Chithandizo cha matenda a 2 a shuga mellitus mankhwala aluso poika

Ndi zaka, ntchito ya kapamba wamunthu imakulirakulira ndipo mitundu ya kagayidwe ka mankhwala imachepa, zomwe nthawi zambiri zimayambitsa kukula kwa matenda a shuga mwa okalamba. Chithandizo cha matendawa chimafunikira njira yapadera, popeza muukalamba odwala amatha kudwala matenda osiyanasiyana, omwe ndi kuphwanya kwa kumwa mankhwala ambiri a shuga.

Chifukwa chake, odwala onse enieni komanso abale awo ayenera kudziwa mtundu wa mapiritsi 2 a shuga mwa odwala okalamba omwe amagwiritsidwa ntchito ngati mankhwala amakono, momwe angatenge ndikusakaniza molondola. Kuthandizira odwala matenda ashuga okalamba, ochitidwa mogwirizana ndi malamulo onse, kumatha kuwonjezera moyo wa munthu wachikulire ndikupanga kukhala lokwanira.

Zoyambitsa matenda ashuga okalamba

Pakatha zaka 50, munthu amakhala ndi kuchepa kowoneka bwino kwa kulolera kwa shuga, zomwe zimapangitsa kuti shuga azikhala pang'ono pang'onopang'ono. Chifukwa chake pofika zaka 60, kuchuluka kwa glucose pamimba yopanda kanthu kumakwera pa 0,55 mmol / L, ndikatha kudya 0,5 mmol / L.

Izi zikuchitika mtsogolo ndipo zaka 10 zilizonse zikubwerazi, kuchuluka kwa shuga kwa munthu wachikulire kumachulukirachulukira. Kuphatikiza apo, ndikofunikira kutsimikizira kuti izi ndizowerengeka ndipo mwa anthu ena omwe ali ndi zaka, kuchuluka kwa glucose kumatha kuwonjezeka pamlingo wokwera.

Pali zinthu zitatu zazikuluzikulu zomwe zingayambitse matenda ashuga a mtundu wa 2 mwa anthu okulirapo zaka 50. Ngakhale kukhalapo kwa m'modzi wa iwo kumachulukitsa chiopsezo chotenga matendawa, ndipo kupezeka kwa atatu mwa milandu 95 pa 100 kumapangitsa kuti adziwe matenda a shuga.

Chifukwa chiyani matenda ashuga amakalamba?

1. Kuchepa kwa chidwi chamkati mwamtundu wa insulin (kukana kwa insulin) komwe kumachitika chifukwa cha kusintha kwa thupi.
2. Kuchepetsa kutulutsa kwa insulin ndi ma pancreatic β-cell,
3. Kuchepa kwa mahomoni a insretin ndi kuchepa mphamvu kwa thupi kwa okalamba.

Kukana insulini nthawi zambiri kumapezeka mwa anthu okalamba, koma nthawi zambiri amakhudza amuna ndi akazi achikulire omwe ali onenepa kwambiri. Ngati zizindikiro zoyambirira za kusagwirizana kwa insulini mpaka insulin sizitenga zoyenera, ndiye kuti kuphwanya kumeneku kungayambitse kukula kwa matenda osokoneza bongo.

Mwa anthu onenepa kwambiri, chinthu chachikulu chomwe chikukulimbikitsani kukula kwa matenda a shuga ndi kuchepa kwa kupanga kwa insulin. Mu odwala oterowo, mutatha kudya, kapamba samayamba kupanga insulin mwachangu, monga zimachitikira mwa anthu athanzi, zomwe zimapangitsa kuchuluka kwa shuga m'magazi.

Ma insretins ndi mahomoni opangidwa ndi m'mimba thirakiti pakudya ndipo amathandizira kupanga insulin. Ndi wopanda mahomoni ofunikira kapena kuchepa kwa chidwi cha minyewa kwa iwo, wodwalayo amasungidwa insulin pafupifupi 50% kuposa anthu omwe ali ndi chakudya chamagulu olimba.

Koma zinthu zonsezi zomwe zimayambitsa matenda ashuga, monga lamulo, ndizotsatira zamakhalidwe osayenera.

