Emhlabeni jikelele, kuye kwaba nokwenyuka minyaka yonke kwenani labantu abanesifo sikashukela. Ingxenye yenkinga ihlobene nezinto ezinempilo, njengoba kunama-carbohydrate amaningi anokugaya kalula ekudleni kwansuku zonke. Kepha hhayi ukudla kuphela okuyimbangela yokwanda kwalesi sifo. Enye yezinto ezibangela ubhubhane lwesifo sikashukela ukubangelwa izakhi zofuzo - lokhu kusho ukubukeka okungenakugwenywa kwamazinga kashukela akhuphukile ezizukulwaneni, uma okungenani omunye wabazali enalesi sifo.
Njengoba inani leziguli ezine-glucose elishintshiwe elibekezelelekile liphezulu kakhulu, imboni yezemithi ikhiqiza izidakamizwa ezisebenza ngempumelelo kakhulu ze-antidiabetes. Benza impilo ibe lula kubantu, futhi uma belandela uhlobo lokudla nokuzivocavoca, baba neqhaza ekuphathweni okuphelele kwamazinga kashukela egazini.
Okususwa ngama-sulfonylureas nama-biguanides: ukuhambisana kwamanje kwezidakamizwa
Kusukela ngama-60s wekhulu leminyaka elidlule, ukuthuthukiswa okusebenzayo kwezidakamizwa zokulawulwa okusebenzayo kwamazinga kashukela wegazi sekuqalile. Iqembu lokuqala lezidakamizwa ezisetshenziselwa isifo sikashukela, elasiza abantu ngempela, kwakuyi-sulfonylureas. Umnyombo wesenzo sezidakamizwa ulula - zivusa amaseli we-pancreas, abhekene nokukhiqizwa kwe-insulin. Ngenxa yalokhu, secretion yama-hormone ayakhuphuka, futhi ushukela wegazi uyancipha ngohlobo 2 sikashukela.
Amalungiselelo weSulfonylurea
Kukhona izizukulwane ezintathu ze-sulfonylureas. Imithi eqenjini lokuqala ayisasetshenziswa namuhla, yize imboni yezamayeza iqhubeka nokukhiqizwa okulinganiselwe kwe-tolbutamide ne-carbamide. Ama-sulfonylureas wesizukulwane sokuqala anciphisa awekho ngokuphelele ekukhiqizeni. Imithi yeqembu lesibili nelesithathu isetshenziswa kabanzi okwamanje ekuziphatheni komtholampilo. Ezifundeni eziningi zaseRussia kuhlala kuyizo kuphela ezitholakalayo kuzo zonke izigaba zezakhamizi.
Izibhebhe zesifo sikashukela ezihlobene nesizukulwane sesibili nesesithathu sokuphuma kwe-sulfonylurea zingokulandelayo:
- glibenclamide;
- i-gliclazide;
- glycidone;
- glipizide;
- glimeperide.
Okudume kakhulu yi-glibenclamide, eyakhiwa kuqala, kepha kuze kube namuhla ayilahlekanga ukubaluleka kwayo. Amagama ayo okuhweba "ngendlebe" kwiziguli eziningi ezinesifo sikashukela:
- Maninil;
- UBenjamini;
- IGlibamide;
- Daonil;
- I-Glimidstad;
- I-Euglucon.
IManinil ithandwa ikakhulukazi, ngoba inefomu lokukhishwa le-microionized elenza ukufakelwa kwalo muthi.
Isizukulwane esisha (sesithathu) sifanekiselwa umuthi owodwa - i-glimeperide. Kuyaziwa ngaphansi kwezimpawu zokuthengisa ezilandelayo:
- I-Amaryl;
- I-Diamerid;
- UGlemaz;
- Glemauno;
- I-Glimedex.
I-Glimeperid ayihlukile kuzidakamizwa zangaphambili ekusebenzeni kwayo kokusebenza, kepha inomphumela ozinzile ngokwedosi elisezingeni eliphansi, futhi ibekezelelwa kangcono yiziguli.
Izinzuzo eziphambili ze-sulfonylureas kuhlobo lwesifo sikashukela sohlobo 2:
- umphumela omuhle futhi ozinzile;
- i-latitude ephezulu yokwelapha - ungayandisa kaningi le dosi ngaphandle kokwesaba ukudakwa;
- ukubekezelela okuhle;
- izindleko eziphansi;
- isilinganiso esiphindwe kabili ngosuku;
- ukuvumelana okulula namanye ama-ejenti we-antidiabetesic;
- ukutholakala emakhemisi ngisho nasezindaweni ezikude.
