ʻO nā hopena hoʻonā o ka maʻi maʻi

ʻO nā hopena o ka maʻi diabetes

Hoʻololi ka lāʻau kūlohelohe ʻo ke ʻano maʻi II

Nā hōʻailona o ka maʻi II

ʻO nā maʻi ākea (make wai, polyuria, pruritus, kokoke i nā maʻi) e maʻalahi a i ʻole. Hoʻopuka pinepineʻia (ma ka 80-90% o nā maʻi).

ʻO ka hemahema o ka insulin e hōʻemi ai i ka maʻi metabolic e like me ka mea e kū pū me ka nele o ka insulin, akā naʻe, ʻaʻole i hoʻopiʻi ʻia kēia mau maʻi, a me ke ʻano maʻi diabetes II ka nui o ka asymptomatic ma 50% o nā mea maʻi me ka huelo a me ka hyperglycemia modale.

ʻAʻole e like me ka hemahema o ka insulin, me ka hemahema o ka insulin, ua paʻa ka hopena o ka insulin ma ka kiko adipose, he nui nā maʻi o nā mea i hana i ka insulin. Hoʻokomo ʻia ka insulin ma ka adipose tissue i ka lipogenesis, poloka i ka lipolysis a me ka hoʻokuʻu o ka momona o ka momona i loko o ke koko, no laila, me ka maʻi type II, ʻaʻole kuhi ka ketoacidosis, ʻaʻole i emi ka pa o ke kino, akā, e hoʻomoʻo ka huelo. Pēlā ʻo obesity, ma ka ʻaoʻao hoʻokahi, ʻo ia ka hopena koʻikoʻi koʻikoʻi, a ma kekahi, kahi o ka hōʻike mua o ka maʻi II o ka maʻi nui.

No ka mea, ʻaʻole he maʻi o ka synthesis o ka insulin, hoʻoneʻe ʻia ka nui o ke koko kiʻekiʻe me ka hoʻokahe ʻia o ka insulin mai nā β-cells, ka mea hyperinsulinemia. ^ E Ha yM. Hoʻopili ʻia kahi kiʻekiʻe o ka insulin i ka hana ʻole a me ka luku ʻana i nā mea i nānā mai i nā insulin, e hōʻemi ana i ka hoʻohaʻahaʻa glucose i nā kiko. ʻAʻole hiki i ka insulin ke hoʻololi hou i ka glycemia; Ke kū'ē i ka insulin. ^ E Ha yM. I ka manawa like, kahi kiʻekiʻe o glucose i loko o ke koko e hoʻemi i ka hoʻonaninua ʻana o nā β-cell i ka glucose, ma muli o kēia, ua hoʻolāleʻa a hele ʻole paha ka hana mua o insulin.

Ma ka maʻi diabetes II II, ʻike ʻia ka hyperinsulinemia (80%), hypertension arterial (50%), hyperlipidemia (50%), atherosclerosis, neuropathy (15%) a me ka maʻi nephropathy maʻi (5%).

ʻO nā hoʻopiʻi huehue he kiko no nā maʻi II a me ke ʻano II.

ʻO ka hoʻoheheʻeʻana o nā loea ma ka wahi mua, me ka hōʻeha o ka metabolic i loko o ka nupepa ma ke ʻano, hiki ke alakaʻi i ka hoʻomohala ʻana i nā hoʻopiʻi kuʻuna i ke ʻano o ka coma. Coma he kūlana koʻikoʻi loa kēia, i hiʻohiʻona ʻia e ka hohonu hohonu o ka ʻōnaehana ma waena o ka uha, hoʻomau mau o ka ʻike ʻana, nalowale i nā hopena o nā ʻano kūwaho o kekahi ʻano ikaika. Hiki i nā pōmole i ka maʻi diabetes i nā ʻano ʻekolu: ketoacidotic, hyperosmolar a lactic acidosis.

ʻO ka coma Ketoacidotic hele pū me ka maʻi diabetes type, i ke ʻano o ka lilo ʻana o nā kino ketone ma mua o 100 mg / dl (a hiki i ka 400-500 mg / dl).

Nā alakaʻi Hyperketonemia i:

1) acidosis, ka mea e poloka ai i ka hana o ka nui o nā enzymes, ka mea hanu mua, ka mea e hōʻeha ai i ka hypoxia a me ka hoʻēmi ʻana i ka synthena o ATP.

2) ka hyperosmolarity, e alakaʻi ana i ka maʻi wai a me ka haunaele o ka pae wai-electrolyte, me ka pohō o ka paʻakai, sodium, ka phosphorus, magnesium, calcium, nā bicarbonate.

ʻO kēia, me kahi koʻikoʻi nui, e hōʻeha kahi coma me kahi hāʻule o ke kahe koko a me ka hoʻolālā ʻana o ka maikaʻi ʻole o ka aʻalolo.

