Abantu abaningi kufanele basebenzise amaphilisi we-hypoglycemic wesifo sikashukela sohlobo 2, uhlu lwesizukulwane esisha luvuselelwa njalo ngonyaka ngentuthuko entsha. Uma ekuqaleni izimpawu "zesifo sikashukela" namazinga eglucose zingalawulwa ngokudla nangokuzivocavoca, khona-ke ngokuhamba kwesikhathi izindawo zomzimba ziyachithwa, futhi ngeke zikwazi ukubhekana nale nkinga ngokwayo.
Kumele kuqashelwe ukuthi kunezinhlobo ezimbili zikashukela - ezincike ku-insulin futhi ezingatheni nge-insulin. Esimweni sesibili, ngenkambo ende ye-pathology, abanesifo sikashukela baqala ukusebenzisa izidakamizwa ezicindezela ukumelana ne-insulin.
Imakethe yamakhemikhali inikeza inani elikhulu lezidakamizwa ezinciphisa ushukela, kepha ngamunye wabo unendlela ekhethekile yokwenza, ukuphambana kanye nemiphumela emibi engahle ibe khona. Cabanga izinhlobo eziphambili zemithi ye-hypoglycemic.
Izinhlobo eziphambili zemithi yesifo sikashukela sohlobo 2
Ukuthuthukiswa kwesifo sikashukela sohlobo 1 kuhlotshaniswa ikakhulu ne-autoimmune disorder. Kulokhu, umsebenzi wamanyikwe awukhubazekile, ngenxa yalokho amaseli we-beta we-islet apparatus ayeka ukukhiqiza ama-hormone anciphisa ushukela - i-insulin. Ngokungafani neyokuqala, onesifo sikashukela sohlobo 2, ukukhiqizwa kwama-hormone akuyeki. Le nkinga ihlobene nokuzwela kwama-cell receptors aqaphela i-insulin.
Uhlobo lwesibili lwe-pathology luthinta ama-90% abo bonke abanesifo sikashukela. Imvamisa laba ngabantu abaneminyaka engaphezulu kwengama-40 kuya kwengama-40 bathambekele ekukhuluphiseni noma abanezihlobo ezinesifo sikashukela (genetic factor).
Ngo-2017, imithi eminingi enciphisa ushukela iye yathuthukiswa futhi yathuthukiswa. Kuze kube manje, lezi zinhlobo ezilandelayo ze-hypoglycemic agents
Ngcono ukuzwela kwe-insulin kwamaseli:
- ama-thiazolidinediones (uPioglar kanye neDiglitazone);
- i-biguanides (metformin).
Izidakamizwa ezintsha ezaqala ukwenziwa ngonyaka ka 2000s:
- Ama-inhibitors e-DPP-4 (Ongliza noJanuviya);
- i-alpha glucosidase inhibitors (Glucobai);
- I-GLP-1 receptor agonists (iViktoza neBaeta).
Izikhuthazo zeHormone:
- i-meglitinides (Starlix neNovonorm);
- derivatives sulfonylurea (Maninyl, Glurenorm ne Diabeteson).
Uhlobo lwesithathu lwesidakamizwa luthinta kabi umsebenzi we-pancreatic futhi liyawudiliza. Lapho uthatha le mishanguzo, cishe njalo kunethuba lokushintshwa kwesifo sikashukela sohlobo 2 kuye kwesokuqala.
Izidakamizwa ezishiwo ngaphambilini zokwelapha isifo sikashukela sohlobo 2 zibhekwa njengesizukulwane esisha sezidakamizwa, imininingwane eningiliziwe ezokwethulwa kamuva.
Amaseli athuthukisa ukutholakala kwe-insulin
I-Thiazolidinediones yaqala ukusetshenziswa njengama-ejenti ukuthi i-hyperglycemia ephansi, muva nje. Le mishanguzo yesifo sikashukela ayithinti amangqamuzana e-beta; kunalokho, athuthukisa ukuzwela kwezicubu ze-peripheral to insulin. Ngenxa yalokhu, ama-thiazolidinediones anciphisa i-glucose futhi athinta kahle ukugxila kwe-lipid.
