I-insulin ibandakanyeka kulawulo lwe-metabolism, ukuhanjiswa kwe-transmembrane kwama-ion, ama-amino acid. Umphumela we-insulini kuma-carbohydrate metabolism kunzima ukuwuthatha ngokweqile. Abantu abanesifo sikashukela futhi bakhombisa izimpawu zokulimala kwemetabolism.
Isifo sikashukela mellitus sitholakale kakhulu muva nje. Izifo zidala ukuphazamiseka okuhlukahlukene kwe-metabolic. Isifo sikashukela i-mellitus, i-pathological physiology engahluka kakhulu, isendaweni yesithathu ngemuva kwezifo ze-oncology nezifo zenhliziyo. Kunabantu abacishe babe yizigidi eziyi-100 abanesifo sikashukela emhlabeni. Njalo eminyakeni eyi-10, inani labanesifo sikashukela liba ngaphezu kwezikhathi ezi-2.
Abantu abavela emazweni asathuthuka kanye nezinto ezingathathelwa ndawo emazweni athuthukile basengozini enkulu yokugula. Ukuphazamiseka kwemetabolic ku-mellitus yesifo sikashukela kuholela kuma-pathologies ahlukahlukene. Isifo sikashukela sohlobo 2 sivame ukuthinta abantu ngemuva kweminyaka engama-45.
I-Mechanism yesenzo se-insulin
Ngo-1869, abakwaLangerhans bathola iziqhingi kuma-pancreas kamuva aqanjwa ngaye. Kwaziwa ukuthi isifo sikashukela singabonakala ngemuva kokususwa kwesibindi.
I-insulin iprotheni, okungukuthi, i-polypeptide equkethe amaketanga ka-A no-B. Baxhunywe ngamabhuloho amabili angenasisekelo. Kuyaziwa manje ukuthi i-insulin iyakhiwa futhi igcinwe amaseli e-beta. I-insulin iphazanyiswa ama-enzymes abuyisa izibopho ze-disulfide futhi abizwa nge- "insulinase." Ngaphezu kwalokho, ama-enzyme e-proteinolytic abandakanyeka ku-hydrolysis yamaketanga ezingxenyeni eziphansi zamangqamuzana.
Kukholelwa ukuthi i-inhibitor eyinhloko ye-insulin secretion yi-insulin egazini ngokwayo, kanye namahomoni e-hyperglycemic:
- adrenaline
- ACTH,
- i-cortisol.
I-TSH, i-catecholamines, i-ACTH, i-STH kanye ne-glucagon ngezindlela ezahlukahlukene yenza kusebenze i-adenylcyclase kulwelwesi lweseli. Lesi sakamuva sakha ukwakheka kwe-cyclic 3,5 adenosine monophosphate, sisebenzisa enye into - iprotein kinase, sisebenzisa imicrotubules ye-beta-Island, okuholela ekunciphiseni kokukhishwa kwe-insulin.
Ama-microtubules luhlaka lwe-beta-cell lapho i-insulin eyakhiwe khona ngaphambili ihamba ngamaseli kuya kulolwelwesi lweseli.
Isikhuthazo esinamandla kakhulu sokwakheka kwe-insulin i-glucose yegazi.
Indlela yokusebenza kwe-insulin nayo ilele ebudlelwaneni bokuphikisana nabalamuli be-intracellular 3,5 - GMF kanye ne-3,5 AMP.
Umshini we-carbohydrate metabolism
I-insulin ithinta umzimba we-carbohydrate kushukela. Isixhumanisi esiyisihluthulelo salesi sifo ukuntuleka kwale nto. I-insulin inethonya elihle kuma-carbohydrate metabolism, kanye nezinye izinhlobo zemetabolism, ngoba ukugcinwa kwe-insulin kuyancipha, umsebenzi wayo uyancipha, noma ukwamukelwa kwezicubu ezixhomekeke kumsulin ngamaseli kuyaphazamiseka.
