Limagwirira ntchito ya Biguanides > Chithandizo ndi kupewa

Kwa zaka zambiri osalimbana ndi ma DIABETES?

Mutu wa Bungwe: “Mudzadabwitsidwa kuti kumakhala kovuta motani kuchiritsa matenda a shuga tsiku lililonse.

Matenda a shuga ndi chitukuko cha chitukuko cha anthu akukhala chochitika chofala. Malinga ndi ziwerengero, 15% ya anthu onse akudwala ndi vuto losasangalatsa ili komanso lopweteketsa moyo, pafupifupi kuchuluka komweko sadziwa kuti ali ndi zizindikiro zoyambitsa matenda ashuga kapena kale ali kale ndi omwe akudwala.

Kutengera izi, m'modzi mwa atatu amamva izi panjira yawo, ndikofunikira kuti nthawi zonse muzifufuza kuti muchepetse, kapena vuto linalake lalikulu, kutsagana ndi matendawa moyo wonse, ndikumakhala munthu wathunthu komanso wachimwemwe.

Kodi Biguanides ndi chiyani?

Biguanides ndi mankhwala apadera omwe amapangidwa kuti achepetse kukana kwa insulin kwa maselo amthupi mwakuchepetsa kuyamwa kwa mashuga osiyanasiyana komanso mafuta m'matumbo. Ndi imodzi mwanjira zambiri zochizira matenda ashuga, omwe amadziwika ndi kuchuluka kwambiri kwa glucose m'magazi komanso chifukwa cha chibadwa chamtundu kapena chikhalidwe chopanda thanzi.

Mndandanda wazinthu zomwe zachokera pagululi ndi:

Guanidine - anagwiritsidwa ntchito mosamala mu Europe wakale, koma nthawi yomweyo anali oopsa kwa chiwindi. Sikugwiritsa ntchito pano,
Sintalin - adapangidwa kuti athane ndi mtundu wofatsa wa matendawa, koma kuwopsa kwambiri komanso mawonekedwe a insulin m'mankhwala adathandizira kuyimitsidwa kwa maphunziro okhudzana, ngakhale mankhwalawa adagwiritsidwa ntchito mpaka 40s ya zaka zapitazi,
Buformin ndi Fenformin - adapezeka m'ma 50s m'zaka za zana la 20, chifukwa chakufunika kugwiritsa ntchito mankhwala othandizira pakamwa pochiza matenda amtundu wa 2, koma adawululanso zovuta za matenda am'mimba ngati zotsatira zoyipa. Kupitilira apo kuwopsa kwawo kunatsimikiziridwa ndikuletsa zoletsedwa mwamphamvu za mankhwalawa. Tsopano atha kukhala osaloledwa a Metformin chifukwa cha mtengo wotsika, koma ichi ndiye chiopsezo chosavomerezeka.
Metformin (yekhayo amene amaloledwa kuchokera pagulu losankhidwa, chifukwa cha chiopsezo chochepa cha lactic acidosis). Komanso mankhwalawa amadziwika kuti Glucofage, Siofor. Pali mapiritsi okhala ndi mbali zingapo momwe amaphatikizidwira. Zotsatira zakufufuza (mpaka pano pa mphutsi), zidatsimikiziridwa kuti mtsogolomo, Metmorfin atha kukhala "piritsi ya ukalamba" chifukwa cha katundu wothandizira.

Njira yamachitidwe

Monga mukudziwa, thupi lathu limatha kupeza shuga m'njira ziwiri:

Kunja ndi chakudya.
Ndi gluconeogenesis mu chiwindi.

Chifukwa chake, pali makonzedwe osungira shuga pamlingo wokwanira bwino. M'mawa kwambiri, shuga amatuluka mumtsempha wamagazi ndikuupereka ku ubongo, mwakutero amalimbitsa ndikuwonetsetsa kuti magwiridwe ake ali olimba. Koma tikapanda kugwiritsa ntchito mulingo woyenera, ndiye kuti zochulukazo zidzakhazikitsidwa thupi ngati mafuta.

