DIABETI QANDi

DIABETI QANDi (Diabetes mellitus), kasalii qand, qandpeshobi, bemorii gadudhoi dokhili, ki hangomi on az sababi dar organizm narasidani gormoni gadudi zeri meda – insulin mubodilai moddaho khalal meyobad. Tibqi malumoti omorii Tashkiloti Umumijahonii Tandurusti miqdori bemoroni giriftori D. q. dar tamomi kurai zamin 159 mln. nafarro tashkil medihad. In nishondod dar bayni kudakon ba 15 mln. naf. rasidaast.
Dar jumhurii mo taqr. 0,2 – 0, 3% aholi ba in bemori giriftor ast. Binobar in, D. q.-ro muammoi asr niz menomand, zero on badi bemorihoi dilu ragho va saraton dar joi seyum meistad. Har 10 – 15 sol miqdori in bemori du marotiba ziyod meshavad. Az in lihoz dar bisyor mamlakatho, az jumla dar Tojikiston D. q. nafaqat mushkiloti tib, balki mushkiloti ijtimoi niz gashtaast.
D. q. navi I (insulini: hujayrahoi makhsus onro kam hosil mekunand) va navi II (gayriinsulini: dar surati sust shudani faoliyati insulin, afzudani tajziyai on, ziyod gashtani talaboti boftaho ba insulin va g. rukh menamoyad) meshavad.
Dar paydoishi D. q. irsiyat mavqei muhim dorad. Purkhuri, hamchunin az had ziyod istemol kardani angishtobi zudhazm niz boisi inkishofi D. q. meshavad. Qandi khun angezandai asosii hujayrahoe meboshad, ki insulinro sintez mekunand. Doimi baland budani miqdori qandi khun (dar asnoi purkhuri) boisi sust shudani faoliyati hujayrahoi mazkur megardad. Bazan illathoi gunoguni gadudi zeri meda (nig. Pankreatit) niz metavonand sababi D. q. shavand. D. q. badi holathoi sakhti asabivu ruhi va bemorihoi siroyati niz inkishof meyobad. Binobar norasoii insulin jigar va mushakho qobiliyati ba glikogen tabdil dodani qandro az dast medihand. Az in sabab boftaho qandro tajziya (oksid) namekunand va onro hamchun manbai energiya istifoda namebarand. Dar natija miqdori qand dar tarkibi khun afzuda (giperglikemiya), ikhroji on tavassuti peshob ziyod meshavad (glikozuriya). Bemoron zud-zud tashna memonand, bisyor peshob (dar yak shaboruz to 6 l va ziyodtar) mekunand. Vazni khosi peshob az sababi qand doshtan ziyod ast. Marizon az khorishi pust (khususan pusti atrofi maqad) aziyat mekashand. YAke az alomathoi khosi D. q. paydoishi bemorihoi rimnoki pust ast; faoliyati uzvhoi tanosul niz khalal meyobad. Dar natijai tabobati nodurust ahvoli bemor vaznin shuda, az sababi illat yoftani asabhoi kanori dardi dastu poy avj megirad. Ikhtiloli bosira (binobar tagyiroti khunraghoi shabakiyai chashm) va osebi boftahoi gurda orizahoi noguvoru vaznini D. q. meboshand. D. q. ba inkishofi ateroskleroz musoidat mekunad.
