Ọrịa mgbu na-arịa ọrịa shuga na-arịa ala

Ikike nke ingga n’ihu na Mmụta Ọkachamara nke Ọkachamara

Ngalaba Ọgwụ, Endocrinology na Medicine mberede

“Ọrịa shuga mellitus n'ihi nnukwu ọrịa na-efe efe”

Ọria mamiri ọria mamiri

1. Ọnọdụ nke ọrịa shuga pancreatogenic n'ọtụtụ nhazi nke ọrịa shuga

2. The pathogenesis nke ọrịa shuga n'ihi nnukwu ọrịa ma ọ bụ na-adịghị ala ala pancreatitis

3. Ọnwụ nke ọrịa shuga na-akpata n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala

4. Ngosipụta nke ọrịa shuga n’ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala

4.1 Ọrịa na-adịghị ala ala nke ọrịa shuga na-egbu pancreatogenic

5. Nchọpụta ọrịa shuga na-arịa pancreatitis na-adịghị ala ala

6. Akụkụ ọgwụgwọ nke ọrịa shuga pancreatogenic mellitus

Ọrịa shuga mellitus, nke abụọ nke ọrịa nke mpaghara exocrine nke pancreas, ma ọ bụ ọrịa shuga nke pancreatogenic, bụ ọnọdụ nke hyperglycemia na-adịgide adịgide, nke na-etolite n'ihi ọrịa pancreatic enwetara, nke mebiri ma exocrine ma ọrụ endocrine pancreatic. Ndị ọrịa na-ebutekarị mgbaàmà ndị metụtara hyperglycemia, mana ha na-egosi n'ụzọ doro anya ihe ize ndụ dị elu nke hypoglycemia na enweghị nsogbu glycemic.

A kọwaara ọrịa shuga nke abụọ na ọrịa shuga na 1788 na Sir Thomas Cowley, bụ onye kọrọ akụkọ banyere nwoke “gbara afọ 34, gbasiri ike, gbasie ike ma buru ibu”, “onye nwere ọrịa shuga” na “nke nta nke nta gwụsịrị ike na, n'agbanyeghị ọgwụgwọ, ọ mechara nwụọ. " Mgbe a na-eme nchọpụta ahụ, “ihe areụrị ahụ jupụtara na okwute na-etinye na ya. Ha nwere ọtụtụ nha. Elu ha adịghị ka nke okwute okwute.

Ihe karịrị 100 afọ mgbe e mesịrị, na 1889, Minkowski gosipụtara na nnwale nnwale nke ndị nkịta kpatara ọrịa shuga, na 1940, Schumaker kpebiri na ọ dịkarịa ala 2% nke ọrịa ọrịa ọ bụla kpatara nnukwu ọrịa shuga. N'agbanyeghị ịnakwere eziokwu ahụ bụ na nnukwu ọrịa pancreatitis adịkarịghị agbasa na ọrịa shuga, ndị dọkịta malitere ịchọpụta ọrịa pancreatitis na-adịghị ala ala ma ọ bụ ngbanwe nke nnukwu pancreatitis dị ka ihe na-akpatakarị ndidi glucose.

Ọrịa shuga mellitus bụ otu n’ime ọrịa ndị a na-anaghị ahụkarị maka ụwa niile. Nke a bụ ihe nke asaa na - akpata ọnwụ na United States na n'ozuzu, ihe ize ndụ nke ọnwụ n'etiti ndị nwere ọrịa shuga bụ ihe dị okpukpu abụọ nke ndị na - arịa ọrịa shuga. Ndị na-arịa ọrịa shuga nwere ohere dị ukwuu nke ịmalite ọrịa obi, ọrịa strok, ọdịda akwara na-agwụ agwụ, ischemia ụkwụ aka yana nkwarụ anya na ìsì. Site na echiche banyere ahụ ike gbasara ahụ ike, ndị nwere ọrịa shuga chọrọ ihe kachasị ike ugboro abụọ karịa ka e jiri ya tụnyere ndị na-enweghị ya. Maka ebumnuche ndị a, yana n'ihi njikọta ya na ihe ndị ọzọ amaara na ọrịa obi, gụnyere ọbara ọgbụgba, ọrịa dyslipidemia na oke ibu, mgbochi na nyocha oge nke ọrịa shuga na ọrịa mellitus nwere nnukwu nsonaazụ.

Nnukwu ọrịa a na - eme ka ọ bụrụ ihe na - akpata ahụ, ọ na - emetụta akụrụngwa na - ezughi oke nke sistem na akụkụ ahụ. Ọrịa afọ na-eme kwa afọ dịgasị iche iche site na pancreatitis site na mmadụ 13 ruo 45/100000. Nnukwu pancreatitis bụ ọrịa na-efekarị ọsịsọ, hyperglycemia bụ ihe ịrịba ama mbido mbụ nke eji eme ya na ụdị prognostic. A na-ewere hyperglycemia a, dị ka iwu, dị ka ihe dị ịtụnanya, nke a na-edozi kpamkpam na ihe fọrọ nke nta ka ọ bụrụ ndị ọrịa niile. Nke a na - akọwa ihe kpatara eji etinye glucose homeostasis ugboro ugboro mgbe ọ gachara n'ụlọ ọgwụ. Ihe omuma banyere oria ndi oria ohuru na oria obia n’azu oria n’arusi oria n’agha na-emegiderita. Reportsfọdụ akụkọ na-egosi na a na-eweghachi glucose homeostasis kpamkpam, na dịka ndị ọzọ, nkwarụ ya na-adịgide na akụkụ dị ukwuu nke ndị ọrịa. Nnyocha e mere n'oge na-adịbeghị anya gosikwara na ndị ọrịa nwere ọrịa hyperglycemia dị obere n'oge ọrịa na-arịwanye elu n'ihe ize ndụ nke ibute ọrịa shuga. Na mgbakwunye, atụmanya nke ịrịa ọrịa shuga na ọrịa shuga na-akpata ọrịa na-akpata nnukwu ọrịa ka na-apụtachaghị ìhè, dịkwa ka etiology na ogo nke nnukwu pancreatitis. Ihe dị ka otu ụzọ n'ụzọ anọ nke ọrịa akwara na-aga n'ihu na-eduga na ọrịa na-adịghị ala ala.

Ọrịa ọgbụgbọ na-efe efe bụ usoro mkpali ma bụrụkwa nke na - enwe mmetụta na-aga n’ihu ma na-atụgharị uche na mbụ nke exocrine na, na ọkwa ọzọ, endocrine parenchyma nke pancreas, nke na - esochi ya na anụ ahụ na - emegharị ihe. Kwa afọ nke ọrịa na-adịghị ala ala dị iche site na 5 ruo 12/100000 ndị nwere ọrịa ọria ala, oke ya bụ ihe dịka mmadụ 50/100000. Ntinye aka nke endocrine pancreatic anụ ahụ na-eme n'oge ngwụsị nke ọrịa. Dika ntuziaka ogwu di iche-iche maka ichoputa na ọgwụgwọ nke pancreatitis na-adịghị ala ala nke Russia Gastroenterological Association na 2013, akara nke exocrine na endocrine pancreatic insufficiency na-apụta na ọkwa nke atọ nke ọrịa na-adịghị ala ala, na ọrịa mellitus na-etolite na ọkwa nke IV, nke a na-egosipụta site na atrophy nke pancreas.

Ndị ọrịa na-ebutekarị mgbaàmà ndị metụtara hyperglycemia, mana ha nwere ohere dị oke nke ịbawanye hypoglycemia na enweghị nsogbu glycemic. Ọbara hypoglycemia nke metụtara insulin ma ọ bụ ọgwụ sulfonylurea bụ ihe zuru ebe niile ma ọ na-akawanye njọ ma dịtee aka. Hypoglycemia bụ ihe rụpụtara nke imebi ihe mgbochi na iweghachi glucose n'ihi ezughị ezu nke glucagon, mmeghachi nke catecholamine na-adịghị ike na mmebi nke imeju na-esochi site na umeji. Site na echiche nke usoro ọgwụgwọ, ọ nwere ike ịdị mkpa idobe ọkwa glucose plasma ntakịrị karịa oke kwesịrị iji zere mmeghachi omume hypoglycemic ugboro ugboro ma melite ogo nke ndụ.

Nchọpụta ezighi ezi nke ọrịa shuga mellitus n'ihi nnukwu ọrịa ma ọ bụ na-arịa ọrịa pancreatitis na-eduga n'ịgwọ ọgwụ ezughị ezu nke ndị ọrịa a, yana ọnọdụ concomitant (nri, nri, wdg) na-emetụta ọnọdụ nri nke onye ọrịa. Na mgbakwunye, ojiji a na-ahụkarị ka ọ bụrụ ihe na - eme ka mmadụ nwee ọrịa ogologo oge na - adịwanye ndụ nke ndị ọrịa nwere ọrịa obi cystic fibrosis, na, nke kachasị, mgbasa na - arịwanye elu nke ọrịa na - adịghị ala ala, na - atụ aro na mellitus ọrịa shuga n'ihi nnukwu ọrịa ma ọ bụ nke na - adịghị ala ala ga - achọkwu nlebara anya site na ndị ọrịa diabetologists na gastroenterologists.

