Insulin kukana - ndichiyani? The matenda kagayidwe kachakudya ndi insulin kukaniza

Kwa anthu osiyana yodziwika ndi mosiyanasiyana luso insulin yotithandiza shuga kutengedwa. Nkofunika kudziwa kuti munthu akhoza kukhala ndi kulingalira yachibadwa limodzi kapena angapo zotsatira za pawiri ndi pa nthawi yomweyo - ndi kukana kotheratu kwa ena. Kenako, ife yosanthula maganizo "insulin kukana": icho chiri, mmene imasonyezedwa.

mwachidule

Patsogolo polimbana ndi lingaliro la "insulin kukana", chomwe chiri ndi zimene makhalidwe amachita, ziyenera kuti matenda si zachilendo. Oposa 50% ya anthu ndi oopsa amadwala matendawa. Nthawi zambiri, insulin kukana (imene, adzakhala pansipa) opezeka mu okalamba. Koma nthawi zina izo wapezeka ana. insulin kukana syndrome zambiri si wapezeka kale, zilibe amayamba kudziwonetsa kuphwanya njira kagayidwe kachakudya. Anthu ali pangozi anthu ndi dyslipidemia kapena kulemala shuga kulolerana, kunenepa kwambiri, matenda oopsa.

insulin kukaniza

Ndi chiyani icho? Tchulani amachita kuphwanya chiyani? Kagayidwe kachakudya matenda kukaniza insulin ndi yankho lolakwika wa chamoyo kuti kanthu mmodzi wa mankhwala. Lingaliro amagwira ntchito ndi mavuto osiyana kwachilengedwenso. Izi, makamaka, ananena kuti chikoka cha insulin pa mapuloteni ndi zamadzimadzi kagayidwe, mawu losokonekera, ndi mtima za indofeliyamu ntchito. Yankho mkhutu amatsogolera ndi kuwonjezeka mu ndende magazi a pawiri chofunika wachibale buku zilipo shuga. insulin kukaniza matenda - matenda kuphatikiza. Kumafuna kusintha shuga kulolerana, mtundu 2 shuga, dyslipidemia, kunenepa. "Syndrome X" ndipo kumaphatikizapo kulanda kukana shuga (insulin amadalira).

limagwirira chitukuko

Kwathunthu kufufuza akatswiri ake kuti tsiku analephera. Matenda chopatsa chitukuko cha kukana insulin kumachitika misinkhu zotsatirazi:

• Cholandilira. Pankhaniyi, boma zasonyezedwa kuyandikana kapena kuchepa kwa chiwerengero cha maselo.
• Pa mlingo zoyendera shuga. Pankhaniyi, wapezeka kuchepa kwa mamolekyulu GLUT4.
• Pre-receptoral. Pankhaniyi tilankhula za insulin nthenda.
• Postreceptor. Pankhaniyi pali kuphwanya phosphorylation ndi kusokonezeka kwa HIV mbendera.

Kuvutika kwa mamolekyulu insulin ndi mokwanira kawirikawiri ndi ilibe tanthauzo matenda. cholandilira kachulukidwe akhoza utachepa odwala chifukwa maganizo olakwika. Ndi chifukwa hyperinsulinemia. Nthawi zambiri, odwala ndi kuchepa kwa manambala cholandilira mwapang'ono. Pankhaniyi, mlingo ndemanga si muyezo imene anatsimikiza zimene digiri ali insulin kukana. Zimayambitsa matenda ndi kuchepetsedwa ndi akatswiri postreceptor kuyan'anila kufala. Ndi precipitating zinthu, makamaka, monga:

• Kusuta.
• Kuchuluka zili TNF-Alpha.
• Ndichepe zolimbitsa thupi.
• Kuwonjezeka woipa wa zidulo sanali esterified mafuta.
• Age.

