Mankhwala a Antithyroid amagwiritsidwa ntchito pa hyperthyroidism (thyrotooticosis, matenda a bazedova). Pakadali pano, mankhwala a antithyroid amagwiritsidwa ntchito makamaka. thiamazole (merkazolil)zomwe zimalepheretsa thyroperoxidase ndipo zimapangitsa iodination ya tyrosine zotsalira za thyroglobulin ndikusokoneza kapangidwe ka T₃ ndi T₄. Gawani mkati. Mukamagwiritsa ntchito mankhwalawa, leukopenia, agranulocytosis, zotupa za pakhungu ndizotheka. Kukulitsa kwa chithokomiro.

Monga mankhwala a antithyroid, ayodini amadziwika mkati - kalia iodide kapena ayodini muyezo waukulu (160-180 mg). Potere, ma ayodini amachepetsa kupanga kwa chithokomiro cha chithokomiro cha pituitary, motero, kaphatikizidwe ndi katulutsidwe ka T kamachepa₃ ndi T₄ . Njira yofananira yoletsa kutulutsa kwa mahomoni olimbikitsa chithokomiro amawonedwanso diiodotyrosine. Mankhwala amaperekedwa pakamwa. Amayambitsa kuchepa kwa kuchuluka kwa chithokomiro. Zotsatira zoyipa: mutu, lacrimation, conjunctivitis, kupweteka kwa zotumphukira, laryngitis, zotupa pakhungu.

Jekeseni wokhazikika wa insulin

Mlingo wa insulin: mosasamala payekhapayekha.

Mulingo woyenera kwambiri uyenera kuchepetsa kuchuluka kwa magazi kukhala abwinobwino, kuchotsa glucosuria ndi zizindikiro zina za matenda ashuga.

Malo Othandizira a Subcutaneous (mayeso osiyanasiyana): kutsogolo kwa khoma lam'mimba, kunja kwa mapewa, kutsogolo kwa ntchafu, matako.

Mankhwala ochepera - m'mimba (kuthilira mwachangu),

Mankhwala okhalitsa - m'chiuno kapena matako.

Mapewa sakhala omasuka kuti adzivulaze.

Kuchita bwino kwa mankhwalawa kumayang'aniridwa ndi

- Kutsimikiza kwapangidwe ka "njala" yamwazi ndi

- Kutuluka kwa mkodzo wake patsiku

Njira yabwino kwambiri yochizira matenda a shuga 1

Reimen ya jakisoni wambiri wa insulin yemwe amatsata katulutsidwe kathupi ka insulin.

Muzochitika zathupi

secaltion ya basal (maziko) ya insulini imachitika mosalekeza ndipo ndi gawo limodzi la insulin pa ola limodzi.

Pa zolimbitsa thupi insulin katulutsidwe nthawi zambiri amachepetsa.

Secretion yowonjezera (yolimbikitsidwa) ya insulin (mayunitsi 1-2 pa 10 g ya chakudya) amafunikira.

Katizidwe katemera ka insulin kameneka kangapangidwe motere:

Asanadye chilichonse, mankhwala omwe amagwira ntchito mwachidule amaperekedwa.

Secaltion ya basal imathandizidwa ndi mankhwala omwe akhala akuchita kwa nthawi yayitali.

Zovuta za insulin mankhwala:

Mavuto a shuga

- ntchito osakwanira Mlingo wa insulin,

Popanda chisamaliro chachikulu, chikomokere matenda a shuga (ophatikizidwa ndi matenda a ubongo)

nthawi zonse umapha.

- kuchuluka kwa CNS kuledzera ndi matupi a ketone,

Chithandizo chadzidzidzi zachitika wamitseko kuyambitsa kwa insulin.

Mothandizidwa ndi mlingo waukulu wa insulin m'maselo limodzi ndi shuga zimaphatikizapo potaziyamu

(chiwindi, minofu ya mafupa),

Magazi a potaziyamu amagwa kwambiri. Zotsatira zake, kusokonezeka kwa mtima.

Insulin ziwopsezo, chitetezo insulin.

Lipodystrophy pamalo opangira jekeseni.

Pofuna kupewa, tikulimbikitsidwa kusintha malo a jakisoni a insulin mkati mwake.

Kukonzekera kwa parathyroid

Horoni ya parathyroid ya polypeptide parathyroid imakhudza kagayidwe ka calcium ndi phosphorous. Amayambitsa kutsekeka kwa mafupa. Imalimbikitsa kuyamwa kwa calcium mayoni a m'mimba, kumapangitsanso kuyamwa kwa calcium ndikuchepetsa kubwezeretsanso kwa phosphate mu aimpso tubules. Pamenepa, zochita za mahomoni a parathyroid zimawonjezera kuchuluka kwa Ca 2+ m'madzi a m'magazi. Mankhwala a parishroid parusha parathyroidin ntchito hypoparathyroidism, spasmophilia.

