Umsebenzi wezitho nezinhlelo emzimbeni womuntu kungenzeka kuphela ngamapharamitha athile wesimo sangaphakathi sangaphakathi. Izinkomba zigcinwa ngokuzithiba.
I-glucose yegazi kuyinkomba ye-carbohydrate metabolism futhi ilawulwa ngohlelo lwe-endocrine. Ku-mellitus yesifo sikashukela, inqubo iyaphazamiseka ngenxa yokulahleka kwamandla e-insulin okwehlisa i-hyperglycemia.
Indima yendlela yokunxenxa ukuletha amazinga kashukela egazini elijwayelekile idlalwa ngamalungiselelo e-insulin noma amaphilisi anciphisa ushukela. Ukuze ugweme izinkinga ngenxa yokushintshashintsha koshukela wegazi, kuyadingeka ukufezekisa i-glycemia eqondisiwe.
I-glucose metabolism nokuphazamiseka kwayo kwisifo sikashukela
Emzimbeni, i-glucose ivela ekudleni, ngenxa yokuqhekeka kwezitolo ze-glycogen esibindini nesisipha izicubu, futhi yakhiwa ngesikhathi se-gluconeogenesis kusuka kuma-amino acid, lactate ne-glycerol. Ukudla kuqukethe izinhlobo eziningana zama-carbohydrate ahlukahlukene - ushukela, i-sucrose (disaccharide) nesitashi (polysaccharide).
Ushukela oyinkimbinkimbi udilizwa ngaphansi kwethonya lama-enzyme asendimeni yokugaya ukudla aze alula futhi, njengeglucose, angena egazini ephuma emathunjini. Ngaphezu ushukela, i-fructose ingena emgudwini wegazi, okuthi kuwo izicubu zesibindi iguqulwe ibe ushukela.
Ngakho-ke, ushukela yi-carbohydrate eyinhloko emzimbeni womuntu, ngoba usebenza njengomphakeli wamandla wendawo yonke. Kumaseli obuchopho, ushukela kuphela ongasebenza njengesakhi.
I-glucose engena egazini kufanele ingene esitokisini ukuze isetshenziselwe izinqubo ze-metabolic zokukhiqizwa kwamandla. Lokhu, ngemuva kokuthi ushukela ungene egazini kusuka kumanyikwe, kukhishwe i-insulin. Leli kuphela i-hormone elinganikeza ushukela kumaseli wesibindi, izicubu zomzimba nezicubu ze-adipose.
Inani elithile likashukela, elingafunwa ngumzimba ngalesi sikhathi, lingagcinwa esibindini njenge-glycogen. Lapho-ke, lapho izinga le-glucose lehla, liyabhidlika, ngaleyo ndlela kwandise okuqukethwe kwalo egazini. Isiza ekubekelweni phansi kwe-glucose ne-insulin.
Ushukela wegazi ulawulwa, ngaphezu kwe-insulin, ngama-hormone anjalo:
- I-pancreatic hormone (amaseli we-alpha) - i-glucagon. Ngcono ukugqashuka kwe-glycogen kuma-molecule eglucose.
- I-Glucocorticoid evela ku-adrenal cortex - i-cortisol, ekhulisa ukwakheka kwe-glucose esibindini, ivimbela ukuthathwa kwayo ngamaseli.
- Amahora we-adrenal medulla - adrenaline, i-norepinephrine, athuthukisa ukuqhekeka kwe-glycogen.
- Ihormone ye-anterior pituitary gland - i-hormone yokukhula, ama-hormone okukhula, isenzo sayo sinciphisa ukusetshenziswa kweglucose ngamaseli.
- Ama-hormone e-thyroid asheshisa i-gluconeogenesis esibindini, avimbele ukufakwa kwe-glycogen esibindini nesicubu somzimba.
Ngenxa yomsebenzi walawa ma-hormone, i-glucose igcinwa egazini ekuxakweni okungaphansi kuka-6.13 mmol / L, kepha iphakeme ngaphezu kwe-3.25 mmol / L esiswini esingenalutho.
Ku-mellitus yesifo sikashukela, i-insulin emangqamuzaneni e-pancreas ayakhiqizwa noma inani layo liyancishiswa lize lilinganiselwe elingakuvumeli ukufakwa kweglucose egazini. Lokhu kwenzeka ngesifo sikashukela sohlobo 1. Amaseli weBeta abhujiswa ngokubamba iqhaza kwamagciwane noma ama-antibodies athuthukile kumaseli, kanye nezakhi zawo.
Ukubonakaliswa kwesifo sikashukela sohlobo 1 kukhula ngokushesha, ngoba ngalesi sikhathi cishe 90% yenani eliphelele lamaseli e-beta licekelwe phansi. Iziguli ezinjalo, ukuze zilondoloze umsebenzi obalulekile, zinqunywa ukwelashwa kwe-insulin okutholwa ngonjiniyela bezakhi zofuzo.
