So asikre a ɛwɔ wo mogya mu nso dɔɔso anɔpa? So eyi betumi afi Somogyi Nkɛntɛnso no mu?

So woanya eyi ato wo, asikreyarefo pɛn? Ɛwom mpo sɛ woanom w’aduru anadwo na asikre dodow a ɛwɔ wo mogya mu no so yiye de, nanso sɛ wosɔre anɔpa na wohwɛ wo glucometer a, asikre a ɛwɔ wo mogya mu no dɔɔso yiye. Ebia woresusuw sɛ, "Oh, minnim sɛ ebia menom insulin a ɛdɔɔso anadwo anaa." Nanso nea enti a ɛte saa no betumi ayɛ biribi soronko koraa sen sɛnea wususuw. Ɛnnɛ yɛreka tebea bi a wobetumi asusuw ho wɔ mmere te sɛ eyinom mu, nanso wonnim no yiye ho asɛm. Ɛno ne ‘Somogyi nkɛntɛnso’ no.

Dɛn ne Somogyi Nkɛntɛnso?

Sɛ yɛbɛka no tiawa a, Somogyi Nkɛntɛnso no ne bere a asikre dodow a ɛwɔ wo mogya mu no so tew dodo (hypoglycemia) anadwo fã bere a woada no, na wo nipadua no yi hormone ahorow fi mu de yɛ ho biribi, na ɛma asikre dodow a ɛwɔ wo mogya mu no kɔ soro dodo (hyperglycemia) bere a wosɔre anɔpa no. Ɛte sɛ rɔba a sɛ wogyae a, ɛsan kɔ baabi biako. Ɛtɔ mmere bi a wɔfrɛ eyi "rebound hyperglycemia."

Oduruyɛfo bi a wɔfrɛ no Michael Somogyi na odii kan huu eyi wɔ 1930 mfe no mu, na ɛno nti na wɔde ne din too tebea no so no.

Nanso biribi a ɛho hia sɛ yɛte ase ni. Nyansahufoɔ da so ara mmu Somogyi Effect no sɛ ɛyɛ 100% a wɔada no adi, ɛyɛ ‘nsusuiɛ’. Ɛno kyerɛ sɛ ɛwom sɛ nyansahu mu adanse wɔ hɔ a ɛkyerɛ sɛ ebetumi aba de, nanso ɛnyɛ obiara na ogye tom. Bere bi a atwam no, na nnuruyɛfo susuw sɛ eyi ne ade titiriw a ɛma asikre dɔɔso wɔ mogya mu anɔpa, nanso mfiridwuma mu nneɛma foforo, titiriw nea aba a wɔde kɔ so hwɛ glucose so (CGM) no ama nsemmisa asɔre wɔ adwene yi ho.

Nanso, ɛho hia yiye sɛ wuhu eyi sɛ nneɛma pii a ɛma asikre kɔ soro anɔpa no mu biako.

Dɛn ne nneɛma afoforo a ɛma asikre dɔɔso wɔ mogya mu anɔpa?

Ansa na wode nsateaa bɛkyerɛ Somogyi nkɛntɛnso no nkutoo no, nneɛma afoforo pii wɔ hɔ a ɛtaa ma asikre a ɛwɔ mogya mu kɔ soro anɔpa.

• Nnuru dodow a ɛnnɔɔso: Sɛ wonom asikreyare aduru anaa insulin kakraa bi anadwo a, ebetumi ahwere nea etu mpɔn ansa na anɔpa na ama asikre a ɛwɔ wo mogya mu akɔ soro.
• Dawn Phenomenon: Eyi ne ade a ɛtaa ma asikre a ɛwɔ mogya mu kɔ soro anɔpa. Momma yɛnhwɛ eyi mu nkɔ akyiri kakra.
• Anwummere aduan ne nnuru dodow a ɛnhyia: Sɛ wɔansusuw insulin dodow no ho sɛnea ɛne carbohydrates dodow a wodi wɔ anwummere aduan mu no nhyia a, asikre dodow a ɛwɔ mogya mu no betumi akɔ soro anɔpa.
• Insulin Resistance: Tebea a nipadua no mu nkwammoaa ntumi nyɛ insulin ho adwuma yiye.