Ngenxa yokwephulwa kwe-carbohydrate metabolism ku-mellitus yesifo sikashukela, umsebenzi wokuthathwa kwe-glucose ungene kumaseli uyancipha, umthamo wawo egazini uyanda, nezindlela zokusebenzisa ushukela ezizimele ze-insulin ziyasebenza.
I-Sorbitol shunt yisimo lapho i-glucose incishiselwa i-sorbitol, bese i-oxidised to fructose. Kodwa i-oxidation ikhawulelwe i-enzyme encike ku-insulin. Lapho i-polyol shunt icushiwe, i-sorbitol iqongelela izicubu, lokhu kunomthelela ekubonakala:
- i-neuropathy
- katarayta
- ama-microangiopathies.
Kukhona ukwakheka kwangaphakathi kwe-glucose kusuka kumaprotheni kanye ne-glycogen, kepha ngisho nalolu hlobo lwe-goiukosis aluthwa amaseli, ngoba kunokuntuleka kwe-insulin. I-Aerobic glycolysis ne-pentose phosphate shunt iyacindezelwa, kuvela i-cell hypoxia kanye nokuntuleka kwamandla. Umthamo we-hemoglobin ye-glycated uyakhuphuka, akuyona into ethwala umoya-mpilo, ekhulisa i-hypoxia.
Iprotein metabolism kushukela ingathikamezeka:
- i-hyperazotemia (inani elikhulayo le-nitrogen eseleyo),
- i-hyperazotemia (ukukhuphuka kwevolumu yamakhemikhali e-nitrogen egazini).
Imvelo yamaprotheni nitrogen ingu-0.86 mmol / L, futhi i-nitrogen ephelele kufanele ibe ngu-0.87 mmol / L.
Izimbangela ze-pathophysiology yilezi:
- ukwanda kwamaprotheni
- kusebenze kokuqanjwa kwama-amino acid esibindini,
- initrogen eseleyo.
I-nitrogen engamaprotheni yi-nitrogen:
- ama-amino acid
- urea
- i-ammonia
- i-creatinine.
Lokhu kungenxa yokunyuka kokubhujiswa kwamaprotheni, ikakhulukazi esibindini nasemisipha.
Ngomchamo onesifo sikashukela, umthamo wamakhompiyutha we-nitrogen uyakhuphuka. I-Azoturia inezizathu ezilandelayo:
- ukukhuphuka kwenqwaba yemikhiqizo ene-nitrogen esegazini, ukucekeka kwabo emchameni,
- ukungasebenzi kahle kwama-metabolism abonakala nge-ketonemia, i-hyperlipidemia, i-ketonuria.
Esikhathini sikashukela, i-hyperlipidemia iyakhula, okuwukukhuphuka kwegazi lamazinga e-lipid. Inani labo lingaphezu kokujwayelekile, okungukuthi ngaphezulu kwama-8 g / l. I-hyperlipidemia elandelayo ikhona:
- ukuvuselelwa kwezicubu ze-lipolysis,
- ukuvimbela kokubhujiswa kwe-lipid ngamaseli,
- ukwanda kwe-cholesterol,
- ukunqandwa kokulethwa kwamafutha aphezulu kumaseli,
- umsebenzi wehlile we-LPLase,
- ketonemia - ukwanda kwevolumu yemizimba ye-ketone egazini.
Eqenjini lezidumbu ze-ketone:
- i-acetone
- i-acetoacetic acid
- i-p-hydroxymalic acid.
Umthamo ophelele wezidumbu ze-ketone esegazini ungaphezulu kuka-30-50 mg%. Kunezizathu zalokhu:
- ukusebenza kwe-lipolysis,
- ukukhuphuka kwe-oxidation kumaseli amaningi aphezulu,
- ukumiswa kokuqanjwa kwe-lipid,
- ukwehla kwe-oxidation ye-acetyl - i-CoA kuma-hepatocytes ngokwakhiwa kwezidumbu ze-ketone,
Ukwabiwa kwemizimba ye-ketone kanye nomchamo kuwukubonakaliswa kwesifo sikashukela esibonisa inkambo engemihle.
Imbangela ye ketonuria:
- imizimba eminingi ye-ketone ehlungiwe ezinso,
- ukuphazamiseka kokudla kwamanzi kushukela, kuboniswa yi-polydipsia ne-polyuria,
I-Polyuria iyindlela yokusebenza ekhonjiswa ekwakhiweni nasekuchazeni komchamo ngevolumu edlula amanani ajwayelekile. Ngaphansi kwezimo ezijwayelekile, kusuka ku-1000 kuye ku-1200 ml kukhishwa ngosuku olulodwa.
Isifo sikashukela, i-diuresis yansuku zonke ingu-4000-10 000 ml. Izizathu yilezi:
- I-Hyperosmia yomchamo, eyenzeka ngenxa yokususwa kwe-glucose eyeqile, i-ion, i-CT ne-nitrogen compounds. Ngakho-ke, ukuhlunga koketshezi ku-glomeruli kuyashukunyiswa futhi kuvimbela ukuphinda kubuye,
- Ukwephulwa kokuphindukuzalwa kanye ne-excretion, okubangelwa i-neuropathy yesifo sikashukela,
- I-Polydipsia.
I-insulin ne-fat metabolism
Ngaphansi kwethonya le-insulin, isibindi singagcina inani elithile le-glycogen. I-glucose ethe xaxa engena esibindini iqala ukwenza i-phosphorylate futhi ngaleyo ndlela igcinwe esitokisini, kodwa bese iguqulwa iba ngamafutha, kunokuba i-glycogen.
Lokhu kuguqulwa kube ngamafutha kungumphumela wokuvezwa ngokuqondile kwe-insulin, futhi igazi elakheka phakathi nenqubo yamafutha acid lihanjiswa ngezicubu ze-adipose. Egazini, amafutha ayingxenye ye-lipoprotein, edlala indima enkulu ekwakhiweni kwe-atherossteosis. Ngenxa yale pathology, ingaqala:
- embolism
- ukushaya kwenhliziyo.
Isenzo se-insulin kumaseli we-adipose izicubu ziyafana nomphumela wazo kumaseli wesibindi, kepha ukwakheka kwamafutha acid esibindini kuyasebenza ngokwengeziwe, ngakho-ke kudluliswa kusuka kuwo kuya kwezicubu ze-adipose. Amafutha acid kumaseli agcinwa njenge-triglycerides.
Ngaphansi kwethonya le-insulin, ukwephulwa kwe-triglycerides kwezicubu ze-adipose kuncishiswa ngenxa yokuvinjwa kwe-lipase. Ngaphezu kwalokho, i-insulin isebenze ekuqukeni kwamafutha acid ngamangqamuzana futhi ibandakanyeka ekunikezelweni kwawo nge-glycerol, edingekayo ekwakhiweni kwe-triglycerides. Ngakho-ke, ngokuqhubeka kwesikhathi, amafutha aqongelela, kufaka phakathi i-physiology yesifo sikashukela mellitus.
Umphumela we-insulin kuma-metabolism wamafutha ungahle uguqulwe, ngezinga lawo eliphansi, ama-triglycerides aphinda ahlukaniswe ngama-acid acid kanye ne-glycerol. Lokhu kungenxa yokuthi i-insulin inhibits lipase ne-lipolysis isebenza lapho ivolumu yayo incishisiwe.
Ama-acid acids amahhala, akhiwa ngesikhathi i-hydrolysis ye-triglycerides, ngasikhathi sinye ingena egazini futhi isetshenziswa njengomthombo wamandla wezicubu. I-oxidation yalawa ma-asidi ingaba kuwo wonke amaseli, ngaphandle kwamaseli wezinzwa.
