Type 2abetes mellitus (T2DM) ndimatenda a dongosolo, munthawi yomwe chitukuko cha maselo amthupi chimatha kuzindikira insulini ndikusiya kuyamwa glucose, chifukwa chomwe chimayamba kukhazikika m'magazi. Pofuna kupewa kuchuluka kwa shuga m'magazi, madokotala amalimbikitsa kuti odwala matenda ashuga azitsatira zakudya zamagulu ochepa komanso masewera olimbitsa thupi. Komabe, njirazi sizipereka zotsatira zabwino nthawi zonse, ndipo matendawa amayamba kupita patsogolo, omwe amakakamiza munthu kupita ku zochitika zowopsa - kupita ku maphunziro azachipatala. Koma pali china chatsopano pakuchiza matenda a shuga 2, omwe tikukambirana tsopano.
Mawu ochepa onena za matendawa
Mosiyana ndi mtundu woyamba wa matenda ashuga, T2DM imathandizidwa koposa, ngati, idayamba pa nthawi. Ndi matendawa, ntchito ya kapamba imasungidwa, ndiye kuti, palibe kuchepa kwa insulin mthupi, monga momwe zimakhalira poyamba. Chifukwa chake, chithandizo chamankhwala sichofunikira pano.
Komabe, popeza kuti pakukula kwa T2DM, kuchuluka kwa shuga m'magazi kumakhala kopitilira muyeso, kapamba "amakhulupirira" kuti sagwira ntchito mokwanira komanso imathandizira kupanga insulin. Zotsatira zake, chiwalocho chimakhala pamavutikidwe kwambiri, chomwe chimayambitsa kuwonongeka pang'ono kwa maselo ake komanso kusintha kwa T2DM kupita ku T1DM.
Chifukwa chake, madokotala amalimbikitsa kuti odwala awo azitha kuyang'anira kuchuluka kwa shuga m'magazi ndipo, ngati ukuwonjezeka, nthawi yomweyo amachitapo zinthu zomwe zingalolere kuchepetsedwa. Ndi T2DM, ndizokwanira kumangotsatira kadyedwe ndi masewera olimbitsa thupi. Ngati izi sizithandiza, mutha kuyang'ana ku thandizo la mankhwala ochepetsa shuga.
Koma chithandizo chonsechi cha shuga chimatha. Ndipo poganizira kuti chiwerengero cha anthu omwe akudwala matendawa chikuwonjezeka chaka chilichonse, madokotala akuwonjezeranso njira yatsopano ya chithandizo cha matenda osokoneza bongo operekedwa ndi asayansi komanso makampani osiyanasiyana opanga mankhwala. Kodi amalola kuti muthane ndi matenda awa, kapena kuti aletse kutalika kwake? Izi ndi zina zambiri tidzazikambirana tsopano.
Glitazones
Njira zatsopano zochizira T2DM zikuwonetsa kugwiritsa ntchito mankhwala am'badwo waposachedwa, omwe amaphatikizira otchedwa glitazones. Agawidwa m'magulu awiri - pioglitazones ndi rosiglitazones. Zinthu zothandizazi zimathandizira kukondoweza kwa ma receptors omwe amapezeka mu nuclei ya adipose ndi minofu minofu. Pamene maphikidwe awa adakonzedwa, pamakhala kusintha kwa zolembedwa zamtundu zomwe zimayendetsa kayendedwe ka glucose ndi lipid metabolism, chifukwa chomwe maselo amthupi amayamba kulumikizana ndi insulin, kuyamwa glucose ndikuletsa kuti asakhazikike m'magazi.
Limagwirira ntchito ya glitazones
Mankhwala otsatirawa ali m'gulu la pioglitazones:
- Aktos
- Mdierekezi
- Piroglar.
Kudya kwa mankhwalawa kumachitika kamodzi kokha patsiku, mosasamala nthawi yakudya. Kumayambiriro kwenikweni kwa chithandizo, mlingo wawo ndi 15-30 mg. Zikachitika kuti pioglitazone sichimapereka zotsatira zabwino motere, mlingo wake umachulukitsidwa kufika pa 45 mg. Ngati mankhwalawa atengedwa limodzi ndi mankhwala ena othandizira T2DM, ndiye kuti mulingo woyenera sayenera kupitirira 30 mg patsiku.
Zokhudza rosiglitazones, mankhwala otsatirawa ndi a gulu lawo:
- Avandia
- Osunthika.
Mankhwalawa aposachedwa amatengedwa pakamwa kangapo patsiku, komanso mosasamala nthawi yakudya. Pa magawo oyambirira a mankhwalawa, mlingo wa tsiku ndi tsiku wa rosinlitazone ndi 4 mg (2 mg imodzi). Ngati mavutowo sanawonedwe, amatha kuwonjezeka mpaka 8 mg. Popanga mankhwala ophatikiza, mankhwalawa amatengedwa pamlingo wochepa - osapitirira 4 mg pa tsiku.