Ndikofunika kumwa Metformin nthawi imodzi ndi chakudya, kumakhala kosavuta kumalowa m'magazi pakukonzekera mwachangu kusiyana ndi m'mimba yopanda kanthu. Thupi limagwira ntchito pa hepatocytes, kukulitsa chidwi cha minyewa kupita ku insulin ndikuchepetsa kuyamwa komweko m'matumbo.

Zotsatira zoyenera za kutenga Metmorphine:

kutsitsa kwokhazikika kwama malo ogulitsa mafuta,
kulimbitsa chidwi
Kuchepetsa shuga m'njira yovomerezeka,
kutsitsa hemoglobin wa glycated mpaka 1.5%,
palibe kuchepa kwa shuga m'magazi pambuyo pogona ndi njala yofananira mwa odwala a gulu lachiwiri ndi anthu athanzi,
lipolysis activation,
zoletsa za lepogis,
cholesterol yotsika
otsika triglycerides,
milingo yotsika kwambiri ya lipoproteins,
kuchepa kwa zinthu zamagulu a hemostasis.

Zotsatira zoyipa

Zotsatira zoyipa zomwe mankhwalawa amayambitsa nthawi zambiri kuposa zina, atha kukhala:

kutupa kwa m'mimba kapena kungoyipa,
kukulitsa kuchuluka kwa serotonin (mahomoni achisangalalo) m'matumbo, komwe kumalimbikitsa ntchito yake ndikumayambitsa matenda otsegula m'mimba pafupipafupi,
vitamini B12 hypovitaminosis,
zotupa pakhungu,
mawonekedwe a lactic acidosis,
testosterone yachepa mwa amuna,
mawonekedwe a megaloblastic anemia (osowa kwambiri).

Contraindication

Metformin imatsutsana mu:

zakumwa zoledzeretsa, chifukwa zimapangitsa kuti acidified ya magazi ikhale ndi kuchepa kwa shuga, ndipo izi ndizowopsa.
kugwira ntchito molimbika kwa anthu opitilira 60,
The kukhalapo kwa pachimake zinthu ndi kufunika insulin mankhwala,
Mimba ndi kuyamwa
kulephera kwa impso kapena mavuto ena a impso,
mavuto a chiwindi
kukhalapo kwa lactic acidosis (pamene zomwe lactic acid zili m'magazi zidapitilira,
kukhalapo kwa matenda a hypoxic (kuchepa magazi, kupuma, kulephera kwamtima),
pachimake kwamikodzo thirakiti matenda
matenda a bronchopulmonary,
kuperewera kwa zakudya m'thupi ndi kutopa kwa thupi.

Kuyanjana kwa mankhwala osokoneza bongo

Chochitikacho chimakulitsidwa limodzi ndi:

Insulin
Ma secretogens
Acarbose,
Mao zoletsa,
Cyclophosphamide,
Clofibrate
Salicylates
ACE zoletsa,
Oxytetracycline.

Chochita chimafooka chikaphatikizidwa ndi:

GKS,
njira zakulera za mahomoni
mahomoni a chithokomiro
thiazide okodzeya,
Zochokera ku Nicotine
Epinephrine
Glucagon
Phenothiazine zotumphukira.

Pakati pa gulu lonse la Biguanides, Metformin ndiwotsika mtengo, wopezeka paliponse komanso wothandiza kwambiri pochiritsa. Ngati zizindikiro zoyambirira za matenda atapezeka, muyenera kufunsa dokotala komanso kukayezetsa magazi. Ndi kugwiritsa ntchito mankhwala mosamala muyezo Mlingo, mutha kukonza thanzi lanu lonse ndikukhala osasamala, osadziwa nkhawa.

Kanema wochokera kwa Dr. Malysheva pazoyambirira zitatu za matenda ashuga:

Chofunikira kukumbukira ndikuti shuga sakhala sentensi, komanso kuti zovuta zam'masiku oyambitsidwa zimatha kuchepetsedwa potsatira zakudya ndi malangizo a dokotala.

