Khi dtfdc phat hien m&c benh dai thao dtfdng, ngtfdi benh thtfdng co dau hieu tam than buon chan.
Nhieu ngtfdi cl vao trang thai soc hoac tram cam.
Nhieu nghien ctfu cl tre bi m ic benh dai thao dtfdng cho thay tinh trang roi loan tam than cl benh nhi va cha me cac chau chi trd lai binh thtfdng sau 1 nam.
Nhtfng trtfdng hdp keo dai tren 1 nam buoc phai co bien phap can thiep.
* Cac yeu to nguyen nhan gay roi loan tam than luc chan doan:
- Lo lang ve tinh hinh benh tat hien tai.
- Cam thay nhtf bi toi loi va/ hoac ttfc gian khi biet bi dai thao dtfdng.
- Cam thay bat tai, bat ltfc trtfdc benh tat (lo khong co kha nang quan ly, dieu tri benh).
- Lo sd ve cac bien chtfng trong ttfdng lai va chet sdm.
216 ♦
- Mat muc dich song, khat vong song do benh tat.
- Lo ling ve ttfdng lai khong dtfdc dam bao chac chan.
- Thtfa nhan stf thay doi phtfdng thtfc song la vinh vien do hau qua cua benh dai thao dtfdng.
* De tien hanh dieu tri co hieu qua, can lam mot so viec:
- Thao luan vdi ngtfdi benh va gia dinh ho (bo", me hoac vd, chong) ve ke hoach giao due va dieu tri cho ngtfdi benh dai thao dtfdng.
- Thanh lap cac doi cong tac de quan ly benh trong do vait ro cua ngtfdi thay thuoc chuyen khoa la rat quan trong. Ho phai la ngtfdi dieu hoa cac chuyen nganh khac nhtf dinh dtfdng, tam than, dieu dtfdng...
- Dat van de giao due la muc dich chinh cho ngtfdi benh dai thao dtfdng de ngtfdi benh phai ttf hoc hoi, ttf xac dinh, tim ra cho minh mot htfdng di thich hdp.
- Phai chu y toan dien den giao due che do an, loai bo thdi quen co hai (nhtf uong rtfdu, hut thuoc la, cac roi loan ve an, uong...) theo chien ltfdc dtfdi day:
Cf con g sd
- Tao dieu kien thuan tien cho cong viec dtfdc giao.
- Thdi gian lam viec cang uyen chuyen cang tot.
- Thtfdng co ngtfdi nhac nhd cong viec.
- Cd ke hoach lam viec cang chi tiet, ti mi cang tot.
D oi quan ly benh ddi th ao diidng
- Co moi lien he chat che gitfa ngtfdi benh va doi quan ly benh dai thao dtfdng.
- Tim hieu nhtfng dieu ngtfdi benh hy vong.
- Thao luan vdi ngtfdi benh ve nhtfng dieu ho nen hy vong.
- Trang bi cho ngtfdi benh nhtfng kien thtfc cd ban dac biet.
- Tranh dung nhieu thuat ngtf chuyen mon.
- Khich le ngtfdi benh noi ra nhtfng quan diem cua ho, de ho dat ra nhtfng cau hoi.
- Khich le ngtfdi benh tap trung phoi hdp hanh dong v6i thay thuoc.
Che do sinh h oat vd lam viec• • •
- Loi cuon ngtfdi benh va gia dinh ho vao ke hoach hanh dong.
- De ngtfdi benh thao luan can nh&c cung thay thuoc khi lap ke hoach va xac dinh muc dich dieu tri va che do dieu tri.
- Giam gia va han che den mtfc thap nhat cac phtfc tap khi co the lam dtfdc (gia thanh thap, ddn gian nhat ve che do an, luyen tap va thuoc).
- Thich tfng che do nay cho ngtfdi benh va gia dinh ho ve cac mat: loi song, van hoa, tai chinh.
Chien liicfc g ia o due
- Phd bien cac kien thiic ve dai thao diidng va thiidng xuyen bo sung kien thiic mdi, ky thuat mdi.
- Nen viet cac tai lieu ro rang, de hieu.
Chien liicfc ve hanh vi doi xit
- Khuyen khich ngtfdi benh hdp tac vdi thay thuoc va ttf theo ddi quan ly benh tat cua minh.
- Thiet lap muc tieu quan ly dtfdng mau cho doi ttfdng.
- Khuyen khich gia dinh va cong dong tham gia thay doi hanh vi cua ngtfdi benh, giup ngtfdi benh ttf phan dau dat den muc dich dieu tri.
