I-World Health Organisation ibize ushukela ukuthi ibe yinkinga yawo wonke ubudala nawo wonke amazwe. Isifo sikashukela i-mellitus sibekwa endaweni yesithathu kwizimbangela zokufa ngemuva kwenhliziyo nomdlavuza.
Iningi - cishe ama-90% awo wonke amacala atholakele, i-akhawunti yohlobo 2 sikashukela mellitus, okuhlangene nokumelana ne-insulin (insensitivity). Izinga lokukhuphuka kweglucose egazini lenzeka ngenxa yokungakwazi kwe-insulin ukuxhuma nama-receptors kanye nokuqhuba i-glucose esitokisini.
Njengoba ngaphezu kwefa, ukondleka kudlala indima ekwakhiweni kwesifo sikashukela sohlobo 2 nemiphumela yaso - ukukhuluphala, umsebenzi ophansi womzimba, kuvame ukwenzeka ngemuva kwesizinda se-atherosclerosis kanye ne-hypertension, kubalulekile ukuphatha isifo sikashukela sohlobo 2 hhayi ngemithi kadokotela kuphela. Kepha kuyadingeka ukuguqula yonke indlela yokuphila, lapho ukuthuthuka kwesifo sikashukela, kanye nempilo ngokujwayelekile, kuzoncika.
Singalawulwa kanjani isifo sikashukela?
Ngohlobo lwe-2 yesifo sikashukela, ukwelashwa kwenziwa ngokunciphisa amazinga kashukela egazini, kuyilapho kudingeka ukuthi kuhlolwe izinkomba ezingaka kakhulu njengamanje njengokuqina kwazo isikhathi eside. Kulokhu, kusetshenziswa inkomba ye-glycated hemoglobin.
Ngokuyinciphisa ngo-1%, kungenzeka ukuthi kunciphise ingozi yezinkinga zesifo sikashukela ngendlela ye-nephropathy ne-retinopathy ngo-35-38%. Ukuqapha ushukela wegazi kanye nomfutho wegazi kuvimbela ukukhula kwesifo se-cerebrovascular, coronary isifo senhliziyo, kubambezela ukubonakaliswa kwe-angiopathy eseceleni ngesimo sonyawo sikashukela.
Izici ezenza kube nzima ukwelashwa kwenhlobo yesifo sikashukela sohlobo 2 ukukhula kwayo kubantu abavuthiwe nabadala nge-pathology ye-vascular ehambisanayo, ukwehla kwezinqubo ze-metabolic emzimbeni futhi kunciphise ukusebenza ngokomzimba nangokomphakathi.
Njengoba kungenakwenzeka ukwelapha isifo sikashukela, kwenziwa uhlelo lokuphathwa kwesifo sikashukela esigulini ngasinye. Kuyasiza ukuphila impilo egcwele, kulondolozwe impilo futhi kugweme izinkinga eziyingozi.
Izindlela eziphambili zokwelashwa kwesifo sikashukela sohlobo 2 zihlanganisa:
- Ukwelashwa kokudla.
- Ukuncishiswa kwengcindezi.
- Umsebenzi womzimba.
- Ukwelashwa kwezidakamizwa.
Ukwelashwa kufaka phakathi zombili izidakamizwa zokunciphisa ushukela wethebhulethi, kanye nesigaba esisha sama-incretomimetics, kanye nokwelashwa kwe-insulin lapho kukhonjisiwe.
Izindlela zokubuyelwa kwesifo sikashukela i-mellitus zisetshenziswa njengezinga lokwelashwa; zingahluka kancane ngokuya ngeminyaka kanye ne-pathology ehambisanayo. Kepha ukuthola umhlahlandlela, ukuthi ngabe kwenziwa ukwelashwa okusebenzayo yini, kuyadingeka ukuthi ufunde izinkomba ze-carbohydrate metabolism ukuze uhambisane nemingcele enjalo (zonke izinombolo ku-mmol / l):
- I-glycemia esheshayo: igazi le-venous (ukuxilongwa kwelabhoratri) elingaphansi kuka-6, egazini le-capillary (ukuziqapha nge-glucometer noma imichilo yokuhlola ebonakalayo) - ngaphansi kuka-5.5.
- I-Glycemia ngemuva kwamahora ama-2 (igazi lama-venous ne-capillary) - ngaphansi kuka-7.5.
- I-cholesterol ephelele ingaphansi kuka-4,5
- I-Lipoproteins: kwabantu abaphansi - abangaphansi kuka-2,5; okuphezulu - kwabesilisa ngaphezu kuka-1, nakwabesifazane abangaphezu kuka-1,2.
