Mkamwa mwa munthu, chimbudzi cha glycogen ndi wowuma chimayamba mchikakamizo cha amvase amousase. Mothandizidwa ndi amylase m'matumbo ang'onoang'ono, chikhazikitso chomaliza cha polysaccharides ku maltose chimachitika.
Zomwe zili m'matumbo madzi ambiri a ma hydrolases - ma enzyme omwe amawononga sucrose, maltose ndi lactose (disaccharides) kuti fructose, galactose ndi glucose (monosaccharides).
Galactose ndi glucose zimatengedwa mwachangu ndi microvilli ya m'matumbo aang'ono, amalowa m'magazi ndikufika pachiwindi.
Kukula kwa glucose komanso kupatuka kumapezeka mu plasma, komanso seramu yamagazi, imagawidwa chimodzimodzi pakati pazinthu zopangidwa ndi plasma.
Glucose ndiye chizindikiro chachikulu cha kagayidwe kazachilengedwe, ndipo zopatsa zam'thupi ndi:
- polysaccharides: wowuma ndi mapadi,
- fructose ndi glucose,
- sucrose ndi lactose,
- shuga ena.
Mulingo wa shuga:
- Kwa ana asanakwane, chizolowezi ndi 1.1-3.33 mmol / l,
- Kwa akhanda tsiku limodzi lokha 2.22-3.33 mmol / l,
- kwa ana mwezi uliwonse 2.7-4.44 mmol / l,
- kwa ana opitirira zaka zisanu, 3.33-5.55 mmol / l,
- mukukula mpaka 60 4.44-6.38 mmol / l,
- anthu ochokera wazaka 60 - chizolowezi ndi 4.61-6.1 mmol / l.
Hypoglycemia imaperekedwa kwa achikulire ngati zopezeka za glucose sizikufika 3,3 mmol / L. Shuga wokwera (kapena nthawi zina ngakhale hyperglycemia) amaikidwa ngati kuwunika kwawonetsa kuti zomwe zili mu glucose ndizopamwamba kuposa 6.1 mmol / l.
Ndikofunikira kudziwa kuti kuphwanya kwa kagayidwe kazakudya kumayambira pagawo lililonse la metabolism ya shuga. Izi zitha kuchitika pamene shuga agwidwa m'mimba, ndikulowetsedwa m'matumbo ang'onoang'ono kapena magawo a ma cell metabolism a ziwalo zama thupi.
Hyperglycemia kapena kuwonjezeka kwa kuchuluka kwa shuga kumatha chifukwa cha:
- physiological hyperglycemia: Kusuta fodya, kupsinjika, zolimbitsa thupi, kusakhazikika mtima, kuthamanga kwakukulu pa jakisoni,
- shuga kwa anthu azaka zonse,
- matenda am'mimba,
- gigantism, acromegaly, thyrotooticosis, pheochromocytoma ndi ma endocrine ena endologies,
- matenda a kapamba, mwachitsanzo, kapamba kapamba kapena pachimake, cystic fibrosis, hemochromatosis ndi zotupa za kapamba,
- matenda am'mimba, makamaka chiwindi ndi impso,
- kukhalapo kwa ma antibodies kuma insulin receptors,
- kugwiritsa ntchito khofi, thiazides, glucocorticoids ndi estrogens.
Hypoglycemia kapena kuchepa kwa glucose kungakhale ndi:
- matenda a kapamba: adenoma, carcinoma, hyperplasia, insulinoma, kuperewera kwa glucagon,
- hypothyroidism, adrenogenital syndrome, matenda a Addison, hypopituitarism,
- mwa mwana wakhanda wosabadwa ndi mayi yemwe ali ndi matenda ashuga
- mankhwala osokoneza bongo a insulin ndi hypoglycemic wothandizira,
- matenda oopsa a chiwindi: carcinoma, cirrhosis, hemochromatosis, hepatitis,
- zotupa zomwe sizipweteka pancreatic: fibrosarcoma, khansa yam'mimba kapena adrenal gland,
- galactosemia, matenda a gyrke,
- zovuta zosiyanasiyana za autonomic, gastroenterostomy, post-gastroectomy, gastrointestinal motility disorder
- kusala kudya kwanthawi yayitali, matenda a malabsorption komanso mavuto ena akudya.
