Imbali yembali: uhlobo lwesi-2 lwesifo sikashukela, i-décompensation stage, i-subcompensation, inkqubo enzima, ixhomekeke kwi-insulin, kuxhomekeke kwi-insulin, kuxhomekeke kwi-polyneuropathy. Forecast

Mhlawumbi, abantu abaninzi abanonwabe ngembali yabo yezobugqirha. Isifo sikashukela sephepha 2, esiboniswe kuyo, sinokubangela ukuphelelwa lithemba. Kodwa ngaba kufanelekile ukuyeka nokuphelelwa lithemba? Yeyingozi kangakanani le sifo, kwaye njani ukujongana nayo - siya kuqonda.

Isifo sikashukela sisifo - yintoni ingozi?

Abantu bavame ukuva malunga nesifo sikashukela, kodwa ke bambalwa kuphela abazi ukuba kuyintoni. Kufuneka kuqatshelwe ukuba imbono "yesifo sikashukela" ngumfanekiso oqokelelweyo. Ngaphantsi kweli xesha, izifo ezininzi zeenkqubo ze-endocrine ziya kudibanisa. Izizathu zokuvela kwazo zininzi, kodwa, njengommiselo, iingxaki ze-endocrine, kunye nokuntuleka kwe-insulin, zisentliziyweni yesifo. Enye into ingaba ukungakwazi ukuthatha i-glucose ngesibindi kunye nezicubu zomzimba. Ngelo xesha elifanayo emzimbeni inqanaba layo likhuphuka, leyo leyo, eyona nto ibangela imbandezelo kwi-metabolism.

Isifo sikashukela esinesifo - iintlobo zayo

Iyeza zanamhlanje zihlukanisa iintlobo ezimbini zezi zifo. Ukuqhafaza kwenzeka ngokuxhomekeke kwinto engakwazi ukuyenza-insulin okanye isiqhelo-ichaza imbali yonyango. I-diabetes mellitus type 2, njengokulawula, ayihambelani nokusilela kwe-insulin, ukuphuhliswa kwayo okubandakanyekayo kwi-pancreas. Ngokuqhelekileyo, imbangela yokuphuhliswa kwayo iyancipha ekuveleleni kwimizimba kunye nezicubu kule hormone. Isifo sikashukela se-insulin-kuxhomekeke kuyo-uhlobo lokuqala - luhambelana ngqo nokusilela kwe-insulin emzimbeni. Ukungabikho kwale hormone kubangela ukuba i-glucose, engena emzimbeni, ayinakwenziwa, okanye iyenzeka ngokwaneleyo, ngelixa igazi layo likhula njalo, kwaye ukuze kugcinwe ubomi, izigulane ezinjalo ziphoqelelwa ukuba zithole i-insulin eyongezelelweyo.

Imbali yembali - uhlobo lwesi-2 lweswekile

Esi sifo sesifo sikashukela sabizwa ngokuba yi-insulin-emele. Ngokutsho kwedatha yeenkcukacha, izigulane ezijongene nale hlobo lwesifo zibaninzi kunokokuqala. Xa uneminyaka yobudala, ingozi yokuba esi sifo siya kubonakala ngokunyuka kakhulu. Ngokuqhelekileyo ukuphuhliswa kwayo kubonakala kungabonakali, kwaye isigulane ixesha elide alingazi malunga nale nzala, idatha eyimvumela ukuba ayikrokrele ayibonakali nembali yesifo. Isifo sikashukela solu hlobo 2 kulo mzekelo sibonwa ngokuba "ukufumana okungafunekiyo" ngexesha loviwo oluqhelekileyo. Isalathisi esona sikhulu, esikuvumela ukuba usikrokre ubukho bentsholongwane, kukuhlolwa kwegazi apho i-glucose yanda khona. Ngaloo ndlela, xa imbali yonyango ikwenziwa, thayipha i-diabetes ye-2 ihlukaniswe ngo:

• Ukuvela kwizigulane ezinesisindo esifanelekileyo;
• Evezwe kwizigulane ezinobunene.

