Zochita pafamu. Kukonzekera kwa insulin kochepa. Kuyanjana ndi cholandirira kumtundu wakunja kwa maselo, ndikupanga insulini yolandirira. Mwa kukulitsa kaphatikizidwe ka cAMP (m'maselo amafuta ndi maselo a chiwindi) kapena kulowa mwachindunji mu cell (minofu), insulini yolandirira insulin imapangitsa njira zina, kuphatikizira kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase, etc.). Kutsika kwa glucose m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa zotupa, kukondoweza kwa lipoenaisis, glycogenogeneis, kaphatikizidwe ka protein, kuchepa kwa kuchuluka kwa kupanga kwa shuga ndi chiwindi (kuchepa kwa kuphulika kwa glycogen), ndi zina. mphindi, imafika pazofunikira pambuyo pa maola 1-3 ndipo imatha, kutengera mlingo, maola 5-8. Kutalika kwa mankhwalawa kumatengera mlingo, njira, malo oyendetsera ndipo ali ndi machitidwe ofunikira payekha.

Pharmacokinetics Kukwana kwa mayamwidwe zimatengera njira yoyendetsera (s / c, i / m), malo oyang'anira (pamimba, ntchafu, matako), mlingo, insulin ndende ya mankhwala, etc. Amagawidwa mosiyanasiyana mu minofu. Simadutsana chotchinga ndi mkaka wa m'mawere. Imawonongeka ndi insulinase, makamaka m'chiwindi ndi impso. T 1/2 - kuchokera kwa ochepa mpaka mphindi 10. Amachotsa impso (30-80%).

Zizindikiro. Type 1 shuga mellitus, mtundu 2 shuga mellitus: gawo la kukana mankhwalawa a hypoglycemic, kuperewera pakamwa zamankhwala hypoglycemic (kuphatikiza mankhwala), matenda ashuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, matenda osokoneza bongo omwe adachitika panthawi yoyembekezera (ngati sichothandiza pakudya) ntchito pafupipafupi kwa odwala omwe ali ndi matenda a shuga ku matenda opatsirana ndimatenda akulu, ndi maopareshoni omwe akubwera, kuvulala, kubala mwana, ndi kuphwanya malamulo pazokhudza Ene zinthu akuyendera mankhwala yaitali kukonzekera insulin.

Contraindication Hypersensitivity, hypoglycemia.

Mlingo Mlingo ndi njira yoyendetsera mankhwalawa imatsimikiziridwa payekhapayekha pazotsatira zilizonse za glucose m'magazi musanadye ndi maola 1-2 mutatha kudya, komanso malinga ndi kuchuluka kwa glucosuria ndi machitidwe a matendawa.

Mankhwala amatumizidwa s / c, mu / m, mu / mkati, mphindi 15-30 musanadye. Njira yodziwika kwambiri yoyendetsera ntchito ndi sc. Ndi matenda ashuga a ketoacidosis, chikomokere cha matenda a shuga, pakachitika opaleshoni - mu / mu ndi / m.

Ndi monotherapy, pafupipafupi makonzedwe nthawi zambiri amakhala 3 katatu patsiku (ngati kuli kotheka, mpaka nthawi 5-6 patsiku), tsamba la jakisoni limasinthidwa nthawi iliyonse kupewa chitukuko cha lipodystrophy (atrophy kapena hypertrophy ya subcutaneous mafuta).

Pafupifupi tsiku lililonse 30-30 IU ana - 8 IU, ndiye muyezo tsiku lililonse - 0,5-1 IU / kg kapena 30-40 IU 1-3 pa tsiku, ngati n`koyenera - 5-6 pa tsiku . Pa mlingo wa tsiku ndi tsiku wopitilira 0,6 U / kg, insulin iyenera kuperekedwa ngati ma jakisoni a 2 kapena kuposa m'malo osiyanasiyana a thupi.

Ndikotheka kuphatikiza ndi ma insulin omwe amakhala nthawi yayitali.

Njira yothetsera insulini imatengedwa kuchokera ku vial ndi kuboola ndi singano yosalala ya singano yoyimitsira ndi waya yopukutira mutachotsa kapu ya aluminium ndi ethanol.

Zotsatira zoyipa. Thupi lawo siligwirizana (urticaria, angioedema - malungo, kufupika, kuchepa kwa magazi),

hypoglycemia (pallor of the khungu, thukuta kwambiri, thukuta, pakamwa, kunjenjemera, njala, kusokonezeka, nkhawa, paresthesias mkamwa, kupweteka mutu, kugona, kugona, mantha, kupsinjika, kusakwiya, chikhalidwe chosazolowereka, kusowa kwa kayendedwe, vuto lakulankhula ndi kuyankhula komanso masomphenya), hypoglycemic coma,

hyperglycemia ndi matenda ashuga acidosis (pa Mlingo wochepera, kulumpha jakisoni, kusadya bwino, motsutsana ndi maziko akumatenda ndi matenda): kugona, ludzu, kusowa kudya, kutulutsa nkhope),

kuda nkhawa (mpaka kukula kwa precomatose ndi chikomokere),

kuchepa kwakanthawi kowoneka (nthawi zambiri kumayambiriro kwa zamankhwala),

immunological cross-reaction ndi insulin ya anthu, kuwonjezeka kwa gawo la anti-insulin antibodies, kenako kuwonjezeka kwa glycemia,

Hyperemia, kuyabwa ndi lipodystrophy (atrophy kapena hypertrophy of subcutaneous fat) pamalo a jekeseni.

Kumayambiriro kwa mankhwalawa - kutupa ndi kusokonezeka komwekonso (ndizosakhalitsa ndipo kumatha ndikupitilira chithandizo).

Bongo. Zizindikiro: hypoglycemia (kufooka, “thukuta” “thukuta”

Chithandizo: wodwalayo atha kuyerekezera yekha pakubweretsa shuga kapena zakudya zopatsa mphamvu zophatikizika m'thupi.

Subcutaneous, i / m kapena iv yolowetsa glucagon kapena iv hypertonic dextrose solution. Ndi chitupa cha hypoglycemic coma, 20-40 ml (mpaka 100 ml) wa 40% dextrose solution amawayamwa kudzera mu mtsempha kulowa kufikira wodwalayo atatuluka.

Kuchita. Mankhwala osagwirizana ndi mayankho a mankhwala ena.

Mphamvu ya hypoglycemic imapangidwira ndi sulfonamides (kuphatikizapo mankhwala a hypoglycemic, sulfonamides), ma inhibitors a MAO (kuphatikizapo furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (kuphatikizapo salicylates), anabolic (kuphatikiza stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, phenfluramine, Li + kukonzekera, pyridoxine, quinidine, quinine, etloro.

Glucagon, somatropin, corticosteroids, kulera kwamkamwa, estrogens, thiazide ndi loop diuretics, BMKK, mahomoni a chithokomiro, heparin, sulfinpyrazone, sympathomimetics, danazole, tricyclic antidepressants, colonidin, inthocin, inthani. epinephrine, blockers a H 1 histamine receptors.

Beta-blockers, reserpine, octreotide, pentamidine imatha kuwongolera ndi kufooketsa mphamvu ya hypoglycemic ya insulin.

Malangizo apadera. Musanatenge insulini kuchokera ku vial, ndikofunikira kuti muwone mawonekedwe a yankho. Matupi achilendo akaonekera, kusefukira kapena kutentha kwa zinthu pagalasi la vial, mankhwalawa sangathe kugwiritsidwa ntchito.

Kutentha kwa insulin yoyenera kuyenera kukhala kutentha kwambiri. Mlingo wa insulin uyenera kusinthidwa matenda opatsirana, matenda a chithokomiro, matenda a Addison, hypopituitarism, kulephera kwaimpso ndi matenda ashuga okonda anthu opitirira zaka 65.

Zomwe zimayambitsa hypoglycemia zimatha kukhala: insulin, mankhwala osokoneza bongo, kudumpha chakudya, kusanza, kutsegula m'mimba, kupsinjika kwa thupi, matenda omwe amachepetsa kufunikira kwa insulin (matenda apamwamba a impso ndi chiwindi, komanso hypofunction ya adrenal cortex, pituitary kapena chithokomiro gland), kusintha kwa malo jakisoni (mwachitsanzo, khungu pamimba, phewa, ntchafu), komanso mogwirizana ndi mankhwala ena. Ndikotheka kuchepetsa kuchuluka kwa shuga m'magazi posamutsa wodwala kuchokera ku insulin ya nyama kupita ku insulin ya anthu.

Kusamutsa wodwala kupita ku insulin yaumunthu kuyenera kukhala koyenera nthawi zonse kumayang'aniridwa ndi adokotala. Chizolowezi chokhala ndi hypoglycemia chimatha kuvulaza kuthekera kwa odwala kutenga nawo mbali mokwanira mumsewu, komanso kukonza makina ndi zida zamagetsi.

Odwala omwe ali ndi matenda ashuga amatha kuyimitsa pang'ono hypoglycemia yomwe amamva pakudya shuga kapena zakudya zamagulu owonjezera (tikulimbikitsidwa kuti nthawi zonse muzikhala ndi shuga osachepera 20 g). Ndikofunikira kudziwitsa adokotala za hypoglycemia yomwe yasamutsidwa kuti athetse vuto la kufunika kwa kukonza mankhwalawa.

Mankhwalawa a insulin yocheperako pokhapokha, kuchepa kapena kuwonjezeka kwa kuchuluka kwa adipose minofu (lipodystrophy) m'dera la jakisoni ndikotheka. Izi zimapewedwa makamaka ndikusintha malo a jekeseni. Pa nthawi yoyembekezera, ndikofunikira kuganizira kuchepa (I trimester) kapena kuwonjezeka (II-III trimesters) pazofunikira za insulin. Nthawi yobadwa pambuyo pokhapokha ndipo mwayamba kubadwa, zofunika za insulin zimatha kugwa kwambiri. Pa mkaka wa m`mawere, kuwunikira tsiku ndi tsiku kumafunikira kwa miyezi ingapo (mpaka kufunika kwa insulin kukhazikika).

Mulingo woyenera wa mahomoni ndiye maziko a kukula kwathunthu kwa thupi la munthu. Chimodzi mwamahomoni ofunika kwambiri m'thupi la munthu ndi insulin. Kuperewera kwake kapena zochulukirapo kumabweretsa zotsatirapo zoyipa. Matenda a shuga ndi hypoglycemia ndi magawo awiri olimbitsa thupi omwe amakhala osasangalatsa a thupi, omwe amanyalanyaza chidziwitso cha insulin ndi kuti mulingo wake uyenera kukhala wotani.

Hormone insulin

Ulemu wopanga ntchito zoyambirira zomwe zidapanga njira yodziwitsira matendawa ndi wa wasayansi waku Russia Leonid Sobolev, yemwe mu 1900 adaganiza zogwiritsa ntchito kapamba kuti apeze mankhwala opatsirana ndipo adapereka lingaliro la insulin. Zoposa zaka 20 zidagwiritsidwa ntchito pakufufuzanso, ndipo pambuyo pa 1923 kupanga insulin kwa mafakitale kudayamba. Masiku ano, maholide amaphunziridwa bwino ndi sayansi. Amatenga nawo gawo la kuwonongeka kwa ma carbohydrate, omwe amayambitsa matenda a metabolism komanso mafuta.

