Diabetes

Diabete mellitus ivuga indwara zibangamira uko umubiri ukoresha isukari yo mu maraso (glucose). Glucose ni isoko y'ingufu ikomeye ku mitsi igize imikaya n'imiterere y'umubiri. Ni nayo ngufu nyamukuru y'ubwonko.

Intandaro nyamukuru ya diabete itandukana bitewe n'ubwoko. Ariko uko ubwoko bwa diabete ufite bwose bwose, bushobora gutera isukari nyinshi mu maraso. Isukari nyinshi mu maraso ishobora gutera ibibazo bikomeye by'ubuzima.

Indwara zidakira za diabete harimo diabete yo mu bwoko bwa mbere na diabete yo mu bwoko bwa kabiri. Indwara za diabete zishobora gukira harimo diabete itaragara neza na diabete iterwa no gutwita. Diabete itaragara neza ibaho iyo urwego rw'isukari mu maraso rurengeje urugero rusanzwe. Ariko urwego rw'isukari mu maraso ntiruba rwo hejuru ngo ruvugwe ko ari diabete. Kandi diabete itaragara neza ishobora gutera diabete keretse hafashwe ingamba zo kuyikumira. Diabete iterwa no gutwita ibaho mu gihe cyo gutwita. Ariko ishobora kuzimira nyuma y'uko umwana avutse.

Ibimenyetso bya diyabete biterwa n'ukuntu isukari y'amaraso yawe iri hejuru. Bamwe mu bantu, cyane cyane niba bafite diyabete ibanziriza iya nyayo, diyabete iterwa n'inda cyangwa diyabete yo mu bwoko bwa 2, bashobora kutabona ibimenyetso. Muri diyabete yo mu bwoko bwa 1, ibimenyetso bikunda kuza vuba kandi bikaba biremereye.

Bimwe mu bimenyetso bya diyabete yo mu bwoko bwa 1 na diyabete yo mu bwoko bwa 2 ni ibi bikurikira:

• Kumva inyota kurusha uko bisanzwe.
• Gushobora kenshi.
• Kugabanya ibiro utabishaka.
• Kugaragara kwa Ketone mu mpiswi. Ketone ni umusaruro w'isusurutse ry'imitsi n'amavuta bibaho igihe hari insuline idahagije.
• Kumva unaniwe kandi udashoboye.
• Kumva uhangayitse cyangwa kugira izindi mpinduka z'imitekerereze.
• Kugira amaso y'umwijima.
• Kugira ibikomere bikira buhoro.
• Kugira indwara nyinshi, nka za ndwara z'urukoko, iz'amenyo n'iz'igitsina.

Diyabete yo mu bwoko bwa 1 ishobora gutangira mu myaka yose. Ariko ikunda gutangira mu bwana cyangwa mu myaka y'ubwangavu. Diyabete yo mu bwoko bwa 2, ubwoko busanzwe, ishobora kuvuka mu myaka yose. Diyabete yo mu bwoko bwa 2 igaragara cyane mu bantu barengeje imyaka 40. Ariko diyabete yo mu bwoko bwa 2 mu bana iriyongera.

• Niba utekereza ko wowe cyangwa umwana wawe ashobora kuba afite diyabete. Niba ubona ibimenyetso byose bishoboka bya diyabete, hamagara umuganga wawe. Uko iyi ndwara imenyekanye hakiri kare, ni ko kuvurwa gutangira vuba.
• Niba umaze kuvurwa diyabete. Nyuma yo kubona ubuvuzi, uzakenera gukurikiranwa hafi n'abaganga kugeza igihe isukari y'amaraso yawe izahorana umutekano.

Kugira ngo umuntu yumve diabete, ni ngombwa gusobanukirwa uko umubiri ukoresha glucose ubundi. Insulin ni hormone iva mu mpyiko iri inyuma kandi hepfo y'igifu (pancreas). Pancreas irekurira insulin mu maraso. Insulin itembera, igateza isukari kwinjira mu mitsi. Insulin igabanya isukari iri mu maraso. Uko isukari mu maraso igenda igabanuka, ni ko n'ihindurwa rya insulin riva muri pancreas rigenda rigabanuka. Glucose-isukari-ni isoko y'ingufu ku mitsi igize imikaya n'utundi tugize umubiri. Glucose iterwa n'ibintu bibiri by'ingenzi: ibyokurya na figwa. Isukari ijya mu maraso, aho ijyamo mu mitsi ifashwa na insulin. Figwa ibika kandi ikora glucose. Iyo glucose yagabanutse, nko mu gihe umaze igihe utariye, figwa isenya glycogen yabitswe ikayihindura glucose. Ibi bituma glucose yawe iba muri urwego rusanzwe. Impamvu nyamukuru y'ubwoko bwinshi bwa diabete ntizwi. Mu bihe byose, isukari yiyongera mu maraso. Ibi biterwa n'uko pancreas idakora insulin ihagije. Diabete yo mu bwoko bwa mbere n'iya kabiri bishobora guterwa n'ivangura ry'imiterere y'umuntu cyangwa ibidukikije. Ntabwo birasobanutse ibyo bintu bishobora kuba.

Ibyago by'indwara ya diyabete biterwa n'ubwoko bwa diyabete. Amateka y'umuryango ashobora kugira uruhare mubwoko bwose. Ibintu by'ibidukikije n'ubwibumbye bishobora kongera ibyago bya diyabete yo mu bwoko bwa mbere.

Rimwe na rimwe, abagize umuryango w'abantu bafite diyabete yo mu bwoko bwa mbere bapimwa kugira ngo harebwe niba bafite uturemangingabo tw'umubiri (autoantibodies). Niba ufite utwo turemangingabo, ufite ibyago byiyongereye byo kurwara diyabete yo mu bwoko bwa mbere. Ariko si buri wese ufite utwo turemangingabo arwara diyabete.

Uruhando cyangwa ubwoko bw'abantu bashobora kongera ibyago byo kurwara diyabete yo mu bwoko bwa kabiri. Nubwo bitaramenyekana impamvu, bamwe mu bantu — barimo abirabura, abahispanike, abanyamerika bakomoka mu Buhindi n'abanyamerika bakomoka muri Aziya — bafite ibyago byinshi.

Prediabete, diyabete yo mu bwoko bwa kabiri na diyabete iterwa n'inda y'umugore birakunda cyane mu bantu bafite ibiro byinshi cyangwa bafite umubyibuho ukabije.

Ingaruka z'igihe kirekire za diyabete ziraza buhoro buhoro. Uko umaze igihe kinini ufite diyabete - kandi uko isukari yawe mu maraso idakozwe neza - ni ko ibyago byo kugira ingaruka bikomeye. Amaherezo, ingaruka za diyabete zishobora gutuma udashobora gukora imirimo cyangwa bikagutwara ubuzima. Mu by'ukuri, diyabete itaragaragaye ishobora gutera diyabete yo mu bwoko bwa 2. Ingaruka zishoboka zirimo:

• Indwara z'umutima n'imijyana y'amaraso (indwara z'umutima). Diyabete yongera cyane ibyago byinshi by'ibibazo by'umutima. Ibi bishobora kuba birimo indwara y'imitsi y'umutima ifite ububabare mu gituza (angina), gufatwa n'indwara y'umutima, gucika kw'imitsi y'amaraso (stroke) no gutomba kw'imitsi y'amaraso (atherosclerosis). Niba ufite diyabete, ushobora kurwara indwara y'umutima cyangwa gucika kw'imitsi y'amaraso.
• Kwangirika kw'imitsi iterwa na diyabete (diabetic neuropathy). Isukari nyinshi ishobora gukomeretsa inkuta z'imitsi mito y'amaraso (capillaries) ihisha imitsi, cyane cyane mu maguru. Ibi bishobora gutera guhindagurika, kubabara, gutwika cyangwa ububabare busanzwe butangirira ku ntoki cyangwa ku birenge hanyuma bugakwirakwira hejuru.

Kwangirikwa kw'imitsi ifitanye isano n'igogora bishobora gutera ibibazo byo kugira iseseme, kuruka, impiswi cyangwa kubabara mu nda. Ku bagabo, bishobora gutera kudakora imibonano mpuzabitsina.

• Kwangirikwa kw'impyiko biterwa na diyabete (diabetic nephropathy). Impyiko zifite udutose dutwara amaraso (glomeruli) duto duto dukoresha mu gusukura imyanda mu maraso. Diyabete ishobora kwangiza ubu buryo buto bwo gusukura.
• Kwangirikwa kw'amaso biterwa na diyabete (diabetic retinopathy). Diyabete ishobora kwangiza imitsi y'amaraso y'ijisho. Ibi bishobora gutera ubuhumyi.
• Kwangirikwa kw'ibirenge. Kwangirikwa kw'imitsi mu birenge cyangwa amaraso make ajya mu birenge byongera ibyago byo kugira ibibazo byinshi mu birenge.
• Indwara z'uruhu n'akanwa. Diyabete ishobora gutuma ugira ibibazo by'uruhu, harimo ubwandu bw'ibinyabuzima byangiza n'ibinyabuzima by'ibinyampeke.
• Kubura kumva. Ibibazo byo kumva birakunda cyane mu bantu bafite diyabete.
• Alzheimer's disease. Diyabete yo mu bwoko bwa 2 ishobora kongera ibyago byo kugira uburwayi bwo mu bwonko, nka Alzheimer's disease.

Kwangirika kw'imitsi iterwa na diyabete (diabetic neuropathy). Isukari nyinshi ishobora gukomeretsa inkuta z'imitsi mito y'amaraso (capillaries) ihisha imitsi, cyane cyane mu maguru. Ibi bishobora gutera guhindagurika, kubabara, gutwika cyangwa ububabare busanzwe butangirira ku ntoki cyangwa ku birenge hanyuma bugakwirakwira hejuru.

Kwangirikwa kw'imitsi ifitanye isano n'igogora bishobora gutera ibibazo byo kugira iseseme, kuruka, impiswi cyangwa kubabara mu nda. Ku bagabo, bishobora gutera kudakora imibonano mpuzabitsina.

Abagore benshi bafite diyabete yo mu gihe cyo gutwita babyara abana bazima. Ariko kandi, isukari mu maraso idakozwe neza cyangwa idakurikiranwa ishobora gutera ibibazo kuri wowe n'umwana wawe.

Ingaruka ku mwana wawe zishobora guterwa na diyabete yo mu gihe cyo gutwita, harimo:

• Gukura cyane. Glucose nyinshi ishobora kwambuka placenta. Glucose nyinshi ituma umwijima w'umwana ukora insuline nyinshi. Ibi bishobora gutuma umwana wawe akura cyane. Bishobora gutera kubyara bigoye kandi rimwe na rimwe hakaba hakenewe kubaga.
• Isukari nke mu maraso. Rimwe na rimwe abana b'ababyeyi bafite diyabete yo mu gihe cyo gutwita bagira isukari nke mu maraso (hypoglycemia) nyuma gato yo kuvuka. Ibi biterwa no kuba umusaruro wabo wa insuline ari mwinshi.
• Diyabete yo mu bwoko bwa 2 nyuma y'imyaka. Abana b'ababyeyi bafite diyabete yo mu gihe cyo gutwita bafite ibyago byinshi byo kugira umubyibuho ukabije na diyabete yo mu bwoko bwa 2 nyuma y'imyaka.
• Urupfu. Diyabete yo mu gihe cyo gutwita idakurikiranwa ishobora gutera urupfu rw'umwana mbere cyangwa nyuma gato yo kuvuka.

Ingaruka ku mubyeyi zishobora guterwa na diyabete yo mu gihe cyo gutwita, harimo:

• Diyabete yo mu gihe cyo gutwita. Niba wari ufite diyabete yo mu gihe cyo gutwita mu gihe cyo gutwita kimwe, ushobora kongera kuyigira mu gihe cyo gutwita gikurikiyeho.

Diabete ya type 1 ntishobora kwirindwa. Ariko imyifatire myiza yo kwita ku buzima ifasha mu kuvura diabete ya mbere y'igihe, diabete ya type 2 na diabete iterwa n'inda, ishobora kandi gufasha kuyirinda:

• Funga ibiryo byiza. Hitamo ibiryo bifite amavuta make n'amacalorie make kandi byinshi mu fibres. Funga imbuto, imboga n'ibinyampeke byuzuye. Funga ubwoko butandukanye kugira ngo wirinde kubura ubwenge.
• Kora imyitozo ngororamubiri byinshi. Gerageza gukora iminota 30 y'imyitozo ngororamubiri ya aerobic buri munsi. Cyangwa gerageza gukora byibuze iminota 150 y'imyitozo ngororamubiri ya aerobic mu cyumweru. Urugero, ujye ugenda buri munsi. Niba udashobora gukora imyitozo myinshi, uyigabanye mu duce duto mu gihe cy'umunsi.
• Kumanura ibiro byinshi. Niba uri umubyibuhe, kugabanya nibura 7% by'uburemere bw'umubiri wawe bishobora kugabanya ibyago bya diabete. Urugero, niba upima ibiro 200 (kilogram 90.7), kugabanya ibiro 14 (kilogram 6.4) bishobora kugabanya ibyago bya diabete. Ariko ntukagerageze kugabanya ibiro mu gihe utwite. Ganira n'abaganga bawe ku biro bikwiriye kugira mu gihe utwite. Kugira ngo ugume ufite ibiro bikwiriye, shyira imbaraga mu mpinduka z'igihe kirekire mu myifatire yawe yo kurya no gukora imyitozo ngororamubiri. Ibuka akamaro ko kugabanya ibiro, nko kugira umutima muzima, imbaraga nyinshi n'icyizere cyiyubaha. Kumanura ibiro byinshi. Niba uri umubyibuhe, kugabanya nibura 7% by'uburemere bw'umubiri wawe bishobora kugabanya ibyago bya diabete. Urugero, niba upima ibiro 200 (kilogram 90.7), kugabanya ibiro 14 (kilogram 6.4) bishobora kugabanya ibyago bya diabete. Ariko ntukagerageze kugabanya ibiro mu gihe utwite. Ganira n'abaganga bawe ku biro bikwiriye kugira mu gihe utwite. Kugira ngo ugume ufite ibiro bikwiriye, shyira imbaraga mu mpinduka z'igihe kirekire mu myifatire yawe yo kurya no gukora imyitozo ngororamubiri. Ibuka akamaro ko kugabanya ibiro, nko kugira umutima muzima, imbaraga nyinshi n'icyizere cyiyubaha. Rimwe na rimwe imiti iba ari igisubizo. Imiti yo mu kanwa yo kuvura diabete nka metformin (Glumetza, Fortamet, izindi) ishobora kugabanya ibyago bya diabete ya type 2. Ariko imyifatire myiza yo kwita ku buzima ni ingenzi. Niba ufite diabete ya mbere y'igihe, jya upimisha isukari yawe mu maraso nibura rimwe mu mwaka kugira ngo wirinde kwandura diabete ya type 2.

Umuganga w’indwara z’imisemburo Yogish Kudva, M.B.B.S., arasubiza ibibazo bikunze kubaho cyane ku diyabete yo mu bwoko bwa mbere.

Ubu buryo bwiza bwo kuvura diyabete yo mu bwoko bwa mbere ni ukoresha uburyo bwa otomatike bwo gutanga insuline. Iyi sisitemi irimo ikintu gipima isukari mu maraso buri kanya, igipompo cy’insuline, na algorithm ya mudasobwa ihora ihinduranya insuline isubiza ku kimenyetso cy’igipima cy’isukari mu maraso buri kanya. Umurwayi agomba kwandika amakuru yerekeye ingano y’isukari afata mu biribwa byo kurya kugira ngo atange insuline ijyanye n’ibi biribwa.

Gupima hakoreshejwe igipima cy’isukari mu maraso ntibihagije kuko bipimo by’isukari mu maraso mu bantu bafite diyabete yo mu bwoko bwa mbere bihinduka cyane kuva ku bisanzwe kugeza ku bicye cyangwa ku byinshi mu gihe gito cyane cy’umunsi, igipima cy’isukari mu maraso buri kanya gikenewe kugira ngo hamenyekane niba ubuvuzi ari bwo bwiza kandi no kumenya uko wakongera ubuvuzi.

Amabwiriza ya none asaba gukoresha igipima cy’isukari mu maraso buri kanya. Igipimo cy’igihe umuntu amara buri munsi afite isukari iri hagati ya 70 na 180 miligaramu kuri desilitri ni cyo gipimo nyamukuru cy’ubuvuzi bukwiye. Uyu mubare ugomba kuba 70% cyangwa hejuru yawo buri munsi. Byongeye kandi, igipimo cy’igihe umuntu amara afite isukari iri munsi ya 70 kigomba kuba munsi ya 4% kandi kirenze 250 kigomba kuba munsi ya 5%. Biragaragara ko gupima hemoglobin A1C kugira ngo hamenyekane niba ubuvuzi ari bwo bwiza ntibihagije.

