Thayipha isifo sikashukela sokuqala

Isifo sikashukela i-mellitus iyindlela yokusebenza yezinqubo ze-metabolic ezenzeka ngenxa yokwephulwa kokukhiqizwa kwe-insulin noma ukungasebenzi kahle kwesenzo sayo emzimbeni womuntu. Ukubonakaliswa okuyinhloko kwazo zonke izinhlobo zesifo izinga eliphezulu le-glycemia (ushukela wegazi). Lesi simo sicaphukisa ukuthuthukiswa kwezinkinga ezinzima futhi ezingalapheki, eziba yimbangela yokufa kwabantu abagulayo.

Isifo sikashukela sohlobo loku-1 siyindlela ye-pathology. Kwenzeka ngenxa yokukhiqizwa okunganele kwe-insulin ye-hormone ngamaseli we-pancreas. Kunezimo zobunzima ekusetshenzisweni kohlobo olufanele lwesifo, kodwa lapho uziqhelanisa kubaluleke kakhulu ukungalazi uhlobo lolo hlobo, kodwa ukuthola isimo sokuncephezela esigulini.

I-physiology ye-carbohydrate metabolism

Ngaphezu kwe-insulin, ama-pancreas ahlanganisa i-glucagon, somatostatin ne-pancreatic polypeptide. Zonke zixhumene: i-glucagon ithathwa njengento ekhuthaza ukukhiqizwa kwe-insulin, kanti i-somatostatin inomphumela wokuvimbela.

Ngemuva kokuthi imikhiqizo equkethe ama-carbohydrate ingena emgodini wesisu, ihlephuka iye kuma-monosaccharides bese ingena egazini. Umphumela uba yi-hyperglycemia. I-insulin iphendula ngezigaba ezimbili. Inani lehomoni eliqongelele emangqamuzaneni phakathi kokudla likhishwa masinyane liye egazini. Ama-pancreas ayaqhubeka nokuxubanisa into kuze kufike lapho kufundwa ushukela.

I-Etiology yesifo sikashukela sohlobo 1

Lesi sifo sohlelo lwe-endocrine singakhula kunoma iyiphi iminyaka, kepha sithinta kakhulu abantu abasha. Uhlobo lwe-1 isifo sikashukela yisifo esidalwa ukuthi sinezakhi zofuzo, kepha izinqubo ze-autoimmune zinikeza indawo ehlonishwayo kwi-pathogenesis.

"Isifo Somnandi" - i-pathology ephelezelwa yi-glycemia ephezulu

Kunemibono ethi hlobo lwe-1 isifo sikashukela esingenzeka singenxa yesenzo se-pathological of Enteroviruses, virus rubella, ukwelashwa okuhlala isikhathi eside kwezinqubo ezi-pancreatic malignant nge-cytostatics.

Isifo sikashukela sohlobo 1 sivame ukuvela nezinye izifo:

• i-pathology yezindlala ze-adrenal;
• i-alopecia;
• vitiligo;
• i-autoimmune thyroiditis;
• Isifo sikaCrohn;
• rheumatism.

Indlela yokuthuthukisa

Izimpawu ezinqala zesifo sikashukela sohlobo 1 zivela lapho inqubo ye-autoimmune ibhubhisa ngaphezu kwama-75-80% amangqamuzana okuvikela insulin. Intsha iboniswa ngentuthuko esheshayo, futhi kusukela esikhathini sokubonakaliswa kuze kube yilapho kuqala izinkinga ezinzima, kungadlula amasonto ambalwa nje.

Amacala ayaziwa, ngokuhlukile, abonakala ngesimo sokuvilapha isikhathi eside kwiziguli ezindala. Kwatholakala ukuthi unesifo sikashukela sohlobo 2, ukwelashwa kwenziwa ngemishanguzo ye-hypoglycemic, kodwa ngemuva kweminyaka embalwa, kwavela izimpawu zokushoda kwe-insulin ngokuphelele.

I-pathogenesis yohlobo lwe-1 yesifo sikashukela exhomeke ku-insulin isuselwa ekushodeni kwe-hormone ngokuphelele. Ngenxa yokungapheleli kwayo, inqubo yokuthatha ushukela izicubu iyaphazamiseka, futhi indlala yamandla iyakhula. Esigabeni sokuqala, kusetshenziswa izindlela ezinxenxa isimo se-gluconeogeneis, lapho umzimba ngokuzimela uzama ukukhiqiza ushukela ngaphandle kokuthola izinsiza zamandla ezidingekayo. Lokhu kukhulisa ukusebenza kwakhe okuphezulu ngisho nangaphezulu egazini.

I-Langerhans-Sobolev Islands - indawo yama-pancreas esekela ama-hormone

Ukusebenza kwesibindi kuyacindezelwa, futhi nezinga lemizimba ye-ketone (acetone) esegazini iyakhuphuka, okuholela enkingeni enkulu yohlobo lwe-1 isifo sikashukela - ketoacidosis.

Izigaba zesifo

Ekwakhekeni kwesifo sikashukela sohlobo 1, kanye namanye amafomu alo, kunezigaba ezintathu eziphambili:

• isifo sikashukela;
• isigaba sokugcina;
• isigaba sokubonisa.

Isifo sikashukela isikhathi sokuqala lapho umzimba womuntu unqunyelwa khona ukuba wakhe isithombe esibonakalayo salesi sifo. Amaqembu anobungozi afaka abantu abathile aboniswe yilezi zinto ezilandelayo:

Umchamo ushukela kushukela

• ukuba khona komzali oyedwa noma bobabili abagulayo;
• ukuzalwa kwengane enomlando we-macrosomia;
• ukuba khona kwesisindo somzimba ngokweqile;
• isifo sokuqina kwemizwa;
• ukonakala kwe-metabolic yemvelo yokuzalwa;
• ukuba khona kwezimila;
• Ukwelashwa kwe-steroid yesikhathi eside.

Isigaba sokugcina sibonisa ukungabikhona kwezimpawu, ukubalwa kwegazi kanye nomchamo wokuthola amazinga kashukela nakho kungaba yinto evamile. Kodwa-ke, lapho wenza isivivinyo sokubekezelela i-glucose (ukuhlaziywa nge "umthwalo"), kungenzeka ukucacisa ubukhona be-pathology.

Isigaba sokubonisa sihambisana nokubonakaliswa okucacile kwesifo futhi kuqinisekiswa izifundo zaselebhu.

Amasu we-pathology

Ama-degree amathathu obunzima besifo:

1. Ukukhanya - izinkomba zikashukela ezingaphansi kuka-10 mmol / l, ukuntuleka kwe-glucosuria, isithombe somtholampilo sitshengiswa kabi.
2. Amanani aphakathi nendawo - okushukela ngaphezulu kwe-10-12 mmol / l, i-glucosuria, izimpawu eziphawuliwe.
3. Kakhulu - zonke izinqubo ze-metabolic azilimalanga, amazinga aphezulu kashukela egazini nomchamo, ingozi enkulu yokuba nesifo sikashukela nezinkinga ezivela kusihlaziyo esibonakalayo, izinso, inhliziyo nemithambo yegazi, uhlelo lwezinzwa.

Izimpawu

I-insulin encike kwisifo sikashukela i-insulin (IDDM) yehlukile kwezinye izinhlobo zesifo ngezimpawu zayo ezivezwa kakhulu. Iziguli zikhala ngokukhishwa kwesikhumba, ukoma kwe-pathological, ukumbumbuluzwa ngokweqile komchamo. Abanesifo sikashukela bangaphuza amalitha angaphezu kuka-7 amanzi ngosuku.

Ukoma ngokweqile kungenye yezimpawu eziphambili zalesi sifo.

Isibonakaliso esibalulekile somtholampilo sohlobo lwe-1 sikashukela mellitus (sincike ku-insulin) ukwehla okukhulu kwesisindo somzimba. Iziguli zingalahlekelwa ama-8-10 kg ezinyangeni ezimbalwa. Kukhona ukubekezela, ukozela okungapheli, ukusebenza kahle okuncane. Ezigabeni zokuqala, isifiso sokudla ngokweqile senzeka, kepha sithathelwa indawo yizimpawu zokungafisi ukudla, ukubonakala kwephunga le-acetone elisuka emlonyeni, ukugcwala kwenhliziyo, isicanucanu, futhi kwesinye isikhathi ngisho nokuhlanza.

Izimpawu eziqondile zesifo:

• amanxeba amade angalapheki namathumba esikhunjeni;
• dermatomycosis;
• ukuncipha kwesikhumba;
• "isifo sikashukela" ezinganeni;
• umthunzi ophuzi wamapuleti ezipikili, izinyawo nezandla;
• ukuqubuka njalo kwezinsini, ukopha kwazo.

Izinkinga

Ukushintshwa okungazelelwe koshukela wegazi kuholela ekukhuleni kwezinkinga ezinzima futhi ezingamahlalakhona. Ama-comas abhekwa njengeyingozi kakhulu, ngoba adinga ukunakekelwa okuphuthumayo esigulini. Ukuntuleka kokungenelela okufika ngesikhathi okuholela ekufeni.

Imbangela enkulu yezinkinga ezingamahlalakhona yi-pathology yemithambo yegazi nezinzwa, ejwayelekile kwisifo sikashukela. I-Hyperglycemia inomphumela onobuthi ezindongeni ze-vascular and fibre nerve nerve, eguqula ukusebenza kwabo okujwayelekile. Ukucaciswa kwemithambo emikhulu nemincane kuncishisiwe, okuholela ekuphulweni kokuhlinzekwa kwegazi ezithanjeni nokukhula okuqhubekayo kwe-hypoxia kuze kufike ku-gangrene.

Imicu ye-nerve ihlushwa ukulimala kwemikhumbi ye-epineural. Izinguquko ezijwayelekile zokudlulisela umfutho, amaseli ezinzwa ayafa. Umphumela uwukuphulwa kwe-innervation kanye ne-pathology yazo zonke izinhlobo zokuzwela.

Izinkinga eziphambili zesifo sikashukela sohlobo 1 zibhalwe etafuleni.

Izinkinga zesimo esibi nesingamahlalakhona ziyimbangela enkulu yokufa okuphezulu phakathi kwabanesifo sikashukela.

Ukuxilonga

Ukuxilongwa kwe- "insulin sikashukela" kwenziwa ngesisekelo sezimpawu ezejwayelekile kanye ne-hyperglycemia esetshenzisiwe elebhu. Uchwepheshe wehluka ngale mibandela elandelayo:

• isifo sikashukela insipidus;
• i-polydipsia yemvelo ye-psychogenic;
• ukusebenzelana kwegazi kwezindlala ze-parathyroid;
• ukwehluleka kwezinso okungamahlalakhona.

Ukuhlolwa kwegazi

Ngaphezu kokuhlaziywa okujwayelekile, okubonisa isimo somzimba ngenxa yezinga lezinto ezakhiwe, i-hemoglobin, i-ESR, ukuhlangana kwegazi, i-endocrinologist ichaza izindlela ezilandelayo zokuxilonga:

• Ukuhlolwa kwegazi kwe-glucose - okunquma ukusebenza kwegazi le-capillary, kunikezwa esiswini esingenalutho kusuka ngomunwe.
• I-biochemistry yindlela yokufunda nge-venous igazi. Kuyo, amanani kashukela azohluka ngo-10-12% kokuqukethwe egazini le-capillary.
• Ukuzimisela kokubekezelela - kukuvumela ukuthi ucacise izinga le-glucose ne-insulin egazini ngaphambi nangemva "komthwalo" we-carbohydrate.
• I-Glycated hemoglobin - ukuhlaziywa kunquma amanani aphakathi kashukela ezinsukwini ezingama-60-90 ezedlule.
• I-Fructosamine - Hlaziya amazinga eglucose ezinsukwini eziyi-14-21 ezedlule.

Ukubalwa komchamo

Ekuhlaziyeni jikelele, i-glucosuria akufanele ibe yinto evamile (amanani aphezulu avumelekile angama-0.8 mmol / l). Ukuhlaziywa nsuku zonke, ngaphezu kokuba khona ushukela, kukuvumela ukuthi unqume inani lomchamo okhishwe kanye nokucacisa ubukhona be-polyuria noma i-oliguria esigulini.

Imivimbo yokuvivinya yokunqunywa kwemizimba ye-acetone kumchamo - indlela ecacile esetshenziswa ekhaya naselabhoratri

Udokotela angayala izivivinyo ezithile ukuze kutholakale imizimba ye-ketone emchameni. Lokhu kuyimikhiqizo ye-metabolic, ukubukeka kwayo okubonisa ukwephulwa kwe-lipid ne-carbohydrate metabolism.

Izici zokwelapha

Cishe akunakwenzeka ukwelapha isifo sikashukela ngezindlela zesimanje ezaziwayo, ikakhulukazi uma ucabanga ukuthi iziguli eziningi ziya kudokotela ngezimpawu ezisobala zalesi sifo. Mayelana nesifo sikashukela sohlobo 1, kungashiwo ukuthi ukwelashwa kwe-insulin kuyisisekelo sokwelashwa. Lokhu kuyindlela yokufaka esikhundleni se-insulin ngezincazelo zayo zokwenziwa.

Ukusebenza kahle kwaboniswa irejimendi ye-insulin Therapy, efana nokufihlwa komzimba kwento esebenzayo e-hormone. Isidingo sinikezwa ngemijovo emibili yomuthi wesikhathi esiphakathi noma ukuphathwa okukodwa kwesikhathi eside. Inani le-analogue elisetshenzisiwe akufanele lidlule i-50% yesibalo esiphelele ngosuku.

Ukukhiqizwa okunomsoco kwe-hormone kuthathelwa indawo kungeniswa kwe-insulin emfushane noma ye-ultrashort ngaphambi kokudla. Inani elidingekayo lomuthi libalwa ngokuya ngokuthi kutholwa malini ama-carbohydrate enkambisweni yokudla kanye nezinkomba zeshukela ngalesi sikhathi.

Ukulungiswa kwe-insulin kulawulwa ngokungaziphathi. Ukuze wenze lokhu, sebenzisa i-insulin, ipampu noma ipeni yesirinji. Indlela ejwayelekile yipeni yesirinji, ngoba akukho ukungahambi kahle ngokwethulwa komkhiqizo, inqubo yokujova ilula futhi ilula.

Uhlu lwama-insulin asetshenzisiwe:

• I-Humalog, Aspart - isenzo se-ultrashort;
• I-Insuman Rapid, uHumulin P - isenzo esifushane;
• I-Protafan NM, i-Insuman Bazal - ubude besikhathi esiphakathi;
• U-Levemir, uLantus - isenzo eside.

Ipeni lesirinji - indlela elula nelula yokusebenzisa i-hormone

Imithetho yokudla okunempilo

Imenyu yesifo sikashukela isuselwa ekuthobeleni imithetho yokudla okuphansi kwe-carb. Ucwaningo lufakazele ukusebenza kokudla okunjalo, ngoba kukuvumela ukuthi uthole isinxephezelo ngalesi sifo futhi usigcine kulelo zinga isikhathi eside.

Imithetho eyisisekelo:

• Ukunciphisa inani lama-carbohydrate atholwe kuma-50-60 g ngosuku.
• Ukushintsha imikhiqizo ene-digestible saccharides nalezo ezinenani elikhulu le-fiber ekwakhiweni.
• Shintsha ushukela wokufaka esikhundleni (i-fructose, i-sorbitol) noma usebenzise ama-sweeteners wemvelo (i-stevia, isiraphu yemaple).
• Ukudla ngakunye kufanele kuqukethe inani elifunekayo lamaprotheni.
• Amajikijolo, amantongomane, ushokoledi omnyama, uju - ukudla okufanele kunqunyelwe, kepha kusadliwa “ngesifo esimnandi”.
• Thatha inkomba ye-glycemic yemikhiqizo ekwakhiweni kwemenyu ngayinye.
• Kala amazinga kashukela wegazi ngaphambi nangemva kwehora lesibili ngemuva kokungena kokudla emzimbeni, uqopha imininingwane kwidayari yomuntu ngamunye.

Umsebenzi womzimba

Ukuzivocavoca umzimba okuncane kuyinzuzo yomzimba wesifo sikashukela. Noma yimuphi umsebenzi, kukhona ukwanda kokuzwela kwamangqamuzana nezicubu ukungena ku-insulin, izinhlaka zokuphila zegazi ziyathuthuka, isisindo somzimba siyancishiswa, umsebenzi wohlelo lwenhliziyo uqiniswa.

Ukuhlakulela isethi yokuzivocavoca kuzosiza udokotela oholayo. Imithwalo ebalulekile ayidingeki, kepha isigamu sehora lokuzivocavoca umzimba sizohlomula kuphela.

Yize isifo sikashukela sithathwa njengokuxilongwa okunamandla, akusona isizathu sokuyeka. Ukwelashwa okwanele, ukuhambisana nemithetho yokudla kanye nokuzivocavoca umzimba kuyisihluthulelo sokuthola isinxephezelo nokuvimbela ukuthuthukiswa kwezinkinga.