Clinid npaj Starlix, Novonorm - ntshav qabzib los tswj

Tsis zoo li nateglinide (Starlix), repaglinide (Novonorm) tsis tsuas yog ua tau zoo txo ​​qis tom qab, tab sis kuj tseem ceev ceev glycemia, vim nws txoj kev sib txuas nrog SUR receptor ntev dua. Tab sis nateglinide rau qhov qis dua ua rau muaj kev tsis haum ntshav, tab sis tib lub sijhawm nws cov nyhuv ntawm theem ntawm HbA1c kuj tseem tsawg heev. Lawv ua tau zoo heev hauv kev sib tw "tsis muaj zog" uas muaj feem ntau cov neeg mob ntshav qab zib mellitus, i.e. hauv cov neeg uas tsis tau txais cov tshuaj sulfa yav dhau los.

Cov Khoom Qhia. Glinids tuaj yeem raug suav tias yog pib kev kho mob rau T2DM, tshwj xeeb tshaj yog rau cov tib neeg muaj tus mob postprandial hyperglycemia thiab cov phiaj xwm ua ntej noj mov, uas tau txhawb los ntawm kev noj zaub mov zoo thiab ua kom lub cev ua si. Cov neeg sib tw rau kev kho mob glinid tej zaum yuav yog cov neeg mob uas ntshai kev loj hlob ntawm cov ntshav qab zib, tshwj xeeb, cov neeg laus. Lawv ua tau zoo rau cov neeg mob uas tsis tshua nyiam noj thaum nruab hnub (1-2 zaug), tab sis tib lub sij hawm noj loj. Lawv tuaj yeem siv rau hauv cov neeg mob uas muaj kev fab tshuaj rau sulfonamides, vim tias cov qauv hauv tshuaj lom neeg tsis siv rau lawv.

Cov suab thaj txo qis ntawm glinides nyob rau hauv dav dav, uas tau kwv yees los ntawm theem HbA 1 c, yog li pom qis dua li ntawm sulfanilamides thiab ntau npaum li 0.7-1.5% hauv cov neeg mob teb rau kev kho mob. Glinides kuj tseem tuaj yeem ua ke nrog lwm cov tshuaj uas muaj suab thaj txo qis, ntawm chav kawm, tshwj tsis yog muaj sulfonamides, uas lawv muaj ib qho chaw muaj kev txiav txim siab hauv beta cell. Rau tib qho laj thawj, ib qho yuav tsum tsis txhob xav tias yuav los ntawm lawv qhov tshwm sim hauv cov neeg mob uas sulfonamides tau poob lawv cov txiaj ntsig lossis hauv feem ntau tiv thaiv sulfanilamides.

Feem ntau, qhov tsis zoo ntawm cov av nplaum yog qhov yuav tsum tau siv ntau cov tshuaj nruab hnub, qis dua muaj peev xwm txo qis HbA 1 s tshaj li sulfonamides thiab tus nqi siab.

Cov sib txuam thiab cov kev txwv. Glinides yog contraindicated nyob rau hauv hom 1 mob ntshav qab zib mellitus, thaum tus neeg mob loj hlob ketoacidosis lossis nrog paub hypersensitivity rau lawv, zoo li hauv cov menyuam yaus (tsis muaj cov ntaub ntawv ntawm lawv kev nyab xeeb nyob rau hauv rooj plaub tom kawg). Lawv tuaj yeem ua rau cov ntshav qog ntshav qis, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj kabmob hepatic, adrenal lossis pituitary tsis txaus, hauv cov neeg mob uas tsis muaj zog thiab cov neeg tsis muaj zog. Glinides rau qhov tsawg dua li sulfonamides ua rau mob ntshav qab zib thiab feem ntau hauv cov neeg mob uas tsis tau txais kev kho mob qhov ncauj qhov ncauj ntshav thiab kho nrog HbA 1 c

Glinids yog contraindicated thaum cev xeeb tub thiab pub niam mis, txawm hais tias lawv tsis tau pom tias muaj teebmeem teratogenic, tab sis tsuas yog ntxias cov cev pob txha tsis zoo thaum cev xeeb tub thiab lactation hauv plab thiab menyuam mos. Tsuas yog qee tus tsiaj tau tsim tsa lub zoo ntawm clayeys nrog mis nyuj, tab sis cov kev tshawb fawb zoo li no tsis tau ua hauv cov poj niam laus. Hauv qhov no, lawv raug contraindicated thaum lactation.

Glinides tuaj yeem kho rau lub raum tsis ua hauj lwm yam tsis muaj kev txwv tsis zoo.

Hauv cov tib neeg muaj mob hepatic me me tsis txaus, glinides yog cov tshuaj tsis muaj kev txwv, tab sis lawv cov metabolism yuav maj mam poob rau qee cov neeg mob, uas ua kom cov ntshav qab zib muaj txiaj ntsig ntawm glinids thiab lawv cov koob tshuaj yuav raug txo lossis lawv cov kev coj noj coj ua hauv lub sijhawm loj yuav tsum tau ua. Hauv kev mob siab hauv daim siab, lawv tau raug contraindicated (kev tshawb fawb hauv pawg no ntawm cov neeg mob tseem tsis tau ua).

Cov hnub nyoog laus thiab cov tub lossis ntxhais tsis cuam tshuam rau cov metabolism ntawm cov av nplaum thiab yog li lawv tsis muaj kev txwv rau lub hnub nyoog thiab poj niam txiv neej.

Kev mob ntshav qab zib, mob lub ntsws ua pa, mob ntsws, xeev siab, raws plab, cem quav, mob caj dab, yuag, thiab mob taub hau tau sau tseg ntawm cov kev xav tsis zoo uas pom nrog glinids.

Cov ntaub ntawv dav dav

Meglitinides (derivatives ntawm benzoic acid) yog cov chav kawm tshiab ntawm cov tshuaj uas ua rau cov kua insulin ntau dua. Meglitinides suav nrog cov tshuaj xws li repaglinide thiab nateglinide.

Cov txheej txheem ntawm kev ua ntawm meglitinides yog ze rau lawv cov kev nqis tes ua ntawm ATP-dependant K + channels. Hauv qab ntawm meglitinides, K + kev tso cai raug kaw, qhov rhiab ntawm β-hlwb rau cov kua nplaum ntawm lub ntsej muag nce, yog li ua cov kua dej hauv cov kua hauv cov lus teb rau glycemia ntau zog.

Ib qho tseem ceeb ntawm meglitinides yog tias nrog lawv cov kev pab, cov theem pib ntawm insulin tso rov qab, thiab tom qab ntawd, vim lub sijhawm luv luv ntawm kev nqis tes, lub sijhawm ntev hyperinsulinemia tsis tsim.

Ib qho tshwj xeeb ntawm cov tshuaj lag luam ntawm meglitinides yog lawv lub peev xwm yuav tsum nqus tau txoj hnyuv hauv lub sijhawm luv heev.

Hauv cov ntshav, feem ntau ntawm sulfonylurea derivatives thiab meglitinides khi rau cov ntshav plasma protein (90-99%). Meglitinides, ntawm qhov tsis tooj, yuav yoog, pib ua thiab muaj feem sai sai, thiab qhov no yog lawv qhov txiaj ntsig zoo. Lawv qhov kev txiav txim pib tsuas yog ob peb feeb tom qab noj, tab sis nws tsuas kav ntev li 1 teev, yog li meglitinides siv nrog txhua pluas noj.

Cov metabolism ntawm meglitinides yog nqa tawm los ntawm daim siab, thiab cov tshuaj tau raug tshem tawm tsuas yog los ntawm txoj hnyuv, uas tso cai rau lawv los siv rau hauv kev kho mob ntawm cov neeg mob ntshav qab zib hom 2 nrog kev mob raum.

Tab. Qee qhov chaw muag tshuaj tsis zoo ntawm meglitinides

Cov yam ntxwv ntawm cov txheej txheem ntawm kev nqis tes ua thiab pharmacokinetics pub meglitinides nyob hauv lawv tus kheej cais tshwj xeeb hauv kev kho mob ntshav qab zib hom 2. Ua tsaug rau cov cwj pwm no, pab pawg tau txais nws lub npe thib ob - kev hwm zoo glycemic.

Piv rau sulfonylurea derivatives, meglitinides qib qis glycemia postprandial ntau dua, tab sis lawv txo qis dua ntawm kev yoo glycemia.

Meglitinides noj tam sim ntawd ua ntej noj mov, lossis nrog zaub mov noj, lossis ob peb feeb tom qab noj mov. Qib ntawm cov tshuaj insulin rov mus rau qhov qub 3 teev tom qab kev noj cov meglitinides, uas ua rau lub cev muaj teeb meem ntawm cov tshuaj insulin rau kev noj zaub mov thiab txo qhov kev pheej hmoo ntawm hypoglycemia hauv kev noj mov.

Yog li, cov tshuaj no pub rau tus neeg mob hloov kho kom yooj yim dua rau qhov teeb meem ntawm kev ua raws li kev noj haus. Nyob rau hauv rooj plaub ntawm hla zaub mov noj, cov tshuaj kuj tseem raug hla. Qhov no tseem ceeb heev rau cov neeg mob hluas uas ua lub neej nquag, vim tias yog tias kho nrog sulfonylurea, yuav muaj kev pheej hmoo ntawm lub qog ntshav qab zib hauv qhov no.

Vim hais tias tus nqi siab ntawm cov tshuaj, qhov tseem ceeb tshaj plaws yog lawv lub sijhawm sib xyaw nrog metformin rau cov neeg mob hauv kev txhaj tshuaj rau metformin monotherapy tsis tso cai them cov nqi kho mob, tshwj xeeb tshaj yog tias qib postprandial glycemia tsuas yog nce. Txawm li cas los xij, meglitinides kuj tseem siv tau ua kev kho mob hlwb (qhov ua tau zoo sib xws rau sulfonylurea derivatives) lossis hauv kev sib xyaw nrog thiazolidinediones.

Meglitinides feem ntau ua tau zoo los ntawm cov neeg mob. Cov kev mob tshwm sim feem ntau ntawm cov tshuaj ntawm pawg piav qhia yog hypoglycemia.

Glinides npaj

Cov sawv cev ntawm pawg no suav nrog:

Glinides mechanism ntawm kev nqis tes ua

Cov tshuaj hauv pawg no tsuas yog ua haujlwm ntawm beta hlwb ntawm tus txiav ua kua txiav. Cov tshuaj uas txuam nrog rau cov protein tshwj xeeb hu ua SUR1 receptor, uas yog nyob rau ntawm beta hlwb ntawm cov txiav thiab vim li ntawd, ua rau lub cev tsis zais ntawm cov tshuaj insulin.

Yog li, sulfonylurea derivatives (i.e., gliclazide, glycoverone, glimepiride) tau txuas rau tib cov protein.

Yuav ua li cas glinids ua

Qhov sib txawv hauv kev ua ntawm clayides thiab sulfonylurea derivatives yog tias yav dhau los ua haujlwm sai dua thiab muaj txiaj ntsig zoo dua. Vim qhov no, noj sai ua ntej noj mov lossis tom qab lawv, lawv cov piam thaj qis, uas nce tom qab noj mov thiab tsawg dua ua rau cov piam thaj tsis muaj.

Vim li ntawd, cov piam sij ntawm cov insulin hauv cov ntshav nce ntxiv. Qhov kev txiav txim no tsuas yog ua tau yog tias cov hlwb pancreatic tseem tuaj yeem tsim thiab kaw nws.

Hauv hom 2 Ntshav Qab Zib, beta hlwb raug paub tias "poob" thiab tsis tuaj yeem tsim insulin ntxiv lawm. Yog li ntawd, yuav tsum tau qhia nws rau hauv daim ntawv ntawm kev txhaj tshuaj subcutaneous, thiab siv cov av nplaum yog qhov tsis muaj nqi.

Rau leej twg glinids yog tshuaj

Hauv qee lub tebchaws nyob sab Europe, glinids yog siv los kho tus mob ntshav qab zib hom 2 hauv kev sib xyaw nrog kev noj haus thiab kev tawm dag zog, lossis kev sib xyaw nrog kev noj haus, kev tawm dag zog, thiab metformin.

Lawv ua ke nrog sulfonylurea derivatives tsis pom zoo. Tsis tas li, tsis txhob siv cov tshuaj glinides yog tias sulfonylureas tsis muaj txiaj ntsig rau koj (hauv qhov no, glinides kuj tseem yuav tsis ua haujlwm).

Cov txheej txheem thaiv rau kev siv ntawm av nplaum

Muaj ntau tus lej sib kis rau kev siv av nplaum.

Qhov tseem ceeb tshaj yog:

• Hypersensitivity los yog kev fab tshuaj rau cov tshuaj ntawm pawg no yav dhau los,
• Yam 1 ntshav qab zib
• Lub xub ntiag ntawm cov ntshav qab zib muaj teeb meem (ketoacidosis, mob ntshav qab zib coma - cov mob no yuav tsum tau kho nrog insulin),
• Cev xeeb tub thiab lactation,
• Ua rau lub siab tsis ua haujlwm ntxiv.
• Nws yuav tsum tau siv nrog ceev faj hauv lub raum lossis hepatic tsis txaus, adrenal tsis txaus, hauv lub hnub nyoog laus thiab thaum muaj teeb meem tsis zoo.
• Nws yuav tsum tsis txhob siv nyob rau hauv cov xwm txheej uas qhov xav tau ntawm lub cev insulin nce siab - piv txwv, muaj mob hnyav lossis phais txheej txheem. Hauv cov xwm txheej zoo li no, feem ntau nws yuav tsum tau siv tshuaj insulin ib ntus.

Yuav noj li cas

Kev noj cov tshuaj yog kwv los sai ua ntej lossis thaum noj mov.

Nws tsis yog yuav tsum saib xyuas lub sijhawm noj mov. Ntxiv mus, tom qab sab laj tus kws kho mob, peb tuaj yeem hloov kho qhov ntau npaum li cas ntawm cov tshuaj ua ntej noj mov. Yog tias koj npaj yuav noj ntau, koj tuaj yeem nce nws.

• Qhov siab tshaj plaws ib koob tshuaj repaglinide yog 4 mg (qhov siab tshaj plaws niaj hnub noj yog 16 mg).
• Txog rau nateglinide, qhov siab tshaj plaws txhua hnub koob yog 180 mg.

Yog tias koj tsis nco qab noj tshuaj kom ncav sijhawm, koj tsis tas yuav haus ob lub tshuaj nrog noj tom ntej, vim tias qhov no tuaj yeem ua rau ntshav qab zib tsawg.

Glinids thiab Meglitinides: kev txiav txim ntawm ntshav qab zib

Tau ntau xyoo tsis muaj kev vam meej nrog DIABETES?

Lub taub hau ntawm lub koom haum: “Koj yuav xav tsis thoob tias yoojyim kho mob ntshav qab zib li cas los ntawm kev noj tshuaj txhua hnub.

Cov hauv kev niaj hnub ntawm kev kho mob ntshav qab zib koom nrog kev siv tshuaj kho mob uas yog rau pab pawg sib txawv rau kev kho mob.

Txog hnub, rau ntau yam sib txawv ntawm cov tshuaj qab zib kom sawv ntsug hauv chaw muag tshuaj.

Cov tshuaj uas tsis muaj piam thaj tsuas yog siv yog tias tus neeg mob muaj hom 2 mob ntshav qab zib mellitus, uas tsis yog cov tshuaj insulin.

Txhua yam tshuaj rau cov tshuaj pharmacological hauv qab no:

1. Kev Loj Loj.
2. Glinidam.
3. Glitazone.
4. Alpha glucosidase inhibitors.
5. DPP-4 cov tshuaj tiv thaiv.
6. Sulfonamides.
7. Ua ke.

Cov pab pawg ntawm cov tshuaj loj nrog rau ib qho tshuaj - Metformin. Cov cuab yeej no tau siv txij li xyoo 1994. Qhov cuab yeej siv yog qhov feem ntau siv los txo cov suab thaj hauv lub cev.

Glitazones suav nrog ib qho tshuaj noj - Pioglitazone. Cov tshuaj yuav pab ua kom cov cell ua ke ntawm cov qe peripheral rau insulin thiab txhim kho tus nqi ntawm cov rog metabolism.

Alpha glucosidase inhibitors inhibit kev zom ntawm carbohydrates, tiv thaiv kom tsis txhob muaj cov piam thaj hauv ntshav plasma.

DPP-4 inhibitors cuam tshuam rau kev puas tsuaj ntawm glucagon-zoo li polypetide 1 (GLP-1) thiab inhibit qhov enzyme DPP-4.

Sulfanilamides yog siv los ua cov tshuaj uas muaj suab thaj thiab yog qhov nrov tshaj plaws. Qhov kev nqis tes ua ntawm cov tshuaj ntawm cov pab pawg no yog ua raws li kev ua kom cov txheej txheem ntawm cov kua dej los ntawm cov hlwb pancreatic. Tam sim no, 4 chav kawm ntawm sulfonamides tau raug tsim.

Cov tshuaj sib xyaw ua ke yog cov tshuaj uas muaj ntau cov kev ua haujlwm nquag nyob hauv lawv cov muaj pes tsawg leeg.

Glinids suav nrog ob qho tshuaj rau hauv lawv cov muaj pes tsawg leeg - Repaglinide thiab Nateglinide. Cov tshuaj muaj cov nyhuv txhawb rau hauv cov beta hlwb ntawm cov leeg ua pob ntawm cov leeg.

Ntxiv rau cov nyhuv suab thaj-qis, cov av xeb muaj lwm yam ntxiv:

• tsis pab txhawb rau koj qhov hnyav,
• thaum siv cov tshuaj ntawm cov pab pawg no hauv tus neeg mob, qhov ntxim nyiam ntawm lub qog ntshav qog tau txo qis ntau zaug nyob rau hauv kev sib piv nrog sulfonamides.

Zoo li txhua yam tshuaj, cov khoom nyob hauv pawg av nplaum muaj ntau qhov tsis zoo:

• thaum lawv siv, muaj sij hawm ntawm kev txhim kho hypoglycemia,
• Nws tsis pom zoo kom siv tshuaj kho mob yog tias tus neeg mob muaj qee cov kab mob siab.

