Mankhwala a Hypoglycemic: kuwunika kwa othandizira a hypoglycemic

Kuphatikiza pa insulini, yoyendetsedwa ndi makolo m'thupi la wodwalayo, pali mankhwala omwe amakhala ndi vuto la hypoglycemic mukamamwa pakamwa. Amagwiritsidwa ntchito pochiza matenda a shuga a 2.

Mankhwala omwe ali ndi vuto la hypoglycemic pokonza pakamwa amagawidwa m'magulu:

• zochokera sulfonylurea,
• meglitinides,
• khwawa
• khalimon
• alpha glucosidase zoletsa,
• incretinomimetics.

Pali mibadwo ingapo yamaphunziro a sulfonylurea:

• Mbadwo woyamba - Carbutamide, Tolbutamide, Chlorpropamide ndi Acetohexamide,
• Mbadwo wachiwiri - Glibenclamide, Glibornuril, Glyclazide, Glisoxepide, Glycvidone ndi Glipizide,
• M'badwo wachitatu - Glimepiride.

Kuchita kwa mankhwalawa kwatengera kukondweretsedwa kwa maselo a beta a zisumbu za Langerhans za kapamba, zomwe zimathandiza kuwonjezera kutulutsa kwawo kwa insulin. Chifukwa cha kuyambika kwa vuto la hypoglycemic, maselo omwe amatha kupanga insulini ayenera kukhalabe m'matumbo. Mankhwala ena amathandizira kuti chidwi cha insulin chodalira insulin chiwerenso m'thupi komanso kuti muchepetse kaphatikizidwe ka shuga m'chiwindi ndi mafuta. Izi zimatheka pochulukitsa zolandilira zomwe zimapezeka m'maselo a chandamale ndikuwongolera kulumikizana kwawo. Mankhwala osokoneza bongo amakhudza kupanga kwa somatostatin powonjezera kupanga kwake, zomwe zimapangitsa kuchepa kwa kaphatikizidwe ka glucagon.

Mankhwala ochokera pagululi amagwiritsidwa ntchito pochiza matenda amishuga amitundu iwiri komanso osakwanira pakudya, pomwe mawonekedwe ofatsa amakhala ochepa.

Kutumizidwa kwa odwala azaka zapakati pakalibe zizindikiro za ketoacidosis ndi anorexia, zovuta zovuta komanso matenda opatsirana, chithandizo chomwe chimaphatikizapo kukhazikitsa insulin kholo. Sanasungidwe ngati kufunikira kwa insulin tsiku ndi tsiku kumadutsa 40, maphunziro osokoneza bongo, shuga, ketosis, mbiri yodwala matenda ashuga. Komanso ndi hyperglycemia yoposa 13.9 mmol / l ndi glucosuria yayikulu, malinga ndi zovuta zochizira.

Zotsatira zoyipa:

• achina,
• kumva mseru, kusanza ndi kutsegula m'mimba,
• cholestatic jaundice,
• kunenepa
• kuchepa kwa chiwerengero cha leukocytes ndi mapulateleti,
• agranulocytosis,
• hemolytic ndi aplastic anemia,
• chifuwa - kuyabwa, erythema, ndi khungu.

Kugwiritsa ntchito nthawi yayitali kumatha kutha kutha kwa zotsatira zoyambitsa zabwino za maselo a beta. Popewa izi, amatha kuphatikizidwa ndi insulin kapena kupuma pakulimbana. Izi zimakuthandizani kuti mubwezeretse kuyankhidwa kwa maselo a beta ku mankhwala omwe adamwa.

Masiku ano, kuikidwa kwa mankhwala a m'badwo woyamba kumasiyidwa pang'onopang'ono, popeza mibadwo ina imakhala yothamanga kwambiri pakuchepetsa mankhwala, chiwopsezo cha zotsatira zoyipa chimachepa. Mwachitsanzo, m'malo mwa 2 g patsiku la Tolbutamide, 0,02 g ya Glibenclamide ndi mankhwala.

Mphamvu yotchulidwa ya hypoglycemic imadziwika mukamamwa Glibenclamide, motero ndi muyezo wofufuza mphamvu yochepetsera shuga ya mankhwala atsopano. Amakamizidwa kwathunthu m'matumbo m'nthawi yochepa, motero, imayikidwa muyezo waukulu.

Glyclazide samangoyendetsa shuga, komanso imathandizira pa magawo a hematological ndi rheology yamagazi. Izi zimalepheretsa zovuta zamagulu a shuga monga retinopathy ndi thrombosis.

Chifukwa cha kuchuluka kwa matumbo kudzera m'matumbo, Glycvidon amapatsidwa ntchito yovomerezeka yaimpso.

Gulu la meglitinides limaphatikizapo Repaglinide ndi Nateglinide.

Repaglinide imachokera ku benzoic acid, kutsitsa kwake shuga kumafanana ndi sulfonylureas. Zotsatira zoyambira ndi hypoglycemia. Amagwiritsidwa ntchito mosamala pakagwiritsidwa ntchito kwa chiwindi ndi impso.

Nateglinide ndichokera ku D-phenylalanine, imakhala yothamanga koma yosakhazikika pakuchepetsa shuga.

Biguanides akuphatikizapo Metformin, Buformin, ndi Fenformin. Kuchita kwa biguanides kumakhazikika pang'onopang'ono mapangidwe a shuga m'magazi a chiwindi, kukulitsa kugwiritsidwa ntchito kwa minofu yake ndikusintha kumangiriza kwa insulini kupita ku ma receptor ofanana. Nthawi yomweyo, amalepheretsa kaphatikizidwe ka shuga m'mafuta, amachepetsa mayamwidwe am'matumbo, amatulutsa kagayidwe kazakudya zamafuta ndikuchepetsa mphamvu ya kaphatikizidwe kwamafuta. Chifukwa chake, mankhwalawa ndi biguanides, kuchepa kwa chilonda kumadziwika, zomwe zimapangitsa kuchepetsa thupi.

Amayikidwa popanda kukhudzidwa kwa chakudya komanso kumwa mankhwala a sulfonylurea.

• mtundu 1 shuga
• wonenepa
• acidosis
• chikomokere
• kulephera kwa mtima
• pachimake myocardial infaration,
• kulephera kupuma
• sitiroko
• matenda opatsirana
• opareshoni
• ntchito kwa chiwindi ndi impso,
• mimba
• kuyamwa
• kuchepa magazi

Kutenga biguanides kungayambitse kukulitsa mavuto: kuwoneka kwa kutsekemera kwachitsulo mkamwa wamkamwa, kusokonezeka kwa kutaya kwam'mimba, kuthana ndi khungu, kuchepa kwa magazi, ndi zina.

Thiazolidinediones akuphatikizapo Pioglitazone, Ciglitazone, Troglitazone, Rosglitazone ndi Englitazone. Kuchita kwa mankhwalawa kumakhazikika pakuwonjezera chidwi cha minyewa ya insulin, kuchepetsa kuchepa kwa lipids mu minofu ndi minyewa ya adipose, komanso kutulutsidwa kwa glucose ku chiwindi.

Alfa-glucosidase zoletsa - Acarbose ndi Miglitol - amalepheretsa kupanga kwa shuga m'matumbo kuchokera ku polysaccharides ndi oligosaccharides kuchokera ku chakudya. Izi zimapangitsa kuchepa kwa shuga m'magazi. Chifukwa cha izi, chakudya chamafuta omwe amadya samachotsedwa m'thupi.

Kutenga alpha-glucosidase zoletsa akhoza limodzi ndi mavuto a dyspeptic chifukwa kuphwanya chimbudzi ndi mayamwidwe wanga, kagayidwe kamene kamachitika m'matumbo akulu. Pachifukwa ichi, chithandizo chimayendetsedwa ndi chakudya chokhwima, chomwe chimatanthawuza kuletsa kovuta kwa kudya kovuta kwa chakudya.

Othandizira a hypoglycemic aposachedwa ndi ma incretin mimetics, omwe ali fanizo la ma incretins. Ma insretins ndi mahomoni opangidwa ndi maselo apadera a m'matumbo atatha kudya, omwe ali ndi mphamvu yolimbikitsa pakupanga insulin. Incretinomimetics imaphatikizapo liraglutide, lixisenatide, sitagliptin, saxagliptin ndi alogliptin.

Za makolo

Kukhazikitsa kukonzekera kwa insulin ndikofunikira kwa mtundu wa 1 shuga, komwe kumadziwika ndi kubisala ndi kupanga kwa insulin kwina ndi maselo a beta a pancreatic a Langerhans. Ndi kukhazikika kwa mkhalidwe wa wodwalayo, makonzedwe a insulin amafunikira - chithandizo chothandizira.

Zofunikira zofuna insulin makonzedwe a 2 matenda a shuga:

• ketoacidosis
• hyperosmolar ndi lactic acidotic chikomokere,
• matenda opatsirana komanso oyera
• opareshoni
• kuchuluka kwa matenda osachiritsika,
• mimba
• Zizindikiro zakukula kwamavuto am'mimba,
• kuwonda mwadzidzidzi
• kukula kwa kukana kwa mankhwala amkamwa hypoglycemic.

Mlingo wa insulin womwe umayendetsedwa umafanana ndi kuchuluka kwa kusakwanira. Mankhwala, muyezo ndi njira ya makonzedwe amatsimikiziridwa ndi endocrinologist kutengera zomwe zimachitika komanso zotsatira za kafukufuku wowonjezera.

• ochita mwachidule - Insulan, Actrapid, Swinsulin ndi ena,
• nthawi yayitali - Semilong, Protafan, Semilent, Rapitard ndi ena,
• kuleza mtima - tepi ya insulin, insulin ultralente ndi ena.

Mankhwalawa amachokera ku mtundu woyamba wa matenda a shuga, insulin ya nthawi zosiyanasiyana imalowetsedwa m'malo ena mothandizidwa ndi dokotala. Kuti mupeze phindu pamankhwala, zakudya ndizovomerezeka. Ma insulin okhwima pang'ono ndi omwe amatha kutumikiridwa kudzera m'mitsempha, yomwe imagwiritsidwa ntchito pakupanga chikomokere.

Chithandizo cha insulin chingakhale chovuta:

• hypoglycemic syndrome,
• chifuwa
• insulin kukana
• post-jakisoni lipodystrophy,
• insulin edema.

Kuti mupeze insulini, muyenera kutaya syringe yotaya, endocrinologist ayenera kufotokozera momwe mungagwiritsire ntchito. Insulin imasungidwa mufiriji, jekeseni aliyense asanatulutsidwe ndikuwotha kutentha.

Pali njira zinanso zoyendetsera insulin - pampu ya insulini yokhala ndi chowonjezera cha insulin, mitundu yosiyanasiyana ya zolembera za syringe zomwe zimapangidwira kuti azigwiritsa ntchito mobwerezabwereza.

Pali mankhwala ambiri a hypoglycemic omwe amathandiza polimbana ndi matenda ashuga, koma ndi endocrinologist wokhayo amene angadziwitse mankhwala othandizira.

Katundu ndi zochita za sulfonylurea zotumphukira

Makina a sulfonylureas adapezeka mwangozi mkati mwa zaka zana zapitazi. Kugwiritsa ntchito kwazophatikizira zotere kunakhazikitsidwa panthawi yomwe zidadziwika kuti odwala omwe amamwa mankhwala a sulfa kuti athetse matenda opatsirana nawonso amachepa m'magazi awo. Chifukwa chake zinthu izi zimatanthauzanso odwala.

Pazifukwa izi, nthawi yomweyo anayamba kufunafuna zotengera za sulufanilamide ndi mphamvu yotsitsa shuga m'thupi. Ntchitoyi idathandizira kuphatikizika kwa zinthu zoyambirira zadziko lapansi za sulfonylurea, zomwe zimatha kuthetsa mavuto a matenda ashuga.

Zovuta za sulfonylurea zotumphukira zimayenderana ndi kutsegula kwa maselo apadera a pancreatic beta, omwe amalumikizidwa ndi kukondoweza komanso kuchuluka kwa insulin. Chofunikira chofunikira pakuwoneka bwino ndicho kukhalapo kwa kapamba amoyo komanso maselo athunthu a beta.

Ndizofunikira kudziwa kuti ngati atagwiritsa ntchito nthawi yayitali kuchokera kuzomwe amapanga, mapangidwe awo abwino amakhala otayika. Mankhwalawa amasiya kukhudza chinsinsi cha insulin. Asayansi akukhulupirira kuti izi zimatheka chifukwa cha kuchepa kwa chiwerengero cha ma cell a beta. Zinawululidwanso kuti pakatha nthawi yopuma mu chithandizo chotere, momwe maselo agwiritsidwira ntchito mankhwalawa atha kubwezeretsedwanso.

Ma sulfonylureas ena amatha kupatsanso mphamvu yowonjezera. Kuchita koteroko kulibe phindu lachipatala. Zotsatira zowonjezera-pancreatic zimaphatikizapo:

1. kuwonjezeka kwa chiwopsezo cha insulin-wodalira zimakhala kuti insulin wa amkati chilengedwe,
2. utachepa chiwindi shuga.

Makina onse amakula machitidwe awa pa thupi ndi chifukwa chakuti zinthu ("Glimepiride" makamaka):

1. onjezani kuchuluka kwa zolandilira zomwe zimakhudzidwa ndi insulin pa foni ya chandamale,
2. moyenera kukonza insulin-receptor mogwirizana,
3. sinthani kusintha kwa chizindikiro cha postreceptor.

Kuphatikiza apo, pali umboni kuti zotumphukira za sulfonylurea zimatha kukhala chothandizira kutulutsidwa kwa somatostatin, zomwe zingapangitse kuponderezedwa kwa glucagon.

Sulfonylureas

Pali mibadwo ingapo ya chinthu ichi:

• Mbadwo woyamba: "Tolazamide", "Tolbutamide", "Carbutamide", "Acetohexamide", "Chlorpropamide",
• Mbadwo wachiwiri: Glibenclamide, Glikvidon, Gliksoksid, Glibornuril, Gliklazid, Glipizid,
• M'badwo wachitatu: Glimepiride.

Mpaka pano, m'dziko lathu, mankhwala osokoneza bongo a m'badwo woyamba sakonda kugwiritsidwa ntchito.

Kusiyana kwakukulu pakati pa mankhwala 1 ndi 2 mibadwo mosiyanasiyana magawo a zochita zawo. 2nd sulfonylurea ya mbadwo ungagwiritsidwe ntchito mosiyanasiyana, zomwe zimathandiza kuchepetsa moyenera zovuta zingapo zoyipa.

Kuyankhula manambala, ntchito zawo zidzakhala zokwera 50 kapenanso 100 kapamwamba. Chifukwa chake, ngati pakati pa mankhwala a m'badwo wa 1p omwe mankhwalawa amafunika kukhala 0,75 mpaka 2 g, ndiye kuti mankhwala a 2nd amapereka kale 0,02-0.012 g.

Mitundu ina ya hypoglycemic ingathenso kukhala yosiyana pakulolera.

Mankhwala otchuka kwambiri

Gliclazide - Ichi ndi chimodzi mwa mankhwalawa omwe amaperekedwa nthawi zambiri. Mankhwalawa samangokhala ndi kuyimitsa kwa hypoglycemic, komanso amathandizira kusintha:

• Zizindikiro za hematological
• rologicalological magazi,
• machitidwe otumphukira, kuchuluka kwa magazi,
• heparin ndi fibrinolytic ntchito,
• kulolerana kwa heparin.

