Mob ntshav qab zib mellitus (DM) yog ib qho kab mob endocrine nrog rau kev kawm mus ntev. Nws manifests nws tus kheej nyob rau hauv metabolic teeb meem ntawm carbohydrate thiab dej metabolism, nrog rau hyperglycemia, uas yog, nce ntshav qab zib. Mob ntshav qab zib nws tus kheej tsis yog qhov txaus ntshai, vim tias qib qab zib tuaj yeem ua rau ntau txoj hauv kev, tab sis nws yog qhov txaus ntshai vim nws cov teeb meem.
Cov poj niam yuav mob ntau dua, thiab lawv kuj muaj mob ntshav qab zib ntau dua. Raws li kev txheeb cais, niaj hnub no 7% ntawm cov neeg nyob hauv lub ntiaj teb yog cov ntshav qab zib. Ntawm cov thawj lub tebchaws yog Is Nrias teb, Tuam Tshoj thiab Asmeskas, nyob rau hauv 4 qhov chaw yog Russia (10 lab tus tib neeg - 3.5%). Tus naj npawb ntawm cov neeg mob tau loj hlob sai heev uas, raws li kev txheeb cais, txhua 7 vib nas this, 2 tus neeg tau kuaj pom tus kab mob no. Cov neeg tuag txhua xyoo yog kwv yees li 2 lab tus tib neeg. Txawm hais tias ntshav qab zib yog tus thawj coj niaj hnub no, nws tau paub thiab piav qhia thaum ntxov li xyoo pua AD. e. hauv Ancient tim Nkij teb chaws thiab Rome.
nkag siab txog ntshav qab zib
Yuav kuaj mob" mob ntshav qab zib ", tus kws kho mob yuav tsum muaj cov txiaj ntsig ntawm kev tshuaj xyuas tag nrho ntawm tus neeg mob, vim muaj ntau hom thiab qib ntawm tus kab mob no.
Mob ntshav qab zib yog qhov txawv ntawm qhov yug los thiab kis tau, thawj thiab theem nrab, menyuam yaus lossis menyuam yaus, thiab cov neeg laus. Qhov kev faib zaum kawg tso cai rau peb tham txog pathology ntawm hom 1 thiab 2. Txawm hais tias kev faib ua theem thiab hom tau raug tshem tawm txij li xyoo 1999, cov kws kho mob thoob plaws ntiaj teb siv cov kev faib tawm, vim qhov no yog qhov tseem ceeb thaum xaiv cov kev kho mob thiab kev kuaj mob. Qhov tshwm sim ntawm hom 1 mob ntshav qab zib tsuas yog 5%, hom 2 mob ntshav qab zib loj hlob hauv 95% ntawm cov neeg mob. Cov theem, chav kawm thiab ua rau txawv, tab sis cov teeb meem yog tib yam.
Hom 1 mob ntshav qab zib yog hu ua menyuam yaus lossis menyuam yaus vim nws tuaj yeem tshwm sim hauv cov menyuam yaus, txawm tias menyuam yug tshiab, thiab cov hluas hnub nyoog qis dua 30 xyoo. Nyob rau hauv xyoo tas los no, cov hnub nyoog kab tau loj hlob mus rau 45. Hom ntshav qab zib no yog insulin-dependant - IDDM. Qhov no txhais tau hais tias qhov ua rau tus kab mob no nyob rau hauv kev ua haujlwm tsis zoo ntawm cov txiav txiav, cov beta hlwb uas tsis tsim cov tshuaj insulin, lossis tsim nws tsawg heev.
Insulin yuav tsum tau muab los ntawm sab nraud los muab lub cev. Qhov no yog nws qhov sib txawv tseem ceeb ntawm hom 2 mob ntshav qab zib mellitus, uas yog suav tias yog kab mob ntawm cov neeg laus, txhim kho tom qab 40 thiab yog insulin-ywj siab - NIDDM. Kev tsim cov tshuaj insulin hauv beta hlwb yog qhov qub, tab sis lub hlwb ntawm cov kabmob thiab cov ntaub so ntswg tsis tau txais nws vim ntau yam, uas yuav tau tham hauv qab no.
Muaj ib qho xwm txheej thaum muaj piam thaj ntau hauv cov ntshav, thiab cov hlwb ntawm lub cev tshaib plab. Glucose tsis dhau los ntawm lawv. Insulin ntau, tab sis pabNws tsis muaj peev xwm "qhib" cell rau cov piam thaj, vim hais tias cov hlwb lawv tus kheej tiv taus nws. Yog li, lub npe thib ob ntawm cov ntshav qab zib no yog insulin resistant. Hom no feem ntau tshwm sim.
