Chithandizo cha matenda A shuga A Type 2

Mfundo zoyenera kuchitira mtundu wa 2 matenda a shuga (DM-2):

kuphunzira ndi kudziletsa,
zakudya mankhwala
Kuchita masewera olimbitsa thupi,
mankhwala othandiza kuchepetsa shuga (TSP),
mankhwala a insulin (kuphatikiza kapena monotherapy).

Mankhwala othandizira a SD-2 amapatsidwa mankhwala omwe amadya zakudya zowonjezera komanso zowonjezera zolimbitsa thupi kwa miyezi itatu samalola kukwaniritsa cholinga cha chithandizo cha wodwala wina.

Kugwiritsidwa ntchito kwa TSP, ngati mtundu waukulu wa hypoglycemic therapy ya SD-2, kwaphatikizidwa mu:

zovuta zonse zopweteka matenda a shugaSD),
kuwonongeka kwambiri kwa chiwindi ndi impso zamtundu uliwonse, zikuchitika ndikuphwanya ntchito yawo.
mimba
kubala mwana
nyere
matenda a magazi
matenda otupa a pachimake
gawo la organic ya mavuto a shuga,
othandizira opaleshoni
kuchepa thupi pang'onopang'ono.

Kugwiritsa ntchito TSP mwa anthu omwe ali ndi kutupa kwa nthawi yayitali pachilichonse sikulimbikitsidwa.

The pharmacotherapy a mtundu 2 matenda a shuga amachokera pa kukhudzidwa kwa zikuluzikulu za pathogenetic yolumikizira matendawa: kuphwanya insulin katulutsidwe, kukhalapo kwa insulin kukana, kuchuluka kwa shuga chiwindi, shuga. Kuchita kwa mankhwala ochepetsa mphamvu ya piritsi omwe amapezeka pang'onopang'ono kumatengera kuphatikiza kwa njira zolipirira zotsatira zoyipa za zinthu izi zam'thupi (algorithm yothandizira odwala omwe ali ndi matenda a shuga a 2 akuwonetsedwa pa mkuyu. 9,1).

Chithunzi 9.1. Algorithm yochizira odwala omwe ali ndi matenda a shuga a 2

Malinga ndi mfundo za momwe mukugwiritsira ntchito, zochita za TSP zimagawidwa m'magulu akulu atatu:

1) Kupititsa patsogolo katemera wa insulin: zolimbikitsa kaphatikizidwe ndi / kapena kutulutsa kwa insulin ndi ma cell a B - sulfonylureas (PSM), nesulfanylurea secretagogues (glinides).
2) Kuchepetsa kukana kwa insulini (kuwonjezera insulin sensitivity): kuletsa kuchuluka kwa shuga wama chiwindi ndi kupititsa patsogolo kugwiritsidwa ntchito kwa glucose pogwiritsa ntchito zotumphukira. Izi zikuphatikiza ndi Biguanides ndi thiazolinediones (glitazones).
3) Kupondeleza kunyowa kwa matumbo m'matumbo: a-glucosidase inhibitors (gome. 9.1.).

Tebulo 9.1. Limagwirira zake ntchito pakamwa kuchepetsa shuga

Pakadali pano, magulu a mankhwalawa akuphatikizapo:

1. Kukonzekera kwa sulfonylurea m'badwo wachiwiri:

glibenclamide (Maninil 5 mg, Maninil 3.5 mg, Maninil 1.75 mg)
gliclazide (Diabeteson MV)
glimepiride (amaryl)
glycidone (glurenorm)
glipizide (Glibenez retard)

2. Nesulfanylurea secretagogues kapena prandial glycemic Administrators (glinids, meglitinides):

Repaglinide (Novonorm)
nateglinide (Starlix)

3. Biguanides:

Metformin (Glucophage, Siofor, Formin Pliva)

4. Thiazolidinediones (glitazones): zotakasitsa zomwe zitha kuwonjezera chidwi cha zotumphukira kuzinthu za insulin:

rosiglitazone (Avandia)
pioglitazone (Aktos)

5. A-glucosidase blockers:

Sulphonylureas

Kupanga kwa hypoglycemic zotsatira za PSM ndikuthandizira kaphatikizidwe ndi katulutsidwe ka insulin ndi maselo a kapamba B, kuchepa kwa neoglucogeneis m'chiwindi, kuchepa kwa glucose kutuluka kwa chiwindi, kuwonjezera mphamvu ya insulin yotengera insulin chifukwa chodziwikirana ndi ma receptors.

Pakadali pano, muzochitika zamankhwala, PSM m'badwo wachiwiri ukugwiritsidwa ntchito, omwe akufanizira ndi sulfonylurea kukonzekera kwa m'badwo I (chlorpropamide, tolbutamide, carbutamide) ndi zabwino zingapo: ali ndi zochitika zapamwamba za hypoglycemic, ali ndi zovuta zochepa, samakonda kucheza ndi mankhwala ena, amamasulidwa ochulukirapo omasuka. Zizindikiro ndi zoyipiritsa za phwando lawo zawonetsedwa pagome. 9.2.

