ŞCOALA TEHNICĂ POSTLICEALĂ SANITARĂ,,HENRI SANITARĂ,,HENRI COANDĂ” COAND Ă” FELDRU
LUCRARE DE DIPLOMĂ
PARTICULARITĂŢI DE ÎNGRIJIRE ŞI TRATAMAENT LA PACIENTUL CU DIABET ZAHARAT TIP. I
COORSONATOR: As.Med. Pr MUREŞAN VERONICA
ABSOLVENT: BOTA MARCELA
1
CAPITOLUL I:
INTRODUCERE Nurs!"u# es$e %r! de&!'( d($) de Vr"!( Vr"!( H(!ders*! +! 1- /U! 0*% 0* %#e #e22 de (0$3 (0$3$) $)' ' de des& s&)4 )4ur( ur($e $e +! s0*% s0*%u# u# %r** %r**3)r 3)r s(u s(u e e!' !'!e !er r s)!)$)', s)!)$)', ( re054$")r re054$")r e, (r d(0) (0es$ #u0ru !u es$e %*s6#, (s"ur(re( (s"ur(re( u!e *r' #!4$$e”. Es$e 0u!*s0u$ &(%$u# 0) e2(e!u# ed0(# 7 (0$u# %res$($ de ed0 !u e%u8 e% u8e( e(8) 8) e! e!su su## 3* 3*#u #u de %r(0$ %r(0$0 0 4 (0'u (0'u! ! 0(re 0(re 0* 0*!s !s$$ $$ue ue +!"r +!"r9r 9re( e( 6*#!(3u#u. /Med0u# $re0e, (ss$e!$( r)5!e. Med0u# %res0re, (ss$e!$( e2e0u$)” 7 ($) de 0e +!de%#!re( *6#"('#*r 0(re re3!, #( u! !3e# su%er*r de +!'e#e"ere 4 !$er%re$(re, 0( ur(re ( %re")$r s(#e de 6(8) 4 $e;!0* %r*&es*!(#e , 0*!s$$ue (%*r$u# re(r0(6# (# (ss$e!$e ed0(#e. Pre")$re( de 6(8) ( (ss$e!$e ed0(#e + %er$e, %e de * %(r$e +!su +!su4 4re re(( ( ( %r*& %r*&u! u!d) d) 4 ( ( r(% r(%d) d) ( u! u!*r *r 0u 0u!* !*4$ 4$! !'e 'e 4 %r(0 %r(0$ $0 0 de s%e0(#$($e 4 ( u#$) re0e%$3$($e &(') de 4$!') 4 &(') de !*u, (r %e de (#$) %(r$e, u! *r8*!$ ( #(r", * *re!$(re ( r(%d) #( %($u# 6*#!(3u#u. Ass$e!$( ed0(#) ( 0)re s(r0!) de 6(8) es$e (s"ur(re( 0*!d'#*r *%$e de +!"r9 +!"r9re re ( 6* 6*#!( #!(3 3#*r #*r,, (re (re ($r6 ($r6u' u' de +!"r9 +!"r9r ree e ed d0( 0(#) #) %r*%r %r*%ru u8 8s) s),, "e!0*s(!$(re , *r"(!8($*r0e, edu0($3e 4 "*s%*d)re4$.
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CAPITOLUL II:
MEMORIU EXPLICATIV
Nu)ru# %ers*(!e#*r (&e0$($e de d(6e$ 8(;(r($ es$e +! 0*!$!u) 0re4$ 0re4$ere ere,, &e!* &e!*e! e!u# u# (0es (0es$( $( (3 (35! 5!dd 3( 3(#(6 #(6# #$($ $($ee %e %e!$r !$ruu $*($e $*($e ')r# ')r#ee #u, de0 4 %e!$ru '(r( !*(s$r). L( s&5r4 s&5r4$u $u## (! (!u#u u#u 1 1= = +! R*5 R*5! !(( e2 e2s s$(u $(u >= >=>. >.?? ???? %e %ers* rs*(! (!ee 6*#!(3e de d(6e$ (&#($e +! e3de!'( 0e!$re#*r de s%e0(#$($e. Se es$e(8) 0) !u)ru# 0e#*r 0u d(6e$ !ed("!*s$0($ s(u #($e!$ es$e 4 ( (re, (s$&e# +!05$ (%r*2($3 (%r*2($3 u! #*! de r*5! r*5! se 0*!&ru!$) 0*!&ru!$) 0u (0e(s$) (#(de de $eu$. C*!$(0$u# (0es$*r( 0u 0(dre#e ed0(#e +! u!$)' 0u d3erse %r*&#ur ed0(#e $re6ue s) !e (!$e(s0) &(%$u# 6!e 0u!*s0u$ 0), su00esu# $er(%eu$0 %e!$ru *r0e (#$) (&e0'u!e es$e 0*!d'*!($ de %)s$r(re( u!u e0;#6ru e$(6*#0 6u!, +! s%e0(# "#0e0. De*(re0e ( +! &(#e d*u) 0(8ur de d(6e$ !su#!*de%e!de!$ 4 3)85!d %r*6#ee#e, !e3*#e #*r, 05$ 4 d! d*r!'( de ( u#$) !&*r('e (su%r( (0es$e 6*# ( ;*$)r5$ s) $r($e8 (0es$ su6e0$ +! %r*e0$u# eu de d%#*).
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CAPITOLUL III:
ANATOMIE ŞI FIZIOLOGIE P(!0re(su# es$e * "#(!d) (6d*!(#) (se)!)$*(re 0( s$ru0$ur) "#(!de#*r s(#3(re. P(!0re(su# (re * &*r) %rs($0) !ere"u#($) 4 (!($*0 se +%(r$e +! 0(%, 0*r% 4 0*(d). Es$e s$u($ %e %ere$e#e %*s$er*r (6d*!(#, re$r*%er$*!e(# 4 (re ur)$*(re#e de!su! (%r*2($3e: - "reu$($e ? 7 > " - #u!"e 1< 7 1> 0 - "r*se 1,> 7 <,> 0 ♦
C(%u# %(!0re(su#u se (&#) +! 0*!0(3$($e( %*$0*(3e du*de!(#e 4 es$e (0*%er$ +! &*(r$e 0) )sur) de (0es$(.
♦
A!$er*r , %(!0re(su# se +!3e0!e(8) 0u 0*#*!u# $r(!s3ers, 3(se#e e8e!$er0e su%er*(re, 3(se#e "(s$r*du*de!(#e 4 %(!0re($0* du*de!(#e.
♦
P*s$er*r, %(!0re(su# se +!3e0!e(8) 0u 3e!( 0(3) !&er*(r), 3e!( s%#e!0), r!0;u# s$5!" 4 3(se#e (0es$u( $*($e (0es$e e#ee!$e (!($*0e se%(r) %(!0re(su# de ( d*u( 3er$e6r) #*6(r).
