Ukuqunjelwa ushukela egazini kuyinkomba eyinhloko lapho kulinganiselwa khona i-carbohydrate metabolism emzimbeni. Kumuntu ophilile, uyi-3.3-5.5 mmol / L.
Amapharamitha we-glycemic anjalo angaba ngaphambi kokudla. Emini, ingashintsha ngaphansi kwethonya le-glucose kusuka ekudleni, ekusebenzeni ngokomzimba, ekucindezelekeni kwengqondo nangokomzwelo, nokuthatha umuthi.
Ukuchezuka okunjalo ngokuvamile akudluli i-30%, ngokukhuphuka kwe-glycemia, i-insulin ekhishwe ngokwanele ukwenza i-glucose kumaseli. Ku-mellitus yesifo sikashukela, ukuntuleka kwe-insulin kwenzeka futhi ushukela wegazi uhlala uphakeme njalo.
Ushukela onxephezelwe futhi obolile
Inkambo yesifo sikashukela i-mellitus ingahluka ngokuya ngokuthi ukudla okungakanani, umuthi kanye nokuzivocavoca komzimba kungafinyelela isinxephezelo sikashukela wegazi ophezulu. Ngesifo esinxephezelwe kahle, iziguli zihlala zisebenza kahle futhi zinenhlalo isikhathi eside.
Ngale kokuhlukahluka kwesifo sikashukela i-mellitus, amapharamitha aphambili we-glycemia asondelene nokujwayelekile, ushukela kumchamo awunqunywa, awekho ama-surges abukhali kushukela wegazi, izinga le-glycated hemoglobin alidluli ku-6.5%, futhi ukwakheka kwe-lipid kwegazi nomfutho wegazi kuhluke kancane kokuphilayo.
Uhlobo lwesifo sikashukela olungaphansi lwenzeka lapho i-glycemia ikhuphuka ifinyelela ku-13.9 mmol / l, i-glucosuria kwenzeka, kepha umzimba ulahlekelwa ushukela ongadluli kuma-g g ngosuku.Ushukela kuleli cala uhambisana nokuguquguquka okukhulu kushukela wegazi, kepha ikoma alikho. Ingozi eyandayo yokuqhamuka nezinkinga zenhliziyo nemithambo yegazi.
Isifo sikashukela sibhekwa njengento ebanjisiwe kula mazinga:
- Ukusheshisa i-glycemia kungaphezu kwe-8.3 mmol / l, futhi phakathi nosuku - ngaphezulu kwe-13.9 mmol / l.
- I-glucosuria yansuku zonke ngaphezulu kwe-50 g.
- I-Glycated hemoglobin ingaphezulu kwe-9%.
- Khuphula i-cholesterol yegazi ne-low density lipids.
- Umfutho wegazi ungaphezulu kwe-140/85 mm Hg. Ubuciko.
- Izidumbu zeKetone zivele egazini nomchamo.
Ukwehliswa kwesifo sikashukela kubonakaliswa ukuthuthukiswa kwezinkinga ezinzima nezingamahlalakhona. Uma ushukela wegazi ungama-15 mmol / l, khona-ke lokhu kungaholela ekutheni abe nesifo sikashukela, esingenzeka ngesimo se-ketoacidotic noma i-hyperosmolar state.
Izinkinga ezingalapheki ziba nokukhula isikhathi eside koshukela, imvamisa ngaphezulu kweminyaka eminingana.
Lokhu kufaka phakathi isifo sikashukela se-polyneuropathy, ngokwenziwa kwesifo sikashukela sikashukela, i-nephropathy, i-retinopathy, kanye ne-systemic micro- kanye ne-macroangiopathies.
Izizathu zokunqunywa kwesifo sikashukela
Imvamisa, isidingo esandayo se-insulin siholela ekwephulweni kwesinxephezelo sikashukela ngokumelene nesizinda sezifo ezithathelanayo ezihlobene, izifo ezihlangana zezitho zangaphakathi, ikakhulukazi uhlelo lwe-endocrine, ngesikhathi sokukhulelwa, ukukhula ngesikhathi sobusha kanye nokuphikisana nokwanda kwe-psychoemotional overstrain.
Ukwanda okuthe xaxa koshukela wegazi kuya ku-15 mmol / l nangaphezulu kungaba nokuphazamiseka okuthe xaxa ekuhlinzekweni kwegazi kuya ebuchosheni nasenhlizweni yenhliziyo, ukulimala, ukungenelela kokuhlinzwa, ukushiswa, kanti izinga le-hyperglycemia lingaba uphawu lokuxilonga lokuhlola ubukhulu besimo sesiguli.
