I-pathology ejwayelekile ehlobene nezifo ze-endocrine yisifo sikashukela. Kuyingozi ngoba kuhambisana nokuphulwa kwazo zonke izinhlobo zemetabolism. Ngaphezu kwalokho, lesi sifo sisongela ngezinkinga ezinzima noma sekwephuzile futhi sidinga ukwelashwa okuqhubekayo, ukubambelela ekudleni. Ngasikhathi sinye, ngesikhathi sokwelashwa, cishe akunakwenzeka ukuqeda izimbangela zesifo sikashukela, futhi ukwelashwa kuncishiswa ukunciphisa izimpawu.
Ukuhlukaniswa kwe-Etiological kanye nezimpawu
Izinga le-glucose kushukela likhuphuka ngenxa yokufakwa emzimbeni ngenxa yokuntuleka kwe-insulin. Uma le nqubo ivela ngenxa yokuntuleka kwe-proinsulin synthesis ngenxa yokubhujiswa kwamaseli e-pancreatic, lesi sifo sihlulwa njengohlobo lwesifo sikashukela 1. Imvamisa kutholakala kubantu abangaphansi kweminyaka engama-25.. Izibonakalisa ngezimpawu ezilandelayo:
ukomela okukhulu kanye nokudla okwandayo;- iphunga le-acetone elisuka emlonyeni;
- ukuchama kaningi;
- ukuphulukiswa kwenxeba okumpofu;
- isikhumba esikhanyayo.
ukomela okukhulu kanye nokudla okwandayo;Emuntwini onqwabelana ngokweqile kwezicubu ze-adipose, kwenzeka ngokweqile i-hormone synthesis, kepha impendulo ye-metabolic ku-insulin ayonakalisiwe, futhi "ukusilela okuhlobene" kwenzeka. Le ndlela yalesi sifo ibizwa ngokuthi isifo sikashukela sohlobo 2. Kusongela kakhulu kubantu asebekhulile. Ngaphezu kwalokho, izimpawu zaso azicacanga kangako ukuthi umuntu angakwazi ukuthi ukugula kwakhe. Kodwa-ke, udinga ukunaka lezi zimpawu ezilandelayo:
- ukukhathala
- umbono onciphile;
- ukukhubazeka kwenkumbulo;
- izinhlungu lapho uhamba;
- ukuqubuka okungapheli kwabesifazane.
Ingxenye yeziguli ezigabeni zokuqala zezimpawu ayinazo. Kepha lapho-ke kungenzeka kube nokuhlasela kwenhliziyo okungazelelwe, unhlangothi, isifo sezinso, noma ukulahleka kombono. Njalo eminyakeni eyishumi, inani labantu abanesifo sikashukela liphindwe kabili, ngakho-ke udinga ukubona udokotela ekubonisweni kokuqala.
Izinkinga ezinokwenzeka
Okokuqala, isifo sikashukela siyingozi ngezinkinga ezingavela ezinsukwini noma amahora ambalwa noma zikhule ngaphezu kwezinyanga neminyaka. Esimweni sokuqala, abonakala njengama-acute, elesibili - sekwephuzile. Ngamunye wabo ungumphumela wokwanda okuqhubekayo kwe-glucose yegazi nokuphazamiseka kwe-metabolic kwezicubu ezilahlekelwe amandla okubamba i-monosaccharide.
Izimo ezimbi
Njengoba izicubu zingasebenzisi i-glucose kushukela, ikhuphuka le-carabolism yamafutha namaprotheni avela. Imikhiqizo ye-metabolism yabo ephakathi iqoqana egazini, ngenxa yalokhu ketoacidosis iyakhula, ephazamisa imisebenzi ebalulekile yomzimba.
Ukufakwa kwegazi nge-saccharide kuholela ekwandeni kwengcindezi yayo, ngenxa yokuthi inani elikhulu lamanzi nama-electrolyte alahlekile kumchamo. Ngenxa yalokhu, izicubu eziningi nezicubu ziyahlupheka, i-nephropathy, i-neuropathy, i-ophthalmopathy, i-micro- ne-macroangiopathy, futhi ngisho nesifo sikashukela. Uhlelo lokuzala nalo luyathinteka, amadoda angabhekana nokungabi namandla, abesifazane abangazalani.