1. Debe oria a na - enye oria a dika oria shuga

Dika ihe choro banyere uzo ichoputa oria oria shuga n’abuo 5 nke algorithms nke nlekọta ahuike di iche n’ilebara ndi oria n’ariri oria oria obi agha, ihe nchoputa nke oria di n’azu agha kwesiri iju “oria mamelitus n’ihi (gosi ihe kpatara ya)”

Dabere na nhazi ndị ọrịa American Diabetes Association, ọrịa shuga pancreatogenic bụ ọrịa shuga 3 (T3cDM). N'ime ntuziaka maka ọrịa shuga, ọrịa obi EASD / ESC, ọrịa shuga pancreatogenic bụ “ọrịa shuga ndị ọzọ: ọrịa shuga nke ukwuu mgbe ọtụtụ ọrịa (pancreatitis, trauma or surgery pancreatic)”

Nkewa ihe kpatara oria shuga mellitus nke oria nke oria exocrine (T3cDM, American Diabetic Association, 2013)
1. Pancreatitis
2. Mmerụ ahụ / yiri nke akwara
3. Neoplasia
4. Cystic fibrosis
5. Hemochromatosis
6. Fibrocalcule pancreatopathy
7. Ndị ọzọ.

2. Pathogenesis nke ọrịa shuga mellitus n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala

Enweghị echiche doro anya banyere usoro pathogenetic nke dalfunction hormonal na nnukwu ọrịa pancreatitis, enweghị algorithms nkịtị maka mgbazi ya. Mmekọrịta chiri anya na arụ ọrụ dị n'etiti exo- na endocrine ọrụ nke akwara ga-edurukwa nnabata na ọrịa nke akụkụ a.

Mmebi nke pancreas maka mmepe nke ọrịa shuga kwesịrị ịba ụba, ma e wezụga ọrịa cancer, nke na mgbakwunye na ibelata oke nke mkpụrụ ndụ beta, usoro ọgwụgwọ ndị ọzọ. Ahụmahụ na iji ụdị ngụgụ a na-egosipụta na-egosi na maka mmalite nke ọrịa shuga, a ga-ewepụrịrị ihe karịrị 80-90% nke anụ ahụ a na-eme. Iji mee ka metabolism mebiri emebi nke ukwuu, ntụgharị ihu mmadụ dị n'ụdị mmadụ kwesịrị ịbụ ihe karịrị 50%, ebe ngọngọ ngọngọ na-akpachapụ anya na-ebute ọrịa shuga. N'ime ndị ahụ siri ike, hamipancreatectomy na-eso nnabata glucose na-emebisị nsogbu na 25% nke ikpe, na, dịka iwu, ọ nweghị ihe karịrị 20-25% nke pancreas residual chọrọ iji hụ na homeostasis glucose nkịtị.

N'afọ 1896, Chiari tụrụ aro imeze nke pancreas n'ihi nsonso akwara nke enzymes a na-eme ka ọ bụrụ ọria. Mgbe e mechara ọ bịara doo anya na opekata mpe ọkara mkpụrụ ndụ acinar nwere ike imebi agbanyeghị mbọ trypsinogen. Ruo ugbu a, a mụọbeghị nnabata nke ọrịa pancreatitis nke ọma, ọ bụ ezie na ọ dabere nke ukwuu na / ma ọ bụ onye mgbasa ozi sistemụ mkpali sitere na ya. Enwere ike ịhụ mmeghachi omume mmebi nke na - eduga na necrosis na-akpata ngwa ngwa na ọtụtụ akụkụ anụ ahụ na ọnwụ nke 7-15% na 20% nke ndị ọrịa. A na-ahụta azịza nke sistemu nke sistemu ma na-achịkwa ya site na ịgbalite nke ihe na-akpata mbufụt nke cytokines, immunocytes na usoro mmeju. N'otu oge ahụ, a na-emeghachi omume mmeghachi omume na-alụ ọgụ, nke na-egbochi cytokines na mgbochi mgbochi cytokine. Mmeghachi omume mgbochi a nwere ike igbochi nzaghachi ọrịa ahụ, nke na-etinye ndị nnabata n'ihe ize ndụ nke ibute ọrịa. N'ụzọ na-akpali mmasị, mkpụrụ ndụ beta nke a na-ahụ anya na-egosipụta ihe mmetụta ndị a na-ahụ maka imebi, nke a na-esonye na pathogenesis nke ụdị shuga 2.

Hyperglycemia na nnukwu pancreatitis bụ n'ihi insulin insulin na-akpata, mbelata nke ojiji nke glucose na-emetụta ala, yana mmụba nke homonụ mgbochi-homonụ. A na-ejikọta hyperglycemia siri ike na ọrịa pancreatitis siri ike ma bụrụ ihe na - adịghị mma prognostic. Ọrịa hyperglycemia dị obere na glucosuria na-adị ihe dị ka 50% nke ndị ọrịa nwere nnukwu ọrịa pancreatitis. Ogo ogo nnabata shuga dị n'ọbara bụ ihe na-egosi ịdị njọ nke pancreatitis. Mmanya na-akpata mmerụ ahụ dị njọ na pancreatitis na-aba n'anya na-enwekarị mgbagwoju anya site na ịnabata glucose na-enweghị isi. Hyperglycemia na-eso ọgụ nke pancreatitis bụ nsonaazụ nke pancreas na steeti nchegbu nchegbu. Ma ogo na nsogbu nke metabolic na carbohydrates metụtara ogo nke emebi emebi akwara. Nnyocha nke mmalite nke nnwale akwara necrotic pancreatitis na oke (5 awa site na mmalite nke ọrịa ahụ) gosipụtara edema, ọbara ọbara, necrosis na-egbu egbu, mbibi acinar na leukocyte infiltration nke akụkụ exocrine nke pancreas, ebe mmiri mmiri endocrine na-ejigide usoro dị mma, mkpụrụ ndụ b na-enwekwa ego zuru ezu. . Agbanyeghị, ikike izochi insulin na nzaghachi mkpali glucose rụpụrụ ọrụ nke ọma (P> 0.05). Nlere nke agwaetiti pensụl na-agbanweghị agbanwe na mgbanwe mkpamkpa doro anya na mpaghara mgbukpọ dị nso. Onye na - ebu glucose akpọnwụ akpọnwụ (GLUT 2) na nnwale ahụ nwere itinye uche dị ala, ya mere, mmachi insulin na-arịa ya na nnukwu ọrịa akwara, o nwere ike ịbụ ihe isi ike na ibuga glucose na sel.

N'ime ndị ọrịa nwere nnukwu ọrịa ọrịre, ọrịa insulin plasma dị ala karịa n'ime ahụike. Ihe nzuzo insulin na-a toụ ya na glucose ma ọ bụ glucagon anaghị arụ ọrụ, ebe mkpamkpa alanine na-ebute mmụba nkịtị na ọkwa insulin. Site n'ibelata ike nke usoro ahụ ike, mmepụta insulin nkịtị na-achọ ịmaliteghachi. Plasma glucagon na-abawanye, na-adịkarị elu ruo ihe dịkarịa ala izu 1. Nchikota nke hyperglucagonemia na hypoinsulinemia zuru ezu ịkọwapụta mmepe nke ketoacidosis na obere ụkọ nke ọrịa mamịrị.

Na mgbakwunye na ịbawanye ọkwa glucose plasma, n'ọtụtụ ndị ọrịa nwere ọrịa pancreatitis na enweghị akụkọ ihe mere eme nke hyperlipidemia, enwere ike itinye uche n'ọbara liuls. Ọbara triglycerides> 1000-2000 mg / dl na ndị ọrịa nwere ụdị nke I, IV ma ọ bụ V hyperlipidemia (nhazi ọkwa Fredrickson) bụ ihe dị egwu maka ọrịa pancreatitis nke nnukwu. Ihe ndi choputara ihe bara uru nke Plasma bara uba kariri oria a na-acho acho, n'ihi nsonsosi insulin ya na mmụba nke ihe glucagon na cortisol. N'agbanyeghi eziokwu na mgbanwe na mpaghara homonụ na nnukwu ọrịa ọrịa pancreatitis nwere ike itinye aka na mmepe nke ketoacidosis, nke a bụ ihe a na-adịghị ahụkebe, n'ihi ịchekwa nzuzo nke insulin endogenous, zuru oke iji gbochie lipolysis na ketogenesis, yana n'ihi ezughị ezu nke glucagon.

Ekpebichala usoro ihe omume niile na-eduga n'ọrịa na-adịghị ala ala n'ụzọ zuru ezu. Ọmụmụ ihe nyocha egosila na mkpali imebi ihe na - akpata nbibi nke ụdị oxygen na - emeghachi omume, ịhapụ cytokines na mbelata antioxidants, nke na - eduga na pancreatostasis, i.e. mgbochi nke apical exocytosis site na mkpụrụ ndụ acinar pancreatic. Mkpụrụ ndụ ndị a na - ezobe enzymes ndị mepụtara ọhụrụ n'ime arịa ọbara na akwara ọbara, na - eme ka mmeghachi omume mkpali. N'oge na-adịbeghị anya, a kọrọ na cyclooxygenase 2, bụ onye na-achịkwa mmepụta nke prostaglandin, na-arụ ọrụ dị mkpa na pathogenesis nke mmebi nke exocrine na akụkụ endocrine na pancreatitis na-adịghị ala ala.

