Me kahi papa lōʻihi o ka maʻi, pono nā mea maʻi e lawe i nā lāʻau lapaʻau no ka maʻi type type 2 o ka hanauna hou. I ka hoʻomaka, hiki ke mālama ʻia ka "maʻi ʻala" ma o ka hoʻopili ʻana i ka meaʻai kūpono a me ke ola ʻana i ke ola, akā ke lōʻihi o ka manawa, hoʻohana ʻia nā hana o ka pancreas a me nā hoʻohaʻa ʻana i ke kō.
Nui nā keu o lākou i ke kūʻai aku i ka lāʻau lapaʻau, akā ʻo wai ka mea i loaʻa i ka hopena therapeutic loa?
He mea paʻakikī loa e pane i ka nīnau, no ka mea, he kūpono paha lākou no ka mea maʻi hoʻokahi, akā ʻaʻole kūpono no kekahi. No laila, i kēia ʻatikala, e hōʻike ʻia ka hopena o nā ʻano o nā mea lapaʻau nui.
Nā ʻano maʻi 2 like me nā maʻi maʻi
Ua kapa ʻia nā maʻi maʻi diabetes like 2 ke kūʻokoʻa, no ka mea me ka hoʻomohala ʻana o ka maʻi, he ʻano haʻahaʻa e hoʻemi ai i ka hilahila e ka pancreas. Loaʻa ka pilikia holoʻokoʻa i ka hoʻomaopopo ʻana o ka insulin e nā cell peripheral i hana ʻia ka hana o ka receptor. Kūkulu ʻia kēia ʻano neʻe i ka hanauna kahiko mai ka makahiki he 40, ʻo ia hoʻi i ka poʻe me ka momona nui a me ka hoʻoilina.
I kēia mau lā, ke kūkulu ʻia nei nā lāʻau hou i loko o ka honua e kōkua i ka hoʻoneʻe maʻamau i ka glucose a hoʻomaha i ka mea hoʻomanawanui i nā hōʻailona maʻi maʻi. Aia ma lalo kahi papa inoa o nā ʻano lāʻau nui:
- ʻO ka hoʻonui ʻana i ka hikiwawe o nā selela i ka hormone: thiazolidinediones (Diaglitazone, Pioglar), biguanides (Metformin, Glucofage).
- ʻO nā lāʻau hou hou i hoʻomaka e hana ʻia i nā 2000s: DPP-4 inhibitors (Januvia, Onglisa), GLP-1 receptor agonists (Baeta, Victoza), alpha-glucosidase inhibitors (Glucobai).
- ʻO ka hoʻouluʻana i ka hana insulin: ka deronoma o ka sulfonylurea (Maninil, Glyurenorm, Diabeton), meglitinides (Starlix, Novonorm).
Pono e hōʻike ʻia e pili pono ka derogative sulfonylurea a me meglitinides i ka pancreas, hoʻoheheʻe ʻia. I ka poʻe maʻi e lawe ana i kēlā mau lāʻau lapaʻau, aia ka hopena o kahi hoʻololi o ka lua o ka ʻano o ka maʻi i ka mea mua.
Pili nā lāʻau āpau i luna aʻe e pili ana i ka hanauna hou o nā lāʻau lapaʻau a ua hoʻohana ʻia no ka mālama ʻana i ka maʻi maʻi type 2.
ʻO kēlā me kēia mau ko lākou mau hiʻohiʻona, nā pono a me nā hemahema, e hōʻike ʻia ana ma hope.
Nā hiʻohiʻona o ka maʻi maʻi
Ma hope o ka ʻike ʻana o ke kanaka iā ia iho i ʻelua mau ʻano nui o ka maʻi - i ʻole ka make wai ʻole a me ka urination pinepine, e huli ʻo ia i kahi nīnau lapaʻau e kuhikuhi iā ia i kahi maʻi kūpono.
Ke hoʻokaʻawale nei i ka hōʻike, ua huki a kulu ʻia ka mana veous a, i loaʻa ka hopena iʻoi aku ma mua o nā palena palena o 5.5 a me 6.1 mmol / L, kahi ma ia manawa, hiki iā mākou ke kamaʻilio e pili ana i ka hiki ʻana o ka prediabetes a maʻi paha.
A laila, i mea e hoʻoholo ai i ke ʻano o nā patologi, e hana ʻia ana kahi hōʻike ma ka pae o C-peptide a me GAD antibodies. Inā loaʻa i ka mea maʻi ka lua o ke ʻano o ka maʻi maʻi, hoʻomohala ʻia ke kauka komo i kahi lāʻau lapaʻau e pili ana:
- mea ʻai kūikawā;
- hoʻoikaika kino;
- hoʻomau mau ʻana i nā pae glucose;
- ka lawe ʻana i nā lāʻau lapaʻau haʻahaʻa.
