Uhlobo lwe-1 LADA sikashukela ngesimo esithambile

I-LADA - isifo sikashukela se-autoimmune kubantu abadala. Lesi sifo siqala eminyakeni engama-35-65, imvamisa sineminyaka engama-45-55. Ushukela wegazi ukhuphuka ngokulinganisela. Izimpawu ziyefana nohlobo 2 lwesifo sikashukela, ngakho-ke ama-endocrinologists ajwayele ukungawasebenzisi kahle amakhambi. Eqinisweni, i-LADA iyi-1 yesifo sikashukela esesimweni esihle.

Isifo sikashukela se-LADA sidinga ukwelashwa okukhethekile. Uma usiphatha njengohlobo 2 sikashukela esivame ukuphathwa, khona-ke isiguli kufanele sidluliselwe ku-insulin ngemuva kweminyaka engama-3-4. Lesi sifo siqala ukuba nzima. Kufanele ufake imithamo ephezulu ye-insulin. Ushukela wegazi ugxuma kanzima. Uzizwa kabi ngaso sonke isikhathi, izinkinga zesifo sikashukela zikhula ngokushesha. Iziguli zikhubazeka futhi ziyafa.

Abantu abayizigidi ezimbalwa abanesifo sikashukela sohlobo 2 bahlala emazweni akhuluma isiRussia. Kulaba, ama-6-12% empeleni ane-LADA, kepha awazi ngayo. Kepha isifo sikashukela i-LADA kumele siphathwe ngendlela ehlukile, uma kungenjalo, imiphumela iba mibi. Ngenxa yokuxilongwa okungafanele nokwelashwa kwalolu hlobo lwesifo sikashukela, amashumi ezinkulungwane zabantu afa minyaka yonke. Isizathu ukuthi iningi lama-endocrinologists alazi ukuthi i-LADA iyini nhlobo. Bahlonza isifo sikashukela sohlobo 2 kuzo zonke iziguli zilandelana futhi banikeze ukwelashwa okujwayelekile.

Ishukela likashukela we-autoimmune kubantu abadala - ake sibheke ukuthi siyini. I-Latent isho ukuthi ifihliwe. Ekuqaleni kwesifo, ushukela ukhuphuka ngokulinganisela. Izimpawu zimnene, iziguli zithi zibalulekile ngenxa yezinguquko ezihlobene nobudala. Ngenxa yalokhu, isifo sivame ukutholakala sekwephuze kakhulu. Ungaqhubeka ngasese iminyaka eminingana. Isifo sikashukela sohlobo 2 ngokuvamile sinenkambo efanayo. I-Autoimmune - imbangela yalesi sifo ukuhlaselwa kwamasosha omzimba kumaseli we-pancreatic beta. Lokhu kwehlukile kwisifo sikashukela sohlobo lwe-LADA 2, ngakho-ke sidinga ukuphathwa ngendlela ehlukile.

Ungasenza kanjani isifo

I-LADA noma uhlobo 2 sikashukela - ungazihlukanisa kanjani? Ungasibona kanjani isiguli kahle? Iningi labasebenza nge-endocrinologists ababuzi le mibuzo ngoba abasoli ukuthi kukhona isifo sikashukela i-LADA nakancane. Beqa lesi sihloko ekilasini esikoleni sezokwelapha, bese beqhubeka nezifundo zemfundo. Uma umuntu enoshukela omningi maphakathi nexhegu, utholakala ngokuzenzekelayo enesifo sikashukela sohlobo 2.

Kungani kubalulekile esimweni somtholampilo ukuhlukanisa phakathi kwe-LADA ne-Type 2 sikashukela? Ngoba imigomo yokwelashwa kumele ihluke. Ngohlobo 2 sikashukela, ezimweni eziningi, kubekwa amaphilisi anciphisa ushukela. Lawa ama-sulfonylureas kanye nobumba. Abadume kakhulu kubo yi-maninyl, glibenclamide, glidiab, diabepharm, diabeteson, gliclazide, amaryl, glimepirod, glurenorm, novonorm nabanye.