Ndi chiwalo chiti chomwe chimatulutsa insulini

Zikondamoyo, komwe ma bunge a ma B-cell amapezeka, amadziwika ndi sayansi ngati mabwalo amilandu a Lawrence kapena pancreatic, amagwira ntchito ngati insulin yopanga insulin. Mphamvu yokhudzana ndi maselo ndi yaying'ono ndipo imangokhala 3% yokha ya kuchuluka kwa kapamba. Kupanga kwa insulini kudzera m'maselo a beta kumachitika, gawo laling'ono la proinsulin limasungidwa ndi timadzi.

Kodi subtype ya insulin siyikudziwika mokwanira. Homoni imodzimodziyo, isanatenge mawonekedwe omaliza, imalowa mu chipinda cha cell cha Golgi, pomwe chimatsirizidwa kukhala boma la mahomoni athunthu. Mchitidwewo umatha pomwe mahomoni amayikidwa m'miyala yapadera ya kapamba, komwe amasungidwa kufikira munthu atadya. Mphamvu za B-cell ndizochepa ndipo zimatha msanga munthu akamagwiritsa ntchito zakudya zosavuta za carbohydrate, zomwe zimayambitsa matenda ashuga.

Kodi insulin ya hormone ndi iti - iyi ndiye yofunika kwambiri kuyang'anira metabolic. Popanda izi, shuga wolowa m'thupi kudzera mu chakudya sangalowe mu khungu. Hormayo imachulukitsa kuchuluka kwa ma membrane a maselo, chifukwa chake glucose amalowetsedwa m'thupi la selo. Nthawi yomweyo, timadzi timapangitsa kuti shuga asandulike kukhala glycogen, polysaccharide yomwe imakhala ndi mphamvu zomwe thupi la munthu limagwiritsa ntchito ngati zikufunika.

Ntchito za insulin ndizosiyanasiyana. Amapereka minofu yamasamba ntchito, kukhudza njira za mapuloteni ndi mafuta kagayidwe. Ma mahomoni amatenga gawo lazidziwitso za ubongo, zomwe, malinga ndi zolandilira, ndizomwe zimafunikira kufunikira kwa chakudya chamafuta othamanga: ngati pali zambiri zake, ubongo umatsimikiza kuti maselo amafa ndi njala komanso malo osungirako ayenera kupangidwa. Zotsatira za insulin thupi:

Zimalepheretsa ma amino acid kuti asagonjetsedwe kukhala shuga wophweka.
Zimasintha kaphatikizidwe ka mapuloteni - maziko a moyo.
Simalola mapuloteni m'misempha kuti asokonezeke, amalepheretsa minyewa ya atrophy - anabolic.
Amachepetsa kudzikundikira kwa matupi a ketone, ochulukirapo omwe amapha anthu.
Imalimbikitsa kuyendetsa kwa potaziyamu ndi ion ya magnesium.

Ntchito ya insulin m'thupi la munthu

Kusowa kwa mahomoni kumalumikizidwa ndi matenda omwe amatchedwa shuga. Omwe akudwala matendawa amakakamizika kupaka jekeseni wowonjezera m'magazi. Choyipa china ndi kuchuluka kwa mahomoni, hypoglycemia. Matendawa amapangitsa kuti magazi azithanso kuchepa komanso kuchepa kwa mtima. Kuchulukitsa kuwonjezeka kwa insulin katulutsidwe ndi glucagon ya mahomoni opangidwa ndi ma alpha maselo a pancreatic a Langerhans.

Minofu yodalira insulin

Insulin imathandizira kupanga mapuloteni m'misempha, popanda minofu minofu sangathe kupanga. Kupanga kwa minofu ya adipose, yomwe nthawi zambiri imagwira ntchito zofunika kwambiri, ndizosatheka popanda mahomoni. Odwala omwe ayamba kudwala matenda a shuga amakumana ndi ketoacidosis, mtundu wa vuto la metabolic lomwe limapangitsa kuti anthu azidwala kwambiri.

Madzi a insulin

Ntchito za insulin zimaphatikizapo kuthandizira kuchuluka kwa glucose m'magazi, kuyang'anira kagayidwe ka mafuta ndi mapuloteni, kusintha michere minofu. Nthawi zonse pamakhala zotsatirazi.

kapangidwe kazakudya zomanga thupi,
mulingo wa kagayidwe ndi katemera amasungidwa,
imapangitsa kapangidwe ka glycogen, kamene kamakulitsa kupirira ndikusintha kwamisempha minofu,
ma amino acid, shuga, potaziyamu amalowa m'maselo.

Mafuta a insulin amayeza mu µU / ml (0,04082 mg wa mankhwala a kristalo amatengedwa ngati gawo limodzi). Anthu athanzi amakhala ndi chizindikiro chofanana ndi 3-25 pamaudindo otere. Kwa ana, kuchepa mpaka 3-20 μU / ml ndikuloledwa. Mwa amayi apakati, chizolowezi chimakhala chosiyana - 6-27 mkU / ml, mwa anthu achikulire opitilira 60 chizindikiro ichi ndi 6-35. Kusintha kwazomwe zikuchitika kukuwonetsa kukhalapo kwa matenda oopsa.

Wokwera

Kuchulukitsa kwanthaŵi yayitali kwamankhwala osokoneza bongo kumawopseza kusintha kwosasintha kwa matenda. Vutoli limachitika chifukwa cha kutsika kwa shuga. Mutha kumvetsetsa kuchuluka kwa insulin ndende ndi zizindikiro: kunjenjemera, thukuta, malovu, modzidzimutsa ndimatenda, nseru, kukomoka, chikomokere. Zizindikiro zotsatirazi zimakhudza kuchuluka kwa mahomoni:

zolimbitsa thupi,
kupsinjika kwakanthawi
Matenda a chiwindi ndi kapamba,
kunenepa
kuphwanya kukana kwa maselo ku chakudya,
ovary polycystic,
Kulephera kwa ntchito yamatumbo
khansa ndi chotupa chinyezi cha adrenal gland.

Kutsitsidwa

Kuchepa kwa ndende ya insulin kumachitika chifukwa cha kupsinjika, kulimbitsa thupi kwambiri, kutopa kwambiri, tsiku lililonse kumwa mafuta ambiri oyeretsedwa. Kuperewera kwa insulin kumalepheretsa kuchuluka kwa shuga, ndikuchulukitsa kuchuluka kwake. Zotsatira zake, pamakhala ludzu lamphamvu, nkhawa, kugwidwa mwadzidzidzi ndi njala, kusakwiya, komanso kuyamwa pafupipafupi. Chifukwa cha zofanana ndi insulin yotsika komanso yayikulu, kuzindikira kwake kumachitika ndi maphunziro apadera.

Zomwe insulin imapangira odwala matenda ashuga

Nkhani ya zida zopangira mahomoni ndi yofunika kwa odwala ambiri. Insulin yomwe ili m'thupi la munthu imapangidwa ndi kapamba, ndipo mitundu yotsatirayi imapezekanso:

Nkhumba kapena bovine - zochokera nyama. Zopangira zikondamoyo zogwiritsidwa ntchito. Kukonzekera kwa zopangira nkhumba kumakhala ndi ma proinsulin, omwe sangathe kulekanitsidwa, amakhala magwero azosokoneza.
Biosynthetic kapena nkhumba yosinthidwa - kukonzekera kwapawiri kumapangidwa ndikusintha ma amino acid. Zina mwazabwino ndi kuphatikiza thupi la munthu komanso kusowa kwa ziwengo. Zowonongeka - kuperewera kwa zopangira, zovuta za ntchito, mtengo wokwera.
Genetic engineering recombinant - imatchedwa "insulin yaumunthu" mwanjira ina, chifukwa imafanana kwathunthu ndi mahomoni achilengedwe. Thupi limapangidwa ndi ma enzyme a yisiti tizilombo toyambitsa ndi kusinthidwa kwa geni.

Malangizo ogwiritsira ntchito insulin

Ntchito za insulin ndizofunikira kwambiri kwa thupi la munthu. Ngati muli ndi matenda ashuga, ndiye kuti mwalandira kwa dokotala ndi kulandira mankhwala omwe mankhwalawo amaperekedwa kwaulere m'mafakitala kapena zipatala. Pakufunika kwachangu zitha kugulidwa popanda mankhwala, koma muyeso uyenera kuonedwa. Popewa bongo wambiri, werengani malangizo ogwiritsira ntchito insulin.

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malangizo omwe aphatikizidwa phukusi lililonse la kukonzekera kwa insulini, zomwe zikuwonetsa kugwiritsidwa ntchito ndi mtundu wa 1 shuga mellitus (wotchedwanso insulin) ndipo, mwanjira zina, lembani matenda ashuga a 2 a mellitus (osadalira insulini). Zinthu zotere zimaphatikizira kusalolera kwa othandizira a hypoglycemic, kukula kwa ketosis.

Makulidwe a insulin

Dokotalayo amakupatsirani mankhwalawa atapezeka kuti mwapezeka ndi magazi. Zochizira matenda a shuga gwiritsani ntchito mankhwala osiyanasiyana malinga ndi nthawi yochepa: yayifupi komanso yayitali. Chisankho chimatengera kuopsa kwa matendawa, momwe wodwalayo alili, kuthamanga kwa kuyambika kwa mankhwala:

Kukonzekera kwakanthawi kochepa kumapangidwira kwa subcutaneous, intravenous kapena intramuscular management. Imakhala yofulumira, yochepa, yochepetsa shuga, imaperekedwa kwa mphindi 15-20 musanadye kangapo / tsiku. Zotsatira zimachitika mu theka la ola, pazofunikira - mu maola awiri, maola pafupifupi asanu ndi limodzi okha.
Kuchita nthawi yayitali kapena kupitilira apo - kumakhudza maola 10-36, kungachepetse jakisoni tsiku lililonse. Zoyimitsidwa zimaperekedwa kudzera mwa intramuscularly kapena subcutaneally, koma osati kudzera m'mitsempha.

Ma syringe amagwiritsidwa ntchito kuwongolera kulowetsedwa ndi kutsata mlingo. Gawo limodzi limafanana ndi ziwerengero zingapo. Malangizo a insulin

sungani zokonzekera mufiriji, ndipo zomwe zimayambira firiji, konzekerani mankhwala musanalowe, chifukwa ozizira ndi ofooka.
ndibwino kubaya mahomoni osakhalitsa pakhungu la m'mimba - jekeseni mu ntchafu kapena pamwamba pa matako mumagwira pang'onopang'ono, kuposa koyipa - paphewa.
mankhwala ogwira ntchito yayitali adalowetsedwa kudzanja lamanzere kapena lamanja,
jekeseni aliyense m'malo osiyanasiyana,
jekeseni wa insulin, gwira gawo lonse lathupi lathunthu - kuti mupewe kuwawa ndi zisindikizo.
kutali ndi jakisoni womaliza osachepera 2 cm,
musagwire khungu ndi mowa, mumawononga insulin,
ngati madzi atuluka, singano idayikidwa molakwika - muyenera kuigwira pakhale madigiri 45-60.

Zotsatira zoyipa

Ndi subcutaneous makonzedwe a mankhwala, kukula kwa lipodystrophy pamalo jakisoni ndikotheka. Osowa kwambiri, koma amawoneka ngati thupi lawo siligwirizana. Ngati zikuchitika, monga chithandizo chamankhwala ndi wogwirizira zimafunikira. Zoyipa zotsutsana ndi:

hepatitis pachimake, matenda amkati, jaundice, kapamba,
nephritis, urolithiasis,
mtima wowonongeka.

Mtengo wa insulin

Mtengo wa insulin umatengera mtundu wa wopanga, mtundu wa mankhwalawa (kufupika / nthawi yayitali yochitapo kanthu, zowonjezera chakudya) komanso kuchuluka kwa ma CD. Mtengo wa 50 ml ya insulinum ya mankhwala pafupifupi ma ruble 150 ku Moscow ndi St. Insuman yokhala ndi cholembera - 1200, Protafan yoimitsidwa ili ndi mtengo pafupifupi ruble 930. Mlingo wa mankhwala amakhudzanso kuchuluka kwa insulin.

Nditapeza insulin yoyeretsa kwambiri, funso linadzuka pakukula kwa mitundu ya insulin. Mukugwiritsa ntchito njira zodziwira kuchuluka kwa insulin m'magazi, ma antibodies mpaka insulin adapezeka. Kafukufuku awonetsa kuti odwala omwe amagwiritsa ntchito bovine / porcine insulin anali ndi antibodies ambiri kuposa kugwiritsira ntchito insulin yokha.

Ma antibodies awa atha kukhala insulin-binding, yomwe ingayambitse kukana insulini, komanso ndikutulutsa kwa insulin, hypoglycemia yopanda chidwi. Yafika nthawi yoti m'malo mwa nkhumba mukhale bovine, koma odwala mayiko ena akukana kugwiritsa ntchito mankhwala a nkhumba pazifukwa zachipembedzo.

Vutoli lakhala maziko othandizira "insulin ya anthu." Mu 1963, nthawi ya "insulin yaumunthu" idayamba atatha a Mirsky ndi anzawo a insulin kuchokera ku zikondamoyo, ndipo kuyambira 1974, atatulukira pakupanga mankhwala kuchokera ku amino acids, kuthekera kwa kuphatikiza kwathunthu kwa mankhwala a insulin yaanthu.
Mu 1979-1981 Ukadaulo wa ma DNA wa biosynthetic ndi njira yopangira yopangira insulin mwa kuyika enzyme m'malo mwa amino acid molekyu (Markussen) anapangidwa. Semi-yopanga insulin yaumunthu yopangidwa kuchokera ku nkhumba, dzina lake lolondola ndi insulini yosinthika ya nkhumba. Pano sichigwiritsidwa ntchito.

Motsatira amino acid mu molekyulu ya porcine ndi insulin yaumunthu ndi yofanana, kupatula kwa amino acid yomaliza ya B unyolo: mu porcine insulin - alanine, mwa anthu - threonine. Njira yopangira theka ndiyomwe imapangitsa chidwi cha alanine ndi kulowetsedwa ndi threonine. M'zaka khumi zapitazi, njira yopangira insulin yatsala pang'ono kusinthidwa ndi imodzi yachilengedwe. Njira ya biosynt synt (genetic engineering) yopanga insulin ya munthu ndi njira yosinthira chidziwitso chakuchiziwidwa cha zinthu zazamoyo kuti zigwirizane ndi mapuloteni akunja.
Insulin yaumunthu yachilengedwe imapangidwa pogwiritsa ntchito ukadaulo wa DNA.

Pali njira ziwiri zazikulu.
1. Patulani kaphatikizidwe pogwiritsa ntchito majini osinthika.
2. Kuchokera kwa proinsulin wopangidwa ndi bakiteriya wosinthika mwa majini.

Phenol kapena metacresol amagwiritsidwa ntchito ngati cholembera kuti asungidwe antimicrobial state insulins a insulin yochepa ndi isophanes, ndipo paraben (methyl parahydroxybenzoate) imagwiritsidwa ntchito pa mtundu wa Lente insulins. Kutengera mtundu wamatenda a shuga, mankhwala a insulin amasonyezedwa pafupifupi 30-30% ya odwala. Awa ndi odwala omwe ali ndi matenda amtundu 1 shuga, omwe amapanga 10-15% odwala onse omwe ali ndi matenda ashuga, komanso odwala omwe ali ndi mtundu wa 2 matenda a shuga a mellitus subtype, omwe amapanga 15-25% ya odwala onse omwe ali ndi matenda a shuga a 2.
Mpaka pano, mankhwala a insulin akadali njira yokhayo ya pathogenetic yomwe imasunga moyo ndi kuthekera kugwira ntchito kwa odwala omwe ali ndi matenda amtundu wa 1.

Chifukwa chake, mankhwala a insulini amakhalapo amoyo wonse, omwe, kumene, amabweretsa zovuta zina kwa wodwalayo chifukwa chofunikira kukhalabe ndi vuto la kuphatikiza kagayidwe kabwino pafupi ndi la munthu wathanzi. Palibenso njira ina yothandizira kulowetsedwa kwa insulin, ngakhale kungokhala kutsanzitsa kwa zotsatira za thupi. Munthawi yovomerezeka, insulin imalowa nthawi yomweyo m'mitsempha ya chotupa, kenako mu chiwindi, pomwe singakwanitse, ena onse ali pamphepete. Zonsezi zimachitika mwachangu kwambiri kotero kuti mulingo wa glycemia ukhoza kusungidwa m'malo osaneneka ngakhale mutadya. Njira ina imawonedwa ndi insulin yolumikizidwa ndi khungu: yachedwa kulowa m'magazi ndipo makamaka m'chiwindi, pambuyo pake kuchuluka kwa insulin m'magazi kumakhala kosachulukirapo kwa nthawi yayitali. Koma njira zamakono zogwirira ntchito zamankhwala a insulin zimapangitsa kuti njira ya odwala omwe ali ndi matenda a shuga a mtundu wa I ikhale pafupi kwambiri. Izi zitha kuchitika kokha pophunzitsa odwala omwe ali ndi matenda ashuga.

Kufunika kochita mapulogalamu ophunzitsira odwala matenda ashuga kwadziwika. Pofika mu 1925, m'modzi mwa apainiyawa a insulin, a E. Joslin, amaphunzitsa odwala zomwe amawona kuti ndizofunikira kwambiri pakuchita bwino kwa mankhwala: kutsimikiza mtima katatu kwa glycosuria komanso kusintha kwa mlingo wa insulin kutengera zomwe wapeza. Kufunika kwamankhwala othandizirana kunalibe. Koma pobwera insulin kukonzekera, chitukuko cha mankhwala a insulin sichinasinthe. Odwala anali oletsedwa kusintha pawokha mankhwala a insulin, amapaka jekeseni wokhazikika pokhapokha kamodzi patsiku, ndipo kwa zaka zambiri anaiwalako za thanzi labwinobwino, kupirira chiopsezo cha hypoglycemia ndi kufunika kwakukhalira kuchipatala.

Pofika kumayambiriro kwa zaka za m'ma 80, akatswiri a matenda ashuga anali atayeretsa kwambiri mankhwala a insulin, insulin ya anthu, njira zowongolera zoperekera insulin (zotaya za insulin ndi ma cholembera), ndi njira zowonetsera glycemia ndi glycosuria pogwiritsa ntchito zingwe zoyeserera. Mosiyana ndi ziyembekezo, kugwiritsa ntchito kwawo kokha sikunachititse kuchepa kwa kuchuluka kwa zovuta za shuga komanso kusintha kosalekeza pakubwezeretsanso kwa kagayidwe kazakudya. Malinga ndi kutsimikiza kosavomerezeka kwa akatswiriwo, njira yatsopano idafunikira yomwe ingalole kuyendetsa bwino matenda osachiritsika ophatikizira wodwalayo pakulamulira kwake matenda ashuga ndi chithandizo chake. Pakadali pano, mawu akuti "maphunziro achire" amavomerezedwa ndi World Health Organisation, ndipo ndi gawo lofunika kwambiri pochiza matenda amtundu uliwonse. Pokhudzana ndi odwala omwe ali ndi matenda a shuga 1, izi makamaka zikutanthauza kuti wodwalayo ayenera kukhala wodziwa kwambiri za insulin.

Zolinga zamatenda a insulin odwala omwe ali ndi matenda amtundu wa 1:
1) kusintha kagayidwe kagayidwe kazakudya (mwachidziwikire, kusintha kagayidwe kakang'ono ka magazi, kuletsa kuchuluka kwake, hyperglycemia, glycosuria ndi hypoglycemia atatha kudya, mokwanira - kuthetseratu zovuta zamatenda a shuga, ketosis, hyperglycemia, kutchulidwa, nthawi zambiri kumachitika kapena mosazindikira. achina
2) sinthani zakudya zanu ndikukhalanso ndi thupi labwino odwala,
3) sinthayi mafuta kagayidwe (malinga ndi cholesterol yathunthu, L PNP, L PVP, triglycerides, mu seramu yamagazi),
4) kusintha moyo wabwino ndikukhala ndi moyo wabwinobwino komanso waulere wodwala,
5) kuteteza chitukuko kapena kuchepetsa maselo a mitsempha ndi mitsempha ya shuga.

Mapamba amunthu, pazifukwa zosiyanasiyana, nthawi zambiri sangatulutse insulini. Kenako muyenera kugwiritsa ntchito majini okhala ndi insulin, yomwe imalowa m'malo mwa insulin ya anthu.

Mtundu wa insulin waumunthu umapezeka kapena mu kapangidwe ka Escherichia coli, kapena kuchokera ku insulin ya insulin ndikusintha amino acid.

Kuti muyesere magwiridwe antchito a kapamba amunthu, ma jakisoni a insulin amachitika. Mtundu wa insulin umasankhidwa kutengera mtundu wa matenda komanso thanzi la wodwalayo. Insulin imatha kutumikiridwa kudzera m'mitsempha kapena intramuscularly. Kwa chithandizo cha moyo wonse komanso chautali, jakisoni wa subcutaneous amagwiritsidwa ntchito nthawi zambiri.

Zolemba za insulin

Matenda a shuga omwe amadalira a insulin amafunikira chithandizo cha moyo wonse. Moyo wa munthu umadalira kupezeka kwa insulin. Matendawa amadziwika kuti ndi mliri wosagonjetseka ndipo ndiwo wachitatu pofalikira padziko lapansi.

Kwa nthawi yoyamba, insulin idapangidwa kuchokera ku zikondamoyo za galu. Patatha chaka chimodzi, mankhwalawo adayamba kugwiritsidwa ntchito. Pambuyo pa zaka 40, adatha kupanga mahomoni munthawi ya mankhwala.

Pambuyo kanthawi, mitundu ya insulin yokhala ndi kuyeretsa kwambiri idapangidwa. Ntchito ikuchitikanso kuti mupange insulin yaumunthu. Kuyambira 1983, mahomoni awa adayamba kumasulidwa pamsika wamafuta.

M'mbuyomu, anthu odwala matenda ashuga ankalandira mankhwala opangidwa ndi nyama. Tsopano mankhwalawa ndi oletsedwa. M'mafakitala, mutha kugula zida zogulira ma genetic, kupangidwa kwa mankhwalawa kutengera kusintha kwa chinthu cha gene mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya a E. coli umagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kutulutsa timadzi tambiri timadzi tambiri.

Insulin yamakono yamankhwala ndi yosiyana:

nthawi yowonetsera, pali yochepa, ultrashort komanso insulin yotalikilapo,
kutsatira kwa amino acid.

Palinso mankhwala osakanikirana omwe amatchedwa osakaniza. Mu kapangidwe ka ndalama zotere mumakhala insulin yokhala ndi nthawi yayitali komanso yochepa.

