I-Serum glucose: okuqukethwe okujwayelekile ekuhlaziyeni

Emlonyeni womuntu, ukugaya kwe-glycogen nesitashi kuqala ngaphansi kwethonya le-salivary amylase. Ngaphansi kwethonya le-amylase emathunjini amancane, i-cleavage yokugcina yama-polysaccharides kumala maltose iyenzeka.

Okuqukethwe ujusi wamathumbu wenani elikhulu lama-hydrolases - ama-enzyme aphula i-sucrose, i-maltose ne-lactose (disaccharides) ukuze kufakwe i-fructose, galactose ne-glucose (monosaccharides).

IGalactose noshukela kudonswa ngokushesha yi-microvilli yesisu esincane, ingena egazini futhi ifinyelele esibindini.

Ukuvama kwe-glucose nokuphambuka kutholakala ku-plasma, naku-serum yegazi, kusatshalaliswa ngokulinganayo phakathi kwezinto ezakhiwe ne-plasma.

I-glucose iyinkomba enkulu ye-carbohydrate metabolism, nemikhiqizo ye-carbohydrate yile:

1. ama-polysaccharides: isitashi ne-cellulose,
2. i-fructose noshukela,
3. sucrose kanye lactose,
4. obunye ushukela.

Izinga lamazinga kashukela:

• ezinganeni ezizalwe ngaphambi kwesikhathi, okujwayelekile yi-1.1-3.33 mmol / l,
• izingane ezisanda kuzalwa usuku olungu-1 2.22-3.33 mmol / l,
• wezingane ezinyangeni 2.7-4.44 mmol / l,
• ezinganeni ezineminyaka engaphezulu kwemihlanu, 3.33-5.55 mmol / l,
• ebudaleni kuze kufike ku-60 4.44-6.38 mmol / l,
• abantu abavela eminyakeni engama-60 ubudala - okujwayelekile ngu-4.61-6.1 mmol / l.

I-Hypoglycemia inikezwa abantu abadala uma okuqukethwe kwe-glucose kungafiki ku-3.3 mmol / L. Ushukela ophakanyisiwe (noma kwezinye izimo ngisho ne-hyperglycemia) ubekwa uma ukuhlaziya kuveza ukuthi okuqukethwe ushukela kuphezulu kune-6.1 mmol / l.

Kubalulekile ukwazi ukuthi ukwephulwa kwe-carbohydrate metabolism kuqala kunoma yisiphi isigaba soshukela umzimba. Lokhu kungaba lapho ushukela egaywe endaweni yokugaya ukudla, ungeniswa emathunjini amancane noma esigabeni se-cellular metabolism of carbohydrate ezithweni zomuntu.

I-Hyperglycemia noma ukwanda kokuhlungwa kweglucose kungabangelwa:

1. i-hyperglycemia ngokomzimba: ukubhema okusheshayo, ukucindezela, ukungasebenzi kahle komzimba, imizwa engemihle, ukushesha okukhulu kwe-adrenaline ngesikhathi somjovo,
2. isifo sikashukela kubantu bayo yonke iminyaka,
3. ukuvuvukala kwengqondo,
4. i-gigantism, i-acromegaly, i-thyrotooticosis, i-pheochromocytoma namanye ama-endocrine pathologies,
5. Izifo ze-pancreatic, ngokwesibonelo, i-pancreatitis engamahlalakhona noma ebabayo, i-cystic fibrosis, i-hemochromatosis kanye nama-tumor pancreas
6. Izifo zohlelo lokugaya ukudla, ikakhulukazi isibindi nezinso,
7. ukuba khona kwama-antibodies kuma-insulin receptors,
8. ukusetshenziswa kwe-caffeine, i-thiazides, i-glucocorticoids nama-estrogens.