Ukwanda kwe-glucose yohlobo 2 sikashukela i-mellitus (uhlobo 2 sikashukela) kungenxa yokuthi izitho ezithembele ku-insulin zakha ukumelana nesenzo se-insulin. Ama-receptors ayo alahlekelwa amandla abo okuphendula, aboniswa ekuthuthukisweni kwezimpawu ezijwayelekile zesifo sikashukela, ezenzeka ngokumelene nesizinda se-hyperglycemia ne-hyperinsulinemia.
I-Hyperglycemia isho zonke izinkomba zeglue egazini kushukela, okuncike ohlotsheni lokuhlaziywa:
- I-capillary (kusuka emunweni) negazi lama-venous - ngaphezu kwe-6.12 mmol / l.
- I-plasma yegazi (ingxenye engamanzi ngaphandle kwamaseli) ingaphezu kuka-6.95 mmol / l.
Lezi zinombolo zibonisa ushukela wokuqala wokuzila ngemuva kokulala.
Ukuphendula komzimba eglucose kushukela
Igama elithi "ukubekezelela ushukela" lisho amandla okubamba ushukela ekudleni noma lapho liphethwe ngomlomo noma ngaphakathi. Ukutadisha leli khono, kwenziwa isivivinyo sokubekezelela ushukela.
Lapho uthatha i-glucose ngesilinganiso se-1 g / kg ngehora, izinga lingakhuphuka amahlandla kanye nesigamu. Ngemuva kwalokho izinga layo kufanele linciphe, njengoba izicubu ziqala ukumunca ngokubamba iqhaza kwe-insulin. Ukungena kwe-glucose kumaseli kubangela izinqubo ze-metabolic ukukhipha amandla kuwo.
Ngasikhathi sinye, ukwakheka kwe-glycogen, ukukhuphuka kwe-glucose oxidation, kanti ihora lesibili ngemuva kokuhlolwa kuletha okuqukethwe ushukela ezingeni lakhona lasekuqaleni. Ingaqhubeka nokuwela ngaphansi kwethonya le-insulin.
Lapho i-glucose yegazi incipha, i-insulin iyayekiswa ukuthunyelwa bese kuthi kuphela isigaba sayo esiyisisekelo, esingasho lutho sokugcina. Ukuhlolwa kokubekezelela i-glucose ngokuvamile akubangeli i-glucosuria (ukubukeka kwe-glucose kumchamo).
Ngesifo sikashukela, kubekezelelwa ukubekezelela ushukela omncane, okuzibonakalisa:
- Ukwanda kushukela wegazi oyisisekelo.
- Ngemuva kokuzivocavoca, i-glycemia iyanda futhi ayiweli ezingeni lokuqala emahoreni ama-2.
- IGlucose ivela emchameni.
Ukuhlolwa kokubekezelela kwe-glucose kukuvumela ukuthi ukhombe izigaba ze-asymptomatic zesifo sikashukela - i-prediabetes, lapho izinga lokuqala lingase libe elijwayelekile, futhi ukuthathwa kweglucose kuphazamisekile.
Ukuhlolwa kwemiphumela yokuhlolwa kwenziwa ngokwamapharamitha alandelayo (igazi lonke ngo-mmol / l): okujwayelekile ngaphambi kokuhlolwa - 3,3 kuye ku-5.5; ngemuva kwamahora ama-2 - aze afike ku-7.8; kwehle ukubekezelela ukubekezelela - okungaphansi kuka-6.1, ngemuva kwamahora ama-2 - ngaphezulu kwama-6.7, kodwa ngaphansi kuka-10. Noma yini engenhla ithathwa njengesifo sikashukela.
Ukuhlolela ukumelana kwe-glucose kukhonjiswa ngokwandisa isisindo somzimba, isisulu sokuthola ifa, isifo senhliziyo kanye ne-hypertension, okuvame ukutholakala kusifo sikashukela sohlobo 2.
Uma isiguli sinokulimazeka ngesimo sokwanda koshukela noma ukudla okuthikamezayo kwe-glucose, bayalulekwa ukuthi banciphise isisindo ngokweqile futhi baphendukele ekudleni okukhonjiswa ushukela:
Khipha ushukela nayo yonke imikhiqizo nokuqukethwe kwayo, ama-khekhe kusuka kufulawa yeprimiyamu.
- Nciphisa utshwala, imikhiqizo yezilwane enamafutha.
- Yenqaba impahla ekheniwe, inyama ebhemayo, ama-marinade, u-ayisikhilimu, iziphuzo ezifakiwe.
- Shintshela ekudleni okwenziwe ngamaprotheni anele, imifino emisha namafutha emifino.
Isinxephezelo sikashukela
Ukunquma ubudlelwano phakathi kwesinxephezelo sikashukela namazinga kashukela, sigxila ku-glycated hemoglobin, kushesha nase-glycemia ngemuva kokudla, ukuba khona kwe-glucose kumchamo, kanye ne-cholesterol, i-triglycerides, umfutho wegazi, kanye nenkomba yesisindo somzimba kuyahlolwa.
Lapho ushukela wegazi eboshelwe kumaprotheni, kwakhiwa amakhompiyutha azinza, afaka i-glycated hemoglobin. Uma kungekho sikashukela, lenza lisuka ku-4 liye ku-6% we-hemoglobin ephelele yegazi.
