قد يَرتفِع السكر في الدم في داء السُّكري لأسباب عديدة. عليكَ معرفة أسباب وأعراض وعلاج ارتفاع سكر الدم عند الحضور إلى الطوارئ؛ للحصول على المساعدة.
متى تزور الطبيب
اطلب المساعدة الفورية من الطبيب أو اتصل بالرقم 911 (أو رقم الطوارئ في بلدك أو مدينتك) في الحالات الآتية:</h3><ul dir="rtl"> <li dir="rtl">إذا كنت مصابًا بإسهال أو قيء مستمر، ولا يمكنك إبقاء أي أطعمة أو سوائل في معدتك</li> <li dir="rtl">إذا ظلت مستويات غلوكوز الدم لديك أعلى من 240 ملغم/دل (13.3 ملليمولاً/لتر) وكانت تظهر عليك أعراض وجود كيتونات في البول</li></ul>
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</section>
<section>
<h4>الأسباب</h4>
<div class="section-description">
<p dir="rtl">يعمل الجسم أثناء عملية الهضم على تكسير الكربوهيدرات الموجودة في الطعام، مثل الخبز والأرز والمعكرونة، إلى جزيئات سكر. وأحد أنواع جزيئات السكر يُعرَف باسم الغلوكوز. وهو أحد مصادر الطاقة الرئيسية في الجسم. يُمتص الغلوكوز ويذهب مباشرةً إلى مجرى الدم بعد الأكل، لكنه لا يستطيع الدخول إلى خلايا معظم أنسجة الجسم من دون مساعدة الأنسولين. الأنسولين هرمون يفرزه البنكرياس.</p><p dir="rtl">عند ارتفاع مستوى الغلوكوز في الدم، يفرز البنكرياس الأنسولين. ويعمل الأنسولين على فتح الخلايا حتى يدخل الغلوكوز إليها. وتوفر هذه العملية الطاقة التي تحتاجها الخلايا لتعمل بشكل سليم. ويُخزَّن الغلوكوز الزائد في الكبد والعضلات.</p><p dir="rtl">وتقلل هذه العملية كمية الغلوكوز الموجودة في مجرى الدم وتمنعه من الوصول إلى مستويات عالية خطيرة. ومع رجوع مستوى السكر في الدم إلى حالته الطبيعية، تنخفض في المقابل كمية الأنسولين التي يفرزها البنكرياس.</p><p dir="rtl">أما داء السكري، فيؤدي إلى خفض آثار الأنسولين على جسمك بمعدلات كبيرة. فقد يرجع السبب في ذلك إلى عدم قدرة البنكرياس على إنتاج الأنسولين، كما هو الحال في داء السكري من النوع الأول، أو قد يكون بسبب مقاومة جسمك لتأثير الأنسولين أو عدم إنتاج ما يكفي من الأنسولين للحفاظ على مستوى الغلوكوز الطبيعي كما هو الحال في داء السكري من النوع الثاني.</p><p dir="rtl">وبالنسبة إلى المصابين داء السكري، يتراكم الغلوكوز في مجرى الدم. وتُعرَف هذه الحالة المَرضية باسم فرط سكر الدم. وقد يرتفع الغلوكوز حتى يصل إلى مستويات خطيرة إذا لم يُعالَج على نحو ملائم. كما يُستخدَم الأنسولين والأدوية الأخرى لخفض مستويات السكر في الدم.</p>
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</section>
<section>
<h4>عوامل الخطورة</h4>
<div class="section-description">
