Ọrịa siri ike nke ọrịa shuga

Ihe ojoo nke oria shuga

Mgbanwe Metabolic na ụdị shuga II

Mgbaàmà nke ụdị shuga II

Ihe mgbaàmà izugbe (akpịrị ịkpọ nkụ, polyuria, pruritus, na-ebutekarị ọrịa na-efe efe) dị nro ma ọ bụ anọghị ya. Ọtụtụ mgbe oke ibu (na 80-90% nke ndị ọrịa).

Enweghị insulin insulin na-eme ka nsogbu nke metabolic yiri nke na-eme na insulin erughi oke, agbanyeghị, ọrịa ndị a anaghị ekwupụta nke ọma, ụdị ọrịa shuga II bụ asymptomatic na 50% nke ndị ọrịa nwere oke ibu na oke hyperglycemia.

N'adịghị ka erughi insulin zuru oke, yana erughi insulin, mmetụta nke insulin na-adịgide na anụ ahụ adipose, nke nwere nnukwu ọdịnaya nke ndị na - anabata insulin. Insulin na adipose anụ ahụ na - akpali lipogenesis, na - egbochi lipolysis na ịhapụ abụba abụba n'ime ọbara, yabụ, na ụdị ọrịa shuga II, a hụghị ketoacidosis, ibu ahụ anaghị ebelata, mana, oke ibu na-eto. Ya mere, oke ibu, n'aka nke ya, bụ ihe kachasị mkpa dị n'ihe ize ndụ, na nke ọzọ, otu n'ime ngosipụta mbụ nke ụdị shuga II.

Ebe ọ bụ na insulin anaghị emepụtakarị ihe niile, glucose ọbara dị ala na-eme ka mmiri ọgwụ insulin si n'ahụ gị pụta. hyperinsulinemia. Nnukwu insulin na-eme ka ndị na - anabata insulin na - akwalite ma na - emebi ndị na - anabata insulin, nke a na --ebelata nnabata glucose nke anụ ahụ. Insulin enweghịzi ike ịhazi glycemia; nguzogide insulin. N'otu oge, ọkwa glucose dị n'ọbara na-ebelata ịmịnye mkpụrụ ndụ β-sel ka ọ nwee glucose, n’ihi nke a, usoro izipu nke insulin na-egbu oge ma ọ bụ anọghị ya.

N'ime ụdị shuga II, hyperinsulinemia (80%), ọbara mgbali akwara (50%), hyperlipidemia (50%), atherosclerosis, neuropathy (15%) na ọrịa mamịrị nephropathy (5%).

Ọrịa dị iche iche akọwapụtara maka ụdị nke mbụ na ụdị shuga II.

Ihu mmiri nke ụbụrụ n’ime akpa ihe, yana nkwarụ metabolic n’arụ akwara, nwere ike ibute mmepe nke nnukwu nsogbu n’ụdị coma. Coma nke a bụ ọnọdụ dị oke njọ, nke e jiri nkụda mmụọ miri emi nke usoro ụjọ ahụ, ụta na-enweghị nhụsianya, enweghị mmeghachi nke mmeghachi omume mpụga nke ike ọ bụla. Coma na ọrịa shuga nwere ike ime n'ụdị atọ: ketoacidotic, hyperosmolar na lactic acidosis.

Ketoacidotic coma na - apụta na ọrịa shuga Idị m, mgbe ịta ahụ nke ketone bịara dị elu karịa 100 mg / dl (ihe ruru 400-500 mg / dl).

Hyperketonemia na-eduga:

1) acidosis, nke na-egbochi ọrụ nke ọtụtụ enzymes, nke bụ isi akụkụ okuku ume, nke na-akpata hypoxia na mbelata na njikọ ATP.

2) hyperosmolarity, nke na-eduga ná mmiri akpukpo ma mebie nguzogide mmiri-electrolyte, na ọnwụ nke potassium, sodium, phosphorus, magnesium, calcium, bicarbonate ion.

Nke a, nwere otu nsogbu, na-akpata coma nwere mbelata ọbara mgbali na mmepe nke nnukwu akụrụ ọdịda.

