Ciwon sukari mellitus MAGANAN: alamu da jiyya na cutar sankara

A karni na 21 shine karni na sabbin fasahohi da kirkire-kirkire, da kuma karni na sabbin cututtukan.

Jikin ɗan adam ya banbanta a tsarin sa, amma kuma yana bada gazawa da kurakurai.

Karkashin tasirin abubuwa daban-daban da masu rikice-rikice, za a iya canza kwayar halittar mutum, wanda ke haifar da cutar ƙwayar cuta.

Cutar sankarau tana daga cikin wadancan.

Mene ne ciwon sukari na modi

Ciwon sukari mellitus wani cin zarafi ne a cikin tsarin endocrine, tushen shine cikakkiyar / karancin insulin a cikin jikin mutum. Wannan bi da bi yana haifar da katsewa a cikin duk metabolism. Daga cikin dukkanin rikice-rikice na tsarin endocrine, yana ɗaukar wuri na 1. A matsayin sanadin mutuwa - wuri na 3.

Don haka, akwai fannoni:

• dogara da insulin ko kuma irin ciwon sukari na 1,
• mara amfani da insulin ko kuma irin ciwon sukari guda 2,
• Ciwon sukari yayin daukar ciki (gestational).

Haka kuma akwai takamaiman nau'ikan:

• pancreatic beta tantanin halitta maye gurbi,
• damakamaka,
• na ciwon maɗamfari
• Ciwon sukari da ke haifar da sinadarai da magunguna.

MUTU shine wani nau'in cutar sankararren cuta mai saurin haifuwa a cikin lokacin daga 0 zuwa 25 shekaru. Abinda ya faru a cikin yawan jama'a shine kusan 2%, kuma a cikin yara - 4.5%.

MATA (balaga-a sa ciwon sukari na matasa) a zahiri sauti kamar "manya masu ciwon sukari a cikin matasa." Ana yada shi ta hanyar alaƙar gado, yana ɗaukar halaye na 'yancin kai (yara maza da mata suna daidai da abin). Laifi yana faruwa a cikin ɗaukar bayanan da ke da alaƙa, saboda wanda dalilin canje canje, wanda shine aikin ƙwayoyin beta.

Kwayoyin Beta suna samar da insulin, wanda ake amfani dashi don sarrafa glucose mai shigowa. Shi, bi da bi, yana aiki a matsayin madadin makamashi don jiki. Tare da ModY, ana katse tsarin kuma jinin jini a cikin yaro ya tashi.

Rarrabawa

Zuwa yau, masu bincike sun gano alamun 13 na ciwon sukari na zamani na MODI. Sun yi daidai da maye gurbi a cikin kwayoyin halittun 13 waɗanda ke haifar da wannan cutar.

A cikin 90% na lokuta, nau'ikan 2 ne kawai ake samu:

• MODY2 - lahani cikin ƙwayoyin glucokinase,
• MODY3 - lahani ne a cikin hanyar don abubuwan nukiliya na hepatocytes 1a.

Sauran fom din suna lissafin nauyin 8-10% na lokuta.

• MODY1 - lahani cikin kyaututtukan da ke haifar da makaman nukiliya na hepatocytes 4a,
• MODY4 - lahani ne a cikin asalin abubuwan ingantawa na insulin,
• MODY5 - lahani a cikin kyautuka don yanayin nukiliyar hepatocytes 1b,
• MODYX.

Amma akwai wasu kwayoyin halitta waɗanda masana kimiyya ba su iya tantance su ba tukuna.

Symptomatology

Ana gano cutar sankarau a cikin yara zuwa mafi girman kwatsam, tunda hoton asibiti ya bambanta. Da farko dai, yana da alaƙa da alamomin nau'in 1 da nau'in ciwon sukari na 2. Cutar na iya bayyana kanta na dogon lokaci ko kuma ta haifar da ciwon suga wanda ke yawan fama da ciwon suga.

