Kev kho mob hom 2 mob ntshav qab zib mellitus teem sijhawm kho mob

Nrog lub hnub nyoog, ib tus neeg lub cev ua haujlwm tsis zoo thiab cov tshuaj metabolism hauv tsis zoo, uas feem ntau ua rau kev txhim kho ntshav qab zib hauv cov neeg laus. Kev kho mob ntawm tus kab mob no yuav tsum muaj kev tshwj xeeb, zoo li hauv cov neeg laus laus muaj peev xwm raug kev txom nyem los ntawm ntau yam kab mob mus ntev, uas yog kev tsis sib haum rau kev noj ntau yam tshuaj rau ntshav qab zib.

Yog li, ob tus neeg mob lawv tus kheej thiab lawv cov txheeb ze yuav tsum paub txog hom tshuaj mob ntshav qab zib hom 2 hauv cov neeg laus siv rau hauv cov tshuaj niaj hnub, yuav ua li cas coj thiab sib txuas nrog lawv kom raug. Kev kho mob ntshav qab zib hauv cov laus, ua raws li txhua txoj cai, tuaj yeem hloov lub neej ntev ntawm cov neeg laus thiab ua kom tiav ntau dua.

Ua rau muaj ntshav qab zib rau cov laus

Tom qab 50 xyoo, ib tus neeg muaj qhov kev ceeb toom txo cov ntshav qabzib tsawg, uas ua rau cov ntshav qab zib muaj tsawg zuj zus. Yog li thaum muaj hnub nyoog 60 xyoo, cov ntshav muaj cov ntshav qabzib hauv lub plab yuav nce ntxiv hauv nruab nrab 0.05 mmol / L, thiab tom qab noj mov 0.5 mmol / L.

Cov cwj pwm no txuas ntxiv mus rau yav tom ntej thiab txhua 10 xyoo tom ntej, cov ntshav qab zib cov ntshav ntawm cov neeg laus yuav nce siab zuj zus. Ntxiv mus, nws yog ib qho tseem ceeb los taw qhia tias cov ntsuas no yog nruab nrab thiab hauv qee cov neeg muaj hnub nyoog, ntshav qabzib tuaj yeem nce ntxiv hauv qhov siab.

Muaj peb lub ntsiab tseem ceeb rau kev txhim kho hom ntshav qab zib 2 hauv cov neeg laus dua 50 xyoo. Txawm hais tias muaj ib ntawm ib ntawm lawv nce txoj kev pheej hmoo yuav kis tus kab mob no, thiab muaj peb ntawm 95 hauv 100 kis ua rau muaj mob ntshav qab zib.

Vim li cas tus kab mob ntshav qab zib pib loj zuj zus hauv cov neeg laus:

1. Txo cov leeg hauv lub cev rau insulin (insulin tsis kam) tshwm sim los ntawm lub hnub nyoog hloov hauv lub cev,
2. Txo cov tshuaj insulin ntau lawm los ntawm pancreatic β-hlwb,
3. Kev ua yeeb yam tsawg zuj zus lawm thiab lawv cov kev ua rau lub cev tsis muaj zog hauv cov neeg laus.

Cov tshuaj Insulin feem ntau kuaj tau rau cov neeg muaj hnub nyoog laus, tab sis feem ntau nws cuam tshuam rau cov txiv neej laus thiab cov poj niam uas rog dhau. Yog hais tias thawj cov tsos mob ntawm cov nqaij mos tsis zoo rau kev tiv thaiv insulin tsis ntsuas kev tsim nyog, ces qhov kev ua txhaum no yuav zam txoj kev coj ua rau mob ntshav qab zib mellitus.

Hauv cov tib neeg muaj lub cev qhov hnyav, qhov tseem ceeb uas cuam tshuam rau kev txhim kho ntshav qab zib yog qhov kev poob qis hauv insulin ntau lawm. Hauv cov neeg mob zoo li no, tom qab noj mov, lub cev tsis tau pib nqus ntshav insulin, raws li tshwm sim hauv cov neeg noj qab haus huv, uas ua rau muaj ntshav qab zib ntau ntxiv.

Tus incretins yog cov tshuaj hormones tsim tawm los ntawm kev mob plab thaum noj mov thiab uas ua rau cov insulin ntau lawm. Nrog rau qhov tsis txaus ntseeg cov tshuaj hormones no tseem ceeb lossis txo qis rhiab ntawm cov ntaub so ntswg rau lawv, tus neeg mob zais cia li 50% tsawg tshaj li cov insulin tsawg dua li cov neeg uas lub plab zom mov noj qab nyob zoo.

Tab sis txhua yam saum toj no ua rau muaj ntshav qab zib, raws li txoj cai, yog qhov txiaj ntsig ntawm kev ua neej tsis raug.

Tsis kam txais cov cwj pwm tsis zoo, ua raws li kev noj zaub mov zoo thiab ua kom lub cev ua si ntau ntxiv tuaj yeem txo lub sijhawm ntau ntawm qhov muaj peev xwm ua kom yuag yuag, thiab vim li no cov tsos mob ntshav qab zib hom 2.

Cov tshuaj rau ntshav qab zib pawg loj

Ua raws li hom mob ntshav qab zib uas koj tau raug mob, koj tus kws kho mob yuav sau ntawv noj tshuaj los kho. Mob ntshav qab zib Hom 1 ib txwm kho nrog cov tshuaj insulin, rau lwm hom ntshav qab zib ntau yam uas muaj peev xwm yuav loj dua. Qhov mob hnyav heev ntawm tus kab mob kuj tseem ua txoj haujlwm.

Tshuaj rau ntshav qab zib

homDaim ntawv thov tshuaj Biguanides (metformin)Metformax
Siofor
Avamina
Ntsia hauv qab
Ntsuasyog lawmNtsiav tshuaj / tsiav tshuaj sulfonylureasDiaplel MR, Gliclada, Diagen, Amaryl, Glibetic, Simglik, Glibenseyog lawmntsiav tshuaj glinidsPrandin, Enyglid, Starlixyog lawmntsiav tshuaj Thiazolidinediones (glitazones)Bioton, Pioglitazoneyog lawmntsiav tshuaj DPP-4 inhibitors (glyphins)Januvia, Ristaben, Galvus, Onglisa, Trazhentayog lawmntsiav tshuaj Kev npaj cov tsis ntseeg (GLP-1 analogues)Bayetta, Bidureron, Victoza, Lixunia, Eperzanyog lawmkev txhaj tshuaj SGLT-2 Cov Tshuaj Hluav Taws Xob (Glyphosin)Dapagliflozin, Canagliflozin, Empagliflosinyog lawmkev txhaj tshuaj tshuaj insulinyog lawmyog lawmMob ntshav qab zib Gestational, LADA thiab lwm yamkev txhaj tshuaj acarboseAdex, Glucobayyog lawmNtshav Qab Zib Hom 2,

ntshav qab zib hom 1 nrog kev tiv thaiv insulinntsiav tshuaj

Phiv los ntawm cov tshuaj ntshav qab zib

Cov kev mob tshwm sim yog cov tsos mob los yog mob los ntawm kev noj tshuaj pab. Txhua yam tshuaj muaj cov kev mob tshwm sim, thiab cov tshuaj ntshav qab zib, alas, tsis muaj qhov tshwj xeeb. Ua ntej koj pib noj cov tshuaj mob ntshav qab zib, xav txog qhov tshwm sim tsis zoo los ntawm lawv cov yeeb yam. Koj tus kws kho mob, thaum sau ntawv noj tshuaj rau koj cov ntshav qab zib, yuav tsum nrog koj tham txog qhov yuav tshwm sim tuaj nrog koj thiab qhia koj txog kev tiv thaiv lawv li cas.

Qhov uas koj yuav muaj kev phiv yog ib lo lus nug ntawm ib tus neeg - lawv tuaj yeem ua tau mob siab lossis hais tau meej heev. Qee zaum cov kev mob tshwm sim yog qee qhov txaus ntshai, uas tuaj yeem yog qhov txaus ntshai hauv lawv tus kheej. Txawm li cas los xij, cov no yog qee tus neeg tsawg.

Kev kho mob hom 2 mob ntshav qab zib mellitus cov tshuaj tiv thaiv tsis zoo

Yog koj tsis xis nyob los ntawm kev noj tshuaj mob ntshav qab zib, qhia koj tus kws kho mob.

Qee cov tshuaj tiv thaiv kab mob ntshav siab, tshwj xeeb tshaj yog cov siv los kho hom 2 ntshav qab zib, tuaj yeem ua rau mob plab, tab sis feem ntau ploj mus tom qab 2-3 asthiv.

Kev ntshav siab

Lub hom phiaj tseem ceeb ntawm cov tshuaj tiv thaiv kab mob ntshav qab zib yog kom txo cov ntshav qab zib. Txawm li cas los xij, qee cov tshuaj tuaj yeem txo cov ntshav qab zib kom qis mus rau theem txaus ntshai, ua rau ntshav qab zib tsis txaus.

Cov tshuaj uas ua rau muaj piam thaj kom tsawg (Kev txo cov ntshav qis):

• tshuaj insulin
• sulfonylurea derivatives,
• tais av.

Yog tias koj noj cov tshuaj no tas li, yuav tsum muaj kua nplaum nrog koj.

Kawm paub ntxiv txog kev muaj ntshav qab zib, hypoglycemic cov tsos mob thiab yuav kho hypoglycemia li cas: Kev mob ntshav qab zib, yog dab tsi thiab vim li cas kev tawm tsam txaus ntshai rau cov neeg mob ntshav qab zib

Cov Yuav Tsum Muaj

Kev tiv thaiv tsis zoo rau kev siv tshuaj txhais tau hais tias nyob hauv qee kis peb yuav tsum tsis txhob noj tshuaj - piv txwv li, muaj lwm yam kab mob lossis cev xeeb tub. Ib qho xwm txheej uas nquag tshwm sim yog lus ceeb toom tias koj yuav tsum tau ceev faj tshwj xeeb, piv txwv li, tsis txhob haus cawv lossis tsav tsheb.

Qee zaum ob hom tshuaj tsis tuaj yeem ua ke. Qhov no yog vim li cas koj tus kws kho mob yuav tsum paub tag nrho keeb kwm ntawm koj tus mob ua ntej sau ntawv yuav cov tshuaj tshiab. Yog tias koj xav tias hauv cov lus qhia rau cov tshuaj, muaj cov contraindications uas koj ntshai, tsis txhob hnov ​​qab qhia tus kws kho mob txog nws.

Kev kho mob ntshav qab zib hom 2 hnub no cov tshuaj

Tam sim no, tshuaj los ntawm rau pawg yog siv los kho ntshav qab zib.

Metformin muaj nyob hauv ntau cov npe khoom lag luam ntawm ntau cov tuam ntxhab.

• Metformin txhim kho cov metabolism hauv kev noj cov zaub mov los ntawm kev ua kom cov kua qabzib ua rau cov ntshav qabzib hauv lub siab thiab nce qhov kev nkag siab ntawm cov ntaub so ntswg mus rau insulin (txo qis hauv insulin tsis kam).
• Metformin txo qhov hnyav, txhim kho lipid metabolism hauv cov ntshav thiab muaj cov kev tiv thaiv ntawm lub plawv (cardioprotective).
• Metformin yog siv los kho tus mob ntshav qab zib hom 2 raws li kev kho mob monotherapy lossis hauv kev sib xyaw nrog lwm cov tshuaj tiv thaiv kab mob thiab / los yog insulin, thiab tseem tuaj yeem siv los kho ntshav qab zib (ntshav qabzib tsis txaus, qabzib tsis ua haujlwm), thiab polycystic ovary syndrome.