Ukucindezela amazinga kashukela egazi ngemithi kunganciphisa amazinga kashukela abe ngu-3.3 mmol / L noma ngaphansi. Kulokhu, kuvela isimo esisongela impilo - i-hypoglycemia, engahlulwa ngokuphuza isisombululo sikashukela, ukudla ukudla okune-carbohydrate, ukufaka umjovo wokulungiswa kwe-glucagon emsipha noma emthanjeni onesisombululo se-glucose esingu-40%. Esimweni sokugcina, injekishini eyengeziwe ye-thiamine iyadingeka ukugwema ukuqina kwemisipha yendawo.
Ngenxa yesifo sikashukela, i-lactic acid iyakha egazini, kanye nokulingana kuguqukela ohlangothini lwe-acid. Ngokuphikisana nesizinda sokushoda kwezitho ezithile zomzimba nokuhlinzekwa okungekuhle kwe-oksijini kwezicubu, i-acid iqongelela izicubu, i-microcirculation iyaphazamiseka. Umphumela uba yi-lactic acidosis. Isiguli sinokuzwa okumnyama, asikwazi ukuphefumula ngokujwayelekile, ingcindezi yaso iyehla, kunzima ukuchama. Lesi simo esiku-70% samacala siphela ngokufa, izinyathelo kumele zithathwe ngokushesha. Isiguli sinikezwa idrophu ye-2% yesoda ye-soda futhi silaliswa esibhedlela ngokuphuthumayo.
Ngenxa yesifo sikashukela, izivikela zomzimba ziyancipha, futhi isiguli sibekezelela izifo ezithathelwanayo zimbi kakhulu, kaningi kuba nesifo sofuba samaphaphu.
Isifo sikashukela sikashukela
Ukuma eceleni kuyinto efana ne-coma, okubangelwa ukushoda kwe-insulin. Kungumphumela wezimo ezimbili ezimbi kakhulu:
- i-ketoacidosis ebangelwa ukwanda kwe-acidity nokusetshenziswa okunganele kwemizimba ye-ketone ekhiqizwa yisibindi ekuphenduleni indlala yezicubu ezincike kwi-insulin ezingakwazi ukusebenzisa ushukela;
- i-lactic acidosis, ikhula ngenxa yokuqongelelwa kwemikhiqizo ye-metabolic engaphansi kwe-oxidized.
I-Coma ayikhuli ngokushesha. Ngosuku olwandulela yena, isiguli siqala ukuzwa imizwa, ukoma komile, ukoma, ukulahlekelwa yinhliziyo. Kulokhu, kuyadingeka ukuthi aqale ukwelashwa ngokuphuthumayo, kuze kube yilapho umuntu onesifo sikashukela engakafiki ekuguleni futhi engakaphelelwa wazi.
Uma lokhu kusenzakala, dinga ukubiza ngokushesha i-ambulensi, bese ulala isiguli ukuze ukuphefumula kwakhe kube nzima. Ukufika Ochwepheshe bathola ukoma kwesifo sikashukela ngalezi zinto ezilandelayo ezihlukanisayo:
- yomile, ifudumele esikhunjeni sokuthinta;
- iphunga lama-apula noma i-acetone ephuma emlonyeni;
- ishayela elibuthakathaka;
- umfutho wegazi ophansi;
- amashiya athambile.
Isiguli sizonikezwa isixazululo se-glucose esibuhlungu bese siyiswa esikhungweni sokunakekelwa esibucayi. I-coma ingahlala isikhathi eside kakhulu. Abanye abantu bachitha amashumi eminyaka kuyo, kodwa bangaze bayeke.
Izilonda ezifika emuva kwesikhathi
Isifo sikashukela sohlobo 2 siyingozi nge-retinopathy. Leli igama lokulimala kwe-retinal, okuhambisana nokuphefumula, i-edema, nokwakhiwa kwemikhumbi emisha. Uma inqubo ye-pathological ithinta i-fundus, i-retina izophuma ngokweqile. Lokhu yimbangela enkulu yokulahleka kombono kubantu abaneshukela abaneminyaka ephakathi nabadala.
