Type 2 lefu la tsoekere

Lefu la tsoekere ke lefu le sa feleng la endocrine le hlahang khahlano le semelo sa insulin e phethahetseng kapa e amanang le insulin. Hormone e hlahisoa ke manyeme, e leng lihlekehleke tsa Langerhans.

Pathology e thusa ho nts'etsopele ea mathata a maholo a metabolic (ho na le ho se sebetse ha mafura, protheine, motsoako oa lik'habohaedreite). Insulin ke hormone e khothalletsang ho phatloha le ho pepesetsoa ha tsoekere ka potlako, empa ha e haella kapa e sa lekane, ts'ebetso ena ea senyeha, e lebisang keketseho ea glucose maling.

Mathata a kotsi ka ho fetisisa a ka lebisa ho lefu la tsoekere, ho khothaletsoa likeletso tsa kliniki ho mokuli bophelo bohle. Re tla bua ka bona ka ofising ea rona ea bongoli.

Lefu la tsoekere ke lefu le atileng.

Mefuta ea lefu la tsoekere

Endocrine pathology e arotsoe ka mefuta e 'meli:

• Type lefu la tsoekere
• mofuta II lefu la tsoekere.

Lenane la 1. Mefuta ea lefu la tsoekere:

Mofuta oa lefu la tsoekere	Ho lemalla insulin	Tlhaloso	Sehlopha sa likotsi
Type lefu la tsoekere	Insulin e itšetlehileng ka eona	Polao e felletseng ea li-lets cell tsa lihlekehleke tsa Langerhans. Ho haella ha insulin.	Likarolo tse nyane tsa batho ba ka tlase ho lilemo tse 30.
Lefu la tsoekere la Type II	E seng insulin e ikemetseng	Ho haella ha insulin. Ho ka etsoa tlhahiso e tloaelehileng ea lihormone, empa maikutlo a litho tsa eona li ea fokola.	Batho ba kaholimo ho lilemo tse 30, khafetsa, ba nona haholo.

Ho bohlokoa. Le ha lefu la tsoekere la mofuta oa II le fumanoa ho batho feela kamora lilemo tse 30, lingaka li hlokomela ponahatso ea lefu lena ho bakuli ba boima bo feteletseng, ke hore, ka lefu le phahameng la botenya, mofuta ona oa lefu o ka hlaha o sa le monyane haholo.

Ka bongaka, ho ntse ho na le mofuta oa mofuta oa thuto ea lefu la tsoekere la lefu la tsoekere, likhothaletso tsa kalafo li tsamaisana le likhothaletso tsa lefu la tsoekere la 'nete.

Pele ho tsohle, tsena ke:

• phepo e nepahetseng
• bophelo bo botle
• ho tsamaea khafetsa moeeng o mocha,
• ho shebella khafetsa ho pepesetsoa ha tsoekere maling.

Lefu lena le fumanoa ho basali nakong ea kemaro. Mefuta ea tsoekere e ka nyoloha ho basali ba bakhachane nakong e fapaneng ea bokhachane, mme ho na le monyetla oa ho ba le lefu la tsoekere la mofuta oa II kamora ho beleha.

Ho ikoetlisa khafetsa ho thusa ho fokotsa kotsi ea ho ba le lefu la tsoekere la 'nete.

Hlokomela Lefu la tsoekere le ka ipata autoimmune ka tlhaho. Ponahatso e hlakileng ea lefu lena kapa nts'etsopele ea butle-butle ea pathology e bonoa ka tekanyo e lekanang.

Setšoantšo sa Clinical

Ha matšoao a pele a tšosang a lefu la tsoekere a hlaha, mokuli o ea ngakeng, moo a hlahlobeloang e le ho bona hore na lefu la lefu lena ke lefe.

Matšoao a latelang a bontša alamo:

• khafetsa ho ntša,
• lenyora le sa feleng
• molomo o omileng, 'metso
• phaello kapa tahlehelo e sa laoleheng
• takatso e feteletseng ea lijo kapa ho ba sieo ha eona ka botlalo,
• sekhahla sa pelo
• pono e fokotsehileng
• maikutlo a ho hlohlona sebakeng se haufi.

Hlokomela Lefu la tsoekere ke mofuta oa bophelo bo hlokang hore motho a lule a hlokometse bophelo bo botle ba hau. Ho boloka ts'ebetso e tloaelehileng ea 'mele, WHO e hlahisitse likhothaletso bakeng sa lefu la tsoekere, ho u lumella ho laola boiketlo ba mokuli le ho fokotsa matšoao a amanang le lefu lena.

Tlhokomeliso ea Algorithm

Joalokaha bohle re tseba, tlhahlobo e loketseng ea mali eu lumella ho tseba ka boteng ba lefu la tsoekere.

Ha ho netefatsa matšoao a glycemia, algorithm ea tlhahlobo ke e latelang:

• etsa tlhahlobo ea mali bakeng sa tsoekere bonyane makhetlo a 4 ka letsatsi,
• Teko ea mali ea ho fumana hemoglobin ea glycated e lokela ho etsoa bonyane nako e le 'ngoe ka kotara (eu lumella ho tseba tekanyetso ea tsoekere ea mali ka nako e telele ho fihlela likhoeli tse 3),
• ho tseba se tsoekere ka har'a moroto bonyane nako e le ngoe ka selemo,
• fana ka mali bakeng sa biochemistry bonyane nako e le 'ngoe ho likhoeli tse 12.

Ntho e ka sehloohong e ka u thusang ho fumana lefu la tsoekere ke tlhahlobo ea mali bakeng sa tsoekere.

Boithuto bo entsoeng ke Mokhatlo oa Lefatše oa Bophelo bo paka hore lefu la tsoekere ke bothata ba lefats'e mme tharollo ea lona ke boikarabello ba eseng feela mokuli ka boeena, empa Mmuso ka kakaretso. Ke ka lebaka leo WHO e hlahisitseng likhothaletso bakeng sa bakuli ba nang le lefu la tsoekere mellitus, bobeli le mofuta oa 2.

Li na le algorithm e tloaelehileng ea ho hlahloba, malebela a ho laola khatello ea tsoekere maling le mekhoa ea ho fana ka thuso ea pele bakeng sa lefu la tsoekere.

E khahla. Ka selemo sa 2017, sehlopha sa bongaka sa WHO se thehile le ho fana ka khatiso ea borobeli ea "Malebela mabapi le phano ea tlhokomelo e khethehileng ea bongaka bakeng sa bakuli ba nang le lefu la tsoekere."

Ntle le ho ithuta le ho latela likeletso tsa bongaka tse ntlafalitsoeng ke WHO, bakuli ba tlameha ho mamela le ho latela litlhahiso tsa bongaka tsa endocrinologist. Phekolo ea lefu lena e kenyelletsa ho lekola bophelo ba mokuli khafetsa, hobane khafetsa lipontšo tsa kliniki ea mafu ke matšoao a mafu a kopaneng a hlokang kalafo e eketsehileng ea lithethefatsi.

Ha e le tlhatlhobo e eketsehileng, ho boletsoe:

• Ultrasound ea mpa
• electrocardiogram
• tlhahlobo ea khatello ea mali
• tlhahlobo ea pono
• etela ngaka ea gynecologist kapa urologist.

Lithupelo tsa batho ba nang le lefu la tsoekere

Bakuli bohle ba nang le lefu la tsoekere ba laeloa ho ea lithupelong tse hlophisitsoeng ke litsi tse khethehileng.

Li-class li arotsoe ka mekhahlelo e 'meli:

Lenane la 2. Sepheo sa lithuto tsa batho ba nang le lefu la tsoekere:

Thutong ea sekolo	Morero
Pele	Ho tseba motho oa pele ka lefu la hae. Litsebi li bua ka liphetoho tse bakiloeng ke lefu la tsoekere bophelong ba bona ba ka moso: phepo e nepahetseng, kemiso ea letsatsi le letsatsi, ho hlahloba tekanyo ea maemo a tsoekere, ho sebelisa meriana.
E phetoa	Ho pheta melao ea thupelo ea pele le ho kenyelletsa tse ncha tse mabapi le liphetoho 'meleng.

Har'a bakuli ba lefu la tsoekere, likarolo tse latelang lia khetholoha:

• batho ba nang le lefu la tsoekere la mofuta oa I,
• batho ba nang le lefu la tsoekere la II,
• bana ba banyenyane
• moimana.

Koetliso e tla nkoa e le molemo haeba lihlopha tsa baithuti li abuoa ka nepo le likarolo tsohle tse amanang le bophelo ba tsona li ka nkuoa.

Koetliso bakeng sa lefu la tsoekere ke karolo ea bohlokoa ea lenaneo la kalafo ea lefu la kelello.

Matichere a lithuto tsa koetliso a tlameha ho ba le thuto ea thuto le bongaka, 'me a fane ka lipuo ho latela maemo a ntlafalitsoeng a WHO.

Litaba tse lokelang ho sebetsoa lenaneong:

• mefuta ea lefu la tsoekere
• lijo
• boikoetliso
• likotsi tsa glycemia le mekhoa ea ho e thibela,
• Meriana e thusang ho fokotsa tsoekere ea mali,
• Tlhaloso ea kalafo ea insulin le tlhoko ea ts'ebetsong,
• litlamorao tse ka bakoang ke lefu la tsoekere
• maeto a qobelloang ho litsebi tsa bongaka.

Lithuto li tlameha ho u joetsa hore na u ka kenya insulin hantle joang le ho hlahloba boemo ba tsoekere ea mali. Tsebo e fumanoeng nakong ea koetliso e tla lumella batho ba nang le lefu la tsoekere ho fokotsa likotsi tsa tlhaselo ea hypoglycemic le hyperglycemic, le ho tsoela pele ho phela ka phello e fokolang ea lefu lena ho phetseng hantle.

Malebela mabapi le lefu la tsoekere

Motho e mong le e mong ea nang le lefu la ho tepella, ngaka ea methapo ea kutlo ka bomong o fana ka tumellano ea kalafo e loketseng ea lefu la tsoekere, litlhahiso le ho laela maemo a ts'ebetso ea ona. Likeletso tsohle tse ikhethang li its'etleha ka mofuta oa lefu lena, tsela ea lona le ho ba teng ha li-pathologies tse tšoanang.

Lijo tsa lefu la tsoekere

Pele ho tsohle, ho bakuli ba fumanoang ba na le lefu la tsoekere, lenaneo la kalafo le qala ka phetoho ea phepo e nepahetseng.

• se ke oa tlola lijo
• ja lijo tse nyane
• ho ja khafetsa (makhetlo a 5-6 ka letsatsi),
• eketsa tšebeliso ea fiber,
• kantle ho tse tsoang lijong tsohle tse thibetsoeng, haholo-holo lijo tse nang le tsoekere.

Ho latela likhothaletso tsa WHO, tafole ea 9 e abeloa bakuli ba lefu la tsoekere, lenaneo la phepo e reretsoe ho boloka tsoekere e tloaelehileng maling.

Phepo e nepahetseng le e leka-lekaneng ke senotlolo sa kalafo ea lefu la tsoekere.

Ho bohlokoa. Bakuli ba nang le lefu la tsoekere ba hlokahala hore ba lule ba lekola khalori ea ho ja. Bophahamo ba bona ba letsatsi le letsatsi bo lokela ho tsamaisana le tšebeliso ea matla a 'mele, ho nahana ka mokhoa oa bona oa bophelo, boima, bong le lilemo.

Lihlahisoa tse latelang li lokela ho ba teng lijong tsa motho ea lefu la tsoekere:

Ho ja limatlafatsi tsa letsatsi le letsatsi ho lokela ho ajoa ho latela molao-motheo o latelang:

• protheine - eseng ho feta 20%,
• mafura - eseng ho feta 35%%
• lik'habohaedreite - eseng tse fetang 60%
• mafura a polyunsaturated mafura - eseng ho feta 10%.

Ntle le likhothaletso tse kaholimo bakeng sa phepo e nepahetseng, bakuli ba hloka ho eketsa tšebeliso ea limela ka litlamorao tse phahameng tsa tsoekere. Ho khothalletsoa hore e nkuoe ka mokhoa oa li-decoctions kapa infusions, meriana ea limela e tla ba sebaka se loketseng bakeng sa ts'ebetso ea lithethefatsi tse theko e boima.

Tsena li kenyeletsa:

• litholoana le makhasi a nati,
• fragole
• li-blueberries
• molora oa thaba
• elecampane
• oats
• clover
• pods tsa linaoa
• lingonberry
• lebelo.

Lethathamo lena le pharaletse ebile le ka tsoelapele ka nako e telele, ho feta moo, litlamelong tsa litlama u ka fumana litlokellane tse khethehileng tsa litlama tse tlatsetsang ho feteng ha tsoekere maling maling. Ho bohlokoa ho hlokomela hore lijalo tsena ha li kenye letsoho ho lokisoeng ha tsoekere feela, empa li ama le bophelo bo botle ka kakaretso.

Motsoako oa litlama ke o mong oa likarolo tsa bohlokoa tsamaisong ea kalafo ea lefu la tsoekere.

Ka lebaka la hore khahlano le lefu la tsoekere la mofuta oa 2 lefu la tsoekere lea eketseha, likhothaletso tsa phepo e nepahetseng li amana le lipalo tsa kenyelletso ea lijo lihlopheng tsa bohobe (XE). Bakeng sa batho ba nang le lefu la tsoekere ha ho na feela tafole e entsoeng ka ho khetheha ea likarolo tsa bohobe, eo ho leng bonolo ho ithuta ho e sebelisa. Kamora tšebeliso ea nako e telele, ba bangata ba khetholla hore na XE e sebetsa leihlo lefe.

Mohlala, 1 XE e na le:

• khalase ea lebese, kefir, yogurt kapa yogurt (250 ml),
• chisi ea chisi e nang le morara o se nang tsoekere (40 dikgerama),
• sopho ea noodle (3 tbsp),
• porridge efe kapa efe e phehiloeng (2 tbsp.spoons),
• litapole tse khotliloeng (2 tbsp.spoons).

Ho bohlokoa. Litsebi tsa lefu la tsoekere ha lia lumelloa ho noa joala, empa maemong a sa tloaelehang ho lumelloa ho nka veine e khubelu e omisitsoeng e sa feteng ligrama tse 150.

Phekolo ea "insulin" ea lefu la tsoekere la mofuta oa

Joalo ka ha le tseba, mofuta oa lefu la tsoekere ke mofuta o mong o amanang le insulin, likhothaletso tsa mantlha tsa mofuta oa 1 lefu la tsoekere le bua ka tsamaiso ea liente tsa insulin. Mokhoa oa ho alafa oa insulin o tlameha ho ba o utloisisehang hape o ikemiselitseng ho latela litšobotsi tsa 'mele.

Tekanyetso ea insulin e baloa feela ke ngaka e tlang, ha a ntse a nahana ka lintlha tsa bohlokoa, tse kang:

• boima
• lilemo
• tekanyo ea ho hlobaela ha pancreatic,
• mahloriso a tsoekere maling.