I ka hopena o ka hypokalemia e alakaʻi i ka hypotension o nā māla palupalu a me ka striated, kahi hoʻohaʻahaʻa i ke kani vascular, kahi hoʻokahe i ke kahe o ke koko, arrhythmia cardiac, hypotension muscle respiratory me ka hoʻomohala ʻana i nā hana ʻoi ʻana o ka hana hanu, atony gastric me ka gastric paresis a me nā ʻeha o ka ʻōpū, hypoxia koʻikoʻi. Ma ke kumu maʻamau o ka make maʻamau, noho ia ma o 2-4%.

ʻO ka piko Hyperosmolar ʻano pili no ka maʻi type II, ʻike ʻia me ka hyperglycemia kiʻekiʻe. ʻO ka hapa nui i ka hyperglycemia kiʻekiʻe ma muli o ka hiki ʻole o ka renal concomitant, hoʻonāukiuki ʻia e ke kaumaha, trauma, dehydration kino o ke kino (ka luaʻi, ʻōpū, ʻokiʻoki, ʻokiʻoki i ke koko, a me nā mea ʻē aʻe). Hoʻokū maikaʻi ka coma Hyperosmolar i nā lā he nui, me ka kōkua o ke kanaka (ʻaʻole i hoʻohālikelike ʻia e ka inu ʻana), i ka manawa o ka paeʻā aʻe o ka glucose i 30-50 mmol / l.

ʻO ka Hyperglycemia paipai i ka polyuria, hana kūlana maʻi hyperosmotice kū ai huehue nā ōpala, e alakaʻi ana i ka hoʻopiʻi ʻana i ka kaulike wai-electrolyte.

ʻO kahi hoʻohemo nui ʻana o ke kino ma o ka pakanā, ka maʻiʻeha, ke kahe o ke koko ma muli o ka polyuria a me ka loaʻa ʻole o ka inu ʻana e alakaʻi hypovolemia. ʻO ka hypovolemia kumu a hōʻemi ai i ke kahe koko, ke kiʻekiʻe o ke koko, ke hoʻonui nei i ka ʻike a me ka hiki ʻōpalaola. ^ E Ha yM. Hōʻalo ka Hemodynamic i ke ʻano ischemia nā ōpala, ka hoʻomohala ʻana o ka hypoxia, ka hōʻiliʻili o ka lactate a me ka emiʻole o ka ikehu. Hoʻopuka ʻo ischemia Renal i ka hiki ʻana o ka hana ʻole o ka renal hina ʻole - anuria. ^ E Ha yM. Alakaʻi ʻo Anuria i ka hōʻiliʻili ʻana o ke koena hauā i loko o ke koko (amonia, urea, waʻa amino); maʻi pākaukau. ^ E Ha yM. ʻO ka hypovolemia ma o ald testosterone e hōʻemi i ka urinary excretion o NaCl, nā mea e kumu ai hypernatremia a me hyperchloremia. ^ E Ha yM. Hoʻonui ka Hyperazotemia, ka hypernatremia a me ka hyperchloremia i ka mokuahi hyperosmotic a me ka pohō ʻana o ke kaulike wai-electrolyte.

ʻO ka hemahema o ka ikehu a me ka hilahila o ka pale o ka wai-electrolyte e pale i ka hoʻokumu ʻia o ka pōpoki o nā neurons a me ka hana ʻana o nā mea hoʻonani i ke aʻalolo ma kahi o ke kihi kūloko, kahi i alakaʻi ai i ka coma. ʻO ka make ma ka hyperglycemic coma he 50%.

Lactic acidotic coma ʻano hiʻohiʻona no ka maʻi type II, ka mea me ka hōʻiliʻili o ka lactate. Ma mua o ka waiʻona o ka lactic, ka hoʻohioloʻana o ka adrenoreceptors i catecholamines i kahi i hoʻohaʻahaʻa nui, hoʻoulu kahi i hoʻihoʻi ʻole ʻia. ʻIke ʻia ka coagulopathy metabolic, i hōʻike ʻia e DIC, thrombosis peripheral, thromboembolism (myocardial infarction, stroke).

ʻO ka Acidosis me ka nui o nā kino ketone a me ka lactate mea paʻakikī iā Hb i ka hoʻololi ʻana i ka oxygen i ka kiko (hypoxia), he āina ia i ka hana o nā ʻāmeʻa a nui, ma mua, synthesis ATP, ka hele a me ka hana ʻana o nā mea kūlike o ka membrane ka paʻa, kahi e pale ai i ka hoʻōla ʻana o nā impulses i ke aʻalolo ma ka pūpū a me ka hōʻā.

ʻAʻole i ʻike i ka mea āu e ʻimi nei? E hoʻohana i ka huli:

Ka hana o ka hoʻomohala o ka ketoacidosis

ʻO ka ketoacidosis Diabetic ka mea maikaʻi loa ʻo ka mea hoʻokūkū o ka metabolic e hiki ke hele i ka maʻi type 1. Kuhi loa, ʻike ʻia kekahi maʻi ʻoi like ʻole i ka maʻi diabetes type 2.

