Gluconorm: nā ʻōlelo aʻoaʻo no ka hoʻohana ʻana: kumukūʻai a me nā loiloi o ka maʻi maʻi e pili ana i nā lāʻau maʻi maʻi

Ua hana ka endocrinologist i kahi maʻi - kahi kūlana prediabetic. Ke ulu mau nei ka paona, nā kuʻuna metabolic, maikaʻi loa, ka hele ʻana o ke kō (hypoglycemic syndrome). I ka pōkole, leʻaleʻa. I ka wā e ʻai ai ʻoe i ka papaʻai, piʻi ke kō, hāleʻa, ʻike ʻia nā hōʻailona maʻamau. E hoʻomaka me, i mea e hōʻemi ai i koʻu mau makemake, ua kuhikuhi ʻia au i kēia lāʻau lapaʻau i ka pāʻina awakea 1 ka manawa i ka lā 1 papa, akā naʻe, ʻaʻohe hopena, ʻaʻohe. Hele wau i kekahi kauka hou, i kauoha aku iā Siofor 850, e lawe iaʻu iho. Ua loaʻa ka hopena ma ka lā mua o ka hoʻokipa ʻana, i ke ahiahi a makemake wau e ʻai liʻiliʻi. Ma hope o 2 mau pule o ka mālama ʻana, ua hoʻemi ʻia ke kaumaha ma 1.5 kg. ʻAe, a maikaʻi wau.

Aia i hoʻokahi makahiki mai koʻu mau maʻi me ka maʻi diabetes type 2, ma hope o ka mea i kuhikuhi ai ke kauka iaʻu i kahi meaʻaiʻaiʻai a me ka gluconorm. Lawe mākou i kahi papa no hoʻokahi mahina, akā i kēia manawa ʻaʻole e piʻi ka glucose i luna o ka 6-7. He mea minamina wale nō ka pono o ka meaʻai e mālama ʻia. ʻOiai ke koʻikoʻi ke olakino, ʻoiaʻiʻo.

ʻO ka wehewehe pōkole

200 miliona ... He mea pono ke hoʻomanaʻo i kēia helu, no ka mea eia ke kumu o ka helu o ka poʻe e maʻi nei i ka maʻi maʻi i kēia lā. A e like me nā wānana o ka ʻepekema (a ʻaʻole hoʻi i nā mea pessimistic nui loa), ma ka 2030 e manaʻo mākou he hoʻonui ma kēia helu ma ka liʻiliʻi a i ka hapa. ʻElua mau kumu nui o ka pathological e kū pono ana i ka mea i hoʻomaka ai ka maʻi diabetes: ka kū ʻana o ka pale ʻana a me ka insulure pancreatic i ka hana ʻana o ka insulin endogenous. No ka hōʻemi i ka hopena o nā maʻi vascular hikiʻole (makapō, hōʻeha ka naʻau a me nā hōʻeha, nā ʻōpū o nā wāwae), pono e mālama mau ʻoe i kou lima ma ka pulse (a i ʻole, ma ka mika) i mea e mālama mau ai i ka ʻike koko i ka pae o ka glucose koko. I kēia mea, ʻo ka ulu ʻana o ka lāʻau ke hana kumu i ke ʻano o ka maʻi maʻi. E like me ke kānāwai, e hoʻomaka ʻia ka lāʻau antidiabetic me ka monotherapy, e hoʻohana ana i ka metformin a i ʻole sulfonylureas (glibenclamide glyclazide, glimepiride). I ka wā e hiki mai ana, me ka ʻike maikaʻi ʻana i ka hoʻopili ʻana o nā ʻōhua biochemical, ua hoʻomaka ʻia nā hui ʻana o nā lāʻau lapaʻau a e pili pū ʻia ana nā inikini insulin. Eia nō: mai No ka mea, ua manaʻo ʻia ka maʻi diabetes he maʻi holomua, ʻoiai me ka holomua mua o ka monotherapy, ma ka manawa koke koke, e hoʻohui hou ai i ka hoʻohui ʻia ʻo ka pharmacological hoʻokahi a i ʻole ʻelua mau papa hana o ka puke ʻo Mashkovsky.

