Hyperglycemia thiab impaired insulin secretion yog ob yam kab mob ntau tshaj plaws hauv cov menyuam yaus thiab cov tub ntxhais hluas. Raws li lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb, qhov tshwm sim ntawm cov me nyuam muaj ntshav qab zib yog nce zuj zus. Hauv 5-10 xyoo tom ntej no, cov neeg mob tau npaj siab nce siab ntxiv los ntawm 70%.
Puas muaj ntshav qab zib rau tus menyuam?
Tus kws kho mob tau piav qhia tias txawm yog cov me nyuam yug tshiab, cov kev ua mob hauv endocrine tshwm sim tsis hais hnub nyoog li cas. Ntau tus niam txiv xav paub seb puas muaj peev xwm muaj ntshav qab zib rau cov menyuam yaus uas tsis muaj qhov tseem ceeb ua rau tus kab mob. Lo lus teb rau lo lus nug no zoo. Muaj ntau hom mob ntawm tus kab mob hauv kev saib xyuas, qee yam ntawm lawv tus kheej vim yog sab nraud lossis lwm yam kev mob ntsws.
Hom mob ntshav qab zib nyob rau hauv cov me nyuam
Ntxiv nrog rau hom kab mob uas paub zoo tshaj plaws, uas tau faib tawm raws li insulin vam khom, muaj lwm hom teeb meem ntawm metabolic hauv carbohydrates. Tsis tshua muaj hom mob ntshav qab zib:
- Neonatal. Qhov sib txawv ntawm tus kab mob no yog kuaj pom cov me nyuam mos thiab cov me nyuam mus txog 6 lub hlis. Cov kab mob ntshav qab zib no nyob rau hauv cov menyuam yaus tshwm sim nyob rau hauv daim ntawv mus ntev. Hauv thawj cov ntaub ntawv, tus menyuam xav tau cov tshuaj insulin maj mam nws ploj nws tus kheej rau ib nrab xyoo. Lub cev qeeb ntawm pathology yav tom ntej no yuav yog 50%. Qhov thib ob subtype yog cov cim los ntawm kev xav tau lub neej rau cov tshuaj insulin.
- MODY. Cov tsiaj uas tau hais no yog deciphered raws li ib qho kev paub ntawm cov ntshav qab zib rau cov menyuam yau (Kev Txaus Siab-Pib Ntshav Qab zib ntawm Yong). MODY yog qhov tshuaj tiv thaiv kab mob ntawm pancreatic hlwb inherited hauv hom autosomal dominant (tsis txuam nrog rau kev sib deev ntawm tus me nyuam, kis ntawm ib tiam dhau ib tiam). Qhov mob ntshav qab zib no muaj 9 subspecies, feem ntau yog cov uas tau pom los ntawm cov hoob kawm me, qee zaum kuj tsis muaj cov tshuaj insulin ntxiv.
- Secondary. Ib hom kab mob tsawg kawg ntawm tus kab mob uas tshwm sim tawm tsam keeb kwm ntawm kev mob caj dab heev. Cov kab mob ntshav qab zib no tuaj yeem nrog cov syndromes ntawm Rogers, Wolfram, Alström, Rabson-Mendelholl, leprechaunizm, lipodystrophy thiab lwm pathologies.
1 hom mob ntshav qab zib mellitus
Cov hom kab mob ntawm cov kab mob endocrine ntev (hom tshuaj insulin) yog qhov feem ntau ntawm cov me nyuam me. Diabetes mellitus type 1 hauv cov me nyuam yog cais ua 2 pawg:
- autoimmune;
- idiopathic.
Thawj daim ntawv ntawm tus kab mob yog tsiag ntawv los ntawm kev kuaj pom nyob hauv cov ntshav, uas tawm tsam thiab rhuav tshem cov kob ntawm cov kab mob hauv cov kob pancreas. Vim li ntawd, cov kab mob hauv lub cev endocrine ua rau cov insulin tsis txaus los ua kom cov ntshav qis. Nws yog qhov nyuaj dua los piav txog idiopathic ntshav qab zib nyob rau hauv cov me nyuam - qhov ua rau hom kab mob pathology no tsis paub. Hauv cov ntshav ntawm tus me nyuam, tsis muaj tshuaj tiv thaiv, tab sis tus kab mob no tau zoo ib yam nkaus.
2 hom mob ntshav qab zib mellitus
Ib hom kab mob insulin-independent ntawm tus kab mob twb tau kuaj pom feem ntau rau cov laus thiab cov neeg laus. Mob ntshav qab zib hom 2 hauv cov me nyuam pib tsim nyuam qhuav. Qhov no yog vim muaj kev hloov hauv txoj kev ua neej thiab kev noj haus ntawm cov niaj hnub no. Malnutrition thiab tsawg muaj kev cuam tshuam kev rog, uas ua rau endocrine mob.
