Ma ke ʻano he kanaka me ka maʻi diabetes, pehea kou manaʻo e pili ana i kou pae kō koko i ka lā a pau? Pehea lākou i ke kakahiaka, pehea lākou ma hope o ka ʻaina awakea, pehea lākou ma mua o ka moe ʻana, a pēlā aku. ʻO kekahi o nā mea āu e lohe pinepine ai i ke kamaʻilio ʻana me kāu kauka ʻo ia ka huaʻōlelo 'A1C'. Hoʻohana pinepine ʻia ia e hoʻoholo ai inā ua kaohi ʻia kāu maʻi diabetes. Akā ʻo A1C anei ka moʻolelo holoʻokoʻa? I kēia lā e kamaʻilio mākou e pili ana i kahi ʻano hana hou a ʻoi aku ka pono e hāʻawi iā ʻoe i kahi ʻike hohonu o kāu maʻi diabetes ma mua o A1C. Kāhea mākou iā ia ʻo 'Time in Range' a i ʻole 'TIR'.
He aha ka Manawa ma ka Pae (TIR)?
I ka ʻōlelo maʻalahi, ʻo ka Time in Range (TIR) ka nui o ka manawa i ka lā e noho ai kou mau pae kō koko i loko o kāu "pahuhopu." Hoʻohana pinepine ʻia kēia ma ke ʻano he pakeneka.
I kēia manawa ke noʻonoʻo nei paha ʻoe i ke ʻano o kēia "pahuhopu pae". No ka hapa nui o nā pākeke me ka maʻi diabetes Type 1 a i ʻole Type 2, akā ʻaʻole nā mea āpau, ʻo kēia pae pahuhopu he pae glucose koko ma waena o 70 mg/dL a me 180 mg/dL .
ʻO ka maʻamau, ʻōlelo nā kauka e mālama i kāu TIR ma luna o 70% . ʻO ke ʻano o kēia, pono e noho kāu mau pae kō i loko o kēlā pae no ka liʻiliʻi he 17 mau hola ma waho o 24 mau hola o ka lā.
Pehea mākou e ana ai i kēia TIR?
ʻO ke ala maikaʻi loa a maʻalahi hoʻi e ana pololei i kāu TIR, ʻo ia ka hoʻohana ʻana i kahi hāmeʻa i kapa ʻia ʻo Continuous Glucose Monitor (CGM) . He hāmeʻa liʻiliʻi kēia āu e ʻaʻahu ai ma kou kino. Ana ia a hoʻopaʻa i nā pae glucose i loko o ka wai interstitial ma lalo o kou ʻili i 24 mau hola o ka lā. A laila hiki iā ʻoe ke hoʻoiho i kēlā ʻikepili i kahi polokalamu a polokalamu paha e ʻike pono ai i kāu TIR.
ʻOiaʻiʻo, ʻo ke ʻano maʻamau o ka lawe ʻana i ke koko mai kahi manamana lima hiki ke hāʻawi i kahi manaʻo o ka TIR. Akā no kēlā mea pono ʻoe e nānā i kāu kō i nā manawa he nui i ka lā. Eia nō naʻe, ʻoi aku ka nui o ka ʻikepili i loaʻa mai kahi CGM ma mua o kēlā. No laila, pololei loa ka waiwai TIR i loaʻa.
Me kēia ʻenehana CGM, nui ka poʻe me ka maʻi diabetes a me kā lākou mau kauka e nānā i kēia waiwai TIR e loiloi i ka maikaʻi o ka hana ʻana o kā lākou hoʻokele maʻi diabetes. Me kēia ʻikepili, hiki iā ʻoe a me kāu kauka ke hoʻonohonoho i nā pahuhopu hou a hana i nā hoʻololi e pono ai i kāu hoʻolālā lapaʻau.
Pehea e nānā ai i kahi hōʻike Manawa ma ka Paepae?
Inā ʻoe e hoʻohana i kahi CGM, hōʻike pinepine ka hōʻike TIR iā ʻoe i kahi pā kū pololei kala. He mea maʻalahi kēia ke hoʻomaopopo. Hōʻike ka ʻōmaʻomaʻo i ka wā i loko o ka pae kō o kou koko. Hōʻike nā kala ʻē aʻe (melemele, ʻalani, ʻulaʻula) i ka wā i waho o ka pae kō o kou koko (haʻahaʻa a kiʻekiʻe paha).
E nānā kākou pehea e hōʻike ai kahi hōʻike CGM maʻamau i ka ʻike.
| Ka pae kō (mg/dL) | Manaʻo (kūlana) |
|---|---|
| Ma lalo o 54 (< 54) | Haʻahaʻa loa / Ma lalo o ka pae |
| 54 a 69 | Haʻahaʻa / Ma lalo o ka pae |
| 70 a 180 | I loko o ka laulā - hōʻike pinepine ʻia i ka ʻōmaʻomaʻo. |
| 181 a i 250 | Kiʻekiʻe / Ma luna o ka pae |
| ʻOi aku ma mua o 250 (> 250) | Kiʻekiʻe Loa / Ma luna o ka pae |
Hiki i kāu hōʻike CGM ke hōʻike i kēia ʻike ma ke ʻano ʻē aʻe. Inā he mau nīnau kāu e pili ana i kēia, e noi i kāu kauka no ka wehewehe ʻana.
Pehea ka lōʻihi o koʻu manawa ma ka laulā?
He mea nui loa kēia: ʻO kāu pae pahuhopu glucose a me ka pahuhopu TIR he mea kū hoʻokahi iā ʻoe. ʻO ke ʻano kēia he ʻokoʻa paha lākou mai nā pahuhopu o haʻi.
E hoʻoholo pū ʻoe a me kāu kauka i nā pahuhopu kūpono loa iā ʻoe. Eia kekahi, ʻaʻole like kēia mau pahuhopu i kou ola a hiki ke loli i ka hala ʻana o ka manawa.
Pono nā kumu e like me kēia i ka hoʻoholo ʻana i kāu mau pahuhopu:
- ʻEhia ka lōʻihi o kou maʻi diabetes?
- Kou mau makahiki a me kou manaʻolana ola.
- Loaʻa iā ʻoe nā maʻi ʻē aʻe e hoʻopilikia ai i kou pae kō koko? (e laʻa, ka hana ʻino o nā puʻupaʻa, gastroparesis)
- He maʻi cardiovascular kou?
- Loaʻa iā ʻoe ka hypoglycemia ununawantness, kahi kūlana kahi āu e ʻike ʻole ai i nā hōʻailona o ke kō koko haʻahaʻa (hypo)?
- Ke hāpai nei ʻoe a ke manaʻolana nei paha e hāpai?
ʻAe, e nānā kākou i kekahi mau pahuhopu TIR i ʻae pinepine ʻia. Eia hou, he mau ʻōlelo aʻoaʻo laulā wale nō kēia. ʻOkoʻa paha kāu pahuhopu mai kēia.
| Nā pahuhopu maʻamau no ka hapa nui o nā pākeke me ka maʻi diabetes Type 1 a i ʻole Type 2 | |
|---|---|
| Kūlana | Pahuhopu (pakeneka o ka manawa i ka lā) |
| I loko o ka pae i kuhikuhi ʻia (70-180 mg/dL) | Ma ka liʻiliʻi he 70% |
| Pae haʻahaʻa (54-69 mg/dL) | Ma lalo o 4% |
| Haʻahaʻa loa ka pae (< 54 mg/dL) | Ma lalo o 1% |
| Pae kiʻekiʻe (181-250 mg/dL) | Ma lalo o 25% |
| Kiʻekiʻe loa ka pae (> 250 mg/dL) | Ma lalo o 5% |
| Kuhi ʻia i nā poʻe i pilikia nui o ka hypoglycemia | |
|---|---|
| I loko o ka pae i kuhikuhi ʻia (70-180 mg/dL) | Ma ka liʻiliʻi he 50% |
| Pae haʻahaʻa (< 70 mg/dL) | Ma lalo o 1% |
| Kiʻekiʻe loa ka pae (> 250 mg/dL) | Ma lalo o 10% |
| Nā pahuhopu no nā poʻe me ka maʻi diabetes Type 1 i ka wā hāpai | |
|---|---|
| I loko o ka pae maʻamau (63-140 mg/dL) | Ma ka liʻiliʻi he 70% |
| Pae haʻahaʻa (< 63 mg/dL) | Ma lalo o 4% |
| Kiʻekiʻe kiʻekiʻe (> 140 mg/dL) | Ma lalo o 25% |
ʻOkoʻa paha nā pahuhopu no ka maʻi diabetes gestational a me ka maʻi diabetes type 2 i ka wā hāpai, no laila he mea nui e kūkākūkā me kāu kauka i nā pahuhopu i kōkua nui a kūpono hoʻi iā ʻoe.
He aha ka pilina ma waena o A1C a me TIR?
He mea nui loa ia e hoʻomaopopo i ka ʻokoʻa ma waena o kēia mau mea ʻelua.
- ʻO TIR (Time in Range) kahi ana e hāʻawi i ka ʻike e pili ana i nā loli o kāu mau pae kō i loko o kekahi mau hola a i ʻole mau lā.
- ʻO A1C kahi hoʻāʻo koko e hōʻike ana i kou pae kō koko awelika i nā mahina 2-3 i hala .
E noʻonoʻo iā A1C e like me ka heluhelu ʻana i kahi hōʻuluʻulu manaʻo o kahi mokuna i loko o kahi puke. Hāʻawi ia iā ʻoe i kahi manaʻo iki. Akā, ua like ka TIR me ka heluhelu ʻana i ka mokuna holoʻokoʻa, kēlā me kēia huaʻōlelo, kēlā me kēia ʻōlelo. Loaʻa iā ʻoe nā kikoʻī āpau me ka maopopo. ʻAʻole hāʻawi ka A1C iā ʻoe i kekahi ʻike e pili ana i ke kiʻekiʻe a i ʻole ka haʻahaʻa o kāu kō.
No ke aha e hiki ai i kahi A1C ke alakaʻi hewa?
E noʻonoʻo i kēia mau kānaka ʻelua.
1. Kanaka mua: Kūlohelohe kona pae kō koko i ka lā a pau. I kekahi manawa haʻahaʻa loa (hypo), i kekahi manawa kiʻekiʻe loa.
2. Kanaka ʻelua: Ke kūpaʻa mau nei kona pae kō koko i ka lā a pau, ma kahi o 154 mg/dL.
Loaʻa paha i kēia mau kānaka ʻelua kahi A1C o 7%. No ka mea, he awelika wale nō ka A1C. Eia nō naʻe, ʻokoʻa loa kā lākou mau waiwai TIR. ʻOi aku ka haʻahaʻa o ka TIR o ke kanaka mua. ʻO ia hoʻi, ʻoi aku ka nui o ka pilikia o ko lākou kino i ka loaʻa ʻana o nā hopena ʻaoʻao o ka maʻi diabetes.
Eia kekahi, hiki i nā poʻe me nā kūlana ma lalo nei ke loaʻa nā waiwai A1C pololei ʻole:
- Anemia
- Nā ʻano like ʻole o ka hemoglobin
- Ka nele i ka hao
- Hāpai keiki
- Maʻi akepaʻa
I kēia manawa, ʻaʻole e pani piha ʻo TIR i ka hoʻāʻo A1C. Ua hōʻike ʻia nā makahiki he ʻumi o ka noiʻi ʻana e hiki i nā pae A1C ke wānana i kou pilikia o ka loaʻa ʻana o nā pilikia maʻi diabetes. ʻO ia ke kumu e hoʻohana pū ai nā kauka i ka A1C a me TIR e kiʻi i kahi kiʻi piha a pololei hoʻi o kāu hoʻokele maʻi diabetes.
