Mohato oa pele oa ho laola tsoekere ea hau ea mali ke ho fumana thuto ea boithati ea ho itlhokomela e le hore u utloisise lintlha tsa motheo tse ka u thusang ho finyella ts'ebetsong ea tsoekere e ntle ea mali. Ho itšetlehile ka hore na tsoekere ea mali ea hau e phahame hakae, moeli oa pele oa phekolo ke phetoho ea bophelo-ho ja lijo tse nang le phepo e nepahetseng ea lik'habohaedreite, ho ikoetlisa ka ho lekaneng le ho lahleheloa ke boima ke mehato e boima bakeng sa ho finyella tšelo ea tsoekere ea mali.
Esita le liphetoho tse nyenyane li ka etsa phapang e khōlō. Empa, ho na le monyetla, o tla hloka ho noa meriana hore o laole tsoekere ea mali.
Haeba tsoekere ea hao ea mali e lula e le telele ka nako e telele, u ka 'na ua ba le kotsing e eketsehileng ea ho hlaheloa ke mathata a tsoekere a kang lefu la pelo, ho otloa ke pelo, ho senyeha ha liphio, ho foufala le ho khethoa. Ho boloka tsoekere ea mali ka boemong bo botle ho ka fokotsa kapa ho lelefatsa monyetla oa mathata ana.
The American Diabetes e na le algorithm eo meriana e lokelang ho khethoa. Ho na le mehala ea pele-line, line ea bobeli, joalo-joalo. Meriana ea lefu la tsoekere e ka fapana haholo hohle ho lihlopha-kaofela li etsa lintho tse fapaneng 'me li ka fapana haholo. Ke habohlokoa hore ngaka ea hao e lule e hopotse-e leng bophelo bo botle, boima ba 'mele, mokhoa oa bophelo oa bophelo le boemo ba moruo pele u fana ka meriana.
Lintlha Tse Potlakileng ka Meriana ea Ts'oaetso
- Lihlopha tse sa tšoaneng tsa meriana ea lefu la tsoekere li sebetsa likarolong tse itseng tsa 'mele oa hau ho laola tsoekere ea mali (mali a tsoekere).
- Ka linako tse ling ho hlokahala meriana e fetang e le 'ngoe ho laola tsoekere ea mali. Tabeng ena o ka nka meriana e kopaneng kapa mefuta e 'meli e fapaneng ea meriana.
- Ho kopanya mefuta e 'meli ea meriana ka nako e' ngoe ho ka etsa hore ho be bonolo hore tsoekere ea hao ea mali e theohe haholo (hypoglycemia).
- Meriana e meng ea lefu la tsoekere e ka eketsa boima ba 'mele. Haeba u na le boima bo feteletseng, mefuta ena ea meriana ha e ntle hobane boima ba 'mele bo na le kotsi ea ho ba le tsoekere e phahameng ea mali.
- Meriana e meng ea lefu la tsoekere e na le kankere (empa ha e na insulin) mme e ka thusa ho finyella taolo ea tsoekere ea mali le tahlehelo ea boima ba 'mele.
- Ke ntho e tloaelehileng hore batho ba nang le lefu la tsoekere nako e telele haholo ba behoe insulin.
Meriana ea Molomo e fumanehang
Mona re sheba lihlopha tse supileng tsa meriana ea molomo bakeng sa phekolo ea lefu la tsoekere ea mofuta oa 2 hammoho le lithethefatsi tse tsoang lihlopheng tse sa tšoaneng:
Biguanides
Metformin, e kholoanyane, e ntse e le eona e sebelisoang haholo ka ho fetisisa ea mofuta oa pele oa lefu la tsoekere la mofuta oa 2.
Li-biguanides tse fumanehang li kenyeletsa:
- Fortmate
- Karolo e nyenyane ea lik'hemik'hale
- Glucophage XR
- Glumetza
- Riomet (Liquid Metformin)
Liphello tse bohloko tse ka hlahisoang ke li-biguanides li kenyeletsa tse latelang:
- ho hlajoa ke pelo, letšollo, kapa mpa e halefileng ha u qala ho nka mofuta ona oa meriana-litla-morao tsena li ka 'na tsa tloha ka mor'a nakoana
- hangata, boemo bo tebileng bo bitsoang lactic acidosis
Sulfonylureas
Sulfonylureas e etsa hore li-pancreas li etse insulin e eketsehileng, e thusang ho fokotsa mali a hao. Ba 'nile ba ba teng ka nako e telele' me hangata ba sebelisoa e le moemeli oa bobeli ho thusa ho fokotsa tsoekere ea mali ea nako ea lijo. Li lokela ho sebelisoa ka tlhokomelo ho batho ba tsofetseng hobane baahi bana ba kotsing e kholo ea ho ba le tsoekere ea mali e tlase.
