Rarrabewa (nau'ikan) ciwon sukari

A karkashin sunan "ciwon sukari" yana ɓoye wasu cututtuka masu kama da yawa. Dalilan ci gaban su da dabarun magani na asali daban ne. Ingancin ingancin haƙuri a rayuwa ya dogara da ingantaccen ganewar asali, sabili da haka, an sake duba yanayin ciwon sukari akai-akai da rikitarwa. A cikin nau'ikan sanannun 1 da 2, yanzu an ƙara nau'ikan tsaka-tsaki na tsaka-tsaki guda biyu, don kowane ɗayan abin da aka ƙaddara mafi kyawun maganin.

Yanzu mutane sama da miliyan 400 suna fama da cutar sankara, don haka matsalolin rarrabuwa, bayyanar cututtuka na farko, da zaɓin mafi kyawun magani sun zama ɗayan manyan fifiko a cikin maganin duniya.

Mafi yawan nau'ikan cututtukan ciwon sukari

Daga cikin dukkan nau'ikan ciwon sukari, nau'in 1 ya ba da kusan kashi 7% na duk cututtukan da ke tattare da cutar. Dalilin karuwar sukari shine lalata sel beta wadanda suke cikin farji. Cutar ta ci gaba cikin hanzari, a ƙarshe, samar da insulin na haƙuri ya tsaya gaba ɗaya. Yawan sukari na jini yakan fara girma lokacin da kashi 20% na sel ba su ragu ba. Wannan nau'in ciwon sukari ana ɗaukarsa cuta ce ta matasa, saboda tana ƙaruwa sau da yawa a cikin yara da matasa a lokacin haɓaka da haɓaka. Sakamakon ƙarancin ƙwayar cutar, ana samun gado sosai. Marasa lafiya ba su da wata alama ta waje ta wacce mutum zai iya shakkar haɓakar kamuwa da ciwon sukari 1.

Yanzu akwai gwaje-gwaje na musamman waɗanda za ku iya gano tsinkayen kwayoyin halitta ga wannan nau'in ciwon sukari. Yana da alaƙa da wasu kwayoyin halittar tsarin HLA - antigens leukocyte na ɗan adam. Abin takaici, waɗannan gwaje-gwajen ba su sami amfani mai amfani ba, tun da ma sanin kasancewar kwayoyin halittu masu haɗari, masana kimiyya har yanzu ba za su iya hana lalacewar sel ba.

Nau'in cuta na 1 shine yawanci an kasu kashi biyu: autoimmune da idiopathic:

Ciwon sukari da hauhawar jini zai zama abin da ya wuce

• Normalization na sukari -95%
• Cirewa kan jijiyoyin mara wuya - 70%
• Cire zuciyar mai karfin zuciya -90%
• Rabu da cutar hawan jini - 92%
• Increasearuwar kuzarin rana, inganta bacci da dare -97%

1. Ciwon kansa tsokani rigakafin mutum. Yayin lalata cell da kusan watanni shida bayan kammala dakatar da aikin insulin, ana samun autoantibodies a cikin jini wanda yake yin gaba da sel jikinsu. A matsayinka na mai mulkin, rashin isasshen rigakafin yana haifar da abubuwan waje. A halin yanzu, an gano wasu daga cikinsu: ƙwayar ƙwayar cuta, ƙwayar cuta, wani ɓangaren enteroviruses, kamuwa da cuta na CMV, a cikin yara 'yan ƙasa da shekara ɗaya - madarar saniya.
2. Ciwon mara na Idiopathic mafi yawanci a cikin wakilan Asiya da Negroid jinsi. Hoto na asibiti a cikin marasa lafiya iri ɗaya ne: ƙwayoyin huhu kuma sun ruguje da sauri, sukari ya girma, insulin ya ragu, amma ba a iya gano ƙwayoyin rigakafi.

Yawancin masu ciwon sukari (bisa ga ƙididdigar da yawa daga 85 zuwa 95%), waɗanda aka gano tare da ciwon sukari na 2. Haɓaka cutar kuma ya dogara da gado, kuma yana da sauƙi a waƙa: yawancin marasa lafiya suna da dangi na kusa da masu ciwon sukari. Raunin da aka gada daga gado ana tsammanin shine ƙashin kyallen takarda don rasa hankalin insulin. Koyaya, takamaiman kwayoyin halittar dake da alhakin kamuwa da wannan nau'in ciwon sukari ba'a riga an kafa su ba.

