Ngokwesifo sikashukela sohlobo 2, udokotela unquma ukudla okudla okuphansi kwe-carb, ukuqeqeshwa kahle kwezemidlalo, namaphilisi okwehlisa ushukela, asiza ukugcina ukunakekelwa kukashukela wegazi kusesimweni esidingekayo.
Okwamanje, kunenketho enkulu yemithi yokunciphisa ushukela yesizukulwane esisha okufanele ithathwe ngohlobo lwesibili sikashukela. Zonke zihlukile ohlelweni lokusebenza, zinezinkomba zazo kanye ne-contraindication, ukusabela okungekuhle.
Amathebhulethi anamuhla akhethwa ngawodwana, izici eziningi zinakwa njengeminyaka yesiguli, "ulwazi" lwe-pathology, ukugula okuhlobene kanye nezinkinga ezikhona.
Ukuhlukaniswa kwemithi ekwehlisa ushukela esetshenziselwa uhlobo 1 nesifo sikashukela kufanele kubhekwe. Khomba ukuthi imiphi imishanguzo yesizukulwane esisha esebenza kahle kakhulu, futhi ukusebenza kwayo kuncikephi?
Ukuhlukaniswa kwezidakamizwa
Kungcono ukunquma amaphilisi anciphisa ushukela lapho isiguli sinezinga eliphakeme likashukela emzimbeni, kanye nasekutholakaleni kwesifo sikashukela sekwephuzile.
Noma ngokumelene nesizinda sokuntuleka kwemiphumela isikhathi eside ngemuva kwenkambo yokwelapha, enconywe ngaphambili.
Khumbula ukuthi le mithi ayisetshenziselwa ukwelapha isifo sikashukela sohlobo 1, futhi inconywa ngokunakekelwa okukhethekile ngesikhathi sokukhulelwa.
Ukuhlukaniswa kwezidakamizwa zohlobo 2 sikashukela:
- Ama-Derivatives we-sulfonylureas aba nomthelela ekwehleni kwezinga le-glycogen esibindini, ahlinzeke ukukhiqizwa okukhuphukile kwehomoni (insulin) ngenhloso elandelayo yokubuyisa amaseli we-pancreatic.
- AmaBiguanides kanye ne-thiazolidinediones izidakamizwa ezandisa ukuthikamezeka kwezicubu zomzimba emzimbeni ziye ku-hormone, kuyilapho zinciphisa ukumunca ushukela emathunjini.
- I-Meglitinides inamandla okukhulisa ukukhiqizwa kwe-pancreatic insulin.
- Ama-inhibitors we-Alpha glucosidase anconyelwa ukunciphisa ushukela emzimbeni, andise umsebenzi wokugaya ukudla kwe-carbohydrate emathunjini, futhi anciphise isisindo somzimba ngokunciphisa ukumuncwa kwama-carbohydrate.
Eqinisweni, ukuhlukaniswa kwezidakamizwa ezinciphisa ushukela kukhulu kakhulu kunalokho okungenhla. Okwamanje, uhlu lungafakwa nezidakamizwa zesizukulwane sesine - uGalvus, Januvia.
Ngokuhlanganiswa kwale mishanguzo neminye imithi, kungenzeka ukuthi kunciphise kakhulu ukugcwala kwe-glucose emzimbeni.
Sulfonylureas
Imithi yalesi sigaba isetshenziswe kwezokwelapha isikhathi esingaphezu kwengxenye yekhulu, futhi ithola idumela elihle ngenxa yokusebenza kwayo. Banomphumela wehlise ushukela, ngoba bathinta ngqo amaseli we-pancreatic.
Ukuphendula kwe-biochemical okwenzeka emzimbeni womuntu kufaka isandla "ekukhululweni" kwe-insulin, ngenxa yalokho i-hormone engena ohlelweni olujwayelekile lokujikeleza komuntu.
Imithi yaleli qembu ikhulisa ukuthikamezeka kwezicubu ezithambile kushukela, isiza ukugcina ukusebenza kwezinso okuphelele futhi inciphise nengozi yokuhlakulela i-pathologies ye-inhliziyo.
Kodwa-ke, ngokubhekisele emuva kwezinzuzo zezinsizakusebenza ze-sulfonylurea, imiphumela emibi ekusebenziseni kwabo ingahlukaniswa:
- Ukwehla kwamaseli we-beta wesikhumba.
- Ukungezwani komzimba.
- Isisindo senzuzo.
- Ukwephulwa komgudu wokugaya ukudla.
