Ingabe nawe unoshukela ophezulu egazini ekuseni? Ingabe lokhu kungenxa ye-Somogyi Effect?

Wake wakwenza lokhu, wena onesifo sikashukela? Ngisho noma ubuphuza imithi yakho ebusuku futhi amazinga kashukela egazini lakho elawulwa kahle, uma uvuka ekuseni bese uhlola i-glucometer yakho, ushukela wakho wegazi uphezulu kakhulu. Ungase ucabange, "O, angazi ukuthi ngiphuze i-insulin eyanele yini ebusuku." Kodwa isizathu salokhu kungaba yinto ehluke ngokuphelele kunalokho ocabanga. Namuhla sikhuluma ngesimo esingasolwa ngezikhathi ezinjengalezi, kodwa esingaziwa kahle. Yilowo 'umphumela we-Somogyi.'

Iyini i-Somogyi Effect?

Kalula nje, i-Somogyi Effect yilapho amazinga kashukela egazini lakho ehla kakhulu (hypoglycemia) phakathi nobusuku ngenkathi ulele, futhi umzimba wakho ukhipha ama-hormone ngenxa yalokho, okwenza amazinga kashukela egazini lakho akhuphuke kakhulu (hyperglycemia) uma uvuka ekuseni. Kufana nebhande lerabha elibuyela emuva ohlangothini olulodwa uma udedela. Lokhu ngezinye izikhathi kubizwa ngokuthi "i-rebound hyperglycemia."

Lokhu kwaqala ukutholwa ngawo-1930 ngudokotela ogama lakhe linguMichael Somogyi, yingakho lesi simo siqanjwe ngaye.

Kodwa nansi into ebalulekile okufanele uyiqonde. Ososayensi abakabheki umphumela we-Somogyi njengofakazelwe ngokuphelele, 'kuyinkolelo-mbono'. Lokho kusho ukuthi yize kukhona ubufakazi besayensi bokuthi kungenzeka, akubona bonke abakwamukelayo. Esikhathini esidlule, odokotela babecabanga ukuthi lesi yisona sizathu esiyinhloko soshukela ophezulu egazini ekuseni, kodwa ubuchwepheshe obusha, ikakhulukazi ukufika kokuqapha okuqhubekayo kwe-glucose (CGM), kuphakamise imibuzo ngalo mbono.

Kodwa-ke, kubaluleke kakhulu ukuqaphela lokhu njengenye yezizathu eziningi zokuphakama koshukela egazini ekuseni.

Yiziphi ezinye izizathu zoshukela ophezulu egazini ekuseni?

Ngaphambi kokukhomba umunwe kuphela kumphumela weSomogyi, kunezinye izimbangela eziningana ezivamile zoshukela ophezulu egazini ekuseni.

• Umthamo wemithi onganele: Uma uphuza imithi yakho yesifo sikashukela noma i-insulin encane kakhulu ebusuku, ingase ilahlekelwe ukusebenza kwayo ekuseni futhi ibangele ushukela ophezulu egazini.
• Isenzakalo Esimangalisayo: Lesi yisona sizathu esivame kakhulu sokuba noshukela ophezulu egazini ekuseni. Ake sibheke lokhu ngemininingwane ethe xaxa.
• Ukungafani phakathi kwesidlo sakusihlwa nesilinganiso semithi: Uma umthamo we-insulin ungabalwanga ukuze ulingane nenani lama-carbohydrate adliwayo ngesikhathi sakusihlwa, amazinga kashukela egazini angakhuphuka ekuseni.
• Ukumelana ne-insulin: Isimo lapho amangqamuzana omzimba engasabeli kahle ku-insulin.

Uyini umehluko phakathi komphumela we-Somogyi kanye ne-Dawn Phenomenon?

Nakuba kokubili lokhu kubangela ukwanda koshukela egazini ekuseni, kunomehluko omkhulu phakathi kwalokhu okubili. Njengomuntu onesifo sikashukela, ukuqonda lo mehluko kuzokusiza kakhulu.

I-Dawn Phenomenon yilapho imizimba yethu ikhipha khona ama-hormone athile ngokwemvelo (njenge-cortisol kanye ne-growth hormone) ekuseni kakhulu (cishe ngo-3-4 ekuseni). La ma-hormone abangela ukuba amazinga kashukela egazini akhuphuke. Lokhu kuyiqiniso nakubantu abangenaso isifo sikashukela, kodwa imizimba yabo ikhiqiza futhi ilawule i-insulin. Abantu abanesifo sikashukela abakwazi ukwenza lokhu, ngakho-ke banamazinga aphezulu kashukela egazini ekuseni.