Lawa maphilisi ayingozi ezigulini ezinesifo sikashukela sohlobo 2, ngoba “aqeda” amanyikwe. Funda i-athikili emithini yesifo sikashukela ukuthola eminye imininingwane. Kodwa-ke, ezigulini ezinesifo sikashukela se-autoimmune i-LADA ziyingozi ngokwedlulele izikhathi ezi-3-4. Ngoba ngakolunye uhlangothi, amasosha omzimba ashaya ama-pancreas abo, ngakolunye uhlangothi, amaphilisi alimazayo. Ngenxa yalokhu, amaseli we-beta ancishiswa ngokushesha. Isiguli kufanele sidluliselwe ku-insulin ngemithamo ephezulu ngemuva kweminyaka emi-3-4, okungcono kakhulu, ngemuva kweminyaka engama-5-6. Futhi lapho "ibhokisi elimnyama" liseduze nje ekhoneni ... Kuhulumeni - imali eqhubekayo hhayi ezinkampanini zempesheni.

Ngabe i-LADA ihluke kanjani kwisifo sikashukela sohlobo 2:

1. Njengomthetho, iziguli azinaso isisindo ngokweqile, ziyimizimba emincane.
2. Izinga le-C-peptide esegazini liyehliswa, kokubili esiswini esingenalutho nangemva kokuvuselelwa nge-glucose.
3. Ama-antibodies kumaseli we-beta atholakala egazini (i-GAD - kaningi, i-ICA ​​- ngaphansi). Lokhu kuwuphawu lokuthi amasosha omzimba ahlasela ama-pancreas.
4. Ukuhlolwa kofuzo kungakhombisa ukuthambekela kokuhlaselwa kwe-autoimmune kumaseli e-beta. Noma kunjalo, lokhu kuyindleko ebizayo, futhi ungayenza ngaphandle kwayo.

Isibonakaliso esiyinhloko ukuba khona noma ukungabikho kwesisindo ngokweqile. Uma isiguli sincane (simuncana), khona-ke nakanjani asinaso isifo sikashukela sohlobo 2. Futhi, ukuze kwenziwe isifo ngokuqiniseka, isiguli sithunyelwa ukuyohlola igazi nge-C-peptide. Ungenza futhi nokuhlaziya ama-antibodies, kepha ayabiza ngentengo futhi awatholakali njalo. Eqinisweni, uma isiguli singumzimba omncane noma sigobile umzimba, khona-ke lokhu kuhlaziya akudingeki kakhulu.

Ngokwedlule, kunconywa ukuthi kuhlaziywe ama-antibodies kuma-GAD beta cell ezigulini ezinesifo sikashukela sohlobo 2 esikhuluphele. Uma la ma-antibodies etholakele egazini, lapho-ke imiyalo isho - kuncikene ukunquma amaphilisi asuselwa ku-sulfonylureas nase-ironides. Amagama walezi zibhebhe abhalwe ngaphezulu. Kodwa-ke, kunoma yikuphi, akufanele ukwamukele, noma ngabe ungakanani umphumela wokuhlolwa. Esikhundleni salokho, lawula ushukela wakho ngokudla okuphansi kwe-carb. Ngemininingwane engaphezulu, bona indlela yezinyathelo nezinyathelo zokwelapha isifo sikashukela sohlobo 2. Ama-nuances wokwelapha ushukela we-LADA achazwe ngezansi.

Ukwelashwa kwesifo sikashukela se-LADA

Ngakho-ke, sithole ukuthi lesi sifo sizoxilongwa, manje ake sithole ama-nuances wezokwelashwa. Umgomo oyinhloko wokwelapha isifo sikashukela se-LADA ukugcina ukukhiqizwa kwe-pancreatic insulin. Uma lo mgomo ungafinyeleleka, khona-ke isiguli siphila size siguga kakhulu ngaphandle kwezinkinga ze-vascular nezinkinga ezingadingekile. Ukukhiqizwa okungcono kwe-beta-cell kwe-insulin kugcinwa, yilapho ushukela eqhubeka kalula khona.

