Ukuxilongwa kwesifo sikashukela ezimweni eziningi akunzima kudokotela. Ngoba ngokuvamile iziguli ziphendukela kudokotela sekwephuzile, zisesimweni esibi. Ezimweni ezinjalo, izimpawu zesifo sikashukela zishiwo kakhulu ukuze kungabikho phutha. Imvamisa umuntu onesifo sikashukela uya kudokotela okokuqala hhayi yedwa, kodwa e-ambulensi, ngoba engazi lutho ngohlobo likashukela. Kwesinye isikhathi abantu bathola zodwa izimpawu zesifo sikashukela kubo noma ezinganeni zabo bese beya kudokotela ukuze aqinisekise noma aphikise lokho kutholwa. Kulokhu, udokotela unquma uchungechunge lokuhlolwa kwegazi ngoshukela. Ngokusekelwe emiphumeleni yalezi zivivinyo, kutholakala ukuthi isifo sikashukela siyatholakala. Udokotela futhi unaka ukuthi yiziphi izimpawu isiguli esinazo.
Okokuqala, bahlola igazi likashukela kanye / noma bahlole i-hemoglobin ye-glycated. Lokhu kuhlaziya kungakhombisa okulandelayo:
- ushukela wegazi ojwayelekile, umsoco weglucose onempilo;
- ukubekezelela i-glucose engasebenzi kahle - i-prediabetes;
- ushukela wegazi uphakame kangangokuba uhlobo lwe-1 noma uhlobo 2 sikashukela lungatholakala.
Kusho ukuthini imiphumela yokuhlolwa ushukela wegazi?
| Isikhathi sokuthumela sokuhlaziywa | Ukuhlushwa kwe-glucose, mmol / l | |
|---|---|---|
| Igazi leminwe | Ukuhlolwa kwegazi kwelebhu ushukela ovela emthanjeni | |
| Norm | ||
| Esiswini esingenalutho | < 5,6 | < 6,1 |
| 2 amahora emva kokudla noma ukuphuza ikhambi le-glucose | < 7,8 | < 7,8 |
| Ukubekezelela ushukela okhubazekile | ||
| Esiswini esingenalutho | < 6,1 | < 7,0 |
| 2 amahora emva kokudla noma ukuphuza ikhambi le-glucose | 7,8 - 11,1 | 7,8 - 11,1 |
| Isifo sikashukela mellitus | ||
| Esiswini esingenalutho | ≥ 6,1 | ≥ 7,0 |
| 2 amahora emva kokudla noma ukuphuza ikhambi le-glucose | ≥ 11,1 | ≥ 11,1 |
| Incazelo engahleliwe | ≥ 11,1 | ≥ 11,1 |
Amanothi etafuleni:
- Ngokusemthethweni, kunconywa ukuthi uxilonge isifo sikashukela kuphela ngesisekelo sokuhlolwa kwegazi elabhorethri. Kepha uma isiguli sesikhulumile izimpawu futhi ne-glucometer engenisiwe engenisiwe isetshenziselwa ukuhlaziywa kwegazi kusuka emunweni, khona-ke ungaqala ngokushesha ukwelapha isifo sikashukela ngaphandle kokulinda imiphumela evela elabhorethri.
- Ukuzimisela okungahleliwe - nganoma yisiphi isikhathi sosuku, ngaphandle kwesikhathi sokudla. Kwenziwa phambi kwezimpawu eziphawuliwe zesifo sikashukela.
- Ukuphuza isixazululo sikashukela kuyindlela yokuhlolelwa i-glucose yomlomo. Isiguli siphuza i-75 g ye-glucose enamanzi noma i-82,5 g ye-glucose monohydrate encibilikisiwe ku-250-300 ml wamanzi. Emva kwalokho, ngemuva kwamahora ama-2, igazi lakhe liyahlolwa ushukela. Ukuhlolwa kwenziwa ezimweni ezingabazekayo zokucacisa ukutholakala kwale nkinga. Funda kabanzi ngakho ngezansi.
- Uma ushukela luphakama kowesifazane okhulelwe, khona-ke isifo sikashukela sokutholwa kwesifo sitholakala ngokushesha, sekuvele ngokwemiphumela yokuhlolwa kwegazi kokuqala. Amasu anjalo anconywe ngokusemthethweni ukuze aqale ngokushesha ukwelashwa ngaphandle kokulinda ukuqinisekiswa.
