I-diabetes mellitus yisifo esiyingozi lapho izinqubo ze-metabolic, kufaka phakathi i-carbohydrate metabolism, ziphazamiseka. Lesi sifo sinenkambo engapheli, futhi singelashwa ngokuphelele, kepha singanxeshezelwa.
Ukuze ungabi nezinkinga zesifo sikashukela, kuyadingeka ukuthi uvakashele njalo i-endocrinologist kanye ne-Therapist. Kubalulekile ukuqapha izinga leshukela, okufanele lisuke ku-4 liye ku-6.6 mmol / l.
Wonke umuntu onesifo sikashukela kufanele azi ukuthi imiphumela ye-hyperglycemia engapheli ivame ukuholela ekukhubazekeni ngisho nasekufeni, kungakhathalekile ukuthi hlobo luni lwesifo. Kepha yiziphi izinkinga zikashukela ezingaba khona futhi kungani zivela?
Izinkinga zesifo sikashukela: indlela yokuthuthuka
Kumuntu ophile kahle, ushukela kufanele angene kumaseli omzimba nemisipha, awanikeze amandla, kepha kwisifo sikashukela uhlala emgudwini wegazi. Njengoba kunoshukela ophakeme njalo, okuyi-hyperosmolar, izindonga zemithambo yegazi kanye nezitho ezijikeleza igazi zilimele.
Kepha lezi yizinkinga zesifo sikashukela ezifika sekwedlule isikhathi. Ngokuntuleka kwe-insulin okunzima, kuvela imiphumela ebuhlungu edinga ukwelashwa ngokushesha, ngoba ingaholela ekufeni.
Ngohlobo 1 sikashukela, umzimba awunantuleka kwe-insulin. Uma ngabe ukushoda kwe-hormone kunxephezelwa yi-insulin therapy, imiphumela yesifo sikashukela izoqala ukukhula ngokushesha okukhulu, okuzonciphisa kakhulu isikhathi sokuphila komuntu.
Ngohlobo 2 sikashukela, amanyikwe akhiqiza i-insulin, kodwa amaseli omzimba ngasizathu simbe akakuboni. Kulokhu, izidakamizwa ezinciphisa ushukela ziyabekelwa, nezidakamizwa ezikhulisa ukumelana kwe-insulin, ezizokwenza kube nezinqubo ezijwayelekile zesikhathi somuthi.
Imvamisa, izinkinga ezibucayi zohlobo 2 lwesifo sikashukela aziveli noma zibonakala zilula kakhulu. Kepha ezimweni eziningi, umuntu uthola kuphela ukuthi kukhona umuntu onesifo sikashukela lapho isifo siqhubeka, bese imiphumela yakhe ingaphenduki.
Ngakho-ke, izinkinga zesifo sikashukela zihlukaniswe ngamaqembu amabili:
- ekuseni
- sekwephuzile.
Izinkinga ezinkulu
Imiphumela yokuqala yesifo sikashukela ifaka izimo ezenzeka ngokumelene nesizinda sokuncipha okubukhali (i-hypoglycemia) noma i-hobby (hyperglycemia) ekuhlushwa ngeglucose yegazi. Isimo se-hypoglycemic siyingozi ngoba uma simiswa ngokungafanele, izicubu zobuchopho ziqala ukufa.
Izizathu zokubonakala kwayo zihlukahlukene: i-overdose ye-insulin noma ama-hypoglycemic agents, ukucindezelwa ngokweqile komzimba nangokomzwelo, ukweqa ukudla, njalonjalo. Futhi, ukwehla kwezinga likashukela kwenzeka ngesikhathi sokukhulelwa nangezifo zezinso.
Izimpawu ze-hypoglycemia ubuthakathaka obukhulu, izandla eziqhaqhazelayo, ukufiphaza isikhumba, isiyezi, ukuzizwa kwezandla nokulamba. Uma kulesi sigaba umuntu engathathi ama-carbohydrate asheshayo (isiphuzo esimnandi, amaswidi), khona-ke uzothuthukisa isigaba esilandelayo, esibonakaliswa yilezi zimpawu ezilandelayo:
- delirium;
- ukusebenzisana okungahambi kahle;
- ubuqili;
- umbono ophindwe kabili
- ulaka;
- izibuko
- fossing "goosebumps" phambi kwamehlo;
- ishayela ngokushesha.
