Hōʻike ʻia nā maʻi mellitus ma muli o ke kaohi kino o ka hoʻoliʻiliʻi a me ke hoʻonui ʻana o ke kaomi gula. Ua hoʻonohonoho ʻia nā papa heluʻAʻI, kahi i hōʻike ʻia ai nā ʻano maʻi like ʻole.
Wahi a nā helu helu 2017, ʻoi aku ka nui o 150 miliona mau kānaka i ʻike ʻia me ka maʻi maʻi. I nā makahiki i hala iho nei, ua loaʻa pinepine nā hihia o nā maʻi. ʻO ka pilikia nui loa o ka hoʻokumu ʻana o ka maʻi ma hope o 40 mau makahiki.
Aia nā papahana e loaʻa i kahi pae o nā kaʻina e hōʻemi ai i ka ulu ʻana o ka maʻi maʻi a hōʻemi i ka hopena o ka make. Ke lawe nei i ka hemoglobin glycosylated e hiki ke hoʻomaopopo i ka maʻi diabetes a kuhikuhi i kahi regimen lapaʻau.
Nā hiʻohiʻona o ka hoʻomaka a me ke ʻano o ka maʻi
Hoʻokumu ka hoʻomohala ʻana i ka patology me nā mea he nui. Inā loaʻa he predisposition hoʻoilina, a laila kiʻekiʻe ke koʻikoʻi o ka maʻi maʻi. Hiki nō hoʻi ke maʻi mai ka hoʻopiʻi ʻia ʻana o nā palupalu a nā hewa o nā pilikia koʻikoʻi me kekahi mau mea kino. ʻO kēia maʻi ke kumu o ka nui o nā maʻi ʻē aʻe.
ʻO ka maʻi mellitus type 1 ka mea i loaʻa ma o ka malfunction o nā pū beta. ʻO ke ʻano o nā hana beta kele e hōʻike ana i ke ʻano o ka maʻi. Hoʻololi ka maʻi diabetes mellitus i nā keiki i kēlā me kēia makahiki, e komo pū ana i nā pēpē.
No ka hoʻomaopopo ʻana i ka maʻi, pono e hana i kahi hōʻike koko, e kiʻekiʻe ke kiʻekiʻe o ka glucose. Hiki i ke kauka ke kamaʻilio e pili ana i ka diabetes idiopathic me ka insulin haʻahaʻa ma ke kino.
Hiki ke hoʻohālikelike ʻia ka maʻi type 1 i ka manawa e pili kokoke ana ka nui o nā pakanu kalama i kahi o ke olakino. Hōʻike ʻia ka subcompensation e nā pōkole pōkole o ka hypoglycemia a i ʻole hyperglycemia, ʻoiai ʻaʻohe ʻano kīnā.
Me ka hoʻokaʻawale ʻana, hiki i ke kahe o ke koko ke loli nui, hiki paha i ka precoma a me ka coma. Ma ka lōʻihi o ka wā, ʻike ʻia ka acetone i ka urine.
Nā hōʻailona ʻānō o ke ʻano maʻi 1:
- makewai
- pinepineia urination,
- ikaika ikaika
- mea kaumaha
- ʻili ʻia ka ʻili,
- maikaʻi maikaʻi ʻole, nāwaliwali, nāwaliwali,
- nā hōʻeha a me nā ʻehaʻeha o ka naʻau
- ka ʻūʻū nui, mālama i ka ʻili,
- luaʻi a kahila
- haʻahaʻa haʻahaʻa i nā maʻi,
- ʻeha ka ʻōpū.
Nui ka anamnesis i kahi ʻike maka ʻole, ka hana o ke ake, ka hoʻokahe koko i nā wāwae, a me kahi hōʻemi o ka naʻau o ka hapa o nā wāwae.
Hōʻike pinepine nā type 2 diabetes mellitus i nā poʻe waena a me nā poʻe kahiko. Hōʻike ʻia ka maʻi e ka ʻike ʻino o ka insulin. Hiki ke tupu kēia ma muli o ka hāpai ʻana, ka momona nui, a i ʻole nā mea ʻē aʻe. Hoʻomaka ka maʻi maʻamau i kekahi manawa a ʻaʻole loaʻa nā hōʻailona maʻa.
