I ka waha o ke kanaka, ua hoʻomaka ʻia ka kāpili ʻana o ka glycogen a me ke kō ma lalo o ka mana o ka amylase salivary. Ma lalo o ka hopena o ka amylase i ka ʻōpū liʻiliʻi, hele mai ka hoʻoneʻe hope loa o nā polysaccharides i ka maltose.
ʻO nā mea i loko o ka waiʻawa o ka waiʻona nui o nā hydrolases - nā enzyme e wāwahi i ka sucrose, maltose a me lactose (disaccharides) i ka fructose, galactose a me ka glucose (monosaccharides).
Hoʻolula koke ʻia ka Galactose a me ka glucose e ka microvilli o ka pūpū liʻiliʻi, komo lākou i ke kahe a hiki i ka ate.
ʻIke ʻia ka ʻōhumu a me ke kūpaʻa i ka plasma, me ke kaʻi ʻana i ka koko serum, ua hoʻokaʻawale ʻia ʻia ma waena o nā kumumana i hana ʻia a me ka plasma.
ʻO Glucose ke kumu nui o ka minamina o ka paʻakai kino, a me nā huahana kalapika:
- polysaccharides: starch and cellulose,
- fructose a me ka glucose,
- sucrose a lactose,
- kekahi mau papaʻaina.
Hōʻano o ka pae glucose:
- no nā pēpē makua, ʻo ka lula ke 1.1-3.33 mmol / l,
- no na keiki hou 1 lā 2.22-3.33 mmol / l,
- no na keiki malama 2.7-4.44 mmol / l,
- no na keiki maluna o elima mau makahiki, 3.33-5.55 mmol / l,
- i ka wā ʻelemakule a hiki i 60 4.44-6.38 mmol / l,
- nā kānaka mai 60 mau makahiki - ke kumu kūloʻo 4.61-6.1 mmol / l.
Hāʻawi ʻia ka hypoglycemia i nā pākeke inā ʻaʻole i loaʻa ka ʻike glucose i 3.3 mmol / L. Hōʻailona ka nui o ke kō (a i kekahi mau hihia ke ʻano o ka hyperglycemia) inā hōʻike ka loiloi e ʻoi loa ka ʻike o ka glucose ma mua o 6.1 mmol / l.
He mea nui ia e ʻike e hoʻomaka ana ka lilo ʻana o nā mea laʻe i ka hana i ka wā hoʻoliʻina o ke kō. Hiki i kēia ke kaʻaʻī o ka meli i loko o ka huina o ke kūwele, hoʻopio ʻia i loko o ka pākī liʻiliʻi a i ʻole ma ke ʻano o ka hoʻoneʻe o ka nui o nā kāʻei o ka ʻai ma loko o nā ʻōpū o ke kanaka.
ʻO ka Hyperglycemia a i ʻole ka hoʻonui ʻana i ka kaʻe o ka glucose e hiki i nā kumu:
- hyperglycemia physiological: ka waʻa wikiwiki, ke kaumaha, lawa ʻole o ka hana kino, nā manaʻo ʻino, ke holo nui ʻana o ka adrenaline i ka wā o ka hōʻea
- maʻi hānai i nā kānaka o nā makahiki āpau,
- hemorrhage cerebral,
- gigantism, acromegaly, thyrotoxicosis, pheochromocytoma a me nā ala āpau endocrine,
- ʻO nā maʻi pancreatic, no ka laʻana, ʻoi aku ka lolo a i ʻole a pancreitis, cystic fibrosis, hemochromatosis a me nā ihu o ka pancreas,
- nā maʻi o ka ʻōnaehana kūwī, ʻoiaʻiʻo hoʻi ka nui o nā a me nā ʻāpana,
- ka heleʻana o nā antibodies i nā receptor insulin,
- ka hoʻohanaʻana o ka caffeine, thiazides, glucocorticoids a me estrogens.
Hiki i ke hypoglycemia a i ʻole hoʻēmi i ka glucose i:
- ʻO ka maʻi pancreatic: adenoma, carcinoma, hyperplasia, insulinoma, kakahonu glucoseagon,
- hypothyroidism, adrenogenital syndrome, maʻi ʻo Addison, hypopituitarism,
- ma kahi keiki hānau mua i hānau ʻia e ka wahine me ka maʻi maʻi
- he overdose o nā insulin a me nā hypoglycemic agents,
- nā maʻi maʻi ʻeha: carcinoma, cirrhosis, hemochromatosis, hepatitis,
- nā hōʻoki maʻi non-pancreatic: fibrosarcoma, ʻōpū o ka ʻōpū a i ʻole ka'āpala adrenal,
- galactosemia, maʻi gyrke,
- nā ʻano maʻi autonomic, gastroenterostomy, post-gastroectomy, gastrointestinal motility disorder,
- hookeai loihi, malabsorption syndrome a me na pilikia e ai,
- makeʻe me nā salicylates, arsenic, chloroform, antihistamines a i nā waiʻona wai hoʻi,
- hookeua o ke a me ke anu,
- ka hoʻohana ʻana o ka amphetamine, steroid a me propranolol.
