Hei tangata mate huka, e hia te nui o ō whakaaro mō ō taumata huka toto i te roanga o te rā? Kei te pēhea ō rātou āhua i te ata, kei te pēhea ō rātou āhua i muri i te tina, kei te pēhea ō rātou āhua i mua i te moe, tera pea kei te whakaaro tonu koe ki ēnei mea. Ko tētahi o ngā kupu e rangona ana e koe ina kōrero koe ki tō tākuta ko te 'A1C'. He maha ngā wā ka whakamahia hei tirotiro mēnā kei raro i te mana whakahaere tō mate huka. Engari, ko te A1C te katoa o te kōrero? I tēnei rā ka kōrero tātou mō tētahi tikanga hou ka hoatu ki a koe he māramatanga hohonu ake mō tō mate huka i te A1C, ā, he nui ake te whai hua. Ka kiia e mātou ko te 'Time in Range' ko te 'TIR' rānei.
He aha te Wā i te Awhe (TIR)?
Ki te kī māmā noa, ko te Wā i roto i te Awhe (TIR) te roanga o te wā i te awatea e noho tonu ai ō taumata huka toto i roto i tō "awhe whainga". I te nuinga o te wā ka inehia tēnei hei ōrau.
Tērā pea kei te whakaaro koe he aha tēnei "awhe whāinga". Mō te nuinga o ngā pakeke he mate huka Momo 1, Momo 2 rānei, engari ehara i te katoa, ko tēnei awhe whāinga he taumata huka toto i waenga i te 70 mg/dL me te 180 mg/dL .
Ko te tikanga, ka tūtohu ngā tākuta kia noho tō TIR ki runga ake i te 70% . Ko te tikanga me noho ō taumata huka ki roto i taua awhe mō te iti rawa 17 hāora i roto i ngā hāora 24 o te rā.
Me pēhea tā tātou ine i tēnei TIR?
Ko te huarahi pai rawa atu, me te huarahi māmā rawa atu hoki ki te ine tika i tō TIR ko te whakamahi i tētahi taputapu e kiia nei ko te Aroturuki Hukapapa Tonu (CGM) . He taputapu iti tēnei ka mau ki tō tinana. Ka ine, ka tuhi hoki i ngā taumata huka i roto i te wai i waenganui i tō kiri, 24 hāora ia rā. Kātahi ka taea e koe te tango i aua raraunga ki tētahi taupānga, ki tētahi pūmanawa rānei, kia kite ai koe he aha tō TIR.
Ina hoki, mā te tikanga noa o te tango toto mai i te maihao ka taea te hoatu he whakaaro mō te TIR. Engari mō tēnā me tirotiro e koe tō huka i ētahi wā i te rā. Heoi, he nui atu i tēnā te nui o ngā raraunga i whiwhihia mai i te CGM. Nō reira, he tino tika hoki te uara TIR i whiwhihia.
Mā tēnei hangarau CGM, he tokomaha ngā tāngata mate huka me ā rātou tākuta e titiro ana ki tēnei uara TIR hei aromatawai i te pai o te mahi a tā rātou whakahaere mate huka. Mā ēnei raraunga, ka taea e kōrua ko tō tākuta te whakatakoto whāinga hou me te hanga i ngā huringa e tika ana ki tā kōrua mahere maimoatanga.
Me pēhea taku tiro i tētahi pūrongo Wā i roto i te Awhe?
Ki te whakamahi koe i te CGM, ka whakaatuhia e te pūrongo TIR he pae poutū tae. He māmā noa iho tēnei ki te mārama. Ko te kakariki te tohu i te wā i roto i te awhe o ō taumata huka toto. Ko ētahi atu tae (kōwhai, karaka, whero) te tohu i te wā i waho o te awhe o ō taumata huka toto (iti, teitei rānei).
