Type 2 ciwon sukari insulin far

Alexey ROMANOVSKY, Mataimakin Farfesa, Ma'aikatar Endocrinology BelMAPO, Dan takarar Kimiyya na Kimiyya

Me yasa mutum yake buƙatar insulin?

A jikin mu, insulin yana da manyan ayyuka guda biyu:

• Yana haɓaka shigarwar glucose a cikin sel don abincirsu,
• yana da tasirin anabolic, i.e. yana ba da gudummawa ga tsarin metabolism na gaba daya.

A yadda aka saba, samuwar da kwantar da insulin yana faruwa ta atomatik ta amfani da hadaddun hanyoyin sarrafa kwayoyin. Idan mutum bai ci abinci ba, to ana iya cire insulin a cikin adadi kaɗan - wannan basal insulin tsarewa (a cikin manya har zuwa raka'a insulin 24 a kowace rana).

Nan da nan bayan cin abinci, a cikin martani don haɓakar glucose na jini, ana samun saurin sakin insulin - wannan shine abin da ake kira postprandial insulin ɓoye.

Me zai faru da ɓoye insulin a cikin nau'in ciwon sukari na 2?

Kamar yadda ka sani, akwai manyan nau'ikan ciwon sukari guda biyu. Tare da nau'in 1 na ciwon sukari, ƙwayoyin ƙwayar pancreatic ß sun lalace gaba ɗaya, sabili da haka, an tsara wa marasa lafiya nan da nan magani na maye tare da shirye-shiryen insulin.

Tsarin ci gaban cuta a cikin nau'in ciwon sukari na 2 ya fi rikitarwa. Mutanen da ke cikin halin gado sakamakon abinci mai daidaitawa (yawan adadin kuzarin da ake ci) da kuma yanayin rayuwa yana fuskantar ƙimar nauyi, yawan ƙwayar visceral (na ciki) da haɓakar glucose jini.

Lokacin da nau'in ciwon sukari na 2 ke kasancewa koyaushe insulin juriya - rigakafin sel jikin mutum zuwa yawan insulin. Saboda wannan, tsarin gudanarwar jiki yana kara ɓarin insulin daga sel and kuma matakan glucose na al'ada. Koyaya, ƙara yawan insulin yana ba da gudummawa ga haɓakar kitse na ciki, wanda ke haifar da ƙarin karuwa a cikin glucose, sannan ƙara haɓaka insulin, da dai sauransu.

Kamar yadda kuke gani, anyi ɓullo da'irar mugunta. Don kiyaye matakan glucose na jini na yau da kullun, ƙwayar ƙwayar ƙwayar cuta dole ne asirce da insulin. A ƙarshe, lokaci ya zo da lokacin da aka gaza biyan diyya na ƙwayoyin B kuma keɓaɓɓen matakin glucose - nau'in ciwon sukari na 2 ya tashi.

Sannan akwai raguwar de-sel a hankali kuma ana yawan rage yawan insulin a kai a kai. Bayan shekaru 6 daga lokacin bayyanar cutar, ƙwayar ƙwayar cuta ta sami damar samar da 25-30% na yawan adadin insulin din da ake buƙata kowace rana.

Ka'idojin KayaHanyoyin kwantar da hankali

Don magance cututtukan hyperglycemia, likitocin suna jagora ta hanyar tsarin magani na zamani wanda aka samu ta Diungiyar Diungiyar Ciwon Cutar ta Amurka da Diungiyar Ciwon Ciwon Turai. Publishedarshe na ƙarshe (ƙarshe) an buga shi a cikin Janairu 2009.

Lokacin yin bincike, yawanci ana bada shawara tare da gyare-gyare na rayuwa, wanda ke haifar da tsarin ciwon sukari da ƙarin aiki na yau da kullun. Bugu da ƙari, an bada shawara nan da nan don amfani da shirin rage sukari na ƙungiyar biguanide - metformin, wanda ke inganta aikin insulin a cikin hanta da tsokoki (yana rage juriya na insulin).

Wadannan jiyya yawanci sun isa don rama wa masu ciwon sukari a farkon cutar.

A tsawon lokaci, magani na rage sukari na biyu, yawanci daga ƙungiyar sulfonylurea, yawanci ana haɗuwa da metformin. Shirye-shiryen Sulfonylurea suna haifar da ß sel su ɓoye adadin insulin wajibi ne don daidaita glycemia.

Tare da ingantaccen matakin yau da kullun na glycemia, ƙimar haemoglobin (HbA1c) ya kamata ya wuce 7%. Wannan yana samar da ingantaccen rigakafin rikicewar cututtukan cututtukan fata. Koyaya, asarar ci gaba mai aiki ß-sel tana haifar da gaskiyar cewa ko da matsakaiciyar ƙwayar sulfonylurea ba ya samar da sakamako mai mahimmanci na sukari. Wannan sabon abu ana kiransa da juriya na sulfonylamide, wanda baya nuna yanayin halayyar sa - Rashin insulin nasa.

Ka'idodin Insulin Therapy

Idan matakin HbA1c ya tashi kuma ya rigaya ya wuce 8.5%, wannan yana nuna buƙatar nadin insulin. Sau da yawa, marasa lafiya suna tsinkaye wannan labarai a matsayin jumla dake nuna matakin ƙarshe na ciwon sukari, suna ƙoƙarin shawo kan cututtukan hyperglycemia ba tare da taimakon injections ba. Wasu marasa lafiya tsofaffi, saboda hangen nesa mara kyau, basa ganin rarrabuwa akan sirinji ko lambobi a kan sirinji don haka sun ƙi sarrafa insulin. Koyaya, yawancin suna motsawa kawai ta hanyar rashin tsoro don rashin kulawa na maganin insulin, allurar yau da kullun. Ilimi a makarantar ciwon sukari, cikakkiyar fahimta game da hanyoyin ci gaban ci gabanta na taimaka wa mutum ya fara yin insulin farjin a kan lokaci, wanda hakan babban abin alfahari ne ga cigaban shi da lafiyar sa.

Wa'azin insulin yana buƙatar saka idanu na kai tsaye ta amfani da glucometer ɗin mutum. Duk wani kuma musamman jinkiri na farawa daga farawar insulin yana da haɗari, saboda yana ba da gudummawa ga hanzarta haɓakar rikicewar cututtukan cututtukan fata.

Harkokin insulin a cikin nau'in 2 na ciwon sukari yawanci baya buƙatar jinkiri mai mahimmanci, injections da yawa, kamar a cikin nau'in 1 na ciwon sukari. Hanyoyi na ilimin insulin, har ma da kwayoyi da kansu, na iya bambanta kuma ana zaɓa su daban daban.

Hanya mafi sauƙi kuma mafi inganci don fara maganin insulin don maganin ciwon sukari na 2 shine shigar da insulin guda ɗaya mai aiki kafin lokacin bacci (yawanci a 10 p.m.) ban da magunguna masu rage sukari. Kowane mutum na iya aiwatar da irin wannan jiyya a gida. A wannan yanayin, yawan farawa yawanci raka'a 10 ne, ko raka'a 0.2 a 1 kg na nauyin jiki.

Manufar farko ta irin wannan tsarin kulawa ta insulin shine don daidaita matakan glucose na jini da safe (akan komai a ciki, kafin karin kumallo). Sabili da haka, don kwanaki uku masu zuwa wajibi ne don auna matakin azumi glycemia kuma, idan ya cancanta, haɓaka kashi na insulin ta hanyar raka'a 2 kowace kwana 3 har sai sukarin jinin mai azumi ya isa ga darajar ƙimar (4-7.2 mmol / l).

Kuna iya ƙara yawan sauri, i.e. Raka'a 4 kowace rana 3 idan sukari na safe ya fi 10 mmol / l.

Idan akwai alamun hypoglycemia, ya kamata ku rage kashi na insulin ta hanyar raka'a 4 a lokacin bacci kuma ku sanar da endocrinologist ɗin game da shi. Haka ya kamata a yi idan sukarin jini na safiya (a kan komai a ciki) ƙasa da mm 4 /ol / L.

Ta hanyar dawo da sukari da safe zuwa al'ada, kuna ci gaba da gudanar da aikin da aka zaɓa na insulin kowane dare kafin lokacin bacci. Idan bayan watanni 3 matakin HbA1c bai wuce 7% ba, ana ci gaba da wannan ilimin.

Shawarwarin zamani don maganin cututtukan type 2 suna ba da amfani ga metformin koyaushe a hade tare da maganin insulin, wanda ke inganta tasirin insulin kuma yana ba da damar rage kashi. Tambayar dakatar da shirye-shiryen sulfonylurea (glibenclamide, glyclazide, glimeperide, da dai sauransu) lokacin da aka tsara bayanin maganin insulin an yanke hukunci daban-daban ta endocrinologist.

Ci gaba da cutar na iya buƙatar gabatar da ƙarin allura ta insulin ƙarin aiki kafin karin kumallo. Sannan ana samun tsarin da ke gaba: ana yin insulin aiki mai-tsawo kafin karin kumallo da kuma abincin dare, kuma a lokaci guda, ana ɗaukar nauyin 1700-2000 na metformin kowace rana. Irin wannan tsarin kulawa yawanci yana ba da gudummawa ga kyakkyawan biyan diyya na shekaru.

Wasu marasa lafiya na iya buƙatar buƙatar inshora insulin na gajeren aiki sau 2-3 a rana. Za'a iya ba da tsarin jinya mai yawa na injections nan da nan idan aka makara (shekaru da yawa daga baya ya zama dole) qaddamar da ilimin insulin kuma in babu diyyar cutar sankara.

Cututtukan kamuwa da cuta, ciwon huhu, tsawaita tiyata, da dai sauransu. na bukatar insulin na wucin gadi ga dukkan masu cutar, ba tare da la’akari da tsawon lokacin da ake fama da cutar siga ba. An tsara wannan nau'in maganin kuma an soke shi a asibiti yayin asibiti.

Jiharmu tana samar da duk marasa lafiya da insulin ɗabi'ar ɗan adam na ƙimar inganci kyauta!

Farawar ta dace da kuma yanayin da ya dace na maganin insulin yana taimaka wa al'ada ba kawai matakan sukari na jini ba, har ma da metabolism, wanda yake amintaccen kariya ne daga haɓakar rikicewar cututtukan ƙwayar cuta na kullum.