Tekanyetso ea insulin ea letsatsi le letsatsi e baloang ka ente tse 'maloa, empa ho tlameha ho hopoloa hore karolo e le' ngoe ea ente e lokela ho sebelisa palo eohle ea tsoekere e kenang.

Hlokomela hore ho lipalo, mofuta oa moriana o boetse oa bohlokoa, ka moeli oa ho o hlahisa o arotsoe ka:

• "insulin" e phahameng haholo
• lietsahala insulin
• ketso tse mahareng
• telele
• ketso e makatsang.

Bokhabane bo boholo ba puseletso ea insulin bo bonoa ka ho hlahisoa ha insulin ea nakoana le nako e khutšoane ea ho pepeseha. Ka tloaelo, mefuta ena ea lithethefatsi e fanoa ntle le ho senya pele u ja kapa hang hoba u je. Lithethefatsi tse nkang nako e telele hangata li fanoa hoseng le ka shoalane pele ho robala.

Ho kenya insulin ka mpeng ho etsa hore moriana o phatlohe kapele.

Hape, ha u bala tekanyo, palo ea XE e nkuoa tlhokomelong, ke hore, ka linako tse fapaneng tsa letsatsi le ka bongata bo fapaneng ba boleng le lijo tsa 1 XE, ho hlokahala insulin e itseng. Re supa hape, lipalo tsohle tsa litekanyetso tsa moriana li etsoa feela ke ngaka e eang. Ho fetola tekanyetso ka boeona ha ho kgothaletswe.

Hlokomela Liente li etsoa ka pene e khethehileng ea syringe, ho loketse haholo ts'ebeliso e ikemetseng. Ho fa batho ba lefu la tsoekere lintho tse hlokahalang bakeng sa liente (pente, insulin) ho tla lefella litšenyehelo tsa lichelete tsa sechaba.

Kalafo ea insulin bakeng sa lefu la tsoekere la mofuta oa II

Mofuta oa lefu la tsoekere la Mofuta oa II, joalo ka ha re hlokometse ka holimo, ha se mofuta o itšetlehileng ka insulin, empa maemong a mang, ha ts'ebetso ea ts'ebetso ea setšoantšo sa kliniki e qala, ho ka ba le tlhoko ea liente.

Phekolo ea "insulin" ea lefu la tsoekere la mofuta oa II e boletsoe maemong:

• Teko ea mali bakeng sa hemoglobin ea glycated e hlahisoa ke letšoao la 9% kapa ho feta (e tsamaeang le lipontšo tse hlakileng tsa kliniki ea lefu la tsoekere la Mofuta oa II),
• nakong ea kalafo ea lithethefatsi ho mokuli nako e telele ha ho na matla a ho hlaphoheloa,
• nalane ea li-contraindication bakeng sa ho sebelisa lithethefatsi tsa hypoglycemic,
• Liteko tsa mali le tsa moroto li bonts'a litaba tsa ketone le tsoekere ka mokhoa o hlakileng.
• mokuli o bontšoa ho kenella ha ho buuoa.

Haeba lefu la tsoekere le na le lipontšo tsa kalafo ea insulin, ngaka e lokela ho bua le eena ka kotsi ea hypoglycemia le ho mo fa litlhahiso mabapi le mokhoa oa ho itshwara lipontšong tsa pele tsa boemo ba methapo.

Ho bohlokoa. Maemong a sa tloaelehang, kalafo ea insulin ha e fane ka litholoana tse ntle, ebe ngaka e etsa qeto ea tlhoko ea matla a eona. Ka mantsoe a mang, litekanyetso tsa letsatsi le letsatsi tsa insulin bakeng sa mokuli ka mong li eketseha ho fihlela metabolism ea carbohydrate 'meleng e lekantsoe.

Likarolo tsa liente tsa insulin

Joalokaha re hlokometse ka holimo, insulin e arotsoe ka mefuta e 'maloa ho latela phello. Liente tsa e 'ngoe le e' ngoe ea tsona li na le litšobotsi tsa bona tsa ho monya le phello ea ketso.

Lethathamo la 3. Mefuta ea insulin le litlamorao tsa eona:

Mofuta oa insulin	Litšobotsi tsa Tšusumetso
Ultrashort	Li-insulin tsa Ultrashort li na le karolo e khethollang - li fanoa hang-hang pele ho lijo kapa hang ka mor'a lijo. Li-insulin tse sebetsang ka nako e khuts'oane li kenyelletsa: Humalog, Novorapid. Mokhoa ona oa ho enta o loketse li-diabetes, ha o bake pherekano le lipalo tsa nako ea ente ea ho qetela.
Nakoana	Litokisetso tsa insulin tse sebetsanang le nako e khutšoane li fanoa pele kapa ka mor'a lijo, empa li tiisoa nako ea ho qeta metsotso e 30, hobane ke ka mor'a nako ena moo moriana o qalang ho kenya tšebetsong ketso ea ona. Hlokomela hore mofuta o mokhuts'oane oa insulin o na le karolo ea hore ha tekanyetso e eketseha, litlamorao ho lithane li lieha ho tsamaea. Nako e phahameng ea ho qala ha ketso ke metsotso e 90, nako ea phello ke lihora tse 4-6.
Ho nka nako e telele	Insulin ea nako e telele e fapana le mefuta e khuts'oane ka hore e kenya letsoho moetlong o sa feleng oa tlhahiso ea insulin. E tsamaisoa makhetlo a 2 ka letsatsi le karohanyo ea lihora tse 12 ho isa ho tse 12. Ente ea pele ke hoseng pele ho lijo tsa hoseng, 'me ea bobeli e le ka shoalane pele u robala. Mofuta ona oa lithethefatsi o na le ntho e tlamellang li-hormone mme o thibela ho tsamaisoa ha eona ho ea maling.

Ho tlameha ho boleloa ka thoko hore ho ntse ho e-na le mofuta oa insulin o kang oa bongata bo phahameng. Lithethefatsi tse joalo li na le lisutu tse telele le tse khutšoane.

Ha o sebelisa mofuta ona oa moriana, ha ho hlokahale ho fana ka ente hoseng pele ho lijo tsa hoseng le ka shoalane pele ho lijo tsa mantsiboea, kaha e tsamaisoa ka thata hang ka letsatsi. Empa u se ke oa lebala hore ho bala litekanyetso tsa lithethefatsi tse joalo ho thata haholo.

Palo ea tekanyetso ea insulin e etsoa hantle ke ngaka ea hau.

Phekolo ea lefu la tsoekere

Lefu la tsoekere la Mofuta oa 2 le fapana le lefu la tsoekere la mofuta oa 1 hobane ha le hloke ho kenngoa liente tsa insulin, 'me, ka hona, ka lefu lena, mokuli o lokela ho ela hloko haholo mokhoa oa bophelo le phepo e nepahetseng.

Ho joalo, ka lebaka la boikoetliso bo itekanetseng ba 'mele, motho a ka fihlela sephetho se latelang:

• activate metabolism ea carbohydrate,
• fokotsa mmele
• etsa hore mosebetsi oa pelo le pelo li fetohe.

Moroalo le mofuta oa boikoetliso li laetsoe ke ngaka e eang. Ha u khetha, e tataisoa ke likarolo tse latelang:

• boima ba mokuli
• lilemo
• tekanyo ea ponahatso ea methapo ea mafu,
• bophelo bo botle ka kakaretso
• boteng ba maloetse a kopaneng.

Nako e tloaelehileng ea litlelase ke ho tloha metsotso e 30 ho isa ho hora e le 'ngoe,' me palo ea ho ikoetlisa ka beke ke makhetlo a 3-4.

Hlokomela Ho ikoetlisa ha mofuta o mong le o mong ho thibetsoe ho batho ba nang le lefu la tsoekere ba nang le ts'ebetso ea phefumoloho e sa sebetseng le mathata a methapo. Pele a fana ka physiotherapy, ngaka e fa mokuli phetisetso ho electrocardiogram.

Koetliso ea Cardio e hlophisehileng hammoho le boikoetliso ba matla e ka fihlella liphetoho tse ntle tsa nako ea tsoekere ea mofuta oa I le lefu la tsoekere la II, hape e thusa ho fokotsa likotsi tsa ho ba le komello.

Mokhoa oa bophelo o mafolofolo o ka ntlafatsa maemo a lefu la tsoekere.

Haeba mokuli a sa bonts'a liphetoho molemong oa ntlafatso, ngaka e fetola litlhahiso mabapi le bophahamo ba mojaro le palo ea litlelase ka beke.

Moriana oa litlama

Phytotherapy ea lefu la tsoekere e tla fana ka phello e ntle hammoho le kalafo e ka sehloohong ea lithethefatsi. Re lokela ho hlokomela hore tšebeliso ea meriana efe kapa efe ea meriana ea setso e lokela ho tšohloa le ngaka ea hau.

Limela tse bohlokoa ka ho fetisisa bakeng sa lefu la tsoekere:

• dandelion
• leqheka
• li-blueberries
• molora oa thaba
• elecampane
• oats
• lekhasi la bay
• E khohlela letlapa.

Motsoako oa litlama o ka ntlafatsa maemo a tsoekere ea mali.

Metsing a setso, ho na le mekhoa e mengata e tlatselletsang tsoekere ea mali.

Re tla hlahisa ho babali ba 'maloa ba bona:

1. Motsoako oa dandelion - 3 tbsp. likhaba, metsi a belang - likhalase tse peli. Pheha infusion bakeng sa metsotso e 6, ebe o tloha ho etsa joalo. Nka kopi e le 1 ea moro kahare metsotso e 30 pele u e ja.
2. Stinging nettle - 1 tbsp. khaba, metsi a belang - kopi e le 1. Tšela semela ka metsi a belang ebe u tlohela metsotso e 30. Nka ka molomo bakeng sa 1 tbsp. khaba makhetlo a 3 ka letsatsi metsotso e 20 pele ho lijo.
3. Plantain - 1 tbsp. khaba, metsi a belang - kopi e le 1. Tšela makhasi a omeletseng a metsi a belang ka metsi a belang ebe u tlohela metsotso e 20. Nka ka khaba e le 'ngoe khaba makhetlo a 3 ka letsatsi pele ho lijo.

Tlhaloso e khutšoane

Lefu la tsoekere Na sehlopha sa maloetse a metabolic (metabolic) a tšoauoa ke hyperglycemia e sa foleng, e leng sephetho sa secretion sa insulin, litlamorao tsa insulin, kapa lintlha tsena ka bobeli.

Khoutu (li) tsa ICD-10:

ICD-10
Khoutu	Sehlooho
E 11	Mellitus e sa itšetleheng ka insulin
E 11.0	ka komello
E 11.1	le ketoacidosis
E 11.2	ka ho senyeha ha meno
E 11.3	ka tšenyo ea leihlo
E 11.4	le mathata a methapo
E 11.5	ka tšenyo ea potoloho ea potoloho,
E 11.6	ka mathata a mang a boletsoeng,
E 11.7	ka mathata a mangata
E 11.8	ka mathata a sa hlalosoang.

Nts'etsopele ea protocol / Tlhahlobo: 2014 (e ntlafalitsoe 2017).

Maele a sebelisitsoeng ho protocol:

Ag	–	khatello ea kelello ea methapo
HELL	–	khatello ea mali
ACE	–	angiotensin-e fetolang enzyme
in / Ka	–	kahare
DKA	–	lefu la tsoekere ketoacidosis
I / U	–	insulin / lik'habohaedreite
ICD	–	lietsahala tse sebetsang
HDL	–	high density lipoprotein
LDL	–	li-lipoprotein tse fokolang haholo
NPII	–	infusionane ea insulin e tsoelang pele
Jab	–	tlhahlobo ea mali ka kakaretso
OAM	–	urinalysis
Lifespan	–	tebello ea bophelo
RCT	–	liteko tse laoloang ka mokhoa o ikhethileng
SD	–	lefu la tsoekere
VTS	–	lefu la tsoekere la maoto
SCF	–	sekhahla sa filtara ea glomerular
SMG	–	tlhaiso ea tsoekere e tsoelang pele ea letsatsi le letsatsi
TG	–	thyroglobulin
TVET	–	thyroperoxidase
TTG	–	thyrotropic globulin
Ultrasound	–	ultropta dopplerography
Tlhahlobo ea Ultrasound	–	tlhahlobo ea ultrasound
USP	–	insulin ea insulin
FA	–	ho ikoetlisa
XE	–	likarolo tsa bohobe
XC	–	k'holeseterole
ECG	–	electrocardiogram
ENG	–	electroneuromyography
Hbalc	–	glycosylated (glycated) hemoglobin
IA-2, IA-2 β	–	li-antibodies tsa tyrosine phosphatase
IAA	–	li-antibodies ho insulin

Basebelisi ba Protocol: lingaka tsa tšohanyetso, lingaka tse akaretsang, lingaka tsa bongaka, lingaka tsa likokoana-hloko, lingaka.

Sehlopha sa Bakuli: batho ba baholo.

Boemo ba bopaki:

A	Tlhahlobo ea boleng bo phahameng ba meta-tlhahlobo, tlhahlobo e hlophisehileng ea li-RCT kapa li-RCT tse kholo tse nang le monyetla o fokolang haholo (++) oa phoso e hlophisitsoeng, litholoana tsa tsona li ka fetisetsoa ho sechaba se lumellanang.
Ho	Li-cohort tsa boleng bo phahameng (++) tse hlophisehileng kapa lithuto tsa taolo ea cohort kapa lithuto tsa maemo a phahameng kapa li-control-kesi tse nang le kotsi e fokolang haholo ea phoso e hlophisitsoeng kapa li-RCT tse nang le kotsi e tlase (+) ea phoso e hlophisitsoeng, liphetho tsa tsona li ka fetisetsoa ho palo e lumellanang. .
Le	Phuputso e hlophisitsoeng ea cohort kapa ea linyeoe kapa thuto e laoloang ntle le ho ba le khethollo ka kotsi e tlase ea leeme (+). Liphetho tsa tsona li ka fetisetsoa ho sechaba se lumellanang kapa li-RCT ka kotsi e tlase haholo kapa e tlase ea phoso e hlophisitsoeng (++ kapa +), liphetho tsa tsona li ke ke tsa fetisoa ka kotlolloho ho baahi ba lumellanang.
D	Tlhaloso ea letoto la linyeoe kapa thuto e sa laoloang kapa maikutlo a setsebi.
GPP	Mokhoa o motle oa bongaka.