I ka lāʻau lapaʻau, hoʻokahi mau hiʻohiʻona kūlana waena, ʻaʻole ia he mellitus maʻi maoli, akā ʻaʻole ia ka paʻamau. Pili kēia i ka hoʻohaʻahaʻa glucose ʻaʻa.
Ma kēia hihia, e helu mau ana ka pae ʻai wikiwiki ma lalo o 6.1 mmol / L, a ma hope o ʻelua mau hola ma hope o ka hoʻokele ʻana o ka glucose ka 7.8 - 11.1 mmol / L. ʻO ka wehewehe ke hōʻike nei i kahi kiʻekiʻe o ka maʻi maʻi i ka wā e hiki mai ana. Aia ke ʻano o nā maʻi i nā kumu ʻē aʻe. Aia i kona inoa ponoʻī - prediabetes.
Aia kahi manaʻo o ka wikiwiki o ka glycemia. ʻO ka kaohi ʻana o ke kō kōloli no ka ʻōpū ʻole o ke kahe a me ka serum ma ʻaneʻi 5.5 - 6.1 mmol / L, a ʻelua mau hola ma hope o ka hoʻokomo ʻana i nā glucose, he maʻi ka hōʻailona, ʻo ia hoʻi, ma ka 7.8 mmol / L. Ua noʻonoʻo ʻia kekahi o nā mea pili i ka hopena o ka hoʻomohala hou ʻana o ka maʻi mellitus, ʻo ka hoʻoholo o ka hiki koke ʻole mai.
ʻO ka pākēnē e pili ana i ka loaʻa ʻole o nā meaʻai no 8 mau hola a keu paha.
ʻO nā nuances e hoʻoholo ai i ka glucose o ke koko
Hiki ke hoʻokau ʻia ka loaʻa ʻana o ka ikehu glucose.
- ke ʻano o ka kūloko o ka adrenal, ka kelipuna pituitary a me nā kūloko thyroid.
- nā pāpā a me nā maʻi i loko o ka ate,
- maʻi, ʻeha ʻole o kona ʻano,
- ka ʻike ʻana i ka hoʻomanawanui i ka glucose i loko o ka poʻe i hoʻomākaukau i ka maʻi maʻi,
- momona momona
- maʻi ma ka wahine hāpai
- nā hoʻololi i ke kūpaʻa glucose.
Pono ʻoe e ʻike he pono ka wehewehe ʻana e hāʻawi i ka ʻai no 8 mau hola ma mua o ka nānā ʻana. ʻOi aku ka maikaʻi ʻana e lawe ai i ke koko i ke kakahiaka. ʻO kahi overvoltage, he kūlohelohe a me ka noʻonoʻo, ua hoʻokaʻawale ʻia hoʻi.
Serum, a i ole ia, i kahi huaʻōlelo he mea hoʻokaʻawale ʻia mai nā hale i loko o ʻelua mau hola ma hope o ke lawe ʻia he kiʻi koko. Eia kekahi, hiki iā ʻoe ke hoʻohana i kahi tuba kūikawā i loaʻa nā glycolysis inhibitors. Inā ʻaʻole hoʻokō kēia mau kūlana, a laila pono paha nā kolohe underestimates.
Hoʻopilikia ʻia kahi hōʻike glucose koko aʻe i kēia mau ʻano:
- noiʻi reductometric, ua kau ia i ka hiki ke glucose e hoʻihoʻi i ka nitrobenzene a me nā paʻakai keleawe,
- noiʻi enzymatic, no ka laʻana, kaʻina glucose oxidase;
- ke ʻano o ke ʻano kala, kahi hana kūikawā i hōʻike ʻia i ka hoʻomakeke ʻana o nā calcium.
ʻO ke kaila o ka oxidase ka hana i ka loiloi o ka nui o ke kō i loko o ka urine a me ke koko ma kahi ʻōpū ʻole. Kahi ʻia ke kaʻina hana i ka hoʻoliʻi glucose glucose i ka hoʻoliʻi glucose glucose me ka hoʻolālā o ka hydrogen peroxide, kahi e hoʻonui ai i ka orthotolidine i ka wā peroxidase.
Kuhi ʻia ke kaila o ka hoʻokeo koko ma ke ala photometric, aʻo ke ʻano o ka kala i hoʻohālikelike ʻia me kahi kiʻi calibration.