Clinid tshuaj siv feem ntau siv los ua tus neeg sawv cev rau kev kho mob hom 2 mob ntshav qab zib mellitus.

Kev taw qhia thiab contraindications rau kev siv ntawm av nplaum

Lub ntsiab tseem ceeb rau kev siv av nplaum yog qhov pom ntawm hom II mob ntshav qab zib mellitus hauv tus neeg mob hauv qhov tsis muaj kev ua tau zoo los ntawm kev thov kev noj zaub mov noj thiab kev tawm dag zog.

Cov tshuaj koom nrog pab pawg no yog siv los txo cov suab thaj hauv tus neeg mob lub cev.

Ib yam li ib yam yeeb tshuaj twg, cov tshuaj noj rau cov pawg av nplaum muaj ntau tus lej sib kis rau siv.

Cov hauv kev siv rau cov av nplaum yog cov hauv qab no:

1. Lub xub ntiag ntawm hypersensitivity.
2. Muaj cov ntshav qab zib hom 1 hauv tus neeg mob.
3. Txoj kev loj hlob hauv lub cev ntawm cov mob uas xav tau kev kho mob insulin.
4. Lub xub ntiag ntawm cov mob tsis txaus ntseeg nyob rau hauv kev ua haujlwm ntawm lub raum thiab mob siab.
5. Lub caij nyoog ntawm kev xeeb tub thiab lub sijhawm pub mis.

Nws tsis pom zoo kom sau tshuaj rau glinids hauv cov neeg mob ntawm cov menyuam yaus thiab cov tub ntxhais hluas hnub nyoog qis dua 18 xyoo, tsis tas li ntawd, nws tsis pom zoo siv tshuaj rau kev kho mob ntshav qab zib rau cov neeg mob uas muaj hnub nyoog 75 xyoos.

Feem ntau cov kev mob tshwm sim ntawm kev siv hom tshuaj no yog:

• kev ua haujlwm ntawm lub cev ua haujlwm ntawm lub plab zom mov, ua kom pom tseeb ntawm cov tsos ntawm ntuav thiab cov kev xav ntawm xeev ntuav,
• Hauv qee kis, kev fab tshuaj tiv thaiv ua xua, tshwm sim hauv daim ntawv ntawm daim tawv nqaij ua pob
• qee zaum muaj kev hloov pauv ntawm kev hloov pauv.

Hauv qee kis, muaj qhov pom ntawm qhov muag, nrog los ntawm kev hloov pauv ntawm cov suab thaj hauv lub cev.

Lub tshuab ntawm kev txiav txim ntawm av nplaum

Glinides yog stimulants ntawm insulin ntau lawm. Cov tshuaj no txawv ntawm sulfonamides tsis yog tsuas yog structurally, tab sis kuj pharmacologically. Glinids tau tsim tawm los ua cov tshuaj uas pab ua kom rov qab los thiab nce tus naj npawb ntawm pancreatic hormone insulin ua los ntawm beta hlwb.

Glinids yuav tsum noj tshwj xeeb thaum noj mov, qhov no tso cai rau koj ua raws li kev noj haus ntau dua thaum piv rau kev noj haus thaum noj sulfonamides.

Meglitinides muaj lub luv luv ib nrab-lub neej, uas txo qhov ntxim nyiam ntawm kev txhim kho lub xeev hypoglycemic.

Lub sijhawm no, meglitinides suav nrog ob qho tshuaj noj - Nateglinide thiab Repaglinide.

Tus txheej txheem ntawm kev ua ntawm cov tshuaj yog raws li nws cov txiaj ntsig ntawm ATP-cov neeg nyob ntawm cov calcium uas tso tawm ntawm cov beta-cell daim nyias nyias. Qhov no ua rau depolarization ntawm daim nyias nyias thiab qhib ntawm calcium calcium. Tom qab kis kab mob rau cov ntaub so ntswg, cov tshuaj muaj ntau ntxiv hauv kev nkag mus ntawm calcium ions rau hauv hlwb los ntawm qhov chaw sib cais.

Kev nce ntxiv hauv cov concentration ntawm cov calcium hauv lub cell ua cov txheej txheem cov tshuaj insulin.

Cov kev sib txuas uas meglitinides ua nrog cell receptors tsis ruaj khov, yog li ntawd, cov txheej txheem tsim tau siv sijhawm luv luv.

Clinid npaj, thaum qhia rau hauv lub cev, ncav lub siab tshaj plaws nyob rau hauv cov ntshav ib teev tom qab kev tswj hwm. Lub bioavailability ntawm cov tshuaj yog hais txog 56%.

Kev tswj hwm ib txhij ntawm cov tshuaj nrog zaub mov tsis cuam tshuam rau lub sijhawm kom mus txog qhov siab tshaj plaws ntawm cov khoom sib txuam hauv cov ntshav, thiab qhov siab tshaj plaws ntawm cov tshuaj txuam nrog txo 20%. Glinides muaj peev xwm khi rau cov ntshav plasma protein, qib qhov khi tau ncav cuag 98%.

Ib nrab-lub neej ntawm cov tshuaj los ntawm lub cev yog kwv yees li ib teev.

Qhov tshem tawm ntawm kev npaj ntawm av nplaum pawg yog nqa tawm tsuas yog nrog quav. Nyob rau hauv txoj kev no, kwv yees li 90% ntawm cov metabolites tsim thaum lub cev metabolism yog tas. Ib qho ntxiv, kev tshem tawm ntawm cov tshuaj yog nqa tawm ib nrab los ntawm kev tso tawm hauv lub cev nrog zis.

Qhov tsis zoo ntawm hom tshuaj no yog qhov xav tau ntawm ntau cov tshuaj thoob plaws ib hnub thiab tus nqi siab ntawm cov tshuaj.

Kev siv cov tshuaj Starlix

Starlix yog ib yam tshuaj uas noj tam sim ntawd ua ntej noj mov hauv kev kho mob hom 2 mob ntshav qab zib mellitus. Lub sijhawm nruab nrab ntawm kev noj cov tshuaj thiab cov zaub mov yuav tsum tsis pub ntau tshaj 0.5 teev.

Thaum siv cov tshuaj rau kev kho mob monotherapy, ib koob tshuaj ib zaug ntawm 120 mg tau pom zoo. Cov tshuaj yuav tsum tau noj peb zaug ib hnub. Cov tshuaj yuav tsum tau noj ua ntej noj tshais, noj su thiab ua hmo.

Yog tias qhov kev pom zoo ntawm cov tshuaj tsis tso cai kom ua tiav cov txiaj ntsig uas xav tau, kev noj tshuaj ib zaug yuav raug nce ntxiv rau 180 mg.

Kev hloov pauv ntawm qhov muaj peev xwm ntawm cov tshuaj yog nqa tawm tsis tu ncua raws li cov txiaj ntsig tau los ntawm kev kuaj sim ntawm HbA1c ntsuas thiab glycemia ntsuas ib mus rau ob teev tom qab noj mov.

Starlix tuaj yeem, yog tias tsim nyog, yuav siv los ua txoj hauv kev kho kom zoo los ntawm hom 2 mob ntshav qab zib mellitus. Cov tshuaj tuaj yeem siv ua ke nrog metformin.

Thaum siv Starlix nrog rau Metformin, kev siv ib koob yuav tsum yog 120 mg peb zaug ib hnub. Cov tshuaj thaum lub sij hawm txoj kev kho yog npaum li cas ua ntej noj mov.

Nyob rau hauv qhov kev tshwm sim uas, thaum lub sijhawm ua haujlwm ntawm txoj kev kho mob nyuaj, HbA1c tus nqi ze lub cev qhov ntsuas pom tau hais tias, qhov koob tshuaj ntawm Starlix coj tau tuaj yeem txo mus txog qib 60 mg peb zaug hauv ib hnub ntawm kev txiav txim siab ntawm tus kws kho mob uas tuaj koom.

Kev siv ntawm cov tshuaj Novonorm

Cov tshuaj Novonorm yog yeeb tshuaj, uas suav nrog qhov tshuaj repaglinide nyob rau hauv qhov ntau npaum li cas ntawm 0.5, 1 lossis 2 mg yog qhov tseem ceeb cov khoom xyaw.

Thawj koob tshuaj rau kev kho ntshav qab zib yuav tsum yog 0.5 mg ntawm cov tshuaj sib txuas.

Kev nce ntxiv rau txoj cai tau tso cai tsis pub dhau 7-14 hnub tom qab pib siv cov tshuaj tsis tu ncua.

Yog tias kuaj kab mob siab nyob hauv tus neeg mob ntshav qab zib mellitus kuaj, HbA1c raug soj ntsuam ntau dua li ntawm 2 lub lis piam.

Txog kev kho mob pob qij txha, peb cov neeg nyeem tau siv DiabeNot siv tau zoo. Pom qhov nrov ntawm cov khoom no, peb tau txiav txim siab muab nws rau koj kom txaus siab.

Cov tshuaj tau tso cai rau siv nyob rau hauv cov tshuaj ntau kawg hauv qab no:

1. Ib koob tshuaj ib zaug ntawm cov tshuaj yuav tsum yog 4 mg ntawm cov tshuaj nquag.
2. Kev noj tshuaj txhua hnub yuav tsum tsis pub tshaj 16 mg.

Qhov zoo tshaj plaws lub sijhawm rau kev noj tshuaj yog 15 feeb ua ntej noj mov, tab sis nws tseem tuaj yeem noj cov tshuaj 30 feeb ua ntej noj cov zaub mov lossis tam sim ntawd ua ntej kev siv.

Yog tias ib pluas noj hla dhau los ntawm cov neeg mob, cov tshuaj yuav tsum tsis txhob noj.

Hauv kev siv ntawm kev noj mov ntxiv, ib qho tshuaj yuav tsum tau siv.

Qhov sib txawv tseem ceeb ntawm Starlix thiab Novonorm yog tias tom kawg muaj peev xwm txo cov ntshav qabzib tsis tsuas yog tom qab noj mov, tab sis kuj tseem nyob nruab nrab ntawm cov zaub mov zoo li no. Qhov no yog vim muaj peev xwm ntawm cov nquag koom nrog SUR receptor thiab tsim kev sib raug zoo ntxiv nrog nws.

Nws yuav tsum raug sau tseg tias Starlix muaj peev xwm ua rau muaj kev npau taws tsawg dua rau qhov pom ntawm cov cim ntawm kev txhim kho ntawm lub xeev hypoglycemic nyob rau hauv kev sib piv nrog Novonorm.

Clinide Phiv Sab Caum Thiab Kev Ceev Faj

Tom qab lub qhov ncauj tswj hwm, kev npaj rau cov pab pawg glinid pab txhawb cov txheej txheem ntawm cov tshuaj insulin thaum ntxov ntawm cov qe ntshav ntawm pancreatic nqaij rhiab rau qhov kev ua ntawm hom kev npaj no. Kev siv cov tshuaj no hauv kev ua txhaum cov lus qhia rau kev siv lossis cov lus pom zoo tau txais los ntawm tus kws kho mob endocrinologist tuaj yeem ua rau hom II mob ntshav qab zib mellitus, uas yog insulin-ywj siab cov kab mob endocrine ntawm cov tsos mob ntawm hypoglycemia.

Xws li cov nyhuv ntawm lub cev xav kom siv tshuaj tam sim ua ntej noj mov.

Ua raws li tag nrho cov kev cai thiab cov lus pom zoo thaum siv cov tshuaj muaj txiaj ntsig ua rau pawg av nplaum, nws tsis ua rau lub xeev hypoglycemic.

Cov tshuaj no zoo tshaj plaws thaum siv thaum ntxov ntawm kev txhim kho hom ntshav qab zib hom 2. Cov theem pib ntawm kev loj hlob ntawm tus kabmob tau raug cais los ntawm qhov tseeb tias nyob rau lub sijhawm no kev ua haujlwm ntawm lub hlwb pancreatic, uas yog lub luag haujlwm rau cov synthesis ntawm insulin, yog khaws cia.

Qhov ntxim nyiam ntawm kev txhim kho lub xeev hypoglycemic nyob rau hauv lub cev ntawm tus neeg mob nrog tus mob ntshav qab zib hom 2 yuav luag sib luag ntawm cov xwm txheej ntawm tus mob ntshav qab zib nrog kev siv sulfonylurea derivatives muaj lub sijhawm luv luv ntawm kev ua.

Thaum siv cov kev npaj ntawm cov av nplaum, yuav tsum tau saib xyuas tshwj xeeb yog tias tus neeg mob lub siab tsis ua haujlwm. Qhov no yog vim muaj qhov tseeb tias cov metabolism hauv lub ntsiab tseem ceeb ntawm cov tshuaj yog nqa tawm hauv daim siab ua haujlwm. Ob qho tshuaj uas zwm rau cov pab pawg no khi rau cytochrome P-350, uas hais txog cov khoom siv hauv lub siab ua haujlwm tiv thaiv kab mob siab.

Kev ceev faj yuav tsum tau siv thaum siv tshuaj yeeb nyob rau hauv ib qho xwm txheej uas nws tsis muaj peev xwm ua tau kom tswj tau theem ntawm glycemia hauv lub cev. Cov xwm txheej zoo li no yuav yog kev txhim kho kev kis mob hauv lub cev, kev ua rau mob hnyav, thaum phais mob. Yog tias qhov xwm txheej no tshwm sim, kev siv tshuaj yuav tsum tau txiav tawm thiab hloov mus rau kev siv cov tshuaj insulin.

Cov ntaub ntawv hais txog cov tshuaj uas siv los kho ntshav qab zib tau teev tseg hauv video hauv tsab xov xwm no.

Hom Insulin

Kev lag luam kws tshuaj tau muab cov neeg mob tsis tsuas yog lub sijhawm luv luv, tshuaj tiv thaiv kab mob, tabsis kuj muaj kev ua haujlwm ntev thiab nruab nrab, tsiaj, tib neeg kev tsim hluav taws xob. Rau kev kho mob ntawm thawj thiab hom thib ob ntawm ntshav qab zib mellitus, endocrinologist qhia rau cov neeg mob, nyob ntawm daim ntawv, theem ntawm tus kab mob, ntau hom tshuaj, cim los ntawm lub sijhawm ntawm kis, pib thiab ncov kev ua si.

Cov ntsiab lus nthuav tawm tseeb: Thawj thawj zaug, xyoo 1921, insulin tau cais tawm ntawm cov leeg txiv ntoo ntawm cov nyuj. Lub Ib Hlis hauv qab no yog cim los ntawm kev pib soj ntsuam cov tshuaj hormones hauv tib neeg. Xyoo 1923, qhov kev ua tau zoo tshaj plaws ntawm cov kws tshuaj tau raug muab tsub rau lub Nobel nqi zog.

Hom insulin thiab lawv cov kev txiav txim ntawm tes (rooj):

Yuav txiav txim siab li cas thaum tswj hwm, siv tshuaj dabtsi, ntau hom tshuaj insulin? Tsuas yog tus kws endocrinologist thiaj tuaj yeem teb cov lus nug no. Tsis txhob muab tshuaj rau tus kheej noj hauv txhua kis.

Cov yam ntxwv ntawm kev ua ntawm luv luv insulin

Lub cev noj qab haus huv tsim cov tshuaj hormones, ib txwm nyob hauv cov qe hlwb ntawm cov islet ntawm Langerhans ntawm lub txiav. Lub cev tsis zoo ua rau cov tshuaj tiv thaiv ua rau lub cev ua haujlwm tsis zoo, ua rau lub cev hauv lub cev tsis ua haujlwm hauv txhua lub cev thiab ua rau cov ntshav qab zib. Ntawm cov theem pib ntawm kev loj hlob ntawm tus kabmob, cov neeg mob feem ntau tau sau luv luv ua haujlwm insulins.

1. Cov tshuaj insulin luv muaj qhov pib qeeb (ntawm 20 txog 40 feeb), yog li qee lub sijhawm yuav tsum dhau ntawm kev txhaj tshuaj ntawm lub cev thiab noj mov.
2. Tus nqi ntawm cov khoom noj uas yuav tsum tau noj tom qab muaj cov tshuaj insulin sai sai yuav tsum tsim nyog rau cov koob tshuaj ntawm cov tshuaj. Nyob rau hauv tsis muaj ib yam dab tsi yuav tsum koj hloov qhov kev pom zoo ntawm cov khoom noj. Cov zaub mov ntau tuaj yeem ua rau hyperglycemia, tsawg dua rau kev mob ntshav qab zib tsawg.
3. Cov lus qhia ntawm luv luv ua yeeb yam xav tau cov khoom noj txom ncauj - tom qab 2-3 teev muaj lub ncov siab nyob rau hauv kev ua ntawm cov tshuaj, yog li lub cev xav tau carbohydrates.

Xyuam Xim: Lub sijhawm rau kev suav lub sijhawm thiab koob tshuaj yog qhia txog - cov neeg mob muaj lawv tus kheej tus yam ntxwv ntawm lub cev. Yog li ntawd, cov koob tshuaj thiab lub sijhawm tau txiav txim los ntawm tus kws kho mob endocrinologist ib tus zuj zus rau txhua tus neeg mob.

Kev txhaj tshuaj yuav tsum tau txhaj tsuas yog siv cov tshuaj tsis muaj zog insulin thiab tsuas yog nyob rau lub sijhawm tshwj xeeb. Cov tshuaj yog muab tshuaj subcutaneously, qee zaum intramuscularly. Tsuas yog qhov chaw txhaj tshuaj tuaj yeem hloov me ntsis, uas tsis tas yuav tsum tau zaws tom qab txhaj tshuaj kom cov tshuaj ntws zoo rau hauv cov ntshav.

Nws yog ib qho tseem ceeb heev uas tus neeg mob tsis tau hloov mus rau tus kws kho mob koom nrog cov txheej txheem ntawm kev tshuaj xyuas tas li, nws tus kheej saib xyuas nws kev noj zaub mov zoo thiab kev ua neej.

• cov tshuaj insulin sai sai rau kev nqus ntawm cov suab thaj,
• Cov tshuaj pab txhawb kev tso tawm tswj hwm qee qib ntawm cov tshuaj hormones hauv cov hlab ntshav.

Yuav ua li cas cais ntawm nws tus kheej laij lub sijhawm

• koj yuav tsum nkag mus rau lub koob tshuaj ntawm 45 feeb ua ntej noj,
• saib xyuas cov piam thaj hauv tsib feeb txhua tsib feeb,
• yog tias cov piam thaj hauv cov piam thaj poob 0.3 hli, koj yuav tsum ua zaub mov noj tam sim ntawd.

Kev suav kom paub tseeb txoj kev tswj hwm ntawm txoj kev loj hlob coj los ua rau kev kho mob ntshav qab zib mellitus thiab kev tiv thaiv ntawm cov teeb meem. Qhov koob tshuaj insulin npaj rau cov laus yog los ntawm 8 tus PIECES txog 24 PIECES, rau cov menyuam yaus - tsis ntau tshaj 8 PIECES ib hnub.

Cov Yuav Tsum Muaj

Zoo li ib yam tshuaj twg, insulin ceev muaj contraindications thiab phiv.

• kab mob siab, mob tawm ntawm lub plab thiab hauv plab,
• nephrolithiasis, jade,
• qee qhov kev kho plawv.

Cov kev mob tshwm sim tsis zoo yog ua txhaum kev haus ntau npaum li cas: kev ua kom lub cev tsis muaj zog, tawm hws ntau, salivation, mob hauv lub plab, muaj qhov tsis haum nrog tsis nco qab, tsis nco qab lawm.

Luv Khoom Insulin Me Me

Yuav ua li cas tsis txhob ntxhov siab los ntawm cov npe ntawm cov tshuaj zoo sib xws hauv lub tsev muag tshuaj? Kev siv tshuaj insulin sai, tib neeg lossis lawv cov analogues, yog qhov sib hloov pauv tau:

Xaus

Cov tshuaj insulin luv luv yog cov tshuaj uas tus kws kho mob endocrinologist kho ntshav qab zib. Txhawm rau cov kev kho mob kom ua tau zoo thiab tsis coj ua kev puas tsuaj rau hauv daim ntawv ntawm hypo- hyperglycemia, nruj me ntsis raws li cov koob tshuaj, lub sijhawm siv, kev tswj hwm khoom noj. Hloov cov tshuaj nrog analogues tsuas yog tom qab sab laj nrog kws kho mob. Nws yog ib qho tseem ceeb ntawm nws tus kheej txheeb xyuas theem ntawm cov piam thaj hauv cov ntshav, qee zaus ntsuas kev ntsuas, thiab kho kev tiv thaiv thiab ntsuas kev kho mob.

Nta ntawm thiazolidinediones

Thiazolidinediones, hauv lwm lo lus glitazones, yog ib pawg ntawm cov tshuaj qab zib uas muaj lub hom phiaj txhawm rau nce cov kev lom neeg ntawm cov tshuaj insulin. Txog kev kho mob ntshav qab zib mellitus tau pib siv tsis ntev los no - txij li xyoo 1996 los. Tau coj tawm nruj raws li kws kho mob hais.

Glitazones, ntxiv rau kev txiav txim siab hypoglycemic, muaj cov txiaj ntsig zoo ntawm lub plawv hlab plawv. Cov kev ua hauv qab no tau pom: antithrombotic, antiatherogenic, tiv thaiv. Thaum noj thiazolidinediones, qib ntawm glycated hemoglobin poob qis rau nruab nrab li 1.5%, thiab qib ntawm HDL nce.

Kev kho mob nrog cov tshuaj ntawm chav kawm no tsis muaj tsawg dua li kev kho nrog Metformin. Tab sis lawv tsis siv nyob rau theem pib nrog hom 2 mob ntshav qab zib. Qhov no yog vim qhov loj heev ntawm kev phiv thiab tus nqi siab. Niaj hnub no, glitazones raug siv los txo qis glycemia nrog sulfonylurea derivatives thiab metformin. Lawv tuaj yeem raug sau ob leeg sib cais nrog txhua cov tshuaj, thiab sib xyaw.

Qhov zoo thiab qhov tsis zoo

Ntawm cov yam ntxwv ntawm cov tshuaj muaj qhov zoo thiab tsis zoo:

• nce lub cev hnyav los ntawm 2 kg ntawm qhov nruab nrab,
• Cov npe loj ntawm cov kev mob tshwm sim
• Txhim kho lipid profile
• Kev cuam tshuam zoo rau insulin tsis kam
• txo qis kev ua haujlwm qis dua piv rau metformin, sulfonylurea derivatives,
• txo cov ntshav siab
• txo cov xwm txheej cuam tshuam rau kev txhim kho atherosclerosis,
• khaws cov kua dej, thiab raws li qhov tshwm sim, kev pheej hmoo ntawm lub plawv tsis tuaj yeem nce,
• txo qhov ceev cov pob txha, nce qhov kev pheej hmoo ntawm pob txha lov,
• hepatotoxicity.

Mechanism ntawm kev ua

Thiazolidinediones ua rau cov receptors, uas ua kom qhov kev faib tawm thiab kom muaj zog ntawm cov piam thaj los ntawm hlwb. Kev ua ntawm cov tshuaj hormones hauv lub siab, adipose cov nqaij thiab cov leeg txhim kho. Ntxiv mus, qhov cuam tshuam rau theem ntawm ob lub cim kawg tseem muaj ntau dua.

Glitazones tsis txhawb kev tsim cov tshuaj insulin los ntawm pancreatic cells-hlwb.Qhov kev txo qis hauv kev ua tiav yog ua tiav los ntawm kev txo qis cov tshuaj insulin ntawm cov ntaub so ntswg thiab kev siv cov kua nplaum ntau los ntawm cov ntaub so ntswg. Cov piam thaj-ua kom qis dua, raws li txoj cai, tshwm sim maj. Kev noj cov ntshav qabzib tsawg kawg yog pom tsuas yog tom qab ob lub hlis twg. Kev kho nrog nrog qhov hnyav nce.

Muaj kev txhim kho hauv kev tswj cov zom zaub mov kom muaj ntshav qab zib kom tsawg. Thaum ua ke nrog metformin thiab sulfonylurea derivatives, glycemic tswj tau txhim kho hauv cov neeg mob ntshav qab zib hom 2, nrog rau cov tseem ceeb hauv cov ntshav plasma hormone ntau ntau. Glitazones ua dab tsi tsuas yog muaj cov tshuaj insulin.

Cov tshuaj Pharmacokinetic yuav txawv nyob ntawm cov tshuaj. Tsis txhob cuam tshuam rau lawv tus tub los ntxhais thiab hnub nyoog ntawm tus neeg mob. Nrog rau daim siab puas hauv cov neeg mob, nws hloov cov chaw muag tshuaj.

Kev taw qhia thiab contraindications

Thiazolidinediones yog kho rau cov ntshav qab zib tsis yog insulin-mob ntshav qab zib (ntshav qab zib hom 2):

• raws li kev kho mob rau cov neeg mob uas tswj cov qib glycemia tsis siv tshuaj (noj zaub mov thiab ua si lub cev),
• raws li kev kho ob yam nyob rau hauv nrog sulfonylurea npaj,
• raws li kev kho mob dual nrog metformin rau kev tswj glycemic txaus,
• raws li triple kev kho mob ntawm "glitazone + metformin + sulfonylurea",
• ua ke nrog tshuaj insulin
• ua ke nrog cov tshuaj insulin thiab metformin.

Ntawm cov contraindications kom noj tshuaj:

• ib tug neeg intolerance,
• cev xeeb tub / lactation,
• hnub nyoog txog 18 xyoo
• daim siab ua haujlwm - mob hnyav thiab mob nyhav,
• lub plawv dhia tsis zoo
• lub raum tsis ua haujlwm yog mob hnyav.

Video qhuab qhia ntawm kev npaj ntawm thiazolidinedione pab pawg:

Sab sij huam

Ntawm cov kev mob tshwm sim tom qab noj thiazolidinediones yog:

• rau cov poj niam - coj khaub ncaws tsis xwm yeem,
• kev txhim kho lub plawv tsis ua haujlwm,
• ua txhaum cai ntawm qhov xwm txheej hormonal,
• nce qib ntawm daim siab enzymes,
• anemia
• ntshav qab zib,
• hypercholesterolemia,
• mob taub hau thiab kiv taub hau,
• hnyav
• nce qab los noj mov
• mob plab, kiv,
• daim tawv nqaij ua pob, tshwj xeeb, urticaria,
• o tuaj
• muaj zog rog ntau zuj zus
• pom kev pom
• benign formations - polyps thiab hlwv,
• sab sauv ntawm txoj hlab ua pa tuaj.

Hauv chav kawm ntawm kev kho, qhov hnyav thiab cov paib tau raug saib xyuas uas qhia tau hais tias muaj kua paim rov qab los. Kev kuaj xyuas lub siab ua haujlwm. Tau haus ntau hauv cov cawv cov cawv tsis cuam tshuam dab tsi rau kev tswj glycemic.

Tsuas tshuaj, txoj kev ntawm kev coj

Glitazones raug coj tawm yam tsis hais txog zaub mov. Dosage kev kho rau cov neeg laus nrog kev sib txawv me me hauv daim siab / ob lub raum tsis tau nqa tawm. Cov ntawv tom kawg ntawm cov neeg mob tau sau tseg kom tsawg dua ntawm cov tshuaj txhua hnub. Cov koob tshuaj yog txiav txim los ntawm tus kws kho mob ib leeg zuj zus.

Lub sijhawm pib ntawm kev kho mob pib nrog qhov txhaj tshuaj tsawg. Yog tias tsim nyog, nws yog nce nyob rau hauv ntau ntau nyob ntawm cov tshuaj. Thaum ua ke nrog cov tshuaj insulin, nws txoj kev noj tshuaj tsis hloov pauv lossis txo qis nrog cov lus ceeb toom ntawm kev mob hypoglycemic.

Thiazolidinedione Cov Npe Tshuaj

Ob tus neeg sawv cev ntawm glitazone muaj nyob rau ntawm cov chaw muag tshuaj hnub no - rosiglitazone thiab pioglitazone. Thawj thawj hauv cov pab pawg yog troglitazone - nws tau sai sai vim tias kev txhim kho ntawm daim siab mob siab.

Cov tshuaj raws rosiglitazone suav nrog cov hauv qab no:

• 4 mg avandia - Spain,
• 4 mg Diagnitazone - Ukraine,
• Roglit ntawm 2 mg thiab 4 mg - Hungary.

Piogitazone-based tshuaj muaj xws li:

• Glutazone 15 mg, 30 mg, 45 mg - Ukraine,
• Nilgar 15 mg, 30 mg - Is Nrias teb,
• Dropia-Sanovel 15 mg, 30 mg - Qaib Cov Txwv,
• Pioglar 15 mg, 30 mg - Is Nrias teb,
• Pyosis 15 mg thiab 30 mg - Is Nrias teb.

Kev cuam tshuam nrog lwm yam tshuaj

1. Rosiglitazone. Kev haus cawv tsis cuam tshuam rau kev tswj glycemic. Tsis muaj qhov cuam tshuam loj nrog cov ntsiav tshuaj tiv thaiv kab mob, Nifedipine, Digoxin, Warfarin.
2. Pioglitazone. Thaum ua ke nrog rifampicin, cov nyhuv ntawm pioglitazone tsawg dua. Tej zaum qhov poob qis hauv kev ua haujlwm zoo thaum siv tshuaj ntsiav. Thaum siv ketoconazole, glycemic tswj feem ntau tsim nyog.

Thiazolidinediones tsis tsuas txo cov suab thaj kom tsawg, tab sis kuj tseem muaj cov txiaj ntsig zoo ntawm cov hlab plawv. Ntxiv rau qhov zoo, lawv muaj ib tug xov tooj ntawm qhov tsis zoo, feem ntau ntawm cov uas yog kev txhim kho lub plawv tsis ua hauj lwm thiab txo pob txha lub cev.

Lawv nquag siv hauv kev kho nyuaj, siv cov thiazolidinediones rau kev tiv thaiv kev txhim kho tus kab mob yuav tsum muaj kev kawm ntxiv.