ʻAno 2 mellitus mole:
- pūpū, i hōʻike ʻia e ka hoʻomau ʻana o ka maʻi ma o ka ʻai ʻana a i hui pū ʻia me ka hoʻohana ʻana o ka lāʻau kūpono,
- ka awelika o ka manawa e hoʻokau ʻia ai ma hope o ke hoʻopau ʻana i nā papa he nui o ka lāʻau hoʻokaʻa gula. ʻO nā ʻōhumu vascular liʻiliʻi e hiki mai,
- Hana ʻia kahi ʻano paʻakikī inā hana ka hoʻokō ʻana me ka papa hoʻohaʻahaʻa i ke kō a me nā insulin, a i ʻole like me ka insulin. ʻO nā maʻi hōʻeha koʻikoʻi vascular, nephropathy, retinopathy, a me nā neuropathy he mea maʻamau.
Maluhia kekahi kanaka me ka maʻi type 2. Aia kahi hech i ka palaki a me ka perineum. Hoʻonui pinepine ka paona kino, maʻi, nā maʻi ʻoi o ka ʻili. ʻO ka hele ʻana o ke kino kūleʻa kekahi ʻano.
He kanaka mau ka nāwaliwali o ka māno a me ka haki nui. Kūʻē nā wāwae, ʻaʻole palupalu nā wāwae. Hoʻoulu mālie ka hihiʻo, hiki ke ulu ikaika ka lauoho a, a ma nā hopena i hiki ke hāʻule. Hōʻike liʻiliʻi nā ulu liʻiliʻi melemele i ke kino, pinepine i ka ʻoli nui ʻana a me ka ʻaʻa ʻana o ka ʻula ʻili.
ʻIke ʻia ka nui o ka insulin i ka wā pinepine, no ka mea, ʻaʻohe ʻano hōʻike. Hōʻalo kēia ʻano i nā maʻi o ka ʻōnaehana vascular. I ka wā e mālama ai, pono e ʻohi ʻia nā meaʻai a i nā lāʻau lapaʻau i kauoha ʻia e kāu kauka.
Hiki ke hōʻike ʻia nā maʻi maʻi ʻokoʻa, ʻoiai ke ʻano like. Hōʻike ka hiʻohiʻona o nā maʻi hoʻopiʻi i kēlā me kēia holomua. Aia nā puʻuwai o ke koʻikoʻi, ka maʻi diabetes mellitus, nā ʻano, he ʻano ʻano like ʻole, ʻokoʻa nā ʻano like ʻole a me nā pae.
Me ka maʻi maʻi, e hoʻomau ka maʻi diabetes me nā wahi ʻole. Ke kū nei ka papa waena, ma hope o kekahi manawa hoʻomaka nā pilikia:
- ʻike maka
- huakaʻi renal function,
- kuhihewa o ka io o nā ʻoihana ma waena.
Me kahi papa koʻikoʻi o ka maʻi, hiki i nā pathologies koʻikoʻi ke hoʻomau i kēlā me kēia.
Ma muli o nā hopena i kū mai i ke kino, e hoʻonui ʻia ka hoʻokumu ʻana o ka hemoglobin glycosylated. Aia pū kahi hui o ka glucose a me ka hemoglobin. Aia i ka pae o ka hoʻolālā hemoglobin e hilinaʻi i ka pae o ke kō. E like me nā hualoaʻa o ka loiloi, ua hoʻoholo ʻia ka nui o ka hemoglobin, i hui pū ʻia me ke kō ma luna o kekahi manawa.
Loaʻa ka Glycosylated hemoglobin i nā poʻe olakino, akā i ka nui o nā mea liʻiliʻi. Me ka maʻi o ka maʻi maʻi, i kēia mau kuhikuhi he mau manawa ma mua o ka maʻamau. Inā hoʻi hou ka nui o ke kō i ka hilahila, a laila e mau manawa no ka hemoglobin e hoʻi i ka maʻamau.
Hoʻoholo ʻia ka hopena o ka ʻoihana e ka pae o ka hemoglobin.
Hoʻololi ʻana i ka maʻi maʻi
Wahi a nā noiʻi ʻepekema, ua hoʻokumu ʻo ka poʻe loea mai WHO i ka papa o ka maʻi maʻi. Ua hōʻike ka hui e pili ana ka hapa nui o nā maʻi āpau i nā maʻi like 2, 92% o ka nui.
Pākuhi helu diabetes 1 no ka 7% o ka nui o nā hihia. ʻO nā maʻi maʻi ʻē aʻe no ka 1% o nā hihia. Ma kahi o 3-4% o nā wahine hāpai i loaʻa i ka maʻi maʻi gestational.
