Umuthi onqunywe kakhulu kunoshukela emhlabeni yiMetformin, futhi isetshenziswa abantu abayizigidi eziyi-120 nsuku zonke. Umlando wezidakamizwa uneminyaka engaphezu kwamashumi ayisithupha, phakathi naleso sikhathi kwenziwa izifundo eziningi, kukhombisa ukusebenza kwawo nokuphepha kweziguli. Imvamisa, iMetformin isetshenziselwa uhlobo 2 sikashukela ukunciphisa ukumelana ne-insulin, kepha kwezinye izikhathi lungasetshenziswa ukuvimbela ukuthuthukiswa kokuphazamiseka kwe-carbohydrate futhi njengokwengezwa kwe-insulin yokwelapha isifo sohlobo lokuqala.
Umuthi unobuncane be-contraindication futhi awunamphumela omubi ojwayelekile wabanye ama-hypoglycemic agents: awukhulisi ubungozi be-hypoglycemia.
Ngeshwa, iMetformin isenamaphutha. Ngokusho kokubuyekezwa, engxenyeni yesihlanu yeziguli ezinatha, kubhekwa ukuphazamiseka kwesisu. Kungenzeka ukunciphisa amathuba okusabela komuthi ngohlelo lokugaya ukudla ngokwandisa kancane kancane umthamo nokusebenzisa ukwakheka okusha, okuqhubeka isikhathi eside.
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
Izimpawu Metformin
I-Metformin iklanywa ngokwakhiwa kwemithi yembuzi, isitshalo esijwayelekile esinezakhiwo ezinwebayo ezinoshukela. Ukunciphisa ubuthi futhi uthuthukise umphumela we-hypoglycemic wembuzi, umsebenzi waqala ukwabiwa kwezinto ezisebenzayo kuwo. Baphenduka baba ngama-biguanides. Njengamanje, iMetformin ingukuphela kwesidakamizwa kuleli qembu eseliphumelele ngempumelelo ukulawulwa kokuphepha, okusele kwaba yingozi esibindini futhi kwandisa kakhulu ingozi ye-lactic acidosis.
Ngenxa yokusebenza kwayo nemiphumela emincane kakhulu, kungumuthi wolayini wokuqala ekwelapheni isifo sikashukela sohlobo 2, okungukuthi, sinqunyelwe kwasekuqaleni. I-Metformin ayikhulisi i-insulin synthesis. Ngokuphambene nalokho, ngenxa yokwehla kweshukela egazini, i-hormone iyayeka ukukhiqizwa ngevolumu ekhuphukayo, evame ukwenzeka lapho kuqala isifo sikashukela sohlobo 2.
Ukwemukelwa kwalo kukuvumela:
- Qinisa ukuphendula kwamaseli ku-insulin, okungukuthi, ukunciphisa ukumelana ne-insulin - imbangela eyinhloko yokuphazamiseka kwe-carbohydrate kubantu abakhuluphele ngokweqile. I-Metformin ehambisana nokudla nokuzivocavoca ingasinxephezela isifo sikashukela sohlobo 2, kungenzeka ukuthi yelaphe i-prediabetes futhi isize ukuqeda i-metabolic syndrome.
- Yehlisa ukumuncwa kwama-carbohydrate avela emathunjini, okubuye kunciphise ushukela wegazi.
- Ukunciphisa ukukhiqizwa kwe-glucose esibindini, ngenxa yalokho izinga layo esegazini lehla esiswini esingenalutho.
- Thonya iphrofayili ye-lipid yegazi: yandisa okuqukethwe kwama-lipoprotein aphezulu kwabantu kuwo, unciphise i-cholesterol nama-triglycerides ayingozi emithanjeni yegazi. Lo mphumela unciphisa ubungozi bezinkinga zesifo sikashukela.
- Thuthukisa ukuqalwa kabusha kwezibalo zegazi elisha emithanjeni, yenze buthaka ukunamathela kwe-leukocytes, okungukuthi, unciphise ingozi ye-atherosclerosis.
