Isifo sikashukela yisifo esingelapheki esibonakaliswa ukuphazamiseka kwe-metabolic, ikakhulukazi i-metabolism ye-glucose (ushukela) kanye ne-lipids. Igama elithi "isifo sikashukela" lihlanganisa izindlela eziningana ze-nosological ezifanayo nezimpawu zazo, kepha ziyahlukahluka inqubo yokuthuthuka kwenqubo ye-pathological kanye nezindlela zokuyiqeda.
Isifo sikashukela sohlobo 2 kungenye yezindlela ezivame kakhulu. Ku-80% wazo zonke iziguli zemitholampilo, kutholakala le ndlela yokuxilonga, futhi cishe ezingamaphesenti angama-50 iziguli azikwazi ukuba khona kwalesi sifo ngenxa yenkambo yesifo asymptomatic. Lo mbhalo uchaza kabanzi izimbangela zokuvela kwe-pathology, izimpawu, ukutholwa nezindlela zokwelapha.
Imininingwane ejwayelekile
Ngokwezibalo, abantu abafinyelela ku-5% bezwe ngalinye banesifo sikashukela, futhi kubantu asebekhulile nalabo abanesisindo somzimba, isibalo sikhuphukela kuma-20-25%. Yile ndlela yokusebenza ye-endocrine ethatha enye yezindawo ezihola phambili phakathi kwezimbangela zokukhubazeka nokufa kweziguli (kungaphambi kwezifo zenqubo ye-inhliziyo nenqubo yamathumbu).
Uma sikhuluma ngesifo sikashukela, izizathu zokukhula kwaso zifaka lezi zinto ezilandelayo:
- inani le-pathologies yezakhi zofuzo ezibandakanyeka ekwenziweni kwalesi sifo liyanda;
- emazweni athuthuke kakhudlwana, ukwanda kwesibalo sabantu abanesifo sikashukela kungenxa yokwanda kwesikhathi sokuphila kwesibalo sabantu;
- ukungondleki, imikhuba emibi, isisindo somzimba we-pathological - lezi zinto ziya ngokuya zibonakala empilweni yabamele umphakathi;
- ukwanda kwezinguquko ze-atherosulinotic emikhunjini kuyakhuphuka.
Ukuxilongwa ngesikhathi kuyakuvumela ukuthi ukhombe lesi sifo ezisegangeni zokuqala futhi uvikele ukuqhubeka kwawo
Lesi sifo sikhula kanjani futhi kanjani?
Isifo sikashukela sohlobo 2 (i-mellitus, i-non-insulin encike kwisifo sikashukela) sibonisa amazinga aphezulu kashukela egazini lesiguli, avela ngenxa yokuthi amangqamuzana nezicubu zomzimba aphelelwe umuzwa we-insulin. Le nto yi-pancreatic hormone ebhekene nokuhanjiswa kwe-glucose nokungena kwayo kumaseli. Ngokuphikisana nesizinda sezinguquko eziningi, ama-cell receptors abucayi awaziboni "i-hormone," noma izinga lawo lanele ukuqeda imisebenzi.
Isizungu
Kulesi sigaba, akunakungatshazwa ukuthi izici zamafa zineqhaza elibalulekile ekwakhiweni kwezifo zengqondo. Ngokwezifundo zomtholampilo, ukuqagelwa kofuzo lokuthayipha isifo sikashukela esingezansi kunengxenye yento efanayo ekuveleni kwesifo sohlobo 1 (okuncike kakhulu kwe-insulin).
Ukuqinisekiswa - ukwenzeka kwalesi sifo ku-95% ngasikhathi sinye kuwo womabili amawele afanayo. Kodwa-ke, indlela yokubamba iqhaza 'kokwephuka' kofuzo ayifundiswanga ngokuphelele. Kunezindlela ezimbili ongakhetha kuzo:
- Kunezinhlobo ezimbili zofuzo ezihilelekile ekwenziweni kwalesi sifo, ezihlobene ngokuphelele. Owokuqala unesibopho sokwephulwa komkhiqizo wama-pancreas, owesibili - wokunciphisa ukuzwela kwamangqamuzana nezicubu kuwo.
