Izinkinga Zesifo Sikashukela

Isifo sikashukela yi-pathology yomzimba, ekhonjiswa ngokuntuleka kokukhiqizwa kwe-insulin noma ukwephulwa kwesenzo sayo. Lesi sifo singakhungathekiswa yizimo eziningi ezihlukaniswe ngamaqembu amakhulu amakhulu: i-pathologies eyingozi kanye ne-pathologies engapheli (sekwephuzile). Kusuka ezinqubweni ezinjalo okuxoxwa ngazo esihlokweni ukuthi isikhathi nekhwalithi yempilo yesiguli incike.

Isifo sikashukela sikashukela

Izinkinga zesifo sikashukela zifaka i-ketoacidosis yesifo sikashukela - ukubola kwezinqubo ze-metabolic ngokumelene nesizinda sesifo esingaphansi, esibonakaliswa ngamaphuzu alandelayo:

• ngokuphelele (onesifo sikashukela sohlobo loku-1) noma isihlobo (esine-Type 2 pathology) ukuntuleka kwe-insulin;
• amazinga aphezulu kashukela egazini (ngaphezulu kwe-14 mmol / l);
• ukuvela kwemizimba ye-acetone egazini nomchamo;
• ushintsho kwe-pH yegazi ekuqondeni kwe-acidosis (pH ngaphansi kuka-7.2);
• ukungazi kahle kwesiguli.

Ngeshwa, imiphumela ebulalayo ayijwayelekile nge-ketoacidosis. Ngokwemininingwane engekho emthethweni, sikhuluma nge-7-10% yawo wonke amacala emitholampilo. Ingozi ikhuphuka kaninginingi uma isiguli singumuntu osekhulile ophethwe umfutho wegazi ophansi, kanye nokuthi ngabe kunezifo ezithile ezihambisana nazo.

Ukuhogela i-acetone ephuma emlonyeni - inqubo ebalulekile yokuxilonga yezinkinga

Izici ezicasulayo zezinkinga ze-ketoacidotic kushukela yilezi:

• izifo ezithathelwanayo;
• izinqubo zokuvuvukala zesimo esibuhlungu;
• ukulimala kwemishini;
• ukungenelela kokuhlinzwa;
• ukuthatha imishanguzo ye-hormonal (glucocorticosteroids, ama-hormone ocansi) noma ama-diuretics;
• isikhathi sokuzala ingane.

Kodwa-ke, imbangela ejwayelekile yezinkinga ibhekwa njengokuziphatha okungafanele kwabanesifo sikashukela uqobo. Sikhuluma ukweqa umjovo we-insulin, ukubalwa okungalungile kwethamo lomuthi, ukusetshenziswa komuthi ophelelwe yisikhathi, inqubo engafanele yokuqondisa i-hormone.

Izimpawu nokwelashwa

Isifo sikashukela sikashukela sikhula amahora amaningi, futhi sihlala izinsuku ezimbalwa. Ukoma kwe-pathological, ukwanda kokuchama, isikhumba esomile, ukuncipha kwesiguli, nobuthakathaka obukhulayo buyanda. Kamuva, kuba nokuhlanza, nobuhlungu besisu, iphunga le-acetone emoyeni okhipha. Izimpawu ezikhonjwe ngokusobala zokuphelelwa ngamandla.

Ukuxilongwa okuphuthumayo, ushukela ne-acetone emchameni kunqunywa kusetshenziswa imichilo eqondile. Le ndlela isetshenziselwa ukucacisa isimo sesiguli ekhaya noma egumbini lokuphuthumayo lesikhungo sezokwelapha. Ithebula elingezansi libonisa izindlela zokunqunywa kobukhali besifo sikashukela (DKA).

Ukwelashwa kufaka:

• ukuphathwa kwe-insulin;
• ukulungiswa kwemali esele ye-electrolyte;
• ukuqedwa kwezinguquko kwi-pH yegazi;
• Ukwelashwa kwezifo ezihlangene.

I-Hyperosmolar hyperglycemia

Lesi yisibalo esibuhlungu se- “sifo esimnandi”, esibonakaliswa ukungabikho kwezidumbu ze-acetone emchameni nasegazini, kepha kuhambisana nezibalo zikashukela eziphezulu (zingafinyelela ku-50 mmol / L), ukuphuma kwegazi elinamandla ngokweqile kanye nokuphelelwa ngamandla komzimba. Le pathology iyisibonelo esiyisisekelo sokuthuthuka kwezinkinga zohlobo 2 sikashukela.

