Siv tau tshuaj zoo rau kev kho mob ntshav qab zib hom 2

Cov yam ntxwv ntawm muab tshuaj rau cov ntshav qab zib

Ua ntej tshaj plaws, kev xaiv yog muab rau cov tshuaj uas muaj qhov pheej hmoo tsawg kawg ntawm hypoglycemia: biguanides, gliptins, incretinsCov. Yog tias ib tus neeg muaj kev rog dhau los ntawm kev rog dhau thiab mob ntshav siab, ntau zuj zus ntxiv yog qhov zoo dua - lawv tuaj yeem txo qhov hnyav thiab tswj ntshav siab.

Cov txheej txheem ntawm kev teem caij ntawm biguanides: thawj koob tshuaj metformin yog 500 mg 2-3 zaug ib hnub tom qab noj mov. Cov koob tshuaj ntxiv no ua tau kwv yees li 2 lub lis piam tom qab pib kho mob. Qhov ntau kawg txhua hnub noj cov tshuaj no yuav tsum tsis pub tshaj 3000 mg. Kev maj mam nce zuj zus vim yog qhov muaj teeb meem tshwm sim ntawm txoj hnyuv huam tsawg dua.

Gliptins: tshuaj rau ntshav qab zib ntawm tiam tshiab no, tau noj 1 ntsiav tshuaj (25 mg) ib hnub twg, tsis hais txog ntawm cov zaub mov noj.

Kev ua txhaum: cov tshuaj ntawm cov pab pawg no tau hais nyob rau hauv daim ntawv ntawm cov kev daws rau kev txhaj tshuaj. Lawv muab rau 1 lossis 2 zaug nyob rau ib hnub, nyob ntawm ntau tiam.

Yog tias monotherapy muab cov txiaj ntsig tsis zoo, cov tshuaj sib txuas hauv qab no ntawm cov kab mob ntshav qab zib tau siv:

1. Metformin + Gliptins.
2. Incretins + metformin.
3. Metformin + sulfonylurea kev npaj.
4. Glinides + metformin.

Thawj ob qhov sib xyaw ua ke muaj kev pheej hmoo ntawm hypoglycemia, qhov hnyav rau lawv tseem ruaj khov.

Tswv yim ntawm prescribing sulfonylurea npaj: nws nyob ntawm lub sijhawm tsim tshuaj. Feem ntau siv tshuaj yeeb 1 zaug nyob rau ib hnub thaum sawv ntxov. Nrog rau qhov ua kom ntau ntxiv, muab cov hau kev tuaj yeem muab faib rau thaum sawv ntxov thiab yav tsaus ntuj.

Txheej txheem ntawm kev muab cov av nplaum: Ib qho tshwj xeeb ntawm kev siv cov tshuaj no yog cov tshuaj ntawm pawg neeg no tau faib tawm kom ua khoom noj thiab tau noj tam sim ntawd nyob rau hauv pem hauv ntej ntawm nws. Feem ntau cov ntsiav tshuaj tau noj 3 zaug ib hnub.

Alpha Glucosidase Cov Kws Tshuaj: qhov ua tau zoo ntawm kev siv tshuaj yog pom tsuas yog tias koj noj cov ntsiav tshuaj tam sim ntawd ua ntej noj mov. Thawj koob tshuaj 50 mg yog qaug cawv 3 zaug nyob rau ib hnub. Qhov nruab nrab cov tshuaj rau hauv txhua hnub yog 300 mg. Qhov siab tshaj plaws yog 200 mg 3 zaug ib hnub. Yog tias tsim nyog, nce cov koob tshuaj tom qab 4-8 lub lis piam.

Thiazolidinediones: Cov tshuaj yuav tau noj 1-2 zaug hauv ib hnub, nyob ntawm tiam. Lub sijhawm noj mov tsis cuam tshuam rau lawv qhov kev ua tau zoo. Yog tias tsim nyog, nce ntxiv rau qhov muab tshuaj, nws nce ntxiv tom qab 1-2 lub hlis.

Sau npe rau cov piam thaj txo cov tshuaj

Tus kws kho mob xaiv qee pawg ntawm cov tshuaj, suav txog tus yam ntxwv ntawm tus neeg: cov kab mob concomitant, muaj cov hnyav dua, muaj teeb meem nrog CVS, kev noj haus, thiab lwm yam.

Kev Loj Loj

Ntawm tag nrho cov tshuaj nyob hauv pab pawg no, methylbiguanide derivatives, metformin, tau txais koob meej tshaj plaws. Nws cov kev ua ntawm kev ua raws li qhov kev txo qis ntawm cov piam thaj hauv lub siab ua rau lub siab thiab txo qis hauv insulin los ntawm cov leeg nqaij thiab cov nqaij rog.

Lub hauv paus tseem ceeb ua ke yog metformin. Npaj raws nws:

• Merifatin;
• Formin ntev;
• Glyformin;
• Tsawv
• Glucophage;
• Siofor;
• Diaformin.

Cov txiaj ntsig tseem ceeb:

• tsis cuam tshuam lossis txo qhov hnyav lub cev;
• tuaj yeem ua ke nrog lwm cov ntsiav tshuaj ntawm cov tshuaj hypoglycemic;
• muaj kev pheej hmoo qog ntshav qab zib;
• tsis txhob txhim kho kev zais cia ntawm lawv tus kheej cov kua dej;
• txo txoj kev pheej hmoo ntawm qee yam kab mob plawv;
• Txo lossis tiv thaiv kev txhim kho mob ntshav qab zib hauv cov neeg tsis txaus metabolism metabolism;
• nqi.

Qhov tsis zoo:

• feem ntau ua rau muaj kev phiv los ntawm cov hnyuv hauv plab, yog li ntawd, tau sau tseg ua ntej rau cov koob tshuaj qis;
• tej zaum yuav ua rau lactic acidosis.

Cov Tshuaj Tiv Thaiv:

• Kev ua raws li kev noj zaub mov kom tsawg-tsawg calories (tsawg dua 1000 kcal tauj ib hnub).
• Kev tsis haum tshuaj rau ib qho ntawm cov khoom siv.
• Cov teeb meem mob siab, nrog rau kev quav dej quav cawv.
• Cov mob tsis zoo ntawm lub raum thiab lub plawv tsis ua haujlwm.
• Lub sijhawm cev xeeb tub.
• Cov menyuam yaus hnub nyoog txog 10 xyoo.

Sulfonylureas

Lub tswv yim tseem ceeb ntawm kev ua yog txhawb kev ua kom zais ntawm ib tus kheej cov insulin. Qhov tseem ceeb tshuaj thiab cov tshuaj rau ntshav qab zib hom 2 no yog:

1. GliclazideCov. Cov npe ua lag luam: Golda MV, Gliclad, Diabetalong, Glidiab. Liajntsum MV, Diabefarm, Diabinax.
2. Glimepiride: Instolit, Glaim, Diamerid, Amaril, Meglimid.
3. Glycidone: Yuglin, Glurenorm.
4. Glipizide: Glibenez rov qab los.
5. Glibenclamide: Statiglin, Maninil, Glibeks, Glimidstad.

Qee cov tshuaj muaj nyob hauv daim ntawv ntev - xa mus rau MV (hloov kho tso tawm) lossis qeeb qeeb. Qhov no tau ua tiav los txhawm rau txo cov ntsiav tshuaj ib hnub. Piv txwv li, Glidiab MV muaj 30 mg ntawm cov tshuaj thiab noj ib zaug ib hnub, txawm tias cov koob tshuaj tau nce ntxiv, thiab ib txwm Glidiab - 80 mg, kev txais tos tau faib rau thaum sawv ntxov thiab yav tsaus ntuj.

Lub ntsiab zoo ntawm cov pab pawg yog:

• cov nyhuv ceev;
• txo qhov kev pheej hmoo ntawm vascular cov teeb meem ntshav qab zib hom 2;
• nqi.

Qhov tsis zoo:

• kev pheej hmoo ntawm kev txhim kho hypoglycemia;
• lub cev tau txais sai sai rau lawv - kev txhim kho;
• tej zaum kev nce hauv lub cev hnyav;
• tuaj yeem tsim kev phom sij rau teeb meem nrog cov hlab plawv.

