Isinyathelo sokuqala ekulawuleni ushukela egazini lakho ukuthola isifo sikashukela semfundo yokuzilawula ukuze ukwazi ukuqonda izici eziyinhloko ezingakusiza ukuba uzuze ukulawulwa ushukela omuhle wegazi. Kuncike ekutheni izinga lakho lokushukela egazini liphakeme kangakanani, umzila wokuqala wezokwelapha ukuguqula indlela yokuphila-ukudla ukudla okunomsoco we-carbohydrate, ukuvivinya ngokwanele nokunciphisa umzimba kuyisinyathelo esibalulekile ekufezeni ukulawulwa ushukela egazini.
Ngisho nezinguquko ezincane zingenza umehluko omkhulu. Kodwa, kukhona ithuba, kuzodingeka uthathe imithi ukuze ulawule ishukela egazini lakho.
Uma ushukela egazini lakho lihlala isikhathi eside, ungase ube nengozi eyengeziwe yokwelapha isifo sikashukela ezifana nokushaya kwenhliziyo, ukulimala, ukulimala kwezinso, ukuphuphuthekisa, nokuchithwa. Ukugcina ushukela wakho wegazi ngezinga elihle kunganciphisa noma kwandise ithuba lakho lezinkinga.
I-American Diabetes ine-algorithm lapho imithi okufanele ikhethwe khona. Kunamalungu okuqala-line, umugqa wesibili, njalonjalo. Imithi yesifo sikashukela ingahluka kakhulu phakathi kwamakilasi-bonke benza izinto ezehlukene futhi bangahluka kakhulu. Kubalulekile ukuba udokotela wakho agcine engqondweni-impilo yakho yonke, isisindo, indlela yokuphila nesimo sezomnotho ngaphambi kokumisa imithi.
Amaqiniso Okusheshayo Ngokwemishanguzo YeShukela
- Izigaba ezahlukene zemithi yesifo sikashukela zisebenza ezingxenyeni ezithile zomzimba wakho ukulawula ushukela wegazi (i-blood glucose).
- Ngezinye izikhathi kuyadingeka imithi engaphezu kweyodwa ukulawula ushukela wegazi. Kulesi simo ungathatha imithi yokwelapha noma izinhlobo ezimbili zemithi.
- Ukuhlanganisa izinhlobo ezimbili zemithi ngezinye izikhathi kungenza kube lula ukuthi ushukela wakho wegazi luzokwehla kakhulu (hypoglycemia).
- Ezinye imithi yesifo sikashukela ingabangela ukuzuza kwesisindo. Uma ukwedlula ngokweqile, lezi zinhlobo zemithi ayilungile ngoba isisindo esingaphezu kwesisindo singumngcipheko ongenamkhawulo we-ushukela wegazi ophakeme.
- Eminye imithi yesifo sikashukela ijojowe (kodwa ayikho i-insulin) futhi ingasiza ekufezeni ukulawulwa ushukela wegazi nokulahlekelwa isisindo.
- Kuyinto engavamile kubantu abanesifo sikashukela isikhathi eside kakhulu ukuba banqunywe i-insulin.
Imithi ekhona yomlomo etholakalayo
Lapha sibheka amakilasi ayisikhombisa emithi yomlomo yokwelapha uhlobo lwesifo sikashukela kanye nokuhlanganiswa kwezidakamizwa ezivela emakilasini ahlukene:
Biguanides
I-Metformin, i-biguanide, ihlala iyisisetshenziswa somuthi wesifo sikashukela sohlobo lokuqala.
Ama-biguanides atholakalayo afaka:
- I-Fortmate
- I-glucophage
- I-Glucophage XR
- I-Glumetza
- I-Riomet (Liquid Metformin)
Imiphumela emibi engenzeka emibi ye-biguanides ifaka okulandelayo:
- isisu, isifo sohudo, noma isisu esithukuthele lapho uqala ukuthatha lolu hlobo lwemithi-lemiphumela emibi kungenzeka ukuthi ihambe ngemva kwesikhathi
- okungavamile, isimo esibi esibizwa ngokuthi i-lactic acidosis
Sulfonylureas
I-Sulfonylureas ivuselela ama-pancreas ukwenza i-insulin engaphezulu, okusiza ukwehlisa i-glucose yegazi lakho. Baye bahlala isikhathi eside futhi bavame ukusetshenziselwa njenge-agent eseyisibili ukusiza ukunciphisa ushukela wegazi ngesikhathi sokudla. Kufanele zisetshenziswe ngokucophelela kubantu asebekhulile ngoba le nsizakalo isengozini enkulu yokuthuthukisa ushukela ophansi wegazi.
