Generalitati%0D%0ADiabetul+zaharat+este+o+afectiune+endocrina+caracterizata+prin+anomalii+metabolice%2C+in+special+ale+metabolismul+glucidic.+Diabetul+zaharat+apare+cand+pancreasul+secreta+cantitati+insuficiente+de+insulina+sau+cand+modul+in+care+organismul+utilizeaza+insulina+este+deficitar.+Insulina+este+hormonul+care+asigura+necesarul+energetic+celular%2C+prin+utilizarea+zaharului+%28glucozei%29+de+catre+celule.+Daca+secretia+de+insulina+este+deficitara+sau+in+cazul+in+care+exista+rezistenta+la+actiunea+acesteia+in+tesuturile+tinta%2C+nivelul+zaharului+din+sange+%28glicemia%29+este+mult+prea+mare%2C+iar+tesuturile+nu+mai+pot+utiliza+glucoza+pentru+producerea+de+energie.+Daca+nivelul+glicemiei+este+persistent+crescut+apar+complicatii+la+nivelul+ochilor%2C+inimii%2C+vaselor+de+sange%2C+nervilor+si+rinichilor.+Daca+glicemia+atinge+valori+foarte+mari+se+produce+un+dezechilibru+metabolic+sever+ce+caracterizeaza+cetoacidoza+diabetica+%28CAD%29.+%0D%0ADiabetul+zaharat+tip+1+apare+la+orice+varsta%2C+insa+predomina+la+copii+si+adulti+tineri%2C+motiv+pentru+care+este+numit+de+catre+unii+autori+diabet+juvenil.+De+asemenea%2C+un+termen+sinonim+folosit+adesea+pentru+diabetul+zaharat+tip+1+este+diabetul+zaharat+insulino-dependent+%28diabetul+zaharatid%29.+O+forma+de+diabetul+zaharat+tip+1+este+diabetul+latent+autoimun+al+adultului%2C+cu+debut+la+varsta+adulta%2C+adesea+confundat+cu+diabetul+zaharat+tip+2.+%0D%0ADiabetul+zaharat+tip+1+reprezinta+5%25-10%25+din+totalul+cazurilor+de+diabet.+Cea+mai+frecventa+forma+de+diabet+este+diabetul+zaharat+tip+2+%28diabet+insulino-independent%29%3B+alte+forme+de+diabet+zaharat+includ+diabetul+gestational+si+diabetul+secundar.+%0D%0A%0D%0A%0D%0APlanuirea+unei+sarcini+%0D%0A%0D%0A%0D%0AFemeile+care+au+diabet+zaharat+tip+1+si+care+raman+insarcinate+trebuie+sa+se+prezinte+la+medicul+curant+pentru+a+fi+sigure+ca+mentin+sub+control+valoarea+glicemiei.+Hiperglicemia+din+primul+trimestru+de+sarcina+determina+risc+crescut+de+defecte+fetale.+O+monitorizare+atenta+a+valorilor+glicemiei+in+timpul+sarcinii+reduce+riscul+de+aparitie+a+defectelor+fetale.+Nivelul+glicohemoglobinei+%28hemoglobina+A1c%29+trebuie+sa+creasca+cu+mai+putin+de+1%25+decat+nivelul+normal.+%0D%0AFemeile+diabetice+care+nu-si+doresc+copii+pot+folosi+metode+de+contraceptie+care+scad+riscul+unor+defecte+fetale+datorate+unor+sarcini+nedorite.%0D%0A%0D%0ACuprins+articol%0D%0A%0D%0AGeneralitati%0D%0ACauze%0D%0ASimptome%0D%0AMecanism+fiziopatogenetic%0D%0AFactori+de+risc%0D%0AConsultul+de+specialitate%0D%0AMedici+specialisti+recomandati%0D%0AInvestigatii%0D%0ADiagnostic+precoce%0D%0ATratament+medical%0D%0AProfilaxie%0D%0ATratament+ambulatoriu%0D%0ATratament+medicamentos%0D%0ATratament+chirurgical%0D%0AAlte+tratamente%0D%0ACauzeSus%0D%0ADiabetul+zaharat+tip+1+apare+ca+urmare+a+distrugerii+autoimune+a+celulelor+beta-pancreatice+care+secreta+insulina.