Mtundu Wamtundu uwu Ungathandizire Kuteteza shuga
Mankhwala osaphatikizapo insulini ndi mtundu wa mankhwala omwe amagwiritsidwa ntchito pang'onopang'ono kuti akhale mafuta. Sizimagwiritsidwa ntchito ngati wothandizira mzere woyamba, koma mitundu yambiri ingagwiritsidwe ntchito kuphatikizapo mankhwala a shuga wamlomo komanso mankhwala a insulini.
Mwachindunji, GLP-1 receptor agonists ndi mtundu wa mankhwala osagwiritsidwa ntchito ndi insulini omwe amayamba kukhala otchuka komanso otchuka, omwe amapita patsogolo kutsogolera ndi kusanthula shuga. Kafukufuku wasonyeza kuti mankhwalawa, omwe amagwiritsidwa ntchito kuphatikizapo zakudya ndi masewero olimbitsa thupi, omwe amawathandiza kuchepetsa thupi, amakhala ndi nthawi yayitali, amathandizira odwala omwe ali ndi matenda a shuga, kuchepetsa thupi lawo, kuchepetsa magazi awo a shuga . komanso kungachepetse kuchuluka kwa mtima wa imfa.
Kafukufuku wamakono akusonyeza kuti mankhwalawa ndi apamwamba pochepetsa shuga la magazi poyerekezera ndi mitundu yosiyanasiyana ya mankhwala odzitcha komanso osakhala otsika kwa mankhwala ophatikizapo insulini (insulin yaitali), kuphatikizapo GLP-1 agonist ndi basal insulin , komanso insulin yofulumira .
Amagwira Ntchito Motani?
Mankhwalawa amagwira ntchito chifukwa anthu omwe ali ndi matenda a shuga a mtundu wa 2 amakhala otsika kwambiri mu incretin, kutanthauza kuti ali ndi mahomoni ochepa. Imodzi ya hormone, yomwe imadziwika kuti glucagon-ngati peptide (GLP-1), ndi yochepa mwa anthu omwe ali ndi shuga. GLP-1 nthawi zambiri imamasulidwa m'matumbo anu aang'ono mukamadya, ndipo zimathandiza kuchepetsa njira yomwe chakudya chimachokera m'mimba mwako, ndikuyang'anira shuga lanu la magazi pambuyo chakudya.
Phindu la agonists la GLP-1 ndilo kuti amatsanzira hormone ya GLP-1 mwakumangirira GLP-1 receptors ndi kutulutsa kutulutsidwa kwa insulini, zomwe zimachepetsa shuga ya magazi. Galamukani-1 agonist imathandizanso m'mimba, ubongo, mphukira, ndi chiwindi kuti chiwonjezere chidziwitso chokwanira komanso kuchepetsa kutentha kwa magazi , zomwe zimapangitsa kuti thupi liwonongeke komanso zimapangitsa kuti shuga aziwongolera.
Kawirikawiri, iwo samalimbikitsa chitemera cha hypoglycemia chifukwa amangogwira ntchito pamene pali shuga m'dongosolo lanu. Izi ndi zopindulitsa kwa anthu omwe ali ndi vuto la hypoglycemia, komabe, akamagwiritsidwa ntchito kuphatikiza ndi insulini kapena sulfonylurea chiopsezo cha hypoglycemia chimawonjezeka. Ngati mukufuna njira yosiyana ya kasamalidwe ka shuga, kambiranani ndi dokotala kuti mumvetse bwino ngati njirayi ndi yoyenera kwa inu ndipo ingakuthandizeni kuti muzitha kuwongolera bwino matenda anu a shuga.
Zotsatira za Thupi
Ubongo: GLP-1 imatumiza ubongo kwa ubongo, makamaka hypothalamus, kuwuza kuchepetsa madzi ndi kudya. Chotsatira chake, munthu amene amatenga GLP-1 agonist amadza msanga mofulumira. Mukamamva mofulumira kwambiri, mumatha kudya zakudya zochepetsetsa, motero, kulemera. Chifukwa chakumverera kwanu kumatha kuchepa, ndikofunikanso kukumbukira kutulutsa madzi.
Minofu: GLP-1 imachulukitsa gluconeogensis mu minofu. Izi zimathandiza kuchepetsa shuga wambiri mwa kuyambitsa maselo a maselo ndi kuwonjezera mphamvu ya insulini (momwe thupi lanu limagwiritsira ntchito insulini).
Pancreas: GLP-1 imapangitsa kuti magazi asapitirire kutsekemera pamene akukumana ndi shuga. Izi zimathandiza kuchepetsa pambuyo pa zakudya zamagazi. Kuonjezerapo, GLP-1 imachepetsa kusungunuka kwa glucagon ndikuwonjezera somostatin kusungunuka. Ntchito ya Glucagon ndikuteteza kuti dzuwa lisatengeke kwambiri. Kwa anthu omwe ali ndi matenda a shuga a mtundu wa 2, glucagon imatha kukweza ma shuga a m'magazi kwambiri chifukwa palibe insulini yokwanira yomwe imawombera shuga kapena thupi silingathe kuyankha ndi insulini . Choncho, pochepetsa glucagon zotsatira, shuga ya magazi imachepetsedwa.