P(!0re(su# %re8!$) * 0*%*!e!$) e2*0r!) (0!*(s) , 0u r*# +! se0re'( e!8e#*r %#0($e +! d"es$e 4 * 0*%*!e!$) e!d*0r!). L( (&ere , 0*%*!e!$( e!d*0r!) es$e ("#*er($) +! &*r('u!#e 0u!*s0u$e su6 !ue#e de I!su#e#e L(!"er;*!s. A0es$e( su!$ ds%ers($e +! $*($) s$ru0$ur( %(!0re(su#u, d(r ( (#es +! 0*(d( (0es$u(. L( !d3du# (du#$, !u)ru# !su#e#*r es$e de (%r*2($3 1,> #%(!0re(s. I!su#e#e 0*!'! 0e#u#e se0re$*(re de ;*r*! 4 su!$ se%(r($e u!e#e de (#$e#e %r! 'esu$ %(!0re($0 e2*0r! (u * !er3('e s%($0) 4 %(r(s%($0) 4 * 3(s0u#(r8('e (r$er(#) &*(r$e 6*"($). Cr0u#('( 3e!*(s) ( !su#e#*r dre!e(8) dre0$ +! 0r0u#('( %*r$(#) 0ee( 0e +!se(!) 0) ;*r*! !su#(r (9u!" +! 0*!0e!$r('e (re +! &0($, ( +!(!$e de ( (9u!"e #( 'esu$ur#e %er&er0e. F0($u# de"r(de(8) 4 +!#)$ur) * (re %(r$e d! !su#!( %e 0(re * %re4$e. Se %*($e e2%#0( (s$&e#, de 0e !3e#u# !su#!ee es$e ( 0 de05$ !3e#u# !su#!e 0r0u#(!$e d! 3e!( %*r$). O !su#) L(!"er;*!s (re: - +!$re =?? 0e#u#e B6e$( 0(re se0re$) !su#!) ds%use +! 0e!$ru#
!su#!e - 0e#u#e A (#&( 0(re se0re$) "#u0*"*!u# - 0e#u#e Dde#$( 0(re se0re$) s*($*s$($!u# - 0e#u#e F se0re$*(re de %*#%e%$d %(!0re($0 (0es$e( u#$e $%ur 0e#u#(re,
su!$ ds%use #( %er&er( !su#e 4 re%re8!$) %r*0e!$u# 0e#u#(r res$(!$. Ce#u#e#e !su#(re se0re$) 4 (#$e %e%$de (0$3e 6*#*"0 0u su!$ e!8( !u$) de0(r6*2#(8( (0du#u "#u$(0 GAD 0u u! r*# de (u$*(!$"e! +! de0#(!4(re( %r*0esu#u (u$*u! s%e0&0 d(6e$u#u 8(;(r($ $% 1 4 (#!) ( 0)re ;%erse0re'e se %resu%u!e 0) s$) #( 6(8( %($*"e!e8e d(6e$u#u 8(;(r($ $% <. >
PATOLOGIE (Modii!"#i $%&!#'%i!' )& di%*'+, -%%#%/ B*s!$e8( !su#!e (re #*0 du%) u! %r*"r( 0*d&0($ "e!e$0, &*(r$e r"ur*s 4 0(re (re ( u#$e e$(%e %reer")$*(re. A0es$e e$(%e 0*!du0 #( 6*s!$e8( %re0urs*ru#u !su#!e 4 (!ue ( %r*!su#!e. Pr*!su#!( (re * (0'u!e 6*#*"0) u#$ ( s#(6) 0*%(r($3 0u 0e( ( !su#!e. ! (!u$e s$u(' %($*#*"0e, 0u (r & d(6e$u# 8(;(r($ de8e0;#6r($, d(6e$u# 8(;(r($ $% < 0u *6e8$($e, se %*$ *6ser3( 0re4$er (#e !3e#e#*r 0r0u#(!$e (#e %r*!su#!e. Se0re'( de !su#!) es$e s$u#($) +! *d s%e0&0 de "#u0*8). L( su%r(&('( 0e#u#e#*r 6e$( &u!0'*!e(8) u! ss$e de re0u!*(4$ere ( "#u0*8e re%re8e!$($ de re0e%$*r /"#u0*se!s6#”. O 0re4$ere 0u 1? " ( "#0ee, de$er!) (0$3(re( ss$eu#u. Se0re'( de !su#!) (re d* $%: %ru# $% se0re$*r, 05!d e#6er(re( !su#!e se &(0e r(%d, (0e(s$) %r) &(8) se0re$*re dur5!d >1? !u$e (# d*#e( $% se0re$*r, +!0e%e du%) 1? !u$e 4 dure(8) ($5$ 05$ (0'*!e(8) s$u#u#. Se0re'( de !su#!), ( %*($e & s$u#($) de (!*(08, "#u0*"*!, ;*r*! !$es$!(#, ed0('( ;%*"#0e(!$) *r(#), ss$eu# !er3*s 3e"e$($3, e$0. Od($) e#6er($) +! $*re!$u# 0r0u#($*r, !su#!( &*re(8) 0u %r*$e!e#e, 0*%#e2e 0r0u#(!$e. A0es$e( $r(!s%*r$) !su#!( 4 * e#6ere(8) %e )sur( !e0es$)'#*r *r"(!su#u.
I!su#!( (0'*!e(8) (su%r( *r"(!e#*r '!$), %r! !$eredu# re0e%$*r#*r !su#!e. A0e4$( /re0u!*s0” !su#!(, * /#e(")” 4 * /$r(!s%*r$)” +! !$er*ru# 0e#u#e u!de (0e(s$( +4 +!de%#!e4$e (0'u!#e. Or de 05$e *r re0e%$*r !su#!e su&er) * s0)dere !uer0), (%(re (4( !u$( re8s$e!') #( !su#!). A0e(s$) s$(re se 0(r(0$er8e(8) %r! s0)dere( e&0(0$)' !su#!e de4 %re8e!$) 4 +! 0*!se0!'), %r! (%(r'( ;%er"#0ee. D!$re 0e#e ( %*r$(!$e e&e0$e (#e !su#!e, s%e0&0): s$u#(re( "#0*"e!*"e!e8e s$u#(re( #%*"e!e8e s$u#(re( s!$e8e %r*$e0e 4 ( (08#*r !u0#e0, e$0. s$u#(re( 0*!suu#u %er&er0 (# "#u0*8e se *%u!e de"r(d)r de%*8$e#*r de "#0*"e! "#0*"e!*#8( +%ed0) de"r(d(re( de%*8$e#*r de #%de #%*#8(, 4 &*r(re( 0*r%#*r 0e$*!0, e$0. I!su#!( es$e 0e# ( %*r$(!$ ;*r*! 0u (0'u!e ;%*"#0e(!$), d! *r"(!s. Pre8e!'( s( es$e !ds%e!s(6#) %r*0ese#*r (!(6*#0e 4 e0;#6ru#u e!er"e$0 (# *r"(!su#u. A# d*#e( ;*r*! se0re$($ de 0e#u#e#e %(!0re($0e !su#(re A es$e "#u0*"*!u#. A0'u!#e #u %r!0%(#e su!$: s$u#(re( "#0*"e!*#8e 4 e#6er(re( "#u0*8e +! 0r0u#('e s$u#(re( de"r(d)r %r*$e!e#*r us0u#(re s$u#(re( #%*#8e s$u#(re( se0re'e de !su#!). G#u0("*!u#, (#)$ur de e%!e&r!), 0*r$s*#, ;*r*! $r*de! 4 ;*r*!u# de 0re4$ere, re%re8!$) ;*r*! ;%er"#0e*!', de 0*!$r(re"#(re.
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0.D'i&i1i'2!,%3ii!%#'2!#i'#ii d' di%4&o3i!%#' D'i&i1i'. D(6e$u# es$e u! s!dr* 0u%r!85!d u! "ru% ;e$er*"e! de $u#6ur)r 0(re %*$ (3e( * e$*#*"e d&er$), d(r 0(re (u +! 0*u! ;%er"#0e(, (s*0($) 0u *d&0)r #%de 4 %r*$e!e #( &e# de %*r$(!$e. C#(s&0(re( d(6e$u#u 8(;(r($ 4 ( (#$*r 0($e"*r de $*#er(!') (#$er($) #( "#u0*8).
A. C,%3',' !,i&i!' D(6e$u# 8(;(r($ D(6e$u# 8(;(r($ !su#!*de%e!de!$ D(6e$u# 8(;(r($!de%e!de!$: (&)r) *6e8$($e 6 0u *6e8$($e D(6e$u# 8(;(r($ (s*0($ (#!u$r'e. A#$e $%ur de d(6e$ (s*0($e 0u u!e#e 0*!d' s(u s!dr*(e: 16*# %(!0re($0e <6*# 0u e$*#*"e ;*r*!(#) @$u#6ur)r !duse de ed0(e!$e s(u su6s$(!'e 0;0e $u#6ur)r (#e !su#!e *r (#e re0e%$*r#*r s) >u!e#e s!dr*(e "e!e$0e.