Hoʻolohe pū ka mālama ola olakino i ka hihia o nā prediabetes. ʻO kēia kahi kahi i ka mea i kuhikuhi ʻia e ka glucose i loko o ke koko iʻoi aku ma mua o ka maʻamau, akā ʻaʻole hoʻi i hiki i nā waiwai i ʻike ʻia i loko o nā ʻano mana o ka maʻi. Ma ke kānāwai, ʻo ka prediabetes ma mua o kahi maʻi piha piha.
Hoʻokumu ʻia ka maʻi ma muli o nā hopena hewa o ke kino, no ka laʻana, heʻe ʻole i ka hoʻoili ʻana o ka glucose. Kuhi ʻia kēia mau ʻike ma ka poʻe me ka maʻamau a keu ke kaumaha.
ʻO ke ʻano o nā maʻi ʻē i hoʻoili ʻia inā hoʻoili ʻia ka glucose i loko o ke kino, akā ma muli o nā hoʻopiʻi, hiki ke loli ke kūlohelohe a hana ʻia nā hana synthesis.
Mai 2003, ua loaʻa ka maʻi diabetes i nā pōkole i manaʻo ʻia e ka Hui Diabetes ʻAmelika.
Hōʻike ka mellitus type 1 i ka luku ʻia ʻana, ʻo ia ke kumu e loaʻa ai ka hemahema i ka insulin i loko o ke kino. Hōʻike ka mellitus type 2 no ka mea ke hoʻopau nei ka hopena ola o ke insulin i ke kino.
ʻO kekahi mau ʻano maʻi maʻi i hele mai ma muli o nā maʻi like ʻole, a me ke komo ʻole ʻana o nā poli beta. Ma kēia ʻano, he ʻōlelo aʻo i ka wā kūlohelohe.
I ka papa o kā WHO helu i ka makahiki 1999, aia kekahi mau loli i ka hoʻolālā ʻana o nā ʻano maʻi. Ma kēia manawa hoʻohana ʻia nā helu Arab, ʻaʻole ka Roma.
ʻO nā poʻe loea o ka manaʻo o ka "maʻi gestational" komo i ka maʻi ʻaʻole wale i ka wā e hāpai ana, akā kekahi mau pilikia o nā metabolism o ka paʻakai. Ma o kēia hana mākou i nā hana hewa i hiki mai i ka wā o ka hānau ʻana o ke keiki, a ma hope.
ʻAʻole ʻike ʻia nā kumu o ka maʻi gestational. Hōʻike ka hōʻike hōʻike, ʻoi aku ka maʻi o ka maʻi ma nā wahine i kaupaona, ʻano type diabetes 2, a i ʻole ovarian polycystic.
I nā wahine, i ka wā hāpai, hiki i kahi hōʻemi ke hoʻoneʻe ʻia i nā ʻōpū i ka insulin, e hoʻomaka ʻia e ka hoʻololi ʻana o ka hormonal a me kahi predisposition hoʻoilina.
Hoʻokaʻawale ʻia ka ʻaoʻao 3 mai ka papa inoa o nā ʻano o nā maʻi, ka mea i ʻike ʻia ma muli o ke kī hōʻino.
Ua hopena i hiki i kēia mea ke hoʻopilikia i ka metabolism protein, eia naʻe, ʻaʻole hiki ke hoʻonāukiuki i ka helehelena o ka mellitus maʻi.
Ka Hōʻailona o ka maʻi maʻi maʻi maʻi
Hiki i ka hapa nui o nā maʻi maʻi maʻi i ʻelua mau pūʻulu: nā mea maʻi me ka diabetes type type 1 mellitus (DM 1), i pili pū me ka hemahema o insulin, a me nā mea maʻi me ka maʻi diabetes mellitus (DM 2), e kūlike me ka pale ʻana o ke kino i ka insulin.
Hoʻolaha pinepine ia e hoʻoholo i ke ʻano o ka maʻi maʻi, no laila e hoʻomohala ʻia nei kahi papa hou o nā maʻi maʻi maʻi, i ka wā i ʻāpono ʻia ʻole e WHO. I ka papa helu ʻāina aia kekahi ʻāpana "Diabetes mellitus indefinite type".
Kuhi ʻia nā helu o nā maʻi maʻi palela e hoʻonāukiuki ʻia:
- maʻi ʻana
- nā lāʻau lapaʻau
- endocrinopathy
- maʻiʻaʻai pancreatic,
- nā huina pilikino.