Kukana zizolowezi zoipa, kutsatira kadyedwe komanso kuchita masewera olimbitsa thupi nthawi zambiri kumachepetsa kuopsa kwa kagayidwe kazakudya, motero kuwoneka kwa matenda a shuga a 2.

Mankhwala osokoneza bongo a magulu akuluakulu a shuga

Kutengera mtundu wa shuga omwe mukudwala, dokotala wanu akupatsirani mankhwala oti muthandizire. Matenda a shuga amtundu wa 1 amathandizidwa nthawi zonse ndi insulin, chifukwa mitundu ina ya matenda osiyanasiyana a shuga imakhala yayikulu kwambiri. Kukula kwa matendawo kumathandizanso.

Mankhwala osokoneza bongo a shuga

mitunduFomu ya mankhwala Biguanides (metformin)Metformax
Siofor
Avamina
Glucophage
ZachikaleindeMapiritsi / makapisozi sulfonylureasDiaplel MR, Gliclada, Diagen, Amaryl, Glibetic, Simglik, Glibenseindemapiritsi glinidsPrandin, Enyglid, Starlixindemapiritsi Pangamira (glitazones)Bioton, Pioglitazoneindemapiritsi DPP-4 zoletsa (glyphins)Januvia, Ristaben, Galvus, Onglisa, Trazhentaindemapiritsi Kukonzekera kwa Incretin (GLP-1 analogues)Bayetta, Bidureron, Victoza, Lixunia, Eperzanindejakisoni SGLT-2 Inhibitors (Glyphosin)Dapagliflozin, Kanagliflozin, Empagliflosinindejakisoni insulinindeindeMatenda a shuga a Gestational, LADA ndi mitundu inajakisoni acarboseAdex, GlucobayindeType 2 shuga,

lembani matenda ashuga 1 omwe ali ndi insulinmapiritsi

Zotsatira zoyipa za odwala matenda ashuga

Zotsatira zoyipa ndi zizindikiro kapena matenda omwe amayamba chifukwa chmamwa mankhwala. Mankhwala onse ali ndi zovuta, komanso mankhwala osokoneza bongo, tsoka, ndi osiyana. Musanayambe kumwa mankhwala a shuga, lingalirani za zoyipa zawo. Dokotala wanu, popereka mankhwala anu a shuga, akuyenera kukambirana nanu za zotsatira zoyipa ndikukulangizani momwe mungapewere.

Kukula komwe mukakumana ndi zovuta ndi funso laumwini - akhoza kukhala ofatsa kapena otchulidwa. Nthawi zina zovuta zimakhala zowopsa, zomwe zimatha kukhala chiwopsezo mwa izo zokha. Komabe, izi ndi zochitika zosowa kwambiri.

Chithandizo cha matenda a 2 a matenda a shuga a mellitus

Ngati mukumva kusowa chifukwa ch kumwa mankhwala aliwonse a shuga, dziwitsani wopereka chithandizo chaumoyo.

Mankhwala ena othandizira odwala matenda ashuga, makamaka omwe amagwiritsidwa ntchito pochiza matenda amtundu wa 2, amatha kubweretsa m'mimba, koma amapita pakatha milungu iwiri kapena itatu.

Hypoglycemia

Cholinga chachikulu cha mankhwala othandizira odwala matenda ashuga ndikuchepetsa shuga. Komabe, mankhwala ena amatha kutsitsa shuga m'magazi mpaka kukhala owopsa, ndikupangitsa hypoglycemia.

Mankhwala omwe amachititsa shuga wochepa (hypoglycemia):

• insulin
• zochokera sulfonylurea,
• zadothi.

Ngati mukumwa mankhwalawa, nthawi zonse khalani ndi shuga.

Dziwani zambiri za hypoglycemia, zizindikiro za hypoglycemic komanso momwe mungachitire hypoglycemia: Hypoglycemia, ndichani ndipo ndichifukwa chiyani kuukira kuli koopsa kwa odwala matenda ashuga

Contraindication

Contraindication kumwa mankhwala zikutanthauza kuti nthawi zina sitiyenera kumwa mankhwala - mwachitsanzo, matenda ena kapena kutenga pakati. Mlandu wamba ndi chenjezo kuti muyenera kusamala mwapadera, mwachitsanzo, popewa kumwa mowa kapena kuyendetsa galimoto.

