Mathata a methapo le methapo ho lefu la tsoekere

Ho haella ka botlalo ha insulin (sekoli se ka sehloohong sa metabolic ho tsoekere) se lebisa ho sitisoeng ha mefuta eohle ea metabolism, mme ka holim'a tsohle - carbohydrate:

ho eketseha ha gluconeogenesis ka lebaka la tahlehelo ea khatello ea "insulin" ea li-enzyme tsa bohlokoa tsa gluconeogenesis,

ho eketseha ha glycogenolysis tlasa ts'usumetso ea glucagon, gluconeogeneis e eketsehileng le glycogenolysis e baka tsoekere e ngata maling le

phetiso ea eona ka li-membrane ho lisele tse itšetlehileng ka insulin e senyeha ka lebaka la khaello ea insulin.

Kahoo, e ikhethang ketsahaloha 'mele o na le tlala ea matla o nang le mohloli o mongata oa matla o tsoang maling.

Hyperglycemia - letšoao le ka sehloohong la lefu la tsoekere - ea eketseha plasma osmolaritymme e isa hoho omella hoa sele. Hang ha monyako oa renal bakeng sa glucose (8-10 mmol / L) o feta, o hlahella ka har'a moroto, o etsa horeglucosurialepolyuria(matšoao a ho bolaoa ha DM). Polyuria e amana le ho thatafala ha metsi le li-electrolyte ka lebaka la mongobo o phahameng oa moroto oa mantlha. Polyuria le hyperosmia li bakalenyoralepolydipsiahapenocturia(matšoao a ho bolaoa ha DM).

Osmotic diuresis e lebisa ho hoholo ho omella ka botlaloleKehoeoping. Liphello tsa ho omella kehypovolemia, ho fokotseha ha khatello ea mali, ho mpefatsa ho eketsehileng ha kelello, liphio, khatello ea filtration,oliguria(ho fihlela ho nts'etsopele ea ho hloleha ha renal haholo ". Ntle le moo, ka lebaka la ho fokola hoa metsi, ho fifala ha mali hoa hlaha, ho putlama, ho hlohlona ICE, le mathata a methapo ea methapo a lebisa hohypoxialisele.

Hyperglycemia e boetse e lebisa ts'ebetsong potoloho ea polyol(ka ts'ebetso ea aldoreductase). Ke metabolism e ikemetseng ea "glucose" ka sebopeho sa sorbitol le fructose. Lihlahisoa tsena li bokellana linthong tse sa sebetseng tsa insulin tse ikemetseng (lilense, lithane tsa methapo, lisele tsa sebete, lisele tse khubelu tsa mali, methapo ea mali, basophilic insulocytes) mme, ka ho ba osmotic, e hohela metsi, e lebisang ho senyeha ha lisele tsena.

Hyperglycemia ka ho bokella sorbitol (mme, ka hona, depletion ea libaka tsa polokelo tsa NADPH₂), hape hape ka lebaka la ho fokotseha hoa ts'ebetso ea protheine kinase C, e lebisa ho fokotseha ha motsoakonitric oxide (endothelial relaxation factor), e lebisang ho vasoconstriction le tischem ischemia,

Hyperglycemia le eona e lebisa ho hyalinosisle ho totisa mabota a methapo ea mali (hyalinosis - sebopeho sa li-glycoprotein, tseo, ha li feta kamoreng e ka tlase ea capillaries, li oela habonolo mme li hyalinized).

Hyperglycemia e matlafatsa ts'ebetso glycosylation ea protheine(glycosylation ke ts'ebetso ea khokahano e se nang enzymatic ea tsoekere le lihlopha tsa amino tsa protheine). Ka lebaka leo, lihlahisoa tse tsitsitseng tsa glycosylation li thehoa:

glycosylated hemoglobin. Ho ba le kamano e phahameng ea oksijene, ha e e fe lisele, hypoxia e hlaha,

glycosylated apoprotein ea LDL le HDL, e lebisang keketseho ea keketseho ea LDL / HDL.

glycosylation ea liprotheine tsa mokhoa oa ho tsitsipana le anticoagulation, e lebisang ho thrombosis e eketsehileng,

glycosylation ea liprotheine tsa mantlha tsa membrane e ka tlas'a lefatše le collagen,

glycosylation ea myelin, e lebisang phetohong ea sebopeho sa boitsebahatso,

glycosylation ea liprotheine tsa lense, e lebisang tlhabong ea likatse,

glycosylation ea liprotheine tsa insulin transporter, tse lebisang ho hanyetsaneng ha insulin, jj.

