Insulin imakhudzidwa ndi kayendedwe ka kagayidwe, kayendedwe ka transmembrane ka ion, ma amino acid. Zotsatira za insulin pa kagayidwe kazakudya zimavuta kuzidalira. Anthu omwe ali ndi matenda ashuga amawonetsanso kuchepa kwa kagayidwe.
Matendawa matenda a shuga apezeka pafupipafupi kwambiri. Matenda amachititsa matenda osiyanasiyana a metabolic. Matenda a shuga, matenda am'mimba omwe amatha kukhala osiyanasiyana, ali pamalo achitatu pambuyo pa matenda a oncology ndi a mtima. Pali anthu pafupifupi 100 miliyoni omwe ali ndi matenda ashuga padziko lapansi. Zaka khumi zilizonse, kuchuluka kwa odwala matenda ashuga kumapitilira 2 times.
Anthu ochokera kumaiko osatukuka ndi zinthu zodwala kumayiko otukuka ali pachiwopsezo chachikulu cha kudwala. Mavuto a metabolism a shuga mellitus amatsogolera ku ma pathologies osiyanasiyana. Matenda a shuga a Type 2 nthawi zambiri amakhudza anthu pambuyo pa zaka 45.
Njira ya zochita za insulin
Mu 1869, a Langerhans adapeza zilumba mu zikondamoyo zomwe adadzatcha dzina lake. Zinadziwika kuti matenda ashuga amatha kuonekera atachotsetsa England.
Insulin ndi mapuloteni, ndiye kuti, polypeptide yomwe imakhala ndi unyolo wa A ndi B. Amalumikizidwa ndi milatho iwiri yopanda tanthauzo. Tsopano ndikudziwika kuti insulin imapangidwa ndikusungidwa ndi maselo a beta. Insulin imasokonezedwa ndi ma enzymes omwe amabwezeretsa ma disulfide bond ndipo amatchedwa "insulinase." Kupitilira apo, ma enzymes a proteinolytic amakhudzidwa ndi hydrolysis ya unyolo kumitundu yochepa yamolekyulu.
Amakhulupirira kuti choletsa chachikulu cha insulin katulutsidwe kamadzi ndi insulin m'magaziwo, komanso mahomoni a hyperglycemic:
- adrenaline
- ACTH,
- cortisol.
TSH, catecholamines, ACTH, STH ndi glucagon m'njira zosiyanasiyana zimayambitsa adenylcyclase mu nembanemba ya cell. Yotsirizira imayambitsa mapangidwe a cyclic 3,5 adenosine monophosphate, imayambitsa chinthu china - puloteni kinase, imapatsa ma microtubules a beta, omwe amatsogolera pang'onopang'ono kumasulidwa kwa insulin.
Ma Microtubules ndimapangidwe a beta-cell omwe m'mbuyomu amapanga insulin m'mayendedwe am'mimba.
Chowonjezera champhamvu kwambiri cha mapangidwe a insulin ndi glucose wamagazi.
Limagwirira a insulin limagonekanso mu mgwirizano wotsutsana ndi okhazikika okambirana 3,5 - GMF ndi 3,5 AMP.
Limagwirira a chakudya kagayidwe
Insulin imakhudza kagayidwe kazakudya zam'mimba mu shuga. Chinsinsi cholumikizira matendawa ndi kuchepa kwa chinthu ichi. Insulin imakhudza kwambiri kagayidwe kazakudya, komanso mitundu ina ya kagayidwe, popeza katemera wa insulin amachepetsa, ntchito zake zimachepa, kapena kulandila kwa minofu yodalira insulin ndi maselo kumayipa.
Chifukwa chophwanya kagayidwe kazakudya mu shuga mellitus, ntchito ya m'magazi am'magazi imatsika, kuchuluka kwake m'magazi kumawonjezeka, komanso njira zogwiritsira ntchito shuga zomwe zimayimira payekha zimapangitsa insulin.
Sorbitol shunt ndimkhalidwe womwe glucose amachepetsedwa kukhala sorbitol, kenako umatulutsa oxidin kuti asekerere. Koma makutidwe ndi okosijeni amachepetsa ndi enzyme yodalira insulini. Pamene polyol shunt imayendetsedwa, sorbitol imadzaza mu minofu, izi zimapangitsa mawonekedwe a:
- mitsempha
- katarayta
- michereopathies.