Ihe na-ebute hypokalemia na-eduga na hypotension nke anụ ahụ dị nro na nke akwara, mbelata ụda olu, mbelata ọbara mgbali, akwara arrhythmia, hypotension muscle na mmepe nke nnukwu akụkụ okuku ume, ọnya afọ na paresis nke afọ na mgbochi afọ na nnukwu hypoxia na-etolite. N'ihe na-akpata ọnwụ, ọ nwere ihe dịka 2-4%.

Hyperosmolar coma njirimara maka ụdị shuga II, a na-ahụ ya na hyperglycemia dị elu. Ọtụtụ na-enwe hyperglycemia dị elu n'ihi ọdịda akụrụngwa na-akpata, ọ na-ewe iwe site na nchekasị, trauma, akpịrị ịkpọ nkụ nke ahụ (vomiting, afọ ọsịsa, ọkụ, nkụ ọbara, wdg). Hyperosmolar coma na-etolite nwayọ, ọtụtụ ụbọchị, na enweghị enyemaka mmadụ (na-enweghị ihe ọ byụ byụ site na ị drinkingụ), mgbe ọdịnaya glucose ruru 30-50 mmol / l.

Hyperglycemia na-akwalite polyuria, mepụta Ọnọdụ hyperosmoticnke na-akpata akpịrị ịkpọ nkụ anụ ahụ, na-eduga na mmeghasị nke nguzo mmiri-electrolyte.

Idebe akpukpo aru nke akpukpo aru site na ino anwu, oria ya, mwepu obara n'ihi polyuria na enweghi mmanya n’eduba hypovolemia. Hypovolemia na-ebute mbelata ọbara mgbali elu, ọbara ọgbụgba, mmụba na viscosity na ike ya thrombosis. Ahụhụ erughị ala na - eduga ischemia anụ ahụ, mmepe nke hypoxia, ụkọ nke lactate na ụkọ ike. Renal ischemia na - eduga na mmepe nke nnukwu nsogbu akwara - ngbaka. Anuria na - eduga n'ịba mkpokọ nitrogen n'ime ọbara (amonia, urea, amino acid); hyperazotemia. Hypovolemia site na aldosterone na-ebelata urinary excretion nke NaCl, nke kpatara hypernatremia na hyperchloremia. Hyperazotemia, hypernatremia na hyperchloremia na-akwalite steeti hyperosmotic na mmebi nke nguzo mmiri-electrolyte.

Enweghi ike na nsogbu nke nguzo mmiri-electrolyte na-egbochi inwe ike na akpụkpọ ahụ nke neurons na omume nke mmetụta akwara na sistemụ akwara, nke na-eduga na mmepe nke coma. Ọnwụ nke hyperglycemic coma bụ 50%.

Lactic acidotic coma njirimara maka ụdị shuga II, ọ na-ewere ya na mkpokọta lactate. Na ọnụnọ nke lactic acid, uche nke ndị adrenoreceptors na catecholamines belatara nke ukwuu, ujo na-enweghị atụ na-amalite. Metabolic coagulopathy pụtara, nke gosipụtara site na DIC, ngụgụ nke okirikiri, thromboembolism (infarction myocardial, ọrịa strok).

Acidosis nwere oke ketone ahụ na lactate na-eme ka o sie ike maka Hb ịnyefe oxygen na anụ ahụ (hypoxia), ọ na-egbochi ọrụ nke ọtụtụ enzymes, nke bụ isi, ATP njikọ, na-arụ ọrụ na -eme ka ihe mejupụtara graf nke membrane, nke na-egbochi ụzọ nke irighiri akwara na anụ ahụ ma na-akpata coma.

O dighi ahu ihe ichoro? Jiri ọchụchọ:

Usoro mmepe nke ketoacidosis

Ketoacidosis na-arịa ọrịa shuga bụ ụdị nsogbu ọrịa metabolic kachasị njọ nke nwere ike ịpụta na ụdị shuga 1. N’adịghị ike, ụdị ọrịa mamịrị a na-adị n’ụdị shuga dị iche iche.

Ihe kpatara ọnọdụ a nwere ike ịbụ nchọpụta a na - ahụkarị ụdị shuga mellitus nke 1, nke na - enweghị insulin n'ime ahụ.