Izi ndi zinthu zazikulu zimene zimachititsa insulin kukana kambirimbiri kuposa ena. Chithandizo zikuphatikizapo ntchito:

• Thiazide okodzetsa gulu.
• Beta-adrenergic blockers.
• asidi Nicotinic.
• Corticosteroids.

chinawonjezeka kukaniza insulin

Miyoyo ya shuga kagayidwe amapezeka adipose minofu minofu, ndi chiwindi. minofu chigoba metabolizes pafupifupi 80% pawiri lapansi. Minofu Pankhaniyi amachita ngati gwero lofunika kukaniza insulin. Adani a shuga mu maselo ikuchitika mwa wapadera zoyendera GLUT4 mapuloteni. Pamene lilime ndi adamulowetsa ndi insulin zinayambitsa angapo zochita phosphorylation. Kenako zotsatira mu translocation wa GLUT4 kuti selo nembanemba ku cytosol lapansi. Popeza shuga angathe kulowa selo. Insulin kukana (mlingo adzasonyezedwa hereinafter) chifukwa cha kuchepa kwa mlingo wa translocation wa GLUT4. Iwo amatchuka kuchepa magwiritsidwe ndi shuga kutengedwa. Pamodzi ndi izi, kupatula zomwe adani a shuga mu zimakhala zotumphukira, pamene hyperinsulinemia ndi kuletsedwa kwa chiwindi shuga kupanga. Mu mtundu 2 shuga ndi anayambiranso.

kunenepa

Iwo pamodzi insulin kukana zambiri zokwanira. Pamene kupyoza mtima kulemera 35-40% tilinazo akutsikira ndi 40%. Ili mu m'mimba khoma minofu mafuta ali apamwamba kagayidwe kachakudya ntchito kuposa limene lili pansipa. Pa kuzipenya mankhwala anasonyeza kuti bwino kumasulidwa ku kufalitsa zipata mafuta zidulo ndi ulusi m'mimba amakwiya ulimi wa triglycerides chiwindi.

zizindikiro matenda

Insulin kukana, yomwe zizindikiro imakhudzana ndi chisokonezo kagayidwe kachakudya mwina advantageously kuti amaganiziridwa odwala ndi kunenepa m'mimba, gestational shuga, mbiriyakale banja la mtundu 2 shuga, dyslipidemia ndi matenda oopsa. Pa chiopsezo ndi akazi ndi polycystic n'kuwasanganiza syndrome (PCOS). Chifukwa chakuti kunenepa amachita ngati chikhomo kukaniza insulin, m'pofunika kupenda chikhalidwe, mmene muli kufalitsidwa kwa minofu adipose. malo ake akhoza ginekoidnomu - mu mmunsi mwa thupi, kapena yotha mtundu - mpanda kutsogolo kwa peritoneum lapansi. Kudzikundikira mu theka chapamwamba thupi ali amakangana zofunika kwambiri insulin kukana, asintha shuga kulolerana ndi shuga, kunenepa kuposa mbali m'munsi. Pofuna kudziwa kuchuluka kwa m'mimba minofu mafuta akhoza kugwiritsa ntchito njira zotsatirazi: kudziwa chiŵerengero cha circumference m'chiuno circumference ntchafu ndi BMI. Pa chiwerengero cha 0,8 akazi ndi 0,1 kwa amuna ndi BMI kuposa 27 amapezeka ndi kunenepa m'mimba ndi kukana insulin. Zizindikiro matenda akuwonetseredwa kunja. Makamaka pa khungu amalembedwa wamakwinya, akhakula malo hyperpigmented. Nthawi zambiri iwo m'malembo m'khwapa, elbows, pansi mabere. Analysis kukaniza insulin ndi mawerengedwe chilinganizo. HOMA-IR kuchita masamu motere: kudya insulin (Mu / L) X kudya shuga (mmol / L). Chifukwa analandira lagawidwa ndi 22,5. Kuti adzakhala ndi insulin kukana index. Norma - <2,77. Pamene zopatuka motsogozedwa kuwonjezeka tilinazo zikhoza matenda matenda zimakhala.

Matenda a machitidwe ena: atherosclerosis

Masiku ano palibe kufotokoza asanakwatire limagwirira cha zochita insulinorezistenotnosti kugonjetsedwa kwa dongosolo mtima. Pangakhale zotsatira mwachindunji atherogenesis. Ndi chifukwa cha luso insulin yotithandiza kaphatikizidwe wa lipids ndi zigawo za kuchuluka kwa minofu yosalala mpanda chotengera. Pamodzi ndi izi mwina chifukwa cha arteriosclerosis kugwirizana matenda kagayidwe kachakudya. Mwachitsanzo, angakhale oopsa, dyslipidemia, kusintha shuga kulolerana. Mu pathogenesis matenda ndi yapadera kufunika chakhungu ntchito ya endothelium mtima. ntchito yake ndi kukhalabe kamvekedwe ka njira magazi ndi secreting timene vasodilation ndi vasoconstriction. M'chigawo malamulo insulin kumapangitsa zosangalatsa za ulusi yosalala minofu ya linga chotengera ndi kumasuka okusayidi nitric (2). Komanso, mphamvu yake kumapangitsanso endothelium amadalira vasodilation kwambiri anasinthidwa odwala ndi kunenepa. N'chimodzimodzinso odwala ndi kukana insulin. Ndi chitukuko cha inatsekeratu mtsempha wamagazi kulephera kulabadira zimene zikuchitika wabwinobwino, ndiponso kuchita zambiri, mukhoza kulankhula za gawo loyamba la matenda microcirculatory - microangiopathy. chikhalidwe ichi pathological zimawonedwa mu ambiri odwala matenda a shuga (shuga).

Insulin kukana zingachititse atherosclerosis ndi chisokonezo mu ndondomeko ya fibrinolysis. PAI-1 (plasminogen activator woletsa) ali woipa mkulu odwala matenda ashuga ndi wonenepa nondiabetic. Kaphatikizidwe PAI-1 analimbikitsa proinsulin ndi insulin. Mlingo wa fibrinogen ndi zinthu zina procoagulant komanso kuchuluka.

Asintha shuga kulolerana ndi mtundu 2 shuga

Insulin kukana chinthu isanafike mawonetseredwe matenda a shuga. Pakuti kuchepetsa ndende ya shuga kukumana maselo beta mu kapamba. Kuchepetsa ndende ikuchitika ndi kuwonjezeka yopanga insulin, womwe akutitsogolera kuti hyperinsulinemia wachibale. Euglycemia akhoza anakhalabe mu odwala malinga maselo beta akukhalabe misinkhu ndi mkulu wa madzi insulin kugonjetsa kukana. Potsilizira pake, luso limeneli atayika, ndi ndende ya shuga kumawonjezera kwambiri. Chofunika kwambiri, zomwe ndi udindo hyperglycemia pa chopanda kanthu m'mimba pa maziko a mtundu 2 shuga, insulin kulimbana ndi chiwindi. Yankho wathanzi ndi kuchepetsa kupanga shuga. Pamene insulin kukana, yankho atayika. Chifukwa cha zimenezi, kwambiri chiwindi shuga kupanga akupitiriza, chifukwa mu kusala hyperglycemia. Imfa ya luso la maselo beta kupereka insulin hypersecretion m'pamene kusintha kwa kukana insulin ndi hyperinsulinemia kwa shuga kulolerana asintha. Kenako, boma adziwonetsa ndi shuga matenda ndi hyperglycemia.