Kupeza insulini kungathenso kuwonetsedwa mu matenda monga:

Lactic acid, matenda ashuga ndi hypersmolar,
Mtundu 1 wa matenda a shuga a insulin
Ndi matenda, chithandizo cha opaleshoni, kuchulukitsa kwa matenda osachiritsika,
Matenda a shuga ndi / kapena kuwonongeka kwa chiwindi, pakati komanso pobereka.
Type 2 shuga mellitus osagwirizana ndi antidiabetesic mkamwa othandizira,
Zotupa za khungu la Dystrophic,
Kulimbitsa kwambiri munjira zosiyanasiyana,
Njira yayitali yopatsirana.

Kutalika kwa insulin

Potengera nthawi ndi magwiridwe antchito, insulin imasiyanitsidwa:

ultrashort
mwachidule
nthawi yayitali
kuchitapo kanthu kwanthawi yayitali.

Ultrashort amalowetsa zinthu pambuyo jakisoni. Kuchuluka kwake kumatheka pambuyo pa ola limodzi ndi theka.

Kutalika kwa zochita kumafika maola 4. Insulin yamtunduwu imatha kutumikiridwa musanadye kapena musanadye. Kupeza insulini sikutanthauza kupuma pakati pa jakisoni ndi chakudya.

Ultrashort insulin sikufuna zakudya zowonjezera pamtunda wa kuchitapo, komwe kuli kosavuta kuposa mitundu ina. Insulin yotere imaphatikizapo:

Ma insulin afupia amayamba kuchita pambuyo pa theka la ola. Chiwongola dzanja chikuyambira patatha maola atatu. Zochitazo zimatha pafupifupi maola 5. Insulin yamtunduwu imaperekedwa musanadye, muyenera kukhala ndi pakati pakati pa jakisoni ndi chakudya. Kudya kumaloledwa pambuyo pa mphindi 15.

Kugwiritsa ntchito insulin yocheperako, muyenera kukhala ndi mankhwalawa patatha maola ochepa jakisoni. Nthawi ya chakudya iyenera kuyenderana ndi nthawi yapamwamba ya mahomoni. Ma insulin afupia:

Himulin Wokhazikika,
Khalid
Monodar (K50, K30, K15),
Insuman Rapid,
Humodar ndi ena.

Ma insulini apakatikati ndi mankhwala osokoneza bongo omwe nthawi yayitali ya maola 12-16. Mtundu woyamba wa shuga, insulin yamunthu imagwiritsidwa ntchito ngati maziko kapena basal. Nthawi zina muyenera kupanga jakisoni 2 kapena katatu patsiku m'mawa ndi madzulo ndi gawo la maola 12.

Insulin yotere imayamba kugwira ntchito pambuyo pa maola 1-3, ikufika pachimake patatha maola 4-8. Kutalika ndi maola 12-16. Mankhwala apakatikati akuphatikizapo:

Humodar br
Protafan
Humulin NPH,
Novomiks.
Insuman Bazal.

Ma insulin omwe amakhala nthawi yayitali amakhala a insulin kapena oyambira insal. Munthu angafunike jakisoni imodzi kapena iwiri patsiku. Amagwiritsidwa ntchito pochiza matenda a shuga a 2.

Mankhwala amakhala ndi cumulative effect. Mphamvu ya Mlingo imawonekera kwambiri pambuyo masiku atatu. Wothandizirana kwa nthawi yayitali amagwira ntchito patatha maola 4-6 jakisoni. Zochita zawo zapamwamba zimachitika m'maola 11 mpaka 14, izi zomwe zimachitika pafupifupi tsiku limodzi.

Mwa zina mwa mankhwalawa, pali ma insulin omwe alibe phindu. Ndalama zotere zimachitika modekha ndipo nthawi zambiri zimatsata momwe masoka achilengedwe amakhala mwa munthu wathanzi.

Izi insulini ndi monga:

Lantus
Monodar Long,
Monodar ultralong,
Ultralente
Ultralong,
Humulin L ndi ena,
Lantus
Levemir.

Malangizo ofunikira kuti mugwiritse ntchito

Amayi omwe ali ndi matenda ashuga ayenera kudziwitsa oyang'anira azaumoyo za zakutsogolo kapenanso kutenga pakati. Gulu ili la azimayi nthawi zambiri okhala ndi mkaka wa m'mawere limasowa kusintha kwamankhwala, komanso zakudya.

Pophunzira za kuwopsa kwa kukonzekera kwa insulin, asayansi sanapeze zotsatira za mutagenic.

Ndikofunika kudziwa kuti kufunika kwa mahomoni kumatha kuchepa ngati munthu ali ndi vuto la impso.Munthu amatha kusamutsidwira ku mtundu wina wa insulin kapena mankhwala omwe ali ndi dzina lina loyang'aniridwa pokhapokha atayang'aniridwa ndi achipatala.

Mlingo uyenera kusinthidwa ngati zochitika za insulin, zamtundu kapena mitundu, zasinthidwa. Kufunika kwa insulin kungachepetse ndi matenda otsatirawa:

Ntchito zosakwanira za adrenal, chithokomiro cha England
Hepatic ndi aimpso kulephera.

Ndi kupsinjika kwa m'maganizo kapena matenda ena, kufunika kwa insulin kumawonjezeka. Kusintha kwa mankhwalawa kumafunikanso ndi kulimbitsa thupi.

Zizindikiro za hypoglycemia, ngati insulin ya anthu imagwiridwa, ikhoza kutchulidwa kochepa kapena zosiyana ndi zomwe zinali ndi kuyambitsa kwa insulin yoyambira nyama.

Ndi matenda a shuga wamagazi, mwachitsanzo, chifukwa cha chithandizo champhamvu ndi insulin, zonse kapena mawonekedwe ena a hypoglycemia amatha, zomwe anthu ayenera kudziwa.

Zoyambirira za hypoglycemia zimatha kusintha kapena kukhala zofatsa pochiza matenda ashuga kapena kugwiritsa ntchito beta-blockers.

Zotsatira zoyipa zam'deralo zimatha kuyambika pazifukwa zosakhudzana ndi mphamvu ya mankhwalawa, mwachitsanzo, kuyambitsa khungu pakhungu ndi mankhwala kapena jakisoni wosayenera.

Nthawi zina, mapangidwe a zonse sayanjana, chithandizo chofunikira ndikofunikira. Desensitization kapena kusintha kwa insulini kungafunenso.

Ndi hypoglycemia mwa anthu, chidwi ndi kuthamanga kwa zomwe psychomotor zimatha kuchepa. Izi zitha kukhala zowopsa nthawi zomwe ntchitozi ndizofunikira. Mwachitsanzo, kuyendetsa galimoto kapena njira zosiyanasiyana.

Izi ndizofunikira kwambiri kwa anthu omwe ali ndi vuto losazindikira, lomwe ndi harbinger la hypoglycemia. Muzochitika izi, adotolo omwe amafunikira ayenera kuwunikira kufunika koyendetsa galimoto modekha. Kanemayo munkhaniyi ayankhula za mitundu ya insulin.

Insulin yaumunthu imanena za mahomoni omwe amapanga kapamba. Amagwiritsidwa ntchito pochiza matenda ashuga. Kuti muthane ndi chizolowezi cha kapamba, wodwalayo amapaka jakisoni:

zotsatira zazifupi
zopitilira
nthawi yayitali yochitapo kanthu.

Mtundu wa mankhwalawa umatsimikizika potengera thanzi la wodwala komanso mtundu wa matenda.

Mitundu ya insulin

Insulin idapangidwa koyamba kuchokera ku zikondamoyo za agalu. Patatha chaka chimodzi, mahomoniwa adagwiritsidwa ntchito kale. Zaka zina 40 zidapita, ndipo zidatheka kupanga insulin mosiyanasiyana.

Pambuyo kanthawi, zinthu zofunikira kwambiri zodziyeretsa zinapangidwa. Pambuyo pazaka zowerengeka, akatswiri adayamba kupanga kapangidwe ka insulin ya anthu. Kuyambira 1983, insulini idayamba kupangidwa pamakampani ambiri.

Zaka 15 zapitazo, matenda ashuga ankawagwiritsa ntchito zopangidwa ndi nyama. Masiku ano, ndi oletsedwa. M'mafakitala, mutha kupeza zokonzekera zaumisiri, kupanga ndalama izi kutengera kutengera kwa chinthu cha gene mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya osagwiritsa ntchito tizilombo ta Escherichia coli amagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kupanga insulin kwa anthu.

Kusiyana pakati pa zida zonse zamankhwala zomwe zilipo lero ndi:

munthawi yowonekera, osachita kanthu kwakanthawi kochepa, ma insulin osakhalitsa pang'ono komanso insulin yochepa.
mogwirizana ndi amino acid.

Palinso mankhwala ena omwe amaphatikizidwa kuti "zosakaniza", amakhala ndi insulin yokhala ndi nthawi yayitali komanso yochepa. Mitundu yonse 5 ya insulin imagwiritsidwa ntchito pazolinga zawo.

Mwachidule kuchita insulin

Ma insulin omwe amagwira ntchito mwachidule, nthawi zina a ultrashort, ndi mayankho a crystalline zinc-insulin ovuta ndi mtundu wa pH wosaloledwa. Ndalama izi zimagwira mwachangu, komabe, mphamvu ya mankhwalawa ndiyosakhalitsa.

Monga lamulo, mankhwalawa amaperekedwa kwa mphindi 30-45 musanadye. Mankhwala ofanana amatha kuthandizidwa kudzera mu mnofu komanso m'mitsempha, komanso insulin.

Wothandizila wa ultrashort akamalowa m'mitsempha, shuga ya plasma imatsika kwambiri, zotsatira zake zimatha kuchitika pambuyo pa mphindi 20-30.

Posachedwa, magazi adzatsukidwa ndi mankhwalawo, ndipo mahomoni monga makatekisolidi, glucagon ndi STH zimakulitsa kuchuluka kwa glucose mpaka gawo loyambirira.

Pankhani yakuphwanya popanga mahomoni olimbana ndi mahomoni, kuchuluka kwa shuga kwa magazi sikokwanira kwa maola angapo pambuyo pobayikiridwa ndi mankhwala, chifukwa kumakhudza thupi pambuyo pochotsedwa m'magazi.

Mahomoni ochita kupanga mwachidule ayenera kubayidwa m'mitsempha:

pakutsitsimuka komanso kusamalidwa kwambiri,
odwala matenda ashuga a ketoacidosis,
ngati thupi lisintha mwachangu kufunika kwa insulini.

Odwala omwe ali ndi njira yokhazikika ya matenda a shuga, mankhwalawa nthawi zambiri amatengedwa limodzi ndi zotsatira zazitali komanso nthawi yayitali.

Insulin yocheperako pang'onopang'ono ndi mankhwala apadera omwe wodwala amatha kukhala nawo mu kachipangizo kapadera kogwiritsa ntchito.

Kulipiritsa chotulutsira, zinthu zothandizidwazo zimagwiritsidwa ntchito. Izi sizimalola kuti insulini ikhale pansi pa khungu pakhungu pang'onopang'ono.

Masiku ano, timadzi tating'onoting'ono timayendetsedwa mu mawonekedwe a hexamers. Mamolekyu a chinthuchi ndi ma polima. Hexamers amatengeka pang'onopang'ono, zomwe sizimalola kufikira kuchuluka kwa insulin ndende ya plasma ya munthu wathanzi atatha kudya.

