 2

Laboratorwopereka	Kuyendera pafupipafupi
Kudziletsa	Pakadutsa matenda komanso kuwonongeka - tsiku lililonse kangapo patsiku. Kupitilira apo, kutengera mtundu wa FTA: - pa mankhwala a insulin okwanira: pafupifupi kanayi tsiku lililonse, - pa PSST ndi / kapena GPP-1 ndi / kapena insulin ya basal: osachepera 1 nthawi patsiku nthawi zosiyanasiyana za tsiku + 1 mbiri ya glycemic (osachepera 4 pa tsiku) pa sabata, - pazosakanikirana ndi insulin zopangidwa kale: osachepera 2 pa tsiku mosiyanasiyana + 1 mbiri ya glycemic (osachepera 4 pa tsiku) pa sabata, - pa chithandizo cha zakudya: 1 pa sabata pa nthawi zosiyanasiyana za tsiku,
Hbalc	1 nthawi m'miyezi itatu
Kuwunika kwa biochemical (protein yonse, cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, bilirubin, AST, ALT, creatinine, kuwerengetsa kwa GFR, K, Na,)	Kamodzi pachaka (posintha)
Jab	Kamodzi pachaka
OAM	Kamodzi pachaka
Kutsimikiza mu mkodzo wa chiŵerengero cha albumin ndi creatinine	Kamodzi pachaka
Kutsimikiza kwa matupi a ketone mumkodzo ndi magazi	Malinga ndi zikuwonetsa
Tanthauzo la IRI	Malinga ndi zikuwonetsa

*Pakakhala zizindikiro za zovuta za matenda ashuga, kuwonjezera kwa matenda ophatikizika, kuwoneka kwa zinthu zowopsa, funso la mayeso limasankhidwa payekhapayekha.

Tebulo 11. Mndandanda wa mayeso othandiza ofunikira kuwunikira wamphamvu kwa odwala omwe ali ndi matenda a shuga a 2 * 3.7

Njira Yoyeserera ndi Zida	Kuyendera pafupipafupi
SMG	Malinga ndi zikuwonetsa
Kuyendetsa magazi	Pakuchezera kulikonse kwa dokotala. Pamaso pa matenda oopsa - kudziwunika kwa magazi
Kupenda kwamapazi ndi kuwunika kwamapazi	Pakuchezera kulikonse kwa dokotala
ENG ya malekezero apansi	Kamodzi pachaka
ECG	Kamodzi pachaka
ECG (yokhala ndi mayesero opsinjika)	Kamodzi pachaka
Pesi x-ray	Kamodzi pachaka
Ultrasound ya ziwiya za m'munsi malekezero ndi impso	Kamodzi pachaka
Ultrasound yam'mimba	Kamodzi pachaka

* Pakakhala zizindikiro za zovuta za matenda ashuga, kuwonjezera kwa matenda ophatikizika, kuwoneka kwa zinthu zowopsa, funso la mayeso limasankhidwa payekhapayekha.

Zisonyezero zamankhwala othandizira:
- Kukwaniritsa zolinga zamtundu wa НвА1с ndi glycemia,
· Kukwanitsa kwa zomwe zimayambitsa matenda a lipid metabolism,
Kukwaniritsa chandamale chamagazi,
- Kukula kokulimbikitsidwa kwa kudziletsa.

Chithandizo (kuchipatala)

MITUNDU YOPHUNZITSIRA MALO OGWIRA NTCHITO YOSAVUTA: Mankhwala okwanira ochepetsa shuga akusankhidwa.

Khadi Lounikira Odwala, Njira Yodwala


Chithandizo chosamwa mankhwala: onani malo apamwamba.

Chithandizo cha mankhwala: onani malo apamwamba.

Chithandizo: ayi.

Kukonzanso: onani malo apamwamba.

Zisonyezero zamankhwala othandizira: onani malo apamwamba.

Kuchipatala

ZITSANZO ZOTHANDIZA MALO OGWIRITSIRA NTCHITO YOFESA MALO A HOSPITALIZATION

Zisonyezero zakugonekedwa kuchipatala:
· State kuwonongeka kwa chakudya kagayidwe kachakudya, osalondola pamaziko apadera,
· Nthawi zambiri mobwerezabwereza hypoglycemia kwa mwezi umodzi kapena kuposerapo,
· Kukula kwa mitsempha ndi mitsempha (retinopathy, nephropathy) zovuta zamtundu 2 shuga, matenda ammimba a shuga.
· Amayi oyembekezera omwe ali ndi matenda a shuga a 2, omwe amadziwika nthawi yapakati.

Zisonyezo zakuchipatala mwadzidzidzi:
Coma - hyperosmolar, hypoglycemic, ketoacidotic, lactic acid.