Pali kupangika kwa shuga kwa protein ndi glycogen, koma mtundu uwu wa goiukosis sukutenga ndi maselo, chifukwa pali kusowa kwa insulin. Aerobic glycolysis ndi pentose phosphate shunt imapanikizika, cell hypoxia ndi kuperewera kwa mphamvu kumawonekera. Kuchuluka kwa hemoglobin ya glycated kumawonjezeka, sikuti amanyamula mpweya, womwe umathandizira hypoxia.
Mapuloteni a metabolism omwe ali ndi shuga amatha kuchepa:
- hyperazotemia (kuchuluka kwa mabacteria otsalira),
- hyperazotemia (kuchuluka kwa kuchuluka kwa nayitrogeni m'magazi).
Mulingo wanthawi zonse wa mapuloteni ndi 0,86 mmol / L, ndipo nayitrogeni yonse iyenera kukhala 0,87 mmol / L.
Zomwe zimayambitsa matenda a pathophysiology ndi:
- kuchuluka kwa mapuloteni
- kutsegula kwa kuphatikizika kwa amino acid mu chiwindi,
- asafe otsalira.
Nayitrogeni wopanda puloteni ndi nayitrogeni:
- ma amino acid
- urea
- ammonia
- creatinine.
Izi zimachitika chifukwa chowonjezera kuwononga kwa mapuloteni, makamaka m'chiwindi ndi minofu.
Mu mkodzo wa shuga, kuchuluka kwa mankhwala a nayitrogeni kumawonjezeka. Azoturia ali ndi zifukwa zotsatirazi:
- kuchuluka kwazinthu zomwe zimakhala ndi nayitrogeni m'magazi, kutulutsa kwawo mkodzo,
- kagayidwe kakang'ono ka mafuta kamakhala ndi ketonemia, hyperlipidemia, ketonuria.
Mu matenda a shuga, hyperlipidemia imayamba, komwe kumawonjezera kuchuluka kwa magazi a milingo ya lipid. Chiwerengero chawo ndichoposa chachilendo, ndiye kuti, kuposa 8 g / l. Hyperlipidemia yotsatirayi ilipo:
- minyewa activation lipolysis,
- kuletsa kuwonongeka kwa lipid ndi maselo,
- kuchuluka mafuta m'thupi,
- kuletsa kwamtundu wama asidi ochulukirapo ku maselo,
- kuchepa kwa ntchito ya LPLase,
- ketonemia - kuwonjezeka kwa kuchuluka kwa matupi a ketone m'magazi.
Pagulu la matupi a ketone:
- acetone
- acetoacetic acid
- p-hydroxymalic acid.
Kuchuluka kwa matupi a ketone m'magazi kumatha kukhala okwera kuposa 30-50 mg%. Pali zifukwa izi:
- kutsegula lipolysis,
- kuchuluka oxidation m'maselo amafuta ambiri,
- kuyimitsidwa kwa kapid
- kuchepa kwa oxidation a acetyl - CoA mu hepatocytes ndi mapangidwe a matupi a ketone,
Kugawidwa kwa matupi a ketone pamodzi ndi mkodzo ndikuwonetsera kwa matenda osokoneza bongo a maphunziro osavomerezeka.
Chochititsa ketonuria:
- matupi ambiri a ketone omwe amasefa mu impso,
- mavuto a kagayidwe wamadzi mu shuga, owonetsedwa ndi polydipsia ndi polyuria,
Polyuria ndi matenda omwe amafotokozedwa pakupanga mkodzo ndi kuchuluka kwake kwamkodzo mu voliyumu yomwe imaposa zinthu wamba. M'mikhalidwe yokhazikika, kuyambira 1000 mpaka 1200 ml amatulutsidwa tsiku limodzi.
Ndi matenda a shuga, diuresis tsiku lililonse ndi 4000-10 000 ml. Zifukwa zake ndi izi:
- Hyperosmia ya mkodzo, womwe umachitika chifukwa cha kuchotsedwa kwa glucose owonjezera, ma ions, CT ndi ma nitrogen. Chifukwa chake, kusefukira kwamadzi mu glomeruli kumalimbikitsidwa ndikuletsa kubwezeretsanso,
- Kuphwanya kwa reabsorption ndi chimbudzi, zomwe zimayambitsidwa ndi matenda a shuga;
- Polydipsia.
Insulin ndi mafuta kagayidwe
Mothandizidwa ndi insulin, chiwindi chimatha kusunga glycogen yochepa chabe. Glucose owonjezera omwe amalowa m'chiwindi amayamba phosphorylate motero amasungidwa mu cell, koma kenako amasinthidwa kukhala mafuta, osati glycogen.
Kusintha kumeneku m'mafuta ndi chifukwa chodziwonetsa mwachindunji ku insulin, ndipo magazi omwe amapangidwira mkati mwa mafuta acids amatengedwa kupita ku minofu ya adipose. M'magazi, mafuta ndi gawo la lipoproteins, omwe amathandiza kwambiri popanga matenda a atherosulinosis. Chifukwa cha matenda awa, zitha kuyamba:
- embolism
- vuto la mtima.
Zochita za insulin pama cell a adipose zimakhala zofanana ndi momwe zimakhudzira maselo a chiwindi, koma mapangidwe a mafuta achilengedwe m'chiwindi amalimbitsa thupi kwambiri, chifukwa chake amasamutsidwa kupita ku adipose minofu. Mafuta acids m'maselo amasungidwa ngati triglycerides.
Mothandizidwa ndi insulin, kuwonongeka kwa triglycerides mu adipose minofu kumachepetsedwa chifukwa chopinga lipase. Kuphatikiza apo, insulin imayendetsa kaphatikizidwe wamafuta acids m'maselo ndipo imagwira nawo ntchito yawo ndi glycerol, yomwe imafunikira pakuphatikizika kwa triglycerides. Chifukwa chake, pakapita nthawi, mafuta amadziunjikira, kuphatikizapo physiology ya matenda a shuga a mellitus.
Zotsatira za insulin pa metabolism yamafuta zitha kusinthika, ndi otsika kwambiri, triglycerides imagawidwanso m'mafuta acids ndi glycerol. Izi ndichifukwa choti insulini imaletsa lipase ndi lipolysis imayatsidwa pamene kuchuluka kwake kumachepetsedwa.
Mafuta achilengedwe opanda mafuta, omwe amapangidwa nthawi ya hydrolysis ya triglycerides, nthawi yomweyo amalowa m'magazi ndipo amagwiritsidwa ntchito ngati mphamvu yopangira minofu. The oxidation a ma asidi awa amatha kukhala m'maselo onse, kupatula maselo amitsempha.
Mafuta ochulukirapo omwe amamasulidwa pakakhala kusowa kwa insulini kuchokera m'mabatani amafuta amadziwikanso ndi chiwindi. Maselo a chiwindi amatha kupanga triglycerides ngakhale pakhale insulin. Ndikusowa kwa chinthu ichi, mafuta acids omwe amatulutsidwa m'matumba amaphatikizidwa m'chiwindi mu mawonekedwe a triglyceride.
Pachifukwachi, anthu omwe ali ndi vuto la insulin, ngakhale amakonda kutsika thupi, amayamba kunenepa kwambiri m'chiwindi.
Kuchepa kwa lipid ndi kagayidwe kazakudya
Mu matenda ashuga, insulin glucagon index imatsitsidwa. Izi zimachitika chifukwa cha kuchepa kwa insulin katulutsidwe, komanso kuwonjezeka kwa kupanga kwa glucagon.
Mavuto a lipid metabolism mu shuga mellitus akuwonetsedwa mu kukondoweza kochepa kosungirako ndikuwonjezera kukondoweza kwa kulimbikitsa kosungirako. Mukatha kudya, mu postabsorption state ndi:
- chiwindi
- minofu
- minofu ya adipose.
Zogaya ndi ma metabolites awo, m'malo momasungidwa ngati mafuta ndi glycogen, zimazungulira m'magazi. Njira zama cyclic zimayambikanso pamlingo wina, mwachitsanzo, zimachitika nthawi imodzi za gluconeogeneis ndi glycolysis, komanso njira yamavuto amafuta ndi kaphatikizidwe.
Mitundu yonse ya matenda a shuga imadziwika ndi kulekerera kwa glucose, ndiye kuti, hyperglucoseemia atatha kudya kapenanso pamimba yopanda kanthu.
Zoyambitsa zazikulu za hyperglucoseemia ndi:
- kugwiritsa ntchito adipose minofu ndi minofu yochepa, chifukwa pakakhala insulin HLBT-4 siiwonekera poyera pa adipocytes ndi myocyte. Glucose sungasungidwe ngati glycogen,
- glucose m'chiwindi sagwiritsidwa ntchito posungira glycogen, chifukwa ndi kuchuluka kwa insulin komanso kuchuluka kwambiri kwa glucagon, glycogen synthase imagwira ntchito,
- shuga wa chiwindi sagwiritsidwa ntchito popanga mafuta. Ma michere a glycolysis ndi pyruvate dehydrogenase ali mu mawonekedwe ochepa. Kusintha kwa glucose kukhala acetyl-CoA, komwe ndikofunikira pakuphatikizidwa kwamafuta acids, ndizoletsa,
- njira ya gluconeogeneis imayendetsedwa pazotsalira zambiri za insulin ndi glucagon komanso kuphatikiza kwa glucose kuchokera ku glycerol ndi amino acid ndikotheka.
