Isikweletu sikashukela ezinganeni: izici zokuthuthuka kwalesi sifo

Kuzo zonke izimo zesifo sikashukela, uhlobo lokuqala lwesifo lufika ku-10%. Kufakwe ngaphansi kwayo yizingane, intsha nentsha.

Izimbangela eziphambili zesifo sikashukela ukucabanga okuvela kwilifa nokuthambekela kokuphendula kohlobo lwe-autoimmune.

Ukubonakaliswa kwalesi sifo kuvame ukubonakala lapho cishe wonke amaseli akhiqiza i-insulin esevele ebhujelwe kumanyikwe. Ngakho-ke, kubalulekile ukwenza ukuxilongwa kusenesikhathi futhi unikeze ukwelashwa esikhundleni se-insulin ukuze ulondoloze impilo yesiguli.

Sikhula kanjani isifo sikashukela esincike ku-insulin?

Ukuze uzuze isinxephezelo ngezinqubo ze-metabolic kuhlobo lwe-1 mellitus yesifo sikashukela, i-insulin iyadingeka ukuvimba ukuthuthukiswa kwengxenyana enzima ye-β-ketoacidotic coma. Ngakho-ke, uhlobo lokuqala lwesifo sikashukela lwabizwa ngokuthi i-insulin-kuncike.

Ngokusho kocwaningo lwakamuva, ukusabela kwe-autoimmune kuholela ekufeni kwamangqamuzana akhiqiza i-insulin ngamacala angama-95%. Iba nokukhubazeka kofuzo okuzala.

Inketho yesibili yi-idiopathicabetes mellitus, lapho kunokuthambekela kwe-ketoacidosis, kepha amasosha omzimba awaphazamiseki. Ngokuvamile zithinteka kakhulu ngabantu bendabuko yase-Afrika noma yase-Asia.

Isifo sikashukela i-mellitus sikhula kancane kancane, enkambweni yaso kunezigaba ezifihliwe nezicacile. Ngokunikezwa ushintsho emzimbeni, izigaba ezilandelayo zokukhula kokuhlukahluka okuhlobene nesifo se-insulin ziyahlukaniswa:

1. Isakhi sofuzo.
2. Isici esinikezayo: Amagciwane weCoxsackie, i-cytomegalovirus, i-herpes, isimungumungwane, i-rubella, umiyane.
3. Ukusabela kwe-Autoimmune: ama-antibodies kuma-ispancreatic ama-Langerhans, ukuvuvukala okuqhubekayo - insulin.
4. I-mellitus ye-Latent yesifo sikashukela: i-glucose esheshayo ingaphakathi kobubanzi obujwayelekile, ukuhlolwa kokubekezelela i-glucose kwembula ukwehliswa kwe-insulin.
5. Isifo sikashukela esikhohlisayo: ukoma, isifiso sokudla, ukuchama ngokweqile, nezinye izimpawu ezinesifo sohlobo 1 sikashukela. Okwamanje, ama-90% amaseli e-beta abhujiswa.
6. Isigaba esibulalayo: isidingo semithamo emikhulu ye-insulin, izimpawu ze-angiopathy kanye nokuthuthukiswa kwezinkinga zesifo sikashukela.

Ngakho-ke, lapho kutholwa isifo, isigaba sokuqala soshukela i-mellitus silingana nesinyathelo sento evusayo ngokumelene nesizinda sobubi bokuzala obuzuzisiwe. Kubandakanya futhi ukuthuthukiswa kokuphazamiseka kwe-immunological kanye ne-latent (latent) yesifo sikashukela mellitus.

Ukubonakaliswa kokudalwa kwesifo sikashukela ezinganeni kuhambelana nokuvela okusobala, kufaka "i-honeymoon" (ukuxolelwa) kanye nesigaba esingapheli, lapho kunokuncika impilo yonke ku-insulin.

Ngokuqhubeka kwesikhathi eside kwesifo kanye nokuqhubeka kwesifo, isigaba esibulalayo siyenzeka.

Isigaba esinqunyiwe kanye nokuqalwa kwesifo sikashukela ezinganeni

Isigaba okwenzeka ngaso ukubhujiswa kwamaseli e-pancreatic, kepha azikho izimpawu zesifo sikashukela, kungahlala izinyanga ezimbalwa noma iminyaka. Ngesikhathi sokuhlolwa okujwayelekile, ingane kungenzeka ingakhombisi ukukhubazeka.

