He aha ka manaʻo o "Time in Range (TIR)" no ʻoukou ka poʻe i loaʻa i ka maʻi diabetes? E ʻike pono kākou!

Loaʻa iā ʻoe ka maʻi diabetes? A i ʻole kekahi o kou ʻohana a i ʻole he hoaaloha i loaʻa i ka maʻi diabetes? A laila ua lohe paha ʻoe, a ua kamaʻilio paha kāu kauka e pili ana i kēia mea i kapa ʻia ʻo 'Time in Range'. No laila, e kamaʻilio kākou e pili ana i ia mea me ka maʻalahi a me ka maopopo i kēia lā. ʻOiai he mea hou kēia, he mea ia e kōkua nui ai i ka kaohi ʻana i ka maʻi diabetes.

He aha kēia "Manawa ma ka Pae" (TIR)?

I ka ʻōlelo maʻalahi, ʻo "Time in Range" (TIR) ​​​​ka nui o ka manawa e hiki ai i kahi kanaka me ka maʻi diabetes ke mālama i ko lākou pae kō koko (glucose) i loko o kahi pae i manaʻo ʻia . E noʻonoʻo i kāu kauka e haʻi aku ana iā ʻoe e mālama i kāu mau pae kō koko ma waena o kēia pae a me kēia pae. Ana kēia i ka lōʻihi o kou noho ʻana i loko o kēlā pae.

No ka hapa nui o ka poʻe me ka maʻi diabetes, ʻo ka poʻe me ka Type 1 Diabetes a me nā pākeke me ka Type 2 Diabetes, ʻo kēia pae pahuhopu ma waena o 70 a me 180 milligrams i kēlā me kēia deciliter (mg/dL) . Akā, ʻaʻole like kēia no kēlā me kēia kanaka, a hiki ke ʻokoʻa mai kēlā kanaka a kēia kanaka. Ana ʻia ka TIR ma ke ʻano he pakeneka . ʻŌlelo pinepine nā kauka e hoʻāʻo e mālama i kāu TIR ma luna o 70% . ʻO ia hoʻi, pono ke kō o kou koko i loko o kēlā pae no ka liʻiliʻi he 17 mau hola mai loko mai o 24 mau hola o ka lā. ʻO ia ka manawa e hiki ai iā ʻoe ke noʻonoʻo ua kāohi maikaʻi ʻia kāu maʻi diabetes.

Pehea ʻoe e ana pololei ai i kēia TIR?

ʻO ke ala maʻalahi a pololei hoʻi e ʻike ai i kāu TIR, ʻo ia ka hoʻohana ʻana i kahi Continuous Glucose Monitor (CGM) . Ua lohe paha ʻoe i kēia hāmeʻa ma mua. He hāmeʻa liʻiliʻi ia e hiki ke hoʻokomo ʻia ma lalo o ka ʻili o kou lima a ʻōpū paha . ʻOiai ʻoe e ʻaʻahu ana, ana mau 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. Ua like ia me kahi mākaʻi liʻiliʻi e ʻimi nei i kāu kō. A laila hiki iā ʻoe ke hoʻoiho i kēia ʻikepili glucose me ka hoʻohana ʻana i nā polokalamu i hoʻopili ʻia i ka hāmeʻa CGM a i ʻole kahi polokalamu ma kāu kelepona a hahai i kāu TIR.

ʻOiaʻiʻo, hiki iā ʻoe ke loaʻa kahi manaʻo maʻamau o kāu TIR ma ka hana ʻana i kahi ʻōkuʻi lima lima . Akā inā ʻoe e hana i kēlā, pono ʻoe e nānā i kou kō koko i nā manawa he nui i ka lā . ʻOiai i kēlā manawa, ʻaʻole ia e hāʻawi i ka ʻikepili kikoʻī e like me ka 'CGM'. E noʻonoʻo e like me ka hoʻohuli ʻana i nā ʻaoʻao o kahi puke. Akā ʻo ka 'CGM' ua like ia me ka heluhelu ʻana i ka puke holoʻokoʻa! Hāʻawi ia iā ʻoe i kahi kiʻi piha o kou mau pae kō koko.

Ma muli o kēia mau mīkini 'CGM', ke hoʻohana nei ka poʻe he nui me ka maʻi diabetes a me kā lākou mau kauka i kēia TIR e kōkua iā lākou e mālama i kā lākou maʻi diabetes.E loiloi pololei i kāu ʻikepili TIR. Ma ka nānā ʻana i kāu ʻikepili TIR, 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 ke ʻano o kēia hōʻike TIR?

Ma kēia mau hōʻike TIR, i loaʻa mai ka polokalamu ma nā mīkini CGM, ʻike pinepine ʻia nā pae like ʻole o kāu mau pae kō ma ke ʻano he kaha kū pololei kala . He mea maʻalahi loa ke hoʻomaopopo.

• Hōʻike ʻia ka manawa i loko o ka pae kō i ka ʻōmaʻomaʻo . ʻO kēia ka mea a mākou e hoʻoikaika nei e hoʻomaikaʻi.
• ʻO nā pae ʻē aʻe, ʻo ia hoʻi nā manawa i haʻahaʻa a kiʻekiʻe paha nā pae kō, ua hōʻike ʻia i nā kala ʻē aʻe e like me ka melemele, ʻalani, a me ka ʻulaʻula .

Eia ke ʻano o ka hōʻike ʻia ʻana o kēia mau pae ma kahi hōʻike `CGM` maʻamau (mai lalo a luna):

• Ma lalo o 54 mg/dL (< 54 mg/dL) — Haʻahaʻa loa (ma lalo o ka pahuhopu). E ʻike ʻia kēia me he ʻulaʻula lā. Hiki ke lilo i kūlana weliweli kēia.
• Ma waena o 54 mg/dL a me 69 mg/dL — Haʻahaʻa (ma lalo o ka pahuhopu). Hiki ke nānā aku kēia i ka ʻalani. He wahi kēia e pono ai ke nānā aku.
• Ma waena o 70 mg/dL a me 180 mg/dL — i loko o ka laulā. ʻO ia ka mea i loko o ka ʻōmaʻomaʻo . Ke hoʻāʻo nei mākou a pau e hoʻonui i kēia ʻāpana ʻōmaʻomaʻo!
• Ma waena o 181 mg/dL a me 250 mg/dL — kiʻekiʻe (ma luna o ka pahuhopu). Me he melemele lā kēia.
• ʻOi aku ma mua o 250 mg/dL (> 250 mg/dL) — Kiʻekiʻe loa (ma luna o ka pahuhopu). Hōʻike pū ʻia kēia ma ke ʻano he kala ʻulaʻula. Inā hoʻomau kēia, ʻaʻole maikaʻi.

Akā e hoʻomanaʻo, hiki i kekahi mau hōʻike CGM ke hōʻike i kēia ʻikepili ma ke ʻano ʻē aʻe. Inā pilikia ʻoe i ka hoʻomaopopo ʻana i kēia ʻike, he manaʻo maikaʻi loa ia e kamaʻilio me kāu kauka . Hiki iā lākou ke wehewehe iā ʻoe.

ʻEhia ke kumukūʻai o kaʻu TIR?

Inā loaʻa iā ʻoe ka maʻi diabetes, ʻo ka pae pahuhopu no kou pae kō koko he mea kū hoʻokahi ia iā ʻoe . ʻO ia hoʻi, ʻaʻole like kāu pae pahuhopu me kaʻu. E hoʻoholo pū ʻoe a me kāu kauka i ka pae pahuhopu kūpono loa iā ʻoe a me ka nui o ia pae āu e makemake ai e noho. Hiki ke loli kēia mau pahuhopu i kou ola a pau.

Aia kekahi mau kumu e hiki ke hoʻopilikia i nā pahuhopu glucose:

• ʻEhia ka lōʻihi o kou maʻi diabetes ?
• Kou mau makahiki a me kou olakino laulā .
• Loaʻa iā ʻoe nā pilikia olakino ʻē aʻe e hoʻopilikia ai i kāu pae kō koko, e like me ka hana ʻino ʻana o ka puʻupaʻa a i ʻole ka gastroparesis .
• Inā loaʻa iā ʻoe nā maʻi cardiovascular .
• ʻO kahi kūlana kahi āu i ʻike ʻole ai i nā hōʻailona o ke kō koko haʻahaʻa (hypoglycemia unawareness)Inā aia. ʻO ia hoʻi, inā ʻaʻole ʻoe e manaʻo i ka poniuniu a me ka hou āu e ʻike ai i ka wā e hāʻule ai kou pae kō, he mea pilikia iki ia.
• Inā ʻoe e hāpai ana a i ʻole e hoʻāʻo ana e hāpai , loli nui kāu mau pahuhopu i kēia mau manawa.

ʻAe, e nānā kākou i nā ʻōlelo aʻoaʻo maʻamau i hāʻawi pinepine ʻia.

Nā pahuhopu TIR no ka hapa nui o nā pākeke me ka maʻi diabetes type 1 a i ʻole type 2:

• Ma ka liʻiliʻi he 70% o ka manawa ma waena o 70 a me 180 mg/dL (i loko o ka pae i kuhikuhi ʻia).
• ʻO ka manawa ma lalo o 54 mg/dL e emi iho ma mua o 1%.
• Pono ka manawa ma waena o 54 a me 69 mg/dL ma lalo o 4%.
• Pono ka manawa ma waena o 181 a me 250 mg/dL ma lalo o 25%.
• ʻO ka manawa ma luna o 250 mg/dL pono e emi iho ma mua o 5%.

Nā pahuhopu TIR no nā poʻe i ʻoi aku ka nui o ka pilikia o ke kō koko haʻahaʻa (hypoglycemia):

ʻO kēia no ka poʻe i loaʻa pinepine ke kō koko haʻahaʻa.

• Ma ka liʻiliʻi he 50% o ka manawa ma waena o 70 a me 180 mg/dL (i loko o ka pae maʻamau).
• ʻO ka manawa i hoʻolilo ʻia ma lalo o 70 mg/dL e emi iho ma mua o 1%.
• ʻO ka manawa ma luna o 250 mg/dL pono e emi ma lalo o 10%.

Nā pahuhopu TIR no nā pākeke me ka maʻi diabetes type 1 i ka wā hāpai:

He mea nui loa kēia, no ka mea, hiki ke hoʻopilikia i ke keiki.

• Ma ka liʻiliʻi he 70% o ka manawa, aia ma waena o 63 a me 140 mg/dL (ma ka pae maʻamau). He ʻokoʻa iki ka pae ma ʻaneʻi, ʻike ʻoe? He mea nui loa ia e kaohi i kāu mau pae kō i ka wā hāpai.
• ʻO ka manawa ma lalo o 63 mg/dL e emi iho ma mua o 4%.
• ʻO ka manawa ma luna o 140 mg/dL pono e emi ma lalo o 25%.

ʻOkoʻa paha nā alakaʻi no ka maʻi diabetes gestational a me ka maʻi diabetes type 2 i ka wā hāpai. Eia hou, he mau alakaʻi laulā kēia. He mea nui e kūkākūkā me kāu kauka i nā pahuhopu glucose e pono loa a kūpono hoʻi nou. E aʻo lākou iā ʻoe i ke ala hana maikaʻi loa no kou kūlana.

He aha ka pilina ma waena o kēia TIR a me A1C?

Ua lohe paha ʻoe i kēia hoʻāʻo A1C . Hoʻohana ka nui o nā kauka iā ia e ʻike i ke ʻano o ka mālama ʻia ʻana o kāu maʻi diabetes. No laila, ua like anei ʻo TIR a me A1C? ʻAe, he wahi iki.

Ana ʻo TIR i ka pae o kāu mau pae glucose i loko o kekahi manawa, mai kekahi mau hola a i kekahi mau lā, ʻoiai ʻoe e komo ana i kahi CGM. Ua like ia me kahi kiʻi pōkole . Hiki iā ʻoe ke ʻike pololei i ke ʻano o ka loli ʻana o kāu kō i kēlā me kēia lā.

Eia nō naʻe, he hoʻāʻo koko ʻo A1C i hana ʻia ma kahi keʻena hoʻokolohua . Ana ia i kou pae glucose awelika i nā pule 8 a 12 i hala . ʻAʻole hiki i kahi hoʻāʻo A1C ke haʻi iā ʻoe pehea e loli ai kou kō koko. Hāʻawi wale ia i kahi waiwai awelika.

I ka ʻōlelo maʻalahi:

E noʻonoʻo i kēia ʻano: Ua like ʻo A1C me ka heluhelu ʻana i kahi hōʻuluʻulu mokuna o kahi puke.Akā, ʻo ka hoʻohana ʻana i kahi `CGM` a me ka nānā ʻana i ka TIR ua like ia me ka heluhelu ʻana i ka mokuna holoʻokoʻa . A laila loaʻa iā ʻoe kahi ʻike hohonu a ʻoi aku ka maopopo o ia mea. Maopopo iā ʻoe? Hōʻike maopopo ka TIR i ke ʻano o ke kō i nā manawa like ʻole o ka lā, ma hope o ka ʻai ʻana, ma hope o ka hoʻoikaika kino.

Mai ka makahiki 1960, ua hilinaʻi nui nā kauka a me nā maʻi diabetes i ka A1C e ana i ka maikaʻi o ka hoʻokele ʻana i ka maʻi diabetes. Eia nō naʻe, mai ka hiki ʻana mai o nā mīkini CGM, ua ʻike nā kauka a me nā maʻi e hāʻawi ana kēia TIR i kahi kiʻi ʻoi aku ka pono a me ka pololei o ka hoʻokele ʻana i ka maʻi diabetes .

ʻOi loa aku no ka poʻe me ka maʻi diabetes Type 1 , hiki ke loli nui nā pae kō koko i nā lā, nā pule, a me nā mahina. No laila, ʻaʻole ka awelika o ka waiwai A1C he ana pololei ia o kā lākou mālama ʻana.

Eia kekahi laʻana, e noʻonoʻo:

Aia kekahi kanaka nona nā pae kō koko e piʻi mau ana i lalo loa a kiʻekiʻe loa hoʻi. Akā, he 7% paha ko lākou A1C.

Aia kekahi kanaka ʻē aʻe nona ke kiʻekiʻe o ke kō koko i paʻa ma kahi o 154 mg/dL i ka hapa nui o ka manawa. Hiki paha i kāna A1C ke 7%.

ʻIke ʻoe? ʻOiai like ko lākou A1C, hiki ke ʻokoʻa loa kā lākou mau waiwai TIR. ʻOi aku ka haʻahaʻa o ka TIR o ke kanaka mua no ka mea aia mau ʻo ia ma waho o ka pae i manaʻo ʻia. ʻOi aku kona pilikia no ka hypoglycemia.

Eia kekahi, ʻaʻole pololei paha ka hoʻāʻo A1C i nā poʻe me nā kūlana penei:

• Anemia (ka nele o ke koko).
• Nā ʻano like ʻole o ka hemoglobin.
• Ka nele i ka hao.
• Ka hāpai ʻana.
• Maʻi akepaʻa.

Hiki ke ʻokoʻa ka pololei o nā waiwai A1C ma waena o nā heluna kanaka like ʻole.

Eia nō naʻe, e like me ke kūlana o nā mea, ʻo ka hiki ʻana mai o TIR ʻaʻole ia he manaʻo e pau ka hoʻāʻo ʻana o A1C . Ua hōʻike ʻia nā makahiki he ʻumi o ka noiʻi hiki i nā pae A1C ke wānana i ka ulu ʻana a i ʻole ka pale ʻana i nā pilikia maʻi diabetes. No laila, ke hoʻohui nei nā kauka i nā hoʻāʻo TIR a me A1C e loaʻa ai kahi kiʻi piha o ka hoʻokele glucose.

No ke aha he mea nui kēia TIR?

Hāʻawi ʻo TIR iā ʻoe i kahi kiʻi pololei o nā loli o nā pae glucose e hele mai me ka maʻi diabetes. E noʻonoʻo e pili ana i ka nui o nā mea e hoʻopilikia ai i kāu mau pae kō, e like me ka meaʻai āu e ʻai ai, ka hoʻoikaika kino āu e hana ai, nā lāʻau lapaʻau āu e lawe ai, a me kou pae kaumaha ! No laila, ʻo ka nānā ʻana i kāu ʻikepili TIR (ʻoi aku hoʻi i ka wā e hoʻohana ai i kahi 'CGM') hiki ke hāʻawi iā ʻoe i kahi ʻike maikaʻi aʻe i ke ʻano o ka hoʻopilikia pololei ʻana o kēia mau mea like ʻole i kāu mau pae glucose .

Eia kekahi laʻana, e ʻike paha ʻoe ua emi iho kāu TIR ke loaʻa iā ʻoe ke kuni no hoʻokahi pule. A i ʻole, e ʻike paha ʻoe ua piʻi nui kou kō koko ma hope o ka ʻai ʻana i kahi meaʻai kikoʻī, a ua emi iho kāu TIR. Ke ʻike ʻoe i kahi mea e like me ia, hiki iā ʻoe ke nīnau i kāu kauka, 'Pehea e hiki ai iaʻu ke hoʻomākaukau maikaʻi e kāohi i kaʻu maʻi diabetes i ka manawa aʻe e maʻi ai au?' A i ʻole, e noʻonoʻo paha ʻoe, 'Pehea ka hopena o kēlā ʻano meaʻai iaʻu, a pono anei iaʻu e hoʻololi i ke ʻano o kaʻu ʻai ʻana?' I nā huaʻōlelo ʻē aʻe, hiki i ka TIR ke lilo i mea kōkua nui i ka hoʻokele ʻana i kāu maʻi diabetes ma ke ʻano e kūpono i kou nohona .

Hiki ke loaʻa nā pilikia maʻi diabetes inā emi ka TIR?

Ke hoʻomau nei ka noiʻi ʻana i kēia, akā ua ʻike ʻia nā noiʻi o kēia manawa i ka emi ʻana o nā pae TIR, piʻi aʻe ka pilikia o nā pilikia e pili ana i ka maʻi diabetes .

Ua hōʻike ʻia nā haʻawina e hiki i nā loli nui o ke kō koko (i kapa ʻia ʻo glycemic variability) ke hoʻonui i ke kaumaha oxidative a me ka mumū i loko o ke kino. Hiki i kēia mau kūlana ke hōʻino i nā cell . Ua hoʻopili kekahi mau haʻawina i kēia mau loli glucose nui i:

• Hoʻonui ʻia ka pilikia o ke kō koko haʻahaʻa (hypoglycemia).
• Hoʻonui ʻia ka pilikia o ka maʻi cardiovascular.
• Ka hōʻino ʻana o ka 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 pilikia o ka poʻe me ka maʻi diabetes type 2 i loaʻa ka TIR haʻahaʻa a me ke ʻano glycemic kiʻekiʻe o ka retinopathy e pili ana i ka maʻi diabetes, kahi pilikia o ka maʻi diabetes e hoʻopilikia ai i nā maka . Ua ʻike ʻia kekahi noiʻi ʻē aʻe ua pili nui ka TIR haʻahaʻa me ka nui o ka pilikia o ka neuropathy autonomic cardiovascular, kahi maʻi nerve e hoʻopilikia ana i ka ʻōnaehana cardiovascular .

No laila, ke hōʻike nei kēia mau haʻawina i ke koʻikoʻi o ka mālama ʻana i kāu TIR i ke kiʻekiʻe e like me ka hiki . Ke aʻo hou aku nā mea noiʻi, hiki i nā loea maʻi diabetes ke hoʻololi i kēia mau pahuhopu TIR i ka wā e hiki mai ana.

Pehea e hoʻonui ai i kaʻu TIR?

ʻO ke kī i ka hoʻomaikaʻi ʻana i kāu TIR, ʻo ia ka ʻike pono i ka mea e hoʻopilikia nei i kāu pae glucose . Hiki i kēia ke lōʻihi. ʻOiaʻiʻo, hiki ke manaʻo ʻia he hoʻokolohua ʻepekema pau ʻole. No laila, he mea nui e kālele i hoʻokahi kumu i ka manawa a e lokomaikaʻi iā ʻoe iho . Mai hopohopo, a e hoʻāʻo e noʻonoʻo mālie i kēia mau mea.

Inā ʻike ʻoe e hoʻomau ka piʻi a i ʻole ka hāʻule ʻana o kāu mau glucose i kekahi mau manawa o ka lā, e nānā pono i kāu mau hana a me kāu mau hana a puni ia manawa.

Eia kekahi laʻana, e ʻike paha ʻoe e piʻi mau ana kāu mau pae glucose ma hope o ka ʻaina kakahiaka. Aia kekahi mau kumu e hiki ai ke hana ʻia kēia:

• ʻAʻole kēia ka manawa kūpono e lawe ai i kāu lāʻau maʻi diabetes (e.g. insulin ).
• ʻAʻole lawa a nui paha ka lāʻau lapaʻau.
• ʻO ke kaulike o nā meaʻai āu e ʻai ai a me nā meaola nui i loko (nā kalapona, ka momona, a me ka protein) . Ke ʻai nui nei paha ʻoe i nā kalapona.
• Nā lāʻau lapaʻau ʻē aʻe e lawe i ke kakahiaka (hiki i kekahi mau lāʻau lapaʻau ke hoʻopilikia i nā pae kō koko).
• ʻO ka inu ʻana i nā mea inu i loaʻa ka caffeine e like me ke kofe i ke kakahiaka (hoʻopilikia kēia i kekahi poʻe).

He hoʻokahi wale nō laʻana kēia. He maʻi paʻakikī loa ka maʻi diabetes. Aia kekahi mau hoʻolālā e hiki ke kōkua iā ʻoe e hoʻomaikaʻi i kāu TIR. E like me nā manawa a pau, ke noʻonoʻo nei ʻoe e hana i nā hoʻololi i kāu hoʻolālā hoʻokele, ʻoi aku ka maikaʻi o ka hana pū ʻana me kahi loea maʻi diabetes (e.g., he endocrinologist) a i ʻole he loea mālama a me ka hoʻonaʻauao maʻi diabetes i hōʻoia ʻia (CDCES) . Hiki iā lākou ke alakaʻi iā ʻoe ma o ke kaʻina hana a pane i kāu mau nīnau.

Leka Lawe-Home

No laila, ʻo kēia "Manawa ma ka Pae" (TIR) ​​he ala hou a pono loa ia no ka poʻe me ka maʻi diabetes e ana i kā lākou hoʻokele glucose. Hiki i ka hoʻomaopopo ʻana i ka ʻike TIR a me kāu ʻikepili glucose ke manaʻo iki he paʻakikī. Mai hopohopo, hiki iā ʻoe ke maʻa iki iā ia.

E hoʻomanaʻo, aia mau kāu kauka ma laila e kōkua iā ʻoe e hoʻomaopopo i kāu TIR a hoʻohana iā ia 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 mau hoʻolālā hoʻokele e like me ia. He paʻakikī ke ola me ka maʻi diabetes, akā me nā mea hana hou e like me kēia, hiki ke maʻalahi iki. ʻAʻole ʻoe hoʻokahi, a he nui ka poʻe e hiki ke kōkua iā ʻoe ma kēia huakaʻi.

`Maʻi diabetes, Manawa i loko o ka laulā, TIR, Glucose, Pae kō koko, CGM, A1C