Abubuwan waje suna da mahimmanci sosai: shekaru (yawanci sama da 40), kiba, motsi mara kyau, abinci mai daidaitawa. Gudanar da sukari a cikin nama yana da wuya. Kwayoyin cutar ta Pancreatic a karkashin irin wannan yanayi ana tilasta su su samar da insulin a wani matakin da koyaushe. Idan ba su yi nasara ba, glycemia yana ƙaruwa. A tsawon lokaci, samar da insulin ya fara zama ƙasa, sannan girman sautinsa ya zama ƙasa da ƙasa.

Yawan lalata kwayoyin sel a nau'in ciwon sukari 2 shine mutum: wasu marasa lafiya sun riga sun cika shekaru 10 daga baya sun tilasta musu yin allurar insulin, yayin da wasu ke samar da insulin nasu na tsawon rayuwarsu. A cikin rarrabuwar nau'in cuta ta 2, an nuna wannan yanayin: ciwon sukari mellitus tare da rinjaye na juriya na insulin ko tare da fifikon samar da insulin.

Rarrabawa da aka karɓa a Rasha

Tun 1999, likitancin Rasha ke yin amfani da rarrabuwa na duniya a duniya. Lambobi daga wannan rarrabuwa an lullube su ne a cikin bayanan likitanci, izinin mara lafiya, da aka yi amfani da shi a cikin bayanan lissafi, rahoton ƙididdiga. Yanzu nau'in goma na rarrabuwa yana aiki - ICD-10. Ya ƙunshi lambobi 6 don ciwon sukari:

1. An sanya E10 ga marasa lafiya da ke fama da ciwon sukari-na insulin, wato, waɗanda waɗanda, saboda dalilai na kiwon lafiya, ya kamata su allurar da insulin. A aikace, wannan rukuni ya hada da nau'in ciwon suga guda 1.
2. E11 shine lambar don cututtukan da ba su da insulin-insulin, watau, nau'ikan 2. Ko da mara lafiya yana da doguwar rashin lafiya, ƙarancin insulin ba shi da ƙima, kuma yana karɓar insulin ta hanyar allura, ba a canza lambar cutar ba.
3. E12 - ya kamata a sanya wannan rukunin don marasa lafiya waɗanda ke haifar da ciwon sukari mellitus sakamakon abinci mai narkewa. Haɗin tsakanin abinci mai gina jiki da ciwon sukari a halin yanzu yana cikin shakka, don haka wannan lambar ba ta amfani ba.
4. E13 - wasu nau'ikan cututtukan ciwon sukari, nau'ikan Mody masu wuya ana maganarsu zuwa lambar.
5. E14 - ciwon sukari, nau'in wanda ba'a bayyana shi ba. Ana amfani da lambar yayin da nau'in rashin lafiyar ke cikin shakka, kuma ya kamata a fara magani nan da nan.
6. O24 cuta ce da ke tasowa yayin daukar ciki (ciwon suga na cikin mahaifa). Ya kasance ga wani rukuni ne daban, tunda bayan haihuwa sukari yakan daidaita shi.

Disordersarancin cuta na rayuwa wanda har yanzu ba zai iya kasancewa yana ɗauke da ciwon sukari ba ana ɗauke shi azaman R73.

An fara amfani da wannan rarrabewar ciwon suga a cikin duniya a cikin 1994. Zuwa yau, an fi tsohon lokaci. Cutar ta bayyana sababbin nau'ikan, ƙarin hanyoyin bincike na zamani sun bayyana. Yanzu WHO na aiki akan sabon tsarin ICD-11, ana sa ran canzawar zuwa wurin shine a 2022. Wataƙila, za a sabunta tsarin lambar don ciwon sukari. Hakanan za'a cire kalmomin "insulin-dogara" da "insulin-mai zaman kansu" kuma za'a cire su.

WHO rarrabuwa

Tsarin da yafi dacewa yanzu shine bisa ga WHO 2017. An ƙirƙira shi a cikin 1999, bayan haka ana maimaita shi akai-akai.

A cikin wannan rarrabuwa, ba a kula da ciwon sukari azaman cuta daban ba, amma azaman ciwo. Ana daukar babban sukari a matsayin ɗayan bayyanar kowace cuta a cikin jiki, wanda ya haifar da cin zarafin samarwa ko aikin insulin. Abubuwan da suka haifar sun hada da aikin autoimmune, juriya na insulin, cututtukan cututtukan cututtukan fata, lahani na ƙwayoyin cuta.

