Ukhuphuka kweglucose kwegazi kuphakamisa izinkinga eziningi ze-vascular and metabolic, eziholela emiphumeleni engenakuphikiswa cishe kuwo wonke izicubu zomzimba, kufaka phakathi izitho ezibalulekile. Ukuvimbela izinkinga zesifo sikashukela, iziguli zibekelwa ukwelashwa masisha ngangokunokwenzeka ukuze kufakwe ushukela ngokwejwayelekile.
Ngaphezu kwe-glycemia, izinga lomfutho wegazi kanye nezici zofuzo nazo zithinta isilinganiso sezinkinga. Kwezinye iziguli ezinokulawulwa okunganele kwe-glycemic, ukuphazamiseka kuqala emashumini eminyaka kamuva, kepha iningi labanesifo sikashukela libathola kungakapheli iminyaka emi-5 yokugula. Isifo sohlobo 2, njengomthetho, sitholakala sekwedlule isikhathi lapho izinkinga zokuqala sezivele ziqalile ezigulini.
Yiziphi izinhlobo zezinkinga zesifo sikashukela?
Izinkinga zesifo sikashukela zivame ukuhlukaniswa ngamaqembu emi-2 yevolumu - kakhulu futhi sekwephuzile. Izimo ezesabekayo zifaka izimo ezikhula esikhathini esingamahora amaningi, ezimeni ezimbi kakhulu, ngaphezulu kwezinsuku ezimbalwa. Imbangela yabo iphansi kakhulu noma ushukela omningi kakhulu emikhunjini. Kuzona zozimbili lezi zinguquko, izinguquko eziningi kumetabolism nokusebenza kwesitho ziqala, kuye kwenzeke ukoma, bese kuba ngumphumela obulalayo. Esigulini dinga ukunakekelwa kwezokwelashwa ngokusheshabuyisela imisebenzi yomzimba ophikweni lokunakekela olunzulu.
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%
Izinkinga zakamuva ziqongelela amashumishumi eminyaka, imbangela yazo isifo sikashukela esibolile. Lapho likhuphuka ushukela wegazi ojwayelekile, kuba nezinkinga ezikhula ngokwengeziwe. Izinkinga zasemuva kwesikhathi zisebenza kwezicubu zemithambo nemikhumbi emazingeni amakhulu nakakhulu. Okokuqala, umsebenzi wezitho ezisengozini kakhulu uyaphazamiseka: izinso namehlo. Ekugcineni, umuntu onesifo sikashukela uqoqa yonke “inqwaba” yezifo ezingamahlalakhona: kusuka ku-nephropathy kuya onyaweni lwesifo sikashukela. Ezinganeni, iningi lezinkinga livela ngesikhathi sokuthomba.
Izinkinga Eziyingozi ku-Diabetes
Hhayi kuphela onesifo sikashukela, kodwa futhi nezihlobo zakhe kufanele ziqaphele izinketho ezingaba khona ngenxa yezinkinga ezinzima. Kuzo zonke izimo, lokhu kuyinkomane. Zibangelwa ukuncipha okukhulu kwesifo sikashukela i-mellitus (hyperosmolar kanye ne-ketoacidotic coma), noma ukweqisa kwama-ejenti we-hypoglycemic (hypoglycemic coma), noma ukwakheka ngokweqile kwe-lactate ngaphansi kwethonya lezimbangela zangaphandle (lactic acidosis coma). Akukona ngaso sonke isikhathi ukuqaphela ubunzima obukhulu esiteji sokuqala. Lapho ubukhulu besimo bukhula, isiguli sife ngokushesha, sidinga usizo lwabanye.