No ke aha he mea nui ka manawa ma ka laulā (TIR)?
Hāʻawi ʻo TIR iā ʻoe i kahi kiʻi maopopo loa o nā loli o ke kō koko e hele mai me ka maʻi diabetes. ʻO nā mea e like me ka meaʻai a mākou e ʻai ai, ka hoʻoikaika kino a mākou e hana ai, nā lāʻau lapaʻau a mākou e lawe ai, a me ko mākou pae kaumaha e pili ana i nā pae kō koko. Ke nānā ʻoe i kāu ʻikepili TIR, hiki iā ʻoe ke hoʻomaopopo pehea e pili pololei ai kēlā me kēia mea i kāu mau pae kō koko.
Eia kekahi laʻana, e noʻonoʻo ua loaʻa iā ʻoe ke kuni no hoʻokahi pule. Ke nānā ʻoe i kāu hōʻike TIR i kēlā pule, ʻike ʻoe ua hāʻule nui kāu waiwai TIR. A laila, i ka manawa aʻe e maʻi ai ʻoe, hiki iā ʻoe ke kamaʻilio me kāu kauka e pili ana i ke ʻano o ka hoʻomākaukau ʻana no ia mea a me ka mālama ʻana i kāu maʻi diabetes ma mua.
Nā pilikia TIR a me ka maʻi diabetes
Ua hōʻike ʻia e ka noiʻi aia kahi pilina ma waena o nā waiwai TIR haʻahaʻa a me nā pilikia i hoʻokumu ʻia e ka maʻi diabetes.
Hiki i ka loli o ke glycemic ke hoʻonui i ke kaumaha oxidative a me ka mumū i loko o ke kino, hiki ke hōʻino i nā cell i loko o ke kino. Ua ʻike ʻia e ka noiʻi ʻana ua hoʻonui kēia loli kiʻekiʻe i nā pae kō koko i ka pilikia o:
- Hoʻonui ʻia ka nui o ka hypoglycemia.
- Hoʻonui ʻia ka pilikia o ka maʻi cardiovascular.
- Ka hōʻino ʻana o ka hana noʻonoʻo a me ka noʻonoʻo (hana noʻonoʻo).
- Ka emi ʻana o ke ʻano o ke ola.
Eia kekahi, ua ʻike ʻia kekahi noiʻi he ʻoi aku ka nui o ka loaʻa ʻana o nā maʻi diabetes Type 2 me ka TIR haʻahaʻa a me ke ʻano o ke kō koko kiʻekiʻe i nā hihia koʻikoʻi o ka retinopathy e pili ana i ka maʻi diabetes. Ua ʻike ʻia kekahi noiʻi ʻē aʻe i kahi pilina ikaika ma waena o ka TIR haʻahaʻa a me ka neuropathy autonomic cardiovascular.
Hōʻike kēia mau mea a pau i ke koʻikoʻi o ka mālama ʻana i kāu waiwai TIR ma ka pae kiʻekiʻe loa.
Pehea e hiki ai iaʻu ke hoʻonui i koʻu manawa ma ka mākeke?
ʻO ke ala nui e hoʻomaikaʻi ai i kāu TIR, ʻo ia ke ʻike pono i nā mea e hoʻopilikia nei i kāu pae kō. Hiki i kēia ke lōʻihi. Hiki ke manaʻo maoli ʻia he hoʻokolohua ʻepekema pau ʻole.