Magwero ndi mabuku

1. Miniti ya misonkhano ya Joint Commission for the Health of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2017
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Empagliflozin monga chowonjezera pa metformin kuphatikiza sulfonylurea mwa odwala omwe ali ndi matenda a shuga a 2: sabata la 24, losintha mwachisawawa, lakhungu lachiwiri, loyesedwa ndi malo. Kusamalira Matenda a shuga 2013, 36: 3396-404. 12) Häring HU, Merker L, Seewaldt-Becker E, et al. Empagliflozin monga chowonjezera pa metformin mwa odwala omwe ali ndi matenda a shuga a 2: sabata la 24, osasankhidwa, akhungu lachiwiri, loyesedwa ndi placebo. Kusamalira Matenda a shuga 2014, 37: 1650-9. 13) Nisly SA, Kolanczyk DM, Walton AM. Kanagliflozin, yatsopano sodium-glucose cotransporter 2 inhibitor, pochiza matenda a shuga.67Am J Health Syst Pharm. - 2013 .-- 70 (4). - R. 311-319. 14) Lamos EM, Younk LM, Davis SN. Kanagliflozin, zoletsa wa sodium-glucose cotransporter 2, pochizira matenda a shuga 2. Katswiri Opin Drug MetabToxicol 2013.9 (6): 763-75. 15) Stenlöf K, Cefalu WT, Kim KA, et al. 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Analimbikitsa kukhutitsidwa kwamankhwala kwa odwala omwe ali ndi vuto la 1 la shuga omwe amathandizidwa ndi insulin glargine 100U / mL motsutsana ndi Nulin insulin: Kufufuza kwa olosera ofunikira kuchokera awiri mayeso olamulidwa mwachisawawa. J Matenda A shuga. 2017 Mar, 31 (3): 562-568. 19) Blevins T, Dahl D, Rosenstock J, et al. Kuchita bwino ndi chitetezo cha LY2963016 insulin glargine poyerekeza ndi insulin glargine (Lantus®) mwa odwala omwe ali ndi matenda amtundu wa 1 omwe ayesedwa mosasintha: kafukufuku wa 1 1. Matenda a shuga ndi Matenda a Metabolism. Juni 23, 2015. 20) L. L. Ilag, M. A. Deeg, T. Costigan, P. Hollander, T. C. Blevins, S. V. Edelman, et al. Kufufuza kwa immunogenicity ya LY2963016 insulin glargine poyerekeza ndi Lantus®insulinglargine mwa odwala omwe ali ndi mtundu 1 kapena mtundu 2 shuga. Matenda a shuga ndi Matenda a shuga, Januware 8, 2016.21) Gilor C, Ridge TK, Attermeier KJ, Graves TK. Pharmacodynamics ya insulin detemir ndi insulin glargine yoyesedwa ndi isoglycemic clamp njira mu amphaka athanzi. J Vet Intern Med. 2010 Jul-Aug, 24 (4): 870-4. 22) Fogelfeld L, Dharmalingam M, Robling K, Jones C, Swanson D, Jacober S. Chiwopsezo chosasinthika, chochitikira chofanizira kuyerekeza kuyimitsidwa kwa insulin lispro protamine ndi kudziletsa kwa insulin odwala omwe ali ndi matenda a shuga a 2 .Diabetes Med. 2010 Feb, 27 (2): 181-8. 23) Reynolds LR. Kuyerekeza ma insulins amanyansidwa ndi glargine amtundu wa 2 matenda ashuga: ofanana kuposa kusiyana.Commentary.Postgrad Med. 2010 Jan, 122 (1): 201-3. 24) Zinman B, Philis-Tsimikas A, Cariou B, et al, m'malo mwa Ofufuzira a NN1250-3579 (BEGIN Mara Long). Kusamalira Matenda a shuga. 2012.35 (12): 2464-2471. 25) Heller S, Buse J, Fisher M, et al, m'malo mwa BEGIN Basal-Bolus Mtundu Woyesera wa 1. Lancet. 2012.379 (9825): 1489-1497. 26) Gough SCL, Bhargava A, Jain R, Mersebach H, Rasmussen S, Bergenstal RM. Kusamalira Matenda a shuga. 2013.36 (9): 2536-2542. 27) Meneghini L, Atkin SL, Gough SCL, et al, m'malo mwa NN1250-3668 (BEGIN FLEX) Woyesa Mlandu. Kusamalira Matenda a shuga. 2013.36 (4): 858-864. 28) Kuyesa Kufufuza za Kugwira Ntchito ndi Chitetezo cha Insulin Degludec mwa Ana ndi Achinyamata Okhala ndi Type 1 Diabetes Mellitus (BEGIN ™) ClinicalTrials.gov Chidziwitso: NCT01513473. 29) Dailey G, Lavernia F. Kuunikira kwa chitetezo ndi chidziwitso cha insulin glargine 300 unit / ml, kapangidwe katsopano ka insulin glargine.Diabetes ObesMetab. 2015.17: 1107-14. 30) SteinstraesserA et al. Kufufuza kwatsopano kwa insulin glargine 300 U / ml imakhala ndi kagayidwe kofanana ndi insulin glargine 100 U / ml. Matenda a shuga ObesMetab. 2014.16: 873-6. 31) BeckerRHetal. New insulin glargine 300 Units • mL-1 imapereka chithunzithunzi chokwanira kwambiri komanso kuwongolera kwa glycemic kwa nthawi yayitali poyerekeza ndi insulin glargine 100 Units • mL-1.DiabetesCare. 2015.38: 637-43. 32) Riddle MC et al. New Insulin Glargine 300 Units / mL motsutsana ndi Glargine 100 Units / mL mwa Anthu Okhala ndi Matenda A 2 Kugwiritsa Ntchito Basal ndi Mealtime Insulin: Glucose Control and Hypoglycemia mu 6-Month Randomised Controlled Trial (Dongosolo 1) .Diabetes Care. 2014.37: 2755-62. 33) Yki-Järvinen H et al. Watsopano insulin glargine 300 mayunitsi / mL motsutsana glargine 100 mayunitsi / mL mwa anthu amtundu wa 2 osokoneza bongo omwe amamwa komanso basal insulin: kuwongolera kwa glucose ndi hypoglycemia m'miyezi 6 yoyesedwa mosasamala (6). Chisamaliro cha Matenda a shuga 2014, 37: 3235-43. 34) Bolli GB et al. New insulin glargine 300 U / ml poyerekeza ndi glargine 100 U / ml mwa anthu a insulin-naïve omwe ali ndi matenda a shuga 2 pamankhwala ochepetsa shuga a m'magazi: kuyesedwa kosaloledwa (CHIVUMBULUTSO 3) .Diabetes ObesMetab. 2015.17: 386-94. 35) PD PD, Bergenstal RM, Bolli GB, Ziemen M, Rojeski M, Espinasse M, Riddle MC. New Insulin Glargine 300 Units / mL motsutsana ndi Glargine 100 Units / mL mwa Anthu Okhala ndi Matenda Ati Awa Matenda A shuga: A Opanda Mankhwala, Gawo 3a, Open-Label Clinical Tental (DIYO 4). Kusamalira Matenda a shuga. 2015 Dec, 38 (12): 2217-25. 36) Zowonetsa za Clinical T kesi Program ndi Kugwiritsa Ntchito kwa Insulin Degludec / Insulin Aspart mu Diabetes Management Ganapathi Bantwal1, Subhash K Wangnoo2, M Shunmugavelu3, S Nallaperumal4, KP Harsha5, ArpandevBhattachary. 37) Chitetezo, Pharmacokinetics ndi Pharmacodynamics a ma IDegAsp Awiri (Kafukufuku Wimodzi) Kukonzekera Kwachiwiri ndi Insulin Degludec (Kafukufuku Wodziwika) Zokonzekera mu Zolemba za Japan. ClinicalTrials.gov Chidziwitso: NCT01868555. 38) Aroda VR et al, LixiLan-L Kuyesera Koyesera.Erratum. Kugwira Ntchito ndi Chitetezo cha LixiLan, Kuphatikiza Kwakusintha Kwa Matenda a Insulin Glargine Plus Lixisenatide mu Mtundu Wachiwiri wa Matenda a shuga Osayatsidwa Bwino pa Basal Insulin ndi Metformin: Mlandu wa LixiLan-L. Ntchito Zosamalira Matenda a shuga 2016.39: 1972-1980; Chisamaliro cha Matenda A shuga. 2017 Apr 20. 39) Rosenstock J et al, LixiLan-O Oyesera Ofufuza. Erratum. Ubwino wa LixiLan, Kuphatikiza Kwosasinthika-Kuthanso kwa Insulin GlarginePlusLixisenatide, Versus Insulin Glargine ndi Lixisenatide Monocompitors a Type 2 Diabetes Okulamulidwa Mosakwanira pa Omwe Omvera Amakhala Ndi Chiyeso cha LixiLan-O. Ntchito Zosamalira Matenda a shuga 2016.39: 2026 2035; Kusamalira Matenda A shuga. 2017 Apr 18. 40) Stephen CL, Gough, Rajeev Jain, ndi Vincent C Woo. Insulin degludec / liraglutide (IDegLira) zochizira matenda amtundu wa 2. 41) Machitidwe Awiri a Liraglutide ndi Insulin Degludec mu Mtundu Wachiwiri wa Matenda A shuga: Chiyeso Poyerekeza Kugwira Ntchito ndi Chitetezo cha Insulin Degludec / Liraglutide, Insulin Degludecand Liraglutide mu Nkhani Zomwe zili ndi Type 2 Diabetes (DUAL ™ I) ClinicalTrials.gov Identifier: NCT. 42) Chiyeso cha Clinical Poyerekeza Glycemic Control and Safety of Insulin Degludec / Liraglutide (IDegLira) Versus Insulin Glargine (IGlar) monga Therapy yowonjezera ku SGLT2i mu Zolemba Zokhala ndi Type 2 Diabetes Mellitus (DUALTM IX) Cl3ical3ri033NCT33 NCT. 43) Chithandizo cha Insulin degludec / liraglutide (IDegLira) Kupititsa patsogolo Kulamulira kwa Glycemic kwa Akuluakulu omwe ali ndi Type 2 Diabetes Mellitus NDA 208583 Chidule Chopereka. 44) "Zomwe muyenera kudziwa za Biosimilar Medicines Products". A Consensus InfirmationDocument.EuropeanCommision. Ref. Ares (2014) 4263293-18 / 1 // 2014. 45) "Chitsogozo Pazinthu Zofanana Zamapulogalamu Omanga Zamoyo Zokhala ndi Mapuloteni Ochokera ku Biotechnology monga Mankhwala Ogulitsa Mankhwala - Zosagwirizana Ndi Zachipatala" European Medicines Agency. 18 Disembala 2014 EMEA / CHMP / BMWP / 42832/2005 Rev1 Komiti Yazachipatala Zazogwiritsira Ntchito Kugwiritsa Ntchito Kwaanthu (CHMP). 46) "Malangizo pazomwe sizingachitike kuchipatala komanso zaumoyo zomwe zimapangidwanso monga mankhwala omwe amaphatikizanso insulin." European Medicines Agency .. 26 February 2015 EMEA / CHMP / BMWP / 32775 / 2005Rev. 1 Komiti Yopangira Zamankhwala Kugwiritsa Ntchito Anthu (CHMP).

Mtundu wachiwiri wa shuga - mawonekedwe a matendawa

Kuti magwiritsidwe ntchito moyenera, thupi limafunikira mphamvu nthawi zonse, yomwe imapangidwa kuchokera kuzakudya zomwe zawonongeka. Wopatsira wamkulu ndiye glucose. Pofuna kuti shuga amuyamwidwe ndi minofu, timafunikira timadzi timene timatulutsa - insulin, yomwe imapangidwa ndi kapamba.

Mtundu wachiwiri wa matenda ashuga, chitsulo chimagwira ntchito moyenera, koma maselo amakula mahomoni. Zotsatira zake, shuga samaperekedwa ku maselo, koma amakhalabe m'madzi a m'magazi. Thupi limayamba kusowa mphamvu. Ubongo umayankha pamkhalidwewo ndi chizindikiro chowonjezera kupanga insulin. Kuchuluka kwa mahomoni sasintha zinthu.

