Insulin na - akwalite njikọ nke abụba sitere na glucose na hepato- na lipocytes. N'okpuru ikike ya, a na-emeghachi omume na ihe nrịbama nke acetyl-CoA, na-esote nzụlite malonyl-CoA, nke na-agbatị mkpụrụ ndụ FFA, ebumnuche nke homonụ ahụ bụ enzyme acetyl-CoA-carboxylase (acetyl-CoA CO2 ligase).

Insulin na-egbochi mmetụta nke homonụ lipolytic ọ bụla (adrenaline, glucagon, STH, glucocorticoils), ma na - ekepụta oke nke isocitrate na -ketoglutarate - ndị na - eme acetyl-CoA-carboxylase.

A maara na a na-ebuga ọdụdụ abụba site na imeju na-eme ka anụ ahụ dị ka akụkụ nke Lipoproteins dị ala (VLDL) dị ala nke umeji Insulin na-eme ka ọrụ nke lipoprotein lipase, nke na-ebugharị VLDL na ntughari nke ọdụdụ n'ime adipocytes.

Insulin na - eme ka a na - ebute glucose na adipocytes ma na - egbochi enzyme lipolytic nke mkpụrụ ndụ adipose - lipase hormone na - emetụta.

N'okpuru ọrụ insulin, mmegharị nke glycolysis na-enye lipogenesis plastically (alfa-glycerophosphate), na mmegharị nke ụzọ pentose - ike (site na ntinye nke NADPH₂). 4,2000

Nlegide insulin

Nlegide insulin bụ nzaghachi metabolic na endogenous ma ọ bụ ọgwụ insulin. N'okwu a, mgbochi nwere ike igosipụta onwe ya dịka otu n'ime mmetụta insulin si arụ ọrụ, ma ọ bụ n'ọtụtụ.

Insulin bụ homonụ peptide nke emepụtara n’ime mkpụrụ ndụ beta nke agwaetiti dị n’akpata ọrịa nke Langerhans. Ọ nwere ọtụtụ ọrụ na metabolic Filiks na ihe niile anụ ahụ. Isi ọrụ nke insulin bụ iji glucose site na mkpụrụ ndụ - homonụ ahụ na - eme ka enzymes glycolysis na - eme ka ọ nwee ume, na - eme ka glucose na - adịwanye mma, na - eme ka gluogenụ si glucose na akwara na imeju, na - emekwa ka njikọ nke protein na abụba sikwuo ike. Usoro nke na-akpali ntọhapụ nke insulin bụ iwelie itinye uche nke glucose n'ọbara. Na mgbakwunye, usoro nri na insulin insulin na-akpali site na nri oriri (ọ bụghị naanị carbohydrate). Ekpochapụ homonụ site n'ọbara ọbara bụ nke kachasị site na umeji na akụrụ. Mmebi nke ihe insulin na anụ ahụ (erughi insulin dị ala) bụ isi ihe na mmepe nke ụdị shuga nke 2.

Edere ọgwụ hypoglycemic maka ndị ọrịa nwere ụdị ọrịa shuga 2 nke mellitus, nke na-eme ka ojiji nke glucose dị na uru ahụ dị elu ma na-eme ka ọgụgụ isi insulin dịkwuo elu.

N'ime mba ndị mepere emepe, a na-edekọ mgbochi insulin na 10-20% nke ndị bi. N'afọ ndị na-adịbeghị anya, a matawo mmụba nke ọnụ ọgụgụ ndị ọrịa na-eguzogide ọgwụ n'etiti ndị na-eto eto na ndị na-eto eto.

Ichegide insulin nwere ike ịmalite n'onwe ya ma ọ bụ ihe kpatara ọrịa. Dabere na ọmụmụ, edere insulin na-eguzogide na 10-25% nke ndị mmadụ na-enweghị nkwarụ metabolism na oke ibu, na 60% nke ndị ọrịa nwere ọbara mgbali elu (yana ọbara mgbali 160/95 mm Hg. Art. Na nke dị elu), na 60% nke ọrịa hyperuricemia, na 85% nke ndị nwere hyperlipidemia, na 84% nke ndị ọrịa nwere ụdị ọrịa shuga 2, yana 65% nke ndị nwere nsogbu glucose.

