Isifo sikashukela yisifo esiyingozi senkambiso ye-metabolic emzimbeni womuntu. Ukwephulwa kwemibono kuvela ngenxa yokungapheleli kwe-insulin (i-hormone ekhiqizwa yi-pancreas) noma ukwephulwa komphumela wayo kumaseli nezicubu. Mhlawumbe umphumela ohlanganisiwe walezi zinto zombili.
Isifo sikashukela i-mellitus ihlukaniswe ngezinhlobo eziningana ezinomshini wokuthuthuka ohlukile, kepha uphawu olufanayo yi-hyperglycemia (izinombolo eziphakeme zikashukela wegazi). Uhlobo lwesibili lwalesi sifo luyindlela yokuzimela ye-insulin, okungukuthi, i-insulin apparatus yokwenza inani elanele le-insulin ye-hormone, kodwa amangqamuzana omzimba alahlekelwa umuzwa wawo kuwo, umane ungaphenduli umphumela wawo.
Ekwelashweni kwesifo sikashukela sohlobo 2, odokotela batusa ukuthi kubuyekezwe ukudla kwesiguli, kusetshenziswa imishanguzo eminingi esehlisa ushukela, futhi kuholele indlela yokuphila esebenzayo yokunciphisa umzimba (lokhu kuzonyusa ukusebenza kwekhambi). Uhlu lwamathebulethi wesifo sikashukela sohlobo 2, kanye nezici zenhloso nokudla kwazo kubhekwe ngazo endatshaneni.
Izici zokusebenzisa izidakamizwa
Ukusebenziseka kokusetshenziswa kwezidakamizwa kuhlolwa ngokuhlolwa kwebhubhoratri nokwenziwe ngesimo sesiguli. Izinhloso izifundiswa eziba khona zilwela:
- ukukhuphuka okuphezulu kwe-glycemia kuze kufike ku-5.6 mmol / l;
- izinga likashukela ekuseni alikho ngaphezulu kuka-5.5 mmol / l;
- izibalo ze-hemoglobin ye-glycated kuze kufike ku-5.9%, okuhle kunakho konke - u-5.5% (onale nkomba, ubungozi bokuthola ubunzima besifo sikashukela buncishiswe kayishumi);
- amanani ajwayelekile we-cholesterol nezinye izinto ezibandakanyeka ku-lipid metabolism;
- izinga lomfutho wegazi alikho ngaphezulu kwe-130/85 mm RT. Ubuciko., Ukuntuleka kwezinkinga ezinkulu zegazi;
- ukulungiswa kwe-vascular elasticity, ukuntuleka kwezilonda ze-atherosulinotic;
- izinkomba ezifanele zokubumbana kwegazi;
- i-acuity enhle yokubuka, ukungabikho kokuncipha kwayo;
- izinga elijwayelekile lomsebenzi wengqondo nokwazi;
- ukubuyiselwa kokuzwela kwemikhawulo engezansi, ukungabikho kwezilonda eziyinqwaba esikhunjeni.
Izidakamizwa eziphambili ezisetshenziselwa ukwelapha i-pathology
Kunamaqembu amabili amakhulu emithi ehlukaniswe ngamaqembu amancane. Izidakamizwa ze-Hypoglycemic (hypoglycemic) kuhloswe ngazo ukulwa nenani elikhulu le-glucose egazini. Abamele:
- zobumba;
- derivatives sulfonylurea.
Imithi yaleli qembu izisusa zokwenziwa kwe-insulin ye-hormone ngamanyikwe. Zinqunyelwe kuphela ngokuya ngobukhona bamaseli asebenzayo wezinto ezingaphakathi ezifakwayo. Umphumela wabo ongemuhle emzimbeni wesiguli ukuthi isiguli singathola isisindo ngenxa yokugcinwa kwamanzi nosawoti, nezidakamizwa zingadala ukwehla okubucayi kwamazinga kashukela.
Iqembu lesibili lemithi ngama-antihyperglycemic agents. Abamele lezi zidakamizwa zethebhulethi abaphazamisi ukusebenza kwezinto ezisetshenziselwa ukufakwa; zivimbela ukwanda kwezibalo zikashukela ngokwandisa ukusetshenziswa kwazo ngamaseli e-peripheral izicubu. Abamele iqembu:
- thiazolidinediones;
- ama-biguanides;
- Ama-inhibitors ama-cy-glucosidase.
Udokotela ofanelekayo ofanele we-endocrinologist ofunde yonke imininingwane yezokwelapha neyelabhoratri mayelana nesiguli kufanele akhethe irejimeni yokwelashwa
Umehluko omkhulu phakathi kwemithi
Lapho ukhetha amaphilisi aphumelela kakhulu wohlobo 2 lwesifo sikashukela, udokotela uhlola amandla abo okuthonya izinga le-glycosylated hemoglobin. Izinombolo ezincane kakhulu zimpawu ze-α-glucosidase nama-glinid inhibitors. Amanani we-HbA1C ngesikhathi sokwelashwa ancishiswa ngo-0.6-0.7%. I-Thiazolidinediones ihlala endaweni yesibili emsebenzini. I-HbA1C ngokumelene nesizinda sokuphuza kwabo incishiswe ngo-0.5-1.3%.
Okokuqala nje kuthathwe izinto ezithathwa ngama-sulfonylureas nama-biguanides. Ukwenza ukwelashwa ngalezi zidakamizwa kungahle kwehle ukwehla kwezinga le-hemoglobin ye-glycosylated nge-1.4-1,5%.
I-Glycated (glycosylated) hemoglobin ikhombisa isilinganiso se-glycemia ezinsukwini ezingama-90 ezedlule.
Kubalulekile ukuthi ubhekele indlela yezenzo zezidakamizwa ezidingweni zazo. Ama-inhibitors we-Α-glucosidase asetshenziswa uma isiguli sinezibalo ezijwayelekile zoshukela ngaphambi kokuba imikhiqizo ingene emzimbeni, kodwa i-hyperglycemia ihora ngemuva kwale nqubo. Isimo esiphikisayo sijwayelekile ukusetshenziswa kwama-biguanides: ushukela ophakeme ngaphambi kokudla ngokuhlanganiswa nezinombolo ezijwayelekile ngemuva kokudla.
I-Endocrinologists inaka isisindo sesiguli. Isibonelo, okuvela ku-sulfonylurea akunconyelwa ukwelashwa kubantu abanesifo sikashukela abanokukhuluphala, okungenakushiwo nge-thiazolidinediones. Lezi zimali zisetshenziselwa ngqo isisindo somzimba wesiguli. Lokhu okulandelayo kuchaza isimo seqembu ngalinye lezidakamizwa zesifo sikashukela sohlobo 2.
I-glu-glucosidase inhibitors
Abamele abamele ama-antihyperglycemic agents abasebenza ezingeni lepheshana lesisu. Umkhakha wanamuhla wezemithi waseRussia unganikeza inketho eyodwa kuphela yama-inhibitors - isidakamizwa Glucobay (acarbose). Umuthi osebenzayo, oyingxenye yomuthi, ubopha ama-enzyme esibeletho esincane, wehlise izinqubo zokuqhekeka okuyinkimbinkimbi nokutholwa kwama-carbohydrate alula.
Kuyaziwa ukuthi i-acarbose iyakwazi ukunciphisa ingozi yokulimala emisipha yenhliziyo nemithambo yegazi. Ukusebenza kwesenzo salo akuqondakali ngokuphelele, kepha-ke kunobufakazi bokuthi lo muthi awuthinti nhlobo ukwakheka koshukela ngamaseli wesibindi nezinqubo zokusebenzisa ushukela onqenqemeni.
Ukuhlanganiswa kwe-Glucobai:
- ngesisombululo se-insulin;
- ama-biguanides;
- derivatives sulfonylurea.