Pang'onopang'ono, kupanga kwa insulini kumachepetsedwa kwambiri chifukwa cha kuvala kwa thupi ndi kufooka, ndipo mwina kusiya. Matendawa amakula pang'onopang'ono ndipo poyamba alibe chizindikiro. Ndi mawonekedwe apamwamba a matendawa, amatha kupita ku gawo la 1.

Matenda a shuga

Gellational matenda a shuga ndi vuto lomwe limapezeka mwa azimayi munthawi ya bere. Zikuwoneka motsutsana ndi maziko a kuphwanya kwa kagayidwe kazachilengedwe ndi kusintha kwina kwa metabolic.

Matenda amtunduwu amapezeka kale prenatal nthawi, ndipo chomwe chimayambitsa chitukuko ndi kuchepa kwa chidwi cha minyewa kupita ku insulin ya mahomoni chifukwa cha kusokonekera kwa mahomoni m'thupi la mayi wapakati. Zomwe zimayambitsa nthawi zambiri zimaphatikizira kunenepa kwambiri.

Nthawi zambiri, matendawa amabisika ndipo amapezeka kuti ali kale mochedwa. Kuyesedwa pafupipafupi kwa labotale komanso kuyang'aniridwa ndi achipatala kudzakuthandizani kupewa matendawa.

Poyerekeza ndi GDM, mkazi pambuyo pake amawonjezera mwayi wokhala ndi matenda amtundu wachiwiri wa matenda ashuga.

Chidwi Mu theka la GDM, azimayi omwe ali ndi pakati kachiwiri ali pachiwopsezo.

Ndikofunikanso kunenanso kuti mwa azimayi omwe adatenga GDM, chiopsezo chokhala ndi matenda amtundu wa II chikuwonjezerekanso.

Zambiri

MALO OGANIZIRA A PROTOCOL

Mndandanda wazopanga protocol:
1) Nurbekova Akmaral Asylovna - Doctor of Medical Sayansi, Pulofesa wa Department of Internal Medicine No. 2 wa Republican State Pedagogical University ku Perm State Pedagogical University Kazakh National Medical University yemwe adatchedwa S.D. Asfendiyarova. "
2) Bazarbekova Rimma Bazarbekovna - Doctor of Medical Science, Pulofesa, Mutu wa Dipatimenti ya Endocrinology ya Kazakh Medical University ya Kupitiliza Maphunziro JSC, Tcheyamani wa Public Association "Association of Endocrinologists a Kazakhstan".
3) Smagulova Gaziza Azhmagievna - Wofunsidwa wa Sayansi Yachipatala, Mutu wa Dipatimenti ya Propaedeutics of Internal Matenda ndi Clinical Pharmacology, Republican State Pedagogical University ku Western-Kazakhstan State Medical University yotchedwa M. Ospanov.

Chizindikiro chosagwirizana ndi chidwi: ayi

Ndemanga:
Espenbetova Mayra Zhaksimanovna – Doctor of Medical Sayansi, Pulofesa, Mutu wa Dipatimenti Yogwira Ntchito Zazachipatala mu General Medical Practice, Semipalatinsk State Medical Academy.

Chowonetsa mikhalidwe ya kukonzanso protocol: kukonzanso protocol patatha zaka 5 chitasindikizidwa komanso kuyambira tsiku lomwe adayamba kugwira ntchito kapena pamaso pa njira zatsopano ndi umboni.

Zakumapeto 1

Njira zowunikira za 2 matenda a shuga 2, 3
Kuunikira kumachitika kuti muzindikire odwala omwe ali ndi matenda ashuga. Kusanthula kumayamba ndi kusala glycemia. Panthawi ya kudziwa kuti standardoglycemia kapena kusala kudya glycemia (NGN) - oposa 5.5 mmol / L, koma ochepera 6.1 mmol / L kwa magazi othandizira komanso oposa 6.1 mmol / L, koma ochepera 7.0 mmol / L kwa venous plasma ndi mankhwala a pakamwa glucose kulolerana (PHTT).
PGTT sachitidwa:
Malinga ndi matenda omwe ali pachimake,
· Poyerekeza ndi kugwiritsa ntchito mankhwala kwakanthawi kochepa komwe kumakulitsa glycemia (glucocorticoids, mahomoni a chithokomiro, thiazides, beta-blockers, etc.)
PGTT iyenera kuchitika m'mawa motsutsana ndi zakudya zosachepera masiku atatu (zopitilira 150 g zamankhwala tsiku). Kuyesaku kuyenera kupitilira kusala kudya kwa maola osachepera 8 mpaka 14 (mutha kumwa madzi). Pambuyo pakupereka magazi pamimba yopanda kanthu, woyeserera amayenera kumwa magalamu 75 a glucose kapena 82,5 g shuga wa monohydrate wosungunuka mu 250-300 ml ya madzi osaposa mphindi 5. Kwa ana, katundu ndi 1.75 g wa glucose wa glucose pa kg iliyonse ya thupi, koma osapitirira 75 g. Pambuyo pa maola awiri, kuyesedwa kwachiwiri kwa magazi kumachitika.

Zisonyezero zojambula za asymptomatic shuga
Anthu onse amayang'aniridwa kukhala BMI ≥25 kg / m 2 ndi zotsatirazi zinthu zoopsa:
· Kukhala ndi moyo wopendekera,
· Achibale a mzere woyamba wa abale omwe ali ndi matenda ashuga,
Anthu amitundu yosiyanasiyana omwe ali pachiwopsezo cha matenda ashuga,
· Amayi omwe ali ndi mbiri yakubadwa kwa mwana wosabadwa wamkulu kapena wodwala matenda ashuga
Hypertension (Hyp140 / 90 mmHg kapena pa antihypertensiveapy),
Mulingo wa HDL wa 0,9 mmol / l (kapena 35 mg / dl) ndi / kapena triglyceride wa 2.82 mmol / l (250 mg / dl),
Kupezeka kwa HbAlc ≥ 5.7% isanakhudzidwe ndi kulolerana kwa glucose kapena kusala kwamphamvu kwa glucose,
Mbiri ya matenda amtima,
· Matenda ena okhudzana ndi kukana insulini (kuphatikizapo kunenepa kwambiri, acanthosnigras),
Polycystic ovary syndrome.
Ngati mayesowa ndi abwinobwino, ayenera kubwerezedwa zaka zitatu zilizonse. kuwunika zachitika anthu onse azaka zopitilira 45. Ngati mayesowa ali abwinobwino, muyenera kubwereza zaka zitatu zilizonse.
Kujambula ziyenera kuchitika mwa ana opitirira zaka 10 ndi achinyamata onenepa ndi zinthu ziwiri kapena zingapo zowopsa.

Zakumapeto 1

DIAGNOSTIC NDIPO KUTSITSA DIABETIC KETACACIDOSIS ALGORITHM PANSI WA EMERGENCY

Diabetesic ketoacidosis (DKA) ndi ketoacidotic chikomokere
DKA ndi matenda okhudzana ndi matenda ashuga okhathamira, owonetsedwa ndi kuwonjezereka kwa glucose komanso kuchuluka kwa matupi a ketone m'magazi, mawonekedwe awo mkodzo komanso kukula kwa metabolic acidosis, omwe ali ndi magawo osiyanasiyana a matenda obanika kapena popanda iwo, amafunikira kuchipatala kwadzidzidzi.

Zakumapeto 2

DIAGNOSTIC NDIPO KUTSILIZA KWAULERE KWA DIABETIC HYPOGLYCEMIC CONDURE / AKUDZA PAKATI PA EMERGENCY(ziwembu)

Ikani wodwalayo kumbali yake, kumasula zingwe zamkati pazakudya (osathira zotsekemera mkatikati mwa mkamwa),
♦ iv 40-100 ml ya yankho la dextrose 40% (mpaka kupumula kwathunthu kwa chikumbumtima);
♦ njira ina - 1 mg (ana aang'ono 0,5 mg) glucagon s / c kapena / m,
Conscious ngati chikumbumtima sichikabwezeretsedwa, yambani kumenya nkhondo ndi matenda a mtima: ma colloids, osmodiuretics, zigawo zamagazi.

Zakumapeto 3

DIAGNOSTIC NDIPONSE ZOPHUNZITSA DIABETIC HYPEROSOLARY COMA ALGORITHM YOLEMBEDWA NDI EMERGENCY

Matenda a shuga ana

Poona ziwonetsero zakukula kwa matenda ashuga padziko lonse lapansi, zitha kudziwika kuti chiwerengero cha ana omwe adziwitsidwa ndi matendawa chikuwonjezeka chaka chilichonse. Ngakhale kuti mtundu wa shuga wa mtundu wa I ndi "unyamata", ndiye kuti, umakula mwa anthu osaposa zaka 30, ngakhale milandu ya matenda a shuga a II imadziwika muubwana.