Ma ka manawa like, ma ka pae mua o ka hoʻomohala ʻana o ka maʻi, hiki i ka mea maʻi ke hana me ka ʻai kūpono, ka hoʻomaha ikaika a me ke kaohi gula. ʻO kēlā me kēia mau mahina 2-3 he kuleana ʻo ia e lawe i nā hoʻokolokolo ma kahi keʻena olakino, no laila hiki i ke kauka ke hoʻoholo i ka hopena o ka lāʻau lapaʻau. Inā pilikia ke kūlana o ka mea maʻi, pono ke kauka ke kauka i nā lāʻau lapaʻau me ka hopena hypoglycemic.
Inā momonaʻole ka mea maʻi, a laila hoʻomau paha ke kauka i nā lāʻau lapaʻau me ka mea ikaika - metformin. Ma ke hoʻohana ʻana o kēia pono hana e kōkua i ka hoʻemi ʻana i ke kaumaha o ke kino a me ke kiʻekiʻe o ka glucose. Inā ʻaʻole ka mea hoʻomanawanui i ka pilikia, a laila ke kauka ke kauka i nā lāʻau lapaʻau e hoʻoikaika ai i ka naʻau a me ka hana o ka insulin e ka pancreas. ʻO nā ʻano hoʻi i pili i ka maʻi maʻi e pono hoʻi e noʻonoʻo. ʻO kahi laʻana, inā he pilikia ka maʻi o ka maʻi, a laila pono ke kauka ke koho i nā lāʻau lapaʻau e hoʻoiho ʻia e nā kino ʻē aʻe.
E like me kāu e ʻike ai, pono kēlā me kēia maʻi diabetes i ke ala kūikawā ma ke ʻano o ka maʻi maʻi. No laila, hiki i ke kauka komo hele wale nō ke kuhikuhi i nā lāʻau lapaʻau kūpono kūpono a helu i kā lākou dosage. ʻAʻole pono ke kūlohelohe pilikino ponoi, ua loaʻa nā lāʻau lapaʻau āpau i nā contraindications a me nā hopena maikaʻi loa e hiki ke alakaʻi i nā hopena i hōʻino ʻia.
Nā lāʻau lapaʻau e hoʻonui ai i ka naʻau
ʻIke ʻia ʻo Thiazolidinediones i kēia mau makahiki wale nō a ʻo kēia mau makahiki i hoʻomaka ai e lilo i mau lāʻau e hypoglycemic. ʻAʻole pili kēia ʻano lāʻau i ka pancreas e hana i ka insulin, e pili ana i ka ʻili o nā pūpuna a me nā ʻine i kahi hormone hoʻohaʻahaʻa i ke kō.
Hoʻopili i nā mea e hōʻemi ai i ka glycemia, hoʻonui i ka uluʻana o nā mea nānā, e hoʻopilikia nui ka thiazolidinediones i ka ʻōlelo lipid. ʻO ka hopena hypoglycemic o kēia mau lāʻau he 0.5-2%. No laila, hiki iā lākou ke hoʻohana pū me ka monotherapy a me ka hui pū me ka insulin, metformin a me sulfonylureas.
ʻO Thiazolidinediones e loaʻa nā lāʻau e like me Pioglar, Actos, Diglitazone. ʻO kā lākou pōmaikaʻi, ʻaʻole lākou e hana i ka hypoglycemia. Hōʻike ʻia kēia pūʻulu o nā lāʻau lapaʻau i ka mea nui loa i ka hakakā i ka pale ʻana i ka insulin.
ʻO ka mea i hōʻike i ka biguanides ka waiwai metformin. ʻO ia ka mea ikaika i nā lāʻau lapaʻau o kēia hui. Hoʻomaka ia e hoʻohana i ka hana olakino mai ka makahiki 1994. I kēia wā, ʻo ia mau lāʻau ka mea i kaulana loa i ka wā i kuhikuhi ʻia ai i nā mea maʻi me ka maʻi maʻi. Hoʻololi ka Metformin i ka glucose mai ka palapalapa i ke koko a hoʻonui i ka ʻike ʻana i nā koholā peripheral i ka insulin i hana ʻia. I loko o kahi kīhāpai, hiki i ka mea lapaʻau ke hāʻawi aku i kahi helu helu nunui o nā lāʻau laʻala, no ka mea aia lākou āpau i ka māhele nui - metformin, ʻo kahiʻokoʻa wale nō ka mea i loaʻa. Hoʻopili kēia ma Bagomet, Gliformin, Glyukofazh, Formmetin, Siofor, Metformin 850 a me nā mea ʻē aʻe.
I waena o nā hiʻohiʻona kūpono o ka hana o ka metformin, kahi hōʻemi haʻahaʻa o ka hypoglycemia, ka paleʻana i ka atherosclerosis, ka hoʻolilo ʻana i ke kaupaona a me ka hiki ʻana o ka hui pū me ka insulin a me nā lāʻau hoʻohaʻahaʻa i nā hilo. I kekahi mau hihia, hiki ke loaʻa nā hopena kūpono ʻole a me nā hemahema o ka metformin, no ka laʻana:
- ʻO ka huehue hanu ʻoi loa i ka hoʻomaka ʻana o ka ʻoihana (hoʻomehana, ka luaʻi, ka ʻūhā, ke nānā ʻana, ka nele o kaʻai ʻana).
- ʻO ka hiki ʻole ke hoʻohana i ka lāʻau lapaʻau no nā maʻi o ka pūpū, ka pāhī ʻana, ka puʻuwai a me nā pilikia ʻole.
- Ka liʻiliʻi e hōʻemi ana i ka hoʻomohala ʻana i ka waiū waiū.
Eia kekahi, i ka wā o ka manawa lōʻihi, hiki i nā pilikia me kahi hemahema o ka mauʻu B12.
Nā lāʻau hou
ʻO ka DPP-4 inhibitors ka hanauna hou o nā lāʻau lapaʻau; ua hoʻohana ʻia ma ka 2006. ʻO kēlā mau lāʻau wale nō ʻaʻole e hoʻopilikia i ka hoʻokumu ʻana o ka insulin. Hiki iā lākou ke pale aku i ka poli-like polypeptide 1 (GLP-1) i hoʻopili ʻia e nā ʻōpū mai ka luku ʻana i ka enzyme DPP-4.
ʻO kēia kahi e puka ai ka inoa o kēia mau lāʻau lapaʻau. Hoʻonāukiuki ʻia ka GLP-1 i ka hana ʻana o ka insulin, kahi e hoʻemi ai i ke pae o ke kō i loko o ke kino o ke kanaka. Eia kekahi, ʻaʻole ʻo GLP-1 e ʻae i ka hoʻomohala ʻana o ka glucagon, ʻo ia hoʻi, e pale aku i ka insulin mai ka hoʻohana ʻana i kona hopena.
ʻO ka mea kūpono e hōʻalo ʻia ia mau lāʻau i ka hypoglycemia, no ka mea e pau lākou i ka hana ma hope o ka hoʻomau ʻana o ka ʻike o ka hilo. ʻAʻole lākou e hoʻonui i ke kaumaha o ke kino a ke hoʻohana nei me ka aneane āpau. ʻO kaʻokoʻa wale nō ka injection agonists o nā mea hoʻokipa GLP-1, ka insulin (ʻo Galvus wale nō ke kuhikuhi). Hiki i nā lāʻau lapaʻau ke hōʻeha i nā hopena ʻino e pili ana i nā ʻehaʻeha o ka ʻōpū, ʻaʻole hoʻi ke aʻo ʻia e hoʻohana ia mau mea no nā maʻi o nā palū a me nā pōpoki. I kēia lā, nā mea lapaʻau e like me saxagliptin (Onglisa), sitagliptin (Januvia) a me vildagliptin (Galvus) i mea maʻamau.
ʻO ka GLP-1 receptor agonist he hormone ia e hāʻawi wale ʻana i nā hōʻailona i ka pancreas e pili ana i ka hana ʻana o ka insulin, akā e hōʻemi ana i ka momona a hoʻihoʻi i nā pū aʻai i hoʻopau ʻia. No ka mea ʻo GLP-1 ma hope o ka ʻai ʻana i ka hoʻopau ʻia i loko o nā minuke 2, ʻaʻole hiki iā ia ke hoʻokuʻi piha i ka hana o ka insulin. No laila, aia nā mea kikoʻī o Viktoz a me Bayet, i hoʻokuʻu ʻia ma ke ʻano o nā injections. Pono e noʻonoʻo i ka laʻa hope loa he mau hora wale nō, a me Victoza - i ka lā āpau.
E pale aku i ka pale o ka glucose glucosidase i ka hoʻololi ʻana o nā minamina i ka glucose. Hoʻokomo nui ia mau lāʻau inā loaʻa kahi maʻi diabetes i ka nui o ke kaila glucose ma hope o ka ʻai ʻana. Hiki ke hoʻohana ʻia nā lāʻau maʻi maʻi e hui pū me kekahi mau lāʻau hypoglycemic. ʻO nā hopena maikaʻi loa i ka wā e lawe ana i ka mea paʻa alpha-glucosidase ʻoi ka pilikia o ka digestive - flatulence, ʻeha. No laila, ʻaʻole hiki iā lākou ke hoʻohana no nā maʻi ʻawaʻawa. ʻO ka hoʻohana pū ʻana me ka metformin he mea kūpono ʻole hoʻi, no ka mea hiki ke hoʻonui i ka hōʻailona o ka maʻi ʻeha o ka gastrointestinal.
