Ndi zaka, ntchito ya kapamba wamunthu imakulirakulira ndipo mitundu ya mankhwala kagayidwe imasokonekera, zomwe nthawi zambiri zimayambitsa kukula kwa matenda a shuga mwa okalamba. Chithandizo cha matendawa chimafunikira njira yapadera, popeza muukalamba odwala amatha kudwala matenda osiyanasiyana, omwe ndi kuphwanya kwa kumwa mankhwala ambiri a shuga.
Chifukwa chake, odwala onse enieni komanso abale awo ayenera kudziwa mtundu wa mapiritsi 2 a shuga mwa odwala okalamba omwe amagwiritsidwa ntchito ngati mankhwala amakono, momwe angatenge ndikusakaniza molondola. Kuthandizira odwala matenda ashuga okalamba, ochitidwa mogwirizana ndi malamulo onse, kumatha kuwonjezera moyo wa munthu wachikulire ndikupanga kukhala lokwanira.
Zoyambitsa matenda ashuga okalamba
Pakatha zaka 50, munthu amakhala ndi kuchepa kowoneka bwino kwa kulolera kwa shuga, zomwe zimapangitsa kuti shuga azikhala pang'ono pang'onopang'ono. Chifukwa chake pofika zaka 60, kuchuluka kwa glucose pamimba yopanda kanthu kumakwera pafupifupi 0,05 mmol / L, ndipo atatha kudya 0,5 mmol / L.
Izi zikuchitika mtsogolo ndipo zaka 10 zilizonse zikubwerazi, kuchuluka kwa shuga kwa munthu wachikulire kumachulukirachulukira. Kuphatikiza apo, ndikofunikira kutsimikizira kuti izi ndizowerengeka ndipo mwa anthu ena omwe ali ndi zaka, kuchuluka kwa shuga kumatha kuwonjezeka kwambiri.
Pali zinthu zitatu zazikuluzikulu zomwe zingayambitse matenda ashuga a mtundu wa 2 mwa anthu okulirapo zaka 50. Ngakhale kukhalapo kwa m'modzi wa iwo kumachulukitsa chiopsezo chotenga matendawa, ndipo kupezeka kwa atatu mwa anthu 95 mwa 100 kumabweretsa kupezeka kwa matenda ashuga.
Chifukwa chiyani shuga imayamba mwa okalamba:
- Kuchepa kwa chidwi chamkati kwa insulin (insulin kukana) komwe kumayamba chifukwa cha kusintha kwa thupi;
- Kuchepetsa kutulutsa kwa insulin ndi ma pancreatic β-cell;
- Kuchepa kwa mahomoni a insretin ndi kuchepa mphamvu kwa thupi kwa okalamba.
Kukana insulini nthawi zambiri kumapezeka mwa anthu okalamba, koma nthawi zambiri amakhudza amuna ndi akazi achikulire omwe ali onenepa kwambiri. Ngati zizindikiro zoyambirira za kusagwirizana kwa insulini mpaka insulin sizitenga zoyenera, ndiye kuti kuphwanya kumeneku kungayambitse kukula kwa matenda osokoneza bongo.
Mwa anthu onenepa kwambiri, chinthu chachikulu chomwe chikukulimbikitsani kukula kwa matenda a shuga ndi kuchepa kwa kupanga kwa insulin. Mwa odwala, mutatha kudya, kapamba samayamba kutulutsa insulini mwachangu, monga zimachitikira mwa anthu athanzi, zomwe zimapangitsa kuchuluka kwa shuga m'magazi.
Ma insretins ndi mahomoni opangidwa ndi m'mimba thirakiti pakudya ndipo amathandizira kupanga insulin. Ndi wopanda mahomoni ofunikira awa kapena kuchepa kwa chidwi cha minyewa kwa iwo, wodwalayo amasungidwa ndi insulin yokwanira 50% kuposa anthu omwe ali ndi chakudya chamagulu olimba.
Koma zinthu zonsezi zomwe zimayambitsa matenda ashuga, monga lamulo, ndizotsatira zamakhalidwe osayenera.
Kukana zizolowezi zoipa, kutsatira kadyedwe komanso kuchita masewera olimbitsa thupi nthawi zambiri kumachepetsa kuopsa kwa kagayidwe kazakudya, motero kuwoneka kwa matenda a shuga a 2.
Lemberani mankhwala a shuga atatu okalamba
Chithandizo cha matenda a shuga 2 a okalamba odwala okalamba ziyenera kuphatikizapo kukana zakudya zamagulu azakudya zambiri komanso kukhazikitsa njira zolimbitsa thupi zotheka. Izi zimachepetsa kuchuluka kwa shuga m'magazi ndikuchepetsa kuchuluka kwa mapiritsi ochepetsa shuga.
Kugwiritsa ntchito mankhwala antidiabetesic ndi gawo lofunika kwambiri pa matenda a shuga kwa anthu akuluakulu.
Pochizira odwala matendawa kwa okalamba, mankhwala a magulu otsatirawa amagwiritsidwa ntchito: Biguanides, sulfonylureas, glyptins, alpha-glucosidase inhibitors ndi insulin.
Biguanides
Mankhwala othandizira odwala matenda ashuga okalamba nthawi zambiri amaphatikiza ndi biguanides omwe amathandiza kuti thupi lizikoka shuga, amalimbikitse kupanga zawo za insulin, kupewa mapangidwe a glucose pama mankhwala osagwiritsa ntchito carbohydrate komanso amachepetsa kwambiri cholesterol yoyipa.
Kuchokera pagulu la biguanides, omwe anali odziwika kwambiri pakati pa odwala matenda ashuga anali mankhwala a Metformin, pamaziko omwe mankhwalawa amapangidwa motere:
- Glucophage;
- Avandamet;
- Bagomet;
- Metfogamm;
- Siofor.
Metformin imakhala ndi phindu pabwino m'thupi la wodwalayo, popanda kuchititsa kufooka kapenanso popanda kuyambitsa hypoglycemia. Kuphatikiza apo, kugwiritsa ntchito mankhwalawa sikuwonjezera thupi, koma kumathandizira kuchepetsa thupi. Kale masabata oyamba omwe mumalandira chithandizo ndi Metformin, wodwala amatha kutaya pafupifupi 3 kg.
Metformin ndi mankhwala omwe ali ndi magulu osiyanasiyana azithandizo zomwe zimathandiza kwambiri odwala matenda ashuga. Chifukwa chake Metformin imathandizira kuchepetsa chiopsezo cha kugunda kwamtima ndi kugunda kwa mtima, kuchepetsa matenda othamanga kwa magazi ndipo imathandizanso kuti mtima ukhale wogwira ntchito.
Nthawi zina, kugwiritsa ntchito Metformin kungayambitse kukalamba, kukhumudwa, komanso kugaya chakudya. Komabe, Zizindikiro zosasangalatsa zotere sizimapitilira masiku awiri, ndipo zitatha. Mankhwalawa samayambitsa mavuto ena.
Mwambiri, Metformin ndi mankhwala othandiza kwambiri, koma osavomerezeka kwa anthu okalamba omwe ali ndi matenda a impso.
Komanso, kumwa mankhwalawa kumapangidwa mu matenda omwe angayambitse hypoxia mwa okalamba.
Sulfonylureas
Gulu lina lotchuka la mankhwala omwe madokotala nthawi zambiri amapereka kwa odwala awo okalamba ndi sulfonylureas. Mankhwalawa akhala akugwiritsidwa ntchito pochiza matenda ashuga kwa nthawi yayitali, kuyambira zaka 50s zapitazo.
Kukonzekera komwe kumapangidwa pamaziko a sulfonylureas ndi amitundu iwiri - m'badwo woyamba komanso wachiwiri. Zothandiza kuchokera ku sulfonylureas a m'badwo woyamba lero sizigwiritsidwanso ntchito, makamaka pochiza odwala okalamba.
Nawonso, mankhwala a m'badwo wachiwiri omwe amagwiritsidwa ntchito pagululi amagwiritsidwa ntchito pochiza matenda amtundu wa 2 osakanikirana ndi zakudya zamafuta ochepa ndipo nthawi zambiri amaphatikizidwa ndi biguanides, omwe ndi Metformin.
Zothandiza kuchokera ku sulfonylureas zimatha kukhala zothandiza pokhapokha thupi la munthu likupanga yake insulin, apo ayi kugwiritsa ntchito kungakhale kopanda ntchito. Mankhwalawa amathandizira kubisalira kwa insulin chifukwa cha kapamba, komwe kumapeto kwake kumapangitsa kutsika kwathunthu.
Kuphatikiza apo, mankhwala a sulfonylurea ali ndi zovuta zoyipa, monga:
- Amatha kuyambitsa matenda a hypoglycemia, ndiko kuti, kutsika lakuthwa kwa shuga m'magazi. Vutoli limakhala lalikulu kwambiri ngakhale kwa wachichepere, ndipo kwa wokalamba wodwala amatha kukhala wakufa;
- Madokotala ambiri ali ndi chitsimikizo kuti mankhwala omwe ali mgululi amatha kusokoneza kapamba pakapita nthawi ndikupangitsa kuti insulin itulutsidwe kwathunthu;
- Kutenga mankhwala a sulfonylurea kumatha kuyambitsa kulemera kwakukulu, komwe sikofunikira kwambiri kwa matenda ashuga a 2, chifukwa amatha kudwalitsa wodwala.
Chifukwa chake, ngati pali mwayi wotere, ndiye kuti mankhwalawa agwiritsidwe ntchito ndi mankhwala ena osavulaza.
Izi zimangopindulitsa wodwalayo atakalamba.
Ma giliki
Gliptins kapena dzina lathunthu la dipeptidyl peptidase-4 inhibitors ndi mankhwala omwe amalimbikitsa kugwira ntchito kwa glucagon-like peptide-1 (GLP-1), yomwe imagwirizana ndi mahomoni a m'mimba. Amathandizira kukulitsa katemera wa insulin, komanso amathandizira kuletsa kupanga kwa glucagon, mahomoni omwe amachititsa kuchuluka kwa shuga m'magazi.
Dipeptidyl peptidase-4 ndi enzyme yomwe imagwira ku GLP-1, ikuwononga kapangidwe kake ndikuchotsa machitidwe ake. Koma mankhwala a gulu la dipeptidyl peptidase-4 zoletsa amaletsa kuchitapo chake, potero, amalimbikitsa ntchito ya GLP-1.
Ndikumamwa mankhwalawa, kuchuluka kwa GLP-1 m'magazi a wodwala kuli pafupifupi kawiri kuposa momwe thupi limagwirira ntchito, zomwe zimawapangitsa kukhala njira imodzi yochepetsera shuga.
Mankhwala otsatirawa ndi a gulu la glisitins:
- vildagliptin;
- sitagliptin;
- saxagliptin.
Ndikofunika kutsindika kuti mankhwalawa omwe ali pamwambapa akupitilizabe kugwirabe ntchito kufikira magazi atasungidwa kwambiri. Ngati ingagwire bwino - mpaka 4.5 mmol / l, ndiye kuti mankhwalawa amasiya kutulutsa insulin ndikusokoneza kupanga glucagon.
Mankhwala onse ochokera pagulu la gliptins amatha kuphatikizidwa ndi mankhwala ena, osawopa kuwonjezera zotsatira zoyipa.
Pankhaniyi, zotsatira zabwino kwambiri pochiza matenda a shuga zitha kupezeka mwa kuphatikiza zoletsa za dipeptidyl peptidase-4c ndi Metformin.
Alpha Glucosidase Inhibitors
Mankhwala ochokera ku gulu la alpha-glucosidase inhibitors amalepheretsa kubisala kwa michere ya m'mimba komanso amathandizira kuti thupi lisamamwe ndi thupi. Izi zimalola kuchepetsa shuga wambiri mu shuga yachiwiri.
Mankhwalawa ndi othandiza kwa okalamba omwe ali ndi kuwonjezereka kwa glucose wamagazi atatha kudya. Koma popeza mankhwalawa amasokoneza chimbudzi cha zovuta komanso zovuta zamafuta, nthawi zambiri zimayambitsa mavuto monga kutsegula m'mimba, kutulutsa magazi ndi kuchuluka kwa mpweya.
Pachifukwa ichi, mukumwa mankhwala kuchokera ku gulu la alpha-glucoside inhibitors, wodwalayo ayenera kutsatira zakudya zamafuta ochepa, zomwe zingapewe zotsatirapo zilizonse zosasangalatsa. Koma mwayi wofunikira wa alpha-glucosidase inhibitors ndikuti samayambitsa kulemera.
Mwa alpha-glucosidase inhibitors, mankhwala otsatirawa ndi othandiza kwambiri:
- Glucobay;
- Diastabol
Insulin
Dotoloyo akupereka jakisoni wa insulin kwa wodwala wachikulire ngati mankhwala ena a shuga monga mankhwala ochepetsa shuga, kudya zakudya zamagulu ochepa, komanso kuchita masewera olimbitsa thupi sizinathandize kuti magazi achepetse.
Kuchepetsa chiopsezo cha hypoglycemia, chomwe chimachuluka kwambiri pogwiritsa ntchito insulin pochiza matenda a shuga a 2, ayenera kuphatikizidwa ndi Metformin. Izi zimachepetsa kwambiri mulingo wa insulin, zomwe zikutanthauza kuteteza wodwala kuti asatseke kwambiri ndi shuga.
Insulin, monga lamulo, imagwiritsidwa ntchito panthawi yomwe kuchuluka kwa glucose m'magazi a wodwala kumafika pazovuta kwambiri. Pankhaniyi, jakisoni wa insulin amathandizira wodwala wachikulire ndipo pambuyo masiku 2 amayamba kumva bwino.
Chithandizo chachikulu cha odwala okalamba omwe ali ndi jakisoni wa insulin:
- Ngati wodwala akuwonjezeka shuga akamadzuka, ndiye kuti ayenera kuchita jakisoni mmodzi wa insulin yayitali tsiku lisanagone;
- Imathandizanso pochiza matenda amishuga a 2 okalamba omwe ali ndi insulini yofunikira kwambiri. Ayenera kuyilowetsedwa m'thupi kawiri patsiku m'mawa ndi madzulo;
- Kuti achepetse kuchuluka kwa shuga m'magazi mwachangu, insulini yapakatikati imatha kusakanikirana ndi insulin yochepa kapena yochepa-yochita pakanthawi 50:50 kapena 30:70. Jakisoni wotere amayenera kupatsidwanso kawiri pa tsiku.
- Malangizo a insulin omwe amagwiritsidwa ntchito polimbana ndi matenda amtundu wa 1 angagwiritsidwenso ntchito pochiza matenda a shuga a 2. Kuti muchite izi, ndikofunikira jekeseni wa insulin nthawi yayitali kamodzi patsiku, komanso kupereka jekeseni wa jekeseni wa insulin nthawi yayitali musanadye.
Mitundu ya mankhwalawa a shuga iphatikizidwa mu kanema munkhaniyi.
