Amandla wokulawula i-glycemia abhekisela kokunye kokuboniswa kokulondolozwa kokuqina kwemvelo yangaphakathi yomzimba. Imvamisa, ama-carbohydrate angenayo aphuma ekudleni aguqulwa abe ushukela, odlulisa i-insulin esitokisini, lapho unikeza khona amandla emzimbeni ngokusebenzisa ukusabela kwe-glycolysis.
Ku-mellitus yesifo sikashukela, ukushoda kwe-insulin kuholela ekutheni i-glucose ihlale egazini futhi ibangele ukulimala kwemithambo yegazi, izinzwa nezitho zangaphakathi zomzimba, futhi umzimba ushintshela komunye umthombo wamandla - amafutha.
Ubungozi benye indlela enjalo yokuthola izinto zamandla ukuthi bakha imizimba ye-ketonic enobuthi emzimbeni. Ngokuxineka okukhulu kwabo egazini, kungaba nenkinga enkulu, isifo sikashukela se-ketoacidotic. Ngalesi simo, kunengozi enkulu yokufa uma kungekho ukwelashwa ngokushesha.
Izizathu zokunqunywa kwesifo sikashukela
Inkambo yesifo sikashukela incike ekutheni asondele kangakanani kumanani egazi weglucose ajwayelekile. Umkhawulo ongenhla, emva kwalokho izinkinga zohlobo lokuthamba ziqala noma izimpawu zokulimala kwezicubu zezinzwa, imithambo yegazi, izinso nesitho sokubona kukhuphuka - lokhu kungu-7.8 mmol / l uma ulinganiswa ngaphambi kokudla.
Ngemuva kokuthi ushukela ukhuphuke kakhulu, ingozi yokuba nesifo sikashukela yanda, futhi uma ushukela wegazi ungama-20, kusho ukuthini lokhu ngomzimba? Nge-hyperglycemia enjalo, ukwakheka kwezidumbu ze-ketone kwenzeka ngokungenakuphikwa, ngoba lokhu kusho ukuntuleka kwe-insulin kohlobo 1 sikashukela noma inkambo ende yesifo sikashukela sohlobo 2.
Ngesikhathi semetabolism ejwayelekile, i-insulin ivikela izicubu ze-adipose kusuka ekuwohlokeni okwandayo futhi ayivumeli ukwanda kwamazinga wegazi wama-acid acid, lapho kwakheka khona imizimba ye-ketone. Ngokuntuleka kwamangqamuzana, indlala iyakhula, okwenza ukuthi kusebenze umsebenzi wama-hormone aphikisayo, okuholela eqinisweni lokuthi ushukela wegazi ungaphezu kwama-20 mmol / l.
Kuhlobo lwesifo sikashukela sohlobo 2, ukwanda kokuhlungwa kwe-glucose okweqile kwe-20 mmol nge-1 litre yegazi akunakubangela ukwakheka kwezidumbu ze-ketone, inqobo nje uma kukhona i-insulin eyanele egazini ukuvikela izicubu ze-adipose. Ngasikhathi sinye, amaseli awakwazi ukufaka umsoco glucose futhi isimo se-hyperosmolar sikhula emzimbeni kuze kube kuqala ukoma.
Izizathu eziholela engcupheni yokwanda koshukela ukuya kumamitha angama-25 / l:
- Ukweqa ukuphathwa noma ukuphathwa kwezidakamizwa ezinciphisa ushukela - amaphilisi noma i-insulin.
- Ukukhanselwa okungagunyaziwe kokwelashwa okunqunyelwe (ngokwesibonelo, ukwelashwa ngamakhambi abantu noma izithasiselo zokudla).
- Indlela engalungile yokulethwa kwe-insulin nokuntuleka kokulawulwa kwe-glycemic.
- Isimo sokutheleleka kwezifo noma izifo ezihlangene: ukulimala, ukusebenza, ingcindezi, ukwehluleka kokujikeleza kwegazi obukhulu)
- Ukukhulelwa
- Okuqukethwe kwe-carbohydrate eningi ekudleni.
- Ukuzivocavoca nge-hyperglycemia.
- Ukusebenzisa kabi utshwala.
Lapho uthatha umuthi othile ngokumelene nesizinda sokulawulwa okunganele kwe-carbohydrate metabolism, kungahle kube nezinga loshukela wegazi lama-20 mmol / L noma ngaphezulu: izidakamizwa ze-hormonal, i-nicotinic acid, i-diuretics, i-Isoniazid, i-Difenin, i-Dobutamine, iCalcitonin, i-beta-blockers.
Ukuqala kwesifo sikashukela sohlobo 1 kungabonakala nge-hyperglycemia ephezulu (ushukela wegazi 20 nangaphezulu), i-ketoacidosis. Lokhu kwahluka kokuqala kwesifo kubonwa cishe esigabeni seziguli ezinokuxilongwa sekwephuzile kanye nokuntuleka kokwelashwa nge-insulin.
Izigaba zeKetoacidosis
Isigaba sokuqala sesifo sikashukela i-mellitus decompensation silingana ne-ketoacidosis elinganiselayo futhi sazibonakalisa ngesimo sobuthakathaka obujwayelekile, ukungakhathali, ukukhathala okuphezulu, ukozela, i-tinnitus kanye nesifiso sokudla esinciphile. Ukuphila kahle kweziguli kuya ngokuya kukhula kancane kancane, kuba nesicanucanu nobuhlungu besisu, ukoma okwandayo nokuchithwa ngokweqile komchamo, ukunciphisa umzimba, ukuhogela i-acetone ephuma emlonyeni.
Isigaba sesibili sisho ukuthuthukiswa kwe-precoma. Iziguli ziba ukungabi nandaba nabanye, ukwanda okubangelwa ukushisa ngamandla, ukunyuka kobuhlungu besisu, ukwanda kwamehlo kuphazamisekile, ukuphefumula okuncane kuqhamuka, isikhumba some ngokuthinta, isikhumba singavuleli isikhathi eside, izindebe zomile, ziboshwe, ulimi lome, futhi izici zobuso zikhonjwa.
Ezingeni lokuphefumula, isiguli siba nokuphefumula okunomsindo, ukwehla komfutho wegazi, ukwazi ukungasebenzi kahle, ukushaya ngamandla, ukugcinwa komchamo nesikhumba esibandayo nesomile.
I-Ketoacidotic coma enokuxilongwa okungafanele nokuntuleka kokwelashwa okwanele kungaholela ezinkingeni ezinjalo:
- I-Pulmonary embolism.
- I-vein thrombosis ejulile.
- Ukuhlaselwa yisifo senhliziyo.
- Ingozi ye-Cerebrovascular.
- I-pneumonia yokuphefumula, i-edema yamaphaphu.
- I-Cerebral edema.
- I-colitis Erosive ne-gastritis
Ukwelashwa Ketoacidosis
Ukunquma i-insulin ezigulini ezisesimweni se-ketoacidosis kuyindlela enkulu yokwelashwa, kepha ukuphathwa kwayo kufanele kuhambisane nokuqapha njalo kwe-glycemia kanye nokuphathwa okufanayo kwamalungiselelo we-potassium ukuvimbela i-hypokalemia enzima, engabulala.
Ukuqala kokulungiswa kokushintshwa kwe-acid esegazini ngesisombululo se-soda kuyinto ethile enganconyelwanga, ngoba i-carbon dioxide eyakhiwe ikhulisa i-acidosis ngaphakathi kweseli futhi iholele ku-edema yamakhemikhali, ngokungenisa ngokushesha i-bicarbonate, i-hypokalemia kungenzeka.
I-insulin inikezwa iziguli ezinjalo kuphela nge-intramuscularly, umthamo wokuqala ungasukela kumayunithi angama-20 kuye kwangama-40, kuye ngezinga le-hyperglycemia. Akunconyelwe ukufaka i-insulin ngokungabonakali ngenxa yokuphuza ukumunca kanye nendlela yokufaka emzimbeni, ngoba umuthi usebenza imizuzu eyi-15 ukuya ku-20 futhi uthululwa ngokushesha.
Izici zokwelashwa kweziguli yilezi:
- I-insulin kufanele ibekelwe noma isiguli singakwazi ukudla sodwa.
- Ukuphathwa kwe-glucose okumaphakathi akuqali ngaphambi kokuqiniswa kwe-glycemia ku-11 mmol / L.
- I-insulin emfushane ihanjiswa okungenani izikhathi ezi-6 ngosuku.
- Ukunyusa ingcindezi, izidakamizwa ze-vasoconstrictor akufanele zichazwe.
- Kuzo zonke izimo zesisu esibuhlungu noma izimpawu zokushaywa kweziguli ezinesifo sikashukela, ushukela wegazi nama-ketones omchamo kufanele kulinganiswe.
Ukuthola uketshezi olulahlekile kuyindlela ebalulekile. Lokhu, kusuka emahoreni okuqala kokuxilongwa kwe-ketoacidosis, ukuphathwa kwe-intravenous of saline kwemvelo kunqunyelwe.
Ama-antibiotic kungenzeka anconyelwe ukuvikela ukutheleleka, kanye ne-heparin ukuvikela i-vascular thrombosis.
Ukwehlisa Uhlobo 2 Sikashukela
Ukuthuthukiswa kwe-hyperosmolar coma kuhambisana nezinga eliphakeme le-glycemia (ngaphezulu kwe-20-30 mmol / l), ukuphuma komzimba okukhulu, i-hypernatremia kanye nokungabikho kokubunjelwa kwezidumbu ze-ketone. Lesi simo sikhula kaningi ezigulini esezikhulile ezinokubola kwesifo sikashukela sohlobo 2.
Ukwenqaba ukwelashwa, ukuphazamiseka kakhulu kokudla, izifo ezihlangana nazo, imishanguzo, i-hypothermia, ukuntuleka kokuphuza uketshezi, ukushiswa, isifo sohudo, ukugabha okukhulu, i-hemodialysis kungavusa izinga eliphakeme le-hyperglycemia.
Izimpawu ezingasiza ekuhlonzeni ukwanda kokoma, ukuchama ngokweqile, i-tachycardia, ukuqina, kanye nokwehla komfutho wegazi. Isici sesithombe somtholampilo esimweni se-hyperosmolar ukunamathiselwa kokuphazamiseka kwengqondo ne-neurological, okungabhekwa njengezimpawu ze-psychosis eyingozi:
- I-Bullshit.
- Ukukhishwa.
- Ukunyakaza kwama-Chaotic.
- Inkulumo engenalutho noma engabonakali.
- Ukwephulwa kokuzwela nokuzwela.
Isimo sehyperosmolar sikhula kancane kakhulu kune-ketoacidosis. Izimpawu zayo zanda kusuka ezinsukwini ezi-5 kuya emasontweni amabili.
Ukubonakaliswa kokuphelelwa ngamandla kukhulunywa kakhulu, kepha akukho phunga lezidumbu ze-acetone ne-ketone emchameni.
Ukwelashwa kwe-Hyperosmolar
Isidingo sokuphathwa kwe-insulin ezigulini ezinjalo kwesinye isikhathi siphansi, sisuka kumayunithi ama-2 kuye kwayi-4 ngehora ngokuqapha okuphathelene noshukela egazini. Isimo esiyinhloko sokwelapha le nkinga yesifo sikashukela ukuphuculwa komzimba kabusha.
Kulokhu, isilinganiso sokuphathwa kwekhambi kufanele sibe sezingeni eliphansi ukuze singabangeli ukuphazamiseka kokujikeleza kwegazi. Ngaphezu kwalokho, kuyadingeka ukukala izinga le-sodium esegazini. Uma idlula i-150 mmol / l, khona-ke isisombululo se-sodium chloride ekuqoqweni kwe-hypotonic ka-0.45% siyasetshenziswa.
Ubuncane bungamalitha ama-8 wamanzi atholiswa ezigulini ezinjalo, okufanele kwenziwe kuze kube yilapho i-osmolarity incishiswa amayunithi angama-7-10 ngosuku.
Lapho wenza izinga lesodium lifane ngokwejwayelekile, sebenzisa usawoti ojwayelekile.
Ukuvimbela isifo sikashukela ukubola
Yini okufanele yenziwe ukuze kuvinjelwe ukukhula kwezinkinga zohlobo 1 nohlobo 2 lwesifo sikashukela? Isimo esiyinhloko ukwelashwa okulungile kwesifo. Lokhu kusho ukusetshenziswa komthamo owanele we-insulin noma izidakamizwa ezinciphisa ushukela nokudla okuqukethe ikakhulukazi imikhiqizo enenkomba ephansi ye-hypoglycemic.
Lokhu kufaka imifino eluhlaza, isitshalo seqanda, amantongomane, ama-cherries, ama-lingonberry, ama-apula angatholakali, kanye nezinhlamvu zokusanhlamvu eziphelele - i-buckwheat, oatmeal. Ngaphezu kwalokho, ukudla okungenawo amafutha aqukethe iprotheni kuyasiza - iziphuzo zobisi, ushizi we-cottage shizi, inyama nenhlanzi, imikhiqizo yenkukhu. Imifino kudliwa kahle kumasaladi ayoliswe ngamafutha zemifino.
Uma usebenzisa amaswidi alungiselelwe kuma-ushukela esikhundleni, udinga ukulawula ukwakheka, ngoba imvamisa ifaka ufulawa omhlophe, amafutha we-trans, ama-molasses. Ngakho-ke, noma yikuphi ukudla okudinga ukukudla ngaphansi kokulawulwa koshukela.
Kukhishwe emandleni:
- Noma yimuphi amaswidi nemikhiqizo kafulawa.
- Iphalishi esheshayo.
- Ukudla okuthosiwe, inyama enamafutha noma inhlanzi.
- Amasoseji athengiwe, ukudla okusemathinini.
- Amazambane, irayisi ehlutshiwe, ubhanana, u-ayisikhilimu, izithelo ezomisiwe, uphudingi.
- Amajusi ahlanganisiwe nanoma yiziphi iziphuzo ezimnandi.
Ukwelashwa kweziguli ezinokwehla okukhulu kwezinga le-glycemia kwenziwa esibhedlela, lapho kufanele kukhethwe khona umthamo we-insulin noma amaphilisi okwehlisa ushukela. Uma kunesidingo, kuzokwenyuka umthamo noma kungene imijovo eyengeziwe yesifo sikashukela sohlobo 1 sikashukela, kanye nesifo sohlobo 2 sikashukela, i-insulin noma inhlanganisela yokwelapha.
Izimpawu ze-hyperglycemia zizodingidwa kabanzi ngemininingwane yisazi sevidiyo esikulesi sihloko.