Isigaba sesibili asihlali isikhathi eside, kodwa kungenzeka ukusiza isiguli kulokhu uma umnikeza isisombululo esincane esimnandi. Kodwa-ke, ukudla okuqinile kuleli cala kufakwe i-contraindised, njengoba isiguli kungenzeka ukuthi sivimbelwe izindiza.
Ukubonakaliswa kwesikhashana kwe-hypoglycemia kufaka phakathi izithukuthuku, ukuqina, isikhumba esidabukile, nokulahlekelwa ukwazi. Kulesi simo, kubalulekile ukubiza i-ambulensi, lapho udokotela ezofaka isisombululo se-glucose emithanjeni yesiguli.
Uma kungekho ukwelashwa okufika ngesikhathi, umuntu uzoshintsha ukwaziwa. Uma kwenzeka sekhubazeka, angafa nokufa, ngoba indlala yamandla izohambisa ukuvuvukala kwamangqamuzana obuchopho kanye nokuphefumula okulandelayo kuwo.
Izinkinga ezilandelayo zokuqala zesifo sikashukela yizimo ze-hyperglycemic, ezibandakanya izinhlobo ezintathu zama-com:
- ketoacidotic;
- i-lacticidal;
- hyperosmolar.
Le miphumela yesifo sikashukela ivela phakathi kokunyuka koshukela wegazi. Ukwelashwa kwabo kwenziwa esibhedlela, ekunakekelweni okujulile noma ophikweni olunakekela abaguli kakhulu.
I-ketoacidosis yohlobo 1 sikashukela ivela kaningi ngokwanele. Izizathu zokuvela kwayo ziningi - ukweqa imithi, noma umthamo wazo ongalungile, ukuba khona kwezinqubo zokuvuvukala okunamandla emzimbeni, ukushaya kwenhliziyo, unhlangothi, ukwanda kwesifo esingelapheki, izimo zokwaliwa yilesi sifo, njll.
I-ketoacidotic coma iba ngephethini ethile. Ngenxa yokuntuleka kwe-insulin okungazelelwe, i-glucose ayingeni emangqamuzaneni futhi inqwabelana egazini. Ngenxa yalokhu, "amandla endlala" ayaqala, ephendula kuwo, umzimba uqala ukukhipha ama-hormone okucindezela anjenge-glucagon, i-cortisol ne-adrenaline, okubuye kwandise i-hyperglycemia.
Kulokhu, umthamo wegazi uyakhuphuka, ngoba i-glucose iyinto ye-osmotic eheha amanzi. Kulokhu, izinso ziqala ukusebenza kakhulu, lapho ama-electrolyte eqala ukungena kumchamo ngoshukela, othulwe kanye namanzi.
Ngenxa yalokhu, umzimba ukhipha amanzi emzimbeni, futhi ubuchopho nezinso kuhlupheke ukuthola okungatheni kwegazi.
Ngesikhathi sokulamba kwe-oxygen, i-lactic acid iyakhiwa, ngenxa yalokho i-pH iba yi-acidic. Ngenxa yokuthi i-glucose ayiguquki amandla, umzimba uqala ukusebenzisa ukugcotshwa kwamafutha, ngenxa yalokho kuvela ama-ketones egazini, okwenza i-pH yegazi ibe ne-acidic ngokwengeziwe. Lokhu kuthinta kabi umsebenzi wobuchopho, wenhliziyo, wokugaya ukudla nezitho zokuphefumula.
Izimpawu ze-ketoacidosis:
- I-Ketosis - isikhumba esomile nolwelwesi lwama-mucous, ukoma, ukozela, ubuthakathaka, ikhanda, isifiso sokudla, ukwanda kokuchama.
- I-ketoacidosis - iphunga le-acetone elisuka emlonyeni, ukozela, umfutho ophansi wegazi, ukugabha, izinhlungu zenhliziyo.
- I-Precoma - ukugabha, ukuphefumula, ukuphefumula izihlakala, izinhlungu zenzeka ngesikhathi sokuqina kwesisu.
