Cov tshuaj kho ntshav qab zib tshiab tshaj plaws uas pib tshwm sim xyoo 2000s yog cov tshuaj muaj zog ntxiv. Raug tsim, lawv raug tsim los txo cov ntshav qab zib tom qab noj nrog ntshav qab zib hom 2. Txawm li cas los xij, hauv lub peev xwm no lawv tsis tshua nyiam peb. Vim tias cov tshuaj no ua ntau txoj hauv kev zoo ib yam li Siofor (metformin), lossis tseem tsis tau muaj txiaj ntsig, txawm tias lawv kim heev. Lawv tuaj yeem tsim kho ntxiv rau Siofor, thaum nws qhov kev ua yog tsis txaus, thiab cov mob ntshav qab zib tsis xav pib txhaj tshuaj insulin.
Baeta thiab Viktoza cov tshuaj kho ntshav qab zib yog zwm rau pab pawg ntawm GLP-1 receptor agonists. Lawv yog qhov tseem ceeb hauv qhov lawv tsis tsuas yog txo cov ntshav qab zib tom qab noj mov, tab sis kuj txo qhov qab los noj mov. Thiab tag nrho cov no tsis muaj kev phiv tshwj xeeb.
Tus nqi tseem ceeb ntawm cov tshuaj ntshav qab zib hom 2 tshiab yog tias nws txo qis qab los noj mov thiab pab tswj hwm ntau dhau. Ua tsaug rau qhov no, nws yuav yooj yim rau cov neeg mob ua raws li cov zaub mov tsis muaj rog ntau thiab tiv thaiv kev ua kom tawg. Kev muab tshuaj tshiab rau ntshav qab zib kom txo qis qab los noj mov tseem tsis tau pom zoo. Ntxiv mus, lawv txoj kev sim tshuaj hauv kev sib xyaw ua ke nrog cov zaub mov uas tsis muaj carbohydrate ntau tsis tau ua. Txawm li cas los xij, kev coj ua tau pom tias cov tshuaj no pab tiag tiv nrog kev tswj tsis tau gluttony, thiab cov kev mob tshwm sim yog yam me.
Hom tshuaj twg haum rau txo qhov qab los noj mov
Ua ntej yuav hloov mus rau kev noj haus cov zaub mov uas tsis muaj carbohydrate, txhua tus neeg mob ntshav qab zib hom 2 tau mob ntxiv rau kev noj haus carbohydrates. Qhov no dependence manifests nws tus kheej nyob rau hauv daim ntawv ntawm tas mus li carbohydrate overeating thiab / lossis bouts ntawm monstrous gluttony. Ib yam li tus tib neeg muaj mob quav dej quav cawv, nws tuaj yeem "nyob hauv lub plhaw" thiab / lossis ib txwm sib tawg.
Cov neeg uas muaj rog rog thiab / lossis hom ntshav qab zib hom 2 tau hais tias lawv tsis qab los noj mov. Qhov tseeb, nws yog zaub mov carbohydrates los liam rau qhov tseeb tias cov neeg mob li no muaj kev noj kev tshaib plab. Thaum lawv hloov mus rau noj cov protein thiab cov rog zoo lub cev, lawv lub qab los feem ntau rov qab los rau hauv qub.
Kev noj zaub mov kom tsis txhob muaj cov carbohydrate ib leeg pab kwv yees li 50% ntawm cov neeg mob tiv nrog kev ua kom rog. Lwm cov neeg mob ntshav qab zib hom 2 xav tau kev ntsuas ntxiv. Cov tshuaj ntau ntxiv yog "thib peb ntawm kev tiv thaiv" pom zoo los ntawm Dr. Bernstein tom qab noj cov tshuaj chromium picolinate thiab ua kom pom tus kheej.
Cov tshuaj no suav nrog ob pawg tshuaj:
- DPP-4 inhibitors;
- GLP-1 receptor agonists.
