Mellitus ea lefu la tsoekere e sa itšetleheng ka insulin ke e 'ngoe ea mefuta ea lefu lena, e tšoaeang ho fokotseha ha kutloisiso ea lisele le lisele tsa mmele ho ea ketsong ea "insulin" ea "hormone". Ntho ena e hlahisoa ke lisele tsa lisebelisoa tsa ka hare tsa manyeme. Mosebetsi oa ona ke ho tsamaisa limolek'hule tsa glucose ka har'a lisele ho fana ka matla.
Meleng ea lefu la tsoekere la mofuta oa 2, hyperglycemia e bonoa - tekanyo e phahameng ea tsoekere. Letšoao lena le nkoa le etella pele, ke motheong oa lona hore ts'oaetso e netefalitsoe. Ho loantša lipalo tse phahameng tsa glycemia, kalafo ea phepo (khalemelo ea phepo e nepahetseng), ts'ebetso ea 'mele le kalafo ea lithethefatsi e sebelisoa. Sengoloa se tla shebisisa likarolo tsa ho khethoa le tsamaiso ea lithethefatsi. Lethathamo la lithethefatsi tse fokotsang tsoekere bakeng sa lefu la tsoekere la mofuta oa 2, lipontšo tsa ts'ebeliso ea bona le melao-motheo ea kalafo li tšohloa ka tlase.
Melao-motheo ea kalafo ea lithethefatsi
American Diabetes Association le European Association for the Study of Diabetes e hatisa hore glycosylated hemoglobin e nkuoa e le mokhoa o ka sehloohong oa tlhahlobo ho hlahloba boemo ba mokuli. Ka palo e kaholimo ho 6.9%, liqeto tsa k'hadinale li lokela ho etsoa mabapi le kalafo. Leha ho le joalo, haeba sena ha se taba ea bakuli bohle, empa mabapi le linyeoe tse ikhethang tsa kliniki, ho lokela ho netefatsoa hore matšoao ha a fetelle ho 6%.
Hang hoba ba netefatse tlhahlobo ea "lefu le monate" mofuta oa 2 (joalo ka lefu la tsoekere le bitsoa bathong ba tloaelehileng), lingaka tsa endocrinologists li beha Metformin. Likarolo tsa ts'ebeliso ea lithethefatsi li tšoauoa ka tsela e latelang:
- mori ha o kenye letsoho ho nona;
- e na le litla-morao tse fokolang;
- ha e tsose litlhaselo tsa ho fokotseha ho matla ha tsoekere ea mali ho lefu la tsoekere;
- behiloeng kamoso ntle le likhanyetsano;
- e mamelletsoeng hantle ke bakuli;
- e bua ka lithethefatsi tsa theko e tlase.
Endocrinologist - setsebi se tla thusa mokuli ho sebetsana le pathology
Bohlokoa! Pheko e 'ngoe e nang le litafole tse fokotsang tsoekere e ntse e lokisoa nakong ea kalafo le Metformin.
Tse latelang ke lihlopha tse ka sehloohong tsa lithethefatsi tse theolelang tsoekere, baemeli ba tsona ba sebetsang, haholo-holo sepheo le tsamaiso.
Lihlopheng tse ka sehloohong tsa lithethefatsi
Endocrinology ea mehleng ena e sebelisa lihlopha tse 5 tsa meriana ho theola tsoekere ea mali ho lefu la tsoekere. Li arotsoe ka lihlopha tse peli tse kholo:
- Baemeli ba Hypoglycemic (meriana e fokotsang tsoekere ea mali). Li khothaletsa tlhahiso ea "insulin" ea insulin, e amang boima ba mokuli (e eketsa) mme e ka baka tsitsipano e matla ea glycemia. Baemeli ke sulfonylureas le letsopa.
- Meriana ea antihyperglycemic (lithethefatsi tse sa lumelleng tsoekere ea mali ho phahama kaholimo ho tumello). Baemeli ba sehlopha ba eketsa tšebeliso ea tsoekere ho potapotileng, empa ho hang ha ba khothalletse ts'ebetso ea pancreatic. Tsena li kenyelletsa li-biguanides, li-blockers tsa alpha-glucosidase le thiazolidinediones.
Lethathamo: Ho bapisoa ha lithethefatsi tse ka sehloohong tse fokotsang tsoekere
| Sehlopha sa kalafo | Ketsahalo ea baemeli ho monotherapy | Ho sebetsa hantle | Matšoao a ho khethoa |
| Alpha Glucosidase Inhibitors | Fokotsa hemoglobin ea glycosylated ka 0,7% | E khaola lipontšo tsa hyperglycemia kamora ho ja | Glycemia ka mor'a ho ja le tsoekere e tloaelehileng ea ho itima lijo |
| Sulfonylureas | Fokotsa hemoglobin ea glycosylated ka 1.5% | E susumetsa tlhahiso ea insulin | Abela ho se be le boima ba 'mele oa' mele |
| Likhalefo | E tšoanang le alpha glucosidase inhibitors | Abela bakuli ba sa lakatseng ho latela kalafo ea ho ja | |
| Biguanides | Fokotsa hemoglobin ea glycosylated ka 1,7% | E eketsa kutloisiso ea insulin ea lisele | Tsoekere e phahameng ea ho itima lijo le glycemia e tloaelehileng ka mor'a ho ja |
| Thiazolidinediones | E fokotsa hemoglobin ea glycosylated ka 0.5-1.3% | E ntlafatsa kutloisiso ea insulin ea lisele | Bakeng sa bakuli ba nang le boima ba 'mele bo phahameng |
| Insulin | Moemeli ea sebetsang ka ho fetisisa, o fetola matšoao ho boemo bofe kapa bofe boo o bo batlang | E khaola Insulin | Abelana le phello, ho haella ha lithethefatsi tse ling bakeng sa kalafo ea basali baimana |
Biguanides
Boemong ba hona joale, lithethefatsi tse sebelisoang ka ho fetisisa sehlopheng ke Metformin. E tloaelehile ka lebaka la kotsi e tlase ea lactic acidosis nakong ea kalafo. Li-Biguanides li khona ho fetola mekhoa ea metabolic ka lebaka la:
- ho fokotseha ha gluconeogeneis (ho thehoa ha glucose ke sebete ho tsoa linthong tse se nang carbohydrate);
- ho eketsa tekanyo ea tsoekere ka lisele le lisele;
- liphetoho ka lebelo la ho monngoa ha tsoekere ka popelong ea mala.
Melemo le mathata a sehlopha
Biguanides e fokotsa tsoekere hantle le glycosylated hemoglobin, e fokotsa butle boima ba 'mele, e emise takatso ea lijo ea methapo. Lithethefatsi li lokile ka hore ha li qobelle tsoelo-pele ea hypoglycemia ea hoseng khahlano le tlala bosiu.
Tšebeliso ea Metformin ea nako e telele e na le phello e molemo ho metabolism ea mafura.Metformin ea lithethefatsi ha e khothalletse feela ho phatloha ha lipids, empa e boetse e thibela ho etsoa ha lithane tsa adipose. Biguanides e boetse e thusa ho tlosa cholesterol e mpe 'meleng, e fokotsa palo ea li-triglycerides le LDL. Kameho e ntle ho boemo ba tsamaiso ea mali ea mali.
Litšobotsi tsa kalafo
Metformin e ka fokotsa glycemia ha e sebelisoa e le monotherapy kapa hammoho le kalafo ea insulin, sulfonylureas. Li-Biguanides ha li khethoe maemong a latelang:
- nako ea ho emara le ho nyeheloa ke mpa;
- maemo a hlobaetsang, ho kenyeletsoa komisi;
- mekhahlelo ea lipolao tsa liphio le sebete;
- mekhoa ea tšoaetso e mpe;
- khahlano le semelo sa kalafo ea ho ja ka khalori ea letsatsi le letsatsi e ka tlase ho 1000 kcal;
- bakuli ba ikoetlisang haholo;
- bakuli ba tsofetseng.
Alpha Glucosidase Inhibitors
Mmaraka oa sejoale-joale oa litlama oa Russia o na le sehlahisoa se le seng feela se ngolisitsoeng sa sehlopha. Sena ke Glucobai (ntho e sebetsang ke acarbose). Setlhare se tlamahane le li-enzyme tsa ka mpeng, se liehisa ts'ebetso ea ho petsoha le ho monya li-saccharides. Sephetho se thibela keketseho ea tsoekere ka mor'a hore lijo li kenngoe.
Ka ts'ebetso ea 'nete, monotherapy e nang le alpha-glucosidase inhibitors e sebetsa hantle feela ho batho ba fumanoeng ba lefu la tsoekere pele. Lihlopha tse peli li kopantsoe khafetsa: inhibitors + sulfonylureas, inhibitors + biguanides, inhibitors + insulin therapy.
Liteko tsa tleliniking li bontšitse katleho ea tšebeliso ea Glucobay
Litlamorao tse kholo tsa Glucobai li amahanngoa le tlolo ea ts'ebetso ea ts'ebetso ea phepelo ea ka mpeng. Bakuli ba na le litletlebo tsa letšollo, lithunthung. Lits'oaetso tse mabapi le ho beoa ha moriana ke:
- diverticulitis;
- lefu la masapo le sa foleng;
- ulcerative colitis;
- Lefu la Crohn;
- ho ba teng ha likhanyetsano;
- hernia ea peritoneum.
Sulfonylureas
Baemeli ba sehlopha sena, ba theola tsoekere ea mali, ba ile ba fumanoa ka monyetla. Pele, ho ne ho lumeloa hore meriana e na le litlamorao tse ikhethileng. Kamora ho fumana bokhoni bo eketsehileng ba sehlopha, bo-rasaense ba ile ba qala ka boomo ho batla meriana eo e nang le phello e phatlalalitsoeng ea hypoglycemic. Sena se ile sa lumella tšebeliso ea baemeli bakeng sa kalafo ea lefu la tsoekere la mofuta oa 2.
Ketso ea lintho tse nkiloeng ho sulfonylurea ke e latelang:
Mofuta o mocha oa meriana ea lefu la tsoekere- ho hlohlelletsa lisebelisoa tsa kahare;
- tsosoloso ea kutlo ea lisele tsa lihlekehleke tsa Langerhans-Sobolev;
- keketseho ea palo ea li-receptor tse hlokahalletseng liseleng tsa bokaholimo ba lisele.
Likotsi tsa sehlopha ke monyetla oa ho fumana boima ba 'mele nakong ea phekolo le baemeli ba sehlopha sa bobeli sa moloko (mohlala, Maninil). Ha u sebelisa mokhoa o ts'oanang, ts'ebetso ea ho senyeha ha likepe tsa coronary e eketsoa haholo, ketsahalo ea ho nyekoa ke pelo e ba thata le ho feta.
Contraindication ho lengolo la ngaka ea meriana:
- mofuta o itšetlehileng ka "insulin" oa "lefu le monate";
- nako ea ho emara le ho nyeheloa ke mpa;
- ho ba teng ha matla a kutloisiso ea motho ka mong;
- mathata a hlobaetsang ka tsela ea boemo ba ketoacidotic, hyperosmolar;
- Psychology
- ho fokotseha hoa boemo ba lisele tse tšoeu tsa mali maling a tlase ho tloaelehileng.
Baemeli ba sehlopha ba na le monyetla o fapaneng oa ho theola tsoekere e matla, e lokelang ho tsotelloa ha u khetha phekolo.
Ho sebelisana le lithethefatsi tse ling
Kotsi ea ho fokotseha ho hoholo hoa maemo a tsoekere ea mali e ntlafatsoa ke ho kopana ha sulfonylureas e nang le lithibela-mafu tse ngata, li-anticoagulants tse sa sebetseng, le li-agents tsa salicylic acid. Joala le bona bo ntlafatsa sephetho sa hypoglycemic.
Lithethefatsi tsa sehlopha ha li sebetse hantle ha li kopantsoe:
- ka li-thiazides;
- calcium antagonists
Glibenclamide
Moemeli oa moloko oa bobeli oa lithethefatsi. Mabitso a khoebo - Maninil, Euglyukan. Maninil e nkoa e le moemeli ea atlehang ka ho fetisisa oa hypoglycemic ea subgroup, leha ho le joalo, e na le litemoso tse ngata, li-contraindication ebile li ka baka litlamorao.
Ha e laeloe nts'etsopele ea nephropathy ea lefu la tsoekere, e nang le kotsi e kholo ea lefu la gallstone. Motsoako o ka khonehang le metformin.
Glimepiride
Moloko oa boraro oa lithethefatsi. Mabitso a khoebo - Glemaz, Amaril. Lithethefatsi tsa ka tlung ha li ame boima ba 'mele; li nooa hang ka letsatsi. Ka tšenyo e matla mesifa ea pelo, u ke ke ua fetisetsa mokuli ka ente ea insulin, hobane glimepiride ha e ame menyetla ea potasiamo ea lisele tsa pelo.
Gliclazide
Moemeli oa moloko oa bobeli oa lihlahisoa tsa sulfonylurea. Abela bakuli ba nang le tloaelo ea ho ba botenya. Moriana o na le "lefu le monate" ha ho na matšoao a kalafo. Mabitso a Khoebo:
- Diabetes;
- Diamicron;
- Dramion;
- Medoclazide.
Likhalefo
Lithethefatsi tsena tsa ho fokotsa tsoekere ea mali li nkuoa e le li-pancreatic insulin. Li nkuoa ka kotloloho ka nako ea lijo. Baemeli ba tummeng ka ho fetisisa sehlopheng ke Nateglinides, Repaglinides.
Palo ea moriana maling e nyoloha ha e kopantsoe le litlhare tse latelang:
- ka ketoconazole;
- Miconazole;
- Clarithromycin;
- Erythromycin;
- Gemfibrozil;
- Li-NSAID;
- beta blockers;
- li-salicylates.
Boemo ba ntho e sebetsang 'meleng bo fokotseha tlasa ts'usumetso ea barbiturates, carbamazepine.
NovoNorm - moemeli oa sehlopha sa letsopa
Li-glinids li laeloa bakeng sa kalafo ea lefu la tsoekere mellitus, eo ho eona ho nang le lipalo tse tloaelehileng tsa tsoekere pele li ja le tse phahameng ka mor'a ho ja lijo. Mekhoa ea kalafo e bontšoa ho bakuli ba tsofetseng, hammoho le ba nang le kotsi e kholo ea ho ba le boemo ba hypoglycemic. Li-glinides li loketse ho phekola bakuli ba nang le kutloelo-bohloko e eketsehileng ea motho ka mong ho tsoa ho sulfonylurea.
Litlamorao tse sa rateheng nakong ea kalafo:
- mafu a tšoaetsanoang a karolo e kaholimo ea phefumoloho;
- ho ruruha ha li-sinuses tsa paranasal;
- ho nyekeloa ke pelo, letšollo;
- bohloko bo kopaneng
- cephalgia;
- boima ba 'mele.
Thiazolidinediones
Baemeli ba sehlopha ba matlafatsa kutloisiso ea lisele tsa sethoathoa le lisele mohato oa "insulin" ea "hormone". Lithethefatsi tse tummeng ke Aktos, Avandia. Meriana ha e khone ho fokotsa glycemia feela, empa e boetse e tsosolosa metabolism ea lipid.
Ts'ebetsong ea bona, li-agents li tlase ho lihlopha tse ling tsa lithethefatsi tsa molomo tsa hypoglycemic. Ho feta moo, ho nka thiazolidinediones ho tsamaisana le keketseho ea boima ba 'mele oa mokuli. Ka lefu la pelo, lithethefatsi li hanyetsoa ka lebaka la bokhoni ba ho boloka mokelikeli 'meleng le ho baka ponahalo ea edema.
Basali ba lokela ho matlafatsa mehato ea ho thibela bokhachane, hobane lithethefatsi li ka tsosa ponahalo ea ovulation esita le nakong ea premenopause.
Lihlopha tsohle tse hlalositsoeng tsa meriana li lokela ho sebelisoa feela ka tlasa tlhokomelo ea setsebi se tšoanelehang. Morero oa mantlha ke ho fumana puseletso. Ho lekola khafetsa katleho ea kalafo ho u fa monyetla oa hore u hlahlobe mofuta oa kalafo ka nako le hore u khethe tse sebetsang hantle maemong a bongaka.