To,'#%&1" %,'#%" ,% 4,+!o-"5 (&)r) *6e8$($e 60u *6e8$($e 0(s*0($e 0u u!e#e 0*!d' s(u s!dr*(e. D(6e$u# 8(;(r($ "es$('*!(#
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B. C%'4o#ii,' !+ #i3! 3%i3i!: Tu#6ur(re %re(#(6#) ( $*#er(!'e #( "#u0*8) Tu#6ur(re %*$e!'(#) ( $*#er(!'e #( "#u0*8).
P'#3o%&',' $#'-'&6&d #i3! !#'3!+ $'&#+ di%*'. A. Ri3! !#'3!+ $'&#+ di%*'+, i&3+,i&o7d'$'&d'& %reds%*8'e "e!e$0): &r(', sur*r, "ee!d(6e$0 0u d(6e$ !su#!*de%e!de!$ %re8e!'( (!$0*r%#*r (!$0e#u#e !su#(re %(!0re($0e: r)s%u!s !su#!0 s0)8u$ #( "#u0*8( (d!s$r($) !$r(3e!*s 0r*s*( &e$(#) e!(r;( +!$5r8($).
B. Ri3! !#'3!+ $'&#+ di%*'+, i&3+,i&o7i&d'$'&d'&: rude de "r(du# I 0u d(6e$ !su#!*!de%e!de!$ e20esu# %*!der(# (0r*s*( &e$(#)rs0 %e!$ru () 0re4$ere( $r(!8$*re ( "#0ee +! d&er$e 0*!d', %re0u: s(r0!), $r($(e!$ 0*r$0*d , $r($(e!$ dure$0, ("resu!e 6*#*"0), s$res &80 s(u %s;0. D(6e$u# 8(;(r($ !su#!*de%e!de!$ es$e * &*r) de 6*(#) 0(re se +!re"s$re(8) +! 1?1> d!$re 0(8ur#e de d(6e$0 d! '(r( !*(s$r). E( se 0(r(0$er8e(8) %r!$r* !su&0e!') (6s*#u$) de se0re'e !su#!0), de6u$ re#($3 (6ru%$ 0u s%$*e e3de!$e %*#ure, %*#d%se, %*#&("e, %erdere %*!der(#) 4 $e!d!') #( 0e$*(0d*8). A0e(s$) &*r) de 6*(#) %*($e & +!$5#!$) #( $*($e 35rs$e#e, d(r 0(r(0$er8e(8) ( (#es %(0e!' #( 0(re 6*(#( de6u$e(8) su6 @? (!. Su6 (0e(s$) 35rs$) (%r*(%e $*' %(0e!' su!$ !su#!*de%e!de!'. D(6e$u# !su#!*de%e!de!$ se ( !ue4$e d(6e$ de $% 1.
EPIDEMIOLOGIE D(6e$u# 8(;(r($ se 0u!*(4$e d! (!$0;$($e. D($e e%de*#*"0e %r*%ru8se e2s$) d! %r( %(r$e ( (0es$u se0*#. ! #ue, +! %re8e!$ $r)es0, %r*6(6#, %es$e 1>? #*(!e d(6e$0, d!$re 0(re @? #*(!e !su#!* de%e!de!'. De4, (%r*(%e $*($e s$ud#e e%de*#*"0e e&e0$u($e +! d&er$e ')r su6#!(8) 0re4$ere( 0*!$!u) ( d(6e$u#u +! u#$e#e de0e!, 0(re ( &*s$ %(r(#e#) 0u 0re4$ere( s$(!d(rdu#u de 3('), +! '(r( !*(s$r) r$u# de 0re4$ere ( &re03e!'e 6*# ( &*s$ u#$ ( #e!$.
ETIOLOGIE C(u8e#e d(6e$u#u su!$ u#$ ds0u$($e, * sere de &(0$*r %reds%*8(!' s(u &(3*r8(!', (35!d r*# %*r$(!$ +! (%(r'( 6*#. D!$re (0e4$( e!'*!): V6#3%5 d(6e$u# %*($e (%)re( #( *r0e e$(%) d! 3('( *u#u, +!0e%5!d 0u 0*%#)r( 4 $er!5!d 0u 6)$r5!e'e(. Se 3( 3*r6 (s$&e# de &*r( 9u3e!#) 1<1> (! s(u de d(6e$u# de ($ur$($e, 0u &re03e!') ( (re +!$re >? 4 ? de (! M'di+, +#*%&: %r! sede!$(rsu# %e 0(re +# %#0) se %(re 0) es$e &(3*r8($ +! (%(r'( 6*# P#o'3i+&'%5 !d0) * &re03e!') ( (re #( !$e#e0$u(#, #( 0e 0e #u0re(8) +! edu# (#e!$(r, 0( 4 #( 0e 0(re, +! "e!er(#, su!$ ( $r(u($8(' %s;0 E#'di%'%5 es$e &(0$*ru# %reds%*8(!$ 0e# ( %*r$(!$ +! d(6e$u# 8(;(r($. Es$e 3*r6( de * %reds%*8'e *r6d) ered$(r), +!$ru05$ +! (!$e0ede!$e#e ered*0*#($er(#e (#e 6*#!(3#*r se 0*!s$($) %re8e!'( d(6e$u#u +!$r* %r*%*r'e de (%r*(%e >. 1?
A0e(s$) %reds%*8'e ered$(r) %*($e %r(, ( r(r, u! 0(r(0$er dre0$ de $r(!s$ere ( 6*# de #( (s0e!de!' #( des0e!de!', d(r de 0e#e ( u#$e *r (0e(s$) $r(!s$ere s(re de #( * "e!er('e #( (#$( 6u!0!e%*$ s(u ( u! 0(r(0$er 0*#($er(# u!0;!e%*$. Co&3%4+i&i%'%5 de4 0*!$r*3ers($), ( &)0u$ s) se *6ser3e 0) 6*(#( (%(re ( &re03e!$ #( rude#e de s5!"e (#e d(6e$0#*r. E( )re4$e de0 4(!se#e de %u!ere +! e3de!') ( $(re#*r ered$(re. D! 0e#e ( sus s(r %u$e( 0*!0;de 0) 6*#!(3u# s(r !(4$e 0u * %reds%*8'e #($e!$), ered$(r), 0(r(0$er8($) %r!$r* s$(re de J!&er*r$($e”, %r! su6&u!0'*!(#$($e( (%(r($u#u !su#(r %(!0re($0. As$&e#, 6*#!(3u# %*$e!'(# %*($e de3e! +! (!u$e 0*!d' d(6e$0 de d($( (0e(s$( 0(u8e 054$"($e 0u su!$ su%r((#e!$('( 4 de0 *6e8$($e( 0(re ure(8) 3*r &(0e (!&es$) (0e(s$) %reds%*8'e #($e!$), &(3*r85!d (%(r'( d(6e$u#u 8(;(r($. S$($s$0#e (r($) 0) (9*r$($e( d(6e$0#*r su!$ ;%er%*!der(#, 0ee( 0e ( &)0u$ %e M(r0e# L(66K s) (&re 0) Jd(6e$u# 6e!"!, ( (#es, es$e ( de"r(6) u! 30u de (#e!$('e, 0(re du0e #( *6e8$($e 4 (%* #( d(6e$”. ! s&5r4$, * sere de (&e0'u! %*$ (3e( u! r*# *0(8*!(# +! (%(r'( d(6e$u#u 8(;(r($, 0u su!$: %(!0re($$e#e, $r(u($se#e 0r(!e!e s(u (6d*!(#e, (#0**#su#, ds0r!#e (0r*e"(#(, su%r(re!(#su# , ($er*s0#er*8(, #uesu#, e$0., 0(re %*$ %r*du0e e%u8(re( %(!0re(su#u e!d*0r!.
