Metformin - ndi chiyani ndipo chifukwa

Metformin imapezeka m'mapiritsi. Amakhala ndi 500 ndi 850 mg pazinthu zazikulu komanso zothandizira - talc, povidone ndi magnesium sulfate.

Metformin imadziwika kuti ndiye mankhwala abwino osakanikirana a shuga a shuga a 2 shuga. Amachepetsa kukhazikika pamimba yopanda kanthu, komanso pambuyo pa kudya kwa thupi m'thupi. Sisintha kapangidwe ka insulin ndi kapamba, chifukwa chake sichikhala pachiwopsezo cha kuyambitsa matenda a hypoglycemic chifukwa cha kutsika kwa shuga m'magazi.

Imachepetsa cholesterol, ndipo makamaka lipids, imayambitsa atherosulinosis, yomwe imapangitsa kukhala chida chapadera chopewa zovuta zamatenda a shuga.

Zisonyezero zogwiritsidwa ntchito:

• Kwa odwala omwe mankhwalawo amadya ndipo zolimbitsa thupi zimalephera, makamaka ndi kunenepa kwambiri,
• Madokotala nthawi zambiri amapereka mankhwala akangomupeza, chifukwa zimatsimikiziridwa kuti odwala osakwana 25% amatha kutsatira zakudya komanso kuchuluka kwa ntchito.

Malangizo oyendetsedwa ndi mankhwalawa akuwonetsa kuti amagwiritsidwa ntchito ngati mtundu wachiwiri wa matenda ashuga. Posachedwa, zidakhazikitsidwa kuti ngakhale ndi insulin yomwe imadalira matenda, mkhalidwe wa insulin kukana kumachitika. Izi zimachitika pafupipafupi mu achinyamata chifukwa cha kuchuluka kwa mahomoni opanga. Kuphatikiza kwa mankhwala a insulin ndi Metformin kungawathandize.

Mankhwala amatengedwa ngati mankhwala okhawo omwe amathandizira kupewa matenda.. Izi ndi chifukwa cha machitidwe ake - sizimachepetsa kuchuluka kwa shuga m'magazi.

Mankhwala atha kutumikiridwa podziwitsa anthu omwe ali pachiwopsezo chachikulu mwa anthu:

• kuchuluka kwa thupi pamwambapa 35,
• kuphwanya cholesterol ndi mbiri ya lipid,
• Achibale apafupi ali ndi matenda ashuga 2,
• matenda oopsa apezeka
• glycated hemoglobin index ali pamwamba 6%.

Nthawi zambiri, mlingo woyambirira ndi 500 kapena 850 mg kawiri tsiku lililonse.. Mapiritsi amatengedwa ndi chakudya kapena pambuyo pake. Pakatha sabata, muyezo wa shuga umachitika ndipo mulingo ungachulukane, ndipo pafupipafupi makonzedwe amakula mpaka katatu. Kuchuluka kwa mankhwalawa ndi 3 g (1 g katatu patsiku).

Ngati mankhwalawa amagwiritsidwa ntchito ndi insulin, ndiye kuti mlingo wake wokwanira nthawi zambiri umakhala wofanana kuchokera pa 1000 mpaka 2550 mg. Imakhalabe yokhazikika panthawi yamankhwala, ndipo kuchuluka kwa insulin kumawonjezeka kapena kutsika kutengera kuyezetsa magazi. Ana kuyambira azaka 10 amafunsidwa 500 kapena 850 mg kamodzi. Mutha kuwonjezera kuchuluka kwa tsiku ndi tsiku mpaka 2000 mg.

Kwa odwala okalamba Pali choopseza cha kuwonongeka kwa impso, motero, musanayambe mankhwala ndipo ngati kuli koyenera, mulingo wambiri, mkodzo uyenera kupimidwa ndikuwonetsa kusefedwa kwa glomerular. Pakulephera kwa impso, mapiritsi awiri a 500 mg amatengedwa. Ngati, poyerekeza ndi chithandizo cha mankhwalawo, ntchito ya impso imachepa, ndiye kuti mankhwalawo amasiya, ndipo wodwalayo amapatsidwa mapiritsi ena kapena insulin.

Ndi matenda 2 a shuga, mankhwalawa amatengedwa nthawi yayitali. Kutha kwathunthu kwa kuchepetsa kwa chithandizo cha shuga sikumachitika, koma kutengera magawo a labotale komanso momwe wodwalayo alili, mlingowo umachepa kapena ukuwonjezeka, mankhwala ena amawonjezeredwa pamankhwala.

Mwambiri, mankhwalawa amalekeredwa bwino ndipo amagwiritsidwa ntchito pakukonzanso kwakutali kwa shuga m'magazi. Mavuto omwe angakhalepo:

• Odwala ambiri m'masiku oyambilira a Metformin atangoyamba masiku 7 amapezeka ndi mseru, kupweteka kwam'mimba, kusanza, kutsekula m'mimba, kusilira, kuchepa kwa chakudya (muyenera kugawa mlingo wonse wa mankhwalawo komanso kumwa mankhwalawo ndi chakudya),
• kuopseza kopitilira muyeso wa lactic acid m'magazi - lactic acidosis, ndi owopsa chifukwa choopsa chotenga chikomokere ndi zotsatira zakupha, kuchita masewera olimbitsa thupi, kudya kwambiri mowa, kudya kalori yaying'ono (mpaka 1200 kcal mwa akuluakulu), kuwonongeka kwa matenda osokoneza bongo kumayambitsa kuchuluka kwa lactic acid,
• Kugwiritsa ntchito nthawi yayitali kumayambitsa kuchepa kwa mavitamini B12 kuchokera ku chakudya, izi zimayendetsedwa ndi kuphwanya magazi ndikupanga magwiridwe amanjenje (prophylactic makonzedwe a B12 ngati gawo la mavitamini ovomerezeka).
• kusintha kwa kulawa, kuphwanya chiwindi, kupweteka ndi kulemera mu hypochondrium yoyenera, zotupa, kuyabwa kwa khungu, redness.

Ngakhale chiwopsezo kugwiritsa ntchito mankhwala pa mimba sichinakhazikitsidwe, koma kuyambika kwake nthawi zambiri kumakhala chizindikiro cha insulin. Kuyamwitsa pa chithandizo ndi Metformin sikulimbikitsidwa.popeza amachotseredwa mkaka wa m'mawere.

Mafuta a mankhwalawa:

• Chikwanje,
• Novoformin,
• Bagomet,
• Fomu
• Siofor
• Meglifort
• Metfogamma,
• Fomu,
• Metamine
• Insulor,
• Dianormet.

Teformin yopanga teva imatha kugulidwa pamakementi a mankhwala pamtengo wa 27 hhucnias kapena ma ruble 70 ku phukusi lomwe lili ndi mapiritsi 500 mg pazinthu 30. Mlingo wa 850 mg ndi wokwera mtengo kwambiri chifukwa cha ma 3 hhucnias kapena ma ruble 15.