Ọnọdụ a nwekwara ike ịpụta ma ọ bụrụ na egotaghị usoro ọgwụgwọ usoro ọgwụgwọ shuga 1 dị. Ọtụtụ mgbe nke a na-eme mgbe ị na-eji insulin echekwara na-ekwesịghị ịdị ma ọ bụ nwee ndụ shelf, njikwa insulin na-ezighi ezi, ọkachasị, n'ihi nbibi nke usoro nchịkwa ya, yana imebi usoro ị doụ ọgwụ.

Ọrịa pathophysiology nke ketoacidosis gụnyere ọtụtụ nkebi. Ọ bụrụ na insulin emeghị, ọ̀tụ̀tụ̀ shuga dị n'ọbara na-agbago nke ukwuu, ihe akwara ya na-amalitekwa iwepụta akụrụ yana nnukwu mmiri. Onye ọrịa nwere akpọnwụ akpọnwụ, ọ na-aga mposi mgbe mgbe ma na-eri ọtụtụ mmiri. Akpukpo aru na mucous ahụ na - ehicha ma bido ida aba. Sugar nwere ike ịbanye na anụ ahụ nke anụ ahụ, yabụ a na-eji ụlọ nchekwa abụba intracellular mee ihe dị ka ihe maka mmepụta ume. N'okwu a, onye ọrịa na-efunahụ oke ahụ ya.

N'oge mmebi nke abụba, a na-ahapụ ahụ ketone na ọdụdụ abụba n'efu na oke. Ha na-agbakọ n'ọbara onye ọrịa n'ọtụtụ. N'okwu a, pH nke ọbara na-ama jijiji, na ịba ụba acidity na-amalite ime ka ụlọ iku ume na-akpasu iwe. Ihe ịrịba ama nke ọnọdụ a bụ ume mkpụmkpụ ma ọ bụ nke iku ume miri emi ma na-eme mkpọtụ. Na mgbakwunye, isi acetone na-egosi site na onye ọrịa.

Ọrịa mamịrị na-amalite ọtụtụ ụbọchị, oge ụfọdụ. Ka ọrịa ahụ malitere, onye ọrịa na-akwụsị iso ndị ọzọ ikwurịta okwu, ọkachasị ehi ụra. Achọrọ ya ka ọ nye nlekọta ahụike ka ọ ghara ịma mmụọ na nsogbu nke akpịrị.

Enyemaka na ketoacidosis mejupụtara na ntinye nke insulin n'ime intravenously na obere usoro onyonyo nwere otu elekere.

Na mgbakwunye, a na-enye onye ọrịa ọgwụ ọgwụ na-enyere aka ịnagide akpịrị ịkpọ nkụ na iweghachi ọkwa nnu dị n'ọbara, yana ọgwụ ndị ọzọ, dabere n'ọnọdụ onye ọrịa.

Usoro nke mmepe nke hyperosmolar coma na akara ya

Hyperosmolar coma bụ ọrịa metabolic siri ike na ụdị shuga nke 2. N’oge na-adịghị anya, ọnọdụ a nwere ike ịpụta n’ụdị shuga ndị ọzọ.

Ọtụtụ mgbe, ọrịa na - aputa ihe n’etiti ndị agadi nwere nsogbu n’arụ ọrụ. A na-ahụ maka ọrịa pathophysiology nke mmụba dị ka mmụba nke shuga ọbara n'ọtụtụ dị ize ndụ. Ma, pH nke ọbara agbanweghị. Site na ụdị coma a, ogo nke akpịrị nke anụ ahụ na-amalite. N’ụbọchị ole na ole, n’oge mmepe dị otú ahụ mere, onye ọrịa nwere ike ida ihe dị ka 10% n’arọ.

Hyperosmolar coma nwere ike ime na ụdị ndị a:

Vomiting ugboro ugboro, afọ ọsịsa.
Ihe eji eme ihe.
Mmachi na mmiri ịmịcha mmiri.
Ọbara.
Ọkụ na mmerụ ahụ.
Ọrịa na-efe efe.
Njehie na ihe oriri.
Usoro ịwa ahụ

Ihe ịrịba ama nke akpịrị na-arịa hyperosmolar nwere ike ime ọbụlagodi onye ọrịa nwere ọnọdụ dị nwayọ nke ọrịa shuga 2dị nke Abụọ, nke zuru oke ịgbaso nri na ị dietụ ọgwụ. N'ime ndị agadi, ọrịa nwere ike ịkpalite ọgba aghara na metabolism metabolism, nke na-esote ya na-ebute nsogbu nke ọrịa shuga.

