Diabetesology ke karolo ea endocrinology e ithutang lefu la tsoekere, ho hlaha ha lona le nts'etsopele, mathata a tlisoang ke lona - mafu a bobeli.

Ho ithuta maemo a methapo le ts'ebetso e senyehileng ea litho tsa motho le litsamaiso, hammoho le ho ithuta le ho nts'etsapele ho thibela lefu la tsoekere, ho theha mekhoa ea ho fumana le ho alafa lefu la tsoekere le mathata a amanang le lona.

Lefu la tsoekere le ile la hlahella le tsoa ho endocrinology ka kakaretso ka lebaka la ho rarahana ho hoholo ha bongaka le lipontšo tse fapaneng tsa lefu la tsoekere, ho rarahana ha khalemelo ea maemo a lefu la tsoekere le bohlokoa ba bothata ba lefu la tsoekere. Lefu la tsoekere ke lefu le atileng ka ho fetisisa tsamaisong ea endocrine mme le fumana likarolo tsa lefu la seoa le sa foleng.

Palo e tobileng ea bakuli ho thata ho e tseba ka lebaka la ho se sebetse hantle ha mekhoa ea tlhahlobo ea mafu, mohlomong palo ea bakuli e batla e le 1% ea baahi mme palo ea bakuli e lula e eketseha. Bakuli ba nang le bothata ba ho kula ha se sehlopha se ikhethileng; ho tse ling, lihlopha tse ikhethang tsa lefu la tsoekere li ka khetholloa.

Saense ea mehleng ea kajeno ea lefu la tsoekere ke e 'ngoe ea makala a saense a ntseng a eketseha ka potlako saense le sebaka se ikhethileng sa tlhokomelo ea bophelo bo botle bo thehiloeng ho katleho ea biology, immunology, le genetics ea molek'hule.

Lefu la tsoekere - lefu la lefutso kapa lefutso le futsitsoeng le bakoang ke ho haella ka botlalo kapa ho amana le 'mele oa insulin. Lipontšo: keketseho e ngata ea tsoekere maling, keketseho e matla ea moroto o nang le tsoekere, lenyora, boima ba 'mele, bofokoli, ho hlohlona.

Sebaka se ikhethileng sa lefu la tsoekere ke nts'etsopele ea lefu la tsoekere la bongoana.

Ho ba le lefu la tsoekere ho kenya letsoho ho ithuteng lefu la tsoekere le lefu la tsoekere ka botlalo, ho latela mathata a teng a metabolism, a ikemiselitseng ho felisa kapa ho lefella ho haella ha insulin, ho etsa hore methapo ea metabolic e be le ts'ebetso, ho khutlisa ts'ebeliso e mpe ea 'mele le kelello, ho thibela liphetoho tse kholo tsa litho tsa ka hare, ophthalmic, mathata a methapo ea kutlo, hammoho le ho netefatsa kholo e tloaelehileng ea bana le kholo ea bona e tloaelehileng.

Karolo e ka sehloohong ea ho rarolla mathata ana e bapaloa ke lijo tse ntlafalitsoeng, lithethefatsi tse fokotsang tsoekere ea mali, mekhoa ea phekolo ea bongaka bo kenyeletsang, boikoetliso bo khethehileng le mmuso o laoloang oa boikoetliso. Lijo tse sebelisitsoeng li atametse haufi le 'mele, ka ho fokotseha hanyenyane ha ho na le lik'habohaedreite le mafura, ntle le lihlahisoa tse nang le lik'habohaedreite tse kenang habonolo.

Ts'ebeliso ea boikoetliso ba 'mele' meleng kalafong e rarahaneng e ntlafatsa tloaelo le metabolism, e amanang le litlamorao le tšusumetso ea ho ikoetlisa bakeng sa bana. Tlas'a tšusumetso ea ts'ebetso ea 'mele, tšebeliso ea mesifa ea tsoekere, mafura acid le' mele oa ketone oa eketseha, e leng ho fokotsang litaba tsa lintho tsena 'meleng, li tsamaisa metabolism hape e fokotsa kotsi ea ho ba le lefu la tsoekere.

Ho bana ba maemong a ho hola le nts'etsopele e sa feleng, ts'ebeliso ea boikoetliso ba 'mele e boetse e hlokahala e le mokhoa oa ho tloaela tšebeliso ea matla - boemo ba bohlokoa ba ho kenya ts'ebetsong matla a matla bakeng sa nts'etsopele ea mesifa ea marapo. Sena se bohlokoa molemong oa ho ikamahanya le 'mele oa ngoana hore o be le matla a eketsehileng, ho ela hloko litlamorao tsa mmele le biochemical tsa ts'ebetso ea' mele ea matla a fapa-fapaneng, ho tsosa mekhoa ea matla a anaerobic (glycolysis, ho phatloha ha glycogen) mme ho lebisa ho bokelleng ha lactic acid le metabolic acid, ntle le ho ama maemo a tsoekere ea mali. Mosebetsi oa litlelase tse joalo ke ho khothaletsa puseletso e sa khaotseng ea ts'ebetso le ho boloka boemo bo feto-fetoha le khatello ea 'mele ea ngoana e ntseng e hola.

O mong oa mesebetsi ea bohlokoahali ho hlophisa ts'ebeletso ea lefu la tsoekere ke ho boloka, ho ntlafatsa le ho koetlisa basebetsi ba bacha ba tšoanelehang haholo.

Ho kenyelletsoa ha mosebetsi o ikhethang oa lefu la tsoekere ho ba tlhokomelong ea bophelo bo botle ho thusa ho ntlafatsa boleng ba tlhokomelo ea bongaka bakeng sa bakuli ba nang le lefu la tsoekere, le ho ntlafatsa boleng ba bophelo ba bona.

Ho thata ho lumellana le 'nete ea lefu le sa foleng, hobane motho o fetola tsela eohle eo a phelang ka eona, haholo ho bakuli ba nang le lefu la tsoekere. Bakuli ba tseba hore ba kanna le mathata a kamoso a ka hlahang kamora nako, le tebello ea bophelo e ka fokotseha, boleng ba bophelo le bona bo ka fetoha.

Ngaka e tlameha ho hlalosa le ho etsa tsohle e le hore mokuli a tsebe hantle boemo ba hae, a mo tšoare ka mokhoa o lerato, 'me a phele le lefu la tsoekere a sa nyahame. Bothata bona bo tebile haholo ho bana le lilemong tsa bocha. Empa mathata a mangata a ka bonelloa pele mme a hlola haeba mohopolo o tloaelehileng o kopantsoe le maikutlo a nepahetseng ho mokuli le ho tiea kalafong e lebisitsoeng. Ho na le tlhoko ea tšepo ea hore nakong e tlang ho tla ba le molemo ho feta kalafo ea hona joale le lithethefatsi.

Ekaterina Nailevna Dudinskaya

Ekaterina Dudinskaya: "Ho na le ntho e le 'ngoe ea bohlokoa - lingakeng tsa sejoale-joale, litekanyetso tse ling, li-algorithms le litlhahiso tsa machabeng li sebelisoa, ho latela seo lingaka lefats'e li sebetsang. Ba beha litekanyetso tsa tsoekere ea mali, melaoana ea phekolo, lithethefatsi tsa mola oa pele le oa boraro, lithethefatsi tse khahlano le tse ling. Haeba moriana o sa etsa lipatlisiso tse nepahetseng ho latela moralo o itseng, ha oa kenngoa tumellanong le algorithms, 'me ho thibetsoe ho li sebelisa ho qoba likhothaletso tsena. editsiny, 'me hona joale melao-motheo ena e lokela ho lateloa ho pholletsa le. "

1. Na ho na le kalafo ea lefu la tsoekere e sa amaneng le tsamaiso ea "insulin" e tloaelehileng?

Lebaka la nts'etsopele ea lefu la tsoekere ke ho haella ha "insulin" ea 'mele oa motho. Ho haella hona ho ka ba ho felletseng kapa ho amana. Ka lebaka la khaello ea tekano (hangata ke mofuta oa lefu la tsoekere) ho sebelisoa litlhare tse fokotsang tsoekere. Leha ho le joalo, maemong a mang, ha baa lekana ho theola tsoekere ea mali ka katleho. Ebe ngaka e eang e eketsa liente tsa insulin kalafong maemong a fapaneng a mofuta. Bakuli ba joalo ba ka fokotseha nakong e tlang insulin kapa esita le ho e lahla ka ho felletseng. Empa ngaka e etsa qeto ena ka bonngoe, e nahanisisa ka lefu le litšoaneleho tsa mokuli ka mong.

Se boletsoeng ka holimo se amana le khaello ea insulin. Ka ho haella ha eona ka botlalo (mofuta oa 1 lefu la tsoekere le mefuta e meng ea eona) ho hana ho sebelisa insulin ho ka lebisa litlamorao tse ke keng tsa fetoloa - esita le lefu. Ntle le moo, 'mele ha o na kae kapa kae moo o ka sebelisang hormone ena. Lithethefatsi tsa sejoale-joale li khona ho etsisa tšebetso e tloaelehileng ea manyeme, li etsa tsoekere e maling le ho thusa ho thibela mathata a maholo. Ka hona, kalafo e sebetsang feela ea lefu la tsoekere la mofuta oa 1 e lula e le kalafo ea insulin. Ka bomalimabe, lithuto tsa mahlale lefatšeng ka bophara li bonts'a hore ka nako e khuts'oane, ho ke ke ha ba le kalafo e 'ngoe bakeng sa lefu lena la lekholo lena la lilemo.

Na ho na le kalafo tse sebetsang hantle bakeng sa lefu la tsoekere la mofuta oa 1 ho feta kalafo ea pompo?

Pompo ea "insulin" hammoho le lisirinji le lipene tsa syringe ke e 'ngoe ea mekhoa ea ho tsamaisa insulin. Pompo e hlahisa li-insulin tse hlahisang 'mele, ka hona mokhoa ona o haufi haholo le mosebetsi oa' mele oa pancreas ea hau mme o lumella mokuli ho qoba liente tse ngata. Ho kalafo ea pompo, ho sebelisoa insulin feela ea nakoana kapa ea liketso tsa ultrashort, ka hona, ka lebaka la pampiri, mokuli o tlosa tlhoko ea ho latela kemiso e thata ea lijo. Ntle le moo, ka thuso ea eona hoa khoneha ho hlophisa mekhoa e fapaneng ea tsamaiso ea lithethefatsi - ho latela hore na o ja lijo tsa mofuta ofe le hore na o lokela ho etsa mosebetsi oa mofuta ofe. Kahoo mokuli ka pompo ea insulin ha e laole maemo a glucose feela, empa hape e thusa bophelo ba hau haholo.

3. Na li-insulin tse tsoang malapeng li fapane le tse tsoang kantle ho naha, 'me na ho tšoenyeha ha mokuli ha ho ba fetisetsa litsing tsa insulin ho loketse?

Indastering ea morao-rao ea meriana, li-genetic li sebelisoa haholo - lithethefatsi tse hlahisoang ke baetsi ba fapaneng, empa li na le molek'hule e tšoanang. Thepa ea molek'hule ena e ts'oana hantle le lithethefatsi tsa pele. Tlhahiso ena ea bioequivalence, pele, e tiisoa nakong ea liteko tse ngata, 'me, ea bobeli, e sebetsa e le tokiso ea thekiso ea li-generics. Metsoalle ea sejoale-joale insulin analogue Baetsi ba kantle ho naha ka sebopeho sa lik'hemik'hale le thepa ha ba fapana ho hang le lithethefatsi tsa pele mme ba netefalitse ts'ebetso ea bona le polokeho ea bona.

5. Na ho kotsi ho sebelisa lithibela-mafu bakeng sa lefu la tsoekere?

Lithibela-mafu tse ling li tsejoa ho ntlafatsa litlamorao tsa insulin mme li ka lebisa ho hypoglycemia. Ka lehlakoreng le leng, mafu a ho ruruha a mpefatsa nako ea lefu la tsoekere le ho eketseha tsoekere ea mali. Ka hona, nakong ea kalafo ea lithibela-mafu, ho itlhahlobe haholoanyane ha maemo a tsoekere a hlokahala.