Choyambitsa chachikulu cha matendawa chiri kuphwanya kapangidwe ka insulin, chifukwa chake njira za metabolic zimasokonekera komanso kuchuluka kwa shuga m'magazi kumawonjezeka.

Zomwe zimayambitsa matenda amtundu wa shuga wa ana mu ana, monga akulu, zimaphunziridwabe, koma chomwe chikuyambitsa matendawa ndi:

• cholowa
• zopsinjika pafupipafupi
• machitidwe
• kusokoneza chilengedwe.

M'zaka zaposachedwa, pakhala kuwonjezereka kwa chitukuko cha matenda ashuga mwa ana.

Ngati tizingolankhula za kukula kwa matenda ashuga amtundu wa ana mu ana, ndiye kuti titha kunena kuti zomwe zimayambitsa matenda ndi izi:

• onenepa kwambiri
• kumangokhala
• chibadwa.

Ngati matenda ashuga mwa ana apezeka, malingaliro anu azikhala mogwirizana ndi omwe onse amavomereza. Choyamba, azikhala ndi thanzi labwino, kudya mokwanira komanso kutsatira madokotala.

Mfundo zachikhalidwe zopezera chakudya

Odwala omwe ali ndi matenda ashuga ayenera kudya kangapo 5-6 pa tsiku m'magawo ang'onoang'ono. Chakudya chimayenera kukhala ndi cholembera chochepa kwambiri komanso chokhala ndi glycemic yotsika kapena yapakati kuti munthu asalemere msanga komanso asavutike chifukwa cha kusintha kwadzidzidzi m'magazi a shuga. Kuphatikiza apo, gawo laling'ambikalo laling'onolo, limakhala losavuta kulikumba ndikuligwiritsa ntchito, ndipo kulemera kwina kwa ziwalo zam'mimba m'matumbo a shuga kulibe ntchito.

Polemba mndandanda woyenera, endocrinologist, pamodzi ndi wodwalayo, ayenera kuganizira za mawonekedwe a kagayidwe kake, zomwe amakonda, kulemera kwake, zaka zake komanso kupezeka kwa matenda ena. Zakudya zamafuta ochepa sizabwino kwa anthu ena, kwa ena, zakudya zamafuta ochepa, komanso chachitatu, zakudya zoyenera zomwe zimakhala ndi zopatsa mphamvu zochepa. Njira yokhayo yodziwika komanso kuchuluka kwa zinthu zachilengedwe zofunikira m'zakudya ndizofunikira kwambiri pakuthandizira chithandizo ndikutsatira kwakanthawi chakudya popanda zolephera.

Pali mfundo zamakonzedwe azakudya, zomwe ndi zofunika kutsatira onse, ngakhale mtundu wa matenda:

• Chakudya cham'mawa chizikhala ndi zakudya zomwe zimapangitsa kuti mafuta azikhala pang'ono tsiku lonse,
• yopuma pakati chakudya sayenera upambana 3 hours,
• ndi nkhawa yayikulu yanjala, ndikofunikira kuyeza shuga wamagazi ndikudya zakudya zopatsa thanzi (maapulo, mtedza), ndi hypoglycemia, idyani chakudya ndi chakudya chamagulu othamanga,
• ndibwino kuphatikiza nyama osati ndi chimanga, koma ndi masamba am'ma masamba, chifukwa ndi osavuta kuyamwa komanso osavuta kugaya,
• sutha kugona ndi mawu osaneneka okhudzidwa ndi njala, musanagone mutha kumwa kapu ya kefir yamafuta ochepa kapena yogati yachilengedwe popanda zowonjezera.

Plums, beets ndi mkaka zimathandizira kukonza chimbudzi ndikuwonjezera matumbo a matumbo. Pa chifukwa chomwechi, mutha kumwa kapu yamadzi pamimba yopanda mphindi 15 asanadye chakudya cham'mawa. Izi zimayambitsa chimbudzi ndikuyendetsa bwino chimbudzi.

Mosasamala mtundu wa shuga, ndikofunikira kuti wodwala azitsatira zakudya. Zowona, ndi mtundu wodwala womwe umadalira insulin, umatha kuchepa pang'ono, chifukwa wodwalayo amapanga jakisoni wa mahomoni ndipo amatha kudziwa kuchuluka kwa mankhwalawa malinga ndi zomwe akufuna kudya. Koma mulimonsemo, onse odwala matenda ashuga sayenera kudya zakudya zamafuta ambiri, chifukwa zimayambitsa kusintha kwa shuga m'magazi ndikuyambitsa zovuta mtsogolo.

Maziko azakudya ayenera kukhala masamba. Amakhala ndi index ya glycemic yotsika komanso mawonekedwe okwera kwambiri, omwe amafunikira mayendedwe amamba. Ndi matenda a shuga, kagayidweko kamachepa, ndipo wodwalayo amatha kusokonezeka ndi kudzimbidwa, komwe kumadzaza ndi kuledzera kwa thupi. Kuti mupewe izi, ndikofunikira kudya masamba 3-4 pa tsiku. Muli mavitamini ndi michere yazinthu zofunika kuti magwiridwe antchito onse a ziwalo ndi machitidwe azikhala. Zipatso ndizothandizanso kwa odwala matenda ashuga, koma kuwasankha, muyenera kulabadira index ya glycemic - iyenera kukhala yotsika kapena yapakati.

Makamaka othandizira odwala matenda ashuga ndi zakudya zotere:

• tomato
• kolifulawa
• dzungu
• apulo
• peyala
• Zipatso za malalanje
• makangaza
• biringanya
• uta
• adyo
• tsabola.

Pakati pa nsomba ndi nyama, muyenera kusankha mitundu yoyonda. Ndi bwino kuphika ziwotchera kapena mu uvuni popanda kuwonjezera mafuta ambiri. Nyama iyenera kupezeka muzakudya tsiku lililonse, nsomba - pafupifupi kawiri pa sabata. Anthu odwala matenda ashuga amaperekedwa bwino ndi filimu yophika kapena yowotcha ya Turkey, yophika kapena yophika nkhuku yopanda khungu komanso nyama ya kalulu. Pollock, hake ndi tilapia ndichisankho chabwino kwambiri pa nsomba, chifukwa izi ndizophatikiza zamafuta ochepa zomwe zimapangidwa ndi mankhwala. Ndiosafunika kuti odwala adye nkhumba, mafuta amphaka, nyama ya bakha, tsekwe komanso nsomba zamafuta, chifukwa zinthu izi zimanyamula zikondamoyo ndikuwonjezera mafuta m'thupi.

Zothandiza kwambiri ndi phala la tirigu, buckwheat, mapira ndi phala ya pea. Mndandanda wawo wa glycemic ndiwambiri, ndipo ali ndi mavitamini ambiri, chitsulo, calcium ndi zinthu zina zokutsatira. Mukamapanga menyu, odwala matenda ashuga ayenera kupatula semolina ndi kupukutira mpunga kuchokera pamenepo, popeza palibe chilichonse chothandiza mwa iwo chomwe chili ndi zopatsa mphamvu zambiri.

Zifukwa zachitukuko

Mtundu wachiwiri wa matenda a shuga umayamba chifukwa chakutha komanso kung'ambika thupi, chifukwa chake matenda opatsirana amapezeka kwambiri mwa anthu opitilira zaka 40.

Koma palinso zifukwa zina komanso zopangitsa kuti matendawa atukuke:

• kufalitsa majini. Ngati pali achibale omwe ali ndi matenda ashuga (amtundu uliwonse), ndiye kuti mwayi wokhala ndi matenda wowonjezereka ungowonjezereka ndi 50%,
• anthu onenepa kwambiri amatha kutenga chiwopsezo cha matendawa, chifukwa kuchuluka kwa mafuta kumachepetsa chidwi cha maselo, komanso kuchepetsa magwiridwe antchito.
• kudya kolakwika. Kugwiritsa ntchito pafupipafupi zakudya za shuga, zamafuta, komanso zopatsa chakudya
• kugwiritsa ntchito mphamvu zochepa, kumachitika ndimphamvu zolimbitsa thupi,
• kusintha kwa zamankhwala mu kapamba,
• matenda opatsirana pafupipafupi okhudza kugaya chakudya,
• kutopa kwamthupi ndi kwakuthupi, komanso kupsinjika kwapafupipafupi komanso kukhumudwa,
• kuchuluka pafupipafupi kwa kupanikizika
• Mankhwala osokoneza bongo ndi kupangika kwa zovuta zomwe zimakhudza kugwira ntchito kwa England.

