Ci gaba da karuwa a yawan masu haƙuri da ke fama da nau'in ciwon suga guda 2 na marassa lafiya da kuma ƙarshen rikicewar jijiyoyin bugun gini, ya sanya wannan cuta a matsayin matsala ta duniya.
Ciwon sukari (mellitus) bashi da tsamanin ko dai ci gaban masana'antu da ƙasashe masu ci gaba ko kuma ƙasashe masu tasowa. WHO ta kiyasta cewa akwai kusan mutane miliyan 150 masu ciwon sukari a duk duniya. Kuma karuwa na shekara-shekara na cutar shine 5-10%.
A Rasha a yau kusan mutane miliyan 2.5 da ke da cutar sankarau suna rijista. Amma wannan adadi bashi da karshe, tunda yawan wadanda ba a gano ba sun kusan miliyan 8. A saukake, 5% na yawan mutanen Russia suna fama da ciwon sukari. Daga cikin waɗannan, 90% suna da ciwon sukari na 2.
Mafi yawan rikice-rikice na ciwon sukari sune cututtukan zuciya, wanda a cikin 70% na lokuta suna haifar da sakamako mai lalacewa. A saboda wannan dalili ne, Americanungiyar Americanungiyar Haurobiya ta Amurka ta tsara cutar a matsayin cututtukan zuciya.
Abubuwan haɗari
Hypglycemia na Postprandial shine wuce haddi na sukari na jini na 10 mmol / L ko mafi girma bayan yawan cin abinci na yau da kullun. Muhimmancin postprandial da hyperglycemia na baya a cikin pathogenesis na ƙarshen rikice rikice na bugun jini na jijiyoyin jiki yana da girman gaske. Rashin narkewar ƙwayar cuta a cikin nau'in 2 na ciwon sukari suna haifar da wasu haɗari masu haɗari don tasoshin jini da zuciya, gami da:
- Kiba
- Hawan jini.
- Babban matakan hanawa 1 yana kunna fibrinogen da plasminogen.
- Hyperinsulinemia.
- Dyslipidemia, wanda yafi haɓaka low HDL cholesterol (babban yawan lipoproteins) da hauhawar jini.
- Insulin juriya.
Rtarkewar cutar daga cututtukan zuciya da yawan bayyanar cututtuka marasa ƙarancin wannan cuta a cikin marasa lafiya da ke fama da ciwon sukari mellitus sau 3-4 sun fi na mutanen da ke yin aure ɗaya amma ba su da ciwon suga.
Saboda haka, abubuwanda ba a iya gano abubuwan haɗari da abubuwan da ke tattare da sifar nau'in 2 na ciwon sukari ba, wanda ya haɗa da juriya na insulin da hyperglycemia, yakamata suyi alhakin saurin ci gaba na jijiyoyin bugun jini a cikin wannan mara lafiyar.
Manuniya na yau da kullun na sarrafa sukari mai yawa (haemoglobin mai narkewa, glycemia na azumi) ba su bayyana cikakkiyar haɗarin rikice rikicewar cututtukan zuciya ba a cikin marasa lafiya da ke fama da ciwon sukari na 2. Abubuwan da ke tattare da hadarin sun hada da:
- Hawan jini.
- Tsarin gado.
- Jinsi (maza sun fi saurin kamuwa).
- Dyslipidemia.
- Shekaru.
- Shan taba.
Cutar Postprandial maida hankali ne
Amma, kamar yadda sakamakon bincike mai zurfi ya nuna, postprandial glycemia yana taka rawar gani daidai gwargwadon ci gaban cututtukan zuciya da atherosclerosis. Binciken asibiti na DECODE wanda ke kimanta haɗarin mace-mace a cikin bambance-bambancen hyperglycemia daban-daban sun nuna cewa yawan haɗuwa da glucose postprandial shine haɗarin haɗari mai cin gashin kansa wanda ke da tsinkaye fiye da haemoglobin glycated.
Wannan binciken ya tabbatar da cewa lokacin da ake nazarin hadarin sakamako na rashin lafiyar zuciya da ke haifar da cutar sankara mai nau'in 2, mutum ya kamata yayi la’akari ba kawai alamomin yin azumin glycemia HbA1c ba, har ma da matakin glucose a cikin jini awa 2 bayan cin abinci.