Kodwa-ke, ekusebenziseni ngempumelelo kwezidakamizwa ngisho nesizukulwane sesithathu, isimo esibaluleke kakhulu siyadingeka - amaseli we-pancreatic kumele akhiqize i-insulin okungenani ngamanani alinganiselayo.
Uma kungekho mahomoni, khona-ke akunangqondo ukukhuthaza umsebenzi weziqithi zeLangerhans. Into yesibili ephazamisa iziguli ezinesifo sikashukela ukuncipha kokusebenza kahle ngemuva kweminyaka eminingana yokusetshenziswa. Ukumelana namalungiselelo we-sulfonylurea kuyaqala, okuholela ekwandeni kwamazinga kashukela egazini. Ngenxa yalokhu, kuyadingeka ukwandisa umthamo wokufinyelela okuphezulu okuvunyelwe noma ushintsho kwamanye amaphilisi we-antidiabetesic.
IBiguanides
Phakathi kwama-biguanides - esinye sezidakamizwa esidume kakhulu sikashukela sohlobo 2, okwamanje i-metformin kuphela isetshenziswa kabanzi.
Inzuzo yayo eyinhloko ukuthi ithuthukisa isenzo se-insulin receptors futhi isheshise i-glucose metabolism. Ngenxa yalokhu, ngisho nangamazinga amancane e-hormone, ukwehla isikhathi eside ushukela wegazi kungenzeka. I-Metformin yehlisa isisindo futhi yehlise hamu, okubalulekile kwiziguli ezikhuluphele. Umuthi uhlanganiswe kahle cishe nayo yonke imishanguzo yesimanje yokuphikisana nesifo sikashukela.
Izidakamizwa ezintsha zomlomo ze-hypoglycemic: izinzuzo ezisemqoka
Ingxenye ebaluleke kakhulu yempumelelo ekwelapheni isifo sikashukela yikhono lokulawula ngempumelelo amazinga kashukela ngemuva kokudla. Kungalesi sikhathi lapho kubhekwa inani eliphakeme kakhulu lokunyuka kwalo, okuthinta kabi inkambo yesifo. Ngakho-ke, ama-ejenti asebambisene nabanesifo sikashukela athuthukiswa. Clinids angokuleli qembu - repaglinide futhi nateglinide.
I-Repaglinide (NovoNorm) inezici ezilandelayo:
- kuthathwe ngomlomo ngaphambi kokudla kuphela - uma kungekho ukudla, khona-ke isidingo somuthi siyanyamalala;
- kunciphisa kuphela i-postprandial (ngemuva kokudla) i-glycemia, ngaphandle kokuthinta izinga elijwayelekile le-glucose egazini;
- yenza ngokushesha, ngamandla futhi ngokushesha;
- ayiqoqeki emzimbeni, ithuliswa kalula yizinso noma kukhona ukungapheleli kwazo;
- inentengo ephansi - efinyeleleka emphakathini jikelele;
- noma yiziphi izidakamizwa eziyisisekelo ze-antidiabetesic zihlanganiswa kalula ku-repaglinide;
- Inombukiso ophansi we-contraindication nemiphumela emibi.
Ububi obukhulu be-repaglinide ukuthi ayisebenzi nge-monotherapy. Ingasetshenziswa kuphela ezinhlotsheni ezithambile zesifo sikashukela i-mellitus noma ngokuhlangana neminye imithi. Kodwa-ke, ukuba khona kwama-ejenti asebenza ngokuyisisekelo asebenzisa kahle izinzuzo zokwelapha ze-repaglinide, njengokukhetha kokuqala kokubekezelela ushukela okhubazekile.
Ukwelapha okusha kwesifo sikashukela dapagliflozin. Indlela yokusebenza isebenza ihluke kakhulu kuwo wonke amanye amaphilisi we-antidiabetesic. Umuthi usebenza ngokugcwele ekuvuseleleni kabusha kwe-glucose ezinso, okunyusa ukuphuma kwawo kumchamo. Ngenxa yalokhu, i-glycemia iyancipha noma kungekho msebenzi wokusebenza kahle weseli we-pancreatic. Kwethulwa emakethe yaseRussia ngaphansi kwegama lokuhweba I-Forsiga.
Izici eziphambili ze-dapagliflozin:
- indlela entsha yokusebenza - ayixhomekeki esimweni sama-insulin receptors kwizitho ezihlosiwe naseziqhingini zeLangerhans;
- kuhle ukuqala kokwelashwa;
- umlutha awukhuli, ungasetshenziswa amashumi eminyaka ngaphandle kokunciphisa ukusebenza;
- umsebenzi womuthi ezigulini ezinokukhuluphala uyancipha;
- izindleko eziphakeme;
- ayinakuhlanganiswa ne-diuretics, ikakhulukazi nge-furosemide;
- ngesilinganiso esiphakeme se-hemoglobin yandisa ubungozi be-thromboembolic complication;
- ayikwazi ukusetshenziswa phambi kwesifo sikashukela sohlobo 2 kubantu asebekhulile - iminyaka ephezulu yokuqalisa ukwelashwa ifinyelela eminyakeni engama-74.
Njengamanje, ekusetshenzisweni, i-dapagliflozin isetshenziswa ngezinga elithile, ikakhulukazi kubantu abasha abangakhuluphele. Kepha umuthi unamathuba amahle.
Ukwelashwa kwezidakamizwa sikashukela okwamanje akunangqondo ngaphandle nguyenkungu. Muva nje, izidakamizwa zaleli qembu zisetshenziswa kakhulu ekusebenzeni kwemitholampilo. Bazisungule njengezidakamizwa ezisebenza isikhathi eside eziphephile eziqinisa ngempumelelo izinga le-glycemia. Ziyindlela yokuthola ukwelashwa okuyisisekelo okuyisisekelo futhi zidinga ukungena okuphoqelekile kwansuku zonke. Indlela yokusebenza yinto ekhuthaza ama-PPARy receptors, athuthukisa umbono we-insulin kumaseli wethagethi. Njengomphumela, ngisho nethamo elinganele le-hormone elikhiqizwe ngamanyikwe lisebenza kakhulu ekulinganiseni amazinga kashukela.
Thayipha izibhebhe zesifo sikashukela sohlobo 2 ezihlobene nama-thiazolidinediones - roxiglitazone futhi pioglitazone. Izici zabo eziphambili:
- umthamo owodwa uhlinzeka ngokuphelele ngokulawula ushukela amahora angama-24;
- vikela ngokwanele emaphethelweni we-postprandial;
- ukulungiswa kwamthamo okulula - 2, 4 no-8 mg;
- alikho icala elilodwa lokweqisa ngokweqile elotshwe;
- angasetshenziswa asebekhulile;
- kwehlisa i-cholesterol;
- efanelekile njengomuthi kuphela;
- ukungabikho kwe-insulin yabo uqobo - izidakamizwa zesifo sikashukela kuleli qembu azisebenzi ngokuphelele;
- imvamisa ngokumelene nesizinda sokwelashwa, i-edema iyenzeka.
Ukuqapha lapho uthatha i-thiazolidinediones kufanele kubhekwe kwabesifazane ngesikhathi se-premenopusing. Noma kungabikho umjikelezo ojwayelekile, i-roxiglitazone icasula i-ovulation, engaholela ekukhulelweni okungakahlelwanga, okuzodingeka ukuthi kuphazanyiswe ngokungafanele.
Izidakamizwa zakamuva ekwelapheni isifo sikashukela sohlobo 2
Ukuthuthuka njalo kwesayensi ekufuneni izidakamizwa ezisiza ukuthuthukisa ikhwalithi yempilo yeziguli ezinesifo sikashukela kuyaqhubeka. Eminyakeni yamuva nje, sekuvele amaphilisi amasha anciphisa ushukela wegazi ngohlobo 2 sikashukela - incretinomimetics. Umnyombo wesenzo sabo ukukhuthaza nokwandisa umsebenzi we-glucagon polypeptide. Yi-hormone esebenza ku-insulin synthesis kumaseli weLangerhans. Iqembu le-incretin mimetics lifaka:
- sitagliptin;
- saxagliptin;
- vildagliptin;
- linagliptin;
- gozogliptin;
- alogliptin.
Kwaziwa kakhulu ekujuleni kwenhliziyo kwemithi. sitagliptin ngaphansi kwegama lokuhweba UJanuvia futhi vildagliptin ("Galvus"). Lawa maphilisi kashukela anezimpawu ezilandelayo:
- ukulawulwa okwanele kwe-glycemic kungakapheli amahora angama-24 ngemuva komthamo owodwa;
- isibonisi esiphansi sokuphendula okungalungile;
- ukuthuthukisa ikhwalithi yempilo yeziguli ngisho nange-monotherapy;
- ungahlanganisi nokuphuma kwe-sulfonylurea ne-insulin;
- ilungele ukuqala ukwelashwa;
- umlutha nokuqina ngisho nokusebenzisa isikhathi eside akwenzeki.