Matenda a shuga

Tsoka ilo, matenda ashuga ndi matenda omwe amakhala moyo wonse. Mankhwala, wodwalayo amayenera kuphunzira njira zatsopano ndi kuwongolera moyo wake. Matendawa amapezeka ndi kuchepa kwa pancreatic hormone insulin (fomu yodalira insulin) kapena kuphwanya kachitidwe kake (mtundu wosadalira insulini).

Njira zonsezi zimaphatikizidwa ndi hyperglycemia (kuchuluka kwa shuga m'magazi). Mofananamo, kusokonezeka kwa metabolic ndi kusintha kwa ntchito ya ziwalo zingapo ndi machitidwe amakula. Kugawidwa kwa matendawa kukhala amtundu 1 ndi 2 sikungokhala ndi phindu la kuchipatala lomwe limagwiritsidwa ntchito posankha mankhwala omwe amafunikira, komanso loyambitsa matenda, popeza zomwe zimayambitsa matendawa ndizosiyana.

Chithandizo cha matenda osokoneza bongo chimadalira kukonza moyo ndi zakudya, zolimbitsa thupi ndi mankhwala othandizira, zomwe zimatengera mtundu wa matenda ndi njira ya kakulidwe. Nkhaniyi ikuwunika zamankhwala zothandiza zomwe akatswiri aza matenda a shuga angapereke pakadali pano komanso zomwe zikuchitika.

Mankhwala ogwiritsidwa ntchito

Mankhwala a shuga mellitus (kupatula insulin) amagawidwa m'magulu akulu otsatirawa:

ndalama zomwe cholinga chake ndi kukulitsa chidwi cha maselo a mthupi kupita ku mahomoni a kapamba,
mankhwala omwe amalimbikitsa kukondoweza, chifukwa chomwe insulin synthesis imapangidwira,
mankhwala a m'badwo watsopano - izi zikuphatikiza mitundu ingapo ya mankhwala omwe ali ndi magwiridwe osiyana siyana,
mankhwala a shuga omwe amachedwetsa shuga kuti atuluke m'matumbo am'mimba kulowa m'magazi (Acarbose).

Pancreatic zokupatsani mphamvu

Gulu loyamba la oimira ndi mankhwala a sulfa a shuga. Mankhwalawa cholinga chake ndi kudalitsa ntchito ya insulin mobisa masisumbu a Langerhans-Sobolev. Zotsatira zake ndikuwonjezereka kwa kaphatikizidwe kazinthu zomwe zimagwira ntchito zamafuta.

Zisonyezero zogwiritsidwa ntchito:

zaka zopitilira 40, malinga ngati kuchuluka kwa insulin sikugwiritsidwe ntchito kale,
kuchuluka kwa matendawa, komwe kukonza mankhwalawa sikuchotsa shuga wambiri.

Zotsatira zosagwiritsidwa ntchito ndi mankhwalawa:

mawonekedwe ofatsa a "matenda okoma"
kupezeka kwa ketoacidosis, chikomokere matenda ashuga kapena mkhalidwe wokongola pakalipano komanso kale.
kuchuluka kwa shuga m'magazi omwe amalimbikira pakukonzanso zakudya.
matenda am'mafupa, kwamikodzo dongosolo kapena chiwindi,
mimba ndi mkaka wa m`mawere.

Sulfonylureas

Gulu laling'ono la mankhwala a sulfa. Kapangidwe ka zochita zawo ndikulimbikitsa maselo a insulin-secretory, kuonjezera mphamvu ya mahomoni, ndikuchepetsa kumangiriza kwa insulin. Zomwe zimachokera ku sulfonylureas zimatha kukulitsa chidwi cha maselo kupita ku mahomoni ndikuwonjezera kuchuluka kwa zolandilira mu insulin. Mankhwala osokoneza bongo amaletsa kumasulidwa kwa shuga ku chiwindi ndikukula kwa boma la ketoacidotic.

Zofunika! Mankhwala a gululi amatha kulepheretsa zochitika za glucagon ndi somatostatin, omwe ndi insulin antagonists.

Mankhwala osokoneza bongo (Glibenclamide, Tolbutamide, Diabeteson, Euglikon, Tolinase) amapatsidwa mankhwala ochizira matenda amtundu wa 2 omwe ali ndi vuto labwinobwino kapena kuchuluka kwa wodwalayo, ngati mankhwala azakudya sangathe kuthana ndi milingo ya glycemia yodwala komanso zaka zopitilira 12-15.