I-sulfonylureas etholakalayo ihlanganisa:
- I-Glimepiride (i-Amaryl)
- I-Glyburide (i-Diabeta, i-Micronase)
- I-Glipizide (i-Glucotrol, i-Glucotrol XL)
Imiphumela engalungile engenzeka ye-sulfonylureas ifaka okulandelayo:
- i-blood glucose ephansi
- isisu esibuhlungu
- ukuqhuma kwesikhumba
- inzuzo yesisindo
I-Alpha-Glucosidase Inhibitors
I-Alpha-glucosidase inhibitors isebenza ngokunciphisa ukugaya ukudla okuphezulu kuma-carbohydrate, njengelayisi, amazambane, isinkwa, ubisi, nezithelo. Ukutholakala kwe-alpha-glucosidase inhibitors kufaka:
- I-Miglitol (i-Glyset)
- I-Acarbose (Precose)
Imiphumela engalungile engenzeka ye-alpha-glucosidase inhibitors yilezi:
- ubuhlungu besisu, igesi, ukuqhuma, noma isifo sohudo-lezi zivame ukuhamba ngemva kokuthatha lezi philisi okwesikhashana
Thiazolidinediones
I-Thiazolidinediones yenza uzwele kakhulu kwi-insulin. I-thiazolidinediones etholakalayo ihlanganisa:
- I-Actos (i-pioglitazone)
- I-Avandia (i-rosiglitazone)
Uma unesifo senhliziyo, akufanele uthathe lolu hlobo lwephilisi. Lolu hlobo lwephilisi lungabangela ukwehluleka kwenhliziyo ukuphoqa noma ukwenza kube kubi nakakhulu. Ucwaningo luye lwabonisa ukuthi i-Avandia ihlotshaniswa nobungozi obukhulu bokuhlaselwa kwenhliziyo kanye nobuhlungu besifuba noma ukunganaki emithanjeni yegazi evinjelwe.
Ngo-Septhemba 2010, i-FDA yayinqanda ukusetshenziswa kwe-Avandia nanoma yikuphi ukuhlanganiswa kwezidakamizwa kuhlanganise ne-Avandia ngenxa yokwanda kwengozi yomzimba. I-FDA ihoxise ezinye zalezi zimingcele ngo-2013, kanti konke okunye ngo-2015, njengomphumela wezivivinyo zemitholampilo ezintsha (ikakhulukazi isilingo se-RECORD). Nokho, naphezu kokutholakala kwawo e-US, odokotela abaningi bagweme ukubeka i-Avandia. Eqinisweni, iziguli ezintsha kufanele zenziwe i-Avandia kuphela uma zingenakukwazi ukulawula ukulawula i-glucose ukuthatha noma yimuphi omunye umuthi. Ngaphezu kwalokho, i-Actos yisidakamizwa esithandwayo kuleli klasi leziguli ezintsha.
Uma okwamanje uthatha i-Avandia futhi uzuza kulo muthi, ungakwazi ukuqhubeka uyithatha; Nokho, kufanele uxoxe ngalolu khetho nodokotela wakho. Uma ungakaze wenze kanjalo, kubalulekile ukuthi uhlangane nodokotela wakho futhi uxoxe ngezinkinga ezihambisanayo.
Imiphumela emibi engaba khona ye-thiazolidinediones ihlanganisa:
- Ukuhluleka kwenhliziyo ngokukhululeka kuyisici esibi kakhulu
- i-anemia
- ingozi eyengeziwe yokukhulelwa ngisho noma uthatha amaphilisi okulawula ukubeletha
- ukwandisa amathuba okuhlukunyezwa kwamathambo kwabesifazane
I-Meglitinides
I-Meglitinides ifana ne-sulfonylureas ngoba yandisa ukukhishwa kwe-insulini, kodwa yenza okufutshane. Le mithi ngokuvamile inhle kubantu abakhulile abadinga usizo ngokunciphisa ushukela wabo wesikhathi sokudla. Noma kunjalo, kumele kuthathwe kathathu ngosuku futhi kungaba nzima ukuhambisana nayo.
