Izidakamizwa ezintsha zesifo sikashukela eziqale ukuvela eminyakeni yama-2000 ziyizidakamizwa ze-incretin. Ngokusemthethweni, zenzelwe ukwehlisa ushukela wegazi ngemuva kokudla nohlobo 2 sikashukela. Kodwa-ke, kule ndawo abanasisekelo esikhulu kithi. Ngoba lezi zidakamizwa zisebenza ngendlela efanayo neSiofor (metformin), noma zisebenza kancane, yize zibiza kakhulu. Zingabekwa ngokungeziwe ku-Siofor, lapho isenzo sakhe singasenele, futhi onesifo sikashukela angafuni ukuqala ngokujova i-insulin.
Imithi yesifo sikashukela i-Baeta neViktoza ingeyeqembu lama-GLP-1 receptor agonists. Kubalulekile ukuthi banganciphisi ushukela wegazi ngemuva kokudla, kepha futhi banciphise iphango. Futhi konke lokhu ngaphandle kwemiphumela emibi ekhethekile.
Inani leqiniso lomuthi omusha we-2 yesifo sikashukela ukuthi kunciphisa isifiso sokudla futhi kusiza ukulawula ukuzidla ngokweqile. Ngenxa yalokhu, kuba lula ukuthi iziguli zilandele ukudla okune-carbohydrate ephansi futhi zivikele ukuhlukana. Ukunquma izidakamizwa ezintsha zesifo sikashukela ukwehlisa inkanuko akumukelwa ngokusemthethweni. Ngaphezu kwalokho, izivivinyo zabo zemitholampilo ngokuhlanganiswa nokudla okune-carbohydrate okuningi azenziwanga. Kodwa-ke, ukuzijwayeza kukhombisile ukuthi le mishanguzo iyasiza ngempela ukubhekana nobudlova obungalawulwa, futhi imiphumela emincane incane.
Yimaphi amaphilisi afanele ukwehlisa isifiso sokudla
Ngaphambi kokushintshela ekudleni okune-carbohydrate ongaphakeme, zonke iziguli ezinesifo sikashukela sohlobo 2 zingomlutha wobunzima kuma-carbohydrate adliwayo. Lokhu kuncika kubonakala ngesimo sokudla ngokweqile i-carbohydrate kanye / noma ukuzenyeza njalo kobudlova obukhulu. Ngendlela efanayo nomuntu ophethwe uphuzo oludakayo, angahlala “engaphansi kophupho” futhi / noma ngezikhathi ezithile azihlangabeze.
Abantu abanokukhuluphala kanye / noma isifo sikashukela 2 kuthiwa banesifiso sokudla. Eqinisweni, kungukudla kwama-carbohydrate asolayo iqiniso lokuthi iziguli ezinjalo zihlangabezana nomuzwa ongapheli wendlala. Lapho baphendukela ekudleni amaprotheni kanye namafutha emvelo anempilo, isifiso sabo sokudla sivame ukubuyela kokujwayelekile.
Ukudla okune-carbohydrate kuphela kusiza cishe ama-50% eziguli ukubhekana nokuncika kwe-carbohydrate. Ezinye iziguli ezinesifo sikashukela sohlobo 2 zidinga izindlela ezengeziwe. Izidakamizwa ze-incretin "zingumugqa wesithathu wokuzivikela" onconywe uDkt Bernstein ngemuva kokuthatha isithombe se-chromium kanye ne-hypnosis.
Le mishanguzo ifaka amaqembu amabili izidakamizwa:
- I-DPP-4 inhibitors;
- Ama-agonists we-GLP-1 receptor.
Zisebenza kangakanani izidakamizwa ezintsha zikashukela?
Ukuhlolwa kwezokwelapha kukhombisile ukuthi ama-DPP-4 inhibitors nama-GLP-1 receptor agonists behlisa ushukela wegazi ngemuva kokudla ezigulini ezinesifo sikashukela sohlobo 2. Lokhu kungenxa yokuthi zivusa ukukhululeka kwe-insulin ngamanyikwe. Njengomphumela wokusetshenziswa kwabo kuhlangene nokudla “okunokulinganisela,” i-hemoglobin ye-glycated yehla ngo-0,5-1%. Futhi, abanye ababambiqhaza bokuhlola banciphise isisindo kancane.
Lokhu akuyona i-godend ukuthi impumelelo iyini, ngoba i-Siofor (metformin) endala enhle ngaphansi kwezimo ezifanayo yehlisa i-glycated hemoglobin ngo-0.8-1.2% futhi isiza ngempela ukunciphisa isisindo ngamakhilogremu ambalwa. Noma kunjalo, kunconywa ngokusemthethweni ukunquma izidakamizwa zohlobo lwe-incretin ngaphezu kwe-metformin ukuze kuthuthukiswe umphumela wazo futhi kubambezele ukuqala kokwelashwa kohlobo lwesifo sikashukela sohlobo 2 nge-insulin.