Ihe Ndị Na-akpata Esemokwu

Usoro nke mmepe nke nguzogide insulin erughi nke oma. A na-ahụta isi ihe kpatara ya dị ka mmebi iwu na ọkwa postreceptor. Edozighi ya nke ọma na ọrịa ọrịa a na-ebute mmepe nke usoro a na agbanye, n'agbanyeghị eziokwu ahụ na enwere mkpụrụ ndụ ihe atụ doro anya na mmepe nke nguzogide insulin.

Ihe mere insulin nwere ike ịbụ ihe mebiri emebi nke ike ya igbochi mmepụta glucose na umeji yana / ma ọ bụ kpalite mbido nke glucose site na anụ ahụ dị n'akụkụ. Ebe ọ bụ na akwara na-eji akụkụ dị ukwuu nke glucose eme ihe, a na-atụ aro na ihe kpatara uto nke insulin na-egbochi nwere ike ịmịcha glucose site na uru ahụ, nke insulin na-akpali.

Na mmepe nke nguzogide insulin na mellitus ọrịa shuga nke ụdị nke abụọ, a na-agakọ agakọ na ihe ndị enwetara. Na ụmụ ejima monozygotic nwere ụdị ọrịa mellitus nke 2, a na-ahụ ihe nnabata insulin n'ụzọ ọzọ ma e jiri ya tụnyere ejima na-arịa ọrịa shuga mellitus. Ngalaba nnweta nke insulin na-egosipụta onwe ya n’oge ngosipụta nke ọrịa ahụ.

Usoro mmachi nke metabolism metabolism na-egbochi mmezu nke imeju abụba (ma nke dị nfe ma nke siri ike) yana mmerụ ahụ na-esochi ma ọ bụ kansa imeju.

Ihe kpatara nke nnweta insulin nke abụọ n’ime ụdị shuga mellitus nke abụọ gụnyere ọnọdụ nke hyperglycemia dị ogologo, nke na-eduga n’ibelata mmetụta ndu insulin (nnabata insulin na-akpata).

Na ọrịa shuga mellitus nke ụdị nke mbụ, nguzogide insulin nke abụọ na-apụta n'ihi nchịkwa na-adịghị mma nke ọrịa shuga, ebe a na-emeziwanye ụgwọ maka metabolism metabolism, mmetụta insulin na-abawanye nke ukwuu. N'ime ndị ọrịa nwere ụdị ọrịa shuga 1 nke mellitus, mgbanwe insulin na-agbanwegharị ma na -eme ka ọbara ọbara haemoglobin glycosylated.

Ihe ndị nwere ike imepụta nguzogide insulin gụnyere:

• mkpụrụ ndụ ihe nketa
• Iri ahụ́ gị gabigara ókè (mgbe ị gafere ezigbo ibu ahụ site na 35-40%, anụ ahụ na insulin na-agbadata ihe dịka 40%),
• ọbara mgbali ike
• ọrịa na-efe efe
• nsogbu metabolic
• oge ime
• mmerụ ahụ na itinye aka n'ịwa ahụ,
• enweghị mmega ahụ
• omume ojoo
• na-a aụ ọgwụ ọjọọ
• nri adịghị mma (nke bụ isi n'iji carbohydrates a nụchara anụcha),
• ihi ura nke abali
• ọnọdụ nrụgide oge
• nká
• nke ndị agbụrụ ụfọdụ (Hispanics, African Americans, Native Americans).

Ofdị ọrịa ahụ

Nnyocha insulin nwere ike ịbụ isi na nke abụọ.

Ọgwụ ọgwụ nke nguzogide insulin na-enweghị mmezi nke oke ibu anaghị arụ ọrụ.

Site na mbido, ekewa ya n'ụdị ndị a:

• physiological - nwere ike ime n'oge uto, n'oge afọ ime, mgbe ụra abalị, na -e nwere abụba buru ibu na nri,
• metabolic Achọpụtara ya na ụdị ọrịa shuga 2 bụ ọrịa shuga, ọrịa ketoacidosis nke na-arịa ọrịa shuga, oke ibu, hyperuricemia, erighị ihe na-edozi ahụ, ị ​​alcoholụbiga mmanya ókè.
• endocrine - hụrụ hypothyroidism, thyrotoxicosis, pheochromocytoma, syndenko-Cushing's syndrome, acromegaly,
• ndị na - abụghị endocrine - ọ na - ebute site na ọrịa imeju, akwara akwara na - adịghị ala ala, ọrịa ogbu na nkwonkwo, nkụda obi, ọnya afọ, myotonic dystrophy, mmerụ ahụ, ịwa ahụ, ọkụ, sepsis.