- I-Prandin (Repaglinide)
- I-Starlix (i-Nateglinide)
Imiphumela engalungile engenzeka ye-Prandin ifaka phakathi:
- i-blood glucose ephansi
- inzuzo yesisindo
- isisu esibuhlungu
- ubuhlungu emuva noma ikhanda
I-DPP4 Inhibitors
I-DPP4 Inhibitors ngokuvamile isetshenziswa njenge-agent yomugqa wesibili ukusiza ushukela oshukela ngemuva kokudla. I-DPP4 Inhibitors yehlisa i-glucose yegazi ngokusiza umzimba wakho wenze insulin xaxa uma kudingeka, ikakhulukazi emva kokudla. Kubuye kusize ukugcina isibindi sakho ekubeka i-glucose egcinwe egazini lakho. I-DPP4 Inhibitors ihlanganisa:
- I-Januvia (Sitagliptin)
- I-Trajenta (i-Linagliptin)
- I-Onglyza (i-Saxagliptin)
- I-Nesina (Alogliptin)
Imiphumela emibi engase ibe khona ihlanganisa:
- ukutheleleka okuphezulu kokuphefumula
- ikhala eligijima
- Umphimbo obuhlungu
- ikhanda
SLGT-2 Inhibitors
Isebenza ngezinso zakho ukusiza ukususa i-glucose ngokweqile (ushukela) emzimbeni wakho uma uchama. I-SLGT-2 Inhibitors ihlanganisa:
- I-Canagliflozin (i-Invokana®)
- I-Dapagliflozin (i-Farxiga®)
- I-Empagliflozin (i-Jardiance®)
Imiphumela emibi engaba khona ihlanganisa:
- Ukutheleleka kwe-urinary noma izifo zesilonda
- ukuphelelwa amandla kwamanzi
- umdlavuza wesisu
- I-Canaglifozin ingandisa ingozi yokuxoshwa, kodwa inganciphisa ingozi yesifo senhliziyo
Amaphilisi ayisifo sikashukela
Amaphilisi okuhlanganiswa anezinhlobo ezimbili ezahlukene zesifo sikashukela. Amaphilisi amaningi enhlanganisela ayatholakala, kufaka phakathi:
I-Actoplus Met (pioglitazone / metformin)
I-Avandamet (i-rosiglitazone / i-metformin)
I-Avandaryl (i-rosiglitazone / i-glimepiride)
I-Duetact (pioglitazone / glimepiride).
I-Glucovance (i- glyburide / i-metformin)
I-Glyxambi (i-jardiance / i-tradjenta)
I-Invokamet (i-canagliflozin / i-metformin HCl)
I-Janumet ne-Janumet (XR) (sitagliptin / metformin).
I-Jentadueto (i- linagliptin / i-metformin HCl)
U-Juvisync (sitagliptin no-Simvastatin)
I-Kazano (i-alogliptin / i-metformin)
I-Kombiglyze XR (i-saxagliptin / i-metformin)
I-Metaglip (i-glipizide / i-metformin).
I-Oseni (alogliptin / pioglitazone)
I-Synjardi (i-metformin / i-jardiance)
I-Xigudo XR (i- dapagliflozin / i-metformin HCl)
Okungeyona Injectable Injectables: GLP-1 Agonists
Ama-agonists e-GLP-1 ayilona uhlobo lwe-non-insulin ejoqwayo imithi eye yanda kakhulu ethandwa futhi evelele, eyenza indlela yayo ibe yindlela yokunakekelwa nokucwaninga ngesifo sikashukela. Ucwaningo luye lwabonisa ukuthi lezi zinhlobo zemithi, uma zisetshenziselwa ukuhambisana nokudla nokuzivocavoca, kokubili ukwenza okufushane nokusebenza isikhathi eside, kusiza iziguli ezine-type 2 yesifo sikashukela ukuthi zithwale isisindo, zinciphise i-hemoglobin A1C (isilinganiso esiyizinyanga ezintathu soshukela egazini), kanye njengoba kungenzeka ukunciphisa izinga lokufa kwenhliziyo. Lezi zinhlobo zemithi azijwayele ukusetshenziselwa ukwelashwa komugqa wokuqala, kodwa zingasetshenziswa ngokuhambisana nemithi yomlomo futhi zikhonjiswe ukuthi azizona ezingaphansi kwezinhlawulo zokuhlanganiswa ezifana ne-basal insulin (i-insulin esebenza isikhathi eside), kanye no-GLP-1 agonist ngokumelene i-basal insulin, kanye ne-insulin esheshayo ngokushesha.
Ama-agonists e-GLP-1 akhuthaza ukukhululwa kwe-insulin e-glucose, okunciphisa ushukela wegazi emva kokudla. Zenza futhi esiswini, ubuchopho, ama-pancre kanye nesibindi ukwandisa imizwa yokugcwele ekhuthaza ukulahlekelwa isisindo.