Kia titiro tātou me pēhea te whakaatu i ngā mōhiohio i roto i tētahi pūrongo CGM noa.
| Taumata huka (mg/dL) | Te tikanga (tūnga) |
|---|---|
| Iti iho i te 54 (< 54) | Tino Iti / Kei raro iho i te awhe |
| Mai i te 54 ki te 69 | Iti / I raro iho i te awhe |
| 70 ki te 180 | Kei roto i te awhe - e whakaaturia ana i te nuinga o te wā i te kākāriki. |
| 181 ki te 250 | Teitei / Kei runga ake i te awhe |
| Neke atu i te 250 (> 250) | Tino Teitei / Kei runga ake i te awhe |
Tērā pea ka rerekē te whakaaturanga o ēnei mōhiohio e tō pūrongo CGM. Mēnā he pātai āu mō tēnei, pātai atu ki tō tākuta mō ētahi whakamārama.
Kia pēhea te roa o taku Wā i roto i te Awhe?
He mea tino nui tēnei: He motuhake ki a koe te whānuitanga o tō taumata huka me te taumata TIR. Ko te tikanga, he rerekē pea ēnei i ngā whāinga a ētahi atu.
Mā kōrua ko tō tākuta e whakatau tahi ko ēhea ngā whāinga e pai ana māu. Waihoki, kāore ēnei whāinga e noho rite tonu puta noa i tō oranga, ā, ka rerekē pea i roto i te wā.
Ka whai wāhi ēnei āhuatanga ki te whakatau i ō whāinga:
- Kia pēhea te roa o tō mate huka?
- Tō tau me te roanga o te ora.
- He mate hauora anō ōu e pā ana ki te taumata huka toto? (hei tauira, te ngoikore o te mahi a ō whatukuhu, te mate puku)
- He mate manawa tōu?
- Kei te pāngia koe e te kore mōhio ki te hypoglycemia, he āhuatanga e kore ai koe e rongo i ngā tohu o te huka toto iti (hypo)?
- Kei te hapu koe, kei te tumanako rānei koe kia hapu?
Āe, me titiro tātou ki ētahi whāinga TIR e whakaaetia whānuitia ana. He taunakitanga whānui noa iho ēnei. Tērā pea he rerekē tō whāinga i tēnei.
| Ngā whāinga noa mō te nuinga o ngā pakeke he mate huka momo 1, momo 2 rānei | |
|---|---|
| Tūnga | Whāinga (ōrau o te wā i te rā) |
| I roto i te awhe kua whakaritea (70-180 mg/dL) | Neke atu i te 70% |
| Taumata iti (54-69 mg/dL) | I raro iho i te 4% |
| Taumata tino iti (< 54 mg/dL) | I raro iho i te 1% |
| Teitei o te taumata (181-250 mg/dL) | I raro iho i te 25% |
| Te taumata tino teitei (> 250 mg/dL) | I raro iho i te 5% |
| E aro ana ki te hunga e tino mōrearea ana ki te hypoglycemia | |
|---|---|
| I roto i te awhe kua whakaritea (70-180 mg/dL) | Neke atu i te 50% |
| Taumata iti (< 70 mg/dL) | I raro iho i te 1% |
| Te taumata tino teitei (> 250 mg/dL) | I raro iho i te 10% |
| Ngā whāinga mō te hunga e pāngia ana e te mate huka momo 1 i te wā e hapu ana | |
|---|---|
| I roto i te awhe noa (63-140 mg/dL) | Neke atu i te 70% |
| Taumata iti (< 63 mg/dL) | I raro iho i te 4% |
| Teitei o te taumata (> 140 mg/dL) | I raro iho i te 25% |
He rerekē pea ngā whāinga mō te mate huka hapūtanga me te mate huka momo 2 i te wā e hapū ana, nō reira he mea nui kia kōrero tahi koe me tō tākuta mō ngā whāinga e tino whai hua ana, e tino pono ana hoki mōu.
He aha te whanaungatanga i waenga i te A1C me te TIR?
He mea tino nui kia mārama ki te rerekētanga i waenganui i ēnei mea e rua.