- poyizoni ndi salicylates, arsenic, chloroform, antihistamines kapena mowa,
- kulimbitsa thupi kwambiri ndi kutentha thupi,
- kugwiritsa ntchito amphetamine, steroids ndi propranolol.
Mankhwala, pali mkhalidwe wina wapakatikati, si weniweni matenda a shuga, koma osati wamba. Izi zikutanthauza kulekerera shuga.
Mwanjira imeneyi, shuga othamanga azikhalabe pansipa 6.1 mmol / L, ndipo patatha maola awiri mutayamwa glucose adzakhala 7.8 - 11.1 mmol / L. Tanthauzoli likuwonetsa kuthekera kwakukulu kwa matenda ashuga m'tsogolo. Maonekedwe a matendawa amatengera zinthu zina zambiri. Ili ndi dzina lake - prediabetes.
Pali lingaliro la kusala kudya glycemia. Kuwunika kwa mulingo wa shuga pamimba yopanda kanthu m'magazi ndi seramu pano ndi 5.5 - 6.1 mmol / L, ndipo maola awiri mutatha kutsata shuga, chizindikirocho ndichabwinobwino, ndiye kuti pafupifupi 7.8 mmol / L. Amawerengedwa kuti ndi zinthu zoopsa pakuyambitsidwa kwa matenda a shuga, kutsimikiza kwa zomwe sizingachitike mwachangu.
Kusala kudya kumatanthauza kusapezeka kwa chakudya chilichonse kwa maola 8 kapena kuposerapo.
Malingaliro a kudziwa shuga
Kuchuluka kwa kuchuluka kwa glucose kungafufuzidwe ndi:
- matenda a gren adrenal, England
- Kusokonezeka ndi matenda a chiwindi.
- matenda ashuga, mosasamala mtundu wake,
- kudziwa kulekerera kwa glucose mwa iwo omwe ali ndi chiyembekezo cha matenda a shuga,
- onenepa kwambiri
- shuga kwa amayi apakati,
- Kusintha kwa kulolerana kwa shuga.
Muyenera kudziwa kuti tanthauzo lake likufunika kusiya zakudya kwa maola 8 musanawunike. Kusanthula kumatengedwa bwino m'mawa. Kupitilira muyeso konse, kupsinjika kwamthupi ndi m'malingaliro, sikumaperekedwanso.
Seramu, kapena mwanjira ina, madzi a m'magazi, amalekanitsidwa ndi maselo mkati maora awiri pambuyo poti magazi awatenge. Kuphatikiza apo, mutha kugwiritsa ntchito chubu yapadera yokhala ndi glycolysis inhibitors. Ngati zoterezi sizikwaniritsidwa, ndiye kuti onamizira onama akhoza.
Kuyesedwa kwa shuga m'magazi kumaphatikiza njira izi:
- kafukufuku wa reductometric, zimatengera luso la glucose kubwezeretsa mchere wa nitrobenzene ndi mchere wamkuwa,
- kafukufuku wa enzymatic, mwachitsanzo, njira ya glucose oxidase;
- njira yochitira mitundu, njira yapadera yofotokozedwayi Kutentha kwa chakudya chamoto.
Njira ya glucose oxidase ndikuwunika kuchuluka kwa shuga mumkodzo ndi magazi pamimba yopanda kanthu. Njira imakhazikika pa glucose oxidase enzyme popanga hydrogen peroxide, yomwe oxidizing orthotolidine pa peroxidase.
Magetsi othamanga a glucose amawerengedwa ndi njira ya Photometric, pomwe kukula kwake kwamtundu kumayerekezedwa ndi graph.
