Izidakamizwa zokunciphisa ushukela wegazi kuhlobo 2 sikashukela

I-mellitus yesifo sikashukela enganciki i-insulin ingenye yezindlela zesifo, esibonakala ngukuncipha kokuzwela kwamangqamuzana nezicubu zomzimba esenzweni se-insulin ye-hormone. Le nto ikhiqizwa ngamaseli wemishini yokufakelwa yangaphakathi yamanyikwe. Umsebenzi wawo ukuthutha ama-molecule eglucose ngaphakathi kwamangqamuzana ukuze anikeze owokugcina amandla.

Egazini lesifo sikashukela sohlobo 2, i-hyperglycemia iyabonakala - izinga eliphakeme loshukela. Lesi sibonakaliso sithathwa njengokuhola, ngesisekelo saso ukuthi ukuxilongwa kwaqinisekiswa. Ukulwa nezibalo eziphakeme ze-glycemia, ukwelashwa kokudla (ukulungiswa kokudla okunempilo), ukusebenza komzimba kanye nokwelashwa kwezidakamizwa kuyasetshenziswa. Lesi sihloko sizogxila ezicini zokuqokwa kanye nokuphathwa kwezidakamizwa. Uhlu lwezidakamizwa ezinciphisa ushukela wesifo sikashukela sohlobo 2, izinkomba zokusebenzisa kwazo kanye nemigomo yokwelashwa kuxoxwa ngazo ngezansi.

Imigomo yokwelashwa kwezidakamizwa

I-American Diabetes Association kanye ne-European Association for the Study of Diabetes zigcizelela ukuthi i-glycosylated hemoglobin ibhekwa njengeyona nto ebalulekile yokuxilonga ekuhloleni isimo sesiguli. Ngesibalo esingaphezulu kwe-6.9%, izinqumo zekhadinali kufanele zenziwe ngokuya ngokwelashwa. Kodwa-ke, uma lokhu kungezona zonke iziguli, kodwa mayelana namacala athile asemtholampilo, kufanele kuqinisekiswe ukuthi izinkomba azihambi ngaphezu kwe-6%.

Ngokushesha ngemuva kokuqinisekisa ukutholakala kohlobo lwe- "isifo esimnandi" uhlobo 2 (njengoba isifo sikashukela sibizwa kubantu abavamile), ama-endocrinologists anquma iMetformin. Izici zokusebenzisa umuthi zibonakaliswa ngokulandelayo:

• umuthi awunikele ekuzuzeni isisindo;
• inemiphumela emincane okungenani;
• ayivuseli ukuhlaselwa kokwehla okubucayi koshukela wegazi kushukela;
• oqokwe lapho kungekho khona ukuphikisana;
• ibekezelelwe kahle iziguli;
• kubhekiswa ezidakamizweni zezindleko eziphansi.

I-Endocrinologist - uchwepheshe ozosiza isiguli ukubhekana ne-pathology

Kubalulekile! Ukwelashwa okuqhubekayo ngamathebhulethi anciphisa ushukela kulungiswa lapho sekuphathwa iMetformin.

Lokhu okulandelayo kungamaqembu aphambili wezidakamizwa ezinciphisa ushukela, abamele babo ngempumelelo, ikakhulukazi inhloso nokuphatha.

Amaqembu aphambili wezidakamizwa

I-endocrinology yesimanje isebenzisa amakilasi ama-5 emithi ukwehlisa ushukela wegazi kushukela. Bahlukaniswe ngamaqembu amakhulu amabili:

• Ama-Hypoglycemic agents (imishanguzo eyehlisa amazinga kashukela wegazi). Zigqugquzela ukukhiqizwa kwe-insulin yensulin, ethinta isisindo sesiguli (inyuka), futhi ingavusa ukwehla okubucayi kwe-glycemia. Abamele bangama-sulfonylureas kanye nobumba.
• Imithi ye-antihyperglycemic (izidakamizwa ezingavumeli ushukela wegazi ukuba ukhuphuke ngaphezulu kwesilinganiso esivumelekile). Abamele iqembu benyusa ukusetshenziswa koshukela emngceleni wethafa, kodwa ngandlela thile bavuselele umsebenzi we-pancreatic. Lokhu kufaka phakathi i-biguanides, i-alpha-glucosidase blockers ne-thiazolidinediones.

Ithebula: Ukuqhathanisa izidakamizwa eziphambili zokunciphisa ushukela

IBiguanides

Njengamanje esigabeni samanje, isidakamizwa esisetshenziswa kakhulu seqembu yiMetformin. Kujwayelekile ngenxa yengozi ephansi ye-lactic acidosis ngesikhathi sokwelashwa. AmaBiguanides ayakwazi ukulungisa izinqubo ze-metabolic ngenxa yokuthi:

• ukunciphisa ijubane i-gluconeogeneis (ukwakheka kwe-glucose ngesibindi kusuka ezintweni ezingewona i-carbohydrate);
• ukwanda kokudla ushukela ngamangqamuzana nezicubu;
• Izinguquko ezilinganisweni zokufakwa ushukela emgodini wamathumbu.