ʻAʻole pili kēia mau ʻano maʻi me ke ʻano pathogenetically, heʻokoʻa ka ʻokoʻa.
ʻO ka papa o nā maʻi maʻi maʻi e like me ka ʻike o ka WHO ka 4 mau maʻi o nā maʻi a me nā pūʻulu, kahi i kuhikuhi ʻia e nā palena ʻae o nā home home o glucose.
Hiki i ke ʻano maʻi diabetes like ʻole 1:
- kūwili uila
- idiopathic.
ʻO ka maʻa maʻi mellitus type 2 ke ʻano i ka papa inoa:
- hana hoʻopiʻi palena palena home glucoseost,
- pale ʻia ka hoʻonaninani glucose
- glycemia kiʻekiʻe ma ka ʻōpū ʻole,
- maʻi kanikele hoʻi i ka wā hāpai,
- o na ano e ae o ke mai.
Nā maʻi pancreatic:
- loko o nā ʻōpū
- lōkohu
- nā hōʻeha
- huikaih
- fibrosing calculous pancreatitis,
- hemochromatosis.
Endocrinopathies:
- ʻEha ka puʻe o Cush
- glucagonoma
- somatostatinoma
- tirekaxosis
- kauola
- nā pheochromocytoma.
ʻO nā pilikia genetic o ka hana insulin:
- lipoatrophic maʻi,
- ʻano type
- leprechaunism, Donohue syndrome (type 2 diabetes mellitus, intrauterine growth retardation, dysmorphism),
- ʻO Rabson-Mendenhall syndrome (acanthosis, diabetes mellitus a me ka pineal hyperplasia),
- ʻO nā mea ʻē aʻe.
Hōʻalo i nā ʻano mea maʻi o ka maʻi maʻi:
- Nā maʻi ʻeha o ke kanaka (type 1 diabetes mellitus, hoʻopaʻapaʻa o ka ʻōpū, nā kūlana paʻa ʻole)
- Nā antiododies i nā receptors insulin.
ʻO ka papa inoa o nā syndromes i hui pū me ka maʻi diabetes:
- ʻ .lelo Turner
- Nā maʻi haʻihaʻi
- Lawrence-Luna-Beadle syndrome,
- Loaʻa nā kalaha o Getington,
- tungsten syndrome
- ʻO ka maʻi Klinefelter
- ataxia o Friedreich,
- porphyria
- ʻĀnana Prader-Willi,
- myotonic dystrophy.
Nā maʻi:
- cytomegalovirus a i ʻole endogenous rubella,
- nā maʻi ʻē aʻe ʻē aʻe.
ʻO kahi ʻano e hoʻokaʻawale kahi maʻi maʻi o nā wahine hāpai. Aia kekahi ʻano maʻi ʻē aʻe e lawe ʻia mai e nā lāʻau a me nā lāʻau lapaʻau.
Ma muli o nā Diagnostics e like me nā kūlana o WHO
Kūkulu ʻia nā kaʻina hana diagnostic i ka ʻike ʻana o ka hyperglycemia ma lalo o kekahi mau kūlana. ʻAe ke ʻano o nā ʻano maʻi maʻi i nā ʻano like ʻole. He like ʻole ia, no laila ʻo ka haʻalele ʻana o nā hōʻailona ʻole e kāpae i ka hopena o ka maʻi.
ʻO ka WHO Worldwide Diagnostic Standard e wehewehe i ka mau palena o ka palena palena i ka home home home glucose i hoʻokumu ʻia i ka pae koko koko e hoʻohana ana i kekahi mau ala.
Kaʻana:
- ʻO ka glucose glucose ma kahi ʻōpū ʻole (ma lalo o ʻewalu mau hola ma hope o ka ʻai),
- huka koko kō (i kekahi manawa o ke ao, ke waiho ʻole ʻana i ka ʻai i ka meaʻai),
- glycemia ma 120 mau minuke o kahi hoʻoliʻoli hoʻoliʻi waha ma ka 75 g o ka glucose.
Hiki ke maʻi ka maʻi maʻi i ʻekolu mau ala:
- ka loaʻa ʻana o nā hōʻailona puʻuwai o ka maʻi + glycemia random har ʻoi aku ma mua o 11.1 mmol / l,
- glycemia ma luna o ka ʻōpū ʻole ma mua o 7.0 mmol / l,
- glycemia ma ka minute 120 o ka PTTG ma mua o 11.1 mmol / l.
