So asikre a ɛwɔ wo mogya mu dɔɔso anɔpa, sɛ wowɔ asikreyare mpo a? Momma yensua saa ‘Somogyi nkɛntɛnso’ yi ho ade?

So woyɛ obi a ɔnom insulin ma Asikreyare? Sɛ saa a, so woahyɛ no nsow sɛ asikre dodow a ɛwɔ wo mogya mu no akɔ soro mpofirim bere a wosɔre anɔpa no? Sɛ mpo wonom w’aduru no anadwo na wohwɛ yiye a, ɛyɛ nwonwa sɛ woda so ara wɔ bi anɔpa? Ade biako nti a ɛte saa betumi ayɛ ‘Somogyi nkɛntɛnso’. Momma yɛnka eyi ho asɛm nkɔ akyiri kakra .

Dɛn ne Somogyi nkɛntɛnso no?

Sɛ yɛbɛka no tiawa a, Somogyi nkɛntɛnso no ne bere a asikreyarefo a ɔnom insulin nya asikre dodow a ɛwɔ mogya mu no so tew mpofirim (hypoglycemia) anadwo, na ɛno akyi no asikre dodow a ɛwɔ mogya mu no kɔ soro mpofirim (hyperglycemia) anɔpa. Eyi ba esiane sɛnea nkwaadɔm bi a ɛwɔ yɛn nipadua mu no yɛ adwuma nti. Fa no sɛ, anadwo fã no, wo mogya mu asikre so tew mpofirim, na wo nipadua susuw sɛ, "Oh, saa ɔbarima yi rekɔ ɔhaw mu," na ɛma hormone ahorow gyae de gye no nkwa. Ɛno nti na asikre dodow a ɛwɔ wo mogya mu no kɔ soro anɔpa no.

Wɔde Oduruyɛfo Michael Somogyi, oduruyɛfo bi a odii kan huu no wɔ 1930 mfe no mu no din ato so. Ɛtɔ da bi a nnuruyɛfo frɛ no ‘rebound hyperglycemia’.

Nanso biribi a ɛsɛ sɛ wuhu ni. Somogyi nkɛntɛnso no da so ara yɛ ‘nsusuwii’ wɔ nhwehwɛmufo mu, a ɛkyerɛ sɛ ɛyɛ adwene bi kɛkɛ. Ɛno kyerɛ sɛ ɛnyɛ nea wɔada no adi 100%, nanso nyansahu mu adanse wɔ hɔ a ɛfoa so. Bere bi a atwam no, na nnuruyɛfo susuw sɛ eyi ne ade titiriw a ɛma asikre kɔɔ soro anɔpa. Nanso nhwehwɛmu foforo, titiriw nhwehwɛmu a wɔde glucose monitoring a ɛkɔ so (CGM) di dwuma no ama nsemmisa asɔre wɔ adwene yi ho.

Nneɛma afoforo pii wɔ hɔ a enti asikre dodow a ɛwɔ mogya mu betumi akɔ soro anɔpa, ɛnyɛ Somogyi nkɛntɛnso no nkutoo:

• Nnuru dodow a wonom no nnɔɔso, efisɛ efi wo nipadua mu anadwo.
• Tebea bi a wɔfrɛ no Dawn phenomenon. (Yɛbɛka eyi nso ho asɛm)
• Nnuru dodow a wɔnom wɔ anwummere aduan mu no ne aduan dodow nhyia.
• Insulin a ɛko tia nyarewa a obi wɔ.

Nsonsonoe bɛn na ɛwɔ Somogyi nkɛntɛnso ne Dawn adeyɛ no ntam?

Okay, afei ebia woresusuw ho sɛ, ‘Dɛn ne adekyee adeyɛ yi?’ Eyinom abien nyinaa yɛ nneɛma a ɛma asikre dodow kɔ soro anɔpa wɔ nnipa a wɔwɔ asikreyare mu.