I-Hypoglycemia noma ukwehla kwe-glucose kungaba nalokhu:

• ukuphazamiseka kwepancreatic: i-adenoma, i-carcinoma, i-hyperplasia, i-insulinoma, ukushoda kwe-glucagon,
• I-hypothyroidism, i-adrenogenital syndrome, isifo sika-Addison, i-hypopituitarism,
• enganeni ngaphambi kwesikhathi izalwe ngowesifazane onesifo sikashukela
• i-overdose ye-insulin ne-hypoglycemic agents,
• Izifo ezinzima zesibindi: i-carcinoma, i-cirrhosis, i-hemochromatosis, i-hepatitis,
• izilonda ezingezona i-pancreatic ezimbi: i-fibrosarcoma, umdlavuza wesisu noma i-adrenal gland,
• i-galactosemia, isifo se-gyrke,
• ukuphazamiseka okuhlukahlukene kwe-autonomic, gastroenterostomy, post-gastroectomy, gastrointestinal motility disorder,
• ukuzila isikhathi eside, i-malabsorption syndrome kanye nezinye izinkinga zokudla,
• ubuthi ngama-salicylates, i-arsenic, chloroform, antihistamines noma notshwala,
• ukuzikhandla okukhulu ngokomzimba kanye nomkhuhlane,
• ukusetshenziswa kwe-amphetamine, ama-steroid ne-propranolol.

Kwezokwelapha, kunesimo esisodwa sokuziphatha esiphakathi, akuyona i-mellitus yangempela yesifo sikashukela, kodwa hhayi okujwayelekile. Lokhu kubhekela ukungabekezeleleki kwe-glucose.

Kulesi simo, izinga lokudla okushukela liyohlala lingaphansi kuka-6.1 mmol / L, futhi ngemuva kwamahora amabili ngemuva kokuphathwa kwe-glucose kuzoba ngu-7.8 - 11.1 mmol / L. Le ncazelo ikhombisa amathuba aphezulu kashukela ngokuzayo. Ukuvela kwalesi sifo kuncike kwezinye izinto eziningi. Inegama layo - i-prediabetes.

Kunomqondo wokuzila ukudla kwe-glycemia. Ukuhlaziywa kwezinga leshukela lesisu esingenalutho egazini kanye ne-serum lapha kungu-5.5 - 6.1 mmol / L, kanye namahora amabili ngemuva kokuphathwa kwe-glucose, inkomba ijwayelekile, okungukuthi, cishe u-7.8 mmol / L. Kubhekwe futhi njengezinto eziyingozi ekwakhekeni okwengeziwe kwesifo sikashukela, ukunqunywa kwalokho okungenzeka kungeke kwenzeke ngokushesha.

Ukuzila ukudla kusho ukungabikho kokudla amahora angama-8 noma ngaphezulu.

Ama-nuances wokunquma ushukela wegazi

Izinga lokuhlushwa ushukela lingaphenywa nge:

1. I-pathology ye-adrenal gland, i-pituitary gland kanye ne-yegilo yegilo,
2. ukuphazamiseka nezifo esibindini,
3. ushukela, noma ngabe uluhlobo luni,
4. ukuthola ukubekezelelwa kwe-glucose kulabo abacatshangelwe isifo sikashukela,
5. ngokweqile
6. ushukela kwabesifazane abakhulelwe,
7. izinguquko ekubekezelelekeni kweglucose.

Udinga ukwazi ukuthi incazelo idinga ukunikela ngokudla amahora angama-8 ngaphambi kokuhlaziywa. Ukuhlaziywa kungcono ukuthatha igazi ekuseni. Noma yikuphi ukweqisa, ukucindezela ngokomzimba nangokwengqondo, nakho akufakiwe.

ISerum, noma ngamanye amagama iplasma, ihlukaniswa namaseli kungakapheli amahora amabili kuthathwe isampula yegazi. Ngaphezu kwalokho, ungasebenzisa ishubhu ekhethekile enama-inhibitors we-glycolysis. Uma lezi zimo zingahlangatshezwanga, khona-ke ukunganakwa okungamanga kungenzeka.

Ukuhlolwa kweglucose kwegazi kubandakanya izindlela ezilandelayo:

• ucwaningo lwe-reductometric, kususelwa emandleni we-glucose ukubuyisela usawoti we-nitrobenzene nosawoti wethusi,
• ucwaningo lwe-enzymatic, ngokwesibonelo, indlela ye-glucose oxidase;
• indlela yokusabela umbala, indlela ekhethekile ekhonjiswe ekushiseni kwama-carbohydrate.

Indlela ye-glucose oxidase ukuhlaziya inani likashukela kumchamo negazi esiswini esingenalutho. Indlela isuselwa ekuphenduleni kwe-glucose oxidase enzyme ye-glucose oxidase ngokwakhiwa kwe-hydrogen peroxide, okuyi-oxidizing orthotolidine ngesikhathi se-peroxidase.