Yuav siv cov tshuaj ntshav qab zib tshiab li cas?
Cov chaw soj ntsuam tau pom tias DPP-4 inhibitors thiab GLP-1 receptor agonists txo qis cov ntshav qab zib tom qab noj mov hauv cov neeg mob uas muaj ntshav qab zib hom 2. Qhov no yog vim tias lawv txhawb cov kua dej los ntawm cov hlab ntshav txiav los ntawm kab mob ntshav ntswg. Raws li kev siv lawv kev siv ua ke nrog kev noj haus "sib npaug", glycated hemoglobin txo los ntawm 0.5-1%. Tsis tas li, qee cov neeg koom kev ntsuam xyuas poob ceeb thawj me ntsis.
Qhov no tsis yog godsend qhov kev ua tiav yog dab tsi, vim tias qhov zoo qub Siofor (metformin) nyob rau hauv tib cov xwm txheej txo qis glycated hemoglobin los ntawm 0.8-1.2% thiab yeej pab kom yuag los ntawm ntau phaus. Txawm li cas los xij, nws tau pom zoo kom sau cov tshuaj muaj zog ntxiv rau cov tshuaj metformin ntxiv txhawm rau txhim kho nws cov nyhuv thiab ncua kev pib kho rau hom ntshav qab zib hom 2 nrog insulin.
Bernstein pom zoo tias cov neeg mob ntshav qab zib yuav tsum noj cov tshuaj no tsis yog kom noj cov insulin secretion, tab sis vim nws cov txiaj ntsig ua rau txo qis qab los noj mov. Lawv pab tswj kev txais zaub mov, ua kom nrawm ntawm qhov pib ntawm qhov lom zem. Vim tias qhov no, kis ntawm qhov ua tsis tau ntawm kev noj cov zaub mov uas tsis muaj carbohydrate hauv cov neeg mob tshwm sim ntau tsawg.
Bernstein sau ntawv ntxiv rau cov tshuaj incretin tsis yog rau cov neeg mob ntshav qab zib hom 2 nkaus xwb, tab sis rau cov neeg mob ntshav qab zib hom 1 uas muaj teeb meem dhau hwv. Tseem ceeb, cov tshuaj no tsis yog tsim rau hom neeg mob ntshav qab zib hom 1. Lus khaws xav Cov neeg mob uas muaj ntshav qab zib hom 1 uas tau muaj tus mob ntshav qabzib huam, xws li, ncua sij hawm nchuav tawm ntawm lub plab vim qhov ua tsis tau zoo ntawm cov hlab ntshav, yuav siv tsis tau cov tshuaj no. Vim tias nws yuav ua rau lawv haj yam tsis zoo.
Ua li cas cov tshuaj incretin ua hauj lwm?
Cov tshuaj incretin ua rau lub siab tsis zoo vim tias lawv ua kom qeeb ntawm lub plab tom qab noj mov. Qhov ua kom tshwm sim txuas ntxiv ntawm qhov no yog xeev siab. Txhawm rau txo qis tsis xis nyob, pib noj cov tshuaj nrog qhov tshuaj tsawg kawg nkaus. Maj mam nce nws thaum lub cev yoog. Sijhawm dhau sijhawm, xeev siab poob rau hauv cov neeg mob feem ntau. Raws li kev xav, muaj lwm cov kev mob tshwm sim - ntuav, mob plab, cem quav lossis zawv plab. Dr. Bernstein sau tseg tias hauv kev coj ua lawv tsis pom.
