Mankhwala atsopano a shuga omwe adayamba kuwoneka mu 2000s ndi mankhwala a insretin. Mosavomerezeka, amapangidwa kuti achepetse magazi pambuyo kudya ndi shuga yachiwiri. Komabe, pamenepa sizitikhudza kwenikweni. Chifukwa mankhwalawa amachita mosiyanasiyana ndi Siofor (metformin), kapena sagwira ntchito kwenikweni, ngakhale kuti ndi okwera mtengo kwambiri. Amatha kutumikiridwa kuphatikiza Siofor, pomwe zochita zake sizikwanira, ndipo odwala matenda ashuga safuna kuyambitsa kubaya.
Mankhwala a shuga a Baeta ndi Viktoza ali m'gulu la GLP-1 receptor agonists. Ndizofunikira chifukwa samangotsitsa shuga wamagazi ndikatha kudya, komanso amachepetsa kudya. Ndipo zonsezi popanda zovuta zapadera.
Phindu lenileni la mitundu yatsopano ya matenda ashuga ndikuti amachepetsa kudya komanso amathandizira kuchepetsa kudya kwambiri. Chifukwa cha izi, zimakhala zosavuta kuti odwala azitsatira zakudya zamagulu ochepa komanso kupewa kuwonongeka. Kupereka mankhwala atsopano a shuga kuti muchepetse chilakiko sikumavomerezedwa kale. Kuphatikiza apo, mayeso awo azachipatala osakanikirana ndi kadyedwe kotsika thupi sanachitepo. Komabe, machitidwe awonetsa kuti mankhwalawa amathandizadi kuthana ndi kususuka kosalamulirika, ndipo zotsatirapo zake ndizochepa.
Ndi mapiritsi ati omwe ali oyenera kuchepetsa chilimbikitso
Asanayambe zakudya zamafuta ochepa, odwala onse omwe ali ndi matenda ashuga a 2 amalephera kudya zakudya zopatsa thanzi. Kudalira kumeneku kumawonekera mu mawonekedwe a kudya pafupipafupi kwa mafuta ochulukirapo komanso / kapena kupuma pafupipafupi kwa kususuka kopatsa chidwi. Momwemonso munthu amene ali ndi chidakwa, nthawi zonse amakhala “wopanda chiyembekezo” komanso / kapena nthawi zina amatha kumangokhala ndwii.
Anthu onenepa kwambiri komanso / kapena matenda a shuga 2 amadziwika kuti ali ndi vuto losakhutira. M'malo mwake, ndizopatsa mphamvu zamagetsi zamagetsi kuti ziziimba mlandu chifukwa chakuti odwala oterewa amakhala ndi vuto la kugona. Akayamba kudya mapuloteni komanso mafuta achilengedwe, chakudya chawo chimakhala chabwinobwino.
Chakudya chamafuta ochepa okha chimathandiza pafupifupi 50% ya odwala kuthana ndi kudalirika kwa chakudya. Odwala ena omwe ali ndi matenda a shuga a 2 amafunikira njira zina. Mankhwala a incretin ndi "njira yachitatu yodzitetezera" yomwe Dr. Bernstein adapereka atatha kutenga chromium piritsi komanso kudzidalira.
Mankhwalawa amaphatikiza magulu awiri a mankhwalawa:
- DPP-4 zoletsa;
- GLP-1 receptor agonists.
Kodi mankhwala atsopano a shuga amathandiza bwanji?
Mayeso azachipatala awonetsa kuti DPP-4 inhibitors ndi GLP-1 receptor agonists amachepetsa shuga m'magazi atatha kudya odwala omwe ali ndi matenda a shuga a 2. Zili choncho chifukwa amalimbikitsa kubisirana kwa insulin ndi kapamba. Zotsatira zake pakugwiritsa ntchito limodzi ndi zakudya “zopatsa thanzi”, hemoglobin ya glycated imatsika ndi 0,5-1%. Komanso, ena omwe amayeserera mayeso amachepetsa thupi pang'ono.
Izi sizitanthauzira kuti kupindula ndi chiyani, chifukwa Siofor wakale (metformin) wakale yemwe ali ndi vuto lomweli amachepetsa glycated hemoglobin ndi 0.8-1.2% ndipo amathandizanso kuchepa thupi ndi ma kilogalamu angapo. Komabe, amavomerezeka kuti apereke mankhwala a mtundu wa incretin kuwonjezera pa metformin kuti athandizitse kusintha kwake komanso achedwetsa kuyamba kwa chithandizo cha matenda a shuga a 2 omwe ali ndi insulin.
Dr. Bernstein akuvomereza kuti odwala matenda ashuga amwe mankhwalawa kuti asapangitse insulini kubisala, koma chifukwa chakuchepa kwa kudya. Amathandizira kuyendetsa kudya, kuthamangitsa kuyambika kwa satiety. Chifukwa cha izi, zolephera zolephera pazakudya zamagulu ochepa mwa odwala zimachitika kangapo.
Bernstein amalembera mankhwala ochepetsa khansa kwa odwala matenda a shuga a 2, komanso kwa odwala omwe ali ndi vuto la shuga 1 omwe ali ndi vuto la kudya kwambiri. Mosavomerezeka, mankhwalawa samapangidwira odwala 1 a shuga. Zindikirani Odwala omwe ali ndi matenda amtundu woyamba a shuga omwe adwala matenda a diabetesic gastroparesis, i.e., akuchedwa kuchotsa kwam'mimba chifukwa cha kuwonongeka kwa neural, sangathe kugwiritsa ntchito mankhwalawa. Chifukwa zidzawonjezera.
Kodi mankhwala aretretin amagwira ntchito bwanji?
Mankhwala a incretin amachepetsa chilakolako cha chakudya chifukwa amachepetsa kuyamwa kwam'mimba atatha kudya. Zotheka mwa izi ndi mseru. Kuti muchepetse kusasangalala, yambani kumwa mankhwalawa ndi muyezo wochepa. Pang'onopang'ono muchulukitse pamene thupi lasinthana. Popita nthawi, nseru imazimiririka mwa odwala ambiri. Nthawi zina, zovuta zina zimatheka - kusanza, kupweteka m'mimba, kudzimbidwa kapena kutsegula m'mimba. Dr. Bernstein akuti pochita izi samayang'aniridwa.
Ma Dhib-4 ma inhibitors amapezeka pama mapiritsi, ndipo GLP-1 receptor agonists mu mawonekedwe a yankho la subcutaneous makongoletsedwe. Tsoka ilo, omwe amapezeka m'mapiritsi samathandizira kuti azilakalaka kudya, ndipo shuga yamagazi amachepetsedwa pang'ono. Kwenikweni agonists a GLP-1 receptors amachita. Amadziwika kuti Baeta ndi Viktoza. Amayenera kupaka jakisoni, monga insulin, kamodzi kapena kangapo patsiku. Njira imodzimodzi yopanda jakisoni yopanda jakisoni.
GLP-1 receptor agonists
GLP-1 (glucagon-like peptide-1) ndi amodzi mwa mahomoni omwe amapangidwa m'matumbo am'mimba poyankha kudya. Zimalembera kapamba kuti nthawi yakwana kutulutsa insulini. Homoni imeneyi imachepetsa kutsukanso kwa m'mimba ndipo izi zimachepetsa chilakolako chofuna kudya. Amanenanso kuti amathandizira kuchira kwa ma cell a pancreatic beta.
Glucagon wachilengedwe ngati peptide-1 amawonongeka m'thupi patatha mphindi 2 atapangidwa. Zimapangidwa momwe zimafunikira ndikuchita mwachangu. Ma analogu ake opanga ndi mankhwala a Bayeta (exenatide) ndi Viktoza (liraglutide). Amangopezeka mwa ma jakisoni okha. Baeta ndi yovomerezeka kwa maola angapo, ndipo Viktoza - tsiku lonse.
Baeta (Exenatide)
Opanga mankhwala a Baeta amalimbikitsa jakisoni imodzi pa ola limodzi asanadye chakudya cham'mawa, ndipo winanso madzulo, ola limodzi asanadye chakudya chamadzulo. Dr. Bernstein amalimbikitsa kuti azichita mosiyana - kumenya Bayete 1-2 maola asanafike nthawi yomwe wodwalayo amakonda kwambiri kapena kusirira. Ngati mumadya kamodzi patsiku, zikutanthauza kuti Bayet ikhoza kubayira kamodzi muyezo wa ma 5 kapena 10 ma kilogalamu. Ngati vuto la kudya kwambiri limapezeka kangapo masana, ndiye kuti muzipaka jakisoni nthawi zonse kwa ola limodzi musanakumane ndi vuto lililonse, mukadzilola kudya kwambiri.
Chifukwa chake, nthawi yoyenera ya jakisoni ndi Mlingo imakhazikitsidwa poyesa ndi zolakwika. Mwachidziwitso, mlingo waukulu wa Baeta tsiku lililonse ndi 20 mcg, koma anthu omwe ali ndi kunenepa kwambiri angafunike zina zambiri. Poyerekeza ndi chithandizo cha Bayeta, mankhwalawa a mapiritsi a insulin kapena a shuga musanadye angathe kuchepetsedwa ndi 20% pomwe. Kenako, motengera zotsatira za kuyeza shuga m'magazi, muwone ngati muyenera kuichepetsa kapena kuiwonjezera.
Victoza (liraglutide)
Mankhwala Viktoza adayamba kugwiritsidwa ntchito mu 2010. Jakisoni wake ayenera kuchitidwa 1 nthawi patsiku. Jakisoni amatha maola 24, monga momwe opangirawo amanenera. Mutha kuchita nthawi iliyonse masana. Koma ngati mumakhala ndi vuto la kudya nthawi yomweyo, mwachitsanzo, musanadye nkhomaliro, itanani foni ya Victoza 1-2 musanadye nkhomaliro.
Dr. Bernstein amawona Victoza ngati mankhwala amphamvu kuti athe kulimbana ndi chilakolako cha kudya, kuthana ndi kudya kwambiri komanso kuthana ndi kudalirika kwa chakudya. Ndiwothandiza kwambiri kuposa Baeta, komanso yosavuta kugwiritsa ntchito.
DPP-4 zoletsa
DPP-4 ndi dipeptyl peptidase-4, enzyme yomwe imawononga GLP-1 m'thupi la munthu. DPP-4 zoletsa ziletsa izi. Mpaka pano, mankhwalawa ali m'gulu lino:
- Januvia (sitagliptin);
- Onglisa (saxagliptin);
- Galvus (vidlagliptin).
Awa onse ndi mankhwala opezeka m'mapiritsi, omwe amalimbikitsidwa kuti amwe nthawi 1 patsiku. Palinso Pulogalamu Yogulitsa Mankhwala (linagliptin), omwe sagulitsidwa ku mayiko olankhula Russia.
Dr. Bernstein anena kuti zoletsa za DPP-4 sizilibe chidwi kwenikweni ndi chidwi cha chakudya, komanso zimachepetsa shuga m'magazi mutadya. Amapereka mankhwalawa kwa odwala omwe ali ndi mtundu wachiwiri wa shuga omwe akutenga kale metformin ndi pioglitazone, koma sangathe kufikira shuga wabwinobwino ndipo amakana kuthandizidwa ndi insulin. Ma Dhib-4 ma inhibitors omwe ali munthawiyi siwothandiza m'malo mwa insulini, koma izi ndi zabwinoko kuposa chilichonse. Zotsatira zoyipa zakumwa mosazindikira sizichitika.
Zotsatira zoyipa zamankhwala kuchepetsa nkhawa
Kafukufuku wazinyama adawonetsa kuti kumwa mankhwala ochepetsa minyewa kumapangitsa kuti maselo awo apangidwe. Sizinadziwikebe ngati zomwezo zimachitikira anthu. Kafukufuku wofanana wa nyama adapeza kuti kuchuluka kwa khansa imodzi ya chithokomiro kumachulukirachulukira. Kumbali inayo, shuga wambiri amachititsa kuti pakhale mitundu 24 ya khansa. Chifukwa chake mapindu a mankhwalawa momveka bwino amapitilira muyeso womwe ungakhalepo.
Pamodzi ndi kumwa mankhwala amtundu wa insretin, chiopsezo cha kapamba - kutupa kwa kapamba - chinajambulidwa kwa anthu omwe kale anali ndi vuto la kapamba. Choyambitsa chiopsezo, choyamba, chidakwa. Magawo otsala a odwala matenda ashuga sayenera kuwopa.
Chizindikiro cha kapamba ndi ululu wam'mimba wosayembekezeka komanso wopweteka. Ngati mukumva, onani dokotala nthawi yomweyo. Adziwitsanso kapena kutsutsa kuti matendawa ndi a kapamba. Mulimonsemo, musiyeni kumwa mankhwalawa ndi ntchito ya insretin mpaka zonse zitheke.
