Iyo Iyo Mhando YeMishonga Inogona Kubatsira Kudzora Chirwere Cheshuga
Kwete-insulin injectables rudzi rwemishonga inorovedzwa sasi mutsvina mumashupu nemashizha kana peni. Hazvifananidzi kushandiswa sekutanga rokutanga kurapa, asi mhando dzakawanda dzinogona kushandiswa mukubatana nemuromo wemishonga yechirwere cheshuga pamwe neine insulin therapy.
Kunyanya, GLP-1 receptor agonists rudzi rwekusina insulini inopindwa mishonga inowedzera kuve yakakurumbira uye inozivikanwa, ichiita kuti iende mberi mberi kwekutarisira chirwere cheshuga nekutsvakurudza. Zvidzidzo zvakaratidza kuti idzi mhando yemishonga, iyo inoshandiswa mukubatana nekudya nekuita muviri, zvose zvishoma nekuita nekuita kwenguva refu, zvinogona kubatsira varwere vane chirwere chechirwere cheshuga kushaya uremu, kuderedza hemoglobin A1C (musvondo wemwedzi 3 we shuga yavo yeropa) , se pamwe nechinangwa chinogona kuderedza chiyero chepfungwa yekufa.
Ongororo yemazuva ano inoratidza kuti mishonga iyi inokunda mukuderedza kusviba kweropa nekuenzaniswa nemhando dzakasiyana siyana yemishonga yemuromo uye haisi pasi pezvirongwa zvinosanganiswa zvakadai sebasal insulin (kwenguva refu inobata insulin), pamwe ne GLP-1 agonist kurwisa insulini yebasal , uye kukurumidza kushandisa insulin .
Vanoshanda Sei?
Idzi mhando yemishonga inoshanda nokuti vanhu vane chirwere cheshuga chechipiri vane kuderera kwe incretin zvinorehwa, zvinoreva kuti vane zvinyorwa zvisinganyanyi zvinyorwa. Rimwe incretin hormone zvakanyanyozivikanwa seglucagon-like peptide (GLP-1), yakaderera kune vanhu vane chirwere cheshuga. GLP-1 inowanzobudiswa kubva mudumbu rako duku kana iwe uchidya, uye inoshanda kunonoka kugadzirisa nzira iyo zvokudya zvinosiya mudumbu rako, kudzora shuga yako yeropa mushure mokudya.
Kubatsirwa kweGLP-1 agonists ndeyekuti vanofananidza GLP-1 hormone nekusunga ku GLP-1 receptors uye kukurudzira kusununguka kwe insulini, iyo inoderedza shuga yeropa. GLP-1 agonist inoshandawo mukati mudumbu, uropi, pancreas, uye chiropa kuwedzera manzwiro ekuzara uye kuderedza mushure mekudya kweropa sutu , izvo zvinosimudzira kuora muviri uye zvinovandudza kugadzirisa kwega shuga.
Kazhinji, hazvisi kukurudzira hypoglycemia nokuti dzinoshanda chete kana kune glucose muhutano hwako. Ichi chinhu chakanaka kune avo avo vanowanzoita hypoglycemia, zvisinei, kana vakashandiswa pamwe chete ne insulini kana sulfonylurea ngozi ye hypoglycemia inowedzera. Kana uri kutsvaga sarudzo yakasiyana yekutarisira chirwere cheshuga, taura nachiremba wako kuti unzwisise zviri nani kana sarudzo iyi yakakodzera iwe uye inogona kukubatsira zviri nani kudzora chirwere cheshuga.
Migumisiro pamuviri
Ubongo: GLP-1 inotumira chiratidzo kuuropi, kunyanya hypothalamus, ichiudza kuti kuderedza mvura uye kudya kwekudya. Somugumisiro, munhu anotora GLP-1 agonist anowedzera zvakakwana nokukurumidza. Sezvaunonzwa uzere nekukurumidza, iwe unogona kudya zvokudya zvishomanana uye, semugumisiro, uremerwe uremu. Nokuti kunzwa kwako kunwa kunogona kuderera, zvakakoshawo kuti uyeuke kune hydrate kudzivirira kupera simba.
Tsvina: GLP-1 inowedzera gluconeogensis mumusungo. Izvi zvinobatsira kuderedza shuga yeropa kuburikidza nekuita kuti glucose iwedzere nemasero uye kuwedzerwa insulin senitivity (muviri wako unoshandisa sei insulini zvakanaka).
Pancreas: GLP-1 inowedzera insulin kuvhara kana ichibatana neglucose. Izvi zvinobatsira kuderedza mushure mekudya kudya kwemashuga eropa. Mukuwedzera, GLP-1 inoderedza kuchengetedza glucagon uye inowedzera somostatin secretion. Basa reGlucagon nderokudzivirira ropa remasuru kubva pakuenda zvakanyanya. Kune vanhu vane chirwere cheshuga chechipiri, glucagon inogona kukwidza mazinga eropa glucose akakwirira zvikuru nokuti pane zvimwe hazvina kukwana insulin inowanikwa kuchera yega yega kana muviri haukwanisi kupindura insulini . Nokudaro, nokuderedza glucagon yakabuda, ropa shuga inoderedzwa.
