Mtundu wachiwiri wa matenda a shuga olembetsa: mndandanda

Malinga ndi malingaliro WHO (World Health Organisation) mankhwalawa mtundu wa matenda a shuga 2, kuphatikiza zakudya zoyenera komanso kugwiritsa ntchito zolimbitsa thupi ndikofunikira kwambiri. Ndikofunikira kwambiri kukulitsa kugwiritsa ntchito mankhwalawa osagwiritsa ntchito mankhwala osokoneza bongo zaka zoyambirira pambuyo pakupezeka kwa matenda ashuga, chifukwa Izi zimathandizira kwambiri kutha kwa matendawa, komanso zimapanga maziko abwino ogwiritsira ntchito mankhwala, ngati pakufunika.

Inde, sikuti wodwala aliyense amakhala ndi zakudya komanso zolimbitsa thupi zomwe zimakhala zokwanira kukhala ndi shuga m'magazi, makamaka matenda ashuga. Muzochitika izi, mapiritsi ochepetsa shuga amayikidwa.

Mwa odwala ena, mankhwala omwe amachepetsa shuga amayenera kuyambira pomwe matenda atapezeka ndi shuga; Nthawi zambiri izi zimachitika chifukwa cha matendawa atazindikira kale. Kupatula apo, tikudziwa kuti mtundu wachiwiri wa matenda ashuga amatha kupitilira kwa nthawi yayitali.

Kumbukirani kuti cholinga chachikulu pakuperekera chithandizo cha matenda ashuga ndicho kukhalabe ndi shuga m'magazi momwe mungathere, ndikofunikira kuti mukwaniritse zonse zomwe mungapeze mu njira ya mankhwala. Zakudya, ntchito zolimbitsa thupi ndi mankhwala ochepetsera shuga ziyenera kugwiritsidwa ntchito pakukhazikitsa njira yabwino kwambiri.

Mankhwala amakono ochepetsa shuga

M'zaka zaposachedwa, kusankha kwa mankhwala ochepetsa shuga kwakula kwambiri.

Pakati pawo, magulu angapo amatha kusiyanasiyana malinga ndi momwe akuchitira:

1. Mankhwala omwe amapangitsa kuti insulin itulutsidwe ndi kapamba.
2. Kukonzekera komwe kumapangitsa zochita za insulini pazomwe zili mu cell (kuwonjezera insulin sensitivity).
3. Mankhwala osokoneza bongo omwe amachepetsa kuyamwa kwa mafuta m'matumbo.

Zachidziwikire, kusankha kwa mankhwalawa kapena kuphatikiza kwake pamilandu iliyonse, komanso kusankha kwa mankhwalawo, ali kwathunthu ku udokotala. Chifukwa chake, mawonekedwe a mankhwalawa, omwe timapereka pansipa, sangatchulidwe monga chitsogozo pakugwiritsa ntchito kwawo!

Mankhwala aliwonse ali ndi mayina awiri: apadziko lonse lapansi, kutanthauza chinthu chomwe chimagwira, komanso malonda (malonda). Zomwezi zimatha kukhala ndi zochuluka zakumapeto, popeza opanga osiyanasiyana amapereka malonda awo mayina osiyanasiyana, kuphatikizira kutumiza kumayiko osiyanasiyana. Wodwalayo ayenera kudziwa dzina la mankhwala padziko lonse lapansi. Zidzawonetsedwa nthawi zonse pamalonda pafupi ndi malonda (nthawi zambiri zilembo zing'onozing'ono)!

Pansipa tikuwonetsa mayina apadziko lonse lapansi a mankhwalawo, ndi omwe amagulitsa pamakampani.

Mankhwala othandizira kapamba

Gululi limaphatikizapo mankhwala odziwika bwino a gulu la sulfonylurea (pali ambiri aiwo, tidzawalembetsa patsogolo) ndi mankhwala atsopano repaglinide (Novonorm) ndi nateglinide (Starlix).

Ma sulfonylureas omwe amagwiritsidwa ntchito kwambiri ndi awa: glibenclamide (Maninil), glyclazide (Diabeteson MV), glycidone (Glurenorm), glimepiride (Amaryl).

Limagwirira ntchito awa onse mankhwalawa makamaka kulimbikitsa kutulutsa kwa insulin ndi kapamba, komwe kumapangitsa kutsika kwa shuga m'magazi.

