MITU YA NKHANI YOPHUNZITSA TIYERE 2

Matenda a shuga mdziko muno ndi amodzi mwa matenda asanu achilengedwe omwe makolo athu olumala ndi kufa. Ngakhale molingana ndi ziyerekezo zosasangalatsa, mpaka anthu opitilira diabetes okwana 230 amafa chaka chilichonse chifukwa cha matenda ashuga omwe ali mdziko muno. Ambiri aiwo sangathe kuthana ndi vuto lawo popanda mankhwala abwino.

Mankhwala omwe amachepetsa kwambiri shuga komanso omwe amayesedwa nthawi yayitali amachokera ku gulu la ma biagunides ndi sulfonylureas. Amaphunziridwa kwambiri muzochita zamankhwala komanso maphunziro ambiri, amagwiritsidwa ntchito pamagulu onse a shuga 2.

Mankhwala osakanikirana Glimecomb (mu mtundu wapadziko lonse Glimekomb) adapangidwa pamaziko a biagunide ndi kukonzekera kwa sulfonylurea, kuphatikiza mphamvu za metformin ndi glycazide, yomwe imalola glycemia kukhala yoyendetsedwa bwino komanso moyenera.

Pharmacology Glimecomb

Makina amachitidwe azomwe zimakhazikitsidwa ndizovuta zimasiyana kwambiri, izi zimapangitsa kutsogolera vutoli kuchokera kumitundu yosiyanasiyana.

Gawo loyamba la mankhwalawo likuyimira m'badwo watsopano wa sulfonylureas. Kuchepetsa kwa shuga kwa mankhwalawa kumathandizira pakupanga insulin ya amkati mwa β-maselo a kapamba. Chifukwa cha kukondoweza kwa minofu ya glycogen synthase, kugwiritsidwa ntchito kwa glucose ndi minofu kumakhala bwino, zomwe zikutanthauza kuti samasinthidwa mwachangu kukhala mafuta. Matendawa amagwira mawonekedwe a glylazide m'masiku ochepa, kuphatikizapo matenda ashuga a metabolic.

Hyperglycemia, yomwe nthawi zambiri imadziwonetsera pambuyo pa kudya zakudya zamagulu, siowopsa pambuyo pa gliclazide. Kuphatikiza kwa mapapo am'magazi, ntchito ya fiblinolytic ndi heparin imawonjezeka ndi mankhwalawa. Kulekerera kwakukulu kwa heparin, kumakhala ndi mankhwala komanso antioxidant.

Makina a ntchito ya metformin, yomwe ndi yachiwiri yofunikira ku Glimecomb, imakhazikika pakuchepa kwa shuga ya basal chifukwa cha kayendedwe ka glycogen kamene kamatuluka m'chiwindi. Kukulitsa chidwi cha ma receptors, mankhwalawa amachepetsa kukana kwa maselo ku insulin. Mwa kuletsa kupanga kwa shuga m'mapuloteni ndi mafuta, imathandizira kayendedwe kazake kuti minofu ya minofu igwiritsidwe ntchito.

M'matumbo, metformin imalepheretsa kuyamwa kwa shuga m'makoma. Kapangidwe ka magazi kamakhala bwino: kuchuluka kwa cholesterol kwathunthu, triglycerol ndi LDL ("yoyipa" cholesterol) kumachepa, kuchuluka kwa cholesterol ya HDL ("yabwino" kumawonjezeka). Metformin sichikhudza ma β-cell omwe amachititsa kuti pakhale insulini yawoyawo. Mbali iyi, njirayi imayang'anira gliclazide.

Pharmacokinetics wa mankhwala

Pambuyo polowa m'matumbo am'mimba, mankhwalawa amamwa mwachangu: pa mlingo wa 40 mg, mtengo wokwanira wa Cmax (2-3 μg / ml) umadziwika m'magazi pambuyo pa maola 2-6. Gliclazide imamangiriza mapuloteni ake pa 85-98%. Biotransfform ya mankhwala amapezeka m'chiwindi. Mwa metabolites omwe amapangidwa, amodzi amakhala ndi mphamvu pa microcirculation.

Hafu ya moyo wa T1 / 2 imachokera ku maola 8 mpaka 20. Zinthu zowola zimathetsa impso (mpaka 70%), pang'ono pang'ono (mpaka 12%) zimachotsa matumbo. Mankhwalawa amagwira ntchito masana. Mu odwala matenda ashuga okalamba, mankhwala a Glyclazide processing sanalembedwe. Zinthu zowola zimachokera mwachilengedwe: 65% - ndi mkodzo, 12% - yokhala ndi ndowe.

M'matumbo am'mimba, mankhwalawa amalowetsedwa ndi 48-52%. Kusala bioavailability sikupitirira 60%. Mafuta ambiri (1 μg / ml) m'magazi amawonedwa pambuyo pa maola 1.8-2.7. Kugwiritsira ntchito mankhwalawa ndi chakudya kumachepetsa Cmax ndi 40% ndikuchepetsa kuchuluka kwa kukwaniritsidwa kwa mphindi 35. Metformin pafupifupi samagwirizana ndi mapuloteni amwazi, koma amadziunjikira m'maselo ofiira amwazi.

Hafu ya moyo wa T1 / 2 ndi maora 6.2. Ma metabolites amachotsedwa makamaka ndi impso komanso pang'ono (pafupifupi chitatu) ndi matumbo.

Ndani sakukwanira ndi Glimecomb

Mankhwala osakanikirana sakusankhidwa:

1. Anthu odwala matenda ashuga a mtundu woyamba,
2. Ndi ketoacidosis (mawonekedwe a matenda ashuga),
3. Ndili ndi matenda ashuga komanso chikomokere,
4. Odwala kwambiri aimpso kukanika
5. Ndi hypoglycemia,
6. Ngati vuto lalikulu (matenda, kuchepa thupi, kusokonezeka) lingayambitse kusokonekera kwa impso kapena chiwindi,
7. Momwe ma pathologies amayendera limodzi ndi mpweya wamatenda a minofu (vuto la mtima, mtima kapena kupuma),
8. Amayi oyembekezera komanso oyembekezera
9. Pogwiritsa ntchito miconazole,
10. Pazotheka kuphatikiza mapiritsi ndi insulin (matenda, maopareshoni, kuvulala kwambiri),
11. Ndili ndi hypocaloric (mpaka 1000 kcal / tsiku),
12. Kwa oledzera omwe ali ndi poyizoni wa mowa,
13. Ngati muli ndi mbiri ya lactic acidosis,
14. Ndi hypersensitivity ku zosakaniza za mankhwala.

Glimecomb idathetsedwa masiku awiri m'mbuyomu komanso kwa nthawi yomweyo pambuyo poti wodwala amayesedwa ngati akuwunika ma radioisotope kapena X-ray pogwiritsa ntchito zikwangwani zoimira iodini.

Osamapereka mankhwala kwa odwala matenda ashuga okalamba (atatha zaka 60), ngati amakakamizidwa kugwira ntchito zolimba, zomwe zimakwiyitsa lactic acidosis.

Zotsatira zoyipa

Mankhwala onse opangidwa, ngakhale otetezeka kwambiri, amakhala ndi zotsatira zosayenera. Kukonzekera kwachiwiri-kozungulira sulfonylurea - erythropenia, agranulocytosis, hemolytic anemia, pancytopenia, matupi a vasculitis, kukanika kwa chiwindi.

Metformin ya m'badwo wachitatu ndi mankhwala otetezeka kwambiri.

Munthawi yosinthira, odwala matenda ashuga amadandaula za zovuta za dyspeptic zokha: kukhumudwa pang'onopang'ono, kuchepa kwa chakudya, kusintha kwa kukoma (kuwoneka kwa kukoma kwazitsulo).

Kuphatikiza pazotsatira zake zonse, Glimecomb adalemba enaake. Zojambula zawo zimawonetsedwa pagome.

Zowonongeka zowonekera sizimalembedwa kawirikawiri, zomwe zimafunikira kusintha kwa mlingo kapena kusinthidwa kwathunthu kwa Glimecomb ndi ma visantimidwe.

Mlingo wa glimecomb ndi mawonekedwe

Wopanga waku Russia AKRIKHIN amatulutsa Glimecomb mwa mawonekedwe a mapiritsi a cylindrical oyera ndi tint wachikasu, wokhala ndi mzere wogawika. Kapangidwe ka marble kotheka.

Piritsi lililonse lili ndi 40 mg ya gliclazide ndi 500 mg ya metformin. Onjezani zinthu zoyambira ndi mafilimu: sorbitol, croscarmellose sodium, povidone, magnesium stearate. Pa mbale iliyonse m'maselo a contour, mapiritsi 10 amaikidwa. Bokosi la makatoni limatha kukhala ndi matuza angapo. Ndikotheka kupaka mankhwalawo m'mapulasitiki ndi cholembera.

Mankhwala omwe mumalandira amamasulidwa. Mankhwalawa safuna mikhalidwe yapadera yosungirako (youma, yosafikika kwa ana ndi malo otentha a ultraviolet, kutentha kwa chipinda). Wopanga amasankha moyo wa alumali wa Glimecomb mpaka zaka 2. Mankhwala omalizira ayenera kutayidwa.

Momwe mungagwiritsire ntchito

Kwa mankhwala Glimecomb, malangizo ogwiritsira ntchito amalimbikitsa kumwa mankhwalawo ndi chakudya kapena pambuyo pake. Mlingo wake umasankhidwa ndi adotolo, kulingalira za kusanthula, mkhalidwe wa wodwalayo, kuopsa kwa matendawa, zovuta zina, momwe munthu amathandizira pakumwa mankhwalawo.

Malingaliro oyambira sapitilira piritsi limodzi kapena atatu patsiku ndi kumwa pang'onopang'ono mpaka mpaka mapiritsi 5 / tsiku. mpaka mutapeza zotsatira zabwino. Mlingo wa tsiku ndi tsiku nthawi zambiri umagawidwa mu 2 Mlingo - m'mawa ndi madzulo.

Kuthandiza ndi bongo

Kupezeka kwa metformin poyeserera ndi mlingo kungayambitse lactic acidosis, ndi kupezeka kwa gliclazide - ku hypoglycemia.

Ngati pali zizindikiro za lactic acidosis (chidwi, kupumira msanga, kusapeza tulo, kupweteka kwa minyewa, matenda osokoneza bongo), mankhwalawa amathetsedwa, ndipo wodwalayo amapititsidwa kuchipatala mwachangu, popeza wovutayo amatha kubwezeretsedwanso kuchipatala pogwiritsa ntchito hemodialysis.

Ngati matenda a hypoglycemic sakhala akulu, ndikokwanira kuwapatsa shuga kapena wowonjezera shuga. Ngati sakhudzidwa, mankhwala (40% yankho la shuga, glucagon, dextrose) amathandizidwa ndi jakisoni kapena dontho. Wodwalayo akachira, amapatsidwa chakudya chambiri chamafuta kuti asabwezeretsenso.

Malangizo apadera

M'masiku oyambilira, ndikofunikira kuwunika mwadongosolo kuchuluka kwa kusala kudya ndi postprandial (maola 2 mutatha kudya) shuga. Zotsatira zonse zoyezera ziyenera kulembedwa mu mbiri ya wodwala matenda ashuga.

Glimecomb ndi yoyenera kwa odwala matenda ashuga omwe amapatsidwa chakudya chokwanira. Ngati palibe chakudya chokwanira, wodwalayo samanyalanyaza chakudya cham'mawa kapena amatenga nawo mbali kwambiri pamasewera, chifukwa cha kupezeka kwa gliclazide, chitukuko cha zochitika za hypoglycemic ndizotheka. Hypoglycemia imakhumudwitsanso anthu ogwira ntchito molimbika pakudya zopanda pake, kumwa mowa mwauchidakwa, kumwa mankhwala ochepetsa shuga motsatana. Chifukwa chake, ndikofunikira kuti odwala matenda ashuga azitsatira malangizo onse azachipatala okhudzana ndi kuchuluka kwa mankhwalawa.

Ngati moyo wa wodwalayo wasintha (kuchuluka kwa nkhawa, kudya, kulimbitsa thupi), dokotala amatha kusintha njira zamankhwala ndikusintha mlingo wa mankhwala a hypoglycemic.

Chidwi chachikulu popereka mankhwala a Glimecomb ayenera kuperekedwa kwa anthu okalamba omwe ali ndi thanzi lathanzi komanso operewera kwa zakudya m'thupi, omwe akuvutika ndi pituitary-adrenal pathologies.

Zizindikiro zamankhwala za hypoglycemia yomwe ikubwera imatha kuphimba β-blockers, reserpine, clonidine, guanethidine.

Kuchiza ndi mankhwalawa kumafuna kuwunikira momwe impso zimayambira, popeza mankhwalawo amawapangitsanso mtolo wowonjezera. Mlingo wa lactate umayang'aniridwa kamodzi miyezi isanu ndi umodzi, komanso kupweteka kwa minofu.

Pa nthawi ya mankhwala a Glimecomb, ndikofunikira kusamala mukamayendetsa, kutalika, komanso kuchita zinthu zina zoopsa. Izi zikuthandizira kupewa zovuta kwambiri pakagwa mavuto.

Ndemanga za Odwala

Kupezeka kwake komanso kuthandizira kwa mankhwalawa ophatikizidwa kunamupatsa kutchuka koyenera: kuwunika kwa odwala matenda ashuga komanso madokotala amakonda kwambiri za mankhwala a Glimecomb.

Elizaveta Olegovna, wothandizira. Mukakalamba, kagayidwe kazakudya kamachepa kuti zinthu zavunda zisadziunjike mthupi, mankhwalawa ayenera kuikidwa mosamala. Mwamwayi, zovuta zazikulu atatha kulandira chithandizo ndi Glimecomb sizichitika kawirikawiri, ndiye ndimalimbikitsa kuti odwala anga "omwe ali ndi matenda ashuga" ayesere mankhwala osakanikirana. Zigawo zake payekhapayekha (metformin ndi gliclazide) ndizodziwika kale kwa ambiri, motero thupi limalandira mankhwalawo mwakachetechete. Ndikofunika kudziwa kuti kugwiritsa ntchito mankhwalawa mosavuta, monga zaka, ambiri amaiwala kumwa mankhwalawa panthawi.

Dmitry. Zowona zakuti zoyipa zimachitika sabata yoyamba ndizopanda tanthauzo: Ndakhala ndikumwa mwezi wa Glimecomb kwa mwezi tsopano, ndipo monga tsiku loyamba mutu wanga ukupweteka, ndimayamba kusanza, matumbo anga amagwira ntchito mosinthana. Kwa mapiritsi a Glimecomb, mtengo pa intaneti ndi wabwinobwino (ma 60 ma PC. - 450 ma ruble), mankhwalawa amathandiza, chifukwa chake ndimakumana ndi zovuta zonsezi. Koma mwina muyenera kufunsa dokotala - mwina mlingo kapena mankhwalawa asintha.

Ndingasinthe bwanji Glimecomb

Munthawi yogulitsa mankhwala, mapiritsi enieni adzafunika ndalama zokwana zana, ngati zingafunike, nthawi zonse mutha kusankha mayendedwe a Glimecomb.

• Gliformin - ma ruble 250. kwa ma PC 60., kagwiritsidwe kake ka mankhwala kofanana, koma kukhalapo kwa insulin sikokwanira kwa aliyense.
• Diabefarm - ma ruble 150. kwa ma 60 pcs., kuchuluka kwa gliclazide m'mapiritsi awa ndiokwera kwambiri (80 mg), koma kwakukulu kumathetsa mavuto omwewo ngati oyambirirawo.
• Gliclazide MV - ma ruble 200. kwa ma 60 pcs., glycazide mkati mwake muli 30 mg yokha, zisonyezo zogwiritsidwa ntchito ndizofanana.

Madotolo samatsutsa zoyambitsa za matenda okoma. Njira zosagwirizana ndi chithandizo cha matenda amtundu wa 2 omwe amaperekedwa ndi katswiri wazakudya komanso endocrinologist wa gulu lapamwamba kwambiri A. Nikitin pa kanema:

Zisonyezero zakudikirira

Sulfonylurea derivatives (PSM) ndi mitundu yodziwika bwino kwambiri yamankhwala 2 a odwala matenda ashuga pambuyo pa metformin. Kuphatikizidwa kwa PSM ndi metformin ndikofunikira kwa odwala omwe omwe kudya-carb ochepa, masewera, ndi metformin samapereka kuchepetsedwa kwa shuga.

Zinthu izi zimagwira pazolumikizira zazikulu za matenda amtundu wa 2 shuga: kukana kwambiri kwa insulini komanso kuchepa kwa insulin, chifukwa chake zimapereka zotsatira zabwino kuphatikiza. Glyclazide, yomwe ndi gawo la mankhwala Glimecomb, ndi PSM wa mibadwo iwiri ndipo imawerengedwa kuti ndi imodzi mwazinthu zotetezeka kwambiri mgulu lake.

Mapiritsi a Glimecomb angalembedwe:

1. Pamene chithandizo cham'mbuyomu chidasiya kupereka chindapusa chabwino cha matenda ashuga.
2. Atangozindikira matenda ashuga, ngati mulingo wa glycemia ndiwokwera kwambiri.
3. Ngati wodwalayo salola kuti metformin ikhale yayikulu.
4. Kuchepetsa kuchuluka kwa mapiritsi odwala omwe amatenga gliclazide ndi metformin.
5. Anthu odwala matenda ashuga omwe glibenclamide (Maninil ndi analogues) kapena kuphatikiza kwake ndi metformin (Glibomet ndi ena) amachititsa hypoglycemia wofatsa kapena wosasinthika.
6. Odwala omwe amalephera aimpso omwe glibenclamide amaletsedwa.
7. Ndi matenda a shuga ophatikizidwa ndi matenda a mtima. Gliclazide sanawonetsedwe kuti alibe vuto pa myocardium.

Malinga ndi kafukufuku, kale mwezi umodzi wochiritsira ndi Glimecomb, shuga yofulumira imachepa ndi pafupifupi 1.8 mmol / L. Pogwiritsa ntchito mankhwalawa, mphamvu zake zimakulirakulira, miyezi itatu itachepa kale 2.9.

Matenda a miyezi itatu amasinthidwe a shuga mu theka la odwala omwe ali ndi matenda osokoneza bongo a shuga, pomwe mankhwalawa sanali oposa mapiritsi 4 patsiku. Kulemera kwambiri komanso hypoglycemia, yofunikira kuchipatala, sinalembedwe ndi mankhwalawa.

Mukapanda kumwa Glimecomb:

• mtundu 1 shuga
• hypoglycemia. Mankhwala sangathe kuledzera mpaka shuga atayamba kuchita bwino,
• zovuta za matenda a shuga, matenda oopsa komanso kuvulala komwe kumafunikira mankhwala a insulin. Mlandu wa lactic acidosis m'mbuyomu,
• mimba, yoyamwitsa,
• X-ray yokhala ndi ma ayodini okhala ndi ayodini
• tsankho ku zilizonse za mankhwala.
• aimpso, kulephera kwa chiwindi, hypoxia, ndi matenda omwe angayambitse izi,
• uchidakwa, kumwa kwambiri kamodzi.

Odwala omwe ali ndi matenda a mahomoni, odwala matenda ashuga okalamba omwe amakhala ndi mphamvu yayitali yolimbitsa thupi, chiwopsezo cha zovuta zimawonjezeka, chifukwa chake akamamwa Glimecomb, ayenera kusamala makamaka ndi thanzi lawo.

Ulendo wakumbiri

Kuyesera kupulumutsa anthu ku "mliri wokoma" kunapangidwa m'zaka zapitazi.

Zowona, malingana ndi ziwerengero, ndiye kuti palibe anthu ambiri odwala matenda ashuga. Matendawa adayamba kufalikira mwachangu pomwe mashelufu am'masitolo athu atayamba kuchoka pazinthu zopanda pake, chifukwa Soviet GOSTs idathetsedwa, ndipo zinthu zatsopano zaukadaulo sizinalepheretse wopanga kuyesa pa thanzi lathu.

Kumvetsetsa kuti vuto lalikulu ndi matenda a shuga mellitus (DM) ndikuphwanya chakudya cha carbohydrate, asayansi adayesetsa kupanga mankhwala padziko lonse omwe amalepheretsa kugwiritsa ntchito zakudya zamagulu, zomwe zimapatsa munthu wamkulu theka la tsiku la zopatsa mphamvu.

Zachidziwikire, lero palibe amene wakwanitsa kukwaniritsa izi popanda chakudya chochepa cha carb, koma kukondoweza kowonjezereka kwamafuta ndi chakudya chamafuta sikungapweteke odwala matenda ashuga, makamaka popeza ochepa aiwo amatha kutsatira zomwe akatswiri a endocrinologist amafufuza.

Glucosidase inhibitors adawonetsa kale zotsatira zabwino polimbana ndi matenda ashuga. Ma enzyme amenewa amatha kuthana ndi shuga ku glucose, yemwe ndi wosavuta kugaya. Chifukwa chake, adawonjezedwa pamndandanda wamankhwala ochizira odwala matenda ashuga.

Pambuyo powerengera zakudya za tsiku ndi tsiku zosakhala ndi matenda ashuga:

• Monosaccharides (mu mawonekedwe a fructose ndi glucose) - 25 g,
• Disaccharides (sucrose) - 100g,
• Polysaccharides (monga wowuma) - 150g.

Titha kumvetsetsa kuti kutsekereza shuga owonjezera kumaperekedwa bwino gawo loyamba la kagayidwe, m'matumbo, kuchokera komwe adzatulukire momwe adalili kale.

Chifukwa chiyani chidwi chachikulu chimaperekedwa kwa wowuma? Gawo lachilengedwe la α-amylase lili ndi amylose ndi amylopectin, ndipo lingathe kuthyoledwa kuti litulutse matumba pogwiritsa ntchito malovu ndi kapamba, zomwe zimakhala ndi ma enzymes a α-amylase.

Ndizachidziwikire kuti kuchepa kwa ntchito ya kapamba ndi matumbo kumachepetsa chidwi chokwanira cha kuchuluka kwa mafuta omwe amalowa mthupi ndi chakudya. Zoletsa za michere ya saccharolytic, yomwe imapezeka m'mazomera ena (mwachitsanzo, mu stevia), sizikumba mosavuta ndipo sizimapereka zotsatira zoyipa.

Ma gawo ochepa a Microbial adapezeka kuti ndi othandiza, omwe ma inhibitors omwe ali ndi mawonekedwe osiyanasiyana azotsatira adapezeka: mapuloteni, aminosaccharides, oligosaccharides, glycopolypeptides. Olisaccharide wolonjeza kwambiri anali Acarbosum, yemwe amapangidwa kuchokera ku tizilombo tating'onoting'ono timene timabzala. Poletsa glucosidases ang'onoang'ono am'matumbo, amachepetsa kusintha kwa wowuma kukhala glucose.

Zotulutsa zina zimapangidwa chifukwa cha ascarbose, koma sizikhala ndi mphamvu zambiri.

Malangizo a kumwa Glimecomb

Kuphatikiza kwa PSM ndi metformin kumawonedwa ngati kwachikhalidwe. Ngakhale pakubwera othandizira atsopano a hypoglycemic, mabungwe apadziko lonse a shuga ndi Unduna wa Zaumoyo ku Russian Federation akupitilizabe kuphatikiza kuphatikiza uku monga kopatsa chidwi kwambiri.

Glyclazide yokhala ndi matenda a shuga a 2 amathandizira kupanga insulin yake, ndikuyamba kugwira ntchito gawo lake loyamba, pomwe shuga yangolowa kumene m'magazi. Kuchita izi kumakupatsani mwayi wochepetsera glycemia mukatha kudya, kutumiza glucose kuzinthu zotumphukira.

Glyclazide imalepheretsa kukhazikika kwa angiopathy: imalepheretsa thrombosis, imasintha kukoka kwam'mimba komanso mkhalidwe wamakoma amitsempha yamagazi. Zotsatira zabwino za gliclazide pamapeto a retinopathy ndi nephropathy zatsimikiziridwa.

Mapiritsi a Glimecomb kwenikweni samatsogolera ku insulin yochuluka m'magazi, chifukwa sayambitsa kulemera. Malangizowo adanenanso kuthekera kwa gliclazide kusintha kukhudzika kwa insulin, koma mwanjira iyi ali kutali ndi metformin, mtsogoleri wodziwika polimbana ndi insulin.

Metformin ndi mankhwala okhawo omwe amalimbikitsidwa kwa anthu amitundu mitundu iwiri ya matenda ashuga kupatula. Zimathandizira kusintha kwa glucose kuchokera m'mitsempha kupita m'magazi, kumalepheretsa kupanga kwa chiwindi ndi chiwindi, kuchedwa kuyamwa kwake m'matumbo.

Mankhwala amalimbana bwino ndi matenda a lipid metabolism, omwe amadziwika ndi mtundu 2 wamatendawa. Chifukwa cha ndemanga zambiri za odwala matenda ashuga, metformin imagwiritsidwa ntchito kuchepa thupi. Sichimayambitsa hypoglycemia, akagwiritsidwa ntchito molingana ndi malangizo amakhala otetezeka kwathunthu.

Maola 2 mutayikidwa pamimba yopanda kanthu

Maola 2,5 ngati mumwa mankhwalawo nthawi yomweyo ndi chakudya, monga malangizo amalangizira.

Kupititsa patsogolo kulekerera kwa metformin ndikutchingira dontho lakuthwa la shuga, mapiritsi a Glimecomb amamwa nthawi yomweyo ndi chakudya kapena atangochita. Chakudya chizikhala chabwino komanso chizikhala ndi chakudya, makamaka chovuta kugaya.

Poyerekeza ndi ndemanga, mpaka 15% ya anthu odwala matenda ashuga amakhulupirira kuti kumwa Glimecomb ndi mankhwala ena ochepetsa shuga kumatha kufunika kotsatira zakudya. Zotsatira zake, amamwa kuchuluka kwa mankhwalawa, omwe amawonjezera zovuta zake komanso mtengo wa chithandizo, akudandaula za shuga yayikulu, komanso m'mbuyomu amakumana ndi zovuta za matenda ashuga.

Tsopano palibe piritsi limodzi la shuga lomwe lingalowe m'malo mwa zakudya. Ndi nthenda yachiwiri ya 2, zakudya zimawonetsedwa popanda chakudya chambiri, zoletsa pang'ono pang'onopang'ono, ndipo nthawi zambiri zimakhala ndi zopatsa mphamvu za calorie - chakudya cha matenda a shuga a 2. Ndondomeko ya chithandizo imaphatikizira kukula kwa kulemera ndi kuchuluka kwa ntchito.

Kuonetsetsa kuti yunifolomu ya Glimecomb masana, mlingo womwe wapatsidwa umagawidwa pawiri - Mlingo ndi madzulo. Malinga ndi ndemanga, zotsatira zabwino kwambiri za chithandizo zimawonedwa mwa odwala omwe amamwa mankhwalawa katatu (mutatha kudya chilichonse), ngakhale kuti malangizo omwe angagwiritsidwe ntchito samapereka mwanjira imeneyi.

Mphamvu ya glimecomb imatha kulimbikitsidwa kapena kufooka mukamamwa mankhwala ena. Mndandanda wamachitidwe ogwiritsira ntchito mankhwalawa ndiwambiri, koma nthawi zambiri kusintha kwa magwiridwe antchito sikofunikira kwambiri ndipo kungasinthidwe mosavuta posintha mlingo.

Kuthekera kwama pharmacological

Mankhwala ofanana ndi Ascarbose:

• Chepetsani kuyamwa kwa matumbo m'matumbo,
• Kuchepetsa matenda a m'mimba (mutatha kudya, "prandial" - "nkhomaliro") glycemia,
• Pewani hypoglycemia,
• Pewani kuthekera kwa kuchuluka kwa insulini.

Mukamadya zakudya zokhala ndi chakudya chamagulu ambiri, vuto la asogbose limadziwika kwambiri.

The inhibitor amathandiza kulimbana ndi kunenepa kwambiri, kutsika kudya ndi caloric kudya zakudya za tsiku ndi tsiku, komanso amachepetsa mawonekedwe a visceral mafuta.

Zowonjezera zamafuta, mafuta am'makolo ambiri amachepetsa mphamvu ya acarbose, chifukwa mphamvu yake imakhala ndi kuphatikiza chakudya, m'malo mwa metabolidi ya lipid.

Chifukwa cha mawonekedwe ake a zamankhwala, inhibitor imamanga ma enzymes am'mimba, kuti isawononge kutsekeka kwa mafuta osokoneza bongo omwe amakhala mosavuta m'matumbo.

Acarbose pogwiritsa ntchito makina ochitapo kanthu akufanana ndi mphamvu ya CHIKWANGWANI, ulusi wopota womwe umapangika, osapezeka kuti ugaye ndi ma enzyme. Kusiyanako ndikuti mankhwalawo amalepheretsa mphamvu za ma enzyes omwe.

Monga kusazindikira kwa maselo, chakudya chamafuta chimakhala "chosatheka" kwa madzi a m'mimba ndikutuluka osasinthika, ndikuchulukitsa ndowe. Kuchokera pamenepa izi zimapangitsa kuti mphamvu ya inhibitor ikhoza kupitilizidwa ngati zinthu zopangidwa ndi ulusi wa coarse zimagwiritsidwa ntchito limodzi. Njira imeneyi imathandiza kwambiri kuchepetsa kunenepa.

Ngakhale chimalepheretsa katundu wake, inhibitor sikuti imaphwanya magwiridwe antchito am'mimba, chifukwa sizikhudza mwachindunji ntchito ya amylo-, proteino- ndi lipolytic ya timinyemba.

Mphamvu ya mankhwalawa imatanthauzanso ndi mlingo: ndi kuchuluka kwa chizolowezi, zizindikiro za hypoglycemic ndizambiri.

Anthu odwala matenda ashuga omwe atenga acarbose ndi zotumphukira zake awonetsa zotsatira zabwino pama paramu ena ofunika:

• Kutsika kwa triglycerol ndi cholesterol m'mwazi,
• Kuchepa kwa lipoprotein lipase ndende mu adipose zimakhala.

Acarbose imalembedwanso mtundu woyamba wa matenda ashuga, popeza kugwiritsidwa ntchito kwake kumachepetsa kuchuluka kwa insulin yokwanira theka.

Mankhwalawa amathandizanso kuti glycemia ikhale yachilendo, koma zakudya zake zimayenera kusinthidwa, chifukwa kuchepa kwa chakudya m'thupi kumakhala koopsa ngati owonjezera.

Ngakhale muzochitika zapamwamba, ndi shuga wowola, pamene insulini imalipira shuga, pambuyo pa maphunziro amodzi a acarbose, odwala matenda ashuga adawona kuchepa kwa glucosuria (kukhalapo kwa glucose mkodzo).

Zimawonjezera kulolerana kwa mankhwalawa ndi glucose, koma sikuti m'malo mwa 100% mankhwala oyamba ochizira matenda a shuga. Amawerengedwa kuti ndiwonjezeranso ngati mankhwala. Mwachitsanzo, acarbose idzakulitsa mphamvu ya sulfonylurea.

Mankhwalawa amasonyezedwanso kwa odwala omwe alibe matendawa omwe sangathe kulekerera insulin.

Ndikofunikira kuti mtundu wamtunduwu wa inhibitor ulibe carcinogenic, embryotoxic ndi mutagenic.

Mankhwalawa satenga pakatumbo, mabakiteriya ndi ma enzyme amathandizira kupanga mitundu 13 ya zinthu. Acarbose wosagwiritsidwa ntchito amasulidwa kudzera m'matumbo mu maola 96.

Glimecomb wa mankhwala ali ndi mwayi umodzi - 40 500, piritsi 40 mg la glycazide, 500 mg ya metformin. Kuti mupeze theka la theka, piritsi likhoza kugawidwa, pali chiwopsezo.

Ngati munthu wodwala matenda ashuga sanalandire metformin kale, piritsi limodzi limayesedwa ngati mankhwala oyambira. Masabata awiri otsatira ndikosayenera kuichulukitsa, kotero mutha kuchepetsa chiwopsezo cha kusapeza bwino m'mimba.

Odwala omwe amadziwa metformin ndipo amalekerera bwino amatha kutumizidwa mapiritsi atatu a Glimecomb. Mlingo wofunikira umatsimikiziridwa ndi dokotala, poganizira kuchuluka kwa glycemia wodwala komanso mankhwala ena omwe amamwa.

Ngati mlingo woyambira simupereka zotsatira zomwe zimafunikira, zimachulukana pang'onopang'ono. Pofuna kupewa hypoglycemia, nthawi yayitali yosintha pakati pa sabata iyenera kukhala sabata limodzi. Kutalika kololedwa ndi mapiritsi 5.

Ngati wodwala amakhala ndi insulin yambiri, Glimecomb mu shuga amatha kumwa ndi metformin. Chiwerengero cha mapiritsi pamenepa amawerengedwa kuti kuchuluka kwa metformin sikupitirira 3000 mg.

Kwa amene acarbose akuwonetsedwa ndikutsutsana

Anhibitor amalembera:

• Type 2 shuga
• Carbohydrate kagayidwe
• Matenda a metabolism,
• Matenda a shuga
• Kunenepa kwambiri
• Kuperewera kwa shuga.
• Kuphwanya kosala kwa glycemia,
• Lactate ndi matenda ashuga acidosis,
• Mtundu woyamba wa shuga.

Kugwiritsa ntchito acarbose kumapangidwa mu:

• Matenda a chiwindi,
• Ketoacidosis,
• Kutupa ndi zilonda zam'mimba,
• Zilcerative colitis
• Kutsekeka kwamkati,
• Matenda a shuga,
• Mimba, kuyamwa,
• Zaka za ana.

Mosamala, acarbose ndi zotumphukira zake zimayikidwa pambuyo povulala, munthawi ya matenda opatsirana, popeza thupi lofooka silikhala ndi mphamvu zokwanira kuti libwerenso. Ndi kuchepa kwa shuga kapena kutsekereza kwake, hypoglycemia kapena acetonemic syndrome ndizotheka.

Zotsatira zoyipa ndizotheka:

• Kusuntha kwamatumbo
• Matenda a Dyspeptic
• Kuchulukitsa kwa kuchuluka kwa ma transaminase,
• Hematocrit kuchepetsa
• Kuchepetsa mavitamini ndi calcium m'magazi,
• Kutupa, kuyabwa, matupi awo sagwirizana.

Kusokonezeka kwa Stool, kupweteka kwam'mimba komanso mavuto ena m'mimba ndi matumbo kumatha kuchitika chifukwa chakuti kuchepa pang'ono kwa mayamwidwe amkati kumapangitsa kuti ena a iwo amadziunjikira m'matumbo amimba ndipo amakhala nthawi yayitali asanalowe m'matumbo akulu.

Zofananazo zimawonedwa pakupanga champagne, pamene mabakiteriya omwe amadalira mafuta ochulukitsa amachepetsa shuga, kusiya zotsatira za moyo wawo wobisika. Mwina, poganiza za chithunzichi, ambiri atasiya mowa.

Mutha kusintha mphepo yamkuntho m'matumbo ndi metronidazole, yomwe adotolo amati imayenderana ndi acarbose. Yoyambitsa kaboni ndi ma ufiti ena omwe amachepetsa matumbo a microclora ali ndi vuto lofananalo.

Kuchepetsa mphamvu ya acarbose munthawi yomweyo:

• Zodzikongoletsera
• Corticosteroids

• Estrogen
• Mankhwala a mahomoni a chithokomiro
• Kulera kwamlomo
• Otsutsa a calcium
• Phenothiazines ndi mankhwala ena.

Mankhwala othandizira pakachitidwe

Kuwerenga pafupipafupi pamtunda wa 130/80 mm Hg. Art. chifukwa odwala matenda ashuga ali ndi zovuta za michere, kukula kwa atherosulinosis, kupitilira kwa matenda a shuga angiopathies. Pankhaniyi, kugwiritsa ntchito mankhwala osokoneza bongo nthawi zonse kumalimbikitsidwa, pomwe nthawi yomweyo kumatsata zakudya zamchere komanso zopatsa mphamvu.

ACE zoletsa

Pakukhazikika pang'onopang'ono kwa mawonekedwe a matenda oopsa, ma blocker a angiotensin (ACE) amagwiritsidwa ntchito, omwe amathandizira kapangidwe ka angiotensin. Pochepetsa kuchuluka kwa angiotensin, tiziwalo timene timatulutsa adrenal timatulutsa aldosterone yochepa, yomwe imasunga sodium ndi madzi mthupi.

Zinthu zogwira zomwe zimatchinga ACE:

• Enalapril
• Perindopril,
• Quinapril,
• Fosinopril
• Kalamazoo,
• Ramipril.

Amadziwika ndi nephroprotective kanthu (pang'onopang'ono njira ya pathological), osaphwanya kagayidwe kazakudya zam'mimba, lipids, minofu insulin.

Zoyipa za zoletsa ndizoleza kuzengereza kwa potaziyamu ndikuwachedwa kugwira ntchito. Zotsatira zakugwiritsidwazo siziwunikiridwa pasanathe milungu iwiri atasankhidwa.

Amaletsa kaphatikizidwe ka renin, kamene kamapangitsa kusintha kwa angiotensin, komwe kumayambitsa kuchepa kwa makoma amitsempha yamagazi. Ma ARB amadziwika ngati tsankho kwa ACE inhibitors likhazikitsidwa. Makina awo amomwe amapangira zamankhwala amodzi ndizosiyana, koma cholinga ndi chimodzimodzi - kuchepetsa zotsatira za angiotensin ndi aldosterone.

Gululi limatchedwa sartani kumapeto kwa mayina a zinthu zomwe zimagwira ntchito:

Ma diuretics amakhala ndi hypotonic yofatsa, imayikidwa limodzi ndi mankhwalawa pogwiritsa ntchito mapiritsi ena a matenda oopsa mu shuga mellitus.

1. Ma loop diuretics (furosemide, lax) amaphatikiza bwino ndi zoletsa za ACE, sizimakhudza kuchuluka kwa shuga, lipids, ndipo ndi oyenera kuti pakanthawi kochepa ayendetse kufafaniza thukuta lalikulu. Kugwiritsidwa ntchito kosalamulirika kumayambitsa kuthamangitsidwa kwa potaziyamu, komwe kungapangitse kuwonjezeka kwa hypokalemia ndi mtima arrhythmia.
2. Chifukwa cha kufatsa kwambiri kwa okodzetsa, thiazide-diuretics (indapamide) sikukhumudwitsa kuchuluka kwa glucose, acid acid, potaziyamu, ndipo sikukhudza magwiridwe antchito a impso.
3. Thiazide diuretics (hypothiazide) Mlingo watsiku ndi tsiku woposa 50 mg amatha kuwonjezera shuga ndi cholesterol. Mankhwala amawayang'anira mosamala mulingo wocheperako chifukwa chakuchepa kwa impso kulephera komanso gout.
4. Zinthu zoteteza potaziyamu (veroshpiron) sizikulimbikitsidwa kuti mugwiritse ntchito mtundu wa shuga wachiwiri, limodzi ndi vuto laimpso.

Beta blockers

Mankhwala angapo omwe amaletsa kukondoweza kwa adrenoreceptors ndi adrenaline ndi norepinephrine amawerengedwa makamaka pochizira ischemia, mtima, kulephera kwa mtima. Ndi hyperglycemia, mapiritsi a matenda oopsa amasankhidwa ndi zina zowonjezera vasodilating:

Kuchita kwa B-blockers kungatulutse vuto lomwe limaphimba mawonetseredwe a glycemia, kotero amayikidwa mosamala, kuwongolera kuchuluka kwa shuga.

Otsutsa a calcium

Calcium calcium blockers - gulu la mankhwala omwe amachepetsa kuchuluka kwa calcium ion. Pumulani ndikukula makoma amitsempha yamagazi, mitsempha, maselo osalala. Magulu omwe agawidwa m'magulu:

1. Verapamil, diltiazem. Kukhudza ntchito ya myocardium ndi maselo amtima, chepetsani kugunda kwa mtima. Kugwiritsa ntchito pamodzi ndi beta-blockers kumatsutsana.
2. Amachokera ku dihydropyridine - nifedipine, verapamil, nimodipine, amlodipine. Amatsitsimula makoma a minofu yosalala, kumawonjezera kugunda kwa mtima.

Ma calcium antagonists samasokoneza chakudya chamafuta, lipid metabolism. Mukagwiritsidwa ntchito ngati mankhwala opondera, mtundu wachiwiri wa matenda ashuga ndiwabwino, koma uli ndi zotsutsana zingapo. Nifedipine imatsutsana mu angina pectoris, kulephera kwa mtima ndi impso, koyenera kupumula kumodzi.

Malinga ndi malangizo, mlingo umatsimikiziridwa malinga ndi kulemera kwa wodwalayo. Ngati, mwachitsanzo, munthu wamkulu wodwala matenda ashuga ali ndi kulemera kwa 60 makilogalamu, mlingo wa 25-50 mg ndi wokwanira kwa iye, ndi mawonekedwe akulu, 100 mg 3 r / tsiku limayikidwa.

Imwani mankhwala musanadye kapena nthawi yomweyo. Amatsukidwa ndimadzimadzi aliwonse, ngati akakhala kuti alibe chakudya chamafuta, ma acarbose sangatenge.

Ngati thupi siligwirizana bwino ndi mlingo wosankhidwa, mutha kuwonjezereka mpaka 600 mg / tsiku. komanso kukwera kwambiri ngati thanzi limalola.

Sitikulimbikitsidwa kuyesa kuchuluka kwa odwala omwe ali ndi zaka zoyambira (kuyambira zaka 65) ndi odwala omwe ali ndi vuto la chiwindi.

Zotsatira zoyipa

Zotsatira zoyipa zambiri zimatha kufooka ngati mutsatira malamulo oti mutenge ndikuwonjezera mlingo kuchokera pamalangizo. Kuletsa kwa Glimecomb chifukwa cha tsankho sikufunika kwenikweni.

Zofananira

Glimecomb alibe ma analoge athunthu olembedwa mu Russian Federation. Ngati mankhwalawo mulibe mankhwala, mankhwala awiri omwe ali ndi zinthu zomwezo angathe kusintha:

1. Metformin ili mu Glucofage yoyambilira yopangidwa ku France, Siofor yaku Germany, Metformin yaku Russia, Merifatin, Glformin. Onse ali ndi mlingo wa 500 mg. Kwa odwala matenda ashuga osalekerera bwino a metformin, mawonekedwe osinthika a mankhwalawa ndi abwino, omwe amatsimikizira kuti kulowa kwa zinthu zomwe zili m'magazi ndikuchepetsa kwambiri mavuto. Awa ndi mankhwala Metformin Long Canon, Metformin MV, Formin Long ndi ena.
2. Gliclazide ndiyotchuka kwambiri pa hypoglycemic. Katunduyu ndi gawo la Russian Glidiab ndi Diabefarm. Gliclazide yosinthidwa pano amawona ngati mawonekedwe omwe amakonda. Kugwiritsidwa ntchito kwake kumachepetsa kuchepa komanso kuopsa kwa hypoglycemia. Gliclazide yosinthidwa imakhala mu kukonzekera Diabefarm MV, Diabeteson MV, Gliclazide MV, Diabetalong, etc. Mukamagula, muyenera kuyang'anira chidwi ndi mankhwalawa, mungafunike kugawa piritsi pakati.

Pali mitundu yambiri ya magulu a Glimecomb pamsika waku Russia. Ambiri a iwo ndi ophatikiza a metformin okhala ndi glibenclamide. Mankhwalawa sakhala otetezeka kuposa glimecomb, chifukwa nthawi zambiri amayambitsa hypoglycemia. M'malo abwino a Glimecomb ndi Amaryl (metformin glimepiride). Pakadali pano, ndiwotsogola kwambiri wamagulu awiri ndi PSM.

Mndandanda wotchuka kwambiri wa acarbose ndi Glucobay. Hypoglycemic wothandizira amapangidwa ku Germany. Kutulutsa mawonekedwe - mapiritsi olemera 50-100 mg, phukusi lililonse lili ndi 30 mpaka 100 zidutswa.

Kuphatikiza pa mankhwala oyamba ku China ndi ku Europe, mutha kugula generic yokhala ndi dzina lodziwika bwino Glucobay, ku USA ndi England - Precose, ku Canada - Prandase. Kwa odwala matenda ashuga okhala ndi zakudya zakum'mawa, mankhwalawa ndi othandizika, ndipo amatchuka kwambiri ku China, ku USA - m'malo mwake, kugwiritsidwa ntchito kwake kumakhala kochepa chifukwa cha kutsegula m'mimba komanso kuphwanya thupi.

Ndemanga za Matenda a shuga

Za mankhwala omwe ali ndi acarbose Glucobay, ndemanga yochepetsera thupi ndi yam'magulu. Mankhwalawa sanapangidwe kuti achepetse thupi, amalembedwa kwa odwala matenda ashuga, nthawi zambiri amtundu wa 2.

Lazurenko Natalia "Sindikulemba za kugwiritsa ntchito mankhwalawa pamwezi ndi acarbose Glucobay. Yoyambitsidwa ndi 50 mg pa mlingo, malinga ndi malangizo omwe amabwera kwa 100 mg. Pa nkhomaliro, ndimatenga 5 mg ya Novonorm.

Tsopano ndinatha kudya shuga ndikatha kudya. Ngati asanadye zochepa kuposa 10, ndiye kuti tsopano ndi 6.5-7 mmol / l. Pofuna kuyesera, ndinadya makeke atatu a nkhomaliro (sayansi siyichita popanda kudzipereka) - Zizindikiro za glucometer ndizabwinobwino.

Vinnik Vlad "Mtengo wa blocker ndi acarbose Glucobai ku Ukraine ndi $ 25, ku Kyrgyzstan - $ 8, ku Russia - mankhwala otsika mtengo kwambiri - kuchokera ku ruble 540. Mosakayikira sachiritsa matenda ashuga, koma amandiwonetsa pamabudula ake.

Popeza ambiri aife timalandira mphamvu zamafuta owonjezera, mankhwala ovomerezeka amathandizadi odwala matenda ashuga komanso iwo omwe amachepetsa thupi kudya ndipo samakhala ndi zotsatirapo zoyipa monga ma analogues, chifukwa amatha kuthandizidwa pamaso pa chidutswa cha keke kapena mayeso ena.

Glimecomb nthawi zambiri amakhutira ndi mankhwalawa. Kumwa piritsi limodzi ndikosavuta kuposa mankhwala awiri. Anandipulumutsa m'masamba atatha chakudya chomwe chinayamba

. Ndizomvetsa chisoni kuti mumzinda wathu kupezeka kwa Glimecomb sikunakhazikitsidwe, nthawi zambiri amasiya kupatsidwa kwaulere. Nthawi imodzi komanso ndalama zomwe sindinathe kupeza, ndinkagula Metformin ndi Diabefarm. Zikuwoneka kuti zigawozo ndizofanana, ndipo mulingo womwewo ndi wofanana, ndipo shuga pamene adatengedwa idakwera pang'ono kuposa ku Glimecomb.

Glimecomb ndi ine sitinachite bwino. Kuyamba chithandizo ndi piritsi limodzi, monga momwe adalembera malangizo ogwiritsira ntchito, kwa ine ndizosatheka, chifukwa shuga imanyalanyazidwa. Zotsatira zake, zoyipa sizimachoka, ngakhale ndimamwa mankhwalawo sabata lachitatu.

Izi zimatembenuza m'mimba, kenako kutsekula m'mimba, ndipo zimachitika tsiku lililonse. Mlingo wambiri wa Glimecomb sikokwanira kuti shuga azitha kutulutsa matenda. Zotsatira zake, adamwetsa zakudya zowonjezera ndikusainira adokotala kuti alandire mankhwalawo ndi wina wowopsa.

Sindinakumane ndi zovuta zilizonse, chifukwa chake mankhwalawo anali abwino. Mapiritsi awiri a glimecomb akwanira kwa ine, ndimamwa m'mawa ndikudya chamadzulo. Zimachitika kuti shuga ndizochepa pang'ono, koma palibe zizindikiro, kotero sindimvera.