Werengani nkhaniyi

The zikuchokera, mawonekedwe akumasulidwa ndi mphamvu ya mankhwalawa

Mankhwalawa amapezeka mu mawonekedwe a mapiritsi. Amakhala ndi 500 ndi 850 mg a metformin ndi zina zothandizira - talc, povidone ndi magnesium sulfate.

Metformin imadziwika kuti ndiye mankhwala abwino osakanikirana a shuga a shuga a 2 shuga. Amachepetsa kukhazikika pamimba yopanda kanthu, komanso pambuyo pa kudya kwa thupi m'thupi. Sisintha kapangidwe ka insulin ndi kapamba, chifukwa chake sichikhala pachiwopsezo cha kuyambitsa matenda a hypoglycemic chifukwa cha kutsika kwa shuga m'magazi. Zotsatira za antiidiabetes zimakhazikitsidwa motere:

• kumawonjezera kumverera kwa minofu minofu yolandirira insulin,
• amaletsa mapangidwe a mamolekyulu atsopano a shuga,
• imalepheretsa kuchepa kwa glycogen ndikuyambitsa kuphatikizika kwa shuga,
• Imachepetsa kuyamwa kwa matumbo m'matumbo,
• imathandizira kulowa kwa glucose m'maselo,
• Amachepetsa thupi ndi kuthira mafuta pamimba,
• amachepetsa cholesterol, makamaka lipids yomwe imayambitsa atherosulinosis.

Gawo lomaliza la Metformin limapangitsa kukhala chida chapadera popewa zovuta zamatenda a shuga. Palinso maphunziro omwe akuwonetsa kutha kwa mankhwalawa popewa matenda a Alzheimer's, zotupa za khansa, menoparance osteoporosis, komanso chithokomiro cha chithokomiro komanso maliseche. Mwina, mankhwalawa amatha kuchepetsa kukalamba m'thupi.

Ndipo pali zambiri popewa zovuta za matenda ashuga.

Momwe mungatenge Metformin pa matenda ashuga

Mankhwalawa akuwonetsedwa kwa odwala omwe kudya mankhwala olimbitsa thupi komanso zomwe amalimbikitsidwa kuchita sizinapereke chifukwa, kunenepa kwambiri. Metformin imafotokozedwa ngati chithandizo chodziimira pawokha kapena kuphatikiza ndi mapiritsi ofanana, insulin. Nthawi zambiri, madokotala amamulembera mankhwala atangozindikira kuti ali ndi vutoli, chifukwa zimatsimikiziridwa kuti odwala osakwana 25% amatha kutsatira zakudya komanso kuchuluka kwa ntchito.

Kodi Metformin ndi chiyani?

Metformin ndi mankhwala opatsirana pakamwa, ali m'gulu la Biguanides. Zotsatira zake za hypoglycemic adakhazikitsidwa mu 1929.

Mankhwala atatu a gulu la Biguanide apangidwa - phenformin, buformin, metformin. Mu 1957, maphunziro azachipatala adayamba ndi biguanides, pomwe ubale unakhazikitsidwa pakati pa kugwiritsa ntchito mankhwalawa ndikupanga lactic acidosis, ndi phenformin chiopsezo cha matendawa chinali chokulirapo ka 50 kuposa ndi metformin.

Zotsatira za kafukufukuyu, phenformin ndi buformin, kenako metformin, adaletsedwa. Mu 1977 ku USA, mu 1978 ku Germany, Switzerland, Austria, mayiko a Scandinavia, mu 1982 ku UK. Mu 1993, nditayang'ananso za metformin potengera kafukufuku wamayiko, idalembetsedwanso ndi a Food and Drug Administration ku United States ndi ku Europe. Ndiye yekha woimira gulu lalikulu la Biguanide lomwe likugwiritsidwa ntchito pano.

Gwiritsani ntchito matenda a shuga a 2

Mankhwala a Metformin ndi njira yosavuta yosinthira mtundu 2 wa matenda ashuga, chifukwa umasintha zotumphukira za insulin, motero umachepetsa kukana kwa insulini. Malinga ndi malingaliro a Consensus pochiza matenda ashuga, anthu omwe ali ndi matenda a shuga 2 kapena onenepa kwambiri, kapena kunenepa kwambiri, ayenera kusankha mankhwalawa.

Cholinga chachikulu pa chithandizo cha matenda amtundu wa 2 ndikukwaniritsa bwino glycemic control. Zambiri kuchokera ku kafukufuku wambiri zawonetsa kuti metformin imathandizira kwambiri kuwongolera kwa glycemic kwa odwala omwe ali ndi matenda a shuga a 2 (amachepetsa kwambiri HHA1c - chizindikiritso cha kayendetsedwe ka shuga m'magazi).

Zambiri kuchokera ku United Kingdom Prospective Diabetes Study (UKPDS) zikuwonetseratu kuti kuwongolera glycemic control mu mtundu 2 wa matenda ashuga, mosatengera njira yomwe izi zimachitikira, zimachepetsa kwambiri kuyambika ndi kusokonezeka kwa matendawo.

Zinapezeka kuti kuchepa kulikonse kwa HbA1c ndi 1% kumachepetsa kwambiri zovuta zonse za matenda ashuga. Pali umboni kuti kuwonjezeka kwa HbA1c pamwambapa 6.5% kumalumikizidwa ndi chiopsezo chokhala ndi zovuta za shuga, komanso zopitilira 7.5% komanso chiopsezo cha zovuta za microvascular.

Ichi ndichifukwa chake cholinga cha chithandizo cha matenda ashuga ndikwaniritsa bwino glycemic control - HbA1c pansipa 6.5%. Zotsatira za UKPDS zidawonetsanso kuti metformin imachepetsa kwambiri zovuta za matenda ashuga ndi sitiroko, zomwe zimapangitsa kutsika kwa kufa poyerekeza ndi sulfonylureas ndi insulin pagulu la odwala matenda ashuga omwe amasunga chiwonetsero chabwino cha glycemic.

Izi zikutsimikizira lingaliro kuti, kuwonjezera pakukweza kayendedwe ka glycemic, mankhwalawa alinso ndiubwino wowonjezereka poyerekeza ndi mankhwala ena othandizira. Lingaliro lamakono pa mankhwalawa a mtundu 2 matenda a shuga ndikuti ndizosatheka kuchiza kuchuluka kwa shuga m'magazi, ndikofunikira kukopa zonse zomwe zingayambitse matenda a shuga - kulemera kwa thupi, kuthamanga kwa magazi, lipids, boma la prothrombotic.

Malinga ndi kafukufuku wambiri, metformin imabweretsa kuwonda, imasintha lipid index (chonsecho cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides), ochepa matenda oopsa, fibrinolysis.

