Ngokuqhubeka kwesikhathi eside kwalesi sifo, iziguli kufanele zisebenzise izidakamizwa zohlobo 2 sikashukela sesizukulwane esisha. Kuqala, “isifo esimnandi” singalawulwa ngokudla okuyikho nendlela yokuphila esebenzayo, kepha ngokuhamba kwesikhathi, izidakamizwa zepancreas nezidambisa ushukela ziyasetshenziswa.
Kukhona eziningi zazo emakethe yamakhemikhali, kepha iziphi ezinomphumela omkhulu kakhulu wokwelapha?
Kunzima kakhulu ukuphendula lo mbuzo, ngoba zingahle zilungele isiguli esisodwa, kepha azilungele esinye. Ngakho-ke, kule ndatshana, imiphumela yezinhlobo eziphambili zemithi izodalulwa.
Izinhlobo Zezidakamizwa Zesifo Sikashukela sohlobo 2
Isifo sikashukela sohlobo 2 sibizwa ngokuthi yi-insulin-esizimele, ngoba ngokukhula kwalesi sifo, i-hormone esehlisa ushukela ikhiqizwa ama-pancreas. Inkinga yonke ilele ekuqashelweni kwe-insulin ngamaseli we-peripheral lapho kusebenza khona i-receptor. Ngokuyisisekelo, i-pathology enjalo ikhula esizukulwaneni esidala kusukela eminyakeni engama-40, ikakhulukazi kubantu abanesisindo ngokweqile kanye nefa.
Namuhla, kukhiqizwa izidakamizwa ezintsha emhlabeni ezisiza ukujwayeza ukugxila koshukela futhi zikhulule isiguli sezimpawu zesifo sikashukela. Ngezansi uhlu lwezinhlobo eziphambili zemithi:
- Ukwandisa ukutholakala kwamaseli kwi-hormone: i-thiazolidinediones (Diaglitazone, iPioglar), i-biguanides (Metformin, Glucofage).
- Izidakamizwa ezintsha ezaqala ukwakhiwa ngonyaka ka 2000s: DPP-4 inhibitors (Januvia, Onglisa), GLP-1 receptor agonists (Baeta, Victoza), alpha-glucosidase inhibitors (Glucobai).
- Ukukhuthaza ukukhiqizwa kwe-insulin: i-sulfonylurea derivatives (Maninil, Glyurenorm, Diabeteson), meglitinides (Starlix, Novonorm).
Kumele kuqashelwe ukuthi i-sulfonylurea derivatives kanye nama-meglitinides ayawathinta kabi amanyikwe, awadonsa. Ezigulini ezithatha izidakamizwa ezinjengalesi, kunengozi yokushintshwa kwesimo sesibili sesifo kuye kwesokuqala.
Zonke lezi zidakamizwa ezingenhla zihlobene nesizukulwane esisha sezidakamizwa futhi sisetshenziselwa ukwelapha isifo sikashukela sohlobo 2.
Ngayinye yazo inezimpawu zayo, izinzuzo zayo nokubi, okuzovezwa kancane kamuva.
Izici zokwelashwa sikashukela
Ngemuva kokuthi umuntu ezitholele ngokwakhe izimpawu ezimbili eziyinhloko zalesi sifo - ukoma okungagculisi nokuchama kaningi, kuyofanele abonane nodokotela oselaphekayo ozomhambisa ekuhlonzeni okufanele.
Lapho uphasa ukuhlolwa, kuthathwa igazi le-capillary noma le-venous futhi, lapho sesithole imiphumela edlula amanani omngcele we-5.5 no-6.1 mmol / L, ngokulandelana, singakhuluma ngokuthuthukiswa kwe-prediabetes noma isifo sikashukela.
Ngemuva kwalokho, ukunquma uhlobo lwe-pathology, ukuhlaziywa kwenziwa ezingeni le-C-peptide ne-GAD antibodies. Uma isiguli sinohlobo lwesibili sikashukela, udokotela ophuthukisayo uthola uhlobo lokwelashwa olufaka:
- ukudla okhethekile;
- ukusebenza komzimba;
- ukuqashwa njalo kwamazinga kashukela;
- ukuthatha izidakamizwa ezinciphisa ushukela.
