Nakong ea kalafo ea lefu la tsoekere, meriana e mengata e laetsoe ho theola tsoekere e maling.
Tsena li kenyelletsa lithethefatsi ho eketsa kutloisiso ea lithane ho insulin, ho ntlafatsa secretion ea li-hormone. Mekhoa e boetse e sebelisetsoa ho sitisa ho kenngoa ha lik'habohaedreite ka mpeng.
Meriana e eketsang secretion ea insulin
Lithethefatsi tse pharalletseng tse tsosang secretion ea insulin. Lithethefatsi tse joalo li kenyelletsa lithethefatsi tse tsoang sehlopheng sa sulfonylurea le meglitinides.
Sulfonylureas
Hona ke sehlopha sa meriana ea maiketsetso e theolelang glucose ea mali. Lithethefatsi tsa sehlopha sena li kenya lisele tsa pancreatic, tse eketsang tlhahiso ea insulin ke 'mele. Bakeng sa sena, lisele tse phetseng hantle tsa beta li tlameha ho ba teng gland.
Ketso ea lithethefatsi ke keketseho ea secretion ea li-hormone le tlhahiso e potlakileng ea tsoekere maling, ho hlohlelletsa lisele tsa β-khatello, khatello ea glucagon, ketosis le secattion ea somatostatin.
Liphetho tsa sulfonylureas li arotsoe ka lihlopha tse peli: ketso e telele le e mahareng. Liphetho tsa secretion ea lihormone tse ntlafatsang li ipapisitse le litekanyetso ha li nkuoa.
Meriana e etselitsoe ho phekola lefu la tsoekere la mofuta oa 2; ha le sebelisetsoe kalafo ea lefu la tsoekere la mofuta oa 1. Khethiloe ka ho fokotseha ha menyetla ea ho qoelisoa ha lisele tsa mmele ho ea ho hormone. E fumaneha ka foromo ea letlapa.
Li-derivatives tsa Sulfonylurea li emeloa ke meloko e 'meli ea lithethefatsi
:
- Butamide, Chlorpropamide. Lithethefatsi li laetsoe ka tekanyetso e kholo mme li bonts'a phello e khutšoane.
- Glipizide, Glibenclamide, Glycvidone. Li na le phello e telele hape li fanoa ka tekanyetso e tlase.
Contraindication e kenyelletsa:
- phokolo ea mali
- lefu la tsoekere la ketoacidosis;
- ho se sebetse ha liphio;
- ts'ebetso ea tšoaetso e mpe;
- moimana, ho lactation;
- ho se sebetse ha sebete;
- pele / ka mora ts'ebetso;
- leukopenia;
- thrombocytopenia;
- mathata a dyspeptic;
- ka seoelo hepatitis;
- boima ba 'mele.
Liphello tse bohloko li bonoa:
- sebopeho sa tatso ea tšepe e molomong;
- ho se sebetse hantle ha sebete;
- lipontšo tsa mmele
- mosebetsi o sa sebetseng oa renal.
Ketsahalo e mpe e atileng haholo ke hypoglycemia.
Meglitinides
Sehlopha sa lithethefatsi tse eketsang secretion ea insulin. Ke bona ba laolang primial glycemia - ba fokotsa tsoekere ka mor'a ho ja. Tšebeliso ea lithethefatsi ho lokisa tsoekere e potlakileng ha ea nepahala. Matšoao a ho amoheloa - DM 2.
Baemeli ba sehlopha sena ke Nateglinides, Repaglinides. Lithethefatsi li ama lisele tsa lisebelisoa tsa islet, li kenya ts'ebetsong sechuation ea insulin. Ho kenella ha hormone ho etsahala metsotso e 15 ka mor'a lijo. Litekanyetso tsa insulin tsa peak li bonoa kamora hora, ho fokotseha - kamora lihora tse 3.
Ho hlohlona ho etsahala ho ipapisitse le khatello ea tsoekere - maemong a tlase a lithethefatsi ka tekanyo e nyane li ama secretion ea hormone. Sena se hlalosa ho ba sieo ha hypoglycemia ha u sebelisa meriana.
E kopantsoe le li-anticiabetes tse ling. E ntlafalitsoe ka lipalo tse kholo, ke karolo ea 9% feela ka lipeo.
