Njengomuntu onesifo sikashukela, ucabanga kangakanani ngamazinga kashukela egazini lakho usuku lonke? Banjani ekuseni, banjani ngemva kwesidlo sasemini, banjani ngaphambi kokulala, njalo njalo. Enye yezinto ozizwa kakhulu lapho ukhuluma nodokotela wakho igama elithi 'A1C'. Livame ukusetshenziswa ukunquma ukuthi isifo sakho sikashukela silawulwa yini. Kodwa ingabe i-A1C iyona indaba yonke? Namuhla sizokhuluma ngendlela entsha newusizo kakhulu ezokunikeza ukuqonda okujulile ngesifo sakho sikashukela kune-A1C. Siyibiza ngokuthi 'Isikhathi Esiphakathi' noma 'i-TIR'.
Iyini Isikhathi Esisebangeni (TIR)?
Kalula nje, i-Time in Range (TIR) yinani lesikhathi phakathi nosuku lapho amazinga kashukela egazini lakho ehlala ngaphakathi "kwebanga lakho eliqondiwe." Lokhu kuvame ukulinganiswa njengephesenti.
Manje ungase uzibuze ukuthi luyini lolu "hla lwemigomo". Kwabaningi abantu abadala abanesifo sikashukela sohlobo 1 noma sohlobo 2, kodwa hhayi bonke, lolu hlu lwemigomo luyizinga likashukela egazini eliphakathi kuka -70 mg/dL no-180 mg/dL .
Odokotela ngokuvamile batusa ukugcina i-TIR yakho ingaphezu kuka-70% . Lokhu kusho ukuthi amazinga akho kashukela kufanele abe ngaphakathi kwalelo zinga okungenani amahora angu-17 emahoreni angu-24 ngosuku.
Silinganisa kanjani le TIR?
Indlela engcono kakhulu nelula yokukala i-TIR yakho ngokunembile ukusebenzisa idivayisi ebizwa ngokuthi i-Continuous Glucose Monitor (CGM) . Lena idivayisi encane oyigqoka emzimbeni wakho. Ilinganisa futhi iqophe amazinga kashukela ku-interstitial fluid ngaphansi kwesikhumba sakho amahora angama-24 ngosuku. Ungabe usulanda leyo datha kuhlelo lokusebenza noma kusofthiwe ukuze ubone ukuthi iyini ngempela i-TIR yakho.
Empeleni, indlela evamile yokuthatha igazi ngomunwe ingakunikeza nombono othile nge-TIR. Kodwa ngalokho kufanele uhlole ushukela wakho izikhathi eziningana ngosuku. Kodwa-ke, inani ledatha elitholwe ku-CGM lingaphezu kwalokho. Ngakho-ke, inani le-TIR elitholwe nalo linembile kakhulu.
Ngalobu buchwepheshe be-CGM, abantu abaningi abanesifo sikashukela kanye nodokotela babo manje babheka leli nani le-TIR ukuze bahlole ukuthi ukuphathwa kwabo kwesifo sikashukela kusebenza kahle kangakanani. Ngale datha, wena nodokotela wakho ningazibekela imigomo emisha futhi nenze izinguquko ezidingekayo ohlelweni lwenu lokwelashwa.
Ngiwubheka kanjani umbiko we-Time in Range?
Uma usebenzisa i-CGM, umbiko we-TIR uvame ukukukhombisa ibha eqondile enemibala. Lokhu kulula ukukuqonda. Okuluhlaza kubonisa ukuthi amazinga kashukela egazini lakho ayekuphi. Eminye imibala (ophuzi, o-orenji, obomvu) ibonisa ukuthi amazinga kashukela egazini lakho ayekuphi (aphansi noma aphezulu).
Ake sibheke ukuthi umbiko ojwayelekile we-CGM ubonisa kanjani ulwazi.
| Izinga likashukela (mg/dL) | Incazelo (isimo) |
|---|---|
| Ngaphansi kuka-54 (< 54) | Phansi Kakhulu / Ngaphansi kwebanga |
| Kusukela ku-54 kuya ku-69 | Ibanga eliphansi / eliphansi |
| 70 kuya ku-180 | Ibanga eliphakathi - ngokuvamile liboniswa ngombala oluhlaza okotshani. |
| 181 kuya ku-250 | Ibanga Eliphezulu / Eliphezulu |
| Ngaphezu kuka-250 (> 250) | Ibanga Eliphezulu Kakhulu / Eliphezulu Kakhulu |
Umbiko wakho we-CGM ungase ubonise lolu lwazi ngendlela ehlukile. Uma unemibuzo ngalokhu, cela udokotela wakho ukuthi akucacisele.