+%0D%0AEreditatea+joaca+un+rol+important+in+patogenia+diabetul+zaharat+tip+1.+Totusi%2C+un+numar+mare+de+pacienti+cu+diabetul+zaharat+tip+1+nu+au+antecedente+familiale+de+diabet+insulino-dependent.+De+aceea%2C+specialistii+considera+ca+un+rol+important+in+etiologia+diabetului+il+au%2C+pe+langa+predispozitia+genetica%2C+anumiti+factori+de+mediu.+Unul+din+factorii+de+mediu+implicat+in+producerea+diabetul+zaharat%2C+este+de+obicei%2C+un+agent+infectios+cum+ar+fi+virusul+coxackie+b.+Relatia+intre+declansarea+diabetului+si+vaccinerea+impotriva+infectiei+cu+haemophilus+influenzae+tip+b+nu+a+fost+demonstrata+desi+s-a+formulat+aceasta+ipoteza.%0D%0A%0D%0ASimptomeSus%0D%0ASimptomele+diabetul+zaharat+tip+1+se+instaleaza+rapid%2C+in+cateva+zile+sau+saptamani+si+sunt+determinate+de+nivelul+crescut+al+glucozei+sanguine.+Simptomatologia+precoce+poate+trece+ignorata+de+catre+pacient%2C+mai+ales+daca+persoana+a+avut+de+curand+gripa.+Aceste+simptome+aparute+precoce+sunt+reprezentate+de%3A+%0D%0A-urinari+frecvente%2C+in+special+nocturne.+Unii+copii+mici+care+au+invatat+sa+folosesca+toaleta+incep+sa+aiba+enurezis+%28sa+urineze+in+pat+in+timpul+noptii%29+%0D%0A-sete+extrema+si+gura+uscata+%0D%0A-scadere+in+greutate+%0D%0A-apetit+crescut.+%0D%0AUneori+nivelul+glicemiei+poate+atinge+valori+foarte+mari+fara+ca+persoana+sa+sesizeze+ca+sufera+de+ceva.+Deoarece+insulina+este+inexistenta%2C+celulele+organismului+nu+mai+pot+utiliza+glucoza+pentru+obtinerea+de+energie.+Datorita+acestei+deficientei+absolute+de+insulina+organismul+utilizeaza+pentru+producerea+de+energie+catabolismul+protidic+si+lipidic.+Arderile+lipidelor+si+proteinelor+sunt+astfel+mult+crescute+producandu-se+in+exces+corpi+cetonici+ce+intra+in+circulatia+sanguina.+Se+produce+una+dintre+cele+mai+severe+complicatii+ale+diabetul+zaharat+tip+1%3A+cetoacidoza+diabetica+%28CAD%29+ale+carei+simptome+sunt%3A+%0D%0A-piele+uscata%2C+rosie%2C+calda+%0D%0A-scaderea+apetitului+alimentar%2C+dureri+abdominale%2C+stari+de+voma+%0D%0A-miros+puternic+caracteristic+al+respiratiei+de+acetona+%0D%0A-respiratie+rapida%2C+profunda+%0D%0A-agitatie%2C+toropeala%2C+confuzie%2C+coma.+Copiii+mici+isi+pierd+interesul+pentru+activitatile+cotidiene.%0D%0A%0D%0AMecanism+fiziopatogeneticSus%0D%0AAparitia+diabetul+zaharat+tip+1+este+determinata+de+distrugerea+autoimuna+a+celulelor+beta-pancreatice.+Rata+distrugerii+acestor+celule+secretoare+de+insulina+este+variabila%2C+astfel+la+copii%2C+boala+se+instaleaza+brusc+deoarece+celulele+beta+sunt+rapid+distruse%2C+in+timp+ce+la+adulti%2C+debutul+este+lent+pentru+ca+distrugerea+celulara+se+produce+progresiv.