Dar surati purra tabobat nakardani bemori ikhtiloli mubodilai moddaho avj girifta, dar khun mahsuli ravgani oksidnashuda, yane payvasthoi ketoni jam meshavand (onho boisi zahroludii organizm megardand). Bemor tadrijan kamishtiho va bemador gashta, mudom tashna memonad, pustu luobpardaho khushk va miqdori peshob ziyod meshavad, azoi badan mekhorad. Ehtimol dilbehuzuri va qay niz rukh namoyand; az dahon bui atseton meoyad. Beholiyu khoboludi ba behushi mubaddal gashta, oqibat orizai vaznintarini D. q. – koma (igmo)-i diabeti sar mezanad. Dar surati bad shudani ahvoli bemor boyad hatman ba dukhtur murojiat kard. Dukhtur bemorro zeri nazorati doimi girifta, tabobat mekunad. Ashkhosi ba tozagi bemorshudaro baroi muoinai mufassal va intikhobi tarzi tabobat dar bemorkhona mekhobonand. Parhez, tazriqi insulin va doruhoe, ki miqdori qandro kam mekunand, vositahoi asosii tabobat meboshand. Maqsadi muolija mutadil gardondani jarayoni mubodilai moddaho dar organizm, kam kardani miqdori qandi khun va peshob ast.
Dar asnoi intikhobi vositai muolija dukhtur navi bemori, vazninii jarayon va bodi noguvori onro ba nazar megirad. CHunonchi, zimni D. q.-i irsi, ki ba on aksar javonon giriftor meshavand, organizm insulinro mutlaqo kam hosil mekunad. Dar chunin holatho bo maqsadi jubroni norasoii on ba organizm insulin mefiristand. Hangomi D. q. odamoni solkhurdai farbeh baroi purra kardani miqdori insulini organizm boyad parhez va az doruhoi qandfaror istifoda namoyand.
Parhezi bemoroni diabeti qandi. Dar vaqti tabobati hama navhoi D. q. parhez zarur ast. Parhez hangomi D. q.-i navi I va II az hamdigar ba kulli farq mekunad. Hangomi tavsiyai parhez ba bemoroni D. q.-i navi I ba kaloriyai gizo diqqat medihand (yane istemoli qarib tamomi gizoho ravo ast). Ba bemoroni D. q.-i navi II, ki bisyor vaqt onho odamoni farbeh meboshand, gizohoi kamkaloriya tavsiya karda meshavad. Bemor boyad dark kunad, ki kadom gizo va bo kadom surat miqdori qandi khunro baland menamoyad.
Tarkibi gizo az safeda, charbho, karbogidratho, moddahoi minerali va vitaminho iborat ast.
Safedaho hamchun masolehi sokhtmon baroi bunyodi hujayrahoi organizm khizmat mekunand. Onho az aminokislotaho iborat meboshand. Safedahoi gizo ba organizm vorid gashta, baroi tahiyai hujayrahoi mushak, pust, uzvhoi dokhili, khun va g. istifoda meshavand. Safedahoi hayvoni khususan dar tarkibi tukhm, mavodi shiri, gusht, mohi bisyorand. Safedahoi naboti dar tarkibi rastanihoi lubiyoi, nask, nakhud, mosh, juvorimakka va zanburugho vujud dorand.
CHarbho (lipidho) ba jism neru mebakhshand, onho manbai gormonho va vitaminho meboshand. 1 g charb 9 kkal neru dorad. Gizohoi doroi charbui hayvoni ba 4 guruh judo meshavand: gizohoe, ki charbi ayon dorand (ravgan, margarin, charbu); gizohoe, ki charbi noayon dorand (gusht, mohi, mahsuloti shiri); gizohoe, ki ravgani nabotii ayon dorand (ravgani pakhta, oftobparast, juvorimakka, zaytun va g.); gizohoe, ki ravgani nabotii noayon dorand (donai oftobparast, chormagz, bodom, pista). Baroi bemoroni D. q. khosa istemoli ravgani rastani mufid ast (kholesterini kam dorad).