Ngokuvamile, izidakamizwa zaleli qembu ziyakwazi ukunciphisa ukugxilwa kukashukela ngo-0.5-2%, ngakho-ke zivame ukuphuzwa zihlanganiswa ne-metformin, injekishini ye-insulin noma i-sulfonylurea derivatives. Izibonelo zezidakamizwa ezisezibhebheni ezingezesigaba sama-thiazolidinediones yiPioglar, Actos neDiaglitazone. Uhlangothi oluhle lokusebenzisa kwabo kungenzeka ngamanani aphansi okwehla ngokushesha kwamazinga kashukela. Imithi enjalo yesifo sikashukela ibhekwa njengethembisa kakhulu ekuqedeni ukumelana ne-insulin.
AmaBiguanides amelwe ngummeleli kuphela - i-metformin, okuyingxenye yezidakamizwa zaleli qembu. Umkhuba wezokwelapha waqala ukusebenzisa lo muthi ngemuva kuka-1994. Ngo-2017, kwakuyi-biguanides eyaba yaziwa kakhulu ekwelapheni isifo sikashukela sohlobo 2. I-Metformin ivimbela inqubo yokukhiqiza ushukela ngesibindi nokungena kwayo egazini. Ngaphezu kwalokho, kuthuthukisa ukuzwela kwezicubu ezixakile ku-insulin. Imakethi yemithi yaseRussia inikezela ngamanani amaningi ezibhebhe zesifo sikashukela sohlobo 2 esiqukethe isithako esisebenzayo - i-metformin hydrochloride. Ama-analogues adumile yiMetformin, iSiofor, iGlucofage nabanye.
Kumele kuqashelwe ukuthi phakathi kwezici ezinhle zokusetshenziswa kwale mishanguzo, kunobungozi obuphansi besimo se-hypoglycemic, ukuvimbela isifo sokuqina kwemithambo yegazi, ukwehla kwesisindo kanye nekhono lokuthatha ngokuhambisana nokwelashwa kwe-insulin nezinye izidakamizwa ezinciphisa ushukela.
Phakathi kwezici ezingezinhle zokusebenzisa i-metformin, izici ezintathu zingahlukaniswa.
- Ukuphazamiseka kokugaya ukudla ekuqaleni kokulashwa okuhambisana nomlutha womzimba esenzweni sento. Izimpawu ezejwayelekile ukuhlanza inhliziyo nokuhlanza, isifo sohudo, ukuntuleka kwesifiso sokudla, ukuthopha.
- Amathuba we-lactic acidosis.
- Ukwelashwa isikhathi eside kunciphisa ukugcwala kuka-Vitamin B 12 emzimbeni.
Akunakwenzeka ukusebenzisa amaphilisi e-metformin ku-pathology yesibindi, ipheshana lokuphefumula, ukuqina kwezinso noma kwenhliziyo.
Izidakamizwa zakamuva
Kusukela ngo-2006, izidakamizwa ezintsha ezibizwa nge- "DPP-4 inhibitors" zaqala ukusetshenziswa kwezokwelapha. Ayihlobene nokukhiqizwa kwe-insulin ngamaseli e-beta. Isenzo sabo sihlose ukuvikela i-polypeptide efana nohlobo lwe-gluceptide yohlobo lokuqala (i-GLP-1), ukukhiqizwa kwayo okwenzeka emathunjini, kusukela emiphumeleni eyonakalisayo ye-enzyme DPP-4. Igama lezidakamizwa kuleli qembu liqhamuka egameni le-enzyme.
I-GLP-1 ithuthukisa ama-pancreas, ngenxa yalokho i-insulin iqala ukukhiqizwa ngezinga elikhulu. I-GLP-1 futhi iphikisana nokukhula kwe-glucagon, okuthinta kabi i-hormone enciphisa ushukela.
Izinzuzo zokusebenzisa ama-DPP-4 inhibitors yilezi:
- Ukungakwazi kwe-hypoglycemia njengoba umuthi uqeda isenzo sawo ngemuva kokulinganisa namazinga kashukela.