- Kukhona ukwephulwa kwenqubo "yokwamukelwa" kwamangqamuzana kashukela ngamaseli anozwela we-insulin.
Xhumanisa nokukhuluphala
Ukuphakama kwezinga lokukhuluphala, kulapho amathuba okuba nesifo sikashukela sohlobo 2 sikhulu, futhi uma isilinganiso sokuqala sokwanda kwesisindo sikhuphula ubungozi ngengxenye, khona-ke isilinganiso saso esinzima siyizikhathi eziyi-10-12.
Indawo eholayo inikezwa emafutheni "angaphakathi", afakwa eduze kwezitho zomzimba. Yikhona ukuba khona kwakhe okuhambisana nokuqala kwalesi sifo nezinye izinto ezethusayo (ukwanda kwe-cholesterol yegazi, ukwanda komfutho wegazi, ukwehla kokuzwela kwe-insulin).
Ukuba khona kwengqimba enkulu yamafutha e-visceral kungenye yezinto ezibangela "isifo esimnandi"
I-hypothesis yokungondleki
Ososayensi bathole ukuthi ukondleka okunganele ngesikhathi sokuphila kwe-intrauterine kanye neminyaka yokuqala engu-1-3 kunganciphisa ukusebenza kwama-pancreas. Uma uqala ukukubona, lokhu kuzwakala kuyinqaba, kepha-ke, kuyaziwa ukuthi ingane izalwe inesethi ephelele yamangqamuzana obuchopho, i-glomeruli yezinso kanye nengxenye kuphela yenani lamaseli emfihlo e-insulin akhona emzimbeni womuntu omdala.
Ukukhathala Kwe-pancreatic
Kukholelwa ukuthi i-mellitus engavikeleki nge-insulin ingakhula ngenxa yokungalingani phakathi komsebenzi we-gland nokuzwela kwe-hormone yamaseli womzimba. Lapho izicubu ziqala ukuphendula kancane ku-hormone, indlala izama ukunxephezela leso simo ngokukhiqizwa okuthe xaxa kwe-insulin. Inqobo nje uma ekwazi ukukwenza lokhu ngezinga elifanele, ukuzwela uyakwazi "ukukhipha".
Ngokushesha lapho kwenzeka ukwehla kwezitho, kuqhamuka isifo, esidlula isikhathi lapho saphenduka uhlobo olungu-1 lwesifo sokugula.
Izici ezivusa inkanuko
Ngaphezu kwalezi zizathu ezingenhla, kunobungozi obukhona ekuthuthukisweni kwesifo sikashukela sohlobo 2, esikhulisa amathuba okuqala kwalesi sifo. Lokhu kufaka phakathi:
Ukudla Okuvunyelwe Isifo Sikashukela Sohlobo 2- ukondliwa okungafanele (ukudla ngokweqile, ukudla ukudla okuningi kwamafutha);
- ukuntuleka kokulawula okwanele kokulingana kwamanzi;
- indlela yokuphila engasebenzi;
- ukusetshenziswa kabi kotshwala
- ukubhema;
- ukusetshenziswa kwesikhathi eside kwezidakamizwa eziningi (ama-hormone e-adrenal cortex, ama-diuretics, ama-antipsychotic);
- iminyaka (ngaphezulu kweminyaka engama-45-50 ubudala);
- umlando wesifo sikashukela sokukhulelwa (indlela ethinta abesifazane abakhulelwe abahlukile);
- i-polycystic ovary;
- umfutho wegazi ophakeme kanye ne-cholesterol "embi";
- ezinye izifo (I-Itsenko-Cushing's syndrome, isimila se-adrenal gland tumor, i-acromegaly).
Ngokuphikisana nesizinda se-pheochromocytoma (i-adrenal gland tumor), izinhlobo ezi-2 zesifo “esimnandi” zingavela
Izigaba kanye neziqu zokugula
Kuhlobo 2 sikashukela mellitus, ukuphathwa kweziguli kukhethiwe ngokuya ngobunzima be-pathology:
- Kulula - izibalo zoshukela wegazi azidluli umkhawulo we-8.5 mmol / l, akukho glucose emchameni. Iziguli zingahle zingabi nazo izikhalazo, ngoba iningi lazo alikwazi ngisho nokuba khona kwalesi sifo.