Lihlahisoa tsohle tsa glycosylation li na le sebopeho se fetotsoeng, se bolelang hore li ka fumana thepa ea antigenic, ka lebaka leo tšenyo ea autoimmune ho litho le lisele tse lumellanang li hlahang.

Khaello ea insulin hape e lebisa kholong lactic acidosis. Mekhoa:

Ho haella ha insulin ho lebisa ho thibeng ha pyruvate dehydrogenase, ka lebaka leo PVA ha e fetohe AcCoA (ho chesa ka c. Krebs). Boemong bona, Ponse e feteletseng e fetoha lactate,

ho haella ha insulin ho matlafatsa protabolism ea "protabolism", e lebisang ho thehoeng ha likarolo tse ngata tsa tlhahiso bakeng sa tlhahiso ea pyruvate le lactate,

tishu hypoxia, hammoho le keketseho ea tšebetso ea lihormone tse loantšanang (haholo-holo adrenaline le STH) ho lebisa ts'ebetsong ea anaerobic glycolysis, e bolelang keketseho ea ho etsoa ha lactate.

Mafura metabolismle mofuta oa 1 lefu la tsoekere, ba amahanngoa le ho haella ha insulin le ho eketseha hoa tšebetso ea lihormone tse loantšanang. Sena se lebisa ho fokotseha ha ts'ebeliso ea tsoekere ka lithaelese tsa adipose ha a ntse a fokotsa lipogenissi le ho ntlafatsa lipolysis. (bakuli ba nang le lefu la tsoekere la 1 ba tšesaane).

Ka lebaka leo, ketogenic amino acids (leucine, isoleucine, valine) le FFA li kena ka har'a sebete, moo li fetoha karoloana ea tšebeliso e feteletseng ea 'mele oa ketone (acetoacetic, b-hydroxybutyric, acetone). Ho ntshetsa peleHyperketonemia

Ho tsepamisa likelello tsa litopo tsa ketone:

inhibit sebopeho sa insulin le ho e etsa,

qhibiliha lipids tsa sebopeho, tse eketsang ts'abo ea lisele,

ho thibela tšebetso ea li-enzyme tse ngata,

inhibit mesebetsi ea tsamaiso ea methapo e bohareng,

baka nts'etsopele ea ketoacidosis,

baka nts'etsopele ea khatello e matlafatsang ea maikutlo,

tlola hemodynamics: inhibit myocardial contractility le ho fokotsa khatello ea mali ka lebaka la keketseho ea likepe tse poteletseng.

Mathata a metabolite ea protheineba nang le lefu la tsoekere ba tsebahala ka:

inhibition of synthesis protein (insulin activates synthesis enzymes) le

keketseho ea ho phatloha ha eona ea mesifa (insulin inhibits gluconeogeneis enzymes, ka lebaka la ho hloka insulin, AK e ea sebopeng sa tsoekere),

kaholimo ho moo, AK conduction ka li-membrane tsa sele e ea ferekanngoa.

Ka lebaka leo, khaello ea protheine e thehoa 'meleng, e lebisang ho:

kholo e makatsang ea bana

ho se lekane ha ts'ebetso ea polasetiki,

leqeba la ho folisa

fokotsa lihlahisoa tsa Ati

fokotswa ho hanela mafu,

kaholimo ho moo, phetoho maemong a li-antigenic tsa liprotheine tsa 'mele li ka baka ts'ebetso ea autoimmune.

Mathata a lefu la tsoekereli arotsoe ka a hlobaetsang le a sa foleng. Mathata a hlobaetsang a lefu la tsoekere - coma. Sa foleng - angiopathies le neuropathies.

Li-angiopathies tsa lefu la tsoekere li arotsoe ka li-micro- le macroangiopathies.

Diabetes Microangiopathies - liphetoho tsa pathological lijana tsa microvasculature.

bokella sorbitol le fructose leboteng la likepe,

lihlahisoa tsa glycosylation tsa liprotheine tsa membrane e ka tlas'a lefatše,

hyalinosis ea lerako la sekepe,

Ka lebaka leo, sebopeho, metabolism le mesebetsi ea lebota la sekepe li senyeha, ischemia ea lithane ea nts'etsapele. Mefuta e ka sehloohong ea microangiopathies: retinopathy le nephropathy.

Lefu la tsoekere la retinopathy- Microangiopathy ea likepe tsa retinal, sethaleng sa terminal se lebisang ho tahlehelo e felletseng ea pono. Microaneurysms, maculopathy, hemorrhages ea vitreous. Liphephetso - mokokotlo oa mokokotlo, glaucoma ea bobeli.

