Nyaya yenyaya: chirwere chechipiri cheshuga cheshuga, chekudzikinura chikwata, kubhadhara, nzira yakaoma, insulini-inotarisira, insulini-inotenderera, chirwere cheshuga chinonzi polyneuropathy. Forecast

Zvichida, kwete vanhu vakawanda vanofara nemanhoroondo avo ezvekurapa. Diabetes mellitus type 2, inoratidzwa mairi, inogona kukonzera kusuruvara. Asi zvakakosha here kukanda mapfumo pasi uye kuora mwoyo? Icho chinotyisa sei chirwere ichi, uye nzira yekugadzirisa naro - tichazonzwisisa.

Diabetes mellitus - chii chinonzi ngozi?

Vanhu vanowanzonzwa nezvechirwere cheshuga, asi vashomanana chete ndivo vanoziva kuti chii. Izvo zvinofanira kuonekwa kuti pfungwa ye "chirwere cheshuga" inobatana. Pasi peshoko iri, zvirwere zvakawanda zve endocrine system zvichabatana. Zvikonzero zvekuitika kwavo zvakanyanya, asi, sekutonga, zvirwere zve endocrine, uye kunyanya kusaputsika kwe insulin, iri pamwoyo wechirwere. Chimwe chinhu chinogona kunge kusakwanisa kudya glucose nechiropa uye mhuka dzomuviri. Panguva imwechete mumuviri muviri wake unomuka, uyo, uyewo, ndiwo mhaka yehutano huzhinji mumetabolism.

Chirwere cheshuga mellitus - mhando dzayo

Mishonga yemazuva ano inoparadzanisa marudzi maviri echirwere ichi. Kukwirira kunowirirana zvichienderana neicho chinonzi insulin kusakwanira - chizvarwa kana zvachose - chinotsanangura nhoroondo yezvokurapa. Diabetes mellitus type 2, sekutonga, haina kubatana nekushaya kukwana kweutachiona, kusimbiswa kwaro kunosanganiswa mune pancreas. Kazhinji, chinokonzera kukura kwayo ndechekuderera mukati mekunzwa kwemuviri uye mishonga kune iyi hormone. Diabetes insulin-inotenderera - rudzi rwekutanga - rwakananga zvakananga nekushaya kukwana kwemuviri mumuviri. Kushayikwa kwehomoni iyi kunotungamirira kune chokwadi chokuti glucose, iyo yakapinda mumuviri, haisati yashandiswa, kana inowanika musingakwanisi, apo ropa raro rinoramba richikura, uye kuitira kuchengetedza hupenyu, vakadai vakamanikidzwa kuwana mamwe maitiro e insulini.

Nhoroondo yekare - rudzi rwechipiri cheshuga cheshuga

Ichi chirwere cheshuga chinonziwo insulini-yakasununguka. Maererano nehuwandu hwemashoko, varwere vanorwara nehutachiwana hwechirwere ichi vazhinji kwazvo kupfuura yekutanga. Nezera, ingozi yokuti chirwere ichi chichazviratidza zvikuru chinowedzera. Kazhinji kacho kukura kwayo kunowanikwa vasingazivi, uye murwere kwenguva yakareba haazive nezvehutachiona huno, iyo inomubvumira kufungidzira haina kuratidza nhoroondo yechirwere ichi. Diabetes mellitus type 2 munyaya ino inoonekwa se "kuwanikwa kusina kuwanikwa" panguva yekuongorora. Chiratidzo chikuru, chinokubvumira kuti ufungidzire kuvapo kwehutachiona huno, kuongorora ropa umo glucose inowedzera. Uyewo, apo nhoroondo yezvokurapa yakaitwa, chirwere chechirwere cheshuga chakaparadzana mu:

• Inosangana nevarwere vane uremu hunorema;
• Yakaratidzwa kune varwere vane uremu.

