Kuwonjezeka kopitilira kwa odwala omwe ali ndi matenda a shuga a 2 komanso zovuta zake zam'mbuyo zam'mimba, akuti matenda ndi vuto lapadziko lonse lapansi.
Matenda a shuga samateteza kumayiko otukuka kopanda maboma kapena dziko lotukuka. WHO ikuyerekeza kuti pali anthu pafupifupi 150 miliyoni omwe ali ndi matenda ashuga padziko lonse lapansi. Ndipo kuchuluka pachaka kwa matendawa ndi 5-10%.
Ku Russia lero odwala pafupifupi 2,5 miliyoni omwe ali ndi matenda a shuga adalembetsa. Koma chiwerengerochi sichili chomaliza, popeza chiwerengero cha milandu yomwe sichinapezeke ndi pafupifupi 8 miliyoni. Mwachidule, 5% ya anthu ku Russia amadwala matenda ashuga. Mwa awa, 90% ali ndi matenda ashuga a 2.
Mavuto ambiri omwe amachitika chifukwa cha matenda ashuga ndi matenda amtima, omwe mu 70% mwa milandu amabweretsa mavuto osaneneka. Pachifukwa ichi, American Association of Cardiology adaigwiritsa ntchito ngati matenda a mtima.
Zowopsa
Postprandial hyperglycemia ndi shuga wambiri wa 10 mmol / L kapena kuposa pambuyo chakudya wamba. Kufunika kwa hyperglycemia ya postprandial ndi maziko mu pathogenesis yovuta yaposachedwa yamatenda a mtima. Mavuto a metabolism a mtundu wa 2 shuga amapanga zinthu zingapo zowopsa m'mitsempha yamagazi ndi mtima, kuphatikiza:
- Kunenepa kwambiri
- Matenda oopsa.
- Mitundu yambiri ya inhibitor 1 yothandizira fibrinogen ndi plasminogen.
- Hyperinsulinemia.
- Dyslipidemia, yomwe imadziwika kwambiri ndi cholesterol yotsika HDL (lipoproteins yapamwamba) ndi hypertriglyceridemia.
- Kukana insulini.
Imfa yodwala matenda a mtima ndi ziwonetsero zomwe sizowopsa za matendawa kwa odwala omwe ali ndi matenda osokoneza bongo ndizochulukirapo katatu kuposa anthu amisinkhu imodzimodzi koma alibe matenda a shuga.
Chifukwa chake, osadziwika omwe ali pachiwopsezo komanso zomwe zimadziwika ndi mtundu wachiwiri wa matenda a shuga, kuphatikiza insulin kukokana ndi hyperglycemia, ayenera kuyang'anira kukula kwa mtima wamatenda a mtima.
Zizindikiro zodziwika bwino za kuwongolera shuga (glycated hemoglobin, glycemia yachangu) sizofotokoza kwathunthu kuchuluka kwa zovuta za mtima ndi odwala omwe ali ndi matenda a shuga a 2. Zina zomwe zatsimikizidwa ndizopweteka:
- Matenda oopsa.
- Kudziletsa.
- Okwatirana (amuna ndi omwe atenga mosavuta).
- Dyslipidemia.
- M'badwo.
- Kusuta.
Postprandial shuga ndende
Koma, monga zotsatira za kafukufuku ochulukirapo zawonetsa, postprandial glycemia imathandizanso kwambiri pakukula kwa matenda a mtima ndi matenda a mtima. Kafukufuku wachipatala cha DECODE yemwe amawunika chiopsezo cha kufa kwa mitundu yosiyanasiyana ya hyperglycemia adawonetsa kuti kuzungulira kwa glucose yodziwika bwino ndi njira yodziyimira yokha yomwe imaneneratu kuposa hemoglobin ya glycated.
Kafukufukuyu adatsimikiza kuti popima chiopsezo cha zotsatira zoyipa za matenda a shuga a 2, munthu ayenera kuganizira osati zokhazokha za kusala kudya kwa glycemia HbA1c, komanso kuchuluka kwa glucose m'magazi 2 maola atatha kudya.
Zofunika! Kugwirizana pakati pa kusala kudya ndi postprandial glycemia kulipo. Thupi silitha kuthana bwino ndi kuchuluka kwa chakudya chambiri chomwe chimaperekedwa panthawi ya chakudya, zomwe zimapangitsa kuti pakhale kuchuluka kapena kutsekemera pang'ono pang'onopang'ono kwa shuga. Zotsatira zake, kuchuluka kwa glycemia kumawonjezeka kwambiri mutangodya, sikugwa masana ndipo ngakhale chizolowezi chomangosala shuga ndimagazi.
Pali lingaliro kuti, pakuwunika chiopsezo cha matenda amtima wamagazi, kuchuluka kwa kuchuluka kwa glucose m'magazi a shuga mellitus omwe amagwirizanitsidwa mwachindunji ndi kudya kwambiri kwa chakudya ndikofunikira kuposa kusala kudya kwa glucose.
Ngati wodwalayo ali ndi zizindikiro zamavuto am'mimba komanso a microcirculatory omwe ali ndi matenda amtundu wa 2, izi zikuwonetsa kuti postprandial hyperglycemia zinachitika kale zisanachitike matenda a matenda ashuga, ndipo chiwopsezo chokhala ndi zovuta zazinthawi yayitali.
M'zaka zochepa zapitazi, pali malingaliro olimba pazokhudzana ndi njira zomwe zimayambitsa matenda a shuga mellitus. Zomwe zimayambitsa matenda a shuga a 2 ndizoperewera insulin komanso insulin kukaniza, Kukula kwake komwe kumadalira kuphatikizika kwa zinthu zomwe zapezeka kapena zobadwa nazo.
Mwachitsanzo, zidapezeka kuti limagwirira la homeostasis limadalira momwe amagwiritsira ntchito mayankho mu chiwindi chovuta - chofukula minofu - maselo a pancreatic beta. Mu pathogenesis ya matenda a shuga, kusakhalapo kwa gawo loyambirira la insulin ndikofunikira kwambiri.
Si chinsinsi kuti glycemia imasinthasintha masana ndikufika pazokulirapo mukatha kudya. Njira yamatulutsidwe a insulini mwa anthu athanzi imakhazikika bwino, kuphatikizapo kuyankha ku mawonekedwe ndi kununkhira kwa chakudya, zomwe zimapangitsa kutulutsa shuga m'magazi.
Mwachitsanzo, mwa anthu omwe alibe vuto la kulolera m'magazi (shuga) kapena matenda ashuga, kubwezeretsanso kwa glucose kumayambitsa kubisala kwa insulin, komwe patatha mphindi 10 kumakhala kofunikira kwambiri. Zitatha izi gawo lachiwiri, nsonga zake zimapezeka mphindi 20.
Odwala omwe ali ndi matenda ashuga a 2 komanso a NTG, amalephera m'njira imeneyi. Kuyankha kwa insulini kulibe kwathunthu kapena pang'ono (gawo loyambirira la insulin katemera), i.e. sikokwanira kapena kuchedwa. Kutengera ndi kuopsa kwa matendawa, gawo lachiwiri limatha kusokonekera kapena kusungidwa. Nthawi zambiri, ndizofanana ndi kulolerana kwa glucose, ndipo nthawi yomweyo palibe kulekerera kwa glucose.
Tcherani khutu! Gawo loyambirira la insulin katulutsidwe limathandizira kukonzekera kwa zotumphukira panthawi yogwiritsa ntchito shuga ndikugonjetsedwa ndi insulin.
Kuphatikiza apo, chifukwa cha gawo loyambirira, kupanga shuga kwa chiwindi kumapanikizidwa, zomwe zimapangitsa kupewa glycemia ya postprandial.
Matenda a hyperglycemia
Matendawa akamakula, pomwe gawo lotsogolera limaseweredwa ndi hyperglycemia, maselo a beta amasiya kugwira ntchito ndipo maselo otulutsa zimawonongeka, chikhalidwe cha insulin secretion chimasokonekera, ndipo izi zimakulitsa glycemia.
Chifukwa cha kusintha kwatsiku, zovuta zimayamba msanga. Maonekedwe a matenda a shuga anggaopathy amatenga nawo mbali:
- Kupanikizika kwambiri.
- Glycation wopanda enzymatic wa mapuloteni.
- Autooxidation wa shuga.
Hyperglycemia imagwira ntchito yayikulu pakuwonekera kwa njira izi. Zimatsimikiziridwa kuti ngakhale asanazindikire hyperglycemia yachangu kwambiri, 75% ya maselo a beta amalephera kugwira ntchito. Mwamwayi, njirayi imasinthidwanso.
Asayansi apeza kuti ma cell a pancreatic beta ali munkhalidwe wamphamvu, ndiye kuti amasinthidwa pafupipafupi komanso ma cell a beta-cell amakwaniritsa zosowa za thupi zofuna za insulin ya mahomoni.
Koma ndi hyperglycemia yosatha, kuthekera kwa maselo a beta omwe angayankhe mokwanira ndi insulin kuyambitsa kukoka kwa glucose kumachepetsedwa kwambiri. Kusakhalapo kwa kuyankha izi pakukweza shuga ndikuwonekera chifukwa chophwanya gawo la 1 ndi 2 la insulin secretion. Nthawi yomweyo, matenda oopsa a hyperglycemia amawonjezera mphamvu ya amino acid pamaselo a beta.
Mankhwala oopsa a glucose
Kupanga kwa insulini kosachiritsika mu hyperglycemia ndi njira yosinthira, malinga ndi kagayidwe kazachilengedwe kamapangika. Kutha kwa hyperglycemia aakulu kusokoneza kupanga insulin kumatchedwa glucose toxicity.
Izi matenda, omwe amapangidwa motsutsana ndi maziko a matenda a hyperglycemia, ndi chimodzi mwazomwe zimayambitsa kukana insulini. Kuphatikiza apo, kuwopsa kwa glucose kumayambitsa kuwonongeka kwa maselo a beta, omwe amawonetsedwa ndi kuchepa kwa ntchito yawo yachinsinsi.
Nthawi yomweyo, ma amino acid, mwachitsanzo, glutamine, amakhudza kwambiri zochita za insulin, kusintha kukamwa kwa shuga. Zikatero, kuzindikirika komwe kumapezeka ndi chifukwa cha kupangika kwa zinthu za metabolic - hexosamines (hexosamine shunt).
Kutengera izi, zikuwonekeratu kuti hyperinsulinemia ndi hyperglycemia imatha kuchita zinthu monga chiopsezo cha matenda amtima. Postprandial ndi maziko a hyperglycemia amachititsa njira zingapo zomwe zimakhudzana ndi zovuta za matenda ashuga.
Matenda a hyperglycemia amatanthauza kupangika kwakanthawi kwa ma free radicals, omwe amatha kumangiriza ku mamolekyulu a lipid ndikuyambitsa kukula kwa atherosulinosis.
Kumangidwa kwa NO molekyulu (nitric oxide), yomwe ndi vasodilator wamphamvu wobisika ndi endothelium, imathandizira kusokonekera kwa endothelial kale komanso imathandizira kukulitsa kwa macroangiopathy.
Chiwerengero chamtundu waulere chimapangidwa nthawi zonse mthupi mu vivo. Nthawi yomweyo, mulingo womwe umasungidwa pakati pa ntchito ya antioxidant chitetezo ndi mulingo wa ma oxidants (ma free radicals).
Koma pansi pazinthu zina, mapangidwe azinthu zowoneka bwino amakula, zomwe zimayambitsa kupanikizika kwa oxidative, motsatana ndi kusalinganika pakati pa machitidwe awa ndi kuwonjezeka kwa chiwerengero cha ma oxidants omwe amatsogolera pakugonjetsedwa kwachilengedwe ma cell mamolekyulu.
Ma mamolekyulu owonongeka awa ndi chizindikiro cha oxidative kupsinjika. Kupanga kwakukulu kwa kusintha kwa zinthu kwaulere kumachitika chifukwa cha hyperglycemia, kuchuluka kwa glucose komanso kutenga nawo gawo pa mapuloteni a glycation.
Chiwerengero chachikulu cha ma radicals aulere ndi cytotoxic pomwe mapangidwe ake amakhala ochulukirapo. Amafunafuna kulanda ma elekitoni achiwiri kapena owonjezera kuchokera ku mamolekyulu ena, mwakutero amawapangitsa kusokonekera kwawo kapena kuwononga kapangidwe ka maselo, minofu, ziwalo.
Kukhazikitsidwa kuti pakukula kwa matenda a shuga ndi atherosclerosis, ndimomwe ndimagulu owopsa kwambiri komanso nkhawa za oxidative zomwe zimachitika, zomwe:
- imayendera akusowa kwa insulin;
- kumabweretsa hyperglycemia.
Hyperglycemia ikhoza kukhala chizindikiro chachikulu cha ntchito ya m'matumbo a m'matumbo.
Chithandizo cha postprandial hyperglycemia
Kuti tikwaniritse chindapusa cha kagayidwe kazakudya, zimakhala zomveka kugwiritsa ntchito njira zingapo:
- mu chakudya chamagulu;
- zolimbitsa thupi;
- pa mankhwala.
