Isibonakaliso esiyinhloko sokuxilongwa kwesifo sikashukela ukutholwa kwe-hyperglycemia. Ukugcotshwa okwandayo kweglucose egazini kukhombisa izinga lokuphazamiseka kwe-carbohydrate metabolism kanye nesinxephezelo sikashukela.
Ukuhlolwa okukodwa kweshukela okushukela kungakhombisi ngaso sonke isikhathi ukungahambi kahle. Ngakho-ke, kukho konke ukungabaza, kwenziwa umthwalo weglucose okhombisa amandla okusebenzisa umzimba ukudla okuvela ekudleni.
Uma amanani aphakanyisiwe we-glycemia etholakala, ikakhulukazi ngokuhlolwa kokubekezelela kwe-glucose, kanye nezimpawu ezibonakalako zesifo sikashukela, ukuxilongwa kuthathwa njengokusunguliwe.
I-metabolism ejwayelekile yeshukela noshukela
Ukuze athole amandla, umuntu udinga ukukuvuselela njalo ngosizo lomsoco. Ithuluzi eliyinhloko elisetshenziswa njengesixhobo se-glucose.
Umzimba uthola amakhalori ngokusabela okuyinkimbinkimbi ikakhulukazi kuma-carbohydrate. Ukufakwa kwe-glucose kugcinwa esibindini njenge-glycogen futhi kudliwa ngesikhathi sokuntuleka kwama-carbohydrate ekudleni .. Izinhlobo ezahlukahlukene zama-carbohydrate zifakwa emikhiqizweni yokudla. Ukuze ungene ku-carbohydrate eyinkimbinkimbi yegazi (isitashi) kufanele wehliswe kushukela.
Ama-carbohydrate alula anjenge-glucose ne-fructose angena emathunjini angashintshiwe futhi ngokushesha andise ukugcwala koshukela egazini. I-Sucrose, ebizwa nje ngokuthi ushukela, ibhekisela kuma-disaccharides; futhi, njengeglucose, ingena kalula egazini. Ephendula ukuthathwa kwama-carbohydrate egazini, kukhululwa i-insulin.
I-pancreas insulin secretion iyona kuphela i-hormone engasiza i-glucose ukuthi idlule kulolwelwesi lwesitho futhi ihlanganyele ekuphendukeni kwe-biochemical. Imvamisa, ngemuva kokukhishwa kwe-insulin, amahora ama-2 ngemuva kokudla, wehlisa izinga likashukela acishe abe amanani okuqala.
Ezigulini ezinesifo sikashukela i-mellitus, ukuphazamiseka okunjalo kwe-glucose metabolism kwenzeka:
- I-insulin ikhishwe ngokungafanele noma ingekho kuhlobo 1 sikashukela.
- I-insulin iyakhiqizwa, kepha ayikwazi ukuxhumana nama-receptors - thayipha isifo sikashukela esingu-2.
- Ngemuva kokudla, i-glucose ayimunwa, kepha ihlala egazini, i-hyperglycemia iyakhula.
- Amaseli wesibindi (i-hepatocytes), izicubu zemisipha ne-adipose azikwazi ukuthola ushukela, zibulawa yindlala.
- Iglucose ethe xaxa inyusa ibhalansi yama-electrolyte, njengoba amangqamuzana ayo edonsela amanzi kwizicubu.
Isilinganiso se-glucose
Ngosizo lwama-hormone e-insulin nawama-adrenal, i-pituitary gland ne-hypothalamus, glucose wegazi ulawulwa. Lapho likhuphuka izinga likashukela wegazi, kuvela i-insulin ethe xaxa. Ngenxa yalokhu, uhla oluncane lwezinkomba ezijwayelekile luyagcinwa.
Ushukela osegazini ekuseni esiswini esinciphile 3.25 -5.45 mmol / L. Ngemuva kokudla, inyuka yaya ku-5.71 - 6.65 mmol / L. Ukuze ulinganise ukugcwala koshukela egazini, kusetshenziswa izindlela ezimbili: ukuxilongwa kwebhubhoratri noma ukuzimisela ekhaya yi-glucometer noma ukuhlolwa okubukwayo.
Kunoma iliphi ilabhorethri esikhungweni sezokwelapha noma isifo esikhethekile, kwenziwa ucwaningo lwe-glycemia. Izindlela ezintathu eziphambili zisetshenziselwa lokhu:
- UFerricyanide, noma uHagedorn-Jensen.
- I-Ortotoluidine.
- Iglucose oxidant.
