Lefu la tsoekere ke lefu la kelello, leo ke lona keketseho ea tsoekere ea mali. Matšoao a mantlha a lefu lena a tsamaisana le hyperglycemia, 'me ka phello ea eona, menyetla ea mathata a lefu la tsoekere e ka boleloa esale pele.
Tekanyo ea glucose e phahameng e lula e senya lerako la methapo 'me e lebisa ho nts'etsopele ea mafu a liphio, retina, tsamaiso ea methapo ea methapo, leifo la lefu la tsoekere, angioeuropathies ea boima bo fapaneng.
Phekolo e sa nepahalang ea lefu la tsoekere kapa ho ba teng ha mafu a kopaneng a ka baka ho feto-fetoha ha tsoekere maling le nts'etsopele ea lefu la lefu la tsoekere, le hlokang tlhokomelo ea bongaka ea tšohanyetso.
Lisosa tsa hyperglycemia ho lefu la tsoekere
Keketseho ea tsoekere ea mali ho mofuta oa 1 lefu la tsoekere e amahanngoa le khaello ea insulin e phethahetseng. Lisele tsa beta ka har'a manyeme li timetsoa ka lebaka la ho hlaha hoa karabelo ea mofuta oa autoimmune. Likokoana-hloko, lintho tse nang le chefo, meriana, khatello ea kelello e baka tlolo ea sesole sa mmele. Ho na le lefu ho bakuli ba reriloeng esale pele ka lefutso.
Mofuteng oa 2 oa lefu la tsoekere, secretion ea insulin ka nako e telele e kanna ea se fapana le e tloaelehileng, empa li-insulin tse amohelang insulin ha li arabe lihormone tsena. Ntho e ka sehloohong holima kholo ea lefu la tsoekere ke botenya khahlanong le semelo sa lefutso. Mofuta oa bobeli oa lefu la tsoekere o hlaha ka lebaka la khaello ea insulin.
Ka bofokoli bo felletseng ba insulin kapa tsoekere, tsoekere e ke ke ea kenella liseleng 'me ea sebetsoa hore e hlahise matla. Ka hona, e lula e le leseli la sejana, e baka phallo ea metsi mecheng, kaha ke ntho e sebetsang. Ho felloa ke metsi 'meleng hoa eketseha' meleng, kaha liphio li tlosa mokelikeli o kulang hammoho le tsoekere.
Ho latela botebo ba hyperglycemia, khakanyo ea lefu la tsoekere e hakanngoa:
- Bonolo: glycemia e ka tlase ho 8 mmol / l, ha ho na glucosuria kapa ho na le menyetla ea tsoekere maling ka moriring. E koaelitsoe ke lijo, angiopathy e sebetsang.
- Tekanyo e leka-lekaneng: tsoekere e potlakileng ho fihla ho 14 mmol / l, tsoekere ka letsatsi ha e holimo ho 40 g, ketoacidosis e etsahala nako le nako. Phekolo e na le matlapa kapa insulin (ho fihla ho li-unit tsa 40) ka letsatsi.
- Tekanyo ea boima: glycemia e kaholimo ho 14 mmol / l, glucosuria e phahameng, insulin e fanoa ka tekanyetso e kholo, ho na le li-angioneuropathies tsa lefu la tsoekere.
Kahoo, haeba ho na le tsoekere ea mali e 16 le hore na ho kotsi ho motho ea nang le lefu la tsoekere, karabo ea potso e ts'oanang e ka ba ntle, hobane letšoao lena le bua ka mokhoa o matla oa lefu la tsoekere.
Boemo bona bo ka fetoha phepelo e matla ea lefu la tsoekere - lefu la tsoekere la ketoacidosis.
Lisosa tsa ketoacidosis ho lefu la tsoekere
Nts'etsopele ea ketoacidosis e etsahala ka tekanyo e phahameng ea glycemia le keketseho ea palo ea 'mele ea ketone maling. Sesosa sa eona ke khaello ea insulin. Mofuta oa pele oa lefu la tsoekere o ka qala ka ketoacidosis ho lefu la morao, mme mofuteng oa 2 oa lefu la tsoekere le hlaha methating ea lefu lena, ha mehloli ea manyeme e felile.
Ho hana insulin kapa ho itlhahisa ka boomo, ts'oaetso le likotsi tse mpe, ts'ebetso, ho nka li-hormone le diuretics, le ho tlosa manyeme ho boetse ho lebisa ho hyperglycemia e matla le ketoacidosis.
Ho haella ha insulin ho lebisa hoketseho ea boemo ba glucagon, hormone ea kholo, cortisol le adrenaline maling, e leng ho tsosang ho phatloha ha glycogen ho sebete le ho thehoa ha glucose ho eona. Sena se lebisa keketseho ea glycemia. Ho feta moo, ha ho na insulin, ho phatloha ha liprotheine le mafura ho qala ka keketseho ea boemo ba amino acid le mafura acid maling.
Kaha glucose ha e eo liseleng, 'mele o qala ho fumana matla ho mafura. ts'ebetsong ea methapo ea ketone e joalo e thehoa - acetone le organic acids. Ha boemo ba bona bo phahame ho feta kamoo liphio li ka tlosang, ketoacidosis e hlaha maling. Mafura a tsoang lijong tse jeoang ha a nke karolo ho ketogenesis.
Boemo bona bo tsamaisana le ho felloa ke metsi haholo. Haeba mokuli a sa khone ho noa metsi a lekaneng, tahlehelo e ka ba ho fihla ho 10% ea boima ba 'mele, bo lebisang ho fokoliseng mmele ka kakaretso.