Isikhathi sami eRange kufanele sibe side kangakanani?
Lokhu kubaluleke kakhulu: Uhla lwakho lwe-glucose target kanye ne-TIR target kuhlukile kuwe. Lokhu kusho ukuthi kungase kuhluke emigomweni yabanye abantu.
Wena nodokotela wakho nizonquma ndawonye ukuthi yimiphi imigomo engcono kakhulu kuwe. Futhi, le migomo ayihlali ifana impilo yakho yonke futhi ingashintsha ngokuhamba kwesikhathi.
Izici ezinjengalezi ziyabandakanyeka lapho kunqunywa imigomo yakho:
- Usunesikhathi esingakanani unesifo sikashukela?
- Ubudala bakho kanye nobude bokuphila kwakho.
- Ingabe unezinye izimo zezokwelapha ezithinta amazinga kashukela egazini lakho? (isib. ukungasebenzi kahle kwezinso, i-gastroparesis)
- Ingabe unesifo senhliziyo?
- Ingabe unesifo sokungazi nge-hypoglycemia, isimo lapho ungaziboni izimpawu zokwehla kukashukela egazini (hypo)?
- Ukhulelwe noma unethemba lokukhulelwa?
Kulungile, ake sibheke eminye imigomo ye-TIR eyamukelwa ngokuvamile. Futhi, lezi yizincomo ezijwayelekile nje. Umgomo wakho ungase uhluke kulokhu.
| Imigomo evamile yabantu abadala abaningi abanesifo sikashukela sohlobo 1 noma sohlobo 2 | |
|---|---|
| Isimo | Ithagethi (iphesenti lesikhathi emini) |
| Ngaphakathi kobubanzi obubekiwe (70-180 mg/dL) | Okungenani u-70% |
| Izinga eliphansi (54-69 mg/dL) | Ngaphansi kuka-4% |
| Izinga eliphansi kakhulu (< 54 mg/dL) | Ngaphansi kuka-1% |
| Izinga eliphezulu (181-250 mg/dL) | Ngaphansi kuka-25% |
| Izinga eliphezulu kakhulu (> 250 mg/dL) | Ngaphansi kuka-5% |
| Ihlose labo abasengozini enkulu ye-hypoglycemia | |
|---|---|
| Ngaphakathi kobubanzi obubekiwe (70-180 mg/dL) | Okungenani u-50% |
| Izinga eliphansi (< 70 mg/dL) | Ngaphansi kuka-1% |
| Izinga eliphezulu kakhulu (> 250 mg/dL) | Ngaphansi kuka-10% |
| Imigomo yabantu abanesifo sikashukela sohlobo 1 ngesikhathi sokukhulelwa | |
|---|---|
| Ngaphakathi kwebanga elijwayelekile (63-140 mg/dL) | Okungenani u-70% |
| Izinga eliphansi (< 63 mg/dL) | Ngaphansi kuka-4% |
| Izinga eliphezulu (> 140 mg/dL) | Ngaphansi kuka-25% |
Imigomo yesifo sikashukela sokukhulelwa kanye nesifo sikashukela sohlobo 2 ngesikhathi sokukhulelwa ingase ihluke, ngakho -ke kubalulekile ukuxoxa nodokotela wakho ukuthi yimiphi imigomo ewusizo kakhulu futhi engokoqobo kuwe.
Buyini ubudlelwano phakathi kwe-A1C ne-TIR?
Kubaluleke kakhulu ukuqonda umehluko phakathi kwalezi ezimbili.
- I-TIR (Isikhathi Esilinganisweni) isilinganiso esinikeza ulwazi mayelana nokushintshashintsha kwamazinga kashukela wakho esikhathini esingamahora noma izinsuku.
- I-A1C ukuhlolwa kwegazi okubonisa izinga lakho elijwayelekile likashukela egazini ezinyangeni ezi-2-3 ezedlule .
Cabanga nge-A1C njengokufunda isifinyezo sesahluko encwadini. Ikunikeza umbono omncane. Kodwa i-TIR ifana nokufunda isahluko sonke, igama ngalinye, umusho ngamunye. Uthola yonke imininingwane ngokucacile. I-A1C ayikuniki ulwazi mayelana nokuthi ushukela wakho uphezulu noma uphansi kangakanani.
Kungani i-A1C ingadukisa?
Cabanga ngalaba bantu ababili.
1. Umuntu wokuqala: Amazinga kashukela egazini lakhe ayashintshashintsha usuku lonke. Ngezinye izikhathi aphansi kakhulu (hypo), ngezinye izikhathi aphezulu kakhulu.
2. Umuntu wesibili: Izinga likashukela egazini lakhe lihlala lizinzile usuku lonke, cishe liyi-154 mg/dL.
Bobabili laba bantu bangase babe ne-A1C engu-7%. Ngoba i-A1C imane nje ijwayelekile. Kodwa-ke, amanani abo e-TIR ahlukile ngokuphelele. I-TIR yomuntu wokuqala iphansi kakhulu. Lokho kusho ukuthi umzimba wabo usengozini enkulu yokuthola imiphumela emibi yesifo sikashukela.
Futhi, abantu abanezimo ezilandelayo bangase babe namanani e-A1C anganembile:
- I-anemia
- Izinhlobo ze-hemoglobin
- Ukuntuleka kwensimbi
- Ukukhulelwa
- Isifo sesibindi
Okwamanje, i-TIR ngeke ithathe indawo yokuhlolwa kwe-A1C ngokuphelele. Ucwaningo lweminyaka eminingi lukhombisile ukuthi amazinga e-A1C angabikezela ingozi yakho yokuthola izinkinga zesifo sikashukela. Yingakho odokotela besebenzisa i-A1C kanye ne-TIR ndawonye ukuze bathole isithombe esiphelele nesinembile sokuphathwa kwakho kwesifo sikashukela.
Kungani Isikhathi Esikububanzi (TIR) sibalulekile?
I-TIR ikunikeza isithombe esicacile kakhulu sokushintshashintsha kwamazinga kashukela egazini okubangelwa isifo sikashukela. Izinto ezifana nokudla esikudlayo, ukuzivocavoca esikwenzayo, imithi esiyiphuzayo, kanye namazinga ethu okucindezeleka konke kuthinta amazinga kashukela egazini. Uma ubheka idatha yakho ye-TIR, ungaqonda ukuthi ngayinye yalezi zinto ithinta kanjani ngqo amazinga kashukela egazini lakho.
Isibonelo, ake sithi ubunomkhuhlane isonto lonke. Uma ubheka umbiko wakho we-TIR kulelo sonto, ubona ukuthi inani lakho le-TIR lehle kakhulu. Ngemuva kwalokho, ngesikhathi esilandelayo lapho ugula, ungakhuluma nodokotela wakho mayelana nendlela yokukulungiselela nokuphatha isifo sikashukela sakho kusenesikhathi.
I-TIR kanye nezinkinga zesifo sikashukela
Ucwaningo lukhombisile ukuthi kukhona ukuxhumana phakathi kwamanani aphansi e-TIR kanye nezinkinga ezibangelwa isifo sikashukela.
Ukuguquguquka kwe-glycemic kungandisa ukucindezeleka kwe-oxidative kanye nokuvuvukala emzimbeni, okungalimaza amaseli emzimbeni. Ucwaningo luthole ukuthi lokhu kuguquguquka okuphezulu kwamazinga kashukela egazini kwandisa ingozi yokuthi:
- Ukwanda kwezehlakalo ze-hypoglycemia.
- Ingozi eyengeziwe yesifo senhliziyo.
- Ukuphazamiseka kokusebenza kwengqondo nokwengqondo (umsebenzi wokuqonda).
- Ukwehla kwezinga lempilo.
