Saqriani diabeti bavSvebsa da mozardebSi

Saqriani diabeti bavSvebsa da mozardebSi

Saqriani diabeti
bavSvebsa da mozardebSi
# 38
2
Temas uZRveba:
ukavSireben ZuZuTi kvebis xangrZli-
marina gordelaZe
vobis Semcirebas, Zroxis rZis naadrev
Tbilisis saxelmwifo samedicino
gamoyenebas axalSobilTa kvebaSi, vi-
universitetis endokrinologiis
rusul infeqciebs, iseTebs rogoricaa
departamentis asistent-profesori
wiTura, ybayura, wiTela, enteroviru-
med.mec.doqtori
sebi da sxva.
ra daavadeba Saqriani
diabeti?
ra aris Saqriani diabetis
ganviTarebis mizezi bavSvTa
da mozardTa asakSi?
Saqriani diabeti (Sd) - es aris md-
amisi mizezi aris insulinis absolu-
gomareoba, romelic xasiaTdeba sisxl-
turi an SefardebiT deficiti, rome-
Si Saqris donis qronikuli momatebiT
lic ganpirobebulia kuWqveSa jirkvlis
(hiperglikemia). janmrTelobis dacvis
beta-ujredebis (aq gamomuSavdeba insu-
msoflio organizaciis mier rekomen-
lini) dazianebiT. es xdeba garkveuli
debul
genetikuri
klasifikaciaSi
gamoyofilia
winaswarganwyobis
fonze
daavadebis ramdenime tipi. Saqriani
garemo faqtorTa zemoqmedebiT. orga-
diabetiT daavadebulTa umravlesobas
nizmi sakuTar beta-ujredebs aRiqvams
aqvs diabeti tipi 1 da tipi 2.
rogorc ucxos da iwyebs mis winaaR-
diabeti tipi 1 - am formas insulin-
mdeg brZolas, autoantisxeulebis ga-
damokidebulsac uwodeben, radgan igi
momuSavebiT.
insulinis deficitiT mimdinareobs da
90%
rodesac beta-ujredTa
am dros, pacientis sicocxlis Sesanar-
bis manifestireba.
ganadgurebulia, xdeba daavade-
Cuneblad aucilebelia insulinis gamoyeneba. Sd tipi 1 ZiriTadad gvxvdeba
Saqriani diabeti bavSvebsa da mozardebSi
bavSvebSi, mozardebSi da axalgazrdebSi, romelTa asaki 35 welze naklebia.
rogoria sisxlSi Saqris done
normaSi da diabetis dros?
janmrTeli adamianis sisxlSi (kapilarul) Saqris done dRis ganmavlobaSi
rogoria Saqriani
gavrceleba?
diabetis
meryeobs Semdeg sazRvrebSi:
uzmoze (igulisxmeba dilis saaTebSi,
zogadad Sd-is gavrceleba mosaxle-
8-14 saaTi Ramis SimSilis Semdeg) 3.3-
obaSi 4-5%-ia, zog qveyanaSi 10%-s
5.5 mmol/l, Wamis Semdeg, rogorc wesi
aRemateba, maT Soris tipi 1 ufro
ar aRemateba 7.8 mmol/l-s. SeiZleba
naklebadaa gavrcelebuli da Seadgens
Segvxvdes sisxlSi Saqris donis sxva
0.4-0.5%-s. diabetiT avadoba izrdeba
maCvenebelic _ mg%. mogvyavs am ori ma-
mTels msoflioSi, gansakuTrebiT
Cveneblis gadaTvlis koeficienti:
5
wlamde asakis bavSvebSi, rasac xSirad
mmol/l * 18 = mg%
mag. 5.5 mmol/l * 18 =99 mg%
aWarbebs >10 mmol/l / 180 mg%-s igi
140 mg% : 18 = 7.8 mmol/l
Cndeba SardSi. organizms Saqris ga-
Saqriani diabetis diagnozi ismeva
mosadevnad sWirdeba didi raodeno-
im SemTxvevaSi Tu pacients aReniSne-
biT siTxe, romelsac igi iRebs Tavisi
ba minimum ori Semdgomi maCvenebeli:
ujredebidan, ase viTardeba organiz-
uzmoze Saqris done meti 6.1 mmol/l
mis gamoSroba, rac
(130mg%) da dRis nebismier dros meti
da wyurviliT vlindeba, Sreba kanic.