- Yehlisa isisindo somzimba, ikakhulukazi ngenxa yengozi enkulu yomzimba wamafutha we-visceral. Ngemuva kweminyaka engu-2 yokusetshenziswa, isisindo seziguli sehle ngo-5%. Ngokuncipha kokudla kwe-caloric, imiphumela yokunciphisa umzimba yathuthukiswa kakhulu.
- Gqugquzela ukuhamba kwegazi kwezicubu ezithambile, okuwukuthi, kuthuthukisa umsoco wazo.
- Ukwenza i-ovulation nge-ovary polycystic,-ke, ingathathwa lapho uhlela ukukhulelwa.
- Vikela umdlavuza. Lesi senzo sivulwe muva nje. Ucwaningo luveze ukuthi izakhiwo ze-antitumor kulesidakamizwa; ubungozi bokuqalwa kwe-oncology ezigulini kwehle ngama-31%. Umsebenzi owengeziwe uyaqhubeka nokutadisha nokuqinisekisa lo mphumela.
- Yehlisa ukuguga. Lokhu kungumphumela we-Metformin ongafakwanga konke, ucwaningo lwenziwa ezilwaneni kuphela, bakhombisa ukwanda kwesikhathi sokuphila kwezinduku zokuhlola. Ayikho imiphumela yokuhlolwa okugcwele komtholampilo ngokuhlanganyela kwabantu, ngakho-ke kusesekuseni kakhulu ukusho ukuthi iMetformin yandisa impilo. Kuze kube manje, le nkulumo iyiqiniso ezigulini ezinesifo sikashukela kuphela.
Ngenxa yomphumela we-multifactorial emzimbeni, izinkomba zokusetshenziswa kwe-Metformin azikhawulwanga ekuelashweni kashukela sikashukela sohlobo 2 kuphela. Ingathathwa ngempumelelo ukuvikela ukuphazamiseka kwe-carbohydrate, ukulungiselela ukunciphisa isisindo. Ucwaningo luye lwabonisa ukuthi kubantu abane-prediabetes (ukubekezelela ushukela), ukukhuluphala, umfutho wegazi ophakeme, i-insulin ethe xaxa) eneMetformin kuphela, isifo sikashukela sasingaphumeleli ukuba ngama-31%. Ukungezelelwa kokudla nemfundo yokuzivocavoca ohlelweni kuyithuthukisile kakhulu imiphumela: i-58% yeziguli ikwazile ukugwema isifo sikashukela.
I-Metformin inciphisa ubungozi bazo zonke izinkinga zesifo sikashukela ngama-32%. Umuthi ukhombisa imiphumela emangazayo ekuvinjelweni kwama-macroangiopathies: amathuba wokuhlaselwa yisifo senhliziyo kanye nesifo sohlangothi sincishiswe ngo-40%. Lesi senzo siqhathaniswa nomphumela we-cardiprotectors aqashelwayo - izidakamizwa zokucindezela nama-statins.
Uhlobo lokukhululwa kwezidakamizwa kanye nemithamo
Umuthi wokuqala oqukethe iMetformin ubizwa ngokuthi iGlucofage, uhlobo lwenkampani yaseFrance iMerck. Ngenxa yokuthi sekudlule iminyaka engaphezu kweshumi kusungulwa lo muthi nokuthola imvume yawo, ukukhiqizwa kwezidakamizwa okunesakhi esifanayo - ama-generics, kuvunyelwe ngokusemthethweni.
Ngokuya kokubuyekezwa kodokotela, abadume kakhulu nabaphezulu kakhulu:
- IGerman Siofor neMetfogammia,
- I-Israel Metformin-Teva,
- I-Russian Glyfomin, i-Novoformin, i-Formmetin, iMetformin-Richter.
IGenerikhi inenzuzo engenakuphikwa: ishibhile kunomuthi wokuqala. Azikho ngaphandle kwezingqinamba: ngenxa yezici zokukhiqizwa, umphumela wazo ungahle ube buthakathaka, futhi ukuhlanza kubi kakhulu. Ekwenzeni amathebhulethi, abakhiqizi bangasebenzisa abanye abafunyelwayo, okungaholela emiphumeleni emibi eyengeziwe.
