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karpSBVpSayCMgW

TwkenamEp¥m sMrab;GñksarB½t’man enAkm<úCa

NI MI

TI ON

RksYgBt’man

ST RY O

F INFOR

MA

RksYgBt’man MINISTRY OF INFORMATION


CMgWTwkenamEp¥m

kar):an;sμaneRbva:Lg; enAkñúgcMeNamRkummnusSGayu 20-79 qñaM ¬KitCa % ¦ 1 2 3 4 5 6 7 8 9 10

RbeTs

NUru Gara:b;rYmeGmIer:t Gar:ab;b‘ÍsaGUDIt )aErn KuyEvt GUm:g; tugháa m:UrIs eGhSúIb miucsuikU Gas‘an ma:eLsIu hVIlIBIn éf km<úCa Lav \NÐÚensuI PUma evotNam Rb‘uyeN suigðbUrI

2007 31 20 17 15 14 13 13 11 11 11

10-14? 6-8? 6-8? 4-6? 4? 4? 4? 4? ? ?

RbeTs

NUru Gara:b;rYmeGmIer:t Gar:ab;b‘ÍsaGUDIt )aErn KuyEvt GUm:g; tugháa m:UrIs eGhSúIb muicsuikU Gas‘an ma:eLsIu hVIlIBIn éf km<úCa Lav \NÐÚensIu mIya:n;ma: evotNam Rb‘uyeN sigðbUrI

RbPB³ shB½n§CMgWTwkenamEp¥mGnþrCati ©

RbPB ³ mUlniFisarB½t’manÉkraCü

kare)aHBum<pSayrbs; mUlniFisarB½t’manÉkraCü edayshkarplitCamYy RksYgsuxaPi)al énRBHraCaNacRkkm<úCa. sRmab;karsaksYrGMBIesovePAenH sUmTMnak;TMngCamYy ³ mUlniFisarB½t’manÉkraCü 875 West End Avenue-Apartment 8A New York, New York 10025-4953 Tel: (212) 865-0431 Website: www.ijf-cij.org

2025 32 22 18 17 16 15 15 13 13 12

14-20? 8-10? 8-10? 6-8? 4-6? 4? 4-6? 4? ? ?


karpSBVpSayCMgW

TwkenamEp¥m sRmab;GñksarB½t’man enAkm<úCa

sresreday ³ BIF½r sþarr (Peter Starr) bkERbeday ³ evC¢> gYnesr½tñ RbwkSaevC¢saRsþ ³ sux b‘uNÑa rcnaTMB½reday ³ Qut QaNa ftrUbeday ³ eLm cMNab; rUbPaBevC¢saRsþ ³ Laboratoires Servier

Back cover: computer-generated insulin image by Isaac Yonemoto i


RbPBB½t’mansMxan;² Centre Européen d’Etude sur Diabète Strasbourg www.ceed-diabete.org

Human Nutrition Unit, University of Sydney Sydney www.glycemicindex.org

International Diabetes Federation Brussels www.idf.org

Kham Lavit Melbourne, Australia

Mission Care Development Organisation Mouries, France www.micadev.org

MoPoTsyo Patient Information Center Phnom Penh www.mopotsyo.org

United States National Library of Medicine and National Institutes of Health Bethesda, Maryland www.nlm.nih.gov

World Diabetes Foundation Copenhagen www.worlddiabetesfoundation.org

World Health Organisation Geneva www.who.int ii


esckþIEføgGMNrKuN eRkABIEføgGMNrKuNdl;RbPBÉksar Edl)anbgðajenAkñúgTMB½rmunenH GñkcgRkgesovePA enH k¾smU sEmþgkardwgKuNpgEdr dl; James nig Ene Riisna Greenfield nig Donald Wilson nig Nancy Ward Edl)anKaMRTKeRmagesovePAenH tamry³ mUlniFisarB½t’manÉkraCü. GñkcgRkg k¾sUmEføgGMNrKuNpgEdrdl; Soren Engel. CaBiessenaH eyIgsUUmsEmþg kardwgKuNy:agRCaleRCA cMeBaHelak nig elakRsI Angelica nig Euan Baird Edl esovePAenH nwgminGacbegáIteLIg)aneLIy ebIsinCaKμankarsmøwgeXIjGnaKtEvgq¶ay ckçúvis½y nig karKaMRThirBaØvtßú rbs;elak nig elakRsIeTenaH.

iii


iv


m a ti k a

matika GarmÖkfa I. karyl;RcLM II. karBit

TwkenamEp¥mCaGVI? TwkenamEp¥mmanb:unμanRbePT? nrNaekItTwkenamEp¥m? GVIeTACaktþahaniP½y?

Gayu elIsTm¶n; b¤ Fat;RCul RbvtþiRKYsarmanTwkenamEp¥m GskmμPaBragkay dMNak;kaleRtomTwkenamEp¥m Catisasn_ RbGb;TI 1 ³ dMNak;kaleRtomTwkenamEp¥mKWCaGIV? RbGb;TI 2 ³GVIeTACasBaØaRBmaneGaydMNwg? • TwkenamEp¥menAkñúgGMLúgeBlmanépÞeBaH etIvamanplvi)akGVIxøH? • CatisárkñúgQamcuHTabxøaMg • GasuIt ektUn enAkñúgQam • GasuItLak;Tic enAkñúgxøÜn • karqøgemeraK)ak;etrI nig BYkpSit • CMgWEPñk • CMgWtRmgenam • CMgWsrésRbsaT • CMgWsrésQamebHdUg • BikarPaB etIeKBüa)alTwkenamEp¥m y:agdUcemþc? • RKb;RKgrbbGahar • lMhat;R)aN • kareRbI»sf etIeKGacbgáarCMgWTwkenamEp¥my:agdUcemþc? • karbgáarbzmmunekItCMgW • karbgáarbnÞab; eRkayekItCMgW • • • • • •

5 7 11 12 12 13 14 14 14 14 14 14 15 15 16 16 16 17 17 17 17 17 18 18 18 18 18 18 19 19 19 20 20 1


m a ti k a

III.

plvi)ak

IV.

skmμPaBénragkay nig karTTYlTan

V.

2

CMgWEPñk • CMgWerTIn EPñk bNþalmkBITwkenamEp¥m • ehIm m:aKul½r • karBüa)al • sßiti CMgWtRmgenam • sm<aFQam • rbbGahar • karCk;)arI • kRmitCatixøaj;enAkñúgQam xusFmμta • ktþaepSgeTot • sßiti CMgWsrésRbsaT • CMgWsrésRbsaT enAGvyv³ • CMgWsrésRbsaTsV½ytü • CMgWsrésRbsaTEtmYy • kareFVIetsþ • karBüa)al CMgWebHdUg-srésQam • CMgWb:HBal;ebHdUg nig crnþQam ciBa©wmebHdUg • CMgWEdlb:HBal;xYrk,al nig crnþQamxYrk,al • CMgWEdlb:HBal;Gvyv³eRkam nig RbGb;eCIg • sßiti • ktþaeRKaHfñak;déTeTot GskmμPaBénragkay sar³RbeyaCn_énskmμPaBragkay CamFüm RbGb;TI 3 ³ niymn½y énBakü “ kareFVIskmμPaBragkay ” nig “ karhat;R)aN ” taragTI 1 ³ skmμPaBlμm nig skmμPaBxøaMgkøa cMNIGahar snÞsSn_Catisár taragTI 2 ³ GaharEdlsm,ÚrenAGasIuI bnÞúkCatisár taragTI 3 ³ ecosvagkarTTYlTanGahar EdlgayRCabcUlnUvkabUnGuIRdat

»sf

»sfRKab;bBa©úHCatisárkñúgQam taragTI 4 ³ GakarbUs taragTI 5 ³ KøIbg;køamIt (Glibenclamide) nig KøIkøahSIt (Gliclazide) taragTI 6 ³ emthV½rmIn (Metformin) taragTI 7 ³ r:UsuIKøItahSÚn (Rosiglitazone) karcak;GaMgs‘uylIn

21 22 22 22 23 23 23 24 24 24 24 24 24 25 25 25 26 26 26 27 27 27 28 28 28 29 30 31 31 32 32 33 36 39 40 41 43 44 45 45 46 46


m a ti k a

karrkeXIj nig karplit GaMgs‘uylIn NPH taragTI 8 ³ GaMgs‘uylIn NPH (Neutral Protamine Insulin) ExSRsLay GaMgs‘uylIn (Insulin analogues) taragTI 9 ³ Insulin Detemir (RDNA) taragTI 10 ³ Insulin Glagine (RbPT RDNA) KMnUsbMRBYjTI 1 ³ Insulin Glagine nig Insulin NPH VI.

karcMNay

VII.

46 47 47 48 48 48 49 51

CMgWruaMér: eFVIeGaycuHexSay>>> nig cMNayluyeRcIn • KMnUsbMRBYjTI2 ³ karcMNayelIsuxPaBRbcaMqñaM sRmab;GñkTwkenamEp¥m nig CMgWTwk enamEp¥menA 25 RbeTs EdlmancMnYnGñkTwkenamEp¥meRcInbMput enAqñaM 2007 52

TwkenamEp¥menAkm<úCa

esckþIepþIm RbGb;TI 4 ³ enAkm<úCa>>> RbGb;TI 5 ³ “ ´cg;ekItCMgWeGds_ ”? eGBIedmIsaRsþ • karrkeXIjnwksμanmindl; taragTI 11 ³ karrkeXIjrbs;karsikSaRsavRCav taragTI 12 ³ dMNak;kaleRtomTwkenamEp¥m nig bBaðaBak;B½næ taragTI 13 ³ TwkenamEp¥m nig CMgWeGds_ KeRmag • bNþúHbNþalRKUGb;rM enAkm<úCa nig evotNam • KøInikenA)at;dMbg nig kMBg;FM • KMrUénkarEfTaMCMgWTwkenamEp¥m • elIkkm<s;karEfTaMenAPñMeBj • mitþ “ Gb;rMmitþ” enAtaEkv taragTI 14 ³ bNþajCMgWTwkenamEp¥m enAPñMeBj nig taEkv minsÁal; b¤ ePøc ³ kumarEdlmanCMgWTwkenamEp¥mRbePT 1 RkumCYyxøÜnÉg taragTI 15 ³ CMnYyxagsuxaPi)al RbGb;TI 6 ³ bnÞHRkdasBinitüTwkenam

snÞsSn_Catisár enAkñúg)ay

taragTI 16 ³ karrkeXIjénkarsikSa KMnUsbMRBYjTI 3 ³ snÞsSn_Catisár (GI) nig kRmitCatisár enAkñúgQam rukçCati»sf RbGb;TI7³ rukçCati\NÐa GacCYy[eKRKb;RKgCatisárenAkñúgQam GñkCMgWTwkenamEp¥m)an taragTI 17 ³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m

VIII.

snÞanuRkm

53 55 56 56 57 58 58 59 60 60 61 62 62 64 65 67 67 69 69 70 71 72 73 74 76 78 85

3


G a r mÖ k f a

GarmÖkfa

5


G a r mÖ k f a


I

karyl;RcLM

7


k a r y l; R c LM

karyl;RcLMGMBICMgWTwkenamEp¥m>>> TwkenamEp¥m minEmnCaCMgW eRKaHfñak;dl;CIviteT

TwkenamEp¥m KWCaCMgWEdlBiXatCa skl edayRbkYtRbECgCamYynwgCMgW eGds_. va)ansmøab;mnusS RbEhlCa 3>8 lannak; kñúgmYyqñaM. enAral; 10 vinaTI manmnusSmñak;søab; edaysar EtmUlehtuEdlTak;TgeTAnwgCMgWTwk enamEp¥m.

CMgWTwkenamEp¥m GacekItman EtkñúgRbeTsGñkmanb:ueNÑaH

CMgWTwkenamEp¥mekItmanelImnusSRKb; rUbedayminKitBIR)ak;cMNUlrbs;mnusS eT. CMgWenH kMBugEtekIneLIgCaRbcaM. enAelIBiPBelakeyIgenH manmnusS ekItCMgWTwkenamEp¥m eRcInCag 240 lannak;eTAeTot. GRtakMeNInenHnwg ekIneLIgrhUtdl; 380 lannak; enA qñaM 2025. enAkñúgRbeTsCaeRcIn enA kñúgtMbn;GasuI/ mCÄwmbUB’a mhassmuRT GUesGanI nig tMbn; karIb‘Ín CMgWTwkenam Ep¥m b:HBal;mnusSrhUtdl; 12-20° ehIyenAqñaM 2025/ 80° én GRtaCMgW TwkenamEp¥mTaMgGs; nwgeXIjmanenA kñúgRbeTs EdlmanR)ak;cMNUlTab nig mFüm.

CMgWTwkenamEp¥m TTYlfvika y:ageRcIn enAkñúgBiPBelak

CMnYyGPivDÆn_pøÚvkar eTAelIEpñksuxPaB kñúgqñaM 2002 )aneLIgdl; 2900 lan duløar EdlkñúgenaH manEt 0/1° Et b:ueNÑaH Edl)anykeTApÁt;pÁg; eTAelI RbePTCMgWrauMér: EdlminEmnCaCMgWqøg. CMnYyPaKeRcIn KWykeTA]btßmÖeTAelI CMgWeGds_. CagenHeTAeTot FnaKar BiPBelak )aneGayR)ak;km©I cMnYn 4200 landuløar sRmab;bBaðasuxPaB kMeNInRbCaCn nig GaharUbtßmÖ enA cenøaHqñaM1997 nig 2002 ehIyman Et 2/5° Etb:ueNÑaH EdlykeTAeRbIelI CMgWrauMér:TaMgGs;enH. 9


I

k a r y l; R c LM

karEfrkSaCMgWTwkenamEp¥m KWminéføeT

karEfTaMGñkCMgWTwkenamEp¥m KWRtUv cMNayeRcInNas; ehIyvagayeFVIeGay manbBaða dl;RbB½n§EfrkSasuxPaB Nas;. »kasesdækic© EdlGgÁkarsh RbCaCati cg;begáItsRmab;RbeTs GPivDÆn_ tamry³eKaledAGPivDÆn_ shsvtSr_ nwgRtUvb:HBal;y:agF¶n;F¶r edaysarplb:HBal;esdækic© Edl bNþal mkBICMgWTwkenamEp¥mkñúgRbeTs EdlmanR)ak;cMNUlTab nig mFüm.

CMgWTwkenamEp¥m PaKeRcInekIt elIburs

CMgWTwkenamEp¥m GacekItelIRsþI eRcIn Cagbursbnþic. vak¾kMBugekIneLIgy:ag xøaMg kñúgcMeNamyuvv½y nig kMBugKMram kMEhgbMpøicbMpøaj dl;RbCaCn CnCati edImpgEdr.

mnusSminGacbgáarCMgW TwkenamEp¥m)aneT

CMgWTwkenamEp¥mRbePT1 KWeyIgminGac bgáar)aneT EtCMgWTwkenamEp¥mRbePT2 eyIgGacbgáarva)an rhUtdl;eTA 80° CMgWTwkenamEp¥m GacekItman edaykarTTYlTanGahar EdleFVIeGay EtelImnusScas;Etb:ueNÑaH mansuxPaBl¥/ begáInkarhat;R)aN CMgWTwkenamEp¥m GacekItmaneLIgelI nig CMrujkarrs;enA kñúgrebobmYy Edl mnusSRKb;v½y. mnusSRbEhl 246 eFVIeGayeyIgmansuxPaBl¥. lannak; EdlmanGayu cenøaHBI 20 eTA 79qñaM GacnwgekItCMgWTwkenamEp¥m. karbgáarCMgWTwkenamEp¥m enAkñúgRbeTsGPivDÆn_ CMgWTwkenamEp¥m cMNayeRcIneBk ekItmaneLIgy:agehacNas; 80lan manviFIbgáarCMgWTwkenamEp¥mCaeRcIn nak; elImnusSEdlmanGayu cenøaHBI EdlminéføeT ehIycMNaytic Etman RbsiTæPaB. Cak;Esþg dUcCayuTæsaRsþ 40-59 qñaM. Eklm¥brisßanrs;enA eGaymanlkçN³ CMgWTwkenamEp¥m GacekItman RbesIreLIg/ karpøas;bþÚrcMNIGahar nig eLIgEtelIGñkFat;RCul begáInkarhat;R)aN GacCYykat;bnßy RbEhlCa 15° énmnusSEdlekItman karratt,atCMgWenH. CMgWTwkenamEp¥m RbePT2 KWCamnusS RbPB³ shB½n§CMgWTwkenamEp¥mGnþrCati enARb‘uyEsl yuvv½y EdlminFat;elIsTm¶n;eT.

10


II karBit

11


II

k a r Bi t

TwkenamEp¥mCaGVI?

RbB½nærMlayGahar

12

lMEBg

TwkenamEp¥m CaCMgWmYy EdlekIteLIg edaysarbBaða EdlTak;TgeTAnwgkar plit nig pÁt;pÁg; GaMgsu‘uylIn enAkñúg xøÜnmnusS. GaharPaKeRcInbMput Edl eyIgbriePaK )ankøayeTACa KøúykUs EdlCaCatisármYyRbePT . eyIgeRbI KøúykUs CaRbPBfamBl edIm,Ipþl; famBldl;sac;duM nig ekasikarbs; eyIg. xøÜnrbs;eyIg dwkCBa¢Ún KøúykUs enAkñúgcrnþQamrbs;eyIg. edIm,IeGay sac;duMrbs;eyIg nig CalikadéTeTot RsUb KøúykUs BIcrnþQamrbs;eyIgenaH eyIgRtUvkar G½rm:Un mü:agehAfa GaMgsu‘uy lIn. ebIKμan GaMgsu‘uylIn eT xøÜnrbs; eyIg minGacTTYl)anfamBl EdlcaM )ac;BIGaharrbs;eyIgeLIy. GaMgsu‘uy lIn RtUv)anplitedayRkeBjFMmYyenA BIeRkayRkBH KWlMEBg. vaRtUvbeBa©j edayekasikaeQμaH Eb‘ta . enAeBl mnusSmñak; manTwkenamEp¥m lMEBgmin GacplitCati GaMgsu‘uylIn )an b¤ xøÜn

eyIgminGaceRbI GaMgsu‘uylIn eGayman RbsiTæPaB. dUecñH GñkTwkenamEp¥m min GaceRbI KøúykUs BIGaharEdlBYkeK briePaK eGay)anRKb;RKan;eLIy. RbkarenH eFVIeGayCati KøúykUs enAkñúg Qam mankarekIneLIg. kRmit KøúykUs enAkñúgQamx<s; b¤ kRmitCatisárenAkñúg Qamx<s; ehAfa CatisárenAkñúgQam x<s;. kRmit KøúykUs enAkñúgQamx<s; GacnaMeGaymanplvi)akF¶n;F¶r. enA eBlbc©úb,nñenH Kμan»sfNaGacBüa)alCMgWTwkenamEp¥m eGayCadac;enaH eLIy. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARb‘uyEsl

TwkenamEp¥mmanb:unμanRbePT? TwkenamEp¥mRbePT 1 eBlxøHRtUv)an ehAfa TwkenamEp¥mEdlGaRs½yelI GaMgsu‘uylIn. vacab;epþImenAkñúgv½yekμg nig sRmbsRmYledayRbB½næPaBsuaM. vabNþalmkBIRbtikmμPaBsuaM eday s½VyRbvtþi EdlkñúgenaH RbB½nækarBarxøÜn rbs;eyIg vayRbhareTAelIekasika Edlplit GaMgsu‘uylIn. eKminTan;yl; c,as;enAeLIy faehtuGVI)anCaRbkarenH GacekItman)an . GñkTwkenamEp¥m


k a r Bi t

RbePT 1 plit GaMgsu‘uylIn tictYc b¤ minplitesaH. CMgWenH GacekItman cMeBaHmnusSRKb;v½y b:uEnþCaTUeTA va ekItmancMeBaHkumar nig mnusSv½yekμg. mnusSEdlmanCMgWTwkenamEp¥mRbePT enH tRmUveGaycak; GaMgsu‘uylIn Caerog ral;éf¶ edIm,IRKb;RKgCatisárenAkñúg Qam. ebIsni CaGñk TwkenamEp¥mRbePT 1 minmanlTæPaBTTYl)an GaMgsu‘uylIn eTenaH BYkeKnwgsøab;. TwkenamEp¥m RbePT 2 eBlxøH ehAfaTwkenamEp¥m minGaRs½yelI GaMgsu‘uylIn b¤k¾Twkenam Ep¥m Edlcab;epþImekItenAelImnusSv½y cMNas;.TwkenamEp¥mRbePT 2CaTUeTA mintRmUveGaycak; GaMgsu‘uylIn eT. CaTUeTA BYkeKGacRKb;RKgCati KøúykUs enAkñúgcrnþQam edaytamdanemIl Gaharrbs;xøÜn hat;R)aNeGayeTog Tat; elbfñaMRKab; nig Gaccak; GaMgsu‘uy lIn pgEdr. TwkenamEp¥mRbePT 2 ekItmanjwkjab;bMput enAkñúgcMeNam mnusScas; EdlmanGayucab;BI 45 qñaM eLIgeTA EdlFat;elIsTm¶n;. b:uEnþ edaysarplvi)ak énkarFat;elIsTm¶n; hYsehtu kñúgcMeNamnusSv½yekμgenaH vakan;EtekItmaneRcIneLIg enAkñúgcMeNamkumar nig mnusSv½yekμg . Twk enamEp¥mRbePT 2 KWCaRbePTTwkenam Ep¥m EdlekItmanjwkjab;bMput eday tMNageGay 90 eTA 95 PaKry én krNITwkenamEp¥mTaMgGs;. ebIsinCa TwkenamEp¥mRbePT 2 min)aneFVIeraK vinic½äy nig Büa)aleT vanwgnaMeGayman plvi)akF¶n;F¶r edayGacbNþaleGay søab;munGayu)an. enATUTaMgBiPBelak mnusSCaeRcInlannak; manTwkenamEp¥m

RbePT 2 edaymin)andwgxøÜneLIy. cM ENkGñkxøHeTot minmanlTæPaBTTYl )ankarEfTaM xagevC¢saRsþRtwmRtUveT. karcab;epþImekItTwkenamEp¥mRbePT2 CaTUeTAk¾manBak;B½næpgEdr nwgktþatMN BUC b:uEnþkarFat;elIsTm¶n; GskmμPaB ragkay nig briePaKGaharmin)anRtwm RtUv begáInhaniP½y cMeBaHkarekItCMgW enH . RsþIxøH ekItman TwkenamEp¥mRb ePT 3 EdlmanlkçN³beNþaHGasnñ KWTwkenamEp¥m enAkñúgGMLúgeBlmanépÞ eBaH. TwkenamEp¥mRbePTenH ekItman cMeBaHRsþIEdlmanépÞeBaH.TwkenamEp¥m GMLúg eBlmanépÞeBaHenH ekItmancMnYn 2-5PaKry énRsþImanKP’TaMgGs; b:uEnþ vaCaTUeTA Gac)at;eTAvij eRkaykar sRmalkUn. RsþIEdlmanTwkenamEp¥m enAkñúgGMLúgeBlmanépÞeBaH nwgbegáIn haniP½yekItTwkenamEp¥mRbePT 2 enA eBlGnaKt. eKk¾segáteXIjmanTwkenam Ep¥mRbePTkRmepSgeTotpgEdr. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARb‘uyEsl

nrNaekItTwkenamEp¥m? TwkenamEp¥m ekItmanminerIsmuxeLIy. nrNak¾eday RsukNak¾eday Gayu bu:nμank¾edayk¾GacekItmanTwkenamEp¥m Edr. mnusSeBjv½yCaeRcIn ekItmanTwk enamEp¥mCaeRcInqñaMehIy eTIbdwgfa xøÜn maneraKsBaØaCMgWenH. mkdl;RtwmeBl EdleKeFVIeraKvinic½äyenaH mnusSeRcIn eBkNas; )anmanplvi)akbNþalmkBI CMgWenHeTAehIy dUcCakarxUcEPñk karxUc tRmgenam CMgWebHdUg kardac;srés

kUnekaH ekasikalMEBg

kUnekaH ekasikalMEBg 13


II

k a r Bi t

QamxYrk,al nig karxUcsrésRbsaT. enAtMbn;CaeRcIn enAkñúgBiPBelak mnusS TwkenamEp¥mCaeRcIn min)aneFVeI raKvinci yä½ Tal;EtesaH. karrkeXIjTwkenamEp¥m enAdMNak;kaldMbUgmann½yfavaGacBüa )al)an nig Gackat;bnßyhaniP½yén karmanplvi)akF¶n;F¶r)any:ageRcIn. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARb‘uyEsl

GVIeTACaktþahaniP½y?

]bkrN_BinitüCatisárenAkñúgQam

cMeBaHTwkenamEp¥mRbePT 1 eKminGac kMNt;)anktþahaniP½y rbs;vaeGay)an c,as;las;eT. b:uEnþ vaRbEhlCaman Tak;TgktþatMNBUC ktþabrisßan Edl GacbNþaleGayekItCMgWenH. ebIsin CamannrNamñak; enAkñúgRKYsarekItTwk • RbvtþiRKYsarmanTwkenamEp¥m enamEp¥menH »kasekItCMgWenH Gacnwg karRsavRCavbgðajfa mnusSkan;Etman ekIneLIg. ktþahaniP½y sRmab;Twk haniP½yxøaMg ebIsinCasmaCikRKYsar enamEp¥mRbePT 2 rYmman ³ Namñak; manTwkenamEp¥m. kalNa TMnak;TMngRKYsarenaHkan;EtCit vakan; • Gayu EtnaMeGaymanhaniP½yx<s;Edr enAkñúg 90 eTA 95 PaKry énGñkTwkenamEp¥m karekItTwkenamEp¥m. man TwkenamEp¥mRbePT 2. Twkenam Ep¥mRbePT 2 CaTUeTAekItmanenAkñúg • GskmμPaBragkay cMeNammnusS EdlmanGayuelIsBI karRsavRCavbgðajfa mnusSEdlmin 40qñaM b:uEnþ\LÚvenH vak¾ekItmaneRcIn manCIvitd¾skmμenaHeT BYkeKmanhapgEdr cMeBaHkumar nig mnusSv½yCMTg;. niP½yeRcInCageK enAkñúgkarekIt Twk mnusSkan;Etcas; kan;EtmanhaniP½y enamEp¥mRbePT 2 . kalNaGñkman ekItCMgWTwkenamEp¥m. lMhat;R)aNkan;Ettic Gñknwgkan;Et man»kaseRcIn ekItTwkenamEp¥m. •

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begáInhaniP½yekItTwkenamEp¥m. Cati xøaj;eRcInhYsehtu hak;dUcCabegáInPaB suaMeTAnwg GaMgsu‘uylIn edayeFVIeGay Cati KøúykUs ekIneLIg nig lTæPaBekIt manTwkenamEp¥m. eTaHbIkarFat;hYs ehtu Gacb:HBal;mnusSRKb;KñakþI ktþa haniP½ysMxan;enaH KWGaharEdlman Catixøaj;x<s; nig famBlx<s; RBmTaMg GskmμPaBragkay . ninñakarkan;Et eRcIn enAbNþaRbeTsCaeRcIn bgðajecj nUvsgÁmmYy EdlmankareRbIGaharmin l¥dl;suxPaB CaCagkarbriePaKEpøeQI Rss; nig bEnø Edll¥sRmab;suxPaB ehIyeKk¾segáteXIjEdrfa skmμPaB ragkay )anfycuHy:agxøaMg ehIyva CMnYsedaykareRbIyanynþvij.

elIsTm¶n; b¤ Fat;RCul

mnusSCag 80PaKry EdlmanTwkenam • dMNak;kaleRtomTwkenamEp¥m Ep¥mRbePT 2 KWCamnusSelIsTm¶n; b¤ mnusSeyIgFmμta manCatisárenAcenøaH Fat;RCul . karelIsTm¶n; b¤ Fat;RCul BI 70 eTA 110 mIlIRkam enAkñúg


k a r Bi t

mnusSmñak; GacekItmanTwkenamEp¥m. b:uEnþ mankarRsavRCavtictYc RtUv)aneFVI eLIgenAeRkAshrdæGaemrik. enAkñúg cMeNamBlrdæGaemrik CnCatiGaRhVik GasuI GuIs,:anic GñkekaH )a:suIhVic nig Cn CatiedImGaemrik sßitenAkñúgcMeNam mnusS EdlgayekItmanTwkenamEp¥m. kñúgcMeNamBlrdæGURsaþlI CnCatiGasuI • Catisasn_ tamEdleyIgdwg Catisasn_ mansar GñkekaH )a:suIhVic GWr:ubxagt,Úg CnCati sMxan; enAkñúgkarkMNt;lTæPaB Edl edImGURsþalI KWgaybMput ekItCMgWenH. 100 mIlIlIRt Qam b¤¤k¾enAcenøaH 3/9 eTA 6/0 mIlIm:Ul kñúg 1lIRtQam. dMNak;kaleRtomTwkenamEp¥m KwkRmit Catisár ¬KøúykUs¦ x<s;CagFmμta b:uEnþ minTan;dl;kRmit EdlRKUeBTücat;Tuk CaTwkenamEp¥meT ¬emIlxageRkam¦.

RbGb;TI1³ dMNak;kaleRtomTwkenamEp¥mKWCaGVI?

dMNak;kaleRtomTwkenamEp¥m Edlsresrkat;fa IGT KWCaeQμaHmYy sRmab;niyayeyageTA dl;kRmitCatisárx<s; CagkRmitFmμta b:uEnþenAeRkamkRmit EdlmanTwkenamEp¥m. vaCakarKYbpSM Kña énkarxUcskmμPaBbeBa©j G½rm:Un GaMgsu‘ylIn nig karFøak;cuHrMejaceqøIytbnwg GaMgsu‘uylIn b¤k¾karsuaMeTAnwg GaMgsu‘uylIn. enAkñúgcMeNammnusS mandMNak;kaleRtomTwkeenamEp¥m karekIn eLIgCatisárenAkñúgQam EdlekIteLIgbnÞab;BIkareRbICatisárenaH KWmanTMhMFMeFgCagFmμta eTaH bICaminxøaMgdUcCamnusSTwkenamEp¥mRbePT2kþI.dMNak;kaleRtomTwkenamEp¥m manhaniP½yx<s; nwgekItmanTwkenamEp¥mRbePT 2 . mnusSmandMNak;kaleRtomTwkenamEp¥m cMnYndl;eTA 4050 PaKry nwgekItmanCMgWTwkenamEp¥mRbePT 2 EdlrYmman kMeNInhaniP½y plvi)aksrés QamtUc² nig CMgWsrésQam-ebHdUg enAkñúgry³eBldb;qñaM. plvi)aksrésQam-ebHdUgGac cab;epþImekItman muneBlEdlTwkenamEp¥mRbePT 2 RtUv)aneFVIeraKvinic½äy. dl;eBlenaH kar xUcsrésQamtUc² RbEhlCaekItman)at;eTAehIy. b:uEnþ vaminEmnminGacbeBa©óskarvivtþn_ eTACaTwkenamEp¥menaHeT ehIymnusSmandMNak;kaleRtomTwkenamEp¥mcMnYn 30PaKry nwg GacvilRtLb;eTArksßanPaB CatisárkñúgQamFmμtavij. mnusSEdlmandMNak;kaleRtom TwkenamEp¥m kRmTTYl)ankarBüa)al BIeRBaHsßanPaBenH kRmnwgRtUv)aneFVIeraKvinicä½y. dMNak; kaleRtomTwkenamEp¥m GacRtUvbgáar)an edaybegáInskmμPaBragkay rkSaTm¶n;eGay )anl¥ ehIybriePaKeGay)anRtwmRtUv sRmab;suxPaB. karsRmkTm¶n; nig begáInskmμPaBragkay Gackat;bnßyPaBsuaMnwg GaMgsu‘uylIn dUecñHvaGaceFVIeGaymankarplit GaMgsu‘uylIn Edlkan; EtmanRbsiTæPaB RKb;RKgCatisárenAkñúgQam. edayehtufa mnusSmandMNak;kaleRtomTwk enamEp¥m manhaniP½yx<s; ekItTwkenamEp¥mRbePT 2 ehIymnusSenAkñúgRkumenH RtYvBinitüeGay eTogTat; rkemIlCMgWTwkenamEp¥mRbePT 2. kalBIqñaM 2003 mnusS 314 lannak; enATUTaMg BiPBelak b¤ 8/2 PaKry énmnusSeBjv½y TUTaMgBiPBelak RtUveKKitfa mandMNak;kaleRtom TwkenamEp¥m . dl;qñaM 2025 eK):an;sμanfa cMnYnenH nwgekIneLIgdl; 472 lannak; b¤ 9 PaK ry énmnusSeBjv½y. kar):an;sμanbgðajfa tMbn;GasuIGaeKñy_ mantYelxGñkmandMNak;kal eRtomTwkenamEp¥m eRcInCageKbMput ¬93 lannak;¦ nig GRtaeRbv:aLg;x<s;bMput ¬13/2 PaKryénmnusSeBjv½y¦. dl;RtwmqñaM 2025 eK):an;sμanfa GasuIGaeKñy_ nwgbnþmanGRta eRbv:aLg;x<s;bMput edaymanGRtadMNak;kaleRtomTwkenamEp¥m 13/5 PaKry kñúgcMeNam mnusSeBjv½y.

RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARbu‘uyEsl

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II

k a r Bi t

RbGb;TI2³ GVIeTACasBaØaRBmaneGaydMNwg?

mnusSGacCYbRbTHsBaØaRBmanepSg²Kña ehIyeBlxøH eKBuMeXIjmansBaØaRBmanTal;EtesaH b:uEnþ xageRkamenH KWCasBaØaEdleKeXIjmanCajwkjab; ³ • • • • • • •

eRskTwkxusFmμta nigs¶Ütmat; enamjwk Gs;kmøaMglðitélð b¤KμankmøaMgkMEhg RskTm¶n;rh½s rbYsRkCa manekItCMgWqøgjwkjab; RBilEPñk

karcab;epþImCMgWTwkenamEp¥mRbePT 1 CaTUeTAPøam² nig rh½sCaxøaMg. sBaØadUcKñaenH Gac b:HBal;dl;GñkTwkenamEp¥mRbePT 2 b:uEnþvaCaTUeTA minsUvCac,as;las;eT . karcab;epþIm ekItCMgWTwkenamEp¥mRbePT 2 ekItmanCabeNþIr² ehtudUecñH eKBi)akrkeXIjva. tamBitmnusS xøH EdlmanTwkenamEp¥mRbePT 2 minbgðajeraKsBaØaEdlCak;EsþgeLIy enAdMNak;kal dMbUg. BYkeKTaMgGs;enH Cajwkjab; RtUv)aneFVIeraKvinicä½yeRcInqñaMeRkaymk KWenAeBlEdlpl vi)akepSg² )anelcecjeTAehIy. TwkenamEp¥m KWCaCMgWmYyCIvit nig ruaMér: EdltRmUveGaymankarRtYtBinitü y:agykcitþTukdak;. ebIminRKb;RKgvaeGay)anRtwmRtUveTenaH vaGacnaMeGaymanplvi)akepSg² dUcCaCMgWebHdUgsrésQam karxUctRmgenam karggwtEPñk nig karxUcsrésRbsaTCaedIm. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARbu‘uyEsl

TwkenamEp¥m enAkñúgGMLúg eBlmanépÞeBaH

RsþIxøH ekItmanTwkenamEp¥mbeNþaH Gasnñ EdlehAfa TwkenamEp¥meBl manépÞeBaH. TwkenamEp¥meBl manépÞ eBaH ekItmanBI 2 eTA 5PaKry énRsþI manépÞeBaHTaMgGs; b:uEnþCaTUeTA va)at; eTAvij enAeBlEdlRsþIsRmalkUn ehIy. b:uEnþ RsþIEdlFøab;manTwkenam Ep¥m enAkñúgeBlmanépÞeBaH b¤k¾pþl; kMeNItdl;Tark EdlFat;cab;BIbYn KILÚRkameLIgeTA KWmanhaniP½yx<s;

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nwgekItmanTwkenamEp¥mRbePT 2 enA eBlbnÞab;mkeTot enAkñúgCIvit. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARbu‘yEsl GgÁkarsuxPaBBiPBelak nig smaKm»sfGURsþalI

etIvamanplvi)akGVIxøH? TwkenamEp¥m CaCMgWruaMér: nig mYyCIvit EdltRmUveGaymankarRtYtBinitüy:ag ykcitþTukdak;. ebIKμankarRKb;RKg eGay)anRtwmRtUveTenaH vaGacnaMeGay manplvi)akepSg² dUcCaCMgWsrés


k a r Bi t

Qam-ebHdUg karxUctRmgenam kar • GasuIt Lak;Tic enAkñúgxøÜn ggwtEPñk nig karxUcsrésRbsaT. GasuIt Lak;Tic enAkñúgxøÜnKWCakarekIn enAkñúgry³eBlxøI plvi)akrYmman ³ eLIg CatiGasuIt Lak;Tic enAkñúgxøÜn. ekasikaplitGasuIt Lak;Tic enAeBl • CatisárkñúgQamcuHTabxøaMg EdlvaeRbICati KøúykUs ¬sár¦ edIm,I mnusSmñak;EdleRbI GaMgsu‘uylIn nwg famBl. ebIsinCamanGasuIt Lak;Tic RbQmmuxnwgbBaðaFøak;cuHCatisár enA enAkñúgxøÜneRcIneBk mnusScab;epþImmin kñúgQam mkkRmitTabxøaMg enAeBlxøH RsYlxøÜn. GasuIt Lak;Tic enAkñúgxøÜn ¬BIeRBaH eKsμanelIsGMBIkRmit GaMg KWkRmman ehIyb:HBal;CasMxan; eTA su‘uylIn EdlRtUveRbI eFVIkarhat;R)aN elIGñkTwkenamEp¥mRbePT 2. hYsehtueBk b¤ briePaKminRKb;RKan;¦. CatisárTabenAkñúgQam GacRtUvEk • karqøgemeraK)ak;etrI nig tRmUvvijy:agrh½s edaybriePaKsár BYkpSit xøH. ebIsinCaminEktRmUveTenaH vaGac GñkTwkenamEp¥mRbePT 2 gayCag naMeGayGñkCMgWsnøb;)at;bg;sμartI. va eK nwgqøgemeraKBBYk)ak;etrI nig pSit. CakarsMxan; EdlGñkTwkenamEp¥m sÁal; karqøgemeraKpSit rYmmanCMgWehImRtbk sBaØa énsßanPaBmanCatisár enAkñúg EPñk nig CMgWrlakEs,k bNþalmkBI QamTab. karqøgemeraK enARkeBjEs,k . kar qøgemeraKpSit rYmman eCIgGñkkILa • GasuIt ektUn enAkñúgQam GtþBlkmμ ERsg nig karqøgemeraK enAeBlEdlxøÜneyIg kat;pþac;Catixøaj; enAtamrnæeyanI. plitplkaksMNl;GasuIt Edlman eQμaHfa ektUn k¾RtUv)anplitecjmk. enAkñúgry³eBlEvgenaH plvi)ak ragkayminGacsU‘RTaMnwgbrimaNGasuIt rYmman ³ ektUn eRcIneLIy ehIyvak¾Büayam kMcat;CatienHecj tamry³Twkenam. • CMgWEPñk b:uEnþ xøÜneyIgminGacbeBa©jCatiGasuIt CMgWEPñk b¤ CMgW erTIn KWCamUlehtucm,g ektUn TaMgGs;eT ehIyvak¾ekIneLIgenA CageK énkarggwtEPñk nig karxUcKMehIj kñúgQam edaybNþaleGaymanCati enAkñúgcMeNammnusSeBjv½yenARbeTs GasuIt ektUn enAkñúgQam. GasuIt GPivDÆn_. 2PaKryénGñkmanTwkenam ektUn enAkñúgQam CasßanPaBmYyEdl Ep¥m Gs;ry³eBl 15qñaM )anggwtEPñk F¶n;F¶r bNþalmkBIkarxVHG½rm:Un GaMg xN³Edl 10PaKry mankarxUcxat su‘uylIn. vab:HBal;CasMxan; cMeBaHGñk KMehIjF¶n;F¶r. TwkenamEp¥mRbePT 1. 17


II

k a r Bi t

CMgWtRmgenam

søab; énmnusSman TwkenamEp¥mRb TwkenamEp¥m CamUlehtunaMmuxeK énkar ePT 2 enARbeTs]sSahkmμ. manCMgWtRmgenam. esÞIrEtmYyPaKbI énGñkTwkenamEp¥m ekItmanCMgWtRmg • BikarPaB enam ehIyRbEhl 20PaKry énGñk TwkenamEp¥m KWCamUlehtujwkjab;Cag TwkenamEp¥mRbePT 1 mankarxUc eKbMput énBikarPaB EdlekItmaneRkA BIeRKaHfñak;]b,tþiehtu . GñkTwkenam tRmgenam. Ep¥m man»kaseRcInCageK dl;eTA 15 eTA 40 dg nwgRtUvkat;Gvyv³xageRkam • CMgWsrésRbsaT CMgWsrésRbsaT EdlbNþalmkBITwk ebIeRbobeFobCamYyRbCaCnFmμta. enamEp¥m b:HBal;y:agehacNas; Bak; RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARb‘uyEsl kNþal éncMnYnmnusSmanTwkenam Ep¥m. manRbePTepSg² énCMgWsrés RbsaT EdlbNþalmkBIkar)at;bg; etIeKBüa)alTwkenamEp¥m GarmμN_enARbGb;eCIg b¤ kñúgkrNIxøH y:agdUcemþc? enARbGb;éd . karQWcukcab;RbGb;eCIg nig bBaðamuxgarepSg² rbs;xøÜneyIg dUc enAeBlbc©úb,nñenH eKminman»sf Edl CaebHdUg EPñk RkBH e)øakenam nig GacBüa)alTwkenamEp¥m eGayCadac; ligÁ. karfycuH b¤ )at;GarmμN_ enARb enaHeT. b:uEnþ karBüa)al EdlmanRbGb;eCIg GacnaMeGayGñkTwkenamEp¥m siTæPaBBitCaman. edaymanlTæPaB eFVI[rbYsRbGb;eCIgxøÜnÉg edaymindwg TTYl)an»sfRtwmRtUv karEfTaMman xøÜn . rbYsenH GacnaMeGaymandMe)A KuNPaB nig dMbUnμanevC¢saRsþl¥² Gñk ehIyGacQandl;karvHkat;Gvyv³. TwkenamEp¥m Gacrs;enAy:agmansuxPaB nig skmμenAkñúgCIvit ehIykat; • CMgWsrésQam-ebHdUg bnßyhaniP½y EdlnaMdl;karekItman CMgWRbB½næcrnþQam tMNageGay 75 plvi)ak. karRKb;RKgTwkenamEp¥m PaKry énkarsøab;TaMgGs; kñúgcMeNam eGay)anl¥ mann½yfa rkSakRmitCati GñkTwkenamEp¥m enAGWr:ub. enAGaemrik sárenAkñúgQam eGayenAekoknwgkRmit CMgWsrésQam-ebHdUg mancMnYncenøaH Fmμta tamEdlGaceFVI)an. kareFVIdeU cñH BI 8 eTA 20 PaKry énGñkTwkenam GacseRmc)an tamviFdI cU teTAenH ³ Ep¥m EdlmanGayuelIsBI 45 qñaM. haniP½yrbs;BYkeK enAkñúgkarekItCMgW • RKb;RKgrbbGahar ebHdUg KWmancMnYnBI 2 eTA 4dg eRcIn Gahar eFVIeGayekInCatisárenAkñúg CagGñkEdlminmanTwkenamEp¥m. va Qam. mnusSTwkenamEp¥m mantRmUv CamUlehtusMxan; énBikarPaB nig kar •

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k a r Bi t

karGaharUbtßmÖdUceKÉgEdr. enaHman PaB eTAelICatisárenAkñúgQam edIm,IeFVI n½yfa rbbGaharEdlmantulüPaB. eGayCatisár mankRmitekoknwgkRmit Fmμta tamEdlGaceFVI)anenaH KWpþl; • lMhat;R)aN RbeyaCn_ dl;karbgáar nig Bnüakar lMhat;R)aN GaceFVIeGayCatisárFøak; vivtþn_ eTACaplvi)ak EdlbNþalmk Tab. dUcCa GaMgsu‘ylIn Edr vak¾CYy BITwkenamEp¥m. lTæplbgðajfa kar ragkay eGayeRbICatisáry:agman RKb;RKg)anl¥ eTAelICatisár enAkñúg RbsiTæPaB. vak¾CYyeGay GaMgsu‘uylIn Qam nig sm<aFQam nwgnaMeGayman manskmμPaB kan;EtmanRbsiTæPaBpg karkat;bnßyy:ageRcIn dl;karekItman Edr. lMhat;R)aN k¾CYysRmkTm¶n; plvi)ak ³ pgEdr. • kat;bnßyrhUtdl;eTA 76PaKry • kareRbI»sf enAkñúghaniP½yekItmanCMgWEPñk GaMgsu‘uylIn Gackat;bnßyCatisár enA • kat;bnßyrhUtdl;eTA50PaKry kñúgQam. GñkTwkenamEp¥mRbePT 1 enAkñúghaniP½y ekItmanCMgW tRmUveGaycak; GaMgsu‘uylIn Caerog tRmgenam ral;éf¶ edIm,IGacrs;)an . GñkTwkenam • kat;bnßyrhUtdl;eTA 60 PaK Ep¥mRbePT 2 GatRmUveGayeRbIfñaM ry enAkñúghaniP½y ekItCMgW RKab; bBa©úHCatisár edIm,IeFVIeGayCati srésRbsaT sárFøak;cuHTab ehIyGñkxøHeTot Gac • kat;bnßyrhUtdl;eTA 33 PaK tRmUveGaymankarcak; GaMgsu‘ylIn ry enAkñúghaniP½yekIteRKaHfñak; enAdMNak;kalNamYy. srésQamkñúgxYrk,al • kat;bnßyrhUtdl;eTA 33 PaK vaCakarsMxan; EdlRtUvseRmceGay ry enAkñúgkarsøab; EdlbNþal )antulüPaB cMeBaHcMNucerobrab;xag mkBIplvi)ak ry³eBlEvg. elI. ticeBk b¤ eRcIneBk vaGaceFVIeGay RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARbu‘yEsl b:HBal;dl;GarmμN_ GñkTwkenamEp¥m. karseRmc)antulüPaBenH tRmUveGay mankarebþCJacitþ eBjmYyCIvit BIsMNak; etIeKGacbgáarCMgWTwkenam GñkTwkenamEp¥m. karsikSaRsavRCav Ep¥my:agdUcemþc? enAcRkPBGg;eKøs edayviTüasßan Twk enamEp¥m nig CMgWtRmgenam nig Rbdab; karelIkkm<s;karyl;dwg enAkñúgcMeNam rMlayGahar nig edayEpñkBiesaFn_Twk GñkviC¢aCIv³ nig saFarNCnGMBIktþa enamEp¥m enAsaklviTüal½y Gk;s_sVWt haniP½y nig eraKsBaØarbs;Twkenam )anbgðajfa karRKb;RKgd¾manRbsiTæ- Ep¥m CaCMhand¾mansarsMxan; eq<aHeTA 19


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rkkarRKb;RKg nig karbgáar.karbgáar ragkay minEmnmansRmab;EtGñkTwk TwkenamEp¥m GacEbgEckCakarbgáar enamEp¥meT TaMgGs;enH k¾mantYnaTImYy bzm nig bnÞab; ³ kat;bnßyCMgWebHdUg nig sm<aFQamx<s; pgEdr. • karbgáarbzmmunekItCMgW ³ eK RtUvrkeGayeXIj nig karBarbuKÁlEdl • karbgáarbnÞab; eRkay manhaniP½y BIkarekItCMgWTwkenam manCMgW ³ vaTak;Tgnwgkarqab;rk Ep¥m. dUecñH vaman\TæiBledayGackat; eXIj nig karbgáarplvi)ak. dUecñH bnßyTaMgesckþIRtUvkar sRmab;karEfTaM vakat;bnßytRmUvkarBüa)al. karqab; CMgWTwkenamEp¥m nig esckþIRtUvkaredIm,I cat;viFankar enAeBlmanTwkenamEp¥m Büa)alplvi)ak EdlTak;TgnwgCMgW nwgpþl;RbeyaCn_eRcIn cMeBaHKuNPaB TwkenamEp¥m. CIvit nig manRbsiTæPaBBiess enAeBl viFankarenaH GacTb;sáat;karbBa¢ÚneTA xN³EdlminTan;manPsþútagrwgmaMenA kan;mnÞIreBTü. \LÚvmanPsþútagEdl eLIy Edlbgðafa TwkenamEp¥mRbePT fa karRKb;RKg)anl¥ eTAelIkRmitCati 1 GackarBar)anb¤Gt;enaH karbgáar sár Gackat;bnßyy:ageRcInKYrsm bzmcMeBaH TwkenamEp¥mRbePT 2 KW cMeBaHhaniP½y EdlnaMeGayekItman manlTæPaBGaceFVI)an . karEkERb plvi)ak nig BnüWtkarvivtþn_ énCMgWTwk rebobrs;enA sMedAsRmk nig RKb;RKg enamEp¥mRKb;RbePT. karRKb;RKg Tm¶n; nig begáInskmμPaBragkay Ca sm<aFQamx<s; nig karekIneLIgCati eKaledAsMxan; enAkñúgkarbgáarTwkenam xøaj; k¾mansarsMxan;Edr. Ep¥mRbePT 2 . plRbeyaCn_énkar kat;bnßyTm¶n; nig karbegáInskmμPaB RbPB³ shB½næCMgWTwkenamEp¥m enARbu‘uyEsl

20


III plvi)ak

21


III

p l vi ) a k

CMgWEPñk

CMgWer:TInEPñk

plvi)akCMgWEPñk ekItmanCajwkjab; cMeBaHGñkTwkenamEp¥m. ebIsinminBüa)aleTenaH vaGacnaMeGayxUcKMehIj EPñk ehIyTIbMput KWxVak;EPñk. manCMgW EPñkBIrRbePT EdlbNþalmkBIpl vi)akelIsrésQamtUc² énGñkTwkenam Ep¥m.

1> CMgWerTInEPñk bNþalmk BITwkenamEp¥m CMgWer:TInEPñk

22

CMgWerTIn EdlbNþalmkBITwkenamEp¥m ekIteLIg edaysarkarxUcxatsrés QamtUc² rbs; erTIn enAEpñkxageRkay énEPñk. srésTaMgGs;enH GacxUc edaysarkRmitCatisár enAkñúgQam x<s; nig sm<aFQamx<s;. dMNak;kal dMbUg énCMgW erTIn eKehAfa CadMNak; kalminTan;rIksay. vaRtUv)ankt; smÁal;edaymanBgtUc² mþgmáal Edl bNþalmkBIkarrIksrésQam qμar² nig karhUrrQamtic² enAelI erTIn. enAdMNak;kalenH karRCabtamsrésQam minFmμta bNþaleGaymankarelc ecjCatiTwk ekasikaQam RbUetGuIn nig Catixøaj;cUleTAkñúgCalika erTIn Edl enACuMvijenaH. enAdMNak;kalenH CMgW CaTUeTA KWminTan;maneraKsBaØaeLIy ebIsinCavaminmanrYmedayehIm m:aKuuy-

l½rén erTIn EPñk (macular oedema) eT enaH ¬sUmGanxageRkam¦. CMgW erTIn TwkenamEp¥m EdlminrIksay b:uEnþF¶n; F¶renaH eKehAfaCaCMgW erTIn eRtomrIk say. enAdMNak;kalrIksayvij eraK sBaØarYmman RBilEPñk b¤ emIleXIjrUb BIr fycuHKMehIj nig eXIjman cMNucexμAGENþt. mnusSvivtþn_ BIdMNak; kalTImYy eTAdMNak;kalTIBIr enAeBl EdlsrésQamfμIrIkecjBI nig kat;tam erTIn CakareqøIytbeTAnwgkgVHGuksuIEsn EdlRtUvpþl;edaysrésQamedIm kMeNIt. enHeKehAfa karbegáItsrés QamfμI. b:uEnþ srésQamfμITaMgenHTn; exSayNas; ehIyEfmTaMgTMngCagay dac; nig hUrQamcUleTAkan;TwkrMGilføa EdlsßitenARkhUgxageRkayrbs;EPñk edayeFVIeGay)aMgKMehIj. Rkm:Calika EdlGacbegáIteLIgenACit erTIn eBlva rbkecjBIEpñkxageRkayénEPñk nwgeFVI eGayggwtEPñk.

2> ehIm m:aKuyl½r

CMgWenH ekIteLIgedaysarkarehIm enA nwg m:aKuyl½r EdlCatMbn;mYy rbs; erTIn. enAeBlEdlsrésQamtUc² xøH enAkñúg erTIn raMgsÞHsrésQam Edl enAEk,renaHrIk edIm,Ib:Hb:UvkarsÞHenH.


p l vi ) a k

srésQamEdlrIkenaH CaTUeTAGac RCab)an ehIysarFaturav k¾mkkkkuj enAm:aKuuyl½r EdlbnþmkeTot vabNþal eGay m:aKuyl½r ehIm ehIyQb;dMeNIr kar. vaCamUlehtujwkjab;bMput Edl naMeGaymankarxUcKMehIj enAkñúgcMeNamGñkCMgW erTIn minrIksay. kar emIlElgeXIj GacekItmanPøam² ehIykarBüa)almineCaKC½yeT.

karBüa)al

ebIKμankareRbIfñaMeTenaH karBüa)alGac rYmmanTRmg;BIrénkareRbIkaMrsμILaEhSr EdlehAfa pan-retinal photocoagulation EdlCaTUeTA eKeRbIviFIenHBüa)al enAdMNak;kalCMgW erTIn eRtomrIksay enAdMNak;kalcugeRkay nig CMgW erTIn TwkenamEp¥mrIksay nig viFImü:ageTot ehAfa focal photocoagulation sRmab; Büa)alkarehIm m:aKuyl½r TwkenamEp¥m EdlKMramkMEhgdl;KMehIj. karBüa)aleday LaEhSr biTkarelcecj tamsrésQamenAkñúg m:aKuyl½r eday BnüWtkarehIm EdlbNþaleGayxUc KMehIj . viFIenH mineFVIeGayRbesIr eLIgvij karemIleXIjRBileT b:uEnþva karBarvamineGaykan;EtF¶n;F¶r. KMehIj Edl)at;enaH minGacRtLb;mkrkPaB edImvijeT .

)anekIneLIgdl; 29 PaKry sRmab;Gñk Edl)aneRbI GaMgsu‘ylIn ry³eBlCag 20qñaM. ebIsinCamin)anBüa)al mnusS TwkenamEp¥m EdlmanehIm m:aKuyl½r cMnYn 25PaKry nwg)at;bg;KMehIjxøH enAkñúgry³eBlbIqñaM.

karBinitüsm<aFQam

RbPB³shB½næTwkenamEp¥menARb‘uyEsl

CMgWtRmgenam CMgWtRmgenam énGñkTwkenamEp¥m KWCa CMgWruaMér: nig vivtþn_eTAmux. vaRtUvsmÁal; edaykarekIneLIg cMnYn Gal;b‘uymIn enAkñúgTwkenam edayeFVIeGaysm<aF QameLIgx<s; ehIymuxgartRmgenam Føak;cuH. PaBkan;EtGaRkk;eTA ekItman enAkñúg nig CuMvij KøÜemrIl EdlCaCalikarceRmaH rbs;tRmgenam. enAkñúg CMgWTwkenamEp¥m kRmit KøúykUs enAkñúg Qam eFVIeGayb:HBal;dl;srésQam tUc² enAkñúgxøÜnTaMgmUl. srésQam TaMgenH GacxUc nig Qb;dMeNIrkarRtwm

tRmgenamFmμta

tRmgenammanCMgW

sßiti

tamsßiti kñúgcMeNamGñkTwkenamEp¥m ry³eBlCag 10qñaM 74PaKry nwgekIt manCMgW erTIn NamYy. RbEhlCa 14 PaKy EdlmanTwkenamEp¥m nwgman ehIm m:aKuyl½r ehIyGRtaeRbv:aLg;

m:asuInlagQam 23


III

p l vi ) a k

RtUv. enAeBlsrésQamtUc² enAkñúg tRmgenamxUc kareRcaHk¾xUcEdr. kak sMNl; nwgenAkkkujenAkñúgQam eday ELk sarFatumantémødéTeTot dUcCa RbUetGuIn )anRCabecj cUleTAkñúgTwk enam. ebIsinCasßanPaBEbbenH ecHEt vivtþn_eTAmuxenaH CMgWtRmgenam GaceTA CakarxUctRmgenam ¬CMgWtRmgenam dMNak;kalcugeRkay¦EtmþgenATIbMput EdlebIisinCaKμankarBüa)al vanwgnaM eGaysøab; . CeRmIsénkarBüa)al sRmab;CMgWtRmgenam dMNak;kalcug eRkay KWkarlagQam ¬GñkCMgWnwgP¢ab; CamYym:asuInlagQamCaeRcInem:ag BI 2 eTA 3 dgkñúgmYys)þah_ b¤ karpSúaM tRmgenam. b:uEnþkarBüa)alenH man témøéføNas; ¬enAGWr:ub CaTUeTAtémø RbEhl 30000GWr:U kñúgmYyqñaM sRmab; karlagQamehIy 12000 GWr:U sRmab; qñaMdMbUg nig eRkaymk 5000GWr:U kñúgmYy qñaM sRmab;karpSúaM. CMgWtRmgenam mk BITwkenamEp¥m Gacbgáar)an edaykar RKb;RKgdUcxageRkam ³

CMgWsrésRbsaT 24

bBaÄb; b¤ BnüWtkarekItCMgWtRmgenam EdlbNþalmkBITwkenamEp¥m.

2> rbbGahar

karkat;bnßybrimaN RbUetGuIn CYybBa©úH sm<aFQam ehIykat;bnßyGRtaFøak; cuHénGRtaceRmaH KøÚemrIl.

3> karCk;)arI

karQb;Ck;)arI GacmanRbsiTæPaBCag eRbIfñaM ehIykat;bnßyhaniP½y énkar vivtþn_CMgW)any:ageRcIn.

4> kRmitCatixøaj;enAkñúgQam xusFmμta

»sfbBa©úHCati kUeLesþr:ul EdlBüa)al kRmitCatixøaj;enAkñúgQam xusFmμta kat;bnßykRmitRbUetGuIn enAkñúgTwkenam ehIyEfrkSamuxgarceRmaH rbs;tRmg enam enAkñúgcMeNamGñkCMgWtRmgenam EdlbNþalmkBITwkenamEp¥m.

5> ktþaepSgeTot

karRKb;RKgCati KøúykUs eGay)anRtwm RtUv karsRmkTm¶n; karhat;R)aN nig 1> sm<aFQam »sfbBa©úHsm<aFQam GacCYyBnüWt karkat;bnßykareRbICati Gal;kul. karvivtþn_CMgWtRmgenam bNþalmkBITwk enamEp¥m. »sfhamXat; Gg;suIm Edl sßiti ERbkøay Gg;süÚtg;suIn EdlehAfaBYk CMgWtRmgenam EdlbNþalmkBITwk enamEp¥m ekIteLIgRbEhlmYyPaKbI ACE manRbsiTæPaB enAkñúgkarbgáarkar vivtþn_ énCMgWtRmgenam eTAkan;dMNak; énkrNICMgWTwkenamEp¥mTaMgGs;. kar mYyeTot. »sfbBa©úHTwkenam beta- xUctRmgenam CaTUeTA ekItmanbnÞab;BI blockers nig calcium channel blockers manTwkenamEp¥m 20 eTA 30qñaM. enA GacbegáInkarRKb;RKgsm<aFQam enA kñúgTwkenamEp¥mRbePT 2 haniP½yekIt kñúgcMeNamGñkTwkenamEp¥m ehIyCYy manCMgWsrésQam-ebHdUg KWmancMnYn


p l vi ) a k

2 eTA 3 dg x<s;CagGñkEdlmanGal;b‘uymIn enAkñúgTwkenam ebIeRbobeFob CamYymnusSmñak; EdlmankarbeBa©j Cati Gal;b‘uymIn Fmμta. karQb;Ck; )arI Gackat;bnßyhaniP½y énkarvivtþn_ cMnYn30 PaKry. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARbu‘uyEsl

CMgWsrésRbsaT CMgWsrésRbsaT bNþalmkBITwkenam Ep¥m KWCasßanPaBmYy EdleFVIeGayxUc srésRbsaTenAkñúgxøÜn. ynþkarBit R)akdenaH eKminTan;dwgenAeLIyeT. karRsavRCavkMBugEtmanbnþeTot b:uEnþ manRTwsþImYycMnYntUcb:ueNÑaH GMBIbBaða enH. Catisárx<s; eFIV[mankarRbmUlpþúM nig b:HBal;ekasikaRbsaT kRmitCati sárenAkñúgQamx<s; b:HBal;dl;brimaN nIRTic GuksuIt kñúgQam. nIRTic GuksuIt CYyBRgIksrésQamtUc² EdlnaMGuk suIEsn eTAeGaysrésRbsaT. kar Føak;cuHkRmit nIRTicGasuIt nwgnaMeGay rYmet,ótsrésQamEdleFVIkarpÁt;pÁg; dl;srésRbsaTedaybNþaleGayxUc srésRbsaT. eraKsBaØamankarERbRbYl eTAtamRbePTTaMgbIénCMgWsrésRbsaT³

1> CMgWsrésRbsaT enAGvyv³

vab:HBal;dl;Gvyv³ . eraKsBaØaCa TUeTArYmman kars<wk GsmtßPaBkñúg karTTYlGarmμN_ BIkarb:H karsgát; kar QWcab; nig karERbRbYlsItuNðPaB. va naMeGaymanGarmμN_QWcukcab; Rkhay

nig cak;edat karQWcukcab;y:agRsYc Rsal; b¤¤ rmYlRkeBI karTTYlGarmμN_ hYsehtu BIkarsÞab sUm,IEtkarsÞab efIr² kar)at;bg;tulüPaB nig karsRmb sRmUYlBiess enATIggwt.

2> CMgWsrésRbsaTsV½ytü ³

vab:HBal;srIragÁxagkñúg. eraKsBaØadUc Ca ceg¥ar k¥Üt GarmμN_twgeBaH nig kar )at;bg;cMNg;Gahar BIeRBaHkarBnüa eBl enAkñúgkareFVIeGayRkBHenATeT edaysarkarxUcsrésRbsaT Edl pÁt;pÁg;RkBH. karBi)akTMBarGahar nig karraK b¤ Tl;lamk ekIteLIgenAeBl EdlsrésRbsaT mkkan;bMBg;Gahar b¤ eBaHevon mankarb:HBal;. CMgWqøgtam RbB½næbgðÚrenam nig karenam edaymindwg xøÜn edaysarkarcal;TwkenameRcInhYs ehtuenAe)øakenam ekItmanenAeBlEdl srésRbsaT mkkan;e)øakenam)anxUc nig b:HBal;TaMgRsugdl;karbeBa©jTwk enam[Gs;BIe)øakenam . GsmtßPaB pøÚvePT kñúgcMeNam burs b¤ RsþIGacnwg ekIteLIg edaysarbBaðasrésRbsaT b¤ crnþQam eTAkan;srIragÁePT. kar Føak;cuHy:agKMhuK énsm<aFQam enA eBlQr nig GgÁúyPøam² RBmTaMgkar KaMgebHdUg KWCaeraKsBaØaF¶n;F¶r déT eTot énCMgWsrésRbsaTsV½ytü. kar hUrejIsxøaMg edaysarGsmtßPaBrbs; xøÜneyIg enAkñúgkarRKb;RKgsItuNðPaB edaysarsrésRbsaT EdlbBa¢amkRk eBjejIs GacnwgekItmanRBmCamYy KñaenaH GñkCMgWGacmindwgGMBIkarFøak;cuH CatisárenAkñúgQam edaysarCMgWsrés

CMgWsrésRbsaT

eCIgGñkekItCMgWTwkenamEp¥m

eCIgGñkekItCMgWTwkenamEp¥m 25


p l vi ) a k

III

RbsaTenHEdr. kareqøIytbtamTmøab; Fmμta cMeBaHCatisárTab enAkñúgQam k¾RtUvxUc edayeFVIeGaylM)akcMeBaHGñk CMgW enAkñúgkardwgGMBIeraKsBaØa.

3> CMgWsrésRbsaTEtmYy

ebHdUg

rlYysac;dMuebHdUg

eRKaHfñak;srésQamkñúgxYrk,al 26

dwgfaQW nig manGVImkb:H. kardak;sm j½rmYyenAcugq¥wg nwgetsþemIlsmtßPaBTTYlrMj½r . smtßPaBdwg karERb RbYlsItuNðPaB Gacdwg)an edayBinitü emIlGarmμN_dwgekþA nig RtCak;. kar viPaKGKÁIsnIsac;duM RtUv)aneRbIedIm,I BinitüemIlkareqøIytb rbs;sac;duM cM eBaHPøúcGKÁIsnI Edlcmøgedaysrés RbsaT enAEk,renaH. kareqøIytbyWt nig exSaybgðajfa mankarxUcsrés RbsaT b¤ sac;duM. karsikSaGMBIkar cmøg rbs;srésRbsaT BinitüemIllM hUrcrnþGKÁIsnI tamsrésRbsaT. crnþ EdlyWt b¤ exSayCag Fmμtabgðajfa mankarxUcsrésRbsaT. karERbRbYl énkareqøIytbsm<aFQam enAeBlQr karERbRbYlcgVak;ebHdUg enAeBlEdl eKdak;édenAkñúgTwkekþA TwkRtCak; nig karBinitü eGkU edIm,IemIlmuxgar éne)øak enam nig EpñkdéTeTot énbMBg;bgðÚrenam KWCakareFIVetsþ EdleRbIedIm,IBinitüemIl karxUcsrésRbsaTsV½ytü.

vab:HBal;dl;srésRbsaTEtmYyb¤Rkum NamYy. eraKsBaØa hak;dUcCaelc eLIgmYyrMeBc ehIyb:HBal;cMsrés NamYy CaBiessCajwkjab;bMputenaH KWenAkñúgxøÜn enAeCIg nig tMbn;k,al . karQWcukcab; enAEpñkxagmuxrbs;ePøA enAxñgxageRkam nig GagRtekok b¤ RTUg RkBH b¤ cegáHGacnwgekItman. kar QWRTUg b¤ eBaH eBlxøHnaMeGayRcLMkar QWcukcab; EdlbNþalmkBIQamciBa©wm ebHdUgminRKb; karKaMgebHdUg nig CMgW rlakExñgeBaHevon. karQWcukcab;enA eRkayEPñk GsmtßPaBrbs;EPñk emIl cMGVImYy kareXIjrUbBIrekIteLIg eday sarkarxUcsrésRbsaT EdlbBa¢amk sac;duMEPñk. s<wkmuxmYycMehog nig bBaða Rtecok b¤ karecHEtB¤semøg gWg² enA kñúgRtecok KWCaeraKsBaØaepSgeTot karBüa)al eKalbMNgénkarBüa)al KWedIm,Ikat; EdlGacelceLIg. bnßyPaBminsuxRsYl nig karQWcab; . kareFVIetsþ kareRbI»sfRtwmRtUv edIm,ICYysRmal kareFVIetsþ nig karBinitüragkay d¾ karQWcab;dUcCa fñaMbM)at;karQWcab;Edl samBaØnwgGaceFVIeLIg edIm,IBinitürk eKeRbITUeTAenaH GacnwgminmanRbsiT§ emIlCMgWsrésRbsaT. GarmμN_dwgQW PaBl¥eLIy . »sfdéTeTot rYmman nig dwgfamanGVIb:H GaceFVIetsþedayeRbI GIumIR)amIn (Imipramine) nig GamIRTIb srésnILúgtUcqμarmYy. eKyksrés talIn (amitryptaline) EdlRtUv)an nILúgtUcqμar dak;eTAelIkEnøgepSg² enA eRbICafñaMRbqaMg nwgkarFøak;TwkcitþenaH elIRbGb;eCIg edIm,IBinitüemIlGarmμN_ KWmanRbsiT§PaBCag enAkñúgkrNI


p l vi ) a k

enH . edIm,IBüa)al b¤ bgáarkarxUcsr ésRbsaTbEnßmeTotenaH nig edIm,IRKb; RKgkarQWcab; b¤ kar)at;bg;GarmμN_ vaCaerOgsMxan; EdlRtUveFVIeGaykRmit CatisárenAkñúgQam sßitenAeRkamkar RKb;RKg)an. edIm,Ikat;bnßybBaða EdlTak;TgeTAnwgeCIg eKRtUvEtman karEfTaMBiess edayRtUveKarBtam rebobEfTaMeCIg . edIm,Ikat;bnßykar rMxan cMeBaHkarrMlayGahar dUcCa ehIm eBaH ceg¥ar k¥Üt eKENnaMeGaybriePaK Gahar EdlmanCatisrés kñúgbrimaN tic b:uEnþjwkjab; . kñúgkrNIEdlF¶n;F¶r kareRbIfñaM nwgGaceFVIeLIg)an. edIm,I kat;bnßykarraKrUs kareRbIfñaMBüa)al raK RtUv)anENnaM. edIm,Ikat;bnßybBaða Edlb:HBal;eTAdl;Rbdab;bgðÚrenam eK ENnaMfa KYrpwkTwkeGay)aneRcIn ehIy enameGayeTogTat; erogral; 3-4 ema:g mþg eTaHbICaGñkminmanGarmμN_ Twk enameBje)aøkenam k¾edaycuH. karman CMgWqøgtamRbdab;bgðÚrenam RtUvEtTTYl karBüa)al eGay)anqab;rh½s. edIm,I kat;bnßykarvilmux nig karcuHexSay enaH eKENnaMeGayGgÁúy b¤ QryWt² dMeLIgk,alERK Bak;eRsameCIgyWt. eKk¾RtUvpþl;fñaMBüa)alpgEdr. edIm,I kat;bnßybBaðapøÚvePT RKUeBTü Gacnwg ENnaMkarBieRKaHCMgW edIm,Ikat;bnßyPaB tantwgGarmμN_ nig fñaMedIm,IBüa)al GsmtßPaBpøÚvePT enAkñúgcMeNamburs nig fñaMkat;bnßyCMgWqøgtamrnþeyanI nig Rbdab;bgðÚrenamkñúgcMeNamRsþI . eBl xøH eKGacENnaMeGaymankarvHkat; . edaysRmalkarcuHexSaysac;dMu kar

Büa)aledayclna nig lMhat;R)aN GacnwgRtUvENnaMeGayeFVI . kareRbIfñaM GaMgs‘uylIn k¾RtUveKyl;fa CYykat; bnßyPaBexSay rbs;sac;duMEdr. RbPB³ mUlniFiCMgWTwkenamEp¥m enATIRkugkUeb:nhaehán

CMgWebHdUg-srésQam TwkenamEp¥m KWCaktþahaniP½y d¾sMxan; mYy sRmab;CMgWebHdUg-srésQam EdlekItman cMeBaHebHdUg nig RbB½n§ crnþQam . TaMgTwkenamEp¥mRbePT 1 nig RbePT 2 manTMnak;TMngKñaya:gCit sñiT§ nwgCMgWebHdUg-srésQam EdlCa mUlehtud¾sMxan; énkarsøab;kñúgcMeNam GñkTwkenamEp¥m . sBaØaKøInik énCMgW ebHdUg-srésQam RtUv)anEbgEck ecjCabIRkum ³

1> CMgWb:HBal;ebHdUg nig crnþ QamciBa©wmebHdUg ³ CMgWebHdUg

edaysarkarsÞHcrnþQamebHdUg Tak; TgnwgkareLIgRkas; énCB¢aaMgsrés Qam-ebHdUg b¤k¾mankMNkQam enA kñúgsrésQam ciBa©wmebHdUg. Rbkar enH bNaþleGaymankareFVITukçbukmñij dl;ebHdUg EdlenATIbMput GacnaMeGay mankarQWcukcab;RTUgF¶n;F¶r karKaMg ebHdUg b¤k¾karsøab;mYyrMeBc .