Izizathu zesifo sikashukela

Ngaphandle kwenkqubo yoqeqesho oogqirha abancinci benza i-medical history yesi sifo, uhlobo lwesibini lwesifo sikashukela esinokubangela izizathu ezininzi. Okuqhelekileyo kwezi zi:

• Ukusetyenziswa kwee-carbohydrates ecocekileyo (iswekile, ishokoledi, i-buns, iitatate) ngobuninzi kunye nokungakwazi ukusetyenziswa kwezifayili zityalo kwisondlo;
• Ubungcwele - phambi kohlobo oluthile lwezilwanyana kubazali, umngcipheko wesifo sikashukela ukhulu kunama-40%;
• Ubutyebi obukhulu, ngokukodwa uhlobo lwe-visceral (i-deposit deposits ikhona ngokubanzi kwindawo yesisu);
• U xinzelelo;
• Ukungasebenzi.

Yintoni eyenzekayo? Pathogenesis

Imbali yesifo sesifo sikashukela se-2 sichaza njengenani leengxaki kwi-metabolism process. Ngomxholo walo ukuxhathisa kwe-insulin - ukungakwazi kwamathambo ukuba ngokuqhelekileyo ubone i-insulin, ngakwesinye icala, kunye nokuphazamiseka kwemveliso ye-hormone kwiiseli eziphazamisayo-kwenye. Ngokuqhelekileyo, ngokunyuka kwinqanaba le-glucose, elenzeka ngokukhawuleza emva kokutya, i-pancreas iqala ukukhuthaza i-insulin ngokunyanisekileyo. Kubantu abanesifo sikashukela se-2, oko akukwenzeka, kwaye i-insulin iyaqala ukuveliswa kuphela xa izinga lokuxubusha kwe-glucose selifikile kumanani aphakamileyo. Nangona kunjalo, nangona ubukho be-insulin, ukwehla kwinqanaba leeshukela kulo mzekelo kwizinga elifunwayo alikho. I-insulin ephakamileyo eqhubekayo igxininisa kwiiseli ezilahlekelwa ukukwazi ukusabela kuyo kwaye ngoku, nangona i-hormone ingaxhuma kwi-cell receptor, akukho mpendulo. Ngokuchasene nezo zinto zitshintsho, iiseli zesibindi ziqala ukwenza intsebenziswano nge-glucose, ngokunyusa ukugxininisa kwigazi. Konke oku akudluli ngaphandle kwemiphumo. Ngokuhamba kwexesha, ngaphantsi kwefuthe le-glucose ephezulu, i-glucose toxicity ikhula, echaphazela kakubi iiseli eziphazamisayo ezivelisa i-insulin, kwaye ngenxa yoko, ukungaphumeleli kwayo kukhula. Ngaloo ndlela, imbali yesifo iyancipha. Uhlobo lwe-2 lwesifo sikashukela ludlulisela ifom xa ulawulo lwe-insulin alukafuneka. Isigulane sesigulane sibuhlungu.

Iimpawu

Kwikliniki yeklasi yesifo sikashukela, kuyaqhelekileyo ukuhlukanisa amaqela amabini eempawu zesifo - esisiseko nesesekondari. Eyona nto iquka:

• I-Polyuria - ininzi yomchamo ikhutshwa (i-glucose, ukungena kuyo, iyandisa kakhulu ingcinezelo ye-osmotic);
• Okwesithathu (i-polydispepsy) - ebonakaliswa yimfuneko engapheliyo yokuphuza;
• Indlala (i-polydisfagy) - ngenxa yokungakwazi kwamaseli ukuxubusha i-glucose nge-insulin, umzimba ufumana isidingo esipheleleyo samandla;
• Ukulahleka kobunzima obunzima - kwenzeka ngokuchasene nemvelaphi yesondlo sokondla.

Zonke ezi zibonakaliso zifana nezohlobo lokuqala lwesifo sikashukela. Udidi lwesibini lunokuthi lugqithise okanye lubangele iimpawu zesekondari:

• Ukutshitshiswa kwesikhumba kunye neembumbulu ezinamaqabunga - ngokuqhelekileyo xa uhlola isigulane kunye nokusola uhlobo lwesifo sikashukela se-diabetes (umlando wezonyango), ibhinqa linokumakisha ukukhangela ukungenakunxulunyaniswa kwizitho zangasese;
• Ubuthathaka obukhulu kunye nentloko;
• Izilonda zesikhumba ezivuthayo, ezinzima ukunyanga;
• Umbono ophantsi.

