Kuthetha ukuthini "iTime in Range" (TIR) ​​​​kuni nina bantu banesifo seswekile? Masifumanise ngokuchanekileyo!

Ngaba unesifo seswekile? Okanye kukho umntu kusapho lwakho okanye umhlobo wakho onesifo seswekile? Ngoko ke kusenokwenzeka ukuba uvile, okanye mhlawumbi ugqirha wakho uthethe ngale nto ibizwa ngokuba yi-'Time in Range'. Ngoko ke, masithethe ngayo ngokulula nangokucacileyo namhlanje. Nangona oku kutsha kancinci, yinto enceda kakhulu ekulawuleni isifo seswekile.

Yintoni le "Time in Range" (TIR)?

Ngamafutshane, "Ixesha eliphakathi" (TIR) ​​​​lixesha umntu onesifo seswekile anokugcina amanqanaba eswekile yegazi (iglucose) ngaphakathi koluhlu oluthile olujoliswe kulo . Khawuthelekelele ugqirha wakho ekuxelela ukuba ugcine amanqanaba eswekile egazini lakho phakathi kolu luhlu nolu luhlu. Oku kulinganisa ixesha ohlala kulo ngaphakathi kolo luhlu.

Kwabaninzi abantu abanesifo seswekile, abo banesifo seswekile sohlobo loku-1 kunye nabantu abadala abanesifo seswekile sohlobo lwesibini, olu luhlu lujoliswe kulo ludla ngokuba phakathi kwama-70 kunye nama-180 milligrams nge-deciliter (mg/dL) . Kodwa oku akufani kuye wonke umntu, kwaye kunokwahluka kumntu nomntu. I-TIR ilinganiswa njengepesenti . Oogqirha badla ngokuthi zama ukugcina i-TIR yakho ingaphezulu kwama-70% . Oko kuthetha ukuba iswekile yakho yegazi kufuneka ibe kuloo luhlu ubuncinane iiyure ezili-17 kwiiyure ezingama-24 ngosuku. Kulapho unokucinga ukuba isifo sakho seswekile silawulwa kakuhle.

Ulinganisa njani le TIR ngokuchanekileyo?

Eyona ndlela ilula nechanekileyo yokufumana i-TIR yakho kukusebenzisa i-Continuous Glucose Monitor (CGM) . Usenokuba ukhe weva ngesi sixhobo ngaphambili. Enyanisweni sisixhobo esincinci esinokunxitywa esibekwa phantsi kwesikhumba sengalo okanye isisu sakho . Ngelixa usinxibile, sihlala silinganisa kwaye sirekhoda amanqanaba eglucose kulwelo olungaphakathi phantsi kwesikhumba sakho iiyure ezingama-24 ngosuku. Kufana nomcuphi omncinci okhangela iswekile yakho. Emva koko ungakhuphela le datha yeglucose usebenzisa isoftware eqhagamshelwe kwisixhobo seCGM okanye usetyenziso kwifowuni yakho kwaye ulandelele i-TIR yakho.

Enyanisweni, ungayifumana ingcamango engeyiyo ye-TIR yakho ngokwenza i-manual finger crap . Kodwa ukuba wenza loo nto, kuya kufuneka ujonge iswekile yakho yegazi izihlandlo ezininzi ngemini . Nangona kunjalo, ayiboneleli ngedatha eneenkcukacha ezininzi njenge-'CGM'. Cinga ngayo njengokuphenya amaphepha encwadi. Kodwa i-'CGM' ifana nokufunda yonke incwadi! Ikunika umfanekiso opheleleyo wamanqanaba eswekile yakho yegazi.

Ngenxa yezi matshini ze-'CGM', abantu abaninzi abanesifo seswekile kunye noogqirha babo ngoku basebenzisa le TIR ukubanceda balawule isifo sabo seswekile.Hlola idatha yakho ye-TIR ngokuchanekileyo. Ngokujonga idatha yakho ye-TIR, wena kunye nogqirha wakho ninokubeka iinjongo ezintsha kwaye nenze utshintsho olufunekayo kwisicwangciso senu sonyango.

Injani le ngxelo ye-TIR?

Kwezi ngxelo ze-TIR, ezivela kwisoftware ekwiimashini ze-CGM, uluhlu olwahlukeneyo lwamanqanaba eswekile yakho ludla ngokuboniswa njengebha ethe nkqo enemibala . Kulula kakhulu ukuyiqonda.

