Ngabe i-insulin inqunyelwe kuliphi izinga kashukela wegazi?

Izinga likashukela (ushukela) egazini kungenye yezinkomba eziphambili zesimo esijwayelekile sohlelo lokuzithiba lomzimba.

Ngokuxilongwa kohlobo lwe-1 yesifo sikashukela (ukuntuleka kwe-insulin), isidingo semijovo asingabazi. Kodwa-ke, kuneziguli eziningi ezitholakala zinesifo sikashukela sohlobo 2 (kuze kube yi-90% yabo bonke abantu abanesifo sikashukela), futhi ukwelashwa kwabo kungenzeka ngaphandle kokusebenzisa i-insulin.

Lapho udokotela etusa ngisho nenkambo yesikhashana yemijovo yeziguli ezinje, kuphakama umbuzo: kuphakama liphi ushukela wegazi?

Isifo sikashukela i-mellitus ne-insulin

I-glucose equkethwe emikhiqizweni, lapho ihlukaniswa ngamangqamuzana asesigabeni samathumbu, ingena egazini, ukusuka lapho kufanele ingene kolwelwesi lwaseli ukunikeza amandla kumaseli.

Ukuze inqubo yokugcina iqhubeke ngokungaphazamiseki, udinga:

1. Inani elanele le-insulin egazini;
2. Ukuzwela kwe-insulin receptors (izindawo zokungena esitokisini).

Ukuze i-glucose ingene esitokisini ingaphazanyiswa, i-insulin kumele ixhumane nama-receptors ayo. Ngokuzwela okwenele, le nqubo yenza ukuba ulwelwesi lweseli luvunyelwe ku-glucose.

Lapho ukuzwela kwe-receptor kukhubazekile, i-insulin ayikwazi ukuxhumana nabo noma i-insulin-receptor ligament ayiholeli ekufunekeni. Ngenxa yalokhu, i-glucose ayikwazi ukungena esitokisini. Lesi simo sivamile kwisifo sikashukela sohlobo 2.

Yini izinkomba ushukela we-insulinKubalulekile! Ukubuyisela ukuzwela kwama-insulin receptors, ungadla nokusetshenziswa kwemithi. Kwezinye izimo udokotela kuphela onganquma, ukwelashwa kwe-insulin (okwesikhashana noma okuhlala njalo) kuyadingeka. Ukufakwa kungakhuphula inani likashukela lingena kumaseli ngisho nokuzwa okuncishisiwe ngenxa yokwanda komthwalo phezu kwawo.

Ukwelashwa kwe-insulin kungaba sesimweni esidingekayo uma ungekho noma wehlakala emiphumeleni yokwelashwa ngemithi, ekudleni nasendleleni yokuphila enempilo. Lapho iziguli zilandela izincomo zikadokotela, isidingo esinjalo asivelanga.

Isibonakaliso sokwelashwa kwe-insulin kungaba inani le-glycemia (inkomba yoshukela wegazi) esiswini esingenalutho egazini le-capillary ngenhla kuka-7 mmol / l noma ngaphezulu kwamahora ayi-11.1 mmol / l 2 ngemuva kokudla. Ukuqokwa kokugcina, kuye ngezinkomba zesiguli ngasinye, kungenziwa kuphela ngudokotela ohambelayo.

Izimo lapho imijovo yomuthi ikwazi ukuguqula izinga likashukela egazini liye phansi ibangelwe yizizathu ezilandelayo:

1. Ukubuyiselwa isikhathi eside. Ukwanda okungapheli koshukela wegazi kwiziguli eziningi kungahle kungabonakali lapho kungekho khona ukulawula, ngoba izimpawu zithathwa njengophawu lwesinye isifo;
2. Umfutho okhuphukayo, wehlise i-acuity ebonakalayo, ikhanda elibi, ukwanda kwesimo semikhumbi. Kulokhu, udokotela angabeka inkambo yokwelashwa kwe-insulin esiteji esibi kakhulu - kuze kube yilapho ushukela wegazi uncipha;
3. Isifo sikashukela se-LADA. Lesi sifo se-autoimmune luhlobo 1 lwesifo sikashukela, esenzeka ngendlela emnene. Ngenxa yokufana kwezimpawu, itholakala njengesifo sikashukela sohlobo 2 futhi iphathwe nemithi ebekelwe yona, yize idinga ukwelashwa okukhethekile. Ngenxa yalokhu, ukuguqulwa kwe-insulin kwenzeka ngokushesha - emva kweminyaka engama-3-4;
4. Ukuphelelwa ngamandla kwepancreatic. Lokhu kucatshangelwa okuhlobene nobudala, ngoba kuvame ukubonwa ezigulini ngemuva kweminyaka engama-45. Njengomphumela wokwanda ushukela (omkhulu kuno-9 mmol / l), amaseli we-pancreatic beta abhekene nokufakwa kwe-insulin anciphisa umsebenzi wawo (okubizwa ngokuthi ubuthi be-glucose). Ukwethulwa kokwelashwa kwe-insulin kunganciphisa amazinga kashukela futhi kunciphise i-pancreas okwesikhashana. Izimpawu zobuthi beglucose ziyakhululeka, futhi ukwelashwa okuqhubekayo kwenzeka ngaphandle kwe-insulin;
5. Izinkinga ezinkulu ze-vascular. Esigabeni sokukhula kwezinkinga ze-vascular (izilonda ezivela ezinso, uhlelo lwezinzwa, izitho ezibonakalayo, imikhumbi emikhulu), ukwelashwa kwe-insulin kungavimbela ukuqhubekeka kwabo noma kuvimbele ukubonakala kwesilinganiso sama-50-60%;
6. Izimo ezimbi kakhulu ezifweni ezinzima. Ngesikhathi somkhuhlane, uma kunesidingo, ukuhlinzwa, ukuhlukumezeka noma inhlekelele yemithambo (isifo sohlangothi, ukushaya kwenhliziyo), ukwelashwa kwe-insulin yesikhashana kukuvumela ukuba ulondoloze amazinga evamile kashukela egazini bese usiza umzimba ukwazi ukubhekana nesimo esibucayi.