Qhov twg txaus ntshai? Nws ntseeg hais tias hom 1 mob ntshav qab zib mellitus tshwm sim sai thiab nyuaj kho.
Heredity plays lub luag haujlwm tseem ceeb: nws tsis ua rau mob ntshav qab zib ncaj qha, tab sis tau txais los ntawm, hauv 70% ntawm cov neeg mob predisposition rau tus kab mob. Ntawm lwm yam: kis kab mob - mob khaub thuas, rubella, kab mob siab kab mob thiab kab mob pox. Lawv ua tus impetus rau qhov tshwm sim ntawm tus kab mob. Kev rog thiab lub cev tsis ua haujlwm yog cuam tshuam rau hom 2 mob ntshav qab zib. Qee cov kab mob ntawm tus txiav nws tus kheej - o, qog, lwm yam endocrinopathies - kuj tuaj yeem ua rau beta hlwb puas. Tsis tas li ntawd, lub luag haujlwm tseem ceeb ntawm kev ntshai thiab kev ntxhov siab, neuroses - lawv tuaj yeem dhau los ua qhov tshwm sim.
Muaj feem kis tau tus mob nce ntxiv raws hnub nyoog. Muaj cov pov thawj zoo li no: txhua 10 xyoo qhov muaj peev xwm ntawm kev mob ntshav qab zib hauv ib tus neeg ob npaug. Nws kuj tau pom tias cov menyuam mos uas noj mis mis muaj feem ntau yuav muaj ntshav qab zib hom 1.
Qhov laj thawj tseem ceeb ntawm T2DM yog plab plab - "lub neej" ntawm plab. Cov neeg no feem ntau yog hypodynamic, noj zaub mov tsis zoo nrog ntau cov carbohydrates yooj yim, cov zaub mov kib thiab tsis tu ncua overeat.
Huab cua teeb meem hauv hom 1 DM - huab cua txias nyiam nws. Kuj tseem muaj menyuam yaus mob ntshav qab zibhem cov neeg uas hnyav thaum yug los, uas tau txiav ntxov ntxov thiab hloov mus rau kev pub mis.
Pathogenesis ntawm tus kab mob
thawj hom yog, qhov tseeb, ib qho txheej txheem autoimmune, thaum koj lub cev tiv thaiv kab mob pib tsim cov tshuaj tiv thaiv kab mob pancreatic. Nws yuam kev rau cov neeg txawv teb chaws, tab sis tuaj yeem hloov kho yam tsis paub.
Nrog DM1, hyperglycemia tsis tuaj yeem raug tshem tawm los ntawm koj tus kheej insulin, vim nws tsis nyob ntawd. Cov tshuaj tiv thaiv ntawm lub cev nyob rau hauv cov ntaub ntawv no yog excretion ntawm cov suab thaj ntau dhau los ntawm cov zis, thiab tso zis ntau zaus. Nyob rau hauv parallel, lub cev qhuav dej tsim nyob rau hauv lub cev. Kev tawg ntawm cov rog pib vim tsis muaj dej thiab khoom noj khoom haus, thiab tus neeg poob phaus.
Daim duab hauv hom 2 mob ntshav qab zib yog txawv kiag li: muaj ntau ntawm cov tshuaj insulin thiab qab zib hauv cov ntshav, tab sis cov hlwb tiv thaiv insulin. Qab zib tsis tuaj yeem nkag mus. Insulin tsis ua lub luag haujlwm ntawm lub luag haujlwm tseem ceeb hauv cov hlwb, uas siv los pab cov piam thaj nkag mus rau hauv cov hlwb.
Y Insulin tawm mus - hyperinsulinemia tshwm sim. Lub siab tseem sim pub cov hlwb nrog piam thaj thiab tsim los ntawm txhua qhov chaw. Tab sis cov khoom zoo li no tsis zoo rau lub txiav, lawv tsoo rau nws, thiab nws txoj haujlwm cuam tshuam.