No laila, e lokomaikaʻi iā ʻoe iho . Mai ho'āʻo e hoʻololi i nā mea āpau i ka manawa hoʻokahi, e kau i ka manaʻo ma ka mea hoʻokahi i ka manawa hoʻokahi.
E noʻonoʻo ʻoe ua ʻike ʻoe ʻaʻole e hele wale ana kou pae kō koko ma waho o ka palena ma hope o ka ʻaina kakahiaka i kēlā me kēia lā. No laila, e makaʻala i kāu mau hana a me kāu mau hana i kēlā manawa.
Eia kekahi laʻana, hiki i nā mea e like me kēia ke hoʻonui i ke kō koko ma hope o ka ʻaina kakahiaka:
- Ua hiki i ka manawa e lawe ai i kāu lāʻau lapaʻau maʻi diabetes (e like me ka insulin).
- ʻO ka nui o ka lāʻau lapaʻau.
- ʻO ke kaulike o nā meaʻai āu e ʻai ai a me nā meaolaola i loko (nā kalapona, nā momona, nā protein).
- Nā lāʻau lapaʻau ʻē aʻe e lawe i ke kakahiaka.
- Ka inu ʻana i kahi mea i loaʻa ka caffeine, e like me ke kofe, i ke kakahiaka.
He hoʻokahi wale nō laʻana kēia. He maʻi paʻakikī loa ka maʻi diabetes. Nui nā ala e kōkua ai i ka hoʻomaikaʻi ʻana i kāu TIR. E hoʻomanaʻo mau, ma mua o ka hana ʻana i kekahi hoʻololi i kāu hoʻolālā lapaʻau, e kamaʻilio me kahi mea loea i ka maʻi diabetes, e like me ka endocrinologist a i ʻole kahi loea mālama a me ka hoʻonaʻauao maʻi diabetes i hōʻoia ʻia (CDCES), a i ʻole ma ka liʻiliʻi o kāu kauka maʻamau.
ʻO ka Manawa ma ka Pae (TIR) he ana hou a he mea pono loa ia no ke ana ʻana i ka hoʻokele maʻi diabetes. I ka wā mua, he mea paʻakikī paha ke hoʻomaopopo i kēia ʻike a me nā ʻikepili TIR āpau. Akā, mai hopohopo. E wehewehe kāu kauka i nā mea āpau a kōkua iā ʻoe e hoʻohana i kēia waiwai TIR no kou pono. I ka hui pū ʻana, hiki iā ʻoe ke hahai i ke ʻano o ka loli ʻana o kāu TIR i ka hala ʻana o ka manawa a hoʻoponopono i kāu hoʻolālā hoʻokele e like me ia.
Leka Lawe-Home
- ʻO ka 'Manawa ma ka Pae' (TIR) ka pakeneka o ka manawa e noho ai kou pae kō koko i loko o ka pae i manaʻo ʻia.
- Hāʻawi kēia i kahi kiʻi maopopo loa a kikoʻī hoʻi o ke ʻano o ka loli ʻana o kāu mau pae kō i ka lā ma mua o ka hoʻāʻo A1C.
- Hoʻoholo ʻia kāu pahuhopu TIR pilikino e ʻoe a me kāu kauka pū. ʻAʻole like ia no nā kānaka a pau.
- Me ka hoʻohana ʻana i ka ʻikepili TIR, hiki iā ʻoe a me kāu kauka ke hana i nā hoʻoholo maikaʻi aʻe e pili ana i ka lāʻau lapaʻau.
- Ma ka hoʻomaikaʻi ʻana i kāu helu TIR, hiki iā ʻoe ke hōʻemi i ka pilikia o nā pilikia lōʻihi i hoʻokumu ʻia e ka maʻi diabetes.
- He huakaʻi kēia. ʻAʻole e holo koke nā mea āpau. E lokomaikaʻi iā ʻoe iho, hiki i nā hoʻololi liʻiliʻi ke hana i kahi ʻokoʻa nui.
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