DPP-4 cov tshuaj tiv thaiv muaj nyob rau hauv cov ntsiav tshuaj, thiab GLP-1 receptor agonists nyob rau hauv daim ntawv ntawm kev daws rau kev tswj hwm subcutaneous hauv cartridges. Hmoov tsis zoo, cov tshuaj hauv cov tshuaj tsis pab tswj kev qab los noj mov, thiab cov ntshav qab zib kom tsawg me ntsis. Ua tau agonists ntawm GLP-1 receptors txoj cai. Lawv hu ua Baeta thiab Viktoza. Lawv yuav tsum tau txhaj tshuaj, yuav luag zoo li cov tshuaj insulin, ib zaug lossis ob peb zaug ib hnub. Cov txheej txheem kev txhaj tshuaj tsis zoo tib yam yog tsim nyog rau kev txhaj tshuaj insulin.
GLP-1 receptor agonists
GLP-1 (glucagon-zoo li peptide-1) yog ib qho ntawm cov tshuaj hormones uas tsim tawm hauv lub plab zom mov hauv kev teb rau kev noj zaub mov. Nws teeb liab rau cov txiav ua kab tias nws yog lub sijhawm los tsim cov tshuaj insulin. Qhov tshuaj hormones no tseem ua rau lub plab zom mov thiab ua rau lub siab tsis qab. Nws kuj tseem pom zoo tias nws txhawb cov kev rov qab ntawm pancreatic beta hlwb.
Lub ntuj tib neeg glucagon-zoo li peptide-1 tau rhuav tshem hauv lub cev 2 feeb tom qab ua ke. Nws yog tsim raws li xav tau thiab ua sai sai. Nws cov tshuaj tiv thaiv hluavtaws yog Bayeta (exenatide) thiab Viktoza (liraglutide) tshuaj. Lawv tseem muaj nyob rau hauv cov qauv kev txhaj tshuaj. Baeta siv tau rau ntau teev, thiab Viktoza - txhua hnub.
Baeta (Exenatide)
Cov neeg tsim khoom ntawm cov tshuaj Baeta pom zoo kom txhaj ib teev rau ib teev ua ntej noj tshais, thiab lwm qhov ntxiv thaum yav tsaus ntuj, ib teev ua ntej noj hmo. Dr. Bernstein pom zoo kom ua yam ntxwv txawv - txhawm rau Bayete 1-2 teev ua ntej lub sijhawm thaum tus neeg mob feem ntau ua haujlwm lossis sib ntau dua ntawm gluttony. Yog tias koj noj ntau tshaj ib zaug hauv ib hnub, nws txhais tau hais tias nws yuav txaus rau Bayet los txhaj ib zaug ib koob 5 lossis 10 micrograms. Yog tias qhov teeb meem ntawm kev noj qab haus huv ntau tshwm sim ntau zaus thaum nruab hnub, tom qab ntawd hno txhua zaus ib teev ua ntej qhov xwm txheej tshwm sim, thaum koj cia koj tus kheej noj ntau dhau.
Yog li, lub sijhawm tsim nyog rau kev txhaj tshuaj thiab kev noj tshuaj yog tsim los ntawm kev sim thiab yuam kev. Raws li txoj kev xav, qhov siab tshaj plaws txhua hnub ntawm Baeta yog 20 mcg, tab sis cov neeg muaj rog rog hnyav yuav xav tau ntau dua. Tawm tsam keeb kwm ntawm Bayeta txoj kev kho mob, cov koob tshuaj insulin lossis ntshav qab zib ua ntej noj mov tuaj yeem raug txo tam sim ntawd 20%. Tom qab ntawv, raws li cov txiaj ntsig ntawm kev ntsuas ntshav qab zib, saib seb koj puas tseem yuav tau txo nws qis lossis hloov lwm qhov ntxiv rau nws.
Victoza (liraglutide)
Cov tshuaj Viktoza tau pib siv nyob rau xyoo 2010. Nws kev txhaj tshuaj yuav tsum tau ua 1 zaug hauv ib hnub. Kev txhaj tshuaj nyob ntev li 24 teev, raws li cov chaw tsim khoom tau thov. Koj tuaj yeem ua nws thaum lub sijhawm yooj yim thaum nruab hnub. Tab sis yog tias koj feem ntau muaj teeb meem nrog kev yaum tib lub sijhawm, piv txwv li, ua ntej noj su, tom qab ntawd hu rau Victoza 1-2 teev ua ntej noj su.
Bernstein xav txog Victoza ib qho tshuaj muaj txiaj ntsig zoo los tswj kev qab los noj mov, tiv dhau lub luag haujlwm thiab kov yeej kev zom zaub mov kom ntau. Nws zoo dua rau ntawm Baeta, thiab nws yooj yim dua rau siv.
DPP-4 cov tshuaj tiv thaiv
DPP-4 yog dipeptyl peptidase-4, ib qho enzyme uas txav GLP-1 hauv tib neeg lub cev. DPP-4 inhibitors inhibit tus txheej txheem no. Txog rau hnub no, cov tshuaj hauv qab no zwm rau hauv pab pawg no:
- Januvia (sitagliptin);
- Onglisa (saxagliptin);
- Galvus (vidlagliptin).
Tag nrho cov no yog cov tshuaj hauv cov ntsiav tshuaj, uas tau pom zoo kom noj 1 zaug nyob rau ib hnub. Kuj tseem muaj cov tshuaj Tradent (linagliptin), uas tsis muag hauv cov tebchaws Lavxias.
Dr. Bernstein sau tseg tias DPP-4 cov tshuaj tiv thaiv kab mob yuav luag tsis muaj feem cuam tshuam rau qhov qab los noj mov, thiab tseem txo qis cov ntshav qab zib tom qab noj mov tas. Nws sau cov tshuaj no rau cov neeg mob ntshav qab zib hom 2 uas twb tau noj cov tshuaj metformin thiab pioglitazone, tab sis tsis tuaj yeem mus txog rau cov ntshav qab zib thiab tsis kam kho mob nrog insulin. DPP-4 inhibitors hauv qhov xwm txheej no tsis muaj kev hloov pauv txaus rau insulin, tab sis qhov no zoo dua tsis muaj dab tsi. Phiv los ntawm kev noj lawv xyaum tsis tshwm sim.
Phiv cov tshuaj uas siv los txo cov qab los noj mov
Cov kev tshawb fawb tsiaj tau pom tias kev noj cov tshuaj incretin-yam ua rau muaj kev rov qab ib nrab ntawm lawv cov hlwb pancreatic. Nws tseem tsis tau txiav txim tias tib yam tshwm sim rau tib neeg. Cov kev tshawb fawb tib tsiaj pom tias kev tshwm sim ntawm ib qho tsawg kawg ntawm cov qog ntshav qog ntshav siab tau nce me ntsis. Ntawm qhov tod tes, cov ntshav qab zib cov ntshav siab yuav ua rau muaj kev phom sij ntawm 24 ntau yam mob qog nqaij hlav. Yog li cov txiaj ntsig zoo ntawm cov tshuaj tau meej meej dua li qhov phom sij muaj peev xwm.
Nrog rau kev noj cov tshuaj ntxiv, ntxiv kev pheej hmoo ntawm tus mob ntxiv - ua rau tus mob leeg qhuav - tau sau tseg rau cov neeg uas yav dhau los muaj teeb meem ntawm tus txiav ua leeg. Qhov kev pheej hmoo no pheej hmoo, ua ntej tshaj plaws, cawv cawv. Cov seem ntawm cov ntshav qab zib tsis yog tsim nyog kev ntshai.
Ib qho cim ntawm pancreatitis yog ib qho kev npaj txhij txog thiab mob plab. Yog tias koj xav tias nws, sab laj nrog tus kws kho mob tam sim ntawd. Nws yuav ua pov thawj lossis rov ua kom pom tus mob ntawm pancreatitis. Nyob rau hauv txhua rooj plaub, tam sim ntawd tsum tsis txhob noj tshuaj nrog kev ua si ntxiv kom txog thaum txhua yam muaj tseeb.