Tcherani khutu! Chofunikira pakuthandizira kwa anthu odwala matenda ashuga ndichakudya chochepa cha calorie komanso masewera olimbitsa thupi okwanira. Zakudya ziyenera kukhala ndi cholinga choletsa chakudya chamafuta kwambiri makamaka oyeretsa. Izi zimalepheretsa kukula kwa postprandial hyperglycemia komanso zimakhudzanso kudwala tsiku lonse.
Zakudya ndi zolimbitsa thupi zokhazokha, monga lamulo, sizingafanane ndi kupanga shuga yayikulu usiku chifukwa cha chiwindi, zomwe zimatsogolera kuthamanga kwambiri komanso postprandial glycemia.
Popeza hyperglycemia ndiye cholumikizira chachikulu cha matenda a insulin, funso la mankhwala a matenda a matenda a shuga a 2 limabuka nthawi zonse. Nthawi zambiri, zochokera ku sulfonylurea zimagwiritsidwa ntchito pamenepa.
Mankhwala omwe ali mgululi amalimbikitsa katemera wa insulin komanso amachepetsa glycemia. Koma zimakhudza kwambiri postprandial hyperglycemia.
Ubale wapakati pakati pa mtima wamankhwala wovuta ndi postprandial hyperglycemia umabweretsa madokotala ndi wodwala, kumbali ina, ntchito yowunika mosalekeza kwa hyperglycemia ya postprandial, ndipo, kwinaku, kugwiritsa ntchito kwa prandial regulators kukonza glycemia.
Kupewera kwa postprandial hyperglycemia popanda kuwonjezera katulutsidwe ka mankhwala amkati mwa insulin kumatha kupezeka pochepetsa adsorption ya chakudya m'matumbo aang'ono pogwiritsa ntchito acarbose.
Kudalira deta yofufuza yotsimikizira gawo lofunikira la amino acid (kupatula glucose) pakapangidwe ka insulin katulutsidwe ka maselo a beta mu chakudya, kafukufukuyu adayamba pazotsatira zomwe zimachepetsa shuga zomwe zimapanga benzoic acid, phenylalanine, yomwe idafika pakupanga kwa repaglinide ndi nateglinide.
Katemera wa insulini wolimbikitsidwa ndi iwo ali pafupi ndi chilengedwe chake chamasamba mwa anthu athanzi akamaliza kudya. Izi zimabweretsa kutsika koyenera kwa milingo yayikulu ya glucose panthawi ya postprandial. Mankhwalawa amakhala ndi yochepa, koma mwachangu, chifukwa chake mutha kupewa kuwonjezeka kwa shuga mutatha kudya.
Posachedwa, zikuwonetsa kuti jakisoni wa insulin kwa odwala omwe ali ndi matenda a shuga a 2 akwera kwambiri. Malinga ndi kuyerekezera kopitilira muyeso, pafupifupi 40% ya odwala omwe ali ndi matenda a shuga a 2 amafunikira chithandizo cha insulin. Komabe, mahomoniwa amalandila ochepera 10%.
Kuyambitsa insulin yothandizira matenda a shuga a 2, zomwe zikuwonetsa miyambo ndi:
- zovuta zazikulu za matenda ashuga;
- opareshoni;
- pachimake cerebrovascular ngozi;
- pachimake myocardial infarction;
- mimba
- matenda.
Masiku ano, madokotala amadziwa bwino kufunika kwa jakisoni wa insulin kuti achepetse vuto la shuga ndikuyambiranso ntchito ya beta-cell mu hyperglycemia yokhazikika.
Kuchepetsa kokwanira kwa shuga mu chiwindi mu mtundu 2 wa shuga kumafuna kuyambitsa njira ziwiri:
- Glycogenolysis.
- Gluconeogenesis.
Popeza mankhwala a insulini amachepetsa gluconeogenesis, glycogenolysis m'chiwindi komanso imapangitsa chidwi cha insulin, izi zimatha kukonza njira za matenda a shuga.
Zotsatira zabwino za insulin mankhwala a shuga zimaphatikizapo:
- kutsika kwa kudya kwa hyperglycemia ndipo mutatha kudya;
- utachepa kwa chiwindi shuga ndi gluconeogeneis;
- kuchuluka kwa insulin monga yankho la kukondoweza kwa shuga kapena kudya;
- kutsegula kwa kusintha kwa antiatherogenic mu mbiri ya lipoproteins ndi lipids;
- kukonza kwa anaerobic ndi aerobic glycolysis;
- kutsika kwa glycation wa lipoproteins ndi mapuloteni.