Yiluphi ushukela obekelwe i-insulin ngesikhathi sokukhulelwa

Ukukhulelwa esigulini esinesifo sikashukela i-mellitus noma isifo sikashukela sokukhulelwa (ukwehluleka kwe-hormonal okuholela ekumelaneni ne-insulin) kungadala isimo lapho ukulungiswa komsoco nendlela yokuphila enempilo kungalethi umphumela ofunekayo. Izinga likashukela lihlala liphakeme, elisongela ukuthuthukiswa kwezinkinga ezinganeni nakumama.

Inkomba yokwelashwa kwe-insulin ngesikhathi sokukhulelwa ingaba ukwanda kwe-polyhydramnios nezimpawu ze-fetopathy enganeni, ekhonjwe ngesikhathi sokuhlolwa kwe-ultrasound, eyenziwa ngezikhathi ezilandelayo:

• Amaviki awu-15 - 20 - ukuqeda ukuphazamiseka kokukhula okukhulu;
• Amaviki angama-20 - 23 - wokuhlola inhliziyo yengane engakazalwa;
• Amaviki angama-28 ukuya kwangu-32 - ukuthola iziphambuko ezingaba khona ngemibandela yokuthuthukiswa kwe-intrauterine.

Lapho kuvela izimpawu ze-hyperglycemia, i-endocrinologist ichaza isilinganiso soshukela lowesifazane okhulelwe izikhathi eziyisishiyagalombili ngosuku ngemiphumela erekhodiwe. Ngokuya ngesimo sempilo ngasinye, indlela evamile yabesifazane abakhulelwe ingaba ngu-3.3-6.6 mmol / l.

Ngesikhathi sokukhulelwa, i-insulin phakathi kwezidakamizwa ezinciphisa ushukela iyona kuphela isidakamizwa esivunyelwe ukusetshenziswa.

Isisekelo sokuqokwa kwemijovo ye-insulin ingaba yimiphumela yamazinga kashukela:

• Egazini le-venous: ngenhla amayunithi angama-5.1 (esiswini esingenalutho), ngaphezulu amayunithi ayi-6.7. (Amahora amabili ngemuva kokudla);
• Ku-plasma yegazi: ngenhla amayunithi angama-5.6. (esiswini esingenalutho), ngaphezulu amayunithi angama-7.3. (2 amahora emva kokudla).

Ngokungezelela emazingeni kashukela, anconyelwe ukuthi ahlolwe izikhathi ezi-6 kuya kwezi-12 ngesonto, abesifazane abakhulelwe badinga ukuqapha:

1. Umfutho wegazi
2. Ukuba khona kwe-acetone kumchamo;
3. Imithamo yento ephethwe;
4. Iziqephu ze-hypoglycemia.

Owesifazane okhulelwe kufanele, ngaphambi kokunquma ukwelashwa kwe-insulin:

• Esibhedlela, thola amakhono wokuzinakekela kanye nolwazi oludingekayo lokuqapha isimo sabo;
• Thola imali yokuzithiba noma wenze izilinganiso ezidingekayo elabhorethri.

Umsebenzi oyinhloko wokwelashwa kwe-insulin phakathi nalesi sikhathi ukuvikela izinkinga ezingaba khona. Kungakhathalekile ukuthi hlobo luni lwesifo, inhlobo yokwelashwa efanelekile ukuphatha i-insulin efushane ngaphambi kokudla kanye nomuthi wesikhathi esijwayelekile sokusebenza ngaphambi kokulala (ukuqinisa i-glycemia ebusuku).

Ukusatshalaliswa komthamo we-insulin wansuku zonke kubheka isidingo somuthi: ebusuku - 1/3, ngesikhathi sasemini -2/3 senani lomuthi.

Kubalulekile! Ngokwezibalo, ngesikhathi sokukhulelwa, uhlobo 1 sikashukela luvame kakhulu, ngoba lukhula ebuntwaneni nasebusheni. Isifo sohlobo 2 sithinta abesifazane ngemuva kweminyaka engama-30 futhi kulula. Kulokhu, amathuba okuthola izinkomba ezijwayelekile zokudla, umsoco wokudla kanye nokuzivocavoca okulinganiselayo kuphezulu. Isifo sikashukela sokukhulelwa siyivelakancane.

Ngabe uluhlobo luni loshukela oludingayo ukufaka umjovo we-insulin

Alikho inani elithile likashukela wegazi lapho imijovo yomuthi inqunyelwe khona, ngoba isinqumo esinjalo senziwa ngesisekelo sezinto ezimbalwa. Udokotela we-endocrinologist kuphela ongabanakekela.

Ukwethulwa kokwelashwa kwe-insulin akunakugwenywa ngokubonisa kwe-12 mmol / l ngemuva kokungabikho komphumela kusuka ekusebenziseni kwamathebulethi noma ekudleni okuqinile. Ngaphandle kwezifundo ezengeziwe (kuphela ngoshukela), i-insulin ifakwa ezimeni ezisongela impilo noma impilo yesiguli.

Lapho isiguli sibhekene nokukhetha (faka i-insulin bese uqhubeka nempilo ejwayelekile noma wenqaba bese ulinda izinkinga), wonke umuntu angazikhethela ngokwakhe.