Mbiri ya matenda: mtundu 2 shuga, sitepe decompensation subcompensation, ndithudi kwambiri, insulin, insulinopotrebny, ashuga polyneuropathy. kaonedwe

Mwina anthu ambiri analimbikitsa mbiri za mankhwala. Mtundu 2 shuga ndi chinaneneratu momwemo mwina zolefulazo kwambiri. Koma kodi n'kofunikira kuleka cholimba? The owopsa matendawa ndi mmene kuthana nazo - ife ifufuza.

Shuga - kodi ngozi?

Nthawi zambiri anthu amve za matenda a shuga, koma anthu ochepa okha ndi chimene icho chiri. Tikumbukenso kuti mawu akuti "shuga" - ndi chithunzi chofanana. Mawu amenewa zidzalumikizana matenda angapo a dongosolo endocrine. zimayambitsa awo achuluka zokwanira, koma monga ulamuliro, matenda zochokera matenda endocrine, ndipo makamaka - kupanda insulin. Chinthu china chingakhale kulephera metabolize shuga ndi chiwindi ndi thupi zimakhala. Pankhaniyi, thupi amawonjezera ake, amene nawonso, amachititsa osiyanasiyana matenda mu kagayidwe.

Shuga - mitundu yake

mankhwala amakono chimasiyanitsa mitundu iwiri ya matenda. Maphunziro kumachitika malinga zotani insulin akusowa - wachibale kapena mtheradi - limafotokoza mbiri ya matenda. Mtundu 2 shuga ambiri kumphatikiza ndi akusowa wa timadzi insulin, amene ali pachibwenzi m'badwo kapamba. Kawirikawiri, chifukwa cha chitukuko ndi kuchepetsa tilinazo ziwalo ndipo zimakhala kuti timadzi izi. Shuga insulin - yoyamba - n'zogwirizana ndi akusowa insulin mu thupi. Chosowa timadzi umenewu umatipatsa chakuti shuga ndi kulowa m'thupi, osati kukonzedwa, kapena ndi zedi osakwanira, ndipo msinkhu wake mu mwazi nthawi zonse kukula, ndipo pofuna kupulumutsa moyo wa wodwala amenewa ayenera kulandira ndi mlingo zina insulin.

Mbiri ya matenda - mtundu 2 shuga

Umenewu umatchedwanso insulin amadalira shuga. Malinga ndi kafukufuku, odwala matenda mtundu wa matenda ndi yaitali kwambiri kuposa poyamba. Ndi zaka, chiopsezo kuti matenda adzaonetsera izo, ali kwambiri. Nthawi zambiri, chitukuko ndi wopanda msoko ndipo wodwalayo kwa nthawi yaitali, samadziwa za matenda amenewa, umboni kuganiza izo susonyeza mbiri ya matenda. Shuga mtundu 2 akupezeka mu nkhani iyi monga "anapezazo mwangozi" pa Kupenda chizolowezi. The chizindikiro chachikulu kuti amalola kuti akuganiza pamaso pa matenda ndi magazi, omwe bwino shuga. Nayenso, pamene anaphedwa mbiri ya matenda, mtundu 2 shuga lagawidwa:

• akupezeka odwala yachibadwa kulemera;
• kuzindikiridwa odwala ndi kunenepa.

shuga Zoyambitsa

Komabe m'kati kuphunzitsa madokotala wamng'ono chikalata mbiri maphunziro a matenda, mtundu 2 shuga sipangakhalenso chifukwa cha zifukwa zingapo. Anthu ambiri ndi:

• kudya chakudya woyengedwa (shuga, chocolate, kuphika, mbatata) lalikulu zedi ndipo kulephera kwa mbewu CHIKWANGWANI mu chakudya;
• chibadwa - pamaso ngati matenda makolo shuga maonekedwe zoopsa kuposa 40%;
• Kunenepa, makamaka choipidwa mtundu (madipoziti mafuta inali makamaka kudera m'mimba);
• oopsa;
• wongokhala.