Mankhwala "Actos" amatanthauza gulu latsopano la mankhwala
Posachedwa, mankhwalawa amagwiritsidwa ntchito kwambiri ngati mankhwala pochiza matenda amtundu wa 2. Ma rosiglitizans onse ndi pioglitazones ali ndi zabwino zambiri. Kulandila kwawo kumapereka:
- kuchepa kwa insulin kukana;
- kutsekereza lipolysis, kutsitsa kuchepa kwa kuchuluka kwamafuta amwazi m'magazi, zomwe zimakhudza molakwika kugawidwanso kwa minofu ya adipose;
- kuchepa kwa triglycerides;
- kuchuluka kwamagazi a HDL (high density lipoproteins).
Chifukwa cha zonse izi, mukamamwa mankhwalawa, chiphuphu chokhazikika cha matenda osokoneza bongo chimatheka - kuchuluka kwa shuga m'magazi kumakhala pafupifupi nthawi zonse komanso momwe wodwalayo amapitira bwino.
Komabe, mankhwalawa amakhalanso ndi zovuta:
- glitazones ndi otsika pogwira ntchito kwa "abale" awo, omwe amagwirizana ndi magulu a sulfonylurea ndi metformins;
- rosiglitazones amaswa chifukwa cha vuto la mtima ndi mtima, chifukwa amatha kubweretsa vuto la mtima kapena stroke (ndipo mtima ndi zomwe zimakhudzidwa ndimatenda a shuga);
- glitazones imakulitsa chilakolako cha thupi ndikuwonjezera thupi, zomwe ndizosafunikira kwambiri pakupanga matenda a shuga a 2, chifukwa izi zimatha kudzetsa mavuto ena azaumoyo komanso kusintha kwa T2DM kupita ku T1DM.
Chifukwa cha kukhalapo kwa zotsatira zoyipa zambiri komanso ma contraindication mu mankhwalawa, ndizosatheka kuzitenga popanda kudziwa dokotala
Zizindikiro ndi contraindication
Pioglitazones ndi rosiglitazones angagwiritsidwe ntchito ngati mankhwala oyimilira pawokha pochiza T2DM, komanso kuphatikiza ndi sulfonylurea ndi metformin (kuphatikiza mankhwalawa kumangogwiritsidwa ntchito pa matenda oopsa). Monga lamulo, amawerengedwa pokhapokha ngati mankhwala othandizira pakudya ndi olimbitsa thupi atha kupereka zotsatira zabwino.
Njira zazikulu zotsutsana ndi kugwiritsa ntchito pioglitazones ndi rosiglitazones ndizotsatira zathupi lanyama ndi matenda:
- mimba ndi mkaka wa m`mawere;
- zaka mpaka 18;
- lembani 1 matenda a shuga ndi zina zomwe zimapangitsa kuti insulini ichite bwino;
- kupitilira gawo la ALT kupitirira nthawi zopitilira 2.5;
- matenda a chiwindi mu pachimake gawo.
Mankhwala "Avandia" ayenera kuyikidwa kokha ndi dokotala
Kuphatikiza poti mankhwalawa amapezeka ndi zotsutsana, amakhalanso ndi zotsatirapo zina. Nthawi zambiri, akagwiritsidwa ntchito ngati odwala, zotsatirazi zimadziwika:
Mankhwala Atsopano a 2 A shuga- Edema, mawonekedwe ake omwe amayamba chifukwa cha kuthekera kwa magawo omwe amagwira ntchito mwa mankhwalawa kuti azitha kusunga madzi mthupi. Ndipo izi zitha kusokoneza ntchito ya mtima ndi mtima, kuonjezera zoopsa zomwe zingayambitse kulephera kwa mtima, kuchepa kwa mtima ndi zina zomwe zingawopseze wodwalayo.
- Kutsika kwa hemoglobin m'magazi (magazi m'thupi), omwe amadzala ndi zovuta zamkati mwaubongo, pomwe amayamba kufa ndi njala. Nthawi zambiri, chifukwa cha kuchepa kwa magazi, kumakhala kuphwanya kayendedwe kazinthu, kuchepa kwamphamvu kwa patency, kusangalala kwa CNS, ndi zina zambiri. Zinthu zonsezi zimasokoneza wodwalayo.
- Kuphwanya ntchito za michere ya chiwindi (ALT ndi AST), yomwe imayambitsa kukula kwa chiwindi kulephera ndi zina zina zam'magazi. Chifukwa chake, mukamatenga pioglitazones ndi reseiglitazones, muyenera kupimidwa magazi pafupipafupi. Ndipo pamenepo
ngati kuchuluka kwa ma enzymes amenewa kumaposa kuchuluka kwa nthawi zopitilira 2.5, kuthetsedwako kwa mankhwalawa ndikofunikira.