Mahimmanci! Haɗin da ke tsakanin azumi da postprandial glycemia lalle ya wanzu. Jiki ba koyaushe zai iya yin nasara da adadin carbohydrates da aka karɓa yayin abinci, wanda ke haifar da tarawa ko jinkirin ɓoye glucose. Sakamakon wannan, matakan glycemia yana ƙaruwa sosai nan da nan bayan cin abinci, baya faɗuwa yayin rana kuma har ila yau ana kiyaye daidaitaccen tsarin sukarin jini.
Akwai zaton cewa, don kimanta haɗarin cututtukan cututtukan zuciya, matakin glucose ya cika cikin jini a cikin ciwon sukari wanda ke da alaƙa kai tsaye da yawan abinci.
Idan mai haƙuri yana da alamun cututtukan jijiyoyin jiki da rikitarwa na microcirculatory tare da ciwon sukari na 2, wannan yana nuna cewa hyperglycemia na postprandial ya faru tun kafin a gano alamun asibiti na ciwon sukari, kuma haɗarin babban rikitarwa ya kasance na dogon lokaci.
A cikin 'yan shekarun da suka gabata, akwai babban ra'ayi game da abubuwan da ake zargin sunadarai na ciwon sukari mellitus. Abubuwan da ke haifar da ciwon sukari na 2 suna lalata insulin insulin da juriya na insulin, ci gaban wanda ya dogara da haɗuwa da abubuwan da aka samo ko asalinsu.
Misali, an gano cewa tsarin homeostasis yana dogara ne akan tsarin karban bayani a cikin hadaddun hanta - cirewar nama - kwayoyin beta na pancreatic. A cikin pathogenesis na ciwon sukari mellitus, rashi wani wuri na farkon insulin insulin yana da matukar mahimmanci.
Ba asirin cewa glycemia tayi sanyi yayin rana kuma ya kai matsakaicin matakan bayan cin abinci. Hanyar sakin insulin a cikin mutane masu lafiya yana da kyau a juye, ya haɗa da amsawa ga ƙanshin abinci da ƙanshin abinci, wanda ke ba da gudummawa ga ƙaddamar da glucose a cikin jini.
Misali, a cikin mutanen da basu da raunin glucose mai rauni (NTG) ko ciwon sukari, maimaita glucose yana haifar da toshewar insulin nan take, wanda bayan mintuna 10 ya kai ga darajar sa. Bayan wannan ya biyo bayan kashi na biyu, ganiyarsa wacce ke faruwa cikin minti 20.
A cikin marasa lafiya da ke dauke da ciwon sukari na 2 kuma tare da NTG, gazawar na faruwa a cikin wannan tsarin. Amsar insulin gabaɗaya ce ko kuma a wani ɓangare (farkon lokacin insulin insulin), i.e. bai isa ko ba da jinkiri ba. Ya danganta da tsananin cutar, ana iya lalata tsari na biyu ko an kiyaye shi. Mafi yawan lokuta, yana dacewa da haƙuri na glucose, kuma a lokaci guda babu haƙuri mai ƙarancin glucose.
Kula! Lokaci na farkon insulin insulin yana bayar da gudummawa ga shiri na kyallen mahaifa lokacin da ake amfani da glucose da kuma shawo kan juriya na insulin.
Bugu da ƙari, saboda farkon lokaci, ana lalata ayyukan glucose ta hanta, wanda ke sa ya yiwu a hana maganin cututtukan bayan cuta.
Ciwon mara na kullum
Yayinda cutar ta haɓaka, wanda shine babban rawar da ke takawa ta hanyar hyperglycemia, ƙwayoyin beta suna rasa aikin su kuma ƙwayoyin bugun jini sun lalace, yanayin bugun insulin yana ɓarna, kuma wannan yana ƙara yawan ƙwayar cuta.
Sakamakon wadannan canje-canjen cututtukan cuta, rikice-rikice da sauri suna haɓaka. A bayyanar masu ciwon sukari da ke fama da cutar ciwon suga:
- Oxidative danniya.
- Non-enzymatic glycation na sunadarai.
- Autooxidation na glucose.
Hyperglycemia yana ɗaukar babban aikin a cikin hanyoyin bayyanar waɗannan ayyukan. An tabbatar da cewa tun kafin a binciki cutar hawan jini, kashi 75% na sel suna rasa aikin su. An yi sa'a, ana sake juya wannan tsari.
Masana kimiyya sun gano cewa ƙwayoyin beta na pancreatic suna cikin yanayi mai ƙarfi, wato, ana sabunta su akai-akai kuma beta-cell mass yana dacewa da bukatun jikin mutum don maganin insulin.