Pathology imayamba ngati pali zifukwa ziwiri kapena zitatu nthawi imodzi. Nthawi zina matendawa amapezeka mwa amayi apakati. Pankhaniyi, kupezeka kwake kumalumikizidwa ndi kusintha kwa mahomoni m'thupi. Nthendayi (nthawi zambiri) imangoyenda yokha ikangobala.

Njira Zothanirana ndi Matenda A shuga

Tsoka ilo, pakuwonjezereka kwa anthu odwala matenda ashuga padziko lapansi. Nthawi zina, pofuna kuchepetsa chiopsezo cha matenda, sizingatheke kukopa zinthu, mwachitsanzo, chikhalidwe cha makolo kapena chilengedwe, koma nthawi zina ndizotheka kuchepetsa mwayi wa matenda.

Pofuna kupewa matenda

• kunenepa
• zakudya zoyenera
• Kuchotsa zizolowezi zoipa,
• magazi shuga.

Gawo 4. Njira zopewera matenda ashuga:

Njira zopewera	Zochitika
Kuzindikiritsa anthu omwe ali pachiwopsezo.	Choyambitsa matenda ambiri a shuga ndicholemetsa. Mwa abambo, gawo lachiuno limaposa 94 cm, ndipo mwa akazi - opitilira 80 masentimita, ndi nthawi yolira mawu. Anthu oterowo akuyenera kuwunikidwa ndi kuwunikidwa mosamala.
Kuyesa kwa ngozi.	Pamene maulendo oyamba osokoneza matendawa akuwonekera, ndikofunikira kuyesa magazi a shuga. Amachitidwa pamimba yopanda kanthu. Kuphatikiza pa kuyesedwa ndi endocrinologist, komanso akatswiri ena, ndikofunikira kuti adziwe matenda amtundu wa concomitant. Mwachitsanzo, kupezeka kwa zovuta m'magulu amtima kumawonjezera chiopsezo cha matenda a shuga.
Kuthetsa zoyipa zoyipa zamagetsi.	Vuto lalikulu lomwe limapangitsa kusintha kwa matenda m'thupi kukhala wonenepa kwambiri. Chifukwa chake, magulu amtundu wa anthu amafunika: Chotsani thupi kwambiri chepetsa kudya kwa mafuta m'thupi, onjezani zolimbitsa thupi (kuyendetsa njinga, kusambira, kuvina, ndi zina zambiri), kuwonda ndi mapiritsi, ngati simungathe kupirira chifukwa cha zakudya.

Pomaliza, tazindikira kuti malinga ndi ntchito yofufuza, akuti kuchepetsa thupi komanso kuchita masewera olimbitsa thupi pafupipafupi kumathandizira:

• kupewa matenda ashuga
• ngati alipo, chepetsani kukula kwa zovuta,
• kupeza zabwino zamatenda.

Pambuyo povomereza kuti mwazindikira kuti mwazindikira kuti mukupezeka ndi vuto, ndikofunikira kuti musinthe moyo wanu, kuyambira zakudya ndikupeza pomaliza mankhwala.

Malangizo oyambira:

• chepetsa mchere wambiri,
• kusiyanitsidwa kwathunthu kwamafuta ndi zakumwa zakumwa zoledzeretsa,
• kudya zakudya zopatsa mphamvu
• kuchuluka kwa mavitamini ndi michere.

Kuwunikira pafupipafupi kuchuluka kwa shuga wamagazi ndi kuyeza kuthamanga kwa magazi kumalepheretsa kuukira kwa hypoglycemia ndi hyperglycemia, komanso chitukuko cha zovuta, zomwe zimatha kukhala zochuluka mu shuga.

Kuwongolera shuga

Kuwunikira pafupipafupi kuchuluka kwa shuga ndi maziko othandizira matenda amtundu uliwonse komanso kupewa mavuto. Ngati wodwala amagwiritsa ntchito mita, amatha kuzindikira kuyambika kwa hypoglycemia kapena kulumpha kwa shuga mu nthawi. Vuto likangowoneka posachedwa, ndizosavuta kupereka thandizo ndikusamalira thanzi la wodwalayo. Kuphatikiza apo, chifukwa cha kuwunika pafupipafupi kwa glycemia, mutha kuyang'anira momwe thupi limayankhira pazakudya zatsopano ndikumvetsetsa ngati ziyenera kuyambitsidwa muzakudya.

Kuti mita iwonetse mfundo zoyenera, ziyenera kuyang'aniridwa nthawi ndi nthawi ndikugwiritsa ntchito njira zothetsera shuga. Zingwe zoyesa sizingagwiritsidwe ntchito tsiku litatha, chifukwa zotsatira zake zitha kupotozedwa.Ndikofunikira kusintha batri yomwe idayikidwa mu chipangizocho, chifukwa zimakhudzanso kutsimikizika kwa mfundo zomwe mwapeza.

Pofuna kukhalabe ndi odwala omwe ali ndi matenda amtundu woyamba 1, ayenera kuwonanso jakisoni wa insulin. Ndi matenda amtunduwu, ndizosatheka kupanga popanda jakisoni, popeza thupi silingathe kutulutsa insulin mulingo woyenera. Palibe zakudya zomwe zingakuthandizeni kuti mukhale ndi thanzi lalitali kwa nthawi yayitali ngati wodwalayo akunyalanyaza jakisoni wa mahomoni kapena kuwapanga mwangozi. Ndikofunikira kuti munthu athe kuwerengera payekha kuchuluka kwa mankhwala omwe amaperekedwa, kutengera zomwe angadye, ndikumvetsetsa kusiyana kwa nthawi yayitali ya insulin.

Mtundu wachiwiri wa matenda ashuga, kapamba amapanga insulin yokwanira (kapena ntchito yake imachepetsedwa pang'ono). Potere, wodwalayo sangafunike jakisoni wa mahomoni, ndipo kuti akhalebe ndi shuga pamlingo wofunikira, ndikokwanira kutsatira zakudya komanso masewera olimbitsa thupi. Koma ngati kukana kwa insulin kwa minofu kumakhala kokwanira kwambiri, ndipo njira zamankhwala sizigwira ntchito mokwanira, molingana ndi malangizo azachipatala ndi ma protocol, wodwalayo amatha kupatsidwa mapiritsi ochepetsa shuga. Ndi endocrinologist wokhayo amene angawasankhe, chifukwa kuyesayesa pakokha kungapangitse kuwonongeka pamlingo wambiri komanso kupitirira kwa matendawa.

Chimachitika ndi chiyani ndi matenda ashuga?

Type 2 shuga mellitus (zakudya ndi mankhwala zimagwirizanitsidwa: popanda kuwona zakudya, kumwa mankhwala sizingagwire ntchito) zimakhudza ntchito ya thupi lonse. Kumayambiriro kwa matendawo, chidwi chamtundu wa insulin chimachepa. Zikondamoyo ndi ziwalo zina zimagwira ntchito mwachizolowezi.

Popanda chithandizo choyenera, kuchuluka kwa shuga m'magazi kumawonjezeka, komwe kumayambitsa "shuga" wama protein a m'magazi. Kusintha kumeneku kumaphwanya kugwira ntchito kwa ziwalo. Thupi limafa ndi njala, zomwe zimathandizanso kuti maboma onse azigwira bwino ntchito.

Kuperewera kwa mphamvu kumayamba kulipidwa ndi kuwonongeka kwa maselo amafuta. Ntchitoyi imayendera limodzi ndi kutulutsidwa kwa poizoni, komwe kumayambitsa thupi lonse ndikusokoneza kugwira ntchito kwa maselo aubongo.

Shuga owonjezera amatsogolera ku kusowa kwamadzi, mavitamini ofunikira ndi mchere amatsukidwa ndi madzi. Mkhalidwe wamatumbowo umakulirakulira, zomwe zimapangitsa kusokonekera mtima. Komanso, chiopsezo chotchingira mitsempha yamagazi chikuchulukira. Zotsatira zake, masomphenya, ntchito ya chiwindi ndi impso imasokonezeka, chifukwa ziwalo izi zimakhala ndimitsempha yamagazi yambiri. Kusokonezeka kwa magazi m'miyendo.