<p dir="rtl">ثمة عوامل عديدة يمكن أن تؤدي إلى الإصابة بارتفاع سكر الدم، نذكر منها ما يلي:</p><ul dir="rtl"> <li dir="rtl">عدم أخذ قدر كافٍ من الأنسولين أو أدوية السكري الأخرى</li> <li dir="rtl">عدم حقن الأنسولين بشكل صحيح أو أخذ أنسولين منتهي الصلاحية</li> <li dir="rtl">عدم اتباع خطة التغذية الخاصة بمرض السكري</li> <li dir="rtl">الخمول</li> <li dir="rtl">الإصابة بمرض أو عدوى</li> <li dir="rtl">أخذ أدوية معينة مثل الستيرويدات أو مثبطات المناعة</li> <li dir="rtl">الإصابة بجرح أو إجراء جراحة</li> <li dir="rtl">التعرض للتوتر العاطفي كالخلافات الأسرية أو مواجهة مشكلات في مكان العمل</li></ul><p dir="rtl">يمكن أن يحفز المرض أو التوتر فرط سكر الدم. ذلك لأن الهرمونات التي يفرزها الجسم لمقاومة المرض أو التوتر يمكن أن تسبب ارتفاع سكر الدم أيضًا. وقد تحتاج إلى تناول أدوية سكري إضافية لإبقاء مستوى غلوكوز الدم لديك عند المعدلات الطبيعية أثناء المرض أو التوتر.</p>
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</section>
<section>
<h4>المضاعفات</h4>
<div class="section-description">
<h3>المضاعفات على المدى الطويل</h3> <p dir="rtl">من الممكن أن يساعد الحفاظ على نسبة سكر الدم ضمن النطاق الصحي على الوقاية من العديد من المضاعفات المرتبطة بداء السكري. وتتضمن المضاعفات طويلة المدى لفرط سكر الدم غير المُعالج ما يلي:</p><ul dir="rtl"> <li dir="rtl">المرض القلبي الوعائي</li> <li dir="rtl">تلف الأعصاب (اعتلال عصبي)</li> <li dir="rtl">تضرر الكلى (اعتلال الكلى السكري) أو الفشل الكلوي</li> <li dir="rtl">تضرر الأوعية الدموية في الشبكية (اعتلال الشبكية السكري)، وقد يؤدي هذا إلى الإصابة بالعمى</li> <li dir="rtl">مشكلات القدمين الناتجة عن الأعصاب التالفة أو ضعف تدفق الدم الذي يمكن أن يؤدي إلى التهابات وتقرحات خطيرة بالجلد، وقد يصل الأمر في بعض الحالات الشديدة إلى البتر</li> <li dir="rtl">مشكلات العظام والمفاصل</li> <li dir="rtl">حالات التهاب الأسنان واللثة</li></ul> <h3>مضاعفات طارئة</h3> <p dir="rtl">إذا ارتفع مستوى السكر في الدم ارتفاعًا كبيرًا أو إذا لم يُعالج، فقد يؤدي ذلك إلى حالتين خطيرتين.</p><ul dir="rtl"> <li dir="rtl"> <p dir="rtl"><b dir="rtl">الحماض الكيتوني السكري.</b> تحدث الإصابة بهذه الحالة عند عدم وجود أنسولين كافٍ في جسمك. وعند حدوث ذلك، لا يستطيع الغلوكوز الدخول إلى الخلايا لإمدادها بالطاقة. ومن ثم يرتفع مستوى السكر في الدم ويبدأ جسمك تحليل الدهون للحصول على الطاقة.</p> <p dir="rtl">عند تحليل الدهون للحصول على الطاقة في الجسم، فإنها تنتج أحماضًا سامة تُسمى الكيتونات. وتتراكم تلك الكيتونات في الدم وفي النهاية تتسرب في البول. يمكن أيضًا أن يؤدي الحماض الكيتوني السكري إذا لم يُعالج إلى غيبوبة السكري التي تشكل تهديدًا للحياة.</p> </li> <li dir="rtl"> <p dir="rtl"><b dir="rtl">فرط الأسمولية وفرط سكر الدم.</b> تحدث هذه الحالة عندما يفرز الجسم الأنسولين، لكنه لا يُستهلك بشكل صحيح. قد ترتفع مستويات الغلوكوز في الدم ارتفاعًا كبيرًا وتتخطى 600 ملغم/دل (33.3 ملليمول/لتر) دون الحماض الكيتوني. وعند الإصابة بهذه الحالة المَرَضية، لا يستطيع الجسم استخدام الغلوكوز أو الدهون للحصول على الطاقة.</p> <p dir="rtl">يتسرب الغلوكوز بعد ذلك في البول مسببًا زيادة التبول. يمكن أن تؤدي حالة فرط الأسمولية وفرط سكر الدم عند عدم علاجهما إلى جفاف وغيبوبة يمكنهما تهديد الحياة. من المهم أن تتلقى رعاية طبية لهذه الحالة عل الفور.</p> </li></ul>
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</section>
<section>
<h4>الوقاية</h4>
<div class="section-description">
<p dir="rtl">للمساعدة في الحفاظ على نسبة السكر في الدم ضمن المعدل الصحي:</p><ul dir="rtl"> <li dir="rtl"><b dir="rtl">اتبع خطة وجبات مرض السكري.</b> إذا كنت تأخذ الأنسولين أو تتناول دواء للسكري عن طريق الفم، فكن منتظمًا فيما يتعلق بكمية وجباتك الرئيسية ووجباتك الخفيفة وتوقيتاتها. ويجب أن يكون الطعام الذي تتناوله متوازنًا مع الأنسولين الذي يعمل في جسمك.</li> <li dir="rtl"><b dir="rtl">راقب مستوى السكر في دمك.</b> يمكنك رصد مستوى السكر في دمك وتسجيله عدة مرات أسبوعيًا أو يوميًا، حسب خطتك العلاجية. فالرصد الدقيق هو السبيل الوحيد لضمان الحفاظ على مستوى السكر في الدم ضمن المعدل المستهدف. لاحظ عندما تكون قراءات الغلوكوز لديك أعلى من المعدل المستهدف أو أقل منه.</li> <li dir="rtl"><b dir="rtl">اتبع بعناية إرشادات الطبيب بشأن كيفية أخذ الدواء.</b></li> <li dir="rtl"><b dir="rtl">عدِّل أدويتك إذا تغير مستوى نشاطك البدني.</b> وينبغي أن يعتمد تعديل الأدوية على نتائج اختبارات سكر الدم وعلى نوع النشاط الذي تمارسه ومدته. إذا كانت لديك أسئلة حول ذلك، فتحدث إلى الطبيب.</li></ul>
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</section>
<section>
<h4>التشخيص</h4>
<div class="section-description">
<p dir="rtl">سيساعدك الطبيب على تحديد النطاق المستهدف لمستوى سكر الدم. وتُوصي مايو كلينك بصفة عامة العديد من المصابين بداء السكري باتباع مستويات السكر في الدم المستهدفة قبل الوجبات على النحو التالي:</p><ul dir="rtl"> <li dir="rtl">بين 80 و120 ميليغرام لكل ديسي لتر (4.4 و6.7 ميليمول لكل لتر) للأشخاص الذين يبلغون 59 عامًا أو أقل وليست لديهم حالات طبية أخرى غير مرض السكري</li> <li dir="rtl">بين 100 و140 ملغم/دل (5.6 و7.8 ميليمول/لتر) للأشخاص التالين: <ul dir="rtl"> <li dir="rtl">مَن هم في سن 60 عامًا فما فوق</li> <li dir="rtl">مَن يواجهون حالات طبية أخرى، مثل مرض الكلى أو القلب أو الرئة</li> <li dir="rtl">مَن لديهم تاريخ من الإصابة بانخفاض نسبة السكر في الدم أو الذين يجدون صعوبة في التعرف على أعراض نقص سكر الدم</li> </ul> </li></ul><p dir="rtl">توصي الجمعية الأمريكية للسكري بصفة عامة العديد من المصابين بداء السكري بالوصول إلى مستويات السكر في الدم المستهدفة على النحو التالي:</p><ul dir="rtl"> <li dir="rtl">بين 80 و130 ملغم/دل (4.4 و7.2 ميليمول/لتر) قبل الوجبات</li> <li dir="rtl">أقل من 180 ملغم/دل (10 ميليمول/لتر) بعد ساعتين من تناول الوجبات</li></ul><p dir="rtl">قد يختلف نطاق السكر المستهدف في الدم، خاصةً في حال الحمل أو الإصابة بمشكلات صحية أخرى ناجمة عن داء السكري. وقد يتغير نطاق السكر المستهدف في الدم كلما تقدمت في السن. ويصعب في بعض الأحيان الوصول إلى نطاق السكر المستهدف في الدم.</p> <h3>مراقبة سكر الدم في المنزل</h3> <p dir="rtl">المراقبة المنتظمة للسكر في الدم باستخدام أحد أجهزة قياس الغلوكوز في الدم هي أفضل طريقة للتأكد من أن خطتك العلاجية تحافظ على بقاء مستوى السكر في دمك ضمن النطاق المستهدف. افحص مستوى السكر في الدم بالمعدل الذي يوصي به الطبيب.</p><p dir="rtl">إذا ظهرت عليك أي أعراض لفرط سكر الدم الشديد، حتى ولو كانت بسيطة، فتحقق من مستوي السكر في الدم فورًا.</p><p dir="rtl">إذا كان مستوى السكر في الدم 240 ملغم/دل (13.3 ميليمول/لتر) أو أعلى، فاستخدم مجموعة اختبار الكيتونات في البول المتاحة دون وصفة طبية. وإذا كانت نتيجة اختبار البول إيجابية، فربما تكون هناك تغيرات في جسمك قد بدأت يمكن أن تسبب الحماض الكيتوني السكري. فتحدث مع الطبيب عن كيفية خفض مستوى السكر في الدم بأمان.</p> <h3>اختبار الهيموغلوبين A1C</h3> <p dir="rtl">أثناء الموعد الطبي، قد يُجري طبيبك اختبار A1C. حيث يُظهر اختبار الدم هذا متوسط مستوى سكر الدم لديك خلال فترة شهرين إلى ثلاثة أشهر الماضية. ويعمل عن طريق قياس نسبة السكر في الدم المرتبطة بالبروتين الذي يحمل الأكسجين في خلايا الدم الحمراء ويُسمى الهيموغلوبين.</p><p dir="rtl">وتعني نسبة A1C الذي تبلغ 7% أو أقل أن خطة العلاج التي تتبعها تؤتي ثمارها، وأن نسبة السكر في الدم منتظمة ضمن نطاق صحي. وإذا كانت نسبة A1C أعلى من 7%، فهذا يشير إلى أن نسبة السكر في الدم، في المتوسط، أعلى من النطاق الصحي. في هذه الحالة، قد يوصي طبيبك بإجراء تغيير في خطة علاج مرض السكري.</p><p dir="rtl">وفي بعض الحالات، وخاصة المرضى المتقدمين في العمر، أو المصابين بأمراض معينة، فإن ارتفاع نسبة A1C إلى 8% أو أعلى قد يكون مقبولاً.</p><p dir="rtl">تتوقف المدة التي عليك إجراء اختبار A1C خلالها على نوع مرض السكري لديك، ومدى نجاحك في التحكم في مستوى السكر في الدم. يُجري معظم المصابين بمرض السكري هذا الاختبار من مرتين إلى أربع مرات سنويًا.</p>
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</section>
<section>
<h4>العلاج</h4>
<div class="section-description">
<h3>العلاج المنزلي</h3> <p dir="rtl">تحدث إلى طبيبك حول التحكم في نسبة السكر في الدم. تعلم كيفية التفرقة بين مختلف الطرق العلاجية التي تساعد في الحفاظ على مستويات الغلوكوز في نطاق الهدف المحدد لك. قد يقترح الطبيب ما يلي:</p><ul dir="rtl"> <li dir="rtl"><b dir="rtl">ممارسة الرياضة.</b> إن المواظبة على ممارسة التمارين الرياضية هي طريقة فعالة في السيطرة على السكر في الدم. لكن لا تمارس الرياضة إذا كانت لديك كيتونات في البول. إذ يؤدي ذلك إلى ارتفاع شديد في سكر الدم.</li> <li dir="rtl"><b dir="rtl">تناول الأدوية الموصوفة لك حسب الإرشادات.</b> إذا كنت تتعرض للإصابة بفرط سكر الدم أحيانًا، فقد يعدِّل الطبيب جرعة الدواء أو وقت أخذه.</li> <li dir="rtl"><b dir="rtl">اتباع خطة تغذية تناسب مرضى السكري.</b> حيث تساعد على تناول وجبات أصغر حجمًا، وتجنب المشروبات المحلاة بالسكر، وتناول وجبات خفيفة متكررة. وإذا كنت تجد صعوبة في الالتزام بخطة وجباتك الغذائية، فتحدث إلى طبيبك أو اختصاصي النظم الغذائية للحصول على المساعدة.</li> <li dir="rtl"><b dir="rtl">فحص مستوى سكر الدم.</b> راقب مستوى الغلوكوز في الدم حسب توجيهات طبيبك. كرر الفحص عدة مرات في حال التعرض لوعكة أو القلق من ارتفاع سكر الدم أو انخفاضه بشدة.</li> <li dir="rtl"><b dir="rtl">تعديل جرعات الأنسولين.</b> قد تساعد التغييرات في برنامج الأنسولين أو أخذ أنسولين تكميلي قصير المفعول على السيطرة على ارتفاع سكر الدم. الأنسولين التكميلي هو جرعة إضافية من الأنسولين تُستخدم للمساعدة على تصحيح ارتفاع مستوى سكر الدم مؤقتًا. استشر الطبيب عن مدى احتياجك إلى الأنسولين التكميلي إذا كان مستوى السكر لديك مرتفعًا.</li></ul> <h3>العلاج الطارئ للارتفاع الحاد في سكر الدم</h3> <p dir="rtl">إذا ظهرت عليك مؤشرات وأعراض الإصابة بالحماض الكيتوني السكري أو حالة فرط الأسمولية وفرط سكر الدم، فربما تتلقى العلاج في قسم الطوارئ أو تُحجَز في المستشفى. (4p4) ويمكن للعلاج في قسم الطوارئ أن يخفض سكر الدم إلى مستواه الطبيعي. ويشمل العلاج عادة:</p><ul dir="rtl"> <li dir="rtl"><b dir="rtl">تعويض السوائل.</b> ستتلقّى السوائل -عبر الوريد عادة- حتى يحصل الجسم على السوائل التي يحتاج إليها. وهذا يعوّض السوائل التي فقدتها في البول. وهو يساعد أيضًا على تخفيف السكر الزائد في الدم.</li> <li dir="rtl"><b dir="rtl">تعويض الكهارل.</b> الكهارل هي أملاح معدنية في الدم، وهي ضرورية لتؤدي الأنسجة وظائفها كما ينبغي. وقد يؤدي نقص الأنسولين إلى خفض مستوى العديد الكهارل في دمك. وستتلقى هذه الكهارل عبر الوريد للمساعدة في الحفاظ على عمل القلب والعضلات والخلايا العصبية على نحو سليم.</li> <li dir="rtl"><b dir="rtl">العلاج بالأنسولين.</b> يعكس الأنسولين العمليات التي تؤدي إلى تراكم الكيتونات في جسمك. ستتلقَّى مع السوائل والكهارل جرعة من الأنسولين عادة ما تكون عبر الوريد.</li></ul><p dir="rtl">وبعد عودة الجسم إلى الوضع الطبيعي، يبحث طبيبك عن السبب المحتمل للارتفاع الحاد في سكر الدم. وفي ضوء ذلك، قد تحتاج إلى إجراء المزيد من الاختبارات وتلقي العلاج.</p>
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</section>
<section>
<h4>الاستعداد لموعدك</h4>
<div class="section-description">
