ʻO ka hoʻonui pinepine ʻana i ka nui o nā poʻe maʻi e loaʻa ana i ka maʻi diabetes mellitus type 2 a me nā hoʻopiʻi mua o kāna vascular pae, e kau nei i kēia maʻi ma ke ʻano honua.
ʻAʻole mālama ʻo Diabetes mellitus i nā ʻāina i kūkulu ʻia a ʻo nā ʻoihana mua a me nā moku i hana ʻole ʻia. Kuhiʻo ʻo WHO he ana ma kahi o 150 miliona mau kānaka me ka maʻi maʻi ma ka honua. A me ka hoʻonui makahiki o ka maʻi i 5-10%.
Ma Rūsia i kēia mau lā e pili ana 2,5 miliona mau maʻi me ka maʻi maʻi maʻi maʻi. Akā ʻaʻole hope loa kēia helu, ʻo ka mea e like me ka 8 miliona ka nui o nā hihia i wehe ʻole ʻia. Hoʻolaha maʻalahi, 5% ka nui o ka lahui a Russia i ʻeha i ka maʻi maʻi. ʻO kēia o ka 90% ua loaʻa ka maʻi diabetes 2 ʻano.
ʻO nā ʻōmaʻi maʻamau o ka maʻi maʻi i nā maʻi cardiovascular, ma ka 70% o nā hihia e alakaʻi i nā hopena catastrophic hikiʻole. No kēia kumu, ua kau i ka American Association of Cardiology ka maʻi like me ka maʻi cardiovascular.
ʻO nā kumu maʻi
ʻO ka postprandial hyperglycemia ka nui o ke kōpaʻa o ke koko o 10 mmol / L a kiʻekiʻe aʻe ma hope o ka pāʻina maʻamau. ʻO ka mea nui o ka postprandial a me ka hope hyperglycemia i ke pathogenesis o nā hoʻopiʻi hope loa o ka maʻi vascular e kiʻekiʻe nui ana. ʻO nā maʻi ma ka metabola o nā maʻi diabetes type 2 ka nui o nā mea e pili ana i nā kīʻaha koko a me ka naʻau, me ka:
- Nā ʻilima
- He maʻi haole.
- ʻO nā papa kiʻekiʻe o ka inhibitor 1 hoʻoili i ka fibrinogen a me ka plasminogen.
- Hāpopu Hyperinsulinemia.
- ʻO ka Dyslipidemia, ka mea i hōʻike nui ʻia e ka HDL haʻahaʻa haʻahaʻa (lipoproteins density kiʻekiʻe) a me hypertriglyceridemia.
- Ke kūlohelohe ʻia.
ʻO ka makeʻana mai nā maʻi puʻukui coronary a me ka helu o nā mea i hōʻike ʻia ʻole e loaʻa i kēia maʻi i nā maʻi me ka maʻi mellitus he 3-4 mau manawa kiʻekiʻe ma mua o ka poʻe o ka makahiki hoʻokahi akā ʻaʻole ka maʻi maʻi maʻi.
No laila, ʻo nā mea kūlohelohe kūpono ʻole a me nā mea i hōʻike i ke ʻano o ka maʻi type 2, me ka pale ʻana o ka insulin a me ka hyperglycemia, pono e kuleana no ka hoʻomohala koke ʻana i ka atherosclerosis vascular i kēia mau maʻi.
ʻO nā hōʻailona maʻamau o ka mālama koko kiʻekiʻe (glycated hemoglobin, wikiwiki ʻo ka glycemia) ʻaʻole i wehewehe pono i ka nui o ka hōʻemi o nā hoʻopiʻi cardiovascular i nā maʻi me nā maʻi diabetes type 2. Hoʻokomo ʻia nā mea i hōʻike ʻia:
- He maʻi haole.
- Henereri predisposition.
- ʻO ke kāne (ʻoi aku ka maʻalahi o nā kāne).
- ʻO ka dyslipidemia.
- Makau.
- Laula.
Hoʻopili i kaʻikepili glucose postprandial
Akā, e like me nā hōʻike o nā noi nui, hōʻike ʻia ka glycemia postprandial i ka nui o ka nui o ka hoʻomohala ʻana i ka maʻi naʻau coronary a me ka atherosclerosis. Ua hōʻike ʻia kahi hōʻike kulana DECODE e pili ana i ka hopena o ka make ma nā ʻano ʻano ʻē aʻe hyperglycemia e hōʻike ana i ka neʻe ʻana o ka glucose koʻikoʻi postprandial he ʻano kūʻokoʻa kūʻokoʻa e ʻoi aku ka hānō ma mua o ka hemoglobin glycated.