UDkt Bernstein uncoma ukuthi abantu abanesifo sikashukela bathathe le mithi hhayi ukukhuthaza ukugcinwa kwe-insulin, kodwa ngenxa yomthelela wabo ekwehliseni hamu. Basiza ukulawula ukudliwa kokudla, basheshise ukuqala kokwenza satiety. Ngenxa yalokhu, amacala okwehluleka ekudleni okune-carbohydrate ephansi kakhulu ezigulini kwenzeka kaningi.
UBernstein ubeka izidakamizwa ze-incretin hhayi kuphela ezigulini ezinesifo sikashukela sohlobo 2, kodwa futhi nakwiziguli ezinesifo sikashukela sohlobo 1 ezinenkinga yokudla ngokweqile. Ngokusemthethweni, le mithi ayihloselwe iziguli ezinesifo sikashukela sohlobo 1. Qaphela Iziguli ezinesifo sikashukela sohlobo 1 esiqale ukukhula kwesifo sikashukela, ie. Ukubambezeleka ukusula isisu ngenxa yokulimala kwe-neural, ngeke zikwazi ukusebenzisa lezi zidakamizwa. Ngoba kuzobenza babe babi kakhulu.
Zisebenza kanjani izidakamizwa ze-incretin?
Umuthi we-incretin wehlisa isifiso sokudla ngoba wehlisa ukudambisa isisu ngemuva kokudla. Umphumela wecala ongaba khona walokhu uzicanucanu. Ukuze unciphise ukungaphatheki kahle, qala ukuthatha umuthi ngethamo elincane. Khuphula kancane lapho umzimba uvumelana. Ngokuhamba kwesikhathi, isicanucanu siyanyamalala ezigulini eziningi. Ngokucatshangelwa, eminye imiphumela emibi iyenzeka - ukugabha, ubuhlungu besisu, ukuqunjelwa noma isifo sohudo. UDkt Bernstein uphawula ukuthi ngokomkhuba awubonwa.
Ama-Dhib-4 ama-inhibitors ayatholakala ezibhebheni, kanye nama-GLP-1 receptor agonists ngendlela yesisombululo sokuphatha ngokungahambi kahle kuma-cartridge. Ngeshwa, lawo amaphilisi empeleni awasizi ukulawula iphango, futhi ushukela wegazi uncishiswa kancane. Empeleni ama-agonists we-GLP-1 receptors isenzo. Babizwa ngokuthi iBaeta neViktoza. Badinga ukujova, cishe njenge-insulin, kanye noma kaningana ngosuku. Indlela efanayo yokujova engenazhlungu ilungele ukujova nge-insulin.
Ama-agonists we-GLP-1 receptor
I-GLP-1 (i-glucagon-like peptide-1) ingenye yama-hormone akhiqizwa emgodini wesisu ukuphendula ukudliwa. Kusayina ama-pancreas ukuthi sekuyisikhathi sokukhiqiza i-insulin. Le hormone ibuye inciphise ukungasebenzi kwesisu futhi ngaleyo ndlela inciphise iphango. Kuphakanyiswa nokuthi kuvuselela ukuvuselelwa kwamaseli we-pancreatic beta.
I-peptide-1 yemvelo yemvelo yabantu ibhujiswa emzimbeni imizuzu emi-2 ngemuva kokuhlanganiswa. Ikhiqizwa njengoba idingeka futhi yenza ngokushesha. Izimpawu zalo zokwenziwa izidakamizwa zeBayeta (exenatide) neViktoza (liraglutide). Zisatholakala kuphela ngesimo semijovo. I-Baeta isebenza amahora amaningi, neViktoza - usuku lonke.
I-Baeta (Exenatide)
Abakhiqizi bomuthi weBaeta batusa umjovo owodwa ngehora ngaphambi kokudla kwasekuseni, kanti omunye kusihlwa, ihora elilodwa ngaphambi kokudla kwakusihlwa. UDkt Bernstein utusa ukuthi kusebenze ngendlela ehlukile - ukugwaza iBayete amahora angama-1-2 ngaphambi kwesikhathi lapho isiguli sivame ukugcwala noma ukuncipha kokudla. Uma udla kakhulu ngosuku, kusho ukuthi kuzokwanela ukuthi iBayet ifake umjovo kanye kuma-micrograms ayi-5 noma ayi-10. Uma inkinga yokudla ngokweqile ivela kaningi phakathi nosuku, bese unikeza umjovo ngaso sonke isikhathi ihora ngaphambi kokuvela kwesimo esijwayelekile, lapho uzivumela ukuba udle ngokweqile.
