Isifo Sikashukela Kubantu Abadala

Ukwelashwa kwesifo sikashukela ekugugeni kuyinkinga ephuthumayo yabafundi abaningi besayithi lethu. Ngakho-ke, silungiselele i-athikili enemininingwane ngale ndaba, ebhalwe ngolimi olutholakala kalula. Iziguli nochwepheshe bezokwelapha bangathola konke abakudingayo lapha ukuthola kahle futhi belaphe isifo sikashukela asebekhulile.

Ukuthi ukwelashwa kwesifo sikashukela osezingeni eliphakeme kungakuthola kanjani kuncike kakhulu emandleni emali kuye nasezihlotsheni zakhe, futhi, unenkinga yokuwohloka komqondo noma cha. Noma kunjalo, izinto ezisetshenziswe kulesi sihloko zizosiza ukwenza inani eliphakeme ekulweni nesifo sikashukela, okungenzeka esimweni umuntu osekhulile akuso.

Kungani ubungozi besifo sikashukela bukhuphuka esegugile

Kusukela eminyakeni engama-50-60, ukubekezelelwa kwe-glucose kuncishiswa ngokungenakuphikiswa kubantu abaningi. Empeleni, lokhu kusho ukuthi ngemuva kweminyaka engama-50 kuyo yonke iminyaka eyi-10 elandelayo:

• ushukela wegazi osheshayo ukhuphuka ngo-0,055 mmol / l;
• ushukela we-plasma glucose emahoreni ama-2 ngemuva kokudla kukhuphuka ngo-0,5 mmol / l.

Sicela wazi ukuthi lezi yizinkomba "ezimaphakathi" nje. Kuwo wonke umuntu osekhulile, ukugxila kukashukela wegazi kuzoshintsha ngendlela yabo. Futhi ngenxa yalokho, ubungozi bokuthola isifo sikashukela sohlobo 2 kwezinye izakhamuzi eziphezulu kuphezulu kakhulu kunakwezinye. Kuya ngempilo umuntu okhulayo ayiholayo - ubukhulu becala, ekusebenzeni kwakhe ngokomzimba nakondlekile.

I-Postprandial glycemia ushukela wegazi ngemuva kokudla. Ngokuvamile kukalwa amahora ama-2 kudliwe. Yile nkomba ekhuphuka kakhulu ebudaleni, okuholela ekwakhiweni kwesifo sikashukela sohlobo 2. Ngesikhathi esifanayo, i-glycemia esheshayo ayishintshi kakhulu.

Kungani ukubekezelelwa kweglucose kungaphazamiseka ngeminyaka? Le nto inezizathu eziningana ezisebenza emzimbeni ngasikhathi sinye. Lokhu kufaka phakathi:

• Ukwehla okuhlobene nobudala kokuzwela kwezicubu kwe-insulin;
• Ukwehliswa kwe secancion ye-pancreatic insulin;
• Ukuqedwa kanye nokwenza kwama-hormone we-incretin buthaka ekugugeni.

Ukwehla okuhlobene nobudala kokuzwela kwezicubu kwe-insulin

Ukwehla kokuzwela kwezicubu zomzimba kuya ku-insulin kubizwa ngokuthi yi-insulin ukumelana. Ikhula kubantu abaningi asebekhulile. Ikakhulu kulabo abakhuluphele. Uma ungathathi izinyathelo zokwelapha, lokhu kungenzeka ukuthi kuholele ku-2 isifo sikashukela.

Ukwanda kwe-insulin kuyimbangela enkulu yesifo sikashukela sohlobo 2 ekhulile. Abaphenyi basaqhubeka nokuqagulisana ukuthi ukumelana nezicubu zemisipha kuyinqubo yemvelo yokuguga. Noma kungenxa yendlela yokuphila engenampilo ekugugeni?

Ngenxa yezizathu zenhlalo nakwezomnotho, abantu asebekhulile badla, ikakhulukazi, ukudla okushibhile, okunekhalori ephezulu. Lokhu kudla kuqukethe amafutha amaningi ezimboni ayingozi nama-carbohydrate, adonswa ngokushesha. Ngasikhathi sinye, kuvame ukungabi nawo amaprotheni, i-fiber kanye nama-carbohydrate ayinkimbinkimbi, adonswa kancane.

Futhi, abantu asebekhulile, njengomthetho, banezifo ezifanayo futhi baphuze nemithi yazo. Le mishanguzo ihlala iba nomthelela omubi kuma-carbohydrate metabolism. Izidakamizwa eziyingozi kakhulu ukwandisa ingozi yakho yesifo sikashukela:

• i-thiazide diuretics;
• ama-beta blockers (angakhethi);
• ama-steroid;
• izidakamizwa ze-psychotropic.

Izifo ezifanayo ezikucindezela ukuthi uthathe izidakamizwa eziningi zilinganisela ukusebenza komzimba kwabantu asebekhulile. Kungaba i-pathologies yenhliziyo, amaphaphu, uhlelo lwe-musculoskeletal nezinye izinkinga. Ngenxa yalokho, isisindo semisipha sincishisiwe, futhi lesi yisizathu esiyinhloko sokwanda kokumelana ne-insulin.

Ekulwenziweni, kusobala ukuthi uma ushintshela empilweni enempilo, ubungozi bokuthola isifo sikashukela sohlobo 2 esekhulile buncishiswa amahlandla ayishumi, okungukuthi, cishe bufika ku-zero. Ungakwenza kanjani lokhu - uzofunda ngokuqhubekayo esihlokweni sethu.

I-pancreatic insulin secretion

Uma umuntu engenakho ukukhuluphala, khona-ke isici esiyingqayizivele sokusungulwa kwe-insulin yi-pancreas yisizathu esikhulu sokwakha isifo sikashukela sohlobo 2. Khumbula ukuthi kubantu abanokukhuluphala, ukumelana ne-insulin yimbangela eyinhloko yesifo sikashukela, yize iqiniso ukuthi ama-pancreas akhiqiza i-insulin ngokujwayelekile.

Lapho umuntu edla ukudla ngama-carbohydrate, kuphakama izinga likashukela egazini. Ukuphendula kulokhu, i-pancreas ikhiqiza i-insulin. I-pancreatic insulin secretion ephendula "umthwalo" we-carbohydrate izigaba ezimbili ezibizwa ngezigaba.

Isigaba sokuqala secretion enamandla ye-insulin, ethatha imizuzu eyi-10. Isigaba sesibili ukugeleza okubushelelezi kwe-insulin kungena egazini, kepha kuthatha isikhathi eside, kuze kube yimizuzu engama-60-120. Isigaba sokuqala secretion siyadingeka "ukucima" ukunyuswa kwe-glucose egazini okwenzeka ngokushesha ngemuva kokudla.

Ucwaningo lukhombisa ukuthi kubantu asebekhulile ngaphandle kwesisindo somzimba ngokweqile, isigaba sokuqala secretion se-insulin sincishiswa kakhulu. Ngokunokwenzeka, ngokufanelekile ngenxa yalokhu, okuqukethwe ushukela egazini plasma amahora ama-2 ngemuva kokudla kuphakama ngokuqinile, i.e., ngo-0.5 mmol / l kuyo yonke iminyaka eyi-10 emva kweminyaka engama-50.

Ososayensi bathole ukuthi kubantu asebekhulile abanesisindo somzimba esijwayelekile, umsebenzi wohlobo lwe-glucosinase uyancishiswa. Le gene inikezela ukuzwela kwamaseli we-pancreatic beta kumphumela ovuselelayo weglucose. Isici saso singachaza ukwehla kokugcinwa kwe-insulin ukuphendula ukungena kweglucose egazini.

Ukuthi secretion kanye nokwenza kwama-incretin kuguquka kanjani kubantu asebekhulile

Ama -retretin ama-hormone akhiqizwa emgodini wesisu ukuphendula ukudla. Futhi bagqugquzela ukukhiqizwa kwe-insulin ngama-pancreas. Khumbula ukuthi umphumela ophambili ovuselelayo ekusithekeni kwe-insulin unokwenyuka kweglucose yegazi.

Isenzo sama-incretins saqala ukufundelwa ngokungathi sína ekuqaleni kwekhulu lamashumi amabili nanye. Kwavela ukuthi ngokujwayelekile, lapho kuthathwa ngomlomo (ngomlomo), ama-insulin carbohydrate akhiqizwa cishe izikhathi ezi-2 kunokuphendula ekuphathweni kwe-intravenous kwenani elilinganayo le-glucose.

Ososayensi baphakamise ukuthi ngesikhathi sokudla nangemva kokudla, izinto ezithile (ama-hormone) akhiqizwa emgudwini wesisu ovuselela ukuthi ama-pancreas enze i-insulin. La mahomoni abizwa ngokuthi ama-incretins. Isakhiwo sabo nendlela yabo yokusebenza isuqondwe kahle.

Ama-incretins yi-hormone glucagon-like peptide-1 (GLP-1) ne-insulinotropic polypeptide (HIP) ye-glucose. Kwatholakala ukuthi i-GLP-1 inethonya elinamandla kuma-pancreas. Akukhulisi kuphela ukuvikela kwe-insulin, kodwa futhi kuvimba ukukhiqizwa kwe-glucagon, “umphikisi” we-insulin.

Ucwaningo luye lwabonisa ukuthi kubantu asebekhulile, ukukhiqizwa kwama-hormonal i-GLP-1 ne-GUI kuhlala kusesilinganisweni esifanayo nakwabancanyana. Kepha ukuzwela kwamaseli we-pancreatic beta esenzweni sama-incretin kuyancipha ngobudala. Lokhu kungenye yezindlela zokuthuthukisa isifo sikashukela, kodwa esingabalulekile kunokuphikisana ne-insulin.

Ukuxilongwa kwesifo sikashukela asebekhulile

Abantu abaphilile bayelulekwa ngemuva kweminyaka engama-45 ukuthi bahlolwe isifo sikashukela kanye eminyakeni emi-3. Thola ukuthi yiziphi izindinganiso zikashukela wegazi. Uyacelwa uqaphele ukuthi isivivinyo sikashukela wegazi esisheshayo asilungile ekuhlolweni kwesifo sikashukela. Ngoba ezigulini eziningi ezinesifo sikashukela, ukushesha kweglue glucose kuhlala kuyinto evamile. Ngakho-ke, sincoma ukuthatha ukuhlolwa kwegazi kwe-glycated hemoglobin.

Ukuzwisisa ukutholakala kwesifo sikashukela, okokuqala funda i-athikili ngakho. Futhi lapha sizoxoxa ngezici ezithile zokuqashelwa kwesifo sikashukela asebekhulile.

Ukuxilongwa kwesifo sikashukela sohlobo 2 kwiziguli esezikhulile kunzima ngoba lesi sifo sivame ukuvela ngaphandle kwezimpawu. Isiguli esikhulile kungenzeka singabi nezikhalazo ezijwayelekile zesifo sikashukela sokoma, ukulunywa, ukuncipha kwesisindo, nokuchama kaningi.

Kuyinto ephawuleka ikakhulukazi ukuthi abantu abadala abanesifo sikashukela abavamile ukukhala ngokoma. Lokhu kungenxa yokuthi isikhungo sokoma kwengqondo saqala ukusebenza sibi kakhulu ngenxa yezinkinga ngemikhumbi. Abantu abaningi asebekhulile banomile obuthakathaka futhi, ngenxa yalokhu, baphindisela ngokungagcini ndawo amanzi agciniwe emzimbeni. Ngakho-ke, bavame ukutholakala benesifo sikashukela lapho befika esibhedlela ngenkathi bekhubazekile kakhulu emzimbeni ngenxa yokuphelelwa ngamandla komzimba.

Ezigulini esezikhulile, hhayi eziqondile, kepha izikhalazo ezivamile zihamba phambili - ubuthakathaka, ukukhathala, isiyezi, izinkinga zememori. Izihlobo zingabona ukuthi ukuwohloka komqondo okuyi-senile kuyaqhubeka. Ebona izimpawu ezinjalo, udokotela uvame ukungaboni nokuthi umuntu osekhulile angaba nesifo sikashukela. Ngokufanelekile, isiguli aselashwa ngenxa yaso, futhi izinkinga ziyaqhubeka.

Kaningi, isifo sikashukela ezigulini esezikhulile sitholwa ngengozi noma sesivele sekwedlule isikhathi, lapho umuntu ehlolwa ngenxa yezinkinga ezinzima zamathambo. Ngenxa yokuxilongwa kwesifo sikashukela sekwephuzile asebekhulile, zingaphezu kwama-50% iziguli ezikulesi sigaba ezihlangabezana nezinkinga ezinzima: izinkinga zenhliziyo, imilenze, ukubona kwamehlo nezinso.

