{"id":8414,"date":"2013-06-21T16:05:54","date_gmt":"2013-06-21T16:05:54","guid":{"rendered":""},"modified":"2013-06-21T16:05:54","modified_gmt":"2013-06-21T16:05:54","slug":"2-tipo-cukrinio-diabeto-gydymo-ypatumai","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/2-tipo-cukrinio-diabeto-gydymo-ypatumai\/8414\/","title":{"rendered":"2 tipo cukrinio diabeto gydymo ypatumai"},"content":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n<![endif]--> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Dr<strong style=\"mso-bidi-font-weight: normal;\">. Egl\u0117 Varanauskien\u0117<\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">LSMU MA Endokrinologijos klinika <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><em style=\"mso-bidi-font-style: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">Gliukoz\u0117s homeostaz\u0117 (<span class=\"st1\">organizmo geb\u0117jimas palaikyti nuolatin\u0119 gliukoz\u0117s koncentracij\u0105 kraujyje) <\/span>yra sud\u0117tingas procesas, priklausantis nuo daugelio veiksni\u0173. Pastaruoju metu nustatyta, kad gliukoz\u0117s homeostaz\u0119, t. y. gliukoz\u0117s kontrol\u0119, daugiausia lemia ne tik insulino, bet ir gliukagono sekrecija (ma\u017edaug vienodai \u2013 po 50 proc.). Insulinas ir gliukagonas vadinami hormonais antagonistais. Dabartin\u0117je literat\u016broje skelbiami duomenys leid\u017eia teigti, kad abu \u0161ie hormonai vienodai veikia gliukoz\u0117s koncentracij\u0105 kraujyje. <\/span><\/em><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">2010\u20132011 metais pasirod\u0117 mokslini\u0173 publikacij\u0173, skelbian\u010di\u0173, jog sergant 2 tipo cukriniu diabetu gliukagono kiekis reik\u0161mingai padid\u0117ja (hiperglikemijai po valgio didel\u0119 \u012ftak\u0105 turi nepakankama gliukagono supresija). Tyrimuose pasteb\u0117ta, kad, skiriant gliukagono i\u0161siskyrim\u0105 slopinan\u010dius veiksnius, reik\u0161mingai pager\u0117ja glikemijos kontrol\u0117 \u2013 gliukoz\u0117s koncentracija suma\u017e\u0117ja 1,5\u20132 mmol\/l nestebint hipoglikemijos. Sergant 2 tipo CD, sutrinka ir insulino, ir gliukagono sekrecija. Gliukagonas da\u017enai slopinamas nepakankamai, o kartais galima net paradoksin\u0117 padid\u0117jusi gliukagono sekrecija \u2013 d\u0117l to dar labiau pablog\u0117ja glikemijos kontrol\u0117, padid\u0117ja glikemijos po valgio svyravimai ir kyla didesn\u0117 \u0161irdies ir kraujagysli\u0173 lig\u0173 i\u0161sivystymo rizika. Tod\u0117l nuolat ie\u0161koma nauj\u0173 efektyvi\u0173 vaist\u0173 s\u0117kmingai glikemijos kontrolei u\u017etikrinti.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">Inkretin\u0173 efektas<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Inkretinai \u2013 \u017earnyne i\u0161skiriami hormonai: GLP-1 (\u012f gliukagon\u0105 pana\u0161us peptidas) ir nuo gliukoz\u0117s (patenkamo maisto) priklausomas insulinotropinis peptidas (GIP). Stimuliuojant kasos insulino sekrecij\u0105 pagal gliukoz\u0117s koncentracij\u0105 kraujyje, ger\u0117ja glikemijos kontrol\u0117. Be to, GLP-1 slopina gliukagono sekrecij\u0105 ir taip ma\u017eina kepen\u0173 gliukoz\u0117s gamyb\u0105. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Visi \u0161ie hormonai (ypa\u010d GLP-1) veikia kasos alfa ir beta l\u0105steles. Stimuliuodami beta l\u0105steles, hormonai insulino sekrecij\u0105 skatina pagal gliukoz\u0117s koncentracij\u0105 kraujyje, o veikdami alfa l\u0105steles slopina gliukagono sekrecij\u0105 ir ma\u017eina kepen\u0173 gliukoz\u0117s gamyb\u0105. Jeigu glikemija ma\u017eesn\u0117, tai ma\u017eesn\u0117 ir insulino sekrecija: vadinasi, kasa nei\u0161sekinama, aktyviau slopinamas gliukagono i\u0161siskyrimas, tod\u0117l ma\u017e\u0117ja kepen\u0173 gliukoz\u0117s gamyba.Taigi vaistai, slopinantys gliukagono i\u0161siskyrim\u0105 ir skatinantys insulino sekrecij\u0105, yra \u017eenkliai efektyvesni \u2013 i\u0161 \u0161ios naujos vaist\u0173 grup\u0117s daug tikimasi gydant 2 tipo CD. Neatsitiktinai pastaruoju metu moksliniuose kongresuose itin daug d\u0117mesio skiriama \u012fvairiems GLP-1 agonistams, nuolat ap\u017evelgiamai ir \u012fvertinami \u012fvairi\u0173 tyrim\u0173 rezultatai. Ypa\u010d domimasi nauju GLP-1 agonistu liksisenatidu<em style=\"mso-bidi-font-style: normal;\">,<\/em> kuris buvo lyginamas su kitais GLP-1 agonistais, vartojamais 2 tipo CD gydyti. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">GLP-1 agonist\u0173 farmakologin\u0117 klasifikacija<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Visi GLP-1 agonistai skiriami \u012f dvi pagrindines grupes. Pirmajai priklauso agonistai, pagaminti GLP-1 pagrindu (liraglutidas, taspogliutidas, albiglutidas, kt.), antrajai \u2013 eksenatido pagrindu (eksenatidas, ilgo veikimo eksenatidas, liksisenatidas, kt.). <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Lyginant grupes nustatyta: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\" type=\"circle\">\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Insulino sekrecij\u0105, priklausomai nuo gliukoz\u0117s, abi vaist\u0173 grup\u0117s veikia vienodai.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Antrajai grupei priklausantys vaistai labiau veikia maisto evakuacij\u0105 i\u0161 skrand\u017eio. Abiej\u0173 grupi\u0173 vaist\u0173 svor\u012f ma\u017einantis poveikis pana\u0161us.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Poveikis glikozilintam hemoglobinui \u2013 antrajai grupei priklausantys vaistai suma\u017eina ma\u017edaug 1 proc., o pirmajai \u2013 apie 1,5 proc. <\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Poveikis glikemijai nevalgius \u2013 glikemij\u0105 nevalgius geriau veikia pirmosios grup\u0117s preparatai<em style=\"mso-bidi-font-style: normal;\">.<\/em><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Poveikis glikemijai po valgio \u2013 glikemij\u0105 po valgio geriau veikia antrosios grup\u0117s vaistai.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Poveikis \u0160KL rizikos veiksniams \u2013 teigiam\u0105 \u012ftak\u0105 daro abiej\u0173 grupi\u0173 vaistai.<s><\/s><\/span><\/li>\n<li class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Nepageidaujamas vaist\u0173 poveikis (pvz., pykinim\u0105 da\u017eniau sukelia antrajai grupei priklausantys vaistai). Pankretitas i\u0161sivysto labai retais atvejais vartojant abiej\u0173 grupi\u0173 vaistus. Yra duomen\u0173, jog pirmajai grupei priklausantys vaistai da\u017eniau sukelia skydliauk\u0117s v\u0117\u017e\u012f.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 18.0pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">\u00a0<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 18.0pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">Pagrindiniai vaist\u0173 skirtumai<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u0160i\u0173 grupi\u0173 vaistai skiriasi pusiniu skilimo periodu: eksenatidas \u2013 2 val., liraglutidas \u2013 12 val., liksisenatidas \u2013 2\u20134 val., eksenatidas (ilgo poveikio) \u2013 8\u201312 dien\u0173 ir albiglutidas \u2013 5\u20138 dienos.