Mellitus wosadalira insulin ndi amodzi mwa mitundu ya matendawa, omwe amadziwika ndi kuchepa kwa chidwi cha maselo ndi minyewa yamthupi pakuchitika kwa insulin ya mahomoni. Izi zimapangidwa ndi maselo a ziwiya zobisika za kapamba. Ntchito yake ndikuyendetsa mamolekyu a glucose mkati mwa maselo kuti apereke mphamvu yotsalayo.
M'magazi a matenda a shuga a mtundu 2, hyperglycemia imawonedwa - shuga wambiri. Chizindikiro ichi chimawerengedwa kuti ndi chotsogola, ndi pamaziko ake kuti matendawo awatsimikizira. Pofuna kuthana ndi ziwerengero zapamwamba za glycemia, chithandizo chamankhwala (kukonza zakudya), zolimbitsa thupi ndi mankhwala othandizira amagwiritsidwa ntchito. Nkhaniyi ithandiza kudziwa zomwe zimachitika pakukhazikitsidwa kwa mankhwala osokoneza bongo. Mndandanda wamankhwala ochepetsa shuga a matenda ashuga amtundu wa 2, zomwe zikuwonetsa kugwiritsa ntchito ndi mfundo zamankhwala zakambidwa pansipa.
Mfundo za mankhwalawa
American Diabetes Association ndi European Association for the Study of Diabetes ikugogomeza kuti glycosylated hemoglobin imawerengedwa monga njira yayikulu yodziwira poyesa momwe wodwalayo alili. Ndi chiwerengero pamtunda wa 6.9%, zosankha zamakadinala ziyenera kupangidwa malinga ndi mankhwala. Komabe, ngati izi sizokhudza odwala onse, koma zokhudzana ndi matenda ena azachipatala, ziyenera kutsimikiziridwa kuti zowonetsa sizipitilira 6%.
Atangotsimikizira kutsimikizika kwa matenda a "matenda okoma" a mtundu wa 2 (monga momwe matenda ashuga amatchulira anthu wamba), endocrinologists amalembera Metformin. Zomwe amagwiritsidwa ntchito ndi mankhwalawa zimadziwika motere:
- mankhwalawa samathandizira kulemera;
- ali ndi zovuta zochepa;
- sichimayambitsa chiwopsezo chakuchepa kwakukulu kwa shuga mu shuga;
- anasankhidwa popanda contraindication;
- wolekeredwa bwino ndi odwala;
- amatanthauza mankhwala a mtengo wotsika.
Endocrinologist - katswiri yemwe amathandiza wodwalayo kuthana ndi matenda amisempha
Zofunika! Mankhwala ena okhala ndi mapiritsi ochepetsera shuga amakonzedwa kale mothandizidwa ndi Metformin.
Otsatirawa ndi magulu akuluakulu a mankhwala ochepetsa shuga, oimira awo ogwira, makamaka cholinga ndi makonzedwe.
Magulu akuluakulu a mankhwala osokoneza bongo
Endocrinology yamakono imagwiritsa ntchito magulu asanu amankhwala kuti achepetse shuga m'magazi a shuga. Agawidwa m'magulu awiri akulu:
- Othandizira a Hypoglycemic (mankhwala omwe amachepetsa shuga ya magazi). Amathandizira kupanga insulin ya insulin, yomwe imakhudza kulemera kwa wodwalayo (imawonjezera), ndipo imatha kuyambitsa kuchepa kwambiri kwa glycemia. Oyimira ndi sulfonylureas ndi dongo.
- Mankhwala a Antihyperglycemic (mankhwala omwe salola shuga wamagazi kukwera pamwamba pazovomerezeka). Oyimira gulu amathandizira kuchuluka kwa shuga mu zotumphukira, koma sizingalimbikitse zochitika za pancreatic. Izi zikuphatikiza ndi Biguanides, alpha-glucosidase blockers ndi thiazolidatediones.
