Chithandizo cha matenda a shuga a mtundu wachiwiri, mankhwala osokoneza bongo ndi zina mwa mankhwalawa ziyenera kuthandizidwa ndi katswiri wazachipatala. Odwala ambiri omwe ali ndi vutoli, kakulidwe ka matenda amapezeka mosiyanasiyana, mokhudzana ndi kuwonetsedwa kwa machitidwe a chiwalo chilichonse.
Kuphatikiza apo, pali zinthu zambiri zomwe zingayambitse matenda amtundu wa 2, zomwe zimafunikanso kuyang'anira chidwi posankha njira yoyenera yolangira komanso kusankha mankhwala a antiidiabetes.
Onse omwe ali ndi matenda ashuga omwe ali ndi mtundu wodziyimira pawokha wa matenda amapatsidwa mankhwala ovuta mosalephera.
Mpaka pano, kumwa kamodzi kokha kwamankhwala omwe ali ndi othandizira a hypoglycemic sikungadzetse zotsatira zabwino kwambiri.
Zotsatira zabwino kwambiri zimatheka ngati malingaliro onse a akatswiri odziwa zaumoyo akutsatiridwa.
Kodi ndi mfundo zazikulu ziti zochizira matendawa?
M'magulu azachipatala, njira zamakono zamankhwala zimaphatikizapo mbali zazikulu zotsatirazi:
- Kutsatira zakudya zopangidwa mwapadera. Kusankhidwa kwamankhwala ndi zakudya zomwe sizimagwiritsidwa ntchito sikuti kumangoleketsa kuchuluka kwa zophatikiza zama carbohydrate, komanso kumathandizira kulemera. Akuluakulu a odwala matenda ashuga ndi matebulo No8, No9 ndi No9-A.
- Masewera olimbitsa thupi opangidwa kuti athetse ziwonetsero za matenda amakhudzanso matenda a magazi. Nthawi zina zimakhala zokwanira kukhala ndi moyo wakhama, kuyenda tsiku lililonse ndi chakudya chokwanira pamenyu, kuti wodwalayo amva bwino.
- Mankhwala. Mankhwala amakono opangidwa ndi katswiri wazachipatala angathandize kubwezeretsa kuchuluka kwa shuga kukhala kwabwinobwino.
Mankhwala onse omwe amagwiritsidwa ntchito pochiritsa ali ndi zochitika zawo zamankhwala:
- mankhwala omwe amalimbikitsa kapamba kuti apange insulin yambiri;
- mankhwala omwe amachititsa chidwi cha maselo ndi minyewa ya thupi kupita kwa yogwira yomwe imapangidwa ndi maselo a beta, kugwiritsa ntchito kwawo ndikofunikira makamaka pamaso pa insulin kukaniza wodwala;
- mankhwala omwe amachepetsa mayamwidwe obwera a michere m'matumbo.
Mankhwala ndi oimira magulu ndi magulu osiyanasiyana. Chodziwika kwambiri komanso chogwiritsidwa ntchito ndi mankhwala amakono:
- Mankhwala oimira gulu la zotumphukira za sulfonyl. Awo mankhwalawa amachita kumalimbitsa kubisalira kwa insulin ya amkati mtundu. Ubwino waukulu wa gulu la mankhwalawa ndi kulekerera mosavuta kwa mankhwalawa kwa odwala ambiri.
- Malo azachipatala, oyimira kalasi ya mankhwala a greatuanide. Zotsatira zawo zazikulu ndikuchepetsa kufunikira kwa ma cell a beta kupatula pawiri yogwira.
- Mankhwala, omwe amachokera ku thiazolidinol, amathandizira pakuchepetsa kwakukulu kwa shuga ndikusokoneza ntchito ya mbiri yamafuta.
- Amayamwa.
Ngati mankhwala omwe ali pamwambapa omwe amachepetsa shuga samabweretsa zabwino, mankhwala a insulin angagwiritsidwe ntchito.
Mankhwala a magulu a meglitinide ndi thiazolidinedione
Meglitinides ndimankhwala omwe amachepetsa shuga komanso amathandizira kupanga mahomoni ndi ziphuphu. Samaphatikizidwa m'magulu aliwonse azamankhwala ochepetsa shuga. Kugwiritsa ntchito mankhwala mwachindunji kumatengera kuchuluka kwa hyperglycemia. Malinga ndi kuchuluka kwa glucose okwanira, michere yambiri imapangidwa ndi thupi mukamamwa mankhwala opangira mankhwala.
Meglitins amalephera kulowa mu tiziwalo tating'onoting'ono tating'onoting'ono, ndipo mphamvu zawo zimayang'aniridwa ku membrane wa khungu, motero, kukakamiza kwa biosynthesis m'maselo a beta sikuchitika.
Kukonzekera kwam'mapiritsi amakono kuchokera ku gulu la meglitinide kumachitika pang'ono, ndikubwezeretsa shuga mwachangu. Komanso, atatha ola limodzi kapena awiri, atayamwa, mankhwala ambiri m'madzi am'madzi amawonedwa.
Mankhwala amatha kugwiritsidwa ntchito ngati mankhwala odziimira pawokha pochiza matendawa kapena kukhala gawo la zovuta mankhwala.
Omwe akuyimira kwambiri mapiritsi omwe ali mgululi ndi a Novonorm ndi Starlix. Mu kapangidwe ka mankhwala opangira mankhwala pali gawo limodzi lokhazikika - nateglinide.
Posachedwa, mankhwala akukonzekera kuchokera ku gulu la thiazolidinediones alowa kuchipatala machitidwe othandizira odwala. Zochita zawo nthawi zina zimakhala zofanana ndi Biguanides:
- mankhwala kusintha chiwopsezo cha zimakhala kwa ma cell beta mahomoni, kuchepetsa kupita patsogolo kwa kukana kwa mahomoni, osakhudza kukondoweza kwa kupanga kwa insulin;
- ali ndi tanthauzo la hypoglycemic;
- kukhudza bwino mbiri ya mafuta;
- sangalatsani mtundu wa geni.
Mankhwalawa a matenda amtundu wa endocrine amatha kuchepetsa chiwopsezo chowoneka ndi kupitilira kwa zovuta zamtima ndi mtima, zomwe ndi gawo lofunikira kwa odwala ambiri.
Masiku ano, pali magulu atatu ofunikira a mankhwala-thiazolidinediones:
- Mapiritsi a m'badwo woyamba omwe amawonetsa kutchulidwa kwa hepatotoxic ndi mtima. Woimira wake ndi Troglitazone. Chifukwa cha mawonekedwe ake, sagwiritsidwa ntchito pochiritsa matenda amakono.
- Mankhwala a m'badwo wachiwiri (Pioglitazone).
- Mankhwala a m'badwo wachitatu - Rosiglitazone.
Mankhwalawa mapiritsi am'badwo wachiwiri ndi wachitatu angagwiritsidwe ntchito ngati monotherapy komanso ngati gawo la chithandizo chovuta. Nthawi zambiri, akatswiri azachipatala amapereka mankhwala omwe amapezeka ndi metformin.
Zochitikazo zikufotokozedwa ndikuti ma biguanides amaponderezera gluconeogenesis, ndipo thiazolidinediones imakulitsa kugwiritsidwa ntchito kwapadera kwa shuga.
Mankhwala sulfonylurea zotumphukira
Chithandizo cha zovuta pakumayendetsa dongosolo la endocrine la mtundu wachiwiri kwa nthawi yayitali chimaphatikizira kugwiritsa ntchito mankhwala apiritsi, omwe ndi oimira sulfonylurea.
Makampani opanga mankhwala amapanga mitundu ingapo yokhudzana ndi gululi.
Zothandiza kuchokera ku sulfonylureas ndi mankhwala azikhalidwe angapo.
Njira yoperekera mphamvu ya gulu lotere la mankhwala kwa wodwala ndikuwonetsa zotsatirazi:
- yambitsa njira ya kukondoweza kwa maselo a beta a kapamba ndikuchulukitsa kuchuluka kwa kupezeka kwa maselo otengera insulin
- yambitsa kukhathamiritsa kwa timadzi timene timagwira mu cell ndi kuletsa kwa insulinase ntchito;
- kufooketsa mgwirizano mu mahomoni ovuta ndi mapuloteni;
- muchepetse kuchuluka kwa insulin kwa ma antibodies;
- amathandizira kukulitsa chidwi cha ma receptors a cell membrane am'mimba ndi lipid minofu kuti insulin;
- onjezani kuchuluka kwa zolandilira mahomoni pamitsempha yama minofu;
- amathandizira kukonza magwiritsidwe a shuga mu chiwindi ndi minofu;
- zimapangitsa ndulu ya gluconeogeneis mu chiwindi ndi lipid zimakhala;
- kuponderetsa lipolysis;
- kuonjezera mayamwidwe ndi makutidwe ndi okosijeni a shuga.
Mankhwala amakono, mitundu ingapo ya mankhwala yokhudzana ndi mankhwala a sulfonyl imaperekedwa:
- Mankhwala a m'badwo woyamba, omwe mu mankhwala amakono samagwiritsidwa ntchito chifukwa cha zovuta zina ziwalo zina ndi machitidwe - Tolazamide, Carbutamide.
- Mankhwala a m'badwo wachiwiri, omwe Glibenclamide, Gliclazide ndi Glipizide ndikuyimira.
Kuphatikiza apo, pali mankhwala a m'badwo wachitatu omwe amapangidwa pamaziko a glimepiride.
Mankhwala a Gulu la Biguanide
Kugwiritsa ntchito mankhwala osokoneza bongo a mtundu wa 2 shuga nthawi zambiri kumakhudzana ndi kugwiritsa ntchito mankhwala ochokera ku gulu la Biguanide. Chifukwa cha kugwiritsa ntchito kwawo, kuchuluka kwa insulin yotulutsidwa m'magazi kungatheke.
Mankhwalawa mankhwalawa amathandizira odwala matenda amtundu wa 2 matenda a shuga amachepetsa minyewa ya gluconeogeneis, ma elekitironi onyamula ma cell a mitochondrial. Njira za glycolysis zimakhudzidwa, maselo amatenga chakudya cham'mimba bwino, ndipo mayamwidwe ake ndi makoma a matumbo ochepa a m'mimba amachepa.
Mankhwala samachititsanso kuti magazi asadutse kwambiri, chifukwa samapangitsa kuti maselo a beta asungike.
Njira yochitira Biguanides pa thupi la munthu ndikuwonetsa zotsatirazi:
- pali kuchepa kwa kuchuluka kwa glycogen kuchokera ku chiwindi, komwe kumapangitsa kuwonjezeka kwa gawo loyambira la chakudya m'magazi;
- kuletsa kwa kaphatikizidwe ka shuga kuchokera ku mapuloteni ndi mafuta amapezeka;
- kapangidwe ka shuga m'magazi amayamba;
- onse mankhwala a greatuanide amagwira ntchito ngati othandizira kuchuluka kwa maselo ndi zimakhala kuti apange insulin, yomwe imalepheretsa kukula kwa kukana kwa mahomoni;
- kuthandiza kuchepetsa mayamwidwe a shuga kulowa m'matumbo;
- chifukwa cha zochita za ma biguanides, momwe njira yogwiritsira ntchito shuga kukhala mkaka wa m'mimba imawonedwa;
- pali kuchuluka kwa lipids m'magazi ndi kuchepa kwa cholesterol m'thupi;
- minofu minofu mothandizidwa ndi biguanides amayamba kuyamwa shuga wambiri.
Mankhwala a shuga a 2 a mtundu wa shuga a Biguanide ali ndi mwayi umodzi wambiri mosiyana ndi mankhwala ena - samatsogolera pakukula kwa hypoglycemia, ndiye kuti, kuchuluka kwa shuga m'magazi sikumatsika kwambiri.
Metformin hydrochloride imagwiritsidwa ntchito ngati chosakaniza chachikulu pokonzekera mapiritsi a Biguanide. Kutengera zosowa za odwala, mapiritsi a mtundu wa 2 shuga ogwiritsidwa ntchito mosiyanasiyana (500, 850, 1000 mg ya mankhwala othandizira) kapena othandizira omasulidwa nthawi yayitali amapezeka kwa odwala matenda ashuga.
Mankhwala akuluakulu otengera metformin a matenda a shuga a 2 amadziwika kwambiri - Siofor, Glyukofazh ndi Formetin.
Mankhwala a alpha glucosidase ndi insretin inhibitor
Mankhwala osokoneza bongo amatha kuchitika pamaziko a kumwa mankhwalawa kuchokera ku gulu la ma proretin.
Dziwani kuti ma insretins ndi mahomoni omwe amapangidwa m'matumbo atatha kudya.
Ntchito yawo imakhala yolimbikitsa kwambiri kutulutsa insulin. Pankhaniyi, ma protein amayamba kugwira ntchito pokhapokha kuchuluka kwa glucose m'magazi, ndikasintha kwa chizindikirochi, njira yolimbikitsira kupanga kwa mahomoni imayima.
Chifukwa cha izi, kugwiritsa ntchito ma insretin sikupangitsa kuti hypoglycemia ikhale.
Kuphatikiza apo, mankhwalawa amalepheretsa kuyamwa kwa matumbo m'matumbo ndipo, motero, amachepetsa kuchuluka kwa mafuta m'thupi m'magazi.
Gawo lalikulu la mankhwala ndi Sitagliptin.
Mpaka pano, mankhwala omwe ali ndi Sitagliptin pokha kapangidwe kake sapezeka.
Nthawi yomweyo, pali mitundu yambiri ya mankhwala ophatikizidwa pamsika, omwe amagwira ntchito kwambiri omwe ndi sitagliptin ndi metformin.
Oyimira odziwika kwambiri ndi mankhwala ochepetsa shuga monga Bagomet, Metglib ndi Yanumet.
Mapiritsi a alpha glucosidase inhibitor mu shuga ndi monga othandizira popanga enzyme inayake m'matumbo yomwe imasungunula zovuta zamankhwala.
Ndi chifukwa chake kuti mayamwidwe a ma polysaccharides achepetsedwa. Mankhwala amakono a shuga ayamba kugwiritsidwa ntchito machitidwe azachipatala chifukwa chakuti ali ndi chiwerengero chochepa cha zoyipa ndi zotsutsana.
Mapiritsi a alpha glucosidase inhibitor amtundu wa 2 shuga amatengedwa nthawi yomweyo ndi zakudya, kuwonjezera pa kutchulidwa kwa hypoglycemic, musapangitse kuwonjezeka kwa thupi.
Mankhwala omwe akuphatikizidwa m'gululi akuphatikizapo Miglitol ndi Acarbose, Glucobay.
Ntchito zochizira insulin mankhwala matenda
Ngakhale kuti chitukuko cha matenda a pathological, monga lamulo, kuchuluka kwakokwanira kwa insulin m'magazi kumapangidwa m'mitundu yachiwiri ya matenda ashuga, pali milandu pamene chithandizo cha insulin chikufunika. Izi zimawonekera pomwe kuwonongeka mu ntchito ya kapamba kumawonedwa pamene kukula kwa insulin.
Mosiyana ndi mawonekedwe a insulin omwe amadalira phula, odwala matenda ashuga omwe ali ndi mawonekedwe osadzimira a insulin amatchulidwa jakisoni wa insulini osati malinga ndi zosowa zofunika, koma kusintha mafuta a plasma, ngati njira zina ndi mankhwala sizinabweretse zotsatira zoyenera.
Kukonzekera kwa insulin kotengera matendawa kumatengera mitundu yosiyanasiyana malingana ndi nthawi komanso nthawi yanthawi ya kuwonekera kwa zotsatira zake komanso nthawi yayitali yothandizidwa.
Mankhwala amakono amapereka odwala ake kugwiritsa ntchito mitundu yotsatirayi ya insulin yodalira matendawa:
- Mankhwala a ultrashort.
- Kuwonetsera kwakanthawi insulin.
- Hormonal mankhwala a sing'anga nthawi kukhudzana.
- Wokhala insulin yayitali.
Zomwe zimadziwika ndi ultrashort ndi mankhwala osokoneza bongo, omwe amawonetsa ntchito zake mkati mwa mphindi zisanu mutakhazikitsa. Zotsatira zabwino kwambiri zochizira zimawonedwa pafupifupi ola limodzi jekeseni. Pankhaniyi, zotsatira za jakisoni zimapitilira kwakanthawi.
Mankhwala othandizira mawonekedwe apafupi, omwe amayamba kugwira ntchito pafupifupi theka la ola pambuyo pokhazikitsidwa pansi pa khungu. Monga lamulo, mankhwala onse omwe amagwira ntchito mwachidule amapangidwa kuti athetse mawonekedwe a hyperglycemia, omwe nthawi zambiri amawonedwa pambuyo pa chakudya.
Mankhwala a mahomoni a nthawi yayitali nthawi zambiri amagwiritsidwa ntchito molumikizana ndi insulin yochepa. Nthawi yawo ya kukopa, monga lamulo, imatenga maola 12 kapena 12. The achire zotsatira pambuyo jekeseni wayamba kuwonekera pambuyo maola awiri kapena atatu, ndipo pazenera ambiri mu magazi zimawonedwa pambuyo pafupifupi maola sikisi ndi asanu ndi atatu.
Mankhwala okhazikika kwa mahomoni amagwiritsidwa ntchito molumikizana ndi insulin yochepa. Iyenera kuperekedwa kamodzi patsiku, nthawi zambiri m'mawa. Cholinga chokhala ndi insulin yayitali ndikukhalabe ndi matenda a glycemia usiku.
Zomwe ndimankhwala omwe angathandize kuchiza matenda a shuga afotokozedwa mu kanema munkhaniyi.