I-Hypoglycemia
I-Hypoglycemia kubantu abaphilile ibhekwa njengokudonsa ushukela ngaphansi kuka-2.6 uma kunezimpawu ezibonakalayo: injabulo, ukuthuthumela kwangaphakathi, indlala, ikhanda, ukujuluka okusebenzayo, ukungakwazi ukugxila. Uma lezi zimpawu zingekho, u-2.2 mmol / L uthathwa njengomngcele obucayi. Njengoba unesifo sikashukela, umbono we-hypoglycemia ungathikamezeka. Iziguli, ezihlushwa njalo amaconsi kashukela, azihlali zizizwa. Ngakolunye uhlangothi, nge-glucose ekhuphuka njalo, izimpawu zingazwakala lapho ushukela wehla uye ku-5. Ngokulashwa kwezidakamizwa, i-glycemia iphakanyiselwa emkhawulweni ophansi we-3.3.
I-hypoglycemia emnene ithathwa njengeyilokho okwakwazi ukumisa isiguli ngokwaso, kungakhathalekile ukuthi ushukela unzima kangakanani nezimpawu. Uhlobo ngalunye lwesifo sikashukela luhlangana nabo okungenani kanye ngesonto, noma ngabe leso sifo sinxeshezelwe.
Izinkinga ezinkulu ze-hypoglycemic zibandakanya izimo lapho abanesifo sikashukela bedinga usizo lwangaphandle. 4% weziguli ezinesifo sikashukela zibulawa yi-hypoglycemia enzima. Ezimweni eziningi, imbangela yokufa akuyona indlala yobuchopho (umphumela oqondile wokuntuleka kwe-glucose emikhunjini), kodwa izici ezihlobene: ukudakwa, ukuphazamiseka kwesigqi senhliziyo, i-thrombosis. Imvamisa ye-hypoglycemia enzima: uhlobo lwe-1 sikashukela - amacala angu-0.08-0.14 ngonyaka kumuntu ngamunye, uhlobo lwe-2 - 0.03-0.11.
>> Ukuthi wenzeni nge-hypoglycemia - usizo lokuqala
I-ketoacidotic coma
I-ketoacidosis iba ngenxa yokubola kakhulu kwesifo sikashukela. Izimpawu zalo ushukela wegazi ophakeme (> 13.9), imizimba ye-ketone emchameni (> ++) kanye negazi (> 5), i-metabolic acidosis (i-pH <7.3), ukwazi ukungasebenzi kahle emazingeni ahlukahlukene. Ngesikhathi sokuphila, i-ketoacidotic coma iba ku-1% yabanesifo sikashukela, iziguli ezinoshukela oluphakeme kakhulu zisengozini enkulu. Kuma-hyperglycemic combs, i-ketoacidotic ijwayelekile kunabanye, ama-90% eziguli ezamukelwe ekunakekelweni okunzulu angasindiswa. Ingozi yokufa iphakeme kubantu abanezinkinga eziningi zakamuva zesifo sikashukela nezinye izifo ezenzeka njalo.
>> I-ketoacidotic coma - izimpawu nokwelashwa
I-Hyperosmolar coma
I-hyperglycemia enkulu futhi iyimbangela yale nkinga, kepha ukuphazamiseka kwe-metabolic kukhula ngendlela ehlukile. I-Ketosis ne-acidosis ezigulini azikho, ushukela ukhuphuka ngokuqinile ufike ku-35 mmol / l futhi ngaphezulu, ukukhuphuka kwegazi osmolarity (kwabantu), futhi ukuphuma komzimba okuqinile kuqala.
I-Hyperosmolar coma ihlala iphindwe kayishumi kune-ketoacidotic. Isiguli esijwayelekile singumuntu osekhulile onesifo sikashukela sohlobo 2. Izici zobungozi yizifo zabesifazane, izifo ezithathelwanayo. Ingxenye yesithathu yeziguli ekhephuka ngokweqile (hyperosmolar coma) yayingazi ukuthi ngaphambili yayinesifo sikashukela.