1. Kukonzekera kwa insulini ndi zochita zopanga ma hypoglycemic

Insulin imapangitsa kuti cell membrane receptors yolumikizana ndi tyrosine kinase. Pankhaniyi, insulin:

amalimbikitsa kuyamwa kwa glucose ndi maselo amisempha (kupatula dongosolo lamanjenje lamkati), ndikuthandizira kayendedwe ka glucose kudzera mu zimagwira ma cell,

amachepetsa shuga m'magazi,

3) imalimbikitsa mapangidwe a glycogen ndi mawonekedwe ake m'chiwindi,

4) amalimbikitsa kapangidwe ka mapuloteni ndi mafuta komanso kupewa choleabolism yawo,

5) amachepetsa glycogenolysis mu chiwindi ndi chigoba minofu.

Ndi kupanga insulin yokwanira, matenda a shuga amakula, momwe zimagwirira ntchito zamafuta, mafuta ndi mapuloteni.

Type Iabetes mellitus (wodalira insulini) amagwirizanitsidwa ndi kuwonongeka kwa maselo a β-maselo a Langerhans. Zizindikiro zikuluzikulu za mtundu wa matenda a shuga a m'magazi a shuga: hyperglycemia, glucosuria, polyuria, ludzu, polydipsia (kuchuluka kwamadzi ambiri), ketonemia, ketonuria, ketacidosis. Mitundu ikuluikulu ya matenda a shuga popanda chithandizo imatha kwambiri, kufa kumachitika m'chiwopsezo cha hyperglycemia, acidosis, kusazindikira, kununkhira kwa acetone mkamwa, mawonekedwe a acetone mkodzo, etc.). Mtundu woyamba wa matenda a shuga a mellitus, mankhwala okhawo othandiza ndi kukonzekera kwa insulin komwe kumayendetsedwa ndi kholo.

Type II matenda a shuga a mellitus (osadalira insulini) amagwirizanitsidwa ndi kuchepa kwa insulin secretion (kuchepa kwa ntchito ya β-cell) kapena kukula kwa minofu kukana insulin. Kutsutsa kwa insulin kumatha kuphatikizidwa ndi kuchepa kwa kuchuluka kapena chidwi cha insulin receptors. Pankhaniyi, kuchuluka kwa insulin kungakhale kwabwinobwino kapenanso kukwezedwa. Kuchuluka kwa insulini kumapangitsa kuti kunenepa kwambiri, chifukwa chake mtundu wachiwiri wa matenda a shuga nthawi zina umatchedwa shuga wambiri. Mtundu wachiwiri wa matenda a shuga a mellitus, othandizira a hypoglycemic amagwiritsidwa ntchito, omwe, osakwanira, amaphatikizidwa ndi insulin.

Pakadali pano, kukonzekera bwino kwambiri kwa insulin ndikobwereza kukonzekera kwa insulin. Kuphatikiza apo, amagwiritsa ntchito mankhwala a insulin omwe amapezeka kuchokera ku kapamba ka nkhumba (insulin ya nkhumba).

Kukonzekera kwa insulin kwa anthu kumapezeka ndi ma genetic engineering.

Insulin yosungunuka yaumunthu (Actrapid NM) amapangidwa m'mabotolo a 5 ndi 10 ml okhala ndi 40 kapena 80 PIECES mu 1 ml, komanso makatoni a 1.5 ndi 3 ml a ma syringe pensulo. Mankhwalawa amaperekedwa pakhungu pakatha mphindi 15 mpaka 20 musanadye katatu pa tsiku. Mlingo amasankhidwa payekha kutengera kuopsa kwa hyperglycemia kapena glucosuria. Zotsatira zimayamba pambuyo pamphindi 30 ndipo zimatha maola 6-8. Lipodystrophy imatha kukhazikika m'malo obaya jakisoni wambiri, motero tikulimbikitsidwa kusinthana malo a jekeseni nthawi zonse. Pa matenda a shuga, matenda a insulin amatha kutumikiridwa kudzera m'mitsempha. Ngati bongo la insulin, hypoglycemia imayamba. Pallor, thukuta, kumva mwamphamvu njala, kunjenjemera, palpitations, mkwiyo, kuwoneka. Hypoglycemic shock (kusazindikira, kugwedezeka, vuto la mtima) imayamba. Pazizindikiro zoyambirira za hypoglycemia, wodwalayo ayenera kudya shuga, makeke, kapena zakudya zina zokhala ndi shuga. Pothana ndi vuto la hypoglycemic, njira ya glucose kapena 40% ya glucose imabayidwa kudzera m'mitsempha.

Crystalline Zinc Kuyimitsidwa kwa Insulin ya Anthu (Ultratard HM) imayendetsedwa kokha pakhungu. Insulin imatengedwa pang'onopang'ono kuchokera ku minofu yaying'ono, zotsatira zake zimatha pambuyo pa maola 4-12, kutalika kwa nthawi ndi maola 24. Mankhwalawa amatha kugwiritsidwa ntchito ngati othandizira osakaniza ndi mankhwala omwe amapezeka mwachangu komanso mwachidule.

Kukonzekera kwa inshuwaransi kwa Porcine kuli chimodzimodzi pochita ndi insulin yokonzekera anthu. Komabe, matupi awo sagwirizana ndi omwe amatha kugwiritsa ntchito.

Insulinsungunukaosatenga nawo mbali opangidwa m'mabotolo a 10 ml okhala ndi 40 kapena 80 PIECES mu 1 ml. Lowani pakhungu pakadutsa mphindi 15 musanadye katatu pa tsiku. Intramuscular and intravenous management ndikotheka.

Insulin-zinckuyimitsidwaamorphous kutumikiridwa kokha pansi pa khungu, kupatsa kuyamwa pang'onopang'ono kwa insulini m'malo a jekeseni, motero. Kukhazikika kwa zochita pambuyo pa maola 1.5, nsonga ya kuchitapo kanthu pambuyo maola 5-10, kutalika kwa zochita ndi maola 12-16.

Insulin Zinc Crystal Kuyimitsidwa kutumikiridwa kokha pakhungu. Kukhazikika kwa zochita pambuyo pa maola 3-4, nsonga ya kuchitapo kanthu pambuyo pa maola 10-30, nthawi yayitali ndi maola 28-36.

Synthetic hypoglycemic wothandizira

Magulu otsatirawa opanga ma hypoglycemic othandizira amadziwika:

1) zotumphukazi

Derivatives of sulfonylureas - butamide, chlorpropamide, glibenclamide zotchulidwa mkati. Mankhwalawa amalimbikitsa katemera wa insulini ndi β-maselo a zisumbu za Langerhans.

Mphamvu ya zochita za sulfonylurea zotumphukira zimagwirizanitsidwa ndi njira ya ATP-yodalira K + ya β-cell ndi depolarization ya membrane wa cell. Pankhaniyi, njira zomwe zimadalira Ca 2+ zimayendetsedwa, kulowa kwa Ca g + kumapangitsa kuti insulin itulutsidwe. Kuphatikiza apo, zinthu izi zimakulitsa chidwi cha insulin receptors kuchitira insulin. Zinawonetsedwanso kuti zinthu zochokera ku sulfonylurea zimawonjezera mphamvu yolimbikitsa ya insulin pa kayendedwe ka glucose m'maselo (mafuta, minofu). Zotumphukira za Sulfonylurea zimagwiritsidwa ntchito mtundu II shuga mellitus. Ndi matenda a shuga a Type I, ndi osathandiza. Cholowamo chakudya cham'mimba mwachangu komanso mokwanira. Ambiri amamangilira mapuloteni a plasma. Wopangidwira m'chiwindi. Ma metabolabol amatulutsidwa makamaka ndi impso, ndipo gawo lina amatha kuchotseredwa ndi bile.

Zotsatira zoyipa: nseru, kulawa kwazitsulo mkamwa, kupweteka m'mimba, leukopenia, matupi awo sagwirizana. Ndi bongo wambiri wa sulfonylurea zotumphukira, hypoglycemia n`zotheka. Mankhwala amakhala akuphwanya milandu ya chiwindi, impso, ndi magazi.

Biguanides - metformin zotchulidwa mkati. Metformin:

1) amalimbikitsa kukoka kwa glucose pogwiritsa ntchito zotumphukira, makamaka minofu,

2) Amachepetsa gluconeogenesis m'chiwindi,

3) amachepetsa mayamwidwe a shuga m'matumbo.

Kuphatikiza apo, metformin imachepetsa kudya, imalimbikitsa lipolysis komanso imalepheretsa lipogenesis, imapangitsa kuchepa kwa thupi. Amasankha mtundu wachiwiri wa shuga. Mankhwalawa amamwetsedwa bwino, nthawi yayitali ya maola 14. Zotsatira zoyipa: lactic acidosis (kuchuluka kwa lactic acid m'mapazi am'magazi), kupweteka mumtima ndi minofu, kufupika, komanso kutsekemera kwazitsulo mkamwa, mseru, kusanza, kutsekula m'mimba.