Ala mmiri nile nke Langerhans, n’ezie, echekwara nke ọma, ma e jiri ya tụnyere mbibi nke mkpụrụ ndụ acinar. Mgbe ụfọdụ, pancreas nwere ike ịnwe ọdịdị nke adenomatous n'ihi ọnwụ ahụ kpamkpam na anụ ahụ exocrine na njikọ ya na ichebe akụkụ nke endocrine.N’agwaetiti ndị ọzọ, nhazi nke akụkụ endocrine nke mkpụrụ ndụ na-ewere ọnọdụ na mbelata nke mkpụrụ ndụ beta karịa mkpụrụ ndụ alfa, nke na-eduga ngbanwe na mkpụrụ ndụ 2: 1. ọnụ ọgụgụ mkpụrụ ndụ delta, dị ka a na-achị, ka bụrụ ihe dị mma, ma nwee ntakịrị mmụba na ọnụ ọgụgụ mkpụrụ ndụ PP. Agwaetiti gbara gburugburu anụ ahụ nkịtị, dị ka a na-achị, nwere ihe mejupụtara cytological nkịtị, nke na-egosi mmetụta trophic nke ọrịa ụjọ nke exocrine. Igha nje na-eme na pancreatitis na-adịghị ala ala nwekwara ike ibute nsị nke incretins, nke, n'aka nke ya, nwere ike itinye aka na dysfunction nke sel belet na ịnagide glucose na-adịghị mma.

A na-ahụ ọkwa dị n'ọrịa shuga dị elu na fibrocal iyanu pancreatitis na ebe igwu mmiri, na-enwe foto mara mma nke ọma. A na-ahụ ụdị a nke ọrịa akwara na-adịghị ala ala n'ime ụmụ na ndị okenye na-eto eto n'ime ime obodo na mba ndị na-emepe emepe. Ekwuputala na 60-70% nke ikpe niile nke ọrịa pancreatitis na-adịghị ala ala na India na China nwere ike metụtara ọrịa pancreatitis na-ekpo ọkụ. Ọrịa ndị ọrịa shuga na-agbanwe agbanwe nwere oke agbanwe agbanwe, site na 0,5 ruo 16% na India wee rute 80% n'etiti ndị ọrịa na-eto eto na-ewere insulin na Nigeria.

Ọrịa shuga bụ ihe fọrọ nke nta ka ọ bụrụ nhụsianya nke ọrịa akwara na-egbu mgbu ma na-etolite n'ime afọ iri mgbe mmalite nke ọrịa pancreatitis, ma na-agbadata n'ụzọ doro anya karịa afọ onye ọrịa. Imirikiti ndị ọrịa nwere nnukwu nnabata mgbe ha na-eme nyocha, etiology nke gụnyere ụkọ protein-kalori, ojiji nke toxins dị iche iche, nsị nke abụọ nke akwara na, ikekwe, mkpụrụ ndụ ihe nketa. Ọrịa shuga na nke a, dị ka a na-achị, siri ike ma chọọ insulin ọgwụgwọ, ọ bụ ezie na ọmụmụ pathohistological na immunohistochemical na-egosi ịchebe mkpụrụ ndụ nwere insulin nke ọma na pancreas nke ndị ọrịa nwere fibrocalcule pancreatitis. Ihe nzuzo insulin nke ezumike na-akọwapụtakarị mmepe pụrụ iche nke ketoacidosis na ndị ọrịa nwere ọrịa akwara fibrocalculeous.

Nkọwapụta etiological ụfọdụ akọwapụtara maka ọrịa akwara na-eso akpata ike ịnagide anagide ihe. Hypertriglyceridemia, dịka ọmụmaatụ, jikọtara ya na insulin na-eguzogide ma na-akpatakarị ọrịa mellitus na-arịa ọrịa. Ihe ọcoụcoụ na-egbu egbu na-ebelata mmetụta insulin na-eduga ma mee ka mmadụ nwee ike ịghara ịnabata glucose site na ikpughe imeju. Site na ọrịa ọrịa akwara na-eketa ekwo ekwo, ọrịa na-adịghị ahụkebekarị ọrịa shuga, ọrịa shuga nwere ike ịmalite n'oge ikpeazu, enwere ike ịrịa ọrịa mamịrị ogologo oge.

Ezi ezinụlọ banyere ọrịa shuga mellitus nwere ike ime ka ndị ọrịa nwere ọrịa pancreatitis na-adịghị ala ala na mmepe nke ọrịa shuga na nwata. Ọrịa shuga na-enweghị njikọ ọ bụla na ọrịa pancreatitis dị elu karịa n'ezinụlọ nke ndị ọrịa ahụ malitere ọrịa shuga. Agbanyeghị, egosiputara na mmụba dị ukwuu nke ụdị HLA B8, DR3, DR4, na DR3 / DR4 na ndị ọrịa nwere ọrịa mellitus mgbe ọnya na-adịghị ala ala. A tụwo aro na autoimmunity nwere ike itinye aka na mmepe nke ọrịa shuga na ọrịa na-adịghị ala ala, ebe ọ bụ na achọtara mgbochi ọgwụ nke mkpụrụ ndụ islet na ụfọdụ ndị ọrịa tupu ọrịa shuga amalite. Agbanyeghị, nke a bụ isi okwu moot. Achọpụtara ọria akwara autoimmune site na ịba oke na nwekwa fibrosis nke jikọtara ya na mkpụrụ ndụ nke mononuclear. Ọgba aghara ahụ nwere ike ibute ọrịa n’akwara ma ọ bụ guzobe akpụ, nke nwere malabsorption na cholestasis, mgbe ụfọdụ, a na-achọpụta ọrịa kansa ma ọ bụ ọrịa ịba ọcha n’anya.

Ọkpụkpụ mkpụrụ ndụ ihe nketa nwere ike ibute ma endocrine na ụkọ nke pancreatic; ntụgharị mkpụrụ ndụ nke pancreatic na - eme ka ọ ghara ịdị mma, na - ekpebi mbelata nke uka beta, dịka a na - ahụ na ọria.

Usoro a na-ahụ anya na pancreatitis na-adịghị ala ala na-eduga n'ịbelata sel nke beta ma nwee ike ịgbanwe mbuba nke pancreas, nke na-eduga n'ịdị na-esi ísì ụtọ nke agwaetiti, nnyefe nke usoro ihe nzuzo na mkpụrụ ndụ beta, yana mbelata nke mbufụt homonụ nke pancreatic. Ọnwụ nke mkpụrụ ndụ beta na-arụ ọrụ na-akọwa mbelata nke insulin na-ebelata: ka ukwuu ọnwụ nke pancreatic endocrine anụ ahụ, ka ukwuu nhụsianya nke insulin insulin na ogo nnabata glucose. N'ime ndị ọrịa nwere ọrịa mellitus nke abụọ na ọrịa na-adịghị ala ala nke nwere hyperglycemia dị nwayọọ ruo obere oge, basal plasma ịba uru insulin nwere ike ịbụ nke dị elu ma ọ bụ nke dị elu. Agbanyeghị, ịmịnye insulin na-arịa ya fọrọ nke nta ka ọ bụrụ mgbe niile Mbelata ike nwere insulin n'ime ndị ọrịa a doro anya ma na-egosi mbelata ọkọnọ insulin. Mgbe ọkwa glucose plasma gafere 10 mmol / L (180 mg / dl), insulin plasma na nha nke C-peptide anaghị achọpụta.

Nzaghachi nke mkpụrụ ndụ beta na amino acid na-ebelata dabere na ogo ọnwụ nke sel beta yana ogo nke ogo glucose ogo.

Arginine na - akpali akpali nke C-peptide nwere ike ịbụ ihe dị mma n’etiti ndị ọrịa nwere ọrịa ọria ala na-anabatakwa nnabata glucose, mana ọ na-ebelata mgbe niile n’arụ ndị ọrịa na-ebu ọnụ.

Exocrine na endocrine ọrụ na-emekọrita onwe ha, nke na-egosi njikọta mmekọrịta dị n'etiti usoro mkpali na anụ ahụ exocrine na mmepe nke ọrịa shuga. Achọtara nnabata e mere n'etiti insulin na-a gluụ ya na ọnya glucose nke enzymes pancreatic na ihe ọ duụ duụ duodenal mgbe nchịkwa ọgbasa nke cholecystokinin-pancreosimine (CCK-PZ). Ndị ọrịa nwere steatorrhea nwere obere nzuzo nke C-peptide karịa na ndị ọrịa nwere nkwarụ na-esighi ike nke ọrụ exocrine.

N’ebe ndị mmadụ nọ, ahụ́ ike na-akpata insulin na-eme ka mmadụ nwee insulin kpụ ọkụ n’ọnụ karịa itinye ume n’oghere nke glucose na-akpata, n'ihi na ịgbalite sistemụ incretin. Na pancreatitis na-adịghị ala ala, nzuzo nke ihe ndị dị na mbụ: cholecystokinin, gastrin, enteroglucagon, glucose-based insulinotropic peptide (GIP) na polysaptide vasoactive na-akawanye njọ. N’aka nke ozo, ihe omumu emere na nso nso a gosiputala nzipu nke glucagon dika peptide-1 (GLP-1), na nzaghachi nke onodu glucose na onu n’azu ndi oria oria n’azu oria n’aria anakpo ndi ozo. glucose. N'ime ndị ọrịa nwere ọrịa mellitus nke abụọ na ọrịa pancreatitis na-adịghị ala ala, nzaghachi insulin na cholecystokinin bụ nke ruru ogo hyperglycemia. N'ụzọ dị iche, insulin insulin na nzaghachi GIP belata. Na agbanyeghị, GLP-1 infusion na ndị ọrịa nwere mellitus nke abụọ nke ọrịa shuga na-adịghị ala ala na-esobelata mmụkọ ọbara na mmụba na ịta ahụhụ plasma nke C-peptide, mmeghachi omume a adịghị iche na nke a hụrụ na ndị nwere ahụ ike. Na ọrịa shuga mellitus, nke abụọ na-arịa pancreatitis na-adịghị ala ala, ọ ka na-edoghị anya ma enwere ọghọm ọ bụla nke na-agbanwe agbanwe ma ọ bụ na mmiri nke homonụ na hormones na-agbanwe n'otu oge. Plasma GIP na-abawanye na ndị ọrịa nwere ọrịa mellitus na-arịa ọrịa na-adịghị ala ala, karịsịa mgbe ọpụpụ insulin. N'aka nke ozo, ogo nke mmụba na cholecystokinin metụtara plasma na-emetụta ma e jiri ya tụnyere isiokwu na-enweghị ọrịa shuga ma ọ bụ ndị ọrịa na-adịghị arịa ọrịa shuga na-arịa ọrịa na-adịghị ala ala.