Chikuchitika ndichiyani? pathogenesis

Mbiri ya matenda shuga mtundu 2 akufotokozera m'mene chiwerengero cha kuyan'anila mu ndondomeko ya kagayidwe. Bukuli lili ndi kukana insulin - kulephera kwa zimakhala zambiri kutenga insulin, pa dzanja limodzi, ndi kuphwanya timadzi izi kupoletsa maselo a kapamba - pa ena. Mwachibadwa, ndi kuwonjezeka shuga msinkhu, lomwe limapezeka nthawi yomweyo pambuyo chakudya, kapamba kupanga mankhwala akuyamba mosamala. Anthu a mtundu II shuga, izi zimachokeradi, ndi kokha ayamba kupanga mankhwala pamene woipa shuga kale ukufika manambala mkulu. Komabe, ngakhale pamaso pa insulin, kutsitsa shuga, mu nkhani iyi msinkhu anakhumba amapezeka. Zonse okwera ndende ya insulin kumabweretsa chakuti maselo kutaya luso lawo kumuyankha, ndipo tsopano, ngakhale timadzi sangathe kugwirizana kwa maselo lilime, palibe anachita. Against maziko a kusintha maselo a chiwindi anayamba mwachangu lithe shuga, mopitirira kuwonjezeka ndende zake magazi. Zonsezi sukupita popanda zotsatira. Patapita nthawi, pansi kanthu a mkulu wa ndende shuga shuga kawopsedwe zingachitike zomwe limakhudza anthu maselo pancreatic kubala insulin, ndipo monga Motero, akusowa ake akufotokozera. Choncho, kuwonjezera pa mbiri ya matenda. Mtundu 2 shuga m'malo mawonekedwe insulinopotrebny pamene insulin sanayambebe chofunika. alili chatsitsa.

zizindikiro

Mu chipatala tingachipeze powerenga shuga anaganiza kuonetsetsa magulu awiri zizindikiro za matenda - pulayimale ndi sekondale. Waukulu monga:

• polyuria - ndi allocated kwambiri ya mkodzo (shuga, kugwera izo, kwambiri kumawonjezera kuthamanga osmotic);
• ludzu (polidispepsiyu) - yodziwika ndi zonse zosowa wosazima kwa wakumwa;
• njala (polidisfagiyu) - chifukwa kulephera kwa maselo kuphunzira shuga ntchito insulin, thupi amafunika mosalekeza mphamvu;
• mwadzidzidzi kuwonda - izo zikuchitika motsutsa likhale kuchuluka kudya.

Zizindikiro zonsezi kwambiri khalidwe la mtundu woyamba wa matenda a shuga. Mtundu yachiwiri ikuyenda zambiri asymptomatic kapena kuchititsa mbali yachiwiri:

• kuyabwa khungu ndi mucous nembanemba - kangapo anayendera wodwala ndipo anaganiza mtundu 2 shuga (mbiri), mkazi akhoza kukondwerera mumamva kuyabwa wa kumaliseche;
• ambiri kufooka ndi mutu;
• zotupa yotupa ndi ovuta kuchiza;
• utachepa masomphenya.

Monga ulamuliro, ambiri chabe samapereka tcheru kuti zizindikiro zotere, ndipo matenda chiwululidwe kokha pa siteji ya mavuto.

Ana ndi shuga

Mwatsoka, shuga chimatengedwa ngati matenda wachiwiri ambiri aakulu. boma kuti anatero Pediatrics. Shuga (mtundu 2) mbiri ya matenda a mwanayo zambiri kuika mu gulu la matenda owopsa. Ichi ndi chifukwa chakuti ndi osiyana ndi matenda zambiri mofulumira chitukuko cha wamkulu ndi nthawi zimatengera kuposa zilonda. Komabe, mu nkhani iyi, chirichonse kumadalira luso la makolo kusintha mphamvu ya mwana ndi kuonetsetsa mankhwala makonzedwe yake. Komanso, n'kofunika kuti azindikire matenda mu nthawi. Ngati mwana ali ndi zizindikiro zotsatirazi yomweyo kufunsa munthu m'thupi yemwenso:

• mwana akukumana ludzu nthawi zonse;
• nthawi zambiri amakhala ndi kupita ku chimbudzi (kusukulu kapena sukulu ya mkaka amakakamizidwa kangapo kupempha chilolezo kuchokera ku sukulu);
• anachepetsa thupi;
• pali kutopa.

diagnostics

Shuga ndi matenda zochokera mayesero mkodzo ndi magazi. Mu munthu wathanzi mu shuga mkodzo si n'chiyani, ndipo msinkhu magazi ake si upambana 5.5. Zotsatira odalirika, mwazi otengedwa chala kapena mtsempha (pachakudya chomaliza ayenera kumwedwa maola osachepera 8 pamaso ndondomeko), pamaso yobereka Simungathe kumwera lokoma tiyi, khofi kapena madzi. Tikumbukenso kuti matenda a shuga ndi matenda pa mitengo pamwamba 7. Ngati mitengo osiyanasiyana pa 4 ndi 7, m'kaundula chakhungu shuga kulolerana.