Ade a ɛba anɔpatutuutu no yɛ asikre dodow a ɛkɔ soro wɔ awosu mu a efi nkwaadɔm pii (te sɛ cortisol ne onyin hormone) a ɛba anɔpatutuutu mu ba. Eyi yɛ ade a ɛfata.

Nanso wɔ Somogyi nkɛntɛnso no mu no, hormone ahorow nso reyɛ adwuma, nanso ɛba esiane asikre a ɛso tew mpofirim (hypoglycemia) anadwo nti. Wɔ adekyee adeyɛ mu no, asikre nkɔ soro esiane asikre a ɛso tew saa nti.

Ade foforo a ɛho hia ne sɛ adekyee adeyɛ no, a nea ɛde asikre a ɛwɔ mogya mu kɔ soro anɔpa no ka ho , abu so kɛse sen Somogyi nkɛntɛnso no.

Dɛn ne Somogyi nkɛntɛnso no ho sɛnkyerɛnne?

Somogyi nkɛntɛnso no ho sɛnkyerɛnne titiriw ne sɛ asikre dodow a ɛwɔ wo mogya mu no kɔ soro bere a wosɔre anɔpa no. Sɛ́ ebia wobɛhwɛ wo glucometer anaasɛ wode CGM (Continuous Glucose Monitoring) afiri di dwuma no, ɛbɛkyerɛ sɛ asikre dodow a ɛwɔ wo mu no dɔɔso anɔpa.

Ɛdenam sɛnea asikre a ɛwɔ wo mogya mu no dɔɔso so no, ebia wubenya yare no ho sɛnkyerɛnne te sɛ eyinom bere a wosɔre anɔpa no:

• Sukɔm a ɛtaa de obi (polydipsia).
• Ɔkɔm a wɔte nka kɛse sen sɛnea ɔtaa yɛ.
• Nsu a wɔtaa tow .
• Tipaeɛ.
• Abufuw ne abufuw a wɔte nka (abufuw).

Dɛn nti na Somogyi nkɛntɛnso no ba?

Sɛnea Somogyi nkɛntɛnso no nsusuwii kyerɛ no, sɛ asikre dodow a ɛwɔ wo mogya mu no so tew dodo (hypoglycemia) anadwo fã bere a woada esiane insulin a worenom nti a, wo nipadua no bɛbɔ mmɔden sɛ ‘ebegye’ wo afi saa asikre tebea a ɛba fam no mu.

Nipadua no gyae hormone ahorow pii ma saa ‘nkwa adwuma’ yi. Wɔn titiriw ne:

• Adrenaline a ɛwɔ nipadua no mu
• Nnuru a wɔfrɛ no corticosteroids
• Nkwammoaa a ɛma obi nyin
• Glucagon a wɔfrɛ no glucagon

Saa nkwaadɔm yi ma wo mmerɛbo no yi glucose anaa asikre pii kɔ wo mogya mu sen sɛnea ɛte daa. Saa glucose a woyi fi mu yi ma asikre dodow a ɛwɔ wo mogya mu no kɔ soro. Sɛ wowɔ asikreyare a, wo dwensɔtwaa no ntumi nyɛ insulin a ɛdɔɔso a ɛbɛma asikre dodow a ɛkɔ soro yi ano, anaasɛ ɛnnyɛ biara koraa. Eyi nti na asikre dodow a ɛwɔ wo mogya mu no kɔ so yɛ kɛse no.

Wɔ obi a onni asikreyare mu no, nipadua no fi awosu mu hwɛ asikre dodow a ɛwɔ mogya mu so na ɛma ɛkɔ so tra baabi pɔtee bi. Ɛno nti na Somogyi nkɛntɛnso no nka nnipa a wonni asikreyare no.

Wobɛyɛ dɛn anya oduruyɛfo a ɔte sɛ eyi?