- Izinkomba ze-Medium - glycemia ngenhla kwe-8.5 mmol / l, izimpawu sezisondele ngokuphelele. Uhlobo lwesifo sikashukela sohlobo 2 lubonakaliswa eqinisweni lokuthi iziguli zikhononda ngesifiso esiqhubekayo sokuphuza, ukuchama kakhulu, ukukhononda ngokuqhuma kwesikhumba, kanye nokwehla kwezinga laso lokubona.
- Kakhulu - kuboniswa ukuphazamiseka okunamandla kwe-metabolic. Iningi labanesifo sikashukela baba nezinkinga kusuka ekuhlaziyweni okubonakalayo, izinso nobuchopho. Ingozi enkulu yezinkinga zokukhohlisa.
Ngokuya ngezinamba ze-glycemia nokuthi zingagcinwa kanjani kuhlaka olwemukelekayo, ziyahlukanisa:
- ushukela onxephezelwe;
- i-mellitus yesifo sikashukela engancishisiwe;
- isimo sokubuyiselwa kwemali.
Esimweni sokuqala, izehlakalo zanda ngendlela yokuthi izinkomba zoshukela zisondele kokujwayelekile. Azidingi ukungenelela okungathi sína kwezokwelashwa, zingalungiswa ngosizo lomsebenzi owanele womzimba nokwelashwa kokudla.
Isimo sokukhokha kancane sidinga ukwelashwa okungathi sína, futhi isimo esivamile sesiguli sidinga ukulungiswa. Lokhu kuyadingeka ukuvikela ukuqhubeka kwesifo kanye nokuvinjwa kwezifo ezingapheli eziholela ekukhubazekeni.
Isifo sikashukela esiwohloka sihlukahluka kakhulu kakhulu kwe-pathology. Njengomthetho, lezi yizigaba ezibulalayo, ezibonakala ngokubonakala kwesifo sikashukela (retinopathy yesifo sikashukela (ukulimala kwamehlo kuze kube ubumpumputhe), i-nephropathy (ukwehluleka kokuqina kwe-renal), ukulimala kwamangqamuzana obuchopho nemithambo yegazi.
Izimpawu
Ukuqala kwalesi sifo, ngokungafani nohlobo 1 lwezifo, kuhamba kancane. Lesi sifo sikhula isikhathi eside, iningi leziguli lifunde ngokuba khona kwesifo sikashukela lapho kutholwa udokotela wezifo zamehlo, i-ophthalmologist, i-neuropathologist. Ukuxilongwa kungenzeka ngemuva kokuhlolwa kwezokwelashwa okulandelayo ngokusho kwemiphumela yokuhlolwa kwelebhu.
Iziguli zikhononda ngokuchama okweqile, isifiso sokusebenzisa amanzi amaningi, ubuthakathaka obukhulu nokukhathala okusheshayo. Iziguli zithi zisheshe zikhathale futhi zizizwe zimbi ngemuva kokuzivocavoca kanzima komzimba. Ngasikhathi sinye, isifiso esandayo sokudla, ukugoba ebusuku, ushintsho ekubonakaleni kokubi, ukuqubuka kwenzeka esikhumbeni.
Ngezimpawu, ungaqagela ukuba khona kwalesi sifo, kepha ukuxilongwa kuqinisekiswa kuphela ngezifundo zaselebhu
Kubalulekile! Amadoda akhononda ngokuncipha kwesifiso sobulili, ukwanda kwangaphambi kokubeletha, ukunyamalala kwesifiso sobulili ngaso leso sikhathi sokusondelana kwezocansi.
Isifo sohlobo 2 esivele esigabeni sokuhambela kokuqala kudokotela singahambisana nokuboniswa okulandelayo:
- izinga likashukela eliphezulu - 100% yamacala;
- isisindo somzimba we-pathological - 80%;
- amazinga aphezulu e-insulin egazini ngaphambi kokudla - 78%;
- inani elinyukayo lomfutho wegazi - 50%;
- ukwanda kwe-cholesterol "embi" egazini - 50%;
- izifo zenhliziyo nezemithambo - 30%;
- ukulimala kwamehlo nohlelo lwezinzwa oluyingozi - 15-20%;
- ukulimala kwezinso - 5-7%.