8. Na ke 'nete hore mathata a mofuta oa 1 lefu la tsoekere a hlaha le ka puseletso e ntle ea lefu?

E ntle puseletso ea lefu la tsoekere - Ona ke motheo oa thibelo ea mathata. Mokuli o lokela ho hopola hore mofuta oa lefu la tsoekere ha o ame lebelo le ho teba ha kholo ea mathata. Phekolo lefu la tsoekere e sebetsang hantle haholo methating ea pele ea kholo ea bona, ka hona, ho bohlokoa hore bakuli bohle ba nang le lefu la tsoekere ba hlahlobeloe sepetlele se khethehileng sa endocrinological.

9. Na bana ba nang le lefu la tsoekere la 1 ba ka etsa thuto ea 'mele sekolong?

Kajeno lefu la tsoekere ke maikutlo ao bophelo ba ngoana a nang le bona mofuta oa 1 lefu la tsoekere ha ea lokela ho fapana le bophelo ba lithaka tsa hae tse phetseng hantle. Haeba ngoana a e-na le puseletso e ntle ea lefu la tsoekere, ha ho na mathata, o koetlisitsoe sekolong sa lefu la tsoekere, o tseba likarolo tsa kalafo ea insulin nakong ea ts'ebetso ea 'mele, melao-motheo ea thibelo le phomolo hypoglycemia, ebe ka tlasa maemo ana, o ka etsa thuto ea 'mele sekolong. Leha ho le joalo, matšoao le li-contraindran tsa ho ikoetlisa ka 'mele o mong le o mong o lokela ho khethoa ke ngaka ea lefu la tsoekere. Ntle le moo, sechaba sa endocrinological se bona ho hlokahala ho hlahisa thupelo e ikhethang mabapi le tšebelisano le bana le bacha ba nang le lefu la tsoekere lenaneong la koetliso la matichere a thuto efe kapa efe. Ntle le moo, liithuti tse lefu la tsoekere Boholo ba bophelo ba bona ha bo qete le batsoali ba tsebang mafu a bana ba bona, empa ke matichere ao ka linako tse ling a sa khoneng ho fa ngoana thuso e hlokahalang.

10. Ke melao efe e lokelang ho bolokoa ke ba leng moeling (pele ho lefu la tsoekere)?

Mohopolo oa "prediabetes" o kenyelletsa maemo a kang ho itima lijo ka matla glycemia le ho mamella tsoekere e sa sebetseng hantle. Maemo ka bobeli a fumanoa motheong oa tlhahlobo e khethehileng, eo, ka ho belaela hanyane ka hanyane ha lefu la tsoekere kapa ka boima bo feteletseng ba mmele, e lokelang ho fetisoa ka tleliniking. Lingaka li sebelisa polelo ea prediabetes haeba mokuli a le kotsing e kholo ea ho holisoa mofuta oa lefu la tsoekere. Haeba, sethaleng sa lefu la tsoekere, motho o qala ho ikakhela ka setotsoana bophelong ba motho (ho ja ka tekano, ho ikoetlisa, ho eketsa boima ba 'mele), joale ho na le monyetla o mong le o mong oa ho qoba kapa ho liehisa kholo ea lefu lena. Mohlala, liphuputso li bonts'itse hore ho theola boima ba 'mele ka lipalo tsa 5-7%, lijo tse nang le phepo e nepahetseng, tse tlase, boikoetliso ba metsotso e 30 makhetlo a 5 ka beke, ho ka fokotsa kotsi ea lefu la tsoekere ka 58%.

12. Ka 2000, ts'ebetso ea ho kenya lisele (tsa liphoofolo) tse fanang ka liphapanyetsano tsa pancreas e ile ea thibeloa Russia. Na ho na le mesebetsi e teng ka tsela ee ea ho phekola lefu la tsoekere le thibelo ea mathata a lona? Na mokhoa ona oa kalafo oa lefu la tsoekere la mofuta oa 2 o ka sebelisoa ka mokhoa o sebelisang insulin?

Pele o sebelisoa ts'ebetsong ea bongaka ea letsatsi le leng le le leng, mekhoa efe kapa efe ea liteko ea ho loantša lefu la tsoekere e lokela ho feta liteko tsa liteko tsa laboratori le tsa bongaka, tse nkang lilemo. Mme haeba mokhoa o le mong kapa o mong o thibetsoe ke molao, joale mosebetsi o sebakeng sena kaofela o "lehloa". Ka hona, ho thata haholo ho araba potso ea hau ka kotloloho le ka nepo.

13. Na stem cell transplantation e tsoang ho mong ka motho ea haufi ea tloaelo e etsoang kalafong ea lefu la tsoekere ho bana ba nang le lisele le khokahano ea sehlopha? Liphello tsa kalafo ee ke life? E sebetsa hakae?

Lisele tsa stem li ntse li ithutoa kajeno ke litsebi lefatseng ka bophara. Leha ho le joalo, liphetho tsa lithuto tse tebileng le tse kholo 'meleng oa motho ha li e-so fumanoe. Ho na le datha mabapi le ho hlahisoa ha lisele tsa stem ho bakuli ka bomong ba nang le lefu la tsoekere, ho kenyeletsa le naha ea rona, empa ha ho na mokhoa oa ho sebelisa data ena hajoale - ho lateloa ha nako e telele 'me palo e kholo ea lithuto e hlokahala. Ho tseba katleho ea mokhoa ona, ho tla nka nako e ngata, ka hona, ho bua ka tšebeliso e atileng ea lisele tsa bakoang bakeng sa kalafo lefu la tsoekere, haholoholo baneng, ha e so fihle.

14. Hobaneng kalafo eohle e khutlisang lihormone bakeng sa basali ba menopausal e theoha feela mefuteng ea lithethefatsi tsa estrogen-progestogen mme ho se na motho ea reng basali le bona ba hloka ho fuoa li-androgens tsee?

Ho fihla joale, lithuto mabapi le tšebeliso ea li-androgens ho basali nakong ea ho khaotsa ho ilela khoeli li fokola haholo, liphetho tsa bona lia hanyetsana 'me li hloka ntlafatso e tebileng le tlhaiso ea nako e telele. Lefatšeng ka bophara, ho khothalletsoa feela litokisetso tsa estrogen-progestogen - ka mefuta e fapaneng. Leha ho le joalo, ho na le mabaka 'ohle a ho lumela hore tšebeliso ea androgens ho HRT ke taba ea bokamoso bo haufi haholo.