Njengomgaqo, ngokugqithiseleyo abayithobeli loo mpawu, kwaye eso sifo sinokufunyanwa kuphela kwisigaba seengxaki.

Abantwana kunye nesifo sikashukela

Ngelishwa, isifo sikashukela ngoku siyabonwa njengesibini sesifo esingasigxina. Yilokho okusemgangathweni kwezempilo ezisemthethweni. Isifo sikashukela (uhlobo lwesi-2) imbali yengonyango yengane ihlala ibeka kwisigaba sezifo eziyingozi. Oku kubangelwa ukuba ikhosi yayo ihluke kwiyomntu omdala ngokuphuhlisa ngokukhawuleza kwaye ngokuphindaphindiweyo kuqhubeka ngokugqithiseleyo. Nangona kunjalo, kulo mzekelo, konke kuxhomekeke ekubeni abakwazi ukulungelelanisa umsoco womntwana kunye nokubeka iliso ukusetyenziswa kwezidakamizwa ngexesha elifanelekileyo. Ukongeza, kubaluleke kakhulu ukuchonga isifo ngexesha. Ukuba umntwana unempawu ezilandelayo, ukubonisana ngokukhawuleza kwe-endocrinologist kuyimfuneko:

• Umntwana uhlala elambile;
• Ngokuphindaphindiweyo uye kwindlu yangasese (esikolweni okanye e-kindergarten iphoqelelwe ukuya kumaxesha amaninzi ukucela izifundo);
• Ubunzima bomzimba obuphantsi;
• Ukukhathala okungapheliyo kubonwa.

Diagnostics

Ukufumanisa i-diabetes ngesiseko somchamo kunye nokuhlolwa kwegazi. Ngomntu onempilo, i-glucose ayitholakali kumchamo, kodwa egazini layo izinga alidluli 5.5. Iziphumo ezinokwethenjelwa, igazi lithathwe eminwe okanye emthanjeni (isidlo sokugqibela kufuneka sithathwe ubuncinane kwiiyure eziyi-8 ngaphambi kokuba inkqubo), phambi kokuzinikela, awukwazi ukusela i-tea efanelekileyo, ikhofi okanye ijusi. Kufuneka kuqatshelwe ukuba i-diabetes mellitus ifunyaniswe kwizinga eliphezulu ngasentla. 7. Ukuba ngaba ama-indices aguqukayo ukusuka kwi-4 ukuya kwe-7, ngoko kukwaphulwa kwe-glucose tolerance.

Olunye uvavanyo oluvumela ukuchonga esi sifo nokucacisa ixabiso elithandabuzo luvavanyo lokunyamezela kwe-glucose (GTT). Ikuvumela ukuba ufumane idatha kwizinga le-glucose kwisisu esingenanto, kwaye emva kweeyure ezimbini emva kokuba athathe isisombululo se-glucose. Ngokuqhelekileyo, emva kwe-glucose, ingqwalasela yayo ayifanele ibe ngaphezu kwama-7.8. Olu vavanyo aluqhutywanga xa i-glucose ngaphambi kokuba uvavanyo luphezulu ngaphezu kwe-6.1 ukuba isigulane sinembali yezifo ezigulane, ukungenelela kokugonywa, ukuphazamiseka kwe-myocardial, ukunyamezela, kunye nokusebenzisa iziyobisi ezandisa i-glucose. Yonke le nkcukacha ibonisa imbali yonyango.

Isifo sikashukela sephepha 2, umvuzo

Njengabaphi na isifo, isifo sikashukela sinakho ukukhula nokwandisa iimpawu. Kwimiqathango emithathu ekhoyo ekhoyo. Isigaba sembuyekezo sisetyenziswe xa izibonakaliso zesigulane zihamba ngendlela evamile. Ukuba ixesha lingathathwa, okanye ayingenisi siphumo esilindelekileyo, ngoko isifo sifika kwisigaba se-subcompensation. Kule meko, imeko yesigulane, yeyona nto ayilona nto ibhetele, kodwa nayo ayikho into engafanelekanga. Ngomhla isigulane asilahlekanga ngaphezu kwamahlanu amagremu we-glucose kumchamo , kwaye izinga lakhe legazi li malunga ne-13.8, i- acetone emcinini ayikho. Kule nqanaba, uphuhliso lwe-coma ye-hyperglycemic alinakwenzeka. Umbuso ophakathi phakathi kwembuyekezo kunye nokuhlawulwa kwemali kuhanjiswa kwisigaba senqumla, kunye ne-glucose level 7.5, ipesenteji ye-hemoglobin 6.5%, kunye ne-glucose yokuzila ngaphantsi kwe-6.1. Isigaba sokuhlawula sisetyenziswe ukuba izibonakaliso zigqithise imida elandelayo:

• Umgangatho we-glucose ungaphezulu kwe-9;
• Glycerized hemoglobin - ngaphezu kwe-9%;
• Ukutya i-glucose - ngaphezu kwe-7.

Utshintsho kwezi zikhombisi kunye nokusebenza kwonyango oluchanekileyo kunceda ukulandelela imbali yesifo. Isifo sikashukela sephepha 2, inkambo ebunzima yokuyiphatha okanye ukukhushulwa yimiba ethile, iya kwinqanaba lokuhlawula.

Izinto ezibangela ukuhlaziywa

Ngokuqinisekileyo, ngamnye umzimba unomntu ngamnye, kwaye izinto ezinonophelo kweso sifo zingahluka, kodwa ezi zizona ziqhelekileyo:

• Ukutya, ukuphulwa kokutya;
• Impazamo ekukhetheni imveliso yeyeza, i-dose okanye ukwenqaba unyango;
• Ukuzicoca okanye ukusetyenziswa endaweni yokutya okuncedisiweyo yokutya;
• Ukwenqaba ukutshintshela kwi-insulin yonyango;
• Izifo ezikhuthaza ukunyuka kwamanzi umzimba;
• Iimeko ezinzima.

Zonke ezi zinto ngokwazo okanye ngokudibeneyo zichaphazela kakhulu iinkqubo zeendlela zokuxilisa, kwaye ngenxa yoko, kukho ukwanda kwinqanaba le-glucose, elibhalela imbali yesifo. I-diabetes mellitus uhlobo lwesi-2, isigaba sokuhlaziywa kwezinto eziqhutyelwa phambili ngokubonakala kweengxaki ezahlukahlukeneyo ezivela kwiimpawu kunye nomzimba womzimba, kufumana isicatshulwa esisongelayo kwaye, ukuba ingaphathwa kakubi, ingasongela ubomi bomguli. Kule meko, iingxaki zinokukhula njengoko zihlala ixesha elide, kwaye ngokoqobo kwimiba yeeyure.

Isigaba sokunciphisa

Njengoko ukwanda kwe-glucose kwanda, kwaye ukulungiswa kwayo kudinga amanyathelo angakumbi, imbali yesifo iyancipha. Isifo sikashukela (uhlobo lwesi-2), isithintelo sakhe esichazwa ngumngcipheko omkhulu weengxaki, sidinga isimo sengqondo esibalulekileyo. Oku kubangelwa ukuba kunokuba nzima kakhulu ukutshintshisa izinga le-glucose zombini ngoncedo lokutya kunye nokusetyenziswa kwamachiza. Ngenxa yoko, kuyimfuneko ukuba uqaphele ngenyameko imeko yesigulane, ngenxa yokuba kungabikho kwimiba yokusetyenziswa kweziyobisi, utshintsho lwezifo kwizitho ezahlukahlukeneyo ngokukhawuleza zenzeka. Ngoko ke, ezi zigulane zifuna ukunyangwa kwezonyango, kwaye zidla ngokunyamekela.

Ubunzima bokulawula okuzimeleyo kwiimeko zakho kubaluleke kakhulu apha. Ngethamsanqa, iyeza zanamhlanje zinokukhetha okwaneleyo kwindlela yoku. Imivavanyo eyahlukeneyo kunye nezixhobo ezichonga umgangatho we-glucose, vumela isigulane sesifo sikashukela ukuba sichaze ngokuzimeleyo imeko yaso kwaye, kuxhomekeke kwiziphumo, senze isilungiso.