Chiyeso china kudziwa matenda ndi kumveketsa phindu zokayikitsa, ndi shuga kulolerana mayeso (OGTT). Iwo amalola kuti deta za mlingo wa shuga kudya magazi, komanso maora awiri anatenga shuga njira. Bwinobwino pambuyo shuga ndende yake sayenera pamwamba 7,8. Kuyeza kumeneku si ikuchitika pamene shuga pamaso pa mayeso pamwamba 6.1 ngati wodwalayo ali ndi mbiri za matenda pachimake pano, opaleshoni, m'mnyewa wamtima infarction, zoopsa, ndipo pamene kulandira mankhwala kuonjezera shuga. deta onsewa amasonyeza mbiri ya matenda.

Lembani shuga 2, subindemnification

Mofanana ndi matenda aliwonse, shuga amamuchititsa Kuonjezera ndi patsogolo zizindikiro. Iwo n'kopanda pa masitepe atatu. siteji malipilo aikidwa pa njira ya ntchito wodwalayo mwakale. Ngati nthawi satenga miyeso, kapena musati kubweretsa zotsatira kuyembekezera, matenda zipita siteji subcompensation. M'njira, mmene wodwalayo, osati zabwino, komanso uncritical. Pa tsiku wodwala wotaya mkodzo zosaposa magalamu makumi asanu a shuga, ndi msinkhu wake mu magazi ndi za 13.8, ndi acetone mkodzo si. Development wa chikomokere hyperglycemic pa siteji imeneyi, n'zosatheka. Ndi sitepe subkomensatsii m'nyimbozo mkhalidwe wapakati pakati kulipidwa ndi decompensated, maziko kutenga malipiro chapamwamba mfundo shuga 7.5, kuchuluka kwa hemoglobin glikerirovannogo 6.5% shuga ndi kusala kudya - zosakwana 6.1. decompensation siteji akonzedwa, ngati zizindikiro olumpha malire zotsatirazi:

• magazi shuga - oposa 9;
• glikerirovanny hemoglobin - oposa 9%;
• kudya shuga - 7.

Kusintha zokhazikitsidwa awa ndi mphamvu ya mankhwala zotchulidwa amathandiza kuti tifufuza mbiriyakale ya matenda. Lembani shuga 2, aakulu Inde amene amayankha bwino mankhwala kapena amayamba ndi zinthu zina, chinthu amapita ku decompensation.

Zinthu kuchititsa decompensation

Kumene, aliyense thupi zosiyana, ndipo zinthu zomwe zimathandiza matenda angakhale osiyana, koma ambiri ndi awa:

• kudya, kuphwanya zakudya;
• vuto kusankha mankhwala, mlingo wake, kapena kukana chithandizo;
• kudzikonda ntchito kapena zowonjezera zakudya mu lieu anasankha mankhwala;
• chokana kupita pa mankhwala insulin;
• matenda, kulimbikitsa madzi m'thupi;
• mavuto.

Zonsezi payekha kapena akaphatikiza ndi zayamba bwanji boma njira kagayidwe kachakudya, ndi chifukwa, pali ponso zizindikiro mlingo shuga limene likuthandiza mbiri ya matenda. Lembani shuga 2, decompensated yomwe mu nkhani iyi ndi kuwonjezera maonekedwe a mavuto osiyanasiyana mu ziwalo ndi machitidwe a thupi, izo zimakhala kuopseza ndi chithandizo pachithunzichi akhoza kuwononga moyo wodwalayo. Pankhaniyi, zosokonezeka angathe kukhala nthawi yaitali, kwenikweni mkati maola.

decompensated

Monga ndende ya ukuwonjezeka shuga, ndi chilangizo chake amafuna miyeso zikuluzikulu, kulimbikitsa ndi mbiri ya matenda. Shuga (mtundu 2), decompensation amene amakhala ndi chiopsezo cha matenda oyamba, pamafunika kusamala kwambiri kuganizira. Ichi ndi chifukwa chakuti zovuta kusintha mlingo wa shuga ntchito onse zakudya ndi kugwiritsa ntchito mankhwala osokoneza bongo. Motero, muyenera mosamala ndipo nthawi kuyan'ana mkhalidwe wa mtima, chifukwa ngati sipakhala zotsatira akangofika ntchito mankhwala mwamsanga pali kusintha pathological ziwalo zosiyanasiyana. Choncho, odwalawo amafunika kuti wodwalayo kuchipatala, ndi nthawi mu chipinda mwadzidzidzi.

