Isifo sikashukela yi-pathology, isibonakaliso esiyinhloko saso ukwanda koshukela wegazi. Izimpawu eziphambili zalesi sifo zihambisana ne-hyperglycemia, futhi ngokunxeshezelwa kwaso, kungenzeka ukubikezela amathuba ezinkinga zesifo sikashukela.
Izinga le-glucose elanda njalo lilimaza udonga lwe-vascular futhi liholele ekuthuthukisweni kwezifo zezinso, i-retina, i-peripheral system system, unyawo lwesifo sikashukela kanye ne-angioneuropathies yobunzima obuhlukahlukene.
Ukwelashwa okungalungile kwesifo sikashukela i-mellitus noma ukuba khona kwezifo ezinzima ezibangelwa ukugula kungadala ukuguquguquka kushukela wegazi ngokwenziwa kwesifo sikashukela esidinga ukunakekelwa okuphuthumayo.
Izimbangela ze-hyperglycemia kushukela
Ukwanda koshukela wegazi ngohlobo 1 sikashukela kuhlangene nokusilela ngokuphelele kwe-insulin. Amangqamuzana we-beta kumanyikwe aphulwa ngenxa yokuvela kokuphendula kohlobo lwe-autoimmune. Amagciwane, izinto ezinobuthi, umuthi, ukucindezela kukhuthaza ukwephulwa komzimba okunjalo. Kunesifo ezigulini ezibangelwa ufuzo.
Ngohlobo 2 sikashukela, ukugcinwa kwe-insulin isikhathi eside kungahluka kokujwayelekile, kodwa ama-insulin receptors awaphenduli kule hormone. Isici esiyinhloko ekwakhiweni kwesifo sikashukela ukukhuluphala ngokweqile kwesizinda sobuchopho befa. Uhlobo lwesibili sikashukela lwenzeka ngokuntuleka kwe-insulin.
Ngokuntuleka kwe-insulin ngokuphelele noma okuhlobene, i-glucose ayikwazi ukungena kumaseli futhi icutshungulwa ukukhiqiza amandla. Ngakho-ke, ihlala i-lumen yomkhumbi, ibangele ukuphuma kwe-fluid kusuka ezicutshini, ngoba iyinto esebenzayo ngokungajwayelekile. Ukwehla komzimba kukhula emzimbeni, ngoba izinso zisusa umthamo ogulayo we-fluid kanye noshukela.
Ngokuya kobunzima be-hyperglycemia, inkambo yesifo sikashukela ilinganiselwa:
- Imnene: glycemia eshesha ngaphansi kuka-8 mmol / l, akukho-glucosuria noma kukhona iminonjana ye-glucose emchameni. Kukhokhelwa ngokudla, i-angiopathy esebenzayo.
- Ukwehla okulinganiselayo: ushukela wokuzila ukudla kuze kufike ku-14 mmol / l, ushukela we-glucosuria ngosuku ongekho ngaphezu kwe-40 g, i-ketoacidosis yenzeka ngezikhathi ezithile. Ukwelashwa kusetshenziswa ngamathebhulethi noma nge-insulin (kuze kufike kumayunithi angama-40) ngosuku.
- I-degree Strip: i-glycemia ngenhla kwe-14 mmol / l, i-glucosuria ephezulu, i-insulin ilawulwa ngemithamo emikhulu, kune-angioneuropathies yesifo sikashukela.
Ngakho-ke, uma kukhona ushukela wegazi ongu-16 nokuthi ngabe uyingozi yini kwisifo sikashukela, impendulo yombuzo ofanayo ungaba kuphela omuhle, ngoba lolu phawu lubhekisela enkambisweni enzima yesifo sikashukela.
Lesi simo singakhula sibe yinkinga enkulu yesifo sikashukela - isifo sikashukela.