Gome: Kuyerekezera kwa mankhwala othandizira omwe amachepetsa shuga
| Gulu lamankhwala | Ntchito za oimira monotherapy | Kugwiritsa ntchito bwino | Zisonyezero zakudikirira |
| Alpha Glucosidase Inhibitors | Amachepetsa glycosylated hemoglobin ndi 0.7% | Amachotsa mawonetseredwe a hyperglycemia atatha kudya | Glycemia mutatha kudya ndi shuga wamba |
| Sulfonylureas | Kuchepetsa hemoglobin wa glycosylated ndi 1.5% | Imalimbikitsa kupanga insulin | Perekani chifukwa cha kuchepa kwa thupi |
| Ma glinids | Zofanana ndi alpha glucosidase inhibitors | Perekani kwa odwala omwe safuna kutsatira chithandizo chamankhwala | |
| Biguanides | Kuchepetsa hemoglobin wa glycosylated ndi 1.7% | Kuchulukitsa chidwi cha insulin | Kuthamanga kwambiri shuga ndi glycemia wabwinobwino mutatha kudya |
| Milaz | Imachepetsa glycosylated hemoglobin ndi 0.5-1.3% | Imapangitsa chidwi cha insulin | Kwa odwala omwe ali ndi thupi lalikulu |
| Insulin | Woyimira wogwira bwino kwambiri, amasintha zizindikiro kuzinthu zilizonse zomwe angafune | Amachotsa Kuchepa kwa Insulin | Tumizani ndi kuwonongeka, kusakwanira kwa mankhwala ena mankhwalawa amayi apakati |
Biguanides
Pakadali pano, mankhwala omwe agwiritsidwa ntchito kwambiri gululi ndi Metformin. Ndizofala chifukwa cha chiwopsezo chochepa cha lactic acidosis munthawi yamankhwala. Biguanides amatha kusintha kagayidwe kachakudya chifukwa:
- Kuchepetsa gluconeogenesis (mapangidwe a shuga ndi chiwindi kuchokera ku zinthu zopanda chakudya);
- kuchuluka kwa shuga maselo ndi minofu;
- kusintha kwa mayamwidwe a shuga m'matumbo.
Zabwino ndi zoyipa za gululi
Biguanides amachepetsa shuga ndi glycosylated hemoglobin, amachepetsa thupi pang'ono, amasiya kudya. Mankhwalawa ndi abwino chifukwa samabweza m'mawa matenda a hypoglycemia.
Kugwiritsa ntchito Metformin kwa nthawi yayitali kumakhala ndi phindu pa metabolism yamafuta.Mankhwala Metformin samangoletsa kuchepa kwa lipids, komanso amathandizira kupangika kwa minofu ya adipose. Biguanides amathandizanso kuchotsa cholesterol yoyipa kuchokera mthupi, kuchepetsa kuchuluka kwa triglycerides ndi LDL. Zothandiza pa mkhalidwe wa magazi coagulation dongosolo.
Zochizira
Metformin imatha kuchepetsa glycemia ikagwiritsidwa ntchito ngati monotherapy kapena kuphatikiza ndi insulin, sulfonylureas. Biguanides sanalembedwe milandu izi:
- nthawi ya bere ndi mkaka wa m`mawere;
- pachimake, kuphatikizapo chikomokere;
- magawo a matenda a impso ndi chiwindi;
- pachimake matenda njira;
- motsutsana ndi maziko azakudya zomwe zimapangidwira tsiku ndi tsiku osakwana 1000 kcal;
- odwala omwe akuchita masewera olimbitsa thupi kwambiri;
- odwala okalamba.
Alpha Glucosidase Inhibitors
Msika wamakono waku Russia wokhala ndi gulu limodzi lokha lolembetsedwa. Awa ndi Glucobai (chinthu chogwira ntchito ndi acarbose). Mankhwalawa amamangirira ku michere ya m'matumbo, ndikuchepetsa njira yogawa ndikumwedwa kwa saccharides. Zotsatira zake ndikuletsa kuchuluka kwa shuga chakudya chikadzalowetsedwa.
Zochita zenizeni, monotherapy yokhala ndi alpha-glucosidase inhibitors imagwira ntchito pokhapokha ngati anthu omwe adapezeka kale ali ndi matenda ashuga. Magulu awiri nthawi zambiri amaphatikizidwa: inhibitors + sulfonylureas, inhibitors + biguanides, inhibitors + insulin therapy.
Kuyesedwa kwa zamankhwala kwatsimikizira kugwiritsidwa ntchito kwa Glucobay
Zotsatira zoyipa za Glucobai zimayenderana ndi vuto la m'mimba. Odwala amakhala ndi zodandaula za kutsegula m'mimba, kumatulutsa. Contraindging poika mankhwalawa ndi:
- diverticulitis;
- matumbo osakwiya;
- zilonda zam'mimba;
- Matenda a Crohn;
- kukhalapo kwa adhesions;
- hernia ya peritoneum.
Sulfonylureas
Oimira gulu lino, kutsitsa shuga wamagazi, adapezeka mwangozi. Poyamba, ankakhulupirira kuti mankhwala ali ndi antibacterial yokha. Atazindikira kuthekera kowonjezereka kwa gululi, asayansi mwadala adayamba kufufuza mankhwalawo omwe ali ndi tanthauzo la hypoglycemic. Izi zidaloleza kugwiritsa ntchito nthumwi zochizira matenda amitundu iwiri.
Zochita za sulfonylurea zotumphukira ndi izi:
Mankhwala Atsopano a 2 A shuga- kukondoweza kwa zida zama insular;
- kubwezeretsa chidwi cha maselo a masinthidwe a Langerhans-Sobolev;
- kuwonjezeka kwa zolandilira zolimba pama nkhope a zotumphukira maselo.
Zoyipa zomwe gululo ndi kuthekera kwa kulemera kwakanthawi othandizira ndi oyimira a m'badwo wachiwiri (mwachitsanzo, Maninil). Mukamagwiritsa ntchito njira imodzimodziyo, njira zowonongeka m'matumbo a coronary zimakulitsidwa, njira ya kugunda kwa mtima imakhala yovuta kwambiri.
Contraindication kupita kwa mankhwala:
- insulin yodalira "matenda okoma";
- nthawi ya bere ndi mkaka wa m`mawere;
- kukhalapo kwa chidwi chaumwini;
- zovuta pachimake mu ketoacidotic, hyperosmolar boma;
- matenda a chithokomiro;
- kutsika kwa milingo yama cell oyera m'magazi pansipansi.
Oimira gulu ali ndi mwayi wosiyana ndi shuga wambiri, womwe uyenera kuganiziridwa posankha chithandizo.
Kuchita ndi mankhwala ena
Chiwopsezo chochepetsetsa kwambiri m'magazi a shuga m'magazi mumalimbikitsidwa ndi kuphatikiza kwa sulfonylureas ndimankhwala angapo othandizira, anticoagulants, ndi othandizira othandizira a salicylic acid. Mowa umalimbikitsanso mphamvu ya hypoglycemic.
Mankhwala a gulu amayamba kugwira ntchito mosaphatikizika:
- ndi thiazides;
- odana ndi calcium.
Glibenclamide
Woimira m'badwo wachiwiri wa mankhwala osokoneza bongo. Mayina amalonda - Maninil, Euglyukan. Maninil amadziwika kuti ndiogwiritsa ntchito kwambiri pa gulu laling'ono, komabe ali ndi machenjezo, contraindication ndipo amatha kuyambitsa mavuto.
Sichikulamulidwa kuti pakhale nephropathy yokhala ndi matenda ashuga, omwe ali ndi chiopsezo chachikulu cha matenda a ndulu. Kuphatikiza komwe kungatheke ndi metformin.
Glimepiride
M'badwo wachitatu wa mankhwala osokoneza bongo. Mayina amalonda - Glemaz, Amaril. Mankhwala a subgroup samakhudza thupi; amatengedwa kamodzi patsiku. Mukuwonongeka kwakapweteka kwa minofu ya mtima, simungathe kusamutsa wodwalayo kuti apange jakisoni wa insulin, chifukwa glimepiride sichikhudza mayendedwe a potaziyamu a maselo amtima.
Gliclazide
Woyimira m'badwo wachiwiri wa zotumphukira za sulfonylurea. Perekani kwa odwala omwe ali ndi vuto la kunenepa kwambiri. Mankhwalawa ndi othandizira ngati "matenda okoma" pakalibe zizindikiro zamankhwala. Mayina Ogulitsa:
- Diabetes;
- Diamicron;
- Dongosolo;
- Medoclazide.
Ma glinids
Mankhwalawa ochepetsa shuga a magazi amaonedwa ngati othandizira a pancreatic insulin. Amatengedwa mwachindunji panthawi yazakudya. Oimira otchuka a gululi ndi Nateglinides, Repaglinides.
Kuchuluka kwa mankhwalawa m'magazi kumakwera ndikaphatikizidwa ndi mankhwala awa:
- ndi ketoconazole;
- Miconazole;
- Clarithromycin;
- Erythromycin;
- Gemfibrozil;
- NSAIDs;
- beta blockers;
- salicylates.
Mlingo wa yogwira zinthu mthupi umachepa mchikakamizo cha barbiturates, carbamazepine.
NovoNorm - woimira gulu la dongo
Ma glinids amapatsidwa mankhwala ochizira matenda a shuga, momwe mumakhala kuchuluka kwa shuga musanadye komanso kuthamanga mukamadya chakudya. Mankhwala amawonetsedwa kwa odwala okalamba, komanso omwe ali ndi chiopsezo chokhala ndi vuto la hypoglycemic. Ma glinides ndi abwino kuthandizira odwala omwe ali ndi chidwi chowonjezeka cha sulfonylurea.
Zosafunika zotheka pa mankhwala:
- matenda opatsirana a chapamwamba kupuma thirakiti;
- kutupa kwa paranasal sinuses;
- kupumirana mseru, kutsekula m'mimba;
- kupweteka kwa molumikizana
- cephalgia;
- kunenepa.
Milaz
Oyimira gulu amathandizira chidwi cha zotumphukira zimakhala ndi maselo pakuchitapo kanthu kwa insulin ya mahomoni. Mankhwala otchuka ndi Aktos, Avandia. Mankhwala sangathe kuchepetsa glycemia, komanso kubwezeretsa kagayidwe ka lipid.
Muzochita zawo, othandizira amakhala otsika kuposa magulu ena a mankhwala amkamwa a hypoglycemic. Kuphatikiza apo, kutenga thiazolidinediones kumayendera limodzi ndi kuwonjezeka kwa thupi la wodwalayo. Ndi mtima matenda, mankhwala amatsutsana chifukwa chokhoza kusunga madzi m'thupi ndikupangitsa maonekedwe a edema.
Amayi ayenera kulimbikitsa njira zoteteza kutenga pakati, chifukwa mankhwalawa amatha kulimbikitsa mawonekedwe a ovulation ngakhale pa premenopusing.
Magulu onse ofotokozedwa ayenera kugwiritsidwa ntchito moyang'aniridwa ndi katswiri woyenera. Cholinga chachikulu ndikupeza chipukuta misozi. Kuyang'anira momwe ntchito ikugwirira ntchito kumakupatsani mwayi wowunika momwe mungalandire chithandizo chamankhwala ndikusankha othandiza kwambiri munjira inayake yachipatala.
