Ngobudala, umsebenzi wamanyikwe womuntu uyeva futhi izinhlobo zemithi yokudla izidakamizwa ziyaphazamiseka, okuvame ukuholela ekwakhiweni kwesifo sikashukela asebekhulile. Ukwelashwa kwalesi sifo kudinga indlela ekhethekile, njengoba esekhulile iziguli zingahlushwa uhla lwezifo ezingamahlalakhona, okuyi-contraindication ngokuthatha izidakamizwa eziningi zesifo sikashukela.
Ngakho-ke, zombili lezi ziguli ngokwazo nezihlobo zazo kufanele zazi ukuthi hlobo luni lwezibhebhe zesifo sikashukela ezigulini esezikhulile ezisetshenziswa emithini yesimanje, ukuthi ungazithatha kanjani futhi uzihlanganise ngokufanele. Ukwelashwa kwesifo sikashukela kubantu asebekhulile, okwenziwe ngokuya ngemithetho yonke, kungayandisa kakhulu impilo yomuntu osekhulile futhi kuyenze iphelele.
Izimbangela zesifo sikashukela asebekhulile
Ngemuva kweminyaka engama-50, umuntu unokuncipha okubonakalayo kokubekezelela i-glucose, okuholela ekukhuleni kancane kancane koshukela wegazi. Ngakho-ke lapho ineminyaka yobudala engama-60, izinga likashukela wegazi esiswini esingenalutho lukhuphuka ngokwesilinganiso esingu-0,05 mmol / L, nangemva kokudla ngo-0,5 mmol / L.
Lo mkhuba uyaqhubeka ngokuzayo futhi njalo eminyakeni eyishumi ezayo, izinga likashukela wegazi lomuntu osekhulile lizokhula ngokuqinile. Ngaphezu kwalokho, kubalulekile ukugcizelela ukuthi lezi zinkomba zingaphakathi futhi kubantu abathile abaneminyaka yobudala, amazinga kashukela akhuphuka ngezinga eliphakeme.
Kunezinto ezintathu ezibalulekile zokuthuthukiswa kwesifo sikashukela sohlobo 2 kubantu abangaphezulu kweminyaka engama-50. Ngisho nokuba khona komunye wabo kukhulisa kakhulu ingozi yokuthola lesi sifo, futhi ukuba khona kwamathathu kwabangu-95 kwayi-100 kuholela ekuhlolweni kwesifo sikashukela.
Kungani isifo sikashukela sikhula kubantu asebekhulile:
- Ukwehla kokuzwela kwezicubu zangaphakathi kuya ku-insulin (ukumelana ne-insulin) okubangelwa izinguquko ezihlobene nobudala emzimbeni;
- Ukunciphisa ukukhiqizwa kwe-insulin ngama-pancreatic β-cell;
- Ukukhiqizwa okwehlisiwe kwama-hormone we-incretin kanye nomphumela wawo obuthakathaka emzimbeni kubantu asebekhulile.
Ukuphikiswa kwe-insulin kuvame ukutholakala kubantu abakhulile, kepha kuvame kakhulu ukuthinta abesilisa nabesifazane asebekhulile abakhuluphele ngokweqile. Uma izimpawu zokuqala zokulimala kwezicubu ku-insulin zingathathi izinyathelo ezidingekayo, khona-ke lokhu kuphulwa kuzoholela nakanjani ekuthuthukisweni kwesifo sikashukela mellitus.
Kubantu besisindo esijwayelekile, into esemqoka ethonya ukuthuthukiswa kwesifo sikashukela ukwehla komkhiqizo we-insulin. Ezigulini ezinjalo, ngemuva kokudla, amanyikwe awaqali ukusebenzisa i-insulin ngenkuthalo, njengoba kwenzeka kubantu abanempilo, okubangela ukwanda okukhulu koshukela wegazi.
Ama-incretin angama-hormone akhiqizwa ipheshana lesisu ngesikhathi sokudla futhi okwenza kusebenze ukukhiqizwa kwe-insulin. Ngokuntuleka kwalawa mahomoni abalulekile noma ukuncipha kokuzwela kwezicubu kuwo, isiguli sivezwa cishe ngama-50% ngaphansi kwe-insulin kunabantu abanesistimu yokugaya ukudla enempilo.