Lesi sifo sitholakala kanjani?
Kukhona izifundo eziyisisekelo futhi ezingeziwe eziqinisekisa ukutholakala kwale sifo. Okuyinhloko kufaka phakathi ukucolisiswa kwezinkomba zoshukela wegazi (venous, capillary) ngaphambi kokudla kanye namahora ambalwa ngemuva kokuthathwa kwemikhiqizo yokudla emzimbeni, isivivinyo esinomthwalo woshukela nokuzimisela kwezinombolo ze-glycosylated hemoglobin.
Ucwaningo olwengeziwe:
- I-peptide;
- izinga le-insulin engasebenzi;
- i-biochemistry yegazi.
Izinkomba zokufakwa esibhedlela kwesiguli esibhedlela:
- ukubola kwesifo;
- ukulimala emithanjeni yamaphethelo aphansi ngobuhlungu kanye nokuba khona kwezinguquko eziyinqaba esikhunjeni;
- isikhathi sokuzala ingane;
- ukuhlaselwa njalo okubucayi kokwehlisa ushukela wegazi ezinsukwini ezingama-30 ezedlule;
- izinkinga zesifo (i-retinal hemorrhage, gangrene of the lowities, ukushaya kwenhliziyo, ukoma).
Uma ukuxilongwa kungasunguliwe, kepha kukhona izinsolo zokuba khona kwaso, kwenziwa ukuhlolwa kokuxilonga. Okokuqala, kulinganiswa ushukela osheshayo. Uma kunezinombolo ezikububanzi obungu-5.5-6.1 mmol / L egazini elivela emunweni noma ku-6.1-7 mmol / L kusuka emthanjeni, udokotela unquma ukuhlolwa ngomthwalo ushukela.
IGlucose powder yocwaningo ingathengwa ekhemisi
Akuqhutshwa esikhathini esibi sesifo noma uma isiguli sithola ukwelashwa ngama-hormone, ama-diuretics, ama-beta-blockers. Ukuxilongwa kungokulandelayo:
- ezinsukwini ezintathu zokugcina inani lokudla kwe-carbohydrate alilinganiselwe;
- ekuseni isiguli singadli, ungaphuza kuphela amanzi;
- thatha igazi emthanjeni noma emunweni;
- isihloko siphuza isixazululo esimnandi esuselwa ku-glucose powder;
- ngemuva kwamahora ama-2, i-biomaterial iphinde futhi ithathwe ngendlela efanayo.
Okunye ukuhlaziya okubalulekile ukutadisha nge-glycosylated hemoglobin. Abantu abaphilile banemiphumela esukela ku-4 iye ku-6%. Ku-diabetes, izinombolo zincike ekutheni izinga le-glycemia liphakeme kangakanani. I-Pathology ithathwa njengomphumela ngaphezulu kwe-6.5%.
Izici zokwelapha
Izinhloso eziphambili zokwelapha:
- ukufezekiswa kokulawulwa okwanele kwamapharamitha we-biochemical kanye nenqubo yezinqubo ze-metabolic;
- ukuvimbela ukuthuthukiswa kwezinkinga ze-vascular.
Izindlela zokwelapha zanamuhla zifaka ukusetshenziswa kwezokwelapha, ukudla okwenziwa emzimbeni, ukwelashwa.
Funda kabanzi ngemigomo yokwelashwa yesifo sikashukela sohlobo 2 kule ndatshana.
Ukulungiswa kokudla okunempilo
Izinhloso eziyinhloko zokwelashwa kokudla:
- ukuvimbela ushukela wegazi owengeziwe ngemuva kokudla;
- ukulwa nesisindo se-pathological;
- ukususwa kwe-cholesterol "embi" emzimbeni;
- ukunciphisa ubungozi bokuthola ubunzima besifo;
- ukuhlinzeka umzimba ngawo wonke amavithamini adingekayo, amaminerali, izakhi zomzimba.
