Isifo sikashukela i-mellitus sivela ngenxa yokulimazeka kokudla okunemithi emzimbeni kanye nokwanda kokuhlushwa kashukela egazini. Kuhlukaniswa ukwahlukaniswa kwe-WHO, lapho kukhonjiswa khona izinhlobo ezahlukahlukene zezifo.
Ngokwezibalo zika-2017, abantu abangaphezu kwezigidi eziyi-150 baqashelwa njengesifo sikashukela. Eminyakeni yamuva, amacala alesi sifo asebe kaningi kakhulu. Ingozi enkulu yokwakheka kwalesi sifo kwenzeka ngemuva kweminyaka engama-40.
Kunezinhlelo eziqukethe iqoqo lezinyathelo zokunciphisa izehlakalo zesifo sikashukela nokunciphisa ubungozi bokushona. Ukuthola i-glycosylated hemoglobin kwenza sikwazi ukubona isifo sikashukela futhi sinikeze uhlobo lwelashwa.
Izici zemvelaphi nenkambo yalesi sifo
Ukuthuthukiswa kwe-pathology kuthonywa izici eziningi. Uma kunokuqagelwa kokufa, khona-ke amathuba esifo sikashukela aphezulu kakhulu. Lesi sifo singakhula futhi ngenxa yokulimazeka komzimba nokungabikhona kwezinkinga ezinkulu ngezitho ezithile zomzimba. Lesi sifo siyimbangela yenqwaba yezinye izifo ezinzima.
Uhlobo lwe-1 isifo sikashukela senzeka ngenxa yokungasebenzi kahle kwamaseli we-beta. Indlela esebenza ngayo amaseli we-beta abika uhlobo lwesifo. Isifo sikashukela ezinganeni sikhula kunoma iyiphi iminyaka, kufaka phakathi izinsana.
Ukubona lesi sifo, kuyadingeka ukwenza uhlolo lwegazi, izinga likashukela lizobe liphezulu. Udokotela angakhuluma ngesifo sikashukela se-idiopathic esine-insulin ephansi emzimbeni.
Isifo sikashukela sohlobo loku-1 singalunxephezelwa uma isilinganiso se-carbohydrate metabolism sisondele kulowo muntu onempilo. Ukunciphiswa kukhonjiswa ngeziqephu zesikhashana zesikhashana ze-hypoglycemia noma i-hyperglycemia, kuyilapho kungekho kukhubazeka.
Ngokuwohloka, ushukela wegazi ungashintshashintsha kakhulu, kungahle kube nokucaca kanye nokukhohlisa. Ngokuhamba kwesikhathi, i-acetone iyatholakala kumchamo.
Izimpawu zohlobo 1 sikashukela:
- ukoma
- ukuchama kaningi,
- isifiso esinamandla
- ukunciphisa umzimba
- ukonakala kwesikhumba,
- ukusebenza kabi, ukukhathala, ubuthakathaka,
- ukuphathwa ikhanda nekhanda
- ukujuluka okukhulu, ukulunywa kwesikhumba,
- ukugabha kanye nenausea
- ukumelana okuphansi ezifweni,
- Ubuhlungu besisu.
Ama-anamnesis ngokuvamile aqukethe ukungaboni kahle, ukusebenza kwezinso, ukulethwa kwegazi emilenzeni, kanye nokwehla kokuzwela kwezingalo.
Uhlobo lwesifo sikashukela sohlobo 2 luvame ukuvela kubantu abaneminyaka ephakathi nabadala. Lesi sifo sibonwa ngokungaboni kahle kwe-insulin. Lokhu kungenzeka ngenxa yokukhulelwa, isisindo ngokweqile, noma ezinye izinto. Ukugula kwesinye isikhathi kuvela ngasese futhi kungabi nazimpawu ezicacile.
