DIABETES
Wanhanthok:
Diabetes (Diabetes Mellitus)
haibasi laiwong kayana punba hyperglycemia (glucose gi chang wangba) nattraga
insulin ga mari leinaba maramdagi thokhallakpa amadi matam sangna metabolism da
akaiba lakpa maramna Diabetes haiba laina asi thokhallak-i. Loinana Diabetes na
atoppa hakchanggi (khudam oina mit, kidney, singli-naori gi laina) tongan
tonganba kayatsingda laina kayasu thokhalli.
Diabetes thokhallakpagi achouba
maramsingdi chakchayuthak kaiba, hakchang sajel nattraga hakchang leng otpagi
chang watpa, charol surol da naba, amadi atoppa laina leibadagi oihallakpani.
Diabetes hairiba laina asina naba hourakpa matamda laina asigi laiwong uba
fangba nattraga fangdabasu yai.
Metabolisam:
Hakchang semgat sagatpa,
semjinba, fagathanba, panggal piba asinachingba kaya toubagi thabak chatthaba
asibu metabolism hairaga khangnei.
HOURAKFAM (ETIOLOGY, CAUSE,
ORIGIN):
Diabetes ki lainagi hourakfam
amadi makhalsing adudi – Diabetes hairiba laina asi eikhoi meeoibana chariba
thakliba, punsi khuhing asinachingba kayagasu yamna mari leinei. Loinana maru
oina toina thengnaba makhal ahumdi makhagi asini:
1. Type I Diabetes: IDDM (insulin-dependent
diabetes mellitus) or juvenile diabetes hairagasu khangnei. Tasengna lainasigi
hourakfamdi khangba ngamdri. Pancreas na insulin mapung fana puthokpa ngamdaba,
atoppa amana nouriba angang yoklakpa matamda san gi sanggomna yokpa loinana chahi
matang nouringeida machi oiba chinjak chaba thakpa watpa, wakhalgi potlum yamna
nanglakpa angang singgi tunggi punsidasu laina asina naraknabagi maram kharadi
adum lei haina thajanei. Laina asi naha oiribasingda maruoina chahi 35 gi makha
da leiba meesingda laina asi nai. Changchat oina chada 10% di T1DM laeina asi
uba fang-i. Laina laiwong ikhang khanghoudana thokkanba, athubada laiyengbagi
mityeng changsindrabadi aruba fivam da tagalli.
2. Type II Diabetes: Hakchanggi
Cells na insulin sijinnaba ngambagi chang hantharakpa, maramsidagi matam
sanglaklaba matungda insulin puthokpagi changsu hantharak-i. NIDDM (non
insulin-dependent diabetes mellitus) nattraga adultonset diabetes hairagasu
khangnei. Malemsida meeoi 27 million dagi henna Diabetes makhal asina nai
loinana nongma nongmagi ishing ichaogumna hengatlakli. Laina asina naba
hourakpa matam da khangba ngamhouba yai, khangba ngamhoudaba yai. Maru oina
T2DM asi chahi 35 gi mathakta leiba meesingda nagalli. Laina asina naraknabagi
yamna chaoba maram kharadi hakchang ka henna noiba, imung manung, mari-mata da
nabadagi charon-suronda lounahouba, thamoigi leina leiba, mirollingeida
Diabetes na nakhiba, chakcha yuthakta cheksindaba, hakchang sajel toudaba,
tumba chaba wakhal gi potlum yamna leiba, mayai kaba chinjak sijinnaba
asinachingba kayamarumga yamna mari leinei.
3. Gestational Diabetes:
Nupisingda thokkanba diabetes makhal amani. Maruoina mamang da sugar wangbagi
thoudok leikhidriba, mironlaba matungda ee da yaoba sugar gi chang henba,
angang unnaraba matungda chap chaba changda amuk hantharakkani.
4. Diabetes: Hanna atoppa
leinana nabadagi nattraga fivam kharadagi thokhallakpasing
a. Genetic defects: Maturity
onset diabetes of the young (MODY): Autosomal dominant inherited gi diabetes
makhal amani.
b. Atoppa congenital syndrome
(genetic syndrome) leibadagi nahallakpa; leina kharagi ming oina pallabada-
Down Syndrome, Klinefelter’s syndrome, Turner’s syndrome, Wolfram’s syndrome,
Myotonic dystrophy, Prader-Willi syndrome, Bardet-Bied asinachingba
c. Endocrinopathies: Acromegaly,
Cushing’s syndrome, Hyperthyroidism, Pheochromocytoma asinachingba.
d. Pancreas amadi Pancreases gi
cells singgi mathou kairaktuna amang-ata amasung asoiba leihallakpadagi diabetes
ki laina nahallakpa yao-i; khudam oina chronic pancreatitis, cystic fibrosis,
toxins na pancreatic beta cells da sokhanbadagi thorakpa diabetes.
e. Drugs: Glucocorticoids,
thiazides, phenytoin.
f. Infections: Cytomegalovirus
infection, coxsackie virus B, mumps, retroviruses.
Toina thengnaba laiwong kharadi
(Sign and symptoms):
* Hakchak yamna chokthaba,
* Mit masen marang uba,
* Ishing toina chatpa,
* Karigumba ama toubada pukning
changba ngambagi chang hanthaba,
* Unsa da ahongba lakpa,
* Kok chikpa,
* Aram khourangba chaning
thakningbagi chang hengatpa, asinachingbasing asi thengnagani.
