ʻO ka pancreas o ke kanaka, ʻo ia hoʻi nā kelena beta o nā mokupuni o Langerhans, e hana i ka insulin. Inā luku ʻia kēia mau ʻāpana kūikawā, a laila he maʻi ia o ka maʻi maʻamau o ka maʻi maʻamau.
No kēia maʻi maʻamau-ʻona, kūmau loa ka hemahema o ka insulin hormone he ʻano maʻamau.
I kekahi mau hihia, mau ka maʻi maʻa i nā mākaʻi o ka hōʻeha o ka autoimmune (idiopathic type 1 diabetes).
ʻO Etiology o ka maʻi
ʻO ka maʻi diabetes type 1 ka maʻi hoʻoilina, akā he predisposition genetic e hoʻoholo i kona hoʻomohala ʻana i kahi hapakolu wale nō. ʻO ka hopena o ka pathology i kahi keiki me ka makuahine-maʻi diabetes, ʻaʻole loa aku ma mua o 1-2%, makuakāne maʻi - mai ka 3 a 6%, ka hoahānau - ma kahi o 6%.
Hoʻokahi a i ʻole kekahi mau māka humoral o nā maʻi pancreatic, kahi o nā antibodies i nā mokupuni o Langerhans, hiki ke ʻike ʻia i ka 85-90% o nā maʻi:
- nā antibodies e ka glutamate decarboxylase (GAD);
- nā antibodies i ka phosphatase tyrosine (IA-2 a me IA-2 beta).
Ma kēia hihia, ʻo ka mea nui o ka luku ʻana i nā hua beta i hāʻawi ʻia i nā mea o ke kaola o ke kelepona. Pānaʻi maʻamau ka maʻi maʻamau me ka HLA haplotypes e like me DQA a me DQB.
Hoʻohui pinepine ʻia kēia ʻano pathology me nā maʻi endocrine autoimmune e like me, no ka laʻana o Addison's disease, autoimmune thyroiditis. He mea nui hoʻi ka etiology Non-endocrine:
- vitiligo;
- ʻōmaʻomaʻo rheumatic;
- alopecia;
- ʻO nā maʻi a Crohn.
ʻO nā pathogenesis o ka maʻi maʻi
Hoʻololi ka maʻi diabetes type 1 i ka wā e hōʻino ai kahi kaʻina autoimmune i 80 a 90% o nā peka beta pancreatic. Eia kekahi, loli mau ka ikaika a me ka wikiwiki o kēia kaʻina pili. ʻO ka pinepine, ma ke papa papa o nā maʻi i ka poʻe ʻōpio a me nā ʻōpio, luku luku ʻia nā mea i nā maʻi, a wikiwiki koke ka maʻi diabetes.
Mai ka hoʻomaka ʻana o ka maʻi a me kāna mau maʻi lapaʻau mua loa i ka hoʻomohala ʻana o ka ketoacidosis a i ʻole ketoacidotic coma, ʻaʻohe mau manawa he mau pule e hiki ke hala.
I kekahi mau mea'ē aʻe, ʻaʻole i loaʻa nā maʻi maʻamau, i nā mea maʻi ma mua o 40 mau makahiki, hiki i ka maʻi ke hana malū (latent autoimmune diabetes mellitus Lada).
Eia kekahi, i kēia kūlana, ua nānā aku nā kauka i ka maʻi diabetes mellitus type 2 a ua ʻōlelo aku i kā lākou poʻe maʻi e hiki ai ke hoʻopiʻi i ka hemahema o ka insulin me ka sulfonylureas.
Eia naʻe, i ka manawa o ka manawa, hoʻomaka nā hōʻailona o kahi hemahema o ka hormone:
- ketonuria;
- lilo ka kaumaha;
- kūlike o ka hyperglycemia e pili ana i ka mua o ka hana maʻamau o nā lāʻau pā e hōʻemi ai i ke kō koko.
Hoʻokumu ʻia ka pathogenesis o ke ʻano maʻi type 1 i ka pau ʻole o ka hormone hina. Ma muli o ka hikiʻole o ke kōʻai gula i loko o nā ʻoloka pono i ka insulin (ka pūpū a me ka momona), ulu ka nui o ka ikehu a, ma muli o kēia, lilo ka lipolysis a me ka proteolysis i ikaika loa ai. ʻO kekahi kaʻina hana e kumu ai ke kaupaona ʻana.