N'ime ndị ọrịa nwere ọrịa akwara na-adịghị ala ala, a na-ejikarị mkpụkọ glucose na-ebu ọnụ ruo mgbe 20-40% nke oke sel beta na-efu. Agbanyeghị, ogo nke beta cell mass na-esonyere mmerụ akara nke mwepụta glucose na-ebute ụzọ, ọbụlagodi na nzaghachi cholecystokinin na arginine ka bụ ihe kwesịrị. Mgbanwe na ihe ndị mere na amino acid na-apụta ìhè mgbe oke beta-cell belatara site na 40-60%. N'ikpeazụ, mgbe oke beta-cell na-agbada site na ihe karịrị 80-90%, hyperglycemia na-ebu ọnụ na insulin nke nwere nsogbu na-etolite na nzaghachi maka ndị odeakwụkwọ niile. Glucagon zoro ezo n'ime ndị ọrịa a bụ heterogeneous, a na-ahụkwa ọnọdụ abụọ bụ isi. Ọ bụ ezie na ụfọdụ ndị ọrịa nwere nkwarụ jikọtara insulin na nzuzo glucagon, ndị ọzọ nwere ike igosipụta nnukwu hypoinsulinemia na glucagon glusagon buru ibu. Na mgbakwunye, mmeghachi omume nke glucagon maka mkpali na arginine ma ọ bụ alan na-emebisị naanị na 50% nke ndị ọrịa nwere nnabata glucose. Site n'ọrịa nke ọrịa pensụl, ike nke mkpụrụ ndụ alfa nwere ike ịza hypoglycemia na-akpata insulin. Agbanyeghị, itinye ọnụ glucose na ọnụ nwere ike isonyere ya na mmụba dị iche iche na ọkwa glucagon nke plasma, ebe nzaghachi glucagon na nzuzo na cholecystokinin bụ ma ọ bụ abawanye.

A na-enwe arụmụka banyere ụdị molekul na isi iyi nke glucagon na-ekesa n'ime ndị ọrịa na-arịa ọrịa shuga n'ihi ọrịa na-adịghị ala ala. Ọbụlagodi ụdị glucagon immunoreactive immunoreactive anọ (nke ihe dị n'ime ihe karịrị 50,000, 9,000, 3,500 na 2,000) kpebisiri ike na plasma nke mmadụ nwere ahụ ike. Glucagon nwere nnukwu molikel nke 3500 sitere na nsogbu a na - enweta ọgwụ mgbu ma nwekwaa ọrụ ndu zuru oke. Nke a bụ naanị ụdị na-emeghachi omume na mkpali na arginine na mgbochi nke somatostatin. Ọmụmụ ihe omumu na nyocha chromatographic na-akwado echiche nke mmalite nke pancreatic na-ekesa glucagon na pancreatitis na-adịghị ala ala, mana ntinye dị ukwuu nke enteropancreatic glucagon na ọkwa plasma nke redioimmunoassay tụpụtara. N'ihi ya, usoro mkpụkọ basal nke eriri afọ na-abawanye na ndị ọrịa nwere ọrịa mellitus.

3. Ọnwụ nke ọrịa shuga na-akpata n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala

Ihe omuma banyere oria oria nke abuo gbasara oria n’akporita oria a ka di obere, mana onodu oria a karie karie ka ekwenye na ya. Dabere na ọmụmụ ochie, ọrịa shuga pancreatogenic na-akpata 0.5-1.7% nke ọrịa shuga niile. N'ime akụkọ na-adịbeghị anya, e mere atụmatụ na ọrịa shuga dị n'ọtụtụ 9.2% na ndị ọrịa shuga German 1868 bụ ndị na-edepụta akwụkwọ mkpesa na-ezighi ezi na onyonyo adịghị mma. Na njikọ ọzọ nke 1922 autoantibody-na-adịghị mma na-arịa ọrịa exocrine na endocrine pancreatic insufficiency na mgbanwe nke morphological pancreatic, naanị 8% nke ikpe chọpụtara ọrịa shuga mellitus, ebe na 80% nke ụdị shuga 2 chọtara ọrịa shuga na 12% nke ndị ọrịa - ụdị shuga 1. N’ezie, n’ogbe ndị a, 76% ndị ọrịa nwere ọrịa ọria ala, 8% nwere hemochromatosis, 9% nwere kansa pancreatic, 4% nwere ọnya cystic fibrosis, e mekwara ụdị pịkụl na 3% nke ikpe.

Ọnọdụ nke pancreatitis na-adịghị ala ala dị elu na ndị mmadụ na-a consumptionụbiga mmanya ókè na mba ndị dị ebe okpomọkụ, ebe ọnụọgụ ọrịa shuga na-akpata fibrocalcule pancreatitis nwere ike iru 90%, nke ruru 15-20% nke ndị ọrịa niile nwere ọrịa shuga. Ya mere, enwere ike bụrụ ihe a na-elekarị anya ịkọwapụta ọrịa shuga na-akpata ọrịa pancreatitis, nchọpụta nke ọrịa shuga na-egbu egbu na-elegharakarị anya, a na-eleghara ndị ọrịa n'ozuzu ha anya.

N ’usoro nyocha iri abụọ na isii ndị ọrịa na-ele anya nke metụtara 1102 ndị nwere ọrịa pancreatitis, a na-ahụkarị ọrịa shuga na / ma ọ bụ ọrịa shuga na 37% nke ikpe. Ọrịa zuru oke nke ọrịa shuga, ọrịa shuga, na ọgwụgwọ insulin mgbe ọrịa pancreatitis jisiri ike bụ 16%, 23%, na 15%. Ọrịa shuga ọhụrụ mellitus malitere na 15% nke ndị mmadụ n'ime ọnwa iri na abụọ tupu ihe mbụ metụtara ọrịa akwara.

ihe ize ndụ ahụ mụbara nke ukwuu site na afọ 5 (n'ihe banyere ihe egwu 2.7). A hụrụ ọnọdụ yiri nke a n'ihe banyere ịgwọ insulin.

Ndị ọrịa nwere ọria irokari na-ebutekarị ọrịa kansa na / ma ọ bụ ọrịa shuga mgbe ahapụchara ha n'ụlọ ọgwụ, ihe ọghọm ha nke ibute ọrịa shuga dị okpukpu abụọ n'ime afọ ise sochirinụ.

A hụrụ ọgwụ shuga na / ma ọ bụ ọrịa shuga n'ihe fọrọ nke nta ka ọ bụrụ 40% nke ndị ọrịa mgbe ọ na-arịasaghị ọrịa pancreatitis, a na-akọpụtakwa ọrịa shuga n'ihe fọrọ nke nta ka ọ bụrụ 25% nke ndị ọrịa mgbe ọ na-arịa ọrịa pancreatitis nnukwu, 70% nke chọrọ ọgwụ insulin mgbe niile. Na mgbakwunye, ogo nke nnukwu ọrịa pancreatitis na-egosi na ọ nweghị obere nsogbu na mmepe nke ọrịa kansa ọria mamịrị ma ọ bụ ọrịa shuga mgbe ọrịa pancreatitis jisiri ike. Ndị ọrịa nwere nnukwu ọrịa na-efe efe nwere nanị ntakịrị ntakịrị nke ma ọrịa shuga (20%) na ọrịa shuga mellitus (30%). Nchịkọta meta-regression gosikwara na ihe ọghọm nke ịrịa ọrịa kansa na-arịa ma ọ bụ ọrịa shuga mgbe ọrịa pancreatitis na-akpata nwere nnwere onwe na etiology, yana afọ na okike. Mmepe nke ma ọrịa shuga na ọrịa shuga bụ ihe a na-ahụkarị na mmalite oge oke ọrịa pancreatitis. Ọnwụ nke ọrịa shuga na ọrịa shuga n'ime ọnwa iri na abụọ ka ọrịa mbụ nke ọrịa pancreatitis buru ibu bụ 19% na 15%. Ọ bụ ihe nwute, enwere nanị otu nnyocha e nyochara ndị ọrịa nwere ọria ịba ọcha n'anya wee chọpụta ma ha malitere ịrịa ọrịa shuga, mana, dịka akwụkwọ si kwuo banyere ọrịa shuga, o yikarịrị ka ndị ọrịa nwere ọrịa shuga.

Nnukwu pancreatitis bụ ihe a ma ama na-akpata ọrịa shuga. Ọ bụ ezie na mfu na mkpụrụ ndụ akwara n'ihi necrosis (ma ọ bụ na-enweghị ịwa ahụ) ka a na-ele anya bụ isi ihe kpatara ọrịa shuga mgbe ọrịa pancreatitis dị nnukwu, na ihe karịrị 70% ndị ọrịa, oke nke necrosis agafeghị 30%, na 78% nke ndị ọrịa nọ na nchebara echiche. Na mgbakwunye, o doro anya na enweghị mmetụta ọrịa ahụ dị n'ihe ize ndụ nke ibute ọrịa shuga. Nke a na-egosi na ọrịa shuga mgbe ọrịa pancreatitis gasịrị nwere ike ịmalite n'ihi usoro dị iche na necrosis.

