Ukwelashwa kohlobo 2 lwesifo sikashukela, izidakamizwa nezinye izinto zokwelashwa kufanele kuchazwe uchwepheshe wezokwelapha. Ezigulini eziningi ezinalokhu kutholwa, ukuthuthukiswa kwe-pathology kwenzeka ngezindlela ezihlukile, maqondana nokubonakaliswa kwezimpawu zomzimba ngamunye.
Ngaphezu kwalokho, kunezinto eziningi ezingavusa isifo sohlobo lwe-2, okudingeka futhi ukunaka lapho ukhetha indlela yokwelashwa efanelekile futhi ukhetha imithi ye-antidiabetes.
Bonke abanesifo sikashukela abanefomu elizimele lesifo banikezwa ukwelashwa okuyinkimbinkimbi ngaphandle kokuhluleka.
Kuze kube manje, umthamo owodwa kuphela wezokwelapha onama-hypoglycemic agents awukwazi ukuletha imiphumela ephezulu ngempela.
Umphumela omkhulu ungatholakala uma zonke izincomo zochwepheshe bezokwelapha obukela isiguli zilandelwa.
Imaphi amaphuzu asemqoka wokwelashwa kwalesi sifo?
Ezimweni zomtholampilo, inkambo yanamuhla yokwelashwa ifaka lezi zindawo eziyinhloko ezilandelayo:
- Ukuhambisana nokudla okwezokwelapha okuklanyelwe ngokukhethekile. Ukukhetha okungafani kwamamenyu nokudla okusetshenzisiwe akugcini nje ngokunciphisa inani lamakhompiyutha e-carbohydrate alula, kepha futhi kunomthelela ekujuleni kwesisindo. Okusemqoka kwabanesifo sikashukela amatafula uNo8, No9 no-No9-A.
- Ukuzivocavoca umzimba okwenzelwe ngqo ukutatamisa izimpawu ze-pathology nakho kuthinta kahle ukujwayezwa koshukela wegazi. Kwesinye isikhathi kwanele ukuhola indlela yokuphila esebenzayo, ukuhamba nsuku zonke emoyeni omusha nokudla okufanele kumenyu, ukuze isiguli sizizwe singcono kakhulu.
- Ukwelashwa kwezidakamizwa. Imithi yesimanje yemithi enqunywe uchwepheshe wezokwelapha izosiza ukubuyisela amazinga kashukela abejwayelekile.
Yonke imishanguzo esetshenziselwa ukwelashwa inezinto zayo zokwelapha:
- imithi ekhuthaza ama-pancreas ukukhiqiza i-insulin ethe xaxa;
- imishanguzo ekhulisa ukuzwela kwamangqamuzana nezicubu zomzimba ekhempini esebenzayo ekhiqizwa amaseli we-beta, ukusetshenziswa kwawo kubaluleke kakhulu lapho kukhona ukumelana ne-insulin esigulini;
- amakhambi anciphisa ukumuncwa kwama-carbohydrate angenayo esiswini.
Imithi ingabamele amaklasi namaqembu ahlukile. Ethandwa kakhulu futhi esetshenziswa umuthi wanamuhla:
- Imithi emele isigaba se-sulfonyl derivatives. Isenzo sabo se-pharmacological sihloselwe ukuvusa imfihlo ye-insulin yohlobo lwe-endo native. Inzuzo enkulu yaleli qembu lezidakamizwa ukubekezelela okulula umuthi ezigulini eziningi.
- Izikhungo zezokwelapha, abamele isigaba se-genuanide ekhemisi semithi. Umphumela wabo oyinhloko ukunciphisa isidingo samaseli e-beta ukuzehlukanise i-compound esebenzayo.
- Amakhemisi, okuyi-thiazolidinol derivatives, anikela ekunciphiseni okukhulu koshukela futhi kuthinta nomsebenzi wephrofayili yamafutha.
- Ama -retretins.
Uma izidakamizwa ezingenhla zemithi ezinciphisa ushukela zingalethi umphumela omuhle, ukwelashwa kwe-insulin kungasetshenziswa.
Imithi yama-meglitinide namaqembu e-thiazolidinedione
I-Meglitinides yimithi enomphumela wehlisela ushukela futhi ikhuthaza ukukhiqizwa kwama-pancreas kumakhanoni. Akafakiwe kunoma yiliphi iqembu lama-ekhemisi ashukela anciphisa ushukela. Ukusebenza kokuphuza imithi ngokuqondile kuya nge-hyperglycemia. Ngokufanele, lapho kukhuphuka inani le-glucose, amakhompiyutha amaningi okugcwala azokhiqizwa ngumzimba lapho uthatha umkhiqizo wezemithi.