Ukuqina kweglucose okusheshayo kubalwa ngendlela ye-photometric, ngenkathi ubukhulu bomibala buqhathaniswa negrafu yokulinganisa.

Ukuzivocavoca kwemitholampilo kunganquma ushukela:

1. egazini le-venous, lapho impahla evela ekuhlaziyweni yigazi eliphuma emthanjeni. Kusetshenziswa abahlaziyi abazenzakalelayo,
2. egazini le-capillary, elithathwa emunweni. Indlela ejwayelekile, yokuhlaziya udinga igazi elincane (okujwayelekile akuyona ngaphezulu kwe-0,1 ml). Ukuhlaziywa kwenziwa futhi ekhaya ngesixhobo esikhethekile - i-glucometer.

Izinhlobo ezifihliwe (ezincishisiwe) ze-carbohydrate metabolism

Ukuhlonza okufihliwe, okungukuthi, izinhlobo ezingekho emthethweni zokuphazamiseka kwe-carbohydrate metabolism, kusetshenziswa isivivinyo sokubekezelela ushukela we-glucose noma ukuhlolwa kwe-glucose.

Uyacelwa uqaphele: uma izinga le-glucose legazi le-venous elithathwe esiswini esingenalutho lingaphezulu kuka-15 mmol / l, khona-ke ekuxilongeni isifo sikashukela, i-glucose yokubekezela ayidingeki.

Luyini uvivinyo lwe-glucose olubekezelelwa ngaphakathi?

Isifundo sokubekezelela i-glucose esiswini esiswini esingenalutho, senza sikwazi ukukhipha konke okuhambisana nokuntuleka kokugaya, kanye nokufakwa kwe-carbohydrate emathunjini amancane.

Izinsuku ezintathu ngaphambi kokuqala kwesifundo, isiguli sibekelwa ukudla okuqukethe cishe i-150 g nsuku zonke. Ukuhlaziywa kwenziwa ngesisu esingenalutho. I-glucose iphathwe kahle ngaphakathi ngesilinganiso se-0.5 g / kg yomzimba, ngesisombululo se-25% ngomzuzu owodwa noma emibili.

Ku-plousma yegazi ene-venous, ukugxilwa kweglucose kunqunywa amahlandla ayisishiyagalombili: isikhathi esingu-1 esiswini esingenalutho, futhi izikhathi zokuphumula 3, 5, 10, 20, 30, 45 kanye nemizuzu engama-60 ngemuva kokuba i-glucose ikhishwe ngaphakathi. Izinga le-insulin le-plasma linganqunywa ngokufana.

I-coefficient of assimilation yegazi ikhombisa izinga lokunyamalala kwe-glucose egazini ngemuva kokuphathwa kwe-intravenous. Ngasikhathi sinye, isikhathi esithathayo ukwehlisa izinga likashukela izikhathi ezi-2 sinqunywa.

Ifomula ekhethekile ibala lokhu kugcwaliseka: K = 70 / T1 / 2, lapho i-T1 / 2 inani lamaminithi adingekayo ukunciphisa ushukela wegazi izikhathi ezi-2, imizuzu eyi-10 emva kokufakwa kwayo.

Uma yonke into ingaphakathi kwemingcele ejwayelekile, khona-ke imizuzu embalwa ngemuva kokwethulwa kwe-glucose, izinga layo lejubane lokudla lifinyelela ezingeni eliphakeme - ifinyelela ku-13.88 mmol / L Izinga le-insulin eliphakeme liyabonakala emizuzwini emihlanu yokuqala.

Izinga le-glucose libuyela inani layo lokuqala ngemuva kwemizuzu engaba ngu-90 ukusuka ekuqaleni kohlaziyo. Ngemuva kwamahora amabili, okuqukethwe ushukela kwehla ngezansi kwesisekelo, kuthi ngemuva kwamahora ama-3, izinga libuyele kwisisekelo.

Izici ezilandelayo zokubamba ushukela ziyatholakala:

• kubantu abanesifo sikashukela kungaphansi kwe-1,3. I-peak insulin yokuhlonza itholwa ngemuva kwemizuzu emihlanu ngemuva kokuqala kokuhlaziywa,
• kubantu abadala abanempilo abangenakho ukuphazamiseka kwe-metabolic of carbohydrate, isilinganiso sikhulu kune-1,3.