Glucokinase wani abu ne da ke cikin hanta.

• motsawar glucose da canzawa zuwa glucose-6-phosphate a cikin ƙwayoyin beta na pancreatic da hanta hepatocytes (a haɗewar glucose),
• sarrafa kan sakin insulin.

Kimanin nau'ikan maye gurbi na 80 na gulukokinase an bayyana su a cikin littattafan kimiyya. A sakamakon haka, aikin enzyme yana raguwa. Rashin isasshen amfani da glucose yana faruwa, saboda haka, sukari ya tashi.

• iri daya faruwa a duka yara mata da maza,
• azumi hyperglycemia har zuwa 8.0 mmol / l,
• glycosylated haemoglobin a matsakaita kan 6.5%,
• asymptomatic Hakika - sau da yawa ana gano yayin binciken likita,
• matsanancin rikice-rikice (retinopathy, proteinuria) - da wuya,
• watakila mafi muni da tsufa,
• sau da yawa babu buƙatar insulin.

Hakikanin gaskiya na nukiliya na Hepatocyte 1a shine furotin da aka bayyana a hepatocytes, tsibirin na Langerhans, da kodan. Ba a san hanyar ci gaban maye gurbi a cikin yara masu fama da ciwon sukari na zamani ba. Rashin aikin aiki na beta-cell-cell na ci gaba kuma yana lalata insulin. Wannan ana lura da shi a cikin kodan - ana rage maye gurbin glucose da amino acid.

Yana da sauri bayyana kanta:

• kara glucose zuwa adadi mai girma,
• m macro- da microvascular rikitarwa,
• rashin kiba
• tabarbarewa na lokaci,
• kama da nau'in 1 na ciwon sukari,
• m insulin.

Tsarin nukiliya na Hepatocyte 4a shine kayan abinci mai gina jiki wanda ke cikin hanta, koda, koda da hanjinsa. Wannan nau'in yayi kama da mody3, amma babu wani canji a cikin kodan. Rashin gado yana da wuya, amma mai tsanani ne. Mafi yawanci ana bayyana bayan shekaru 10 da haihuwa.

Dalilin mai ingantawa na insulin1 yana da hannu cikin haɓakar ƙwayar cuta. Lamarin yana da kankanta. Gano cutar a jarirai saboda rashin ci gaban gabobin. Ba a san matsakaicin rayuwar waɗannan yaran ba.

Hepatocyte factor nukiliya 1b - wanda ke a cikin gabobin da yawa kuma yana shafar ci gaban gabobin har ma a cikin utero.

Tare da lalacewa, kwayoyin maye, canje-canje an riga an bayyane su a cikin jariri:

• rage nauyin jiki
• cututtukan ƙwayar sel,
• lalata garkuwar jiki.

Sauran nau'ikan nau'in modi suna da irin wannan bayyani, amma za'a iya bambance wani nau'in kawai ta hanyar binciken kwayoyin.

Binciko

Cikakken tsarin da aka tsara daidai yana shafar zaɓin dabarun warkewa na likita. Mafi sau da yawa, ana gano nau'in 1 ko nau'in ciwon sukari na 2 ba tare da zargin wani abu ba. Babban ma'aunin bincike:

• shekaru 10-45 shekaru,
• rajista data kan sukari mai yawa a cikin mutanen 1, na 2,
• babu bukatar insulin tare da cutar tsawon shekaru 3,
• karancin nauyi,
• alamu na yau da kullun na furotin C-peptide a cikin jini,
• karancin maganin cututtukan farji.
• rashi na ketoacidosis tare da bayyananniyar bayyana.

Tsarin Nazarin Marasa lafiya:

• cikakken nazari game da anamnesis da korafi, zana bishiyar iyali, yana yiwuwa a bincika dangi,
• halin glycemic da azumi sukari,
• nazari na rashin hawan glucose,
• kafa glycated haemoglobin,
• Nazarin kwayoyin halittar jini (jimlar CTF, triglycerides, AST, ALT, urea, uric acid, da sauransu),
• Duban dan tayi na ciki,
• karafarini
• Binciken kwayoyin halitta,
• shawarwari tare da likitan mahaifa, likitan kwakwalwa, likitan tiyata, likita na gaba daya.