Zochita zamankhwala zimatha kudziwa shuga:
- m'magazi a venous, pomwe zinthu kuchokera kuzowunikirazo ndi magazi ochokera m'mitsempha. Openda okhazikika amagwiritsidwa ntchito,
- m'magazi a capillary, omwe amachotsedwa chala. Njira yofala kwambiri, pakuwunika muyenera magazi pang'ono (chizolowezi sichaposa 0.1 ml). Kuwunikiranso kumachitidwanso kunyumba ndi zida zapadera - glucometer.
Mitundu yobisika (yowoneka bwino) yamitsempha yamafuta
Kuti muzindikire zobisika, ndiye kuti, mitundu yaying'ono yamatenda am'mimba ogwiritsa ntchito, kuyesa kwa glucose pakamwa kapena kuyesa kwa glucose pamagwiritsidwe ntchito.
Chonde dziwani: ngati kuchuluka kwa glucose m'magazi a venous otengedwa pamimba yopanda kanthu ndi apamwamba kuposa 15 mmol / l, ndiye kuti matenda a shuga sayenera kufunikira.
Kodi mayeso ololera a glucose olowa mkati ndi otani?
Kafukufuku wovomerezeka wa glucose wopaka pamimba yopanda kanthu, amachititsa kuti asatengere chilichonse chomwe chimakhudzana ndi kusowa kwa chimbudzi, komanso kuyamwa kwa chakudya cham'mimba.
Kwa masiku atatu isanayambike phunzirolo, wodwalayo amamulembera zakudya zomwe zimakhala pafupifupi 150 g tsiku lililonse. Kusanthula kumachitika pamimba yopanda kanthu. Glucose imayendetsedwa pamitseko ya 0,5 g / kg thupi, mwa njira ya 25% yothetsera mphindi imodzi kapena ziwiri.
Mu plousma wamagazi, minyewa ya m'magazi imatsimikizika kanthawi 8: nthawi imodzi pamimba yopanda, ndipo zina 3, 5, 10, 20, 30, 45 ndi 60 pambuyo pa shuga zimaperekedwa. Mlingo wa plasma insulin ukhoza kutsimikizika limodzi.
Kutheka kogwiritsa ntchito magazi kumawonetsa kuchepa kwa shuga m'magazi pambuyo pakupanga kwake kwamkati. Nthawi yomweyo, nthawi yomwe imatenga kuchepetsa kuchuluka kwa shuga ndi 2 nthawi imatsimikizika.
Fomula yapadera imawerengera izi: K = 70 / T1 / 2, pomwe T1 / 2 ndi kuchuluka kwa mphindi zomwe zimafunikira kuchepetsa shuga wa magazi ndi 2, pakatha mphindi 10 kulowetsedwa.
Ngati zonse zili mkati mwa malire abwinobwino, ndiye kuti mphindi zochepa pambuyo pobweretsa shuga, magazi ake othamanga amafika pamtunda wapamwamba - mpaka 13.88 mmol / L. Mankhwala a insulin okwanira amawonekera mphindi zisanu zoyambirira.
Mkulu wama glucose amabwerera ku mtengo wake woyambirira pambuyo pafupifupi mphindi 90 kuchokera pomwe amayambira kusanthula. Pambuyo maola awiri, zomwe zili ndi glucose zimatsikira pansi pomwe, ndipo patatha maola atatu, mulingo wabwerera.
Zochitika zotsatirazi za glucose zomwe zilipo:
- mwa anthu omwe ali ndi matenda a shuga amakhala pansi pa 1.3. Peak insulin ndende ikupezeka maminiti asanu mutayamba kusanthula,
- mwa anthu achikulire athanzi omwe alibe matenda a kagayidwe kazakudya, kuchuluka kwake ndi kwakukulu kuposa 1.3.
Hypoglycemic ndi hyperglycemic coefficients
Hypoglycemia ndi njira ya pathological yomwe imamasulira kukhala shuga wotsika wamagazi.
Hyperglycemia ndi chizindikiro chachipatala, chomwe chimawonetsa kuchuluka kwa glucose pazambiri za seramu.