Ukunqunywa komthamo okungalungile kwemithi ye-insulin noma ye-hypoglycemic kungadala ukwanda koshukela wegazi. Iziguli zingaphazamisa ngokuzenzakalelayo inkambo yokwelashwa noma zokwephula umthetho wokudla okufihliwe.
Uma kungekho ukulungiswa kwamthamo ngenxa yokuvinjelwa okuphoqelelwe kokusebenza ngokomzimba, i-glycemia ingakhula kancane kancane.
Izimpawu zokukhula kwe-hyperglycemia
Ukwanda ushukela wegazi kungaba bukhali. Lokhu kutholakala kakhulu ngohlobo olusanda kutholwa lwesifo sikashukela, ngoba i-insulin ayikho emzimbeni, uma ingaqalwa ngomjovo, iziguli ziwela enkingeni.
Ngokuthola kwesifo sikashukela i-mellitus ngokumelene nesizinda somuthi wokwelashwa, izimpawu ze-hyperglycemia zanda kancane kancane. Iziguli zikhulise ukoma, isikhumba esomile, ukuphuma komchamo, ukunciphisa umzimba. Lokhu kungenxa yokuthi ushukela wegazi ophakeme uholela ekusatshalalisweni koketshezi lwezicubu, lungena emithanjeni.
Uma ingekho i-insulin eyanele egazini, khona-ke izinqubo zokuphuka kwe-lipid ziqala ukubonakala ezicutshini ze-adipose, ama-asidi wamafutha wamahhala ngenani elandayo avela egazini. Kulezi, imizimba ye-ketone yakha kumaseli wesibindi, ingumthombo wamandla womzimba ngokudla okunganele kwe-glucose.
Imizimba yeKetone inobuthi ebuchosheni, ayikwazi ukusetshenziselwa umsoco esikhundleni sama-molecule we-glucose, ngakho-ke, ngokuqukethwe kwayo okuphezulu egazini, kuvela izimpawu ezinjalo:
- Ubuthakathaka obukhali, ukozela.
- Isicanucanu, ukuhlanza.
- Ukuphefumula kaningi futhi okunomsindo.
- Ukulahleka kancane kancane.
Isibonakaliso esibonakalayo se-ketoacidosis kushukela sinephunga le-acetone elisuka emlonyeni. Ngaphezu kwalokho, izimpawu zesisu esibuhlungu ziyabonakala ngenxa yokucasulwa kolwelwesi lwe-mucous lwesisu namathumbu yimizimba ye-ketone, ama-hemorrhage amancane akhombe ku-peritoneum, kanye nokungalingani kwe-electrolyte.
Izinkinga ze-ketoacidosis zingaba yi-pulmonary ne-cerebral edema, okuvame ukwenzeka ekwelashweni okungafanele, i-thromboembolism ngenxa yokuphelelwa ngamandla emzimbeni nokuqina kwegazi, kanye nokunameka kokutheleleka ngegciwane.
Ukuxilongwa kwe-ketoacidosis
Izimpawu ezinkulu lapho izinga le ketoacidosis lingahlolwa ngalo wukungaphezulu kokujwayelekile kokuqukethwe kwemizimba ye-ketone egazini: ngesilinganiso se-acetone, i-acetoacetic ne-beta-hydroxybutyric acid kuze kufike ku-0,15 mmol / l, kodwa lidlula inani lama-3 mmol / l, kepha lingakhuphuka ngamashumi wezikhathi. .
Izinga loshukela wegazi ngu-15 mmol / l, ushukela ekugxileni okubalulekile kutholakala umchamo. Ukusabela kwegazi kungaphansi kwe-7.35, futhi ngesilinganiso esinamandla se-ketoacidosis ngaphansi kwe-7, okubonisa i-metabolic ketoacidosis.
Izinga le-sodium ne-potaziyamu liyancipha ngenxa yokuthi uketshezi oluvela kumaseli lungena esikhaleni esingaphezulu, futhi i-osmotic diuresis iyanda. Lapho i-potassium ishiya ingqamuzana, okuqukethwe kuyo egazini kuyanda. I-leukocytosis, ukwanda kwe-hemoglobin ne-hematocrit ngenxa yokuqina kwegazi kuyaphawulwa.
Lapho wamukelwa ophikweni lokunakekela olunzulu qapha izinkomba ezilandelayo:
- I-Glycemia - kanye ngehora ngokuphathwa kwe-insulin, njalo ngamahora ama-3 ngokuqothuka. Kufanele yehle kancane.