Chofunika kwambiri apa ndi kuthekera kwa ulamuliro osadalira pa chikhalidwe chawo. Mwamwayi, mankhwala amakono ndalama zokwanira kusankha zimenezi. mayesero osiyanasiyana ndi zipangizo kuti kudziwa mlingo wa shuga, amalola odwala matenda a shuga kudzimvera oterewa chikhalidwe chawo ndipo, malingana ndi zotsatira, kuchita uphunguwo.

Insulin mu mankhwala a shuga

Monga matenda ili m'kati, ndipo akufotokozera kutopa maselo pancreatic zomwe zikugwira yopanga insulin. Zimenezi zimafuna nthawi yomweyo timadzi mankhwala. Malinga ndi kafukufuku wa posachedwapa, nthawi zina yekha limakupatsani kukhala shuga pa mlingo bwino. Komabe, tisaganize kuti poika insulin - ndi moyo. Nthawi zambiri, mtundu 2 shuga, insulin, mbiri zachipatala, amene akuoneka kuti zoyembekezeka kugwila moyo wambiri insulin, ndi ena khama la wodwalayo apite gulu kuti, musati amafuna ulamuliro nthawi zonse timadzi izi. Shuga pankhaniyi amatanthauza pathologies anthu amene angakhale ndi zotsatira achire Nkofunika, ndi khama ulamuliro pa gawo la wodwalayo. Choncho, ndi ku chilango chake pankhani ya zakudya, kudzikonda kuwunika mlingo wa shuga ndi mankhwala yake kudzadalira mlingo wa chipukuta misozi cha matenda. Komabe, nthawi zina, poika insulin - muyeso mokakamizidwa. Izi zimachitika:

• pa mimba;
• mu nkhani ya matenda a mtima kapena zikoti;
• pa opaleshoni;
• matenda opatsirana pyoseptic khalidwe;
• pamlingo apamwamba diagnostics zasayansi.

Chifukwa china chachikulu poika kuvomerezedwa insulin kungakhale kupanda yosiyanasiyana ya timadzi ichi, chimene zikutsimikiziridwa ndi mbiri ya matenda. Mtundu 2 matenda a shuga amene sitepe decompensation amakhala ndi kupata sankatha kulemera ndi kukula ketoacidosis, ndi chitsanzo chabwino.

Tikumbukenso kuti lero mankhwala kwambiri kukodzedwa kuchuluka kwa ntchito insulin, ndipo mwalamulo anatsimikizira kuti efficacy wa monotherapy ndi mankhwala akumwa awasungira pasanathe zaka 6. Ndiye tiyenera mankhwala mankhwala zambiri. Malinga ndi zochita atsopano pa matenda a shuga, insulin ntchito Zikatero, ankaona kuti waphindu.

zosokonezeka pachimake

zosokonezeka wokonda decompensated - ndi mkhalidwe umene pali owononga moyo wodwalayo. Iwo zambiri chifukwa cha kuchuluka kwambiri mlingo wa shuga ndi matenda okhudzana a kagayidwe. Pa zosayembekezereka ya chikhalidwe ichi ndi thandizo lofunika yake, monga mukudziwa zizindikiro za zinthu izi ayenera osati madokotala, komanso anamwino, ndi mbiri unamwino matendawa ndi mtundu 2 shuga ndi mavuto ake anafotokoza motere.