oopsa

Pali njira zingapo zimene zingachititse kuti chitukuko pa maziko a kukana insulin. Kuzipenya zikusonyeza kuti chifooke vasodilation ndi vasoconstriction kutsegula zimachititsa kuti kukana mtima. Insulin amalimbikitsa mitsempha kukondoweza (wachifundo) dongosolo. Zimenezi zimabweretsa kuwonjezeka plasma norepinephrine ndende. Odwala ndi kukana insulin kuchuluka poyankha angiotensin. Komanso, mungakonze linaphwanya vasodilation. Malamulo boma insulin kumapangitsa zosangalatsa za mtima minofu khoma. Vasodilatation mu nkhani iyi ndi mkhalapakati ndi kutuluka / m'badwo wa za indofeliyamu okusayidi nitric. Odwala ndi kukana insulin, ntchito za indofeliyamu ndi makutu. Izi amachepetsa vasodilation ndi 40-50%.

dyslipidemia

Pamene insulin kukana akusokoneza zachilendo linanena bungwe yimitsira mafuta ufulu zidulo pambuyo kudya minofu adipose. Kuchuluka ndende umabala gawo lapansi kwa kaphatikizidwe kumatheka wa triglycerides. Ichi ndi chinthu chofunikira kwambiri VLDL kupanga. Pamene hyperinsulinemia yafupika ntchito yofunika enzyme - lipoprotein lipase. Mwa kusintha Mkhalidwe chapansipansi sipekitiramu LDL mtundu shuga 2 ndi kukana insulin ayenera otchulidwa chodziwa mlingo wa makutidwe ndi okosijeni wa particles LDL. Kuti atengeke ndondomeko izi amaonedwa apolipoproteins glycated.

miyeso achire

Kuwonjezeka insulin tilinazo chingapezeke mu njira zingapo. Chofunika kwambiri ndi kuchepetsa kulemera ndi masewera olimbitsa thupi. Zakudya ndi zofunika kwa anthu amene anapezeka ndi kukana insulin komanso. Zakudya kumathandiza kuti olimba mu masiku pang'ono. Owongolera tilinazo zambiri idzalimbikitsa kuwonda. Kwa anthu ndi otsimikiza insulin kukana, chithandizo tichipeza magawo angapo. Olimba a zakudya ndi thupi ntchito imatengedwa kukhala woyamba chithandizo siteji. Kwa anthu amene apeza insulin, zakudya ayenera kukhala otsika-kalori. A kuchepa odziletsa thupi (makilogalamu 5-10) Nthawi zambiri amathandiza kusintha kulamulira misinkhu shuga. Milingo 80-90% ndi anagawira pakati zimam'patsa ndi mafuta, 10-20% ku mapuloteni.

mankhwala

Amatanthauza "Metamorfin" amatanthauza gulu la mankhwala biguanide. Mankhwala bwino zotumphukira ndi kwa chiwindi insulin tilinazo. Pankhaniyi izo zikutanthauza ziribe mphamvu pa katulutsidwe ake. Popeza kukonzekera insulin "Metamorfin" operewera. Amatanthauza "Troglitazone" ndi woyamba medicament tiazolidinedionov gulu lomwe amaloledwa kugwiritsa ntchito mu USA. Mankhwala kumawonjezera mayendedwe a shuga. Izi mwina chifukwa cha kutsegula kwa PPAR-Popanga madzi a gamma cholandilira. Ndipo potero kumatheka GLUT4 akuti, womwe amatsogolera ndi kuwonjezeka insulin-inalimbikitsa shuga adani. Kwa odwala amene ali ndi kukana insulin, chithandizo angathe kuperekedwa ndi pamodzi. Njira pamwamba angagwiritsidwe ntchito osakaniza ndi sulfonylurea, ndipo nthawi zina ndi mzake kubala zotsatira synergistic pa shuga madzi ndi matenda ena. Mankhwala "Metamorfin" osakaniza sulfonylurea ndi kumawonjezera katulutsidwe ndi insulin tilinazo. Pankhaniyi, misinkhu shuga ndichepe kudya ndi pa chopanda kanthu m'mimba. Odwala amene apatsidwa kuphatikiza chithandizo, anali mawonetseredwe ambiri a hypoglycemia.