+%0D%0AUneori%2C+aparitia+simptomelor+de+diabet+urmeaza+unei+infectii+virale+%28virusul+gripal%29.+%0D%0ADaca+se+intarzie+prezentarea+la+medic%2C+datorita+distructiei+masive+a+celulelor+beta%2C+deficitul+absolut+de+insulina+produce+hiperglicemie+marcata%3B+organismul+utilizeaza+arderea+proteinelor+si+lipidelor+pentru+producerea+de+energie.+Apar+corpii+cetonici+si+acizii+grasi+in+exces+si+se+instaleaza+una+dintre+cele+mai+severe+complicatii+ale+diabetului+zaharat+tip+1+CAD%2C+care+necesita+interventie+de+urgenta.+%0D%0AIn+anumite+situatii%2C+se+observa+ca+pentru+o+scurta+perioada+-+cateva+saptamani+sau+luni+-+pancreasul+este+capabil+sa+secrete+insulina%2C+aceasta+perioada+poarta+numele+de+%22luna+de+miere%22+si+nu+este+necesara+administrarea+insulinei+sau+se+administreaza+doar+o+mica+cantitate+de+insulina%2C+in+functie+de+capacitatea+secretorie+a+pancreasului.+Dupa+incheierea+%22lunii+de+miere%22+este+obligatorie+administrarea+cronica+de+insulina.+%0D%0ACei+care+au+diabet+zaharat+tip+1+vor+urma+un+tratament+individualizat+care+cuprinde%3A+%0D%0A-administrarea+de+insulina+%0D%0A-dieta+adecvata+%0D%0A-program+de+exercitii+fizice+%0D%0A-monitorizarea+zilnica+a+glicemiei.+%0D%0AValorile+glicemiei+persoanelor+cu+diabet+insulino-dependent+sunt+de+cele+mai+multe+ori+in+afara+limitelor+normale+datorita+injectiilor+cu+insulina+care+pot+determina+rapid%2C+doar+in+cateva+minute%2C+scaderea+marcata+a+glicemiei+%28hipoglicemie%29%2C+ce+constituie+o+urgenta+medicala+redutabila.+Pe+de+alta+parte%2C+hiperglicemia%2C+se+dezvolta+lent%2C+in+decurs+de+ore+sau+zile.+Daca+hiperglicemia+persista+apare+CAD.+%0D%0AIn+timp%2C+apar+leziuni+ale+tesuturilor+si+organelor+determinate+de+hiperglicemia+persistenta+producandu-se+retinopatia+diabetica%2C+nefropatia+diabetica%2C+neuropatia+diabetica%2C+afectiuni+cardiace+%28infarcte+miocardice%29+si+vasculare+%28accidente+vasculare+cerebrale+si+obstructii+vasculare%2C+in+special+la+nivelul+membrelor+inferioare%29.+Daca+glicemia+este+mentinuta+in+limite+de+siguranta+se+poate+preveni+cel+putin+instalarea+acestor+complicatii+grave.+Desi%2C+unii+dezvolta+complicatii+chiar+cu+un+control+bun+al+glicemiei.%0D%0AComplianta+crescuta+a+pacientului+%28colaborarea+pacientului+cu+specialistul+si+urmarea+cu+sfintenie+a+tratamentului+prescris%29+ii+determina+pacientului+un+sentiment+de+securitate%2C+senzatia+ca-si+controleaza+boala+si+confera+o+stare+de+bine.%0D%0A%0D%0AFactori+de+riscSus%0D%0AFactorii+de+risc+pentru+diabetul+zaharat+tip+1+sunt+urmatorii%3A+%0D%0A-+istoric+familial+de+diabet+zaharat+tip+1+creste+riscul+de+a+avea+anticorpi+anti-celule+insulare+dar+nu+si+riscul+ca+acea+persoana+sa+faca+diabetul+zaharat+tip+1.