Achọtara ọgwụ mgbochi glutamic acid decarboxylase (IA2) na ndị ọrịa nwere ọrịa shuga mellitus autoimmune latent na ụdị ọrịa shuga nke 1. Ọ ga-ekwe omume na nnukwu ihe otiti na-eme ka mmeghachi omume na mkpụrụ ndụ ihe nketa eburula ụzọ nọrọ n'ihe ize ndụ nke ịmalite ọrịa shuga mellitus. Na mgbakwunye, ọ na-adịbeghị anya na-atụ aro na ụfọdụ ihe metabolic, dị ka oke ibu na hypertriglyceridemia, na-etinye ndị ọrịa n'ihe ize ndụ dị elu nke ịmalite ọrịa pancreatitis, nke a na-akpọ "nnukwu metabolic pancreatitis," na ihe ndị a nwekwara ike ịbawanye n'ihe ize ndụ nke ịmalite ọrịa shuga mgbe ọrịa pancreatitis nnukwu.Ebe ọ bụ na enweghi data dị na ndị na-egosi metabolic tupu ọgụ mbụ nke ọrịa pancreatitis, ọmụmụ ihe ọdịnihu ga-aza ajụjụ banyere ọnụnọ nke preexisting autoantibodies, mgbanwe ma ọ bụ arụ ọrụ na-ebute mmepe nke hyperglycemia na ọrịa shuga mellitus mgbe ọrịa pancreatitis na-akpata.

Ọ dịkwa uru ịmara na ọnụnọ nke ọrịa mellitus dị adị tupu a na-ele onwe ya anya dị ka ihe ize ndụ maka ọrịa pancreatitis, nke na-ekwusi ike na ntọala siri ike maka mgbanwe mgbanwe metabolism metụtara nnukwu pancreatitis.

Mgbe ị na-enyocha usoro ọrịa a ka oge na-aga, ọ na-achọpụta na njupụta nke ọrịa kansa na-arịa ọrịa shuga na ọrịa shuga dị iche iche amụbawo nke ukwuu n'oge. Ekwesiri ịghọta na njupụta nke ọrịa shuga mellitus na-abawanye nke ukwuu mgbe afọ iri anọ na anọ gasịrị, mmetụta nke ịka nká na arụ ọrụ sel na mmụba nke insulin na-akpata site na oke ibu nwere ike ịkọwa akụkụ a, n'agbanyeghị, nyocha ihe omimi gosiri na afọ adịghị oke mkpa. n'etiti ndị ọrịa mgbe ọria ha na-akpata nnukwu ọrịa. Anotherzọ ọzọ enwere ike bụ na ụfọdụ ndị mmadụ nwere ike ugboro ugboro ibuso nnukwu ọrịa ọgụ ọsịsa tupu enyocha ya mgbe afọ ise gachara. A kọrọ nke a na ụfọdụ ọmụmụ, mana etinyeghị nke a na ọtụtụ ọrụ agụnyere. Nke a pụtara na nsonaazụ ọgụ ugboro ugboro nke nnukwu pancreatitis na ihe ize ndụ nke ịrịa ọrịa shuga na ọrịa shuga nwere ike ime ka ha nwekwuo oge na-esochi. Ọ bụ ihe amabeghị ma ọgụ ugboro ugboro nke nnukwu ọrịa a na-eme ka ọ bụrụ na ọ nwere ike iso na-akpata mkpụrụ ndụ akwara, na-eme dị ka o kwere omume maka mmepe nke ọrịa shuga mellitus na ọnọdụ ndị metụtara ya.

4. Ngosipụta nke ọrịa shuga n’ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala

Ndị ọrịa nwere ụdị oria nke abụọ na-arịa ọrịa shuga nwere mgbaàmà ndị ha na hyperglycemia, mana ohere dịkwuo elu nke hypoglycemia. Ọnọdụ nke hypoglycemia nke metụtara insulin ọgwụ ma ọ bụ ọgwụ sulfonylurea bụ ihe zuru oke ma na-abụkarị ihe siri ike ma na-adịte aka, nke a na-edugakarị n'ụlọ ọgwụ ma tinye ndị ọrịa n'ihe ize ndụ nke ọnwụ. Ọrịa hypoglycemia bụ ihe a na-ahụkarị bụ mgbe ọ bụla ọ na-apị panateatectomy, na-akpata ọnwụ na 20-50% nke ndị ọrịa Foto dị otú ahụ dị egwu bụ nsonazụ nke imebi iwu na iweghachi glucose. Ike nke anụ ahụ ịzaghachi na mbelata glucose plasma bụ ezughi ezu nke glucagon, mmeghachi nke catecholamine belata na mmụba nke mmụpụta nke imeju glucose na imeju. Mmụba na nsogbu nke hypoglycemic nke nwere ihe jikọrọ enweghị nsogbu glycemic.

Abusega ethanol na-aga n’ihu mgbe ọgwụ ma ọ bụ ọgwụgwọ ịgwọ ọrịa nke pancreatitis nwere ike imetụta nguzozi metabolic nke ndị ọrịa nwere ọrịa shuga, ebe ọ bụ na mmanya na-egbochi gluconeogenesis, na-emetụta hypothalamic-pituitary zoro ezo nke adrenocorticotropic homonụ na uto uto, ma na-eme ka insulin guzogide. Hypoglycemia pụrụ ịdị ize ndụ karịsịa ma ọ bụrụ na a na-ebelata nri ị na-eri, ọ bụrụkwa na a na-echekwa ụlọ ahịa glycogen.

Abuse abuseụbiga mmanya na-egbu egbu mgbe ọ kwụsịrị ọgụ bụ ihe dị mkpa na mmepe nke hypoglycemia na ọnwụ. N'ime ndị ọrịa a, ọfụma na nchịkwa insulin na-atụnye ụtụ na enweghi ike metabolic.

N'aka nke ọzọ, mmepe nke ketoacidosis na ọrịa shuga na ọrịa mellitus nke pancreatogen dị ụkọ ọbụlagodi na ndị ọrịa enweghị nchekwa mkpụrụ ndụ nke C-peptide. Mgbe nke a mere, ha na-abụkarị ndị e jikọtara ha na ọnọdụ nrụgide dịka ọrịa ma ọ bụ ịwa ahụ. N'oge oke insulin nke mmiri ọgwụ, mkpolata abụba na mkpo ala lipolysis na-enye obere aka n'ihe ize ndụ nke ketosis. A na-ahụta ihe yiri nke ahụ na ketosis na ọrịa mellitus nke ebe okpomọkụ, ebe nsogbu na-adịghị mma na obere abụba nke abụba na-enweghị afọ ojuju na-eme ka mbelata njikọ nke anụ ketone. Ọrụ nke erughi glucagon n’ichebe ndị ọrịa shuga na-egbu palọ na ketoacidosis bụ arụmụka. Agbanyeghị, ọ ga - ekwe omume na, n'agbanyeghị eziokwu ahụ glucagon nwere ike ịdị mkpa maka mmepe nke ketosis, erughi ya nwere ike gbuo oge ma ọ bụ kwụsịlata ogwe ketoacidosis nke ọrịa mamịrị.

Ihe isi ike na ijigide njikwa metabolic afọ ojuju na ndị ọrịa nwere ọrịa mellitus n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala kpatara nsonye nke otu ọrịa a na ụdị "ọrịa shuga na-esighi ike."

Enweghi ike iju mmiri nke puru iche nke malabsorption nwere ike inye aka na akwusi ike nke glucose. Steatorrhea nwere ike ibute malabsorption glucose, si otú a na-enye aka na mmeghachi omume hypoglycemic postprandial, yana mgbanwe mgbanwe insulin. Mmepe nke ọrịa shuga na ndị ọrịa nwere ọrịa pancreatic nwere ike jikọta ya na oke oke ibu, nke siri ike idozi ọbụlagodi na ọgwụ insulin kwesịrị ekwesị. Na mgbakwunye, ịtalata ibu naanị nwere ike gbanwee ọmịiko insulin.

4.1 Ọrịa na-adịghị ala ala nke ọrịa shuga na-egbu pancreatogenic

Kemgbe ngwụcha afọ ndị 1950, a na-aghotakarị ya na ọrịa shuga na-arịa ọrịa pancreatitis na-adịghị ala ala adịghị emetụta nsogbu vaskụla. Iji kọwaa nkwenkwe a, e kwupụtara ọtụtụ ihe, gụnyere ọgwụ mkpụrụ ndụ na-apụtaghị ma ọ bụ belata, enweghị ume nke umeji, cholesterol dị ala, obere kalori, wdg. Agbanyeghị, n'ihi ogologo oge ndụ nke ndị ọrịa, a na-anakọta ọtụtụ ikpe ọrịa shuga.

Ọrịa ọrịa obi na-arịa ọrịa mamịrị nke ọrịa mamellitus mgbe ọrịa pancreatitis na-adịghị ala ala ma ọ bụ pancreatectomy dị iche na nke pụtara na mbụ. N'oge na-adịbeghị anya, nyocha nke ziri ezi karị banyere ọrịa mamịrị retinopathy ekpughere ekpughe ọnọdụ 30-40%, ọnụọgụ yiri nke a hụrụ na ndị ọrịa nwere ọrịa shuga 1. Ọnọdụ nke retinopathy na-emetụta na oge nke hyperglycemia. Enweghị usoro doro anya n'etiti ọnụnọ nke retinopathy na ezigbo akụkọ banyere ezinụlọ nke ọrịa shuga, ugboro ole nchọpụta antigens HLA, ọnụnọ nke mgbochi na mkpụrụ ndụ islet, ma ọ bụ ọkwa plasma nke C-peptide.