Nephropathy ea lefu la tsoekere- Tšenyo e ikhethileng ea li-microvasculature tsa lijana tsa liphio, e tsamaeang le ho etsoa ha li-glomerulosclerosis le CRF setsing sa ho bola.

Letsoalo la lefu la tsoekere- Tšenyo ea methapo ea methapo e bohareng.Mekhoa:

glycosylation ea liprotheine tsa membrane tsa kamore e ka tlase,

bokella sorbitol le fructose leboteng la likepe,

Sena sohle se lebisa ho matlafatsang, ho fokotseha ha lebota la sekepe, ho eketseha ha tumello, ho nyamela ha li-heparin receptors, ho khomarela liplatelete ka bongata le ho susumetsa ho eketseha ha mesifa ea mesifa, ho ea pele le ho ntlafatsoantshetsopeleatherosulinosis. Mefuta e ka sehloohong ea li-macroangiopathies tsa lefu la tsoekere:

ho senyeha ha coronary, ka hona, lefu la pelo le ho nyekeloa ke pelo joalo ka mathata a lona,

Tšenyo ea likokoana-hloko tsa qoqotho ka tsela ea methapo, mathata a nakoana a ho potoloha ha pelo le dementia,

Lits'oants'o tse bobebe tsa likepe tsa lipallo tse tlase ka mokhoa oa claudication, necrosis, gangrene.

Lefu la tsoekere- Tšenyo ea methapo ea kutlo ho lefu la tsoekere.

peripheral nerve protein glycosylation,

sebopeho sa li-antibodies ho liprotheine tse fetotsoeng le autoaggression mabapi le li-antigen tsa lisele tsa methapo,

ho bokella ha sorbitol le fructose ho li-neurons le lisele tsa Schwann,

ea fokotseha HA HO na motsoako leboteng la sekepe.

Sena sohle se lebisa ho sitiseng phallo ea mali a makatsang, ho fokotseha ha motsoako oa myelin, le ho fokotseha butle-butle molemong oa litšusumetso tsa methapo. Mefuta ea lefu la tsoekere:

Tšenyo ea CNS (encephalopathy, myelopathy),

Tšenyo ea methapo ea kutlo (polyneuropathy, mononeuropathy): mathata a koloi le a maikutlo,

tšenyo ea methapo ea kutlo (autonomic neuropathy): litšitiso tsa taolo ea tšebetso ea pelo, molumo oa methapo, lesapo la mokokotlo, lesapo la mokokotlo.

Angiopathies le neuropathies li ka lebisa ho mathata a lefu la tsoekere a kang leifo la tsoekere.

Leoto la lefu la tsoekere- Boemo ba leoto ba leoto ho lefu la tsoekere, le tšoauoang ke tšenyo letlalong le linama tse bonolo, masapo le manonyeletso ebile li bonahetse ka sebopeho sa liso tsa trophic, liphetoho tse kopantsoeng le masapo le liprosesa tsa purulent-necrotic (ho fihla ho gangrene).

Mathata a hlobaetsang a lefu la tsoekere - coma.

Lefu la tsoekere. Sesosa se tobileng sa nts'etsopele ea lefu la tsoekere la lefu la tsoekere ha se lefu la tsoekere ka bolona, hobane ha ho hlile ha se thata ho nts'etsopele ea komello, empapuseletso.

Lefu la tsoekere le lekantsoeng- boemo boo ho bona mathata a metabolic le litho tsa 'mele a sebetsang ho tsona ka lefu lena a fihlang maemong a mahlonoko mme a tsamaisana le mathata a tlokotsi a homeostasis: hyperosmolarity and dehydration, dyselectrolythemia, ketoacidosis, lactic acidosis, hypoxia e matla, jj.senya kelello, ho bolelang ho lebisa ho nts'etsopele ea komello.

Ho ipapisitse le mofuta oa lefu la tsoekere le lefu la mellitus le tšobotsi ea ketoacidosis, kapa hyperosmolarity, kapa lactic acidosis e ka ba teng ho mokuli ea itseng. Mabapi le sena, ho na le likhetho tse 3 bakeng sa DC:

ketoacidotic hyperglycemic coma,

hyperosmolar hyperglycemic coma,

Mefuta ena e meraro ea DC e na le pathogenesis e ts'oanang e amanang le ho bola ha lefu la tsoekere, empa e na le phello ea mofuta o itseng oa lefu le itseng.

