#1
|
|||
|
|||
Íèçêèå ñàõàðà óòðîì
Óâàæàåìûå ãîñïîäà!
Ìîÿ äî÷ü, åé 40 ëåò áîëüíà èíñóëèíçàâèñèìûì äèàáåòîì 24 ãîäà è 18 ëåò ðàññåÿííûì ñêëåðîçîì. Èíâàëèä 1 ãðóïïû. Ïðèíèìàåò èíñóëèí Ëåâåìèð 2 ðàçà â äåíü, óòðîì è âå÷åðîì, óòðîì 24 åäèíèöû, âå÷åðîì -6 åäèíèö. Íîâîðàïèä ïî ðàñ÷åòó. Ñ ñåðåäèíû îêòÿáðÿ ýòîãî ãîäà ó íåå ïî óòðàì ïîÿâèëàñü ãèïîãëèêåìèÿ. Íà÷àëè ñíèæàòü äîçû Ëåâåìèðà. Ñ ñóììàðíîé 30 åä. ñíèçèëè äî 20åä. ïî óòðàì. Êîëè÷åñòâî ãèïîãëèêåìèé óìåíüøèëîñü. ×òî-òî â îðãàíèçìå ïîìåíÿëîñü. Ýíäîêðèíîëîã íàçíà÷èë àíàëèçû. Àíàëèçû ïðèëàãàþòñÿ. Òàêæå áûë ñäåëàí àíàëèç êðîâè íà ÀÊÒÃ, ðåçóëüòàò -35,2. Âðà÷ îöåíèë àíàëèçû êàê õîðîøèå. Êðîìå ÒÒÃ. Íàçíà÷èë Ëåâîòåðîêñèí â äîçå 25ìã. Íå ÿñíî, ÷òî ïðèâåëî ê óìåíüøåíèþ ïîòðåáíîñòè èíñóëèíà? ×òî ìîæåò áûòü? Ïðîøó íå ïðèíèìàòü âî âíèìàíèå íàëè÷èå áàêòåðèàëüíîé çàãðÿçíåííîñòè ìî÷è. Íå áûëî âîçìîæíîñòè íîðìàëüíî ñîáðàòü ìî÷ó. |
#2
|
||||
|
||||
Âîçìîæíîé ïðè÷èíîé òàêîãî ìîæåò áûòü âîçíèêøèé ãèïîòèðîç, ñêîðåå âñåãî òîæå àóòîèììóííîãî ãåíåçà, íà ìîé âçãëÿä äîçà òèðîêñèíà ìàëîâàòà, íà÷èíàòü ëå÷åíèå ñëåäóåò ñ ìèíèìóì 1 ìêã/êã âåñà (ó áîëüøèíñòâà ñ ãèïîòèðîçîì ïîääåðæ. äîçà 1.5-1.75 ìêã/êã), ó âîçìîæíîì ãèïîãëèêåìè÷åñêîì äåéñòâèè ãèïîòèðîçà íàïðèìåð çäåñü:
The hypoglycemic side of hypothyroidism [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
|
|||
|
|||
Ïîìèìî ãèïîòèðåîçà -÷òî èçìåíèëîñü?
Ñíèæåíèå âåñà, àðòåðèàëüíîå Äàâëåíèå , íîâûå ïðåïàðàòû? |
#4
|
|||
|
|||
Ñïàñèáî áîëüøîå.
Íè÷åãî íå ìåíÿëîñü, âåñ è ïð. - òîæå ñàìîå. Ïðèíèìàåò ïðåïàðàòû: ãàëàíòàìèí - íåñêîëüêî ëåò è 6 ìåñÿöåâ èììóíîãëîáóëèí ÷åëîâåêà íîðìàëüíûé. Äîêòîð ïðåäïîëàãàë, ÷òî ïî÷êè èëè íàäïî÷å÷íèêè, àíàëèçû íå ïîäòâåðäèëè. Âðà÷ ñêàçàë, ÷òî ãèïîòåðèîç âûçûâàåò ïîâûøåíèå ñàõàðîâ 25 ìã ëåâîòèðîêñèíà - íà÷àëüíàÿ äîçà, ïüåò 2 äíÿ. ×åðåç íåäåëþ áóäåì ïîâûøàòü äî 50ìã. |
#5
|
||||
|
||||
Öèòàòà:
First, in hyperthyroid patients, the diagnosis of glucose intolerance needs to be considered cautiously, since the hyperglycemia may improve with treatment of thyrotoxicosis. Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia. Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] íå âèæó ñìûñëà òèòðîâàòü äîçó òèðîêñèíà - ýòî èíîãäà äåëàåòñÿ ó ïîæèëûõ ñ çàáîëåâàíèÿìè ñåðäöà
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
|
|||
|
|||
Ïîæàëóéñòà,ïîñìîòðèòå íå ñîäåðæèò ëè ïðåïàðàò èììóíîãëîáóëèíà ìàëüòîçó?
|
#7
|
|||
|
|||
Âàäèì Âàëåðüåâè÷!
Ñïàñèáî áîëüøîå çà ñòàòüþ. Î÷åíü ïðîÿñíèëà ñèòóàöèþ. Ñêîðåå âñåãî ó íàñ ãèïîòåðèîç âûçûâàåò ãèïîãëèêåìèþ. Ïîêàæó ñòàòüþ íàøåìó âðà÷ó. Åùå ðàç ñïàñèáî. |
#8
|
|||
|
|||
Èììóíîãëîáóëèí ñîäåðæèò êèñëîòó àìèíîóêñóíóþ è áîëüøå íè÷åãî.
|
#9
|
||||
|
||||
Ýóòèðîêñ äîçèðóåòñÿ â ìêã - íå â ìã.
__________________
Ã.À. Ìåëüíè÷åíêî |