+Doar+10-15%25+din+pacientii+cu+diabetul+zaharat+tip+1+au+istoric+familial%3A+%0D%0A-riscul+este+de+6%25+daca+tatal+are+diabet+insulino-dependent+%0D%0A-in+cazul+in+care+fratii%2Fsurorile+au+diabetul+zaharat+tip1+riscul+de+a+face+boala+este+de+5%25+%0D%0A-mama+cu+diabet+zaharat+tip+1%2C+riscul+ca+descendentii+sa+faca+diabet+este+de+2%25+%0D%0A-In+cazul+gemenilor+univitelini+riscul+este+de+30-50%25+%0D%0A-in+cazul+in+care+un+parinte+si+un+frate%2F+o+sora+au+diabet+insulino-dependent+riscul+este+de+30%25.+%0D%0ARasa+alba+prezinta+risc+crescut+pentru+diabetul+zaharat+tip+1+comparativ+cu+afro-americanii%2C+hispanicii%2C+asiaticii.+%0D%0APrezenta+anticorpilor+anti-celule+beta+in+sange+-+atat+istoricul+familiar+cat+si+prezenta+ac+anti-celule+beta+predispun+la+dezvoltarea+diabetul+zaharat+tip1.+%0D%0AInfectii+virale+in+timpul+copilariei+-+infectia+cu+enterovirusuri%2C+in+special+infectia+cu+coxackieB+creste+de+6+ori+riscul+de+diabet+zaharat+tip+1.+Totusi%2C+un+copil+care+avut+o+infectie+cu+coxackieB+nu+va+dezvolta+obligatoriu+boala.+%0D%0AConsumul+de+lapte+de+vaca+-+sugarii+intarcati+inainte+de+varsta+de+3+luni+sau+hraniti+cu+lapte+de+vaca+inaintea+varstei+de+4+luni+au+risc+semnificativ+mai+mare+de+a+face+diabet+zaharat+tip+1+daca+se+asociaza+cu+predispozitia+genetica+sau+cu+prezenta+altor+factori+de+risc.+Copii+care+au+frati+cu+diabet+si+care+beau+mai+mult+de+236%2C6+ml+de+lapte+pe+zi+prezinta+un+risc+de+4+ori+mai+mare+de+a+avea+anticorpi+anti-celule+beta+si+dea+face+astfel+diabet+insulino-dependent.+Specialistii+nu+cunosc+rolul+jucat+de+laptele+de+vaca+in+patogenia+diabetului+zaharat+tip+1.%0D%0A%0D%0AConsultul+de+specialitateSus%0D%0AReprezinta+o+urgenta+medicala%3A+%0D%0A-+o+persoana+care-si+pierde+starea+de+constienta%2C+iar+respiratia+are+miros+de+mere+verzi+%28acetona%29+-+cetoacidoza+diabetica.+%0D%0AConsult+de+specialitate%3A+%0D%0A-prezenta+simptomelor+de+sete+intense%2C+urinare+excesiva%2C+scaderea+in+greutate%2C+apetit+crescut+necesita+consult+medical+pentru+investigatii+paraclinice+%0D%0A-persoana+care+are+antecedente+familiale+de+diabet+insulino-dependent+si+doreste+sa+se+testeze+pentru+diabet+zaharat.%0D%0A%0D%0AMedici+specialisti+recomandatiSus%0D%0AReprezinta+o+urgenta+medicala%3A+%0D%0A-+o+persoana+care-si+pierde+starea+de+constienta%2C+iar+respiratia+are+miros+de+mere+verzi+%28acetona%29+-+cetoacidoza+diabetica.+%0D%0AConsult+de+specialitate%3A+%0D%0A-prezenta+simptomelor+de+sete+intense%2C+urinare+excesiva%2C+scaderea+in+greutate%2C+apetit+crescut+necesita+consult+medical+pentru+investigatii+paraclinice+%0D%0A-persoana+care+are+antecedente+familiale+de+diabet+insulino-dependent+si+doreste+sa+se+testeze+pentru+diabet+zaharat.+%0D%0AMedicii+specialisti+recomandati+sunt%3A%0D%0A%0D%0A-endocrinologul+%0D%0A-medicul+de+familie+%0D%0A-medicul+generalist+%0D%0A-internistul+%0D%0A-medicul+pediatru.%0D%0A%0D%0AInvestigatiiSus%0D%0AO+mare+parte+dintre+pacientii+cu+diabet+insulino-dependent+sunt+depistati+ca+sufera+de+aceasta+boala%2C+dupa+ce+sunt+internati+de+urgenta+pentru+cetoacidoza+diabetica+%28CAD%29.+Aceasta+urgenta+medicala+apare+atunci+cand+glucoza+nu+mai+poate+fi+utilizata+ca+sursa+de+energie+pentru+organism+fiind+catabolizate+in+schimb+proteinele+si+lipidele%2C+producandu-se+in+exces+corpi+cetonici+si+acizi+grasi.+CAD+apare+la+toti+pacientii+cu+diabet+zaharat+tip+1+%28si+in+anumite+cazuri+de+diabetul+zaharat+tip+2%29+cand+valorile+glicemiei+sunt+extrem+de+mari.+%0D%0APacientii+spitalizati+cu+CAD+trebuie+atent+monitorizati+din+punct+de+vedere+electrolitic+si+al+nivelului+glicemiei.+%0D%0ADaca+persoana+nu+este+in+CAD%2C+conform+asociatiei+americane+de+diabet+%28ADA%29+pentru+punerea+diagnosticului+de+diabet+zaharat+se+iau+in+consideratie+antecedentele+heredocolaterale+%28istoricul+familiar%29%2C+examenul+clinic+si+teste+care+pun+in+evidenta+valorile+mari+ale+glucozei+sanguine%3A+%0D%0A-masurarea+glicemiei%2C+de+obicei+pe+nemancate%2C+dar+poate+fi+recoltat+sange+la+orice+ora+daca+individul+nu+a+mancat+%0D%0A-test+oral+de+toleranta+la+glucoza+%28TTOG%29+-+se+bea+o+solutie+de+glucoza+si+se+masoara+nivelul+glicemiei+la+2+ore+de+la+ingestie.%0D%0A%0D%0AAlte+teste+care+ajuta+la+punerea+diagnosticului+de+diabetul+zaharat%0D%0A%0D%0AMasurarea+nivelului+de+hemoglobina+A1c%2C+a+hemoglobinei+glicozilate+%28glucohemoglobina%29+este+o+practica+obisnuita+in+cazulul+diabetului%3B+totusi%2C+ADA+nu+o+recomanda+ca+metoda+de+diagnostic.+Acest+test+este+recomandat+pentu+monitorizarea+tratamentului+la+pacientii+care+nu-si+determina+nivelul+glicemiei+frecvent+la+domiciliu.+Hemoglibina-A1c+este+determinata+la+2-3+luni+de+la+inceperea+tratamentului%3B+se+evalueaza+astfel+valoarea+glicemiei+dupa+instituirea+terapiei.+%0D%0AAtat+determinarea+ambulatorie+a+glicemiei+cat+si+depistarea+glucozei+urinare+nu+sunt+recomandate+pentru+screeningul+sau+pentru+diagnosticul+diabetului.%0D%0A%0D%0ADiagnostic+precoceSus%0D%0AScreeningul+este+recomandat+copiilor+sau+adultilor+ai+caror+parinti%2C+frati+sau+surori+au+fost+diagnosticati+cu+diabet+zaharat+tip+1.+Desi+determinarea+anticorpilor+anti-celule+beta-insulare+este+un+indicator+pentru+diabetul+zaharat+tip+1+nu+este+recomandata+ca+metoda+de+screening.+%0D%0APersoanele+la+care+s-au+depistat+acesti+anticorpi+trebuie+sa-si+dea+acordul+pentru+introducerea+intr-un+program+de+cercetare+si+sa+fie+disponibili+de+a+participa+la+astfel+de+studiu.%0D%0A%0D%0ATratament+medicalSus%0D%0ATratamentul+la+adulti%0D%0A%0D%0AToti+pacientii+cu+diabet+zaharat+tip+1+trebuie+tratati+cronic+%28toata+viata%29+cu+insulina+pentru+a+se+mentine+nivelul+glicemiei+cat+mai+aproape+de+valoarea+tinta.+Tratamentul+cu+insulina+presupune%3A+%0D%0A-injectii+zilnice+cu+insulina+sau+utilizarea+unei+pompe+de+insulina+%0D%0A-monitorizarea+nivelului+glicemiei+prin+testarea+ambulatorie+%0D%0A-mentinerea+unei+diete+sanatoase+in+care+carbohidratii+sa+fie+distribuiti+pe+parcursul+unei+zile+astfel+incat+sa+fie+evitate+cresterile+bruste+ale+glicemiei+imediat+dupa+mese+%0D%0A-program+regulat+de+exercitii+fizice%2C+deoarece+activitatea+fizica+creste+eficacitatea+insulinei+%0D%0A-control+medical+periodic+prin+care+se+monitorizeaza+si+se+ajusteaza+tratamentul.+Testele+de+screening+si+examinarea+periodica+sunt+obligatorii+si+sunt+efectuate+cu+scopul+de+a+preveni+instalarea+complicatiilor+cronice+ale+diabetului%3A+retinopatia%2C+nefropatia%2C+neuropatia%2C+afectiunile+cardiovasculare+%0D%0A-oprirea+fumatului+%0D%0A-limitarea+ingestiei+de+alcool%3B+consumul+de+alcool+creste+riscul+comei+hipoglicemice.+%0D%0AMulti+pacienti+sunt+depistati+cu+diabet+dupa+internarea+de+urgenta+pentru+cetoacidoza+diabetica+%28CAD%29.+Daca+simptomele+sunt+severe%2C+trebuie+transferati+intr-o+sectie+de+terapie+intensiva.+Tratamentul+CAD+necesita+administrarea+de+fluide+in+perfuzie+pentru+controlul+deshidratarii+si+echilibrare+electrolitica%2C+cat+si+insulina+intravenos+pentru+a+scadea+hiperglicemia+marcata+si+a+stopa+productia+in+exces+a+corpilor+cetonici.%0D%0A%0D%0ATratamentul+la+copii%0D%0A%0D%0ATratamentul+diabetului+zaharat+tip+1+la+copii+include+aceleasi+masuri+ca+la+adulti+cu+scopul+de+a+mentine+glicemia+in+limite+normale.+In+plus%2C+sunt+necesare+masuri+care+sa+permita+cresterea+si+dezvoltarea+in+parametri+normali.%0D%0A%0D%0AProfilaxieSus%0D%0AIn+prezent%2C+nu+exista+tratament+profilactic+al+diabetului+zaharat+tip+1%2C+totusi%2C+studiile+incearca+sa+gasrgical%0D%0AAlte+tratamente%0D%0+pacientii+cu+predispozitie+genetica+de+a+face+boala.+Cei+cu+antecedente+familiale+%28frati%2C+surori%2C+parinti%29+de+diabet+zaharat+insulino-dependent+si+care+doresc+sa+participe+la+studii+clinice+se+vor+adresa+medicului+specialist%2C+cerand+sa+fie+testati+pentru+anticorpii+anti-celule+beta%2C+deoarece+prezenta+acestora+in+ser+creste+riscul+de+aparitie+a+bolii.+%0D%0AStudiile+pe+animale+si+trialurile+clinice+efectuate+la+oameni%2C+au+arata+ca+insulina+in+doze+mici%2C+administrata+oral+sau+injectabil+poate+preveni+dezvoltarea+diabetul+zaharat+tip+1.+Insa%2C+un+studiu+efectuat+pe+un+lot+mai+mare%2C+a+demonstrat+ca+nu+este+prevenita+sau+intarziata+aparitia+diabetului+insulino-dependent.+Intr-un+alt+studiu%2C+in+care+insulina+a+fost+administrata+oral+s-a+observat+doar+ca+este+intarziat+debutul+bolii.+%0D%0AIntr-un+studiu+realizat+pe+copii+care+au+primit+suplimente+nutritive+de+vitamina+D+s-a+observat+ca+a+fost+redus+riscul+de+aparitie+a+diabetului.+Insa%2C+excesul+de+vitamina+D+poate+fi+daunator%2C+ca+urmare+nu+se+recomanda+administrarea+decat+in+cazul+deficientei+vitamina+D.+%0D%0AVaccinarea+nu+este+corelata+cu+cresterea+riscului+de+a+face+diabet%3B+deci+copii+cu+factori+de+risc+pentru+diabet+zaharat+tip+1+pot+fi+supusi+vaccinarii+obligatorii.%0D%0A%0D%0AProfilaxia+complicatiilor+diabetului%0D%0A%0D%0APersoanele+cu+diabet+zaharat+tip+1+pot+preveni+sau+intarzia+aparitia+complicatiilor+cronice+ale+acestuia%3A+%0D%0A-+nefropatia+diabetica%2C+retinopatia%2C+neuropatia+sau+afectiunile+cardiovasculare%2C+prin+mentinerea+glicemiei+in+limite+normale.+Acestia+vor+fi+supusi+unui+control+medical+periodic+pentru+a+putea+fi+depistate+precoce+semnele+si+simptomele+acestor+complicatii.+In+cazul+in+care+sunt+depistate+si+tratate+precoce%2C+leziunile+organice+produse+pot+fi+stopate%2C+evolutia+lor+poate+fi+incetinita+sau+chiar+aceste+leziuni+pot+fi+reversibile+%0D%0A-+afectiunile+cronice+ca+hipertensiunea+sau+hipercolesterolemia+trebuie+tratate+medicamentos.+Oprirea+fumatului+scade+riscul+aparitiei+acestor+complicatii+%0D%0A-+alte+probleme+de+sanatate+supraadaugate+pot+creste+riscul+dezvoltarii+complicatiilor+cronice.%0D%0A%0D%0AProfilaxia+gripei+si+a+infectiei+pneumococice%0D%0A%0D%0APersoanele+cu+diabet+insulino-dependent+vor+fi+supusi+vaccinarii+anuale+antigripale+si+antipneumococice+odata+la+5+ani.+Vaccinarea+antipneumococica+previne+imbolnavirea+determinata+de+pneumococ%2C+frecvent+intalnita+la+diabeticii+cu+afectiuni+cardiace+si+renale%2C+crescand+riscul+instalarii+complicatiilor%2C+al+spitalizarilor+si+a+mortalitatii+prin+infectii+gripale+si+pneumococice.%0D%0A%0D%0ATratament+ambulatoriuSus%0D%0ALa+diabeticii+insulino-dependenti+medicul+specialist+va+institui+o+dieta+echilibrata%2C+va+prescrie+un+tratament+individualizat+cu+insulina+si+un+program+regulat+de+exercitii+fizice+pentru+a+mentine+glicemia+la+un+nivel+de+siguranta.+%0D%0AIn+special+la+copii%2C+aceste+trei+modalitati+importante+de+reglare+a+glicemiei+vor+fi+adecvate+in+functie+de+activitatea+desfasurata.+%0D%0ATratamentul+zilnic+al+diabetului+cuprinde%3A+%0D%0A-injectii+repetate+cu+insulina+sau+folosirea+unei+pompe+de+insulina+%0D%0A-dieta+echilibrata+cu+repartizarea+carbohidratilor+pe+parcursul+unei+zile+%0D%0A-activitate+fizica+%0D%0A-glicemia+sa+fie+verificata+de+cateva+ori+pe+zi%2C+la+nevoie+si+in+timpul+noptii.%0D%0A%0D%0APasii+care+trebuie+urmati%0D%0A%0D%0APacientul+diabetic+trebuie%3A+%0D%0A-sa+poarte+o+bratara+de+identificare+medicala+prin+care+in+caz+de+urgenta+medicii+sa+afle+rapid+diagnosticul+de+diabet+%0D%0A-sa+stie+sa+intervina+rapid+atat+in+caz+de+hiper+cat+si+de+hipoglicemie+pentru+a+preveni+instalarea+complicatiilor+acute+amenintatoare+de+viata+%0D%0A-sa+stie+cum+sa-si+adapteze+dozele+de+insulina+in+cazul+in+care+se+imbolnavesc+sau+in+cazul+aparitiei+unei+sarcini+%0D%0A-sa+se+prezinte+la+control+medical+periodic+pentru+monitorizarea+bolii+si+a+tratamentului.