Isinyathelo sokuqala ekulawuleni ushukela wegazi kukufumana imfundo yokulawula ulawulo lwe-diabetes ukuze ukwazi ukuqonda izinto eziphambili ezinokukunceda ukuphumeza ukulawula i-sugar sugar. Ngokuxhomekeke ekuphakanyeni kwakho i-sugar suars ephakamileyo, umgca wokuqala wonyango uguqula indlela yokuphila-ukutya ukutya okunokulinganisela kwe-carbohydrates, ukuzivocavoca ngokwaneleyo kunye nokulahleka kwesisindo ngamanyathelo abalulekileyo ekuphumezeni ukulawula iswekile.
Nokuba utshintsho oluncinci lunokwenza ukubahluko omkhulu. Kodwa, kukho ithuba, kuya kufuneka uthabathe amayeza ukuba ufumane i-sugar suars.
Ukuba ushukela wakho wegazi lihlala liphakamileyo ixesha elide, unakho ukwanda komngcipheko wokuba neengxaki zesifo sikashukela ezifana nokuhlaselwa yintliziyo, ukubetha, ukulimala kweentso, ukuphosa, kunye nokuchithwa. Ukugcina ushukela wegazi kwindawo elungileyo kunokunciphisa okanye kwandise ithuba lakho leengxaki.
I-American Diabetes ine-algorithm ekufuneka ikhethwe ngayo imithi. Kukho abameli bokuqala, umgca wesibini, njalo njalo. Isifo sikashukela sichaphazeleka kakhulu kwiiklasi-bonke benza izinto ezahlukeneyo kwaye banokuhluka kakhulu. Kubalulekile ukuba ugqirha wakho agcine engqondweni-impilo yakho yonke, ubunzima, indlela yokuphila kunye nesimo sezoqoqosho phambi kokumisela unyango.
Iinkcukacha Ngokukhawuleza NgeMiyeza yeSifo sikashukela
- Iindidi ezahlukeneyo zonyango lwe-diabetes zisebenza kwiindawo ezithile zomzimba wakho ukulawula iswekile yegazi (i-blood glucose).
- Maxa wambi amayeza angaphezu kweyodwa adingekayo ukulawula iswekile yegazi. Kule meko unako ukuthatha inxube yamachiza okanye iintlobo ezimbini ezahlukeneyo zamachiza.
- Ukudibanisa iindidi ezimbini zonyango ngamanye amaxesha kungenza kube lula ukuba iswekile legazi lakho liye lahla kakhulu (u-hypoglycemia).
- Amanye amayeza enesifo sikashukela angenza uzuze umzimba. Ukuba ukhuluphele, ezi ntlobo zonyango azizona ezifanelekileyo kuba ubunzima obuninzi buyingxaki yengozi ye-sugars ephezulu yegazi.
- Amanye amayeza enesifo sikashukela ayinayo (kodwa ayikho i-insulin) kwaye inokukunceda ukuphumeza ukulawula iswekile yegazi kunye nokulahleka kwesisindo.
- Akuqhelekanga kubantu abanesifo sikashukela ixesha elide ukuba banqunywe i-insulin.
Imithi ekhoyo yomlomo
Apha sijonge iiklasi ezisixhenxe zemilomo yomlomo yokonyango lwesifo seswekile kunye nokudibanisa kwezilwanyana ezivela kwiiklasi ezahlukeneyo:
Biguanides
I-Metformin, i-biguanide, ihlala isisigxina esisetyenziswa kakhulu kwisigaba sokuqala sesi-2 se-diabetes.
Biguanides zifumaneka ziquka:
- Ngomnye
- Glucophage
- Glucophage XR
- Glumetza
- Riomet (iLiquid Metformin)
Imiphumo emibi engenzekayo ye-biguanides ifaka oku kulandelayo:
- isicongconi, isifo sohudo okanye isisu esisiphazamisayo xa uqale uthabatha olu hlobo lweyeza-ezi ziphumo zempembelelo ziya kuhamba emva kwexesha
- kunqabile, imeko ebalulekileyo ebizwa ngokuthi i-lactic acidosis
Sulfonylureas
I-Sulfonylureas ivuselela i-pancreas ukwenza i-insulin engaphezulu, encedisa ukunciphisa igazi lakho i-glucose. Baye bahlala ixesha elide kwaye badla ngokusetyenziswa njenge-arhente yesibini ukunceda ukunciphisa iishukela zegazi ngexesha lokutya. Zifanele zisetyenziswe ngokulumkileyo kuba sele zikhulile ngenxa yokuba le nxaxheba iyingozi enkulu yokuphucula iishukela eziphantsi kwegazi.