Mimba komanso matenda ashuga

Mimba ikachitika motsutsana ndi mtundu wa matenda a shuga a mtundu woyamba, mkazi angafunikire kusintha mlingo wa insulin. M'mitundu itatu yosiyanasiyana, kufunika kwa timadzi timeneti ndi kosiyana, ndipo ndizotheka kuti nthawi zina mayi woyembekezera atha kukhala ndi jakisoni kwakanthawi. Endocrinologist, yemwe, limodzi ndi obstetrician-gynecologist amayang'ana wodwalayo panthawi yanstation, ayenera kutenga nawo gawo posankha mitundu yatsopano ndi mitundu ya mankhwalawa .. Amayi oyembekezera amenewa amafunikanso kusintha kadyedwe, chifukwa munthawi ya moyo wa mayi, kufunika kwa michere ndi mavitamini kumawonjezeka.

Pali mtundu wamatenda womwe umayamba mwa azimayi panthawi yoyembekezera - ndimawu osokoneza bongo. Pankhaniyi, wodwalayo sanatchulidwe jakisoni wa insulin, ndipo shuga ya magazi imakhala yofanana, chifukwa cha zakudya. Zakudya zonse zokhala ndi shuga komanso zipatso zomwe zimakhala ndi carbohydrate yambiri, shuga, buledi ndi makeke siziperekedwa kuchakudya. Mayi woyembekezera ayenera kudya zakudya zamafuta, zakudya kuchokera ku tirigu ndi masamba.Kudya kwa wodwala yemwe ali ndi vuto la matenda osokoneza bongo kumathandizira kuchepetsa chiopsezo chotenga matenda obwera chifukwa cha kubereka ndi zovuta za kubereka, komanso zimathandizanso kupewa matenda kuti asadwalitse "matenda obadwa nawo" ambiri. Malinga ndi malingaliro a adokotala, monga lamulo, mwana atabadwa, mavuto omwe amapezeka ndi kagayidwe kazakudya amatha, ndipo misempha ya magazi imasintha.

Chitetezo cha matenda a shuga

Matenda a shuga a matenda ashuga ndi vuto lalikulu la matenda osokoneza bongo, omwe amadziwika ndi kusintha kwa pathological mu minyewa yam'munsi. Zizindikiro zoyambirira zimatha kukhala dzanzi ndi kumva kuwawa kwa khungu, kusintha kwa mtundu wake ndi kuchepa pang'ono kwamaso amtopola komanso kumva kupweteka. Pambuyo pake, zilonda zam'mimba zimapangidwa kumapazi, chifukwa cha kuperewera kwa zakudya m'thupi lathu, zomwe zimachiritsa bwino komanso kwa nthawi yayitali. Ngati nthendayo yaphatikizana ndi chilonda chonyowa, chiopsezo chotenga matenda osokoneza bongo chikukula, zomwe zimatha kuduladula phazi ngakhale kufa.

Pofuna kupewa zovuta za matendawa, muyenera:

• gwiritsitsani malamulo a ukhondo panu komanso khalani oyera mapazi anu
• Yang'anani khungu la miyendo kuti muvulaze zazing'ono, abrasions ndi ming'alu,
• kupukusa kwamiyendo kwa tsiku ndi tsiku kuti magazi azisinthasintha komanso magazi azisungika
• mutatha madzi, pukuta khungu ndi thaulo lachilengedwe,
• sankhani nsapato zabwino zovala tsiku lililonse popanda nsapato zazitali,
• nyowetsani khungu pafupipafupi ndi kirimu kapena mafuta odzola kuti asawonongeke.

Pa nthawi yomwe amakambirana a endocrinologist, ndikofunikira kuti adokotala awonetsetse miyendo ya wodwalayo, ndipo ngati ndi kotheka, afotokozere maphunziro a mankhwalawa kuti magazi awonjezeke. Pa polyclinics, monga lamulo, zipinda za matenda osokoneza bongo, komwe wodwalayo amatha kuyeza khungu la miyendo ndikuwonetsetsa momwe alili.

Kupewa mavuto a impso ndi maso

Matenda a diabetes nephropathy ndi vuto linanso lomwe limayambitsa matendawa mosavuta. Chifukwa chakuti kuchuluka kwambiri kwa glucose kumapangitsa magazi kukhala ochulukirapo, zimakhala zovuta kuti impso zizisefa. Wodwala akayamba kudwala matenda oopsa limodzi, mavutowa amachititsa kuti matenda a impso asokonezeke komanso kugwiritsa ntchito zida za "impso".

Kuti muchepetse chiopsezo chotenga nephropathy yayikulu, muyenera:

• Nthawi zonse kuyeza shuga wamagazi ndikusungika pamulingo womwe mukufuna,
• kuchepetsa kuchuluka kwa mchere m'zakudya kuti zisayambitse kutupa ndi mavuto;
• ngati mapuloteni apezeka mkodzo, zakudya zotsika za protein ziyenera kutsatiridwa
• kuwunika chizindikiro cha mafuta kagayidwe ndi kupewa kuchuluka kwamphamvu m'magazi.

Chiwalo china chofunikira chomwe chimadwala matenda a shuga ndi maso. Matenda a shuga a retinopathy (kusintha kwa ma pathological mu retina) angayambitse kuchepa kwakukulu kwa kuwona kwamaso ndi khungu. Popewa, ndikofunikira kukaonana ndi dokotala wamaso pakapita miyezi isanu ndi umodzi ndikuyang'aniridwa. Kuwunikira pafupipafupi kuchuluka kwa shuga m'magazi ndiye njira yothandiza kwambiri yopewa zovuta zam'mbuyo. Ndi chifukwa cha kuchuluka kwambiri kwa shuga m'magazi kuti kusintha kwamatenda m'magazi ang'onoang'ono kumapita ndikuwonongeka kwamaso. Tsoka ilo, retinopathy ndiyosatheka kupewa, koma chitukuko chake chitha kuyimitsidwa ndikuchepetsedwa.

Matenda a shuga sindiwo matenda omwe matenda a shuga amayamba kukula kuposa kale. Matendawa amasiya chizindikiritso chake m'magawo onse a moyo wa munthu, zomwe zimamupangitsa kuti azikhala ndi chidwi ndi kusankha kwa zakudya komanso kukonza zochitika za tsiku ndi tsiku. Koma kutsatira malingaliro a madotolo ndikumvetsera thanzi lanu, mutha kuphunzira kukhala ndi matenda osaganizira nthawi zonse.Ndi matenda opatsirana bwino a shuga, chiwopsezo cha zovuta ndizochepa, ndipo moyo wa wodwalayo ndiwokwera kwambiri.

Zizindikiro za matenda a shuga a Type 2

Pa gawo loyambirira, matendawa amapitilira popanda chizindikiro chowoneka. Ngati matendawa sanapezeke kapena chithandizo choyenera sichalandilidwa, matenda am'kati amapitiriranso limodzi ndi mawonekedwe:

• kumangokhala kuwuma pamlomo wamkamwa, limodzi ndi ludzu losatha. Chizindikiro ichi chimachitika chifukwa chakuti timadzi tambiri timafunikira kuti tichotse glucose owonjezera m'magazi. Thupi limagwiritsa ntchito izi madzi onse obwera ndi madzi kuchokera minofu,
• mapangidwe a mkodzo wambiri, chifukwa chake, munthu amapita kuchimbudzi,
• thukuta lomwe limachulukirachulukira,
• kuchuluka kwauma kwa khungu ndi mucous nembanemba, limodzi ndi kuyabwa,
• kusowa kwa chinyezi komanso kusowa zakudya m'thupi la mitsempha ya m'maso kumapangitsa kuti pakhale zowonongeka,
• ma microcracks ndi mabala amachiritsa pang'onopang'ono,
• kupindika kwakanthawi kwa minofu kumachitika chifukwa cha kusayenda bwino kwamanjenje.
• kutupa kwa malekezero okhala ndi zowawa ndi dzanzi,
• chifukwa chosowa mphamvu, pali kufooka mwamphamvu, kuchuluka kwa chilimbikitso ndi arrhythmia,
• kuchepa kwamphamvu kwa chitetezo chathupi, pokhudzana ndi izi kumachitika kawirikawiri kuzizira.

Pachigawo choyambirira, pamakhala kuchuluka kwa chilakolako chofuna kudya, kutopa komanso kufunikira kwa madzi pafupipafupi. Kupatula / kutsimikizira matenda a shuga, ndikofunikira kufunsa othandizira / dokotala kuti akayeze magazi a shuga. Kumayambiriro kwa matendawa, chithandizo, ndikokwanira kusintha zakudya.

Kutengera ndi kuwopsa kwa zizindikiro, mawonekedwe amchithandizo ndi zovuta zomwe zimadza chifukwa cha matendawa, shuga agawidwa m'magulu anayi a zovuta.