Binciken karshe shine binciken kwayoyin halitta.

Ana yin gwajin Gene ne ta hanyar sarkar polymerase (PCR). Ana ɗaukar jini daga cikin yaro, to lallai ne a keɓance kwayoyin halittar da suka zama tilas a cikin dakin gwaje-gwaje don gano maye gurbin. Daidai daidai kuma hanya mai sauri, tsawon lokaci daga kwanaki 3 zuwa 10.

Wannan ilimin ilimin tarihin yana bayyana kanta a cikin shekaru daban-daban, saboda haka ya kamata a daidaita magani (misali, yayin balaga). Shin akwai maganin warkaswar modi? Da farko dai, an tsara aikin motsa jiki na yau da kullun da kuma ingantaccen tsarin abinci. Wasu lokuta wannan ya isa kuma yana haifar da cikakken diyya.

Babban kayan abinci da kuma tattara hankalinsu na yau da kullun:

• furotin 10-20%,
• fats kasa da 30%
• carbohydrates 55-60%,
• cholesterol kasa da 300 mg / rana,
• fiber 40 g / rana
• gishirin gishiri kasa da 3 g / rana.

Amma tare da yanayin taɓarɓarewa da rikice-rikice iri-iri, ana kara aikin canza magani.

Tare da MODY2, magungunan rage sukari ba a sanya su ba, tun da sakamako yana daidai da 0. Bukatar insulin ya kasance ƙasa kuma an wajabta shi yayin bayyanar cutar. Akwai wadataccen abinci da wasanni.

Tare da MODY3, magungunan farko-na farko sune sulfonylurea (Amaryl, Diabeton). Tare da shekaru ko rikitarwa, an bayyana buƙatar insulin.

Sauran nau'ikan suna buƙatar ƙara kulawa daga likita. Babban magani yana tare da insulin da sulfonylurea. Yana da mahimmanci a zabi madaidaicin kashi kuma a hana rikice-rikice.

Hakanan shahararrun su ne yoga, motsa jiki na numfashi, magungunan gargajiya.

Idan babu maganin da ya dace, irin wannan rikice-rikice suna yiwuwa:

• rage rigakafi,
• mai tsanani siffofin da cututtuka,
• rashin tausayi da jijiyoyin jiki
• rasa haihuwa a cikin mata, rashin ƙarfi a cikin maza,
• anomalies a cikin ci gaban gabobin,
• Shiga cikin cutar kansar idanu, kodan, hanta,
• cin gaban mai fama da cutar siga.

Don guje wa wannan, an tilasta wa kowane iyaye ya kasance a faɗake kuma nan da nan tuntuɓi kwararrun malami.

Shawarwarin

Idan aka tabbatar da gano yanayin asibiti na MODI, to lallai ne a kiyaye ka'idoji masu zuwa:

• Ziyarci endocrinologist 1 lokaci / rabin shekara,
• Duba maganin haemoglobin 1 lokaci / rabin shekara,
• Janar gwaje-gwaje dakin gwaji 1 lokaci / shekara,
• dauki matakin hana daukar ciki a asibiti sau 1 / shekara,
• tafiye-tafiye marasa kula da marasa lafiya zuwa asibiti tare da karuwa da glucose na jini a ko'ina cikin rana da / ko alamun ciwon sukari.

Bin waɗannan sharuɗan zai taimaka wajen hana ciwon sukari.

Mene ne ciwon sukari na zamani

MUTANE masu ciwon sukari rukuni ne na ƙwaƙwalwar ƙwayoyin cuta guda ɗaya wanda ke haifar da mummunan ƙwayar cuta da tsoma baki tare da amfani da al'ada na glucose daga jini ta tsokoki na jikin mutum. A mafi yawan, cutar ta bayyana kanta lokacin balaga. Akwai sigar da 50% na ciwon sukari na yara yana ɗayan nau'ikan MODI.