Zvinokonzera chirwere cheshuga

Kunyangwe mukugadzirira kudzidzisa vanachiremba vaduku kuumba nhoroondo yezvechirwere chechirwere, chirwere chechipiri chirwere cheshuga mellitus umo chinogona kukonzerwa nezvikonzero zvakawanda. Chinyanya kukosha pane izvi ndeichi:

• Kushandiswa kwemakrobohydrates akacheneswa (shuga, chokoti, buns, mbatatisi) muhuwandu hwakawandisa uye kusakwana kwemashizha emiti muzvokudya;
• Heredity - muhupo hwehutano hwakafanana pakati pevabereki, dambudziko rekushaya chirwere cheshuga rinopfuura 40%;
• Kuwedzerwa muviri, kunyanya zvinonzi visceral (mafuta aripo anowanikwa munharaunda yedumbu);
• Hypertension;
• Zvisizvo zvisingaiti.

Chii chiri kuitika? Pathogenesis

Nhoroondo ye chirwere chechirwere chechipiri chirwere cheshuga mellitus chinotsanangura sehuwandu hwevhiringidzi mumatabolism. Pamusoro payo ndiyo insulin kushorwa - kusakwanisa kwemasukisi kuti kazhinji kuone insulini, kune rumwe rutivi, uye kukanganisa kwekubudiswa kwehomoni iyi mune pancreatic cells - kune imwe. Kazhinji, nekuwedzera kwezinga rehuga, rinoitika pakarepo mushure mekudya, pancreas inotanga kushingaira kubudisa insulini. Kune vanhu vane chirwere cheshuga chechipiri, izvi hazviitike, uye insulin inotanga kubudiswa chete kana uwandu hwekutengesa kweglucose hwakatowanikwa kare. Zvisinei, pasinei nokuvapo kwe insulini, kuderera kwezinga re shuga munyaya iyi kunzvimbo yakatarwa hakuiti. A constantly insulin concentration inowanzoita kuti masero anorega kukwanisa kuita mazviri uye ikozvino, kunyange kana hormone inogona kushamiswa kune sero rekugamuchira, hapana chakaita. Mukurwisana kwemashure ekuchinja uku, masero eropa anotanga kushingaira kugadzira glucose, achiwedzera kuwedzera kwaro muropa. Zvose izvi hazviperi pasina migumisiro. Nokufamba kwenguva, pasi pesimba rekunyanya kweglucose, glucose toxicity inokura, iyo inokanganisa zvinokonzera pancreatic masero anobudisa insulini, uye nekuda kweizvozvo, kushayikwa kwayo kunowedzera. Nokudaro, nhoroondo yechirwere inowedzera. Rudzi rwechipiri chirwere cheshuga mellitus chinotsiva fomu apo insulini inenge isati yadiwa. Mamiriro ekurwara anowedzera.

Zviratidzo

Mumakiriniki echechi yechirwere cheshuga, zvakajairika kusiyanisa mapoka maviri ezviratidzo zvechirwere - chechipiri uye chekondari. Iyo huru inosanganisira:

• Polyuria - yakawanda yemuyo inosunungurwa (glucose, kupinda mairi, inowedzera osmotic pressure);
• Chechi (polydispepsy) - inoratidzirwa nechido chinogara chiripo, chisingaverengeki chekunwa;
• Nzara (polydisfagy) - nemhaka yokusakwanisa kwemasero kunoshandisa glucose ne insulin, muviri unowana chido chenguva dzose ye simba;
• Kurashika kwakakosha kwehuremu - zvinowanzopesana nemamiriro ekuwedzera kwechido.

Zvose izvi zviratidzo zvinowanzoenderana neyekutanga chirwere cheshuga. Rudzi rwechipiri runogona kunge ruregerero kana kukonzera zviratidzo zvechipiri:

• Kuchenesa kweganda nemukoma - kazhinji kana uchitarisa murwere uye uchifungidzirwa sorudzi rwechipiri chirwere cheshuga mellitus (chirwere chechiremba), mukadzi anogona kuratidza kusinganisa kusingagadziki mumadzimai edzimba;
• Kazhinji kushaya simba uye musoro wemusoro;
• Zvirwere zvinopisa muviri, izvo zvakaoma kubata;
• Kupera kwemaonero.

Sezvo mutemo, vakawanda vanongoteerera zviratidzo zvakadaro, uye chirwere chacho chinogona kuonekwa chete pamatambudziko ezvinetso.