<p dir="rtl">إذا كنت تواجه مشكلة في الحفاظ على نسبة السكر في الدم ضمن المعدل الطبيعي، فبادر بزيارة الطبيب، حيث يمكن أن يساعدك الطبيب على إجراء تغييرات للسيطرة على داء السكري لديك بشكل أفضل.</p><p dir="rtl">إليك معلومات لمساعدتك على الاستعداد لزيارة الطبيب، ومعرفة ما يمكن توقعه من الطبيب.</p> <h3>ما يمكنك فعله</h3> <ul dir="rtl"> <li dir="rtl"><b dir="rtl">التزم بأي قيود يجب اتباعها قبل الموعد الطبي.</b> إذا كان طبيبك سيختبر مستوى السكر في دمك، فقد يطلب منك الامتناع عن تناوُل الطعام أو الشراب باستثناء الماء لمدة تصل إلى ثمان ساعات قبل موعدك الطبي. عندما تحدِّد موعدًا طبيًا، اسأل عن أي قيود تتعلق بالأكل أو الشرب.</li> <li dir="rtl"><b dir="rtl">دوِّن معلوماتك الشخصية الأساسية،</b> وهي تشمل حالات الإجهاد الشديدة التي تعرضت لها أو تغييرات الحياة التي مررت بها مؤخرًا.</li> <li dir="rtl"><b dir="rtl">اكتب قائمة بكل الأدوية</b> والفيتامينات والمكملات الغذائية التي تتناولها.</li> <li dir="rtl"><b dir="rtl">أعدّ سجلًّا بقيم الغلوكوز التي قستها.</b> قدِّم لطبيبك سجلاً مكتوبًا بخط يدك أو مطبوعًا بقيم الغلوكوز في دمك وأوقات قياسه والأدوية التي تتناولها. يُمكن لطبيبك من خلال هذا السجل التعرف على اتجاهات هذه القيم، وتقديم توصياته بشأن كيفية الوقاية من فرط سكر الدم أو تعديل الدواء الذي تتناوله لعلاجه.</li> <li dir="rtl"><b dir="rtl">دوِّن الأسئلة التي تريد طرحها</b> على الطبيب. إذا احتجت إلى المزيد من المعلومات عن كيفية التحكم في داء السكري، فاحرص على طلبها.</li> <li dir="rtl"><b dir="rtl">اسأل عما إذا كنت تحتاج إلى عبوات إضافية للدواء أم لا.</b> يُمكن أن يجدد لك طبيبك وصفات الأدوية أثناء موعدك الطبي.</li></ul><p dir="rtl">قد تشمل الأسئلة التي ترغب في طرحها بشأن فرط سكر الدم ما يلي:</p><ul dir="rtl"> <li dir="rtl">كم مرة أحتاج إلى مراقبة نسبة السكر في الدم؟</li> <li dir="rtl">ما مستوى سكر الدم المستهدف في حالتي؟</li> <li dir="rtl">كيف يُؤثر النظام الغذائي وممارسة الرياضة على نسبة السكر في دمي؟</li> <li dir="rtl">متى يمكنني إجراء اختبار الكيتونات؟</li> <li dir="rtl">كيف يُمكنني منع ارتفاع نسبة السكر في الدم؟</li> <li dir="rtl">هل هناك ما يدعو للقلق بشأن انخفاض نسبة السكر في الدم؟ ما الأعراض التي يتعين عليَّ الانتباه إليها؟</li> <li dir="rtl">هل سأحتاج إلى رعاية تفقدية؟</li></ul> <h3>التخطيط للإجازة المرضية</h3> <p dir="rtl">قد يؤدي المرض أو العدوى إلى ارتفاع مستوى السكر في الدم، ولذا من المهم التخطيط لهذه الحالات. تحدث إلى الطبيب بشأن وضع خطة للإجازة المَرَضية. وتتضمن الأسئلة التي تود طرحها ما يلي:</p><ul dir="rtl"> <li dir="rtl">كم مرة ينبغي لي مراقبة نسبة السكر في الدم عندما أكون مريضًا؟</li> <li dir="rtl">هل تتغير جرعة حقن الأنسولين أو حبوب السكري التي تؤخذ عن طريق الفم عندما أكون مريضًا؟</li> <li dir="rtl">متى ينبغي إجراء اختبار الكيتونات؟</li> <li dir="rtl">ماذا لو كنت غير قادر على تناول الطعام أو المشروبات؟</li> <li dir="rtl">متى ينبغي طلب المساعدة الطبية؟</li></ul>
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