Kuphatikiza apo, Glyclazide imatha kuletsa kukula kwa microvasculitis (kuwonongeka kwa retina), kuletsa kuwonetsedwa kulikonse kwamapulogalamu, kumakulitsa kwambiri index index yosagwirizana ndikuwonetsa zofunikira za antioxidant zabwino.

Glycvidon - mankhwala omwe angagwiritsidwe ntchito m'magulu a odwala omwe ali ndi vuto laimpso pang'ono. Mwanjira ina, bola 5 peresenti ya metabolites omwe amatsitsidwa ndi impso ndi 95 otsala ndi matumbo

Glipizide Ili ndi tanthauzo lotsogola ndipo imatha kuyimira chiwopsezo chochepa kwambiri pakubwera kwa hypoglycemic. Izi zimapangitsa kuti zisakhale zophatikiza komanso osakhala ndi metabolites yogwira.

Zomwe zimagwiritsidwa ntchito pakamwa pakamwa

Mapiritsi aantidiabetic akhoza kukhala chithandizo chachikulu cha matenda amtundu wa 2, omwe samalira pakumwa mankhwala a insulin. Mankhwalawa amalimbikitsidwa kwa odwala omwe ali ndi zaka zopitilira 35 ndipo popanda zovuta zake:

1. ketoacidosis
2. zoperewera pazakudya
3. matenda omwe amafunikira insulin.

Kukonzekera kwa Sulfonylurea sikumawonetsedwa kwa odwala omwe, ngakhale atakhala ndi chakudya chokwanira, chofunikira cha tsiku ndi tsiku cha insulin chimaposa chizindikiro cha 40 magawo. Kuphatikiza apo, adotolo sangawalembere ngati pali mtundu wina wa matenda osokoneza bongo, mbiri yokhala ndi matenda ashuga komanso glucosuria wotsutsana ndi maziko a zakudya zoyenera.

Kusamutsa mankhwalawa sulfonylurea n`zotheka pansi pa vuto la kufooka kagayidwe, kulipidwa ndi jakisoni owonjezera a insulin mu Mlingo wa osachepera 40 mayunitsi. Ngati ndi kotheka, mpaka ma PIECES 10, kusinthaku kudzapangidwa kuchokera kwa omwe amachokera ku mankhwalawa.

Kugwiritsidwa ntchito kwa nthawi yayitali pogwiritsa ntchito mankhwala a sulfonylurea kungayambitse kukana, komwe kumatha kugonjetsedwa ndi mankhwala osakanikirana okha ndi insulin. Mtundu woyamba wa matenda ashuga, njira imeneyi imapereka zotsatira zabwino mwachangu komanso zithandiza kuchepetsa kufunikira kwa insulin, komanso kukonza njira ya matendawa.

Kuchepa kwa kupitirira kwa retinopathy chifukwa cha sulfonylurea kwawonedwa, ndipo matenda ashuga a retinopathy ndiwovuta kwambiri. Izi zitha kukhala chifukwa cha zochitika zapangiri zomwe zimachokera, makamaka zam'badwo wachiwiri. Komabe, pali kuthekera kwina kwa ma atherogenic.

Tiyenera kudziwa kuti zochokera ku mankhwalawa zitha kuphatikizidwa ndi insulin, komanso ma biguanides ndi "Acarbose". Izi ndizotheka ngati thanzi la wodwalayo silikuyenda bwino ngakhale ndi insulin zana limodzi ndi insulin.

Kugwiritsa ntchito mankhwala ochepetsa shuga a sulfonamide, ziyenera kukumbukiridwa kuti ntchito zawo zitha kuchepetsedwa:

1. anticoagulants
2. salicylates,
3. Butadion
4. Ethionamide
5. Cyclophosphamide
6. manzeru
7. Chloramphenicol.

Mukamagwiritsa ntchito ndalamazi kuphatikiza mankhwala a sulfa, kagayidwe kake kangakhale kolemekezeka, komwe kungayambitse kukula kwa hyperglycemia.

Ngati muphatikiza zotumphukira za sulfonylurea ndi thiazide diuretics (mwachitsanzo, "Hydrochlorothiazod") ndi BKK ("Nifedipine", "Diltiazem") mu milingo yayikulu, ndiye kuti zotsutsana zimatha kuyamba. Thiazides amatseka mphamvu ya zotumphukira za sulfonylurea potsegula njira zam potaziyamu. Ma LBCs amabweretsa kusokonezedwa pakupezeka kwa calcium ion ku cell ya beta ya kapamba.

Zomwe zimachokera ku sulfonylureas zimathandizira kwambiri zotsatira ndi kulolera zakumwa zoledzeretsa. Izi ndichifukwa chakuchedwa mu njira ya oxidation ya acetaldehyde. Kuwonetsedwa kwa zochita zonga za antabuse ndizothekanso.

Kuphatikiza pa hypoglycemia, zotsatira zosayenerera zingakhale:

• mavuto a dyspeptic
• cholestatic jaundice,
• kunenepa
• aplastic kapena hemolytic anemia,
• kukula kwa thupi lawo siligwirizana,
• leukopenia wokhazikika,
• thrombocytopenia
• agranulocytosis.

Meglitinides

Pansi pa meglitinides ayenera kumvetsedwa oyang'anira.

Repaglinide ndi yochokera ku benzoic acid. Mankhwala ndi osiyanasiyana mu kapangidwe ka mankhwala kuchokera ku sulfonylurea zotumphukira, koma amakhudzanso thupi. Repaglinide imalepheretsa njira zotsalira za potaziyamu ya ATP m'maselo a beta ndipo imalimbikitsa kupanga insulin.

Kuyankha kwa thupi kumabwera theka la ola mutatha kudya ndikuwonetsedwa ndi kuchepa kwa shuga m'magazi. Pakati pa chakudya, kuchuluka kwa insulin sikusintha.

Monga mankhwala ozikidwa pa sulfonylureas, choyipa chachikulu ndi hypoglycemia. Mosamala kwambiri, mankhwalawa amatha kuvomerezedwa kwa odwala omwe ali ndi vuto laimpso kapena chiwindi.

Nateglinide ndi yotengera D-phenylalanine. Mankhwalawa amasiyana ndi ena ofanana nawo mwachangu, koma osakhazikika. M'pofunika kugwiritsa ntchito mankhwalawa mtundu wachiwiri wa matenda ashuga a 2 kuti achepetse kuchepa kwa hyperglycemia ya postprandial.

Biguanides akhala akudziwika kuyambira 70s ya zaka zapitazi ndipo adalembedwa kuti amasungidwe a insulin ndi maselo a beta a kapamba. Mphamvu zawo zimatsimikiziridwa ndi kulepheretsa kwa gluconeogeneis m'chiwindi komanso kuwonjezereka kwa kuthekera kwa shuga. Kuphatikiza apo, chidachi chingachedwetse kuchepa kwa insulin ndikukulitsa kumangiriza kwake kwa insulin receptors. Mwanjira iyi, kagayidwe kake ndi mayamwidwe a glucose kumachuluka.

Biguanides samachepetsa shuga la magazi a munthu wathanzi komanso iwo omwe ali ndi vuto lachiwiri la matenda ashuga (kuperekedwa kosala usiku).

Hypoglycemic biguanides angagwiritsidwe ntchito popanga matenda a shuga a 2. Kuphatikiza pa kuchepetsa shuga, gulu ili la mankhwala omwe amagwiritsidwa ntchito kwa nthawi yayitali limakhudza metabolism yamafuta.

Chifukwa cha kugwiritsa ntchito mankhwala a gululi:

1. lipolysis adayambitsa (njira yogawa mafuta),
2. kuchepa kwamtima
3. Kuchepetsa thupi pang'onopang'ono kumakhala kwabwinobwino.

Nthawi zina, kugwiritsidwa ntchito kwawo kumayendetsedwa ndi kuchepa kwa zomwe zili mu triglycerides ndi cholesterol m'mwazi, titha kunena kuti biguanides ndi mapiritsi ochepetsa shuga m'magazi.

Mtundu wachiwiri wa matenda osokoneza bongo a shuga, kuphwanya kwa kagayidwe kabwino kumatha kuphatikizidwa ndi mavuto mu metabolism yamafuta. Pafupifupi 90 peresenti, odwala ndi onenepa kwambiri. Pachifukwa ichi, ndikukula kwa matenda a shuga, komanso kunenepa kwambiri, ndikofunikira kugwiritsa ntchito mankhwala omwe amapangitsa kuti matenda a lipid metabolism azitha.

Chizindikiro chachikulu cha kugwiritsidwa ntchito kwa Biguanides ndi mtundu wa 2 shuga. Mankhwala ndi ofunikira makamaka motsutsana ndi maziko a kunenepa kwambiri komanso osagwiritsa ntchito mankhwalawa kapena osakwanira pakukonzekera sulfonylurea. Kuchita kwa Biguanides sikumachitika popanda insulin m'magazi.

Alfa glucose inhibitors amalepheretsa kuwonongeka kwa polysaccharides ndi oligosaccharides.Kuyamwa ndi kupanga shuga kumatsitsidwa ndipo pamakhala chenjezo la kukula kwa postprandial hyperglycemia. Zakudya zamafuta onse omwe adatengedwa ndi chakudya, m'malo awo osasinthika, amalowa m'magawo a matumbo ang'ono ndi akulu. The mayamwidwe monosaccharides kumatenga mpaka 4 maola.

Mosiyana ndi mankhwala a sulfa, ma alpha glucose inhibitors sawonjezera kutulutsa kwa insulin ndipo sangayambitse hypoglycemia.

Zotsatira za kafukufukuyu, zidatsimikiziridwa kuti chithandizo chothandizira mothandizidwa ndi "Acarbose" chikhoza kutsagana ndi kuchepa kwamphamvu yopanga zovuta zolemetsa za atherosclerosis.

Kugwiritsa ntchito zoletsa zotere kumatha kukhala ngati monotherapy, ndikuwaphatikiza ndi mankhwala ena amkamwa omwe amachepetsa shuga ya magazi. Mlingo woyambayo nthawi zambiri umakhala 25 mpaka 50 mg musanadye kapena nthawi ya chakudya. Ndi chithandizo chotsatira, mulingo ungathe kuchuluka kwake (koma osapitirira 600 mg).

Zizindikiro zazikulu za alpha-glucosidase zoletsa ndi: mtundu wachiwiri wa matenda osokoneza bongo omwe amakhala ndi vuto lodana ndi zakudya, mtundu 1 shuga mellitus, koma malinga ndi kuphatikiza kwa mankhwalawa.

Mankhwala otchuka a hypoglycemic ndi mitundu yawo

Matenda a shuga ndi njira yodziwika bwino yomwe imakhudza anthu ambiri. Matendawa amadalira (mtundu 1) komanso wodziimira payekha (mtundu 2) kuchokera ku insulin. Mwanthawi yoyamba, kuyambitsa kwake kumafunika, ndipo chachiwiri - kuyamwa kwa mapiritsi a hypoglycemic.

Zochita zamkamwa za hypoglycemic mankhwala ndizolinga zochepetsa shuga. Makinawa amatengera kumangiriza kwa insulin ku ma receptor ake, omwe amalola kuti akhudze kagayidwe ka shuga. Zotsatira zake, mulingo wa glucose umatsika chifukwa chakuti kugwiritsa ntchito kwake paziphuphu kumawonjezeka ndipo kupanga shuga mu chiwindi kumalephereka.

Mphamvu ya othandizira pakamwa imaphatikizidwanso ndi kukondoweza kwa β-cell a kapamba, momwe amapanga insulin ya insulin. Mankhwala amalimbikitsa ntchito yotsiriza, amathandizira pakumanga kwake mofulumira kwa ma receptor, omwe amachititsa kuti shuga ayambe kuyamwa.

Insulin ndiye chinthu chachikulu chomwe anthu odwala matenda ashuga amafunikira. Koma kupatula iye pali mankhwala ambiri othandizira pakamwa omwe ali ndi vuto la hypoglycemic. Amapangidwa ngati mapiritsi ndipo amatengedwa pakamwa pa matenda a shuga.

Mankhwala amathandizanso kuti shuga asungunuke. Pali magulu angapo a mankhwala osokoneza bongo. Izi zimaphatikizapo sulfonylureas, meglitinides, biguanides, alpha-glucosidase inhibitors.

Pakulamulira kwa makolo, insulin imagwiritsidwa ntchito. Jekeseni ndizofunikira kwambiri kwa odwala omwe ali ndi matenda a shuga 1. Izi gawo la matenda limodzi ndi kuphwanya kwa kupanga amkati insulin. Chifukwa chake, kuti wodwalayo akhale ndi vuto lakelo, chithandizo chamankhwala chimathandizira pakubweretsa insulin.

Pali nthawi zina pomwe kugwiritsa ntchito insulin ndikofunikira kwa matenda a shuga a 2. Izi zikuphatikiza:

• Ketoacidosis.
• Coma
• Matenda opatsirana kapena oyera.
• Kuthandizira opaleshoni.
• Nthawi zochulukitsa matenda aakulu.
• Kubala mwana.
• Kukhalapo kwa kuphwanya kwakukulu pakugwira ntchito kwamitsempha yamagazi.
• Kuchepetsa thupi mwadzidzidzi.
• The zikamera wa kukana pakamwa hypoglycemic mapiritsi.

Mlingo wa insulin umatsimikiziridwa mosamalitsa ndi adokotala. Lowetsani zinthu zochuluka monga wodwala alibe. Pakapita nthawi, chidachi chimakhudzanso zosiyana: zazifupi, zazitali komanso zazitali.

Mankhwalawa amalowetsedwa pansi pakhungu m'ziwalo zina za thupi molingana ndi mapulani omwe dokotala amapanga.Mothandizidwa ndi mafupa, mankhwalawa amaloledwa kupakidwa pokhapokha chifukwa cha kupuma, pogwiritsa ntchito wothandizirana pang'ono.

Mankhwala a insulin angayambitse mavuto ena. Wodwala amatha kudwala matenda a hypoglycemic, sayanjana, insulin, lipodystrophy, kutupa.

Insulin imalowetsedwa pogwiritsa ntchito syringe kapena pampu yapadera. Njira yotsatirayi ndiyosavuta kugwiritsa ntchito ndipo itha kugwiritsidwa ntchito mobwerezabwereza.

Mankhwala amapereka mibadwo ingapo ya chida ichi. Zoyambazo zikuphatikiza mapiritsi a pakamwa "Tolbutamide", "Carbutamide", "Acetohexamide", "Chlorpropamide", mpaka wachiwiri - "Glycvidon", "Glizoksid", "Gliclazid", "Glipizid", ndipo wachitatu - "Glimepiride".

Tsopano, mankhwala a hypoglycemic a m'badwo woyamba sagwiritsidwa ntchito pochiza matenda ashuga. Mankhwala a magulu osiyanasiyana amasiyana wina ndi mzake pochita zinthu. Njira za mibadwo iwiri imagwira ntchito, motero imagwiritsidwa ntchito pazing'ono. Izi zimapewa kupezeka kwa zotsatira zoyipa.

Madokotala amakonda mankhwala am'kamwa kutengera ndi matenda. Polimbana ndi shuga wambiri, mapiritsi otsatirawa adziwonetsa bwino:

• Glycvidon. Amawerengera pakamwa kuti apite kwa odwala omwe ali ndi vuto laimpso. Chidacho chimathandizira kuchepetsa kuchuluka kwa shuga m'magazi, kukonza mkhalidwe wa wodwalayo.
• "Glipizide." Mapiritsi amkamwa amakhala ndi tanthauzo la matenda ashuga, osaperekanso zovuta.