- Ko te TIR (Time in Range) he ine e whakarato ana i ngā mōhiohio e pā ana ki ngā piki me ngā heke o ō taumata huka i roto i ngā hāora, i ngā rā rānei.
- He whakamātautau toto te A1C e whakaatu ana i te taumata huka toto toharite mō ngā marama 2-3 kua hipa .
Whakaarohia te A1C he rite ki te pānui i tētahi whakarāpopototanga o tētahi upoko o tētahi pukapuka. Ka hoatu he whakaaro iti ki a koe. Engari ko te TIR he rite ki te pānui i te upoko katoa, i ia kupu, i ia rerenga kōrero. Ka mārama te māramatanga o ngā taipitopito katoa. Kāore te A1C e hoatu he mōhiohio ki a koe mō te teitei, te iti rānei o tō huka.
He aha te take e taea ai e te A1C te whakapohehe?
Whakaarohia ēnei tāngata tokorua.
1. Tangata tuatahi: Ka rerekē haere ngā taumata huka toto i te roanga o te rā. I ētahi wā he tino iti (hypo), i ētahi wā he tino teitei.
2. Tangata tuarua: Kei te noho pumau tonu te taumata huka toto i te roanga o te rā, tata ki te 154 mg/dL.
Tērā pea he 7% te A1C o ēnei tāngata e rua, nā te mea he toharite noa iho te A1C. Heoi, he rerekē rawa ngā uara TIR o rāua. He iti iho te TIR o te tangata tuatahi. Ko te tikanga he nui ake te mōrearea o te tinana ki te pāngia e ngā pānga taha o te mate huka.
Waihoki, ko te hunga whai mate e whai ake nei ka hē pea ā rātou uara A1C:
- Te mate toto iti
- Ngā momo rerekētanga o te hemoglobin
- Te korenga o te rino
- Te haputanga
- Mate ate
I tēnei wā, kāore te TIR e whakakapi katoa i te whakamātautau A1C. Kua whakaatuhia e ngā rangahau maha ngā tau ka taea e ngā taumata A1C te tohu i tō tupono ki te whakawhanake i ngā raruraru mate huka. Koia te take e whakamahia ngātahi ai e ngā tākuta te A1C me te TIR kia whiwhi ai i tētahi pikitia tino whānui me te tika ake o tō whakahaere mate huka.
He aha te hiranga o te Wā i roto i te Awhe (TIR)?
Mā te TIR ka mārama ake te tirohanga ki ngā piki me ngā heke o te huka toto e pā ana ki te mate huka. Ko ngā mea pēnei i te kai e kainga ana e tātou, te whakakori tinana e mahia ana e tātou, ngā rongoā e tangohia ana e tātou, me ō tātou taumata ahotea katoa ka pā ki ngā taumata huka toto. Ina tirohia e koe ō raraunga TIR, ka taea e koe te mārama ki te pānga tika o ia mea ki ō taumata huka toto.
Hei tauira, whakaarohia kua pāngia koe e te kirika mō te wiki. Ina tirohia e koe tō pūrongo TIR i taua wiki, ka kite koe kua tino heke te uara TIR. Kātahi, i te wā ka pāngia koe e te mate, ka taea e koe te kōrero ki tō tākuta mō te whakarite mōna me te whakahaere i tō mate huka i mua i te wā.
Ngā raruraru o te TIR me te mate huka
Kua whakaatuhia e ngā rangahau he hononga i waenga i ngā uara TIR iti me ngā raruraru i puta mai i te mate huka.
Ka taea e te rerekētanga o te glycemic te whakanui ake i te ahotea waikura me te mumura i roto i te tinana, ka taea ai te kino i ngā pūtau o te tinana. Kua kitea e ngā rangahau ko tēnei rerekētanga nui o ngā taumata huka toto ka whakanui ake i te mōrearea o:
- Te pikinga ake o te maha o ngā mate huka toto (hypoglycemia).