Uma isiguli sinalolu hlobo lwesifo sikashukela, khona-ke amasosha omzimba ahlasela ama-pancreas, abhubhisa amaseli we-beta akhiqiza i-insulin. Le nqubo ihamba kancane kuneyesihlobo sikashukela esivamile. Ngemuva kokuthi onke amaseli e-beta efa, lesi sifo siba sikhulu. Ushukela "udlula", kufanele ufake imithamo emikhulu ye-insulin. Eqa ushukela wegazi uyaqhubeka, imijovo ye-insulin ayikwazi ukubathobisa. Izinkinga zesifo sikashukela zanda ngokushesha, isikhathi sokuphila sesiguli siphansi.

Ukuvikela amaseli we-beta ekuhlaselweni kwe-autoimmune, udinga ukuqala ukujova i-insulin ngokushesha ngangokunokwenzeka. Okuhle kunakho konke - ngokushesha ngemuva kokuxilongwa. Imijovo ye-insulin ivikela ama-pancreas ekuhlaselweni amasosha omzimba. Zidingeka ngokuyinhloko kulokhu, futhi ngezinga elincane, ukwenza ushukela wegazi ube ngokwejwayelekile.

I-algorithm ekwelapheni isifo sikashukela i-LADA:

1. Shintshela ekudleni okuphansi kwe-carbohydrate. Lokhu kuyindlela eyinhloko yokulawula isifo sikashukela. Ngaphandle kokudla okune-carbohydrate ephansi, zonke ezinye izindlela ngeke zisize.
2. Funda i-athikili nge-insulin dilution.
3. Funda izindatshana ze-insulin Lantus enwetshiwe, i-levemir, i-protafan nokubalwa kwemithamo ye-insulin esheshayo ngaphambi kokudla.
4. Qala ngokujova i-insulin ende isikhathi eside, noma ngabe, ngenxa yokudla okuphansi kwe-carbohydrate, ushukela awukhuphuki ngaphezu kuka-5.5-6.0 mmol / L esiswini esingenalutho nangemva kokudla.
5. Imithamo ye-insulin izodinga ephansi. Kungcono ukuthi ufake i-Levemir, ngoba ingahlanjululwa, kepha uLantus - cha.
6. I-insulin eyengeziwe kufanele ifakwe umjovo noma ngabe ushukela esiswini esingenalutho futhi ngemuva kokudla ungakhuphuki ngenhla kuka-5.5-6.0 mmol / L. Futhi ngisho nangokwengeziwe - uma ikhuphuka.
7. Qapha ngokucophelela ukuthi ushukela wakho uziphatha kanjani phakathi nosuku. Kukala ekuseni ngesisu esingenalutho, ngaso sonke isikhathi ngaphambi kokudla, bese kuba amahora ama-2 ngemuva kokudla, ebusuku ngaphambi kokulala. Kanye ngesonto futhi ukukala phakathi kobusuku.
8. Ngokuya ushukela, khulisa noma wehlise imithamo ye-insulin ende. Ungadinga ukukukhipha amahlandla ama-2-4 ngosuku.
9. Uma, ngaphandle kwemijovo ye-insulin ende, ushukela usalokhu uphakanyisiwe ngemuva kokudla, kufanele futhi ufake i-insulin ngokushesha ngaphambi kokudla.
10. Akunjalo, ungathathi amaphilisi kashukela - i-sulfonylureas kanye ne-saltides. Amagama abathandwa kakhulu abhalwe ngaphezulu. Uma i-endocrinologist izama ukukunikeza le mithi, mtshengise isiza, wenze umsebenzi wokuchaza.
11. Amathebhulethi weSiofor ne-Glucofage asebenza kuphela kwabanesifo sikashukela esikhuluphele. Uma ungenaso isisindo ngokweqile - ungazithathe.
12. Ukuvivinya umzimba kuyithuluzi elibalulekile lokulawula ushukela ezigulini ezikhuluphele. Uma unesisindo somzimba esijwayelekile, kezivocavoca umzimba ukuze uthuthukise impilo yonke.
13. Akufanele ube nesithukuthezi. Funa injongo yokuphila, uzibekele imigomo ethile. Yenza okuthandayo noma lokho oziqhenyayo ngakho. Isisusa siyadingeka ukuze siphile isikhathi eside, ngaphandle kwalokho asikho isidingo sokuzama ukulawula isifo sikashukela.