•
11.1 mmol/l-ze (200mg%).
sisuste,
sunarianobis
rogor gamomuSavdeba
insulini da ras emsaxureba igi
organizmSi?
adamians
Tavisi
cxovelmyofelo-
bisaTvis aucileblad sWirdeba ener-
piris simSraliT
moTenTiloba,
daqveiTeba
Sromi-
marTalia
Saqari didi raodenobiTaa sisxlSi,
magram insulinis ukmarisobis gamo igi
ver aRwevs ujredebSi da organizmi ganicdis energiis naklebobas.
•
wonis kleba gaZlierebuli madis
gia, romelsac igi iRebs glukozisgan.
fonze, radgan organizmi energiis wya-
glukoza organizmSi warmoiqmneba kuW-
rod ver iyenebs Saqars, eZebs alterna-
nawlavis traqtSi sakvebis gadamuSave-
tiul wyaros energiis misaRebad. iwyeba
biT, ris Semdegac gadadis sisxlSi da
cximebis, SemdgomSi ki cilebis daSla.
miewodeba milionobiT ujreds sxva-
siTxis dakargvasTan erTad es yvelafe-
dasxva qsovilSi (kunTovani, cximovani,
ri xels uwyobs wonaSi klebas. energiis
RviZlis da sxva). aq xdeba misi energiad
mudmivi deficitis gamo ki adamians
gardaqmna. swored insulinia is nivTie-
uZlierdeba SimSilis grZnoba.
reba, romelis meSveobiT
ujredebs
•
kanze Cirqovani gamonayris gaCe-
sisxlidan miewodeba glukoza.
na, Sexorcebis unaris daqveiTeba
ra klinikuri suraTi
axasiaTebs sisxlSi Saqris
donis matebas?
Tebs imunitets anu organizmis brZo-
sisxlSi Saqris donis mateba aqvei-
lis unars infeqciebis mimarT.
SeiZleba
sisxlSi Saqris donis momatebas axa-
Sardvis gaxSireba, maT Soris Ra-
miTac, Sardis raodenobis momateba
•
zemoTCamoTvlili
mxolod erTi an ramdenime simptomi
siaTebs Semdegi niSnebi:
•
yvela
niSani erTad ar Segvxvdes da pacients
aReniSnebodes.
gvinda
gansakuTrebiT
avRniSnoT,
piris
rom hiperglikemiis niSnebi adamians
simSrale sisxlSi Saqris normuli Se-
xSirad mxolod daavadebis sawyis sta-
mcvelobis dros SardSi Saqari ar
diaze awuxebs, SemdgomSi mkurnalobis
isazRvreba. rodesac glikemia
fonze bavSvebi da mozardebi Tavs mS-
gaZlierebuli
wyurvili,
gada-
Saqriani diabeti bavSvebsa da mozardebSi
3
4
venivrad grZnoben, maSinac ki rodesac
ZiriTadi kvebebis da Zilis win. am mo-
glikemiis done aRemateba 14-16 mmol/
Txovnis binis pirobebSi ganxorcieleba
l-sac ki, amaSia diabetis mTeli sivera-
SesaZlebelia Saqris sazomi avtomatu-
ge, radgan Tu droze ar iqna dawyebu-
ri xelsawyoebis (e.w. “glukometre-
li diabetis mkurnaloba, mdgomareoba
bis”) meSveobiT. garda amisa, arsebobs
SeiZleba mkveTrad gauaresdes da gar-
vizualuri
Tuldes diabeturi komiT.
saSualebas aZleven pacients binis pi-
test-Cxirebi,
romlebic
robebSi gaakontrolon SardSi Saqari
SeiZleba Tu ara Saqriani
diabetisgan gankurneba
da rogoria am daavadebis
ganviTarebis riski ojaxis
sxva wevrebisaTvis?
Saqriani diabeti
qronikuli daava-
rogoria dietoTerapiis
principebi Saqriani
daiabetis dros bavSvebsa da
mozardebSi?
debaa, romlisganac sruli gankurneba
tipi 1 Saqriani diabetis mkurnalo-
jerjerobiT SeuZlebelia. amave dros,
bis ZiriTad meTods warmoadgens Sena-
dReisaTvis arsebobs daavadebis mkur-
cvlebiTi insulinoTerapia, dietoTe-
nalobis da koreqciis efeqturi meTo-
rapia ki atarebs damxmare xasiaTs.
debi, romelTa gamoyenebis fonze ar
kvebis racioni bavSvebsa da mozar-
xdeba sicocxlis xangrZlivobis Semci-
debSi diabetis dros kaloriulobis
reba da cxovrebis xarisxis gauareseba.
da ZiriTadi sakvebi ingredientebis
Saqriani diabeti tipi 1-is mkurnalo-
(cila, cximi, naxSirwyali) mixedviT
bisTvis bavSvebsa da mozardebSi dRei-
praqtikulad Seesabameba jansaRi kve-
saTvis mTels msoflioSi mxolod insu-
bis racions.
cilebi da cximebi ar iwveven orga-
lini gamoiyeneba.
Saqriani diabeti bavSvebsa da mozardebSi
da ketosxeulebi (acetoni).
Tu Saqriani diabeti tipi 1-iT ava-
nizmSi Saqris mniSvnelovan matebas.
daa erT-erTi mSobeli an da-Zma, am
aseTi TvisebebiT xasiaTdebian naxSi-
tipis diabetis riski bavSvebisTvis ar
rwylebi. amitom bavSvebma da mozardeb-
aRemateba 5%-s. Tu orive mSobeli an
ma diabetiT cila da cximi unda miiRon
identuri tyupis calia avad diabetiT
im raodenobiT ramdenic sWirdeba maT
- riski izrdeba 30-50%-mde.
aradiabetian Tanatolebs. SezRudvebi
ki exeba, mxolod naxSirwylebs.
ra sixSiriT unda
vakontroloT Saqari sisxlSi?
dReisaTvis mTels msoflioSi miRebulia sakvebi produqtebis puris erTeule-
insulinoTera-
biT Sefaseba. produqtis im raodenobas,
pia gulisxmobs yoveldRiurad sisxl-
romelic Seicavs daaxloebiT 12 gram nax-
Si Saqris kontrols minimum 3-4 jer -
Sirwyals ewodeba 1 puris erTeuli.
intensificirebuli
amitom yvela is sakvebi produqti,
kvebidan aucileblad unda iqnes ga-
romelic Seicavs naxSirwylebs, SeiZle-
moricxuli tkbili sasmelebi - limo-
ba gamosaxul iqnas puris erTeulebis
naTi, wvenebi, kamfetebi da sxva. anu
meSveobiT, moviyvanT zogierT maTgans:
is produqtebi, romlebic Seicaven e.w.
magaliTad 1 puris erTeuls Seesa-
martiv Saqrebs. martivi Saqrebi momen-
bameba:
talurad iwveven sisxlSi Saqris donis
purfunTuSeulidan:
matebas.
•
25 gr TeTri puri
•
30 gr Wvavis puri
•
35 gr fenovani comi
Saqriani diabetis qronikuli
garTulebebi
xilidan:
diabetis xangrZlovobasTan erTad
•
100 gr vaSli
(gamovlenidan
•
100 gr bali
dad
•
100 gr qliavi
ze
•
130 gr gargari
da nervuli sistemis dazianeba, rac
•
130 grami greifruti
dakavSirebulia
5
wlis
Semdeg),
cu-
kontrolirebadi diabetis fonviTardeba Tvalebis, Tirkmelebis
mikroangiopaTiebis
rZis produqtebidan:
universalur meqanizmTan. diabeturi
•
ucximo rZe 250 ml _ 1 Wiqa
nefropaTia uviTardeba pacientTa 30-
•
mawoni 250 ml - 1 Wiqa
50%-s. diabeturi retinopaTia 10%-s.
•
iogurti 1% 250 ml - 1 Wiqa
diabetian pacientebSi sibrmave viTar-
marcvlovnebidan:
deba 25-jer ufro xSirad, vidre saer-
•
15 grami anu 2 sufris kovzi wiwi-
To populaciaSi. sisxlZarRvovan gar-
buras fafa
TulebaTa profilaqtikis safuZvels
15 grami anu 1.5 sufris kovzi
naxSirwylovani cvlis kargi kontroli
“herkulesi”
warmoadgens.
•
puris erTeulebze
saorientacio moTxovna asakis
mixedviT
asaki
1-3w
4-6w
7-10w
11—14w
(gogona)
11—14w
(biWi)
15-18w
(gogona)
15-18w
(biWi)
sauzme
2
3
4
5
5
5
5
me-2 sauzme
1.5
2
2
2
2
2
2
sadili
2
3
4
5
5
5
4
samxari
1
1
2
2
2
2
2
vaxSami
1.5
2
2
2
2
2
2
me-2 vaxSami
1.5
2
2
2
2
2
2
p.e saerTo raodenoba
10-11
12-13
15-16
18-20
16-17
19-21
18-20
Saqriani diabeti bavSvebsa da mozardebSi
5
6
Saqriani diabetis mwvave
garTulebebi
zodi kviris ganmavlobaSi normalur
movlenad iTvleba.