Amma tare da ci gaba da rashin ƙarfi a jiki, ikon tsira da ƙwayoyin beta don bayar da amsa sosai tare da insulin zuwa haɓakar glucose mai ƙarfi an rage shi sosai. Rashin wannan amsa ga shigarwar glucose abu ne da ya saba da kashi na 1 da na 2 na insulin ɓoyewar. A lokaci guda, cututtukan hyperglycemia na haifar da tasirin amino acid akan ƙwayoyin beta.
Guba mai guba
Bala'i na samarda insulin a cikin cututtukan ciki wanda yake jujjuyawar tsari ne, idan har aka samarda metabolism metabolism. Ofarfin ƙwayar cuta na yau da kullun don rushe aikin insulin ana kiranta mai guba.
Wannan ilimin, wanda ya haɗu da asalin cututtukan ƙwayar cuta, shine ɗayan manyan abubuwan da ke haifar da juriya na insulin sakandare. Bugu da kari, yawan gubar glucose yana haifar da halayen sel na beta, wanda aka bayyana da raguwa a cikin ayyukan sirrin su.
A lokaci guda, wasu amino acid, alal misali, glutamine, ya shafi aikin insulin, yana daidaita shaƙar glucose. A cikin irin waɗannan yanayi, ciwon sikirtaccen ƙwaƙwalwar cuta shine sakamakon samuwar samfuran metabolism - hexosamines (hexosamine shunt).
Dangane da wannan, ya zama a bayyane cewa hyperinsulinemia da hyperglycemia na iya kasancewa a matsayin abubuwan haɗari masu zaman kansu don cututtukan zuciya. Postprandial da yanayin hyperglycemia yana haifar da wasu hanyoyin hanyoyin cututtukan da suka shafi ci gaban cututtukan ciwon sukari.
Rashin hankali na kullum yana haifar da daɗaɗɗen haɓakar juzu'ai, waɗanda ke da ikon ɗaure wa ƙwayoyin lipid kuma su tsokani farkon haɓakar atherosclerosis.
Theaƙatar kwayar halittar NO BA (nitric oxide), wacce take da ƙarfin vasodilator da ke haɗuwa da endothelium, tana haɓaka kyakkyawan ƙarewar endothelial kuma yana haɓaka haɓakar macroangiopathy.
Wani adadin tsattsauran ra'ayi na kullun yana gudana a cikin jiki a cikin vivo. A lokaci guda, ana kiyaye daidaituwa tsakanin ayyukan kariya na antioxidant da kuma matakin oxidants (masu tsattsauran ra'ayi).
Amma a karkashin wasu yanayi, haɓakar mahaɗa masu rikitarwa masu tasowa, wanda ke haifar da damuwa ga damuwa, tare da rashin daidaituwa tsakanin waɗannan tsarin tare da ƙaruwa da adadin abubuwan haɗari waɗanda ke haifar da shan kashi na ƙwayoyin halitta.
Wadannan kwayoyin da suka lalace sune alamomin damuwa na rashin karfin sinadarai. Babban samuwar tsattsauran ra'ayi na faruwa ne sakamakon hauhawar jini, haɓaka tasirin glucose da sa hannu cikin hanyoyin glycation na furotin.
Adadi mai yawa na tushen radical sune cytotoxic lokacin da samuwar su tayi wuce kima. Suna neman kama na biyu ko ƙarin electron daga wasu ƙwayoyin, ta haka suna haifar da rushewarsu ko lalata tsarin sel, kyallen, gabobin.
An tabbatar da cewa yayin aiwatar da haɓakar ciwon sukari mellitus da atherosclerosis, daidai yake da wuce haddi mai ƙarfi da damuwa na damuwa wanda ke gudana, wanda
- raunin insulin;
- take kaiwa zuwa hyperglycemia.
Hyperglycemia na iya zama alama ta farko ta ayyukan endothelial na tasoshin jijiyoyin jini.
Jiyya na cututtukan postprandial hyperglycemia
Don cimma biyan diyya ga ƙwayoyin carbohydrate, mai hankali ne a sanya tsarin matakan da suka ƙunshi:
- a cikin daidaitaccen abinci;
- a cikin aiki na jiki;
- a cikin magani mai guba.