- I-Triglycerides: ngaphansi kuka-1.7.
Ngaphezu kwalokho, udokotela olingayo ulinganisela amaphesenti we-hemoglobin ye-glycated - akufanele ibe ngaphezulu kuka-6.5% futhi umfutho wegazi ngengozi ephansi ye-angiopathy akufanele udlule ku-130/80 mm Hg. Ubuciko.
Ukwelashwa kokudla kohlobo lwesibili sikashukela
Ngomkhulu ngokweqile, imfuneko yokudla iyancishiswa okuqukethwe kwekhalori. Ukudla okumaphakathi kwekhalori akufanele kudlule i-1800 kcal. Ngeviki udinga ukunciphisa isisindo ngo-500 g - 1 kilog.
Uma le nkomba inciphile, khona-ke kukhonjiswa ukuthi usuku olulodwa ngesonto ushintshele ekuthuliseni umsoco ngezinhlanzi, ubisi noma imikhiqizo yemifino enamakhalori afinyelela ku-1000 kcal. Izimiso eziyisisekelo zokudla okunempilo ukwenqatshwa kwama-carbohydrate asheshayo, angena ngokushesha futhi amafutha ezilwane agcwele inyama.
Isidlo siphoqelekile ngokuqinile ngesikhathi ngamahora afanayo, ukudla njalo, okungenani izikhathi ezi-6 ngosuku ngezingxenye ezincane. Lokhu kuvama kokudla kudla kufaka isandla ekujezisweni kwesisindo kanye nokugcina uzinzo weglue ngaphandle kokugxuma okungazelelwe, ngakho-ke, njengoba isiguli sathola ngesifo sikashukela, ukudla okwelaphayo kufanele kuqashelwe.
Ukwelashwa okuphumelelayo kwesifo sikashukela sohlobo 2, udinga ukukhipha ngokuphelele imikhiqizo ohlwini:
- Imikhiqizo Flour: isinkwa esimhlophe, namakhekhe, khekhe puff, muffin, amakhukhi, waffles.
- Ushukela, amaswidi, ujamu, u-ayisikhilimu, ushukela, uphudingi, uju.
- Ama-grice grats, i-semolina ne-pasta
- Inyama Egcweleyo Ne Offal
- Izinhlanzi ezinamafutha, ezinosawoti nezibhemayo, ukudla okusemathinini emafutheni.
- Amagilebhisi, omisiwe, izinsuku, ubhanana, amakhiwane, amajusi wezithelo ezimboni.
Ushukela uthathelwa indawo yi-fructose, i-sorbitol, i-xylitol, i-aspartame, noma i-stevia. Kuhlelwa ukwehlisa usawoti ube ngu-3-5 g ngosuku. Kufanele kukhunjulwe ukuthi emikhiqizweni yokudla okujwayelekile kuqukethe cishe i-1 -2 g. Ngomfutho wegazi ophakeme noma nge-nephropathy, ukudla akufakiwe.
Ekudleni kwesifo sikashukela sohlobo 2, kumele kube khona i-fiber eyanele yokudla kusuka kumifino emisha noma ebilisiwe, inani eliphelele le-fiber akufanele libe ngaphansi kwama-40 g. I -atsha lingasetshenziswa ekudleni ukunciphisa inkomba ye-glycemic.
Imifino kufanele ibe yintsha ngangokunokwenzeka ngendlela yama-saladi ngamafutha zemifino. Izaqathe abilisiwe, beet kanye namazambane alinganiselwe.
Inani lamaprotheni nsuku zonke kufanele libe ngu-0.8 -1 g ngekhilogremu yesisindo sesiguli ngasinye. ngokwakhiwa kwe-pathology yezinso, kuyancishiswa. Amaprotheni ancamela ukuthola izinhlanzi, imikhiqizo yobisi enamafutha aphansi, inyama engenamafutha. Indlela engcono yokupheka iyabilisa, ukuthosa kungcono ukuyisebenzisa.
Njengomthombo wevithamini, ungasebenzisa i-rosehip decoction, ujusi noma isiphuzo sezithelo kusuka ku-cranberries, ama-blueberries, ama-blueberries, i-decoction ye-chokeberry, iqoqo le-vithamini. Ebusika nasentwasahlobo, kukhonjiswa ama-multivitamini.
Ukusetshenziswa kwemisebenzi yomzimba kushukela
Ukuqamba izincomo ku-regimen yomsebenzi wokuzivocavoca kuyenziwa kucatshangelwa ubudala, ukuqina, isimo esivamile sesiguli. Ukuba khona kwezinkinga zesifo sikashukela nezifo ezihambisana nayo kubaliwe.