Thaum kawg cov tshuaj insulin nres. Tsis tas li ntawd, nyob rau theem ntawm ntshav qab zib mellitus, cov piam thaj hauv cov ntshav hloov nws qhov kev ua rau cov hlab ntsha ntawm phab ntsa, ua rau lawv tawg. Cov roj (cholesterol) ua rau thaj chaw puas tsuaj - atherosclerosis pib. Ua ntej tshaj plaws, capillaries, paj hlwb raug cuam tshuam, thiab mob ntshav qab zib pib.
Type of diabetes
Tshwj tsis yog rau hom 1 thiab hom 2 mob ntshav qab zib:
- gestational - tsim thaum cev xeeb tub, tom qab yug menyuam feem ntau ploj;
- DM vim kev noj zaub mov tsis zoo;
- secondary or symptomatic diabetes.
theem ntawm Ntshav Qab Zib Hom 1
Degrees of SD1:
- Thawj theem ntawm ntshav qab zib muaj ib qho kev kawm zoo. Glycemia tsuas yog 7 mmol / l, cov ntshav tsis txawv, tsis muaj suab thaj hauv cov zis. Tsis muaj teeb meem, theem yog yooj yim them nyiaj los ntawm kev noj zaub mov thiab tshuaj tshwj xeeb kom txo cov suab thaj. Lub sijhawm no, lossis thawj theem ntawm ntshav qab zib, hu ua premorbid. Ntau tus kws kho mob xav tias nws yuav tsum tau ua kom muaj kev tiv thaiv hauv cov xwm txheej zoo li no, tshwj xeeb tshaj yog tias tus neeg muaj kev pheej hmoo rau kev xeeb tub. Pathology tsuas tuaj yeem tshawb pom los ntawm kev txheeb xyuas cov noob tsis zoo nyob rau hauv ib qho kev hloov pauv.
- Qib thib ob, lossis theem 2 mob ntshav qab zib, dhau los ua ib feem. Kev puas tsuaj ntawm beta hlwb pib. Cov teeb meem pib tshwm sim. Daim duab ntawm ntshav qab zib nyob rau theem pib qhia tias cov tsos mob tshwm sim li cas rau tus neeg: tso zis ntau zaus, nqhis dej, pom kev tsis pom kev.
- Nyob rau theem peb, kev kho mob tsis txwv rau kev noj zaub mov thiab tshuaj. Glucose yog nquag nyob rau hauv cov zis, glycemia yog 14 mmol / l. Kev tsim cov tshuaj insulin tsawg dua. Cov tsos mob ntawm cov teeb meem twb pom tseeb: qhov muag pom tau sai sai, nce siab tau tsim, paresthesia ntawm ceg ceg.
- Nyob rau theem plaub ntawm kev ua haujlwmTsis muaj cov tsos mob tshwm sim, tab sis cov neeg mob yws yws ntawm mob khaub thuas, mob tsis tu ncua, conjunctivitis, qaug zog thiab malaise. Lub hom phiaj ntawm kev kho mob yog qhov muag thiab tawv nqaij teeb meem.
- Thaum theem thib tsib ntawm ntshav qab zib, 90% ntawm beta hlwb twb puas lawm. Cov tsos mob yog vivid.
- theem thib rau yog qhov nyuaj tshaj plaws. Cov islets ntawm Langerhans raug rhuav tshem tag nrho. Cov piam thaj nce mus txog 25 mmol / L, hauv cov zis - glucosuria, proteinuria, teeb meem hauv lub raum tsis ua haujlwm, gangrene ntawm cov ntiv taw, trophic ulcers rau lawv.
mob ntshav qab zib hom 2
Qib, lossis theem, ntawm hom 2 mob ntshav qab zib kuj muaj lawv tus yam ntxwv:
- Mild degree - kev txhim kho yog ua tiav los ntawm kev noj zaub mov thiab tshuaj txo cov piam thaj. Qhov nyiaj them rov qab, lossis thawj zaug, theem ntawm ntshav qab zib yog thim rov qab. Glycemia <7, 7 mmol / L, tsis muaj glucosuria.
- Nyob rau theem nrab ntawm ntshav qab zib mellitus, kev txhim kho tuaj yeem ua tiav (glycemia<12, 7) los ntawm kev noj cov ntsiav tshuaj txo qis - 2-3 ntsiav tshuaj. Insulin tseem tsis tau txuas nrog. Cov piam thaj ntau dua 10 mmol / l, qab zib tshwm hauv cov zis. Ntawm cov tsos mob: polydipsia, qhov ncauj qhuav, tsis muaj zog, polyuria. Nyob rau ntawm daim tawv nqaij ntev tsis kho pustules. Subcompensatory theem, lossis theem 2 mob ntshav qab zib mellitus, yog ib nrab rov qab los nrog kev kho kom raug. Ntxiv nrog rau qhov ncauj tshuaj tiv thaiv hyperglycemic (OPBs), kev siv cov tshuaj insulin yuav tsum tau.