Ua rau ntawm cov ntshav qab zib mellitus
Cov xwm txheej uas ua rau cov kev mob siab piav qhia nyob ntawm seb nws zoo li cas. Neonatal, secondary thiab MODY-ntshav qab zib tshwm sim vim cov noob noob tuag. Cov kab mob tsis tshua muaj nrog rau kev phom sij. Lub ntsiab ua rau hom 1 mob ntshav qab zib mellitus tau muab faib ua 2 pawg:
- caj ces;
- sab nrauv.
Hereditary predisposition nyob rau hauv cov ntaub ntawv no tsis hloov hauv cov noob cais, tab sis nyob rau hauv lawv cov tshwj xeeb ua ke. Qhov muaj ntshav qab zib mellitus hauv niam txiv los yog lwm tus neeg hauv tsev neeg tsis yog qhov kev lees paub ntawm txoj kev loj hlob ntawm tus me nyuam. Los qhib thiab taw kev ua kom tsis zoo hauv endocrine, yuav tsum muaj lwm yam ntxiv sab nraud:
- khoom noj khoom haus tsis zoo (preservatives, nitrates, gluten);
- co toxins;
- kab mob viruses ( rubella , parotitis, Epstein-Barr thiab lwm tus);
- mob nyhav los sis mob nyhav.
Qhov ua rau hom 2 mob ntshav qab zib yog qhov tsis zoo rau lub neej rau me nyuam yaus. Hloov ntawm kev ua haujlwm ntawm cov txiav thiab cov metabolic ntshawv siab hauv lub cev tshwm sim rau hauv keeb kwm ntawm:
- tas li overeating;
- rog;
- tsis muaj kev sib haum xeeb;
- nquag siv "khoom noj khoom haus vas nthiv".
Mob ntshav qab zib mellitus rau cov me nyuam - cov tsos mob thiab cov cim
Lub npe ntawm cov kab mob pathology hauv cov me nyuam mos tau pom zoo sai dua rau cov laus. Cov tsos mob ntawm cov ntshav qab zib nyob hauv cov me nyuam yog nce zuj zus vim yog:
- kev paub tsis meej ntawm cov enzymes thiab endocrine systems;
- metabolism ceev nrooj, nrog rau cov carbohydrates thiab suab thaj;
- unformed neural bundles.
Nrog insulin deficiency, tsis qab zib, thiab lub hlwb lub cev muaj zog zog tshaib plab. Rau nws cov quenching, Sibhawm pib yuav consumed nrog tsim ntawm ketone lub cev thiab acetone, uas yog cov tshuaj lom. Qhov no mechanism yog lub luag hauj lwm rau txoj kev ntshav qab zib yog pom nyob rau hauv cov me nyuam. Disintegration khoom tsim nyob rau hauv cov ntshav, provoking ketoacidosis thiab cov tsos mob thaum ntxov ntawm tus kab mob.
Thawj cov cim mob ntshav qab zib hauv cov menyuam yaus
Yog tias daim ntawv TSIS XYUAS tshwm sim, tus kab mob no maj mam pib nrog daim duab uas pom tau tias tus me nyuam leej niam leej txiv tsis tuaj yeem pom. Hauv lwm cov mob, ntshav qab zib mellitus nce nrawm heev - cov tsos mob ntawm cov menyuam yaus thaum ntxov ntawm kev mob ntsws muaj xws li:
- ib qho kev xav hauv kev nqhis dej thiab qhov muag nyob hauv qhov ncauj;
- enuresis ;
- nquag tso zis ;
- kev noj qab haus huv ntxiv;
- xav pw tsaug zog tom qab noj mov;
- nkees.
Rau ob peb lub lis piam, cov tsos mob ntawm cov ntshav qab zib nyob hauv cov menyuam yaus nce. Tsis tas li ntawd pom tias:
- causeless poob phaus;
- tsis pom kev;
- kab mob rau daim tawv nqaij;
- neurodermatitis ;
- mycoses;
- khaus ntawm daim tawv nqaij;
- ichthyosis.