Kuyankha pazotsatira za mankhwala omwewo kumatha kusiyanasiyana pakati pa odwala osiyanasiyana (mpaka kufooka kwathunthu).

Iliyonse ya mankhwalawa imakhala ndi mawonekedwe ake, omwe adokotala amawaganizira, ndikupanga nthawi yoika wodwala wina. Kusiyanitsa kofunikira kumakhudzana ndi kutalika kwa kuchitapo kanthu.

Glibenclamide ndi gliclazide zimathandizira kuchepetsa shuga kwa maola pafupifupi 12, motero amapatsidwa kawiri patsiku, m'mawa komanso madzulo.

Glycvidone amakhala ndi nthawi yofupikirako, itha kumwa mankhwala katatu patsiku (musanadye chakudya chachikulu).

Nthawi yochepa kwambiri yogwiranso ntchito mokhazikika komanso nateglinide. Mankhwalawa, machitidwewo amayamba mwachangu ndipo amapitilira pokhapokha chakudya chikamakwera. Chifukwa chake, amatchedwa oyang'anira chakudya a shuga.

Kutalika kwakutali ndi glimepiride, mankhwalawa odwala ambiri amatha kugwiritsidwa ntchito kamodzi patsiku. Tsopano palinso mtundu wina wa gliclazide - Diabeteson MV.

Choyipa chachikulu chosagwiritsidwa ntchito ndi mankhwala omwe amapangitsa kuti pakhale insulin ndi hypoglycemia.

Mankhwalawa onse amatsutsana ndi matenda amtundu woyamba wa shuga, kutenga pakati ndi mkaka wa m`mawere, matenda owopsa (kuphatikizapo matenda ashuga, kupindika kwa m'mimba, sitiroko, ndi zina zotere), komanso kusalolera kwa munthu payekha.

Mankhwala a gululi sakupanga nzeru kuphatikiza wina ndi mnzake. Kuphatikizidwa ndi metformin (onani pansipa), mosiyana, kumatha kukhala kothandiza kwambiri. Ena mwa mankhwalawa amatha kugwiritsidwa ntchito bwino limodzi ndi insulin.

Mankhwala a Insulin Sensitization

Gululi limaphatikizapo metformin wodziwika bwino wa mankhwala (Siofor, Glucofage) ndi atsopano - pioglitazone (Actos), rosiglitazone (Avandia).

Metformin imathandizira kuyamwa kwa shuga ndi maselo amthupi popanda kuwonjezera kutulutsa kwa insulin ndi kapamba. Imagwiritsidwa ntchito bwino kwambiri kwa odwala omwe ali ndi matenda a shuga 2 omwe amanenepa kwambiri. Metformin sikukula chilimbikitso (izi nthawi zina zimawonedwa pokonzekera sulfonylurea). Mukamamwa metformin, ndiye kuti palibe hypoglycemia.

Metformin sagwiritsidwa ntchito ngati chiwongola dzanja kapena matenda a impso, kulephera kwa mtima, komanso mapiritsi aliwonse ochepetsa shuga - pakakhala pakati komanso mikhalidwe yovuta kwambiri (matenda ashuga, kugunda kwa mtima, sitiroko, ndi zina).

Metformin itha kugwiritsidwa ntchito limodzi ndi mankhwala omwe amalimbikitsa kutulutsa kwa insulin ndi kapamba, komanso insulin.

Kodi insulin ingafunike liti?

Ngakhale kuti ndi mtundu wachiwiri wa matenda ashuga, chiwindi chake chimatulutsidwa, pakapita nthawi, odwala ena angafunike chithandizo cha insulin.

Izi nthawi zambiri zimakhudzana ndi kuchepa kwa ntchito ya pancreatic, yomwe pazinthu zochepetsetsa zomverera za insulin zimabweretsa kuwonongeka kwakukulu kwa matenda ashuga.

Insulin imalembedwa mtundu wa shuga wachiwiri wa shuga wambiri wokhala ndi shuga wambiri, ngati njira zina zonse zochepetsera sizigwira ntchito (zakudya, masewera olimbitsa thupi, mapiritsi ochepetsa shuga, komanso kuphatikiza kwake).

Kukhazikitsidwa kwa insulin nthawi zambiri kumawopseza wodwala, nthawi zina kwambiri mpaka amakana kulandira chithandizo. Uwu ndi cholakwika cholakwika kwambiri, chifukwa cholinga chachikulu chamankhwala othandizira odwala matenda ashuga ndicho kukhalabe ndi shuga m'magazi momwe angathere.

Kuvulala komwe kumayambitsidwa ndi thupi ndi shuga wambiri sikungafanane ndi zosokoneza kwakanthawi koyamba kwa mankhwala a insulin!

Zosasangalatsa kwambiri (komanso pafupipafupi!) Mkhalidwe uli motere. Insulin imalembedwa ngati wodwala yemwe ali ndi matenda ashuga a 2, koma shuga m'magazi ake akadali okwera. Chowonadi ndi chakuti kungopereka mankhwala a insulin sikutanthauza kutsimikizika kwa kuchuluka kwa shuga m'magazi.

Pambuyo pofotokoza insulini, kupweteka kwakanthawi komanso ntchito yayitali kumatsalira kwa adokotala komanso kwa wodwala. Ndikofunikira kuwonjezera chiwongolero cha mafuta amwazi, kudziwa bwino zatsopano (lingaliro la "mkate mkate" monga kuchuluka kwa chakudya, ndi zina) ndi maluso (njira ya jakisoni, ndi zina).

Ndikofunikanso kumvetsetsa kuti mlingo wa insulin kuti mupeze chipukutiro cha odwala omwe ali ndi matenda a shuga a 2, atapatsidwa chidwi, amatha kukhala okwera kwambiri. Odwala nthawi zina amawopa kuchuluka kwa insulin "yayikulu", ngakhale siyikhala yovulaza payokha, chifukwa imakhala m'thupi la munthu aliyense.

Zotsatira zosafunikira za mankhwala a insulin zingakhale kuwonda. Izi zikuyenera kukumbukiridwa, ndipo ngati izi zachitika, yesetsani kuchepetsa kuchuluka kwa kalori.

Nthawi zina, insulini ingafunike ngati muyeso wakanthawi. Izi ndizotheka ndi matenda oopsa, monga chibayo, njira zothandizira, kugunda kwamtima, kugunda, etc.

Chowonadi ndi chakuti kuphwanya kwakukulu kulikonse mthupi kumayambitsa kuwonongeka kwa shuga m'magazi. Vutoli lingathe kuwopseza chitukuko cha matenda ashuga. Nthawi ya insulin yothandizira odwala matenda ashuga omwe amakhala ndi shuga imakhala nthawi zosiyanasiyana, nthawi zambiri mpaka pakukhazikika. Kenako, motsogozedwa ndi shuga m'magazi, insulin ikhoza kuthetsedwa. Kuphatikiza apo, insulini imalembedwa kwakanthawi kwa opaleshoni yayikulu.

I.I. Dedov, E.V. Surkova, A.Yu. Zazikulu

General malangizo a mankhwala a 2 shuga

Chimodzi mwazinthu zazikulu zothandizira bwino matenda ndi matenda oyamba kwambiri. Njira zamakono zofufuzira zimatha kuzindikira kupatuka pa siteji yophwanya yankho lolondola la maselo pakuwonjezeka kwa shuga m'magazi.

Pambuyo pakuzindikira, ntchito zamtopola zimagwiritsidwa ntchito, zomwe zimapangitsa kuti zikwaniritse zomwe mukufuna glycemic panthawi yochepa kwambiri. Mankhwala onse a mono-ndi osakaniza angagwiritsidwe ntchito, lingaliro lenileni limapangidwa ndi adotolo kutengera gawo ndi mawonekedwe a matendawa.

Pambuyo pakuwunika kawirikawiri kuchipatala kutengera zomwe zapezedwa, njirayi imatha kusintha. Kuphatikiza apo, ngati kuli kotheka, mankhwala a insulin amachitidwa, chifukwa cha zomwe zolakwika za carbohydrate metabolism zimalipiridwa.

Zisonyezo zoika mankhwala, gulu la mankhwala

Pambuyo pakuyamba kumwa mankhwala, mwayi wodziyambiranso wa insulin katulutsidwe m'makhalidwe ofunikira amachepetsedwa kwambiri, nthawi zambiri, chitsulo chimafikira kwathunthu. Pambuyo pakupezeka kwa matenda oyambira m'magawo oyambirira, njira zopezera zakudya, kuchuluka kwa ntchito zamagalimoto ndi kusintha kwa moyo kumayesedwa. Pokhapokha ngati kuyesa kuchiza matenda omwe ali ndi njira izi sikuthandiza, chithandizo chamankhwala chimayikidwa.

Mankhwala amkamwa amagawidwa m'mitundu itatu.

Mitundu ya mankhwala ochepetsa shuga

Mitundu ya mankhwala ochepetsa shuga

Mankhwala omwe amapezeka ndi mankhwala ena atha kuchitika pokhapokha mutazindikira koyenera. Zochita za zinthu zomwe zikuyenera kugwira ntchito zikuyenera kufanana ndi zomwe zimayambitsa matenda a shuga a mtundu wachiwiri ndipo cholinga chake ndi kuti athetse. Mndandanda wa mankhwala omwe amagwiritsidwa ntchito kwambiri akufotokozedwa.

Ma secretogens (zolimbikitsa insulini)

Mankhwala odziwika kwambiri, opangidwa pamaziko a sulfonylurea, amadziwika ndi mphamvu zosiyanasiyana komanso kuchuluka kwa mayamwidwe. Mlingo wokhazikika umafunika, bongo wambiri ungayambitse hypoglycemia. Awa ndimatenda am'mimba omwe amayamba chifukwa cha kuchepa kwambiri kwa kuchuluka kwa shuga m'magazi. Magawo am'mapapo amadziwika ndi khungu lotumbululuka, thukuta, komanso tinthu tambiri. Mitundu yayikulu, kusokonezeka kwa chikumbumtima, kusokonezeka kwa mawu, kuchepa kwa mayendedwe ndi kusintha zimawonekera. Wodwalayo amatha kugwa.

Maselo a pancreatic beta amalimbikitsidwa ndi chinthu chogwira ntchito, chomwe chimayambitsa kuwonjezeka kwa insulin katulutsidwe. Kutalika kumachepetsedwa ndi kuchuluka kwa maselo.

1. Mapindu ake. Ali ndi mankhwala oti achire, amachepetsa HbA1C ndi 2%, komanso amathandizira kubisala. Ndi njira za potaziyamu zokha zomwe zimatsekedwa. Odwala omwe amamwa mankhwalawa sangasamutsidwe kupita ku insulin pa gawo la coronary syndrome.
2. Zoyipa. Pa phwando, phokoso lanjala limawonekera, kulemera kwa wodwalayo kumawonjezeka mofulumira.

Zotsatira zake zimaphatikizapo kutenga pakati komanso kuyamwitsa, kusowa kwa ma cell a beta, atrophy ya chithokomiro.

Maninil

Mankhwala amakono, ndi am'badwo wachiwiri, ali ndi mphamvu yotsitsa shuga. Amapangidwa ndi maselo a chiwindi, samakhudza impso. Mlingo wambiri watsiku ndi tsiku sungadutse 20 mg, kwa anthu okalamba mlingo umachepetsedwa mpaka 10 mg. Mapiritsi amatengedwa kawiri pa tsiku, mlingo umasinthidwa poganizira kuopsa kwa matendawa. Zotsatira zake zimayesedwa pambuyo pa masabata anayi akugwiritsika ntchito mosalekeza, ngati kusintha kwakukwanira sikokwanira, ndiye kuti muyenera kusinthira ndikuphatikiza chithandizo.

Diabetes

Ili pamalo achiwiri pafupipafupi a makonzedwe, kuyerekezera kuchuluka kwa insulini kwaposachedwa, sikungochepetsa shuga wamagazi, komanso kusintha magawo ake a rheological. Imakhala ndi phindu pakupereka magazi, sikuloleza kukula kwa ma cell a retinal, ndikuwonetsa katundu wa antioxidant. Kutengera ndi gawo la matendawa, lingagwiritsidwe ntchito kamodzi kapena kawiri pa tsiku. Zotsatira zoyambirira zimatsimikiziridwa sabata pambuyo poyambira kutsata, kuwonjezeka kwa tsiku ndi tsiku kumaloledwa pokhapokha kuwunika mkodzo ndi magazi. Kudya wambiri sikungathe kupitirira 320 mg / tsiku.

Glimepiride

Amatengera mankhwala a m'badwo wachitatu, omwe amatulutsa insulin kwa maola 24, amatha kupatsidwa infracation ya myocardial. Pambuyo makonzedwe, thupi samadzikundikira, chifukwa cha mkodzo ndi ndowe. Amatengedwa kamodzi patsiku, gawo la digiri ndi mlingo woyambirira ndi 1 mg. Kuwunika kwa machitidwewo kumachitika pambuyo pa sabata lamankhwala, kusintha kwa kuchuluka kwa mankhwala komwe kumaloledwa kumachitika pokhapokha kuwunika mkodzo ndi magazi. Mukasinthira ku mankhwala ena, kuchuluka pakati pa milingo yamankhwala osiyanasiyana sikungadziwike.

Alpha Glucosidase Inhibitors

Mankhwala ochepetsa shuga: alpha glucosidase inhibitors

M'dziko lathu, kuchokera ku banja lalikulu la mankhwalawa ogwira ntchito, wothandizira m'modzi yekha ndiye adadutsa boma kulembetsa - acarbose. Acarbose imagwira ntchito ngati zosefera, kuletsa zovuta zamatumbo kuti zisatengeke m'magazi. Amamangirira ku enzyme yamatumbo ang'onoang'ono ndipo samalola kuti igwetse ma polysaccharides ovuta. Chifukwa chake, chitukuko cha hyperglycemia chimaletsedwa.

1. Mapindu ake. Sizikhudzanso kuchuluka kwa glucose, sizimalimbikitsa kupanga kwake. Zabwino pazokhudza thupi, wodwalayo amayamba kuchepa thupi pang'ono. Zotsatira zake zimatheka chifukwa chakuti glucose wocheperako pang'ono amalowa m'thupi. Pochita, zatsimikiziridwa kuti chifukwa chogwiritsa ntchito acarbose nthawi yayitali, kupita patsogolo kwa mitsempha ya mitsempha imachepetsa, amawonjezera mawonekedwe awo, ndipo minyewa yosalala ya makoma a capillary imakhala bwino. Mankhwalawa samatengedwa m'magazi, omwe amachotsa kupezeka kwa ziwalo zamkati.
2. Zoyipa. M'matumbo, chifukwa cha kuchuluka kwa chakudya chambiri chopanda michere, kupatsa mphamvu kumayamba, komwe kungayambitse kutulutsa ndi m'mimba. Kugwiritsa ntchito bwino kwa mankhwalawa ndizocheperako poyerekeza ndi metformin ndi sulfonylurea.

Sizoletsedwa kwa odwala matenda a chiwindi, kutupa kosiyanasiyana kwamatumbo, kulephera kwa impso, amayi oyembekezera komanso oyembekezera. Zotsatira zoyipa sizimachitika.

Amamwa musanadye, mlingo woyambirira umakhala katatu katatu 50 mg aliyense. Pambuyo pa milungu 4 mutamwa mankhwalawa, muyenera kupuma.

Glucobay

Pseudotetrasaccharide wa michere yoyambira, imakhudza kuchuluka kwa glucose wofikika, imakhazikika m'magazi ake masana. Kuzindikira kwakukulu kumachitika patatha maola awiri pambuyo pa kukhazikitsidwa, kumatsitsidwa ndi matumbo (50%) ndi impso (50%). Kuchita bwino kumayesedwa pambuyo pa masabata anayi a mankhwala, monga momwe zikuwonekera, mlingo wa tsiku ndi tsiku umatha kuchuluka mpaka 200 mg katatu patsiku. Kugwiritsa ntchito kophatikiza ndi adsorbents sikulimbikitsidwa.

Miglitol

Ndi choletsa alpha glucosiad, mankhwala a hypoglycemic. Mlingo woyambirira wa 25 mg katatu patsiku, kuyesedwa kwa mphamvu kumachitika pambuyo pa masabata pafupifupi 4-8. Kutengera ndi mayeso a labotale, mlingo umasinthidwa ndipo umatha kukwera mpaka 100 mg nthawi imodzi. Zotsatira zoyipa, kutulutsa, kutsegula m'mimba, kuwonekera kwa pakhungu komanso kawirikawiri zotupa pakhungu kumatha kuchitika. Iwo ali osavomerezeka kuti atenge ndi matumbo matenda, kutsekeka kwa m'matumbo ang'ono ndi zilonda zam'mimbazi. Imachepetsa kupezeka kwa propranolol ndi ranitidine.

Oxide

Wolepheretsa mpikisano wa alpha-glucose omwe amaphwanya polysaccharides. Imalepheretsa kupangika kwa shuga, kumapangitsa kutsika kwake m'magazi. Sichikukhudzana kwambiri ndi ntchito ya c-glucosidase. Mankhwalawa amalowetsedwa pang'ono m'magazi, omwe amachepetsa chiopsezo cha kuyipa kosavomerezeka ndipo amachotsedwa mwachangu mthupi ndi ndowe. Sizoletsedwa kuperekera odwala matenda ashuga pambuyo pa zovuta pakuchita opareshoni ndi m'matumbo.

Kukonzekera kwa Glitazone

Mankhwala masiku ano amagwiritsa ntchito othandizira awiri am'mgulu lino: pioglitazone ndi rosiglitazone.

Zinthu zomwe zimagwira zimapangitsa kuti maselo a minofu ndi adipose apangidwe, zomwe zimapangitsa kuti kuchuluka kwa insulini kupanga. Tizilombo ta zotumphukira zimayamba kuyankha bwino kupezeka kwa insulin.

1. Mapindu ake. Amaganizira mankhwala othandiza kwambiri pakati pa mankhwala amkamwa. Chifukwa chotseka kwa lipolysis m'magazi, kuchuluka kwamafuta am'mafuta amachepetsa, minofu imagawidwanso kwa subcutaneous. Zinthu zomwe zimagwira ntchito zimachulukitsa kuchuluka kwa lipoproteins yapamwamba, kutsitsa milingo ya triglycerides.
2. Zoyipa. Zosokoneza bwino magwiridwe antchito a mtima, monotherapy amachepetsa thupi la HbA1C. Kugwiritsa ntchito nthawi yayitali kungayambitse kuchuluka kwa thupi.

Ntchito ngati monopreparations kapena kuphatikiza ndi zida zina zamankhwala. Nthawi zina zimayambitsa kusungunuka kwa madzi m'thupi, kuchepa kwa magazi m'thupi komanso kupatuka kwa michere ya chiwindi kuchokera ku chizolowezi.

Mdyerekezi wamba

Imakhazikitsidwa moyenera pa monotherapy ya odwala onenepa kwambiri, imalimbikitsa ma gamma receptors. Kuchulukitsa kugwiritsidwa ntchito kwa glucose, kumawongolera kuyika kwa plasma. Kugwiritsira ntchito nthawi yayitali pakachulukidwe Mlingo kumapangitsa kuti muwoneke komanso kugona. Nthawi zina zimathandizira matenda opatsirana a kupuma.

Phuli

Zimapangitsa ma γ-receptors omwe amagwira nawo ntchito yochepetsera kuchuluka kwa shuga m'magazi, amachepetsa kuchuluka kwa triglycerides. Imakhala ndi kuyamwa kwakukulu, imachotsedwa m'thupi la wodwalayo ndi ndulu, ndende yambiri m'magazi imatha kufikira maola 24. Kuzunzanitsa koyenera kumafuna masiku asanu ndi awiri. Osavomerezeka kuti agwiritsidwe ntchito ndi amayi apakati ndi amayi oyamwitsa.

Avandia

Kuchulukitsa kumverera kwamafuta minofu yolandila ku insulin, kusunga ndi kubwezeretsa ntchito yachilengedwe ya maselo a beta. Momwe zimachepetsera kuchuluka kwa mafuta acids, zimapangitsa kuti glycemic control. Ndi zoletsedwa kutenga odwala omwe ali ndi hypersensitivity ku rosiglitazone, amayi oyamwitsa ndi amayi apakati.

Kuphatikiza mankhwala

Ngati monotherapy yawonetsa kuti siyothandiza ngakhale pa mlingo waukulu, ndiye kuti chithandizo chamankhwala angapo chiyenera kuyikidwa. Kusankha kwina kumapangidwa poyang'ana mawonekedwe a matendawo ndi kuthekera kwa thupi la wodwalayo. Nthawi zambiri, mankhwalawa amasankhidwa omwe amakhudza kuwonjezeka kwa insulin katulutsidwe komanso chidwi cha zotumphukira. Mankhwala achiwiri amawonjezeredwa pokhapokha atawunika, pomwe mlingo woyambayo sunachepe.