- I-Coma - ukuphefumula okunomsindo, ukuqina kwesikhumba, ukukhishwa kwemizwa, ukulahleka kwengqondo.
I-Hyperosmolar coma ivame ukuvela kubantu asebekhulile abanefomu elizimele lesifo le-insulin. Le nkinga yesifo sikashukela yenzeka ngokumelene nesizinda sokuphelelwa ngamandla isikhathi eside, ngenkathi kusegazini, ngaphezu kokuqukethwe ushukela omningi, ukugcwala kokuqina kwe-sodium. Izimpawu eziphambili yi-polyuria ne-polydipsia.
I-lactic acidosis ivame ukwenzeka ezigulini ezineminyaka engama-50 nangaphezulu ngokuqina kwezinwele, i-hepatic insufficiency noma izifo zenhliziyo. Ngalesi simo, ukugcwala okukhulu kwe-lactic acid kuyaphawulwa egazini.
Izimpawu eziholayo ukuqothuka, ukwehluleka ukuphefumula, ukuntuleka kokuchama.
Izinkinga ezifika ngemuva kwesikhathi
Ngokuphikisana nesizinda se-mellitus yesikhathi eside sesifo sikashukela, ukuvela kwezinkinga sekwephuzile okungelashwa noma kudinga ukwelashwa okude. Ngezinhlobo ezahlukahlukene zesifo, imiphumela ingahluka futhi.
Ngakho-ke, ngohlobo lokuqala lwesifo sikashukela, isifo sikashukela sonyawo, ikhathalogu, i-nephropathy, ukungaboni ngenxa ye-retinopathy, ukuphazamiseka kwenhliziyo nezifo zamazinyo kuvame ukukhula. Nge-IDDM, isifo sikashukela esihlasela isifo sikashukela, i-retinopathy, i-retinopathy kwesinye isikhathi sivela kakhulu, futhi ama-vascular and inhliziyo pathologies awalona uphawu lalolu hlobo lwesifo.
Nge-retinopathy yesifo sikashukela, imithambo, imithambo, kanye nama-capillaries e-retina kuyathinteka, ngoba ngokumelene nesizinda se-hyperglycemia engapheli, imikhumbi iyancipha, yingakho bengatholi igazi elanele. Ngenxa yalokhu, kwenzeka izinguquko eziwohlokayo, nokushoda komoya-mpilo kufaka isandla ekutheni ama-lipids nosawoti we-calcium alungiswa ku-retina.
Ukushintshwa okunjalo kwe-pathological kuholela ekwakhekeni kwezibazi futhi kungena ngaphakathi, futhi uma kunokuqhamuka kwesifo sikashukela esibuhlungu, i-retina izohamba futhi umuntu angaba yimpumputhe, kwesinye isikhathi kuye kube ne-vitreous hemorrhage noma i-glaucoma.
Izinkinga ze-Neurological nazo azijwayelekile kushukela. I-Neuropathy iyingozi ngoba inomthelela ekuqubukeni konyawo lwesifo sikashukela, okungaholela ekunqunyweni kwesitho.
Izimbangela zokulimala kwezinzwa kwisifo sikashukela aziqondakali ngokuphelele. Kepha kuhlukaniswa izici ezimbili: eyokuqala ukuthi ushukela ophakeme ubangela ukulimala kwe-edema ne-nerve, kanti okwesibili ukuthi imicu yezinzwa ihlushwa ukuntuleka kwezakhi zomzimba ngenxa yokulimala kwemithambo yegazi.
I-mellitus encike kwisifo sikashukela esinezinkinga zezinzwa ingabonakala ngezindlela ezihlukile:
- I-Sensory neuropathy - ibonakaliswa umuzwa wokuphazamiseka emilenzeni, bese kuba ezingalweni, esifubeni nasiswini.
- Ifomu le-Urogenital - liyavela lapho izinzwa ze-sacral plexus zilimele, ezithinta kabi ukusebenza kwe-bladder kanye ne-ureters.
- I-neuropathy ye-Cardiovascular - iboniswa yi-palpitations ejwayelekile.
- Ifomu lesisu - libonakaliswa ukwephulwa kokudlula kokudla ngokusebenzisa i-esophagus, kuyilapho kukhona ukwehluleka kokuhamba kwesisu.