* Sokpa-panba oisillakpa nattraga
fagatlakpada matam sangna changba.
TYPE 1 DIABETES amadi TYPE 2
DIABETES anigi khetnaba khara:
Autoantibodies: Meeoibagi
hakchang na puthokchaba laina-tinna ngakthokchanabani
Dibetes ketoacidosis: Ee da
ketone gi chang ka henna wangbani; athuba matamda layengbagi mityeng
changsindrabadi khudong thiningaini; karigumba ketoacidosis na naraklabadi
ishing ka henna chatpa, hakchanggi arumba hanthaba, yamna chokthaba, puk naba,
blood pressure low oiba, mit masen marangna uba, shor manam asinba (acetone) manam
namba, oning oning touba nattraga oba asinachingbasi uba fanggani.
Diagnosis : Diabetes na nare
haiba khangdoknabagi changyeng khara tougani.
*Fasting plasma glucose test:
- Yamdrabada pung 8-12 di
karigumba amatta charoi thakloidabani. (Chewing gum, smoke, exercise
hairibasing asisu yaona charoi touroidabani)
- Pung 24 gi manung da mayai kaba
chinjak sijinnaroidabani.
- Hidak chaba oirabadi chariba
hidaksing mangjounana Doctor da haigadabani.
- Chada thaktaba asi pung 14 dagi
helhalloidabani maramdi matam hendokkhrabadi karigumba matamdasu achumba chang
fangba ngamdaba thengnei.
*Oral glucose tolerance test
– Puk hanglingeida glucose test
toubada leigadaba changdagi henna wangna leiramlabadi Glucose 75g pijaraba
matung pung 2 gi matung da amuk hanna glucose test tougani y
*Random plasma glucose test
– Akaknaba matam naidana touba
makhal amadi.
Glucose amadi Insulin gi
samlakpa khara:
Glucose: Meeoibana sijinnaribaba
chinjak ta yaoba carbohydrates ta glucose asi fang-i. Carbohydrate asi yamna
maruoiba meeoibagi hakchang da panggal (energy/fuel) piba amani. Chasinkhiba
chinjak sing tumhanbagi thouwong chattharakpada carbohydrates asi icham chamba
sugar oina (glucose, galactose, amadi fructose) machet makai taduna Intestine
(maril) dagi chupsillaba matungda hakchanggi cells, tissues amadi organs na
sijinnei, atoppa kharana Liver amadi muscles singda tunggi sijinnabagi mathou
taraktrifaoba tungsinduna thammi. The Dietary Guidelines ki matung inna mee
amana nongmada 25-65% mathou tai haina lou-i. Carbohydrates maruoina makhal
ahum thokna khaidokpa yai.
Sugar
(athumba)
Fruits (hei-ra
sing)
Vegetables
(mana masing)
Milk
(shanggom)
Milk products
(shanggom na saba chinjaksing)
Starch
(chanang)
Vegetables
Grains (hawai
chengwai)
Cooked dry
beans and peas (akangba, thongdoklaba hawaising)
Fiber
(mashing)
Fruits
Vegetables
Whole grains
Cooked dry
beans and peas
Insulin haibasi glucose gi chang
nemhanba ngamba hormone makhal amani. Masina ee da yaoba glucose bu puduna
hakchanggi cells singda youhalli, loinana adipose tissue, muscles (smooth muscle
gi oinadi nakoinana IGF-1 gi maridagi thabak tou-i) amasung maruoina Liver da
tungsinduna thammi. Pancreas gi islets of Langerhans ta beta cells singna
insulin puthoktuna thadorak-i. Karigumba puthokliba insulin gi chang asina
thabak tourakpa matam da konnadraba nattraga hakchang gi cells na insulin gi
kannafam leihandraba nattraga insulin masada asoiba leiraba hairiba fivam sing
asida glucose fajana lousinnabagi thabak hakchang gi cells na hantharakani
loinana liver amadi muscles singdasu tungsinbagi chang wathallaklani. Maramsing
asidagi ee da glucose gi chang hengatlakkni amsung protein puthokpagi chang
hanthahallaklani. Asumna metabolism da akaiba kaya thoklakkani.
Diabetes mellitus na nare
hainabagi tangkak kharadi:
Fasting plasma glucose level ≥ 7.0
mmol/L (≥126 mg/dl)
Puk hanglingeida glucose test toubada
leigadaba changdagi henna wangna leiramlabadi Glucose 75g pijaraba matung pung
2 gi matung da amuk hanna glucose test tougani karigumba Plasma glucose ≥11.1
mmol/L (≥200 mg/dl) dagi henba.
Laiwong utthokba yai utthoktabasu
yai. Glycated hemoglobin (HbA1c) ≥48 mmol/mol (≥6.5 DCCT %)
Mathakki test sing asi anirak
hanna toubada hanjin hanjinna leigadaba changdagi hellabadi meeoi adu Diabetes
mellitus na nare haina lougani. Impaired fasting glycaemia amasung Impaired
glucose tolerance asi prediabetic states ni haina lougani. Tangkak asi Diabetes
mellitus naraknabagi yamna chaoba tangkak amani loinana Heart ki leina
kayamarum thoraknabagisu machak ama oihalli.
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