Nsonsonoe bɛn na ɛda Somogyi Nkɛntɛnso ne Adekyee Adeyɛ no ntam?

Ɛwom sɛ eyinom abien nyinaa ma asikre a ɛwɔ mogya mu no kɔ soro anɔpa de, nanso nsonsonoe kɛse da abien no ntam. Sɛ́ obi a ɔwɔ asikreyare no, nsonsonoe yi a wobɛte ase no bɛboa wo kɛse.

Dawn Phenomenon yɛ bere a yɛn nipadua fi awosu mu yi nkwaadɔm bi (te sɛ cortisol ne onyin hormone) fi adi anɔpatutuutu (bɛyɛ anɔpa 3-4). Saa nkwaadɔm yi ma asikre dodow kɔ soro wɔ mogya mu. Eyi te saa wɔ nnipa a wonni asikreyare nso fam, nanso wɔn nipadua yɛ insulin na ɛhwɛ so. Nnipa a wɔwɔ asikreyare ntumi nyɛ eyi, enti asikre a ɛwɔ wɔn mogya mu no dɔɔso anɔpa.

Nanso Somogyi Nkɛntɛnso no yɛ soronko. Ɛba bere a asikre a ɛwɔ mogya mu (hypoglycemia) so tew anadwo fã no. Wɔ Dawn Phenomenon mu no, asikre a ɛwɔ mogya mu no nkɔ fam anadwo.

Ma yɛnhwɛ nsonsonoe titiriw a ɛda abien no ntam.

Dɛn ne Somogyi nkɛntɛnso no ho sɛnkyerɛnne?

Eyi ho sɛnkyerɛnne titiriw ne asikre a ɛkɔ soro wɔ mogya mu bere a wosɔre anɔpa no. Nanso, ebia wubehu sɛnkyerɛnne ahorow a ɛkyerɛ sɛ asikre a ɛwɔ wo mogya mu no so tew anadwo nso.

Nsɛnkyerɛnne a ɛkyerɛ sɛ asikre a ɛwɔ mogya mu dɔɔso anɔpa (Hyperglycemia) .

• Sukɔm a ɛkɔ soro: Te a wobɛte nka sɛ wunnya nsu a ɛdɔɔso ɛmfa ho sɛnea wobɛnom no.
• Nsu a wɔtaa tow: Ɛsɛ sɛ wɔtow nsu mpɛn pii sen sɛnea wɔtaa tow.
• Ɔkɔm a ɛkɔ soro: Ɔkɔm a wɔte nka sen sɛnea ɔtaa yɛ anɔpa.
• Tiyɛ: Tiyɛ bere a woasɔre anɔpa no.
• Abufuw: Nneɛma nketenkete ho abufuw.

Nsɛnkyerɛnne a ɛkyerɛ sɛ asikre a ɛwɔ mogya mu sua anadwo (Nocturnal Hypoglycemia) .

Ebia worenhu saa sɛnkyerɛnne ahorow yi esiane sɛ woada nti.

• Fifiri a ɛba wɔ nna mu: Fifiri a ɛba araa ma ntama ne mpaboa no yɛ nsu.
• Dae bɔne: Sɛ wosɔre fi nna mu bere a woada dae a ɛyɛ hu akyi.
• Dae a ɛnyɛ ahomegye: Ɔtow ne ho na ɔdannan, ɔda a ɔnyɛ ahomegye.
• Sɛ wosɔre anɔpa a, ɔbrɛ a wobɛte nka: Sɛ wote nka sɛ woabrɛ na woayɛ basaa anɔpa, bere a woada yiye mpo akyi.

Sɛ wowɔ sɛnkyerɛnne te sɛ eyinom anadwo na asikre a ɛwɔ wo mogya mu no dɔɔso anɔpa a, ebia wubesusuw sɛ Somogyi nkɛntɛnso no.

Dɛn nti na eyi rekɔ so? Dɛn nti na ɛte saa?

Fa no sɛ, wonom insulin a wɔde twitwiw wo mu anadwo, anaasɛ woteɛteɛ w’apɔw mu ansa na woadi anwummere aduan. Esiane eyi nti, anadwo fã bere a na woada no, a wunnim mpo no, asikre dodow a ɛwɔ wo mogya mu no so tew wɔ ɔkwan a ɛyɛ hu so (`hypoglycemia`).

Saa bere yi de, wo nipadua susuw sɛ, "Oo, biribi bɔne bi rekɔ so!" Enti nipadua no yɛ ade a egye ntɛmpɛ de "gye" wo nkwa. Ɛne sɛ, ɛma nkwaadɔm pii kɔ mogya no mu mpofirim a ɛyɛ adwuma wɔ tebea horow a egye ntɛmpɛ mu.

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

Saa nkwaadɔm yi bom de sɛnkyerɛnne bi kɔ wo mmerɛbo mu sɛ "Yi asikre fi wo mogya mu ntɛm!" Afei mmerɛbo no ma glucose pii a wɔde asie hɔ no fi wo mogya mu mpofirim.

Sɛ eyi to obi a onni asikreyare a, wɔn nipadua no yɛ insulin de hwɛ asikre dodow a ɛkɔ soro no so. Nanso esiane sɛ wo nipadua a asikreyare wom no ntumi nyɛ saa nti, asikre dodow a ɛkɔ soro no kɔ soro ara kwa, na sɛ wosɔre anɔpa a, wuhu asikre dodow a ɛkɔ soro (hyperglycemia) . Ɛno ne nea ɛba, wɔ ɔkwan a ɛyɛ tiawa so.

Ɔkwan bɛn so ankasa na wuhu tebea yi?

Esiane sɛ nneɛma pii nti na asikre a ɛwɔ mogya mu no dɔɔso anɔpa nti, ebetumi ayɛ den kakra sɛ yebehu sɛ ebia eyi ne Somogyi nkɛntɛnso no anaa. Afei nso, sɛnea yɛadi kan aka no, esiane sɛ wommu eyi sɛ ade a ɛtaa de ba bio nti, ebetumi ayɛ asɛnnennen ama oduruyɛfo mpo sɛ "ɔbɛhwehwɛ" bi.

Ade a eye sen biara a ɛsɛ sɛ woyɛ, sɛ wokɔ so nya asikre a ɛdɔɔso wɔ wo mogya mu anɔpa a, ne sɛ wo ne wo asikreyare ho oduruyɛfo bɛkasa afa ho. Ɔbɛbɔ mmɔden ahu nea ɛde ba denam sɛnea asikre dodow a ɛwɔ wo mogya mu resakra no a ɔbɛhwɛ so.

Ɔkwan pa a wobɛfa so ayɛ eyi ne sɛ wode Continuous Glucose Monitoring (CGM) afiri bedi dwuma. Eyi ma wuhu sɛnea asikre dodow a ɛwɔ wo mogya mu asesa anadwo mũ no nyinaa no ho mfonini a emu da hɔ.

Sɛ womfa CGM nni dwuma a, ebia wo duruyɛfo bɛka akyerɛ wo sɛ yɛ biribi te sɛ eyi:

Ɛdenam eyi a wobɛyɛ nna kakraa bi na wode akenkan no akyerɛ wo duruyɛfo so no, obetumi anya nea ɛkɔ so anadwo no ho adwene pa. Sɛ asikre a ɛwɔ wo mogya mu no sua anadwo fã na ɛkɔ soro anɔpa a, ebetumi ayɛ Somogyi nkɛntɛnso no.

Ano aduru bɛn na wobetumi ayɛ ama eyi?

Sɛ wuhu nea ɛde ba wie a, ɛsɛ sɛ wo ne wo duruyɛfo bom yɛ adwuma hwehwɛ ano aduru. Ɛsono obiara, enti ano aduru biara nni hɔ a ɛfata obiara. Ebia ebegye bere kakra ansa na woahu nea ɛyɛ adwuma yiye ma wo.

Ebia wo duruyɛfo bɛka ano aduru te sɛ eyinom ho nyansa:

• Insulin anaa nnuru dodow a wobɛsesa: Ebia wɔbɛka akyerɛ wo sɛ tew insulin dodow a wode di dwuma no so kakra anadwo.
• Anwummere aduan a wobɛsesa: Ebia wɔbɛtu wo fo sɛ sesa carbohydrates, protein, anaa srade dodow a wudi wɔ anwummere aduan mu. Ebia wobetu wo fo nso sɛ di kakra ansa na woada.
• Insulin Pɔmpɛ a Wɔdannan: Sɛ ɛbɛyɛ yiye a, insulin pɔmpɛ betumi aboa ma wɔahwɛ insulin dodow so pɛpɛɛpɛ.
• Bere a wode teɛteɛ w’apɔw mu a wobɛsakra: Sɛ woteɛteɛ w’apɔw mu anwummere anaa anadwo a, ebia wobɛpɛ sɛ wosakra bere anaa sɛnea woteɛteɛ w’apɔw mu no.

Sɛ wobu ani gu eyi so a, nsɛnnennen bɛn na ebetumi aba?

Ɛmfa ho sɛ ebia Somogyi nkɛntɛnso no ba ankasa anaasɛ ɛnte saa no, tebea yi ma nsɛm atitiriw abien sɔre a ɛsɛ sɛ yɛn a yɛwɔ asikreyare no hu:

1. Asikre dodow a ɛkɔ soro wɔ mogya mu bere nyinaa.

2. Asiane a ɛwɔ mogya mu asikre a ɛba fam anadwo.

1. Asikre dodow a ɛkɔ soro wɔ mogya mu bere nyinaa

Asikre a ɛwɔ wo mogya mu a ɛkɔ soro nnɔnhwerew kakraa bi anɔpa biara no nyɛ papa mma asikreyare a wodi ho dwuma nyinaa. Ɛbɛtumi ama wo `A1C` boɔ akɔ soro. `A1C` yɛ sɔhwɛ a ɛma wunya adwene wɔ asikre dodow a ɛwɔ wo mogya mu wɔ asram abiɛsa a atwam no mu. `A1C` bo a ɛkɔ soro wɔ bere tenten mu no ma asiane a ɛwɔ hɔ sɛ wubenya nsɛnnennen a efi asikreyare mu ba no yɛ kɛse.

• Aniwa a ɛsɛe (Retinopathy) .
• Asaabo a ɛsɛe (Nephropathy) .
• Neuropathy (ɛka ntini ahorow) .
• Koma mu yare

2. Asiane a ɛwɔ mogya mu asikre a ɛba fam anadwo

Nnipa pii hu asikre a ɛba fam ho sɛnkyerɛnne bere a asikre a ɛwɔ wɔn mogya mu no so tew sen 70 mg/dL no. Ebia wɔn ho bɛwosow, ɔkɔm de wɔn, na wɔn ho fifiri atɔ wɔn. Nanso sɛ eyi ba bere a woada a, ebia ɛbɛkyɛ dodo sɛ wubehu yare no ho sɛnkyerɛnne no na akanyan wo. Asikre a ɛkɔ fam kɛse betumi de obi nkwa ato asiane mu.

Sɛ wotaa hu sɛ asikre a ɛwɔ wo mogya mu no so tew anadwo a, hwɛ hu sɛ wo ne wo duruyɛfo bɛkasa afa ho. Ebia ɛho behia sɛ wosakra w’ayaresa nhyehyɛe no na wɔasiw ano.

Bere bɛn na ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn ampa?

Sɛ asikre a ɛdɔɔso wɔ wo mogya mu bere nyinaa bere a wosɔre anɔpa no a, mmu w’ani ngu so. Ɛho hia sɛ woka kyerɛ wo asikreyare ho oduruyɛfo. Obetumi ahwɛ w’akenkan ahorow, ahu sɛ ebia nea ɛde ba ne Somogyi nkɛntɛnso, Dawn adeyɛ no, anaa biribi foforo, na wama wo ayaresa a eye sen biara ama wo.

Asikre a ɛwɔ mogya mu a ɛkɔ soro anɔpa no betumi ayɛ abasamtu ankasa. Nanso esiane sɛ ano aduru biako biara nni hɔ a ɛfata obiara nti, ebia ebegye bere kakra ansa na woanya ano aduru a ɛfata ama wo. Nya abotare na wo ne wo duruyɛfo nyɛ adwuma. Sɛ woyɛ ho biribi mprempren a, ebetumi aboa wo kɛse ma woakwati bere tiaa ne bere tenten mu nsɛnnennen.