Kuti muchotse matenda ashuga ndi zizindikiro zake, mankhwala apadera amagwiritsidwa ntchito omwe cholinga chake ndi kuchepetsa shuga mumagazi a wodwala. Othandizira antidiabetesic (hypoglycemic) amatha kugwiritsa ntchito kwa makolo, komanso pakamwa.
Mankhwala a Orog hypoglycemic hypoglycemic nthawi zambiri amadziwika motere:
- zotumphukira za sulfonylurea (awa ndi Glibenclamide, Glikvidon, Gliklazid, Glimepirid, Glipizid, Chlorpropamide);
- alpha glucosidase inhibitors ("Acarbose", "Miglitol");
- meglitinides ("Nateglinide", "Repaglinide");
- biguanides ("Metformin", "Buformin", "Fenformin");
- thiazolidinediones (Pioglitazone, Rosiglitazon, Tsiglitazon, Englitazon, Troglitazon);
- incretinomimetics.
Katundu ndi zochita za sulfonylurea zotumphukira
Makina a sulfonylureas adapezeka mwangozi mkati mwa zaka zana zapitazi. Kugwiritsa ntchito kwazophatikizira zotere kunakhazikitsidwa panthawi yomwe zidadziwika kuti odwala omwe amamwa mankhwala a sulfa kuti athetse matenda opatsirana nawonso amachepa m'magazi awo. Chifukwa chake zinthu izi zimatanthauzanso odwala.
Pachifukwachi, nthawi yomweyo anayamba kufunafuna mankhwala ena a sulfonamides okhala ndi mphamvu yotsika shuga m'thupi. Ntchitoyi idathandizira kuphatikizika kwa mitundu yoyamba ya sulfonylurea, yomwe idatha kuthetsa mavuto a matenda ashuga.
Kuwonetsedwa kwa zotumphukira za sulfonylurea kumalumikizidwa ndi kutsegulira kwa ma cell a pancreatic beta enieni, omwe amalumikizidwa ndi kukondoweza komanso kuchuluka kwa insulin. Chofunikira chofunikira kuti mukhale ndi zotsatira zabwino ndicho kukhalapo kwa kapamba amoyo komanso maselo athunthu a beta.
Ndizofunikira kudziwa kuti ngati atagwiritsa ntchito nthawi yayitali kuchokera kuzomwe amapeza, mphamvu zawo zoyambirira zimatha. Mankhwalawa amasiya kukhudza chinsinsi cha insulin. Asayansi akukhulupirira kuti izi zimatheka chifukwa cha kuchepa kwa chiwerengero cha ma cell a beta. Zinawululidwanso kuti pakatha nthawi yopuma mu chithandizo chotere, momwe maselo agwiritsidwira ntchito mankhwalawa amatha kubwezeretsedwanso.
Ma sulfonylureas ena amatha kupatsanso mphamvu yowonjezera. Kuchita koteroko kulibe phindu lachipatala. Zotsatira zowonjezera-pancreatic zimaphatikizapo:
- kuchuluka kwa insulin-kudalira zimakhala kuti insulin ya amkati chikhalidwe;
- kuchepa kwa shuga m'magazi.
Makina onse a chitukuko cha izi pa thupi ndi chifukwa chakuti zinthu ("Glimepiride" makamaka):
- onjezani kuchuluka kwa zolandilira zomwe zimakhudzidwa ndi insulin pa foni ya chandamale;
- moyenera kukonza insulin-receptor mogwirizana;
- sinthani kusintha kwa chizindikiro cha postreceptor.
Kuphatikiza apo, pali umboni kuti zotumphukira za sulfonylurea zimatha kukhala chothandizira kutulutsidwa kwa somatostatin, zomwe zingapangitse kuponderezedwa kwa glucagon.
Sulfonylureas
Pali mibadwo ingapo ya chinthu ichi:
- Mbadwo woyamba: "Tolazamide", "Tolbutamide", "Carbutamide", "Acetohexamide", "Chlorpropamide";
- Mbadwo wachiwiri: Glibenclamide, Glikvidon, Gliksoksid, Glibornuril, Gliklazid, Glipizid;
- M'badwo wachitatu: Glimepiride.
Mpaka pano, m'dziko lathu, mankhwala osokoneza bongo a m'badwo woyamba sakonda kugwiritsidwa ntchito.
Kusiyana kwakukulu pakati pa mankhwala a 1st ndi 2nd m'badwo wosiyanasiyana wa zochita zawo. 2nd sulfonylurea ya mbadwo ungagwiritsidwe ntchito mosiyanasiyana, zomwe zimathandiza kuchepetsa moyenera zovuta zingapo zoyipa.
Kuyankhula manambala, ntchito zawo zidzakhala 50 kapenanso 100 kapamwamba. Chifukwa chake, ngati pakati pa mankhwala a m'badwo wa 1p omwe mankhwalawa amafunika kukhala 0,75 mpaka 2 g, ndiye kuti mankhwala a 2nd amapereka kale mlingo wa 0,02-0.012 g.
Mitundu ina ya hypoglycemic ingathenso kukhala yosiyana pakulolera.
Mankhwala otchuka kwambiri
Gliclazide - Ichi ndi chimodzi mwazamankhwala zomwe zimakhazikitsidwa nthawi zambiri. Mankhwalawa samangokhala ndi zotsatira zapadera za hypoglycemic, komanso amathandizira kusintha:
- Zizindikiro za hematological;
- rheological katundu wamagazi;
- machitidwe a heestatic, kukoka kwa magazi m'magazi;
- heparin ndi fibrinolytic ntchito;
- kulolerana kwa heparin.
Kuphatikiza apo, Glyclazide imatha kuletsa kukula kwa microvasculitis (kuwonongeka kwa retina), kupondera kuwonetsedwa kulikonse kwamapulogalamu, kumakulitsa kwambiri index index yosagwirizana ndikuwonetsa zofunikira za antioxidant zabwino.
Glycvidon - mankhwala omwe angagwiritsidwe ntchito m'magulu a odwala omwe ali ndi vuto laimpso pang'ono. Mwanjira ina, malinga ngati impso zimapatsa 5 peresenti ya metabolites, ndi 95 - matumbo otsala
Glipizide Ili ndi tanthauzo lotsogola ndipo imatha kuyimira chiwopsezo chochepa kwambiri pakuchitika kwa hypoglycemic. Izi zimapangitsa kuti zisamangokhala komanso kuti musakhale ndi metabolites yogwira.
Zomwe zimagwiritsidwa ntchito pakamwa pakamwa
Mapiritsi aantidiabetic akhoza kukhala chithandizo chachikulu cha matenda ashuga amtundu wa 2, omwe samayimira pakumwa insulin. Mankhwalawa amalimbikitsidwa kwa odwala azaka zopitilira 35 ndipo popanda zovuta zake:
- ketoacidosis;
- zoperewera pazakudya;
- matenda omwe amafunikira insulin.
Kukonzekera kwa Sulfonylurea sikumawonetsedwa kwa odwala omwe, ngakhale atakhala ndi chakudya chokwanira, chofunikira cha tsiku ndi tsiku cha insulin chimaposa chizindikiro cha 40 magawo (UNITS). Kuphatikiza apo, adotolo sangawalembere ngati pali mtundu wina wa matenda oopsa a shuga, mbiri yodwala matenda ashuga komanso glucosuria wotsutsana ndi maziko a zakudya zoyenera.
Kusamutsa mankhwalawa sulfonylurea n`zotheka pansi pa vuto la kufooka kagayidwe, kulipidwa ndi jakisoni owonjezera a insulin mu Mlingo wa osachepera 40 mayunitsi. Ngati ndi kotheka, mpaka ma PIECES 10, kusinthaku kudzapangidwa kuchokera ku izi.
Kugwiritsidwa ntchito kwa nthawi yayitali pogwiritsa ntchito mankhwala a sulfonylurea kungayambitse kukana, komwe kumatha kugonjetsedwa ndi mankhwala osakanikirana ndi kukonzekera kwa insulin. Mtundu woyamba wa matenda ashuga, njira imeneyi imapereka zotsatira zabwino mwachangu komanso zithandiza kuchepetsa kufunikira kwa insulin, komanso kukonza njira ya matendawa.
Kuchepa kwapang'onopang'ono kwa retinopathy chifukwa cha sulfonylurea kunadziwika, ndipo matenda a shuga a retinopathy ndiwovuta kwambiri. Izi zitha kukhala chifukwa cha angioprotective zochita zake, makamaka zam'badwo wachiwiri. Komabe, pali kuthekera kwina kwa ma atherogenic.
Tiyenera kudziwa kuti zochokera ku mankhwalawa zitha kuphatikizidwa ndi insulin, komanso ma biguanides ndi "Acarbose". Izi ndizotheka ngati thanzi la wodwalayo silikuyenda bwino ngakhale ndi insulin yokwanira zana limodzi patsiku.
Kugwiritsa ntchito mankhwala ochepetsa shuga a sulfonamide, ziyenera kukumbukiridwa kuti ntchito zawo zitha kuchepetsedwa:
- anticoagulants osadziwika;
- salicylates;
- "Butadion";
- Ethionamide;
- Cyclophosphamide;
- tetracyclines;
- Chloramphenicol.
Mukamagwiritsa ntchito ndalamazi kuwonjezera pa mankhwala a sulfa, metabolism imatha kulemala, zomwe zingayambitse kukula kwa hyperglycemia.
Ngati muphatikiza zotumphukira za sulfonylurea ndi thiazide diuretics (mwachitsanzo, "Hydrochlorothiazod") ndi BKK ("Nifedipine", "Diltiazem") mu milingo yayikulu, ndiye kuti zotsutsana zimatha kuyamba. Thiazides amatseka mphamvu ya zotumphukira za sulfonylurea potsegula njira zam potaziyamu. Ma LBCs amabweretsa kusokonezedwa pakupezeka kwa calcium ion ku ma cell a beta a kapamba.
Zomwe zimachokera ku sulfonylureas zimathandizira kwambiri zotsatira ndi kulolera zakumwa zoledzeretsa. Izi ndichifukwa chakuchedwa mu makulidwe a oxidation a acetaldehyde. Kuwonetsedwa kwa zochita zonga za antabuse ndizothekanso.
Kuphatikiza pa hypoglycemia, zotsatira zosayenerera zingakhale:
- mavuto a dyspeptic;
- cholestatic jaundice;
- kulemera;
- aplastic kapena hemolytic anemia;
- kukula kwa thupi lawo siligwirizana;
- leukopenia wokhazikika;
- thrombocytopenia;
- agranulocytosis.
Meglitinides
Pansi pa meglitinides iyenera kumvetsedwa oyang'anira.
"Repaglinide" ndi yochokera ku benzoic acid. Mankhwala ndi osiyana mu kapangidwe ka mankhwala kuchokera ku sulfonylurea zotumphukira, koma zimakhudzanso thupi. Repaglinide imalepheretsa njira zotsalira za potaziyamu ya ATP m'maselo a beta ndipo imalimbikitsa kupanga insulin.
Kuyankha kwa thupi kumabwera theka la ola mutatha kudya ndikuwonetsedwa ndi kuchepa kwa shuga m'magazi. Pakati pa chakudya, kuchuluka kwa insulin sikusintha.
Monga mankhwala omwe amachokera ku sulfonylurea zotumphukira, vuto lalikulu ndi hypoglycemia. Mosamala kwambiri, mankhwalawa amatha kuvomerezedwa kwa odwala omwe ali ndi vuto laimpso kapena chiwindi.
Nateglinide ndi yotengera D-phenylalanine. Mankhwalawa amasiyana ndi ena omwe amafanana mwachangu, koma osakhazikika. M'pofunika kugwiritsa ntchito mankhwalawa mtundu wachiwiri wa matenda ashuga a 2 kuti muchepetse kusintha kwa postprandial hyperglycemia.
Biguanides akhala akudziwika kuyambira 70s ya zaka zapitazi ndipo adalembedwa kuti amasungidwe a insulin ndi maselo a beta a kapamba. Kukopa kwawo kumatsimikiziridwa ndi kulepheretsa kwa gluconeogeneis mu chiwindi ndi kuwonjezeka kwa kuthekera kwa shuga. Kuphatikiza apo, chidachi chingachedwetse kuchepa kwa insulin ndikukulitsa kumangiriza kwake kwa insulin receptors. Mwanjira iyi, kagayidwe kake ndi mayamwidwe a glucose kumachuluka.
Biguanides samachepetsa shuga la magazi a munthu wathanzi komanso iwo omwe ali ndi vuto lachiwiri la matenda ashuga (kuperekedwa kosala usiku).
Hypoglycemic biguanides angagwiritsidwe ntchito popanga matenda a shuga a 2. Kuphatikiza pa kuchepetsa shuga, gulu ili la mankhwala omwe amagwiritsidwa ntchito kwa nthawi yayitali limakhudza metabolism yamafuta.
Chifukwa cha kugwiritsa ntchito mankhwala a gululi:
- lipolysis imayendetsedwa (njira yogawa mafuta);
- kuchepa kwa chakudya;
- Kuchepetsa thupi pang'onopang'ono kumakhala kwazonse.
Nthawi zina, kugwiritsidwa ntchito kwawo kumayendetsedwa ndi kuchepa kwa zomwe zili triglycerides ndi cholesterol m'mwazi, titha kunena kuti biguanides ndi mapiritsi ochepetsa shuga m'magazi.
Mtundu wachiwiri wa matenda ashuga, kusokonekera kwa kagayidwe kazakudya kangathe kuphatikizidwa ndi mavuto mu metabolism yamafuta. Pafupifupi 90 peresenti, odwala ndi onenepa kwambiri. Pachifukwa ichi, ndikukula kwa matenda a shuga, komanso kunenepa kwambiri, ndikofunikira kugwiritsa ntchito mankhwala omwe amapangitsa kuti matenda a lipid metabolism azitha.
Chizindikiro chachikulu cha kugwiritsidwa ntchito kwa Biguanides ndi mtundu wa 2 shuga. Mankhwala ndi ofunika kwambiri motsutsana ndi maziko a kunenepa kwambiri komanso osagwiritsa ntchito mankhwalawa kapena osakwanira pakukonzekera kwa sulfonylurea. Zochita za Biguanides sizikuwoneka popanda insulin m'magazi.
Alfa glucose inhibitors amalepheretsa kuwonongeka kwa polysaccharides ndi oligosaccharides. Kuyamwa ndi kupanga shuga kumatsitsidwa ndipo pamakhala chenjezo lokhudza chitukuko cha postprandial hyperglycemia. Zakudya zamafuta onse omwe adatengedwa ndi chakudya, m'malo awo osasinthika, amalowa m'magawo a matumbo ang'ono ndi akulu. The mayamwidwe monosaccharides kumatenga mpaka 4 maola.
Mosiyana ndi mankhwala a sulfa, ma alpha glucose inhibitors samachulukitsa kutulutsidwa kwa insulin ndipo sangayambitse hypoglycemia.
Zotsatira zamaphunziro, zinatsimikiziridwa kuti chithandizo chamankhwala mothandizidwa ndi "Acarbose" chikhoza kutsagana ndi kuchepa kwamtundu wa mwayi wokhala ndi mavuto akulu a atherosulinosis.
Kugwiritsa ntchito zoletsa zotere kumatha kukhala ngati monotherapy, ndikuwaphatikiza ndi mankhwala ena amkamwa omwe amachepetsa shuga la magazi. Mlingo woyambayo nthawi zambiri umakhala 25 mpaka 50 mg musanadye kapena pakudya. Ndi chithandizo chotsatira, mlingo ungathe kuwonjezeka mpaka kufika pazowonjezera (koma osapitirira 600 mg).
Zizindikiro zazikulu za alpha-glucosidase zoletsa ndi: mtundu wachiwiri wa matenda osokoneza bongo omwe amakhala ndi vuto lodana ndi zakudya, mtundu wa 1 shuga mellitus, koma malinga ndi kuphatikiza mankhwala.