2.3.1.2. Ma pancreatic mahomoni ndi maumboni awo opangira

Kasitomala amapanga mahomoni awiri: insulin ndi glucagon, omwe ali ndi mphamvu zambiri pamlingo wa shuga m'magazi. Insulin imatsitsa shuga m'magazi, kuonetsetsa kuti kayendetsedwe kake kamalumikizana ndi maselo ndikugwiritsa ntchito minofu, imalimbikitsa mapangidwe a shuga-6-phosphate, imayendetsa njira zamagetsi zopangira mphamvu, zimathandizira kapangidwe ka mapuloteni ndi mafuta acids. Kuperewera kwa insulin kumayambitsidwa ndi matenda a shuga - matenda oopsa, owonetsedwa ndi kuchuluka kwa shuga m'magazi ndi mawonekedwe ake mu mkodzo, njira zophatikizira zamadzimadzi (ndi kudzikundikira kwa matupi a ketone), kuchepa kwa lipid metabolism komanso kukula kwa mtima wam'mitsempha yamagazi (diabetic angiopathies). Carbohydrate kufa ndi maselo (minofu yodalira insulin), kusalinganika kwa electrolyte ndi ketoacidosis kumayambitsa kukula kwa chiwonetsero chachikulu cha matenda osokoneza bongo - matenda a shuga.

Insulin ndi mapuloteni okhala ndi maunyolo awiri a polypeptide omwe amalumikizidwa ndi milatho ya disulfide. Pakadali pano, kapangidwe ka insulin yaumunthu ndi nyama yachitika, njira yopangira biotechnological popanga (genetically engineulin insulin) yasintha. Insulin imagwiritsidwa ntchito ngati matenda a shuga omwe amadalira insulin omwe amakhala ndi vuto la ketoacidosis. Kukhazikitsidwa kwa insulin kwa odwala omwe ali ndi matenda ashuga kumabweretsa kutsika kwa magazi ndi kudziwikirana kwa glycogen mu minofu. Amachepetsa glucosuria ndi chifukwa cha polyuria ndi polydipsia. Mapuloteni ndi lipid kagayidwe kamafanana, zomwe zimabweretsa kuchepa kwa zomwe zimakhala mu nayitrogeni. Matupi a Ketone amasiya kupezeka m'magazi ndi mkodzo.

Muzochita zachipatala, kukonzekera kwa insulin ndi nthawi yolingana ya zochita (zazifupi, zapakati, zazitali) zimagwiritsidwa ntchito. Mlingo amawerengedwa payekhapayekha, poganizira kuopsa kwa njirayi. Pofuna kuchepetsa kuchuluka kwa jakisoni, atakwanitsa kulipidwa, odwala amasamutsidwa kwa insulin yokhala ndi nthawi yayitali: kuyimitsidwa kwa crystalline zinc-insulin, kuyimitsidwa kwa insulin-ultralong, protamine-zinc - insulin. Nthawi zambiri, mitundu yosiyanasiyana ya insulin (malinga ndi nthawi yayitali) ya insulin imagwiritsidwa ntchito pochiza. Kukonzekera kwa insulin sikuvuta. Insulin imapangidwira m'chiwindi ndi insulinase, yomwe imapangitsa kukhala kosakwanira kwa nthawi yake (maora 4-6). Jakisoni wa insulin ndiwowawa kwambiri; Insulin ndi mitundu yake yayitali imatha kuyambitsa zovuta. Ndi mankhwala osokoneza bongo ambiri a insulin, matendawa amatha kuyamba. Ndi hypoglycemia yocheperako pang'ono, imatha kulipidwa ndi kudya shuga kapena zakudya zamafuta, chifukwa chokhala ndi vuto ndikofunikira kuperekera shuga kholo.

Kuphatikiza pa insulin, othandizira opanga hypoglycemic amagwiritsidwa ntchito ngati othandizira a hypoglycemic. Izi zimaphatikizapo zotumphukira za sulfonylurea: tolbutamide (butamide), chlorpropamide, biguanides: buformin (glibutide, metformin (glucophage, glyformin). komanso insulin ndi sulfonamides.The akufuna njira ya zochita pakamwa antidiabetesic wothandizirana chikugwirizana ndi kuchuluka insulin ndi cell kudziwa izo sheney. limagwirira cha zochita za biguanide ofanana nawo akatumba chifukwa cha kukondoweza shuga kutengedwa ndi yimitsira njira shuga mayamwidwe.