Mofuta oa bobeli oa lefu la tsoekere le decompensation hangata o tsamaea le mmuso oa hyperosmolar. Kaha insulin e teng e thibela ho etsoa ha 'mele oa ketone, empa kaha ho se karabelo ho eona, hyperglycemia ea eketseha. Matšoao a ho butsoa ha hyperosmolar:
- Motsoako o mongata haholo.
- Lenyora le ke keng la hlakoloa.
- Nausea
- Ho fokotsa boima ba 'mele.
- Khatello ea mali e phahameng.
- Methati e phahamisitsoeng ea sodium maling.
Lisosa tsa boemo ba hyperosmolar e ka ba ho omella ka tekanyo e kholo ea lithethefatsi tsa diuretic, ho hlatsa, kapa lets'ollo.
Ho boetse ho na le mekhoa e kopantsoeng ea ketoacidosis le hyperosmolar decompensation.
Matšoao a ketoacidosis
Lefu la tsoekere le tšoauoa ka keketseho ea butle-butle ea matšoao a hyperglycemia. Ketoacidosis e hlaha ka nako ea letsatsi kapa ho feta, ha molomo o omileng o eketseha, le haeba mokuli a e-noa metsi a mangata. Ka nako e ts'oanang, malaise, hlooho, mathata a ka mpeng ka mokhoa oa lets'ollo kapa ho sokela, bohloko ba ka mpeng le ho hlatsa ka linako tse ling ho bakuli.
Keketseho ea hyperglycemia e lebisa ho khathatsong ea kelello, ponahalo ea lerata le ho phefumoloha khafetsa, letlalo le ikutloa le omme ebile le chesa, monko oa acetone o tsoang molomong, 'me ha o tobane le mabali a mahlo, bonolo ba bona bo senoloa.
Liteko tsa bosholu bo netefatsang ketoacidosis li lokela ho etsoa liponong tsa pele tsa hyperglycemia. Tlhahlobo ea mali e etsa qeto ea ho eketseha ha tsoekere ho feta 16-17 mmol / l, 'mele ea ketone e teng maling le moriring. Sepetlele, liteko tse joalo lia etsoa:
- Glycemia - ka hora.
- 'Mele oa Ketone o maling le ka moroto - lihora tse' ne kaofela.
- Lielektrone tsa mali.
- Palo e felletseng ea mali.
- Diminineine ea mali.
- Qeto ea mali pH.
Phekolo ea hyperglycemia le ketoacidosis
Mokuli ea nang le matšoao a ketoacidosis hang-hang o fuoa lerotholi le nang le letsoai la 'mele' me likarolo tse 20 tsa insulin e sebetsanang le nako e khutšoane li kenngoa ka har'a methapo.
Ka mor'a moo, insulin e ntse e tsoela pele ho kenngoa ka har'a methapo kapa ka har'a mesifa ka tekanyo ea likarolo tse 4-10 ka hora, e thibelang ho phatloha ha glycogen ke sebete mme e sitisa ketogenesis. Ho thibela ho lula ha insulin, albin e tsamaisoa ka botlolong e le 'ngoe.
Hyperglycemia e tlameha ho fokotseha butle, hobane ho theoha ha tsoekere ka potlako ho ka lebisa ho edema ea osmotic, haholo-holo ho edema ea boko. Motšehare o hloka ho fihla boemong ba 13-14 mmol / l. haeba mokuli a sitoa ho ja lijo a le mong, o fuoa tsoekere ea 5% e le mohloli oa matla.
Kamora hore mokuli a fole, 'me glycemia e tsitsitse boemong ba 11-12 mmol / l, o khothalletsoa hore a noe metsi a mangata, o ka ja lijo-thollo tse halikiloeng, litapole tse khotliloeng, meroho kapa sopho e entsoeng ka makhapetla. Ka glycemia e joalo, insulin e tsamaisoa butle-butle qalong, hanyane ka hanyane ho latela tloaelo e tloaelehileng.
Ha o tlosa mokuli ho lefu la lefu la tsoekere la ketoacidosis, ho sebelisoa litlhare tse latelang:
- Sodium chloride 0,9% ka kakaretso ea boima ba 7-10% ea boima ba 'mele lihoreng tse 12 tsa pele.
- Plasma e nkela khatello ea systolic ka tlase ho 80 mm Hg. Art.
- Potasiamo chloride e laoloa ke maemo a mali. Pele, mokuli o fumana infusions ea potasiamo, ebe litokisetso tsa potasiamo matlapeng a beke.
- Ho kenngoa ha soda ha ho sebelisoe hangata ho lokisa acidosis.
Tharollo ea 0,45% ea sodium chloride e sebelisetsoa ho phekola boemo ba hyperosmolar mme insulin ha e sebelisoe kapa e laetsoe ka litekanyetso tse nyane haholo. Malebela ho bakuli ba hlokahalletseng: lino tse ngata tsa metsi, lino tse nooang li nkiloe masapo, li-carbohydrate tse bonolo ha li kenyelletsoe ka thoko. Ho thibela thrombosis, bakuli ba tsofetseng ba fuoe heparin.
Ho thibela keketseho ea tsoekere ea mali le nts'etsopele ea ketoacidosis ho lefu la tsoekere, ho ka etsahala feela ka ho lekola khafetsa boemo ba glycemia, ho latela lijo tse nang le thibelo ea lik'habohaedreite tse bonolo, ho nka metsi a lekaneng, ho fetola tekanyetso ea insulin kapa matlapa a mafu a kopaneng, khatello ea maikutlo e feteletseng.
Tlhahisoleseling mabapi le hyperglycemia e hlahisoa ka video sehloohong sena.