Ukwephulwa kokuvunyelwa kwemithambo, ukwanda kokuqina kwabo, ukuthambekela kwe-thrombosis ne-atherossteosis kugcina kuholele ku-angiopathy. I-Hyperglycemia kwisifo sikashukela iholela ekuphazamisekeni kwe-metabolic ezinxenyeni zezinzwa. Lokhu kusongela i-polyneuropathy ngendlela yokulahleka kobuhlungu nokuzwela kokushisa, ngenxa yokuthi isiguli silimala kalula.
I-metabolism ephazamisekile yama-carbohydrate namafutha ezithweni ezithinta izicubu ithinta izitho ezilandelayo:
- izinso: i-albhamuin ikhishwa emchameni, kwenzeka i-proteinuria, bese kwehluleka ukuqina kwezinso;
- Amehlo: ukuvela kwamalensi kwenzeka, futhi izinhlwathi zikhula masisha.
Ngaphezu kokulimala komzimba, i-microcirculation yenziwa ngokungalungile, i-ischemic necrosis ibonakaliswa yi-arthropathy enobuhlungu obuhlangene nokuhamba okulinganiselwe. Izinguquko ze-anatomical nezisebenza zingenzeka onyaweni. Izinqubo ze-Purroc necrotic ezikuyo, izilonda nezilonda zamehlo zengeza ku-syndrome yesifo sikashukela, ethi ezimweni ezithuthukile idinga ukunqunywa. Isifo sikashukela naso sisibi ngoba kulimaza impilo ye-psyche. Ngenxa yakho, ukuguquguquka kwemizwa okuvame ukubonwa, ukudangala, ukuphazamiseka kokukhathazeka kwenzeka, i-encephalopathy iyatholakala.
Futhi, ngokumelene nesizinda sikashukela, esibhubhisa umzimba futhi siguqule ukwakheka kwegazi, izifo ezingalapheki zingakhula. Iminyaka eyishumi yokuntuleka kokuthathwa koshukela okujwayelekile ibonakala kusimo semikhumbi. Umbani wazo uncishisiwe, futhi izindonga ziba zingaqondakali kahle kumantongomane. Amathishu aswele i-oksijini kanye nokudla okunempilo, ngokumelene nalesi sizinda, unhlangothi, ukushaya kwenhliziyo, isifo senhliziyo kungakhula. Ukuntuleka kokuhlinzekwa kwegazi esikhunjeni kuholela ekubonakaleni kwezilonda ezinamahlwili, okuthi kamuva kube ngumthombo wokutheleleka. Ngaphansi kwezinguquko ezibalulekile, uhlelo lwezinzwa lubonakala njengobuthakathaka obuqhubekayo emilenzeni kanye nobuhlungu obungamahlalakhona.
Izindlela zokwelapha
Isifo sikashukela siyimiphumela eyingozi, ngakho-ke udinga ukuqala ukwelashwa ngesikhathi. Inani elinyukayo lomchamo, inkinga yokudla, ukwehla kwesisindo kufanele kube okwesabisayo futhi kufanele kube yisikhathi sokunquma izinga le-monosaccharide egazini futhi lenze isivivinyo sokubekezelela ushukela. Uma ukugxila kwe-glucose ne-glycohemoglobin kuphezulu, ushukela ukhona emchini, kanti i-acetone nayo ilapho, kutholakala isifo sikashukela.
Njengengxenye yokwelapha, izimpawu zomtholampilo zesifo ziyaqedwa, kulawulwa i-metabolic, kuthathwa izinyathelo zokuvikela izingqinamba futhi inhloso ukuqinisekisa ikhwalithi yempilo ejwayelekile. Isiguli sidinga ukuthatha imishanguzo, sinamathela ekudleni okhethekile, umthamo wokuzivocavoca umzimba kanye nokuzilawula njalo.
Ukwelashwa kwe-insulin nezidakamizwa ze-hypoglycemic
Ngohlobo lokuqala lwesifo, ukuphazamiseka kwe-carbohydrate metabolism kunxephezelwa ngokwelashwa kwe-insulin, lapho umuntu aphoqwa khona ukuthi ajove ama-hormone nsuku zonke. Uhlobo lokwelashwa lukhethwa ngudokotela ngemuva kokuqashelwa kokunakekelwa kwangaphambi kokulawulwa kwenani le-glucose egazini. Umthamo ojwayelekile amayunithi angu-0.5-1 ngekhilogremu ngosuku.
Ngohlobo lwesibili sikashukela, isilinganiso esinjalo asidingwa njalo, kuvame ukusetshenziswa izidakamizwa ezinciphisa ukumuncwa kwe-glucose futhi zandise ukuzwela kwezicubu ku-insulin (metmorphine, rosiglitazone), kanye nezidakamizwa ezithuthukisa ukugcinwa kwe-hormone (vildagliptin, glibenclamide). Ama-enzyme asemzimbeni aphula ama-carbohydrate kuya ku-glucose akhinyelwa yi-acarbose, futhi i-metabolism yamafutha ijwayelekile yi-fenofibrate.
Ukudla
Isinxephezelo esigcwele se-carbohydrate metabolism asenzeki ngaphandle kokudla. Ngaphezu kwalokho, kwesinye isikhathi kwanele ukwelashwa futhi ungakwenza ngaphandle kwemithi ezigabeni zokuqala zesifo sikashukela sohlobo 2. Ukudla okungalungile kuyingozi ngohlobo lokuqala, ngoba lokhu kungaholela enkomeni enomphumela obulalayo.
Ohlelweni lokudla okufanele kwesifo, ama-carbohydrate angagayi ayafakwa ekudleni. Inani lama-carbohydrate ayinkimbinkimbi angena emzimbeni lilawulwa ngokuqinile. Zilinganiswa kumayunithi wesinkwa (1XE = 10-12 g wama-carbohydrate = 20-25 g wesinkwa). Ngaphambi kokusebenzisa umkhiqizo, umuntu onesifo sikashukela uhlola inani lamayunithi esinkwa etafuleni elikhethekile esebenzisa itafula elikhethekile. Ngosuku, angasebenzisa kusuka ku-12 kuye ku-25 XE, kodwa ekudleni okukodwa inani labo akufanele lingabi ngaphezu kwe-7. Utshwala buhlotshaniswa.
Konke ukudla okudliwayo ngosuku kufanele kubhalwe kudayari ekhethekile. Lokhu kusiza ukubalwa futhi kuvumela uma kwenzeka ukonakala ukuthi uthathe ngokushesha isilinganiso esifanele se-insulin eyengeziwe noma isidakamizwa esinciphisa ushukela.
Ukuhlinzwa kwe-Metabolic
Kusetshenziswa izindlela zokubambisa umzimba, lesi sifo asikwazi ukwelashwa. Kepha ukuhlinzwa ngezinga eliphakeme kungenzeka kusindise umuntu kuhlobo 2 lwesifo sikashukela. Ukuhlinzwa kuqukethe i-gastric ne-biliopancreatic shunting, lapho kudalwa khona indawo yokugcina engxenyeni engenhla yesisu, equkethe amasentimitha ayi-30 okudla okuqinile. Ukudla kudlula iningi lesisu kanye ne-jejunum.
Njengomphumela wokungenelela, isisindo somzimba siyancipha, ukudla akudluleli kwi-duodenum, kepha kuthunyelwa ku-ileum, i-mucosa yayo efihla i-peptide ngenxa yokuxhumana nokudla, okwenza ukukhiqizwa kwe-insulin nokukhula kwamaseli we-pancreatic. Ku-80−98% yamacala, lokhu kuholela ekululameni.
Izindlela zokuvimbela
Ukuvimbela izinkinga, okuyingozi enkulu yesifo sikashukela, kufaka ukubhekwa njalo kwengcindezi yegazi nokulungiswa kwayo ngemithi uma kunesidingo, kanye nokwelashwa okwehlisa i-lipid. Lokhu kubandakanya ukufaka izidakamizwa ezilawula ama-triglycerides aphansi kanye ne-low-density lipoprotein, okunciphisa ukuqhubekela phambili kwezifo ze-ischemic, ukulimala kwe-retina kanye nezinzwa. Uma kunengozi enkulu yezinkinga ezinkulu ze-macrovascular, la ma-ejenti ahlanganiswa ne-fenofibrate.
Izinga eliphakeme lempilo yeziguli kungenzeka kuphela esimweni sokubheka njalo kwezinkomba, ukwelashwa, isenzo esisheshayo lapho sikhula nezinkinga. Kungakho kubaluleke kakhulu ukukhomba izimpawu zesifo sikashukela ngesikhathi bese ulandela ngokuqinile konke ukunconywa kukadokotela.