Ukuxilongwa kwe-mellitus yesifo sikashukela esingajwayelekile kungenzeka kuphela lapho kutholwa amasosha omzimba noma izimpawu zofuzo zokubhujiswa kwe-autoimmune kwamangqamuzana akha i-insulin.

Lapho kutholakala ukuthambekela kokuthuthukisa lesi sifo, izingane ziyabhekelelwa futhi ucwaningo lwe-carbohydrate metabolism lwenziwa kaningi kunakwamanye amaqembu. Ukukhonjwa nokwanda okwalandela kwe-titer yama-antibodies anenani lokuxilonga:

• Kumaseli we-pancreatic islet.
• I-glutamate decarboxylase ne-tyrosine phosphatase.
• Ama-Autoantibodies okuba ne-insulin.

Ngaphezu kwalokho, ukutholwa kwezimpawu zemvelo zohlobo lwe-HLA ne-INS genotype, kanye nokwehla kwezinga lokukhishwa kwe-insulin lapho kuphendulwa isivivinyo sokubekezelela i-glucose.

Ukudalwa kohlobo lokuqala lwesifo sikashukela kwenzeka ngokuntuleka kwe-insulin. Ngenxa yalokho, i-glucose cishe ayingeni emangqamuzaneni, futhi igazi layo liqukethe inani eleqile. Izicubu zemisipha zidla ushukela omncane, okuholela ekubhujisweni kwamaprotheni. Ama-amino acid akhiwa kule nqubo adonswa egazini yisibindi futhi asetshenziselwa ukwakheka kweglucose.

Ukuqhekeka kwamafutha kuholela ekwandeni kwezinga lamafutha acid egazini kanye nokwakheka kwamangqamuzana amasha e-lipid nemizimba ye-ketone evela kuwo esibindini. Ukwakheka kwe-glycogen kuncishisiwe, futhi ukuqhekeka kwayo kuyathuthukiswa. Lezi zinqubo zichaza ukuboniswa kwesifo sikashukela sohlobo lokuqala.

Naphezu kweqiniso lokuthi ukuqala kwesifo sikashukela ezinganeni kuvame ukuba nzima, kungazelelwe, kwandulelwa yisikhathi sokugcina esifinyelela eminyakeni eminingana. Ngalesi sikhathi, ngaphansi kwethonya lokutheleleka ngegciwane, ukungondleki, ukucindezela, ukuphazamiseka komzimba kwenzeka.

Ngemuva kwalokho, ukukhiqizwa kwe-insulin kuyancipha, kepha isikhathi eside ngenxa ye-glucose yayo eseleyo yokugcwala igcinwa ngaphansi kwemikhawulo ejwayelekile.

Ngemuva kokushona okukhulu kwamaseli we-islet, izimpawu zesifo sikashukela zenzeka, ngenkathi ukucasulwa kwe-C-peptide kuhleli.

Izimpawu zokuqala kwesifo sikashukela

Ukubonakaliswa kwesifo sikashukela esigabeni sokuqala kungachazwa, kuvame ukwenziwa iphutha kwezinye izifo. Ezimweni ezinjalo, ukuxilongwa kuyabambezeleka futhi isiguli sisesimweni esibucayi lapho kutholakala ukuthi sinesifo sikashukela.

Kuyo leyo mindeni lapho abazali begula isifo sikashukela sohlobo 1, kuye kuqoqeke i-genetic pathologies bese kuba “nomphumela wangaphambi kokubonisa amandla”. Ukuthuthukiswa kwesifo sikashukela ezinganeni kwenzeka ngaphambili kunakubazali babo, futhi inkambo yalesi sifo iba nzima kakhulu. Ukwanda kwenani leziguli ezinesifo sikashukela sohlobo 1 kwenzeka kakhulu ngenxa yezingane kusuka ezinyangeni ezimbili kuya eminyakeni emi-5.

Ngokuya ngokuboniswa, ukudakwa kwesifo sikashukela kungaba ngezinhlobo ezimbili: okungaxineki futhi okuqinile. Isifo sikashukela esingenamandla kakhulu sibonisa ngokubonakala kwezimpawu ezincane ezidinga ukuxilongwa okuhlukile.