• Ixesha apho inqanaba leswekile yakho laliphakathi liboniswa ngombala oluhlaza . Yile nto sonke esizama ukuyiphucula.
• Ezinye iireyithingi, oko kuthetha amaxesha apho amanqanaba eswekile ephantsi okanye ephezulu, ziboniswa ngeminye imibala efana nomthubi, iorenji, kunye nobomvu .

Nantsi indlela ezi zigaba eziboniswa ngayo kwingxelo eqhelekileyo ye-`CGM` (ukusuka ezantsi ukuya phezulu):

• Ngaphantsi kwe-54 mg/dL (< 54 mg/dL) — Iphantsi kakhulu (ngaphantsi kwethagethi). Oku kuya kubonakala kubomvu. Oku kunokuba yimeko eyingozi.
• Phakathi kwe-54 mg/dL kunye ne-69 mg/dL — Iphantsi (ngaphantsi kwethagethi). Oku kunokubonakala ngathi yiorenji. Le yindawo ekufuneka iqwalaselwe.
• Phakathi kwe-70 mg/dL kunye ne-180 mg/dL — ngaphakathi. Yiyo loo nto ikwindawo eluhlaza . Sonke sizama ukwenza le ndawo iluhlaza ibe nkulu!
• Phakathi kwe-181 mg/dL kunye ne-250 mg/dL — iphezulu (ngaphezu kwethagethi). Oku kubonakala ngathi kutyheli.
• Ingaphezulu kwe-250 mg/dL (> 250 mg/dL) — Iphezulu kakhulu (ngaphezu kwethagethi). Oku kukwabonakala njengombala obomvu. Ukuba oku kuyaqhubeka, akulunganga.

Kodwa khumbula, ezinye iingxelo zeCGM zinokubonisa olu lwazi ngendlela eyahlukileyo. Ukuba unengxaki yokuqonda olu lwazi, ngokuqinisekileyo licebo elihle ukuthetha nogqirha wakho . Banokukuchazela lona.

Ingakanani i-TIR yam?

Ukuba unesifo seswekile, uluhlu olujoliswe kulo lwamanqanaba eswekile egazini lakho luhlukile kuwe . Oko kuthetha ukuba uluhlu olujoliswe kulo alufani nolwam. Wena nogqirha wakho niza kugqiba kunye ukuba loluphi uluhlu olujoliswe kulo olulungele wena kunye nokuba lungakanani olo luhlu ekufuneka ulujonge ukuhlala kulo. Ezi njongo zinokutshintsha ubomi bakho bonke.

Kukho izinto ezininzi ezinokuchaphazela iinjongo zeglucose:

• Unexesha elingakanani unesifo seswekile ?
• Ubudala bakho kunye nempilo yakho ngokubanzi .
• Unezinye izifo ezichaphazela amanqanaba eswekile egazini lakho, ezinje ngokungasebenzi kakuhle kwezintso okanye i-gastroparesis .
• Ukuba unesifo sentliziyo .
• Imeko apho ungaziyo iimpawu zeswekile ephantsi egazini (ukungazi nge-hypoglycemia)Ukuba ikhona. Oko kukuthi, ukuba awuziva isiyezi nokubila okuvayo xa inqanaba leswekile yakho lihla, kuyingozi kancinci.
• Ukuba ukhulelwe okanye uzama ukukhulelwa , iinjongo zakho zitshintsha kakhulu ngeli xesha.

Kulungile, ngoku makhe sibone ukuba zeziphi iingcebiso eziqhelekileyo ezihlala zinikwa.

Iinjongo ze-TIR kubantu abadala abaninzi abanesifo seswekile sohlobo 1 okanye uhlobo 2:

• Ubuncinane i-70% yexesha phakathi kwe-70 kunye ne-180 mg/dL (ngaphakathi koluhlu olumiselweyo).
• Ixesha elingaphantsi kwama-54 mg/dL kufuneka libe ngaphantsi kwe-1%.
• Ixesha eliphakathi kwama-54 nama-69 mg/dL kufuneka libe ngaphantsi kwe-4%.
• Ixesha eliphakathi kwe-181 kunye ne-250 mg/dL kufuneka libe ngaphantsi kwe-25%.
• Ixesha elingaphezulu kwe-250 mg/dL kufuneka libe ngaphantsi kwe-5%.