Karbogidratho sarchashmai neru meboshand (1 g qand 4 kkal neru dorad). Onho ba chand guruh judo meshavand: oddi (monosakharidho va disakharidho), mas., glyukoza, fruktoza, sakharoza, laktoza va maltoza; murakkab (polisakharidho), mas., krakhmal, glikogen va kletchatka. Glyukoza dar tarkibi angur, sharbati angur va asal vujud dorad. Fruktoza dar tarkibi seb, aflesun, shaftolu, tarbuz, inchunin mevahoi khushk, sharbatho, asal va nushokiho mavjud ast. Sakharoza dar shakli kholis hamchun qand (shakar) va dar tarkibi mahsuloti qannodi, ord, sharbatho va murabbohoi gunogun joy dorad. Krakhmal ba gayr az holati kholis, hamchunin dar tarkibi mahsuloti ordi, makaroni va kartoshka mavjud ast. Glikogen dar jigar hosil meshavad. Kletchatka dar hujayrahoi rastani, mahsuloti gallagi, mevaho va sabzavot duchor meoyad.
Baroi bemoroni D. q. mavodi khurokiro ba se qism taqsim mekunand: 1) gizohoe, ki onhoro metavon tanovul namud, vale qabl az in onhoro baroi nazorati miqdor ba vohidi non (VN) bargardondan lozim ast; 2) gizohoe, ki ba vohidi non gardondani onho shart nest (muvofiqi khohish metavon tanovul namud); 3) gizohoe, ki dar mavridi zarurat istemol meshavand (mas., dar holati past shudani miqdori qandi khun).
Vohidi non baroi arzyobii miqdori karbogidratho istifoda meshavad; yak VN ba 12 g qand yo 25 g non barobar ast.
Ba guruhi shiriniho qand, asal, sharbathoi gunogun, murabbo, kompot, mahsuloti qannodi (tort, kulchaqand, pecheni, yakhmos, hamai namudi konfetho), angur, kharbuza va g. dokhil meshavand. SHiriniho qandi khunro zud baland mekunand. Binobar in istemoli onho baroi bemoroni D. q. zarar dorad.
Ba mavodi ordi va yarma dar navbati avval noni siyoh mansub ast. Zero noni safed zud hazm shuda, qandi khunro baland mekunad. Agar bukhankai noni siyoh taqr. ba gafsii 1 sm burida va ba du hissa taqsim karda shavad, taqr. 25 g-ro tashkil medihad. Hamin burida 1 VN ast. Ba in guruh yarmahoi marjumak, birinj, gandum, jav dokhil meshavand, ki istemoli onho baroi bemoron ravost.
Meva az jumlai gizohoi mamul buda, qandi on tez jabbida meshavad. Agar mevaro muvofiqi VN hisob bikunem, pas istemoli on joiz ast. Hangomi D. q. istemoli angur, anjir, kharbuza, banan, ananas, khurmo, maviz va guling khele mahdud karda meshavad. Bemoron boyad ba qadri zaruri seb, nok, sitrusiho, tarbuz, zardolu, shaftolu, olu, anor, olubolu, gelos, qulfinay, qot, zirk, angat istemol namoyand. SHarbati mevahoro faqat baroi bartaraf sokhtani gipoglikemiya istifoda mebarand.
Karbogidratho khususan dar tarkibi kartoshka bisyor meboshand. Baroi hamin, miqdori onhoro ba VN gardonida, sipas istemol kardan lozim ast. YAk dona kartoshkai andozaash miyona ba 1 VN barobar meboshad. Ba bemoroni D. q. istemoli tamomi namudhoi karam, sabzi, shalgam, shalgamcha, pomidor, bodiring, kadu, boimjon, lablabu, piyozi kabud va bekhpiyoz, toron, kabudi (shibit, gashnij), zanburugho va g. joiz ast.
Mahsuloti shiri (shir, sarshir, jurgot va g.) niz az rui VN hisob karda meshavad (1 istakon=1 VN). Qaymoq, tvorog, ravgani maska va panir miqdori qandro ziyod namekunand.
Mahsuloti gushti va mohi dar holati biryon yo dampaz qandro baland namesozand. Ba hasib va hasibchaho krakhmal, ba qimmakabob nonu kartoshka, ba tukhmbiryon (omlet) ord hamroh karda meshavad. Binobar in az istemoli onho boyad khuddori kard.

Miqdori mavode, ki ba 1 VN barobar ast
(istemoli hamin miqdori mavod ba bemoron ravost)

SHiriniho
SHakar 1 qoshuq
Qand 2,5 pora (12 g)
Asal 1 qoshuq
Kvas 1 istakon (200 ml)
Limonad ¾ istakon (70 ml)
SHarbati seb kamtar az 1/3 istakon (70 ml)
SHarbati angur ½ istakon (100 ml)

Mavodi ordi, yarma va mahsuloti gushti bo ilovai non va krakhmal

Non, kulcha 1 burida (12 g)
Krakhmal 1 qoshuq
Ord 1 qoshuq
Hamiri nopukhtai varaqi 35 g
Sambusai gushti 25 g
Noni khushk 20 g
Pechenii parhezi 3 dona
Noni qoqi kufta 1 qoshuq (15 g)
CHalpaki tunuk (blini) 1 donai kalon
CHalpaki gafs (aladi) 1 donai miyona
Tushberai mevagi 2 dona
Tushberai gushti 4 dona
YArma (az gallai dilkhoh) 2 qoshuq
Oshi burida, oshi tuppa (makaronho) 1,5 qoshuq
Gushti qimma (kotletho) 1 donai miyona
Hasibi obpaz, hasibcha 150 – 200 g

Mevayu buttameva

Seb 1 donai miyona (100 g)
Nok 1 donai miyona (90 g)
Banan ½ dona (90 g)
Aflesun 1 donai miyona (170 g)
Mandarin 3 donai mayda (170 g)
Tarbuz 400 g bo pustash
Harbuza 300 g bo pustash
Zardolu 3 donai miyona (110 g)
Olu 4 donai miyona (100 g)
Olui surkh 3 donai miyona (80 g)
Ananas 90 g bo pustash
Anor 1 donai kalon (200 g)
Hurmo 1 donai miyona (80 g)
Mango 80 g
Kivi 150 g
Olucha, gelos 15 donai kalon (100 g)
Guling, olui khushk, maviz 20 g
Buttamevaho (qulfinay,
tuti zamini, marminjon,
qot, tamashk) 1 piyola (150 g)

Sabzavot

Kartoshka 1 donai miyona
Kuftai kartoshkagi 1,5 qoshuq
Kartoshkabiryon 2 qoshuq (12 buridacha)
Kartoshkabiryoni khushk (chipsi) 25 g
Lubiyo 5 qoshuq
Juvorimakka ½ sarak
Mushung 110 g (7 qoshuq)
Sabzavoti digar (karam, lablabu,
sabzi, turb, shalgam, shalgamcha, pomidor,
bodiring, kadu, piyoz, chukri, kabudi) Ba hisob girifta nameshavad
Soya, ravgani rastani Ba hisob girifta nameshavad
CHormagz, donai oftobparast (magzi
vaznash na kam az 59 g) Ba hisob girifta nameshavad

Mavodi shiri

SHir, jurgot, sarshiri ravgannokiash gunogun 1 istakon
Kulchai paniri 1 donai miyona
YAkhmos 65 g

Nushokiho

SHarbati aflesun ½ istakon (100 g)
Pivoi parhezi 1 istakon (200 g)
Qahva, choyi be qand Ba hisob girifta nameshavad

Hurok boyad vitaminhoi S va guruhi V doshta boshad. Taomro ruze 4 – 5 marotiba khurdan lozim; ba nahori 25%, ba nahorii 2-yum 10%, ba khuroki nisfiruzi 35%, ba khuroki begoh 10% va ba khuroki shom 20%-i kaloriyai shaboruzii khurok boyad rost oyad. Sanoati khurokvori baroi bemoroni giriftori D. q. parhezonai makhsus istehsol mekunad, ki angishtobi zudhazm nadorad (mas., non, hasib va konfethoi diabetie, ki az ksilit yo sorbit tayyor mekunand). Insulin vositai asosii tabobati D. q. (gayr az jarayoni sabuki on) ast. Tasiri preparathoi insulin az 6 – 8 soat to 30 – 36 soat davom mekunad. Navi insulin va voyai onro dukhtur muqarrar menamoyad. Baroi tabobati D. q. boyad khudi bemor faol boshad; bemor yo yagon kheshi nazdiki u az kormandi tib usuli tazriqi insulinro meomuzad. Mavridi suzandoru kardan, qoidahoi antiseptika va aseptika boyad rioya shavand. Insulinro 10 – 20 daq. pesh az taom tazriq mekunand. Davomot va muhlati tasiri insulinro ba nazar girifta, nizomi istemoli taomro tartib medihand. Tanho dukhtur tarzi tabobati tainshuda va voyai insulinro metavonad tagyir dihad. Mariz boyad parhez va rejimi tainkardai dukhturro rioya karda, ba muoinai laboratori hozir shavad.
Mavridi tazriqi insulin (khususan hangomi vayron kardani tartibi gizo) mumkin ast, ki miqdori qandi khun az had kam shuda, gipoglikemiya sar zanad. Dar chunin holat bemor nokhost behol va sakht gurusna shuda, araq mekunad, dilash mezanad; dar u alomati tars va bazan dardi sar, larzishi badan, tahayyuj ba vujud meoyad. Dar in hol bemor boyad 3 – 5-dona qand khurad yo qandchoy nushad. In tadbir inkishofi igmoi gipoglikemiyaviro peshgiri mekunad. SHakhsi giriftori D. q., ki insulin (khususan insulini tasirash tuloni) qabul mekunad, boyad doimo hamroh qand girifta gardad. Bemor boyad dar kissa khatchae doshta boshad, ki dar on oid ba bemori va miqdori qabuli insulin malumot dihad; in ba kormandoni tib baroi sari vaqt va durust yori rasonidan kumak menamoyad. Dar asnoi ba amal omadani gipoglikemiya bemor boyad hatman baroi aniq kardani tarzi tabobat ba dukhtur murojiat kunad. Baroi muolijai D. q. doruhoero niz istifoda mebarand, ki onho ba hosil shudan va tasiri insulin taqviyat mebakhshand. CHunin doruhoro zeri mushohidai doimii dukhtur va nazorati laboratori kor mefarmoyand. Dar baze mavridho jarayoni bemori va paydo shudani bodi noguvor talab mekunad, ki tarzi tabobatro tagyir dihand, yane ba bemor muvaqqati yo doimi bar ivazi tabletka (qurs) insulin firistand. Hamai bemoroni giriftori D. q.-ro az rui joi istiqomat zeri nazorati tibbi megirand. Ba bemoron doruhoi zaruriro bepul medihand. Dar holati sabuk budani bemori bo tavsiyai dukhtur tabobati kurortiyu sanatori, varzishi shifoi, obbozi, piyodagardi, lijatozi muvofiqi maqsad ast.
Diabeti qandi dar kudakon. Insulin baroi sabzishi kudak ahamiyati nihoyat kalon dorad. Binobar in dar davrai inkishofi kudakon dar 4 – 6 va 8 – 12-solagi, hamchunin dar davrai inkishofi jinsii onho, ki organizm ba gizo talaboti beshtar dorad, D. q. bisyor ba mushohida merasad. Sababi D. q. dar kudakon niz gunogun meboshad, mas., sakht tarsidan, lat khurdani mayna va shikam, amrozi siroyati, farbehi va g. D. q. dar kudakoni navzod niz ba vujud meoyad. Kudaki bemor pistoni modarro harisona memakad, hol on ki toraft kharobu logar meshavad; u noorom buda, zud-zud peshob mekunad, parpechash badi khushk shudan, misli ohari (krakhmalkhurda) ast. Dar kudakon, odatan, D. q.-i navi I (insulini) ba nazar merasad. Binobar in onho boyad ruze 3 marotiba insulin qabul kunand (bo suzandoru). Muallimon boyad vazi kudaki bemorro donand va ba khurok khurdani u (hatto dar vaqti dars) mone nashavand.
Baroi peshgirii D. q. az purkhuri va suiistemoli shirini khuddori karda, vazni muqarrarii badanro nigoh doshtan, gazaki rohhoi talkha va gadudi zeri medaro sarivaqt tabobat kardan lozim ast. Dar mavridi tamoyuli irsi ba D. q. doshtan, bo maqsadi sari vaqt oshkor sokhtani alomathoi avvalini ikhtiloli mubodila va rafi on nazorati doimii tibbi zarur ast. Hangomi paydoishi D. q. orizahoi noguvori on boyad peshgiri karda shavand. Baroi peshgirii amrozi rimnok bemoron boyad pustro toza nigoh doshta, onro az zakhmi khurd, kharoshidan, zarb khurdan ehtiyot kunand, chunki mavridi D. q. har guna osebi pust metavonad ba reshi bedarmon tabdil yobad. Nigohubini dahon khele muhim ast, sole du marotiba az nazorati dukhturi dandon guzashtan lozim. Hamroh shudani har guna bemorihoi digar, kori vaznini jismoni va iztirobi asabiyu ruhi jarayoni bemoriro vaznin megardonand.

SH.S. Anvarova.