Ukuhlukaniswa kwamathebulethi wesifo sikashukela sohlobo 2

Imininingwane ekulesi sihloko ngeke ibe yintsha kubantu abazibonela mathupha ukuthi yisiphi isifo se-XXI century, okuyisifo sikashukela, futhi le nhloso ayisethiwe. Kodwa-ke, kuzoba wusizo olukhulu kulabo abadinga imininingwane eningilizayo futhi ehlelekile maqondana nesifo sikashukela sohlobo 2 nokuthi singalashwa kanjani.

Kafushane ngesifo sikashukela

Ukuvuselela inkumbulo, kubalulekile ukuqaphela ukuthi, ngokuphumelela okuhlukahlukene, umhlaba ulwa nezinhlobo ezimbili zesifo sikashukela. Uyini umehluko wabo oyisisekelo?

Esokuqala sihambisana nokungasebenzi kahle kwe-pancreatic, eyeka ukukhiqiza inani elidingekayo le-insulin, elilawula ushukela wegazi.

Ngohlobo lwesibili lwesifo sikashukela, ama-pancreas akhiqiza i-insulin eyanele, kodwa izitho ezithile nezicubu ezingasayiboni le siginali ye-insulin elawulayo.

Ngemuva kwalokho "i-insulin generator" engaqondakali iqala ukukhiqiza i-hormone eyengeziwe, okuholela ekugqokeni kokuqala kwamangqamuzana e-beta abhekene nokwenziwa kwawo.

Kungenxa yokuhlukahluka ukuthi izifo zathola amagama azo:

1. Uhlobo lokuqala luthembele ku-insulin.
2. Uhlobo lwesibili luzimele.

Siyethemba ukuthi manje konke sekucacile futhi kunengqondo ukuqhubeka nesigaba esilandelayo - ukwelashwa kwesifo sikashukela sohlobo 2. Ngendlela, itholakala kuma-90% eziguli ezinalesi sifo.

Ukusetshenziswa kwezidakamizwa zesifo sikashukela sohlobo 2

Namuhla, ukwelashwa kwesifo sikashukela sohlobo 2 asikwazi ukukhipha lesi sifo ngokuphelele, sikhohlwe ngakho kuze kube phakade. Kepha lokhu, ukuze uqonde, akusona isigwebo. Ukudla nokuthatha umuthi wokuhlangana kuzokuvumela ukuthi uqhubeke ujabulele impilo futhi ungalahlekelwa yimibala yokukhanya kwayo.

Lapho besungula isu lokwelashwa, odokotela bacabanga ngezinyathelo ezine zokusebenzisa, kubandakanya nosizo lwezokwelapha:

1. Okokuqala: ukudla okuphansi kwe-carb.
2. Okwesibili: Ukudla okuphansi kuma-carbohydrate + ukufakwa komzimba osebenzayo.
3. Okwesithathu: amaphilisi amabili okuqala + esifo sikashukela, avuselela ukuqonda kwamaseli ku-insulin.
4. Okwesine: ubandakanyeka ezinhlotsheni ezinzima zesifo sikashukela esinamandla. Izidakamizwa ezimbili zokuqala + ze-insulin +.

Umqondo wokwelashwa sikashukela 2

Izidakamizwa eziphambili zokwelashwa

Silindele ukubuyekezwa okuningiliziwe kwezidakamizwa ezithinta umphumela omuhle ekwelashweni kwesifo sikashukela, kufanele kwaziwe ukuthi uhlu lwamaphilisi ohlobo lwesifo sikashukela sikhulu impela futhi ahlukaniswe izigaba eziningi.

Zihlukile emizimbeni ethintekile kuyo nendawo okuyo:

• pancreas
• jejunum
• izicubu zephutha.

Isibonakaliso esihlanganayo nenhloso esemqoka yazo zonke izidakamizwa ukwehla koshukela wegazi.

Amaqembu amakhulu afaka:

1. ISulfonylurea. Leli qembu, ngenxa yesisusa se-pancreatic, lisiza ukwehlisa amazinga kashukela.
2. IBiguanides. Indlela yokusebenza isuselwa ekuvuseleleni inqubo yokuthathwa kwe-glucose ngokucindezela i-gluconeogeneis.
3. I-Thiazolidinediones. Lapho uthatha le mishanguzo, ukumelana ne-insulin kuyancipha, okungukuthi, amaseli aqala ukuphendula nge-insulin, ngaleyo ndlela anciphise ushukela wegazi.
4. I-Alpha Glucosidase Inhibitors. Lapho isisu sidonsa ama-carbohydrate ahlukahlukene, le mishanguzo inciphisa ukusebenza kwamathumbu, okuthi futhi, kunciphise okuqukethwe kweglucose.
5. Glinids. Zigqugquzela ukukhiqizwa kwe-insulin futhi, ngenxa yalokho, zinciphisa ushukela wegazi.
6. Ama -retretins. Iqembu elisha lezidakamizwa elikhulisa ukukhiqizwa kwe-insulin.

Sulfonylureas

Ehlelweni lokwelapha isifo sikashukela sohlobo lwesibili, izidakamizwa ezinciphisa ushukela, ezisuselwa ku-sulfonylurea, zisebenza ngezindlela eziningi:

• ukunciphisa ubukhona be-glycogen egazini;
• gqugquzela ukuvikelwa kwe-insulin;
• yenza kusebenze ukusebenza kwamaseli we-pancreatic β-cell.

Amagama izidakamizwa: Amaryl, Diabeteson, Minidiab, Glyurenorm, Maninil, Gliclazide MV.

Izinzuzo:

1. Zonke izidakamizwa zinomphumela obalulekile we-hypoglycemic.
2. Eminye imishanguzo (bheka izinkomba) inciphisa ukuthi kungenzeka kwezibalo zegazi.
3. Izindlela ezinjengeGliclazide MV - zivikela ngenso izinso.

Okubi:

1. Kunobungozi obukhulu be-hypoglycemia - ukuwa ushukela ngaphansi kokujwayelekile.
2. Ukuthuthuka okusheshayo kokumelana - ukumelana nomzimba kulezi zidakamizwa.
3. Lapho kuthonya inqubo yokukhiqizwa kwe-insulin, kunamathuba aphezulu okuvusa iphango futhi, ngenxa yalokho, ukwanda kwesisindo somzimba.

IBiguanides

Leli qembu lezidakamizwa, "ukuvusa" amaseli, lishukumisela ukuphendula kwabo ekuboneni i-insulin yabo ekhiqizwayo, futhi kunciphisa amathumbu lapho iglucose igxilile.

Ukubonakaliswa okungahambi kahle okuhlonziwe ngesikhathi sokuvivinywa kwemitholampilo kubeka imingcele ethile yobudala kubantu asebekhulile, nasezigulini ezinenhliziyo, isibindi kanye nezifo zezinso.

Amagama: Metformin, Glucophage, Siofor.

Izinzuzo:

1. Akukhuthazi ukukhiqizwa kwe-insulin ethe xaxa, kepha kugqugquzela ukusetshenziswa okuningana kwe-hormone esele ithuthukisiwe, okuthi nayo ivikele ama-pancreas ekucindezelekeni ngokweqile.
2. Banomphumela ophumelelayo uma kuqhathaniswa nezindlela zeqembu le-sulfonylurea.
3. Musa ukwandisa indlala - lokhu kunomthelela omuhle ekunciphiseni isisindo.
4. Ehlelweni lokuthatha iphrofayili ye-lipid (i-cholesterol esegazini) ithuthukiswa kakhulu.
5. Isixhumanisi se-heeledasis, inqubo yokwakheka kwezinqe zegazi emithanjeni eyonakele (ukwelashwa), sithuthukiswa kakhulu.

Okubi:

• ukubonakaliswa okungenzeka kokungasebenzi komzimba esiswini;
• ubungozi bokubumba i-lactic acid abufakiwe - lactic acidosis.

Ividiyo evela kuDkt Malysheva:

I-glu-glucosidase inhibitors

Izitha zabantu abanesifo sikashukela zingama-carbohydrate ahlukahlukene, njenge-sucrose, umala, isitashi nabanye, yize zithakwa kalula ngamathumbu, zibangela ukulimala okukhulu emzimbeni. Ukuze unciphise isifiso sokugcina futhi unciphise ukusebenza kwawo, ama-inhibitors e-α-glucosidase (alpha-glucosidase) athathwa.

Amagama: Acarbose, Miglitol, Diastabol, Glucobay. Kuwo wonke amalungiselelo, into esebenzayo yi-acarbose.

Izinzuzo:

1. Ngenkathi kuthatha ama-inhibitors, amazinga we-insulin awakhuphuki, okungukuthi, akukho bungozi be-hypoglycemia.
2. I-Acarbose inciphisa ukumuncwa kwama-carbohydrate, yakha izimo zokunciphisa inani lamakhalori adliwayo futhi, ngenxa yalokho, ukunciphisa isisindo sesiguli.
3. Kuyaphawuleka ukuthi ukusetshenziswa isikhathi eside kwe-acarbose kunciphisa izinga lokuthuthuka kwezinqubo ze-atherosclerotic ohlelweni lwezinhliziyo.
4. Ama-inhibitors ngese ngalinye awahlanganisi ekwakhiweni kwegazi futhi awayona ingozi ngenxa yezinkinga.

Okubi:

1. Ngenqubo yokugaya, amanye ama-carbohydrate awekho ngaphansi kwemiphumela ye-enzymatic futhi emathunjini angabakhangisi abaphambili be-Fermentation, izibonakalisa ngokugcwala kanye nohudo.
2. Uma kuqhathaniswa ne-Biguanides ne-sulfonylurea, i-acarbose inomphumela ophansi wokushukela.

Glinids

Indlela yokwelapha yale mishanguzo ukuvimba iziteshi ezibucayi ze-potassium ATP ezibandakanyeka emgomeni we-insulin ogcotshwa amaseli we-beta, futhi wehlise nengozi ye-hyperglycemia (ushukela owedlulele), ongalandela ngemuva kokudla.

Amagama: Novonorm, Starlix, Repaglinide, Nateglinide.

Izinzuzo:

• umphumela we-insulinotropic utholakala ngokushesha okukhulu - ngemuva kwemizuzu engu-7 ngemuva kokudla;
• ukubuyiselwa kwesigaba sokuqala secretion ye-insulin kwenzeka ngenxa yokungena njalo kobumba;
• Izidakamizwa zaleli qembu zinikeza i-insulin ephelele yokudla.

Okubi:

• Imitholampilo, esebenza emzimbeni, ngokungaqondile ivusa ukwanda kwesisindo sabashukela.
• ukusetshenziswa isikhathi eside kwalezi zidakamizwa kuholela ekuluthweni umlutha futhi, ngenxa yalokho, ukusebenza kwazo kuyancipha.

Ama -retretins

Njengokungqubuzana okuhle kakhulu, ukwenziwa ngcono kwezindlela zokwelapha ukulwa nesifo sikashukela akusamile. Eminyakeni eyishumi edlule, kube nempumelelo ebonakalayo ebhokisini lamathuluzi. Izici zokwelapha ezimangalisayo zama-hormone ezingakhuthaza ukukhiqizwa kwe-insulin - ama-incretin atholakele.

Umnyombo wethonya labo ukuthi ngemuva kokudla sibonga ama-insretin, ngaphezu kwe-70% ye-insulin igcinwa emzimbeni. Futhi ngeshwa, ezigulini ezinesifo sikashukela sohlobo 2, umsebenzi wale nqubo uncishiswa kakhulu.

Ngosizo lomzimba kweza imithi emisha eyenza kusebenze kabusha i-insulin.

Bahlanganiswa baba ngamaqembu amabili ama-hormone:

1. Ama-agonists e-glucone-like peptide-1 noma i-GLP-1.
2. IGlucose-insulinotropic polypeptide noma HIP.

Izici zokuma kwama-insretin:

Uhlu lwezidakamizwa zaphesheya luvunyelwe nguMnyango Wezempilo, ukusakazwa kwazo kuvunyelwe eRussia.

Nazi izidakamizwa ezaziwa kakhulu:

• I-Exenatide (Baeta) umuthi ovela eJalimane.
• ILiraglutide yiqembu laseDenmark elenza amakhambi.
• ISitagliptin (Januvia) - ekhiqizwe ifektri yezokwelapha yaseDashi.
• I-Vildagliptin (Galvus) - Umkhiqizo waseSwitzerland.
• I-Saxagliptin umuthi wesifo sikashukela waseMelika.
• ILinagliptin (Transeta) - yenziwe eJalimane.
• I-Liksysenatyd ikhambi laseFrance.
• I-Albiglutide (Tanzeum) umuthi ovela eJalimane.

Izinto ze-Thematic zevidiyo ezivela engqungqutheleni yezokwelapha:

Eminye imishanguzo esetshenziswa ngabanesifo sikashukela

Njengoba kuye kwaphawulwa kaninginingi, "impi" enesifo sikashukela sohlobo 2 iyalwelwa kuzo zonke izindlela, kungagcini emithini yokwehlisa ushukela.

Ukugwema imiphumela emibi nokuqina okujwayelekile kwamakhono omzimba, odokotela basebenzisa izidakamizwa ngezinhloso ezahlukahlukene:

1. Ukulawulwa komfutho wegazi ophezulu - izidakamizwa ze-antihypertensive.
2. Ukuqinisa izicubu zenhliziyo nemithambo yegazi - i-Cardio ne-vasotonic.
3. Ama-Enzymatic agents ekusebenzeni okulinganiselayo komgudu wokugaya ukudla: ama-probiotic - amagciwane atholwe ngokukhethekile nama-prebiotic - "ukudla" kwama-probiotic.
4. Ama-Painkiller nama-anticonvulsants. Lezi zimali ziyadingeka ukwenza i-polyneuropathy ihlukane - ukuhlanganiswa kwesifo sikashukela.
5. Ama-anticoagulants yizidakamizwa ezivimba ukubonakaliswa kwe-thrombogenic.
6. Ukubuyisa i-metabolism (izinqubo ze-metabolic), kunikezwa i-fibrate nama-statins.

Kuhlanganisiwe

Ezingxenyeni ze-athikili, lapho kwakubhekwa khona amaqembu ayizidakamizwa aphambili, kwagcizelelwa ukuthi ngezinye izikhathi ukusetshenziswa okukhethekile (i-mono) kwezidakamizwa zohlobo olufanayo akunikezi imiphumela oyifunayo.

Ososayensi baphethe ukuthi ukuphumelela kwezidakamizwa ezihlanganayo. Lesi sinqumo sasivumela ukuthi sikhuphule umphumela wezokwelapha ngokwenza ngamaphuzu ahlukene omzimba, futhi sinciphise nemiphumela emibi.

Izibonelo zokuhlanganiswa okunjalo okuphumelelayo zingabonakala etafuleni:

Imithi yabanesifo sikashukela asebekhulile

Ukwelashwa okusebenzayo kwesifo sikashukela ezigulini nasebegugile, ngaphezu komphumela wezidakamizwa kulesi sifo, kubalulekile ukufaka izinhlelo ezimbili ezihambisana nalokhu:

1. Ukwenqatshwa kokudla okungenamsoco.
2. Ukufakwa komzimba okwenzeka emzimbeni enkambisweni yansuku zonke.

Ngaphezu kwalokho, amaqembu alandelayo wezidakamizwa asetshenziselwa ukwelashwa okuyinkimbinkimbi:

1. IBiguanides: ISiofor, iMetfogamma, iGlucofage, Avandamet, iBagomet.
2. Okususwayo kwe-sulfonylureas: IGlyclazide, Glimepiride, Glycvidone, Glipizide GITS.
3. Ama-Gliptins: Sitagliptin, Vildagliptin, Saxagliptin.
4. Ama-inhibitors we-Alpha glucosidase: Diastabol, Glucobay.
5. Insulin

Izidakamizwa ze-antihypertensive

Izidakamizwa ezihlisela umfutho wegazi ophansi zilayini olude kunazo zonke phakathi kwabo bonke "abazalwane" bomndeni omkhulu wezidakamizwa.

Kuyinto i-arterial hypertension (AH) okuyi-mellitus yesifo sikashukela esiqhubekayo. Imvamisa, izimpawu zayo zenzeka ngisho nangaphambilini kunesithombe somtholampilo sokugula okungaphansi.

Uhlu lwezidakamizwa ezinemisebenzi ye-antihypertgent liyanaba kakhulu, kepha akubona bonke abangabiza isimo sabasizi ekwelashweni kwesifo sikashukela sohlobo 2 - konke lokhu kuhlotshaniswa nemiphumela emibi eyenzekayo.

Ososayensi bahlukanisa amaqembu ayisihlanu aphambili emithi ye-antihypertensive:

1. Ama-diuretics I-Loop diuretics kanye ne-thiazides: Indapamide, Ipothiazide, Chlortalidone, Edekrin, Lasix. Imithi yaleli qembu ikwazi ukwehlisa umfutho wegazi, kepha hhayi ukuqeda ubudlelwano bomphumela oyimbangela.
2. I-Angiotensin II receptor blockers: I-Losartan, iMikardis - ngokusebenza bayfana nama-inhibitors e-ACE, kepha babekezelelwa kangcono yiziguli.
3. Ama-Calcium Antagonists: I-Nifedipine, iVerapamil, yokwandisa ukukhanyisa kwemithambo yegazi, yehlisa amathuba e-albhamuinuria - ukukhishwa kwamaprotheni okweqile emchameni.
4. I-Angiotensin-Ukuguqula i-Enzyme Inhibitors (i-ACE inhibitors): I-Enalapril, i-Captopril - vikela inhliziyo nemithambo yegazi, ihlinzeke ngomphumela we-nephroprotective.
5. Ama-blocker e-Beta: INebile, iCarvedol - inomphumela kwizicubu zamaseli ezitholakala enhliziyweni nasezinso.

Izimo namaFibrate

Inhloso yaleli qembu kunzima ukungayibukeli phansi, ngoba iyithuluzi elisebenzayo ekulweni nezilonda zesibindi ze-atherosulinotic.

Izimo zilawula inqubo yokwakhiwa kwe-cholesterol, imelana nokuvela kwama-plaque odongeni lwangaphakathi lwemithambo yegazi.

Uhlu lwezidakamizwa eqenjini lama-statins:

• I-Pitavastatin;
• Simvastatin;
• ILovastatin;
• UPravastatin;
• Osuvastatin;
• I-Fluvastatin;
• Atorvastatin.

Amafutha agxilwe ekuvinjelweni ukwakheka kwe-triglycerides - amafutha angathathi hlangothi esibindini futhi awasuse egazini.

Lokhu kufaka phakathi:

• I-Lipanor;
• I-Lipantyl;
• I-Lopid
• Atromide;
• Atromidine;
• I-Bezamidine;
• I-Miskleron;
• IGavilon;
• Tricor
• Normolite;
• I-Lipantyl;
• Bezalip.

Ividiyo evela kuDkt Malysheva:

Ama-Neuroprotectors

Ukungabonakali kwe- "sifo esimnandi", njengoba isifo sikashukela kubizwa kanjalo, kubonakala ngezindlela eziningi. Kwezinye izimo, nohlelo lwethu lwezinzwa alukwazi ukumelana nalo.

Ukunqotshwa kanye nokudangala kwakhe kunezibonakaliso ezilandelayo:

• isifo sohlangothi
• isifo sokuqina kwesifo sikashukela.
• i-symmetric distal polyneuropathy;
• isifo sikashukela se-neuropathy;
• i-autonomic polyneuropathy;
• isifo sikashukela i-amyotrophy;
• i-cranial neuropathy;
• Isifo sikashukela sonyawo sikashukela.

Ngakho-ke, inhloso eyinhloko yama-neuroprotectors ukulinganisela imetabolism yobuchopho (imetabolism) namandla aphezulu wamaseli ayo.

Ngama-neuroprotectors angabasizi abathembekile bobuchopho ekusebenzeni kwayo ekubonakalisweni okuhlukahlukene okungalungile, okubandakanya uhlobo lwe-2 sikashukela mellitus.

Ngokusho kwezindawo zesicelo, iqembu le-neuroprotective lahlukaniswa laba ngamaqembu amancane ayisihlanu:

1. Imithi yokujikeleza kwegazi: iTiklid, iSinkumar, iClopidogrel, iPhenylin, iClopidogrel, iWarfarin.
2. I-Nootropic: iPiracetam, iCerebrolysin, iSemax. I-Picamilon, eCeraxon.
3. Ama-antioxidants: iCorvitin, i-Quercetin, i-Glycine, i-Flacumin, iNiacin, iGlutamine, iComplat
4. Imithi yesenzo esihlanganisiwe: I-Thiocetam, Fezam.
5. Ama-Adaptogens: i-tincture ye-Eleutherococcus, ukukhishwa kwe-ginseng ewuketshezi, i-tincture yomvini we-Chinese magnolia.

Isifo sikashukela sohlobo 2 siyisifo esiyingozi esishintsha kakhulu indlela yokuphila yomuntu. Noma kunjalo, ungapheli amandla.

Siphatha i-easel ezandleni zethu bese siyifaka umbala ngemibala ekhanyayo nsuku zonke esefikile, sibeka izinto ezintathu eziphambili njengesisekelo sephalethi: ukudla okunempilo kilojoule ongaphakeme, ukusebenza kahle komzimba nemithi eyinkimbinkimbi.

Ngikholwe, isithombe sizomangalisa.