- I-neuropathy yesikhumba - ibonakala ngokulimala kwezindlala zamathumbu, ngenxa yokuthi isikhumba somile.
I-Neurology kwisifo sikashukela iyingozi ngoba lapho inqubo yokwakhiwa kwayo isiguli iyeka ukuzizwa izimpawu ze-hypoglycemia. Futhi lokhu kungaholela ekukhubazekeni noma ngisho nasekufeni.
I-Syndrome yesandla nonyawo lwesifo sikashukela kwenzeka ngomonakalo emithanjeni yegazi nezinzwa zangaphakathi zezicubu ezithambile, amalunga namathambo. Izinkinga ezinjalo zenzeka ngezindlela ezihlukile, konke kuya ngefomu. Ifomu le-neuropathic lenzeka ku-65% yamacala e-SDS, ngomonakalo wezinzwa ongadlulisi ukuthambekela kwezicubu. Ngalesi sikhathi, phakathi kweminwe nokuphela, isikhumba siyakhula bese sikhanywa, bese kuthi kamuva izilonda zivele kuso.
Ngaphezu kwalokho, unyawo luyajuluka bese lushisa. Futhi ngenxa yomonakalo kwezicubu ze-articular nethambo, ubungozi bokuqhekeka okuzenzakalelayo bukhuphuka kakhulu.
Ifomu le-ischemic lakhiwa ngenxa yokugeleza kwegazi okungekuhle emithanjeni enkulu yonyawo. Lokhu kuphazamiseka kwemizwa kubangela ukuba unyawo lubande kakhulu, lube yizilonda ezinesifo se-cyanotic, ephaphathekile nobuhlungu kuso.
Ukuxhaphaka kwe-nephropathy kushukela sikhulu impela (cishe ama-30%). Le nkinga iyingozi ngoba uma ibingatholakali ekuqaleni kwesigaba esithuthukayo, lapho-ke izophela ngokuthuthukiswa kokwehluleka kwezinso.
Ngohlobo 1 noma isifo sikashukela 2, ukulimala kwezinso kuhlukile. Ngakho-ke, ngefomu elincike ku-insulin, lesi sifo sikhula ngokuvamisile futhi kaningi esemncane.
Esikhathini sokuqala, inkinga enjalo yesifo sikashukela ihlala ivela ngaphandle kwezimpawu ezicacile, kepha ezinye iziguli zingahlangabezana nezimpawu ezinjengokuthi:
- ukozela
- ukudumba;
- iminyakazo
- ukungasebenzi kahle kwesigqi senhliziyo;
- isisindo somzimba;
- ukomiswa nokulunywa kwesikhumba.
Okunye ukubonakaliswa okuqondile kwe-nephropathy ubukhona begazi emchameni. Kodwa-ke, lolu phawu alwenzeki kaningi.
Lapho lesi sifo siqhubeka, izinso ziyeka ukuqeda ubuthi egazini, bese ziqala ukuqongelela emzimbeni, kancane kancane ziyifake ubuthi. I-Uremia ivame ukuhambisana nomfutho wegazi ophakeme nokudideka.
Isibonakaliso esiholayo se-nephropathy ukuba khona kwamaprotheni kumchamo, ngakho-ke bonke abanesifo sikashukela kudingeka bahlole umchamo okungenani kanye ngonyaka. Ukwehluleka ukwelapha inkinga enjalo kuzoholela ekwehlulekeni kwezinso, lapho isiguli singeke siphile ngaphandle kwe-dialysis noma ukufakelwa kwezinso.
Izinkinga zenhliziyo nezemithambo yesifo sikashukela nazo azijwayelekile. Imbangela evame kakhulu yama-pathologies anjalo yi-atherosulinosis yemithambo yegazi ehambisa inhliziyo. Lesi sifo senzeka lapho i-cholesterol ifakwa ezindongeni zemithambo, okungaholela ekushayweni yinhliziyo noma ekushayweni yisifo sohlangothi.
Abanesifo sikashukela bathambekele kakhulu ekuhlulekeni kwenhliziyo. Izimpawu zakhe ukushoda komoya, ama-ascites, nokuvuvukala kwemilenze.