Uma isiguli sithatha amalahle e-activated noma amalungiselelo asuselwa kuma-enzymes wokugaya ngasikhathi sinye naleli qembu lemithi, umsebenzi we-inhibitors uyaphazamiseka. Leli qiniso kumele licatshangwe lapho kwenziwa irejimeni yokwelashwa.
Ukuzelapha - akuvunyelwe, bonana nodokotela ngaphambi kokuthenga umuthi
IGlucobai akufanele isetshenziselwe isifo sikashukela sohlobo 2 uma kunale mibandela elandelayo:
- izifo zesisu zemvelo yokuvuvukala;
- i-ulcerative colitis;
- ukuphazamiseka kwengxenye ethile yesisu;
- i-pathology enzima yesibindi.
IBiguanides
Njengamanje esigabeni samanje, ama-Biguanides awanakho ukusetshenziswa okubanzi kangako eRussia njengakwamanye amazwe. Lokhu kuhlotshaniswa nengozi enkulu ye-lactic acidosis ngemuva kokwelashwa. IMetformin yiphilisi elihle kakhulu neliphephe kakhulu lesifo sikashukela sohlobo 2, ezisetshenziswa kaningi ukwedlula bonke abanye abameleli beqembu.
Izifundo zemitholampilo zisahloselwe ucwaningo olunzulu ngesenzo sezinto ezisebenzayo ezakha ama-greatuanides. Kuyaziwa ukuthi izidakamizwa aziwuthinti umsebenzi wezinto ezisetshenziselwa ukufakwa ngaphakathi, kepha lapho kukhona i-insulin yama-hormone, inyusa izinga lokudla ushukela ngamaseli omzimba nangamafutha. I-Metformin isebenza kuma-receptors amangqamuzana aphathekayo, ikhuphula inani layo futhi ikhulisa ukuzwela esenzweni sezinto ezisebenza ngama-hormone.
Lawa maphilisi ezinhlobo 2 zesifo sikashukela anqunywa kumacala alandelayo:
Thayipha uhlu 2 lwemithi yesifo sikashukela- isisindo esikhulu sesineke;
- ukungasebenzi kahle kokwelashwa namanye amaqembu ama-hypoglycemic agents;
- isidingo sokwandisa umphumela wezidakamizwa lapho uhlanganisa izidakamizwa eziningana.
I-Metformin ingasetshenziselwa i-monotherapy. Ngaphezu kwalokho, umuthi ubekelwe ukuvimbela ukuthuthukiswa kwesifo "esimnandi" ngemuva kwesizinda sokubekezelela i-glucose engasebenzi kahle, iziguli ezinokukhuluphala kweziguli kanye neziguli ezine-pathology evela ku-lipid metabolism.
Ukwelashwa ngesifo sikashukela nge-Biguanides kuqinisekisiwe kulezi zimo ezilandelayo:
- Thayipha i-1 mellitus yesifo sikashukela enokuthambekela kokuthuthukisa isimo se-ketoacidotic;
- isigaba sokubola lesi sifo;
- i-pathology evela esibindini kanye namathuluzi wezinso;
- ukwelashwa kwesifo sikashukela sohlobo 2 kwiziguli esezikhulile;
- ukuntuleka kwamaphaphu noma izicubu zenhliziyo;
- izilonda zemithambo ye-atherosulinotic;
- I-hypoxia yanoma imuphi umsuka;
- isikhathi sokukhulelwa;
- isidingo sokungenelela kokuhlinzwa;
- utshwala.
Ukubonakala kwezidumbu ze-ketone kungenye yezindlela zokuphikiswa ekwelashweni ngezindlela zamathebulethi
Sulfonylureas
Le mishanguzo yokwelapha isifo sikashukela sohlobo 2 inomphumela oshiwo kakhulu we-hypoglycemic. Bangaphezu kwama-20 amagama abamele iqembu abaziwa, ahlukaniswe izizukulwane eziningana. Ama-Derivatives we-sulfonylureas anomthelela kumaseli angafakwanga, agqugquzela ukukhishwa kwe-hormone nokukhululwa kwayo kungena egazini.