2> CMgWEdlb:HBal;xYrk,al nig crnþQamxYrk,al ³ karrMxandl;

karpÁt;pÁg;Qam mkkan;xYrk,al nig naM eGaymaneRKaHfñak; srésQamxYr 27


III

p l vi ) a k

k,al EdlCakar)at;bg;Pøam² mYyrMeBc Qam EdlciBaw©mebHdUg. BYkeKTMngCa énmuxgarrbs;xYrk,al edaybNþal man»kasdUcKña kñúgkarmanbBaðaKaMg eGaysøab;tMbn;NamYyenAkñúgxYrk,al. ebHdUg ebIeRbobeFobCamYy GñkKμan TwkenamEp¥m EdlFøab;mankarKaMgebH 3> CMgWEdlb:HBal; Gvyv³ dUg. ebIsinCaBYkeK mansm<aFQam eRkam nig RbGb;eCIg ³ vaRtUv x<s; RBmTaMgmanCMgWTwkenamEp¥mEfm )aneKsÁal;fa CaCMgWsrésQam Epñk eTotenaH BYkeKnwgman»kasdl;eTA xagcug. vaCajwkjab; bNþalmkBIkar BIrdg RbQmeTAnwgbBaðaeRKaHfñak; ceg¥ótsrésQam EdlnaMQameTAkan; srésQamkñúgxYrk,al dUcCaGñkman eCIg nig sac;duMéd . kar)at;bg;karpÁt; sm<aFQamx<s;Edr. pÁg;Qam GacbNaþleGaymandMe)A s¥úyrlYy (gangrene) EdlTIbBa©b; Gac ktþaeRKaHfñak;déTeTot naMdl;karkat;Gvyv³ nig karQWcukcab; haniP½y srésQam-ebHdUg Tak;Tg CaTUeTA enAtMbn;kMPYneCIg enAeBledIr . nwgdMNak;kal eRtomTwkenamEp¥m (Impaired

sßiti

CMgWebHdUg-srésQam tMNageGay 50 PaKry énkarsøab;TaMgGs; bNþal mkBITwkenamEp¥m nig BikarPaB ya:g eRcIn. ebIeRbobeFobCamYyRbCaCn TUeTA GñkTwkenamEp¥m TMngCasøab;BI 510 qñaM muneK b¤nwgGacman»kaseRcIn CageKdl;eTABIrdg kñúgkarekItmanCMgW KaMgebHdUg b¤k¾ eRKaHfñak;srésQam enAkñúgxYrk,al. GñkCMgW man»kasdl; eTA 40 dg eRcInCageK nwgRtUvkat;eCIg ecal nig man»kaseRcInCageK dl;eTA bYndg kñúgkarekItmanbBaðasÞHsrés

28

glucose

tolerance

)

nig TwkenamEp¥m KμanGVIsgS½yeT KW edaysarkarCab;Tak;Tgrbs;va CamYy ktþahaniP½yebHdUg-srésQam dUc Casm<aFQamx<s; kUeLesþr:ul GaRkk; RbePT LDL x<s; kRmit kUeLesþr:ul l¥ RbePT HDL Tab nig karCk;)arI. kar pøas;bþÚrrebobrs;enA EdleFVIeGayRb esIreLIg karRKb;RKg;Cati KøúykUs kñúg Qam dUcCakarsRmkTm¶n; karEkERb rbbGahar nig karbegáInlMhat;R)aN RbEhlCanwgCYykat;bnßyktþahaniP½yebHdUg-srésQamTaMgenH. RbPB³ shB½n§TwkenamEp¥mGnþrCati enARb‘uyEsl


IV

skmμPaBénragkay nig karTTYlTanGahar

29


IV

s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

GskmμPaBénragkay RsþIFat;RCul

edkenAeBléf¶ GacbegááIn»kas ekItCMgWTwkenamEp¥m)an

GskmμPaBénragkay KWCabBaðaskl énsuxPaBsaFarN³. y:agehacNas; 60° éncMnYnRbCaCnTaMgGs; enAelI BiPBelak min)aneFVIskmμPaBragkay RKb;RKan; edIm,IeGaymansuxPaBl¥eT. bBaðaenH mYyEpñkbNþalmkBIskmμPaB ragkayminRKb;RKan; enAeBlTMenr nig bNþalmkBIkarekIneLIg nUv\riyabf GgÁúyyUr kñúgeBleFVIkar nig enApÞH. Cag enHeTAeTot karekIneLIgénkareRbI R)as;meFüa)ayeFVIdMeNIr EdlCacMNuc “Gskmμ ” EdlvaTak;TgnwgkarFøak;cuH énskmμPaBragkay. “karekIneLIg énkareRbIR)as;

meFüa)ayeFVIdMeNIr EdlCa cMNuc “Gskmμ ” Edlva Tak;TgnwgkarFøak;cuH skmμPaBragkay ”

karrs;enAedaykarGgÁúyes¶ómeRcIn 30

kRmitGskmμPaBénragkayenH KWman kRmitx<s; enARKb;RbeTsTaMgGs;. enA tamTIRkugFM² EdlkMBugEtmankarrIk ceRmInesdækic©y:agrh½s enAkñúgRbeTs kMBugGPivDÆn_ GskmμPaBénragkayKW CabBaðaEdlmanTMhMFMeFgCag enAkñúg RbeTsGPivDÆn_. kñúgcMeNamktþaEdl CMrujeGaymanGskmμPaB énragkay

KWmandUcCa mnusSENnNan;tan;tab;/ cracrkksÞH karekIneLIgnUvPaBRkIRk nig bTelμIs]Rkidækmμ KuNPaBxül;min l¥ nig kgVHxaténsYnc,ar kEnøgedIr kMsanþ kEnøghat;kILa>>>.l. enATICn bT énRbeTsEdlkMBugGPivDÆn_ skmμ PaBGgÁúymYykEnøgry³eBlyUr dUcCa karGgÁúyemIlTUrTsSn_ KWkMBugEtekIn eLIgpgEdr. CMgWminqøg EdlTak;TgnwgGskmμPaB ragkay \LÚvenH kMBugkøayCabBaða suxPaBsaFarN³d¾FMbMput enAkñúgRb eTsCaeRcIn. 80PaKry énGñksøab; TaMgGs; edaysarCMgWTwkenamEp¥m KW sßitenARbeTs EdlmanR)ak;cMNUlTab nig mFüm enAkñúgBiPBelak. kñúgeBl CamYyKñaenH GskmμPaBénragkay kMBugekIneLIg enAkñúgcMeNamyuvv½y CMu vijBiPBelak CaBiess enAkñúgtMbn; TIRkugEdlRkIRk. eK)a:n;sμanfa man yuvv½ymindl;mYyPaKbIpg EdleFVI skmμPaBragkayRKb;RKan; edIm,Ipl RbeyaCn_dl;suxPaBrbs;BYkeK naeBl bc©úb,nñkal nig eBlGnaKt. GRta Føak; cuHenH KWmYyPaKFM bNþalmkBIkarekIn eLIgénkarGgÁyú enAkñgú CIvti RbcaMéf¶rbs; BYkeK. Ca]TahrN_ manekμgticNas;


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

EdlcMNayeBledIr b¤ CiHkg;eTAeron briePaKGahar kan;EtmantulüPaB. ehIyeBlCaeRcInelIslub rbs;BYkeK KWcMNayeTAelIkaremIlTUrTsSn_ elg “karedIr GacCakareFVIskmμPaB ragkay EdlgayeFVI ehÁmkMuBüÚT½r nig eRbIR)as;kMuBüÚT½r CaCag bMput nig EdleKENnaM kareFVIskmμPaBragkay nig karelg eGayeFVIeRcInCageK ” kILa. skmμPaBragkaydéTeTot enA tamsala k¾RtUv)ankat;bnßypgEdr. kareFVIskmμPaBragkay eRcInCagenH CaeRcIn dl;suxsar³RbeyaCn_énskmμPaB pþPaBl;nUvnisar³RbeyaCn_ g CYydl;karrkSaTm¶n;pgEdr. karhat;R)aN KWCaTRmg;énkareFVIskmμ ragkayCamFüm PaBragkayEtvaminEmnCaviFIEtmYyKt; skmμPaBénragkay KWCaKnøwHkñúgkar enaHeT. kareFVIskmμPaBragkay Gac kMNt;famBl EdleyIgbeBa©jecal eFVIeTA)anenARKb;TIkEnøg nig mincaM)ac; ehIymansarsMxan;Nas; cMeBaHtulü- RtUvkarsmÖar³ Es,keCIg nig exaGavéfø PaBénfamBl. kareFVIskmμPaBrag GVIeLIy. karyYr\va:n;/ eQI/ esovePA/ kaylμm² y:agehacNas; 30naTI BrTark/ k¾dUcCakareLIgCeNþIr eday kñúgmYyéf¶ enAGMLúgeBl 5éf¶ kñúgmYy eCIg CaCagCiHCeNþIrynþ KWsuT§EtCakar s)aþh_ vaGacCYykat;bnßynUvhaniP½y eFVIskmμPaBragkayd¾l¥mYy. karedIr ekItCMgWTwkenamEp¥mRbePT 2 nig Rb GacCakarGnuvtþd¾l¥bMput nig CaviFId¾l¥ ePTCMgWminqøgepSg²eTot dUcCaCMgWsr bMput cMeBaHkareFVIskmμPaBragkay ésQam-ebHdUg nig eRKaHfñak;srés eRBaH eyIgmincaM)ac;eTAbnÞb;hat;R)aN/ QamkñúgxYrk,al . sMrab;CMgWTwkenam GagEhlTwk b¤ eRbI]bkrN_kILa Ep¥m kareFVIlMhat;R)aNragkaylμm² epSg²eT . kareFVIskmμPaBragkay GacCYykat;bnßybrimaNsárkñúgQam mincaM)ac;RtUvkarcMNayeBlevlaeRcIn CaBiess enAeBlmankarrYmpSM énkar eT CaBiess eyIgGacbBa©ÚlvaeTAkñúg

bursFat;RCul

eKeRcInENnaMeGayedIrEbbenH

RbGb;TI3 ³ niymn½y énBakü “kareFVIskmμPaBragkay ” nig “karhat;R)aN ” GgÁkarsuxPaBBiPBelak )aneGayniymn½yelIBakü "kareFVIskmμPaBragkayfa Ca\riyabf TaMgLay EdleFVIeGaysac;duMmanclna enAkñúgeKalbMNgepSg² kñúgeBleBjmYyéf¶. " cMENkÉBakü karhat;R)aN " KWCaEpñkmYyénkareFVIskmμPaBragkay EdlkareFVIclnaenH man bMNgc,as;las; nig eFVIcuHeLIg " kñúgeKalbMNgeFVIeGaysac;dMurwgmaM nig BRgwgpøÚvdkdegðIm nig ebHdUg. RbPB³ GgÁkarsuxPaBBiPBelak

kareLIgCeNþIr 31


IV

s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

skmμPaBRbcaMéf¶)an. CagenHeTAeTot kareFVIskmμPaBragkaygay² ry³ eBl 30naTI kñúgmYyéf¶ nig 5éf¶ kñúg 1 s)aþh_ GaceFVICadMNak;kalepSg² enAkñúgmYyéf¶k¾)an. GñkxøH cUlcitþkar edIrelOn ry³eBl 10naTI cMnYn 3dg kñúgmYyéf¶ b¤ 20naTI enAeBlRBwk nig 10naTI enAeBléf¶. skmμPaBFmμta dUcCakaredIreLIgCeNþIr/ CiHkg;eTAeFVI kar/ karedIrtampøÚv GacpSM)anCaskmμ PaBragkay EdlRtUveFVIenAkñúgmYyéf¶ ehIybegáItCaskmμPaBeTogTat; Ca erogral;éf¶. CaBiess sar³RbeyaCn_ énskmμPaBragkayTaMgGs;enH Gac eFVIeGayeyIgrIkray eTaHCakarcab; epþImenH yWteBlbnþick¾eday. kareFVI skmμPaBragkay )anbegáInnUvmuxgar nig KuNPaBénCIvit sMrab;mnusSv½y cMNas;. yuvCn yuvtI kñúgv½ysikSa RtUv )anENnaMeGayeFVIskmμPaBragkay lμm² ry³eBl 60naTI Caerogral;éf¶ edIm,IFananUvkarlUtlas; Rbkbeday suxPaBl¥.

GRta emtabUlik kMBugeFVIkarrbs;mnusS mñak; nig GRta emtabUlik rbs;mnusS mñak; EdlKμanskmμPaB . mYy METKW CatémøfamBl énkarGgÁúyes¶óm Edl smmU l eTAnw g kareRbI R )as; f amBl 1 KILÚkaLÚrI kñúg 1K>k kñúg 1 em:ag. eK):an;sμanfa ebIeRbobeFobCamYynwg karGgÁúyes¶om mnusSmñak; eRbIfamBl BI 3 eTA 6 dg (3-6 METs) eRcInCag enAeBleFVIskmμPaBragkaylμm² nig eRcInCag 6 dg (6 METs) enAeBl eFVIskmμPaBragkayxøaMgkøa. RbPB³ GgÁkarsuxPaBBiPBelak

cMNIGahar

xN³EdlkgVHkareFVIskmμPaBragkay )aneFVIeGaymnusS 1>9 lannak; søab; enACMuvijBiPBelak GgÁkarsuxPaBelak )anKitTukfa mnusSRbmaNCa 2>7lan nak; søab;Caerogral;qñaM edaysarkar )anbriePaKEpøeQI nig bEnøtictYceBk. cMNIGahar Edlb:HBal;dl;suxPaB nig GaMgtg;sIuet énskmμPaBragkay RtUv kgVHkareFVIskmμPaBragkay KWCaktþa )anKitCaxñat MET EdlCapleFobén cm,gBIr EdleFVIeGaykRmitCatisárenA

taragTI1³ skmμPaBragkaymFüm nig xøaMgkøa Gaharminl¥sRmab;suxPaB KWsßitenAkñúgcMeNamktþasMxan;² EdleFIVeGaykRmitCati KøúykUs kñúgQamekIneLIg 32

skmμPaBragkaymFüm edIrrh½rhYn raM eFVIsYn eFVIkic©karpÞH edIr)aj;stV b¤k¾ CYbCMuKñatamRbéBNI cUlrYmelgehÁm nig kILaCamYYyekμg² b¤beNþIr stV eFVIdMbUlpÞH Rbk;dMbUl/ KUrrUb yYrGIva:n; eRkam 20 K>k

skmμPaBragkayxøaMgkøa rt; edIr b¤ eLIgPñM CiHkg; hat;R)aN GaeGrU:b‘íc CiHkg;ya:gelOn elgRbkYtehÁm b¤ kILa ¬]TahrN_ )al;Tat; b¤ )al;e)aH CaedIm¦ CIkRbLay CIkdI xøaMgkøa yYrGIva:n;eRcInCag 20 K>k


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

kñúgQam nig sm<aFQamekIneLIg k¾dUc CaeFVIeGayekIneLIg Catixøaj;kñúgQam karelIsTm¶n; nig Fat;RCulCaedIm. ktþaTaMgBIr k¾GacnaMeyIgekItCMgWraMuér: epSg² dUcCa CMgWTwkenamEp¥m/ CMgWsr ésQam-ebHdUg nig CMgWmharIkEdr.

CatisárenAkñúgQam cMeBaHGñkekItCMgW TwkenamEp¥m RtUvEtrwtt,itkarTTYlyk nUvCati kabUnGuIRdat BIGamIdug EdlCa b:UlIsakarIt EdleXIjmaneRcInenAkñúg cMNIrGahar dUcCa )ay dMLÚg nMb½ug nig mI b¤ KuyTav.

“ mnusSRbmaN 2>7 lannak;

snÞsSn_Catisár

Tak;TgnwgGahar GgÁkarsuxPaBBiPB elak )anENnaMeGaymnusSTaMgGs;Kña begáInkarbriePaKbEnø EpøeQI sENþk RKab;EpøeQIEdlGachUb)an nig RKab; FBaØCatiTaMgmUl eGay)aneRcIn . GgÁkarenH k¾ENnaMEdrfa RtUvecHkRmit BIkarTTYlyk nUvfamBlBICatixøaj; srub edaybEgVrkareRbIxøaj; BIxøaj;Eq¥t mkrkxøaj;minEq¥t nig kRmitkareRbI R)as;sáresrI dUcCa m:UNUsakarIt DIsa karItEdldak;bEnßmenAkñúgGahar plit tameragcRk. eRkABIsrá samBaØFmμtaenaH sáresrIrYmman sárxab;enAkñúgTwkXμúM Twk suIr:U nig TwkEpøeQInana. edIm,IRKb;RKg

tameKalkarN_TUeTA eK)anENnaM eGayGñkekItCMgWTwkenamEp¥m KYrrwtt,it karTTYlykCati kabUnGuIRdat Edlman enAkñúg)ay mkenARtwmcMnYn 25°kñúg mYyeBl eday 50° TTYl)anBIbEnø EpøeQI nig 25° eTot )anmkBIGahar EdlmanCati RbUetGIun eRcIn dUcCa RtI sac; nig s‘ut. eTaHy:agenHkþI Cati kabUnGIuRdat mindUcKñaTaMgGs;eT . ]TahrN_ Cati kabUnGIuRdat enAkñúg)ay RtUv )anrMlay nig RCabcUly:agelOn eTA kñúgxøÜn nig eFVIeGayCatisárenAkñúgQam eLIgxøaMg ÉCati kabUnGIuRdat enAkñúgmI b¤ KuyTavvij RtUv)anrMlay nig RCabcUl eTAkñúgxøÜnyWtCag. dUecñH GñkekItCMgW TwkenamEp¥m KYrecosvagnUvGahar Edl mansnÞsSn_Catisárx<s;. edayehtufa

søab;Caerogral;qñaM edaysar kar)anbriePaKEpøeQI nig bEnø tictYceBk ”

GgÁkarsuxPaBBiPBelak ENnaMeGaybegáInkarbriePaKEpøeQI nig bEnø EpøeQIhUbRKab; ¬sENþkdICaedIm¦nig RKab;FuBaØCatiTaMgmUl

33


IV

34

s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

eKENnaMeGayGñkCMgWTwkenamEp¥m cm¥inGaharedayeRbIeRbgtic. brimaNRbUetGIun bEnø nig EpøeQI EdlbriePaKmþg² KYrmancMnYnbIdg énbrimaN kabUnGIuRdat Edl)anmkBIGahar EdlmanGamIdug dUcCa)ay nMb½ug nig dMLÚg


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

RKUeBTüENnaMeGayGñkCMgWTwkenamEp¥m kRmitkareRbI kabUnGIuRdat mkRtwm 25PaKry énGaharmþg² edayTukeGay 25PaKryeTot )anmkBI RbUetGIun. EpøeQI nig bEnø KYrmancMnYnya:gtic 50PaKry enAkñúgGaharmYyeBl².

35


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

IV

taragTI2 ³ GaharEdlsm,ÚrenAGasIu GaharEdlman kabUnGIuRdat snÞsSn_Catisár

)ay mansnÞsSn_Catisárx<s;

nMb½ug mansnÞsSn_Catisárx<s;

snÞsSn_CatisármFüm 36

)ays ¬GgárpáamøiH¦ m:al;tUs ¬50 m>k¦ KøúykUs ¬50 m>k¦ )aydMeNIb nMRkLan )ayx©b; ¬rebobCb:un¦ )ayGgársRmUb )aycugGgár mIcinRss; )ayRtIegot ePsC¢³ Gatorade dMLÚg «Lwk )ays ¬Fmμta¦ nMbu½g caéxV TwkXμMú )aysac;man;qaCamYybEnø bbr s TwkRkUckMb:ug mñas; dMLÚg)araMgesJar sár s ¬50k¦ dMLÚg)araMgcMhuy KuyTavsrésFM nMdMLÚg)araMg )ays ¬RKab;Evg¦ TMBaMg)ayCUrexμA KuyTavsréstUc ¬taMghun¦ ePsC¢³ kUka/ buibsuI lðúg

109 105 100 94 91 88 87 86 82 79 78 77 76 75 75 75 74 73 69 68 66 66 65 62 61 60 60 59 58 58 56

bnÞúkCatisár 46 11 10 31 23 25 37 37 34 40 12 13 5 29 11 15 16 55 23 23 5 16 8 15 23 12 25 11 23 15 4


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

GaharEdlman kabUnGIuRdat snÞsSn_Catisár )ay? eBat dMLÚgCVa )aydMeNIb sVay TwkRkUcRc)ac; mIcinFmμta Lak;tUs Rtav eck mIqa Lak;tUs bbrRkhm nM)a:v Epøe)a:m mIsYr emSARkeGAQUk KavcMhuy RhVúctUs bbr knÞk;

56 55 54 50 51 50 49 46 48 47 46 46 42 39 39 39 33 28 23 19

bnÞúkCatisár 24 18 19 14 8 12 12 5 4 11 19 5 14 12 6 18 3 6 2 3

eBat snÞsSn_CatisármFüm

TwkRkUcRc)ac; mansnÞsSn_CatisármFüm

eck mansnÞsSn_CatisárTab

e):am mansnÞsSn_CatisárTab

snÞsSn_enHbgðajfa etIRbePTGahar epSg² nwgRtUvrMlay nig RCabcUleTA kñúgxøÜnelOnb:uNÑaenaH vaRtUv)aneKeRbI sMrab;sμan nUv\T§iBlénGahar mkelI CatisárenAkñúgQam. TsSnTan sRmab;snÞsSn_ EdlcMNat; fñak;GaharepSg² RtUv)anbegáIteLIg edayRkummYy EdldwknaMeday David Jen Kin EdlCaGñkÉkeTs GaharrUbtßmÖ kaNada enAsklviTüal½y

tUr:ugtU kalBIqñaM 1981 . enAeBlEdl snÞsSn_enaH )anbegáIteLIg eKsnμt;fa KøúykUs suT§ RtUv)anrMlay nig RCabcUl kñúgxøÜnelOnCagGahardéTeTot Edl manCati kabUnGIuRdat. dUecñH KøúykUs k¾RtUvkMNt;fa mantémø 100 . b:uEnþ cab;taMgBIeBlenaHmk eKrkeXIjfa kabUnGIuRdat )anmkBIGgárpáamøiH man témøsnÞsSn_Catisár 109 BIeRBaHvaRtUv )anRCabcUlkñúgxøÜnelOnCag KøúykUs suT§eTAeTot ehIymanplb:HBal;eTA

37


IV

s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

elIkRmitCatisárenAkñúgQam xøaMgCag. nig bnÞúkCatisár CaPasaGg;eKøs-cin krNIdUcKñaenH KWekItmancMeBaH ma:l;tUs nig GaharGasuITUeTACag 100 mux EdlCa DIsakarIt pliteLIgCaEpñk mYy énkarplitRsaebor Edlmantémø “ GñkekItCMgWTwkenamEp¥m KYrkRmit karTTYlykCati snÞsSn_Catisár 105 . témøsnÞsSn_Catisár énRbePTGahar epSg² kñúgRkumEtmYy dUcCa Ggár nig dMLÚg GacxusEbøkKñay:agxøaMg . karERb RbYldéTeTot GacbNaþlmkBIkarTMu b¤k¾ rebobcm¥inGahar nig GVIEdlykmk briePaKCamYyva. ]TahrN_ )ays man témøsnÞsSn_Catisárx<s; Cag)aysEdl briePaKCamYyGahardéTeTot dUcCaRtI CaedIm. dUecñH eKeGayeyabl;fa Gñk CMgWTwkenamEp¥m minRtUvbriePaKGahar Edlsm,Úr kabUnGIuRdat mYymuxeLIy. TsSnavdþIGaharrUbtßmÖ KøInik Gaemrik )ane)aHBum<taragCaGnþrCati enAcenøaH qñaM 1995-2002. GñkniBn§Can;x<s; éntaragTaMgenaH KWelakRsI Jennie Brand-Miller EdldwknaMEpñkGaharrUbtßmÖmnusS enAsalaviTüasaRsþ m:UelKul nig mIRkub enAsaklviTüal½y sIutnI . Rkumrbs;Kat; )anQanmuxeK enAkñúgkarRsavRCavsnÞsSn_CatisárGs; ry³eBlCagmYyTsvtSr_mkehIy. eRkABIkareFVIBiesaFn_eTAelIGaharCag 400mux esvaRsavRCavsnÞsSn_Catisár énsaklviTüal½y suItnI ehAkat;fa SUGiRS e)aHBum<Caerogral;Ex nUv TsSnavdþI eGLicRtUnik CaPasaGg;eKøs nig Pasacin. RkumCnCatiGURsþalIenH k¾)ane)aHBum<pSay nUvbBa¢ItémøsnÞsSn_ 38

kabUnGuIRdat dUcCa mkRtwmEt 25°kñúg GaharmYyeBl ”

GahardUcCa )aydMeNIb )aycMhuy nMb½ug nig dMLÚgEp¥mCaedIm mantémø snÞsSn_CatisárkñúgQam Cag 70 Edl eKcat;Tukfa mankRmitx<s;. GahardUc Cabbr nig dMLÚges¶ar RtUvcat;Tukfaman snÞsSn_enH mFüm EdlmantémøcenøaH BI 69 mk 56 RtUvcat;Tukfa man\TæiBl mFüm eTAelIkRmitCatisárkñúgQam. GahardUcCa bbr nig KuyTav-mI nig dMLÚges¶ar RtUvcat;Tukfa mankRmit mFüm. témøsnÞsSn_ 55 b¤ TabCag enH bgðajplb:HBal;tic eTAelIkRmit CatisárenAkñúgQam ehIyvamanGahar dUcCa eBat Rtav eck nig KuyTav-mI CaedIm. “)aydMeNIb )aycMhuy/

nMbu½g nig dMLÚgEp¥m KWCaGahar Edlmantémø snÞsSn_Catisárx<s; ”

buKÁliksuxaPi)al xagEfTaMsuxPaB )aneGayeyabl;fa mnusSmanCMgWTwk enamEp¥m KYrEtykcitþTukdak; dl; kabUnGuIRdat EdlmantémøsnÞsSn_Cati


s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

sárTabCag 40 dUcCa taMgh‘un bbrknÞk; nig Gahar EdleFVIBIemImQUk. kñúg cMeNamGaharcin eKrkeXIjfa daMs‘ug nig nM):avcMhuy Edlmanjat;sac; k¾ mantémøsnÞsSn_CatisárvTabEdr. b:uEnþ pliitplTaMgenH GacmanCatixøaj;eRcIn dUecñH vaGaceFVIeGaymanbBaðakan;Et F¶n;F¶r sRmab;GñkCMgWTwkenamEp¥m Edl elIsTm¶n; b¤ Fat;elIsTm¶n;RCul .

bnÞúkCatisár bnÞúkCatisár vas;brimaN kabUnGuIRdat enAkñúgGahar bEnßmelItémøsnÞsSn_ Catisár Edlvas;EtKuNPaB cMeBaHkar EdlfaetI kabUnGuIRdat RtUv)anrMlay rh½sy:agNa ehIyRsUbykeday ragkayrh½sy:agNa . dUecñH vaCa meFüa)ayl¥bMput EdlkarBüakrN_ plb:HBal; énRbePTepSg² nig brimaN GaharenAkñgú kRmitCatisrá enAkñgú Qam. GaharEdlmanbrimaN kabUnGuIRdat dUcKña Cajwkjab; vamantémøsnÞsSn_ CatisárenAkñúgQamepSgKña. ]TahrN_ Epø e)a:m nig dMLÚg suTæEtman kabUnGuIRdat 30PaKry eFobnwgTm¶n; . e):am b¤ dMLÚg EdlmanTm¶n; 50 Rkam nwgman kabUnGuIRdat cMnYn 15Rkam. edaymantémøsnÞsSn_Catisár cMnYn 40 e):am manbnÞúkCatisár enAkñúgQam 6Rkam ¬40KuN 15 Ecknwg 100¦. b:uEnþedayehtufa dMLÚgmantémø snÞsSn_cMnYn 80 bnÞúkCatisár rbs;va KW 12Rkam ¬80 KuN 15 Ecknwg 100¦. eyIgGacniyaymüa:geTotfa

karbriePaKdMLÚg nwgman\TæiBlBIrdg eTAelIkRmitCatisárkñúgQam ebIeRbob eFobCamYykarbriePaKEpøe):am. “GaharxøH EdlmankabUnGIuRdat TabGacpÞúkCatixøaj;eRcIn ”

xN³EdlbnÞúkCatisár manRbeyaCn_ enAkñúgkarRsavRCav EpñkGaharUbtßmÖ rbs;saklviTüal½ysuIdnI rkeXIjfa témøsnÞsSn_Catisár mansarRbeyaCn_ eRcInCagcMeBaHGñkTwkenamEp¥m. enH mkBIGaharmanCati kabUnGuIRdat Tab xøH dUcCa daMsu‘g nig nM):avcMhuyCaedIm GacnwgmaneBareBjedayxøaj;RbePT epSg² minl¥. dUecñHeKeGayeyabl; fa KYreRbIsnÞsSn_edIm,IeRCIserIsGahar EdlRtUvbriePaK enAkñúgRkumGahar. tamviFIenH GñkTwkenamEp¥mnwgGac TsSn_Tayfa )ayNa KuyTav b¤ mI Na nMb½ugNa Edlmanplb:HBal;ticbMput eTAelIkRmitCatisár. eKalbMNgenaH KWminRKan;EtedIm,IeRCIserIsGahar Edl man kabUnGuIRdat TabeT b:uEnþEfm TaMgeRCIserIsGahar EdlnwgeRbIeBl yUr edIm,IrMlay nig RsUbcUlragkay. enAeBlCamYyKñaenaH vaCakarsMxan; EdlKYrEtbriePaKtic cMeBaHGaharEdl manCati kabUnGuIRdat eRcIn dUcCa)ay b¤ KuyTav edIm,IkRmittémøsnÞsSn_Cati sár énGaharTUeTA. edaysarehtupl enH GñkTwkenamEp¥menAkm<úCa KYrEtkat; bnßykarbriePaK)ay eGay)ancMnYn 25 PaKry kñúgmYyeBl ebIeKbriePaK 39


IV

s k mμ P a B é n r a gk a y ni g k a r T TY l T a n G a h a r

)ayeRcIn kRmiténCatisárenAkñúgQam karenH nwgnaMeGaybegáInhaniP½y én nwgeLIgdl;kMBUlx<s;CageK ehIyvaRtUv plvi)ak EdlbNþalmkBITwkenam kareBlyUr edIm,IvilmkFmμtavij. Rb Ep¥m.

GgÁkarsuxPaBBiPBelak ENnaMeGaybegáInkarbriePaKsENþk nig EpøeQIhUbRKab;

taragTI3³ ecosvagkarTTYlTanGahar EdlgayRCabcUl kabUnGuIRdat GaharEdlsm,ÚrkabUnGIuRdat enAkm<úCa nig evotNam GñkTwkenamEp¥mKYrEtBisar )ayqa mIqa dMLÚg)araMgecon caéxV nMdMLÚgmIecon bEg¥mdMLÚgmI CamYyTwkedaHeKa b¤ dUg TwkGMeBA/ Twketñat eckecon )ays 1 can kñúgmYyeBl bbrs KuyTav dMLÚg)araMges¶ar b¤ qaCamYybEnø nMbu½g mIcinRss; mIkBa©b;RsuH eck/ eckGaMg eckes¶ar eBates¶ar/ GaMg sENþkbNþúH sENþkesog Rtav emSARkeGAQUk sENþkdI RKab;sVaycnÞI 40

tictYc tictYc tictYc tictYc tictYc tictYc tictYc tictYc eBlxøH eBlxøH eBlxøH eBlxøH eBlxøH eBlxøH jwkjab; jwkjab; jwkjab; jwkjab; jwkjab; jwkjab; jwkjab; jwkjab; jwkjab;


V »sf

41


»sf

»sfRKab;bBa©úHCatisárkñúgQam kñúgcMeNam»sfRKab; sRmab;Büa)al dMNak;kaleRtomTwkenamEp¥m nig CMgW TwkenamEp¥mRbePT 2 rYmmanfñaMmYy Rkum EdleKsÁal;faCaBYk Gal;hVa-Køúy kUsIudas GIunIb‘ÍT½r (alpha-glucosidase inhibitors) EdlrYmman GakarbUs (acarbose). »sfTaMgGs;enH KWCaBYk raMgsÞHCati GamIdug (starch blockers) EdleRbI Gg;sIum Gal;hVa-KøúykUsIudas (alpha-glucosidase) EdleXIjman enA kñúgeBaHevontUc edIm,Ikat;bnßykarrMlay Cati kabUnGIuRdat. fñaMraraMgBYk GamIdug enH manRbsiT§PaB enAdMNak;kaldMbUg éndMNak;kaleRtomTwkenamEp¥m ehIy GacCYyBüa)alCMgWTwkenamEp¥mRb ePT 2 enAeBlvaRtUv)anykeTAeRbI KYbpSMCamYyfñaMepSgeTot . »sf Edl bBa©úHCati KøúykUs enAkñúgQam RtUv)an ehAfa fñaMRKab;bBa©úHCatisárkñúgQam b¤ fñaMRKab;RbqaMgnwgCatisárkñúgQamx<s;. fñaMenHrYmman eseRktaháÚs (secreta gogues) ¬»sfCMrujkarbeBa©jsarFatu b¤ G½rmUn epSgeTot¦ nig BYkePJac GaMgs‘uylIn (insulin sensitizers).

epSgeTot beBa©jmk tamrebobmYy dUcCa G½rm:Un haáRsIÞn (gastrin) ePJac karbeBa©jGasIutBIRkBHCaedIm. fñaMePJackarbeBa©j GaMgs‘uylIn (insulin sensitizers) rYmman RkumfñaM EdleK sÁal;faCa s‘ulhVÚnIlUero ( sulfonylureas) EdlePJackarbeBa©jGaMgs‘uylIn BIekasikaEb‘ta enAkñúglMEBg . vaKWCa fñaMRKab;bBa©úHCatisárkñúgQam EdleRbI R)as;ya:gTUlMTUlaydMbUgeK ehIyva rYmman KøIbg;køamIt (glibenclamide) nig KøIkøahSIút (gliclazide) EdlCaRkum fñaMCMnan;TIBIr .

eseRktaháÚs rYmman RkumfñaMmYyepSg eTot EdlehAfa b‘ÍhaánIt (biguanides) Edl)anmkBI smasFatu haánIDIn eseRktaháÚs (secretagogues) Ca (guanidine) EdleXIjmanenAkñúgpáa sarFatu EdlbNþaleGaysarFatumYy lILak; (lilac) )araMg (Galega offici-

fñaMRKab;bNþúHCatisárkñúgQam 43


V

»sf

. rukçCatipáaenH eKFøab;Kitfa Tak; Tgya:gCitsñiTæ eTAnwgrukçCati RtMexμac (purple tephrosia) rhUtdl;eBl eRkaymk vak¾RtUvcMNat;fñak;enAkñúg RbePTepSg. páalILak; duHkñúgéRBenA GWr:ub ehIyvaRtUv)anykmkeRbIsRmab; Büa)alTwkenamEp¥m enAkñúgevC¢saRsþ buraN Gs;ry³eBlCaeRcInstvtSr_mk ehIy . cab;taMgBIeBlRtUvbegáIteLIg enATsvtSr_ 1950 fñaM b‘ÍháanIt xøH RtUv)andkecjBITIpSar edaysar\T§iBl manCatiBul rYmman karmanCatiGasIut Lak;Tic EdlGaceFVIeGaysøab;)an. bc©úb,nñenH fñaM emthV½rmIn (metformin) EdlmansmasPaB b‘ÍháanIt RtUv)an nalis)

taragTI4 ³ GakarbUs Rkum eQμaH vamanRbsiT§ PaBya:g dUcemþc

GakabUs (Acabose)

plb:HBal; bnÞab;bnSM

RbPB ³ Bayer AG 44

eRbIya:gTUlMTUlay edIm,IBüa)almnusS elIsTm¶n; nig mnusSFat;RCul Edlman kRmitCatisárenAkñúgQamx<s;CagFmμta b¤k¾man TwkenamEp¥mRbePT 2 . emthV½rmIn manRbsiT§PaB edaykat; bnßybrimaN KøúykUs Edlpliteday ekasikaeføIm ehIybegáInPaBrMeBaJac sac;dMucMeBaH GaMgs‘uylIn. fñaMePJac GaMgs‘uylIn rYmman RkumfñaMEdlsÁal; faCa düasüÚlIDIndüÚn (thiazolidinedione) b¤ KøItahSÚn (glitazones) EdlmanRbsiT§PaB edaysarbegáInPaB rMeBaJacrbs;eføIm Catixøaj; nig ekasika sac;dMu cMeBaH GaMgs‘uylIn.

Gal;hVa-KøúykUsIudas GIunIb‘ÍT½r (alpha- glucosidase inhibitor) KøúykUeb (gluycobay) /eRbkUs ( precose) nig Rbg;das (prandase ) fñaMGakarbUs KWCaBBYkraraMgCatiGamIdug EdleRbIGg;sIum Gal;hVa KøúykUsIdas EdleXIjmanenAkñúgeBaHevontUc edIm,Ikat;bnßykarrMlayGahar eTAelICati kabUnGIuRdat. RbkarenH BnüaeBlkarRCab m:UelKul sár BIkñúgeBaHevon. dUecñH vaGacbeBa©óskareLIgx<s; énCati KøúykUs enAkñúgQam bnÞab;BIkar briePaKGahar ¬rhUt dl; 58%¦ ehIytRmUvkar GaMgs‘uylIn eRkayeBl Gahar RtUv)ankat;bnßy. edayehtufa vaRtUveTAdl;eBaHevon enAeBldMNal Kña CamYykabUnGuIRdatenaH fñaMenH RtUveRbIenAeBlbriePaKGahar edIm,IeGay manRbsiT§PaB. xül;kñúgeBaH KWekItmanCajwkjab; BIeRBaHfñaMenH raraMgkarrMlayGaharTaMg Gs; énCati kabUnGIuRdat ¬Gahar Edlmin)anrMlay qøgkat;eBaHevonehIy RtUvkat;pþac; edayBYkemeraK)ak;etrI Edlplitxül;ya:geRcIn¦. raK Capl b:HBal;bnaÞb;bnSMmYyeTot. edIm,Ikat;bnßyeraKsBaØaTaMgGs;enH Rkumh‘un Bayer )anENnaM eGaycab;epþImeRbIva edaykRmitTab ehIybegáInCabeNþIr² enAGMLúgeBlCaeRcIns)aþh_. ebIsinCava RtUv)aneRbICamYyfñaMNamYy enARkum Sulfonylurea enaH GakarbUs GacbegáInhaniP½y CatisárkñúgQamTab. enAkñúg krNIenH sár b¤ GaharEp¥mdéTeTot nwgminGacbBaÄb;eraKsBaØaCatisárkñúg Qam)aneT BIeRBaH GakabUs nwgraraMgmineGaymankarrMlay kabUnGIuRdat.


»sf

taragTI5 ³ KøIbg;køamIt (Glibenclamide) nig KøIkøahSIt (Gliclazide) Rkum eQμaH

vamanRbsiT§ PaBya:g dUcemþc plb:HBal; bnÞab;bnSM

¬RbePT secretagogue¦ KøIbg;køamIt (glibenclamide) RtUv)anecjlk;enATIpSar edayRkumh‘un Bayer edaymaneQμaH GWKøúykaháúg (Euglucagon), KøINas (glynase) nig mIRkUNas ¬enAGaemrik¦nig daGUnIl (Daonil ) nig sWmIdaGUnIl (Semi Daonil) ¬enAGWr:ub¦. Rkumh‘un Bayer lk;fñaM KøIkøahSIt (Gliclazide) edaymaneQμaH CaDIya:mIRkug (Diamicron). enARbeTs\NÐa fñaMenH lk;enATIpSar edayman eQaμH Dianorm-In. fñaMbMELg DIya:mIRkug rYmman Remicron, Diabeton / Dianormax nig Diaprel MR nig Uni Diamicron. Sulfonylureas ePJacedaypÞal; eTAelIkarbeBa©j GaMgs‘uylIn BIlMEBg. plb:HBal;bnÞab;bnSM énBYk sulfonylureas KWbegáInskmμPaB GaMgs‘uylIn enA kRmit ekasika. Sulfonylureas

KøIbg;køamIt (Glibenclamide)

KøIkøahSIút (Gliclazide)

plb:HBal;bnÞab;bnSMrYmman kareLIgTm¶n; nig kRmitCatisárTabenAkñúgQam. eraKsBaØaepSg²eTot rYmman QWk,al RbtikmμEs,k RbtikmμnwgCatiGal;kul raK karminrMlayGahar GarmμN_twgeBaH ceg¥ar b¤ karcuHexSaycMNg;Gahar. RbCaCnxøH gaynwgRbtikmμcMeBaHBnøWRBHGaTitü .

RbPB ³ Bayer AG

taragTI6 ³ emthV½rmIn (Metformin) Rkum eQμaH vamanRbsiT§ PaBya:g dUcemþc plb:HBal; bnÞab;bnSM

RbPB ³ Bayer AG

smasFatu b‘ÍháanIt ¬RbePTmYyeTotrbs; secretagogue)

Glucophage, Riomet, Formet, Glumetza, Obimet, Dianben, Diabex, Diaformin

emthV½rmIn CasmasFatu b‘ÍháanIt EtmYyKt; EdlGacrk)an . vamanRbsiT§PaB CasMxan; edaykat;bnßybrimaN KøúykUs EdlplitedayekasikaefIøm nig begáIn RbsiT§PaBsac;dMucMeBaH GaMgs‘uylIn. vaeFVIeGayekasika GacbM)at;CatisárBI kñúgQam ya:gmanRbsiT§PaB. emthV½rmIn k¾kat;bnßybrimaNsár Edlplit edayekasikaenAkñúgeføIm nig kat;bnßykarRCabCati KøúykUs BIeBaHevon eRkayeBlGahar . plb:HBal;BIkareRbIfñaMenH dUcCa ehImeBaH xül;kñúgeBaH ceg¥ar QWrmYl RkBH nig raK. edIm,Ikat;bnßyplb:HBal; eGay)anCaGb,brimar Bayer )anENnaMkarcab;epþImeRbIvaCamYykRmitTab ehIybegáInvaCabeNþIr² enAGMLúg eBlCaeRcIns)aþh_. kareRbI emthV½rmIn enAGMLúgeBlbriePaKGahar b¤ eRkay Gahar k¾Gackat;bnßyplb:HBal;enHEdr . eKRtUveRbIfñaMenH edayRbugRby½tñ cMeBaHmnusSEdlmanGayuBI 65qñaM eLIgeTA nig minRtUveRbI cMeBaHmnusSNa EdlxUceføIm b¤ tRmgenameLIy b¤ mnusSEdlkñúgeBlfμI²enH manCMgWKaMg ebHdUg. eKk¾minKYrENnaM eGayeRbIfñaMenH cMeBaHGñkQWcukcab;RTUg nig manbBaða ebHdUg EdlGacmankRmitGuksIuEsnTab . GñkpwkCatiRsvwgeRcIn k¾minKYreRbI Edr. sßanPaBmanCatiGasIut Lak;Tic kñúgxøÜn Caplb:HBal;d¾kRmmYy b:uEnþvaGac eFIVeGaysøab;)an. vaTMngCaGacekItmaneRcInCageK cMeBaHGñkEdlmanbBaða epSgeTot dUc)anKUsbBaa¢k;xagelI. sRmab;ehtuplenH GñkCMgWEdleRbI emthV½rmIn KYrkMuesBeRKOgRsvwgeRcIneBk .

emthV½rmIn (Metformin)

45


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taragTI7 ³ r:UsuIKøItahSÚn Rkum

RkumevC¢bNÐit

eQμaH vamanRbsiT§ PaBy:ag dUcemþc plb:HBal; bnÞab;bnSM

(Rosiglitazone)

KøItahSÚn (glitazones) b¤ thiazolidinediones ¬RbePTmYyeTot én»sfePJac GaMgs‘uylIn ¦ Gav:g;DIya: (Avandia) ( GlaxoSmithKline ) sarFatuenH manRbsiT§PaB edaybegáInPaBrMejac rbs;eføIm xøaj; nig ekasikarsac;dMu cMeBaH GaMgs‘uylIn. vak¾GacrkSamuxgar énekasikarlMEBg Edlplit GaMgs‘uylIn pgEdr .