15. Ke liphekolo life tse sebetsang ka ho fetisisa tsa botenya?

Pele ho tsohle, ona ke kalafo ea ho ja hammoho le ho ikoetlisa ka ho lekaneng. Mekhoa ea kalafo ea ho phekola botenya ha e sebelisoe "ho e-na le" phepo e nepahetseng, empa e le tlatsetso ea eona. Setlahare ka seng se na le litlamorao le litlamorao. Ka hona, lijo, le boikoetliso, le kalafo ea lithethefatsi li khethoa hamolemo hammoho le ngaka e tla nahanela litšobotsi tsohle, hammoho le matšoao le litlatsetso bakeng sa kalafo ea botena.

Lefu la tsoekere: Karolo ea Kajeno holima thuto ea lefu la tsoekere

Lefu la tsoekere ke karolo ea endocrinology. Diabetesology e ithuta ka litaba tse amang nts'etsopele ea bokuli bo kang lefu la tsoekere.

Litsebi lefapheng la bongaka sebakeng sena li ithuta litaba tse amanang le lefu la tsoekere:

1. Lisosa tsa boemo ba pathological.
2. Mekhoa ea ho phekola lefu la tsoekere la mefuta e fapaneng.
3. Mekhoa ea ho thibela lefu la tsoekere.

Lingaka tse sebetsanang le thuto ea lefu la tsoekere, lisosa tsa ho hlaha hoa lona le thibelo li bitsoa litsebi tsa lefu la tsoekere. Lingaka tse ithutang lefu la tsoekere le mekhoa ea lona ea kalafo ke litsebi tse tšoanelehang haholo tsa endocrinology.

Lefu la tsoekere ke lefu le hlahang ka lebaka la nts'etsopele ea ts'ebetso ea ts'ebetso ea lisele tsa pancreatic tse ikarabellang tlhahisong ea insulin.

Sesosa sa ho kula hape e ka ba ho fokotseha hoa kutlo ea lisele tsa membrane ea lisele tsa li-insulin tse itšetlehileng ka insulin ho insulin.

Mofuta o atileng oa lefu la tsoekere ke mofuta oa 2 lefu la tsoekere.

Lefu la tsoekere le hlaha ka lebaka la ts'oaetso eohle ea mathata a endocrine, a khetholloang ke khaello ea insulin e felletseng ka mmele. Ntle le moo, nts'etsopele ea lefu la tsoekere e ka bakoa ke ponahalo ea litšitiso ho mefuta eohle ea li-metabolic process.

Ts'ebetso tse joalo 'meleng oa motho ke:

• protheine ea metabolism
• lipid
• metsi le letsoai
• liminerale
• carbohydrate.

Mefuta e atileng haholo ea lefu la tsoekere ke:

1. Ho itšetleha ka insulin - mofuta oa 1 lefu la tsoekere.
2. Mofuta oa 2 oa lefu la tsoekere o sa itšetleheng ka insulin.
3. Lefu la tsoekere.

Ho feta moo, litsebi tsa lefu la tsoekere li totobatsa boemo bo ikhethang ba 'mele oa motho o bitsoang prediabetes. Ka prediabetes ho batho, keketseho ea boemo ba tsoekere 'meleng e bonoa e le hore e fapana le tloaelo e ikemiselitseng' meleng, empa ha e fihle pontšo eo boemo ba motho bo ka khetholloang ka hore ke lefu la tsoekere.

Matšoao a hlokang ho buisanoa le lefu la tsoekere

Haeba ho sa tloaeleha hore na ho na le mathata a tšebetso ea 'mele a sebetsang hantle, o lokela ho ikopanya le setsi sa bongaka bakeng sa likeletso le tumello ea kalafo e itseng haeba ho hlokahala.

Ho na le matšoao a 'maloa, ponahalo ea eona e ka bonts'ang kholo ea lefu la tsoekere' meleng oa motho.

Haeba e 'ngoe ea matšoao ana e fumanoa, o lokela ho batla thuso ea ngaka ea lefu la tsoekere hang-hang.

Matšoao a mantlha a bonts'ang kholo ea lefu la tsoekere ke a latelang:

• likhathatso mosebetsing oa libaka tse tlase,
• ponahalo ea bofokoli bo eketsehileng le ho phatloha ho akaretsang,
• ho hlaha ha lenyora le matla le le sa tloheng,
• urination e eketsehileng,
• ponahalo ea mokhathala o eketsehileng oa 'mele,
• phokotso e kholo ea bophelo bo botle ba 'mele,
• phetoho ea boima ba 'mele ntle le ho ba teng ha litabatabelo tse bonahalang bakeng sa sena.

Ho buisana le ngaka ea lefu la tsoekere le ho etsa tlhahlobo e felletseng ea 'mele oa mokuli eo matšoao ana a khetholloang e lumella ho lemoha lefu la tsoekere' meleng le mehato ea kalafo e tlang ka nako.

Morero oa liketsahalo tse joalo ke ho etsa hore index ea glycemic e lule 'meleng le ho emisa ho hlaha hoa mathata a teng ka tsoelo-pele ea mofuta o itseng oa lefu la tsoekere.

Ke joang kopano le ngaka ea lefu la tsoekere?

Ketelo ea pele ho ngaka ea lefu la tsoekere ha e tšoane le bakuli ba etelang lingaka tse ikhethang.

Ketelong ea pele ho ngaka ea lefu la tsoekere, ngaka e etsa tlhahlobo ea pele ea mokuli.

Nakong ea ho etsa tlhahlobo ea pele, ngaka e fumana lipotso tse fapa-fapaneng tse u lumellang ho etsa qeto ea pele ka ho ba teng kapa ho se be teng ha mokuli ea nang le mathata a metabolic 'meleng.

Nakong ea tlhahlobo, ngaka e fumana lipotso tse latelang:

1. Bakuli ba na le litletlebo life ka maemo a bona.
2. E lekola boteng ba matšoao a ts'oaetso ea lefu la tsoekere kapa boemo ba 'mele ba prediabetes.
3. E hlakisa nako eo matšoao a sebopeho a hlahang haeba a le teng ho mokuli.