Me ka piʻi nui o ka glycemia, hele ka hyperosmolarity, i hele pū me ka diuresis osmotic a me ka dehydration. Me ka nele o ka ikehu a me ka hormone, disin exhibit the secretion of glucagon, cortisol and hormone ulu ulu.
ʻOiai e ulu ana ka glycemia, hoʻoulu ka gluconeogenesis. ʻO ka wikiwiki o ka lipolysis i loko o nā lau momona e hoʻoulu ai i ka nui o ka nui o nā momona momona.
Inā loaʻa kekahi nele o ka insulin, a laila paʻa ka mākia liposynthetic o ke aʻalolo, a me nā hui momona ʻomaʻomaʻi ua hoʻoikaika ʻia i ka ketogenesis. ʻO ka hōʻiliʻili o nā ketone e lilo i ka hoʻomohala ʻana o ka ketosis diabetes a me kona hopena, ka ketoacidosis maʻi diabetes.
E kū'ē i kahi kūlana o kahi hoʻonui holomua i ka pehu a me ka acidosis, hiki i kahi kohu ke hoʻomohala.
ʻO ia, inā ʻaʻohe lāʻau lapaʻau (lawa pono ʻoiʻi i ka lāʻau a me ka rehydration), ma kahi o 100% o nā hihia e hōʻeha ai i ka make.
Hoʻomaopopo o nā maʻi Diabetes Type 1
Loaʻa loa ʻia kēia ʻano patology - ʻaʻole pinepine pinepine ma mua o 1.5-2% o nā maʻi āpau o ka maʻi. ʻO ka hopena e pili ana i ka wā ola e loaʻa i ka 0.4%. Hoʻomaʻama pinepine ka maʻi o kahi maʻi i kēlā maʻi ma ka makahiki he 10 a me 13 makahiki. ʻO ka nui o ka hōʻike o ka patology e hele ana i nā makahiki 40.
Inā maʻamau kēia hihia, ʻoi aku i nā kamaliʻi a me nā ʻōpio, a laila e hōʻike ʻia ka maʻi iā ia iho me ka hōʻike ʻana i ka hōʻailona soratology. Hiki ke ulu i loko o kahi mau mahina a i hoʻokahi pule paha. Nā maʻi a me nā maʻi e like me nā mea e hoʻonāukiuki ai i ka hōʻike o ka maʻi maʻi.
Nā hōʻailona āpau i nā ʻano o nā maʻi āpau:
- polyuria;
- it o ka ʻili;
- polydipsia.
Kuhi ʻia kēia mau ʻōuli me ka maʻi type 1. I loko o ka lā, hiki i ka mea maʻi ke inu a hoʻokaʻawale i nā liʻiliʻi he 5-10 lita o ka wai o ka wai.
Kuhi kūikawā no kēia ʻano o ka maʻi e lilo ia i mea kaumaha koʻikoʻi, aia ma 1-2 mau mahina e hiki ke 15 kg. Eia kekahi, e maʻi ka mea maʻi:
- nāwaliwali o ke kino;
- hiamoe
- ho'ēmi ʻia ka hana.
I ka wā mua, hiki ke hoʻopulapula paha iā ia me ka nui ʻole o ka nui o ka ʻono, ke hoʻololi ʻia nei e anorexia i ka wā e hoʻonui nui ana ka ketoacidosis. E ʻike ka mea maʻi i kahi ʻano ʻohu o ka acetone mai ka waha o ka waha (loaʻa paha kahi ala fruity), nausea a me ka pseudoperitonitis - ka ʻeha o ka ʻōpū, nā puʻuwai kaumaha, hiki ke hōʻeha i kahi pōʻino.
I kekahi mau hihia, ʻo ka hōʻailona mua o ka maʻi diabetes type 1 i ka poʻe maʻi maʻi pediatric e hoʻomau ʻia ka ʻike mua ʻana o ka maʻi. Hiki ke hoʻohālikelike ʻia e kūʻē i ke ʻano o ka pathologies concomitant (ʻeha a maʻi infectious paha), hāʻule paha ke keiki i kahi pōʻino.
Kēia, inā ʻo ka mea maʻi he ʻelemakule ma mua o 35 mau makahiki me ka maʻi maʻi (me ka maʻi maʻamau autoimmune), ʻaʻole paha i ʻike ka maʻi iā ia iho, a ke hōʻike ʻia nei i ka ulia pōpilikia ma ke ʻano o ka hoʻāʻo ʻana i ke kō.
ʻAʻole hōʻemi ke kanaka kaumaha, polyuria a me polydipsia e maʻalahi.