Inani elikhulu kakhulu lama-asidi anamafutha akhululwa lapho kunokuntuleka kwe-insulin emabhulokeni amafutha abuye athelwe yisibindi. Amaseli wesibindi angakwazi ukuhlanganisa ama-triglycerides noma kungekho i-insulin. Ngokuntuleka kwalokhu, ama-acid anamafutha akhululwa emabhulokheni aqoqwa esibindini ngendlela ye-triglyceride.
Ngalesi sizathu, abantu abanokuntuleka kwe-insulin, naphezu kokuthambekela okujwayelekile kokunciphisa umzimba, bakhulisa ukukhuluphala esibindini.
I-lipid engasebenzi kahle ne-carbohydrate metabolism
Esikhathini sikashukela, inkomba ye-insulin glucagon yehliswa. Lokhu kungenxa yokwehla kwe-insulin secretion, kanye nokwanda kokukhiqizwa kwe-glucagon.
Ukuphazamiseka kwe-lipid metabolism ku-mellitus yesifo sikashukela kuvezwa ekukhuthazeni okubuthakathaka kokulondolozwa nokukhushulwa okwandayo kokugqugquzelwa kwezindawo ezigcinwe ezitolo. Ngemuva kokudla, esifundeni se-postabsorption yile:
- isibindi
- umsipha
- izicubu ze-adipose.
Imikhiqizo yokugaya nama-metabolites ayo, esikhundleni sokugcinwa njengamafutha nama-glycogen, ajikeleza egazini. Izinqubo ze-cyclic nazo zivela ngezinga elithile, ngokwesibonelo, izinqubo ezifanayo ezenzeka nge-gluconeogeneis ne-glycolysis, kanye nenqubo yokuqhekeka kwamafutha nokwakheka.
Zonke izinhlobo zikashukela zibonakaliswa ukubekezelela ushukela omncane, okungukuthi, i-hyperglucoseemia ngemuva kokudla noma ngisho nesisu esingenalutho.
Izimbangela eziphambili ze-hyperglucoseemia yilezi:
- ukusetshenziswa kwezicubu ze-adipose nezicubu zomkhawulo kukhawulelwe, ngoba lapho kungekho i-insulin HLBT-4 ayivezwa ngaphezu kwe-adipocytes nama-myocyte. I-glucose ayikwazi ukulondolozwa njenge-glycogen,
- i-glucose esibindini ayisetshenziselwa ukugcinwa ngendlela ye-glycogen, ngoba ngevolumu ephezulu ye-insulin kanye ne-glucagon ephezulu, i-glycogen synthase ayisebenzi,
- i-glucose yesibindi ayisetshenziselwa ukwakheka kwamafutha. Ama-enzymes we-glycolysis kanye ne-pyruvate dehydrogenase asesimweni esivumelanayo. Ukuguqulwa kweglucose ibe yi-acetyl-CoA, okudingekayo ekuhlanganisweni kwamafutha acid, kuvinjelwe,
- indlela ye-gluconeogenesis icushiwe ekuqoqweni okuphansi kwe-insulin kanye ne-glucagon ephezulu kanye nokwakheka kweglue kusuka ku-glycerol kanye nama-amino acid.
Okunye ukubonakaliswa kwesifo sikashukela kuyizinga elikhulayo lama-lipoproteins, imizimba ye-ketone namafutha asimahla wamafutha egazini. Amafutha adliwayo awafakwa kwezicubu ze-adipose ngoba i-adipocyte lipase isesimweni esisebenzayo.
Kuqukethwe okuqukethwe okuphezulu kwamafutha acid egazini. Amafutha acid adonswa yisibindi, amanye awo aguqulwa aba ngama-triacylglycerols, angena egazini njengengxenye ye-VLDL. Inani elithile lama-acid angena ku-β-oxidation ku-mitochondria yesibindi, bese i-acetyl-CoA esetshenzisiwe isetshenziselwa ukwakheka kwezidumbu ze-ketone.