1. Hyperglycemic chikomokere (hyperosmolar ndi ketoatsidoticheskaya) - Chinthu awo zimasiyanitsa ndi mwapang'onopang'ono. Zinthu kuwachititsa kukhala osakwanira mlingo kapena anaphonya phwando insulin, zakudya matenda (kwambiri mowa chakudya) thupi pa maziko a hyperglycemia, kulephera kuyan'ana mlingo wa shuga, mowa kapena mankhwala ena. Kukomoka, zikuoneka kukula kwa masiku angapo ludzu, polyuria (kuchuluka mkodzo), aakulu madzi m'thupi. magazi yafupika, ndi tachycardia. Pamene kuwonongeka a khunyu zotheka ndi maganizo a chikumbumtima. Kusenda zimakhalapo youma zotheka, acetone fungo pa mpweya. Pankhaniyi, munthuyo ayenera hospitalization mwamsanga ndiponso chithandizo chamankhwala.
2. Hypoglycemic chikomokere - amayamba kuchepa lakuthwa mu shuga m'magazi (zosakwana 3 mmol / l), umene ubongo amaloŵamo kupanda lakuthwa zakudya. chikhalidwe ichi kungakhale ndi ambiri osokoneza wa insulin, kujomba limodzi chakudya kapena molakwa osankhidwa zakudya, mowa kapena mankhwala osokoneza bongo. Kukomoka kuukira akufotokozera mofulumira. Yodziwika ndi thukuta ozizira pa mphumi, kufooka, dzanja inagwedezeka, mutu, dzanzi cha milomo. The wodwala aukali, bwino mgwirizano kayendedwe, pali kugunda, pawiri masomphenya, chisokonezo. Mu masiteji kenako pali imfa ya chikumbumtima, khunyu. Prehospital odwala akhoza anapatsidwa wokoma chakumwa kapena chakudya, konzekera ndi kuwapititsa ku malo dokotala kuti malangizo chisamaliro.

zosokonezeka mochedwa

zosokonezeka zimenezi zikuchitika mu shuga decompensated, pambuyo zaka zingapo matenda. Ngozi iwo kuti iwo ali pang'onopang'ono mosadziwa kuvutika alili. Komanso, nthawi zambiri ndi kulemba shuga mankhwala akhoza sitingakumane kuti posapita nthawi, iwo siziwoneka.

1. Retinopathy amakhala ndi zotupa kwa diso. Mwatsoka, ngakhale patsogolo onse mankhwala amakono, pakutchulidwa wa retinopathy odwala ndi Mtundu II matenda a shuga amene kumatenga zaka zoposa 20, wakudza 100%. kudwala Izi zimapangitsa kukha magazi mu fundus, ndipo pambuyo pake zikubweretsa kumaliza imfa ya masomphenya.
2. Angiopathy - ndi kuphwanya permeability mtima, amene akukhala chifukwa cha thrombosis ndi atherosclerosis. Kodi kukhala mu nthawi yochepa (pafupifupi chaka), mosiyana ndi mavuto ena yaitali nthawi zambiri wolemetsedwa ndi mbiri.
3. Mtundu 2 shuga, matenda ashuga polyneuropathy, umenenso vuto wamba, akaundula mu 90% ya milandu. Kukomoka, izi anamasuliridwa akunde misempha omwe amalamulira minofu ndi ziwalo. Polyneuropathy angasonyeze hypersensitivity, pachimake mwadzidzidzi (zikulilima) ululu, moto. Komanso kuwonekera kwa neuropathy kungakhale dzanzi, yafupika tilinazo, chifukwa mu kuvulala ambiri. The ziwalo kungakhale m'mimba, mkodzo incontinence, mutu, chizungulire, kusokonezeka mu ntchito za mtima.
4. Ashuga phazi - amakhala ndi maonekedwe a miyendo ndi, makamaka, pa mapazi a zilonda matenda ashuga venous, abscesses, m'madera necrotic. N'chifukwa chake odwala matenda izi, izo tikulimbikitsidwa kulipira mwapadera kusankha nsapato.

kaonedwe

Ndi zomvetsa chisoni, koma potsiriza kugonjetsa shuga mankhwala amakono sindingakhoze. Komabe, zikhoza kusintha pa nthawi yake kwa kuvutika amene amayambitsa kochulukira ndende ya shuga mu thupi la munthu, ndiko kuti, mtundu 2 shuga. Mbiri ya matenda, kuti madokotala ananena zawo za matenda ambiri, ngati si onse, kudzadalira mtima kwa iye wodwala. Ndi ulamuliro mosamala iye mlingo wa shuga ndi zizindikiro zina, zofunika mlingo kudzudzulidwa, kudya pang'ono ndi malangizo a madotolo, mukhoza kupewa mavuto kwa zaka zambiri.