Kodwa umphumela we-Somogyi uhlukile. Kwenzeka ngenxa yokwehla koshukela egazini (hypoglycemia) phakathi nobusuku. Esimweni Sokuntwela Kokusa, akukho ukwehla koshukela egazini ebusuku.

Ake sibheke umehluko omkhulu phakathi kwalokhu okubili.

Ziyini izimpawu zomphumela weSomogyi?

Isibonakaliso esiyinhloko salokhu amazinga aphezulu kashukela egazini uma uvuka ekuseni. Kodwa-ke, ungase ube nezimpawu zoshukela ophansi egazini ebusuku.

Izimpawu zoshukela ophezulu egazini ekuseni (i-Hyperglycemia)

• Ukoma okwandayo: Ukuzizwa sengathi awutholi amanzi anele kungakhathaliseki ukuthi uphuza kangakanani.
• Ukuchama njalo: Ukudinga ukuchama kaningi kunokujwayelekile.
• Ukwanda kwendlala: Ukuzizwa ulambile kakhulu kunokujwayelekile ekuseni.
• Ikhanda elibuhlungu: Ikhanda elibuhlungu uma uvuka ekuseni.
• Intukuthelo: Ukuthukuthela ngezinto ezincane.

Izimpawu zokwehla koshukela egazini ebusuku (Nocturnal Hypoglycemia)

Ungase ungaziboni lezi zimpawu ngoba ulele.

• Ukujuluka ebuthongweni: Ukujuluka kakhulu kangangokuthi amashidi nama-pajamas kumanzi.
• Amaphupho amabi: Ukuvuka ebuthongweni ngemva kokuphupha iphupho elesabekayo.
• Ukulala okungenazithiyo: Ukujikijela nokuphenduka, ukulala ngokunganaki.
• Ukuzizwa ukhathele uma uvuka ekuseni: Ukuzizwa ukhathele futhi uthukuthele ekuseni, ngisho nangemva kokulala kahle.

Uma unezimpawu ezinjengalezi ebusuku futhi ushukela wakho wegazi uphezulu ekuseni, ungase usole umphumela weSomogyi.

Kungani lokhu kwenzeka? Iyini imbangela?

Cabanga nje, uphuze umjovo we-insulin ebusuku, noma uvivinya umzimba ngaphambi kokudla kwakusihlwa. Ngenxa yalesi sizathu, phakathi nobusuku ngesikhathi ulele, ngaphandle kokuqaphela, izinga likashukela egazini lakho lehla kakhulu ('hypoglycemia').

Kuleli qophelo, umzimba wakho ucabanga ukuthi, "O, kuzokwenzeka into embi!" Ngakho umzimba uthatha isinyathelo esiphuthumayo ukuze "ukusindise". Okusho ukuthi, ukhipha ama-hormone amaningana egazini asebenza ezimweni eziphuthumayo.

• I-Adrenaline
• Ama-Corticosteroids
• I-hormone yokukhula
• I-Glucagon

La ma-hormone ayahlangana ukuze athumele isignali esibindini sakho ethi "Faka ushukela ngokushesha egazini lakho!" Isibindi bese sikhipha ngokuzumayo inani elikhulu le-glucose eligcinwe lapho egazini lakho.

Uma lokhu kwenzeka kumuntu ongenaso isifo sikashukela, umzimba wakhe ukhiqiza i-insulin ukulawula amazinga kashukela aphezulu. Kodwa ngenxa yokuthi umzimba wakho onesifo sikashukela awukwazi ukwenza lokho, amazinga kashukela aphezulu ayaqhubeka ekhuphuka, futhi uma uvuka ekuseni, ubona amazinga kashukela aphezulu (i-hyperglycemia) . Yilokho okwenzekayo, kalula nje.

Uyithola kanjani ngempela le simo?

Njengoba kunezizathu eziningi zokuphakama kukashukela egazini ekuseni, kungaba nzima kancane ukunquma ukuthi lokhu kuyimiphumela yeSomogyi. Futhi, njengoba sishilo ngaphambili, njengoba lokhu kungasabhekwa njengembangela evamile kakhulu, kungaba yinselele ngisho nakudokotela "ukukuxilonga".

Into engcono kakhulu ongayenza, uma uqhubeka nokuba noshukela ophezulu egazini ekuseni, ukukhuluma nodokotela wakho wesifo sikashukela ngakho. Uzozama ukuthola imbangela ngokubheka ukuthi amazinga kashukela egazini lakho ashintsha kanjani.

Indlela engcono kakhulu yokwenza lokhu ukusebenzisa idivayisi ye-Continuous Glucose Monitoring (CGM). Lokhu kukuvumela ukuthi ubone igrafu ecacile yokuthi amazinga kashukela egazini lakho ashintshe kanjani ubusuku bonke.