Udokotela ofanelekayo noma i-endocrinologist efanelekile isiza ukubala inani le-caloric nsuku zonke lesiguli esithile. Isiguli kufanele sidle kaningi, kepha ezingxenyeni ezincane, senqaba ushukela nokunye ukudla okune-carbohydrate okunama-sacgesides wokugaya kalula ekwakhiweni. Ukudla okunjalo kufanele kufakwe esikhundleni sokudla nefayibha yokudla, nayo eyiqembu lama-carbohydrate, kepha ikhuphula ushukela wegazi kancane.
Utshwala kufanele bushiywe, ikakhulukazi ama-cocktails amnandi. Lapho uhlanganisa ukudla ngakunye, kubalulekile ukuthi ubheke izinga lomsebenzi wesifo sikashukela.
Izinguquko eziphambili ekudleni:
- Ukunciphisa ukungena kwamafutha ekudleni (uwoyela, imajarini, u-ayisikhilimu, inyama nenhlanzi yezinhlobo ezinamafutha).
- Yehla ngenani le-lipids egcwele
- Ukufakwa kwemikhiqizo yamaprotheni kumenyu (inhlanzi, i-veal, i-turkey, inkukhu).
- Ukufakwa kwefayibha yokudla nefayibha (imifino, izithelo, okusanhlamvu, ilayisi onsundu).
- Ukwehla kokudla kwe-cholesterol (amaqanda angabi ngaphezu kwezicucu ezimbili ngeviki, offal).
Ukudla okungenamsoco akumele kube wusizo kuphela, kodwa futhi nakho ukunciphisa isisindo somzimba we-pathological
Ukusuka eziphuzweni kuvunyelwe ukudla amanzi amaminerali ngaphandle kwegesi, ujusi osanda kufakwa, itiye eliluhlaza. Inani elivunyelwe le-kefir, ubisi kanye ne-cocoa kufanele lixoxwe nodokotela wakho.
Ngohlobo 2 lwe-pathology, ukusetshenziswa kwezinongo ezithile kuyasiza. Ezinye zazo ziyakwazi ukwehlisa i-glycemia. Ochwepheshe batusa ukuthi kufakwe ekudleni:
- turmeric;
- usinamoni
- amabhantshi;
- barberry.
Umsebenzi womzimba
Ukwanda, uhlobo, ubude bokuzivocavoca okubandakanya lo mkhakha, obizwa ngokuthi ukwelashwa ngokomzimba, kuya ngesimo esivamile sabashukela, izibalo ze-glycemia, iminyaka kanye nezinga lomsebenzi wansuku zonke. Ososayensi sebefakazele ukuthi ezemidlalo zingenziwa kuphela uma ushukela wegazi ungeqi i-14 mmol / L. Ngamanani aphezulu, ubungozi bezinkinga ezinkulu bukhuphuka ngezikhathi ezingama-5 noma ngaphezulu.
Kubalulekile ukuzihlola nsuku zonke kwamazinga kashukela, umfutho wegazi, ukushaya kwenhliziyo. Ukuvivinya umzimba okwanele kunemiphumela elandelayo emzimbeni wesifo sikashukela:
- kwandisa ukuzwela kwamangqamuzana ku-insulin;
- isusa cholesterol "embi";
- kwandisa umsebenzi wegazi we-fibrinolytic, kunciphisa ukubukeka kwawo;
- kunciphisa amazinga aphezulu e-insulin egazini;
- kunciphisa ukukhishwa kwama-hormone okucindezela;
- kwandisa ama-endorphin ne-testosterone;
- kuthuthukisa ukuhamba kwegazi;
- isekela umsebenzi wesicubu senhliziyo ezingeni elifanele.
Iziguli zinconyelwa ukuhamba, ukuhamba ngebhayisikile, ukubhukuda, ukushushuluza, i-yoga.