ʻO ka mea mua, hiki i ke kauka ke hana i ka maʻi diabetes 2 ʻano a hoʻomaka i ka mālama ʻana me nā lāʻau lapaʻau e hōʻemi i ke kō i nā papa. E ʻae ʻia kēia ma hope o kekahi manawa e hōʻoia i kahi uku ʻokoʻa no ka maʻi. Eia nō naʻe, ma hope o kekahi mau makahiki, maʻamau ma hope o ka makahiki 1, e loaʻa i ka mea maʻi i nā hōʻailona ma muli o ka piʻi ʻana o ka hapa o ka wī ʻana i ka insulin.
- kau kaumaha;
- ketosa;
- ketoacidosis;
- ka hiki ʻole ke mālama i ke kō ma nā kō i nā pae i koi ʻia.
Nā kulekele no ka maʻi ʻana i ka maʻi diabetes
Kuhi ʻia kēlā ʻano 1 o ka maʻi i hōʻike ʻia e nā hōʻailona ʻānō a he ʻano ʻike maʻamau ʻole ia, kahi ʻike screening e hoʻomaʻamaʻa i nā pae kōpī koko ʻaʻole i lawe ʻia. ʻO ka liʻiliʻi o ka hoʻomohala ʻana i ka maʻi type 1 i ka pili pili ʻana he liʻiliʻi, ka mea, me ka hapa ʻole o nā ala kūpono no ka hoʻomaka mua ʻana o ka maʻi, e hoʻoholo ai i ka like ʻole o ka loiloi hohonu o ka maʻi immunogenetic o nā māka i loko o lākou.
Kuhi ʻia ka maʻi i ka ʻōpū o nā hihia, e kau ʻia ana ma muli o ke ʻano o ka nui o ke kahe nui o ke koko i loko o kēlā mau maʻi e loaʻa nei nā hōʻailona o ka hema ʻana o ka insulin.
ʻO ka hoʻāʻo ʻana i ka waha e ʻike ʻole ai ka maʻi nui.
ʻAʻole ka wahi hope loa o ka maʻi maʻi. Pono e hōʻoia i ka maʻi maʻi i nā hihia kānalua, ʻo ia hoʻi ke ʻike i ka glycemia moderate i ka ʻole o nā hōʻailona maopopo a mālamalama o ka maʻi mellitus type 1, ka mea nui me ka hōʻike ʻana i ka wā ʻōpio.
ʻO ka pahuhopu o kēlā maʻi like paha e hoʻokaʻawale i nā maʻi mai nā ʻano maʻi maʻi ʻē aʻe. No ka hana ʻana i kēia, e hoʻohana i ke ala o ka hoʻoholo ʻana i ke ʻano o ka bas-C-peptide a me 2 mau hola ma hope o ka ʻai ʻana.
ʻO nā mākaʻamau no ka waiwai kūlohelohe kumu i nā hihia nui ʻole ka hoʻoholo ʻana o nā māka immunological o ke ʻano maʻi type 1.
- nā antibodies i nā mea uluʻai o ka pancreas;
- glutamate decarboxylase (GAD65);
- ʻO ka phosphatase tyrosine (IA-2 a me IA-2P).
Huaʻa noho hoʻoponopono
Hoʻokumu ʻia nā mea lapaʻau no kekahi ʻano maʻi o ka maʻi maʻi i ka 3 mau kumu aʻoaʻo:
- ka hoʻemi ʻana i ke kōpaʻa koko (i ko mākou hihia, ʻo ka inikini insulin);
- kaʻai ʻai;
- hoʻomanawanui hoʻonaʻauao.
ʻO ka hoʻomaʻamaʻaʻana me ka insulin no ka peʻa type 1 he mea kūʻokoʻa. ʻO kāna kumu e hoʻonui i ka imitation o ke kūlohelohe o ka insulin i mea e loaʻa ai i nā koi uku no ka loaʻa ʻana. Hoʻomaʻamaʻa pololei loa kahi maʻi insulin i ka male ʻana o ka hana o ka hormone.
ʻO ka pono o kēlā me kēia lā no ka haki e pili ana i ke kiʻekiʻe o kāna peʻa basal. 2 kaʻi ʻana o kahi lāʻau lapaʻau maʻamau o ka lōʻihi o ka ʻike a i ʻole ka inikini o ka lōʻihi o ka insulin Glargin e hiki ke hāʻawi i ke kino me ka insulin.