Meglitinides

Awa ndimankhwala ochepetsa shuga, zomwe zimakhudzana ndi kukondoweza kwa kupanga insulin. Kugwiritsa ntchito bwino kwa mankhwalawa kumatengera glycemia. Kwambiri kuchuluka kwa shuga m'magazi a shuga, omwe amalimbikira kwambiri ndi mankhwalawa. Oimira atsopano - Novonorm, Starlix. Njira zimakhala ndi yochepa, kudya kumayenera kuchitika mphindi 5 asanadye.

Starlix ndimakonzedwe apiritsi omwe amagwira ntchito ndi nateglinide. Amasankhidwa mtundu wa odwala matenda ashuga amtundu wa II akakhala kuti samachita bwino pakudya komanso amakhala ndi thupi lokwanira. Starlix sikulimbikitsidwa chifukwa cha matenda omwe amadalira insulini, kukula kwa dziko la ketoacidotic, panthawi ya bere ndi mkaka wa m`mawere, kwa ana ochepera zaka 18.
Novonorm ndi mankhwala amkamwa omwe amagwiritsidwa ntchito pochiza matenda amtundu wa 2. Itha kuphatikizidwa ndi biguanides ngati alephera monotherapy. Contraindations ofanana ndi Starlix. Chenjezo liyenera kuchitika ndi matenda a chiwindi, kulephera kwaimpso, kuledzera komanso vuto lalikulu la thupi.

Zomvera

Awa ndi mankhwala omwe zochita zawo zimathandizira kuti chidwi cha maselo chikhale ndi mphamvu ya insulin. Izi zimaphatikizapo magulu awiri a mankhwala: Biguanides ndi thiazolidinediones.

Imodzi mwazigawo zamankhwala oteteza pakamwa. Oimira gulu samakhudza kuchuluka kwa insulin ndipo sangathe kuchitapo kanthu kapena kuperewera kwakukulu.

Metformin ndiye piritsi labwino kwambiri. Mukamagwiritsa ntchito, kuchepa kwa thupi kumawonedwa mwa odwala, pomwe zotsatirapo zake ndizotheka ndi mankhwala omwe ali ndi insulin analogues ndi sulfonylurea. Metformin imatha kuyendetsa kagayidwe ka lipid, kuchepetsa kuchuluka kwa mafuta m'magazi.

Pogwiritsa ntchito nthawi yayitali, mutha kuzindikira kupezeka kwa pakamwa pazitsulo, kutsutsana ndi mseru komanso kusanza, kutsekula m'mimba, kumatulutsa. Nthawi zina, lactic acidosis imayamba - chikhalidwe chokhala ndi lactic acid m'mwazi movutikira ndikufunika kuchipatala msanga.

Siofor ndi woimira wina wotchuka wa Biguanides. Siofor amachepetsa kuchepa kwa shuga m'magazi, kukulitsa chidwi cha minyewa kupita ku insulin ndikulepheretsa mapangidwe a shuga ndi chiwindi. Kuphatikiza apo, mankhwalawa ali ndi lipid-yotsitsa ndipo amathandizira pakulimbitsa magazi. Amawonetsedwa ngati matenda amtundu 2 kuphatikiza kunenepa kwambiri.

Thimang

Mankhwala amagwiritsidwa ntchito kuti akwaniritse zotsatira za hypoglycemic chifukwa kuchepa kwa insulin. Izi ndi zida zaposachedwa. Mankhwala amakono amatha kupereka njira zingapo - Aktos, Avandia.

Mankhwala amakhudzana ndi insulin sensitivity chifukwa cha zomwe zimapangitsa lipid ndi minofu yam'mimba, komanso chiwindi, komwe kukuwonjezereka kwa kugwiritsa ntchito shuga komanso kuchepa kwakapangidwe kake. Kumwa mankhwala kumatha kuchepetsa hemoglobin wa glycated ndi 1.5%.