Chiwindi: GLP-1 imatulutsa shuga, yomwe imathandiza kuchepetsa shuga. GLP-1 imachulukitsa gluconeogensis, yomwe ndi njira yamagetsi yomwe imayambitsa shuga kuchokera ku zinthu zopanda mafuta, monga mapuloteni ndi mafuta. Pamene gluconeogensis ikuwonjezeka, glucagon (hormone yomwe imathandiza kuonjezera shuga wa magazi) zimalandira kuchepa kwa chiwindi, kulepheretsa kutuluka kwa shuga komanso kuyambitsa shuga ndi maselo omwe amathandiza kuchepetsa shuga.
Mimba: GLP-1 imachepetsa kutsekemera kwa asidi ndipo imachepetsanso kutaya kwa m'mimba, zomwe zimachepetsa msanga kuti zakudya zimachokera m'mimba mwako, kuwonjezeka kwathunthu, kuchepetsa kuchepa kwa shuga, komanso nthawi zambiri kumayambitsa nthenda. Mtengo wochepa umene chakudya chimachokera m'mimba umachepetsera kudya, zomwe zimapangitsa kuti thupi lichepe. Kuchepetsa kutaya thupi kumachepetsa kusakaniza kwa insulini, motero kuchepetsa kutentha kwa magazi.
Mitundu Yotani ya GLP-1 Agonists?
Agalist-GLP-1 agonist akhoza kuthyoledwa m'magulu awiri osiyana: machitidwe achifupi, omwe nthawi zambiri amatha kuponyedwa kamodzi kapena kawiri patsiku, kapena nthawi zambiri, zomwe zimaperekedwa kamodzi pamlungu. Mtundu wa GLP-1 umene mumalandira udzadalira mbiri yanu ya zamankhwala, inshuwalansi, zokonda zanu komanso shuga la magazi. Ena GLP-1 agonists akhoza kukhala okwera mtengo; choncho ndizomveka kutchula inshuwalansi musanayambe kulandira mankhwala kuti mupeze mankhwala.
Zochita Zakafupi GLP-1 Agonists - Kamodzi kapena kawiri Tsiku Lililonse
Mankhwala: Kuwonjezera
Dzina lajambula: Byetta
Dose: Yambani ndi 5mcg kawiri tsiku lililonse 60 minutes musanadye chakudya ndi kuwonjezeka mpaka 10mcg patatha mwezi umodzi.
Zowonjezera: Mmodzi mwa mitundu yochepa kwambiri ya GLP-1 agonists, mwinamwake chifukwa wakhala ataliatali kwambiri.
Zoipa: Ayenera kupatsidwa mphindi 60 asanadye chakudya chomwe chingakhale chosokoneza.
Zolingalira Zina: Byetta amasokonezeka kupyolera mu impso ndipo sakuvomerezeka kwa anthu omwe ali ndi GFR wa 30 kapena osachepera.
Mankhwala: Liraglutide
Dzina lajambula: Victoza
Dose: 0.6mcg kwa sabata limodzi ndikuwonjezera mlingo ku 1.2mcg. Ngati shuga wamagazi ali pa cholinga, mukhoza kusunga mlingo umenewu, kapena kuwonjezeka kufika 1.8mcg ngati kuloledwa. Dokotala wanu akuyenera kukukulangizani momwe mungakulitsire mlingo.
Zosangalatsa: Zatsimikiziridwa kuti zimataya kwambiri.
Zoipa: Ziyenera kuperekedwa kamodzi tsiku ndi tsiku. Odwala amavomereza kuti phokoso lalikulu limakhalapo, ndipo chifukwa chake kuli kolemetsa kwambiri.
Mankhwala: Lixisenatide
Dzina lajambula: Adlyxin
Dose: 10 mcg tsiku lililonse kwa milungu iwiri ndikuwonjezeka mpaka 20 mcg tsiku lililonse.
Zomwe zilipo: Ali ndi mphamvu yofanana ndi Byetta.
Zosokoneza: Ziyenera kutayidwa tsiku lililonse 60 mphindi isanafike chakudya choyamba cha tsikulo
Zifukwa zina: Kodi zimadulidwa kudzera impso ndi kuzipewa ndi GFR's
Kuchita Zakale GLP-1 Agonist - Kamodzi Katemera Wopweteka
Mankhwala: Kupatula mawonekedwe a Byetta nthawi yaitali
Dzina lajambula : Bydureon (atchulidwa ngati chiwindi ndi chida kapena cholembera)
Dose: 2mg mlungu uliwonse, kuperekedwa kamodzi pa sabata.
Kuchepetsa A1C: Pafupifupi 1.3 peresenti.
Zomwe: Kupatsidwa kamodzi pamlungu; akhoza kulembedwa kudzera peni.
Zosokoneza Bwino: Kodi dzina lachikazi limatulutsidwa ndipo liyenera kupeŵedwa ndi GFR 30 kapena zochepa. Kuphatikiza apo, mlingo wa singano ndi wakuda (23G).
Zolingalira Zina: Zofukufuku zawonetsa kuti ndizochepa kwa Victoza zokhudzana ndi kuchepetsa A1C ndipo zingakhale zovuta pakuyesa (muyenera kusakanizidwa). Kuonjezera apo, anthu ambiri amadandaula za momwe machitidwe amachitira.
Mankhwala: Dulaglitide
Dzina lajambula: Trulicity (pensulo)
Dose: Yambani ndi 0.75mg mlungu uliwonse ndipo muwonjezere kufika 1.5mg mu masabata 6 mpaka 8.
Kuchepetsa A1C: Pafupifupi 1.4 peresenti.
Zowonjezera: Sichiyenera kusakanizidwa. Simukuyenera kugwirizanitsa singano ndipo mukhoza kutaya pensulo yonse mu chidebe chowombera mutapereka mlingo. Icho chimapangidwa kamodzi pa sabata ndipo chiri ndi kuchepa kwa A1C kuposa Victoza.
Zosokoneza: Sichikuphimbidwa ndi inshuwalansi zonse ndipo zingakhale zodula.
Kodi Zotsatira Zilipo?
- Zotsatira zofala kwambiri za AGP-1 agonists ndizosautsa, kusanza ndi kutsekula m'mimba. Izi zimachitika pafupifupi 10 mpaka 40 peresenti (malingana ndi mankhwala enieni) a anthu ndipo amavomerezedwa ndi antchito ochepa. Komabe, zotsatirazi zimakhala zochepa ngati munthu ali pa mankhwala kwa nthawi yaitali. Kuonjezerapo, ngati mutenga nthawi yochepa yochita GLP-1, monga Victoza, kuigwira musanayambe kugona kungakuthandizeni kuchepetsa kunyowa.
- Maphunziro omwe apangidwa pa makoswe amasonyeza kuti ena a GLP-1 agonists, makamaka liraglutide ndi dulaglutide, akhoza kulimbikitsa zotupa za khungu. Ngakhale kuti maphunzirowa sanachitidwe pa anthu, ndibwino kuti anthu omwe ali ndi mbiri yakale kapena mbiri ya banja ya khansa ya chithokomiro ya medullary ndi Multiple Endocrine Neoplasia mtundu 2 sagwiritsa ntchito GLP-1 agonsists.
- Ndi akatswiri ena a AGP-1 agonists pali zochepa zomwe zingakumane ndi chiopsezo cha kuperewera kwa madzi (kutupa kwa ziphuphu).
- Anthu amatha kupeza machitidwe a jekeseni komwe mankhwalawa amaikidwa.
Ndani Ayenera Kupewa Mankhwalawa?
Mankhwalawa sakuvomerezedwa ngati:
- muli ndi mbiri yakupha.
- muli ndi mbiri ya gastroparesis (kufooka kwa m'mimba).
- muli ndi mbiri yakale kapena mbiri ya banja la khansa ya chithokomiro kapena anthu ambiri otchedwa Endocrine Neoplasia mtundu 2.
Komanso, anthu omwe ali ndi matenda a shuga omwe atha kugwira ntchito ya impso, ndi GFR (glomerular filtration rate) kapena 30 kapena pang'ono sayenera kugwiritsa ntchito bydureon ndi byetta. Kambiranani ndi dokotala wanu ngati mukufuna kutenga agonist ena.
Palibe umboni wokwanira wothandizira chitetezo kwa odwala omwe ali pa dialysis, motero kupeŵa kugwiritsa ntchito GLP-1 pakati pa anthuwa ndi kwanzeru.
Kodi Chotsatira N'chiyani?
Monga mankhwala a shuga akupitiriza kuwonjezeka ndipo kafukufuku akuyenda mofulumira kuti mitundu yowonjezereka, yabwino, komanso yowonjezera ya agonist ya GLP-1, tikutsimikiza kuti tikuwona mankhwala ambiri akubwera mtsogolomu. Ndipotu, wina GLP-1 agonist amene akugwiritsa ntchito chipangano cha FDA, semaglutide, amanenedwa kuchepetsa mavuto a mtima pa 26 peresenti. Ndipo monga bonasi, semaglutide ya pamlomo ili mu mayesero a gawo lachiwiri, zomwe zikutanthauza tsiku limodzi, GLP-1 agonist sangadayidwe.
> Zotsatira:
> Dungan, K, DeSantis, A. Gulu la glucagon-ngati peptide 1 odwala agonist kuti amwe mankhwala a mtundu wa shuga 2. Zaposachedwa.
> Vishal, Gupta. Glucagon-yofanana ndi peptide-1 analogues: Mwachidule. Indian J Endocrinol Metab. 2013 May-June, 17 (3): 413-421.
> Smilowitz, N, Donnino, Robert, Schwartzbard, Arthur. Glucagon-onga a peptide receptor agonist matenda a shuga: Ntchito mu mtima wa mtima. Kudutsa.