Kukhona ama-agonists abambalwa abasebenza futhi abasebenza isikhathi eside. Ezinye zijojowe kanye noma kabili ngosuku futhi ezinye kanye ngesonto. Ukuningi kwalolu hlobo lwemithi kuqhubeka kuvunywe yi-FDA futhi sizoqhubeka nokubheka lezi zimvume.
Ezinye zazo zihlanganisa:
- Byetta (Exenatide): injected kabili nsuku zonke.
- I-Victoza (i-Liraglutide): injected kanye nsuku zonke.
- I-Adlyxin (Lixisenatide): injected kanye nsuku zonke.
I-Bydureon (Ukufaka ifomu elide elidala le-Byetta) L elijova kanye ngeviki.
- I-Tanzeum (i-Albiglutide): injected kanye ngesonto ngalinye.
- I-Trulicity (i-Dulaglitide): injected kanye ngesonto ngalinye.
- I-Ozembic (i-Semaglutide) - nje yamukelwa imvume ye-FDA njenge-injection esisodwa ngeviki, kodwa ayitholakali okwamanje
Imiphumela emibi engenzeka:
- ukunxanxathela, ukuhlanza, isifo sohudo (okuvame ngokwengeziwe nama-agent abambisane abancane)
- Ucwaningo lwezintambo lubonise ingozi ekhulayo emathunjini e-c-cell e-thyroid
- ingozi encane yokwanda kwe-pancreatitis
Indlela Yokuthi Ngumuphi Umuthi Wesifo Sikashukela Ukuthatha
Ngenxa yenani elikhulu lemithi etholakalayo yokwelapha uhlobo lwesifo sikashukela, ungase udideke ngokuthi iyiphi imithi engcono kakhulu kuwe.
I-American Diabetes Association (ADA) kanye ne-American Association of Clinical Endocrinologists (AACE) seyakhele izilungiso ezihambisana nezici ezithile, ezifana nobudala, ubude bokushukela kwesifo sikashukela, ukulawulwa kwegazi glucose kanye nezinye izindaba zezempilo ukusiza odokotela neziguli zabo ukuba banqume ukuthi imiphi imithi kuhle kakhulu. Ngezinye izikhathi, ungase uqale ngemithi eyodwa, kuphela ukuthi uqaphele ukuthi ayisebenzi kahle futhi kuzomele udinge olunye uhlobo noma ushintshe ngokuphelele. Udokotela wakho uzosebenza nawe ukucacisa izidakamizwa ezifanele kakhulu noma inhlanganisela yezidakamizwa kuye ngezimo zakho ngabanye. Konke lokhu, kubalulekile ukuthi wenze ukuguqulwa kokuphila, njengokudla ukudla okunempilo nokwenza iphuzu lokuzivocavoca nsuku zonke. Imithi yesifo sikashukela ihloswe ukuba ihambisane nokudla nokuzivocavoca umzimba futhi uma izinguquko zokuphila zingenziwa, imithi izodinga ukwandiswa futhi ifakwe. Ukuze uthole olunye ulwazi mayelana nokuthi kungani, nini, nokuthi ungathatha kanjani imishanguzo yakho yesifo sikashukela: All About Oral Diabetes Imithi
Kuthiwani Nge-Insulin?
Abantu abanesifo sikashukela isikhathi eside noma labo abangakwazi ukulawula ushukela wabo wegazi nge-injection yomlomo noma engekho-insulin kungadingeka ukuthi bathathe i-insulin ukulawula ushukela wabo wegazi. Ngezinye izikhathi i-insulin isungulwa kumuntu wesifo sikashukela futhi uma abantu beqhamuka ubuthi lwe-glucose kuxazululwa ukuthi lo mgomo ungenziwa lula. Ukuze uthole olunye ulwazi mayelana nokuthi izinhlobo ezahlukene ze-insulini zisebenza kanjani: Izinhlobo Ezihlukahlukene Ze-Insulin Zisebenza Kanjani?
> Imithombo:
> I-American Diabetes Association. Amazinga Wokunakekelwa Kwezokwelapha Esifo Sikashukela - 2017. Ukunakekelwa Kweshukela . 2017 Jan; 38 (I-Suppl 1): S1-132.
> Jonas D, Van Scoyoc E, Gerrald K, et al. I-Portland (OR): i-Oregon Health & Science University.