ʻAʻole pono ka nui o ka nui o ka hormone basal i waena o nā koi o ka lā maʻamau no ka lāʻau lapaʻau.
E hoʻololi ʻia ka polus (kaʻaina) i ka inika e nā injections o ke ʻano o ke kanaka o ka pōkole a i ʻole ka pōkole o ka hōʻike ʻana o ka maʻi i hana ʻia ma mua o ka papaʻaina. I kēia hihia, ua kāhā ʻia ke ʻano hana ma ke ʻano e pili ana i kēia mau ʻōlelo:
- ka nui o nā huapalapala e manaʻo ʻia e hoʻopau ʻia i ka wā ʻai;
- ka pae momona koko i loaʻa, hoʻoholo ʻia ma mua o kēlā me kēia inikini insulin (helu ʻia me ka glucometer).
Ma hope koke iho o ka hōʻike ʻana o ka maʻi mellitus type 1 a i ka hoʻomaka ʻana o ka mālama ʻana no ka manawa lōʻihi, pono ka liʻiliʻi no ka hoʻomākaukau ʻana i ka insulin a emi mai ka 0.3-0.4 U / kg. A kapa ʻia kēia ʻano ʻo "honeymoon" a i ʻole ka pau ʻana o ka kala mau ʻana.
Ma hope o kahi manawa o ka hyperglycemia a me ke ketoacidosis, kahi i hoʻopaʻa ʻia ai ka hana i ka insulin e ke ola ʻana o nā cell beta, ua hoʻopaʻi ʻia ka hormonal a me ka hoʻokalakupua o ka hoʻokalakupua. Hoʻihoʻi ka lāʻau lapaʻau i ka hana o nā pūpū pancreatic, a laila e lawe i ka mea huna o ka insulin.
Hiki kēia mau kau i nā hebedoma a hala i kekahi mau makahiki. I ka hope loa, akā, ma muli o ka luku ʻia e ka autoimmune i nā koena beta-cell, pau ka hana remisi a koi ʻia ka mālama koʻikoʻi.
Non-insulin-hilinaʻi mellitus (type 2)
Hōʻī ke ʻano o kēia ʻano neʻe inā hiki ʻole i nā ʻōpili o ke kino ke hoʻopiha piha i ke kōpaʻa a i ʻole ka hana ʻana ma ka kiko piha. ʻO kahi pilikia i loaʻa kekahi inoa ʻē aʻe - extrapancreatic insufficiency. He ʻokoʻa paha ka ʻano etiology o kēia ʻano.
- kahi hoʻololi i ke ʻano o ka insulin me ka hoʻomohala ʻana i ka momona, overeating, he ʻano hana maʻalahi, ka maʻi o ka arterial, i ka wā ʻelemakule a me ke alo o nā additions;
- kuhi hewa i nā hana o nā ʻenehana receptor ma muli o ka pale hewa ʻana o kā lākou helu a i ʻole ʻano;
- ka lawa ʻole o ka hana kō ma nā kōoole;
- intracellular pathology, ma kahi o ka hoʻoili ʻia ʻana o kahi kuhi i nā organel celleles mai ka mea i hoʻokipa me ka paʻakikī, he paʻakikī;
- hoʻololi i ka hana huna o ka insulin i ka pancreas.
Nā ʻano maʻi maʻi
Mamuli i ka paʻakikī o ka maʻi type kīnā 2, e mahele iā ia i:
- haʻahaʻa haʻahaʻa. Hoʻohālikelike ia me ka hiki ke mākaukau i ka nele o ka insulin, i lalo o ka hoʻohana ʻana i nā lāʻau a me nā mea ʻai e hiki ai ke hōʻemi i ke kō koko koko i loko o ka manawa pōkole;
- kūlana kiʻekiʻe. Hiki iā ʻoe ke hoʻohālikelike i nā loli metabolic i hāʻawi ʻia ma ka liʻiliʻi he 2-3 mau lāʻau e hoʻemi ʻia i ka glucose. I kēia papa hana, e hui pū me ka hikiʻole i ka metabolic me ka angiopathy;
- kahua ʻeha. ʻO ia hana maʻamau i ke kūlana e pono ai ka hoʻohana ʻana o kekahi mau ʻano o ka hoʻohaʻahaʻa i ka glucose a me ka hoʻonāʻana i ka insulin. Hoʻomaʻamaʻa pinepine ka mea maʻi ma kēia pae i nā hōʻeha.
He aha ka ʻano maʻi maʻa he 2?