Ekwesịrị ka enye onye ọrịa nwere akara hyperosmolar nlekọta mberede mgbe ọ bụla n'ụlọ ọgwụ. Emere ọgwụgwọ a ka iweghachi mmiri dị na ahụ ya site na enyemaka nke intus. Na mgbakwunye, a na-ahụ maka insulin n'ime obere akụkụ kwa elekere.

Usoro mmepe nke acidicis lactate

Lactic acidosis bụ ọnọdụ dị njọ nke na-apụta n'ihi mmụba dị elu na ọkwa anụ ahụ nke lactic acid, nke bụ pathophysiology. Mmepe nke ọnọdụ a bụ njirimara ndị agadi na-arịa ọrịa shuga na ọrịa nke obi, imeju, akụrụ, ngụgụ, yana ndị a alcoụrụma. Ọkwa lactic acid na-ebilite na ezughi oke inye anụ ahụ akwara oxygen.

Ihe ịrịba ama nke lactic acidosis gụnyere: mgbu n'ime obi na n'azụ azụ azụ, adịghị ike, mgbu akwara, mkpụmkpụ ume ọbụna n'oge izu ike, mgbu n'ime afọ, ike ọrụ. Ihe ịrịba ama nke lactic acidosis bụkwa ihe ngosipụta nke ọgbụgbọ na ọgbụgbọ. Lactic acid nwere mmetụta mgbakasị ahụ na etiti akụkụ iku ume, nke mere na onye ọrịa ahụ nwere iku ume miri emi ma na-ebe uda.

Usoro ọgwụgwọ a sitere na ntinye nke azịza alkali, yana mmiri mmiri na ọgwụ ndị ọzọ na-eme ka ọbara mgbali elu dị mma. Mgbe ufodu odi nkpa ime ka obara di ocha mee ka onye obara di ime ya.

Usoro nke hypoglycemia

Hypoglycemic coma na - eme mgbe enwere mbelata nke glucose ọbara. Ọ bụ ihe kachasịkarị n'etiti ọnọdụ mberede na ndị nwere ọrịa shuga. Mgbagha a bụ ihe a na-ahụkarị na ndị na-arịa insulin na-arịa ụdị ọrịa shuga ọ bụla.

Usoro mmepe hypoglycemia bụ nke enweghị ume na akụrụngwa nke ụbụrụ ụbụrụ yana mwepụta nke hormone ahụ na-eme n'otu oge ahụ n'ọbara buru ibu. Ihe ịrịba ama nke hypoglycemia bụ:

anya ntughari
isi ọwụwa
Ire na egbugbere ọnụ,
ọnọdụ nchegbu
ihe nke nchegbu na ụjọ,
ntị ntị
okwu adighi ike
tachycardia
ogwe
nsogbu nri
Anụ ahụ na aka ya
agụụ
ọhụhụ ụzọ na ndị ọzọ.

Mgbe mgbaàmà mbụ nke hypoglycemia mere, onye ọrịa kwesịrị iri ihe dị ụtọ. Nhọrọ kacha mma ga-abụ mmiri mkpụrụ osisi ma ọ bụ tii dị ụtọ. Ọ bụrụ na onye ọrịa ahụ emeghị ihe ndị ahụ, o nwere ike mechaa mata na ọ ga-adaba na mmiri.

Na nke a, enyemaka na-etinye aka na nhazi nke usoro ọgwụgwọ glucose ma ọ bụ ntụtụ intramuscular site na iji glucagon. Na nnukwu hypoglycemia, a chọrọ ịga ụlọ ọgwụ onye ọrịa n'ụlọ ọgwụ maka nyocha na ọgwụgwọ.

Ọ bụrụ na enyere onye ọrịa aka n’oge, ọ ga-ekwe omume ịkwụsị usoro nke mmepe nke nnukwu ọnọdụ ọbụlagodi mgbe ihe mgbaàmà mbụ pụtara. Ma ọ bụghị ya, ịkọ ahụ ga - adị njọ - nhịahụ nwere ike ibute ọnwụ onye ọrịa. Site na oria mamria di mamria, onwu dika ihe dika pacenti iri n’azu uto nke udiri onodu a.

3. Mbido ọrịa shuga

Ihe na - akpata ọrịa ịrịa ọrịa shuga bụ hyperglycemia. Hyperglycemia na-eduga ná mmebi nke arịa ọbara

Fig. 11–31. Mgbanwe na metabolism nke ọrịa shuga mellitus na ihe kpatara coma mamịrị.

yana dysfunction nke anụ ahụ na akwara dị iche iche.

Otu n’ime ihe kacha arụ ọrụ nke mmebi anụ ahụ bụ ọrịa shuga bụprotein glycosylation, na-eduga na mgbanwe na njikọ ha na ọrụ ha. Protefọdụ ihe nchebe na-enwekarị ihe ndị mejupụtara carbohydrate, na nguzobe nke glycoproteins dị otú a na - aga n'ihu enzymatically (dịka ọmụmaatụ, ịkpụkpọ homonụ glycoprotein nke adenohypophysis). Ka osi di, mmekorita nke enzymatic na glucose n’etiti amino n’enweghi nkpuchi - enzymatic glycosylation of protein n’enwe ike n’ahu mmadu. N'ime akwara ndị ahụ siri ike, mmeghachi omume a na-aga nwayọ nwayọ. Na hyperglycemia, usoro nke glycosylation na-agbatịkwu. Ogo glycosylation nke protein na-adabere na ọsọ nke mmeghari ohuru ha. Jiri nwayọ na-agbanwe protein gị na-agbakọwanye mgbanwe. Otu n'ime ihe ịrịba ama mbụ nke ọrịa mellitus bụ mmụba dị okpukpu abụọ na ọnụọgụ haemoglobin glycosylated (norm N_bA_1C5,8-7,2%). Ihe atụ ọzọ nke iji nwayọọ na-agbanweta protein bụ kristal - protein lens. Na glycosylation, kristal na-etolite nchịkọta ụbụrụ nke na-abawanye ike nke oghere. Ngosipụta nke oghere na-agbada, igwe ojii na-apụta, ma ọ bụ cataract.

Nwayọọ nwayọọ na ịgbanye protein na-agụnye protein nke intercellular matrix, membranes basement. Mkpumkpu nke membranes dị n’okpuru ala, otu n’ime nsogbu njiri mara ọrịa shuga mellitus na-eduga na mmepe nke angiopathies na-arịa ọrịa shuga.

Ihe kpatara ọtụtụ ọrịa na - egbu oge ịrịa ọrịa shuga bụkwa na-abawanye ọnụego ntụgharị nke glucose na sorbitol (lee nkebi nke 7).

Mmeghachi nke ntụgharị glucose na mmanya hexatomic (sorbitol) bụ nke enzyme aldose reductase jikọtara ya. Ejighi Sorbitol na ụzọ metabolic ndị ọzọ, usoro ya na-agbasa site na sel bụ nwayọ. N'ime ndị ọrịa nwere ọrịa mellitus nke ọrịa shuga, sorbitol na-agbakọ na retina na oghere nke anya, sel nke glomeruli nke akụrụ, mkpụrụ ndụ Schwann, na endothelium.

Sorbitol na oke ọnụọgụ bụ ihe na-egbu egbu nye sel. Ntinye ya na neurons na-eduga na mmụba nke osmotic pressure, swelling cell na edema anụ ahụ. Iji maa atụ, oghere opacification nwere ike itolite n'ihi oghere nke oghere site na mgbakọta nke sorbitol na ndakpọ nke usoro kristal nke enyere iwu.

Ọrịa mamịrị na-arịa ọrịa shuga. Ọrịa mamịrị angiopathies na-ebute isi nke membranes vaskụla nke akwara. N’ime ogwe glucose dị elu na plasma ọbara, proteoglycans, collagens, glycoproteins glycosylate, mgbanwe na oke n’etiti mmiri mejupụtara okpuru ulo ahụ, a na-akpaghasị usoro nhazi ya.

Macroangiopathy gosiputara na ọnya nke nnukwu arịa na nke etiti nke mkpụrụobi, ụbụrụ, akụkụ ala. Mgbanwe ọrịa sitere na akwara dị n’ime akwara na mbibi mgbidi akwara n’etiti na elu ime bụ nsonaazụ glycosylation nke membranes okpuru ulo na protein nke intercellular matrix (collagen na elastin), nke na-eduga n’ịbelata ịdị nkọ nke akwara. Na njikọta hyperlipidemia, nke a nwere ike ịbụ ihe kpatara mmepe nke atherosclerosis. Ọrịa shuga, atherosclerosis bụ ihe a na-ahụkarị, na-etolite etolite etolite ma na-aga n’ihu ọsọ ọsọ karịa enweghị ọrịa shuga.

Microangiopathy - nsonaazụ nke mbibi capillaị na obere arịa. Egosiputara n'ụdị nephro-, neuro- na retinopathy.

Onye Nifa na-etolite n’ihe dị ka otu ụzọ n’ụzọ atọ nke ndị ọrịa na-arịa ọrịa shuga. Enwere ike ịchọpụta mgbanwe elektrọn microscopic na akpụkpọ anụ okpuru ala na renal glomeruli ugbua n’afọ mbụ mgbe nyochachara ya. Agbanyeghị, n'ọtụtụ ndị ọrịa, ihe ịrịba ama nke ajọ ọrịa nephropathy na-apụta mgbe afọ shuga dị afọ 10-15. Ihe ịrịba ama nke mmalite nke nephropathy bụ microalbuminuria (n'ime 30-300 mg / ụbọchị), nke na-esote ọria ọrịa nephrotic ọrịa, nke nwere proteinuria dị elu, hypoalbuminemia na edema.

Retinopathy nsogbu kachasị njọ nke ọrịa shuga na ihe kachasị akpata ikpu ìsì, na-etolite na 60-80% nke ndị ọrịa nwere ọrịa shuga

ọrịa shuga. N'oge mgbanwe, basal retinopathy na-amalite, nke na-egosipụta onwe ya n'ọrịa azụ, vasodilation nke retina, edema Ọ bụrụ na mgbanwe ndị ahụ emetụtaghị macula, ọhụhụ ụzọ anaghị adịkarị. N’ọdị n’ihu, ọrịa retinopathy nwere ike ịmalite, nke a na-egosipụta na neoplasms nke retina na arịa dị oke egwu. Mkpochasị na nnukwu ihe nke arịa ndị a kpụrụ ọhụrụ na-ekpebi ọbara ọgbụgba ugboro ugboro na anụ ahụ retina ma ọ bụ akụkụ akwara. N'ebe ọbara ọgbụgba na-amalite, fibrosis na-amalite, na-eduga na mkpochapụ azụ na enweghị atụ.

B. Nchọpụta ọrịa shuga

Ọtụtụ mgbe, enwere ike ịme nchọpụta nke ọrịa shuga na ndabere nke akara ngosipụta nke ọrịa shuga - hyperglycemia, polyuria, polydipsia, polyphagia, mmetụta nke nkụ akọrọ. Achọpụtara ihe ịrịba ama biochemical nke IDDM na ndabere nke:

ule nnabata glucose (lee fig 11-30). Plasma glucose dị elu karịa 10 mmol / l awa 2 mgbe ike shuga na-egosi ọrịa mellitus,

mkpebi nke glycosylated haemoglobin. Na ọrịa shuga, ọkwa H_bA_1s, ihe dị ka 5% nke ngụkọta haemoglobin, na-abawanye site ugboro 2-3,

enweghị insulin na ọkwa C-peptide n’ime ọbara na mmamịrị. Dị ka ọ na-adịkarị, insulin na C-peptide na-ezobe na mkpokọta mgbali. Ebe ọ bụ na umeji na-ejide ihe dị ka 2/3 nke insulin, ngụkọta nke insulin / C-peptide na akwara portal na akụkụ akụkụ bụ 1/3. Uru nke C-peptide dị na ọbara ma ọ bụ mmamịrị na-enye gị ohere nyocha nke ọma n ’ọkwa sel-arụ ọrụ.

albuminuria. Na-arịa ọrịa shuga, ihe na-eme kwa ụbọchị nke albumin dị ihe dị ka 30-300 mg - microalbuminuria (nke dị ihe dịka 8 mg).

N'ihi na NIDDM na-eji nwayọ nwayọ, a na-achọpụta mgbaàmà nke oge gboo, hyperglycemia, na ụkọ insulin mgbe e mechara, ọtụtụ mgbe yana mgbakwunye na mgbaàmà nke ọrịa shuga n'oge.

D. achesbịaru nso na ọgwụgwọ nke ọrịa shuga

Treatmentgwọ ọrịa shuga na-adabere n’ụdị ya (M ma ọ bụ nke II), dị mgbagwoju anya ma tinye nri, ojiji nke ọgwụ na-ebelata shuga, ọgwụ insulin, yana mgbochi na ọgwụgwọ nke nsogbu.

A na - ekewa ọgwụ ndị na - eme ka okpukpo dị ugbu a ụzọ abụọ: usoro sulphonylurea na biguanides. Nkwadebe nke ebumnuche ya na-akpali mkpali insulin gụnyere sulfonylureas (dịka ọmụmaatụ, mannyl). A kọwara usoro nke sulfonylureas site na mmetụta ha na ọrụ nke ọwa ọkụ K + na-emetụta ATP. Mmụba na mkpokọta intracellular nke K + na-eduga na mkpopu akpụkpọ ahụ na ebufe ngwa ngwa nke sọlfọsị ion na-abanye na sel, n'ihi nsonaazụ insulin na-akpali.

Biguanides bụ ìgwè ọzọ dị mkpa nke ọgwụ na-ebelata shuga. Dabere na ụfọdụ ọmụmụ, biguanides na-abawanye ọnụ ọgụgụ ndị na-ebugharị glucose GLUT-4 n’elu anụ ahụ adipose na akwara mkpụrụ ndụ.

Isingzọ ndị na-ekwe nkwa iji gwọọ ọrịa shuga gụnyere ihe ndị a: ntụgharị nke agwaetiti pancreatic ma ọ bụ sel lated dịpụrụ adịpụ, mmịnye mkpụrụ ndụ a na-esetịpụ, yana mkpali nke usoro ntụgharị nke palọg.

Na ụdị ọrịa shuga mellitus abụọ, usoro ọgwụgwọ nri bụ ihe kachasị mkpa. Ha na-atụ aro nri dị mma: carbohydrates kwesịrị maka 50-60% nke ngụkọta kalori nke nri (ewezuga ahụ nwere ike inye nri carbohydrates, biya, mmanya, syrups, achịcha, wdg), protein - 15-20%, abụba niile. - enweghị ihe karịrị 25-30%. Ekwesịrị iji nri 5-6 ugboro n'ụbọchị.

Pathogenesis

Hypoglycemic coma na-etolite na ndị ọrịa nwere ọrịa mellitus nke ọrịa shuga, n'ọtụtụ oge, mgbe ị ofụ ọgwụ insulin ma ọ bụ nkwadebe sulfonylurea na nri na-abata, karịsịa carbohydrate, enweghị otu. Na ọrịa shuga mellitus, hypoglycemic coma na-etolite ọtụtụ oge karịa ketoacidotic.

Dị ka ọ na-adị, hypoglycemia na hypoglycemic coma na-eme na ndị ọrịa nwere ụdị ọrịa mellitus nke nwere insulin na-adaberekarị, nke enweghị ike ịtọpụta ihe mpụga nke mmụba na mberede na insulin. N'ụdị ndị ọzọ, oge na-akpasu iwe bụ ogologo oge n'etiti nri, ịba ụba nke arụ ọrụ, ọgbụgbọ, afọ ọsịsa na ọnọdụ ọrịa ndị ọzọ. Ọrịa shuga na-arịa ọnya ụbụrụ na-akpata ọnya, eriri afọ, ọnọdụ endocrine, mmepe nke ọdịda akụrụ nwere ike ibute nnukwu hypoglycemia. Ọtụtụ mgbe a na-amalite mmiri ọgwụ hypoglycemic na nchịkwa insulin, nke nwere ike ime n'ọnọdụ ndị a:

njehie usoro onunu ogwu (ịta insulin kwadebe, dịka ọmụmaatụ, yana udiri U40 karịa U100, ya bụ, ugboro abụọ 2.5 ka etinyere ọgwụ, ma ọ bụ insulin ahọrọ insulin na ezighi ezi).
mmejọ nke ịisterụ ọgwụ ahụ (ọ bụghị n'okpuru anụ ahụ, kama intramuscularly) - agịga ogologo, ma ọ bụ ụma intramuscular na-ezube iji mee ka ọ dịkwuo elu ma kwalite mmetụta nke homonụ.
ịhapụ ị carbohydụ carbohydrates mgbe ị nyesịrị insulin ọgwụ dị mkpụmkpụ (“echefuru iri nri”) - nri ehihie, nri ehihie ma ọ bụ nri abalị nke abụọ na mmemme insulin na-adị obere oge,
“Activityrụ ọrụ” mmega ahụ n'ihi enweghị ihe ndị ọzọ na-a ofụ ya: a na - echekwa insulin jected “echefurula” iri nri (anaghị eri nri ndị ọzọ na-enye ya nri iji mee ka ọ nwee mmega ahụ na-adịghị ahụkebe) → gbara ọsọ, ịgba bọl, igwu mmiri, ice rink na ndị ọzọ Coma
na -akpo ebe insulin insulin (kpachara anya - iji mee ka insulin ghara ime ihe ngwa ngwa ma obu ihe mberede - mgbe ị na - abanye insulin n’ime apata mgbe i na - agba aru),
mwepu nke mmiri ọgwụ buru ibu nke gbawara insulin-antibody,
mgbe m na-a alcoholụ mmanya,
n’ihu imeju buru ibu
megide ndabere nke ụkọ akwara na-adịghị ala ala,
n’oge ime dị,
igbu onwe onye
insulin gbara gharị na omume psychi na ndi ozo.

N'ime ndị nwere ọrịa shuga, ọbara ọgbụgba hypoglycemic nwere ike ịbụ nsonaazụ insulin zuru oke, ọkachasị mgbe ewepụrụ onye ọrịa na steeti ketoacidosis.

Mmepe nke oke hypoglycemic mmeghachi omume ga-ekwe omume megide ndabere nke ị alcoholụ mmanya, mmetụta dị ala nke shuga na-abụ nke a na-adịghị elebara anya, na-eburu n'uche naanị carbohydrates na nhazi nke ihe ọholicụholicụ na-egbu egbu na nkwadebe nke nri. Mmanya na-egbochi njikọta glucose site na akụrụngwa na-abụghị carbohydrate na imeju, si otú ahụ na-abawanye ugboro nke hypoglycemia na ndị ọrịa na ọgwụgwọ insulin. Drunk Theụbiga mmanya ókè, ogologo oge na mgbochi nke gluconeogenesis, yabụ hypoglycemia nwere ike ime ọbụlagodi awa ole na ole ị .ụchara mmanya.

Edebere mkpokọ glucose dị ala ma ọ bụrụ

A na-ewepụ glucose n'ọbara na ngwa ngwa karịa etinye uche gị na eriri afọ ma ọ bụ imeju mejuputara,
mmebi glycogen na / ma ọ bụ njikọ glucose site na akụrụngwa na-enweghị carbohydrate na imeju enweghị ike ikwugide ọnụego glucose,
Ihe ndị a dị n’elu jikọtara.

Ọtụtụ mgbe, mmalite nke ụgwọ maka ọrịa shuga mellitus na-eme ka ọnụnọ anụ ahụ dịkwuo elu na insulin, nke chọrọ mbelata oge a na-etinye na homonụ a na-ahụ site na mpụga.

Ọgwụ Sulfanilamide enweghị ike ibute mmeghachi omume hypoglycemic, tumadi ha nwere ike ime na ndị agadi ọrịa nwere njikọ ọrịa shuga na ọrịa nke akụrụ, imeju ma ọ bụ obi, yana agụụ ma ọ bụ erighị nri na-edozi ahụ. Ojiji nke ufodu ogwu na sulfonamides nwere ike kpalite mmepe nke onwu. Dịka ọmụmaatụ, acetylsalicylic acid na salicylates ndị ọzọ, site na ibelata njikọ nke sulfonamides na protein plasma ọbara na ibelata mmamịrị ha na mmamịrị, mepụta ọnọdụ maka mmepe nke mmeghachi omume hypoglycemic.