Rkumh‘un GlaxoSmithkline RBmanfa fñaM Gav:g;DIy:a GacbNaþleGay b¤ eFVIeGay kan;EtF¶n;F¶r dl;karcuHexSayebHdUg . eyagtamRkumh‘un Bayer )aneGaydwg fa rosiglitazone GacTak;TgnwgkareLIgTm¶n; cMeBaHmnusSxøH. CaviFankarbgáar Rkumh‘unenHniyayfa mnusSEdlelbfñaM KøItahSÚn KYrEtBinitümuxgareføIm eGay)aneTotTat; enAGMLúgeBlqñaMdMbUg BIeRBaH fñaMmunenH enAkñúgRkumdUcKña (troglitazone) )anbNþaleGayekItCMgWeføIm EdlGaceFIVeGaysøab;)an kñúg cMeNammnusSxøH. dUecñHfñaMenH RtUv)aneKQb;eRbIcab;taMgBIeBlenaHmk .

RbPB ³ Bayer AG r:Uma:nI

kaNada

Gg;eKøs

46

daNWma:k

karcak;GaMgs‘uylIn ciBa©wmkUnedayTwkedaH nig RtI. RKUeBTü r:UmuaMg eQμaH nIkULa b:UelsÁÚ (Nicolae RtUv)ancat;TukCamnusS Paulescu) dMbUgeK Edlyk GaMgs‘uylIn BIstVEqá kalBIqñaM 1921. bu:Enþ rgVan;NUEbl sRmab;karrkeXIj )anRtUvRbKl;eTA eGayGñkviTüasaRsþ cMnYnBIrrUb mkBI saklviTüal½y tUr:ugtU RbeTskaNada KW eRhVedrIk )anTIg (Frederick Banting) nig cn ma:k;eLGUd (John McLeod) kalBIqñaM 1923. mkdl;dMNak;kal enH mnÞIrBiesaFn_ daNWma:k Nordisk k¾kMBugEtBüa)al GñkCMgWTwkenamEp¥m karrkeXIj nig kar edayeRbI GaMgs‘uylIn ykmkBIekakalMEBgstVeKa . hans_ RKIsÞan plitGaMgs‘uylIn NPH sihaehá dn EdlCasßabnikmYyrUb rbs; IrBiesaFn_enaH)anbegáIt GaMgs‘uylIn GaMgs‘yu lIn RtUv)anplitedayBBYkstV mnÞ manRbsiT§PaByUr CaelIkdMbUg enAqñaM karcak; GaMgs‘uylIn RtUv)aneRbIR)as; edIm,IRKb;RKgCati KøúykUs kñúgcMeNam kumar nig mnusSeBjv½y EdlmanCMgW TwkenamEp¥mRbePT 1 nig RbePT 2 EdlminGacBüa)al)an edayfñaMRKab; EtmYymux. karcak;eRkamEs,k )anedIr tYCMnYs GaMgs‘uylIn EdlCaFmμta va RtUv)anpliteLIgedayxøÜneyIg eday CYyeGayCati KøúykUs cl½tBIcrnþQam eTAkñúgCalika EdlenATIenaH vaRtUv)an sþúkTuksRmab;famBl ehIybBaÄb;eføIm mineGayplit KøúykUs bEnßmeTot.


»sf

1926 edaybEnßmCati RbUtamIn BITwk kamstVRtI eTAelI GaMgs‘uylIn Edl ykmkBIstVRCUk. fñaMenH k¾RtUv)andak; eQμaHfa neutral protamine Hagedorn (NPH) ehIyeRkaymk k¾mankarRb kasecjeRbIplitpl GaMgs‘uylIn NPH Edl\LÚvenH RtUv)ancat;TukCa GaMgs‘uylIn ry³eBlmFüm bnÞab;BIkar begáIt GaMgs‘uylIn EdlmanRbsiT§PaB EvgCagenH.

éf¶ . Insulin detemir Edllk;enA TIpSar Ca Levemir edayRkumh‘un»sf Novo Nordisk CaTUeTA RtUv)aneKcak; mþgkñúgmYyéf¶ enAeBlGahareBll¶ac b¤ enAeBledkyb; b¤ cak;BIrdg kñúg mYyéf¶ enAeBlRBwk nig l¶ac . vaman TRmg;CaGMBUlknÞúH Edldak;enAkñúgb‘íc nig b‘ícEdlman kaTus enaH . Insulin glargine lk;enATIpSar edayRkumh‘un »sf)araMg Sanofi-Aventis edayman

r:UsKøItahSÚn (Rosglitazone) stV

taragTI8 ³ GaMgs‘uylIn NPH ( Neutral Protamine Insulin) Rkum eQμaH

GaMgs‘uylIn ry³eBlmFüm

vamanRbsiT§ PaBy:ag dUcemþc plb:HBal; bnÞab;bnSM

vacab;epþImbBa©úHkRmit KøúykUs kñúgQam enAry³eBl 1-3 ema:g bnÞab;BIkar cak; ehIyvamanRbsiT§PaBxøaMg RbEhlCa 8 ema:g bnÞab;BIkarcak;. vaman ry³eBlBI 12 eTA 16 ema:g .

Novolin R, Novolin N, Novolin 70/30 (Novo Nordisk), Humulin R, Humulin N, Humulin 70/30, Humulin 50/50, Humulin RU-500 (Elililly )

kRmit KøúykUs enAkñúgQamTab RkhmEs,k ehIm nig rmas; enAkEnøgcak;fñaM .

RbPB³ bNaÑl½yCati evC©saRsþ nig viTüasßanCatisuxPaB ¬Gaemrik¦

ExSRsLay GaMgs‘uylIn

eQμaH Lantus RtUv)ancak;mþg kñúgmYy éf¶ enAeBlcUldMeNk. vamanTRmg;Ca (Insulin analogues) GMBUl nigkaTus. brimaNEdleRbI KW GaRs½yeTAelIGahar b¤ CMgWdéT kar vaKWCa GaMgs‘uylIn mnusS EdlRtUveFVI hat;R)aN nig »sfdéTeTot Edl visVkmμEhSn ehIymanry³eBlEvg . kMBugeRbI GacERbRbYltameBlevla. dUecñH CaTUeTA vaRtUv)aneRbImþgkñúgmYy

47


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taragTI9 ³ Rkum eQμaH vamanRbsiT§ PaBy:ag dUcemþc

Insulin Detemir ( RDNA) Insulin analogue

EdlmanskmμPaByUr

Levemir (Novo Nordisk)

cab;epþImbBa©úHkRmitCati KøúykUs enAkñúgQam enAry³eBlRbEhlmYyem:ag bnÞab;BIcak;ehIy manRbsiT§PaBRbEhl 26 ema:g edayKμaneBlEdl skmμPaBeLIgxøaMgeLIy. edayRtUvcak;mþg b¤ BIrdg kñúgmYyéf¶ vapþl; GaMgs‘uylIn eBjmYyéf¶ nig mYyyb; edayCYyGñkCMgW GacEfrkSakRmit KøúykUs eGayenAFmμta enAcenøaHeBlGahar nig eBledk. Levemir GacRtUv)aneRbI edayGñkCMgWEdleRbIfñaM GaMgs‘uylIn manskmμPaBrh½s edIm,IRKb;RKgCatii KøúykUs eBjmYyéf¶ nig enAGMLúgeBlGahar enAeBlkRmitvaekIneLIg . kRmit KøúykUs TabkñúgQam KWCaplb:HBal;bnÞab;bnSMjwkjab;CageK ehIyva GacbegáIt b¤ manry³eBlyUr edaysarCatiGal;kul. plb:HBal; déTeTot rYmman RbtikmμenAkEnøgcak; RkhmEs,k ehIm rmas; nig Rbtikmμ GaElrsuI.

plb:HBal; bnÞab;bnSM

RbPB³ Novo Nordisk A/S : bNaÑl½yCati evC©saRsþ nig viTüasßanCatisuxPaB ¬Gaemrik¦

taragTI10 ³ Rkum eQμaH vamanRbsiT§ PaBy:ag dUcemþc plb:HBal; bnÞab;bnSM

RbPB RDNA)

Insulin Glagine (

Insulin analogue

manskmμPaByUr

Lantus (Sanofi-aventis)

cab;epþImbBa©úHCati KøúykUs enAkñúgry³eBlmYyema:g bnÞab;BIcak; ehIyman ry³eBlRbEhl 26 ema:g edayKμankMeNInskmμPaBxøaMgeLIy . CaTUeTA RtUv)aneRbIKYbpSMCamYyfñaMRKab; Büa)alCMgWTwkenamEp¥m . kRmit KøúykUs kñúgQamTab KWCaplb:HBal;bnÞab;bnSM jwkjab;bMput. plb:HBal;déTeTot rYmman RbtikmμkEnøgcak; edayrYmmankarERbRbYl Calikaxøaj;enAkEnøgcak; Rbtikmμ GaElrsIu rYmman rmas; nig knÞÜlRkhm.

RbPB³ Sanofi-avantis, bNaÑl½yCati evC©saRsþ nig viTüasßanCatisuxPaB ¬Gaemrik¦

KMnUsbMRBYjTI1 ³

Insulin Glargine

nig Insulin NPH

kareRbICatisár GRta * (mg/kg/min)

6 5

Insulinglargine (N = 20)

4 3

NPH insulin

2

(N = 20)

1 0 0

48

10

20

eBlevlabnÞab;BIcak;

RbPB³ Sanofi-avantis, bNaÑl½yCati evC©saRsþ nig viTüasßanCatisuxPaB ¬Gaemrik¦

30


VI karcMNay

49


k a r cM N a y

CMgWruaMér: eFVIeGaycuHexSay>>> nig cMNayluyeRcIn enAkñúgry³eBlBIrTsvtSr_ knøgmk TwkenamEp¥m )anelceLIgCaCMgWKMram kMEhgd¾sMxan; dl;suxPaBBiPBelak. enAqñaM 1989 smaCelIkTI 42 rbs; GgÁkarsuxPaBBiPBelak EdlekaHRb CuMeday GgÁkarshRbCaCati enATIRkug hSWENv )anGnum½tesckþIseRmcmYy edIm,Ibgáar nig RKb;RKgCMgWenH. eday TTYlsÁal;BIkarKMramkMEhg énrbb Gaharminl¥ nig GskmμPaBragkay EdlTak;TgCMgWTwkenamEp¥menaH smaC enaH )anGnum½tyuTæsaRsþBiPBelak mYy sRmab;rbbGahar nig skmμPaB ragkay enAkic©RbCuM elIkTI 57 enAkñúg qñaM2004. enAqñaM 2006 mhasnñi)atshRbCa Cati )anerobcMeGaymanTivaTwkenam Ep¥m BiPBelak CaTivamYy rbs;sh RbCaCati EdlRtUvR)arB§Caerogral;qñaM cab;taMgBIqñaM 2007 mkedayeFVIkar GeB¢aIjGgÁkarGnþrCati sgÁmsuIvil nig vis½yÉkCn edIm,IeGaycUlrYm. esckþI seRmcenaH k¾GMBavnavpgEdr eGay

elIkkm<s;karyl;dwgsaFarN³ tam ry³karGb;rM nig RbB½næpSBVpSay GMBI CMgWTwkenamEp¥m nig plvi)akrbs;va RBmTaMgviFIbgáar nig EfTaM . esckþI seRmcenaH )anniyayfa “Twkenam Ep¥m CaCMgWraMuér: eFVIeGaycuHexSay nig cMNayfvikareRcIn EdlbgáhaniP½y nig plvi)akF¶n;F¶r sRmab;RKYsar rdæCa smaCik nig BiPBelakTaMgmUl ”. va k¾Ca “karRbQmF¶n;F¶r cMeBaHkar seRmceKaledAGPivDÆn_ Edl)anRBm eRBogCaGnþrCati edayrYmmaneKal edAGPivDÆn_shsSvtSr_ ”. esckþI seRmcTTYlsÁal; nUv “esckþIRtUvkar bnÞan;edIm,ICMruj nig elIkkm<s;suxPaB mnusSehIypþl;lTæPaB TTYl)ankar Büa)alkarGb;rMkarEfTaMsuxPaB ”. va k¾)anelIkTwkcitþ eGaysmaCikshRbCaCati begáIteKalneya)ayCatii sRmab;karbgáar karEfTaM nig karBüa)alCMgWTwkenamEp¥m eGaysmRsbeTA nwgkarGPivDÆn_ énRbB½næEfTaMsuxPaB rbs;BYkeK. RbPB³ shB½næCMgWTwkenamEp¥mGnþrCati enARb‘uyEsl

51


VI

k a r cM N a y

KMnUsbMRBYjTI2 ³ karcMNayelIsuxPaBRbcaMqñaM sRmab;Gñk TwkenamEp¥m nig CMgWTwkenamEp¥m enA 25 RbeTs Edlman cMnYnGñkTwkenamEp¥meRcInbMput enAqñaM 2007 India China United States of America Russian Federation Germany Japan Pakistan Brazil Mexico Eqypt Italy Bangladesh France Ukraine Turkey Thailand Korea, Republic of Philippines Indonesia Poland Iran, Islamic Republic of Spain Nigeria Canada United Kingdom

karcMNaysRmab;CMgWTwkenamEp¥m GñkCMgWTwkenamEp¥m

karcMNaysuxPaBRbcaMqñaM sRmab;GñkTwkenamEp¥m nig CMgWTwkenamEp¥m CaeRcInBan;landuløar 0

20

40

60

80

RbPB³ Diabetes Atlas Third Edition, shB½n§CMgWTwkenamEp¥mGnþrCatiqñaM 2006

52

100

120

140


VII CMgwWTwkenamEp¥m enA km<úCa

53


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

esckþIepþIm CMgWTwkenamEp¥m )ankøayCaXatkr d¾s¶at;es¶omFMbMput nig kan;EteRcInenA km<úCa. Cajwkjab; va)ansmøab;mnusS enAeBlEdlBYkeK kMBugrs;enAkñúgsßan PaBCIvPaB nig CIvitd¾l¥ Rbkbeday plitPaBenAeLIy. b:uEnþ muneBlEdl vasmøab;mnusSNamñak; va)aneFVIeGay RkumRKYsarenaH hinehacRTBüsm,tþi nig RbPBFnFanhirBaØvtßú edaybgçM eGay «Buk-mþay bBaÄb;karsikSarbs; kUn bþI-RbBnæ lk;eKaRkbI nig dIFøI ehIy RKYsar k¾Føak;enAkñúgbMNul Edlnwgmin Gacecosvagput ” -m>B>C “

beNþIr² ehIy\LÚv mankarykcitþTuk dak;eTAdl;CMgWminqøg dUcEdl)anbgðaj edaykarbegáItkmμviFiviTüasaRsþ edIm,I edaHRsaybBað a CM g W T w k enamEp¥ m enA km<úCa. CaEpñkmYyénkmμviFIenH smaKm CMgWTwkenamEp¥mkm<úCa RksYgsuxaPi)al mCÄmNÐlGwr:ub sikSaCMgWTwkenamEp¥m nig Rkumh‘un»sfeQμaH (Servier) )an shkarKña edIm,IeFVIkarsikSaRsavRCav cMnYnBIr enAkñúgqñaM 2004 nig 2005. karsikSaenHbgðajnUv eRbv:aLg;x<s; én CMgWTwkenamEp¥m EdlmanrhUtdl;eTA R)aMPaKry enAkñúgtMbn;CnbT nig 10 PaKry enAtMbn;TIRkug. lTæplkar RsavRCavTaMgenaH )annaMdl;karsikSa RsavRCaveGBIedmIsaRsþ edIm,IkMNt;GMBI ktþa EhSn rbs;RbCaCankm<úCa enAkñúg karekItCMgWTwkenamEp¥m nig eRbv:aLg; énplvi)ak mkBICMgWTwkenamEp¥m RBm TaMgsnñisITRbcaMqñaM nig TivaTwkenamEp¥m karbNþúHbNþal sRmab;buKÁlikeBTü TUeTA nig GñkÉkeTs RBmTaMgkarebIk KøInik nig mCÄmNÐlTwkenamEp¥m.

eKdwgy:agtictYcb:ueNÑaH GMBICMgWTwk enamEp¥m enAkm<úCa rhUtdl;edIm stvtSr_TI 21. rbbExμrRkhm man tYnaTIsMxan;mYy enAkñúgkarbMpøajRbB½næ suxaPi)alsaFarN³ EdlCaRbPBd¾KYr eGay)armÖmYy BIeRBaHfa RbeTs GPivDÆn_tictYc Cajwkjab;RtUvb:HBal; y:agF¶n;F¶r edaysarCMgWTwkenamEp¥m edaysarEtGnþrkalesdækic©-sgÁm kar pøas;bþÚrGaharrUbtßmÖ nig skmμPaB ragkay. enAeBlBuMmanTinñn½y GMBICMgW TwkenamEp¥m GaCJaFrsuxaPi)alCati )anepþatkarykcitþTukdak; eTAelICMgW Rkumh‘un EsvIey: (Servier) nig saxa rbs;xøÜnenAGasuI skmμCageKenAkm<úCa enAtMbn;RtUBic nig kgVHGaharUbtßmÖ. ehIyKaMRTy:agxøaMg dl;karbegáIt b:uEnþ GtþcritEbbenH )anERbRbYlCa kmμviFIenH. BYkeKTaMgBIr edIrtYnaTIsMxan;

55


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

RbGb;TI4 ³ enAkm<úCa

karBinitüCati KøúykUs enAkñúgQameTIbEtGaceFVI)an enAqñaM 2006 mnusSCaeRcIn cUlcitþFat;elIsTm¶n; GñkTwkenamEp¥m mYycMnYntUcb:ueNaÑH EdlmanRbdab;BinitüCatisáredayxøÜnÉg GaMgs‘uylIn mantémø 16 duløa enAPñMeBj KWbYndg éntémøkñúgBiPBelak mnusSCaeRcIneCOfa GñkTwkenamEp¥m minGacerobkar)an karEfTaMTwkenamEp¥m minmandak;bBa©Úl enAkñúgkarFanara:b;rgsuxPaBeT KYrEtmankumarTwkenamEp¥m RbePT 1 cMnYn 2000 nak; b:uEnþeKeXIjticCag 100 nak; . manGñkTwkenamEp¥mR)aMdg eRcInCagGñkmanpÞúkemeraKeGds_

RbPB³ m>B>C

kñúgkarerobcM nig Gnuvtþn_karsikSaRsav RCavedaypþl;luycMnYn 30/000 GWr:U edIm,IKaMRTdl;mCÄmNÐlGWr:ub sRmab; karRsavRCavCMgWTwkenamEp¥m enAGMLúg eBlbIqñaM.

Catikm<úCa edaymankarekIneLIg én skmμPaBTak;TgnwgkarBüa)al nig RsavRCavTwkenamEp¥m. b:uEnþ enAman kic©karCaeRcIneTot EdlRtUveFVI. kmμviFI TwkenamEp¥mkm<úCa )anbNþaleGay mankarcab;GarmμN_CaGnþrCati ehIyeK enAkñúgry³eBlR)aMqñaMknøgmk eKeXIj sgÇwmfa CMnYyhirBaØvtßú nig CMnYyskmμ mankarpøas;bþÚr\riyabT cMeBaHTwkenam PaBCak;Esþg nwgnaMeGaymankarrIk Ep¥m enAkñúgcMeNamGaCJaFrsuxaPi)al ceRmInfμI enAeBlGnaKt.

RbGb;TI5 ³ “´cg;eGay´manCMgWeGds_ ”? enAedImTsvtSr_ 1990 RbB½n§suxaPi)alkm<úCa RtUvksageLIgvij bnÞab;BImansRgÁamCaeRcIn TsvtSr_. CMnajkarbreTs nig TIPñak;garCMnYy )anerobcMRbB½n§suxaPi)al EdlFnFanPaK eRcInbMput epþateTAelICMgWqøg xN³EdlminKitdl;CMgWminqøg>>> ebIsinCaeyIgeFVIePøcmYyEPøt GMBI sIlFm’ vahak;dUcCa smehtupl EdlRbeTsGPivDÆn_ pþl;GaTiPaBdl;CMgWqøg dUcCaCMgWeGds_ nig emeraKeGds_ enAeBlEdlBYkeKsnüapþl;mUlniFi BIeRBaH vaGaceGayRbeTsGñkmanCYy xøÜnÉgpgEdr edaykarCYydl;RbeTsdéTenaH . RbPB ³ m>B>C

56


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

eGBIedmIsaRsþ

PaKxagekIt énTIRkugesomrab nig sMLg 10 KILÚEm:Rt BIPaKxageCIg én dMEdk enAelIpøÚv EdlminTan;cak;ekAs‘U. lkçxNÐesdækic© enAPUmiTaMgBIr manPaB RkIRk edaymanGnam½ytictYc ehIy KμanTwkm:asuIn nig GKÁIsnIeT. karGegát enAkMBg;cam RtUveFVIeLIgcMeBaHmnusS cMnYn 1195 nak; enAkñúgXuMbwgkuk Edl CatMbn;TIRkug nig manR)ak;cMNUlCa mFüm kñúgTIrYmextþ nig XuMvalvg; Edl CaXMu manmnusSkuHkrbMput EdlenATI enaHPaKeRcIn naMKñaeFVIBaNiC¢kmμ nig kargarrdæaPi)al. eRkABIkareFVIetsþCati KøúykUs enAkñúgQam edIm,IrkemIlTwk enamEp¥m b¤ dMNak;kaleRtomTwkenam Ep¥m GñkRsavRCav )aneFVIkMNt;Rta sm<aFQam snÞsSn_Tm¶n;xøÜn eFobnwg km<s; nig Gnu)atcegáH-RtKak rbs; GñkcUlrYm. kRmgsMnYrxøImYy kt;Rta eraKvinic½äymun² énCMgWTwkenamEp¥m b¤ sm<aFQamx<s; RbvtþiRKYsar Gahar skmμPaBragÁÁkay nig karCk;)arI.

tMbn;GasuI)a:suIhVic RtUv)anKitfa rgpl b:HBal;y:agF¶n;F¶r edaysarTwkenam Ep¥m. b:uEnþ Tinñn½yEdlGacTukcitþ)an GMBI eRbv:aLg; nig lkçN³énkareLIg CatisárenAkñúgQam kñúgcMeNamRbCaCn GasuI enAEtmanxSt;exSayenAeLIy. enAqñaM 2004 GñkRsavRCav)aneFVIkar Gegát eTAelImnusSeBjv½ycMnYn 2246 nak; EdlmanGayucab;BI 25 qñaM eLIg eTA EdlRtUveRCIserIsedayRBav² enA kñúgshKmn_CnbT enAextþesomrab nig shKmn_ manmnusSeRcInRKan;ebI kñúgextþkMBg;cam. karGegátenH GaceFVI eTA)an edaymankarRKaMRT edaysh RbtibtþikarpÞal; rvagsmaKm Twkenam Ep¥mkm<úCa nig RksYgsuxaPi)aleday mankarKaMRT xaghirBaØvtßú bec©keTs nig PsþúPa Edlpþl;edaymCÄmNÐl GWr:ub sikSaTwkenamEp¥m enATIRkug RsþasbYr GgÁkarRKUeBTüKμanRBMEdn EblhSik nig kariyal½yPñMeBj GñkniBnæ nig ):arIs rbs;Rkumh‘un»sf)araMg smaKmCMgWTwkenamEp¥mkm<úCa eQμaH Rkumh‘un EsrvIey (Servier). enAPñMeBj “TwkenamEp¥m ekItmaneRcIn

enAkm<úCa CagkarrMBwgTuk BIeBlmuneTAeTot ”

karGegátenAesomrab RtUv)aneFVIenAelI mnusScMnYn 1051 nak; kñúgPUmiBIr enA RsukdMEdk EdlsßitenAEpñkxageCIg én pøÚvCati cm¶ayRbEhl 40 KILÚEm:Rt BI

saRsþacarü lwm kWKI evC¢bNÐit esg esrI evC¢bNÐit TUc Xun

mCÄmNÐlGWr:ub sikSaRsavRCavTwkenamEp¥m enARsþasbYr evC¢bNÐit hILrI XIg saRsþcarü mIEsl b½ugehS GgÁkarsuxPaBBiPBelak enATIRkughSWENv evC¢bNÐit eháacka r:uklIk 57


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

karrkeXIjnwksμanmindl;

edayehtufa km<úCa KWCaRbeTsRkIRk mYy ehIyrebobrbbrs;enA manlkçN³ tamRbéBNIenAeLIy . ebItamsþg;dar GnþrCati karrkeXIj)anbgðajfa Gñk cUlrYmGegátcMnYn 15 PaKry enAesom rab nig 26PaKry enAkMBg;cam man kRmit KøúykUs minFmμta KWCaerOgmYy nwksμanmindl;eLIy. GRta eRbv:aLg; KW 5 PaKry enAesomrab nig 11 PaKry

enAkMBg;cam edayxusRsLH BIkarsμan Tuk EdlfaGRtaeRbv:aLg; mancMnYnBI 1 eTA 9 PaKry enAkñúgcMeNammnusS eBjv½y EdlmanGayucab;BI 20qñaM eLIgeTA. eRbv:aLg; én dMNak;kal eRtomTwkenamEp¥m rwtEtx<s;CagenH eTot edaymancMnYn 10 PaKry enA esomrab nig 15 PaKry enAkMBg;cam. BIrPaKbI énGñkEdleFVIeraKvinic½äy KWmin dwgmuneLIyfa xønÜ mansßanPaBEbbenH.

taragTI11 ³ cMnYnGñkcUlrYm/ eRbvaLg;/ krNIfIμ nig eRtomTwkenamEp¥m tamGayu

c

b

b c

Twkenam krNI Twkenam krNI Twkenam krNI extþ IGT nig cMnYn Ep¥m fμI (%) cMnYn Ep¥m fμI IGT Ep¥m fμI (%) (%) (%) (%) (%) (%) (%) Gayu esom rab

25-34 35-44 45-54 55-64 ≥65

90 0 109 5>5 94 6>4 52 7>7 29 3>5

0 4 5 2 2

5>6 171 7>3 186 7>5 171 19>2 106 27>6 43

1>2 3>8 7>6 9>4 2>3

2 6 8 6 0

5>3 11>3 12>9 7>6 14>0

0>8 4>4 7>2 8>9 2>8

RKb; 374 4>6 13 10>2 677 4>9 22 9>8 4>8 Gayu kMBg; cam

5-34 35-44 45-54 55-64 ≥65

64 138 105 69 67

3>1 7>3 14>3 13>0 22>4

1 8 9 6 7

7>8 128 8>7 179 16>2 216 13>0 118 17>9 111

1>6 1 6>7 9 15>3 19 11>9 6 21>6 18

11>7 14>0 16>7 16>1 28>8

2>1 6>9 15>0 12>3 21>9

2 10 13 8 2

IGT (%)

5>4 9>8 10>9 11>4 19>4

35 9>9 2 17 28 12 22

10>4 11>7 16>5 14>9 24>7

RKb; 443 11>5 31 12>4 752 11>3 50 16>9 11>4 81 15>2 Gayu

58

RbPB ³ TsSnavdþI The Lancet 2005


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

RbkarenH KWmanlkçN³RsedogKñaeTAnwg karrkeXIj enAkñúgRbeTskMBugGPivDÆn_ ehIyvaqøúHbBa©aMgGMBIesckþIRtUvkar edIm,I elIkkm<s;karyl;dwgsaFarN³ karGb;rM viC¢aCIv³ nig BRgwgesvasuxPaB EdlTak; TgnwgTwkenamEp¥m. TwkenamEp¥m min )aneFVIeraKvinicä½y manenAesomrabeRcIn CagenAkMBg;cam ehIyvaekItmancMeBaH burseRcInCagRsþIbnþic. kñúgcMeNam Gñk EdleFVIeraKvinicä½yehIyenaH manGñkTwk enamEp¥m 11 nak; enAesomrab ¬69

karrkeXIjsMxan;bMputKWfa CMgWTwkenam Ep¥mmaneRcInenAkm<úCa hYsBIkarnwk sμaneTAeTot. edaymancMnYnRbCaCn d¾eRcIn nig kMeNInesdækic©d¾elOnenaH GasuI KWCasñÚlénkarratt,at CMgWTwkenam Ep¥mkñúgBiPBelak edaykñúgenaH RbeTs cin nig \NÐa manGñkCMgWTwkenamEp¥m eRcInCageKbMptu . b:Eu nþRbeTsenA\NÐcÚ ni RtUveKyl;fa minsUvCamanhaniPy½ énCMgW TwkenamEp¥meT BIeRBaHRbeTsTaMgGs; enH eTIbEtegIbecjBIPaBRkIRk nig PaB

taragTI12 ³ dMNak;kaleRtomTwkenamEp¥m nig bBaðaBak;B½n§ dMNak;kaleRtomTwkenamEp¥mEtmYy karFat;RCulEtmYy sm<aFQamx<s;EtmYy dMNak;kaleRtomTwkenamEp¥m nig karFat;RCul sm<aFQamx<s; nig karFat;RCul dMNak;kaleRtomTwkenamEp¥m nig sm<aFQamx<s; dMNak;kaleRtomTwkenamEp¥m Fat;RCul nig sm<aFQamx<s; KμanbBaaðTaMgenH

PaKry¦ nig 45 nak; enAkMBg;cam ¬82 PaKry¦kMBugEteRbIfñaMRKab;. evC¢saRsþ buraN RtUv)anRbkan;yk edayGñkTwk enamEp¥m 6nak; enAesomrab ¬38PaK ry¦ nig 8nak; enAkMBg;cam ¬15 PaK ry¦edayPaKeRcIn eRbIvaCamYyfñaMRKab; edIm,IBüa)al karelIsCatisárenAkñúg Qam. KμanGñkCMgWTwkenamEp¥mNamñak; enAesomrab KWmanEt 3nak; b:ueNÑaH enAkMBg;cam ¬5 PaKry¦ EdlBüa)al eday GaMgsu‘ylIn.

eRbva:Lg;enA eRbva:Lg;enA esomrab (%) kMBg;cam (%) 8 6 7 3 2 2 1 70

8 17 7 7 6 5 7 43

Éekaxagneya)ay. xN³EdlTinñn½yBI RbeTsevotNam )anKaMRTdl;KMnitEbb enH EtkarGegátenAkm<Cú a )anpþln; vU dMeNIr erOgepSgBIenH. dMNak;kaleRtomTwk enamEp¥m enAPUmiCnbTkñúgextþesomrab mankRmitx<s; dUcCaenATIRkug haNUy nig enARbeTséf Edlmanesdækic© TIpSaryUrmkehIyenaH . GRtaeRbv:aLg; dMNak;kaleRtomTwkenamEp¥m 26 PaKry enAkMBg;cam RbEhlCaman cMNat;fñak;x<s;CageKbMput enAkñúgtMbn; 59


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

rhUtmkTl;eBlenH. vak¾KYreGaykt; smÁal;Edrfa GñkcUlrYm 25PaKry enA kMBg;cam nig Et 9PaKry enAesomrab many:agehacNas; BIr kñúgcMeNam lkçNÐbI EdlTak;TgKña KWdMNak;kal eRtomTwkenamEp¥m karFat;elIsTm¶n; nig sm<aFQamx<s;. RbPB³ m>B>C/ TsSnavdIþLg;est 366 ecjpSay éf¶TI5 viciäka 2006 ¬TwkenamEp¥m nig CMgWBak;B½n§ enAkm<úCa/ karGegáteGBImIsaRsþBIrelIk ¦

dl;karRKb;RKgCMgWruaMér:b:unμaneT. cMeBaH GñkCMgW EdlmanCMgWminqøg dUcCaCMgWTwk enamEp¥m nig CMgWebHdUgCaedIm minman Rkbx½NÐrcnasm<½n§EfTaM sRmab;GñkCMgW mincUlsRmakkñúgmnÞIreBTü edayRKU eBTürbs;mnÞIreBTübEg¥keT . eday knøgmk minEdlmankarbNþúHbNþal dl;bKu lÁ ki suxaPi)al GMBkI arEfTaMCamUl dæan cMeBaHCMgWTwkenamEp¥menaH RbeTs km<úCa RtUv)aneKeRCIserIsCaRbeTs

taragTI13³ TwkenamEp¥m nig CMgWeGds_

kar)a:n;sμan kar)a:n;sμan rbs; nigkarGegát GgÁkarsuxPaBBiPBelak

CnCatikm<úCa EdlmanTwkenamEp¥m 255/0001

111/0002

kar)a:n;sμan edaymCÄmNÐlCati RbyuTænwgCMgWeGds_ esIrEs,k nig kameraK

58/0003

RbCaCnkm<úCa EdlmanemeraKeGds_ 1 2 3

2004 muneBlGegát kar)a:n;sμan EdlQrelImUldæan kar)a:n;sμan cMnYn 67/000 enA qñaM 2006 eday ¬mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIrEs,k nig kameraK ¦

KeRmag

60

manesvaEfTaMCMgWTwkenamEp¥m tictYc Nas;enAkm<úCa ehIyesvaTaMgGs;enaH PaKeRcIn manEtenAkñúgraCFanIPñMeBj b:ueNÑaH . cMeBaHGñkCMgWPaKeRcIn Edl rs;enAtamextþ ebIkalNaeKdwgfa xøÜn eKekIteraKTwkenamEp¥m eKeRcInEtrt; eTArkkarEfTaMBIRKUburaN RKUeBTüÉkCn b¤ eFVIdMeNIrmkPñMeBj . esvaEfTaMsux PaBsaFarN³ enAkm<úCa )anepþatesÞIr EtTaMgRsug eTAelIkarBüa)alCMgWRsYc Rsal; b:uEnþ minsUvCa)anykcitþTukdak;

mYy kñúgcMeNamRbeTsTaMgbYn sRmab; karsikSaRsavRCav ry³eBl 6 Ex Edl mankarKaMRTBIshB½n§CMgWTwkenamEp¥m BiPBelak (World Diabetes Federation) EdlmanmUldæan enATIRkug kUEBnhaehán ehIy nig mUlniFiCMgWTwkenamEp¥m Gnþr Cati (International Diabetes Foundation) EdlmanmUldæan enATIRkug Rb‘uyEsl enAkñúgqñaM 2003 . cab;BIeBlenaHmk RksYgsuxaPi)al nig GgÁkarsuxPaB BiPBelak )anshkary:agCitsñiT§ Ca mYynwgmUlniFiTaMgBIrenH ehIynigédKU ÉeTotdUcCa GgÁkar ebskkmμGPivDÆn_


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

karEfTaMrbs;)araMg (France’s Mission RkugRb‘uyEsl )aneRCIserIsyk km<úCa Care Development Organization) nig evotNam CaRbeTseKaledA sRmab; EdleKsÁal;eRkameQμaHfa Mica-DO kmμviFIry³eBl 2qñaM enAkñúgkarbNþúH smaKmCMgWTwkenamEp¥mkm<úCa nig bNþal Gñkpþl;esvaEfTaMsuxPaB cMnYn m>B>C EdlCamCÄmNÐlpþl;B½t’man 300nak; GMBIkarEfTaM karRKb;RKg nig dl;GñkCMgWTwkenamEp¥m enAPñMeBj karGb;rMRbCaCn GMBICMgWTwkenamEp¥m. nig extþtaEkv . CamYynwgRbCaCn EdlmanCMgWTwkenam

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

Exemsa 2006 - Exemsa 2008 shB½n§CMgWTwkenamEp¥mGnþrCati Margaret McGill

135/400duløa ¬mUlniFi CMgWTwkenamEp¥mBiPBelak 135/400duløa¦ pþl;karbNþúHbNþaldl;GñkRbkbviC¢aCIv³suxaPi)al enAkm<úCa nig evotNam GMBIkarEfTaM RKb;RKg nig Gb;rMRbCaCn GMBICMgWTwkenamEp¥m

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán

bNþúHbNþalRKUGb;rM enAkm<úCa nig evotNam

Ep¥m RbmaNCa 210>000nak; Edl )anTTYlkarGb;rM RbeTskm<úCa nig karGb;rMRbCaCn GMBICMgWTwkenamEp¥m evotNam )anedIrtYCaKMrUsakl,gmYy mantYnaTIsMxan;Nas; enAkñúgkarbgáar sRmab;karBRgIkskmμPaB rbs;mUlniFi Tb;sáat;plvi)akyUrGEgVg ehIy eTAGnaKt . manplb:HBal;y:agBitR)akd eTAelI ninñakar nig lT§plénCMgWTwkenamEp¥m KeRmagenH RtUv)anbegáIteLIg eday enH. edIm,IeFVIkarbNþúHbNþal dl; QrelImUldæanviFIsaRsþ :bNþúHbNþal GñkGb;rM EpñkBieRKaHeyabl; kñúgkar RKUbegÁal : ehIymanbIEpñk. EpñkTI 1 Gb;rM GMBICMgWTwkenamEp¥m (The Diabetes KWCakarbNþúHbNþalry³eBl5éf¶ cMnYn 2vKÁ CUndl;Gñkpþl;esvaEfTaMsuxPaB Education Consultative Section) rbs; shB½n§ CMgWTwkenamEp¥m BiPBelak cMnYn 25nak; . enAkñúgEpñkTI 2 sikçakam )anbegáItkmμviFIbNþúHbNþal EdlTTYl TaMg50nak; énkarbNþúHbNþal kñúgEpñk sÁal;CaGnþrCati edIm,IbNþúHbNþal TI1 RtUv)aneKrMBwgTukfa nwgerobcMTI buKÁliksuxaPi)al GMBICMgWTwkenamEp¥m. kEnøg sRmab;CMgWTwkenamEp¥mmYyeLIg ÉksarenH Tak;TgCaBiess dl;RbeTs enAkñúgshKmn_rbs;xøÜn ehIyeFVIkar kMBugGPivDÆn_ EdlminFøab;mankarbNþúH bNþúHbNþalbnþ dl;Gñkpþl;esvaEfTaM bNþalEbbenHBImunmk . enAkñúgqñaM suxPaB cMnYn 5nak; epSgeTot GMBIkar 2006 mUlniFi EdlmanmUldæan enATI Gb;rM karEfTaM nig RKb;RKgCMgWTwkenam

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CM gw Tw k e n a m E p¥ m e n A k m<ú C a

Ep¥m enAkñúgry³eBl 1qñaM . bnÞab;mk KMrUénkarEfTaMCMgWTwkenamEp¥m mankarbNþúHbNþalfñak;x<s; cMnYn 3éf¶. enAkñúgKeRmagedayELkmYy Edlcab; epþImeLIg enAkñúgqñaM 2007 RksYgsuxa KøInikenA)at;dMbg nig kMBg;FM Pi)al CamYynigGgÁkarsuxPaBBiPB enAkñúgKeRmagqñaM 2006 mUlniFi CMgWTwk elak nig smaKmCMgWTwkenamEp¥mkm<úCa enamEp¥mBiPBelak )ansRmbsRmYl )anrYmKñaerobcMesvaEfTaMsuxPaB enA begáItKøInikBIr enA)at;dMbg nig kMBg;FM. kñúg KøInik CMgWTwkenamEp¥m nig sm<aF BYkGñksμ½RKcitþ mkBIsmaKmCMgWTwk Qamx<s; kñúgmnÞIreBTüextþ enA)at; enamEp¥mkm<úCa CaGñkGnuvtþn_KeRmag dMbg kMBg;FM kMBg;cam eBaFisat; nig enH eRkamCMnYy]btßmÖ BIRkumh‘unplit éRBEvg . KeRmagenH manbMNgcg; »sf s‘uyEGt Novo Nordisk ehIy pþl;esvaedaypÞal; dl;GñkCMgWTwkenam TTYlkugtWn½r BIRkumh‘undwkTMnijtam Ep¥m RbmaN Ca 40>000nak; RBmTaMg k):al; Maersk nig smÖar³BIsb,úrsCn elIkkm<s;karEfTaM dl;GñkCMgWRbmaN epSg². KøInikTaMgBIr cab;dMeNIrkarBI Ca 120/000nak; enAtamRsuknana kñúg edImqñaM 2007 mk. kñúgry³kalmYy extþTaMg5 kñúgry³eBlbIqñaM . eKrMBwgfa qñaMdMbUg KøInik enA)at;dMbg )anpþl;kar KøInikTaMgGs;enH nwgeRbIR)as;RKUeBTü BieRKaHCMgW dl;GñkCMgW cMnYn 3>608 nak; nig Kilanub,dæak BI 30 eTA 35 nak; ehIy)anpþl;karBüa)al dl;GñkCMgW Edl)anTTYlkarbNþúHbNþal BIsh cMnYn 2>400 nak; cMENkÉKøInik enA B½n§CMgWTwkenamEp¥m GnþrCati enAkñúg kMBg;FM )anpþl;karBieRKaHCMgW dl;Gñk KeRmagmunenaH. CamYyKñaenaH buKÁlik CMgW cMnYn1/000 nak; nig pþl;kar suxaPi)al cMnYnBI 30 eTA 40nak; enA Büa)aldl;GñkCMgW cMnYn 700 nak;. kñúgextþnImYy² nwgTTYl)annUvkarbNþúH manKøInikBIreTot RtUv)anbegáIteLIgEfm bNþalGMBICMgWTwkenamEp¥m nig GMBIkar eTot enAesomrab nig RkecH enAkñúgqñaM Büa)aleCIg rbs;GñkmanCMgWTwkenam 2008 eRkamkarKaMRT]btßmÖbEnßm . Ep¥m ehIybuKÁlikmNÐlsuxPaB Rb maNCa 100nak; enAkñúgextþnImYy²

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

ExkBaØa 2006 smaKmCMgWTwkenamEp¥mkm<úCa evC¢> lwm kWKI RbFansmaKmCMgWTwkenamkm<úCa dMNak;kalTI1³ 46/702 duløa dMNak;kalTI2³ 48/830duløa elIkkMBs;karyl;dwg GMBICMgWTwkenamEp¥m nig begáInkar TTYlesvaBüa)al

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán 62


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

nwgTTYl)annUvkarbNþúHbNþal GMBIkar EfTaM karBinitürkCMgW nig kar):an;RbmaN haniP½yF¶n;F¶r. kñúgeBlenaH KeRmag k¾manbMNgcg;begáIt[mansþg;dar én karEfTaMfñak;CatimYyeLIg CamYynwg mKÁúeTsk_ ehIynigRbB½n§RKb;RKg Tinñn½ymYypgEdr. KeRmag manbMNgcg;eFVIsmahrNkmμ esvaEfTaMCMgWTwkenamEp¥m cUleTAkñúg RbB½n§esvaEfTaMsuxPaB rbs;rdæaPi)al EdlmanRsab; rYmTaMgbuKÁlikTIkEnøg mnÞIrBiesaFn_ nig »sfsarvnþpgEdr. buKÁlikevC¢saRsþ nig Kilanub,dæak énKøInik kñúgKeRmagsakl,g rYmpSM CamYynwgmnÞIreBTü nig mNÐlsuxPaB RtUvcUlrYm enAkñúgkarGb;rMbNþúHbNþal bnþCab;CaRbcaM GMBIkarEfTaM nig karRKb; RKgCMgWTwkenamEp¥m. karbNþúHbNþalenaH sgát;F¶n;eTAelI karRKb;RKgCMgWTwkenamEp¥m edayxøÜn Ég nig eTAelImitþGb;rMmitþ edIm,I[Gñk CMgW ecHEfTaMxøÜnedayxøÜnÉg ehIykat; bnßytémøcMNay eTAelIesvasuxPaB. kñúgry³eBlmYyqñaMdMbUg KeRmagenHman bMNgcg;GPivDÆn_CMnaj rbs;RKUbNþúH

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

bNþal edayEp¥keTAelIkarbNþúH bNþalBImunenAkm<úCa nig evotNam. Kilanub,dæakmñak;² RtUvTTYlkarbNþúH bNþald¾twgEtg cMnYn 4 s)þah_ rYcehIy BYkeKnwgTTYlkarbNþúHbNþalbnþeTot enAtamTIkEnøgeFVIkar. enAkñúgqñaMTI 2 tMNagRKUbNþúHbNþal nig tMNagGñk CMgW RtUverobcMÉksarGb;rM sRmab;Gñk CMgW. enAeRkamKeRmagenH smaKmCMgW TwkenamEp¥mkm<úCa RtUvbegáItsaxarbs; xøÜn edIm,IpSarP¢ab;eTAnwgKøIniktamextþ nImYy². smaKm k¾eFVIkarpgEdr enAkñúgkarkMNt; rkyuT§saRsþ RbkbedaynirnþrPaBmYy edIm,IFanafa eKGacTTYl)an»sfTwk enamEp¥m y:agCab;lab; enAkñúgextþ eKaledA . edayEp¥keTAelIkarBinitüemIl nig kar erobcMsarCafμIeLIgvij elIRkbx½NÐ Edl Gnuvtþn_ enAkñúgextþsakl,gTaMg 5 KeRmag)anbegáItyuT§saRsþ nig KMrUmYy sRmab;ykeTAGnuvtþn_ enAkñúgmnÞIreBTü bEg¥kepSg²eTot ¬extþesomrab nig RkecH¦. eK)ansgÇwmfa KMrUenH Gacnwg RtUv)anBRgIk[RKbdNþb;elICMgW minqøg

ExkBaØa 2006 smaKmCMgWTwkenamEp¥mkm<úCa evC¢> lwm kWKI RbFansmaKmCMgWTwkenamEp¥mkm<úCa dMNak;kalTI1³ 46/702 duløa dMNak;kalTI2³ 48/830duløa elIkkm<s;karyl;dwg GMBICMgWTwkenamEp¥m nig begáInkar TTYlesvaBüa)al

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán

63


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

epSgeTotpgEdr . KeRmagenH RtUv)an Gnuvtþ RsbeTAtamyuT§saRsþCatikm<úCa sþIBICMgWminqøg edIm,IelIkkm<s; karkat; bnßyktþahaniP½y rYmman Gaharmin sUvmanCIvCati PaBGskmμénragkay ehIynigkarCk;)arIpgEdr. KeRmagenH rYmman kmμviFIsakl,gBinitüsuxPaB mnusScas; enAkñúgmNÐlsuxPaBcMnYn 10 EdlmanTaMgkar):an;RbmaN nig karRKb;RKgGñkEdlgaynwgekItCMgWenH xøaMgCageKpgEdr .

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

karGb;rM nig yl;dwgGMBICMgWTwkenam Ep¥m. eKaledArbs;KeRmagKW bNþúH bNþalevC¢bNÐit cMnYn 13 nak; Kilanub,dæakcMnYn 30 nak; nig GñksgÁm kic©cMnYn 9nak; ehIypþl;esvabnþeTA RbCaCncMnYn 22/000 nak; kñúgenaH 10/000nak; )anTTYleraKviPaK nig B½t’man É 12/000 nak; eTot TTYl )ankarEfTaM b¤ karGb;rM . enAkñúgEpñk mYyénKeRmagenaH GgÁkar m>B>C EdlCaGgÁkarkñúgRsukmYy eFVIkarGb;rM

Exmkra 2007/ ExFñÚ 2009 RksYgsuxaPi)al/ GgÁkarsuxPaBBiPBelak/ shB½n§CMgWTwkenamEp¥mGnþrCati evC¢> lwm kWKI RbFansmaKmCMgWTwkenamEp¥mkm<úCa 848/564duløa ¬mUlniFiCMgWTwkenamEp¥mBiPBelak 423/284duløa¦ erobcMKMrUsßitesßr nigkarEfTaMCMgWTwkenamEp¥m enAkñúgRbB½n§suxaPi)al saFarN³ nig RsavRCavrkyuT§saRsþ bgáarTb;sáat;

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán

elIkkm<s;karEfTaMenAPñMeBj

64

edIm,IbegáInkarGb;rM karEfTaM nig kar Büa)alCMgWTwkenamEp¥m RksYgsuxa Pi)al )anbegáIt naykdæan CMgWTwk enamEp¥mmYyeLIg enAkñúgmnÞIreBTü RBHkusum³ enAkñúgqñaM 2005 . vaKWCa naykdæan EtmYyKt; rbs;mnÞIreBTü EdlmanCMnajBiess xag Gg;dURKIn saRsþ GaharUbtßmÖ nig CMgW emtabUlik enAkm<úCa . enAkñúgKeRmagry³eBl 3qñaMmYy Edlcab;epþImenAkñúgqñaM 2006 GgÁkarebskkmμGPivDÆn_ karEfTaM rbs;)araMg )aneFVIkarbNþúHbNþaldl; buKÁliksuxaPi)al Eklm¥karTTYl)an nUvesvadl;GñkRkIRk ehIynig)anbegáIn

suxPaB enAkñúgtMbn;xVHxatCageK enA PñMeBj )aneRCIserIsykGñkCMgWTwk enamEp¥m cMnYn 3nak; mkbNþúHbNþal [eTACaGñkGb;rMxagsgÁmkic© sRmab; eFVIkarelIkkm<s;karyl;dwg karGb;rM nig karEsVgrkCMgWTwkenamEp¥m eGay eXIjTan;eBlevla. KeRmagenH k¾eFVI karsikSapgEdr GMBITMnak;TMngKñarvag CMgWTwkenamEp¥m CamYynwgCMgWEdlbgá eLIg edayvIrus dUcCaCMgWeGds_ CMgW eføImRbePT eb nig es . KeRmagenH k¾eFVIkarsikSapgEdr GMBIrbbhUbcuk tamRbéBNI sMedAEkTmøab;hUbcuk rbs; GñkCMgWTwkenamEp¥m .


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

Exmkra qñaM2006/ Exmkra qñaM2009/ BnüarrhUtdl; ExkBaØa qñaM2009 GgÁkarebskkmμ GPivDÆn_karEfTaMrbs;)araMg - mIkadU Dr. Jaqueline Diquemare

189/280GWr:U ¬mUlniFiCMgWTwkenamEp¥mBiPBelakcUlrYm 107/700GWr:U¦ elIkkm<s;karEfTaMGñkCMgWTwkenamEp¥m edaybNþúHbNþalGñkman viC¢aCIv³ EfTaMsuxPaB sRmbsRmYl karTTYl)annUv»sf cMeBaHGñk EdlRkIRkCageK ehIyelIkkm<s;karyl;dwgGMBICMgWTwkenamEp¥m .

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán

enAedImqñaM 2008 naykdæan manevC¢ bNÐit cMnYn 4nak; Edlpþl;karBieRKaH CMgW dl;GñkCMgW RbmaNCa 500nak; kñúg 1Ex². manGñkCMgWCagBak;kNþal EdlmkBIxageRkAraCFanIPñMeBj ehIy 10° mkBIextþq¶ay². bIPaKbYn én GñkCMgW nig smaCikRKYsar)anyl;dwg GMBITwkenamEp¥m KWCaCMgWF¶n;F¶rmYy ehIy RbEhlCaBak;kNþal )andwgfa vaGac eFVI[EPñkggwt nig eFVI[mankarkat; eCIg . sRmab;GñkCMgW Edlmanelc ecjCaplvi)akeTAehIyenaH eK)anrk eXIjfa PaBRkIRk KWCa]bsKÁcm,g eRBaHRbCaCnRkIRk KμanR)ak;edIm,IsVH EsVgrkB½t’manbEnßmeTot b¤ karBüa)al GVIeT. ]bsKÁepSg² eTotrYmman kar sÞak;esÞIr rbs;buKÁliksuxaPi)alExμr enA kñúgkarEsVgrkdMbUnμan BIshesvikrbs; eK ehIynigkarecjevC¢bBa¢a eRcInxøaMg hYsehtueBk. eKk¾)anrkeXIjpgEdr fa CaerOy² plRbeyaCn_pÞal;xøÜn rbs;RKUeBTü )aneRCotERCk eFVIeGay b:HBal; dl;plRbeyaCn_rbs;GñkCMgW.

mitþGb;rMmitþenAtaEkv

RbsinCaKμankarEfTaMsmRsbeT CMgW TwkenamEp¥m nwgeFVI[b:HBal;dl;plit PaBrbs;mnusS. dUecñH karGb;rMRbCaCn [ecHRKb;RKgsuxPaBpÞal;xøÜn mansar³ sMxan;xøaMgNas; enAkñúgkarecosvag sßanPaB EdlRKYsarRtUvbgçMcitþbBaÄb; kUnmin[eTAeron b¤ lk;RTBüsm,tþiman eKaRkbI dIFøI CaedIm . enAkñúgKeRmag Edlcab;epþImeLIg enAcugqñaM 2007 mnÞIrsuxaPi)al extþtaEkv )anesñIsuM[ mCÄmNÐlB½t’manCMgW rbs;GgÁkar m>B>C [BRgIkskmμPaBrbs;eK BI tMbn;GnaFibetyü enAPñMeBj cUleTA kñúgmNÐlsuxPaB cMnYn 9 EdlsßitenA kñúgrgVg;smtßkic© rbs;RsukRbtibtþi GgÁkar. KMnitpþÜcepþImenH manbMNgcg;eFVI[Gñk EdlmanCMgWTwkenamEp¥m ecHRKb;RKg CMgWedayxøÜnÉg edaybegáIt[manGñk EdlCamitþGb;rMmitþmñak;eLIg enAkñúg shKmn_rbs;eK . rhUtmkdl; cugqñaM 65


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

2008 manmitþGb;rMmitþ cMnYn 10 nak; EdlRtUv)anbNþúHbNþal ¬KWmanmitþ Gb;rMmitþmñak; enAkñúgmNÐlsuxPaBnImYy² énmNÐlsuxPaBTaMg 9 nig mñak;eTot enAkñúgmNÐlsuxPaBTI 10 EdleTIbEt RtUv)anbegáIteLIg enAkñúgRsukRbtibtþi enaH¦ .

mitþGb;rMmitþ erobcMkarCYbRbCuMKña Caerog ral;s)þah_rvagGñkNa EdlmanCMgWTwk enamEp¥m EdleTIbEt)anmkcuHeQμaH fμI² ehIyEdlminecHRKb;RKgxøÜnÉg b¤ RKb;RKgsßanPaBpÞal;xøÜn min)anl¥. kareFVIEbbenH manbMNgcg;[RbCaCn enAkñúgshKmn_ sÁal;mitþGb;rMmitþ ehIy rt;mkrkKat;enAeBlNa EdleKsgS½y mitþGb;rMmitþ KWCaRKhsßmñak; Edlman faxøÜneK manCMgWTwkenamEp¥m. CMgWTwkenamEp¥m EdlRtUv)anTTYl karbNþúHbNþalBI m>B>C . Kat;KWCa rhUtmkdl;cugqñaM 2008 KeRmag)an Gñkpþl;B½t’man enAkñúgmUldæan GMBI rkeXIjfa GñkmanCMgWTwkenamEp¥mcMnYn CMnajCamUldæan Tak;TgeTAnwgCMgWTwk 300nak; enAkñúgcMeNamRbCaCnTaMg enamEp¥m ehIyCYyGñkCMgWÉeTot² [ Gs; 38>000nak; EdlRtUv)anBinitü. ecHeTArkesvaEfTaMsuxPaB. mankar ÉksarmitþGb;rMmitþ k¾mancuHpSaypgEdr epþatCaBiess eTAelIkarvas;Evg Cati enAkñúgTsSnavdIþ rbs;RksYgsuxaPi)al KøúykUs enAkñúgTwkenam edayxøÜnÉg ehIy)anEckCUn dl;buKÁliksuxaPi)al edayeRbIbnÞHRkdasBinitüTwkenam nig cMnYn 20>000 nak; . KeRmagenH man karsRmbCIvPaBrs;enA kñúgkarhUbcuk bMNgcg;rk[eXIj nUvkrNImanCMgWTwk enamEp¥m [)an 1/400nak; enARtwm nig karhat;R)aNpgEdr . edImqñaM 2010. RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ m>B>C

ry³eBl édKU GñkTTYlxusRtUv fvika eKalbMNg

Ex kBaØa qñaM 2007/ ExkumÖ³ qña M2010 mCÄmNÐlpþl;B½t’man dl;GñkCMgW rbs; m>B>C Maurits van Pelt

259/620 duløa ¬mUlniFiCMgWTwkenamEp¥m BiPBelak cUlrYm 120/888 duløar¦ begáItkmμviFImitþGb;rMmitþ kñúgcMeNamRbCaCnRkIRk EdlmanCMgWTwkenamEp¥m

RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ kUEBnhaehán

66


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI14³ bNþajCMgWTwkenamEp¥m enAPñMeBj nig taEkv

enAcugqñaM 2008 m>B>C )ankt;RtaeXIjmanGñkCMgWTwkenamEp¥m RbmaNCa 1/100nak; enAPñMeBj nig taEkv . RkummitþGb;rMmitþ )anEckrMElkB½t’man nig eqøIyeTAnwgsMNYr enAkñúgkarRbCuMCaerogral;s)þah_ Edl)anepþatCa Biess eTAelIGñkCMgWfμI EdlRtUvkareronsURtcMeNHdwgmUldæan GMBICMgWTwkenamEp¥m .

cab;epþIm

2005 2006 2007

2008

TItaMg

PñMeBj RsHck Gnøg;k¶an bwgkk; bwgsaLag bUrIkILa RsukRbtibtþiGgÁrkar extþtaEkv éRBs,at GgÁrka taePm RtBaMgGeNþIk RtaMkk; RtBaMgRBIg Kus éRBQYr GgÁtaesam RsukRbtibtþidUnEkv extþtaEkv éRBsøwk RsukRbtibtþiKIrIvgS extþtaEkv remj

GñkCMgWTwkenamEp¥m

cab;epþIm

162 150 144 56 68

GñkRsI laC lINa elak eRsg san GñkRsI Tit TUc elak Kat b‘unQan GñkRsIéh can;fa

51 63 74 42 66 33 57 13 55

elak Ém saxun elak emoc suIpun GñkRsI mitþv:an;Nav elak RBab edn GñkRsI Guwm sarun elak Q kn elak lb; supl elak Eb:n Nat elak Bil eDOm

17 elak Cin Bn 37 elak kub ekg

RbPB ³ m>B>C

minsÁal; b¤ ePøc ³ kumar EdlmanCMgWTwkenamEp¥m RbePT 1 fVIebI CMgWTwkenamEp¥mRbePT 1 minsUv RtUv)aneKdwgB¤£ enAkñúgcMeNamsaFarNCny:agNakþI k¾b:uEnþ smaKmCMgW TwkenamEp¥mkm<úCa )an):an;RbmaNfa

mankumarRbEhlCa 1>000nak; enA TUTaMgRbeTs EdlmanCMgWenH. témøén karEfTaMkumar EdlmanCMgWTwkenamEp¥m RbePT 1 enH KWRbEhl Ca 50duløa kñúg 1Ex² . témøenH manrYmTaMgkarRtUveFVI dMeNIrCaRbcaMeTAkan;KøInik edIm,ITTYl karcak; GaMgs‘uylIn bUkrYmTaMgbnÞH Rkdas sRmab;RClk;Twkenam edIm,IRtYt BinitüGRta KøúykUs enAkñúgQampg .

67


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

sgÇwmfa nwgrkeXIjmankrNICMgWTwk “´sgÇwmfa eyIgGackMNt; enamEp¥m RbePT 1 eRcInEfmeTot tam rkeXIjmankrNIenH ry³karpSBVpSaytamsarB½t’man viTüú nig TUrTsSn_ . Kat;Kitfa enAeBlNa eRcInCagenH ” EdleK)anrkeXIjenaH kumarTaMgGs; enaH nwgRtUv)anbBa¢Únmkkan; KøIniksaxa —evC¢> lwm kWKI RbFan smaKmCMgWTwkenamEp¥mkm<úCa rbs;smaKm edIm,ITTYlesvaEfTaM nig karBüa)al ehIyk¾GacTTYlkarpþl; meFüa)ay [eTAsalaeronEfmeTot pg . ebItamelakevC¢bNÐitlwm kWKI EdlCa RbFansmaKm CMgWTwkenamEp¥mkm<úCa enaH RksYgsuxaPi)al minmansßitikumar Edlman CMgWTwkenamEp¥mRbePT 1 enHeT . k¾b:uEnþ mankumar EdlmanGayu eRkam 14 qñaM cMnYn 60 nak;ehIy Edl )anmkTTYlesvaEfTaM nig kartamdan nig karBüa)albnþ enAÉmnÞIreBTükumar EdldMeNIrkar edayPñak;garpþl;CMnYy breTs . kumarTaMgGs;enaH RBmTaMg RkumRKYsarrbs;eK kMBugEtts‘Urs;enA y:aglM)ak enAkñúgsßanPaBxVHxat TaMg xaghirBaØvtßú esdækic© sgÁmkic© ehIy nigcitþsaRsþ. " ´sgÇwmfa eyIgGacrk eXIjmankrNIenHeRcInCagenH ".

68

smaKmCMgWTwkenamEp¥mkm<úCa )aneRbI R)as;GMeNay EdleKTTYl)antamry³ Rkumh‘un NUv:U n½rDIsá enAkñúg qñaM 2006 nig 2007 edIm,ICYydl;kumar Edlman CMgWTwkenamEp¥m RbePT 1 nig begáIt KøInik sRmab;GñkCMgW EdlRtUvkarGaMgs‘uylIn. elakevC¢bNÐit lwm kWKI

ebItammCÄmNÐlpþl;B½t’manCMgW m>B>C kumarPaKeRcIn enAkm<úCa Edlman CMgW TwkenamEp¥mRbePT 1 eRcInEt)an søab;)at;bg;CIvit munnwgBYkeK)anTTYl kareFVIeraKvinicä½y . :evC¢bNÐitExμr )an raykarN_fa eKminEdl)anCYbCamYy nwgkumarEbbenHeT k¾b:uEnþ mankumar EbbenH cMnYn 2>000 nak; enArs;enA eLIy enAkm<úCa. ehtukarN_enHbgðaj [eXIjfa enHminEmnRKan;EtCa karxVH karpþl;B½t’man eTA[GñkCMgW Etb:ueNÑaH eT k¾b:uEnþ vamankarcaM)ac; EdlRtUvelIk km<s;esvasuxPaB edaypþl;karbNþúH bNþal EksRmYlBiFIkar nig PsþúPar eLIgvijpgEdr :. RbPB ³ shB½n§CMgWTwkenamEp¥mBiPBelak/ m>B>C


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

RkumCYyxøÜnÉg BYkGñkCMgWTwkenamEp¥m EdlCaRkummitþ Gb;rMmitþ KYrEtRtUv)anrab;bBa©ÚleTAkñúg RbB½n§EfTaMsuxPaBbzm . k¾b:uEnþ BYk GñkerobcMeKalneya)ayPaKeRcIn )an niyayfa kareFVIGnþraKmn_ eTAelICMgW ruaMér :minmanRbsiT§PaBeT b¤fa CMgWruaMér: KWCareNþAd¾exμAggwt (black hole) Ca Biess sRmab;karbgáarCabnþ kñúg cMeNamGñkCMgW. BYkm©as;CMnYybreTs k¾epþatCMnYyrbs;eK EteTAelICMgWqøg ehIyenAkñúgfvikakmμviFI manEt 1° Et b:ueNÑaH sRmab;CMgWminqøg ebIeTaHbICava ¬CMgWminqøg¦ )anbNþaleGaymankar søab;CagBak;kNþal kñúgcMeNamkar søab;TaMgGs; edayCMgWenHkþI.

taragTI15³ CMnYyxagsuxaPi)al

karEbgEckCMnYybreTs [vis½ysuxaPi)al enAkm<úCa

xÞg;fvika

RKb;RKgCMgWqøg pþl;esva suxPaBmata nig Tark RKb;RKg nig rdæ)al CMgWminqøg

(%)

58 24 9 8 1

RbPB ³ m>B>C

kgVHxat enAkñúgeKalneya)ayenH )an eFVI[ekItmanPaBRkIRk edaysar)an GnuBaØat[manBikarPaB munkalkMNt; cUlmkCMnYsplitPaBeTAvij.GaCIvkmμ )ancl½teTAy:agelOn edIm,IQaneTA kþab;»kas[)an ehIy)aneFVI[mankar RcbUkRcbl;eLIg enAkñúgkarpþl;B½t’man.

BYkGñkeRbIR)as; Edl)armÖcMeBaHsuvtßiPaB rbs;plitpl ecHEtcg;cayvay eTaHbICaeKmin)andwgfa GVIEdlCaCeRmIs l¥k¾eday. GñkEdlQñHeK KWBYkGaCIvkrNa Edl)ancMNayeRcIn enAkñúgkar eXasnaplitplrbs;eK . CMgWTwkenamEp¥m KWCaCMgWmYy EdlbBa¢ak; faxVHevC¢bNÐit nig Kilanub,dæak Edl )anTTYlkarbNþúHbNþal. GñkNaEdl )anTTYlkarbNþúHbNþal TTYlR)ak; ]btßmÖTabxøaMgNas;. RbB½n§suxaPi)al saFarN³ tRmg;eq<aHeTArkEtkrNICMgW RsYcRsal; Edlmanry³eBlxøI. cMNUl rbs; buKÁliksuxaPi)al hak;dUcCaRtUv )anbMeBjbEnßm edayGñkCMgWrauMér: Edl jaMjIedaysareraKsBaØayUrGEgVg. “GñkCMgW Edll¶g;exøA

RtUv)aneKekg ykcMeNjBIelI ”

buKÁliksuxaPi)al minRtUv)aneKpþl; R)ak;elIkTwkcitþ edIm,I[epÞrcMeNHdwg rbs;eKeTA[RbCaCn EdlmanCMgWruaMér: eT. elIsBIenaHeTAeTot GñkCMgW Edl l¶g;exøA RtUv)aneKekgykcMeNjBIelI. RBmCamYyKñaenaH GñkCMgWTwkenamEp¥m RtUv)aneKsnμtTukCamunfa KWCaGñkman Fat;ehIycas; b¤ minsUvmankarGb;rM[ ecHRKb;RKgCMgWedayxøÜnÉg .

CMgTW kw enamEp¥mRbePT 1 CaTUeTAtRmUveGaycak; GaMgs‘yu lIn 69


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

:eFVICamitþGb;rMmitþmñak; kñúgmYy RKb;RKgkRmit KøúykUs enAkñúgQam éf¶ GacnwgeFVI[eKElgRtUvkar nig GMBIsm<aFQampgEdr . BYkeKk¾ RtUvEtyl;dwgpgEdr GMBIfaetI GVI²TaMg evC¢bNÐit : enAkñúgbrisßanEbbenH bNþajmitþGb;rM mitþ KWCakarvinieyaKd¾sMxan; enAkñúgRbeTsmYy EdlmanR)ak;cMNUlTab dUc Ca km<úCaenH. bNþajEdl m>B>C )an erobcMeLIg enAkñúgRsukRbtibtþirbs;RksYgsuxaPi)al manGñkCMgWTwkenamEp¥m EdlCaGñkRKb;RKgBYkmitþGb;rMmitþ Ca GñkdwknaM ehIyEdlRtUvTTYlbnÞúkeFVIkar Gb;rMmitþ enAkñúgshKmn_nImYy². mitþ Gb;rMmitþ KWCaBYkGñkCMgWTwkenamEp¥m Edl ecHCYyxøÜnÉg mkBIxageRkAvis½ysuxa Pi)al ehIy)ansμ½RKcitþeFVIkar. edIm,I )ankøayeTACamitþGb;rMmitþmñak; Edl manKuNPaB eKRtUvecHGan nig sresr ehIyqøgkat;karRbLgmYy eRkayBI )anTTYlkarbNþúHbNþal cMnYn 6s)þah_ rYcmk .

Gs;enH Gacrk)anedayrebobNa . enHKWCatYnaTI rbs;RkummitþGb;rMmitþ EdlrYmman TaMgkarecHvaytémøeTA elIGñkCMgWTwkenamEp¥mÉeTot edIm,I BinitüemIlkRmit KøúykUs kñúgTwkenam KøúykUs kñúgQam sm<aFQam cgVak; ebHdUg karvas;pleFob Tm¶n; nig km<s; nig TMhMcegáH ehIybnÞab;mk eFVIr)ay karN_eTA[GñkRKb;RKg. BYkmitþGb;rM mitþ k¾eFVIkar):an;RbmaNpgEdr GMBIbBaða EdlekIteLIgelIeCIgGñkCMgW ehIynig bBaðaxagsrésRbsaT .

RbCaCn EdlmanCMgWTwkenamEp¥m RtUv mansmtßPaBGacvas;kRmit KøúykUs enAkñúgQamedayxøÜnÉg)an ehIyRtUv yl;dwgGMBIkartmcMNIGahar GMBIkar hat;R)aN ehIynigGMBI»sf EdlGac

GtßRbeyaCn_edaypÞal;mYy énbNþaj mitþGb;rMmitþ KWkarqab;rkeXIjGñkman CMgWTwkenamEp¥m tamry³karEckcay bnÞHRkdasBinitüTwkenam [ykeTAeFVI etsþedayxøÜnÉg. eKalbMNgsRmab;

“RkumCYyxøÜnÉg GacCYy

RKb;RKgcMNay eTAelI CMgWTwkenamEp¥m)an ”

RbGb;TI6³ bnÞHRkdas;BinitüTwkenam bnÞHRkdas BinitüQamrk KøúykUs fVIebIeTogTat;Cag b:uEnþmantémøéføCag bnÞHRkdas BinitüTwk enamrk KøúykUs (urine strips) rhUtdl;eTA 20 dg. bnÞHRkdasBinitüTwkenam EdlviC¢man swg EtCanic©kal cg¥úlGMBIGRta KøúykUs kñúgQamx<s;eBk k¾b:uEnþ bnÞHRkdasBinitüTwkenam Edl GviC¢manvij minR)akdfa KμanCMgWTwkenamEp¥m enaHeT. karRbQmenAkñúgdMNak;kalenH KWRtUv CYyGñkCMgWTwkenamEp¥m enAkñúgshKmn_ EdlminGacRtYtRtaCMgW rbs;xøÜn)an [eTACamankar RtYtRtaelICMgWrbs;eK)aneTAvij. edayeKGacrkbnÞHRkdas BinitüTwkenam)an GñkCMgWGaceFVI etsþ edayxøÜnÉg)anCaRbcaM. bnÞHRkdas BinitüTwkenam GacCYyeFVI[eKyl;dwg GMBI\T§iBl éncMNIGaharEdleKhUb eTAelIkRmit KøúykUs enAkñúgQamrbs;eK)an . 70

RbPB ³ m>B>C


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

ry³eBl 2qñaM KWelIkkm<s;karyl;dwg [GñkCMgWcMnYn 50° dwgxøÜnfa eKman CMgWenH edayekIneLIgBIkRmitRbmaN Ca 30° enAeBlsBVéf¶. GtßRbeyaCn_ epSg²eTot rbs;bNþajmitþGb;rMmitþ rYm man karepÞrcMeNHdwg nig CMnajEkERb Tm¶n; nig kat;bnßysm<aF eTAelIesva suxaPi)al . enAkñgú cMeNamRbCaCnkm<Cú a RbmaNCa 1lan nak; RtUv)anjaMjIeday CMgWTwkenamEp¥m nig sm<aFQamx<s; eK sgÇwmfa RkumCYyxøÜnÉg GacCYyRKb; RKgcMNay eTAelICMgWTwkenamEp¥m Rb caMqñaM [cuHBI 250 landuløa mkenARtwm Et 40 landuløa Etb:ueNÑaH . RBmeBl CamYyKñaenaH témødMeNIrkar énbNþaj mitþGb;rMmitþ EdlmanKñaRbmaNCa 600 nak; RtUv)aneKsgÇwmfa Gs;Rtwm Et 10duløa Etb:ueNÑaH sRmab;GñkCMgW mñak; kñúgry³eBl 1qñaM . CaTIbBa©b; RkumCYyxøÜnÉg )anCYyelIkkm<s;KuN PaB énCIvPaBrs;enA rbs;RbCaCn EdlmanCMgWTwkenamEp¥m eRBaHeK)an TTYlB½t’man EdleKRtUvkar edIm,IRKb; RKgRtYtRtasuxPaBxøÜnÉg ehIycMNay y:agtictYcbMput enAkñúgkarEfTaM suxPaB . RbPB ³ Maurits van Pelt, m>B>C

snÞsSn_Catisár enAkñúg)ay

Cnkm<úCa briePaK kabUnGuIRdat kñúgkRmit mYyy:agx<s; KWrhUtdl;eTA 77° én famBlTaMgGs; Edl)anmkBIkarhUb )ay. karhUb)ayeRcIn nig rebob cMGin)ay CaTUeTA enHGacCaktþa Edl rYmcMENkeFVI[ekItCMgW ¬TwkenamEp¥m¦ )an .

bnÞHRkdasBinitüCatisár

enAkñúgqñaM 2006 BYkGñkRsavRCavkm<úCa nig )araMg )aneFVIkarsikSa GMBIviFIcMGin )ay 4 Ebb edIm,IGaceFVIkar):an;RbmaN eTAelIplb:HBal; énkarlagGgár mun nwgdaM)ay eTAelIsnÞsSn_Catisár. kar sikSaenaH manbMNgcg;Eklm¥ nig pþl; dMbUnμan GaharUbtßmÖ cMeBaHGñkCMgWTwk enamEp¥m nig pþl;Gnusasn_bgáar Tb;sáat; CMhanTI 1 nig TI 2 dl;RbCa Cn EdlGacnwgRbQmCamYynwg haniP½y ekItCMgWTwkenamEp¥m nig GñkEdl manbBaða edaysarkar)at;sNþab;Fñab; én KøúykUs .