Lokho okubizwa ngokuthi ukungabekezeleleki kwe-glucose, sibheka isifo sikashukela esigcwele ngokuphelele. Odokotela ezimweni ezinjalo abaluxiloli ushukela ukuze bangahlupheki nesiguli, kepha bathumele imzwangedwa ekhaya ngaphandle kokwelashwa. Kodwa-ke, uma ushukela ngemuva kokudla udlula i-7.1-7.8 mmol / L, izinkinga zesifo sikashukela zikhula ngokushesha, kufaka phakathi izinkinga ezinso, imilenze kanye namehlo. Ingozi enkulu yokufa ngenxa yokuhlaselwa yisifo senhliziyo noma unhlangothi kungakapheli iminyaka emi-5 kamuva. Uma ufuna ukuhlala, khona-ke funda uhlelo lokwelapha isifo sikashukela sohlobo 2 bese ulusebenzisa ngokucophelela.
Izici zohlobo 1 sikashukela
Uhlobo 1 sikashukela i-mellitus kwesinye isikhathi siqala ngokungenangqondo, futhi isiguli ngokushesha siba nezinkinga ezinzima ze-metabolic. Imvamisa, i-comma yesifo sikashukela noma i-acidosis enzima ibonwa ngokushesha. Izimpawu zohlobo lwesifo sikashukela sohlobo lokuqala ziqala ukuvela ngokuzenzakalela noma amasonto angama-2-4 emva kokutheleleka. Ngokuphazima kweso, isiguli sibona umlomo owomile, womile kuze kube amalitha ama-3-5 ngosuku, isifiso sokudla (i-polyphagy). Ukuchama nakho kuyanda, ikakhulukazi ebusuku. Lokhu kubizwa nge-polyuria noma isifo sikashukela. Konke lokhu okungenhla kuhambisana nokuncipha kakhulu kwesisindo, ubuthakathaka, nokusikeka kwesikhumba.
Ukumelana nomzimba ezifweni kuyancipha, futhi izifo ezithathelwanayo zivame ukuvela. Emavikini okuqala esifo sikashukela sohlobo 1, i-acuity ebonakalayo ivame ukuwa. Akumangazi, ngokumelene nesizinda sezimpawu ezinamandla kangaka, i-libido ne-potency ziyancishiswa. Uma isifo sikashukela sohlobo 1 singatholakali ngesikhathi futhi kungaqali ukwelashwa, khona-ke ingane noma isifo sikashukela esidala siya kudokotela esimweni se-ketoacidotic coma ngenxa yokuntuleka kwe-insulin emzimbeni.
Isithombe somtholampilo sesifo sikashukela sohlobo 2
Uhlobo 2 sikashukela i-mellitus, njengomthetho, iba kubantu abaneminyaka engaphezu kwengama-40 abakhuluphele ngokweqile, futhi izimpawu zayo zanda kancane kancane. Isiguli kungenzeka singazizwa noma sinake ukuwohloka kwempilo yakhe kuze kube iminyaka eyi-10. Uma isifo sikashukela singatholakali futhi selashwa sonke lesi sikhathi, kuba nezinkinga ze-vascular. Iziguli zikhononda ngobuthakathaka, kwehlise inkumbulo yesikhashana, nokukhathala okusheshayo. Zonke lezi zimpawu zivame ukubangelwa yizinkinga ezihlobene nobudala, kanti ukutholwa koshukela osezingeni eliphezulu kwenzeka ngengozi. Ngesikhathi sokuhlonza isifo sikashukela sohlobo 2 kusiza ukuhlolwa okuhleliwe okuhleliwe kwabasebenzi bamabhizinisi nezinhlangano zikahulumeni.
Cishe zonke iziguli ezitholakala zinesifo sikashukela sohlobo 2, kutholakala izici zobungozi:
- ukuba khona kwalesi sifo emndenini oseduze;
- ukuthambekela kwemindeni ngokweqile;
- kwabesifazane - ukuzalwa kwengane enesisindo somzimba esingaphezu kwamakhilogremu amane, kwakhuphuka ushukela ngesikhathi sokukhulelwa.