hipoglikemiis pirveli simptomebis
hipoglikemia
hipoglikemia ewodeba sisxlSi Saqris
ganviTarebisTanave aucilebelia naxSi-
donis swraf da mkveTr daqveiTebas
rwylebis dauyovnebliv miReba. rTuli
hipoglikemia SeiZleba
gamoiwvios in-
naxSirwylebis (puri, fafa, xili) miRe-
sulinis Warbma dozam, agreTve kvebis
bisas sisxlSi Saqari iweva mxolod 20-
gamotovebam, Zlierma da xangrZlivma
30 wuTis Semdeg. imisaTvis rom, sisxl-
fizikurma datvirTvam, daavadebebma,
Si Saqris donem saswrfod moimatos
romlebic mimdinareobs RebinebiT da
diabetinma pirma unda miiRos iseTi ti-
nawlavTa moqmedebis gaxSirebiT. mo-
pis e.w. martivi naxSirwylebi, romle-
zardebSi hipoglikemia SeiZleba ga-
bic amoRebulia misi kvebis racionidan
moiwvios alkoholis miRebam.
mag. Saqari, tkbili wvenebi, kamfeti da
hipoglikemias
axasiaTebs
Semdegi
romlebic sisxlSi Saqris dones
ramdenime wuTSi weven maRla. msubuqi
Tavbrusxveva,
anda
hipoglikemiis mosaxsnelad sakmarisia
e.w. ”Sinagani kankali”, sifermkrTale,
miviRoT 4-5 cali Saqris natexi anda
mxedvelobis gaoreba an gabundovneba,
tkbili wveni (200 ml). amitom yvela
mousvenroba, xasiaTobrivi cvlilebebi,
diabetianma Tan unda ataros Saqari,
SiSi,
romelic yvelaze mosaxerxebelia msu-
xelebis
kankali
gaxSirebuli guliscema, Zlieri
SimSilis SegrZneba. aseTi simptomebi
Saqriani diabeti bavSvebsa da mozardebSi
a.S.
niSnebi: mkveTri sisuste, oflianoba,
buqi hipoglikemiis mosaxsnelad
axasiaTebs hipoglikemiis msubuq for-
am dros sasurveli ar aris Sokola-
mas. Tu saswrafod ar moxda hipoglike-
dis miReba, radgan igi ar iZleva sisxl-
miis kupireba, igi SeiZleba msubuqi
Si Saqris donis iseT swraf matebas,
formidan gadaizardos mZime formaSi.
rogorc Saqari.
hipoglikemiis mZime formas axasiaTebs
mZime hipoglikemiis dros, diabetia-
moZraobis kordinaciis da metyvelebis
ni pacienti Tavad ver SeZlebs Tavisi
darRveva, krunCxva, gonebis dakargva.
mdgomareobis gakontrolebas. am dros
es mdgomareoba pacientis sicocxli-
aucilebelia samedicino Careva sisxl-
saTvis
warmoad-
Si glukozis Seyvana (intravenurad).
gens. msubuqi hipoglikemia, romelic
arsebobs aseve saojaxo pirobebSi mZime
droulad ixsneba ar tovebs aranair
hipoglikemiidan pacientis gamosayva-
uaryofiT kvals pacientis janmrTlo-
ni samkurnalo preparati glukagonis
baze. kompensirebuli diabetis drosac
saxiT, romelic keTdeba kunTebSi.
realur
safrTxes
ki hipoglikemiuri epizodebi gardauvalia. msubuqi hipoglikemiis 2-3 epi-
hiperglikemia
tonis gansazRvra. acetonis gaCena pa-
hiperglikemiis dros sisxlSi Saqris
cientisTvis saxifaTo mdgomareobaze
maCvenebeli mkveTradaa momatebulia.
miuTiTebs da dauyovnebliv unda mi-
pacients aqvs: Zlieri wyurvili, pi-
marToT eqims. aseTi situacia SeiZleba
ris simSrale, SimSilis grZnoba, xSiri
ganviTardes: insulinis dozis nakle-
Sardva. Tu sisxlSi Saqris done didi
bobis an ineqciis gamotovebis, kvebis
xnis manZilze rCeba maRali da am fon-
reJimis xSiri darRvevis (didi raode-
ze
Rebineba,
nobiT naxSirwylebis miReba), stresu-
zogadi sisuste, muclis tkivili. am
li situacis, TandarTuli daavadebis
SemTxvevaSi aucilebelia - SardSi ace-
(gripi, angina da sxv.) dros.
pacients uviTardeba
dausviT SekiTxva “Tqvens eqims” telefonis nomerze: 46 30 10
eleqtronul misamarTze: www.gpc.ge www.reda.ge
an “wiTeli A” - s afTiaqebSi moiTxoveT da
SeavseT specialuri kiTxvarebi
uyureT gadacemas
`Tqveni eqimi”, kviras 16:10 imedis arxze
Saqriani diabeti bavSvebsa da mozardebSi
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