Ngaphezu kwalokho, olunye ucwaningo luthole ukuthi abantu abanesifo sikashukela sohlobo 2 abane-TIR ephansi kanye nokuguquguquka okuphezulu koshukela egazini banamathuba amaningi okuba nezimo ezimbi ze-retinopathy ezihlobene nesifo sikashukela. Olunye ucwaningo luthole ubudlelwano obuqinile phakathi kwe-TIR ephansi kanye ne-cardiovascular autonomic neuropathy.
Konke lokhu kubonisa ukuthi kubaluleke kangakanani ukugcina inani lakho le-TIR lisezingeni eliphezulu.
Ngingasithuthukisa kanjani isikhathi sami eRange?
Indlela eyinhloko yokuthuthukisa i-TIR yakho ukuthola ukuthi yiziphi izici ezithinta amazinga kashukela wakho. Lokhu kungathatha isikhathi. Kungazwakala njengokuhlolwa kwesayensi okungapheli.
Ngakho-ke, yiba nomusa kuwe . Ungazami ukushintsha yonke into ngesikhathi esisodwa, gxila entweni eyodwa ngesikhathi.
Ake sithi uqaphela ukuthi amazinga kashukela egazini lakho adlula izinga lawo kuphela ngemva kokudla kwasekuseni nsuku zonke. Ngakho-ke, naka imikhuba yakho nemisebenzi yakho ngaleso sikhathi.
Isibonelo, izinto ezinjengalezi zingabangela ushukela wegazi ukuba ukhuphuke ngemva kokudla kwasekuseni:
- Sekuyisikhathi sokuthatha imithi yakho yesifo sikashukela (njenge-insulin).
- Umthamo womuthi.
- Ibhalansi yokudla okudlayo kanye nezakhamzimba ezikuqukethe (ama-carbohydrate, amafutha, amaprotheni).
- Eminye imithi okufanele uyithathe ekuseni.
- Ukuphuza into equkethe i-caffeine, njengekhofi, ekuseni.
Lesi yisibonelo esisodwa nje. Isifo sikashukela siyisimo esiyinkimbinkimbi kakhulu. Kunezindlela eziningi zokusiza ukuthuthukisa i-TIR yakho. Khumbula njalo, ngaphambi kokwenza noma yiziphi izinguquko ohlelweni lwakho lokwelashwa, khuluma nomuntu ogxile kwisifo sikashukela, njengodokotela we-endocrinologist noma uchwepheshe wezokunakekelwa kwesifo sikashukela oqinisekisiwe (CDCES), noma okungenani udokotela wakho ojwayelekile.
I-Time in Range (TIR) iyisilinganiso esisha nesiwusizo kakhulu sokulinganisa ukuphathwa kwesifo sikashukela. Ekuqaleni, kungase kubonakale kunzima ukuqonda lonke lolu lwazi nedatha ye-TIR. Kodwa ungakhathazeki. Udokotela wakho uzokuchaza konke futhi akusize usebenzise leli nani le-TIR ukuze kuzuze wena. Ndawonye, ningalandelela ukuthi i-TIR yakho ishintsha kanjani ngokuhamba kwesikhathi futhi nilungise uhlelo lwenu lokuphatha ngokufanele.
Umlayezo Wokuya Nawe Ekhaya
- 'Isikhathi Esilinganisweni' (TIR) yiphesenti lesikhathi lapho izinga likashukela egazini lakho lingaphakathi kwebanga eliqondiwe.
- Lokhu kunikeza isithombe esicacile nesiningiliziwe sokuthi amazinga kashukela wakho ashintsha kanjani usuku lonke kunesivivinyo se-A1C.
- Inhloso yakho ye-TIR inqunywa nguwe nodokotela wakho ndawonye. Akufani kuwo wonke umuntu.
- Usebenzisa idatha ye-TIR, wena nodokotela wakho ningenza izinqumo ezingcono mayelana nokwelashwa.
- Ngokuthuthukisa isikolo sakho se-TIR, unganciphisa ingozi yezinkinga zesikhathi eside ezibangelwa isifo sikashukela.
- Lolu uhambo. Akuzona zonke izinto ezizohamba kahle ngokushesha. Yiba nomusa kuwe, izinguquko ezincane zingenza umehluko omkhulu.
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