Ese uhita wumva ubukonje, ibyuya, no kuzunguza? Bishobora kuba ari insulinoma! Reka tubiganireho.

Ese wigeze ugira isereri, kubabara umutwe, no gutera ubwoba mu buryo butunguranye, nk'igihe isukari mu maraso yawe igabanuka? Hari igihe utekereza ko ibi biterwa nuko ushonje gusa, ariko gake cyane, hashobora kubaho indi mpamvu ibitera. Uyu munsi, tugiye kuvuga ku ndwara idakunze kugaragara ariko y'ingenzi ugomba kumenya. Iyo ni indwara yitwa insulinoma.

Iyi insulinoma ni iki?

Muri make, insulinoma ni ikibyimba gito kitari kanseri kivuka muri pancreas yacu. Ubu ushobora kwibaza icyo iyi pancreas ari cyo. Pancreas ni urugingo ruto ariko rufite akamaro cyane ruherereye mu nda yacu, inyuma y'igifu. Ikora imisemburo idufasha gusya ibyo turya, ndetse n'imisemburo yitwa insuline, igenzura urugero rw'isukari mu maraso yacu.

Rero, iyo iyi insulinoma itangiye, ituma insuline nyinshi isohoka mu maraso yacu kuruta uko bikwiye. Ni nk'amazi yazibye ahora ava.

Izi insulinoma ni ubwoko bw'ikibyimba cy'ubwonko gikura mu icuraburindi ryitwa Pancreatic Neuroendocrine Tumors (pNETs). Izi ni ibibyimba bidakunze kugaragara. Igice cyiza ni uko 85% kugeza 90% by'izi insulinomas atari ibyimbi/ibyimbi. Ibi bivuze ko zidakwirakwira mu bindi bice by'umubiri bitari irya pancreas. Ariko, ni gake cyane, zishobora guhinduka ibyimbi/ibibyimbi. Iyo bibayeho, birashoboka cyane ko byakwirakwira mu tunyangingo tw'amaraso no mu mwijima.

Insulinoma igira ingaruka zite ku mubiri?

Navuze mbere ko insulinoma ari ikibyimba gitanga insuline nyinshi cyane. None se, bigenda bite iyo insuline nyinshi? Inshingano nyamukuru ya insuline ni ukujyana isukari (tuyita kandi glucose) mu maraso ikayishyira mu turemangingo. Hanyuma uturemangingo duha ingufu. Ariko iyo insuline nyinshi, ingano y'isukari mu maraso igabanuka mu buryo butunguranye. Ibi tubyita hypoglycemia . Mu rurimi rwa Sinhala, bivuze kugabanuka kw'isukari mu maraso.

Iyo isukari yawe mu maraso igabanutse gutya, utangira kugira ibimenyetso.

Tekereza, wariye ifunguro rya mu gitondo, wagiye mu biro, kandi uri ku kazi. Uhita wumva ubabara, ubyiye ibyuya, uzungera, kandi ufite umutwe ukennye. Ni nk'aho unaniwe kandi ushonje.

Mu bihe nk'ibi, iyo uriye cyangwa unyoye vuba ikintu kiryoshye, nk'umutobe w'amapera, igikombe cy'icyayi kirimo isukari, cyangwa imineke, utangira kumva umeze neza nyuma y'igihe runaka.

Ariko, kugira isukari nke mu maraso nk'iyi, cyane cyane utazi impamvu yayo kandi utazi igihe izongera kubaho, biteye ubwoba cyane. Rero, ni byiza guhora ubika akantu gato, nka tofe, hafi yawe. Nanone, niba warahuye n'iki kibazo, ugomba kujya kwa muganga vuba bishoboka ukamubwira ibyacyo.

Ni ibihe bimenyetso by'ibi?

Ikimenyetso nyamukuru cya insulinoma, nkuko byavuzwe mbere, ni uko isukari yo mu maraso igabanuka (hypoglycemia). Ibi bishobora gutera ibimenyetso bitandukanye.

Ibimenyetso bisanzwe:

Ibi ni ibimenyetso bya mbere ushobora kubona:

• Guhuzagurika cyangwa kugorana kwibanda ku byo ukora: Nk'aho umutwe wawe uri kuzunguruka, ntushobora kwibanda ku byo ukora.
• Kubira ibyuya: Kubira ibyuya gusa, wenda ibyuya bikonje.
• Umutima utera cyane: Ukumva umutima wawe utera cyane.
• Guhangayika cyangwa kurakara: Guhangayika gusa, kurakara vuba.
• Guhinda umushyitsi: Ukumva amaguru n'amaboko byawe binyeganyega.
• Kumva inzara cyane.