Uhlobo 2 isifo sikashukela:
- iphaphu, ebonakala ngokuqina kwesifo ngokudla noma ngokuhlangana nokusetshenziswa komuthi ofanele,
- isilinganiso lapho ukuqiniswa kwenzeka ngemuva kokudla amaphilisi amaningana omuthi okwehlisa ushukela. Izinkinga ezincane ze-vascular zingase zivele,
- Isigaba esibi senzeka uma ukuzinza kwenziwa kuphela ngamacwecwe anciphisa ushukela kanye ne-insulin, noma kuphela nge-insulin. Izinkinga ezinkulu ze-vascular, nephropathy, retinopathy, ne-neuropathy zivamile.
Umuntu onesifo sohlobo 2 uhlala womile. Kukhona i-itch ku-groin ne-perineum. Isisindo somzimba sikhuphuka kancane kancane, kuvela izifo zokuvuvukala zesikhumba. Ukungavuselelwa kabusha kwezicubu nakho kuyisimilo.
Umuntu uhlala enobuthakathaka bemisipha nokuwohloka okujwayelekile. Imilenze ihlala ikindiki, ama-cramp akuvamile. Umbono ufiphele kancane, izinwele zobuso zikhule kakhulu, futhi emaphethelweni zingawa. Ukhula okuncane okuphuzi kuyavela emzimbeni, imvamisa kuba nokujuluka okukhulu nokulimala kwejwabu.
I-insulin e-Latent itholwa kancane kakhulu, ngoba akukho okubonakaliswayo. Lolu hlobo luvusa izifo zohlelo lwe-vascular system. Ngesikhathi sokwelashwa, kumele kudliwe izondlamzimba zokudla kanye nemithi ebekwe udokotela wakho kufanele isetshenziswe.
Isifo sikashukela singavezwa ngokuhlukile, noma ngabe uhlobo lufana. Ukuvela kwezinkinga kusikisela ukuthi lesi sifo sisesigabeni esithuthukayo. Kunobukhulu obukhulu, isifo sikashukela, ukuhlukaniswa ngezigaba, okunezinhlobo eziningana, kuyehluka ngezinhlobo nezigaba.
Ngesifo esithambile, isifo sikashukela siqhubeka ngaphandle kwezinkinga. Lapho isigaba saphakathi senzeka, ngemuva kwesikhashana izinkinga ziqala:
- ukungaboni kahle
- umsebenzi wezinso ongasebenzi kahle,
- ukungasebenzi kahle kohlelo lwezinzwa oluphakathi.
Ngenkambiso eqinile yesifo, ama-pathologies angathi sína angakhula impilo yomuntu yansuku zonke.
Njengomphumela wokuvela okwenzeka emzimbeni, ukwakheka kwe-glycosylated hemoglobin kuyathuthukiswa. Kukhona inhlanganisela ye-glucose ne-hemoglobin. Izinga lokwakheka kwe-hemoglobin lincike kushukela. Ngokwemiphumela yokuhlaziywa, inani le-hemoglobin, elihlanganiswe noshukela esikhathini esithile esithile, kunqunywa.
I-Glycosylated hemoglobin nayo ikhona kubantu abaphilile, kepha ngamanani amancane. Isifo sikashukela, lezi zinkomba ziphakeme kaningana kunokujwayelekile. Uma inani loshukela libuyela kokujwayelekile, khona-ke kuthatha isikhashana ukuthi i-hemoglobin ibuyele kwesejwayelekile.
Ukusebenza kwezokwelapha kunqunywa lizinga le-hemoglobin.
Ukuhlukaniswa kwesifo sikashukela
Ngokusekelwe ocwaningweni lwesayensi, ochwepheshe abavela ku-WHO badale ukuhlukaniswa kwesifo sikashukela. Le nhlangano ibika ukuthi iningi labantu abanesifo sikashukela banesifo sohlobo 2, abangama-92% sebebonke.
Thayipha isifo sikashukela esingu-1 cishe i-7% yenani eliphelele lamacala. Ezinye izinhlobo zokugula ziba yi-1% yamacala. Cishe i-3-4% yabesifazane abakhulelwe banesifo sikashukela sokukhulelwa.