Masana ilimin kimiyya sunyi imani da cewa rarrabuwa ta zamani zata canza fiye da sau ɗaya. Wataƙila, ana sauya hanyar zuwa nau'in ciwon sukari na 2. Za'a kula da ƙarin hankali ga waɗannan dalilai kamar kiba da salon rayuwa. Raba nau'in ciwon sukari na 1 shima zai canza. Ta hanyar da aka lissafta kwayoyin halittar dake da alhakin nau'ikan Mody 1-6, za a gano duk lahanin kwayoyin halittar da ke da alhakin cutar ta 1. Sakamakon haka, nau'in idiopathic na ciwon sukari zai shuɗe.

Sauran rarrabuwa

An rarraba nau'in ciwon sukari na 2 a cikin digiri gwargwadon ƙarfin cutar:

Rarrabuwa ta hanyar tsarin biyan diyya ana amfani dashi don kimanta nasarar magani. Hanya mafi dacewa don yin wannan ita ce amfani da gwajin haemoglobin (HG), wanda ya ba ku damar gano duk canje-canje a cikin sukari sama da watanni 3.

Muddin yana iya yiwuwa a ci gaba da kamuwa da cutar siga a cikin lokaci na rama, to da wuya a sami sabbin rikice-rikice da ci gaban wadanda ake dasu. Misali, tare da nau'in diyya 1, hadarin retinopathy ya ragu da kashi 65%, neuropathy da kashi 60%. An samo madaidaiciyar dangantaka tsakanin biyan diyya da rikitarwa a cikin 75% na masu ciwon sukari. Kimanin kashi 20% na masu saurin shan wahala ba sa samun rikice-rikice tare da kowane glycemia, likitoci sun danganta wannan ga halayen kwayoyin halitta. A cikin 5% na marasa lafiya, rikice-rikice na haɓaka ko da tare da raunin da ya kamu da cutar sankara.

Matsakaici

Tsakanin yanayin al'ada na carbohydrate metabolism da nau'in ciwon sukari na 2, akwai wani yanayi na tsaka-tsaki, wanda galibi ana kiran shi prediabetes. Cutar sankarau cuta ce mai saurin kamuwa da cuta wanda ba za a iya warkar da ita har abada ba. Cutar sukari cuta ce ta sakewa. Idan kun fara jiyya a wannan matakin, a cikin rabin lokuta, za a iya hana sukari kamuwa da cuta. Matsakaitan jihohin na WHO sun hada da:

1. Mai rauni (rage) haƙuri haƙuri. Ana gano NTG idan mai haƙuri yana shan hankali a hankali ta hanyar mai haƙuri maimakon ta lafiyar mutum. Binciken sarrafawa don wannan yanayin shine gwajin haƙuri haƙuri.
2. Azumtar glycemia. Tare da NGN, sukari da safe zai kasance sama da ƙimar al'ada, amma a ƙasa iyakar da ke ba ku damar nazarin ciwon sukari. Ana gano NTG ta amfani da jarabawar glucose na rana.

Wadannan rikice-rikice ba su da wata alama, ana yin gwajin ne kawai sakamakon sakamakon gwajin sukari. Ana bada shawarar gwaje-gwaje ga mutanen da ke cikin haɗarin kamuwa da cuta ta 2. Abubuwan haɗari sun haɗa da kiba, rashin gado, tsufa, hauhawar jini, ƙarancin motsa jiki, abinci mara daidaitacce tare da wuce haddi na carbohydrates da fitsari.

Sharuɗɗa don gano ciwon sukari

WHO ta ba da shawarar ka'idodi don gano ciwon sukari:

1. Alamar cututtuka na yau da kullun: saurin urination, ƙishirwa, cututtuka na yau da kullun, ketoacidosis + gwajin sukari ɗaya a saman iyakar ciwon sukari. Yankin yanzu an karɓa: sukari mai azumi yana saman 7; bayan cin abinci sama da 11.1 mmol / L
2. Kwayar cutar ba ta halarta, amma akwai bayanai daga gwaje-gwaje biyu sama da na al'ada, waɗanda aka ɗauka a lokuta daban-daban.