Ua hōʻoia ʻia kēia noiʻi ʻana i ka nānā ʻana i ka hopena o ka hopena o ka hopena cardiovascular o ka maʻi maʻamau ʻo ka maʻi 2, pono e noʻonoʻo kekahi i nā hōʻailona wale nō e pili ana i ka wikiwiki ʻo glycemia HbA1c, akā hoʻi ka pae o ka glucose i loko o ke koko 2 mau hola ma hope o ka ʻaina.
Nui! Loaʻa kahi pilina ma waena o ka hoʻokē ʻai a me ka glycemia postprandial. ʻAʻole hiki i ke kino ke kū me ka mau ka hānai i ka nui o nā waihona i loaʻa i ka wā o ka papa, e alakaʻi ana i ka hōʻiliʻili ʻana a i ʻole ka hoʻolima iki o ka glucose. Ma muli o kēia, hoʻonui nui ʻia ka pae o ka glycemia ma hope o ka ʻai ʻana, ʻaʻole ia e hina i ka lā a ʻo ke ʻano o ka ʻaʻa ʻana o ka ʻaila koko ka mālama.
Aia kekahi manaʻo he, no ka loiloi ʻana i ka hopena o nā maʻi o ka ʻōnaehana cardiovascular, ka nui o ka glucose i kūwau i ke koko i ka diabetes mellitus e pili pono ana me ka ʻaina ʻai e ʻoi aku ka nui ma mua o ka huakaʻi ʻai.
Inā loaʻa i ka mea maʻi ka hōʻailona o nā hoʻopiʻi vascular a me ka microcirculatory me ka maʻi diabetes type 2, hōʻike kēia i ka hala ʻana o ka hyperglycemia postprandial ma mua o ka ʻike ʻana i nā hōʻailona lapaʻau o ka maʻi maʻi, a ua loaʻa ka hopena o nā hoʻopiʻi kiʻekiʻe no kahi manawa lōʻihi.
I kekahi mau makahiki i hala iho nei, aia kahi manaʻo ikaika e pili ana i nā hana hoʻohālikelike i ka mellitus maʻi diabetes. ʻO ke kumu o ka diabetes type 2 he mea huna i ka huna a me ka pale ʻana i ka insulin, ka hoʻolālā ʻana e pili ana i ka hui pū ʻana o nā mea i loaʻa a i ʻole ka congenital.
No ka laʻana, ua loaʻa ka mana o ka homeostasis e hilinaʻi i ka ʻōnaehana hoihoi ma ka palupalu paʻakikī - neʻe ʻia o nā ʻāpana - pancreatic beta cells. I loko o nā pathogenesis o ka mellitus o ka maʻi mellitus, ʻo ka loaʻa ʻole o kahi wīwī o ka neʻe ʻana o ka inikini insulin i mea nui loa.
ʻAʻole ia he mea huna o ka glycemia e lele i ka lā a hiki i ka pae kiʻekiʻe ma hope o ka ʻai ʻana. Mālama ʻia ka ʻōnaehana o ka insulin i ka poʻe olakino, me ka pane ʻana i ka ʻano a me ka ʻono o ka meaʻai, ka mea i hāʻawi ʻia i ka hoʻokuʻu ʻana i ka glucose i loko o ke koko.
ʻO ka laʻana, i ka poʻe i loaʻa ʻole ka maʻi me ka hoʻomanawanui i ka glucose (NTG) a i ʻole ka maʻi diabetes, hoʻokaʻawale i nā glucose i ka neʻe manawa o ka insulin, a ma hope o 10 mau minuke i kona waiwai nui loa. Ma hope o ka hahai ʻana i ka lua o ka lua, ʻo ke kau o ka mea e piʻi ai i 20 mau minuke.