I-Insulin kwiTyhuse

Njengoko eso sifo siyaqhubeka, ukuchithwa kwala maseli e-pancreatic aququzelela i-insulin iyaqhubeka. Le nkqubo idinga ukuphathwa ngokukhawuleza kwonyango lwe-hormone. Njengoko uphando lwangoku lubonisa, ngamanye amaxesha oku kuphela kunceda ukugcina amanqanaba e-glucose kwizinga elifanelekileyo. Nangona kunjalo, akuyimfuneko ukuqwalasela ukuba injongo ye-insulin yinto yobomi. Ngokuqhelekileyo uhlobo lwesi-2 lwesifo sikashukela, umxhasi we-insulin, ukuba imbali yakhe yonyango ibonakala ibhujiswe ukulungisa impilo yonke ye-insulin, phantsi kweminye imizamo ethile kwisigulane sinokungena kulolu hlobo xa ukulawulwa rhoqo kwe-hormone kungadingeki. Isifo sikashukela esichaphazelekayo ngokubhekiselele kulo mba kubhekiselele kulawo mathambo apho, ukuze kufezekiswe umphumo wonyango, ukulawula kunye nomzamo kwisigulane kubaluleke kakhulu. Ngoko, kuvela ekuqeqesheni kwakhe ngokutya, ukubeka iliso kwinqanaba leeshukela kunye nokudla ngexesha elifanelekileyo ngexesha leemvavanyo eziza kuxhomekeka. Nangona kunjalo, kwezinye iimeko, ukuqeshwa kwe-insulin ngumlinganiselo onyanzelekileyo. Oku kwenzeka:

• Ngexesha lokukhulelwa;
• Kwimeko yokubetha okanye ukuhlaselwa kwentliziyo;
• Ngongenelelo lophulo;
• Nezifo ezithathelwanayo zesimo se-purulent-septic;
• Ngezibonakaliso ezongeziweyo zokuxilongwa kwebhubhoratri.

Esinye isizathu esibalulekileyo sokuba kuqeshwe isigunyaziso se-insulin singabonakaliswa ngokucacileyo kule hormone, eqinisekisa ubungqina bembali. Uhlobo lwe-2 lwe-diabetes mellitus, inqanaba lokunciphisa umonakalo elibhekiselele ekulahlekeni kokunyuka kwesisindo nokukhula ketoacidosis, ngumzekelo ocacileyo waloo.

Kufuneka kuqatshelwe ukuba namhlanje iyeza landise kakhulu ububanzi bokusetyenziswa kweyeza-insulin, kwaye liqinisekiswa ngokusemthethweni ukuba ukuphumelela kwonyango lomlomo kunye ne-monotherapy lihlala lingaphantsi kweminyaka engama-6. Emva koko ndimele ndinike amachiza amaninzi. Ngokweziganeko zakutshanje kwonyango lwesifo sikashukela, ukusetyenziswa kwe-insulin kwiimeko ezinjalo kuthathwa njengempumelelo.

Iingxaki ezintle

iingxaki Acute of decompensated - yimeko apho kukho isoyikiso ebomini yesigulane. idla ngokubangelwa yi ukwanda okubonakalayo kwizinga glucose kunye nezifo ezinxulumene ngayo ukutya. Phezu ukwenzeka kwale meko uncedo ezibalulekileyo ngexesha elifanelekileyo, njengoko nazi iimpawu ezi meko kufuneka nje kuphela oogqirha, kodwa abongikazi, le imbali impelesi sifo babe uhlobo 2 seswekile kunye neengxaki zawo zichazwa ngolu hlobo lulandelayo.