Lokhu kufaka lezi zimpawu ezilandelayo:

1. I-Envesis, okuyiphutha ukuthola ukutheleleka emgodini we-urin.
2. Ukutheleleka kwe-Vaginal candidiasis.
3. Ukuqunjelwa, okubhekwa njengophawu lwe-gastroenteritis.
4. Izingane azitholi isisindo noma zehlise isisindo ngendlela ephakeme.
5. Izifo zesikhumba ezingalapheki.
6. Kwehliswe ukusebenza kwezifundo, ukugxila okungekuhle, ukungasebenzi.

Ukuqala okukhulu kwesifo sikashukela kubonakaliswa ikakhulukazi yizimpawu zokuphelelwa ngamandla, okuholela ekuchama kakhulu, ekuhlanzeni njalo. Ngesifiso esandayo sokudla, izingane zilahlekelwa isisindo somzimba ngenxa yamanzi, i-adipose nezicubu zemisipha.

Uma lesi sifo siqhubeka ngokushesha, khona-ke iphunga le-acetone lizwakala emoyeni ochithekayo, i-rubeosis yesifo sikashukela (ukuqubuka kwezihlakala) esihlathini sengane, ukuphefumula kuba okujulile futhi njalo. Ukwanda kwe-ketoacidosis kuholela ekutheni ungaboni kahle, izimpawu zokuncipha kokwehla kwengcindezi, ukukhuphuka kwenhliziyo, i-cyanosis yamalunga.

Izinsana ekuqaleni zinesifiso esihle sokudla, kepha ukulahleka kwesisindo kwazo kuyaqhubeka isikhashana, khona-ke i-ketoacidosis kanye nokufakwa okungafanele kokudla kokujoyina amathumbu. Esikhathini esizayo, isithombe somtholampilo sihambisana nokuqala kokutheleleka, ukwakheka kwesimo se-coma noma septic.

Uma kutholakala ukuthi isifo sikashukela sitholakele, kepha kukhona ukungabaza ngohlobo lwesifo, khona-ke lezi zimpawu ezilandelayo zikhuluma ngokuncika kwe-insulin.

• I-Ketonuria
• Ukwehla komzimba.
• Ukuntuleka kokukhuluphala, i-metabolic syndrome, umfutho wegazi ophakeme.

Yini i-honeymoon yesifo sikashukela?

Ekuqaleni kohlobo lwe-1 mellitus yesifo sikashukela, kunesikhathi esifushane lapho isidingo sokuphathwa kwe-insulin sinyamalala noma isidingo saso sincipha kakhulu. Lesi sikhathi sabizwa ngokuthi "i-honeymoon." Kulesi sigaba, cishe zonke izingane zithola i-insulin encane, ziye kufinyelela kumayunithi angama-0.5 ngosuku.

Umshini wokuthuthuka okunjalo okucatshangelwe yingoba ama-pancreas ahlanganisa izinqolobane zokugcina zamaseli e-beta futhi i-insulin igcinwe, kepha akwanele ukunxephezela ngokuphelele inani elikhulayo le-glucose egazini. Isimo sokuxilonga ukwehlisa umthamo we-insulin izinga le-hemoglobin ye-glycated ngaphansi kwe-7%.

Isikhathi sokuqothuka kwezithandani singaba izinsuku noma izinyanga ezimbalwa. Ngalesi sikhathi, izingane zingaphula ukudla, zingalondolozi izinga elifunekayo lomsebenzi womzimba, kepha izinga le-glycemia lihlala livamile. Lokhu kuthuthukiswa kuholela ekwenqatsheni kwe-insulin, njengoba ingane izizwa kahle.

Imiphumela yokuhoxa okungagunyaziwe kwamalungiselelo e-insulin iholela ekubuyiselweni kwemali.

Ngasikhathi sinye, kunephethini: phambi kwe-ketoacidosis ku-dut ye-Type 1 yesifo sikashukela, isigaba sokuxolelwa ngokwengxenye kungenzeka singenzeki noma sibe mfushane kakhulu.

Ukuxhomekeka kwe-insulin okungapheli

Ngesithombe somtholampilo esandisiwe sikashukela, kukhona ukwehla kancane kancane kokukhiqizwa okuseleyo kwe-insulin kumanyikwe. Le nqubo isheshiswa izifo ezihlangene, izifo, ukugula, ukungondleki.