I-Hypoglycemic ne-hyperglycemic coefficients

I-Hypoglycemia yinqubo ye-pathological ehumusha i-glucose ephansi yegazi.

I-Hyperglycemia iwuphawu lomtholampilo, olukhombisa okuqukethwe kwe-glucose ephezulu enobuningi be-serum.

Izinga eliphakeme livela ngesifo sikashukela i-mellitus noma okunye ukuphazamiseka kohlelo lwe-endocrine.

Imininingwane ngesimo se-carbohydrate metabolism ingatholakala ngemuva kokubalwa izinkomba ezimbili zocwaningo lokubekezelela i-glucose:

• I-hyperglycemic coefflements yisilinganiso sezinga le-glucose ngehora, kufinyelela ezingeni lesisu esingenalutho,
• I-hypoglycemic coefflication yisilinganiso sezinga le-glucose amahora ama-2 ngemuva kokulayisha ezingeni laso esiswini esingenalutho.

Ebantwini abaphilile, i-hypoglycemic coeffnty engaphansi ingaphansi kwe-1,3, futhi izinga le-hyperglycemic alidluli ngaphezu kwe-1.7.

Uma amanani ajwayelekile okungenani enkomba eyodwa edluliwe, khona-ke lokhu kukhombisa ukuthi ukubekezelelwa kwe-glucose kuncishisiwe.

I-Glycosylated hemoglobin kanye nezinga layo

I-hemoglobin enjalo ibizwa nge-HbA1c. Le yi-hemoglobin, engene ekuphenduleni okungamakhemikhali ngamakhemikhali nge-monosaccharides, futhi, ikakhulukazi, nge-glucose, esegazini elijikelezayo.

Ngenxa yalokhu kusabela, insalela ye-monosaccharide inamathele kumolekyulu yamaprotheni. Umthamo we-glycosylated hemoglobin ovela ngqo kuncike ekugxileni kashukela egazini, kanye nesikhathi sokuhlangana kwekhambi ne-hemoglobin ene-glucose.

Kungakho okuqukethwe yi-hemoglobin ye-glycated kunquma isilinganiso samandla eglucose egazini isikhathi eside, okuqhathaniswa nesikhathi sokuphila kwe-hemoglobin molecule. Cishe izinyanga ezintathu noma ezine.

Izizathu zokwabela isifundo:

1. ukuhlolwa kanye nokuxilongwa kwesifo sikashukela,
2. ukuqaphela isikhathi eside lesi sifo nokubheka ukwelashwa kwabantu abanesifo sikashukela,
3. ukuhlaziywa kwesinxephezelo sikashukela,
4. Ukuhlaziywa okwengeziwe kwe-glucose ukubekezelelwa kokuvivinya njengengxenye yokuxilongwa kwesifo sikashukela esisheshayo noma isimo esandulela lesi sifo,
5. isifo sikashukela sokugcina ngesikhathi sokukhulelwa.

Isilinganiso kanye nezinga le-hemoglobin ye-glycated ekuphenduleni nge-thiobarbituric acid lisuka ku-4,5 liya ku-6, amaphesenti ama-1 e-molar, njengoba ukuhlaziya kukhombisa.

Ukuhunyushwa kwemiphumela kuhlanganiswa ngomehluko kubuchwepheshe belebhu kanye nomehluko wabantu abafundile. Ukuzimisela kunzima, ngoba kukhona ukusabalala kwamanani we-hemoglobin. Ngakho-ke, kubantu ababili abanesilinganiso esifanayo soshukela wegazi, angafinyelela ku-1%.

Amanani akhula lapho:

1. i-mellitus yesifo sikashukela nezinye izimo ezibonakaliswa ukubekezelelwa kwe-glucose engalunganga,
2. ekuboneni izinga lesinxephezelo: sisuka ku-5.5 - 8% - ushukela onxephezelwe, ukusuka ku-8 kuye ku-10% - isifo esincishwe kahle, esisuka ku-10 saya ku-12% - isifo esincishwe ingxenye ethile. Uma iphesenti likhulu kune-12, khona-ke lokhu sikashukela okungabaliwe.
3. ukushoda kwensimbi
4. i-splenectomy
5. ukwanda okungamanga ngenxa yokuqoqwa okukhulu kwe-hemoglobin ye-fetus.

Amanani ancipha uma:

• ukopha
• i-hemolytic anemia,
• ukumpontshelwa igazi
• hypoglycemia