Ihe mgbaàmà insulin Resistance

Enweghị akara ọ bụla akọwapụtara na insulin na-eguzogide.

Ọtụtụ mgbe enwere ọbara mgbali elu - a na-achọpụta na ọ bụ oke ọbara mgbali elu, ka ukwuu n ’ogo insulin na-eguzogide. Ọzọkwa, n’ime ndị ọrịa na-egbochi insulin, a na-enwekarị agụụ, mkpụrụ nke afọ buru ibu, enwere ike ịba ụba gas.

Ihe ịrịba ama ndị ọzọ nke nguzogide insulin gụnyere itinye uche n'ihe, ike ịmụrụ anya, ikelatala, ike ọgwụgwụ, ụra ehihie (karịchaa mgbe erichara nri), nkụda mmụọ.

Diagnostics

Iji chọpụta insulin na-eguzogide ọgwụ, mkpesa mkpesa na anamnesis (gụnyere akụkọ ezinụlọ), nyocha ebumnuche, nyocha ụlọ nyocha nke nguzogide insulin.

Mgbe ị na-anakọta anamnesis, a na-elebara anya ọnụnọ nke ọrịa shuga mellitus, ọbara mgbali elu, ọrịa obi na ndị ikwu, yana ndị ọrịa na-amụ nwa, ọrịa shuga n’oge ime.

A na-arụ ọrụ dị mkpa na ọgwụgwọ ahụ site na mgbazi nke ndụ, isi ihe oriri na ahụ ike.

Nchọpụta ụlọ nyocha nke nnwale insulin na-enyocha gụnyere nyocha ọbara na mmamịrị n'ozuzu ya, nnwale ọbara biochemical, na mkpebi ụlọ nyocha nke ọkwa insulin na C-peptide n'ime ọbara.

Dabere na njirisi nyocha nke nkwụghachi insulin nke Healthtù Ahụ Ike adoptedwa nakweere, ọ ga-ekwe omume ịnwe ọnụnọ ya na onye ọrịa dabere na usoro ndị a:

• ụdị oke ibu,
• Elu triglycerides ọbara dị elu (nke dị elu karịa 1.7 mmol / l),
• ogo lipoproteins dị elu (dị n'okpuru 1.0 mmol / l n'ime ụmụ nwoke na 1.28 mmol / l n'ime ụmụ nwanyị),
• ndidi nnabata glucose na-egbu mmụọ ma ọ bụ ịba ụba glucose ọnụ ebu ọnụ (ibu ọnụ glucose dị elu karịa 6.7 mmol / l, ọkwa glucose awa abụọ mgbe nyocha nnabata glucose dị 7.8-1-1 mmol / l),
• excretion nke albumin na mmamiri (microalbuminuria nke dị elu karịa 20 mg / min).

Iji chọpụta ihe ọghọm nke nguzogide insulin na nsogbu metụtara ọrịa obi, a na-ekpebi ntụpọ nke ahụ:

• erughị 18.5 n'arọ / m 2 - enweghi ike ahu, odi obere,
• 18.5-24.9 n'arọ / m 2 Ikike anụ ahụ nkịtị, ihe ize ndụ nkịtị,
• 25.0 – 29.9 n'arọ / m 2 - buru oke ibu, ihe egwu karie,
• 30.0-34.9 n'arọ / m 2 - oke ibu nke ogo 1, ihe ize ndụ dị elu,
• 35.0-39.9 n'arọ / m 2 - oke ibu 2 ogo, oke ihe egwu,
• 40 n'arọ / m 2 - oke ibu 3 ogo, oke ihe egwu di egwu.

Ọgwụ insulin na-eguzogide ọgwụ

Ọgwụ iji guzogide insulin bụ ịba ọgwụ mgbochi hypoglycemic. Ndị ọrịa nwere ụdị ọrịa shuga mellitus nke 2 na-enye ọgwụ hypoglycemic nke na-eme ka ojiji nke glucose site na anụ ahụ na-eme ka ọ dịkwuo elu ma nwee mmụba nke anụ ahụ na insulin, nke na-eduga n'ịkwụ ụgwọ nke metabolism metabolism na ndị ọrịa dị otú ahụ. Iji zere ịrụ ọrụ imeju na-arịa ya n'oge ọgwụgwọ ọgwụ, a na-atụ aro ileba anya n'ọtụtụ hepatic n'ọbara ọbara nke ndị ọrịa ọ dịkarịa ala otu ugboro n'ime ọnwa atọ.

N'ime mba ndị mepere emepe, a na-edekọ mgbochi insulin na 10-20% nke ndị bi.

N'ihe banyere ọbara mgbali elu, a na-enye ọgwụ ọgwụgwọ antihypertensive. Site na cholesterol dị ukwuu n'ọbara, a na-egosipụta ọgwụ ndị na-agbada Lipid.

Ekwesịrị iburu n'uche na ọgwụ ọgwụ nke nguzogide insulin na-enweghị mmezi nke oke ahụ gị anaghị arụ ọrụ. A na-arụ ọrụ dị mkpa na ọgwụgwọ ahụ site na mgbazi nke ndụ, isi ihe oriri na ahụ ike. Na mgbakwunye, ọ dị mkpa ịhazi usoro kwa ụbọchị iji hụ na izu ike zuru ezu nke abalị.

Usoro mmega ahụ na - eme ka ị nwee ike ịmịpụta akwara, yana ịbawanye ike ma nwekwaa ike iwetulata glucose n'ọbara n'etinyeghị ọgwụ insulin ọzọ. A na-atụ aro ka ndị ọrịa nwere insulin na-emega ahụike maka opekata mpe nkeji iri atọ kwa ụbọchị.

Canbelata ego nke anụ ahụ adipose na abụba dị ukwuu nwere ike ịme ya nke ọma. Liposuction ịwa ahụ nwere ike ịbụ laser, mmiri jet, radiofrequency, ultrasound, a na-arụ ya n'okpuru usoro ọgwụgwọ izugbe na-enye gị ohere iwepụ 5-6 lita abụba n'otu usoro. Liposuction na-abụghị nke ịwa ahụ abụghị obere ihe kpatara ya, enwere ike ịrụ ya n'okpuru ọgwụ mgbochi mpaghara ma nwee oge mgbake dị mkpirikpi. Maindị kachasị nke mmiri ọgwụ ana-eme ụfụfụ bụ cryolipolysis, ultrasonic cavitation, yana inpa liposuction.

Na oke oke ibu, enwere ike ịtụle okwu banyere usoro ịwa ahụ ara.

Nri maka iguzogide insulin

Ihe ga-enyere gi aka ime ka insulin ghara ikwusi ike bu nri nri. Nri kwesiri ibu akwukwo-akwukwo nri, ndi n’enye ya n’agha n’enye ha dika ala glycemic di obere.

Edere insulin na-eguzogide na 10-25% nke ndị mmadụ na-enweghị nsogbu metabolic na oke ibu.

A na-atụ aro inine na -eme ka obere ihe oriri na fiber, nri anụ, nri anụ na azụ, mmiri ara ehi na mmiri ara ehi, efere buckwheat, na nri nwere omega-3 abụba, potassium, calcium na magnesium.

Belata akwụkwọ nri ndị dị n’ime stachi (poteto, ọka, ugu), ewepu achịcha ọcha na achịcha, osikapa, pasta, mmiri ara ehi niile, bọta, shuga na achịcha, ihe ọ fruitụ fruitụ mkpụrụ osisi, mmanya, na achịcha e ghere eghe na mmanụ. .

Maka ndị ọrịa nwere ọgwụ insulin, a na-atụ aro nri Mediterranean, nke mmanụ oliv bụ isi mmalite nke lipids nke ihe oriri. Ahịhịa na mkpụrụ osisi na-egbu egbu, mmanya na-acha ọbara ọbara (na enweghị ọrịa nke usoro obi na ihe mgbochi ndị ọzọ), ngwaahịa mmiri ara (yogọt eke, feta chiiz) nwere ike itinye na nri. A ga-eri mkpụrụ osisi, mkpụrụ akụ, mkpụrụ, mkpụrụ oliv, ọ karịghị otu ugboro n'ụbọchị. Ga- amachi iji anụ uhie, anụ ọkụkọ, abụba anụmanụ, àkwá, nnu.

Nsogbu na nsonaazụ nwere ike ime

Nguzogide insulin nwere ike ibute atherosclerosis site na imebi fibrinolysis. Na mgbakwunye, megide nzụlite ya, ụdị ọrịa mellitus 2 nke ọrịa shuga, ọrịa obi, ọrịa akpụkpọ (black acanthosis, acrochordon), polycystic ovary syndrome, hyperandrogenism, nhụjuanya uto (ịmụbawanye ọdịdị ihu, mmụba ngwa ngwa) nwere ike ịmalite. Usoro mmachi nke metabolism metabolism na insulin na-eduga na mmepe nke imeju na-egbu egbu (ma nke dị nfe ma nke siri ike) yana nnukwu ihe mgbapụta ma ọ bụ kansa imeju.

E nwere ọdịnala pụtara ìhè maka mmepe nke nguzogide insulin.

N'iburu nchoputa nke oge ya na ọgwụgwọ ziri ezi, prognosis ahụ dị mma.

Mgbochi

Iji gbochie mmepe nke nguzogide insulin, a na-atụ aro ya:

• mmezi nke oke ibu,
• ezigbo ihe oriri
• ọnọdụ ezi ọrụ na ezumike,
• mmega ahụ zuru oke
• na-ezere ọnọdụ ndị na-akpata nrụgide
• ịhapụ omume ọjọọ,
• n'oge ọgwụgwọ nke ọrịa ndị nwere ike ibute mmepe nke nguzogide insulin,
• n'oge arịrịọ maka enyemaka ahụike na nyocha nke nguzogide insulin n'ihe metụtara enyo enyo na ọ na-emebi metabolism,
• Zere ị drugsụ ọgwụ ọjọọ.

Symptomatology

Chọpụta usoro a bụ ihe siri ike, ebe ọ bụ na ogologo oge ọ nwere ike bụrụ asymptomatic kpamkpam. Na mgbakwunye, ngosipụta ụlọ ọgwụ ugbu a bụ ihe na-enweghị atụ na ọdịdị, ya mere ọtụtụ ndị ọrịa anaghị achọ nlekọta ahụike n'oge ha, na-ekwu na ahụ esighi ike na ike ọgwụgwụ ma ọ bụ afọ.

Na agbanyeghị, ụdị mmebi ahụ na arụ ọrụ nke ahụ ga-esonyere akara ndị a:

• ọnụ kpọrọ nkụ, n'agbanyeghị akpịrị ịkpọ nkụ mgbe niile na ojiji nke nnukwu mmiri mmiri,
• nhọrọ nri - n'ọtụtụ oge, ndị ọrịa dị etu a gbanwere mmasị uto ha, 'a dọtara ha' ka ha rie nri,
• isi ọwụwa na-enweghị ihe pụtara ìhè, oge ụfọdụ iwe,
• ike gwụrụ, ọbụlagodi mgbe ezumike zuru ezu,
• mgbakasị ahụ, oke iwe, nke ga-abụ n'ihi erughi glucose na ụbụrụ,
• obi palpitations
• afọ ntachi na-anaghị akpata nri
• Ọsụsọ mụbara, ọkachasị n'abalị,
• n'ime ụmụ nwanyị - nsọ nwanyị,
• oke ibu - oke abụba gburugburu ubu akwa yana akpa nwa,
• acha uhie uhie na obi na olu, nke nwere ike ijikọta ya na itching. Ọrịa anaghị arịa ọrịa na ụdị mgbaàmà ndị yiri akpịrị.

Na mgbakwunye na eserese etiological nke mpụga, a ga-egosipụta ọnụnọ nke ụdị ihe mgbaàmà a site na ịdabere n'ụkpụrụ ndị na - egosi na LHC:

• ista nke cholesterol dị mma "belata,
• ego nke triglycerides karịa nke nkịtị site na 1.7 mmol / l,
• ego nke cholesterol nke “jọrọ njọ” dị elu karịa nke nkịtị site na 3.0 mmol / l,
• otú protein dị na mmamịrị,
• ọnụ ọgụgụ glucose ọbara na-ebu ọnụ karịrị iwu 5.6-6.1 mmol / l.

Ọ bụrụ n ’foto dị n’elu ahụ dị n’elu, ị kwesịrị ịchọrọ enyemaka ahụike ozugbo. Ngwọta onwe onye, ​​na nke a, abụghị naanị ihe na-ekwesịghị ekwesị, kamakwa ọ na-eyi ndụ egwu.