Izimpawu ezithile ezihambisana nesifo sikashukela sohlobo 2 zomile kuze kufike kumalitha angama-3-5 ngosuku, ukuchama kaningi ebusuku, futhi amanxeba awaphili kahle. Futhi, izinkinga zesikhumba ziyayeka, izifo zokukhunta. Iziguli zivame ukunaka lezi zinkinga kuphela lapho sezivele zilahlekelwe ngama-50% esisindo esisebenzayo samaseli we-pancreatic beta, i.e. isifo sikashukela sinakwa kakhulu. Ezigulini ezingama-20-30%, isifo sikashukela sohlobo 2 sitholakala kuphela lapho esibhedlela ngenxa yokuhlaselwa yisifo senhliziyo, unhlangothi, noma ukulahlekelwa umbono.
Isifo Sikashukela
Uma isiguli sinezimpawu ezinzima zesifo sikashukela, khona-ke ukuhlolwa okukodwa okukhombise ushukela wegazi owanele kwanele ukwenza ukuxilongwa bese kuqala ukwelashwa. Kepha uma ukuhlolwa kwegazi ushukela kuphume kukubi, kepha umuntu akanazimpawu nakancane noma ababuthaka, khona-ke ukutholakala kwesifo sikashukela kuba nzima ngokwengeziwe. Kubantu abangenaso isifo sikashukela i-mellitus, ukuhlaziya kungakhombisa ushukela wegazi ophakeme ngenxa yokutheleleka kakhulu, usizi noma ukucindezela. Kulokhu, i-hyperglycemia (ushukela wegazi ophakeme) ihlala iba yisikhashana, i.e. yesikhashana, futhi ngokushesha konke kuzobuyela kwesejwayelekile ngaphandle kokwelashwa. Ngakho-ke, izincomo ezisemthethweni ziyakwenqabela ukutholakala kwesifo sikashukela kususelwa ekuhlaziyweni okukodwa okungaphumelelanga uma kungekho zimpawu.
Esimweni esinjalo, kwenziwa isivivinyo esengeziwe sokubekezelela ushukela we-glucose (PGTT) ukuqinisekisa noma ukuphika ukutholwa. Okokuqala, isiguli sithatha isivivinyo segazi sokuzila ushukela ekuseni. Ngemuva kwalokho, uphuza ngokushesha amanzi angama-250-300 ml, lapho kuwo u-75 g we-glucose we-anhydrous noma u-82,5 g we-glucose monohydrate. Ngemuva kwamahora ama-2, kwenziwa isampula yegazi ephindaphindwe lapho kuhlaziywa ushukela.
Umphumela we-PGTT yisibalo “ushukela we-plasma ngemuva kwamahora ama-2” (2hGP). Kusho okulandelayo:
- I-2hGP <7.8 mmol / L (140 mg / dl) - ukubekezelela ushukela ojwayelekile
- I-7.8 mmol / L (140 mg / dL) <= 2 hGP <11.1 mmol / L (200 mg / dL) - ukubekezelela ushukela okhubazekile
- I-2hGP> = 11.1 mmol / l (200 mg / dl) - ukuhlolwa kokuqala kwesifo sikashukela. Uma isiguli singenazimpawu, khona-ke sidinga ukuqinisekiswa ngokuqhuba ezinye izikhathi ezi-1-2 ezinsukwini ezimbalwa ezizayo.
Kusukela ngo-2010, i-American Diabetes Association ikhuthaze ngokusemthethweni ukusetshenziswa kohlolo lwegazi lwe-glycated hemoglobin ukuthola isifo sikashukela (yenza lolu vivinyo! Ncoma!). Uma inani lalesi sikhombisi iHbA1c> = 6.5% selitholakala, khona-ke isifo sikashukela kufanele sitholakale, sikuqinisekisa ngokuhlolwa okuphindaphindwe.
Ukuxilongwa okuhlukile kwesifo sikashukela sohlobo lwe-1 no-2
Azikho ngaphezu kwezi-10-20% zeziguli ezinesifo sikashukela sohlobo 1. Bonke abanye banesifo sikashukela sohlobo 2. Ezigulini ezinesifo sikashukela sohlobo loku-1, izimpawu zikhulu, ukuqala kwalesi sifo kubukhali, futhi ukukhuluphala kuvame ukungabikho. Iziguli ezinesifo sikashukela sohlobo 2 zivame ukuba ngabantu abakhuluphele abaphakathi kweminyaka nabadala. Isimo sabo asisibi kangako.