- Amathuba okwandisa isisindo somzimba ngenxa yokudla amaphilisi awafakwa.
- Zingasetshenziswa ngokuhlanganiswa cishe nazo zonke izidakamizwa ngaphezu kwama-injon agonists we-GLP-1 receptors ne-insulin.
Phakathi kwemiphumela emibi, ungagxila ekucasukeni kokugaya ukudla, okuvame ukubonakaliswa ubuhlungu besisu kanye nenausea. Amaphilisi ezinshukela anjalo awanconywa ukuthi asetshenziswe kwephula isibindi noma izinso. Leli qembu lezidakamizwa lihlukaniswe laba yi: saxagliptin (Onglisa), vildagliptin (Galvus), sitagliptin (Onglisa).
Ama-agonist we-GPP-1 receptor ama-hormone akhuthaza ukukhiqizwa kwe-pancreatic insulin nokulungisa amaseli e-islet alimele. Ngaphezu kwalokho, lolu hlobo lwesidakamizwa lwehlisa ukukhuluphala ngokweqile kwiziguli ezikhuluphele. Le mishanguzo ayakhiwa ngendlela yamaphilisi, ingathengwa kuphela ngesimo sama-ampoules omjovo. Ummeleli waleli qembu yisidakamizwa esisha iViktoza, kanye neBaeta.
Ama-inhibitors we-Alpha glucosidase avimbela ukuguqulwa kwe-glucose kusuka kuma-carbohydrate. Izidakamizwa zaleli qembu zisetshenziselwa lapho isiguli sine-glucose ekhulayo ngemuva kokudla. Lezi zimali zingahlanganiswa nanoma yiziphi izidakamizwa ezinciphisa ushukela. Okuwukuphela kokususwa kwe-alpha-glucosidase inhibitors ukuthi ukusetshenziswa kwayo kwenqatshelwe ku-pathologies yamathumbu.
Imiphumela emibi ejwayelekile ngemuva kokuthatha izidakamizwa yizinkinga zokugaya - ukwanda ukwakheka kwegesi emathunjini nohudo. Nge-metformin, lesi sidakamizwa kungcono ukungasisebenzisi, ngoba sithinta nesistimu yokugaya ukudla komuntu. Abamele leli qembu nguDiastabol noGlucobay.
Ama-hormone ezikhuthaza
Isintu sazi isikhathi eside ngokutholakala kwe-sulfonylurea, kodwa sisebenzise kuphela ekwelapheni izifo ezithathelwanayo. Umphumela wazo we-hypoglycemic watholakala ungahlosile ngesikhathi seMpi Yezwe II.
Ukwelashwa okunjalo kwesifo sikashukela kuthinta umsebenzi wamaseli we-beta akhulunywa ngamanyikwe, enza i-hormone ihlanganiswe. Ukutholwa kweSulfonylurea kuqale kabusha ukukhiqizwa kwe-insulin futhi kwandise ukuzwela kwama-cell receptors ku-insulin.
Kodwa-ke, lezi zimali zidala imiphumela emibi engafuneki njengokuthi:
- isimo se-hypoglycemia;
- ukuncipha kwamaseli we-beta;
- isisindo somzimba.
Ukugcwala ngokweqile kwama-pancreas kuholela eqinisweni lokuthi uhlobo lwesibili lwe-pathology luwela kolokuqala. Lokhu kusho ukuthi ukuze kugcinwe amanani eglucose ngaphakathi kwemikhawulo ejwayelekile, isiguli kuzodingeka ukuthi sijobe ama-hormone njalo. Ama-dravatives we-sulfonylureas ahlukaniswe izigaba eziningana:
- UGlyclazide - Diabeteson MV noGlidiab MV.
- I-Glimepiride - uGlemaz no-Amaril.
- Glycvidone - Glurenorm.
- I-Glibenclamide (Maninyl).
Izidakamizwa zeqembu le-meglitinide futhi zivusa ukukhiqizwa kwe-hormone enciphisa ushukela. Kunconywa kulabo abanesifo sikashukela ekukhuphukeni koshukela egazini ngemuva kokudla. Leli qembu lifaka izigaba ezimbili zemithi - i-nateglinide (Starlix) ne-repaglinide (Novonorm).
Izinzuzo zokusebenzisa lezi zidakamizwa zingabhekwa ukuthi azithinti isisindo somzimba wesiguli futhi empeleni aziholeli esimweni se-hypoglycemia.
Kodwa-ke, izidakamizwa ezikuleli qembu zidala ukuvela okuthile okubi okuhambisana nezinqubo zokugaya nezinzwa, ukuvuvukala kwepheji lokuphefumula elingaphezulu.
Ukonakala kwezidakamizwa ngentengo ephakeme kunalokho, akusebenzi kakhulu umphumela we-hypoglycemic kanye nokusetshenziswa okuphindaphindwe phakathi nosuku.
Ukwelashwa nemiphumela yokwenqaba kwayo
Izimpawu eziphambili zesifo sikashukela ziwukuhambela njalo okuya endlini yangasese nokoma okungapheli. Lezi zimpawu ezimbili eziphambili zingakhombisa ukwephulwa kwezinga le-glycemia. Uma umuntu ezibona lezo zimpawu kuye, udinga ukubona udokotela wezokwelapha kungekudala.
Isizathu sokufa okuphezulu kweziguli ezinesifo sikashukela sihambisana ngqo nokwelashwa okungafanele futhi okungasebenzi. Ngesikhathi sokuqokwa nodokotela ochwepheshe, isiguli kufanele sitshele ngokuningiliziwe ngazo zonke izimpawu ezimkhathazayo. Ngemuva kwengxoxo, udokotela unquma ukutholakala kwesifo sikashukela.
Kunezivivinyo eziningana ongalazi ngazo izinga kashukela, kepha okulula futhi okushesha kakhulu ukutadisha kwegazi kusuka emunweni noma emthanjeni. Uma imiphumela ingaphezulu kwe-5.5 mmol / L (igazi le-capillary) ne-6.1 mmol / L (igazi eli-venous), lokhu kungakhombisa isifo sikashukela noma isifo sikashukela. Ukunquma uhlobo lwesifo, kuhlaziywa okwenziwa nge-C-peptides nokuqukethwe ama-antibodies e-GAD.
Uma udokotela ethole isifo sikashukela sohlobo 2, uthola uhlobo oluthile lokwelashwa olukhethekile oluqukethe izakhi ezine ezibalulekile:
- ukulawulwa glycemic njalo;
- umsoco okhethekile;
- indlela yokuphila ehambayo;
- ukuthatha imishanguzo.
Ukugcina yonke le mithetho kuphela ongalawula inani loshukela egazini futhi uvikele ukukhula kwemiphumela emibi yesifo sikashukela. Isimo sokunganaki empilweni yakho kungaholela ekukhuleni:
- Ukwehluleka okukhulu kwezinso.
- I-retinopathy yesifo sikashukela - ukhubazeka okubukwayo okuvela ekuvuvukaleni kwe-retinal.
- Isifo sikashukela sikashukela ukuphazamiseka kohlelo lwezinzwa.
- Gangrene lamaphethelo aphansi. Kulokhu, ukunqunywa komlenze kungadingeka kwisifo sikashukela.
- I-Glycemic coma.
- I-Myocardial infarction noma unhlangothi.
Udinga ukwelapha isifo sikashukela ngesikhathi. Lesi sifo akusona isigwebo, ikhulu lokugcina, ngenxa yobuchwepheshe bamuva, abantu baphila nalo ngokugcwele.
Into esemqoka ukungalahli ithemba. Umuthi wanamuhla awumi: zonke izinsuku, ososayensi bakha umuthi omusha oqukethe ama-contraindication ambalwa futhi onomphumela omuhle kakhulu wokwelapha.
Kumele kukhunjulwe ukuthi uma usebenzisa umuthi, kufanele uhambisane nemithamo efanele nezincomo zikadokotela. Ngale ndlela, amazinga kashukela angagcinwa ngezinga elijwayelekile. Ividiyo ekulesi sihloko ikhuluma ngokwelashwa kwesifo sikashukela sohlobo 2.