Ithuluzi lokulawula isifo sikashukela ekudleni elinama-carbohydrate aphansi kakhulu. Isifundo somzimba, i-insulin nezidakamizwa - emva kwayo. Ngokwesifo sikashukela se-LADA, udinga ukujova i-insulin noma kunjalo. Lokhu ngumehluko omkhulu ekwelashweni kwesifo sikashukela sohlobo 2. Ukufakwa kwemithamo emincane ye-insulin kudingeka kwenziwe, noma ngabe ushukela ucishe uvamile.

Qala ngemijovo ye-insulin enwetshiwe emithanjeni emincane. Uma isiguli sinamathela ekudleni okuphansi kwe-carbohydrate, khona-ke imithamo ye-insulin iyadingeka ngokuncane, singasho, i-homeopathic. Ngaphezu kwalokho, iziguli ezinesifo sikashukela i-LADA zivame ukungabi nesisindo ngokweqile, futhi abantu abanciphile babe namanani amancane we-insulin. Uma unamathela kwirejimeni futhi ujova i-insulin ngendlela eyalwe, ukusebenza kwamaseli we-pancreatic beta kuzoqhubeka. Ngenxa yalokhu, uzokwazi ukuphila ngokujwayelekile kuze kube yiminyaka engama-80-90 noma ngaphezulu - ngempilo enhle, ngaphandle kwama-spikes ushukela kanye nezinkinga zemithambo yegazi.

Amacwecwe esifo sikashukela, angawamaqembu e-sulfonylureas ne-ironides, ayingozi ezigulini. Ngoba badonsa ama-pancreas, yingakho amaseli we-beta efa ngokushesha. Ezigulini ezinesifo sikashukela se-LADA, kuyingozi izikhathi ezingama-3-5 ukwedlula ezigulini ezinesifo sikashukela sohlobo olujwayelekile. Ngoba kubantu abane-LADA, amasosha abo omzimba abhubhisa amaseli we-beta, futhi amaphilisi ayingozi akhulisa ukuhlaselwa kwawo. Ezigulini ezinesifo sikashukela sohlobo 2, ukwelashwa okungafanele “kubulala” ama-pancreas ngeminyaka eyi-10-15, nasezigulini ezine-LADA - imvamisa eminyakeni eyi-3-4. Noma ngabe yisiphi isifo sikashukela onaso - yeka amaphilisi ayingozi, landela ukudla okune-carbohydrate okuphansi.

Isibonelo sempilo

Owesifazane, oneminyaka engama-66 ubudala, ukuphakama okungu-162 cm, isisindo esingu-54-56 kg. Isifo sikashukela iminyaka engu-13, i-autoimmune thyroiditis - iminyaka eyi-6. Ushukela wegazi kwesinye isikhathi ufinyelela ku-11 mmol / L. Kodwa-ke, ngize ngijwayele iwebhusayithi ye-Diabetes-Med.Com, angizange ngilandele ukuthi iguquka kanjani phakathi nosuku. Izikhalazo ze-neuropathy yesifo sikashukela - imilenze iyavutha, bese iba yindawo ebandayo. I-Heredity is bad - ubaba wami wayenesifo sikashukela kanye ne-leg gangrene ngokunqunywa. Ngaphambi kokushintshela ekwelashweni okusha, isiguli sithathe uSiofor izikhathi ezi-2 000 ngosuku, kanye noTiogamma. I-insulin ayizange ifake umjovo.