Iinjongo ze-TIR kubantu abasengozini ephezulu kuneyomndilili yokuba neswekile ephantsi egazini (hypoglycemia):

Oku kwenzelwa abo badla ngokuba neswekile ephantsi egazini.

• Ubuncinane i-50% yexesha phakathi kwe-70 kunye ne-180 mg/dL (ngaphakathi komlinganiselo oqhelekileyo).
• Ixesha elichithwa ngaphantsi kwe-70 mg/dL kufuneka libe ngaphantsi kwe-1%.
• Ixesha elingaphezulu kwe-250 mg/dL kufuneka libe ngaphantsi kwe-10%.

Iinjongo ze-TIR kubantu abadala abanesifo seswekile sohlobo loku-1 ngexesha lokukhulelwa:

Oku kubaluleke kakhulu, kuba kunokuchaphazela umntwana.

• Ubuncinane i-70% yexesha, iphakathi kwe-63 kunye ne-140 mg/dL (kwinqanaba eliqhelekileyo). Uluhlu apha lwahlukile kancinci, uyabona? Kubaluleke kakhulu ukulawula amanqanaba eswekile yakho ngexesha lokukhulelwa.
• Ixesha elingaphantsi kwama-63 mg/dL kufuneka libe ngaphantsi kwe-4%.
• Ixesha elingaphezulu kwe-140 mg/dL kufuneka libe ngaphantsi kwe-25%.

Izikhokelo zesifo seswekile sokukhulelwa kunye nesifo seswekile sohlobo lwesibini ngexesha lokukhulelwa zinokwahluka. Kwakhona, ezi zizikhokelo eziqhelekileyo. Kubalulekile ukuxoxa nogqirha wakho ngezona njongo zeglucose ziluncedo kwaye zinokwenzeka kuwe. Baza kukucebisa ngeyona ndlela ifanelekileyo yokwenza imeko yakho.

Yintoni ubudlelwane phakathi kwale TIR kunye ne-A1C?

Mhlawumbi ukhe weva ngolu vavanyo lwe-A1C . Oogqirha abaninzi bayalusebenzisa ukubona ukuba isifo sakho seswekile silawulwa kakuhle kangakanani. Ngoko ke, ngaba i-TIR kunye ne-A1C ziyafana? Ewe, kancinci.

I-TIR ilinganisa uluhlu lwamanqanaba eglucose yakho kwixesha elithile, ukusuka kwiiyure ezimbalwa ukuya kwiintsuku ezimbalwa, ngelixa unxibe i-CGM. Kufana nesithombe sexesha elifutshane . Ungayibona ngqo indlela iswekile yakho etshintsha ngayo imihla ngemihla.

Nangona kunjalo, i-A1C luvavanyo lwegazi olwenziwa kwilebhu . Lulinganisa amanqanaba akho aqhelekileyo eglucose kwiiveki ezisi-8 ukuya kwezili-12 ezidlulileyo . Uvavanyo lwe-A1C alunakukuxelela indlela iswekile yakho yegazi etshintsha ngayo. Lunika ixabiso eliphakathi kuphela.

Kalula nje:

Cinga ngale ndlela: I-A1C ifana nokufunda isishwankathelo sesahluko sencwadi.Kodwa ukusebenzisa i-'CGM' nokujonga i-TIR kufana nokufunda isahluko sonke . Emva koko ufumana ukuqonda okunzulu ngakumbi nokucacileyo ngayo. Uyaqonda? I-TIR ibonisa ngokucacileyo indlela iswekile eziphatha ngayo ngamaxesha ahlukeneyo emini, emva kokutya, emva kokuzilolonga.

Ukususela ngeminyaka yoo-1960, oogqirha kunye nabantu abanesifo seswekile bebexhomekeke kakhulu kwi-A1C ukuze bajonge ukuba ulawulo lweswekile luhamba njani. Nangona kunjalo, ukusukela oko kwavela oomatshini be-CGM, oogqirha kunye nezigulane baye baqonda ukuba le TIR inika umfanekiso oluncedo nochanekileyo wolawulo lweswekile .

Ingakumbi kubantu abanesifo seswekile sohlobo loku-1 , amanqanaba eswekile egazini anokutshintshatshintsha kakhulu ngokuhamba kweentsuku, iiveki, kunye neenyanga. Ke ngoko, ixabiso eliqhelekileyo le-A1C alisoloko liyindlela echanekileyo yokulawula.

Umzekelo, cinga ngoku:

Kukho umntu onamaqondo eswekile egazini ahlala ehla kakhulu kwaye enyuka kakhulu kwakhona. Kodwa i-A1C yakhe isenokuba yi-7%.

Kukho omnye umntu onezinga leswekile egazini elizinzileyo elimalunga ne-154 mg/dL uninzi lwexesha. I-A1C yakhe isenokuba yi-7%.

Uyabona? Nangona i-A1C yabo ifana, amaxabiso abo e-TIR anokwahluka kakhulu. I-TIR yomntu wokuqala iphantsi kuba uhlala engaphandle koluhlu olujoliswe kulo. Usemngciphekweni omkhulu we-hypoglycemia.

Kwakhona, uvavanyo lwe-A1C lusenokungachaneki kubantu abanezi meko zilandelayo:

• I-anemia (ukungabikho kwegazi).
• Iintlobo zeHemoglobin.
• Ukunqongophala kwesinyithi.
• Ukukhulelwa.
• Isifo sesibindi.

Ukuchaneka kwamaxabiso e-A1C kunokwahluka phakathi kwamaqela ahlukeneyo.

Nangona kunjalo, njengoko izinto zimi, ukufika kwe-TIR akuthethi ukuba uvavanyo lwe-A1C alusayi kusetyenziswa . Uphando lwamashumi eminyaka luye lwabonisa ukuba amanqanaba e-A1C anokuxela kwangaphambili uphuhliso okanye ukuthintela iingxaki zesifo seswekile. Ke ngoko, oogqirha badibanisa uvavanyo lwe-TIR kunye ne-A1C ukuze bafumane umfanekiso opheleleyo wolawulo lwe-glucose.

Kutheni le TIR ibaluleke kangaka?

I-TIR ikunika umfanekiso ochanekileyo wokuguquguquka kwamanqanaba eglucose okubangelwa sisifo seswekile. Cinga ngezinto ezininzi ezichaphazela amanqanaba eswekile yakho, njengokutya okutyayo, umthambo owenzayo, amayeza owasebenzisayo, kunye nenqanaba loxinzelelo lwakho ! Ngoko ke, ukujonga idatha yakho ye-TIR (ingakumbi xa usebenzisa i-'CGM`) kunokukunika ukuqonda okungcono kwendlela ezi zinto ezahlukeneyo ezichaphazela ngayo ngqo amanqanaba akho eglucose .

Umzekelo, ungaphawula ukuba i-TIR yakho yehlile xa unomkhuhlane kangangeveki. Okanye, ungaphawula ukuba iswekile yakho yegazi inyuke kakhulu emva kokutya ukutya okuthile, kwaye i-TIR yakho yehlile. Xa ubona into enjalo, ungabuza ugqirha wakho, 'Ndingakulungiselela njani ngcono ukulawula isifo sam seswekile kwixesha elizayo xa ndigula?' Okanye, ungacinga, 'Olo hlobo lokutya lundichaphazela njani, kwaye ndifanele nditshintshe indlela enditya ngayo?' Ngamanye amazwi, i-TIR inokuba luncedo olukhulu ekulawuleni isifo sakho seswekile ngendlela ehambelana nendlela ophila ngayo .

Ngaba iingxaki zesifo seswekile zinokwenzeka ukuba i-TIR yehla?

Uphando ngale nto lusaqhubeka, kodwa izifundo zangoku zifumanise ukuba njengoko amanqanaba e-TIR ehla, umngcipheko weengxaki ezinxulumene nesifo seswekile uyanda .

Izifundo zibonisa ukuba ukuguquguquka okukhulu kwamanqanaba eswekile egazini (okubizwa ngokuba yi-glycemic variability) kunokunyusa uxinzelelo lwe-oxidative kunye nokudumba emzimbeni. Ezi meko zingonakalisa iiseli . Ezinye izifundo zidibanise oku kuguquguquka okukhulu kweswekile kunye:

• Umngcipheko ophezulu wokuba neswekile ephantsi egazini (hypoglycemia).
• Umngcipheko okhulayo wesifo sentliziyo.
• Ukuphazamiseka komsebenzi wokuqonda.
• Umgangatho wobomi ophantsi.

Ngaphezu koko, olunye uphando lufumanise ukuba abantu abanesifo seswekile sohlobo lwesibini ababene-TIR ephantsi kunye nokuguquguquka okuphezulu kwe-glycemic babenomngcipheko ophezulu we-retinopathy enxulumene nesifo seswekile, ingxaki yesifo seswekile echaphazela amehlo . Olunye uphando lufumanise ukuba i-TIR ephantsi yayinxulunyaniswa kakhulu nomngcipheko ophezulu we-cardiovascular autonomic neuropathy, isifo semithambo-luvo esichaphazela inkqubo yentliziyo .

Ngoko ke, ezi zifundo zibonisa ukubaluleka kokugcina i-TIR yakho iphezulu kangangoko kunokwenzeka . Njengoko abaphandi befunda ngakumbi, iingcali zesifo seswekile zinokutshintsha ezi njongo ze-TIR kwixesha elizayo.

Ndingayandisa njani i-TIR yam?

Eyona nto ibalulekileyo ekuphuculeni i-TIR yakho kukufumanisa ukuba yintoni kanye kanye echaphazela amanqanaba eglucose yakho . Oku kungathatha ixesha. Enyanisweni, kunokuvakala ngathi luvavanyo lwesayensi olungapheliyo. Ngoko ke, kubalulekile ukugxila kwinto enye ngexesha kwaye ube nobubele kuwe . Musa ukoyika, kwaye zama ukufumanisa ezi zinto kancinci kancinci.

Ukuba uqaphela ukuba amanqanaba akho eglucose ayaqhubeka enyuka okanye ehla ngamaxesha athile osuku, jonga ngokusondeleyo imikhwa yakho kunye nemisebenzi oyenzayo ngelo xesha.

Umzekelo, ungaqaphela ukuba amanqanaba akho eswekile yegazi ayaqhubeka enyuka emva kwesidlo sakusasa. Kukho izizathu ezahlukeneyo zokuba oku kungenzeka:

• Ayiloxesha elifanelekileyo lokusela amayeza akho esifo seswekile (umz. i-insulin ).
• Umthamo wamayeza onganeleyo okanye ogqithisileyo.
• Ukulinganisela kokutya okutyayo kunye nezondlo eziphambili eziqulathwe kuko (iicarbohydrate, amafutha kunye neeproteni) . Usenokuba utya iicarbohydrate ezininzi kakhulu.
• Amanye amayeza onokuwasela kusasa (amanye amayeza anokuchaphazela amanqanaba eswekile egazini).
• Ukusela iziselo ezine-caffeine ezifana nekofu kusasa (oku kuyabachaphazela abanye abantu).

Lo ngumzekelo omnye nje. Isifo seswekile sisifo esinzima kakhulu . Kukho amaqhinga amaninzi anokukunceda uphucule i-TIR yakho. Njengesiqhelo, xa ucinga ngokwenza utshintsho kwisicwangciso sakho solawulo, kungcono ukusebenzisana nengcali yesifo seswekile (umz., ingcali ye-endocrinologist) okanye ingcali yokhathalelo lweswekile kunye nemfundo (CDCES) . Banokukukhokela kule nkqubo kwaye baphendule imibuzo yakho.

Umyalezo Wokuya Ekhaya

Ngoko ke, le "Time in Range" (TIR) ​​​​yindlela entsha neluncedo kakhulu kubantu abanesifo seswekile yokulinganisa ulawulo lwabo lweglucose. Ukuqonda ulwazi lwe-TIR kunye nedatha yakho yeglucose ngamanye amaxesha kunokuvakala kunzima kancinci. Ungakhathazeki, ungaqhelana nayo kancinci kancinci.

Khumbula, ugqirha wakho uhlala ekhona ukukunceda uqonde i-TIR yakho kwaye uyisebenzisele inzuzo yakho. Kunye, ninokulandelela indlela i-TIR yakho etshintsha ngayo ngokuhamba kwexesha kwaye nilungise amaqhinga enu okulawula ngokufanelekileyo. Ukuphila nesifo seswekile ngumceli mngeni, kodwa ngezixhobo ezintsha ezifana nezi, kunokwenziwa kube lula kancinci. Awuwedwa, kwaye baninzi abantu abanokukunceda kolu hambo.

"Isifo seswekile, Ixesha eliphakathi, i-TIR, i-glucose, inqanaba leswekile egazini, i-CGM, i-A1C