Yuav noj cov tshuaj metformin kom raug li cas

Metformin yuav tsum tau pib nrog kev noj tshuaj me me kom txo tau cov kev mob tshwm sim, feem ntau yog mob plab hnyuv, xws li xeev siab, mob plab, roj, raws plab, thiab xim hlau.

Yog tias cov tsos mob no tshwm sim, qhov koob tshuaj yuav raug txo lossis hloov los ntawm lwm lub tuam txhab tsim khoom. Cov tshuaj no muaj qhov cuam tshuam zoo ntawm lub cev thiab tsis tuaj yeem raug pov tseg rau qhov tsis tseem ceeb.

Yuav noj cov tshuaj metformin rau ntshav qab zib hom 2 li cas

Metformin muaj kev nyab xeeb heev, nws tsis ua rau hypoglycemia, vim tias nws tsis nce zais insulin los ntawm tus txiav tsis ua kab mob ntxiv.

• Nws yuav tsum nco ntsoov tias metformin tswj cov metabolism hauv cov piam thaj hauv lub cev, thiab nws cov nyhuv tag nrho hauv daim ntawv ntawm qhov txo qis hauv qabzib tshwm sim tom qab siv li 2 lub lis piam.
• Tsis txhob noj cov tshuaj metformin hauv kev tsis meej pem, uas yog, thaum cov ntshav qabzib nce siab, koj noj cov ntsiav tshuaj thiab cia siab tias yuav tsum ceev ceev - metformin tsis ua haujlwm nrawm.

Metformin contraindications thiab phiv

Cov kev qhia tsis meej txog kev siv cov metformin yog:

• mob raum lossis lub siab ua haujlwm poob,
• cawv quav cawv syndrome
• lub plawv dhia tsis zoo
• mob ob leeg heev ob leeg mob ntsws (COPD),
• pw tsaug zog apnea mob.

Sulfonylurea tshuaj mechanism ntawm kev txiav txim

• Sulfonylureas txo qis glycemia los ntawm kev ua cov kab mob ua yeeb yam ntxiv rau pancreatic, uas tseem cuam tshuam cov piam thaj hauv cov ntshav hauv ntau yam kabmob. Lawv siv hauv cov qauv hauv ncoo.
• Lawv tau txais txiaj ntsig zoo hauv kev txo qis ntshav qabzib ntau, tab sis lawv tuaj yeem ua rau kom ntshav qab zib. Lawv yuav tsum tau coj los noj thaum sawv ntxov ua ntej noj tshais. Tus kws kho mob yuav xaiv cov tshuaj thiab txiav txim qhov ntau npaum li cas.

Yuav noj li cas

Sulfonylureas tuaj yeem siv ib leeg los yog ua ke nrog metformin thiab lwm yam kev tiv thaiv kab mob siab.

Contraindications rau lawv siv yog:

• cov kev tsis txaus siab tseem ceeb ntawm sulfonylurea yog cov ntshav qabzib thiab tseem tuaj yeem ua rau nce phaus,
• mob siab hnyav ua haujlwm.

Acarbose yog tshuaj tua kab mob ua kom haum xeeb hauv daim ntawv ntawm cov ntsiav tshuaj, inhibiting qhov nqus ntawm cov piam thaj los ntawm lub plab zom mov thiab yog li txo cov glycemia.

Cov lus qhia acarbose rau kev siv

Cov tshuaj tuaj yeem raug coj hauv kev kho mob nrog metformin thiab lwm yam tshuaj tiv thaiv kab mob ntshav siab. Nws tau noj 2-3 zaug ib hnub ua ntej noj mov. Cov kev mob tshwm sim muaj xws li flatulence, qee zaum raws plab. Cov tsos mob no yuav hnyav dua yog tias tus neeg mob tsis ua raws li kev qhia noj zaub mov. Contraindication rau kev siv acarbose yog lub raum thiab mob hepatic tsis txaus.