Tebulo 9.2. Zizindikiro ndi contraindication kumwa mankhwala

Chithandizo cha PSM chimayamba ndi gawo limodzi musanadye kadzutsa (mphindi 30 musanadye) pa mlingo wotsika kwambiri, ngati pakufunika kutero, pang'onopang'ono mumawonjezera ndi masiku 5-7 mpaka kuchepetsa kwa glycemia kupezeka. Mankhwala okhala ndi kuyamwa mwachangu (micronized glibenclamide - 1.75 mg manin, 3.5 mg mannin) amatengedwa mphindi 15 asanadye. Ndikulimbikitsidwa kuti chithandizo ndi TSP chiyambitsidwe ndi othandizira, monga gliclazide (MV diabeteson), ndikutembenukira ku mankhwalawa amphamvu (mannyl, amaryl). PSM yokhala ndi nthawi yochepa yochita (glipizide, glycidone) imatha kutumikiridwa katatu patsiku (Table 10).

Glibenclamide (maninyl, betanase, daonil, euglucon) ndi mankhwala ogwiritsidwa ntchito kwambiri sulfanylurea. Amapangidwa mokwanira mthupi ndi kupangika kwa metabolites yogwira komanso yosagwira ndipo imakhala ndi njira yowonjezera iwiri (50% kudzera mu impso ndi gawo lofunikira ndi bile). Pamaso pa kulephera kwa impso, kumangika kwake pamapuloteni kumachepa (ndi hypoalbuminuria) ndipo chiopsezo chokhala ndi hypoglycemia chikuwonjezeka.

Tebulo 10. Chithunzithunzi cha Mlingo ndi Mlingo wa PSM

Glipizide (glibenesis, glibenesis retard) imapukusidwa mu chiwindi kuti ipange ma metabolites osagwira, omwe amachepetsa chiopsezo cha hypoglycemia. Ubwino wa kumasulidwa kwamphamvu glipizide ndikuti zomwe zimagwira zimamasulidwa mosalekeza ndipo sizimadziyimira pawokha pakudya. Kuwonjezeka kwa katulutsidwe ka insulini pakugwiritsa ntchito kumachitika makamaka poyankha kudya, komwe kumachepetsa nawonso vuto la hypoglycemia.

Glimepiride (amaryl) - piritsi latsopano lotsitsa shuga, lomwe nthawi zina limanenedwa m'badwo wachitatu. Ili ndi 100% bioavailability ndipo imasankha kusankha kwa insulini kuchokera ku maselo a B pokhapokha pakudya, sikulepheretsa kuchepa kwa insulin katemera panthawi yochita masewera olimbitsa thupi. Izi machitidwe a glimepiride amachepetsa mwayi wa hypoglycemia. Mankhwalawa ali ndi njira ziwiri zowonjezera: ndi mkodzo ndi bile.

Glyclazide (Diabeteson MV) imadziwikanso ndi bioavailability (97%) ndipo imapangidwa mu chiwindi popanda kupangika kwa metabolites yogwira. Njira yayitali ya gliclazide - diabeteson MB (njira yatsopano yotulutsidwa) imatha kusintha mwachangu ma receptors a TSP, omwe amachepetsa mwayi wachiwiri wotsutsa komanso amachepetsa chiopsezo cha hypoglycemia. Mu achire Mlingo, mankhwalawa amatha kuchepetsa zovuta za oxidative nkhawa. Izi monga pharmacokinetics za matenda a shuga a mellitus MV amalola kugwiritsa ntchito odwala omwe ali ndi matenda a mtima, impso ndi okalamba.

Komabe, munthawi zonsezi, mlingo wa PSM uyenera kusankhidwa payekhapayekha, kukumbukira kuwopsa kwa machitidwe a hypoglycemic mwa anthu okalamba.

Glycvidone amadziwika ndi mawonekedwe awiri: yochepa kuchitapo kanthu komanso chochepa chotseka kudzera impso (5%). 95% ya mankhwalawa amachotsedwa mu ndulu. Mothandizidwa bwino kuchepetsa kuchuluka kwa glucose osamba komanso mukatha kudya, komanso kutalikirana kwakanthawi kwake kumapangitsa kuti asamagwire bwino glycemia ndikuchepetsa chiopsezo cha hypoglycemia. Glurenorm ndi imodzi mwanjira zotetezeka, zochokera ku sulfanylurea, ndi mankhwala osankhidwa pochiza odwala okalamba, odwala omwe ali ndi vuto la impso komanso omwe ali ndi vuto la postprandial hyperglycemia.

Poganizira za matenda a matenda a shuga a mtundu wachiwiri okalamba, monga, kuchuluka kwambiri kwa matenda a postprandial glycemia, zomwe zimayambitsa kufa kwakukulu chifukwa cha zovuta zamtima, kwakukulu, kuikidwa kwa TSP ndizoyenera makamaka kwa odwala okalamba.

Poyerekeza ndi kugwiritsa ntchito sulfanylurea kukonzekera, mavuto akhoza kuchitika. Choyamba, izi zimakhudza kukhazikika kwa hypoglycemia. Kuphatikiza apo, pali kuthekera kwa kupweteka kwa m'mimba (nseru, kusanza, kupweteka kwa epigastric, kusawoneka kawirikawiri kwa jaundice, cholestasis), matupi awo sagwirizana kapena oopsa (pakhungu vasculitis). Pali umboni wosatsutsika wa mtima wazomwe zimachitika mu PSM.

Nthawi zina, mankhwalawa amachepetsa shuga, kutsutsana ndi oimira gululi kungawonedwe. Mlanduwo pakakhala kusowa kwa kuyeza kwa shuga komwe kumayembekezeredwa kuyambira masiku oyamba achipatala, ngakhale kusintha kwasintha kwa mankhwalawa komanso kuchuluka kwa mlingo wa tsiku ndi tsiku kufikira momwe tingathere, tikulankhula za kukana kwenikweni kwa TSP. Monga lamulo, kupezeka kwake kumachitika chifukwa chakuchepa kwa chinsinsi chake cha insulin, chomwe chikuwonetsa kufunikira kosamutsa wodwala kupita ku insulin.

Kugwiritsidwa ntchito kwa nthawi yayitali kwa TSP (zaka zopitilira 5) kungayambitse kuchepa kwa chidwi chawo (kukana kwachiwiri), zomwe zimachitika chifukwa chakuchepa kwa kumangiriza kwa mankhwalawa ku zolandilira zimakhala za insulin. Mwa ena mwa odwalawa, mankhwala a insulini kwakanthawi kochepa amatha kubwezeretsa chidwi cha glucose receptors ndikukulolani kuti mubwererenso kugwiritsa ntchito PSM.

Kukana kwachiwiri kwa mankhwala ochepetsa shuga piritsi komanso kukonzekera kwa sodfanilurea, makamaka, kumachitika pazifukwa zingapo: SD-1 (autoimmune) imapezeka molakwika ngati mtundu wachiwiri wa matenda ashuga, palibe kugwiritsa ntchito mankhwala osagwiritsa ntchito mankhwalawa a CD-2 (mankhwala othandizira pakudya, dosed zolimbitsa thupi), mankhwala osokoneza bongo a hyperglycemic effect (glucocorticoids, estrogens, thiazide diuretics mu waukulu doses, l are used Thyroxine).

Kuchulukitsa kwa concomitant kapena kuwonjezerapo kwa matenda oyanjana kumapangitsanso kuchepa kwa chidwi cha TSW. Pambuyo pakuleka izi, kugwira ntchito kwa PSM kumatha kubwezeretsedwanso. Nthawi zina, pokonzekera kukana kwenikweni kwa PSM, zotsatira zabwino zimapezeka pogwiritsa ntchito mankhwala osakanikirana ndi insulin ndi TSP kapena kuphatikiza kwamagulu osiyanasiyana a mankhwala ochepetsa shuga.

Nesulfanylurea zachinsinsi (glinides)

Tebulo 11. Kugwiritsa ntchito kwazinsinsi

Zisonyezero zogwiritsidwa ntchito mobisa:

CD-2 yomwe yangopezeka kumene ndi zizindikiro zosakwanira katemera wa insulin (wopanda thupi kwambiri),
CD-2 yokhala ndi vuto lalikulu la postprandial hyperglycemia,
SD-2 mwa anthu okalamba
SD-2 ndi tsankho ku TSP ina.

Zotsatira zabwino mukamagwiritsa ntchito mankhwalawa zimapezeka kwa odwala omwe ali ndi mbiri yochepa ya matenda a shuga a 2, ndiye kuti, ndi insulin yotetezedwa. Ngati glycemia ya postprandial itakhala bwino ndikugwiritsa ntchito mankhwalawa, komanso kusala glycemia kumakhalabe kokwezeka, amathanso kuphatikizidwa ndi metformin kapena insulin yayitali musanagone.
Repaglinide imatheka makamaka kudzera m'mimba thirakiti (90%) ndi 10% yokha mkodzo, kotero mankhwalawa sanapatsidwe pachigawo choyambirira cha kulephera kwa aimpso. Nateglinide imapukusidwa mu chiwindi ndikuchotsedwa mu mkodzo (80%), motero, ndikosayenera kuyigwiritsa ntchito mwa anthu omwe ali ndi vuto la hepatic ndi aimpso.
Kuwonekera kwa zoyipa za ma secagagog ndi ofanana ndi omwe amakonzekera sulfanilurea, popeza onsewa amalimbikitsa kubisalira kwa insulin.
Pakadali pano, pazokonzekera zonse za gulu la Biguanide, metformin yokha imagwiritsidwa ntchito (glucophage, siofor, formin pliva). Kutsitsa kwa shuga kwa metformin kumachitika chifukwa cha njira zingapo zamtundu wa extrapancreatic (ndiye kuti, sizimakhudzana ndi katulutsidwe ka insulin ndi maselo a pancreatic B). Choyamba, metformin imachepetsa kuchuluka kwa shuga ndi chiwindi chifukwa cha kuponderezedwa kwa gluconeogeneis, chachiwiri, kumawonjezera chidwi cha zotumphukira za minofu ya insulin (minofu komanso, mpaka pang'ono, mafuta), chachitatu, metformin imakhala ndi mphamvu ya anorexigenic, chachitatu, - imachepetsa kuyamwa kwa matumbo m'matumbo.
Odwala omwe ali ndi matenda ashuga, metformin imasintha kagayidwe ka lipid chifukwa cha kuchepa kwapang'onopang'ono khalidalak (TG), otsika ochepa lipoproteins (LDL), cholesterol yathunthu ndi LDL cholesterol mu plasma. Kuphatikiza apo, mankhwalawa ali ndi vuto la fibrinolytic chifukwa chothandizira kuthamanga kwa thrombolysis komanso kuchepetsa kuchuluka kwa fibrinogen m'magazi.
Chizindikiro chachikulu chogwiritsa ntchito metformin ndi CD-2 yokhala ndi kunenepa kwambiri komanso / kapena hyperlipidemia. Mwa odwala, metformin ndi mankhwala osankha chifukwa chakuti amathandiza kuchepetsa kunenepa komanso samalimbikitsa Hyperinsulinemia yokhudza kunenepa kwambiri. Mulingo wake umodzi ndi 500-1000 mg, mlingo wa tsiku ndi tsiku ndi 2,5 mpaka g, muyezo womwe umagwiritsidwa ntchito tsiku lililonse kwa odwala ambiri sutsika 2-2.25 g.
Kuchiza nthawi zambiri kumayamba ndi 500-850 mg patsiku, ngati kuli kotheka, kuonjezera mlingo ndi 500 mg ndi gawo limodzi la sabata 1, kamodzi katatu patsiku. Ubwino wa metformin ndikuthekera kwache kuponderezana ndi chiwindi. Poganizira izi, ndikwabwino kuyambiranso kamodzi patsiku kuti tipeze kuchuluka kwa glycemia m'mawa kwambiri.
Metformin itha kugwiritsidwa ntchito ngati monotherapy yokhala ndi zakudya mwa anthu omwe ali ndi matenda a shuga a 2 komanso kunenepa kwambiri, komanso kuphatikiza ndi PSM kapena insulin. Mankhwala omwe amaphatikizidwa amadziwika ngati chithandizo chamankhwala chogwirizana ndi maziko a monotherapy sichikwaniritsidwa. Pakadali pano, pali kukonzekera kwa glibomet, komwe ndi kuphatikiza kwa glibenclamide (2,5 mg / tabu.) Ndi metformin (400 mg / tabu.).
Chochulukitsa choopsa kwambiri cha mankhwala a biguanide ndi lactic acidosis. Kuwonjezeka kwakukulu kwa lactate pamilandu iyi kumalumikizidwa, poyamba, ndi kukondoweza kwa kupanga kwake mu minofu, ndipo chachiwiri, ndikuti lactate ndi alanine ndiye magawo akuluakulu a gluconeogeneis oponderezedwa mukamamwa metformin. Komabe, ziyenera kuganiziridwa kuti metformin, yodziwika molingana ndi zikuwonetsa ndikutsata ma contraindication, siyambitsa lactic acidosis.
Poganizira za pharmacokinetics of metformin, kuchoka kwake kwakanthawi ndikofunikira poyambitsa radiopaque iodine yomwe ili ndi zinthu, isanachitike opaleshoni yayikulu (osachepera maola makumi asanu ndi awiri ndi awiri), munthawi ya ntchito (asanagwire ntchito komanso masiku angapo pambuyo pake), ndi kuwonjezera kwa matenda opatsirana oyipa komanso kufalikira kwa matenda osachiritsika.
Kwambiri, Metformin imalekeredwa bwino. Zotsatira zoyipa, ngati zikukula, ndiye kumayambiriro kwa chithandizo ndikusowa msanga. Izi zimaphatikizira kuphika, kusanza, kutsegula m'mimba, kusapeza bwino mu dera la epigastric, kuchepa kwa chakudya komanso kutsekemera kwazitsulo mkamwa. Zizindikiro za Dyspeptic zimaphatikizidwa makamaka ndi kutsika kwa mayamwidwe a shuga m'matumbo ndikuwonjezera njira za nayonso mphamvu.
Nthawi zina, pali kuphwanya matumbo a vitamini B12. Zomwe zimachitika sizingachitike. Chifukwa cha kuchepa kwa chidwi ndi insulin, metformin sikamapangitsa chitukuko cha hypoglycemia ngakhale ndimankhwala osokoneza bongo komanso othina.
Zoyipa zotsutsana ndi kugwiritsa ntchito metformin ndi: hypoxic zinthu ndi acidosis ya etiology iliyonse, mtima kulephera, kusokonezeka kwambiri kwa chiwindi, impso, mapapu, zaka zakale, kumwa mowa kwambiri.
Pochiza ndi metformin, ndikofunikira kuwunikira zizindikiro zingapo: hemoglobin (1 nthawi m'miyezi 6), serum creatinine ndi transaminases (1 nthawi pachaka), ngati kuli kotheka - kuseri kwa lactate m'magazi (1 nthawi m'miyezi 6). Pakumva kupweteka kwa minofu, kuwunika mwachangu kwa lactate yamagazi ndikofunikira, nthawi zambiri msambo wake ndi 1,3-3 mmol / l.
Thiazolidinediones (glitazones) kapena zotulutsa chidwi
Thiazolidinediones ndimapiritsi atsopano otsitsa shuga. Kapangidwe ka zochita zawo ndiko kuthekera kochotsa matenda a insulin, omwe ndi chimodzi mwazifukwa zazikuluzakhazikitsira matenda a shuga a mtundu wachiwiri. Ubwino wowonjezera wa thiazolidinediones kuposa ma TSP ena onse ndi machitidwe awo a hypolipidemic. Mphamvu yotsitsa kwambiri ya lipid imaperekedwa ndi actos (pioglitazone), yomwe imatha kuthetsa hypertriglyceridemia ndikuwonjezera zomwe anti-atherogenic highensens lipoproteins (HDL).
Kugwiritsira ntchito thiazolidinediones kwa odwala omwe ali ndi matenda a shuga a 2 kumatsegula mwayi wopewera zovuta zamtima, dongosolo lachitukuko lomwe limachitika makamaka chifukwa cha kukana insulini komanso kusokonezeka kwa lipid metabolism. Mwanjira ina, mankhwalawa amathandizira chidwi cha zotumphukira zathupi lathu kuti azigwiritsa ntchito mphamvu zawo zamkati mwa insulin ndipo nthawi yomweyo amachepetsa kuchuluka kwake m'magazi.
Pakakhala katulutsidwe wa amkati insulin (CD-1) kapena kuchepa kwa katulutsidwe kake (njira yayitali yodwala matenda a shuga 2, limodzi ndi chiphuphu chosakwanira pa mlingo waukulu wa TSP), mankhwalawa sangakhale ndi vuto la hypoglycemic.
Pakadali pano, pali mitundu iwiri ya gululi yomwe imagwiritsidwa ntchito: rosiglitazone (avandia) ndi pioglitazone (actos) (Gome 12).
Gome 12. Kugwiritsa ntchito thiazolidinediones
80% ya omwe ali mgululi amapangidwa ndi chiwindi ndipo 20% yokha ndi yomwe imatsitsidwa ndi impso.
Thiazolidinediones simalimbikitsa kubisika kwa insulini ndi kapamba, chifukwa chake samayambitsa mikhalidwe ya hypoglycemic ndikuthandizira kuchepetsa hyperglycemia.
Mankhwalawa ndi glitazones, kuwunika kuyenera kwa ntchito ya chiwindi (serum transaminases) kumafunika kamodzi pachaka. Zotsatira zina zomwe zingakhalepo zingaphatikizepo kutupa ndi kunenepa kwambiri.
Zizindikiro zama glitazones ndi:
CD-2 yomwe yadziwika kumene ndi ma insulin (chifukwa chosagwiritsa ntchito mankhwala okhawo olimbitsa thupi),
SD-2 ndi kulephera kwa mankhwala othandizira wamba a PSM kapena biguanides,
SD-2 ndi tsankho kwa mankhwala ena ochepetsa shuga.

Zoyipa zotsutsana ndi glitazones ndi: zopitilira 2 peresenti ya seramu transaminases, mtima kulephera kwa III-IV digiri.
Mankhwala osokoneza bongo a gululi amatha kugwiritsidwa ntchito limodzi ndi sulfanilurea, metformin ndi insulin.
A-glucosidase zoletsa
Gulu la mankhwalawa limaphatikizira othandizira omwe amalepheretsa michere ya m'mimba, yomwe imathandizira pakupasuka komanso kuyamwa kwa michere m'mimba yaying'ono. Mafuta osaphatikizika amalowa m'matumbo akulu, pomwe amawonongeka ndi matumbo kuti CO₂ ndi madzi. Nthawi yomweyo, kuthekera kwa kugwirizananso ndi shuga m'magazi kumachepa. Kupewa kuyamwa msanga m'matumbo ndikuwongolera kugwiritsidwa ntchito kwa shuga ndi chiwindi kumayambitsa kuchepa kwa postprandial hyperglycemia, kuchepa kwa katundu pama cell a pancreatic B ndi hyperinsulinemia.
Pakadali pano, mankhwala okhawo ochokera ku gululi adalembetsa - acarbose (glucobai). Kugwiritsidwa ntchito kwake kumagwira ntchito limodzi ndi msana wa glycemia mutatha kudya komanso mwachizolowezi - pamimba yopanda kanthu. Chizindikiro chachikulu cha kugwiritsa ntchito glucoboy ndi njira yofatsa ya 2 shuga. Chithandizo chimayamba ndi mlingo wochepa (50 mg ndi chakudya chamadzulo), ndikuwonjezera pang'onopang'ono mpaka 100 mg katatu patsiku (mlingo woyenera).
Ndi glucobai monotherapy, kusintha kwa hypoglycemic sikukula. Kuthekera kwa kugwiritsa ntchito mankhwalawa kuphatikiza ndimankhwala ena ochepetsa shuga, makamaka ochulukitsa a insulin, angayambitse kukula kwa hypoglycemic.
Zotsatira zoyipa za acarbose ndizobisika, kutulutsa, kutsegula m'mimba, matupi awo sayanjana. Ndi mankhwala opitilira muyeso ndi zakudya (kuchotsedwa kwa chakudya chambiri), madandaulo am'mimba amachoka.
Zotsatira za kupezeka kwa acarbose:
Matumbo oyenda ndi malabsorption,
kupezeka kwa diverticulums, zilonda, zithupsa, ming'alu m'mimba,
gastrocardial syndrome
Hypersensitivity kuti acarbosis.

T.I. Rodionova
Kusankha kwamankhwala ndi cholinga chake
Njira zakuchiritsira zamakono za mtundu wachiwiri wa matenda ashuga zimaphatikizanso kugwiritsa ntchito njira zosiyanasiyana zowongolera shuga m'thupi la wodwalayo panthawi yamankhwala. Chofunikira kwambiri pazamankhwala ndi kusankha kwa mankhwala komanso mankhwala omwe amagwiritsidwa ntchito pochiza matenda amtundu wa 2 shuga.
Chithandizo chamakono cha matenda ashuga amtundu wa 2 mothandizidwa ndi mankhwala sichithetsa zofunikira pakukhazikitsa malangizo omwe akufuna kusintha moyo wawo wodwala.
Mfundo zamankhwala othandizira kudya ndi:
Kutsatira malamulo a zakudya zopatsa thanzi. Muyenera kudya katatu pa tsiku. Kudya kuyenera kuchitidwa m'magawo ang'onoang'ono, kutsatira dongosolo lomwelo la chakudya.
Ngati onenepa kwambiri, mumagwiritsa ntchito zakudya zamafuta ochepa.
Kuchulukitsa zakudya, zomwe zimakhala ndi fiber yambiri.
Kuchepetsa kudya zamafuta ambiri.
Kuchepetsa kudya zamchere tsiku lililonse.
Kusiyanitsa ndi zakumwa ndi zakumwa zoledzeretsa.
Kuchulukitsa zakudya zamafuta ambiri.
Kuphatikiza pa chithandizo chamankhwala pothana ndi matenda a shuga a 2, maphunziro a thupi amagwiritsidwa ntchito mwachangu. Zochita zolimbitsa thupi zimalimbikitsidwa kwa odwala omwe ali ndi matenda amtundu wa 2 mu mawonekedwe amtundu womwewo wa kuyenda, kusambira ndi kuyendetsa njinga.
Mtundu wa zochitika zolimbitsa thupi komanso kulimba kwake zimasankhidwa payekha kwa wodwala aliyense yemwe ali ndi matenda a shuga a mtundu wa 2. Ganizirani posankha katunduyu:
zaka odwala
zambiri za wodwala
kukhalapo kwa zovuta ndi matenda owonjezera,
zolimbitsa thupi zoyambira, etc.
Kugwiritsa ntchito zamankhwala pochiza matenda ashuga kumakupatsani mwayi wowonekera wa glycemia. Maphunziro azachipatala omwe amagwiritsa ntchito njira zamakono zochizira matenda osokoneza bongo amatilola kunena motsimikiza kuti zolimbitsa thupi zimathandizira kuti shuga agwiritsidwe ntchito ka plasma, kutsitsa chidwi chake, kumapangitsa kagayidwe ka lipid m'thupi, kuletsa kukula kwa matenda a shuga a shuga.
Chithandizo cha matenda ashuga
Musanaphunzire momwe njira zatsopano zakugwirira ntchito pochizira matenda a shuga 2 zimagwirira ntchito, muyenera kuphunzira momwe mtundu wa 2 wodwala amathandizidwira pogwiritsa ntchito njira yakale.
Lingaliro la chithandizo ndi njira yachikhalidwe limapangidwa poyang'anira mwamphamvu shuga wambiri m'thupi la wodwalayo, poganizira za momwe thupi limakhalira ndi machitidwe a matendawa.
Pogwiritsa ntchito njira yachikhalidwe, chithandizo cha matendawa chimachitika njira zonse zodziwira matenda zitachitika. Akalandira chidziwitso chazonse zokhudzana ndi thupi, adotolo amakupatsani chithandizo chamankhwala ndikusankha njira yoyenera kwambiri kwa wodwalayo.
Chithandizo cha matendawa pogwiritsa ntchito njira zachikhalidwe chimaphatikizira kugwiritsa ntchito nthawi imodzi mankhwalawa, mwachitsanzo, mtundu 1 wa shuga, zakudya zapadera zamagulu, masewera olimbitsa thupi, kuphatikiza apo, mankhwala apadera ayenera kumwedwa ngati gawo la mankhwala a insulin.
Cholinga chachikulu chomwe ndimagwiritsidwe ntchito a matenda a shuga ndikuchotsa chizindikiro chomwe chimawoneka pamene kuchuluka kwa shuga m'magazi kukwera kapena pamene kugwera kwambiri pansi pazomwe zimachitika. Mankhwala atsopano opangidwa ndi akatswiri opanga mankhwala amapangitsa kuti pakhale shuga wambiri m'thupi la wodwalayo akamagwiritsa ntchito mankhwala.
Njira zachikhalidwe zochizira matenda ashuga zimafuna kugwiritsa ntchito njira yachikhalidwe kwakanthawi yayitali, nthawi yamankhwala ingatenge zaka zingapo.
Mtundu wofala kwambiri wamatenda ndi matenda ashuga 2. Kuphatikiza mankhwala amtunduwu wa shuga kumafunikanso kugwiritsidwa ntchito kwa nthawi yayitali.
Kutalika kwakanthawi kothandizidwa ndi njira yachikhalidwe kumakakamiza madokotala kuyamba kufunafuna njira zatsopano zochizira matenda ashuga komanso mankhwala aposachedwa kwambiri pochiza matenda amtundu wa 2, omwe adzafupikitsa nthawi yayitali.
Pogwiritsa ntchito zomwe zapezeka mu kafukufuku wamakono, lingaliro latsopano lothandizira matenda a shuga lapangidwa.
Kupanga njira zamankhwala mukamagwiritsa ntchito njira zatsopano ndikusintha njira munthawi ya chithandizo.
Njira zamakono zochizira matenda amitundu iwiri
Kafukufuku wamakono akuonetsa kuti pochiza matenda amtundu wa 2 shuga, nthawi yakwana yoti asinthe lingaliro. Kusiyana kwakuthupi komwe matenda amakono amakuyerekeza ndi miyambo ndikuti, kugwiritsa ntchito mankhwala amakono ndi njira zamankhwala, mwachangu momwe zingatherere matenda a glycemia m'thupi la wodwalayo.
Israeli ndi dziko lomwe lili ndi mankhwala otsogola. Yoyamba yokhudza njira yatsopano yovomerezeka idakambidwa ndi Dr. Shmuel Levit, yemwe amagwira ntchito kuchipatala cha Asud ku Israel. Kuchita bwino kwa Israeli pakuchiza matenda a shuga ndi njira yatsopanoyo kudavomerezedwa ndi Komiti Yadziko Lonse Yazachipatala pakuzindikira matenda ndi matenda a shuga.
Kugwiritsira ntchito njira yachikhalidwe yochiritsira poyerekeza ndi yamakono kuli ndi zovuta zina, zomwe zimapangitsa kuti njira yogwiritsira ntchito njira yachikhalidwe ndiyosakhalitsa, nthawi zina ndikofunikira kubwereza maphunziro a chithandizo.
Akatswiri a endocrinology amasiyanitsa magawo atatu akuluakulu mankhwalawa mtundu wa 2 matenda a shuga, omwe amapereka njira yamakono yochizira matenda a kagayidwe kazakudya m'thupi.
Kugwiritsa ntchito metformin kapena dimethylbiguanide - mankhwala omwe amachepetsa shuga m'thupi.
Zochita za mankhwala ndi izi:
Chidacho chimapereka kuchepa kwa kuchuluka kwa shuga m'magazi a m'magazi.
Kuchulukitsa chidwi kwa maselo mu minofu yodalira insulini kupita ku insulin.
Kupereka kuthamanga kwa shuga kwa maselo pakufalikira kwa thupi.
Kuthamanga kwa mafuta acid oxidation njira.
Kuchepetsa shuga m'mimba.
Kuphatikiza ndi mankhwalawa, mutha kugwiritsa ntchito njira zamtunduwu monga:
insulin
glitazone
Kukonzekera kwa sulfonylurea.
Kutheka kokwanira kumatheka pogwiritsa ntchito njira yatsopano yothandizira mankhwalawa pochulukitsa mulingo wa mankhwala pakapita nthawi pofika 50-100%
Protocol yamankhwala mogwirizana ndi njira yatsopano imalola mwayi wophatikiza mankhwala omwe ali ndi zotsatira zomwezo. Zipangizo zamankhwala zimakupatsani mwayi wothandizira panthawi yochepa kwambiri.
Zochita zomwe zimagwiritsidwa ntchito mankhwalawa zimapangidwa kuti zisinthe momwe mankhwalawo amachitikira, kuchuluka kwa insulin komwe kumapangidwa ndi kapamba, ndikumachepetsa insulin.
Mankhwala ochizira matenda a shuga a 2
Nthawi zambiri, kugwiritsa ntchito mankhwala osokoneza bongo molingana ndi njira yamakono imagwiritsidwa ntchito kumapeto kwa chitukuko cha matenda ashuga a mtundu 2.
Choyamba, pakupereka mankhwala, mankhwala amathandizidwa kuti achepetse kuthana ndi shuga kuchokera m'matumbo a lumen ndikukhazikika kwa glucose omwe amatengedwa ndi ma cell a chiwindi ndikusintha chidwi cha insulin yodalira insulin.
Mankhwala omwe amagwiritsidwa ntchito pochiza matenda a shuga akuphatikizanso mankhwala a magulu otsatirawa:
khwawa
khalimon
mankhwala a sulfanilurea a m'badwo wachiwiri, etc.
Kuchiza ndi mankhwala kumaphatikiza kumwa monga:
Bagomet.
Metfogama.
Fomu.
Diaformin.
Glformin.
Avandia
Aktos.
Diabeteson MV.
Ziphuphu.
Maninil.
Glimax
Amaril.
Glimepiride.
Glybinosis achigonjetse.
Novonorm.
Starlix.
Dziwani.
Woopsa matenda, alpha-glycosidase ndi fenofibrate inhibitors amagwiritsidwa ntchito pochiza. Mankhwala ochizira amasankhidwa ndi endocrinologist yemwe amadziwa mawonekedwe a matendawa mwa wodwala wina. Mankhwala aliwonse ayenera kuperekedwa kwa odwala pokhapokha ndi dokotala yemwe wapanga chithandizo chachikulu. Endocrinologists a ku Russia amadziwa bwino njira yatsopano yothandizira.
Mdziko lathu, odwala ayamba kuchitira odwala monga njira za madotolo aku Israeli, kusiya njira zachikhalidwe.
Kutchulidwa kwamagulu a mankhwala omwe amagwiritsidwa ntchito pa matenda ashuga
Mankhwala a gulu la Biguanide adayamba kugwiritsidwa ntchito zaka zoposa 50 zapitazo. Choipa cha mankhwalawa ndichotheka kwambiri mawonekedwe awo a lactic acidosis. Buformin ndi phenformin ali m'gulu la mankhwalawa. Kuperewera kwa mankhwala m'gululi kunapangitsa kuti asatengedwe m'maiko ambiri mndandanda wazololedwa. Chithandizo chokhacho chovomerezedwa kuti chigwiritsidwe ntchito mgululi ndi metformin.
Kuchita kwa mankhwalawa kumachitika chifukwa cha njira zingapo zomwe sizimagwirizana ndi njira ya insulin yotulutsidwa ndi beta cell ya kapamba. Metformin imatha kupondereza kupanga kwa glucose ndi ma cell a chiwindi pamaso pa insulin. Kuphatikiza apo, mankhwalawa amatha kuchepetsa kukonzekera kwa insulin.
Njira yayikulu yogwiritsira ntchito m'badwo watsopano wa sulfonylureas ndi kukondoweza kwa insulin. Anamwino a gululi amagwira ntchito pama cell apancreatic, kuwonjezera luso lawo lachinsinsi.
Mothandizidwa ndi mankhwala, mankhwalawa sulfonylureas amayamba ndi otsika kwambiri Mlingo, ndipo Mlingo umawonjezereka ndi mankhwala ena pokhapokha ngati pakufunika.
Zotsatira zoyipa zogwiritsidwa ntchito ndi mankhwalawa ndizotheka kwakukulu kwakatukuka kwa vuto la hypoglycemia m'thupi la wodwalayo, kuchuluka kwa thupi, kuwoneka ngati zotupa pakhungu, kuyabwa, matenda am'mimba, matenda ammimba, ndi ena.
Thiazolidinediones ndi mankhwala omwe ali m'gulu latsopano la mankhwala omwe amachepetsa kuchuluka kwa shuga mthupi. Mankhwala osokoneza bongo omwe ali mgululi amachita pamulingo wa receptor. Ma receptor omwe amawona izi amachokera pamaselo amafuta ndi minofu.
Kuchita kwa mankhwala ndi ma receptors kungakulitse chidwi cha maselo kuti apange insulin. Thiazolidinediones imapereka kuchepa kwa insulin kukana, komwe kumakulitsa kwambiri kugwiritsidwa ntchito kwa shuga. Mankhwalawa amaphatikizidwa kwa odwala omwe ali ndi vuto lalikulu la mtima. Kanemayo munkhaniyi apitiliza mutu wa chithandizo cha matenda ashuga.