Marasa lafiya masu ciwon sukari suna mamakin: coma mai ciwon sukari: menene? Menene masu ciwon sukari ke tsammanin idan ba kwa shan insulin akan lokaci kuma ya hana jiyya? Kuma mafi mahimmancin tambaya da ke damuwa da marasa lafiya na sassan endocrine a cikin dakunan shan magani: Idan sukari jini ya cika 30, me zan yi? Kuma menene iyakance mata?
Zai zama mafi daidai don magana game da cutar rashin lafiyar masu fama da cutar sankara, tunda an san nau'ikan coma 4. Uku na farko sun kasance hyperglycemic, hade da karuwar taro na sukari a cikin jini.
Cutar Ketoacidotic
Cutar Ketoacidotic halayyar marasa lafiya ce da ke dauke da ciwon sukari na 1. Wannan mummunan yanayin yana faruwa ne sakamakon karancin insulin, sakamakon wanda ya rage yawan amfani da glucose, ana lalata metabolism a kowane matakai, kuma wannan yana haifar da mummunan aiki na ayyukan duk tsarin da sassan jikin mutum. Babban mahimmancin ilmin etiological na ketoacidotic coma shine kasawar insulin gudanar da aiki da kuma tsalle mai tsayi a cikin glucose jini. Hyperglycemia ya kai - 19-33 mmol / l kuma mafi girma. Sakamakon shi ne ƙuna mai zurfi.
Yawancin lokaci, ƙwayar ketoacidotic ta haɓaka a cikin kwanaki 1-2, amma a gaban abubuwan dalilai masu tayar da hankali, zai iya haɓaka da sauri. Abubuwan farko na bayyanar cutar sankarau alamu ne na karuwa a cikin sukari na jini: haɓakar ɗabi'a, sha'awar sha, polyuria, numfashin acetone. Fata da mucous membranes sun cika yawa, akwai ciwon ciki, ciwon kai. Yayin da coma ke ƙaruwa, ana iya maye gurbin polyuria ta anuria, saukar jini zai yi yawa, bugun jini yana ƙaruwa, ana lura da ciwon tsoka. Idan tarota na jini ya wuce 15 mmol / l, dole ne a sanya mara lafiya a asibiti.
Cutar Ketoacidotic ita ce matakin ƙarshe na ciwon sukari, wanda aka bayyana ta hanyar cikakken asarar hankali, kuma idan ba ku taimaki mai haƙuri ba, mutuwa na iya faruwa. Ya kamata a kira taimakon gaggawa.
Domin rashin isasshen ko isasshen kula da insulin, dalilai masu zuwa suna aiki:
- Marasa lafiya ba shi da masaniya game da cutar sa, bai je asibiti ba, don haka ba a gano cutar sankara ba a cikin lokaci.
- Inulin insulin na inganci ne ko kuma ya ƙare;
- Violationetare cin abincin, yin amfani da carbohydrates mai sauƙin narkewa, yawan kitse, barasa, ko matsananciyar yunwar.
- Sha'awar yin kisan kai.
Marasa lafiya ya kamata su sani cewa tare da nau'in ciwon sukari na 1, buƙatar insulin yana ƙaruwa a waɗannan halaye masu zuwa:
- yayin daukar ciki
- tare da concomitant cututtuka,
- a cikin lahanta rauni da kuma tiyata,
- tare da tsawancin gudanar da glucocorticoids ko diuretics,
- yayin aiki ta jiki, yanayin damuwa na damuwa.
A pathogenesis na ketoacidosis
Rashin insulin shine sakamakon karuwar samar da kwayoyin hodar Iblis - glucagon, cortisol, catecholamines, adrenocorticotropic da hormones na somatotropic. Ana hana glucose daga shiga hanta, zuwa cikin sel tsokoki da tsopose nama, matakin sa a cikin jini ya tashi, kuma yanayin hauhawar jini ya faru. Amma a lokaci guda, sel suna fuskantar yunwar makamashi. Sabili da haka, marasa lafiya da ciwon sukari suna fuskantar yanayin rauni, rashin ƙarfi.
Don kuma ta yadda za a sake mamaye yunwar makamashi, jiki yana fara wasu hanyoyin makamashi na maye gurbin - yana kunna lipolysis (bazuwar kitse), wanda ke haifar da samuwar kitse mai ƙoshin mai, unesterified fatty acid, triacylglycerides. Tare da rashin insulin, kashi 80% na kuzarin da jiki ke samu yayin hada-hadar kitse na kitse, yana tara abubuwan da suka lalata (acetone, acetoacetic da β-hydroxybutyric acid), wadanda suke yin abubuwan da ake kira jikin ketone. Wannan yana bayani game da nauyi asara na masu ciwon sukari. Yawan wucewar sassan ketone a cikin jiki yana ɗaukar ajiyar alkaline, a sakamakon abin da ketoacidosis ke haɓaka - cuta mai zurfi na rayuwa. Lokaci guda tare da ketoacidosis, metabolism na ruwa-electrolyte yana da damuwa.
Hyperosmolar (rashin ketoacidotic) coma
Hyperosmolar coma yana da haɗari ga marasa lafiya da ke fama da ciwon sukari na 2. Wannan nau'in coma a cikin ciwon sukari yana faruwa ne sakamakon karancin insulin, kuma ana saninsa da yawan zubar jiki, yawan hauhawar jini (haɓakar sodium, glucose da urea cikin jini).
Hyperosmolarity na jini plasma yana haifar da mummunan rauni na ayyukan jiki, asarar hankali, amma a cikin rashi na ketoacidosis, wanda aka bayyana shi ta hanyar samar da insulin ta hanyar ƙwayar cuta, wanda har yanzu bai isa ba don kawar da hyperglycemia.
