Type 2 matenda a shuga a insulin

Alexey ROMANOVSKY, Pulofesa Wothandizira, Dipatimenti ya Endocrinology BelMAPO, Woyankha wa Sayansi ya Zamankhwala

Kodi nchifukwa ninji munthu amafunikira insulin?

Mu thupi lathu, insulin ili ndi ntchito ziwiri:

• amalimbikitsa kulowerera kwa glucose m'maselo mu zakudya zawo,
• ili ndi anabolic zotsatira, i.e. zimathandizira kagayidwe kazachilengedwe.

Nthawi zambiri, mapangidwe ndi katulutsidwe a insulini amangochitika okha pogwiritsa ntchito njira zowerengera zamomwe zimapangidwira. Ngati munthu sakudya, ndiye kuti insulini imachotsedwera pafupipafupi - izi basal insulin katulutsidwe (mwa munthu wamkulu mpaka magawo 24 a insulin patsiku).

Mukangodya, poyankha kuwonjezeka kwa shuga m'magazi, pamakhala kutulutsidwa mwachangu kwa insulini - uyu ndiye wotchedwa insulin postprandial insulin secretion.

Chimachitika ndi chiyani ndi insulin secretion ya 2 shuga?

Monga mukudziwa, pali mitundu iwiri yayikulu ya matenda ashuga. Ndi matenda amtundu wa 1 shuga, ma cell a pancreatic are amawonongeka kwathunthu, chifukwa chake, odwala amathandizidwa nthawi yomweyo kulandira chithandizo cha insulin.

Matenda a matenda a shuga a mtundu wachiwiri ndi ovuta. Anthu omwe ali ndi vuto lobadwa chifukwa chakudya chopanda malire (kuchuluka kwa zakudya zopatsa mphamvu) komanso kukhala ndi moyo wokhazikika kumakhala ndi kuchuluka, kuchuluka kwambiri kwamafuta a mkati (mkati) komanso kuchuluka kwa shuga m'magazi.

Matenda a shuga a mtundu 2 amapezeka nthawi zonse insulin kukana - chitetezo chokwanira cha maselo a thupi kupita ku insulin. Poyankha izi, kayendetsedwe kazomwe thupi limakulitsa katulutsidwe ka insulini kuchokera ku maselo a ß komanso kuchuluka kwa shuga kumasintha. Komabe, kuchuluka kwa insulini kumapangitsa kuti mafuta ochulukirapo apangidwe, zomwe zimapangitsa kuti shuga iwonjezeke, ndiye kuti insulin ingowonjezereka, ndi zina zambiri.

Bwalo loyipa kwambiri limapangidwa, monga mukuwonera. Pofuna kukhala ndi magazi abwinobwino, kapamba amayenera kutulutsa insulin yambiri. Pomaliza, nthawi imafika yomwe mphamvu za B-cell zimatha ndipo kuchuluka kwa glucose kumakwera - shuga yachiwiri imayamba.

Ndipo pali kuchepa pang'onopang'ono kwa maselo a ß-cell ndipo kuchuluka kwa insulin kumachepetsedwa nthawi zonse. Pambuyo pazaka 6 kuyambira nthawi yomwe amadziwika, kapamba amatha kupanga 25-30% yokha ya insulin tsiku lililonse.

Mfundo zotsitsa shugaMankhwala

Kuthana ndi hyperglycemia, madokotala amatsogozedwa ndi ndondomeko yamakono yamankhwala yopangidwa ndi Consensus of the American Diabetes Association ndi European Diabetes Association. Mtundu wake womaliza (womaliza) udasindikizidwa mu Januwale 2009.

Popanga matenda, mankhwalawa nthawi zambiri amalimbikitsidwa ndi kusintha kwa moyo, komwe kumatanthauza kudya zakudya za anthu odwala matenda ashuga komanso kuchita zinthu zina zolimbitsa thupi. Kuphatikiza apo, nthawi yomweyo amalimbikitsidwa kugwiritsa ntchito kukonzekera kutsitsa kwa shuga kwa gulu la greatuanide - metformin, yomwe imapangitsa magwiridwe antchito a insulin m'chiwindi ndi minofu (amachepetsa kukana insulin).

Mankhwalawa nthawi zambiri amakhala okwanira kulipira matenda a shuga kumayambiriro kwa matendawa.

Popita nthawi, mankhwala achiwiri omwe amachepetsa shuga, nthawi zambiri ochokera ku gulu la sulfonylurea, nthawi zambiri amawonjezeredwa ndi metformin. Kukonzekera kwa Sulfonylurea kumapangitsa kuti maselo ß amasungire kuchuluka kwa insulini yofunikira kuti glycemia isinthe.

Ndi mulingo wa glycemia wabwino tsiku lililonse, mfundo za glycated hemoglobin (HbA1c) siziyenera kupitirira 7%. Izi zimapereka chitetezo chodalirika cha zovuta za matenda ashuga. Komabe, kuchepa kwapang'onopang'ono kwa magwiritsidwe ntchito a ß-cell kumabweretsa chakuti ngakhale milingo yayitali kwambiri ya sulfonylurea siliperekanso mphamvu yotsitsa shuga. Vutoli limatchedwa sulfonylamide kukana, komwe silikuwonetsa momwe lilili - kusowa kwa insulini yake.