Mtundu woyamba wa shuga

Chosadabwitsa kuti, metformin itha kugwiritsidwa ntchito ngati matenda a shuga 1. Awa ndi mankhwala okhawo akumwa a hypoglycemic omwe amagwiritsidwa ntchito pa matenda a shuga 1. Iyenera kugwiritsidwa ntchito pokhapokha pothandizidwa ndi insulin. Metformin ndi yoyenera kwa odwala omwe ali ndi matenda amtundu 1 omwe ali onenepa kwambiri kapena onenepa kwambiri, kapena amene amawonjezera kulemera kwawo pang'onopang'ono panthawi ya mankhwala a insulin, anthu omwe amatsutsana ndi insulini komanso pang'onopang'ono mlingo wa insulin popanda kusintha glycemic.

Kutchepetsa kwa Metformin ndi Anti-Kunenepa

Kafukufuku wambiri, mwa anthu onenepa opanda matenda a shuga, zidapezeka kuti mutatenga metformin, kunenepa kwambiri komanso kuthamanga kwa shuga m'magazi, kuchuluka kwa leptin, kuchuluka komanso kuperewera kwa cholesterol ya LDL. Chifukwa chake, kunenepa kwambiri komanso kukokana kwake ndi insulin, zikuwonetsa kugwiritsa ntchito metformin. Anthu ambiri pamenepa, a metformin akumwa zolemetsa, ndipo malinga ndi ndemanga - zotsatira zake ndi zabwino!

Pazonse, mankhwalawa amagwira ntchito motere - amachepetsa gluconeogenesis m'chiwindi, amalimbikitsa kuyipa kwazowonjezera ndi kuyamwa, komanso amachepetsa matumbo - izi zonse zimatha kutsitsa thupi.

Zokhudza kumwa mankhwala ngati amenewo kuti muchepetse kunenepa ... bwino, kufunsana ndi endocrinologist kapena wathanzi.

Zochita zazikulu

Amachepetsa shuga la magazi, Amachepetsa thupi, Amachepetsa insulin, Amachepetsa insulinemia, Amakhala ndi zotsatira zopindulitsa pa lipids (cholesterol yathunthu, HDL-cholesterol, LDL-cholesterol, triglycerides), Amakhudza kwambiri fibrinolysis (kudzera PAI-1), zopindulitsa pa endothelial kukanika, Amachepetsa chiopsezo cha mtima.

Zotsatira zoyipa

Zotsatira zoyipa kwambiri mutatha kutenga metformin zimayenderana ndi m'mimba thirakiti - kutsekula m'mimba, kutulutsa magazi, kusefukira kwamkati, matumbo m'matumbo. Izi zimachitika mwa 20% ya anthu.

Ndi mlingo woyenera wa titration - kuyambira mlingo wotsika ndikuwonjezera pang'onopang'ono, komanso kumwa mankhwala ndi chakudya, kuchuluka kwake kumachepetsedwa kwambiri.

Choyipa chachikulu cha mankhwala a metformin ndi lactic acidosis, yomwe imachitika kawiri kawiri mpaka 9 mwa odwala 100,000. Amawonedwa mwa anthu omwe ali ndi matenda oopsa omwe amakhudzana ndi minyewa ya ischemia ndi hypoxia, yomwe mwa iwo okha imatha kuyambitsa lactic acidosis.

Chifukwa chake, matenda oterewa ndi contraindication ku metformin. Lactic acidosis imatha kupewedwa ngati zikuwonetsedwa mosamala mu chithandizo cha metformin. Mosiyana ndi othandizira ena odwala matenda amkamwa (omwe amachititsa kuti insulin itulutsidwe), mankhwalawa samatsogolera ku hypoglycemia.

Izi zimapangitsa kuti ikhale yoyenera kugwiritsidwa ntchito ndikulimbana ndi insulin komanso kunenepa kwambiri, ngakhale popanda matenda a shuga, komanso ana.

Contraindication

Contraindication ku metformin ndi matenda omwe amalumikizidwa ndi minofu yambiri ya hypoxia ndi ischemia - kulephera kwa mtima, kulowetsedwa kwapachimake, chiwindi ndi impso. Poganizira za data ya UKPDS, dziwani kuti matenda amtima osatsatiridwa ndi kulephera kwa mtima ndi chisonyezo chogwiritsa ntchito, osati kuphwanya malamulo a metformin.

Kwenikweni, Metformin imachotsedwa kudzera mu impso, choncho siyiyenera kugwiritsidwa ntchito ngati mkhutu waimpso. Metformin iyenera kuyimitsidwa masiku atatu asanachitidwe opaleshoni, ndikubwezeretsedwanso pakatha magetsi ndikugwira ntchito yachilendo.

Ndikofunika kusiya kumwa mankhwalawa masiku 1-2 musanayambe maphunziro osiyanitsa ndi makolo. Ukalamba, wophatikizidwa ndi zowonongeka zamkati zamkati, umadziwikanso kuchiritsa kwa metformin.

Mndandanda wa zotsutsana ndi mankhwala Metformin

Hypersensitivity to metformin kapena zina zothandizira, matenda ashuga a ketoacidosis ndi matenda a shuga, matenda a impso, kuwonongeka kapena kuwonongeka kwa impso, Kulephera kwamkati, vuto lachiwopsezo cha impso, monga kufooka, matenda opatsirana, mantha, kugwirira ntchito kwa ayodini wokhala ndi mankhwala a radiopaque, Matenda owopsa kapena osatha omwe angayambitse hypoxia ya minofu, monga mtima kapena kupuma, vuto la mtima waposachedwa myocardium, mantha, kulephera kwa chiwindi, kuledzera kwambiri, uchidakwa.

Kuphatikiza ndi mankhwala ena a shuga

Kafukufuku waku UKPDS adawonetsa kufunikira kwa chithandizo choyambirira choyambirira cha matenda ashuga amtundu wa 2. M'chaka chachitatu nditazindikira, 50% ya odwala anali pamankhwala ophatikiza, ndipo mchaka chachisanu ndi chinayi, 75% yaiwo.

Metformin, ngati singachepetse shuga, imatha kutengedwa ndikuphatikizidwa ndi magulu ena a mankhwalawa pochiza matenda ashuga, popeza momwe amagwirira ntchito ndiosiyana ndi othandizira ena:

Ndi sulfonylureas, yomwe imalimbikitsa kubisalira kwa insulin - Maninil, Minidiab, Glucotrol XL, Diaaprel MR, Diabresid, Amaryl, mtundu wa 2 matenda a shuga, mutha kutenga metphorine ndi glycazide, Ndi prandial glucose okhazikika omwe amathandizira kubisala koyambirira kwa insulin - NovoNormin, diazolol Sinthani zotumphukira kanthu insulin, koma mosiyana makina - Avandia, Ndi insulin. Kuphatikizidwa kwa metformin ndi insulin kumapangitsa kuti kukana kwamtundu wa insulin kukhale kovuta komanso kumapangitsa kuchepetsa kwakukulu kwa Mlingo wa insulin.

Udindo wa metformin mu njira yamakono yochizira ndi kupewa mtundu wa matenda a shuga 2

O.M.Smirnova
Endocrinological Research Center Metformin ndi othandizira kwambiri pa antihyperglycemic omwe amagwiritsidwa ntchito pochiza DM2. Kusanthula kwa kamangidwe ka zochita zake kumawonetsedwa. Zochita za mtima ndi anticancer za metformin zimakambidwa. Zotsatira za multicentre zophunziridwa za metformin zimafotokozedwa.
Mawu ofunika: lembani 2 matenda a shuga, metformin, lactacidosis, kulephera kwamkati mtima, antioncogenic

Biguanides akhala akugwiritsidwa ntchito pazamankhwala kwazaka zopitilira 50. Pulofesa Lefebvre P. alemba kuti lero titha kuchiritsa, koma osati kuchiritsa, matenda a shuga mellitus (DM). Matenda a 2 a shuga (T2DM) ndiwo mtundu waukulu wa matendawa. Malinga ndi kulosera kwa WHO, podzafika chaka cha 2025 kuchuluka kwa odwala matenda ashuga kudzaposa 380 miliyoni. Mabungwe otsogola masiku ano amalimbikitsa kuti ayambe kulandira chithandizo cha T2DM posintha masinthidwe aumoyo ndi makonzedwe a metformin. Panganoli, zotsatira zatsopano zokhudzana ndi zomwe zimapezeka kumene za metformin ndizosangalatsa.

Metformin idayambitsidwa muzochitika zamankhwala zochizira T2DM mu 1957 ku Europe komanso mu 1995 ku USA. Metformin pakadali pano ndi hypoglycemic yodziwika bwino kwambiri ku Europe, United States ndi mayiko ena. Kupanga kwa antihyperglycemic zochita za metformin kumamveka bwino. Kafukufuku wambiri apeza kuti metformin siyimakhudzanso kubisika kwa insulini ndi β-cell, koma imakhala ndi extrapancreatic. Imayitanitsa:

• kuchepa kwam'mimba chakudya
• kuchuluka kutembenuka kwa glucose kuti agwiritse ntchito m'mimba,
• kuchuluka kwa insulin kwa ma receptor,
• GLUT 1 transporter gene expression (secretion),
• kuchuluka kwa shuga m'mimba,
• kusuntha (kusamutsa) GLUT 1 ndi GLUT 4 kuchokera pa membrane wa plasma kupita kumtundu wam'minyewa,
• shuga wocheperako,
• glycogenolysis
• kutsika kwa triglycerides (TG) ndi kuchepa kwa lipoproteins (LDL),
• mkulu osachulukitsa lipoprotein (HDL).

Mkuyu. 1. Mphamvu ya antihyperglycemic ya metformin

Njira yayikulu yogwirira ntchito ya metformin imalimbana ndi kuthana ndi zotumphukira mu zochita za insulin, makamaka izi zimagwira minofu ndi minyewa ya chiwindi (Gome 1).

Gome 1
Njira zamatenda a metformin zokhudzana ndi mphamvu yake ya antihyperglycemic (IW Campbell, P Ritz, 2007) 3

Metformin imawonjezera madzi am'magazi a plasma mwa anthu. Ntchito zathupi la plasma nembanemba zimadalira luso la mapuloteni awo kuti azitha kuyenda momasuka mkati mwa phospholipid bilayer. Kutsika kwa membrane fluidity (kuchuluka kwa mawonekedwe kapena mawonekedwe a mamasukidwe) kumawonedwa kawiri kawiri pazoyeserera komanso zamankhwala, zomwe zimatsogolera pakupanga zovuta. Kusintha kakang'ono m'magawo a maselo ofiira m'magazi omwe kale amathandizidwa ndi metformin adadziwika. Mphamvu ya metformin pa nembanemba ndipo zigawo zake zimawonetsedwa pa Chithunzi 2.

Mkuyu. 2. Zotsatira za metformin pa membrane wa plasma ndi zida zake

Maphunziro angapo azachipatala omwe ali ndi kapangidwe kena adasindikizidwa, kutsimikizira zotsatira za metformin pa hepatic glucose metabolism. Zotsatira za kafukufuku wamtundu wakawiri wosasinthika wazomwe zafotokozedwa Chithunzi 3.

Mkuyu. 3. Mphamvu ya metformin ndi placebo pa glycemia ndi zizindikiro zosankhidwa za glucose metabolism mwa odwala omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo a 2 mellitus (owerenga kawiri mosazindikira crossover)

Phunziroli, kusiyana kwakukulu pakati pamaguluwo kunapezeka, kutsimikizira kuponderezedwa kwa kupanga kwa shuga ndi chiwindi ndi kuwonjezera kwa metformin.

Kafukufuku wina wachiwiri wakhungu, wosapangidwa mosiyanasiyana kuyerekezera kupanga shuga kwa chiwindi pogwiritsa ntchito metformin ndi rosiglitazone pansi pa hyperinsulinemia yoyendetsedwa, metformin adawonetsedwa kuti amapondereza kwambiri kupanga kwa shuga kwa chiwindi poyerekeza ndi rosiglitazone.

Mkuyu. 4. Kupsinjika kwa chiwindi cha hepatic shuga chopangidwa ndi metformin mu hyperinsulinemia yoyesedwa (mayeso akhungu losaona kawiri)

Zotsatira zamatenda a metformin, kuphatikiza pazomwe zili ndi antihyperglycemic, zimamveka bwino. Zidaperekedwa koyamba atamaliza kafukufuku wa nthawi yayitali ndi UKPDS (United Kingdom Prospective Diabetes Study) mu 1998, zomwe zidawonetsa kuti chithandizo chamankhwala cha Metformin chimachepetsa chiopsezo cha zovuta:

• minyewa - 32%,
• kufa kwa matenda ashuga - 42%,
• kufa kwathunthu - 36%,
• myocardial infarction - 39%.

Izi zinali zokhutiritsa kwambiri kotero kuti metformin idakonzedweratu ngati mankhwala otetezeka komanso othandiza kuchepetsa shuga.

M'tsogolomu, zinthu zambiri zamtima wa metformin zimatsimikiziridwa (Gome 2).

Amakhulupilira kuti ndi kupezeka kwa zinthu izi komwe kumafotokozera zina zowonjezera komanso zoteteza kwa metformin mu mtundu 2 wa matenda ashuga.

Gawo 2
Cardioprotective katundu wa metformin

Zotsatira Zofunikira Zofufuzira Pazaka 10 zapitazi

Glucophage (metformin) imatha kukhala ndi zinthu zina zodziyimira pawokha zomwe zimapangitsa kuti mankhwalawa azikhala ochepa. Zotsatira izi ndizopadera.

Kuchita kwapawiri kwa Glucofage kumafotokozera zotsatira zakuchepetsa kwaimfa zomwe zapezeka ku UKPDS.

Zambiri zomwe zidapezedwa zaka zotsatila zidatsimikiza zoyeseza zabwino za metformin m'maphunziro angapo. Chifukwa chake, chithandizo ndi metformin, poyerekeza ndi chithandizo china chilichonse, chimakhudzana ndi kufa kwapansi pazomwe zimayambitsa, infarction ya myocardial, zizindikiro za angina pectoris kapena mawonekedwe aliwonse a mtima poyerekeza ndi anthu omwe adalandira chithandizo china.

Mkuyu. 5. Zotsatira za matenda amtima pazaka 3 zowonekera

Chimodzi mwa zigawo zoyenera pokambirana za kutha kwa mayendedwe amakono pa chithandizo cha T2DM ndi nkhani zachitetezo cha onse omwe amachepetsa shuga komanso kuphatikiza kwawo. Zolemba zosiyanasiyana zamankhwala zimaganiziridwa, imodzi mwazomwe zinali zogwirizana za American Diabetes Association (ADA) ndi European Association for the Study of matenda ashuga (EASD), zosonyezedwa Chithunzi 6.

Mkuyu. 6. Consistent ADA / EASD Algorithm

Pa chithunzi chomwe tawonetsedwa, tikuwona kuti metformin ilipo mu njira zonse zamankhwala. Pankhaniyi, ndikofunikira kulingalira nkhani yazowonetsa ndi zotsutsana pakugwiritsa ntchito metformin, potengera deta yomwe ilipo.

Choyamba, ndikofunikira kuyankha funso loti chithandizo chokhala ndi metformin chiyenera kuyambika kuyambira pomwe chimadziwika, komanso njira zosinthira moyo? Chifukwa kwa anthu ambiri omwe ali ndi matenda a shuga a mtundu wachiwiri, kusintha kwa moyo sikumabweretsa kukwaniritsidwa kapena kusungidwa kwa milingo ya glycemic, yomwe itha kukhala chifukwa cha izi:

• kusakwanira kwa zinthu zochepetsera thupi,
• kukonzanso thupi
• kupitilira kwa matenda
• kuphatikiza kwa izi.

Kuphatikiza pa chakuti odwala ena amakhala osalolera mankhwalawa (malinga ndi olemba osiyanasiyana - kuchokera pa 10 mpaka 20%), pali zotsutsana zomveka zoika metformin.

Contraindication ku Metformin

• Matenda owopsa kapena osachiritsika omwe angayambitse minyewa hypoxia (mwachitsanzo, kulephera kwa mtima kapena m'mapapo, infarction ya myocardial, kugwedezeka).
• Hepatic insuffidence, pachimake mowa, uchidakwa.
• Kulephera kwamkati kapena kuwonongeka kwa impso (creatinine chilolezo) Zovuta zomwe zingawononge impso ntchito (kuchepa kwa thupi, matenda opha ziwopsezo, kugwedezeka, kuperewera kwamitsempha ya othandizira a radiopaque).
• Kuchepa kwa thupi, matenda a shuga a ketoacidosis, diabetesic, hypersensitivity kuti metformin kapena zigawo zake (Gome 3).

Gawo 3
Malangizo apadera a kutenga metformin

Kukula kwa contraindication pakusankhidwa kwa metformin, malinga ndi olemba osiyanasiyana, ndizosiyana kwambiri. Chifukwa chake, malinga ndi zomwe zafotokozedwera Chithunzi 7, kulephera kwamtima kosalekeza (CHF) ndi 87%.

Chimodzi mwazomwe chimayambitsa nkhawa ndi kukhazikitsidwa kwa metformin ndi chiopsezo cha lactic acidosis pamaso pa zinthu zilizonse zomwe zimayendetsedwa ndi hypoxia. Lactic acidosis ndizosowa kwambiri koma zowopsa. Kufupika kwake, malinga ndi olemba osiyanasiyana, pamakhala milandu itatu mwa zaka 100,000 za odwala omwe amathandizidwa ndi metformin.

Lactic acidosis ndi matenda oopsa kwambiri. Kafukufuku wochitika ndi Stacpool P.W. c et al. idachitidwa mwa kupenda ndi kuchiza odwala 126 omwe adavomerezedwa m'chipinda chothandizira kwambiri omwe anali ndi lactate level ya ≥5 mmol / L, m'magazi ochepa a pH 35 7.35, kapena deficit base> 6 mmol / L. Pa nthawi yachipatala, 80% mwa odwalawa adapezeka kuti ali ndi matenda obisika. Sepsis, kulephera kwa chiwindi ndi matenda opuma ndizo zinthu zazikulu zomwe zimatsogolera pakupanga lactic acidosis. Zomwe zimapulumuka pambuyo pa maola 24 zinali 59%, zitatha masiku atatu - 41% ndi 17% zitatha masiku 30.

Milandu ya lactic acidosis yokhudzana ndi kutenga biguanides yaphunziridwa mwatsatanetsatane. Zakhazikitsidwa modalirika kuti chiopsezo cha lactic acidosis ndikusankhidwa kwa Fenformin ndiwokwera maulendo 20 kuposa momwe mungagwiritsire ntchito metformin. Pachifukwa ichi, kugwiritsa ntchito Fenformin ndizoletsedwa m'maiko ambiri padziko lapansi, kuphatikizapo Russia. Pofuna kupewa zovuta zoopsazi, ndikofunikira kupenda odwala mosamala asanapereke mankhwala (onani pamwambapa).

Funso loti mungathe kugwiritsa ntchito metformin mu matenda osalephera a mtima (CHF) ndi mutu wofunikira komanso wokambirana mwachangu. Mpaka pano, zochitika zambiri zapezeka, zomwe zikuwonetsa phindu logwiritsa ntchito metformin pochiza odwala omwe ali ndi matenda a shuga a 2 komanso a mtima akulephera. Phunziro limodzi lotere ndi ntchito. Cholinga cha phunziroli chinali kuyesa kuyanjana pakati pa kayendetsedwe ka metformin ndi zotsatira zamankhwala mwa odwala omwe ali ndi vuto la mtima komanso matenda amtundu wa 2. Pogwiritsa ntchito nkhokwe zaumoyo (Canada), odwala 12,272 odwala matenda a shuga a 2 omwe alandila mankhwala ochepetsa shuga kuyambira 1991 mpaka 1996. Pakati pa iwo, odwala 1,833 omwe ali ndi CHF adadziwika. 208 adalandira metformin monotherapy, 773 sulfonylurea derivatives (SM) ndipo anthu 852 adalandira chithandizo chamankhwala. Avereji ya odwala anali zaka makumi asanu ndi awiri ndi ziwiri. Panali amuna 57% aanthu, kutsata kwapakati kunali zaka 2.5. CHF idapezeka koyamba kuchipatala, ndiye kuti kumayambiriro kwa phunzirolo. Zotsatira zake zinali zaka 9 (1991 - 1999). Imfa pakati pa anthu omwe adalandira: SM - 404 (52%), metformin - 69 (33%), chithandizo chophatikiza - milandu 263 (31%). Kufa kwa zoyambitsa zonse pambuyo pa chaka chimodzi kunali anthu 200 kwa anthu omwe adalandira SM. (26%), mwa anthu omwe amalandila metformin - anthu 29. (14%), pamodzi ndi mankhwala - 97 (11%). Zinadziwika kuti metformin, yonse monga monotherapy komanso monga gawo la mankhwala ophatikiza, imalumikizidwa ndi kufa pang'ono komanso kusakhazikika kwa odwala omwe ali ndi CHF ndi T2DM poyerekeza ndi SM.

Phunziro la Britain ku 2010 lidaphatikizapo odwala 8,404 odwala T2DM omwe angopeza kumene komanso omwe adapezeka kuti ali ndi vuto la mtima (1988 mpaka 2007). Kuwunika koyerekeza zomwe zimayambitsa kufa kunachitika m'magulu awiri (amafa 1,633 aliyense). Malinga ndi zotsatira zake, zidafotokozedwa kuti poyerekeza anthu omwe sanalandire mankhwala othandizira odwala matenda ashuga, kugwiritsa ntchito metformin kumalumikizidwa ndi chiopsezo chotsika cha kufa poyerekeza ndi mankhwala ena othandizira matenda ashuga, kuphatikiza ngakhale zinthu zomwe sizingakhale bwino monga kayendedwe ka glycemic, kuchepa kwa ntchito yaimpso, kunenepa kwambiri komanso kunenepa. ochepa matenda oopsa. Izi ndizogwirizana ndi ntchito yam'mbuyomu momwe zidawonetsedwa kuti anthu omwe ali ndi vuto la mtima wogwiritsa ntchito Metformin anali ndi chiopsezo chochepa cha kufa kuposa anthu omwe amagwiritsa ntchito mankhwala ena opatsirana.

Malangizo ena ofunikira komanso odalirika pophunzira za metformin ndi anti-oncogenic effect. Kafukufuku wambiri wa matenda adafalitsidwa omwe akuwonetsa kuchepa kwa kukula kwa khansa pakati pa odwala omwe amagwiritsa ntchito metformin. Chimodzi mwazinthu izi ndi kafukufuku wobwera chifukwa cha anthu omwe amagwiritsa ntchito malo kuchokera ku Saskatchewan, Canada, 1995-2006. Cholinga cha phunziroli chinali kuphunzira za kufa kwa khansa komanso mgwirizano ndi antidiabetesic mankhwala a T2DM. Tidayesa odwala 10,309 odwala matenda amtundu wa 2 omwe anali ndi metformin yoyambirira, mankhwala a sulfonylurea derivatives (SM) ndi insulin. Avereji ya odwala anali zaka 63.4 ± 13.3, mwa iwo 55% anali amuna. Metformin adalandira odwala 1,229 monga monotherapy, CM kwa 3,340 odwala ngati monotherapy, kuphatikiza mankhwala - 5,740, insulin ya 1,443 idawonjezeredwa. Nthawi yowonera inali zaka 5.4 ± 1.9.

Ponseponse, kufa kwa khansa kunali 4.9% (162 mwa 3,340) mwa anthu omwe adalandira SM, 3.5% (245 mwa 6,969) - metformin ndi 5.8% (84 kuchokera 1,443) - insulin. Zomwe zimaperekedwa ndi Bowker zikuwonetsa kuwonjezeka kawiri pachiwopsezo cha khansa pagulu la odwala omwe ali ndi insulin mankhwala achibale a gulu la metformin 1.9 (95% CI 1.5-2.4, p AST, alkaline phosphatase imakhala yochulukirapo kuposa kawiri kuposa momwe imakhalira Njira ya NAFLD imatha kukhala yovuta komanso yolakwika, yachiwiri pamakhala zotsatira za kulephera komanso chiwindi kapena hepatocellular carcinoma.

Zinapezeka kuti minofu yolimbana ndi mankhwala omwe amachepetsa kukana kwa zotumphukira zimakhala ku insulin ndizosiyana. Chifukwa chake, thiazolidinediones (TZD) amachita makamaka pamlingo wa minofu ndi adipose, komanso metformin pamlingo waukulu kwambiri.

Mkuyu. 9. Target minitsi ya metformin ndi thiazolidinediones

Chifukwa chake, pochizira NAFLD, ndikofunikira kuti mugwiritse ntchito metformin. Zotsatira zakugwiritsa ntchito metformin mu maphunziro angapo omalizidwa mwa odwala popanda matenda a shuga akufotokozedwera tebulo 4.

Gawo 4
Kafukufuku wokhudza mphamvu ya Metformin mwa odwala omwe ali ndi NAFLD

Pomaliza, ndikofunikira kufotokozera mwachidule ntchito yayikulu yomwe idamalizidwa kale ndikuwonetsa ziyembekezo zomwe zingafotokozeredwe metformin lero (Gawo 5).

Gawo 5
Ntchito zamakono komanso zamtsogolo za metformin

Posachedwa, mitundu yatsopano ya metformin, Glucofage® Long, iwoneka mchipatala ku Russia.

Mkuyu. 10. Wofulumira kutulutsa metformin yoyendetsedwa kamodzi tsiku lililonse. GelShield cholowetsa dongosolo

Njira yamtunduwu wothira mankhwala kwa nthawi yayitali imapangidwira kuthana ndi mavuto monga kusokonezeka kwa m'mimba, kupewetsa njira ya mankhwalawa kwa okalamba, kuonjezera kutsata ndikuthandizira mankhwalawa. Mankhwalawa agwiritsidwa ntchito kale mmaiko aku Europe ndipo akuphatikizidwa ngati mankhwala oyambira pamavuto azamayiko ambiri. Mankhwalawa adayesedwa m'maphunziro apadziko lonse osiyanasiyana ndipo adatsimikizira kugwira ntchito kwake komanso chitetezo.

Pomaliza, ndikofunikira kutsindika kuti metformin ndi imodzi mwa mankhwala akale kwambiri, ndipo ambiri mwa mankhwalawa akumveka bwino, komabe, mankhwalawa ali ndi udindo waukulu pakuthandizira T2DM. Maphunziro azachipatala akupitilizabe, ndipo mwina zambiri mwazinthu zake zopindulitsa zimapezeka.

Metformin yoletsa matenda ashuga

Matenda a 2 a shuga amatha kupewedwa! Uku ndikumaliza kochokera ku kafukufuku wa ku US mwa anthu omwe ali ndi kuchepa kwa kulolera kwa glucose komwe adayamba kufalitsa koyambirira kwa 2002.

Njira yachilengedwe yodwala matenda ashuga a 2 imadutsa pamizere ingapo - kuchokera pakubweza kwa shuga normal kuperewera kwa shuga ⇒ kuchepa kwa glucose ⇒ shuga Anthu omwe amalekerera shuga wambiri ali pachiwopsezo chotenga matenda a shuga - 5.8% awo amadwala chaka chilichonse.

Dokotala Prevention Programme (DPP) adachitidwa pa odzipereka okwana 3234 omwe ali ndi vuto loleza shuga, adawonedwa kwa zaka ziwiri miyezi isanu ndi itatu.

Adagawika m'magulu atatu pogwiritsa ntchito njira zitatu zosiyanasiyana:

1. Gulu loyamba - anthu 1,079, adasintha moyo wawo kuti achepetse thupi osachepera 7%, zolimbitsa thupi mphindi 150 pa sabata,
2. Gulu lachiwiri - odwala 1073, adalandira placebo,
3. Gulu lachitatu, anthu a 1082, adalandira metformin pa mlingo wa 1700 mg patsiku.

Zotsatira za kafukufukuyu zikuwonetsa kuti kusintha kwa moyo kumachepetsa chiopsezo chotenga matenda ashuga ndi 58%, ndi metformin ndi 31% poyerekeza ndi placebo. Mwa ophunzira 100 omwe adachita nawo kafukufuku, ndi anthu 4.8 okha omwe ali ndi moyo wathanzi omwe adapanga matenda ashuga, 7.8 kuchokera pagulu la metformin ndi 11 ochokera ku gulu la placebo.

Zizindikiro zazikulu zamakono zogwiritsira ntchito mankhwalawa

Mankhwalawa amagwiritsidwa ntchito osati mtundu wachiwiri wa shuga, komanso milandu inanso.

Matenda a shuga a Type 2 ndi chithandizo choyambirira kwa odwala omwe ali onenepa kwambiri komanso onenepa kwambiri, Type 1 shuga - kuphatikiza ndi insulin, odwala omwe ali onenepa kwambiri kapena onenepa kwambiri, anthu omwe ali ndi insulini komanso omwe amapezeka ndi insulin yayikulu, kapena omwe amawonjezera Mlingo wa insulin mosakhazikika. Dziwani, pofuna kupewa matenda ashuga - anthu omwe ali ndi chiwopsezo chachikulu chotenga matendawa (okhala ndi vuto la kusala kudya glucose, ndi kulolerana kwa glucose), Mukunenepa kwambiri, ngakhale osalephera shuga istentnosti insulin, amene amagwirizana ndi chiopsezo cha matenda a mtima odwala ndi kwambiri kukana insulin, monga acanthosis nigricans syndrome, mu syndrome polycystic n'kuwasanganiza.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Metformin siilimbikitsidwa pa nthawi yoyembekezera. Insulin nthawi zambiri imakhazikitsidwa pa nthawi yapakati chifukwa imakhala ndi shuga wamkulu wamagazi. Chitetezo cha mankhwalawa kwa mayi woyamwitsa sichinatsimikizidwe ndi chithandizo cha metformin, chifukwa chake kufunsa dokotala ndikofunikira.
Palibe chidziwitso chokwanira chogwiritsidwa ntchito ndi ana. Mtundu wa matenda a shuga omwe amathandizidwa ndi mankhwalawa ndi osowa mwa ana.

Katundu woyambira

Mwa mankhwala amakono a antiidiabetes, metformin imatenga malo a greatuanide wodziwika komanso wogwira mtima. Zotsatira zamankhwala zimatengera thupi la wodwalayo, matendawo ndi mtundu wake. Pakati pa anthu omwe ali ndi matenda a shuga a 2 omwe amadalira insulin, mankhwalawa amagwiritsidwa ntchito nthawi zambiri.

Mankhwala ali mu mawonekedwe a mapiritsi amkamwa:

1. Chowoneka mosiyana ndi mankhwalawa ndiko kukhoza kwake kuchepetsa misempha popanda kuwonjezera insulin. Chiwindi, minofu minofu mwachilengedwe imatenga glucose, kuchuluka kwa glucose m'matumbo amachepetsa, ndipo palibe kutulutsa kwakatulu kwa timadzi.
2. Chuma china chabwino cha mankhwalawo ndi kuthekera kwake kuchepetsa kuchepetsa kwa wodwala.
3. Mankhwala amaletsa thrombosis, kuchepetsa kuchuluka kwa cholesterol yoyipa m'magazi.
4. Mosiyana ndi mankhwala ena a gulu lomwelo, samayambitsa kudumpha mu kuthamanga kwa magazi ndi tachycardia.

Kuchepetsa kapangidwe ka mankhwala a insulin - insulin, mankhwala omwe amalemera kwambiri amachepetsa hyperinsulinemia. Mothandizidwa ndi mankhwala, kuchuluka kwa mafuta acids, komanso glycerol kumawonjezeka.

Mankhwalawa sangathe kugwira ntchito ngati akuphwanya malamulo a mankhwalawo, kusayang'anira zakudya zapadera, komanso kuyendetsa molakwika shuga. Mankhwala amodzi sangasinthe thanzi la munthu wodwala matenda ashuga, koma njira yolumikizana ndi vutoli ithandizanso kukonza moyo wa anthu.

Kugwiritsa ntchito bwino shuga

Maphunziro amakono azamankhwala

Kuphatikiza pa kuchitapo kanthu kokhudzana ndi kuwongolera kuchuluka kwa shuga m'magazi, malinga ndi kafukufuku wa sayansi, metformin imakhala ndi phindu pamtima ndi m'mitsempha yamagazi, komanso imakhudzanso izi:

1. Pambuyo pamankhwala omwe mumalandira ndi mankhwalawa, chiopsezo cha matenda a mtima mu odwala matenda ashuga amachepetsa.
2. Ndi mawonekedwe osadalira insulin omwe amadwala, kuchuluka kwa zochitika za khansa, makamaka zikondamoyo, matumbo ndi ziwalo zina zamkati, zimachepa.
3. Mapiritsi amakhudza momwe minofu imakhalira, khalani kupewa kwa mafupa kwa odwala.

Kutengera zaka zambiri zokumana nazo zamankhwala, mtundu wa matenda amtundu wa 2 wa mtundu wa shuga umasankhidwa nthawi zambiri. Chidacho chimaphatikizidwa ndi mankhwala ambiri a antiidiabetes.

Mapiritsi ndi othandiza komanso otetezeka kwa anthu ochepera zaka 80 kapena kupitirira pamikhalidwe ina. Chithandizo choyambirira ndikofunikira pamtundu uliwonse wamatendawa ndipo zimapereka zotsatira zabwino mukathandizidwa ndi gulu la Biguanides.

Momwe mungachiritsire matenda ashuga amtundu wa 2

Kugwiritsa ntchito mankhwala osokoneza bongo

Mankhwala a shuga metformin amangoperekedwa ndi adokotala. Metformin imatengedwa yokha kapena kuphatikiza ndi antidiabetic agents, kutengera ndi matendawa. Kwa akulu, mlingo wa 500 mg kapena kupitilira umaperekedwa kangapo patsiku potengera momwe thupi limakhalira.

Kuchuluka kwa mankhwalawa kumawonjezeka pang'onopang'ono kupewa mavuto. Osapitilira muyeso wa 3000 mg wa tsiku kwa 3 Mlingo wake kapena mukatha kudya. Pazowongolera kwambiri shuga, magazi amaphatikizidwa ndi kayendetsedwe ka insulin.