Kamora tlhahlobo ea pele, ngaka e eang e lekanya litaba tsa tsoekere 'meleng oa mokuli kapa e khothaletsa ho ikopanya le laboratori e khethehileng bakeng sa monehelo oa mali bakeng sa tlhahlobo ea lik'habohaedreite tsa plasma.

Haeba ho hlokahala lithuto tse ling, urinalysis e ka fuoa:

Ho feta moo, ho ka khethoa ho lekola letsatsi le letsatsi tsoekere ea plasma ea mokuli.

Kamora ho fumana liphetho tsohle tse hlokahalang tsa tlhahlobo le ho bokella tlhaiso-leseling e hlokahalang, ngaka ea lefu la tsoekere e etsa tlhahlobo ea mafu mme, ha ho hlokahala, e nts'etsapele morero o le mong oa mehato ea kalafo.

Khetho ea moralo oa mehato ea kalafo e ipapisitse le liphetho tsa hlahlobo le litšobotsi tsa 'mele oa mokuli tse nang le lefu la tsoekere.

Mehato ea kalafo e sebelisetsoang ho phekola lefu la tsoekere ha e sebelise meriana feela e theolang boemo ba tsoekere plasma ea mali.

Morero oa mehato ea kalafo o ka kenyelletsa ho fetola nako ea lijo le nako ea lijo, kemiso le tatellano ea meriana.

Khalemelo le matla a ho ikoetlisa 'meleng oa mokuli, phetoho e akaretsang ea bophelo, ho lahla mekhoa e mebe, e kang ho tsuba koae le tšebeliso ea joala.

Ngaka ea lefu la tsoekere e etsa eng?

Setsebi sa lefu la tsoekere ke ngaka e sebetsang ho ntlafatseng kalafo ea kalafo le thibelo ea lefu la tsoekere le mathata a amanang le ho ata ha lefu lena 'meleng oa mokuli.

Boemo ba bohlokoa ka ho fetisisa bakeng sa kalafo e atlehileng ea lefu lena ke ho iphumanela lefu ka nako le ho thibela tsoelo-pele ea lona ho isa maemong ao mathata a ka bang le ona.

Mathata a mofuta oa lefu la tsoekere la mofuta oa 2 le lefu la tsoekere la Mofuta oa 1 a na le tšusumetso e kholo tšebetsong ea litho tsa motho ka mong le tsamaiso ea tsona ka kakaretso.

Bakeng sa ho thibela nts'etsopele ea mathata a tsamaeang le kholo ea mofuta o mong le o mong oa lefu la tsoekere, o lokela ho etela ngaka ea lefu la tsoekere hangata bakeng sa likeletso le phetoho ea mokhoa oa kalafo.

Ho ikopanya le ngaka ea lefu la tsoekere ka nako le nako ho u etela ho u thusa ho nka mehato e nepahetseng ka nako ho lokisa boemo ba tsoekere 'meleng le ho fetola tšebetso ea metabolic.

Ho bonoa khafetsa ke ngaka e eang ho qoba tsoelo-pele ea 'mele ea mafu a tebileng a amanang le lefu la tsoekere, ho amang ts'ebetso ea methapo ea pelo le methapo e meng.

O ka ithuta ka mekhoa e metle ea lefu la tsoekere ka ho shebella video e sehloohong sena.

Liphihlelo tsa sejoale-joale

Lefu la tsoekere le 'nile la tsebahala ho lingaka ho tloha mehleng ea khale. Tlhaloso ea pele ea bongaka ea bokuli bona e fanoe ke ngaka ea Moroma ea bitsoang Areteus lekholong la bobeli la lilemo A.D. e., o boetse a kenyelletsa poleloana "lefu la tsoekere" ts'ebetsong ea bongaka. Tlhaloso ea lefu lena e boetse e fanoa ho papyrus ea boholo-holo ea Baegepeta (hoo e ka bang ka 1000 BC), ho Galen (130-200), ka "Tibetan canon Chjud-shi (VIII century), ho setsebi sa Maarabo Avicenna (980-1037 gg.) le mehloling e meng.

Ka 1776, ngaka ea Lenyesemane, Matthew Dobson (1731-1784), o ile a fumana hore moroto oa bakuli o na le tsoekere e ngata haholo (tsoekere), ka lebaka leo lefu le ileng la tsejoa e le lefu la tsoekere.

Paul Langerhans (1847-1888), setsebi sa kelello sa Jeremane se ithutileng ka sebopeho sa makhopho, o hlalositse ho bokellana ha lisele tse ikhethileng liseleng tsa gland, tseo hona joale li tsejoang hore li hlahisa insulin. Kamora nako eo, lihlopha tsena li ile tsa bitsoa lihlekehleke tsa Langerhans. Ngaka ea Russia Yarotsky (1866-1944) ke rasaense oa pele ea ileng a bua ka 1898 mohopolo oa hore lihlekehleke tsa Langerhans li hlahisa lekunutu la kahare le amang metabolism ea tsoekere 'meleng. Oscar Minkowski (1858-1931) le Joseph von Mehring (1849-1908) ba bakile "lefu la tsoekere la ho leka" ho lintja ka ho tlosa makhopho ka 1889 mme ba fihlela qeto ea hore ho na le khokahano lipakeng tsa ho tlosoa ha tšoelesa le nts'etsopele ea lefu la tsoekere. Kamora nako, rasaense oa Russia, Leonid Sobolev (1876-1919) ho dissertation ea hae e hlahisitsoeng ka 1901, o ile a paka hore lihlekehleke tsa Langerhans li boloka hormone e khethehileng e laolang tsoekere ea mali.

Lilemo tse mashome a mabeli hamorao, bafuputsi ba Canada Frederick Bunting (1891-1941) le Charles Best (1899-1978) ba ile ba qolla lihormone tsena, tse bitsoang insulin, 'me ka 1922 "mehla ea" insulin "e ile ea qala kalafo ea lefu la tsoekere. Bunting le Moprofesa MacLeod, ea neng a okametse mosebetsi, ba hapile Moputso oa Nobel ka lebaka la sena.