Izi zinali chiyambi cha kupanga zopangira zapakati zomwe zimayimira:

Mayesero ambiri azachipatala adachitidwa, chifukwa chake, zida zothandiza kwambiri, mayina a otchuka kwambiri

Mitundu ya insulin iyi imatengedwa kuchokera pansi pakhungu katatu katatu poyerekeza ndi insulin ya anthu. Izi zimabweretsa kuti gawo lalikulu kwambiri la insulin m'magazi limafikiridwa mwachangu, ndipo njira yochepetsera glucose imathamanga.

Ndi kuyambitsa kuphika kwa mphindi 15 musanadye, zotsatira zake zidzakhala zofanana ndi jakisoni wa insulin kwa munthu mphindi 30 asanadye.

Ma mahomoni amphamvu yothamanga kwambiri amaphatikiza lyspro-insulin. Ndi zotumphukira za insulin ya anthu yomwe imapezeka ndikusinthana kwa proline ndi lysine m'matcheni a 28 ndi 29 B.

Monga insulin yaumunthu, m'makonzedwe opangidwa, lyspro-insulin ilipo mu mawonekedwe a hexamers, komabe, wothandizirayo akadzalowa m'thupi la munthu, amasintha kukhala ma monomers.

Pazifukwa izi, lipro-insulin imakhala ndi zotsatira zake, koma zotsatira zake zimakhala kwakanthawi. Lipro-insulin iwina poyerekeza ndi mankhwala ena amtunduwu pazinthu zotsatirazi:

imapangitsa kuchepetsa kuopseza kwa hypoglycemia ndi 20-30%,
Kuchepetsa kuchuluka kwa A1c glycosylated hemoglobin, komwe kumawonetsa chithandizo chokwanira cha matenda ashuga.

Popanga insulin, gawo lofunikira limaperekedwa m'malo mwa proartic acid m'malo mwa Pro28 mu B. Monga lyspro-insulin, mankhwalawa, omwe amalowa m'thupi la munthu, posakhalitsa amagawanika kukhala opanga monoma.

Pharmacokinetic katundu wa insulin

Mu shuga mellitus, mankhwala a insulin amatha kukhala osiyana. Nthawi yapamwamba kwambiri ya kuchuluka kwa plasma insulin komanso zotsatira zazikulu zochepetsera shuga zimatha kusiyana ndi 50%. Kukula kwinanso kwa kusinthika koteroko kumadalira kuchuluka kosiyanasiyana kwa mankhwala kuchokera kuzinthu zowoneka bwino. Komabe, nthawi ya insulin yayitali komanso yochepa ndiyosiyana.

Zotsatira zamphamvu kwambiri ndi mahomoni a nthawi yayitali komanso nthawi yayitali. Koma posachedwa, akatswiri apeza kuti mankhwala ochepetsa mphamvu ali ndi zinthu zofananira.

Kutengera ndi insulin, ndikofunikira kubaya mahomoni nthawi zonse m'matumbo a subcutaneous. Izi zikugwiranso ntchito kwa odwala omwe sangathe kuchepetsa kuchuluka kwa shuga m'magazi chifukwa cha zakudya komanso mankhwala omwe amachepetsa shuga, komanso azimayi omwe ali ndi matenda osokoneza bongo panthawi yomwe ali ndi pakati, odwala omwe ali ndi matenda omwe amapangidwa chifukwa cha pacreatectomy. Apa titha kunena kuti nthawi zonse samapereka zomwe zikuyembekezeka.

Chithandizo cha insulin ndi chofunikira pa matenda monga:

hyperosmolar chikomokere,
matenda ashuga ketoacidosis,
pambuyo opaleshoni kwa odwala matenda a shuga,
pomwe chithandizo cha insulin chimathandizira kuti shuga akhale mu plasma,
Kuchotsa kwina kwa metabolic metabolologies.

Zotsatira zabwino zimatheka pogwiritsa ntchito njira zovuta zochizira:

Kufunika kwa insulin tsiku ndi tsiku

Munthu wokhala ndi thanzi labwino komanso wathanzi labwino amapanga magawo 18-40 patsiku, kapena mayunitsi 0,2-0,5 / kg wa insulin yayitali. Pafupifupi theka la bukuli ndi chimbudzi cha m'mimba, chotsalacho chimapukutidwa mutatha kudya.

Hormayo imapangidwa kukhala magawo a 0,5-1 pa ola limodzi. Shuga atalowa m'magazi, kuchuluka kwa katulutsidwe ka timadzi timeneti kumakwera mpaka ku magawo 6 pa ola limodzi.

Anthu onenepa kwambiri komanso omwe ali ndi insulin kukana omwe amadwala matenda ashuga amatha kupanga ma insulini mwachangu kangapo pambuyo kudya. Pali kulumikizana kwa mahomoni omwe amapangidwa ndi portal system ya chiwindi, pomwe gawo limodzi limawonongeka ndipo silimafikira magazi.

Odwala amtundu wa matenda a shuga 1, kusowa kwa mahomoni tsiku ndi tsiku ndi kosiyana:

Kwenikweni, chizindikirochi chimasiyana kuchokera pa 0,6 mpaka 0,7 mayunitsi / kg.
Ndi kulemera kambiri, kufunikira kwa insulin kumawonjezeka.
Munthu akamafuna mayunitsi 0,5 okha patsiku, amakhala ndi maholide okwanira kapena thupi labwino.

Kufunika kwa mahomoni a insulin ndi amitundu iwiri:

Pafupifupi theka la zofunikira za tsiku ndi tsiku ndi za mawonekedwe oyambira. Hormone iyi imathandizira kupewa kufalikira kwa shuga mu chiwindi.

Mu mawonekedwe a posachedwa, zofunika tsiku lililonse zimaperekedwa ndi jakisoni musanadye. Timadzi timadzi timatenda timadzi timene timayamwa.

Kamodzi patsiku, wodwalayo amapatsidwa jakisoni wa insulin ndi nthawi yayitali, kapena wothandizira akaphatikizidwa amaphatikiza insulini yokhala nthawi yayitali komanso mahomoni apakati. Kusungitsa glycemia pamlingo wabwinobwino, izi sizingakhale zokwanira.

Ndiye dongosolo la mankhwalawa limakhala lovuta kwambiri, pomwe limagwiritsidwa ntchito limodzi ndi insulin ya nthawi yayitali ndi insulin ya nthawi yayitali kapena insulin ya nthawi yayitali ndi insulin ya nthawi yayifupi.

Nthawi zambiri wodwalayo amathandizidwa molingana ndi mtundu wosakanikirana wa mankhwala, akaperekera jakisoni imodzi pakudya kadzutsa, ndipo wina amadya. Hormone mu nkhani iyi imakhala ndi insulin ya nthawi yayifupi komanso nthawi yayitali.

Mukalandira mankhwalawa a mankhwalawa a mahomoni a NPH kapena insulin, tepiyo silipereka glycemia usiku, ndiye kuti jakisoni imagawidwa m'magawo awiri: asanadye chakudya chamadzulo, wodwalayo amapaka jekeseni wa insulin, ndipo asanagone, amapatsidwa NPH insulin kapena tepi ya insulin.

Mayina amalonda

Mutu	Mtengo wa Wyszkowski Index ®

Insulin ndi mankhwala ofunikira, yasintha miyoyo ya anthu ambiri omwe ali ndi matenda ashuga.

M'mbiri yonse yamankhwala ndi mankhwala azaka za 20, mwina gulu limodzi lokha lamankhwala lofunikanso lomwe lingathe kusiyanitsidwa - awa ndi maantibayotiki. Iwo, monga insulin, adalowa mankhwala mwachangu ndikuthandizira kupulumutsa miyoyo yambiri ya anthu.

Tsiku la matenda ashuga limachitika pachikondwerero cha World Health Organisation chaka chilichonse, kuyambira 1991 pa tsiku lobadwa la katswiri wofufuza zamankhwala ku Canada F. Bunting, yemwe adapeza insulin ndi J.J. Macleod. Tiyeni tiwone momwe timadzi timeneti timapangidwira.

Kodi pali kusiyana kotani pakati pa kukonzekera kwa insulin wina ndi mnzake

Kuchuluka kwa kuyeretsa.
Zomwe zimalandila ndiku nkhumba, bovine, insulin ya anthu.
Zowonjezera zomwe zimaphatikizidwa ndi yankho la mankhwalawa ndizosunga, othandizira, ndi ena.
Kusintha
pH yankho.
Kutha kusakaniza mankhwala achidule komanso osakhalitsa.

Insulin ndi mahomoni omwe amapangidwa ndi maselo apadera mu kapamba. Ndi puloteni wokhala ndi mitundu iwiri, yomwe imaphatikizapo 51 amino acid.

Pafupifupi magawo 6 biliyoni a insulini amwedwa pachaka padziko lapansi (gawo limodzi ndi ma micrograms a 42). Kupanga insulini kumakhala kwadzaukadaulo kwambiri ndipo kumachitika kokha kudzera mwa njira za mafakitale.

Magwero a insulin

Pakadali pano, kutengera gwero la zopangidwazo, nkhumba insulin ndi kukonzekera kwa insulin ya anthu ndizayokha.

Ma insulin a nkhumba tsopano ali ndi kuyeretsa kwambiri, ali ndi vuto labwino, ndipo palibenso zotsutsana nazo.

Kukonzekera kwa insulin kwaumunthu kumagwirizana kwathunthu pakupanga kwamankhwala ndi mahomoni amunthu. Nthawi zambiri zimapangidwa ndi biosynthesis pogwiritsa ntchito ma genetic engineering technology.

Opanga akuluakulu amagwiritsa ntchito njira zopangira zotere zomwe zimatsimikizira kuti malonda awo amakwaniritsa zonse zabwino. Palibe kusiyana kwakukulu machitidwe aumunthu ndi porcine monocomponent insulin (i.e., oyeretsedwa kwambiri) adapezeka; mokhudzana ndi chitetezo cha mthupi, malinga ndi maphunziro ambiri, kusiyana kwake ndi kochepa.

Zinthu zothandiza zomwe zimagwiritsidwa ntchito popanga insulin

Mu botolo ndi mankhwalawa muli yankho lomwe silokhala ndi insulin ya mahomoni, komanso mankhwala ena. Aliyense wa iwo ali ndi gawo linalake:

kuchuluka kwa zochita za mankhwala,
njira yothetsera matenda
kukhalapo kwa buffer katundu wa yankho ndi kukhalabe wosalimba pH (acid-base balance).

Kukula kwa insulin

Kuti apange insulin yowonjezera, yomwe ndi imodzi mwa mankhwala awiri, zinc kapena protamine, imawonjezeredwa ku yankho la insulin yachilendo. Kutengera izi, ma insulin onse amatha kugawidwa m'magulu awiri:

protamine insulin - protafan, insuman basal, NPH, humulin N,
zinc-insulin - insulin-zinc-suspensions a mono-tard, tepi, humulin-zinc.

Protamine ndi mapuloteni, koma mayendedwe osokoneza monga mawonekedwe a ziwonetsero kwa iwo ndi osowa kwambiri.

Kupanga malo osagwirizana ndi yankho, yankho la phosphate limawonjezedwanso kwa ilo. Tiyenera kukumbukira kuti insulini yokhala ndi phosphates ndiyoletsedwa kuphatikiza insulin-zinc kuyimitsidwa (ICS), popeza zinc phosphate imayambira munthaka iyi, ndipo zochita za zinc-insulin zimafupikitsidwa m'njira yosadalirika.

Zida zophera tizilombo

Zina mwazomwe zimapangidwira, malinga ndi njira zamatenda ndi tekinoloje, ziyenera kuyambitsidwa pakukonzekera, zimakhala ndi zotsatsira matenda. Izi zimaphatikizapo cresol ndi phenol (onse awiri ali ndi fungo linalake), komanso methyl parabenzoate (methyl paraben), yomwe ilibe fungo.

Kuyambitsidwa kwa chilichonse chosungirako ndipo kumapangitsa fungo linalake la insulin. Zosungirako zonse zomwe zimapezeka kuti zimapezeka mu insulin sizikukhudza.

Protamine insulins nthawi zambiri amaphatikizapo cresol kapena phenol. Phenol sangathe kuwonjezeredwa ku mayankho a ICS chifukwa amasintha mphamvu ya ma cell ma cell. Mankhwalawa akuphatikizapo methyl paraben. Komanso, ayoni a zinc amagwiritsa ntchito njira yotsatsira.

Chifukwa cha chitetezo chamtunduwu cha anti-bacterial ambiri, chitetezo chimagwiritsidwa ntchito popewa kukula kwa zovuta zomwe zingayambike chifukwa cha kuipitsidwa kwa bakiteriya pamene singano imayikidwa mobwerezabwereza mu vial yankho.

Chifukwa cha kukhalapo kwa njira yotchinjirizira, wodwalayo angagwiritse ntchito syringe yomweyo popanga jakisoni wa mankhwalawa kwa masiku 5 mpaka 7 (malinga ngati amangogwiritsa ntchito syringe). Kuphatikiza apo, mankhwala osungira amayesetsa kuti musamwe mowa pakhungu musanalowe, koma pokhapokha ngati wodwalayo apanga jakisoni yekha ndi syringe ndi singano yopyapyala.

Insulin Syringe Calibration

Pokonzekera insulin yoyamba, gawo limodzi lokha la mahomoni linali mu mlomo umodzi wa yankho. Pambuyo pake, kupsinjika kunawonjezeka. Zokonzekera zambiri za insulin m'mabotolo omwe amagwiritsidwa ntchito ku Russia zimakhala ndi magawo 40 mu 1 ml ya yankho. Mbale zambiri zimayikidwa chizindikiro cha U-40 kapena 40 mayunitsi / ml.

Amapangidwira kuti azigwiritsidwa ntchito ponseponse, kungofuna insulini yotere ndikuwunika kwawo kumapangidwa molingana ndi mfundo iyi: syringe ikadzaza ndi 0,5 ml yankho, munthu amapeza magawo 20, 0,35 ml amagwirizana ndi magawo 10 ndi zina zotero.

Chizindikiro chilichonse pa syringe ndi chofanana ndi voliyumu inayake, ndipo wodwalayo amadziwa kale kuchuluka kwamagawo omwe ali mgawoli. Chifukwa chake, kuwerengera kwa ma syringes ndikumaliza kwa kuchuluka kwa mankhwalawa, kuwerengera pakugwiritsa ntchito insulin U-40. Magawo anayi a insulin ali mu 0,1 ml, 6 mayunitsi - mu 0,15 ml ya mankhwalawa, ndi zina mpaka magawo 40, omwe amafanana ndi 1 ml yankho.

Ma millor ena amagwiritsa ntchito insulin, 1 ml yomwe muli mayunitsi 100 (U-100). Mankhwala oterowo, ma syringe amtundu wapadera amapangidwa, omwe ali ofanana ndi omwe takambirana pamwambapa, koma amawayika mosiyanasiyana.

Ikutengera izi ndende iyi (ndiyokwera ka2,5 kuposa muyezo). Pankhaniyi, kuchuluka kwa insulin kwa wodwalayo, kumene, kumakhalabe chimodzimodzi, chifukwa kumakwaniritsa kufunikira kwa thupi kwa kuchuluka kwa insulini.

Ndiye kuti, ngati m'mbuyomu wodwalayo adagwiritsa ntchito mankhwalawo U-40 ndikubaya mayunitsi 40 a mahomoni patsiku, ndiye kuti alandiranso magawo 40 omwewo atabayidwa insulin U-100, koma jekeseni kochulukirapo ka 2,5. Ndiye kuti, magawo 40 omwewo azikhala mu 0,4 ml ya yankho.

Tsoka ilo, si madokotala onse komanso makamaka odwala matenda a shuga omwe amadziwa izi. Mavuto oyamba adayamba pomwe ena mwa odwala adayamba kugwiritsa ntchito ma insulin injector (ma syringe pens) omwe amagwiritsa ntchito ma penfill (ma cartridge apadera) okhala ndi insulin U-40.

Ngati mudzaza syringe ndi yankho lolembedwera U-100, mwachitsanzo, mpaka mpaka mayunitsi 20 (i.e. 0.5 ml), ndiye kuti bukuli lidzakhala ndi magawo 50 a mankhwalawo.

Nthawi iliyonse, ndikudzaza ma syringes U-100 ndi ma syringe wamba komanso kuyang'ana pazidutswa zomwe zadulidwa, munthu adzalandira mlingo wa 2,5 kuposa womwe wawonetsedwa pamlingo wa chizindikiro ichi. Ngati dokotala kapena wodwala sazindikira vuto ili, ndiye kuti mwayi wokhala ndi vuto lalikulu la hypoglycemia ndiwokwera chifukwa cha mankhwala osokoneza bongo omwe nthawi zambiri amachitika.

Kumbali ina, nthawi zina pamakhala ma insulin omwe amawongolera makamaka mankhwala a U-100. Ngati syringe yotere imadzazidwa molakwika ndi njira yokhazikika ya U-40, ndiye kuti mlingo wa insulini mu syringe udzakhala wocheperapo ndi theka kuposa womwe walembedwa pafupi ndi chizindikiro chofananira pa syringe.

Zotsatira zake, kuwonjezereka kwamphamvu kwa glucose kumatha kuchitika koyamba. M'malo mwake, zonse, ndizomveka - pachidutswa chilichonse cha mankhwalawa ndikofunikira kugwiritsa ntchito syringe yoyenera.

M'mayiko ena, mwachitsanzo, Switzerland, malingaliro adaganiziridwa mosamalitsa, malinga ndi kusintha koyenera komwe adapanga kuti insulin ikonzekere idalembedwa kuti U-100. Koma izi zimafunikira kuyanjana kwambiri ndi onse omwe ali ndi chidwi: madokotala a akatswiri ambiri, odwala, anamwino ochokera m'madipatimenti aliwonse, akatswiri a zamankhwala, opanga, olamulira.

M'dziko lathu, ndizovuta kwambiri kusamutsa odwala onse kuti agwiritse ntchito insulin U-100 kokha, chifukwa, mwakuthekera, izi zidzatsogolera kuchuluka kwa zolakwika posankha mtundu.

Kuphatikiza kwafupikitsika ndi insulin yayitali

Mankhwala amakono, chithandizo cha matenda ashuga, makamaka mtundu woyamba, nthawi zambiri chimachitika pogwiritsa ntchito mitundu iwiri ya insulin - yochepa komanso yayitali.

Zingakhale zosavuta kwa odwala ngati mankhwala omwe ali ndi mphamvu zosiyanasiyana atha kuphatikizidwa mu syringe imodzi ndikuperekedwa nthawi yomweyo kuti musavulaze khungu kawiri.

Madokotala ambiri sakudziwa chomwe chimapangitsa kuti athe kusakaniza ma insulin osiyanasiyana. Maziko ake ndi mankhwala ndi galenic (yotsimikizika ndi kapangidwe kake) yoyanjanitsidwa kwaatalikirana ndi yayifupi.

Ndikofunika kwambiri kuti posakaniza mitundu iwiri ya mankhwala, kuyambitsa mwachangu insulin sikufupika kapena kutha.

Zatsimikiziridwa kuti mankhwala omwe amagwira ntchito mwachidule amatha kuphatikizidwa jekeseni m'modzi ndi protamine-insulin, pomwe kuyamba kwa insulin yocheperako sikunachedwe, chifukwa insulle insulin siyimangidwa kuti ipangike.

Poterepa, wopanga mankhwalawa alibe ntchito. Mwachitsanzo, amatha kuphatikizidwa ndi humulin H kapena protafan. Kuphatikiza apo, zosakaniza izi zimatha kusungidwa.

Ponena za kukonzekera kwa zinc-insulin, kwakhala kuti kwayamba kalekale kuti insulini-zinc-suspension (crystalline) singaphatikizidwe ndi insulin yochepa, chifukwa imamangilira ma ioni a zinc ndikusintha kukhala insulin yayitali, nthawi zina pang'ono.

Odwala ena amapereka mankhwala ochepetsa, ndiye, osachotsa singano pansi pakhungu, amasintha pang'ono pang'ono, ndipo zinc-insulin imabayidwa.

Malinga ndi kayendetsedwe ka kayendetsedwe kameneka, kafukufuku wina wasayansi wambiri wachitika, kotero sizingatheke kunena kuti nthawi zina ndi njira iyi ya jakisoni kuphatikizira kwa insulin-insulin ndi mankhwala omwe amangogwiritsa ntchito pakanthawi kochepa kumatha kupanga pansi pa khungu, komwe kumapangitsa kuti mayiyo asavutike.

Chifukwa chake, ndikwabwino kupaka insulin yayifupi mosiyana ndi zinc-insulin, pangani jekeseni awiri osiyana m'malo a khungu omwe ali osachepera 1 cm kupatula wina ndi mnzake.

Wophatikiza insulin

Tsopano makampani opanga mankhwala amapanga kukonzekera komwe kumakhala ndi insulin yochepa pamodzi ndi protamine-insulin mwachiwonetsero chokwanira. Mankhwalawa akuphatikizapo:

Zophatikiza zomwe ndizothandiza kwambiri ndizomwe kuchuluka kwa insulin kwa nthawi yayitali kuli 30:70 kapena 25:75. Kuwerengera kumeneku kumasonyezedwa nthawi zonse mu malangizo ogwiritsira ntchito mtundu uliwonse wa mankhwala.

Mankhwala oterewa ndi oyenera kwambiri kwa anthu omwe amatsatira kudya kosalekeza, olimbitsa thupi nthawi zonse. Mwachitsanzo, nthawi zambiri amagwiritsidwa ntchito ndi odwala okalamba omwe ali ndi matenda amtundu wa 2.

Ma insulin osakanikirana sakhala oyenera kukhazikitsidwa kwa mankhwala omwe amadziwika kuti "osinthika" a insulin, pakakhala koyenera kuti asinthe nthawi zonse mlingo wa insulin.

Mwachitsanzo, izi zikuyenera kuchitika pakusintha kuchuluka kwa chakudya chamagulu m'zakudya, kuchepetsa kapena kukulitsa zochitika zolimbitsa thupi, ndi zina zambiri. Pankhaniyi, mlingo wa basal insulin (womwe umakhala nthawi yayitali) sungasinthe.

Insulin yaumunthu imanena za mahomoni omwe amapanga kapamba. Amagwiritsidwa ntchito pochiza matenda ashuga. Kuti muthane ndi chizolowezi cha kapamba, wodwalayo amapaka jakisoni:

zotsatira zazifupi
zopitilira
nthawi yayitali yochitapo kanthu.

Mtundu wa mankhwalawa umatsimikizika potengera thanzi la wodwala komanso mtundu wa matenda.