Umuthi ukhishwa ngendlela yamathebulethi wokuphathwa komlomo, umthamo we-500, 850, 1000 mg. Umphumela wehlisela ushukela ezinkingeni ze-carbohydrate metabolism ubonwa uqala kusuka ku-500 mg. Kwisifo sikashukela, umthamo ophelele ngu-2000 mg.. Ngokukhuphuka kwalo kuya ku-3000 mg, umphumela we-hypoglycemic ukhula kancane kunokuba ingozi yemiphumela emibi. Ukwanda okuthe xaxa komthamo akugcini nje ngokungenamsebenzi, kodwa futhi kuyingozi. Uma amaphilisi ama-2 we-1000 mg akwanele ukwenza i-glycemia ibe ngcono, isiguli sinqunyelwe futhi ukwehlisa izidakamizwa kwamanye amaqembu.
Ngaphezu kwe-Metformin emsulwa, kuhlanganiswa amalungiselelo ahlanganayo kashukela, isibonelo, i-Glibomet (ene-glibenclamide), i-Amaryl (ene-glimepiride), i-Yanumet (ene-sitagliptin). Inhloso yabo inesizathu sesifo sikashukela sesikhathi eside, lapho umsebenzi we-pancreatic uqala ukonakala.
Kukhona nezidakamizwa ezinezenzo ezinde - i-Glucofage Long (umthamo 500, 750, 1000 mg), i-analogues Metformin Long, Glodein Prolong, IFomine Long. Ngenxa yesakhiwo esikhethekile sethebhulethi, ukumuncwa kwalesi sidakamizwa kuncishiswa, okuholela ekunciphiseni okubili kokuvama kwemiphumela emibi evela emathunjini. Umphumela we-hypoglycemic ugcinwe ngokuphelele. Ngemuva kokuthi iMetformin igxiliwe, ingxenye engasebenzi yethebulethi iyadedelwa ezindlebeni. Ukudonswa okukuphela kwaleli fomu ukukhuphuka okuncane ezingeni lama-triglycerides. Ngaphandle kwalokho, umphumela omuhle kuphrofayili ye-lipid yegazi uhlala.
Ungayithatha kanjani i-metformin
Qala ukuthatha iMetformin ngethebhulethi engu-1 ka-500 mg. Uma umuthi ubekezelelwa kahle, umthamo uyakhuphuka ufike ku-1000 mg. Umphumela wehlisela ushukela uba kancane kancane, ukwehla okuqinile kwe-glycemia kubonwa ngemuva kwamasonto amabili wokuphatha. Ngakho-ke, umthamo ukhuphuka ngo-500 mg ngeviki noma emibili, kuze kube yilapho ishukela inxephezelwa. Ukunciphisa umthelela omubi wokugaya, umthamo wansuku zonke uhlukaniswe ngemithamo emithathu.
I-metformin ekhishwa kancane iqala ukuphuza ngethebhulethi eyi-1, okokuqala ukuthi umthamo ulungiswe ngemuva kwezinsuku eziyi-10-15. Isilinganiso esivunyelwe esiphezulu ngamathebhulethi ama-3 we-750 mg, amaphilisi ama-4 we-500 mg. Umthamo wonke wesidakwa udakwa ngasikhathi sinye, ngesikhathi sokudla kwakusihlwa. Amathebulethi awakwazi ukuchobozeka futhi ahlukaniswe izingxenye zawo, ngoba ukwephulwa kwesakhiwo sawo kuzoholela ekulahlekelweni kwesenzo eside.
Ungathatha i-Metformin isikhathi eside, ikhefu ekwelashweni alidingeki. Ngesikhathi sokudla, ukudla okune-carb ephansi kanye nokuzivocavoca umzimba kukhanseliwe. Lapho kukhona ukukhuluphala, banciphisa ukudliwa kwekhalori.
