Kusho ukuthini ukuthi "Isikhathi Esilinganiselwe (TIR)" kini eninesifo sikashukela? Ake sithole ukuthi kuyini!

Ingabe unesifo sikashukela? Noma ingabe othile emndenini wakho noma umngane wakho unesifo sikashukela? Kungenzeka ukuthi uke wezwa, noma mhlawumbe udokotela wakho ukhulume ngale nto ebizwa ngokuthi 'Isikhathi Esilinganiselwe'. Ngakho-ke, ake sixoxe ngayo kalula nangokucacile namuhla. Nakuba lokhu kusha kancane, kuyinto esiza kakhulu ekulawuleni isifo sikashukela.

Iyini le "Time in Range" (TIR)?

Kalula nje, "Isikhathi Esilinganisweni" (TIR) ​​​​yisikhathi umuntu onesifo sikashukela angagcina amazinga akhe kashukela egazini (i-glucose) ngaphakathi kwebanga elithile eliqondiwe . Cabanga udokotela wakho ekutshela ukuthi ugcine amazinga akho kashukela egazini phakathi kwaleli banga naleli banga. Lokhu kulinganisa ukuthi uhlala isikhathi esingakanani ngaphakathi kwalelo banga.

Kubantu abaningi abanesifo sikashukela, kokubili labo abanesifo sikashukela sohlobo 1 kanye nabantu abadala abanesifo sikashukela sohlobo 2, lolu hlu oluqondiwe luvame ukuba phakathi kwama-milligram angu-70 no-180 nge-deciliter (mg/dL) . Kodwa lokhu akufani kuwo wonke umuntu, futhi kungahluka kumuntu nomuntu. I-TIR ilinganiswa njengephesenti . Odokotela bavame ukuthi uzame ukugcina i-TIR yakho ingaphezu kuka-70% . Lokho kusho ukuthi ushukela wakho wegazi kufanele ube kulolo hlu okungenani amahora angu-17 emahoreni angu-24 ngosuku. Yilapho-ke lapho ungacabanga khona ukuthi isifo sakho sikashukela silawulwa kahle.

Ulinganisa kanjani le TIR ngokunembile?

Indlela elula nenembile kakhulu yokuthola i-TIR yakho ukusebenzisa i-Continuous Glucose Monitor (CGM) . Kungenzeka ukuthi wake wezwa ngale divayisi ngaphambilini. Empeleni iyithuluzi elincane eligqokwayo elibekwa ngaphansi kwesikhumba sengalo noma isisu sakho . Ngesikhathi uligqoka, lihlala lilinganisa futhi liqopha amazinga kashukela kuketshezi olungaphakathi kwesikhumba sakho amahora angama-24 ngosuku. Kufana nomseshi omncane ofuna ushukela wakho. Ungalanda le datha kashukela usebenzisa isofthiwe exhunywe kudivayisi ye-CGM noma uhlelo lokusebenza efonini yakho bese ulandelela i-TIR yakho.

Empeleni, ungathola umbono ongemuhle nge-TIR yakho ngokuhlaba umunwe ngesandla . Kodwa uma wenza lokho, kufanele uhlole ushukela wakho wegazi izikhathi eziningana ngosuku . Ngisho noma kunjalo, awunikezi idatha enemininingwane eminingi njenge-'CGM'. Cabanga ngakho njengokuphenya amakhasi encwadi. Kodwa i-'CGM' ifana nokufunda yonke incwadi! Ikunikeza isithombe esiphelele samazinga kashukela egazini lakho.

Ngenxa yale mishini ethi 'CGM', abantu abaningi abanesifo sikashukela kanye nodokotela babo manje basebenzisa le TIR ukuze babasize baphathe isifo sabo sikashukela.Hlola idatha yakho ye-TIR ngokunembile, okuvumela wena nodokotela wakho ukuthi nizibekele imigomo emisha futhi nenze izinguquko ezidingekayo ohlelweni lwenu lokwelashwa.

Ubukeka kanjani lo mbiko we-TIR?

Kule mibiko ye-TIR, evela kusofthiwe emishinini ye-CGM, amazinga ahlukene kashukela wakho avame ukuboniswa njengebha eqondile enemibala . Kulula kakhulu ukuyiqonda.

• Isikhathi lapho izinga lakho likashukela laliphakathi nendawo siboniswa ngombala oluhlaza . Yilokhu sonke esilwela ukukuthuthukisa.
• Amanye amazinga kashukela, okusho izikhathi lapho amazinga kashukela ephansi noma ephezulu, aboniswa ngeminye imibala efana nophuzi, i-orenji, kanye nobomvu .

Nansi indlela la mabanga aboniswa ngayo embikweni ojwayelekile we-`CGM` (kusukela phansi kuya phezulu):

• Ngaphansi kuka-54 mg/dL (< 54 mg/dL) — Kuphansi kakhulu (ngaphansi kwenhloso). Lokhu kuzobonakala kubomvu. Lokhu kungaba yisimo esiyingozi.
• Phakathi kuka-54 mg/dL no-69 mg/dL — Kuphansi (ngaphansi kwenhloso). Lokhu kungase kubukeke ku-orenji. Lena futhi indawo okufanele uyinake.
• Phakathi kuka-70 mg/dL no-180 mg/dL — okuphakathi nendawo. Yilokho okuluhlaza okotshani . Sonke sizama ukwenza le ngxenye eluhlaza ibe nkulu!
• Phakathi kuka-181 mg/dL no-250 mg/dL — okuphezulu (ngaphezu kwethagethi). Lokhu kubukeka njengophuzi.
• Kukhulu kuno-250 mg/dL (> 250 mg/dL) — Kuphezulu kakhulu (ngaphezu kwenhloso). Lokhu kubonakala njengombala obomvu. Uma lokhu kuqhubeka, akukuhle.

Kodwa khumbula, eminye imibiko ye-CGM ingabonisa le datha ngendlela ehlukile. Uma unenkinga yokuqonda lolu lwazi, ngokuqinisekile kuwumqondo omuhle ukukhuluma nodokotela wakho . Bangakuchazela lona.

I-TIR yami kufanele ibe malini?

Uma unesifo sikashukela, izinga lokugxila kwamazinga kashukela egazini lakho lihlukile kuwe . Lokho kusho ukuthi izinga lokugxila kwakho alifani nelami. Wena nodokotela wakho nizonquma ndawonye ukuthi yiliphi izinga lokugxila elikulungele kangcono nokuthi kufanele uhlose ukuhlala kulo kangakanani. Le migomo ingashintsha impilo yakho yonke.

Kunezici eziningana ezingathinta imigomo ye-glucose:

• Usunesikhathi esingakanani unesifo sikashukela ?
• Iminyaka yakho kanye nempilo yakho iyonke .
• Unezinye izimo zezokwelapha ezithinta amazinga kashukela egazini lakho, njengokungasebenzi kahle kwezinso noma i-gastroparesis .
• Uma unesifo senhliziyo .
• Isimo lapho ungazi khona izimpawu zokwehla koshukela egazini (ukungazi nge-hypoglycemia)Uma kukhona. Okusho ukuthi, uma ungazizwa isiyezi nokujuluka okuzwayo lapho amazinga akho kashukela ehla, kuyingozi kancane.
• Uma ukhulelwe noma uzama ukukhulelwa , imigomo yakho ishintsha kakhulu kulezi zikhathi.

Kulungile, manje ake sibone ukuthi yiziphi izincomo ezijwayelekile ezivame ukunikezwa.

Izinhloso ze-TIR kubantu abadala abaningi abanesifo sikashukela sohlobo 1 noma uhlobo 2:

• Okungenani u-70% wesikhathi phakathi kuka-70 no-180 mg/dL (ngaphakathi kwebanga elibekiwe).
• Isikhathi esingaphansi kuka-54 mg/dL kufanele sibe ngaphansi kuka-1%.
• Isikhathi esiphakathi kuka-54 no-69 mg/dL kufanele sibe ngaphansi kuka-4%.
• Isikhathi esiphakathi kuka-181 no-250 mg/dL kufanele sibe ngaphansi kuka-25%.
• Isikhathi esingaphezu kuka-250 mg/dL kufanele sibe ngaphansi kuka-5%.

I-TIR ihloselwe abantu abasengozini ephezulu kunesilinganiso soshukela wegazi ophansi (hypoglycemia):

Lokhu kwenzelwa labo abavame ukuba noshukela wegazi ophansi.

• Okungenani u-50% wesikhathi phakathi kuka-70 no-180 mg/dL (ngaphakathi kwebanga elijwayelekile).
• Isikhathi esichithwa ngaphansi kuka-70 mg/dL kufanele sibe ngaphansi kuka-1%.
• Isikhathi esingaphezu kuka-250 mg/dL kufanele sibe ngaphansi kuka-10%.

Izinhloso ze-TIR kubantu abadala abanesifo sikashukela sohlobo 1 ngesikhathi sokukhulelwa:

Lokhu kubaluleke kakhulu, ngoba kungathinta ingane.

• Okungenani u-70% wesikhathi, uphakathi kuka-63 no-140 mg/dL (ebangeni elijwayelekile). Ububanzi lapha buhlukile kancane, uyabona? Kubaluleke kakhulu ukulawula amazinga kashukela wakho ngesikhathi sokukhulelwa.
• Isikhathi esingaphansi kuka-63 mg/dL kufanele sibe ngaphansi kuka-4%.
• Isikhathi esingaphezu kuka-140 mg/dL kufanele sibe ngaphansi kuka-25%.

Iziqondiso zesifo sikashukela sokukhulelwa kanye nesifo sikashukela sohlobo 2 ngesikhathi sokukhulelwa zingase zihluke. Futhi, lezi yiziqondiso ezijwayelekile. Kubalulekile ukuxoxa nodokotela wakho ukuthi yiziphi izinhloso ze-glucose eziwusizo kakhulu futhi ezingokoqobo kuwe. Bazokweluleka ngesinyathelo esingcono kakhulu sesimo sakho.

Buyini ubudlelwano phakathi kwale TIR kanye ne-A1C?

Cishe uke wezwa ngalokhu kuhlolwa kwe-A1C . Odokotela abaningi bayakusebenzisa ukubona ukuthi isifo sakho sikashukela silawulwa kahle kangakanani. Ngakho-ke, ingabe i-TIR ne-A1C ziyinto efanayo? Yebo, kancane.

I-TIR ilinganisa ububanzi bamazinga akho kashukela esikhathini esithile, kusukela emahoreni ambalwa kuya ezinsukwini ezimbalwa, ngenkathi ugqoke i-CGM. Kufana nesithombe sesikhashana . Ungabona ngqo ukuthi ushukela wakho ushintsha kanjani usuku nosuku.

Kodwa-ke, i-A1C ukuhlolwa kwegazi okwenziwa elebhu . Kukala amazinga akho ajwayelekile kashukela emavikini ayi-8 kuya kwayi-12 edlule . Ukuhlolwa kwe-A1C akukwazi ukukutshela ukuthi ushukela wakho wegazi ushintshashintsha kanjani. Kunikeza inani elimaphakathi kuphela.

Kalula nje:

Cabanga ngalokhu: I-A1C ifana nokufunda isifinyezo sesahluko sencwadi.. Kodwa ukusebenzisa i-'CGM' nokubuka i-TIR kufana nokufunda isahluko sonke . Bese uthola ukuqonda okujulile nokunemininingwane eminingi ngakho. Uyaqonda? I-TIR ikhombisa ngokusobala ukuthi ushukela uziphatha kanjani ngezikhathi ezahlukene zosuku, ngemva kokudla, ngemva kokuzivocavoca.

Kusukela ngawo-1960, odokotela kanye nabantu abanesifo sikashukela bathembele kakhulu ku-A1C ukuze bahlole ukuthi ukuphathwa kwesifo sikashukela kuhamba kahle kangakanani. Kodwa-ke, selokhu kwafika imishini ye-CGM, odokotela kanye neziguli baye baqaphela ukuthi le TIR inikeza isithombe esiwusizo nesinembile sokuphathwa kwesifo sikashukela .

Ikakhulukazi kubantu abanesifo sikashukela sohlobo 1 , amazinga kashukela egazini angashintshashintsha kakhulu ngokuhamba kwezinsuku, amasonto, nezinyanga. Ngakho-ke, isilinganiso senani le-A1C asiyona njalo indlela enembile yokuphatha kwabo.

Isibonelo, cabanga ngalokhu:

Kukhona umuntu omazinga akhe kashukela egazini ahlala ehla kakhulu futhi enyuka kakhulu futhi. Kodwa i-A1C yakhe ingaba ngu-7%.