GñkniBn§

mnÞIreBTüRBHkusum ³ evC¢bNÐit esg esrI nIeym:U KI kaNarI m>B>C Maurits van Pelt

saklviTüal½y m:ugBWlIey Genevieve Cassanas

enAkñúgqñaM 1999 GgÁkares,ógGahar BiPBelak )anpSBVpSayGMBITRmg; GaharUbtßmÖmYy edayniyayfa RbCa

Jean de la Tullaye

mIkadU Jacqueline Diquemare 71


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

karsikSa)aneFVIetsþ elIrebobcMGinGgár páaxJI. kñúgrebobcMGin 2 Ebb EdleKlag Ggár 4 Twk nig 1 Twk munnwgdak;GgárcUl eTAkñúgTwkRtCak;cMGin cMnYn 23 naTI. kñúgrebob 2 y:ageTot eKlagGgár 4 Twk nig 1 TwkEdr Etdak;GgárcUleTAkñúgTwk daMBuH ehIycMGinEtkñúgeBl 18 naTI eT . “GgárRbePTenH KWCaGgár

EdlRbCaCnkm<úCa niymhUb eRcInCageK EdlmankRmit Catisárx<s;Nas;. GñkCMgW TwkenamEp¥m KYrEtbnßy karhUb)ay EdldaMeday GgárRbePTenH ” eRkayBI)aneFVIetsþ eTAelIGñksμ½RKcitþ cMnYn 10nak; BYkGñkRsavRCav)anrk eXIjfa snÞsSn_Catisár enAkñúg)ay EdleK)anlagGgár 4Twk mandUcKña min faeKdaMkñúgTwkRtCak; b¤ kñúgTwkekþAenaH eT. cMeBaH)ay EdleKlagGgár Et 1 Twk snÞsSn_CatisárenAkñúg)ay Edl

daMkñúgTwkRtCak; manTabxøaMgCag enAkñúg )ayEdldaMkñúgTwkekþA. k¾b:uEnþ karsikSa )anrkeXIjfa Cati KøúykUs kñúg)ay EdleKlagGgárEtmYyTwk ehIyyk eTAdaMkñúgTwkRtCak; mankarRsUbcUleTA kñúgQamyWtxøaMgNas; cMeBaHGñksμ½RK citþTaMg 10nak; ehIynigfa karcMGin )ayEbbenH KYrEtRtUveFVIkarsikSa Ca bnþeTAeTot. CamYynwgkar EdlkarsikSa)anrkeXIj fa karlagGgár 4Twk nig 1Twk KμanGVI EdlxusKñaeT cMeBaHsnÞsSn_Catisár enA kñúg)ay BYkGñkniBn§)aneFVIkarkt;smÁal; fa enHKWCaRbePTGgár EdleKniymhUb eRcInCageKenAkm<úCa ehIyvamanCati sárx<s;Nas;. GñkCMgWTwkenamEp¥m KYr Etkat;bnßykarhUb)ayenH ehIyKYr hUb RbUetGunI GaharmanCatisrés nig RbePTCatixøaj; EdleFVI[mansuxPaBl¥ enAkñúgeBlhUb)ay . RbPB ³ Study changes in glycemic index

of white rice according to how it is prepared (www.mopotsyo.org/20070730GI-final.pdf)

taragTI16³ karrkeXIj énkarsikSa TwkRtCak; lag 4 Twk TwkRtCak; lag 1 Twk TwkBuH lag 4 Twk TwkBuH lag 1 Twk

72

rebobdaM

snÞsSn_Catisár 91 87 90 97


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI16³ snÞsSn_Catisár ( GI) nig kRmitCatisár enAkñúgQam

x<s;

kRmitCatisárenAkñúgQam

GI

GI

Tab

eBl / em:ag

brimaNkabUnGIuRdat enAkñúgÉksareyag nig Gahar sRmab;eFIVetsþ RtUvEtdUcKña RbPB ³ EpñkGaharUbtßmÖmnusS enAsaklviTüal½ysIudnI

)ay mansnÞsSn_Catisárx<s;

73


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

rukçCati»sf søwkRmHeRBA

EpølVa

søwkRmMu

ebItamGgÁkarsuxPaBBiPBelak RbCa CnmYycMnYnFM enAkñúgRbeTskMBug GPivDÆn_ BwgEp¥kPaKeRcIn eTAelIRKU buraN nig »sfrukçCati. fVIebIeKman »sfTMenIb sm,Úry:agNakþI k¾»sf buraN enAEtRtUv)aneKniymdEdl. ebI eTaHCay:agNakþI manrukCç ati»sf EtmYy cMnYntUcb:ueNÑaH EdlRtUv)aneK[témøfa manKuNPaBCa»sf EbbviTüasaRsþ. manTinñn½yGMBIsuvtßiPaB nig RbsiT§PaB EtelIrukçCati mYycMnYnticEtb:ueNÑaH nig elIsarCaticRmaj;ecjmkelIeRKOgpSM nig elIrebobpSM. elIsBIenaH eTAeTot TIpSar»sfburaN minsUvmankarcat; Ecg[)anl¥eT enAkñúgRbeTsPaKeRcIn ehIyplitpl k¾xVHkarkt;RtacuHbBa¢I EfmeTot . “TIpSar»sfburaN minsUv

mankarcat;Ecg[)anl¥eT enAkñúgRbeTsPaKeRcIn ehIyplitpl k¾xVHkarkt;Rta cuHbBa¢IEfmeTot ” edImbeBaØIrEk¥k

74

stVBiesaFn_

enAkm<úCa mankarxitxMerobcMcMNat;fñak; rukçCati»sf taMgBIknøHstvtSr_munmk emø:H. ebItam»sfkarICatiGURsþalI Edl manedImkMeNItkm<úCamñak; KWelak xaM LavIt mhaviTüal½y»sfsaRsþ enA PñMeBj )andak;bBa©ÚlrukçviTüa mkkñúg kmμviFIsikSa edayTak;TgCaBiessGMBI RbePTrukçCatikñúgRsuk taMgBIedImTsvtSr_

qñaM 1960 mk. elak xaM LavIt )an e)aHBum<esovePAmYyk,al enAkñúgqñaM 2004 EdlmanraynamrukçCati»sf EdlmanenAkm<úCa cMnYn 515 mux . kñúg cMeNamrukçCatiTaMgGs;enaH manEtRb EhlCa 38 mux Etb:ueNÑaH EdlGac eRbI b¤ eFVIkarsikSafa manlkçN³sm,tþi Ca»sfRbqaMgnwgkareLIgCatisár enA kñúgQam edIm,IykmkBüa)alCMgWTwk enamEp¥m)an ¬sUmGacEpñkbnÞab;¦ . sarCati EdleKcRmaj;ecjBIrukçCati RtUv)aneKeRbI Gs;kalCayUrNas;mk ehIy enAkñúgkarBüa)al CMgWTwkenam Ep¥m. edayTTYlsÁal;fa plb:HBal; rbs;va minRtUv)aneKeFVIkarsikSaRsav RCav[eRCARCH rhUteTAdl;kRmitekasika enAkñúgmnÞIrBiesaFn_enaHeT BYkGñk RsavRCav énsaklviTüal½y XIg enA kñúgTIRkugLúg )ankMNt;rksarFatu eFVI [cuHCatisárenAkñúgQam kñúgrukçCati mü:ag enAkm<úCa ehA vløiTas;éRB. eK )anrkeXIjfa sarFatucRmaj;rbs;C½r enaH EdlGacrlaykñúgTwk eFVI[mankar beBa©jkal;süÚm nig GaMgs‘uylIn qøg kat;ekasikaekIneLIg enAkñúgekasika Eb‘ta rbs;stVkNþúr nig mnusS ebIsin CaeKeRbIva enAkñúgkMhab;mYy Edlmin GnuBaØat[ekasikars;)aneT. enAkñúg eBlEdlBYkGñkRsavRCavenaH bgðaj KMehIjrbs;eK enAkñúgkarRbCuMRbcaMqñaM énsmaKm Gg;dURKIn viTüa enATIRkugLúg enAkñúgqñaM 2005 eK)ansnñidæanfa sar-


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

FatucRmaj; ecjBIrukçCatienaH Gacyk eTAeRbIenAkñúgkarBüa)al edIm,IePJac[ mankarbeBa©j GaMgs‘uylIn elIGñkCMgW TwkenamEp¥m)an . kñúgbNþaRbePTrukçCati EdleKbgðajenA km<úCa edIm Madagascan periwinkle (Catharanthus roseus) RtUv)anTak;Taj karykcitþTukdak; BIsMNak;GnþrCati CaxøaMg. enAkm<úCa eKsÁal;edImenaHfa CaedImpáataMgyU KWCarukçCati EdlRtUv)an eRbIsRmab;karBüa)al CMgWTwkenamEp¥m enAkñúgtMbn;CaeRcIn enAkñúgRbeTs\NÐa ekaHkar:aGuIb nig ekaHkñúgmhasmuRT ):asuIhVic . enAkñúgqñaM 2003 BYkGñk RsavRCav mkBIsaklviTüal½y \RnÞa enA\NÐa nig saklviTüal½ysuIdnI enA GURsþalI )anrkeXIjfa TwkEdlRc)ac; ykecjBIsøwkeQIenaH manRbsiT§PaB Nas; enAkñúgkarkat;bnßyGRta KøúykUs kñúgQam TaMgcMeBaHstVkNþúr Edlman TwkenamEp¥m TaMgstVkNþúrEdlFmμta. edaysegáteXIjfa rukçCatienaH RtUv)an eKykmkeRbI CayUrlg;Nas;mkehIy enAkñúg»sfburaN\NÐa eRkameQμaHfa GyurevT BYkGñkRsavRCav)anpþl; eyabl;fa eRKOgpSMrbs;va k¾Gacman skmμPaB tamrebobdUcCa skmμPaB »sf sulfonylurea edayePJaceFVIeGay mankarbeBa©j GaMgs‘uylIn eRcIn . BYkGñkRsavRCav )aneFVIkarsnñidæanfa :karsikSarbs;eyIg )anbBa¢ak;[eXIj

c,as;fa TwkEdlRc)ac;ecjBIsnøwkpáa taMgyU (Catharanthus roseus) man skmμPaB RbqaMgnwgCMgWTwkenamEp¥m ehIyva)anKaMRT dl;kareRbICaRbéBNI énsnøwkedImpáaenH edayBYk»sfkarI GyurevT enAkñúgkarRtYtBinitüCMgWTwk enamEp¥m. edayehtuenaH vaGacCYy enAkñúgkarbgáarplvi)ak rbs;CMgWTwk enamEp¥m)an ehIyGacykeTAeRbI bEnßm rYmCamYy»sfRbqaMgnwgCMgWTwk enamEp¥m)an :. elak xaM LavIt )an[eyabl;fa kar eRbIrukçCati RtUv[mankarRtYtBinitüy:ag ditdl; BIGñkEdlmanviC¢aCIv³EfTaM suxPaB. Kat;)anniyayfa :ral;kar pSM»sf ecjBIrukçCatienH Gacnwgman \T§iBlpÞúyeTAvij ehIynigmanRbtikmμ RbqaMgpgEdr :. mankarhammin[Gñk Edlmansm<aFQamTab nig GñkEdl Tl;lamkeRbIeT . edaykarratt,at rbs;CMgWTwkenamEp¥m kMBugEtrIkraldalCaTUeTA ehIyman karRsavRCavviTüasaRsþ kan;EteRcIn eLIg GMBI»sfburaN. r)aykarN_sþI BIlT§plénkarsikSaenH edayGñk sarB½t’man EdlmanCMnajxagsuxPaB k¾mankan;EteRcIneLIgpgEdr . kñúg GtßbTrbs;sarB½t’man r:yT½r )anelIk GMBIkarRsavRCavfμI² GMBIRbsiTæPaBbBa©úH Catisár énrukçCati»sf\NÐa mYyEbb enAkñúgRkumBYk muWLúg .

RmH

søwk)as

nenag

eBat

kNþúrmanCMgWTwkenamEp¥m

75


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

RbGb;TI7³ rukçCati\NÐa Gac enAkm<úCa eKsÁal;vafa Cavløi)as; Edl CYy[eKRKb;RKgCatisárenAkñúg EtgEtvareLIgelIGVI² ehIyKWCaRbePT Qam GñkCMgWTwkenamEp¥m)an rukçCativløi EdlmankMeNItenAkm<úCa . RtkYn

emImxÞwmRkhm

EpøRtEbk

EpøRBwgedaHRkbI

EpøRTlwgTwg

kNþúrEdlmanCMgWTwkenamEp¥m CamYymitþrbs;eK EdlsuxPaBl¥ 76

jÚvy:k ¬r:yT½r¦ ³ karsikSafμI²mYy )anbgðaj lT§pl[eXIjfa sarCatiEdleKcRmaj;ecj BIrukçCati Coccinia indica EdlCarukçCatimanduH Caerogral;qñaM CaeRcIn enARbeTs\NÐa GacCYy [RbCaCn Edlman CMgWTwkenamEp¥mRbePT 2 kRmitRsal [RtYtRtakRmitsár enAkñúgQam rbs;eK)an . BYkGñkRsavRCav)aneFVIkarkt; smÁal;enAkñúgTsSnavdþI :karEfTaMCMgWTwkenam Ep¥m :fa fVIebI Coccinia indica EdleKeRcInEt sÁal; eRkameQμaHfa Coccinia cordifolia RtUv)an eKykmkeRbI enAkñúgkarBüa)alCMgWTwkenam Ep¥m tamEbbRbéBNIy:agNakþI k¾enAminTan;man karsikSa GMBIkarRtYtBinitü [)anc,as;las; enAeLIyeT. edIm,IBinitüemIl\T§iBlrbs;rukçCatienH eTAelIkRmitCatisárenAkñúgQam BYkGñk RsavRCav\NÐa)an[GñkCMgTW kw enamEp¥mRbePT 2 EdleKeTIbEt)ankMNt;rkeXIj cMnYn 60 nak; [TTYlyksarCati EdlcRmaj;ecjBI Coccinia b¤ sarFatuBiesaFn_ (placebo) enAkñúgkarBüa)al. sarCatienaH RtUv)aneKykmkeRbIR)as; Gs; kalBI35 eTA 60qñaM mkehIyenAkñgú karBüa)al CMgW bUkrYmnwgkartmcMNIGahar nig rebobrbb rs;enA. ebItamelak evC¢bNÐit erbicka KUrIy:an énviTüasßansuxPaBRbCaCn nig karRsavRCav KøInik enA bwgháal½r nig shkarIrbs;Kat; )anrk eXIjfamankarxusKñay:agxøagM GMBkI RmitCatisrá enAkñúgQamrbs;GñkCMgWTwkenamEp¥m eRkayBI eK)aneFVIkarBüa)aleday coccinia. GñkEdl Büa)aleday coccinia cMnYn 90éf¶rYcmk Catisár )anfycuHGs;16° enAkñúgeBlBYkGñkEdl)an Büa)aleday placebo kRmitCatisrá )anekIneLIg bnþic. GñkCMgWEdl)anTTYl cocciniamanRmit CatisárfycuH18° enAeRkayeBlbriePaKGaharrYc cMENkÉGñkCMgWEdl)anTTYl placebo mankRmitCatisárkñúgQamekIneLIgbniþc. kar sikSaenH)anbgðaj[eXIjc,as;fasarCaticRmaj; ecjBI cocciniamanskmμPaB eFVI[Catisárkñúg QamfycuH cMeBaHGñkCMgWTwkenamEp¥mRsal. k¾b:uEnþ elak erbickaKUrIy:an nig shkarI)aneFVI karkt;smÁal;fa eKRtUveFVIkarsikSaeRcIn Cabnþ eTotedIm,I kMNt;[)anGMBIynþkarenH . éf¶TI 25b kumÖ³ qñaM 2008

lkçN³sm,tþirbs;

bitter

melon

b¤ RmHRsuk k¾Cakmμvtßú énkarsikSaCaeRcInpgEdr . enAkñúgqñaM 2004 GñkviTüasaRsþ én saklviTüal½y s‘UhS‘Úka rbs;Cb:un )an cuHpSayGMBI\T§iBlénRmHRsuk eTAelI kRmit KøúykUs kñúgQamrbs;stVkNþúr manTwkenamEp¥m . eK)an[stVkNþúr suIRmHenaH ehIybgçM[vaeFVIclna kñúg ry³eBl 5 s)þah_ . GñkRsavRCav)an rkeXIjfa kar[suIRmHrYmpSMCamYynwg kareFVIclna manRbsiT§PaBy:agxøaMg enAkñúgkarkat;bnßy KøúykUs kñúgQam xøaMgCagkarEdl[suIEtRmH b¤ [EteFVI clnasuTæsaF . eK)aneFVIkarsnñidæan fa karbriePaKRmH rYmpSMCamYynwgkar [eFVIclnahat;R)aN mansar³sMxan; xøaMgNas; enAkñúgkarBüa)al CMgWTwk enamEp¥mRbePT 2 . (Momordica charantia)

BYkGñkviTüasaRsþ k¾)aneFVIkarRsavRCav pgEdr eTAelI\T§iBlrbs;RKab;nenag Exμr ¬KWBYk Luffa argyptiaca¦ EdlenA kñúgRkum muWLúg Edr . manRbePTrukçCatiepSg²eTot Edl)an eFVI[eKmankarykcitþTukdak;pgEdr dUcCaBYk water conculvulus (Ipomora aquatica) EdlExμreyIgehAfaRtkYn . enAkñúgqñaM 2000 BYkGñkRsavRCavmk BIRbeTsRsIlgáa )anbgðaj[eXIjfa Twk EdleKcRmaj;ecjBIRtkYn man RbsiT§PaB enAkñúgkarbBa©úHCatisár enA


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

kñúgQamrbs;kNþúr EdlmanCMgWTwk enamEp¥m dUcCa tolbutamide Edr Edl Ca»sf fulsonylurea dMbUg² EdlBYk GñkRsavRCav)araMg nig GaløWm:g; )anrk eXIj enAkñúgBak;kNþalstvtSr_TI20. xÞwm)araMg k¾RtUv)aneKrkeXIjfa man RbeyaCn_ dl;GñkCMgWTwkenamEp¥mpg Edr. enAkñúgkarsikSamYy sþIBIrukçCati »sfmYycMnYn EdleKe)aHBum<pSayenA kñúgqñaM1999 GgÁkarsuxPaBBiPBelak )anTTYlsÁal;fa karsikSaKøInik )an bgðaj[dwgfa xÞwmRkhm (Allium cepa) man\T§iBl RbqaMgnwgkareLIgCatisár kñúgQammnusS . enAkñúgkarsikSamYy enaH GgÁkarsuxPaBBiPBelak )aneFVI karkt;smÁal;fa TwkxÞwmRkhm cMnYn 100 mIlIRkam GaceFVI[kRmitsárkñúg QamfycuH)an. enAkñúgkarsikSamYy eTot )anbgðaj[eXIjfa kardak;xÞwm eqA cUleTAkñúgrbbhUbcuk rbs;GñkCMgW Edl minGaRs½yeTAnwg GaMgs‘uylIn enaH )anbBa©úHkRmiténkareRbIfñaM enA kñúgkarRtYtBinitüCMgWTwkenamEp¥m . EpøeQI EdlmanenAkm<úCa k¾CaRbPB mYyepSgeTotpgEdr enAkñúgkarRbqaMg eTAnwgkareLIgCatisár enAkñúgQam. enAkñgú qña2M 004 viTüasßanRsavRCavrbs; kUer: GMBICIvviTüasaRsþ nig CIvbec©kviTüa )ane)aHBum<pSay nUvkarRsavRCavmYy Edl)anbgðaj[eXIjfa sarCatiEdl cRmaj;ecjBIsøwkRtEbk (Psidium guajava) k¾manlkçN³sm,tþi Gackat; bnßyCatisárEdr. BYkGñkRsavRCavkUer: )anBinitüeXIjfa karcak;bBa©ÚlsarCati

cRmaj;enaH enAkñúgstVkNþúr )aneFVI[ Catisár s‘ucRkUs kñúgQam fycuHCa eRcIn. RKab;EpøeQI kñúgRkum jumbu mYy Ebb EdlExμreyIgehAfa RBIgedaHRkbI (Syzium cumini) k¾manlkçN³sm,tþi dUcKñaenHEdr . enAkñúgqñaM 2003 BYkGñk RsavRCavCati\NÐa enAÉsaklviTüal½y GaNam:al½y enAkñúgrdæ tamIl NaDU )anrkeXIjfa CatiRsa EdleKcRmaj; ecjBIRKab;RBIgenaH )aneFVI[Catisárkñúg QamkNþúrfycuHCaxøaMg . BYkeK)an eFVIkarsnñidæanfa sarCaticRmaj;enaH man\TæiBldUcKñanwg GaMgs‘uylIn Edr. ebItamelak xaM LavIt »sfkarIGURsþalI manedImkMeNItkm<úCa )anrkeXIjfa \TæiBlrbs;sarCati EdlcRmaj;ecjBI Epø b¤RKab;BYk jumbu eTAelIstV CYnkal dUcKñaeTAnwg\TæiBl rbs; tolbutamide EdlCa»sf sulfonylurea dMbUgeK . mankarRsavRCavepSgeTot EdleFVIkar sikSaeTAelI\TæiBlbBa©úHCatisárkñúgQam rbs;søwk bilimbi (Averhhoa bilimbi) EdleKehAfaRtlwgTwg . eRkayBI)an eFVIkarBüa)alstVkNþúr CamYynwgsar Cati EdlcRmaj;ecjBIsøwkeQIenH cMnYn 14éf¶ BYkGñkRsavRCav énsaklviTüal½y Cati sigðburI )aneFVIkarsnñidæan enAkñúgqñaM 2005 fa sarCaticRmaj;enaH KWCaRbPB RbkbeTAedayskþanuBl sRmab;eRbICa fñaMelb Büa)alCMgWTwkenamEp¥m. k¾b:uEnþ manGñkEdlmanbBaðatRmgenamxøH )an søab; eRkayBI)anhUb startfruit (Averhhoa carambola) EdldUcKñaeTAnwgGVI EdlExμr eyIgehAfas<W. RbPB ³ PIFWsþarr/ mUlniFisarB½t’manÉkraCü

77


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa Exμr

¬edIm¦ kenÞcGal kumareBRC kulabPñM

RbePT

Rkum

sMRsáwt

Gg;eKøs

)araMg

Boehmeria

Urticacae

interrupta

(nettles)

Stephania

Menispermaceae

rotunda

(flowering plants)

rukçCatienHl,Ifa manlkçN³ sm,tþi sRmab;Büa)al CatisárenAkñúgQamx<s;.

Malvaceae

eKl,Ifa b¤srbs;va manRbeyaCn_ Büa)alCMgWTwkenamEp¥m.

sarFatucRmaj;ecjBIrukçCati enH RtUv)aneKraykarN_fa manRbsiTæPaBeFVIeGay CatisárFøak;cuH.

Pavonia rigida

(mallows)

edImk¥Üt

¬edIm¦ k,alruy RkBat;RCUk

Caesalpinia

Leguminoseae

major

(legumes)

Latakaranja Molucca bean

Bondue

Putikaranja

Bonducella

Jaune

Kuberakshi

nut

Guilandina

Physic nut

bonduc

Sweet

Herbe

broomweed

A balai

Jastimadhu

Scoparia

Scrophulariaceae

dulcis

(figworts)

Sida

Malvaceae

Bala

Country

cordifolia

(mallows)

Batyalaka

mallow

edImcRgÁg;sVa edImeCIgeKa

Alliumcepa

Liliaceae

Palandu

(lilies)

Durgandha

Onion

78

Oignon

smasFatu GaemlIn EdlykecjBIrukçCati enHGacnwgeRbICafñaM Büa)alTwkenamEp¥m

sarFatucRmaj;rbs;va GaceFVIeGayCatisárenA kñúgQammnusSFøak;cuH enAeBleRbIvatammat;. l,IfamanlkçN³sm,tþi EdleFVIeGayCatisár kñúgQamFøak;cuH.

Yellow elder

Tecoma

Bignoniaceae

stans

(trumpet creepers)

Bauhinia

Leguminosae

Kovidara

Orchid tree

Arbre

variegata

(legumes)

Kanchanara

Mountain

orchidee

ebony

RKab;lIg RtUv)an eKRbIBüa)al karekIn eLIgCatisárkñúgQam.

lkçN³sm,tþirbs;va rYmman skmμPaBeFVI eGayCatisár enAkñúgQamFøak;cuH

Beejband

xÞwmRkhm

kareRbIR)as;

lkçN³sm,tþi EdleFVIeGay CatisárkñúgQamFøak;cuH kMBugsßiteRkamkarRsavRCav edayminTan;manlTæpl enAeLIy.


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa ¬t ¦ Exμr

RbePT

Rkum

dMLÚgRkwg

Amomum

Zingiberaceae

villosum

(gingers)

Catharanthus

Apocynaceae

Madagascan

roseus

(dogbanes)

periwinkle

páataMgyU

sMRsáwt

Gg;eKøs

)araMg

eK)ansikSaeTAelIlkçN³ sm,tþi RbqaMgnwgkareLIg Catisárx<s;. rukçCatienH enAeBlykeTA rm¶as; vaGacBüa)alkar ekIneLIgCatisár enAkñúg Qam. b:uEnþKYreRbIva eday mankarBinitütamdan y:agditdl; BIbuKÁlikEfTaM suxPaB. vaminGaceRbI)an cMeBaHmnusSEdlman sm<aFQamTab nig Tl;lamk.

Cayenn jasmine

RtkYn

Ipomoea

Convolvulaceae

aquatica

(morning glories)

Kalambi

Water

Liseron

Convolvulus

d’eau

Water spinach

RtEbk

RtEbkéRB

Psidium

Myrtaceae

Perala

Common

guajava

(myrtles)

Amratafalam

guava

Lager

Lythraceae

Arjuna

Rose of

Stroemia

(flowering plants) Pulahashtree

speciosa

Neelabrala-

Pride of

krati

India

India

Sarapunkha

RtMuexμac

kareRbIR)as;

Tephrosia

Leuminoseae

Sarpadarush-

Purple

purpurea

(Legumes)

Trika

trephosia

Meshasringi

Goyavier

karsikSaRsavRCav bgðajfa vaGacmanlkçN³ sm,tþi eFVIeGayCatisár kñúgQamfycuH. sarFatumü:ag eQμaH EkresTIn (Quercetin) EdlykecjBIRtEbkenH l,IfamanRbsiTæPaB RbqaMgnwgTwkenamEp¥m. søwk nig EpøTuM mansarFatu sMxan;mü:ag EdlRsedognwg GaMgsu‘uylIn. dUecñH vaGac manRbsiTæl¥ kñúgkarBüa)al RbqaMgnwgTwkenamEp¥m. kalBIdMbUg eKcat;Tukva enAkñúgRkumpáalILak;)araMg EdlCafñaMsMxan;sRmab; Büa)alTwkenamEp¥m. vak¾RtUv)aneRbICafñaM Büa)alGsmtßPaB pøÚvePTpgEdr. 79


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa ¬t ¦ Exμr

¬vløi¦ Tas;éRB

RTlwgTwg

¬edIm¦ bgÁI edImbejIEk¥k )as

RbePT

Rkum

sMRsáwt

Gymnema

Asclepiaddoideae

Bilimbi

sylvestre

(milkweeds)

Bilimbing

Averrhoa

Oxalidaceae

bilimbi

(wood sorrels)

Tournafortia

Boraginaceae

Montana

(forget me nots)

Helixanthera

Loranthaceae

longispicata

(flowering plants)

Coccinia

Cucurbitaceae

Vimboshta

indica

(melons)

Vimbaja

Gg;eKøs

søwkkrbs;va RtUv)aneRbI sRmab;Büa)alsm<aF Qamx<s; nig Catisárx<s; enAkñúgQam. sarFatuEdleKcRmaj; b¤ b¤s nig emImrbs;va l,Ifa manRbsiTæPaBRbqaMgnwg CatisárenAkñúgQamx<s;. Emkrbs;val,Ifa man RbsiTæPaB RbqaMgnwgTwk enamEp¥m. enAbg;háal; val,Ifa man RbsiTæPaBkat;bnßyCatisár enAkñúgTwkenam ehIyRtUv)an eRbI CMnYsGaMgsu‘uylIn edIm,IBüa)alTwkenamEp¥m. RbsiTæPaBkat;bnßyCatisár enAkñúgQam GacseRmc )an edaypwkTwk)as cRmaj; ecjBIsøwkrbs;va cMnYn 20 mIlIlIRt kñúgmYyKILÚRkam énTm¶n;xøÜnmnusS.

Tundiki

RBMbnøa

Smilax

Similacaceae

Glablous

glabra

(greenbiers)

greenbier

Carissa

Apocynaceae

Cochin-

(dogbanes)

chinensis 80

kareRbIR)as;

rukçCatienH mantémøy:ag BitR)akd edIm,IBüa)al TwkenamEp¥m. lTæpl bgðajfa vaGacbegáInkar begáItekasikalMEBg EdlbeBa©j GaMgsu‘uylIn.

Bimbi

b:eRbIs

)araMg

sarFatucRmaj; eQμaH emtaNul RtUveKraykarN_ fa manRbsiTæPaB eFVIeGay CatisárkñúgQamFøak;cuH. l,Ifa manRbsiTæPaB RbqaMgnwgTwkenamEp¥m.


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa ¬t ¦ Exμr

RbePT

Rkum

sMRsáwt

Gg;eKøs

)araMg

eBat

Zea

Graminaceae

Yavanala

Maize

Mais

mays

(grasses)

Ficus

Maoraceae

religiosa

(mulberries)

eBaFi

Sweet corn

Peepala

Sacred fig

Shreevaksha Peepul tree

Figuier des pagodes

Sevya Aswatha

RBIgedaHRkbI

Syzygium

Myrtaceae

cumini

(myrtles)

Jambu

Aegle

Rutaceae

Jambula

Bilva

Golden apple Oranger de

Bilvam

Bael fruit

Sriphal

tree

GñkviTüasaRsþ )anrkeXIj bU:lIsakarIt fμImYy BI b¤s nig edImeBat EdlmantYnaTI sMxan; enAkñúgkarRCabCati KøúykUs tamRkBH nigeBaHevon sRmab;Gñk TwkenamEp¥m. sarFatucRmaj;ecjBIsm,k manRbsiTæPaB eFVIeGay CatisárenAkúñgQamcuH. enH RbEhlCaedaysar vtþmanrbs; Eb‘ta-suIesþr:ul (beta-sisterol) . rm¶as;søwk edIm nig sm,k eQI GaceRbICafñaMBüa)al TwkenamEp¥m. cRmaj;Epø nig RKab; manRbsiTæPaBeFVI eGayCatisárkñúgQamFøak; cuH kñúgcMeNamstV eday eBlxøH eKGaceRbobeFob vaeTA nwg tUlb‘uytamIt (Tolbutamide). emSAman kRmiteRbIR)as;cMnYn 0/3 eTA 2 Rkam ehIyfñaMTwk mankRmiteRbIR)as; 4-8 mIlIlIRt sRmab; GñkTwkenamEp¥m.

Jambul Java plum

ePñA

kareRbIR)as;

Malabar

søwks¶Üt qugCamYyTwkekþA l,Ifa manRbsiTæPaBeFVIeGay CatisárenAkúñgQamcuH.

Bengal quince Bel

RmuM

Moringa

Moringaceae

oleifera

(moringas)

Sobhanjana Horseradish

Ben aile

Dvishigru

tree

Noix de

Murungi

Ben

ben

Sigru

søwk nig sm,kedIm rbs;va RtUv)aneK niyayfamanRb siTæPaBRbqaMgsm<aFQam x<s; nig Catisárx<s;enA kñúgQam. 81


VII

CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa ¬t ¦ Exμr

RbePT

Rkum

sMRsáwt

Gg;eKøs

)araMg

RmHRsuk

Momordica

Cucurbitaceaea

Karavella

Bitter gourd

Margose

charantia

(melons)

Sushavi

Bitter

A piquants

cucumber

Paroka

RmHeRBA s

Ocimum

Labiateae

tenuiflorum

(mints)

Vishnu priya Holy basil Tulasi

Basil des moines

Divya Bharati Krishnamul

kareRbIR)as;

eKniyayfa vaGacBüa)al TwkenamEp¥m)an. sarFatu cRmaj;ecjEpørbs;va GaceRbIsRmab;Büa)al sm<aFQamx<s;. søwkrbs;va RtUv)aneKniyay famanRbsiTæPaBRbqaMg sm<aFQamx<s; nig Catisárx<s;enAkñúgQam.

Manjari

¬edIm¦rugÁ ¬vløi¦ remottUc nenagmUl

Garcinia

Guttiferae

Tapinja

Gamboge

Gomme-

hanburyi

(flowering plants)

Teramnus

Leguminoseae

labialis

(legumes)

Luffa

Cucurbitaceae

Raja

Sponge

Eponge

aegyptiaca

(melons)

Koshataki

gourd

Vegetale

Dirgha

Smooth

Courge

patola

luffa

touchon

gitte

karRsavRCavfμI² bgðajfa vamanRbsiTæPaBRbqaMg nwgCatisárx<s;enA kñúgQam.

Masha parni

sarFatucRmaj;rbs;va RtUv)anraykarN_fa eKGaceRbIsRmab;Büa)al Catisárx<s;enAkñúgQam.

Wash sponge Patola

¬páa¦ rMeyal

Hibiscus

Malvaceae

Japa

China rose

Hibiscus

Rosa-sinensis

(mallows)

Rud-

Shoe flower

Rose de

hrapushpra

Chinese

Chine

hibiscus

¬edIm¦ rak;)at

82

Droogmansia

Leguminoseae

godefroyana

(legumes)

sarFatucRmaj;ecjBIsøwk rbs;va RtUv)anraykarN_fa eKGaceRbIsRmab;Büa)al CatisárenAkñúgQamx<s;. ¬b¤s?¦ RtUv)anraykarN_fa eKGaceRbIsRmab;Büa)al sm<aFQamx<s; nig Catisár enAkñúgQamx<s;.


CM gw Tw k e n a m E p¥ m e n A k m<ú C a

taragTI17³ rukçCatiEdleKsÁal; sRmab;Büa)alTwkenamEp¥m enAkm<úCa ¬t ¦ Exμr

RbePT

Rkum

sMRsáwt

Gg;eKøs

)araMg

lðúgxVg

Jatropha

Euphorboaceae

Kanana

Purging

Medicinier

curcas

(spurges)

eranda

nut

des

Parvata

Barbades

yeranda

Feve d’enfer

lVaRsuk b¤ edImlab

Ficus

Moraceae

racemosa

(mulberries)

Udumbara

Gular fig

GMBi;lTwk

Anacardium

Anacardiaceae

Shoephahara

Cashew

occidentale

(cashews)

Pithecello-

Leguminoseae

Manila

bium dulce

(Legumes)

tamarind

sarFatucRmaj;ecjBIsøwk rbs;va RtUv)anRsavRCav edIm,IrkemIl ERkgvaman RbsiTæPaB RbqaMgTwk nwgenamEp¥m. edayeRbICamYyTwkXμúM vamanRbsiTæPaB sRmab; Büa)alCatisár x<s;enAkñúgQam.

Cluster fig Country fig

sVaycnÞI

kareRbIR)as;

Cajou Acajou

sarFatucRmaj;ecjBIsøwk rbs;va RtUv)anraykarN_fa eKGaceRbI eFVIeGayCatisár enAkñúgQamrbs; stVkNþúrFøak;cuH. søwk rbs;va Edlhals¶Üt ykmkqugTwkekþA GacBüa)alCatisár enAkñúgQamx<s;. sm,kedImrbs;va RtUv)aneRbIkñúgevC¢saRsþ buraN edImI,Büa)al TwkenamEp¥m.

RbPB ³ xaM LavIt/ rukçCatievC¢saRsþrbs;km<úCa ³ CRmksarFatuKImI nig kareRbIR)as;

83


VIII snÞanuRkm

85


VIII

s nÞ a nu R k m

snÞanuRkm Acarbose

GakabUs

Gal;hVa

86

GakabUs ³ vaCafñaMmYy Ep¥m BiessGñkEdlmanGRta Gal;-

Rkum sRmab;bBa©úHCatisár. GakabUs KWCaeQμaHrYm sRmab;»sfRKab; Edl eRbIedIm,IBüa)al CMgWTwkenamEp¥m RbePT 2. varaMgxÞb; Gg;suIm Edl rMlayCatiemSAsár enAkñúgmðÚbGahar. CalTæpl vaeFVIeGaykRmitCatisár enAkñúgQam mankMeNInyWt nig Tab kñúgry³eBleBjmYyéf¶ CaBiess bnÞab;BIkarbriePaKGaharPøam². vasßit enAkñúgRkum»sf EdlehAfa Gal;hVaKøúykUsuIdas GInIb‘ÍT½r (Alpha-glucosidase inhibitors). eQμaHBaNiC¢ kmμ rYmman KøúykU)ay (glucobay) eRbkUs (precose) nig ERbndas ( prandase).

b‘uymIn eRcInenAkñúgTwkenam vak¾Gac CYyBnüWt dl;kareFVIeGayxUctRmg enampgEdr. Albumin

Gal;b‘uymIn KWCaRbePT

RbUetGuIn samBaØmYy. varYmman Gal;b‘uymIn EdlCaRbUetGuIn EdleKeXIj manenAkñúgCatirMGilBN’s rbs;s‘ut. Albuminuria

Gal;b‘uymIn kñúg

Twkenam³ KWCalkçxNÐmYy EdlTwk

enammanCati Gal;b‘uymIn eRcInCag Fmμta. CatiGal;b‘uymIn enAkñúgTwkenam mann½yfa vak¾GacCasBaØamYy énCMgW tRmgenampgEdr. brimaNGal;b‘uymIn ticenAkñúgTwkenam eKehAfamIRkU Gal;Acidic foods GaharmanCati b‘uymIn (microalbumin). GasuIt ³ GaharmanCatiGasuIt dUcCa RkUcqμar nig TwkexμH RtUv)aneKrkeXIjfa Alpha cells ekasikaGal;hVa³ vaeFVIeGaykarrMlayCati kabUnGuIRdat ekasikaGal;hVa CaRbePTekasika enA yWt ehIyrkSakRmitCatisárkñúgQam kñúglMEBg Edlplit nig beBa©jCati eGayenAefr. G½rm:Un mü:ag ehAfa Køúykaháúg (glucagon) . ragkayeyIg bBa¢Ún Agiotensin-coverting enzyme (ACE) sBaØamYy eTAeGayekasika Gal;hVa inhibitors fñaMbBa©úHsm<aFQam edIm,IeGayvaplit G½rmU:n KøúykahÁúg BYk ACE ³ KWCa»sfRKab; EdlbBa©úH enAeBlEdlCatisár enAkñúgQamFøak; sm<aFQam. sRmab;GñkCMgWTwkenam cuHTabeBk . bnÞab;mk KøúykahÁúg eFVI


s nÞ a nu R k m

dMeNIrmkkan;eføIm EdlenATIenaH vaRtUv Anti-diabetes drugs fñaMBüa)al )anbeBa©j eGaycUleTAkñúgcrnþQam TwkenamEp¥m ³ »sfBüa)alCMgWTwk sRmab;karbegáItfamBl. ekasikaenH enamEp¥m EdlrYmman »sfRKab; nig eKykeQμaHtam Gal;hVa EdlCatY GaMgs‘uylIn sRmab;cak;. GkSrdMbUgeK enAkñúgPasaRkic ehIy Avandia Gav:g;düa ³ KWCaeQμaH eBlxøH eKsresrva (α). BaNiC¢kmμ én»sfBüa)alTwkenamEp¥m Alpha-glucosidase inhibitors enAkñúgRkum rUsuIKøItahSÚn (rosiglitazone) RkumTb;sáat; Gg;sIum Gal;hVa Edllk;enATIpSar edayRkumh‘un»sf køúykUsIudas ³ KWCaRkum»sfRKab; eQμaH GlaxoSmithkline. sRmab;Büa)al CMgWTwkenamEp¥mRb ePT 2. varaMgxÞb; Gg;suIm EdlrMlay "Bad" cholesterol kUeLesþrul GamIdug enAkñúgmðÚbGahar. GaRkk; ³ RbCaCnsamBaØ niymehA vafa Catixøaj;GaRkk;. vaKW CakUeLesþrul Amylase Gg;sIumGamILas ³ Ca lIb:URbUetGuIn Edlmandg;suIetTab. Gg;suImmYy EdlbMEbkCatiGamIdug nig KøúykahÁúg. GamILas manenAkñúgTwk Balanced diets tulüPaBrbb mat;mnusS nig lMEBg. Gahar ³ Gahar mantulüPaB CYy RKb;RKgkRmiCati KøúykUs enAkñúgQam Amylopectin and amylose edaydak;kMhit dl;kareRbICati kabUnGamILÚbiucTIn nig GamILÚs ³ GuIRdat EdlRtUvrMlaycUlkñúgxøÜn y:ag vaCaCatisár )anmkBI GamIdug. sarFatu rh½s dUcCa)ay dMLÚg nMb½ug nig KuyTav BIrenH manenAkñúgGahar GamIdug. mI CaedIm xN³Edlkat;bnßykareRbI GamILÚbuicTIn mancMnYn 70 PaKry én CatieRbg eGay)andl;cMNucGb,brima GamIdug eTaHbICaPaKryrbs;va mankar enAeBlqa nig econmðÚbGahar. GnuERbRbYl eTAtammðÚbGaharepSg²kþI. sasn_ naeBlbc©úb,nñ KW dak;kMhit kar ]TharN_ cugGgár man GamILÚbuicTIn eRbICati kabUnGuIRdat EbbenH RtwmmYy nig snÞsSn_Catisárx<s; CagGgárRKab; PaKbYnénGahar nig RbUetGuIn mkBImðÚb EvgxøH dUcCa GgárnagmøiH. dUecñH RbePT Gahar dUcCaRtI sac; su‘ut mkRtwm GgárEdlman GamILÚs eRcInRtUveK brimaNdUcKña. eKk¾pþl;Gnusasn_ Edr yl;fa manRbeyaCn_dl;GñkCMgWTwk fa GaharEdlmantémøsnÞsSn_Catisár enamEp¥m dUcCaBBYkmI EdleFVIBIsENþk x<s; Cag 70 PaKry KYrEtRtUvecosvag. )ay Edlman GamILÚs cMnYn 37 GaharTaMg enaH rYmman )ay dMLÚgEp¥m PaKry. nMb½ug nMcaéxV nuMbBa©úk EdleFVIBIGgár b¤¤ sENþk)ay. GaharBak;kNþaleTot KYrEt)anmkBI EpøeQI nig bEnø.