Vana uye chirwere cheshuga

Zvinosuruvarisa kuti, chirwere cheshuga chave chaonekwa sechipiri chechirwere chisingaperi chisingagumi. Izvi ndizvo zvinorehwa nehutano hwepamusoro. Chirwere cheshuga mellitus (chinyorwa 2) nhoroondo yezvechiremba yemwana kakawanda inowanzoisa muchikamu chezvirwere zvinotyisa. Izvi zvinokonzerwa nekuti chikamu chayo chinopesana neicho chemunhu mukuru nekukurumidza kukurudzirwa uye kazhinji zvinowedzera zvinonyanyisa. Zvisinei, munyaya iyi, zvinhu zvose zvinoenderana nekwanisi yevabereki kugadzirisa kudya kwemwana uye kutarisa kushandiswa kwakakodzera kwemishonga. Mukuwedzera, zvakakosha kuziva chirwere ichi munguva. Kana mwana wacho ane zviratidzo zvinotevera, kubvunzurudzwa kwekukurumidzira kwemugumo wemagokorokori inokosha:

• Mwana anoona nyota nguva dzose;
• Zvizhinji zvinowanzoenda kuchivanze (kuchikoro kana kuchikoro chekumanikidzirwa kumanikidzirwa kusvika kakawanda kuti akumbire zvidzidzo);
• Kupera muviri;
• Kushushikana kusingaperi kunoonekwa.

Diagnostics

Kuongorora chirwere cheshuga pamusana pemuviri uye kuongorora ropa. Mune munhu ane hutano, glucose haigoni kuonekwa mumuguta, asi muropa mazinga ayo haadarika 5.5. Nokuda kwemigumisiro yakavimbika, ropa rinotorwa kubva kumunwe kana mutsara (yekupedzisira kudya kunofanira kutorwa maawa masere musati maitiro), usati wazvipira, iwe haugoni kunwa sweet tea, kofi kana jisi. Izvo zvinofanira kuonekwa kuti chirwere cheshuga chinokonzerwa nehuwandu huri pamusoro pe 7. Kana zvikaitika kana zvikwangwani zvichinyatsobuda kubva 4 kusvika ku7, iko kukanganisa kwekushushikana kweglucose kwakanyorwa.

Chimwe chiedzo chinobvumira kuziva chirwere ichi uye kujekesa kusava nechokwadi kwehutano ndiko kuedza kwekushushikana kweglucose (GTT). Iko inokubvumira kuwana dhigirii pamwero weglucose mudumbu risina chinhu, uyewo maawa maviri mushure mokunge atora glucose solution. Kazhinji, mushure meglucose, maitiro acho haafaniri kunge akareba kupfuura 7.8. Uyu muedzo hauna kuitwa apo glucose isati yasvika yakareba kupfuura 6.1 kana murwere ane nhoroondo yezvirwere zvakakomba, kupindira kwokuvhiya, myocardial infarction, kushungurudzika, uye paunotora zvinodhaka zvinowedzera glucose. Zvose izvi deta zvinoratidza nhoroondo yezvokurapa.

Diabetes mellitus type 2, subcompensation

Kufanana nechirwere chipi nechipi, chirwere cheshuga chinowanzovakwa nekuwedzera zviratidzo. Muzvikamu zvaro zvemazuva ano zvakasiyana. Chikamu chekubhadhara chinotarirwa apo zvirwere zvevarwere zvinosvika pakugara. Kana nguva yacho isati yatorwa, kana kuti isingounisi mhinduro inotarisirwa, ipapo chirwere chinoenda kuchikwata chekubhadhara. Muchiitiko ichi, mamiriro ezvinhu emuurwere, chokwadi, haasi iye akakodzera, asiwo asina kunyora. Pazuva iro murwere anorasikirwa nemagiramu makumi mashanu emasukirini mumuguta , uye ropa rake rinenge 13.8, acetone mumuguta haisipo. Panguva ino, kukura kwe hyperglycemic coma hakugoneki. Pakati pehurumende pakati pekubhadhara uye kubhadhara kunotumirwa kumutsara wechitsiko, nejiji yeglucose 7.5, muzana weglycated hemoglobin 6.5%, uye kushamba kweglucose pasi pe 6.1. Iko kunokonzera kubhadhara kunogadzirirwa kana zviratidzo zvichipfuura nemiganhu inotevera:

• Nhamba yeglucose inopfuura 9;
• Glycerized hemoglobin - inopfuura 9%;
• Kuchengeta glucose - zvinopfuura 7.

Kuchinja mune zviratidzo izvi uye kubudirira kwehutano hwakarongwa kunobatsira kuona nhoroondo yehosha. Diabetes mellitus type 2, iyo nzira yakaoma iyo yakaoma kurapa kana kugumburwa nezvimwe zviitiko, inopinda muchikamu chekudzikinura.

Zvinokonzera kukanganisa

Ichokwadi kuti mhuka imwe neimwe inomunhu oga, uye izvo zvinowedzera kuwedzera kwechirwere chacho zvinogona kunge zvakasiyana, asi izvi ndizvo zvakanyanya kuitika:

• Kunyanya kudya, kuputsa kwekudya;
• Chikanganiso mukusarudzwa kwemushonga wemishonga, chirwere chayo kana kukaramba kurapwa;
• Kuzvishongedza kana kushandiswa panzvimbo yezvakatarisirwa kudya zvinowedzera;
• Kuramba kuchinja kune insulin therapy;
• Zvirwere zvinokurudzira kuderedza muviri;
• Kunetseka mamiriro ezvinhu.

Zvose izvi zvinhu zvakasiyana kana zvakasanganiswa zvinokanganisa hutsika hwemagetsi, uye sechikonzero, kune kuwedzera kwemazinga emaglucose, anonyora nhoroondo yechirwere. Diabetes mellitus type 2, danho rekudzikinura iro rinowedzera kukura nekuonekwa kwezvinetso zvakasiyana-siyana kubva kune nhengo uye zvirongwa zvemuviri, zvinowana munhu anotyisidzira uye, kana zvisina kutarisirwa, zvinogona kutyisidzira upenyu hwomurwere. Muchiitiko ichi, zvinetso zvinogona kukura sezvakareba kwenguva, uye chaizvoizvo munyaya yeawa.

Chikamu chekudzikinura

Sezvo kuwedzera kweglucose kuchiwedzera, uye kururamisa kwayo kunoda zviito zvakakomba, nhoroondo yechirwere inowedzera. Chirwere cheshuga mellitus (chinyorwa 2), icho kuderedzwa kwacho kunoratidzirwa nehuwandu hwehutambudziro, hunoda maitiro akachenjerera zvikuru. Izvi zvinokonzerwa nekuti iyo inogona kuva yakaoma zvikuru kugadzirisa iyo yeglucose level pamwe chete nekubatsirwa kwekudya uye nekushandisa kwemishonga. Nokuda kweizvi, zvakakosha kuchenjerera uye nguva dzose kutarisa mamiriro emurwere, nokuti mukusavapo kwechirwere chekurapa nekushandiswa kwezvinodhaka, kuchinja kwehutano muzvikamu zvakasiyana-siyana zvinoitika nokukurumidza. Nokudaro, varwere ava vanoda kuongororwa kwechiremba, uye kazhinji kakawanda mukunyatsotarisirwa.

Kubvira kwekutonga kuzvimiririra pamusoro pemamiriro ako pachako kunokosha zvikuru pano. Nenzira, mushonga wemazuva ano une chisarudzo chakanaka chezvikonzero zveizvi. Miedzo yakasiyana-siyana uye mazano akasiyana-siyana anotsanangura huwandu hweglucose, anobvumira murwere ane chirwere cheshuga kuti azviongorore kuti aone nezvemamiriro avo uye, zvichienderana nemigumisiro, ita kururamisa.

Insulin muTachiona Cheshuga

Sezvo chirwere ichi chichifambira mberi, kupera kwemasero epaccatic anowedzera insulin anowedzerawo. Izvi zvinoda nguva pfupi kutarisira hormone therapy. Sezvo kutsvakurudza kwemazuva ano kunoratidza, pane dzimwe nguva izvi chete zvinobatsira kuchengetedza mazinga emasukirwo panzvimbo yakakodzera. Kunyange zvakadaro, hazvibviri kufunga kuti chinangwa che insulini ndechehupenyu. Kazhinji rudzi rwechipiri chirwere cheshuga chinonzi diabetes, insulin chinotarisirwa, iyo nhoroondo yezvokurapa inoratidzika inoparadzwa kugadzirisa kudya kwemazuva ose, pane imwe nzira miitiro yemurwere inogona kupinda iyo iyo iyo nguva dzose kutungamirirwa kwei hormone hakudi. Chirwere cheshuga chinotarisa panyaya iyi chinoreva maitiro avanoita apo, kuitira kuti zvive nehutano hwekurapa, kutonga uye kushanda kune chikamu chemu murwere kunokosha zvikuru. Saka, kubva pakuranga kwake pamusoro pekudya, kuzvitarisira kwehuga yepamusoro uye kudya kwenguva yakakodzera yemishonga iyo chikamu chekubhadharwa kwechirwere chichatsigira. Zvisinei, pane dzimwe nguva, kusarudzwa kwe insulini inotarisirwa. Izvi zvinoitika:

• Panguva yekuzvitakura;
• Mukana wekurohwa kana kuora mwoyo;
• Nekupindira kwekuvhiya;
• Nezvirwere zvinotapukira zve purulent-septic character;
• Nekuwedzera kwezviratidzo zve laboratori kuongororwa.

Chimwe chikonzero chinokosha chekugadzwa kwekuchengetedzwa kwe insulini kunogona kuva chirevo chakajeka chemu hormone, iyo inosimbisa nhoroondo yezvokurapa. Rudzi rwechipiri chirwere cheshuga mellitus, iyo decompensation yero inoratidzirwa kuti inonzi progressive kuora muviri uye kukura ketoacidosis, muenzaniso wakajeka weizvi.

Zvinofanira kuonekwa kuti nhasi mishonga yakawedzera zvakanyanya kufanana kwekushandiswa kwe insulin therapy, uye yakanyatsosimbiswa kuti kubudirira kwezwi remuromo ne monotherapy inoramba iri pasi pemakore matanhatu. Zvadaro ndinofanira kurapa mishonga yakawanda. Maererano nemaitiro ekupedzisira ekurapwa kwechirwere cheshuga, kushandiswa kwe insulini mumamiriro ezvinhu akadaro kunofungidzirwa zvakanyanya.

Matambudziko akaoma

Chenjera matambudziko anoitika decompensated - huri ine ngozi chaiyo kune murwere upenyu. Vari kazhinji zvinokonzerwa kuwedzera padanho shuga uye nezvimwe zvinetso zviri muviri. Pamusoro panowanikwa ichi kunokosha uye nenguva rubatsiro, sezvamunozivawo zviratidzo ezvinhu izvi hazvifaniri vanachiremba chete, asiwo manesi, nhoroondo ukoti chirwere vane mhando 2 chirwere cheshuga uye matambudziko ayo vanorondedzerwa sezvinotevera.