Esemokwu na-aga n'ihu banyere ọrịa nke nephropathy na-arịa ọrịa shuga n'ọrịa shuga nke abụọ. Authorsfọdụ ndị dere kọrọ na ha "enweghị ike ịchọta onye ọ bụla maara banyere ọrịa nkwenye nke intracappillary glomerulosclerosis yana hemochromatosis ma ọ bụ pancreatitis. N'agbanyeghị nke a, ọnụ ọgụgụ na-arịwanye elu nke nodular glomerulosclerosis na ndị ọrịa nwere ọrịa shuga n'ihi A ekwupụtala banyere ọrịa shuga glomerulopathy na ọrịa mamịrị zuru oke, mana e kwesịrị ịtụle oge dị mkpirikpi. Nke a na - akọwa ihe mere ọ ga - eji sie ike ịchọpụta ngwụsị ngwangwa nke ọrịa mamịrị, ebe enwere ike ịchọta mgbanwe n'oge ọrụ ọtụtụ afọ tupu mmalite nke albuminuria. N'ime usoro 86 ndị ọrịa nwere ọrịa shuga n'ihi nnukwu ọrịa ma ọ bụ ọrịa na - adịghị ala ala, urinary albumin excretion e kpebiri ihe karịrị 40 mg / 24 h na 23% nke ndị ọrịa, na albuminuria jikọtara ya na afọ nke ọrịa shuga na ọbara mgbali, mana ọ bụghị ya na akụkọ banyere ezinụlọ nke ọrịa shuga, antigens HLA, ma ọ bụ ọkwa plasma C-peptide. Ọrịa retinopathy ji ihe dị ka okpukpu abụọ karịa nke ndị ọrịa nwere MAU, na-atụ aro na mkpakọrịta "oculorenal" nke akọwara na onye nwere ọrịa shuga 1 ụdị nke abụọ na-apụtakwa na ọrịa shuga pancreatogenic. A ga - achọpụta hyperfiltration nke glomerular, ihe ịrịba ama ọzọ nke mbido gbasara akụrụ, nwere ụdị ọrịa shuga nke pancreatogenic ka achọpụtara. N'agbanyeghị mmerụ akụrụ na-arịa ọrịa akụrụngwa, ọkwa albumin excretion karịrị 0,5 g / day ma ọ bụ ọdịda akụrụngwa abụghị ihe arụ.

Neuropathy bụ mkpesa a na-ahụkarị n'ọrịa shuga nke pancreatogenic. A na-achọpụta 10-20% nke polyneuropathy distal ma ọ bụ mononeuropathy, na akara electrophysiological nke nrụgide na-emetụta ihe karịrị 80% nke ndị ọrịa nwere ọrịa mellitus nke abụọ na ọrịa nke ọria. Achọpụtara na mmetụta uche ịma jijiji na-ama jijiji n'otu aka ahụ yana ụdị ọrịa shuga 1.

N'adịghị ka ọrịa retinopathy na nephropathy, ọ nweghị mmekọrịta dị n'etiti neuropathy na oge ọrịa shuga. Nke a nwere ike ịbụ n'ihi nsonaazụ ihe ndị ọzọ na-abụghị hyperglycemia (ise anwụrụ, mmanya na malabsorption).

E nwekwara mgbanwe na sistemụ akwara autonomic. A hụrụ nhụjuanya nke mgbanwe mgbanwe obi na 8% nke ndị ọrịa nwere ọrịa mellitus mgbe ọrịa pancreatitis na-adịghị ala ala, ebe a hụrụ ntụpọ ókèala na mgbakwunye 13% nke ndị ọrịa a. Agbanyeghị, ekwesịrị ileba anya na njikọta hyperglycemia na ọrịa mamịrị na-arịa ụkwara ume ọkụ na neuropathy, n'ihi na ị alcoholụ mmanya na-aba n'anya ndị a. Ya mere, ezigbo usoro pathogenetic neuropathy na ndị ọrịa nwere ọrịa mellitus na-arịa ọrịa pancreatic, o yikarịrị, gụnyere ọtụtụ ihe.

Macroangiopathies, karịsịa infarction myocardial, adịkarịghị n'ọrịa shuga nke pancreatogenic. N'ime otu akụkọ, a hụrụ nsogbu vaskụla na 25% nke ndị ọrịa nwere ọrịa mellitus ọrịa shuga mgbe ọrịa ọsịsị na-adịghị ala ala, yana ụfọdụ etinyere mbepụ ma ọ bụ ịwa ahụ akwara. Ogologo oge dị mkpirikpi nke ọrịa shuga mellitus na ọrịa na-akpata pancreatic na-eme ka o sie ike ịchọpụta nhụsianya nke nnukwu ọrịa ụkwara akwara na ndị ọrịa a. Dabere na otu nlele ogologo oge dị, ugboro ole ọnwụ obi na-egbu ndị ọrịa na-arịa pancreatitis na-adịghị ala ala bụ 16%, nke dị ala karịa na-arịa ọrịa shuga oge gboo.

5. Nchọpụta ọrịa shuga na-arịa pancreatitis na-adịghị ala ala

Ọ bụghị mgbe niile ka ọ dị mfe ịchọpụta ma chọpụta onye ọrịa nwere ọrịa mellitus n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala. Ogologo oge ịdị adị nke ụdị 1 na nke ọrịa shuga mellitus na-esonyere ezughi oke nke akụkụ exocrine nke pancreas, ndị ọrịa na-arịa ọrịa shuga nwere nnukwu ihe ize ndụ nke ịmalite ọrịa na / na-adịghị ala ala n'ọnọdụ ọ bụla.

Ndị ọrịa nwere akụkọ ihe mere eme nke pancreatitis nwere ike ịmalite ụdị shuga 1 ma ọ bụ ụdị nke ọrịa shuga 2, n'agbanyeghị ọnọdụ ọrụ exocrine pancreatic. Iji mee ka ndị ọrịa shuga na-arịa ọrịa nke ọma dị ka nnukwu ọrịa ma ọ bụ nke na-adịghị ala ala, a na-ahụkarị usoro nyocha nke adịghị ugbu a. N. Ewald et al na-atụ aro iji usoro ndị a:

Ihe njiri mara (ghaghi idi):

- Njuputa nke nkpọkwo ume nke Exocrine (monoclonal fecal elastase-1 ma ọ bụ ule arụmọrụ aka)

- Pathology nke pancreas n'oge onyonyo (endoscopic ultrasound, MRI, CT)

- Enweghi ụdị oria 1 nke ejikọtara ya na ihe nrịba ama nke autoimmune

- Enweghị ọnya na - egbochi polypeptide

- Isi gbochie nzuzo (dịka, GLP-1)

- Enweghị ike iguzogide insulin (dịka ọmụmaatụ HOMA-IR insulin resistance index)

- arụ ọrụ beta na-arụ ọrụ (dịka HOMA-B, ọkwa C-peptide / glucose)

- Di ala nke vitamin abụba na-agbanye ike (A, D, E na K)

N'ọnọdụ ọ bụla, ngosipụta ọhụụ nke ọrịa shuga kwesịrị iji njirisi nke European Association kọwara maka Ọrịa Shuga (EASD) na American Diabetes Association (ADA) ma lelee ọrịa shuga nke pancreatogenic. Ma ọ dịkarịa ala, ọ bụrụ na onye ọrịa ahụ gosipụtara onyonyo onyonyo na-ekpo ọkụ ma na-eme mkpesa nke mgbaàmà site na eriri afọ, onye dọkịta kwesịrị ịma banyere ịdị adị nke ọrịa shuga na-amalite ma chọpụta nchọpụta ọzọ.

Onye ọrịa ọ bụla na - arịa ọrịa na - adịghị ala ala kwesịrị, n'ezie, ga - enyocha maka mmepe nke ọrịa mamịrị nke ọrịa pancreatogenic mellitus. Ntụle mbụ nke ndị ọrịa nwere ọrịa na-adịghị ala ala kwesịrị ịgụnye nyocha nke ibu ọnụ glycemia na HbA1c. Ekwesiri imeghari ihe omumu ndi a ma obu opekempe n’afọ. Nchoputa ihe omumu nke obula n’ime ha choro ime nyocha ozo. Ọ bụrụ na nsonaazụ nnwale ahụ na-egosi nnabata glucose na-enweghị isi, a na-atụ aro ule nnabata glucose ọnụ. Ntughari nyocha nke insulin na / ma ọ bụ C-peptide nwere ike ịba uru na ịmata ọdịiche dị n'etiti ụdị ọrịa shuga nke mellitus 2 na ọrịa shuga n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala.

Esstụle mmeghachi omume nke polypeptide pancreatic na hypoglycemia nke insulin na-akpata, infestion ma ọ bụ ngwakọta nke nri nwere ike ịmasị nchọpụta nchọpụta ọzọ. Enweghi nzaghachi nke polypeptide nke pancreatic na-enye mmadụ ohere ịmata ọdịiche nke ọrịa shuga na mellitus na ụdị 1, ọ nwekwara ike ịmata ọdịiche dị n'ọrịa shuga n'ihi nnukwu ọrịa ma ọ bụ ọrịa na-adịghị ala ala site na ụdị 2 na ọkwa elu polypeptide dị elu. Mkpebi mgbe nile nke mmiri ọgwụ a na-egbochi idobe na nzaghachi nke polypeptide nke a na-eme kwa ụbọchị, agaghị ekwe omume.