- Cov theem decompensatory hnyav - ua tiav irreversibility ntawm qhov tshwm sim, ntau yam teeb meem thiab kev ua txhaum ntawm carbohydrate thiab txhua hom metabolism hauv lub neej. Hyperglycemia >12, 7 mmol / L, coma tuaj yeem tshwm sim. Lub tsev kho mob tau qhia, muaj angio-thiab neuropathy.
Cov tsos mob thiab cov tsos mob
Cov tsos mob ntawm cov ntshav qab zib thaum ntxov yog qhov hloov maj mam. Hauv hom 1 mob ntshav qab zib mellitus, daim duab kho mob loj hlob sai thiab mob, tsis pub dhau ob peb lub lis piam. Qhov tseeb tshaj plaws kos npe rau yog qhov tseeb ntawm qhov pib ntawm pathology. Lub xeev ntawm kev noj qab haus huv poob qis heev, ntawm thawj cov tsos mob ntawm thawj theem ntawm ntshav qab zib tuaj yeem raug sau tseg:
- nce qab los noj mov tas li ntawm kev tshaib kev nqhis;
- thirst;
- qaug zog thiab qaug zog ntev;
- poob phaus;
- tawm tsam xeev siab thiab ntuav;
Qhov kub poob rau 35.6-36.2 degrees. Nov yog hom 1 hom cim.
theem pib ntawm ntshav qab zib IDDM yog tus cwj pwm los ntawm thinning ntawm daim tawv nqaij, qhov tawg yooj yim tshwm sim, khawb qhov tsis zoo. Cov teeb meem tsis pom kev yog tshwm sim hauv daim ntaub thaiv ua ntej lub qhov muag, qhov muag tsis pom kev loj hlob. Cov no yog cov cim qhia los ntawm lub hlwb uas tsis tau txais khoom noj txaus. Paub txog qhov muaj ntshav qab zib yog qhov yooj yim - pub ntshav rau cov piam thaj. Kev ua tsis tiav ntawm hom 1 ntshav qab zib, tsis zoo li hom 2, yuav ua rau tsis nco qab sai.
Yuav ua li cas txheeb xyuas ntshav qab zib hom 2?
Muaj ob peb lub cim thawj zaug ntawm theem pib mob ntshav qab zib hom 2, cov neeg uas muaj cov tsos mob no tseem tsis tau xav tias qhov pib ntawm pathology thiab tsis mus ntsib kws kho mob. Cov no suav nrog:
- obesity;
- xav tau khoom qab zib thiab hmoov txhuv nplej siab;
- kev tshaib kev nqhis;
- qaug zog tas mus li thiab pw tsaug zog nruab hnub.
Tseem ib qho ntawm thawj qhov kev hu xov tooj ntawm cov theem pib mob ntshav qab zib tuaj yeemtshwm sim nws tus kheej hauv kev nce siab.
Tom qab koom nrog:
- nausea;
- chim siab;
- tsis tsim nyog txo qhov pom;
- tingling thiab goosebumps nyob rau hauv ob txhais ceg;
- qhuav sagging tawv nqaij - cream tsis muab nyhuv;
- lub qhov ncauj qhuav thiab saj yog xim hlau;
- pob thiab khaus ntawm daim tawv nqaij;
- khaus qhov ncauj;
- cardialgia;
- kho tsis zoo ntawm tej qhov txhab thiab abrasions.
Kuj nyob rau hauv cov poj niam, cov tsos mob ntawm cov ntshav qab zib thaum ntxov yog tshwm sim nyob rau hauv daim ntawv ntawm hyperhidrosis thiab daim di ncauj pob, nce tso zis thaum hmo ntuj. Nocturia yog me me hauv ntim - los ntawm 100 txog 230 ml.
Txo libido, potency. Cov tsos mob tsis tshwm sim hauv droves, singly, ntau xyoo. Lub capillaries yog dilated, lub ntsej muag yog pasty, nrog ib tug liab tint. Cov tawv nqaij yog flabby thiab qhuav, rau tes yog nkig, tsis sib xws. Tom qab 50 xyoo, gingivitis, periodontal kab mob thiab caries koom. Cov pos hniav los ntshav, ua pa tsis zoo. Daim duab ntawm qhov pib mob ntshav qab zib mellitus (nws cov tsos mob) tau nthuav tawm hauv qab no.