Ngakho-ke, isikhathi esifanele somjovo nomthamo sisungulwa ngokuhlolwa nephutha. Ngokwe-theoretically, umthamo ophezulu we-Baeta yi-20 mcg, kepha abantu abanokukhuluphala ngokweqile bangadinga okuningi. Ngokuphikisana nesizinda sokwelashwa kweBayeta, umthamo wamaphilisi we-insulin noma kashukela ngaphambi kokudla ungancishiswa ngokushesha ngo-20%. Ngemuva kwalokho, kususelwa emiphumeleni yokulinganisa ushukela wegazi, bheka uma usadinga ukwehlisa noma okuphambene nalokho ukuze ukwandise.
IVictoza (liraglutide)
Isidakamizwa iViktoza saqala ukusetshenziswa ngo-2010. Umjovo wakhe kufanele wenziwe isikhathi 1 ngosuku. Umjovo uthatha amahora angama-24, njengoba abenzi bethi. Ungakwenza nganoma yisiphi isikhathi esivumelana nosuku. Kepha uma uvame ukuba nezinkinga zokudla ngokweqile ngasikhathi sinye, ngokwesibonelo, ngaphambi kokudla kwasemini, bese ushayela i-Victoza amahora angama-1-2 ngaphambi kwasemini.
UDkt Bernstein ubheka uVictoza njengomuthi onamandla wokulawula isifiso sokudla, ubhekane nokudla ngokweqile kanye nokunqoba ukuxhomekeka kwe-carbohydrate. Isebenza kakhulu kune-Baeta, futhi kulula ukuyisebenzisa.
I-DPP-4 inhibitors
I-DPP-4 yi-dipeptyl peptidase-4, i-enzyme ebhubhisa i-GLP-1 emzimbeni womuntu. I-DPP-4 inhibitors ivimba le nqubo. Kuze kube manje, izidakamizwa ezilandelayo zaleli qembu:
- UJanuvia (sitagliptin);
- Onglisa (saxagliptin);
- UGalvus (vidlagliptin).
Yonke le yimithi esezibhebheni, ezinconywayo ukuthi zithathwe isikhathi esisodwa ngosuku. Kukhona ne-tradent drug (linagliptin), engathengiswa emazweni akhuluma isiRussia.
UDkt Bernstein uphawula ukuthi ama-inhibitors e-DPP-4 cishe awanawo umthelela ekudla, futhi futhi anciphise noshukela wegazi ngemuva kokudla. Ubeka le mishanguzo ezigulini ezinesifo sikashukela sohlobo 2 esevele zithatha i-metformin ne-pioglitazone, kepha ezingakwazi ukufinyelela ushukela wegazi ojwayelekile futhi zenqabe ukwelashwa nge-insulin. Ama-inhibitors e-DPP-4 akulesi simo awayona indawo efanelekile ye-insulin, kepha lokhu kungcono kunalutho. Imiphumela emibi yokuthatha kubo ayenzeki.
Imiphumela emibi yemithi yokunciphisa iphango
Izifundo zezilwane zikhombisile ukuthi ukuthatha izidakamizwa zohlobo lwe-incretin kuholele ekubuyiselweni okuyingxenye kwamaseli abo we-pancreatic beta. Okwamanje akukaziwa ukuthi into efanayo yenzeka kubantu. Ucwaningo olufanayo lwezilwane lwathola ukuthi ukwanda komdlavuza we-thyroid onqabile kukhuphuke kancane. Ngakolunye uhlangothi, ushukela wegazi ophakeme unyusa ubungozi bezinhlobo ezingama-24 zomdlavuza. Ngakho-ke izinzuzo zezidakamizwa ngokusobala zingaphezu kwengozi engaba khona.
Kanye nokudla izidakamizwa zohlobo lwe-incretin, ingozi eyandayo yesikhumba se-pancreitis - kwaqoshwa kubantu ababekade benenkinga ngenxa yamanyikwe. Le ngozi ikhathazeka, okokuqala, izidakwa. Izigaba ezisele zabanesifo sikashukela azifanele ukwesatshwa.
Isibonakaliso se-pancreatitis sibuhlungu obungakalindeleki futhi obukhulu besisu. Uma uzizwa, thintana nodokotela ngokushesha. Uzoqinisekisa noma aphikise ukutholakala kwe-pancreatitis. Kunoma ikuphi, yeka ngokushesha ukuthatha izidakamizwa nomsebenzi we-incretin kuze kube yilapho yonke into icacile.