Kodwa zonke izimbangela ezingenhla zesifo sikashukela, njengomthetho, ziyimpilo yokuphila engalungile.
Ukwenqaba imikhuba emibi, ukulandela ukudla nokuzivocavoca okwandisa umzimba kunganciphisa amathuba amaningi we-carbohydrate metabolism, ngakho-ke ukubukeka kwesifo sikashukela sohlobo 2.
Thayipha amakhambi esifo sikashukela asebekhulile
Ukwelashwa kohlobo lwesifo sikashukela sohlobo 2 ezigulini esezikhulile kufanele kubandakanye ukwenqatshelwa kokudla okunama-carbohydrate amaningi kanye nokwenza imisebenzi yokuzivocavoca okwenzeka emzimbeni. Lokhu kuzonciphisa ukugcwala koshukela egazini futhi kunciphise umthamo wamaphilisi anciphisa ushukela.
Ukusetshenziswa kwezidakamizwa ezilwa nesifo sikashukela nakho kuyingxenye ebalulekile yokwelashwa kwesifo sikashukela kubantu abadala.
Ukwelashwa okusebenzayo kwalesi sifo kubantu asebekhulile, izidakamizwa zamaqembu alandelayo asetshenziswa: i-biguanides, i-sulfonylureas, i-glyptins, i-alpha-glucosidase inhibitors ne-insulin.
IBiguanides
Ukwelashwa kwezidakamizwa sikashukela kubantu asebekhulile kuvame kakhulu ukufaka ama-biguanides asiza umzimba ukuthola i-glucose, kuvuselele ukukhiqizwa kwe-insulin yawo uqobo, ukuvimbela ukwakheka kweglucose ezakhiweni ezingeyona i-carbohydrate futhi kunciphise kakhulu izinga le-cholesterol embi.
Eqenjini le-Biguanides, okwakuvame kakhulu phakathi kwabanesifo sikashukela kwakuyi-Metformin yezidakamizwa, ngesisekelo lapho izidakamizwa ezinjalo zidalwe njenge:
- IGlucophage;
- Avandamet;
- I-Bagomet;
- Metfogamm;
- Siofor.
I-Metformin inomphumela omuhle emzimbeni wesiguli, ngaphandle kokubangela ukuncipha kwe-pancreatic futhi ngaphandle kokubangela i-hypoglycemia. Ngaphezu kwalokho, ukusetshenziswa kwalesi sidakamizwa akusonyusi isisindo somzimba, kepha kunalokho kunomthelela ekunciphiseni isisindo. Kakade emavikini okuqala okwelashwa nge-Metformin, isiguli singalahlekelwa cishe yi-3 kg.
I-Metformin iyisidakamizwa esinalo lonke uhla lwezimpawu zokwelapha eziwusizo ngokukhethekile kwisifo sikashukela ezigulini esezikhulile. Ngakho-ke iMetformin isiza kakhulu ekunciphiseni ubungozi bokuhlaselwa yisifo senhliziyo nokushaywa unhlangothi, iguqule umfutho wegazi futhi ngokuvamile ithuthukise ukusebenza kohlelo lwethambo nenhliziyo.
Kwezinye izimo, ukusetshenziswa kweMetformin kungadala ukuqhuma kwabadala, ukuthopha, kanye nokugaya ukudla. Kodwa-ke, izimpawu ezinjalo ezingemnandi zivame ukuhlala kungadluli izinsuku ezingama-2-3, kuthi ngemuva kokunyamalala ngokuphelele. Lesi sidakamizwa asibangeli eminye imiphumela emibi.
Ngokuvamile, iMetformin iyisidakamizwa esisebenza kakhulu, kepha ayinconywa kubantu asebekhulile abahlushwa izifo zezinso.
Futhi, ukuthatha lo muthi ku-contraindified ezifweni ezingadala i-hypoxia ezigulini esezikhulile.
Sulfonylureas
Elinye iqembu elidumile lezidakamizwa abavame ukunquma iziguli zabo esezikhulile ngama-sulfonylureas. Le mishanguzo isetshenziselwe ukwelapha isifo sikashukela isikhathi eside, kusukela ngawo-50s wekhulu leminyaka elidlule.