Hiki i ka hoʻomaʻamaʻa lāʻau lapaʻau ke hoʻoholo i ka glucose:
- ma ke koko venous, kahi o ke kumu mai ke kaomi, he koko mai ka vein. Hoʻohana ʻia nā mea kākau loiloi,
- i ke koko kapili, ua lawe ʻia mai ka manamana lima. ʻO ke ala maʻamau, no ka hōʻike ʻana āu e pono ai i ke koko liʻiliʻi (ʻoi aku ka maʻamau o ka 0.1 ml) ʻaʻole pono. Hana ʻia ka nānā ʻana i ka home me kahi haʻomaʻo kūikawā - he glucometer.
Ka hūnā ʻia (subclinical) pūpū o ka ʻaiā o ka mea hoʻonāola
No ka hoʻomaopopo ʻana i ka peʻe, ʻo ia hoʻi, nā hana subclinical o ka huina o ka ʻaina metabolism, kahi hoʻāʻo ʻia ka hoʻonaninani glucose glucose a i ʻole ka hoʻāʻo ʻia ka hoʻonaninani glucose intravenous.
E nānā: inā he nui loa ka glucose o ka glucose o ke koko i lawe ʻia ma ka ʻōpū ʻole i kahi kiʻekiʻe ma mua o 15 mmol / l, a laila no ka maʻi o ka maʻi mellitus, ʻaʻole koi ʻia ka hoʻonaninani glucose.
He aha ka laʻana o ka hoʻoliʻi intravenous glucose?
Ka hoʻāʻo ʻana i ka hoʻonaninani glucose ma intravenous ma luna o ka ʻōpū ʻole, hiki i ka hoʻokaʻawale ʻana i nā mea āpau e pili pū ana me ka nele o ka ʻimi ʻana, a me ke komo ʻana o nā kōmeʻe ma ka pānaʻi liʻiliʻi.
No nā lā ʻekolu ma mua o ka hoʻomaka ʻana o ke aʻo ʻana, e kuhikuhi ʻia ka mea maʻi i kahi mea ʻai e pili ana i ka 150 g i kēlā me kēia lā. Hana ʻia ke ʻano ma ka ʻōpū ʻole. Hoʻolimalima ʻia ka Glucose i ka helu o ka 0.5 g / kg koʻikoʻi kino, ma ke ʻano he 25% mau hopena i hoʻokahi a i ʻelua mau minuke.
I loko o kahi plasma koko momona, ua hoʻoholo ʻia ka hoʻoliʻi o ka glucose i 8 mau manawa: 1 ka manawa ma kahi ʻōpū ʻole, a me nā manawa hoʻomaha 3, 5, 10, 20, 30, 45 a me 60 mau minuke ma hope o ka lawelawe ʻia ʻana o ka glucose. Hiki ke hoʻoholo i ka insulin insulin plasma i like like.
Hōʻike ka koikoi o ka hoʻomoʻo o ke koko i ka emi o ka nalowale o ka glucose mai ke koko ma hope o kāna kūpeʻe intravenous. I ka manawa like, ʻo ka manawa e pono ai e hōʻemi i ka pae glucose ma o 2 mau manawa i hoʻoholo ʻia.
Hoʻomoe ka hana hoʻokele kūikawā i kēia kuleana: K = 70 / T1 / 2, kahi ʻo T1 / 2 ka helu o nā minuke e pono ai e hoʻemi i ka glucose koko ma nā manawa 2, 10 mau minuke ma hope o kona kolohe ʻana.
Inā palena nā mea āpau i loko o nā palena maʻamau, a laila he mau minuke ma hope o ka hoʻokomo ʻia o ka glucose, hiki i kona lolo wikiwiki ke ana i ke kiʻekiʻe - a hiki i ka 13.88 mmol / L. ʻIke ʻia nā kiʻekiʻe o ka insulin i nā minuke ʻelima.
Hoʻi hou ʻia ka pae glucose i kāna waiwai kumu ma hope o ka mau minuke 90 mai ka hoʻomaka o ka loiloi. Ma hope oʻelua mau hola, ua hāʻule ka ʻōlelo o ka glucose ma lalo o ka pae, a ma hope o 3 mau hola, e hoʻi ka pae i ka waihona.
Loaʻa nā mea ʻokoʻa o ka glucose assimilation e loaʻa nei:
- i nā poʻe me ka maʻi maʻi ma lalo o 1.3. Kuhi ʻia ka ʻike i ka wī e piʻi ana i ka minuke ʻelima mau minuke ma hope o ka hoʻomaka ʻana o ka hoʻoili ʻana.
- i nā pākeke olakino ʻaʻole i loaʻa i ka maʻi o ka metabola nā haʻalika, ʻoi aku ka nui o ka ratio ma mua o 1,3.
He pono ka hoʻohui hypoglycemic a me ka hyperglycemic
ʻO ka hypoglycemia kahi kaʻina hana pili i ka loulou i ka kahe koko haʻahaʻa.