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Liksisenatido veikimo mechanizmas atitinka kit\u0173 GLP-1 agonist\u0173 mechanizm\u0105. Klinikini\u0173 tyrim\u0173 duomenimis, liksisenatidas efektyviai atkuria pirm\u0105 insulino sekrecijos faz\u0119. Viename i\u0161 tyrim\u0173, kuriame buvo lyginamas liksisenatidas su liraglutidu, nustatyta, kad glikemijos po valgio svyravimai yra ma\u017eesni vartojant liksisenatid\u0105. Liksisenatido ekskrecija per inkstus, kai glomerul\u0173 filtracijos greitis \u2013 30\u201350 ml\/min. beveik nesiskyr\u0117 arba skyr\u0117si ma\u017eai. Esant \u017eenkliam inkst\u0173 funkcijos nepakankamumui (GFG &lt; 30 ml\/min.), liksisenatido i\u0161siskyrimas suma\u017e\u0117jo apie 30 proc. Pacientams, gydomiems 20 mg liksisenatido vien\u0105 kart\u0105 per dien\u0105 ir lygia greta d\u0117l \u0160KL vartojantiems varfarin\u0105, lizinopril\u012f, digoksin\u0105, nepasteb\u0117ta reik\u0161ming\u0173 s\u0105veik\u0173, tod\u0117l doz\u0117s koreguoti nereikia. Vaist\u0173 pana\u0161umus ir tr\u016bkumus pad\u0117s \u012fvertinti klinikini\u0173 tyrim\u0173 rezultatai ir, \u017einoma, klinikin\u0117 praktika.<s> <\/s><\/span><\/p>\n<p class=\"MsoNormal\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 115%;\" lang=\"LT\">\u00a0<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">Derinys: bazinis insulinas ir GLP-1 agonistas<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u012evertinus tyrim\u0173 duomenis, galima teigti, kad bazinis insulinas daugeliui pacient\u0173 teb\u0117ra svarbiausia gydymo priemon\u0117. Jis efektyviausiai palaiko rekomenduojam\u0105 HbA<sub>1c<\/sub> koncentracij\u0105 pacientams, kuriems ji yra vidutin\u0117 arba didel\u0117 (\u2265 8 proc.). Kita vertus, tam tikr\u0173 grupi\u0173 pacientams gali b\u016bti naudingi GLP-1 agonistai: pavyzd\u017eiui, tais atvejais, kai HbA<sub>1c<\/sub> koncentracija padid\u0117jusi nedaug (&lt; 8,0 proc.) ir\/arba kai KMI yra didelis (&gt; 35 kg\/m\u00b2). Svarbu nepamir\u0161ti to, kad kai kurie pacientai gali netoleruoti \u0161alutinio \u0161i\u0173 vaist\u0173 poveikio vir\u0161kinamajam traktui. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">Tik\u0117tina, kad, gydant bazinio insulino ir GLP-1 deriniu, galima pasiekti ger\u0173 rezultat\u0173, nes:<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level1 lfo2;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><span style=\"line-height: 150%;\" lang=\"LT\">&#8211;<span style=\"font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal; -moz-font-feature-settings: normal; -moz-font-language-override: normal;\">\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><span style=\"line-height: 150%;\" lang=\"LT\">\u0161i\u0173 vaist\u0173 veikimo mechanizmas yra skirtingas, tod\u0117l galimas sinerginis poveikis;<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level1 lfo2;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><span style=\"line-height: 150%;\" lang=\"LT\">&#8211;<span style=\"font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal; -moz-font-feature-settings: normal; -moz-font-language-override: normal;\">\u00a0\u00a0\u00a0 <\/span><\/span><span style=\"line-height: 150%;\" lang=\"LT\">GLP-1 (pvz., liksenatidas, eksenatidas) ma\u017eina glikemij\u0105 po valgio, o jo poveik\u012f gali papildyti insulinas, kuris veikia gliukoz\u0117s koncentracij\u0105 plazmoje nevalgius;<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 36.0pt; text-align: justify; text-indent: -18.0pt; line-height: 150%; mso-list: l0 level1 lfo2;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><span style=\"line-height: 150%;\" lang=\"LT\">&#8211;<span style=\"font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal; -moz-font-feature-settings: normal; -moz-font-language-override: normal;\">\u00a0\u00a0 <\/span><\/span><span style=\"line-height: 