Izimbangela ze-ketoacidosis kushukela
Ukuthuthukiswa kwe-ketoacidosis kwenzeka ngezinga eliphakeme le-glycemia kanye nokwanda kwenani lemizimba ye-ketone egazini. Imbangela yazo ukuntuleka kwe-insulin. Uhlobo lokuqala lwesifo sikashukela lungaqala nge-ketoacidosis ekuxilongeni sekwephuzile, futhi ngohlobo 2 lwesifo sikashukela kwenzeka ezigabeni zokugcina zalesi sifo, lapho izinsalela zamanyikwe ziqediwe.
Ukwenqaba noma ukungafuni kwe-insulin ngokweqile, izifo ezihlangene nokulimala, ukusebenza, ukuthatha ama-hormonal kanye ne-diuretics, kanye nokususa ama-pancreas nakho kuholela kwi-hyperglycemia ephezulu ne-ketoacidosis.
Ukushoda kwe-insulin kuholela ekwandeni kwezinga le-glucagon, i-hormone yokukhula, i-cortisol ne-adrenaline egazini, ekhuthaza ukuwohloka kwe-glycogen esibindini kanye nokwakheka kwe-glucose kuyo. Lokhu kuholela ekwandeni kwe-glycemia. Ngaphezu kwalokho, lapho kungekho i-insulin, ukuwohloka kwamaprotheni namafutha kuqala ngokwanda kwezinga lama-amino acid namafutha acid egazini.
Njengoba i-glucose ingekho emangqamuzaneni, umzimba uqala ukuthola amandla emafutheni. inqubo yokuphendula okunje imizimba ye-ketone yakhiwa - i-acetone ne-organic acid. Lapho izinga labo liphakeme kunokuba izinso zikhiphe, i-ketoacidosis iba negazi. Amafutha avela ekudleni okudliwayo awabambi iqhaza ku-ketogeneis.
Lesi simo sihambisana nokuphelelwa ngamandla komzimba. Uma isiguli singakwazi ukuphuza amanzi anele, lokho kulahleka kungafinyelela ku-10% wesisindo somzimba, okuholela ekuwohlokeni komzimba okujwayelekile.
Uhlobo lwesibili sikashukela olunokubola luvame ukuhambisana nombuso we-hyperosmolar. Njengoba i-insulin etholakalayo ivimbela ukwakheka kwezidumbu ze-ketone, kepha njengoba kungekho kusabela kuyo, i-hyperglycemia iyanda. Izimpawu zokuncipha kwe-hyperosmolar:
- Ukuphuma komchamo ngokweqile.
- Ukoma okungenakuqedwa.
- Isicanucanu
- Ukwehla komzimba.
- Umfutho wegazi ophakeme.
- Amazinga aphezulu we-sodium egazini.
Izimbangela zesimo se-hyperosmolar kungaba ukomisa ngethamo elikhulu lezidakamizwa ze-diuretic, ukugabha, noma uhudo.
Kukhona futhi ukuhlanganiswa kwe-ketoacidosis kanye ne-hyperosmolar decompensation.
Izimpawu ze-ketoacidosis
Isifo sikashukela mellitus sibonakaliswa ukwanda kancane kancane kwezimpawu ze-hyperglycemia. I-ketoacidosis iba nengakapheli usuku noma ngaphezulu, kanti umlomo owomile uyanda, noma isiguli siphuza amanzi amaningi. Ngesikhathi esifanayo, i-malaise, ikhanda, ukuphazamiseka kwamathumbu ngendlela yesifo sikashukela noma ukuqunjelwa, ubuhlungu besisu kanye nokuhlanza ngezikhathi ezithile kweziguli.
Ukwanda kwe-hyperglycemia kuholela ekuqwashisweni okungasebenzi kahle, ukubukeka kokuphefumula nokuphefumula kaningi, isikhumba sizwa somile futhi sishisa, iphunga le-acetone elisuka emlonyeni, kuthi lapho licindezelwa ngokumelene namashiya, kubonakale ukuthamba kwalo.
