Imbangela yokukhuphuka kweglucose kungaba ukweqiwa isikhathi eside kwama-steroid egazini. Kulokhu, ukuxilongwa kwesifo sikashukela se-steroid kwenziwa. Ngokuvamile, ukungalingani kuphakama ngenxa yemithi ebekiwe, kodwa futhi futhi kungaba yingxaki yezifo eziholela ekwandeni kokukhululwa kwama-hormone. Ezimweni eziningi, ushintsho lwe-pathological ku-metabolism wama-carbohydrate luyaphenduka, ngemuva kokuhoxiswa kwezidakamizwa noma ukulungiswa kwesimbangela sesifo, ziyanyamalala, kepha kwezinye izimo bangaqhubeka ngemuva kokwelashwa.
Ama-steroid ayingozi kakhulu awabantu abanesifo sikashukela sohlobo 2. Ngokwezibalo, ama-60% eziguli kufanele athathe amanye esikhundleni se-hypoglycemic agents nge-insulin therapy.
Isifo sikashukela seSteroid - siyini?
I-Steroidal, noma eyenziwe izidakamizwa, isifo sikashukela yisifo esiholela ku-hyperglycemia. Isizathu salokhu umphumela ongemuhle wama-glucocorticoid mahormone, asetshenziswa kabanzi kuwo wonke amagatsha ezokwelapha. Banciphisa umsebenzi wamasosha omzimba, babe nemiphumela yokulwa nokuvuvukala. Ama-Glucocorticosteroids afaka iHydrocortisone, iDixamethasone, iBetamethasone, iPrednisolone.
Kafushane nje, kungabi ngaphezu kwezinsuku ezingama-5, ukwelashwa ngalezi zidakamizwa kunqunyelwe izifo:
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
- amathumba amabi
- i-bacterial meningitis
- I-COPD yisifo samaphaphu esingamahlalakhona
- gout esiteji esibuhlungu.
Isikhathi eside, izinyanga ezingaphezu kweziyi-6, ukwelashwa kwe-steroid kungasetjenziswa kwezifo zangaphakathi zephayini, izifo ze-autoimmune, ukuvuvukala kwamathumbu, izinkinga zesikhumba, kanye nokudluliselwa kwezitho. Ngokwezibalo, izigameko zesifo sikashukela ngemuva kokusetshenziswa kwalezi zidakamizwa azidluli kuma-25%. Isibonelo, ekwelashweni kwezifo zamaphaphu, i-hyperglycemia ibonwa ku-13%, izinkinga zesikhumba - ku-23,5% yeziguli.
Ingozi yesifo sikashukela se-steroid yanda ngo:
- isifiso sokuthola ifa lokuthayipha isifo sikashukela sesi-2, izihlobo zomndeni wokuqala onesifo sikashukela;
- isifo sikashukela sokukhulelwa ngesikhathi sokukhulelwa okungenani kokukodwa;
- isifo sikashukela;
- ukukhuluphala, ikakhulukazi isisu;
- i-polycystic ovary;
- ubudala.
Ukuphakama umthamo wemithi othathwe, kuphakamisa amathuba wesifo sikashukela:
| Umthamo we-hydrocortisone, mg ngosuku | Ingozi eyandayo yezifo, izikhathi |
| < 40 | 1,77 |
| 50 | 3,02 |
| 100 | 5,82 |
| 120 | 10,35 |
Uma isiguli ngaphambi kokwelashwa kwe-steroid singenayo imishanguzo yokudla kwasekuqaleni yama-carbohydrate, i-glycemia imvamisa iba njalo ezinsukwini ezi-3 ngemuva kokukhanselwa kwayo. Ngokusetshenziswa isikhathi eside kwale mishanguzo futhi inethuba lokuthola isifo sikashukela, i-hyperglycemia ingaba yimbi, idinga ukulungiswa impilo yonke.
Izimpawu ezifanayo zingavela ezigulini ezinokukhubazeka kokukhiqizwa kwama-hormone. Imvamisa, isifo sikashukela siqala ngesifo i-Itsenko-Cushing's, imvamisa kakhulu nge-hyperthyroidism, pheochromocytoma, trauma noma i-brain tumor.
Izizathu zokuthuthuka
Kukhona ubudlelwano obuqondile be-multicomponent phakathi kokusetshenziswa kwe-glucocorticoid kanye nokuthuthukiswa kwesifo sikashukela se-steroid. Izidakamizwa zishintsha i-biochemistry yezinqubo ezenzeka emzimbeni wethu, zivusa i-hyperglycemia ezinzile:
- Zithinta ukusebenza kwamangqamuzana we-beta, ngenxa yokuthi kuncishiswa ukwakheka kwe-insulin, ukuphuma kwawo egazini kuyacindezelwa ngenxa yokuphuza i-glucose.
- Kungadala ukufa okukhulu kwamaseli we-beta.
- Banciphisa umsebenzi we-insulin futhi, ngenxa yalokho, bathikameza ukudluliswa kwe-glucose kwezicubu.
- Yehlisa ukwakheka kwe-glycogen ngaphakathi kwesibindi nemisipha.
- Umsebenzi we-enteroglucagon we-hormone uyacindezelwa, ngenxa yokuthi lapho ukukhiqizwa kwe-insulin kuncipha futhi.
- Bandisa ukukhishwa kwe-glucagon, i-hormone esenza buthaka imiphumela ye-insulin.
- Zenza i-gluconeogeneis isebenze, inqubo yokwenziwa kwe-glucose kusuka kumakhemikhali wesimo esingeyona i-carbohydrate.
Ngakho-ke, ukukhiqizwa kwe-insulin kuncishiswa kakhulu, ngakho-ke ushukela awukwazi ukufinyelela emgomweni wawo - kumaseli womzimba. Ukugeleza kweglucose egazini, kunalokho, kukhuphuka ngenxa ye-gluconeogeneis kanye nokuncipha kokukhishwa koshukela ezitolo.
Kubantu abane-metabolism enempilo, ukuhlanganiswa kwe-insulin kuyanda ngemuva kwezinsuku ezingama-2-5 zokuthatha ama-steroid ukunxephezela umsebenzi wayo oncishisiwe. Ngemuva kokuyeka umuthi, ama-pancreas abuyela kusisekelo. Ezigulini ezinobungozi obukhulu besifo sikashukela se-steroid, isinxephezelo singase singanele, i-hyperglycemia yenzeka. Leli qembu livame ukuba nokuqhekeka okuholela kwisifo sikashukela esingamahlalakhona.
Lesi sifo sinikezwa ikhodi ye-ICD ye-10 E11 uma umsebenzi we-pancreatic ugcinwe ngokwengxenye, no-E10 uma amaseli e-beta ebhujiswa ngaphambili.
Izici nezimpawu zesifo sikashukela se-steroid
Zonke iziguli ezithatha ama-steroid kufanele zizazi izimpawu eziqondene noshukela:
- i-polyuria - ukwanda kokuchama;
- i-polydipsia - ukoma okuqinile, cishe nokungabi buthaka ngemuva kokuphuza;
- ulwelwesi lwe-mucous olomile, ikakhulukazi emlonyeni;
- isikhumba esithambile, esingenangqondo;
- isimo sokukhathala njalo, ukusebenza okunciphile;
- ngokuntuleka okukhulu kwe-insulin - ukunciphisa umzimba ngokweqile.
Uma lezi zimpawu zenzeka, kuyadingeka ukuthola ushukela onesifo sikashukela. Isivivinyo esizwela kakhulu kuleli cala ukuvivinya ukubekelwa phansi koshukela. Kwezinye izimo, kungakhombisa ushintsho kuma-carbohydrate metabolism kungakapheli amahora angama-8 ngemuva kokuqala kokuthatha ama-steroid. Izindlela zokuhlonza ziyefana nakwezinye izinhlobo zesifo sikashukela: ushukela ekugcineni kokuhlolwa akufanele ube ngaphezulu kuka-7.8 mmol / l. Ngokukhuphuka kokugxilwa kumayunithi ayi-11.1, singakhuluma ngokuphazamiseka okubalulekile kwe-metabolic, okuvame ukungaphenduki.
Ekhaya, isifo sikashukela esingahlonzwa sitholakala kusetshenziswa i-glucometer, izinga elingaphezulu kwe-11 ngemuva kokudla libonisa ukuqala kwalesi sifo. Ushukela wokuzila uyakhula ngokuhamba kwesikhathi, uma ungaphezulu kwamayunithi angama-6.1, udinga ukuxhumana ne-endocrinologist ukuze uthole ukuhlolwa nokwelashwa okwengeziwe.
Izimpawu zesifo sikashukela kungenzeka zingabikhona, ngakho-ke kuyisiko ukuphatha ushukela wegazi ezinsukwini ezimbili zokuqala ngemuva kokuphathwa kwe-glucocorticoids. Ngokusebenzisa isikhathi eside kwezidakamizwa, ngokwesibonelo, ngemuva kokudluliswa, izivivinyo zinikezwa masonto onke phakathi nenyanga yokuqala, bese kuthi emva kwezinyanga ezintathu nezinyanga eziyisithupha, kungakhathalekile ukuba khona kwezimpawu.
Ungasiphatha kanjani isifo sikashukela se-steroid
Ishukela likashukela libangela ukwanda kakhulu koshukela ngemuva kokudla. Ubusuku nokusa ngaphambi kokudla, i-glycemia kuyinto evamile okokuqala ngqa. Ngakho-ke, ukwelashwa okusetshenzisiwe kufanele kunciphise ushukela phakathi nosuku, kodwa ungavusi i-hypoglycemia yangemuva kosuku.
Ukwelashwa kwesifo sikashukela i-mellitus, kusetshenziswa izidakamizwa ezifanayo nakwezinye izinhlobo zesifo: ama-hypoglycemic agents kanye ne-insulin. Uma i-glycemia ingaphansi kuka-15 mmol / l, ukwelashwa kuqala ngezidakamizwa ezisetshenziselwa isifo sikashukela sohlobo 2. Izinombolo zikashukela eziphezulu zibonisa ukonakala okukhulu ekusebenzeni kwe-pancreatic, iziguli ezinjalo zinqunywe imijovo ye-insulin.
Izidakamizwa ezisebenzayo:
| Izidakamizwa | Isenzo |
| I-Metformin | Kuthuthukisa ukuqonda kwe-insulin, kunciphisa i-gluconeogeneis. |
| Izinsizakalo ze-sulfanylureas - glyburide, glycoslide, repaglinide | Ungabeki izidakamizwa zesenzo eside, ukuqapha imvamisa yokudla kokudla kuyadingeka. |
| I-Glitazones | Khulisa ukuzwela kwe-insulin. |
| Analogs of GLP-1 (enteroglucagon) - exenatide, liraglutide, lixisenatide | Isebenza kangcono kunesifo sikashukela sohlobo 2, sandisa ukukhishwa kwe-insulin ngemuva kokudla. |
| I-DPP-4 inhibitors - sitagliptin, saxagliptin, alogliptin | Yehlisa amazinga kashukela, ukhuthaze ukunciphisa umzimba. |
| Ukwelashwa kwe-insulin, kuye ngezinga le-insulin yabo, kukhethwe uhlobo lwendabuko noma olunamandla | I-insulin esebenza njenge-insulin imvama futhi inqunyelwe ngaphambi kokudla. |
Ukuvimbela
Ukuvimbela nokutholwa kwesifo sikashukela okuyisikhathi esifanele kuyingxenye ebalulekile yokwelashwa ngama-glucocorticoids, ikakhulukazi lapho ukusetshenziswa kwawo kwesikhathi eside kulindeleke. Izinyathelo ezifanayo ezisetshenziselwa isifo sikashukela sohlobo 2, ukudla okune-carb ephansi kanye nokuzivocavoca okwenyukayo, kunciphisa ubungozi bokwephulwa kwe-carbohydrate metabolism.
Ngeshwa, le prophylaxis inzima, ngoba ama-steroid andisa isifiso sokudla, futhi izifo eziningi eziziphatha zibakhipha noma zibeke umngcele kakhulu kwezemidlalo. Ngakho-ke, ekuvinjelweni kwesifo sikashukela se-steroid, indima eyinhloko ingeyokuxilongwa kokuphazamiseka nokulungiswa kwabo ezingeni lokuqala ngosizo lwemithi enciphisa ushukela.