Kungcono ukwazi ukuthi iyiphi indlela yokuzimisela okufanele ibe yiyona, ngoba amazinga kashukela wegazi angahle ancike ekutheni asetshenziswa kanjani ama-reagents (kwendlela yeHagedorn-Jensen, izibalo ziphakeme kancane). Ngakho-ke, kungcono ukubheka ushukela wegazi esiswini esingenalutho endaweni yokucwaninga ngaso sonke isikhathi.
Imithetho yokwenza ucwaningo lokuhlushwa kwe-glucose:
- Hlola ushukela wegazi ekuseni esiswini esingenalutho kuze kube ngamahora ayi-11.
- Ayikho indlela yokuhlaziya kusuka emahoreni ayi-8 kuye kwayi-14.
- Ukuphuza amanzi akuvunyelwe.
- Usuku olwandulela lolu hlaziyo, awukwazi ukuphuza utshwala, ukuthatha ukudla ngokulinganisela, ungadli ngokweqile.
- Ngosuku lokuhlaziywa, ukusebenza ngokomzimba, ukubhema akunakwa.
Uma kuthathwa imithi, khona-ke kubalulekile ukubonana nodokotela mayelana nokukhanselwa kwabo noma ukuhlehliswa kwesikhathi kabusha, ngoba imiphumela engamanga ingatholwa.
Isimo sikashukela wegazi ekuseni segazi kusuka emunweni sisuka ku-3.25 siye ku-5.45 mmol / L, futhi kusuka kumthambo, umkhawulo ongaphezulu ungaba sesiswini esingenalutho esingu-6 mmol / L. Ngaphezu kwalokho, izindinganiso ziyahluka lapho kuhlaziywa lonke igazi noma i-plasma okukhishwa kuwo wonke amaseli egazi.
Kunokwehluka futhi encazelweni yezinkomba ezejwayelekile zezigaba ezahlukahlukene zobudala. Ukushisa ushukela ezinganeni ezingaphansi kweminyaka eyi-14 kungaba ngu-2.8-5.6 mmol / L, kuze kube yinyanga eyi-1 - 2.75-4.35 mmol / L, futhi kusuka ngenyanga engu-3.25 -5.55 mmol / L.
Kubantu asebekhulile ngemuva kweminyaka engama-61, izinga eliphakeme likhuphuka njalo ngonyaka - 0,056 mmol / L iyengezwa, izinga likashukela ezigulini ezinjalo ngu-4.6 -6.4 mmol / L Eminyakeni engu-14 kuye kwengama-61, kwabesifazane nabesilisa, okujwayelekile kuyizinkomba kusuka ku-4.1 kuye ku-5.9 mmol / l.
Ngesikhathi sokukhulelwa, i-carbohydrate metabolism ingaphazamiseka. Lokhu kungenxa yokukhiqizwa kwe-placenta yama-hormone we-contra-mahormone. Ngakho-ke, bonke abesifazane abakhulelwe bayalulekwa ukuba bahlolwe ushukela. Uma iphakanyisiwe, lapho-ke kutholakala ukuthi kutholakala isifo sikashukela sokukhulelwa. Owesifazane kufanele ahlolwe izivivinyo ngu-endocrinologist ngemuva kokubeletha.
Ushukela wegazi phakathi nosuku ungahluka futhi kancane, ngakho-ke udinga ukubheka isikhathi sokuthatha igazi (idatha ku-mmol / l):
- Ngaphambi kokuntwela kokusa (kusuka emahoreni amabili kuya kwayi-4) - ngenhla kuka-3.9.
- Esikhathini sasekuseni ushukela kufanele usukele ku-3.9 uye ku-5.8 (ngaphambi kokudla kwasekuseni).
- Ngaphambi kwasemini ntambama - 3.9 -6.1.
- Ngaphambi kokudla kwakusihlwa, 3.9 - 6.1.
Amanani kashukela esiswini esingenalutho futhi ngemuva kokudla nawo anokungafani, inani labo lokuxilonga: ihora eli-1 ngemuva kokudla - ngaphansi kuka-8.85.
Futhi ngemuva kwamahora ama-2, ushukela kufanele ube ngaphansi kuka-6.7 mmol / L.
Ushukela wegazi ophakeme futhi ophansi
Ngemuva kokuthi umphumela utholakele, udokotela uhlola ukuthi ivamile kangakanani i-carbohydrate metabolism. Imiphumela ekhuphukayo ibhekwa njenge-hyperglycemia. Isimo esinjalo singadala izifo nokucindezela okukhulu, ukucindezela ngokomzimba nangokwengqondo, nokubhema.