ʻO ka hui maʻamau antidiabetic i loko o ka hana lapaʻau ka metformin + glibenclamide. ʻO ka gluconorm lāʻau lāʻau i nā mea a pau i kēia ligament hypoglycemic ikaika. ʻO ka Metformin biguanide e hoʻohaʻahaʻa i ka hoʻokahe koko me ka hoʻohaʻahaʻa ʻana i ka paepae no ka mālama ʻana i ka insulin i nā ʻiʻo peripheral a hoʻonui i ka uptake glucose e nā kiko. Hoʻopili kēia kinona i ka hoʻopili ʻana o nā hāmeʻe i loko o ka pānaʻi ʻana a hana i ke kāpili o ka glucose ma ka ate. Hoʻomaikaʻi hoʻi ʻo Metformin i ke kiʻi lipid o ke koko, hoʻemi i ka pae o ka kolamu "kino". ʻO Glibenclamide, ʻo ia hoʻi, ʻo ka ʻiʻo o ka ʻiʻo o ka sulfonylurea. Hoʻopuka i ka hoʻokuʻu ʻana o ka insulin ma ka hoʻonui ʻana i ka naʻau o ka pancreatic β-cell i ka glucose a me ka pae o ka pilina o ka insulin me nā cell target.

Hoʻohana pinepine ʻia ka Gluconorm i ka meaʻai i ka ʻōhua i ʻae ʻia me ke kauka (hiki iā ia ke kū hoʻokahi i kēlā me kēia hihia). Ma ka ʻōlelo maʻamau, hoʻomaka lākou "hoʻomaka" mai hoʻokahi papa a laila hoʻoponopono i ka ʻawaʻawa i kēlā me kēia 1-2 mau pule, e noʻonoʻo ana i ka pae o ka glucose i ke koko, ʻoiai ʻaʻole e hoʻonui i ka paepae i kēlā me kēia lā o 5 mau papa.

Lapaʻau

ʻO Gluconorm ® kahi hui pūpū o ʻelua mau loiloi hypoglycemic waha o nā hui lāʻau lapaʻau like ʻole: metformin a me glibenclamide.

Aia ʻo Metformin i ka hui o ka biguanides a hōʻemi i ka hoʻoliʻi serum ma o ka hoʻonui ʻana i ka ʻike ʻana o nā ʻiʻo peripheral i ka hana o ka insulin a hoʻonui i ka uptake glucose. Hoʻēmi i ka komo ʻana o nā huapalapala i loko o ka digestive tract a hoʻopaʻa i ka gluconeogenesis ma loko o ka ate. He hopena maikaʻi hoʻi ka lāʻau lapaʻau i ka ʻike lipid o ke koko, e hoʻohaʻahaʻa i ka pae o ka nui o ka cholesterol. LDL a me triglycerides. ʻAʻole ia e kumu i ka pane hypoglycemic.

No ka hui ʻo Glibenclamide e pili ana i ka hui o nā kōmani sulfonylurea o ka lua o ka hanauna. Hoʻonohonoho ia i ka hana huna insulin ma ka hoʻohaʻahaʻa ʻana i ka paepae pancreatic β-cell glucose, hoʻonui i ka ʻike ʻana i ka insulin a me kona paa ʻana i nā cell target, hoʻonui i ka hoʻokuʻu ʻana i ka insulin, e hoʻonui ana i ka hopena o ka insulin ma ka ʻāʻī a me ka puʻuwai glucose uptake, a pale i ka lipolysis ma ka adipose tissue. Nā hana i ka lua o ka hana ʻana o ka inikini insulin.

Lapaʻau lāʻau

Ke hoʻokau ʻia, mālamaʻia mai ka gastrointestinal tract ʻo 48-84%. He manawa e hiki ai i C_max - 1-2 hola V_{e d} - 9-10 lita. ʻO ka kamaʻilio pū me nā protein plasma he 95%.

Ua aneane ʻokoʻa loa i ka ate a me ka hoʻokumu ʻana o ʻelua mau metabolite hana, ʻo kekahi kekahi a hoʻopiʻi ʻia e nā ʻeha, a ʻo kekahi i nā ʻāpana o nā ʻāpana. T_1/2 - mai 3 a hiki i ka 10-16 hola

Ma hope o ka lawelawe waha, ua hoʻoiho ʻia mai ka gastrointestinal tract piha loa, 20-30% o ka nui i loaʻa i ka feces. ʻO ka bioavailability kūpono mai 50 a 60%. Me nā ingestion like ʻole, ua hoʻemi ʻia a emi mai ka hoʻopili ʻana o ka metformin Hāʻawi koke ʻia ia i ka kiko, hoʻomaʻamaʻa ʻole ia i nā protein plasma.

Hoʻomili ʻia ia i kahi pae palupalu loa a hoʻopā ʻia e nā keiki. T_1/2 aneane 9-12 hola

E hoʻokuʻu i ke ʻano

ʻO nā papa ʻulaʻula like ʻole o ka ʻulaʻula a i ʻole hoʻi he keʻokeʻo, puni, biconvex, ma kahi hoʻomaha mai ke keʻokeʻo a keʻokeʻo me kahi paʻu hina.

Nā mea hoʻihoʻi: nā cellulose microcrystalline - 100 mg, starch corn - 20 mg, silikone koloila colloidal - 20 mg, gelatin - 10 mg, glycerol - 10 mg, magnesium stearate - 7 mg, talc purified - 15 mg, sodium croscarmellose - 30 mg, sodium carboxymethyl starch - 18.3 mg, cellacephate - 2 mg, diethyl phthalate - 0.2 mg.

10 kamepiula - nā kāmele (4) - nā ʻeke pepa.
20 mau kāleka. - nā kāmele (2) - nā kīʻaha o ke kāleka.

Hoʻohana pinepine ʻia ka lāʻau lapaʻau, me ka papaʻaina. Hoʻoholo ʻia ka nui o ka lāʻau e ke kauka ponoʻī no kēlā me kēia maʻi, e pili ana i ke kiʻekiʻe o ka glucose koko.

ʻO ka maʻamau maʻamau ka pae ʻono. (400 mg / 2,5 mg) / lā. I kēlā me kēia 1-2 mau pule ma hope o ka hoʻomaka ʻana o ka hoʻomaʻamaʻa, hoʻoponopono ʻia ke ʻano o ka lāʻau lapaʻau ma muli o ke kau o ka glucose koko. Ke hoʻohālikelike nei i ka lāʻau hui mua me ka metformin a me ka glybeklamide, ua kuhikuhi ʻia nā papa 1-2. Kūpono ʻia ka Gluconorm ma mua o ka hopena o mua o kēlā

ʻO ka papa helu ʻehā loa no 5 mau papa.

Ke keu

ʻO kahi overdose a i ʻole ka heleʻana o nā mea pili i hiki ke hoʻowalewale i ka hoʻomohala ʻana o ka acidosis lactic, ʻoiai ʻO ka metforminum kahi papa i ka hoʻomākaukau. Ke hele nei nā hōʻailona o ka lactic acidosis (ka luaʻi, ka ʻōpū o ka ʻōpū, nā nāwaliwali ākea, nā ʻōpūʻī o ka naʻau), pono ʻoe e hoʻōki i ka lawe ʻana i ka lāʻau. Lactic acidosis kahi kūlana e koi ai i ka mālama maʻi olakino, mālama pono i ka lactic acidosis e lawe ʻia i loko o ka haukapila. ʻO ka hopena kūpono e pili ana i ka hemodialysis.

Hiki i kahi overdose ke alakaʻi i ka uluʻana o ka hypoglycemia ma muli o ka loaʻaʻana o glibenclamide i ka hoʻomākaukau. Nā hōʻailona o ka hypoglycemia: ka pōloli, ka momona nui loa, nāwaliwali, palpitations, pallor o ka ʻili, paresthesia o ka wahaosa waha, nā mea haʻalulu, nā hopohopo maʻamau, ʻeha, ka hiamoe o ka pathological, nā hana hiamoe, ka manaʻo hopohopo, nā palena o ka neʻe ʻana o nā neʻe, nā maʻi neurological ʻole. Me ka hoʻomohala ʻana o ka hypoglycemia, hiki i nā mea maʻi ke nalowale i kā lākou iho a me ka ʻike.

Me ka hypoglycemia maʻalahi a hōʻoluʻolu paha, lawe i ka dextrose (glucose) a i ʻole ka hilo i ke kō. Ma ka hihia o ka hypoglycemia koʻikoʻi (ka nalowale o ka ʻike) ʻole, kahi hopena o 40% dextrose (glucose) a i ʻole glucagon intravenous, v / m, s / c e lawelawe ʻia iv. Ma hope o ka hāpai hou ʻana, pono e hāʻawi ka mea maʻi i ka meaʻai i ka momona o ka pale i ke pale ʻana i ka hoʻomohala hou ʻana o ka hypoglycemia.

Hoʻohui

ACE inhibitors (captopril, enalapril), histamine H blockers hoʻomaikaʻi i ka hopena hypoglycemic o ka lāʻau.₂nā mea kūmole (cimetidine), nā antifungal agents (miconazole, fluconazole), NSAIDs (phenylbutazone, azapropazone, oxyphenbutazone), fibrates (clofibrate, bezafibrat), anti-tuberculosis drug (ethionamide), salicytates, anticoagulant MAO, ka lōʻihi o ka manawa sulfonamides, cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline, theophylline, tubular secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, me nā mea ʻē aʻe ʻO ka lāʻau hypoglycemic (acarbose, biguanides, insulin), allopurinol.

Barbiturates, corticosteroids, adrenostimulants (epinephrine, clonidine), nā lāʻau antiepileptic (phenytoin), nā blockers kahalulu kalepa, nā mālamuku anhydrase carbonic (acetazolamide), thiazide diuretics, chlortalidone, furosemide, diazanazide, triaakenene , morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, iodine-i pili ana i nā huaola tiroid, nā paʻakai lithium, ma nā wai haʻahaʻa - nā waikele nikotiniki, chlorpromazine, nā ʻōpala a me nā estrogens.

Kāohi i ka hoʻohuihui ʻana i ka wai (ammonium chloride, calcium chloride, ascorbic acid ma nā wai he nui) hoʻonui i ka hopena ma ka hoʻemi ʻana i ka pae o ke kipi a hoʻonui i ka reabsorption o glibenclamide.

Hoʻonui ka Ethanol i ka nui o ka acidact lactic.

Hoʻohālikelike ka Metformin C_max a T_1/2 furosemide e 31% a me 42.3%, loaʻa.

Hoʻonui ka Furosemide C_max metformin e 22%.

Hoʻonui ka Nifedipine i ka hoʻopili ʻana, C_max hoʻoluhi i ka hoʻopauʻana o ka metformin.

ʻO nā lāʻau lapaʻau cationic (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamteren a me vancomycin) i hūnā ʻia i loko o nā tubule e hoʻokūkū ana no nā ʻōnaehana o ka tubular a hiki ke hoʻonui i ka C me ka lōʻihi o ka hoʻokō_max 60% metformin.

Nā hopena hopena

Ma ka ʻāpana o ka pākūkū kila: hiki i ka hypoglycemia.

Mai ka huehui a me ka mokukū: luhi - paʻa, ka luaʻi, ka ʻōpū o ka ʻōpū, ka lilo ʻana o ka momona, "ʻono" ʻono i loko o ka waha, i kekahi mau hihia - jaundice cholestatic, hoʻonui i ka hana o nā enme o ka huina, hepatitis.

Mai ka ʻōnaehana hemopoietic: līpeke - leukopenia, thrombocytopenia, erythrocytopenia, aneane loa ʻole - agranulocytosis, hemolytic a megaloblastic anemia, pancytopenia.

Mai ka ʻaoʻao o ka pūnaehana nūhou: hōʻeha, ka ʻōpū, nāwaliwali, nā luhi, ʻelele - paresis, nā maʻi hoʻoweliweli.

ʻAeola a me ka immunopathological ʻano: jarang - urticaria, erythema, hōʻeha o ka ʻili, ke kuni, arthralgia, proteinuria.

Nā hopena dermatological: paʻakikī - photosensitivity.

Mai ka ʻaoʻao o ka hana metabolism: lactic acidosis.

Nā mea hou: ka hopena kūlohelohe o ka hōʻemi o ka waiʻona ma hope o ka inu ʻana, i hōʻike ʻia e ka hoʻopiʻi ʻana o ka kaʻe a me ka hanu (disulfiram-like ka hopena: pihoʻi, hoʻāhu ka wela o ka maka a me ke kino o luna, tachycardia, dizziness, headache).

Pākuʻi type 2 i nā pākeke:

• me ka loaʻa ʻole o ka mālama meaʻai, hoʻokolohua a me ka hoʻokaʻina mua me ka metformin a i ʻole glibenclamide,
• e hoʻololi i ka terapi mua ma mua o nā lāʻau lapaʻau (metformin a me glibenclamide) i nā mea maʻi me ka pae o ka kaila koko a maikaʻi.

