Mapiritsi ochepetsa shuga m'magazi: mitundu ndi magwiridwe antchito a shuga

Mankhwala ambiri odziwika a kagayidwe kachakudya kagayidwe kazakumwa kamavulaza. Kulandila kwawo kuyenera kusiyidwa, ndikuwasinthanitsa ndi njira yothandizira matenda a shuga a 2. Phunzirani momwe mungachepetse magazi ndikuwakhazikika. Tsambali endocrin-patient.com imaphunzitsira momwe angayendetsere kagayidwe kazakudya kosasokoneza popanda kufunika kumwa mapiritsi owopsa komanso okwera mtengo, komanso osasala kudya komanso jakisoni wa Mlingo waukulu wa insulin. Pansipa mupeza mndandanda wa mankhwala omwe luso lawo lochiritsira matenda a shuga limadzetsa vuto.

Zambiri pazamankhwala omwe Dr. Bernstein amagwiritsa zimafalitsidwa pano. Wakhala akudwala matenda ashuga amtundu woyamba kwa zaka zopitilira 70. Anatha kukhala ndi moyo zaka 83, kupewa mavuto akulu, kukhalabe ndimaganizo komanso kukhala ndi thupi labwino. Mwa odwala ake, ambiri ndi anthu odwala matenda ashuga a 2, chifukwa nthendayi imachulukapo ka 9-10 kuposa kuukira kwa autoimmune pa kapamba. Pochiza matenda a shuga a mtundu wa 2, Dr. Bernstein adadzazanso dzanja lake pazaka 30 akuchita.

Mankhwala omwe alembedwa pansipa amapangitsa kuti kapamba apange insulin yambiri. Dr. Bernstein akuwonjeza kuti ndi zovulaza, kulandira kwawo kuyenera kuyimitsidwa. Muli ndi mapiritsi abwino komanso otetezeka momwe mungagwiritsire ntchito shuga anu kukhala abwinobwino.

Mankhwala owopsa - onse omwe amaphatikizidwa ndi gulu la sulfonylureas, komanso glinids (meglitinides). Izi ndi zida zotchuka Diabeteson MV, Amaril, Maninil, Glidiab, Glyurenorm, NovoNorm ndi mayendedwe awo.

Kodi chifukwa chiyani mankhwalawa omwe amachititsa kuti kapamba apange insulin yambiri?

1. Samachiza matenda amtundu wa 2 shuga, koma amawonjezera zovuta za metabolic zomwe zimayambitsa. Odwala omwe ali ndi magazi, kuchuluka kwa insulini ndikokwanira kuposa kwazonse, koma maselo sazindikira. Ndikofunikira kubwezeretsa izi, osachulukitsa katundu pa kapamba.
2. Kuchuluka kwa insulini m'magazi kumatsekereza kuchepa kwa minofu ya adipose, ndikuchepetsa kuchepa kwa thupi. Zimayambitsanso vasospasm ndikusunga madzi owonjezera mthupi. Izi zimapangitsa edema, kukula kwa matenda oopsa komanso kulephera kwa mtima, kumawonjezera mwayi wolimbana ndi matenda a mtima komanso sitiroko.
3. Kumwa mankhwala osokoneza bongo kumayika nkhawa kwambiri pakupanga insulin m'thupi. Zotsatira zake, kapamba amatha, pakapita nthawi, matendawa amakhalanso amtundu woyamba wa shuga, momwe mapiritsiwo samathandizanso.
4. Mankhwalawa amatha kuchepetsa shuga m'magazi, ndikupangitsa zizindikilo, kuphatikizaponso kusazindikira ndi kufa. Vutoli limatchedwa hypoglycemia. Ndi chithandizo china, mutha kusunga shuga wabwinobwino popanda chiopsezo cha hypoglycemia.

Mankhwala a Diabeteson MV, Amaryl, Maninil, Glidiab, Glurenorm, NovoNorm ndi kufananiza kwawo kumathandizira kuti matendawa akhale ovuta a 1 shuga.

Odwala amayamba kuchepa thupi. Mapiritsi nthawi zambiri amasiya kuthandizira, shuga yamagazi imathamangira ku 13-15 mmol / l ndi kukwera. Pakadali pano, ndikufunika kuyamba kubayitsa insulin, apo ayi wodwalayo amagwa ndikumwalira. Nthawi zambiri, mpaka kapamba atatha, zimatenga zaka 4-8. Komabe, anthu owonda omwe adapezeka kuti ali ndi matenda osokoneza bongo a 2, amatenga mankhwala oopsa kumanda mwachangu kwambiri - zaka 1-2.

Mafuta otsogola amawononga mtima ndi mtima. Chifukwa chake, odwala ambiri omwe ali ndi matenda amtundu wa 2 samakhala ndi moyo mpaka atayamba kudwala matenda ashuga amtundu woyamba. Nthawi zambiri amafa ndi vuto la mtima kapena sitiroko.Odwala omwe ali ndi mwayi wokhala obadwa ndi mtima wolimba amakhala nthawi yayitali koma amavutika ndi zovuta m'maso, miyendo, ndi impso. Ngati izi sizikugwirizana ndi inu, werengani momwe mungachepetsere shuga wamagazi, tsatirani malingaliro a Dr. Bernstein ndikukana kumwa mankhwala owopsa.

Mutha kupeza ndemanga zambiri za odwala matenda ashuga za mankhwala omwe atchulidwa pamwambapa. Inde, mankhwalawa mwachangu komanso mwamphamvu amachepetsa shuga la magazi. Poyamba, zizindikiritso za glucometer zimasangalatsa odwala, koma zimatheka chifukwa chakuchulukitsa kudalirika kwa nthawi yayitali. Pakatha zaka zochepa, kumwa mankhwala ovulaza kumatha kulepheretsa maselo a pancreatic beta. Matendawa amasandulika kukhala mtundu woyamba wa matenda ashuga, pokhapokha ngati mtima wopha kapena matenda opha ziwopsezo zimachitika kale.

Onani vidiyo yokhudza momwe wodwala matenda a shuga a 2 adasinthira moyo wake ndikuchira popanda mapiritsi ndi insulin.

Kanemayo sanena kuti ngwazi yake idasinthira pakudya chamafuta ochepa. Koma dziwani kuti anatero. Chifukwa palibe njira ina.

Mapiritsi a shuga osavulaza amachepetsa shuga, koma achulukitse kufa kwa odwala. Madokotala ambiri amadziwa izi, komabe akupitiliza kulemba Diabeteson MV, Amaril, Maninil, Glidiab, Glyurenorm, NovoNorm ndi mayendedwe awo. Mu 2010, kafukufuku wamkulu wa ACCORD adalengezedwa. Adayesa njira zitatu zochizira matenda amtundu wa 2. Kwa odwala omwe amatenga mankhwala a sulfonylurea, kufa kwawo kunali kokulirapo kuposa m'magulu ena. Pambuyo kanthawi, mapiritsi wamba a Diabetes adachotsedwa pamsika, ndikungosiya Diabeteson MV, yomwe singawononge kapamba mwachangu kwambiri, koma idavulaza.

Mitundu ya 2 ya matenda ashuga siyabwino?

Mankhwala othandiza kwambiri, osapweteka, komanso opindulitsa a shuga amatchedwa metformin. Imatsitsa shuga, imathandizira kuchepetsa thupi, imasintha zotsatira za kuyesa kwa magazi kwa cholesterol. Mankhwalawa amatalikitsa moyo wa anthu odwala matenda ashuga komanso, mwina, ngakhale anthu athanzi. Makamaka, dokotala wotchuka Elena Malysheva adapangitsa kuti metformin ikhale yotchuka ngati mankhwala ochizira.

Glucophage ndi Glucophage Long, komanso Siofor, ndi mapiritsi otchuka omwe kaphatikizidwe kake ndi metformin. Ena mwa mankhwalawa amayenera kukhala gawo la mtundu wanu 2 wodwala matenda a shuga. Komabe, metformin imagulitsidwanso ngati mankhwala osakanikirana ndi zotumphukira zoopsa za sulfonylurea. Sayenera kumwedwa kuti apewe mavuto omwe atchulidwa pamwambapa.

Opanga mankhwala ovulaza amitundu yachiwiri ya shuga ayesa kutsimikizira madokotala ndi odwala kuti palibenso njira ina yothandizira mapiritsi awa. Monga, ngati wodwalayo sakufuna kuyamba kubaya insulin, ndiye kuti alibe chithandizo china. Izi sizowona. Zakudya zama carb zotsika zimachepetsa shuga m'magazi ndipo zimachotsa zovuta za metabolic zomwe zimachitika kwa odwala matenda ashuga komanso onenepa kwambiri.

Werengani nkhani "Zakudya za Type 2abetes" mwatsatanetsatane. Mothandizidwa ndi glucometer yolondola, mutha kuwonetsetsa kuti njira zamankhwala zomwe zafotokozedwera patsamba lino zikuyenda bwino. Shuga amatsika pambuyo pa masiku atatu okha, thanzi limakhalanso bwino.

Mitundu ya Matenda A shuga

Chithandizo cha matenda a shuga chimatengera zomwe zimayambitsa ndi mtundu wa matenda. Pali mitundu inayi ya mitundu yake.

1. Mtundu woyamba wa shuga. Choyambitsa matendawa ndi kuchepa kwa maselo a pancreatic beta omwe amapanga insulini, zomwe zimachitika chifukwa cha autoimmune reaction. Matenda amtunduwu amangothandizidwa ndi kukonzekera kwa insulin.
2. Type 2 shuga. Pakatikati pa matendawa ndi kusazindikira kwa maselo a thupi kupita ku insulin. Kumayambiriro kwa matendawa, kuchuluka kwa insulini kumapangidwa, zomwe zimapangitsa kuti wodwalayo asazindikire kuchuluka kwa glucose m'magazi. Matendawa akamapitirira, katemera wa insulini ndi kapamba amakhala wosakwanira, komwe kumayambitsa matenda a hyperglycemia komanso kukula kwa matenda. Ndi chithandizo cha matenda amtunduwu omwe mapiritsi ochepetsa shuga amagwiritsidwa ntchito. Komanso, udindo wokhala ndi moyo wathanzi mwa odwalawa ndikofunikira, ndipo chithandizo chamankhwala chogwiritsidwa ntchito ndi mapiritsi chimangowonedwa ngati chachiwiri.
3. Matenda a shuga Itha kuphatikizidwa ndi matenda angapo, kusintha kwa majini, kuwonongeka kwa kapamba chifukwa cha mowa kapena mankhwala osokoneza bongo. Zikatero, chithandizo chimakhala chovuta chifukwa cha kuchuluka kwa glucagon (mahomoni amenewa amawonjezera kuchuluka kwa shuga m'magazi). Popeza tanthauzo lenileni la matendawa ndi losakwanira katemera wa insulin, mankhwalawa amaphatikizapo kuperekera insulin ndi jakisoni.
4. Matenda a shuga. Kupanda kutero, matenda a shuga. Pankhaniyi, kudya okhwima ndi zolimbitsa thupi zotchulidwa. Ndipo pakalibe mphamvu - jakisoni wa insulin, popeza mapiritsi amakhudza mwana wosabadwayo.

Mankhwala odziwika komanso othandiza ochepetsa shuga m'magazi a shuga: kuwunika, malangizo ogwiritsira ntchito

Matenda a shuga tsopano ali vuto lodziwika bwino. Kupatula apo, kusokoneza magwiridwe antchito a kapamba ndizosavuta kwambiri. Izi zitha kuchitika chifukwa cha kupsinjika kwakukulu, kusowa kwa chakudya, kusakhala ndi chizolowezi chomwa madzi komanso moyo wopanda nkhawa. Anthu onenepa kwambiri nawonso ali pachiwopsezo. Monga lamulo, pamaso pa zovuta za kapamba, kapangidwe ka insulin, kamene kofunikira pa kagayidwe kazakudya, kamasokonekera. Opitilira 80 peresenti ya anthu omwe akupitiliza kuchuluka kwa glucose wamagazi amadwala matenda amtundu wa 2 shuga. Odwala, monga lamulo, safuna jakisoni wokhazikika wa insulin, chifukwa glycemia pankhaniyi imatha kuwongoleredwa mothandizidwa ndi mankhwala amitundu yosavuta yotulutsidwa. Pali mapiritsi ambiri omwe amathandiza kuchepetsa shuga. Njira zoterezi zimagwiranso ntchito pochiza matenda ashuga. Kuphatikiza mitundu yoposa 40 ya mankhwala omwe amagwiritsidwa ntchito pamsika wogulitsa mankhwala popanga zinthu zabwino. Lero tikambirana mndandanda wamankhwala omwe amachepetsa shuga. Komabe, ndi adokotala okha omwe angakupatseni mankhwala oyenera. Osamachita izi nokha.

Mwachidule

Mapiritsi ochepetsa shuga m'magazi, omwe amagwiritsidwa ntchito kukonza zovuta zamtundu wa 2 shuga mellitus, amagawidwa m'magulu angapo. Gulu lawo limatengera njira kapena zochita za mankhwala. Pofuna kuthana ndi hyperglycemia, mankhwala otsatirawa amagwiritsidwa ntchito.

• Zothandiza kuchokera ku sulfonylureas. Mankhwala omwe amalimbikitsa kupangika kwa insulin yanu ya mahomoni ndi ma cell a pancreatic. Izi zikuphatikizapo Glibenclamide ndi Gliclazide. Ubwino wa mankhwalawa ndi mtengo wotsika mtengo, kulekerera kwabwino. Mankhwala okhala ku Sulfanylurea amachepetsa shuga m'magazi, amachepetsa kuchuluka kwa hemoglobin wa 2%.
• Biguanides. Awa ndi mankhwala omwe amasintha ntchito ya insulin ndikulimbikitsa kusinthana kwa shuga m'magazi a thupi. Kuphatikiza apo, amathandiza kuti shuga asamasanduke. Ali ndi matenda ambiri, komabe, ma contraindication ogwiritsa ntchito ndi matenda a impso ndi mtima chifukwa choopsa cha ketoacidosis. Gululi limaphatikizapo Metformin, Glucophage.
• Alfa glucosidase zoletsa. Zitsanzo za mankhwalawa ndi Acarbose ndi Miglitol. Mankhwalawa atha kulepheretsa kugwira ntchito kwa ma enzymes omwe amachititsa kuti magazi asamayende bwino m'mimba, motero kuchepetsa shuga m'magazi. Pogwiritsa ntchito, milingo ya glycated hemoglobin imatsika ndi 0,5-1%. Nthawi zina, zimayambitsa zovuta monga kutulutsa ndi m'mimba.
• Gliids ndi meglitinides. Mankhwala omwe amalimbikitsa katemera wa insulin ndi maselo a pancreatic. Kuchita kwawo kumadalira shuga: kukhathamira kwa glucose, momwe mankhwalawo amagwira ntchito. Chifukwa cha izi, hypoglycemia simachitika panthawi ya chithandizo. Gulu la mankhwalawa limaphatikizapo Novonorm ndi Starlix.
• Dipeptidyl peptidase inhibitors. Mankhwalawa amathandizira kubisika kwa insulini, kuletsa kubisika kwa glucagon. Zitha kugwiritsidwa ntchito pawokha komanso mosagwirizana ndi othandizira ena, monga Metformin. Pafupifupi palibe mavuto, musathandizire kulemera. Chitsanzo cha gululo la ndalama ndi Januvia.
• Ndalama zophatikizika. Amalembedwa chifukwa cha kulephera kwa monotherapy. Mwachitsanzo, piritsi limodzi la Glycovansa limaphatikiza Metformin ndi kukonzekera kwa sulfonylurea, Gliburide.

Zochokera ku sulfonylureas

Pochita za endocrinologists, zotumphukira za sodfanilurea zimagwiritsidwa ntchito nthawi zambiri. Mankhwalawa agwiritsidwa ntchito kwa zaka zoposa 50, amagwira ntchito kwambiri chifukwa chazomwe zimachitika pancreatic function, komanso ali ndi zovuta zochepa.

Zochita zawo zimakhazikitsidwa ndi kukondweretsedwa kwa ntchito ya maselo a pancreatic beta, chifukwa chomwe kupanga kwa insulin kumathandizira, ndipo kuzindikira kwa receptor kumakulitsidwa. Glibenclamide, Gliclazide, Maninil, Amaryl amagwiritsidwa ntchito.

"Diabetes" ndi mankhwala amakono a gululi, omwe ndi othandiza kwambiri, kuphatikiza mitsempha yamagazi pazotsatira zoyipa za hyperglycemia. Mlingo wothandizila ndi kuchuluka kwa mankhwalawa amasankhidwa payekha ndi dokotala, kutengera kuchuluka kwa shuga ndi magazi ena okhudzana ndi matendawa.

Pa chithandizo, ndikofunikira kuyesedwa pafupipafupi, kudziwa kuchuluka kwa shuga ndi glycated hemoglobin. Izi zimachitika pofuna kuwongolera chithandizo ndipo ngati kuli koyenera, chithandizireni. Ubwino wakuchokera ku sulfonylurea ndi:

• zotchulidwa hypoglycemic zotsatira,
• kukondoweza kwa nsonga zoyambirira za kupanga insulin,
• kupezeka muukonde wa mankhwala,
• mtengo wotsika
• njira yolandirira bwino.

Kuphatikiza pazabwino, ndalama izi zimatulutsa zovuta zazikulu.

• Kuchuluka kwachuma, kulemera. Izi zimawonedwa motsutsana ndi maziko ogwiritsa ntchito mankhwala a m'badwo wachiwiri, zimachitika chifukwa cha kukondoweza kwa mathero a insulin secretion mukamamwa mankhwalawa.
• Kulephera kugwiritsa ntchito nthawi zina. Mwachitsanzo, panthawi yoyembekezera, pamene mukuyamwitsa, ndimatenda a chithokomiro, impso ndi chiwindi.
• Chiwopsezo chachikulu cha hypoglycemia. Makamaka ndi mankhwala osokoneza bongo kapena kudumpha zakudya. Kuwongolera mkhalidwe wa hypoglycemic, mankhwala amagwiritsidwa ntchito kuwonjezera shuga: shuga wamagulu, njira zothetsera shuga ndi dextrose, glucagon.
• Zotsatira zoyipa. Khansa ya m'mimba, kutsekula m'mimba ndikotheka.

"Metformin" ("Siofor", "Glucofage") - mapiritsi omwe adapangidwa pamodzi ndi sulfanylurea zotumphukira kapena ngati njira ina.Zimalepheretsa mapangidwe a glycogen mu chiwindi, zimapangitsa chidwi cha zotumphukira zolandilira ku insulin, komanso zimachepetsa kuyamwa kwa mafuta osavuta m'mimba.

Ubwino wa chida ndi:

• Matenda a shuga
• kuchepa kwamafuta akununkhira,
• chiopsezo chochepa cha hypoglycemia,
• matenda a lipid kagayidwe.

Zoyipa za Metformin zimaphatikizapo kuti mukamalandira chithandizo pamakhala mwayi pang'ono wopanga lactic acidosis. Kuwonetsedwa koyambirira kwa vutoli kumaphatikizapo nseru, kusanza, kutsegula m'mimba, kuchepa kwa thupi, kupweteka kwa minofu. Ngati zizindikiro zotere zikuwoneka, muyenera kusiya kumwa mankhwalawo, kukaonana ndi dokotala.

Mankhwala ndi a gulu la oyendetsa sodium-glucose amtundu wachiwiri. Amachepetsa kuchuluka kwa shuga m'magazi mwakuchepetsa mayamwidwe ake m'matumbo am'mimba, chimbudzi chowonjezera mu mkodzo. Mankhwalawa amalekeredwa bwino ndi odwala, nthawi zina akamwedwa, shuga yochepa ndi chizungulire amalemba, zomwe zimachotsedwa ndikusintha kwa Mlingo. Koma "Forksig" silingagwiritsidwe ntchito ndikuwonjezera chidwi cha munthu pazinthu zazikulu kapena zothandizira za mankhwalawa.

Mankhwala azitsamba

Zitsamba zopangira mankhwala, mankhwala othandizira at homeopathic ndi zakudya zowonjezera zakudya zimagwiritsidwa ntchito mu shuga kuchepetsa shuga. Kuphatikiza apo, mankhwala ophatikizika kuchokera ku zomerazi amatha kuledzera kuti azitha kusintha kagayidwe kachakudya, koma onetsetsani kuti mwawaphatikiza ndi zakudya zama carb ochepa komanso zolimbitsa thupi zolimbitsa thupi. Ubwino wazitsamba zimaphatikizapo kulolera bwino, kupezeka.

Zotsatirazi zimawerengedwa kuti ndizothandiza matenda ashuga:

• makungwa ndi masamba a mabulosi oyera,
• msuzi wa oat, odzola,
• sinamoni
• zipatso ndi mabulosi abulu,
• masamba a dandelion
• phulusa laphiri
• chipukutira.

Ngakhale otetezeka komanso kusapezeka kwa zovuta, mankhwala opangidwa ndi mbewu samatha kuchepetsa kwambiri kuchuluka kwa shuga m'magazi omwe ali ndi matenda ashuga, chifukwa chake kugwiritsa ntchito nokha m'malo mwa mapiritsi omwe adalimbikitsa ndi dokotala siotetezeka. Ndipo musanagwiritse ntchito mbeu iliyonse kuti muchepetse shuga, muyenera kufunsa endocrinologist.

Kugwiritsa ntchito mankhwala a shuga

Mankhwala a Diabeteson mu mapiritsi amodzi ndi kumasulidwa kosinthika (MV) amaperekedwa kwa odwala omwe ali ndi matenda a shuga a 2, omwe kudya ndi kuchita masewera olimbitsa thupi samayendetsa bwino matenda. The yogwira pophika mankhwala ndi gliclazide. Ndi m'gulu la sulfonylureas. Gliclazide imalimbitsa maselo a kancreatic pancreatic beta kuti apange ndikusunga insulin yambiri m'magazi, timadzi timene timatsitsa shuga.

Ndikulimbikitsidwa kuti odwala omwe ali ndi matenda a shuga a 2 sayenera kufotokozedwa poyambira, koma mankhwala a Metformin - Siofor, Glucofage kapena Glformin. Mlingo wa metformin pang'onopang'ono umachulukitsidwa kuchokera 500-850 mpaka 2000-3000 mg patsiku. Ndipo pokhapokha ngati mankhwalawo amachepetsa shuga mosakwanira, zochokera ku sulfonylurea zimawonjezeredwa kwa iwo.

Gliclazide mapiritsi otulutsidwa otulutsidwa mosiyanasiyana kwa maola 24. Mpaka pano, machitidwe othandizira odwala matenda ashuga amalimbikitsa kuti madokotala azigwiritsa ntchito Diabeteson MV kwa odwala awo omwe ali ndi matenda a shuga a 2, m'malo mwa m'badwo wam'mbuyomu sulfonylureas. Mwachitsanzo, onani nkhani ya "Zotsatira za kafukufuku wa DYNASTY (" A Diabeteson MV: pulogalamu yowonera pakati pa odwala omwe ali ndi matenda a shuga 2 nthawi zonse azolowera kuchita ")" mu magazine "Matenda a Endocrinology" No. 5/2012, wolemba M. V. Shestakova, O K. Vikulova ndi ena.

Diabeteson MV amachepetsa kwambiri magazi. Odwala monga choncho ndiosavuta kutenga kamodzi patsiku. Amakhala otetezeka kuposa mankhwala akale - zotumphukira za sulfonylurea. Komabe, zimakhala ndi vuto, chifukwa chake ndibwino kuti odwala matenda ashuga asamamwe.Werengani pansipa zomwe zili ndi vuto la Diabetes, lomwe limafotokoza zabwino zake zonse. Tsamba la Diabetes-Med.Com limalimbikitsa chithandizo chamankhwala amtundu wa 2 wopanda mapiritsi owononga.

• Chithandizo cha matenda a shuga a mtundu wachiwiri: njira yotsatirira - yopanda njala, mankhwala osokoneza bongo komanso jakisoni wa insulin
• Mapiritsi a Siofor ndi Glucofage - metformin
• Momwe mungaphunzirire kusangalala ndi maphunziro akuthupi

Ubwino ndi zoyipa

Chithandizo cha matenda a shuga a mtundu wachiwiri mothandizidwa ndi mankhwalawa a Diabeteson MV zimapereka zotsatira zabwino pakanthawi kochepa:

• Odwala achepetsa shuga la magazi,
• chiopsezo cha hypoglycemia sichikupitilira 7%, chomwe ndi chotsika kwambiri poyerekeza ndi zina zomwe zimachokera ku sulfonylurea,
• ndikwabwino kumwa mankhwalawo kamodzi patsiku, kotero odwala samapereka chithandizo,
• mukumwa mankhwala a gliclazide pamapiritsi otulutsa, thupi la wodwalayo limakulitsidwa pang'ono.

Diabeteson MB yakhala mtundu wotchuka wa mankhwala ashuga a 2 chifukwa ali ndi zabwino kwa madotolo ndipo ndi abwino kwa odwala. Ndiosavuta nthawi zambiri kuti ma endocrinologists akupatseni mankhwala kuposa kulimbikitsa odwala matenda ashuga kuti azitsatira zakudya komanso masewera olimbitsa thupi. Mankhwalawa amachepetsa shuga ndipo amalekeredwa bwino. Palibe oposa 1% ya odwala omwe amadandaula za zoyipa, ndipo ena onse amakhutira.

Zoyipa zamankhwala a Diabeteson MV:

1. Imathandizira kufa kwa maselo a pancreatic beta, chifukwa matendawa amasintha kukhala matenda a 1 a shuga. Nthawi zambiri zimachitika pakati pa 2 ndi 8 zaka.
2. Mwa anthu ochepa thupi komanso owonda, matenda ashuga omwe amadalira insulin amayamba makamaka - osachedwa kuposa zaka 2-3.
3. Sizichotsa zomwe zimayambitsa matenda a shuga a 2 - kuchepa kwa chidwi kwamaselo kuti insulini. Vutoli limatchedwa insulin kukana. Kutenga Diabeteson kumatha kulimbikitsa.
4. Amachepetsa shuga yamagazi, koma samachepetsa kufa. Izi zidatsimikiziridwa ndi zotsatira za kafukufuku wawukulu wapadziko lonse ndi ADVANCE.
5. Mankhwalawa amatha kuyambitsa hypoglycemia. Zowona, kuthekera kwake ndikocheperako poyerekeza ndi kutengedwa kwina kutachitika. Komabe, matenda ashuga amtundu wa 2 amatha kuyendetsedwa mosavuta popanda chiwopsezo cha hypoglycemia.

Akatswiri kuyambira m'ma 1970 adziwa kuti zinthu zochokera ku sulfonylurea zimachokera ku mtundu wachiwiri wa matenda ashuga. Komabe, mankhwalawa akupitilizabe kutumikiridwa. Cholinga chake ndikuti amachotsa mtolo kwa madokotala. Pakanakhala kuti palibe mapiritsi ochepetsa shuga, ndiye kuti madokotala amayenera kulemba zakudya, masewera olimbitsa thupi, ndi mtundu wa insulin kwa aliyense wodwala matenda ashuga. Iyi ndi ntchito yovuta komanso yosayamika. Odwala amakhala ngati ngwazi ya Pushkin: "Palibe zovuta kundinyenga, inenso ndili wokonzeka kudzinyenga." Alola kumwa mankhwala, koma sakonda kutsatira kadyedwe, masewera olimbitsa thupi, komanso makamaka jekeseni wa insulin.

Zowonongeka za Diabeteson pamaselo a beta a kapamba kwenikweni siziwakhudza endocrinologists ndi odwala awo. Palibe zolemba m'magazini azachipatala zokhudzana ndi vutoli. Cholinga chake ndikuti odwala ambiri omwe ali ndi matenda amtundu wa 2 alibe nthawi yopulumuka asanayambe matenda a shuga. Machitidwe awo a mtima ndi cholumikizira chochepa kwambiri kuposa kapamba. Chifukwa chake, amafa ndi vuto la mtima kapena sitiroko. Chithandizo cha matenda a shuga a mtundu 2 pochokera pakudya kopatsa mphamvu ya calcium nthawi imodzi imapangitsa matenda ashuga, kuthamanga kwa magazi, zotsatira za kuyezetsa magazi kwa cholesterol ndi zina zomwe zimayambitsa mtima.

Zotsatira zakuchipatala

Momwe mayeso akulu azachipatala a Diabeteson MV anali kuphunzira VUTO: Chitetezo cha matenda a shuga komanso matenda a VAscular -
preterax ndi Diamicron MR Kuwongoleredwa Kuwunika. Idayambitsidwa mu 2001, ndipo zotsatira zake zidasindikizidwa mu 2007-2008. Diamicron MR - pansi pa dzina ili, glyclazide pamapiritsi osintha osinthika amagulitsidwa ku mayiko olankhula Chingerezi. Izi ndi chimodzimodzi ndi mankhwala a Diabeteson MV.Preterax ndi mankhwala ophatikiza matenda oopsa, zosakaniza zomwe zili indapamide ndi perindopril. M'mayiko olankhula Chirasha, amagulitsidwa pansi pa dzina la Noliprel. Phunziroli lidakhudza odwala 11,140 omwe ali ndi matenda a shuga 2 komanso matenda oopsa. Adawonedwa ndi madotolo kuzipatala 215 zamayiko 20.

Diabeteson MV imatsitsa shuga, koma siyimachepetsa kufa kwa odwala omwe ali ndi matenda ashuga a 2.

Malinga ndi zotsatira za kafukufukuyu, zidapezeka kuti mapiritsi opsinjika mwa odwala omwe ali ndi matenda a shuga 2 amachepetsa pafupipafupi zovuta zamtima ndi 14%, mavuto a impso - mwa 21%, kufa - ndi 14%. Nthawi yomweyo, Diabeteson MV imachepetsa shuga m'magazi, imachepetsa kufalikira kwa matenda ashuga nephropathy ndi 21%, koma sizimakhudza kufa. Gwero la chilankhulo cha ku Russia - nkhani "Chitsogozo chothandizira odwala omwe ali ndi matenda a shuga 2: zotsatira zakufufuza" muzolemba System Hypertension No. 3/8, wolemba Yu. Karpov. Gwero loyambirira - "Gulu la Mgwirizano WABODZA. Kuzindikira kwamphamvu kwa shuga wamagazi ndi zotsatira zake zam'mitsempha mwa odwala omwe ali ndi matenda a shuga a 2 ”mu New England Journal of Medicine, 2008, No. 358, 2560-25252.

Odwala odwala matenda amtundu wa 2 amamulembera mapiritsi ochepetsa shuga ndi jakisoni wa insulin ngati zakudya ndi zolimbitsa thupi sizimapereka zotsatira zabwino. M'malo mwake, odwala safuna kutsatira zakudya zochepa zopatsa mphamvu. Amakonda kumwa mankhwala. Amakhala akukhulupirira kuti njira zina zochiritsira zothandiza, kupatulapo mankhwala ndi jakisoni a milingo yayikulu ya insulin, kulibe. Chifukwa chake, madokotala akupitilizabe kugwiritsa ntchito mapiritsi ochepetsa shuga omwe samachepetsa kufa. Pa Diabetes-Med.Com mutha kudziwa kuti ndizosavuta bwanji kuthana ndi matenda ashuga amtundu wa 2 popanda zakudya za "njala" komanso jakisoni wa insulin. Palibe chifukwa chomwa mankhwala oyipa, chifukwa mankhwalawa amathandizanso.

• Chithandizo cha matenda oopsa kwa odwala omwe ali ndi mtundu woyamba 1 ndi shuga
• Mapiritsi a Pressure Noliprel - Perindopril + Indapamide

Mapiritsi osinthidwa osinthidwa

Diabeteson MV - mapiritsi osinthidwa amasinthidwe. Chithandizo - gliclazide - chimamasulidwa kwa iwo pang'onopang'ono, osatero nthawi yomweyo. Chifukwa cha izi, kuphatikizika kwa gliclazide m'magazi kumakhalabe kwa maola 24. Imwani mankhwalawa kamodzi patsiku. Monga lamulo, limayikidwa m'mawa. Common Diabeteson (wopanda CF) ndi mankhwala achikulire. Piritsi lake limasungunuka kwathunthu m'matumbo atatha maola awiri ndi atatu. Gliclazide yonse yomwe imakhala imalowa nthawi yomweyo m'magazi. Diabeteson MV imatsitsa shuga bwino, komanso mapiritsi wamba, ndipo zotsatira zake zimatha msanga.

Mapiritsi amasinthidwe amasinthidwe amakono ali ndi phindu lalikulu pamankhwala okalamba. Chachikulu ndichakuti amakhala otetezeka. Diabeteson MV imayambitsa hypoglycemia (kutsitsidwa shuga) kangapo poyerekeza ndi a Diabetes omwe amapezeka nthawi zonse ndi ena amachokera ku sulfonylurea. Malinga ndi kafukufuku, chiopsezo cha hypoglycemia sichidutsa 7%, ndipo nthawi zambiri chimatha popanda zizindikiro. Poyerekeza ndi pobwera kuti mupeze mtundu watsopano wamankhwala, matenda oopsa a hypoglycemia omwe ali ndi vuto losokonezeka samachitika kawirikawiri. Mankhwalawa amalekeredwa bwino. Zotsatira zoyipa zimadziwika mu zosaposa 1% za odwala.

Mu zolemba m'magazini azachipatala, adziwe kuti molekyulu ya Diabeteson MV chifukwa cha mawonekedwe ake apadera ndi antioxidant. Koma izi zilibe phindu lenileni, sizikhudza kuthandizira kwa chithandizo cha matenda ashuga. Amadziwika kuti Diabeteson MV imachepetsa mapangidwe amwazi m'magazi. Izi zimachepetsa chiopsezo cha stroke. Koma palibe komwe kwatsimikiziridwa kuti mankhwalawa amaperekadi zoterezi. Zoyipa zamankhwala a shuga, zotumphukira za sulfonylurea, zidalembedwa pamwambapa. Mu Diabeteson MV, kutayikira kumeneku sikumatchulidwa kwenikweni poyerekeza ndi mankhwala akale. Imakhudzanso pang'ono ma cell a beta a kapamba. Mtundu wa 1 wa inshuwaransi sukutuluka mwachangu.

Momwe mungamwe mankhwalawa

Diabeteson MV imatengedwa kamodzi patsiku, nthawi zambiri imakhala ndi kadzutsa. Piritsi la 60 mg lochekera limatha kugawidwa m'magawo awiri kuti mupeze mlingo wa 30 mg. Komabe, sichitha kutafunidwa kapena kuphwanyidwa. Tengani mankhwalawo ndi madzi. Webusayiti ya Diabetes-Med.Com imalimbikitsa mankhwala othandizira odwala matenda ashuga amtundu wa 2. Amakulolani kuti musiye matenda a shuga, kuti musayang'anitsidwe ndi zovuta zake. Komabe, ngati mumamwa mapiritsi, tsiku lililonse osapeza mipata. Popanda apo shuga amakwera kwambiri.

Kuphatikiza pa kutenga matenda a shuga, kulekerera mowa kumatha kukulirakulira. Zizindikiro zake ndi kupweteka mutu, kufupika, kupweteka kwam'mimba, mseru komanso kusanza.

Mitengo yotsatira ya sulfonylureas, kuphatikiza Diabeteson MV, si mankhwala oyamba ashuga amitundu iwiri. Mosavomerezeka, ndikulimbikitsidwa kuti odwala azisankhidwa choyamba mapiritsi a metformin (Siofor, Glucofage). Pang'onopang'ono, mlingo wawo umakulitsidwa mpaka pazochulukirapo 2000-3000 mg patsiku. Ndipo pokhapokha ngati izi sizikwanira, onjezerani Diabeteson MV. Madokotala omwe amapereka mankhwala a shuga m'malo mwa metformin amalakwitsa. Mankhwalawa onse akhoza kuphatikizidwa, ndipo izi zimapereka zotsatira zabwino. Kupitilira apo, sinthani ku pulogalamu yachiwiri ya matenda ashuga kukana mapiritsi owononga.

Zomwe zimachokera ku sulfonylureas zimapangitsa khungu kumvetsetsa kwambiri ma radiation ya ultraviolet. Chiwopsezo cha kutentha kwa dzuwa chikuwonjezeka. Ndikulimbikitsidwa kugwiritsa ntchito ma sunscreens, ndipo ndibwino kuti musayake ndi dzuwa. Ganizirani za chiopsezo cha hypoglycemia chomwe Diabeteson angayambire. Mukamayendetsa kapena kugwira ntchito yoopsa, yesani shuga yanu ndi glucometer mphindi 30-60 zilizonse.

Ndani sakukwanira

Diabeteson CF sayenera kumwedwa ndi aliyense, chifukwa njira zina zochizira matenda ashuga 2 zimathandiza ndipo sizimayambitsa mavuto. Zoponderezedwa ndi boma zalembedwa pansipa. Dziwani kuti ndi magulu ati a odwala omwe akuyenera kupatsidwa mankhwalawa mosamala.

Pakakhala pakati komanso poyamwitsa, mapiritsi aliwonse omwe amachepetsa shuga amakhala otsutsana. Diabeteson MV siikuperekedwa kwa ana ndi achinyamata, chifukwa kugwira ntchito ndi chitetezo cha gululi sichinakhazikitsidwe. Musamamwe mankhwalawa ngati m'mbuyomu simunakhale nawo kapena mankhwala ena a sulfonylurea. Mankhwalawa sayenera kumwa ndi odwala omwe ali ndi matenda amtundu woyamba 1, ndipo ngati muli ndi vuto losakhazikika la 2 shuga, nthawi zambiri za hypoglycemia.

Zotumphukira za Sulfonylurea sizingatengedwe mwa anthu omwe ali ndi matenda owopsa a chiwindi ndi impso. Ngati muli ndi matenda ashuga a nephropathy - kambiranani ndi dokotala. Mwambiri, amalangizanso kulowetsa mapiritsiwo ndi jakisoni wa insulin. Kwa okalamba, Diabeteson MV ndi yoyenera ngati chiwindi ndi impso zawo zimagwira bwino. Mosavomerezeka, zimapangitsa kusintha kwa mtundu wa 2 shuga kukhala mtundu wovuta kwambiri wa insulin wodalira inshuwaransi. Chifukwa chake, odwala matenda ashuga omwe akufuna kukhala ndi moyo wautali popanda zovuta, ndibwino kuti asamwe.

Kodi Diabeteson MV imalembedwa mosamala nthawi ziti?

• hypothyroidism - ntchito yofooka ya chithokomiro komanso kusowa kwa mahomoni ake m'magazi,
• kuchepa kwa mahomoni opangidwa ndi tiziwalo timene timatulutsa timadzi tambiri,
• zakudya zosakhazikika
• uchidakwa.

Diabeteson analogues

Mankhwala oyamba a Diabeteson MV amapangidwa ndi kampani yopanga mankhwala Laboratory Serviceier (France). Kuyambira mu Okutobala 2005, adasiya kupereka mankhwala am'badwo wapitalo ku Russia - mapiritsi a shuga a shuga a 80 mg. Tsopano mutha kugula kokha mapiritsi a Diabeteson MV - mapiritsi otulutsidwa amasinthidwe. Fomu ya Mlingo iyi ili ndi zabwino zake, ndipo wopanga adaganiza zokhazokha. Komabe, gliclazide pamapiritsi otulutsira mwachangu imagulitsidwa. Izi ndi fanizo za Diabetes, zomwe zimapangidwa ndi opanga ena.

Kukonzekera komwe kaphatikizidwe kake ndi gliclazide mu mapiritsi otulutsira msanga tsopano kwatha. Ndikofunika kugwiritsa ntchito Diabeteson MV kapena mawonekedwe ake m'malo mwake. Chabwinonso chithandizo ndi mtundu wa matenda a shuga a 2 chifukwa chokhala ndi zakudya zamagulu ochepa. Mudzatha kukhala ndi shuga wokhazikika wabwinobwino, ndipo simudzafunika kumwa mankhwala ovulaza.

Diabeteson kapena Maninil - zomwe zili bwino

Gwero la gawoli linali la mutu wakuti "Kuopsa kwa anthu wamba komanso kuwonongeka kwa mtima, komanso kuwonongeka kwamatenda am'mimba komanso ngozi yam'mimba yovuta kwambiri kwa odwala omwe ali ndi vuto la matenda ashuga a 2 malinga ndi mtundu wa kuyamba kwa matenda a hypoglycemic" munkhani ya "Matenda a shuga" 4 4 .9. Olemba - I.V. Misnikova, A.V. Dreval, Yu.A. Kovaleva.

Njira zosiyanasiyana zochizira matenda amtundu wa 2 zimachitika mosiyanasiyana pachiwopsezo cha matenda a mtima, sitiroko komanso kufa kwathunthu mwa odwala. Olemba nkhaniyo adafufuza zambiri zomwe zidalembedwa mu mbiri ya anthu odwala matenda ashuga a dera la Moscow, omwe ndi gawo la boma lolembetsa matenda a shuga a Russia Federation. Anawunika anthu omwe anapezeka ndi matenda a shuga a 2 mu 2004. Amayerekezera mphamvu ya sulfonylureas ndi metformin ngati amathandizidwa zaka 5.

Zinapezeka kuti mankhwalawa - mankhwala a sulfonylurea - ndizovulaza kuposa zothandiza. Momwe amathandizira poyerekeza ndi metformin:

• chiopsezo cha kufa ndi mtima wonse chidachulukitsidwa,
• chiwopsezo cha mtima - chachulukitsidwa ka 4,6,
• chiopsezo cha matenda a sitiroko chinachulukitsidwa katatu.

Nthawi yomweyo, glibenclamide (Maninil) inali yovulaza kuposa gliclazide (Diabeteson). Zowona, nkhaniyi sichinatchule kuti ndi mitundu iti ya Manilil ndi Diabeteson yomwe imagwiritsidwa ntchito - mapiritsi otulutsidwa kapena ena wamba. Zingakhale zosangalatsa kuyerekezera zomwe zimachitika ndi odwala omwe ali ndi matenda amtundu wa 2 omwe adalandira mankhwala a insulin m'malo mwa mapiritsi. Komabe, izi sizinachitidwe, chifukwa odwala oterowo sanali okwanira. Ambiri mwa odwala amakanika jakisoni jakisoni, motero anapatsidwa mapiritsi.

Mafunso Ofunsidwa Kawirikawiri

A Diabetes adawongolera matenda amtundu wa 2 bwino kwa zaka 6, ndipo tsopano asiya kuthandiza. Anawonjezera mlingo wake mpaka 120 mg patsiku, koma magazi a magazi akadali okwera, 10-12 mmol / l. Chifukwa chiyani mankhwalawa alephera? Kodi atichitira chiyani tsopano?

Diabetesone ndi wochokera ku sulfonylurea. Mapiritsiwa amachepetsa shuga m'magazi, komanso amakhala ndi zovulaza. Pang'onopang'ono amawononga ma cell a pancreatic beta. Pambuyo pa zaka 2-9 za kudya kwawo kwa wodwala, insulini ikusowa kwenikweni m'thupi. Mankhwala sakutha chifukwa ma cell a beta "atha". Izi zikanachitika kale. Kodi atichitira chiyani tsopano? Kufunika kubaya insulin, palibe njira. Chifukwa muli ndi matenda ashuga amtundu wa 2 adasanduka mtundu waukulu wa shuga. Patani diabeteson, sinthani ku chakudya chochepa chamafuta ndipo mupeze insulin yambiri kuti mukhale shuga wabwinobwino.

Wachikulire wakhala akudwala matenda a shuga 2 amtundu wazaka zisanu ndi zitatu. Shuga wamagazi 15-17 mmol / l, zovuta zopangidwa. Adatenga manin, tsopano adasamukira ku Diabeteson - sizinaphule kanthu. Kodi ndiyambe kumwa amaryl?

Zomwezo ngati wolemba wa funso lakale. Chifukwa chazaka zambiri zosachiritsika bwino, matenda ashuga amtundu wa 2 asintha kukhala mtundu waukulu wa shuga. Palibe mapiritsi omwe angapatsidwe. Tsatirani pulogalamu ya matenda a shuga 1, yambani kubayila insulin.Zochita, nthawi zambiri zimakhala zosavuta kukhazikitsa chithandizo choyenera cha odwala matenda ashuga. Ngati wodwala akuwonetsa kuiwalika ndi kusakhazikika - siyani chilichonse monga momwe ziliri, ndipo dikirani modekha.

Kwa matenda a shuga a 2, adokotala adandiuza 850 mg tsiku lililonse kwa Siofor. Pambuyo pa miyezi 1.5, adasamukira ku Diabeteson, chifukwa shuga sizidagwere konse. Koma mankhwalawa nawonso ndi osathandiza kwenikweni. Kodi ndizoyenera kupita ku Glibomet?

Ngati Diabeteson sachepetsa shuga, ndiye kuti Glybomet sikhala othandiza. Mukufuna kuchepetsa shuga - yambani kubayila insulini. Pa vuto la matenda apamwamba a shuga, palibe njira yina yomwe ingapezeke. Choyamba, sinthani ku chakudya chochepa chamafuta ndikuleka kumwa mankhwala owononga. Komabe, ngati mwakhala muli ndi mbiri yakale ya matenda ashuga amtundu wa 2 ndipo mwathandizidwa molakwika pazaka zapitazi, ndiye kuti mukufunikanso kubaya insulini. Chifukwa chakuti kapamba amatayika ndipo sangathe kupirira popanda kuthandizidwa. Zakudya zamafuta ochepa zimatsitsa shuga wanu, koma osazungulira. Kuti mavutowa asadzayambike, shuga sayenera kupitirira 5.5-6.0 mmol / l 1-2 mawola atatha kudya m'mawa pamimba yopanda kanthu. Phatikizani pang'onopang'ono insulini pang'ono kuti mukwaniritse izi. Glibomet ndi mankhwala ophatikiza. Zimaphatikizapo glibenclamide, yomwe imakhala ndi zovulaza zofanana ndi Diabetes. Osagwiritsa ntchito mankhwalawa. Mutha kutenga "pure" metformin - Siofor kapena Glyukofazh. Koma palibe mapiritsi omwe angalowe m'malo mwa jakisoni wa insulin.

Kodi ndizotheka ndi mtundu wachiwiri wa shuga kutenga Diabeteson ndi sapxin kuti muchepetse thupi nthawi yomweyo?

Momwe diabeteson ndi sapxin zimalumikizirana - palibe deta. Komabe, Diabetes imalimbikitsa kupanga insulin ndi kapamba. Insulin, nayenso, imasintha shuga kukhala mafuta ndikulepheretsa kuchepa kwa minofu ya adipose. Mokulira kwambiri m'magazi, zimakhala zovuta kwambiri kuchepetsa thupi. Chifukwa chake, odwala matenda ashuga ndi othandxin amakhala ndi zotsutsana. Reduxin amayambitsa mavuto ambiri ndipo chizolowezi chake chimayamba msanga. Werengani nkhani ya "Momwe mungachepetse thupi ndi matenda ashuga a 2." Siyani kumwa Diabeteson ndi sapxin. Sinthani ku chakudya chochepa chamafuta. Amasintha shuga, kuthamanga kwa magazi, cholesterol m'magazi, ndipo mapaundi owonjezera amathanso.

Ndakhala ndikutenga Diabeteson MV kwa zaka 2 kale, kuthamanga shuga kumakhalabe pafupifupi 5.5-6.0 mmol / l. Komabe, chidwi choyaka m'mapazi chayamba posachedwa ndipo mawonekedwe akutsika. Chifukwa chiyani zovuta za matenda ashuga zimayamba ngakhale shuga ndi abwinobwino?

Dotolo adayikira Diabeteson kuti akhale ndi shuga wambiri, komanso zakudya zochepa zopatsa mphamvu komanso zosakoma. Koma sananene kuti angachepetse kuchuluka kwa zopatsa mphamvu. Ngati ndimadya zopatsa mphamvu 2000 patsiku, ndiye kuti sizachilendo? Kapena mukufunanso zochepa?

Zakudya zanjala zimathandiza kuchepetsa shuga m'magazi, koma machitidwe, ayi. Chifukwa odwala onse amamuthawa. Palibe chifukwa chokhalira ndi njala! Phunzirani ndikutsatira mtundu wa 2 wa matenda a shuga. Sinthani ku chakudya chochepa chamafuta - chimakhala chokoma mtima, chokoma komanso chotsika shuga. Lekani kumwa mapiritsi owononga. Ngati ndi kotheka, jekeseni insulini ingapo. Ngati vuto lanu la shuga silikuyenda, ndiye kuti mutha kusunga shuga wabwinobwino popanda jakisoni.

Ndimatenga Diabeteson ndi Metformin kuti ndikalipire T2DM yanga. Mwazi wamagazi umagwira 8-11 mmol / L. The endocrinologist akuti izi ndi zotsatira zabwino, ndipo zovuta zanga zaumoyo zimayenderana ndi zaka. Koma ndikuwona kuti zovuta za shuga zikukula. Ndi chithandizo chiti chothandiza kwambiri chomwe mungalangize?

Shuga wabwinobwino wamagazi - monga mwa anthu athanzi, osapitilira 5.5 mmol / l mutatha 1 ndi maola awiri mutadya. Nthawi zonse, matenda a shuga amakula. Kuti muchepetse shuga ndikuwasunga bwino, werengani ndikutsatira njira yachiwiri yothandizira anthu odwala matenda ashuga. Chiyanjano chake chimaperekedwa poyankha funso lapita.

Dokotala adalamula kuti atenge Diabeteson MV usiku, kotero kuti panali shuga wabwinoko m'mawa wopanda kanthu.Koma malangizowo akuti muyenera kumwa mapiritsiwa kuti mudye chakudya cham'mawa. Ndiyenera kukhulupirira ndani - malangizo kapena malingaliro a dokotala?

Wodwala matenda a shuga a 2 omwe ali ndi zaka 9 zokumana, zaka 73. Shuga amakwera mpaka 15-17 mmol / l, ndipo manin samatsitsa. Anayamba kuchepa thupi kwambiri. Kodi ndiyenera kupita ku Diabeteson?

Ngati mannin satsitsa shuga, ndiye kuti palibe lingaliro kuchokera kwa Diabetes. Ndinayamba kuchepa thupi kwambiri - zomwe zikutanthauza kuti palibe mapiritsi omwe angathandize. Onetsetsani kuti mwabaya insulin. Matenda othamanga 2 a shuga asintha kukhala matenda ashuga amtundu woyamba, motero muyenera kuphunzira ndikukhazikitsa pulogalamu yothandizira matenda a shuga 1. Ngati sizotheka kukhazikitsa jakisoni wa okalamba wodwala matenda ashuga, siyani zonse momwe ziliri ndikuyembekezera modekha. Wodwalayo amakhala ndi moyo wautali ngati atathetsa mapiritsi onse a shuga.

Ndemanga za Odwala

Anthu akayamba kumwa diabetes, shuga wawo wamagazi amatsika mofulumira. Odwala amadziwa izi pakuwunika kwawo. Mapiritsi osinthidwa osinthidwa nthawi zambiri samayambitsa hypoglycemia ndipo nthawi zambiri amalekeredwa bwino. Palibe kubwereza komwe kumanenedwa za mankhwala a Diabeteson MV pomwe munthu wodwala matenda ashuga amadandaula za hypoglycemia. Zotsatira zoyipa zokhudzana ndi kufinya kwam'mimba sizimakhazikika nthawi yomweyo, koma patatha zaka 2-8. Chifukwa chake, odwala omwe adayamba kumwa mankhwalawa posachedwa samatchula.

Oleg Chernyavsky

Kwa zaka 4 ndakhala ndikumwa piritsi la Diabeteson MV 1/2 m'mawa nthawi yam'mawa. Chifukwa cha izi, shuga imakhala yabwinobwino - kuyambira 5.6 mpaka 6.5 mmol / L. M'mbuyomu, idafika 10 mmol / l, mpaka idayamba kuthandizidwa ndi mankhwalawa. Ndimayesetsa kuchepetsa maswiti komanso kudya pang'ono, monga adokotala adalangizira, koma nthawi zina ndimatsika.

Mavuto a shuga amabwera pamene shuga amasungidwira maola angapo chakudya chikatha. Komabe, kuthamanga kwa shuga m'magazi kumatha kukhala kwabwinobwino. Kuwongolera shuga osala kudya komanso osayesa pambuyo pake pakatha maola awiri ndikudya kumadzinyenga nokha. Muwalipira ndikuwoneka koyambirira kwa zovuta zovuta. Chonde dziwani kuti miyezo ya shuga ya magazi kwa anthu odwala matenda ashuga ndiochuluka. Mwa anthu athanzi, shuga atatha kudya sakwera pamwamba pa 5.5 mmol / L. Muyeneranso kuyesetsa kuzizindikira, osamvetsera nthano zomwe shuga itatha kudya 8-11 mmol / l ndiyabwino kwambiri. Kukwaniritsa kuyendetsa bwino shuga.

Svetlana Voitenko

Dokotala wothandizira wa endocrinologist adandiuza kuti ndikhale ndi matenda ashuga, koma mapiritsiwa adangokulirakulira. Ndakhala ndikutenga kwa zaka ziwiri, nthawi iyi ndidasanduka munthu wokalamba kwenikweni. Ndataya 21 kg. Masomphenya amagwa, khungu limakhala lakuwona pamaso, mavuto ndi miyendo idawonekera. Mwazi umakhala wowopsa kuyeza ndi glucometer. Pepani matenda ashuga amtundu wa 2 asintha kukhala mtundu waukulu wa matenda ashuga.

Odwala onenepa kwambiri omwe ali ndi matenda a shuga a 2, zotumphukira za sulfonylurea zimathetsa kapamba, makamaka pambuyo pa zaka 5-8. Tsoka ilo, anthu owonda komanso owonda amachita izi mwachangu kwambiri. Phunzirani nkhani yokhudza matenda a shuga a LADA ndikuyesa mayeso omwe alembedwamo. Ngakhale ngati pali kuchepa kwamphamvu kwa thupi, ndiye kuti popanda kusanthula zonse zili zomveka ... Phunzirani pulogalamu ya chithandizo cha matenda a shuga 1 ndikutsatira malangizowo. Patulani diabeteson yomweyo. Jakisoni wa insulin ndi ofunika, simungathe popanda iwo.

Andrey Yushin

Posachedwa, dotolo yemwe adalipo adandiwonjezera piritsi limodzi la 2/2 la metformin kwa ine, lomwe ndidali nditagula kale. Mankhwala atsopanowa adayambitsa vuto la atypical - zovuta m'mimba. Nditatha kudya, ndimamva kuwawa m'mimba mwanga, kutulutsa, nthawi zina kutentha. Zowona, kulakalaka kunagwa. Nthawi zina simumamvanso ludzu, chifukwa m'mimba mwadzaza kale.

Zizindikiro zomwe zimafotokozeredwa sizotsatira zoyipa za mankhwalawa, koma zovuta za shuga zomwe zimatchedwa gastroparesis, gawo la ziwongo zamatumbo. Imachitika chifukwa cha kuwonongeka kwa mitsempha yomwe imalowa mu kayendedwe kazinthu zamagetsi ndikuwongolera chimbudzi.Ichi ndi chimodzi mwamawonekedwe a matenda am'mimba. Njira zapadera ziyenera kuchitidwa motsutsana ndi izi. Werengani nkhani yomwe "Diabetesic gastroparesis" mwatsatanetsatane. Zimasinthidwa - mutha kuzichotsa kwathunthu. Koma chithandizo ndimavuto ambiri. Zakudya zamafuta ochepa, masewera olimbitsa thupi komanso jakisoni wa insulin zimathandizira kuti shuga azingokhala pokhapokha mutagwira ntchito m'mimba. Matenda a shuga ayenera kuchotsedwa, monga onse odwala matenda ashuga, chifukwa ndi mankhwala owopsa.

Pambuyo powerenga nkhaniyi, mudaphunzira zonse zomwe mukufuna pa mankhwala a Diabeteson MV. Mapiritsi awa mwachangu komanso mwamphamvu amachepetsa shuga. Tsopano mukudziwa momwe amachitira izi. Zafotokozedwera mwatsatanetsatane momwe Diabeteson MV imasiyanirana ndi zomwe zimachokera m'mibadwo yam'mbuyomu. Muli ndi maubwino, koma zovuta zake zimapezekabe. Ndikofunika kuti musinthane ndi mtundu wachiwiri wa chithandizo cha matenda ashuga kukana kumwa mapiritsi owononga. Yesani zakudya zamafuta ochepa - ndipo patatha masiku atatu mutha kuwona kuti mutha kusunga shuga wabwinobwino. Palibenso chifukwa chotengera zochokera ku sulfonylurea ndikuvutika ndi zovuta zake.

Mankhwala ochepetsa shuga m'magazi: gulu

Gulu lomwe limaganiziridwalo limadziwika ndi chosasinthika. Ichi ndichifukwa chake, pofuna kuthandizira kuyang'ana, magulu ena am'magulu adadziwika, iliyonse yomwe ili ndi njira yapadera yochitirapo kanthu.

1. MaChinsinsi. Kukonzekera kutsitsa shuga wamagazi, omwe ali m'gululi, amathandizira kwambiri kuti insulini izitulutsidwa m'maselo a kapamba.
2. Zomvera. Othandizira awa amathandizira kuwonjezera kukhudzika kwa zotumphukira zapadera zazovuta za zotsatira za insulin ya mahomoni.
3. Alfa glucosidase zoletsa. Mankhwala otere amasokoneza mayamwidwe okangalika a insulin m'chigawo china cha m'mimba.
4. Mankhwala atsopano ochepetsa shuga zimakhudzanso minofu ya adipose mu thupi la munthu, komanso zimathandizira kupanga mapangidwe a insulin.

MaChinsinsi

Mankhwala odziwika bwino a gululi la mankhwala. Ndi mankhwala omwe amachepetsa msanga magazi.

Pali magulu awiri a othandizira: zotumphukira za sulfonylurea, ndi methyl glinides. Amasiyana mumachitidwe ogwirira ntchito.

Mankhwala otsatirawa ndi a gawo loyambirira: Gimeperid, Glycvidon, komanso Glibenclamide. Ndemanga zimanena kuti mankhwalawa onse ndi othandizanso kuchepetsa shuga. Amayambitsa kutulutsa kwa insulini m'magazi, omwe, amathandizira kuchepetsa kwambiri glycemia. Kusiyana kwawo kumangokhala mu kuchuluka kwa zinthu zomwe zimaphatikizidwa mu gawo limodzi la ntchito. Zoyipa za gululi: mankhwalawa amachotsa kapamba ndipo pakapita kanthawi amakhala osagwira ntchito. Ichi ndichifukwa chake mankhwala azikhalidwe amayesera kuwagwiritsa ntchito mochepera.

Mankhwala otsatirawa amatumizidwa ku gawo lachiwiri:

• "Nateglinide". Imayambitsa kutulutsa kwa insulin (gawo lake loyamba).
• "Repaglinide." Zofanana ndi mankhwala akale. Kusiyanako kumakhala mu mlingo woyenera (motere, mlingo wa tsiku ndi tsiku umachokera ku mamiligalamu khumi mpaka khumi ndi anayi).

Mankhwalawa onse kuti muchepetse shuga wa magazi ayenera kumwedwa musanadye.

Zomvera

Zinthu zamankhwala zimagawidwa m'magulu awiri: Biguanides ndi thiazolidones.

Woimira wodziwika kwambiri m'gulu loyamba ndi Metformin, mankhwala ochepetsa shuga m'magazi, omwe tidzakambirana zambiri pambuyo pake m'nkhaniyi. Akatswiri onse awiriwa komanso odwala amamuthokoza. Mankhwalawa ndi odalirika, otetezeka, olekeredwa bwino.

Mankhwala a gulu lachiwiri akuphatikizapo Rosiglitazon ndi Pioglitazon. Mankhwalawa amagulitsidwa mu mawonekedwe a piritsi.Kubwezera kwakukulu kwa mankhwalawa ndi chiopsezo chachikulu chotenga khansa (makamaka, zotupa za chikhodzodzo) ngati nthawi yayitali yogwiritsira ntchito miyezi 12.

Alpha Glucosidase Inhibitors

Ndalama zomwe zimaphatikizidwa ndi gululi nthawi zonse zimaperekedwa ngati gawo la zovuta kuchira. Mmodzi mwa oimira odziwika ndi "Akarobaza". Mankhwalawa amalepheretsa kuyamwa kwa chakudya cham'mimba m'mimba. Zotsatira zosasangalatsa ndi kusanja. Imwani piritsi katatu patsiku musanadye.

Mankhwala atsopano ochepetsa shuga

Mankhwala omwe akupezeka masiku ano samakwaniritsa zosowa za odwala, chifukwa chake kafukufuku akuchitika nthawi zonse ndipo mankhwala opangidwa mwatsopano akupangidwa.

Zotsatira zabwino zimawonetsedwa ndi "Liraglutide", yomwe imakhudza kwambiri minofu ya adipose ndipo sikuti imatsitsa kapamba. Mankhwalawa amagulitsidwa ngati cholembera (chimodzimodzi) ndi insulin yapamwamba. Mankhwalawa amayenera kuperekedwa mwachangu.

"Januvia": malangizo ogwiritsira ntchito

Mtengo wa mankhwalawo umavomerezeka mokwanira ndi mtundu wake. Ogula akuti mankhwalawo omwe ali pamndandandawo ndi othandizadi ngati mankhwala othandizira kupewa monga zakudya zapadera ndi masewera ena olimbitsa thupi, omwe akuwonetsedwa kwa odwala omwe ali ndi matenda a shuga a 2, ngati njira zowongolera glycemic control.

Komanso, akatswiri amalimbikitsa kumwa mankhwalawa kuphatikiza ndi thiazolidinedione kapena metformin. Njira yakuchiritsira iyi iyenera kugwiritsidwa ntchito pokhapokha zovuta za monotherapy, zakudya ndi masewera sizithandiza kusunga kuchuluka kwa shuga m'magazi pamlingo woyenera.

Madokotala omwe amapezekapo amalimbikitsa kwambiri kuti odwala awerenge mosamala zomwe malangizo ogwiritsira ntchito akunena za kukonzekera kwa Januvia asanayambe chithandizo. Mtengo wapakati wa mankhwala ndi ma ruble 3,000 ndi mazana awiri. Mtengo nthawi zambiri umadalira ndendende malo omwe amagulitsa mankhwala.

"Baeta": malangizo ogwiritsira ntchito

Mtengo wa mankhwalawa umachokera ku anayi ndi theka mpaka ma ruble 3,000.

Mankhwala omwe amafunsidwa amaperekedwa kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri. Mankhwalawa amagwira ntchito monga mbali yofunika kwambiri ya monotherapy, komanso ngati gawo limodzi la mankhwala. Amagwiritsidwa ntchito molumikizana ndi zakudya zapadera komanso masewera olimbitsa thupi osankhidwa bwino.

Momwe mungagwiritsire ntchito mankhwalawa? Iyenera kuperekedwa mwachangu m'mimba, pamphumi kapena ntchafu. Mlingo wogwira ntchito ndi ma microgram asanu. Iyenera kuperekedwa kawiri pa tsiku osachepera ola limodzi asanadye. Pakupita mwezi umodzi, mlingo umalimbikitsidwa kuwonjezedwa.

Ndikofunikira kuti wodwalayo aphunzire zonse zakukonzekera Bayeta asanayambe chithandizo: malangizo ogwiritsira ntchito, mtengo wa mankhwalawo, cholowa m'malo ndi zotsutsana. Izi zikuthandizira kupewa zovuta zosagwiritsa ntchito mankhwalawa.

Kukonzekera "Galvus" kumayitanitsa malangizo ogwiritsira ntchito othandizira a hypoglycemic. Amagwiritsidwa ntchito mwachangu mu shuga ya mtundu wachiwiri.

Mankhwala tikulimbikitsidwa kuti agwiritsidwe ntchito limodzi ndi zakudya zomwe zaperekedwa komanso kuchita masewera olimbitsa thupi mwapadera, kapena osakanikirana ndi mankhwala monga Metformin, ngati njira yoyambirira ya chithandizo ayamba kugwira ntchito mosakwanira.

Pali zotsutsana pa kugwiritsa ntchito mankhwalawa. Mwa iwo: m'badwo wa ana (mpaka zaka khumi ndi zisanu ndi zitatu), galactose tsankho (makamaka, kubereka osalolera), hypersensitivity imodzi ya zigawo zina za mankhwalawa, kusowa kwa lactase, komanso glucose-galactose malabsorption, kufooka kwa chiwindi ntchito.

Kodi ndingamwe mankhwalawo? Mankhwalawa amamwa pakamwa, mosasamala chakudya. Ngati wodwala amatenga insulin ndi metformin, ndiye kuti mankhwalawo amadziwitsidwa pa mlingo wa ma grig zana zana patsiku.Komabe, mulingo woyenera ayenera kutsimikiziridwa ndi adokotala okha, omwe ali ndi chidziwitso chokwanira chokhudza thanzi la wodwalayo ndipo amatha kuwunika moyenera zidziwitso zonse zomwe zilipo zokhudzana ndi mankhwala a Galvus (malangizo, magwiritsidwe, makamaka ntchito).

Chofunikira chachikulu pa mankhwalawa ndi metamorphine hydrochloride. Amawerengedwa ngati mankhwala amphamvu ochepetsa shuga a gulu la Biguanides. Akatswiri amatcha Siofor mankhwala abwino kwambiri m'gululi la mankhwala, omwe ndi oyenera kugwiritsa ntchito osati othandizira, komanso kupewa. Mankhwalawa amatha kukhala gawo lalikulu la monotherapy, komanso gawo la zovuta zovuta, zomwe zimaphatikizapo zinthu zina zomwe zimachepetsa shuga.

Kodi Siofor amachepetsa bwanji magazi? Zonse zimatengera momwe wodwalayo amatsatira molondola kwa akatswiri. Musanayambe chithandizo, ndikofunikira kupenda momwe impso zimagwirira ntchito komanso njira yonse yowonekera. Maphunzirowa amayenera kuchitika miyezi isanu ndi umodzi yonse mukamalandira chithandizo komanso chaka china mukamaliza. Simungathe kumwa ayodini nthawi imodzi ndi mankhwala ochepetsa shuga. Komanso kumwa mankhwalawa kwa masiku awiri chisanachitike mayeso a X-ray komanso kwa maola angapo pambuyo pake. Kumayambiriro kwa mankhwalawa, munthu ayenera kupewa kuchita zinthu zomwe zingafunike kuti ayankhe ndi kuikirapo mtima.

Ndi zoletsedwa kumwa mowa panthawi yamankhwala.

Chofunikira chachikulu cha mankhwalawo chomwe chikufunsidwa ndi metformin hydrochloride. Gawani "Metformin" mu shuga ya digiri yachiwiri kwa odwala omwe samadwala ketoacidosis (makamaka, imakhudza anthu omwe amakonda kunenepa kwambiri), komanso pakalibe zovuta zamankhwala. Nthawi zina amagwiritsidwa ntchito limodzi ndi insulin (yothandiza kwambiri kunenepa kwambiri).

Pali zotsutsana pa kugwiritsa ntchito mankhwalawa. Mwa iwo: kuvutikira kwa impso, kuchepa madzi m'thupi, matenda ashuga a ketoacidosis, chikomokere, kutentha thupi, matenda ashuga, matenda opatsirana, Hypoxia, opaleshoni, kuvulala kwambiri, poyizoni wam'mimba, kusokoneza chiwindi, nthawi ya gestation, wailesi ya radioisotope, lactic acidosis, otsika kalori chakudya, tsankho la munthu pazigawo za mankhwala.

Kuwongolera kwa glycemia kuyenera kuchitika pokhapokha kuyang'aniridwa ndi katswiri waluso komanso mothandizidwa ndi mankhwala apamwamba. Chifukwa chake, ndikofunikira kuyang'anira chidwi pakusankhidwa kwa mankhwala oyenera. Kusanthula mosamala zazomwe zili pamwambazi kudzakuthandizani pankhani yovutayi. Unikani mosamalitsa mbali zonse za mankhwala osankhidwa musanayambe chithandizo.

Sankhani zinthu zanu zokha komanso za okondedwa anu. Khalani athanzi!

Mankhwala ochepetsa shuga m'magazi a 2 shuga

Pharmacology yamakono imapereka kusankha kwakukulu kwa mitundu ingapo ya mankhwala omwe amathandizira kuchepetsa ndikusintha momwe wodwalayo alili. Chithandizo chiyenera kudalira momwe munthu akumvera, makamaka kuopsa kwa matendawa ndi zaka zake.

Type 2 shuga mellitus ndi endocrine matenda omwe maselo amthupi amakana insulini yopangidwa ndi kapamba.

Zotsatira zake, maselo amataya chidwi chake ndi timadzi tambiri, ndipo glucose sangathe kulowa m'matimu, kudzikundikira m'thupi. Nawonso, chiwerengero cha insulin chikuwonjezereka, chifukwa kapamba amayamba kupanga kuchuluka kwa timadzi tambiri tambiri.

Pakukhazikika kwa matendawa, kuphwanya njira zonse za metabolic m'thupi kumachitika, ziwalo zambiri zamkati ndi kachitidwe zimavutika.

Njira zamakono zochizira matenda zimatengera mfundo izi:

1. Kutsatira zakudya. Kusankhidwa kwamankhwala ndi zakudya zomwe sizingagwiritsidwe ntchito sizingothandiza kuchepetsa kuchuluka kwa shuga, komanso zimathandizira kuchepetsa kunenepa. Monga mukudziwa, chimodzi mwazinthu zomwe zimapangitsa kuti matenda ashuga amtundu wa 2 akhale onenepa.
2. Thupi lathupi limathandizanso kuchepetsa shuga la magazi. Nthawi zina zimakhala zokwanira kukhazikitsa moyo wokangalika, kuyenda tsiku ndi tsiku ndi mpweya wabwino komanso thanzi labwino, kotero kuti wodwalayo akumva bwino.
3. Mankhwala. Mankhwala okhazikitsidwa ndi dokotala amathandizanso kuti shuga ibwererenso mwakale.

Mpaka pano, chithandizo cha matenda a shuga 2 ndi kugwiritsa ntchito imodzi mwa magulu otsatirawa a zida zamankhwala:

• Mankhwala omwe amachokera ku sulfonylurea. The pharmacological tingati kulimbikitsa katulutsidwe wa amkati insulin. Ubwino waukulu wa gulu la mankhwalawa ndi kulekerera mosavuta kwa mankhwalawa kwa odwala ambiri.
• Zogulitsa kuchokera ku gulu la Biguanide. Zotsatira zawo cholinga chake ndikuchepetsa kufunika kwa insulin katulutsidwe.
• Mankhwala omwe amachokera ku thiazolidinol amathandizira kuchepetsa shuga m'magazi ndipo amathandizanso kusintha kwa mawonekedwe a lipid.
• Amayamwa.

Ngati mankhwala omwe ali pamwambapa omwe amachepetsa shuga ya magazi samabweretsa zabwino, mankhwala a insulin angagwiritsidwe ntchito.

Maziko a mankhwala onse ochokera ku gulu la Biguanide ndiwothandizika ngati metformin. Type 2 shuga mellitus nthawi zambiri amawonetsedwa molumikizana ndi insulin - kulephera kwa maselo kudziwa bwino mahomoni opangidwa ndi kapamba.

Zotsatira zazikulu zamankhwala zomwe mankhwala ochokera ku gulu la Biguanide ndi:

• chepetsani shuga ”
• malamulo a insulini kupanga ndi kapamba, amene amachepetsa kuchuluka kwake mthupi организ
• sizimathandizira pakukula kwa hypoglycemia.

Kuphatikiza apo, mankhwala osokoneza bongo pamodzi ndi chithandizo choyenera cha zakudya amatha kuchepetsa thupi komanso kuthana ndi kunenepa kwambiri, zomwe ndizofunikira kwambiri kwa odwala omwe ali ndi vutoli.

Metformin amagwiritsidwa ntchito pochiza matenda osokoneza bongo chifukwa chowonjezera insulin. Imachepetsa kuyamwa kwa glucose m'matumbo ang'onoang'ono ndikuchepetsa mphamvu yake yopanga maselo a chiwindi.

Kuchuluka kwa Mlingo wa mankhwalawa kutengera mlingo wake. Mpaka pano, mapiritsi oterewa akupezeka ndi 400, 500, 850 kapena 100 mg ya mankhwala othandizira piritsi limodzi.

Ndi mankhwala ati a gululi omwe akupezeka pamsika? Choyambirira, mankhwalawa akuphatikiza othandizira pakamwa awa:

Kuphatikizika kwa mankhwalawa kuli ndi chinthu chachikulu chomwe chimagwira - metformin, yomwe imatha kuperekedwa mosiyanasiyana ndipo, mwanjira ina, imakhala ndi zotsatira zina.

Mankhwala oterewa amaperekedwa m'mafakitala amzindawo kokha ndi mankhwala.

Chachikulu contraindication ndi zoyipa za othandizira - Biguanides

Kugwiritsa ntchito mankhwala ochokera ku gulu la Biguanide kuyenera kuchitika moyang'aniridwa ndi adotolo, chifukwa ali ndi zotsutsana zambiri ndipo zimatha kupangitsa kukulitsa zovuta zina zoyipa.

Zina mwazinthu zomwe sizinaoneke bwino pazinthu zosiyanasiyana ndi ziwalo monga izi:

• mavuto am'mimba - kutsekula m'mimba, kumatupa, kapena kupweteka pamimba
• kusanza ndi kusanzaꓼ
• kukula kwa lactic acidosis,
• anemia yam'magazi,
• kukula kwa thupi lawo siligwirizana lomwe limadziwonetsa pa chimodzi kapena zingapo zomwe zimapanga mankhwala,
• lactic acidosis.

Ndi zoletsedwa kumwa mankhwalawa limodzi ndi zakumwa zoledzeretsa ngakhale zili zochepa.

Kuphatikiza apo, contraindication akamamwa mankhwalawa ndi monga:

1. mavuto ndi yachibadwa ntchito kwa impso ndi chiwindi,
2. ketoacidosis
3. bronchitis
4. matenda osiyanasiyana a mtima, kulephera mtima,
5. matenda amapezeka m'mapapo, zimachitika zovuta kupuma,
6. chiwonetsero cha matenda opatsirana,
7. opaleshoni yaposachedwa komanso kuvulala,

Iyenera kuthandizidwa makamaka pakumwa mankhwala osokoneza bongo kapena hypersensitivity ku chimodzi kapena zingapo za mankhwalawa.

Zochizira maphunziro a mankhwala zochokera sulfonylurea

Pofuna kuchepetsa shuga m'magazi a shuga a 2, mankhwala a sulfonylurea angagwiritsidwe ntchito. Zomwe zimakhudza thupi la wodwalayo ndizowonetsa zotsatirazi:

• pali kuwonjezeka kwa kupanga kwa mahomoni, chifukwa maselo a pancreatic beta adamulowetsa клеток
• imathandizira kukonza insulin yomwe imatengedwa ndi maselo a thupiꓼ
• ndi mapiritsi ochepetsa magazi.

Gulu la mankhwalawa limatha kuphatikizira imodzi mwa magawo omwe amagwira ntchito - glibenclamide (mankhwala a m'badwo woyamba) kapena glimepiride (mankhwala a m'badwo wachiwiri).

Mapiritsi oyamba a sulfonylurea adapanga kuti azitha kuchepetsa shuga m'magazi, koma kuti zitheke, pakufunika mlingo waukulu wa mankhwalawo.

Masiku ano, matenda a shuga a 2 amagwiritsa ntchito zida zamakono kwambiri zomwe zimafuna kuti mlingo wotsika ukhale ndi zotsatira zabwino. Chifukwa chake, zoyipa zomwe zimachitika m'thupi la wodwala zimatha kupewedwa.

Ndi othandizira otani omwe ali mgululi? Msika wama pharmacological umapereka mankhwala otsatirawa a sulfonylurea:

Zonsezi ndi fanizo ndipo zimatha kusiyanasiyana ndi kuchuluka kwa zinthu zomwe zimapangidwa pakupanga kwawo, kampani yopanga ndi ndondomeko yamitengo. Kusankhidwa kwa mankhwala enaake kumachitika kokha ndi adokotala. Kuphatikiza apo, ngakhale ofanana amafanana ndi mankhwalawo, kusintha kwa mankhwalawo kuyeneranso kuchitidwa pambuyo povomerezeka ndi dokotala.

Zovuta zowonetsera sulfonylurea zimatha, monga lamulo, mpaka maola khumi ndi awiri. Ichi ndichifukwa chake, nthawi zambiri, mankhwalawa amawonetsedwa kawiri patsiku - m'mawa ndi madzulo. Ngati pakufunika kuchepa kwapang'onopang'ono kwa shuga m'magazi, nthawi zina kumwa katatu kwa mankhwalawa kumagwiritsidwa ntchito.

Kugwiritsa ntchito mankhwala a gululi ndikotheka munthawi zotsatirazi - pamaso pa kunenepa kwambiri, ngati zakudya sizikuthandizira kuti matenda a shuga m'magazi, kwa odwala omwe adapezeka zaka zosakwana khumi ndi zisanu zapitazo.

Kodi zotsutsana ndimamwa mankhwala a sulfonylurea ndi ati?

Ngakhale kugwiritsidwa ntchito bwino kwa mankhwala a gululi, kuchuluka kwa mankhwala osokoneza bongo omwe amapitilira kungayambitse chiwonetsero cha zotsatira zoyipa komanso zovuta zoyipa mthupi, zomwe zimatha kudziwonetsa zotsatirazi:

1. Zitha kupangitsa kuti shuga wamagazi akhale otsika kwambiri. Ichi ndichifukwa chake amaletsedwa kugwiritsa ntchito mankhwalawa Mlingo woposa malangizo a dokotala.
2. Zimathandizira kukulira chilimbikitso, chomwe chitha kuwonetsa molakwika ngati kuwonjezeka kwa kulemera kwa wodwalayo. Potere, ndikofunikira kutsatira mosamalitsa menyu osadya osati kudya kwambiri.
3. Kuwonetsedwa kwa zovuta kumatha kuwonjezeka chifukwa cha kuphatikiza kwa mankhwala omwe ali ndi zakumwa zoledzeretsa, mankhwala othandizira kapena pakakhala kulimbitsa thupi kwakukulu.
4. Matenda a impso ndi chiwindi amatha.
5. Maonekedwe a thupi lawo siligwirizana ndi chimodzi kapena zingapo za mankhwala a gululi. Monga lamulo, zimachitika ngati pakuluma kwa khungu, zotupa m'thupi lonse kapena kutupa kwa minofu.
6. Mavuto am'mimba, nseru, kutsegula m'mimba, kapena kudzimbidwa kumatha kuchitika.

Kuphatikiza apo, pali zoletsa zingapo pomwe kugwiritsa ntchito mankhwala kosavomerezeka:

• ngati mukukumana ndi vuto la impso kapena chiwindi
• ngati thupi likuchepa, komwe kumayendetsedwa ndi kuchepa kwambiri kwa thupiꓼ
• pa chitukuko cha matenda opatsirana kapena matenda ena a pakhunguꓼ
• ngati pali kusalolera kwa chinthu chachikulu chogwira ntchito.

Kuphatikiza apo, mankhwalawa saloledwa kugwiritsidwa ntchito panthawi yomwe muli ndi pakati komanso nthawi yotsekemera.

Mankhwala osokoneza bongo omwe ali ndi mankhwala ampretin

Mankhwala osokoneza bongo amatha kuchitika pamaziko a kumwa mankhwalawa kuchokera ku gulu la ma proretin. Tiyenera kudziwa kuti maretretins ndi mahomoni omwe amapangidwa m'matumbo atatha kudya. Ntchito yawo yayikulu ndikulimbikitsa kutulutsa insulin. Poterepa, ma protein amayamba kugwira ntchito pokhapokha kuchuluka kwa glucose m'magazi, ndikazindikiridwa ndi chizindikirochi, njira yolimbikitsira kupanga kwa mahomoni imayima. Chifukwa cha izi, kugwiritsa ntchito ma insretin sikupangitsa kuti hypoglycemia ikhale.

Kuphatikiza apo, mankhwalawa amalepheretsa kuyamwa kwa matumbo m'matumbo, motero, amachepetsa kuchuluka kwa shuga m'magazi.

Gawo lalikulu la mankhwala ndi Sitagliptin. Mpaka pano, mankhwala omwe ali ndi Sitagliptin pokha kapangidwe kake sapezeka. Nthawi yomweyo, pali mitundu yambiri ya mankhwala ophatikizidwa pamsika, zigawo zikuluzikulu zomwe ndi sitagliptin ndi metformin. Mapiritsi otchuka kwambiri m'gululi ndi:

Mankhwala osakanikirana nthawi zambiri amagwiritsidwa ntchito ngati mankhwala osagwiritsidwa ntchito ndi mankhwala amodzi.

Kukhazikitsidwa kwa mankhwalawa kuyenera kuthandizidwa ndi adokotala, chifukwa cha chithunzi chonse cha odwala. Mankhwala sagwiritsidwa ntchito pochiza matenda amisala 1 a shuga, ana kapena odwala okalamba. Kuphatikiza apo, muyenera kuganiziranso za kuperekedwa kwa ndalama kwa anthu omwe ali ndi matenda a impso kapena ziwalo zamtima.

Dotolo ayenera kukhala ndi chidziwitso chonse cha moyo wa wodwalayo, matenda opatsirana ndi mankhwala omwe amamwa. Pokhapokha ngati mutachita izi, mudzatha kusankha chithandizo chamankhwala choyenera kwambiri, ndikuthandizira kusintha.

Zambiri pazamankhwala ochepetsa shuga zimaperekedwa mu kanema munkhaniyi.

Kuwunikiridwa kwa mapiritsi ochepetsa shuga m'magazi a 2 shuga

Mapiritsi ochepetsa shuga m'magazi a shuga a 2 amakhala ndi zotsatira zosiyana mthupi. Zina mwazomwe zimapangitsa kuti kapamba azigwira insulin, chachiwiri chimakulitsa chidwi cha insulin, ndipo chachitatu chimachepetsa kuyamwa kwa matumbo m'matumbo. Odwala omwe ali ndi matenda ashuga amatha kusankha mankhwala ochepetsa shuga a shuga a matenda 2 a shuga pakulimbikitsa kwa endocrinologist. Adziwitsanso mankhwala ena abwino omwe angagwirizane ndi zomwe zimachitika mthupi ndipo amagwira ntchito moyenera. Kusankhidwa kwa mankhwala kumafuna njira yodalirika ndipo zimatengera kulimbikitsidwa ndi katswiri yemwe angalingalire za mankhwala omwe wapatsidwa komanso momwe wodwalayo alili. Mapiritsi amayamba kumwa ngati zakudya, masewera olimbitsa thupi, komanso moyo wabwino sizithandiza kutsika shuga m'magazi a 2 shuga. Mukamamwa mapiritsi ochepetsa shuga, muyenera kuyang'anira shuga wamagazi anu kuti muchepetse kukula kwa glycemia.

Dokotala wanu atha kukuwuzani kuti ndi ma greatuanides, sulfonylureas, ndi ma incretinomimetics omwe amapezeka mu mawonekedwe apiritsi ndipo amatha kutsitsa shuga.

Biguanides amaimiridwa ndi zochokera ku dimethylbiguanide - metformin. Zimathandizira kuchepetsa kukana kwa insulin mwa anthu omwe ali ndi matenda ashuga a 2. Kuwonjezeka kwa insulin chifukwa cha mankhwalawa sikuti kumapangitsa kuti kapangidwe kake kazitulutsa.

Chidacho chomwe chili ndi mapiritsi okhala ndi dzina la malonda:

Kamodzi m'thupi, chinthu chogwira bwino chimakonza mayendedwe a shuga kudzera mu membrane wa cell kupita ku endothelium, minofu yosalala, komanso minofu ya mtima. Odwala omwe amathandizidwa ndi chinthu ichi, kuchepa thupi kumachitika chifukwa cha kuchepa kwa ma seramu lipids. Mankhwala okhala ndi izi amagwira ntchito amalembedwa m'njira zochepa, chifukwa amakhala ndi mphamvu yokhudza thupi ndipo amatha kupangitsa kuti akhale ndi vuto la m'mimba.

Ngati matenda otsekula m'mimba samakhazikika mkati mwa sabata, mlingo woyambira wa metformin wowonjezera umakulitsidwa katatu. Mulingo wapamwamba wa tsiku ndi tsiku wa yogwira ntchito ndi 3000 mg. Imwani mapiritsi omwe amachepetsa shuga, komanso chakudya, kumwa madzi ambiri. Mlingo umayendera ndi dokotala.

Kutsekula m'mimba sikuli kokha zotsatira zoyipa za metformin. Atatha kumwa kwambiri, odwala ena amakhala ndi kakumwa kazitsulo pakamwa pawo. Kufuna kudya kumatha kuchepa kwambiri, ndipo nthawi zina pamakhala kusamvetseka m'mimba komanso kukulira chakudyacho. Maonekedwe a lactate acidosis ndi vuto linanso la chinthu chogwira ntchito. Kuchepetsa mlingo, kutenga folic acid ndi mavitamini a B kungathandize kuchepetsa kuwonekera kwa zotsatira zosafunikira.

Metformin imawonetsera bwino mawonekedwe ake osakanikirana ndi sulfonylurea kapena insulin. Kuphatikiza ndi zinthu izi, zimapangitsanso kagayidwe kazakudya, ndipo izi zimathandiza kupewa zovuta za matenda ashuga a 2.

Sulfonylurea amatanthauza chinthu chochepetsa shuga chomwe chimapangidwa kuchokera ku sulfamide. Amagwiritsidwa ntchito pa matenda a shuga a 2. Mapiritsi a Sulfonylurea amalimbikitsa masamba a pancreatic islet, omwe amachititsa kuti insulin ipange.

Mankhwala ochepetsa shuga mwa kupanga insulin yoletsa ntchito ya enzyme yomwe imaphwanya insulin ndikuchepetsa mgwirizano wake ndi mapuloteni. Amachepetsa kumangiriza kwa insulin ku ma antibodies ndikuwongolera kugwiritsidwa ntchito kwa glucose mu minofu minofu ndi chiwindi. Mutatha kumwa mankhwalawa, kumva kwa minofu ndi ma adipose minofu yolandirira insulin kumakhala bwino. Mankhwala okhala ndi chinthu ichi chogwiritsidwa ntchito kwambiri amaperekedwa ndi opanga osiyanasiyana. Itha kukhala:

• Antibet
• Amaril
• Betanase
• Gilearm
• Glibenclamide Teva,
• Tolinase
• Euglucon,
• Diabeteson MV,
• Mdyerekezi
• Glibenez
• Minidab
• Movoglek.

Mankhwala okhala ndi sulfonylurea amalimbikitsidwa ndi endocrinologist pazotsatirazi:

• kukhala ndi thupi labwinobwino kapena kuchuluka kwa thupi,
• shuga wamagazi sangathe kuchepetsedwa mukudya,
• Matenda a shuga a Mtundu Wachiwiri amadziwika kwa zaka zosaposa 15.

Kukonzekera kwa Sulfonylurea kungathandizire kukulitsa kwa chikhalidwe cha hypoglycemic chifukwa cha mankhwala osokoneza bongo ochuluka. Kugwiritsa ntchito mankhwala kwa nthawi yayitali kungayambitse kuphwanya magazi, tinnitus ndi mutu. Pa mankhwala, totupa pa thupi, cholestatic hepatitis ndi kuwonongeka kwa impso. Mankhwala omwe ali ndi sulfonylurea sakusankhidwa:

• amayi apakati ndi oyamwitsa
• mu chiwindi ndi matenda a impso,
• Panthawi yoonda kwambiri,
• ndi matenda akhungu ndi zotupa pakhungu,
• sulfonylurea tsankho.

Matenda a shuga a Type 2 amatha kuthandizidwa ndimankhwala opatsirana. Otchedwa mahomoni am'mimba, omwe amapangidwa ndi thupi lathanzi poyankha kudya. Zofunikira kuti tikulimbikitse insulin.

Ma insretins amayamba kugwira ntchito pokhapokha magazi a shuga atapitilira 5-5,5 mmol / l, ngati magazi a m'magazi atakhazikika, ma insretins amasiya kupanga insulin. Mbali iyi ya zochitika za ma insretins imayimitsa kukula kwa zizindikiro za hypoglycemia.

Thupi limatulutsa mahomoni awiri a "incretin". Amatchedwa glucose-insulinotropic polypeptide, kapena HIP, ndi glucagon-ngati peptide-1, kapena GLP-1. Zotsirizirazi zimakhala ndi zotsatira zambiri kuposa GUI. Ndipo izi zimachitika chifukwa chakuti zimakhudza ziwalo zosiyanasiyana komanso minofu yambiri chifukwa choti zolandilira zomwe zimapanga zimapezeka m'malo osiyanasiyana a thupi la munthu. Ma receptors opanga HIP amapezeka pamwamba pa maselo a pancreatic beta.

Ma incretinomimetics amathandizira kuti shuga ya magazi ikhale yabwinobwino pochepetsa chidwi chifukwa GLP-1 imakhudza hypothalamus. Katunduyu amathandizira kuwongolera kunenepa.

GLP-1 imalimbikitsa kukula ndi kusinthika kwa maselo a pancreatic ndikusungidwa kwawo kuti asawonongedwe. Izi zimalepheretsa kuchepa kwathunthu kwa kapamba.

Zinthu zokhala ndi mahomoni achilengedwe sizingagwiritsidwe ntchito ndi opanga, chifukwa mahomoni amawonongeka mofulumira m'thupi. GLP-1 imawonongeka mu mphindi 2, ndi GUI m'mphindi 6, ndipo munthawi imeneyi amawongolera mokwanira kuti azitha kuphatikiza insulin yokha.

Kampani yamankhwala Merck & Co, Inc. maka ku USA, yatulutsa mankhwala opanga Sitagliptin, choletsa kusankha kwa enzyme dipeptidyl peptidase 4. Amasankha mosamala ntchito za ma enzyme omwe amawononga maretamini ndipo amathandizira kuti azigwira ntchito nthawi yayitali.

Mapiritsi, mankhwalawa sapezeka mu mawonekedwe ake enieni, koma ali ndi mitundu ya mitundu ya mankhwala okhala ndi metformin ndi sitagliptin. Izi zikuphatikiza:

• Avandamet
• Amaril M,
• Bagomet,
• Galvus Met,
• Glimecomb,
• Glyformin
• Metglib
• Metformin Richter,
• Janumet.

Mapiritsi operekedwa ndi makampani opanga mankhwala akunja ndi okwera mtengo kwambiri. Ma analogu apanyumba ndi otchipa kangapo ndipo angagwiritsidwe ntchito ndi odwala omwe ali ndi matenda a shuga a 2.

Choyamba, adotolo amafufuza mankhwala osokoneza bongo a greatuanides kapena sulfonylureas, ndikusankha imodzi mwamankhwala.

Pambuyo pakuchepetsa mphamvu yawo, mphamvu ya zinthu zomwe zimagwira imalimbikitsidwa ndikuwonjezeranso mankhwala ena kuchokera ku gulu lomwelo kapena loyandikana nawo. Izi zitha kukhala banja:

• khalidkalin and sulfonylureas,
• sulfonylureas awiri,
• sulfonylureas ndi incretinomimetics.

Izi zimathandiza odwala ena omwe ali ndi mtundu wachiwiri wa matenda ashuga kusiya magazi awo kwakanthawi kwinaku akumamwa mapiritsi kuti achepetse. Thupi likasiya kuyamwa mapiritsi, amasinthana jakisoni.

Carbohydrate blockers Glucobai, Acarbose, Lipobay ndi Polyphepan ali ndi zotsatira zoyipa, koma onse amakhala ndi zotsatirapo zoyipa. Mashuke osafunikira amayambitsa mapangidwe owonjezera a gasi, omwe amachititsa kuti matumbo ake atuluke. Katunduyu salola adokotala kuti ayamikire odwala awo ngati kukonzekera kwakukulu pakuchepetsa shuga.

1. 
   Buku lophikira la Dietetic, Nyumba Yofalitsa Mabuku ya Sayansi Yonse pa UNIZDAT - M., 2015. - 366 c.
2. 
   Kuzin, M.I. Pancreatitis / M.I. Kuzin, M.V. Danilov, D.F. Blagovidov. - M.: Mankhwala, 2016 .-- 368 p.
3. 
   Lembani matenda ashuga a 2. Kuchokera ku malingaliro oti mupitilize. - M: Medical News Agency, 2016. - 576 c.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10.Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Zolemba za maphunziro a matenda a shuga a 2 okalamba

Njira yodwala matenda ashuga a mtundu 2 kwa anthu okalamba ndiosiyana ndi kwa achinyamata. Matendawa ali ndi zotsatirazi:

• Imachitika popanda zizindikilo zakunja zokhala ndi matenda a shuga - palibe Zizindikiro zakukodza pafupipafupi, ludzu, pakamwa lowuma,
• pali zizindikiro zapadera zamatenda - kusokonezeka kukumbukira, kufooka konsekonse,
• Kusintha kwamapangidwe m'makoma amitsempha yamagazi wapezeka kale panthawi yodziwitsa,
• Matenda a minyewa angapo akupanga,
• mwa odwala ambiri okalamba, kuwunika kwa labotale sikuwonetsa kukwezeka kwa magazi m'thupi.

Kaya chithandizo chamankhwala okalamba chikuyenda bwino zimadalira zinthu zambiri:

• zambiri za wodwala
• kukhalapo kapena kusakhalapo kwa mtima
• kumvetsetsa kwa odwala komanso kuthekera kochita zinthu zofunika tsiku ndi tsiku - kuwunika shuga, kumwa mapiritsi, kudya,
• kuopsa kwa hypoglycemia - kuchepa kwambiri kwa shuga m'magazi pansi pa mulingo woyenera,
• kukula kwa chizindikiritso cha wodwalayo - kuiwala kukumbukira, kusungidwa kwa kulingalira, kuganiza bwino kwa malingaliro.

Kusungulumwa, penshoni yocheperako, kuyiwalako, zovuta zophunzira njira zofunikira za matenda ashuga pakudziletsa kwamatenda zimayambitsa zovuta zina pothandizira odwala okalamba.

Lembani mankhwala a shuga a 2 kuti muchepetse shuga

Mankhwala ochepetsa msuzi amagawika m'magulu angapo malinga ndi momwe amachitira. Mndandanda wamakalasi a mankhwala osokoneza bongo a shuga ndi motere:

• biguanides (metformin),
• Kukonzekera kwa sulfonylurea
• glinids (meglitinides),
• kachikachiyama (glitazones),
• α-glucosidase zoletsa,
• glucagon-ngati peptide receptor agonists -1 (aGPP-1),
• dipeptidyl peptidase-4 zoletsa (IDPP-4, gliptins),
• lembani 2 sodium glucose cocransporter zoletsa (INGLT-2, glyphlosins),
• insulini.

Mapiritsi zochizira matenda a shuga okalamba 2, zofunika zapadera zimagwira:

• chiopsezo cha hypoglycemia - kutsika kwadzidzidzi kwa shuga m'munsi mwambiri, kuyenera kuchepetsedwa
• kusowa kwa chiwindi, impso, mtima,
• mankhwalawa sayenera kuyenderana ndi mankhwala ena.
• kumwa mapiritsi kuyenera kukhala kosavuta.

Zochizira matenda amtundu wa 2 odwala okalamba, mankhwala otetezeka kwambiri ndi ma dipeptidyl peptidase-4 inhibitors. Ndi kugwiritsa ntchito kwawo, chiwopsezo cha hypoglycemia amachepetsa.

Metformin imalembedwa kwa anthu aang'ono ndi okalamba, ngati wodwalayo alibe zotsutsana ndi kuvomereza kwake.
Mosamala, odwala azaka zoyenera ayenera kukonzekera sulfonylurea, popeza chiwopsezo cha hypoglycemia chimawonjezeka ndi ukalamba. Pambuyo pa zaka 61, osavomerezeka kumwa gibenclamide - mapiritsi a gululi.

Chenjezo limaperekedwa kuti alembe 2 sodium glucose cotransporter inhibitors. Sayenera kugwiritsidwa ntchito ndi ma diuretics.
Thiazolidinediones ngati njira yothandizira odwala matenda ashuga okalamba sizomwe zidalembedwa.

Biguanides pochiza matenda a shuga agwiritsidwa ntchito kwazaka zoposa 50. Omwe akuimira kwambiri m'gululi ndi manformin ndi phenformin. Komabe, phenformin idathetsedwa chifukwa chowonjezera chiopsezo cha kupangika kwa lactic acidosis pamene akumatenga.Lactic acidosis (mkaka chikomokere) ndizovuta zowonjezera zomwe zimakhudzana ndikuphwanya asidi oyambira thupi ndikulimbikitsa acidity. Lactic acidosis yoyambitsidwa ndi metformin ndiyosowa kwambiri. Chifukwa chake, kuyambira 2005, malinga ndi malingaliro a mabungwe apadziko lonse a shuga, metformin ndi mankhwala a mzere woyamba wochizira matenda a shuga a mtundu wachiwiri.

Kukonzekera koyambirira kwa metformin ndi mankhwala omwe ali pansi pa mayina ogulitsa Siofor (Berlin-Chemie AG, Germany), Glucophage (Nycomed, Austria). Mapiritsi ali ndi mitundu yambiri ya mankhwala - generic mankhwala.

Metformin ndi piritsi yothandiza kuchepetsa magazi yomwe imagwiritsidwa ntchito kwambiri m'maiko ambiri. Mankhwalawa amagwiritsidwa ntchito pochiza matenda am'mimba a shuga kwa nthawi yayitali, motero momwe amagwiritsira ntchito antihyperglycemic amamveka bwino. Kukhazikika kuti mankhwalawa amayambitsa:

• kuchepa kwam'mimba chakudya
• kuchuluka kutembenuka kwa shuga m'matumbo mwanga,
• kuchuluka kwa insulin kwa ma receptor,
• kuchuluka kwa shuga m'mimba,
• kutsika kwa shuga m'magazi, triglycerides ndi lipoproteins ochepa,
• kuchuluka kwa osachulukitsa lipoproteins.

Metformin imagonjetsa kukana, kusazindikira (kukana) kwa zotumphukira zimakhala ku insulin, makamaka minofu ndi chiwindi. Chifukwa chogwiritsa ntchito mankhwalawa:

• kupanga shuga kumalepheretsa chiwindi,
• insulin sensitivity ndi minofu ya glucose ikukweza
• mafuta acids amadzaza

Kutsika kwa zotumphukira za insulin kukakamizidwa ndi metformin kumapangitsa kuti pakhale shuga mu chiwindi, minofu ndi minyewa ya adipose. Chifukwa cha izi, hyperglycemia sichimakula, zomwe ndizowopsa pakupanga zovuta za matendawa.

Zina mwazotsatira za metformin ndi kutsekula m'mimba ndi mavuto ena am'mimba: kulawa kwazitsulo pakamwa, nseru, matenda a anorexia, omwe kumayambiriro kwa chithandizo amawonedwa pafupifupi 20% ya odwala, koma zimadutsa patatha masiku angapo. Matendawa amakhudzana ndikuchepa kwa mayamwidwe a shuga m'matumbo aang'ono ndi metformin. Zokwanira mu chakudya cham'mimba, chakudya chopatsa mphamvu chimapangika kupatsa mphamvu komanso kusweka. Kusinthasintha pang'onopang'ono kwa wodwalayo kuti apangidwe ndi metformin kumathandizidwa ndi kupatsidwa mankhwala osachepera 500 mg, woyamba asanagone, kenako palimodzi kapena atatha kudya, ndi kapu yamadzi. Metformin imawonjezera lactate zomwe zimakhala m'matumbo aang'ono ndipo imangochulukitsa kuchuluka kwake m'magazi, zomwe zimawonjezera chiopsezo cha lactic acidosis.

Kafukufuku wasonyeza kuti pochiza matenda ashuga, metformin ndi mankhwala othandiza omwe amachepetsa shuga m'magazi pachiwopsezo chokhala ndi hypoglycemia poyerekeza ndi sulfonylurea ndi insulin. Siofor ndi mankhwala othandiza omwe amachepetsa kupanga shuga ndi chiwindi, zomwe zikutanthauza kuti zimakhudza chinthu chofunikira kwambiri pakuwonjezera kuchuluka kwa shuga m'magazi.

Tsopano metformin ndiye mankhwala abwino kwambiri ochizira matenda amishuga a 2. Sungatchedwe kuti mankhwala aposachedwa, chida cham'badwo wotsiriza, koma chidwi cha mankhwalawa sichitha. Kafukufuku wambiri amachitika ndi mankhwalawa. Mankhwalawa ndi apadera, monga momwe mwayi watsopano wogwiritsira ntchito umawululidwira.
Zimakhazikitsidwa kuti kuwonjezera pa antihyperglycemic, metformin imakhala ndi zotsatiranso zina. Mankhwalawa amakhudza njira zomwe zimatsogolera pakukula kwa atherosulinosis:

• Amagwira ntchito za endothelium - masanjidwe a maselo akukhazikika mkati mwa magazi ndi ziwiya za m'mimba, zamkati zamtima,
• amachiritsa matenda osachiritsika,
• amachepetsa kuopsa kwa oxidative nkhawa - njira maselo kuwonongeka chifukwa makutidwe ndi okosijeni,
• bwino zimakhudza mafuta kagayidwe ndi njira ya kusungunuka kwa magazi kuundana.

Metformin si chithandizo chokwanira cha matenda a shuga a mtundu wachiwiri, komanso mankhwalawa omwe ali ndi prophylactic athane ndi matenda a mtima. Mankhwala amatha kulepheretsa kukula kwa maselo a chotupa, komanso kuchepetsa kuchepa kwa ukalamba. Komabe, maphunziro owonjezera amafunikira kutsimikizira izi.

Dipeptidyl peptidase-4 inhibitors (gliptins) - mankhwala atsopano a shuga

Ma inhibitors a dipeptidyl peptidase-4 ndi mankhwala atsopano omwe amachepetsa shuga ya magazi. Mankhwalawa adapangidwa ndikuganizira chidziwitso cha thupi la ma insretins, mahomoni omwe amapangidwa pambuyo pa chakudya komanso zomwe zimapangitsa kuti pakhale insulin, yomwe idawoneka m'zaka za m'ma 2000. Malinga ndi momwe machitidwe a gulu lino la mankhwalawa atengedwera:

• shuga wodalira shuga
• shuga yodalira glucagon katulutsidwe - katemera wa kapamba,
• kuchepa kwa shuga m'magazi.

Chimodzi mwazinthu zabwino zazikulu za gulu latsopano lamapiritsi ochepetsa shuga ndikusowa kwa chiopsezo cha hypoglycemia. Mu ukalamba, zochitika za hypoglycemic zimatha kuyambitsa vuto la matenda oopsa, kupanikizana kwa ziwiya zam'mimba ndi chitukuko cha infarate yokhala ndi myocardial infarction, kuwonongeka kwadzidzidzi.
Ma Gliptins angathe kutumizidwa:

• zochizira odwala omwe apezeka ndi matenda a shuga,
• osalekerera kapena kuphwanya malire poika ma biguanides,
• kuphatikiza ndi mapiritsi ena ochepetsa shuga.

Mankhwala amakhala ndi zovuta zochepa, samayambitsa kuwonjezeka kwa thupi, kuchepa kwapang'onopang'ono kwa m'mimba. Kulandila kwa glyptins sikuyenda ndi chitukuko cha edema. Mankhwalawa amitundu iwiri ya matenda ashuga amatha kumwa mankhwala aliwonse a impso. Metformin, glucagon-like peptide receptor agonists, ndi cy-glucosidase inhibitors amachititsa kukhumudwa m'matumbo, pomwe glyptins amaloledwa bwino ndi odwala.
Koma chithandizo chatsopano cha matenda ashuga chili ndi vuto lalikulu. Mankhwalawa ndi okwera mtengo.
Mosamala, mankhwala a shuga omwe ali mgululi "dipeptidyl peptidase-4 inhibitors" adalembedwa:

1. kulephera kwambiri kwa chiwindi (kupatula saxagliptin, linagliptin),
2. ndi kulephera kwa mtima.

Mapiritsi a matenda amtundu wa 2 shuga a gulu la gliptins amalembedwa mu ketoacidosis, vuto la shuga lomwe limadza chifukwa cha kusowa kwa insulin panthawi yapakati komanso mkaka wa m'mawere.
Muzochita zamankhwala, ma dipeptidyl peptidase-4 zoletsa agwiritsidwa ntchito kuyambira 2005. Mndandanda wamankhwala omwe ali m'gulu la IDPP-4 lolembetsedwa ku Russia awonetsedwa mu tebulo 1.
Gome 1

Pakati pawo, ma gliptins amasiyana nthawi yotenga kanthu, kuyanjana ndi mankhwala ena, mwayi wogwiritsidwa ntchito m'magulu ena a odwala. Pankhani yochepetsera kuchuluka kwa shuga m'magazi, chitetezo ndi kulolerana, mapiritsi amtundu wa 2 awa ndi ofanana.

Mankhwalawa a shuga amaperekedwa limodzi ndi metformin. Vildagliptin ndi sitagliptin atha kutumikiridwa ndi insulin kukonzekera, komwe kumatsegula mwayi watsopano wophatikiza mankhwala kwa odwala omwe atenga nthawi yayitali.

Zoletsa za dipeptidyl peptidase-4 kuyambira pomwe mawonekedwe awo adakwanitsa kutenga malo olimba pakati pa mankhwalawa pochizira matenda a shuga a 2. Chiwopsezo chochepa cha hypoglycemia, osakhudzanso kulemera kwa thupi, ndipo palibe zoyipa zochokera m'matumbo am'mimba zimasiyanitsa kalasi ili la mankhwala ndi mankhwala ena pochizira matenda amtundu wa 2.

Kukonzekera kwa Sulfonylurea

Malinga ndi momwe amagwirira ntchito, kukonzekera kwa sulfonylurea ndi gawo la othandizira omwe amayambitsa insulin secretion (secretagogues). Kwa zaka zambiri, mankhwalawa a gululi akhala abwino pakati pa mapiritsi onse omwe amachepetsa shuga ya magazi. Mapiritsi amathandizira kupanga insulini m'magazi ndipo ndi njira yothandiza kwambiri pakuwongolera shuga.

Koma kugwiritsa ntchito sulfonylurea kukonzekera kumalumikizidwa ndi kuwonjezeka kwakukulu kwa kulemera kwa thupi ndi chiopsezo cha hypoglycemia, ndipo chitetezo chamthupi chimayamba msanga. Chifukwa chake, gululi la mankhwalawa limatsutsana ndi mankhwala ena omwe amachepetsa shuga la magazi. Koma ngati pali contraindication pakugwiritsa ntchito metformin, sulfonylureas amalembedwa ngati mapiritsi akuluakulu.

Odwala okalamba, chifukwa cha chiwopsezo cha hypoglycemia, kukonzekera kwa sulfonylurea kumalimbikitsidwa kuti ayambitsidwe Mlingo wokwanira theka akadali aang'ono, ndipo mlingo uyenera kuwonjezeka pang'onopang'ono.

Mndandanda wa mankhwala omwe ali mgululi ndiwotalikirapo. Mankhwala amagawika m'mibadwo iwiri. Oimira ambiri am'badwo wotsatira wa sulfonylurea ndi glimepiride, glibenkamide, glyclazide, glipizide, glycidone. Mankhwala a m'badwo woyamba sagwiritsidwa ntchito pochita matenda.
Mndandanda wa mankhwala am'magulu a sulfonylurea aperekedwa mu tebulo 2.
Gawo 2

Mavuto ena akhoza kubuka, omwe mapiritsi ndi abwino kwa wodwala wina, yemwe mankhwalawo amachokera pamndandanda. Pakati pawo, mapiritsiwa ndi osiyana:

• magazi kutsitsa ntchito,
• Kutalika kwa kuchitapo kanthu
• Malangizo
• chitetezo.

Kafukufuku wambiri wachitika momwe mankhwala othandizira odwala matenda ashuga a sulfonylurea adayesedwanso kuti atetezeke. Komabe, ndi glibenclamide okha omwe adadziwika ndi World Health Organisation ndi Unduna wa Zaumoyo ku Russia ngati mankhwala abwino kwambiri omwe amalimbikitsidwa kuti agwiritse ntchito matenda a shuga kuchokera kwa onse oimira kalasi iyi.

Glibenclamide ndi piritsi ya shuga yothandiza yomwe yapulumutsa miyoyo ya odwala ambiri padziko lonse lapansi. Mankhwalawa ali ndi njira yodziwika yothandizira, komanso ndi yekhayo mankhwala a sulfonylurea omwe chitetezo chawo chimayesedwa pakagwiritsidwe ntchito mwa amayi apakati. Kuchita bwino ndi chitetezo cha glibenclamide pochiza matenda amtundu wa 2 zatsimikiziridwa ndi kafukufuku wautali wa umboni wokwera. Mphamvu yowonjezera ya mankhwalawa pakuchepetsedwa kwa zovuta za microvascular panthawi yake yayitali imadziwika. Kuchiza ndi glibenclamide imodzi kwazaka zambiri kumawonedwa ngati njira yofunika kwambiri, nthawi zina chithandizo chokhacho chothandiza.

Zoposa zaka 10 zapitazo, mawonekedwe a glibenclamide adapangidwa, omwe ali ndi zabwino kwambiri, pafupifupi zana la bioavailability, zomwe zimayamba mwachangu kwambiri.

Okalamba salimbikitsidwa kuti apereke sulfonylureas yayitali yochita chiopsezo cha hypoglycemia. M'malo mwake, ndibwino kutenga gliclazide, glycidone.

Ma glinids (meglitinides)

Ma Clinids amalimbikitsa katemera wa pancreatic insulin. Muzochita zamankhwala, gulu ili la mapiritsi a mtundu wa 2 shuga limagwiritsidwa ntchito pafupipafupi: silothandiza kwenikweni kuposa mankhwala a sulfonylurea, koma ndi okwera mtengo. Makamaka, ma glinids amapatsidwa shuga wa magazi akamatuluka atatha kudya (postprandial glycemia). Mankhwala amalimbikitsa gawo loyambirira la insulin. Atatha mapiritsiwo, amawamwetsa mwachangu, ndikufika pandende yayikulu kwambiri ya plasma mkati mwa ola limodzi.
Makhalidwe a mankhwalawo, mndandanda wazabwino ndi zoyipa zomwe amagwiritsidwa ntchito ndi mankhwala opangidwa ndi dongo akuwonetsedwa mu tebulo 3.
Gawo 3

Α-glucosidase inhibitors - mankhwala atsopano

Limagwirira a zochita za mankhwala a kalasi la cy-glucosidase inhibitors zimakhazikitsidwa pang'onopang'ono kumasulidwa kwa glucose kuchokera ku zovuta zamankhwala. Izi zimachepetsa hyperglycemia atatha kudya. Mwa kuwongolera kuyamwa kwa glucose m'matumbo, alpha-glucosidase inhibitors amachepetsa kusinthasintha kwa tsiku ndi tsiku m'madzi am'magazi.

Mankhwala a gululi salimbikitsa insulin secretion, chifukwa chake samatsogolera ku hyperinsulinemia ndipo samayambitsa hypoglycemia. Kuchepetsa kuyamwa kwa glucose m'magazi motsogozedwa ndi mankhwala a kalasi cy-glucosidase inhibitors kumathandizira kugwira ntchito kwa kapamba ndikuwatchinjiriza ku kutopa kwambiri.

Class cy-glucosidase inhibitors imaphatikizapo acarbose, miglitol, ndi voglibosis. Mankhwala atsopano kuchokera pagululi ndi voglibosis. Malinga ndi mayeso azachipatala, voglibosis imathandiza kwambiri pochiza odwala omwe ali ndi matenda a shuga 2 omwe amakhala ndi shuga wambiri (7.7 mmol / L) ndi high postprandial glycemia (kupitirira 11.1 mmol / L). Ubwino wa mankhwalawa ndikuti palibe zomwe zimachitika mu hypoglycemic, zomwe ndizofunikira kwambiri kwa okalamba.
Ku Russia, ma acarbose okha ndi omwe amalembetsa ku mankhwala osokoneza bongo. Dzina lamalonda lazinthu zomwe zili ndi ichi ndi Glucobay. Mapiritsi amapezeka mu mlingo wa 50 ndi 100 mg, ayenera kumwedwa katatu patsiku.

Zotsatira zoyipa zomwe zimachitika kwambiri mukamamwa ma cul-glucosidase inhibitors zikutuluka, kusokonekera komanso kutsekula m'mimba, zovuta zomwe zimatengera mlingo wa mankhwalawa komanso kuchuluka kwa chakudya. Zotsatira izi sizingatchulidwe kuti ndi zowopsa, koma ndi chifukwa chofala chomwe amachotsera mankhwalawa. Zotsatira zoyipa zimayamba chifukwa cha kuchuluka kwa chakudya chamafuta omwe amapaka m'matumbo akulu. Kuopsa kwa zosafunika zotsatira kumachepetsedwa poyambira kulandira mankhwala ochepa Mlingo ndikuwonjezera pang'onopang'ono.

Kuphwanya kwakukulu kogwiritsa ntchito mankhwalawa a kalasi cy-glucosidase inhibitors ndi matenda am'mimba.

Glucagon-ngati peptide receptor agonists -1 - mankhwala a shuga a mibadwo yotsiriza

Glucagon-like peptide-1 receptor agonists (AH) (GLP-1) ndi mankhwala aposachedwa kwambiri pochiza matenda ashuga.
Chochita chachikulu chogwiritsa ntchito mankhwalawa mkalasi ndicho kukondoweza kwa insulin yotulutsidwa ndi maselo a beta. Mankhwala amachepetsa m'mimba. Izi zimachepetsa kusinthasintha kwa postprandial glycemia. Mankhwala osokoneza bongo a mkalasi imeneyi amathandizira kumverera kwodzaza ndi kuchepetsa kudya, kuchepetsa chiopsezo chokhala ndi matenda amtima.
Mndandanda wa mankhwala osokoneza bongo a glucagon-peptide - 1 receptor agonist akuwonetsedwa mu tebulo 4.
Gawo 4

Zomwe zalembedwera AR GPP-1 zili ndi zosiyana pamapangidwe amitundu. Ena mwa mankhwalawa amagwiritsidwa ntchito kale - amawongolera kuchuluka kwa glucose mukatha kudya, pomwe ena - osagwiritsa ntchito mankhwala - amachepetsa shuga la magazi.

Short-acting prandial ARGP-1 ARs (exenatide ndi lixisenatide) amalepheretsa katulutsidwe wa glucagon ndikuchepetsa gastric motility ndikuchotsa. Izi zimabweretsa kutsika kwa mayamwidwe a glucose m'matumbo ang'onoang'ono komanso moyenera amachepetsa kutulutsa kwa insulin.

GPP-1 ARs yopanda nthawi yayitali imagwira ntchito kapamba, ndikuyambitsa katemera wa insulin komanso kuletsa kupanga kwa glucagon. Izi zimathandizira kuchepa kwapang'onopang'ono kwa postprandial glycemia komanso kuchepa kwakukulu kwa glycemia posunga kubisala kwa glucagon komanso kuchepetsa chilakolako chofuna kudya.

Ma nonprandial ARPP-1 AR akuphatikiza ndi ma exenatide osachedwa, liraglutide, albiglutide, ndi semaglutide. Njira zingapo zochitira zinthu zimachepetsa kuyamwa kwa zinthu kuchokera kumisempha yodutsa. Zotsatira zake, kutalika kwa mankhwalawa kumawonjezeka.
Zabwino ndi zoyipa zamakalasi A mankhwala a GLP-1 amalembedwa pa tebulo 5.
Gawo 5

Gulu latsopanoli la mankhwala likulembedwera chithandizo cha matenda a shuga 2 ngati njira yolumikizira mankhwala a metformin, sulfonylureas, kapena kuphatikiza kwa izi kuti apititse patsogolo kulamulidwa kwa glycemic.

Kulandila kwa kalasi A mankhwala a GLP-1 sikuyenda ndi hypoglycemia, koma 30 - 45% ya odwala amawonetsa zovuta kuchokera m'matumbo am'mimba - kusokonezeka mu mawonekedwe a mseru, kusanza kapena kutsegula m'mimba, komwe kumachepera nthawi.

Type 2 sodium glucose cocransporter inhibitors (glyphlosins) - mtundu waposachedwa mankhwala a shuga a 2

Mitundu 2 ya sodium glucose cocransporter inhibitors (INGLT-2) ndi mapiritsi aposachedwa omwe amachepetsa shuga la magazi.Monga njira ya m'badwo waposachedwa, INGLT-2 imachita zinthu mosiyana kwambiri ndi mtundu wina uliwonse wa mankhwala a shuga. Limagwirira a zochita za mankhwala a mkalasi lino amachepetsa kuyimitsidwa kwina koyipa kwa shuga mu impso. Izi zimachotsa glucose m'thupi mkodzo. Zotsatira zake zimakhala kuchepa kwakutali kwa shuga m'magazi ndikuchulukitsa katemera wa insulin komanso kutsika kwa insulin.

Mndandanda wa mankhwala a kalasi ya glyphlozin omwe adalembetsedwa ku Russia ndi mayina awo azamalonda ndi awa:

• dapagliflozin (Forsig),
• empagliflozin (ma jardins),
• canagliflozin (Invocana).

Mapiritsi a kalasi ya Glyphlosin amalimbikitsa kuphipha kwa shuga mu mkodzo. Kuchokera pamenepa, odwala amachepetsa thupi. Mu maphunziro, odwala omwe amatenga dapagliflozin osakanikirana ndi metformin kwa milungu 24 adataya thupi kwambiri kuposa omwe amatenga metformin yokha. Kulemera kwa thupi sikuchepa osati chifukwa chamadzi, komanso chifukwa cha mafuta. Komabe, mankhwala atsopano a shuga sangakhale piritsi la chakudya. Kuchepa kwambiri kwa thupi kumachepa m'magazi mzere wamagazi ukamakhazikika pamikhalidwe yofananira.

Mankhwala a kalasi ya Glyphlosin amawonetsedwa pa gawo lililonse la matendawa kuphatikiza mitundu ina iliyonse yamankhwala. Ndi otetezeka komanso ogwira ntchito.
Komabe, odwala omwe akutenga dapagliflozin ali pachiwopsezo chotenga matenda amtundu, makamaka matenda oyamba ndi mafangasi. Komanso, mankhwalawa m'sukuluyi amalimbikitsa kuchuluka kwa lipoprotein otsika, komwe ndikofunikira kuganizira, chifukwa odwala matenda a shuga ali pachiwopsezo cha matenda amtima.
Zowopsa zomwe zingachitike mutatenga mapiritsi a kalasi ndi mtundu wa 2 wa sodium glucose cotransporter zoletsa:

• achina,
• kuwonongeka kwaimpso,
• diuretic kwenikweni
• kutsika kwa magazi pamagazi,
• kutsitsa magazi
• kuphwanya mineral metabolism.

Mankhwala amathandizidwa mosamala muukalamba, ndi matenda opatsirana a genitourinary thirakiti, pamene akumwabe okodzetsa.
Mankhwala a kalasi ya Glyphlosin ali ndi vuto lalikulu. Ndiokwera mtengo.

Thiazolidinediones (glitazones) - mankhwala atsopano a shuga 2

Thiazolidinediones ndi gulu latsopano la mankhwala. Adavomerezedwa kuti agwiritsidwe ntchito ngati mankhwala ochizira matenda a shuga 2 mu 1996. Kupanga kwawo kwamachitidwe ndi kuwonjezeka kwa insulin sensivivity, ndiko kuti, insulin kukana, chimodzi mwamagawo ofunikira a shuga.

Kuthana ndi kuchepetsedwa kwa chidwi cha maselo ku insulin, mapiritsi amathandizira mphamvu yokhudza thupi lawo la insulin ndipo nthawi yomweyo amachepetsa kuchuluka kwake m'magazi. Kuphatikiza apo, glitazones amatha kusungirako magwiridwe antchito, ndiye kuti, amatha kuletsa matenda amtundu wa 2, omwe amawapangitsa kukhala apamwamba kuposa mapiritsi ena pochiza matenda ashuga.

Ku Russia, mankhwala awiri ochokera pagulu lomwe analingaliridwa adalembetsa - rosiglitazone ndi pioglitazone. Odwala amatenga rosiglitazone padziko lonse lapansi kwazaka zambiri. Nthawi zambiri amatumizidwa ndi matenda ashuga ku Russia. Kutetezeka kwa mtima wa Rosiglitazone kunanenedwapo kale: chiopsezo chowonjezereka cha kuphwanya myocardial ndi kufa kwamtima. Komabe, mankhwalawo pambuyo pake adakonzedwanso.

Kafukufuku awonetsa kuti ngati rosiglitazone amathandizidwa ndi mankhwala amodzi kokha kwa nthawi yayitali, kufunika kowonjezeranso mankhwala sikubwera mwachangu monga momwe kumachitikira ndi ena (glyburide kapena metformin) omwe amaphunzira mankhwala.

Glitazone mankhwala ili ndi maubwino angapo. Koma achipatala sathamangira kuyambitsa mankhwala a mkalasi ili machitidwe ambiri.Maganizo a gulu lachipatala okhudzana ndi kufunikira ndi chitetezo cha ntchito ya thiazolidatedione agawidwa. Zomwe zimatsutsa kwambiri ndikusowa kwa chidziwitso pa chitetezo cha mankhwalawa kwa nthawi yayitali.
Zambiri pazotsatira zoyipa za glitazones ndizofunikira:

• kunenepa kwambiri (pafupifupi 3 - 6 kg),
• madzi osungidwa ndi chitukuko cha edematous syndrome ndi kulephera kwa mtima,
• kuchepa kwa mafupa a minerals.

Kafukufuku wowonjezera amafuna deta yomwe kugwiritsidwa ntchito kwa thiazolidinediones kumalumikizidwa ndi chiwopsezo chowonjezeka cha neoplasms zoyipa, makamaka zotupa za colon, monga momwe zimatsimikizidwira ndi maphunziro oyesera. Chiwopsezo chowonjezeka chapezeka pamlingo wokulirapo wa rosiglitazone.
Musanafotokozere mankhwala a kalasi ya thiazolidinedione, ndikofunikira kuti muwunike kuopsa kwa matenda a mtima. Zomwe zimayambitsa chiwopsezo chake ndi izi:

• kulephera kwa mtima
• myocardial infarction kapena matenda a mtima,
• ochepa matenda oopsa
• lamanzere lamitsempha lamanzere,
• kuwonongeka kwakukuru m'mavala a mtima,
• zaka zopitilira 70
• nthawi yodwala matenda ashuga yoposa zaka 10,
• kutupa kapena kuchiza ndi malupu okodzetsa,
• kukula kwa edema kapena kuwonda pakukula mankhwalawa ndi glitazones,
• mankhwala a insulin
• kukhalapo kwa matenda a impso kulephera (creatinine woposa 200 μmol / l).

Kuphunzira njira zolondola ndi madera omwe kugwiritsa ntchito mankhwalawa gululi, maphunziro ambiri azachipatala akhala akupitilizidwa.

Koma mpaka pano, mankhwala aposachedwa a mtundu wachiwiri wa matenda ashuga a mtundu wa thiazolidatediones sanagwiritsidwe ntchito ngati mankhwala akuluakulu othandizira odwala. Ziyeso zowonjezera zamankhwala ziyenera kuchitidwa kuti zitsimikizire chitetezo kuti chigwiritsike ntchito kwa nthawi yayitali.

Okalamba insulin mankhwala

Ndi maphunziro apang'onopang'ono a shuga, ndikotheka kupatsa insulin wodwala. Insulin siyingatengedwe pakamwa ngati mapiritsi, chifukwa madzi a m'mimba amaziwona mwanjira yomweyo monga chakudya ndikuphwanya mofulumira kuposa momwe zimakhalira. Kuti mupeze mlingo wa insulin, muyenera kupeza jakisoni. Njira zochizira matenda a insulin mukakalamba sizimasiyana ndi zomwe odwala amakupatsani.

Ma insulin amagawidwa kukhala mankhwala achidule komanso osakhalitsa. Kutalika kwa nthawi ya insulin mu anthu osiyanasiyana ndi munthu payekha. Chifukwa chake, kusankha kwa insulini regimen kumachitika moyang'aniridwa ndi madokotala. Mu chipatala, mulingo wa glycemia umayendetsedwa, mlingo wa insulin umasankhidwa molingana ndi njira za metabolic m'thupi, zakudya, zolimbitsa thupi.

Popeza wodwalayo amapereka insulin payekha, chithandizo cha insulin mwa odwala okalamba ndizotheka pokhapokha ngati ntchito zachidziwitso za odwala okalamba zimasungidwa, malingaliro awo adziko ndi okwanira, ataphunzira malamulo a insulin chithandizo ndikudziyang'anira payekha glycemia.
Mndandanda wa kukonzekera kwa insulini kolembetsedwa ku Russia kukuwonetsedwa mu tebulo 6.
Gawo 6

Ndi mankhwala ati a shuga omwe amakhala bwino: akale kapena atsopano

Akatswiri apadziko lonse pankhani yogwiritsa ntchito bwino mankhwala sawalimbikitsa kuti pakhale mankhwala osokoneza bongo atsopano omwe alipo. Kusiyana kwake ndi komwe kumachitika ngati mankhwala atsopano "adasintha" chithandizo cha matenda. Kutetezeka kwathunthu kwa mankhwala kumatsimikiziridwa pokhapokha zaka 10 pambuyo poti anthu ambiri akugwiritsa ntchito moona.

Mapiritsi abwino kwambiri a matenda a shuga a 2 amadziwika ndi World Health Organisation okha metformin ndi glibenclamide. Chifukwa ndi iwo omwe ali ndi umboni wabwino kwambiri kuti mapiritsiwa ndi othandiza komanso otetezeka. Mankhwala omwe amatchulidwa amaphatikizidwa bwino kwambiri malinga ndi "kuthekera - chitetezo - mtengo wamankhwala."
Malingaliro akulu ndi malingaliro athunthu okhudzana ndi kuthekera kwa kuwongolera njira ya matenda a shuga 2 amapezekedwa ndikugwiritsa ntchito mapiritsi a metformin ndi glibenclamide. Kafukufuku wamkulu, yemwe adatha zaka 5, kuwunika kugwira ntchito ndi chitetezo cha metformin, glibenclamide ndi rosiglitazone pochiza odwala omwe ali ndi matenda a shuga a 2, adawonetsanso motsimikiza kuti mankhwala "akale" ndi othandiza kwambiri. Amakhala otetezeka poyerekeza ndi rosiglitazone "yatsopano".
Chofunika kwambiri posankha mtundu wa mankhwala a shuga 2 ndikofunikira kuti pakhale njira yoyenera yolumikizira glycemic ngati njira yotsimikiziridwa kwambiri yopewa komanso yochepetsa kupitilira kwa zovuta za micro- and macrovascular.

Komabe, chitsimikizo chofunikira kwambiri chikugogomezeredwa: kwa mankhwala osokoneza bongo "akale" a shuga, zovuta zomwe zimachitika zimamveka bwino ndipo pafupifupi zonse zimayembekezereka komanso zongoyerekeza. Zowopsa zomwe zimayambitsa mapiritsi "atsopano" zimatha kukhala zosayembekezereka komanso zadzidzidzi. Chifukwa chake, kufufuza kwanthawi yayitali komanso mapulogalamu owunikira, makamaka mankhwala omwe ali ndi ziwalo zambiri zomwe zingagwiritsidwe ntchito, ndizofunikira kwambiri.

Mwachitsanzo, rosiglitazone, woimira gulu la thiazolidinediones, omwe anali ndi zida zambiri zowonetsera, anali kugwiritsa ntchito moyenera kwa zaka pafupifupi 8, pamene kwa nthawi yoyamba pamakonzedwe a maphunziro azachipatala a nthawi yayitali, njira yatsopano idawululidwa - mafupa. Pambuyo pake, zidapezeka kuti izi, zomwe zimapangidwanso ndi pioglitazone, zomwe zimayamba kupezeka mwa akazi, zimagwirizanitsidwa ndi kuwonjezeka kwa pafupipafupi kwa ma fractures. Kafukufuku wotsatira adawonetsa chiopsezo chowonjezeka cha myocardial infarction pa chithandizo cha rosiglitazone ndi chiopsezo chokhala ndi khansa ya chikhodzodzo ndi pioglitazone.

Zotsatira zoyipa za mankhwala osokoneza bongo zitha kukhala "zowononga" kwambiri kwa odwala omwe ali ndi matendawa. Ngakhale mavuto monga hypoglycemia, kuwonda, osanenanso za kukhala ndi edema, mafupa am'mimba, kulephera kwamtima kosagwirizana, ndizabwino kwambiri kwa odwala omwe ali ndi matenda amtundu wa 2, omwe amakonda kwambiri kufanana ndi matenda.

Kumvetsetsa mfundo zomwe zatchulidwa pamwambapa, ndibwino kuyamba kulandira chithandizo chamankhwala omwe mwaphunzira kwambiri. Alibe mbiri yabwino yachitetezo okha, komanso luso lapamwamba kwambiri la hypoglycemic. Mankhwala "atsopano" analibe nthawi kuti atsimikizire chitetezo chawo pogwiritsa ntchito nthawi yayitali. Kuphatikiza apo, sanawonetse zotsatira zabwino za hypoglycemic poyerekeza ndi zachikhalidwe, "zakale". Mfundozi zimachitika pambuyo pa maphunziro ambiri.

Ndi mankhwala ati omwe mungakonde? Kodi njira yabwino kwambiri yothetsera matenda a shuga a 2 ndi iti? European Association for the Study of Diabetes imalimbikitsa kusankha mankhwala omwe ali ndi umboni wokwanira (kafukufuku) womwe umatsimikizira mapindu ndi chitetezo cha kalasi iliyonse ya mankhwalawa pochiza matenda ashuga.

Mbadwo waposachedwa wamankhwala umawoneka kuti ndiwothandiza kwambiri. Koma chiyembekezo chogwiritsidwa ntchito chiziyembekezedwa pokhapokha chitsimikiziro cha machitidwe ambiri komanso yayitali. Ku Europe ndi USA, odwala ambiri akupitiliza kuthandizidwa ndimankhwala otsimikiziridwa komanso ophunziridwa bwino.
Njira zothandiza kwambiri poyambira chithandizo cha matenda a shuga 2 zimapezekanso metformin, poganizira zotsatira zake zabwino, komanso zotumphukira za sulfonylureas - gulu loyambirira la mankhwala osokoneza bongo omwe amathandizidwa kwambiri komanso kusintha kwa mankhwalawa.

Mitundu "yakale" yakale, yamakhwala - mankhwala a metformin ndi sulfonylureas amakhalabe odziwika padziko lonse lapansi pochiza matenda amtundu wa 2. Chifukwa chomwe adawasankhira zokonda zawo anali zotsatirazi:

• chitetezo pakuchiritsa odwala
• kukwaniritsa zotsatira zabwino za nthawi yayitali,
• kukhudzidwa kwa moyo wabwino komanso chiyembekezo cha moyo,
• kuthekera kwachuma.

Ndipo mankhwalawa adzakhala ofunikira pachipatala cha matenda ashuga kufikira zowonjezereka zokhudzana ndi mankhwala atsopano zikupezeka, mpaka maphunziro akulu atawonetsa luso lawo lokwera poyerekeza ndi mankhwala achikhalidwe.

Zotsatira za mayeso azachipatala zazitali komanso chidziwitso chachikulu chomwe mwapeza muzochita zolimbitsa thupi ndizotsimikizika komanso zotsimikizika kwambiri posankha mankhwala othandizira mankhwalawa matenda a shuga.