11
PATOGENIE D! %u!0$ de 3edere %($*"e!e$0, d(6e$u# 8(;(r($ es$e * $u#6ur(re +! e$(6*#su# "#u0de#*r +! %r!0%(#, 0(re 3( du0e #( ;%er"#0ee 4 "#0*8ure. ! e$(6*#su# "#u0de#*r, du%) (6s*r6'( !$es$!(#) (u #*0 d*u) (r %r*0ese: "#0*"e!e8( 4 "#0*"e!*#8(. Glicogeneza es$e de%u!ere( #( !3e#u# &0($u#u ( "#u0*8e su6
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es$e $r(!s&*r(re( "#0*"e!u#u +! "#u0*8) $*%re(
"#0*"e!u#u %r! ;dr*#8) (%) 4 *6#8(re( #u +! s5!"e, du%) !e0es$)'#e *r"(!su#u. esu$u# us0u#(r es$e 0e# ( (re 0*!su($*r de "#u0*8), e20esu# de "#u0*8), de%u!5!duse su6 &*r) de "r)se +! %*!0u#u# (d%*s. Cu (#$e 0u3!$e, +! (0es$ 0r0u$ se (&#) #( 0e d* %*# : &0($u# (re#e de%*8$(r 4 ds$r6u$*r de "#u0*8) 4 'esu$ur#e +! %ru# r5!d us0u#(r, (re#e 0*!su($*r. Le")$ur( +!$re 0e d* %*# es$e &)0u$), u!de "#u0*8( se e!'!e 0*!s$(!$ +!$re ?,=? 4 1,
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I!su#!( es$e u! 0*%#e2 de (!*(08, 0e 0*!'!e su#& des0*%er$) de P(u#es0u 4 (%* de B*!$!" 4 Bes$ +! 1<1 es$e ;*r*!u# 0u 0e# ( %*r$(!$ r*# +! d(6e$u# 8(;(r($. A0'u!e( s( ;%*"#0e(!$) se e2%#0) %r!: ( s$u#(re( "#0*"e!e8e ;e%($0e 4 us0u#(re 6 !;6(re( "#0*!e*"e!e8e 0 &(3*r8(re( #%d*"e!e8e d! "#u0de, su6 &*r) de "r)se de de%*8$ +! 'esu$u# su60u$(!($. d (0'u!e( de %r*$e0'e &(') de e!8e#e 0e#u#(re, ;e2*!*8( 4 "#u0*u$!( 4 (!$("*!0) &(') de ;*r*!u# 0*!$r(!su#(r (# %re;%*&8e #( !3e#u# 'esu$ur#*r. ! &!(#, %u$e 0*!sder( d(6e$u# 0( &!d d($*r($ &e u!u su60*!su $su#(r de "#u0*8), &e u!e su%r(%r*du0' ;e%($0e de "#u0*8). A6e#e s$u(' du0 #( (0e#(4 re8u#$($, ;%er"#0ee 4 "#0*8ure. L( (0es$e &e!*e!e %(r$0%) 4 0e#(#' &(0$*r !eur*e!d*0r! 0*r$e2u#, ;%*&8(, su%r(re!(#e#e, e$0.. Su60*!suu# $su#(r es$e #e"($ de !su&0e!'( !su#!0), (r e20esu# de %r*du0'e ;e%($0) de "#u0*8) es$e d($*r($ 0e#*r#(#' &(0$*r 0u (0'u!e ;%er"#0e(!$).
DIAGNO8TIC 8i9$o9'5 s%$*($*#*"( +! d(6e$u# 8(;(r($ %*$ & $%0) 4 ($%0). Simptomatologia atipică :
6*(#( es$e des0*%er$) +!$5%#)$*r 0u *0(8(
u!u e2(e! 0#!0 s(u ( u!e (!(#8e. A#$e*r, 6*#!(3u# se (drese(8) ed0#*r %e!$ru d3erse (&e0'u! s(u $u#6ur)r der($$e, &uru!0u#*8e, !e3r(#", 0(re +! (0es$ 0(8 su!$ 0*%#0(' (#e d(6e$u#u.
1
Simptomatologia tipică :
(0e(s$) (!&es$(re es$e 0(r(0$ers$0) 6*#.
B*#!(3u# %re8!$) $r(d) 0#!0) s%e0&0): %*#&("e &*(e e2("er($), u!e*r (de3)r($) 6u#e, %*#d%se se$e e20es3) 4 %*#ure dure8) (re. P*#&("( (%(re de*(re0e 'esu$ur#e su!$ +!$r* J&*(e” %er(!e!$) de "#u0*8), %e!$ru 0) (0e(s$( !u %*($e & 0*!su($) 0( ur(re ( #%se de !su#!). P*#ur( se d($*re(8) "#u0*8e 0res0u$e +! s5!"e, 0(re 3( $re6u e#!($). E#!(re( "#u0*8e %r! ur!) se &(0e 0u (9u$*ru# (%e 0(re %r*3!e d! 'esu$ur. A4( se e2%#0) %*#ur( >= #< *re 4 %*#d%s( se!8('( de se$e %e 0(re * d) *r"(!su#u s%*#ere( +! (%). T(6#*u# 0#!0 es$e 0*%#e$($ de: s0)dere +! "reu$($e, (s$e!( &80) 4 !$e#e0$u(#) #%s( de %u$ere, s0)dere( %u$er de 0*!0e!$r(re, $u#6ur)r de e*re, s*!*#e!') , 0r(%e us0u#(re 05r0e, %rur$ "e!$(#, !&e0' "e!$(#e 4 ur!(re.
DIAGNO8TICUL DE LABORATOR AL DIABETULUI ZAHARAT G#0e( es$e (!(#8( re3e#($*(re %e!$ru d("!*s$0(re( 4 0*!du0ere( $r($(e!$u#u d(6e$u#u 8(;(r($. De %re08( 4 de %re0*0$($e( 0u 0(re es$e %us d("!*s$0u# de s0)dere ( $*#er(!'e #( "#u0*8) de%!de +!$5r8ere( s(u (!u#(re( rs0u#u de (%(r'e ( 0*%#0('#*r d(6e$u#u. Metode folosite pentru determinarea glucozei în sânge.
Me$*de#e redu0$*e$r0e s(u 0u &err0*!d) su!$ +!0) &*#*s$e, 0( 4 0e( 0*#*re$r0) 0u *r$*$*#ud!). ! %re8e!$ +!s) e$*de#e e!8($0e su!$ 0e# ( #(r" r)s%5!d$e, +! *d s%e0(# 0e#e 0u ;e2*!*8) 4 "#u0*8* de;dr*"e!($). V(#*r !*r(#e %e!$ru "#0e( ( 9eu! %r! e$*de#e e!8($0e: ? 11? " "#u0*8)d#. ser.
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G#0e( es$e e2%r($) +! "d#., *##, "# 1 *## Q 1- "d# 1 "#Q1?? "# Q >,> *##. De$er!)r#e "#0e0e se &(0 d!: s5!"e 3e!*s $*$(#, s5!"e 0(%#(r $*$(#, %#(s) 3e!*(s). E4(!$*(!e#e d! s5!"e !$e"r(# su!$ %re8er3($e 0u &#u*rur) 4 d(0) !u su!$ 0e!$r&u"($e ed($ %*$ su&er d!u)r (#e "#u0*8e 0u %5!) #( 1?. V(#*(re( "#u0*8e d! s5!"e#e 3e!*s $*$(# es$e 0u 1> ( 0) de05$ 0e( de$er!($) +! %#(s) 3e!*(s) s(u ser. Pe!$ru 0) +! %r(0$0) !e +!$5#! ( (#es 0u de$er!)r#e "#0e0e d! s5!"e#e 0(%#(r 4 d! %#(s) 3e!*(s), 3* &(0e 05$e3( re&err #( (0es$e(. Glucoza din plasma venoasă (re 3(#*r 0u 1?1> ( (r 0*%(r($3
0u 0e( d! s5!"e#e $*$(# 0(%#(r. D("!*s$0e#e s(u !&r)r#e de d("!*s$0e (#e d&er$e#*r &*re de (#$er(re ( $*#er(!'e #( "#u0*8) se &(0 %r! de$er!)r "#0e0e d! %#(s) 3e!*(s). R(%d$($e( 4 %re08( de$er!)r#*r "#0e0e r(%*r$($e #( s5!"e#e $*$(# 0(%#(r &(0 d! 6(!de#e$e#e re(0$3e s(u d! s$r%sur * s*#u'e de(#) %e!$ru (u$*0*!$r*#. De08#e $er(%eu$0e %*$ & #u($e r(%d, +! de%#!) 0u!*4$!') de 0(u8) 4 #( r5!du# #*r 0*!$r*#($e de ( u#$e *r< ;. Cr$er#e de d("!*s$0 %e!$ru d(6e$u# 8(;(r($ u!(! (00e%$($e 4 re0*(!d($e de *r"(!se#e !$er!('*!(#e. L$( su%er*(r) ( 3(#*r !*r(#e "#0e0e %#(s($0e %re%*!d(#e es$e 11? "d# ,1 *## - L$( su%er*(r) ( 3(#*r !*r(#e ( "#0ee #( < ; du%) +!0)r0(re( 0u
"#u0*8) es$e 1? "d# =,- *##, +! 0(dru# $es$u#u *r(# de $*#er(!') #( "#u0*8) TTGO.