Ukuhlolwa kwe-antibody kukhombisa ukwehla kwe-autoallergy, ngoba amaseli we-beta ayafa. Ukufa kwabo okuphelele kwenzeka eminyakeni emithathu kuya kwemihlanu. Izinga lamaprotheni e-glycated egazini liyakhuphuka, futhi kwenziwa izinguquko emithanjeni, okuholela ezinkingeni ngendlela ye-neuropathy, nephropathy, retinopathy.

Enye yezinto ezenziwa yisifundo sikashukela sohlobo 1 ezinganeni noma eshumini nambili ukukhula kwesifo sikashukela esibizwa ngokuthi yi-labile. Lokhu kungenxa yokuthi ama-antibodies kuma cell pancreatic athambekele ukuvusa ama-insulin receptors ezicutshini zemisipha, izicubu ze-adipose nesibindi.

Ukusebenzisana kwama-antibodies nama-receptors kuholela ekunciphiseni kweglucose yegazi. Lokhu-ke kusebenze ukwahlukana okuzwela kohlelo lwezinzwa kanye ne-hyperglycemia kwenzeka ngenxa yesenzo sama-hormone okucindezela. I-overdose ye-insulin noma yeqa ukudla inethonya elifanayo. Kuyingozi ukungalandeli imigomo yokudla okunesifo sikashukela sohlobo 1.

Isifo sikashukela sentsha sinokuhlukahluka okunjalo phakathi:

1. Ithoni engazinzi yohlelo lwezinzwa.
2. Ukwephulwa njalo kwe-regimen yokuphathwa kwe-insulin nokudla okwenziwa ngabaningi.
3. Ukulawulwa kwe-glucose engasebenzi kahle.
4. Izifundo zeLabile ezinama-hypoglycemia ne-ketoacidosis.
5. Ukucindezeleka kwengqondo-ngokomzwelo nangokwengqondo.
6. Umlutha wotshwala nokubhema.

Ngenxa yomthelela ohlanganisiwe wezinto ezinjalo, ukukhishwa kwama-hormone aphikisayo kwenzeka: i-adrenaline, prolactin, androgens, i-catecholamines, i-prolactin, i-adrenocorticotropic hormone, i-chorionic gonadotropin ne-progesterone.

Wonke ama-hormone akhulisa isidingo se-insulin ngenxa yokwanda kwamazinga kashukela egazini lapho ekhishwa embhedeni we-vascular. Lokhu futhi kuchaza ukwanda kwe-glycemia ekuseni ngaphandle kokuhlaselwa ushukela owela ebusuku - into ethi "into yokusa yokusa" ehambisana nokwanda ebusuku kwe-hormone yokukhula.

Izici zokwelashwa kwesifo sikashukela ezinganeni

Ukwelashwa kwesifo sikashukela ezinganeni kuvame ukwenziwa ngamalungiselelo e-insulin yabantu. Njengoba le insulin ikhishwa ngobunjiniyela bezakhi zofuzo, inemiphumela emibi embalwa futhi izingane kuyaqabukela ziyayangana nayo.

Ukukhethwa komthamo kwenziwa ngokuya ngesisindo, iminyaka yengane kanye nezinga le-glucose egazini. Uhlelo lokusebenzisa i-insulin ezinganeni kufanele lusondele kakhulu emgomeni womzimba wokuphuza i-insulin kusuka kumanyikwe.

Ukuze wenze lokhu, sebenzisa indlela yokwelashwa kwe-insulin, ebizwa ngokuthi isisekelo-bolus. I-insulin esebenza isikhathi eside inikezwa izingane ekuseni nakusihlwa ukuze zibuyisele ukugcinwa okuvamile kwe-basal.

Lapho-ke, ngaphambi kokudla ngakunye, kufakwa umthamo obaliwe we-insulin osebenza kancane ukuze uvimbele ushukela wegazi ngemuva kokudla, futhi ama-carbohydrate asuka ekudleni angangenwa ngokuphelele.

Ukulawula inkambo yesifo sikashukela nokugcina i-glycemia izinzile, kuyanconywa:

• Ukwethulwa komuntu ngamunye okhethiwe we-insulin.
• Ukuhambisana nokudla.
• Ukukhishwa ushukela kanye nokuncipha kwama-carbohydrate namafutha ezilwane.
• Ukwelashwa okujwayelekile kwesifo sikashukela nsuku zonke.

Kwividiyo ekulesi sihloko, u-Elena Malysheva ukhuluma ngesifo sikashukela sabantwana.