I-sulfonylureas ifumaneka:
- Glimepiride (Amaryl)
- I-Glyburide (i-Diabeta, iMicronase)
- I-Glipizide (i-Glucotrol, i-Glucotrol XL)
Imiphumo emibi engenzekayo ye-sulfonylureas ibandakanya oku kulandelayo:
- i-blood glucose ephantsi
- isisu esimoshakele
- ukugqithisa kwesikhumba
- ukutyeba kwakho
I-Alpha-Glucosidase Inhibitors
I-Alpha-glucosidase inhibitors isebenza ngokunciphisa ukugaya ukutya okuphezulu kwi-carbohydrate, njengerayisi, iitapile, isonka, ubisi kunye neziqhamo. Ukufumaneka kwe-alpha-glucosidase inhibitors kufaka:
- Miglitol (Glyset)
- Acarbose (Precose)
Imiphumo emibi ekhoyo ye-alpha-glucosidase inhibitors yile:
- intlungu yesisu, i-gas, bloating, okanye isifo sohudo-ezi zibonakaliso ziyahamba emva kokuba uthathe la mapilisi ngexesha elithile
Thiazolidinediones
I-Thiazolidinediones yenza ukuba ukhululeke kakhulu kwi-insulin. I-thiazolidinediones ekhoyo iquka:
- Actos (pioglitazone)
- Avandia (rosiglitazone)
Ukuba unesifo senhliziyo, akufanele uthathe lolu hlobo lwepilisi. Olu hlobo lwepilisi lunokubangela ukuba i- congestive heart failure or make worse. Izifundo zibonise ukuba u-Avandia unxulumene nobungozi obuninzi bokuhlaselwa kwentliziyo kunye nentlungu yesifuba okanye ukungahambi kakuhle kwimithambo yegazi.
NgoSeptemba 2010, i-FDA inqande ukusetyenziswa kwe-Avandia kunye nayiphi na inhlanganisela yeziyobisi kuquka i-Avandia ngenxa yokwanda kwengozi yomzimba. I-FDA ihoxise ezinye zezithintelo ngo-2013, kunye nezinye ngo-2015, njengesiphumo sezilingo zamachiza ezintsha (ngokukodwa ityala le-RECORD). Nangona kunjalo, nangona kutholakala e-US, oogqirha abaninzi banqanda ukumisela i-Avandia. Enyanisweni, izigulane ezintsha kufuneka zibekwe iAvandia kuphela xa zingenakukwazi ukuphumeza ukulawula i-glucose ukuthatha naziphi na ezinye iziyobisi. Ukongezelela, i-Actos yiyonyango ekhethiweyo kule klasi kwizigulane ezintsha.
Ukuba ngoku uthabatha u-Avandia kwaye uzuza kulo mayeza, unokukwazi ukuqhubeka uyithatha; Nangona kunjalo, kufuneka uxoxe ngale ndlela kunye nodokotela wakho. Ukuba awukwenzi oko, kuyimfuneko ukuba udibane nodokotela wakho kwaye uxoxe nayiphi na ingozi ehambelana nayo.
Imiphumo emibi engenzekayo ye-thiazolidinediones iquka:
- Ukungaphumeleli kwentliziyo yintliziyo yinkalo ebalulekileyo kakhulu
- i-anemia
- ingozi eyongeziweyo yokukhulelwa nokuba ngaba uthatha iipilisi zokulawula ukuzala
- ukwanda komngcipheko weethambo kubasetyhini
Meglitinides
I-Meglitinides zifana ne-sulfonylureas kuba zandisa imveliso ye-insulin, kodwa zenza okufutshane. Ezi zonyango zilungele izigulane ezidala ezifuna uncedo ngokunciphisa i-sugars-time sugar. Nangona kunjalo, kufuneka bathathwe kathathu ngosuku kwaye kunzima ukuthobela.