Ukusetshenziswa isikhathi eside kungaholela ekuntuleni kwevithamini B12, ngakho-ke abantu abanesifo sikashukela abathatha iMetformin kufanele badle imikhiqizo yezilwane nsuku zonke, ikakhulukazi isibindi, izinso nenyama yenkomo, futhi bahlolwe njalo ngonyaka ukuthola i-B12 defence anemia.
Inhlanganisela ye-metformin neminye imithi:
| Ukwabelana ngemikhawulo | Ukulungiselela | Isenzo esingafunwa |
| Kunqatshelwe ngokuphelele | Amalungiselelo wokuqhathanisa i-X-ray nokuqukethwe kwe-iodine | Kungavusa i-lactic acidosis. I-Metformin inqanyulwa ezinsukwini ezi-2 ngaphambi kocwaningo noma ukusebenza, iphinde iqale emuva kwezinsuku ezi-2 emva kwazo. |
| Ukuhlinzwa | ||
| Ayidingeki | I-Alcohol, konke ukudla nemithi equkethe | Bandisa ingozi ye-lactic acidosis, ikakhulukazi kwabanesifo sikashukela ekudleni okune-carb ephansi. |
| Kudingeka ukulawula okwengeziwe | I-Glucocorticosteroids, i-chlorpromazine, i-agaists ye-beta2-adrenergic | Ukukhula ushukela wegazi |
| Imithi yokucindezela ngaphandle kwe-ACE inhibitors | Ingozi ye-hypoglycemia | |
| Ama-diuretics | Amathuba we-lactic acidosis |
Imiphumela emibi nokuphikisana
Imiphumela emibi ethatha iMetformin nobuningi babo bokuvela:
| Imicimbi Emibi | Izimpawu | Imvamisa |
| Izinkinga zokugaya | Isicanucanu, ukulahleka kwesifiso sokudla, izihlalo ezikhululekile, ukugabha. | ≥ 10% |
| Ukuphazamiseka kwengqondo | Ukunambitheka kwensimbi emlonyeni, kuvame esiswini esingenalutho. | ≥ 1% |
| Ukungezwani komzimba | Ukugoqa, ubomvu, ukulunywa. | < 0,01% |
| I-Lactic acidosis | Esigabeni sokuqala - izinhlungu zemisipha, ukuphefumula ngokushesha. Ngemuva kwalokho - ukwehluleka, ukucindezela okunciphisile, i-arrhythmia, i-delirium. | < 0,01% |
| Umsebenzi wesibindi ongasebenzi kahle, i-hepatitis | Ubuthakathaka, ukukhuphuka kokugaya ukudla, i-jaundice, izinhlungu ngaphansi kwezimbambo. Ukuchitheka emva kokukhanselwa kweMetformin. | Amacala angawodwa |
I-Lactic acidosis yisimo esiyivelakancane kodwa esibulalayo. Emiyalweni yokusetshenziswa, kubelwe isigaba sonke. Amathuba we-acidosis aphezulu nge:
- overdose ye-metformin;
- utshwala;
- ukwehluleka kwezinso;
- ukuntuleka komoya-mpilo ngenxa ye-angiopathy, i-anemia, isifo samaphaphu;
- ukuntuleka okukhulu kwe-Vitamin B1;
- ebudaleni.
Ukunakwa ikakhulukazi lapho uthatha iMetformin kufanele ikhokhwe ekuhambisaneni kwayo notshwala. Ukwephulwa okuqinile kokusetshenziswa kwesidakamizwa kuwukuphuza utshwala, ikakhulukazi ngezinkinga zesibindi. Noma uhlela ukuphuza ingilazi yonke yewayini, iMetformin ejwayelekile kufanele ikhanselwe emahoreni angama-18, inwetshiwe - ngosuku. Ikhefu elide kangaka lizothusa kakhulu isinxephezelo sikashukela, ngakho-ke kunengqondo ngokwengeziwe ukushiya ngokuphelele utshwala.