No ka hoʻonui i ka glycemia, he pae kūpono o ka glucose i loko o ke koko koko ka ʻano o ka ʻōpū ʻole, ʻo ia ka 5.6 - 6.9 mmol / L.
Hōʻike ʻia ka hoʻohaʻahaʻa glucose glucose i loaʻa i ka pae momona o 7.8 - 11.0 mmol / L i nā minuke 120 o PTTG.
Nā Kūʻai Kūleʻa
ʻO ke koko glucose i loko o kahi kanaka olakino e pono he 3.8 - 5.6 mmol / l ma kahi ʻōpū ʻole. Inā ʻaʻole pinepine ka glycemia i hala aku i ka 11.0 mmol / L i ke koko capillary, pono kahi maʻi lua, e hōʻoia i ka maʻi maʻi.
Inā ʻaʻohe symptomatology, a laila pono ʻoe e aʻo i ka maʻi glycemia i nā kūlana maʻamau. ʻO ka hoʻopiliʻana i ka glycemia ka liʻiliʻi ma lalo o 5.6 mmol / L kahi mea hoʻohālikelike i ka maʻi maʻi. Inā piʻi nui ka glycemia ma mua o 6.9 mmol / l, a laila hōʻoia i ka maʻi o ka maʻi maʻi.
ʻO Glycemia ma ka waena o 5.6 - 6.9 mmol / l pono e noiʻi ma kahi noi ma PTTG. Ma kahi hōʻike hoʻokolohua glucose, hōʻike ʻia ka maʻi diabetes e ka glycemia ma hope o ʻelua mau hola he nui ma mua o 11.1 mmol / L. Pono e ʻōlelo ʻia ka noiʻi a ua hoʻohālikelike ʻia nā hopena ʻelua.
No kahi ʻike loiloi kino o ka maʻi type o ka type 1 a me ke ʻano 2, hoʻohana ʻia ʻo C-peptides ma ke ʻano he hōʻailona no ka mea huna o ka ʻimi ʻana o ka endogenous, inā ʻike ʻole ʻia ke kiʻi o ka maʻi. I ka maʻi lā 1, ʻike ʻia nā kumu basal i kekahi manawa i ka zero.
Me nā maʻi o ka lua, ʻokoʻa ke ʻano o ka waiwai, akā, me ka kū ʻana o ka insulin, hoʻonui.
Me ka hoʻomohala ʻana o kēia ʻano maʻi, ua hoʻonui pinepine ʻia ka pae o C-peptides.
ʻO nā ʻōhua hiki
Ma muli o ka maʻi diabetes mellitus hiki ke alakaʻi i ka pohō nui o ke olakino. E kū'ē i ke kua o ka maʻi, e hoʻomohala kekahi mau ala ʻē aʻe, me ka manaʻo ʻole o ka papa o ka maʻi maʻi. E hōʻike iki ana nā hōʻailona a he mea nui ia e hele i nā pae a pau o ka hoʻokolohua e hōʻoia ai i ka maʻi kūpono. ʻO ka hoʻolālā ʻana o nā hoʻopiʻi me ka mālama kūpono ʻana o ka maʻi maʻi e kū mai me ka ʻole o ka pau.
ʻO kekahi laʻa, ʻike pinepine ka retinopathy, ʻo ia hoʻi, ʻo ka retinal detachment a i ʻole kona hoʻololi ʻana. Me kēia patula, hoʻomaka ka hemorrhage ma nā maka. Inā ʻaʻole i hoʻomaʻamaʻa, hiki ke makapō piha ka mea maʻi. Hōʻike ʻia ka maʻi me ka
- hoʻoweliweli o nā kīʻaha koko
- ke ʻano o nā puʻuwai koko.
ʻO ka polyneuropathy ka nalowale o ka mālama ʻana i ka mahana a me ka hōʻeha. I ka manawa like, hoʻomaka nā ʻūlū ma ka lima a me nā wāwae. Hoʻonui nā ʻano manaʻo ʻole a pau i ka pō. ʻAʻole ho'ōla i nā ʻōpū no ka manawa lōʻihi, a aia kekahiʻano kiʻekiʻe o ka ulu ʻana i ka gangrene.
Ua kapa ʻia ka nephropathy diabetic i loko o ka maʻi palaka, ka mea e hoʻonāuki i ka hana huna ʻana i ka protein i loko o ka pā. ʻO ka pinepine, ulu nā hina.
ʻO nā ʻano maʻi maʻi i laila e haʻi aku i ka loea i ka wikiō ma kēia ʻatikala.
