Popeza matendawa amatenga nthawi yayitali, odwala ayenera kumwa mankhwala a 2 a shuga am'badwo watsopano. Poyamba, "matenda otsekemera" amatha kuthandizidwa ndikudya moyenera komanso kuchita masewera olimbitsa thupi, koma popita nthawi, mankhwalawa amayamba kugwiritsidwa ntchito pancreas.
Pali ambiri aiwo pamsika wamankhwala, koma ndi ati omwe ali ndi chithandizo chachikulu kwambiri?
Ndikosavuta kuyankha funsoli, chifukwa atha kukhala oyenera kwa wodwala m'modzi, koma osayenera kwa wina. Chifukwa chake, m'nkhaniyi, zotsatira za mitundu yayikulu ya mankhwala zidzaululidwa.
Mitundu ya Mankhwala Olimbana ndi Matenda A shuga
Matenda a shuga a Mtundu Wachiwiri amatchedwa insulin-Independent, chifukwa ndi chitukuko cha matendawa, timadzi timene timatsika timene timapanga shuga timapangidwa ndi kapamba. Vuto lonse limakhala pakuzindikiridwa kwa insulin ndi maselo otumphukira omwe ma receptor ntchito amawonongeka. Kwenikweni, matenda oterewa amakula m'badwo wakale kuyambira wazaka 40, makamaka kwa anthu onenepa kwambiri komanso cholowa.
Masiku ano, mankhwala atsopano akupangidwa mdziko lapansi omwe amathandizira kuchepetsa kukhudzika kwa glucose ndikuthandizira wodwala wokhala ndi matenda a shuga. Pansipa pali mndandanda wamitundu yayikulu yamankhwala:
- Kuchulukitsa chiwopsezo cha maselo ku mahomoni: thiazolidatediones (Diaglitazone, Pioglar), biguanides (Metformin, Glucofage).
- Mankhwala atsopano omwe adayamba kupangidwa mu 2000s: DPP-4 inhibitors (Januvia, Onglisa), GLP-1 receptor agonists (Baeta, Victoza), alpha-glucosidase inhibitors (Glucobai).
- Kupanga kwa insulini: zotumphukira za sulfonylurea (Maninil, Glyurenorm, Diabeteson), meglitinides (Starlix, Novonorm).
Tisaiwale kuti sulfonylurea zotumphukira ndi meglitinides zimawononga kapamba, kutulutsa. Odwala omwe amamwa mankhwalawa, pamakhala chiopsezo cha kusintha kwachiwiri kwa matenda.
Mankhwala onse omwe ali pamwambawa ndi okhudzana ndi mbadwo watsopano wa mankhwalawa ndipo amagwiritsidwa ntchito pochiza matenda amtundu wa 2 shuga.
Iliyonse mwazomwe zili ndi mawonekedwe ake, zabwino zake ndi zoyipa zake, zomwe zidzaululidwa pang'ono pambuyo pake.
Zokhudza chithandizo cha matenda ashuga
Munthu akazindikira yekha ziwiri zazikulu za matendawa - ludzu losasangalatsa komanso kukoka pafupipafupi, ayenera kufunsa dokotala yemwe angamuthandize kuti adziwe zoyenera kudziwa.
Mukadutsa mayeso, magazi a capillary kapena venous amatengedwa ndipo, atapeza zotsatira zopitilira malire a 5.5 ndi 6.1 mmol / L, motero, titha kufotokoza za chitukuko cha prediabetes kapena matenda ashuga.
Kenako, kuti mupeze mtundu wa matenda, kusanthula kumachitika pamlingo wa C-peptide ndi ma GAD antibodies. Ngati wodwala ali ndi mtundu wina wa matenda ashuga, dokotala wopezekapo amakhala ndi njira yothandizira:
- zakudya zapadera;
- zolimbitsa thupi;
- kuyang'anira pafupipafupi kuchuluka kwa shuga;
- kumwa mankhwala ochepetsa shuga.
Nthawi yomweyo, pakuyambira kwa matendawo, wodwalayo amatha kuchita ndi zakudya zoyenera, kupumula kwachangu komanso kuwongolera shuga. Pakatha miyezi iwiri iliyonse amakakamizidwa kukayezetsa kuchipatala, chifukwa chake dokotala amatha kudziwa momwe mankhwalawa alili othandiza. Ngati vuto la wodwalayo likuipiraipira, dokotala amayenera kukupatsani mankhwala okhala ndi matenda a shuga.
Ngati wodwalayo ali wonenepa kwambiri, ndiye kuti dokotalayo amatha kupereka mankhwala omwe ali ndi mankhwala - metformin. Kugwiritsa ntchito chida ichi kukuthandizira kuchepetsa kulemera kwa thupi ndi shuga. Ngati wodwalayo alibe vuto lotere, ndiye kuti dokotala amakupatsani mankhwala omwe amalimbikitsa chidwi ndi kupanga kwa insulin ndi kapamba. Ma pathologies omwe amagwirizana ndi matenda a shuga ayeneranso kuganiziridwa. Mwachitsanzo, ngati wodwala ali ndi vuto la impso, ndiye kuti dokotalayo ayenera kusankha mankhwalawa omwe atulutsidwe ziwalo zina.
Monga mukuwonera, aliyense wodwala matenda ashuga amafuna njira yapadera pochizira matendawa. Chifukwa chake, ndi dokotala wokhazikika amene angakupatseni mankhwala oyenera kwambiri ndikuwerengera kuchuluka kwake. Kudzichitira nokha mankhwala sikuli koyenera, mankhwala aliwonse amakhala ndi zotsutsana komanso zoyipa zomwe zingayambitse zovuta zina.
Mankhwala osokoneza bongo kuti mukulitse chidwi cha maselo
Thiazolidinediones adapezeka posachedwapa ndipo ndizaka zaposachedwa pomwe zomwe adayamba kugwiritsidwa ntchito ngati mankhwala a hypoglycemic. Mankhwala amtunduwu samakhudzana ndi kapamba kuti apange insulin, imakhudza chiwopsezo cha maselo ndi minyewa kupita ku timadzi timene timatsitsa.
Kuphatikiza pa kuchepetsa glycemia, kukulitsa chidwi cha ma receptors, thiazolidinediones zimakhudza mbiri ya lipid. Hypoglycemic zotsatira za mankhwalawa ndi 0.5-2%. Chifukwa chake, zimatha kugwiritsidwa ntchito limodzi ndi monotherapy komanso kuphatikiza ndi insulin, metformin ndi sulfonylureas.
Thiazolidinediones amaphatikiza mankhwala monga Pioglar, Actos, Diglitazone. Ubwino wawo ndikuti iwo samayambitsa hypoglycemia. Gulu la mankhwalawa limawerengedwa kuti ndilo labwino kwambiri polimbana ndi insulin.
Woimira biguanides ndi chinthu metformin. Kuti ndi gawo limodzi la mankhwala a gululi. Zinayamba kugwiritsidwa ntchito pazachipatala kuyambira 1994. Mpaka pano, mankhwalawa ndi otchuka kwambiri akaperekedwa kwa odwala matenda a shuga. Metformin imachepetsa shuga kuchokera ku chiwindi kupita m'magazi ndipo imakulitsa chidwi cha zotumphukira kwa insulin. Mu pharmacy, pharmacist amatha kupereka kuchuluka kwa mankhwala a analog, popeza onse ali ndi chigawo chachikulu - metformin, kusiyana kokha ndi omwe amapezeka. Izi zikuphatikizapo Bagomet, Glformin, Glyukofazh, Formmetin, Siofor, Metformin 850 ndi ena.
Mwa zina zabwino za machitidwe a metformin, pali kuchepa kwakukulu kwa hypoglycemia, kupewa atherosulinosis, kuchepa thupi ndi mwayi wophatikizidwa ndi insulin ndi mankhwala ena ochepetsa shuga. Nthawi zina, zotsatira zosavomerezeka ndi zovuta za metformin ndizotheka, mwachitsanzo:
- Matenda am`mimba thirakiti kumayambiriro kwa mankhwala (nseru, kusanza, kutulutsa, kutsegula m'mimba, kusowa kwa chakudya).
- Kulephera kugwiritsa ntchito mankhwalawa matenda a chiwindi, kupuma thirakiti, mtima ndi impso.
- Chiwopsezo chochepa chotenga mkaka wowawasa.
Kuphatikiza apo, munthawi yayitali chithandizo, mavuto omwe ali ndi vuto la vitamini B12 angachitike.
Mankhwala atsopano
DPP-4 inhibitors ndi m'badwo watsopano wa mankhwala; agwiritsidwa ntchito kuyambira 2006. Mankhwalawa okha sangakhudze mapangidwe a insulin. Amatha kuteteza glucagon-ngati polypeptide 1 (GLP-1) yopangidwa ndi matumbo kuti asawonongedwe ndi enzyme DPP-4.
Apa ndipomwe dzina la mankhwalawa limachokera. GLP-1 imayambitsa kupanga insulin, yomwe imachepetsa kuchuluka kwa shuga mthupi la munthu. Kuphatikiza apo, GLP-1 simalola kukula kwa glucagon, komwe, kumapangitsa kuti insulini ipereke mphamvu zake.
Chosangalatsa ndichakuti mankhwalawa samayambitsa hypoglycemia, popeza amasiya kuchita pambuyo pakukhazikika kwa shuga. Samachulukitsa thupi ndipo amagwiritsidwa ntchito ndi mankhwala pafupifupi onse. Chosiyana ndi ma injon agonists a GLP-1 receptors, insulin (ndi Galvus yekhayo angayikidwe). Mankhwala amatha kuyambitsa zovuta zomwe zimakhudzana ndi ululu wam'mimba, sikofunikira kuti muzigwiritsa ntchito kwa matenda a chiwindi kapena impso. Masiku ano, mankhwala monga saxagliptin (Onglisa), sitagliptin (Januvia) ndi vildagliptin (Galvus) ndiofala.
IGP-1 receptor agonist ndi mahomoni omwe samangopereka zikondwerero za kapamba za kupanga insulin, komanso amachepetsa chilakolako chofuna kukonza ndikusintha ma cell a beta. Popeza GLP-1 mutatha kudya iwonongedwa mkati mwa mphindi ziwiri, siyingachititse kuti insulin ipange. Chifukwa chake, pali ma fanizo a Viktoz ndi Bayet, omwe amatulutsidwa mwanjira zovomerezeka. Tiyenera kudziwa kuti mankhwala omaliza amakhala maola ochepa, ndipo Victoza - tsiku lonse.
Ma alpha glucosidase zoletsa amachepetsa kutembenuka kwa chakudya kukhala glucose. Mankhwalawa ndi othandiza kwambiri pamene wodwala matenda ashuga amawonjezera kuchuluka kwa glucose atatha kudya. Mankhwala a shuga amatha kugwiritsidwa ntchito limodzi ndi mankhwala aliwonse a hypoglycemic. Zotsatira zoyipa zoyipa mukamamwa ma alpha-glucosidase zoletsa ndizovuta zam'mimba - flatulence, kutsekula m'mimba. Chifukwa chake, sizingagwiritsidwe ntchito matenda a m'matumbo. Kugwiritsa ntchito zovuta ndi metformin kumakhalanso kosafunikira, chifukwa kumatha kuyambitsa kuwonjezeka kwa matenda am'mimba.
Omwe akuimira kwambiri mankhwalawa ndi Glucobai ndi Diastabol.
Zothandizira insulin
Mphamvu ya hypoglycemic ya zotumphukira za sulfonylurea idapezeka mwangozi pa Nkhondo Yachiwiri Yapadziko Lonse, pomwe amagwiritsidwa ntchito kulimbana ndi matenda. Mankhwalawa amagwira ntchito pama cell a beta omwe amapezeka mu inshuwaransi. Mankhwala a shuga oterowo amayambiranso kupanga mahomoni, komanso kusintha kwamphamvu kwa maselo ndi minofu yake.
Nthawi yomweyo, mankhwala ali ndi zovuta zina: kulemera, hypoglycemia (kuchepa msanga kwamisempha yotsika kwambiri), kuchuluka kwambiri kwa maselo a beta. Zotsatira zake, odwala matenda ashuga ena amayamba kudwala matenda oyamba 1, amafunikira insulin. Pamankhwala mutha kugula chilichonse mwa magulu anayi a zotumphukira za sulfonylurea, mwachitsanzo:
- glibenclamide (Maninyl);
- gliclazide (Diabeteson MV, Glidiab MV);
- glycidone (glurenorm);
- glimepiride (Amaril, Glemaz).
Meglitinides imalimbikitsa kupanga kapamba wa pancreatic. Madokotala ambiri amalimbikitsa kugwiritsidwa ntchito kwawo ndi odwala omwe ali ndi shuga m'magazi atadya. Mankhwalawa amayenera kudyedwa katatu patsiku chakudya chachikulu. Kugwiritsa ntchito kwawo pamodzi ndi zotumphukira za sulfonylurea sikungakhale kopanda tanthauzo, chifukwa ali ndi zotsatira zomwezo. Kuchipatala mungagule ndalama zochizira matenda amtundu wa 2 shuga, omwe agawidwa m'magulu awiri: repaglinide (Novonorm) and nateglinide (Starlix).
Ndemanga za odwala ambiri zikuwonetsa kuti Novonorm samangochepetsa shuga pambuyo chakudya, komanso amachepetsa pamimba yopanda kanthu. Nthawi yomweyo, mphamvu ya hypoglycemic ya mankhwalawa imasiyana kuchokera ku 0.7 mpaka 1.5%. Pankhani imeneyi, nthawi zambiri amagwiritsidwa ntchito ndi mankhwala osokoneza bongo kuposa sulfonylurea.
Mwa zabwino za meglitinides titha kudziwika kuti sizichulukitsa thupi ndipo pazocheperako zimayambitsa kugunda kwa hypoglycemia. Zotsatira zosafunikira mukamagwiritsa ntchito mankhwala zimatha kukhala zovuta m'mimba, sinusitis, mutu, matenda opatsirana am'mimba thirakiti. Mwa zoperewera, munthu amatha kuchotsera mtengo kukonzekera, kubwereza kasamalidwe masana, ndikuchepetsa kwambiri shuga.
Monga mukuwonera, pali mankhwala ambiri omwe amachepetsa shuga. Koma chilichonse chaiwo chimakhudzanso thupi la wodwalayo. Chifukwa chake, mankhwalawa matenda a shuga a 2, ndikofunikira kukaonana ndi dokotala. Ndiye amene atha kusankha mankhwala omwe ali ndi zotsatira zabwino komanso kuvulaza thupi la odwala matenda ashuga. Vidiyo yomwe yatchulidwa munkhaniyi iyankha mafunso okhudza matenda amisempha.