Ezinye izinto ezithathwa yi-sulfonylurea zingakhuphula inani lama-receptor abuzwela i-insulin kumaseli we-pherleal, anciphisa ukumelana kokugcina kwe-mahormone. Okumelwe yilungu labamele iqembu lesifo sikashukela sohlobo 2:
- Mina isizukulwane - i-Chlorpropamide, Tolbutamide;
- Isizukulwane II - Glibenclamide, Glyclazide, Glimepiride.
Izithasiselo ze-sulfonylureas zingasetshenziswa zombili ngesimo se-monotherapy futhi ngokuhlangana namanye ama-ejenti omlomo anciphisa ushukela wegazi. Ukusetshenziswa kwezinto ezimbili eqenjini elilodwa lezidakamizwa akuvunyelwe.
Ukwelashwa kuvame ukubekezelelwa kahle ngabanesifo sikashukela. Kwezinye izimo, iziguli zingakhalaza ngokuhlaselwa kokwehla okubucayi kwe-glycemia. Kubantu asebekhulile, ingozi yokuthola i-hypoglycemia inyuka ngesigamu, ehambisana nokuba khona kwezifo ezingapheli zesifo esingaphansi, ukusetshenziswa kwezinye izidakamizwa, kanye nokusetshenziswa kwamanani amancane okudla.
Eminye imiphumela emibi yokwelashwa:
- izikhathi zokuhlanza;
- i-anorexia;
- ukuthakazelelwa kwesikhumba kanye nesifo sohudo;
- isifo sohudo
- imivimbo yesikhumba;
- ushintsho ekubaleni kwegazi kwelebhu.
Ukwelashwa kwezidakamizwa kohlobo 2 lwesifo sikashukela i-mellitus enokususa kwe-sulfonylurea akwenziwa ngesikhathi sokukhulelwa nokuqunjelwa, ngomonakalo omkhulu wemishini yezinso, ngokumelene nesizinda sefomu elihlobene nesifo se-insulin.
Glinids
Bangama-secretagogue angama-nonsulfonylurea. Leli qembu limelelwa ngemithi yeNateglinide neRepaglinide. Izidakamizwa zilawula ushukela wegazi ngemuva kokudla, ungavusi ukuhlaselwa kokwehla okubucayi kwe-glucose. Izikhathi zokwelashwa ezingezinhle zingumsebenzi ophansi wokwehlisa ushukela, okuqhathaniswa nesenzo se-α-glucosidase inhibitors, ingozi enkulu yokwandisa isisindo sesiguli, kanye nokwehla kokusebenza ngempumelelo kokwelashwa esikhathini saso eside.
Ukuxhumana ngokuqokwa kwezidakamizwa:
- ukuba khona kwe-hypersensitivity yomuntu ngamunye ezingxenyeni ezisebenzayo;
- uhlobo lwesifo esincike ku-insulin;
- ukukhulelwa nokuqunjelwa;
- izimo ezibulalayo ze-pathology yezinso nesibindi;
- iminyaka emincane yesiguli;
- abanesifo sikashukela asebekhulile (ngaphezulu kweminyaka engama-73-75 ubudala).
Izici zokusetshenziswa kobumba (udokotela angabuyekeza umthamo nobuningi bokuphatha)
Kubalulekile! Kwezinye izimo, komzimba ungakhula. Njengomthetho, nge-hypersensitivity yomuntu ngamunye noma ngokumelene nesizinda sokuhlanganiswa kobumba neminye imithi yomlomo.
Ama -retretins
Ama-hormone abizwa ngokuthi yizinto ezisebenza ngama-hormone zomgudu wokugaya ukudla, ovuselela ukukhiqizwa kwe-insulin. Omunye wabamele imishanguzo emisha nguSitagliptin (Januvia). I-Sitagliptin yenzelwe i-monotherapy kanye nokwelashwa okuhlanganiswa ngokuhlangana ne-sulfonylureas, i-biguanides.
Ukunquma lesi sidakamizwa kubantu asebekhulile akudingi ukulungiswa komthamo; ezinganeni nakwintsha, iSitagliptin ayisetshenzisiwe ekwelashweni. Izifundo zemitholampilo zikhombisile ukuthi ama-incretins anganciphisa i-glycosylated hemoglobin ngaphezulu kwezinsuku ezingama-90 ngama-0.7-0.8%, ngenkathi esebenzisa iMetformin - ngo-0.67-0.75%.
Ukwelashwa isikhathi eside kugcwele imiphumela emibi elandelayo:
- izinqubo ezithathelwanayo zepheshana lokuphefumula elingaphezulu;
- isifo sohudo
- i-cephalgia;
- isimo se-hypoglycemic.
Eminye imishanguzo esetshenziselwa isifo sikashukela sohlobo 2
Ngaphezu kwamathebhulethi anciphisa ushukela, odokotela banquma:
- izidakamizwa ze-antihypertensive - izidakamizwa zokulwa nenani elikhulu lomfutho wegazi;
- i-vaso- ne-cardiotonics - ukusekela umsebenzi wemisipha yenhliziyo nemithambo yegazi;
- imishanguzo ye-enzymatic, pre- kanye ne-probiotic - izindlela zokuxhasa ukusebenza kwepheshana lesisu;
- ama-anticonvulsants, ama-anesthetics endawo - asetshenziselwa ukulwa nezinkinga zesifo sikashukela i-mellitus (polyneuropathy);
- ama-anticoagulants - vimbela i-thrombosis;
- ama-statins nama-fibrate - izidakamizwa ezibuyisela izinqubo ze-metabolism yamafutha, zisusa i-cholesterol eyeqile emzimbeni.
Inani elikhulu lezinhlobo zemithi, ama-nephroprotectors kanye nezithasiselo zokudla zingangezwa, ezivunyelwe ukusetshenziswa, kepha kuphela ngaphansi kokuqondisa kwe-endocrinologist efanelekayo.
Izidakamizwa ze-antihypertensive
Umfutho wegazi ophakeme ungenye yezindlela ezijwayelekile ezenzeka ngokumelene nesizinda sesifo "esimnandi". Izimpawu zalesi simo zenzeka ngisho nangaphambilini kunesithombe somtholampilo sesi sifo esikhona.
I-Hypertension ikhulisa ubungozi bezinkinga ezisuka enhliziyweni, emithanjeni yegazi, nasezinso amahlandla amaningi, ngakho-ke, idinga ukulungiswa ngokushesha
Ukulwa nenani elikhulu lomfutho wegazi, amaqembu alandelayo emithi ye-antihypertensive anqunyelwe:
- Ama-inhibitors e-ACE (i-Captopril, i-Enalapril) - anomphumela omuhle kakhulu, avikele inhliziyo nemithambo yegazi, anciphise ukumelana kwezicubu namangqamuzana kwi-hormone yamanyikwe.
- I-Diuretics (i-thiazides ne-loop diuretics) - umuthi waleli qembu unganciphisa ingcindezi, kepha ungasusi i-etiological factor uqobo, okuholele ekwakhiweni kwesimo segazi esinegazi.
- Ama-β-blockers (Nebilet, Carvedilol) - athinta amaseli akhiwe enhliziyweni nenhliziyo yezinsiza.
- Abamelene neCalcium (Verapamil, Nifedipine) - izidakamizwa zikhulisa i-lumen ye-vascular, zinciphise ukubonakaliswa kwe-albhamuinuria, proteinuria.
- Ama-antagonists we-RA-II (Mikardis, Losartan) - ahambelana ne-ACE inhibitors, abekezelelwa kangcono yiziguli.
