Neuropathie Ya Diabete

Neuropathie ya diabete ni ubwoko bw'ubwangavu bw'imijyana bushobora kubaho ufite diabete. Isukari nyinshi mu maraso (glucose) ishobora gukomeretsa imijyana mu mubiri wose. Neuropathie ya diabete ikunda kwangiza imijyana yo mu maguru no mu birenge.

Bitewe n'imijyana ikozweho, ibimenyetso bya neuropathie ya diabete birimo ububabare n'ubusinzane mu maguru, mu birenge no mu ntoki. Bishobora kandi guteza ibibazo mu gipimo cy'igogorwa, mu nzira y'umusemburo, mu mitsi y'amaraso no mu mutima. Bamwe bagira ibimenyetso bito. Ariko kuri abandi, neuropathie ya diabete ishobora kuba ibabaza cyane kandi igahagarara.

Neuropathie ya diabete ni ikibazo gikomeye cya diabete gishobora kugera kuri 50% by'abantu barwaye diabete. Ariko ushobora kenshi gukumira neuropathie ya diabete cyangwa kugabanya umuvuduko wayo ukoresheje imicungire ihamye y'isukari mu maraso n'imibereho myiza.

Hari ubwoko bune nyamukuru bwa diyabete neuropathy. Ushobora kugira ubwoko bumwe cyangwa ubundi burenze bumwe bwa neuropathy.

Ibimenyetso byawe biterwa n'ubwoko ufite n'imitsi ikabirijwe. Ubusanzwe, ibimenyetso bigenda bigaragara buhoro buhoro. Ushobora kutamenya ko hari ikibazo kugeza ubwo imitsi yangiritse cyane.

Hamagara umuvuzi wawe kugira ngo umubonane niba ufite:

• Ibikomere cyangwa uburwayi ku kirenge cyawe byanduye cyangwa bitakira
• Gutwika, kuribwa, intege nke cyangwa ububabare mu ntoki cyangwa mu birenge biguhungabanya ibikorwa bya buri munsi cyangwa ibitotsi
• Impinduka mu gushobora kugira ibiryo, gukora mu gikari cyangwa imibonano mpuzabitsina
• Kuzenguruka no gucika intege

Ishyirahamwe ry'Amerika ryita ku ndwara ya diyabete (ADA) riragira inama yuko isuzuma rya diyabete neuropathy rigomba gutangira ako kanya nyuma y'aho umuntu abonye indwara ya diyabete yo mu bwoko bwa 2 cyangwa imyaka itanu nyuma yo kubonwa kw'indwara ya diyabete yo mu bwoko bwa 1. Nyuma yaho, isuzuma riragirwa inama rimwe mu mwaka.

Impamvu nyakuri y'ubwoko bwose bwa neuropathy ntiiramenyekana. Abashakashatsi batekereza ko uko igihe gihita, isukari nyinshi mu maraso idakozweho igenda yangiza imiyoboro y'imbere kandi ikabangamira ubushobozi bwayo bwo kohereza amakuru, bigatuma haba diabetic neuropathy. Isukari nyinshi mu maraso inagabanya imbaraga z'inkuta z'uturemangingo duto tw'amaraso (capillaries) dutanga umwuka n'ibiribwa ku miyoboro y'imbere.

Umuntu wese ufite diabete arashobora kurwara neuropathy. Ariko ibi bintu bikurikira byongera ibyago byo kwangirika kw'imijyana y'imbere:

• Kugenzura nabi isukari mu maraso. Isukari idakurikiranwa mu maraso yongera ibyago byo kwangirika kose guterwa na diabete, harimo no kwangirika kw'imijyana y'imbere.
• Amateka ya diabete. Ibyago byo kurwara diabetic neuropathy byiyongera uko umuntu amaze igihe kinini afite diabete, cyane cyane niba isukari mu maraso idakurikiranwa neza.
• Indwara z'impyiko. Diabete ishobora kwangiza impyiko. Kwongera kwangirika kw'impyiko byohereza uburozi mu maraso, ibyo bikaba bishobora gutera kwangirika kw'imijyana y'imbere.
• Kuba uremeretse. Kugira umubyibuho ukabije (BMI) wa 25 cyangwa hejuru bishobora kongera ibyago byo kurwara diabetic neuropathy.
• Kunywa itabi. Kunywa itabi bigabanya kandi bikarinda imitsi, bigatuma amaraso adatembera neza mu maguru no mu birenge. Ibi bituma ibikomere bikira bigoranye kandi bikangiza imijyana y'imbere.

Neuropathie ya diabete ishobora gutera ingaruka nyinshi zikomeye, harimo:

• Kubura ubumenyi bwa hypoglycémie. Ibiyiko by'isukari mu maraso biri munsi ya 70 miligramu kuri desililitiro (mg/dL) — 3.9 milimoli kuri litiro (mmol/L) — bisanzwe biterwa no guhinda umushyitsi, gucana ibyuya no gutera umutima vuba. Ariko abantu bafite neuropathie ya autonome bashobora kutagaragaza ibimenyetso byo kuburira.
• Gutakaza urutoki, ikirenge cyangwa ukuguru. Kwangirika kw'imitsi bishobora gutera igihombo cy'ubwumva mu birenge, ku buryo n'ibikomere bito bishobora guhinduka ibyo kubabara cyangwa ibyo kubabaza bitagaragaye. Mu bihe bikomeye, ubwandu bushobora gukwirakwira mu gice cy'igitugu cyangwa gutera urupfu rw'umubiri. Gukuraho (guca) urutoki, ikirenge cyangwa igice cy'ukuguru bishobora kuba ngombwa.
• Ubukana bw'inzira y'umuyoboro w'inkari n'ubushitsi bw'inkari. Niba imitsi igenzura umukaya wangiritse, umukaya ushobora kutazura neza igihe umuntu ari kwinnya. Bakteri zishobora kwibasira mu mukaya no mu mpyiko, zikaba intandaro y'ubwandu bw'inzira y'umuyoboro w'inkari. Kwongera kwangirika kw'imitsi bishobora kandi kugira ingaruka ku bushobozi bwo kumva ko ukeneye kwinnya cyangwa kugenzura imitsi isohora inkari, bigatuma habaho gutakaza (ubushitsi).
• Kumanuka cyane kw'umuvuduko w'amaraso. Kwongera kwangirika kw'imitsi igenzura umuguzi w'amaraso bishobora kugira ingaruka ku bushobozi bw'umubiri bwo guhindura umuvuduko w'amaraso. Ibi bishobora gutera igabanuka rikomeye ry'umuvuduko igihe umuntu ahagaze nyuma yo kwicara cyangwa kuryama, ibyo bishobora gutera guhinda umushyitsi no gutakaza ubwenge.
• Ibibazo by'igogorwa. Niba kwangirika kw'imitsi bibaye mu nzira y'igogorwa, gucibwamo cyangwa guhitamo, cyangwa byombi bishoboka. Kwongera kwangirika kw'imitsi bifitanye isano na diabete bishobora gutera gastroparesis, uburwayi aho umwijima usohora buhoro cyangwa ntusohora na gato. Ibi bishobora gutera kubyimba no kudogora.
• Ibibazo by'imyororokere. Neuropathie ya autonome ikunze kwangiza imitsi igira ingaruka ku ngingo z'imyororokere. Abagabo bashobora kugira ibibazo byo kudakora imibonano mpuzabitsina. Abagore bashobora kugira ibibazo byo kubura amavuta yo kwisiga no kubaho.
• Kwiyongera cyangwa kugabanuka kw'umunyu. Kwongera kwangirika kw'imitsi bishobora guhungabanya uko ibyondo by'umunyu bikora kandi bigatuma bigoye umubiri kugenzura ubushyuhe neza.

Urashobora gukumira cyangwa gutinda indwara y'imitsi iterwa na diyabete n'ingaruka zayo binyuze mu kugenzura neza isukari yawe mu maraso no kwita ku birenge byawe neza.

Umuganga wawe usanzwe ashobora kubona indwara y'imitsi iterwa na diyabete akoresheje isuzuma ngororamubiri kandi agasesengura neza ibimenyetso byawe n'amateka yawe y'ubuzima.

Umuganga wawe asanzwe abanza kureba ibi bikurikira:

Hamwe n'isuzuma ngororamubiri, umuganga wawe ashobora gukora cyangwa gutegeka ibizamini byihariye kugira ngo afashe kubona indwara y'imitsi iterwa na diyabete, nka:

• Imbaraga z'imikaya muri rusange n'uburyo bwayo

• Imikorere y'imitsi

• Uburyo bwumva ubushyuhe, ububabare, ubushyuhe n'ibitera umuvuduko

• Isuzuma ry'umutwe w'insinga. Umutwe w'insinga ya nayiloni yoroheje (monofilament) ukoreshwa mu gukora ku bice by'uruhu rwawe kugira ngo harebwe uburyo bwumva ubushyuhe.

• Isuzuma ry'imikorere y'imiti y'imbere. Iri suzuma ridafite ingaruka rikoreshwa mu kureba uburyo imitsi yawe isubiza umuvuduko n'impinduka z'ubushyuhe.

• Isuzuma ry'umuvuduko w'amashanyarazi mu mitsi. Iri suzuma ripima uburyo bwihuse imitsi yo mu biganza n'amaguru itwara amashanyarazi.

• Electromyography. Bita isuzuma ry'igipimo, iri suzuma rikunda gukorwa hamwe n'isuzuma ry'umuvuduko w'amashanyarazi mu mitsi. Ripima amashanyarazi ava mu mikaya yawe.

• Isuzuma ry'imitsi ikora mu buryo bwihariye. Ibizamini byihariye bishobora gukorwa kugira ngo harebwe uburyo umuvuduko w'amaraso wawe uhinduka igihe uri mu myanya itandukanye, niba ibyuya byawe biri mu rugero rusanzwe.

Neuropathie ya diabete nta muti uyizi kandi uzwi. Intego y'ubuvuzi ni ukugira ngo:

Kugumana isukari y'amaraso muri urwego rwawe rwagenewe ni ingenzi mu gukumira cyangwa gutinza ibibazo by'imitsi. Gucunga neza isukari y'amaraso bishobora no kunoza bimwe mu bimenyetso byawe biriho. Umuganga wawe azamenya urwego rwiza rwagenewe kuri wowe hashingiwe ku bintu birimo imyaka yawe, igihe umaze ufite diabete n'ubuzima bwawe muri rusange.

Urugero rw'isukari y'amaraso rugomba kuba ukurikije umuntu ku giti cye. Ariko muri rusange, American Diabetes Association (ADA) iragira inama y'ibi byiciro by'isukari y'amaraso ku bantu benshi barwaye diabete:

American Diabetes Association (ADA) muri rusange iragira inama y'igipimo cya glycated hemoglobin (A1C) cya 7.0% cyangwa munsi yaho ku bantu benshi barwaye diabete.

Mayo Clinic ikangurira kugira urwego rwo hasi gato rw'isukari y'amaraso ku bantu benshi bakiri bato barwaye diabete, n'urwego rwo hejuru gato ku bantu bakuze bafite izindi ndwara kandi bashobora kuba bafite ibyago byinshi byo kugira ibibazo byo kugira isukari y'amaraso nke. Mayo Clinic muri rusange iragira inama y'ibi byiciro by'isukari y'amaraso mbere y'ifunguro:

Ubundi buryo bw'ingenzi bwo gufasha kugabanya cyangwa gukumira ko neuropathie ikomeza kuba mbi harimo kugumana umuvuduko w'amaraso uri munsi y'uburebure, kugumana ibiro byiza no gukora imyitozo ngororamubiri buri gihe.

Imiti myinshi ivura ibibazo by'imitsi iterwa na diabete iboneka, ariko ntiyakora kuri buri wese. Iyo utekereza ku miti iyo ari yo yose, vugana n'abaganga bawe ku byiza n'ingaruka zishoboka kugira ngo umenye icyakugirira akamaro.

Ubuvuzi buvura ububabare burimo:

Imiti ivura ihungabana. Imiti imwe ivura ihungabana iragabanya ububabare bw'imitsi, nubwo utazi ihungabana. Imiti ivura ihungabana ya Tricyclic ishobora gufasha mu bubabare buke cyangwa bwo hagati. Imiti iri muri uyu muryango irimo amitriptyline, nortriptyline (Pamelor) na desipramine (Norpramin). Ingaruka mbi zishobora kuba zibabaza kandi zirimo umunwa wumye, impatwe, ubunebwe no kugorana kwibanda. Iyi miti ishobora kandi guteza ubusembwa iyo uhinduye umwanya, nko kuva kuryama ukajya guhagarara (orthostatic hypotension).

Serotonin na norepinephrine reuptake inhibitors (SNRIs) ni ubundi bwoko bw'imiti ivura ihungabana bushobora gufasha mu bubabare bw'imitsi kandi bufite ingaruka nke. ADA iragira inama ya duloxetine (Cymbalta, Drizalma Sprinkle) nk'ubuvuzi bwa mbere. Ikindi gishobora gukoreshwa ni venlafaxine (Effexor XR). Ingaruka zishoboka mbi zirimo isereri, ubunebwe, ubusembwa, kugabanuka kw'irari ryo kurya n'impatwe.

Rimwe na rimwe, imiti ivura ihungabana ishobora kuvanga n'imiti ivura indwara zifata ubwonko. Iyi miti ishobora kandi gukoreshwa n'imiti ivura ububabare, nko gufata imiti iboneka nta rupapuro. Urugero, ushobora kubona impumuro ya acetaminophen (Tylenol, izindi) cyangwa ibuprofen (Advil, Motrin IB, izindi) cyangwa igitambara cyo ku ruhu gifite lidocaine (ikintu gipfundikira).

Kugira ngo ubone ubuvuzi bw'ibibazo, ushobora kuba ukeneye ubufasha bw'inzobere zitandukanye. Ibi bishobora kuba harimo inzobere ivura ibibazo by'inzira y'umuyoboro w'inkari (urologist) n'inzobere y'umutima (cardiologist) ishobora gufasha gukumira cyangwa kuvura ibibazo.

Ubuvuzi ukeneye biterwa n'ibibazo bya neuropathie ufite:

Umuvuduko muke w'amaraso iyo uhagaze (orthostatic hypotension). Ubuvuzi butangira guhindura imibereho yawe, nko kudakoresha inzoga, kunywa amazi menshi, no guhindura imyanya nko kuva kwicara ukajya guhagarara buhoro buhoro. Kuryama n'umutwe w'igitanda uhagaze kuri santimetero 10 kugeza kuri 15 bifasha gukumira umuvuduko w'amaraso mwinshi nijoro.

Umuganga wawe ashobora kandi kugira inama yo gushyigikira igifu na imikaya (abdominal binder na compression shorts cyangwa stockings). Imiti myinshi, yaba yonyine cyangwa hamwe, ishobora gukoreshwa mu kuvura orthostatic hypotension.

• Kugabanya umuvuduko

• Kugabanya ububabare

• Gucunga ibibazo no gusubiza imikorere

• Hagati ya 80 na 130 mg/dL (4.4 na 7.2 mmol/L) mbere y'ifunguro

• Munsi ya 180 mg/dL (10.0 mmol/L) amasaha abiri nyuma y'ifunguro

• Hagati ya 80 na 120 mg/dL (4.4 na 6.7 mmol/L) ku bantu bari munsi y'imyaka 59 badafite izindi ndwara

• Hagati ya 100 na 140 mg/dL (5.6 na 7.8 mmol/L) ku bantu bafite imyaka 60 n'abarengeje, cyangwa ku bafite izindi ndwara, harimo iz'umutima, iz'ibihaha cyangwa iz'impyiko

• Imiti ivura indwara zifata ubwonko. Imiti imwe ikoreshwa mu kuvura indwara zifata ubwonko (epilepsy) ikoreshwa kandi mu kugabanya ububabare bw'imitsi. ADA iragira inama yo gutangira na pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) nayo ni amahitamo. Ingaruka mbi zishobora kuba harimo ubunebwe, ubusembwa, no kubyimba mu ntoki no mu birenge.

• Imiti ivura ihungabana. Imiti imwe ivura ihungabana iragabanya ububabare bw'imitsi, nubwo utazi ihungabana. Imiti ivura ihungabana ya Tricyclic ishobora gufasha mu bubabare buke cyangwa bwo hagati. Imiti iri muri uyu muryango irimo amitriptyline, nortriptyline (Pamelor) na desipramine (Norpramin). Ingaruka mbi zishobora kuba zibabaza kandi zirimo umunwa wumye, impatwe, ubunebwe no kugorana kwibanda. Iyi miti ishobora kandi guteza ubusembwa iyo uhinduye umwanya, nko kuva kuryama ukajya guhagarara (orthostatic hypotension).

Serotonin na norepinephrine reuptake inhibitors (SNRIs) ni ubundi bwoko bw'imiti ivura ihungabana bushobora gufasha mu bubabare bw'imitsi kandi bufite ingaruka nke. ADA iragira inama ya duloxetine (Cymbalta, Drizalma Sprinkle) nk'ubuvuzi bwa mbere. Ikindi gishobora gukoreshwa ni venlafaxine (Effexor XR). Ingaruka zishoboka mbi zirimo isereri, ubunebwe, ubusembwa, kugabanuka kw'irari ryo kurya n'impatwe.

• Ibibazo by'inzira y'umuyoboro w'inkari. Imiti imwe igira ingaruka ku mikorere y'umwijima, bityo umuganga wawe ashobora kugira inama yo guhagarika cyangwa guhindura imiti. Gahunda yo kunyara buri gihe cyangwa kunyara buri masaha make (kunyara igihe) mugihe ushyira igitutu gito ku gice cy'umwijima (munsi y'inda) bishobora gufasha ibibazo bimwe by'umwijima. Ubundi buryo, harimo no kwishyiramo catheter, bishobora kuba bikenewe mu gukura imyanda mu mwijima wangiritse n'imitsi.
• Ibibazo by'igogorwa. Kugira ngo ugabanye ibimenyetso byoroheje bya gastroparesis — ibibazo byo kugogora, guhinda umwuka, isereri cyangwa kuruka — kurya ibiryo bike, bikunze kuba byinshi bishobora gufasha. Guhindura imirire n'imiti bishobora gufasha kugabanya gastroparesis, impatwe, guhitamo no kuruka.
• Umuvuduko muke w'amaraso iyo uhagaze (orthostatic hypotension). Ubuvuzi butangira guhindura imibereho yawe, nko kudakoresha inzoga, kunywa amazi menshi, no guhindura imyanya nko kuva kwicara ukajya guhagarara buhoro buhoro. Kuryama n'umutwe w'igitanda uhagaze kuri santimetero 10 kugeza kuri 15 bifasha gukumira umuvuduko w'amaraso mwinshi nijoro.

Umuganga wawe ashobora kandi kugira inama yo gushyigikira igifu na imikaya (abdominal binder na compression shorts cyangwa stockings). Imiti myinshi, yaba yonyine cyangwa hamwe, ishobora gukoreshwa mu kuvura orthostatic hypotension.

• Ibibazo by'imibonano mpuzabitsina. Imiti ifatwa mu kanwa cyangwa inshinge ishobora kunoza imikorere y'imibonano mpuzabitsina kuri bamwe mu bagabo, ariko ntitekanye kandi ikagira umumaro kuri buri wese. Ibikoresho bya vacuum bishobora kongera amaraso ajya mu gitsina. Abagore bashobora kungukirwa na lubrificants yo mu gitsina.

Ibi bishobora kugufasha kumva umeze neza muri rusange kandi bigabanye ibyago byo kwibasirwa na diyabete ya nerofi:

Kora imyitozo ngororamubiri buri munsi. Gukora imyitozo ngororamubiri bituma isukari mu maraso igabanuka, bituma amaraso atembera neza kandi bikarinda umutima wawe. Gerageza gukora imyitozo ngororamubiri yoroshye iminota 150 cyangwa imyitozo ngororamubiri ikomeye iminota 75 mu cyumweru, cyangwa guhuza imyitozo ngororamubiri yoroshye n'ikomeye. Ni byiza kandi kuruhuka buri minota 30 kugira ngo ukore imyitozo ngororamubiri migufi.

Ganira n'abaganga bawe cyangwa umuganga wita ku myitozo ngororamubiri mbere yo gutangira gukora imyitozo ngororamubiri. Niba ufite ikibazo cyo kumva nabi mu birenge, ubwoko bumwe bwimyitozo ngororamubiri, nko kugenda, bushobora kuba bwiza kurusha ubundi. Niba ufite ikibazo cy'ikirenge cyangwa ububabare, komeza gukora imyitozo idasaba gushyira umurego ku kirenge cyawe cyangiritse.

• Kugumana umuvuduko w'amaraso uri hasi. Niba ufite umuvuduko w'amaraso uri hejuru na diyabete, ufite ibyago byinshi byo kwibasirwa n'ingaruka mbi. Gerageza kugumana umuvuduko w'amaraso mu rwego muganga wawe aguteguriye, kandi ujye ubugenzura buri gihe ugiye kwa muganga.
• Fata ibiryo byiza. Fata indyo yuzuye irimo ibiryo bitandukanye byiza - cyane cyane imboga, imbuto n'ibinyampeke byuzuye. Koresha ibiryo bike kugira ngo ugere ku kigero cyiza cy'uburemere cyangwa ukigumane.
• Kora imyitozo ngororamubiri buri munsi. Gukora imyitozo ngororamubiri bituma isukari mu maraso igabanuka, bituma amaraso atembera neza kandi bikarinda umutima wawe. Gerageza gukora imyitozo ngororamubiri yoroshye iminota 150 cyangwa imyitozo ngororamubiri ikomeye iminota 75 mu cyumweru, cyangwa guhuza imyitozo ngororamubiri yoroshye n'ikomeye. Ni byiza kandi kuruhuka buri minota 30 kugira ngo ukore imyitozo ngororamubiri migufi.

Ganira n'abaganga bawe cyangwa umuganga wita ku myitozo ngororamubiri mbere yo gutangira gukora imyitozo ngororamubiri. Niba ufite ikibazo cyo kumva nabi mu birenge, ubwoko bumwe bwimyitozo ngororamubiri, nko kugenda, bushobora kuba bwiza kurusha ubundi. Niba ufite ikibazo cy'ikirenge cyangwa ububabare, komeza gukora imyitozo idasaba gushyira umurego ku kirenge cyawe cyangiritse.

• Reka kunywa itabi. Gukoresha itabi mu buryo ubwo aribwo bwose bigutera ibyago byo kugira ikibazo cyo kutembera kw'amaraso mu birenge, ibyo bikaba bishobora gutera ibibazo mu gukira. Niba unywa itabi, ganira n'abaganga bawe kugira ngo ubone uburyo bwo kubireka.