- Prandin (Repaglinide)
- Starlix (Nateglinide)
Imiphumo emihle eyenzekayo yePrandin iquka:
- i-blood glucose ephantsi
- ukutyeba kwakho
- isisu esimoshakele
- intlungu okanye intloko
DPP4 Inhibitors
I-DPP4 Inhibitors isetyenziselwa njenge-arhente yomgca wesibini ukunceda isishukela esilandelayo emva kokutya. I-DPP4 Inhibitors inciphisa i-blood glucose yakho ngokunceda umzimba wakho wenze insulin xa kufuneka, ngakumbi emva kokutya. Kwakhona kunceda ukugcina isibindi sakho ngokubeka i-glucose egciniweyo kwigazi lakho. DPP4 Inhibitors ziquka:
- Januvia (Sitagliptin)
- Trajenta (Linagliptin)
- Onglyza (Saxagliptin)
- Nesina (Alogliptin)
Imiphumo emibi ingenzeka:
- usulelo oluphezulu lokuphefumula
- impumlo enemifinya
- umqala obuhkungu
- intloko
SLGT-2 Inhibitors
Usebenza ngeentso zakho ukunceda ukususa i-glucose engaphezulu (ushukela) emzimbeni wakho xa uchama. I-SLGT-2 Inhibitors ziquka:
- Canagliflozin (i-Invokana®)
- Dapagliflozin (Farxiga®)
- Empagliflozin (Jardiance®)
Iziphumo ezichaphazelekayo ezichaphazelekayo zibandakanya:
- Usulelo lwe-Urinary okanye i-leaven infections
- ukupheliswa kwamanzi
- nomhlaza wesisu
- I-Canaglifozin inokunyusa umngcipheko wokugxothwa, kodwa inganciphisa ingozi yesifo senhliziyo
Iipilisi zeSwekile
Iipilisi zokudibanisa ziqulethe iintlobo ezimbini ezahlukeneyo zesifo seswekile. Uninzi lweepilisi ezidibeneyo ziyafumaneka, kuquka:
Actoplus Met (pioglitazone / metformin)
I-Avandamet (rosiglitazone / metformin)
Avandaryl (rosiglitazone / glimepiride)
I-Duetact (pioglitazone / glimepiride).
I-Glucovance (glyburide / metformin)
Glyxambi (i-jardiance / i-tradjenta)
I-Invokamet (canagliflozin / metformin HCl)
UJanumet noJanumet (XR) (sitagliptin / metformin).
Jentadueto ( linagliptin / metformin HCl)
Juvisync (sitagliptin kunye neSimvastatin)
Kazano (alogliptin / metformin)
I-Kombiglyze XR (saxagliptin / metformin)
I-Metaglip (glipizide / metformin).
Oseni (alogliptin / pioglitazone)
I-Synjardi (i-metformin / i-jardiance)
Xigudo XR ( dapagliflozin / metformin HCl)
Izilwanyana ezingenayo i-Insulin: i-GLP-1 Agonists
I-GLP-1 i-agonists ye-receptor yindlela yokungaxilisi i-insulin yonyango ekhuselweyo eyenziwa kakhulu kwaye idumile, eyenza indlela yayo ibe yindlela yokunyamekela nokunyamekela isifo sikashukela. Izifundo ziye zabonisa ukuba ezi ntlobo zamachiza, xa zisetyenziselwa ukudibanisa nokutya kunye nokuzilolonga, kokubambisana okufutshane kunye nokusebenza kwexesha elide, kunceda izigulane ezine-type 2 zesifo sikashukela zinciphisa umzimba, zinciphise i-hemoglobin A1C (i-average average month of their blood sugar), kunye ezinokunciphisa izinga lokufa kwe-cardiovascular death. Ezi ntlobo zonyango azisebenziswanga njengonyango lokuqala, kodwa zingasetyenziswa ngokubambisana namachiza omlomo kwaye ziboniswe zingekho phantsi kweerimim enjenge-basal insulin (i-insulin esebenza ixesha elide), kunye ne-GLP-1 agonist i-basal insulin, kunye ne-insulin esebenza ngokukhawuleza.
I-GLP-1 i-agonists ivuselela ukukhutshwa kwe-insulin ekuxhaseni i-glucose, eyanciphisa i-sugar post post. Baye benza isisu, ubuchopho, i-pancreas kunye nesibindi ukwandisa iimvakalelo zokuzaliseka ezikhuthaza ukulahleka kwesisindo.
Kukho abambalwa abakwenzayo kunye ne-AGP-1 agonists esebenza ixesha elide. Ezinye zijojowe kanye okanye kabini imihla ngemihla kunye nabanye kanye ngeveki. Uninzi lwale meko lwamachiza luyaqhubeka luya kuvunywa yi-FDA kwaye siza kuqhubeka sijonge ezi zivunyiweyo.
Ezinye zezi ziquka:
- Byetta (Exenatide): injected kabini imihla ngemihla.
- UVictoza (Liraglutide): inject once once.
- I-Adlyxin (Lixisenatide): inject once once.
I-Bydureon (iqhube ifom ye-Byetta yexesha elide) injected kanye ngeveki.
- I-Tanzeum (Albiglutide): injected kanye ngeveki.
- I-Trulicity (iDulaglitide): injected kanye ngeveki.
- I-Ozembic (i-Semaglutide) - ifunyenwe imvume ye-FDA nje nge-weekly injection, kodwa ayifumaneki okwamanje
Iziphumo ezinokwenzeka:
- isicongconi, ukuhlanza, isifo sohudo (esivamile kunye nama-agent agcinisayo)
- Izifundo zentonga zibonise umngcipheko ophezulu kwiisilini ze-c-cells
- ncipheko encinci yokwanda kwe-pancreatitis
Indlela yokwazi ukuba yiyiphi imishanguzo yesifo sikashukela sokuthatha
Ngenxa yenani elikhulu lamachiza afumanekayo kunyango lwesifo sikashukela, unokudideka malunga naluphi unyango olungcono kuwe.
Umbutho we-American Diabetes Association (ADA) kunye ne-American Association of Clinical Endocrinologists (AACE) sele iqulunqe izilungiso ngokusekelwe kwimimiselo ethile, njengokuba ubudala, ubude besifo sikashukela, ukulawula i-blood glucose kunye neminye imiba yezempilo ukunceda amayeza kunye nezigulane zabo ukuba zichongaphi na amayeza lu ngileyo. Ngamanye amaxesha, ungaqala ngamachiza omnye, kuphela ukuba uqaphele ukuba ayisebenzi kakuhle kwaye uza kufuneka ungeze olunye uhlobo okanye utshintshe ngokupheleleyo. Ugqirha wakho uza kusebenza nawe ukufumanisa isilwanyana esifanelekileyo okanye ukudibanisa iziyobisi kuye kuxhomekeke kwiimeko zakho. Kulo xesha, kubalulekile ukuba wenze ukuguqulwa kwendlela yokuphila, njengokutya ukutya okunempilo nokwenza iqondo lokusebenzisa imihla ngemihla. Isifo seswekile sisetyenziselwa ukuba sibe nesigxina ekudleni nasekusebenziseni umzimba kwaye ukuba ukutshintsha kwendlela yokuphila kungeyenziwe, imithi iya kufuneka ikhutshwe ize ifakwe. Ukufumana ulwazi oluthe xaxa malunga nokuba kutheni, nini, kwaye ungathabatha njani imishanguzo yakho yeswekile: Yonke malunga neMil
Kuthiwani Nge-Insulin?
Abantu abanesifo sikashukela ixesha elide okanye abo abangakwazi ukulawula iishukela zabo zegazi kunye ne-oral or non-insulin injectables bangadinga ukuthatha i-insulin ukulawula iishukela zegazi. Ngamanye amaxesha i-insulin iyaziswa kwi-regimen yomntu wesifo sikashukela kwaye emva kokuba abantu beqhekeza i-glucose toxicity i-regimen ingenziwa lula. Ukufumana ulwazi olungakumbi malunga nendlela ezahlukahlukeneyo zokusebenza kwe-insulin: Zinjani iintlobo zee-insulini?
> Imithombo:
> I-American Diabetes Association. ImiGangatho yoLondolozo lwezoNyango kwiSwekile-2017. 2017 Jan; 38 (iSiza 1): S1-132.
> Jonas D, Van Scoyoc E, uGerrald K, et al. I-Portland (OR): IYunivesithi yezeMpilo neYunivesithi yaseOregon.