1. Hyperglycemic isiqaqa (hyperosmolar kunye ketoatsidoticheskaya) - inkalo lwabo lokwahlula ke kancane. Izinto ezibangela ukuba babe oyidlayo ayoneli okanye yolwamkelo lwakho insulin, ukutya disorder (kukutya kakhulu carbohydrate), umthambo kwisiqalo of hyperglycemia, ukusilela iliso kwinqanaba glucose, utywala okanye amayeza athile. Ngokwezonyango, kubonakala ukuba ukukhula iintsuku eziliqela lunxano kunye polyuria (ukwanda umchamo), emzimbeni kakhulu. uxinzelelo gazi lifinyele, kunye tachycardia. Xa ukonakala unditsho kunokwenzeka nokudandatheka lokuqonda. Kwesikhumba imikrwelo owomileyo kunokwenzeka, acetone ivumba ngexesha zingumphunga. Kulo mzekelo, ixhoba kufuneka esibhedlele kwangoko kunye nonyango.
2. isiqaqa Hypoglycemic - kubangelwa kukuhla elibukhali kwi glucose egazini (ngaphantsi kwe-3 mmol / l), apho ingqondo ivavanywa ukunqongophala elibukhali kwezondlo. Le meko kungabangela i libanda kwencindi, isuka imitsi enye ukutya okanye abakhethwe ngokungachanekanga ukutya, utywala okanye iziyobisi. kuhlaselwa ngokwezonyango okhula ngokukhawuleza. Lubonakala ngokuba ukubila ebandayo ebunzi, buthathaka, iingcangcazela ngesandla, intloko ebuhlungu, antsi imilebe. Le isigulane ndlongondlongo, kakubi elungelelanisiweyo iintshukumo zabo, kukho kwentliziyo, umbono kabini, ukudideka. Kumanqanaba kamva kukho ilahleko lokuqonda, ukuxhuzula. Prehospital ezinjalo izigulane zinganikwa ukusela elithozamisayo okanye into etyiwayo, nehlombe kuyiswe kwiziko lonyango kukhathalelo kulandela-up.

iingxaki ekupheleni

iingxaki ezinjalo kwenzeka seswekile decompensated, emva kweminyaka emininzi zokugula. Ingozi kubo ukuba kancane kancane ingabonakali sibe sibi imeko yesigulane. Ukongeza, unyango seswekile badla nokubhala ngeke sikwazi ukuqinisekisa ukuba kungekudala, akayi kuvela ukuba.

1. Retinopathy luphawulwa izitshanguba retina. Ngelishwa, phezu kwazo zonke inkqubela amayeza mihla, xa kukuvela retinopathy kwizigulane kunye Type II diabetes, okuhlala iminyaka engaphezu kwama-20, isondela 100%. Le leengxaki ibangela hemorrhages kwi fundus, yaye ekugqibeleni kukhokelele ukugqiba ukulahleka umbono.
2. Angiopathy - are nokunyhashwa permeability semithambo, nto leyo iba unobangela thrombosis kunye yegazi. Ngaba zokuphuhlisa ixesha elifutshane (malunga nonyaka), xa kuthelekiswa nezinye iingxaki zexesha elide basoloko umthwalo imbali.
3. Type 2 diabetes sinwenwa, polyneuropathy seswekile, apho kananjalo kwingxaki eqhelekileyo, Iirejista ngo-90% yamatyala. Ngokwezonyango, oku kuthetha kuyoyisa kwimithambo- ukulawula izihlunu kunye nezibilini. Polyneuropathy ngazo hypersensitivity, yondele ngesiquphe (average) iintlungu, uvutha. Kwakhona zokubonisa neuropathy inokuba imilenze, kunciphise novakalelo, leyo ukonzakala ezininzi. Izibilini inokuba urhudo, ngumchamo wokuchama, intloko ebuhlungu, isiyezi, aphazamiseka kumsebenzi kwentliziyo.
4. unyawo abaneswekile - luphawulwa imbonakalo imilenze, ingakumbi, iinyawo izilonda lwemithambo seswekile, amathumba, iindawo necrotic. Kungenxa yoko le nto izigulana na kwesi sifo, kucetyiswa ukuba anikele ingqalelo ekhethekileyo ngokukhethwa izihlangu.

Outlook

Kubuhlungu, kodwa ekugqibeleni kusoyisa isifo seswekile zezonyango namhlanje abakwazi. Noko ke, ukuze wenze kakuhle uhlengahlengiso ngexesha ezingaqhelekanga oko kubangele uxinzelelo ukwanda glucose emzimbeni womntu, oko kukuthi, uhlobo 2 diabetes sinwenwa. Imbali esi sifo, i-ALS kwesi sifo kwindawo ezininzi, ukuba asingabo bonke, kuya kuxhomekeka sengqondo kuye malunga nesigulane eso. Kunye nokulawulwa kakuhle ukuba inqanaba iswekile kunye neminye imiqondiso, kukulungiswa idosi kuyimfuneko, itye kunye neengcebiso oogqirha, unako ukuthintela iingxaki iminyaka emininzi.