Ngokusho kweziguli, ukuphazamiseka kokugaya ukudla nokunambitha imvamisa kungokwesikhashana futhi kunyamalale lapho nje umzimba uvumelana nomuthi. Kaningi zidlula ngaphandle kokwelashwa ngemuva kwamaviki ama-2. Ukunciphisa ukungaphatheki kahle, umthamo unyuswa kahle. Kwezinye izimo, kufanelekela ukushintshela kwi-Glucophage Long ende evunyelwe kangcono.
Uhlu lwe-contraindication:
- Izimo ezidinga ukwelashwa kwe-insulin okwesikhashana zifaka phakathi izinkinga zesifo sikashukela (i-ketoacidosis, i-precoma ne-coma), ukuhlinzwa, ukuhluleka kwenhliziyo, ukushaya kwenhliziyo.
- I-nephropathy yesifo sikashukela, kusukela esigabeni 3.
- Isifo sezinso, esiyinkimbinkimbi yesikhashana ngokuphelelwa ngamandla, ukushaqeka, ukutheleleka okunzima.
- Idluliselwe ngaphambilini i-lactic acidosis.
- Ukuphuza ikhalori okunganele (1000 kcal noma ngaphansi).
- Ukukhulelwa Ngohlobo 2 lwesifo sikashukela, iMetformin kufanele ichithwe futhi kwelashwe i-insulin esiteji sokuhlela.
Akukona ukweqa umthetho ukuthatha i-Metformin, kepha kudinga ukubhekwa okwengeziwe kwezokwelapha ngaphezulu kweminyaka engu-60, uma isiguli sinesifo sezinso noma sinengcindezi enkulu. Umuthi ungadlula ubisi lwebele, kepha awutholakalanga umphumela omubi enganeni. Uma ukondla kuvunyelwe nophawu emiyalweni yokusebenzisa "ngokuqapha". Lokhu kusho ukuthi isinqumo sokugcina senziwa ngudokotela, ekala izinzuzo nezinzuzo ezingabakhona zeMetformin.
Ama-analog we-Metformin - ungangena kanjani esikhundleni?
Uma iMetformin ingabekezelelwa kahle, ingashintshwa ngomuthi osebenza isikhathi eside noma i-analogue ephelele yomunye umenzi.
| Ukulungiselela kweMetformin | Uphawu lwentengiso | Intengo yethebhulethi engu-1 ngu-1000 mg, ama-ruble. |
| Umuthi woqobo | I-Glucophage | 4,5 |
| I-Glucophage Long | 11,6 | |
| I-analogue ephelele yesenzo esijwayelekile | Siofor | 5,7 |
| Glyformin | 4,8 | |
| Metformin teva | 4,3 | |
| I-Metfogamma | 4,7 | |
| IFethethine | 4,1 | |
| Qedela i-analogue yesenzo eside | Ifomu elide | 8,1 |
| Ukwanda kwesikhathi | 7,9 |
Lapho kukhona ama-contraindication, umuthi ukhethwa ngomshini ofanayo womsebenzi, kodwa ngesakhiwo esehlukile:
| Iqembu lezidakamizwa | Igama | Inani ngepakethe ngalinye, hlikihla. |
| Ama-Dhib4 Inhibitors | UJanuvia | 1400 |
| UGalvus | 738 | |
| Ama-agonist we-GPP1 | Victoza | 9500 |
| I-Baeta | 4950 |
Ukushintshwa komuthi kufanele kwenziwe kuphela njengoba kuyalelwe udokotela futhi kungaphansi kokuqondisa kwakhe.
Ukucwilisa iMetformin
I-Metformin kungenzeka ingasizi wonke umuntu ukuthi anciphise isisindo. Ukusebenza kwayo kufakazelwe kuphela ukukhuluphala esiswini. Kuvame kakhulu emadodeni, isisindo esikhulu ngokweqile sinqwabelana esiswini ngesimo samafutha e-visceral. Kufakazelwe ukuthi iMetformin isiza ukunciphisa noma ukugcina isisindo somzimba, ukunciphisa amaphesenti wamafutha e-visceral, futhi ekuhambeni kwesikhathi - ukusatshalaliswa okunempilo kwezicubu ezinamafutha emzimbeni. Kuphakanyiswa ukuthi umuthi ungathinta uhlelo lwezinzwa, wehlise iphango. Ngeshwa, akubona bonke abaqaphela lo mphumela.