Nokwarem no, Somogyi nkɛntɛnso no nyɛ ade a ɛtaa ma asikre kɔ soro anɔpa, enti ebetumi ayɛ den kakra sɛ wobehu. Na sɛnea madi kan aka no, nhwehwɛmu a aba nnansa yi kyerɛ sɛ ebia ɛnyɛ ɛno na ɛma asikre a ɛwɔ mogya mu no kɔ soro anɔpa. Enti ebetumi ayɛ den, sɛ ɛnyɛ nea entumi nyɛ yiye mpo a, sɛ oduruyɛfo betumi ahu no pɛpɛɛpɛ denam ka a ɔbɛka sɛ, ‘Ɛyɛ, eyi ne no so.

Sɛ wotaa nya asikre a ɛwɔ wo mogya mu anɔpa a, ɛbɛyɛ papa sɛ wo ne wo duruyɛfo a ɔboa wo ma wudi wo asikreyare ho dwuma no bɛkasa. Ɔbɛhwɛ sɛnea asikre dodow a ɛwɔ wo mogya mu no sakra na wabɔ mmɔden sɛ obehu nea ɛde ba. Ɔkwan a etu mpɔn sen biara a wobɛfa so ayɛ eyi ne sɛ wode CGM (Continuous Glucose Monitoring) afiri bedi dwuma.

Sɛ womfa CGM nni dwuma a, ebia wo duruyɛfo bɛka akyerɛ wo sɛ hwɛ asikre dodow a ɛwɔ wo mogya mu mpɛn pii da biara. Nhwɛsoɔ:

• Nnɔnhwerew abien wɔ anwummere aduan akyi.
• Ansa na wobɛda.
• Anadwo mfinimfini (sɛ nhwɛso no, bɛyɛ anɔpa nnɔn abien anaa nnɔn abiɛsa).
• Bere a ɔsɔre anɔpa no.

Afei nso, wɔka kyerɛ wo sɛ kyerɛw nsɛm nketenkete te sɛ nnuan a wudi anadwo, dodow a wudi, ne sɛ woteɛteɛ w’apɔw mu anadwo a, apɔw-mu-teɛteɛ ko a woyɛ ne bere tenten a woyɛ.

Sɛ oduruyɛfo no boaboa nsɛm yi nyinaa ano nkutoo na obetumi ahu nea ɛde asikre a ɛkɔ soro wɔ mogya mu anɔpa no ba.

Ɔkwan bɛn so na wɔsa Somogyi nkɛntɛnso no?

Bere a wo ne wo duruyɛfo abom ahu sɛnea asikre dodow a ɛwɔ wo mogya mu yɛ n’ade anadwo awie no, wobetu wo fo wɔ nsakrae a wubetumi ayɛ de aboa ma asikre a ɛkɔ wo mogya mu anɔpa no ano. Kae sɛ ɛsono obiara nipadua, na nneɛma pii wɔ hɔ a ɛka asikre dodow a ɛwɔ mogya mu. Enti, nea wubetumi ayɛ de asiw asikre a ɛkɔ mogya mu anɔpa ano no betumi ayɛ soronko wɔ onipa biara ho.

Ebia wo duruyɛfo bɛka nneɛma te sɛ:

• Asikreyare aduru anaa insulin dodow a wobɛsesa.
• Nnuan ahorow a wudi anwummere a wobɛsakra no. Sɛ nhwɛso no, ebia ebehia sɛ wudi nnuan a protein, carbohydrates, anaa srade pii wom, anaasɛ ebehia sɛ wudi kakraa bi.
• Sɛ ɛbɛyɛ yiye a, sɛ wodan kɔ insulin pɔmpɛ so a, ɛbɛma woatumi adi wo insulin dodow so pɛpɛɛpɛ.
• Bere a wɔde teɛteɛ apɔw mu anadwo a wɔbɛsakra.

Nsɛnnennen bɛn na eyi betumi de aba?