Mfundo za Insulin Therapy

Ngati mulingo wa HbA1c ukukwera ndipo wafika kale pa 8.5%, izi zikuwonetsa kufunikira koika insulin. Nthawi zambiri, odwala amawona nkhani iyi ngati sentensi yotanthauza gawo lomaliza la matenda ashuga, kuyesera kuthana ndi hyperglycemia popanda thandizo la jakisoni. Odwala ena okalamba, chifukwa cha kusaona bwino, samawona magawano pa syringe kapena manambala pa cholembera ndipo amakana kupereka insulin. Komabe, ambiri amayendetsedwa ndi mantha osaneneka a insulin, jakisoni a tsiku ndi tsiku. Maphunziro kusukulu ya matenda ashuga, kumvetsetsa kwathunthu momwe magwiridwe ake apang'onopang'ono kumathandizira munthu kuti ayambe kupanga insulin panthawi, zomwe zimamupangitsa kuti akhale wathanzi komanso thanzi.

Kukhazikitsidwa kwa insulin kumafuna kudziyang'anira pawokha pogwiritsa ntchito glucometer. Kuchepetsa kwakanthawi komanso makamaka pakulimbikitsa kuyamba kwa insulini kumakhala koopsa, chifukwa kumathandizira kuti chiwopsezo cha matenda ashuga chizikhala chambiri.

Mankhwala a insulin 2 a matenda a shuga nthawi zambiri safuna mtundu wowonjezera, jakisoni angapo, monga mtundu 1 wa shuga. Njira za mankhwala a insulin, komanso mankhwalawo pawokha, amatha kukhala osiyana ndipo amasankhidwa nthawi zonse payekha.

Njira yosavuta kwambiri komanso yothandiza kwambiri yoyambira insulin yothandizira mtundu wa matenda ashuga 2 ndikumalowetsa insulini imodzi yayitali asanadutse (nthawi zambiri nthawi ya 10 p.m.) kuwonjezera pamankhwala ochepetsa shuga. Munthu aliyense akhoza kuchitira kunyumba chithandizo chotere. Poterepa, mlingo woyambira nthawi zambiri umakhala magawo 10, kapena masentimita 0 pa kulemera 1 pa thupi.

Cholinga choyambirira cha mankhwalawa amtundu wa insulin ndikuwonjezera mtundu wa shuga m'magazi (pamimba yopanda kanthu, asanadye chakudya cham'mawa). Chifukwa chake, kwa masiku atatu otsatirawa ndikofunikira kuyeza kuchuluka kwa kusala kwa glycemia ndipo ngati kuli kotheka, onjezani kuchuluka kwa insulin ndi magawo awiri tsiku lililonse mpaka masiku atatu omwe magazi atasala kudya afike pazomwe mukufuna (4-7.2 mmol / l).

Mutha kuwonjezera msanga, i.e. Magawo anayi aliwonse masiku atatu aliwonse ngati shuga m'mawa apamwamba kuposa 10 mmol / l.

Ngati muli ndi zizindikiro za hypoglycemia, muyenera kuchepetsa kuchuluka kwa insulin ndi magawo anayi musanalowe ndikuwuzani endocrinologist za izo. Zomwezo ziyenera kuchitidwa ngati shuga m'mawa (pamimba yopanda kanthu) anali ochepera 4 mmol / L.

Pobwezeretsa shuga m'mawa ngati momwe zimakhalira, mumapitiliza kupereka mankhwala osokoneza bongo tsiku lililonse musanagone. Ngati pambuyo pa miyezi itatu mulingo wa HbA1c ndi wochepera 7%, mankhwalawa amapitilizidwa.

Malangizo amakono othandizira odwala matenda amtundu wa 2 amathandiza kuti metformin igwiritsidwe ntchito limodzi ndi insulin, yomwe imasintha zotsatira za insulini ndipo imalola kuchepetsa mlingo wake. Funso la kuthetsedwa kwa sulfonylurea kukonzekera (glibenclamide, glyclazide, glimeperide, etc.) popanga mankhwala a insulini amasankhidwa payekhapayekha ndi endocrinologist.

Kupitirirabe kwa matendawa kungafune kuyambitsidwa kwa jakisoni wowonjezera wa insulin yotalikirapo musanadye chakudya cham'mawa. Kenako chiwembu chotsatira chimapezeka: insulin yowonjezera imathandizidwa musanadye chakudya cham'mawa komanso musanadye chakudya, ndipo nthawi yomweyo, 1700-2000 mg ya metformin imatengedwa patsiku. Dongosolo lotere la mankhwala nthawi zambiri limathandizira kubwezeretsa shuga kwa zaka zambiri.

Odwala ena amafunanso jakisoni wachiwiri wa insulin pang'ono. Malangizo owonjezera a jakisoni wambiri amatha kutumikiridwa nthawi yomweyo ngati mochedwa (zaka zingapo pambuyo pake pakufunika) kuyambitsa insulin mankhwala ndipo pakalibe kubwezeredwa kwa shuga.

Matenda akulu, chibayo, opaleshoni yayitali, etc. amafuna insulin yothandizira odwala onse, mosatengera nthawi yayitali. Chithandizo chamtunduwu chimafotokozedwa ndikuchotsedwa m'chipatala nthawi yakuchipatala.

Boma lathu limapereka odwala onse omwe ali ndi ma insulin opangidwa ndi chibadwa cha mtundu woyenera waulere!

Kuyamba koyenera komanso kuchita moyenera mankhwala a insulini kumathandizira kuchepetsa kuchuluka kwa shuga m'magazi, komanso metabolism, yomwe ndi chitetezo chodalirika pakukula kwa zovuta za matenda ashuga.