Izindlela zanamuhla zokwelapha isifo sikashukela zibandakanya ukusetshenziswa kwezidakamizwa zokwelapha ezingamaqembu ahlukahlukene ngezinhloso zokwelapha.
Kuze kube manje, izinhlobo eziyisithupha ezahlukahlukene zemithi enciphisa ushukela zivelele ekhemisi.
Izidakamizwa ezokwehlisa ushukela zisetshenziswa kuphela uma isiguli sine-Type 2 sikashukela mellitus, esingancike ku-insulin.
Zonke izidakamizwa zingamaqembu alandelayo wezokwelapha:
- IBiguanides.
- I-Glinidam.
- I-Glitazone.
- I-alfa glucosidase inhibitors.
- Ukuvinjwa kwe-DPP-4.
- Ama-Sulfonamides.
- Kuhlanganisiwe.
Iqembu lama-Biguanides lifaka isidakamizwa esisodwa - iMetformin. Leli thuluzi belisetshenziswa kusukela ngo-1994. Ithuluzi yiyona esetshenziswa kakhulu ukunciphisa ushukela emzimbeni.
I-Glitazones ifaka umuthi owodwa - iPioglitazone. Umuthi usiza ukwandisa ulwelwesi lwamaseli wezinsizi ezifika emgodini we-insulin futhi uthuthukisa izinga lokudla okunamafutha emzimbeni.
I-Alpha-glucosidase inhibitors ivimbela ukugaya kwe-carbohydrate, ivikele ukungena kweglucose kuplasma wegazi.
I-DPP-4 inhibitors ivimbela ukubhujiswa kwe-glucagon-polypetide 1 (GLP-1) futhi ivimbele i-enzyme DPP-4.
Ama-Sulfanilamides asetshenziswa njengezidakamizwa ezinciphisa ushukela futhi zithandwa kakhulu. Isenzo sezidakamizwa zaleli qembu sisuselwa ekuvuseleleni kwenqubo yokukhiqizwa kwe-insulin ngamaseli e-pancreatic. Njengamanje, amakilasi ama-4 ama-sulfonamides asethuthukisiwe.
Imithi ehlanganisiwe ingama-ejenti anezakhi eziningana ezisebenzayo ezisebenzayo ekwakhekeni kwazo.
Ama-Glinids afaka izidakamizwa ezimbili ekwakhiweni kwazo - i-Repaglinide neNateglinide. Izidakamizwa zinomphumela ovuselelayo kumaseli we-beta wezicubu ze-pancreatic.
Ngaphezu komphumela wokwehlisa ushukela, i-ironides inezinye izakhiwo:
- akunikeleli ekuzuzeni isisindo;
- lapho usebenzisa izidakamizwa zaleli qembu esigulini, amathuba we-hypoglycemia anciphisa izikhathi eziningana ngokuqhathaniswa ne-sulfonamides.
Njenganoma imuphi umuthi, izikhwama zeqembu lobumba zinemiphumela emibi eminingana:
- uma isetshenziswa, kunethuba lokuthuthuka kwe-hypoglycemia;
- Akunconywa ukusebenzisa umuthi uma isiguli sinezifo ezithile zesibindi.
Izidakamizwa zeClinid zivame ukusetshenziswa njengezakhi zokuqala ukwelashwa kwe-Type 2 sikashukela mellitus.
Izinkomba kanye ne-contraindication zokusetshenziswa kobumba
Isibonakaliso esiyinhloko sokusetshenziswa kobumba wukuba khona kohlobo lwesifo sikashukela sohlobo II esigulini lapho kungaphumeleli khona lapho kusetshenziswa ukwelashwa kokudla kanye nomsebenzi womzimba.
Izidakamizwa zaleli qembu zisetshenziselwa ukunciphisa izinga loshukela emzimbeni wesiguli.
Njenganoma yisiphi isidakamizwa, imithi yeqembu lobumba inezindlela eziningi zokuphikisana ukuze isetshenziswe.