Ukwephulwa kwe-regimen yokuphuza kungenye yezimbangela zokuthuthuka kwe-hyperosmolar coma

Izici zokusungulwa kwesimo se-hyperosmolar:

• izifo ezithathelwanayo ezihambisana ne-hyperthermia, ukuhlangana kokuhlanza;
• i-pulmonary embolism;
• ukuvuvukala okukhulu kwamanyikwe;
• i-thrombosis yemikhumbi ye-mesenteric;
• ukopha
• izimo ezishisayo;
• ukwehluleka kwezinso;
• i-peritoneal dialysis;
• ukuhlaselwa ukushisa noma i-hypothermia.

Ukuboniswa kwale nkinga nokwelashwa kwayo

I-neuropathy yesifo sikashukela kanye nokwelashwa kwayo

I-Hyperosmolar complication iba kancane kancane kunesimo se-ketoacidosis. Izimpawu zokuqala zivela ezinsukwini ezimbalwa, noma ngisho namasonto, ngaphambi kwesithombe somtholampilo esikhanyayo. Ekuhlolweni, isiguli sinamanzi: isikhumba sakhe kanye nolwelwesi lwamafinyila selomile, i-turgor iyancipha, i-palpation inquma ukuthi ama-eyebalks asethambile.

Kamuva, umfutho wegazi uyancipha, ngemuva kokuchama ngokweqile, isikhathi sokwehla okukhulu komchamo noma ukungabikho kwawo ngokuphelele kwenzeka. Akukho phunga le-acetone emoyeni eliqediwe kanye nemizimba ye-acetone esegazini nomchamo (izimpawu ezithile ezivumela ukwahlukanisa ubunzima).

Izimpawu ze-Neurological zimpawu zokuxaka uhlobo 2 lwesifo sikashukela:

• iminyakazo
• ukukhubazeka kwenkulumo;
• i-nystagmus (ukuguquguquka kweso okuvame ukungaphenduki);
• i-paresis nokukhubazeka;
• ubumpumputhe bobumbili ngekota noma engxenyeni yomkhakha wokubukwa.

Ukwelashwa kwe-pathology kuyafana nokwenza ukwelashwa kwe-ketoacidosis, kepha kunezici ezithile. Ukuvuselelwa komzimba kuqala ngesisombululo se-glucose, kamuva bashintshela ku-hypotonic, bese kuba yisixazululo somzimba se-sodium chloride. Amazinga kashukela aphezulu emzimbeni ancipha kancane, njengoba kwenza ne-hyperosmolarity.

I-Lactic acidosis (lactic acidosis)

Lesi yisimo se-pathological esiyinkinga enkulu yesifo sikashukela. Kubonakala nge-metabolic acidosis kanye namazinga aphezulu e-lactic acid egazini. Ngeshwa, i-lactic acidosis ezimweni eziningi zokwelashwa ihlala ingaziwa, umphumela odabukisayo wenzeka ku-80% weziguli.

Isimo sivezwa ngokususwa kancane kwe-lactic acid emzimbeni. Kungenteka kuphambane nesendlalelo sekutfutfuka kwe-izicubu hypoxia ngesimo sekushaqeka kwemisuka ehlukahlukene, ngokumelene nesizinda sokungaphumeleli kwenhliziyo okungapheli, ngokufaka ubuthi bekhabhoni.

Ezinye izimbangela zokuphazamiseka kwesifo sikashukela:

• ukwehluleka kwesibindi noma kwezinso;
• i-anemia
• izinqubo zesimila;
• i-pancreatitis
• ukuntuleka kwe-adrenal;
• ukushiswa ukushisa;
• ukusetshenziswa kwemithi (ama-salicylates, ethanol, biguanides).

I-lactic acid molecule - into eqongelela emzimbeni ngokumelene nesizinda se-lactic acidosis

Ukuze uthole kahle isimo se-pathological, kuyadingeka ukucacisa izinga le-lactate egazini. Njengomthetho, izinkomba zayo zidlula i-2.2 meq / l, kaningi - 5 meq / l. Kunzima ukuthola ukuxilongwa okulungile, ngoba izimpawu azicaciswanga. Bangakhula ngendlela yobuthi be-Biguanide. Isibonakaliso kuphela esikwenza ucabange Ubuhlungu bemisipha. Kwenzeka ngokumelene nesizinda sokuqongelela kwe-lactic acid emzimbeni.

Ukwelashwa kuqukethe ukuqashwa kwe-oksijeni therapy, ukuphathwa kwe-glucose okufakwa emzimbeni nge-insulin emfishane, ukwethulwa kwemithamo emincane ye-sodium bicarbonate, kanye ne-hemodialysis.

I-Hypoglycemia

Isibonelo senkinga yesifo sikashukela ezinganeni nakubantu abadala. Lesi simo sibonisa ukuncipha kwezibalo ze-glucose engaphansi kuka-2.7 mmol / L, okuhambisana nesithombe somtholampilo, noma ngaphansi kwe-2.2 mmol / L, noma ngabe izimpawu zikhona. I-Hypoglycemia inezindlela ezimbili:

• mnene - isiguli singasusa ngokuzimela ukuvela kwezibonakaliso zezinkinga;
• okukhulu - i-pathology ihambisana nokwazi ukungasebenzi, umuntu akakwazi ukuzimela ezimele ngokuzimela.

Lokhu okulandelayo yizici eziphambili ezidonsela phambili ukukhula kwezinkinga kushukela we-mellitus wohlobo lokuqala noma lwesibili. Izici ezihambisana nokwelashwa kwezidakamizwa ze-hypoglycemic zihlukaniswe ngamaqembu amakhulu amathathu:

1. I-overdose ye-insulin noma amaphilisi okwehlisa ushukela - isiguli sikhethe ngokungafanele leli dosi (elisetshenziswe ngaphezu kokudingekile), amaphutha ekusebenzeni kwepeni le-insulin, imitha ye-glucose engasebenzi kahle (izinombolo eziphakeme kunalokho empeleni), i-overdose enenhloso ngemuva kwezinjongo zokuzibulala.
2. Shintsha esenzweni se-insulin noma ngamathebhulethi ama-hypoglycemic agents - ukuguquka kusuka kwesinye isidakamizwa kuya kwesinye, ukubambezele ukuqedwa kwesidakamizwa ngokumelene nesizinda sokwehluleka kwezinso, ukuba khona kwama-antibodies ku-pancreatic hormone, inqubo engalungile yokuphatha, ukusetshenziswa okuhlangene kwama-ejenti amaningi we-hypoglycemic.
3. Ukuzwela okwandayo kwe-hormone - ukusebenza ngokomzimba okusebenzayo, inkathi ngemuva kokuzalwa kwengane ekukhanyeni, i-adrenal noma ukwehluleka kwesibindi.

Kunezici ezihambisana nokudla kwabantu. Isibonelo, isiguli singaphuthelwa isikhathi sokudla main noma i-snack, umsebenzi wokuzivocavoca okungenzeka ukuthi awubaliwe emthanjeni wesidakamizwa, ukuphuza utshwala, amasonto okuqala we-12 okukhulelwa nesikhathi sokuqunjelwa yisisu kungavela.

Ushukela omncane wegazi - isimo se-hypoglycemia esidinga ukulungiswa ngokushesha kwezokwelapha

Izimpawu nokwelashwa

Ngesikhathi se-precoma, izinkinga zesifo sikashukela i-mellitus (uhlobo 1, uhlobo 2, ifomu lokuthinta) iziguli zikhononda ngokujuluka ngokweqile, ikhanda, isiyezi, ukuthuthumela, isicanucanu kanye nendlala enkulu.

Izimpawu zesikhashana zeqembu le-neuroglycopenic yezimpawu ziyajoyina. Lokhu kufaka phakathi ubuthakathaka, imizwa yokulimala kwesikhumba, umuzwa wokwesaba, ukudideka esikhaleni nesikhathi, ukulahleka kwenkumbulo kwesikhashana. Uhlu luhlanganisa ukwazi ukungasebenzi kahle nethokomele.

Izinyathelo zokuqeda isimo se-hypoglycemic kufanele ziqalwe ezigulini ezinesifo sikashukela, lapho izinga likashukela likububanzi be-3.3-3.7 mmol / L. Le yinketho enhle kakhulu engavumeli ushukela ukuthi wehle. I-hypoglycemia emnene isuswa ngokufaka into emnandi. Isibonelo, amaswidi, amabhisikidi, itiye elishisayo elimnandi, ujamu. Isifo sikashukela ekwelashweni kwe-insulin kufanele ngaso sonke isikhathi sibe nokuthile okumnandi.