Mankhwala ochepetsa shuga a mkamwa - njira yayikulu yothandizira mtundu wa matenda a shuga a 2, omwe samadalira insulin. Mankhwala hypoglycemic wothandizira amalembera odwala azaka zopitilira 35, komanso kuti odwala alibe ketoacidosis, kuperewera kwa zakudya m'thupi, matenda, chifukwa cha chithandizo chomwe insulin imafunikira.

Mapiritsi a Sulfonylurea saloledwa kugwiritsidwa ntchito ndi anthu omwe amafunikira insulin yambiri tsiku lililonse, amadwala kwambiri matenda osokoneza bongo, matenda a shuga, komanso glucosuria wamkulu.

Ndi chithandizo chazitali ndi mapiritsi amlomo, kukana kumatha kulowa mthupi, komwe kumatha kuthandizidwa mothandizidwa ndi zovuta za insulin. Kwa odwala omwe ali ndi mtundu woyamba wa matenda ashuga, mankhwalawa amathandizira kuti azichita bwino osati mwachangu, komanso amachepetsa kudalira kwa insulin.

Mapiritsi amatha kuphatikizidwa ndi insulin, biguanides pamtundu pamene wodwalayo samva bwino akudya mankhwala akulu a insulin patsiku. Kuphatikiza ndi othandizira monga Butadion, Cyclophosphamide, Levomycetin, kumabweretsa kuwonongeka pakuchitika kwa zotumphukira.

Ndi kuphatikiza kwa sulfonylureas ndi okodzetsa ndi CCB, kukondana kumatha kuyamba. Payokha, ndikofunikira kutchulapo zakumwa za kumwa pomwa mapiritsi. Zotumphukira zimakhudza kuchuluka kwa mowa.

Ndalama zomwe zimawonedwa zimathandizira kutulutsa kwa insulin timadzi m'magazi. Chimodzi mwa izo ndi Repaglinide. Amachokera ku benzoic acid. Amasiyana ndi kukonzekera kwina kwa sulfonourea, koma zimakhudzanso thupi. Mankhwala amathandizira kubisika kwa insulin.

Thupi limayankha polandila pambuyo pa mphindi 30 pochepetsa kuchuluka kwa shuga m'magazi a wodwalayo. Mapiritsi a pakamwa a Repaglinide ayenera kumwedwa mosamala odwala omwe adapezeka kuti ali ndi chiwindi komanso impso.

Chithandizo china chokhudzana ndi meglitinides ndi Nateglinide. Amachokera ku D-phenylalanine. Mapiritsi a pakamwa ndi othandiza kwambiri, koma samatenga nthawi yayitali. Ndikulimbikitsidwa kumwa mankhwalawa kwa anthu odwala matenda ashuga a 2.

Cholinga chake ndikupondereza kupanga kwa glucose m'chiwindi ndikuwonjezera mphamvu zake kuchokera m'thupi.Komanso, othandizira pakamwa amalimbikitsa ntchito ya insulin, amathandizira kulumikizana kwake bwino ndi ma receptors ake. Izi zimakuthandizani kusintha kagayidwe kachakudya njira ndikuwonjezera kuyamwa kwa shuga.

Biguanide ali ndi zotsatira zabwino pamaso pa matenda a shuga 2, samachepetsa shuga m'magazi a munthu wathanzi. Kuphatikiza pa kuchepetsa shuga, mankhwalawa pogwiritsa ntchito nthawi yayitali amakhala ndi phindu pa kagayidwe ka lipids m'thupi. Izi ndizofunika kwambiri, chifukwa anthu odwala matenda ashuga nthawi zambiri amakhala onenepa kwambiri.

Mukamamwa mapiritsi, njira yogawa mafuta imakhala yofanana, chilakolako chofuna kudya chimachepetsedwa, mkhalidwe wa wodwalayo umabwezeretseka pang'onopang'ono. Nthawi zina kugwiritsa ntchito gululi la mankhwalawa kumapangitsa kuchepa kwa mafuta a triglycerides ndi cholesterol m'magazi.

Mapiritsi amkamwa a gululi amathandizira kupondereza njira yogawa chakudya. Zotsatira zake, kusamwa bwino shuga kumachitika, kupanga kwake kumachepa. Izi zimathandiza kupewa kuchuluka kwa shuga, kapena hyperglycemia. Zakudya zamafuta omwe munthu amadya ndi chakudya amalowa m'matumbo amtundu womwewo momwe amalowera m'thupi.

Chizindikiro chachikulu cha kukhazikitsidwa kwa mapiritsi amlomo oterewa ndi mtundu wa 2 shuga, womwe sungathe kuthandizidwa ndi chakudya chamagulu. Amaperekanso mankhwala a mtundu woyamba wa matenda, koma monga gawo la chithandizo chokwanira.

Madokotala makamaka amakonda kupereka mankhwala apakamwa otchedwa "Glidiab" kwa odwala. Chothandizira chawo chachikulu ndi gliclazide. Mankhwalawa amathandizira kuchepetsa shuga m'magazi, kusintha magawo a hematological, magazi, hemostasis, magazi.

Chidachi chimalepheretsa kuwonongeka kwa retinal, chimachotsa zotsatira zoyipa za mapulosi, zimakhala ndi antioxidant. Simungathe kuwafotokozera ngati pali vuto la hypersensitivity ku zigawo zikuluzikulu za mankhwalawa, mtundu 1 wa matenda a shuga, ketoacidosis, chikomokere, matenda a impso ndi chiwindi, kubereka ana komanso kudyetsa, wazaka zosakwana 18.

Mapiritsi okhudzana ndi pakamwa amathandizira kupanga insulin ndi kapamba, kusintha kumasulidwa kwa chinthu ichi. Komanso zimakhudza chitukuko cha tilinazo zotumphukira zimakhala kuti insulin. Mankhwala ndi mtundu wa 2 shuga mellitus pa monotherapy kapena osakaniza metformin kapena insulin.

Saloledwa kumwa mapiritsi a anthu omwe ali ndi ketoacidosis, chikomokere, kumva kwambiri kwa mankhwalawa, chiwindi chachikulu kapena matenda a impso, kutsutsana kwa lactose, kusowa kwa lactase m'thupi. Komanso, simungagwiritse ntchito mankhwalawa amayi apakati komanso oyamwa, ana.

Amapezeka mu mapiritsi amkamwa otchedwa "L-thyroxine". Perekani ntchito kuti muthandizire kukonza kwa kagayidwe kazakudya ndi zinthu zina zofunika, kulimbikitsa ntchito ya mtima ndi mitsempha yamagazi, dongosolo lamanjenje.

Kugwiritsa ntchito mankhwala pakamwa ndizoletsedwa kwa odwala omwe ali ndi vuto la kusagwirizana ndi ziwalo zake, thyrotoxicosis, vuto la mtima, myocarditis, adrenal insuffuffence, kudziwa galactose, kuchepa kwa lactase, komanso kuyamwa shuga.

Mapiritsi amachepetsa kuchuluka kwa shuga m'magazi, amateteza kufalikira kwa shuga mthupi lonse. Mankhwala amalimbikitsidwa kwa odwala omwe ali ndi matenda a shuga a 2, ngati kudya komanso kuchita masewera olimbitsa thupi sizinadzetse vuto.

Pali zotsutsana zambiri pakugwiritsa ntchito mankhwala akumwa. Kugwiritsa ntchito nthawi yayitali kumawononga thanzi la munthu. Metformin saloledwa kugwiritsidwa ntchito ndi hypersensitivity kwa mankhwala osokoneza bongo, chikomokere, matenda a chiwindi, kulephera kwa impso, matenda opatsirana opereshoni, opaleshoni yayikulu, uchidakwa, kuledzera, kubereka ana, ana osakwana zaka 10.

Mndandanda wa zinthu za hypoglycemic umaphatikizanso tiamazole - yogwira mankhwala a pakamwa "Tyrosol". Amasankhidwa kuti thyrotoxicosis achepetse kupanga mahomoni a chithokomiro. Kuchotsa kwa matendawa ndikofunikira pamaso pa matenda ashuga.

Sikulangizidwa kumwa mapiritsi a agranulocytosis, kuleza mtima kwa mankhwala, granulocytopenia, kugwiritsa ntchito sodium levothyroxine pa nthawi yobala mwana, cholestasis, ana osaposa zaka 3. Mosamala kwambiri, mankhwala amkamwa ndi ofunikira kwa anthu omwe ali ndi vuto la chiwindi.

Matenda a shuga ndi matenda oopsa omwe amafunikira chithandizo. Njira zofunikira za chithandizo ziyenera kupangidwa ndi adokotala. Malangizo olakwika othana ndi matenda amzeru amatha kubweretsa zotsatira zowopsa pa moyo wamunthu komanso thanzi.

Mankhwala a Hypoglycemic amagwiritsidwa ntchito pochiza matenda ashuga. Mankhwalawa amathandizira kupanga insulini mu kapamba ndikuchulukitsa chidwi cha maselo chandamale ndikuchitanso mahomoni awa. Mndandanda wamankhwala ndiwowonjezereka, chifukwa umayimiriridwa ndi kuchuluka kwakukulu kwa zinthu zogwiritsidwa ntchito ndi mayina amalonda.

Ma Synthetic hypoglycemic agents amagwiritsidwa ntchito mtundu wa 2 shuga kuti achepetse magazi. Kuchita kwawo kumalumikizidwa ndi kuyamba kwa kupanga kwawo kwa insulin mwa maselo a beta a anthu okhala ku Langerhans. Ndi njirayi yomwe imasokonezedwa ndi kuwonjezeka kwa shuga m'magazi. Insulin imachita mbali yofunika kwambiri m'thupi, chifukwa choti glucose, yomwe ndi mphamvu yosungirako mphamvu, imatha kulowa mu cell. Amalumikizana ndi molekyulu ya shuga ndipo, motero, imalowa mkati mwa cytoplasm ya cell.

Zinthu za Hypoglycemic zimatha kupanga kupanga somatostatin, zimachepetsa kaphatikizidwe ka glucagon.

Mankhwala omwe amagwiritsidwa ntchito pochiza matenda abwinobwino amathandiza kuti shuga ayambe kulowa mu cell, motero thupi limagwiritsa ntchito mphamvu zomwe zimaperekedwa ndi chakudya. Kuphatikiza apo, ena mwa mankhwalawa amatha kukulitsa chidwi cha minyewa kupita ku insulin yaying'ono yomwe imapangidwa ndi kapamba. Zinthu za antidiabetic zimatha kukonza ubale wa insulin-receptor komanso kupanga chizindikiro chotumizidwa ku ubongo kuti chipange kuchuluka kwakukulu kwa mahomoni awa.

Kutengera mtundu wa magwiritsidwe, chifukwa chomwe kuchepa kwa shuga m'magazi, mankhwala onse amagawika m'magulu angapo a zinthu. Pali mitundu yotere ya mankhwala ochepetsa shuga:

Mankhwala ochepetsa shuga akhoza kugawidwa m'magulu angapo.

• sulfonylurea ndi zotumphukira zake,
• inhibitory alpha glucosidases,
• meglitinides,
• khwawa
• khalimon
• kuchuluka kwa insulin - insretinomimetics.

Biguanides, komwe Metformin ndi yake, amathandizira kuchepetsa kubisalira kwa shuga ndi chiwindi kuchokera mumapuloteni ndi mafuta, komanso amachepetsa minyewa ya insulin. Ma insulin, omwe amakhala ndi sulfonylurea, ngati meglitinides, amatha kupititsa patsogolo kubisika kwa mahomoni mu kapamba. Ma glitazones amachepetsa kukana kwa thupi ndi zinthu ndikumapondereza kapangidwe ka shuga. Mankhwala osokoneza bongo monga alpha-glucosidase inhibitors amatha kuipitsa kuyamwa kwa glucose pazopangira zakudya, pomwe amachepetsa kulumpha kwawo m'madzi a m'magazi.

Awa ndi mankhwala osokoneza bongo omwe amatha kumwa pakamwa popanda kugwiritsa ntchito jakisoni. Amagwiritsa ntchito poyambira matendawa ndi mankhwala ochepa omwe amagwiritsidwa ntchito komanso ochepa. Nthawi zambiri, makapisozi kapena mapiritsi amagwiritsidwa ntchito. Kukonzekera kwa pakamwa ndi koyenera kwa wodwala, sikufuna maluso owonjezera ndi momwe angakhalire kuti akwaniritse.

Matenda a 2 a shuga amagwiritsidwanso ntchito ngati jakisoni.Izi ndizotheka ngati wodwala akufunika kuchuluka kwa zomwe zimagwira, zomwe zimafuna kuti wodwala atenge mapiritsi akuluakulu. Njira iyi yoyendetsera ndiyovomerezeka kwa odwala osalolera ndalama, komanso ngati pali vuto lalikulu la m'mimba. Kugwiritsa ntchito mankhwala aubwino pakukhumudwitsa kwa wodwala, komwe kumadodometsa kugwiritsa ntchito kwachilendo kwa zinthu za antidiabetic mkati, kumawonetsedwa.

Kusankhidwa kwa mankhwala ochepetsa shuga, okhala ndi zinthu zothandiza kwambiri:

Mankhwalawa atha kukhala ofanana ndi sodium levothyroxine.

• tolbutamide
• carbamide,
• chlorpropamide
• glibenclamide,
• glipizide
• gliclazide
• glimepiride
• levothyroxine sodium,
• metformin hydrochloride,
• tiamazole,
• glycidone
• kubwezera.

Mankhwala omwe ali pamsika omwe ali ndi mawonekedwe omwewo amatha kukhala ndi mayina osiyanasiyana.

Kutengera m'badwo watsopano wa sulfonylureas. Amatenga nawo gawo pantchito yopanga insulin yoyambirira ndi ma beta cell a kapamba. Imasunthira bwino nsonga za kukwera kwa shuga m'magazi ndikusungabe nthawi zonse chimodzimodzi. Kuphatikiza apo, mankhwala omwe amakhalapo amatha kuletsa thrombosis ndikuchepetsa kuchuluka kwa zovuta za matenda ashuga.

Amanenanso za sulfonylurea yosiyanasiyana, koma angagwiritsidwe ntchito pa matenda a shuga 1. Imawonjezera kutulutsa kwa insulin, zomwe zimakhudza njira za potaziyamu za maselo a beta. Mphamvu ya mankhwalawa sichikhala nthawi yayitali, motero, kumwa kwachiwiri ndikofunikira pambuyo maola 5-8. Chida sichikugwiritsidwa ntchito ngati kuphwanya chiwindi kapena impso kapena matenda akulu a diabetes ketoacidosis.

Mankhwala a hypoglycemic omwe amafanana ndi mahomoni a chithokomiro omwe amapangidwa ndi chithokomiro cha chithokomiro. Amagwiritsidwa ntchito limodzi ndi mankhwala omwe amapangidwa mwanjira ina ndipo amalimbikitsa kukondoweza bwino kwa insulin limodzi ndi shuga ndi maselo a chandamale. Chifukwa chake, kuchuluka kwa shuga m'magazi kumatsika mofulumira. Nthawi zambiri imagwiritsidwa ntchito ngati chikomero cha hyperglycemic, popeza chimachitika mwachangu komanso chofunikira.

Zili mndandanda wa mankhwala a gulu la greatuanide ndipo zimalepheretsa kuyamwa kwa glucose m'matumbo, zomwe zimalepheretsa mapangidwe a shuga mu chiwindi. Izi zimathandiza kuchepetsa kufunika kwa kupanga insulin. Oyenera bwino kwa odwala omwe ali onenepa kwambiri chifukwa chodya kwambiri. Thunthu limasinthasintha bwino magazi lipoproten, kupewa chitukuko cha atherosulinosis ndi mavuto a mtima khoma.

Ndi cholepheretsa cha mahomoni a chithokomiro, ndipo amagwiritsidwa ntchito ngati mankhwala osokoneza bongo a hypoglycemic, ndizofunikira makamaka pakugwiritsa ntchito sodium levothyroxine. Kuti mugule mankhwalawa pogwiritsa ntchito mankhwalawa, muyenera kupatsidwa mankhwala, chifukwa ndi mankhwala amphamvu omwe, ngati atagwiritsidwa ntchito molakwika, angayambitse zovuta kapena ngakhale kufa kwa wodwala.

Kawunikidwe ka mankhwala ochepetsa shuga a shuga 2

Mankhwala ochepetsa shuga a mtundu wachiwiri wa shuga amapanga maziko a mankhwalawa. Hypoglycemic wothandizira pakamwa imayikidwa ngati, mothandizidwa ndi mankhwala othandizira komanso njira yodziwika yolimbitsa thupi, sizingatheke kulipira chipukuta matendawa. Mapiritsi onse ochepetsa shuga ali ndi zisonyezo zawo ndi mawonekedwe ake ogwiritsira ntchito, omwe amawaganizira akapatsidwa wodwala wina.

Mndandanda wa mankhwala amkamwa a hypoglycemic akuphatikizapo mankhwala ambiri. Mapiritsi ochepetsa shuga samayikidwa nthawi yomweyo. Kumayambiriro kwa matendawa, kusintha kwa matenda a shuga nthawi zambiri kumachitika ngati wodwalayo atsatira mankhwala okhazikika ndipo tsiku lililonse amachita masewera olimbitsa thupi.

Ndi endocrinologist wothandizira wodwala yekha amene angasankhe moyenera mankhwala ochepetsa shuga. Mukamapereka mankhwala, zotsatirazi zimakumbukiridwa:

• mayamwidwe
• mphamvu ya mankhwala,
• nthawi ya chimbudzi cha thupi yogwira,
• ntchito mankhwala mogwirizana ndi gawo la insulin katulutsidwe,
• kulolerana kwa mankhwala osokoneza bongo - lingalirani za moyo, matenda othandizira,
• mwayi wazolowera mapiritsi,
• Momwe ziwalo zamankhwala zimapangidwira - chiwindi kapena impso,
• mavuto.

Makina ochitapo kanthu a PSSP (mawuwa amatanthauza kuchepetsa mankhwala a pakamwa) ochokera m'magulu osiyanasiyana ndiosiyana, popeza amachokera pazinthu zina. Mapiritsi ambiri a hypoglycemic amateteza shuga ndi:

• kukondoweza kwa kutulutsa kwina kwa insulin yake,
• onjezani mphamvu ya mahomoni opangidwa,
• muchepetse shuga mu ziwalo ndi magazi.

Kusankhidwa koyenera kwa mapiritsi ochepetsa shuga a matenda ashuga a 2 kumathandizira gulu lawo. Gawani:

• sulfonylurea,
• mankhwala ochokera pagulu la Biguanides,
• alpha glycosidase zoletsa,
• mankhwala a thiazolidinedione,
• dongo.

Kuti khazikitse misinkhu ya shuga, odwala nthawi zambiri amapatsidwa njira yophatikizira - kutenga PSSP m'magulu osiyanasiyana. Mankhwala am'badwo waposachedwa amapatsidwa zabwino zingapo poyerekeza ndi zachikhalidwe, koma mukazisankha, maubwino amomwe matendawa amayenera kukumbukiridwa.

Mndandanda waukulu wamankhwala ochepetsa shuga a matenda ashuga amtundu wa 2 umaphatikizira ndi ma biguanides - othandizira pakamwa omwe amasokoneza kayendedwe ka glucose kuchokera chiwindi kupita ku ziwalo ndikuthandizira mayamwidwe ake ndikusweka kwa minofu minofu. Samakulitsa zobisika za mahomoni awoawo.

Biguanides amaletsa kupanga kwa lipoproteins ndi ma acid, zomwe zimachepetsa kupezeka kwa kusintha kwa ma atherosselotic. Nthawi yomweyo, kulemera kumachepetsedwa, zomwe zimathandiza kwambiri ngati wodwala wodwala matenda amtundu wa 2 akayamba kunenepa. Mukamachitira ndi biguanides, palibenso kumverera kwanjala, komwe kumathandizanso pakutsatira chithandizo cha zakudya.

Zovuta za biguanides zimaphatikizapo kudziunjikira kwa asidi m'magazi, zomwe zimatsogolera ku ketoacidosis. Mankhwala ochokera pagululi saloledwa kugwiritsidwa ntchito ngati pali mbiri ya matenda amtima, matenda a mtima, kulephera kwaimpso komanso kupuma. Contraindicated kwa kukonza shuga onse trimesters wa mimba ndipo ngati odwala matenda ashuga amadwala uchidakwa.

Mankhwala othandizira a Biguanides ndi metmorphine, mitundu ingapo ya mapiritsi amapangidwa pamaziko ake. Mndandanda wawo ukuphatikizapo:

• Glucophage. Kuti mukwaniritse zotsitsa shuga, mankhwalawa amagwiritsidwa ntchito osasokoneza. Mukamamwa, mowa ndi mankhwala okhala ndi ethanol samaperekedwa. Glucophage yayitali imakhala ndi metamorphine yomwe imakhala nthawi yayitali.
• Bagomet. Zotsatira zoyipa zimalembedwa nthawi zambiri mukamagwiritsa ntchito mankhwalawa pochiza odwala okalamba.
• Siofor. Mankhwala ochepetsa shuga kuphatikiza ndi zakudya zama carb ochepa amathandiza kuti muchepetse kunenepa kwambiri.
• Metformin Acre. Full achire ntchito ya mankhwala zimatheka pambuyo milungu iwiri ya makonzedwe.

Biguanides sachititsa kuti shuga achepe, koma mulingo wa wodwala aliyense umasankhidwa payekhapayekha.

Kuchita kwa mankhwala amkamwa a hypoglycemic ndi sulfonylurea makamaka kumapangitsanso kugwira ntchito kwa ma islet cell a gland, omwe chifukwa chake amalimbikitsa kupanga insulin. Nthawi yomweyo, mankhwala:

• Sinthani chidwi cha zolandilira minofu ku mahomoni,
• zoletsa glucogenesis - kapangidwe ka shuga kuchokera pamafuta azakudya, mapuloteni,
• ziletsa ntchito za maselo a alpha omwe amapezeka m'matumbo ndipo amachititsa kuti shuga asungidwe - glucagon yomwe ili ndi kanthu kosiyana ndi insulin,
• letsa kutulutsa kwa zinthu za shuga m'magazi a chiwindi.

Othandizira aposachedwa a sulfonylurea hypoglycemic amagwiritsidwa ntchito kwambiri pothandizira odwala omwe ali ndi matenda ashuga. Zotsatira zoyipa zakumbuyo, nseru, kugaya chakudya, kukomoka, kupweteka kwa mutu, ndi vuto laimpso zimawonetsedwa nthawi zambiri. Odalirika

• ndi kuchepa kwapang'onopang'ono kwa kulemera kwa thupi kwa odwala,
• ndi matenda pachimake ndi kulowererapo kwa opaleshoni,
• ndi matenda owopsa a impso ndi chiwindi.

Amakhala ndi mphamvu zakuthambo, chifukwa chake, samalandira amayi apakati. Gulu la sulfonylurea limaphatikizapo:

• Chlorpropamide. Kutalika kwa zotsatira za hypoglycemic ndi maola 24.
• Glibenclamide. Yakhala ikugwiritsidwa ntchito pochiza matenda ashuga kuyambira zaka za m'ma 1900.
• Maninil. Kuti mukwaniritse zovuta za hypoglycemic, mapiritsi amamwa tsiku lililonse nthawi yomweyo.
• Glipizide. Chenjezo limaperekedwa kwa odwala.
• Gliclazide. Popewa hypoglycemia, tikulimbikitsidwa kuti muzidya pafupipafupi, simungatsatire zakudya zovuta.

Mankhwala osokoneza bongo amatsogolera ku hypoglycemia. Zothandiza kuchokera ku sulfonylureas sizothandiza ngati maselo ambiri a beta afa kale. Pa kutsatira kwawo chakudya. Pazifukwa zosadziwika, sulfanylurea mwa odwala ena sawonetsa katundu wa hypoglycemic.

Ma glinids ali ndi mphamvu yolimbikitsa pa maselo a beta a gland. Mankhwalawa amathandizira kukhazikika pamlingo wa glucose m'magazi, chiopsezo chogwa kwambiri mthupi mthupi poyerekeza ndi mankhwala a sulfanilurea ndi otsika kwambiri.

Ma glinids amalimbikitsidwa kuti akhale ndi shuga kwa odwala omwe shuga ya magazi yawo imakwera mpaka kuchuluka. Imwani musanadye katatu patsiku.

Katundu wochepetsera shuga ndi ofanana ndi zotumphukira za soufanilurea, ndikosayenera kugwiritsa ntchito mapiritsi ochokera m'magulu awiriwa nthawi imodzi.

Palibe phindu lililonse mukamagwiritsa ntchito, madokotala amakonda kuwalembera kuti atchule mitundu yachiwiri ya anthu ashuga ngati amayamba mankhwala ochepetsa shuga. Pogwiritsa ntchito nthawi yayitali ma glinides, mphamvu zawo za m'thupi zimachepa.

Mndandanda wamadothi ulinso ndi mankhwala awiri:

Yoyamba imakhala ndi miyala ya Novonorm, yachiwiri - mu Starlix. Repaglinide, mosiyana ndi nateglinide, otsika hyperglycemia yomwe imawoneka ngati wodwala matenda ashuga amakhala ndi njala yayitali.

Ma glinids sakhala ndi malire pazaka; nthawi zambiri amalembedwa limodzi ndi maPR. Gwiritsani ntchito mosamala ngati pali matenda a chiwindi. Osamapereka mankhwala awa kwa odwala matenda a shuga omwe amadalira insulin.

Thiazolidinediones, kapena njira zina glitazones, zimapangitsa chidwi cha minofu cholandirira. Kubwezeretsanso shuga kumapanikizidwa, ndipo nthawi yomweyo kumwa kwake kumakulitsidwa. Pali umboni kuti glitazones amatha kuchepetsa chiopsezo cha kupangitsa matenda a mtima ndi mitsempha yamagazi. Koma, ngakhale izi, thiazolidinediones sizomwe zimagwiritsidwa ntchito pothandizira odwala omwe ali ndi matenda ashuga, popeza nthawi zonse amathandizira.

• Zimatsogolera kukuwonjezeka kwa kulemera kwa thupi, makamaka chifukwa cha kuchuluka kwa madzi mthupi. Edema nthawi zambiri imayambitsa kupezeka kwa kulephera kwa mtima.
• Thandizani ku ma fractures. Mukatenga glitazones, minofu yam'mafupa imatsitsidwa, kupindika kwake kumachepa, ndipo kuvulala pang'ono kumayambitsa kusweka. Chifukwa chake, mankhwalawa saikidwa kwa akazi mu kusintha kwa thupi kapena ngati wodwala wazindikira zomwe zingachitike.
• Kupangitsa eczema. Mankhwalawa a glitazones mwa odwala ena, kusintha kwa khungu kunalembedwa.

Mndandanda wa thiazolidinediones umaphatikizapo Rosiglitazone (Avandia, Roglit) ndi Pioglitazone (Aktos, Diaglitazone). Zogwiritsidwa ntchito pakulephera kwa impso.

Malinga ndi kafukufuku wa zamankhwala, kuchepetsa mphamvu ya shuga wa alpha-glucosidase kumalumikizidwa ndi kuyamwa kwa mafuta amthupi a chakudya m'matumbo. Zotsatira zake, hyperglycemia samakula. Ma enzyme zoletsa samachulukitsa thupi, koma amakhala ndi zotsatirapo:

• chimbudzi,
• kuchuluka kwa mpweya,
• kutsegula m'mimba

Kuchita zosafunikira kumatha kupewedwa ngati mutsatira malamulo ovomerezeka. Chithandizo cha alpha glucosidase inhibitors amayamba ndi waukulu. Mapiritsi ochepetsera shuga amatengedwa ndimakudya, tikulimbikitsidwa kutsatira zakudya - kuchepetsa kudya zamafuta osaphatikizidwa bwino. Mlingo ukuwonjezeka pang'onopang'ono - mpaka 25 mg pa sabata.Pogwiritsa ntchito moyenera ma inhibitors, mavuto amachepetsa, nthawi zambiri zimachitika mkati mwa mwezi umodzi.

Zomwe zimagwira ntchito ya enzyme inhibitors ndi acarbose, kutengera izi, mankhwala Vogliboz, Miglitol, Glyukobay amapangidwa.

Mankhwala atsopano a hypoglycemic a m'badwo watsopano ndi othandiza kwambiri ndipo amakhala ndi zovuta zochepa. Maepeptidyl peptidase inhibitors amaphatikizidwa pamndandanda wawo; motsogozedwa ndi iwo, kupanga incretin, timadzi timene timakhudza mapangidwe a insulin, timayambitsa.

M'badwo watsopano wa othandizira a hypoglycemic amagwiritsidwa ntchito palokha pawokha komanso kuphatikiza ma PRSP ena. Osatengera kulemera, amaloleza kugwiritsa ntchito nthawi yayitali. Oimira:

• Januvius. Mapiritsi a 25 mg, 50 kapena 100 mg amatengedwa kamodzi patsiku kapena akangomaliza kudya. Januvia amalimbikitsa katemera wa insulin pokhapokha shuga m'thupi likwezedwa. Chifukwa chake, mutamwa mankhwalawa palibe chiopsezo cha hypoglycemia. Kugwiritsa ntchito mankhwalawa sikungakhale chithandizo cha matenda a shuga okha, komanso kupewa matenda ashuga.
• Galvus. Kuchulukitsa katulutsidwe ka ma polypeptides, kumawonjezera chidwi cha maselo a islet. Kugwiritsa poyang'ana boma la zolimbitsa thupi ndi zakudya mankhwala.

Kugawidwa kwa mapiritsi amakono ochepetsa shuga kumakhalanso ndi mankhwala osokoneza bongo. Izi zikuphatikizapo DiabeNot. Mankhwala achilengedwe, opangidwa pamaziko a zomera, amathandizira:

• kutsegula kwa maselo a beta,
• kusintha kwa kagayidwe kachakudya njira,
• kuyeretsa zamitsempha ndi magazi,
• kulimbitsa chitetezo chokwanira.

Mayeso azachipatala atsimikizira kuti DiabeNot amachepetsa shuga mthupi komanso kupewa zovuta. Kumwa mankhwalawa kumabwezeretsanso kugwira ntchito kwa kapamba ndi maselo a chiwindi, sikuyambitsa zovuta. Makapisozi amatengedwa kawiri tsiku lililonse.

Pambuyo isanayambike mimba, chithandizo cha PSSP chimaperekedwa kwa akazi. Mankhwala ambiri ochepetsa shuga amalowerera mu placenta, yomwe imatha kusokoneza kukula kwa mwana wosabadwayo.

Pambuyo pamimba, odwala matenda a shuga amasamutsidwa kupita ku insulin. Horm imasankhidwa muyezo woyenera womwe kale udagwiritsidwa ntchito ndi PSSP.

Ndikofunikira kuyang'anitsitsa zisonyezo za shuga, mayi woyembekezera ayenera kuyeserera magazi ndi mkodzo pafupipafupi. Njira ya matenda ashuga pamene mukubereka mwana zimatanthauzanso kudya komanso kugwiritsa ntchito zolimbitsa thupi.

Zoyenera, azimayi omwe ali ndi matenda ashuga ayenera kukonzekera kukhala ndi pakati pasadakhale.

• Katundu wa teratogenic wa othandizira a hypoglycemic amawonetsedwa bwino masabata oyambilira atatenga pakati, zomwe zimatsogolera kuimfa.
• Ngati mayi akufuna kubereka mwana, dokotala yemwe akupezekapo akhoza kumusamutsira mankhwala a insulin pasadakhale.

Mankhwala ochepetsa shuga kwa odwala matenda a shuga amasankhidwa ndi adokotala. Kusankha kwawo pawokha ndikovuta ndipo kumakhala chifukwa cha zovuta zosakonzekera. Pa magawo oyamba a chithandizo, wodwalayo ayenera kuyang'anira thanzi lake mosamala, azichita glucometry nthawi zonse. Kukhazikitsidwa kwa othandizira a hypoglycemic sichizindikiro chothetsa chakudyacho. Ngati zoletsa zakudya sizilemekezedwa, ndiye kuti chithandizo cha PSSP sichingabweretse phindu.

Mankhwala oterowo ndi cholinga chotsitsa kuchuluka kwa shuga m'magazi a anthu.

Mankhwala a Hypoglycemic, kuphatikizapo mawonekedwe awo, ali ndi kachitidwe kamodzi kachitidwe. Insulin imayamba kumangiriza ku ma receptors, mwakutero ikukhudza kagayidwe kazakudwala. Mankhwalawa amathanso kukhudza kapamba.

Mankhwala onse a hypoglycemic amagawidwa m'magulu angapo. Dziwani kuti gulu lirilonse liri ndi mawonekedwe ake, kotero mawonekedwe ammankhwala amatha kukhala osiyana:

• Gulu lodziwika bwino ndi sulfonylureas. Gulu ili lagawika m'mibadwo ingapo (I, II ndi III m'badwo).
• Gulu lachiwiri ndi alpha-glucosidase inhibitors, limaphatikizapo mankhwala ochepa kuposa gulu loyamba. Gulu ili, mosiyana ndi loyamba, limalekerera heparin.
• Gulu lachitatu ndi meglitinides. Nthawi zambiri, m'malo mwa gululi, analogi za mankhwala omwe amaphatikiza ndi benzoic acid amapatsidwa.
• Gulu lachinayi ndi agalu.
• Lachisanu - thiazolidinediones.
• Ndipo gulu lachisanu ndi chimodzi ndi incretinomimetics.

Gulu lirilonse la mankhwala limakhala ndi mawonekedwe ake ochita. Ngakhale kuti ma analogues a mankhwala a hypoglycemic ali ndi mawonekedwe ofanana, amatha kusintha thupi la wodwalayo m'njira zosiyanasiyana. Chifukwa chake, musanalowe m'malo mwa mankhwala ndi analog paokha, ndikofunikira kukaonana ndi dokotala kuti mupewe zovuta zazikulu.

Mapiritsi a Glidiab 80 mg, paketi ya mapiritsi 60 (mtengo - ma ruble 130)

Mapiritsi a Glimepiride 2 mg, paketi 30 mapiritsi (mtengo - ma ruble 191)

L-thyroxine mapiritsi 100 mcg, paketi ya mapiritsi 100 (mtengo - ma ruble 69)

Mapiritsi L-Thyroxine 50 Berlin-Chemie 50 mcg, paketi ya mapiritsi 50 (mtengo - ma ruble 102,5)

L-thyroxine mapiritsi 100 a Berlin-Chemie 100 mcg, paketi ya mapiritsi 100 (mtengo - rubles 148,5)

L-thyroxine mapiritsi 150 a Berlin-Chemie 150 mcg, paketi ya mapiritsi 100 (mtengo - 173 ma ruble)

Mapiritsi Metformin 1 g, mapiritsi 60 pa paketi iliyonse (mtengo - ma ruble 250.8)

Mapiritsi Metformin Canon 850 mg, paketi 30 mapiritsi (mtengo - ma ruble 113.7)

Mapiritsi Metformin MV-Teva 500 mg, paketi 30 mapiritsi (mtengo - ma 135 rubles)

Mapiritsi Tyrosol 5 mg, paketi 50 mapiritsi (mtengo - 189.2 ma ruble)10 mg, paketi 50 mapiritsi (mtengo - ma ruble 370.8)

Mu shuga, chithandizo chikuyenera kukhala chokwanira: zakudya, mankhwala a hypoglycemic, masewera olimbitsa thupi ndi insulin ngati akuwonetsedwa. Pakadali pano pali mankhwala osiyanasiyana osiyanasiyana omwe amachepetsa shuga la magazi. Bambo anga anapezeka ndi matenda a shuga. Poyamba, Siofor adalembedwa, koma mankhwalawo analibe vuto, adatembenukira kwa endocrinologist. Dotolo adayambitsa Metformin. abambo akumva bwino.

Apa ndikuvomereza kwathunthu. Mwangozi atazindikira matenda ake, umboniwo unamenya 14mmol / l. Anayamba kumwa metformin ndi mavitamini, Halvus adayesa kutenga kangapo, anali ndi zoyipa, adayika pambali. Ndipo kudya komanso kuchita masewera olimbitsa thupi, kukana mowa ndi kusuta fodya ndiyofunika!

Mtundu wachiwiri wa matenda ashuga, ndinayesa mankhwala ochepetsa shuga, kuphatikizapo Glucofage, Siofor, ndi Tyrosol. Koma aliyense wa iwo sakanachita popanda zoyipa. Kuphatikiza apo, ali ndi kulemera posachedwa, ndipo kutaya ndi matenda otere ndikovuta kwambiri. The endocrinologist adalemba Metformin. Pafupifupi palibe mavuto, kupatula pang'ono kusanza mukayamba. Ndine wokondwa kuti ichi ndi mankhwala osokoneza bongo komanso okwera mtengo. Magazi a shuga amakhazikika bwino, amathandizanso pakukula kwa kulemera.

Ndikuvomereza kuti pakuthandizira odwala matenda ashuga ndikofunikira kutsatira kwambiri zakudya zamafuta ochepa ndipo ndikofunikira kuti kudya mapiritsi kumangiridwe pazakudya. Ndinapezeka kuti ndimayesa mankhwala osiyanasiyana ochepetsa shuga. Awa ndi Siofor, ndi Tiyroxol, ndipo ngakhale Diabetes. Ndipo zowonadi, mankhwala aliwonse ali ndi zabwino zake komanso zovuta zake. Tsopano ndikumwa Acarbose. Ndimamwa mapiritsi ndi chakudya, amakhala oleza bwino, samayambitsa mavuto. Ndipo koposa zonse - mosiyana ndi mankhwala ena ochepetsa shuga, samathandizira kuti apeze mapaundi owonjezera, zomwe ndizofunikira kwa ine.

1. 
   Fadeeva, Matenda a Anastasia. Kupewa, chithandizo, zakudya / Anastasia Fadeeva. - M: Buku la Demand, 2011. - 176 c.
2. 
   Karpova E.V. Kuyang'anira matenda ashuga. Mwayi Watsopano, Quorum - M., 2011. - 208 p.
3. 
   Aleshin B.V. Kukula kwa goiter ndi pathogeneis wa matenda a goiter, State Medical Publishing House of the Russian SSR - M., 2016. - 192 p.

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 webusayiti, kukambirana ndi akatswiri ndizofunikira nthawi zonse.

Mankhwala a Hypoglycemic: kuwunika kwa othandizira a hypoglycemic

Pofuna kuthana ndi matenda a shuga ndi zizindikiro zake, mankhwala apadera amagwiritsidwa ntchito omwe cholinga chake ndi kuchepetsa shuga mumagazi a wodwala. Othandizira antidiabetesic (hypoglycemic) amatha kugwiritsa ntchito kwa makolo, komanso pakamwa.

Mankhwala a Orog hypoglycemic hypoglycemic nthawi zambiri amadziwika motere:

1. zotumphukira za sulfonylurea (awa ndi Glibenclamide, Glikvidon, Gliklazid, Glimepirid, Glipizid, Chlorpropamide),
2. alpha glucosidase inhibitors ("Acarbose", "Miglitol"),
3. meglitinides (Nateglinide, Repaglinide),
4. biguanides ("Metformin", "Buformin", "Fenformin"),
5. thiazolidinediones (Pioglitazone, Rosiglitazon, Tsiglitazon, Englitazon, Troglitazon),
6. incretinomimetics.

Kuphatikiza mankhwala ndi m`kamwa hypoglycemic wothandizila pa matenda a matenda a shuga 2

Mtundu 2 wa matenda a shuga a mellitus (DM) ndi matenda osachiritsika, osakhazikika omwe amayamba chifukwa cha zotumphukira za insulin komanso kubisala kwa insulin. Ndi matenda a shuga a 2, kukokana kwa minofu, minyewa ya adipose, komanso minyewa ya chiwindi pokhudzana ndi insulin imawonedwa.

Minofu minisitini kukana ndikoyamba komanso mwina kutengera kwa chibadwa, chomwe chiri patsogolo kwambiri pakuwonekera kwa matenda a 2 a shuga. Kuphatikizika kwa minofu ya glycogen kumathandizira kuti shuga ayambe kudalira insulin. Komabe, kusokonekera kwa glycogen kaphatikizidwe kumakhala kolemala panjira ya mayendedwe a shuga ndi phosphorylation.

Kuphwanya zochita za insulin m'chiwindi imadziwika ndi kusapezeka kwa njira zake zoletsa mphamvu ya gluconeogenesis, kuchepa kwa kapangidwe ka glycogen mu chiwindi, ndi kutseguka kwa njira za glycogenolysis, zomwe zimabweretsa kuwonjezeka kwa kupanga kwa shuga ndi chiwindi (R. A. DeFronzo Lilly Lecture, 1988).

Chigwirizano china chomwe chimagwira gawo lalikulu pakukula kwa hyperglycemia ndiko kukaniza kwa minyewa ya adipose pokhudzana ndi insulini, ndiko kukaniza insulin. Kulephera kwa insulin poletsa lipid oxidation kumabweretsa kutulutsidwa kwamafuta ambiri amafuta acid (FFA). Kukula kwa kuchuluka kwa FFA kumalepheretsa mayendedwe a glucose ndi phosphorylation ndikuchepetsa glucose oxidation ndi minye glycogen synthes (M. M. Hennes, E. Shrago, A. Kissebah, 1998).

Mkhalidwe wa kukana insulini komanso chiopsezo chokhala ndi matenda amtundu wa 2 ndichikhalidwe cha anthu omwe ali ndi visceral m'malo mofalitsa kufalitsa kwa minofu ya adipose. Ichi ndichifukwa cha michere ya microscionical ya visceral adipose minofu: imayankha mofooka ku mphamvu ya insulin. Kuwonjezeka kwa kaphatikizidwe wa tumor necrosis factor kunawonedwa mu visceral adipose minofu, yomwe imachepetsa ntchito ya tyrosine kinase ya insulin receptor ndi phosphorylation ya mapuloteni a gawo lapansi la insulin receptor. Hypertrophy ya adipocytes mu m'mimba mtundu wa kunenepa kumabweretsa kusintha kwa mapangidwe a insulin receptor mocule ndi kusokonekera kwa kumangiriza kwake kwa insulin.

Kukana kwa insulin ndi kusakwanira kwachilengedwe kwa maselo pakuchitika insulin, ndikofunikira kwambiri m'magazi. Kukaniza kwa insulin kumawonekera kale nthawi yayitali isanayambike shuga ndipo imayendetsedwa ndi majini ndi chilengedwe (moyo, zakudya).

Malingana ngati ma pancreatic β-cell amatha kupanga insulini yokwanira kulipira zolakwika izi ndikukhalitsa mkhalidwe wa hyperinsulinemia, hyperglycemia sidzakhalapo. Komabe, malo osungirako a β-cell atatha, mkhalidwe wakusowa kwa insulin kumachitika, womwe umawonetsedwa ndi kuwonjezeka kwa shuga wamagazi ndikuwonetsa shuga.Malinga ndi zotsatira za kafukufuku (Levy et al., 1998), mwa odwala omwe ali ndi matenda a shuga a 2 omwe amangodya, patadutsa zaka 5-7 atadutsa matendawa, kuchepa kwakukulu kwa ntchito ya of-cell kumachitika, pomwe chidwi cha insulin sichiri kwenikweni zikusintha. Kupanga kwa kuchepa kwapang'onopang'ono kwa ntchito ya β-cell sikumveka bwino. Kafukufuku wowerengeka akuwonetsa kuti kuchepa kwa kusintha kwa β-cell komanso kuchuluka kwa apoptosis pafupipafupi ndizotsatira zamavuto otsimikiza. Mwinanso, kubisala kwambiri kwa insulin koyambirira kwa matendawa kumapangitsa kuti kufa kwa β-maselo kapena kubisalira kwakulu kwambiri kwa amylin (polypeptide ya amyloid yophatikizidwa pamodzi ndi proinsulin) kungayambitse amyloidosis a zilumba.

Mtundu wachiwiri wa matenda ashuga, zolakwika zotsatirazi mu insulin katulutsidwe zimawonedwa:

• kuchepa kapena kuchepa kwakukulu kwa gawo loyamba la insulin yotulutsa shuga,
• kutsika kapena kusakwanira kotakasuka katemera wa insulin,
• kuphwanya katulutsidwe wa pulsatory wa insulin (wabwinobwino pali kusinthasintha kwakasinthika kwa insulin insulin ndi nthawi ya 9-14 mphindi),
• kuchuluka kwa proinsulin,
• kusinthika kwakubwezeretsanso kwa insulin katulutsidwe chifukwa cha shuga ndi lipotoxicity.

Njira zothandizira matenda a shuga a mtundu wachiwiri ziyenera kukhala ndi cholinga chofuna kuteteza njira zomwe zimayambitsa matendawa, i.e., kuchepetsa insulin ndikusintha ntchito ya improving-cell.

Zochitika pa matenda a shuga:

• matenda oyambukira (pa gawo la kulolerana kwa glucose),
• njira zamphamvu zamankhwala zochotsa matenda a glycemia,
• kugwiritsa ntchito kwambiri mankhwala ophatikiza,
• yogwira insulin mankhwala kukwaniritsa carbohydrate kagayidwe kachakudya.

Njira zamakono zothandizira kubwezera mtundu wa matenda ashuga a 2, omwe amafunsidwa ndi International Diabetes Federation European Region mu 2005, akuwonetsa kusala kudya kwa glycemia pansi pa 6.0 mmol / L, ndi maola awiri mutatha kudya pansipa 8 mmol / L, glycated HbA1c hemoglobin pansipa 6.5% , Normolipidemia, kuthamanga kwa magazi m'munsi mwa 140/90 mm RT. Art., Index misa pamunsi pa 25 kg / m2. Zotsatira za UKPDS zidatilola kuganiza kuti chiwopsezo cha kukula ndi kufalikira kwa zovuta za matenda ashuga amtundu wa 2 komanso momwe matendawa amadzidalira amatengera mwachindunji mtundu wa kayendetsedwe ka glycemic komanso kuchuluka kwa HbA1c (I. M. Stratton, A. L. Adler, 2000).

Pakalipano, pali njira zopanda mankhwala komanso zamankhwala zothandizira kukonza insulin. Njira zopanda phokoso zimaphatikiza zakudya zama calorie ochepetsetsa zomwe zimapangitsa kuchepetsa thupi, komanso zolimbitsa thupi. Kuchepetsa thupi kumatheka chifukwa chotsatira zakudya zamafuta ochepera 30%, mafuta osachepera 10%, ndi mafuta ochulukirapo kuposa 15 g / kg patsiku, komanso masewera olimbitsa thupi nthawi zonse.

Odwala atha kulimbikitsidwa kuchita masewera olimbitsa thupi pafupipafupi (kuyenda, kusambira, kugudubuza chimtunda, kuyenda panjinga) kwa mphindi 30 mpaka 45 kuyambira katatu mpaka kasanu pa sabata, komanso kuchita masewera olimbitsa thupi (J. Eriksson, S. Taimela, 1997). Kuchita masewera olimbitsa thupi kumapangitsa kuti pakhale shuga wambiri, pakulimbitsa thupi komwe kumapangitsa kuti glucose ayambe kudzilamulira yekha. Kuphatikiza apo, pochita masewera olimbitsa thupi pamachepa milingo ya insulin m'magazi. Kutenga kwa minofu ya glucose kumakulanso ngakhale kutsika kwamankhwala a insulin (N. S. Peirce, 1999).

Zakudya ndi zolimbitsa thupi zimapanga maziko omwe chithandizo cha odwala onse omwe ali ndi matenda amtundu wa 2 amakhazikitsidwa, ndipo ndi gawo lofunikira la mankhwalawa matenda a shuga a 2 - mosasamala mtundu wa hypoglycemic therapy.

Mankhwala othandizira amapatsidwa mankhwala omwe amadya zakudya zowonjezera komanso kuwonjezereka zolimbitsa thupi kwa miyezi itatu samalolera kukwaniritsa cholinga chamankhwala.Kutengera ndi machitidwe a zochita, pakamwa hypoglycemic mankhwala amagawika m'magulu atatu akuluakulu:

kuwonjezera insulin katulutsidwe (secretogens):

- ntchito yayitali - zochokera sulfonylureas zam'badwo wa 2 ndi 3: glycazide, glycidone, glibenclamide, glimeperide,

- Mwachidule (prandial Administrators) - glinides: repaglinide, nateglinide,

- thiazolidinediones: pioglitazone, rosiglitazone,

Orother antidiabetesic monotherapy imakhudza mwachindunji gawo limodzi lokha la ulalo wa matenda ashuga a mtundu 2. Odwala ambiri, mankhwalawa samapereka mphamvu yayitali yogwiritsira ntchito kuchuluka kwa shuga m'magazi, ndipo pakufunika kuphatikiza mankhwala. Malinga ndi UKPDS (R. C. Turner et al., 1999), monotherapy yokhala ndi mankhwala amkamwa hypoglycemic pambuyo pazaka 3 kuyambira pachiyambire othandizira anali othandiza kokha mwa 50% ya odwala, ndipo pambuyo pa zaka 9 kokha mu 25%. Izi zimabweretsa chidwi chambiri cha mitundu yosiyanasiyana ya mankhwala ophatikiza.

Kuphatikiza mankhwala kumachitika ngati kulephera kwa monotherapy ndi shuga yoyambirira yotsitsa shuga yoikidwa muyezo waukulu. Ndikofunika kugwiritsa ntchito kuphatikiza kwa mankhwalawa omwe amakhudza chinsinsi cha insulini komanso mphamvu ya zotumphukira zama cell to the insulin.

Kuphatikizidwa kwa mankhwalawa:

• sulfonylurea derivatives + biguanides,
• sulfonylurea derivatives + thiazolidinediones,
• glinides + greatuanides,
• glinides + thiazolidinediones,
• kachikachiyama +
• acarbose + mankhwala aliwonse a hypoglycemic.

Monga zotsatira za kafukufukuyu zikuwonetsa, kuchepa kwambiri kwa hemoglobin wa glycosylated panthawi yophatikiza mankhwalawa ndi mankhwala amkamwa awiri sikupitirira 1.7% (J. Rosenstock, 2000). Kusintha kwina pakubweza kwa carbohydrate metabolism kungatheke pogwiritsa ntchito mitundu itatu ya mankhwala kapena kuwonjezera insulin.

Malangizo a mankhwala othandizira kuphatikiza ndi awa:

• Poyamba, pa monotherapy ndi mankhwala oyamba ochepetsa shuga, ngati kuli kofunikira, onjezani mlingo mpaka muyeso.
• Ngati mankhwala ali osagwira, onjezerani mankhwala ena a gulu lina mwazotheka achire.
• Ndi osakwanira, kuphatikiza kumawonjezera mlingo wa mankhwala wachiwiri mpaka wokwanira.
• Kuphatikiza kwa mitundu itatu ya mankhwala ndikotheka ngati milingo yayikulu yam'mbuyomu siyothandiza.

Kwa zaka zopitilira 30, kukonzekera kwa sulfonylurea kwakhala pamalo akuluakulu pochizira matenda a shuga a 2. Zochita zamankhwala a gululi zimagwirizanitsidwa ndi kubisalira kwa insulini komanso kuchuluka kwa insulin yozungulira, koma pakapita nthawi amalephera kuyang'anira glycemic control ndi β-cell function (J. Rachman, M. J. Payne et al., 1998). Metformin ndi mankhwala omwe amasintha kukhudzidwa kwa minofu ndikumapangitsa insulin. Njira yayikulu yogwiritsira ntchito metformin cholinga chake ndikuchotsera insulin yolimbana ndi chiwindi ndikuchepetsa kuchuluka kwa shuga ndi chiwindi. Metformin imatha kupondereza gluconeogenesis poletsa ma enzymer a ndondomekoyi m'chiwindi. Pamaso pa insulin, metformin imachulukitsa kugwiritsidwa ntchito kwa minofu ya glucose poyambitsa insulin receptor tyrosine kinase ndi kusamutsidwa kwa GLUT4 ndi GLUT1 (ma glucose omwe amayendetsa) m'maselo a minofu. Metformin imachulukitsa kugwiritsidwa ntchito kwa glucose ndimatumbo (kupititsa patsogolo anaerobic glycolysis), yomwe imadziwonetsera kuchepa kwamlingo wamagazi m'magazi omwe amayenda kuchokera m'matumbo. Kugwiritsa ntchito metformin kwanthawi yayitali kumakhudza kagayidwe ka lipid: kumabweretsa kuchepa kwa cholesterol ndi triglycerides m'magazi. Limagwirira a metformin ndi antihyperglycemic, osati hypoglycemic.Metformin sichepetsa kuchuluka kwa glucose m'magazi m'munsi mwake, motero, ndi metformin monotherapy palibe mikhalidwe ya hypoglycemic. Malinga ndi olemba angapo, metformin ili ndi anorectic. Odwala omwe amalandila metformin, kuchepa kwa thupi kumawonedwa, makamaka chifukwa cha kuchepa kwa minofu ya adipose. Zotsatira zabwino za metformin pazinthu za fibrinolytic zamagazi chifukwa cha kuponderezedwa kwa plasminogen-1 activator inhibitor kwatsimikiziridwa.

Metformin ndi mankhwala omwe makonzedwe ake amachepetsa pafupipafupi kuchuluka kwa matenda ashuga a micro- ndi microvascular diabetesic ndipo amakhudza chiyembekezo chokhala ndi moyo wa odwala omwe ali ndi matenda a shuga a 2. Kafukufuku yemwe akuyembekezeka ku UK (UKPDS) adawonetsa kuti metformin imachepetsa chiwerengero cha anthu omwalira ndi matenda oyambitsidwa ndi matenda ashuga ndi 42% kuyambira nthawi yodziwitsa, anthu omwe amafa ndi 36%, komanso kuchuluka kwa odwala matenda ashuga ndi 32% (IM) Stratton, AL Adler et al., 2000).

Kuphatikiza kwa Biguanides ndi zotumphukira za sulfonylurea kumawoneka ngati koyenera, chifukwa zimakhudza maumwini onse a pathogenesis a mtundu 2 matenda ashuga: kumalimbikitsa kutulutsa insulin ndikukulitsa kumva kwa insulin.

Vuto lalikulu pakupanga kukonzekera kophatikiza ndikusankha kwa zinthu zomwe zimafunidwa mwachilengedwe ndipo zimakhala ndi pharmacokinetics. Ndikofunikira kuganizira kuchuluka komwe magawo amatulutsa piritsi kuti akwaniritse kuchuluka kwa magazi panthawi yoyenera.

Piritsi yotulutsidwa ya glucovans yomwe yangotulutsidwa kumene, mphamvu ndi chitetezo chake zomwe zaphunziridwa bwino m'mayesero azachipatala okonzekera bwino.

Glucovans ndipophatikiza mapiritsi ophatikizidwa, omwe amaphatikizapo metformin ndi glibenclamide. Pakadali pano mitundu iwiri ya mankhwalawa imaperekedwa ku Russia, yomwe ili ndi piritsi limodzi: metformin - 500 mg, glibenclamide - 5 mg ndi metformin - 500 mg, glibenclamide - 2.5 mg.

Pali zovuta zina zaluso kuphatikiza metformin ndi glibenclamide piritsi limodzi. Glibenclamide sichisungunuka bwino, koma imatengedwa bwino kuchokera ku yankho m'matumbo am'mimba. Chifukwa chake, pharmacokinetics ya glibenclamide imadalira kwambiri mtundu wake. Odwala omwe amalandira ma micronized komanso mawonekedwe a glibenclamide, kuchuluka kwa mankhwalawa kwa plasma kunali kosiyana kwambiri.

Tekinoloje yopanga ma glucovans ndiyopadera (S. R. Donahue, K. C. Turner, S. Patel, 2002): glibenclamide mu mawonekedwe a tinthu tating'onoting'ono tofotokozedwa mofananitsidwa amagawidwa mu masanjidwe a metformin yosungunuka. Kapangidwe kameneka kamatsimikizira kuchuluka kwa kutulutsa kwa glibenclamide kulowa m'magazi. Mukamamwa glucovans, glibenclamide imawonekera m'magazi mwachangu kuposa momwe mukugwiritsira ntchito glibenclamide ngati piritsi limodzi. Kukwaniritsidwa koyambirira kwa kuchuluka kwa glibenclamide mu plasma mukamamwa glucovans imakupatsani mwayi woti mugwiritse ntchito mankhwalawa ndi chakudya (H. Howlett, F. Porte, T. Allavoine, G. T. Kuhn, 2003). Makhalidwe azambiri pazambiri za glibenclamide mukamamwa mankhwala ophatikizira ndi monotherapy ndi ofanana. Ma pharmacokinetics a metformin, omwe ali gawo la glucovans, samasiyana ndi a metformin, omwe amapezeka ngati mankhwala amodzi.

Kafukufuku wothandizidwa ndi ma glucovans adachitika m'magulu a odwala omwe sanakwaniritse kuwongolera koyenera kwa glycemic panthawi ya monotherapy ndi glibenclamide ndi metformin (M. Marre, H. Howlett, P. Lehert, T. Allavoine, 2002). Zotsatira za kafukufuku wamitundu yambiri zinawonetsa kuti zotsatira zabwino kwambiri zimapezeka m'magulu a odwala omwe amatenga glucovans. Pambuyo pa chithandizo cha masabata 16, HBa1c ndi kusala kwamagazi m'magulu a odwala omwe amatenga glucovans ndi chiyerekezo cha metformin + glibenclamide 500 mg / 2,5 mg kutsika ndi 1.2% ndi 2.62 mmol / l, motero, ndi chiyerekezo cha metformin + glibenclamide 500 mg / 5 mg ndi 0.91% ndi 2.43 mmol / L, ali m'gulu la odwala omwe akutenga metformin, izi zimatsika kokha ndi 0.19% ndi 0.57 mmol / L, komanso pagulu la odwala kutenga glibenclamide, pa 0,33% ndi 0,73 mmol / L, motsatana.Komanso, kuphatikiza kwakukulu kwa mankhwala ophatikiza kumatheka ndi zotsika zomaliza za metformin ndi glibenclamide poyerekeza ndi zomwe zimagwiritsidwa ntchito mu monotherapy. Chifukwa chake, pokonzekera pamodzi, mulingo wambiri wa metformin ndi glibenclamide anali 1225 mg / 6.1 mg ndi 1170 mg / 11.7 mg (kutengera mtundu wa mankhwalawo), pomwe anali ndi monotherapy, mulingo wambiri wa metformin ndi glibenclamide anali 1660 mg ndi 13.4 mg Chifukwa chake, ngakhale atakhala kuti amamwa mankhwala ochepetsa mphamvu ya shuga, njira zomwe zimagwirizana ndi metformin ndi glibenclamide, zomwe zimagwiritsidwa ntchito piritsi limodzi lophatikizira, zimapereka kuchepa kwa shuga kwa magazi kuposa monotherapy.

Chifukwa cha kudya mwachangu kwa glibenclamide kuchokera ku mankhwala ophatikizika kulowa m'magazi panthawi ya mankhwala a glucovans, kuwongolera kwamphamvu kwambiri m'magazi pambuyo pudya kumatheka poyerekeza ndi monotherapy ndi zida zake (S. R. Donahue et al., 2002).

Kuwunikanso koyambira kunawonetsanso kuti glucovans imachepetsa kwambiri HbA1c kuposa kuphatikiza kwa glucophage ndi glibenclamide. Zotsatira za phunziroli zidawonetsa kuti posamutsa odwala kuchokera pakuphatikizidwa kwa glucophage ndi glibenclamide kupita ku glucovans management, kuchepa kwakukulu pamlingo wa HbAlc kunawonedwa (pafupifupi 0,6%), ndipo zotulukazo zimatchulidwa kwambiri mwa odwala omwe ali ndi msana woyamba wa HbA1c> 8%. Zinawonetsedwanso kuti ma glucovans adalola kuyendetsa bwino kwambiri kwa postprandial level ya glycemia kuposa kugwiritsidwa ntchito kophatikizana kwa glibenclamide ndi metformin (S. R. Donahue et al., 2003).

Chizindikiro cha kuphatikiza ma glucovans ndi: mtundu wachiwiri wa matenda ashuga mwa achikulire omwe sangathe kugwira ntchito yotsatira ya monotherapy ndi metformin kapena glibenclamide, komanso kusintha kwa mankhwala am'mbuyomu ndi mankhwala awiri: metformin ndi glibenclamide. Contraindication poika metformin ndi glibenclamide ndi contraindication poika ma glucovans.

Mavuto akulu okhudzana ndi kulolera kwa ma glucovans monga kuphatikiza pamodzi komwe kumakhala ndi glibenclamide ndi metformin ndi zizindikiro za hypoglycemia komanso mavuto obwera chifukwa cha m'mimba. Kuchepetsa mlingo wa mankhwala antidiabetesic amachepetsa pafupipafupi mavuto. Pafupipafupi matenda a hypoglycemia ndi dyspeptic mwa odwala omwe sanalandire mapiritsi ochepetsa shuga pakumwa ma glucovans anali otsika kwambiri kuposa monotherapy yokhala ndi glibenclamide ndi metformin. Odwala omwe analandila metformin kapena sulfonylurea kukonzekera, pafupipafupi zotsatila za glucovans nthawi zambiri zinali zofanana ndi pamene chipatala chokhala ndi monotherapy chimagwira. Nthawi zambiri, zizindikiro za hypoglycemia munthawi ya mankhwala omwe amakhala ndi glibenclamide (onse awiri monotherapy ndi mankhwalawa, komanso mawonekedwe osakanikirana) amawonekera mwa odwala omwe ali ndi HbA1c yoyambira pansipa 8.0 mmol / L. Zinawonetsedwanso kuti mwa okalamba palibe kuwonjezeka kwa zochitika za hypoglycemia pochiza glucovans.

Kutsatira zolakwika za madokotala ndichimodzi mwazinthu zazikulu zopewera chithandizo chokwanira cha odwala omwe ali ndi matenda osiyanasiyana a matenda a shuga. Zotsatira zakufufuza zambiri zikuwonetsa kuti gawo limodzi mwa magawo atatu a odwala omwe ali ndi mtundu wachiwiri wa shuga amatsatira mokwanira mankhwalawa. Kufunika kwa kumwa mankhwalawa nthawi imodzi kumayambitsa zovuta kwa wodwalayo pazovomerezeka za madokotala ndipo zimakhudza kwambiri mtundu wa chithandizo. Kuwunikanso kwakanema kwa odwala mu 1920 kudasamutsidwa, kusamutsidwa kuchokera ku mankhwalawa amkamwa ndi metformin kapena glibenclamide kupita kumayendedwe omwewa a mankhwalawo kapena kwa metformin / glibenclamide yophatikizidwa.Zotsatira za phunziroli zinaonetsa kuti pakati pa odwala omwe amamwa mankhwalawo, njira zochizira zimawonedwa pafupipafupi kuposa pakati pa odwala omwe amapatsidwa mankhwala amodzi a metformin ndi glibenclamide (77% ndi 54%, motero). Posamutsa odwala kuchokera ku monotherapy yomweyo kukhala mankhwala osakanikirana, adayamba kukhala ndi malingaliro abwino kwambiri kuti atsatira mankhwalawa (kuchokera pa 71 mpaka 87%).

Glucovans wotengedwa ndi chakudya. Mlingo wa mankhwalawa umatsimikiziridwa ndi dokotala aliyense payekha kwa wodwala aliyense - kutengera mlingo wa glycemia. Nthawi zambiri, muyeso woyamba ndi piritsi limodzi la glucovans 500 / 2,5 pa tsiku.

Posintha njira yothandizira yophatikizira ndi metformin ndi glibenclamide, mlingo woyambirira ndi mapiritsi 1-2 a 500 / 2.5 mg, kutengera mtundu waukulu wa monotherapy. Mlingowo umakonzedwa pambuyo pa masabata onse a 1-2 pambuyo poyambira chithandizo, kutengera mtundu wa shuga. Mlingo wambiri watsiku ndi tsiku ndi mapiritsi 4 a glucovans 500 / 2,5 mg kapena mapiritsi awiri a glucovans 500/5 mg.

Pakadali pano, kukonzekera kosakanikirana ndi mankhwala a metformin ndi sulfonylurea kwapangidwa ndipo akugwiritsidwa ntchito mwakhama (Gome 1). Chimodzi mwa mankhwalawa ndi glibomet, yomwe ndi kuphatikiza kwa glibenclamide (2.5 mg) ndi metformin (400 mg). Chizindikiro chogwiritsa ntchito mankhwalawa ndi mtundu 2 wa shuga osagwiritsa ntchito mankhwala othandizira kapena monotherapy omwe ali ndi mankhwala amkamwa a hypoglycemic. Malangizo abwino a makonzedwe a mankhwalawa amaphatikizanso piritsi limodzi la piritsi 1 patsiku ndi chakudya, pang'onopang'ono pang'onopang'ono pang'onopang'ono. Mlingo woyenera amatengedwa ngati piritsi limodzi la 2 piritsi. Pazipita tsiku lililonse mapiritsi 4 - mapiritsi 2 2 pa tsiku. Glibomet ndi mankhwala oyamba kuphatikiza shuga omwe amaphatikizidwa ku Russia. Zotsatira za kafukufuku wazachipatala zatsimikizira kuti zimachita bwino, chitetezo, kulekerera bwino komanso kugwiritsa ntchito bwino odwala omwe ali ndi matenda a shuga a 2 (M. B. Antsiferov, A. Yu. Mayorov, 2006). Nthawi yomweyo, pafupifupi gawo lililonse la gawo lililonse la mankhwalawa lomwe limapanga mankhwalawo linakhala yotsika kuwirikiza kawiri kuposa mlingo womwe umagwiritsidwa ntchito pa monotherapy yam'mbuyomu, ndipo kutsika kwa shuga kunali kwakukulu kwambiri. Odwala adawona kuchepa kwa chikondwerero, kulimbitsa thupi, komanso kusowa kwa mikhalidwe ya hypoglycemic.

Glitazones (sensitizer) amaimira gulu latsopano la mankhwala omwe amalimbikitsa kukhudzidwa kwa minofu ndipo amatsimikizira kuti ndi othandiza pakulipira matenda a shuga 2 (Clifford J. Bailey et al., 2001). Mankhwala a gululi (pioglitazone, rosiglitazone) ndi zida zopanga ma nyukiliya receptors g zochititsidwa ndi peroxisome proliferator (PPARg). Kutsegula kwa PPARg kumasintha mawonekedwe amitundu yomwe imakhudzidwa ndi ma metabolic monga adipogeneis, kufalikira kwa chizindikiro cha insulin, kayendedwe ka glucose (Y. Miyazaki et al., 2001), komwe kumayambitsa kuchepa kwa kukana kwa minofu ku zochita za insulin m'maselo a chandamale. Mu minofu ya adipose, mphamvu ya glitazones imabweretsa kuponderezedwa kwa njira za lipolysis, pakuphatikizika kwa triglycerides, zomwe zimapangitsa kuchepa kwa mulingo wa FFA m'magazi. Chifukwa chake, kuchepa kwa milingo ya FFA ya plasma kumalimbikitsa kutseguka kwa shuga wama minofu ndikuchepetsa gluconeogenesis. Popeza ma FFA ali ndi mphamvu ya lipotoxic pama cell β, kuchepa kwawo kumathandizira ntchito yotsiriza.

Glitazones amatha kuwonjezera mawu ndikusunthira kwa transporter ya glucose pamtunda wa adipocyte poyankha zochita za insulin, zomwe zimayambitsa kugwiritsa ntchito shuga ndi minofu ya adipose. Glitazones imakhudza kusiyanitsa kwa preadipocytes, komwe kumabweretsa kuwonjezeka kwa gawo laling'onoting'ono, koma likuwonetsetsa kwambiri maselo a insulin. Mu vivo ndi vitro glitazones amachepetsa mawu a leptin, motero zimakhudza unyinji wa minofu ya adipose mwanjira (B. M.Spiegelman, 1998), komanso zimathandizira pakusiyanitsa minofu ya bulauni ya adipose.

Glitazones imathandizira kuti shuga agwiritsidwe ntchito. Monga momwe amadziwika, odwala omwe ali ndi matenda a shuga a 2, pali kuphwanya kwa insulin-zolimbikitsidwa kwa insulin receptor phosphatidylinositol-3-kinase mu minofu. Kafukufuku wofanizira adawonetsa kuti, mosiyana ndi maziko a mankhwala a troglitazone, insulini yolimbikitsidwa ya phosphatidylinositol-3-kinase inachulukitsa pafupifupi katatu. Poyerekeza ndi chithandizo cha metformin mankhwala, palibe zosintha muzochitika za enzyme zoterezi (Y. Miyazaki et al., 2003).

Zotsatira za kafukufuku wa labotale zimasonyeza kuti glitazones (rosiglitazone) imateteza chitetezo ku β-cell, imalepheretsa kufa kwa β-cell pokulitsa kuchuluka kwawo (P. Beales et al., 2000).

Kuchita kwa ma glitazones, omwe cholinga chake ndi kuthana ndi insulin ndikusintha ntchito ya β-cell, sikuti amangokulolani kuti mukhale ndi magwiridwe oyenera a glycemic, komanso komanso kupewa matenda omwe akupitilira, kuchepa kwina kwa ntchito ya ma cell a β komanso kupita patsogolo kwa zovuta zam'magazi. Mwa kukhudza pafupifupi magawo onse a metabolic syndrome, glitazones mwina itha kuchepetsa mwayi wokhala ndi matenda amtima.

Pakadali pano, mankhwala awiri ochokera ku gulu la thiazolidinedione adalembetsa ndikuvomerezeka kuti agwiritse ntchito: pioglitazone (actos) ndi rosiglitazone.

Chizindikiro chogwiritsa ntchito glitazones monga monotherapy ndi mtundu woyamba wa matenda ashuga wachiwiri omwe ali ndi zizindikiro za insulin yolimbana ndi zakudya zosagwira komanso zolimbitsa thupi.

Monga mankhwala ophatikiza, glitazones amagwiritsidwa ntchito pakakhala kuti palibe mokwanira kuwongolera glycemic mukamamwa metformin kapena sulfonylurea. Kuti muchepetse kuwongolera kwa glycemic, mutha kugwiritsa ntchito kuphatikiza kwapatatu (glitazones, metformin ndi sulfonylureas).

Kuphatikiza koyenera komanso koyenera kwa glitazones ndi metformin. Mankhwala onsewa ali ndi vuto la hypoglycemic ndi hypolipidemic, koma kachitidwe ka rosiglitazone ndi metformin ndiosiyana (V. A. Fonseca et al., 1999). Glitazones makamaka imapangitsa kuti shuga ayambe kudalira insulin. Zochita za metformin cholinga chake ndicho kupondereza kapangidwe ka shuga m'chiwindi. Kafukufuku akuwonetsa kuti ndi glitazones, osati metformin, yomwe imatha kuwonjezera ntchito ya phosphatidylinositol-3-kinase, imodzi mwazinthu zazikulu zofunikira kwambiri pakufalitsa chizindikiro cha insulin, nthawi zopitilira katatu. Kuphatikiza apo, kuwonjezera kwa glitazones ku metformin mankhwala kumabweretsa kusintha kwakukulu mu ntchito ya β-cell poyerekeza ndi metformin therapy.

Pakadali pano, waphatikiza mankhwala atsopano - avandamet. Mitundu iwiri ya mankhwalawa imapangidwa ndi mtundu wina wa rosiglitazone ndi metformin: rosiglitazone 2 mg ndi 500 mg metformin ndi rosiglitazone 1 mg wophatikizidwa ndi 500 mg metformin. Malowa omwe amatsimikizidwa ndi mapiritsi 1-2 kawiri pa tsiku. Mankhwala samangokhala othandizira kuchepetsa shuga poyerekeza ndi gawo lililonse palokha, komanso amachepetsa kuchuluka kwa mafuta ochulukirapo. Mu 2002, avandamet adalembetsa ku United States, mu 2003 - ku Europe. Posachedwa, mawonekedwe a chida ichi ku Russia akuyembekezeredwa.

Kuphatikizidwa kwa glitazones ndi sulfonylurea zotumphukira kumalola munthu kuchita zinthu ziwiri zolumikizana ndi matenda a shuga 2: kuyambitsa insulin katulutsidwe (zotumphukira za sulfonylurea) ndikukulitsa chidwi cha minofu kuti ichitike insulin (glitazone). Posachedwa, mawonekedwe a apandaril osakanikirana a mankhwala (rosiglitazone ndi glimepiride) akuyembekezeka.

Komabe, monga zikuwonekera ndi zotsatira za kafukufuku yemwe wachitika mwa odwala omwe ali ndi matenda a shuga a 2 omwe adalandira monotherapy ndi sulfonylureas komanso kuwonongeka kwa kagayidwe kazakudya, kuwonjezeranso kwa rosiglitazone (avandium) kunapangitsa kutsika kwakukulu kwa HbA1c ndi glycemia patatha maola awiri kuchokera pakubweza kwa glucose (Table 2).

Pambuyo pa miyezi isanu ndi umodzi ya kuphatikiza mankhwala, kubwezeretsa kwa chakudya cha carbohydrate kunatheka mu 50% ya odwala (I.V. Kononenko, T.V. Nikonova, O. M. Smirnova, 2006).Kusintha kwa chikhalidwe cha carbohydrate metabolism kunatsagana ndi kuwonjezeka kwa chidwi cha minyewa mpaka kuchitidwe cha amkati insulin, ndi kuchepa kwa basal ndi postprandial hyperinsulinemia (Gome 3). Zotsatira zamaphunziro athu zidawonetsera bwino kuphatikizidwa kwa rosiglitazone ndi kukonzekera kwa sulfonylurea.

Ubwino wotsatira wophatikiza shuga wochepetsera shuga wothandizirana ndi sulfonylurea ndi glitazones titha kusiyanitsidwa poyerekeza ndi sulfonylurea monotherapy yokhayo:

• kulipira kwabwino kwa matenda ashuga ndikusankhidwa kwakanthawi kothandizirana,
• kupewa chitukuko cha hyperinsulinemia, kuchepa kwa insulin,
• kukonza β-cell ntchito - potero kukwaniritsa kuthekera kozengereza kusamukira ku insulin.

Chifukwa chake, cholinga cha mankhwalawa mtundu wa shuga wachiwiri ndikukwaniritsa ndikuwongolera moyenera kuchuluka kwa shuga wamagazi, chifukwa chiwopsezo cha kukulitsa ndikupita patsogolo kwa zovuta za matenda a shuga 2 komanso kuchuluka kwa matendawo kumatengera mwachindunji mtundu wa kayendetsedwe ka glycemic komanso kuchuluka kwa HbA1c. Kuti tikwaniritse kulipidwa kwa chakudya cha carbohydrate metabolism, njira yotsatira ya algorithm yothandizira odwala omwe ali ndi matenda amtundu wa 2 angapangidwe malinga ndi kuchuluka kwa hemoglobin ya glycosylated (onani mkuyu. 2). Kuphatikiza mankhwala ndi chimodzi mwazigawo zazikulu pothandizira odwala omwe ali ndi matenda a shuga a 2 ndipo ayenera kugwiritsidwa ntchito m'magawo oyambira momwe amalembedwera, chifukwa izi zimakuthandizani kuti muzitha kuyendetsa bwino glycemic, komanso kuthana ndi metabolic syndrome. Kuphatikizanso, kuphatikiza ndi gawo lokhazikika la zigawo zosiyanasiyana kumachitika mosiyanasiyana.

• Chifukwa cha kuchuluka kwa mankhwalawa kwa mankhwala osakanikirana, kulekerera kwawo ndikwabwino ndipo zotsatira zoyipa zimawonedwa kuposa ndi monotherapy kapena ndi mankhwala osiyana ophatikizidwa.
• Mukamamwa mankhwala ophatikiza, pamakhala kugonjera kwapamwamba, popeza kuchuluka ndi kuchuluka kwa mapiritsi kumachepetsedwa.
• Kugwiritsa ntchito mankhwala ophatikiza kumapangitsa kuti pakhale mankhwala othandizira atatu.
• Kupezeka kwa mitundu yosiyanasiyana ya mankhwalawa omwe amaphatikiza mankhwala ophatikizika kumapangitsa kuti pakhale kusintha kosiyanasiyana kwa mankhwalawa.

I.V. Kononenko, woimira mabungwe azachipatala O. M. Smirnova, dokotala wa sayansi ya zamankhwala, ESC RAMS, Moscow

Mankhwala ochepetsa shuga a shuga a chachiwiri - Mankhwala ochepetsa shuga a m'badwo watsopano.

Pakuwongolera kagayidwe ka wodwala yemwe ali ndi matenda a shuga a 2 molondola momwe angathere, madokotala amagwiritsa ntchito mankhwala osankhidwa mwapadera, omwe aliwonse omwe amagwira ". Actos ® ndi glitazones zina zimangowonjezera kukhudzika kwa minofu ndikupanga insulin, komanso zimachepetsa kuchuluka kwa kupanga kwa chiwindi mu chiwindi, komanso kuchepetsa chiopsezo cha zovuta zamtima.

Ichi ndichopanga cha magawo awiri opangidwa motengera zomera zotetezeka. Pachigawo choyamba, achire zotsatira zimachitika pogwiritsa ntchito zakudya, kusintha kwaumoyo, ndi njira zina.

Ndi mankhwala ati a shuga omwe ali bwino komanso othandiza? Panthawi imeneyi, munthu amayamba kunenepa kwambiri, makamaka mapewa, mikono ndi m'mimba zimayamba kulimba.

Gwero la nkhaniyi

Munthu amafunikira shuga monga mafuta, ndipo amapangidwa kuchokera ku chakudya chamafuta omwe amapezeka ndi chakudya ndipo amagawidwa mthupi lonse mothandizidwa ndi magazi. Ndipo kuti akhutitse khungu lililonse ndi mphamvu zofunika, kapamba, yemwe amayamba kutulutsa insulin, amaphatikizidwanso pantchitoyi. Homoni imeneyi imathandizanso shuga.

Mlingo wosakwanira wa shuga siziwopseza kungokhala chikomokere, komanso kuti zotsatira zakupha zitha kuchitika.

Glypoglycemia imachitika chifukwa cha shuga osakwanira, omwe amaphatikizidwa muzakudya, kapena chifukwa cha kupanga kwambiri insulin.

Matenda a shuga amapezeka m'mitundu iwiri:

1. Choyamba ndi mawonekedwe odalira insulini. Poterepa, anthu odwala amakakamizidwa kubaya insulin panthawi yofanana kuti athe kupanga kuchuluka kwa shuga. Mlingo watsimikiza ndi dokotala.
2. Fomu yosadalira insulini.

Ngati pali insulin yochuluka kwambiri, ndiye kuti chiwindi chimayesa kukhazikitsa malire ndikupanga glycogen. Koma ngati mulibe kapena wocheperako, mankhwala amapulumutsa.

Hypoclickimia imawoneka makamaka chifukwa cha:

• Mlingo wa insulin molakwika.
• kutsitsa shuga wamagazi, nthawi zambiri amamwa mowa,
• kutalika kwa chakudya, zakudya zoperewera, kuphatikizapo zakudya,
• zolimbitsa thupi, zomwe zidapangitsa kuti pakhale shuga ndi glycogen,
• mankhwala osokoneza bongo, omwe amaphatikizapo mankhwala omwe amavuta kuphatikiza ndi mankhwala omwe amapangidwa pochiza matenda a shuga, mwachitsanzo, Aspirin, Allopurinol.

Ngati munthu alibe matenda a shuga, ndiye kuti hypoglycemia imatha kuyambitsa matenda aliwonse omwe amagwirizana ndi endocrine system.

Mkhalidwe wa hypoglycemia ukhoza kukhala ndi madigiri atatu osakhazikika, komanso kutsika shuga, kumakhala kowopsa kwambiri momwe matendawo alili ndi zizindikiro zake:

1. Chizindikirochi chili pansipa ngati 3.8 mmol / l, nseru, mantha, kuyamba kuzizira, milomo kapena zala zimamveka - Umu ndi momwe gawo lofatsa limawonekera.
2. Ndi kusakhazikika kwenikweni, nkovuta kukhazikika, malingaliro amasokonezeka, munthu amakhala wotentha kwambiri. Mutu umayamba, kuchuluka kwa kayendedwe kumakhala kovuta, ndizovuta kuyankhula, pali kufooka kwamphamvu.
3. Vuto lalikulu kwambiri, shuga akatsika kwambiri kuposa 2.2 mmol / l, amaphatikizidwa ndi kukomoka, kukomoka, kukomoka, komanso kugwa. Kutentha kwa thupi kumachepetsedwa kwambiri. Zombo zapamadzi zimayamba kusokonekera, zomwe zimatha kubweretsa khungu komanso angiopathy.

Mankhwala a Hypoglycemic amathandizira kukhala ndi thupi kuti lisakhale lowopsa. Ndikofunika kudziwa kuyambika kwa matendawa ndikuwonetsetsa kuti athetse matendawa. Zothandiza kwambiri pamenepa ndi glucagon. Mankhwalawa ndi mahomoni omwe amabisa ziphuphu, komanso amathandizira kupanga shuga m'magazi.

Ngati munthu wodwala matenda ashuga sangadye kapena akutsalira, njira yotsimikizika ndiyo kubaya njira ya glucagon kudzera m'mitsempha, kapena m'mitsempha. Imagwira kwa mphindi 20, ndipo mankhwalawo akayamba kugwira ntchito, wopezayo ayenera kupatsidwa chakudya ndi chakudya chamagulu ochepa.

Wothandizirayi akalowa m'thupi, zimathandizira kuti shuga azichulukirachulukira, ndipo pamakhala njira yowonjezera gluconeogeneis, ndiko kuti, kupanga ma glucose m'chiwindi.

Mankhwalawa amathandizanso kupindika, pomwe theka-moyo wake umalowa m'magazi am'magazi, kuyambira 3 mpaka 6 maminiti.

Tsukani matumbo msanga

Chifukwa cha kuphatikiza kwa insulin mwa wodwala, kulakalaka kwambiri kumachepetsedwa, komwe kumathandiza kwambiri odwala matenda ashuga komanso anthu onenepa kapena onenepa kwambiri. Mankhwala ochepetsa shuga amtunduwu amalembedwa motere: Nthawi zina, sulfonamides amapatsidwa mankhwala osakanikirana ndi insulin.

• Mankhwala atsopano abwino kwambiri a mtundu 1 komanso a shuga a 2.
• Njira zamakono zochizira matenda amtundu wa 2 shuga

Gulu la ndalama izi limaphatikizapo Januvia, Galvus, Saksagliptin. Zambiri Popeza pali mankhwala ambiri ochepetsa shuga m'magazi, ndidaganiza kuti ndikudziwitsani. Kuti muchite bwino, ndikuwonetsa m'mabakhu dzina lodziwika kwambiri lazamalonda, koma kumbukirani kuti pali ena ambiri.

Ndizololedwa kulandira insulin, kutengera kutalika kwa zochita, m'mitundu ingapo: Kusankhidwa kwa mankhwala oyenera, kusankha kwa mankhwala ndi njira zamankhwala zimapangidwira ndi endocrinologist. Chifukwa chake, ndinasankha kuchita izi: Ndimayankhula mwachidule za mankhwala ena ndipo ndimapereka ulalo kwa nkhani yomwe zonse zimafotokozedwa mwatsatanetsatane.

Mankhwala ochepetsa shuga omwe akuphatikizidwa ndi osavuta kwambiri chifukwa gawo lililonse la chinthu chilichonse limakhala locheperako kuposa lomwe lingatenge "aliyense payekha." Tsatirani ulalo ndikupeza zambiri zokhudzana ndi hypoglycemic.

Chithandizo cha matenda a shuga

Bwanji osasokonezeka m'malo osiyanasiyana ndikusankha mankhwala oyenera ochepetsa shuga? Pachifukwa ichi, Mlingo wofotokozedwa ndi adotolo uyenera kuyang'aniridwa mosasamala.

Ndizachidziwikire kuti mankhwalawa omwe amaperekedwa pochizira matenda amishuga a 2 sayenera kwenikweni kwa odwala matenda ashuga omwe insulin yake siyipangidwa. Oimira meglitinides ndi kukonzekera kwa Novonorm ndi Starlix. Kuphatikiza apo, odwala ena amayamba kuchuluka.

Ndikukumbuseni, abwenzi, kuti mankhwala aliwonse ali ndi dzina lake lakunja lopanda mgwirizano, amatchedwa INN. Starlix ® ndiyotetezedwa kuti iwonongeke ndi impso komanso chiwindi, samayambitsa kulemera komanso amachepetsa chiopsezo cha hypoglycemia.

Chithandizo ndi Zakudya za Bukhu la Matenda a shuga

Ndipo kale mu 1923 anafalikira padziko lonse lapansi. Chifukwa chake, amalekeredwa bwino, amakhala ndi zovuta zochepa poyerekeza ndi monotherapy kapena pamene wodwala matenda ashuga amatenga mankhwala osiyanasiyana mosiyana.

Koma nthawi zina, ngakhale kumwa mankhwala akumwa sikothandiza. Odwala omwe ali ndi matenda amtundu wa 2 amatha kupita popanda mapiritsi ochepetsa shuga kwa nthawi yayitali ndikukhalabe ndi shuga yamagazi pokhapokha ngati akutsatira zakudya zamagulu ochepa komanso kuchita masewera olimbitsa thupi okwanira.

• Type 2 matenda a shuga oletsa kupanikizika, mndandanda wamapiritsi
• Mankhwala ochepetsa shuga a magazi a matenda a shuga a 2
• Metformin - ithandiza ndi matenda ashuga
• Matenda a shuga ku USA amathandizidwa, mapiritsi aku America ndipo
• Chithandizo cha Matenda a shuga - Mtundu Wachiwiri wa Matenda A shuga Kuchepetsa
• Mtundu Wachiwiri wa Matenda Ochepetsa Matenda a shuga

Mankhwalawa sadzachepetsa shuga pang'onopang'ono pamlingo wokhazikika, ndipo ngati wodwala amathandizidwa ndi iye yekha, sadzakhala ndi hypoglycemia. Mankhwalawa akugulitsidwa mpaka pano pa tsamba lovomerezeka la wopanga.

Trophic ulcer shuga

Oyimira bwino a gululi ndi Glucobay ndi Miglitol. Komabe, izi sizikhudza kwambiri deta yakugwiritsa ntchito mankhwalawa kwa odwala omwe ali ndi matenda a shuga a 2. Gome 5 ikuwonetsa kuchuluka kwa odwala omwe adwala matenda a shuga. Chifukwa chake, ma Dhib-4 inhibitors ndi agonists a GLP-1 pang'onopang'ono akutenga malo awo mothandizidwa ndi odwala matenda a shuga a mtundu wachiwiri. Kukula kwa ma Dhib-4 zoletsa komanso agonists a GLP-1 pochiza odwala omwe ali ndi matenda a shuga a 2 amakhalabe opanda tanthauzo ndipo osapitirira 0,2%.

Udindowu uli ndi zifukwa zomveka: popeza mtundu wachiwiri wa matenda a shuga suchitika nthawi zonse chifukwa cha kuperewera kwa insulini, kupanga mahomoni ambiri sikungathandize kuti ma cell atha kukhala osagwirizana nawo. Novonorm® imafuna kusankha kwa mlingo, koma monga mankhwala am'mbuyomu, sayambitsa hypoglycemia. Amagwiritsidwa ntchito onse mu monotherapy (pakangogwiritsidwa ntchito mankhwala amodzi okha), komanso kuphatikiza ndi metmorphine kapena insulin.

Chifukwa chake, tiyesetsa kupereka chidule cha mankhwala otchuka a shuga ndikuyamba ndi mankhwala omwe amagwiritsidwa ntchito pochiza matenda a shuga a 2. Zinthu izi tsopano ndizofunikira kwambiri pakuwonjezereka kwa odwala omwe ali ndi matenda ashuga.

Zizindikiro zakuchipatala

Mankhwala a Glucagon amadziwika ngati:

• kutsitsa magazi
• Mankhwala othandizira odwala matenda amisala amafunika,
• monga thandizo lothandizira pa nthawi ya matenda am'mimba, matumbo, njira yama radiology.

Ndikofunikira kubwezeretsa glycogen mu chiwindi ndi kupewa yachiwiri ya hypoglycemia pambuyo pakupereka mankhwala, adokotala amafotokozera zakudya.

Mankhwala atatha kulowa mthupi, pamakhalanso zotsatira zina zoyipa:

• kusanza ndi kusanza
• thupi lawo siligwirizana monga zotupa, kuyabwa, nthawi zambiri - angioedema,
• kuchepetsedwa kwa mavuto.

Pali gulu la anthu omwe sayenera kuthandizidwa ndi glucagon. Mankhwala ndiwotsutsana ngati pali:

• Hypersensitivity pazinthu zilizonse za mankhwala,
• mavuto ndi thumbo ta adrenal,
• hypoglycemia yachilengedwe yamakhalidwe osiyanasiyana, zimayambitsa ndi adokotala.

Pa nthawi yoyembekezera komanso mkaka wa m'mawere, chithandizo ndi mankhwalawa sichikulangizidwa, koma ngati pakufunika, ndiye kuti chitha kugwiritsidwa ntchito pokhapokha ngati pali milandu yambiri.

Wothandizira wa hypoglycemic ndi ufa wosindikizidwa wokwanira, amakhalanso ndi zosakaniza zina malinga ndi kuchuluka kwa mankhwalawa: lactose, glycerin, phenol.

Mankhwala ali onse mumtundu umodzi wa mankhwala osungunulira, komanso osinthika. Iyenera kusungidwa pamtunda wa 2-8 digiri Celsius ndipo siyiyenera kuyesedwa dzuwa lowala.

Malangizo ogwiritsira ntchito

Njira yothetsera vutoli ndi yoyenera kugwiritsidwa ntchito mkati mwa maola 24 okha. Mankhwalawa amapangidwira kuti azigwira bwino ntchito, chifukwa chake ngati munthu wakomoka chifukwa cha matenda, ayenera kudzuka pambuyo pa mphindi 5, ndipo pambuyo mphindi 20 amatha kuyang'anitsitsa ndikuyankha mafunso momveka bwino. Koma ngati wodwalayo sanakhale bwino, muyenera kumuyimbira dokotala, ndipo mwina, muyenera kupaka jakisoni kapena dextrose kudzera m'mitsempha.

Glucose imayenera kupezeka m'magazi pafupipafupi, mankhwala amafunikira ngati akutsitsidwa. Mapiritsi a glucose amalowetsedwa mosavuta m'magazi, ndipo zotsatira zake zabwino zimayamba msanga chifukwa chakuti sizimayenda mu chiwindi chilichonse. Pokhapokha gawo loyambirira - likalowa mkamwa - gawo lina lamkati limalowa kulowa m'magazi, ndipo gawo lotsala kuchokera m'mimba ndi matumbo limalowa mwachangu, zotsatira zake zimakhala zabwino, chifukwa shuga wamwazi akamakwera ngakhale zisonyezo zili zochepa komanso momwe wodwalayo alili kuchuluka kotero kuti kapamba satulutsa insulini, ngati ndi matenda a shuga II, odwala omwe ali ndi matenda amtundu wa I, insulin siyosowa konse m'thupi.

Ngati shuga sagwa pansipa, shuga pa wodwala matenda a shuga II sangakhale ndi phindu lalikulu, chifukwa pancreatic insulin imatulutsa.

Ndani ali ndi matenda a shuga a mtundu wa shuga, shuga, 1 g yake, amamuwonjezera shuga ndi 0.28 mmol / l, koma muyenera kuwerengera moyenera kuchuluka kwake.

Glucose amapangidwa osati pamapiritsi, komanso monga madzi amadzimadzi.
Fomuyi ndiyofunikira kwambiri ngati munthu ali ndi mtundu wodwala kapena wowonda, ndipo sangathe kumeza mankhwalawo.

Mitundu yabwino kwambiri ya glucose ndi ma gel, amafunika kumata mafuta m'mkamwa ndi masaya awo mkati, ndiye kuti wodwalayo ali ndi vuto lalikulu sangathe kutsamwa, ndipo pakatha mphindi 5 adzachira.

Ndikofunikira kuti iwo omwe ali ndi shuga ochepa azikhala nawo nthawi zonse, komanso cholembera chizichenjeza ena za matendawa komanso zoyenera kuchita ngati munthu wachira chifukwa cha vuto la matenda.