Ukuxhumana kokusetshenziswa kobumba yilezi ezilandelayo:
- Ukuba khona kwe-hypersensitivity.
- Ukuba khona kohlobo lweshukela sikashukela esigulini.
- Ukuthuthukiswa emzimbeni wezimo ezidinga ukwelashwa kwe-insulin.
- Ukuba khona kwezifo ezinzima ekusebenzeni kwezinso nesibindi.
- Isikhathi sokukhulelwa nesikhathi sokuncelisa.
Akunconyelwe ukuthi kunikezwe ama-glinids ezigulini zezingane kanye nentsha engaphansi kweminyaka engu-18, ngaphezu kwalokho, akunconywa ukusebenzisa izidakamizwa ekwelapheni isifo sikashukela ezigulini ezingaphezu kweminyaka engama-75.
Imiphumela emibi ejwayelekile yokusebenzisa lolu hlobo lwesidakamizwa yilena:
- ukuphazamiseka kokusebenza kwamapheshana emathunjini, okubonakala ngokubonakala kokuhlanza nemizwa yokucanuzelelwa kwenhliziyo;
- kwezinye izimo, ukuvela kokungezwani komzimba kuvela, kuboniswe ngesimo sokuqhuma kwesikhumba
- ngezinye izikhathi kunokukhula okwesikhashana komsebenzi we-transamylase.
Kwezinye izimo, kunokulimazeka okubukwayo, okuhambisana nokushintshashintsha kwezinga loshukela emzimbeni.
Umshini wesenzo sobumba
Ama-glinides ayizisusa zokukhiqizwa kwe-insulin. Le mishanguzo ihlukile kuma-sulfonamides hhayi ngokwesakhiwo kuphela, kepha futhi nangokhemisi. Ama-Glinids athuthukiswa njengemithi esiza ukusiza ukubuyisela nokwandisa inani le-insulin ye-pancreatic hormone eyenziwe nge-beta cell.
Ama-glinids kufanele athathwe kuphela ngesikhathi sokudla, lokhu kukuvumela ukuthi unamathele ekudleni okukhululekile xaxa ngokuqhathaniswa nokudla lapho uthatha i-sulfonamides.
Ama-Meglitinides anokuphila okufushane okuyingxenye, okunciphisa amathuba okukhula kwesimo se-hypoglycemic.
Okwamanje, ama-meglitinides afaka imithi emibili - i-Nateglinide ne-Repaglinide.
Ukusebenza kwesimo somuthi kuncike kumphumela wawo kwiziteshi ze potassium ezincike ku-beta-cell membranes. Lokhu kuholela depolarization ulwelwesi kanye nokuvulwa iziteshi calcium. Ngemuva kokuchayeka kwezicubu ze-pancreatic, izidakamizwa zikhulisa ukungena kwe-calcium ion kumaseli kusuka esikhaleni se-interellular.
Ukwanda kokuhlushwa kwe-calcium esitokisini kusebenze inqubo yokukhiqizwa kwe-insulin.
Ukuxhumeka okwakhiwa yi-meglitinides nama-cell receptors akuzinzile, ngakho-ke, okuyinkimbinkimbi okwakhiwe kuhlala isikhathi esifushane.
Ukulungiselela ama-Clinid, lapho kungeniswa emzimbeni, kufinyelela ekugxilweni okuphezulu egazini ihora elilodwa ngemuva kokuphathwa. I-bioavailability yemithi icishe ibe yi-56%.
Ukuphathwa kanyekanye kwezidakamizwa ngokudla akusithinti kakhulu isikhathi sokufika kwenani eliphakeme lekhompiyutha esebenzayo egazini, kanti isilinganiso esiphezulu sekhompiyutha sincishiswa ngo-20%. Ama-Glinides akwazi ukubopha amaprotheni e-plasma, izinga lokubopha lifinyelela ku-98%.
Ukuphila kwesigamu umuthi okuvela emzimbeni cishe kuyihora elilodwa.
Ukuhoxiswa kwamalungiselelo eqembu lobumba kwenziwa ikakhulu ngamalongwe. Ngale ndlela, cishe ama-90% ama-metabolites akhiwa ngesikhathi se-metabolism ayachithwa. Ngaphezu kwalokho, ukuhoxiswa kwalo muthi kwenziwa kancane ngohlelo lwe-excretory ngomchamo.
Ukungathandeki kwalolu hlobo lwezidakamizwa isidingo semithamo eminingi yezidakamizwa usuku lonke kanye nezindleko eziphakeme zemithi.
Ukusetshenziswa kwe-Starlix yezidakamizwa
I-Starlix yisidakamizwa esithathwa ngokushesha ngaphambi kokudla lapho kulashwa uhlobo lwe-2 mellitus yesifo sikashukela. Isikhathi sokuthatha umuthi nokudla akufanele sidlule amahora angama-0.5.
Lapho usebenzisa umuthi nge-monotherapy, kunconywa umthamo owodwa we-120 mg. Umuthi kufanele uphuzwe kathathu ngosuku. Umuthi kufanele uphuzwe ngaphambi kokudla kwasekuseni, kwasemini kanye nakusihlwa.
Uma irejimeni yomuthi enconyiwe ingavumeli ukufezekisa umphumela owufunayo wokwelapha, umthamo owodwa ungandiswa ube ngu-180 mg.
Ukulungiswa komthamo osebenzayo wesidakamizwa kwenziwa njalo ngokuya ngemiphumela yocwaningo lwelabhorethi yezinkomba ze-HbA1c kanye nezinkomba ze-glycemia ihora elilodwa kuya kwamabili ngemuva kokudla.
I-Starlix, uma kunesidingo, singasetshenziswa njengengxenye ekwelashweni okuyinkimbinkimbi kohlobo lwesifo sikashukela sohlobo 2. Umuthi ungasetshenziswa ngokuhlangana ne-metformin.
Lapho usebenzisa i-Starlix ngokuhlangana neMetformin, umthamo owodwa osetshenzisiwe kufanele ube ngu-120 mg kathathu ngosuku. Umuthi ngesikhathi sokwelapha okuyinkimbinkimbi uthathwa ngaphambi kokudla.
Esimweni lapho phakathi nokwelashwa okuyinkimbinkimbi, inani le-HbA1c lisondela kwisikhombi esimiselwe ngokomzimba, umthamo we-Starlix othathwe ungancishiswa ufinyelele ezingeni lama-60 mg kathathu ngosuku ngokubona kukadokotela obonayo.
Ukusetshenziswa kwesidakamizwa i-Novonorm
Isidakamizwa i-Novonorm yisidakamizwa, esifaka i-repaglinide kumthamo we-0.5, 1 noma 2 mg njengesithako esiyisisekelo esisebenzayo.
Umthamo wokuqala wokwelashwa kwesifo sikashukela kufanele ube ngu-0.5 mg wekhompiyutha esebenzayo.
Ukwanda komthamo akuvunyelwe ngaphambi kwezinsuku ezingama-7-14 ngemuva kokuqala kokusetshenziswa kwomuthi njalo.
Uma kutholakala ukwehluleka kwesibindi esigulini esinesifo sikashukela i-mellitus, i-HbA1c ibhekwe kaningi kunangaphambi kwamasonto ama-2.
Umuthi uvunyelwe ukusetshenziselwa imithamo ephezulu elandelayo:
- Umthamo owodwa womuthi kufanele ube ngu-4 mg wesidakamizwa esisebenzayo.
- Umthamo wansuku zonke wezidakamizwa akufanele udlule i-16 mg.