Zokonzekera zomwe zimapezeka kuchokera ku zopangira zachilengedwe

Kulandila timadzi ta nkhanu ndi ng'ombe ndi ukadaulo wakale womwe sugwiritsidwa ntchito masiku ano. Izi zimachitika chifukwa cha mankhwala ochepa omwe adalandiridwa, zomwe zimapangitsa kuti pakhale zovuta zina komanso kuyeretsa kosakwanira. Chowonadi ndi chakuti popeza mahomoni ali ndi mapuloteni, amakhala ndi ma amino acid ena.

Insulin yomwe imapangidwa mthupi la nkhumba imasiyana mu ma amino acid omwe amapangidwa ndi insulin yaumunthu 1 amino acid, ndi bovine insulin ndi 3.

Kumayambiriro ndi pakati pa zaka za zana la 20, pamene mankhwala ofananawo analibe, ngakhale insulin yotereyi inali yopambana pamankhwala ndikulola kutenga chithandizo cha odwala matenda ashuga kupita nawo kumalo ena atsopano. Ma Horoni omwe adapangidwa ndi njirayi amachepetsa shuga m'magazi, komabe, nthawi zambiri ankayambitsa zovuta komanso chifuwa. Kusiyana pakapangidwe ka amino acid ndi zosafunika zamankhwala zimakhudza mkhalidwe wa odwala, makamaka m'magulu omwe ali pachiwopsezo cha odwala (ana ndi okalamba). Chifukwa china chosalolera bwino za insulin yotereyi ndi kupezeka kwa kuyamwa kwa mankhwala osagwiritsa ntchito (proinsulin), komwe sikunali kotheka kuti athetse kusiyanasiyana kwa mankhwalawa.

Masiku ano, pali ma insuge apamwamba apamwamba omwe alibe zoperewera. Zimapezeka kuchokera kapamba wa nkhumba, koma zitatha zimayatsidwa ndikuwonjezera kuyeretsa. Zili ndi mitundu yambiri ndipo zimakhala ndi zotuluka.

Insulin ya nkhumba yosinthidwa sikuti imasiyana ndi mahomoni amunthu, chifukwa chake imagwiritsidwabe ntchito

Mankhwalawa amaloledwa ndi odwala bwino ndipo samayambitsa mavuto, samachepetsa chitetezo cha mthupi ndipo amachepetsa shuga la magazi. Bovine insulin sikugwiritsidwa ntchito ngati mankhwala masiku ano, chifukwa chifukwa chakunja kwake kumakhudza chitetezo chathupi komanso machitidwe ena a thupi.

Katswiri wa Majini a Insulin

Insulin yaumunthu, yomwe imagwiritsidwa ntchito ngati odwala matenda ashuga, pamsika wamafuta amapezeka m'njira ziwiri:

ntchito enzymatic mankhwala a porcine insulin,
kugwiritsa ntchito majini osinthika amtundu wa Escherichia coli kapena yisiti.

Ndi kusintha kwa mankhwala a physico-cell, mamolekyulu a porcine insulin pansi pa michere yapadera amakhala ofanana ndi insulin yaumunthu. Kapangidwe ka amino acid kamakonzedwe kotsatira sikusiyana ndi kapangidwe kazinthu zachilengedwe zomwe zimapangidwa m'thupi la munthu. Panthawi yopanga, mankhwalawa amayeretsedwa kwambiri, chifukwa chake samayambitsa zovuta kapena mawonekedwe ena osayenera.

Koma nthawi zambiri, insulin imapezeka pogwiritsa ntchito mitundu yosinthika (genetically modified). Pogwiritsa ntchito njira za biotechnological, mabakiteriya kapena yisiti amasinthidwa m'njira yoti iwonso atulutse insulin.

Kuphatikiza pakupanga insulin yokha, kuyeretsedwa kwake kumachita mbali yofunika. Kuti mankhwalawa asayambitse zovuta zilizonse komanso zotupa, pagawo lililonse ndikofunikira kuyang'anira kuyera kwa zovuta zamagulu ndi zovuta zonse, komanso zosakaniza zomwe zimagwiritsidwa ntchito.

Pali njira ziwiri zopangira insulin. Yoyamba mwa izo idakhazikitsidwa ndikugwiritsa ntchito mitundu iwiri yosiyanasiyana. Iliyonse imapangika gawo limodzi lokha la mamolekyule a ma DNA (pali awiri okha, ndipo amapindika molunjika). Kenako maunyolo awa amalumikizidwa, ndipo mu njira yotsatila ndikothekanso kupatulira mitundu yogwira insulin kwa iwo omwe alibe phindu lililonse kwachilengedwe.

Njira yachiwiri yomwe mungalandire mankhwalawa pogwiritsa ntchito Escherichia coli kapena yisiti zimatengera kuti microbe yoyamba imapanga insulin (ndiye kuti, preinsor yake ndi proinsulin). Kenako, pogwiritsa ntchito enzymatic chithandizo, fomu iyi imayatsidwa ndikugwiritsidwa ntchito ngati mankhwala.

Ogwira ntchito omwe ali ndi mwayi wopezeka m'malo ena opanga zovala ayenera kuvala suti yodzitetezera, yomwe imachotsa kulumikizana ndi mankhwalawa ndi madzi amthupi la anthu.

Njira zonsezi nthawi zambiri zimakhala zamagalimoto, mpweya ndi mawonekedwe onse polumikizana ndi ma ampoules ndi mbale sizowoneka bwino, ndipo mizere yokhala ndi zida ndiyosindikiza.

Njira za biotechnology zimathandizira asayansi kuti aganizire njira zina zothanirana ndi shuga. Mwachitsanzo, pakadali pano, maphunziro oyamba opanga ma cell a pancreatic beta akuchitika, omwe amatha kupezeka pogwiritsa ntchito njira zopangira majini. Mwina m'tsogolomu adzagwiritsidwa ntchito kukonza zomwe zimachitika m'thupi mwa wodwala.

Kupanga zamakono ndi njira yovuta yaukadaulo, yomwe imaphatikizapo magalimoto ndi kulowererapo pang'ono kwa anthu

Zowonjezera zina

Kupanga kwa insulin popanda maipi mu masiku amakono kuli kovuta kulingalira, chifukwa amatha kusintha zinthu zake zamankhwala, kuwonjezera nthawi yofunikira ndikuchita zoyera kwambiri.

Mwa zomwe ali nazo, zosakaniza zina zonse zitha kugawidwa m'magulu otsatirawa:

prolongators (zinthu zomwe zimagwiritsidwa ntchito popereka nthawi yayitali ya mankhwala),
mankhwala ophera tizilombo toyambitsa matenda
olimbitsa, chifukwa chomwe acidity yoyenera imasungidwa mu yankho la mankhwalawa.

Kupitiliza Zowonjezera

Pali ma insulin omwe amagwira ntchito kwa nthawi yayitali omwe zochita zake zimakhala kwa maola 8 mpaka 42 (kutengera gulu la mankhwalawo). Izi zimatheka chifukwa cha kuwonjezera pa zinthu zapadera - zotambuzira ku yankho la jakisoni. Nthawi zambiri, imodzi mwamafuta awa imagwiritsidwa ntchito pazolinga izi:

Mapuloteni omwe amalimbitsa nthawi ya mankhwalawa amayeretsedwa mwatsatanetsatane ndipo amakhala otsika pang'ono (mwachitsanzo, protamine). Mchere wamchere wa zinc sukhudzanso zochita za insulin kapena thanzi la munthu.

Momwe mungagwiritsire ntchito insulin ya anthu odwala matenda ashuga

Insulin yaumunthu ndi chida chothandiza kupangira odwala omwe ali ndi mitundu yoyamba komanso yachiwiri ya matenda ashuga. Ndi chipangizo chamajini chomwe chimasungunuka kwambiri mu zakumwa. Kuvomerezedwa kuti mugwiritse ntchito ngakhale mukakhala ndi pakati.

Zotsatira za pharmacological

Mankhwalawa akukhudzana ndi ma insulin osakhalitsa. Kapangidwe kenakake ka insulin-receptor pamwamba pa michere yambiri yamaselo ambiri, omwe amawoneka atatha kulumikizana mwachindunji ndi mawonekedwe a membrane a cell. Kuphatikizika kwa cycloo oxygenase mkati mwa maselo a chiwindi ndi mawonekedwe a mafuta akuwonjezeka.

Insulin imatha kulowa mwachindunji m'maselo a minofu. Poterepa, machitidwe onse omwe amapezeka m'maselo amasinthidwa. Kuphatikizika kwa michere yofunika ya hexokinase ndi glycogen synthetase kumakulanso.

Kuchulukana kwa shuga m'magazi kumatsika chifukwa chogawa mwachangu mkati mwa maselo. Kutsimikizika kwake kwabwino ndi matupi onse amthupi kumachitika. Pali kukondoweza kwa machitidwe a glycogenogeneis ndi ma cell lipogenis. Mapangidwe a mapuloteni amapangidwa mwachangu. Mlingo wofunikira wa kupanga shuga m'magazi a chiwindi umachepetsedwa kwambiri ndikuchepetsa kuwonongeka kwa ulusi wa glycogen.

Pharmacokinetics

Kuchuluka kwa mayamwidwe a insulin nthawi zambiri kumadalira momwe zinthu zomwe zimagwirira ntchito zimathandizira. Zambiri zimachitika chifukwa cha mlingo womaliza, kuchuluka kwa insulini mu jakisoni wa jekeseni komanso pamalo omwe jakisoniyo yayamba. Timalizi zimagawidwa mosiyanasiyana.Insulin siyingalowe chotchinga cha placenta.

Insulin siyingalowe chotchinga cha placenta.

Itha kuwonongeka pang'ono ndi insulinase mwachindunji m'chiwindi. Imapukusidwa makamaka mwa kusefa impso. Kuthetsa theka-moyo sikudutsa mphindi 10. Kuchuluka kwa insulin koyera m'magazi kumawonedwa mkati mwa ola limodzi pambuyo pake. Zotsatira zake zimatha mpaka maola 5.

Momwe mungatengere insulin yaumunthu

Mlingo ndi njira yotsogoza mwachindunji imatsimikiziridwa pokhapokha pa shuga ya magazi, komanso maola awiri mutatha kudya. Kuphatikiza apo, phwando limatengera kuuma kwa chitukuko cha glucosuria.

Nthawi zambiri, subcutaneous makonzedwe. Chitani mphindi 15 chakudya chachikulu chisanachitike. Pa matenda a shuga a ketoacidosis kapena chikomokere, inshuwarayo imabayira jekeseni, nthawi zonse kudzera m'mitsempha ya gluteus, opaleshoni iliyonse isanachitike.

Ndikulimbikitsidwa kupereka mankhwalawa katatu pa tsiku. Pofuna kupewa zilonda zam'mimba zambiri, simungathe kumeza mankhwalawo m'malo omwewo. Ndiye dystrophy yama subcutaneous yamafuta siziwona.

Akuluakulu tsiku lililonse mlingo 40 ndi ana, ndipo kwa ana ndi magawo 8. Nthawi zonse oyendetsera kasamalidwe kawiri pa tsiku. Ngati pali chosoweka chotere, ndiye kuti mutha kulandira insulin mpaka kasanu.

Akuluakulu tsiku lililonse insulin ndi 40 magawo.

Malangizo apadera

Musanakumane yankho mwachindunji kuchokera m'botolo, muyenera kulionadi kuti likuwonekera bwino. Ngati matenda atayamba, mankhwalawa sayenera kumwa.

Mlingo wa insulin umasinthidwa motere:

matenda opatsirana
Kulakwitsa chithokomiro
Matenda a Addison
hypopituitarism,
matenda ashuga okalamba.

Nthawi zambiri, kuwonetsedwa kwa hypoglycemia yamphamvu imayamba. Zonsezi zimayamba chifukwa cha mankhwala osokoneza bongo, kukhazikika kwa insulin komwe kumachokera munthu, kufa ndi njala, kutsegula m'mimba, kusanza komanso zizindikiro zina za kuledzera. Hypoflycemia yofatsa imatha kuyimitsidwa pomwa shuga.

Mlingo wa insulin umasinthidwa kwa odwala okalamba.

Ngati zizindikiro zazing'ono za hypoglycemia zikuwoneka, muyenera kulankhulana ndi katswiri nthawi yomweyo. Wofatsa, kusintha kwa mankhwalawa kungathandize. M'mavuto akuchulukirapo, mankhwala ogwiritsira ntchito doporization ayenera kugwiritsidwa ntchito. Nthawi zambiri, kuchotsa kwathunthu kwa mankhwala kapena kulandira chithandizo kumafunikira.

Kumbukirani kuti m'dera la kayendetsedwe ka chiwongola dzanja, mitundu ina ya mafuta m'mimba imatha kuwonekera. Koma izi zitha kupewedwa ndikusintha malo a jakisoni.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Kuwongolera kuchuluka kwa shuga mthupi la mayi wapakati ndikofunikira. Mu trimester yoyamba, kufunika kwa insulin yoyera kumachepera pang'ono, ndipo kumapeto kwa nthawi kumawonjezeka.

Pa yoyamwitsa, mayi angafunike kusintha kwa insulin ndi zakudya zapadera.

MP ilibe mutagenic komanso ma genetically poizoni.

Kugwiritsa ntchito kwa vuto la chiwindi

Mosamala, anthu omwe ali ndi matenda a chiwindi ayenera kumwa mankhwalawa. Pakusintha pang'ono kwa zitsanzo za chiwindi, tikulimbikitsidwa kusintha mlingo.

Mosamala, insulini iyenera kutengedwa kwa anthu omwe ali ndi matenda a chiwindi.

Bongo

Zizindikiro zosokoneza bongo zimatha kuchitika pafupipafupi:

hypoglycemia - kufooka, thukuta kwambiri, khungu la pakamwa, kunjenjemera kwa malekezero, lilime lonjenjemera, njala,
hypoglycemic chikomokere ndi chivomerezo.

Chithandizo chake chimakhala chodziwikiratu. Hypoglycemia yofatsa imatha kudutsa mutatha kudya shuga kapena chakudya chamafuta ambiri.

Glucagon woyela amapaka jekeseni kuti aletse zizindikiro za kuchuluka kwa mankhwala osokoneza bongo. Pakumala kukomoka mwadzidzidzi, mpaka 100 ml ya mankhwala osokoneza bongo a dextrose amadzilowetsa pansi mpaka wodwala kwambiri atatuluka.

Kuchita ndi mankhwala ena

Yankho la insulin yopanga ndi yoletsedwa kuphatikiza ndi njira zina za jakisoni. Zotsatira zazikulu za hypoglycemic zimangowonjezereka ngati zimagwiritsidwa ntchito limodzi ndi sulfonamides, Mao inhibitors, ndi anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine ndi ena a beta-blockers amathandizanso pakugwiritsa ntchito mankhwalawa.

Mphamvu ya hypoglycemic imafooka mukatengedwa ndi mahomoni akuluakulu a chithokomiro, njira za kulera, glucagon, estrogens, heparin, sympathomimetics ambiri, antidepressants, antagonists a calcium, morphine ndi nikotini.

Modziletsa amakhudza insulin pakamwa shuga a beta-blocker, reserpine ndi pentamidine.

Madera okhathamiritsa

Tizilombo toyambitsa matenda tomwe timapangira insulini ndikofunikira kuti tizilombo tating'onoting'ono tisachulukane panthawi yosungirako ndikugwiritsa ntchito momwemo. Zinthu izi ndizosungirako komanso kuonetsetsa kuti mankhwalawo amasungidwa. Kuphatikiza apo, ngati wodwala amapereka mahandawo kuchokera kwa iye yekha, ndiye kuti mankhwalawo amatha kwa masiku angapo. Chifukwa cha ma antibacterial apamwamba kwambiri, sangakhale ndi mwayi wotaya mankhwala osagwiritsidwa ntchito chifukwa choganiza kuti zitha kubereka mwanjira yankho la ma virus.

Zinthu zotsatirazi zitha kugwiritsidwa ntchito ngati mankhwala ophera majeremusi popanga insulin:

Ngati yankho lake lili ndi ayoni a zinc, amakhalanso ngati chosungirako chifukwa cha antimicrobial

Popanga mtundu uliwonse wa insulini, zinthu zina zoyambitsa matenda zimakhala zoyenera. Kuchita kwawo ndi mahomoni kuyenera kufufuzidwa pamlingo woyeserera koyambirira, popeza osungirako sayenera kusokoneza zochita za insulin kapena kusokoneza katundu wake.

Kugwiritsira ntchito mankhwala osungirako nthawi zambiri kumapangitsa kuti timadzi timadzi timene timatulutsa pakhungu popanda kulandira mankhwala asanachitike ndi mowa kapena antiseptics (wopanga nthawi zambiri amatanthauza izi pamalangizo). Izi zimathandizira kukhazikitsa kwa mankhwalawa ndikuchepetsa kuchuluka kwa mankhwalawa pokonzekera jakisoni wokha. Koma malingaliro awa amangogwira ntchito ngati yankho limaperekedwa pogwiritsa ntchito syringe imodzi ya insulini ndi singano yopyapyala.

Olimbitsa

Olimba amafunika kuti pH yothetsera vutoli ikhalebe yokhazikika. Kusungidwa kwa mankhwalawa, ntchito zake ndi kukhazikika kwa katundu wamafuta zimadalira kuchuluka kwa acidity. Popanga mahomoni a jakisoni kwa odwala matenda ashuga, ma phosphates nthawi zambiri amagwiritsidwa ntchito pazolinga izi.

Kwa insulin yokhala ndi zinc, njira zothetsera kukhazikika sizofunikira nthawi zonse, chifukwa zitsulo zazitsulo zimathandizira kukhalabe koyenera. Ngati agwiritsidwa ntchito, ndiye kuti mitundu ina ya mankhwala imagwiritsidwa ntchito m'malo mwa phosphates, popeza kuphatikiza kwa zinthu izi kumabweretsa kupendekera ndi kusakwaniritsidwa kwa mankhwalawo. Chuma chofunikira chomwe chikuwonetsedwa kwa okhazikika onse ndi chitetezo ndi kulephera kulowa pazosintha zilizonse ndi insulin.

A endocrinologist wokhoza bwino ayenera kuthana ndi kusankha kwa majakisoni obwera ndi shuga kwa wodwala aliyense payekhapayekha. Ntchito ya insulin sikuti kungokhala ndi shuga wambiri m'magazi, komanso osati kuvulaza ziwalo zina ndi machitidwe ena. Mankhwalawa ayenera kukhala osalowerera m'thupi, otsika pang'ono komanso oyenera kugula. Ndiwothekanso kosavuta ngati insulin yosankhidwa ikhoza kusakanizidwa ndi mitundu yake ina kutengera nthawi yochitapo kanthu.

Kuyenderana ndi mowa

Kumwa insulin sikugwirizana ndi kumwa mowa. Zizindikiro za kuledzera zikuchulukirachulukira, ndipo zotsatira za mankhwalawo zimachepetsedwa kwambiri.

Kumwa insulin sikugwirizana ndi kumwa mowa.

Pali mitundu ingapo yofunika:

Berlinsulin N Mwachizolowezi,
Diarapid CR,
Wotsimikiza
Insulin Actrapid,
Insuman Rapid,
Pakati
Pensulin,
Humodar.

Musanagule mankhwala kuti musinthe m'malo mwa mankhwala, muyenera kufunsa katswiri. Ngakhale maMS ena ndi otsika mtengo, atha kukhala ndi zotsatira zosiyana. Mankhwala onse amachita mosiyanasiyana pama receptor receptor. Chifukwa chake, kuchuluka kwa glucose sikungotengera zomwe zimagwira, komanso kuthekera kwake kumangiriza ku zovuta za receptor. Kuphatikiza apo, chilichonse chimakhala ndi zake ndi ma contraindication, chifukwa chake amasankhidwa ndi dokotala payekhapayekha.

Zosungidwa zamankhwala

Amasungidwa pa kutentha osaposa + 25 ° C pamalo otetezedwa kwambiri kuchokera kwa ana aang'ono. Ndikofunika kupewa dzuwa lowongolera mwachindunji.

Insulin ya Anthu imasungidwa pa kutentha osaposa + 25 ° C.

Ndikofunikira kuonetsetsa kuti yankho silitaya mawonekedwe ake, ndipo palibe mawonekedwe pansi. Izi zitachitika, ndiye kuti mankhwalawo sangathe kugwiritsidwa ntchito.

Wopanga

Pali mabungwe angapo omwe amapanga insulin yaumunthu:

Sanofi (France),
NovoNordisk (Denmark),
EliLilly (USA),
Pharmstandard OJSC (Russia),
National Biotechnology OJSC (Russia).

Oksana, wazaka 48, Rostov-on-Don: “Posachedwa, ndinapezeka ndi matenda a shuga 1. Anapatsidwa mankhwala a insulin. Amagulitsidwa m'mabotolo, imodzi ndiyokwanira kwa nthawi yayitali. Ichi ndi chimodzi mwamapulogalamu. Mtengo siwokwera kwambiri. Ndine wokhutira ndi momwe mankhwalawo amathandizira. Patangopita masiku ochepa, kuchuluka kwa shuga kwa magazi kunali kofanana. Chokhacho ndikuti mankhwalawa ayenera kusankhidwa malinga ndi kusintha kwa shuga. Ndipo izi ziyenera kuchitika kokha ndi dokotala, chifukwa zizindikiro za bongo ndizowopsa pamoyo.

Ndikupangira jakisoni nthawi zonse, koma osachepera katatu patsiku, chifukwa mankhwalawa sanatalike kwambiri, sikokwanira kwa tsiku lonse. "

Alexander, wazaka 39, Saratov: “Ndakhala ndikudwala matenda a shuga kwa nthawi yayitali. Amandichitira mothandizidwa ndi zolembera za syringe, zomwe ndizosavuta kugwiritsa ntchito. Kumayambiriro kwenikweni kwa makonzedwe, panali zochitika zina zakumaloko momwe zimakhalira ndi hematomas m'dera loyang'anira mankhwalawa. Komano adotolo adati ndichofunika kuperekera jakisoni m'malo osiyanasiyana kuti tipewe kulowetsedwa. Atayamba kutero, hematomas sanapangenso. Chobwereza chokha ndichochita kwakanthawi kamankhwala. Amakhala ndi maola opitilira 5. Ndipo kotero - zotulukapo zake nzabwino. "

Zotsatira zoyipa

Hypoglycemia (nthawi zambiri kuposa momwe mumagwiritsira ntchito insulin pokonzekera nyama), AR - nthawi zambiri. Zolakwika zakanthawi kochepa - nthawi zambiri kumayambiriro kwa insulin.

Actrapid, Humulin, Insuran.