Na farko ire-iren wannan nau'in cutar ita ce ta farko da aka gano ta a cikin 1974, kuma kawai a cikin tsakiyar 90s, godiya ga ci gaba a cikin kwayoyin halittar kwayoyin halitta da kuma yiwuwar wucewa gwaje-gwajen kwayoyin halittar mutum gaba daya, bayyanannen alamun wannan cutar ya zama mai yiwuwa.

A yau an san nau'ikan nau'ikan nau'ikan 13 na zamani. Kowannensu yana da nasa asalin tsarin lahani na asali.

Rikodin dake nuna lalataccen guntun tsari yana rufe sassan hepatocytes, kwayoyin insulin da kwayoyin halitta wadanda ke da alhakin rarrabewar neurogenic, da kuma kwayar sel da kansu da kuma samar da abubuwa.

Lastarshe akan jerin, ciwon sukari na MODY 13 shine sakamakon maye gurbi a cikin kaset ɗin da aka ɗauka na ATP: a cikin yankin na dangin C (CFTR / MRP) ko a cikin memba 8 (ABCC8).

Don bayani. Masana kimiyya sun tabbatar da cewa wannan ba cikakken lissafi bane na lahani, tunda maganganun cututtukan da ke kamuwa da cuta a cikin matasa waɗanda ke ci gaba da ganowa, waɗanda ke bayyane “a hankali” a nau'in balagaggu, ba sa nuna lahani na sama lokacin da aka ƙaddamar da gwajin kwayoyin, kuma ba za a iya danganta su da na farko da ba zuwa nau'in cuta na biyu ba, kuma ba zuwa tsaka-tsakin sifar Lada ba.

Bayyanar asibiti

Idan muka kwatanta cutar sukari ta zamani (MODI) tare da nau'in ciwon sukari na-insulin-insulin-type 1 ko kuma ciwon sukari na 2, to hanyarsa zata gudana lami lafiya kuma a hankali, ga kuma me yasa:

• Ba kamar DM1 ba, lokacin da adadin ƙwayoyin beta waɗanda ke samar da insulin suka zama dole don tasirin glucose yana raguwa koyaushe, wanda ke nufin cewa kwayar halittar insulin da kanta kuma tana raguwa, tare da cutar sukari ta zamani na MODI yawan ƙwayoyin da ke “lalacewa” a koyaushe
• rashin magani na DM 2 babu makawa yana haifar da hare-hare na hyperglycemia da karuwar ƙwayar ƙwayar tsoka ta suturar insulin, wanda ta hanyar ana samar da shi a farkon a cikin adadin al'ada, kuma kawai tare da doguwar cutar yana haifar da raguwa a cikin kwayar cutar sa, da ciwon sukari na zamani na MODI, gami da cikin "masu tsufa" marasa lafiya, ya keta haƙurin glucose kaɗan da kaɗan kuma a mafi yawan lokuta ba sa haifar da canje-canje a cikin nauyin jiki, ƙishirwa mai yawa, yawan motsa jiki da urination.

Tabbatacce, kuma ba ma 100% ba, wane irin cuta ne ciwon sukari na zamani na MODI a cikin yaro ko nau'in ciwon sukari na 1, likita zai iya kawai bayan gwajin kwayoyin.