1. Hyperglycemic chaanoziva (hyperosmolar uye ketoatsidoticheskaya) - zvavo runoratidza ndiyo zvishoma nezvishoma. Zvinhu zvichiita kuti vave kukwana chipimo chemushonga kana kurashikirwa negashiro jekiseni, zvokudya chirwere (kunyanya kudyiwa makabhohaidhiretsi), maekisesaizi uri yaitwa hyperglycemia, kukundikana kuongorora padanho shuga, doro kana zvimwe mishonga. Akaora, zvinoita sokuti kukura anoverengeka mazuva nyota uye polyuria (wakawedzera weti), zvikuru kupera mvura mumuviri. BP ipfupi, uye tachycardia. Kana Kuipa zvichibvira nokugwinha uye kuora mwoyo kuti pfungwa. Ganda rakaoma zvichibvira anokwenya, acetone kwakanaka panguva nedzinovengwa. Panyaya iyi, munhu anofanira pakarepo muchipatara uye kurapwa.
2. Hypoglycemic chaanoziva - kunokonzerwa rakapinza kudzikisa shuga ropa (asingasviki 3 mmol / l), apo uropi kaviri rakapinza kushaya muviri. Ichi kunogona kumutsa ovhadhozi insulin yakakodzera, kurovha mumwe kudya kana zvisiri akasarudzwa zvokudya, doro kana kushandisa zvinodhaka. Akaora kurwisa hwapedyo nokukurumidza. Dzinoratidzwa ziya chando pahuma, simba, ruoko chakamira pakunodengenyeka zvine, nomusoro, chiveve kwemiromo. The murwere nehasha, taita chikwata masangano avo, pane kurova kwehana, chiono kaviri, kuvhiringidzika. In akazotevera matanho pane kurasikirwa kuziva, pfari. Varwere Prehospital kwakadaro kunogona kupiwa chinonhuhwira zvinobata kana chimwe chinhu chokudya, anodziya uye zvifambiswe kuti vezvokurapa nzvimbo kuti arambe kutarisirwa.

mukupera yematambudziko

yematambudziko kwakadaro rwakavapo decompensated cheshuga, pashure pemakore chirwere. Danger ndechokuti vari zvishoma nezvishoma uye zvisingaoneki achiipa murwere ezvinhu. Uyezve, kazhinji kuverenga chirwere cheshuga mushonga anogona hazvivimbisi kuti pakupedzisira, havangavi kuonekwa.

1. Retinopathy kunoratidzwa maronda of the retina. Zvinosuruvarisa, pasinei nokufambira mberi mune zvokurapa ano, panowanikwa retinopathy pavarwere vane Type II cheshuga, huchavapo kwemakore anopfuura 20, anosvika 100%. zvokurwara ichi chinoita hemorrhages ari fundus, uye pakupedzisira kunotungamirira apedzise kurasikirwa wezvakaonekwa.
2. Angiopathy - vari kutyora vascular permeability, iyo inova chinokonzera thrombosis uye atherosclerosis. Inogona kuva pfupi (rinenge gore), mukusiyana kune mamwe matambudziko-refu kuti kazhinji kuvaremedza kare.
3. Type 2 cheshuga mellitus, chirwere cheshuga polyneuropathy, pakarovererwawo nevakawanda kuomesa, kunonyora muna 90% nyaya. Akaora, ichi anoshandura kukunda tsinga kuti kudzora tsandanyama uye nhengo dzomukati. Polyneuropathy anogona kuratidza hypersensitivity, kungoerekana chenjera (kutsvaira) marwadzo, ichipfuta. Uyewo Kuratidza neuropathy angava chiveve, akaderedza nehanya, zvichiguma makuvaro dzakawanda. Zvomukati zvinogona manyoka, Urinary incontinence, kutemwa nomusoro, dzungu, zvinovhiringidza mubasa mwoyo.
4. rutsoka chirwere cheshuga - kunoratidzwa pakuonekwa makumbo uye, kunyanya pamusoro petsoka chirwere cheshuga venous maronda, abscesses, necrotic nzvimbo. Ndokusaka varwere vanotambura nezvirwere ichi, Zvinokurudzirwa kubhadhara ngwariro chaiyo kusarudzwa shangu.

mataridzikiro

Zvinosuruvarisa, asi pakupedzisira akunde chirwere cheshuga mushonga ano haagoni. Zvisinei, zvingaita zvakanaka kuchinja panguva yakakodzera abnormalities kuti anokonzera yakawedzerwa Kuwanda shuga mumuviri womunhu, kureva mhando 2 chirwere cheshuga mellitus. Nhoroondo chirwere, iyo fungidziro chirwere ichi muna zhinji, kana kwete zvose, achavaponesa mafungiro kwaari zvomurwere. With nokungwarira kudzora naye padanho shuga uye zvimwe zviratidzo, anodiwa chipimo chemushonga kururamiswa, kudhayeta uye vanorumbidza vanachiremba, unogona kudzivisa matambudziko kwemakore akawanda.