Rashin ruwa daga jikin mutum, wanda yana daya daga cikin abinda ke haifar da cutar sankarar mahaifa, shine
- yawan wuce gona da iri na diuretics,
- zawo da amai na kowane ilimin etiology,
- rayuwa a cikin yankuna masu yanayin zafi, ko aiki a yanayin zafi;
- rashin ruwan sha.
Abubuwa masu zuwa suma suna shafar asalin ƙwayar cuta:
- Rashin insulin;
- Ingantaccen ƙwayar cutar insipidus;
- Zagi da abinci dauke da carbohydrates, ko manyan allurai na glucose injections;
- ko yanayin tsinkayen ciki, ko hemodialysis (hanyoyin da suka shafi tsabtace kodan ko peritoneum).
- Tsawo mai tsawan jini.
Haɓaka ƙwayar hyperosmolar yana da alamun gama gari tare da ketoacidotic coma. Yaya tsawon lokacin da precoatous ɗin ya kasance ya dogara da yanayin ƙwayar cuta, iyawarsa don samar da insulin.
Rashin daidaituwa a jiki da sakamakonsa
Cutar HyperlactacPs na faruwa ne sakamakon tarin lactic acid a cikin jini sakamakon karancin insulin. Wannan yana haifar da canji a cikin tsarin sinadaran jini da asarar hankali. Abubuwanda zasu biyo baya suna da ikon haifar da cutar mahaifa:
- Icientarancin isashshen oxygen a cikin jini sakamakon gazawar zuciya da gazawar numfashi wanda ya tashi a gaban kwayoyin cuta irin su asma, mashako, gazawar jijiyoyin jini, cututtukan zuciya;
- Cututtukan kumburi, cututtuka;
- Cutar koda ko na hanta;
- Haramcin shan giya;
Pathogenesis
Babban dalilin cutar hyperlactac cuta shine karancin iskar oxygen a cikin jini (hypoxia) akan asalin karancin insulin. Hypoxia yana motsa glycolysis anaerobic, wanda ke haifar da wuce haddi na lactic acid. Sakamakon rashin insulin, ayyukan enzyme wanda ke inganta sauyawar pyruvic acid zuwa acetyl coenzyme ya ragu. Sakamakon haka, an juya pyruvic acid zuwa lactic acid kuma ya tara cikin jini.
Saboda karancin iskar oxygen, hanta bata iya amfani da lactate mai yawa. Canza jini yana haifar da take hakkin kwanciyar hankali da kuma ƙwaƙwalwar ƙwayar zuciya, ƙuntata tasoshin yanki, sakamakon haifar da laima
Sakamakon, kuma a lokaci guda, alamun hyperlactac cuta coma sune raunin tsoka, angina pectoris, tashin zuciya, amai, amai, rashin haske.
Sanin wannan, zaku iya hana farkon kwayar cutar coma, wanda ke haɓakawa a cikin fewan kwanaki idan kun sanya haƙuri a asibiti.
Dukkanin nau'ikan da ke sama na com sune hyperglycemic, wato, haɓaka saboda hauhawar haɓakar sukari na jini. Amma aiwatar da juyawa zai yiwu kuma, idan matakin sukari ya faɗi ƙasa warwas, sannan cutar sikila za ta iya faruwa.
Hyma na jini
Cutar hypoglycemic a cikin ciwon sukari mellitus yana da tsari na baya, kuma zai iya haɓaka lokacin da aka rage adadin glucose a cikin jini sosai har zuwa rashin ƙarfi a cikin kwakwalwa.
Wannan yanayin yana faruwa a cikin waɗannan lambobin:
- Lokacin da aka sami yawan insulin na insulin ko rage magunguna na baka.
- Mai haƙuri bai ci abinci akan lokaci ba bayan ya ɗauki insulin, ko kuma abincin ya ƙaranci a cikin carbohydrates;
- Wani lokacin aikin adrenal, ƙwaƙƙwaran ƙwaƙƙwaran ƙwaƙwalwar hanta yana raguwa, sakamakon haka, ƙwayar insulin yana ƙaruwa.
- Bayan tsananin aiki na zahiri;
Orarancin wadatar glucose a cikin kwakwalwa yana haifar da hypoxia kuma, a sakamakon haka, lalata ƙwayoyin sunadarai na carbohydrates a cikin ƙwayoyin tsohuwar ƙwayar jijiya.
Alamar hauhawar jini:
- Feelingarin jin yunwar;
- rage aiki da hankali;
- wani canji a yanayi da halin da bai dace ba, wanda za a iya bayyana shi cikin matsanancin tashin hankali, ji na damuwa;
- girgiza hannu
- tachycardia;
- pallor
- Asedara yawan jini;
Tare da raguwar sukari na jini zuwa 3.33-2.77 mmol / L (50-60 mg%), sabon abu mai sauƙi mai laushi ya fara faruwa. A wannan yanayin, zaku iya taimaka wa mai haƙuri ta hanyar ba shi shan shayi mai ɗumi ko ruwa mai daɗi guda 4 na sukari. Madadin sukari, zaku iya sa cokali na zuma, jam.
Tare da matakin sukari na jini na 2.77-1.66 mmol / L, duk alamun alamun hawan jini suna lura. Idan akwai wani mutum kusa da mara lafiyar da zai iya bayar da allura, za a gabatar da glucose a cikin jini. Amma mara lafiya zai ci gaba da zuwa asibiti don neman magani.
Tare da raunin sukari na 1.66-1.38 mmol / L (25-30 mg%) da ƙananan, hankali yakan zama asara. Bukatar gaggawa kiran motar asibiti.