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V%,o#i d' di%4&o3i! $o-ii:5 "#0e( %#(s($0) %re%r*!d(#) 1< "d# = *##, 0*!&r($) +! 8u( ur)$*(re "#0e( %#(s($0) #( < ; du%) +!0)r0(re( 0u "#u0*8) (! re%e$) #( @ (! d(0) es$e !*r(#) 35rs$( 4 > (!, +! 0*!d'#e +! 0(re es$e *6e8 IMC <= "< (re rude de "r(du# I 0u d(6e$ 8(;(r($ (%(r'!e u!e e$! 0u rs0 +!(#$ (re (0r*s* es$e 0u!*s0u$ 0u HTA (re HDLC @> 4s(u $r"#0erde#e <>? "d# es$e 0u!*s0u$ (!$er*r 0u "#0ee 0res0u$) %re%r(!d(#) s(u 0u $*#er(!') s0)8u$) #( "#u0*8).
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I!d&ere!$ de $%u# 6(!de#e$e#*r, 0*!d'#e de %)s$r(re (#e (0es$*r( su!$ (0e#e(4: +!$re <@? Ce#sus s0*($ere( &e0)re 6(!de#e$e es$e ur($) ed($ de +!0;dere( e$(!4) ( &#(0*!u#u d*%u# s(u &#(0*!u# 0*!'! su6s$(!'e ;dr*&#e 0(re e!'! us0($ (eru# d! !$er*r 0(%)$u# re(0$3 (# 6(!de#e$e#*r !u $re6ue ($!s d(0) 6(!de#e$e#e su!$ '!u$e +! &#(0*!u# *r"!(# e#e su!$ 3(#(6#e %5!) #( d($( e!'*!($) %e &#(0*! &e0(re &#(0*! (re %r*%ru# s)u 0*d, 0ee( 0e *6#") #( !e+!s$r)!(re( 6(!de#e$e#*r +! (#$e &#(0*(!e 4 #( 0(#6r(re( re0$re( 0*du#u 0*res%u!8)$*(re ( (%(r($e#*r.
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GLICOZURIA Es$e u$#) ( (#es %e!$ru ur)rre( e&0e!'e $r($(e!$u#u d(6e$u#u 8(;(r($ , d(r ( %u'! u$#) %e!$ru d("!*s$0u# de %re08e (# d(6e$u#u 8(;(r($. ! "e!er(#, 3(#*r#e "#0e0e 1-? "d# se +!s*'es0 de "#0*8ure. Pr("u# re!(# 3(r(8) de #( !d3d #( !d3d, de #( * "ru%) de 35rs$) #( (#$(. ! %r(0$0) re0ur"e, +! "e!er(#, #( ( u#$e *d(#$)' de de$er!(re (#e "#0*8ure. G#0*8ur( d! ur!( de < ;. Re0*#$(re( ur! +!0e%e du%) %r( 0'u!e ($!(#) 05!d ur!( se (ru!0) 4 !0#ude $*($e e#!)r#e ur!(re d! < ;, (#)$ur de 0'u!e( ($!(#) ( 8#e ed($ ur)$*(re. Me$*d( %re8!$) ur)$*(re#e de8(3(!$(9e: !u %er$e 3er&0(re( "#0*8ur#*r +! (!u$e !$er3(#e d! 0e#e < ; es$e d&0# de e&e0$u($ +! 0*!d' de (0$3$($e e2$r(d*0#u. G#0*8ur( &r(0'*!($) re%re8!$) re0*#$(re( +! < re%r8e ( 3*#uu#u ur!(r, %e %er*(de de $% 6!e de$er!($e.
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Me$*d( es$e (3(!$(9*(s) %e!$ru 3er&0(re( e&0e!'e &e0)re %r8e de !su#!)< ;. G#0*8ur( d! ur!( s%*!$(!) %re8!$) (re#e (3(!$(9 0) %*($e & de$er!($) %r! (u$*0*!$r*# s$r%sur, +! *r0e 0*!d' de (0$3$($e. Pre08) 0), "#0*8ur( (6se!$) !u +!se(!) e0;#6ru e$(6*#0 &*(r$e 6u! 0 d*(r 3(#*r "#0e0e 1-? "d#, du%) 0u !u %*($e *re!$( (su%r( ;%*"#0e#*r. Fe0(re su6e0$ d(6e$0 $re6ue s)4 0u!*(s0) %r("u# re!(# 4 s) &e edu0($ +! s0*%u# 0*re#)r "#0*8ur#*r 4 "#0e#e.
CETONURIA A%(r'( 0*r%#*r 0e$*!0 ur!(r de*!s$re(8) 0e# ( (dese( !e!'( 0*%#0('#*r (0u$e de $% 0e$*(0d($0. T*' su6e0' d(6e$0 !s$ru' +4 3*r de$er!( 0*r% 0e$*!0 ur!(r *r de 05$e *r: "#0e#e de%)4es0 <>?@?? "d# (%(r !$er0ure!$e !&e0'*(se !$*#er(!') d"es$3) "re('), 3*0), d(ree s(r0!).
DIAGNO8TIC POZITIV ! &*re#e $%0e se 6(8e(8) %e $r(d( 0#!0) s%$*($0): %*#&("e, %*#d%se 4 %*#ure. G#0e( 0res0u$) %es$e 1,<> 4 "#0*8ur( 0*!&r) d("!*s$0u#. ! &*re#e 0u s%$*($*#*"e ($%0), %r*6e#e de #(6*r($*r #)ures0 %r*6#e(.
DIAGNO8TIC DIFERENŢIAL
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A0es$( (re +! 3edere de*se6re( d(6e$u#u 8(;(r($ de * sere de (#$e s$)r *r6de (se)!)$*(re 4 (!ue: Glicozuria renală
!u$) 4 Jd(6e$u# re!(#” "#0e( es$e
!*r(#), d(r 6*#!(3u# (re "#0*8ure %e!$ru 0) %r*"r(u# re!(# de e#!(re ( "#u0*8e es$e s0)8u$. Glicozuriile paradiabetice
!u$e 4 glicozurii alimentare se
*6ser3) +! su%r((#e!$('e, +! *6e8$($e, #( ;%er$e!s3, +! u!e#e ds0r! s(u, u!e*r, #( !su&0e!'e ;e%($0e 0r*8e. B*#!(3 !u %re8!$) se!e#e 0#!0e (#e d(6e$u#u. G#0*ru8( !u de%)4e4$e 1? " , (r "#0e( !u $re0e de 1,<> " d!e('(. A0es$e s$)r su!$ !u$e de u! (u$*r 4 s$)r J%red(6e$0e”, ur5!d ( su"er( 0) e#e %*$ e3*#u( s%re u! d(6e$ (de3)r($. A#' #e !ues0 Jd(6e$e e2$r(!su#(re”, (d0) d(6e$e %r! $u#6ur)r +! e0(!su# de "#0*re"#(re. Diabet insipid es$e
* (&e0'u!e 0(re %*($e 0re( 0*!&u8e 0u
d(6e$u# 8(;(r($. Se!u# 0(r(0$ers$0 +! d(6e$u# !s%d es$e %*#ur( e20es3) 1?1> #< de *re. Tu#6ur(re( es$e d($*r$) ;*r*!u#u (!$dure$0 se0re$($ de #*6u# %*s$er*r (# ;%*&8e +! 0(!$$)' reduse. D&ere!'ere( de d(6e$u# 8(;(r($ se 6(8e(8) %e (6se!'( ;%er"#0ee 4 ( "#u0*8e +! ur!) 4 %e de!s$($e( ur!e 0(re es$e de 1??11??<.! d(6e$u# 8(;(r($ ur!( (re * de!s$($e (re 1?<>1?<- d! 0(u8( %re8e!'e "#u0*8e. L(0$*8ur( de s(r0!) s(u +! %er*(d( de (#)%$(re es$e $r(!8$*re, &)r) %*r$(!'). D("!*s$0u# de 0er$$ud!e +! 0(8ur#e de du6u !# d) %r*6( de #(6*r($*r !u$) ;%er"#0e( %r*3*0($).
F*re 0#!0e: <
+! &u!0'e de 35rs$) se 0u!*(4$e d(6e$u# 9u3e!#, 0u e3*#u'e se3er) d(6e$u# de ($ur$($e 0(re es$e &*r( *64!u$) ( d(6e$u#u 8(;(r($ 0u &re03e!'( +!$re ?? (! d(6e$u# 6)$r5!#*r, 0u e3*#u'e #u!"), d(r 6e!"!). Du%) 0r$er e$(6*#0e se de*se6es0: d(6e$u# "r(s s(u 6e!"! d(6e$u# s#(6 s(u 0*!su%$3 0u e3*#u'e 4 %r*"!*s$0 se3ere.
EVOLUŢIE. PROGNO8TIC. COMPLICAŢII D(6e$u# 8(;(r($ es$e * 6*(#) 0r*!0), !e3!de0(6#). Cu u! $r($(e!$ 0*!dus 0*re0$, 3('( 6*#!(3u#u es$e de!$0) 0u ( *(e!#*r !*r(#. ! (see!e( s$u(', d(6e$u# r)5!e ( u#$ * J!&r$($e” de05$ * 6*(#). Su!$ 0(8ur +! 0(re %r*"!*s$0u# %*($e & ("r(3($ %r! (%(r'( u!*r 0*%#0(' +! e3*#u'( 6*#. A0es$e( %*$ & "r(3e 4 se0u!d(re. C*%#0('#e "r(3e su!$: 0*(, ($er*s0#er*8( 3(s0u#(r), $u6er0u#*8( %u#*!(r). Coma diabetică: 0*( se!&0) %erdere( 0u!*4$!'e, ( *6#$)' 4 (
se!s6#$)' 0u %)s$r(re( res%r('e 4 ( 0r0u#('e. C*( es$e e0;3(#e!$u# 0#!0 (# s$)r de 0e$*(0d*8) de0*%e!s($). !(!$e de 3ree, 05!d !su#!( !u er( 0u!*s0u$), 0*( er( s&5r4$u# !e2*r(6# (# *r0)ru 6*#!(3. E( (%)re( 0( * &($(#$($e +! &('( 0)re( !u se %u$e( #u%$(. As$)8 0*( es$e e2$re de r(r) <@ , d(r !s$(#(re( e (re * "r(3$($e de*se6$). De (0ee( $re6ue re0u!*s0u$), %e!$ru ( %u$e( & %re3e!$) 4 0*6)$u$) #( $%. A3er$se!$u# es$e d($ de (%(r'( 4 !s$(#(re( (!*re2e #( u! d(6e$0, 0(re de *60e es$e %*#&(". Res%r('( de3!e ds%!e0) uss*u#, 0u r*s de (0e$*!) s(u ere %u$rede. Se ( %*$ (d)u"( 0e&(#ee, (e'e#, 0*#0, s*!*#e!').
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C5!d 0*( es$e !s$(#($), 0ee( 0e %res*!e(8) es$e #%s( de 0u!*4$!') ( 6*#!(3u#u. E2(e!u# de #(6*r($*r (r($) "#0e( %es$e <@ " , s0)dere( re8er3e (#0(#!e su6 <> 3(#. CO< %#(s), ;e*0*!0e!$r('e %r! des;dr($(re 1>@?.??? de #eu0*0$e, "#0*8ure (re. D("!*s$0u# 0*e #( u! d(6e$0 0u!*s0u$ !u es$e "reu %e 6(8( se!e#*r de ( sus. Es$e ( d&0# #( u! d(6e$0 !e0u!*s0u$, 05!d $re6ue de*se6$) de (#$e 0*e ;e*r("0), !e*%#(80), ;e%($0), ure0), (#0**#0), e$0.. Tr($(e!$u# $re6ue s) &e e!er"0, !s$$ure( #u (35!d re8u#$($e %*8$3e +! %es$e ? d! 0(8ur. Ateroscleroza
3(s0u#(r) r)5!e (s$)8 %*($e 0e( ( &re03e!$) 4
%*r$(!$) 0*%#0('e ( d(6e$u#u, d($ &!d s0)dere( +! &re03e!') ( 0*e d(6e$0e. D!$re #*0(#8)r#e ($er*s0#er*8e, 0e#e ( 0u!*s0u$e su!$: A$er*s0#er*8( 0ere6r(#) 0(re %*($e de$er!( (00de!$e 0ere6r(#e 3(s0u#(re A$er*s0#er*8( 0*r*!(r(!) 0(re se (!&es$) %r!
6*##e
0*r*!(re#*r (!"!( %e0$*r(#), !&(r0$u# *0(rd0, 0(u8e redu$(6#e 4 %r*3*0($*(re &re03e!$ de e2$us #( 6*#!(3 d(6e$0 A$er*s0#er*8( 3(s0u#(r) %er&er0) 0(re du0e #( (r$er*%($#e %er&er0e d(6e$0e. U!( d!$re 0e#e ( "r(3e 0*%#0(' d! (0es$ "ru% es$e "(!"re!( d(6e$0) #( +!0e%u$ us0($), u#$er*r, %r! su%r(!&e0$(re, ued). Tuberculoza pulmonară:
d(6e$u# 8(;(r($ es$e * 6*(#) 0(re +! "e!er(#
&(3*r8e(8) !&e0'#e. Tu6er0u#*8( %u#*!(r) 0(%)$) u! (s%e0$ 0#!0 0(3$(r, 0u e3*#u'e "r(3).
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C*%#0(' se0u!d(re: * sere de 0*%#0(' ( %u'! "r(3e 4 0(re &re03e!$ 0*!s$$ue 4 se!e %r! 0(re 6*(#( +4 (!u!') %re8e!'( su!$: 0*%#0(' 0u$(!($e: &uru!0u#*8), &uru!0u#u# (!$r(0*d, e$0. 0*%#0(' d"es$3e: (#3e*#$) e2%u#83), %*ree de!$(r), e$0. 0*%#0(' re!(#e: s0#er*8) re!(#), e$0. 0*%#0(' !er3*(se: !e3r(#", !e3r$e s0($0e +!de*se6, %*#!e3r$), !e3r$) (0us$0), (%($e, 0(%(0$($e de u!0) redus) (#$e 0*%#0(': re$!$) d(6e$0), 0($(r(0$).
TRATAMENT Tr($(e!$u# es$e 0ur($3 4 %r*&#(0$0. Tr($(e!$u# 0ur($3 es$e: "e!* de$e$0, ed0(e!$*s 4 6(#!e*&8*$er(%u$0. Tratamentul igienodietetic:
(0$3$($e( &80), 3('( +! 40(re 0( 4
re"u# (#e!$(r, (0es$e( su!$ *6#"($*r, 0;(r +!(!$e de ( (d!s$r( 6*#!(3u#u !su#!). A#e!$('( 6*#!(3u#u 3( & (d(%$($) "reu$)' 0*r%*r(#e 4 u!0 s(#e, de0 0;e#$ue##*r e!er"e$0e (#e *r"(!su#u s)u.
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Poate fi diabetul ţinut sub control?
Des"ur. C*!0e!$r('( 8(;)ru#u +! s5!"e 0u!*s0u$) 4 su6 !ue#e de glicemie %*($e & e!'!u$) +! #$e !*r(#e 0;(r 4 de 0)$re 0e 0(re (u &*s$ d("!*s$0(' 0u d(6e$ de $% II d(0) (0e4$( se ;r)!es0 s)!)$*s, &(0 su&0e!$) 40(re &80) 4 +4 %)s$re(8) "reu$($e( 0*r%*r(#) 05$ ( (%r*(%e de de(#.
A,i9'&%1i' 3"&"o%3" < E='#!i1i+ i-i! > Co&#o,+, di%*'+,+i De (see!e(, "reu$($e( !*r(#) (9u$) u#$ #( !*r(#8(re( "r)s#*r d! s5!"e 4 #( s0)dere( $e!su! (r$er(#e. U! d!$re d(6e$0 $re6ue s) &*#*se(s0) 4 ed0(e!$e %e!$ru (4 !*r(#8( "#0e(. Dieta cea mai sănătoasă pentru diabetici
F*#*sre( %r(de (#e!$('e s)!)$*(se $e (9u$) s) 0*!su * 3(re$($e de (#e!$e s)!)$*(se. A$u!0 05!d 0*!su * 3(re$($e de (#e!$e, *r"(!su# *6'!e $*($e 3$(!e#e 4 !er(#e#e de 0(re ( !e3*e.
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ATENŢIE? A0e(s$( es$e * 3(r(!$( ( %r(de (#e!$('e 0(re !0#ude 0(r!e. Es$e %re&er(6# s( re!u!'(' #( (0es$ (#e!$, +!$ru05$ 0(r!e( !u es$e !ds%e!s(6#( u!e (#e!$(' s)!)$*(se d%*$r3), e( 0*!'!e !uer*(se su6s$(!'e d)u!)$*(re s)!)$)'. V) re0*(!d s) s$ud(' * 3(r(!$) 3e"e$(r(!) ( %r(de . N. $r. C*!su(' (#e!$e d&er$e d! &e0(re "ru%) +! &e0(re 8. S$ud(' e2e%#u# de ( 9*s %e!$ru ( 3ede( 0u se %*($e re(#8( (0es$ #u0ru. Zi+% 0 Zi+% @ F#+!'5 )r %(r) %*r$*0(#) 6(!(!( V'#d'+#i5 3(r8( s(#($( &(s*#e 3erde Cereale şi amidonoase
Cere(#e#e 4 (d*!*(se#e su!$ * 0($e"*re de (#e!$e +! 0(re se !0#ud %5!e(, 0ere(#e#e %e!$ru 0u# de9u!, %(s$e#e &)!*(se, 0(r$*& 4 (#$e #e"ue 0u 0*!'!u$ 0res0u$ de (d*!. C*!su(' (d*!*(se #(
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&e0(re (s). U! *(e! 3) 3*r s%u!e 0) !u e 6!e s) 5!0(' %re( u#$ d! (s$&e# de (#e!$e, d(r (0es$ s&($ !u ( es$e 0*re0$. C*!suu# de (#e!$e 6*"($e +! (d*! s( d*3ed$ ( & s)!)$*s %e!$ru $*($) #ue(, !0#us3 %e!$ru 0e 0(re su&er) de d(6e$. Nu)ru# de %*r' %e 0(re #e %*' 0*!su( +! &e0(re 8 de%!de de
Ne0es(ru# $)u de 0(#*r S0;e( de $r($(e!$ (!$d(6e$0 %e 0(re * &*#*se4$.
Ad*!*(se#e *&er) *r"(!su#u e!er"e, 3$(!e, !er(#e, %re0u 4 &6re. A'&1i'? Cere(#e#e !$e"r(#e su!$ ( s)!)$*(se %e!$ru 0) e#e 0*!'! ( u#$e 3$(!e, !er(#e s &6re. F6re#e 0*6($ 0*!s$%('( s 0*!$r6ue #( s)!)$($e( !$es$!e#*r. Cât este o porţie de amidonoase?
1 P*r'e:
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P*' 0*!su( u!(, d*u( s(u $re %*r' de (#e!$e (d*!*(se #( u! %r5!8. D(0) &*#*se4$ ( u#$ de05$ * s!"ur) %*r'e #( * (s), %*' @?
*%$( +!$re ( 5!0( ( u#$e $%ur de (#e!$e (d*!*(se s(u ( u#$e %*r' d! (0e#(4 (#e!$.
Cum să cumperi, să găteşti şi să consumi alimente amidonoase cât mai sănătoase?
Cu%)r(' 0ere(#e 4 %5!e !$e"r(#e
C*!su(' 05$ ( %u'! 4 ( r(r (d*!*(se %r)9$e, 6*"($e +! "r)se, 0u (r & 0(r$*& %r)9', 0;%sur#e, %re%(r($e#e de %($sere, 6s0u', 6r*4e#e e$0.
F*#*s' (ur$ de"res($ s(u %(r'(# de"res($ +! #*0 de s5!$5!) %e!$ru 0(r$*& 0*%'.
!#*0u' (*!e8( d! s(!dY0;ur 0u u4$(r.
!#*0u' (*!e8( 4 (r"(r!( &*#*s$e 0u %5!e, 0;&#e s(u %5!e %r)9$) 0u (#$er!($3e de"res($e %(r'(# s(u $*$(#.
F*#*s' ds%*8$3e de $% s%r( %e!$ru ( %u#3er8( u#eu# %e (#e!$e +! #*0 de ( (d)u"( u#e 0( ($(re, dresur de s(#($e, u!$ s(u (r"(r!).
G)$' 4 0*!su(' 0ere(#e#e 0u #(%$e de"res($ s5!$5!$ s(u %(r'(# de"res($ 1.
F*#*s' !u( "eur s(u du#0e'ur &)r) 8(;)r, 6r5!8) de 3(0 &)r) "r)se s(u (ur$ de"res($.
Verdeţuri
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Verde'ur#e su!$ (#e!$e s)!)$*(se %e!$ru $*', !0#us3 %e!$ru d(6e$0. C*!su(' +! &e0(re 8 3erde'ur 4 #e"ue 0rude 4 ")$$e. E#e 3) *&er) 3$(!e, !er(#e 4 &6re, 0u &*(r$e %u'!e 0(#*r. Nu)ru# de %*r' %e 0(re (r $re6u s) #e 0*!su +! &e0(re 8 de%!de de
Ne0es(ru# $)u de 0(#*r Cu +' +!"r9e4$ d(6e$u#.
Cât de mult este o porţie de verdeţuri?
1 P*r'e:
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P*' 5!0( u!(, d*u) s(u $re %*r' de 3erde'ur #( * (s). D(0) 0*!su ( u#$ de05$ * %*r'e #( * (s), %*' *%$( +!$re ( 0*!su( $%ur d&er$e de 3erde'ur s(u ( ser3 d*u) s(u $re %*r' d! (0e#(' $% de 3erde'ur.
Cum să cumperi, să găteşti şi să consumi verdeţuri cât mai sănătoase?
C*!su(' 3erde'ur 4 #e"ue 0rude s(u ")$$e 0u %u'!) s(u &)r) "r)se (d)u"($). D(, es$e %*s6# 0( 3erde'ur#e s) &e ")$$e 4 0*!su($e &)r) !0 u! %0 de "r)seZ
!0er0(' dresur de s(#($e &)r) "r)se s(u 0u 0*!'!u$ redus de "r)se #( 3erde'ur#e 4 s(#($e#e 0*!su($e.
G)$' 3erde'ur#e #( (6ur +!)6u4$ s(u 0u * 0(!$$($e 0) de (%), &)r) "r)se.
Ad)u"(' %u'!) 0e(%) s(u us$ur* )ru!'$e.
F*#*s' %u'! su0 de #)5e %e!$ru ( d( "us$ 3erde'ur#*r s(u s(#($e#*r.
Pres)r(' de(su%r( r*de! 4 0*!de!$e 3e"e$(#e. A0es$e( d(u "us$ de#0*s d(r !u 0*!'! "r)s s(u 0(#*r (%r*(%e de#*0.
D(0) &*#*s' * 0(!$$($e 0) de "r)se, (#e"e' u#e de )s#!e, de &#*(re( s*(re#u s(u (r"(r!) de 0*!ss$e!') *(#e #( $u6 +! #*0 de 0(r!e "r(s), u!$, s#)!!) s(u dresur "r(se. Fructe
@@
Fru0$e#e su!$ s)!)$*(se %e!$ru $*($) #ue(, !0#us3 %e!$ru d(6e$0. Fru0$e#e !e d(u e!er"e, 3$(!e, !er(#e 4 &6re.
Nu)ru# de %*r' %e 0(re $re6ue s) #e 0*!su 8#!0 de%!de de
Ne0es(u# de 0(#*r. Cu +' $r($e8 d(6e$u#.
Cât este o porţie de fructe?
1 P*r$e:
< P*r$:
P*' s) 0*!su u!( s(u d*u) %*r' de &ru0$e #( * (s). D(0) )!5!0 ( u#$ de05$ * %*r'e #( * (s), (#e"e $%ur d&er$e de &ru0$e s(u 0*!su) d*u) %*r' d! (0e#(4 &ru0$. @
Cum ar trebui să mănânc fructele?
P*' 5!0( &ru0$e#e +! s$(re 0rud), su6 &*r) de su0 &)r) (d(us de 8(;)r s(u 0*!ser3($e +! sr*% %r*%ru *r %r! us0(re.
Cu%)r(' &ru0$e de de!su! ( 0.
C*!su(' de %re&er!') &ru0$e#e !$e"r(#e +! #*0 s) 6e' d*(r su0u# #*r. Pe #5!") (#$e (3(!$(9e, 3) 3e' s)$ur( ( re%ede.
Cu%)r(' !u( su0ur de &ru0$e 0(re 0*!'! 1?? su0 !($ur(# de &ru0$e, &)r) (d(us de 8(;)r.
Be' su0u# de &ru0$e +! 0(!$$)' 0.
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Lapte şi iaurt
L(%$e#e 4 (ur$u# de"res($e s(u %(r'(# de"res($e su!$ s)!)$*(se %e!$ru $*($) #ue(, !0#us3 %e!$ru d(6e$0. L(%$e#e 4 (ur$u# !e *&er) e!er"e, %r*$e!e, 0(#0u, 3$(!( A 4 (#$e 3$(!e 4 !er(#e. Be' 8#!0 #(%$e de"res($ s5!$5!$ s(u %(r'(# de"res($ 1. F*#*s' (ur$ de"res($ s(u %(r'(# de"res($. A0es$e( 0*!'! ( %u'!e "r)s $*$(#e, s($ur($e 4 0*#es$er*#.
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Cât este o porţie de lapte şi iaurt?
1 P*r$e:
Proteine şi alimente proteice
A#e!$e#e %r*$e0e su!$ 0(r!e(, *u)#e, 6r5!8(, %e4$e#e, #e"u!*(se#e us0($e &(s*#e, s*( e$0. 4 $*&u. C*!su(' 0(!$$)' 0 d! (0es$e (#e!$e +! &e0(re 8.
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Ne0es(ru# $)u de 0(#*r.
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Cât este o porţie de alimente proteice
1 P*r$e:
ATENŢIE? M)re( %*r'e %e 0(re * 0*!su(' (0u s(r %u$e( s) &e %re( (reZ O %*r'e $re6ue s) !u de%)4e(s0) ?? " du%) ")$re, (d0) * 6u0($) de de!su!e( u!u %(0;e$ de 0)r' de 9*0. Cum să cumperi, să găteşti şi să consumi alimente proteice cât mai sănătoase?
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răsimi şi uleiuri
Gr)s#e 4 u#eur#e se ")ses0 +! 35r&u# %r(de. A0e(s$( !e s%u!e 0) $re6ue s) #e 0*!su) !u( +! 0(!$$)' 0, +!$ru05$ 0*!'! &*(r$e u#$e 0(#*r. U!e#e "r)s 0*!'! 4 "r(s s($ur($e 4 0*#es$er*# 0(re su!$ d)u!)$*(re s)!)$)'. Gr)se( %*($e %r*3e! 4 d! (#$e (#e!$e, 0u es$e 0(r!e( 4 u!e#e %r*duse #(0$($e. A#e!$e#e 6*"($e +! "r)s su!$ s%$$*(re. D(r %)s$r(re( 0*!suu#u (0es$*r (#e!$e #( 3(#*r s0)8u$e 3) (9u$) s) s0)%(' de #*"r(e#e +! %#us, s) 3) re(du0e' #( !*r(# 8(;)ru# 4 "r)s#e d! s5!"e 4 s) s0)de' 3(#*r#e $e!su! (r$er(#e. Cât este o porţie de grăsimi sau ulei
1 P*r$e: @-
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Mese#e %e 0(re #e 0*!su %*$ !0#ude u!( s(u d*u( %*r' de "r(se. Dulciuri
Du#0ur#e se ")ses0 $*$ +! 35r&u# %r(de. A0e(s$( !e s%u!e 0) $re6ue s) #e 0*!su) +! 0(!$$)' 0 4 r(r. Du#0ur#e 0*!0e!$r($e 0*!'! 0(#*r &*(r$e u#$e d(r !u 4 (#$e su6s$(!'e !u$r$3e. U!e#e du#0ur 0u (r & %r)9$ur#e, %#)0!$e#e, 4 %r*duse#e de 0*&e$)re 0*!'! 4 0(!$$)' (%re0(6#e de "r)se. De (see!e(, e#e %*$ Du#0ur#e su!$ &*(r$e s%$$*(re. D(r d(0) #e 3e' 0*!su( d(r +! 0(!$$)' 0, 3e' reu4 s) e#!(' #*"r(e#e +! %#us, s) 3) e!'!e' "#0e( 4 "r)s#e d! s5!"e su6 0*!$r*# 4 s) s0)de' 3(#*r#e $e!su! (r$er(#e.
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Cât este o porţie de dulciuri?
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D! 05!d +! 05!d %u$e' 5!0( 05$e * %*r'e de du#0ur. Or0u, es$e 6!e s) ds0u$(' 0u ed0u# d3s. +! #e")$ur) 0u (0es$ su6e0$. Cum pot să!mi satisfac dorinţa de dulce?
C*!su(' d! 05!d +! 05!d 05$e * %*r'e de +!";e'($) de"res($), %re%(r($) +! 0(s), (ur$ s(u u! s;(e d! &ru0$e du#0. Nu u$(' 0) 4 (#e!$e#e de"res($e s(u 0u 0*!'!u$ redus de 8(;)r 0*!'! 0(#*r. I!0#ude'#e +! %#(!u# d3s. (#e!$(r. Piramida alimentaţiei sănătoase
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su!$ s!"ure#e 0(re se %*$ (d!s$r( I.V, I.M., S.C. Ce#e#(#$e $%ur de !su#!e se (d!s$re(8) e20#us3 S.C.
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COMPLICAŢIILE TRATAMENTULUI IN8ULINIC -
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P(0e!$( se re0re(8) ur)r!d $e#e38*ru# 4 (s0u#$5!d r(d*u#, de (see!e( 0u#$3) #e"ue 4 &#*r +! "r)d!( %r*%re. ").#evoia de a învă%a.
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CONCLUZII
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BIBLIOGRAFIE
/MEDICINĂ INTERNĂ” L. G;er(s
Ed.Med0(#) 1
/MANUAL DE MEDICINĂ INTERNĂ” C.B*ru!de#
Ed.Med0(#) 1=
/TEHNICA NGRI`IRII BOLNAVULUI” C.M*8es
Ed.Med0(#) 1-?
/NGRI`IRI SPECIALE ACORDATE PACIENILOR DE CĂTRE ASISTENII MEDICALI” L.T$r0)
Ed.V('( Med0(#) R*5!e(s0)
/GERIATRIE PRACTICĂ” C.B)#)0e(!u S$*#!0
Ed.Med0(#)
/DIABETUL _AHARAT. GHID PRACTIC” Pr*&.dr.C.Du$res0u Dr. R.Per0u!
Ed.S(e0u#u
1