I-Autoimmune thyroiditis ingumbala we-yegilo yegilo ngenxa yokuthi ihlaselwa amasosha omzimba. Ukuxazulula le nkinga, ama-endocrinologists anqume i-L-thyroxine. Isiguli siyithatha, ngenxa yokuthi ama-hormone we-thyroid egazini ajwayelekile. Uma i-autoimmune thyroiditis ihlanganiswe nesifo sikashukela, khona-ke mhlawumbe uhlobo lweshukela esingu-1. Kubuye kube yisici ukuthi isiguli asikhuluphele. Kodwa-ke, odokotela abaningi be-endocrinologists bathola isifo sikashukela esingu-2 ngokuzimele. Uyabelwe ukuthatha uSiofor futhi unamathele ekudleni okunekhalori ephansi. Omunye wodokotela ngeshwa uthe kuzosiza ukuvikela izinkinga ngomqubuko we-thyroid uma ususa ikhompyutha endlini.

Kusuka kumlobi walesi siza Diabetes-Med.Com, isiguli sathola ukuthi empeleni unesifo sikashukela sohlobo lwe-LADA 1 ngesimo esincane, futhi udinga ukuguqula ukwelashwa. Ngakolunye uhlangothi, kubi ukuthi waphathwa kabi iminyaka eyi-13, yingakho isifo sikashukela sikwazile ukuthuthuka. Ngakolunye uhlangothi, wayenenhlanhla enkulu ukuthi azange anikeze amaphilisi agqugquzela ukukhiqizwa kwe-insulin ngamanyikwe. Ngaphandle kwalokho, namuhla bekungeke kwenzeke kalula kanjalo. Izibhebhe ezilimazayo "ziqeda" ama-pancreas iminyaka engu-3-4, ngemuva kwalokho isifo sikashukela siba namandla.

Njengomphumela wokuguqukela ekudleni okune-carbohydrate ephansi, ushukela wesiguli wehle kakhulu. Ekuseni ngesisu esingenalutho, futhi nangemva kokudla kwasekuseni nangelantshi, kwaba ngu-4.7-5.2 mmol / l. Ngemuva kwesidlo sakusihlwa sekwedlule, cishe 9 p.m. - 7-9 mmol / l. Esizeni, isiguli safunda ukuthi kufanele sidle isidlo sakusihlwa kusenesikhathi, amahora angama-5 ngaphambi kokulala, futhi sahlehlisa isidlo sasebusuku amahora ayi-18 kuya kwayi-19. Ngenxa yalokhu, ushukela kusihlwa ngemuva kokudla nangaphambi kokulala wehlela ku-6.0-6.5 mmol / L. Ngokusho kwesiguli, ukunamathela ngokuqinile ekudleni okune-carbohydrate kulula kakhulu kunokulamba nokudla okudla okune-khalori ephansi odokotela abamyalele kona.

Ukwemukelwa kukaSiofor kukhanseliwe ngoba akukho mqondo weziguli ezithambile nezithambile ezivela kuye. Isiguli besesinesikhathi eside sifuna ukuqala ukujova i-insulin, kodwa sasingazi ukuthi sikwenza kanjani kahle. Ngokwemiphumela yokulawula ushukela ngokucophelela, kwavela ukuthi phakathi nosuku ziziphatha ngokujwayelekile, futhi zivuka kuphela kusihlwa, ngemuva kuka-17,00. Lokhu akuyona into ejwayelekile, ngoba abanesifo sikashukela abaningi banezinkinga ezinkulu noshukela ekuseni esiswini esingenalutho.

Ukulungisa ushukela wakusihlwa ejwayelekile, saqala ngomjovo we-1 IU we-insulin enwetshiwe ngo-11 a.m. Kungenzeka ukudweba umthamo we-1 PIECE ungene kwisirinji kuphela ngokuphambuka kwe-± 0.5 PIECES ohlangothini olulodwa noma kolunye. Esikhathini isirinji kuzoba ngu-0.5-1.5 PIECES we-insulin. Ukuze udle ngokunemba, udinga ukufaka i-insulin. I-Levemir yakhethwa ngoba iLantus ayivunyelwe ukuthi ihlanjululwe. Isiguli sifaka i-insulin amahlandla ayi-10. Ezitsheni ezihlanzekile, uthela ama-PIECES angama-90 we-saline yezomzimba noma amanzi wokujova kanye nama-PIECES ayi-10 eLevemir. Ukuthola umthamo we-1 PIECE we-insulin, udinga ukufaka umjovo ongu-10 WOKUXHUMeka kwalokhu kuhlanganiswa. Ungayigcina esiqandisini izinsuku ezi-3, ngakho-ke iningi lesisombululo liyachitheka.