Le nkinga kunzima ukuyithola ekuqaleni, ngoba umuntu onesifo sikashukela unezimpawu ezinoshukela omningi kanye nokuphelelwa ngamandla komzimba. Akunakwenzeka ukubikezela ukuthi ukuphazamiseka kwe-metabolic kuqala ukukhula kanjani. Imiphumela ebulalayo ene-hyperosmolar coma ivame kakhulu ukwedlula i-ketoacidotic coma: isilinganiso esijwayelekile sokufa ngu-12-15%, uma ukwelashwa kwaqalwa esigabeni esinzima - kufika kuma-60%.
Mayelana ne-hyperosmolar coma - //diabetiya.ru/oslozhneniya/giperosmolyarnaya-koma.html
I-Hyperlactacidemic coma
Ezigulini ezinesifo sikashukela, ama-lactates anganqwabelana egazini. Lokhu kuyimikhiqizo ye-metabolic yokuthi kubantu abaphilile idliwe yisibindi ngendlela esifike ngesikhathi. Uma ngasizathu simbe le nqubo ingenzeki, i-lactic acidosis iyakhula. Ukuxazulula kubonakaliswa izinga eliphezulu le-lactic acid emikhunjini, umehluko omkhulu we-anionic. Ukwehla komzimba kuvame ukungabikho. Lapho i-lactic acidosis ingena esigabeni esinzima, zonke izinhlobo zemetabolism ziyaphazamiseka, ukudakwa okunamandla kuqala.
I-Hyperlactacidemic (lactic acidotic) coma uhlobo olungajwayelekile futhi oluyingozi kakhulu lwama-coma. Izinkinga zenzeka ku-0,06% yabanesifo sikashukela, ezigulini eziningi (ngokusho kokulinganisa okuhlukahlukene, ukusuka ku-50 kuye ku-90%), iphela kakhulu. Ngesifo sohlobo 2, ingozi ye-lactic acidosis iyanda:
- overdose ye-metformin;
- ukuncipha kwesifo sikashukela;
- utshwala;
- umsebenzi omkhulu womzimba;
- i-hepatic, inhliziyo, ukwehluleka kwezinhlungu noma ukuphefumula;
- i-anemia
- ubudala.
Izici eziningi zikhona ngasikhathi sinye, kuphakama amathuba we-lactic acidosis.
Izinkinga ezisheshayo ezinesifo sikashukela
Ngo-mellitus ongenasinxephezelo ongaxhunyelwanga kahle, ukuphazamiseka emikhunjini nasemithanjeni yezinzwa kukhula kancane kancane. Ngenxa yalokhu, izingxenye zomzimba nezitho zomzimba wonke ziphelelwa umsoco ojwayelekile, kuvela izifo ezingamahlalakhona ezikhathaza kakhulu impilo yeziguli, kuholele ekukhubazekeni nasekufeni ngaphambi kwesikhathi. Izinkinga ezinjalo zesifo sikashukela zibizwa sekwephuzile, ngoba ukukhula kwazo kudinga iminyaka, noma amashumi eminyaka. Njengomthetho, izimpawu zokuqala zokuphazamiseka zitholakala eminyakeni engu-5 ngemuva kokuqala kwesifo. Ukulawulwa kwe-glucose okungcono, izinkinga zesifo sikashukela zizoqala ngokuhamba kwesikhathi.
Izinkinga ezenziwa kamuva zihlukaniswe ngamaqembu amakhulu ama-3, ngalinye eliholela ekwakhiweni kwezifo ezithile ezingamahlalakhona:
- microvascular
- macrovascular
- i-neuropathy.
Izinkinga ze-Microvascular
Iqembu lifaka phakathi isifo sikashukela ezinshukela. Lezi yizilonda zemikhumbi emincane kakhulu yomzimba wethu: ama-capillaries, ama-venules kanye nama-arterioles. Ama-Microangiopathies atholakala kuma-diabetes kuphela, asikho esinye isifo esiholela kulokho kuphazamiseka.
Imbangela enkulu yezinkinga ze-microvascular ukushintshwa ezindongeni zemithambo yegazi ngaphansi kwethonya le-glycation, okubuye kuncike ezingeni likashukela egazini. Ukweqiwa kwama-radicals wamahhala kanye nokuqukethwe okunyukayo kwe-lipid yegazi, isimilo sohlobo 2 sikashukela, kusheshisa ukukhula kwesifo. Ngenxa yalokhu, izindonga zemithambo yegazi zanda ngokweqile, zelulwa, ziyanqotshwa, futhi hemorrhages ngezikhathi ezithile zenzeka. Ukukhula okungalawulwa kwemikhumbi emisha, okuthi ngaphandle kokudla okwanele nakho kuwele ngokushesha.
Uma le nqubo ingamiswa ngesikhathi, izitho ezibalulekile zingahlala ngaphandle kokuphakelwa kwegazi. Izinkinga zeMicrovascular zilimaza i-retina ne-glomeruli ye-renal.
Izinkinga zeMacrovascular
Ama-Macroangiopathies awumphumela we-atherossteosis, okwenzeka hhayi nje kwisifo sikashukela. Noma kunjalo, lezi zinkinga zingabikwa ngokuphepha kwabanesifo sikashukela, ngoba zivela kaningi izikhathi ezi-3.5 ngokuphazamiseka kwe-carbohydrate metabolism. Imiphumela ye-macroangipathy yisifo senhliziyo esiyindilinga, ukuthambisa kwemithambo yethambo, i-ischemia ye-cerebral, stroke.
Izici ezikhulisa ubungozi bezinkinga ze-vascular:
- isikhathi sesifo sikashukela;
- i-hyperglycemia, izinga le-GH> 6% libucayi;
- ukumelana ne-insulin;
- amazinga aphezulu e-insulin abonakala ngohlobo 2 sikashukela;
- umfutho wegazi ophakeme
- ukwephulwa kwesilinganiso se-lipids egazini;
- isisindo ngokweqile;
- ubudala
- ukubhema kanye notshwala;
- ifa.
I-Neuropathy
I-neuropathy yesifo sikashukela nayo ingumphumela we-glycemia ekhuphukayo. Ngaphansi kwethonya ushukela, uhlelo lwezinzwa oluphakathi noma oluthintekayo luyathinteka. Lapho kukhona i-microangiopathy emikhunjini ekhonza imicu yezinzwa, i-neuropathy iba ngokushesha.
Le nkinga inezimpawu ezithile: ukuzindla, ukushisa, ama-goosebumps, umkhawulo ophansi wokuzwela. Imilenze ephansi ingeyokuqala ukuhlupheka, ngokuqhubeka kokuphazamiseka, izandla, isisu, nesifuba soshukela kungathinteka.
Ubuhlungu nge-neuropathy bungancisha ngokuphelele umuntu ukulala okujwayelekile, okuholele ekucindezelekeni okukhulu. Usicindezela isiguli ngokweqiniso, ezimweni eziyinkimbinkimbi, ama-opioid kuphela angasiqeda. Ukwephulwa kokuzwela kuholela ekutheni umuntu onesifo sikashukela angazizwa elimele kancane, eshiswa, ehloka futhi eqala ukwelashwa ngokutheleleka kwamanxeba kuphela. Ngaphezu kwalokho, ngesifo sikashukela, amandla okuvuselelwa kwezicubu ayancipha. Ngokubambisana ne-angiopathy, i-neuropathy ingaholela ekulimaleni kwezicubu eziyinkimbinkimbi kuze kufike kwi-necrosis. Imvamisa, lezi zinkinga ziba khona ezinsukeni zezinyawo (ezinshukela sikashukela).
Akunakwenzeka ukubikezela ukusebenza kwesitho sakho esizophazamisa i-neuropathy. Isiyezi, i-arrhythmias, izinkinga zokugaya ukudla, ukuchama, ukukhuphuka, ukujuluka, nezinye izifo eziningi zingavela.