Ama-Incretinomimetics izidakamizwa zokwelapha isifo sikashukela sohlobo 2 ngombono omuhle kakhulu. Ukuqhubeka nokufunda kwe-glucagon polypeptide stimulants kungaholela empumelelweni enkulu ekuphatheni kwezifo nasekubambeleleni kweziguli ezindleleni zokwelapha. Ukusetshenziswa kwabo kukhawulelwe ngesici esisodwa kuphela - izindleko eziphakeme kunalokho, kepha le mithi esetshenziselwa isifo sikashukela 2 ifakiwe kumzuzo yenhlangano neyesifunda.
Kodwa yini okufanele yenziwe ezigulini lapho i-glucagon polypeptide ingakhiqizwa kahle futhi ukuvuswa kwayo ngezindlela zomlomo kungalethi umphumela oyifunayo? Imithi emisha eyisisekelo yesifo sikashukela sohlobo 2 iyimijovo ye-analogues yale hormone. Eqinisweni, izidakamizwa ezinjalo ngama-incretinomimetics afanayo, kepha aphathwa ngabazali. Isidingo sokuphuza amaphilisi siyanyamalala ngokuphelele.
Kumele kuqashelwe ukuthi imijovo yama-incretin mimetics ayihlobene ne-insulin, ngenxa yalokho, ayisetshenziselwa ukuntuleka kwayo ngokuphelele.
Iqembu labalingisi be-incretin mimetics lifaka:
- exenatide;
- ukuhlalaglutide;
- lixisenatide;
- I-liraglutide (yaziwa kakhulu ngegama lerhwebo elithi "Saksenda").
I-injekishini ye-inretion incretin mimetics yisizukulwane esisha sezidakamizwa sokubhekana nokulawulwa kwe-glycemic ezigulini ezinesifo sikashukela esingaxhomekeki ku-insulin. Zikhishelwa ngaphandle kwesisu esiswini noma ethangeni ngokwazo ngosuku. Imvamisa, ngisho nangezinhlobo ezinzima zesifo, ukulawula ngokuphelele kwe-glycemia kungatholwa. Kodwa-ke, uma kunesidingo, angahlanganiswa ne-metformin ukuthuthukisa umsebenzi wama-receptors kumaseli kwelitshe. Ngaphezu kwalokho, inhlanganisela enjalo iyathembisa ikakhulukazi uma isifo sikashukela sohlobo 2 sihlanganiswa nokukhuluphala esemncane.
Ukuphumelela kwangempela kokulawulwa kwe-glycemic yi-kuhlalaglutide (Trulicity). Kuyi-mretetic ye-injretin ye-injretin, kepha isikhathi eside esengeziwe sokwenza. Umjovo owodwa unele izinsuku ezingama-7, futhi ngenyanga, imijovo emi-4 yanele. Ngokuhambisana nokudla kanye nokuzivocavoca okulinganiselayo, i-Livingglutide izovumela iziguli ukuba ziholele indlela yokuphila esezingeni eliphezulu futhi zinganciki ekudleni kwamathebhulethi nsuku zonke isifo sikashukela sohlobo 2. Kunezici ezi-2 kuphela ezilinganisela ukusetshenziswa kwemijovo yakamuva - akuzona zonke iziguli ezivuma ukuthi imijovo lapho kunenye indlela ngamaphilisi, kanye nezindleko eziphakeme.
Isiphetho
Ngakho-ke, okwamanje kunezindlela eziningi zokwelapha zokwelashwa okusebenzayo kwesifo sikashukela sohlobo 2. Lezi izidakamizwa zethebhulethi ezivela emaqenjini ahlukahlukene, nezidakamizwa ezijozayo. Uchwepheshe onolwazi oqonda izici zomkhakha wezokwelapha wanamuhla uzokhetha kalula ukwelashwa okudingekayo kwanoma yisiphi isiguli, ebheka izimfanelo zakhe ngamunye. Izidakamizwa zesifo sikashukela zihlanganisa ukwelashwa okusebenzayo kanye nokulula kumuntu ogulayo. Ezinye izixazululo ezifakelwayo zivumela ukukhunjulwa kweviki kuphela kwesidingo sezindlela zokwelapha.
Ukufundwa kwamathuba amasha okwelashwa kwe-pharmacological akuyeki - izidakamizwa ezilungele futhi eziphephile zenzelwe ukwehlisa ushukela wegazi, okuvumela ukubheka okuhle ngekusasa leziguli ezakha isifo esingathandeki.