Fora, nakong ea Ntoa ea Bobeli ea Lefatše, lingaka Zhanbon le Lubatier ba ile ba ithuta ka phello ea seculin ea insulin ea lithethefatsi tsa sulfa tse fokotsang tekanyo ea tsoekere ea mali. Ka lebaka leo, ka lebaka la boiteko ba bo-ramahlale ba 'maloa (Chen, 1946, Savitsky le Mandryka, 1949, Usse, 1950), bohareng ba mashome a mahlano, lithethefatsi tsa molomo tsa sehlopha sa sulfamide - tolbutamide, carbutamide, chlorpropamide, li ile tsa kena tšebetsong ea bongaka. Re ka nahana hore ho tloha ka nako eo ho tsoekere ea lefu la tsoekere ho qalileng nako ea kalafo ea sejoale-joale le taolo ea lefu la lefu la tsoekere.

Liphihlelo tsa sejoale-joale

Tsoelo-pele ea hona joale taolong ea lefu la tsoekere e kenyeletsa: ts'ebeliso ea mefuta e mengata ea insulin le litafole tsa molomo, litlatsetso tse entsoeng ka hloko le lihlahisoa tsa glycemic, tlhaiso ea bakuli ea boemo ba bona ba sebelisa li-glucometer, le litlhahiso mabapi le ts'ebetso ea 'mele.

Mefuta ea lefu la tsoekere

Ho latela tlhaloso ea WHO, lefu la tsoekere ke sehlopha sa mafu a metabolic a hlahang ka lebaka la tšireletso ea insulin e sa tsitsang, liphetoho liketsong tsa eona, kapa ka lebaka la lintlha tsena ka bobeli.

Insulin ke hormone e hlahisoang ke lisele tsa pancreatic beta. Ha e laole feela metabolism ea lik'habohaedreite, empa le mefuta e meng ea metabolism - protheine, mafura, e kenella mererong ea phapang ea sele.

DM e bua ka lefu la kelello le nang le ts'oaetso e sa feleng le tšenyo ea litho tse fapaneng tsa 'mele.

Boteng ba lefu la tsoekere, esita le kalafo e lekaneng, ho thata ho qoba mathata a amanang le lefu lena. Mathata a atileng haholo a lefu la tsoekere ke angiopathies (diabetesic angiopathy) le polyneuropathy. Ka lehlakoreng le leng, mathata ana a baka tšenyo ea litho tse ngata - liphio, methapo ea mali ea pelo, tsamaiso ea methapo, letlalo, nts'etsopele ea leoto la retinopathy le lefu la tsoekere.

Ka karolelano, lefu la tsoekere le arotsoe ka mefuta e 'maloa.

• Mofuta oa 1 oa lefu la tsoekere (mofuta oa 1 lefu la tsoekere), kapa mofuta o itšetlehileng ka insulin, ha o amahanngoe feela le tšenyo ea autoimmune kapa idiopathic ho lisele tsa pancreatic beta, empa hape le lisosa tse ling tse bakang tšenyo ea lisele tse hlahisang insulin (k.k.lehola). Sena se lebisa tlhokomelong e matla ea insulin kapa e batlang e felletse. Mofuta oa 1 oa lefu la tsoekere hangata o hlaha ho bacha.
• Mofuta oa lefu la tsoekere o sa itšetleheng ka insulin (T2DM) o hola hangata o le lilemong tse hloahloa (hangata o moholo ho feta lilemo tse 40-50) ho batho ba nang le lefutso. Nts'etsopele ea eona e kenyeletsa ho ba teng hoa tlhaho ea liphatsa tsa lefutso le lintlha tsa kantle. Li-prerequisites tsa lefutso ho lumeloa hore li bapala karolo ea bohlokoa ho ntlafatseng lefu la tsoekere la mofuta oa 2 ho feta mofuteng oa 1 oa lefu la tsoekere.

Pathogenesis ea lefu la tsoekere la mofuta oa 2

Bokapele ba lefutso la tsoekere ea mofuta oa 2 bo paka hantle lipatlisisong tse ngata tsa lefutso. Hoo e ka bang mefuta ea 100 e fumanoe, polymorphisms ea eona (liphatsa tsa lefutso) e eketsa haholo monyetla oa ho ba le lefu la tsoekere. Ka lehlakoreng le leng, liphatsa tsena tsa lefutso li arotsoe ka lihlopha moo lihlahisoa tsa mofuta ona li amang tšebetso ea lisele tsa pancreatic beta tse hlahisang insulin, bofokoli ba liphatsa tsa lefutso ts'ebetsong ea insulin le li-receptor tsa eona, le kholo ea insulin. Mefuta e ithutoang haholo ea lefu la tsoekere la mofuta oa 2 e laolang tšebetso ea lisele tsa pancreatic beta e kenyeletsa mefuta ea PRAG, KCNG11, KCNQ1, ADAMTS9, HNF1A, TCF7L2, ABCC8, GCK, SLC30A8 le ba bang ba bangata.

Ho na le mabaka a mabeli a amehang pathogenesis ea lefu la tsoekere la mofuta oa 2 - ho hanyetsa insulin le phetoho ts'ebetsong ea lisele tsa beta. Ha ho hlake kamehla hore na mabaka ke afe a mantlha.

Boemo bo bakiloeng ke ho fokotseha ha kutloisiso ea lisele ho insulin, khahlano le sekhahla sa palo ea bona e lekaneng kapa se fetang tekanyo e kaholimo ea se tloaelehileng, se bitsoa ho hanyetsa insulin. Hyperinsulinemia e qobelloang e qala methating ea lefu la tsoekere mme ke e 'ngoe ea matšoao a ho nona.

Hajoale, lefu la tsoekere la mofuta oa bobeli le hlalosoa e le tlolo ea metabolism ea carbohydrate, e bakoang haholo ke ho haelloa ke insulin le khaello ea insulin kapa ho senyeha ha secretion ea lihormone ntle le insulin.

Ho itšireletsa ha mesifa ho insulin ho hlalosoa ke ho fokotseha ha methapo ea kutlo ea insulin kapa ho se sebetse hantle ha li-enzyme tse hlahisang insulin.