I-glucose ingakhuphuka ngenxa yesenzo samahomoni adrenal okwesikhashana ezimweni ezibeka engcupheni impilo. Ngaphansi kwalezi zimo, ukwanda kungokwesikhashana futhi ngemuva kokuphela kwesenzo sento ecasulayo, ushukela wehla uye kwesejwayelekile.
I-Hyperglycemia ngezikhathi ezithile ingavela nalokhu: ukwesaba, ukwesaba okukhulu, izinhlekelele zemvelo, izinhlekelele, imisebenzi yezempi, nokufa kwabathandekayo.
Ukuphazamiseka kokudla ngesimo sokudla kakhulu esondweni lokudla kwe-carbohydrate nekhofi kungakhombisa noshukela okhulayo ekuseni. Imithi eqhamuka eqenjini le-thiazide diuretics, izidakamizwa ze-hormonal zandisa ukugcwala kweglucose egazini.
Imbangela evame kakhulu ye-hyperglycemia yisifo sikashukela. Ingatholakala ezinganeni nakubantu abadala, imvamisa kakhulu ngesifiso sofuzo kanye nesisindo somzimba esandayo (uhlobo 2 sikashukela), kanye nokuthambekela kokuphendula kwe-autoimmune (uhlobo 1 isifo sikashukela).
Ngaphezu kwesifo sikashukela, i-hypoglycemia iwuphawu lwezifo ezinjalo:
- I-endocrine pathology: i-thyrotooticosis, i-gigantism, i-acromegaly, isifo se-adrenal.
- Izifo ze-pancreatic: isimila, i-pancreatic necrosis, i-pancreatitis eqeda noma engalapheki.
- I-hepatitis engapheli, isibindi esinamafutha.
- I-nephritis engapheli kanye nephrosis.
- I-cystic fibrosis
- Ukushaywa unhlangothi nokushaya kwenhliziyo esigabeni esibuhlungu.
Ekuphendukeni kwe-autoallergic kumaseli we-beta kuma-pancreas noma ingxenye yayo, kanye nokwakhiwa kwamasosha omzimba ukuya ku-insulin, i-hyperglycemia iyakhula.
Ukwehlisa ushukela wegazi kungahlotshaniswa nokuncipha kokusebenza kwesistimu ye-endocrine, uma kwenzeka izinqubo zesimila, ikakhulukazi ezilimazayo: I-Hypoglycemia ihambisana nesibindi somdlavuza wesibindi, isifo samathumbu, ubuthi be-arsenic noma utshwala, nezifo ezithathelanayo ngomkhuhlane.
Izinsana ezifika ngaphambi kwesikhathi nezingane ezinoshukela zingaba noshukela omncane wegazi. Izimo ezinjalo zenzeka ngendlala ende nokuzivocavoca okunzima komzimba.
Imbangela evame kakhulu ye-hypoglycemia uwukusebenzisa ngokweqile izidakamizwa ze-insulin noma ze-antidiabetes, i-anabolics.
Ukuthatha ama-salicylates ngemithamo emikhulu, kanye ne-amphetamine, kunganciphisa ushukela wegazi.
Ukuhlolwa kwegazi
Ku-mellitus yesifo sikashukela, kuyadingeka ukulungisa ukwanda okuphindaphindiwe koshukela wegazi ngaphandle kwezinye izimbangela ezingadala ukwephulwa okunjalo. Ngaphandle kokuhlolwa kwegazi, ukuxilongwa akunakwenziwa, noma ngabe zikhona zonke izimpawu eziphambili zesifo sikashukela.
Lapho kuhlolwa imiphumela yokuhlolwa kwegazi ushukela, hhayi amanani aphezulu kuphela, kepha futhi namanani asemngceleni, athathwa njenge-prediabetes, inkambo ecashile yesifo sikashukela. Iziguli ezinjalo ziyabhekelwa, zibheka ushukela wegazi kaningi kunabantu abanempilo, ukudla kunqunywe cishe njengesifo sikashukela, umuthi wamakhambi kanye nomsebenzi womzimba.
Amanani afanelekile we-prediabetes: ushukela egazini kusuka ku-5.6 kuya ku-6 mmol / l, futhi uma ukuhlukunyezwa kukhuphuka kuya ku-6.1 nangaphezulu, khona-ke ushukela ungasolwa.
Uma isiguli sinezimpawu zokuphazamiseka kwesifo sikashukela i-mellitus, futhi ushukela wegazi ekuseni ungaphezulu kuka-6.95 mmol / l, nganoma yisiphi isikhathi (kungakhathalekile ukuthi kudliwe) 11 mmol / l, khona-ke ukubhekwa kwesifo sikashukela kuqinisekisiwe.
