Ukubuyekezwa kwezidakamizwa ukwehlisa ushukela wegazi

Ngesikhathi sokwelashwa kwesifo sikashukela, kunikezwa imishanguzo ethile yokwehlisa ushukela wegazi.

Lokhu kufaka phakathi izidakamizwa ukwandisa ukuzwela kwezicubu ku-insulin, ukuthuthukisa ukucashelwa kwama-hormone. Izindlela zisetshenziselwa ukonakalisa ukumuncwa kwama-carbohydrate emathunjini.

Imithi ekhulisa ukuvikelwa kwe-insulin

Izidakamizwa ezisakazekile ezivusa imfihlo ye-insulin. Izidakamizwa ezinjalo zibandakanya nezidakamizwa ezivela eqenjini le-sulfonylurea kanye nama-meglitinides.

Sulfonylureas

Leli yiqembu lemithi yokwenziwa elehlisa ushukela wegazi. Izidakamizwa zalesi sigaba zisebenza amaseli we-pancreatic, athuthukisa ukukhiqizwa kwe-insulin ngumzimba. Ukuze lokhu, amaseli we-beta aphilile kumele abe khona endle.

Isenzo sezidakamizwa ukwanda kokukhushulwa kwama-hormone nokwenziwa kancane kwe-glucose esibindini, ukukhuthaza ama-β-cell, ukucindezelwa kwe-glucagon, ketosis kanye secretion ye-somatostatin.

Ama-Derivatives we-sulfonylureas ahlukaniswe ngamaqembu amabili: isenzo eside nesiphakathi. Umphumela wokuvuselela secretion yama-hormone kuncike kumthamo lapho uthathwa.

Imithi ihloselwe ukwelashwa kwesifo sikashukela sohlobo 2; asisetshenziselwa ukwelapha isifo sikashukela sohlobo 1. Kuqokwe nokwehla kokuqunjelwa kwezicubu ze-hormone. Kuyatholakala ngesimo sethebhulethi.

Ukutholakala kweSulfonylurea kumelelwa yizizukulwane ezimbili zemithi:

1. I-Butamide, i-Chlorpropamide. Izidakamizwa zichazwa kumthamo omkhulu futhi zikhombisa umphumela omfushane.
2. I-Glipizide, Glibenclamide, Glycvidone. Zinomphumela omude futhi zibekwe kumthamo ophansi.

Contraindication ifaka:

• i-anemia
• isifo sikashukela sikashukela;
• ukungasebenzi kwezinso;
• inqubo yokutheleleka ebabazekayo;
• ukukhulelwa, ukukhulelwa;
• ukungasebenzi kwesibindi;
• ngaphambi / emva kokusebenza;
• i-leukopenia;
• i-thrombocytopenia;
• ukuphazamiseka kwe-dyspeptic;
• kuyaqabukela i-hepatitis;
• isisindo somzimba.

Imiphi imiphumela emibi ebonwa:

• ukwakheka kokunambitheka kwensimbi emlonyeni;
• ukungasebenzi kahle kwesibindi;
• ukubonakaliswa komzimba;
• umsebenzi wezinso ongonakalisiwe.

Umcimbi ojwayelekile kakhulu yi-hypoglycemia.

Meglitinides

Iqembu lezidakamizwa elikhulisa ukugcinwa kwe-insulin. Bayizilawuli eziphansi ze-glycemia - banciphisa ushukela ngemuva kokudla. Ukusetshenziswa kwezidakamizwa ukulungisa i-glucose yokuzila ukudla akulungile. Izinkomba zokwamukelwa - DM 2.

Abamele lesi sigaba yiNateglinides, Repaglinides. Izidakamizwa zithinta amangqamuzana wezinto ezisetshenziswayo ze-islet, isebenze ekusithekeni kwe-insulin. Ukwenza kusebenze i-hormone kwenzeka imizuzu engu-15 ngemuva kokudla. Izinga le-insulin eliphakeme libonakala ngemuva kwehora, ukuncipha - ngemuva kwamahora ama-3.

Ukugqugquzeleka kwenzeka ngokuya ngenqwaba yoshukela - emazingeni aphansi esidakamizwa ngemali encane kuthinta ukukhululeka kwehomoni. Lokhu kuchaza ukungabikho kwe-hypoglycemia lapho uthatha imishanguzo.

Kuhlanganiswe namanye ama-antidiabetesic agents. Kukhishwe ngenani elikhulu yizinso, kungama-9% kuphela emathunjini.

I-DM 1, i-ketoacidosis, ukukhulelwa ne-lactation yizona zinto eziphikisayo zokuthatha. Ukuqapha kufanele kuthathwe ekuphuzeni imithi yeziguli esezikhulile. Kuyadingeka futhi ukubhekisisa iziguli ezinezifo zesibindi. Kunconywa ukubheka izinkomba kaningana ngonyaka. Ukuhlola unyaka wokuqala wokwelashwa kufanelekile.

Ama-Meglitinides awadingi ukukhethwa komthamo. Imithi isetshenziswa lapho kudliwa. Izinga le-insulin ngemuva kwamahora ama-3 libuyela kunani langaphambili.

Phakathi kwemiphumela emibi yabonwa:

• ukungaboni kahle
• ukuphazamiseka kwesisu;
• ukubonakaliswa komzimba;
• ukukhuphuka kwama-hepatic indices ekuhlaziyweni kwe-biochemical;
• akuvamile ngokwanele - hypoglycemia.

Akunconyelwe ukusetshenziswa ezimweni ezilandelayo:

• Uhlobo 1 sikashukela;
• ukukhulelwa nokuqunjelwa;
• ukungabekezelelwa kwezidakamizwa;
• isifo sikashukela sikashukela.

Imithi ekhulisa ukuzwela kwezicubu kwe-insulin

Ngohlobo 2 sikashukela, imvamisa akudingekile ukukhuthaza imfihlo ye-insulin, ngoba ikhiqizwa ngamanani anele. Kuyadingeka ukwandisa ukuzwela kwezicubu kuyi-hormone, ngoba kungukuphulwa kwesenzo se-izicubu cell receptors ezikhuthaza ukwanda kweglucose yegazi.

IBiguanides

I-Biguanides - iqembu lezidakamizwa ezikhulisa ukuzwela kwezicubu ku-insulin. Simelelwa yiBuformin, Metformin, Fenformin.

Ziyahlukahluka nge-assimilation ehlukene, imiphumela emibi, umthamo wokuthola umphumela wokwelapha. Njengamanje, kusetshenziswa iMetformin kuphela.

Lapho uthatha umuthi, kukhona ukwehla kokumelana ne-insulin. Umuthi osebenzayo uvimbela i-gluconeogenesis, ushintsha ukumuncwa kwe-glucose. Izinga le- "cholesterol embi" ne-triglycerides nalo liyancishiswa. AmaBiguanides amunca emgodini wokugaya ukudla, owenziwa yizinso ikakhulukazi, ukugcwala okukhulu kufinyelelwa ngemuva kwamahora ama-2. Ukuqedwa kwesigamu sempilo kufinyelela emahoreni angama-4,5.

AmaBiguanides anqunyelwa uhlobo 2 sikashukela kanye nohlobo 1 sikashukela njengengxenye yokwelashwa okuphelele.

Abamele isigaba se-Biguanide asasetshenziselwa:

• ukukhulelwa nokuqunjelwa;
• ukungasebenzi kwesibindi;
• ukungasebenzi kwezinso;
• ukungabekezelelani kwengxenye esebenzayo;
• ukushaya kwenhliziyo;
• inqubo yokuvuvukala okukhulu;
• i-ketoacidosis, i-lactic acidosis;
• ukwehluleka ukuphefumula.

AmaBiguanides ahlanganiswa notshwala. Ababelwa futhi izinsuku ezintathu ngaphambi kwezinsuku ezintathu nezinsuku ezintathu bahlinzwa. Iziguli ezineminyaka engaphezu kuka-60 ubudala zinconywa ukuba zisebenzise imishanguzo kuleli qembu ngokuqapha.

Imiphumela emibi kwinqubo yokuthatha ifaka:

• i-megaloblastic anemia;
• ukuphazamiseka esiswini, ikakhulukazi, isifo sohudo, ukugabha;
• i-acidosis.

Uhlu lwemithi yaleli qembu luhlanganisa: Metfogamma, Metformin, Glukofazh, Adebit, Langerin, Siofor, Bagomet. Izidakamizwa zingahlanganiswa nezinye izidakamizwa ze-glycemic.

Lapho kuhlanganiswa ne-insulin, ukunakekelwa okukhethekile kuyadingeka. Ukusebenza kwezinkomba zezinso kanye noshukela we-glucose kuyabhekwa. Kubhekelwa kakhulu ukuhlanganiswa nezinye izidakamizwa ezingeyona i-glycemic - ezinye zingandisa noma zinciphise umphumela wezidakamizwa zeqembu elikhuluuanide.

I-Thiazolidinediones

I-Thiazolidinediones - iqembu elisha lemithi enciphisa ushukela ekuphatheni ngomlomo. Abenzi kusebenze ukukhululeka kwe-insulin, kodwa bakhulisa ukwanda kwezicubu zayo.

Kunama-2 thiazolidinediones - pioglitazone (isizukulwane sesibili) kanye ne-rosiglitazone (isizukulwane sesithathu). I-Troglitazone (isizukulwane sokuqala) ikhombise imiphumela ye-hepatotoxic ne-cardiotoxic, yingakho iyekwe. Imithi ingasetjenziswa ihlanganiswe nezinye izidakamizwa noma njenge-monotherapy.

Ngokwenza izicubu, isibindi, izidakamizwa zikhulisa ukwanda kwe-hormone. Njengomphumela, ukucubungula i-glucose kuthuthukiswa ngokwanda kokuhlanganiswa kweseli. Umphumela wezidakamizwa uyazibonakalisa ukhona wehomoni yakhe.

Kufakwe emgudwini wokugaya ukudla, owembiwa yizinso, owenziwe ngesibindi esibindini. Ukuhlushwa okuphezulu - ngemuva kwamahora we-2,5. Umphumela ogcwele amandla uvela ngemuva kwezinyanga ezimbalwa zokuphuza umuthi.

Izidakamizwa zinciphisa ngempumelelo ushukela, zithinte kahle iphrofayili ye-lipid. Imiphumela ayisebenzi kangako kune-biguanides. Yonke imishanguzo eqenjini inyusa isisindo. Umphumela uncike esikhathini sokwelashwa kanye nasemthanjeni. Kukhona nokugcinwa kwamanzi emzimbeni.

Ngesikhathi sokwelashwa nge-thiazolidinediones, isimo esisebenzayo sesibindi sihlaziywa ngezikhathi ezithile. Uma isiguli sinezingozi zokuthola ukuhluleka kwenhliziyo, khona-ke i-thiazolidine therapy ayinqunyelwe.

Ezimweni ezinjalo, udokotela unquma i-insulin, i-sulfonylureas, i-metformin.

Izidakamizwa ezisuselwa ku-Thiazolidinedione: Avandia, Aktos.

Contraindication:

• ukukhulelwa, ukukhulelwa;
• ukwephulwa kwesibindi;
• Uhlobo 1 sikashukela;
• iminyaka engu-18.

Imiphumela elandelayo elandelayo yabonwa kusetshenziswa imithi:

• isisindo somzimba;
• ingozi eyengeziwe yokuqhekeka ngenxa yokuncipha kokuqina kwamathambo;
• ukwephulwa kwesibindi;
• i-hepatitis;
• ukwehluleka kwenhliziyo;
• ukudumba;
• eczema

Kusho ukumunca i-carbohydrate emathunjini

I-alfa glucosidase inhibitors yizidakamizwa eziphazamisa ukumuncwa kwama-carbohydrate emathunjini. Banomphumela ongeziwe we-endocrine ekwelapheni isifo sikashukela. Thinta ukugcwala koshukela ngemuva kokudla. Ngenxa yalokhu, ukuthuthukiswa kwe-hypoglycemia kuncishiswa kakhulu.

Ama-inhibitors we-AG aphazamisa ukuwohloka kwama-carbohydrate, ngenxa yokuthi ukungena kwawo kuncipha. Into esebenzayo idala izithiyo ekungeneni kwe-carbohydrate iye egazini.

Ama-inhibitors we-Alpha glucosidase asetshenziswa kakhulu ngokuhlanganiswa namanye ama-glycemic agents kanye ne-insulin. Iqokwe ku-Type 2 sikashukela.

Imelwe yiVoglibosis, Acarbose, Miglitol. Manje kusetshenziswa kuphela izidakamizwa ezimbili zokugcina. Imiphumela yemitholampilo iyafana, kepha umphumela uhlukile kancane.

I-Acarbose ivimbela i-lactose ne-amylase futhi cishe ayigxiniwe emathunjini. Kungangeza ama-enzyme wesibindi. I-Miglitol igcina i-glycogeneis esibindini, igxiliswa amathumbu. Kuthinta ukumuncwa kweGlibenclamide neMetformin ngaphandle kokubonakaliswa kwemitholampilo.

Ngesikhathi sokusetshenziswa kwemithi yalesi sigaba kuyabonakala:

• ukuncishiswa kwezinkinga zesifo senhliziyo;
• ukunciphisa ukuqhubekela phambili kwe-atherosclerosis;
• ukuphazamiseka kwamathumbu emathunjini, ikakhulukazi, isifo sohudo kanye ne-flatulence.

Contraindication ukusetshenziselwa:

• i-ulcerative colitis;
• isifo sikashukela sikashukela;
• ukukhulelwa
• ukuvinjwa kwamathumbu;
• ukucaphuka
• ukungasebenzi kwesibindi;
• ukuqina kwamathumbu;
• ukwehluleka kwezinso.

Imiphumela emibi ibonakaliswa ikakhulukazi kusuka emgudwini wesisu. Lokhu kanye nesifo sohudo, izinhlungu zasendaweni, ukugcwala kwethafa, ukwanda kwama-enzyme wesibindi.

Ngokusebenzisana kwe-hypertension inhibitors ngezidakamizwa ze-antidiabetic kanye ne-insulin, umphumela wokugcina unganda. Ukuvimbela umphumela we-hypoglycemic, umthamo ukhethwe ngokucophelela.

AmaSorbents, amalungiselelo e-enzymatic anciphisa izinga lokusebenza kweMiglitol ne-Acarbose. Ama-Corticosteroids, niacin, ama-diuretics, ama-hormone e-thyroid anciphisa umsebenzi wama-inhibitors we-AH. IMiglitol inciphisa i-bioavailability yeRanitidine, i-Digoxin.

Incretinomimetics

Ama-incretin angama-hormone akhethekile akhiqizwa ngemuva kokudla. Banciphisa ukuthulula isisu, bavuse ukukhululeka kwe-insulin, bayeke ukucasha ngokweqile kwe-glucagon futhi banciphise iphango. Esikhathini sikashukela, imisebenzi enjalo iyancishiswa, futhi okuqukethwe kwe-hormone akunakwa. Inani labo libuyiselwa kusetshenziswa i-incretinomimetics. Benza ngcono umphumela wokwelapha futhi banesithakazelo esithile kwezokwelapha.

Ama-asccinomimetics ahlobana nokuhlanganiswa kwamaprotheni. Amelelwa ngamaqembu amabili izidakamizwa:

• Iqembu 1 - Exenatide. Kuyi-mretetic eqondile ye-incretin. Lokhu kufaka iBaeta, Viktoza. Zisetshenziswa njengezijova ezingaphansi. Ukuthuthukisa umphumela, hlanganisa nezinye izidakamizwa ze-glycemic.
• Iqembu 2 - i-insulinotropic polypeptide. Kwethulwa yimithi: Galvus, Januvius. Zihlobanise nama-incretinomimetics angaqondile. IDipeptidyl peptidase, ebola ama -retretin, ivinjiwe. Inikezwe ngokwahlukana futhi ihlangana neminye imithi.

Umuthi uqala indlela yokukhiqizwa kwama-hormone - bangena egazini ngemuva kwemizuzu embalwa. Ukungezelelwa okwandisiwe kuvuselela ukuvuselelwa kweseli le-pancreatic kanye nenani lamahomoni akhiqizwayo. Umsebenzi wezidakamizwa wenzeka emazingeni aphezulu kashukela, futhi ngamazinga aphansi, isenzo siyaphela.

Phakathi kokuphulwa kokuvunyelwa:

• isifo sikashukela sikashukela;
• ukukhulelwa, ukukhulelwa;
• ukungasebenzi kwezinso;
• I-LED 1;
• iminyaka engu-18.

Phakathi kwemiphumela emibi ngesikhathi sokwelashwa kuyabonakala:

• ukungahambi kahle komzimba;
• ikhanda
• isicanucanu, ukuhlanza
• ubuthakathaka, ukozela.

Imithi yesigaba se-incretin mimetics ingabekwa emazingeni okuqala okubonakaliswa kwalesi sifo. Basiza ukugcina umsebenzi we-beta cell. Ehlelweni lokwelapha asebekhulile, kukhona ikakhulukazi izinkomba eziguquguqukayo. Ngesikhathi sokulashwa, umuthi ngezinga elincane uthinta ukukhula kwe-hypoglycemia.

Ividiyo yezidakamizwa ezintsha zesifo sikashukela:

Iqembu ngalinye lezidakamizwa linqunywa ngudokotela ngokuya ngesithombe somtholampilo kanye nezimpawu zenkambo yesifo sikashukela. Zingasetshenziswa kokubili ngokuhlanganiswa nanjenge-monotherapy. Ngesikhathi sokulashwa, kunconywa ukuthatha i-biochemistry yegazi ukuhlola isimo sezitho zomzimba.