Maloetse ao lefu la tsoekere le bang le 'ona

Ntle le lefu la tsoekere la mefuta ea pele le ea bobeli, mefuta e ikhethileng ea lefu la tsoekere e hlahang ho mafu a itseng kapa li-syndromes le maemo li a khetholleha.

Maloetse a mang a endocrine le autoimmune a ka amahanngoa le lefu la tsoekere: Lefu la Graves (le kenyelletsa chefo e nyane), Itsenko-Cushing's syndrome (hypercorticism), pheochromocytoma (adrenal gland tumor), acromegaly, glucagonoma, anemia e mpe, hypothyroidism, hepatitis e sa foleng,.

Lefu la tsoekere le ka hlaha le mafu a pancreatic: pancreatitis, cystic fibrosis, tumor, hemochromatosis. Lefu la tsoekere la methapo ea kutlo le arohantsoe ka lebaka la ho ba teng ha lefu la IPEX, le kamora ho hlaha ha li-antibodies ho li-insulin le li-insulin receptors. IPEX syndrome e tšoauoa ka dysregulation ea mmele, polyendocrinopathy (lefu la tsoekere, hypothyroidism) le autoimmune Enteropathy, e iponahatsang e le malabsorption syndrome. Ho hlaha hoa eona ho amana le liphetoho tse bang teng ka har'a mofuta oa FOXP3, moo tatellano ea protheine ea lesela e kentsoeng, e ikarabellang bakeng sa ts'ebetso e tloaelehileng ea li-T-lymphocyte tse tsamaeang le, ka hona, nts'etsopele ea ho se lekane ha thibelo ea mali le a thibeloang mafu. Lefu la tsoekere le itšetlehileng ka insulin le hlahisoang ke lefu lena le iponahatsa, e le molao, likhoeling tse 6 tse qalang tsa bophelo ba ngoana.

Mefuta e meng ea lefu la tsoekere e kenyelletsa lefu la tsoekere, le emang ka lebaka la ho se sebetse hantle ha lisele tsa beta le liphatsa tsa lefutso tsa insulin (MODY-1-6, liphetoho tsa methapo ea methapo ea methapo, lefu la mofuta oa insulin, joalo-joalo).

Kamano pakeng tsa nts'etsopele ea lefu la tsoekere le tšoaetso ea vaerase e fetisitsoeng (ho ba teng ha cytomegalovirus, vaerase ea Coxsackie B3 le B4, mofuta oa reovirus 3, congenital rubella) e qalile. Ho ile ha fumaneha hore kamora koluoa ​​ea li-mumps kamora lilemo tse peli, palo ea linyeoe tsa lefu la tsoekere har'a bana li eketsehile.

Nts'etsopele ea lefu la tsoekere e ka etsahala ka ho ba teng ha litlolo tse itseng tsa lefutso tse kopaneng le lefu la tsoekere. Tsena li kenyelletsa syndromes: Down, Klinefelter, Turner, Prader-Willi le chorea ea Huntington.

Lintho tse sa tloaelehang tsa kotsi ea lefu la tsoekere

Joalokaha ho bontšitsoe lipampiring tse ngata tsa saense, e 'ngoe ea lisosa tse susumetsang ts'ebetso ea autoimmune le kholo ea kholo ea tsoekere ke ts'ebeliso ea lebese la khomo ke masea a sa tsoa tsoaloa. Ho bontšitsoe hore ho ja lebese la khomo ka lijo tsa maiketsetso ho eketsa kotsi ea ho ba le lefu la tsoekere la mofuta oa 1. Ho lumeloa hore mochine ona oa nts'etsopele o amahanngoa le ho ba teng ha liprotheine tse ngata tse nang le phello ea lefu la tsoekere lebese.

Ho hlōloa ha lisele tsa beta tse hlahisang insulin ho ka khoneha ka litlamorao tse chefo liseleng tsena, mohlala, kamora ho nka streptozotocin (lithibela-mafu tse sebelisitsoeng kalafo ea mefuta e meng ea mofets'e).Lithethefatsi tse ling li kenyelletsa glucocorticoids, nicotinic acid, lihomone tsa qoqotho, beta-blockers, pentamidine, vaccor, alpha-interferon, hammoho le lintho tse fumanoang lebeseng la khomo (bovine serum albin peptide). Lihlahisoa tse tsubang tse nang le metsoako ea nitroso li ka bapala karolo e mpe.

Lefu la tsoekere le hlahang nakong ea kemolo (lefu la tsoekere la moimana) le abeloa sehlopha se khethehileng.

Melao-motheo ea ho fumana lefu la tsoekere

Boemong bofe kapa bofe, ho sa tsotelehe mofuta oa lefu la tsoekere le lisosa tsa lona, ​​phetoho ea methapo ea metabolism ea nama ea nama ea kolobe e hlaha 'meleng, hammoho le tlolo ea metabolism ea mafura le liprotheine, tse kenyelletsang lipontšo tsa bohlokoa tsa kliniki.

Mabapi le bohlokoa bo boholo ba lefu lena la lefu lena, potso e hlaha ho hlahlobeng ha eona esale pele ho fana ka kalafo e tlang ka nako le mehato ea thibelo e ikemiselitseng ho fokotsa mathata a teng.

Ho tsoekere ea lefu la tsoekere, qalong, liphetoho tsa metabolism ea lik'habohaedreite li bonahala ka ho hlaka. Ka hona, tlhahlobo ea mantlha ea tlhahlobo ea bongaka le ea laboratori ho fumanoeng lefu la tsoekere ke qeto ea tsoekere ea mali. Tekanyo ea tsoekere e etsoa ka mekhoa ea venous le ea mali a capillary e nkiloeng monoaneng.

Mekhoa ea ho khetholla lefu la tsoekere e hlahisitsoe ke litsebi nako e telele. Ha data e ntse e bokellana, e ne e hlahlojoa le ho ntlafatsoa nako le nako.

Litlhahlobo tsa sejoale-joale tsa lefu la tsoekere le tlhahlobo ea boemo ba glycemic li ipapisitse le likhothaletso tsa WHO ho tloha 1999 ka likeketso tse ling (ho tloha ka 1999 ho isa ho 2015).