- Imizimba yeKetone, ama-electrolyte egazini kanye ne-pH kuze kube yilapho kuvamile ukuzinza.
- Ukuzimisela ngehora nge-diuresis ngaphambi kokuqothulwa komzimba.
- Ukuqashwa kwe-ECG.
- Ukukalwa kokushisa komzimba, umfutho wegazi njalo emahoreni ama-2.
- Ukuhlolwa kwe-X-ray esifubeni.
- Ukuhlolwa kwegazi nomchamo kuvame njalo ezinsukwini ezimbili.
Ukwelashwa nokubhekwa kweziguli kwenziwa kuphela kumayunithi wokunakekelwa noma kwizigceme (ekunakekelweni okunzulu). Ngakho-ke, uma ushukela wegazi engu-15 kufanele wenzeni kanye nemiphumela esongela isiguli ingahlolwa kuphela udokotela ngokuya ngokuhlolwa kwelebhu okuqhubekayo.
Kwenqatshelwe ngokuphelele ukuzama ukwehlisa ushukela ngokwakho.
Ukwelashwa kwe-ketoacidosis yesifo sikashukela
Ukuqashelwa kwesimo sikashukela se-ketoacidotic kunqunywa ukusebenza ngempumelelo kokwelashwa. Isifo sikashukela i-mellitus ne-ketoacidosis yesifo sikashukela ndawonye kuholela ekufeni kwe-5-10%, nakumaqembu aneminyaka engaphezu kwengu-60 nangaphezulu.
Izindlela eziphambili zokwelashwa ukuphathwa kwe-insulin ukucindezela ukwakheka kwezidumbu ze-ketone kanye nokuqhekeka kwamafutha, ukubuyisa izinga lamanzi kanye nama-electrolyte ayisisekelo emzimbeni, i-acidosis kanye nokuqeda izimbangela zalokhu kucindezelwa.
Ukuqeda ukomisa, usawoti womzimba ufakwa ngesilinganiso se-1 litre ngehora, kepha uma kunokuntuleka kwenhliziyo noma izinso, kungancipha. Ukuzimisela kobude nobungako besixazululo esiveziwe kunqunywa esimweni ngasinye ngazinye.
Esigabeni sokunakekelwa okujulile, ukwelashwa kwe-insulin kunqunywa ngobunjiniyela obufushane bezofuzo noma amalungiselelo enziwe ngokwenziwa kwezinhlelo ezilandelayo:
- Ngokuxakayo, kancane, ama-PIECES ayi-10, bese kwehla ama-5 PIECES / ihora, ama-albhamu angama-20% engezwa ukuvikela ukubonwa kokudilika ezindongeni ze-dropper. Ngemuva kokunciphisa ushukela ube ngu-13 mmol / l, isilinganiso sokuphatha sincishiswa amahlandla ama-2.
- Kwi-dropper ngesilinganiso se-0.1 PIECES ngehora elilodwa, bese wehla ngemuva kokuqiniswa kwe-glycemic.
- I-insulin ilawulwa nge-intramuscularly kuphela ngesilinganiso esiphansi se-ketoacidosis yamayunithi ayi-10-20.
- Ngokuncipha koshukela ukuya ku-11 mmol / l, baphendukela kumijovo engabonakali ye-insulin: amayunithi ama-4-6 njalo emahoreni ama-3,
Ngokubuyisela amanzi emzimbeni, isixazululo se-physiological sodium chloride siyaqhubeka sisetshenziswe, khona-ke isisombululo se-glucose esingu-5% singabekwa kanye ne-insulin. Ukubuyisela okuqukethwe okujwayelekile kwezinto ezilandelwayo kusetshenziswa izixazululo eziqukethe i-potassium, magnesium, phosphates. Ochwepheshe bavame ukwenqaba ukwethula i-sodium bicarbonate.
Ukwelashwa kubhekwa njengempumelelo uma ukubonakaliswa kwemitholampilo kwe-ketoacidosis yesifo sikashukela kuqedwa, amazinga kashukela asondele kumanani okugxilwe kuwo, imizimba ye-ketone ayiphakanyisiwe, ukwakheka kwe-electrolyte kanye ne-acid-base kwegazi kusondele kumanani wokomzimba. Iziguli, kungakhathalekile ukuthi hlobo luphi lwesifo sikashukela, ziboniswa ukwelashwa kwe-insulin esibhedlela.
Ividiyo ekulesi sihloko inikeza izincomo zokunciphisa ushukela wegazi.