Kula! Muhimmin mahimmanci ga ingantaccen lura da ciwon sukari shine rage yawan abincin kalori da isasshen aikin jiki. Ya kamata a yi amfani da abin da ake ci a ƙayyadadden halayen carbohydrates kuma musamman waɗanda aka mai da su. Wadannan matakan suna hana ci gaban cututtukan postprandial hyperglycemia kuma suna shafar al'adarta a duk tsawon rana.
Abinci da aiki na jiki shi kaɗai, a matsayin mai mulkin, ba zai iya yin haƙuri tare da samarwar glucose mai daddare a cikin hanta ba, wanda ke haifar da yawan azumin da yatsa da kuma giftawa bayan post.
Tunda hyperglycemia shine babban hanyar haɗin gwiwa da ke haifar da ɓoye insulin, tambayar maganin maganin cututtukan ƙwayar cuta ga nau'in ciwon sukari na 2 koyaushe yana tasowa. Mafi sau da yawa, ana amfani da kalami na sulfonylurea don wannan.
Magunguna a cikin wannan rukunin suna haɓaka ƙwayar insulin kuma rage yawan glycemia na azumi. Amma suna da ƙananan tasiri akan postprandial hyperglycemia.
Dangantaka ta kusanci tsakanin rikice-rikicen bugun zuciya da postprandial hyperglycemia yana haifar da likitoci da masu haƙuri, a gefe guda, aikin kulawa da kullun game da hyperglycemia na postprandial, kuma a ɗayan, yin amfani da masu gudanar da aikin prandial don gyara glycemia.
Yin rigakafin cutar hyperglycemia na postprandial ba tare da haɓaka ƙwayar insulin ba cikin jini zai iya samu ta iyakance adsorption na carbohydrates a cikin ƙananan hanji ta amfani da acarbose.
Dogaro kan bayanan bincike wanda ke tabbatar da muhimmiyar rawar amino acid (banda glucose) a cikin aikin insulin ɓoye ta hanyar ƙwayoyin beta a cikin tsarin abinci, binciken ya fara ne akan tasirin sukari na analogues na benzoic acid, phenylalanine, wanda ya ƙaru a cikin haɗin maganin repaglinide da nateglinide.
Ruwan insulin wanda yake motsa su shine ya kusancin yadda yake a farkon asirce a cikin mutane masu lafiya bayan sun ci abinci. Wannan yana haifar da ingantaccen raguwa a cikin ƙimar glucose mafi girma a cikin postprandial. Magungunan suna da ɗan gajeren, amma saurin tasiri, godiya ga wanda zaku iya hana karuwa mai yawa a cikin sukari bayan cin abinci.
Kwanan nan, alamomin allurar insulin ga marasa lafiya da ke dauke da ciwon sukari na 2 ya karu sosai. Bisa ga ƙididdigar yawancin ra'ayin mazan jiya, kusan 40% na marasa lafiya da ke da nau'in ciwon sukari na 2 suna buƙatar maganin insulin. Koyaya, ƙwayar zahiri tana karɓar ƙasa da 10%.
Don fara maganin insulin don ciwon sukari na 2, alamomin gargajiya sune:
- mummunan rikice-rikice na ciwon sukari;
- ayyukan tiyata;
- mummunan haɗarin cerebrovascular;
- m rashin ƙarfi infarction;
- ciki
- cututtuka.
A yau, likitoci suna da cikakkiyar masaniya game da buƙatar allurar insulin don rage yawan guba da sake dawo da aikin beta-cell a cikin matsanancin matsakaici na matsakaici.
Rage tasiri a cikin samarwar glucose na hanta a cikin nau'in 2 na ciwon sukari yana buƙatar kunnawar matakai guda biyu:
- Glycogenolysis.
- Gluconeogenesis.
Tun da ilimin insulin yana rage gluconeogenesis, glycogenolysis a cikin hanta kuma yana inganta yanayin motsa jiki ga insulin, wannan na iya gyara hanyoyin pathogenetic na ciwon sukari mellitus.
Kyakkyawan tasirin maganin insulin don maganin ciwon sukari sun haɗa da:
- raguwa cikin yawan tashin zuciya da bayan cin abinci;
- rage haɓakar glucose na hanta da gluconeogenesis;
- increasedarin samar da insulin a matsayin martani ga haɓakar glucose ko ci abinci;
- kunna canje-canje na rigakafi a cikin bayanin martaba na lipoproteins da lipids;
- haɓaka anaerobic da aerobic glycolysis;
- rage glycation na lipoproteins da sunadarai.