6. Akụkụ ọgwụgwọ nke ọrịa shuga pancreatogenic mellitus

Ebumnuche bụ isi nke ịgwọ ọrịa shuga mellitus, n'agbanyeghị ụdị ya, gụnyere: iwepu ihe mgbapụta na ebumnuche nke ọrịa ahụ, igbochi ọrịa shuga, igbochi na ịkwụsịlata nsogbu nke ọrịa shuga mellitus (ọrịa mamịrị nephropathy na retinopathy, neuropathy, wdg). Ngwọta nke ọrụ ndị ahụ, dịka echiche ndị nke oge a, ga - ekwe omume mgbe ị nweta ma jigide ọkwa nke glycemia dị ka o kwere mee nye ndị nwere ahụ ike, na - ewepu isi okwu na ebumnuche nke ọrịa ahụ.

Nri nke ọrịa shuga na mellitus na-akpata pancreato kwekọrọ na nke ụdị shuga mellitus 1, ewezuga mkpa ọ dị idozi ọrịa Malabsorption, ụkọ vitamin na ihe metụtara, nhọpụta nke nri n'ụdị na-enye mgbochi nke hypoglycemia.

Ọrịa pancreatitis na-ebute nnukwu ọrịa hyperglycemia na 50% nke ndị ọrịa, oge ụfọdụ ketosis ma ọ bụ ọrịa mamịrị nwekwara ike ịmalite. N'ihe banyere hyperglycemia dị mkpa, ketosis ma ọ bụ coma, ịkpachara anya banyere glucose plasma, electrolytes, ketones na usoro metabolic ndị ọzọ dị mkpa, yana nchịkwa ọmụmụ intravenous na insulin infusions dabere na ụkpụrụ nke ọgwụgwọ nke ketoacidosis ọrịa shuga.

A na-ewere hyperglycemia dị ka nnukwu ihe na-egbochi nkwado nri kwesịrị ekwesị, ọbụlagodi na ndị ọrịa na-arịa ọrịa shuga. Yabụ, inye insulin ahụ zuru oke n'oge nri mmadụ mere ka ọ dị mkpa, na-eji usoro nlekọta insulin nke na-arụ ọrụ ogologo oge.A na-atụ aro ka ndị ọrịa nwere ọtụtụ ọrịa pancreatitis jisie ike site na otu otu ndị dọkịta dị n'ọtụtụ nlekọta na ngalaba nlekọta ahụike.

Maka ndị ọrịa nwere nnukwu ọrịa ọrịa pancreatitis, a ga-atụ aro ọgwụgwọ na-achọghị ka uche, kama ịchọrọ ịrịa ọrịa pancreatic, ebe nke ikpeazụ na-esite na ọrịa shuga. N'okwu niile, ekwesịrị inyocha nnabata glucose ọnwa 3-6 mgbe ihe gbasara nnukwu ọrịa pancreatitis.

N'ime ndị ọrịa nwere ọrịa pịrịtụ na-adịghị ala ala ma ọ bụ nke na -akpọ Paireatectomy, enwere ike inye ndị mmadụ ọgwụ ka ọ bụrụ ndị na-echekwa nzaghachi C-peptide na-eju afọ maka glucagon ma ọ bụ nri nri. Ọ dị mkpụmkpụ, kama ịhọrọ sulfonylureas na-adị ogologo oge iji belata ihe ize ndụ nke hypoglycemia siri ike. Agbanyeghị, ekwesịrị ịkpachara anya mgbe ị na-eji ọgwụ aralụ ọnụ n’ime ndị ọrịa nwere mgbanwe n’omume imeju na-arụ ọrụ. N'oge na-adịbeghị anya, a tụrụ aro maka iji GLP-1 na dipeptidyl peptidase 4 inhibitors, n'ihi na mmetụta ha na-eweda glucose plasma adịghị ka ọ ga-amụba ihe ize ndụ hypoglycemia. Agbanyeghị, enwere nsogbu ụfọdụ n'ihi na amabeghị ma enwere ọghọm nke ibute ọrịa akwara, ikekwe ejikọtara ya na iji ọgwụ agwọ ọrịa.

A chọrọ insulin insulin mgbe ọ bụla, pancreatectomy, ọ bụ ezie na mkpa insulin dị ala karịa ndị ọrịa nwere ụdị shuga 1, ọkachasị n'abalị. N'ụzọ dị iche, ihe a chọrọ na insulin nke postprandial nwere ike ịbụ nke ka ukwuu. Nke a bụ eziokwu ọkachasị ndị ọrịa nwere ngụgụ, ebe ndị ọrịa na - agbagha insulin na - arịa ọrịa na - adịghị ala ala ma ọ bụ akụkụ na akwara na-enwekarị ọgwụ insulin yiri nke ụdị ọrịa shuga 1. Insụ ọgwụ insulin ga-arụ ọrụ ruo ogologo oge kwesịrị iji chịkwaa hyperglycemia n'abalị n'abalị na afọ na-enweghị isi. Analogs na-arụ ọrụ ogologo oge na-ebelata ihe ize ndụ nke hypoglycemia noct tụnyere nke insulin NPH, yabụ nke mbụ kwesịrị ịhọrọ. Yabụ, usoro Basal-bolus oge ochie nwere analorọ insulin na-adị mkpụmkpụ ma dị ogologo oge nwere ike ịdị mma. N'ime ndị ọrịa nwere mmụọ na-anụ ọkụ na ndị gụrụ akwụkwọ, a na-eji ọgwụ insulin mee ihe site na infusionaneous infusion na-aga nke ọma iji nweta njikwa metabolic nke ọma, ebe na-ezere hypoglycemia na ketosis.

Na agbanyeghị ọgwụgwọ a họọrọ, hypoglycemia ka bụ ihe egwu kachasị. Mmụba nke ugboro na ịdị njọ nke ihe omume hypoglycemic bụ ihe nwere ike ịbụ nsonaazụ nke ọtụtụ ihe, gụnyere insulin gabigara ókè, mmetụta insulin, nrụgide na-ezighi ezi, nri ezughị ezu ma ọ bụ nnweta nri, mmanya na ọrịa nke imeju. Ihe ọghọm nke hypoglycemia na-egbu egbu dịkarịsịrị elu na ndị ọrịa nwere ngụgụ nke ọrịa pancreatectomy, nke a akpatawo nchọta maka ịwa ahụ na usoro ọgwụgwọ dị nchebe karị. N'ihi ya, ichekwa duodenum na pylorus yiri ka ọ na-ekwe nkwa njikwa metabolic kwụsiri ike na mbelata nke akụkụ nke hypoglycemia. A ga-elebara mmeghachi omume hypoglycemic anya, ma ọ bụrụ na ọ mere, na a ga-atụle nke ọma ma kọwaara ndị ọrịa ihe ha kpatara na usoro ha. Ekwesịrị ịzụ ndị ọrịa iji gbochie omume nke hypoglycemia siri ike, a ga-elebara ịhapụ ị alcoholụ mmanya anya, ịba ụba ọrụ mmega ahụ, iri nri nri na ịgbaso usoro ọgwụgwọ enzyme. N'oge na-adịbeghị anya, a tụrụ aro maka islet autotransplantation iji gbochie ịdabere insulin. Islet autotransplantation na-eme ka arụmọrụ beta-cell arụ ọrụ na njikwa glycemic dị mma ruo afọ iri na atọ mgbe ịmechara ngụgụ zuru oke maka ọgwụgwọ nke ọrịa na-adịghị ala ala.

N'ihi oke "adịghị ike" nke ọrịa shuga na ndị ọrịa nwere ọrịa pancreatic, agụmakwụkwọ na nyocha onwe onye na ọkwa glucose ọbara dị ezigbo mkpa. Rictchịkwa achịkwa glucose n'ụlọ na ịchịkwa obere insulin insulin, yana usoro agụmakwụkwọ siri ike, nwere ike ibute njikwa metabolic dị mma na ndị ọrịa a. Agbanyeghị, ha ga-esoriri na usoro dị iche iche, gụnyere mmezi ọnọdụ nri na ịhapụ mmanya onye ọrịa. Alcohol consumptionụbiga mmanya ókè na-eduga ná mmebi imeju na-aga n'ihu, naanị nke nwere ike imebi njikwa metabolic.

Ntinye uche na steatorrhea na-abawanye ohere nke hypoglycemia na mmịnye mkpuchi insulin site na nsogbu nke sistem. N'ime ndị ọrịa nwere ọrịa mellitus na-arịa pancreatogenic, a ga-enye ọgwụ enzyme na ọgwụ na-egbochi acid iji belata ntọhapụ nke abụba na stools n'okpuru 20 g / ụbọchị. A na-atụ aro ịgwọta ngwakọta na antagonists nke H2 n'ihi na Mbelata ihe nzuzo acid acid na-ebelata mbibi nke enzymes pancreatic. A na-atụ aro iri nri kalori (karịa 2500 kcal / ụbọchị) nke nwere nnukwu carbohydrates dị mgbagwoju anya ma nwee oke ume. N'ime ndị ọrịa nwere ọrịa pancreatitis na-adịghị ala ala, ịba abụba nwere ike ịbawanye ugboro na ume nke mgbu ime. Ya mere, oke oriri ekwesịghị gafere 20-25% nke ngụkọta calorie. Ahịrị kwesịrị ịdị obere na nri ugboro ugboro, ya na nri 3 bụ isi ya na nri afọ abụọ ma ọ bụ atọ. Ọ bụrụ na ọ dị mkpa, ekwesịrị ịgbakwunye nri ahụ na electrolytes, calcium, vitamin D na potassium. Njeghari ngwangwa nke mbufe na mbufu oria a n’acho na akpokita nwekwara ike iso kpata oria malabsorption na nchịkwa metabolism na-ejighi ike. N'ikpeazụ, na ụfọdụ ndị ọrịa nwere ọrịa mellitus nke abụọ maka ọrịa pancreatic, ọ nwere ike isi ike ịnweta njikwa metabolic kachasị mma n'ihi nnukwu ihe egwu hypoglycemia. Debe ọkwa glucose plasma ntakịrị karịa ka o kwesịrị, ga-adị mkpa iji zere mmeghachi hypoglycemic ugboro ugboro ma melite ogo ndụ. Ekwesiri icheta na ọtụtụ n'ime ndị ọrịa a belatara ndụ ogologo ndụ na obere ihe ize ndụ nke ịmalite ọrịa mamịrị. Ọ bụ ezie na ketoacidosis adịghị ahụkebe, ọ nwere ike ịmalite ngwa ngwa n'okpuru nrụgide (ọrịa, ịwa ahụ, wdg), ma chọọ nhazi kwesịrị ekwesị nke usoro insulin.

Ofdị Ọrịa Pancreatitis

Ọrịa ahụ na-apụta n'ụdị nnukwu na-adịghị ala ala.

N'ụdị dị oke njọ, n'ihi mbufụt, ihe ọ pancụ pancụ pancreatic anaghị agabiga na lumen nke duodenum, mana ọ na-agbari akwara nke pancreas n'onwe ya. Usoro a na - ebute mgbanwe nke necrotic sel nke ndị ọrịa, na n'ọnọdụ kachasị njọ, ọnwụ zuru oke nke gland dum.

A na-ekewa pancreatitis na-adịghị ala ala, dabere na ihe kpatara ya:

1. Nke mbu - ebilite na pancreas n'ihi ihe ụfọdụ.
2. Sekọndrị - bụ nsonaazụ nke ọrịa nke akụkụ ndị ọzọ: cholecystitis, ọnya afọ, enterocolitis.
3. Mgbe ọnyá gasịrị - nsonaazụ nke ikpughe ma ọ bụ ịwa ahụ

Ọrịa shuga 1dị nke mbụ, nke nwere ọrịa ọria, na-apụta n'ihi eziokwu ahụ na akwara ozi anaghị efegharị nri enzymes n'ime lumen nke duodenum 12 ma mmesite nke onwe ya amalite, imebi akwara sel n’ime abụba, njikọ ma ọ bụ ọnwụ nke akụkụ ahụ niile. Ahụ mmadụ nwere insulin zuru oke, ọkwa glucose ọbara na-ebili, nke na-emetụta sistemụ ahụ niile.

Ọrịa shuga 2dị nke abụọ na-emepụta insulin zuru ezu. Mana n'ihi mmebi nke usoro metabolic, ọ rụpụtaghị ọrụ ya bụ nke ọma, na-ekepụta oke ezughi oke.

Mgbanwe nke usoro ọmụmụ na-agbakọta ogologo oge ma ekewa n'ime usoro anọ:

1. N’agba nke mbụ, mkpụmkpụ mkpụmkpụ mkpụmkpụ nwere ogologo okwute. Na gland, a na -emebi mbufụt nke na-adịghị ala ala, ọkachasị na-asọ site n'oge na-eji obere mgbu mgbu. Oge a nwere ike iru afọ 10-15.
2. Ihe e jiri mara usoro nke abụọ na-emetụta usoro nri digestive. Ọbara na-akpali ịtọhapụ insulin n'ime ọbara, nke nwere ike ibute hypoglycemia nwa oge. Ọnọdụ izugbe na-agbagha site na mgbakasị ahụ gbakọrọ agbakasị, ọgbụgbọ, agụụ na-ebelata, ịmepụta gas na akụkụ niile nke eriri afọ.
3. Orụ ọrụ nke pancreas na-ebelata nke ọma. Ma, ọ bụrụ n’afọ na-adịghị efu, nnwale ndị ahụ anaghị ekpughe ọghọm, mgbe emesịrị iri nri, glucose na plasma ọbara na-ekpebi karịa oge nkịtị.
4. Na ọkwa nke ikpeazụ, ịmalite nke ọrịa shuga na-apụta, na-emetụta otu ụzọ n'ụzọ atọ nke ndị ọrịa nwere ọrịa na-adịghị ala ala.

Akụkụ nke N'ezie nke ọrịa shuga na ala ala pancreatitis

Ọ ga-abụ ihe ezi uche dị na ya ikwubi na ọrịa abụọ siri ike ọgwụgwọ karịa otu. Mana omume na-egosi ọdịda nke ụdị nkwubi okwu a. Usoro nke abụọ ahụ nwere ọtụtụ atụmatụ, ekele nke enwere ike ịgwọ ya nke ọma:

1. Fọrọ nke na-enweghị ketoacitosis,
2. Ọgwụ insulin na-edugakarị hypoglycemia,
3. Ọ dị mma maka nri carb dị ala,
4. Na ogbo nke mbụ, ọgwụ ọgwụ maka ọrịa shuga na-agwọ ọrịa nke ọma.

Ọ bụghị ọrịa pancreatitis na-adịghị ala ala bụchaghị akpata ọrịa shuga. Site na ọgwụgwọ ziri ezi na nri siri ike, ị nwere ike ọ bụghị naanị melite pancreas, kamakwa igbochi mmalite nke ọrịa shuga.

Dọkịta endocrinologist na-ahọrọ usoro ọgwụgwọ ọ bụla na nke ọ bụla. Dabere na ngosipụta nke mmepụta enzymes diges site na gland, onye ọkachamara tozuru etopụtara depụtara ọgwụ nnọchi dabere na enzymes ọgwụ nke ime ihe yiri ya. Yana in insulin inje ọ bụrụ na ọ dị mkpa.

Oriri na-edozi ahụ maka pancreatitis na ọrịa shuga

Ikwesiri ịmara na ezigbo ọgwụgwọ na ịgbasochi usoro nri anya nwere ike ibute ọgwụgwọ zuru oke site na ọrịa ndị a siri ike. Na-eri nri mgbe ụfọdụ na obere akụkụ - 250-300 gram kwa nri Nyere mmasị ngwaahịa ndị nwere protein: soy, egg white, anụ, azu, nkpuru.

Wepu na nri acidic nke ihe oriri nke na - akpalite iwepu ihe ọ gastụ rapidụ nke ihe ọricụricụ gastric: acidic, oseose, aokedụrụma, eghe, nwere mmanya, oke ọkụ ma ọ bụ oyi. N'okwu, efere niile. nke nwere ike ibute mgbakasị ahụ na mmiri nzuzo.

A na - eji esi nri ma sie ya ọkụ, kama ikpo ọkụ ma ọ bụ oyi.

Ọ bụrụ na ọ siri ike ịhọrọ nri kwesịrị ekwesị, ịnwere ike itinye ndụmọdụ ndị a kwadoro maka nri nke ahaziri nke akpọkọtara n'okpuru aha: tebụl Nke 5 maka ndị ọrịa nwere ọrịa ogbu egbu na tebụl nke 9 maka ndị ọrịa mamịrị. Mana tupu ịhọrọ nke a ma ọ bụ nri ahụ, ọ dị mkpa ịkpọtụrụ dọkịta gị.

Naanị iburu n'uche njirimara niile nke ọrịa ahụ na ọnọdụ onye ọrịa n'ozuzu ya, dọkịta ahụ na-enye ndụmọdụ kachasị mma banyere ihe oriri.

Nhọrọ ngwaahịa

N'oge dị iche iche nke ọrịa, nri nwere ike ịdị iche iche. Yabụ, dịka ọmụmaatụ, mkpụrụ osisi na-atọ ụtọ ma ọ bụ nke uto ma ọ bụ efere dabere na osikapa, oatmeal na semolina bụ ihe a na-anabata nke ọma n'oge oge mgbatị ahụ, anaghị ewepụ ya kpamkpam mgbe ọrịa ahụ na-akawanye njọ.

Ekwesịrị ịhọrọ ngwaahịa kwesịrị ekwesị n'otu n'otu maka onye ọrịa ọ bụla, na-eburu n'uche:

1. Mmasị onwe gị
2. Ihe na-akpali glucose
3. Anaghị anabata ihe ọ bụla
4. Mmezi nke akari akụkụ nke nri.

N'ime oke, a machibidoro iwu iri nri nwere nnukwu shuga, nri ndị nwere abụba na anwụrụ, achịcha, nri eghe, ọka: osikapa, oatmeal, semolina, mkpụrụ osisi na akwụkwọ nri, achịcha ọcha.

Banyere mmanụ oriri, ọ ka mma iji, n'ụzọ ezi uche dị na ya, linseed na mmanụ nke mmanụ mbụ a na-enwe, nke nwere akụrụngwa na-agwọ ọrịa. Ọ ga-emerụkwa mmiri ara ehi nwere obere abụba. Mmiri ara ehi na-emeju ahụ mmadụ, vitamin, mineral ma na-enyere aka belata nsị na nsị.

Ọ bụ ihe nwute, ndị mmadụ mere ezigbo nhazi nke na, ịghọta nghọta ahụike zuru oke, ha ka "were iberibe olili ha. Ma otu amamihe ndi mmadu achoputala uzo di nfe na nsogbu nke oke aria - agụụ, oyi na udo.

Gbaso usoro iwu a dị mfe ma soro usoro ọgwụgwọ ahọpụtara, ọtụtụ ndị ọrịa nwere ike ịkwụsị ọtụtụ ọrịa wee laghachi n'ọnọdụ ahụike, zuru oke.