Nthawi zina mitundu iwiri ya mankhwala singaphatikizidwe. Ichi ndichifukwa chake dokotala ayenera kudziwa mbiri yonse ya matenda anu musanapange mankhwala atsopano. Ngati mukuganiza kuti malangizo a mankhwalawa, pali ma contraindication omwe mumawopa, musaiwale kuuza dokotala za izi.

Chithandizo cha matenda a shuga a mtundu wachiwiri masiku ano

Pakadali pano, mankhwala ochokera m'magulu asanu ndi limodzi amagwiritsidwa ntchito pochiza matenda ashuga.

Metformin imapezeka pansi pa mayina ambiri opanga osiyanasiyana opanga osiyanasiyana.

• Metformin imathandizira kagayidwe kazakudya mwa kuletsa kupanga kwa shuga m'chiwindi ndikuwonjezera chidwi cha zotumphukira kuti insulin (kuchepa kwa insulin kukaniza).
• Metformin imachepetsa thupi, imasintha kagayidwe ka lipid m'magazi ndipo imateteza mtima (mtima).
• Metformin imagwiritsidwa ntchito pochiza matenda a shuga a mtundu wachiwiri ngati monotherapy kapena kuphatikiza mankhwala ena opatsirana kapena / insulin, komanso itha kugwiritsidwa ntchito pochiza matenda osokoneza bongo a prediabetes.

Momwe mungatengere metformin molondola

Metformin iyenera kuyamba ndi milingo yaying'ono kuti muchepetse zotsatira zoyipa, makamaka pamimba, monga mseru, kupweteka m'mimba, gasi, kutsegula m'mimba, ndi kakomedwe kazitsulo.

Ngati zizindikirozi zikuchitika, mlingo umatha kuchepetsedwa kapena kusinthidwa ndi wopanga wina. Mankhwalawa ali ndi zotsatira zabwino thupi ndipo sangathe kutayidwa pazifukwa zazing'ono.

Momwe mungagwiritsire metformin yamatenda a 2 shuga

Metformin ndiyotetezeka kwambiri, siyambitsa hypoglycemia, chifukwa sichulukitsa katulutsidwe ka insulin ndi kapamba.

• Kumbukirani kuti metformin imayendetsa kagayidwe kazigawo m'thupi, ndipo mphamvu zake zonse m'magazi a glucose zimachitika pakatha masabata pafupifupi awiri.
• Osamamwa piritsi la metformin posokoneza, ndiye kuti, pamene kuchuluka kwa shuga m'magazi kuli kwakukulu, mumamwa mapiritsi ndikuyembekeza kuti matendawa amatha msanga - metformin sikugwira ntchito mwachangu.

Metformin zotsutsana ndi zoyipa

Zoyipa zomwe zimagwiritsidwa ntchito ngati metformin ndi:

• kupweteka kwambiri kwaimpso kapena chiwindi,
• kudalira kwa mowa
• kulephera kwamtima kwambiri
• matenda oopsa a pulmonary matenda a COPD),
• kugona apnea syndrome.

Sulfonylurea mankhwala limagwirira ntchito

• Sulfonylureas amachepetsa glycemia pakukulitsa kapangidwe ka insulin, kamene kamakhudzanso kagayidwe ka glucose mu ziwalo zosiyanasiyana. Amagwiritsidwa ntchito ngati mapiritsi.
• Amathandiza kwambiri kutsitsa shuga, koma amatha kuyambitsa hypoglycemia. Amayenera kumwedwa m'mawa asanadye chakudya cham'mawa. Dokotala amasankha mankhwalawo ndikudziwitsa mtundu wake.

Momwe angatenge

Sulfonylureas ikhoza kugwiritsidwa ntchito yokha kapena kuphatikiza ndi metformin ndi othandizira ena odwala matenda ashuga.

Zoyipa zomwe zimagwiritsidwa ntchito ndi:

• zazikulu zosavomerezeka za sulfonylurea ndi hypoglycemia komanso zingayambitse kulemera,
• kulephera kwambiri kwa chiwindi.

Acarbose ndi mankhwala othandizira odwala matenda a shuga monga mapiritsi, kuletsa kuyamwa kwa shuga m'matumbo am'mimba ndipo potero amachepetsa glycemia.

Malangizo a Acarbose ogwiritsira ntchito

Mankhwala akhoza kutumikiridwa mu mankhwala a metformin ndi mankhwala ena antidiabetes. Amatengedwa katatu patsiku musanadye. Zotsatira zoyipa zimaphatikizira kutsetsereka, nthawi zina kutsegula m'mimba. Zizindikiro izi zitha kukhala zazikulu kwambiri ngati wodwalayo samatsatira malangizo a kadyedwe. Contraindication ntchito acarbose kwambiri aimpso ndi kwa chiwindi insufficiency.

Kukonzekera kwa Incretin

Kukonzekera kwa incretin kumathandizira kubisirana kwa insulin ndi kapamba, komanso kupewa kuphipha kwa m'mimba. Amachepetsa shuga wamagazi ndi thupi. Zotsatira zoyipa zimaphatikizapo kusanza, kusowa kudya, komanso kusanza.

Kukonzekera kwa incretin kumaphatikiza magulu awiri awiri.

Gulu laling'ono loyamba ndi lothandizira la GLP 1 lothandizira (mankhwala ampretin a gulu latsopano la mankhwala: mpakaglutyd, exenatide, liksysenatyd, liraglutide).

Momwe mungapangire ma protein:

• Amabayidwa mosanjira.
• Amagwiritsidwa ntchito kuphatikiza ndi zotumphukira za metformin ndi / kapena sulfonylurea.

Gulu lachiwiri ndi DPP-4 zoletsa (otchedwa glyptins), otengedwa pakamwa. Mankhwala a DPP-4 inhibitor amawonjezera pancreatic insulin secretion, kuletsa kutsekeka kwa m'mimba, kupereka malingaliro okhutira komanso kukhudza dongosolo lamkati lamanjenje, kupondereza chilakolako. Amachepetsa shuga wamagazi ndi thupi. Zotsatira zoyipa zimaphatikizapo kusanza, kusowa kudya, komanso kusanza.

Aya mapiritsi: (linagliptin, saxagliptin, sitagliptin, vildagliptin).

Zina mwa izo zimapezekanso monga kuphatikiza kophatikizira komwe kuli ndi metformin yowonjezera piritsi limodzi.

SGLT2 Inhibitors

• SGLT2 inhibitors (omwe amatchedwa glyphosines, dapagliflozin, empagliflosin, canagliflosin) ndi gulu la mankhwala omwe amalimbikitsa kukoka kwa glucose. Zotsatira zake ndikuchepa kwa shuga wamagazi, kulemera kwa thupi komanso kuthamanga kwa magazi.
• Mankhwalawa nthawi zambiri amatengedwa kamodzi patsiku. Amagwiritsidwa ntchito nthawi zambiri kuphatikiza ndi metformin. Popeza glyphlosins amachulukitsa kuchuluka kwa glucose yemwe amatulutsidwa mu mkodzo, amatha kuyambitsa matenda a kwamikodzo ndi ziwalo zoberekera, chifukwa chake ukhondo umalimbikitsidwa ukamagwiritsa ntchito.

Amachokera ku Thiazolidinedione

Chithandizo chokhacho chomwe chilipo kuchokera ku gulu la thiazolidinedione derivatives (i.e., omwe amatchedwa glitazones) ndi pioglitazone.

• Amachepetsa kukana kwa insulini ndipo, motero, amachepetsa kuchuluka kwa shuga ndi mafuta achilengedwe omasuka m'magazi.
• Mankhwala amatengedwa pakamwa kamodzi patsiku. Pioglitazone imagwiritsidwa ntchito kwambiri kuphatikiza ndi metformin.
• Mankhwalawa amatha kuyambitsa madzi kusungidwa mthupi, chifukwa chake sayenera kugwiritsidwa ntchito mwa anthu omwe ali ndi vuto la mtima.

Magulu omwe ali pamwambawa adatchulidwa pochiza matenda a shuga 2 omwe amathandizidwa ndi adokotala okha. Pochiza matenda amtundu wa 1 shuga, ndi insulin yokha yomwe imagwira ntchito.

Dziwani zambiri za njira zatsopano za mankhwalawa matenda a shuga 2: