Inselele Yokuselapha

“Asikho isifo sikashukela okungathiwa asisibi. Sihlale sisibi njalo.”—U-Anne Daly, we-American Diabetes Association.

“IMIPHUMELA yokuhlolwa kwegazi lakho ibonisa ukuthi kukhona okungahambi kahle. Kudingeka welashwe ngokushesha.” Lapho uDeborah ezwa la mazwi kadokotela, kwaduma upotiyane. Uthi: “Ngalobo busuku, ngangilokhu ngicabanga ukuthi kumelwe ukuba kunephutha abalenze uma behlola. Ngazitshela ukuthi akunakwenzeka ukuthi ngiyagula.”

Njengabantu abaningi, uDeborah wayecabanga ukuthi ungumqemane, ngakho wazishaya indiva izimpawu ezazibelesela. Wayecabanga ukuthi ukoma kwakhe kwakubangelwa ama-antihistamine ayewaphuza. Wayethi ukuchama kwakhe njalo kwakubangelwa ukuthi wayephuza amanzi kakhulu. Ukukhathala kona-ke—ukhona yini umama osebenzayo ongakhathali?

Kodwa ukuhlolwa kwegazi kwembula ukuthi wayenesifo sikashukela. Kwakunzima ngoDeborah ukwamukela imiphumela yokuxilongwa kwakhe. Uthi: “Angitshelanga muntu ukuthi ngiyagula. Ebusuku, lapho umkhaya wami usulele, ngangigqolozela ngaphandle ebumnyameni ngikhale.” NjengoDeborah, abanye lapho bezwa ukuthi banesifo sikashukela, bafikelwa yimizwelo enamandla, ehlanganisa ukucindezeleka ngisho nentukuthelo. UKaren uthi: “Ngangikhala njalo kungavumi ukuba ngikwamukele.”

Lezi yizindlela abantu abavame ukusabela ngazo lapho bebhekana nezimo ezingemnandi. Nokho, uma besekelwa, abanesifo sikashukela bangasamukela isimo. “Umhlengikazi wami wangisiza ukuba ngisamukele isimo sami,” kusho uKaren. “Wangiqinisekisa ukuthi kwakungelona iphutha ukukhala. Ukukhipha ubuhlungu ngale ndlela kwangisiza ukuba ngizivumelanise nesimo.”

Okusenza Sibe Sibi

Isifo sikashukela sibizwa ngokuthi “ukuphazamiseka kwenjini yokuphila,” futhi ngesizathu esizwakalayo. Uma umzimba uhluleka ukugaya ushukela i-glucose, ziningi izinqubo ezibalulekile ezingase ziwohloke, ngezinye izikhathi kube nemiphumela esongela ukuphila. UDkt. Harvey Katzeff uthi: “Akusona isifo sikashukela esibabulalayo abantu, babulawa yizinkinga ezisibangelayo. Siyakwazi ukuvimbela lezo zinkinga, kodwa kuyasehlula ukuzelapha lapho sezivelile.”a

Ingabe labo abanesifo sikashukela banalo ithemba? Yebo—uma beqaphela ukuthi sibi kangakanani lesi sifo bese bevuma ukuthola ukwelashwa.b

Ukudla Nokuvivinya Umzimba

Nakuba isifo sikashukela soHlobo 1 singenakuvinjelwa, ososayensi bahlola izici zofuzo ezisibangelayo futhi bazama ukuthola izindlela zokunqanda ukuzihlasela komzimba. (Bheka ibhokisi elithi “Indima Ye-glucose,” ekhasini 8.) Incwadi ethi Diabetes—Caring for Your Emotions as Well as Your Health ithi: “Makhudlwana amathemba okwelapha isifo sikashukela sohlobo 2. Kwabaningi abathambekele kulesi sifo ngenxa yofuzo, izimpawu ziyagwemeka ngokudla ukudla okunomsoco nangokuvivinya umzimba njalo, kanjalo bahlale beyimiqemane futhi balondoloze isisindo somzimba esifanele.”c

Lapho igcizelela ukubaluleka kokuvivinya umzimba, i-Journal of the American Medical Association yabika ngocwaningo olubanzi olwenziwa kwabesifazane. Lolu cwaningo lwathola ukuthi “ukuzikhandla nje isikhashana kwandisa izinga lokumunca [kwamangqamuzana omzimba] ushukela i-glucose okubangelwa yi-insulin ngamahora angaphezu kwangu-24.” Ngakho-ke, lo mbiko waphetha ngokuthi “ukuhamba nokusebenza ngokuzikhandla kuhlobene nokuncipha okukhulu kwesifo sikashukela sohlobo 2 kwabesifazane.” Abacwaningi batusa ukuvivinya umzimba okusesilinganisweni okungenani imizuzu engu-30 cishe nsuku zonke zesonto. Lokhu kungahlanganisa okuthile okulula njengokuhamba, lokho i-American Diabetes Association Complete Guide to Diabetes ethi “kuyindlela yokuzivivinya engcono, ephephe kunazo zonke nengabizi.”

Nokho, abantu abanesifo sikashukela abavivinya umzimba kufanele bakwenze ngaphansi kokuqondisa kochwepheshe. Esinye isizathu siwukuthi isifo sikashukela singalimaza isimiso semithambo yegazi nesezinzwa, kanjalo kukhinyabezeke ukugeleza kwegazi nokusebenza kwezinzwa. Ngenxa yalokho, umhuzuko nje omncane onyaweni ungase unganakeki, bese uyabhibha—okuyisimo esibi esingaholela ekunqanyulweni kwalo uma lungelashwanga ngokushesha.d

Noma kunjalo, isimiso sokuvivinya umzimba singamsiza umuntu ukuba alawule isifo sikashukela. I-ADA Complete Guide ithi: “Lapho abacwaningi beqhubeka behlola izinzuzo zokuvivinya umzimba njalo, kulapho bethola khona ukuthi kunemiphumela emihle.”

Ukwelapha Nge-insulin

Ngaphezu kokudla nokuvivinya umzimba, abaningi abanesifo sikashukela kumelwe bathasisele ngokuhlola amazinga e-glucose nsuku zonke kanye nemijovo eminingi ye-insulin. Ngenxa yokuthi impilo yabo iye yathuthuka lapho bedla kahle futhi bevivinya umzimba njalo, abanye abanesifo sikashukela soHlobo 2 baye bakwazi ukuyeka ukusebenzisa i-insulin, okungenani okwesikhashana.e UKaren, onesifo sikashukela soHlobo 1, wathola ukuthi ukuvivinya umzimba kwandisa amandla okusebenza komjovo we-insulin. Ngenxa yalokho, uye wakwazi ukunciphisa i-insulin ayidinga nsuku zonke ngamaphesenti angu-20.

Nokho, uma kudingeka i-insulin, asikho isizathu sokuba onalesi sifo azizwe edumele. UMary Ann, ongumhlengikazi onakekela idlanzana labantu abanesifo sikashukela, uthi: “Ukusebenzisa i-insulin akusho ukuthi uyisehluleki. Kungakhathaliseki ukuthi unaluhlobo luni lwesifo sikashukela, uma ulilawula ngokucophelela izinga likashukela egazini, uyonciphisa ezinye izinkinga zempilo kamuva.” Empeleni, ucwaningo lwamuva lwembule ukuthi kubantu abanalesi sifo soHlobo 1 abawagada impela amazinga kashukela egazini, “ehla kakhulu amathuba ezinkinga zamehlo, zezinso nezezinzwa ezibangelwa yisifo sikashukela.” Ngokwesibonelo, ingozi yesifo samehlo (i-retinopathy) yancipha ngamaphesenti angu-76! AbanesoHlobo 2 abawagada impela amazinga kashukela egazini bajabulela izinzuzo ezifanayo.

Ukuze kwenziwe kube lula futhi kungabi buhlungu ukwelapha nge-insulin, imijovo—okuyiyona esetshenziswa kakhulu—inezinaliti ezincane ezingebuhlungu kakhulu. UMary Ann uthi: “Ngokuvamile umjovo wokuqala yiwona obuhlungu. Ngemva kwalokho, iziguli eziningi zithi azizwa lutho.” Ezinye izindlela zokujova zihlanganisa imishini ezishintshayo efaka inalithi esikhunjeni kungabi buhlungu, ama-jet injector afaka i-insulin esikhunjeni ngokufutha kanye, kanye nomshini onepayipi elihlala izinsuku ezimbili noma ezintathu emzimbeni. Intandokazi eminyakeni yamuva nje yisifutho se-insulin esingange-pager. Lesi sifutho, ongasihlela kusengaphambili indlela ofuna sisebenze ngayo, sifaka i-insulin ngepayipi ngezinga elidingwa umzimba nsuku zonke, okwenza ukuba i-insulin isebenziseke ngokunembile kungabi nazinkinga.

Qhubeka Ufunda

Sekukonke, alikho ikhambi lesifo sikashukela elinguzifozonke. Lapho ecabangela indlela yokwelashwa, umuntu ngamunye kumelwe acabangele izici eziningana ukuze enze isinqumo. UMary Ann uthi: “Yize unakekelwa iqembu labezokwelapha, nguwena ongumshayeli.” Eqinisweni, iphephabhuku i-Diabetes Care lithi: “Ukwelapha isifo sikashukela ungenalwazi lokuzinakekela kungase kubhekwe njengokwelapha okusezingeni eliphansi nokungamukeleki.”

Uma abanesifo sikashukela befunda okwengeziwe ngesifo abanaso, baba sesimweni esingcono sokunakekela impilo yabo futhi bandise amathuba abo okuphila isikhathi esijana, benempilo engcono. Nokho, ukuze ube nolwazi oluwusizo kudingeka ube nesineke. Incwadi ethi Diabetes—Caring for Your Emotions as Well as Your Health iyachaza: “Uma uzama ukufunda konke ngasikhathi sinye, cishe uyodideka bese uhluleka ukusebenzisa lolo lwazi ngokuphumelelayo. Ngalé kwalokho, ulwazi oluningi oluwusizo okudingeka ube nalo alutholakali ezincwadini noma emapheshaneni. Luhlobene . . . nendlela izinga likashukela egazini lakho elishintshashintsha ngayo. Lokhu ungakufunda ngokuhamba kwesikhathi, ngokuzama izindlela eziningi.”

Ngokwesibonelo, ngokuqapha ufunda indlela umzimba wakho osabela ngayo uma ucindezelekile, okungase kulenyuse kakhulu izinga likashukela egazini lakho. UKen uthi: “Sengiphile nalo mzimba onoshukela iminyaka engu-50, ngakho ngiyakwazi ongitshela kona!” “Ukulalela” umzimba wakhe kuye kwamsiza, ngoba uKen usakwazi ukusebenza isikhathi esigcwele—ngisho noma eseneminyaka engaphezu kwengu-70 ubudala!

Ukubaluleka Kokusekelwa Umkhaya

Ukusekelwa umkhaya akufanele kubukelwe phansi lapho kwelashwa isifo sikashukela. Eqinisweni, incwadi ethile iphawula ukuthi “indlela umkhaya ophilisana ngayo mhlawumbe iyisici esikhulu kunazo zonke” ekwelapheni isifo sikashukela ezinganeni nasentsheni.

Kuyazuzisa uma amalungu omkhaya efunda ngesifo sikashukela, aze ashintshane ngokuya nogulayo kodokotela. Ulwazi luyowasiza ukuba amsekele, abone izimpawu ezibalulekile futhi azi nokuthi ikuphi okumelwe akwenze. UTed, onenkosikazi ebilokhu inesifo sikashukela soHlobo 1 kusukela ineminyaka emine ubudala, uthi: “Sengiyazi uma ushukela wehlile egazini likaBarbara. Uvele athule phakathi nengxoxo. Ujuluka abe manzi futhi acasulwe ubala nje. Uthatha kade nalapho enza izinto.”

Ngokufanayo, lapho umkaKen, uCatherine, ebona uKen ephaphatheka ebusweni futhi ejuluka, nalapho ebona eshintsha isimo sakhe, uye ambuze umbuzo olula wezibalo. Uma uKen ephaphalaza, uCatherine uyazi ukuthi asikho isinqumo uKen angasenza esesimweni esinjalo abese ethatha isinyathelo ngokushesha ukuze asize. Bobabili uKen noBarbara bakwazisa ngokujulile ukuba nabangane bomshado abanolwazi ababathandayo nababethemba ngokuphelele.f

Amalungu omkhaya anothando kufanele alwele ukuba asekelayo, anomusa nanesineke—okuyizimfanelo ezingasiza umuntu ogulayo ukuba abhekane nezinselele zokuphila futhi okungathuthukisa ukululama kwakhe. Umyeni kaKaren wamqinisekisa ukuthi uyamthanda, okwenza umahluko omkhulu. UKaren uyalandisa: “UNigel wathi kimi, ‘Abantu badinga ukudla namanzi ukuze baphile, njengoba nje nawe udinga ukudla namanzi—kanye nengcosana ye-insulin.’ La mazwi anomusa kodwa ayiqiniso ayeyilokho kanye engangikudinga.”