Miyezo yamatenda	Khalidwe lalikulu	Zosiyanitsa
Zosavuta	Matendawa amapezeka ndi kuwonjezeka pang'ono kwa shuga m'magazi, zomwe zimayambitsa ludzu lochulukirapo, chilimbikitso ndi kufooka kwa minofu. Kusintha kwachisokonezo m'thupi sikumawonedwa. Monga chithandizo, kukonza zakudya mumagwiritsidwa ntchito. Mankhwala amathandizidwa nthawi zina.	Pakadali pano, matenda ashuga amapezeka kawirikawiri, makamaka pama mayeso a akatswiri mukamayezetsa magazi. Kapangidwe ka mkodzo sikusintha. Gawo la glucose lili pamtunda wa 6-7 mmol / L.
Pakatikati	Chizindikiro cha matendawa chimawonjezeka. Pali kuwonongeka pakugwira ntchito kwa ziwalo zamasomphenya, mitsempha yamagazi, magazi osokonekera kufikira miyendo. Kusokera kochuluka m'thupi sikumawonedwa. Chithandizo chili ndi zakudya komanso mankhwala.	Mlingo wa shuga wa mkodzo ndi wabwinobwino, m'magazi ndi 7-10 mmol / L.
Zovuta	Zizindikiro zimatchulidwa. Pali vuto lalikulu pantchito ya ziwalo (kuchepa kwa masomphenyawo, kuthamanga kwa magazi, kupsinjika ndi miyendo). Mankhwalawa, menyu okhwima ndikuwongolera insulin amagwiritsidwa ntchito (mankhwala samapereka zotsatira).	Mimbulu ndi magazi zili ndi shuga wambiri. M'magazi, ndendezo zimasiyanasiyana mosiyanasiyana 11-14 mmol / L.
Kuchulukirachulukira	Kuphwanya ntchito za ziwalo sikungachiritsidwe. Matendawa alibe mankhwalawa; kuwunika shuga nthawi zonse ndikuwonetsetsa kuti jekeseni wa insulin ndi yofunika.	Omukyala ogwabadde mu mulundu guli wakati wa 15-25 mmol / L. Nthawi zambiri munthu amadwala matenda ashuga.

Wopatsa thanzi shuga wambiri wosavuta kuchiza ndikuwongolera shuga. Pa magawo awa, palibe vuto lalikulu m'thupi. Zakudya, kuchepa thupi komanso kumwa mankhwala nthawi zina zimapangitsa kuti zitheke bwino.

Mankhwala ochepetsa shuga

Matenda a 2 a shuga amayambitsidwa ndi zakudya. Ngati chithandizo sichikupereka chiwonetsero, katswiri amakupatsani mankhwala omwe amachepetsa shuga m'magazi. Kumayambiriro kwa chithandizo, mtundu wa mankhwalawa ndi wokhazikika.Kuchita bwino kwa mankhwalawa, kuchuluka kwa mankhwalawa kumakulirakulira.

Mitundu ya mankhwala a hypoglycemic ndi momwe amawonera:

Mtundu wa mankhwala	Cholinga chawo	Dzina lamankhwala
Ma glinides ndi sulfonylureas	Anapatsidwa ntchito yowonjezera kupanga insulin ndi thupi paokha.	Repaglinide, glibenclamide, chlorpropamide.
Biguanides ndi Glitazones	Kuchepetsa kupanga kwa shuga m'chiwindi ndikuwonjezera chidwi cha minofu kuti ikhale shuga. Thandizani kuchepa kwakudya.	Metformin, pioglitazone.
Alpha Glucosidase Inhibitors	Kuchepetsa kuchuluka kwa glucose omwe amapezeka m'matumbo.	Miglitol, insuffor, acarbose.
Glyptins ndi glucagon ngati peptide receptor agonists	Onjezani kupanga insulini ndipo nthawi yomweyo muchepetse ndende ya shuga.	Exenatide, saxagliptin, lixisenatide.
Insulin	Zimalimbikitsa kuyamwa kwa glucose ndi minofu ya thupi.	Insulin
Amachokera ku Thiazolidone	Imalimbikitsa chidwi cha ma cell receptors ku insulin.	Troglitazone, rosiglitazone.

Nthawi zambiri, mankhwalawa 2 kapena 3 amagwirizana. Kugwiritsa ntchito nthawi imodzi kuti mukulitse kupanga kwa insulin, ndimankhwala omwe amachititsa chidwi cha maselo kupita ku hormone, adzakwaniritsa kuchepetsa bwino shuga.

Ndizowopsa kusankha mosamala mankhwala. Kutsika kwakukulu kwa ndende ya shuga kumathandizanso kuti thupi lizigwira ntchito. Ngati mankhwalawa amayambitsa mavuto, amadzichotsa ndi akatswiri. Ndi kusagwira ntchito kwa mankhwalawa, wodwalayo amapatsidwa mankhwala a insulin.

Zakudya za matenda a shuga a 2. Mfundo zaumoyo

Pochiza matenda a shuga, muyenera kutsatira zakudya zomwe zimatengera kuuma kwa matendawa, kupezeka kwa thupi komanso kuchita masewera olimbitsa thupi. Zosankha ziyenera kuvomerezedwa ndi katswiri wopezekapo. Kusintha kwa kuchuluka kwa shuga (kuchuluka kapena kuchepa), wochiritsa amasintha kadyedwe.

Mukamaliza kudya, muyenera kudziwa zinthu zofunika:

• kudya zakudya kuyenera kuchitika nthawi zina pafupifupi 6 pa tsiku,
• chakudya sichiyenera kukhala chopatsa mphamvu komanso kugaya chakudya mosavuta,
• pamaso pa kunenepa kwambiri, ndikofunikira kuchepetsa zopatsa mphamvu zamafuta,
• kuchuluka kwa mchere womwe umatha kuwonongedwa,
• zakumwa zoledzeretsa ndi chakudya
• zipatso zambiri komanso kudya Vitamini kukonzekera kukhalabe chitetezo chathupi.

Zakudya zopatsa thanzi komanso chithandizo cha matenda amtundu wa 2 ndizinthu ziwiri zomwe zimadalirana. Nthawi zina simuyenera kugwiritsa ntchito mankhwala ngati mumasintha zakudya

Ndikofunika kuphika mbale osagwiritsa ntchito mafuta kapena osachepera (mutha kuwira, kuphika). Ndikofunikira kuwonjezera kuchuluka kwa madzi oyera omwe amagwiritsidwa ntchito patsiku. Mukamalemba menyu, ndikofunikira kuganizira za kupezeka kwa mitundu ina ya matenda (matenda am'mimba, mtima, impso).

Katundu Woletsedwa

Type 2 matenda a shuga a shuga

Zinthu Zoletsedwa mwamphamvu	Zamgululi Zoletsedwa Mwamwambo
Zakudya ndi zakudya zomwe zili ndi chakudya chamagetsi.	Mbatata tubers, yophika kokha. Kaloti ndi beets.
Zogulitsa zomwe zimakhala ndi shuga (maswiti, zipatso zouma).	Mbale, kupatula semolina.
Zakudya ndi zopangidwa kuchokera ku ufa wa tirigu	Zopangidwa kuchokera ku ufa wa Wholemeal ndi rye.
Zakudya zokhala ndi mchere wambiri, tsabola, mafuta.	Nthanga ndi mbeu za nyemba.
Zinthu zamkaka zamafuta ambiri.	Mavwende
Minyezi yamafuta ndi mafuta.
Nyama ndi nsomba zokhala ndi mafuta okwanira, okazinga, osuta.
Zonunkhira, soseji, margarine.

Kuchuluka kwa zogwiritsa ntchito zoletsedwa ziyenera kuvomerezedwa ndi akatswiri. Amachulukitsa kuchuluka kwa shuga, koma pang'onopang'ono. Nthawi yomweyo, kudya mitundu iwiri kapena zingapo kuchokera pamndandanda woletsedwa.

Momwe mungayang'anire shuga m'magazi a shuga?

Mu matenda a shuga, kuwunika pafupipafupi kuchuluka kwa shuga ndikofunikira. Glucometer imagwiritsidwa ntchito kuyeza kunyumba. Chofunika ndi muyeso wam'mawa wa tsiku ndi tsiku, musanadye chakudya. Ngati ndi kotheka, ndiyetsaninso masana (mutatha kudya, kulimbitsa thupi kwakukulu).

Zambiri ziyenera kuyikidwa mu kope lapadera, lomwe liyenera kuwonetsedwa kwa akatswiri pakuwunika kotsatira. Mphamvu ya kusintha kwa glucose idzasinthidwa mankhwala (mankhwala, zakudya). Kuphatikiza apo, muyenera kuyang'ananso mu labotale iliyonse miyezi 3-6 (yoyikidwa ndi dokotala).