Ibimenyetso bikomeye:

Iyo igipimo cy'isukari mu maraso yawe kigabanutse cyane, indwara ishobora gukomera cyane. Ushobora kugira ibimenyetso nk'ibi:

• Iyerekwa rirahinduka: Iyerekwa riba ritagaragara neza, nko kubona ibintu bibiri icyarimwe.
• Ingorane zo kuvuga: guceceka amagambo, kudashobora kuvuga neza.
• Kubura uburinganire cyangwa guhuza ibintu: Kuzungazunga iyo ugenda, kunyeganyega iyo ugeze ku kintu runaka.
• Indwara zo mu mutwe: Zishobora kumera nk'izirwaye.
• Gutakaza ubwenge: Ushobora gucika intege ukagwa.

Akenshi, abantu barwaye insulinoma bagira iyi sukari nke mu maraso mu gitondo, ni ukuvuga nyuma yo kubyuka nyuma y'amasaha make yo kwiyiriza ubusa nyuma yo kurya. Ibi twita "hypoglycemia yo kwiyiriza ubusa". Ariko, hari abantu bashobora kugira iyi sukari nke mu maraso ndetse na nyuma gato yo kurya.

Ibi ni ingenzi cyane: Isukari igabanuka mu maraso irashobora kubangamira imirimo yawe ya buri munsi, kandi rimwe na rimwe ishobora gutera kwangirika k'ubwonko, koma ndetse n'urupfu. Niba rero ufite ibimenyetso by'isukari igabanuka mu maraso, menya neza ko wagiye kwa muganga.

Kuki iyi insulinoma ikura?

Mu by’ukuri, abashakashatsi ntibaramenya neza impamvu uturemangingo dukora insuline muri pancreas twigabanyamo kabiri tugakora iki kibyimba mu buryo butunguranye.

Ariko hari ikintu kimwe cyavumbuwe. Ni ukuvuga ko iyi ndwara yitwa insulinoma rimwe na rimwe yitwa Multiple Endocrine Neoplasia type 1, cyangwa (MEN1).Bishobora kandi kujyana n'indwara yo mu muryango yitwa insulinoma. Ibi bibaho iyo ibibyimba byibasiwe n'uturemangingo twinshi dukora imisemburo mu mubiri wacu (urugero, imyakura ya pituitary, imyakura ya parathyroid, pancreas). Si insulinoma zose ziterwa na MEN1, ariko 5% kugeza kuri 10% bya insulinoma zose ziterwa na MEN1.

Niba abagize umuryango wawe, nka mama wawe, so wawe, cyangwa abavandimwe bawe, abaganga bababwiye ko bafite iyi ndwara (MEN1), ugomba kuvugana na muganga wawe ku bijyanye no gupima imiterere y'uturemangingo . Ibi bishobora kugufasha kumenya niba ufite iyi ndwara. Niba ufite iyi ndwara (MEN1), ibi bizamini bishobora no kugufasha kumenya iyi ndwara mbere yuko ikura.

Abaganga babibona bate?

Iyo ugiye kwa muganga, bazakubaza ibimenyetso byawe kandi bagusuzume. Hari ibimenyetso bitatu by'ingenzi bigaragaza ko ufite insulinoma. Ibi tubyita Whipple's triad .

Ni:

1. Kugira ibimenyetso by'isukari nke mu maraso (nk'izunguza no kubira ibyuya, nk'uko byavuzwe mbere)

2. Ikizamini cyemeza ko urugero rw'isukari mu maraso ruri hasi. (Ubusanzwe, ikizamini cyo gutobora urutoki kigaragaza urugero rw'isukari mu maraso ruri munsi ya 55 mg/dL)

3. Ibimenyetso biragenda neza iyo uriye cyangwa unyoye ikintu kirimo isukari (karubohidrati).

Niba ufite ibi bimenyetso uko ari bitatu, muganga wawe ashobora gukeka ko ufite insulinoma. Hanyuma azagutegeka ko hakorwa ibindi bipimo bike kugira ngo yemeze ko ufite indwara.

Ikizamini cyo kwihuta cy'amasaha 72

Iki ni cyo gipimo cy’ingenzi, "gisanzwe" cya insulinoma. Bisaba ko wiyiriza ubusa amasaha agera kuri 72. Ariko ntugire ikibazo, ibi bikorerwa mu bitaro, uyobowe na muganga cyangwa umuforomo. Ntabwo uri wenyine.