Umkhaya nabangane kufanele baqonde nokuthi njengoba amazinga kashukela eshintshashintsha, isifo sikashukela singathinta nemizwelo yomuntu. Owesifazane othile wathi: “Lapho ushukela wehlile egazini, ngiyathula, ngiba neconsi, ngiyahluthuka futhi ngikhungatheke. Bese kungizwisa ubuhlungu ukuzenza ingane ngale ndlela. Kodwa kuyasiza lapho ngazi ukuthi abanye bayasiqonda isizathu sale mizwa—engizamayo ukuyilawula.”

Isifo sikashukela singalawulwa ngokuphumelelayo, ikakhulukazi uma abangane namalungu omkhaya bebambisana nogulayo. Nezimiso zeBhayibheli zingasiza. Kanjani?

[Imibhalo yaphansi]

[Ibhokisi/Isithombe ekhasini 6]

Ingabe Siyisifo Sezingane?

Isifo sikashukela “sesiba isifo sezingane,” kusho uDkt. Arthur Rubenstein, oyisazi esiphambili se-endocrinology futhi ongumphathi weMount Sinai School of Medicine eNew York. Iminyaka yobudala isifo sikashukela esivame ukuqala ngayo kubantu iyehla ngempela. Ekhuluma ngesifo sikashukela soHlobo 2, uDkt. Robin S. Goland, onguchwepheshe walesi sifo, uthi: “Eminyakeni eyishumi edlule, sasifundisa abafundela ubudokotela ukuthi lesi sifo asitholakali kubantu abaneminyaka engaphansi kuka-40. Manje sesiyatholakala kubantu abaneminyaka engaphansi kweyishumi.”

Kungani yanda intsha enesifo sikashukela? Ngezinye izikhathi kusuke kuyindaba yofuzo. Kodwa isisindo somzimba nendawo ezungezile nako kungaba nengxenye. Inani lezingane ezikhuluphele liye laphindeka kabili kule minyaka engamashumi amabili edlule. Kubangelwa yini lokhu? “Kuye kwaba nezinguquko eziningi emikhubeni yokudla nasemisebenzini eyenziwayo phakathi nale minyaka engu-20 edlule,” kusho uDkt. William Dietz, we-U.S. Centers for Disease Control and Prevention. “Lezi zinguquko zihlanganisa ukwethembela ngokwandayo ekudleni okungaphekiwe ekhaya; ukuvama kokungadli ekuseni; ukuphuza iziphuzo ezibandayo nokudla ukudla okungenamsoco ngokwandayo; ukuncipha [kwezifundo zokuzivivinya umzimba] ezikoleni; kanye nokukhishwa kwesikhathi sekhefu esikoleni.”

Isifo sikashukela asinakwelashwa ngokuphelele. Ngakho, kuwukuhlakanipha ukulandela iseluleko somusha othile onalesi sifo, othi nje: “Gwema ukudla okungenamsoco ukuze uhlale uphilile.”

[Ibhokisi/Isithombe ekhasini 8, 9]

Indima Ye-glucose

I-glucose yondla izigidigidi zamangqamuzana omzimba. Nokho, ukuze ingene emangqamuzaneni, idinga “ukhiye”—i-insulin, ikhemikhali ekhiqizwa amanyikwe. Uma umuntu enesifo sikashukela soHlobo 1, usuke engenayo i-insulin. Uma enesoHlobo 2, umzimba awuyikhiqizi i-insulin eyanele.g Ngaphezu kwalokho, amangqamuzana awathandisisi ukwamukela i-insulin. Zombili lezi zinhlobo zesifo sikashukela zinomphumela owodwa: amangqamuzana ayalamba namazinga kashukela egazini aphakame ngendlela eyingozi.

Uma umuntu enesifo sikashukela soHlobo 1, isimiso sakhe sokuzivikela ezifweni sihlasela ama-beta cell akhiqiza i-insulin emanyikweni. Ngakho, isifo sikashukela soHlobo 1 siyisifo sokuzihlasela komzimba futhi ngezinye izikhathi sibizwa ngokuthi isifo sikashukela esibangelwa isimiso somzimba sokuzivikela ezifweni. Izinto ezingase zenze ukuba umzimba uzihlasele wona zihlanganisa ama-virus, amakhemikhali anobuthi neminye imithi. Izakhi zofuzo zingaba nomthelela, ngoba isifo sikashukela soHlobo 1 ngokuvamile silandela ufuzo emalungwini omndeni, futhi sivame kakhulu kwabaMhlophe.

Esifweni sikashukela soHlobo 2, izakhi zofuzo zinengxenye enkulu kodwa ikakhulukazi kubantu abangebona abaMhlophe. AboMdabu base-Australia naboMdabu baseMelika yibona ikakhulukazi abanalesi sifo, kanti aboMdabu baseMelika banezinga eliphakeme kunawo wonke esifo sikashukela soHlobo 2 emhlabeni. Abacwaningi basahlola ukuhlobana kwezakhi zofuzo nokukhuluphala, kanye nendlela ukukhuluphala ngokweqile okubonakala kwandisa ngayo ukumelana kwamangqamuzana ne-insulin kubantu abathambekele kulesi sifo ngenxa yofuzo.h Ngokungefani nesifo sikashukela soHlobo 1, esoHlobo 2 sitholakala ngokuyinhloko kubantu abangaphezu kweminyaka engu-40 ubudala.

[Imibhalo yaphansi]

[Isithombe]

Ingqamuzana le-glucose

[Umthombo]

Courtesy: Pacific Northwest National Laboratory

[Ibhokisi ekhasini 9]

Indima Yamanyikwe

Amanyikwe, acishe alingane nobhanana, angemuva nje kwesisu. Ngokwencwadi ethi The Unofficial Guide to Living With Diabetes, “amanyikwe aphile kahle enza umsebenzi oqhubekayo nomuhle kakhulu wokugcina izinto zisesilinganisweni sazo, agcina amazinga kashukela egazini esimeme ngokukhiqiza umthamo ofanele we-insulin njengoba amazinga kashukela eshintshashintsha phakathi nosuku.” Ama-beta cell asemanyikweni yiwona akhiqiza i-hormone i-insulin.

Lapho ama-beta cell ehluleka ukukhiqiza i-insulin eyanele, ushukela i-glucose uyanqwabelana egazini, ubangele i-hyperglycemia. Ngokuphambene—uma ushukela uphansi egazini—kuthiwa i-hypoglycemia. Sisebenzisana namanyikwe, isibindi sisiza ekulawuleni amazinga kashukela egazini ngokugcina i-glucose engasetshenziswanga iwuhlobo okuthiwa i-glycogen. Lapho kudingeka ushukela emzimbeni, amanyikwe atshela isibindi ukuba siguqule i-glycogen ibe ushukela i-glucose.

[Ibhokisi/Isithombe ekhasini 9]

Indima Kashukela

Kunombono owandile onganembile wokuthi ukudla ushukela omningi kubangela isifo sikashukela. Ubufakazi bezokwelapha bubonisa ukuthi okwandisa ingozi yokungenwa yilesi sifo kubantu abathambekele kuso ngofuzo, ukukhuluphala—kungakhathaliseki ukuthi ungakanani ushukela abawudlayo. Noma kunjalo, ukudla ushukela omningi akunampilo, ngoba awunamsoco futhi ubangela ukukhuluphala.

Omunye umbono onganembile owokuthi abantu abanesifo sikashukela banxanela ushukela ngendlela eyinqaba. Kodwa-ke, iqiniso liwukuthi banesifiso esifanayo sokudla uswidi njengabo bonke abanye abantu. Uma singalawulwa, isifo sikashukela singabanga indlala—kodwa hhayi ekashukela. Abantu abanesifo sikashukela bangawudla uswidi, kodwa kumelwe bahlanganise ushukela abawudlayo nakho konke okunye ukudla abakudlayo.

Ucwaningo lwamuva nje lubonise ukuthi ukudla okunothe nge-fructose—ushukela wezithelo nemifino—kungenza umzimba umelane ne-insulin kuze kubangele ngisho nesifo sikashukela ezilwaneni, kungakhathaliseki ukuthi singakanani isisindo sazo.

[Imidwebo/Izithombe ekhasini 8, 9]

Ukuchaza Isifo Sikashukela Ngendlela Elula

AMANYIKWE

↓ ↓ ↓

↓ ↓ ↓

↓ ↓ ↓

[Umdwebo]

(Ukuze ubone ukuthi indaba ihlelwe kanjani, bheka encwadini)

Ingqamuzana

I-receptor

Intuba

I-insulin

I-nucleus

I-glucose

[Umdwebo]

(Ukuze ubone ukuthi indaba ihlelwe kanjani, bheka encwadini)

UMTHAMBO WEGAZI

Amangqamuzana egazi abomvu

I-glucose

[Umthombo]

Man: The Complete Encyclopedia of Illustration/J. G. Heck

[Isithombe ekhasini 7]

Ukudla okunomsoco kubalulekile kwabanesifo sikashukela

[Izithombe ekhasini 10]

Abanesifo sikashukela bangahlanganyela emisebenzini evamile