Ekutholakalweni kwesifo sikashukela sohlobo 1 nohlobo 2, kusetshenziswa ukuhlolwa kwegazi okwengeziwe:
- ku-C-peptide yokunquma ukuthi ama-pancreas akhiqiza i-insulin yayo yini;
- kuma-autoantibodies kuma-pancreatic beta-cell uqobo ama-antigen - zivame ukutholakala ezigulini ezinesifo sikashukela sohlobo lwe-autoimmune;
- emizimbeni ye-ketone esegazini;
- ucwaningo lofuzo.
Sikulethela ukunakekela kwakho i-algorithm yokuxilonga eyingqayizivele yohlobo 1 nohlobo 2 lwesifo sikashukela:
| Thayipha isifo sikashukela sokuqala | Thayipha isifo sikashukela sesi-2 |
|---|---|
| Iminyaka yokuqala kwalesi sifo | |
| kuze kube iminyaka engama-30 | emva kweminyaka engama-40 |
| Isisindo somzimba | |
| ukusilela | ukukhuluphala ku-80-90% |
| Ukuqala kwezifo | |
| Isipayisi | kancane kancane |
| Isikhathi sesifo | |
| inkathi yasekwindla-ebusika | ulahlekile |
| Inkambo yesifo sikashukela | |
| kukhona okwandisa | uzinzile |
| I-ketoacidosis | |
| ukuthambekela okuphezulu kwe-ketoacidosis | imvamisa ayikhulisi; kulinganiselwe ezimweni ezicindezelayo - usizi, ukuhlinzwa, njll. |
| Ukuhlolwa kwegazi | |
| ushukela uphezulu kakhulu, imizimba ye-ketone ngokweqile | ushukela uphakeme ngokulingana, imizimba ye-ketone ijwayelekile |
| I-Urinalysis | |
| ushukela kanye ne-acetone | ushukela |
| I-insulin ne-C-peptide esegazini | |
| kuncishisiwe | okujwayelekile, kuvame ukuphakanyiswa; kuncishiswe ngohlobo lwesifo sikashukela esijwayelekile esingu-2 |
| Ama-antibodies kumaseli we-beta aslet | |
| kutholwe ku-80-90% emavikini okuqala alesi sifo | abekho |
| I-Immunogenetics | |
| I-HLA DR3-B8, DR4-B15, C2-1, C4, A3, B3, Bfs, DR4, Dw4, DQw8 | akukho okuhlukile kubantu abaphilile |
Le algorithm yethulwe encwadini ethi “Diabetes. Ukuxilongwa, ukwelashwa, ukuvimbela "ngaphansi kokuhlela kwe I.I.Dedova, M.V. Shestakova, M., 2011
Kuhlobo lwesifo sikashukela sohlobo 2, i-ketoacidosis ne-diabetesica kuyivelakancane kakhulu. Isiguli siphendula amaphilisi sikashukela, kuyilapho ngohlobo 1 sikashukela kungasabeli kangako. Uyacelwa ukuthi uqaphele ukuthi kusukela ekuqaleni uhlobo lwe-XXI lwe-2 yesifo sikashukela seluncane kakhulu ". Manje lesi sifo, yize sinqabile, sitholakala kwabasesezingeni lokungena ebusheni ngisho nakwiminyaka eneminyaka engu-10 ubudala.
Izidingo zokuxilongwa kwesifo sikashukela
Ukuxilongwa kungenzeka kube:
- thayipha i-1 isifo sikashukela;
- uhlobo 2 sikashukela;
- isifo sikashukela ngenxa [ekhombisa isizathu].
Ukuxilongwa kuchaza kabanzi izinkinga zesifo sikashukela isiguli esinaso, okungukuthi, izilonda zemithambo yegazi emincane nemincane (i-micro- ne-macroangiopathy), kanye nohlelo lwezinzwa (i-neuropathy). Funda i-athikili enemininingwane, Izinkinga Eziyingozi Zesifo Sikashukela. Uma kunesifo sikashukela sonyawo lwesifo sikashukela, bese unaka lokhu, okubonisa ukwakheka kwawo.
Izinkinga zesifo sikashukela embonweni - zibonisa isigaba se-retinopathy esweni lokunene nesobunxele, noma ngabe kwenziwa i-laser retinal coagulation noma okunye ukwelashwa okuhlinzwa. Isifo sikashukela se-nephropathy - izinkinga ezenzeka ezinso - zikhombisa isigaba sesifo sezinso esingamahlalakhona, ukuhlolwa kwegazi nomchamo. Uhlobo lwe-neuropathy yesifo sikashukela lunqunywe.
Izilonda zemithambo yegazi emikhulu:
- Uma kunesifo senhliziyo esiku-coronary, bese ukhombisa ukwakheka kwawo;
- Ukwehluleka kwenhliziyo - kukhombisa isigaba sayo sokusebenza ngokusho kwe-NYHA;
- Chaza izingozi ze-cerebrovascular ezitholakele;
- Izifo ezingapheli eziqeda amandla emithanjeni yemikhawulo engezansi - ukuphazamiseka kokujikeleza emilenzeni - kukhombisa isigaba sabo.
Uma isiguli sinomfutho wegazi ophakeme, khona-ke lokhu kuyaphawulwa ekuxilongeni futhi kuboniswe nezinga le-hypertension. Imiphumela yokuhlolwa kwegazi kwe-cholesterol embi nokuhle, ama-triglycerides anikezwa. Chaza ezinye izifo ezihambisana noshukela.
Odokotela abanconywanga ekuxilongeni ukuthi basho ubulukhuni besifo sikashukela esigulini, ukuze bangahlanganisi izahlulelo zabo eziphathelene nemininingwane efanele. Ubunzima balesi sifo bunqunywa ubukhona bezinkinga nokuthi bukhulu kangakanani. Ngemuva kokuthi ukuxilongwa kwakheke, kwaboniswa izinga likashukela egazini, okufanele isiguli silwele kulo. Ihlelwe ngawodwana, kuya ngeminyaka, izimo zenhlalo yomnotho kanye nokulindelwa kwempilo yesifo sikashukela. Funda kabanzi “Izinhlobo zoshukela wegazi”.
Izifo ezivame ukuhlanganiswa nesifo sikashukela
Ngenxa yesifo sikashukela, ukungasebenzi komzimba kuyancipha kubantu, ngakho-ke kubanda umkhuhlane kanye nezinduna. Ku-diabetes, izifo zokuphefumula zinzima kakhulu, zingaba izifo ezingamahlalakhona. Iziguli zohlobo 1 nohlobo 2 ezinoshukela zinamathuba amaningi okuba nesifo sofuba kunabantu abanoshukela wegazi ojwayelekile. Isifo sikashukela nesifo sofuba kungumthwalo womabili umthwalo. Lezi ziguli zidinga ukuqashelwa udokotela we-TB impilo yakho yonke ngoba zihlala zinobungozi obukhulu bokwandisa inqubo yesifo sofuba.
Ngenkambo ende yesifo sikashukela, ukukhiqizwa kwama-enzymes wokugaya ngama-pancreas kuyancipha. Isisu namathumbu kusebenza kabi. Lokhu kungenxa yokuthi isifo sikashukela sithinta imithambo eyondla ipheshana le-gastrointestinal, kanye nezinzwa ezikulawulayo. Funda kabanzi esihlokweni esithi "Diabetesic gastroparesis". Izindaba ezimnandi ukuthi isibindi cishe asinaso isifo sikashukela, futhi ukulimala kwendlela yomgudu wesisu kuphindeka kubuyele emuva uma isinxephezelo esihle sitholakala, okuwukuthi, sigcina ushukela ojwayelekile ojwayelekile ozinzile.
Kuhlobo 1 nesifo sikashukela sohlobo 2, kunengozi eyandayo yezifo ezithathelwanayo zezinso nezinhlungu zomchamo. Le yinkinga enkulu, enezizathu ezi-3 ngasikhathi sinye:
- ukunciphisa ukungatheleleki kweziguli ;;
- ukuthuthukiswa kwe-neuronomic ye-autonomic;
- I-glucose ethe xaxa egazini, amagciwane asondelene kakhudlwana azizwa ekhululekile.
Uma ingane inokuphathwa kahle sikashukela isikhathi eside, khona-ke lokhu kuzoholela ekukhuleni okulimazayo. Kunzima kakhulu kwabesifazane abasebasha abanesifo sikashukela ukukhulelwa. Uma bekungenzeka ukuthi ukhulelwe, khona-ke ukuphuma nokukhipha umntwana onempilo kuyinkinga ehlukile. Ukuthola eminye imininingwane, bheka isihloko esithi “Ukwelashwa kwesifo sikashukela kwabesifazane abakhulelwe.”