DM 1, ketoacidosis, ho ima le ho nyekeloa ke lisosa tse ka sehloohong tsa ho e nka. Ho lokela ho ba hlokolosi ha ho nooa meriana bakeng sa bakuli ba tsofetseng. Ho hlokahala hape ho ela hloko bakuli ba nang le mafu a sebete. Ho khothalletsoa ho beha lipontšo makhetlo a 'maloa ka selemo. Ho sheba selemong sa pele sa kalafo ho bohlokoa haholo.
Meglitinides ha e hloke khetho ea litekanyetso. Ho sebelisoa meriana ha ho jeoa. Boemo ba insulin ka mor'a lihora tse 3 bo khutlela ho boleng ba eona bo fetileng.
Har'a litla-morao tse boletsoeng:
- ho senyeha ha pono;
- mathata a ka mpeng;
- lipontšo tsa mmele
- ho eketseha ha lintlha tsa hepatic tlhahlobisong ea biochemical;
- ka seoelo - hypoglycemia.
Ha e khothalletsoe hore e sebelisoe maemong a latelang:
- Mofuta oa 1 lefu la tsoekere;
- ho ima le ho nyekeloa ke mpa;
- ho se mamelle lithethefatsi;
- lefu la tsoekere la ketoacidosis.
Motsoako o eketsang kutloisiso ea lithane ho insulin
Mofuteng oa 2 oa lefu la tsoekere, hangata ha ho hlokahale ho hlohlelletsa secretion ea insulin, hobane e hlahisoa ka bongata bo lekaneng. Hoa hlokahala ho eketsa kutloisiso ea lisele tsa mmele ho ea ho hormone, hobane ke tlolo ea ketso ea li-cell cell receptors tse tsosang keketseho ea tsoekere ea mali.
Biguanides
Biguanides - sehlopha sa lithethefatsi tse ntlafatsang kutloisiso ea lisele tsa mmele ho insulin. Li emeloa ke Buformin, Metformin, Fenformin.
Li fapana ka tekanyo e fapaneng, litla-morao, tekanyetso ea ho fumana sephetho sa kalafo. Hajoale ho sebelisoa Metformin feela.
Ha u sebelisa moriana, ho na le phokotseho ea khanyetso ea insulin. Ntho e sebetsang e thibela gluconeogeneis, e fetola ho monya ha tsoekere. Boemo ba "cholesterol e mpe" le triglycerides le bona bo fokotsehile. Li-Biguanides li kenngoa mohloling oa tšilo oa lijo, o hlahisoang haholo ke liphio, khatello e kholo e fihlella kamora lihora tse peli. Ho felisoa ha halofo ea bophelo ho fihla lihora tse 4,5.
Biguanides e fuoe mofuta oa lefu la tsoekere la mofuta oa 2 le lefu la tsoekere la 1 e le karolo ea kalafo e phethahetseng.
Baemeli ba sehlopha sa Biguanide ha ba sebelisetsoe:
- ho ima le ho nyekeloa ke mpa;
- ho se sebetse ha sebete;
- ho se sebetse ha liphio;
- mamello ho karolo e sebetsang;
- lefu la pelo;
- ts'ebetso ea ho ruruha ea methapo;
- ketoacidosis, lactic acidosis;
- ho hloleha ho phefumoloha.
Li-Biguanides ha li kopantsoe le joala. Ha ba abeloe matsatsi a 3 pele le matsatsi a 3 ka mor'a ho buuoa. Bakuli ba kaholimo ho lilemo tse 60 ba khothalletsoa ho nka meriana ka sehlopha sena ka hloko.
Litla-morao tsa ts'ebetso ea ho nka li kenyeletsa:
- anemia ea megaloblastic;
- gastrointestinal halefisoa, haholo, lets'ollo, ho hlatsa;
- acidosis.
Lethathamo la meriana ea sehlopha le kenyeletsa: Metfogamma, Metformin, Glukofazh, Adebit, Langerin, Siofor, Bagomet. Lithethefatsi li ka kopantsoe le lithethefatsi tse ling tsa glycemic.
Ha e kopantsoe le insulin, ho hlokahala tlhokomelo e khethehileng. Ts'ebetso ea liphio le matšoao a glucose e hlahlojoa. Ho lebisoa tlhokomelo e ikhethileng ho kopants'oa le lithethefatsi tse ling tse sa sebeliseng glycemic - tse ling li ka eketsa kapa tsa fokotsa litlamorao tsa lithethefatsi tsa sehlopha sa Biguanide.
Thiazolidinediones
Thiazolidinediones - sehlopha se secha sa lithethefatsi tse theolelang tsoekere bakeng sa tsamaiso ea molomo. Ha li hlahise secretion ea "insulin", empa li eketsa tsitsipano ea lisele tsa eona.
Ho na le 2 thiazolidinediones - pioglitazone (moloko oa bobeli) le rosiglitazone (moloko oa boraro). Troglitazone (moloko oa pele) o bonts'itse litla-morao tsa hepatotoxic le cardiotoxic, ke ka hona li ileng tsa emisoa. Meriana e ka sebelisoa hammoho le lithethefatsi tse ling kapa e le monotherapy.
Ka ho etsa lintho ka tishu, sebete, lithethefatsi li eketsa monyetla oa ho angoa ke lihormone. Ka lebaka leo, ts'ebetso ea tsoekere e ntlafatsoa ka ho eketseha ha sele. Matla a lithethefatsi a iponahatsa a le teng ha e-na le eona ea lihormone.
Ha e kenelle ka har'a tšilo ea lijo, e sibolotsoeng ke liphio, e kolobisitsoe ka har'a sebete. Khatello e kholo - kamora lihora tse 2,5. Phello e felletseng e hlaha kamora likhoeli tse 'maloa tsa ho nka moriana.
Lithethefatsi li fokotsa tsoekere hantle, li ama profil ea profid. Litlamorao ha li sebetse joaloka li-biguanides. M meriana eohle sehlopheng sena e eketsa boima ba 'mele. Sephetho se latela hore na u nkile kalafo hakae le hore na u natefeloa hakae. Ho boetse ho na le metsi a bolokang 'mele.
Nakong ea phekolo le thiazolidatediones, boemo bo sebetsang ba sebete bo hlahlojoa nako le nako. Haeba mokuli a le kotsing ea ho ba le ho nyekeloa ke pelo, joale kalafo ea thiazolidine ha e laeloe.
Maemong a joalo, ngaka e beha insulin, sulfonylureas, metformin.
Lithethefatsi tse thehiloeng ho Thiazolidinedione: Avandia, Aktos.
Contraindication:
- moimana, ho lactation;
- tlolo ea sebete;
- Mofuta oa 1 lefu la tsoekere;
- lilemo tse 18.
Litlamorao tse latelang li ile tsa bonoa ka tšebeliso ea meriana:
- boima ba mmele;
- kotsi e eketsehileng ea ho robeha ka lebaka la ho fokotseha ha methapo ea masapo;
- tlolo ea sebete;
- hepatitis;
- ho nyekeloa ke pelo;
- ho ruruha;
- eczema
Mokhoa oa ho monya mmele o ka mpeng oa carbohydrate
Li-inhibitors tsa Alpha glucosidase ke lithethefatsi tse sitisang ho kenngoa ha lik'habohaedreite ka mala. Li na le phello e eketsehileng ea endocrine kalafong ea lefu la tsoekere. Ama khahlano le tsoekere ka mor'a ho ja. Ka lebaka lena, nts'etsopele ea hypoglycemia e fokotsehile haholo.
Li-inhibitor tsa AG li sitisa ho phatloha ha lik'habohaedreite, ka lebaka leo ho amohuoa ha tsona ho fokotsoang butle. Ntho e sebetsang e baka litšitiso ho kenella ha lik'habohaedreite maling.
Li-inhibitors tsa Alpha glucosidase li sebelisoa haholo ha li kopana le li-glycemic agents le insulin. E khethiloe ho lefu la tsoekere la mofuta oa 2.
E hlahisoa ke Voglibosis, Acarbose, Miglitol. Hona joale ho sebelisoa meriana e 'meli ea ho qetela. Litlamorao tsa kliniki li tšoana, empa phello e fapana hanyane.
Acarbose inhibits lactose le amylase 'me ha e kenelle ka mpeng. E ka eketsa li-enzyme tsa sebete. Miglitol e boloka glycogeneis ka har'a sebete, e kenella ka mpeng. E ama ho amoheloa ha Glibenclamide le Metformin ntle le ponahatso ea bongaka.
Nakong ea ts'ebeliso ea meriana ea sehlopha sena se bonoa:
- Phokotso ea mathata a lefu la pelo le pelo;
- ho fokotsa tsoelo-pele ea atherosclerosis;
- mafu a ka mpeng a lefu la ka mpeng, haholo-holo lets'ollo le bohlasoa.