Kubantu asebekhulile, umbundu wezinso uyakhuphuka. Ake sibheke ukuthi yini. Kubantu abasha, iglucose itholakala umchamo lapho ukugxilisa kwayo egazini sekucishe kube ngu-10 mmol / L. Ngemuva kweminyaka engama-65-70, “umkhawulo wezinso” uguqukela ku-12-13 mmol / L. Lokhu kusho ukuthi noma isinxephezelo esibi kakhulu sesifo sikashukela kumuntu osekhulile, ushukela awangeni kumchamo, futhi mancane amathuba okuba azotholwa ngokuhamba kwesikhathi.

I-Hypoglycemia asebekhulile - ubungozi nemiphumela

Okokuqala, sincoma ukufunda isihloko esithi "Hypoglycemia in sikashukela." I-Hypoglycemia ekugugeni iyingozi kakhulu. Ngoba kuvame ukuholela ekufeni, okubukeka njengokufa okuvela engozini yemithambo yegazi.

Ukuboniswa kwe-hypoglycemia kuma-diabetics asebekhulile kwehlukile kwezimpawu "zakudala" ezibonwa kubantu abasha. Izici ze-hypoglycemia asebekhulile:

• Izimpawu zakhe zivame ukusulwa futhi kuvezwe kahle. I-Hypoglycemia ezigulini esezikhulile ihlala "ifihliwe" njengokubonakaliswa kwesinye isifo ngakho-ke, ihlala ingaziwa.
• Kubantu asebekhulile, ukukhiqizwa kwama-hormone adrenaline ne-cortisol kuvame ukuwohloka. Ngakho-ke, izimpawu ezicacile ze-hypoglycemia zingase zingabikho: i-palpitations, ukuthuthumela nokujuluka. Ubuthakathaka, ukozela, ukudideka, i-amnesia iza phambili.
• Emizimbeni yabantu asebekhulile, izindlela zokunqoba isimo se-hypoglycemia zithikamezekile, i.e., izinhlelo zokulawula zisebenza kabi. Ngenxa yalokhu, i-hypoglycemia ingathatha isimo esidaliwe.

Kungani i-hypoglycemia ekugugeni iyingozi kangaka? Ngoba kuholela ezinkingeni zenhliziyo ezibonisa ukuthi abanesifo sikashukela asebekhulile ababekezeleli kahle. I-Hypoglycemia yandisa kakhulu amathuba okufa kokuhlaselwa yisifo senhliziyo, unhlangothi, ukuhluleka kwenhliziyo, noma ukuvalwa kwesikejana esikhulu esinegazi.

Uma umuntu onesifo sikashukela osekhulile enenhlanhla eyanele yokuvuka ephila ngemuva kwe-hypoglycemia, khona-ke angahlala ekhubazekile ngokomqondo ngenxa yokulimala kobuchopho okungalungiseki. Lokhu kungenzeka ngesifo sikashukela esemncane, kodwa kubantu abadala amathuba emiphumela emibi aphezulu kakhulu.

Uma isiguli sikashukela esidala sinama-hypoglycemia kaningi futhi singalindele, khona-ke lokhu kuholela ekuweni, okuhambisana nokulimala. Izimpophoma ezine-hypoglycemia ziyimbangela ejwayelekile yokuqhekeka kwamathambo, ukususwa kwamalunga, ukulimala kwezicubu ezithambile. I-Hypoglycemia ekukhuleni yandisa ingozi yokuqhekeka kwe-hip.

I-Hypoglycemia kuma-diabetics asebekhulile kuvame ukwenzeka ngenxa yokuthi isiguli sithatha izidakamizwa eziningi ezahlukahlukene, futhi ziyaxhumana. Ezinye izidakamizwa zingaqhakambisa imiphumela yamaphilisi kashukela, okuphuma ku-sulfonylurea. Abanye - bavusa ukukhululeka kwe-insulin noma bandise ukuzwela kwamangqamuzana esenzweni salo.

Ezinye izidakamizwa zivimba imizwa ebonakalayo yezimpawu ze-hypoglycemia njengethonya eliseceleni, futhi isiguli asikwazi ukukumisa ngesikhathi. Ukubheka konke ukuhlangana kwezidakamizwa okungenzeka esigulini esikhulile esinesifo sikashukela kuwumsebenzi onzima kudokotela.

Ithebula libonisa okunye ukusebenzisana kwezidakamizwa okuvame ukuvusa i-hypoglycemia:

Uma umuntu onesifo sikashukela ekwazi kangcono ukugcina ushukela wegazi lakhe esejwayelekile, mancane amathuba okuthi abe nezinkinga futhi azizwe engcono. Kepha inkinga ukuthi lapho izinga likashukela wegazi lilawulwa kangcono ngokwelashwa “okujwayelekile” kwesifo sikashukela, kwenzeka kakhulu i-hypoglycemia. Futhi ezigulini esezikhulile, kuyingozi ikakhulukazi.

Lesi yisimo lapho izinqumo zombili zingalungile. Ingabe sikhona esinye isisombululo esifanele? Yebo, kunendlela ekuvumela ukuthi ulawule ushukela wegazi kahle futhi ngesikhathi esifanayo ulondoloze amathuba aphansi we-hypoglycemia. Le ndlela ukukhawulela ama-carbohydrate ekudleni kashukela, ukudla ikakhulukazi amaprotheni namafutha emvelo awusizo enhliziyweni.

Ama-carbohydrate ambalwa owadlayo, yehlisa isidingo sakho samaphilisi we-insulin noma kashukela ukwehlisa ushukela wakho. Futhi ngokufanele, mancane amathuba okuba uzokwenzeka i-hypoglycemia. Ukudla, okubandakanya ikakhulu amaprotheni, amafutha emvelo anempilo kanye ne-fiber, kusiza ukugcina amazinga kashukela egazi asondele kokujwayelekile.

Iziguli eziningi ezinesifo sikashukela sohlobo 2, kufaka phakathi asebekhulile, ngemuva kokushintshela ekudleni okuphansi kwe-carbohydrate ziyakwazi ukuyeka ngokuphelele amaphilisi we-insulin namaphilisi kashukela. Ngemuva kwalokhu, i-hypoglycemia ayinakwenzeka nhlobo. Noma ungeke “wagxuma” ngokuphelele kusuka ku-insulin, khona-ke isidingo saso siyokwehla kakhulu. Futhi i-insulin namaphilisi amancane owatholayo, kwehlisa amathuba we-hypoglycemia.

Ukwelashwa kwesifo sikashukela sohlobo 2 kubantu asebekhulile

Ukwelapha isifo sikashukela sohlobo 2 kubantu asebekhulile kuvame ukuba ngumsebenzi onzima ngokukhethekile kudokotela. Ngoba kuvame ukuhlanganiswa yinkimbinkimbi yezifo ezenzeka ndawonye ezinesifo sikashukela, isizungu senhlalo (isizungu, ubuphofu, ukungabi nalusizo), ukufunda isiguli okungahambi kahle, kanye nokuwohloka komqondo okubucayi.

Ngokuvamile udokotela kufanele anikeze izidakamizwa eziningi iziguli esezikhulile ezinesifo sikashukela. Kungaba nzima ukuthi unake konke ukuhlangana kwabo okungenzeka komunye nomunye. Abantu abadala abanesifo sikashukela asebekhulile bavame ukukhombisa ukunamathela okuphansi ekwelashweni, futhi banqume ukuthatha umuthi futhi bathathe izinyathelo zokwelapha isifo sabo.

Ingxenye enkulu yeziguli ezinesifo sikashukela esezikhulile ziphila ezimweni ezingezinhle. Ngenxa yalokhu, bavame ukuba ne-anorexia noma ukudangala okujulile. Ezigulini ezinesifo sikashukela, ukudangala kuholela ekutheni baphule irejimeni yemithi futhi balawule ushukela wegazi ngokungafanele.

Izinhloso zokwelashwa sikashukela kwesiguli ngasinye esidala kufanele zibekwe ngokuhlukile. Zincike ku:

• isikhathi sokuphila;
• ukuthambekela kwe-hypoglycemia enkulu;
• Ngabe kukhona izifo zenhliziyo;
• unezinkinga zesifo sikashukela esivele sakhiwe?
• kuze kube sesimweni semisebenzi yengqondo yesiguli ikuvumela ukuba ulandele izincomo zikadokotela.

Ngomqondo wokuphila okulindelekile (isikhathi sokuphila) seminyaka engaphezu kwe-10-15, inhloso yokwelashwa kwesifo sikashukela esekhulile kufanele kube ukufezekisa i-glycated hemoglobin HbA1C <7%. Njengoba isikhathi sokuphila singaphansi kweminyaka engu-5 - HbA1C <8%. Ukwehlisa ushukela egazini kwisifo sikashukela esidala kufanele kube kahle, kancane kancane.

Ucwaningo olwenziwa ngonyaka ka 2000 lwakhombisa ngokugculisayo ukuthi ukusebenzisa amaqhinga wokulawula ushukela wegazi onamandla, onamandla amakhulu, lokhu kukhulisa kakhulu izigameko ze-hypoglycemia kanye nokufa kwabantu ezigulini esezikhulile ezinesifo sikashukela sohlobo 2. Ngakho-ke, kuyadingeka ukuguqula izinga le-glucose ngokwejwayelekile kancane, ngaphezu kwezinyanga eziningana.

Lapho welapha isifo sikashukela ezigulini esezikhulile, kuyadingeka ukulawula hhayi kuphela ushukela wegazi, kodwa ne-cholesterol, triglycerides nomfutho wegazi. Zonke lezi zinkomba kufanele zigcinwe ngaphakathi kwemikhawulo ejwayelekile ukuvikela ukuthuthukiswa kwezinkinga. Uma bephambuka kokujwayelekile, udokotela ubeka leyo ndlela yokwelashwa efanelekile: ukudla, izidakamizwa kusuka esigabeni sama-statin, imishanguzo ye-hypertension (bheka futhi indawo yethu ekwelashweni kwe-hypertension).

Njengamanje, umlamuli odokotela unezindlela ezilandelayo zokwelapha iziguli ezinesifo sikashukela sohlobo 2, kufaka phakathi asebekhulile:

• ukwelashwa kwesifo sikashukela ngaphandle kwezidakamizwa (ukudla kanye nokuzivocavoca);
• ukwelashwa kwezidakamizwa sikashukela (amaphilisi);
• ukwelashwa kwe-insulin.

Amaphilisi kashukela kanye nemijovo ye-insulin kuzoxoxwa kabanzi ngayo ngezansi. Isenzo sabo sihlose ukulungisa izindlela ezahlukahlukene zokuthuthuka kwalesi sifo:

• ukuzwela okwengeziwe kwezicubu esenzweni se-insulin (ukwehla kokumelana ne-insulin);
• ukugqugquzela ukugcinwa kwe-insulin, ikakhulukazi isigaba sayo sokuqala (asikukhuthazi ukuthatha amaphilisi akhuthaza ukuvikelwa kwe-insulin! yenqaba!);
• ukubuyiselwa komphumela ovuselelayo wamahomoni wama-incretins kuma-pancreas.

Ithuba lokwelashwa ngempumelelo kwesifo sikashukela selikhuphukile kusukela engxenyeni yesi-2 yonyaka ka 2000s, ngokufika kwemithi emisha eqenjini le-incretin. Lokhu kuyizithiyo ze-dipeptidyl peptidase-4 (gliptins), kanye nama-mimetics nama-analogues we-GLP-1. Sikweluleka ukuthi utadishe ngokucophelela imininingwane mayelana nale mithi kwiwebhusayithi yethu.

Sincoma ukuthi iziguli esezikhulile ziguqukele ekudleni okuphansi kwe-carb sikashukela, ngaphezu kwawo wonke amanye amakhambi. Ukudla okuvinjelwe i-carbohydrate kuvunyelwe kuhluleki olunamandla lwezinso. Kuzo zonke ezinye izimo, kusiza ukugcina ushukela wegazi usondele kokujwayelekile, ukugwema "ukugxuma" kwawo futhi kunciphise amathuba we-hypoglycemia.

Umsebenzi womzimba wesifo sikashukela esekhulile

Ukuzivocavoca umzimba kuyingxenye edingekayo ekwelashweni ngempumelelo kwesifo sikashukela. Esigulini ngasinye, ikakhulukazi asebekhulile, ukuzivocavoca komzimba kukhethwa ngakunye, kucatshangelwa izifo ezihambelanayo. Kepha kumele zidingeka. Ungaqala ngokuhamba imizuzu engama-30-60.

Kungani ukusebenza komzimba kusiza kakhulu kushukela:

• kwandisa ukuzwela kwezicubu kuyi-insulin, okungukuthi, kunciphisa ukumelana ne-insulin;
• imfundo yemizimba ivimba ukuthuthukiswa kwe-atherosclerosis;
• Ukuvivinya umzimba kwehlisa umfutho wegazi.

Izindaba ezimnandi: abanesifo sikashukela esikhulile bazwela kakhulu ukuzikhandla ngokomzimba kunabancane.

Ungazikhethela uhlobo lomzimba oluzokulethela injabulo. Sincoma ukuthi uyifunde le ncwadi kaChris Crowley noHenry Lodge "Omncane minyaka yonke."

Le ncwadi emnandi kakhulu mayelana nesihloko semfundo yokuthuthuka kwezempilo kanye nendlela yokuphila esebenzayo yabantu asebekhulile. Sicela usebenzise izincomo zakhe ngokuya ngesimo sakho somzimba. Hlola isihloko sokuvimbela i-hypoglycemia ngesikhathi sokuzivocavoca.

Ukuzivocavoca kushukela kunqunyelwe kulezi zimo ezilandelayo:

• isinxephezelo esingagculisi sesifo sikashukela;
• esimweni se-ketoacidosis;
• nge-angina engazinzi;
• uma une-retinopathy ekhulayo;
• ekwehlulekeni kwe-renal okungamahlalakhona.

Ngaphambi kokuthi uhlanganyele ngokuqinile emfundweni yokuzivocavoca, bonana nodokotela. Funda i-athikili yethu enemininingwane "Ukuzivocavoca umzimba ngokuzivocavoca sikashukela."

Imithi Yesifo Sikashukela Yabaguli Abadala

Ngezansi, uzofunda ngemithi yesifo sikashukela nokuthi isetshenziswa kanjani ukwelapha iziguli esezikhulile. Uma unesifo sikashukela sohlobo 2, sincoma ukuthi wenze okulandelayo:

1. Ukuze wehlise ushukela wegazi lakho futhi uligcine liseduze nokujwayelekile, okokuqala zama ukudla okuvinjelwe i-carbohydrate.
2. Futhi yenza imisebenzi yokuzivocavoca ongayenza futhi ulethe injabulo. Sisanda kuxoxa lo mbuzo ngenhla.
3. Okungenani i-70% yeziguli ezinesifo sikashukela sohlobo 2 zinokudla okwanele okuvinjelwe ama-carbohydrate kanye nokuzivocavoca okukhanyayo ngokomzimba ukwenza ushukela wegazi ube ngokwejwayelekile. Uma lokhu kungenele kuwe - thatha izivivinyo ukuze uhlole izinso bese uthintana nodokotela wakho uma ungakunquma i-metformin (siofor, glucophage). Musa ukuthatha uSiofor ngaphandle kwemvume kadokotela! Uma izinso zisebenza kabi, lo muthi uyafa.
4. Uma uqala ukuthatha i-metformin - ungayeki ukudla okune-carbohydrate ongaphansi kanye nokuzivocavoca.
5. Kunoma ikuphi, wenqaba ukuthatha imithi ekhuthaza ukucashelwa kwe-insulin! Lawa ngama-sulfonylureas nama-meglitinides (i-letsides). Ziyingozi. Ukwenza imijovo ye-insulin kunempilo kunokuthatha la maphilisi.
6. Naka ngokukhethekile izidakamizwa ezintsha ezivela eqenjini le-incretin.
7. Zizwe ukhululekile ukushintshela ku-insulin uma kunesidingo sangempela salokhu, isb. Ukudla okunama-carbohydrate aphansi, ukuzivocavoca nemithi ukunxenxa ushukela wakho akwanele.
8. Funda uhlelo “lokwelashwa kwesifo sikashukela sohlobo 2.”

I-Metformin - ikhambi lohlobo 2 lwesifo sikashukela esekhulile

I-Metformin (ethengiswe ngaphansi kwamagama uSiofor, glucophage) umuthi wokuqala wokukhetha wabanesifo sikashukela asebekhulile. Kunqunyiwe uma isiguli sigcine umsebenzi wokuhlunga kwe-renal (izinga lokuhlunga le-glomerular ngenhla kuka-60 ml / min) futhi azikho izifo ezihambisanayo ezithwala ubungozi be-hypoxia.

Funda i-metformin yethu yendatshana (siofor, glucophage). I-Metformin iyisidakamizwa esimnandi esingagcini nje ngokunciphisa ushukela wegazi, kodwa futhi sinomphumela omuhle emzimbeni. Ayinayo imiphumela etholakalayo (esisazotholwa) njengamanye amaphilisi kashukela.

I-Metformin ayiqedi i-pancreas, ayikhulisi ubungozi be-hypoglycemia, futhi ayibangeli ukukhuluphala kwesisindo. Ngokuphambene nalokho, kuvusa ukulahleka kwesisindo. Ungalindela ukuthi uzolahlekelwa ngo-1-3 kg noma ngaphezulu ngokuthatha i-metformin. Ema-diabetes amaningi, kuqala kubangela ukugcwala kanye nokugayeka, kepha ngemuva kwesikhashana umzimba uyavumelana futhi nalezi zinkinga zihamba.

I-Thiazolidinediones (glitazones)

I-Thiazolidinediones (glitazones) yaqala ukusetshenziswa ukwelapha isifo sikashukela ekuqaleni kwekhulu lama-20 - lama-21. Njenge-metformin, bakhulisa ukuzwela kwezicubu (izicubu, amaseli wamafutha, isibindi) esenzweni se-insulin. Le mithi ayivuseleli ukugcinwa kwe-insulin, futhi ngenxa yalokho ayikhulisi amathuba we-hypoglycemia.

Ama-Thiazolidinediones ngesikhathi se-monotherapy anciphisa izinga le-hemoglobin HbA1C glycated nge-0.5-1.4%. Kodwa zisebenza kuphela uma ama-pancreas eqhubeka nokukhiqiza i-insulin. Ngakho-ke, azisizi ngalutho ezigulini ezinesifo sikashukela sohlobo 2 isikhathi eside, futhi amanyikwe aphelile.

Imithi yesifo sikashukela se-Glitazone yenza ngendlela efanayo ne-metformin, kepha, ngokuhlukile, inemiphumela emibi eyingozi. Uhlu lwalezi zinto ezingemnandi luhlanganisa:

• ukugcinwa kwamanzi emzimbeni;
• isisindo somzimba;
• ukusheshisa ukuthuthukiswa kokuhluleka kwenhliziyo.

Ama-Thiazolidinediones (ama-glitazones) aqiniswe ku-edema noma ukuhluleka kwenhliziyo kwanoma yiliphi ikilasi elisebenzayo. Ezigulini esezikhulile ezinesifo sikashukela, ukusetshenziswa kwalezi zidakamizwa kunzima ngenxa yezizathu ezilandelayo:

• Izazi zesifo sikashukela esidala zivame ukuba nenkinga yokwehluleka kwenhliziyo ukwehluka okuhlukahlukene, ngenxa yezehlakalo zenhliziyo zangaphambili (ukushaya kwenhliziyo).
• I-Thiazolidinediones (glitazones) ifaka isandla ekwakhiweni kwamathambo, i.e., ukufakwa kwe-calcium evela emathanjeni. Bandisa ingozi yokuqhekeka ezigulini esezikhulile izikhathi ezi-2 ezinamandla kunamanye amaphilisi kashukela. Le ngozi inkulu kakhulu kwabesifazane ngemuva kokuya esikhathini.

Inzuzo yokusebenzisa i-thiazolidinediones yesifo sikashukela ukuthi ayandisi ubungozi be-hypoglycemia. Ngaphandle kwalolu thuba olubalulekile, ama-glitazones awawona umugqa wokuqala wokukhethwa kokwelashwa kwesifo sikashukela esekhulile.

Sulfonylureas

Imithi yesifo sikashukela kuleli qembu isetshenzisiwe kusukela ngeminyaka yama-50s yekhulu lamashumi amabili. “Bashaya” amaseli we-pancreatic beta ukuze bakhiqize i-insulin ngokwengeziwe. Isebenza kahle kuze kube yilapho amandla omzimba ukukhiqiza i-insulin yayo ngokuphelele.

Kungani sincoma bonke abanesifo sikashukela ukuthi bayeke ukuthatha le mithi:

• Zivusa i-hypoglycemia. Ezinye izindlela zokunciphisa ushukela wegazi azikho kubi ngaphezu kokutholwa yi-sulfonylurea, futhi musa ukwandisa ubungozi be-hypoglycemia.
• Le mishanguzo igcina “iqeda” amanyikwe. Noma kungaba usizo esigulini ukuba silondoloze amandla okukhiqiza okungenani ezinye ze-insulin yakhe
• Zibangela ukwanda kwesisindo somzimba. Izinketho zokunakekelwa kwesifo sikashukela ezisezingeni eliphansi azikho kubi kakhulu, futhi ngasikhathi sinye azikhulisi ukukhuluphala.

Uzokwazi ukulenza ngokwejwayelekile i-glucose level yakho, ngaphandle kwemithi yaleli qembu futhi ngaphandle kwemiphumela yalo emibi. Imvamisa, iziguli ezinesifo sikashukela zizama ukuthatha izinto eziphuma sulfonylurea njengezinyathelo sokugcina, ukuze zingadlulisi imijovo ye-insulin. “Ukwelashwa” okunjalo kulimaza kakhulu impilo yabo. Zizwe ukhululekile ukuqala ukwelashwa kwe-insulin, uma kunezinkomba zayo. Funda uhlelo “lokwelashwa kwesifo sikashukela sohlobo 2.”

I-Meglitinides (Clinids)

Njengokuphuma kwe-sulfonylurea, le mithi ivuselela amaseli we-beta ukuze enze i-insulin isebenze kakhulu. I-Meglitinides (glinids) iqala ukusebenza ngokushesha okukhulu, kepha umphumela wayo awuhlali isikhathi eside, kuze kube yimizuzu engama-30-90. Le mishanguzo ibekiwe ngaphambi kokudla ngakunye.

Ama-Meglitinides (ama-glinides) akufanele asetshenziswe ngezizathu ezifanayo njenge-sulfonylureas. Basiza "ukucima" ukwanda okubukhali kwe-glucose ngokushesha ngemuva kokudla. Uma uyeka ukudla ama-carbohydrate adonswa ngokushesha, ngakho-ke ngeke ube nalokhu kukhuphuka.

I-dipeptidyl Peptidase-4 Inhibitors (ama-Gliptins)

Khumbula ukuthi i-glucagon-like peptide-1 (GLP-1) ingenye yama-hormone ama-incretins. Zishukumisa ama-pancreas ukukhiqiza i-insulin futhi ngesikhathi esifanayo zivimbe ukukhiqizwa kwe-glucagon, “umphikisi” we-insulin. Kepha i-GLP-1 isebenza kuphela inqobo uma ushukela wegazi ehleli ephakeme.

IDipeptidyl peptidase-4 iyi-enzyme ebhubhisa ngokwemvelo i-GLP-1, futhi isenzo sayo siyanqanyulwa. Imithi eqenjini le-dipeptidyl peptidase-4 inhibitors ivimbela le enzyme ekuboniseni umsebenzi wayo. Uhlu lwamalungiselelo we-glyptin lubandakanya:

• i-vildagliptin (galvus);
• sitagliptin (Januvia);
• saxagliptin (englise).

Vimbela (inhibit) umsebenzi we-enzyme obhubhisa i-hormone GLP-1. Ngakho-ke, ukugxilwa kwe-GLP-1 egazini ngaphansi kwethonya lomuthi kungakhuphukela ezingeni lezikhathi ezi-1.5-2 eliphakeme kuneleveli yomzimba. Ngokufanelekile, izovusa kakhulu ama-pancreas ukukhipha i-insulin egazini.

Kubalulekile ukuthi izidakamizwa eziseqenjini le-dipeptidyl peptidase-4 inhibitors zisebenze nomphumela wazo ngenkathi ushukela wegazi uphakanyisiwe. Lapho kwehla kokujwayelekile (i-4.5 mmol / L), le mishanguzo icishe iyeke ukukhuthaza ukwenziwa kwe-insulin futhi ivimbele ukukhiqizwa kweglucagon.

Izinzuzo zokwelapha isifo sikashukela sohlobo 2 ngezidakamizwa ezivela eqenjini le-dipeptidyl peptidase-4 inhibitors (gliptins):

• azandisi ubungozi be-hypoglycemia;
• musa ukudala isisindo somzimba;
• imiphumela emibi yayo - ayenzeki kaningi kunangesikhathi kuthathwa i-placebo.

Ezigulini ezinesifo sikashukela esineminyaka yobudala engama-65, ukwelashwa nge-DPP-4 inhibitors kungabikho ezinye izidakamizwa kuholela ekwehlekeni kwezinga le-glycated hemoglobin HbA1C lisuka ku-0.7 laya ku-1.2%. Ingozi ye-hypoglycemia incane, isuka ku-0 iye ku-6%. Eqenjini elilawulayo labanesifo sikashukela abathathe i-placebo, ubungozi be-hypoglycemia busuka ku-0 iye ku-10%. Le mininingwane itholakala ngemuva kwezifundo ezinde, kusukela kumaviki angama-24 kuye kwangama-52.

Imithi eqenjini le-dipeptidyl peptidase-4 inhibitors (gliptins) ingahlanganiswa namanye amaphilisi kashukela, ngaphandle kwengozi yokwanda kwemiphumela emibi. Okuthakazelisa kakhulu ithuba lokubanikeza nge-metformin.

Ucwaningo lwango-2009 luqhathanise ukusebenza nokuphepha kokwelapha isifo sikashukela ezigulini esezikhulile ezingaphezulu kweminyaka engama-65 sisebenzisa lezi zinhlanganisela zezidakamizwa ezilandelayo:

• metformin + sulfonylurea (glimepiride <6 mg ngosuku);
• metformin + vildagliptin (galvus) umthamo we-100 mg ngosuku.

Ukwehla kwezinga le-hemoglobin HbA1C ye-glycated ku-diabetesics kuwo womabili amaqembu cishe kwakufana. Kodwa ezigulini zeqembu lokuqala, i-16.4% ye-hypoglycemia yaqoshwa, futhi kwaba yi-1.7% kuphela ekwelapheni i-metformin ene-galvus. Kuyavela ukuthi ukufaka esikhundleni okususelwa ku-sulfonylurea nge-DPP-4 inhibitors kunciphisa imvamisa ye-hypoglycemia ngezikhathi eziyi-10, ngenkathi kugcinwa umphumela wokunciphisa ushukela wegazi.

Ama-mimetics kanye nama-analogues we-GLP-1

Izidakamizwa ezilandelayo zifakiwe kuleli qembu lezidakamizwa ezintsha zesifo sikashukela:

• exenatide (bayeta);
• liraglutin (isisulu).

Indlela yokusebenza yalezi zidakamizwa iyefana nendlela i-dipeptidyl peptidase-4 inhibitors (glyptins) esebenza ngayo. Kepha le mishanguzo ayikho emacwecweni, kepha injekiwe ngokungazelele.

Sekufakazelwe ukuthi ama-mimetics kanye nama-analogues we-GLP-1 aba nomthelela ekwehliseni isisindo futhi abe nengozi ephansi kakhulu yokuthuthukisa i-hypoglycemia. Zingasetshenziswa ezigulini esezikhulile ezinesifo sikashukela esinokukhuluphala kakhulu (inkomba yesisindo somzimba> 30 kg / m2), uma isiguli sikulungele ukunikeza imijovo.

Yizidakamizwa ezibizwa ngokuthi ama-mimetics kanye nama-analogues we-GLP-1 okunengqondo ukusebenzisa njengezinyathelo zokugcina uma isiguli sifuna ukubambezela ukuqala kokwelashwa kwesifo sikashukela nge-insulin. Futhi hhayi ama-sulfonylureas, njengoba kuvame ukwenziwa.

I-Acarbose (glucobai) - isidakamizwa esivimba ukumuncwa kwe-glucose

Umuthi wesifo sikashukela yi-alpha glucosidase inhibitor. I-Acarboro (glucobai) ivimbela ukugaya kwama-carbohydrate ayinkimbinkimbi, i-poly- ne-oligosaccharides emathunjini. Ngaphansi kwethonya lomuthi, i-glucose engaphansi igxilwa egazini. Kepha ukusetshenziswa kwaso kuvame ukuholela ekuqhakazeni, ku-flatulence, kuhudo, njll.

Ukuze unciphise ubunzima bemiphumela emibi, kunconywa ukunciphisa kakhulu ama-carbohydrate ekudleni ngenkathi uthatha i-acarbose (glucobaya). Kepha uma usebenzisa ukudla okune-carbohydrate ephansi kancane, njengoba sincoma, ukuguqula ushukela wegazi kube-ke, asikho isizathu sokuthatha lesi sidakamizwa nakancane.

Ukwelashwa kwesifo sikashukela asebekhulile nge-insulin

I-insulin yohlobo 2 sikashukela ichaziwe uma ukwelashwa ngokudla, ukuvivinya umzimba kanye namaphilisi kashukela kunganciphisi ngokwanele ushukela wegazi. Isifo sikashukela sohlobo 2 siphathwa nge-insulin lapho sihlangana noma singenawo amaphilisi. Uma kunesisindo somzimba ngokweqile, khona-ke imijovo ye-insulin ingahlanganiswa nokusetshenziswa kwe-metformin (siofor, glucophage) noma i-DPP-4 inhibitor vildagliptin. Lokhu kunciphisa isidingo se-insulin futhi, ngenxa yalokho, kwehlisa ingozi ye-hypoglycemia.

Abantu asebekhulile abanesifo sikashukela bahlala besabela kanzima ngokwengqondo lapho udokotela ezama ukunikeza imijovo ye-insulin.Noma kunjalo, uma izinkomba zoku kufanelekile, udokotela kufanele aphikelele ukuthi isiguli “isikhashana” sizame i-insulin, okungenani izinyanga ezingama-2-3. Zizwe ukhululekile ukuqala ukwelapha ushukela esekhulile nge-insulin, uma kukhona ubufakazi balokhu. Funda “Isu Eliphumelelayo Lesifo Sikashukela”

Ngokuvamile kuvela ukuthi abanesifo sikashukela asebekhulile baqala ukuzizwa bengcono kakhulu ezinsukwini ezingama-2-3 ngemuva kokuqala kwemijovo ye-insulin. Kucatshangwa ukuthi lokhu akubangelwa kuphela ngokuncipha koshukela wegazi, kodwa futhi nomphumela we-anabolic we-insulin neminye imiphumela yako. Ngakho-ke, umbuzo wokubuyela ekwelashweni kwesifo sikashukela ngosizo lwamathebulethi unyamalala wodwa.

Ezigulini esezikhulile, ungasebenzisa izikimu ezahlukahlukene zokwelapha nge-insulin:

• Umjovo owodwa we-insulin ngaphambi kokulala - uma ushukela uvame ukuphakanyiswa kakhulu esiswini esingenalutho. I-insulin noma i-“medium” esetshenziswa nsuku zonke ayisebenzi.
• Imijovo ye-insulin yesikhathi esilinganiselwe sesenzo izikhathi 2 ngosuku - ngaphambi kokudla kwasekuseni nangaphambi kokulala.
• Ukufakwa kwama-insulin ahlanganisiwe izikhathi ezi-2 ngosuku. Kuhlanganiswe izingxube ezifakiwe ze-insulin “efushane” ne “medium”, ngezilinganiso ezingama-30: 70 noma ezingama-50: 50.
• I-Baseline bolus regimen yesifo sikashukela se-insulin. Lokhu kungumjovo we-insulin emfushane (i-ultrashort) ngaphambi kokudla, kanye ne-insulin yesikhathi sokusebenza noma “enwetshiwe” ngesikhathi sokulala.

Okokugcina kwemibuso ebhalwe ohlwini yokwelashwa kwe-insulin ingasetshenziswa kuphela uma isiguli sikwazi ukutadisha nokuzihlola ngokwaso ushukela wegazi futhi isikhathi ngasinye ukhethe kahle umthamo we-insulin. Lokhu kudinga ukuthi umuntu osekhulile onesifo sikashukela alondoloze ikhono elijwayelekile lokugxila nokufunda.

Isifo Sikashukela Kwabadala: Ukutholwa

Lapho umuntu esegugile, iba yingozi enkulu yokuba nesifo sikashukela sohlobo 2. Lokhu kungenxa yokuguga kwemvelo komzimba, kepha ikakhulu ngenxa yendlela yokuphila engenampilo yabantu asebekhulile. Eminyakeni engu-45 nangaphezulu - hlola isifo sikashukela njalo eminyakeni emi-3. Kungcono ukuthatha uhlolo lwegazi hhayi ushukela wokuzila, kepha nge-hemoglobin ye-glycated.

Ithuluzi elisebenzayo nelusizo kakhulu ekuvimbeleni nasekwelashweni kwesifo sikashukela sohlobo 2, kufaka phakathi iziguli esezikhulile, ukudla okune-carbohydrate ephansi. Zama ukudla okunempilo futhi okumnandi kokudla kwashukela omncane! Yonke imininingwane edingekayo ekuwebhusayithi yethu, ifaka phakathi uhlu lwemikhiqizo yabanesifo sikashukela - kuvunyelwe futhi inqatshelwe. Ngenxa yalokhu, ushukela wegazi lakho uzoqala ukwehla ube uvamile ngemuva kwezinsuku ezimbalwa. Vele, udinga ukuba nemitha yeglucose yasekhaya futhi uyisebenzise nsuku zonke.

Ukwelashwa ngokomzimba nakho kuyasiza. Thola izinketho zomsebenzi womzimba okulethela injabulo. Lokhu kuzosiza incwadi kaChris Crowley ethi “Omncane minyaka yonke.”

Uma ukudla okune-carbohydrate ephansi kanye nokuzivocavoca kungasizi ukwehlisa amazinga kashukela egazi abe ejwayelekile, bese uvivinya ubonane nodokotela wakho uma kufanele uthathe i-metformin (siofor, glucophage). Ungagijimeli ekhemisi ukuze uthole i-siofor, qala uthathe izivivinyo ubonane nodokotela! Uma uqala ukusebenzisa i-metformin, lokhu akusho ukuthi manje usungayeka ukudla nokudla ngokomzimba.

Uma ukudla, ukuzivocavoca namaphilisi kungasizi kahle, khona-ke ukhonjiswa imijovo ye-insulin. Shesha bese uqala ukuzenza, ungesabi. Ngoba ngenkathi uhlala ngaphandle kokujova i-insulin noshukela wegazi ophezulu - ukhula ngokushesha kwezinkinga zesifo sikashukela. Lokhu kungaholela ekunqunyweni konyawo, ubumpumputhe, noma ukufa okuqhamukayo ngenxa yokuhluleka kwezinso.

I-Hypoglycemia ekugugeni iyingozi kakhulu. Kepha umuntu onesifo sikashukela anganciphisa amathuba akhe acishe abe yi-zero esebenzisa izindlela ezi-3 ezilandelayo:

• Ungathathi amaphilisi kashukela abangela i-hypoglycemia. Lawa ngama-sulfonylureas nama-meglitinides (i-letsides). Ungawenza ushukela wakho abe ngokuphelele ngaphandle kwawo.
• Yidla ama-carbohydrate amancane ngangokunokwenzeka. Noma imiphi i-carbohydrate, hhayi nje leyo ethakwa ngokushesha. Ngoba ama-carbohydrate amancane ekudleni kwakho, okuncane udinga ukujova i-insulin. Futhi i-insulin engaphansi - yehlisa amathuba okukhula kwe-hypoglycemia.
• Uma udokotela eqhubeka nokugcizelela ukuthi uphuza amaphilisi aqhamuka kuma-sulfonylureas noma ama-meglitinides (glinides), thintana nolunye uchwepheshe. Into efanayo uma efakazela ukuthi udinga ukudla "ngokulingana". Musa ukuphikisana, vele ushintshe udokotela.

Sizojabula uma ubhala ngempumelelo yakho nezinkinga zakho ekwelashweni kwesifo sikashukela esegugini kumazwana alesi sihloko.

Funda futhi izindatshana:

• Ubuhlungu bomlenze kushukela - okufanele ukwenze;
• Isifo sikashukela nezinkinga zezinso;
• Imiphi imitha yokukhetha enembile kunazo zonke.