I nā maʻi me ka diabetes type 2 a me NTG, loaʻa kahi hemahema ma kēia ʻōnaehana. ʻO ka paneʻana o ka insulin ua kū a haʻalele paha paha (i ka hoʻomakaʻana o ka hana huna i ka insulin), i.e. ʻaʻole lawa a i ʻole lohi. Aia i ka paʻakikī o ka maʻi, hiki i ka lua a i ʻole ke mālama ʻia. ʻO ka hapa pinepine, ua hoʻohālikelike ʻia ka hoʻohaʻahaʻa glucose, a ma ka manawa like ʻaʻoheʻaina o ka hoʻomehana ʻole o nā glucose.
E makaʻala! Hāʻawi ka hana mua o ka hana huna i ka insulin i ka hoʻomākaukau ʻana o nā ʻiʻo peripheral e ka manawa hoʻohana a hoʻohana ʻia a lanakila i ka pale ʻana i ka insulin.
Eia kekahi, ma muli o ka hoʻomaka mua ʻana, ke kīpī ʻia nei ka hana o ka glucose i ka puʻuwai, e hiki ai i ka mea e pale aku ai i ka glycemia postprandial.
Hulu ka hyperglycemia
Ke ulu nei ka maʻi, kahi e hoʻoikaika ʻia ai ka mana alakaʻi e ka hyperglycemia, pau nā beta beta i ko lākou hana a luku ʻia nā pūlima pulse, ke kālai ʻia nei ke ʻano o ka huna ʻana o ka insulin, a hoʻomāhuahua kēia i ka glycemia.
I ka hopena o kēia mau hoʻololi pathological, e hoʻomohala koke nā ʻōpiopio. I ka hōʻikeʻana o ka angiopathy maʻi maʻi e loaʻa i kahi:
- ʻO ke kaumaha koʻikoʻi.
- Non-enzymatic glycation o nā protein.
- Hoʻomoe o ka glucose.
Lawe ka Hyperglycemia i ka hana nui i nā mīkini o ke ʻano o kēia mau hana. Hōʻoiaʻiʻo ʻo ia ma mua o ka hoʻokau ʻana i ke kiʻekiʻe wikiwiki ʻo hyperglycemia, 75% o nā cell beta ua nalowale i ka hana. ʻO ke kūleʻa, ua hoʻohuli ʻia kēia kaʻina hana.
Ua ʻike nā ʻepekema ʻepekema i nā cell beta pancreatic i kahi kūlana ikaika, ʻo ia hoʻi, ua hoʻonui pinepine ʻia a ua hoʻonui ʻia ka beta-cell mass i nā mea e pono ai ke kino o ka insulin hormone.
Akā me ka hoʻomau ʻana o ka maʻi hyperglycemia hoʻomau, hiki i ka hiki ke ola i nā nūpepa beta ke pane pololei i ka insulin i ka hoʻonāukiuki glucose hoʻonāwī. ʻO ka hala ʻole o kēia pane i ka ukana ukana ka mea nui me ka hala ʻole o ka hana mua a me ka lua o ka neʻe ʻana o ka insulin. I ka manawa like, ʻo ka maʻi hyperglycemia maʻi ʻoi ka hopena o nā waikawa amino i nā cell beta.
Kaona huehū
Hoʻokomo ʻia ka hana o ka insulin i ka hyperglycemia kūloko, kahi hana hoʻihoʻi, hoʻolako ʻia ka maʻamau o ka metabolism i kālai ʻia. ʻO ka hiki ke hoʻonāukiuki i ka maʻi hyperglycemia e hoʻonāukiuki i ka hana o ka insulin i kapa ʻia he toxac glucose.
ʻO kēia kulai, nāna i hoʻokumu i ke kua o ka hyperglycemia maʻi kumu, ʻo ia kekahi o nā kumu nui o ka pale kino o ka insulin. Eia kekahi, nā mea hoʻonā glucose e hoʻomoʻi i ka lawe ʻia ʻana o nā hua beta, kahi i hōʻike ʻia e ka hāʻule ʻana o kā lākou hana huna.
I ka manawa like, kekahi mau acid amino, no ka laʻana, glutamine, e pili nui ana i ka hana o ka insulin, ka hoʻololi ʻana i ka ʻike o ka glucose. I kēlā mau kūlana, ʻo ka desensitization ka mea me ke kumu o ka hoʻokumu ʻana i nā huahana metabolic - hexosamines (hexosamine shunt).
Aia ma muli o kēia, ʻike ia i ka hyperinsulinemia a me ka hyperglycemia hiki ke hana pono i nā mea kūʻokoʻa kūʻokoʻa no nā maʻi cardiovascular. ʻO ka postprandial a me ke ʻano hyperglycemia hoʻowalewale i kekahi mau papa hana pili i ka hana i ka hoʻomohala ʻana o nā hoʻopiʻi maʻi maʻi.
Hoʻopili ka hyperglycemia maʻi i ka hoʻokūkū ikaika o nā radical manuahi, hiki ke hoʻopaʻaʻia i nā molika lipid a hoʻonāukiuki i ka hoʻomaka ʻana o ka atherosclerosis.
ʻO ka paʻa ʻana o ka molekui NO (nitric oxide), he ikaika vasodilator i huna ʻia e ka endothelium, e hoʻomaikaʻi ana i ka disotunction endothelial mua a me ka wikiwiki i ka hoʻomohala ʻana o ka macroangiopathy.
Hoʻomau mau ʻia kekahi mau ʻano nīnū manuahi i loko o ke kino ma vivo. I ka manawa like, mālama ʻia kahi kaulike ma waena o ka hana o ka pale antioxidant a me ka pae o nā oxidants (free radical).
Akā ma lalo o kekahi mau kūlana, ulu ka ulu ʻana o nā pūhui rezelo radical, e pono ke alakaʻi i ka maʻi oxidative, i hele pū ʻia me ka haʻaheo ʻana ma waena o kēia mau papa me ka hoʻonui o ka nui o nā oxidants e alakaʻi i ka poʻomanaʻo o nā moleki mololi.
ʻO kēia mau molekilo i poino ʻia he mau mākaʻina o ka kaumaha oxidative. Ke kiʻekiʻe nui o nā ʻimi manuahi ma muli o ka hyperglycemia, hoʻonui i ka autooxidation o ka glucose a me kona komo ʻana i nā hāmeʻa o ka glycation protein.
ʻO nā helu he nui o nā radical manuahi he cytotoxic i ka mea nui o kā lākou hoʻokumu. Ke ʻimi nei lākou e hopu i ka palona a i ʻole ka mea ʻokoʻa hou aʻe o nā molekue hou, a laila e hoʻopiʻi a i hōʻino paha i ke ʻano o nā ʻona, nā pona, nā kino.
Ua hoʻokumu ʻia ma loko o ka hana o ka hoʻomohala ʻana i ka diabetes mellitus a me atherosclerosis, ʻo ia ka mea maʻamau i ka nui o nā radical free oxidative a me ke kaumaha oxidative e lawe nei, i ka:
- hui pū ʻole insulin;
- alakaʻi i hyperglycemia.
ʻO ka Hyperglycemia ka mea maʻamau o ka hana endothelial o nā moku coronary.
Ke ʻano o ka postgandial hyperglycemia
No ka hoʻokō ʻana i ke koina no ka metabolism, ʻo ia ke ʻano o ke kaʻina hana e like me:
- ma ka hoʻoponopono kaulike;
- i ka hana kino;
- i ka lāʻau lapaʻau.
E makaʻala! ʻO kahi mea nui i ka mālama pono ʻana i ka maʻi diabetes he sub-calorie kaʻai ʻana a me ka hoʻoikaika kino olakino. Pono e kuhikuhi ʻia kaʻai ʻana i ka palena o ka nui o nā mea lae a me nā mea hou ʻia. Kuhi i kēia mau hana i ka hoʻomohala ʻana o ka hyperglycemia postprandial a pili i kona ʻano maʻamau i ke ao.
ʻO kaʻai ʻana a me ke ʻano kino wale nō, ma ke ʻano he kānāwai, ʻaʻole hiki ke hoʻokō i ka hoʻolālā kiʻekiʻe pō i ka pō e make ana e ka ate, ka mea e wikiwiki ai i ka wikiwiki a me ka glycemia postprandial.
No ka mea ʻo ka hyperglycemia ka pilina nui e hoʻopili ʻia ana i ka huna ʻana i ka insulin, e kū mai ka nīnau o ka lāʻau lapaʻau no ka maʻi ʻehā o ka maʻi maʻamau. ʻO ka pinepine loa, hoʻohana ʻia nā derivatives sulfonylurea no kēia.
Hoʻokomo nā lāʻau hoʻohiki ma kēia pūʻulu i ka huna ʻana o ka insulin a hōʻemi i ka wikiwiki o ka glycemia. Akā aia lākou liʻiliʻi liʻiliʻi i ka hyperglycemia postprandial.
ʻO ka pilina kokoke ma waena o nā hoʻopiʻi cardiovascular momona a me ka postprandial hyperglycemia e hoʻohālikelike ai i nā kauka a me ka mea maʻi, ma ka lima hoʻokahi, ka hana o ka mālama mau ʻana i ka hyperglycemia postprandial, a ma kekahi, ka hoʻohana ʻana o nā mea hoʻoponopono prandial e hoʻoponopono i ka glycemia.
ʻO ka pale ʻana o ka hyperglycemia postprandial me ka ʻole o ka hoʻonui ʻana i ka mea huna o ka insulin endogenous hiki ke loaʻa ma ka hoʻopau ʻana i nā adsorption o nā kāmeʻa i loko o ka pākuhi liʻiliʻi e hoʻohana ana i ka acarbose.
Ke hilinaʻi nei i ka ʻike noiʻi e hōʻoia ana i ka hana nui o nā waikela amino (koe wale nō ka glucose) i ka hana o ka huna ʻana o ka insulin e nā cell beta i loko o ka papaʻaina, ua hoʻomaka ʻia ka noiʻi ʻana i nā hopena o ka hilo i nā hopena o nā huaʻoniʻi benzoic, phenylalanine, ka mea i kāpili i ka synthesis o ka repaglinide a me ka nateglinide.
Hoʻokomo ʻia ka mea huna o ka insulin e lākou i kāna hiʻi maoli ʻana i ka poʻe olakino ma hope o ka ʻai ʻana. Ke alakaʻi kēia i ka emiʻana o nā kūmole glucose kiʻekiʻe loa i ka manawa postprandial. He pōkole nā lāʻau lapaʻau, akā ʻo ka hopena wikiwiki, no ka mea hiki iā ʻoe ke pale i ka piʻi nui o ke kō ma hope o ka ʻai ʻana.
ʻO ka manawaʻoi loa, ua hoʻonui nui ʻia nā hōʻailona no ka inikini insulin no nā poʻe maʻi me ka maʻi type 2. E like me nā koho loea maʻamau, ma kahi o 40% o nā mea maʻi me ka maʻi diabetes type 2 e pono ana i ka ʻapiʻema insulin. Eia naʻe, loaʻa mau ka hāmeʻa ma mua o 10%.
E hoʻomaka i ka maʻi insulin no ka maʻi type 2, nā hōʻailona kuʻuna:
- nā hopena koʻikoʻi o ka maʻi maʻi;
- hana hana;
- pilikia ulia cerebrovascular;
- molaki ʻaococial myocardial;
- hapai
- nā maʻi maʻamau.
I kēia mau lā, ʻike nā kauka i ka pono o nā inikini insulin e hōʻoluʻolu i ka pehu o ka glucose a hoʻomau i ka hana beta-cell i ka hyperglycemia moderate.
ʻO ka hopena o ka hoʻohaʻahaʻa ʻana i ka hana glucose glucose i ka diabetes type 2 e pono ai ka hoʻōla ʻana o ʻelua mau hanana:
- Glycogenolysis.
- Gluconeogenesis.
No ka hōʻemi o ka hoʻomehanaʻana o ka insulin i ka gluconeogenesis, ka glycogenolysis i ka ate a hoʻomaikaʻi i ka naʻau o peripheral i ka insulin, hiki i kēia ke hoʻoponopono i nā hana pathogenetic o ka maʻi mellitus.
Loaʻa ka hopena maikaʻi o ka insulin insulin no ka maʻi diabetes.
- hōʻemi i ka wikiwiki o ka hyperglycemia a ma hope o ka ʻai;
- hōʻemi i ka hana glucose glucose a me ka gluconeogenesis;
- hoʻonui i ka hana o ka insulin i ka pane ʻana i ka hoʻohaʻahaʻa glucose a i ʻole ke komo ʻana i ka meaʻai;
- ka hana ʻana o nā loli antiatherogenic i ka ʻaoʻao o ka lipoproteins a me nā lipids;
- ka hoʻomaikaʻi ʻana o ka anaerobic a me ka glycolysis aerobic;
- ka hoʻohaʻahaʻa i ka glycation o lipoproteins a me ka protein.