Ukuhlolwa kokuxilonga okuqinisekisa i-ketoacidosis kufanele kwenziwe ekubonisweni kokuqala kwe-hyperglycemia. Ekuhlolweni kwegazi, kunqunywa ushukela ongaphezulu kwe-16-17 mmol / l, izidumbu ze-ketone zikhona egazini nomchamo. Esibhedlela, izivivinyo ezinjalo ziyenziwa:
- I-Glycemia - ngehora.
- Imizimba yeKetone esegazini nomchamo - njalo emahoreni ama-4.
- Ama-electrolyte egazi.
- Isibalo segazi esiphelele.
- IGazi creatinine.
- Ukunqunywa kwe-pH yegazi.
Ukwelashwa kwe-hyperglycemia ne-ketoacidosis
Isiguli esinezimpawu ze-ketoacidosis sinikezwa ngokushesha i-dropper ene-saline yomzimba futhi amayunithi angama-20 e-insulin ebambela isikhashana aphathwe ngendlela efanelekile.
Ngemuva kwalokho, i-insulin iyaqhubeka ukuphathwa ngokuhlinzwa noma emgudwini ngesilinganiso samayunithi angama-4-10 ngehora, okuvimbela ukuqhekeka kwe-glycogen yisibindi futhi kuvimbela i-ketogenesis. Ukuvimbela ukuhlaliswa kwe-insulin, i-albhamuin ihanjiswa ebhodleleni elifanayo.
I-Hyperglycemia kumele incishiswe kancane, ngoba ukwehla ngokushesha ushukela kungaholela ku-osmotic edema, ikakhulukazi ku-edema yobuchopho. Emini udinga ukufinyelela ezingeni le-13-14 mmol / l. uma isiguli singakwazi ukudla ngokwaso, sinikezwa ushukela ongu-5% njengomthombo wamandla.
Ngemuva kokuthi isiguli siphinde siqaphele, futhi i-glycemia isizinzile ku-11-12 mmol / l, uyanconywa: phuza amanzi amaningi, ungadla okusanhlamvu okulamanzi, amazambane abunjiwe, imifino noma isobho elibunjiwe. Ngama-glycemia anjalo, i-insulin iphathwe ngokungananazi ekuqaleni kwengxenyeni, bese kulandela isikimu esivamile.
Lapho ususa isiguli esimweni se-ketoacidosis yesifo sikashukela, kusetshenziswa le mithi elandelayo:
- I-Sodium chloride engu-0.9% enanini lesisindo esingu-7-10% womzimba emahoreni ayi-12 okuqala.
- I-Plasma ithatha indawo yokucindezela kwe-systolic ngaphansi kwe-80 mm Hg. Ubuciko.
- I-potassium chloride ilawulwa ngamazinga wegazi. Ekuqaleni, isiguli sithola ukumnika kwe-potassium, bese kuthi amalungiselelo e-potassium asetafuleni isonto lonke.
- Ukufakwa kwe-Soda akuvamile kakhulu ukusetshenziswa ukulungisa i-acidosis.
Isisombululo se-0.45% sodium chloride sisetshenziselwa ukwelapha isimo se-hyperosmolar futhi i-insulin ayisetshenziswa noma ibekiwe ngemithamo emincane kakhulu. Iziphakamiso ezigulini eziaziyo: phuza amanzi amaningi, izidlo zithathwa zigxishwe, ama-carbohydrate alula awafakwa. Ukuvimbela i-thrombosis, iziguli esezikhulile zinqunywe i-heparin.
Ukuvimbela ukwanda koshukela egazini kanye nokukhula kwe-ketoacidosis ku-mellitus yesifo sikashukela, kungenzeka kuphela ngokubheka njalo i-glycemia, kulandela ukudla okunomkhawulo wama-carbohydrate agaya kalula, ukuthatha amanzi anele, ukulungisa umthamo we-insulin noma amaphilisi ezifo ezihlangabezana nawo, ukucindezela ngokweqile komzimba, ngokomzwelo.
Imininingwane nge-hyperglycemia ivezwa kuvidiyo ekulesi sihloko.
