Ingaba nawe uneswekile ephezulu egazini ekuseni? Ngaba oku kungenxa yeSomogyi Effect?

Ngaba wakha wadibana nale meko kuwe, mntu unesifo seswekile? Nangona ubusela amayeza akho ebusuku kwaye amanqanaba eswekile egazini lakho elawulwa kakuhle, xa uvuka kusasa uze ujonge i-glucometer yakho, iswekile yakho yegazi iphezulu kakhulu. Usenokuba ucinga, "Owu, andazi ukuba ndithathe i-insulin eyaneleyo na ebusuku." Kodwa isizathu soku sinokuba yinto eyahlukileyo ngokupheleleyo kunokuba ucinga. Namhlanje sithetha ngemeko enokukrokrelwa ngamaxesha anje, kodwa engaziwa kakuhle. Yiyo leyo 'impembelelo yeSomogyi.'

Iyintoni iSomogyi Effect?

Ngamafutshane, iSomogyi Effect ifumaneka xa amanqanaba eswekile egazini lakho ehla kakhulu (hypoglycemia) phakathi kobusuku ngelixa ulele, kwaye umzimba wakho ukhupha iihomoni ngenxa yoko, nto leyo ebangela ukuba amanqanaba eswekile egazini lakho anyuke kakhulu (hyperglycemia) xa uvuka kusasa. Kufana nebhendi yerabha ebuyela kwicala elinye xa uyiyeka. Oku ngamanye amaxesha kubizwa ngokuba yi "rebound hyperglycemia."

Oku kwaqala ukufunyanwa ngeminyaka yoo-1930 ngugqirha ogama linguMichael Somogyi, yiyo loo nto esi sifo sathiywa ngaye.

Kodwa nantsi into ebalulekileyo ekufuneka iqondwe. Izazinzulu azikayithathi njengengqina eli-100% leSomogyi Effect, 'yingcamango'. Oko kuthetha ukuba nangona kukho ubungqina besayensi bokuba inokwenzeka, ayinguye wonke umntu oyamkelayo. Ngaphambili, oogqirha babecinga ukuba esi sesona sizathu siphambili sokuba iswekile yegazi inyuke ekuseni, kodwa ubuchwepheshe obutsha, ingakumbi ukufika kokuhlolwa kweglucose okuqhubekayo (CGM), kuphakamise imibuzo malunga nale ngcamango.

Nangona kunjalo, kubaluleke kakhulu ukuqaphela oku njengenye yezizathu ezininzi zokuba neswekile ephezulu egazini kusasa.

Ziziphi ezinye izizathu zokuba neswekile ephezulu egazini kusasa?

Ngaphambi kokuba ubhekisele kuphela kwisiphumo seSomogyi, kukho ezinye izizathu eziqhelekileyo zokuba neswekile ephezulu egazini kusasa.

• Umlinganiselo onganeleyo wamayeza: Ukuba uthatha amayeza akho eswekile okanye i-insulin encinci kakhulu ebusuku, inokulahlekelwa kukusebenza kwayo kusasa kwaye ibangele iswekile ephezulu egazini.
• Isiganeko Sokuvela Kwelanga: Esi sesona sizathu siqhelekileyo sokuba neswekile ephezulu egazini kusasa. Makhe sijonge oku ngeenkcukacha ezithe vetshe.
• Ukungalingani phakathi kwesidlo sangokuhlwa kunye nomlinganiselo wamayeza: Ukuba umthamo we-insulin awubalwanga ukuze ulingane nobungakanani beecarbohydrate ezityiwayo ngexesha lesidlo sangokuhlwa, amanqanaba eswekile egazini anokunyuka kusasa.
• Ukumelana ne-Insulin: Imeko apho iiseli zomzimba zingasabeli kakuhle kwi-insulin.

Yintoni umahluko phakathi kweSomogyi Effect kunye neDawn Phenomenon?

Nangona zombini ezi zinto zibangela ukunyuka kweswekile egazini ekuseni, kukho umahluko omkhulu phakathi kwazo zombini. Njengomntu onesifo seswekile, ukuqonda lo mahluko kuya kukunceda kakhulu.

I-Dawn Phenomenon kuxa imizimba yethu ikhupha iihomoni ezithile ngokwemvelo (ezifana ne-cortisol kunye ne-growth hormone) kusasa (malunga ne-3-4 kusasa). Ezi homoni zibangela ukuba amanqanaba eswekile egazini anyuke. Oku kuyinyaniso nakubantu abangenaso isifo seswekile, kodwa imizimba yabo ivelisa kwaye ilawula i-insulin. Abantu abanesifo seswekile abakwazi ukwenza oku, ngoko ke banamaqondo aphezulu eswekile egazini kusasa.

Kodwa iSomogyi Effect yahlukile. Yenzeka xa kusenzeka ukwehla kweswekile egazini (hypoglycemia) ezinzulwini zobusuku. KwiDawn Phenomenon, akukho kwehla kweswekile egazini ebusuku.

Makhe sijonge umahluko ophambili phakathi kwezi zimbini.

Zithini iimpawu zesiphumo seSomogyi?

Uphawu oluphambili loku kukuba amanqanaba aphezulu eswekile egazini xa uvuka kusasa. Nangona kunjalo, usenokuba neempawu zeswekile ephantsi egazini ebusuku.

Iimpawu zeswekile ephezulu egazini ekuseni (iHyperglycemia)

• Ukomelela konxano: Ukuziva ngathi awufumani manzi aneleyo nokuba usela kangakanani na.
• Ukuchama rhoqo: Ukufuna ukuchama rhoqo kunesiqhelo.
• Ukwanda kwendlala: Ukuziva ulambile kakhulu kunesiqhelo kusasa.
• Intloko ebuhlungu: Intloko ebuhlungu xa uvuka kusasa.
• Umsindo: Ukucaphuka ngezinto ezincinci.

Iimpawu zeswekile ephantsi egazini ebusuku (Nocturnal Hypoglycemia)

Usenokungaziboni ezi mpawu kuba ulele.

• Ukubila ebuthongweni: Ukubila kakhulu kangangokuba amashiti kunye neepijama zimanzi.
• Amaphupha amabi: Ukuvuka ebuthongweni emva kokuba nephupha eloyikisayo.
• Ukulala okungaphumliyo: Ukujika nokujika, ukulala ungaphumli.
• Ukudinwa xa uvuka kusasa: Ukudinwa nokudinwa kusasa, nokuba sele ulele kakuhle.

Ukuba uneempawu ezinje ebusuku kwaye iswekile yakho egazini iphezulu kusasa, unokurhanela ukuba iSomogyi inefuthe.

Kutheni oku kusenzeka? Yintoni unobangela?

Khawucinge nje, ufumene inaliti ye-insulin ebusuku, okanye uqhelise ngaphambi kwesidlo sangokuhlwa. Ngenxa yesi sizathu, phakathi kobusuku ngelixa ulele, ngaphandle kokuqaphela, inqanaba leswekile egazini lakho liyehla ngendlela eyingozi (`hypoglycemia`).

Ngeli xesha, umzimba wakho ucinga, "Hayi, kuza kwenzeka into embi!" Ngoko ke umzimba uthatha inyathelo elingxamisekileyo "lokukusindisa". Oko kukuthi, ngequbuliso ukhupha iihomoni ezininzi egazini ezisebenza kwiimeko ezingxamisekileyo.

• I-Adrenaline
• Ii-Corticosteroids
• Ihomoni yokukhula
• I-Glucagon

Ezi homoni ziyadibana ukuze zithumele umyalezo esibindini sakho othi "Khupha iswekile ngokukhawuleza ingene egazini lakho!" Emva koko isibindi sikhupha iswekile eninzi ebigcinwe apho iye egazini lakho.

Ukuba oku kwenzeka kumntu ongenaso isifo seswekile, umzimba wakhe uvelisa i-insulin ukulawula amazinga aphezulu eswekile. Kodwa ngenxa yokuba umzimba wakho onesifo seswekile awukwazi ukwenza oko, amanqanaba aphezulu eswekile ayaqhubeka enyuka, kwaye xa uvuka kusasa, ubona amanqanaba aphezulu eswekile (i-hyperglycemia) . Yiloo nto eyenzekayo, ngokulula.

Uyifumana njani kanye kanye le meko?

Ekubeni zininzi izizathu zokuba neswekile ephezulu egazini kusasa, kunokuba nzima kancinci ukufumanisa ukuba le yimpembelelo yeSomogyi na. Kwakhona, njengoko besitshilo ngaphambili, ekubeni oku kungasathathwa njengesizathu esiqhelekileyo, kunokuba ngumceli mngeni nakugqirha "ukuyixilonga".

Eyona nto ingcono onokuyenza, ukuba uqhubeka nokuba neswekile ephezulu egazini kusasa, kukuthetha nogqirha wakho weswekile ngayo loo nto. Uza kuzama ukufumanisa unobangela ngokujonga indlela amanqanaba eswekile egazini lakho atshintsha ngayo.

Eyona ndlela ilungileyo yokwenza oku kukusebenzisa isixhobo esibizwa ngokuba yiContinuous Glucose Monitoring (CGM). Oku kukuvumela ukuba ubone igrafu ecacileyo yendlela amanqanaba eswekile egazini lakho atshintshe ngayo ubusuku bonke.

Ukuba awusebenzisi i-CGM, ugqirha wakho unokukuxelela ukuba wenze into efana nale:

Ngokwenza oku iintsuku ezimbalwa aze abonise ugqirha wakho iziphumo, unokufumana umbono olungileyo wento eyenzekayo ebusuku. Ukuba iswekile yakho egazini iphantsi phakathi kobusuku kwaye iphezulu kusasa, isenokuba yimpembelelo yeSomogyi.

Zeziphi izisombululo ezinokwenziwa koku?

Wakuba ufumene unobangela, wena nogqirha wakho kufuneka nisebenzisane ukuze nifumane isisombululo. Wonke umntu wahlukile, ngoko akukho sisombululo sifanelekileyo kubo bonke. Kungathatha ixesha ukufumana esikulungeleyo.

Ugqirha wakho unokucebisa izisombululo ezifana nezi:

• Ukutshintsha idosi yakho ye-insulin okanye amayeza: Usenokucelwa ukuba unciphise kancinci idosi yakho ye-insulin ebusuku.
• Ukutshintsha isidlo sakho sangokuhlwa: Usenokucetyiswa ukuba utshintshe ubungakanani becarbohydrates, iiproteni, okanye amafutha owatyayo ngexesha langokuhlwa. Usenokucetyiswa nokuba utye isidlo esincinci ngaphambi kokuba ulale.
• Ukutshintshela kwi-Insulin Pump: Ukuba kunokwenzeka, i-insulin pump inokunceda ukulawula iidosi ze-insulin ngokuchanekileyo.
• Ukutshintsha ixesha lokuzilolonga: Ukuba uzilolonga ngokuhlwa okanye ebusuku, ungafuna ukutshintsha ixesha okanye ubukhali bokuzilolonga kwakho.

Ziziphi iingxaki ezinokwenzeka ukuba oku akunanzwa?

Nokuba isiphumo seSomogyi siyenzeka ngokwenene okanye akunjalo, le meko iphakamisa iingongoma ezimbini eziphambili ekufuneka thina bantu banesifo seswekile siziqaphele:

1. Amanqanaba eswekile egazini ahlala ephezulu.

2. Umngcipheko wokuba nezinga eliphantsi leswekile egazini ebusuku.

1. Amanqanaba eswekile egazini ahlala ephezulu

Ukuba namanqanaba aphezulu eswekile egazini iiyure ezimbalwa qho kusasa akulunganga kulawulo lwakho lweswekile. Kunokunyusa ixabiso lakho le-'A1C`. I-'A1C` luvavanyo olunika umbono wamanqanaba aphakathi eswekile egazini lakho kwiinyanga ezintathu ezidlulileyo. Ixabiso eliphezulu le-'A1C` kwixesha elide linyusa umngcipheko wakho weengxaki zeswekile.

• Umonakalo wamehlo (i-Retinopathy)
• Ukonakala kwezintso (i-Nephropathy)
• I-Neuropathy (echaphazela imithambo-luvo)
• Isifo sentliziyo

2. Umngcipheko wokuba nezinga eliphantsi leswekile egazini ebusuku

Abantu abaninzi bafumana iimpawu ze-hypoglycemia xa iswekile yabo yegazi yehla ngaphantsi kwe-70 mg/dL. Basenokungcangcazela, balambe, kwaye babile. Kodwa ukuba oku kwenzeka ngelixa ulele, kusenokuba sekwephuzile ukuqaphela iimpawu kwaye kukuvuse. I-hypoglycemia enzima inokuba yingozi ebomini.

Ukuba uhlala unesi sifo seswekile ephantsi ebusuku, qiniseka ukuba uthetha nogqirha wakho ngaso. Isicwangciso sakho sonyango sisenokufuna ukutshintshwa ukuze kuthintelwe esi sifo.

Ufanele uye nini ngokuqinisekileyo kugqirha?

Ukuba uhlala uneswekile ephezulu egazini xa uvuka kusasa, musa ukuyityeshela loo nto. Kubalulekile ukuxelela ugqirha wakho wesifo seswekile. Angajonga iziphumo zakho, afumanise ukuba imbangela yiSomogyi effect, iDawn phenomenon, okanye enye into, aze akunike unyango olungcono kuwe.

Ukuba neswekile ephezulu egazini ekuseni kunokuba yinto ecaphukisayo kakhulu. Kodwa ekubeni kungekho sisombululo sinye esifanela bonke, kungathatha ixesha ukufumana isisombululo esifanelekileyo kuwe. Yiba nomonde kwaye usebenzisane nogqirha wakho. Ukuthatha inyathelo ngoku kunokukunceda kakhulu ekuphepheni iingxaki zexesha elifutshane nezexesha elide.