Amalungiselelo athuthukiswe ngesisekelo se-sulfonylureas anezinhlobo ezimbili - isizukulwane sokuqala nesesibili. Ama-sulfonylureas wesizukulwane sokuqala namuhla cishe awasasetshenziswa, ikakhulukazi ekwelapheni iziguli esezikhulile.
Futhi, izidakamizwa zesizukulwane sesibili kuleli qembu zisetshenziselwa ukwelapha isifo sikashukela sohlobo 2 ngokuhambisana nokudla okune-carb ephansi futhi kuvame ukuhlanganiswa nama-biguanides, angabizwa ngeMetformin.
Izithasiselo ze-sulfonylureas zingasebenza kuphela lapho umzimba womuntu usakhiqiza i-insulin yawo, ngaphandle kwalokho ukusetshenziswa kwawo kuzobe kungasebenzi ngokuphelele. Le mishanguzo ikhuthaza ukukhushulwa kwe-insulin okwenziwa yi-pancreas, ekugcineni okungaholela ekunciphiseni kwayo ngokuphelele.
Ngaphezu kwalokho, okuphuma ku-sulfonylurea kunemiphumela emibi impela, okungukuthi:
- Zingadala ukuhlaselwa kwe-hypoglycemia, okungukuthi, ukwehla okubukhali koshukela wegazi. Lesi simo sibi kakhulu ngisho nakwinsizwa, futhi kumuntu ogulayo onesiguli angabulala;
- Odokotela abaningi banethemba lokuthi izidakamizwa ezikuleli qembu zingawaphazamisa kakhulu ama-pancreas ngokuhamba kwesikhathi futhi ziholele ekuqothulweni okuphelele kokuqunjelwa kwe-insulin;
- Ukutholwa kokuphuma kwe-sulfonylurea kungadala ukukhuluphala kwesisindo, okungafuneki kakhulu isifo sikashukela sohlobo 2, ngoba kungasenza sibi kakhulu isimo sesiguli.
Ngakho-ke, uma kunethuba elinjalo, khona-ke izidakamizwa zaleli qembu kufanele zitshintshwe nezinye izidakamizwa ezingenangozi.
Lokhu kuzosiza kuphela isiguli esekhulile.
Ama-Gliptins
Ama-Gliptins noma igama eliphelele le-dipeptidyl peptidase-4 inhibitors izidakamizwa ezithuthukisa ukusebenza kwe-glucagon-like peptide-1 (GLP-1), ehlobene nama-hormone ama-insretin. Basiza ukukhulisa ukuvikelwa kwe-insulin, futhi kusiza ukuvimba ukukhiqizwa kwe-glucagon, i-hormone ebangela ukwanda kweglucose yegazi.
IDipeptidyl peptidase-4 iyi-enzyme esebenza ku-GLP-1, ichitha isakhiwo sayo futhi inqede isenzo sayo. Kepha izidakamizwa eziseqenjini le-dipeptidyl peptidase-4 inhibitors zivimba isenzo sazo futhi, ngaleyo ndlela, zandisa umsebenzi we-GLP-1.
Ngenkathi uthatha le mishanguzo, ukuqoqwa kwe-GLP-1 egazini lesiguli kucishe kube kabili uma kuqhathaniswa nokujwayelekile ngokomzimba, okubenza babe enye yezindlela eziphumelela kakhulu zokunciphisa ushukela wegazi.
Le mithi elandelayo ingeyeqembu lama-glissins:
- vildagliptin;
- sitagliptin;
- saxagliptin.
Kubalulekile ukugcizelela ukuthi le mishanguzo engenhla iyaqhubeka nokusebenza kuze kugxiliswe kakhulu ushukela egazini lesiguli. Uma yehlela ezingeni elijwayelekile - ifinyelela ku-4,5 mmol / l, khona-ke le mishanguzo iyeka ngokushesha ukukhuthaza ukuvikelwa kwe-insulin futhi ivimbele ukukhiqizwa kweglucagon.
Zonke izidakamizwa eziseqenjini lama-gliptins zingahlanganiswa nezinye izidakamizwa, ngaphandle kokwesaba ukuthuthukisa imiphumela emibi.