Chiropa: GLP-1 inoderedza hepatic (chiropa) glucose yakabuda, iyo inobatsira kuderedza ropa sutu. GLP-1 inowedzera gluconeogensis, iyo ndiyo nzira yemagetsi inokonzera glucose kubva kune zvisiri-carbohydrate zvinhu, zvakadai seproteine uye mafuta. Sezvo gluconeogensis inowedzera, glucagon (iyo hormone inobatsira kuwedzera sutu yeropa) zvakagadziriswa zvinoderedzwa muropa, kudzivisa glucose kuumbwa uye kukurudzira glucose kubatwa nemasero anobatsira kuderedza shuga.
Dumbu: GLP-1 inoderedza kuvhara asidi uye inoderedza gastric kuvhara, iyo inoderedza kushanda kwekukurumidza kwezvokudya zvinosiya mimba yako, kuwedzera kuzadza, kuderedza kushandiswa kwemashuga eropa nokukurumidza, uye kunowanzokonzera kushungurudza. Nhamba yakaderedzwa iyo zvokudya zvinosiya mudumbu zvinoguma nekuderera kwekudya kwekudya, izvo zvinowanzoita kuti uwedzere kurasikirwa. Kurasikirwa kwemahombeksi kunoderedza kusuruvara kwekuchengetedza, saka kuderedza ropa remashuga.
Ndeapi Mhando dzakasiyana dzeG GLP-1 Agonist?
GLP-1 agonist inogona kuputswa mumapoka maviri akasiyana: maitiro mashomanana maitiro, ayo anowanzoiswa kamwe kana kaviri pazuva, kana kuti maitiro akawanda kwenguva refu, anopiwa kamwechete kwevhiki. Mhando ye GLP-1 yaunogamuchira inobva pane nhoroondo yako yezvechiremba, inshuwarisi, zvaunofarira uye sarudzo yehuga yekutonga. Dzimwe GLP-1 agonist inogona kudhura; saka zvinganzwisisika kutumidza inshuwarisi yako usati wagamuchira chiremba kuti uve nechokwadi chokuti unokwanisa kuwana mushonga.
Short Acting GLP-1 Agonist - Rimwe kana Twese Zuva reNjodzi Injodzi
Zvinodhaka: Kuwedzera
Zita Rekushandisa: Byetta
Dose: Tanga ne 5mcg kaviri zuva nezuva 60 maminitsi musati wadya uye uwedzere kusvika 10mcg mushure memwedzi umwe.
Positives: Imwe yemhando shomanana yeGPP-1 agonists, zvichida nokuti yakange yakapoteredza nguva refu.
Hazvina kunaka: Inofanira kupiwa 60 maminiti tisati tadya kudya kunogona kusakanganisika.
Zvimwe Zvokufungisisa: Byetta yakaderedzwa kuburikidza neitsvo uye haina kukurudzirwa kune vanhu vane GFR vane makumi matatu kana pasi.
Zvinodhaka: Liraglutide
Zita Rekushandisa: Victoza
Dose: 0.6mcg kwevhiki imwe uye kuwedzera dose kusvika ku 1.2mcg. Kana sutu yeropa iri pane chinangwa, unogona kuchengeta chiyero ichi, kana kuwedzera kusvika 1.8mcg sezvinoregererwa. Chiremba wako anofanira kukukurudzira kuti ungawedzera sei chirwere.
Chinhu chakanakisisa: Chave chiratidzwa kuti chinopa kurasikirwa kukuru.
Nhema: Inofanira kupiwa kamwe chete zuva rega rega. Varwere vanorondedzera kukanganisa kwakanyanya kwekushungurudzika, izvo zvichida nei kune kuora kwekurema kwakanyanya.
Zvinodhaka: Lixisenatide
Zita Rekushandisa: Adlyxin
Dose: 10 mcg zuva rega kwevhiki mbiri uye owedzera kusvika 20 mcg zuva rega rega.
Positives: Inonyanya kufanana neByetta.
Zvikanganiso: Unofanirwa kuvharwa zuva rega rega 60 maminitsi musati wapedza kudya kwezuva
Zvimwe zvinofungidzirwa: Zvakaderedzwa kuburikidza neitsvo uye zvinofanira kudziviswa neGFR's
Kubata kwenguva refu GLP-1 Agonist - Kamwe kamwe kwevhiki Injodzi
Zvinodhaka: Kuwedzera kwenguva yakareba yomuitiro weByetta
Zita Rekushandisa : Bydureon (yakarongedzerwa sevheti ine kitambo kana peni)
Dose: 2mg vhiki nevhiki, inopiwa kamwechete pavhiki.
A1C kuderedza: Inenge 1.3 muzana.
Positives: Inopiwa kamwe chete kwevhiki; inogona kurongerwa kuburikidza nepeni.
Zvikanganiso: Zita rakasununguka uye rinofanira kudziviswa neGFR 30 kana kuti pasi. Mukuwedzera, chiyero chetsono chakakura (23G).
Zvimwe Zvokufungisisa: Zvidzidzo zvakaratidza kuti zvakaderera kuVictoza maererano neA1C kuderedza uye inogona kushanda kana kuisa (kunofanira kusanganiswa). Mukuwedzera, vanhu vazhinji vanonyunyuta nezvemaitiro ekuita maiti apo mushonga unorirwa.
Zvinodhaka: Dulaglitide
Zita Rekushandisa: Trulicity (peneni)
Dose: Tanga ne 0.75mg vhiki nevhiki uye kuwedzera kusvika 1.5mg mumasvondo matanhatu kusvika ku8.
A1C kuderedza: Inenge 1.4 muzana.
Positives: Haafaniri kushandiswa. Iwe haufaniri kuisa nhare uye unogona kukanda peni yose mumubhodhoro wekubata shure mushure mekunge maunza chiremba. Iyo yakatorwa kamwechete pavhiki uye ine yakakwirira yeA1C kudarika Victoza.
Zvikanganiso: Hazvifukidzirwi nehupfumi hwose uye zvinogona kudhura.
Chii Chiri Mhinduro Dzakashata?
- Nyaya yakanyanya kufanana nayo yeGLP-1 agonists inosuruvara, kurutsira uye chirwere. Izvi zvinowanikwa munenge 10 kusvika ku40 kubva muzana (zvichienderana nemishonga chaiyo) yevanhu uye inowanzoonekwa mune zviduku zvinoshanda. Zvisinei, izvi zvinokonzerwa nemagumisiro zvinowanzoita kuderera sezvinoita munhu pane mishonga kwenguva yakareba. Mukuwedzera, kana uri kutora nguva pfupi inoshanda GLP-1, yakadai saVictoza, kuitora musati warara kunogona kubatsira kuderedza kunetseka.
- Zvidzidzo izvo zvakaitwa pamakonzo zvinoratidza kuti dzimwe GLP-1 agonists, kunyanya liraglutide uye dulaglutide, inogona kukurudzira mishonga yekirusi chetachiona. Kunyange zvazvo izvi zvidzidzo zvisati zvamboitwa kuvanhu, zvinokurudzirwa kuti vanhu avo vane nhoroondo kana nhoroondo yemhuri ye medullary yekenza yekenza uye Multiple Endocrine Neoplasia rudzi 2 havashandisi GLP-1 agonsist.
- Nevamwe GLP-1 agonists pane imwe inogona kuwedzera mungozi yekutapisa (kuputika kwepascreas).
- Vanhu vanogona kuona maitiro ekuisa majekiseni nzvimbo iyo mishonga inowanikwa.
Ndiani Anofanira Kuzvidzivirira Mhando dzeMishonga?
Iyi mishonga haina kukurudzirwa kana:
- iwe une nhoroondo yepaccreatitis.
- iwe une nhoroondo ye gastroparesis (kuparara kwemuviri).
- Iwe une nhoroondo kana nhoroondo yemhuri ye medullary yekenza yekenza kana vazhinji vevanhu Endocrine Neoplasia rudzi rwechipiri.
Uyezve, vanhu vane chirwere cheshuga avo vakaderera zvepfungwa, vane GFR (glomerular filtration rate) kana 30 kana pasi havafaniri kushandisa bydureon uye byetta. Kurukurai renal dosing nechiremba wako kana uri kutora imwe GLP-1 agonists.
Hapana humwe huchapupu hwakakwana hunotsigira kuchengetedzwa kune varwere vari pa dialysis, saka kudzivisa kushandisa GLP-1 muhuwandu kune huchenjeri.
Chii Chinotevera?
Sezvo chirwere cheshuga chinoramba chichibuda uye tsvakurudzo inokurumidza kuenderera mberi kuti ive yakachengeteka, inonyanya kukosha, uye inoshanda zvakasiyana siyana dzeG GL-1 agonists, tine chokwadi chekuona mimwe mishonga inouya kwatiri munguva yemberi. Muzvokwadi, imwe GLP-1 agonist iyo ikozvino inoshandiswa kugamuchira FDA, semaglutide, inonzi kuderedza mwoyo ngozi kune 26 muzana. Uye sebhonasi, muromo semaglutide uri muchitsauko chechipiri, zvinoreva rimwe zuva, GLP-1 agonist ingasafanira kuiswa.
> Sources:
> Dungan, K, DeSantis, A. Glucagon-like peptide 1 receptor agonists yekurapa rudzi rwechipiri cheshuga cheshuga. Kusvika pari zvino.
> Vishal, Gupta. Glucagon-like peptide-1 zvakafanana: Mhedziso yepamusoro. Indian J Endocrinol Metab. 2013 May-June, 17 (3): 413-421.
> Smilowitz, N, Donnino, Robert, Schwartzbard, Arthur. Glucagon-like peptide receptor agonist chechirwere cheshuga: Chiitiko mumoyo wepfungwa. Circulation.