- Te pikinga ake o te mōrearea o te mate pūnaha toto.
- Te ngoikore o te mahi hinengaro me te hinengaro (te mahi hinengaro).
- Te hekenga o te kounga o te oranga.
I tua atu, i kitea i roto i tētahi rangahau he nui ake te tūponotanga o te hunga mate huka momo 2 me te iti o te TIR me te nui o te huka toto ki te pāngia e te retinopathy kino e pā ana ki te mate huka. I kitea i roto i tētahi atu rangahau he hononga kaha i waenga i te iti o te TIR me te neuropathy autonomic cardiovascular.
E whakaatu ana tēnei katoa i te hiranga o te pupuri i tō uara TIR ki te taumata teitei rawa.
Me pēhea taku whakapai ake i taku wā i roto i te awhe?
Ko te huarahi matua hei whakapai ake i tō TIR ko te tautuhi tika i ngā āhuatanga e pā ana ki ō taumata huka. Tērā pea ka roa te wā. Ka rite ki tētahi whakamātautau pūtaiao mutunga kore.
Nō reira, kia atawhai ki a koe anō . Kaua e ngana ki te whakarerekē i ngā mea katoa i te wā kotahi, arotahi ki te mea kotahi i te wā kotahi.
Whakaarohia kua kite koe i muri i te parakuihi ka piki ake te taumata o te huka i roto i tō toto. Nō reira, kia aro ki ō tikanga me ō mahi i taua wā.
Hei tauira, ko ēnei mea ka piki ake te huka toto i muri i te parakuihi:
- Kua tae ki te wā ki te tango i ō rongoā mate huka (pērā i te insulin).
- Te horopeta o te rongoā.
- Te taurite o ngā kai e kainga ana e koe me ngā matūkai kei roto (ngā warowaihā, ngā ngako, ngā pūmua).
- Ētahi atu rongoā hei tango i te ata.
- Te inu i tētahi mea kei roto te kawheine, pērā i te kawhe, i te ata.
He tauira noa iho tēnei. He tino uaua te mate huka. He maha ngā huarahi hei āwhina i te whakapai ake i tō TIR. Kia maumahara tonu, i mua i te huri i tō mahere maimoatanga, kōrero ki tētahi tohunga mate huka, pērā i te endocrinologist, i te tohunga tiaki me te mātauranga mate huka whaimana (CDCES), i tō tākuta noa rānei.
He inenga hou, he inenga tino whai hua hoki te Wā i roto i te Awhe (TIR) mō te ine i te whakahaere mate huka. I te tīmatanga, tera pea he uaua ki te mārama ki ēnei mōhiohio me ngā raraunga TIR katoa. Kaua e manukanuka. Mā tō tākuta e whakamārama, e āwhina hoki i a koe ki te whakamahi i tēnei uara TIR hei painga mōu. Ka taea e kōrua te whai i te huringa o tō TIR i roto i te wā, me te whakarerekē i tā kōrua mahere whakahaere kia rite ki tēnā.
Karere Tangohia ki te Kāinga
- Ko te 'Wā i roto i te Awhe' (TIR) te ōrau o te wā e noho ana tō taumata huka toto i roto i te awhe ūnga.
- He mārama ake, he taipitopito ake hoki tēnei mō te huringa o ō taumata huka puta noa i te rā, i tō te whakamātautau A1C.
- Mā kōrua ko tō tākuta e whakatau tō whāinga TIR whaiaro. Kāore e rite mō te katoa.
- Mā te whakamahi i ngā raraunga TIR, ka taea e koe me tō tākuta te whakatau pai ake mō te maimoatanga.
- Mā te whakapai ake i tō kaute TIR, ka taea e koe te whakaiti i te mōrearea o ngā raruraru roa e pā mai ana i te mate huka.
- He haerenga tēnei. Kāore e tere te otinga o ngā mea katoa. Kia atawhai ki a koe anō, mā ngā panonitanga iti ka nui te rerekētanga.
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