Anthu ambiri amagwiritsa ntchito mapiritsi a hypoglycemic a matenda a shuga a 2, mndandanda wam'badwo watsopano umasinthidwa chaka chilichonse ndi zochitika zatsopano. Ngati poyamba zisonyezo za "matenda a shuga" ndi kuchuluka kwa glucose zimatha kuyendetsedwa ndi zakudya komanso zolimbitsa thupi, ndiye kuti kupatula nthawi zomwe zimasungidwa m'thupi zimatha, ndipo sizitha kuthana ndi vutoli payekha.
Tiyenera kudziwa kuti pali mitundu iwiri ya anthu odwala matenda ashuga - omwe amadalira insulin komanso osadalira insulini. Pachiwiri, ndikamadwala ambiri, odwala matenda ashuga amayamba kugwiritsa ntchito mankhwala omwe amachepetsa insulin.
Msika wama pharmacological umakhala ndi kuchuluka kwa mankhwala ochepetsa shuga, koma aliyense wa iwo ali ndi njira yapadera yochitira zinthu, zosemphana ndi zovuta zomwe zingachitike. Ganizirani mitundu yayikulu ya mankhwala a hypoglycemic.
Mitundu ikuluikulu ya mankhwala amtundu wa shuga
Kukula kwa matenda amtundu wa 1 kumayenderana ndi vuto la autoimmune. Pankhaniyi, ntchito ya kapamba imalephera, chifukwa cha zomwe ma cell a beta a isletappas amasiya kutulutsa timadzi timene amachepetsa shuga - insulin. Mosiyana ndi woyamba, yemwe ali ndi matenda a shuga a mtundu wachiwiri, kupanga mahomoni sikuma. Vutoli limakhudzana ndi kuzindikira kwa ma cell receptors omwe amazindikira insulin.
Mtundu wachiwiri wa matenda amakhudza 90% ya onse odwala matenda ashuga. Nthawi zambiri awa ndi anthu azaka zopitilira 40-45 omwe amakonda kunenepa kwambiri kapena ali ndi abale omwe ali ndi matenda ashuga (genetic factor).
Pofika chaka cha 2017, mankhwala ambiri omwe amachepetsa glucose adapangidwa ndikupangidwa bwino. Mpaka pano, mitundu yotsatirayi ya othandizira a hypoglycemic
Kupititsa patsogolo chidwi cha insulin:
- thiazolidinediones (Pioglar ndi Diglitazone);
- biguanides (metformin).
Mankhwala atsopano omwe adayamba kupangidwa mu 2000s:
- DPP-4 zoletsa (Onglisa ndi Yanuviya);
- alpha glucosidase inhibitors (Glucobai);
- GLP-1 receptor agonists (Viktoza ndi Baeta).
Mphamvu za mahormone:
- meglitinides (Starlix ndi Novonorm);
- zotumphukira za sulfonylurea (Maninyl, Glurenorm ndi Diabetes).
Mtundu wachitatu wa mankhwalawa umakhudza ntchito ya pancreatic ndikuyichotsa. Mukamamwa mankhwalawa, nthawi zambiri pamakhala mwayi wina woti matenda ashuga a 2 akhale oyamba.
Mankhwala omwe adatchulidwa kale pochizira matenda amtundu wa 2 amadziwika kuti ndi am'badwo watsopano wa mankhwala.
Maselo omwe amathandizira insulin chiwopsezo
Thiazolidinediones adayamba kugwiritsidwa ntchito ngati othandizira omwe amachepetsa hyperglycemia, posachedwa. Mankhwalawa a shuga samakhudza maselo a beta; m'malo mwake, amawongolera chidwi cha zotumphukira za insulin. Zotsatira zake, thiazolidinediones amachepetsa glucose komanso zimakhudza ndende ya lipid.
Mwambiri, mankhwala a gululi amatha kuchepetsa kuchuluka kwa shuga ndi 0.5-2%, chifukwa chake nthawi zambiri amatengedwa limodzi ndi metformin, jakisoni wa insulin kapena zotumphukira za sulfonylurea. Zitsanzo za mankhwala omwe amapezeka m'mapiritsi a gulu la thiazolidatediones ndi Pioglar, Actos ndi Diaglitazone. Mbali yabwino ya momwe amagwiritsidwira ntchito ndi kuchepa kwakukulu kwa kuchepa msanga kwa shuga. Mankhwala a shuga oterewa amawerengedwa kuti ndi abwino kwambiri pakuchotsa insulin.
Biguanides amaimiridwa ndi woimira yekha - metformin, yomwe ndi gawo la mankhwala a gululi. Kuchipatala adayamba kugwiritsa ntchito mankhwalawa itatha 1994. Pofika 2017, anali biguanides omwe adakhala odziwika kwambiri pachipatala cha matenda ashuga a mtundu 2. Metformin imalepheretsa kupanga kwa shuga ndi chiwindi ndi kulowa kwake m'magazi. Kuphatikiza apo, zimathandizira chidwi cha zotumphukira zimakhala ku insulin. Msika wogulitsa ku Russia umapereka mapiritsi ambiri amitundu yachiwiri ya shuga omwe ali ndi chophatikizira - metformin hydrochloride. Ma analogu otchuka ndi Metformin, Siofor, Glucofage ndi ena.
Tiyenera kudziwa kuti pakati pazinthu zabwino zomwe zimagwiritsidwa ntchito ndi mankhwalawa, pali chiopsezo chochepa cha boma la hypoglycemic, kupewa atherosulinosis, kuchepa thupi komanso kuthekera kotenga limodzi ndi insulin mankhwala ndi mankhwala ena ochepetsa shuga.
Pakati pazinthu zoyipa zogwiritsa ntchito metformin, zinthu zitatu zitha kusiyanitsidwa.
- Matumbo oyambitsa matenda kumayambiriro kwa chithandizo chamankhwala omwe amayamba chifukwa chodwala thupi. Zizindikiro zina ndizovuta zam'mimba komanso kusanza, kutsegula m'mimba, kusowa kwa chakudya, kugona tulo.
- The mwayi wa lactic acidosis.
- Kuchira kwakanthawi kwakanthawi kumachepetsa kuchuluka kwa vitamini B m'thupi.
Ndizosatheka kugwiritsa ntchito mapiritsi a metformin mu matenda a chiwindi, kupuma thirakiti, aimpso kapena mtima.
Mankhwala aposachedwa
Kuyambira mu 2006, mankhwala atsopano otchedwa "DPP-4 inhibitors" adayamba kugwiritsidwa ntchito pazachipatala. Zilibe kanthu pakupanga insulin ndi maselo a beta. Kuchita kwawo ndikufuna kuteteza polypeptide yonga ya mtundu woyamba (GLP-1), yopanga yomwe imachitika m'matumbo, kuchokera pakuwonongeka kwa enzyme DPP-4. Mayina a mankhwala omwe ali mgululi amachokera ku dzina la enzyme.
GLP-1 imakulitsa kapamba, chifukwa chake insulin imayamba kupangidwa mokulira. GLP-1 imathandizanso kukula kwa glucagon, komwe kumakhudza kwambiri hormone yotsitsa shuga.
Ubwino wogwiritsa ntchito ziletso za DPP-4 ndi:
- Kusatheka kwa hypoglycemia pomwe mankhwalawa amamaliza kuchitapo pambuyo pogwirizanitsa kuchuluka kwa shuga.
- Kuthekera kokuchulukitsa thupi chifukwa chakumwa mapiritsi sikumaphatikizidwa.
- Zitha kugwiritsidwa ntchito kuphatikiza pafupifupi mankhwala onse kuwonjezera jakisoni agonists a GLP-1 receptors ndi insulin.
Mwa zina zoyipa, mutha kuyang'ana pakukhumudwa, komwe nthawi zambiri kumawonetsedwa ndi kupweteka kwam'mimba ndi mseru. Mapiritsi a shuga ngati amenewo samalimbikitsidwa kuti mugwiritse ntchito kuphwanya chiwindi kapena impso. Gulu la mankhwalawa lagawidwa: saxagliptin (Onglisa), vildagliptin (Galvus), sitagliptin (Onglisa).
GPP-1 receptor agonists ndi mahomoni omwe amalimbikitsa kupanga kwa insulin komanso kukonza maselo owonongeka. Kuphatikiza apo, mtundu uwu wa mankhwalawa umachepetsa kunenepa kwambiri kwa odwala onenepa kwambiri. Mankhwalawa sanapangidwe mwanjira ya mapiritsi, amatha kugulidwa kokha mwa ma ampoules a jakisoni. Woimira gululi ndi mankhwala atsopano a Viktoza, komanso Baeta.
Ma alpha glucosidase inhibitors amalepheretsa kusintha kwa glucose ku chakudya. Mankhwala osokoneza bongo a gululi amagwiritsidwa ntchito pamene wodwala akuchulukitsa kuchuluka kwa glucose atatha kudya. Ndalamazi zimatha kuphatikizidwa ndi mankhwala aliwonse omwe amachepetsa shuga. Minus yokhayo ya alpha-glucosidase inhibitors ndikuti kugwiritsa ntchito koletsedwa.
Zotsatira zoyipa zomwe zimachitika mutatha kumwa mankhwalawa ndizovuta za kugaya - kuchuluka kwa mapangidwe a mpweya m'matumbo ndi m'mimba. Ndi metformin, mankhwalawa ndibwinobwino kuti asagwiritse ntchito, chifukwa amakhudzanso dongosolo la chimbudzi cha anthu. Oimira gulu lino ndi Diastabol ndi Glucobay.
Mphamvu za mahormone
Anthu adziwa za zotumphukira za sulfonylurea kwa nthawi yayitali, koma adazigwiritsa ntchito pokhapokha ngati pali matenda opatsirana. Zotsatira zawo za hypoglycemic zinadziwika mosazindikira pa nkhondo yachiwiri yapadziko lonse.
Chithandizo chotere cha matenda ashuga chimakhudza ntchito ya ma cell a beta omwe amapezeka mu kapamba, omwe amapanga mahomoni. Zotumphukira za Sulfonylurea zimayambiranso kupanga insulini ndikupangitsa kuti maselo azilandira insulin.
Komabe, ndalamazi zimayambitsa mavuto osafunikira monga:
- hypoglycemia boma;
- kutsika kwa maselo a beta;
- kunenepa.
Kupitilira muyeso kwa kapamba kumabweretsa kuti mtundu wachiwiri wa matenda umadutsa woyamba. Izi zikutanthauza kuti pofuna kusungitsa kuchuluka kwa shuga mkati mwa malire, wodwala amayenera kubayidwa mahomoni pafupipafupi. Zothandiza kuchokera ku sulfonylureas zimagawidwa m'magulu angapo:
- Glyclazide - Diabeteson MV ndi Glidiab MV.
- Glimepiride - Glemaz ndi Amaril.
- Glycvidone - Glurenorm.
- Glibenclamide (Maninyl).
Mankhwala a gulu la meglitinide amathandizanso kupanga mahomoni ochepetsa shuga. Amalimbikitsidwa kwa omwe amadwala matenda ashuga omwe magazi awo amawonjezera kuchuluka kwawo atatha kudya. Gululi limaphatikizapo magulu awiri a mankhwala - nateglinide (Starlix) ndi repaglinide (Novonorm).
Ubwino wogwiritsa ntchito mankhwalawa ungathe kuonedwa kuti sukusokoneza kulemera kwa thupi la wodwala ndipo sikuti kumabweretsa mkhalidwe wa hypoglycemia.
Komabe, mankhwala omwe ali mgululi amadzetsa zovuta zina zomwe zimakhudzana ndi m'mimba ndi mitsempha yamatumbo, kutupa kwa thirakiti la kupuma kwapamwamba.
Kuipa kwa mankhwalawa ndi mtengo wokwera kwambiri, wosagwiritsa ntchito kwambiri hypoglycemic komanso kugwiritsidwa ntchito mobwerezabwereza masana.
Chithandizo ndi zotsatira za kukana kwake
Zizindikiro zikuluzikulu za matenda ashuga ndimakonda kupita ku chimbudzi ndi ludzu losatha. Zizindikiro zazikulu ziwiri izi zitha kuwonetsa kuphwanya mulingo wa glycemia. Ngati munthu adziwona yekha mwa iye yekha, ayenera kuwona othandizira posachedwa.
Zomwe zimapangitsa kuti odwala azidwala matenda a shuga azidwala kwambiri zimagwirizanitsidwa ndendende ndi chithandizo chomwe sichimachitika komanso chothandiza. Pokumana ndi katswiri yemwe amapezeka, wodwalayo afotokozere mwatsatanetsatane za zonse zomwe zimamudetsa nkhawa. Pambuyo pa zokambiranazo, adotolo amafufuza kuti adziwe matenda a shuga.
Pali mayeso angapo omwe mungadziwe kuchuluka kwa shuga, koma chosavuta komanso chothamanga kwambiri ndikuphunzira magazi kuchokera chala kapena kuchokera mu mtsempha. Ngati zotsatira zake ndizapamwamba kuposa 5.5 mmol / L (magazi a capillary) ndi 6.1 mmol / L (magazi a venous), izi zitha kuonetsa prediabetes kapena matenda ashuga. Kuti mudziwe mtundu wamatendawa, kuwunika kumachitika chifukwa cha C-peptides komanso zomwe zili mthupi la antibodies a GAD.
Ngati dokotala wapeza mtundu wachiwiri wa matenda ashuga, akupanga njira yapadera yochiritsira yomwe ili ndi zigawo zinayi zikuluzikulu:
- okhazikika glycemic;
- zakudya zapadera;
- moyo wosuntha;
- kumwa mankhwala.
Kungosunga malamulo onsewa ndi pomwe mungathe kuwongolera kuchuluka kwa shuga m'magazi ndikuletsa kupewetsa zotsatira zoyipa za matenda ashuga. Kusasamala thanzi lanu kungapangitse kuti:
- Kulephera kwakukulu kwaimpso.
- Matenda a shuga a retinopathy - kuwonongeka kowonekera chifukwa cha kutupa.
- Matenda a diabetes a neuropathy ndi vuto lamanjenje.
- Gangrene wa m'munsi. Pankhaniyi, kudula mwendo kungakhale kofunikira kwa odwala matenda ashuga.
- Glycemic chikomokere.
- Myocardial infarction kapena stroke.
Muyenera kuchiza matenda ashuga panthawi. Matendawa si sentensi, zaka zapitazi, chifukwa chaukadaulo waposachedwa, anthu amakhala nawo mokwanira.
Chachikulu ndichakuti musataye mtima. Mankhwala amakono samayima: tsiku lililonse, asayansi amatenga mankhwala atsopano omwe amakhala ndi zotsutsana zochepa ndipo amatha kuchita bwino kwambiri.
Tiyenera kukumbukira kuti mukamagwiritsa ntchito mankhwalawa, muyenera kutsatira malangizo olondola a dokotala. Mwanjira imeneyi, milingo ya glucose imatha kusungidwa bwino. Kanemayo munkhaniyi akufotokoza za matenda a matenda a shuga a mtundu wachiwiri.
