1
5 Pocket Jean - 30 / Indigo
$ 404.6 $ 304.6
30
30
32
34
Indigo
Indigo
-
+
5 Pocket Jean - 30 / Indigo
$ 404.6 $ 304.6
30
30
32
34
Indigo
Indigo
-
+
5 Pocket Jean - 30 / Indigo
$ 404.6 $ 304.6
30
30
32
34
Indigo
Indigo
-
+
5 Pocket Jean - 30 / Indigo
30
30
32
34
Indigo
Indigo
-
+
$ 404.6 $ 304.6
5 Pocket Jean - 30 / Indigo
30
30
32
34
Indigo
Indigo
-
+
$ 404.6 $ 304.6
5 Pocket Jean - 30 / Indigo
$ 404.6 $ 304.6
30
30
32
34
Indigo
Indigo
-
+
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28)","#pibtn-icon-font-size":"16px","#continue-text":"Jatka ostoksia","#continue-display":"inline-block","#continue-width":"100px","#continue-height":"42px","#continue-effect-hover":"raise","#continue-font-size":"13px","#continue-font-weight":"400","#continue-font-style":"normal","#continue-text-decoration":"none solid rgb(255, 255, 255)","#continue-color":"rgb(255, 255, 255)","#continue-color-hover":"rgb(255, 255, 255)","#continue-background-color":"rgb(128, 83, 157)","#continue-background-color-hover":"rgb(240, 128, 80)","#continue-border-width":"0px","#continue-border-color":"rgb(0, 0, 0)","#continue-border-color-hover":"rgb(0, 0, 0)","#continue-border-radius":"5px","#checkout-text":"Kassa","#checkout-display":"block","#checkout-width":"100px","#checkout-height":"42px","#checkout-effect-hover":"raise","#checkout-font-size":"13px","#checkout-font-weight":"400","#checkout-font-style":"normal","#checkout-text-decoration":"none solid rgb(255, 255, 255)","#checkout-color":"rgb(255, 255, 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{"#popup-showup-effect":"bounceDownIn","#popup-width":"850px","#popup-font-family":"News_Cycle","#popup-padding":"30px","#popup-background-color":"rgb(255, 255, 255)","#popup-border-width":"0px","#popup-border-color":"rgb(255, 255, 255)","#popup-border-radius":"5px","#product-title-display":"inline","#product-title-font-size":"16px","#product-title-font-weight":"700","#product-title-font-style":"normal","#product-title-text-decoration":"none solid rgb(0, 0, 0)","#product-title-text-align":"left","#product-title-color":"rgb(0, 0, 0)","#success-alert-text":"Product successfully added to your shopping cart","#success-alert-display":"block","#success-alert-font-size":"18px","#success-alert-font-weight":"700","#success-alert-font-style":"normal","#success-alert-text-decoration":"none solid rgb(40, 167, 69)","#success-alert-text-align":"left","#success-alert-color":"rgb(40, 167, 69)","#additional-quantity-text":"Quantity","#additional-subtotal-text":"Subtotal","#additional-total-text":" Total ","#additional-display":"block","#additional-font-size":"14px","#additional-font-weight":"400","#additional-font-style":"normal","#additional-text-decoration":"none solid rgb(0, 0, 0)","#additional-text-align":"left","#additional-color":"rgb(0, 0, 0)","#item-count-text-text":"There are {number} tems in your cart.","#item-count-text-display":"block","#item-count-text-font-size":"18px","#item-count-text-font-weight":"700","#item-count-text-font-style":"normal","#item-count-text-text-decoration":"none solid rgb(0, 0, 0)","#item-count-text-text-align":"left","#item-count-text-color":"rgb(0, 0, 0)","#cart-note-text":"Add a note for admin","#cart-note-display":"block","#cart-note-font-size":"14px","#cart-note-font-weight":"700","#cart-note-font-style":"normal","#cart-note-text-decoration":"none solid rgb(0, 0, 0)","#cart-note-text-align":"left","#cart-note-color":"rgb(0, 0, 0)","#continue-text":"CONTINUE SHOPPING","#continue-display":"inline-flex","#continue-width":"170px","#continue-height":"43px","#continue-font-size":"12px","#continue-font-weight":"400","#continue-font-style":"normal","#continue-text-decoration":"none solid rgb(255, 255, 255)","#continue-color":"rgb(255, 255, 255)","#continue-color-hover":"rgb(228, 228, 228)","#continue-background-color":"rgb(0, 0, 