Izinzuzo kanye nokubi kweqembu

AmaBiguanides anciphisa ngokuphelele ushukela kanye ne-glycosylated hemoglobin, anciphisa kancane isisindo somzimba, ayeke ukuthanda ukudla kwe-pathological. Le mishanguzo ilungile ngoba ayivuseli ukuthuthukiswa kwe-hypoglycemia yasekuseni yokulwa yindlala ebusuku.

Ukusetshenziswa isikhathi eside kweMetformin kunomthelela omuhle kuma-metabolism wamafutha.

Umuthi iMetformin awugcini ngokuqhekeka kokuqhekeka kwama-lipids, kepha futhi uvimbela ukwakheka kwezicubu ze-adipose. AmaBiguanides asiza nokususa i-cholesterol embi emzimbeni, ukunciphisa inani le-triglycerides ne-LDL. Umphumela onenzuzo esimweni sohlelo lwegazi lokujiya.

Izici zokwelapha

I-Metformin inganciphisa i-glycemia uma isetshenziswa njenge-monotherapy noma ihlangana ne-insulin therapy, sulfonylureas. AmaBiguanides awabekwanga amacala alandelayo:

• isikhathi sokukhulelwa nokuqunjelwa;
• izimo ezimbi kakhulu, kufaka phakathi ukoma;
• izigaba ezibulalayo ze-pathology yezinso nesibindi;
• izinqubo zokutheleleka okunamandla;
• ngokumelene nesizinda sokwelashwa kokudla ngekhalori yansuku zonke engaphansi kwe-1000 kcal;
• iziguli ezinomzimba ophakeme;
• iziguli esezikhulile.

I-Alpha Glucosidase Inhibitors

Imakethe yanamuhla yemithi yaseRussia inomkhiqizo owodwa weqembu kuphela. Le yiGlucobai (into esebenzayo yi-acarbose). Umuthi ubopha ama-enzyme asemathunjini, wehlise ijubane inqubo yokuqhekeka kanye nokumuncwa kwama-saccharides. Umphumela uba ukuvimba ukwanda koshukela ngemuva kokuthi ukudla kudakwe.

Ekusebenzeni kwangempela, i-monotherapy ene-alpha-glucosidase inhibitors isebenza kuphela ekutholakaleni kwesifo sikashukela ekuqaleni. Amaqembu amabili avame ukuhlanganiswa: inhibitors + sulfonylureas, inhibitors + biguanides, inhibitors + insulin therapy.

Izilingo zemitholampilo zifakazele ukusebenza ngempumelelo kwe-Glucobay

Umphumela omkhulu we-Glucobai uhlotshaniswa nokuphulwa kwesimo sokusebenza kwepheshana lesisu. Iziguli zinezikhalazo zohudo, ziyaqhakaza. Ukuxhumana ngokuqokwa komuthi yilezi:

• i-diverticulitis;
• i-bowel syndrome;
• i-ulcerative colitis;
• Isifo sikaCrohn;
• ukuba khona kwe-adhesions;
• i-hernia ye-peritoneum.

Sulfonylureas

Abamele leli qembu, behlisa ushukela wegazi, batholwa ngengozi. Ekuqaleni, bekukholelwa ukuthi imithi inomphumela we-antibacterial kuphela. Ngemuva kokuthola amandla angeziwe aleli qembu, ososayensi baqala ngamabomu ukufuna leyo mishanguzo enomphumela we-hypoglycemic. Lokhu kuvumele ukusetshenziswa kwabamele ukwelashwa kwesifo sikashukela sohlobo 2.

Isenzo sokutholakala kwe-sulfonylurea simi ngokulandelayo:

Uhlobo Olusha 2 Lwesifo Sikashukela

• ukuvuselela okokusebenza kokufakelwa;
• ukubuyiselwa kokuzwela kwamaseli wama-isanger weLangerhans-Sobolev;
• ukukhuphuka kwenani lama-receptors abucayi ezingaphezulu zamaseli we-peripheral.

Okubi kweqembu kungenzeka ukuthi uthole isisindo ngesikhathi sokwelashwa nabamele iqembu lesizukulwane sesibili (ngokwesibonelo, Maninil). Uma usebenzisa izindlela ezifanayo, inqubo yokulinyazwa kwemithambo ye-coronary iyanda, inkambo yokuhlaselwa yinhliziyo iba nzima kakhulu.

Contraindication kuya kunikezwa kwemithi:

• ifomu lokuncika kwe-insulin "lesifo esimnandi";
• isikhathi sokukhulelwa nokuqunjelwa;
• ukuba khona kokukhula kokuzwela komuntu ngamunye;
• ubunzima obukhulu ngesimo se-ketoacidotic, isimo se-hyperosmolar;
• i-pathology yegilo;
• ukwehla kwezinga lamaseli amhlophe egazi egazini elingejwayelekile.

Abamele iqembu banethuba elehlukile lokuqhamuka nokwehlisa ushukela, okufanele kucatshangwe lapho bekhetha ukwelashwa.