Sɛ́ ebia Somogyi nkɛntɛnso no na ɛde asikre a ɛwɔ mogya mu anɔpa no ba ankasa anaasɛ ɛnte saa no, esi nsɛm abien a ɛho hia so dua. Ɛsɛ sɛ nnipa a wɔwɔ asikreyare bɔ mmɔden sɛ wɔbɛkwati nsɛnnennen abien yi:

• Asikre dodow a ɛkɔ soro wɔ mogya mu bere nyinaa.
• Asikre dodow a ɛba fam wɔ mogya mu (hypoglycemia) ba anadwo.

Asikre dodow a ɛkɔ soro wɔ mogya mu a ɛkɔ so

Bere a asikre dodow a ɛwɔ wo mogya mu kɔ so yɛ kɛse no, wo HbA1c (A1C) dodow bɛkɔ soro, na wo Time in Range (TIR) ​​so atew. HbA1c nhwehwɛmu no susuw asikre dodow a ɛwɔ wo mogya mu wɔ asram abiɛsa a atwam no mu. TIR yɛ nna ɔha biara mu nkyem 100 a asikre dodow a ɛwɔ wo mogya mu no wɔ nea wɔde asi wɔn ani so no mu.

Dodow a wo A1c ne TIR dodow yɛ kɛse, titiriw sɛ ɛwɔ hɔ mfe pii a, dodow no ara na asiane a ɛwɔ hɔ sɛ wubenya nsɛnnennen afi asikreyare mu no yɛ kɛse. Saa nsɛnnennen yi ho nhwɛso bi ne:

• Aniwa mu yare (Retinopathy) .
• Asaabo mu haw (Nephropathy) .
• Ntini mu yare
• Koma mu yare

Nhwehwɛmu ada no adi sɛ nnipa a wɔwɔ asikreyare betumi atew asiane a ɛwɔ hɔ sɛ wobenya saa nsɛnnennen yi so sɛ wɔma wɔn A1c dodow kɔ fam sen 7% a.

Asikre a ɛdɔɔso wɔ mogya mu anɔpa betumi ayɛ ɔhaw a ɛkɔ so daa, na sɛ wɔansa a, asikre dodow a ɛwɔ wo mogya mu no betumi akɔ so ayɛ kɛse nnɔnhwerew pii da biara. Eyi ma asiane a ɛwɔ hɔ sɛ wubenya asikreyare ho nsɛnnennen no yɛ kɛse bere a bere kɔ so no.

Asikre a ɛba mogya mu a ɛba fam anadwo biako

Wɔ nnipa pii a wɔwɔ asikreyare fam no, asikre a ɛba mogya mu, anaasɛ asikre a ɛba fam, ne bere a asikre a ɛwɔ mogya mu no so tew sen 70 mg/dL (milligram wɔ deciliter biara mu).

Sɛ asikre dodow so tew wɔ mogya mu a, nnipa pii hu yare no ho sɛnkyerɛnne te sɛ eyinom:

• Sɛ wote nka sɛ wo nipadua rewosow.
• Ɔkɔm kɛse a wɔte nka (polyphagia).
• Fifiri ne awɔw a wɔte nka.
• Adwene a ɛyɛ basaa, atenka a ɛma obi ho yɛ hare.
• Koma a ɛbɔ kɔ soro.

Nanso, sɛ asikre a ɛwɔ wo mogya mu no so tew bere a woada a, ebia ebegye bere kakra ansa na woanyane na woahu sɛnkyerɛnne ahorow no. Eyi betumi ayɛ nea asiane wom, na asikre a ɛkɔ fam kɛse betumi de nkwa ato asiane mu. Nsɛnkyerɛnne a ɛkyerɛ sɛ asikre a ɛwɔ mogya mu sua anadwo no betumi ayɛ soronko kakra, a nea ɛka ho ne:

• Dae a wontumi nna, sɛ obi te nka sɛ ne ho nyɛ no dɛ wɔ nna ho.
• Sɛ wote nka sɛ woabrɛ na woamfa w’adwene nsi biribi so bere a wosɔre anɔpa no.
• Dae bɔne a wobɛda.
• Ntade anaa mpa a wohyɛ no yɛ nwini esiane fifiri nti.

Ɛmfa ho sɛnkyerɛnne ahorow a wowɔ a ɛma wususuw sɛ asikre a ɛwɔ wo mogya mu no sua no, ɛho hia sɛ wohwɛ asikre dodow a ɛwɔ wo mogya mu no mu hwɛ sɛnea asikre dodow a ɛwɔ wo mogya mu no sua. Eyi bɛboa wo ma woahu sɛnea wobɛsa. Sɛ wobɛsa asikre a ɛba fam a, ɛsɛ sɛ wudi carbohydrates a ɛyɛ adwuma ntɛmntɛm, a ɛyɛ asikre (te sɛ banana anaa apɔw-mu-teɛteɛ).

Sɛ mpɛn pii no asikre a ɛwɔ wo mogya mu no so tew anadwo a, hwɛ hu sɛ wo ne wo duruyɛfo bɛkasa afa ho. Mobɛbom atumi ayɛ nsakrae wɔ mo asikreyare ano aduru ho nhyehyɛe mu na amma ansi bio.

Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?

Sɛ worenya asikre dodow a ɛkɔ soro bere nyinaa anɔpa a, ɛho hia sɛ wo ne wo duruyɛfo a ɔreboa wo ma woadi wo asikreyare ho dwuma no kasa. Obetumi asɔ asikre dodow a ɛwɔ wo mogya mu ahwɛ, ahu sɛ ebia Somogyi nkɛntɛnso no na ɛde ba, anaasɛ biribi foforo bi rekɔ so, na ɔkamfo ayaresa nhyehyɛe a ɛfata wo akyerɛ.

Asikre a ɛwɔ mogya mu a ɛkɔ soro anɔpa no betumi ayɛ ahometew ankasa na ayɛ nea ɛnyɛ dɛ. Ano aduru biara nni hɔ a ɛfata obiara. Enti ebia ebegye bere kakra ansa na woanya ano aduru a ɛfata ama wo. Wo duruyɛfo betumi aboa wo ma woasi ɔkwan a eye sen biara a wobɛfa so asi gyinae. Nsuro sɛ wobɛsrɛ wɔn mmoa. Sɛ woyɛ ho biribi mprempren a, ebetumi aboa wo ma woakwati bere tiaa ne bere tenten mu nsɛnnennen nyinaa.

Awiei koraa no, ade a ɛho hia sen biara (Take-Home Message) .

Okay, enti seesei woanya nteaseɛ pa wɔ Somogyi effect a yɛkaa ho asɛm no ho. Kae sɛ ɛnyɛ eyi nkutoo nti na asikre kɔ soro anɔpa. Nanso, ɛho hia sɛ yɛma yɛn ani da hɔ.

• Ade titiriw ne sɛ, sɛ asikre a ɛdɔɔso wɔ wo mogya mu anɔpa a, mmu w’ani ngu so. Hwɛ hu sɛ wo ne wo duruyɛfo bɛkasa.
• Sɛ wode CGM (Continuous Glucose Monitoring) redi dwuma a, hwehwɛ wo duruyɛfo mmoa na ɔnhwehwɛ nsɛm no mu yiye.
• Asikre a ɛba mogya mu (hypoglycemia) anadwo yɛ asiane kɛse. Sɛ wowɔ saa sɛnkyerɛnne ahorow yi bi a, ka ho asɛm nso kyerɛ wo duruyɛfo .
• Wo ne wo duruyɛfo nsusuw w’aduan, apɔw-mu-teɛteɛ, ne nnuru dodow a wode di dwuma ho na yɛ nsakrae ma ɛne nea ɛyɛ adwuma yiye ma wo no nhyia.

Asikreyare a wobɛtra ase no yɛ asɛnnennen, nanso sɛ wodi ho dwuma yiye a, wubetumi abɔ bra pa. Nsuro, ɛyɛ yie?

` Somogyi nkɛntɛnso, asikreyare, anɔpa asikre a ɛkɔ soro, asikre a ɛkɔ soro, asikre a ɛkɔ soro, insulin