Mekhoa ea mantlha ea tlhahlobo ea laboratori bakeng sa lefu la tsoekere e kenyelletsa ho tseba ho pepeseha ha glucose, glycosylated (glycated) hemoglobin le ho etsa tlhahlobo ea mamello ea glucose ea molomo ho netefatsa ts'oaetso. Ts'ebetsong ea ho ithuta metabolism ea carbohydrate, re fumane litekanyetso tsa tsoekere maling a pheriferale (venous) le madi a capillary (ho tloha monoaneng), matšoao a khatello ea glycated hemoglobin, litekanyetso tsa "glucose" tse tloaelehileng le tsa pathological li ne li behiloe nakong ea tlhahlobo ea mamello ea glucose.

Glucose ea mali

Ha ho hlahlojoa khatello ea tsoekere, ho bohlokoa ho ela hloko phapang ea litekanyetso tsa eona tse tloaelehileng maling a venous le a capillary eohle. Sena se ka itšetleha ka mohlala, ka boholo ba hematocrit. Ka hona, ha u hlahloba mokuli ka matla, ho molemo ho sebelisa theknoloji e le 'ngoe ea ho lemoha.

Ho fepa glucose ho bolela tsoekere e boletsoeng hoseng kamora ho potlaka ho feta bonyane lihora tse robeli eseng tse fetang tse leshome le metso e mene. Ka tloaelo, tsoekere ha ea lokela ho feta 5.6 mmol / L bakeng sa mali a capillary le ka tlase ho 6.1 mmol / L maling a venous. Lintlha tse fumanoeng li feta kapa li lekana le 6.1 mmol / l mme li feta kapa li lekana le 7.0 mmol / l, ka ho latellana, li sebetsa e le lebaka la tlhahlobo-bocha le tlhahlobo ea mamello ea glucose. Ho fumanoa ha lefu la tsoekere mellitus, le khethiloeng ka lekhetlo la pele, ho tlameha ho pakahatsoa ke tlhahlobo e pheta-phetoang ho netefatsa 'nete ea keketseho ea boemo ba glycemia.

Glucose e ka bang 5.6 - 6.1 mmol / L ka mpeng e se nang mali maling 'ohle a capillary le 6.1 - 7.0 mmol / L maling a venous a ka bonts'a tlolo ea glycemia.

Ho lokela ho hlakisoa hape hore kaha liphetho tsa tlhahlobo li susumetsoa ke lintlha tse ngata (ho sebelisa lithethefatsi tse ling, maemo a lihormone, boemo ba maikutlo, mokhoa oa ho ja), tsoekere e lokela ho khethoa makhetlo a 'maloa.

Qeto ea hemoglobin ea glycated

Ho tloha ka selemo sa 2011, ka kopo ea WHO, boikemisetso ba phepelo ea hemoglobin ea glycated (HbA1c) e sebelisitsoe e le mokhoa oa tlhahlobo ea lefu la tsoekere.

Tloaelo e nkuoa e le khatello e sa feteng 6.0%. Khokahano ea HbA1c e kholo ho feta kapa e lekanang le 6.5% e nkoa e le sesupo sa boteng ba lefu la tsoekere. Ha ho na matšoao a boletsoeng, qeto e thehoa kamora ho bapisa lithuto tse peli - litlhaloso tse peli tsa hemoglobin ea glycated kapa kamora qeto e ts'oanang ea HbA1c le glucose.

Teko ea ho mamella tsoekere ea molomo

Teko ea mamello ea glucose ea molomo (PHTT) e etsoa ho hlakisa tlhahlobo ea liketsahalo tsa glycemia.

Teko e nkuoa e le ntle (netefatso ea ts'oaetso ea lefu la tsoekere mellitus) haeba khatello ea tsoekere ka lihora tse 2 kamora ho nka ligrase tse 75 tsa tsoekere ho motho e kholo ho feta kapa e lekanang le 11.1 mmol / L.

Teko ea ho mamella glucose ea molomo e ka tlas'a melao e thata. Mohlala, ho bana, khokahano ea tsoekere ke ligrose tse 1,75 tsa tsoekere e le 'ngoe ka boima ba' mele e seng ligrama tse 75. Boikarabello ba ngaka e kenang ke ho kenya tšebetsong melao eohle nakong ea tlhahlobo.

Lithuto tse Tsoetseng Pele

Haeba ho na le litletlebo tse tsamaellanang le boteng ba lefu la tsoekere, 'me ka linako tse ling ha ho ka hlaha kotsi (mohlala, tlhahlobo ea thibelo) tlhahlobo ea maemo a phahameng a tsoekere, haeba ho hlokahala, o ka tsamaisa mekhoa e tebileng ea tlhahlobo ea laboratori ho fumanoeng lefu la tsoekere. Liteko tse joalo li kenyeletsa: lithuto tsa biochemical tsa mali le urine (tlhahlobo ea biochemical ea mali, qeto ea C-peptide le insulin, ts'ebetso ea ho hanyetsa insulin, microalbuminuria), tlhahlobo ea tsoekere e tsoelang pele ea lihora tse 24 (CGMS), immunological (ho hlahloba li-antibodies maling), genetic.

Ho sebelisa methapo ea tsoekere ea mali

Lapeng, li-glucometer li sebelisoa ho lekola maemo a tsoekere. Lisebelisoa tsena li tšoauoa ka ho nepahala ho lekaneng ho khethollang dikahare tsa glucose maling a capillary (mali ho tsoa monoaneng) le ho hlahisa sephetho hape. Kaha boikemisetso ba tsoekere bo etsoa ke motho ea kulang ka boeena, sena se hloka bokhoni le mehato ea ho hlahloba maemo ho netefatsa boleng ba mohlahlobi (taolo ea boleng ba metsero ea liteko, betri). Sepetlele le lilaboratoring tse kholo tsa khoebo, glycemia hangata e hlahlojoa ho sebelisoa bahlahlobisisi ba biochemical ba boleng bo phahameng, boleng ba bona bo lokelang ho beoa leihlo ka tatellano, melao ea eona e thehiloeng ke litaelo tsa Lekala la Bophelo la Russian Federation ho netefatsa taolo ea boleng ba liteko tsa laboratori.