Ngesikhathi esifanayo, esigabeni sokuqala sokukhula kwesifo, isiguli singenza ngokudla okufanele, ukuphumula okusebenzayo nokulawula ushukela. Njalo ezinyangeni ezingama-2-2 unesibopho sokuthatha izivivinyo esikhungweni sezokwelapha, ngakho-ke udokotela angakwazi ukubona ukuthi lusebenza kahle kangakanani lolu hlobo lokwelashwa. Uma isimo sesiguli siba sibi kakhulu, udokotela kuyodingeka anikeze amaphilisi kashukela onomphumela we-hypoglycemic.
Uma isiguli sikhuluphele kakhulu, khona-ke udokotela cishe uzonikeza izidakamizwa ngento esebenzayo - i-metformin. Ukusetshenziswa kwaleli thuluzi kuzosiza ukwehlisa isisindo somzimba kanye namazinga kashukela. Uma isiguli singenankinga enjalo, udokotela ubeka imishanguzo ethuthukisa ukuzwela nokukhiqizwa kwe-insulin ngamanyikwe. Ama-pathologies ahambisana nesifo sikashukela nawo kufanele acatshangwe. Isibonelo, uma isiguli sinezinkinga zezinso, khona-ke udokotela kufanele akhethe leyo mishanguzo ezokhishwa ezinye izitho zomzimba.
Njengoba ubona, wonke umuntu onesifo sikashukela udinga indlela ekhethekile ekwelashweni kwalesi sifo. Ngakho-ke, udokotela kuphela ozokwazi ukunquma imishanguzo efanelekile futhi abale umthamo wawo. Ukuzelapha akusifanele, umuthi ngamunye unezimpawu zokuphikisana nemiphumela emibi engaholela emiphumeleni emibi engenakuphikwa.
Izidakamizwa zokwandisa ukuzwela kweseli
Ama-Thiazolidinediones atholakala muva nje futhi eminyakeni yamuva nje aqala ukusetshenziswa njengezidakamizwa ze-hypoglycemic. Lolu hlobo lwesidakamizwa aluthinti ama-pancreas ukukhiqiza i-insulin, luthinta ukutholakala kwamaseli nezicubu kuyi-hormone enciphisa ushukela.
Ngaphezu kokunciphisa i-glycemia, okwandisa ukuzwela kwama-receptors, ama-thiazolidinediones athinta kahle iphrofayili ye-lipid. Umphumela we-hypoglycemic walezi zidakamizwa ngu-0.5-2%. Ngakho-ke, zingasetshenziswa zombili nge-monotherapy futhi zihlanganiswa ne-insulin, metformin ne-sulfonylureas.
I-Thiazolidinediones ifaka izidakamizwa ezifana nePioglar, i-Actos, iDiglitazone. Inzuzo yabo ukuthi empeleni akubangeli i-hypoglycemia. Leli qembu lezidakamizwa lithathwa njengelithembisa kakhulu ekulweni nokulwa ne-insulin.
Ummeleli we-Biguanides yi-into metformin. Ukuthi kuyisakhi esisebenzayo semithi yaleli qembu. Yaqala ukusetshenziswa kwezokwelapha kusukela ngo-1994. Kuze kube manje, izidakamizwa ezinjalo zithandwa kakhulu lapho zinqunyelwe iziguli ezinesifo sikashukela. I-Metformin yehlisa ushukela kusuka esibindini iya egazini futhi yenyusa ukuzwela kwezicubu ezithambile kuyi-insulin ekhiqizwayo. Ekhemisi, usokhemisi anganikeza inani elikhulu kakhulu lezidakamizwa ze-analog, ngoba zonke ziqukethe isakhi esiyinhloko - i-metformin, umehluko kuphela okukhona. Lokhu kufaka iBagomet, Gliformin, Glyukofazh, Formmetin, Siofor, Metformin 850 nabanye.
Phakathi kwezici ezinhle zesenzo se-metformin, kunamathuba aphansi we-hypoglycemia, ukuvimbela isifo sokuqina kwemithambo yegazi, ukwehla kwesisindo kanye nethuba lokuhlanganiswa ne-insulin nezinye izidakamizwa ezinciphisa ushukela. Kwezinye izimo, imiphumela engathandeki kanye nokubi kwe-metformin kungenzeka, ngokwesibonelo:
- Ukuphazamiseka kwendlela yokugaya ukudla ekuqaleni kwezokwelapha (isicanucanu, ukuhlanza, ukuqhakaza, isifo sohudo, ukuntuleka kokudla).
- Ukwehluleka ukusebenzisa umuthi wezifo zesibindi, ipheshana lokuphefumula, ukuhluleka kwenhliziyo nezinso.
- Ingozi encane yokuhlakulela ubisi olunokhilimu.
Ngaphezu kwalokho, ngesikhathi sokwelashwa isikhathi eside, izinkinga zokushoda kwevithamini B12 zingavela.
Izidakamizwa ezintsha
Ama-DPP-4 inhibitors ayisizukulwane esisha sezidakamizwa; asetshenziswa kusukela ngo-2006. Izidakamizwa ezinjalo zodwa azithinti ukwakheka kwe-insulin. Bayakwazi ukuvikela i-glucagon-like polypeptide 1 (GLP-1) ekhiqizwa ngamathumbu ekubhujisweni yi-enzyme DPP-4.
Yilapho igama lale mithi livela khona. I-GLP-1 ivusa ukukhiqizwa kwe-insulin, okunciphisa izinga likashukela emzimbeni womuntu. Ngaphezu kwalokho, i-GLP-1 ayikuvumeli ukuthuthukiswa kwe-glucagon, okuthi, futhi, kuvimbele i-insulin ekusebenziseni umphumela wayo.
Into enhle ukuthi izidakamizwa ezinjalo azikukhuthazi i-hypoglycemia, ngoba bayeka ukwenza isenzo ngemuva kokuqiniswa kokuqukethwe ushukela. Azikhulisi isisindo somzimba futhi zisetshenziswa cishe nazo zonke izidakamizwa. Okuhlukile yizijeziso zomjovo ze-GLP-1 receptors, i-insulin (kungabekwa uGalvus kuphela). Imithi ingadala imiphumela emibi ehambisana nobuhlungu besisu, futhi akuseluleki ukuyisebenzisa ukuthola i-pathologies yesibindi noma izinso. Namuhla, izidakamizwa ezinjenge-saxagliptin (Onglisa), sitagliptin (Januvia) ne-vildagliptin (Galvus) zivamile.
I-GLP-1 receptor agonist yi-hormone enganikezi kuphela amasignesha e-pancreas mayelana nokukhiqizwa kwe-insulin, kodwa futhi inciphisa isifiso sokudla nokulungisa amaseli e-beta onakalisiwe. Njengoba i-GLP-1 ngemuva kokudla ibhujiswe kungakapheli imizuzu emi-2, ayinakuthonya ngokuphelele ukukhiqizwa kwe-insulin. Ngakho-ke, kukhona ukufana kweViktoz neBayet, ekhishwa ngendlela yemijovo. Kufanele kukhunjulwe ukuthi umuthi wokugcina uthatha amahora ambalwa, futhi uVictoza - usuku lonke.
Ama-inhibitors we-Alpha glucosidase avikela ukuguqulwa kwama-carbohydrate abe ushukela. Izidakamizwa ezinjalo ziwusizo kakhulu lapho onesifo sikashukela esanda ukwanda koshukela ngemuva kokudla. Izidakamizwa zesifo sikashukela zingasetshenziswa zihlanganiswe nanoma yiziphi izidakamizwa ze-hypoglycemic. Imiphumela emibi ebonakalayo ngenkathi uthatha i-alpha-glucosidase inhibitors ziyinkinga yokugaya - ukubekezela, uhudo. Ngakho-ke, azikwazi ukusetshenziselwa izifo zamathumbu. Ukusetshenziswa okuyinkimbinkimbi nge-metformin nakho akunasidingo, ngoba kungadala ukwanda kwezimpawu zokuphazamiseka kwesisu.