ʻO ka Hyperglycemia kahi maʻi maʻi lapaʻau, e hōʻike ana i kahi momona glucose i loko o ka nui o ka serum.
Hōʻike ke kiʻekiʻe kiʻekiʻe me ka maʻi mellitus a i ʻole nā pilikia ʻē aʻe o ka hopena endocrine.
Hiki ke loaʻa ka ʻike ma ka kūlana o ka hoʻoliʻiliʻi o ka hana kākela ma hope o ka helu ʻana i ʻelua mau kuhikuhi o ka noiʻi hoʻomanawanui glucose.
- ʻO ka hoʻohālikelike hyperglycemic ka māhele o ka pae glucose i ka hola, i kona pae ma kahi ʻōpū ʻole,
- He ʻoihana hypoglycemic ka mahele o ke aniani o ka glucose 2 mau hola ma hope o ka neʻe ʻana i kona pae ma kahi ʻōpū ʻole.
I nā poʻe olakino, ʻoi aku ka limahana hypoglycemic maʻamau ma mua o 1,3, a ʻaʻole i hele aku ka hyperglycemic pae ma mua o 1.7.
Inā hoʻonuiʻia nā kumukūʻai maʻamau o ka liʻiliʻi o kekahi o nā hōʻailona, a laila e hōʻike ana i ka hoʻemi ʻana o ka hoʻohaʻahaʻa glucose.
ʻO ka hemoglobin Glycosylated a me kona pae
ʻO kēlā hemoglobin i kapa ʻia ʻo HbA1c. He hemoglobin kēia, i komo i loko o kahi kinakona non-enzymatic chemical with monosaccharides, and and specially with glucose, that in the circulate blood.
Ma muli o kēia hopena, hoʻopili ʻia kahi koena monosaccharide i ka mololi protein. ʻO ka nui o ka hemoglobin glycosylated e kū pololei ana i ka neʻe o ke kō i loko o ke koko, a me ka lōʻihi o ka launa pū ʻana o ka hopena me ka hopena o ka glucose a me ka hemoglobin.
ʻO ia ke kumu e pili ai i ka kikoʻī o ka hemoglobin glycated i ka pae kiʻekiʻe o ka glucose i ke koko i ka manawa lōʻihi, kahi i hoʻohālikelike ai i ka ola o ka molekala hemoglobin. He ʻekolu a ʻehā paha mau mahina.
ʻO nā kumu no ka hāʻawi ʻana i ka haʻawina:
- ka nānā ʻana a me ke nānā ʻana i ka maʻi diabetes,
- ka nānā lōʻihi ʻana i ka maʻi a me ka nānā ʻana i ka mālama ʻana i ka poʻe me ka maʻi maʻi,
- helu hoʻoliʻi maʻi diabetes,
- Ka hana hou aku i ka hoʻāʻo ʻana o ka glucose e like me ka mahele o ke ʻano o ka maʻi ʻaʻai lohi a i ʻole kahi kūlana ma mua o ka maʻi,
- latine diabetes ma ke wā hāpai.
ʻO ke kaulike a me ka pae o ka hemoglobin glycated i ka hopena me ka thiobarbituric acid mai ka 4.5 a i ka 6, 1 ka pākeke koina, e like me ka hōʻike ʻana o ka hōʻike.
ʻO ka hoʻākāka o nā hopena he paʻakikī i ka ʻokoʻa o ka ʻenehana kikowaena a me nā ʻokoʻa kūʻokoʻa o ka poʻe i aʻo ʻia. He paʻakikī ka hoʻoholo ʻana, no ka mea aia ka hoʻolaha ʻana o nā waiwai hemoglobin. No laila, ma ʻelua mau kānaka me ke ʻano heʻe koko koko kiʻekiʻe, hiki iā ia ke hiki i 1%.
Ke hoʻonui ʻia nei o nā waiwai:
- maʻi mellitus a me nā kūlana ʻē aʻe i hōʻike ʻia e ka maʻi tolerance glucose.
- ke hoʻoholo nei i ka pae o ka uku: mai 5.5 a 8% - i hoʻoliʻi ʻia i ka maʻi maʻi, mai 8 a 10% - he maʻi i uku ʻia loa, mai 10 a 12% - nā ʻāpana i uku ʻia. Inā ʻoi aku ka nui o ka pakeneka ma mua o 12, a laila ʻo kēia ka maʻi uncompensated.
- pauʻa hao
- māhule
- nā hoʻonui hoʻopiʻi ma muli o ka hoʻokūkū kiʻekiʻe o ka hemoglobin fetal.
Ka emi nā kumu inā:
- kahe koko
- hememia anemia,
- kahe koko
- hypoglycemia.