ʻO ka hiʻohiʻona maʻamau o ka maʻi pākīpī o ka maʻi maʻamau o ka 2 mau manawa:
- wikiwiki wikiwiki. Hoʻololi koke nei i ka insulin i hōʻemi ʻia e pane i ka glucose;
- ʻohiʻohi lohi. Ke hoʻolōʻihi nei ka hoʻokuʻu ʻana mai o ka insulin e hoʻemi i ke koena koko kiʻekiʻe i ke koena. Hoʻomaka ia e hana koke ma hope o ka wikiwiki, akā hoʻokō i ka emi ʻana o ka nui o nā pale.
Inā aia kahi palolo o nā cell beta e lilo i kūpaʻa i nā hopena o ka hormone o ka pancreas, kahi nānāʻole i ka nui o nā hāmeʻe i loko o ke koko e ulu iki ana. Ma ke ʻano 2 mellitus no ka mellitus, ʻaʻohe wikiwiki ka wikiwiki, a me ka wikiwiki ka wikiwiki. He mea waiwai ʻole ka hana insulin a no kēia kumu ʻaʻole hiki ke hoʻomālamalama i ke kaʻina hana.
Ke lawa ʻole ka hana receptor insulin a i ʻole nā hana i post-receptor, ulu ka hyperinsulinemia. Me kahi kiʻekiʻe o ka insulin i ke koko, hoʻomaka ka kino i ka ʻoihana o kona uku, kahi e noʻonoʻo ana i ka hoʻomau ʻana i ke kaulike o ka hormonal. Hiki ke ʻike i kēia ʻano hiʻohiʻona a hiki i ka hoʻomaka ʻana o ka maʻi.
Kūkulu ʻia kahi kiʻi nānā o ka patology ma hope o ka hyperglycemia mau loa no kekahi mau makahiki. ʻO ka hānō o ke kō koko koko paʻakikī e hoʻopilikia i nā pūleka beta. ʻO kēia ke kumu o ko lākou hōʻemi ʻana i ka ʻaʻa, hoʻonāukiuki i ka hoʻoneʻe ʻana i ka hana hana insulin.
E hōʻike ʻia ana nā hemahema o ka insulin e ka hoʻololi o ke kaumaha a me ka hoʻokumu ʻana o ka ketoacidosis. Eia kekahi, ʻo ka hōʻailona o nā maʻi maʻi o kēia ʻano:
- polydipsia a me polyuria. Hoʻomau ka lāʻau Metabolic ma muli o ka hyperglycemia, kahi e hoʻonāukiuki ai i ka piʻi o ke koko osmotic. E hoʻoponopono i ke kaʻina, e hoʻomaka ke kino e hoʻihoʻi i ka wai a me nā electrolytes;
- ʻeha o ka ʻili. ʻO ka ʻili o ke kino no ka hoʻonui koʻikoʻi i ka urea a me nā ketones i ke koko;
- momona momona.
ʻO ka paleʻana i ka insulin e hoʻokō i nā pilikia piha, ka lua a me ka lua. No laila, ʻo ka hui mua o nā kauka i kau ʻia: hyperglycemia, kahi lohi i ka hana glycogen, glucosuria, pale ʻana i ka hopena o ke kino.
ʻO ka hui ʻelua o nā hoʻopiʻi e komo: ka hoʻowalewale ʻana i ka hoʻokuʻu ʻia o nā lipids a me ka protein no kā lākou hoʻololi i ke kinikini, ka pale ʻana i ka hana o nā momona momona a me nā protein, hoʻemi i ka hoʻokaʻa ʻana i ka hoʻopau ʻana i nā kapo momona, ka hoʻokahe wikiwiki ʻana o ka hormone o ka pancreas.
ʻOi aku ka maʻi maʻamau ʻo ka maʻi maʻamau 2. Ma ke ākea, nā hōʻailona maoli o ka hanana nui o ka maʻi e hiki ke hoʻonui ma ka palena haʻahaʻa o ka 2-3 mau manawa.
Eia kekahi, ʻimi nā mea maʻi i ke kōkua olakino ma hope wale nō o ka hoʻomaka ʻana o nā hōʻeha koʻikoʻi a me ka pilikia. No kēia kumu, koi aku nā poʻe endocrinologists i nā mea nui e poina e pili ana i nā hoʻokolokolo olakino maʻamau. E kōkua lākou i ka hoʻomaopopo ʻana i ka pilikia e like me ka hiki ke hoʻomaka a hoʻomaka koke i ka mālama ʻana.