Contraindication bakeng sa ts'ebeliso:
- ulcerative colitis;
- lefu la tsoekere la ketoacidosis;
- boimana
- ho kenella ka mpeng;
- lebone
- ho se sebetse ha sebete;
- ho tiea ka mpeng;
- ho hloleha ha rems.
Litla-morao li bonahala haholo ho tsoa mpeng. Hona le lets'ollo, bohloko ba lehae, ho bata, le keketseho ea li-enzyme tsa sebete.
Ka tšebelisano ea li-inhibitors tsa khatello ea mali ka lithethefatsi tsa antidiabetic le insulin, phello ea eona e ka eketseha. Ho thibela phello ea hypoglycemic, litekanyetso li khethoa ka hloko.
Li-Sorbents, litokisetso tsa enzymatic li fokotsa tekanyo ea katleho ea Miglitol le Acarbose. Corticosteroids, niacin, diuretics, lihormone tsa qoqotho li fokotsa mosebetsi oa li-inhibitors tsa AH. Miglitol e fokotsa bioavailability ea Ranitidine, Digoxin.
Incretinomimetics
Li-insretin ke li-hormone tse khethehileng tse hlahisoang ka mor'a lijo. Ba theola ho se tšolohe ka mpeng, ho hlohlelletsa secretion ea "insulin", ho emisa secretion ea "glucagon" e feteletseng le ho fokotsa takatso ea lijo. Ho lefu la tsoekere, mesebetsi e joalo ea fokotseha, 'me litaba tsa lihormone ha li na thuso. Palo ea bona e khutlisoa ba sebelisa incretinomimetics. Li ntlafatsa phello ea kalafo 'me li thahasella bongaka.
Extcinomimetics e amana le metsoako ea liprotheine. Li emeloa ke lihlopha tse peli tsa lithethefatsi:
- Sehlopha sa 1 - Exenatide. Ke mofuta o tobileng oa "incretin" mimetic. Sena se kenyelletsa Baeta, Viktoza. Li sebelisoa e le liente tsa subcutaneous. Ho ntlafatsa phello, kopanya le lithethefatsi tse ling tsa glycemic.
- Sehlopha sa 2 - insulinotropic polypeptide. E hlahisoa ke meriana: Galvus, Januvius. Amanang le li-incretinomimetics tse sa tobang. Dipeptidyl peptidase, e bolang li-insretin, e thibetsoe. E abeloe ka thoko hape e kopane le meriana e meng.
Ntho ena e qala mochine oa tlhahiso ea li- hormone - li kena maling kapa kamora metsotso e seng mekae. Ho se tsejoe ho eketsehileng ho matlafatsa ho hlasimoloha ha lisele tsa pancreatic le palo ea lihomone tse hlahisoang. Ts'ebetso ea lithethefatsi e etsahala ka tekanyo e phahameng ea tsoekere, mme maemong a tlase, ketso e khaotsa.
Har'a lintho tse khahlanong le ho amoheloa ha molao:
- lefu la tsoekere la ketoacidosis;
- moimana, ho lactation;
- ho se sebetse ha liphio;
- LED 1;
- lilemo tse 18.
Har'a litla-morao nakong ea kalafo ho bonoe:
- karabelo ea mmele o mong le o mong;
- hlooho e bohloko
- ho nyekeloa ke pelo, ho hlatsa
- bofokoli, ho otsela.
Litlhare tsa sehlopha sa li-incretin mimetics li ka fanoa maemong a pele a ponahatso ea lefu lena. Li thusa ho boloka tšebetso ea sele ea beta. Ts'ebetsong ea kalafo ho batho ba tsofetseng, ho na le matšoao a nepahetseng. Nakong ea kalafo, lithethefatsi ho isa hanyane li ama nts'etsopele ea hypoglycemia.
Video ka lithethefatsi tse ncha tsa lefu la tsoekere:
Sehlopha se seng le se seng sa lithethefatsi se laetsoe ke ngaka ho latela setšoantšo sa kliniki le litšobotsi tsa thupelo ea lefu la tsoekere. Li ka sebelisoa hammoho ka kopanelo le joalo ka monotherapy. Nakong ea kalafo, ho khothalletsoa ho nka biochemistry ea mali ho lekola boemo ba litho tsa 'mele.