Nā Hoʻohui

• maʻi diabetes type 1
• maʻi maʻamau ketoacidosis, maʻi kanesa, preca maʻi maʻi,
• huahuʻi,
• pilikia hanalei,
• nā hopena ākea e hiki ke alakaʻi i kahi loli i ka hana o ka keiki (dehydration, impiry maʻi, pīhoihoi),
• nā maʻi akamai a i ʻole ke ʻano hele me ka maʻi hypoxia (puʻuwai a i ʻole ka hanu ʻana, ka hala ʻana o ka myocardial infarction, pīhoihoi)
• pūpū hema
• porphyria
• con conidance con miconazole,
• nā maʻi hōʻeha, nā hōʻemi hōʻemi nui, nā mea hōʻeha, nā kuniahi a me nā ʻano ʻē aʻe e koi ai i ka ʻomo ʻana o ka insulin.
• humuhinu maoli, huokuhiko make,
• lactic acidosis (me ka mōʻaukala),
• hoʻohana no ka liʻiliʻi he 48 mau hola ma mua a i loko o nā hola 48 ma hope o ka lawe ʻana i nā haʻawina radioisotope a i ʻole x-ray me ka hoʻomaka ʻana o ka iodine-medium vari,
• ka adherence i ka meaʻai haʻahaʻa-emi (emi iho ma mua o 1000 kaleka / lā),
• hapai
• umauma umauma,
• hypersensitivity i ka metformin, glibenclamide a me nā mea pōpū sulfonylurea ʻē aʻe, a me nā mea waiwai.

ʻAʻole ia e hoʻohana i ka lāʻau i loko o nā kānaka ma mua o 60 mau makahiki o ka mea e hana i ka hana kino kino, a pili pū me ka piʻi nui o ka hoʻomohala ʻana i ka acidact lactic i loko o lākou.

Me ka mālamaʻana: ka maʻi febrile, ka adrenal insufficiency, hypofunction o ka pituitary anterior, maʻi thyroid me ka hana kīnā ʻole.

ʻŌpū a me ka lactation

I ka wā hāpai, ua contraindicated ka hoʻohana ʻana o ka gluconorm. Ke hoʻolālā nei i ka hapai, me ka mālama ʻana i ka wā hāpai i ka wā e lawe ai iā Gluconorm, pono e haʻalele ʻia ka lāʻau lapaʻau a pono hoʻi e kuhikuhi ʻia ka lāʻau lapaʻau.

ʻO ka Gluconorm ® i contraindicated ma ka umauma, ʻo ka metformin e hele i loko o ka waiū umauma. I kēia hihia, pono ʻoe e hoʻololi i ka hoʻololi ʻana i ka insulin a i ʻole hoʻokū ʻaʻa.

Nā ʻōlelo kikoʻī

ʻO nā hōʻiliʻili o nā maʻi a me nā hōʻeha, ʻoi loa ke kīwī, nā maʻi ʻeha me ka febrile syndrome e koi i ka hoʻokuʻu ʻana i ka lāʻau a me ka koho ʻana i ka hana maʻi insulin.

Pono e kiaʻi pinepine i ka pae glucose i loko o ke koko ma kahi ʻōpū ʻole a ma hope o ka ʻai.

Hoʻomaʻamaʻa ʻia nā mea maʻi e pili ana i ka hoʻonui nui o ka hypoglycemia i nā hihia o ka ethanol, NSAID, a me ka pōloli.

Pono kahi hoʻoponopono hoʻoponopono ʻia no ke ʻano kūlohelohe a me ke kaumaha, kahi hoʻololi i ka ʻai.

I ka wā mālama, ʻaʻole pono e inu i ka waiʻona.

ʻO 48 mau hola ma mua o ka ʻoi a i ʻole ka hoʻōho ʻana o ka mana o ka radiopaque iodine i loaʻa, e hoʻokaʻawale ke keʻena gluconorm. Hoʻomaopopo ʻia ka hana hoʻōla ʻia o Gluconorm ma hope o 48 mau hola.

Hoʻokomo i ka hiki ke lawe i nā kaʻa a kāohi i nā mīkini

I ka wā o ka mālama ʻana, pono e mālama ʻia i ka wā e alakaʻi ana i nā kaʻa a hana i nā hana ʻē aʻe paha e koi ai i ka piʻi ʻana o ka nānā a me ka wikiwiki o ka hopena psychomotor.