Zovuta za shuga > Zizindikiro

Mavuto a shuga

Kusintha kwa masabolism mu mtundu wa shuga wa II

Zizindikiro za matenda amtundu II

Zizindikiro zambiri (ludzu, polyuria, pruritus, amakonda kutenga matenda) ndizofatsa kapena kulibe. Nthawi zambiri kunenepa kwambiri (mu 80-90% ya odwala).

Kuperewera kwa insulin kumayambitsa kusokonekera kwa metabolic ofanana ndi omwe amapezeka ndi kuchepa kwathunthu kwa insulin, komabe, zovuta izi sizitchulidwa, ndipo mtundu II wa shuga nthawi zambiri umakhala wasymptomatic mu 50% ya odwala omwe ali ndi kunenepa kwambiri komanso hyperglycemia.

Mosiyana ndi kuperewera kwathunthu kwa insulini, kuperewera kwa insulin, mphamvu ya insulini imakhalabe pamatumbo a adipose, omwe ali ndi zambiri za insulin receptors. Insulin mu adipose minofu imalimbikitsa lipogenis, imalepheretsa lipolysis ndikutulutsa mafuta achilengedwe m'magazi, chifukwa chake, matenda amtundu wa II, ketoacidosis samayang'aniridwa, kulemera kwa thupi sikuchepa, koma, kunenepa kwambiri kumakula. Chifukwa chake kunenepa kwambiri, kumbali imodzi, ndicho chiopsezo chofunikira kwambiri, ndipo, kwina, kwawonetsero yoyambirira ya matenda amtundu II.

Popeza kuphatikizira kwa insulin nthawi zambiri kumakhala kosavutikira, shuga yayikulu yamagazi imapangitsa kuti insulini isungidwe kuchokera ku β-cell, kuyambitsa hyperinsulinemia. Mkulu insulin ikupangitsa kuti inactivation ndi chiwonongeko cha insulin receptors, zomwe zimachepetsa glucose kulolerana kwa minofu. Insulin sangathenso kutaya matenda a glycemia; insulin kukana. Nthawi yomweyo, kuchuluka kwa glucose m'magazi kumachepetsa mphamvu ya maselo a cells-glucose, chifukwa, gawo loyamba la insulin secretion limachedwa kapena kulibe.

Mtundu wachiwiri wa shuga, hyperinsulinemia (80%), matenda oopsa (50%), hyperlipidemia (50%), atherosulinosis, neuropathy (15%) ndi matenda ashuga a shuga.

Mavuto owopsa ndi enieni amtundu woyamba wa shuga wa mtundu II.

Kutha kwa minyewa ya ubongo mu malo oyamba, komanso kusokonezeka kwa kagayidwe kachakudya mu minyewa yamanjenje, kumatha kutsogolera kukula kwa zovuta pachimake. Coma Uwu ndi mkhalidwe woopsa kwambiri, wodziwika ndi kupsinjika kwakukulu kwa dongosolo lamanjenje lamkati, kulephera kukumbukira, kulephera kwakhudzana ndi zochitika zakunja zamphamvu zilizonse. Coma mu matenda a shuga amatha kupezeka m'mitundu itatu: ketoacidotic, hyperosmolar ndi lactic acidosis.

Ketoacidotic chikomokere amapezeka ndi matenda a shuga a mtundu I, pamene kuchuluka kwa matupi a ketone kukwera kwambiri kuposa 100 mg / dl (mpaka 400-500 mg / dl).

Hyperketonemia imatsogolera ku:

1) acidosis, yomwe imalepheretsa ntchito za michere yambiri, makamaka kupuma, komwe kumayambitsa hypoxia ndi kuchepa kwa kaphatikizidwe ka ATP.

2) hyperosmolarity, yomwe imabweretsa kuchepa kwa minofu ndikusokoneza madzi osankhidwa ndi electrolyte, ndikutayika kwa potaziyamu, sodium, phosphorous, magnesium, calcium, bicarbonate ion.

Izi, mwakuya kwina, zimayambitsa kukomoka ndi kutsika kwa magazi komanso kukula kwa aimpso kulephera.

Hypokalemia yomwe imayambitsa imabweretsa kuchepa kwa minofu yosalala ndi yolimba, kuchepa kwa mtima, kutsika kwa magazi, mtima arrhythmia, kupuma kwa minofu ndikumayambika kwa kupuma kwapadera, kupweteka kwa m'mimba ndi matumbo a m'mimba komanso kutsekeka kwamatumbo, hypoxia yayikulu imayamba. Pazomwe zimapangitsa kuti anthu azifa, zimakhala mwa 2-4%.

Hyperosmolar chikomokere yokhala ndi matenda amtundu wa II matenda a shuga, imawonedwa ndi hyperglycemia yapamwamba. Ambiri amakhala ndi hyperglycemia yayikulu chifukwa cha kufooka kwa impso, amakwiya chifukwa cha kupsinjika, kupsinjika, kuchepa thupi m'thupi (kusanza, kutsegula m'mimba, kuwotcha, kuchepa kwa magazi, ndi zina zambiri). Hyperosmolar coma imayamba pang'onopang'ono, kwa masiku angapo, popanda thandizo la anthu (osalipiridwa ndi kumwa), pamene glucose okhathamira afika 30-50 mmol / l.

Hyperglycemia imalimbikitsa polyuria, imapanga Hyperosmotic mkhalidwezomwe zimayambitsa kusowa kwamadzi minofu, zomwe zimayambitsa kusokonezeka kwa mphamvu yamagetsi yamagetsi.

Kutha kwamphamvu kwa thupi ndikusanza, kutsekula m'mimba, kuchepa kwa magazi chifukwa cha kuperewera kwa thupi ndi kusowa kwa chakumwa kumabweretsa hypovolemia. Hypovolemia amachititsa kuchepa kwa kuthamanga kwa magazi, makulidwe amwazi, kuwonjezeka kwa mamasukidwe ake ndi kuthekera kwa thrombosis. Kuwonongeka kwa hememnamic kumabweretsa ischemia minofu, kukula kwa hypoxia, kudzikundikira kwa lactate ndi kuperewera kwa mphamvu. Ral ischemia imabweretsa kukula kwa pachimake impso kulephera - anuria. Anuria imabweretsa kudzikundikira kwa nayitrogeni otsalira m'magazi (ammonia, urea, amino acid); Hyperazotemia. Hypovolemia kudzera aldosterone imachepetsa kwamikodzo ya NaCl, yomwe imayambitsa hypernatremia ndi hyperchloremia. Hyperazotemia, hypernatremia ndi hyperchloremia zimathandizira boma la hyperosmotic komanso kuphwanya koyenera kwamadzi-electrolyte.

Kuperewera kwa mphamvu ndi kusokonezeka kwa mphamvu yamagetsi yamagetsi kumalepheretsa kupangika kwa membrane wa membrane ndi machitidwe a mitsempha m'chigawo chapakati chamanjenje, komwe kumabweretsa kukula kwa chikomokere. Imfa mu hyperglycemic coma ndi 50%.

Lactic acidotic chikomokere Khalidwe lachiwiri la matenda ashuga a II, amachitika ndi kudzikundikira kwa lactate. Pamaso pa lactic acid, mphamvu za adrenoreceptors kuti makatekolamines achepetse, ndikuwadzidzimuka mosagwedezeka. Metabolic coagulopathy imawonekera, yowonetsedwa ndi DIC, zotumphukira za thrombosis, thromboembolism (myocardial infarction, stroke).

Acidosis yokhala ndi matupi owonjezera a ketone ndi lactate imapangitsa kuti HH isasunthire oksijeni ku minofu (hypoxia), imalepheretsa zochitika za ma enzymes ambiri, makamaka, kaphatikizidwe wa ATP, kayendedwe kogwira ntchito ndikupanga ma membrane gradients amachepetsa, omwe amalepheretsa kuyambitsidwa kwa mitsempha mumitsempha yamanjenje ndikumayambitsa kukomoka.

Sanapeze zomwe mukuyang'ana? Gwiritsani ntchito kusaka:

Limagwirira kukula kwa ketoacidosis

Matenda ashuga ketoacidosis ndi mtundu woipa kwambiri wamatenda a metabolic omwe umatha kukhala mtundu wa 1 shuga. Osowa kwambiri, matenda oterewa a shuga amapezeka mtundu 2 wa shuga.

Chomwe chikuchitika ndi izi ndi kupezeka kwa matenda a shuga 1 osadziwika bwino, momwe mulibe insulini m'thupi.

Vutoli limathanso kuchitika ngati njira yoikidwiratu yothetsera matenda a 1 siyowonedwa. Nthawi zambiri izi zimachitika pogwiritsa ntchito insulin yomwe idasungidwa molakwika kapena ndi moyo wa shelufu yomwe yatha, kusalongosoka kolondola kwa insulin, makamaka, chifukwa chakuwonongeka kwa kayendetsedwe kake, komanso kuphwanya mlingo.

The pathophysiology ya ketoacidosis imakhudza magawo angapo. Popanda insulini, kuchuluka kwa shuga m'magazi kumakwera kwambiri, ndipo zochulukirapo zimayamba kutulutsidwa ndi impso limodzi ndi madzi ambiri. Wodwala amakhala ndi vuto losowa madzi m'thupi, nthawi zambiri amapita kuchimbudzi ndikumwa madzi ambiri. Khungu ndi mucous zimafalikira ndipo zimayamba kuchepa. Shuga sangathe kulowa ziwalo zathupi, chifukwa chake malo ogulitsira amkati amagwiritsidwa ntchito ngati chida chopangira mphamvu. Potere, wodwalayo amachepetsa thupi.

Pakusweka kwamafuta, matupi a ketone ndi mafuta achilengedwe aulere amamasulidwa zochuluka. Amadziunjikira m'magazi a wodwala zochuluka. Pankhaniyi, pH yamagazi imasokonekera, ndipo acidity yowonjezereka imayamba kukhumudwitsa malo opumira. Chizindikiro cha izi ndi kupuma movutikira kapena kupuma kwamkokomo. Kuphatikiza apo, fungo la acetone limawonekera kuchokera kwa wodwala.

Matenda a matenda ashuga amakula masiku angapo, nthawi zina maola. Zizindikiro zikayamba, wodwalayo amasiya kulumikizana ndi ena, nthawi zambiri amagona. Amawafunikira kuti athe kupereka chithandizo chodzidzimutsa mwanjira ina kusiya kukomoka komanso kupuma.

Kuthandiza ketoacidosis kumayambira pakukhazikitsa insulin kudzera mu yaying'ono Mlingo wambiri.

Kuphatikiza apo, wodwalayo amapatsidwa mankhwala omwe amathandiza kuthana ndi kuchepa kwa madzi m'thupi komanso kubwezeretsa mchere wambiri m'magazi, komanso mankhwala ena, kutengera mtundu wa wodwalayo.

Limagwirira a chitukuko cha hyperosmolar chikomokere ndi zizindikiro zake

Hyperosmolar coma ndi matenda ovuta a metabolic a 2. Nthawi zambiri, matendawa amatha kuchitika m'mitundu ina ya matenda ashuga.

Nthawi zambiri, matenda amapezeka mwa anthu okalamba omwe ali ndi vuto la mtima. Pathophysiology ya coma yotere imadziwika ndi kuwonjezeka kwa shuga mumagazi owopsa. Komabe, pH yamagazi sasintha. Ndi mtundu wamtunduwu, kumatha mphamvu kwambiri yomanga thupi. Kwa masiku angapo, pakukonzekera kwadzidzidzi kotere, wodwala amatha kutaya pafupifupi 10% ya kulemera kwake.

Hyperosmolar chikomachi chitha kupezeka nthawi ngati izi:

Kusanza wobwereza, kutsegula m'mimba.
Kugwiritsira ntchito okodzetsa.
Kuletsa madzi akumwa.
Kupuma.
Kuwotcha ndi kuvulala.
Matenda opatsirana.
Zolakwika mu zakudya.
Njira zopangira opaleshoni

Zizindikiro za kukomoka kwa Hyperosmolar zimatha kuchitika ngakhale mu wodwala yemwe ali ndi matenda a shuga 2 ochepa, momwe mokwanira kutsatira zakudya ndikumwa mapiritsi. Okalamba, matenda amatha kuyambitsa zovuta mu chakudya cha metabolism, chomwe pambuyo pake chimayambitsa zovuta za matenda ashuga.