Ko taw thiab ntsia thawv fungus lossis trophic rwj feem ntau tshwm sim. Heels ua qhuav, nrog pob kws. Calluses tau yooj yim mob thiab tsis kho tau ntev. Cov ntsia hlau exfoliate, crumble, thicken thiab emit ib qho tsis kaj siab tsw.
Symptomatology tuaj yeem tshwm sim nws tus kheej txawm tias tom qab 10 xyoo. Tag nrho cov kabmob no twb lwj lawm. Cov tsos mob ntawm hom 2 mob ntshav qab zib tsis tshwm sim hauv pawg lossis avalanche, tab sis txawm tias ib qho tsos mob tshwm sim, koj yuav tsum tau kuaj xyuas.
Diagnosis
kuaj ntshav thiab zis yog qhov yuav tsum tau ua.
kuaj ntshav biochemic altaw tes rau zais pathologies. Hom kev tshuaj ntsuam no suav nrog: txhua hom kev txiav txim siab glycemia, lipid spectrum, (cholesterol, triglycerides tau nce hauv hom 1 thiab rog), lipoproteins (hauv hom 1 lawv li qub, thiab hom 2 LDL nce), C-peptide.
Yuav tsum tau muaj kev sab laj ntawm cov kws kho mob nqaim - kws kho mob neuropathologist, kws kho qhov muag. Cov nyiaj tau raug tshuaj xyuas thiab ECG ua tiav.
Hauv cov ntshav capillary lossis venous, tus nqi ntawm insulin, glycated Hg, fructosamine yog txiav txim siab.
Lwm qhov kev ntsuam xyuas tseem ceeb yog kev tshawb fawb cov zis rau cov protein, qab zib, acetone, ketone lub cev.
Yuav muaj teeb meem ntawm kev mob ntshav qab zib
Cov teeb meem txaus ntshai tshaj plaws suav nrog:
- mob ntshav qab zib coma;
- nephropathy;
- retinopathy;
- siab nce;
- edema;
- Ypolyneuropathy;
- Ymacro- thiab microangiopathy;
- diabetic foot syndrome;
- trophic ulcers;
- gangrene mus txog ntua ntawm ceg tawv.
Txoj Cai Kev Kho Mob
Kev kho mob ntshav qab zib hom 1 yog kev kho tshuaj insulin, rau hom 2 mob ntshav qab zib yog kev noj zaub mov thiab tshuaj.
Koj tuaj yeem txo koj cov ntshav qab zib sai sai nrog cov tshuaj PSP. Lawv tuaj nyob rau hauv ntau yam:
- YSulfonylurea raws. Lub sijhawm siv tau yog ib hnub, lawv maj mam txo qhov kev ua tau zoo thiab tsis txhob cia li dhia. Txhim kho kev ua haujlwm ntawm beta hlwb thiab txo cov nqaij mos insulin tsis kam. Cov tshuaj no: Chlorpropamide, Tolazamide, Glibenclamide, Maninil, thiab lwm yam.
- Biguanides -siv los ua ib qho adjuvant hauv hom 2 mob ntshav qab zib, txo qis insulin tsis kam ntawm cov hlwb. Cov no suav nrog: "Bagomet", "Metfogamma", "Glucofage", "Siofor" thiab lwm yam.
- Tshuaj uas cuam tshuam rau kev nqus ntawm carbohydrates thiab ua rau nws qeeb: Acarbose, Guarem, Bayetta, Glucobay.
ntsuas kev tiv thaiv
ntsuas kev tiv thaiv suav nrog:
- hnyav normalization;
- kev ua kom zoo;
- kev noj zaub mov zoo - kev noj haus tsuas yog xaiv los ntawm kws kho mob xwb;
- exclusion of stress;
- tswj lub siab;
- ntsuas suab thaj tsis tu ncua txhawm rau tswj hyperglycemia;
- Y Yuav khoom glucometer thiab ntsuas ntshav qabzib tsis tu ncua raws li kws kho mob tau sau tseg.
Txoj haujlwm ntawm tus kws kho mob thiab tus neeg mob nws tus kheej tsis mus txog qhov teeb meem. Qhov xwm txheej tiag yog los ntawm lawv.