Abezempilo banamuhla babuye babhekane nodaba lwe-prediabetes. Lesi yisimo lapho izinkomba ezilinganisiwe ze-glucose esegazini sezivele zedlula okujwayelekile, kepha nokho ungafinyeleli kumanani abonakala ngohlobo lwesifo lesi sifo. Njengomthetho, i-prediabetes yandulela isifo esigcwele isifo.
Lesi sifo senziwa ngenxa yokusabela okungajwayelekile komzimba, ngokwesibonelo, ukwehluleka ekusebenzeni kweglucose. Lezi zibonakaliso zibonwa kubantu abanokujwayelekile nabakhuluphele ngokweqile.
Olunye uhlobo lwesifo luhlukaniswa lapho i-glucose icutshungulwa emzimbeni, kepha ngenxa yezinkinga, isimo singashintsha futhi umsebenzi wokuqamba uphazamiseke.
Kusukela ngo-2003, isifo sikashukela sitholakele izindlela ezihlongozwe yi-American Diabetes Association.
Uhlobo lwe-1 mellitus yesifo sikashukela luvela ngenxa yokuqothuka kweseli, yingakho ukuntuleka kwe-insulin kwenzeka emzimbeni. Uhlobo 2 sikashukela i-mellitus siyavela ngoba umphumela wegciwane we-insulin uyaphazamiseka emzimbeni.
Izinhlobo ezithile zikashukela zivela ngenxa yezifo ezahlukahlukene, kanye nokuphazamiseka kwamangqamuzana e-beta. Lokhu kuhlukaniswa manje sekululekwe ngokwemvelo.
Ohlelweni lwe-WHO lwango-1999, kunezinguquko ezithile ekubekweni kwezinhlobo zezifo. Manje kusetshenziswa izinombolo zama-Arabhu, hhayi ezaseRoma.
Ochwepheshe be-WHO emcabangweni we- "gestationalabetes" abafaki lesi sifo hhayi nje ngesikhathi sokukhulelwa, kepha futhi nokuphazamiseka okuthile kwe-carbohydrate metabolism. Lokhu kusho ukwephula umthetho okwenzeka ngesikhathi sokubeletha kwengane, nangemva kwalokho.
Izimbangela zesifo sikashukela sokukhulelwa okwamanje azaziwa. Izibalo zikhombisa ukuthi lesi sifo sivame ukwenzeka kwabesifazane abakhuluphele, uhlobo 2 sikashukela, noma i-ovarian polycystic.
Kwabesifazane, ngesikhathi sokukhulelwa, ukwehla kwezingqinamba zezicubu ze-insulin kungaqala, okuhlinzekelwa ukuguqulwa kwama-hormonal kanye ne-predisposition yefa.
Uhlobo 3 alukhishwe kuhlu lwezinhlobo zezifo, ezingabonakala ngenxa yokungondleki.
Kwaphethwa ngokuthi le nto ingathinta umsoco wamaprotheni, noma kunjalo, ayinakucasula ukuvela kwesifo sikashukela mellitus.
Ukuhlukaniswa Kwesifo Sikashukela Kwamazwe Ngamazwe
Iningi labanesifo sikashukela lingahlukaniswa ngamaqembu amabili: iziguli ezinesifo sikashukela sohlobo lwe-1 isifo sikashukela (DM 1), esihambisana nokushoda kwe-insulin, kanye neziguli ezinomhlobo 2 wesifo sikashukela i-mellitus (DM 2), ezihambisana nokumelana nomzimba kwe-insulin.
Kuvame ukuba nzima ukuthola uhlobo lwesifo sikashukela, ngakho-ke ukufakwa kwesifo esisha sikashukela kusakhiwa manje, okungakavunywa yi-WHO. Ehlukanisweni kunesigaba esithi "Isifo sikashukela mellitusaphakade".
Inani elanele lezinhlobo zesifo sikashukela ezingavuthiwe ezirekhodiwe:
- ukutheleleka
- izidakamizwa
- i-endocrinopathy
- ukungasebenzi kahle kwephaneli,
- izakhi zofuzo.
Lezi zinhlobo zikashukela azihlobene ngokwezifo, ziyahluka ngokwahlukana.
Ukuhlukaniswa kwamanje kwesifo sikashukela ngokuya ngemininingwane ye-WHO kufaka izinhlobo ezi-4 zezifo namaqembu, aqokwa njengokwephulwa komngcele we-glucose homeostasis.
Thayipha isifo sikashukela esincike ku-1 kungaba:
- i-immuno-mediated
- i-idiopathic.
Uhlobo 2 sikashukela mellitus sinokuhlukaniswa:
- ukuphazamiseka kwemingcele kwe-glucose homeostasis,
- ukubekezelela ushukela okhubazekile,
- i-glycemia ephezulu esiswini esingenalutho,
- isifo sikashukela sokukhulelwa ngesikhathi sokukhulelwa,
- ezinye izinhlobo zezifo.
Izifo ze-pancreatic:
- isimila
- i-pancreatitis
- ukulimala
- cystic fibrosis,
- i-fibrosing wokubala i-pancreatitis,
- i-hemochromatosis.
I-Endocrinopathies:
- Isifo sikaCushing
- glucagonoma
- somatostatinoma
- I-thyrotooticosis,
- i-aldosteroma,
- pheochromocytoma.
Ukuphazamiseka kofuzo kwesenzo se-insulin:
- Isifo sikashukela se-lipoatrophic,
- thayipha ukumelana ne-insulin,
- leprechaunism, Donohue syndrome (uhlobo 2 isifo sikashukela, ukubuyiselwa kokukhula kwe-intrauterine, i-dysmorphism),
- IRabson-Mendenhall syndrome (acanthosis, isifo sikashukela kanye ne-pineal hyperplasia),
- Okunye ukwephulwa.
Izinhlobo zokuzivikela ezingejwayelekile zesifo sikashukela:
- Isifo somuntu esiqinile (uhlobo 1 lwesifo sikashukela, ukuqina kwemisipha, izimo zokuphoxeka),
- Ama-antibodies kuma-insulin receptors.
Uhlu lwama-syndromes ahlanganiswe nesifo sikashukela:
- I-Turner syndrome
- Down Down
- I-Lawrence-Moon-Beadle syndrome,
- I-Getington chorea,
- i-tungsten syndrome
- I-Klinefelter syndrome
- i-ataxia yeFriedreich,
- porphyria
- Isifo sePrader-Willi,
- myotonic dystrophy.
Ukutheleleka:
- cytomegalovirus noma endo native rubella,
- ezinye izinhlobo zezifo.
Uhlobo oluhlukile yisifo sikashukela sabesifazane abakhulelwe. Kukhona nohlobo lwesifo esidalwa ngamakhemikhali noma ngemithi.
Ukuxilonga ngokuya ngamazinga we-WHO
Izinqubo zokuxilonga zisuselwa ekubeni khona kwe-hyperglycemia ngaphansi kwezimo ezithile. Izinhlobo zesifo sikashukela ziphakamisa izimpawu ezihlukile. Akuhambisani, ngakho-ke ukungabi bikho kwezimpawu akukukhiphi ngaphandle kokuxilongwa.
I-World World Diagnostic Standard ichaza ukonakala kwemingcele emgodini we-glucose osuselwa emazingeni kashukela wegazi usebenzisa izindlela ezithile.
Yabelana:
- ushukela we-plasma esiswini esingenalutho (okungenani amahora ayisishiyagalombili ngemuva kokudla),
- ushukela wegazi okungahleliwe (nganoma yisiphi isikhathi sosuku, ngaphandle kokudla ukudla),
- i-glycemia emizuzwini engu-120 yokuhlolwa kwe-glucose komlomo nge-75 g ye-glucose.
Isifo sikashukela singatholakala ngezindlela ezintathu:
- ukuba khona kwezimpawu zasendulo zesifo + i-glycemia engahleliwe engaphezu kwe-11.1 mmol / l,
- i-glycemia esiswini esingenalutho ngaphezu kuka-7.0 mmol / l,
- i-glycemia ngomzuzu we-120 we-PTTG ingaphezu kuka-11.1 mmol / l.
Ngokukhuphuka kwe-glycemia, izinga elithile le-glucose ku-plasma yegazi libonisa isisu esingenalutho, yi-5.6 - 6.9 mmol / L.
Ukubekezelela ushukela okhubazekile kubonakaliswa izinga le-glucose lika-7.8 - 11.0 mmol / L emaminithini ayi-120 we-PTTG.
Amanani Avamile
Ushukela wegazi kumuntu ophile kahle kufanele abe ngu-3.8 - 5.6 mmol / l esiswini esingenalutho. Uma i-glycemia ngephutha ingaphezu kuka-11.0 mmol / L egazini le-capillary, kudingeka ukuxilongwa kwesibili, okufanele kuqinisekise ukutholwa.
Uma kungekho i-Symbomatology, khona-ke udinga ukutadisha ukudla kwe-glycemia ezimweni ezijwayelekile. Ukusheshisa i-glycemia ephansi kakhulu kune-5.6 mmol / L akufaki ushukela. Uma i-glycemia ingaphezulu kuka-6.9 mmol / l, khona-ke ukuxilongwa kwesifo sikashukela kuyaqinisekiswa.
I-Glycemia ebangeni le-5.6 - 6.9 mmol / l idinga isifundo ku-PTTG. Ekuhlolweni kokubekezelela ushukela, ushukela ukhonjiswa yi-glycemia ngemuva kwamahora amabili amakhulu kune-11.1 mmol / L. Isifundo sidinga ukuphindwa futhi imiphumela emibili iqhathaniswa.
Ukuxilongwa ngokuphelele kwesifo sikashukela sohlobo 1 nohlobo 2, i-C-peptides isetshenziswa njengesibonakaliso secretion ye-endo native insulin, uma kukhona ukufana kwesithombe sasemtholampilo. Uhlobo lwesifo sohlobo 1, amanani we-basal kwesinye isikhathi ancipha aze abe yi-zero.
Ngohlobo lwesibili lwesifo, inani lingase libe elijwayelekile, kepha ngokumelana ne-insulin, liyanda.
Ngokuthuthukiswa kwalolu hlobo lokugula, izinga lama-C-peptides livame ukwanda.
Izinkinga ezingaba khona
Isifo sikashukela i-mellitus kungaholela ekuwohlokeni okukhulu kwezempilo. Ngokuphikisana nesizinda salesi sifo, amanye ama-pathologies akhula, kungakhathalekile ukuthi kushukela. Izimpawu zizobonakala kancane kancane futhi kubalulekile ukuthi udlule kuzo zonke izigaba zokuhlolwa ukuthola ukutholwa okufanele. Ukuthuthukiswa kwezinkinga zokwelashwa okungafanele kwesifo sikashukela kuphakama nakanjani.
Isibonelo, i-retinopathy ihlala ivela, okuwukuthi, i-retina detachment noma ukuguqulwa kwayo. Ngalesi sifo, ukuphuma kwesibindi emehlweni kungaqala. Uma engalashwa, isiguli singaba impumputhe ngokuphelele. Lesi sifo sibonakaliswa ngu:
- fragility of imithambo yegazi
- ukubukeka kweziqeshana zegazi.
I-Polyneuropathy ukulahleka kokuzwela kokushisa kanye nobuhlungu. Ngaso leso sikhathi, izilonda ezingalweni nasemilenzeni ziqala ukuvela. Yonke imizwa engathandeki inyuka ebusuku. Amanxeba awapholi isikhathi eside, futhi kunamathuba aphezulu okukhula kwe-gangrene.
Isifo sikashukela esibizwa ngokuthi yi-nephropathy sibizwa ngokuthi yi-pathology yezinso, okuvusa imfihlo yamaprotheni emchameni. Imvamisa, ukwehluleka kwezinso kuba khona.
Yiziphi izinhlobo zikashukela ezikhona ezizotshela uchwepheshe kule vidiyo ekulesi sihloko.