Isifo kanye nemicu
Amalungiselelo ala maqembu asetshenziselwa ukulwa nezilonda zesifo semithambo ye-atherosulinotic. Ama-Statins enza inqubo yenqubo yokwakhiwa kwe-cholesterol ngisho nasesigabeni se-hepatic. Umsebenzi wemithi uhlose ukunciphisa inani le-triglycerides ne-cholesterol, ukubekelwa kabusha kwamachaphaza asendaweni engaphakathi yemithambo futhi kunciphise i-lumen ye-vascular.
Kubalulekile! Ukwelashwa isikhathi eside kunciphisa ingozi yokuhlaselwa yisifo senhliziyo nokufa ekufeni kwengxenye eyodwa kwezintathu.
Izimo zibekezelelwa kahle yiziguli. Akunconyelwe izifo ezinzima zesibindi, ngesikhathi sokuzala ingane, nokuncelisa ibele.Ukwelashwa kufanele kuhlale cishe njalo, ngoba ukwenqaba ukuphuza umuthi izinsuku ezingama-30 noma ngaphezulu kubuyisela amazinga e-cholesterol ezinombolweni zawo eziphakeme zangaphambili.
Amafiga akhulisa umsebenzi wento ethile ye-enzymatic ethinta inkambo ye-lipid metabolism. Ngokuphikisana nesizinda sokudla kwabo, amanani we-cholesterol ancishiswa okwesithathu, ama-triglycerides - ngama-20%, kwesinye isikhathi nangesigamu. Ukwelashwa kweziguli esezikhulile kudinga ukulungiswa komthamo.
Ama-Neuroprotectors
Ngokuphikisana nesizinda 'sesifo esimnandi', ukulimala ohlelweni lwezinzwa kungenzeka, okukhonjiswa yile mibandela elandelayo:
- isifo sokuqina kwesifo sikashukela;
- isifo sohlangothi
- i-neuropathies yesifo sikashukela;
- i-symmetric distal polyneuropathy;
- ukuzimela kwe-polyneuropathy;
- isifo sikashukela i-amyotrophy;
- i-cranial neuropathy;
- ezinye izinkinga zezinzwa.
Lapho kuthinteka i-NS yangaphakathi, iziguli zikhononda ngobuhlungu bomlenze, ama-goosebumps, nokuzwela okungajwayelekile
Enye yezidakamizwa ezisetshenziswa kakhulu ukubuyisela izinqubo ze-metabolic kule ndawo yi-Actovegin. Umuthi uthuthukisa ukuhamba kwegazi, uqede indlala komoya-mpilo yamangqamuzana, usheshise ukuthutha kwe-glucose ezindaweni ezilambele amandla ebuchosheni.
Umuthi olandelayo ophumelelayo yi-Instenon. Lokhu kuyi-nootropic enemiphumela yemisipha ne-neurometabolic. Ithuluzi lisekela ukusebenza kwamangqamuzana ezinzwa ezimweni zokuphazamiseka kwegazi okungenampilo kanye nokuntuleka komoya-mpilo.
Futhi, izidakamizwa ezisuselwa ku-thioctic acid (Berlition, Espalipon) ziyasetshenziswa. Bayakwazi ukubopha futhi basuse ama-free radicals, bavuselele ukubuyiselwa kwe-myelin sheath, bese behlisa izinga le-triglycerides ne-cholesterol egazini. Ochwepheshe empeleni bafaka amavithamini e-B-chungechunge, izidakamizwa ze-anticholinesterase ekwakhiweni kwezokwelapha.
Ukuzelapha ngokwakho kohlobo lwesifo oluzimele lwe-insulin, noma ngabe lumnene, akuvunyelwe, ngoba lokhu kungaholela ekwandeni kwesimo se-pathological. Kubalulekile ukuthi i-endocrinologist ibhale irejimeni yokwelashwa ngemuva kokuhlolwa okunzulu kwesimo sesiguli.