Ngaphezu kwalokho, kubantu abanesifo sikashukela, inkinga evame ukwenzeka yi-arterial hypertension.
Kuyingozi ngoba kukhulisa kakhulu ubungozi bezinye izinkinga, kufaka phakathi i-retinopathy, nephropathy, kanye nokwehluleka kwenhliziyo.
Ukuvimbela kanye nokwelashwa kwezinkinga zesifo sikashukela
Izinkinga ezisekuqaleni nasekupheleni sekwelashwa ngezindlela ezahlukahlukene. Ngakho-ke, ukuze sinciphise imvamisa yezinkinga zesifo sikashukela esivela esigabeni sokuqala, kubalulekile ukubheka njalo izinga le-glycemia, futhi uma kwenzeka kukhula isimo se-hypoglycemic noma i-hyperglycemic, thatha izindlela zokwelashwa ezifanele ngesikhathi.
Ukwelashwa kwezifo zohlobo lwesifo sikashukela sohlobo 1 kususelwa ezicini ezintathu zokwelashwa. Okokuqala, kuyadingeka ukulawula izinga le-glucose, okufanele isuke ku-4,4 iye ku-7 mmol / L. Kuze kube manje, basebenzisa izidakamizwa ezinciphisa ushukela noma basebenzise i-insulin yokwelapha isifo sikashukela.
Kubalulekile nokunxephezela izinqubo ze-metabolic eziphazamisekile ngenxa yokushoda kwe-insulin. Ngakho-ke, iziguli zinqunyelwe izidakamizwa ze-alpha-lipoic acid nezidakamizwa zemithambo yegazi. Futhi esimweni se-atherogenicity ephezulu, udokotela ubeka izidakamizwa ezisehlisa i-cholesterol (i-fibrate, ama-statins).
Ngaphezu kwalokho, ukuphathwa ngakunye okukhethekile kuyelashwa. Ngakho-ke, nge-retinopathy yakuqala, i-laser Photocoagulation ye-retina noma ukususwa komzimba we-vitreous (vitrectomy) kubonisiwe.
Endabeni ye-nephropathy, kusetshenziswa imithi yokulwa ne-hypertension, futhi isiguli kufanele silandele indlela ekhethekile yokudla. Ngendlela engapheli yokuhluleka kwezinso, i-hemodialysis noma ukufakelwa kwezinso kungenziwa.
Ukwelashwa kwezinkinga zesifo sikashukela esihambisana nokulimala kwezinzwa kubandakanya ukuthatha amavithamini e-B. Le mishanguzo ithuthukisa ukwenziwa kwezinzwa emisipha. Ukuvuselela imisipha efana ne-carbamazepine, i-pregabalin, noma i-gabopentin nakho kuyakhonjiswa.
Endabeni yesifo sikashukela sikashukela, imisebenzi elandelayo iyenziwa:
- ukukhululwa komzimba;
- ukwelashwa kwe-antibacterial;
- gqoka izicathulo ezikhethekile;
- ukwelashwa kwamanxeba.
Ukuvimbela izinkinga zesifo sikashukela ukuqapha okuhleliwe kwe-glycated hemoglobin neglucose egazini.
Kubalulekile futhi ukuqapha umfutho wegazi, okungafanele ube ngaphezulu kuka-130/80 mm Hg.
Noma kunjalo, ukuze ungasikhulisi isifo sikashukela ngezinkinga eziningi, kuyadingeka ukwenza izifundo ezijwayelekile. Lokhu kufaka phakathi i-dopplerography yemithambo yegazi, ukuhlaziya umchamo, igazi, ukuhlolwa kwe-fundus. Ukubonisana nodokotela oyi-neurologist, udokotela oyi-cardiologist nodokotela wamathambo kuyavezwa.
Ukwehlisa igazi futhi uvikele izinkinga zenhliziyo, udinga ukuthatha i-Aspirin nsuku zonke. Ngaphezu kwalokho, iziguli ziboniswa izivivinyo zokuzivocavoca zesifo sikashukela kanye nokubambelela ekudleni okukhethekile, ukwenqatshwa kwemikhuba emibi.
Ividiyo ekulesi sihloko ikhuluma ngezinkinga zesifo sikashukela.