Chizindikiro china cha matenda ashuga ndi kuchuluka kwa lipoproteins, matupi a ketone ndi mafuta aulere acids m'magazi. Mafuta okometsedwa samayikidwa mu minofu ya adipose chifukwa adipocyte lipase ili m'malo.
Muli nkhani zazikuluzikulu zamafuta zamafuta zamafuta m'magazi zimawonekera. Mafuta acids amatengeka ndi chiwindi, zina mwa izo zimasinthidwa kukhala ma pracylglycerols, ndipo zimalowa m'magazi ngati gawo la VLDL. Mafuta ochulukirapo amalowa mu β-oxidation mu mitochondria ya chiwindi, ndipo omwe amapanga acetyl-CoA amagwiritsidwa ntchito pakupanga matupi a ketone.
Zotsatira za insulin pa kagayidwe kake zimagona poti pakukhazikitsa insulin m'malo osiyanasiyana amthupi, kaphatikizidwe ka mafuta ndi kuwonongeka kwa lipids la triglyceride zimathandizira. Kuchepa kwa lipid metabolism ndiko kusungidwa kwamafuta, komwe kumakwaniritsa zosowa zamagetsi pamavuto.
Maonekedwe ochulukirapo a cAMP amatsogolera kuchepa kwa kaphatikizidwe ka mapuloteni komanso kuchepa kwa HDL ndi VLDL. Zotsatira za kuchepa kwa HDL, kuchuluka kwa mafuta m'thupi kumaselo amachepetsa magazi. Cholesterol imayamba kuyikidwa m'makoma a zombo zazing'onoting'ono, zomwe zimapangitsa kuti pakhale matenda a shuga ndi atherosclerosis.
Zotsatira za kuchepa kwa VLDL - mafuta amadziunjikira m'chiwindi, nthawi zambiri amathandizidwa ngati gawo la VLDL. Protein synthesis imapanikizidwa, zomwe zimapangitsa kuchepa kwa mapangidwe a antibody, kenako, odwala osakwanira a shuga ku matenda opatsirana. Amadziwika kuti anthu omwe ali ndi vuto la protein protein metabolism amadwala furunculosis.
Zovuta zotheka
Microangiopathy ndi matenda a shuga a shuga. Chifukwa cha matenda ashuga a retinopathy, anthu omwe ali ndi matenda ashuga amasiya kuwona mu 70-90% ya milandu. Makamaka, odwala matenda ashuga amakhala ndi matenda amkati.
Chifukwa chosowa HDL, cholesterol yowonjezera imapezeka m'matumbo am'mimba. Chifukwa chake, nthenda ya mtima kapena kuchepa kwa endarteritis imatha kuoneka. Pamodzi ndi izi, microangiopathy yokhala ndi nephritis imapangidwa.
Mu matenda a shuga, matenda a periodontal amapangidwa ndi gingivitis - periodontitis - periodontal matenda. Mu odwala matenda ashuga, mawonekedwe amano amasokonezeka ndipo zimakhala zothandizira zimakhudzidwa.
Zomwe zimayambitsa matenda a microvessels mu zochitika izi, nthawi zambiri, ndikupanga kulumikizana kosagwirizana kwa glucose ndi mapuloteni a khoma lamitsempha. Poterepa, mapulateleti amabisa chinthu chomwe chimalimbikitsa kukula kwa minofu yosalala ya khoma la mtima.
Mavuto a kagayidwe ka mafuta amasonyezedwanso mfundo yakuti kufalikira kwa mafuta m'chiwindi kumachuluka m'chiwindi, lipid resynthesis. Nthawi zambiri, amawachotsa mu mawonekedwe a VLDL, mapangidwe ake omwe amatengera kuchuluka kwa mapuloteni. Mwa izi, opereka gulu la CHZ, ndiye kuti choline kapena methionine, amafunikira.
Kuphatikizika kwa Choline kumapangitsa lipocaine, yomwe imapangidwa ndi epanciliic duct epithelium. Kuchepa kwa izo kumabweretsa kunenepa kwambiri kwa chiwindi ndikupanga mitundu yonse ya shuga ndi yaing'ono.
Kuperewera kwa insulin kumabweretsa kukana kochepera matenda opatsirana. Chifukwa chake, furunculosis imapangidwa.
Kanemayo munkhaniyi ayankhula za zovuta za insulin m'thupi.