Thiazolidinediones amaperekedwa kwa odwala omwe sanonepe kwambiri, chifukwa kugwiritsa ntchito nthawi yayitali kumatha kubweretsa kuwonjezeka kwa thupi chifukwa cha kusungunuka kwa madzi mthupi.

Alpha Glucosidase Inhibitors

Oyimira gulu lino amawongolera mayamwidwe a ma cell kuchokera m'matumbo kulowa m'magazi ndi kutulutsa kwawo kuchokera mthupi. Mndandanda wa mankhwala:

Glucobai (Acarbose) ndi mankhwala apakamwa omwe ayenera kugwiritsidwa ntchito mosamala ngati kuwonongeka kwa makina, matenda opatsirana, chithandizo cha opaleshoni. Sichimayikidwa pa nthawi yoyembekezera komanso mkaka wa m'mawere, odwala ochepa, omwe ali ndi matenda am'mimba komanso matumbo, kulephera kwambiri kwa impso.
Miglitol - imawonjezera mphamvu ya biguanides ndi sulfonylureas. Ndi osafunika kuphatikiza ndi matumbo adsorbents, ma antacid, kukonzekera kwa enzymatic. Gwiritsani ntchito mankhwala othandizira mosamala.

Mankhwala ayenera kumwedwa ndi zakudya. Chochitikacho chimatengera mphamvu ya hypoglycemic, koma alpha-glucosidase zoletsa sizimakhudza magwiridwe antchito a maselo a insulin-secretory a gland. Yoperekedwa ngati gawo la zovuta mankhwala a "matenda okoma".

Mankhwala ophatikizika aposachedwa, omwe amachitika chifukwa cha insulin, malinga ndi glycemic indices. Zinthu zomwe zimagwira zimayambitsa zomwe gluconeogeneis amapanga ndi ma cell opangidwa ndi ma cell a pancreatic. Ma incretins amatha kugwiritsidwa ntchito ngati mono- ndi polytherapy. Chowonadi ndi kutsika pang'ono pang'ono kwa shuga.

Onglisa ndi mankhwala omwe mankhwala ake ndi sansagliptin. Mankhwalawa akhoza kuphatikizidwa ndi Metformin, Actos, Avandia, Glibenclamide. Chithandizo cha munthawi yomweyo cha Onglisa ndi ma insulin analogue sichinaphunzire.
Januvia ndi piritsi lozikidwa pa sansagliptin. Amachepetsa kuthamanga kwambiri kwa glycemia pamimba yopanda kanthu, sizikhudza kulemera kwa wodwalayo.
Vipidia - kuphatikiza kwa izi ndi njira zina zonse za hypoglycemic komanso ma insulin analogi ndizololedwa.

Forsiga ndi mankhwala amakono opangidwa ndi Chingerezi. Asayansi adaganiza zochita zake mwanjira yoti chipangizocho chimapangitsa kuti shuga atuluke m'thupi mwakuwonjezera mphamvu yake m'thupi lathu. Mankhwalawa amatha kugwiritsidwa ntchito limodzi ndi mankhwala ena ochepetsa shuga ndi insulin.

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Njira zina zothandizira odwala

Asayansi aku China apanga othandizira a hypoglycemic, Xiaoke Mapiritsi.Kuyesedwa kwa kachipatala kwatsimikizira kuthekera kwa mankhwalawa kuchepetsa glucose, kusintha mawonekedwe a thupi la wodwalayo, kubwezeretsanso ntchito ya impso, ndikuchotsa chizindikiro cha matendawa.

Xiaoke imachepetsa cholesterol m'magazi, kuchotsa "ochulukirapo" m'thupi, kumawonjezera kamvekedwe ka minofu, kumapangitsa magazi kupita kwa kapamba, kumalimbitsa mitsempha yamagazi. Mankhwalawa amachotsa zinthu zakupha ndi poizoni m'thupi.

Njira ina yothanirana ndi Diabenot. Zosakaniza zake zogwira mtima ndi mankhwala azitsamba. Diabenot adapangidwa ndi asayansi aku Germany, amangotuluka kumene pamsika wama Russia wakuchipatala. Chogwiritsidwacho chili ndi zotsatirazi mthupi la munthu:

kukondoweza kwa ma cell a insulin,
kuyeretsa magazi ndi zamitsempha,
kuchepa kwa glycemia,
kukopa kwa chitetezo
kupewa mavuto.