Kunconywa ukusebenzisa iMetformin yokuncipha kwesisindo kuphela kwiziguli ezinenkinga yokukhuluphala (BMI≥30) noma lapho uhlanganisa isisindo ngokweqile (BMI≥25) nesifo sikashukela, isifo senhliziyo esiku-coronary. Kulokhu, umuthi usebenza ngempumelelo kakhulu, ngoba iningi leziguli elinjalo limelana ne-insulin.
Eminye imithombo ibala umuthi njenge-carbohydrate blocker emathunjini. Empeleni yena ayivimbi ukumuncwa kweglucose, kepha yehlisa ijubane, okuqukethwe kwekhalori kokudla kuzohlala kunjalo. Ngakho-ke, akufanele uzame ukulahlekelwa ngamakhilogremu ambalwa ku-Metformin ukufeza isibalo esihle. Kulokhu akayena umsizi.
Ukusebenza Ngokucobeka
I-Metfomin ayinakubizwa njengezindlela eziphumelela kakhulu zokunciphisa isisindo. Ngokusho kocwaningo, ukusetshenziswa kwesidakamizwa isikhathi eside ngenkathi kugcinwa izindlela zokudla zangaphambilini kunikeza ukulahleka kwesisindo okungama-0.5-4,5 kg. Imiphumela emihle yabonwa eqenjini leziguli ezine-metabolic syndrome: lapho uthatha i-1750 mg ye-Glucofage Long ngosuku, ukwehla kwesisindo ngenyanga yokuqala kwakungu-2.9 kg. Ngaso leso sikhathi, amazinga abo e-glycemia ne-lipid yegazi abuyele kwesejwayelekile, futhi umfutho wegazi labo wehla kancane.
Ukumelana ne-insulin kuholela ekwandeni kwe-insulin, okuvimbela ukuqhekeka kwamafutha, futhi inqubo yokulahlekelwa isisindo inciphisa ijubane. Ngokumelana ne-insulin okuqinisekiswe ukuhlaziya, ukuthatha iMetformin kukuvumela ukuthi "ucindezele" umzimba futhi uqale inqubo yokulahlekelwa isisindo. Ngokwemvelo, umuntu ngeke akwenze ngaphandle kwekhalori ephansi, futhi okungcono, ukudla okuphansi kwe-carb. Bazosiza ekusheshiseni i-metabolism nanoma yimuphi umdlalo.
Malysheva mayelana Metformin
Umethuli wezinhlelo zethelevishini odumile u-Elena Malysheva ukhuluma ngeMetformin kuphela njengendlela yokwandisa impilo, ngaphandle kokuthi asho ukuthi ososayensi abakavezi ubufakazi bangempela kulokhu. Ukuze wehlise isisindo, unikeza ukudla okulinganiselayo nokunama-kilojoule amancane. Ngempilo enhle, leli yithuba langempela lokususa amanoni ngokweqile. Abantu abanesifo sikashukela abakwazi ukulandela lokho kudla, ngoba kugcwele i-carbohydrate.
Ukukhetha izidakamizwa
Ukusebenza kwe-Glucofage nokufana kwayo kusondele, intengo ibuye ihluke kancane, ngakho-ke akunandaba ukuthi uzokhetha muphi. Umuthi osebenza isikhathi eside ubekezelelwa kangcono, futhi kunobungozi obuncane bokweqa umthamo, ngoba udakwa kanye ngosuku.
I-Metformin yesifo se-yegilo
Uma lezi zinyathelo ezingenhla zinganikezi umphumela, futhi isisindo simi ngxi, kufanele unake isimo se-pancreas. Kungcono ukuthatha izivivinyo ze-hypothyroidism (i-thyrotropin, i-thyroxine, i-triiodothyronine) futhi uvakashele i-endocrinologist. Ukwelashwa kweHormone kuvunyelwe ukuhlangana nokusetshenziswa kweMetformin.