Ukubhukuda akusebenzi kuphela kubantu abaphilile, kodwa futhi nakubantu abagulayo
Ukwelashwa ngezidakamizwa
Imithi isetshenziswa kuphela uma isinxephezelo ngokudla nomsebenzi womzimba singatholakali. Nikeza amaphilisi anciphisa ushukela noma ukwelashwa kwe-insulin - ukukhetha kukadokotela we-endocrinologist. Kuya ngobucayi besimo, izinkomba ze-glycemia, ukuba khona kwezinkinga, ukugqugquzelwa yisineke, ubudala nobulili.
Imithi yokwehlisa ushukela kumathebulethi:
- Ama-inhibitors e-Alpha glucosidase izidakamizwa ezintsha ezenza ukuthi ijubane lokufakwa kwe-carbohydrate lisuke emthanjeni wamathumbu lingene egazini. Abamele - Acarbose, Miglitol.
- Ukulungiselela kweSulfonylurea (Chlorpropamide, Glipizide, Tolbutamide) - kuvuselela umsebenzi wamaseli wokugcina we-insulin, ukuthuthukisa isenzo sehormone, ukukhulisa ukuzwela kwamangqamuzana nezicubu kuwo.
- I-Biguanides (Metformin, Fenformin) - ikhulisa ukusetshenziswa kwe-glucose emaphethelweni, yehlisa izinqubo ze-gluconeogeneis, ithuthukise isenzo se-insulin, yandisa inani lama-receptors abucayi ebusweni beseli.
Ukwelashwa kwe-insulin
Hhayi i-mellitus yesifo sikashukela encike ku-insulin kuphela, kodwa futhi nohlobo 2 lwe-pathology lungadinga ukujova kwe-insulin emzimbeni wesiguli. Ukwelashwa kwe-insulin okuhlala isikhathi eside kuchazwa ezimweni lapho isiguli sinokuzwela ngakunye kwe-Biguanides kanye nokutholakala kwe-sulfonylurea, lapho kungekho kusebenza kahle kokulashwa ngamathebhulethi anciphisa ushukela, futhi futhi nangasemuva kokukhula kwezinkinga zesifo sikashukela esingamahlalakhona.
Izinkomba zokwelashwa kwe-insulin yesikhashana:
- ukusebenza nge-anesthesia ejwayelekile;
- ukwelashwa kwe-hormonal kwe-adrenal cortex;
- izifo ezithathelwanayo ezihambisana ne-hyperthermia;
- Izimpawu ezicacile zokushoda kwe-insulin emzimbeni.
Ukwelashwa kwe-insulin - ukwethulwa kwekhambi le-insulin emzimbeni wesiguli ngenhloso yokufaka esikhundleni saso
Amakhambi esintu
Ukusebenza kahle kwemithi engcono kakhulu kungathuthukiswa ngamakhambi esintu. Akukhona ukwelashwa kokukhethwa kwesifo sikashukela, kepha kungasiza ukugcina amazinga we-glucose engaphansi kwemingcele eyamukelekayo.
Inombolo yeresiphi. I-100 g yomkhiqizo kufanele ihlanzwe, ixoxwe. I-slurry eholelwayo ithululelwa ilitha lewayinini elibomvu elomile. Ingxube ifakwa amasonto ama-2 endaweni efudumele. Sebenzisa u-1 tbsp. l ngaphambi kokudla ngakunye.
Inombolo yeresiphi 2. Susa i-anyanisi ikhasi kusuka anyanisi amakhulu amakhulu. Gaya bese uthele amalitha ama-2 amanzi abandayo. Ngemuva kosuku lokugcizelela, ingxube kumele ihlungiwe. Umuthi wesintu uthathwa uhhafu wehora ngaphambi kokudla.
Inombolo yeresiphi 3. Ijusi elisanda kufakwa kufanele lidakwe ngaphambi kokudla ngakunye kwe-3 tbsp. l Inkambo yokwelapha yinyanga.
Ukuphathwa okunjalo okuyinkimbinkimbi kusetshenziswa ukwelashwa kokudla, ukuvivinya umzimba, ukwelashwa ngezidakamizwa nezindlela zokuzihlola kuvumela ukufeza isimo sesinxephezelo, ukuvikela ukuthuthukiswa kwezinkinga eziningi, ukusindisa nokwelula impilo yabantu abagulayo.