Zakudya zowonjezera zakudya

Mu magawo oyamba a shuga, shuga amatha kusinthidwa pogwiritsa ntchito mankhwala othandizira komanso zakudya zamagetsi.

Insulin - mankhwala amamuthandiza kagayidwe kachakudya, amachititsa kapamba, amachepetsa kuyamwa kwa shuga m'magazi.
Tuoti - ali ndi katundu wa hypoglycemic, amatulutsa kagayidwe kachakudya.
Glucberry - mankhwala omwe amachepetsa thupi. Amagwiritsidwa ntchito popewa kukula kwa zovuta zamatenda oyamba.
Dialek ndiwothandiza popanga zinthu zamagetsi, zomwe zimakhala ndi zinthu zomwe zimapangitsa kagayidwe kachakudya.

Chithandizo cha matenda amtundu 1

Mtundu 1 wa matenda am'mimba umadalira shuga. Mankhwala ofunikira kwa odwala oterewa amagawika m'magulu awiri: insulin ndi mankhwala ena omwe amachotsa mavuto okhudzana nawo.

Kutengera kuchuluka kwa jakisoni wa insulin komwe kumayamba komanso kutalika kwake, kupanga kwakanthawi kochepa, nthawi yayitali komanso mankhwala osokoneza bongo amalekanitsidwa. Kuphatikiza kwa ma insulin analogues ndi dongosolo la makonzedwe zimasainidwa ndi endocrinologist payekhapayekha. Dokotala amasankha mankhwalawa kutengera glycemia, kulemera kwa thupi la wodwalayo, kupezeka kwa zovuta, komanso kuchuluka kwa chipukutirozo. Insulin imalowetsedwa ndi syringe kapena pampu.

Mankhwala owonjezera:

ACE zoletsa - chepetsa kuthamanga kwa magazi, muchepetse kuwopsa kwa mankhwala ena mthupi,
Cardio ndi vasotonics - - kusintha ntchito ya mtima ndi mitsempha yamagazi,
ndalama zomwe zimathandizira kugaya chakudya kwam'mimba (ma enzymes, pro- and prebiotic),
antidepressants, anticonvulsants, anesthetics wamba - umalimbana ndi analgesia pofuna kuwonongeka kwa zotumphukira zamagawo amanjenje,
ma statins ndi ma fibrate - magulu omwe amachepetsa chizindikiro cha cholesterol "choyipa", chifukwa chake amalimbana ndi kusintha kwa atherosclerotic m'matombo,
anticoagulants - kupewa mapangidwe magazi.

Mankhwala ofewa

Tsoka ilo, popanda mankhwala, oposa 95% ya anthu odwala matenda ashuga sangathe kubwezeretsa chipukuta matenda. Mankhwala ambiri omwe amaperekedwa amaikidwa ngati mankhwala okwera mtengo. Ndikofunika kukumbukira kuti pali mndandanda wamankhwala osankha pochiza matenda ashuga. Izi zimaphatikizapo mitundu ingapo ya insulin, oimira ma Biguanides, alpha-glucosidase inhibitors, sulfonylureas.

Mowa wa Ethyl, ma syringe omwe amayendetsa insulin amatha kuwonjezeredwa pamndandandawu. Amalandira mankhwala okondera m'mafakitala a boma molingana ndi chikalata chomwe aperekedwe ndi endocrinologist. Nthawi zambiri mumapereka mankhwala ochuluka omwe anali okwanira mwezi umodzi.

Ndikofunika kukumbukira kuti matenda a shuga si matenda omwe amathanso kuthandizidwa “kudzera m'manja”. Izi zodabwitsa zimatha kukhala zovuta chifukwa cha zovuta za impso, mitsempha, komanso ziwiya. Ndiye chifukwa chake kutsatira malangizo a dokotala komanso kufunafuna thandizo pa nthawi yake ndiye njira yabwino.