Tlhomamiso

Sehlopha:

Lethathamo 1. Tlhophiso ea bongaka ea lefu la tsoekere

Type 1 lefu la tsoekere	Tšenyo ea "cell" ea pancreatic, hangata e baka khaello ea insulin e felletseng
Type 2 lefu la tsoekere	Tlolo e tsoetseng pele ea secretion ea insulin mokokotlong oa ho hanyetsa insulin
Mefuta e meng e ikhethang ea lefu la tsoekere	- bofokoli ba liphatsa tsa lefutso tšebetsong ea lisele tsa β, - bofokoli ba liphatsa tsa lefutso ketsong ea insulin, - mafu a karolo ea "makhopho" a pancreas litsoelesa - e qobelloang ke lithethefatsi kapa lik'hemik'hale (kalafo ea HIV / AIDS kapa kamora ho fetisoa hoa setho), - endocrinopathies, - tšoaetso - li-syndromes tse ling tsa lefutso hammoho le lefu la tsoekere
Lefu la tsoekere	E hlaha nakong ea kemaro

Ts'oaetso

MELAO EA DIAGNOSTIC, APPROACHES LE LITCEDOBOTSI 1,3,6,7

Tlhahlobo ea ho hlahloba:
Bofokoli
Malaise
· Ts'ebetso e fokotsehile
Ho hloka kutloelo-bohloko
Letlalo le ho hlohlona ka letlalo
Polyuria
Polydipsia
Pono e fifatsang ea nako le nako
Ho ikutloa o chesa maotong
Makhopho libakeng tse tlaase le paresthesia bosiu,
Liphetoho tsa Dystrophic letlalong le lipekere.
* Litletlebo ha ho ka ba le phoso ea ho fumana hyperglycemia li ka ba sieo.

Anamnesis
Boloetse bona hangata bo iponahatsa bo le ka tlase ho lilemo tse 40, bo etelloa pele ke ho ba teng ha likarolo tsa metabolic syndrome (botenya, khatello ea methapo ea methapo, le tse ling).

Tlhahlobo ea 'mele
Bakuli ba lefu la tsoekere la mofuta oa bobeli ba na:
Matšoao a IR: botenya ba visceral, khatello e phahameng ea mali, acanthosis nigrikans,
Keketseho ea boholo ba sebete,
Matšoao a ho felloa ke metsi 'meleng (li-membrane tsa mucous tse omileng, letlalo, fokotsehileng ka letlalo),
Matšoao a neuropathy (paresthesia, liphetoho tse fetohileng letlalong le lipekere, liso tsa maoto).

Patlisiso ea laboratori:
· Teko ea mali a biochemical: hyperglycemia (tafole. 2),

Lethathamo la 2. Litekanyetso tsa lefu la tsoekere 1, 3

Nako ea boikemisetso	Glucose, mmol / l *
	Mali ohle a capillary	Plasma e bohloko
NORM
Ka mpeng e se nang letho le lihora tse peli kamora PGTT
	Lefu la tsoekere
Ho itima lijo ** kapa lihora tse peli kamora PGTT kapa litlhaloso tse sa reroang	≥ 6,1 ≥ 11,1 ≥ 11,1	≥ 7,0 ≥ 11,1 ≥ 11,1

* Boloetse bo ipapisitse le liteko tsa glucose tsa laboratori
** Ho fumanoa ha lefu la tsoekere ho lokela ho netefatsoa kamehla ka ho netefatsa glycemia matsatsing a latelang, ntle le linyeoe tsa hyperglycemia ntle le tšenyo ea nako ka kalafo ea methapo ea methapo kapa le matšoao a hlakileng.

OAM: glucosuria, ketonuria (ka linako tse ling).
· C-peptide ke letšoao la masapo a insulin a tloaelehileng (0.28-1.32 pg / ml). Teko bakeng sa mehloli ea C-peptide: joalo ka molao, ka T2DM, boemo ba C-peptide boa eketseha kapa bo tloaelehile, ka ponahatso ea insulin defence syndrome e ea fokotseha.
Glycated hemoglobin (HvA1c) - ≥ 6.5%.

Lithuto tsa liletsa (ho ea ka lipontšo):
· ECG - ho khetholla litšitiso tse ka bang teng ka morethetho, ischemia myocardial, matšoao a hypertrophy ea methapo ea mokokotlo oa leqhubu, systolic overload,
· Echocardiography - ho bona matšoao a lefu la methapo ea methapo ea motho ka mong, ho fokotseha ha methapo ea methapo, hypertrophy ea myocardial, libaka tsa ischemia, tlhahlobo ea karolo ea botlamuoa,
Ultrasound ea mpa ea mpa - ho tsebahala ha lefu la methapo ea kutlo,
· UZDG ea likepe tse lipelong tse tlase - ho bona liphetoho matšoao a phallo ea mali methapong le methapong ea maoto
· Ho beha leihlo - ho bona sekhahla se patehileng khatello ea mali, arrhythmias,
· Sistimi ea SMG - mokhoa oa ho shebella glycemia e tsoelang pele ho khetha le ho lokisa kalafo e theolang tsoekere, ho ruta bakuli le ho ba kenya letsoho ts'ebetsong ea kalafo.
X-ray ea maoto - ho lekola ho teba ha botebo ba botebo le botebo ba mesifa ho lefu la tsoekere la maoto,
Tlhahlobo ea Microbiological ea leqebeng le nang le liso tsa maoto - - bakeng sa kalafo ea lithibela-mafu,
· Electroneuromyography ea lintlha tse tlase - bakeng sa ts'oaetso ea lefu la tsoekere le polyneuropathy.

Matšoao bakeng sa tlhahlobo ea litsebi tse patisaneng:
Lethathamo la 6. Lipontšo tsa lipuisano tsa litsebi 3, 7

Setsebi	Morero oa tlhahlobo
Kopo ea lingaka tsa bana	Bakeng sa tlhahlobo le kalafo ea tšenyo ea leihlo ea lefu la tsoekere - ho latela lipontšo
Kopano ea litsebi tsa kelello	Bakeng sa tlhahlobo le kalafo ea mathata a lefu la tsoekere - ho latela lipontšo
Puisano ea Nephrologist	Bakeng sa tlhahlobo le kalafo ea mathata a lefu la tsoekere - ho latela lipontšo
Puisano le ngaka ea pelo	Bakeng sa tlhahlobo le kalafo ea mathata a lefu la tsoekere - ho latela lipontšo
Puisano ea Angiosurgeon	Bakeng sa tlhahlobo le kalafo ea mathata a lefu la tsoekere - ho latela lipontšo

Tlhahlobo e fapaneng

Tlhahlobo e khethollang le tokafalo ea lithuto tse ling

Lethathamo la 4 Litekanyetso tsa tlhahlobo e ikhethang ea lefu la tsoekere la 1 le lefu la tsoekere la mofuta oa 2

Type 1 lefu la tsoekere	Type 2 lefu la tsoekere
Bocha, ho qala ka mokhoa o hlasimolohileng (lenyora, polyuria, boima ba 'mele, ho ba teng ha acetone ka har'a moroto)	Ho nona haholo, khatello ea maikutlo, mokhoa oa ho lula fatše, ho ba teng ha lefu la tsoekere ka lapeng le haufi
Tšenyo ea Autoimmune ea li-β-cell tsa li-isanc tsa pancreatic	Khanyetso ea insulin hammoho le ho se sebetse ka sekhukhu ha β-cell dysfunction

Lithethefatsi (dintho tse sebetsang) tse sebelisoang kalafo

Acarbose (Acarbose)

Vildagliptin (Vildagliptin)

Glibenclamide (Glibenclamide)

Gliclazide (Gliclazide)

Glimepiride (Glimepiride)

Dapagliflozin (Dapagliflozin)

Dulaglutide (Dulaglutide)

Insulin aspart

Insulin aspart biphasic (Insulin aspart biphasic)

Insulin glargine

Insulin glulisine (Insulin glulisine)

Insulin degludec (Insulin degludec)

Sesosa sa insulin

Insulin lispro (Insulin lispro)

Lyspro insulin biphasic (Insulin lispro biphasic)

Soluble insulin (e entsoeng ka liphatsa tsa motho tsa lefutso) (Insulin e qhibilihang (biosynthetic ea motho)

Insulin-isophan (moenjiniere oa liphatsa tsa lefutso tsa motho) (Insulin-isophan (biosynthetic ea motho)

Kanagliflozin (Kanagliflozin)

Lixisenatide (Lixisenatide)

Linagliptin (Linagliptin)

Liraglutide (Liraglutide)

Metformin (Metformin)

Nateglinide (Nateglinide)

Pioglitazone (Pioglitazone)

Repaglinide (Repaglinide)

Saxagliptin (Saxagliptin)

Sitagliptin (Sitagliptin)

Empagliflozin (Empagliflozin)

Phekolo (kliniki ea kantle ho nako)

LITLHAKISO TSA TLHOKOMELISO TLHALOSO EA MOTSOALI OA MAHALA 2,3,7,8,11:
Bakuli ba nang le lefu la tsoekere la mofuta oa 2 ntle le mathata a hlobaetsang, ba ka fumana kalafo ea ntle ntle le nako..

Lipakane tsa kalafo:
· Katleho ea boemo ba motho ba sepheo sa glycemia le HvA1,
Normalization ea khatello ea mali
Naturalization ea lipid metabolism,
Ho thibela mathata a lefu la tsoekere.

Tafole ea 5. algorithm ea khetho ea motho ka mong ea lipheo tsa kalafo bakeng saHbalc2,3

Litekanyetso	MAKA
	nyane	ka karolelano	Nako ea botsofe le / kapa nako ea bophelo * 5
Ha ho na mathata le / kapa kotsi ea hypoglycemia e matla
Ho na le mathata a maholo le / kapa kotsi ea hypoglycemia e matla

* Nako ea bophelo - tebello ea bophelo.

Lethathamo la 6.Fuoa meeli ea sepheoHbalclitekanyetso tse latelang tsa sepheo sa maemo a tsoekere ea pre / postprandial plasma e tla lumellana le 2.3

Hbalc**

Glucose ea plasma nAttachment / Pele ho lijo, mmol / L

Glucose ea plasma hkamora lihora tse peli kamora ho ja, mmol / l

*Litekanyetso tsena tse boletsoeng ha li sebetse ho bana, lilemong tsa bocha le ho basali baimana. Melemo ea taolo ea glycemic mabapi le mekhahlelo ena ea bakuli e tšohloa likarolong tse amehang.
** Boemo bo tloaelehileng ho latela maemo a DCCT: ho fihla ho 6%.

Lethathamo la 7. Target lipid metabolism ho bakuli ba nang le lefu la tsoekere 2,3

Matšoao	Melao ea sepheo, mmol / L *
	banna	basali
K'holeseterole e akaretsang
Cholesterol
HDL k'holeseterole	> 1,0	>1,2
triglycerides

Pmofani	Tsboleng ba sprucemmHg Art.
Khatello ea mali ea Systolic	> 120 * le ≤ 130
Khatello ea mali ea Diastolic	> 70 * le ≤ 80

* Khahlano le nalane ea kalafo ea antihypertensive
Tekanyo ea khatello ea mali e lokela ho etsoa ketelong e 'ngoe le e' ngoe ho endocrinologist. Bakuli ba nang le khatello ea mali ea systolic (SBP) ≥ 130 mm Hg. Art. kapa khatello ea mali ea diastolic (DBP) ≥ 80 mm Hg. Art., E lokela ho ba tekanyo ea bobeli ea khatello ea mali ka letsatsi le leng. Haeba litekanyetso tsa khatello ea mali tse boletsoeng li bonoa nakong ea mehato e pheta-phetoang, ho hlahlojoa ha khatello ea mali ho nkoa ho netefalitsoe (bakeng sa kalafo ea khatello ea methapo ea mali, bona protocol "Arterial hypertension").

Phekolo eo eseng ea lithethefatsi:
Lijo tsa lijo tsa 8 - lijo tse fokotsitsoeng tsa khalori. Bakeng sa bakuli ba fumanang kalafo ea insulin, lijo tse matlafalitsoeng ka fiber ea phepo,
· Mokhoa o akaretsang,
Ho ikoetlisa - ho nahana ka boemo ba pelo le pelo,
Ho ithuta sekolong sa lefu la tsoekere
· Boitlhalo.

Phekolo ea lithethefatsi

Lethathamo la lithethefatsi tsa bohlokoa (ho ba le ts'ebeliso ea 100%):

Lethathamo 9. Lithethefatsi tse theolang tsoekere tse sebelisoang ho phekola lefu la tsoekere la mofuta oa 2

Sehlopha sa mahlale	Lebitso la lithethefatsi tse sa sebetseng machabeng	Mokhoa oa kopo	Boemo ba bopaki
Litokisetso tsa SM	gliclazide	Ka molomo	A
	gliclazide		A
	glimepiride		A
	glibenclamide		A
Li-glinids (meglitinides)	repaglinide	Ka molomo	A
	* nateglinide		A
Biguanides	metformin	Ka molomo	A
TZD (glitazones)	pioglitazone	Ka molomo	A
Α-glucosidase inhibitors	acarbose	Ka molomo	A
aGPP-1	lulaglutide	Ka tsela e ikhethileng	A
	liraglutide		A
	lixisenatide		A
IDPP-4	sitagliptin	Ka molomo	A
	vildagliptin		A
	saxagliptin		A
	linagliptin		A
INGLT-2	empagliflozin 10-12	Ka molomo	A
	dapagliflozin 8-9		A
	canagliflozin 13-15		A
Ultrashort insulin (human insulin analogue)	Lyspro insulin	Subcutanely kapa ka methapo. Subcutanely kapa ka methapo.	A
	Insulin aspart		A
	Insulin glulisin		A
Boits'oaro bo khuts'oane	Soluble e entsoeng ka tlhaho ka insulin	Subcutaneally, ka methapo	A
Li-insulin tsa Nako e Bohareng	Isofan Insulin Moenjineri oa Phello ea Motho	Ka tsela e ikhethileng.	A
Li-insulin tse telele (human insulin analogues)	Insulin glargine 100 PIECES / ml16-20	Ka tsela e ikhethileng.	A
	Sesosa sa insulin 21-23		A
Li-insulin tse eketsehileng	Insulin degludec 24-28	Ka tsela e ikhethileng.	A
	Insulin glargine 300 PIECES / ml29-35		A
Motsoako o entsoeng ka litokisetso tsa insulin tse nkang nakoana le NPH-insulin	Biphasic insulin boenjiniere ba lefutso la motho	Ka tsela e ikhethileng.	A
Li-motsoako tse lokiselitsoeng tse tsoetseng pele tsa li-insulin analogue tsa Ultra-khutšoanyane silafalitsoe Ultra e khuts'oanyane e sebetsang ka insulin	Lyspro insulin biphasic 25/75	Ka tsela e ikhethileng.	A
	Lyspro insulin biphasic 50/50		A
	Insulin aspart 2-phase		A
Motsoako o entsoeng ka litokisetso insulin analogue nako e telele liketso le boqapi "insulin" e phahameng haholo	Insulindegludec + Insulinaspart ka karolelano ea 70 / 3036-37	Ka tsela e ikhethileng.	A
Motsoako o kopaneng oa ente ea nako e telele le e eketsehileng ea insulin le aHPP-1	Insulin Glargine + Lixisenatide (Nako e le 1 ka letsatsi) 38-39	Ka tsela e ikhethileng.

Ka tsela e ikhethileng.
A Insulin degludec + liraglutide
(Nako e le 1 ka letsatsi)
40-43A

Ho latela Consensus of the Public Association "Mokhatlo oa Endocrinologists oa Kazakhstan" bakeng sa tlhahlobo le kalafo ea mofuta oa lefu la tsoekere la mofuta oa 2, 2016, ha o khetha mokhoa oa ho qala le ho ts'ehetsa pheko e fokotsang tsoekere ea mofuta oa 2 lefu la tsoekere, Algorithm e latelang e lokela ho lateloa:

* - Ntle le glibenclamide
Kemiso ea lithethefatsi ha e bonts'e pele ha u li khetha

Ho kena lipakeng: che.