Ngemuva kwezinsuku ezi-5 zalesi rejimeni, isiguli sabika ukuthi ushukela wakusihlwa usungcono, kepha ngemuva kokudla, usakhuphuka wafika ku-6.2 mmol / L. Azikho iziqephu ze-hypoglycemia. Isimo esinemilenze kubukeka sengathi sesingcono, kepha ufuna ukuqeda ngokuphelele i-neuropathy yesifo sikashukela. Ukuze wenze lokhu, kungakuhle ukuthi ugcine ushukela ngemuva kwako konke ukudla kungabi ngaphezu kuka-5.2-5.5 mmol / L. Sinqume ukwandisa umthamo we-insulin uye kuma-1.5 PIECES futhi sihlehlise isikhathi sokulimala kusuka emahoreni ayi-11 siye emahoreni ayi-13. Ngesikhathi sokubhala, isiguli sikule modi. Imibiko ethi ushukela ngemuva kwesidlo sakusihlwa igcinwe ingaphezulu kakhulu kuka-5.7 mmol / L.

Enye inqubo ukuzama ukushintshela ku-insulin engafakwanga insulin. Okokuqala zama i-unit engu-1 ye-Levemire, khona-ke ngokushesha amayunithi ama-2. Ngoba umthamo ka-1.5 E awusebenzi kwisirinji. Uma i-insulin engasebenzi kahle isebenza ngendlela evamile, kungakuhle ukuthi uhlale kuyo. Kule modi, kuzokwazi ukusebenzisa i-insulin ngaphandle kokuchitha futhi kungabikho sidingo sokuncipha nge-dilution. Ungaya eLantus, okulula ukuyithola. Ukuze uthenge i-Levemir, isiguli bekufanele siye kwiriphabhulikhi esingomakhelwane ... Noma kunjalo, uma amazinga kashukela eba mkhulu nge-insulin engasebenzi, kuzodingeka ubuye noshukela oxutshwe.

Ukuxilongwa kanye nokwelashwa kwesifo sikashukela i-LADA - iziphetho:

1. Izinkulungwane zeziguli ze-LADA ziyafa minyaka yonke ngoba zitholakala ngokungafanele ngesifo sikashukela sohlobo 2 futhi ziphathwa ngendlela engafanele.
2. Uma umuntu engenaso isisindo ngokweqile, khona-ke nakanjani akanaso isifo sikashukela sohlobo 2!
3. Ezigulini ezinesifo sikashukela sohlobo 2, izinga le-C-peptide esegazini lijwayelekile noma liphakeme, futhi ezigulini ezine-LADA, liphansi kunalokho.
4. Ukuhlolwa kwegazi kwama-antibodies kumaseli e-beta kuyindlela eyengeziwe yokuthola kahle uhlobo lwesifo sikashukela. Kungcono ukukwenza uma isiguli sikhuluphele ngokweqile.
5. I-Diabeteson, i-manninil, glibenclamide, glidiab, diabepharm, glyclazide, amaryl, glimepirod, glurenorm, novonorm - amaphilisi ayingozi ohlobo 2 sikashukela. Ungazithathe!
6. Ezigulini ezinesifo sikashukela, amaphilisi e-LADA, abhalwe ngaphezulu, ayingozi ikakhulukazi.
7. Ukudla okune-carbohydrate yikhambi eliyinhloko kunoma yisiphi isifo sikashukela.
8. Imithamo engasho lutho ye-insulin iyadingeka ukulawula uhlobo lwe-1 LADA sikashukela.
9. Akunandaba ukuthi le mithamo incane kangakanani, kudingeka ihlatshwe ngendlela eyiyo, ingasuki emijozweni.