Kukhona omunye umuntu onezinga likashukela egazini elizinzile cishe ku-154 mg/dL isikhathi esiningi. I-A1C yakhe ingase ibe ngu-7%.

Uyabona? Ngisho noma i-A1C yabo ifana, amanani abo e-TIR angahluka kakhulu. I-TIR yomuntu wokuqala iphansi ngoba uhlala engaphandle kobubanzi obuqondiwe. Usengozini enkulu yokuthola i-hypoglycemia.

Futhi, ukuhlolwa kwe-A1C kungase kungabi okunembile kubantu abanezimo ezilandelayo:

• I-anemia (ukuntuleka kwegazi).
• Izinhlobo ze-hemoglobin.
• Ukuntuleka kwensimbi.
• Ukukhulelwa.
• Isifo sesibindi.

Ukunemba kwamanani e-A1C kungahluka phakathi kwabantu abahlukahlukene.

Kodwa-ke, njengoba izinto zimi, ukufika kwe-TIR akusho ukuthi ukuhlolwa kwe-A1C kuzobe sekuphelelwe yisikhathi . Ucwaningo lweminyaka eminingi lukhombisile ukuthi amazinga e-A1C angabikezela ukuthuthukiswa noma ukuvimbela izinkinga zesifo sikashukela. Ngakho-ke, odokotela bahlanganisa kokubili ukuhlolwa kwe-TIR kanye ne-A1C ukuze bathole isithombe esiphelele sokuphathwa kwe-glucose.

Kungani le TIR ibaluleke kangaka?

I-TIR ikunikeza isithombe esinembile kakhulu sokuguquguquka kwamazinga kashukela ahambisana nesifo sikashukela. Cabanga ngokuthi zingaki izinto ezithinta amazinga kashukela wakho, njengokudla okudlayo, ukuzivocavoca okwenzayo, imithi oyiphuzayo, kanye nezinga lakho lokucindezeleka ! Ngakho-ke, ukubheka idatha yakho ye-TIR (ikakhulukazi uma usebenzisa i-'CGM`) kungakunikeza ukuqonda okungcono kokuthi lezi zici ezahlukahlukene zithinta kanjani ngqo amazinga akho kashukela .

Isibonelo, ungase uqaphele ukuthi i-TIR yakho yehlile uma unomkhuhlane isonto lonke. Noma, ungase uqaphele ukuthi ushukela wakho wegazi ukhuphuke kakhulu ngemva kokudla ukudla okuthile, futhi i-TIR yakho yehlile. Uma ubona into efana naleyo, ungabuza udokotela wakho, 'Ngingakulungiselela kanjani kangcono ukulawula isifo sikashukela sami ngesikhathi esizayo lapho ngigula?' Noma, ungase ucabange, 'Lolo hlobo lokudla lungithinta kanjani, futhi kufanele ngishintshe indlela engikudla ngayo?' Ngamanye amazwi, i-TIR ingaba usizo olukhulu ekuphatheni isifo sikashukela sakho ngendlela evumelana nendlela yakho yokuphila .

Ingabe izinkinga zesifo sikashukela zingaba khona uma i-TIR yehla?

Ucwaningo ngalokhu lusaqhubeka, kodwa izifundo zamanje zithole ukuthi njengoba amazinga e-TIR ehla, ingozi yezinkinga ezihlobene nesifo sikashukela iyanda .

Izifundo zibonisa ukuthi ukuguquguquka okukhulu kwamazinga kashukela egazini (okubizwa ngokuthi ukuguquguquka kwe-glycemic) kungandisa ukucindezeleka kwe-oxidative kanye nokuvuvukala emzimbeni. Lezi zimo zingalimaza amangqamuzana . Ezinye izifundo zixhumanise lokhu kuguquguquka okukhulu kwe-glucose nalokhu:

• Ingozi eyengeziwe yokuba noshukela ophansi egazini (hypoglycemia).
• Ingozi eyengeziwe yesifo senhliziyo.
• Ukuphazamiseka kokusebenza kwengqondo.
• Ukwehla kwezinga lempilo.

Ngaphezu kwalokho, olunye ucwaningo luthole ukuthi abantu abanesifo sikashukela sohlobo 2 ababene-TIR ephansi kanye nokuguquguquka okuphezulu kwe-glycemic babenengozi ephezulu ye-retinopathy ehlobene nesifo sikashukela, okuyinkinga yesifo sikashukela esithinta amehlo . Olunye ucwaningo luthole ukuthi i-TIR ephansi yayihlotshaniswa kakhulu nengozi ephezulu ye-cardiovascular autonomic neuropathy, ukuphazamiseka kwemizwa okuthinta uhlelo lwenhliziyo .

Ngakho-ke, lezi zifundo zibonisa ukubaluleka kokugcina i-TIR yakho iphezulu ngangokunokwenzeka . Njengoba abacwaningi befunda kabanzi, ochwepheshe besifo sikashukela bangase bashintshe lezi zinhloso ze-TIR esikhathini esizayo.

Ngingayikhulisa kanjani i-TIR yami?

Isihluthulelo sokuthuthukisa i-TIR yakho ukuthola ukuthi yini ngempela ethinta amazinga akho kashukela . Lokhu kungathatha isikhathi. Eqinisweni, kungazwakala njengokuhlolwa kwesayensi okungapheli. Ngakho-ke, kubalulekile ukugxila entweni eyodwa ngesikhathi futhi ube nomusa kuwe . Ungesabi, bese uzama ukuthola lezi zinto kancane kancane.

Uma ubona ukuthi amazinga akho e-glucose ayaqhubeka nokwenyuka noma ukwehla ngezikhathi ezithile zosuku, bhekisisa imikhuba yakho nemisebenzi yakho ngaleso sikhathi.

Isibonelo, ungase uqaphele ukuthi amazinga akho e-glucose ayaqhubeka nokwenyuka ngemva kokudla kwasekuseni. Kunezizathu eziningana zokuthi kungani lokhu kungenzeka:

• Akusona isikhathi esifanele sokuthatha imithi yakho yesifo sikashukela (isib. i-insulin ).
• Umthamo wemithi onganele noma oweqile.
• Ibhalansi yokudla okudlayo kanye nezakhamzimba eziyinhloko ezikuqukethe (ama-carbohydrate, amafutha, kanye namaprotheni) . Kungenzeka ukuthi udla ama-carbohydrate amaningi kakhulu.
• Eminye imithi okufanele uyithathe ekuseni (eminye imithi ingathinta amazinga kashukela egazini).
• Ukuphuza iziphuzo ezine-caffeine njengekhofi ekuseni (lokhu kuthinta abanye abantu).

Lesi yisibonelo esisodwa nje. Isifo sikashukela siyisimo esiyinkimbinkimbi kakhulu . Kunezindlela eziningi ezingakusiza ukuthuthukisa i-TIR yakho. Njengokujwayelekile, uma ucabanga ukwenza izinguquko ohlelweni lwakho lokuphatha, kungcono ukusebenza nochwepheshe wesifo sikashukela (isb., isazi se-endocrinologist) noma uchwepheshe wezokunakekelwa kwesifo sikashukela oqinisekisiwe (i-CDCES) . Bangakuqondisa kule nqubo futhi baphendule imibuzo yakho.

Umlayezo Wokuya Nawe Ekhaya

Ngakho-ke, le "Time in Range" (TIR) ​​​​iyindlela entsha newusizo kakhulu kubantu abanesifo sikashukela yokukala ukuphathwa kwabo kwe-glucose. Ukuqonda ulwazi lwe-TIR kanye nedatha yakho ye-glucose ngezinye izikhathi kungazwakala kunzima kancane. Ungakhathazeki, ungajwayela kancane kancane.

Khumbula, udokotela wakho uhlala ekhona ukukusiza uqonde i-TIR yakho futhi uyisebenzisele inzuzo yakho. Ndawonye, ​​​​ningakwazi ukulandelela ukuthi i-TIR yakho ishintsha kanjani ngokuhamba kwesikhathi futhi nilungise amasu enu okuphatha ngokufanele. Ukuphila nesifo sikashukela kuyinselele, kodwa ngamathuluzi amasha afana nalawa, kungenziwa kube lula kancane. Awuwedwa, futhi baningi abantu abangakusiza kulolu hambo.

'Isifo Sikashukela, Isikhathi Esilinganiselwe, I-TIR, I-glucose, Izinga Likashukela Egazini, I-CGM, I-A1C