Zofunika! Pambuyo masiku 10, mlingo umawunikiranso molingana ndi kuwerengera kwamagazi.

Zotsatira za bongo

M'matumbo amachepetsa kwambiri Mlingo wa mankhwala mseru, kusanza, kutsekula m'mimba. Dongosolo la endocrine limasokonekanso ndipo hypoglycemia imachitika. Mankhwala osokoneza bongo odwala matenda ashuga amawopsa pamoyo, chifukwa chake, ngati zizindikiro zoyambirira zikuonekera, pezani thandizo kuchipatala.

Ndi vuto laimpso, lactic acidosis imatha kuchitika ndikutsatira m'mimba kukhumudwa zizindikiro izi zimawonekera:

• kutentha kwa thupi la munthu kumachepa
• kupuma kumafulumira
• chizungulire chikuwonekera
• kupweteka kwambiri kwa minofu
• wodwalayo amadziona kapena wagundika.

Mankhwala osokoneza bongo komanso osokoneza bongo

Ambiri ali ndi chidwi ndi funso loti ngati pali kudalira mankhwalawa kwa nthawi yayitali komanso ngati zingavulaze thupi nthawi yomweyo. Mapiritsi a Metformin a matenda ashuga sayambitsa matendawa ngakhale pakakhala kusokonezeka kwakanthawi kwamankhwala. Koma kusintha kulikonse pa muyezo ndi mtundu wa mankhwalawo kuyenera kuvomerezedwa ndi dokotala.

Kulowerera kwa mankhwalawa sikuyambitsa kuchuluka kwa thupi kapena kuwonjezeka kwa kuwerenga kwa shuga. Chimodzi mwazinthu zoyipa zomwe zimachitika pakapita nthawi yayitali ndimavuto m'mimba ndi m'matumbo, koma matendawo amadzatha pakapita nthawi.

Kuchita ndi mankhwala ena

Kuphatikizidwa koyenera ndi zinthu zina zamankhwala kumapereka mphamvu zochuluka kuchokera pakutenga metformin. Mankhwala ena amatha kulowetsamo mankhwala ndi gulu la ma biguanides ndipo potero amachepetsa kapena kukulitsa mphamvu ya mapiritsi.

Glucose amachepetsa ndikuphatikiza mankhwala ndi magulu otsatirawa:

• glucocorticoids,
• kulera kwamlomo
• mahomoni a chithokomiro
• okodzetsa ena
• amphanomachul.

Kuphatikiza pa mankhwala ena, kugwiritsa ntchito mowa uliwonse kumaletsedwa mankhwalawa ndi metformin. Mowa wambiri womwe umakhala ndi zakudya zochepa zama calorie ndikumamwa mankhwala ochepetsa matenda ashuga umatitengera kuwopsa kwa lactic acidosis.

Komanso, ndi matenda a endocrine system, muyenera kuwunika momwe impso zimayendera pafupipafupi. Ndikwabwino kusiya mikhalidwe yoipa ndikusinthira ku chakudya chopatsa thanzi, kupatsa kupsinjika kwakanthawi kwamthupi la wodwalayo.

Malangizo! Simungagwiritse ntchito metformin nthawi imodzi ndi zotumphukira za sulfonylurea, chifukwa zinthu zabwino za glucose zimatsika kwambiri.

Mtengo wa mankhwala

Mtengo wapakati wa mapiritsi a metformin hydrochloride umakhalabe wokwanira kugula kwa odwala ambiri. Mtengo umakwera kutengera mlingo wa mankhwalawo ndikuyamba kuchokera ku 90 mpaka 300 ma ruble pakompyuta ya mapiritsi 60.

Kuunikiridwa kwamankhwala nthawi zambiri kumakhala koyenera, chifukwa chida, kuwonjezera pazotsatira zake, zimathandiza kupewa zoyipa za matendawa. Mwa zina zomwe zimafanana ndi mankhwalawa, Siofor, Metphogamm, Diaphor ndi Metformin-Teva ndi ena amadziwika.

Atafunsidwa ngati kuli kotheka kumwa metformin ngati kulibe matenda ashuga, ndi katswiri yemwe angayankhe, chifukwa mankhwalawa amangophatikizana ndi njira zina zopewera. Tsoka ilo, anthu athanzi nthawi zina amagwiritsa ntchito mankhwala kuti achepetse thupi, zomwe zimaletsedwa mwamphamvu ndi akatswiri.

Kuzindikira koyambirira kwa endocrine system pathology

Zizindikiro ndi contraindication

Metformin mu shuga ngati mankhwala osokoneza bongo a endocrine dongosolo zotchulidwa motere:

• Pakadalibe vuto la chakudya,
• odwala matenda ashuga onenepa kwambiri,
• monga monotherapy
• kuphatikiza ndi othandizira ena a hypoglycemic a matenda amtundu 1 ndi 2,
• zochizira matenda a shuga kwa ana pambuyo zaka 10 ngati mankhwala odziyimira pawokha kapena munthawi yomweyo ndi insulin,
• popewa mavuto a matenda.

Popeza lero mankhwala a gulu la Biguanide amagwiritsidwa ntchito mosamala pakukhumudwa kwa mtima, pali zotsutsana zina zomwe malangizowo akuwonetsa:

• matenda a chiwindi ndi impso,
• chidwi chamunthu chogwira ntchito,
• matenda ashuga acidosis okoma kapena opanda chikomokere
• Mimba ndi kuyamwa
• wodwala matenda ashuga
• myocardial infaration
• uchidakwa woperewera wodwala.

Pali nthawi zina pomwe mungaletse mankhwala a shuga:

• Mukamakonzekera mayeso pogwiritsa ntchito mitundu yosiyanitsa,
• musanayambe kuchitidwa opareshoni, mankhwala amabwezeretsedwera limodzi ndi chakudya choyamba atachitidwa opaleshoni.

Kupewa kwa Mavuto a Metformin

Popanda kusintha njira yodwala komanso njira yovuta yochiritsira, ndizosatheka kukwaniritsa zabwino. Kodi metformin ingagwiritsidwe ntchito kupewa matenda ashuga? Ngati pali cholowa chamabadwa ndi zina, ndikofunikira kufunsa ndi endocrinologist.

Kuyesedwa kwamankhwala kwa magulu awiri a odwala, omwe amodzi omwe adamwa mankhwalawo, ndipo wachiwiri amangotsatira kudya, adawonetsa kuti kumwa mankhwalawa mwachangu kumapangitsa kusintha ndi kuchepa kwa shuga m'magazi. Zotsatira za kafukufukuyu zinachitidwa mchaka cha 1998 ndi a Britain Perspective Gulu.

Kuchiza ndi metformin kwa matenda ashuga kuyenera kuyamba mofulumira, chifukwa moyo wa wodwalayo umadalira chithandizo chanthawi yake. Kugwiritsa ntchito moyenera mankhwalawa kumathandiza kupewa zovuta zambiri zamatenda ndikukulitsa moyo wa munthu.