Izenzo zezinkinga ezinzima (ngohlobo lwe-mellitus yesifo sikashukela 1, 2, ifomu lokuthinta):

1. Beka lo muntu eceleni kwakhe, ukuze kuthi lapho ungazi nokuthi unamahlandla amaningi okuhlanzwa, ukugabha kungangeni ku-bronchi.
2. Susa yonke imfucumfucu yokudla emgodini womlomo. Awukwazi ukugcwalisa umuntu ngeziphuzo ezimnandi emlonyeni wakhe uma engazi.
3. Isixazululo sikashukela sifakwa emithanjeni size isiguli siqaphele.
4. IGlucagon ingena ngaphansi kwesikhumba noma umsipha. Le nto isatshalaliswa kwishubhu yesirinji.
5. Ukulaliswa esibhedlela emnyangweni wesibhedlela i-endocrinology noma umnyango wokuvuselela nokunakekela okunzulu.

Uma umuntu ekhubazekile isikhathi esingaphezu kwamahora angama-4-6, ubungozi bokuthola i-edema yamakhemikhali kanye nomphumela obulalayo ukhuphuka kaningana.

Izinkinga ezingamahlalakhona

Isikhathi nekhwalithi yempilo yabanesifo sikashukela okwamanje kuncike ekutheni izinkinga ezifika sekwephuzile kwesifo sikashukela zithuthukile nokuthi zithuthuka ngokushesha kangakanani. Zonke izingqinamba ezingapheli zesifo sikashukela zihlukaniswe ngamaqembu amathathu amakhulu: i-microvascular, macrovascular pathology, neuropathy yesifo sikashukela.

Izinkinga ezingalapheki - ama-pathologies angalapheki

Iqembu le-microvascular pathologies lifaka i-retinopathy (ukulimaza ukuhlaziya okuhlangene) kanye nephropathy (ukulimala kwezinso). Izinkinga zeMacrovascular zifanekiselwa izifo zenhliziyo ezi-coronary, ubuchopho nemithambo yegazi yemikhawulo engezansi. I-neuropathy yesifo sikashukela ngokuya ngendawo yomonakalo ihlukaniswe yaba yiphutha ne-autonomic.

Isifo Sikashukela Sikashukela

Okunye kokuhlukahluka kokulimala kwemithambo lapho kukhona isifo sikashukela, okubonakala ngokuzibandakanya kwinqubo yezinso. Kunezindlela ezimbili:

• i-nodular glomerulossteosis;
• glomerulosulinosis yohlobo lokuphamba.

Umphumela uba ukwehluleka kwezinso. I-Nephropathy yenzeka kuwo wonke umuntu onesifo sikashukela onesifo sohlobo olu-1, nakuwo wonke ummeleli wesine wefomu elizimele lesifo. Njengomthetho, ubunzima buba seminyakeni engu-10-15 ngemuva kokuqala kwesifo sikashukela.

I-nephropathy yesifo sikashukela iba lapho kungekho kulawula okwanele ushukela wegazi, umfutho wegazi, esimweni esiyindalo yofuzo. Isibonakaliso esiyinhloko somtholampilo sokulimala kwezinso yi-microalbuminuria (ukubukeka kwesibalo esincane samaprotheni emchameni), esidlulela ku-proteinuria (okuqukethwe okuphezulu kwamaprotheni kumchamo wamanzi).

I-Glomerulossteosis - isimo sezinso esihambisana nokuvela kwamaprotheni emchameni

I-Microalbuminuria iboniswa yilezi zibalo ezilandelayo: 20-199 mg / ml ye-albhamuin kumchamo, i-30-299 mg ekhiqizwa ngosuku. Kwi-proteinuria, izinombolo zidlula i-200 mg / ml no-300 mg, ngokulandelana.

Imigomo yokwelashwa:

• Ukulawulwa kwe-glycemic;
• Ama-inhibitors e-ACE;
• ama-statins kanye nama-fibrate (lapho kungekho ukukhulelwa);
• imikhawulo yokudla amaprotheni ekudleni.

I-retinopathy yesifo sikashukela

Ukunqotshwa kwe-choroid ngemuva kwesifo sikashukela. Ukhula ngemuva kweminyaka engu-5-7 kusukela ekuqaleni kwalesi sifo sikashukela sesibili, ngemuva kweminyaka engama-20 - ngamaphesenti angama-85.

Izigaba ze-retinopathy (izithombe ezinesimo esishintshiwe se-fundus zingabonakala kumasayithi akhethekile):

• Ifomu elilula - phezu kokuhlolwa kunqunywa ngokuba khona kwama-aneurysms amancane nama-exudates aqinile, akukho zikhalazo ezivela esigulini.
• I-Maculopathy - ama-hemorrhages kanye nokuba khona kwama-exudates aqinile kuma-macula kuyabhekwa, i-acuity ebonakalayo ihlala ijwayelekile.
• Preproliferation - ukubukeka kwe-exudates ethambile, imithambo iba ngumbono, ukuphazamiseka kwe-intracellular kwenzeka.
• Proliferation - neoplasms, kwehlise i-acuity ebonakalayo kuze kube ubumpumputhe, i-glaucoma.

Kubalulekile! Ukuze uthole ukwelashwa, kulungiswa i-glycemia, esigabeni sokugcwala - i-laser photocoagulation (ivumela ukunciphisa ukulahleka kombono), esigabeni sokukhula - vitctuomy.

Ushintsho olubonwa ngesikhathi kuhlolwa i-fundus isiguli ngemuva kwe-retinopathy

I-neuropathy yesifo sikashukela

Ukuxazululwa okungapheli okubonakala ngomonakalo ohlelweni lwezinzwa. Iminyaka eyi-15 ngemuva kokuvela kwesifo sikashukela ivele ku-80% yeziguli. Kwenzeka ngokumelene nesizinda sokulimala kwemithambo, izinguquko ezinqubweni ze-innervation.

I-peripheral neuropathy ihambisana nezikhalazo zokuqina kobuhlungu, ukuqaqamba kobuhlungu emaphethelweni aphansi, ukuzindla, ukuqina. Kukhona ukwephulwa komqondo wokubusa kombuso wokushisa, ukwehla komthambeka, umuzwa wezinhlungu (ngokuvamile abanesifo sikashukela abezwa ukubukeka kwamabele, amanxeba emilenzeni, okuholela ekuthelelekeni nasekukhuleni kwesifo sikashukela sikashukela). Kukhona iminyakazo yobusuku, ukungakwazi ukuhamba ibanga elithile, ukungazinzi kuyenzeka ku-gait.

Kwephula ukubekelwa phansi kwezitho zangaphakathi, sikhuluma nge-autonomic neuropathy:

• i-pathology ohlangothini olulodwa lwezinhliziyo - isiyezi, umfutho wegazi ophansi, i-palpitations yenhliziyo;
• i-neuropathy yesinye - ukuchama okungahambi kahle, ukungasebenzi komchamo;
• ukulimala esiswini - ukuhlaselwa isicanucanu nokuhlanza, i-gastroparesis;
• i-neuropathy yesikhumba - ukoma noma ukujuluka.

Imigomo yokwelashwa ifaka ukufezekisa izibalo ze-glycemic efanele, ukuthatha ama-antidepressants kanye nama-anticonvulsants, amalungiselelo we-thioctic acid, amavithamini e-B-series, kanye ne-physiotherapy.

Imithi esekwe yi-Thioctic acid - iqembu lezidakamizwa ezisetshenziswa kabanzi kushukela

Isifo sikashukela sonyawo sikashukela

Ukuhlangana okunjalo kuphawulwa ngokuba khona kokutheleleka, izilonda noma ukubhujiswa kwezicubu ezijulile zezinyawo, ezenzeka ngokumelene nesizinda sokwephulwa kokuhlinzekwa kwegazi ngenxa yomonakalo emithanjeni yemikhawulo engezansi. Kuvela kwikota yesifo sikashukela. Inqubo ye-pathological eyenzeka neziguli iyabonakala ezithombeni ezithunyelwe kumasayithi akhethekile.

Amaqembu anobungozi wokuqalwa kwesifo afaka:

• abanesifo sikashukela abane-peripheral polyneuropathy;
• ukuba khona kwanoma yiziphi izimo ze-pathological zemithambo yegazi;
• ukushiyeka kwenyawo kwanoma imuphi umsuka;
• ukuba khona kwezinye izinkinga ezingapheli zesifo sikashukela;
• ukubhema nokusebenzisa kabi utshwala;
• ubudala.

Ukwelashwa kususelwa ekwelashweni kwe-insulin, ukuthatha imishanguzo, i-heparin, ama-antiplatelet agents, i-venotonics, ukuqinisa ukwelashwa, ama-antispasmodics nama-NSAIDs.
Isifo sikashukela kanye nezinkinga amagama amabili athi ngeshwa ngeke abe khona ngokuhlukile. Kubalulekile ukuvimbela ukuthuthukiswa kwezimo ze-pathological, ngoba akunakwenzeka ukuba ubalaphe ngalesi sigaba.