Ukuxhumana nezinye izidakamizwa

Ingozi yokwehla okubucayi kwamazinga kashukela wegazi ithuthukiswa yinhlanganisela yama-sulfonylureas enezinombolo eziningi zemithi elwa namagciwane, ama-anticoagulants angaqondile, kanye nama-salicylic acid-based agents. I-Alcohol ibuye ithuthukise umphumela we-hypoglycemic.

Izidakamizwa zeqembu azisebenzi kahle uma zihlanganiswa:

• ngama-thiazides;
• Abamelene ne-calcium.

I-Glibenclamide

Ummeleli wesizukulwane sesibili sezidakamizwa. Amagama okuhweba - Maninil, Euglyukan. I-Maninil ithathwa njenge-ejenti ephumelela kakhulu ye-hypoglycemic ye-subgroup, noma kunjalo, inezixwayiso eziningi, ukuphambana futhi kungadala imiphumela emibi.

Ayinqunyelwe ukuthuthukiswa kwe-nephropathy yesimo sikashukela, nengozi enkulu yesifo se-gallstone. Inhlanganisela engenzeka ne-metformin.

I-Glimepiride

Isizukulwane sesithathu sezidakamizwa. Amagama okuhweba - Glemaz, Amaril. Izidakamizwa ezisezingeni eliphansi azithinti isisindo somzimba; zithathwa kanye ngosuku. Ekulimaleni okukhulu kwemisipha yenhliziyo, awukwazi ukudlulisa isiguli kumijovo ye-insulin, ngoba i-glimepiride ayithinti amashaneli e-potassium amaseli enhliziyo.

I-Gliclazide

Ummeleli wesizukulwane sesibili se-sulfonylurea derivatives. Yabela iziguli ezinomkhuba wokukhuluphala. Umuthi uyasebenza "ngesifo esimnandi" uma kungekho zimpawu zomtholampilo. Amagama Wokuhweba:

• Isifo sikashukela;
• I-Diamicron;
• Dramion;
• I-Medoclazide.

Glinids

Le mishanguzo yokunciphisa ushukela wegazi ibhekwa njengezivuseleli ze-pancreatic insulin. Zithathwa ngqo ngesikhathi sokudla kokudla. Abamele abaziwa kakhulu baleli qembu yiNateglinides, Repaglinides.

Inani lomuthi osegazini likhuphuka lapho lihlanganiswa nale mithi elandelayo:

• nge ketoconazole;
• I-Miconazole;
• Clarithromycin;
• I-Erythromycin;
• I-Gemfibrozil;
• Ama-NSAIDs;
• ama-beta blockers;
• ama-salicylates.

Izinga lezinto ezisebenzayo emzimbeni liyancipha ngaphansi kwethonya le-barbiturates, carbamazepine.

I-NovoNorm - ummeleli weqembu lobumba

Ama-glinids anqunyelwe ukwelashwa kwesifo sikashukela i-mellitus, lapho kunezinombolo ezijwayelekile zoshukela ngaphambi kokudla nokuphakama ngemuva kokudla. Imithi ikhonjiswa ezigulini esezikhulile, kanye nalabo abasengozini enkulu yokuthola isimo se-hypoglycemic. Ama-glinides alungile ekwelapheni iziguli ezinokuzwela ngakunye kokutholwa kwe-sulfonylurea.

Imiphumela engadingeki ngesikhathi sokwelashwa:

• izifo ezithathelwanayo zomgudu wokuphefumula ongenhla;
• ukuvuvukala kwesono se-paranasal;
• ukuphefumula kwenhliziyo, isicashu;
• izinhlungu ezihlangene
• i-cephalgia;
• isisindo somzimba.

I-Thiazolidinediones

Abamele iqembu baqinisa ukuzwela kwezicubu zomzimba namaseli esenzweni se-insulin ye-hormone. Izidakamizwa ezidumile yi-Aktos, Avandia. Imithi ayikwazi ukunciphisa i-glycemia kuphela, kepha futhi ibuyise imetabolism ye-lipid.

Emisebenzini yabo, ama-ejenti angaphansi kwamanye amaqembu izidakamizwa zomlomo ze-hypoglycemic. Ngaphezu kwalokho, ukuthatha i-thiazolidinediones kuhambisana nokwanda kwesisindo somzimba wesiguli. Nge-pathology yenhliziyo, izidakamizwa ziyaphikiswa ngenxa yekhono lokugcina uketshezi emzimbeni futhi kuvuse ukubukeka kwe-edema.

Abesifazane kufanele baqinise izinyathelo zokuvikela ukukhulelwa, ngoba izidakamizwa zingavusa ukubonakala kwe-ovulation ngisho nangesikhathi se-premenopause.

Onke amaqembu achazwe ngemithi kufanele asetshenziswe kuphela ngaphansi kokuqashwa kukachwepheshe ofanelekayo. Umgomo oyinhloko ukuthola isinxephezelo. Ukuqapha njalo ukusebenza ngempumelelo kwezokwelapha kukuvumela ukuthi ubuyekeze irejimeni yokwelashwa bese ukhetha okusebenzayo kakhulu esimweni esithile sasemtholampilo.