Mofuta oa 1 lefu la tsoekere (IDDM)

Mmele ha o hlahise insulin. Batho ba bang ba re mofuta ona ke lefu la tsoekere le itšetlehileng ka insulin, lefu la tsoekere kapa lefu la tsoekere la pelehi. Mofuta oa 1 oa lefu la tsoekere hangata o kenoa pele ho lilemo tse 40, hangata ha e le motho e moholo kapa lilemong tsa bocha. Mofuta oa 1 oa lefu la tsoekere ha o tloaelehe joaloka mofuta oa bobeli. Hoo e ka bang 10% ea mafu ohle a lefu la tsoekere a mofuta oa 1. Bakuli ba nang le lefu la tsoekere la 1 ba lokela ho enta insulin bophelo bohle ba bona. Ba boetse ba lokela ho netefatsa maemo a tsoekere a mali ka ho etsa liteko tsa mali khafetsa le ho latela lijo tse khethehileng. Ka bomalimabe, lefu la tsoekere la mofuta oa 1 le ntse le sa phekolehe, ntle le insulin ho lefu lena, ts'oaetso e matla ea bokooa e hlaha kapele, ebe litholoana tse mpe. Mathata a nako e telele a lefu la tsoekere la mofuta oa 1 (litlamorao tsa lefu la tsoekere) a ka ba: ho foufala, ho nyekeloa ke pelo, ho se sebetse hantle ha meno, ho lemala ha meno, 'dementia, ulophic trophic' (ho fihlela ho khaoloa maoto le matsoho).

Mofuta oa 2 oa lefu la tsoekere (NIDDM)

Mmele ha o hlahise insulin e lekaneng bakeng sa ts'ebetso e nepahetseng, kapa lisele tse 'meleng ha li arabele insulin (insulin upinzani). Hoo e ka bang 90% ea linyeoe tsohle tsa lefu la tsoekere lefatšeng ka bophara li na le lefu la tsoekere la mofuta oa 2.

Batho ba bang ba khona ho laola matšoao a lefu la tsoekere la mofuta oa 2, ba theole boima ba 'mele, ho iphepa hantle, ho ikoetlisa le ho laola boemo ba tsoekere ea mali. Leha ho le joalo, mofuta oa 2 hangata ke bokuli bo tsoelang pele - butle-butle bo mpefala - 'me mokuli o tlameha ho nka lipilisi tsa ho fokotsa tsoekere, kapa le ente ea insulin.

Batho ba nonneng haholo le ba batenya haholo ba kotsing e kholo ea ho ba le mofuta oa 2 ha ba bapisoa le batho ba nang le boima ba 'mele bo phetseng hantle. Batho ba nang le mafura a mangata a ka hare, hape a tsejoang ka hore ke botenya bohareng, mafura a ka mpeng, kapa botenya ba ka mpeng, ba kotsing haholo.

Kotsi ea ho ba le lefu la tsoekere la mofuta oa 2 le eona e kholo ha re ntse re tsofala. Litsebi ha li na bonnete ba hore na ke hobaneng, empa ba re ha re ntse re tsofala, re tloaetse ho nka boima ba 'mele ebe rea ikoetlisa. Batho bao beng ka bona ba haufi ba kulang kapa ba nang le mofuta oa 2 ba kotsing e kholo ea ho tšoaroa ke lefu lena.

Lefu la tsoekere nakong ea kemolo (lefu la tsoekere)

Mofuta ona o ama basali nakong ea kemolo. Basali ba bang ba na le litekanyetso tse phahameng haholo tsa tsoekere ea mali, 'mele ea bona e sitoa ho hlahisa insulin e lekaneng ho tsamaisa tsoekere eohle liseleng, e leng se etsang hore tsoekere e eketsehe butle-butle. Lefu la tsoekere la botšehali le fumanoa nakong ea kemolo.

Boholo ba bakuli ba nang le lefu la tsoekere nakong ea kemolo ba ka laola bokuli ba bona ka ho ikoetlisa le ho ja. Empa le ha ho le joalo 10% -20% ea bona e lokela ho sebelisa meriana e meng ho laola tsoekere ea mali. Lefu la tsoekere le sa tsejoeng kapa le sa laoleheng nakong ea kemolo le ka eketsa menyetla ea mathata nakong ea pelehi. Ngoana a ka hlaha a le maholo.

Lefu la tsoekere la pele

Re lokela ho hlokomela hore ho theola boima ba 'mele (bonyane karolo ea 5 ho isa ho 10 ea boima ba hau bo qalang) ho ka thibela kapa ho liehisa lefu la tsoekere kapa ho folisa ka botlalo lefu la tsoekere pele. Bona: Lipilisi tsa likokoana-hloko Khahlano le Botenya

Boholo ba bakuli ba mofuta oa 2 qalong ba ne ba e-na le lefu la tsoekere pele. Batho ba bangata ba nang le lefu la tsoekere le tsoetseng pele ha ba na matšoao. Ngaka ea hau e ka hlahloba mali a hau ho bona hore na maemo a hau a glucose a phahame ho feta a tloaelehileng. Matsatsing a pele ho lefu la tsoekere, litekanyetso tsa tsoekere ea mali li kaholimo ho tse tloaelehileng, empa ha li phahameng haholo bakeng sa tlhahlobo ea lefu la tsoekere. Lisele tsa 'mele li loantšana le insulin. Boithuto bo bontšitse hore leha e le sethaleng sa lefu la tsoekere, ho senyeha hoa tsamaiso ea pelo le pelo ho se ho etsahetse.

* Bakeng sa tšebeliso e sebetsang ea thepa ea likokoana-hloko tse ka 'nang tsa hlaha ha ho etsoa lithethefatsi tse ncha bakeng sa kalafo le thibelo ea dyslipidemia le lefu la tsoekere, bona litlhaloso bakeng sa "Bifikardio" ea bohlokoa:

TLHAKISO, INSULIN LE CarBOHYDRATES

KAPA LITI TSE 12 TSE TSELLETSENG TSELA EA HO OBESITSA

Kaha boima ba 'mele ke e' ngoe ea lintlha tse khethollang ntlafatsong ea lefu la tsoekere, ho ka ba molemo ho utloisisa hore na ts'ebetso ena e etsahala joang 'meleng le hore na ke eng e e tenang.

Ho lekanya algorithm e ka emeloa ka tsela e latelang: 1. U nahana ka lijo, 2. u qala ho lokolla insulin, 3. insulin e fa 'mele pontšo ea ho boloka mafura acid mme e sa a chese, e lokolla matla, 4. o ikutloa o lapile, 5. tsoekere ea mali e tsoha, 6. lik'habohaedreite tse kenang maling a hao ka sebopeho sa tsoekere; 7. o qala ho etsa insulin e ngata le ho feta; 8. o qala ho ja, 9. o boloka insulin e ngata haholo; fuata esita le 12. o nona

Mafura kamehla o tla tsoa liseleng tsa 'mele. Mme rea fola ho mafura a neng a setse mmeleng. Mafura a bolokiloe seleng ea mafura ka sebopeho sa triglycerides. Triglycerides e thehoa ho tloha mafura a mararo a hokahantsoeng le molek'hule e le 'ngoe ea glycerol ka har'a sele ea mafura. Li kholo haholo hore li ka tsoa ka lisele tsa mafura, ho fapana le acid e mafura, e tsoang habonolo. I.e. Ha li-triglycerides li bokellana haholoanyane, lisele tse ngata li ba matla le ho feta.

Lik'habohaedreite ho na le tse bonolo (tse potlakileng) le tse rarahaneng. Li-carbohydrate tse potlakileng kapa tse bonolo ke likhomphutha tse nang le molek'hule e le 'ngoe kapa tse peli tsa monosaccharide,' me li kotsi ka ho fetisisa mabapi le ho baka botenya.

Li-carbohydrate tse bonolo li arotsoe ka lihlopha tse peli:

Monosaccharides (tsoekere, fructose, galactose),
Li-Disaccharides (sucrose, lactose, maltose)

Li-carbohydrate tse bonolo li kenella hang-hang ka ho kenella tsoekere maling. Sena le sona se thusa ho hlahiseng insulin.

Insulin - Ena ke molaoli oa sehlooho oa metabolism. Ho latela boemo ba eona hore na lisele tsa mafura li tla hlophisoa kapa tsa arohana. Ha maemo a insulin a eketseha, enzyme lipoprotein lipase - (LPL) e sebetsa, e ikarabellang bakeng sa phallo ea mafura seleng. I.e. ha re hlahisa insulin e eketsehileng, LPL e sebetsang e ntse e pompa lisele ka mafura.

Kahoo, tlhahiso ea isulin e bakoa ke lik'habohaedreite. Palo le boleng ba lik'habohaedreite tse sebelisitsoeng li tla lekola hore na ho behiloe mafura a makae.

Mme ho bolela

carbohydrate e eketsa insulin -

- insulin e khothalletsa boteng ba mafura

Sehloohong, bona hape:

Eba bophelo bo botle!

PUSELETSOMABAPI LE LITLHAKU TSA BOPHELO