Izinkinga ezingamahlalakhona
I-Angiopathy ne-neuropathy kuholela ezinhlobonhlobo zezifo ezingamahlalakhona. Noma isiphi isitho se-organ noma izicubu singalimala ku-mellitus yesifo sikashukela. Amehlo, izinso nezinyawo kuvame ukuhlupheka kuqala.
Izinkinga ezingalapheki ezivame kakhulu:
| Lesi sifo | Incazelo | Imiphumela engaba khona |
| I-retinopathy | Ukulimala emuva Kuhambisana nokushawa kwamathambo, i-edema, ukukhula okungalawuleki kwenethiwekhi yemithambo yegazi. Ngemuva kweminyaka engu-8 yokugula, kutholakala uhhafu wesifo sikashukela. | Ukuthathwa kabusha kwe-retinal, ukulahleka kombono. I-retinopathy iyimbangela evame kakhulu yobumpumputhe ekugugeni. |
| I-Nephropathy | I-Microangiopathy ku-renal glomeruli inegalelo ekubuyiselweni kwabo ngezicubu ezibabayo. Umsebenzi we-Renal ulahleka kancane kancane. I-Nephropathy kaningi kunezinye izinkinga iholela ekukhubazekeni, yenzeka kuma-30% abantu abanesifo sikashukela. | I-Edema, umfutho wegazi ophakeme, ukudakwa. Ezimweni ezisezingeni eliphakeme - ukwehluleka kwezinso, ukudluliselwa kwesiguli ku-hemodialysis. |
| Encephalopathy | Ukulimala kobuchopho ngenxa yokungondleki. Esigabeni sokuqala se-asymptomatic, sikhona cishe kubo bonke abantu abanesifo sikashukela. I-encephalopathy eyingozi kakhulu ezinganeni ezinesifo sohlobo 1. | I-migraine enkulu, ubunzima be-psyche, ukukhubazeka okuyingxenye, izinkinga zememori, ubuhlakani obunciphile. |
| Isifo sikashukela | Ubunzima bokuphazamiseka kwe-angiopathic ne-neuropathic ezinyaweni. Ngokuvamile kuhambisana ne-arthropathy. Isikhumba, izicubu, amalunga, amathambo kuyathinteka. | Ukuphulukiswa kwenxeba isikhathi eside, izilonda ezinamahlwili, izicubu zomzimba. Yimbangela evame kakhulu yokuqunjelwa kwezitho eziphansi. |
| I-Arthropathy | Ukungasebenzi okuhlelekile. Ihambisana nobuhlungu, ukuhamba kwemithambo, ukuvuvukala. | Ukulahleka okuyingxenye komsebenzi wezimoto. |
| Ukungasebenzi kwe-Erectile | Ukwephulwa kokuhlinzekelwa kwegazi nokuzwela kwepipi. Isifo sikashukela, ukungasebenzi kahle kwenzeka engxenyeni yamadoda. | Ukuntuleka okuqhubekayo kokudalwa. >> Mayelana nesifo sikashukela ukungabi namandla |
| Isikhumba | Izindawo ezinesikhumba esinciphile, ezomile, ezihlotshiswe ngesikhumba, esifana ne-pigmentation noma imiphumela yokushiswa. | Imvamisa lokhu kuyiphutha lobuciko bokuhlobisa, ukulunywa akunakwenzeka. |
Izici zokuthuthukiswa kwezinkinga zohlobo 1 nesifo sikashukela sohlobo 2
Izibalo zaseRussia mayelana nezinkinga zesifo sikashukela, itafula libonisa idatha ka-2016 etholakala ezikhungweni zezokwelapha.
| Izinkomba | % yenani eliphelele labanesifo sikashukela | |
| Uhlobo olu-1 | 2 uhlobo | |
| I-Neuropathy | 34 | 19 |
| I-retinopathy | 27 | 13 |
| I-Nephropathy | 20 | 6 |
| Umfutho wegazi ophakeme | 17 | 41 |
| I-Macroangiopathy | 12 | 6 |
| Isifo sikashukela | 4 | 2 |
| Izinkinga ezinkulu nge-coma | 2,1 | 0,1 |
| Izinkinga Zokuthuthuka Ezinganeni | 0,6 | - |
Inzalo ekuleli thebula ayibukelwa phansi, ngoba izinkinga ezivele zikhonjisiwe zikhonjisiwe lapha. Ukwephulwa kwangqala kungatholakala kuphela ngokuhlolwa okugcwele, okungezona zonke iziguli ezingabiza.
Uhlobo lwesibili sikashukela lunezici eziningi ezandisa ubungozi bezinkinga: ukuguga, ukukhuluphala, ukwakheka kwegazi lipid. Ngakho-ke, ososayensi abavumelani ngokwezi zibalo ezingenhla. Baqinisekile ukuthi impilo yeziguli ezinesifo sikashukela sohlobo 1 ilawulwa kangcono, kuyilapho ukutholakala kwesifo sikashukela sohlobo 2 kutholakala ngokushesha.
Isifo sohlobo 2 kungenzeka singabonakali isikhathi eside, kepha izinkinga ziqala ukuvela esikhathini se-prediabetes. Ngaphambi kokuxilongwa kwalesi sifo kuthatha isilinganiso seminyaka emihlanu. Ukuthola isifo sikashukela ngaphambili, ngesikhathi sokuhlolwa kwezokwelapha ngezikhathi ezithile, inani labantu abadala lithatha isivivinyo se-glucose. Lolu cwaningo luzosiza ekuboneni i-mellitus yesifo sikashukela esikhona, kepha hhayi imibandela eyandulelayo. Ukuphazanyiswa kwe-carbohydrate yokuqala kungatholakala ngosizo lohlolo lokubekezelela ushukela, olungafakwanga ohlelweni lokuhlolwa komtholampilo, futhi kuzodingeka uzithathe ngokwakho.
Ukuvimbela izinkinga - ukuthi ungakuvimbela kanjani
Kuhle ukukhumbula ukuthi isifo sikashukela sithuthukisa izinkinga kuphela noshukela ophezulu. Akekho umuntu onesifo sikashukela ongayigwema ngokuphelele i-hyperglycemia, kodwa wonke umuntu anganciphisa inani labo.
Ukuze unxephezele kangcono ushukela, kulungiswa ukwelashwa:
- Shintsha kokudla okunempilo. Izingxenye ezincane, ukuntuleka kwama-carbohydrate asheshayo, ukwakheka okucabangayo nokuqukethwe kwekhalori kokudla kuyisinyathelo esibalulekile kushukela ojwayelekile.
- Umsebenzi womzimba. Ubuncane obugunyaziwe - izifundo ezi-3 zehora eli-1 ngeviki. Ukuzivocavoca nsuku zonke kuzothuthukisa isinxephezelo sikashukela.
- Ukulawulwa okuvamile kwe-glycemic. Izilinganiso zikashukela ezivame ukutholakala zitholakale zokwenza ngcono ukubambelela kweziguli ekwelashweni futhi kusize amazinga aphansi we-hemoglobin e-glycated.
- Ungesabi ukwandisa umthamo wamathebulethi ngaphakathi kwemikhawulo evunyelwe ngumyalo. Izinkinga ezibangelwa ushukela ophezulu ziyingozi kakhulu kunemiphumela emibi engenzeka.
- Uma abenzeli be-hypoglycemic benganikeli i-glycemia ejwayelekile, kuyadingeka i-insulin. Ukulawulwa okungcono kakhulu kwesifo sikashukela njengamanje kunikezwa irekhodi elinamandla lokwelashwa kwe-insulin nge-insulin analogues nephampu ye-insulin.
Isigaba sokuqala sezinkinga singalapheka ngokuphelele. Bese kuthi kuphela ekuvinjelweni kokuqhubekela phambili kwezifo ezikhona.