Ezigulini ezinesifo sikashukela sohlobo 2, kunconywa ukuzivocavoca okulingana nohlobo olufanayo lokunyakaza. Ngaphambi kwamakilasi, kanye nangemva kwawo, kuyadingeka ukukala ushukela wegazi, umfutho wegazi kanye nenhliziyo.
Uma ushukela wegazi uphakeme kuno-14 mmol / l, awukwazi ukuzivocavoca, ngoba angangezelela i-glycemia futhi andise i-ketoacidosis esikhundleni sokwehliswa. Futhi, awukwazi ukubhekana noshukela egazini ongaphansi kwe-5 mmol / L.
Ukuze wandise imisebenzi yansuku zonke, kuyanconywa:
- Nsuku zonke: ukupaka imoto noma lapho ushayela ngezithuthi zomphakathi hamba ngamamitha angama-300 kuye kwangama-500 lapho uya khona, ungasebenzisi ilifti, uhambe inja, uye esitolo esikude, ekhemisi noma eposini ukuze uthathe izinyathelo eziningi ngangokunokwenzeka ngosuku.
- Kabili ngesonto, sebenza engadini, welula, i-yoga, igalofu noma isobho.
- Kathathu ngesonto: ukuhamba ngezinyawo, ukugijima, ukubhukuda, ukuhamba ngamabhayisekili, ukudansa.
- Yehlisa ukubuka i-TV, ukufunda noma ukugoqa isigamu sehora, bese wenza ukuzivocavoca okukhanyayo.
Ukuzivocavoca komzimba kufaka isandla ekusebenziseni i-glucose, futhi lesi senzo siyaqhubeka amahora amaningi ngemuva kokuphela kwesikhathi, kodwa futhi sinciphise okuqukethwe kwe-triglycerides egazini, okudala ukulimala kwemithambo, futhi futhi kukwandise nokuqina kwe-lipoproteins. Lezi zinto zinciphisa amathuba okufakwa kwe-cholesterol emikhunjini.
Umsebenzi wegazi we-fibrinolytic uyakhuphuka, ukubonakala kwawo nokunamathela kwe-platelet kuyancipha, futhi nezinga le-fibrinogen liyancipha. Lokhu ukuvimbela okusebenzayo kwe-thrombosis, ukushaya kwenhliziyo nokushaywa unhlangothi.
Umphumela omuhle kumisipha yenhliziyo kuzenzo ezinjalo:
- Umfutho wegazi uyancipha.
- Ku-myocardium, ukusetshenziswa kwe-oxygen kuyanda.
- I-Neuromuscular conduction iyathuthuka.
- Ukukhishwa kwentliziyo kuyanda.
- Izinga lenhliziyo liyaqina.
Ngaphezu kokuthinta isistimu yemisipha kanye nemithambo, ukusebenza komzimba kunomphumela wokulwa nokuxineka, ukunciphisa izinga le-adrenaline, i-cortisol, futhi kwandise ukukhishwa kwama-endorphin ne-testosterone.
Into ebaluleke kakhulu ezigulini ezinesifo sikashukela ukuthi ukusetshenziswa komzimba okwenziwe dosed kwehlisa izinga lokulimala kwe-lino-hyperinsulinemia.
Thayipha umuthi wesi-2 wesifo sikashukela
Kungenzeka ulondoloze impilo ngezindlela ezinesifo sikashukela futhi ezigabeni zokuqala ngokudla nangokuthatha amakhambi amakhambi. Isimo sokunqunywa kwemithi izinga le-hemoglobin ye-glycated ilingana noma inkulu kune-7%.
Umuthi wokuqala ongabekelwa ukuthola isifo sikashukela yi-metformin. Umphumela wayo ekwehliseni ushukela wegazi awuqedi phansi ukongiwa kwamanyikwe, kuvame ukubekezelelwa kahle futhi ayinayo imiphumela emibi.
Inzuzo ebalulekile ukufinyeleleka kwayo kanye nokuntuleka kwethonya kwesisindo. Ngakho-ke, ezigabeni zokuqala zokwelashwa kwesifo sikashukela, yona, kanye nokuncipha kwesisindo kanye nokwenyuka komzimba, kusiza ukuqinisa amazinga we-glucose ngaphakathi kwamapharamitha okuhlosiwe.
Isenzo se-metformin emazingeni kashukela sibonisa imiphumela enjalo:
- Kwandisa ukuzwela kwamaseli wesibindi ku-insulin, okunciphisa ukukhiqizwa koshukela.