Incretin npaj

Cov kev npaj ua ntej nce txhim kho cov zais ntshav ntawm cov kua dej los ntawm cov txiav, thiab tiv thaiv kev mob plab zom mov. Lawv ua rau cov ntshav piam thaj thiab lub cev qhov hnyav. Cov kev mob tshwm sim suav nrog xeev ntuav, tsis qab los noj mov, thiab qee zaum ntuav.

Cov kev npaj rau incretin suav nrog ob pawg me.

Thawj pawg me yog GLP 1 tshuaj tiv thaiv tshuaj (nce tshuaj ntawm ib chav kawm tshiab ntawm cov tshuaj: dulaglutyd, exenatide, liksysenatyd, liraglutide).

Yuav ua li cas yuav muab incretins:

• Lawv raug txhaj tshuaj subcutaneously.
• Lawv raug siv ua ke nrog kev sib txuas ntawm metformin thiab / lossis sulfonylurea.

Qhov tshuaj thib ob yog DPP-4 cov tshuaj tiv thaiv kab mob (sib ntxiv ntawm glyptins), noj ntawm qhov ncauj. DPP-4 inhibitor tshuaj nce pancreatic insulin secretion, inhibit lub plab zom mov, muab qhov kev xav zoo nkaus thiab cuam tshuam rau lub hauv nruab nrab cov hlab hlwb, txwv tsis pub ua kom qab. Lawv ua rau cov ntshav piam thaj thiab lub cev qhov hnyav. Cov kev mob tshwm sim suav nrog xeev ntuav, tsis qab los noj mov, thiab qee zaum ntuav.

Cov no yog cov ntsiav tshuaj: (linagliptin, saxagliptin, sitagliptin, vildagliptin).

Qee qhov ntawm lawv kuj tseem muaj nyob ua ke ua ke npaj cov tshuaj ntxiv metformin hauv ib ntsiav tshuaj.

SGLT2 Cov Tshuaj Hluav Taws Xob

• SGLT2 inhibitors (lub npe hu ua glyphosines, dapagliflozin, empagliflosin, canagliflosin) yog ib pawg tshuaj uas ua rau muaj ntshav tawm ntau ntxiv. Qhov tshwm sim yog txo qis ntshav qabzib, lub cev qhov hnyav thiab ntshav siab.
• Cov tshuaj no feem ntau siv ib hnub ib zaug. Lawv feem ntau siv ua ke nrog metformin. Txij li thaum glyphlosins nce cov piam thaj hauv cov zis, lawv tuaj yeem ua rau mob txeeb zig thiab mob ntawm chaw mos, yog li kev nyiam huv yog pom zoo thaum siv.

Thiazolidinedione derivatives

Cov tshuaj tam sim no muaj los ntawm pab pawg thiazolidinedione derivatives (i.e., thiaj li hu ua glitazones) yog pioglitazone.

• Nws txo cov tshuaj tiv thaiv insulin thiab, yog li, txo qis cov ntsiab lus ntawm cov piam thaj thiab cov roj ntsha dawb hauv cov ntshav.
• Cov tshuaj yuav tau noj qhov ncauj ib hnub ib zaug. Pioglitazone feem ntau siv ua ke nrog metformin.
• Cov tshuaj yuav ua rau kom cov dej hauv lub cev, yog li nws yuav tsum tsis txhob siv rau hauv cov neeg muaj lub plawv tsis ua haujlwm.

Cov tshuaj pab saum toj saud raug xaj hauv kev kho mob hom 2 mob ntshav qab zib mellitus tshwj xeeb los ntawm koj tus kws kho mob tuaj koom. Hauv kev kho mob ntshav qab zib hom 1, tsuas yog cov insulin tsuas ua hauj lwm.

Kawm ntxiv txog cov kev tshiab hauv kev kho mob ntshav qab zib hom 2: