Kukonzekera kwa Clinid Starlix, Novonorm - oyang'anira magazi a shuga

Mosiyana ndi nateglinide (Starlix), repaglinide (Novonorm) sikuti imangoyendetsa bwino postprandial, komanso glycemia yofulumira, popeza kulumikizana kwake ndi SUR receptor ndikutali. Koma nateglinide pazocheperako imayambitsa kukhudzana kwa hypoglycemic, koma nthawi yomweyo zotsatira zake pamlingo wa HbA1c ndizochepa kwambiri. Ndiwothandiza kwambiri kwa omwe amadziwika kuti ndi "osazindikira" omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda a shuga, i.e. mwa omwe sanalandirepo mankhwala a sulfa.

Zizindikiro. Glinids imatha kuonedwa ngati poyambira kuchiza kwa T2DM, makamaka kwa anthu okhala ndi vuto lakale la postprandial hyperglycemia ndi chakudya cham'mbuyo chisanafike chakudya, chomwe chimathandizidwa ndi zakudya komanso zolimbitsa thupi zokwanira. Ofuna chithandizo cha glinid angakhale odwala omwe amawopa kukula kwa hypoglycemia, makamaka, okalamba. Ndiwothandiza kwa odwala omwe samakonda kudya masana (nthawi 1-2), koma nthawi yomweyo amadya magawo akulu. Itha kugwiritsidwa ntchito mwa odwala omwe ali ndi ziwopsezo kuti sulfonamides, chifukwa kapangidwe kazinthu sikumagwira kwa iwo.

Mphamvu yochepetsera shuga ya glinides ambiri, omwe amawerengera kuchuluka kwa HbA 1 c, ndiwotsika poyerekeza ndi a sulfanilamides ndipo amakhala 0.7-1,5% mwa odwala omwe akalandira chithandizo. Ma glinides amathanso kutumizidwa kuphatikiza ndi mankhwala ena ochepetsa shuga, kuphatikiza ndi sulfonamides, omwe amakhala ndi gawo limodzi lazochita mu cell ya beta. Pazifukwa zomwezo, munthu sayenera kuyembekezera kuchokera kwa iwo momwe odwala omwe sulfonamides ataya mphamvu kapena omwe akukhudzidwa ndi sulfanilamides.

Mwambiri, vuto la dongo limakhala kufunika kwa Mlingo wambiri masana, kuthekera kotsika kwa HbA 1 s kuposa sulfonamides ndi mtengo wokwera.

Contraindators ndi malire. Glinides amatsutsana mu mtundu woyamba wa matenda ashuga, pomwe wodwalayo akayamba ketoacidosis kapena ndi hypersensitivity yodziwika bwino kwa iwo, komanso kwa ana (palibe chidziwitso cha chitetezo chawo pamapeto pake). Amatha kuyambitsa hypoglycemia, makamaka kwa odwala omwe ali ndi hepatic, adrenal kapena pituitary insuffidence, odwala ofooka komanso otopa. Ma glinides ocheperako poyerekezera ndi sulfonamides amachititsa hypoglycemia ndipo nthawi zambiri odwala omwe sanalandire chithandizo chilichonse cham'kamwa ndi HbA 1 c

Ma glinids amatsutsana panthawi yomwe ali ndi pakati komanso poyamwitsa, ngakhale sanawonetsedwe kuti ali ndi vuto la teratogenic, koma amangobweretsa ziwopsezo zamafupa panthawi yomwe ali ndi pakati komanso mkaka wa m'mawere mu mafusits ​​ndi makoswe obadwa kumene. Ndi nyama zochepa zokha zomwe zakhazikitsa mayendedwe amkaka ndi mkaka, koma maphunziro otere sanachitike mwa amayi oyamwitsa. Pankhaniyi, iwo amatsutsana panthawi ya mkaka wa mkaka.

Ma glinides amatha kuperekedwa chifukwa cha kulephera kwa impso popanda kusintha kwa mankhwala.

Mwa anthu omwe ali ndi vuto lochepa kwambiri la hepatic, ma glinides amaperekedwa popanda zoletsa, koma kagayidwe kake kangachepetse mwa odwala ena, omwe amawonjezera kuchepa kwa shuga kwa glinids ndipo mlingo wawo umatha kuchepetsedwa kapena makulidwe awo mosadukiza angafunike. Kulephera kwambiri kwa chiwindi, amalephera (maphunziro omwe ali mgulu lino la odwala sanachitike).

Ukalamba ndi ukalamba sizimakhudza kagayidwe kazakudya kotero iwo alibe zoletsa pazaka ndi jenda.

Hypoglycemia, kupuma kwam'mimba thirakiti, sinusitis, nseru, kutsegula m'mimba, kudzimbidwa, kuthana, kulemera, komanso kupweteka pamutu zimadziwika mwazina zoyipa zomwe zimapezeka ndi ma glinids.

Zambiri

Meglitinides (zotumphukira za benzoic acid) ndi gulu latsopano la mankhwala omwe amalimbikitsa katulutsidwe ka insulin. Meglitinides imaphatikizapo mankhwala monga repaglinide ndi nateglinide.

Makina a zochita za meglitinides amagwirizana kwambiri ndi zochita zawo pamayendedwe a ATP-amadalira K +. Mothandizidwa ndi meglitinides, njira za K + zimatsekedwa, chidwi cha β-cell kuti glucose chikulimbikitse, potero amawonjezera katulutsidwe ka insulin poyankha kuchuluka kwa glycemia.

Chofunikira kwambiri cha meglitinides ndikuti ndi thandizo lawo, gawo loyambirira la insulin limabwezeretseka, ndiye, chifukwa cha kanthawi kochepa, hyperinsulinemia yotalikilapo siyikukula.

Chizindikiro cha ma pharmacokinetics a meglitinides ndi kuthekera kwawo kuti azilowetsedwa m'matumbo amphindi pakanthawi kochepa kwambiri.

M'magazi, ambiri amachokera ku sulfonylurea ndi meglitinides amamanga mapuloteni a plasma (90-99%). Meglitinides, m'malo mwake, imatengeka, amayamba kuchita ndipo amachotsedwa mwachangu kwambiri, ndipo uwu ndi mwayi wawo wabwino. Zochita zawo zimayamba mphindi zochepa atangolowa, koma zimangotenga ola limodzi, ndiye meglitinides amagwiritsidwa ntchito ndi chakudya chilichonse.

Kagayidwe ka meglitinides amachitika ndi chiwindi, ndipo mankhwalawa amachotsedwa makamaka m'matumbo, omwe amawalola kuti agwiritsidwe ntchito pochiza odwala omwe ali ndi matenda amtundu wa 2 omwe ali ndi kuwonongeka kwapakati.

Tab. Ma paracokinetic magawo a meglitinides

Zomwe zimapangidwira momwe zimagwirira ntchito komanso pharmacokinetics zimalola meglitinides kuti azikhala ndi awo osiyana mankhwalawa pochiza matenda amtundu wa 2 shuga. Chifukwa cha izi, gululi lidapeza dzina lachiwiri - oyang'anira a gandcemic prandial.

Poyerekeza ndi sulfonylurea zotumphukira, meglitinides kutsika kwa postprandial glycemia kwambiri, koma amachepetsa msanga wa kusala kudya kwa glycemia.

Meglitinides amatengedwa kamodzi musanadye, kapena ndi zakudya, kapena mphindi zochepa mukatha kudya. Mlingo wa insulini umabweleranso koyambirira patatha maola atatu pambuyo pobayidwa wa meglitinides, womwe umatsutsana ndi katemera wa insulin wa chakudya komanso amachepetsa mwayi wa hypoglycemia pakati pakudya.

Chifukwa chake, mankhwalawa amalola wodwala kukhala wosinthika kwambiri pankhani yotsatira zakudya. Pakadyeka chakudya, mankhwalawa amathanso kudumphika. Izi ndizofunikira kwambiri kwa achinyamata odwala omwe amakhala ndi moyo wakhama, chifukwa Ngati mankhwala a sulfonylurea atha kukhala pachiwopsezo cha hypoglycemia pamenepa.

Popeza mtengo wokwera kwambiri wa mankhwalawa, chosangalatsa kwambiri ndikuwikidwa kwawo kuphatikiza ndi metformin kwa odwala omwe metformin monotherapy sanalole kubwezeretsa mokwanira matendawa, makamaka ngati mlingo wa postprandial glycemia ukuwonjezeka. Komabe, meglitinides ingagwiritsidwenso ntchito ngati monotherapy (mphamvu yake imafanana ndi zotuluka za sulfonylurea) kapena kuphatikiza ndi thiazolidinediones.

Meglitinides nthawi zambiri amaloledwa ndi odwala. Zotsatira zoyipa kwambiri zamagulu a omwe afotokozedwawo ndi hypoglycemia.

Kukonzekera kwa Glinides

Oimira gulu lino akuphatikizapo:

Glinides limagwirira ntchito

Mankhwala omwe ali mgululi amagwira ntchito makamaka pamaselo a beta a kapamba. Mankhwala omwe amatsatira amamangilira puloteni yapadera yotchedwa SUR1 receptor, yomwe imakhala pama cell a beta ndipo, motero, imapangitsa kubisika kwa insulin.

Chifukwa chake, sulfonylurea zotumphukira (i.e., gliclazide, glycoverone, glimepiride) zimaphatikizidwa ndi mapuloteni omwewo.

Momwe ma glinids amachitikira

Kusiyana mu machitidwe a dongo ndi zotumphukira za sulfonylurea ndikuti ntchito zakale zimachita mwachangu komanso mopindulitsa. Chifukwa cha izi, mukamadya kwakanthawi musanadye kapena pambuyo pawo, amatsitsa shuga, omwe amadzuka chakudya pambuyo pake ndipo nthawi zambiri samayambitsa shuga.

Zotsatira zake, kuchuluka kwa insulin m'magazi kumawonjezeka. Izi zimatheka pokhapokha ngati ma cell a pancreatic amatha kupanga ndikupanga.

Mtundu wachiwiri wa matenda ashuga, maselo a beta amadziwika kuti "amalephera" ndipo sangatulutsenso insulin. Chifukwa chake, pakufunika kuyambitsa izo mwanjira za jakisoni wanzeru, ndipo kugwiritsa ntchito dongo kulibe ntchito.

Kwa omwe ma glinids adalembedwa

M'mayiko ena ku Europe, ma glinids amagwiritsidwa ntchito pochiza matenda amtundu wa 2 kuphatikiza zakudya ndi masewera olimbitsa thupi, kapena kuphatikiza zakudya, masewera olimbitsa thupi, ndi metformin.

Kuphatikizika kwawo ndi zotumphukira za sulfonylurea sikulimbikitsidwa. Komanso, musagwiritse ntchito ma glinides ngati sulfonylureas sangathe kwa inu (mwanjira iyi, ma glinides nawonso sangagwire ntchito).

Contraindative pakugwiritsa ntchito dongo

Pali zosokoneza zingapo pakugwiritsa ntchito dongo.

Chofunika kwambiri ndi:

• Hypersensitivity kapena thupi lawo siligwirizana ndi mankhwala a gulu lino m'mbuyomu,
• Mtundu woyamba wa shuga
• Kukhalapo kwa zovuta za matenda ashuga (ketoacidosis, chikomokere matenda ashuga - zotere ziyenera kuchitika ndi insulin),
• Mimba komanso kuyamwa,
• Olimba chiwindi kukanika.
• Iyenera kugwiritsidwa ntchito mosamala muimpso kapena kwa chiwindi, kulephera kwa adrenal, ukalamba komanso vuto la kuperewera kwa zakudya m'thupi.
• Siyenera kugwiritsidwa ntchito ngati vuto la insulin lamthupi limakula kwambiri - mwachitsanzo, ngati muli ndi matenda oopsa kapena opaleshoni. Zikatero, zimakhala bwino kugwiritsa ntchito insulin kwakanthawi.

Momwe angatenge

Kumwa mankhwalawa kumachitika nthawi yochepa musanadye kapena chakudya.

Sikuti kuyang'anira nthawi yakudya. Komanso, titaonana ndi dokotala, titha kusintha mankhwalawa tisanadye. Ngati mungakonde kudya zambiri, mutha kuziwonjezera.

• Mlingo umodzi wambiri wa repaglinide ndi 4 mg (mlingo waukulu wa tsiku ndi tsiku ndi 16 mg).
• Kwa nateglinide, mlingo waukulu wa tsiku ndi tsiku ndi 180 mg.

Ngati mwaiwala kumwa mankhwalawa panthawi, simuyenera kumwa mapiritsi awiri ndi chakudya chotsatira, chifukwa izi zingayambitse hypoglycemia.

Glinids ndi Meglitinides: limagwirira ntchito ya matenda ashuga

Kwa zaka zambiri osalimbana ndi ma DIABETES?

Mutu wa Bungwe: “Mudzadabwitsidwa kuti kumakhala kovuta motani kuchiritsa matenda a shuga tsiku lililonse.

Njira zamakono zochizira matenda ashuga zimaphatikizapo kugwiritsa ntchito mankhwala ochiritsira omwe ali m'magulu osiyanasiyana pochizira.

Mpaka pano, mitundu isanu ndi umodzi yamankhwala ochepetsa shuga aonekera mu pharmacology.

Mankhwala ochepetsa shuga amagwiritsidwa ntchito pokhapokha ngati wodwala ali ndi mtundu wachiwiri wa matenda a shuga, omwe samadalira insulin.

Mankhwala onse ali m'gulu lotsatira lamankhwala:

1. Biguanides.
2. Glinidam.
3. Glitazone.
4. Alfa glucosidase zoletsa.
5. DPP-4 zoletsa.
6. Sulfonamides.
7. Kuphatikizidwa.

Gulu la Biguanides limaphatikizapo mankhwala amodzi - Metformin. Chida ichi chakhala chikugwiritsidwa ntchito kuyambira 1994. Chida chake ndi chomwe chimagwiritsidwa ntchito kwambiri kuchepetsa shuga mthupi.

Ma glitazones amaphatikiza mankhwala amodzi - Pioglitazone. Mankhwalawa amathandizira kukulitsa cell ya membala wa zotumphukira maselo kuti apange insulin komanso amachepetsa kuchuluka kwa mafuta kagayidwe.

Alfa glucosidase inhibitors amalepheretsa kugaya kwa chakudya, kupewa kutulutsa shuga m'magazi a m'magazi.

Ma Dhib-4 ma inhibitors amalowerera kuwonongeka kwa glucagon-polypetide 1 (GLP-1) ndikuletsa enzyme DPP-4.

Sulfanilamides amagwiritsidwa ntchito ngati mankhwala ochepetsa shuga ndipo ndiwodziwika kwambiri. Kuchita kwa mankhwala a gululi kwatengera kukondoweza kwa njira ya insulin yopanga ndi ma cell a pancreatic. Pakadali pano, magulu anayi a sulfonamides apangidwa.

Mankhwala osakanikirana ndi othandizira omwe ali ndi mitundu yambiri yogwira popanga.

Ma glinids amaphatikiza mankhwala awiri pakupanga kwawo - Repaglinide ndi Nateglinide. Mankhwalawa ali ndi mphamvu yosangalatsa pa maselo a beta a pancreatic minofu.

Kuphatikiza pa kutsitsa shuga, ma dothi okhala ndi zinthu zina:

• sizimathandizira pakulemera,
• mukamagwiritsa ntchito mankhwala a gululi odwala, mwayi wa hypoglycemia umachepetsedwa kangapo poyerekeza ndi sulfonamides.

Monga mankhwala aliwonse, zinthu zomwe zimapangidwa ndi dongo zimakhala ndi zovuta zingapo:

• ndi kugwiritsa ntchito kwawo, pali mwayi wopanga hypoglycemia,
• osavomerezeka kugwiritsa ntchito mankhwala ngati wodwala ali ndi matenda ena a chiwindi.

Mankhwala a Clinid amagwiritsidwa ntchito nthawi zambiri ngati othandizira poyambira matenda a shuga 2.

Zizindikiro ndi contraindication ogwiritsa ntchito dongo

Chizindikiro chachikulu chakugwiritsira ntchito dongo ndiko kupezeka kwa mtundu wachiwiri wa matenda a shuga wodwala pakadalibe ntchito yochokera pakubwezeretsa zakudya ndi zochita zolimbitsa thupi.

Mankhwala omwe ali mgululi amagwiritsidwa ntchito kuti achepetse shuga m'thupi la wodwalayo.

Monga mankhwala aliwonse, mankhwala a gulu ladongo amakhala ndi zotsutsana zingapo kuti agwiritse ntchito.

Zoyambitsa matope pakugwiritsa ntchito dongo ndi izi:

1. Kukhalapo kwa hypersensitivity.
2. Kupezeka kwa matenda amtundu wa 1 wodwala.
3. Kukula mu thupi la zinthu zofunika insulin mankhwala.
4. Kukhalapo kwa zovuta kwambiri pakugwira ntchito kwa impso ndi chiwindi.
5. Nthawi ya bere ndi nthawi yoyamwitsa.

Sikulimbikitsidwa kupereka mankhwala a glinids mwa odwala ndi ana omwe ali ndi zaka zosakwana 18, kuwonjezera apo, sikulimbikitsidwa kuti mugwiritse ntchito mankhwala ochizira matenda a shuga kwa odwala azaka zopitilira 75.

Zotsatira zoyipa zomwe zimagwiritsidwa ntchito pogwiritsa ntchito mankhwalawa ndi:

• kusokonezeka kwam'mimba, komwe kumawoneka ngati kusanza ndi malingaliro a mseru,
• Nthawi zina, thupi limakumana ndi mawonekedwe a khungu lotupa
• nthawi zina pamakhala kuchuluka kwapang'onopang'ono kwa ntchito ya transamylase.

Nthawi zina, pamakhala kuwonongeka kooneka, komwe kumatsatana ndi kusinthasintha kwa shuga mumthupi.

Limagwirira ntchito dongo

Ma glinides ndi othandizira popanga insulin. Mankhwalawa amasiyana ndi sulfonamides osati mwapangidwe, komanso mankhwala. Ma glinids adapangidwa ngati mankhwala omwe amathandizira kubwezeretsa ndikuwonjezera kuchuluka kwa insulin ya pancreatic hormone yopangidwa ndi maselo a beta.

Ma glinids amayenera kumwedwa kokha pakudya, izi zimakupatsani mwayi wowonjezera zakudya zopatsa mphamvu poyerekeza ndi zakudya mukamamwa sulfonamides.

Meglitinides amakhala ndi theka lalifupi, lomwe limachepetsa mwayi wokhala ndi boma la hypoglycemic.

Pakadali pano, meglitinides akuphatikiza mankhwala awiri - Nateglinide ndi Repaglinide.

Limagwirira a zochita za mankhwala amatengera mphamvu yake pa njira ya ATP-yotengera potaziyamu ya michere ya beta-cell. Izi zimabweretsa kutsika kwa nembanemba ndi kutsegulidwa kwa njira za calcium. Pambuyo podziwikiratu ndi minyewa ya pancreatic, mankhwalawa amachulukitsa kuchuluka kwa calcium ion m'maselo kuchokera kumalo ophatikizana.

Kuwonjezeka kwa kuchuluka kwa calcium mu cell kumapangitsa ntchito ya insulin.

Kulumikizana komwe limapangidwa ndi meglitinides ndi ma cell receptors sikokhazikika, chifukwa chake, zovuta zomwe zimapangidwa zimakhala nthawi yayifupi.

Kukonzekera kwa Clinid, ndikulowetsedwa m'thupi, kumafikira kwambiri pakatha ola limodzi pambuyo pakupereka. The bioavailability mankhwala pafupifupi 56%.

The munthawi yomweyo kuperekedwa kwa mankhwala ndi chakudya sizikhudza kwambiri nthawi kuti afike pazomwe zimapangitsa kuti azigwira ntchito m'magazi, ndipo pazomwe zimapangitsa kuti ambiri azigwira bwino ntchito zimachepetsedwa ndi 20%. Ma glinides amatha kuphatikiza mapuloteni a plasma, omwe amamanga 98%.

Hafu ya moyo wa mankhwala kuchokera mthupi pafupifupi ola limodzi.

Kuchotsa kukonzekera kwa gulu la dongo kumachitika makamaka ndi ndowe. Mwanjira imeneyi, pafupifupi 90% ya ma metabolites omwe amapangidwa panthawi ya metabolism amachotsedwa. Kuphatikiza apo, kuchotsedwa kwa mankhwalawa kumachitika pang'ono kudzera mu mkodzo.

Zoyipa zamtunduwu wa mankhwalawa ndizofunikira zamitundu yambiri tsiku lonse komanso mtengo wokwera wa mankhwalawa.

Kugwiritsa ntchito mankhwala a Starlix

Starlix ndi mankhwala omwe amatengedwa musanadye zakudya panthawi ya mankhwala a matenda a shuga 2. The pakati pakati kumwa mankhwala ndi chakudya sayenera upambana 0.5 maola.

Mukamagwiritsa ntchito mankhwalawa monotherapy, mlingo umodzi wa 120 mg umalimbikitsidwa. Mankhwala ayenera kumwedwa katatu patsiku. Mankhwala ayenera kumwedwa musanadye kadzutsa, nkhomaliro komanso chakudya chamadzulo.

Ngati mankhwalawa amathandizira kuti mankhwalawa asalole kuti mupeze zomwe mungafune, muyezo umodzi ungakulidwe mpaka 180 mg.

Kusintha kwa mankhwalawa kwa mankhwalawa kumachitika pafupipafupi malinga ndi zotsatira za kafukufuku wa zasayansi wa zizindikiro za HbA1c ndi zizindikiro za glycemia ola limodzi kapena awiri mutatha kudya.

Starlix ikhoza, ngati pakufunika, igwiritsidwe ntchito ngati mankhwala othandizira odwala matenda a shuga 2. Mankhwalawa amatha kugwiritsidwa ntchito molumikizana ndi metformin.

Mukamagwiritsa ntchito Starlix molumikizana ndi Metformin, mlingo umodzi womwe umagwiritsidwa ntchito uyenera kukhala wa 120 mg katatu patsiku. Mankhwala pa zovuta mankhwala kumwa pamaso chakudya.

Zikachitika kuti, munthawi ya chithandizo chovuta, kuchuluka kwa HbA1c kumayandikira chisonyezo chokhazikika cha thupi, mlingo wa Starlix womwe umatengedwa umatha kuchepetsedwa mpaka kufika pa 60 mg katatu patsiku mwakufuna kwa dokotala.

Kugwiritsa ntchito mankhwala Novonorm

Mankhwala a Novonorm ndi mankhwala, omwe amaphatikizanso repaglinide mu mlingo wa 0,5, 1 kapena 2 mg monga chinthu chachikulu chogwiritsa ntchito.

Mlingo woyambirira wa mankhwala a shuga ayenera kukhala 0,5 mg pazomwe zimagwira.

Kuchulukitsa kwa mankhwalawa kumaloledwa masiku osakwana 7 mpaka 14 atayamba kugwiritsa ntchito mankhwala.

Ngati kulephera kwa chiwindi kwa wodwala matenda a shuga kwapezeka, HbA1c imayang'aniridwa pafupipafupi kuposa masabata awiri.

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Mankhwala amaloledwa kugwiritsidwa ntchito pazotsatira zazikuluzikulu:

1. Mlingo umodzi wa mankhwalawa uyenera kukhala 4 mg yogwira mankhwala.
2. Mlingo wa tsiku lililonse wa mankhwalawa sayenera kupitilira 16 mg.

Nthawi yoyenera ya kumwa mankhwalawa ndi mphindi 15 musanadye, koma ndizothekanso kumwa mankhwalawa kwa mphindi 30 musanadye chakudya kapena nthawi yomweyo asanayambe.

Ngati chakudya chidadulidwa ndi odwala, mankhwalawo sayenera kumwedwa.

Pakukhazikitsa chakudya chowonjezera, mankhwalawa amayeneranso kugwiritsidwa ntchito.

Kusiyanitsa kwakukulu pakati pa Starlix ndi Novonorm ndikuti chomaliza chimatha kuchepetsa kwambiri kuchuluka kwa shuga osati mutatha kudya, komanso pakati pa zakudya. Izi ndichifukwa cha kuthekera kwa gawo lomwe limagwira nawo gawo la SUR receptor ndikupanga mgwirizano wolimba ndi izo.

Tiyenera kudziwa kuti Starlix imatha kupangitsa pang'ono mawonekedwe a kukula kwa dziko la hypoglycemic poyerekeza ndi Novonorm.

Zotsatira zoyipa ndi kusamala

Pambuyo pakamwa, makonzedwe a gulu la glinid amalimbikitsa njira zoyambira zotulutsira insulin m'matumbo a beta a pancreatic minofu yokhudza zochitika za mtundu uwu wa mankhwalawa. Kugwiritsa ntchito mankhwalawa kuphwanya malangizo ogwiritsira ntchito kapena malingaliro omwe amachokera kwa endocrinologist amatha kupangitsa mtundu wachiwiri wa matenda a shuga, omwe ndi matenda a insulin-Independent endocrine omwe ali ndi matenda a hypoglycemia.

Kusintha koteroko mthupi kumafuna kugwiritsa ntchito mankhwala musanadye.

Kutengera malamulo onse ndi malingaliro akamagwiritsa ntchito mankhwala omwe ali m'gulu loumbidwa ndi dongo, sizimayambitsa chikhalidwe cha hypoglycemic.

Mankhwalawa ndi othandiza kwambiri ngati agwiritsidwa ntchito koyambirira kwa matenda ashuga a 2. Magawo oyamba amakula matendawa amasiyanitsidwa ndikuti nthawi imeneyi magwiridwe antchito a maselo a pancreatic, omwe amachititsa kuti insulini isungidwe, amasungidwa.

Mwayi wopanga mtundu wa hypoglycemic mthupi la wodwala wokhala ndi matenda amtundu wa 2 pafupifupi ndi wofanana ndi pafupipafupi pakukula kwa hypoglycemia ndikugwiritsa ntchito mankhwala a sulfonylurea okhala nawo kwakanthawi kochepa.

Pogwiritsa ntchito kukonzekera kwa dongo, chisamaliro chapadera chiyenera kuchitika ngati wodwala walephera chiwindi. Izi ndichifukwa choti metabolism yayikulu ya mankhwala imachitika m'maselo a chiwindi. Mankhwala onse omwe ali mgululi amalumikizana ndi cytochrome P-350, omwe amatanthauza magawo a dongosolo la chiwindi.

Chenjezo liyenera kuchitika mukamagwiritsa ntchito mankhwala osokoneza bongo omwe ndi osatheka kuwongolera bwino glycemia m'thupi. Zochitika zoterezi zimatha kukhala kukulitsa kwa matenda mthupi, kuwawa kwambiri, pakuchita opareshoni. Izi zikachitika, mankhwala ayenera kusiyidwa ndikuyamba kugwiritsa ntchito mankhwala a insulin.

Zambiri zokhudzana ndi mankhwalawa omwe amagwiritsidwa ntchito pochiza matenda a shuga zafotokozedwa muvidiyoyi.

Mitundu ya Insulin

Makampani opanga zamankhwala amapereka odwala omwe sangokhala ndi mndandanda waufupi, wa insashin, komanso zochita zazitali komanso zapakati, nyama, maumboni amtundu wa anthu. Zochizira mtundu woyamba ndi wachiwiri wa matenda a shuga, endocrinologists amalamula odwala, kutengera mtundu, gawo la matenda, mitundu yosiyanasiyana ya mankhwala, yodziwika ndi nthawi yayitali, kuyambika ndi ntchito.

Chochititsa chidwi: Kwa nthawi yoyamba, mu 1921, insulini idzipatula ku zikondamoyo za ng'ombe. Januware wotsatira adadziwika ndi chiyambi cha mayesero azachipatala a mahomoni mwa anthu. Mu 1923, kupambana kwakukulu kwa akatswiri opanga zamankhwala anapatsidwa mphoto ya Nobel.

Mitundu ya insulin ndi kagwiritsidwe kake (tebulo):

Momwe mungadziwire nthawi yoyenera kuperekera mankhwala, Mlingo, mitundu ya insulin yokonzekera? Ndi endocrinologist yekha yemwe angayankhe funsoli. Osadzilankhulitsa mulimonse.

Zomwe zikuchitika pang'onopang'ono insulin

Thupi lathanzi limatulutsa timadzi tambiri, nthawi zonse m'maselo a beta a ispoti a Langerhans a kapamba. Kuphatikizika kwamahomoni kaphatikizidwe kumayambitsa kusayenda bwino, kusokonezeka kwa metabolic pafupifupi mthupi lonse komanso kukula kwa matenda ashuga. Pa magawo oyambirira a matenda, odwala nthawi zambiri amapatsidwa insulin.

1. Insulin yochepa imayamba pang'onopang'ono (kuyambira mphindi 20 mpaka 40), ndiye kuti nthawi yochepa imayenera kudutsa pakati pa jakisoni wa mahomoni ndi chakudya.
2. Kuchuluka kwa zakudya zomwe zimayenera kudyedwa pambuyo poti insulini yachangu izikhazikitsidwe kuyenera kukhala koyenera kwa mankhwalawo. Palibe chifukwa chomwe muyenera kusintha kuchuluka kwa chakudya. Zakudya zambiri zimatha kukhala ndi hyperglycemia, kupatula hypoglycemia.
3. Kukhazikitsidwa kwa insulin yofulumira kumafunikira zokhwasula-pansi - patatha maola 2-3 pamakhala chiwopsezo cha mankhwala, motero thupi limafunikira chakudya.

Chidwi: Nthawi ya kuwerengera nthawi ndi mlingo wake ikuwonetsedwa - odwala ali ndi machitidwe awo amthupi. Chifukwa chake, mlingo ndi nthawi zimatsimikiziridwa ndi endocrinologist payekha kwa wodwala aliyense.

Jakisoni amayenera kuperekedwa pokhapokha ndi chosawilitsidwa insulini komanso panthawi yokhayo. Mankhwala chikuyendetsedwera, nthawi zina intramuscularly. Ndi malo a jakisoni okha omwe angasinthe pang'ono, omwe safunikira kukonzedwa pambuyo poti jakisoni kuti mankhwalawo ayende bwino m'magazi.

Ndikofunika kuti wodwalayo asatengere kupita kwa sing'anga kuti azimuyang'anira nthawi zonse, iye amawunika momwe amadyera komanso moyo wake.

• mwachangu insulin imayankha mwachangu kukhudzana ndi shuga,
• Kutulutsa komwe kumakhalapo kumakhala ndi gawo linalake la mahomoni m'mitsempha.

Momwe mungadziyimirire pawokha nthawi ya mankhwalawa

• muyenera kulowa muyezo wa mankhwala mphindi 45 musanadye,
• yang'anani kuchuluka kwa shuga pakatha mphindi zisanu zilizonse,
• ngati shuga watsika ndi 0,3 mmol, muyenera kudya nthawi yomweyo chakudya.

Kuwerengeka moyenera kwa mahomoni kumabweretsa kuthandizira kwa matenda osokoneza bongo komanso kupewa mavuto. Mlingo wa kukonzekera kwa insulin kwa akuluakulu ndi kuyambira pa 8 PIECES mpaka 24 PIERES, kwa ana - osaposa 8 PIECES patsiku.

Contraindication

Monga mankhwala aliwonse, insulin yothamanga imakhala ndi contraindication ndi zoyipa.

• hepatitis, zilonda zam'mimba ndi m'mimba,
• nephrolithiasis, yade,
• zolakwika zamtima zina.

Zotsatira zoyipa zimawonetsedwa ndikuphwanya mlingo: kufooka kwambiri, thukuta lomwe limatulutsa, malovu, kuyembekezera, pamakhala kukhumudwa.

Analogi Amfupi a Insulin

Zingasokonezeke bwanji ndi mayina a mankhwala ofananawo mu pharmacy? Insulin yomwe imagwira mwachangu, anthu kapena zithunzi zawo, zimasinthana:

Pomaliza

Insulin yochepa ndi mankhwala osankhidwa ndi endocrinologist kuchiza matenda a shuga. Kuti mankhwalawa akhale othandiza komanso osabweretsa zovulaza monga hypo-, hyperglycemia, kutsatira kwambiri mlingo, nthawi ya makonzedwe, dongosolo la chakudya. Sinthani mankhwalawa ndi analogi pokhapokha mukaonana ndi dokotala. Ndikofunika kwambiri kudziyimira pawokha kuchuluka kwa shuga m'magazi, kuyezetsa nthawi zina, ndikusintha njira zopewera komanso njira zochizira.

Mawonekedwe a thiazolidinediones

Thiazolidinediones, mwa kuyankhula kwina, glitazones, ndi gulu la mankhwala ochepetsa shuga omwe amafunitsitsa kukulitsa zotsatira za kubereka. Zochizira matenda a shuga zayamba kugwiritsidwa ntchito posachedwa - kuyambira 1996. Kupangidwa mosamalitsa ndi mankhwala.

Glitazones, kuwonjezera pa hypoglycemic action, imathandizira mtima wamtima. Ntchito yotsatirayi idawonedwa: antithrombotic, antiatherogenic, anti-kutupa. Mukamatenga thiazolidinediones, kuchuluka kwa hemoglobin ya glycated kumachepera pafupifupi 1.5%, ndipo mulingo wa HDL umakulanso.

Chithandizo cha mankhwala a mkalasi lino sichothandiza kwenikweni kuposa kuchiritsa ndi Metformin. Koma sizigwiritsidwa ntchito poyambira ndi 2 shuga. Izi ndichifukwa cha zovuta zoyipa komanso mtengo wokwera. Masiku ano, glitazones amagwiritsidwa ntchito kutsitsa glycemia wokhala ndi zotumphukira za sulfonylurea ndi metformin. Zitha kutumikiridwa padera ndi iliyonse ya mankhwalawo, komanso kuphatikiza.

Ubwino ndi zoyipa

Mwa zina mwa mankhwalawa pali zabwino komanso zoyipa:

• onjezani thupi ndi 2 kg pafupifupi,
• Mndandanda waukulu wazotsatira zoyipa
• Sinthani mbiri ya lipid
• Momwe zimakhudzira insulin kukana
• ntchito yochepetsera shuga poyerekeza ndi metformin, zotumphukira za sulfonylurea,
• kuthamanga kwa magazi
• sinthani zinthu zomwe zikukhudza chitukuko cha atherosulinosis,
• kusunga madzi, ndipo chifukwa chake, ngozi zakulephera kwamtima zimawonjezeka,
• muchepetse kufooka kwa mafupa, ndikuchulukitsa chiwopsezo cha kugwa,
• hepatotoxicity.

Njira yamachitidwe

Thiazolidinediones amachita pama receptors, omwe amathandizira kugawa ndikupeza shuga ndi ma cell. Zochita za mahomoni m'chiwindi, minofu ya adipose ndi minofu zimayenda bwino. Kuphatikiza apo, zovuta pamlingo wazizindikiro ziwiri zomaliza ndizapamwamba kwambiri.

Glitazones simalimbikitsa kupanga insulin ndi ma pancreatic β-cell.Kuchepetsa magwiridwe antchito kumatheka chifukwa chotsitsa insulin kukokana ndi zotumphukira ndikuonjezera kugwiritsidwa ntchito kwa glucose ndi minofu. Kutsitsa kwa shuga, monga lamulo, kumachitika pang'onopang'ono. Mlingo wocheperako wama glucose umawonedwa pokhapokha pakatha miyezi iwiri. Mankhwalawa amathandizidwa ndi kunenepa kwambiri.

Pali kusintha kwa kagayidwe kachakudya pochepetsa shuga la magazi. Akaphatikizidwa ndi metformin ndi sulfonylurea, zotumphukira zamkati zimasintha mwa odwala omwe ali ndi matenda amtundu wa 2, komanso kuchuluka kwam mahomoni a plasma. Glitazones amachita okha pamaso pa insulin.

Magawo a Pharmacokinetic amatha kusiyanasiyana kutengera mankhwalawo. Osawakhudza amuna ndi akazi komanso zaka. Ndi kuwonongeka kwa chiwindi mwa odwala, amasintha pharmacokinetics.

Zizindikiro ndi contraindication

Thiazolidinediones amalembera omwe amadalira shuga omwe amadalira insulin (mtundu 2 shuga):

• monga monotherapy kwa odwala omwe amawongolera kuchuluka kwa glycemia popanda mankhwala (zakudya ndi zolimbitsa thupi),
• Monga njira ziwiri zophatikizira limodzi ndi kukonzekera kwa sulfonylurea,
• Monga chithandizo chachiwiri ndi metformin yoyang'anira mokwanira glycemic,
• ngati katatu chithandizo cha "glitazone + metformin + sulfonylurea",
• kuphatikiza ndi insulin
• kuphatikiza ndi insulin ndi metformin.

Zina mwazopinga zomwe amamwa mankhwala:

• tsankho
• mimba / mkaka wa m`mawere
• wazaka 18
• Kulephera kwa chiwindi - kuuma koopsa komanso kwapakati,
• kulephera kwamtima kwambiri
• Kulephera kwa aimpso ndikovuta.

Nkhani yavidiyo pakukonzekera kwa gulu la thiazolidinedione:

Zotsatira zoyipa

Zina mwazotsatira zoyipa pambuyo pakupeza thiazolidinediones ndi:

• mwa azimayi - kusamba kwamiseche,
• kulephera kwamtima,
• kuphwanya ufulu wamagulu,
• kuchuluka kwa michere ya chiwindi,
• kuchepa magazi
• achina,
• hypercholesterolemia,
• mutu ndi chizungulire,
• kunenepa
• kulakalaka
• kupweteka pamimba, kukwiya,
• zotupa pakhungu, makamaka urticaria,
• kutupa
• kutopa kwambiri
• kuwonongeka kwamawonekedwe
• mawonekedwe a benign - ma polyps ndi ma cysts,
• chapamwamba kupuma thirakiti matenda.

Munthawi ya chithandizo, kulemera ndi zizindikiritso zimayang'aniridwa zomwe zimawonetsa kusungunuka kwa madzi. Kuwunika ntchito ya chiwindi kumachitidwanso. Kumwa pakamwa moledzera sikukhudza kwambiri glycemic control.

Mlingo, njira yoyendetsera

Glitazones amatengedwa mosasamala chakudya. Kusintha kwa magazi kwa okalamba omwe amapatuka pang'ono m'chiwindi / impso sikuchitika. Omaliza omaliza a odwala ndi omwe amatsitsa kumwa ochepa tsiku lililonse. Mlingo umatsimikiziridwa ndi dokotala payekhapayekha.

Kuyamba kwa mankhwalawa kumayamba ndi mlingo wochepa. Ngati ndi kotheka, imachulukidwa m'maganizo kutengera mankhwala. Akaphatikizidwa ndi insulin, mlingo wake umakhalabe wosasinthika kapena amachepetsa ndi malipoti a machitidwe a hypoglycemic.

Mndandanda wa Mankhwala Osokoneza Thuzi

Oimira awiri a glitazone akupezeka pamsika wamankhwala lero - rosiglitazone ndi pioglitazone. Woyamba m'gululi anali troglitazone - posakhalitsa idathetsedwa chifukwa chopanga chiwindi choopsa.

Mankhwala motengera rosiglitazone akuphatikiza:

• 4 mg avandia - Spain,
• 4 mg Diagnitazone - Ukraine,
• Kuthamanga pa 2 mg ndi 4 mg - Hungary.

Mankhwala okhala ndi piogitazone akuphatikiza:

• Glutazone 15 mg, 30 mg, 45 mg - Ukraine,
• Nilgar 15 mg, 30 mg - India,
• Dropia-Sanovel 15 mg, 30 mg - Turkey,
• Pioglar 15 mg, 30 mg - India,
• Pyosis 15 mg ndi 30 mg - India.

Kuchita ndi mankhwala ena

1. Rosiglitazone. Kuledzera sikukhudza kuwongolera glycemic. Palibe kuyanjana kwakukulu ndi njira zolerera za piritsi, Nifedipine, Digoxin, Warfarin.
2. Pagogazone. Akaphatikizidwa ndi rifampicin, mphamvu ya pioglitazone imachepetsedwa. Mwina kuchepa pang'ono mu mphamvu ya kulera pomwe mukumwa mankhwala apiritsi. Mukamagwiritsa ntchito ketoconazole, kuyang'anira glycemic nthawi zambiri ndikofunikira.

Thiazolidinediones samangochepetsa kuchuluka kwa shuga, komanso zimakhudza dongosolo lamtima. Kuphatikiza pazopindulitsa, ali ndizinthu zingapo zoyipa, zomwe zimakonda kwambiri ndikutukuka kwa mtima komanso kuchepa kwa mafupa.

Amagwiritsidwa ntchito mwachangu mu zovuta mankhwala, kugwiritsa ntchito thiazolidatediones popewa kukula kwa matendawa kumafunikanso kuphunzira.