Kulokhu, imiphumela engcono kakhulu ekwelashweni kwesifo sikashukela ingatholakala ngokuhlanganisa ama-inhibitors we-dipeptidyl peptidase-4c nge-Metformin.
I-Alpha Glucosidase Inhibitors
Izidakamizwa eziseqenjini lama-alpha-glucosidase inhibitors zivimbela imfihlo yokugaywa kwama-enzyme futhi zivimbele ama-carbohydrate ukuthi angangeni emzimbeni. Lokhu kuvumela ukwehliswa okuphawulwe kwamazinga kashukela kuhlobo 2 sikashukela.
Le mishanguzo ilusizo ezigulini esezikhulile ezinokukhula okukhulu kwe-glucose yegazi ngemuva kokudla. Kepha njengoba le mishanguzo iphazamisa ukugaya ama-carbohydrate alula futhi ayinkimbinkimbi, imvamisa ibangela imiphumela emibi efana nesifo sohudo, ukuqhakaza nokwanda ukwakheka kwegesi.
Ngalesi sizathu, ngenkathi uthatha izidakamizwa eqenjini lama-alpha-glucoside inhibitors, isiguli kufanele sinamathele ekudleni okune-carb ephansi, okuzogwema ngokuphelele noma imiphi imiphumela engathandeki. Kodwa inzuzo ebalulekile ye-alpha-glucosidase inhibitors ukuthi ayivuseleli ukuzuza kwesisindo.
Phakathi kwe-alpha-glucosidase inhibitors, le mithi elandelayo isebenza kakhulu:
- Glucobay;
- I-Diastabol
Insulin
Udokotela unikeza umjovo we-insulin esigulini esidala uma ezinye izindlela zokwelapha ushukela ezinjengezidakamizwa ezonciphisa ushukela, ukudla okune-carb ephansi, nokuvivinya umzimba kungasizanga ukufezekisa ukwehliswa okudingekayo koshukela wegazi.
Ukunciphisa ingozi ye-hypoglycemia, ekhuphuka kakhulu lapho usebenzisa i-insulin ekwelapheni isifo sikashukela sohlobo 2, kufanele kuhlanganiswe neMetformin. Lokhu kuzonciphisa kakhulu umthamo we-insulin, okusho ukuvikela isiguli ekwehleni okubukhali koshukela wegazi.
I-insulin, njengomthetho, isetshenziswa ngaleso sikhathi lapho izinga loshukela egazini lesiguli lifinyelela amazinga abucayi. Kulokhu, imijovo ye-insulin isheshe ilethe impumuzo esigulini esegugile futhi emva kwezinsuku ezi-2 iqale ukuzizwa ingcono kakhulu.
Izinhlobo zokwelashwa eziphambili ezigulini esezikhulile ezinemijovo ye-insulin:
- Uma isiguli sanda ushukela wokuzila ngemuva kokuvuka, khona-ke kulokhu kufanele enze umjovo owodwa we-insulin ende ngosuku ngaphambi kokulala;
- Kuyasebenza futhi ekwelashweni kwesifo sikashukela sohlobo 2 kubantu asebekhulile abane-insulin esezingeni eliphakathi. Kumele kungeniswe emzimbeni kabili ngosuku ekuseni nakusihlwa;
- Ukwehlisa amazinga kashukela egazi ngokushesha okukhulu, i-insulin ejwayelekile ingaxutshwa ne-insulin ebambela okwesikhashana noma ye-ultra-iDemo-in-isilinganiso esilinganisweni esingu-50:50 noma esingu-30: 70. Imijovo enjalo kufanele inikezwe kabili ngosuku.
- Uhlobo lonyango lwe-insulin olusetshenziselwa ukulwa nesifo sikashukela sohlobo 1 lungasetshenziswa nasekwelapheni isifo sikashukela sohlobo 2. Ukuze wenze lokhu, kuyadingeka ukufaka umjovo we-insulin isikhathi eside kanye ngosuku, futhi futhi uphathe nomjovo womjovo we-insulin emfushane ngaso sonke isikhathi ngaphambi kokudla.
Izinhlobo zemithi yesifo sikashukela zizohlanganiswa ngevidiyo kule ndatshana.