- Ingozi eyandayo ye-hypoglycemia.
Ngesikhathi sokulashwa ngalezi zidakamizwa, isiguli kufanele silandele ukudla okune-carb ephansi, futhi ukuphuza amaphilisi kufanele kuboshelwe ekudleni ukudla. Ama-draivatives we-sulfonylureas awabekelwe ukwelashwa kwesifo sikashukela se-pancreatic, kanye nangesikhathi sokukhulelwa nokuqunjelwa.
Izidakamizwa ezidonsa ushukela ezidumile zesifo sikashukela kuleli qembu:
- I-Maninil yithebhulethi enamazinga ahlukile wesithako esisebenzayo kumthamo, inganconywa kuzo zonke izigaba zokukhula kwe-pathology. Ukwemukelwa kwalesi sidakamizwa kunikeza ukunciphisa ushukela kusuka emahoreni ayi-10 kuye kwangama-24, kufakiwe.
- I-Glycvidone iboniswa ubuncane be-contraindication, futhi kunconyelwa iziguli esezikhulile, kanye nalabo abangasizanga isondlo esifanele. Umuthi unqunyelwe ngisho noma ungasebenzi kahle izinso, ngoba azibambi iqhaza ekuwususeni emzimbeni.
- I-Amaryl ingenye yezidakamizwa ezihamba phambili zohlobo lwesibili lwesifo. Akuvusi ukwanda kwesisindo somzimba, futhi akunikezi imiphumela emibi ohlelweni lwezinhliziyo.
- I-Diabeteson ikhombisa ukusebenza kahle okuphezulu esigabeni sokuqala sokukhiqizwa kwama-hormone. Futhi ingeza ukuvikela kwemithambo yegazi emiphumeleni emibi ye-glucose ephezulu emzimbeni.
Intengo yamathebulethi eManinil iyahlukahluka kusuka kuma-ruble ayi-150 kuye kwangama-200, i-Amaril ibiza ama-ruble angama-300 ngezingcezu ezingama-30, kuthi iGlycvidon ibize cishe ama-ruble angama-450. Intengo yesifo sikashukela ngama-ruble angama-320.
I-Meglithinide Therapy
Indlela yokusebenza yalesi sigaba semithi ukuvusa ukukhiqizwa kwe-gland yi-gland. Ukusebenza kwesidakamizwa kuhlobene ngqo nokuhlushwa ushukela. Lapho ephakeme, kuzokhiqizwa ama-hormone amaningi.
Abamele abaphambili baleli qembu yiNovoNorm ne-Starlix, ahlobene namathebulethi esizukulwane sakamuva, futhi abonakala ngomphumela omfushane. Udinga ukuthatha umuthi imizuzu embalwa ngaphambi kokudla.
Njengomthetho, ngobuningi bamacala, le mishanguzo inconywa njengengxenye yokwelashwa okuyinkimbinkimbi. Banemiphumela emincane emincane efana nobuhlungu besisu, uhudo, ukusabela komzimba.
Izici zokusebenzisa kanye nemithamo yemithi:
- Umthamo weNovoNorm uhlala ukhethiwe ngokuhlukile. Imvamisa ukunikezwa ukuthatha izikhathi ezintathu kuya kwezine ngosuku, ngokushesha ngaphambi kokudla. Umuthi usebenza kahle, ngakho-ke amathuba okuba wehle kakhulu ushukela ancishiswe abe ngu-zero.
- Iqoqo eliphezulu lento esebenzayo ye-Starlix ibonwa egazini eli-1 ngemuva kokuthatha amaphilisi. Ngalesi sikhathi, imiphumela yempelesi yomuthi iyabonakala, ethatha amahora angama-8.
I-Starlix ayifaki sandla ekuzuzeni isisindo, ayithinti kabi umsebenzi kanye nesimo sezinso, futhi futhi ayisihlukumezi isibindi. Umthamo wesidakamizwa uncike ezimweni eziqondene nesiguli nomlando wakhe wezokwelapha.
Intengo yeNovoNorm iyahlukahluka kusuka kuma-ruble ayi-180 kuya kwangama-200, i-Starlix iyisidakamizwa esibizayo, futhi amaphilisi ayi-120 azobiza cishe ama-ruble ayi-15,000.
Ukwelashwa nge-biguanides ne-thiazolidinediones
Imithi yaleli qembu, ikakhulukazi i-greatuanides, ayivumeli ukukhishwa kwe-glucose esibindini, ngenkathi ihlinzeka ngokugaya okungcono nokuhambisa ushukela ezingeni lamaselula nasezicubu ezithambile zomzimba womuntu.
Le mishanguzo ayikaze ibekelwe ukwelashwa kwe-Type 2 sikashukela ezigulini ezinomlando wezinso noma ukuhluleka kwenhliziyo.
Isikhathi sokusebenza kwezidakamizwa siyehluka kusuka emahoreni ayisithupha kuya kwayi-16, futhi ngasikhathi sinye asifaki sandla ekushintsheni okungazelelwe kwe-glucose emzimbeni. Imiphumela emibi ejwayelekile i-nausea, izinkinga zokugaya ukudla, kanye nezinguquko zokunambitheka.
Eqenjini lama-Biguanides, izidakamizwa ezinciphisa ushukela wohlobo 2 sikashukela, uhlu lumi ngokulandelayo:
- I-Siofor yisidakamizwa sokuqala esinconyelwe iziguli ezinanoma yisiphi isigaba sokukhuluphala noma esinesisindo esikhulu somzimba, ngoba sinikela ukunciphisa umzimba. Umthamo omkhulu ngosuku ngamagremu amathathu, futhi kufanele uhlukaniswe ngama-doses ambalwa.
- I-Metformin isiza ukwehlisa ukufakwa kweshukela emathunjini, futhi iphinde ishukumise ukusetshenziswa kwayo kwezicubu zomzimba. Contraindication: umsebenzi wezinso ongasebenzi kahle, isikhathi sokuvuselelwa ngemuva kokuhlinzwa.
Intengo yezimali incike kumenzi, inani lamathebulethi kuphakethe futhi liyahlukahluka kusuka kuma-ruble angama-200 kuye kwangama-300.
Ama-Thiazolidinediones asebenza kumgomo ofanayo nama-biguanides. Kodwa-ke, isici esihlukanisayo ukuthi abiza kakhulu, ngenkathi enohlu olukhulu lwemiphumela emibi.
Leli qembu lingavezwa ngemithi elandelayo:
- Ama-Actos angabekwa njenge-monotherapy ekwelapheni isifo sohlobo lwesibili. Ngokwehluleka kwemithi, ukwanda kwesisindo somzimba ngesikhathi sokuphathwa kwaso kuyaphawulwa.
- I-Avandia ingumuthi okwenziwa isenzo sawo okuhloswe ngawo ukwenza ngcono izinqubo ze-metabolic, ukwehlisa ukugxilwa kukashukela, kanye nokwandisa ukuthikamezeka kwezicubu ze-insulin.
Ezimweni eziningi zamacala, i-Avandia ichazwa njengengxenye yokwelashwa okuhlanganayo, futhi akuvamile ukuthi isidakamizwa esisodwa. Kwenqatshelwe ngokuqinile ukusebenzisa ngesikhathi sokuzala, ebuntwaneni, ngezinkinga ngohlelo lwenhliziyo.
Intengo ephakathi kumakhemisi e-Avandia ngama-ruble angama-600-800. Ama-Actos azobiza isiguli kusuka kuma-ruble ayi-3000.
I-Alpha Glucosidase Inhibitors
Le mithi yesifo sikashukela isiza ukuvimba i-enzyme ethile yamathumbu encibilika ama-carbohydrate ayinkimbinkimbi. Ngenxa yalokhu, inqubo yokumuncwa kwama-polysaccharides iba kancane.
Ama-inhibitors we-Alpha-glucosidase ayizidakamizwa zesimanje ukwehlisa ushukela wegazi, empeleni awunayo imiphumela emibi, futhi ungavumeli ukwephulwa komgudu wokugaya kanye nokugaya esiswini.
Amatafula kufanele athathwe ngokushesha "nge-sip yokuqala yokudla." Ukubuyekezwa kweziguli kukhombisa ukuthi umuthi ubhekana ngempumelelo nomsebenzi wokwehlisa ushukela wegazi, ngenkathi kungekho mphumela kumanyikwe.
Imithi ekulesi sigaba ingahlanganiswa ngempumelelo namanye amaphilisi okwehlisa ushukela, kanye ne-insulin. Kodwa-ke, lokhu kukhulisa amathuba okukhula kwe-hypoglycemia.
Abamele aziwa kakhulu nabasebenza ngempumelelo baleli qembu:
- IGlucobai inqunywa lapho kuba nokugxuma okubukhali kushukela ngokushesha ngemuva kokudla. Ibekezelelwa kahle iziguli, ayithinti isisindo somzimba. Amaphilisi anconyelwa njengokwelashwa kwe-adjunct okuphelisa ukudla okune-carbohydrate ephansi. Umthamo omkhulu ngosuku ngu-300 mg, ohlukaniswe waba yizicelo ezintathu.
- I-Miglitol ingumuthi obekelwe ukwelashwa kwesifo sikashukela sohlobo 2, lapho ukudla kanye nokuzivocavoca kunganikanga umphumela owafunwayo wokwelapha.
Imithamo ye-Miglitol ikhethwe ngokwahlukile, ngokomqondo, njengoba imvamisa yokusetshenziswa kwayo. Akunakubekwa ngesikhathi sokuzala kwengane, ebuntwaneni, ngezifo ezingamahlalakhona zethambo lesisu, kanye nokuba khona kwe-hernias enkulu.
Intengo yeGlucobay iyahlukahluka kusuka kuma-ruble angama-500 kuye kwangama-800, iMiglitol ibiza cishe ama-ruble angama-600.
Imithi Yesizukulwane esisha
Imboni yezemithi ayimi, minyaka yonke kwenziwa izidakamizwa ezintsha ukulwa nohlobo lwesifo sikashukela sohlobo 2. Muva nje, kuye kwavela lokho okubizwa ngokuthi yi-dipeptidyl peptidase inhibitors, okusiza ukuthuthukisa ukwakheka kwe-insulin, kepha ngasikhathi sinye baqondiswa inani leshukela egazini.
Kunoma yimuphi umzimba ophile kahle, ama-hormone angaphezu kwama-75% akhiqizwa ngaphansi kwethonya lamahomoni athile, ahlanganiswe esigabeni sama-insretins.
Izinto ezinjalo zidala inqubo esiza ukukhipha i-glucose esibindini kanye nama-secrete hormone ngokusebenzisa amaseli we-pancreas. Izidakamizwa zakamuva zingasetshenziswa njenge-monotherapy, futhi zingafakwa ekwelashweni okuyinkimbinkimbi.
Umuthi kufanele uphuzwe ngesikhathi sokudla noma ngemuva kwawo. Babekezelelwa kahle yiziguli. Abamele Bright baleli qembu ngamatafula anjengalawa:
- UJanuvia umuthi wethebhulethi ohlanganisiwe. Amathebulethi athathwa kanye ngosuku, awakhuphi ukukhuphuka kwesisindo somzimba, afaka isandla ekunakekelweni ushukela ojwayelekile esiswini esingenalutho, kanye nangemva kokudla. Kuyaphawuleka ukuthi umuthi uvimbela ukuqhubeka kwe-pathology, wehlisa amathuba okuba nezinkinga.
- IGalvus ingumuthi ovuselela ukusebenza kwamanyikwe. Kunconywa njengendlela yokwelapha i-monotherapeutic, igcwalisa ukudla okudla kahle kanye nokuzivocavoca umzimba okwanele. Ingabekwa ngokuhlanganiswa.
Intengo yamathebulethi kaJanuvius isuka kuma-ruble ayi-3000, kuya ngomkhiqizi nenani lamathebulethi amaphakethe, izindleko zingenyuka. Futhi kuGalvus intengo ingama-ruble angama-800-1600.
Amaphilisi nokukhulelwa
Njengoba imininingwane engenhla ibonisa, izidakamizwa eziningi zibiza ukuphikisana nesikhathi sokuzala ingane. Futhi iqiniso ukuthi izingxenye ezisebenzayo ziyakwazi ukungena kwi-placenta, ngokulandelana, zithinta ukukhula kwengane yesikhathi esizayo.
Uma isiguli sitholakala sine-Type 2 sikashukela mellitus, futhi saphuza izidakamizwa ezinciphisa ushukela, sinconywa ukwelashwa kwe-insulin ngesikhathi sokukhulelwa. Futhi lokhu kwenzeka ngokumelene nesizinda sokuqapha njalo ngudokotela oya kuye, ushukela uhlala ulinganiswa.
I-hormone inqunywe ngudokotela kumthamo lapho intombazane noma owesifazane phambilini ayephuza amaphilisi ukwehlisa ushukela emzimbeni. Okubaluleke kangako ngesimo esijwayelekile ukwelashwa kokudla.
Ukuhambisana nazo zonke izincomo zikadokotela kuzovikela izingqinamba eziningi ezinzima ezibangelwa kokuqukethwe ushukela okuphezulu emzimbeni.
Ividiyo ekulesi sihloko inikeza umbono ophelele wezidakamizwa ezithoba ushukela i-Amaryl.