150%;\" lang=\"LT\">\u0161i\u0173 dviej\u0173 klasi\u0173 vaist\u0173 derinys gali b\u016bti palankus 2 tipo CD sergan\u010di\u0173 pacient\u0173 k\u016bno masei. Gydant insulinu, k\u016bno mas\u0117 da\u017eniausiai padid\u0117ja, tuo tarpu gali b\u016bti kad, vartojant vaist\u0173 derin\u012f, ji nepakist\u0173. <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: 18.0pt; text-align: justify; line-height: 150%;\"><span style=\"font-size: small; line-height: 150%; font-family: arial,helvetica,sans-serif;\" lang=\"LT\">\u0160ie aspektai itin aktual\u016bs klinikin\u0117je praktikoje. Tiek GLP-1, tiek bazinis insulinas yra efektyv\u016bs, anks\u010diau insulino nevartojusiems pacientams, kuri\u0173 glikemijos nepavyksta gerai kontroliuoti gydant geriamaisiais glikemij\u0105 ma\u017einan\u010diais vaistais. <\/span><\/p>\n<p class=\"MsoNormal\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 115%;\" lang=\"LT\">\u00a0<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"line-height: 115%;\" lang=\"LT\">Lietuvos gydytojo \u017eurnalas <br \/><\/span><\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:PunctuationKerning\/>\n  <w:ValidateAgainstSchemas\/>\n  <w:SaveIfXMLInvalid>false<\/w:SaveIfXMLInvalid>\n  <w:IgnoreMixedContent>false<\/w:IgnoreMixedContent>\n  <w:AlwaysShowPlaceholderText>false<\/w:AlwaysShowPlaceholderText>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n   <w:DontGrowAutofit\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><!--[if gte mso 9]><xml>\n <w:LatentStyles DefLockedState=\"false\" LatentStyleCount=\"156\">\n <\/w:LatentStyles>\n<\/xml><![endif]--><!--[if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";\n\tmso-ansi-language:#0400;\n\tmso-fareast-language:#0400;\n\tmso-bidi-language:#0400;}\n<\/style>\n\n\n<![endif]--> <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; text-align: justify; line-height: 150%;\"><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><em style=\"mso-bidi-font-style: normal;\"><span style=\"line-height: 150%;\" lang=\"LT\">Gliukoz\u0117s homeostaz\u0117 (<span class=\"st1\">organizmo geb\u0117jimas palaikyti nuolatin\u0119 gliukoz\u0117s koncentracij\u0105 kraujyje) <\/span>yra sud\u0117tingas procesas, priklausantis nuo daugelio veiksni\u0173. Pastaruoju metu nustatyta, kad gliukoz\u0117s homeostaz\u0119, t. y. gliukoz\u0117s kontrol\u0119, daugiausia lemia ne tik insulino, bet ir gliukagono sekrecija (ma\u017edaug vienodai \u2013 po 50 proc.). Insulinas ir gliukagonas vadinami hormonais antagonistais. Dabartin\u0117je literat\u016broje skelbiami duomenys leid\u017eia teigti, kad abu \u0161ie hormonai vienodai veikia gliukoz\u0117s koncentracij\u0105 kraujyje. <\/span><\/em><\/span><\/p>\n","protected":false},"author":1,"featured_media":8415,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[3544,1032,3545,3165,138,1095],"site":[],"post_item_type":[27345],"class_list":["post-8414","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-gliukagonas","tag-insulinas","tag-kepenu-gliukozes-gamyba","tag-peptidas","tag-vaistai","tag-vaistu-grupes"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8414","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8414"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8414\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8415"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8414"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8414"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8414"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8414"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8414"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}