Ho felisa lefu la tsoekere le matšoao a lona, ho sebelisoa meriana e khethehileng e etselitsoeng ho theola boemo ba tsoekere maling a motho ea kulang. Lisebelisoa tse joalo tsa antidiabetesic (hypoglycemic) li ka ba bakeng sa tšebeliso ea batsoali, hammoho le molomo.
Lithethefatsi tsa molomo tsa hypoglycemic tsa hypoglycemic hangata li aroloa ka tsela e latelang:
- derivatives tsa sulfonylurea (tsena ke Glibenclamide, Glikvidon, Gliklazid, Glimepirid, Glipizid, Chlorpropamide);
- alpha glucosidase inhibitors ("Acarbose", "Miglitol");
- meglitinides ("Nateglinide", "Repaglinide");
- biguanides ("Metformin", "Buformin", "Fenformin");
- thiazolidinediones (Pioglitazone, Rosiglitazon, Tsiglitazon, Englitazon, Troglitazon);
- incretinomimetics.
Thepa le ts'ebetso ea likhakanyo tsa sulfonylurea
Liphetoho tsa sulfonylureas li ile tsa fumanoa ka tšohanyetso bohareng ba lekholo le fetileng la lilemo. Bokhoni ba likhomphutha tse joalo bo thehiloe ka nako eo ho ileng ha etsahala hore bakuli ba neng ba sebelisa lithethefatsi tsa sulfa ho tlosa mafu a tšoaetsanoang le bona ba fokotsehile tsoekere ea bona ea mali. Kahoo, lintho tsena li boetse li na le phello e boletsoeng ea hypoglycemic ho bakuli.
Ka lebaka lena, hang-hang o ile a qala ho batla lintho tse tsoang ho sulfonamides ka bokhoni ba ho theola boemo ba tsoekere maling. Mosebetsi ona o kentse letsoho ho kopaneng ha lintho tsa pele tsa lefats'e tsa sulfonylurea, tse ileng tsa khona ho rarolla mathata a lefu la tsoekere ka nepo.
Ho pepesehela lits'oaetso tsa sulfonylurea ho amana le ts'ebetso ea lisele tse ikhethileng tsa pancreatic beta, e amanang le ho hlohlelletsa le tlhahiso e eketsehileng ea tlhahiso ea insulin. Tlhokahalo ea bohlokoa bakeng sa phello e ntle ke ho ba teng ha makhopho a lisele tsa bophelo le tsa beta tse felletseng.
Hoa hlokomeleha hore ka tšebeliso e telele ea lihlahisoa tsa sulfonylurea, phello ea bona e ntle ea pele e lahlehile ka botlalo. Setlhare se khaotsa ho ama secretion ea insulin. Bo-rasaense ba lumela hore sena se bakoa ke ho fokotseha ha palo ea li-receptor liseleng tsa beta. Ho ile ha boela ha senoloa hore kamora ho phomola kalafong e joalo, karabelo ea lisele tsena ho moriana e ka tsosolosoa ka botlalo.
Li-sulfonylureas tse ling li ka fana ka phello e eketsehileng-pancreatic. Ketso e joalo ha e na boleng ba bohlokoa ba kliniki. Litholoana tse ling tsa pancreatic li kenyelletsa:
- eketseha habonolo ha lisele tse itšetlehileng ka insulin ho insulin ea tlhaho ea tlhaho ea tlhaho;
- tlhahiso e fokotsehileng ea tsoekere maling.
Mochine oohle oa nts'etsopele ea litlamorao ho 'mele o teng hobane taba ea hore dintho ("Glimepiride" ke tsona):
- eketsa palo ea li-receptor tse amehang ho insulin seleng e lebisitsoeng;
- ka mokhoa o loketseng o ntlafatsa tšebelisano ea insulin-receptor;
- fetisa phetisetso ea lets'oao la postreceptor.
Ntle le moo, ho na le bopaki ba hore litokollo tsa sulfonylurea li ka fetoha sesosa sa ho lokolloa ha somatostatin, e tla etsa hore ho khonehe ho hatella tlhahiso ea glucagon.
Sulfonylureas
Ho na le meloko e 'maloa ea ntho ena:
- Moloko oa 1: "Tolazamide", "Tolbutamide", "Carbutamide", "Acetohexamide", "Chlorpropamide";
- Moloko oa bobeli: Glibenclamide, Glikvidon, Glisoksid, Glibornuril, Gliklazid, Glipizid;
- Moloko oa 3: Glimepiride.
Ho fihla joale, naheng ea rona, lithethefatsi tsa moloko oa 1 li batla li sa sebelisoe.
Phapang e kholo lipakeng tsa lithethefatsi tsa moloko oa 1 le 2nd ka mekhahlelo e fapaneng ea ts'ebetso ea bona. Sulfonylurea ea bobeli e ka sebelisoa ka litekanyetso tse tlase, tse thusang ho fokotsa monyetla oa litlamorao tse fapaneng.
Ho bua ka lipalo, ts'ebetso ea bona e tla ba makhetlo a 50 kapa esita le makhetlo a 100. Kahoo, haeba tekanyetso e tloaelehileng ea litekanyetso tsa letsatsi tsa 1 e lokela ho ba ho tloha ho 0,75 ho isa ho 2 g, joale lithethefatsi tsa meloko ea bobeli li se li fana ka tekanyetso ea 0,02-0.012 g.
Litla-morao tse ling tsa hypoglycemic le tsona li ka fapana ka mamello.
Lithethefatsi tse tsebahalang haholo
Gliclazide - Ena ke e 'ngoe ea lithethefatsi tse laetsoeng khafetsa. Lithethefatsi ha li na litlamorao feela tsa boleng bo botle, empa hape li thusa ntlafatsong:
- matšoao a hematological;
- rheological thepa ea mali;
- heestatic system, microcirculation ea mali;
- heparin le tšebetso ea fibrinolytic;
- mamello ea heparin.
Ntle le moo, Glyclazide e khona ho thibela nts'etsopele ea microvasculitis (tšenyo ea morao), e hatelle lipontšo leha e le life tse mabifi tsa liplatelete, e eketsa haholo index ea ho se lumellane mme e bonts'a thepa ea antioxidant e ntle.
Glycvidon - sethethefatsi se ka laeloang lihlopha tseo tsa bakuli ba nang le ts'ebetso ea ho hlaka ea renal. Ka mantsoe a mang, haele hantle, liphio li lokela ho etsa liperesente tse 5 tsa metabolites, le tse 95 tse setseng - mala
Glipizide E na le phello e boletsoeng mme e ka emela kotsi e nyane ho litlamorao tsa hypoglycemic. Sena se nolofalletsa ho se kopane mme o se ke oa ba le metabolites e sebetsang.
Likarolo tsa tšebeliso ea li-agent tsa molomo
Lipilisi tsa antidiabetesic e ka ba kalafo ea mantlha bakeng sa lefu la tsoekere la mofuta oa 2, le ikemetseng ka har'a insulin. Lithethefatsi tse joalo li khothaletsoa ho bakuli ba lilemo tse fetang 35 ntle le mathata a joalo a teng:
- ketoacidosis;
- khaello ea phepo e nepahetseng;
- mafu a hlokang kalafo ea insulin e potlakileng.
Litokisetso tsa Sulfonylurea ha li hlahisoe ho bakuli bao, leha ba na le lijo tse lekaneng, tlhoko ea letsatsi le letsatsi ea "insulin" e feta letšoao la 40 unit (UNITS). Ntle le moo, ngaka e ke ke ea ba fa lingoloa haeba ho na le mofuta o matla oa lefu la tsoekere, nalane ea lefu la tsoekere le glucosuria e phahameng khahlanong le semelo sa phepo e nepahetseng.
Phetisetso ea kalafo ka sulfonylurea e ka khonahala tlasa maemo a lefu la metabolism ea carbohydrate, e lefshoang ka liente tse eketsehileng tsa insulin ka tekanyetso ea likarolo tse ka tlase ho 40. Haeba ho hlokahala, ho fihlela ho LITLHAKU TSE 10, phetoho e tla etsoa ho tsoa litlamorao tsa sethethefatsi sena.
Tšebeliso e telele ea lihlahisoa tsa sulfonylurea e ka baka nts'etsopele ea ho hanyetsa, e ka hlola feela ka kalafo e kopaneng le litokisetso tsa insulin. Ho mofuta oa 1 lefu la tsoekere, leqheka le joalo le tla fana ka phello e ntle kapele 'me le tla thusa ho fokotsa tlhokahalo ea letsatsi le letsatsi ea insulin, hammoho le ho ntlafatsa tsela ea lefu lena.
Ho thefuleha ha tsoelo-pele ea retinopathy ka lebaka la sulfonylurea ho ile ha lemohuoa, 'me lefu la tsoekere la retinopathy ke bothata bo boholo. Sena se kanna sa bakoa ke ts'ebetso ea angioprotective ea lihlahisoa tsa eona, haholo-holo tse tsoang molokong oa bobeli. Leha ho le joalo, ho na le monyetla o itseng oa phello ea bona ea atherogenic.
Ho lokela ho hopoloa hore lintlha tse tsoang ho sena lithethefatsi li ka kopanngoa le insulin, hammoho le biguanides le "Acarbose". Sena se ka etsahala maemong ao bophelo bo botle ba mokuli a sa ntlafatseng le li-insulin tse 100 tse behiloeng ka letsatsi.
U sebelisa litlhare tse fokotsang tsoekere, ho lokela ho hopoloa hore mesebetsi ea bona e ka fokotsoa:
- anticoagulants e sa tobang;
- salicylates;
- "Butadion";
- Ethionamide;
- Cyclophosphamide;
- litopo;
- Chloramphenicol.
Ha o sebelisa chelete ena ho kenyelletsa lithethefatsi tsa sulfa, metabolism e ka fokotsoa, e tla lebisa ho nts'etsopele ea hyperglycemia.
Haeba u kopanya li-sulfonylurea tse tsoang le thiazide diuretics (mohlala, "Hydrochlorothiazod") le BKK ("Nifedipine", "Diltiazem") ka tekanyetso e kholo, joale ho hanyetsana ho ka qala ho hola. Li-Thiazides li thibela katleho ea lits'oaetso tsa sulfonylurea ka ho bula liteishene tsa potasiamo. Li-LBC li lebisa khatellong ea phepelo ea li-ion tsa calcium ho lisele tsa beta tsa manyeme.
Mehloli e tsoang ho sulfonylureas e ntlafatsa haholo phello le ho mamella lino tse tahang. Sena se bakoa ke ho lieha ha ts'ebetso ea oxidation ea acetaldehyde. Ponahatso ea karabelo e kang ea antabuse e ka etsahala.
Ntle le hypoglycemia, ho ka ba le litlamorao tse sa rateheng:
- mathata a dyspeptic;
- cholestatic jaundice;
- boima ba mmele;
- aplastic kapa hemolytic anemia;
- nts'etsopele ea maikutlo a ho kulisa;
- leukopenia e fetoletsoeng;
- thrombocytopenia;
- agranulocytosis.
Meglitinides
Tlas'a meglitinides e lokela ho utloisisoa ke li-regandial regandial.
"Repaglinide" ke derivative ea benzoic acid. Setlhare se fapaneng ka sebopeho sa lik'hemik'hale ho tsoa litsing tse tsoang sulfonylurea, empa li na le phello e ts'oanang 'meleng. Repaglinide e thibela likanale tsa potasiamo tse itšetlehileng ka ATP liseleng tse sebetsang tsa beta mme e khothaletsa tlhahiso ea insulin.
Karabelo ea 'mele e tla halofo ea hora kamora ho ja' me e bonahatsoa ke ho fokotseha ha tsoekere ea mali. Pakeng tsa lijo, mokokotlo oa "insulin" ha o fetohe.
Joalo ka lithethefatsi tse thehiloeng litlamong tsa sulfonylurea, karabelo e mpe ea mantlha ke hypoglycemia. Ka hloko haholo, moriana o ka khothaletsoa ho bakuli ba nang le bothata ba ho ruruha kapa ba sebete.
Nateglinide ke derivative ea D-phenylalanine. Setlhare se fapana le tse ling tse tšoanang ka ts'ebetso e potlakileng, empa e sa tsitsa. Hoa hlokahala ho sebelisa lithethefatsi bakeng sa mofuta oa lefu la tsoekere la mofuta oa 2 ho thusa ho fokotsa hyperglycemia ea postprandial.
Li-Biguanides li 'nile tsa tsejoa ho tloha lilemong tsa bo-70 tsa lekholo la ho qetela la lilemo mme li ne li laetsoe ho pateloa ha insulin ke lisele tsa beta tsa manyeme. Tšusumetso ea bona e khethoa ke ho sitisoa ha gluconeogeneis ka har'a sebete le keketseho ea bokhoni ba ho pepeta tsoekere. Ntle le moo, sesebelisoa se ka fokotsa ho kenella ha insulin le ho eketsa tlamahano ea eona ho li-insulin receptors. Ts'ebetsong ena, metabolism le ho monya ha tsoekere e eketseha.
Biguanides ha e theole tekanyo ea tsoekere ea mali ea motho ea phetseng hantle le ba nang le lefu la tsoekere la mofuta oa 2 mellitus (e fanoeng ka ho itima lijo bosiu).
Hypoglycemic biguanides e ka sebelisoa ho nts'etsopele ea lefu la tsoekere la mofuta oa 2. Ntle le ho fokotsa tsoekere, sehlopha sena sa lithethefatsi ka tšebeliso ea sona ea nako e telele se ama metabolism ea mafura.
Ka lebaka la ts'ebeliso ea lithethefatsi tsa sehlopha sena:
- lipolysis e butsoe (mokhoa oa ho petsoha mafura);
- takatso e fokotsehileng;
- butle-butle boima bo khutlela ho bo tloaelehileng.
Maemong a mang, ts'ebeliso ea bona e tsamaisana le ho fokotseha ha litaba tsa triglycerides le cholesterol maling, ho ka boleloa hore li-biguanides ke matlapa a ho theola tsoekere ea mali.
Mofuta oa 2 lefu la tsoekere, "metabolism ea" carbohydrate e haellang e kanna ea amahanngoa le mathata a metabolism ea mafura. Hoo e ka bang karolo ea 90 lekholong ea bakuli, bakuli ba na le boima ba 'mele. Ka lebaka lena, ka nts'etsopele ea lefu la tsoekere, hammoho le botenya bo sebetsang, ho hlokahala hore ho sebelisoe lithethefatsi tse thathamisang metabolism ea lipid.
Letšoao le ka sehloohong la ts'ebeliso ea li-biguanides ke lefu la tsoekere la mofuta oa 2. Setlhare se hlokahala haholo khahlano le nalane ea boima bo feteletseng le kalafo e sa sebetseng hantle kapa katleho e lekaneng ea litokisetso tsa sulfonylurea. Ketso ea li-greatuanides ha e bonahatsoe ha ho na insulin maling.
Alpha glucose inhibitors e thibela ho phatloha ha li-polysaccharides le oligosaccharides. Ho monya le ho hlahisa tsoekere e fokotsehile ebe ka hona ho na le temoso ea nts'etsopele ea postprandial hyperglycemia. Li-carboote tsohle tse nooang le lijo, boemong ba tsona bo sa fetoheng, li kena likarolong tse ka tlase tsa mala le a maholo. Ho kenngoa ha monosaccharides ho nka lihora tse 4.
Ho fapana le lithethefatsi tsa sulfa, li-inhibitors tsa alpha glucose ha li eketse ho tsoa ha insulin mme li ke ke tsa baka hypoglycemia.
Ka lebaka la lithuto, ho ile ha netefatsoa hore kalafo ka thuso ea "Acarbose" e kanna ea tsamaisana le ho fokotseha ha monyetla oa ho ba le meroalo e meholo ea atherosclerosis.
Ts'ebeliso ea li-inhibitors tse joalo e ka ba ka mokhoa oa monotherapy, hape o li kopanya le lithethefatsi tse ling tsa molomo tse fokotsang tsoekere ea mali. Motsoako oa pele hangata o ba 25 ho isa ho 50 mg hang hang kapa nakong ea lijo. Ka kalafo e latelang, litekanyetso li ka eketsoa ho ea holimo (empa eseng ho feta 600 mg).
Matšoao a mantlha a ho khethoa ha alpha-glucosidase inhibitors ke: mofuta oa 2 lefu la tsoekere le kalafo e mpe ea lijo, mofuta oa 1 lefu la tsoekere, empa ho latela motsoako o kopaneng.