Ukuhlolwa komthwalo we-glucose
Uma ngemuva kokuhlolwa okusheshayo kweglucose kunokungabaza mayelana nokuxilongwa, noma imiphumela ehlukene itholakala ngezilinganiso eziningana, futhi uma kungekho zimpawu ezisobala zesifo sikashukela, kepha isiguli sisengozini yesifo sikashukela, kwenziwa isivivinyo sokuxineka - TSH (isivivinyo sokuvumela ukubekezelela i-glucose).
Ukuhlolwa kumele kwenziwe ngaphandle kokudla okungenani isikhathi esingamahora ayi-10. Ngaphambi kokuhlolwa, kunconywa ukudlala imidlalo futhi noma yimuphi umsebenzi osindayo womzimba kufanele ungafakwa ngaphandle. Izinsuku ezintathu awudingi ukushintsha okudlayo futhi unqande kakhulu ekudleni, okungukuthi, isitayela sokondleka kufanele sibe sejwayelekile.
Uma ngosuku lwakusasa bekunokuphazamiseka kwengqondo okuphathelene nokukhathazeka ngokwengqondo noma ukucindezela okukhulu, khona-ke usuku lokuhlolwa luhlehlisiwe. Ngaphambi kokuhlolwa, udinga ukulala, ngenjabulo eqinile ngaphambi kokulala, ungathatha amakhambi athambisa amakhambi.
Izinkomba zokuhlola ukubekezelela ushukela
- Iminyaka ukusuka eminyakeni engama-45.
- Isisindo esengeziwe, inkomba yesisindo somzimba ngenhla kwe-25.
- I-Heredity - thayipha isifo sikashukela emndenini oseduze (umama, ubaba).
- Owesifazane okhulelwe wayenesifo sikashukela sokukhulelwa noma kuzalwe ingane enkulu (enesisindo esingaphezu kwama-4,5 kg). Ngokuvamile, ukuzalwa kwengane kushukela kuyinkomba yokuxilongwa okuphelele.
- I-Arterial hypertension, ingcindezi engenhla kwe-140/90 mm Hg. Ubuciko.
- Egazini, i-cholesterol, ama-triglycerides ayakhuphuka futhi lipoproteins ephezulu yabantu iyancishiswa.
Ukuze wenze isivivinyo, ukuhlolwa kwegazi okusheshayo kwenziwa kuqala, khona-ke isiguli kufanele siphuze amanzi nge-glucose. Kubantu abadala, inani le-glucose lingama-75 g. Ngemuva kwalokhu, udinga ukulinda amahora amabili, usesimweni sokuphumula ngokomzimba nangokwengqondo. Awukwazi ukuhamba ngezinyawo. Ngemuva kwamahora amabili, igazi liphinde lihlolwe ushukela.
Ukubekezelela i-glucose engasebenzi kahle kuboniswa ukukhuphuka kwe-glucose egazini nasiswini esingenalutho, futhi ngemuva kwamahora ama-2, kepha angaphansi kwesifo sikashukela: ukushukela kwegazi glucose kungaphansi kuka-6.95 mmol / l, amahora amabili ngemuva kokuhlolwa kwengcindezi - kusuka ku-7, 8 kuya ku-11.1 mmol / L.
I-glucose engasebenzi kahle ibonakaliswa yi-glycemia ephezulu ngaphambi kokuhlolwa, kepha ngemuva kwamahora amabili izinga le-glucose alidluli imingcele yomzimba:
- I-glycemia esheshayo ye-6.1-7 mmol / L.
- Ngemuva kokuthatha u-75 g kashukela, ngaphansi kuka-7.8 mmol / L.
Lezi zimo zombili ziwumngcele maqondana nesifo sikashukela. Ngakho-ke, ukuhlonza kwabo kuyadingeka ekuvinjelweni kokuqala kwesifo sikashukela. Iziguli zivame ukunconywa ukwelashwa kokudla, ukunciphisa isisindo, ukusebenza komzimba.
Ngemuva kokuhlolwa ngomthwalo, ukuthembeka kokutholakala kwesifo sikashukela akungabazeki ngokuzila ukudla okusheshayo kwe-glycemia ngaphezulu kuka-6.95 kanye namahora amabili ngemuva kokuhlolwa ngenhla kuka-11.1 mmol / L. Ifomu elikulesi sihloko lizokutshela ukuthi ushukela wegazi kufanele ube yini kumuntu ophilile.
