Rao vat: DAI THAO DUONG - BENH TIEU DUONG va Phac do dieu tri.

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DAI THAO DUONG - BENH TIEU DUONG va Phac do dieu tri.

Tin rao DAI THAO DUONG - BENH TIEU DUONG va Phac do dieu tri duoc dang vao chu de Dich Vu Gia Dinh, khu vuc Ha Noi , the loai Chua xac dinh ngay 14/11/2009 boi Rao Vat. DAI THAO DUONG - BENH TIEU DUONG va Phac do dieu tri da co tat ca 278 luot xem.
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DAI THAO DUONG
- BENH TIEU DUONG va Phac do dieu tri
Nguyen nhan mac benh dai thao duong la do gen di truyen va moi truong song (hoat dong the luc,
che do dinh duong va stress). Benh dai thao duong dan toi nhung bien chung ve
tim mach, the chat. "Khong the phan theo giai doan benh ly, nhung benh dai
thao duong co bien chung cap tinh, nhieu benh nhan bi loet do bien chung benh
mach vanh, mach mau ngoai vi nen phai cat bo chan tay…"
Doi tuong mac benh dai thao duong
thuong o do tuoi tu 30-65, tuy nhien hien nay co nhung benh nhan dai thao duong
moi chi 9-10 tuoi, dieu nay phan anh su tre hoa ve benh nay o nuoc ta.
Tinh toan cua Hoi nguoi giao duc
benh dai thao duong Viet Nam cho thay: Ty le nguoi mac benh dai thao duong nam
2002 chiem 2,7%, den 2008 da tang len 5,7% dan so. Ty le nguoi mac benh dai
thao duong o cac thanh pho lon chiem ty le 7,2% dan so.
Benh dai thao duong, con goi
la Benh tieu duong, la mot benh do roi loan chuyen hoa cacbohydrat khi hooc mon insulin cua tuy bi thieu hay giam tac dong trong co the,
bieu hien bang muc duong trong mau luon cao;
trong giai doan moi phat thuong lam benh nhan di tieu nhieu, tieu ban dem va do
do lam khat nuoc. Benh tieu duong la mot trong nhung nguyen nhan chinh cua
nhieu benh hiem ngheo, dien hinh la benh tim mach vanh, tai bien mach mau nao, mu mat, suy than, liet duong, hoai thu, v.v.
Loai 1 (Typ 1)
Khoang 5-10% tong so benh nhan Benh tieu duong thuoc
loai 1, phan lon xay ra o tre em va nguoi tre tuoi <30T. Cac trieu chung
thuong khoi phat dot ngot va tien trien nhanh neu khong dieu tri. Giai doan
toan phat co tinh trang thieu insulin tuyet doi gay tang duong huyet va nhiem
Ceton.
Nhung trieu chung dien hinh cua Benh tieu duong loai
1 la tieu nhieu, uong nhieu, doi khi an nhieu, mo mat, di cam va sut can, tre
em cham phat trien va de bi nhiem trung.
Loai 2 (Typ 2)
Benh tieu duong loai 2 chiem khoang 90-95% trong tong
so benh nhan benh tieu duong, thuong gap o lua tuoi tren 40, nhung gan day xuat
hien ngay cang nhieu o lua tuoi 30, tham chi ca lua tuoi thanh thieu nien. Benh
nhan thuong it co trieu chung va thuong chi duoc phat hien boi cac trieu chung
cua bien chung, hoac chi duoc phat hien tinh co khi di xet nghiem mau truoc khi
mo hoac khi co bien chung nhu nhoi mau co tim, tai bien mach mau nao; khi bi nhiem trung da keo dai;
benh nhan nu hay bi ngua vung do nhiem
nam am ho; benh nhan nam bi liet duong.
Xet nghiem
Chan doan DTD bang dinh luong duong mau huyet tuong:
DTD: duong mau luc doi ≥126mg/dl (≥7 mmol/l) thu it
nhat 2 lan lien tiep.
Duong mau sau an hoac bat ky ≥200mg/dl (≥11,1mmo;/l).
Nguoi co muc duong mau luc doi tu 5,6-6,9 mmol/l duoc
goi la nhung nguoi co ‘roi loan dung nap duong khi doi’. Nhung nguoi nay tuy
chua duoc xep vao nhom benh nhan DTD, nhung cung khong duoc coi la ‘binh thuong’
vi theo thoi gian, rat nhieu nguoi nguoi ‘roi loan dung nap duong khi doi’ se
tien trien thanh DTD thuc su neu khong co loi song tot. Mat khac, nguoi ta cung
ghi nhan rang nhung nguoi co ‘roi loan dung nap duong khi doi’ bi gia tang kha
nang mac cac benh ve tim mach, dot qui hon nhung nguoi co muc duong mau
<5,5mmol/l.
Doi khi cac bac sy muon chan doan som benh DTD hon
nua bang cach cho uong duong glucose lam boc lo nhung truong hop DTD nhe ma thu
mau theo cach thong thuong khong du tin cay de chan doan. Cach do goi la ‘test
dung nap glucose bang duong uong’.
Test nay duoc thuc hien nhu sau:
Dieu kien: an 3 ngay lien du luong carbonhydrat
(>200g/ngay), khong dung thuoc lam tang duong mau, duong mau luc doi binh
thuong, khong bi stress.
Thuc hien: nhin doi 12 gio, uong 75 gam duong glucose
trong 250ml nuoc (khong nong - khong lanh). Dinh luong duong mau sau 2 gio.
Doc ket qua: ‘Test dung nap glucose duong uong’:
Neu duong mau 2 gio sau uong duong glucose
≥11,1mmol/l: chan doan DTD; neu duong mau 2 gio sau uong duong glucose ≥7,8
mmol/l nhung < 11,1 mmol/l: nhung nguoi nay duoc xep loai giam dung nap
duong glucose. Nguoi mac giam dung nap duong glucose khong nhung co nguy co cao
tien trien thanh DTD sau nay, ma con tang nguy co mac cac benh tim-mach nhu
tang huyet ap, nhoi mau co tim, tai bien mach mau nao.
Dinh luong duong nieu: chi co gia tri rat han huu
trong viec theo doi doi voi ban than benh nhan ngoai tru. Khong dung de chan
doan benh.
Cac xet nghiem bo sung: sau khi duoc chan doan xac
dinh va lam nhung xet nghiem theo doi thuong ky (1-2lan/nam) de tham do cac
bien chung man tinh va de theo doi dieu tri:
Kham lam sang: luu y kiem tra can nang, huyet ap, bat
mach ngoai bien va so sanh nhiet do da, kham ban chan, kham than kinh bao gom
tham do cam giac sau bang am thoa. Kham mat: phat hien va danh gia tien trien
benh ly vong mac.
Xet nghiem: dac biet luu y creatinin, mo mau,
microalbumin nieu (binh thuong < 30 mg/ngay) hoac dinh luong protein nieu.
Do dien tim nham phat hien som cac bieu hien thieu mau co tim. Soi day mat..
Dinh luong HbA1 hoac HbA1c: danh gia hoi cuu tinh
trang duong mau 2-3 thang gan day. Duong mau can bang tot neu HbA1c < 6,5%.
Trong mot so tinh huong (khong phai la xet nghiem
thuong qui):
Fructosamin: cho biet duong mau trung binh 2 tuan gan
day, co nhieu loi ich trong truong hop nguoi mac DTD dang mang thai. Neu duong
mau can bang tot, ket qua < 285 mmol/l.
Peptid C (mot phan cua pro-insulin): cho phep danh
gia chuc nang te bao beta tuy.
Dieu tri :Ket hop 02 loai thuoc la Kinotakara cua
Nhat va K-Biogreen cua My
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