- I-Glycogen synthesis iyanda futhi ukuwohloka kwayo kuyancipha.
- Kwi-adipose nezicubu zomsipha, ukuhambisana kwama-insulin receptors kuyanda.
- Ukusetshenziswa kwe-glucose kwezicubu kuyanda.
- Ukufakwa kweglucose esiswini kuyancishiswa, okunciphisa ukuphuma kwayo egazini ngemuva kokudla.
Ngakho-ke, i-metformin ayinciphisi ushukela, kodwa ngaphezu kwakho konke ivimbela ukwanda kwayo. Ngaphezu kwalokho, kwehlisa i-triglycerides ne-cholesterol egazini, kunciphisa ingozi yokuqhekeka kwegazi. Inempahla yokwehla yokudla eyehla kancane.
Imiphumela emibi ihambisana nokuncipha kokufakwa kweglue emathunjini futhi kungenzeka ngesimo sohudo, ukubhebhetheka, isicanucanu. Lokhu kunganqotshwa ngokuphatha imithamo yokuqala ephansi ngokwenyuka kancane kancane.
Ekuqaleni, i-500 mg inqunyelwe izikhathi ezi-1 noma ezi-2 ngosuku, futhi ngemuva kwezinsuku ezingama-5-7 ungayandisa uma kudingeka ku-850-1000 mg, udinga ukuphuza amaphilisi ngemuva kokudla kwasekuseni nangemva kokudla.
Ukulungiswa kweSulfonylurea kuvuselela ukukhishwa kwe-insulin. Basebenza kumaseli we-beta eziqhingini zeLangerhans. Baqala ukusetshenziswa ngemithamo ephansi kakhulu, bekhula kanye ezinsukwini ezingama-5-7. Izinzuzo izindleko eziphansi nesivinini sokusebenza. Ngasohlangothini olubi - ukungasebenzi kahle kwe-hyperinsulinemia, inzuzo yesisindo, i-hypoglycemia ejwayelekile. Le mishanguzo ifaka phakathi: Glibenclamide, Glimepiride, Gliclazide MV, Glycvidon.
Ngokuvimbela kanye nokwelashwa kwesifo sikashukela sohlobo 2, isidakamizwa i-Acarbose (Glucobai) siyasetshenziswa. Ngaphansi kwesenzo sawo, ama-carbohydrate avela ekudleni awagxilwe, kepha ayakhishwa kanye nokuqukethwe kwamathumbu. Ngakho-ke, ngemuva kokudla akukho gxuma elibukhali kushukela. Umuthi uqobo ngokungenayo awangeni egazini.
I-Acarbose ayithinti i-insulin secretion, ngakho-ke, ayibangeli i-hypoglycemia. Amanyikwe awalayishiwe. Ukusetshenziswa isikhathi eside kwesidakamizwa kunomthelela onjalo kuma-carbohydrate metabolism:
- Ukumelana ne-insulin kuncishisiwe.
- Yehlisa ukudla kwe-glycemia.
- Yehlisa izinga le-hemoglobin ye-glycated.
- Ivimbela izinkinga zesifo sikashukela.
Ukuthatha i-acarbose yangaphambi kwesifo sikashukela kunciphisa ingozi yokuthola lesi sifo ngo-37%. Ekuqaleni, i-50 mg imiselwe kusihlwa kusihlwa ekudleni, umthamo ukhuphuka ufike ku-100 mg izikhathi ezi-3 ngosuku. Ukubuyekezwa kweziguli ezisebenzise leli thuluzi kukhombisa ukuphazamiseka kwamathumbu okwenzeka njalo, ukuqhakaza, izinhlungu emathunjini nokuthopha.
Amaqembu amasha ezidakamizwa ezinciphisa ushukela
I-Glitazones - isigaba esisha sezidakamizwa ze-antidiabetic zisebenza kuma-receptors ku-adipose nezicubu zemisipha, zikhulisa ukuzwela kwazo ku-insulin. Lesi senzo senzeka ngokwandisa isibalo sezakhi zofuzo ezihlanganisa amaprotheni okucubungula i-glucose namafutha acid.
Kulokhu, isibindi, izicubu nezicubu ze-adipose kudla ushukela omningi kusuka egazini, kanye ne-triglycerides kanye namafutha acid yamahhala. Izidakamizwa ezinjalo zibandakanya i-rosiglitazone (Avandia, Roglit) ne-pioglitazone (uPioglar, i-Amalvia, iDam-standard, iPioglit).
Le mishanguzo ifakwa emzimbeni wokuqina kwenhliziyo, nokwanda komsebenzi wokudluliswa kwesibindi, ngokuqunjelwa kanye nokukhulelwa.