GamILas

GamILÚbuicTIn

GamILÚs

87


VIII

s nÞ a nu R k m

Beta cells

RsþI nig bursmanTMgn;Fmμta

ekasika Eb‘ta Caekasika Edlplit GaMgsu‘uylIn. ekasika Eb‘ta enH sßitenA kñúgkMBktUc² énlMEBg. ekasikaenH dak;eQμaHtamtYrGkSr Eb‘ta EdlCatYr GkSrTIBIr enAkñúgPasaRkic. eBlxøH eKsresrvafa ekasika (β). Biguanides

RsþI nig bursFat;elIsTm¶¶n;

RsþI nig bursFat;RCul

Eb‘ta

ekasika Eb‘ta ³ TUlMTUlayCMnYsBaküCati KøúykUs enA

fñaMBBYkb‘ÍhÁanIt ³

b‘ÍhÁanIt dUcCaemth½VrmIn (metformin) KWCaRkum»sfRKab; EdlbBa©úHCatisár enAkñúgQam edaykat;bnßyCatiKøúy kUs Edlpliteday eføIm nig edayCYy eGayragkayeyIg eqøIytbeTAnwg GaMgsu‘uylIn )ankan;Etl¥RbesIr. Blood glucose

KøúykUs kñúgQam ³

KøúykUs kñúgQam CaCatisársMxan;Cag eK enAkñúgQam nig CaRbPBsMxan; én famBlragkay. CatiKøúykUs enAkñúg Qam RtUvvas;Ca mIlIRkam kñúgQam mYyedsIulIRt.

kñúgQam. b:uEnþ vaminRtwmRtUvtamBakü bec©keTseLIy. Body mass index

pleFobTm¶n;

xøÜn nig km<s; ³ CapleFobTm¶n;

xøÜn nig km<s; EdlKNna edaykar EckTm¶n;mnusSmñak; CaKILÚRkam CamYy nwgkm<s;mnusS KitCaEm:Rtkaer:. GgÁkar suxPaBBiPBelak cat;TuksnÞsSn_ ¬pl eFobenH¦ BI 25 KILÚRkam kñúgmYyEm:Rt kaer: eTA 30 KILÚRkam kñúgmYyEm:Rtkaer: CakarelIsTm¶n; b¤ eRcInCagenH Cakar Fat;. enAcenøaH 18>5 eTA 25 KILÚRkam kñúgmYyEm:Rtkaer: KWCaTm¶n;Fmμta ehIy cenøaH 16>5 eTA 18>5 KILÚRkam kñúg mYyEm:Rtkaer: KWCakarsÁmeRkamTm¶n; F¶n;F¶r. sRmab;RbCaCnGasuI tYelx TabCagenH edaykarcat;Tukfa elIs Tm¶n; KWcab;BI 22 eTA 25 KILÚRkam kñúg mYyEm:Rtkaer: ehIykarcat;Tukfa Fat; elIsTm¶n; KWcab;BI 26 eTA 31 KILÚRkam kñúgmYyEm:Rtkaer:.

Blood glucose meters

Rbdab;vas;sárkñúgQam ) Calories kaLÚrI ³ kaLÚrI KWCaÉkktþa and test strip (RsÞIb b¤ bnÞH tMNageGayfamBl Edlpþl;eday sMrab;eRbIvas;Catisár Gahar. kabUnGuIRdat RbUetGuIn Cati kñúgQam ) ³ ]bkrN_TaMgenH xøaj; nig CatiGal;kul CaGñkpþl;kaLÚrI

(

]bkrN_BinitüCatisárenAkñúgQam

bnÞHRkdasBinitüCatisár 88

CYyRKb;RKgCMgWTwkenamEp¥¥m nig bBaða Tak;Tg. eKeRbI RsÞIb edIm,IykQam eRkaymk eKykvas‘kbBa©ÚleTAkñúg ]bkrN_ sMrab;vas;Catisár.

Blood sugar

CatisárkñúgQam ³

enAkñúgrbbGahar. xøaj;man 9 kaLÚrI enAkñúgmYyRkam CatiGal;kul man 7 kaLÚrI ehIy kabUnGuIRdat nig RbUetGuIn KWdUcKñaman 4 kaLÚrI.

Carbohydrates

CatikabUnGIuRdat ³

CatisárenAkñúgQam RtUv)aneRbIy:ag kabUnGuIRdat CaGaharUbtßmÖsMxan;mYy


s nÞ a nu R k m

kñúgcMeNamGaharUbtßmÖsMxan;TaMgbI enA kñúgGahar ¬BIreTotenaH KWRbUetGuIn nig xøaj;¦. GaharEdlpþl;kabUnGuIRdat KW BYkGamIdug dUcCa Ggár nMb½ug bEnø EpøeQI plitplTwkedaH nig sár. kabUnGuIRdat k¾maneQμaHpgEdrfa Ca sakarIt (saccharides) ehIyvamanbTxagcug GUs(ose)mkBIBaküRkicKøkW sU (gleukos) Edlmann½yfa RsaEp¥m. BBYk kabUnGuIRdat sMxan;² CamUldæanenaH KW m:UNUsa karIt (monosaccharides) Catisár samBaØdUcCa KøúykUs RhVúctUs nig háa LaktUs . BBYk m:UNUsakrIt cMnYn BIr GacP¢ab;Kña edIm,IbegáItCa DIsakarIt (disaccharides) dUcCa s‘ucRkUs ¬ KøúykUs nig RhuctUs ¦ nig Lak;tUs ¬KøúykUs nig RhVúctUs¦. karcgP¢ab; Kña rvagBI 3 eTA 10 m:UNU sakarIt RtUv )aneKehAfa GUlIháÚsakarIt . BYk GUlIháÚsakarIt TaMgGs;enH rYmman RhVúctUs GUlIháÚsakarIt EdlcRmaj; ecjBIEpøeQI nig bEnø EdlRtUv)aneK eRbICaeRKOgEp¥mEkøgkøay nig CafñaM CMnYyGahar . BYkva k¾rYmmanExScgVak; m:UelKul RhVúctUs EdlcgP¢ab;Edr . BYk b:UlIsakarIt KWCaRkumsμúRKsμajbnþic énRkum kabUnGIuRdat EdlrYmman m:UNUsakarIt CaeRcIn EdlP¢ab;Kña. eRkABI GamIdug vak¾manBYk KøIkUEhSn EsluyLÚs nig GIunuylIn .

Cellulose

EsluyLÚs ³ vaCa

smasFatusrIragÁ EdlKWCasmasFatu sMxan;mYy énCBaa¢MgekasikarukçCati nig srésbEnø ¬RbEhlCa 90 PaKry enA kñúgCatisréskb,as¦. dUcCaBYk GamIdug nig CatisárbMrugEdr EsluyLÚs KWCa b:UlIsakarIt EdlCa kabUnGIuRdat sμúRKsμaj EdlrYmman m:UelKul KøúykUs mYycMnYn EdlcgP¢ab;KñaenA ExScgVak;RsbKñamYy ¬CaeRcInry dl; Cag 10>000 Ékta D-glucose¦. eTaHbICavaminGacrMlay tampøÚvGahar kþI EsluyLÚs Gacb:HBal;dl;kar rMlayGahar ehIyvaeBlxøH RtUv)aneK sÁal;fa CaCatisrésenAkñúgGahar. dUcCa Epøe):am kar:ut nig sENþk KWCa RbPBCatisrésrlay EdlBnüWt el,Ón rMlayGahar edayBBYkGg;sIum. sRmab;ehtuplenH vamantémøsnÞsSn_ CatisárTab. Catisrés minGacrMlay )an rYmman sm,kEpøeQI nig bEnøxøH RBmTaMgknÞk; k¾CYyBnüWtskmμPaB Gg;sIum pgEdr. b:uEnþ enAeBlEdlCati srésminrlayTaMgGs;enaH RtUv)aneK ykeTAkineGaym:dæéx dUecñH skmμPaB Gg;sIum minRtUv)aneFVIeGayyWteToteT ehIyGahar RtUv)anrMlayya:gelOn. sRmab;ehtuplenH )ays nMb½ug nig KuyTav mI Cajwkjab; mansnÞsSn_ Catisár dUcKñanwgsmasFatuBN’etñat Edl)anmkBIknÞk; Edl)anRsitecj BIRKab;Ggár xusBIRKab;GgársRmUb b¤k¾ Cardiovascular énsrésQamebHdUg ³ EdlTak;TgnwgebHdUg nig RsUvsaLITaMgmUl. srésQam .

EsluyLÚs

89


VIII

s nÞ a nu R k m

EdlTak;TgnwgxYr Creatinine eRkGaTInIn ³ Caplit k,alxagmux ³ EdlTak;Tgnwg plsMNl;BICati RbUetGIun enAkñúgGahar

Cerebral

CITIn

eRkGaTInIn

kUeLesþr:ul l¥

kUeLesþr:ul GaRkk;

90

eserRbum EdlCaEpñkxagmuxbMput nig d¾ nig BIsac;dMuragkay. eRkGaTInIn RtUv sMxan;bMput énxYrk,alTaMgmUl . )anbeBa©jmkeRkA edaytRmgenam . enAeBlEdlCMgWtRmgenam vivtþn_eTAmux Chitin CITIn ¬Catisármüa:gbegáIt kRmitCati eRkGaTInIn enAkñúgQam PñaseRkA énekasikastV¦ ³ vaKWCa nwgekIneLIg . kabUnGIuRdat sμúRKsμajbnþicmYy Edl tamlkçN³KImI RsedogKñaeTAnwg Es- Daonil davnIl ³ CaeQμaH luyLÚs EdlCa b:UlIsakarIt enAkñúg BaNiC¢kmμ sRmab; KøIbg;køamIt rukçCati. RbPBrbs;va rYmmanCBaa©Mg (glibenclamide). ekasika b¤ pSit nig sm,kstVl¥it kþam bgÁar bgág . QITIn rYmmanExScgVak; Dextrose dicRsþÚs ³ vamann½yfa d¾Evgén N-acetylgluco samine EdlCa KøúykUs ehIyCajwkjab; RtUv)aneRbI BBYk m:UNUsakarIt )anmk BIKøúykUs. edIm,IniyayeyageTAdl; sIur:U dicRsþÚs EdlplitedayeRbI Gg;sIummüa:g ehA Cholesterol kUeLesþr:ul ³ Caxøaj; fa GamILÚKøúykUsuIdas (amyloglmYyRbePT EdlplitedayeføIm Edl cosidase) . eXIjmanenAkñúgQam . vak¾eXIj manenAkñúgGaharxøHpgEdr . kUeLesþr:ul Diabeta DIy:aEb‘ta ³ eQμaHBaNiC¢ RtUv)aneRbIedayragkay edIm,Iplit kmμsRmab; KøIbg;køamIt . G½rm:Un nig begáItCBaa¢Mgekasika . kUeLesþr:ull¥ cab;yk kUeLesþr:ul Edl Diabetes mellitus TwkenamEp¥m ³ elIsBIkñúgQameTAkan;eføIm sRmab;kar sMedAeTAelI TwkenamEp¥mRbePT 1 nig kMeTcecal xN³Edl kUeLesþr:ul Ga- 2 RBmTaMgTwkenamEp¥m eBlmanépÞ Rkk; sþúkCatixøaj; enAEpñkxagkñúg én eBaH. enAkñúgTwkenamEp¥mRbePT 1 lMEBg ElgplitCati GaMgs‘uylIn. CBaa¢MgsrésQam . dUecñH CatisárkñúgQam minGac Corn starch GamIdugeBat ³ vaRtUv cUleTAkñúgekasika edIm,IeRbIR)as; )aneRbIedIm,Iplit sIur:U RhuctUs x<s; . sRmab;famBl . enAkñúgTwkenamEp¥m RbePT 2 lMEBgminplit GaMgs‘uylIn Coronary énsrésQam RKb;RKan; b¤k¾ ragkayminGaceRbI GaMgkUr:UENr ³ EdlTak;TgenAnwgsrés s‘uylIn eGay)anRtwmRtUv. Twkenam QamRkhm EdlenACMuvij nig ciBa©wm Ep¥meBlmanépÞeBaH ekItmanenAGMLúg ebHdUg . eBlmanépÞeBaH ehIyCaTUeTA va)at;eTA


s nÞ a nu R k m

vij bnÞab;BIkarsRmalkUn . b:uEnþ vanwg Dianomax DIy:aNUm:ak; ³ begáInhaniP½ydl;mþay EdlnwgGacekIt eQμaHBaNiC¢kmμsRmab; DIya:mIRkug CMgWTwkenamEp¥m enAeBlGnaKt . EdlRtUvEkERb . Diabetic

GñkmanTwkenamEp¥m ³

Dianorm-In

DIy:aNmGuIn ³

Diaprel MR

DIy:aeRbl GwmEGr ³

KWCamnusS EdlekItmanCMgWTwkenamEp¥m eQμaHBaNiC©kmμ sRmab; KøIkøasuIt. b¤ GVI mYyTak;TgnwgCMgWTwkenamEp¥m .

eQμaHBaNiC¢kmμ sRmab; DIya:mIRkug Diabetic foot dMe)AeCIgbNþal EdlRtUvEkERb . BICMgWTwkenamEp¥m ³ BakümYy sMedA eTAelIbBaðaeCIg bNþalmkBICMgWTwk Disaccharides DIsakarIt ³ enamEp¥m . Rkumsár EdlmansársamBaØ cMnYnBIr ¬m:UNUsakarIt¦ . ]TahrN_ rYmman Diabeton DIy:aebtun ³ sucRkUs (sucrose) EdleFVIBI KøúykUs eQμaHBaNiC¢kmμ sRmab; DIya:mIRkug nig RhuctUs nig Lak;tUs EdlrYmman EdlRtUvEkERb . KøúykUs nig haáLak;tUs . ma:ltUs KW N-Acetylglucosomine BIrÉkta. Diabex DIy:abic ³ eQμaHBaNiC¢kmμ BaküDIsakarIt mann½yfa smasFatu sRmab; emthV½rmIn (metformin) . sárBIr ehIyBaküenH mkBIPasaRkic : DIs : Edlmann½yfa BIr BaküLataMg Diaformin DIy:ahV½rmIn ³ eQμaH sakar:Um Edlmann½yfa sár nig bT BaNiC¢kmμsRmab; emthV½rmIn. xagcug (ide) sRmab;begáIteTACanam enAkñúgKImIviTüa.

karbnSúT§Qam (karlagQam ) ³ karbnSúT§Qam yk

Dialysis

Diuretics

fñaMbBa©úHTwkenam ³

FatuBulecj . vaeFIVdUcmuxgartRmg fñaMenHbegáInkarbeBa©jTwkenam . enam EdlminmanbBaða .

DIy:amIRkug ³

Duodenum

Dianben

dMe)AdMNak;kaldMbUg

dMe)AGñkTwkenamEp¥m

DuyGUedNUm ³

EpñkéneBaHevontUc eQμaHBaNiC©kmμ sRmab; KøIkøasuIt RkBHEtmþg . (gliclazide). Diamicron

dMe)AeCIgGñkCMgWTwkenamEp¥m

EdlenACab;nwg dMe)A ¬dMNak;kalF¶n;F¶r¦

DIy:aebn ³

eQμaHBaNiC¢kmμsRmab; emthV½rmIn . 91


VIII

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GgÁkarsuxPaBBiPBelak )anesñIfa GKÁIsnIviPaKsac;dMu ³ KWCakar mnusSeyIg KYrhat;R)aNlμm² Caerog BiesaFn_müa:g EdleRbIedIm,IrkemIl ral;éf¶ eGay)an 30 naTI kñúgmYyéf¶ muxgar rbs;srésRbsaT . vavas; ry³eBl 5éf¶ mYys)aþh_. skmμPaBGKÁIsnI EdlbegáIteLIg eday sac;dMu . Fats Catixøaj; ³ Catixøaj; KWCa GaharrUbtßmÖsMxan;mYy kñúgcMeNam Endocrine glands RkeBj GaharrUbtßmÖsMxan;TaMgbI ¬BIrepSgeTot Gg;dURKIn ³ CaRkumekasika manmux enaHKW kabUnGIuRdat nig RbUetGIun ¦. garBiess EdlbeB©aj G½rm:Un cUleTA Gahar Edlpþl;Catixøaj; rYmman eRbg kñúgQam. varYmmanlMEBg EdlbeBa©j b½r eFVIBIeRbgrukçCati RKab;EpøeQI sac; GaMgs‘uylIn. man; Ta RtI nig plitplTwkedaHdéT eTot. kaLÚrIeRcInhYs nwgRtUvsþúkTuk Endocrinology Gg;dURKInviTüa ³ Caxøaj;enAkñúgragkay edaypþl;eGay CaEmkFagmYy énsrIrviTüa nig evC¢- ragkay nUvkarbRmugTukfamBl nig saRsþ Tak;TgeTAnwgRkeBj Gg;dURKIn karbRmugTuksRmab;muxgarepSgeTot . nig G½rm:Un . Electromyography (EMG)

Calikaxøaj;

Fiber (dietary)

Enzymes

Gg;sIum

Gg;sIum ³ Gg;suIm KWCa niyayeyageTAdl;Gahar Edlman

RbUetGIun plitedayragkay EdlnaM mknUvRbtikmμKImImYy dUcCa Gg;sIum plitedayRkBH edIm,ICYykarrMlay GaharCaedIm .

Euglocon

GWkøkug ³

Exercise

lMhat;R)aN ³ lMhat;

eQμaHBaNiC©kmμrbs; KøIbg;køamIt .

92

Catisrés ³

R)aN KWCaTRmg;mYy énskmμPaBragÁ kay. lMhat;R)aN RtUv)aneKeFVIeLIg edIm,IEfrkSa nig Eklm¥suxPaB nig kay sm,Tar eGay)anrwgmaM varYmman kILa nig skmμPaBdéTeTot . edIm,I eGaymansuxPaBl¥ nig edIm,Ikat;bnßy »kasekIt CMgWTwkenamEp¥mRbePT 2 shB½n§TwkenamEp¥mBiPBelak én

kabUnGIuRdat dUcCa EsluyLÚs Edl minGacrMlay)an. GaharEbbenH RtUv )ancat;TukCaGaharsMxan; sRmab;rbb Gahar EdlnaMeGaysuxPaBl¥ ehIyeK eCOfa vakat;bnßyhaniP½y EdlTak;Tg nwgTwkenamEp¥m. Catisrés kñúgGahar RtUvEbgEckecjCaBIr KWBYkEdlrlay kñúgTwk nig BYkEdlminrlaykñúgTwk . eyageTAtamsalasuxPaBsaFarN³ enAsaklviTüal½yhavWd )aneGaydwg fa Catisrés EdlrlaykñúgTwk CYy BnüWtkarrMlayGahar ehIykat;bnßy kUeLesþr:ul LDL edayP¢ab;CamYy sarFatu EdlmanCatixøaj; enAkMNat; eBaHevon EpñkxageRkam ehIybeBa©j vaecjmkeRkA tamlamk . Catisrés


s nÞ a nu R k m

EdlminrlaykñúgTwkvij CYyCMrujGahar Gangrene dMe)ArlYy ³ Cakarsøab; qøgkat;eBaHevon ehIyCYyTb;sáat;kar Calika bNaþlmkBIkarsÞHcrnþQam Tl;lamk. RbPBénCatisrés Edl b¤ karqøgemeraK)ak;etrI . rlaykñúgTwk rYmman Epøe)a:m EpøB½r sENþk nig RKab;EpøeQI. RbPBénCati Generic drugs »sfeseNrik ³ srésminrlaykñúgTwk rYmman eb:ge)a:H Ca»sf EdlminmaneQμaHBaNiC¢kmμ. Rtsk; kar:ut nig knÞk; . Fortamet

h½Vrtaemt ³

eQμaHBaNiC¢kmμ sRmab; emthV½rmIn .

TwkenamEp¥m eBlmanépÞeBaH ³ ekItmanEtenA

Gestational diabetes

eBlmanépÞeBaH ehIyCaTUeTA )at;eTA vij bnÞab;BIrkarsRmalkUn b:uEnþvabegáIt Focal cMNucskmμPaB ³ mann½y haniP½y EdlfamþayGacnwg ekItCMgW fa ekItmanenARtg;tMbn;BiessNamYy TwkenamEp¥m enAeBlGnaKt . enAkñúgxøÜn . Glibenclamide

RhuctUs ³ sársamBaØ CaeQμaHrYmrbs;

RhuctUs

KøIbg;køamIt ³

Edl EdleXIjmanCaBiess enAkñúgTwkXμMú Epø lk;enATIpSar edaymaneQμaHBaNiC¢kmμ eQI nig bEnøemImxøH k¾dUcCaeBatpgEdr. epSg² dUcCa GWkøÚháúg DIya:ebta hÁINas mIRkUNas daGUnIl nig sWmI daGUnIl . Fruit EpøeQI ³ EpøeQI mkBItMbn; RtUBic dUcCa mñas; lðúg sVay hak;dUcCa Gliclazide KøIkøasIut ³ CaeQμaHrYm mantémøsnÞsSn_Catisárx<s;. b:uEnþ eday rbs; sulfonylurea Edllk;enATIpSar sarvaman kabUnGIuRdat Tab bnÞúkCati edaymaneQμaHBaNiC¢kmμepSg² dUcCa sárkñúgQam mkBIEpøeQITaMgenH KWman DIya:mIRkug DIya:NmGIun . »sfEdl kRmitTabEdr ehIyvaGachUb)aneday EkERb rYmman ermIRkug DIya:Ebtug esrI edayGñkCMgWTwkenamEp¥m . DIya:n½rma:k; DIy:aERblGwmEG‘ Diaprel MR nig G‘uynI DIya:mIRkug. Galactose háaLak;tUs ³ KWCasár samBaØ EdlminsUvCaEp¥mdUcCa KøúykUs Glitazone KøItüahSÚn ³ CaBaküepSg Edlpþl;famBl sRmab;srIragÁ Edl mYyeTotsRmab; thiazolinedione . manCIvit . vamanenAkñúgplitplTwk edaH nig C½rekAs‘UFmμCati Edlplit Glomeruli ekasikaénPñaseRcaH edayrukçCati rYmman saraysmuRT rbs;tRmgenam ³ CasMNuMtUc² én ¬seaweed¦ ehIyk¾RtUvsMeyaKeday srésQamragCargVg;² enAkñúgtRmg ragkaypgEdr . enamEdlenATIenaH mankareRcaHQam Fructose

søaksBaØaGahar EdlmansnÞsSn_Catisár

sulfonylurea

háaLak;tUs

KøIbg;køamIt

KøIkøasuIt

93


VIII

s nÞ a nu R k m

KøúykUs

evC¢bNÐit Brand-Miller ¬CnCatiGURsþalI¦ 94

ehIybeBaa©jecalsarFatu EdlCakak rMlay nig RCabcUlkñúgxøÜnelOnb:uNÑa sMNl;. køÚemrulus (Glomerulus) Ca ehIyRtUv)aneRbIedIm,ITsSn_Tay GMBI namÉkvcn³ . plb:HBal;énGahar eTAelIkRmitCati KøúykUs kñúgQam . ]TahrN_ kabUnGlucobay KøúykUéb ³ vaCaeQμaH GIuRdat enAkñúg)ay RtUv)anrMlayya:g BaNiC¢kmμ»sf GakabUs Edlplit rh½s ehIyeFVIeGayCati KøúykUs enAkñúg edayRkumh‘un»sf Bayer. QamekIneLIgeRcInCag kabUnGIuRdat enAkñúgKuyTav-mI EdlRtUvrMlayyWt Glucagon Køúykaháúg ³ CaG½rm:Un Cag. TsSn³Tan sRmab;snÞsSn_ Edl plitedayekasikaGal;haV enAkñúglM- cMNat;fñak;GaharepSg² RtUv)anbegáIt EBg. vaeFVIeGayCati KøúykUsekIneLIg. eLIgedayRkummYy EdldwknaMeday »sf Køúykaháúg cak; GaceRbIedIm,IBüa- David Jenkins EdlCaGñkÉkeTs )al bBaðaCatisárkñúgQamcuHTabxøaMg . GaharrUbtßmÖ kaNada enAskl viTüal½y tUr:untU kalBIqñaM 1981 . enA GlucoseKøúykUs ³ sársamBaØ Edl eBlEdlsnÞsSn_enaH )anbegáIteLIg CaRbPBfamBlsMxan;mYy enAkñúgsrI- eKsnμt;fa KøúykUs suT§ RtUv)anrMlay ragÁmanCIvit nig CasmasFatumYy én nig RCabcUlkñúgxøÜn elOnCagGahar kabUnGIuRdat. eKsÁal;vaCa edcRtUs déTeTot EdlmanCati kabUnGIuRdat. pgEdr . dUecñH KøúykUs k¾RtUvkMNt;famantémø 100. b:uEnþ cab;taMgBIeBlenaHmk eK Glucose-fructose KøúuykUsrkeXIjfa kabUnGIuRdat )anmkBIGgár RhuctUs ³ CaBakükaNada sMedAeTA páamøiH mantémøsnÞsSn_Catisár 109 elI sIur:UeBat Edlman RhuctUs x<s;. BIeRBaH vaRtUv)anRCabcUlkñúgxøÜnelOn Cag KøúykUs suT§eTAeTot ehIyman Glucophage KøúykUhVas ³ plb:HBal;eTAelIkRmitCatisár enAkñúg CaeQμaHBaNiC¢kmμrbs; emthV½rmIn QamxøaMgCag. krNIdUcKñaenH ekItman Edlpliteday Rkumh‘un»sf Gaemrik cMeBaH ma:l;tUs EdlCa DIsakarIt plit Bristol-Myer Squibb. eLIgCaEpñkmYy énkarplitRsaebor EdlmantémøsnÞsSn_Catisár 105. Glumetza KøúyemthSa ³ témøsnÞsSn_Catisár énRbePTGahar CaeQμaHBaNiC¢kmμrbs; emthV½rmIn . epSg² kñúgRkumEtmYy dUcCa Ggár nig dMLÚg GacxusEbøkKñaCaxøaMg. karERb Glycemic Index (GI) RbYldéTeTot GacbNaþlmkBI karTMu snÞsSn_Catisár ³ GRtaEdlfa etI b¤k¾ rebobcm¥inGahar nig GVIEdlyk RbePTepSg² énkabUn GIuRdat RtUv)an


s nÞ a nu R k m

mkbriePaKCamYyva. ]TahrN_ )aysuTæ mantémøsnÞsSn_Catisárx<s; Cag)ay EdlbriePaKCamYyGahardéTeTot dUc CaRtI. dUecñHeKeGayeyabl;fa GñkCMgW TwkenamEp¥m minRtUvbriePaKGahar Edl sm,Úr kabUnGIuRdat mYymuxeLIy . TsSnavdþI GaharrUbtßmÖ KøInik Gaemrik )ane)aHBum<taragGnþrCati enAcenøaHqñaM 1995-2002 . GñkniBn§Can;x<s; én taragTaMgenaH KW Jennie Brand- Miller EdldwknaMEpñk GaharrUbtßmÖmnusS enA salaviTüasaRsþ m:UelKul nig mIRkub enAsaklviTüal½y sIutnI. Rkumrbs; Kat; )anQanmuxeK enAkñúgkarRsavRCav snÞsSnCatisár Gs;ry³eBlCagmYy TsvtSr_mkehIy. eRkABIkareFVIBiesaFn_ eTAelIGaharCag 400mux esvaRsav RCavsnÞsSn_Catisár énsaklviTüal½y suItnI e)aHBum<Caerogral;Ex nUvTsSnavdþI eGLicRtUnic CaPasaGg;eKøs nig Pasa cin (http://ginews.blogspot.com nig http://ginewschi.blogspot.com) . RkumCnCatiGURsþalIenH k¾dMeNIrkarmUl dæanTinñn½y www.glicemicindex.com nig )ane)aHBum<pSay bBa¢Itémø snÞsSn_ Catisár CaPaGg;eKøs-cin nig bnÞúkGaharGasuI TUeTACag 100mux . GahardUc Ca)aydMeNIb )aycMhuy nMb½ug nig dMLÚg Ep¥mCaedIm mantémøsnÞsSn_Catisárkñúg QamelIsBI 70 EdleKcat;Tukfa man kRmitx<s;. GahardUcCabbr nig dMLÚg es¶ar RtUvcat;Tukfa mansnÞsSn_enH mFüm Edlmantémø cenøaH 69 mk 56 RtUvcat;Tukfa man\TæiBlmFümeTAelI

kRmitCatisárkñúgQam . GahardUcCa bbr nig KuyTav-mI nig dMLÚges¶ar RtUv Etcat;Tukfa mankRmitmFüm. témø snÞsSn_ 55 b¤ TabCagenH bgðajBIpl b:HBal;tic eTAelIkRmitCatisár enAkñúg Qam ehIyvamanGahardUcCa eBat Rtav eck nig KuyTav-mI CaedIm. enA RbeTskm<úCa eKeGayeyabl;fa mnusS manCMgWTwkenamEp¥m KYrEtykcitþTukdak; dl; kabUnGuIRdat EdlmantémøsnÞsSn_ CatisárTabCag 40 dUcCa taMgh‘un bbr knÞk; nig GaharEdleFVIBIemSAemIm QUk. kñúgcMeNamGaharcin eKrkeXIj fa daMs‘ug nig nM):avcMhuy Edlmanjat; sac; k¾mantémøsnÞsSn_CatisárTab Edr. b:uEnþ pliitplTaMgenH Gacman Catixøaj;eRcIn ehIyeFVIeGaymanbBaða kan;EtF¶n;F¶r sRmab;GñkCMgWTwkenam Ep¥m EdlelIsTm¶n; b¤ Fat;RCul.

kareFVI etsþ rksnÞsSn_Catisár ³ Glycemic Index testing

kareFVIetsþsnÞsSn_CatisárkñúgQam man Bak;B½nædl;kareGaymnusSTTYlTan Gahar EdlmanCati kabUnGuIRdat nig karvas;plb:HBal; eTAelIkRmitCati sárenAkñúgQam enAkñúgry³eBl 2em:ag eRkay. enAsaklviTüal½ysuItnI kar eFVIetsþenH Bak;B½nænwgmnusSsuxPaBl¥ y:agehacNas; 10 nak; EdlRtUveK eGaybriePaKCati kabUnGuIRdat Edl GacrMlay)ancMnYnBI 10 eTA 50 Rkam bnÞab;BIkarGt;Gahar kalBIeBlyb;. enAkñúg»kasepSgeTot mnusSEdlRtUv

)ay nMb½ug dMLÚg nig mI suTæEtmansnÞsSn_Catisárx<s;

95


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eFVIetsþenaH RtUv)aneKeGayGahareyag Edlrlayy:agrh½s EdlRtUvkMNt; mantémø 100 kñúgbrimaNdUcKña nwgCati KøúykUs suTæ. tMbn;eRkamkareqøIytb KøúykUs kñúgQam sRmab;GaharEdl eFVIetsþ k¾RtUv)anvas; ehIyEckCamYy tMbn;eRkamkareqøIytb cMeBaHry³eBl 2em:ag énKøúykUs. témøCatisárenAkñúg Qam KWCatYelxmFüm sRmab;mnusS EdleFVIetsþTaMgenaH. Glycemic load

bnÞúkCatisár

kñúgQam ³ vas;brimaN kabUnGuIRdat

enAkñúgGahar bEnßmelItémøsnÞsSn_ Catisár Edlvas;EtKuNPaB cMeBaHkar EdlfaetI kabUnGuIRdat RtUv)anrMlay rh½sy:agNa ehIyRsUbykedayragÁ kayrh½sy:agNa. dUecñH vaCameFüa)ayl¥bMput EdlBüakrN_plb:HBal; énRbePTepSg² nig brimaNGaharenA kñúgkRmitCatisárenAkñúgQam. Gahar EdlmanbrimaN kabUnGuIRdat dUcKña Ca jwkjab; mantémøsnÞsSn_Catisár enA kñúgQamepSgKña. ]TahrN_ Epøe)a:m nig dMLÚg suTæEtman kabUnGuIRdat 30 PaKry eFobnwgTm¶n;. e):am b¤ dMLÚg EdlmanTm¶n; 50Rkam nwgman kabUnGuIRdat cMnYn 15Rkam. edaymantémø snÞsSn_Catisár cMnYn 40 e):am manbnÞúk CatisárenAkñúgQam 6 Rkam ¬40 KuN 15 Ecknwg 100¦. b:uEnþ edayehtufa dMLÚgmantémøsnÞsSn_ cMnYn 80 bnÞúk CatisárkñúgQamrbs;va KW 12 Rkam ¬80 KuN 15 Ecknwg 100¦. eyIgGac niyaymüa:geTotfa karbriePaKdMLÚg

96

nwgman\TæiBlBIrdg eTAelIkRmitCati sárkñúgQam ebIeRbobeFobCamYykar briePaKEpøe):am. xN³EdlbnÞúkCatisár manRbeyaCn_ enAkñúgkarRsavRCav Epñk GaharUbtßmÖmnusS enAsaklviTüal½y suItnI )anrkeXIjfa témøsnÞsSn_Cati sármansarRbeyaCn_eRcInCag cMeBaHGñk TwkenamEp¥m. enHmkBIGaharmanCati kabUnGuIRdat TabxøH dUcCa daMsu‘g nig nM):avcMhuyCaedIm GacnwgmaneBareBj edayxøaj;RbePTepSg²minl¥ . dUecñH eKeGayeyabl;fa KYreRbIsnÞsSn_ edIm,I eRCIserIsGahar EdlRtUvbriePaK enA kñúgRkumGahar. tamviFIenH GñkCMgWTwk enamEp¥m nwgGacTsSn_Tayfa GgárRb ePTNa KuyTavRbePTNa nMb½ugRbePT Na Edlmanplb:HBal;ticbMput eTA elIkRmitCatisár. eKalbMNgenaH KWmin RKan;EtedIm,IeRCIserIsGahar Edlman kabUnGuIRdat TabeT b:uEnþ EfmTaMgeRCIs erIsGahar EdlnwgeRbIeBlyUr edIm,I rMlay nig RsUbcUlragkay. enAeBl CamYyKñaenaH vaCakarsMxan; EdlKYrEt briePaK tictYc cMeBaHGahar Edlman Cati kabUnGuIRdateRcIn dUcCa)ay b¤ Kuy Tav edIm,IkRmittémøsnÞsSn_Catisár én GaharTUeTA. edaysarehtuplenH GñkCMgWTwkenamEp¥menAkm<úCa KYrEtkat; bnßykarbriePaK)ayeGaymkRtwmcMnYn 25PaKry kñúgmYyeBl. ebIeKbriePaK )ayeRcInkRmit énCatisárenAkñúgQam nwgeLIgdl;kMBUlx<s;CageK ehIyvaRtUv kareBlyUr edIm,IvilmkFmμtavij. Rb karenH nwgnaMeGaybegáInhaniP½yénpl vi)ak EdlbNþalmkBITwkenamEp¥m.


s nÞ a nu R k m

Glycogen

CatisárbMrug ³ CakabUn

kidney dialysis

Edlmann½yfa kar

GuIRdat EdlsþúkenAkñúgeføIm sac;duM RBm lagtRmgenam . TaMgxYrk,al nig RkBH. vadMeNIrkarCa RbPBTIBIr énfamBlry³eBlxøI. dUc Hemoglobin eGm:UkøÚb‘Ín vaCaCati CaBYk GamIdug nig BBYk EsluyLÚs Edr RbUetGuIn manBN’Rkhm EdldwkCBa¢Ún KøIkUEhSn KWCa b:UlIsakarIt EdlCaRkum GuksuIEsn enAkñúgQam. saMjúaM énkabUnGuIRdat Edlman mU:elKul Hemorrhage karhUrQam KøúykUs mYycMnYnP¢ab;Kña. KWCakarecjQamtamsrés Edldac;. Glycated hemoglobin

eGm:UkøÚb‘Ín

KøIextFIt ³ CaBakümYyeTot CMnYs

Hemoglobin A1c

glycosylated hemoglobin

CaBakümYyeTot CMnYs glycosylated haemoglobin .

Glycosylated hemoglobin

High-density lipoprotein (HDL)

eGm:UkøÚb‘ÍnKøIkUsuIeltFIt ³

CaTRmg;mYyrbs; eGmU:køÚb‘Ín EdleRbI edIm,Ivas;kMhab; KøúykUs enAkñúgQam. vaRtUv)anrkeXIj edayGñkÉkeTs GIur:g; xagPaBsuaM samuyEGl r:a)a (Samuel Rahbar) .

cholesterol

kUeLesþr:ul l¥

kUeLesþr:ul HDL

CaCatixøaj;mYyRbePT enAkñúgQam Edlcab;ykCati kUeLesþr:ul EdlelIs BIkñúgQameTAeføIm sRmab;karbeBa©j ecal. eBlxøHeKehAfa kUeLesþr:ull¥. High fructose corn syrup (HFCS)

Glynase

KøIkUEhSn ¬sárbMrug¦

KøINas ³ CaeQμaHBaNiC¢kmμ vak¾RtUv)ansÁal;Ca suIr:U eFVIBIGamIdug Edl

man RhuctUs x<s;. vaCa GamIdug eBat Edlykdak;CamYy Gg;suIm edIm,IbegáIn "Good" cholesterol RhuctUs rbs;va nig bnÞab;mk layva kUeLesþr:ull¥ ³ Ca kUeLesþr:ul CamYy KøúykUs enAkñúgTRmg; suIr:U eBat lIb:URbUetGuIn dg;suIetx<s; . suTæ . vaRtUv)aneRbICakarCMnYs sRmab; s‘ucRkUs enAkñúgRbeTsCaeRcIn b:uEnþman HbA1c CaTRmg;mYy rbs;eGmU:KøÚb‘ÍnTMnak;TMngnwgkarFat; kan;EtekIneLIg suIeltFIt . nig karsuaMnwg GaMgsuylIn. man suIr:U RhuctUs x<s; cMnYnbIRbePT. HCFS-42 Hemodialysis karlagQam eKGac EdleRbICasarFatuEp¥m sRmab;RKb; eRbIBakümYyeTot Edlmann½ydUcKña KW eKalbMNgmanRhuctUs cMnYn 42PaKry ehIymanrsCatiEp¥mticCag su‘ucRkUs

suIr:UeBat Edlman RhuctUs x<s;

rbs; KøIbg;køamIt.

evC¢bNÐit Rahbar ¬CnCatiGuIr:g;¦ rUbftrbs; Jazireh Danesh 97


VIII

s nÞ a nu R k m

bnþic. HCFS-55 manRhuctUc cMnYn 55 PaKry ehIymanrsCati swgEtdUc s‘ucRkUs edayeFVIeGayvamanlkçN³ l¥ sRmab;eRbICamYyePsC¢³TwkRkUc. HCFS-90 EdleRbIenAkñúgGahar Edl mankaLÚrITab KWman RhuctUs cMnYn 90 PaKryehIyEp¥mCag s‘ucRkUs . HCFS RtUv)ansÁal;faCa GuIsUKøúykUs enA GWr:ub nig KøúykUs-RhuctUs enAkaNada.

Impaired fasting glucose (IFG)

CatisárminFmμta ³ enAeBltm

GaharkñúgsßanPaBmYy EdlkareFVIetsþ CatisárenAkñúgQam EdleFVIeLIgenA ry³eBl 8 eTA 12 em:ag eRkaykar tmGahar bgðajfa kRmitCatisárx<s; CagFmμta b:uEnþminx<s;dl;kRmitmYy sRmab;kareFVIeraKvinic½äy elICMgWTwkenam Ep¥meT . IFG k¾RtUv)aneKehAfa Ca dMNak;kaleRtomekItCMgWTwkenamEp¥m pgEdr . vamankRmitCatisár enAcenøaH Hormones G½rm:Un ³ CasarFatuKImI EdlplitenAkñúgEpñkmYy énragkay BI 100 eTA 125 mIlIRkam kñúgmYy ehIyRtUvbeBa©jmkkñúgQam edIm,ICMruj edsuIlIRt Qam. b¤ RKb;RKgmuxgarBiess² rbs;ragkay. ]TahrN_ GaMgsu‘uylIn KWCaG½rm:Un Edl plitenAlMEBg EdlR)ab;dl;ekasika Impaired glucose tolerance (IGT) déT faeBlNaRtUveRbI KøúykUs sRmab; dMNak;kal eRtomTwkenamEp¥m ³ famBl. G½rm:Un sib,nimiμt eRbIsRmab; CasßanPaBmYy EdlkRmitCatisárenA CafñaM GacmanmuxgardUc b¤ xusBI G½rm:Un kñúgQamx<s;CagFmμta b:uEnþminx<s;dl; kRmitmYy sRmab;kareFVIeraKvinic½äyCMgW Edlplitedayragkay . TwkenamEp¥meT. IGT k¾RtUv)anehAfa CadMNak;kal eRtomekItCMgWTwkenam Hyperglycemia CatisárkñúgQam x<s;CagFmμta ³ mann½yfa Catisár Ep¥mpgEdr. vamankRmitCatisár enA eRcIneBkenAkñúgQam ehIyCaTUeTA cenøaHBI 140 eTA 199 mIlIRkam kñúg mYy edsuIlIRt Qam BIrem:agbnÞab;BI)an manTak;TgnwgCMgWTwkenamEp¥m. karcab;epþImetsþ pwkCatisártam. Hypertension

sm<aFQamx<s; ³

vaKWCakarekIneLIgsm<aFQamx<s; xus Infarction karrlYyCalika ³ karrlYyCalika ekIteLIgenAeBlman Fmμta . karsÞHkarpÁt;pÁg;Qam eTAkan;srIragÁÁ Hypoglycemia CatisárcuHTab b¤ tMbn;mYyénCalika. karrlYysac;duM CagFmμta ³ mann½yfa Catisártic ebHdUg KWCakarKaMgebHdUg. eBkenAkñúgQam ¬70 mIlIRkam kñúg mYy edsuIlIRt Qam b¤ TabCagenH¦ . 98


s nÞ a nu R k m

Insulin

GaMgs‘uylIn ³ CaG½rm:Un

plitedaylMEBg EdlRKb;RKgbrimaN CatisárenAkñúgQam. G½rm:Un Edlplit edaystVciBa©wmkUnedayTwkedaH nig RtI. RbPBén GaMgsu‘uylIn stV edIm,I Büa)alCMgWTwkenamEp¥m rYmman eKa RCUk nig RtIqøam.

Inulin

GIunuylIn ³ CaCatisrés

rlayenAkñúgTwk EdleKeXIjmanenA kñúgbEnø dUcCa xÞwms xÞwm)araMg nig Ca Biess rukçCati müa:gehAfa GaTIqUk. eKeCOfa GuInuylIn pþl;rhUtdl;eTAmYy PaKbI énfamBl Edl)anmkBImðÚbGahar EdleXIjmanenAkñúg kabUnGuIRdat déTeTot nig man plb:HBal;tictYceTA Insulin analogues RsLay GaMgelIkRmitCatisár enAkñúgQam. s‘uylIn ³ CaTRmg; GaMgsu‘uylIn Islets (of Langerhans) bNþúM EdlmankareFVI visVkmμ eseNTik. ekasika Lg;ehSr:g; CabNþúM én Insulin detemir GaMgs‘uylIn ekasika EdlsßitenAkñúglMEBg Edl edtWemo ³ CaeQμaHrYmsRmab;RsLay plitG½rm:Un EdlCYyragkayenAkñúgkar GaMgsu‘uylIn Edllk;enATIpSar eday bMEbk nig eRbIR)as;Gahar CafamBl. Rkumh‘un daNWm:ak Novo Nortis eRkam ]TahrN_ ekasika Gal;hVa plitG½rm:Un eQμaHBaNiC¢kmμ LWvWenor (Levenir). Køúykaháúg ehIyekasika Eb‘ta plit G½rm:Un GaMgsu‘ylIn. eKk¾ehA vapgEdr Insulin glargine GaMgs‘uylIn fakUnekaH Lg;ehSr:g; bnÞab;BIGñkÉkeTs køasIun ³ KWCaeQμaHrYmsRmab; RsLay eraK CnCatiGaløWm:g;eQμaH pl Lg; ehSr:g; GaMgsu‘uylIn Edllk;enATIpSar eday )aneFVIkarBiBN’naGMBIva enAqñaM1869. Rkumh‘un»sf )araMg EdlmaneQμaHfa Sanofi-Aventis edaymaneQμaHBaNiC¢Isoglucose GIusUKøúykUs ³ CaBakü kmμCa Lg;TUs (Lantus). GWr:ub sMedAeTAelI suIr:UeBat Edlman Catisárx<s;.

»sfePJac ekasikacMeBaH GaMgs‘uylIn ³ Insulin

GuInuylIn

kUnekaH ekasikalMEBg

GaMgsu‘uylIn rUbPaBeday Isaak Yonemoto

sensitizers

CasarFatu EdlrYmmanRkumfñaM Edl ehAfa thiazolidin-edione b¤ehAfa glitazone EdlbegáInPaBrMejac rbs; eføIm xøaj; nig sac;duM cMeBaH GaMgsu‘uy lIn.

Ketoacidosis or diabetic ketoaci-

GasIutektUn eRcIn enAkñúgQam nig Twkenam ³

dosis (DKA)

CasßanPaBseRgÁaHbnÞan; EdlkRmit CatisárkñúgQamx<s;hYsehtu edayrYm man karxVHxatCati GaMgsu‘uylIn naM

evC¢bNÐit Langerhans ¬CnCatiGaløWm:g;¦

99


VIII

s nÞ a nu R k m

eGaymankarbMEbkCatixøaj; enAkñúgxøÜn edIm,IfamBl ehIynaMeGaymankarRb mUlpþúMCati ektUn enAkñúgQam nig Twk enam. eraKsBaØaenaHrYmman ceg¥ar k¥Üt QWeBaH køindkdegðIm dUckøinEpøeQIehIy mandegðImjab; . ebIsinCaminmankar Büa)aleT sßanPaBenH GacbNþal eGaysnøb; nig søab;)an.

Lak;tas vivtþn_enAkñúgcMeNamGñkEdl GaRs½yeTAelIplitplTwkedaH CaRb PBGaharsMxan;rbs;xøÜn. enAGasuIxag ekIt PaBmins‘URTaMcMeBaH Lak;tUs kñúg TwkedaH manCajwkjab; kñúgcMeNamnusS eBjv½y elIkElgEtenA m:ugeháalI EdlenATIenaH TwkedaHesH KWCaRbPB Gahard¾sMxan;. b:uEnþ CnGasuIxagekIt CaTUeTA manPaBFn;CageK eTAnwgTwk Ketones GasuItektUn ³ CasarFatu edaHeKaCUr EdlmanGg;suIm Lak;tas KImI EdlRtUvpliteLIg enAeBlmankar RBmTaMgRbhuk)araMg EdlmanCatixøaj; xVHxat GaMgsu‘uylIn enAkñúgQam ehIy x<s; EtmanbrimaN Lak;tUs Tab. xøÜneyIgbMEbkCatixøaj; enAkñúgxøÜnedIm,I famBl . kRmit ektUn x<s;nwgnaMeGay Lantus GaMgs‘uylIn Lg;Tus ³ manCMgW GasuIt ektUn nig snøb;. eBl CaeQμaHBaNiC¢kmμ sRmab;GaMgsu‘uylIn køasIun Edllk;enATIpSar edayRkum xøH eKehAfa xøÜnsm,Úr ektUn. h‘un Sanofi-Aventis.

GasIutLak;Tik eRcInenAkñúgxøÜn ³ CasßanPaB Edl

Lactic acidosis

Lak;tUs

Lak;tUs Casársmas EdlmanenAkñúgTwkedaHeKa

100

Lente insulin

GaMgs‘uylInyWt ³

sarFaturav énragkay b¤ Calikaman CaGaMgsu‘uylIn manskmμPaBmFüm. CamFüm GaMgsu‘uylIn RbePTenH cab; GasuIt Lak;Tik eRcInhYsehtu. epþImeFVIeGaykRmitCatisár enAkñúgQam Lactose Lak;tUs ³ Casár smasmü:ag Føak;Tab enAry³eBlBImYyem:ag eTABIr eXIjmanenAkñúgTwkedaH . varYmman em:agbnÞab;BIkarcak;. vaman\TæiBlxøaMg cMENk KøúykUs nig háaLaktUs P¢ab; bMput enAry³eBl 8 eTA 12 em:ag CamYyKña. edayplitedaymþay Edl eRkaykarcak; b:uEnþ bnþmanskmμPaB manTwkedaH Lak;tUs KWCaRbPBsm,Úr ry³eBlBI 18 eTA 24 em:ag bnÞab;BI eday kabUnGuIRdat sRmab;Tark ehIy karcak;. eKk¾ehAvafa GaMgsu‘uylIn L. vaRtUvkat;pþac;edayGg;suIm Lak;tas. karplit Lak;tas fycuH eTAtamPaB Levemir GaMgs‘uylIn LWvWemor ³ eBjv½y enAkñúgcMeNamstVciBa©wmkUn CaeQμaHrYmsRmab; GaMgsu‘uylIn edetedayTwkedaHPaKeRcIn. b:uEnþ cMeBaH emor Edllk;enATIpSar edayRkumh‘un mnusS EhSnsRmab;karplit Gg;suIm Novo Nortis.


s nÞ a nu R k m

cMNucelOg enAelI rebobrs;enA ³ karpøas;bþÚrrebob erTIn EPñk ³ CatMbn;BN’elOg

Lifestyle

changes

karpøas;bþÚr

rbbrs;enA KWedIm,ITb;sáat; b¤ edIm,IBnüa eBlkarcab;epþImekItCMgWTwkenamEp¥m RbePT 2.karpøas;bþÚrenaHrYmman kar begáIn skmμPaBragkay ¬hat;R)aN ral;éf¶lμm² ry³eBl 30naTI kñúgry³ eBlR)aMéf¶ enAkñúgmYys)þah_¦ehIy briePaKGahar eGaymantulüPaBCag mun edayman kabUnGuIRdat ticCagmun nig briePaKEpøeQI nig bEnøeRcInCagmun . karpøas;brÚþ TaMgenH k¾Gacrab;bBa©lÚ karedIr CMnYseGaykarCiHtak;suI b¤ ebIkrfynþ.

Macula

eRBOg² ragBgRkeBI sßitenACuMvij Rkluk mþúMCitmNÐlrbs; erTIn EPñk EdlRtUveRbIedIm,IGan nig emIllmi¥t.

Maltose

m:al;tUs ³ vaRtUv)ansÁal;

pgEdr CasártaMgEm:. vaCa DIsakarIt begáIteLIgeday KøúykUs BIrÉktþa. kar plitm:al;tUs BIRKab;FuBaØCati CaEpñk mYy dUcCakardMeNIrkar énplitRsa ebor nig RsavIsÁI.

Metformin

Lipids

emthV½rmIn ³

Catixøaj; ³ CaGasuItxøaj; b¤ emthV½rmIn KWCaeQμaHrYm sRmab;smas

edrIev rbs;va edayrYmmaneRbgFmμCati CatiRkmYn nig esþr:UGuIt. lIBIt GacbMEbk edayragkayeGayeTACafamBl edIm,I kareRbIR)as;.

Liver

m:al;tUs

eføIm ³ CasrIragÁmYy enAkñúgxøÜn

EdlERbkøayGahar eGayeTACafamBl kMcat;Cati Gal;kul nig CatiBul BIkñúg Qam ehIyplitTwkRbm:at; EdlCasar Fatumü:ag EdlGacbMEbkCatixøaj; nig CYykMcat;kaksMNl;kñúgxøÜn.

PaK b‘ÍháanIt Edlkat;bnßybrimaN CatisárenAkñúgefIøIm ehIybegáInkareRbI GaMgsu‘uylIn edayekasikasac;dMu. va RtUv)anlk;enATIpSar edaymaneQμaHfa KøúykUhVas (Glucophase) rIy:Uemt (Riomet) hV½rtaem (Fortamet) KøúyemthSa (Glumetza) GUb‘Íemt (Obimet) düg;ebn (Dianben) düabic (Diabex) nig düahV½rmIn (Diaformin). Microalbumin

mIRkUGal;b‘uymIn ³

mIRkUGal;b‘uymIn CabrimaNtictYc én Gal;b‘uymIn enAkñúgTwkenam EdlGac cholesterol kUeeLesþr:ul LDL ³ CaCatixøaj; eXIjenAkñúgQam Edlcab; rkeXIj edaykarBinitüBiess enAmnÞIr ykCati kUeLesþr:ul CuMvijxøÜn eTAkan; BiesaFn_. kEnøgEdlmantRmUvkar sRmab;;karCYs Culekasika nig sþúkvaTuk enAelICBa¢aMg Micronase mIRkUNas ³ CaeQμaH xagkñúg rbs;srésQamRkhm. eBl BaNiC¢kmμrbs; KøIbg;køamIt. xøH eKehAvafaCa kUeLesþr:ul GaRkk;. Low-density lipoprotein (LDL)

emthV½rmIn

evC¢bNÐit Hagerdorn ¬CnCatidaNIm:ak¦

kUeLesþr:ul GaRkk; ehAfa LDL 101


VIII

s nÞ a nu R k m

Monosaccharides

m:UNUsakarIt ³

mU:NUsakarIt KWCaRkumCatisársamBaØ dUc CaKøúykUs RhuctUs nig háaLak;tUs nig GinGaes TilKøúykUsUmIn. vaCaTRmg; mUldæan én kabUnGuIRdat nig Casmas FatupþúMbegáItCa kabUnGuIRdat EdlsaMjaMu edayrYmman su‘ucRkUs nig Lak;tUs nig b:UlIsakarIt dUcCa GamIdug nig esluyLÚsCaedIm.BaküenHmann½yfaCatisár EtmYy Edl)anmkBIPasaRkic (m:UNU) Edlmann½yfa EtmYy . GkSrLataMg sakar:Um mann½yfa sár nig BakübEnßm cug GuIt (ide) RtUv)aneRbIsRmab;begáIt nam enAkñúgKImIviTüa.

Neuropathy

CMgWsrésRbsaT ³

sMedAeTAelI CMgWRbB½næsrésRbsaT. TRmg;CMgWbIsMxan; enAkñúgcMeNamGñkCMgW TwkenamEp¥m KWCMgWsrésRbsaTEpñk Gvyv³ CMgWsrésRbsaTEpñkRbB½næ sV½ytü nig CMgWsrésRbsaTNamYy. CMgsW résRbsaTEpñkGvyv³ b:HBal;dl; RbGb;eCIg kMPYneCIg b¤ éd ehIyva bNþaleGaymankarQWcab; s<wk kar manGarmμN_cukcab; . TRmg;EdlekIt jwkjab;bMput sRmab;GñkCMgWTwkenam Ep¥menaH KWCMgWsrésRbsaT EpñkGvyv³ Edlb:HBal;CasMxan; eTAelIRbGb; eCIg nig kMPYneCIg. CMgWsrésRbsaT sVy½tü vab:HBal;dl; sYt ebHdUg RkBH Myocardial énekasikasac;dMu eBaHevon fg;TwkRbma:t; e)øakenam nig ebHdUg ³ mann½yfa Tak;Tgnwg Rbdab;bnþBUC . CMgWsrésRbsaTEpñk Calikasac;duMebHdUg . karrlYysac;duM NamYy KWmanplb:HBal; EteTAelI ebHdUg mann½yfa karKaMgebHdUg. srésRbsaTEtmYykEnøgb:ueNÑaH . N-Acetylglucosomine

Gin-GaesTIlKøúykUsUmIn ³ Gin-GaesTIl KøúykUsUmIn

102

CaCatisársamBaØ Edl)anmkBI KøúykUs. vaCasmasFatupSM sRmab; QITIn Edl eXIjmanenAkñúgsMbk b¤ sñÚkstVl¥it nig s½gç ¬xüg ex©A elos RKM¦.

Neutral

Protamine

(NPH) insulin

Hagedorn

GaMgs‘uylIn NPH ³

Ca GaMgsu‘uylIn manskmμPaByWt Edl begáIteLIg kalBIqñaM 1946 eday han;s_RKIsÞan haehádn EdlCasßabnik mYyrUb énRkumh‘un»sf eQμaH NUv:U N½rDIs . haehádn )anrkeXIjfa Nephropathy CMgWtRmgenam ³ RbUtamIn EdlykmkBITwkkamrbs;RtI CatisárenAkñúgQamx<s; nig sm<aF Edldak;bEnßmCamYy GaMgsu‘uylIn stV Qamx<s; GaceFVIeGayxUcekasika RCUk KWminmanRbsiTæPaByUrCag GaMgKøÚemrIl éntRmgenam. enAeBltRmg su‘uylIn FmμtaeT. enamxUc RbUetGuIn nwgRCabecjmkeRkA ehIycUleTAkñúgTwkenam. tRmgenam xUc ElgmansmtßPaBkMcat;kaksMNl; nig CatiTwkEdlelIs enAkñúgcrnþQam.


s nÞ a nu R k m

Noodles

mI-KuyTav ³ vamantémø

snÞsSn_CatisárTabbnþic. eyageTA tamEpñkGaharUbtßmÖmnusS enAsaklviTüal½y suItnI KuyTav-mI manlkçN³ Biess enAkñúgcMeNam kabUnGuIRdat BI eRBaH GamIdug rbs;va manRKab;emSAsár EdlCab;enAkñúgbNþaj RbUetGuIn. edIm,I eFVIeGaytémøsnÞsSn_CatisárcuH Ca Gb,brima eKeGayeyabl;fa sUmkuM cm¥inmI eGayq¥inRCuleBk. Obese

Fat; ³ EdlelIsTm¶n;hYs

ehtu. vamann½yfa pleFobTm¶n; nig km<s; mancMnYncab;BI 30 eLIgeTA. ÉenAtMbn;GasIuGaeKñy_ Gaccab;BI 26 eLIgeTA . Oligosaccharides

Oral glucose tolerance test (OGTT)

kareFVIetsþ rkTwkenamEp¥m edaypwkCatisár ³ KWCakareFVIetsþ

mYy edIm,IeFVIeraKvinic½äy kñúgdMNak;kal eRtomTwkenamEp¥m nig TwkenamEp¥m. kareFVIetsþenH RtUveFVIeLIgedaybuKÁlik EpñkEfTaMsuxPaB bnÞab;BIGñkcUlrYm )an Gt;GaharmYyyb;. eKykQamBIGñk CMgW rYcehIyeGayKat;pwkePsC¢³ Edl manCatisárx<s; . eKykQamGñkCMgW enAcenøaHeBlXøatKña 2 eTA 3 em:ag. lTæplénkareFVIetsþ RtUveRbobeFobCa mYysþg;darmYy ehIybgðajfa etICati sárRtUveRbIR)as;y:agdUcemþc enAkñúgxøÜn kñúgry³eBlmYyenaH. Oral hypoglycemic agents

GUlIháÚsakarIt fñaMRKab;bB©aúHCatisár ³ fñaMelb

GUlIháÜsakarIt KWCaRkumsár Edlmansár samBaز CaeRcIn ¬mU:NUsakarIt¦CaTUeTA mancMnYn BI 3 eTA 10. ]TahrN_ rYm man RhuctUs-GUlIháÚsakarIt Edl cRmaj;ecjBIEpøeQI nig bEnø. eday RtUveRbICaCatisársib,nimμit nig sarFatu bEnßm sRmab;GaharenaH vaTaMgGs;enH rYmman ExSsgVak; mU:elKul RhuctUs EdlP¢ab;Kña. BaküenHrYmman smas FatusárCaeRcIn ehIyvamkBIBaküRkic GUlIháÚ Edlmann½yfa mYycMnYntUc nig BaküLataMg sakarU:m Edlmann½yfa sár nig bTxagcug GuIt EdleRbIsRmab; begáItCanam enAkñúgKImIviTüa.

sRmab;GñkCMgWTwkenamEp¥mRbePT 2 edIm,IrkSakRmitCatisár eGaysßitenACit kRmitFmμtaeGay)an tamEdlGaceFVI eTA)an. »sfRbePTenH eBlxøH RtUv eKehAfa »sfRKab; RbqaMgnwgCatisár x<s;enAkñúgQam. Rkum»sfRKab;sRmab; eFVIeGayCatisár mksßitenAkRmitFmμta enHrYmman Rkum Gal;hVa KøúykUsuIdas b‘ÍháanIt s‘ulhVÚnIlUero nig düahüÚlIDIndüÚn. Overweight

bursFat;RCul

elIsTm¶n; ³ elIsTm¶n;

mann½yfa Tm¶n;elIsBITm¶n;Fmμta ¬pl eFob rvagTm¶n; nig km<s; BI 25 eTA 29>9 b:uEnþ cMeBaHCnCatiGasuIGaeKñy_ vijpleFobenH GacTabrhUtdl; 23¦.

burselIsTm¶n; 103


VIII

s nÞ a nu R k m

Pancreas

kñúgeBlGahar

muneBlGahar

lMEBg ³ KWCaRkeBjd¾FM

mYy enABIeRkayRkBH EdlbeBa©j Gg;suIm rMlayGahar mkkñúgeBaHevon EpñkxagelI . enACab;CamYylMEBgenaH KWkUnekaH Lg;ehSr:g; (Langerhans) EdlbeBa©j G½rm:Un GaMgsu‘uylIn nig KøúykUEhSn cUlmkkñúgQam. Polysaccharides

b:UlIsakarIt ³

CaRkumsaMjauMbnþicén kabUnGuIRdat Edl mansársamBaØCaeRcIn ¬m:UNUsakarIt¦ P¢ab;Kña. ]TahrN_ rYmman GamIdug nig KøIkUEhSn EdlvaTaMgBIrenHsþúk kabUnGuI Rdat. Catisár EsluyLÚs EdlCa b:UlIsakarIt epSgeTot KWCasmasFatu rcnasm<½næ mYyénrukçCati. b:UlIsakarIt déTeTotrYmman GuInuylIn EdlCaCati srésrlaykñúgTwk eXIjmanenAkñúg bEnø nig CITIn EdleXIjmanenACBaa¢Mg pSit nig sm,kkþam bgág nig bgÁar. b:UlIsakarIt k¾manekAs‘UFmμCati Edl eXIjmanenAkñgú saraysmuRT EdlRtUv)an eKeRbIy:agTUlMTUlay edIm,IeFVIeGayman cMNg;jaNGahar. Bakü b:UlIsakarIt KWmkBIBaküRkic b:UlU Edlmann½yfa eRcIn nig BaküLataMg sakar:Um Edl mann½yfasár ehIybTxagcug GuIt Edl eRbIbegáItnamenAkñúgKImIviTüa. Post-prandial

eRkayeBl

Rbg;das ³ CaeQμaH»sf

Prandase

kaNada sRmab; GakarbUs Edlplit edayRkumh‘un )ayy½r (Bayer).

Prandial

vamann½yfa Gahar . Precose

GMLúgeBlGahar ³

enAkñúgxN³briePaK

eRbkUs ³ eQμaHBaNiC¢kmμ

Gaemrik én»sfGakabUs Edlplit edayRkumh‘un )ayy½r.

dMNak;kaleRtom ekItCMgWTwkenamEp¥m ³ niyay

Pre-diabetes

eyageTAdl;dMNak;kalmYy EdlCati sárekIneLIgxusFmμta b:uEnþminTan;dl; dMNak;kalmYy EdlRtUveFVIeraKvinicä½y fa ekItCMgWTwkenamEp¥meLIy . dMNak; kalenH mann½yfa IFG (Impaired Glucose Fasting) mankRmitCatisár enAcenøaHBI 100 eTA 125 mIlIRkam kñúgmYy edsuIlIRt Qam ehIy IGT ( Impaired Glucose Tolerance) man kRmitCatisárenAcenøaHBI 140 eTA 199 mIlIRkam kñúgmYy edsuIlIRt Qam. Pre-prandial

munGahar mann½y

Protamines

RbUtamIn CaRbUetGuIn

fa GMLúgeBlmunbriePaKGahar.

Gahar ³ mann½yfa eRkaykar samBaØ EdlrYmpSMCamYy GasuIt nuyeRkayeBlGahar

104

briePaKGaharrYc .

eKøGuic. eKeXIjmanva CaBiessenAkñúg Twkkamrbs;RtI.


s nÞ a nu R k m

Proteins

RbUetGuIn ³ CaGaharUbtßmÖ CMgW erTIn bNþalmkBICMgWTwkenamEp¥m

mYy kñúgcMeNamGaharUbtßmÖsMxan;TaMg bI enAkñúgGahar. GaharEdlpþl;Cati RbUetGuIn rYmmanRtI sac; man;-Ta s‘ut sENþks¶Üt nig plitplTwkedaH. RbUetGuIn k¾RtUv)aneRbIpgEdr enAkñúgrcna sm<½næekasika G½rm:Un dUcCa GaMgsu‘uylIn nig muxgardéTeTot.

KWCakarxUcsrésQamtUc² enAkñúg erTIn ehIyvaGacbNþal eGaymankar)at; bg;KMehIj.

Riomet

rIy:Uemt ³ CaeQμaH

BaNiC¢kmμrbs; emth½VrmIn.

Rosiglitazone

Protenuria

rUsIuKøItahSÚn ³

RbUetGuIn enAkñúgTwk CaeQμaHsRmab; ehSenrik b¤ eQμaHrYm

enam ³ vaKWCavtþman RbUetGuIn enAkñúg KøItahSÚn Edllk;enATIpSar edayman

Twkenam. vabgðajfa tRmgenamdMeNIr eQμaHBaNiC¢kmμfa Gav:g;düa. karminl¥. Saccharides KWCasár . Remicron ermIRkug ³ CaeQμaH BaNiC¢kmμ sRmab;BYk DIy:amIRkug Edl Secretagogues sarFatuCMrujkar beBa©j³ sarFatu EdlbNþaleGay mankarEkERb. sarFatuepSgeTot RtUv)anbeBa©jtam rebobmYy dUcCa G½rm:Un hÁas®sÞIn ePJac Renal éntRmgenam ³ EdlTak;Tg nwgtRmgenam ]TahrN_ CMgWtRmgenam karbeBa©jCati GasuIt edayRkBH. »sfEdlCMrujkarbeBa©j GaMgsu‘ylIn xUctRmgenam. rYmman Rkum»sfEdleKsÁal; dUcCa s‘ulhVÚnIlUero nig RkummYyeTotehAfa Retina erTIn ³ CaRsTab;mYy enAxag eRkayRKab;EPñk Edlmanekasika Edl b‘ÍháanIt. nwgmanrMejacedaysarBnøW . erTIn eFVI eGaymanrMejacsrésRbsaT Edlqøg Semi Daonil sWmIdavnIl ³ CaeQμaH kat;tamsrésRbsaT (GubTic) mkkan; BaNiC¢kmμ sRmab; KøIbg;køamIt . xYrk,al EdlCaKMehIjrUbPaB RtUv)an Sorbitol srb‘Ítul ³ CasarFatu begáIteLIg. Edl )anplitecjBIxøÜnGñkCMgWTwkenam Ep¥mpÞal;. vaGacbNþaleGayxUcEPñk Retinopathy CMgWerTIn ³ sMedAeTAelI CMgWEdlekItmancMeBaH erTIn eday nig srésRbsaT. bNþalmkBIkarxUc b¤ )at;bg;KMehIj. karb:HBal;eTAelI erTIn edayhUrQam Starch GamIdug ³ CasarFatuBN’s RCab Twkdk; rIksrésQamminFmμta. nig Kμankøin EdlekItmanenAkñúgCalika

r:UsuIKøItahSÚn

CMgWtRmgenam

105


VIII

s nÞ a nu R k m

rukçCati ehIyeKGacTTYlva)an Ca BiessBIFBaØCati dUcCa ¬Ggár eBat nig RsUvsaLI¦ nig rukçCati dUcCadMLÚg nig dMLÚgmI. dUcCaCatisár EsluyLÚs nig KøúykUEhSn ¬sárbRmug¦ Edr GamIdugenH Ca b:UlIsakarIt EdlCa kabUnGuIRdat saMjauMbnþic edayrYmman mUelKul KøúykUs mYycMnYnP¢ab;Kña. GaharEdlman GamIdug KWCaEpñksMxan; énGaharmnusS ehIy GamIdug Ekécñ mankareRbIR)as;enA kñúgGahar nig enAkñúg]sSahkmμ. sár enAkñúg GamIdug enHrYmman dic ®sþÚs EdlCarUbPaBmYy énKøúykUs nig suIr:U eBat Edlman RhuctUs x<s;. Sucrose

s‘ucRkUs

su‘cRkUs ³ Casársmas eFVI

BI KøúykUs nig RhuctUs. vaCasmas FatusMxan;énGMeBA nig rukçCatiéqfav EdleKGaccRmaj; y kCati s á r )an. s‘ucRkUs k¾RtUvcRmaj;ecjBIrukçCati déTeTot edayrYmmanBBYketñat nig RkumdUg. su‘ucRkUs KWCa DIsakarIt Edl gayrMlay edaystVciBa©wmkUneday TwkedaH edayeFVIeGayekIneLIgy:ag rh½s énCatisárenAkñúgQam . kareRbI R)as;vaeRcInhYs RtUveKyl;fa naMeGay Fat;elIsTm¶n; nig manPaBsuaMcMeBaH GaMgsu‘uylIn.

Sugar

Sulfonamides

(Sulphonamides)

s‘ulhVÚNamIt ³ CaRkum»sf Edl

begáIteLIgenA GaløWm:g; kalBITsvtSr_ 1930. vaCa»sfRbqaMgemeraKdMbUg eKbg¥s; enAkñúgBiPBelak. varYmman s‘ulhVÚnIlUero. Sulfonylureas

(Sulphonylureas)

s‘ulhVÚnIlYero ³ KWCa Rkum»sf

EdlePJackarbeBa©j GaMgsu‘uylIn BI ekasika Eb‘ta enAkñúglMEBg. vaCa»sf RKab;RbqaMgnwgCatisárx<s; enAkñúgQam EdlRtUv)aneRbIR)as; y:agTUlMTUlay CageKelIkdMbUg enAkñúgBiPBelak Edl rYmman KøIbg;køamIt nig KøIkøasIut.

Thiazolidinediones

düahSÚlI-

DIndüÚn ³ CafñaMEdleKsÁal;fa Ca

KøItahSÚn EdlbegáInkareRbIR)as; GaMgs‘uylIn rbs;efIøm ekasikaxøaj; nig ekasikasac;dMu . varYmman rUsIuKøItahSÚn . Type 1 diabetes

TwkenamEp¥mRb-

ePT 1 ³ ekItmanenAeBlEdllMEBg

Elgplit GaMgsu‘uylIn )an ehIyCati sár minGaccUleTAkñúgekasika edIm,I eRbIR)as;CafamBl)an.

Type 2 diabetes

TwkenamEp¥m

sár ³ CaRkum kabUnGuIRdat BN’ RbePT 2 ³ ekItmaneLIg enAeBl

s PWø Ep¥m nig rlaykñúgTwk dUcCaBBYk lMEBgminGacplit GaMgs‘uylIn eGay KøúykUs su‘ucRkUs nig RhuctUs CaedIm. RKb;RKan; b¤ ragkayminGaceRbIR)as; GaMgs‘ulIn )anRtwmRtUv. Sulfamides s‘ulhVamIt ³ Bakü)araMg sRmab; su‘ulhVÚNamIt . 106


s nÞ a nu R k m

Uni Diamicron

³ CaeQμaHBaNiC¢kmμ KøúykUs ¬sBaØaénCMgWTwkenamEp¥m b¤ CMgW

sRmab; DIy:amIRkug EdlmankareFVIbERm déT¦ RbUetGuIn ¬sBaØaénkarxUc tRmg enam b¤ CMgWtRmgenam¦ ekasikaQam bRmYl. s ¬sBaØamanCMgWqøg tambMBg;bgðÚrenam¦ b¤ ektUn ¬sßanPaBmanCatiGasuIt ektUn Urea G‘uyer: ³ CakaksMNl;EdleXIj manenAkñúgQam EdlbNþalmkBIIkar cMeBaHGñkTwkenamEp¥m b¤ sßanPaBdéT¦. bMEbkén RbUetGuIn CaFmμta enAkñúgeføIm. Twkenam k¾GacBinitüpgEdr edIm,IrkemIl G‘uyer: RtUv)anbeBa©jBIkñúgQam Ca sBaØahUrQam. kareFVIetsþxøH eRbITwk Fmμta edaytRmgenam nig bnÞab;mk enam EdlykmkBinitüEtmþg. sRmab; etsþxøHeTot karykTwkenam 24 em:ag beBa©jmkkñúgTwkenam. GacCakarcaM)ac;. eBlxøH eKykTwk enameTAbNþúH edIm,IBinitüemIleGay Uremia G‘uyer:kñúgQam ³ KWCaCMgW mYYy EdlTak;TgnwgkMeNInCati Gu‘yer: c,as;fa etImanemeraK)ak;etrIRbePTGVI. enAkñúgQam edaysartRmgenam eFVI karminmanRbsiTæPaB. eraKsBaØa rYm Urology m:URtsaRsþ CaEmkFag man karceg¥ar k¥Üt karcuHexSay kar)at; mYyén srIr³saRsþ nig evC¢saRsþ Edl bg;cMNg;Gahar nig karvilvl;sμartI. Tak;Tgnwgmuxgar nig sNþab;Fñab; én RbB½næTwkenam. RKUeBTü EdlmanÉkeTsBüa)al CMgWtampøÚvbgðÚrenam KWehA Urinalysis karviPaKTwkenam ³ Ca kareFVIetsþmYyeTAelITwkenam edIm,IeFVI fa RKUeBTüÉkeTs xagCMgWpøÚvbgðÚrenam. eraKvinic½äy CMgWRbB½næTwkenam nig RbB½næ déTeTot enAkñúgxøÜn. cMeBaHmnusSman Vascular énsrésQam ³ mann½y TwkenamEp¥m RKUeBTüGacBinitüemIlCati fa srésBiess EdlTak;Tgnwgsrés Qam.

RbB½næbgðÚrenamburs Edlbgðaj tRmgenam bMBg;bgðÚrenam mkkan;e)øakenam/ e)øakenam/ RkeBjRbUsþat/ bMBg;bgðÚrenamecj tamlMdab;lMeday BIelIcuHeRkam

RbB½næbgðÚrenamRsþI EdlbgðajtRmgenam/ bMBg;bgðÚrenam mkkan;e)øakenam/ e)øakenam/ bMBg;bgðÚrenamecj

107


dMNak;kaleRtomTwkenamEp¥m

eRbva:Lg; )a:n;sμane nAkñúgRkummnusSGayu 20-79 qñaM ¬KitCa % ¦ 1 2 3 4 5 6 7 8 9 10

RbeTs

NUru Gara:b;rYmeGmIer:t Gar:ab;b‘ÍsaGUDIt )aErn KuyEvt GUm:g; tugháa m:UrIs eGhSúIb miucsuikU Gas‘an ma:eLsIu hVIlIBIn éf km<úCa Lav \NÐÚensuI PUma evotNam Rb‘uyeN

RbPB³ shB½n§CMgWTwkenamEp¥mGnþrCati

2007 20 18 18 18 18 17 16 15 14 13

20? 14-20? 14-20? 14-20? <4? 4-6? <4? <4? ? >

RbeTs

NUru Gara:b;rYmeGmIer:t Gar:ab;b‘ÍsaGUDIt )aErn KuyEvt GUm:g; tugháa m:UrIs eGhSúIb muicsuikU Gas‘an ma:eLsIu hVIlIBIn éf km<úCa Lav mIya:n;ma: \NÐÚensIu evotNam Rb‘uyeN sigðbUrI

2025 22 20 20 20 20 18 17 16 13 13

20? 14-20? 14-20? 14-20? 4-6? <4? <4? <4? ? ? >


“TwkenamEp¥m KWCaCMgWruaMér: eFVIeGayexSay nig cMNay

fvikareRcIn edayTak;TgCamYyplvi)akF¶n;F¶r EdlbgáhaniP½yxøaMg sRmab;RKYsar rdæCasmaCik nigBiPBelakTaMgmUl ” esckþIseRmc sþIBITivaCMgWTwkenamEp¥mBiPBelak ¬éf¶TI14 Ex vicäika¦ EdlRbkaseday mhasnñi)atshRbCaCati ExFñÚ qñaM 2006.

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