Mu bantu bamwe bafite diyabete yo mu bwoko bwa mbere, gushimwa kw’impyiko bishobora gukorwa. Ibi bishobora kuba gushimwa kw’impyiko cyangwa gushimwa kw’uturemangingo dukora insuline twitwa islet. Gushimwa kw’uturemangingo twa islet bifatwa nk’ubushakashatsi muri Amerika. Gushimwa kw’impyiko bihari nk’ubuvuzi. Aba barwayi bafite hypoglycemia unawareness bashobora kungukirwa no gushimwa kw’impyiko. Abantu bafite diyabete yo mu bwoko bwa mbere bafite ketoacidosis ya diyabete isubiramo bashobora kungukirwa no gushimwa kw’impyiko. Abantu bafite diyabete yo mu bwoko bwa mbere bafite ikibazo cy’impyiko, ubuzima bwabo bushobora guhinduka neza no gushimwa kw’impyiko n’impyiko.

Gerageza kumenya amakuru yerekeye ubushakashatsi bukorwa n’ubuvuzi bushobora kwemezwa kuri diyabete yo mu bwoko bwa mbere. Urashobora kubona aya makuru binyuze mu bitabo byamaze kubaho. Menya neza ko buri mwaka uba ubona umuganga w’inzobere mu ndwara yawe. Ntuzigere utinya kubabaza ikipe yawe y’abaganga ibibazo cyangwa impungenge ufite. Kumenya amakuru ni byo byose. Murakoze ku gihe cyanyu kandi tubifuriza ibyiza.

Ibimenyetso bya diyabete yo mu bwoko bwa mbere bikunze gutangira mu buryo butunguranye kandi akenshi ari byo bituma harebwa urwego rw’isukari mu maraso. Kubera ko ibimenyetso by’ubundi bwoko bwa diyabete na prediyabete bitinda cyangwa bishobora kuba bigoye kubibona, Ishyirahamwe rya Amerika ry’indwara ya diyabete (ADA) ryateguye amabwiriza yo gupima. ADA irasaba ko abantu bakurikira bapimwa diyabete:

• Umuntu wese ufite imyaka irenga 35 agira inama yo gupimwa isukari mu maraso bwa mbere. Niba ibyavuye mu bipimo ari bisanzwe, bagomba gupimwa buri myaka itatu nyuma yaho.
• Abagore bafite diyabete y’inda bagira inama yo gupimwa diyabete buri myaka itatu.
• Umuntu wese wamenyeshejwe ko afite prediyabete agira inama yo gupimwa buri mwaka.
• Umuntu wese ufite virusi itera SIDA (HIV) agira inama yo gupimwa.
• Isuzuma rya A1C. Iri suzuma ry’amaraso, ritagerageza kutagura igihe runaka (gusiba kurya), rigaragaza urwego rwawe rw’isukari mu maraso mu mezi 2 cyangwa 3 ashize. Ripima igipimo cy’isukari mu maraso yifashishije hemoglobin, poroteyine itwara ogisijeni mu maraso y’umutuku. Bita kandi isuzuma rya glycated hemoglobin.

Uko urwego rw’isukari mu maraso rwawe rwiyongera, ni ko hemoglobin uzagira ifite isukari yiyongereye. Urwego rwa A1C rwa 6.5% cyangwa hejuru kuri isuzuma ebyiri zitandukanye bivuze ko ufite diyabete. Urwego rwa A1C ruri hagati ya 5.7% na 6.4% bivuze ko ufite prediyabete. Munsi ya 5.7% bifatwa nk’ibisanzwe.

• Isuzuma ry’isukari mu maraso ryakozwe ku gihe icyo ari cyo cyose. Igipimo cy’amaraso kizafatwa ku gihe icyo ari cyo cyose. Uko waba wararangije kurya, urwego rw’isukari mu maraso rwa 200 miligaramu kuri desilitri (mg/dL) — 11.1 milimoli kuri litiro (mmol/L) — cyangwa hejuru bigaragaza diyabete.
• Isuzuma ry’isukari mu maraso ryakozwe nyuma yo gusiba kurya. Igipimo cy’amaraso kizafatwa nyuma yo kutagura ikinyobwa cyose mu ijoro ryabanje (gusiba kurya). Urwego rw’isukari mu maraso ruri munsi ya 100 mg/dL (5.6 mmol/L) ni rusanzwe. Urwego rw’isukari mu maraso ruri hagati ya 100 na 125 mg/dL (5.6 na 6.9 mmol/L) bifatwa nk’prediyabete. Niba ari 126 mg/dL (7 mmol/L) cyangwa hejuru kuri isuzuma ebyiri zitandukanye, ufite diyabete.
• Isuzuma ry’ubuhangane bw’isukari. Kuri iri suzuma, uba usigaye utaguye ijoro ryose. Hanyuma, urwego rw’isukari mu maraso rwa nyuma yo gusiba kurya rupimwa. Hanyuma unywa ikinyobwa cy’isukari, kandi urwego rw’isukari mu maraso rupimwa buri gihe mu masaha abiri akurikira.

Urwego rw’isukari mu maraso ruri munsi ya 140 mg/dL (7.8 mmol/L) ni rusanzwe. Igipimo kirenze 200 mg/dL (11.1 mmol/L) nyuma y’amasaha abiri bivuze ko ufite diyabete. Igipimo kiri hagati ya 140 na 199 mg/dL (7.8 mmol/L na 11.0 mmol/L) bivuze ko ufite prediyabete.

Isuzuma rya A1C. Iri suzuma ry’amaraso, ritagerageza kutagura igihe runaka (gusiba kurya), rigaragaza urwego rwawe rw’isukari mu maraso mu mezi 2 cyangwa 3 ashize. Ripima igipimo cy’isukari mu maraso yifashishije hemoglobin, poroteyine itwara ogisijeni mu maraso y’umutuku. Bita kandi isuzuma rya glycated hemoglobin.

Uko urwego rw’isukari mu maraso rwawe rwiyongera, ni ko hemoglobin uzagira ifite isukari yiyongereye. Urwego rwa A1C rwa 6.5% cyangwa hejuru kuri isuzuma ebyiri zitandukanye bivuze ko ufite diyabete. Urwego rwa A1C ruri hagati ya 5.7% na 6.4% bivuze ko ufite prediyabete. Munsi ya 5.7% bifatwa nk’ibisanzwe.

Isuzuma ry’ubuhangane bw’isukari. Kuri iri suzuma, uba usigaye utaguye ijoro ryose. Hanyuma, urwego rw’isukari mu maraso rwa nyuma yo gusiba kurya rupimwa. Hanyuma unywa ikinyobwa cy’isukari, kandi urwego rw’isukari mu maraso rupimwa buri gihe mu masaha abiri akurikira.

Urwego rw’isukari mu maraso ruri munsi ya 140 mg/dL (7.8 mmol/L) ni rusanzwe. Igipimo kirenze 200 mg/dL (11.1 mmol/L) nyuma y’amasaha abiri bivuze ko ufite diyabete. Igipimo kiri hagati ya 140 na 199 mg/dL (7.8 mmol/L na 11.0 mmol/L) bivuze ko ufite prediyabete.

Niba umuvuzi wawe atekereza ko ushobora kuba ufite diyabete yo mu bwoko bwa mbere, ashobora gupima umushishi wawe kugira ngo arebe niba hariho ketones. Ketones ni umusaruro ubaho iyo imitsi n’amavuta bikoreshejwe nk’ingufu. Umuvuzi wawe azashobora kandi gukora isuzuma kugira ngo arebe niba ufite uturemangingo twangiza sisitemu y’ubudahangarwa dufatanije na diyabete yo mu bwoko bwa mbere twitwa autoantibodies.

Umuvuzi wawe azashobora kureba niba uri mu kaga gakomeye ka diyabete y’inda hakiri kare mu gihe utwite. Niba uri mu kaga gakomeye, umuvuzi wawe ashobora gupima diyabete mu gihe cy’ubuzima bwawe bwa mbere. Niba uri mu kaga gasanzwe, uzapimwa mu gihe cy’amezi atatu ya kabiri y’inda.