Cov Tshuaj Tiv Thaiv:

• Ntshav Qab Zib Hom 1;
• cov menyuam hnub nyoog;
• lub sijhawm cev xeeb tub thiab lactation;
• kev fab tshuaj rau sulfonamides thiab sulfonylureas;
• lub plab zom mov;
• ketoacidosis, mob ntshav qab zib precoma thiab coma.

Kev tsis ntseeg

Qhov no yog lub npe tshwm sim rau cov tshuaj hormones uas txhawb kev tsim tawm hauv insulin. Cov no suav nrog glucagon-zoo li peptide-1 (GLP-1) thiab glucose-nyob insulinotropic polypeptide (HIP). Endogenous (muaj tswv) ntau ntxiv yog tsim tawm hauv cov zom zaub mov hauv cov lus teb rau cov khoom noj thiab ua kom nquag plias li ob peb feeb. Rau cov neeg muaj ntshav qab zib, exogenous (los ntawm sab nraud) incretins tau tsim, uas muaj kev ua haujlwm ntev dua.

Cov txheej txheem ntawm kev ua ntawm glucagon-zoo li peptide-1 receptor agonists:

• Cov kua nplaum-kev ua kom lub zog ntawm insulin.
• Tsawg cov glucagon tso pa tawm.
• Txo cov kua nplaum tawm ntau los ntawm nplooj siab.
• Cov zaub mov qog ua rau lub plab qeeb dua, uas ua rau kev noj zaub mov tsawg dua thiab poob phaus.

Cov tshuaj yeeb tshuaj thiab cov tshuaj uas cuam tshuam nrog cov teebmeem ntawm GLP-1:

1. Sab nrauv: Byeta.
2. Liraglutide: Victoza, Saxenda.

Qhov zoo:

• muaj cov tib yam li nws tus kheej GLP-1;
• tawm tsam keeb kwm ntawm daim ntawv thov, qhov txo qis hauv lub cev hnyav tshwm sim;
• glycated hemoglobin txo qis.

Qhov tsis zoo:

• tsis muaj cov qauv tshuaj, cov tshuaj siv txhaj tshuaj;
• kev pheej hmoo siab ntawm hypoglycemia;
• nquag muaj cov kev mob tshwm sim los ntawm txoj hnyuv plab hnyuv;
• nqi.

Cov Tshuaj Tiv Thaiv:

• Ntshav Qab Zib Hom 1;
• lub sijhawm cev xeeb tub thiab lactation;
• cov tib neeg tsis qaug rau ib qho twg;
• cov me nyuam muaj hnub nyoog.

Ciaj

Kev kawm, lawv hu ua IDPP-4 lossis hom 4 dipeptidyl peptidase inhibitors. Kuj zwm rau cov pab pawg ntawm incretins, tab sis lawv zoo dua. Lub tshuab ntawm kev txiav txim siab tau txiav txim siab los ntawm kev ua kom sai ntawm kev tsim nws tus kheej lub plab ua haujlwm, uas ua kom lub zog ntawm cov tshuaj insulin hauv cov txiav ua kab raws li cov concentration ntawm cov piam thaj. Lawv kuj muaj piam thaj ntau zuj zus vim cov piam thaj ntau zuj zus thiab cov piam thaj ntau zuj zus.

Muaj ob peb yam tshuaj thiab lawv tau npaj:

1. Sitagliptin: Januvius, Yasitara, Xelevia.
2. Vildagliptin: Galvus.
3. Saxagliptin: Onglisa.
4. Linagliptin: Trazenta.
5. Alogliptin: Vipidia.

Pros:

• tsis tshua muaj teeb meem ntawm lub qog ntshav qab zib;
• tsis cuam tshuam rau lub cev qhov hnyav;
• txhawb cov kev tsim dua tshiab ntawm cov ntaub so ntswg, uas tso cai rau ntshav qab zib kom muaj kev vam meej qeeb dua;
• muaj nyob hauv ntsiav tshuaj daim ntawv.

Cons:

• tsis muaj ntaub ntawv muaj kev nyab xeeb zoo rau kev siv mus sij hawm ntev;
• nqi.

Cov Tshuaj Tiv Thaiv:

1. Lub sijhawm ntawm cev xeeb tub thiab lactation.
2. Yam 1 ntshav qab zib.
3. Ntshav qab zib ketoacidosis.
4. Cov me nyuam lub hnub nyoog.

Alpha Glucosidase Inhibitors

Lub tswv yim tseem ceeb ntawm kev nqis tes ua yog ua kom qhov nqus ntawm carbohydrates hauv txoj hnyuv. Cov tshuaj yeeb dej caw rov qab ua kom qhov kev ua haujlwm ntawm cov enzymes ua lub luag haujlwm rau kev tawg ua kom tsis haum thiab oligosaccharides rau cov piam thaj thiab fructose hauv qhov lumen ntawm txoj hnyuv. Tsis tas li ntawd xwb, lawv tsis cuam tshuam rau lub hlwb pancreatic.

Pab pawg no suav nrog cov tshuaj acarbose, uas yog ib feem ntawm cov tshuaj Glucobay.

Pluses ntawm cov tshuaj:

• tsis cuam tshuam rau qhov hnyav ntxiv;
• Tsis tshua muaj kev pheej hmoo ntawm hypoglycemia;
• txo txoj kev pheej hmoo ntawm kev tsim mob ntshav qab zib hom 2 hauv cov neeg uas muaj kev tiv thaiv ntshav qab zib tsis txaus;
• txo txoj kev pheej hmoo ntawm cov mob plawv.

Cons:

• nquag muaj cov kev mob tshwm sim los ntawm txoj hnyuv plab hnyuv;
• qis dua kev ua tau zoo dua li lwm qhov kev tiv thaiv kab mob hauv qhov ncauj;
• nquag nkag - 3 zaug ib hnub.

Lub ntsiab contraindications:

1. Lub sijhawm ntawm cev xeeb tub thiab lactation.
2. Cov me nyuam lub hnub nyoog.
3. Kev tsis haum tshuaj rau ib qho twg ntawm cov tshuaj.
4. Mob plab hnyuv.
5. Cov qauv mob raum tsis ua haujlwm.

Glinids

Lub tshuab tseem ceeb ntawm kev nqis tes yog qhov ua kom muaj zog hauv insulin ntau lawm. Tsis zoo li lwm pab pawg pharmacological, lawv ua rau muaj kev nce siab ntxiv cov tshuaj insulin nyob rau hauv thawj 15 feeb tom qab noj mov, vim tias “cov peaks” hauv cov ntshav qabzib tau txo qis. Qhov concentration ntawm cov tshuaj hormones nws tus kheej rov qab rau nws cov nqi qub 3-4 teev tom qab kawg koob tshuaj.

Cov tshuaj thiab cov yeeb tshuaj tseem ceeb yog:

1. Cov Duab Tsim Tshuaj LiabCov. Cov npe ua lag luam: Iglinid, Diclinid, NovoNorm.
2. Kev Tshawb Fawb: Starlix.

Pab Pawg:

• kev ceev ntawm kev ua thaum pib kho;
• cov kev siv tau los ntawm cov neeg uas muaj kev noj zaub mov tsis xwm yeem;
• kev tswj ntawm postprandial hyperglycemia - thaum cov ntshav qab zib cov ntshav nce siab tom qab ib pluas noj mus rau 10 mmol / l lossis ntau dua.

Qhov tsis zoo:

• hnyav;
• kev nyab xeeb ntawm cov tshuaj tsis paub tseeb nrog kev siv lub sijhawm ntev;
• qhov ntau zaus ntawm kev siv yog sib npaug nrog cov khoom noj;
• nqi.

Cov Tshuaj Tiv Thaiv:

• cov menyuam yaus thiab hnub nyoog laus;
• lub sijhawm cev xeeb tub thiab pub niam mis;
• Ntshav Qab Zib Hom 1;
• mob ketoacidosis.

Thiazolidinediones

Lawv lwm lub npe yog glitazone. Lawv yog ib pab pawg ntawm cov neeg muaj qhov tsis haum - lawv nce qhov yooj yim ntawm cov ntaub so ntswg mus rau insulin, uas yog, txo cov tshuaj insulin tsis kam. Tus txheej txheem ntawm kev nqis tes ua yog txhawm rau txhawm rau siv cov piam thaj hauv siab. Tsis zoo li sulfonylurea derivatives, cov tshuaj no tsis txhawb qhov tsim tawm ntawm pancreatic beta hlwb los ntawm insulin.

Qhov tseem ceeb tshuaj thiab lawv cov kev npaj yog:

1. PioglitazoneCov. Cov npe kev lag luam: Pioglar, Diab-Norm, Amalvia, Diaglitazone, Astrozone, Pioglit.
2. Rosiglitazone: Avandia.

Cov txiaj ntsig sib xws:

• txo kev pheej hmoo ntawm kev mob macrovascular;
• tsis tshua muaj teeb meem ntawm lub qog ntshav qab zib;
• kev tiv thaiv zoo tiv thaiv beta hlwb ntawm cov txiav;
• txo cov kev pheej hmoo ntawm kev tsim mob ntshav qab zib hom 2 hauv cov neeg kis rau nws;
• qhov txo qis hauv triglycerides thiab nce ntxiv hauv lipoproteins ntau ntom hauv cov ntshav.

Qhov tsis zoo:

• hnyav;
• o ntawm qhov kawg feem ntau tshwm sim;
• kev pheej hmoo ntawm kev tawg ntawm cov leeg pob txha hauv cov poj niam nce;
• cov nyhuv loj hlob qeeb;
• nqi.

Cov Tshuaj Tiv Thaiv:

• daim siab mob
• Ntshav Qab Zib Hom 1;
• mob ketoacidosis;
• lub sijhawm cev xeeb tub thiab pub niam mis;
• lub plawv dhia tsis zoo;
• cov menyuam hnub nyoog;
• edema ntawm tej keeb kwm.

Hom insulin ntshav qab zib hom 2

Lawv sim tsis txhob sau tshuaj rau insulin npaj mus rau qhov kawg - thaum xub thawj lawv tswj hwm hauv cov ntsiav tshuaj daim ntawv. Tab sis qee lub sijhawm cov tshuaj insulin los ua qhov tsim nyog txawm tias tau pib kho.

Kev Taw Qhia:

1. Thawj qhov kuaj pom tus mob ntshav qab zib hom 2, thaum glycated hemoglobin index yog 9% thiab cov tsos mob ntawm decompensation yog qhia.
2. Qhov tsis tshua muaj txiaj ntsig thaum sau tshuaj yuav tsum tau noj ntau npaum li cas ntawm cov ntawv ntim tshuaj uas muaj suab thaj.
3. Lub xub ntiag ntawm contraindications thiab tshaj tawm phiv los ntawm cov ntsiav tshuaj.
4. Ketoacidosis.
5. Kev txhais lus ib ntus yog ua tau thaum ib tus neeg tos kev phais lossis exacerbation ntawm qee cov kab mob ntev tau tshwm sim, nyob rau hauv uas decompensation ntawm carbohydrate metabolism yog ua tau.
6. Cev xeeb tub (hauv ntau kis).

Npaj rau kev tiv thaiv thiab kho mob ntawm cov teeb meem

Cov tshuaj muaj ntshav qab zib qis kom deb ntawm cov tib neeg mob ntshav qab zib xav tau. Muaj ntau ntau pab pawg ntawm cov tshuaj uas pab tswj kev noj qab haus huv, tiv thaiv cov teeb meem los ntawm cov ntshav qab zib 2, lossis kho cov uas twb muaj lawm. Yog tsis muaj cov tshuaj no, lub neej zoo tuaj yeem ua rau tsis muaj kev cuam tshuam.

Cov tshuaj antihypertensive

Tawg ua ke nrog ntshav qab zib ua ib qho sib xyaw ua ke - qhov kev pheej hmoo ntawm lub plawv nres, cwj nrag, dig muag thiab lwm yam teeb meem txaus ntshai ntxiv. Txhawm rau txo qhov ntxim nyiam ntawm lawv txoj kev loj hlob, cov neeg mob ntshav qab zib tau raug yuam ua tib zoo saib xyuas lawv lub siab ntau dua li lwm tus.

Cov pab pawg tiv thaiv zoo nkauj:

1. Cov calcium blockers.
2. ACE inhibitors.
3. Kev tshuaj ntsuab.
4. Beta blockers.
5. Angiotensin-II receptor blockers.

Feem ntau, muaj ntshav qab zib hom 2, ACE inhibitors yog tus kws kho mob tau sau tseg. Pawg no suav nrog:

• Burlipril;
• Diroton;
• Captopril;
• Zokardis;
• Amprilan.

Statins

Lawv yog cov pab pawg ntawm cov tshuaj uas pab txo qis lipoproteins thiab cov ntshav hauv cov ntshav qis. Muaj ntau ntau tiam neeg ntawm statins:

1. Lovastatin, Simvastatin, Pravastatin.
2. Fluvastatin
3. Atorvastatin.
4. Pitavastatin, Rosuvastatin.

Cov tshuaj uas nws cov tshuaj nquag yog atorvastatin:

• Liprimar;
• Torvacard
• Atoris.

Raws li rosuvastatin:

• Neeg Coob
• Roxer;
• Rosucard.

Zoo tshwm sim ntawm statins:

• Cov kev tiv thaiv ntawm cov ntshav txhaws.
• Txhim kho qhov mob ntawm lub puab sab hauv cov hlab ntshav.
• Txoj kev pheej hmoo ntawm kev tsim mob ischemic muaj teeb meem, myocardial infarction, mob stroke thiab tuag vim lawv tau txo.

Alpha Lipoic (Thioctic) Acid

Nws yog cov neeg ua haujlwm zom zaubmov thiab cov tshuaj tua kabmob muaj zog. Nws siv los tswj cov lipid thiab carbohydrate metabolism, txhawb cov metabolism hauv roj. Cov tshuaj pab txo qis cov ntshav qabzib hauv cov ntshav, nce glycogen hauv daim siab thiab kov yeej cov tshuaj insulin.

Tshuaj raws nws nws muaj cov kev xav zoo hauv qab no:

1. Hepatoprotective.
2. Kev Hypolipidemic.
3. Hypocholesterolemic.
4. Kev tua ntshav.
5. Puag ntawm neurons txhim kho.

Thioctic acid-based tshuaj muaj nyob hauv kev sib txawv thiab cov ntawv tso tawm. Qee cov npe lag luam:

• Berlition;
• Thiogamma;
• Tiolepta;
• Oktolipen.

Tus neeg mob ntshav qab zib noj cov tshuaj no rau polyneuropathy - ploj ntawm qhov rhiab vim qhov ua rau cov leeg puas tsuaj, feem ntau hauv ob txhais ceg.

Neuroprotectors

Neuroprotectors yog kev sib koom ua ke ntawm ntau pab pawg ntawm cov tshuaj yeeb dej caw, lub hom phiaj yog los tiv thaiv lub hlwb neurons los ntawm kev puas tsuaj, lawv tseem muaj peev xwm muaj kev cuam tshuam zoo rau cov metabolism, txhim kho lub zog muab ntawm cov hlab ntsha hlwb thiab tiv thaiv lawv los ntawm kev tawm tsam.

Hom ntawm neuroprotectors:

1. Kev Nootropics.
2. Antioxidants.
3. Adaptogens.
4. Cov khoom seem ntawm cov nroj tsuag keeb kwm.

Cov tshuaj ntawm cov pab pawg no yog siv los ntawm cov neeg muaj ntshav qab zib hom 2, uas yog leej twg muaj ntshav qab zib lossis hypoglycemic encephalopathy raug kuaj pom. Cov kab mob tshwm sim vim cov khoom noj hauv lub cev thiab cov ntshav khiav tsis zoo vim cov ntshav qab zib.