Alamar don irin wannan binciken, farashinsa har yanzu yana da ma'ana (30 000 rubles), waɗannan sune alamun cutar ciwon suga na zamani:

• tare da bayyanar cutar, kuma a nan gaba, babu tsalle-tsalle mai tsami a cikin sukari na jini, kuma mafi mahimmanci, tattarawar jikin ketone (samfuran fashewar mai da wasu abubuwan amino) a cikin jini baya haɓakawa sosai, kuma ba a samo su a cikin urinalysis ba,
• nazarin plasma na jini don maida hankali ga C-peptides yana nuna sakamako tsakanin iyakoki na al'ada,
• glycated haemoglobin a cikin jini yana cikin kewayon 6.5-8%, kuma azumin glucose na jini baya wuce 8.5 mmol / l,
• babu alamun lalacewar autoimmunetabbatar da rashi kwayoyin hana daukar ciki ga kwayoyin beta,
• Ciwan zuma ba yakan faru ne kawai a cikin farkon watanni 6 na farkon cutar ba, har ma daga baya, kuma akai-akai, yayin da tsarin ɓarnar ba ya nan,
• koda karamin sashin insulin yana haifar da tsayayyar sakewawanda zai iya zuwa watanni 10-14.

Dabarar magani

Duk da cewa cutar sukari ta zamani (MODI) a cikin yaro ko saurayi na ci gaba a hankali, aikin gabobin cikin gida da yanayin tsarin jikin mutum har yanzu ba shi da kyau, kuma kasancewar rashin magani zai haifar da cutar ta zama mafi muni kuma tafi zuwa mummunan mataki na T1DM ko T2DM.

Abincin da ke motsa jiki da motsa jiki motsa jiki sune tabbataccen kayan aikin jiyya na kowane nau'in ciwon sukari

Bayanin kula da masu ciwon sukari na zamani iri ɗaya ne da wajan koyar da ciwon sukari na 2, amma tare da bibiyar hanyoyin bambanci:

• a farko - an soke allurar insulin kuma mafi kyawun adadin magunguna masu rage sukari, an zaɓi ƙoƙarin jiki na yau da kullun, ana ɗaukar matakan don fayyace buƙata ta iyakance yawan abincin da ke motsa jiki,
• sannan akwai cancelankanin rashi na rage ƙwayoyi masu rage sukari da ƙarin gyaran motsa jiki,
• yana yiwuwa cewa don sarrafa glucose a cikin ƙwayar jini zai isa kawai don zaɓar madaidaiciyar tsari da nau'in aiki na jiki, amma tare da wajabta rage sukari tare da kwayoyi bayan "zagi na hutu" na Sweets.

A bayanin kula. Banda shi ne MAGANAN 4 da 5. Tsarin kulawa dasu iri ɗaya ne tare da gudanarwar marasa lafiya da masu ciwon sukari na 1. Ga duk sauran nau'ikan MODI DM, ana sake dawo da insulin jab din ne kawai idan ƙoƙarin sarrafa sukari na jini tare da haɗuwa da magunguna masu rage sukari + abinci + maganin motsa jiki bai kawo sakamakon da ya dace ba.

Yana nuna nau'ikan nau'ikan SD MODI

Anan ga wani taƙaitaccen bayyani game da nau'ikan MODY tare da nuni da takamaiman hanyar da za a iya sarrafa glucose na jini, ban da abincin kai-dawwama mai ƙoshin lafiya da takamaiman kayan aikin motsa jiki.

Tebur yana amfani da raguwa na SSP - magungunan rage sukari.

Kuma a cikin ƙarshen bayanin, muna so mu ba da shawara ga iyaye waɗanda yaransu ke fama da cutar sankarau. Kada ku azabtar da su sosai lokacin da aka san wasu abubuwan da suka dace da ƙuntatawa game da abinci, kuma kada ku tilasta su su ci gaba da karatun ta hanyar ƙarfi.

Tare da likitan ku, nemi waɗannan kalmomin tallafi da imani waɗanda zasu ƙara motsa ku ku bi abin da kuke ci. Da kyau, masanin ilimin motsa jiki ya kamata yayi ƙoƙarin yin la’akari da fifiko na yaro, kuma ya ninka nau'ikan ayyukan yau da kullun, yana sa azuzuwan ba kawai suna da amfani ba, har ma da ban sha'awa.