Diabetes in bangla dr md toufiqur rahman nicvd cardiologist

1. Wvqv‡ewUm
Wvt ‡gv: †ZŠwdKzi ingvb
mn‡hvMxAa¨vcK, KvwW©IjRx
RvZxq ü`‡ivM BbwówUDU InvmcvZvj
‡k‡ievsjvbMi, XvKv-1207|

2. Case 1
• wg‡mm ingvb, 50 eQi eqm, †ckvqGKRbM„wnbx,_v‡Kb
Kzwgjv| MZ 3gvm hver j¶¨ Ki‡Qb DwbAí‡ZBK¬vwš—
†eva K‡ib Ges AZ¨waK`ye©jjv‡M,Kv‡R †Kvb kw³cvbbv|
Dwb wbqwgZ 35 wgwbUnv‡Ub &IRb wbqš¿‡bi Rb¨| Dbvi
IRb95 †KwR|Dbvi i‡³iMy‡KvR Gi gvÎv (RBS, HBA1C)
cix¶vK‡i †`Lv †Mj(RBS- 15.5mg/L, HBA1C – 9.2%) |
Dbvi Lv`¨vf¨vm cwieZ©bGes gy‡L Lvevi Anti-diabetes
GiJla Ges Avi GKwUBb‡RKkb †`qv nj hv Dbvi&IRb
Kgv‡Zmvnvh¨ Ki‡eGes GKBmv‡_ Wvqv‡ewUmI wbqš¿b
ivL‡e | Dwb1 gvm ci †`Lv Ki‡jb|Dbvi evW myMviGLb
wbqš¿‡b, IRbK‡g‡Q 1 †KwR|Dbv‡K¯^v¯’¨Ki RxebhvÎv

3. Case 2
• wg‡mm Wvwjqv,25 eQi eqm, 24 mßv‡ni Mf©eZx,_v‡Kb
ivgcyiv|Dbvi i“wUb†PKAv‡c Ab¨vb¨ cix¶vicvkvcvwk
(RBS) Gi wi‡cvU©cvIqv †Mj (RBS- 11.6mg/L,) | Dbvi
(Pregnancy ) GiAv‡M (RBS) ¯^vfvweKwQj|MvBbx
we‡lkÁDbvi cieZx©wPwKrmviRb¨ cvVv‡jb|Dbvi
HBA1C –wi‡cvU©Avmj 7.9%, Dbvi Wvqv‡ewUm
wbqš¿‡bi Rb¨ Bbmywjb†`qv njGes eZ©gv‡b Dbvi
Wvqv‡ewUmwbqš¿‡b Av‡Q Ges wbivc‡`39 mßvnci
GKwUKb¨vmš—vb nj|Kb¨v mš—vb I gv Df‡qB fvjI my¯’
Av‡Qb|

4. ü`‡iv‡Mimv‡_Wvqv‡ewU‡mi m¤úK©wK ?
Wvqv‡ewUm njK‡ivbvix ü`‡iv‡Mi Ab¨Zg cÖavb risk factor|
ejv nq Wvqv‡ewUm _vK‡j †ivMxi ü`wc‡Ûi i³bvjx‡Z Pwe©i Av¯—i
Rgv c‡o A_v©r K‡ivbvix ü`‡ivM Av‡Q|
ZvB DbœZ we‡k¦ Wvqv‡ewU‡mi wPwKrmv mvavibZ: ü`‡ivM
we‡klÁivB K‡i_v‡Kb|
Wvqv‡ewUm _vK‡j K‡ivbvix ü`‡iv‡Mi cvkvcvwk †ivMxi nvZ I cv‡qi
i³bvjxi eKA_ev nvU© †dBjvi †ivM n‡Zcv‡i|

5. Wvqv‡ewUmwK ?
Wvqv‡ewUmGKwUwecvKRwbZ†ivM|
G †ivM n‡ji‡³ ¯’vqxfv‡eMy‡KvR Gicwigvb†e‡ohvq| Avgv‡`i kix‡i
AMœ¨vkq†_‡KBbmywjbbvgK GKwUni‡gvbwbtm„Znq|
GB Bbmywj‡biKvRn‡”Q i‡³iMy‡KvR †K †f‡½Zv kix‡iiwewfbœKv‡R
jvMv‡Z mvnvh¨ Kiv|
†Kvb Kvi‡YGB Bbmywjbni‡gvb‡Im¤úyb©ev
Av‡cw¶K NvUwZi Kvi‡YwecvKRwbZmgm¨vim„wó
n‡qMy‡KvR †e‡ohvIqv Ges AwZwi³My‡KvR
cÖkªv‡eimv‡_ †ein‡q AvmvB n‡”Q Wvqv‡ewUm|

6. Wvqv‡ewUm †iv‡Mij¶bwK wK?
1. Nb Nb cÖkªve nIqv,
2. Lye †ekx wccvkv jvMv,
3. AwZwi³ ¶zav cvIqv,
4. ch©vß LvIqvi c‡iI IRb K‡g hvIqv,
5. Aí‡ZB K¬vwš—I `ye©jZv †ea Kiv,
6. kix‡ii†Kvb ¶Z¯’vb ïKv‡Z †`ix nIqv,
wewfbœ Pg©‡ivM †hgb †Lvuk-cvuPov BZ¨vw`†ekx cwigv‡Y †`Lv
†`Iqv |

7. Kv‡`iWvqv‡ewUm nIqvim¤¢vebv ?
‡h †Kvb eq‡m, ‡h Kv‡iv Wvqv‡ewUm n‡Z cv‡i, Z‡e hv‡`i G †iv‡M
Avµvš— nevi m¤¢vebv †ekx Zviv n‡jb :
• 1. hv‡`i es‡k G †ivM Av‡Q | †hgb t evev, gv, `v`v, `v`x hv‡`i G †ivM
Av‡Q |
• 2. hv‡`iIRb †ekx Ges hvivkvixwiKcwikª‡gi†Kvb KvR K‡ibbv|
• 3. Mf©ve¯’vq G †iv‡Mi cÖKvk NU‡Z cv‡i |

8. Wvqv‡ewUm n‡jwbqš¿‡bi Rb¨ wKwK KivDwPZ ?
• Wvqv‡ewUm wbivgq ev m¤ú~Y©i“‡c mviv‡bv hvq bv | Z‡e G †ivM
m¤ú~b©fv‡e wbqš¿b ivLv hvq| K‡qKwU wel‡q †ivMx‡K wbqg gvb‡Z n‡e|
• 1.k„•Ljv t †ivMx‡K Aek¨BGKUv my›`i myôz, k„•LjRxebhvcb Ki‡Z n‡e|
• 2. Lv`¨ e¨e¯’v t †ivMx‡K wKQ~ Lv`¨ MÖn‡Yi bxwZ †g‡b Pj‡Z n‡e|
• 3. Jla t k„•LjvI Lv`¨ e¨e¯’vicvkvcvwk A‡bK †¶‡ÎB Wv³v‡ii civgk©gZ Jla I
Bbmywbj‡bi cÖ‡qvRb n‡Z cv‡i|
• 4. †ivM m¤§‡Ü wk¶v t †h‡nZz Wvqv‡ewUm †ivM‡K mywbqwš¿Z Kiv hvq
†m‡nZz G †ivM m¤§‡Üfv‡jvfv‡e wk¶vMÖnb K‡i Ges G †iv‡Mi RwUjZv
m¤§‡Ü fv‡jvfv‡e †R‡b mn‡RB G †ivM‡K wbqš¿b ivLv hvq|
• 5. wbqwgZ nvuUv-Pjv, nvjKve¨vqvgGes kvixwiKcwikªgG †ivM‡K wbqš¿‡b
ivL‡Z mvnvh¨ K‡i|

9. Wvqv‡ewUm n‡jwK wK LvIqv DwPZ bq?
• wgwó RvZxqLvevi †hgb wgwó RvZxqwe¯‹zU wPwb w`‡q ˆZwi Kiv
†KK, †cwóª, R¨vg,†Rjx,†LRy‡ii im, Zv‡jiim, †KvKv‡Kvjv, †ccwm,
Aviwm †Kvjv, K‡ÛÝ wgé, ¸o, My‡KvR LvIqv DwPZ bq

10. Wvqv‡ewUm n‡j wKwKwRwbm †ekx†L‡Z n‡e ?
• me iKg kvK †hgb cvjskvK,jvjkvK,cyBkvK,KjwgkvK, WvUvkvK,
KPzkvK †ekx †L‡Z n‡e|
• UK RvZxq dj, KvjRvg, Avgov, †jey, Rv¤^yiv, Rvgi“j, AvgjwK I KwP
Wv‡ei cvwb LvIqv hv‡e|
• wPbvev`vg mvgyw`ªK gvQ †ekx †L‡Z n‡e|

11. Wvqv‡ewUm n‡j wKwKai‡biJla e¨envi Kiv nq?
• Wvqv‡ewUm n‡jgy‡L Lvevi JlaI Bbmywjb Bb‡RKkb e¨enviKiv nq|

12. Wvqv‡ewU‡mi wPwKrmvqgy‡L Lvevi Jla wK wK ai‡bi
e¨envi Kiv hvq ?
• Wvqv‡ewUm wPwKrmvq gy‡L Lvevi Jla wnmv‡e mvavibZ :`yB ai‡bi
Jla e¨enviKiv nq|
• GK ai‡bi Jla †ivMxi kix‡iAMœ¨vkqbvgK MÖwš’ †_‡K Bbmywjb
wbimb K‡i Ges
• Aciai‡bi JlaBbmywjb hv‡Zkix‡ifvjfv‡e KvR Ki‡Zcv‡i I Bbmywjb
†iwRôvÝ hv‡Z Kgvq †mfv‡e dvjy K‡i |

13. Wvqv‡ewU‡mi wPwKrmvq †Kvb†Kvb ai‡bi gy‡L
LvIqvi JlaBbmywjb wbmibK‡i ?
• Wvqv‡ewU‡mi wPwKrmvq gy‡L hviv Jlawbtmib KivqZviv njM-
vBK¬vRvBR RvZxq Jla (†hgb- WvB‡gij, Kw¤cÖW,KbmyKb,
Wvqv‡cÖv, MvBwRW BZ¨vw`)wMvgwcivBW RvZxq Jla (†hgb -
A¨vgwij)|

14. †Kvb †Kvb ai‡biJla Bbmywjb †iwRóvÝ Kgvq ?
• ‡gBdiwgb RvZxqJla (†hgb -†Kv‡gU , MvBwgb, Bbdi‡gU cÖf„wZ) I
• wMUvRb RvZxq Jla (†hgb- cvB‡ivweUvRb , iwm wMUvRb) Bbmywjb
†iwR÷vÝ Kgvq|

15. ‡gvUv †ivMx‡`i mvavibZ: †Kvb ai‡biWvqv‡ewUm nq Ges wPwKrmvq
†Kvb ai‡bi Jla e¨enviKiv nq ?
• ‡gvUv †ivMx‡`i mvavibZ: UvBc-2 ai‡biWvqv‡ewUm nq Ges GB
†ivMx‡`i wPwKrmvi Rb¨ †gUdiwgb RvZxq Jla fvj KvR K‡i|

16. gy‡L Lvevi Jla fvjbv Bbmywjb fvj?
• UvBc-1Wvqv‡ewUm †ivMx‡`i †¶‡Î Aek¨BBbmywjb e¨enviKi‡Zn‡e|
• UvBc-2 Wvqv‡ewUm †ivMx‡`i†¶‡Î Wvqv‡ewU‡mi gvÎv Kg n‡j gy‡L
Lvevi Jla w`‡q wbqš¿b Kiv nq|
• gvÎv A‡bK †ekx n‡j cÖ_‡g Bbmywjb w`‡q †gvUvgywU wbqš¿b K‡i
gy‡L Lvevi Jla w`‡q cieZx©‡ZwbqšÎ†bi †Póv Kiv nq|
• †ivMxiIRb †ekx n‡j †gUdiwgb RvZxq Jla w`‡q wbqš¿b Kiv nq|

17. †Kvb†Kvb†¶‡Îgy‡LLveviJla†`qvnq?
• ‡ivMxi Wvqv‡ewU‡mi gvÎv Kg _vK‡jev †ivMxi IRb AZ¨vwaK†ekx
n‡jAvgiv gy‡L Lvevi Jla w`‡q Wvqv‡ewUm wbqš¿b Kwi,A_ev
Bbmywj‡bi cwigvb Lye †ekx cÖ‡qv&Rb n‡jA_¨v©Bbmywjb
†iwRóvm _vK‡jI gy‡L Lvevi Jla Bbmywj‡bi cvkvcvwk e¨enviKiv nq |

18. • Bbmywjb w`‡b KZevie¨enviKiv DwPZ ?
• nvmcvZv‡j fwZ© †ivMx‡`i †¶‡Î A_ev cÖ_gevi Bbmywjb e¨env‡ii†¶‡Î
A_ev Acv‡ik‡bi mgq Bbmywjb e¨enviKi‡jAvgiv ¯^íKvjxb ¯’vqx
(short acting ) Bbmywjb e¨enviKwi, †m‡¶‡Î w`‡b 3evi Bbmywjb
e¨enviKiv nq|
• Bbmywjb (Mixtard)e¨enviKi‡jw`‡b 2evi Kiv DwPZ| `xN©Kvjxq
¯’vqx (Long acting)Bbmywjb e¨enviKiv nq mvavibZ: iv‡Z 1evi
(Bbmywjb MviwRb)|

19. Bbmywjb ev gy‡L Lvevi Jla †L‡j wK wK mZK©Zv†bIqv
DwPZ ?
• Bbmywjb ev gy‡L Lvevi Jla †L‡j KLbI KLbI Wvqv‡ewU‡mi gvÎv A‡bK
K‡g wM‡q nvB‡cv MvB‡mwgqv n‡Z cv‡i, Z‡egvivZœK mgm¨v†`Lv
w`‡Z cv‡i| ZvB G‡¶‡Î mZK©Zv Aej¤^b Kiv DwPZ|
• cÖ‡Z¨K†ivMxievmvq Wvqv‡ewUm gvcvi Rb¨ e¨w³MZhš¿_vKv
DwPZ| †Kvb m‡›`n n‡jB wi‡cv cix¶vKiv DwPZ|
• ZvQvov Wvqwiqv n‡j ev †c‡Ui cxov n‡j A_ev †Kvb †Lvjv Lvevi bv †L‡j
ev †ivRvi mgq Bbmywjb Gi gvÎv wVK Ki‡Zn‡e ev gy‡L hviv Jla
cÖ‡qvR‡b eÜ ivL‡Z n‡e|

20. nvB‡cvMvB †mwgqv n‡j wK Ki‡Z n‡e ?
• nvB‡cvMvB †mwgqv n‡jAwZmËi evW myMvi †PK Kiv cÖ‡qvRb| e-
vW myMvi cix¶vKiv m¤¢e n‡jGes ZvKg gvÎvi n‡jA_ev †PK Kiv m¤¢e
bv n‡jwPwb cvwb‡Z ¸wj‡q †L‡Z n‡e A_ev glucometer cix¶vq M-
y‡Kv‡Ri gvÎv Lye Kg n‡j KvQvKvwQ nvmcvZv‡j fwZ©n‡Z n‡e Ges
wkivq My‡KvR Bb‡RKkb ev m¨vjvBbwb‡Z n‡e|

21. nvB‡cjvB‡mwgqv n‡jwKfv‡e eySv hvq ?
• nvB‡cMvB‡mwgqv n‡j AZ¨vwaKNvg †ei nq cvkvcvwk eyK aodo Kiv,
Aw¯’iZv jvMv, GgbwK AÁvb nIqv Ges wLPzbx I n‡Z cv‡i|