Isikhathi esifanele sokuthatha umuthi yimizuzu eyi-15 ngaphambi kokudla, kodwa futhi kungenzeka ukuthi uthathe imishanguzo imizuzu engama-30 ngaphambi kokudla ukudla noma ngokushesha ngaphambi kokuqalisa kwawo.
Uma isidlo sokweqiwa yiziguli, khona-ke lesi sidakamizwa naso akufanele sithathwe.
Ekwenzeni isidlo esingeziwe, kufanele kusetshenziswe nesidakamizwa.
Umehluko omkhulu phakathi kwe-Starlix neNovonorm ukuthi owokugcina uyakwazi ukwehlisa ngempumelelo amazinga kashukela hhayi nje kuphela ngemuva kokudla, kodwa naphakathi kokudla okunjalo. Lokhu kungenxa yamandla engxenye esebenzayo yokujoyina i-SUR receptor futhi yakhe isibopho esiqinile ngokwengeziwe nayo.
Kumele kuqashelwe ukuthi i-Starlix incane ukuvusa ukubonakala kwezimpawu zesimo se-hypoglycemic ngokuqhathanisa neNovonorm.
Imiphumela Yama-Clinide Side Nezindlela Zokuqapha
Ngemuva kokuphathwa ngomlomo, amalungiselelo eqembu le-glinid avuselela izinqubo zokutholwa kokuqala kwe-insulin kumaseli we-beta wezicubu ze-pancreatic ezithinta isenzo salolu hlobo lokulungiselela. Ukusetshenziswa kwalezi zidakamizwa kwephula imiyalo yokusetshenziswa noma izincomo ezitholwe ku-endocrinologist ohambelayo uyakwazi ukuvusa isiguli ngohlobo 2 lwesifo sikashukela, okuyisifo esisebenza ngokuzimela se-insulin esinezimpawu ze-hypoglycemia.
Umphumela onjalo emzimbeni udinga ukusetshenziswa kwezidakamizwa ngokushesha ngaphambi kokudla.
Ngokuhambisana nayo yonke imithetho nezincomo uma usebenzisa umkhiqizo okwelapha weqembu lobumba, akubangeli isimo se-hypoglycemic.
Le mishanguzo isebenza kakhulu lapho isetshenziswa ezigabeni zokuqala zokukhula kwesifo sikashukela sohlobo 2. Izigaba zokuqala zokukhula kwalesi sifo zihlukaniswa iqiniso lokuthi ngalesi sikhathi umsebenzi wokusebenza kwamaseli we-pancreatic, obhekene nokuhlanganiswa kwe-insulin, uyagcinwa.
Amathuba okukhula kwesimo se-hypoglycemic emzimbeni wesiguli esinohlobo 2 sikashukela cishe silingana nemvamisa ye-hypoglycemia nokusetshenziswa kwe-sulfonylurea derivatives yokuba nesikhathi esifushane sokwenza.
Lapho usebenzisa amalungiselelo eqembu lobumba, ukunakekelwa okukhethekile kufanele kuthathwe uma isiguli sinokuhluleka kwesibindi. Lokhu kungenxa yokuthi i-metabolism eyinhloko yezidakamizwa yenziwa kumaseli wesibindi. Zombili lezi zidakamizwa ezikuleli qembu zibopha i-cytochrome P-350, ebhekisela ezingxenyeni zohlelo lwe-enzyme yesibindi.
Ukuqapha kufanele kuthathwe lapho usebenzisa izidakamizwa esimweni lapho kungenakwenzeka ukulawula kahle izinga le-glycemia emzimbeni. Izimo ezinjalo zingaba ukukhula kokutheleleka emzimbeni, usizi olunzima, ngesikhathi sokuhlinzwa. Uma kwenzeka lesi simo, umuthi kufanele uyekwe bese ushintshela ekusebenziseni i-insulin therapy.
Imininingwane ngezidakamizwa ezisetshenziswa ekwelapheni isifo sikashukela ichaziwe kuvidiyo kule ndatshana.