%0D%0A%0D%0ATratament+medicamentosSus%0D%0AIn+cazul+diabetului+zaharat+tip+1%2C+insulino-dependent+datorat+deficitului+absolut+de+insulina%2C+tratamentul+medicamentos+este+reprezentat+de+administrarea+zilnica+de+insulina.+Aceasta+va+fi+administrata+in+injectii+subcutanate+fie+cu+ajutorul+unei+pompe+de+insulina.+%0D%0ADe+obicei%2C+se+asociaza+insulina+cu+actiune+lunga+administrata+odata+sau+de+2+ori+pe+zi+cu+insulina+cu+actiune+rapida+inainte+de+fiecare+masa.+Dozele+de+insulina+administrate+sunt+individualizate.+De+asemenea%2C+dozele+si+tipul+de+insulina+se+ajusteaza+in+timp%2C+in+functie+de+varsta%2C+constelatia+hormonala+%28ca+in+perioade+de+crestere+rapida+sau+in+timpul+sarcinii%29+sau+de+tipul+de+activitate+fizica+desfasurata.+In+perioadele+cu+stress+emotional+crescut+sau+in+timpul+unei+afectiuni+supraadaugate+dozele+de+insulina+trebuie+crescute.+%0D%0ADaca+apar+complicatii+ale+diabetului+%28ex%3A+nefropatia+diabetica%29%2C+trebuie+sa+se+adauge+medicamente+care+sa+se+adreseze+complicatiei+respective.+%0D%0ATratamentul+hipertensiunii+arteriale+sau+medicamentele+care+scad+valorile+colesterolului+ajuta+la+prevenirea+instalarii+complicatiilor+diabetului.+Dupa+varsta+de+30+ani%2C+se+recomanda+administrarea+unei+doze+mici+de+aspirina+utila+pentru+preventia+infarctului+miocardic%2C+a+accidentelor+vasculare+cerebrale+sau+ale+afectiunilor+vaselor+mari+de+sange.%0D%0A%0D%0ATratament+chirurgicalSus%0D%0ATratamentul+chirurgical+este+indicat+doar+in+situatii+exceptionale%3A+%0D%0A-transplantul+de+pancreas+care+poate+fi+realizat+in+acelasi+timp+cu+transplantul+renal+%0D%0A-transplant+de+insule+pancreatice+este+o+metoda+aflata+inca+in+cercetare.+%0D%0ATransplantul+de+pancreas+este+o+modalitate+terapeutica+foarte+scumpa.+Dupa+interventia+chirurgicala+este+recomandata+administrarea+cronica+%28pentru+tot+restul+vietii%29+a+medicatiei+imunosupresoare+pentru+a+preveni+reactia+de+rejet+a+organului+transplantat.%0D%0A%0D%0AAlte+tratamenteSus%0D%0ANu+exista+tratament+pentru+diabetul+zaharat+tip+1%21%0D%0ANu+sunt+recomandate+alte+abordari+terapeutice+pentru+pacientii+cu+diabet+insulino-dependent.+Unii+pacienti+sunt+tentati+sa+incerce+produse+sau+pilule+care+promit+vindecarea+miraculoasa%2C+insa+aceste+remedii+pot+fi+foarte+scumpe+si+daunatoare.+Aceste+tratamente+alternative+pot+intarzia+sau+inlocui+acele+metode+terapeutice+dovedite+a+fi+eficiente+in+tratamentul+diabetului+insulino-dependent.
0 comentarii:
Trimiteți un comentariu