- Htfdng dan ngtfdi benh biet sii dung cac phtfdng tien theo ddi dtfdng mau, biet cach ghi chep nhtfng thong sd" cd lien quan den van de dtfdng mau.
Cac bien chiing cua ddi thao dudng co roi loan tam than
* Cac bien chiing xay ra tiic thdi:
- Tinh trang nhiem toan ceton.
- Ha dtfdng mau nang.
* Cac bien chiing keo ddi:
Giong nhtf ngtfdi bi dai thao dtfdng khac, cac bien chtfng cd the la benh ly ve mat, than hoac than kinh;
cd dieu stf can thiep kho khan hdn do tinh trang tam than khong on dinh cua ngtfdi benh, ddi hoi thav thuoc va gia dinh ngUdi benh ton nhieu cong stfc hdn.
Stress vd ddi th ao ditdng
Ngiidi ta chtfa ro moi lien he giiia cac stress va stf xuat hien benh. Nhiing cac stress co tac dung trtfc tiep len ngtfdi benh thi da dtfdc thtfa nhan, vi du cac stress lam giam kha nang theo doi benh, stress lam ngtfdi benh chan ddi, an uong that thtfdng, tham chi tang uong rtfdu de giai sau... Nhtfng hanh vi nay khong chi lam tinh trang quan ly dtfdng mau kem di, ma con lam tram trong them cac bien chtfng khac neu co.
M U C LUC
Ltii tiCa...5
Dinh nghia ... 7
Phan lo a i... 7
Ddi thao dieting (DTD) typ 1...7
Ddi thao dieting typ 1 vo can...8
Ddi thao dieting typ 2 ...11
Cac loai ddi thao dieting khac...16
Ddi thao dieting khi co th a i...18
Mot so yeu to nguy cd anh hudng den
kha nang m ac benh DTD 21
Ngudi mdc benh DTD co nen sinh con? 25
Phdng ngiea vd p h a t hien sdm benh D T D...29
Trieu chung benh D T D...35
Chan doan benh D T D...36
Dieu tri benh DTD 41
Che do an dieu tri benh D T D...41
Mot so mau thUc ddn cho ngietii DTD...58
www.daithaoduong.vn ♦ 221
Van dong the liic... 73
Thuoc uong dieu tri benh DTD...83
Thuoc lam cham hdp thu diidng...83
Nhom Biguanide...83
Sulfamide ha diicfng huyet ...86
Thuoc kich thich tiet insulin khong phai sulfamid 88
Nhom thiazolidinediones (glitazone)...89
Byetta - mot loai thuoc mdi dieu tri
benh ddi thao diidng typ 2...90
Dieu tri bien chung benh D T D...93
Bien chiing man tinh ...93
Benh vong mac do DTD...93
Due thuy tinh th e...95
Tang nhan dp...97
Ton thiiefng day than kinh vd cd m a t...97
Benh than DTD ...98
Benh than kinh D TD...104
Benh ly ban chan DTD ...107
Roi loan cUdng dudng d ngudi D T D...109
Tang huyet dp vd DTD ...113
Bien chiing cap tinh ...126
Ha diidng huyet d benh nhan D T D...126
Hdn me tang diidng huyet...131
Insulin trong dieu tri benh D T D...136
Khdi niem chung...136
Ai can dtfdc dieu tri bang insulin...137
Nguon goc cac loai insulin dtfdc sti dung
trong dieu tri D TD...141
Cac cach tiem insulin ...150
Ky thuat tiem insulin ...154
Nguyen tac cd ban dediiu chinh lieu insulin...165
Bao quan insulin...166
Tii do dieting mau vd ttf kiem soat benh...171
Quan ly DTD thai nghen (PGS.TS Ta Van Binh) . .178
Hoi chtfng chuyen hoa (PGS.TS Ta Van Binh) ... .196
Nhtfng van de cd ban ve rdi loan chuyen hoa lipid (PGS.TS Ta Van Binh) ...208
Van de benh ly tam than d ngtfdi DTD (PGS.TS Ta Van Binh) ...216
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Phong
va dieu tri benh dai thao fluting
C H IU T R A C H N H IE M X U A T B A N : Giam doc: DS. Hoang Trong Quang
B IE N T A P :
BS. Nguyen Huy Cirong
SLTA B A N IN:
BS. Nguyen Huy Cixong
T R IN H B A Y B iA : Starbooks
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