Uma ungasebenzisi i-CGM, udokotela wakho angakutshela ukuthi wenze into efana nale:

Ngokwenza lokhu izinsuku ezimbalwa nokubonisa udokotela wakho izilinganiso, angathola umbono omuhle wokuthi kwenzekani ebusuku. Uma ushukela wakho wegazi uphansi phakathi nobusuku futhi uphezulu ekuseni, kungaba umphumela weSomogyi.

Yiziphi izixazululo ezingenziwa ngalokhu?

Uma usuyitholile imbangela, wena nodokotela wakho kufanele nisebenzisane ukuthola ikhambi. Wonke umuntu uhlukile, ngakho-ke asikho ikhambi elifanela wonke umuntu. Kungathatha isikhathi ukuthola ukuthi yini ekusebenzela kahle.

Udokotela wakho angase asikisele izixazululo ezifana nalezi:

• Ukushintsha umthamo wakho we-insulin noma wemithi: Ungase ucelwe ukuthi wehlise umthamo wakho we-insulin kancane ebusuku.
• Ukushintsha isidlo sakho sakusihlwa: Ungase welulekwe ukuthi ushintshe inani lama-carbohydrate, amaprotheni, noma amafutha owadlayo ngesikhathi sakusihlwa. Ungase welulekwe nokuthi udle ukudla okulula okuncane ngaphambi kokulala.
• Ukushintshela ku-Insulin Pump: Uma kungenzeka, i-insulin pump ingasiza ekulawuleni imithamo ye-insulin ngokunembe kakhudlwana.
• Ukushintsha isikhathi sokuzivocavoca kwakho: Uma uzivocavoca kusihlwa noma ebusuku, ungase ufune ukushintsha isikhathi noma ubukhali bokuzivocavoca kwakho.

Yiziphi izinkinga ezingaba khona uma lokhu kunganakwa?

Kungakhathaliseki ukuthi umphumela weSomogyi uyenzeka ngempela noma cha, lesi simo siphakamisa amaphuzu amabili abalulekile okufanele thina esinesifo sikashukela siwazi:

1. Amazinga kashukela egazini aphakeme njalo.

2. Ingozi yokuba namazinga aphansi kashukela egazini ebusuku.

1. Amazinga kashukela egazini ahlala ephezulu

Ukuba namazinga aphezulu kashukela egazini amahora ambalwa njalo ekuseni akukuhle ekuphathweni kwakho kwesifo sikashukela. Kungakhuphula inani lakho le-'A1C`. I-'A1C` iyisivivinyo esinikeza umbono wamazinga akho ajwayelekile kashukela egazini ezinyangeni ezintathu ezedlule. Inani eliphakeme le-'A1C` esikhathini eside landisa ingozi yakho yezinkinga ezibangelwa isifo sikashukela.

• Ukulimala kwamehlo (i-Retinopathy)
• Ukulimala kwezinso (i-Nephropathy)
• I-neuropathy (ethinta imizwa)
• Isifo senhliziyo

2. Ingozi yokuba namazinga aphansi kashukela egazini ebusuku

Abantu abaningi babhekana nezimpawu ze-hypoglycemia lapho ushukela wabo wegazi wehla ngaphansi kuka-70 mg/dL. Bangase bazizwe beqhaqhazela, belambile, futhi bejuluka. Kodwa uma lokhu kwenzeka ngenkathi ulele, kungase kube sekwephuzile ukuqaphela izimpawu bese kukuvusa. I-hypoglycemia enkulu ingaba yingozi empilweni.

Uma uvame ukuba noshukela wegazi ophansi ebusuku, qiniseka ukuthi ukhuluma nodokotela wakho ngakho. Uhlelo lwakho lokwelashwa lungadinga ukushintshwa ukuze luvinjelwe.

Kufanele uye nini kudokotela?

Uma uhlala unoshukela ophezulu egazini uma uvuka ekuseni, ungakushayi indiva. Kubalulekile ukutshela udokotela wakho wesifo sikashukela. Angabheka izibalo zakho, anqume ukuthi imbangela ingumphumela weSomogyi, isenzakalo seDawn, noma okunye, bese ekunikeza ukwelashwa okungcono kakhulu kuwe.

Ukuba noshukela ophezulu egazini ekuseni kungaba yinto ekhungathekisayo ngempela. Kodwa njengoba kungekho ikhambi elilodwa elifanelana nakho konke, kungathatha isikhathi ukuthola ikhambi elifanele wena. Yiba nesineke futhi usebenzisane nodokotela wakho. Ukuthatha isinyathelo manje kungasiza kakhulu ekukusizeni ugweme izinkinga zesikhathi esifushane nezesikhathi eside.