Diabetic coma - cov tsos mob
Tus mob hauv qhov teeb meem tshwm sim yog tias ntshav qab zib mellitus hauv cov me nyuam loj hlob tsis kho. Qhov no yog ib qho xwm txheej tsis tshua muaj teeb meem, uas txawm tias qhov kev tuag yuav yog. Tus yau dua tus me nyuam, nws yuav tsum tau hu rau tsev kho mob kom sai dua. Diabetic coma hauv cov menyuam yaus yog nrog nws los ntawm kev poob siab. Qhov kev mob no tshwm sim los ntawm cov tsos mob nram qab no:
- mob taub hau;
- ntxhov siab, ua raws li los ntawm apathy;
- tsis muaj qab los noj mov;
- xeev siab thiab ntuav;
- zog nqhis dej;
- mob plab;
- kev mob ntawm kev tso zis;
- ib tug ci blush rau ntawm lub puab tsaig nrog daj ntseg ntawm daim tawv nqaij;
- tob thiab ua pa nrov;
- nce lub plawv dhia;
- txo qis hauv lub cev thiab ntshav siab;
- zawv plab nrog ntshav;
- sinking ntawm eyeballs;
- ntse tsw ntawm acetone los ntawm zis;
- cramps ntawm nqua.
Cov teeb meem ntawm cov ntshav qab zib nyob rau hauv cov me nyuam
Tom qab ntawd, qhov kev kuaj pom los ntawm txoj kev kuaj qog los yog tsis muaj kev kho ua rau ua rau muaj kev cuam tshuam loj heev rau txhua lub cev, nrog rau kev ua haujlwm ntawm lub hlwb. Cov teeb meem ntawm ntshav qab zib:
- Neuropathy;
- angina pectoris;
- arteriosclerosis ntawm cov hlab ntsha;
- plawv nres;
- kub siab;
- mob stroke;
- nephropathy;
- raum tsis ua hauj lwm ;
- qeeb hauv kev puas hlwb thiab lub cev kev loj hlob;
- retinopathy;
- hemorrhage nyob rau hauv lub qhov muag;
- glaucoma;
- cataract;
- dig muag;
- paj hlwb rhiab heev ntawm qhov qis dua;
- khaus thiab kua tawv nqaij;
- kab mob bacterial thiab fungal dermatological;
- kev pob txha ntawm pob txha;
- kev sib ceg.
Mob ntshav qab zib mellitus - mob
Kev pom zoo ntawm kev pom zoo ntawm txoj kev txhim kho endocrine pathology yog ua tiav raws li cov kev mob tshwm sim thiab kuaj sim. Cov qoob loo ntawm cov ntshav qab zib ntawm cov me nyuam nyob ntawm nws lub hnub nyoog:
- mus txog 12 lub hlis - 2.8-4.4 mmol / l;
- 1-5 xyoos - 3.3-5 mmol / l;
- tshaj 5 xyoos - txog 5.5 mmol / l.
Yuav kom paub tseeb tias mob ntshav qab zib hauv cov menyuam yaus thiab txiav txim siab nws hom, ntau cov kev ntsuam xyuas ntshav ntxiv tau ua tiav rau cov yeeb yam nram qab no:
- insulin thiab proinsulin;
- C-peptide;
- glycosylated hemoglobin;
- kam rau ua piam thaj;
- acid-base xeev (CBS);
- tshuaj tiv thaiv kab mob beta-hlwb ntawm lub txiav thiab glutamate decarboxylase;
- caj ces hloov.
Nws tseem yuav tsum tsim nyog los tso zis los txiav txim siab txog qhov concentration:
- piam thaj;
- ketone lub cev;
- acetone.
Kev kho mob ntshav qab zib rau cov menyuam
Nws yog ib qho tseem ceeb rau cov niam txiv paub txog tias tus neeg tau txais kev kuaj mob yog qhov tseeb. Mus txog cov kev kho ntawm pancreatic kev ua tiav thiab kev hloov ntawm cov kab mob carbohydrate tau tsim muaj, kev kho mob ntshav qab zib hauv cov menyuam yaus thiaj li yuav yog lub neej ntev. Txoj kev kho yuav tsum muaj thiab tas mus li, nws yuav tsum tau ua raws li tus kws kho mob pom zoo, ua raws li kev noj haus thiab muab sij hawm rau kev siv lub cev.
Thawj qhov uas pib kho yog ib txwm saib xyuas ntshav qab zib ntau ntau. Ua li no, yuav ib qho glucometer thiab kuaj cov kab xev. Yuav kom tswj tau tus kab mob ntawm cov kab mob, kws kho mob yuav tsum muaj lub chaw muag ntawv tshwj xeeb, uas sau tseg tsis tas li nyeem ntawm lub cuab yeej, tab sis kuj yog tus neeg ua haujlwm pab cuam:
- muaj kev ntxhov siab los yog raug mob;
- noj cov zaub mov thiab dej haus;
- kev qoj ib ce;
- dav dav ntawm kev noj qab haus huv thiab lub luag haujlwm.
Kev Kho Mob Hom 1 Ntshav Qab Zib Mellitus Hauv Cov Menyuam
Daim ntawv ntawm cov kab mob pathology no yog kev ua los ntawm tus kab mob plab insulin tsawg hauv tus menyuam lub cev. Yuav kom tswj tau lub neej qub, nws yuav tsum tau them rau qhov tsis muaj ib yam tshuaj ntawm sab nraud. Yuav kom tswj tau hom 1 mob ntshav qab zib rau cov menyuam yaus, txhua txhua hnub txhaj tshuaj insulin yuav tsum tau txhaj. Ntau npaum li cas thiab kev txhaj tshuaj muaj peev xwm raug xaiv los ntawm tus kws tshawb fawb hauv lub tshuab xam tagnrho raws li ntau yam:
- hnub nyoog thiab qhov hnyav ntawm tus mos ab;
- degree ntawm hyperglycemia;
- qhov siab ntawm tus menyuam;
- theem kev qoj ua ub ua no
Tshuaj tiv thaiv kabmob ntshav qab zib hauv cov menyuam yaus tsis kho tus mob uas tsis muaj insulin los. Lwm cov kev kho mob yog charlatanism thiab txaus ntshai rau tus menyuam. Tsuas yog cov tswvyim tswj tau zoo tshaj plaws rau hom kab mob no:
- txhua hnub txhaj;
- kev noj zaub mov ua raws;
- cev ua ub ua no.
Kev Kho Mob Hom 2 Ntshav Qab Zib Mellitus Hauv Cov Menyuam
Qhov piav qhia ntawm pathology yog tsawg dua, feem ntau ntawm 10-20% ntawm cov neeg mob. Qab zib insulin-dependent ntshav qab zib nyob rau hauv cov me nyuam pom zoo ib txoj kev kho, uas muaj xws li cov dej num li no:
- normalization ntawm lub cev hnyav (thaum muaj kev rog);
- kev qoj ib ce;
- qhov ua tiav ntawm kev noj zaub mov;
- noj tshuaj hypoglycemic.
Cov kev ua si uas tsim nyog muaj xws li tsawg kawg yog 3 cov kev ua si ntawm cov kev ua kis las txhua lub lim piam rau 1-1.5 teev. Tsis tas li ntawd, tus me nyuam yuav tsum ua txhua hnub (3-4 km), cov hluas xav kom mus rau 5-7 km. Nrog parallel ua raws li endocrinologist tswv yim rau kev noj haus, qhov no yog txaus kom muaj qhov concentration ntawm qab zib thiab noj qab nyob zoo.
Yog tias tus kabmob ntshav qab zib hauv cov menyuam yaus pom zoo thiab ua ketoacidosis, yuav tsum tau hloov cov insulin deficiency thaum muaj xwm ceev. Tom qab tswj qhov qab zib thiab txo cov qe kab mob hauv lub cev, koj tuaj yeem cheem qhov hno tshuaj. Txhawm rau tswj tau tus kab mob ntawm cov kab mob, cov tshuaj hypoglycemic raug sau rau hauv cov ntsiav tshuaj. Tsuas pub noj tshuaj ntawm pawg neeg no nkaus xwb, tau pom zoo siv rau hauv chaw kho kev puas hlwb - Metformin.
Mob ntshav qab zib rau cov menyuam yaus
Tus menyuam noj cov zaub mov yuav tsum tau pom zoo nrog tus kws kho mob. Kev noj zaub mov zoo nrog hom 2 mob ntshav qab zib zoo ib yam li cov zaub mov rau kev kho tus kab mob insulin-dependent. Nws yog tsim nyog los txo qhov ntim ntawm cov tais diav uas tsim muaj cov kabmob uas muaj zog carbohydrate nyob rau hauv cov txiav:
- ci;
- starch porridge (mov, semolina);
- pasta;
- qos yaj ywm.
Txwv tsis pub khoom:
- pickling;
- cov khoom haus luam yeeb;
- rog pluas noj;
- muaj dej kua;
- bananas;
- txiv hmab txiv ntoo;
- qab zib, cov khoom noj uas muaj cov ntsiab lus siab (chocolate, jam thiab lwm tus).
Hauv daim ntawv qhia zaub mov:
- zaub;
- txiv hmab txiv ntoo;
- nceb noj;
- fermented mis nyuj khoom;
- kev noj zaub mov, nqaij qaib, ntses;
- nqaij nruab deg;
- herbal teas.