Cov ntshav qab zib tsis yog-insulin-tiv thaiv ntshav qab zib yog ib qho ntawm cov qauv kab mob, yog tus cwj pwm los ntawm kev poob qis hauv lub hlwb thiab lub cev nqaij mus rau qhov kev ua ntawm cov tshuaj insulin. Qhov tshuaj yeeb dej caw no yog tsim tawm los ntawm lub hlwb ntawm cov cuab yeej tsis hais lub npe ntawm lub tsev txiav. Nws lub luag haujlwm yog thauj cov suab thaj hauv cov cell kom muab cov zog tom kawg.
Hauv cov ntshav ntawm ntshav qab zib hom 2, hyperglycemia yog cai - muaj qib siab zoo. Qhov tsos mob no yog xam tias yog ua thawj, nws yog nyob ntawm nws lub hauv paus uas kev kuaj mob tau lees paub. Txhawm rau tawm tsam cov lej glycemia siab, kev kho zaub mov noj (kho kom zoo), kev siv lub cev thiab tshuaj kho yog siv. Tsab xov xwm yuav hais txog qhov tshwj xeeb ntawm kev teem caij thiab kev tswj hwm tshuaj. Cov npe ntawm cov piam thaj txo cov tshuaj rau ntshav qab zib hom 2, qhov ntsuas pom ntawm kev siv thiab kev kho yog hais hauv qab no.
Cov hauv paus ntsiab lus ntawm kev kho tshuaj
Lub koom haum American Diabetes Association thiab European Association rau Kev Tshawb Nrhiav Kev Mob Ntshav Qab Zib tau taw qhia tias glycosylated hemoglobin raug suav tias yog yam tseem ceeb rau kev tshuaj xyuas tus neeg mob. Nrog rau daim duab saum toj no 6.9%, kev txiav txim siab cardinal yuav tsum ua raws li kev kho mob. Txawm li cas los xij, yog tias qhov no tsis hais txog txhua tus neeg mob, tab sis hais txog cov kev mob tshwj xeeb, nws yuav tsum ua kom ntseeg tau tias qhov ntsuas tsis dhau 6%.
Tam sim ntawd tom qab paub tseeb txog kev kuaj mob ntawm "tus kab mob qab zib" hom 2 (raws li cov ntshav qab zib hu ua hauv cov neeg ib txwm), cov kws kho mob endocrinologist tau sau ntawv rau Metformin. Cov yam ntxwv ntawm kev siv yeeb tshuaj yog tus cwj pwm raws li hauv qab no:
- cov tshuaj tsis pab txhawb rau qhov hnyav;
- muaj qhov tsawg kawg ntawm kev phiv;
- tsis ua rau muaj kev tawm tsam ntawm kev txo qis nyob rau hauv ntshav qab zib hauv ntshav qab zib;
- taw nyob rau hauv qhov tsis muaj contraindications;
- zoo zam txim los ntawm tus neeg mob;
- hais txog cov tshuaj uas tsis muaj nqi.
Endocrinologist - tus kws kho mob tshwj xeeb uas yuav pab kho tus neeg mob txog pathology
Tseem Ceeb! Cov kev kho mob ntxiv nrog rau cov ntsiav tshuaj qab zib muaj qhov raug kho twb tau dhau los ntawm kev kho mob nrog Metformin.
Hauv qab no yog cov pab pawg tseem ceeb ntawm cov tshuaj qab zib-txo cov tshuaj, lawv cov neeg sawv cev zoo, tshwj xeeb yog lub hom phiaj thiab kev tswj hwm.
Cov pawg tseem ceeb ntawm cov tshuaj
Niaj hnub nimno endocrinology siv 5 hom tshuaj rau cov ntshav qab zib kom ntshav qab zib. Lawv muab faib ua ob pawg loj:
- Cov kab mob ntshav qab zib qis (cov tshuaj uas ua kom cov ntshav qab zib ntau ntau). Lawv txhawb qhov tsim tawm ntawm cov tshuaj insulin endogenous, uas cuam tshuam rau tus neeg mob lub cev qhov hnyav (nce ntxiv), thiab tuaj yeem ua rau muaj qhov tsis txaus ntawm glycemia. Cov sawv cev yog sulfonylureas thiab clayides.
- Cov tshuaj antihyperglycemic (cov tshuaj uas tsis pub ua kom cov ntshav qab zib kom siab dua cov tshuaj uas tau tso cai). Cov neeg sawv cev ntawm pawg nce qab zib noj nyob rau hauv periphery, tab sis tsis muaj txoj hauv kev txhawb nqa kev ua pancreatic. Cov no suav nrog biguanides, alpha-glucosidase blockers thiab thiazolidinediones.
Cov lus: Cov sib piv ntawm cov tshuaj txo qis-ntsiab loj
| Cov pab pawg tshuaj | Cov kev ua si ntawm cov neeg sawv cev hauv kev kho mob monotherapy | Txij nkawm | Cov lus qhia rau kev teem caij |
| Alpha Glucosidase Inhibitors | Txo cov glycosylated hemoglobin los ntawm 0.7% | Tshem tawm kev nthuav qhia ntawm hyperglycemia tom qab noj mov | Glycemia tom qab noj mov nrog kua qab sai |
| Sulfonylureas | Txo glycosylated hemoglobin los ntawm 1.5% | Stimulates insulin ntau lawm | Tso rau hauv qhov tsis muaj pathological lub cev hnyav |
| Glinids | Zoo ib yam li alpha glucosidase inhibitors | Muab rau cov neeg mob uas tsis xav ua raws li kev kho kev noj haus | |
| Kev Loj Loj | Txo glycosylated hemoglobin los ntawm 1.7% | Nce insulin rhiab heev ntawm cov hlwb | Siab yoo qab zib nrog glycemia li qub tom qab noj mov |
| Thiazolidinediones | Txo cov glycosylated hemoglobin los ntawm 0.5-1.3% | Txhim kho insulin rhiab heev ntawm cov hlwb | Rau cov neeg mob lub cev nyhav |
| Cov tshuaj insulin | Tus neeg sawv cev uas tau txais txiaj ntsig zoo tshaj plaws, kho qhov ntsuas rau txhua qib uas xav tau | Tshem tawm cov insulin Qhov Tsis Txaus | Tso rau nrog decompensation, tsis muaj kev ua tau zoo ntawm lwm yam tshuaj rau kev kho mob ntawm poj niam cev xeeb tub |
Kev Loj Loj
Nyob rau theem tam sim no, feem ntau siv tshuaj ntawm cov pab pawg yog Metformin. Nws yog ib qho muaj vim muaj kev pheej hmoo qis ntawm cov kab mob lactic acidosis thaum lub sijhawm kho. Biguanides muaj peev xwm kho cov txheej txheem metabolic vim yog:
- qeeb tawm hauv gluconeogenesis (kev tsim cov piam thaj los ntawm lub siab los ntawm cov khoom uas tsis yog-carbohydrate);
- cov piam thaj ntau ntxiv los ntawm cov hlwb thiab cov nqaij;
- hloov pauv ntawm tus nqi ntawm kev nqus ntawm cov piam thaj hauv cov hnyuv.
Qhov zoo thiab qhov tsis zoo ntawm pawg
Biguanides txig txo cov suab thaj thiab glycosylated hemoglobin, me ntsis txo lub cev qhov hnyav, nres qhov qab plab. Cov tshuaj yog qhov zoo hauv qhov lawv tsis ua rau kev txhim kho thaum sawv ntxov hypoglycemia tiv thaiv kev tshaib plab thaum hmo ntuj.
Kev siv Metformin ntev ntev tau muaj txiaj ntsig zoo rau cov rog rog.Cov tshuaj Metformin tsis tsuas yog tsim kho kev rhuav tshem cov lipids, tab sis kuj tseem tiv thaiv qhov tsim ntawm adipose ntaub so ntswg. Biguanides kuj tseem pab tshem cov roj khov hauv lub cev, txo cov roj triglycerides thiab LDL. Muaj txiaj ntsig zoo rau kev muaj mob ntawm cov ntshav coagulation system.
Cov yam ntxwv khomob
Metformin tuaj yeem txo cov tshuaj glycemia thaum siv los kho kev kho mob lossis ua ke nrog kev siv tshuaj insulin, sulfonylureas. Cov peev txheej loj tsis kho mob raws li hais hauv qab no:
- lub sij hawm ua tes taw thiab lactation;
- mob ceev, nrog rau tsis nco qab;
- davhlau ya nyob twg theem ntawm raum thiab mob siab pathology;
- kev kis mob hnyav;
- tawm tsam keeb kwm ntawm kev noj zaub mov noj nrog lub calorie niaj hnub tsawg dua 1000 kcal;
- cov neeg mob uas lub cev tawm dag zog siab;
- cov neeg laus laus.
Alpha Glucosidase Inhibitors
Kev lag luam kws tshaj lij ntawm Lavxias niaj hnub muaj tsuas yog ib pawg tsim khoom. Qhov no yog Glucobai (cov tshuaj nquag yog acarbose). Cov tshuaj khi rau cov hnyuv enzymes, ua kom qeeb hauv cov txheej txheem ntawm kev faib thiab nqus ntawm saccharides. Qhov tshwm sim yog tiv thaiv qhov nce hauv qab zib tom qab zaub mov noj.
Hauv kev coj ua tiag, kev kho mob monotherapy nrog alpha-glucosidase inhibitors tau zoo tsuas yog pib kuaj mob ntshav qab zib. Ob pawg yog feem ntau ua ke: inhibitors + sulfonylureas, inhibitors + biguanides, inhibitors + insulin kho.
Cov chaw kuaj mob tau ua pov thawj tau txais txiaj ntsig ntawm kev siv Glucobay
Cov kev mob tshwm sim tseem ceeb ntawm Glucobai yog txuam nrog kev ua txhaum ntawm kev ua haujlwm ntawm lub xeev ntawm lub plab zom mov. Cov neeg mob muaj cov lus tsis txaus siab ntawm raws plab, tsam plab. Cov tshuaj tiv thaiv kom tsis txhob xaiv lub sijhawm tshuaj yog:
- diverticulitis;
- chim siab plob tsis so tswj syndrome;
- mob plab hlaub;
- Crohn's mob;
- muaj cov nplaum;
- hernia ntawm peritoneum.
Sulfonylureas
Cov sawv cev ntawm pab pawg no, txo cov ntshav qab zib, tau tshwm sim los ntawm kev muaj hmoo. Thaum pib, nws ntseeg tau tias cov tshuaj muaj cov tshuaj tua kab mob tshwj xeeb. Tom qab nrhiav pom lub peev xwm ntxiv ntawm cov pab pawg, cov kws tshawb fawb tau txhob txwm pib tshawb cov tshuaj uas muaj cov cim suab hypoglycemic. Qhov no tau tso cai siv cov neeg sawv cev rau kev kho mob ntshav qab zib hom 2.
Qhov kev txiav txim ntawm sulfonylurea derivatives yog raws li nram no:
Yam Tshuaj Tshiab Ntshav Qab Zib Tshiab 2- kev tsim kho ntawm cov khoom siv insular;
- rov qab ntawm kev nkag siab ntawm cov hlwb ntawm islets ntawm Langerhans-Sobolev;
- nce ntxiv nyob rau hauv tus naj npawb ntawm rhiab receptors nyob rau thaj chaw ntawm peripheral hlwb.
Qhov tsis zoo ntawm cov pab pawg yog tseem muaj peev xwm nce phaus thaum kho nrog cov neeg sawv cev ntawm pab pawg thib ob (piv txwv li, Maninil). Thaum siv tib txhais tau tias, cov txheej txheem ntawm cov hlab ntsha ntawm cov hlab ntsha puas tsuaj yog qhov hnyav dua, cov chav kawm ntawm lub plawv yuav ua rau muaj kev cov nyom ntau dua.
Cov kev txwv tsis pub siv rau cov tshuaj:
- insulin-tso ua daim ntawv ntawm "kab mob qab zib";
- lub sij hawm ua tes taw thiab lactation;
- lub xub ntiag ntawm nce tus neeg rhiab;
- mob hnyav ua mob hauv daim ntawv ntawm ketoacidotic, hyperosmolar xeev;
- cov thyroid pathology;
- qhov txo qis hauv cov qe ntshav dawb hauv cov ntshav qis dua li ib txwm.
Cov sawv cev ntawm cov pab pawg muaj txoj hauv kev sib txawv ntawm kev txhim kho qhov tseem ceeb txo cov piam thaj, uas yuav tsum txiav txim siab thaum xaiv kev kho mob.
Kev cuam tshuam nrog lwm yam tshuaj
Txoj kev pheej hmoo ntawm kev poob qis hauv cov ntshav qab zib kom zoo yog nce los ntawm kev sib xyaw ntawm sulfonylureas nrog cov naj npawb ntawm cov tshuaj tua kab mob, tsis ncaj rau anticoagulants, thiab cov tshuaj tiv thaiv salicylic acid. Cawv kuj ua rau cov nyhuv hypoglycemic zoo.
Cov tshuaj pab pawg ua tsis tau zoo thaum ua ke:
- nrog thiazides;
- calcium antagonists.
Glibenclamide
Tus sawv cev ntawm kev tsim tshuaj thib ob. Cov npe kev lag luam - Maninil, Euglyukan. Maninil tau suav hais tias yog qhov ua tau zoo tshaj plaws hypoglycemic tus neeg sawv cev ntawm pawg me, txawm li cas los xij, nws muaj tus lej ceeb toom, contraindications thiab tuaj yeem ua rau muaj kev mob tshwm sim.
Nws tsis yog qhov tsim tawm rau kev txhim kho ntawm nephropathy ntawm qhov muaj ntshav qab zib, nrog qhov muaj kev pheej hmoo siab ntawm tus mob gallstone. Muaj peev xwm ua ke nrog metformin.
Glimepiride
Lub cim thib peb ntawm cov tshuaj. Cov npe ua lag luam - Glemaz, Amaril. Pawg tshuaj tsis raug rau lub cev qhov hnyav; lawv raug noj ib hnub ib zaug. Hauv kev mob puas tsuaj rau lub plawv mob, koj tuaj yeem hloov tsis tau tus neeg mob rau kev txhaj tshuaj insulin, vim tias glimepiride tsis cuam tshuam cov potassium ntawm lub plawv.
Gliclazide
Tus sawv cev ntawm 2nd tiam ntawm sulfonylurea derivatives. Muab rau cov neeg mob uas lub siab nyiam rog. Cov tshuaj muaj txiaj ntsig zoo rau "mob qab zib" hauv qhov tsis muaj cov tsos mob hauv kev kho mob. Cov Npe Pauv:
- Ntshav Qab Zib;
- Pob Tsuas;
- Nquag;
- Medoclazide.
Glinids
Cov tshuaj no los txo cov ntshav qab zib yog suav tias yog tshuaj tua kab mob ua rau muaj ntshav qab zib. Lawv tau noj ncaj qha thaum lub sijhawm noj mov. Cov sawv cev nto moo tshaj plaws ntawm cov pab pawg yog Nateglinides, Repaglinides.
Tus nqi ntawm cov tshuaj hauv cov ntshav nce siab thaum ua ke nrog cov tshuaj hauv qab no:
- nrog ketoconazole;
- Miconazole;
- Clarithromycin;
- Erythromycin;
- Gemfibrozil;
- NSAIDs;
- beta blockers;
- salicylates.
Cov theem ntawm cov khoom muaj sia hauv lub cev txo qis hauv qab ntawm barbiturates, carbamazepine.
NovoNorm - tus neeg sawv cev ntawm pawg av nplaum
Glinids yog kho rau kev kho mob ntshav qab zib mellitus, nyob rau hauv uas muaj cov lej ntawm cov piam thaj ua ntej noj mov thiab siab dua tom qab noj zaub mov. Cov tshuaj kho tau qhia rau cov neeg mob laus, nrog rau cov neeg uas muaj kev pheej hmoo siab los ntawm lub siab ntshav qab zib. Glinides yog qhov zoo rau kev kho mob rau cov neeg mob uas muaj kev cuam tshuam ntau tus neeg los ntawm sulfonylurea derivatives.
Qhov tsis zoo xav tau thaum kho:
- kis kab mob ntawm cov mob ua pa sab saud;
- cov mob o ntawm txoj hlab ntshav khiav;
- tsam mob ntawm xeev siab, raws plab;
- mob tej pob txha
- cephalgia;
- hnyav.
Thiazolidinediones
Cov sawv cev ntawm cov pab pawg txhim kho qhov rhiab ntawm peripheral cov ntaub so ntswg thiab cov cell mus rau kev ua ntawm cov tshuaj insulin. Cov tshuaj uas nto moo yog Aktos, Avandia. Cov tshuaj tsis tuaj yeem tsuas yog txo cov glycemia, tab sis kuj tseem tuaj yeem kho cov lipid metabolism.
Hauv lawv cov kev ua ub no, cov neeg sawv cev tau qis dua lwm pab pawg ntawm qhov ncauj tshuaj hypoglycemic. Tsis tas li ntawd, noj thiazolidinediones yog nrog los ntawm kev nce hauv tus neeg mob lub cev hnyav. Nrog kev mob plawv pathology, cov tshuaj yog contraindicated vim tias muaj peev xwm los khaws cov dej hauv lub cev thiab ua rau pom qhov tsos ntawm edema.
Cov poj niam yuav tsum ua kom muaj zog ntsuas kom tiv thaiv tsis pub muaj menyuam, txij li cov tshuaj tuaj yeem txhawb qhov pom ntawm ovulation txawm tias lub sijhawm premenopause.
Txhua pawg tau piav qhia txog ntawm cov tshuaj yuav tsum tsuas yog siv los ntawm kev saib xyuas ntawm tus kws tshaj lij. Lub hom phiaj tseem ceeb yog ua tiav qhov them nyiaj. Kev tshuaj xyuas tas mus li ntawm qhov ua tau zoo ntawm kev kho mob tso cai rau koj los tshuaj lub sijhawm kho thiab xaiv qhov ua tau zoo tshaj plaws hauv qee kis tshwj xeeb.