Ka'idojin lafiyar mutum shine sakamakon binciken zuwa 6.1 akan komai a ciki, zuwa 7.8 bayan cin abinci. Idan bayanan da aka samo ya wuce al'ada, amma a ƙasa iyakar ga masu ciwon sukari, ana gano mai haƙuri da cutar ta kansa. Idan sukari ya fara girma daga sati na biyu na ciki kuma yana cikin kewayon 6.1 zuwa 7 akan komai a ciki, sama da 10 bayan cin abinci, ana gano cutar sankarar mahaifa.

Don bambanta nau'ikan 1 da 2, an gabatar da ƙarin ma'auni:

A wasu halaye, waɗannan sharuɗan basu isa ba, kuma dole ne likitoci su ɗaura hankalin kwakwalwar su kafin yin ingantaccen ganewar asali kuma su tsara ingantaccen magani. Cutar sankarau sananne ne ta kowane lokaci yayin ci gaba. Wannan yanayin ya kasance sananne musamman a cikin shekaru 20 da suka gabata. Haka kuma, rarrabuwa da nau'in ciwon sukari ke dada zama da wahala.

A baya, an yi imani da shi ta atomatik cewa matasa na iya samun nau'in cuta guda 1, kuma manya bayan nau'in 40 - 2. Yanzu tsarin abin da ya faru ya canza sosai. Yawancin marasa lafiya da sukari mai yawa daga shekaru 20 zuwa 40 suna da alamun nau'in 2. Misali, a Amurka sama da shekaru 8 da suka gabata a wannan rukunin mutane sun fara gano nau'in cuta 2 a 21% fiye da sau da yawa. Akwai lamuran yin wannan binciken a cikin yara. Hanya ɗaya mai kama da halayyar duk ƙasashe masu tasowa, shine, akwai ingantaccen sabuntar kamuwa da cutar sukari.

Yara da matasa suna halin mafi saurin haɓakar ciwon sukari. A cikin manya, tsakanin farawa da NTG da ciwon sukari, matsakaicin shekaru 10 wuce, ga matasa kimanin 2.5. Haka kuma, 20% a fili suna da hade da nau'in ciwon sukari, tunda cutar ta haɗu da sannu a hankali, amma yana yiwuwa a gano ainihin cututtukan da ke cikin jini na 1.

Ciwon sukari "Tsarkin" nau'in 1, akasin haka, ya tsufa. A baya can, an saukar da shi har zuwa shekaru 35-40. Yanzu akwai maganganun cututtukan har zuwa shekaru 50. Irin wannan bayyananniyar alama kamar kiba baya sauƙaƙa nau'in ƙuduri. A baya can, ta wurin kasancewarsa ko rashinsa, ya yiwu a ƙayyade nau'in ciwon sukari tare da babban daidaito. Yanzu yawan kiba a cikin mutane ya fi yawa, saboda haka likitoci suna mai da hankali ne kawai game da rashin kiba: idan nauyin yayi daidai, ana kiran nau'in ciwon sukari na 2 a cikin tambaya.

Hankula rikice-rikice

Babban dalilin rikice-rikice shi ne hanyoyin glycation wanda ke faruwa a cikin kyallen takarda lokacin hulɗa tare da sukari mai hawan jini. Sunadarai suna daure cikin kwayar glucose; a sakamakon haka, sel basa iya yin ayyukansu. Ganuwar hanyoyin jini da ke hulɗa da kai tsaye tare da sukari sun fi saurin kamuwa da cuta. A wannan yanayin, mai ciwon sukari yana haɓaka angiopathies na matakai daban-daban.

Rashin damuwa a cikin manyan tasoshin tare da ciwon sukari na barazanar cututtukan zuciya. Microangiopathies yana haifar da keta cinikin jini zuwa kyallen da ke nesa daga zuciya, yawanci ƙafafun haƙuri suna wahala. Hakanan suna shafar yanayin kodan, wanda ke tace sukari daga jini kowane minti kuma yakan cire shi cikin fitsari.

Sakamakon glycation na haemoglobin, isar da iskar oxygen zuwa kyallen. A cikin manyan lokuta, har zuwa 20% na haemoglobin ya daina aiki. Yawan abinci mai narkewa a cikin nau'ikan sorbitol an sanya shi a cikin sel, saboda abin da ƙwayar osmotic ke canzawa a cikin su, kyallen takarda yana kumbura. Kasancewar sorbitol a cikin jijiyoyi, retina da ruwan tabarau suna da haɗari musamman.