Umlando wesikhwama: uhlobo lwesifo sikashukela sesi-2, uhlobo lwe-decompensation, incompensation, inkambo enzima, i-insulin-incike, i-insulin-incike, i-polyneuropathy yesifo sikashukela. Isibikezelo

Mhlawumbe, abantu abaningi abajabuli ngomlando wabo wezokwelapha. Isifo sikashukela se-2, esiboniswe kuyo, singabangela ukudangala okukhulu nakakhulu. Kodwa ingabe kufanelekile ukuyeka nokuphelelwa ithemba? Yeka ukuthi kuyingozi kangakanani lesi sifo, nokuthi singabhekana kanjani nayo - sizoqonda.

Isifo sikashukela - siyini ingozi?

Abantu bavame ukuzwa ngesifo sikashukela, kodwa bambalwa kuphela abazi ukuthi kuyini. Kumele kuqashelwe ukuthi umqondo "wesifo sikashukela" uyisithombe esihlangene. Ngaphansi kwalesi sikhathi, izifo eziningana zesistimu ye-endocrine zizohlangana. Izizathu zokwenzeka kwazo ziningi kakhulu, kepha, njengokungathi umthetho, izifo ze-endocrine, futhi ikakhulukazi ukungabi nalutho kwe-insulin, zisenhliziyweni yesifo. Esinye isici singase singakwazi ukugaya i-glucose ngesibindi kanye nezicubu zomzimba. Ngesikhathi esifanayo emzimbeni izinga layo likhuphuka, okuyinto, futhi, yimbangela yezinkinga eziningi emetabolism.

Isifo sikashukela - izinhlobo zayo

Imithi yesimanje ihlukanisa izinhlobo ezimbili zalesi sifo. Ukukhishwa kwesikhumba kwenzeka ngokuya kokungasebenzi kahle kwe-insulin - isihlobo noma okuphelele - kuchaza umlando wezokwelapha. I-diabetes mellitus type 2, njengomthetho, ayihlotshaniswa nokuntuleka kwe-insulin, ukuthuthukiswa kwayo okubandakanyeka kuma-pancreas. Ngokuvamile, imbangela yentuthuko yayo iyancipha ekuzweleni kwezitho kanye nezicubu kule hormone. Isifo sikashukela esisekelwe ku-insulin - uhlobo lokuqala - luhlobene ngqo nokuntuleka kwe-insulin emzimbeni. Ukuntuleka kwaleli hormone kuholela eqinisweni lokuthi i-glucose, engena emzimbeni, ayicubunguliwe, noma kwenzeka ngokwanele, kanti izinga layo legazi likhula njalo, futhi ukuze kulondolozwe impilo, iziguli ezinjalo ziphoqelelwa ukuba zithole amanani engeziwe e-insulin.

Umlando wekhasi - uhlobo lwesifo sikashukela sesi-2

Lesi sikashukela sibizwa nangokuthi i-insulin-emele. Ngokusho kwedatha, iziguli eziphethwe yilolu hlobo lwesifo zibaningi kakhulu kunezokuqala. Njengoba uneminyaka yobudala, ingozi yokuthi lesi sifo sizozibonakalisa ngokunyuka kakhulu. Ngokuvamile ukuthuthukiswa kwayo kwenzeka kungabonakali, futhi isiguli isikhathi eside asazi ngalezi zinkinga, idatha evumela ukuba asolise ayibonisi umlando wesifo. Uhlobo lwesifo sikashukela soluhlobo 2 kulokhu luyatholakala njengendlela "yokuthola okungahleliwe" ngesikhathi sokuhlolwa okuvamile. Isikhombisi esikhulu, esikuvumela ukuba usolise ukuba khona kwalesi sifo, kuyinto yokuhlolwa kwegazi lapho i-glucose yanda khona. Kanti lapho umlando wezokwelapha wenziwa, thayipha u-2 wesifo sikashukela uhlukaniswe ngokuthi:

• Ukuvela ezigulini ezinesisindo esivamile;
• Kwembulwe iziguli ezinokukhuluphala.