ʻO ke kumu no kēia ʻano ke ʻike ʻole ʻia o ka maʻi diabetes mellitus o ke ʻano, ʻaʻohe ʻano mehana i loko o ke kino.

Hiki paha i kēia kūlana inā ʻaʻole i mālama ʻia ka lāʻau lapaʻau i ʻōlelo ʻia no nā maʻi maʻi type 1. Hōʻike pinepine ʻia kēia i ka hoʻohana ʻana i ka insulin i mālama pono ʻole ʻia a i ʻole me kahi ola i hoʻopau ʻia, ka hoʻokele ʻole ʻana o ka insulin, ʻoiai, no ka haki ʻana o kona ʻōnaehana, a me ka hewa hoʻi ʻole.

ʻO ka pathophysiology o ka ketoacidosis ka nui o nā pae. Ke nele nei i ka insulin, e piʻi ala ka nui o ke kō o ke koko, a hoʻomaka ka nui me ke kīpī ʻana mai e nā keiki me ka nui o ka wai. I ka maʻi o ka mea maʻi, hele pinepine ʻo ia i ka paleta a hoʻopau i nā ʻano he nui. Hoʻopili ka ʻili a me nā meli a me ka hoʻomaka ʻana o ka nalowale. ʻAʻole hiki i ke Sugar ke komo i loko o nā lau o ke kino, no laila ke hoʻohana ʻia nā hale momona momona intracellular i mea hoʻonaninani no ka hana ʻana o ka ikehu. I kēia hihia, hoʻokiʻoki i ka mea maʻi ka paona o ke kino.

I ka wā o ka hakiʻana o nā palaka, nā kino ketone a me nā momona momona i hoʻokuʻu ʻia i nā nui nui. Hōʻuluʻulu lākou i ke koko o ka mea maʻi ma ka nui. I kēia hihia, pilikia ka pH o ke koko, a hoʻomaka ka nui o ka acidity e hoʻonāukiuki i ka kikowaena papa. ʻO kahi hōʻailona o kēia kūlana he pōkole o nā hanu a hohonu hoʻi a me kahi hanu hanu. Eia kekahi, ʻike ka mea ʻono o ka acetone mai ka mea maʻi.

Hoʻokumu ka coma Diabetic i mau lā, i kekahi mau hola. Ke ulu nei nā ʻōuli, hoʻomaʻamaʻa ka mea maʻi ma ke kamaʻilio me nā poʻe ʻē aʻe, ʻo ka mea nui ka hiamoe. Makemake ʻo ia e hoʻolako i ka mālama mālama inā ʻaʻole lilo ka ʻike a me ke coma ma hope e ulu.

Kōkua me ka ketoacidosis ka mea i hoʻokomo i ka insulin intravenously ma nā liʻiliʻi liʻiliʻi me ka nui o hoʻokahi hola.

Eia kekahi, ua hoʻoluhi ʻia ka mea maʻi i nā lāʻau lapaʻau e kōkua ana i ka hōʻino a me ka hoʻihoʻi i nā pae maʻamau o ka paʻakai i loko o ke koko, a me nā lāʻau ʻē aʻe, e pili ana i ke kūlana o ka mea maʻi.

ʻO ka hoʻolālā o ka hoʻolālāʻana o ka comos hyperosmolar a me nā hōʻailona

ʻO ka comper Hyperosmolar kahi maʻi metaboleka koʻikoʻi ma ka wīwī type 2. Kuhi loa, hiki i kēia ʻano ke hele i nā ʻano maʻi like ʻole.

ʻO ka pinepine, loaʻa ka pathology i nā poʻeʻelemakule e loaʻa nā pilikia i ka ʻōnaehana cardiovascular. Hōʻike ʻia ka pathophysiology o kēlā mau coma i ka piʻi nui o ke kōhi koko i nā pae weliweli. Akā, ʻaʻole loli ka pH o ke koko. Me kēia ʻano o ka coma, kahi kiʻekiʻe i ka dehydration o ke kino e ulu ai. I kekahi mau lā, i ka wā e hoʻomohala nei i kēlā ʻano pilikia, hiki i ka mea maʻi ke nalowale e pili ana i 10% o kona paona.

Hiki i ke coma Hyperosmolar ke ʻano i ia mau hihia:

Hoʻomau hou ʻia, nā maʻi ʻeha.
Ka hoʻohana ʻana o ka diuretics.
Hoʻopau i ka wai komo.
Kūpono.
ʻAi a me nā hōʻeha.
Nā maʻi maʻi maʻi.
ʻO nā hala i ka meaʻai.
Nā kaʻina loiloi

ʻO nā hōʻailona o kahi coma hyperosmolar hiki ke hele mai a hiki i kahi mea maʻi me kahi ʻoluʻolu o ke ʻano maʻi maʻamau ʻo 2, ma ia mea e lawa ai ka hahai ʻana i ka ʻai a inu i ka pā. I ka poʻeʻelemakule, hiki i kahi maʻi ke hoʻonāukiuki i nā pilikia ma ka hoʻoliʻoliʻi mai o nā lolo, a ma hope iho e alakaʻi ai i nā hoʻopiʻi o ka maʻi diabetes.

Pono kahi mea maʻi me nā hōʻailona o ka hyperosmolar coma e hāʻawi pono i ka mālama ʻōnaehana i ka hoʻonohonoho haukapila. Hoʻomaopopo ka mālama ʻana i ka hoʻihoʻi ʻana i ka kaila wai i loko o ke kino me ke kōkua o ka infra intous. Eia kekahi, ʻo ka insulin e mālama ʻia i loko o nā wahi liʻiliʻi i kēlā me kēia hola.

ʻO ka hoʻokūkū o ka hoʻomohalaʻana i ka waikawa lactate

ʻO ke ʻano maʻi o ka maʻi lactic kahi kūlana koʻikoʻi ma o ka hoʻonui nui ʻana i ka pae o ke kino o ka lactic acid, ʻo ia kāna pathophysiology. ʻO ka hoʻomohala ʻana i kēia kūlana, he ʻano nui o nā poʻe makua me ka maʻi o ka maʻi ma ka puʻuwai, nā ate, nā ʻōpū, nā ʻōpū, a me nā wai ʻona. Hiki ke kiʻekiʻe o ka waikawa lactic me ka lawa ʻole o ka lako me nā ʻāpana o ke kino.

ʻO nā hōʻailona o ka acidosis lactic e pili ana: ʻeha ma ka umauma a ma hope o ke sternum, nāwaliwali, nā hōʻeha hōʻeha, ke kāwele o ka hanu a hoʻomaha hoʻi, ka ʻeha ma ka ʻōpū, hiki i ka hiki ke hana. ʻO kahi hōʻailona o ka lactic acidosis ka hiʻohiʻona o ka nausea a me ka luaʻi. He hopena hoʻonāukiehu ka Lactic ma ke kikowaena o ka hanu, no laila ke kumu hohonu a me ka puehu hanu ka mea maʻi.

Hoʻokumu ʻia ka mea lapaʻau i ka hoʻokumu ʻana o nā hopena alkali, a me nā wai hou a me nā lāʻau lapaʻau e hoʻomaʻamaʻa i ke koko. I kekahi manawa aia no ka hoʻomaʻemaʻe i ke koko o ka mea maʻi e hoʻohana ana i kahi mea hana papa loea.

Ka hana o ka hypoglycemia

Haka ka hypoglycemic coma i ka hanana nui o ke kahe o ke koko glucose. ʻO ia ka mea maʻamau i waena o nā kūlana o ka pilikia i ka poʻe me ka maʻi maʻi. ʻOi aku kēia mau hoʻopiʻi i ka mea maʻi e pili ana i ka insulin me nā ʻano maʻi o ke ʻano maʻi.

ʻO ka hana o ka hoʻolālāʻana o ka hypoglycemia ka nele o ka ikaika o nā kiko i loko o ka cortex cerebral me ka hoʻokuʻu pū ʻana o ka hormone kaumaha i loko o ke kahe wai i ka nui. ʻO nā hōʻailona o ka hypoglycemia nā:

āhāhuʻe
poʻomanaʻo
ka ʻāʻā ʻana o ka alelo a me nā lehelehe,
hopohole o ka hopohopo
ke ʻano o ke kaumaha a me ka makaʻu
nānā nānā
hoʻonā wahaʻōlelo
tachycardia
nahoa
pilikia hāmeʻomaʻi paʻakikī
e haʻalulu ana i loko o ke kino a me nā ʻalā
pololi
ho'ēmi i ka ʻike a me nā mea ʻē aʻe.

Ke hele nei nā ʻōuli mua o ka hypoglycemia, pono ka mea maʻi e ʻai i kekahi mea momona. ʻO ka koho kūpono ʻo ia ka wai momona a i ʻole kaʻaala ʻoluʻolu. Inā ʻaʻole e lawe ka mea maʻi i kēlā mau aina, hiki iā ia ke lilo i ka naʻau a hāʻule i loko o kahi coma.

I kēia hihia, kōkua ke kōkua ʻana i ka hoʻokō intravenous i kahi hopena glucose a i ʻole ka kaha intramuscular injection me ka ʻōlelo hoʻāla a glucagon. Ma kahi hypoglycemia koʻikoʻi, pono ka hoʻokipa o ka mea maʻi i kahi ʻoihana lapaʻau e pono ai no ka hoʻokolokolo a me ka mālama ʻana.

Inā hāʻawi ʻia ka kōkua kūpono i ka mea maʻi, hiki i ka mea ke pani i ka hana o ka hoʻomohala ʻana i kahi kūlana koʻikoʻi a hiki i nā hōʻailona mua. A i ʻole, ʻaʻole pono ka pupule - hiki i ka hoʻopiʻi ka hopena i ka make o ka mea maʻi. Me ka coma maʻi maʻi, make ka hala ma kahi o 10% o nā hihia a pau o ka hoʻomohala ʻana i kahi ʻano.

3. ʻO nā ʻōhua o ka maʻi maʻi

ʻO ke kumu nui o nā hoʻopiʻi o ka maʻi diabetes e hyperglycemia. Hiki i ka Hyperglycemia ke hōʻino i nā pili koko

Kuhi. 11-31. ʻO kahi hoʻololi i loko o ka metabolism o ka maʻi mellitus o nā maʻi a me nā kumu o ka coma maʻi maʻi.

a me ka huhū o nā ʻāpana a me nā huina.

ʻO kekahi o nā hana nui o ka hōʻino o ka ʻōpū i ka maʻi diabeteskaleka e alakaʻi ana i kahi loli i kā lākou hoʻokuʻina a me nā hana. Loaʻa i kekahi mau ʻōhua i nā mea kalaiia, a me ke kūkulu ʻana i kēlā glycoproteins e hoʻoulu i ka enzymatically (no ka laʻana, ka hoʻokumu ʻana i nā hormones glycoprotein o ka adenohypophysis). Eia nō naʻe, kahi hui ka non-enzymatic o ka glucose me nā pūʻulu amino manuahi o ka nui o ka protein - non-enzymatic glycosylation o nā protein - hiki ke loaʻa i loko o ke kino o ke kanaka. Ma nā kiko o nā kānaka olakino, e hele mālie nei kēia ʻano. Me ka hyperglycemia, hoʻonui ke kaʻina o ka glycosylation. ʻO ka pae nui o ka glycosylation o nā protein e hilinaʻi ana i ka wikiwiki o kā lākou hou. ʻO ka lohiʻana i nā hoʻololi i hōʻemi i nā loli hou aʻe. ʻO kekahi o nā hōʻailona mua o ka maʻi mellitus o ka maʻi i hoʻonui ʻia i ka 2-3 i ka nui o ka hemoglobin glycosylated (maʻamau N_{na B}A_1C5.8-7.2%). ʻO kekahi hiʻohiʻona ʻē aʻe o ka hoʻololi lōlohelohe i nā protein i loaʻa i ke aniani - nā protine lens. Ma luna o ka glycosylation, hoʻopiha i nā crystallins multimolecular aggregates e hoʻonui i ka mana refractive o ka lens. Ke emi nei ka ʻike o ka lens, e kau ana ke ao, a i ʻole cataract.

Hoʻololi i ka hoʻololi lōlū pū me nā protein o ka intercellular matrix, basement membranes. ʻO ka popo ʻana o nā membrane papahele, kekahi o nā hoʻopiʻi e pili ana i ka maʻi mellitus i mea maʻi, alakaʻi i ka hoʻomohala ʻana o nā angiopathies maʻi maʻi.

ʻO ke kumu o nā hala ʻōpiopio o ka maʻi maʻamau o ka maʻi maʻi ke hoʻonui nei i ka piʻi o ka huli o ka glucose i ka sorbitol (e nana i ka pauku 7).

ʻO ka pane ʻana o ka hoʻololi o ka glucose i ka waiʻona hexatomic (sorbitol) i kahiki ʻia e ka enzyme aldose reductase. ʻAʻole hoʻohana ʻo Sorbitol i nā ala hololi hou ʻē aʻe, a lohi i kona kaʻawale ʻana mai nā cell. I nā mea maʻi me ka maʻi mellitus, hōʻiliʻili ka sorbitol i ka retina a me nā lens o ka maka, nā pūnaola o ka glomeruli o nā kolo, nā huaʻōlelo Schwann, ma ka endothelium.

ʻO Sorbitol i nā kikowaena kiʻekiʻe e hoʻopau i nā mea hoʻoweliweli. ʻO kāna hōʻiliʻili i nā neurons e alakaʻi i ka hoʻonui i ke kaomi osmotic, ka huehue o ke a me ka edema kiko. No ka laʻana, hoʻomohala ka opacification lens ma muli o ka huehue o ka lens i hoʻokumu ʻia e ka hōʻuluʻulu ʻana o ka sorbitol a i ʻole hōʻino ʻia o ka hana ʻikepili i kauoha ʻia.

Hoʻopau kūhaka. Hoʻopuka pinepine ʻia nā angiopathies Diabetic e ka hōʻino ʻana i nā membrane basement vascular. I ka hoʻoneʻe kiʻekiʻe o ka glucose i ka plasma koko, ua hui ʻia ka proteoglycans, collagens, glycoproteins glycosylate, ke hoʻololi a me ka ratio i waena o nā mea hoʻohui o ka membranes basement i hoʻopau ʻia, hoʻopau ʻia kā lākou hoʻonohonoho.

Macroangiopathy hōʻike ma nā leʻaleʻa o nā moku nui a me waena o ka puʻuwai, ka naʻau, nā pae haʻahaʻa. ʻO ka hoʻololi ʻana i ka maʻi i loko o ka lula o ka wahī o ka wahī a me ka pōʻino o ka paia o ka paia i loko o ka papa waena a i waho, he hopena ia o ka glycosylation o nā membement basement a me nā protein o ka matrix intercellular (kolagala a me elastin), ka mea e hōʻemi ai i ka hoʻoneʻeneʻe o ka elastity o nā ʻāpana. I ka hui pū me ka hyperlipidemia, hiki ke lilo i ka hopena o ka hoʻomohala ʻana i ka atherosclerosis. Me ka maʻi maʻamau, ʻoi aku ka nui o ka atherosclerosis, ulu i kahi makahiki ma mua o ka holomua ʻana o ka maʻi maʻi.

Hoʻolālā Microangiopathy - ka hopena o ka hōʻino i nā capillaries a me nā moku liʻiliʻi. Hōʻike ʻia i ke ʻano o nephro-, neuro- a me ka retinopathy.

ʻĀnapana hoʻomohala ʻia i kahi hapakolu o nā maʻi me ka maʻi maʻi. ʻO ka hoʻololiʻana o ka electron-mikroscopic i ka membrane basement i ka glomeruli luaʻa i hiki ke ʻike ʻia i ka makahiki mua ma hope o ke ʻano maʻi. Eia naʻe, i ka hapa nui o nā mea maʻi, ʻike ʻia nā hōʻailona lapaʻau o ka nephropathy maʻi ma hope o 10-15 mau makahiki o ka maʻi diabetes. ʻO kahi hōʻailona o nā hoʻomaka mua o ka nephropathy ʻo microalbuminuria (i loko o 30-300 mg / lā), e ulu ana i ka maʻi nephrotic maʻamau, hōʻike ʻia e ka proteinuria kiʻekiʻe, hypoalbuminemia a me edema.

Retinopathy o ka hoʻopiʻi maikaʻi loa ʻana i nā maʻi diabetes a me ke kumu maʻamau ka maʻamau o ka makapō, kūkulu ʻia i ka 60-80% o nā maʻi me ka maʻi maʻi

maʻi maʻi. I ka wā ma mua, ulu ka basin retinopathy, nāna i hōʻike iā ia iho i ka hemorrhages retinal, vasodilation o ka retina, edema inā ʻaʻole i pili nā loli i ka macula, ʻike mau ʻia ka pohō ʻike. I ka wā e hiki mai ana, e hoʻomohala ai ka retinopathy proliferative, i hōʻike ʻia i loko o nā neoplasms o nā kaola retina a me vitreous. Ka huhū a me nā kiʻekiʻe kiʻekiʻe o nā moku i kūkulu ʻia i ka hemorrhages pinepine i ka nui o ka retina a i ʻole vitreous kino. Ma ka kahua o nā paka koko, ulu ka fibrosis, e alakaʻi ana i ka detinal a retinal a me ka nalowale o ka ʻike.

B. ʻO ka maʻi maʻi o ka maʻi maʻi

ʻO ka maʻamau, hiki ke hoʻomākaʻi ʻia i ka maʻi o ka maʻi ma ke kumu o nā hōʻailona maʻamau o ka maʻi maʻi - hyperglycemia, polyuria, polydipsia, polyphagia, ka manaʻo o ka waha maloʻo. ʻO ka hōʻailona nui biochemical hōʻailona o IDDM ua ʻike ʻia ma ka kumu o:

hōʻike hoʻoliʻelima glucose (ʻike Fig. 11-30). ʻO ka pae uila glucose ka nui ma luna o 10 mmol / l 2 mau hola ma hope o ke kau ʻana i ke kōpaʻa e hōʻike ana i ka maʻi mellitus,

hoʻoholo o ka hemoglobin glycosylated. Me ka maʻi o ka maʻi maʻi, ka pae o ka H_{na B}A_1s, ka hōʻike maʻamau no ka 5% o ka nui o ka maʻi hemoglobin, e hoʻonui i ka 2-3 manawa,

ka haʻalele ʻana a i ʻole ka haʻahaʻa o ka insulin a me C-peptide i ke koko a me ka urine. ʻO ka maʻamau, nā mea huna a me C-peptide i hūnā ʻia i nā kaulike equimolar. Ma kahi e pili ana i ka 2/3 o ka insulin e hoʻopaʻa ʻia e ka nuku, ka pae o ka insulin / C-peptide i ka veins portal a me nā moku periferi he maʻamau 1/3. ʻO ka waiwai o ke kiʻekiʻe o ka C-peptide i ka serum a i ka urine paha e hiki iā ʻoe ke loiloi pololei i ka ʻano hana o β-cell,

albuminuria. Me ka maʻi diabetes, ʻo ka lālapa o kēlā me kēia lā o ka albumin ma kahi o 30-300 mg - microalbuminuria (ma kahi o 8 mg).

No ka mea ke ulu nei ka NIDDM i ka wikiwiki, nā hōʻailona maʻamau o ka hau, ma ke ʻano he hyperglycemia, a me ka hemahema o ka insulin ma hope, e hui pū ʻia me nā hōʻailona o ka hoʻopiʻi o ka hopena o ka maʻi maʻi.

D. Hāʻawi i ka pili ʻana i ka maʻi maʻi

Hoʻokumu ka mālama ʻana i ka maʻi lolo i kāna ʻano (I a ʻo II paha), he paʻakikī a kau i ka ʻai, ka hoʻohana ʻana i nā lāʻau hoʻohiolo gula, ke ʻano ʻana o ka insulin, me ka pale ʻana a me ka mālama ʻana mai i nā hōʻahewa.

Ua hoʻokaʻawale ʻia nā lāila hoʻohaʻahaʻa hou i nā meli i ʻelua mau pūʻulu nui: derphatives sulphonylurea a me nā biguanides. ʻO ka hoʻomākaukau e pili ana ka hana no ka hoʻoulu ʻana i ka mea huna insulin i ka sulfonylureas (no ka laʻana, mannyl). Hoʻākāka ka hana o ka hana o ka sulfonylureas ma o ko lākou mana i ka hana o nā kahawai KP-sensitif K +. Ke hoʻonui nei i ka ʻike intacellular o K + e alakaʻi i ka depolarization membrane a hiki i ka neʻe ʻana i ka lawe ʻana i nā meakanu kalapona i loko o ka pūlea, ma muli o ke ʻano o ka huna ʻana o ka insulin.

ʻO Biguanides kekahi ʻano nui i nā lāʻau lapaʻau haʻahaʻa. Wahi a kekahi mau noiʻi, hoʻonui ʻia ka biguanides i ka nui o nā mea halihali GLUT-4 ma ka ʻaoʻao o ka iwi adipose a me nā ʻili kinipōpō.

Hoʻokomo i nā ala e pili ana i ka mālama ʻana i ka maʻi diabetes: ka hoʻololi hou ʻana i nā mokupuni pancreatic a i ʻole cells-cell i hōʻola ʻia, ka hoʻololi ʻana o nā hua i kūkulu ʻia i loko o ke ʻano, me ka hoʻoulu ʻia ʻana o ka ulu ʻai hou o ka pancreatic.

Me nā ʻano like ʻole o ka maʻi mellitus, ʻo kaʻai ʻana i ka meaʻai ka mea nui loa. Kūleʻa lākou i kahi meaʻai kūpono: ʻona kūloko e nānā i ka 50-60% o ka nui o nā calorie o nā meaʻai (ʻo ka ʻokoʻa ke kālai ʻia ʻona huehue, pia, inu ʻona, pōpō, mau keke, etc.), protein - 15-20%, nā momona āpau - ʻaʻoleʻoi aku ma mua o 25-30%. Pono ka ʻai i nā lā he 5-6 i ka lā.

Hōʻailona

Hoʻokomo ka com Hypoglycemic coma i nā mea maʻi me ka maʻi mellitus, i ka nui o nā hihia, i ka wā e hoʻonāukiuki ʻia ai ka nui o ka insulin a i ʻole sulfonylurea hoʻomākaukau ʻana a me ka meaʻai e komo ai, ʻoi loa ka kāloli. I loko o ka maʻi mellitus mola, hypoglycemic coma e ulu pinepine i ka pinepine i ka ketoacidotic.

ʻO ka maʻamau, hele a hypoglycemia a me hypoglycemic coma i nā mea maʻi me ka maʻi koʻikoʻi, koʻikoʻi nā luhi o ka mellitus diabetes insulin-mellitus, kahi hiki ʻole ke hoʻokumu i kahi kumu o waho o ka ulu wikiwiki ʻana i ka ulu ʻana i ka insulin. I nā manawa ʻē aʻe, ʻo nā mea hoʻonāukiuki he mau wā lōʻihi ia ma waena o ka papaʻai, ka nui o ka hoʻoikaika kino, ka luaʻi, nā maʻi a me nā kūlana pathological ʻē aʻe. ʻO ka hoʻohālikelike mellitus maʻi 'aʻai o nā palani, nā palupalu, kahi kūlana endocrine, ka hoʻomohala ʻana o ka hiki ʻole o ka renal i alakaʻi i ka hypoglycemia koʻikoʻi. Hoʻokomo pinepine ka comog hypoglycemic coma me ka hoʻouka nui o ka insulin, hiki ke loaʻa i nā maʻi i kēia manawa:

kekee hala (ʻo ka ʻōpū o ka hoʻomākaukau ʻana o ka insulin, no ka laʻana, me ka ʻili U40 ma kahi o U100, ʻo ia hoʻi, 2,5 mau manawa i kuhikuhi ʻia, a i ʻole he ʻimi i koho ʻia i ka insulin i ka ʻāʻī wīwī).
kahi hewa i ka ʻoihana o ka lāʻau lapaʻau (ʻaʻole ma lalo o ka ʻili, akā intramuscularly) - ka pāpaho lōʻihi, a i ʻole ka pelekū intramuscular intact e hiki ai ke hoʻonui a hoʻonui i ka hopena o ka hormone.
ka nele ʻole e lawe i nā haʻalowa ma hope o ka hoʻokō ʻana i kahi maʻa o ka insulin ʻawaʻawa pōkole ("poina iā ʻoe e ʻai" - a kakahiaka kakahiaka, ʻaina ahiahi a i ʻole pāʻina ʻelua i ka papa o ka hana o ka hoʻomākaukau ʻana o ka insulin hana pōkole).
"Hoʻolālā ʻole" ka hana pilikino ma muli o ka loaʻa ʻole o ka ʻai mau o ka mea laʻa: ke nānā ʻia i ka insulin → “poina” i ʻai (ʻaʻole ʻai i nā papa ʻai kino e hoʻolako ai i ka hana kino pilikino) → hele kaʻau ʻana, ke pāʻani ʻana, ka lawaiʻa, ka hau hau a me nā ʻano ma ke ʻano huikau → hypoglycemia → koma
ka hoʻonui ʻana i ka wahi o ka inikini insulin (manaʻo - i hiki ke hoʻokaʻawale i ka hana o ka hoʻomākaukau ʻana o ka insulin hana pōkole a i ʻole hōʻino ʻia - ʻo ke kau ʻana i ka insulin i ka ʻāʻī a e holo ana i kahi uila).
ka hoʻokuʻu ʻana o ka nui o ka nui o ka hāmeʻa ikaika ma mua o ka hakahaka o ka pūhui o ka insulin-antibody,
oiai e inu ana i ka waiu,
i ke alo o ka momona momona,
e kū aku ana i ka hope o ke kaulike o ka hana renal,
i ka wā hāpai,
hana kūpono
shocks insulin i ka hana psychiatric a pēlā aku.

I ka poʻe me ka maʻi diabetes, he hopena hypoglycemic coma paha ka hopena o ka overdose o ka insulin, inā paha i ka manawa e hoʻoneʻe ana ka mea maʻi mai kahi kūlana ketoacidosis.

ʻO ka hoʻomohala ʻana o ka hopena hypoglycemic koʻikoʻi hiki ke kūʻē i ke kua o ka inu wai, ka hopena hoʻohaʻahaʻa o ka hilo o ka hana i mālama ʻole ʻia, me ka noʻonoʻo ʻana i nā mea huapalapala i ka hana o nā mea inu ʻawaʻawa i ka hoʻomākaukau ʻana o ka meaʻai. Hoʻopā ka ʻawaʻawa i ka synthesis o nā glucose mai nā huahana kala-ole-kalaiwa i ka puhaka, a laila e hoʻonui ai i ka pinepine o ka hypoglycemia i nā maʻi ma ka hoʻomehana insulin. ʻOi aku ka nui o ka inu wai, ʻoi aku ka lōʻihi o ka paʻa ʻana o ka gluconeogenesis, no laila hiki ke hele mai ka hypoglycemia ma hope o kekahi mau hola ma hope o ka inu ʻana.

Kuhi ʻia kahi ʻōhua o ke koko hoʻemi haʻahaʻa inā:

kāpae ʻia ka ʻaihue mai ke koko i kahi wikiwiki ma mua o ka hoʻowalewale ʻana i ka pūpū a i ʻole hoʻi i ka ʻāʻī ʻana o ke akepaʻa.
Hoʻolaha ka glycogen a me / a i ʻole ka synthesis o ka glucose mai nā mea waiwai ʻole-kalaiwa i loko o ka puʻuwai ke hiki ke hoʻopaʻi i ka pae o ka hōʻemi glucose.
Hoʻohui ʻia nā mea ma luna aʻe.

ʻO ka manawa pinepine, ʻo ka hoʻomaka ʻana o ka hoʻonaninani o ka maʻi diabetes e hoʻonui i ka ʻike ʻana o nā ʻiʻo peripheral i insulin, e koi ana i ka hōʻemi o ka manawa o ka nui o ka hormone e hoʻokele ʻia mai waho mai.

Ma muli o ka lāʻau Sulfanilamide hiki ke hōʻemi i ka hopena hypoglycemic, ʻo ka mea nui ke hiki ke hele mai i nā poʻe maʻi me ka hui pū ʻana o ka maʻi mellitus me nā maʻi o ka pūpū, nā puʻuwai a i ʻole ka palaualelo, a me ka pōloli a i ʻole ka pōʻino. ʻO ka hoʻohana ʻana i kekahi mau lāʻau lapaʻau e hui pū me ka sulfonamides hiki ke hoʻonāukiuki i ka hoʻokumu ʻana o kahi coma. No ka laʻana, acetylsalicylic acid a me nā salicylates ʻē aʻe, ma o ka hoʻemi ʻana i ka kaila o ka sulfonamides i nā protein plasma koko a me ka hoʻohaʻahaʻa ʻana i kā lākou excretion i ka urine, hana i nā kūlana no ka hoʻokumu ʻana i kahi hopena hypoglycemic.