Tsamaiso e ngoe

Lethathamo la 10. Lethathamo la litekanyetso tsa laboratori tse hlokang ho hlahlojoa ka matla ho bakuli ba nang le lefu la tsoekere la mofuta oa 2:

Laboratormofani	Khafetsa maqhubu
Ho itaola	Bothata ba lefu lena le ho bolaoa habonolo - letsatsi le letsatsi makhetlo a 'maloa ka letsatsi. Ho ea pele, ho latela mofuta oa FTA: - kalafo e matlafalitsoeng ea insulin: bonyane makhetlo a 4 ka letsatsi, - ho PSST le / kapa GPP-1 le / kapa insulin ea basal: bonyane nako e le 'ngoe ka letsatsi ka linako tse fapaneng tsa letsatsi + 1 profil ea glycemic (bonyane makhetlo a 4 ka letsatsi) ka beke, - motsoako oa insulin o itokiselitseng: bonyane makhetlo a 2 ka letsatsi ka linako tse fapaneng + 1 profil ea glycemic (bonyane makhetlo a 4 ka letsatsi) ka beke, - kalafo ea ho ja: Nako e le 'ngoe ka beke ka linako tse fapaneng tsa letsatsi,
Hbalc	Nako e 1 ho likhoeli tse 3
Tlhahlobo ea biochemical ea mali (protheine e felletseng, cholesterol, cholesterol ea LDL, cholesterol ea HDL, triglycerides, bilirubin, AST, ALT, creatinine, lipalo tsa GFR, K, Na,)	Hang ka selemo (ho sa etsoe liphetoho)
Jab	Hang ka selemo
OAM	Hang ka selemo
Boikemisetso ka moroto oa karolelano ea albin le creatinine	Hang ka selemo
Boikemisetso ba 'mele ea ketone ka har'a moroto le mali	Ho latela lipontšo
Tlhaloso ea IRI	Ho latela lipontšo

*Ha ho na le matšoao a mathata a sa foleng a lefu la tsoekere, ho eketsoa ha maloetse a kopaneng, ponahalo ea lintlha tse eketsehileng tsa kotsi, potso ea khafetsa ea litlhahlobo e etsoa qeto ka bonngoe.

Lethathamo 11. Lethathamo la litlhahlobo tse matlafatsang tse hlokahalang bakeng sa taolo e matla ho bakuli ba nang le lefu la tsoekere la mofuta oa 2 * 3.7

Mokhoa oa ho hlahloba lithulusi	Khafetsa maqhubu
SMG	Ho latela lipontšo
Taolo ea khatello ea mali	Nako le nako ha u etela ngaka. Boteng ba khatello ea mali - ho itlhokomela khatello ea mali
Tlhahlobo ea maoto le leihlo	Nako le nako ha u etela ngaka
ENG ea lipalo tse tlase	Hang ka selemo
ECG	Hang ka selemo
ECG (ka liteko tsa khatello ea maikutlo)	Hang ka selemo
Se-x-ray	Hang ka selemo
Ultrasound ea lijana tsa lipheletso tse tlase le liphio	Hang ka selemo
Ultrasound ea mpa ea mpa	Hang ka selemo

* Ha ho na le matšoao a mathata a sa foleng a lefu la tsoekere, ho eketsoa ha maloetse a kopaneng, ponahalo ea lintlha tse eketsehileng tsa kotsi, potso ea khafetsa ea litlhahlobo e etsoa qeto ka bonngoe.

Matšoao a katleho ea kalafo:
· Ho fihlella lipheo tsa motho ka mong oa НвА1с le glycemia,
· Katleho ea lipid metabolism tsa lipid,
· Katleho ea maemo a khatello ea mali,
· Nts'etsopele ea khothalletso ea boitšoaro.

Phekolo (sepetlele)

LITLHAKISO TSA TLHOKOMELISO TSA BOPHELO: Ho ntse ho khethoa kalafo e lekaneng ea ho theola tsoekere.

Karete ea Teko ea Bakuli, Tsela ea Mamello


Phekolo eo eseng ea lithethefatsi: sheba boemo ba maiketsetso.

Phekolo ea lithethefatsi: sheba boemo ba maiketsetso.

Ho kena lipakeng: che.

Ho lokisa le ho feta: sheba boemo ba maiketsetso.

Matšoao a katleho ea kalafo: sheba boemo ba maiketsetso.

Sepetlele

LITLHAKU TSA BOPHELO TSE BONAHANG TSA BOPHELO

Matšoao a ho pepesoa ho reriloeng:
· Boemo ba ho bolaoa ke metabolism ea carbohydrate, e sa nepahalang motheong oa kantle,
· Hangata khafetsa hypoglycemia ea khoeli kapa ho feta,
· Tsoelo-pele ea khatello ea methapo le pelo (retinopathy, nephropathy) tsa mofuta oa 2 lefu la tsoekere, lefu la tsoekere le tsoekere,
Basali baimana ba nang le lefu la tsoekere la mofuta oa 2 ba lemohileng nakong ea kemolo.

Matšoao a ho pepesoa sepetlele ka tšohanyetso:
Coma - hyperosmolar, hypoglycemic, ketoacidotic, lactic acid.

Mehloli le lingoliloeng

1. Metsotso ea liboka tsa Komisi e Kopaneng ea Boleng ba Litšebeletso tsa Bongaka tsa Lekala la Bophelo la Rephaboliking ea Kazakhstan, 2017
   1. 1) Mokhatlo oa lefu la tsoekere oa Amerika. Melao ea tlhokomelo ea bongaka ho lefu la tsoekere - 2017.DiabetesCare, 2017, Buka ea 40 (Tlatsetso 1). 2) Mokhatlo oa Lefatše oa Bophelo.Tlhaloso, Tlhahlobo, le Karolo ea Lefu la tsoekere le Liphetoho tsa lona: Tlaleho ea tlhahlobo ea WHO. Karolo ea 1: Botsoako le ho khetholla lefu la tsoekere. Geneva, Mokhatlo oa Lefatše oa Bophelo, 1999 (WHO / NCD / NCS / 99.2). 3) Li-algorithms bakeng sa tlhokomelo e khethehileng ea bongaka bakeng sa bakuli ba nang le lefu la tsoekere. Ed. I.I. Dedova, M.V. Shestakova, A.Yu. Mayorova, khatiso ea 8. Moscow, 2017.4) Mokhatlo oa Lefatše oa Bophelo. Ts'ebeliso ea Glycated Hemoglobin (HbAlc) ho Diagnosis of Diabetes Mellitus. Tlaleho e Khethiloeng ea Puisano ea WHO. Mokhatlo oa Lefatše oa Bophelo, 2011 (WHO / NMH / CHP / CPM / 11.1). 5) Bazarbekova R.B., Nurbekova A.A., Danyarova L.B., Dosanova A.K. Tumellano mabapi le tlhahlobo le kalafo ea lefu la tsoekere. Almaty, 2016.6) Deutsche Diabetes Gesellschaft und Deutsche Vereinte Gesellschaftfür Klinische Chemie und Labormedizin, 2016.7) Pickup J., Phil B. Insulin Pump Therapy for Type 1 Diabetes Mellitus, N Engl Med 2012, 366: 1616-24. 8) Zhang M, Zhang L, Wu B, Sefela H, An Z, Li S. Dapagliflozin kalafo ea mofuta oa 2 lefu la tsoekere: tlhahlobo e hlophisehileng le tlhahlobo ea meta-liteko tsa liteko tse laoloang tse sa sebetseng. Diabetes Metab Res Rev. 2014 Mar, 30 (3): 204-21. 9) RaskinP.Sodium-glucose cotransporter inhibition: monyetla oa kalafo bakeng sa kalafo ea mofuta oa 2 lefu la tsoekere. Lefu la tsoekere Metab Res Rev. 2013 Jul, 29 (5): 347-56. 10) Grempler R, Thomas L, Eckhardt M. et al. Empagliflozin, inhibitor e khethiloeng ea sodium glucose cotransporter-2 (SGLT-2): tšobotsi le papiso le li-inhibitors tse ling tsa SGLT-2. Diabetes ObesMetab 2012, 14: 83-90. 11) Häring HU, Merker L, Seewaldt-Becker E, et al. Empagliflozin e le tlatsetso ho metformin hammoho le sulfonylurea ho bakuli ba nang le lefu la tsoekere la 2: beke ea libeke tse 24, teko e sa laoleheng, e sa boneng mahlo hape e laoloang ke sebaka. Tlhokomelo ea lefu la tsoekere 2013, 36: 3396-404. 12) Häring HU, Merker L, Seewaldt-Becker E, et al. Empagliflozin e le tlatsetso ho metformin ho bakuli ba nang le lefu la tsoekere la 2: beke e 24, e sa sebetseng hantle, e sa boneng mahlo hape e le teko e laoloang ke placebo. Tlhokomelo ea lefu la tsoekere 2014, 37: 1650-9. 13) Nisly SA, Kolanczyk DM, Walton AM. Kanagliflozin, inhibitor e ncha ea sodium-glucose cotransporter 2, kalafong ea lefu la tsoekere.67Am J Health Syst Pharm. - 2013 .-- 70 (4). - R. 311-319. 14) Lamos EM, Younk LM, Davis SN. Kanagliflozin, inhibitor ea sodium-glucose cotransporter 2, bakeng sa kalafo ea mofuta oa 2 lefu la tsoekere. Setsebi Opin Drug MetabToxicol 2013.9 (6): 763-75. 15) Stenlöf K, Cefalu WT, Kim KA, et al. Ho sebetsa hantle le polokeho ea canagliflozinmonotherapy lithutong tsa mofuta oa lefu la tsoekere la 2 lefu le sa tsitsang la taolo ea phepo e nepahetseng le boikoetliso.67 Diabetes ObesMetab. - 2013 .-- 15 (4). - P. 372-382. 16) Rossetti P, Porcellati F, Fanelli CG, Perriello G, Torlone E, Bolli GB. Phahameng ea li-insulin tse amanang le insulin ea motho kalafong ea lefu la tsoekere mellitus.ArchPhysiolBiochem. 2008 Feb, 114 (1): 3-10. 17) White NH, Chase HP, Arslanian S, Tamborlane WV, 4030 Sehlopha sa Boithuto. Ho bapisoa ha phapang ea glycemic e amanang le insulin glargine le insulin e kenang bohareng ha e sebelisoa e le karolo ea basal ea liente tse ngata tsa letsatsi le letsatsi bakeng sa bacha ba nang le lefu la tsoekere la 1. 2009 Mar, 32 (3): 387-93. 18) Polonsky W, Traylor L, Gao L, Wei W, Ameer B, Stuhr A, Vlajnic A. E ntlafalitse khotsofalo ea kalafo ho bakuli ba mofuta oa 1 lefu la tsoekere le tšoaroang ke insulin glargine 100U / mL bapisoa le Nulin insulin: Tlhatlhobo ea ba boletsoeng esale pele ba bohlokoa ho tloha ho ba babeli liteko tse laoloang tse sa sebetsoang .. J mathata a lefu la tsoekere. 2017 Mar, 31 (3): 562-568. 19) Blevins T, Dahl D, Rosenstock J, et al. Ho sebetsa hantle le polokeho ea LY2963016 insulin glargine ha e bapisoa le insulin glargine (Lantus®) ho bakuli ba nang le lefu la tsoekere la 1 tekong e laoloang e sa reroang: thuto ea 1. Lefu la tsoekere le Metabolism. La 23 Phuptjane, 2015. 20) L. L. Ilag, M. A. Deeg, T. Costigan, P. Hollander, T. C. Blevins, S. V. Edelman, et al. Teko ea immunogenicity ea LY2963016 insulin glargine ha e bapisoa le Lantus®insulinglargine ho bakuli ba nang le mofuta oa 1 kapa mofuta oa 2 lefu la tsoekere. Lefu la tsoekere le lefu la tsoekere, ka la 8 Pherekhong 2016.21) Gilor C, Ridge TK, Attermeier KJ, Graves TK. Pharmacodynamics of insulin detemir le insulin glargine e lekantsoeng ke mokhoa oa isoglycemic clamp ho likatse tse phetseng hantle .. J Vet Intern Med. 2010 Jul-Aug, 24 (4): 870-4. 22) Fogelfeld L, Dharmalingam M, Robling K, Jones C, Swanson D, Jacober S. Nyeoe e sa fetoheng, e nang le sepheo sa ho bapisa ho emisoa ha insulin lispro protamine le ho emisoa ha insulin ho bakuli ba insulin-naive ba nang le lefu la tsoekere la 2.Diabetes Med. 2010 Feb, 27 (2): 181-8. 23) Reynolds LR. Ho bapisa insulins detemir le glargine ka mofuta oa 2 lefu la tsoekere: ho ts'oana ho feta phapang.Commentary.Postgrad Med. 2010 Jan, 122 (1): 201-3. 24) Zinman B, Philis-Tsimikas A, Cariou B, et al, lebitsong la Bafuputsi ba Nyeoe ba NN1250-3579 (BEGIN Mara Long). Tlhokomelo ea lefu la tsoekere. 2012.35 (12): 2464-2471. 25) Heller S, Buse J, Fisher M, et al, lebitsong la Bafuputsi ba Nyeoe ba Basal-Bolus ba mofuta oa BEGIN. Lancet. 2012.379 (9825): 1489-1497. 26) Gough SCL, Bhargava A, Jain R, Mersebach H, Rasmussen S, Bergenstal RM. Tlhokomelo ea lefu la tsoekere. 2013.36 (9): 2536-2542. 27) Meneghini L, Atkin SL, Gough SCL, et al, lebitsong la Bafuputsi ba Nyeoe ba NN1250-3668 (BEGIN FLEX). Tlhokomelo ea lefu la tsoekere. 2013.36 (4): 858-864. 28) Teko ea ho Lekola Matla a Ts'ireletso le Ts'ireletso ea Insulin Degludec ho bana le Bacha ba nang le Mofuta oa 1 lefu la tsoekere Mellitus (BEGIN ™) ClinicalTrials.gov Setsebi: NCT01513473. 29) Dailey G, Lavernia F. Tlhahlobo ea data le polokeho ea insulin glargine 300 unit / ml, mofuta o mocha oa insulin glargine.DiabetesMesab. 2015.17: 1107-14. 30) SteinstraesserA et al. Ka lipatlisiso tse ncha tsa insulin glargine 300 U / ml e na le metabolism e ts'oanang le insulin glargine 100 U / ml. Lefu la tsoekere LebesMetab. 2014.16: 873-6. 31) BeckerRHetal. New insulin glargine 300 Units • ML-1 e fana ka setšoantšo sa ts'ebetso le taolo ea nako e telele ea glycemic maemong a tsitsitseng ha e bapisoa le insulin glargine 100 Units • mL-1.DiabetesCare. 2015.38: 637-43. 32) Riddle MC et al. New Insulin Glargine 300 Units / mL Khahlano le Glargine 100 Units / mL ho Batho ba nang le Mofuta oa 2 lefu la tsoekere Ho Sebelisa Insulin le Nako ea Lijo: Taolo ea Glucose le Hypoglycemia ka Teko e Laoloang ea Khoeli le Khoeli ea 6-khoeli. 2014.37: 2755-62. 33) Yki-Järvinen H et al. Li-insulin glargine tse ncha tse 300 / mL khahlanong le glargine 100 unit / mL ho batho ba nang le mofuta oa 2 lefu la tsoekere le sebelisang li-insulin tsa molomo le basal insulin: taolo ea glucose le hypoglycemia tekong e laoloang e laoloang ka likhoeli tse 6 (KHAOLO EA 2). Tlhokomelo ea lefu la tsoekere 2014, 37: 3235-43. 34) Bolli GB et al. Insulin glargine 300 U / ml e bapisoa le glargine 100 U / ml bathong ba insulin-naïve ba nang le lefu la tsoekere la 2 ho lithethefatsi tse theolelang tsoekere: teko e laoloang e sa reroang (TLHALOSO 3) .Diabetes ObesMetab. 2015.17: 386-94. 35) PD ea lapeng, Bergenstal RM, Bolli GB, Ziemen M, Rojeski M, Espinasse M, Riddle MC. New Insulin Glargine 300 Units / mL Khahlano le Glargine 100 Units / mL ho Batho ba nang le Mofuta oa 1 lefu la tsoekere: Teko e sa laoleheng, Karolo ea 3a, Teko ea Clinical Clinical e bulehileng (3). Tlhokomelo ea lefu la tsoekere. 2015 Dec, 38 (12): 2217-25. 36) Kakaretso ea Lenaneo la Teko ea Kliniki le Ho sebelisoa ha Insulin Degludec / Insulin Aspart ho Diabetes Management Ganapathi Bantwal1, Subhash K Wangnoo2, M Shunmugavelu3, S Nallaperumal4, KP Harsha5, ArpandevBhattachary. 37) Polokeho, Pharmacokinetics le Pharmacodynamics ea Li-IDegAsp tse peli (e 'ngoe ea ho Utloisisa) Litokisetso le Litokisetso tse peli tsa Insulin Degludec (E' ngoe e Hlahlobang) Litokisong tsa Majapane. ClinicalTrials.gov sesupo: NCT01868555. 38) Aroda VR et al, LixiLan-L Teko Bafuputsi.Erratum. Ho sebetsa hantle le polokeho ea LixiLan, motsoako o ts'oarellang oa Ratio o tsitsitseng oa Insulin Glargine Plus Lixisenatide Mofuta oa 2 lefu la tsoekere o laoloa ka mokhoa o sa lekanyetsoang ho Basal Insulin le Metformin: Teko ea LixiLan-L. Tlhokomelo ea lefu la tsoekere 2016.39: 1972-1980; Tlhokomelo ea lefu la tsoekere. 2017 Apr 20. 39) Rosenstock J et al, Bafuputsi ba Liteko tsa LixiLan-O. Erratum. Melemo ea LixiLan, Ho Kopanya Tekano e Felletseng-Ratio ea Insulin GlarginePlusLixisenatide, Khahlano le Insulin Glargine le Lixisenatide Monocompitors ho Mofuta oa 2 Lefu la tsoekere le laoloang ka ho lekaneng ho li-Agent tsa Molomo: Teko ea LixiLan-O. Tlhokomelo ea lefu la tsoekere 2016.39: 2026 2035; Tlhokomelo ea lefu la tsoekere. 2017 Apr 18. 40) Stephen CL, Gough, Rajeev Jain, le Vincent C Woo. Insulin degludec / liraglutide (IDegLira) bakeng sa kalafo ea lefu la tsoekere la mofuta oa 2. 41) Ketso e kopaneng ea Liraglutide le Insulin Degludec ho Mofuta oa 2 oa Lefu la tsoekere: Teko e Fapakaneng Ts'ebetso le polokeho ea Insulin Degludec / Liraglutide, Insulin Degludecand Liraglutide litabeng tse nang le Mofuta oa 2 lefu la tsoekere (DUAL ™ I) ClinicalTrials.gov Identifier: NCT. 42) Teko ea Tleliniki e Bapisa Taolo ea Glycemic le Polokeho ea Insulin Degludec / Liraglutide (IDegLira) Versus Insulin Glargine (IGlar) joalo ka Therapy ea tlatsetso ho SGLT2i ho lihloohoana le Mofuta oa 2 lefu la tsoekere Mellitus (DUALTM IX) ClinicalTrials33. 43) Phekolo ea Insulin degludec / liraglutide (IDegLira) ea ho Ntlafatsa Taolo ea Glycemic ho Batho ba baholo ba nang le Mofuta oa 2 lefu la tsoekere Mellitus NDA 208583 Tokomane e hlalosang. 44) "Seo u hlokang ho se tseba ka Lihlahisoa tsa Lihlahisoa tsa Bongaka". Consensus InfirmationDocument.EuropeanCommision. Ref. Ares (2014) 4263293-18 / 1 // 2014. 45) "Tataiso ho Lihlahisoa tse Teng tsa Lihlahisoa tsa Bioloji Tse nang le Liprotheine tse nkiloeng ka Biotechnology e le lithethefatsi tsa lithethefatsi - Litaba tse sa sebetseng tsa Clinical le Clinical". Setsi sa Lithethefatsi sa Europe. 18 Pherekhong 2014 EMEA / CHMP / BMWP / 42832/2005 Komiti ea Rev1 ea Lihlahisoa tsa Meriana Bakeng sa Ts'ebeliso ea Batho (CHMP). 46) "Tataiso mabapi le nts'etsopele eo e seng ea bongaka le ea bongaka ea lihlahisoa tse tšoanang tsa litlhare tsa tlhaho tse nang le" insulin "ea motho le" insulin " Mokhatlo oa Europe oa Lithethefatsi .. 26 Hlakola 2015 EMEA / CHMP / BMWP / 32775 / 2005Rev. Komiti e 1 ea lihlahisoa tsa Meriana ea Ts'ebeliso ea Batho (CHMP).