Ama-Meglitins awakwazi ukungena kwezicubu ezingeni lamaselula, futhi ithonya lawo liqondiswe kulolwelwesi lweseli, ngakho-ke, ukucindezelwa kwe-biosynthesis kumaseli we-beta akwenzeki.
Ukulungiswa kwethebhulethi yanamuhla eqenjini le-meglitinide kunesenzo esifushane, ngokushesha ukubuyisela ushukela kokujwayelekile. Ngaphezu kwalokho, vele sekudlule ihora noma amabili, ngemuva kokuphatha kwabo, kuthathwa imishanguzo ephansi yemithi eplasma yegazi.
Imithi ingasetshenziswa njengezemithi ezizimele ekwelapheni lesi sifo noma ibe yingxenye yokwelapha okuyinkimbinkimbi.
Abamele abaphambili bemithi yamaphilisi afakwe kuleli qembu yiNovonorm ne-Starlix. Ngokwakheka kwemithi yemithi kunento eyodwa esebenzayo - nateglinide.
Muva nje, amalungiselelo emithi avela eqenjini lama-thiazolidinediones angenele umkhuba wezokwelapha wokwelapha wenqubo ye-pathological. Isenzo sabo kwezinye izimo siyefana nama-Biguanides:
- Imithi ithuthukisa ukwanda kwezicubu kumaseli we-beta yama-hormone, ukunciphisa ukuqhubekela phambili kokumelana kwama-hormone, kungathinti ukukhuthaza kokukhiqizwa kwe-insulin;
- abe nomphumela obizwa ngokuthi yi-hypoglycemic;
- thinta kahle iphrofayili yamafutha;
- vuselela okubhaliwe kofuzo.
Le mithi yokuphazamiseka kwe-pathological system ye-endocrine ingaguqula ubungozi bokubonakala nokuthuthuka kwezinkinga zenhliziyo nezemithambo, okuyiphuzu elibalulekile ezigulini eziningi.
Namuhla, kunamaqembu amathathu aphambili wemithi-thiazolidinediones:
- Amathebhulethi esizukulwane sokuqala abonisa imiphumela ye-hepatotoxic neyethonya yenhliziyo. Ummeleli wayo yiTroglitazone. Ngenxa yezimpawu zayo, cishe ayisetshenziswa ekwelashweni kwanamuhla kwe-pathology.
- Imithi yesizukulwane sesibili (i-Pioglitazone).
- Imithi yesizukulwane sesithathu - iRosiglitazone.
Le mithi yethebhulethi yesizukulwane sesibili nesesithathu singasetshenziswa kokubili njenge-monotherapy futhi njengengxenye yokwelashwa okuyinkimbinkimbi. Imvamisa, ochwepheshe bezokwelapha banquma ukuqokwa kwabo ngamakhemisi asuselwa emithini.
Izenzo zichazwa iqiniso lokuthi ama-biguanides acindezela i-gluconeogenesis ngenkuthalo, futhi ama-thiazolidinediones akhulisa ukusetshenziswa kwe-glucose yangaphandle.
Izithako zemithi yesifo sulfonylurea
Ukwelashwa kokuphazamiseka ekusebenzeni kohlelo lwe-endocrine lohlobo lwesibili isikhathi eside kufaka ukusetshenziswa kwemithi yethebhulethi, okuyimeli yokuphuma kwe-sulfonylurea.
Umkhakha wemithi ukhiqiza imishanguzo eminingana ehlobene naleli qembu.
Okususwa yi-sulfonylureas yimithi yezizukulwane zezizukulwane eziningana.
Indlela yokusebenzisa umphumela weqembu elinjalo lemikhiqizo yezokwelapha esigulini ukubonakaliswa kwemiphumela elandelayo:
- yenza kusebenze inqubo yokuvuselela amaseli we-beta we-pancreas futhi ikhuphule izinga lokuvuleka kwamangqamuzana ancike kumiseli yomzimba
- kusebenze izinqubo ezisebenza nge-hormone kanye nokuvinjwa komsebenzi we-insulinase;
- yenza buthaka ubudlelwano obusezingeni lama-hormone nama-protein;
- ukunciphisa izinga lokubopha i-insulin kuma-antibodies;
- neqhaza ekwandeni kokuzwela kwama-receptors ama-membrane wamaseli wezicubu zemisipha ne-lipid ukungena kwe-insulin;
- khuphula inani lama-receptors ama-hormone kulwelwesi lwezicubu;
- neqhaza ekuthuthukiseni ukusetshenziswa kwe-glucose esibindini nasemisipha;
- yenza amandla inqubo ye-gluconeogenesis esibindini nakuma-lipid izicubu;
- cindezela i-lipolysis;
- khulisa ukumuncwa kanye ne-oxidation ye-glucose.