Izimbangela zesifo sikashukela

Ngisho nasenkonzweni yokuqeqesha odokotela abasha benza umlando wezokwelapha wesifo, thayipha uhlobo lwesifo sikashukela esingama-2 esingabangelwa izizathu eziningana. Okuvamile kulezi:

• Ukusetshenziswa kwe-carbohydrate ehlanjulisiwe (ushukela, ushokoledi, ama-buns, amazambane) ngobuningi obukhulu kanye nokuntuleka kwemifino yezitshalo ekudleni;
• I-Heredity - lapho abazali behlala khona, ingozi yesifo sikashukela ikhulu kunama-40%;
• Ukukhuluphala, ikakhulukazi uhlobo lwe-visceral (ama-fat deposits atholakala ikakhulukazi esifundeni sesisu);
• I-hypertension;
• Ukungasebenzi ngokomzimba.

Kwenzekani? I-Pathogenesis

Umlando wesifo sohlobo lwesifo sikashukela sesibili sichaza njengenani lezinkinga emgomweni we-metabolism. Emkhakheni wayo ukuphikiswa kwe-insulin - ukungakwazi kwamathambo ukuvame ukubona i-insulini, ngakolunye uhlangothi, nokuphazanyiswa kokukhiqizwa kwaleli hormone kuma cell pancreatic - ngakolunye uhlangothi. Ngokuvamile, ngokunyuka kwezinga le-glucose, elenzeka ngokushesha ngemva kokudla, ama-pancreas aqala ukukhuphula i-insulin ngenkuthalo. Kubantu abane-type 2 yesifo sikashukela, lokhu akukwenzeka, futhi i-insulin iqala ukwenziwa kuphela lapho izinga lokuhlunga kwe-glucose selufinyelele izibalo eziphezulu. Kodwa-ke, naphezu kokuba khona kwe-insulini, ukwehla kwezinga leshukela kulokhu kuya ezingeni elifunayo akukwenzeka. Ukugxila okuphezulu kwe-insulin okuqhubekayo kubangela ukuthi amangqamuzana alahlekelwe amandla okukwazi ukusabela kuwo futhi manje, ngisho noma i-hormone ingaxhuma kwi-receptor yeseli, akukho ukusabela. Ngokumelene nalokhu kwashintsha, amangqamuzana e-isibindi aqala ukwenza i-glucose ngentshiseko, okwandisa ukugxila kwegazi. Konke lokhu akudluli ngaphandle kwemiphumela. Ngokuhamba kwesikhathi, ngaphansi kwethonya eliphakeme lokugcocose, i-glucose toxicity iqala, okuyinto ehlasela kabi amangqamuzana e-pancreatic aveza i-insulin, futhi ngenxa yalokho, ukulahlekelwa kwawo kukhula. Ngakho-ke, umlando wesifo usukhuni. Uhlobo lwe-2 lwesifo sikashukela lufaka esikhundleni sefomu lapho ukuphathwa kwe-insulin kungakafiki. Isigulane sesiguli sibuhlungu.

Izimpawu

Emtholampilo we-classic wesifo sikashukela, kuvamile ukuhlukanisa amaqembu amabili wezibonakaliso zesifo - eyisisekelo nesesibili. Okuyinhloko kuhlanganisa:

• I-Polyuria - ukhipha umchamo omningi (i-glucose, ukungena kuwo, ngokunyusa ukwanda kwengcindezi ye-osmotic);
• Okwesithathu (i-polydispepsy) - ebonakala ngesidingo esingapheliyo sokuphuza;
• Indlala (i-polydisfagy) - ngenxa yokungakwazi kwamaseli ukugcoba i-glucose nge-insulini, umzimba uhlangabezana nesidingo esiqhubekayo samandla;
• Ukulahlekelwa isisindo esibucayi - kwenzeka ngokumelene nesizinda sokudla okukhulu.

Zonke lezi zimpawu zijwayele kakhulu uhlobo lokuqala lwesifo sikashukela. Uhlobo lwesibili lungase lungabi nhlobo noma lubangele izimpawu zokuqala:

• Ukuhlunga isikhumba kanye nezibungu zamangqamuzana - ngokuvamile uma uhlola isiguli futhi usolwe uhlobo lwesifo sikashukela se-type 2 (umlando wezokwelapha), owesifazane angabonakalisa ukuzulazula okungenakubekezeleleka emzimbeni;
• Ukubuthakathaka jikelele kanye nezinwele;
• Izilonda zesikhumba ezivuthayo, ezinzima ukuzinakekela;
• Umbono wehlisa.

Njengomthetho, iningi nje alinaki izimpawu ezinjalo, futhi lesi sifo singatholakala kuphela esigabeni sezinkinga.

Izingane nesifo sikashukela

Ngeshwa, isifo sikashukela manje siyabona njengesifo sesibili esingajwayelekile njalo. Yilokho okushiwo izingane ezisemthethweni. Isifo sikashukela (uhlobo lwesi-2) umlando wezokwelapha wengane ngokuvamile ubeka esigabeni sezifo eziyingozi kakhulu. Lokhu kungenxa yokuthi inkambo yayo ihluke kokomuntu omdala ngokuthuthukiswa okusheshayo futhi ngokuvamile uthola okungaphezulu kabi. Noma kunjalo, kulokhu, konke kuxhomeke ekutheni abazali bakwazi ukulungisa umsoco wengane nokuqapha ukusetshenziswa kwezidakamizwa ngesikhathi esifanele. Ngaphezu kwalokho, kubaluleke kakhulu ukubona lesi sifo ngesikhathi. Uma ingane inezimpawu ezilandelayo, ukubonisana okuphuthumayo kwe-endocrinologist kuyadingeka:

• Umntwana uzwa ukoma njalo;
• Ngokuvamile kuvame ukungena endlini yangasese (esikoleni noma enkulisa ephoqelelwe ukuba acele izifundo eziningi);
• Isisindo somzimba esinciphile;
• Ukukhathala okungapheli kubonakala.

Izifo

Ukuqaphela isifo sikashukela ngesisekelo somchamo kanye nokuhlolwa kwegazi. Ngomuntu onempilo, i-glucose ayitholakali kumchamo, kodwa egazini izinga layo alidluli 5.5. Ngemiphumela enokwethenjelwa, igazi lithathwe emunwe noma emithanjeni (isidlo sokugcina kufanele sithathe okungenani amahora angu-8 ngaphambi kwenqubo), ngaphambi kokuzinikela, awukwazi ukuphuza itiye elimnandi, ikhofi noma ijusi. Kumele kuqashelwe ukuthi isifo sikashukela sitholakala emazingeni angaphezulu kwe-7. Uma kwenzeka uma izinkomba ziguqukela kusuka ku-4 kuya ku-7, ukwehluleka kokubekezelelana kwe-glucose kubhalwe.

Olunye uvivinyo oluvumela ukukhomba lesi sifo nokucacisa amanani angabaza ukuhlolwa kwe-glucose ukubekezelelana (GTT). Ikuvumela ukuba uthole idatha ngezinga le-glucose kwisisu esingenalutho, futhi namahora amabili ngemuva kokuthatha isisombululo se-glucose. Ngokujwayelekile, emva kwe-glucose, ukuhlushwa kwayo akufanele kube ngaphezu kuka-7.8. Lokhu kuvivinywa akukwenziwa uma i-glucose ngaphambi kokuhlolwa iphakeme kune-6.1 uma isiguli sinomlando wezifo ezinzima, ukungenelela kokuhlinzwa, ukungena kwe-myocardial, ukuhlukumezeka, kanye nokusebenzisa izidakamizwa ezandisa ukwanda kweglucose. Yonke le datha ibonisa umlando wezokwelapha.

Isifo sikashukela sehlobo 2, isabelo

Njenganoma isiphi isifo, isifo sikashukela siyakwazi ukwakha nokwandisa izimpawu. Kulezi zigaba ezintathu zamanje zivelele. Isigaba sesinxephezelo sisethwe lapho izinkomba zesiguli zihamba ngendlela evamile. Uma isikhathi singathathwa, noma singalethi umphumela olindelekile, lesi sifo siya esiteji se-subcompensation. Kulokhu, isimo sesiguli akuyona into engcono kunazo zonke, kodwa futhi ayifuni. Ngosuku usuku isiguli asilahlekelwa ngaphezu kwamagremu angu-50 we-glucose emcinini , futhi izinga lakhe legazi lilinganiselwa ku-13.8, i- acetone emcinini ayikho. Kulesi sigaba, ukuthuthukiswa kwe-coma ye-hyperglycemic nakho akunakwenzeka. Isimo esiphakathi phakathi kwesinxephezelo kanye ne-decompensation sidluliselwa esigabeni sesigceme, ngezinga le-glucose 7.5, iphesenti ye-hemoglobin 6.5%, kanye ne-glucose yokuzila engaphansi kuka-6.1. Isigaba sokuqedela isethwe uma izinkomba zidlula imingcele elandelayo:

• Izinga le-glucose lingaphezu kuka-9;
• I-hemoglobin ene-glycerized - engaphezu kuka-9%;
• Ukugaya i-glucose - okungaphezu kuka-7.

Izinguquko kulezi zikhombisi kanye nokusebenza kwemithi enqunyiwe kusiza ukulandelela umlando wesifo. Isifo sikashukela soluhlobo lwesibili, inkambo enkulu okuyinto enzima ukuyiphatha noma yokucasula ezinye izici, ingena esiteji sokukhokha.

Izinto ezibangela ukuchithwa kwemali

Yiqiniso, imvelo ngayinye iyodwa, futhi izici ezenza kube nzima ukubhekana nalesi sifo zingase zihluke, kodwa lezi yizona ezivame kakhulu:

• Ukudla ngokweqile, ukuphulwa kokudla;
• Iphutha ekukhetheni umkhiqizo wokwelapha, umthamo wayo noma ukwenqaba ukwelashwa;
• Ukuzivocavoca noma ukusebenzisa endaweni yezinsiza ezondliwe zokudla;
• Ukwenqaba ukushintshela ekwelapheni kwe-insulin;
• Izifo ezigqugquzela ukungcola umzimba;
• Izimo ezicindezelayo.

Zonke lezi zici ngokuzimele noma ezihlangene ziyakuthinta kakhulu isimo sezinqubo zokudla, futhi ngenxa yalokho, kunyuke emazingeni e-glucose, okuloba umlando wesifo. Isifo sikashukela soluhlobo lwesibili, isiteleka sokuqhathaniswa okuqhubekayo ngokuqhubekayo nokubukeka kwezimo ezihlukahlukene ezivela ezithombeni nasezinkambeni zomzimba, kutholakala umlingiswa osongelayo futhi, uma kungelashwa ngendlela engafanele, kungase kube usongo empilweni yesiguli. Kulesi simo, izinkinga zingathuthuka njengesikhathi eside, futhi ngokoqobo ngamahora amahora.

Isigaba sokudonswa kwemali

Njengoba ukukhula kwe-glucose kwanda, futhi ukulungiswa kwayo kudinga izinyathelo ezingathí sina, umlando wesifo usukhuni. Isifo sikashukela (uhlobo lwesi-2), okusohliswayo okubhekene nengozi enkulu yokucindezeleka, kudinga isimo sengqondo esiqaphile kakhulu. Lokhu kungenxa yokuthi kungaba nzima kakhulu ukulungisa izinga le-glucose kokubili ngosizo lokudla kanye nokusetshenziswa kwemithi. Ngenxa yalokhu, kuyadingeka ukuba uqaphe ngokucophelela futhi njalo njalo isimo sesiguli, ngoba lapho kungekho khona umphumela wokwelashwa nokusetshenziswa kwezidakamizwa, izinguquko ezincane ezithombeni ezihlukahlukene zivele ngokushesha. Ngakho-ke, lezi ziguli zidinga ukunakekelwa kwezokwelapha, futhi kaningi kakhulu ekunakekelweni okuphuthumayo.

Ukukwazi ukulawula okuzimele ngesimo sakho siqu kubaluleke kakhulu lapha. Ngenhlanhla, imithi yesimanje inekhethelo elanele lezindlela kulokhu. Izivivinyo namadivaysi ahlukahlukene anquma izinga le-glucose, vumela isiguli sesifo sikashukela ukuba sihlolele ngokuzimela isimo sabo futhi, ngokuya ngemiphumela, yenza ukulungiswa.

I-insulini ekwelapha isifo sikashukela

Njengoba lesi sifo sithuthuka, ukuchithwa kwamaseli e-pancreatic athuthukisa i-insulin nawo aqala. Le nqubo idinga ukuphathwa ngokushesha kwe-hormone therapy. Njengoba ucwaningo lwamanje lubonisa, ngezinye izikhathi lokhu kuphela kuyasiza ukugcina amazinga e-glucose ezingeni elifanele. Noma kunjalo, akudingekile ukuba ucabange ukuthi injongo ye-insulin ingenxa yokuphila. Ngokuvamile uhlobo lwe-2 lwesifo sikashukela, i-insulin encike ekutheni, umlando wayo wezokwelapha ubonakala ubhekene nokulungiswa kokungenwa kwe-insulin yangempela, ngaphansi kwemizamo ethile engxenyeni yesiguli ingena kuleso sigaba uma ukuphathwa okuvamile kwaleli hormone kungadingeki. Isifo sikashukela esibhekene nalokhu sibhekisela kulawo ma-pathologies lapho, ukuze kutholakale umphumela wokwelashwa, ukulawula kanye nokuzikhandla kwesiguli kubaluleke kakhulu. Ngakho-ke, kungenxa yesiyalo sakhe ngokuphathelene nokudla, ukuziqapha kwezinga likashukela nokudla okufika ngesikhathi esifanele ukuthi imithi yesinxephezelo yesifo izoxhomeka. Kodwa-ke, kwezinye izimo, ukuqokwa kwe-insulin kuyimfuneko evunyelwe. Lokhu kwenzeka:

• Ngesikhathi sokukhulelwa;
• Uma kwenzeka ukushaya noma ukuhlasela kwenhliziyo;
• Ngokungenelela kokuhlinzwa;
• Nezifo ezithathelwanayo zezinhlamvu ze-purulent-septic;
• Ngezinkomba ezengeziwe ze-laboratory ukuxilongwa.

Esinye isizathu esibalulekile sokuqokwa okusemthethweni kwe-insulini kungase kube yinto ecacile ye-hormone, eqinisekisa umlando wezokwelapha. Uhlobo lwesifo sikashukela sesi-2, isigaba sokuqhathaniswa saso esibhekene nokuthi ukulahlekelwa isisindo esilandelayo nokukhula ketoacidosis, kuyisibonelo esihle salokhu.

Kumele kuqashelwe ukuthi namuhla umuthi uye wandisa kakhulu ukusetshenziswa kwe-insulin therapy, futhi kuqinisekiswa ngokusemthethweni ukuthi ukusebenza kahle kwe-oral treatment kanye ne-monotherapy kuhlala ngaphansi kweminyaka engaphansi kwengu-6. Khona-ke kufanele nginikeze imithi eminingana. Ngokwezimo zakamuva zokwelapha isifo sikashukela, ukusebenzisa i-insulin emazweni anjalo kubhekwa njengempumelelo kakhulu.

Izinkinga ezinzima

yezinkinga okukhulu decompensated - yisimo lapho kunosongo yangempela ekuphileni lesiguli. Zivame kubangelwa nokwanda okuphawulekayo ezingeni glucose kanye nezifo eziphathelene umzimba. Phezu okuvela lokhu yinto usizo kakhulu futhi ifike ngesikhathi, njengoba sazi zezimpawu zokuthi isimo akufanele kuphela odokotela, kodwa futhi abahlengikazi, umlando ubuhlengikazi zesifo sikashukela sohlobo 2 kanye nezinkinga zalo bachazwa futhi ngalendlela.

1. Hyperglycemic ikhoma (hyperosmolar futhi ketoatsidoticheskaya) - sici yabo esiwuphawu iyona zavela kancane kancane. Ingabe Zikhona Izimo Ezenza kubenze babe umthamo asanele noma reception aphuthelwe insulin, ukudla disorder (ukusetshenziswa ngokweqile carbohydrate), umsebenzi ku isizinda Hyperglycemia, ukwehluleka ukuqapha ezingeni glucose, utshwala noma imithi ethile. Emtholampilo, kubonakala zikhule eziningana izinsuku ukoma futhi polyuria (kwenyuke umchamo), amanzi emzimbeni ezinzima. Umfutho wegazi kuyehla, kanti tachycardia. Lapho Ukuwohloka Ukudlikizela kungenzeka nokucindezeleka ukwazi. Wesikhumba ezomile imihuzuko kungenzeka, acetone iphunga ngesikhathi okhishwa ngamakhala. Kulokhu, isisulu kudingeka esibhedlela ngokushesha nezinkonzo zokunakekela impilo.
2. ikhoma hypoglycemic - kubangelwa ukwehla elibukhali igazi glucose (esingaphansi 3 mmol / l), lapho ingqondo asitholayo ukuntula abukhali izakhamzimba. Lesi simo singaba kuvuse ukweqisa izidakamizwa insulin, ukweqa omunye ukudla noma ngokungalungile abakhethiwe Ukudla, utshwala noma izidakamizwa. ukuhlaselwa isifo eba ngokushesha. Elinesimo izithukuthuku ebandayo emabunzini, ubuthakathaka, isandla Isakhiwo sazamazama, ikhanda, ukungabi namizwa izindebe. Isiguli is nolaka, kahle esihlelwe ukunyakaza kwabo, kukhona ukushaya kwenhliziyo, umbono double, ukudideka. Ezigabeni kamuva kukhona nokulahlekelwa ukwazi, nokuquleka. Prehospital iziguli anjalo kumele inikwe isiphuzo amnandi noma bathole okudliwayo, kulungele bese uyiswa a isikhungo sokwelapha i-ukunakekelwa eyalandela.

yezinkinga ngasekupheleni

yezinkinga ezinjalo zenzeka sikashukela decompensated, ngemva kweminyaka eminingana ukugula. Ingozi kubo siwukuthi bangamalungu kancane kancane futhi kungabonakali sibe sibi isimo lesiguli. Ngaphezu kwalokho, ngokuvamile ukufunda yokwelapha isifo sikashukela singalimaza akuqinisekisi ukuthi ngesinye, ngeke zivele.

1. Retinopathy libhekene izilonda retina. Ngeshwa, naphezu kwayo yonke intuthuko kwezokwelapha zanamuhla, okuvela kuyo retinopathy in iziguli Uhlobo II sikashukela, okuyinto Uthatha iminyaka engaphezu kwengu-20, lisondela 100%. Lokhu zokugula kubangela nokopha ku fundus, futhi ekugcineni phambili ukuqedela ukulahlekelwa umbono.
2. Angiopathy - ahlukumeza permeability semithambo, okuyinto iba imbangela thrombosis kanye isifo sokuqina kwemithambo yegazi. Can ukuthuthukisa ngesikhathi esifushane (cishe unyaka), ngokungafani nezinye izinkinga eside avame burdened nga ngalindelekile umlando.
3. Isifo sikashukela soHlobo 2, polyneuropathy sikashukela, lapho futhi inkinga evamile, nerejista kuyo u-90% amacala. Emtholampilo, lokhu ihumusha ukunqoba emizweni ukulawula imisipha futhi izitho zangaphakathi. Polyneuropathy engaveza hypersensitivity, acute okungazelelwe (shanela) ubuhlungu, esivuthayo. Futhi izenzo peripheral kungenzeka ukuba ndikindiki encishisiwe ukuzwela, okuholela elimele kakhulu futhi enciphile. Izibilini kungaba isifo sohudo, incontinence urinary, ikhanda, isiyezi, ukuphazamiseka umsebenzi inhliziyo.
4. ngezinyawo Diabetic - libhekene ukubukeka kwemilenze, ikakhulukazi, kwi izinyawo izilonda sikashukela emithambo yegazi, abscesses, izindawo necrotic. Yingakho iziguli lesi sifo, kutuswa ukuba unake okukhethekile ukukhethwa izicathulo.

ukuba nombono ongafani ngeke

Kuyadabukisa, kodwa ekugcineni anqobe sikashukela imithi yesimanje bengayi. Nokho, kungase kwenze kahle izinguquko esifike kwezinso ezibangela i okuhlushwa anda glucose emzimbeni womuntu, okungukuthi, uhlobo 2 ngifundise ngesifo sikashukela. Umlando lesi sifo, onalesi sifo yalesi sifo ngo eziningi, uma kungezona zonke, kuzoncika sengqondo kuye isiguli. Nge control ngokucophelela kuye ezingeni ushukela kanye nezinye izinkomba, adingekayo Isikali ukulungiswa, ukudla futhi izincomo odokotela, ungagwema yezinkinga iminyaka eminingi.