Umphumela we-insulin kumetabolism ubuye eqinisweni lokuthi ngokufakwa kwe-insulin kwezicubu ezihlukile zomzimba, ukwakheka kwamafutha nokuqhekeka kwe-triglyceride lipids kuyasheshiswa. I-metabolidi ye-lipid engasebenzi kahle ukugcinwa kwamafutha, okusebenza ukwanelisa izidingo zamandla ezimweni ezingezinhle.
Ukubonakala ngokweqile kwe-cAMP kuholela ekunciphiseni kokuhlanganiswa kwamaprotheni kanye nokwehla kwe-HDL ne-VLDL. Njengomphumela wokwehla kwe-HDL, ukuphuma kwe-cholesterol kusuka kuma-membrane amaseli kuya kwi-plasma yegazi kuyehla. I-cholesterol iqala ukufakwa ezindongeni zemikhumbi emincane, okuholela ekwakhekeni kwe-angiopathy yesifo sikashukela kanye ne-atherossteosis.
Ngenxa yokuncipha kwe-VLDL - amanqwabelana aqongelela esibindini, kuvame ukuthululwa njengengxenye ye-VLDL. I-Protein synthesis iyacindezelwa, okubangela ukwehla kokwakhiwa kwama-antibody, bese-ke, iziguli zesifo sikashukela ezinganele ezifweni ezithathelwanayo. Kuyaziwa ukuthi abantu abanenkinga yamaprotheni metabolism bahlushwa i-furunculosis.
Izinkinga ezingaba khona
I-Microangiopathy iyi-glomerulonephritis yesifo sikashukela. Ngenxa ye-retinopathy yesifo sikashukela, abantu abanesifo sikashukela balahlekelwa umbono wabo ngamacala angama-70-90%. Ikakhulu, abanesifo sikashukela bahlakulela ikati.
Ngenxa yokuntuleka kwe-HDL, i-cholesterol eyeqile ivela kulwelwesi lweseli. Ngakho-ke, izifo zenhliziyo ezi-coronary noma i-endarteritis eqothulayo zingavela. Kanye nalokhu, kwakheka i-microangiopathy ene-nephritis
Esikhathini sikashukela, isifo se-periodontal sakhiwa nge-gingivitis - periodontitis - isifo se-periodontal. Ku-diabetes, izakhiwo zamazinyo ziyaphazamiseka futhi izicubu ezisekelwayo ziyathinteka.
Izimbangela zenkambiso yama-microvessels kulezi zimo, ngokunokwenzeka, ukwakheka kokuxhunyaniswa kwe-glucose okungenakuphikiswa namaprotheni odongeni lwe-vascular. Kulokhu, ama-platelets afaka isici esivusa ukukhula kwezakhi zomzimba ezibushelelezi odongeni lwe-vascular.
Ukuphazamiseka kwe-metabol metabolism nakho kuvezwa ngeqiniso lokuthi ukungena kwamafutha kwesibindi kuyanda esibindini, i-lipid resynthesis. Imvamisa, zenziwa zisesimweni se-VLDL, ukwakheka kwazo kuncike kumthamo wamaprotheni. Kulokhu, abanikeli beqembu le-CHZ, okungukuthi, i-choline noma i-methionine, bayadingeka.
I-Choline synthesis ivuselela i-lipocaine, ekhiqizwa yi-pancreatic duct epithelium. Ukuntuleka kwalo kuholela ekukhuluphaleni kwesibindi kanye nokwakheka kwezinhlobo zesifo sikashukela kanye nesishukela esiphelele.
Ukushoda kwe-insulin kuholela ekumelaneni okuphansi kwezifo ezithathelwanayo. Ngakho-ke, i-furunculosis iyakhiwa.
Ividiyo ekulesi sihloko izokhuluma ngemiphumela ye-insulin emzimbeni.