Emithini yesimanje, kunikezwa izinhlobo eziningana zemithi ezihlobene ne-sulfonyl:
- Imithi yesizukulwane sokuqala, ethi muthi wesimanje cishe ayikaze isetshenziswe ngenxa yemiphumela emibi kwezinye izitho nezinhlelo - iTolazamide, Carbutamide.
- Imithi yesizukulwane sesibili, yona iGlibenclamide, Gliclazide ne-Glipizide bangabameli.
Ngaphezu kwalokho, kunezidakamizwa zesizukulwane sesithathu ezakhiwe ngesisekelo se-glimepiride.
Imithi yeBiguanide Group
Ukwelashwa kwezidakamizwa zohlobo lwe-2 yesifo sikashukela ngokuvamile kufaka ukusetshenziswa kwemithi eqenjini le-Biguanide group. Ngenxa yokusebenzisa kwabo, kunganda inani le-insulin elithelwe egazini.
Izidakamizwa ezinjalo zokwelapha uhlobo lwe-2 sikashukela i-mellitus zivimbela inqubo ye-gluconeogenesis, ukuthuthwa kwama-elektrikhi kwamaketanga e-mitochondrial energy. Izinqubo ze-glycolysis ziyavuselelwa, amaseli amunca kangcono ama-carbohydrate, futhi ukumunyiswa kwawo ngezindonga zamathumbu amancane emgodini weGastrointestinal kuyancipha.
Imithi ayibangeli ukwehla okubukhali kushukela wegazi, ngoba ayivusi ukukhululeka kwamaseli we-beta.
Indlela yokusebenza kwe-Biguanides emzimbeni womuntu ukubonakaliswa kwale miphumela elandelayo:
- kukhona ukwehla kwenani le-glycogen evela esibindini, okufaka isandla ekhuphukeni kwezinga le-carbohydrate egazini;
- ukuvinjwa kokuhlanganiswa kwe-glucose kusuka kumaphrotheni namafutha kuyenzeka;
- ukuhlanganiswa kokufakwa kweshukela kusibindi kuyasebenza;
- zonke izidakamizwa ze-Biguanide zisebenza njengezishoshovu zezinga lokuzwela kwamaseli nezicubu ukungena ku-insulin, nayo evimbela ukuthuthukiswa kokumelana kwama-hormone;
- asize ukunciphisa ukumuncwa koshukela okungena emathunjini;
- ngenxa yesenzo se-Biguanides, inqubo yokufaka ushukela ku-lactate ohlelweni lokugaya ukudla iyabonakala;
- kukhona ukwanda kwesilinganiso se-lipids egazini kanye nokwehla kwe-cholesterol emzimbeni;
- izicubu zemisipha ngaphansi kwethonya le-greatuanides ziqala ukumunca ushukela omningi.
Izidakamizwa zohlobo lwe-Biguanide Type 2 sikashukela zinenzuzo eyodwa engenakuqhathaniswa nezinye izidakamizwa - aziholeli ekuthuthukisweni kwe-hypoglycemia, okungukuthi, izinga likashukela wegazi alikho ngaphansi kwamazinga ajwayelekile.
I-Metformin hydrochloride isetshenziswa njengesithako esiyisisekelo esisebenzayo kuwo wonke amalungiselelo we-Biguanide abekwe kuwo. Ngokuya ngezidingo zeziguli, amaphilisi wohlobo lwe-2 yesifo sikashukela emithanjeni ehlukahlukene (500, 850, 1000 mg yento esebenzayo) noma ama-ejenti akhululwa isikhathi eside ayatholakala kwabanesifo sikashukela.
Izidakamizwa eziphambili ezenzelwe i-metformin zohlobo 2 sikashukela zithandwa kakhulu - uSiofor, Glyukofazh noFomuetin.
I-Alpha glucosidase nezidakamizwa ze-incretin inhibitor
Ukwelashwa ngezidakamizwa kungenziwa ngesisekelo sokuthatha izidakamizwa eqenjini le-incretin.
Kumele kwaziwe ukuthi ama-incretins ama-hormone akhiqizwa emgodini wesisu ngemuva kokudla.
Umsebenzi wabo ungumphumela ovuselelayo ekuqunjelweni kwe-insulin. Kulesi simo, ama-incretin aqala ukusebenza kuphela lapho kukhona inani elikhulayo le-glucose egazini, ngokuzwakala kwalesi simpawu, inqubo yokuvuselela ukukhiqizwa kwama-hormone iyamiswa.
Ngenxa yalesi sici, ukusetshenziswa kwama -retretins akuholeli ku-hypoglycemia.
Ngaphezu kwalokho, leyo mishanguzo ivimba ukumunwa kwama-carbohydrate emathunjini futhi, ngenxa yalokho, inciphisa izinga lokuhlanganiswa kwe-carbohydrate egazini.
Isakhi esisebenzayo somuthi yi-Sitagliptin.
Kuze kube manje, izidakamizwa ezineSitagliptin kuphela ekwakhiweni kwazo azitholakali.
Ngasikhathi sinye, kunenqwaba yemithi ehlanganisiwe emakethe, izakhi ezisebenzayo eziyinhloko zazo yi-sitagliptin ne-metformin.
Abamele abadume kakhulu izidakamizwa ezinciphisa ushukela njengeBagomet, Metglib neYanumet.
Amathebhulethi e-Alpha glucosidase inhibitor kushukela lesifo sikashukela asebenza njengama-blocker lapho kukhiqizwa i-enzyme ethile emathunjini encibilika ama-carbohydrate ayinkimbinkimbi.
Kungenxa yalokhu ukuthi ukumuncwa kwama-polysaccharides kwehliswa. Imithi yesimanje yesifo sikashukela iya ngokuya isetshenziswa kwezokwelapha ngenxa yokuthi inenamba elincane lemiphumela emibi kanye nokuphikiswa.
Amathebhulethi we-Alpha glucosidase inhibitor wohlobo 2 sikashukela athathelwa ngokushesha ngokudla futhi, ngaphezu komphumela obizwa ngokuthi yi-hypoglycemic, musa ukuvusa inzuzo eyengeziwe isisindo somzimba.
Inani lemithi efakiwe kuleli qembu lifaka iMiglitol ne-Acarbose, iGlucobay.
Isicelo sokwelashwa kwezifo ze-insulin
Naphezu kweqiniso lokuthi ngokuthuthuka kwenqubo ye-pathological, njengomthetho, inani elanele le-insulin egazini likhiqizwa ngohlobo 2 lwesifo sikashukela, kunezimo lapho kudingeka khona ukwelashwa kwe-insulin. Lesi simo sizibonakalisa lapho ukuwohloka komsebenzi wamanyikwe kuqashelwa ngenkathi kuthuthukiswa ukumelana ne-insulin.
Ngokungafani nefomu lokuncika le-insulin, abantu abanesifo sikashukela abanefomu elizimele lesifo banikezwa imijovo ye-insulin hhayi ngokwezidingo ezibalulekile, kodwa ukuthuthukisa ama-carbohydrate e-plasma, uma ezinye izindlela nezidakamizwa zingalethi umphumela odingekayo.
Ukulungiswa kwe-insulin kwifomu lesifo esincike ku-insulin kuvezwa ngokuhlukahlukahluka ngokuya ngesikhathi nesikhathi sokuqala kokubonakaliswa komphumela kanye nesikhathi somphumela wokwelapha.
Umuthi wanamuhla unikeza iziguli zawo ukusetshenziswa kwemithi ye-insulin elandelayo yokufakelwa yesifo esincike ku-insulin:
- Imithi yokuvezwa kwe-ultrashort.
- Ukuvezwa okufushane kwe-insulin.
- Imithi yehormonal yesikhathi esiphakathi yokuvezwa.
- I-insulin esebenza isikhathi eside.
Into yokuvezwa kwe-ultrashort yisidakamizwa, esibonisa imisebenzi yaso ngaphakathi kwemizuzu emihlanu ngemuva kokuphathwa. Umphumela omkhulu wokwelapha ubonwa cishe ihora elilodwa ngemuva komjovo. Kulokhu, umphumela womjovo uyaqhubeka isikhashana.
Izithako zemithi yokuvezwa okufushane, okuqala ukusebenza cishe isigamu sehora ngemuva kokufakwa kwayo ngaphansi kwesikhumba. Njengomthetho, yonke imishanguzo eyenziwe ngamafuphi yenzelwe ukwenza ukubukeka kwe-hyperglycemia kuvame ukubonwa ngemuva kwesidlo sikashukela.
Umuthi weHormone wesikhathi esiphakathi uvame ukusetshenziswa ngokubambisana nama-insulin amafushane. Isikhathi sethonya labo, njengomthetho, sithatha amahora ayishumi nambili kuya kwayishumi nesithupha. Umphumela wokwelapha ngemuva kokuba umjovo uqala ukuvela ngemuva kwamahora amabili kuya amathathu, futhi ukuqina okuphezulu egazini kuyabonakala ngemuva kwamahora ayisithupha kuya kwayisishiyagalombili.
Umuthi we-hormonal osebenza isikhathi eside usetshenziswa ngokuhlangana nama-insulin amafushane. Kumele iphathwe kanye ngosuku, imvamisa ekuseni. Inhloso ye-insulin esebenza isikhathi eside ukugcina izinga elijwayelekile le-glycemia ebusuku.
Yiziphi izidakamizwa ezingasiza ukwelapha isifo sikashukela ezichazwe kule vidiyo kule ndatshana.
