Kev Kho Mob Ntshav Qab Zib hauv Cov Neeg Laus: Ib Txoj Haujlwm Pragmatic

Dr Ravi Sankar Erukulapati
MBBS, MRCP (UK), CCT – GIM, Diabetes & Endocrinology (UK)
Senior endocrinologist
Apollo Tsev Kho Mob, Jubilee Toj Siab, Hyderabad

Kev saib xyuas tus kab mob ntshav qab zib rau cov neeg laus muaj nws tus kheej cov teeb meem, thiab cov no yuav tsum tau xav txog thaum npaj kev kho tus kab mob ntshav qab zib rau cov neeg laus.

Qhov muaj mob ntshav qab zib ntau zuj zus raws li hnub nyoog. Kwv yees li ib feem plaub ntawm cov pej xeem uas muaj hnub nyoog tshaj 65 xyoo muaj mob ntshav qab zib, raws li kev kwv yees. Ib txhia ntawm lawv muaj ntau yam kab mob sib koom ua ke, xws li teeb meem raum, kab mob plawv , uas yuav tsum tau suav nrog, thaum npaj kev kho mob. Ntxiv mus, ib txhia ntawm cov neeg laus yog cov neeg uas vam khom, nyob nrog kev pab los ntawm lwm tus, lub cev lossis nyiaj txiag.

Ntxiv rau saum toj no; polypharmacy (kev siv ntau yam tshuaj los ntawm tus neeg mob) yog ib qho kev txhawj xeeb vim tias ntau tus neeg laus muaj ntau yam tshuaj rau ntau yam mob sib nrug los ntawm ntshav qab zib. Qhov no ua rau muaj teeb meem kev ua raws cai, kev txhawj xeeb txog tus nqi thiab kev sib cuam tshuam ntawm cov tshuaj. Kev ua haujlwm tsis taus thiab teeb meem nco tsis pab qhov teeb meem ib yam nkaus.

Muab tag nrho cov saum toj no, cov kws kho mob ntshav qab zib yuav tsum tau ua kom muaj kev noj qab haus huv tag nrho ntawm tus kheej, kev pheej hmoo rau cov ntshav qab zib tsawg, kev pheej yig thiab lub sijhawm kwv yees ntawm kev muaj sia nyob thaum muab tshuaj thiab thaum npaj cov kev saib xyuas tus kheej. Qhov no kuj pab hauv kev npaj cov tshuaj noj yooj yim uas tuaj yeem ua tau yooj yim los ntawm cov neeg mob thiab lawv cov neeg saib xyuas.

Kev kuaj mob rau kev puas hlwb thiab kev nyuaj siab tuaj yeem ua tau thaum lub sijhawm mus ntsib kws kho mob rau cov neeg laus mus rau cov chaw kho mob ntshav qab zib vim nws pab nrhiav pom cov no, xa mus rau qhov chaw tsim nyog, thiab kev tswj hwm. Yuav tsum zam kev mob ntshav qab zib qis lossis ntshav qab zib qis yuav tsum paub, lees paub thiab kho kom zoo. Qhov no tuaj yeem ua tiav los ntawm kev qhia cov neeg mob kom zoo thiab kev cob qhia cov neeg saib xyuas. Kev teeb tsa cov hom phiaj ntshav qab zib tiag tiag thiab kev siv tshuaj nrog kev pheej hmoo tsawg ntawm ntshav qab zib qis yog qhov tseem ceeb heev.

Cov nqi ntshav qab zib rau cov neeg laus yuav tsum tau txo qis yam tsis tas yuav ua siab loj dhau rau kev tswj hwm ntshav qab zib nruj heev. Tus nqi HbA1c ntawm lub hom phiaj, piv txwv li, qhov nruab nrab ntawm peb lub hlis ntawm kev kuaj ntshav qab zib 'tus nqi lub hom phiaj' yuav tsum tau txo qis. Tib lub sijhawm, nws yog ib qho tseem ceeb los qhia txog kev zam kev qhuav dej , thiab qhov xav tau los tiv thaiv thiab kho cov ntshav qab zib ntau dhau uas yuav ua rau muaj teeb meem txaus ntshai ntawm Hyperglycaemic Coma.

Vim tias kev tswj tus kab mob ntshav qab zib suav nrog kev tshuaj xyuas cov teeb meem xws li Neuropathy, Nephropathy, Retinopathy thiab Kab mob plawv , cov no yuav tsum tau saib xyuas. Kev mob ntshav siab thiab cov roj cholesterol siab yuav tsum tau kho kom zoo nrog cov tshuaj txo ntshav siab thiab statins. Ib tug me nyuam Aspirin rau kev tiv thaiv kev mob plawv, mob hlwb strokes yuav tsum tau qhia thaum twg tsim nyog.

Kev saib xyuas ko taw feem ntau yog qhov chaw tsis saib xyuas hauv cov neeg laus mob ntshav qab zib feem ntau ua rau mob ko taw thiab qee zaum txawm tias txiav. Ib zaug ntxiv, kev kawm, kev tiv thaiv cov teeb meem ntawm ko taw thiab kev tshuaj xyuas tib yam yog qhov tseem ceeb heev. Kev ntsuas yooj yim xws li, tsis taug kev liab qab, saib xyuas pob taws tawg tuaj yeem pab tau ntau.

Raws li Cov Tsev Laus Laus tau dhau los ua tus qauv txawm nyob hauv Is Nrias teb, nws yog qhov tseem ceeb rau kev cob qhia cov neeg ua haujlwm hauv cov tsev kawm ntawv txog cov hauv paus ntawm kev kho mob ntshav qab zib, xws li:

1. Kev lees paub thiab kev kho mob ntshav qab zib tsawg
2. Kev tswj hwm ntawm insulin rau cov neeg laus mob ntshav qab zib muaj teeb meem dexterity lossis teeb meem nco

Kev siv cov tshuaj yooj yim, siv tau zoo nrog cov tshuaj insulins niaj hnub uas tsis tshua muaj kev pheej hmoo ntawm cov ntshav qab zib tsawg, yeej pab tau rau hauv cov txheej txheem no.

Palliative care lossis kev saib xyuas tus neeg mob uas mob ntshav qab zib yuav tsum tau hloov kho kev kho mob tsis tu ncua. Kev nruj BP thiab kev tswj cov piam thaj tsis tsim nyog hauv qhov xwm txheej zoo li no. Cov tshuaj lipid-txo qis yuav tsum tau muab tshem tawm, thiab kev tshem tawm tag nrho ntawm kev kho yuav tsim nyog nyob rau qee qhov xwm txheej. Zuag qhia tag nrho kev nplij siab, tiv thaiv cov tsos mob ntawm kev ntxhov siab, thiab kev khaws cia ntawm lub neej thiab kev hwm yuav tsum yog lub hom phiaj tseem ceeb.

Cov neeg laus, tshwj xeeb tshaj yog cov neeg uas muaj tus kab mob ntshav qab zib, muaj feem yuav raug mob los ntawm cov teeb meem ntawm Covid-19 . Cov chaw kho mob hauv xov tooj yuav pab tau saib xyuas cov neeg mob ntshav qab zib uas laus thaum lub sijhawm Covid no.

Hauv kev xaus lus, cov teeb meem ntawm kev saib xyuas tus kab mob ntshav qab zib rau cov neeg laus tuaj yeem kov yeej tau los ntawm kev siv cov tswv yim yooj yim ntawm kev sib xyaw ua ke kev nkag siab zoo, kev muaj tiag thiab kev khuv leej rau kev kho mob thiab kev qhia cov neeg mob nrog rau lawv cov neeg saib xyuas txog qhov no.