Ukulungiswa kwe-Glitazone kufanele kuthathwe ngemithamo ye-4 ne-8 mg (ye-roxiglitazone) ne-30 mg ngosuku nge-pioglitazone. Lokhu kukuvumela ukuthi wehlise izinga le-glycemia ne-glycated hemoglobin ngo-0.6 - 0,7%.
Izidakamizwa i-Repaglinide neNateglinide zenza ngokunyusa kakhulu ukukhishwa kwe-insulin, ekuvumela ukuthi ulawule ukwanda kwe-glucose ngemuva kokudla. Balingisa amaseli we-beta ngokuvula iziteshi ze-calcium.
Okwakuthembisa kakhulu ekwelashweni kwesifo sikashukela sohlobo 2 kwakuyisidakamizwa esisha esisha - iBaeta. Isenzo saso sivezwa ngama-hormone akhiqizwa emgodini wokugaya - ama-incretin. Ngaphansi kwethonya leBaeta, ukwakheka kwalawa mahomoni kuyenyuka, okukuvumela ukuthi ubuyisele isigaba sokuqala se-insulin secretion, ukucindezela ukukhiqizwa kwe-glucagon namafutha acid.
UByeta wehlisa ukungasebenzi kwesisu, ngaleyo ndlela anciphise ukudliwa. Umphumela wayo awuxhomeki ekujuleni kwesifo sikashukela. Umthamo wokuqala we-5 mcg kabili - ihora ngaphambi kokudla kwasekuseni nangaphambi kwesidlo. Ngemuva kwenyanga, ungakhuphukela ku-10 mcg.
Umphumela omubi - isicanucanu esincane, izimpawu zokuphazamiseka kokugaya ukudla, okuvame ukunyamalala ngemuva kweviki lokuqala lokwelashwa.
I-dipeptidyl peptidase-IV-sitagliptin inhibitor yayingokugcina kwamalungiselelo we-incretin. Lo muthi usebenza njengeBayeta Kepha kwenye i-enzyme, ithuthukisa ukwakheka kwe-insulin ukuphendula ukuthathwa kwama-carbohydrate. Ngasikhathi sinye, kufakwa uphawu olunjenge-glucagon secretion.
ISitagliptin ithengiswa ngaphansi kwegama lokuhweba uJanouvia. Kwahlanganiswa ne-metformin kusidakamizwa iYanumet, esenza ngcono ukwelashwa kwesifo sikashukela sohlobo 2, ngoba umuthi oyinkimbinkimbi onjalo unciphisa ushukela wegazi ngokushesha.
Lapho wenza izifundo zomtholampilo, imiphumela elandelayo yatholakala ngokusetshenziswa kweJanuvia:
- Ezinzile futhi ebonakalayo kwehla glycemia.
- Yehlisa ukungena kwe-glucose ngemuva kokudla.
- Ukwehliswa okukhulu kwe-hemoglobin ye-glycated.
- Isikhathi sokusebenza, okuvumela ukusetshenziswa kanye ngosuku
- Ukuntuleka kwesisindo.
Thayipha 2 isifo sikashukela i-insulin
Eminye imibono eyiphutha mayelana nesifo sikashukela sohlobo 2 ukuthi lokhu kuhluka kulula futhi akudingi ukwelashwa okungathi sína. Lapho isiguli siqonda ukuthi "nginohlobo lwesibili sikashukela," unombono wokuthi lesi yisifo esihilela ukwelashwa ngamaphilisi ngaphandle kwe-insulin.
Izinga le-glycemia ngesikhathi sesifo sikashukela sesikhathi eside livame ukunganakekelwa ngamaphilisi, ngakho-ke, uma ukudla kungasebenzi futhi nemithamo ephezulu yemithi ekwehlisa ushukela, okungukuthi uma i-glycated hemoglobin ingaphezulu kuka-7.5%, ushukela we-glucose osheshayo ungaphezulu kuka-8 mmol / l, inkomba yesisindo somzimba ingaphansi kwama-25 kg / m2 Ukwelashwa kwe-insulin kubonisiwe.
Ukwelashwa kwesifo sikashukela sohlobo 2 nge-insulin kusetshenziselwa i-ketoacidosis, ukungenelela kokuhlinzwa, ukuthuthukiswa kwezifo ezithathelwanayo kanye nezinkinga zesifo sikashukela ngendlela ye-neuropathy kanye ne-vascular pathology enzima. Ividiyo ekulesi sihloko izokhuluma ngezimpawu eziphambili kanye nokwelashwa kwesifo sikashukela.