0)","#continue-background-color-hover":"rgb(0, 0, 0)","#continue-border-width":"0px","#continue-border-color":"rgb(0, 0, 0)","#continue-border-color-hover":"rgb(0, 0, 0)","#continue-border-radius":"0px","#checkout-text":"PROCEED TO CHECKOUT","#checkout-display":"inline-flex","#checkout-width":"169px","#checkout-height":"43px","#checkout-font-size":"12px","#checkout-font-weight":"400","#checkout-font-style":"normal","#checkout-text-decoration":"none solid rgb(255, 255, 255)","#checkout-color":"rgb(255, 255, 255)","#checkout-color-hover":"rgb(228, 228, 228)","#checkout-background-color":"rgb(0, 0, 0)","#checkout-background-color-hover":"rgb(0, 0, 0)","#checkout-border-width":"0px","#checkout-border-color":"rgb(0, 0, 0)","#checkout-border-color-hover":"rgb(0, 0, 0)","#checkout-border-radius":"0px","#tocartbtn-text":"GO TO CART","#tocartbtn-display":"none","#tocartbtn-width":"160px","#tocartbtn-height":"41px","#tocartbtn-font-size":"12px","#tocartbtn-font-weight":"400","#tocartbtn-font-style":"normal","#tocartbtn-text-decoration":"none solid rgb(255, 255, 255)","#tocartbtn-color":"rgb(255, 255, 255)","#tocartbtn-color-hover":"rgb(224, 224, 224)","#tocartbtn-background-color":"rgb(0, 0, 0)","#tocartbtn-background-color-hover":"rgb(0, 0, 0)","#tocartbtn-border-width":"0px","#tocartbtn-border-color":"rgb(0, 0, 0)","#tocartbtn-border-color-hover":"rgb(0, 0, 0)","#tocartbtn-border-radius":"0px"}
{"#stickybar-display":"none","#stickybar-action":"goto_checkout","#stickybar-font-family":"News_Cycle","#stickybar-background-color":"rgb(246, 247, 251)","#stickybar-height":"70px","#stickybar-position":"position_top","#stickybar-offset":"0px","#stickybar-display-type":"alwayshow","#stickybar-title-font-size":"16px","#stickybar-title-color":"rgb(0, 0, 0)","#stickybar-title-font-weight":"500","#stickybar-title-font-style":"normal","#stickybar-title-text-decoration":"none solid rgb(0, 0, 0)","#stickybar-buynow-text":"BUY NOW","#stickybar-buynow-width":"130px","#stickybar-buynow-height":"35px","#stickybar-buynow-font-size":"11px","#stickybar-buynow-effect-hover":"slide","#stickybar-buynow-font-weight":"700","#stickybar-buynow-font-style":"normal","#stickybar-buynow-text-decoration":"none solid rgb(255, 255, 255)","#stickybar-buynow-color":"rgb(255, 255, 255)","#stickybar-buynow-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-background-color":"rgb(37, 37, 37)","#stickybar-buynow-background-color-hover":"rgb(37, 37, 37)","#stickybar-buynow-border-width":"0px","#stickybar-buynow-border-color":"rgb(255, 255, 255)","#stickybar-buynow-border-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-border-radius":"15px"}
{"#stickybar-display":"flex","#stickybar-action":"goto_checkout","#stickybar-font-family":"News_Cycle","#stickybar-background-color":"rgb(255, 255, 255)","#stickybar-height":"70px","#stickybar-position":"position_top","#stickybar-offset":"0px","#stickybar-display-type":"alwayshow","#stickybar-title-font-size":"16px","#stickybar-title-color":"rgb(0, 0, 0)","#stickybar-title-font-weight":"500","#stickybar-title-font-style":"normal","#stickybar-title-text-decoration":"none solid rgb(0, 0, 0)","#stickybar-buynow-text":"BUY NOW","#stickybar-buynow-width":"130px","#stickybar-buynow-height":"35px","#stickybar-buynow-font-size":"11px","#stickybar-buynow-effect-hover":"slide","#stickybar-buynow-font-weight":"700","#stickybar-buynow-font-style":"normal","#stickybar-buynow-text-decoration":"none solid rgb(255, 255, 255)","#stickybar-buynow-color":"rgb(255, 255, 255)","#stickybar-buynow-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-background-color":"rgb(242, 108, 79)","#stickybar-buynow-background-color-hover":"rgb(242, 108, 79)","#stickybar-buynow-border-width":"0px","#stickybar-buynow-border-color":"rgb(255, 255, 255)","#stickybar-buynow-border-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-border-radius":"2px"}
{"#stickybar-action":"goto_checkout","#stickybar-display":"flex","#stickybar-font-family":"News_Cycle","#stickybar-background-color":"rgb(255, 255, 255)","#stickybar-height":"70px","#stickybar-position":"position_top","#stickybar-offset":"0px","#stickybar-display-type":"alwayshow","#stickybar-title-font-size":"16px","#stickybar-title-color":"rgb(0, 0, 0)","#stickybar-title-font-weight":"500","#stickybar-title-font-style":"normal","#stickybar-title-text-decoration":"none solid rgb(0, 0, 0)","#stickybar-buynow-text":"BUY NOW","#stickybar-buynow-width":"230px","#stickybar-buynow-height":"70px","#stickybar-buynow-font-size":"11px","#stickybar-buynow-effect-hover":"slide","#stickybar-buynow-font-weight":"700","#stickybar-buynow-font-style":"normal","#stickybar-buynow-text-decoration":"none solid rgb(255, 255, 255)","#stickybar-buynow-color":"rgb(255, 255, 255)","#stickybar-buynow-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-background-color":"rgb(17, 17, 17)","#stickybar-buynow-background-color-hover":"rgb(17, 17, 17)","#stickybar-buynow-border-width":"0px","#stickybar-buynow-border-color":"rgb(0, 0, 0)","#stickybar-buynow-border-color-hover":"rgb(0, 0, 0)","#stickybar-buynow-border-radius":"0px"}
{"#stickybar-display":"flex","#stickybar-action":"goto_checkout","#stickybar-font-family":"News_Cycle","#stickybar-background-color":"rgb(242, 108, 79)","#stickybar-height":"70px","#stickybar-position":"position_top","#stickybar-offset":"0px","#stickybar-display-type":"alwayshow","#stickybar-title-font-size":"16px","#stickybar-title-color":"rgb(255, 255, 255)","#stickybar-title-font-weight":"500","#stickybar-title-font-style":"normal","#stickybar-title-text-decoration":"none solid rgb(255, 255, 255)","#stickybar-buynow-text":"BUY NOW","#stickybar-buynow-width":"230px","#stickybar-buynow-height":"70px","#stickybar-buynow-font-size":"11px","#stickybar-buynow-effect-hover":"none","#stickybar-buynow-font-weight":"700","#stickybar-buynow-font-style":"normal","#stickybar-buynow-text-decoration":"none solid rgb(255, 255, 255)","#stickybar-buynow-color":"rgb(255, 255, 255)","#stickybar-buynow-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-background-color":"rgb(0, 0, 0)","#stickybar-buynow-background-color-hover":"rgb(0, 0, 0)","#stickybar-buynow-border-width":"0px","#stickybar-buynow-border-color":"rgb(0, 0, 0)","#stickybar-buynow-border-color-hover":"rgb(0, 0, 0)","#stickybar-buynow-border-radius":"0px"}
{"#stickybar-display":"flex","#stickybar-action":"goto_checkout","#stickybar-font-family":"News_Cycle","#stickybar-background-color":"rgb(255, 255, 255)","#stickybar-height":"70px","#stickybar-position":"position_top","#stickybar-offset":"0px","#stickybar-display-type":"alwayshow","#stickybar-title-font-size":"16px","#stickybar-title-color":"rgb(0, 0, 0)","#stickybar-title-font-weight":"500","#stickybar-title-font-style":"normal","#stickybar-title-text-decoration":"none solid rgb(0, 0, 0)","#stickybar-buynow-text":"BUY NOW","#stickybar-buynow-width":"130px","#stickybar-buynow-height":"35px","#stickybar-buynow-font-size":"11px","#stickybar-buynow-effect-hover":"none","#stickybar-buynow-font-weight":"700","#stickybar-buynow-font-style":"normal","#stickybar-buynow-text-decoration":"none solid rgb(255, 254, 254)","#stickybar-buynow-color":"rgb(255, 254, 254)","#stickybar-buynow-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-background-color":"rgb(242, 108, 79)","#stickybar-buynow-background-color-hover":"rgb(244, 72, 35)","#stickybar-buynow-border-width":"0px","#stickybar-buynow-border-color":"rgb(255, 255, 255)","#stickybar-buynow-border-color-hover":"rgb(255, 255, 255)","#stickybar-buynow-border-radius":"0px"}
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Diabeetikko: näiden muuttujien seuranta on oikeasti tärkeää

Diabeetikko: näiden muuttujien seuranta on oikeasti tärkeää

Huomaan vastaanotolla, että moni tyypin 2 diabeetikko ei ole saanut selkeää ohjeistusta siitä, mitä terveysmuuttujia on tärkeä seurata säännöllisesti. Vuositarkastuksen laboratoriotulokset ovat täynnä epämääräisiä lyhenteitä ja numeroita ja vastaanotolla lääkäri mittaa, koputtelee ja palpoi ilman mitään perusteluja.

  Todellisuudessa on vain muutamia oikeasti tärkeitä mittareita joita pitää seurata, jotta voidaan arvioida tyypin 2 diabeteksen hoitotasapaino ja hoidon vaikuttavuus.

1. HbA1c - eli pitkäsokeri

Hba1c eli tutummin joko keskisokeri, pitkä-aikaissokeri tai pitkäsokeri. Tämä lukema tarkoittaa käytännössä hemoglobiiniin (veressä happea kuljettava proteiini) sitoutunutta glukoosin, eli sokerin, määrää. HbA1c kertoo kätevästi noin 2-3 kuukauden verensokerin keskiarvon. Lukema ilmoitetaan prosenteissa ja/tai mmol/mol. Normaali arvo on 4-5,6 % ja 20-42 mmol/mol välissä. 

Edut: 

  • Kuvaa hyvin viimeisen 3 kuukauden verensokerin keskitasoa 
  • Suhteellisen tarkka ja tulos ei ole riippuvainen fysiologisesta tilasta, kuten kokeen ottamisen ajankohdasta, paastoamisesta, sairaudesta, lääkityksestä tai nestetasapainosta.
 

Miinukset: 


  • HbA1c ei anna tarkkaa kuvaa sokeriaineenvaihdunnan poikkeavuuksista
  • Arvo muuttuu hitaasti. Esimerkiksi nopean painonpudotuksen tai lääkemuutoksien vaikuttavuus näkyy vasta 3-6 kuukauden viivellä. 
  • Pitää käydä laboratoriossa laskimokokeessa (nykyään on myös kohtalaisen luotettavia pika-analysaattoreita saatavilla)

2. Lipidit - eli kolesterolit ja triglyseridi

Kolesterolin (kokonaiskolesteroli, LDL ja HDL) ja triglyseridien pitoisuudet ovat hyvä epäsuoramittari elimistön aineenvaihdunnallisesta tilasta ja sisäelinrasvan määrästä. Kokonaiskolesterolin pitoisuudella ei ole niin paljon merkitystä kuin sen trendillä. Kokonaiskolesteroli on “turha" lukema, sillä se ei ole kliinisesti merkittävä.

  Sen sijaan tärkeää on tietää, mikä on kolesterolia kudoksiin kuljettavan (LDL) ja kolesterolia takaisin maksaan kuljettavan (HDL) suhdearvo. Mitä lähempänä arvo on 1.0, sitä parempi se on ja 2.0 on vielä hyväksyttävä.

  Esimerkki: Timon HDL on 1.5 ja LDL on 2.7. Suhdearvo lasketaan jakamalla LDL :n osuus HDL :n osuudella, eli Timon tapauksesa 2.7/1.5 = 1.8.
 

3.​ Verensokerin omaseuranta

Terveydenhuolto on tottunut seuraamaan vain paastosokeria, joka antaa hyvin vähän tietoa kokonaiskuvasta. Paastosokerin osuus on vain noin 10-30 % koko tarjolla olevasta tiedosta, ja sen perusteella on hyvin vaikea tehdä mitään johtopäätöksiä tyypin 2 diabeetikolla. Paastosokeria voidaan toki käyttää diabeteksen diagnosointiin.

  Diabeetikon tärkein omaseurantarutiini on verensokereiden omaseuranta, mitä pitäisi suorittaa 3-5 päivän sarjana, jossa päivittäin otetaan paastosokeri sekä verensokeri ennen jokaista isompaa ateriaa ja aina 2 tuntia jokaisen isomman aterian jälkeen.

  Tarvittaessa tulos voidaan ottaa myös muissa tilanteissa jos poikkeamia on löydetty (esimerkiksi yön aikana, insuliiniannosten yhteydessä, oireiden yhteydessä jne). Verensokerin kattava omaseurantajakso ja keskiarvojen laskeminen pitäisi tehdä vähintään kerran vuodessa, mutta tilanteesta riippuen riippuen tilanteesta tarvittaessa jopa kuukauden välein.

Edut: 

  • Antaa huomattavasti paremman ja tarkemman kuvan, miten elimistön sokeri-aineenvaihdunta toimii. Ihmisen elimistö on huomattavasti dynaamisempi kuin vain “paastotila” vs. “muu aika”.
  • Pystyy tekemään omatoimisesti kotona

Miinukset: 

  • Työläs
  • Sokerimittareiden liuskat eivät ole halpoja 
  • Tulosten tulkitseminen vaatii syvempää osaamista ja kokemusta

Lataa itsellesi verensokerin omaseurantalomake klikkaamalla kuvaa


4. Vyötärönympärys

Vyötärönympärys on paras (ennen kaikkea käytännöllisin ja kustannustehokkain) epäsuoramittari vatsaontelon rasvan määrän arvioimiseksi. Vyötärönympärys on helppo mitata omatoimisesti mittanauhalla. Erityisesti tyypin 2 diabeetikolla vyötärönympärys on huomattavasti tärkeämpi mittari kuin paino tai painoindeksi, sillä sisäelimiin kertynyt rasvan määrä lisää diabetesriskiä ja vie diabetesta huonompaan hoitotasapainoon. Toki kokonaisvaltaisuus on paras ratkaisu hoidon seurantaan ja vaikuttavuuden arviointiin, joten vyötärönympäryksen lisäksi paino kannattaa mitata, painoindeksi laskea ja peilistä arvioita kehonkoostumuksen muutosta.

  Suosittelen mittaamaan vyötärönympäryksen kerran viikossa. Mittaus kannattaa suorittaa aamulla paastotilassa heti vessatoimien jälkeen. Vyötärönympärys mitataan 2-3 cm navan yläpuolelta uloshengityksen jälkeen normaalissa seisoma-asennossa.

Viitearvot ovat hyvin epämääräisiä, sillä tulos on riippuvainen monista asioista, mutta suuntaa antavat arvot ovat: miehet alle 100 cm ja naiset alle 90 cm. Senttien lisäksi jo silmämääräisesti voidaan sanoa onko vatsassa selkeä rasvakerros vai ei.


5. Virtsan proteiinipitoisuus

Virtsan proteiinipitoisuus näyttää, minkälaisessa kunnossa ovat munuaiset ja onko näihin tullut mitään vauriota. Vaihtoehtoisena mittauksena voi olla kreatiniinipitoisuus verestä, joka on tosin epäsuoramittaus ja vähemmän tarkempi.

Munuaisten vajaatoiminta on yleisin diabeteksen komplikaatio ja on olemassa jollakin tasolla suurimmalla osalla diabeetikoista. Viitealueet riippuvat konkreettisesta mittauksesta, mutta esimerkiksi vuorokauden kerääntymä virtsaan on ihannetilanteessa alle 30 mg. Tarkempaa tietoa viitearvoistaa saat minun webinaaristani, jossa kerron tyypin 2 diabeteksen liitännäissairauksista.

Muut oleelliset, mutta ei tärkeimmät (ilman erillistä syytä):

  • Verenpaineiden omaseuranta on kaikille diabeetikoille toisinaan tärkeää, mutta jos diabeetikolla on myös verenpainetauti, tulee verenpaineen muutosta seurata säännööllisesti. Tarkkaa tulosta et saa lääkärin tai hoitajan vastaanotolla vaan tekemällä viiden päivän omaseurantajakson (laadukkaalla laitteella), jossa mittaat verenpaineen kolmen mittauksen keskiarvon aamulla ja illalla. 
  • CRP eli C-reaktiivinen proteiini antaa hyvin kuvan elimistön matala-asteisesta tulehdustilasta. Tulos on hyvin riippuvainen monista muuttujista, kuten vammoista, infektioista ja akuutista fysiologisesta stressista. Kaikki yli 1 mg/l mittaustulokset voi luokitella poikkeavaksi jos tulos on toistuva. Muuten viitearvon raja on yli 3 mg/l. 
  • Laboratoriomittauksessa saatava alaniiniaminotransferaasi eli ALAT kertoo maksan voinnista, kuten mahdollisesta rasvamaksasta. 
  • Miehet (yli 16 v): alle 50 U/l (yksikköä litrassa) 
  • Naiset (yli 16 v): alle 35 U/ 
  • Elintapoihin liittyvien tekijöiden seuraaminen on tyypin 2 diabeetikolle olennaista. Tämä tarkoittaa ainakin energiansaanninnin, aktiivisuuden ja nukkumisen seurantaa. Elintavat ovat lähes aina diabeteksen taustatekijä, joten vain niitä muuttamalla voi vaikuttaa diabeteksen juurisyihin.

Lisäksi on hyvä käydä vuosittain lääkärin kliinisessä kontrollissa ja silmäpohjankuvauksissa. Kokeilla arvioidaan komplikaatioriskiä.

  Kokemukseni mukaan liian iso osa ihmisistä on täysin pihalla kaikkien yllä mainittujen mittareiden tarkoituksesta ja merkityksestä. Suosittelen, että pyydät lääkäriltä aina kattavan perustelun tehtäville mittauksille ja niiden tuloksista.

  Mitä enemmän tiedät, sitä enemmän osaat tilanteeseen vaikuttaa!

Kirjoittanut:

Lempin vastuulääkäri Jakob Valdma