Abamele abaphambili bezidakamizwa ezinjalo yiGlucobai noDiastabol.
Izivuseleli ze-insulin
Umphumela we-hypoglycemic wokuphuma kwe-sulfonylurea watholakala ngengozi phakathi neMpi Yezwe Yesibili, lapho yayisetshenziswa ukulwa nezifo. Le mishanguzo isebenza kumaseli we-beta akuma-pancreas ahlanganisa insulin. Leyo mithi yesifo sikashukela iqhubeka nokukhiqizwa kwe-hormone, futhi ithuthukise nokuzwela kwamangqamuzana nezicubu kuyo.
Ngasikhathi sinye, imithi inezinkinga ezithile: ukwanda kwesisindo, i-hypoglycemia (ukwehla okusheshayo kwamazinga kashukela ngaphansi kokujwayelekile), ukweqisa kanye nokudangala kwamaseli we-beta. Njengomphumela, kwezinye izazi zesifo sikashukela, lesi sifo siba uhlobo 1, oludinga ukwelashwa kwe-insulin okuphoqelekile. Ekhemisi ungathenga noma yiziphi izigaba ezine zokuphuma kwe-sulfonylurea, isibonelo:
- glibenclamide (Maninyl);
- i-gliclazide (Diabeteson MV, Glidiab MV);
- i-glycidone (glurenorm);
- glimepiride (Amaril, Glemaz).
Ama-Meglitinides akhuthaza ukukhiqizwa kwama-pancreatic hormone. Odokotela abaningi batusa ukusetshenziswa kwabo yiziguli ezinoshukela wegazi ophezulu ngemuva kokudla. Le mishanguzo kufanele idliwe kathathu ngosuku ngaphambi kokudla okuyinhloko. Ukusetshenziswa kwabo kanye nokutholakala kwe-sulfonylurea ngeke kube nalutho, ngoba banomphumela ofanayo. Ekhemisi ungathenga imali yokwelapha isifo sikashukela sohlobo 2, esihlukaniswe ngezigaba ezimbili: i-repaglinide (Novonorm) ne-nateglinide (Starlix).
Ukubuyekezwa kweziguli eziningi kukhombisa ukuthi iNovonorm ayinciphisi kuphela ushukela ngemuva kokudla, kodwa futhi iyinciphisa esiswini esingenalutho. Ngaso leso sikhathi, umphumela we-hypoglycemic wezidakamizwa ezinjalo uyahluka kusuka ku-0.7 kuya ku-1.5%. Kulokhu, zivame ukusetshenziswa nezidakamizwa ngaphandle kwe-sulfonylurea.
Phakathi kwezinzuzo ze-meglitinides zingahlukaniswa ukuthi azikhulisi isisindo futhi ngezinga elincane zibangela ukuhlaselwa kwe-hypoglycemia. Imiphumela engathandeki lapho usebenzisa izidakamizwa ingaba ukuphazamiseka kokugaya ukudla, i-sinusitis, ikhanda, izifo eziphezulu zokuphefumula zezifo. Phakathi kwamaphutha, umuntu angakhipha izindleko eziphakeme zamalungiselelo, ukuphathwa okuphindaphindwe phakathi nosuku, kanye nokwehlisa ushukela.
Njengoba ukwazi ukubona, kunezidakamizwa eziningi ezinciphisa amazinga kashukela. Kepha ngamunye wabo unomphumela ohlukile emzimbeni wesiguli. Ngakho-ke, ekwelapheni isifo sikashukela sohlobo 2, kuyadingeka ukubonana nodokotela. Nguye ozokwazi ukukhetha umuthi onomphumela omuhle kakhulu kanye nomthelela omncane emzimbeni womuntu onesifo sikashukela. Ividiyo ekulesi sihloko izophendula imibuzo ngokuqala nokwelashwa kwesifo sikashukela.