Wodwala yemwe ali ndi vuto la kuchepa kwa magazi ayenera kupatsidwa chithandizo chamankhwala kuchipatala. Mankhwalawa cholinga chake ndikobwezeretsanso madzi mthupi mothandizidwa ndi kulowetsedwa mkati. Kuphatikiza apo, insulin imayendetsedwa kudzera m'magawo ochepa ola lililonse.

Limagwirira kukula kwa lactate acidosis

Lactic acidosis ndi vuto lalikulu lomwe limachitika chifukwa cha kuchuluka kwambiri kwa thupi lactic acid, yomwe ndi pathophysiology yake. Kukula kwa mkhalidwewu ndikudziwika kwa anthu okalamba omwe ali ndi matenda ashuga m'matenda amtima, chiwindi, impso, mapapu, komanso zidakwa. Mlingo wa lactic acid umatuluka ndi mpweya wokwanira wamtundu wa oxygen.

Zizindikiro za lactic acidosis zimaphatikizapo: kupweteka pachifuwa komanso kumbuyo kwa kufinya, kufooka, kupweteka kwa minofu, kufupika kwa kupumula ngakhale kupuma, kupweteka m'mimba, kusokonekera kwa mphamvu yogwira ntchito. Chizindikiro cha lactic acidosis ndi mawonekedwe a mseru komanso kusanza. Lactic acid imakhumudwitsa malo opumira, chifukwa chake wodwalayo amapuma mozama komanso phokoso.

Chithandizocho chimachokera pakubweretsa mayankho a alkali, komanso zamadzimadzi ndi zina zomwe zimapangitsa magazi kuchepa. Nthawi zina pamakhala kufunika kuyeretsa magazi a wodwalayo pogwiritsa ntchito zida zochitira impso.

Limagwirira a hypoglycemia

Hypoglycemic coma imachitika ngati magazi achepetsa kwambiri. Ndiofala kwambiri pakati pamagulu amwadzidzidzi kwa anthu odwala matenda ashuga. Vutoli limapezeka kwambiri kwa odwala omwe amadalira insulin omwe ali ndi mtundu wina uliwonse wa matenda ashuga.

Makina a chitukuko cha hypoglycemia ndi kusowa kwa mphamvu mu minyewa ya chotupa cham'mimba ndikutulutsa kwapanthawi yomweyo kwa mahomoni opsinjika kulowa m'magazi ambiri. Zizindikiro za hypoglycemia ndi:

chizungulire
mutu
kuchuluka kwa lilime ndi milomo.
chikhalidwe cha nkhawa
mawonekedwe a nkhawa ndi mantha,
chidwi
kusokonekera kwa mawu
tachycardia
kukokana
zam'mimba thirakiti
kunjenjemera m'thupi ndi miyendo
njala
kuchepa kwamawonedwe ndi ena.

Zizindikiro zoyambirira za hypoglycemia zikachitika, wodwalayo ayenera kudya china chake chokoma. Njira yabwino ikhoza kukhala msuzi wa zipatso kapena tiyi wokoma. Wodwalayo akapanda kuchitapo kanthu, amatha kusokonezeka kenako kugona.

Potere, thandizo limakhala pakukhazikika kwa njira yothetsera shuga kapena jakisoni wamkati ndi yankho la glucagon. Mu hypoglycemia yayikulu, kuchipatala kwa wodwala kuchipatala kumafunika kuti amupime ndi kumuthandiza.

Ngati thandizo la panthawi yake limaperekedwa kwa wodwala, ndizotheka kuyimitsa kayendedwe ka vuto lalikulu ngakhale zizindikilo zoyamba zitawoneka. Kupanda kutero, kudaliraku sikungakhale koyenera - kuvutikaku kungayambitse imfa ya wodwalayo. Ndi chifuwa cha matenda ashuga, kufa ndi pafupifupi 10% ya milandu yonse yachitukuko chotere.

3. Omaliza mavuto a shuga

Choyambitsa chachikulu cha zovuta za matenda ashuga ndi hyperglycemia. Hyperglycemia imabweretsa kuwonongeka kwamitsempha yamagazi

Mkuyu. 11-31. Kusintha kwa kagayidwe ka shuga ndi zomwe zimayambitsa matenda a shuga.

komanso kukanika kwa zimakhala zosiyanasiyana ndi ziwalo.

Chimodzi mwazinthu zazikulu zakuwonongeka kwa minyewa mu shugaprotein glycosylation, zomwe zimatsogolera pakusintha kwanyumba ndi ntchito zawo. Mapuloteni ena nthawi zambiri amakhala ndi chakudya chamagulu am'mimba, ndipo mapangidwe a glycoprotein amenewa amapita modabwitsa (mwachitsanzo, mapangidwe a mahomoni a glycoprotein a adenohypophysis). Komabe, kulumikizana kwa glucose kopanda enzymatic ndi magulu a amino aulere - mapuloteni osapanga enzymatic a mapuloteni - amatha kupezeka m'thupi la munthu. M'matenda a anthu athanzi, izi zimachitika pang'onopang'ono. Ndi hyperglycemia, njira ya glycosylation imathandizira. Mlingo wa glycosylation wa mapuloteni umatengera kuthamanga kwawo. Mapuloteni osintha pang'onopang'ono amasonkhanitsa masinthidwe ena. Chimodzi mwazizindikiro zoyambirira za matenda a shuga ndi kuchuluka kwamphamvu kwa ma glycosylated hemoglobin._bA_1C5.8-7.2%). Chitsanzo china cha mapuloteni osinthika pang'onopang'ono ndi ma crystallins - mapuloteni a mandala. Pakakhala glycosylation, ma crystallins amapanga mphamvu zambiri zowonjezera zomwe zimawonjezera mphamvu yowonjezera ya mandimu. Kuonekera kwa mandala kumachepa, kusefukira kumachitika, kapena mphira.

Mapuloteni osinthika pang'onopang'ono amaphatikizapo mapuloteni a matellase a interellular, membranes apansi. Kunenepa kwa zigawo zapansi panthaka, imodzi mwazomwe zimachitika ndi matenda ashuga, kumabweretsa chitukuko cha matenda a shuga.

Zomwe zimayambitsa zovuta zambiri zam'mbuyomu kukulitsa kusintha kwa glucose kukhala sorbitol (onani gawo 7).

Zomwe zimachitika pakusintha kwa glucose kukhala mowa wa hexatomic (sorbitol) amathandizidwa ndi encyme aldose reductase. Sorbitol sigwiritsidwa ntchito m'njira zina za metabolic, ndipo kuchuluka kwake kosakanikirana ndi maselo kumayenda pang'onopang'ono. Odwala omwe ali ndi matenda osokoneza bongo a shuga, sorbitol imasonkhana mu retina ndi mandala a maso, maselo a glomeruli a impso, maselo a Schwann, mu endothelium.

Sorbitol yozama kwambiri imakhala poizoni m'maselo. Kudzikundikira kwake mu neurons kumabweretsa kuwonjezeka kwa kuthamanga kwa osmotic, kutupa kwa khungu ndi minofu edema. Mwachitsanzo, kupangika kwa mandala kumatha kuchitika chifukwa cha kutupira kwa lens komwe kumachitika chifukwa cha kudzikundikira kwa sorbitol komanso kusokonekera kwa kapangidwe ka kristalo.

A shuga angiopathies. Matenda a shuga angiopathies amayambitsidwa makamaka ndi kuwonongeka kwa ziwalo zapansi pamimba. Pa kuchuluka kwa shuga m'magazi am'magazi, proteinoglycans, collagens, glycoproteins glycosylate, kusinthana ndi kuchuluka pakati pazigawo zamkati zapansi zimasokonekera, gulu lawo limasokonezeka.

Macroangiopathy kuwonetsedwa zotupa za mtima ndi sing'anga wamtima, ubongo, m'munsi. Kusintha kwa masinthidwe am'kati mwa mitsempha ndi kuwonongeka kwa khoma lakunja pakati ndi zigawo zakunja ndizotsatira za glycosylation zam'magawo apansi ndi mapuloteni a matumbidwe a interellular (collagen ndi elastin), omwe amachititsa kuchepa kwa kutanuka kwamitsempha. Kuphatikiza ndi hyperlipidemia, izi zimatha kukhala chifukwa cha chitukuko cha atherosulinosis. Ndi matenda a shuga, atherosclerosis ndiofala kwambiri, amakula atangoyamba kumene ndipo amakula msanga kwambiri kuposa kusowa kwa matenda ashuga.

Microangiopathy - zotsatira za kuwonongeka kwa capillaries ndi zombo zazing'ono. Kuwonetsedwa mu mawonekedwe a nephro-, neuro- ndi retinopathy.

Nephropathy Pafupifupi pafupifupi gawo limodzi mwa magawo atatu a odwala matenda ashuga. Kusintha kwa ma elekitrononi ma microscopic m'chipinda chapansi pa impso glomeruli kumatha kupezeka kale mchaka choyamba atazindikira kuti ali ndi matenda. Komabe, mwa odwala ambiri, zizindikiro za matenda a matenda ashuga nephropathy zimawonekera pambuyo pazaka 10-15 za matenda ashuga. Chizindikiro cha magawo oyambirira a nephropathy ndi microalbuminuria (mkati 30-3000 mg / tsiku), yomwe imayamba kukhala ndi nephrotic syndrome, yodziwika ndi proteinuria yayikulu, hypoalbuminemia ndi edema.

Retinopathy vuto lalikulu kwambiri la matenda ashuga komanso chifukwa chachikulu cha khungu, limapezeka mu 60-80% ya odwala matenda ashuga

matenda ashuga. Poyambirira, basal retinopathy imayamba, yomwe imadziwikika m'matumbo am'mimba, vasodilation ya retina, edema. Ngati zosinthazi sizikhudza macula, kusowa kwamaso sikumachitika kamodzi. M'tsogolomu, prinetos retinopathy yowonjezereka ikhoza kukhala, yowonetsedwa mu neoplasms ya retina ndi ziwiya za vitreous. Kuchepa mphamvu ndi kukhathamira kwamphamvu kwa ziwiya zatsopano zomwe zimapangidwa kumazindikira kutuluka kwa magazi pafupipafupi mu thupi la retina kapena thupi lamphamvu. Patsamba lamagazi, mafupa amayamba, zomwe zimapangitsa kuti pakhale zovuta kuziona komanso kuziona.

B. Kuzindikira matenda ashuga

Nthawi zambiri, kuwunika kwa matenda ashuga kumatha kupangidwa pamaziko azizindikiro zakale za matenda ashuga - hyperglycemia, polyuria, polydipsia, polyphagia, kumverera kwa pakamwa pouma. Zizindikiro zofunikira kwambiri za IDDM zimapezeka pamaziko a:

kuyeserera kwa glucose (onani mkuyu. 11-30). Minyewa ya m'magazi a plasma pamtunda wa 10 mmol / l 2 patatha shuga

Kutsimikiza kwa glycosylated hemoglobin. Ndi matenda a shuga, mulingo wa H_bA_1s, yomwe imakonda kuwerengera pafupifupi 5% yazolemba zonse za hemoglobin, zimachulukitsa katatu,

kusowa kapena kuchepa kwa insulin ndi C-peptide m'magazi ndi mkodzo. Nthawi zambiri, insulini ndi C-peptide zimasungidwa muzoyimira za equimolar. Popeza pafupifupi 2/3 ya insulin imasungidwa ndi chiwindi, chiŵerengero cha insulin / C-peptide mu portal vein ndi zotumphukira zotumphukira nthawi zambiri zimakhala 1/3. Kufunika kwa mulingo wa C-peptide mu seramu kapena mkodzo kumakupatsani mwayi wowunika momwe magwiridwe antchito a cells-cell,

albinuria. Ndi matenda a shuga, kutuluka kwa tsiku lililonse kwa albin pafupifupi 30-300 mg - microalbuminuria (kawirikawiri pafupifupi 8 mg).

Chifukwa NIDDM imakula pang'onopang'ono, zizindikiro zamatenda zam'mimba, hyperglycemia, ndi kuchepa kwa insulin zimadziwika pambuyo pake, nthawi zambiri zimaphatikizidwa ndi zizindikiro za zovuta za matenda ashuga.

D. Kuyandikira kuthandizira odwala matenda ashuga

Chithandizo cha matenda a shuga chimatengera mtundu wake (I kapena II), ndizovuta komanso zimaphatikizapo chakudya, kugwiritsa ntchito mankhwala ochepetsa shuga, mankhwala a insulin, komanso kupewa komanso kuchiza matenda.

Mankhwala ochepetsa shuga masiku ano amagawika m'magulu awiri: zotumphukira za sulphonylurea ndi biguanides. Kukonzekera komwe zochita zawo zimayambitsa kukondoweza insulin katulutsidwe ndikuphatikiza sulfonylureas (mwachitsanzo, mannyl). Makina a zochita za sulfonylureas akufotokozedwa ndi kukopa kwawo pa magwiridwe antchito a ATP-K K. Kuwonjezeka kwa ndende ya K + kumapangitsa kuti ma membrane achuluke ndikuthamangitsa kayendedwe ka calcium mu cell, chifukwa chomwe insulin yotulutsa imakhudzidwa.

Biguanides ndi gulu lina lalikulu la mankhwala ochepetsa shuga. Malinga ndi kafukufuku wina, Biguanides amawonjezera kuchuluka kwa anyani amtundu wa GLUT-4 pamtundu wa adipose minofu ndi minyewa yam'mimba.

Njira zolimbikitsa za matenda ashuga zimaphatikizapo zotsatirazi: kufalikira kwa ma pancreatic ist kapena β-cell, kupatsirana kwa ma cell omwe amapangidwanso, komanso kukondweretsa kwa pancreatic islet regeneration.

Ndi mitundu yonse iwiri ya matenda a shuga, chithandizo cha mankhwala ndizofunikira kwambiri. Amalimbikitsa kudya zakudya zopatsa thanzi: chakudya chamagulu azikhala ndi 50-60% ya zakudya zonse zopatsa mphamvu (kusiyanasiyana kuyenera kukhala chakudya cham'mimba, mowa, mowa, madzi, makeke, ndi zina zambiri), mapuloteni - 15-20%, mafuta onse - osaposa 25-30%. Chakudya chimayenera kudyedwa nthawi 5-6 patsiku.

Pathogenesis

Hypoglycemic coma imayamba mwa odwala matenda a shuga, nthawi zambiri, pamene mankhwala a insulin kapena sulfonylurea akukonzekera komanso zakudya zomwe zikubwera, makamaka chakudya, sizigwirizana. Mu shuga mellitus, kukomoka kwa hypoglycemic kumakula nthawi zambiri kuposa ketoacidotic.

Mwachizolowezi, hypoglycemia ndi hypoglycemic coma zimachitika mwa odwala omwe ali ndi vuto lalikulu la matenda a shuga a insulin, momwe sizingatheke kukhazikitsa chomwe chimapangitsa kuti insulin iwonjezeke mwadzidzidzi. Nthawi zina, mphindi zopsetsa mtima zimakhala nthawi yayitali pakati pa chakudya, kuchuluka kwa masewera olimbitsa thupi, kusanza, kutsekula m'mimba komanso zina. Matenda obwera chifukwa cha matenda a shuga a chiwindi, matumbo, mawonekedwe a endocrine, kukula kwa kulephera kwaimpso kungayambitse kwambiri hypoglycemia. Nthawi zambiri vuto la hypoglycemic limayamba ndi insulin yokwanira, yomwe imatha kuchitika zotsatirazi:

Mulingo wolakwika (kuchuluka kwa insulini kukonzekera, mwachitsanzo, ndi ma syringes a U40 m'malo mwa U100, ndiye kuti, kuchuluka kwa nthawi ya 2,5, kapena mlingo wosankhidwa wa insulini).
cholakwika pakukhazikitsa kwa mankhwalawa (osati pansi pa khungu, koma intramuscularly) - singano yayitali, kapena jekeseni wamitsempha kuti athandizire komanso kuwonjezera mphamvu ya mahomoni.
kulephera kudya zakudya zamafuta atatha kuperekera muyeso wa insulin yochepa ("amaiwala kudya" - chakudya chachiwiri cham'mawa, chakudya chamadzulo kapena chakudya chachiwiri pachikondwerero cha kukonzekera kwa insulin yayifupi),
"Zosakonzekera" zolimbitsa thupi chifukwa chosowa michere yambiri: jekeseni wa mankhwala a insulin "" anaiwala "kudya (sanadye zowonjezera zopatsa mphamvu kuti azichita masewera olimbitsa thupi) → kuyenda mwachangu, kusewera mpira, kusambira, kuyamwa ndi zina zotero → kuyendetsa njinga → hypoglycemia → chikomokere
kukonza malo a jakisoni wa insulini (mwadala - kuti muthandizire kuchitapo kanthu kwakanthawi kokonzekera insulin kapena mwangozi - kwinaku akulowetsa insulin mu ntchafu pamene akukwera njinga),
Kutulutsidwa kwa mahomoni ambiri othandizira pakhungu la insulin-antibody,
kumwa mowa
pamaso pa mafuta a chiwindi,
motsutsana ndi maziko a kulephera kwa impso,
m'mimba
zochita zodzipha
insulin imagwedezeka m'machitidwe azamisala ndi zina.

Mu anthu omwe ali ndi matenda a shuga, chikomokere cha hypoglycemic chimatha kukhala chifukwa cha kuchuluka kwa insulin, makamaka pamene wodwala amachotsedwa ku boma la ketoacidosis.

Kukula kwa vuto la hypoglycemic ndikutheka motsutsana ndi zakumwa zoledzeretsa, zomwe zimachepetsa shuga zomwe sizimayang'aniridwa, chifukwa chokhacho cha zakumwa zomanga thupi pakukonzekera chakudyacho. Mowa umalepheretsa kuphatikiza kwa glucose osagwiritsidwa ntchito popanga chiwindi, zomwe zimapangitsa kuchuluka kwa hypoglycemia mwa odwala omwe ali ndi insulin. Mowa wambiri ukamamwetsedwa, imalepheretsanso kulephera kwa gluconeogenesis, kotero hypoglycemia imatha kuchitika ngakhale patatha maola ochepa mutamwa.

A ochepa magazi glucose amalembedwa ngati:

glucose amachotsedwa m'magazi mofulumira kwambiri kuposa odziwidwa m'matumbo kapena ophatikizidwa ndi chiwindi,
kuchepa kwa glycogen komanso / kapena kaphatikizidwe ka glucose kuchokera ku zinthu zosagwiritsidwa ntchito m'thupi mu chiwindi sikungatheke kulipira kufalikira kwa shuga,
Zomwe zili pamwambazi zimaphatikizidwa.

Nthawi zambiri, kuyambika kwa chiphuphu cha shuga kumapangitsa chidwi cha zotumphukira ku insulin, chomwe chimafuna kuchepetsedwa kwa nthawi yake muyezo wa mahomoni omwe amaperekedwa kuchokera kunja.

Mankhwala a Sulfanilamide samayambitsa matenda a hypoglycemic, makamaka amatha kupezeka ndi odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda a impso, chiwindi kapena kulephera kwa mtima, komanso kufa ndi njala. Kugwiritsira ntchito mankhwala ena osakanikirana ndi sulfonamides kumatha kuyambitsa kupuma. Mwachitsanzo, acetylsalicylic acid ndi ma salicylates ena, amachepetsa kumangiriza kwa sulfonamides ku mapuloteni amadzi am'magazi ndikuchepetsa kutulutsa kwawo mkodzo, zimapangitsa kuti pakhale vuto la hypoglycemic.