Mndandanda wazololedwa ndi GI Chizindikiro

Mu shuga, zotsatirazi zimaloledwa kuti zidyedwe mu kuchuluka kulikonse, koma poganizira zomwe zili ndi calorie ndi GI.

Mndandanda Wazogulitsa	GI (glycemic index)
Mazira owiritsa	48
Bowa wophika	15
Nyanja kale	22
Yophika nsomba zazinkhanira	5
Kefir	35
Mkaka wowonda	30
Tchizi tchizi	45
Tofu tchizi	15
Mkaka wamafuta ochepa	30
Broccoli	10
Nkhaka	10
Phwetekere	20
Biringanya	20
Maolivi	15
Zambiri	10
Maapulo	30
Ngale	34
Plum	22
Cherry	22
Rye mkate	45
Katsabola	15
Saladi	10
Pearl barele phala pamadzi	22
Wholemeal pasitala	38
Oatmeal	40
Zakudya zama mkate	45
Marmalade	30

Mndandandawu ukhoza kuwonjezeredwa ndi ochiritsira, poganizira zolimbitsa thupi komanso kuopsa kwa matendawa.

Zithandizo za anthu

Type 2 shuga mellitus (chakudya ndi chithandizo - zofunikira popewa kukula kwa zovuta komanso kupititsa patsogolo matendawa) kungathe kuthandizidwanso ndikuchiritsika kwa anthu wowerengeka. Kugwiritsa ntchito ndikulimbikitsidwa kuti mukambirane ndi dokotala.

Maphikidwe omwe amasanthula kagayidwe kazakudya mu thupi ndipo amathandizira kuchepetsa thupi:

1. Mu 0,4 l yamadzi otentha, kwezani uchi wa 70 ml ndi 40 g wa sinamoni wouma (ufa). Kuumirira tsiku kuzizira. Kumwa amagawidwa 2 servings. Kugwiritsa ntchito m'mawa ndi madzulo. Kutalika kwa mankhwala mpaka masiku 14.
2. Wotentha mu 0,5 l madzi 10-12 ma PC. masamba a Bay. Imwani 30 ml katatu. Maphunzirowa ndi masiku 10. Ndikofunikira kuchita maphunziro atatu ndikupumula kwa masiku 10.
3. M'malo mwa masamba a tiyi, maluwa otentha a linden. Imwani mpaka makapu awiri a tiyi patsiku.
4. Finely kuwaza 350 g wa adyo ndi parsley ndi 100 g a mandimu zest. Muziganiza ndikuumirira mpaka masiku 14 kuzizira. Gwiritsani 10-12 mg patsiku.
5. Wiritsani 20 g nyemba mu madzi okwanira 1 litre (maola 4). Imwani pafupifupi 300 ml patsiku (itha kugawidwa m'magawo). Kutalika kwa mankhwalawa ndi masiku 31.
6. Zakumwa zomwe zakonzedwa m'malo mwa tiyi (imwani 400 ml patsiku) kuchokera:

• Wort wa St. John, chamomile, mabulosi abulu,
• khungubwi
• tsamba la nyemba
• sinamoni yonse.

Pamaso kusalolera kapena sayanjana, zakumwa siziwonjezera zakudya.

Zochita zolimbitsa thupi

Kupezeka kwa zolimbitsa thupi kuyenera kuchitidwa, ngakhale ngati palibe mavuto ndi kunenepa. Kuchita masewera olimbitsa thupi kumathandizanso kuti mtima ukhale wogwira ntchito, mtima, mitsempha yamagazi komanso kupuma, komanso kukhazikika pakanthupi lathunthu.

Pa nthawi yamakalasi, ndikofunikira kuganizira za mtengowo moyenera, popeza kuwonjezeka kwa calorie kumabweretsa msala, ndipo chakudya, pambuyo pakuchita masewera olimbitsa thupi, chitha kumizidwa ndi kutulutsidwa kwa shuga m'magazi.

Masewera olimbikitsidwa a shuga:

• masewera olimbitsa thupi
• amayenda paki kapena kuwala kumayenda,
• kuyendetsa njinga
• kusambira
• yoga
• kuvina modekha.

Ndikulimbikitsidwa kukambirana za mtundu wa ntchito ndi katswiri wopezekapo. Komanso kugwiritsa ntchito nthawi yokwanira kuchita njirayi.

Matenda opatsirana

Ngati matenda adapezeka kumapeto, chithandizo chokwanira kapena wodwalayo sanatsatire malingaliro a katswiri, zovuta zowopsa zingachitike:

1. Kutupa. Edema imatha kukhala osati kokha (mikono, miyendo, nkhope), komanso mkati mwa thupi. Kutengera ndi zomwe zidathandizira kukulitsa chizindikirocho. Kungakhale kukula kwa mtima kapena kulephera kwa impso, kamenekanso kameneka kamavuta kwa matenda ashuga.
2. Kulimba m'miyendo. Chizindikirochi chimakhalapo ndikuwonjezera mphamvu kwa thupi. Ndi chitukuko cha matendawa, ululu umasokonezeka usiku. Kuphatikiza apo, dzanzi lakufika kumapeto komanso kuchepa kwa chidwi kwakanthawi kumawonekera. Mwinanso kumverera koyaka.
3. Maonekedwe a zilonda. Chifukwa cha shuga wambiri, mabala amachiritsa bwino komanso kwa nthawi yayitali, zomwe zimabweretsa kukula kwa zilonda zotseguka. Wochirikiza akutsimikizira kuti ngakhale mabala ang'onoang'ono amathandizidwa mosamala mpaka bala litachira kwathunthu.
4. Kukula kwa mbewa. Ndi matenda ashuga, chikhalidwe cha ngalawa chimasokonekera, zomwe zimatha kubweretsa. Nthawi zambiri, izi zimadziwika pamiyendo. Zotsatira zake pakupanga magazi, magazi atsopano okhala ndi mpweya komanso michere salowa m'chiuno / kumapazi. Minofu imamwalira. Redness kumachitika, limodzi ndi ululu ndi kutupa. Ngati palibe chithandizo, ndiye kuti buluu chitembenukireni. Miyendo yadulidwa.
5. Kuchulukitsa / kutsitsa. Kusintha kwakukulirapo kwa chizowonetsero nthawi zambiri kumachitika chifukwa cha kuwonongeka kwa impso.
6. Coma Vutoli limatha kuchitika kwambiri chifukwa cha kuchuluka kwa glucose kapena kuchepa (chifukwa cha kuchuluka kwa insulin). Kapena chifukwa cha poizoni wakupha wa thupi ndi poizoni, yemwe amapangidwa pakapangidwa mphamvu kuchokera ku maselo amafuta. Potere, wodwalayo amakhala wokutidwa ndi thukuta lozizira komanso lomata, kuyankhula kumakhala kotsika komanso osazindikira. Ndi kuwonjezeka kwa glucose, mawonekedwe onunkhira a acetone amawonekera. Kenako pamakhala kutayika. Popanda thandizo, kufa mwachangu ndi kotheka.
7. Zowonongeka. Chifukwa chosowa zakudya m'thupi la minyewa ya m'maso ndi mitsempha. Poyamba, madontho, chophimba chimatuluka, pang'onopang'ono khungu lathunthu limatha.
8. Matenda a impso. Chifukwa cha kuchuluka kwa zinthuzo, kulephera kwa impso kumayamba.

Pochiza matenda a shuga, kukula kwa zotsatirapo kumatha kupewedwa. Kutsimikiza kwakanthaŵi koyamba kwa zovuta kumathetsa kupitilizabe kwawo.

Maupangiri azachipatala a matenda a shuga a 2

Ngati matenda a shuga atapezeka, kufunsa wodwala ndi kuyesa shuga ndikofunikira. Mukatsimikizira matendawa, muyenera kupimidwa. Chotsatira, muyenera kutsatira nthawi yonse ya katswiri wothandizira (zakudya, kumwa mankhwala, masewera olimbitsa thupi). Onetsetsani kuti mwayang'ana kuchuluka kwa shuga m'magazi. Zinthu zikasintha, dokotala yemwe akupezekapo ayenera kusintha mankhwalawo.

Matenda a shuga angayambike pang'onopang'ono ndikuwonekedwa kale pakatikati. Ndi mtundu 2, maziko a mankhwalawa ndi zakudya. Ndi mawonekedwe apamwamba, mankhwala kapena jakisoni wa insulini ndikofunikira.

Kapangidwe kake: Mila Friedan