Incretinomimetics
Gulu lina latsopano la mankhwala omwe posachedwapa anayamba kugwiritsidwa ntchito pochiza matenda amtundu wa 2. Mwa izi, otchuka kwambiri ndi Exenatide ndi Sitagliptin. Monga lamulo, mankhwalawa amagwiritsidwa ntchito limodzi ndi Metformin.
Incretinomimetics amathandizira:
- kuchuluka kwa insulin;
- malamulo opanga gastric madzi;
- kuchedwetsa njira za chimbudzi ndi kuperewera kwa chakudya, zomwe zimatsimikizira kuponderezedwa kwa njala ndi kuwonda.
Mukamamwa ingretinomimetics, mseru ndi m'mimba zimatha. Komabe, malinga ndi madotolo, izi zoyipa zimachitika pokhapokha pamankhwala. Thupi likangoyamba kuzolowera mankhwalawa, amazimiririka (zimatenga masiku 3-7).
Incretinomimetics ndi mankhwala amphamvu kwambiri, ndipo ngati atagwiritsidwa ntchito molakwika, amatha kuyambitsa mavuto akulu azaumoyo.
Mankhwalawa amapereka kuwonjezeka kwa insulin m'magazi ndikutchingira kaphatikizidwe ka glucagon, kamene kamakhazikitsa kuchuluka kwa shuga m'magazi ndikuwongolera momwe wodwalayo alili. Ingretinomimetics imakhala ndi zotsatira zokhalitsa, chifukwa chake, kuti mupeze zotsatira zosatha, ndikokwanira kuzitenga nthawi imodzi yokha patsiku.
Maselo a tsinde
Chithandizo cha matenda a shuga a mtundu wachiwiri omwe ali ndi masentimita amodzi ndi njira yodula koma yothandiza kwambiri. Amagwiritsidwa ntchito pokhapokha ngati mankhwala osokoneza bongo samapereka zotsatira.
Kugwiritsa ntchito maselo a tsinde pochiza matenda a shuga kungakwaniritse zotsatirazi:
- kubwezeretsa kwathunthu kwa ntchito za pancreatic ndi kuchuluka kwa insulin;
- matenda a kagayidwe kachakudya njira;
- Kuchotsa kwa endocrine matenda.
Chifukwa chogwiritsa ntchito maselo a tsinde, zimatha kuchotsa matenda ashuga, omwe m'mbuyomu sanali kuzikwaniritsa. Komabe, chithandizo choterechi chili ndi zovuta. Kuphatikiza apo njirayi ndi yodula kwambiri, siyimamvekanso bwino, ndipo kugwiritsa ntchito maselo a stem wodwala kumatha kubweretsa kusintha kosayembekezereka kwa thupi.
Magnetotherapy
Zomwe zimayambitsa kukula kwa matenda ashuga amtundu wa 2 ndizovuta zambiri zamafuta komanso kupsinjika, zomwe zimayambitsa kupanga mahomoni m'thupi monga thyroxine ndi adrenaline. Kuti ma mahomoniwa agwiritsidwe ntchito, thupi limafunikira mpweya wambiri, womwe mutha kupeza kuchuluka kwake kokha mwakuchita zolimbitsa thupi kwambiri.
Magnetorepy imapereka kubwezeretsa kwa chapakati mantha dongosolo ndi kusintha kwa wodwalayo
Koma popeza anthu ambiri alibe nthawi yochita masewera, mahomoni awa amadziunjikira m'thupi, zomwe zimayambitsa njira zosiyanasiyana zamatumbo momwemo. Ndipo matenda a shuga a 2 ayamba kukulira. Pankhaniyi, kugwiritsa ntchito magnetotherapy ndikothandiza kwambiri, komwe kumayendetsa ntchito ya ziwalo zonse zamkati ndikulimbikitsa kugwira ntchito kwa thyroxine ndi adrenoline, potero kuletsa kupititsa patsogolo kwa matendawa komanso kuchepetsa matenda a shuga.
Komabe, kugwiritsa ntchito magnetotherapy sikutheka nthawi zonse. Ali ndi zolakwika zake, monga:
- chifuwa chachikulu
- mimba
- hypotension;
- kutentha kwambiri;
- matenda oncological.
Ngakhale njira zambiri zochizira matenda amtundu wa 2 zawonekeranso ngati mankhwala, ziyenera kumveka kuti onse samamveka bwino. Kugwiritsa ntchito kwawo kungayambitse zotsatira zosayembekezereka. Chifukwa chake, ngati mukuganiza kuyesa njira zaposachedwa zochizira matendawa, ganizirani mozama komanso kambiranani zantchito zonse ndi dokotala.