Ezigulini ezinesifo sikashukela, le nqubo ishesha kakhulu ngenxa yezinga likashukela eliphezulu, okusho ukuthi inani elikhudlwana le-hemoglobin linephutha, elehlisa ukuthuthwa komoya-mpilo kumaseli. Umphumela walolu cwaningo uthonywa yizinga le-glucose elijwayelekile ezinyangeni ezintathu ezedlule, elenza ukuthi kuhlolwe ukusebenza ngempumelelo kokulashwa kwesifo sikashukela.
Isifo sikashukela sibhekwa njengesinxephezelwe ngamanani afinyelela ku-6.5%, sisuka kumaphesenti angama-6.51 asuka ku-7.5 - isaphulelo, ngaphezulu kuka-7.51 - isifo sikashukela esibolile. Kubuye kwafakazelwa ukuthi ukwehlisa iphesenti le-hemoglobin ene-glycated ngamaphesenti kuphela kusiza ukunciphisa izingozi ezinjalo:
- I-retinopathy yesifo sikashukela ku-32%.
- I-Myocardial infarction ngo-17,5%.
- Ukuhlaselwa yi-Brain ngo-15%.
- Isibalo sokufa kwabantu abanesifo sikashukela singama-24,5%.
Uma iziguli ezinesifo sikashukela i-mellitus zehluleka ukugcina izinga le-hemoglobin engaphansi kwe-7%, lesi yisikhathi sokulungiswa kokulashwa, ukushintshela ku-insulin yohlobo 2 sikashukela, imikhawulo yokudla eyandisiwe, umsebenzi owengeziwe womzimba kanye nokuqapha okwandayo kweglucose yegazi.
Ukunquma isinxephezelo sikashukela ngokwezinga le-glycemia, kusetshenziswa izinkomba ze-glucose ezoshesha, amahora ama-2 ngemuva kokudla.
Kumazinga wangaphambi kokudla we-4.35-6.15 mmol / L nangemva kokudla 5.45-7.95 mmol / L, isifo sikashukela sibhekwa njengesihlawulelwayo, futhi uma ngaphambi kokudla ngaphezu kwama-7.8, namahora ama-2 emva - ngaphezulu kwe-10, inkambo enjalo ibhekisela ekubuyiselweni kwemali. Zonke izinkomba zokuphumula phakathi kwala manani zibonisa inkambo yesifo sikashukela engaphansi.
Esikhathini sikashukela obolile, amazinga e-cholesterol egazi angaphezu kuka-6.5 mmol / L, glucosuria, triglycerides ngenhla kwe-2.2 mmol / L, inkomba yomzimba ekhuphukile (enkulu kune-27 kg / m2), futhi futhi uma umfutho wegazi ungaphezu kwe-160/95, nawo uyabhekwa. mmHg Ubuciko.
Ukubola ngokuphelele (ibanga lesi-4 isifo sikashukela kubonakaliswa ukukhula okuqhubekayo kwezinkinga. Ushukela wegazi ukhuphuka ngaphezu kuka-15 mmol / l, awukwazi ukuncishiswa kalula ngisho nangamalungiselelo e-insulin, ukuphuma kwe-glucose ne-protein kumchamo kuyanda, futhi ukwehluleka kwezinso kukhula, kudinga ukuxhumana kwinso.
I-neuropathy yesifo sikashukela ihambisana nokwakhiwa kwezilonda, i-gangrene yonyawo, okuholela ekunqunyiwe, nombono uyancipha. Futhi, leli degree lesifo sikashukela libonakala ngokuthuthukiswa kwama-comas sikashukela: hyperosmolar, hyperglycemic, ketoacidotic.
Ukuze ulawule inkambo yesifo sikashukela, kunconywa ukwenza idayari, ikakhulukazi uma usebenzisa amalungiselelo e-insulin, lapho udinga ukubonisa imiphumela yokulinganisa kashukela wegazi nsuku zonke. Sifunda kokubili i-glycemia yokuzila ukudla nangemva kwekhefu lamahora amabili ngemuva kokudla, uma kunesidingo - ngaphambi kokulala.
Imvamisa enconywayo yezivivinyo nokubonisana nodokotela nayo iyanconywa:
- Kabili ukukala umfutho wegazi nsuku zonke
- Kanye ezinyangeni ezintathu, ukukala izinga le-hemoglobin ye-glycated.
- Kanye nekota vakashela ukuya kwi-endocrinologist
- Kanye ngonyaka ukwenza isifundo se-cholesterol, lipoproteins, renal kanye ne-hepatic tata.
- Kanye ezinyangeni ezingama-6-8, thatha i-electrocardiogram.
- Kanye ngonyaka, vakashela ochwepheshe: udokotela wamehlo, udokotela wezifo zengqondo, udokotela ohlinza i-angiologist, udokotela wezingane.
Mayelana nesifo sikashukela esikuvidiyo kule ndatshana udokotela uzokutshela.
