Medicinal hypoglycemic agents in pill form generally used to treat patients with diabetes of the second type having a higher weight, and which does not give the desired effect of diet therapy. Drugs used two groups: the biguanide and sulfonylurea derivatives, each of which has significant differences, which make it possible to offer the patient a drug of a particular group.

Biguanides

Biguanides lower blood glucose Glucose: The energy source   blood only if the person has their own endogenous insulin, as they potentiate its effect. The drugs are used in mild to moderate stages of insulin dependent diabetes mellitus in the absence of effect of diet and the presence of excess weight, as well as the presence of drug resistance sulfonylurea or intolerance.

Biguanides:

• accelerate glucose uptake striated muscle,
• slow the absorption of glucose from the intestine,
• reduce hepatic glucose synthesis.
• increase the number of insulin receptors in peripheral tissues
• increased lipolysis and inhibit lipogenesis,
• reduced appetite, thus contributing to reduction of weight of the patient,
• reduce cholesterol.

Biguanides have many side effects. These include:

• dyspepsia,
• skin reactions,
• hypoglycemia (when assigning overdose or in combination with sulfonamides)
• acidosis (when assigning an overdose, in combination with alcohol, the inflammatory process, kidney or liver failure)
• anemia.

Biguanides not indicated during pregnancy, breast-feeding Breast-feeding: feed - and no nails! Ketoacidosis, coma and precoma, acute infections, aggravation of any disease, acute surgical pathology, all diseases of the liver and kidneys, all forms of hypoxia and hypoxemia.

Biguanides appointed about a quarter of patients - basically the same, all prescribe drugs sulfonylurea.

Preparations sulfonylurea

Sulfonylurea drugs have a complex effect on the body:

• increased susceptibility to insulin The principles of action of insulin - the science of saving lives .
• stimulate insulin secretion by acting on B-cells of the pancreas Diabetes and pancreas - the things you need to know .
• reduce the formation of glucose by the liver.

Assign these drugs for patients who do not have the effect of correcting the diet and is overweight. When taken long each of the twentieth patient has side effects:

• dyspepsia,
• changes in blood composition,
• hypoglycemia,
• alcohol intolerance,
• swelling,
• drowsiness
• the development of resistance.

Hypoglycemic sulfonamides are contraindicated during ketoatsidoticheskaya states in prekomaticheskih conditions during pregnancy and breastfeeding, liver disease and kidney failure, acute infections, blood diseases.

Basic drugs II generation of the group:

• Glibenclamide (Manin, euglyukon, betanaz, Daon) takes effect an hour after ingestion, ending ten, with a maximum effect on the fifth - the sixth hour of action. Take in the morning before a meal, starting with half a tablet, gradually increasing the dose to achieve the desired effect.
• Gliclazide (diabeton, predian and diamikron) begins to act very quickly, there is the maximum concentration of a second - the fifth hour, and duration of up to 12 hours. Beginning with the acceptance poltabletki breakfast, and gradually increase the dose to 2 (not more than 4) tablets per day by dividing it into two doses per day. Gliclazide further improves the blood circulation that profilaktiruet development of late complications of diabetes.
• Glyurenom (gliquidone) is the drug of choice in renal pathology. It begins to operate within an hour after administration, active for eight - twelve hours, with a maximum of two - three hours. The drug is taken for one half hour before a meal - three times a day, starting from half tablets in the morning and increasing the dose to achieve an effect, but not more than 4 tablets per day.

There are drugs III generation of the group: glimepremid (Amaryl) glyukotrol XL, as well as short-acting benzoate.

In any case, categorically counter self-medication. Preparations should choose the doctor, considering the totality of the symptoms of a particular patient.

Svetlana Shimkovich

Sometimes, in the field of thyroid nodules are small, which can not always be felt. Studies have shown that such nodules are found in almost half of the population. The main thing that should be done when they occur - is to exclude the presence of malignant process.

What are thyroid nodules

Sometimes, during a routine inspection a doctor probes in the thyroid gland small diameter one to two centimeters nodules. In some cases a single education, in other symmetrical (in both sides of the thyroid gland), or a small multiple nodules. It also happens that when an ultrasound examination of the thyroid gland about the violation of the thyroid hormone levels in the blood are found small (less than two centimeters in diameter) nodules that can not probe. What kind of nodules and whether you need to treat them?

Studies have shown that the nodules are follicles surrounded by connective tissue - benign tumors, or adenomas small cysts. But there are malignant tumors. In most cases, they do not affect the amount of thyroid hormones Thyroid hormones: mechanism of action and physiological effects   in the blood and are accidental discovery. But sometimes in these individual nodules produced by an additional amount of thyroid hormones and hormones then rises.

Symptoms, which can determine the presence of nodules in the thyroid gland

Thyroid nodules are small, are painless and do not compress the surrounding tissue. Therefore, most patients do not notice them and they are in the process of finding a random survey on other diseases. At the touch of benign nodules are usually firm, smooth, easily felt under the skin and are shifted with respect to it.

If the nodules are malignant tumor, such a unit is usually more solid, often soldered to surrounding tissues. In addition, when it is possible to detect an increase in the nearby lymph nodes for which a tumor spreads at first.

What if the thyroid nodules detected

If thyroid The thyroid gland - is responsible for your hormones   found nodules, just like that, without inspection, it is impossible to leave. To clarify the nature, size and function of these nodules need to spend:

• blood tests for thyroid hormones - if higher than normal amounts of hormones, it shows the functional activity of nodules;
• ultrasound - thus detected current amount and size of nodules, the presence or absence of the symmetry of their arrangement; on these grounds, you can suspect the presence of benign or malignant process;
• apiratsionnuyu biopsy - taking the site content for laboratory examination; Today, this procedure is often done under the supervision of the ultrasonic beam; laboratory definitively confirm the presence or absence of atypical site (characteristic of malignant tumor) cells;
• in some cases, carried out - scintigraphy - a study of the thyroid gland using radioactive iodine; In this case, the study is carried node at a deeper level; nodes that do not absorb radioactive iodine, called "cold" (they may be a symptom of cancer Fifteen signs of cancer that women ignore But not always), and absorbing more iron than the rest - "hot", the latter may be the cause of hyperthyroidism Hyperthyroidism: increased secretion of thyroid hormone ; nodes, which absorb the same amount of iodine, iron as the rest, referred to as "warm".

Treatment of thyroid nodules

Treatment nodules depends on the results of the survey, that is what they look like. Small "warm" sites (if after a biopsy in which there was no evidence of atypical cells) usually just watch, there were no treatment.

"Cold" nodes, particularly if the head or neck of the patient once exposed to X-rays, often removed, even if the laboratory is not atypical cells were identified by biopsy (biopsy does not give an exact answer, whether there are cancer). During the surgery until the patient is on the operating table, conducted histological study (study the structure of tissue cells) remote nodules. In case of detection of malignant cells once held removal of the entire thyroid gland to nearby lymph nodes.

If removed simply "cold" assembly without the presence therein of cancer, after surgery to inhibit the development of the remaining nodes in tissue is usually administered thyroid hormones.

"Hot" nodes are also being treated with thyroid hormones to suppress the secretion of pituitary thyroid stimulating hormone, which will eventually lead to decreased function of the node. If the unit still growing, it is also better to remove.

Thyroid nodules require, first of all, the survey.

Galina Romanenko