Iyo wiyirije ubusa gutya, igipimo cy'isukari mu maraso yawe kiragabanuka maze ugatangira kubona ibimenyetso, abaganga bazagufata amaraso bakagupima ibi bikurikira:

• Urugero rw'isukari mu maraso
• Urugero rwa insuline
• Urwego rwa proinsuline
• Urwego rwa C-peptide
• Urwego rwa Beta-hydroxybutyrate
• Igipimo cya sulfonylurea (ibi bikoreshwa mu gusuzuma niba hari imiti imwe n'imwe ikoreshwa mu kuvura diyabete mu maraso)

Nyuma yo gufata amaraso, abaganga bazavura isukari yawe iri hasi mu maraso. Ibisubizo by'ibi bizamini bishobora gufasha kumenya niba isukari yawe iri hasi mu maraso iterwa na insuline nyinshi (ibi twita hyperinsulinemia).

Ni ibihe bizamini bindi bikorwa? (Ibizamini byo gushushanya)

Niba ikizamini cyo kwiyiriza ubusa amasaha 72 kigaragaza ko umuntu afite insulinoma, intambwe ikurikiraho ni ukumenya aho ikibyimba kiri muri pancreas n'ingano yacyo. Ibi bishobora gusaba gupimwa kimwe cyangwa byinshi muri ibi bikurikira:

• gupima CT (CT scan)
• Gupima MRI
• Isuzuma rya ultrasound yo mu nda
• Ultrasound ya Endoscopic (EUS): Ibi bikubiyemo gushyiramo umuyoboro ufite kamera nto unyuze mu kanwa hanyuma ukareba mu gatuza.

Niba izi scan zitashoboye kugaragaza neza aho ikibyimba kiri, muganga wawe ashobora gutegeka ikindi kizamini cyihariye cyitwa "selective arterial calcium stimulation test". Iki ni ikizamini kigoye kurushaho.

Ni ubuhe buryo bwo kuvura ibi?

Inkuru nziza ni uko inyinshi mu ndwara za insulinoma zishobora gukira burundu hakoreshejwe kubagwa, cyane cyane iyo ikibyimba kitarakwirakwira mu tundi duce (nonmetastatic).

Ikintu cy'ingenzi ni ukubagwa.

Hari ubwoko butandukanye bwo kubaga. Muganga wawe azaguhitiramo uburyo bwo kubaga bukubereye bitewe n'ubwoko, aho buherereye n'ingano y'ikibyimba cyawe.

• Gukuramo ikibyimba gusa nta kwangiza cyane pancreas, kimwe no gukuramo umuhondo gusa mu gi ritetse.
• Gukuraho pancreatectomy mu gice kimwe: Nk'uko izina ribigaragaza, ibi bikubiyemo gukata no gukuraho igice cya pancreat aho ikibyimba giherereye.
• Kubaga Whipple: Ubu ni ukubaga gukomeye. Bikorwa iyo ikibyimba cyakwirakwiriye (metastatike). Bisaba gukuraho igice cya pancreas n'uturemangingo twegereye.

Buri kubagwa gufite ingaruka zimwe na zimwe. Muganga wawe azagusobanurira byose.

Nigute wagenzura isukari nke mu maraso mbere yo kubagwa kandi niba kubagwa bidashoboka?

Kugeza igihe cyo kubagwa, cyangwa niba kubagwa bidashoboka kubera impamvu runaka, ni ngombwa cyane kugenzura isukari iri hasi mu maraso yawe.

• Suzuma urugero rw'isukari mu maraso yawe buri gihe: Muganga wawe ashobora kukugira inama yo gukoresha sisitemu yo kugenzura isukari mu maraso yawe (CGM) . Ibi bishobora kugufasha kugenzura urugero rw'isukari mu maraso yawe buri gihe. Ibi bishobora kugufasha kumenya urugero rw'isukari mu maraso hakiri kare, cyane cyane nijoro.

Ariko ibuka ko iyi "(CGM)" idakoreshwa mu gupima indwara nka insulinoma, ahubwo ikoreshwa mu gukurikirana indwara imaze kwemezwa.

• Guhindura imirire: Kurya ibiryo ku gihe gisanzwe, cyane cyane karubohidrati zigoye (urugero: umugati w’ibinyampeke, umuceri w’umukara, imboga), bishobora gufasha kwirinda kugabanuka gutunguranye kw’isukari mu maraso. Kurya utuntu duto mbere yo kuryama nabyo bishobora gufasha bamwe mu bantu.
• Isukari iterwa mu mitsi (glucose iva mu mitsi): Niba ufite isukari nke cyane mu maraso, ushobora guhabwa isukari iva mu munyu mu bitaro.
• Ubwoko bw'imiti:
• Diazoxide: Uyu muti ushobora kugenzura irekurwa rya insuline mu ipanjisi. Ushobora kandi kongera irekurwa rya glucagon (iyongera urugero rw'isukari mu maraso) mu mwijima.
• Octreotide na Lanreotide: Iyi miti inafasha kugabanya irekurwa rya insuline muri insulinoma zimwe na zimwe.

Ni ngombwa cyane guhora witwaje ikarita iranga umuganga ivuga ko ufite ikibazo cy'isukari nke mu maraso. Muri ubwo buryo, niba ugize ikibazo gitunguranye, hari umuntu ushobora kugufasha vuba. Nanone, menyesha umuryango wawe n'inshuti zawe ibi n'uko bashobora kugufasha.

Ni iki cyakorwa niba ikibyimba cyarakwirakwiriye (metastasis)?

Ni gake cyane, iyo insulinoma yakwirakwiriye mu bindi bice by'umubiri (metastasis), abaganga bashobora guhuza kubaga n'ubundi buryo bwo kuvura. Cyangwa, niba kubaga bidashoboka, ubu buryo bwo kuvura bushobora gukoreshwa.

• Uburyo bwo kuvura Peptide Receptor Radionuclide (PRRT)
• Ubuvuzi bwibasiwe
• Ubuvuzi bwa Chimiotherapie

Ubu buryo bwo kuvura bugoye, muganga wawe azagusobanurira.

Ese ibi bishobora kuvurwa?

Yego! Insulinoma ikunze gukira burundu iyo umuntu abazwe. Ubushakashatsi bumwe bwagaragaje ko 87% by'abantu babazwe insulinoma itarimo kwangirika bari bakiriho nyuma y'imyaka 10 basanzwe bayirwaye. Icyo ni igipimo cyiza cyane.

Ariko, niba ikibyimba cyarakwirakwiriye (metastatic), igipimo cy'ubuzima bw'imyaka 10 bivugwa ko kiri hafi 33%. Ariko ibuka ko ibi ari ibigereranyo rusange gusa. Bitewe n'uko uhagaze, itsinda ry'abaganga rishobora kuguha amakuru nyayo.

Nibyo koko ijambo "ikibyimba" rishobora kudutera ubwoba. Cyane cyane iyo ari indwara idakunze kugaragara nka insulinoma. Ariko ikintu cyiza ni uko inyinshi muri zo zishobora kuvurwa no kubagwa. Nubwo bimeze bityo, ntabwo byoroshye kumenya ko ufite indwara idakunze kugaragara isaba kubagwa. Ariko ntabwo uri wenyine. Itsinda ry'abaganga bawe rizahora rihari kugufasha, rigusubiza ibibazo byawe, kandi rigufashe. Niba wumva uremerewe cyane mu byiyumvo, vugana na muganga wawe kuri ibyo kandi umenye serivisi ushobora kubonamo ubufasha.

Ibintu by'ingenzi ugomba kwibuka (Ubutumwa bwo kujyana mu rugo)

Sawa, rero, ukurikije ibyo twavuze uyu munsi, ibi ni byo bintu by'ingenzi ugomba kwibuka:

• Insulinoma ni ikibyimba cy’umusemburo (cyane cyane kidakabije) gikura mu icuraburindi. Gitanga insuline nyinshi cyane.
• Ibi bishobora gutera kugabanuka gutunguranye kw'isukari mu maraso (hypoglycemia). Ibi bishobora gutera ibimenyetso nko kuzungera, kubira ibyuya, no gutera ubwoba.
• Niba ukunze kugira ibi bimenyetso, menya neza ko wagiye kwa muganga.
• Ibi bishobora kumenyekana binyuze mu bizamini byihariye (ikizamini cyo kwiyiriza ubusa amasaha 72, scan).
• Uburyo bw'ingenzi bwo kuvura ni ukubagwa. Akenshi, ibi bitanga gukira burundu.
• Mbere yo kubagwa, cyangwa niba kubagwa bidashoboka, ushobora kugenzura urugero rw'isukari mu maraso binyuze mu mirire n'imiti.
• Nubwo iyi ari indwara idakunze kugaragara, umusaruro mwiza ushobora kuboneka iyo imenyekanye hakiri kare kandi ikavurwa neza.

Ntugahangayike, kimwe n'izindi ndwara zose, hari uburyo bwo kuzivura. Icy'ingenzi ni ukwita ku bimenyetso no gushaka inama kwa muganga vuba bishoboka.

Insulinoma , pancreas, insuline, isukari nke mu maraso, hypoglycemia, ikibyimba, imisemburo, kanseri ya pancreas