Sulfonylureas e fumanehang e kenyeletsa:
- Glimepiride (Amaryl)
- Glyburide (Diabeta, Micronase)
- Glipizide (Glucotrol, Glucotrol XL)
Liphello tse mpe tse ka hlahisoang ke sulfonylureas li kenyeletsa tse latelang:
- khase ea mali e tlaase
- ho halefisoa ke mpa
- ho phatloha ha letlalo
- boima ba 'mele
Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors e sebetsa ka ho fokotsa ts'ebetso ea lijo tse phahameng lik'habohaedreite, tse kang raese, litapole, bohobe, lebese le litholoana. Li-inhibitors tsa alpha-glucosidase tse fumanehang li kenyelletsa:
- Miglitol (Glyset)
- Acarbose (Precose)
Litholoana tse bohloko tse ka hlahisoang ke li-alpha-glucosidase inhibitors ke:
- bohloko ba mpa, khase, bloating, kapa letšollo-matšoao ana a atisa ho fela ka mor'a hore u nke lipilisi tsena ka nakoana
Thiazolidinediones
Thiazolidinediones e etsa hore u utloe insulin haholoanyane. Thiazolidinediones e fumaneha e kenyeletsa:
- Actos (pioglitazone)
- Avandia (rosiglitazone)
Haeba u na le bothata ba pelo, ha ua lokela ho nka pilisi ea mofuta ona. Pilisi ea mofuta ona e ka etsa hore pelo ea pelo e fokotsehe kapa e mpefatse. Liphuputso li bontšitse hore Avandia e amahanngoa le kotsi e eketsehileng ea tlhaselo ea pelo le bohloko ba sefuba kapa ho se utloise bohloko ho methapo ea mali e thibelitsoeng.
Ka September 2010, FDA e thibela tšebeliso ea Avandia le mefuta leha e le efe ea lithethefatsi e kenyelletsang Avandia ka lebaka la ho eketsa kotsi ea pelo. FDA e ile ea tlosa tse ling tsa meeli ena ka 2013, 'me tse ling kaofela ka 2015, e le phello ea liteko tsa meriana tse ncha (haholo-holo teko ea RECORD). Leha ho le joalo, ho sa tsotellehe hore na e fumaneha joang Amerika, lingaka tse ngata li qoba ho beha Avandia. Ha e le hantle, bakuli ba bacha ba lokela ho ngolloa Avandia feela haeba ba sa khone ho finyella taolo ea likokoana-hloko ho nka lithethefatsi leha e le life. Ho feta moo, Actos ke lithethefatsi tse khethiloeng sehlopheng sena bakeng sa bakuli ba bacha.
Haeba hona joale u nka Avandia 'me u rua molemo meriana ena, u ka' na ua tsoela pele ho e nka; leha ho le joalo, o tlameha ho buisana le ngaka ena ka kgetho ena. Haeba o eso e-s'o etse joalo, ke habohlokoa hore u kopane le ngaka ea hau mme u buisane ka likotsi tse amanang le tsona.
Liphello tse bohloko tse ka etsahala tsa thiazolidinediones li kenyelletsa:
- ho senyeha pelo ha pelo ea pelo ke phello e tebileng ka ho fetisisa
- khaello ea mali
- kotsi e eketsehileng ea ho ima esita leha u ntse u nka lipilisi tsa thibelo ea bokhachane
- basali ba bangata ba kotsing ea ho robeha masapo
Meglitinides
Meglitinide e tšoana le sulfonylureas ka hore li eketsa tlhahiso ea insulin, empa li etsa lintho tse khutšoanyane. Hangata meriana ena e ntle bakeng sa bakuli ba hōlileng ba hlokang thuso ka ho theola tsoekere ea nako ea lijo. Leha ho le joalo, li tlameha ho nkoa ka makhetlo a mararo ka letsatsi 'me li ka ba thata ho li latela.
- Prandin (Repaglinide)
- Starlix (Nateglinide)
Litholoana tse ka hlahang tsa Prandin li kenyelletsa:
- khase ea mali e tlaase
- boima ba 'mele
- ho halefisoa ke mpa
- bohloko ba morao kapa hlooho
DPP4 Inhibitors
DPP4 Inhibitor e tloaelehile e sebelisoa e le moemeli oa bobeli oa ho thusa tsoekere e setseng ka morao. DPP4 Inhibitors e theola mali a hao a madi ka ho thusa 'meleng oa hao ho etsa insulin e eketsehileng ha e hlokahala, haholo-holo hang ka mor'a lijo. E boetse e thusa ho boloka sebete sa hau se beha bolokolohi bo bolokiloeng ka mali a hau. DPP4 Inhibitors e kenyelletsa:
- Januvia (Sitagliptin)
- Trajenta (Linagliptin)
- Onglyza (Saxagliptin)
- Nesina (Alogliptin)
Liphetho tse bohloko tse ka khonehang li kenyelletsa:
- tšoaetso e phahameng ea ho hema
- nko ea metsi
- 'metso o bohloko
- hlooho
SLGT-2 Inhibitors
E sebetsa ka liphio tsa hau ho thusa ho tlosa tsoekere e feteletseng (tsoekere) 'meleng oa hau ha u ntša metsi. SLGT-2 Inhibitors e kenyelletsa:
- Canagliflozin (Invokana®)
- Dapagliflozin (Farxiga®)
- K'homphieutha (Jardiance®)
Litla-morao tse bohloko tse ka khonehang li kenyeletsa:
- Matšoao a meriana a urinary kapa mafu a tomoso
- ho tsoa metsing
- kankere ea senya
- Canaglifozin e ka eketsa kotsi ea ho khaola, empa e ka fokotsa kotsi ea lefu la pelo
Lipilisi Lipilisi tsa lefu la tsoekere
Lipilisi tsa motsoako li na le mefuta e 'meli e fapaneng ea lipilisi tsa lefu la tsoekere. Lipilisi tse ngata tsa motsoako li teng, ho kenyelletsa:
Actoplus Met (pioglitazone / metformin)
Avandamet (rosiglitazone / metformin)
Avandaryl (rosiglitazone / glimepiride)
Ho tsuba (pioglitazone / glimepiride).
Glucovance (glyburide / metformin)
Glyxambi (jardiance / tradjenta)
Invokamet (canagliflozin / metformin HCl)
Janumet le Janumet (XR) (sitagliptin / metformin).
Jentadueto ( HCl ea linagliptin / metformin)
Juvisync (sitagliptin le Simvastatin)
Kazano (alogliptin / metformin)
Kombiglyze XR (saxagliptin / metformin)
Metaglip (glipizide / metformin).
Oseni (alogliptin / pioglitazone)
Synjardi (metformin / jardiance)
Xigudo XR ( dapagliflozin / metformin HCl)
Likokoana-hloko tse se nang insulin: GLP-1 Agonists
Li-agonists tsa GLP-1 ke mofuta oa non-insulin meriana e nang le lithethefatsi e ntseng e tsebahala le e hlaheletseng, e etsang hore tsela ea eona e be ka pele ho tlhokomelo ea lefu la tsoekere le lipatlisiso. Liphuputso li bontšitse hore mefuta ena ea meriana, ha e sebelisoa hammoho le ho ja le ho ikoetlisa, ka nako e khutšoanyane e sebetsang le e sebetsang ka nako e telele, thusa bakuli ba mofuta oa lefu la tsoekere la bobeli hore ba fokolise boima ba 'mele, ba fokolise lefu la hemoglobin A1C (karolelano ea likhoeli tse tharo tsa tsoekere ea bona ea mali). kaha li ka fokotsa tekanyo ea lefu la pelo. Mefuta ena ea meriana ha e sebelisoe e le meriana ea pele, empa e ka sebelisoa hammoho le meriana ea molomo 'me e bontšitsoe e se ea tlase ho mefuta e kopanetsoeng e kang basal insulin (nako e telele ea insulin), hammoho le GLP-1 agonist versus basal insulin, hammoho le ka potlako ho etsa insulin.
GLP-1 agonists e etsa hore lefu la tsoekere le itšetlehe ka lefu la tsoekere, e leng ho fokotsa tsoekere ea mali. Li boetse li etsa ka mpeng, boko, lik'hafere le sebete ho eketsa maikutlo a botlalo a khothalletsang ho lahleheloa ke boima ba 'mele.
Ho na le liketso tse khutšoanyane le tsa nako e telele tsa GLP-1 agonists. Tse ling li kenngoa hanngoe kapa ka makhetlo a mabeli ka letsatsi le tse ling hang ka beke le beke. Mefuta e mengata ea meriana e ntse e tsoela pele ho amoheloa ke FDA 'me re tla tsoelapele ho batla litumello tsena.
Tse ling tsa tsona li kenyelletsa:
- Byetta (Exenatide): Injected habeli ka letsatsi.
- Victoza (Liraglutide): e kenngoe hang ka letsatsi.
- Adlyxin (Lixisenatide): e entsoe hanngoe ka letsatsi.
Bydureon (Exetatide long acting form of Byetta) L e kenngoa hang ka beke le beke.
- Tanzeum (Albiglutide): ejoe hanngoe hanngoe le beke.
- Trulicity (Dulaglitide): ejoe hanngoe hanngoe le beke.
- Ozembic (Semaglutide) - e fumanoe tumello ea FDA feela hang ka beke e le ngoe, empa ha e fumanehe leha ho le joalo
Litla-morao tse ka khonehang:
- ho nyefutsa, ho hlatsa, letšollo (ho tloaelehileng haholoanyane le mahlahana a khutšoanyane)
- Liphuputso tsa li-rodent li bontšitse kotsi e eketsehileng li-tumor tsa c-cell tsa qoqotho
- ho na le kotsing e nyenyane ea ho ba le tšoaetso ea mafu
Mokhoa oa ho Tseba Mofuta ofe oa meriana ea lefu la tsoekere
Ka lebaka la meriana e mengata e fumanehang bakeng sa ho tšoara mofuta oa lefu la tsoekere ea mofuta oa 2, u ka 'na ua ferekanngoa ka hore na ke meriana efe e molemo ka ho fetisisa ho uena.
Mokhatlo oa Amerika oa lefu la tsoekere (ADA) le Mokhatlo oa American of Clinical Endocrinologists (AACE) li thehile maqheka a thehiloeng ho liphatsa tsa motho ka mong, tse kang lilemo, bolelele ba lefu la tsoekere, ho laola tsoekere ea mali le litaba tse ling tsa bophelo ho thusa lingaka le bakuli ba bona hore na ke meriana efe e molemohali. Ka linako tse ling, u ka qala ka meriana e le 'ngoe, feela ho hlokomela hore ha e sebetse ka katleho' me u tla tlameha ho eketsa mofuta o mong kapa ho fetola ka ho feletseng. Ngaka ea hau e tla sebetsa le uena ho fumana lithethefatsi tse loketseng ka ho fetisisa ho latela maemo a hao ka bomong. Nakong ena eohle, ke habohlokoa hore u etse liphetoho tsa bophelo, tse kang ho ja lijo tse nepahetseng le ho etsa hore u ikoetlise kamehla. Meriana ea lefu la tsoekere e reretsoe ho ikarabella bakeng sa ho ja le ho ikoetlisa 'me haeba liphetoho tsa bophelo li sa etsoa, meriana e tla hloka ho eketseha le ho etsoa. Bakeng sa tlhahisoleseding e eketsehileng mabapi le hore na ke hobane'ng ha, neng, le ho noa meriana ea hau ea lefu la tsoekere: All About About Oral Dialet Medication
Ho thoe'ng ka Insulin?
Batho ba nang le lefu la tsoekere ka nako e telele kapa ba sitoang ho laola tsoekere ea bona ea mali ka lithethefatsi tsa molomo kapa tse seng insulin ba ka 'na ba hloka insulin ho laola tsoekere ea mali. Ka nako e 'ngoe insulin e tsejoa ke lefu la tsoekere la motho mme hang ha batho ba e-na le chefo ea chefo ea pheko e rarolla' muso oo o ka o nolofalletsa. Bakeng sa tlhahisoleseding e eketsehileng mabapi le hore na mefuta e sa tšoaneng ea insulin e sebetsa joang : Mefuta e fapaneng ea insulin e sebetsa joang?
> Mehloli:
> Mokhatlo oa American Diabetes Association. Melao ea Kalafo ea Lefu la tsoekere - 2017. Tlhokomelo ea lefu la tsoekere . 2017 Jan; 38 (Tlatsetso ea 1): S1-132.
> Jonas D, Van Scoyoc E, Gerrald K, le al. Portland (OR): Univesithing ea Bophelo le Saense ea Oregon.