Mofuta oa 2 oa lefu la tsoekere - likarolo tsa lefu lena

Bakeng sa ts'ebetso e tloaelehileng, 'mele o hloka phepelo e sa khaotseng ea matla, e hlahisoang lijong tse felisitsoeng. Sesebelisoa sa mantlha ke tsoekere. Bakeng sa ho monya tsoekere ka lisele, ho hlokahala hormone - insulin, e hlahisoang ke manyeme.

Mofuteng oa 2 oa lefu la tsoekere, tšepe e sebetsa ka mokhoa o tloaelehileng, empa lisele li fetoha ho hanyetsa ha lihormone. Ka lebaka leo, tsoekere ha e isetsoe liseleng, empa e lula lero la mali. Mmele o qala ho hloka matla. Boko bo arabela boemong bona ka letšoao la ho eketsa tlhahiso ea insulin. Ho ata ha lihormone ha ho fetole maemo.

Butle-butle, tlhahiso ea "insulin" e fokotseha haholo ka lebaka la ho tsofala ha litho le ho fokola ha mmele mme e ka emisa ka botlalo. Boloetse bo qala butle butle 'me qalong ha bo na matšoao a boletsoeng. Ka mofuta o tsoetseng pele oa lefu lena, o ka ea sethaleng sa 1.

Lefu la tsoekere

Mellitus ea lefu la tsoekere la setho la botšehali ke boemo ba lefu la sethoathoa bo hlahang ho basali nakong ea kemaro. E hlaha khahlano le semelo sa tlolo ea metabolism ea carbohydrate le liphetoho tse ling tsa metabolic.

Mofuta ona oa lefu o fumanoa o se o le nakong ea bokhachane, mme sesosa se ka sehloohong sa nts'etsopele ke ho fokotseha ha kutloisiso ea lisele tsa mmele ho insulin ea hormone ka lebaka la mathata a lihormone ho mosali oa moimana. Lisosa tse tloaelehileng li kenyelletsa ho nona hangata.

Maemong a khafetsa, lefu lena le ipatile 'me le fumanoe le se le fumanehile ka nako e loketseng. Liteko tsa khafetsa tsa laboratori le tlhahlobo ea bongaka li tla thusa ho thibela lefu lena.

Khahlano le semelo sa GDM, mosali hamorao o eketsa monyetla oa ho ba le lefu la tsoekere la mofuta oa II.

Hlokomela Ka halofo ea maemo a GDM, basali ba nang le moimana oa bobeli ba kotsing.

Hape ho bohlokoa ho supa hore ho basali ba kileng ba feta GDM, kotsi ea ho ba le lefu la tsoekere la mofuta oa II le eketseha le ho feta.

Tlhahisoleseling

LITLHOHONOLOFATSO TSA MOKHATLO OA BOPHELO

Lethathamo la baetsi ba protocol:
1) Nurbekova Akmaral Asylovna - Ngaka ea Saense ea Bongaka, Moprofesa oa Lefapha la Mafu a kahare No. 2 ea Rephabliki ea Republican State Pedagogical Univesithing ea Bongaka ea Tlhaho ea Naha ea Perm State ea Kazab ea Naha ea Perm. Asfendiyarova. "
2) Bazarbekova Rimma Bazarbekovna - Ngaka ea Saense ea Bongaka, Moprofesa, Hlooho ea Lefapha la Endocrinology ea Kazakh Medical University ea Ntoa e Tsoelang Pele ea JSC, molulasetulo oa Mokhatlo oa Sechaba "Mokhatlo oa Endocrinologists oa Kazakhstan".
3) Smagulova Gaziza Azhmagievna - Moqapi oa Saense ea Bongaka, Hlooho ea Lefapha la Propaedeutics ea Mafu a ka hare le Clinical Pharmacology, Republican State Pedagogical University ho Western-Kazakhstan State Medical University e rehelletsoe ka M. Ospanov.

Pontšo ea ho se lumellane ha lithahasello: che

Maikutlo:
Espenbetova Mayra Zhaksimanovna – Ngaka ea Saense ea Bongaka, Moprofesa, Hlooho ea Lefapha la Barekisi ho Tloaelo e Akaretsang ea Bongaka, Semipalatinsk State Medical Academy.

Tšoaetso ea maemo a ho ntlafatsa protocol: ntlafatso ea protocol lilemo tse 5 kamora hore e phatlalatsoe le ho tloha ka nako eo e qalileng ho kenella ka eona kapa ho na le mekhoa e mecha ka boemo ba bopaki.

Sehlomathiso 1

Mekhoa ea ho hlahlobisisa mofuta oa lefu la tsoekere la 2, 3
Ho hlahlojoa ho etsoa ho khetholla bakuli ba nang le lefu la tsoekere. Ho hlahlobisisa ho qala ka ho itima lijo glycemia. Maemong a ho lemaloa ha standardoglycemia kapa ho senyeha ho itima lijo glycemia (NGN) - ho feta 5.5 mmol / L, empa e le tlase ho 6.1 mmol / L bakeng sa mali a capillary le ho feta 6.1 mmol / L, empa e le ka tlase ho 7.0 mmol / L bakeng sa venous plasma e fuoe tlhahlobo ea mamello ea glucose ea molomo.
PGTT ha e etsoa:
Khahlano le semolao sa lefu le bohloko,
· Khahlano le nalane ea ts'ebeliso ea lithethefatsi e khutšoane e eketsang boemo ba glycemia (glucocorticoids, lihormone tsa qoqotho, thiazides, beta-blockers, jj.)
PGTT e lokela ho etsoa hoseng khahlano le nalane ea lijo tse se nang moeli tsa matsatsi a 3 (tse fetang 150 g tsa lik'habohaedreite ka letsatsi). Teko e lokela ho etelloa pele ke ho itima lijo bosiu bosiu bonyane lihora tse 8-14 (u ka noe metsi). Kamora ho ts'oaroa sampole ea mali ka mpeng e se nang letho, taba eo e lokela ho noa ligrose tse 75 g kapa glucose monohydrate e qhibilihang ka 250-300 ml ea metsi ka nako e sa feteng metsotso e 5. Bakeng sa bana, mojaro ke tsoekere e 1,75 g ea boima ba 'mele ka kilo e le' ngoe, empa eseng ho feta 75 g. Kamora lihora tse peli, ho etsoa sampole ea bobeli ea mali.

Matšoao a ho hlahlojoa ha lefu la tsoekere la asymptomatic
Batho bohle ba ka hlahlojoa ho ba le BMI ≥25 kg / m 2 le e latelang mabaka a kotsi:
· Mokhoa oa bophelo bo kopanetsoeng,
· Beng ka motho oa pele oa ba amanang le lefu la tsoekere,
· Baahi ba morabe o kotsing e kholo ea lefu la tsoekere,
Basali ba nang le nalane ea ho ba le ngoana ka lesea le leholo kapa "lefu la tsoekere"
Hypertension (≥140 / 90 mmHg kapa kalafo ea antihypertensive),
Bophahamo ba HDL ba 0,9 mmol / l (kapa 35 mg / dl) le / kapa boemo ba triglyceride ba 2.82 mmol / l (250 mg / dl),
Boteng ba HbAlc ≥ 5.7% ts'ebetso ea mamello ea glucose e senyehileng kapa tsoekere e potlakileng ea ho itima lijo,
Nalane ea lefu la pelo,
Maemo a mang a kliniki a amanang le ho ba le insulin (ho kenyelletsa botenya haholo, acanthosnigras),
Polycystic ovary syndrome.
Haeba tlhahlobo e le ntho e tloaelehileng, e lokela ho phetoa lilemo tse ling le tse ling tse 3. Ntle le lintlha tsa kotsi, screening etsoa batho bohle ba kaholimo ho lilemo tse 45. Haeba tlhahlobo e le ntho e tloaelehileng, u lokela ho e pheta lilemo tse tharo.
Screening e lokela ho etsoa ho bana ba ka holimo ho lilemo tse 10 le bacha feta ka maemo a kotsi a 2 kapa ho feta.

Sehlomathiso 1

HO FIHLELA LE HO FIHLELA DIABETIC KETACACIDOSIS ALGORITHM SEKHOLO EA EMERGENCY

Lefu la tsoekere la ketoacidosis (DKA) le komello ea ketoacidotic
DKA ke pheko e matla ea lefu la tsoekere ea metabolism, e bonahatsang keketseho e matla ea tsoekere le khatello ea 'mele ea ketone maling, ponahalo ea bona ka har'a moroto le nts'etsopele ea metabolic acidosis, e nang le methapo e fapaneng ea ho se tsebe hantle kapa ntle le eona, e hlokang ho kenngoa sepetlele ka tšohanyetso ha mokuli.

Sehlomathiso 2

HO FIHLELA LE HO FIHLELA TLHALOSO EA METSOALLE EA DIABETIC HYPOGLYCEMIC CONDURE / TSOA MOTSOALLE OA EMERGENCY(merero)

♦ beha mokuli lehlakoreng la hae, u lokolle masapo a molomo ho tsoa litšila tsa lijo (u se ke oa tšela tharollo e monate kahara molomo.
♦ iv 40-100 ml ea tharollo ea 40% ea dextrose (ho fihlela a hlaphoheloa ka botlalo);
♦ mefuta e meng - 1 mg (bana ba banyenyane 0.5 mg) glucagon s / c kapa / m,
♦ Haeba kelello e sa khutlisetsoe, qala ntoa ka mokokotlo oa mokokotlo: li-colloids, osmodiuretics, likarolo tsa mali.

Sehlomathiso sa 3

HO FIHLELA LE HO FIHLELA DIABETIC HYPEROSOLARY COMA ALGORITHM KWA SELEMO SA EMERGENCY

Lefu la tsoekere ho bana

Ho shebella matšoao a lipalo a nts'etsopele ea lefu la tsoekere lefats'eng lohle, ho ka lemohuoa hore palo ea bana ba pepesitsoeng ke lefu lena e ntse e eketseha selemo se seng le se seng. Leha e le taba ea hore lefu la tsoekere la mofuta oa "ke la bocha", ke hore, le hlaha ho batho ba ka tlase ho lilemo tse 30, esita le linyeoe tsa lefu la tsoekere la II le tsejoa bongoaneng.

Sesosa se ka sehloohong sa lefu lena ke ho tlola molao oa insulin, ka lebaka leo lits'ebetso tsa metabolic li ferekanyang le tsoekere ea tsoekere maling e eketseha.

Lisosa tsa mofuta oa lefu la tsoekere la bana ho bana, joalo ka ho batho ba baholo, ba ntse ba ithuta, empa mohlomong sesosa sa ho qala ha lefu lena ke:

• lefutso
• khatello ea maikutlo khafetsa
• ts'ebetso
• tšusumetso e mpe ea tikoloho.

Lilemong tsa morao tjena, ho bile le keketseho kholisong ea lefu la tsoekere ho bana.

Haeba re bua ka nts'etsopele ea lefu la tsoekere la mofuta oa II baneng, re ka re lisosa tse tloaelehileng ke:

• ho nona haholo
• bophelo ba ho lula fatše
• phatsa ea tlhaho.

Haeba lefu la tsoekere ho bana le fumanoe, likhothaletso li tla lumellana le WHO ka kakaretso e amoheloang. Pele ho tsohle, li tla amana le phepo e nepahetseng, e leka-lekaneng, bophelo bo mafolofolo le ho latela kalafo ea ngaka e eang.

Mehopolo e akaretsang ea ho fepa

Bakuli ba nang le lefu la tsoekere ba lokela ho ja makhetlo a 5-6 ka letsatsi ka likarolo tse nyane. Lijo li lokela ho ba le lethathamo la khalori e tlase le index ea glycemic e tlase kapa e bohareng e le hore motho a se ke a nona kapele 'me a se ke a ba le mathata a liphetoho tsa tšohanyetso tsoekere ea mali. Ntle le moo, ha karoloana ea sejana e le nyane, ho bonolo haholoanyane ho e hlahloba le ho e tloaela, mme moroalo o eketsehileng ho litho tsa pampiri ea lefu la tsoekere ho lefu la tsoekere ha o na thuso.

Ha a etsa lethathamo la lijo tse nepahetseng, endocrinologist, hammoho le mokuli, o lokela ho nahana ka litšobotsi tsa metabolism ea hae, litakatso tsa tatso, boima, lilemo le ho ba teng ha mafu a mang. Lijo tse nang le nama e tlase ea carb li loketse batho ba bang, ho ba bang, lijo tse nang le mafura a tlase, 'me ea boraro, lijo tse nang le phepo e ntle tse nang le likhalori tse fokolang. Mokhoa o ikhethileng oa motho ka mong le boholo ba lihlahisoa tsa tlhaho tse phetseng hantle lijong ke senotlolo sa katleho ea kalafo le ho khomarela lijo ka nako e telele ntle le liphoso.

Ho na le melao-motheo ea phepo e nepahetseng, eo ho lakatsehang ho e latela tsohle, ho sa tsotelehe mofuta oa lefu:

• Lijo tsa hoseng li kenyeletsa lijana tse nang le lik'habohaedreite tse liehang ho khotsofatsa 'mele ka matla letsatsi lohle,
• khefu pakeng tsa lijo ha ea lokela ho feta lihora tse 3,
• ka maikutlo a matla a tlala, hoa hlokahala ho lekanya tsoekere ea mali le ho ja lijo tse phetseng hantle (liapole, linate), le hypoglycemia, ja lijo ka lik'habohaedreite tse potlakileng,
• ho molemo ho kopanya nama eseng le lijo-thollo, empa le lijana tsa mahlakore a meroho, kaha e kenelletsoe hanyane ebile ho bonolo ho e sefa.
• u ke ke ua robala ka maikutlo a phatlalatso a tlala ea tlala, pele u robala u ka noa khalase ea kefir e mafura a tlase kapa yoghur ea tlhaho ntle le litlatsetso.

Li-plums, li-beet le lihlahisoa tsa lebese li thusa ho ntlafatsa tšilo ea lijo le ho eketsa tšubuhlellano ea mala. Bakeng sa morero o ts'oanang, o ka noela khalase ea metsi ka mpeng e se nang letho hoo e ka bang metsotso e 15 pele ho lijo tsa hoseng. Sena se kenya tšebetsong tsamaiso ea tšilo ea lijo le ho ntlafatsa ts'ebetso ea tšilo ea lijo.

Ho sa tsotelehe mofuta oa lefu la tsoekere, ho bohlokoa hore mokuli a latele mokhoa oa ho ja. Ke 'nete hore ka lefu la mofuta o itšetlehileng ka insulin, le lona le ka fokola hanyane, hobane mokuli o lula a enta li-hormone mme a khona ho bala tekanyo e hlokahalang ea moriana ho latela seo a rerileng ho se ja. Leha ho le joalo, lefu la tsoekere kaofela ha lona le lokela ho qoba ho ja lijo tse nang le carbohydrate e ngata, hobane li baka liphetoho maemong a tsoekere ea mali le ho baka ts'abo ea mathata nakong e tlang.

Motheo oa lijo e lokela ho ba meroho. Li na le index ea "glycemic" e tlase le "fiber e phahameng" e hlokahalang bakeng sa motsamao o tloaelehileng oa bowel. Ka lefu la tsoekere, metabolism e ea fokotseha, 'me mokuli a ka khathatsoa ke ho sokela, e leng ho tlisoang ke ho taoa hoa mmele. Ho qoba sena, ho eletsoa ho ja meroho makhetlo a 3-4 ka letsatsi. Li na le livithamini le liminerale tse hlokahalang bakeng sa tšebetso e tloaelehileng ea litho tsohle le litsamaiso. Litholoana li boetse li na le thuso bakeng sa ba tsoekere, empa ho li khetha, ho hlokahala hore u ele hloko index ea glycemic - e lokela ho ba tlase kapa e bohareng.

Lijo tse joalo li bohlokoa haholo ho batho ba nang le lefu la tsoekere.

• tamati
• kholifolaoa
• mokopu
• apole
• pere
• litholoana tsa lamunu
• kharenate
• eggplant
• seqha
• konofolo
• pepere.

Har'a litlhapi le nama, o hloka ho khetha mefuta e metenya. Ho molemo ho li pheha tse besitsoeng kapa ka ontong ntle le ho eketsa oli e ngata. Nama e lokela ho ba teng lijong ka mehla, litlhapi - makhetlo a ka bang 2 ka beke. Litsebi tsa lefu la tsoekere li sebeletsoa hantle ka fillet ea turkey e phehiloeng kapa e halikiloeng, e apetsoeng kapa e entsoe letlalo e se nang letlalo le likhoho tsa nama ea rabi. Pollock, hake le tilapia ke khetho e ntle ka ho fetisisa bakeng sa litlhapi, kaha tsena ke lihlahisoa tse mafura a tlase tse nang le motsoako o matla oa khemikhale. Ha ho batlehe hore bakuli ba je nama ea nama ea kolobe, nama ea khomo e nang le mafura, nama ea khoho, khantsi le tlhapi e mafura, kaha lihlahisoa tsena li imetsa manyeme le ho eketsa cholesterol ea mali.

Lintho tsa bohlokoa ka ho fetisisa ke li-porridge tsa koro, li-buckwheat, nyalothe le phofo ea pea. Lenane la bona la glycemic ke karolelano, 'me sebopeho sa bona se na le livithamini tse ngata, tšepe, calcium le likarolo tse ling tsa trace. Ha ba theha lethathamo la lijo, batho ba nang le lefu la tsoekere ba hloka ho kenyelletsa semolina le raese e phofsitsoeng ho eona, kaha ho hang ha ho na letho le ka ba thusang ka lintho tse phahameng tsa khalori.

Mabaka a ntlafatso

Mofuta oa bobeli oa lefu la tsoekere hangata o hlaha ka lebaka la ho tepella le ho taboha ha 'mele, kahoo, psychology e atile haholo bathong ba fetang lilemo tse 40.

Empa ho na le mabaka a mang le mabaka a hlasimollang bakeng sa nts'etsopele ea lefu lena:

• phetiso ea lefutso. Haeba ho na le beng ka motho ea nang le lefu la tsoekere (la mofuta ofe kapa ofe), monyetla oa ho ba le lefu la ho eketseha ha methapo o eketseha ka 50%,
• batho ba boima haholo ba kotsing ea kholo ea ts'oaetso ea lefu lena, hobane li-amana tsa mafura li fokotsa kutloisiso ea lisele, hape li fokotsa ts'ebetso ea litho.
• phepo e fosahetseng. Ho sebelisa khafetsa lijo tse nang le tsoekere, tse mafura le tse potlakisang lijo
• tšebeliso e tlase ea matla a polokelo ea motlakase, e etsahala ka tšebetso e fokolang ea 'mele,
• Phetoho ea methapo ea methapo mokhoeng oa manyeme,
• maloetse a tšoaetsanoang khafetsa a amang ts'ebetso ea tšilo ea lijo,
• ho tepella maikutlo le 'mele, hammoho le khatello ea maikutlo le khatello ea maikutlo khafetsa.
• ho eketseha khafetsa ha khatello
• meriana e senyehileng ka nts'etsopele ea litla-morao tse amang ts'ebetso ea tšebetso ea tšoelesa.

Pathology e hlaha ha ho na le mabaka a 2 kapa a 3 hang. Ka linako tse ling lefu lena le fumanoa ho basali baimana. Tabeng ena, ho ba teng ha eona ho amana le liphetoho tsa lihormone 'meleng. Boloetse (hangata) bo itlhahela bo le bong kamora ho pepa.

Mekhoa ea thibelo ea lefu la tsoekere

Ka bomalimabe, ho bile le keketseho ea maemo a lefu la tsoekere lefatšeng. Ka nako e 'ngoe, bakeng sa ho fokotsa kotsi ea pathology, ho ke ke ha khoneha ho susumetsa mabaka a susumetsang, mohlala, lefutso kapa maemo a tikoloho, empa maemong a mang ho ntse ho khonahala ho fokotsa menyetla ea lefu la kelello.

Ho thibela nts'etsopele ea lefu lena ho tla u lumella:

• taolo ea boima ba 'mele
• phepo e nepahetseng
• Ho felisoa ha mekhoa e mebe,
• taolo ea tsoekere ea mali.

Lethathamo la 4. Mehato ea thibelo ea thibelo ea lefu la tsoekere:

Ketso tsa thibelo	Liketsahalo
Boitsebiso ba batho ba kotsing.	Sesosa se atileng haholo sa lefu la tsoekere ke ho ba motenya. Ho banna, sebaka sa letheka se feta 90 cm, mme ho basali - ho feta 80 cm, ke ketsahalo ea ho lla. Batho ba joalo ba lokela ho hlahlobeloa le ho hlahlojoa ka hloko.
Tlhahlobo ea kotsi.	Ha mohala oa pele o tšoenyang oa lefu lena o hlaha, ho hlokahala hore ho etsoe tlhahlobo ea mali bakeng sa tsoekere ea mali. E etsoa ka mpa e se nang letho. Ho kenyelletsa tlhahlobo ea endocrinologist, hammoho le litsebi tse ling, ho hlokahala hore u tsebe li-pathologies tse ling. Mohlala, ho ba teng ha likhathatso tsamaisong ea methapo ea pelo ho eketsa kotsi ea lefu la tsoekere.
Ho felisa tšusumetso e mpe ea lintlha tsa pathological.	Selo sa pele se seholo se susumetsang phetoho ea methapo 'meleng ke boima ba' mele. Ka hona, mekhahlelo e joalo ea batho e hloka: Lahla boima ba 'mele bo feteletseng, fokotsa lijo tse nang le lik'habohaedreite 'meleng, eketsa ho ikoetlisa 'meleng (ho palama baesekele, ho sesa, ho tantša, jj.), ho fokotsa boima ba 'mele ka lipilisi, haeba u sa khone ho sebetsana ka katleho le lijo.

Qetellong, re hlokometse hore ho ea ka mosebetsi oa ho etsa lipatlisiso, ho boleloa hore ho theola boima ba 'mele le ho ikoetlisa kamehla ka tsela e leka-lekaneng ho lumella:

• thibela lefu la tsoekere
• haeba e le teng, fokotsa kholo ea mathata,
• ho fumana mefuta e metle ea methapo ea kutlo.

Kamora ho netefatsa tlhahlobo e nyarosang, ho bohlokoa haholo ho fetola haholo mokhoa oa hau oa bophelo, ho qala ho tloha phepo e nepahetseng le ho qeta ka ho sebelisa meriana.

Keletso mabapi le phaello ea mantlha ho:

• fokotsa tšebeliso ea letsoai,
• ho qheleloa ka thoko ho mafura le lino tse tahang tse nang le joala,
• tšebeliso ea nama ea nama ea nama ea kolobe e ngata
• ho ja li-vithamine le limatlafatsi tse ngata.

Ho lekola khafetsa tsoekere ea mali le tekanyo ea khatello ea mali ho tla thibela litlhaselo tsa hypoglycemia le hyperglycemia, hammoho le nts'etsopele ea mathata, e ka bang bongata ho lefu la tsoekere.

Taolo ea tsoekere ea mali

Ho lekola khafetsa maemo a tsoekere ke motheo oa ho phekola mofuta oa lefu la tsoekere le ho thibela mathata. Haeba mokuli a sebelisa metara kamehla, a khona ho lemoha ho qaleha ha hypoglycemia kapa ho tlōla ha tsoekere ka nako. Hang ha tlolo ea molao e fumanoe, ho ba bonolo ho fana ka thuso le ho boloka bophelo bo botle ba mokuli. Ntle le moo, ka lebaka la ho hlahloba glycemia khafetsa, o ka lekola karabelo ea 'mele ea lijo tse ncha le ho utloisisa hore na li lokela ho kenngoa lijong.

Bakeng sa metara ho bonts'a boleng bo nepahetseng, e lokela ho lekoloa nako le nako le ho hlahlojoa ho sebelisoa litharollo tsa taolo ea tsoekere. Mehala ea liteko e ke ke ea sebelisoa kamora letsatsi la ho felloa ke nako, ka lebaka leo litholoana li ka ts'oaroang haholo.Ho bohlokoa ho fetola betri e kentsoeng ka sesebelisoa ka nako e tšoanang, kaha e boetse e ama bonnete ba boleng bo fumanoeng.

E le ho boloka bophelo bo botle ho bakuli ba nang le lefu la tsoekere la 1, ho lokela ho bonoe mofuta oa ente ea insulin. Ka lefu la mofuta ona, ho ke ke ha khoneha ho etsa ntle le liente, hobane 'mele ha o khone ho hlahisa insulin ka tekanyo e nepahetseng. Ha ho na lijo tse tla u lumella ho boloka bophelo bo botle nako e telele haeba mokuli a hlokomoloha liente tsa li-hormone kapa a li etsa ka mokhoa o sa reroang. Ho bohlokoa hore motho a tsebe ho bala ka kotloloho litekanyetso tse hlokahalang tsa moriana o laetsoeng, ho latela hore na o tla ja eng, le ho utloisisa liphapang nakong ea ts'ebetso ea insulin e khuts'oane le e telele.

Mofuteng oa 2 oa lefu la tsoekere, manyeme khafetsa a hlahisa insulin e lekaneng (kapa ts'ebetso ea eona e fokotsehile hanyane). Maemong ana, mokuli a ke ke a hloka liente tsa li-hormone, 'me molemong oa ho boloka boemo ba tsoekere ba mali, bo tla lekana ho latela mokhoa oa ho ja le ho ikoetlisa. Empa haeba khanyetso ea insulin ea li-tishu e phahame haholo, mme mekhoa ena ea kalafo ha e sebetse ka ho lekana, ho latela likhothaletso tsa lingaka le liprotheine, mokuli a ka fuoa matlapa a ho fokotsa tsoekere. Ke lingaka tsa endocrinologist feela tse lokelang ho li khetha, hobane liteko tsa ho itlhahisa li ka baka tsitsipano maemong a akaretsang le ho eketseha ha lefu lena.

Ho etsahalang ka lefu la tsoekere?

Mofuta oa lefu la tsoekere la mofuta oa 2 (lijo le meriana li kopantsoe: ntle le ho sheba lijo, ho sebelisa lithethefatsi ho ke ke ha sebetsa) ho ama mosebetsi oa setho sohle. Qalong ea nts'etsopele ea lefu lena, methapo ea kutlo ea insulin e fokotseha. Manyeme le litho tse ling li sebetsa ka tsela e tloaelehileng.

Ntle le kalafo e nepahetseng, khatello ea tsoekere maling e ea eketseha, e lebisang "tsoekere" ea lisele tsa protheine maling. Phetoho ena e senya ts'ebetso ea litho. 'Mele o na le tlala ea matla, e leng se lebisang ho se sebetse hantle hoa lits'ebetso tsohle.

Ho haella ha matla ho qala ho buseletsoa ke ho phatloha ha lisele tsa mafura. Ts'ebetso ena e tsamaisana le ho ntšoa ha chefo, e silafatsang 'mele kaofela mme e ama ts'ebetso ea lisele tsa boko.

Tsoekere e ngata e isa ho omeng, livithamini le liminerale tse hlokahalang li hlatsoa metsi ka metsi. Boemo ba likepe bo mpefala, bo lebisang ho hobeng hoa pelo. Hape, kotsi ea ho koaloa ha methapo ea mali e eketseha. Ka lebaka la sena, pono, mosebetsi oa sebete le liphio lia khathatseha, kaha litho tsena li na le methapo e mengata ea mali. Ho potoloha ha mali maling le mahanong.

Boimana le lefu la tsoekere

Haeba bokhachane bo hlaha khahlano le semelo sa mofuta oa 1 lefu la tsoekere, mosali a ka hloka ho ntlafatsa tekanyetso ea insulin. Ka li-trimesters tse fapaneng, tlhoko ea lihormone ena e fapane, 'me ho ka etsahala hore ka linako tse ling tsa boimana mme le moimana a ka khona ho etsa joalo ka nakoana ntle le liente. The endocrinologist, eo hammoho le obstetrician-gynecologist e tla shebella mokuli nakong ea kemaro, ba lokela ho kenya letsoho ha ho khethoa litekanyetso tse ncha le mefuta ea lithethefatsi .. Basali ba joalo ba baimana le bona ba hloka ho fetola lijo, hobane nakong ena ea bophelo ba mosali, tlhoko ea limatlafatsi le livithamini e eketseha haholo.

Ho na le mofuta oa lefu le hlahang ho basali nakong ea kemaro - ke lefu la tsoekere. Maemong ana, mokuli o haufi le ho fuoa ente ea insulin, 'me boemo ba tsoekere ea mali bo etsuoa hantle, ka lebaka la lijo. Lijo tsohle tse tsoekere le litholoana tse nang le moroalo o mongata oa lik'habohaedreite, tsoekere, bohobe le lijo tse rekisoang ha li kenyelletsoe lijong. Mosali oa moimana o lokela ho fumana lik'habohaedreite ho lijo-thollo, pasta ho koro ea durum le meroho.Ho ja hoa mokuli ea nang le lefu la tsoekere la sethoathoa ho bohlokoa ho fokotsa kotsi ea ho hlaha ka mpeng le mathata a ho beleha, hape ho boetse ho thusa ho thibela phetisetso ea lefu lena ho "lefu le felletseng" la tsoekere. Ho latela litlhahiso tsa ngaka e eang, e le molao, kamora hore ngoana a hlahe, mathata a nang le metabolism ea carbohydrate a nyamela, mme maemo a tsoekere ea mali a tloaelehileng.

Thibelo ea lefu la tsoekere la maoto

Lefu la tsoekere la lefu la tsoekere ke bothata bo boholo ba lefu la tsoekere, le tšoauoang ke liphetoho tse bang teng methapong ea linama tse holimo. Matšoao a pele e ka ba ho tsitsipana le ho tsikinyeha ha letlalo, phetoho ea 'mala oa eona le ho lahleheloa ke karolo ea kutlo ea kutlo le bohloko. Nakong e tlang, liso tsa trophic li thehoa maotong, li bakoa ke khaello ea phepo e nepahetseng ea litho tsa lehae, tse folisang hampe le nako e telele. Haeba ts'oaetso e kenella le leqeba le kolobileng, menyetla ea ho ba le koluoa ​​e eketseha, e ka lebisang ho khaoloa leoto esita le lefu.

Ho thibela phepelo ena e mpe ea lefu lena, o lokela ho:

• khomarela melao ea bohloeki 'me u boloke maoto a hao a hloekile
• hlahloba letlalo la maoto khafetsa bakeng sa likotsi tse nyane, litlokotsebe le makhopho,
• ho ikoetlisa ka maoto letsatsi le leng le le leng ho ntlafatsa phallo ea mali le phallo ea mali,
• kamora lits'ebetso tsa metsi, hlakola letlalo ka thaole ea tlhaho,
• khetha lieta tse loketseng ho roala letsatsi le leng le le leng ntle le lieta tse phahameng,
• nosetsa letlalo khafetsa ka tranelate kapa setlolo hore se se ke sa omella.

Nakong ea lipuisano tse reriloeng tsa endocrinologist, ho hlokahala hore ngaka e hlahlobe maoto a mokuli mme, ha ho hlokahala, ho fana ka lithupelo tsa lithethefatsi ho ntlafatsa bongata ba mali. Ho polyclinics, joalo ka molao, likamore tsa ts'ebetso ea maoto a lefu la tsoekere, moo mokuli a ka lekanyang maikutlo a letlalo la maoto le ho hlahloba maemo a bona a akaretsang.

Ho thibela mathata a liphio le mahlo

Lefu la tsoekere ke pheko e 'ngoe ea lefu lena e ntseng e eketseha ka potlako ka tsoekere e phahameng ea mali. Ka lebaka la hore tsoekere e ngata e etsa hore mali a bonahale haholo, ho ba thata le ho feta hore liphio li e sefa. Haeba mokuli a e-ba le khatello ea mali ka bongata ka tsela e tšoanang, mathata ana a ka lebisa ho se sebetsane ha liphekolo le tlhoko ea ho hloela ka mehla (ho sebelisa lisebelisoa tsa "meno a maiketsetso").

Ho fokotsa kotsi ea ho ba le nephropathy e matla, o lokela ho:

• lekanya tsoekere ea mali khafetsa le ho e boloka e le boemong ba eona.
• fokotsa palo ea letsoai lijong hore li se bake mathata a ho ruruha le khatello.
• haeba protheine e fumanoa moriring, ho lokela ho lateloa lijo tse fokolang tsa protheine
• hlokomela matšoao a metabolism ea mafura le ho thibela keketseho e matla ea cholesterol ea mali.

Setho se seng sa bohlokoa se nang le lefu la tsoekere ke mahlo. Diabetesic retinopathy (liphetoho tsa pathological ho retina) li ka lebisa ho fokotseha ho hoholo hoa pono ea acuity esita le bofofu. Bakeng sa thibelo, ho hlokahala hore o etele setsebi sa mahlo sa mahlo ka mor'a likhoeli tse ling le tse ling tse tšeletseng ebe o hlahlojoa ke fundus. Ho lekola khafetsa maemo a tsoekere ea mali ke eona tsela e atlehang ka ho fetisisa ea ho thibela mathata a tebileng a morao. Ke ka lebaka la tsoekere e ngata maling le phetoho ea methapo ea methapo e mengata ea mali e tsoelang pele le pono e sitisang. Ka bomalimabe, retinopathy e batla e le thata ho e qoba, empa nts'etsopele ea eona e ka emisoa mme ea liehisoa.

Lefu la tsoekere ha se lefu feela leo ho lona tsoekere ea mali e fetang ka tsela e tloaelehileng. Boloetse bona bo siea letšoao ho likarolo tsohle tsa bophelo ba motho, bo mo qobella ho ela hloko khetho ea lihlahisoa le lijo tsa letsatsi le letsatsi. Empa ka mor'a litlhahiso tsa lingaka le ho mamela bophelo ba hau, o ka ithuta ho phela le lefu lena ntle le ho nahana ka lona kamehla.Ha motho a e-na le lefu la tsoekere le tlatselitsoeng hantle, menyetla ea ho ba le mathata ha e lekane, 'me bophelo ba mokuli bo phahame haholo.

Matšoao a lefu la tsoekere la Mofuta oa 2

Boemong ba pele, lefu lena le tsoela pele ntle le matšoao a bonahalang. Haeba lefu le sa bonoe kapa kalafo e nepahetseng e sa amoheloe, lefu la tsoekere le tsoela pele le e tsamaeang le matšoao a boits'oaro:

• boikutlo bo sa feleng ba ho oma ka seketsoaneng sa molomo, se tsamaeang le lenyora le sa feleng. Letšoao lena le hlaha ka lebaka la hore metsi a mangata a hlokahala ho tlosa tsoekere e ngata maling. 'Mele o sebelisa metsi le metsi a tsoang lithong tsena.
• Ka lebaka leo, hangata motho o ea ntloaneng,
• mofufutso o eketsehileng, o eketsehang nakong ea boroko,
• ho omella ho eketsehileng ha letlalo le lera la mucous, le tsamaeang le ho hlohlona,
• khaello ea mongobo le khaello ea phepo e nepahetseng ea methapo ea kutlo e baka ho senyeha ha pono,
• li-microcracks le maqeba a folisa butle,
• Ho loants'oa ha litšitšili tsa mesifa ho etsahala ka lebaka la ts'ebetso e mpe tsamaisong ea methapo,
• Ho ruruha ha lipheletso tse tsamaeang le bohloko le botšehali,
• ka lebaka la ho haella ha matla, ho na le bofokoli bo matla, takatso e eketsehileng ea lijo le ho hlophiseha,
• ho fokotseha ho matla ha boits'ireletso, mabapi le sena ho na le sefuba sa khafetsa.

Boemong ba pele, ho na le keketseho ea takatso ea lijo, mokhathala le tlhoko ea khafetsa ea metsi. Ho kenyelletsa / netefatsa lefu la tsoekere, hoa hlokahala ho buisana le setsebi sa bongaka / lingaka ho etsa tlhahlobo ea mali bakeng sa tsoekere. Qalong ea lefu lena, ho lekane ho fetola mokhoa oa ho ja bakeng sa kalafo.

Ho latela boholo ba matšoao, litšobotsi tsa kalafo le mathata a bakoang ke lefu lena, lefu la tsoekere le arotsoe ka likhato tse 4 tsa ho teba.

Methati ea pathology	Tšobotsi e ka sehloohong	Likarolo tse ikhethang
Ho bonolo	Lefu lena le hlaha ka keketseho e nyane ea tsoekere ea mali, e bakang lenyora le eketsehang, takatso e eketsehileng ea lijo le bofokoli ba mesifa. Liphetoho tsa tlhaho ea 'mele ha li shebelle. E le pheko, ho sebelisoa phetoho ea phepo e nepahetseng. Meriana e fanoa maemong a sa tloaelehang.	Lekhetlong lena, lefu la tsoekere le fumanoa maemong a sa tloaelehang, haholo litlhahlobong tsa setsebi ha ho etsoa tlhahlobo ea mali. Sebopeho sa urine ha se fetohe. Tekanyo ea tsoekere e maemong a fapaneng a 6-7 mmol / L.
Karolelano	Tšoaetso ea lefu lena ea eketseha. Ho na le ho senyeha ha tšebetso ea litho tsa pono, methapo ea mali, phepelo e felletseng ea mali maotong. Ho kheloha ho matla 'meleng ha ho bonoe. Phekolo e na le lijo le meriana.	Tekanyo ea tsoekere ea urine e tloaelehile, karolong ea mali ke 7-10 mmol / L.
E boima	Matšoao a bitsoa. Ho na le ts'ebetso e mpe mosebetsing oa litho tsa 'mele (pono e fokotsehileng, khatello e phahameng ea mali khafetsa, ho opeloa ke litho tsa maoto le matsoho. Nakong ea kalafo, ho sebelisoa menu e thata le tsamaiso ea insulin (meriana ha e fane ka litholoana).	Motsoako le mali li na le tsoekere e ngata. Meleng, mahloriso a fapana ka bongata ba 11-14 mmol / L.
Keketseho e matla	Tlolo ea mosebetsi oa litho tsa hau ha e sa tlameha ho fola. Boloetse bona ha bo phekolehe; ho hlahlojoa tsoekere khafetsa le melaoana ea eona ka ente ea insulin hoa hlokahala.	Khokahano ea tsoekere e maemong a 15-25 mmol / L. Hangata motho o oela ho lefu la tsoekere.

Ho bonolo ho phekola lefu la tsoekere le le itekanetseng habonolo. Maemong ana, ha ho na ts'ebetso e matla 'meleng. Lijo, ho theola boima ba 'mele le ho sebelisa meriana ka linako tse ling ho etsa hore ho be bonolo ho fola.

Lithethefatsi tse theolelang tsoekere

Mofuta oa 2 oa lefu la tsoekere o felisoa ke lijo. Ha kalafo e sa fane ka phello e bonahalang, setsebi se fana ka taelo ea ho sebelisa lithethefatsi tse fokotsang palo ea tsoekere maling. Qalong ea kalafo, ho fanoa ka mofuta oa 1 oa litlhare.Bakeng sa katleho ea kalafo, palo ea lithethefatsi e ntse e eketseha butle-butle.

Mefuta ea lithethefatsi tse hypoglycemic le litlamorao tsa tsona:

Mofuta oa lithethefatsi	Morero oa bona	Lebitso la moriana
Li-glinides le sulfonylureas	E abetsoe ho eketsa tlhahiso ea insulin ke 'mele ka bo eona.	Repaglinide, glibenclamide, chlorpropamide.
Biguanides le Glitazones	Fokotsa tlhahiso ea tsoekere maling le eketsa kutloisiso ea lisele tsa tsoekere. Tlatsetsa phokotsong ea takatso ea lijo.	Metformin, pioglitazone.
Alpha Glucosidase Inhibitors	Fokotsa sekhahla sa tsoekere e nkiloeng ke lisele tsa ka mpeng.	Miglitol, insuffor, acarbose.
Li-glyptins le glucagon-peptide receptor agonists	Eketsa tlhahiso ea insulin 'me ka nako e ts'oanang fokotsa khatello ea tsoekere.	Exenatide, saxagliptin, lixisenatide.
Insulin	E khothalletsa ho amoheloa ha tsoekere ke lisele tsa 'mele.	Insulin
Litlatsetso tsa Thiazolidone	E ntlafatsa kutloisiso ea li-receptor tsa sele ho insulin.	Troglitazone, rosiglitazone.

Hangata, ho fanoa ka litlhare tse peli kapa tse 3 tse lumellanang. Ts'ebeliso e tšoanang ea chelete ho eketsa tlhahiso ea insulin, ka meriana e amang kutloisiso ea lisele ho li-hormone, e tla fihlela phokotso e sebetsang tsoekere ea mali.

Ho kotsi ho ikemela ka mokhoa o ikemetseng. Ho fokotseha ho hoholo ha khatello ea tsoekere ho boetse ho na le phello e mpe tšebetsong ea 'mele. Haeba moriana o baka litlamorao, o nkeloa sebaka ke setsebi sa bongaka. Ka ho se sebetse hantle ha moriana, mokuli o fetisetsoa kalafo ea insulin.

Lijo tsa lefu la tsoekere la mofuta oa 2. Melao-motheo ea phepo e nepahetseng

Ha o phekola lefu la tsoekere, o tlameha ho latela lijo kamehla ho latela hore na o kula hakae, ho ba teng ha boima ba 'mele le ho ikoetlisa. Lisebelisoa li tlameha ho lumellanoa le setsebi se eang. Ka liphetoho tsa palo ea tsoekere (eketsa kapa ho fokotseha), setsebi se fetola phepo.

Ha o latela lijo, maemo a bohlokoa a lokela ho bonoa:

• takatso ea lijo e lokela ho ba teng ka lihora tse itseng bonyane makhetlo a 6 ka letsatsi,
• lijo ha lia lokela ho ba le khalori e phahameng ebile lihaha lijo habonolo,
• boteng ba boima bo feteletseng, ho hlokahala ho fokotsa likhalase tsa lijana,
• palo ea letsoai le sebelisitsoeng e lokela ho ba bonyane
• joala le lijo tse bobebe
• litholoana tse phahameng le ho ja litokisetso tsa livithamini tse ngata ho boloka boits'ireletso.

Phepo e nepahetseng le kalafo ea lefu la tsoekere la mofuta oa 2 ke lintho tse peli tse lumellanang. Ka linako tse ling ha ua lokela ho sebelisa litlhare haeba u fetola lijo

Ho bohlokoa ho pheha lijana u sa sebelise oli kapa ka bonyane ba eona (o ka pheha, o baka). Hoa hlokahala ho eketsa palo ea metsi a hloekileng a sebelisoang ka letsatsi. Ha o etsa lethathamo la lijo, ho bohlokoa ho ela hloko boteng ba li-pathologies tse ling (mafu a tšilo ea lijo, pelo, liphio).

Lihlahisoa tse thibetsoeng

Mofuta oa lefu la tsoekere la mofuta oa 2 (lijo le kalafo li tla fana ka phello e ntle, ka phepo e nepahetseng) ka foromo e bonolo e ka tlosoa ka ho tlosa lijo tse kotsi le lijo tse tsoang lijong.

Lihlahisoa Tse Ngotsoeng Ka Matla	Lihlahisoa tse Ngotsoeng ka Molao
Lijana le lijo tse nang le lik'habohaedreite tse tlotsitsoeng.	Metso ea litapole, e phehiloeng feela. Lihoete le li-beet.
Lihlahisoa tse nang le lero le phahameng la tsoekere (liswiti, litholoana tse omisitsoeng).	Likhokho, ntle le semolina.
Lijana le lihlahisoa tse tsoang phofo ea koro	Lihlahisoa tse tsoang ho phofo ea Wholemeal le rye.
Lijana tse nang le letsoai le lengata, pepere, oli.	Lijalo tsa mohloaare le lijalo tsa linaoa.
Lihlahisoa tsa lebese tse nang le mafura a mangata.	Lebone
Li-broth tse mafura le tse mafura.
Nama le tlhapi e nang le mafura a mangata, a khanniloeng, a tsubeloang.
Linoko, lisoso, margarine.

Palo ea ts'ebeliso ea lihlahisoa tse thibetsoeng ka mokhoa o mong e tlameha ho lumellanoa le setsebi se tlang. Ba eketsa bongata ba tsoekere, empa butle butle. Ka nako e ts'oanang, ho sebelisa mefuta e 'meli kapa ho feta ea lihlahisoa tse tsoang lenaneng le thibetsoeng ka molao ho thibetsoe.

Mokhoa oa ho sheba tsoekere ea mali ho lefu la tsoekere?

Ho lefu la tsoekere, ho hlokahala hore ho hlahlojoe maemo a tsoekere kamehla. Gluceter e sebelisoa ho e lekanya hae. Bohlokoa ke tekanyo ea letsatsi le letsatsi ea hoseng, pele u ja lijo. Haeba ho khonahala, lekanya mots'eare (kamora ho ja, ho ikoetlisa ka matla).

Lintlha tsohle li tlameha ho kenngoa bukeng e khethehileng ea lintlha, e lokelang ho bontšoa setsebi lithutong tse latelang. Matla a liphetoho tsa tsoekere a tla fetoloa kalafo (litlhare, lijo). Ntle le moo, o hloka ho etsa tlhahlobo ka laboratoring e 'ngoe le e' ngoe ea likhoeli tse 3-6 (tse behiloeng ke ngaka ea hau).

Lenane la Lihlahisoa tse lumelletsoeng tse nang le GI Indication

Ho lefu la tsoekere, lihlahisoa tse latelang li lumelloa ho jeoa ka bongata, empa ho nahanela litaba tsa khalori le GI ea bona.

Lenane la Lihlahisoa	GI (index ea glycemic)
Mahe a phehiloeng	48
Li-mushroom tse phehiloeng	15
Leoatle leoatle	22
Fish crayfish	5
Kefir	35
Lebese le futhumetseng	30
Chisi ea chisi	45
Chisi ea tofu	15
Lebese le fokolang le mafura	30
Broccoli	10
Likomkomere	10
Tomoso	20
Eggplant	20
Mehloaare	15
Radish	10
Liapole	30
Pear	34
Plum	22
Cherry	22
Bohobe ba Rye	45
Dill	15
Salate	10
Pearl harese ea pearl e metsing	22
Wholemeal bijoux	38
Oatmeal	40
Meqolo ea bohobe	45
Marmalade	30

Lethathamo lena le ka atolosoa ke setsebi sa bophelo, ka ho nahanisisa ka ho ikoetlisa le ho teba ha lefu lena.

Litlhare tsa setso

Mofuta oa lefu la tsoekere la mofuta oa 2 (lijo le kalafo - maemo a hlokahalang ho thibela nts'etsopele ea mathata le nts'etsopele ea lefu lena) li ka laoloa le ho feta ke litlhare tsa batho. Ts'ebeliso ea bona e khothalletsoa ho buisana le ngaka ea hau.

Liphekolo tse fetolang tšebetso ea metabolic 'meleng le tse bakang ho fokotsa boima ba' mele:

1. Ka 0,4 l ea metsi a belang, hlohlelletsa mahe a 70 ml a mahe a linotsi le 40 g ea sinamone e omileng (phofo). Tsitlella letsatsi ka serame. Seno se arotsoe likarolo tse peli. Ho sebelisa hoseng le mantsiboea. Nako ea kalafo e fihla ho matsatsi a 14.
2. Mouoane ka 0.5 l ea metsi 10-12 li-pcs. makhasi a bay. Sebelisa makhetlo a 30 ml makhetlo a 3. Khosi ke matsatsi a 10. Hoa hlokahala ho khanna lithuto tse 3 ka khefu ea matsatsi a 10.
3. Sebakeng sa makhasi a tee, lipalesa tsa linden tse futhumetseng. - Noa linoelo tse peli tsa tee ka letsatsi.
4. Khabeloa hantle ka 350 g ya konofolo le parsley le 100 g ea lemone e tsoekere. Hlohlelletsa le ho tsitlella matsatsi a ka bang 14 a batang. Sebelisa 10-12 mg ka letsatsi.
5. Pheha linaoa tse 20 g ho litara e le ngoe ea metsi (lihora tse 4). Sebelisa ho fihlela ho 300 di ml ka letsatsi (e ka aroloa likarolo tse ling). Nako ea kalafo ke matsatsi a 31.
6. Lino tse phehiloeng ho fapana le tee (nooa 400 ml ka letsatsi) ho tloha:

• St. wort, chamomile, Blueberry, St.
• lekhapetla
• lekhasi la linaoa
• sinamone kaofela.

Ha ho e-na le mamello kapa karabelo e itseng, lino tse nooang ha li fuoe lijo.

Ho ikoetlisa

Ho ba teng ha boikoetliso ba 'mele ho lokela ho etsoa, ​​le haeba ho se na mathata ka boima ba' mele. Ho ikoetlisa ho u thusa ho tloaela mosebetsi oa pelo, methapo ea mali le litho tsa ho hema, hammoho le ho tiisa boemo ba 'mele ka kakaretso.

Nakong ea litlelase, ho bohlokoa ho nka mojaro ka nepo, kaha ho chesa khalori e eketsehileng ho potlakisa tlala, 'me lijo, kamora boikoetliso, li ka kenngoa ka tlhahiso e ngata ea tsoekere maling.

Papali e khothalletsoang lefu la tsoekere:

• boikoetliso ba dumbbell
• ho tsamaea serapeng sa boikhathollo kapa leseli le ntse le sebetsa,
• ho potoloha
• ho sesa
• yoga
• motjeko o bonolo.

Ho khothalletsoa ho buisana ka mofuta oa mosebetsi le setsebi se eang. Hape hammoho le ho sebelisa nako e lekaneng ts'ebetsong.

Mathata a ho kula

Ha lefu le fumanoa kamora nako e telele, kalafo e sa lekaneng kapa mokuli ha a latela litlhahiso tsa setsebi, ho ka hlaha mathata a kotsi:

1. Ho ruruha. Edema e ka nts'etsapele eseng feela (matsoho, maoto, sefahleho), empa le 'mele. Ho ipapisitse le se sebelelitseng nts'etsopele ea lets'oao. E ka ba nts'etsopele ea ho nyekeloa ke pelo kapa a liphio, tseo le tsona e bang mathata a lefu la tsoekere.
2. Ho opeloa ke maoto. Letšoao le fumaneha ka ho ikitlaetsa 'mele haholo. Ka nts'etsopele ea lefu lena, bohloko bo ferekana bosiu. Ho kenyelletsa moo, ho ba le letsoalo la makhaola-khang le tahlehelo ea nakoana ea maikutlo. Mohlomong maikutlo a tukang.
3. Ponahalo ea liso tsa ka. Ka lebaka la mongobo o phahameng oa tsoekere, maqeba a fola hantle le ka nako e telele, e lebisang tlhabollong ea liso tsa ka ntle. Setsebi se khothalletsa hore le ho kuta ho nyane ho phekoloe ka hloko ho fihlela leqeba le folile ka botlalo.
4. Ntshetsopele ea makhopho. Ka lefu la tsoekere, boemo ba likepe bo ferekanngoa, bo ka lebisang ho phatloheng ha bona. Hangata, ketsahalo ena e bonoa le matsoho. Ka lebaka la sebopeho sa seaparo sa mali, mali a ncha a nang le oksijene le limatlafatsi ha a kene letsohong / leotong. Lithane lia shoa. Bofubelu qalong bo hlaha, bo tsamaisana le bohloko le ho ruruha. Haeba ho se na kalafo, eketsa lefu le putsoa. Likhahla li khaotsoe.
5. Keketseho / khatello ea khatello. Phetoho ea boholo ba letšoao la khatello hangata e etsahala ka lebaka la ts'ebetso ea renal e sa sebetseng.
6. Coma Boemo bona bo ka hlaha ka keketseho e matla ea khatello ea tsoekere kapa ho fokotseha (ka lebaka la insulin e ngata). Kapa ka lebaka la chefo e matla ea 'mele ke chefo, e hlahisoang nakong ea ho etsoa ha matla ho tsoa liseleng tsa mafura. Maemong ana, mokuli o koaheloa ke mofufutso o batang le o thetsang, puo e ba e tsitsitseng ebile e sa tsebe letho. Ka keketseho ea tsoekere, tšobotsi ea monko oa acetone e hlaha. Ebe ho na le tahlehelo ea kelello. Ntle le thuso, motho a ka shoa ka potlako.
7. Ho sitisoa ha pono. Ka lebaka la khaello ea phepo e nepahetseng ea lisele tsa mahlo le methapo. Pele, matheba, lesira lea hlaha, butle-butle ho ka ba le bofofu bo felletseng.
8. Ts'ebetso ea menoana e sa sebetseng hantle. Ka lebaka la mojaro o moholo holim'a setho, ho hloleha ho sebetsoa ke letsoele hoa hlaha.

Ha u phekola lefu la tsoekere, litlamorao li ka qojoa. Boikemisetso bo nakong ba qaleho ea nts'etsopele ea mathata a tla felisa tsoelo-pele ea bona e tsoelang pele.

Tataiso ea bongaka ea lefu la tsoekere la mofuta oa 2

Haeba lefu la tsoekere le fumanoa, ho hlokahala hore motho a eteloe ka potlako ho ngaka ea bongaka 'me ho hlokahala tlhahlobo ea tsoekere. Ha o netefatsa lefu lena, o hloka ho etsa tlhahlobo e felletseng. E latelang, o hloka ho latela nako eohle ea ngaka e phekolang (lijo, litlhare, boikoetliso). Etsa bonnete ba hore u hlahloba tsoekere e maling. Haeba maemo a fetoha, ngaka e eang e tlameha ho lokisa kalafo.

Lefu la tsoekere le khona ho hola butle butle 'me le fumanoe le se le le maemong a bohareng. Ka mofuta oa 2, motheo oa kalafo ke lijo. Ka foromo e tsoetseng pele, ho hlokahala meriana kapa ente ea insulin.

Moralo oa Sengoloa: Mila Friedan