ʻO nā māka nui o nā lāʻau lapaʻau ʻo Glucobai a me Diastabol.
Hoʻonāukiuki ʻia
Ua ʻike ʻia ka hopena hypoglycemic derivatives o ka sulfonylurea i ka wā o ke Kaua Honua II, kahi i hoʻohana ʻia ai lākou e hakakā i nā maʻi. Ke hana nei kēia mau lāʻau i nā cell beta i loaʻa i ka pancreas e synthesize i ka insulin. Kēia mau lāʻau lapaʻau e hoʻomau i ka hana o ka hormone, a hoʻomaikaʻi pū i ka mālamalama o nā ʻie a me nā kiko.
I ka manawa like, nā lāʻau lapaʻau i kekahi mau hemahema: loaʻa ka paona, hypoglycemia (ke kahe wikiwiki ʻana i nā nui o ke kōpaʻa ma lalo o ka maʻamau), overstrain a me ka hoʻohaʻahaʻa ʻana i nā cell beta. ʻO ka hopena, ma kekahi mau maʻi maʻi, hele ka maʻi like i ka ʻano 1, e koi ana i ka ʻohiʻana i ka insulin wela. Ma loko o ka hale kūʻai mea hiki ke kūʻai iā ʻoe i kekahi o nā papa o nā derivatives sulfonylurea, no ka laʻana:
- glibenclamide (Maninyl);
- gliclazide (Diabeton MV, Glidiab MV);
- glycidone (glurenorm);
- glimepiride (Amaril, Glemaz).
Hoʻokomoʻo Meglitinides i ka hoʻouluʻana o ka hormone pancreatic. Manaʻo nā kauka he nui i kā lākou hoʻohana e nā poʻe maʻi me ke kō koko koko nui ma hope o ka ʻai ʻana. Pono e hoʻopau ʻia kēia mau lāʻau i ʻekolu mau manawa i ka lā ma mua o ka papa ʻaina nui. ʻO kā lākou hoʻohana me nā derivatives o sulfonylurea, he mea ʻole ka manaʻo, no ka mea, ua like kā lākou hopena. Ma ka lāʻau lapaʻau hiki iā ʻoe ke kūʻai i ke kālā no ka mālama ʻana i nā maʻi maʻi type 2, i hoʻokaʻawale ʻia i ʻelua papaʻa: repaglinide (Novonorm) a me nateglinide (Starlix).
Hōʻike nā loiloi o nā mea maʻi he nui ʻaʻole hoʻemi ka Novonorm i ka liʻiliʻi o ke kō ma hope o ka ʻai ʻana, akā ua hoʻemi ʻia hoʻi ma ka ʻōpū ʻole. I ka manawa like, ʻo ka hopena hypoglycemic o kēlā mau lāʻau huakaʻi e like me ka 0.7 a 1.5%. I kēia mea, hoʻohana pinepine ʻia lākou me nā lāʻau lapaʻau ma mua o ka sulfonylurea.
Ma waena o nā pōmaikaʻi o ka meglitinides hiki ke hoʻokaʻawale i ka mea ʻaʻole lākou e hoʻonui i ka paona, a ma kahi liʻiliʻi e hoʻonāukiuki i ka hōʻeha ʻana o hypoglycemia. Nā hopena kūpono ʻole i ka wā e hoʻohana ai i nā lāʻau lapaʻau ke hiki ke hoʻowalewale i ka maʻi ʻeha, sinusitis, nā ʻeha, nā maʻi ʻeha o ke ala. I waena o nā nāwina hemahema, hiki i kekahi ke wehe i ke kumukūʻai nui o nā mākaukau, hana hoʻomalu i ka wā i ke ao, a me ka hopena haʻahaʻa haʻahaʻa.
E like me kāu e ʻike ai, nui nā lāʻau lapaʻau e hoʻohaʻahaʻa i nā pae haʻahaʻa. Akā loaʻa kēlā me kēia ʻāpana i ka hopena o ke kino o ka mea maʻi. No laila, i ka mālamaʻana i nā maʻi maʻi type 2, pono e nīnau i ke kauka. ʻO ia ka mea e hiki ke koho i ka lāʻau lapaʻau me ka hopena maikaʻi loa a ʻo ka liʻiliʻi i ka hōʻeha ʻana i ke kino o ka maʻi maʻi. E pane ka wikiō ma kēia ʻatikala i nā nīnau e pili ana i ka hoʻomaka a me ka mālama ʻana i ka maʻi maʻi.