Mulingo wapamwamba umawoneka ndi matenda a shuga kapena matenda ena a endocrine.
Zambiri pazochitika za kagayidwe kazakudya zitha kupezeka mutawerengetsera maumboni awiri ofufuza shuga:
- kuchuluka kwa gluerglycemic ndiko kuchuluka kwa shuga mu ola limodzi, mpaka pamimba yopanda kanthu,
- kuchuluka kwa hypoglycemic ndiko kuchuluka kwa shuga m'magawo 2 mutatha kulumikiza mulingo wake pamimba yopanda kanthu.
Mwa anthu athanzi, kuchuluka kwaubwinobwino kwa hypoglycemic kumakhala kochepera 1.3, ndipo mulingo wa hyperglycemic sukudutsa kupitirira 1.7.
Ngati malingaliro abwinobwino a chisonyezo chimodzi apitilira, ndiye kuti izi zikuwonetsa kuti kulolera kwa glucose kumachepetsedwa.
Glycosylated hemoglobin ndi mulingo wake
Hemoglobin yotere imadziwika kuti HbA1c. Iyi ndi hemoglobin, yomwe yalowa mu mankhwala osachita enzymatic okhala ndi monosaccharides, ndipo, makamaka, ndi glucose, yomwe ili m'magazi ozungulira.
Chifukwa cha izi, chotsalira cha monosaccharide chimaphatikizidwa ndi molekyulu ya mapuloteni. Kuchuluka kwa hemoglobin ya glycosylated yomwe imawonekera mwachindunji pakukhazikika kwa shuga m'magazi, komanso nthawi yayitali yogwirizana ndi yankho la shuga ndi hemoglobin.
Ndiye chifukwa chake zomwe zili mu glycated hemoglobin zimatsimikiza kuchuluka kwa glucose m'magazi nthawi yayitali, yomwe ikufanana ndi nthawi ya molekyu ya hemoglobin. Ndipafupifupi miyezi itatu kapena inayi.
Zifukwa zoperekera phunziroli:
- kuwunika ndi kuzindikira matenda ashuga,
- kuyang'anira matenda nthawi yayitali ndikuwunika momwe anthu omwe ali ndi matenda ashuga,
- kusanthula kobwezeretsa matenda a shuga,
- kuwunikira kowonjezereka kwa mayeso ololera wa glucose monga gawo lazindikiritso wa shuga wodwala kapena matenda asanafike matendawa,
- matenda ashuga am'mimba panthawi yapakati.
Mulingo woyenera komanso wofanana wa hemoglobin wa glycated pochita ndi thiobarbituric acid amachokera ku 4.5 mpaka 6, 1 peresenti ya molar, monga momwe kusanthula kukuwonera.
Kutanthauzira kwa zotsatira kumakhala kovuta ndi kusiyana kwa teknoloji ya ma labotale ndi kusiyana komwe anthu omwe adaphunzira. Kutsimikiza ndikovuta, chifukwa kufalikira kwa mfundo za hemoglobin. Chifukwa chake, mwa anthu awiri omwe ali ndi kuchuluka kwa shuga m'magazi, amatha kufikira 1%.
Makhalidwe amakula pomwe:
- matenda a shuga ndi zina zomwe zimadziwika ndi kulolerana kwa shuga,
- kudziwa kuchuluka kwa malipiro: kuyambira 5.5 mpaka 8% - shuga wolipidwa, kuyambira 8 mpaka 10% - nthenda yolipiridwa bwino, kuyambira 10 mpaka 12% - nthenda yolipiridwa pang'ono. Ngati peresentiyo ndi yoposa 12, ndiye kuti izi ndi shuga.
- kuchepa kwachitsulo
- splenectomy
- kuchuluka kwabodza chifukwa cha kuchuluka kwa fetal hemoglobin.
Makhalidwe amatsika:
- magazi
- kuchepa magazi m'thupi,
- kuthira magazi
- hypoglycemia.
