Mtundu woyamba wa shuga

Popeza mtundu 1 wa shuga umakhala wodziwika bwino chifukwa cha kuchepa kwa insulin, chithandizo chamankhwala cholowetsa insulin chimachitika nthawi zonse za matendawa. Ndipo pazifukwa zomwezo, chithandizo cha matenda a shuga 1 a shuga okhala ndi mankhwala ochepetsa shuga, makamaka sulfonamides ndipo, makamaka, biguanides, amatsutsana kwathunthu ngakhale pakanthawi kochepa kuchotsedwa kwa matenda a shuga 1 koyamba kwa matendawa.

Malangizo a odwala omwe ali ndi vuto la matenda a shuga 1 ndi kuphatikiza kwa insulin, popanda mankhwala a hypoglycemic, ketoacidotic.

Cholinga cha mankhwalawa ndikukwaniritsa Normoglycemia ndikuwonetsetsa kukula komanso kukhazikika kwa thupi, chifukwa chachikulu cha ana odwala, achinyamata ndi achinyamata.

Ngati matenda a shuga amtundu woyamba akhazikitsidwa, chithandizo cha insulini chiyenera kuyambika nthawi yomweyo.

Kuyambitsa kwakanthawi kokwanira komanso kolinganiza bwino ka insulin kumalola mu 75-90% ya milandu kuti zitheke kukhululukirana kwakanthawi, kenako ndikukhazikika pamatendawa ndikuchepetsa kukula kwa zovuta.

Type 1 matenda a shuga a insulin

Ndikofunika kuchita ndi insulin mankhwala a odwala omwe ali ndi matenda a shuga 1 m'maboma angapo jakisoni. Pali zosankha zingapo jakisoni wa insulin yambiri. Awiri mwanjira izi ndi zovomerezeka.

Multiple injection mode

1. Wofatsa insulin (Actrapid, Humulin R, Insuman Rapid) asanadye zakudya zazikulu, sing'anga-insulin (Monotard, Protafan, Humulin NPH, Insuman Bazal) asanadye chakudya cham'mawa komanso asanagone.

2. Wofatsa insulin (Actrapid, Humulin R, Insuman Rapid) asanakudye chakudya chachikulu, nthawi yayitali-insulin (Monotard, Protafan, Humulin NPH, Insuman Bazal) asanagone.

Mlingo wa tsiku ndi tsiku wa insulin yochepa umagawidwa motere: 40% imayendetsedwa asanadye chakudya cham'mawa, 30% asanadye chakudya cham'mawa komanso 30% asanadye chakudya chamadzulo. Mothandizidwa ndi kusala kudya glycemia (6.00), mlingo wa insulin (SDI) womwe umakhalapo nthawi yayitali isanayambe kugona uyenera kusinthidwa, ndipo mlingo wa SDI womwe umayendetsedwa musanadye kadzutsa umasinthidwa molingana ndi gawo la glycemia musanadye nkhomaliro (13.00). Mlingo wa insulin yocheperako (ICD) umasinthidwa motsogozedwa ndi postprandial glycemia.

Insulin ya matenda ashuga

Pakadali pano, kukonza nyama yankhumba, nkhumba ndi ma insulin aanthu akupangidwira, yoyamba kukhala yosiyana ndi ya munthu ndi ma amino acids, yachiwiri ndi imodzi, chifukwa chake mapangidwe a antibodies oyamba ndi apamwamba kuposa achiwiri.

Kutsuka kwa kukonzekera kwa insulin mwa kubwereza kukokota ndi chromatografia kumagwiritsidwa ntchito kuti apange zomwe zimatchedwa "monopique" insulin, zomwe, ngakhale zilibe kanthu pazakudya zamapuloteni, zimakhala ndi zosafunikira mwanjira ya kusintha kwa mankhwala a insulin - mono-desamido insulin, mono-arginine insulin, etc. ili ndi acidic malo, omwe amathandizira kuti pakhale kusintha kwina kwakanthawi pokonzekera insulin.

Chiyeretso chowonjezereka cha kukonzekera kotereku pogwiritsa ntchito ion-exchange chromatography chimachotsa zosayenerazi ndikupeza insulin yotchedwa "monocomponent", yomwe imangokhala ndi insulini ndipo imakhala, monga lamulo, pH yosalowerera. Zokonzekera zonse za insulin za anthu ndizopanga zinthu zina.

Pakadali pano, ng'ombe, nkhumba, ndi ma insulin aanthu amatha kupangidwa pogwiritsa ntchito genetic engineering ndi semi-synthetically.

Kukonzekera kwa insulin kumagawika m'magulu atatu kutengera nthawi yomwe achitepo kanthu:

1. Kuchita mwachidule (kosavuta, kusungunuka, kwabwinobwino, kusungunuka) - insulin yokhala ndi maola 4-6.

2. Nthawi yayitali (yapakatikati) ya zochita (tepi, NPH) - mpaka maola 10-18.

3. Kutalika kwa nthawi yayitali (tepi yowonera), kutalika kwa maola 24-36

Kukonzekera kwa insulin kwa syringe ya insulini kumakhala ndi maphikidwe pamipikisano ya 40 PESCES mu 1 ml yankho, komanso makina a insulin, omwe amatchedwa cartridgepenfill pa ndende ya 100 PIECES mu 1 ml (NovoRapid-Penfill).

Jakisoni wa insulin nthawi zambiri amapangidwa ndi syringes yapadera ya insulin m'mafuta a subcutaneous. Malo omwe analimbikitsidwa kuti adziyendetse okha insulin ndi gawo lam'mimba, ntchafu, matako ndi mkono.

Akuluakulu tsiku lililonse a insulin mtundu 1 shuga ndi 0,4-0.9 U / kg thupi.

Mlingo ukakhala wokwera, izi zimawonetsa kukana insulini, koma nthawi zambiri umakhala ndi insulin. Chosowa chochepa chimawonedwa munthawi ya chikhululukiro chokwanira cha matenda a shuga.

Pakusinthanitsa, gawo limodzi la insulini limachepetsa glycemia pachimake pa ntchito pafupifupi 1.5-2 mmol / L, ndipo mkate umodzi (XE) (12 g wamafuta) umawonjezera pafupi 3 mmol / L.

Ma Insulin Therapy Schemes a Type 1 Diabetes

Pakadali pano, muzochitika zamankhwala, njira ziwiri zazikulu za insulin yothandizira mtundu wa 1 shuga mellitus zimagwiritsidwa ntchito:

1. "Chikhalidwe" mankhwala a insulinpamene insulin yocheperako imabayidwa kawiri patsiku ndi insulin yapakatikati.

Mu "chikhalidwe" cha insulin, insulin imaperekedwa kwa maola 0,5 musanadye chakudya, chakudya cham'mawa chisanafike komanso chakudya chamadzulo (magawo azakudya ayenera kukhala pafupifupi maola 12), ndi 60-70% ya mlingo wa tsiku ndi tsiku womwe umaperekedwa m'mawa ndi 30-40% madzulo. Kugwiritsa ntchito bwino kwa mankhwala kwa nthawi yayitali kumawonjezeka pamene insulin yosavuta imayendetsedwa nthawi yomweyo, zomwe zimalepheretsa kuchuluka kwa glycemia pambuyo pa kadzutsa ndi chakudya chamadzulo.

Odwala angapo, njira yodziwitsira katatu ya insulin masana imagwira ntchito kwambiri: IPD imayikidwa ndi ICD m'mawa asanadye chakudya cham'mawa, ndipo ICD imayendetsedwa musanadye chakudya chamadzulo (nthawi ya 18 - 19 h) komanso asanagone (nthawi ya 22-23 h), asanagone, wachiwiri kamodzi patsiku SPD.

Zosakaniza (zosakanikirana) za kukonzekera kwa insulini ndizothandiza kwa chithandizo cha insulin chachikhalidwe, popeza zimakhala ndi zosakanizika zopangidwa ndi insulin yochepa ndi NPH, yomwe imabayidwa ndi syringe kawiri patsiku musanadye kadzutsa ndi chakudya chamadzulo.

Mwachidziwikire, pali mitundu inayi yosakanikirana yamtunduwu yomwe imakhala ndi insulin yosavuta, 10, 20, 30, kapena 40% yosavuta (mwachitsanzo, Humulins M1, M2, M3 kapena M4, motsatana) yosakanikirana ndi IPD (Isofan).

Makhalidwe a pharmacokinetic a insulin yokonzekera awa amatsimikiziridwa, mbali yomweyo, ndi insulin yaying'ono - mankhwalawa amayamba kugwira ntchito pambuyo pa mphindi 30 pambuyo pa utsogoleri, kenako, ndi insulin yayitali, yomwe imapereka nthawi yayitali kuyambira maola 2 mpaka 8 pambuyo pa insulin , nthawi yochitapo (maora 12-16) imangotenga insulin yayitali.

Choyipa chachikulu cha chikhalidwe cha insulini yachikhalidwe ndikufunika kwakutsatira kwambiri zakudya zokhazikika komanso masewera olimbitsa thupi. Vutoli ndi chimodzi mwazifukwa zomwe masiku ano odwala ambiri omwe ali ndi matenda ashuga asankha kusinthira mankhwala a insulin, omwe amachititsa kuti moyo wa wodwala ukhale wosalamulirika, womwe umapangitsa kuti ukhale wabwino.

2. Kwambiri insulin mankhwala:

• kukhazikitsidwa kwa insulin pakati-piritsi kawiri patsiku kumathandizidwa ndi insulin yochepa, yomwe nthawi zambiri imaperekedwa musanadye katatu

- lingaliro la "basal-bolus" - pafupipafupi ("bolus") la insulin yosavuta musanadye chakudya cham'mbuyo cha insulin.

Chithandizo chowonjezera chimaphatikizanso chithandizo ndi insulin dispenser (pomp) - chipangizo chomwe chimangopereka insulin mwamafuta kumafuta osaneneka. Pampu ya insulini ndiye chida chokhacho chomwe chimapereka insulin mosalekeza, mozungulira nthawi zonse.

Ntchito ikupitilira ntchito yazida zomwe zimatchedwa "ma pancreas". Mukaphatikiza pampu ya insulin ndi zida zomwe zimayeza shuga m'magazi pafupipafupi (monga kuvala glucometer), insulin imayendetsedwa molingana ndi kuchuluka kwa shuga m'magazi omwe amaperekedwa ndi glucometer kupita pampu. Chifukwa chake, "pancreas yokumba" amatsata ntchito ya kapamba weniweni molondola monga momwe kungathekere, kupereka chipukuta mthupi kwambiri kwa odwala matenda ashuga.

Kwambiri insulin mankhwala a mtundu 1 shuga.

Kuyamba kwa kupanga chosalekeza cha zolembera zapadera, zotchedwa insulin ndi singano za atraumatic zomwe ndizothandiza kwa pafupipafupi kukonzekera insulini, njira yodziwitsira pafupipafupi insulin (insulin Therapy) yakhala ikuwoneka bwino kwa odwala ambiri omwe ali ndi matenda ashuga.

Mfundo zakuchipinda cha inshuwaransi yokhala ndi matenda amtundu 1 ndikuti pothandizidwa ndi jakisoni wam'mawa ndi madzulo, insulinemia imapangidwa pakati pa chakudya ndi usiku, ndi mphindi 30 asanadye chakudya chachikulu (3-4) kangapo patsiku) chakudya chokwanira cha insulin chosavuta chimaperekedwa. Poyerekeza ndi mbiri yakale yolimba ya mankhwala a insulin, mosiyana ndi chikhalidwe chathu, tsiku lililonse mankhwala a insulin omwe amakhala nthawi yayitali amakhala ocheperako, ndipo alipo ochulukirapo.

M'malo mwa jakisoni 2 wa insulin yapakatikati, mutha kuyambitsa insulin yokhazikika nthawi yamadzulo, yomwe imapereka insulinemia usiku komanso masana, asanadye chakudya chachikulu (insulin "basal bolus").

Zisonyezero zakugwiritsa ntchito insulin ya anthu mu shuga. Popeza kukonzekera kwa insulin yaumunthu kuli ndi immunogenicity yocheperako, ndikofunikira kwambiri kuwalembera amayi apakati omwe ali ndi matenda ashuga kapena kulipira mwachangu zovuta za metabolic owopsa mwa ana omwe amadziwika kuti amalabadira kwambiri poyambitsa mapuloteni akunja. Kukhazikitsidwa kwa insulin yaumunthu kumasonyezedwanso kwa odwala omwe amasiyana ndi mitundu ina ya insulin, komanso insulin lipoatrophy ndi lipohypertrophy.

Mavuto a Insulin Therapy shuga mellitus imadziwonetsera mu mawonekedwe a hypoglycemic reaction, insulin kukana (kufunikira kwa insulin yoposa 200 mayunitsi / tsiku), chifuwa, lipoatrophy kapena lipohypertrophy pamalo a jakisoni a insulin.

Lipohypertrophy imayambitsa insulin tsiku lililonse pamalo omwewo. Ngati insulin ikulowetsedwa m'chigawo chimodzi cha thupi mopitilira 1 pa sabata, lipohypertrophy imakula. Njira yothandizirana yothandiza mankhwalawa ya lipohypertrophy palibe ndipo ngati ikuyimira chilema chodzikongoletsa, chimachotsedwa modabwitsa.

Momwe mungathanirane ndi matenda amtundu wa shuga mu akulu ndi ana

Kwa zaka zambiri osalimbana ndi ma DIABETES?

Mutu wa Bungwe: “Mudzadabwitsidwa kuti kumakhala kovuta motani kuchiritsa matenda a shuga tsiku lililonse.

Zimatsimikiziridwa: mtundu 1 wa shuga mwa anthu ndi matenda osachiritsika. Zizindikiro zimadziwika ndi shuga yayikulu yamagazi. Kuti shuga athe kukodzedwa kwathunthu pama cellular, thupi limafunikira insulini - mahomoni opangidwa ndi kapamba. Maselo a Beta a odwala amangoyala pang'ono pazofunikira zake kapena samatulutsa konse. Ndipo pochiza matenda ashuga, dokotala amamulembera mankhwala a insulin. Mankhwala omwe amaperekedwa ndi jakisoni amathetsa kuchepa kwa timadzi tam'magazi ndipo amateteza kuphwanya ndi kulowerera kwa shuga.

Kukula kwa matendawa kumayambitsidwa ndi kuwonongedwa kwa maselo a beta kuzilumba za Langerlans. Gawo loyamba la kufa kwawo silimakhudza kagayidwe kazakudya m'thupi. Koma nthawi yamtsogolo ikadzabadwanso, njirayi singathenso kuyimitsidwa. Chifukwa chake, njira zochiritsira matenda amtundu wa shuga 1 sizikupezeka. Chithandizo cha matenda a shuga 1 ndikuyang'anira kuchuluka kwa shuga m'magazi. Koma kulankhula za ngati matenda a shuga angachiritsidwe sikothandiza.

Mankhwala

Jakisoni wa mahomoni siochuluka kwambiri pochiza matenda amtundu wa shuga 1 momwe aliri kuti achepetse shuga. Matendawa akapezeka msanga, amamva bwino. Kupatula apo, nthawi yoyamba kupanga mahomoni kupitilirabe, komabe, mpaka pang'ono.

Mbiri - imalowetsa kupanga kwa mahomoni masana.
Chowonjezera - chimakulolani kuti mulipirire chakudya chamagulu omwe amabwera ndi chakudya.

Zakudya zamankhwala

Ndi chithandizo choyenera, simuyenera kutsatira zakudya zilizonse zokhwima. Mankhwala ochizira matenda ashuga amalipiratu chakudya chomwe chikubwera.

Panthawi yosankha kuchuluka kwa mahomoni, ndikofunika kusiya zamankhwala othamanga. M'tsogolomu, ayenera kuchepetsedwa m'mawa. Nthawi yomweyo, ndizoletsedwa kukana chakudya chama carbohydrate: izi sizikhudzanso ngati mtundu 1 wa shuga ungathe kuchiritsidwa. Zakudya zoyenera ndizofunikira kwa odwala, popeza kusapezeka kwa dzuwa kumapangitsa kuti mafuta ayake. Akamagawanika, ma ma ketoni oopsa amayambitsa mseru komanso kupweteka kwambiri m'mutu.

Kugwirizana ndi chakudyacho kumaphatikizapo kuwerengera komwe kumatchedwa mkate magawo - XE. 1 XE - 10 ... 12 g shuga. Kwa akulu, njira yokhayo ndiyabwino, malinga ndi momwe magawo awiri a insulin amalowetsedwera mu XE iliyonse. Kwa ana, mlingo amawerengedwa mosiyanasiyana. Kuphatikiza apo, pazaka zambiri, XE iliyonse imakhala ndi mahomoni akuluakulu.

Zochita zolimbitsa thupi

Masewera amafunikira pochiza matenda ashuga. Inde, iyi si njira yochizira matenda amtundu 1, koma kupsinjika kungathandize kuchepetsa magazi.

Ndikofunikira kuyang'anira kuchuluka kwa glucose musanaphunzitsidwe, pakati komanso kumapeto. Ku 5.5 mmol / L kapena kuchepera, maphunziro akuthupi akhoza kukhala owopsa, choncho muyenera kukhala ndi chithunzithunzi ndi mankhwala ena amtundu wa mafuta, mwachitsanzo, mkate kapena zipatso. Kutsika kwa shuga kupita ku 3.8 mmol / l kumakhala ndi chiopsezo chogwa chikomokere kwa hypoglycemic, kotero makalasi amayenera kuyimitsidwa nthawi yomweyo.

kuthamanga
aerobics
mphamvu zazifupi
zotembenuka, squati,
kutambasula.

Pamodzi, zinthu izi zimapanga pulogalamu yamomwe tingachiritsire matenda ashuga a mtundu woyamba.

Chizindikiro cha mankhwala a insulin

Humalog, Novorapid. Zovomerezeka pambuyo pa mphindi 15, nsonga zimachitika pambuyo pa mphindi 30-120.
Humulin, Actrapid. Imayamba m'mphindi makumi atatu, mkati mwa maola 7-8.
Humulin NPH, protafan NM. Zovomerezeka pambuyo pa maola 1-2 kwa maola 16-20.
Lantus ndi levemire. Ilibe chiwonetsero chodziwika bwino cha zochita, pomwe imathandizira kuti khungu la glucose lifike pafupifupi tsiku limodzi.
Tresiba ndi nthano yamankhwala yomwe imagwira ntchito m'magazi kwa masiku awiri.

Koma mankhwala ophatikiza nthawi zambiri sagwiritsidwa ntchito pochiza matenda amtundu wa 1 shuga. Ndizofunikira mu mawonekedwe ake achiwiri, komanso pa gawo la insulin.

Chithandizo cha odwala matenda a shuga a ana

Matenda akapezeka, mwanayo amathandizidwa kuchipatala, ndiye kuti ayenera kumuyang'anira pafupipafupi. Kodi matenda ashuga angachiritsidwe mwa ana? Komanso achikulire, ayi, koma kudya moyenera, maphunziro olimbitsa thupi, insulin chithandizo komanso zochitika za tsiku ndi tsiku zimapweteketsa njira za odwala matenda ashuga ndikuchepetsa kuopsa kwa zovuta.

Zakudya zimaphatikizapo kuchepetsa kuchuluka kwa zinthu zophika mkate, chimanga, mafuta a nyama. Mwanayo azidya nthawi zisanu ndi imodzi ndi zisanu ndi imodzi patsiku chakudya chochuluka kwambiri cha chakudya cham'mawa komanso chamasana.

Zosavuta, kapena zothamanga - zimachitika pambuyo pa mphindi 20-30, zochitika zimawonedwa mpaka patatha maola atatu jakisoni (Actrapid NM, Humulin pafupipafupi, etc.) Monga lamulo, ndimadzimadzi omveka bwino omwe amayamba pakati asanadye.
Mankhwala ndi pafupifupi kutalika kwa achire kwenikweni. Yovomerezeka pambuyo pa maola 1-3 (Semilent, Aktrafan NM, Humulin N, etc.)
Ma insulin omwe amakhala nthawi yayitali (Insulin-Ultralong) amalimbikitsa kuyamwa kwa shuga mpaka tsiku limodzi ndi theka.

Koma ngakhale kutsatira mfundo zonsezi sikungakhudze ngati zingatheke kuchiritsa matenda osokoneza bongo mwa mwana. Pa moyo wake wonse ayenera kutsatira njira yolembera.

Mlingo wa insulin

Mulingo woyenera kwambiri wa insulin yochulukirapo imasunga shuga wambiri musanachitike ndi maola 2,5 jakisoni.
Mankhwala omwe akhala akuchita kwa nthawi yayitali amathandizidwa kawiri pa tsiku panthawi yomwe akulimbikitsidwa ndi katswiri.
Insulin yosavuta imayendetsedwa musanadye chakudya kuti amalize chakudya. Ndi kuchuluka koyenera m'maola angapo, chizindikiro cha glucose chidzakwera mpaka 3 mmol / L.
Pambuyo maola 4, zakudya zam'magazi ziyenera kukhala zofanana ndi chakudya chisanachitike.

Kodi amadyedwa bwanji a shuga?

Matenda a shuga - matenda otengera kufooka kwa thupi kuti amwe shuga wokwanira. Mavuto a metabolic oterewa amapezeka nthawi zambiri motsutsana ndi vuto la kuperewera kwa zakudya m'thupi. Zakudya za anthu odwala matenda ashuga zimatha kusintha momwe munthu akudwala matenda ashuga, ndipo zakudya zopatsa thanzi ziyenera kusankhidwa moyenera. Uwu ndiwo mkhalidwe wabwino wa chithandizo chopambana.

Kodi kudya mankhwalawa a shuga?

Matenda a shuga amagawidwa kukhala wodalira insulin (mtundu woyamba) komanso osadalira insulini (mtundu wachiwiri). Kuti mankhwalawa azitha kuchiza, mosasamala kanthu za mtundu wake, kuti azichita bwino, ndikofunikira kusankha bwino zakudya zopatsa thanzi, zomwe zingatheke kuteteza kagayidwe. Zakudya za anthu odwala matenda ashuga nthawi zina amatchedwa chakudya nambala 9. Malinga ndi madotolo, zakudya zamankhwala ndizothandiza kwambiri popewa matendawa, ndipo odwala omwe amalandila chithandizo amatha kumwa mankhwala ochepa.

Mankhwala othandizira odwala matenda ashuga ayenera kupangidwa ndi adokotala. Potere, mawonekedwe a matendawa, monga, mwachitsanzo, kuopsa ndi mtundu wa matenda ashuga, amakumbukiridwa. Zakudya za odwala matenda ashuga ayenera kupangidwa payekhapayekha. Pozindikira izi, zakudya sizingophatikizidwa ndi zakudya zokhazokha komanso zotopetsa. M'malo mwake, amatha kukhala opanga kwambiri komanso osangalatsa. Zingofunikira kutsatira mfundo zina, malinga ndi momwe muyenera kutsatira dongosolo lamphamvu.

Zakudya zamchere ndi zonunkhira, zakudya yokazinga, nyama zosuta, zakudya zam'chitini, ndipo mowa sudzaphatikizidwa chakudyacho. Zakudya za shuga ziyenera kukhala zochepa. Ngati mawonekedwe a shuga amawonedwa ngati akulu, ndibwino kuthetsa shuga kwathunthu. Ngati kuchuluka kwa matendawa kumatengedwa ngati ochepa kapena ochepa, zakudya zina zokhala ndi shuga zitha kuloledwa. Koma nthawi yomweyo muyenera kuyang'anira kuchuluka kwa shuga mthupi.

Malinga ndi kafukufuku, mkhalidwe wa matenda ashuga ukusintha moyipa motsogozedwa ndi mafuta omwe amalowa mthupi lambiri. Chifukwa chake, kugwiritsa ntchito mafuta amayenera kulamulidwa, muyenera kudziwa kuti musadye zakudya zabwino zokha. Thanzi la matenda ashuga liyenera kugawidwa moyenera. Ndibwino ngati mumadya kangapo patsiku: kachitidwe kameneka kamakhala ndi zotsatira zabwino pamagazi.

Kodi zakudya zimayenera kupangidwa bwanji kwa mtundu woyamba wa shuga?

Mankhwalawa matenda a shuga a mtundu wodalira insulin, chidwi chochulukirapo chiyenera kulipidwa pakulondola kwa insulin. Dokotala wodya zakudya amasankha mitundu yabwino kwambiri ya mankhwala ndi machitidwe omwe wodwala angadye. Zotsatira zake, kusinthasintha m'magazi a glucose kuyenera kuchepetsedwa, chiwopsezo cha zovuta zingapo chimachepetsedwa. Zakudya mankhwalawa matenda a shuga omwe amadalira insulin amathandizira kwambiri. Iyenera kupangidwa ndi katswiri, chifukwa mtundu uwu wa shuga ndi wowopsa, ndipo umathandizidwa makamaka ndi mankhwala, ndiye kuti, kuyambitsa insulin.

Pofuna kuwerengera zolondola kwambiri za kuchuluka kwa insulini ndi zakudya zomwe zimadyedwa, akatswiri azakudya atulutsa lingaliro lotchedwa "mkate mkate." Malinga ndi kachitidwe ka mkate, umodzi wawo ndi wofanana ndi 10-12 g wamafuta (ichi ndi lalanje kapena mkate). Ngati zadziwika kuti 30 gm ya mkate wakuda, ndi apulo wamba (kukula kwake), ndi theka la kapu ya oatmeal kapena buckwheat zimagwirizana ndi gawo limodzi la mkate, akhoza kuphatikizidwa bwino ndikugawidwa.

Chipinda cha mkate chimatha kuwonjezera shuga wa magazi ndi 2.8 mol / l. Kuti thupi lizilamwa, pamafunika magawo awiri a insulini. Kwa odwala matenda ashuga omwe amalandila insulin, ndikofunikira kuti aziona kudya tsiku ndi tsiku kwamatumbo, omwe amafanana ndi mankhwala omwe amaperekedwa.

Ngati muyeso sakutsatiridwa, kuchuluka kwa shuga m'magazi kumachuluka kapena kuchepa, hyperglycemia kapena hypoglycemia imachitika.

Pambuyo pokhazikitsa lingaliro lotere ngati mkate, zinakhala zosavuta kupanga mndandanda wa anthu odwala matenda ashuga, ngati mungafune, zakudya zina zomwe zili ndi zakudya zimatha kusinthidwa mosavuta kukhala zina.

Pazonse, munthu ayenera kulandira 18-25 XE (mkate magawo) patsiku. Ndikwabwino kuwagawa zakudya 6: chakudya chamadzulo, nkhomaliro komanso chakudya cham'mawa, odwala matenda ashuga - mayunitsi atatu, chakudya chamasana kapena masana - magawo 1-2, ndi zina zambiri.

Ngati katswiri aphatikiza zakudya za odwala omwe ali ndi matenda a shuga 1, ntchito yayikulu ndikuwerengera moyenera kuchuluka kwa chakudya chamagulu. Kwa odwala omwe si onenepa kwambiri, zakudya za shuga sizikhala m'kudya zakudya zina, koma kuchuluka kwake.

Kutengera malamulo ena, munthu wodwala matenda a shuga omwe amadalira insulin amatha kudya chakudya chimodzimodzi ndi anthu athanzi, kupatula kusiyanasiyana pang'ono:

Pa chakudya chimodzi, munthu sayenera kudya chakudya chambiri. 70-90 g .ikwanira
Asanadye chilichonse, mlingo wa insulin ndi kuchuluka kwa XE (mkate magawo) amayenera kuwerengedwa molondola monga momwe kungathekere.
Chotsani zakumwa zoziziritsa kukhosi: Zakumwa zochokera ku kaboni, zakumwa zotsekemera za tiyi, tiyi ndi shuga.

Mtundu wachiwiri wa matenda ashuga

Kudya mopitirira muyeso, kunenepa kwambiri nthawi zambiri kumakhala zifukwa zazikulu za matenda ashuga achiwiri, osadalira insulini. Mukamapangira mankhwala othandizira odwala matenda ashuga, ntchito zomwe zimapangitsa gawo lalikulu la metabolism zimapangitsa kuti matenda asamasokonekera. Kuti maselo a thupi azikhudzidwa kwambiri ndi insulin, chakudya chamagulu odwala matenda ashuga chiyenera kuphatikizidwa ndi zochitika zolimbitsa thupi nthawi zonse.

Mtundu wachiwiri wa matenda ashuga, odwala ambiri ndi onenepa kwambiri. Kwa iwo, zakudya zopatsa thanzi ziyenera kusankhidwa payekhapayekha, poganizira za jenda ndi zaka za munthu, zochitika zake zolimbitsa thupi. Pakadwala matenda amtundu wachiwiri, zakudya za odwala matenda ashuga ziyenera kuthandizira kuchepetsa thupi. Kwa odwala, owerengera omwe amawerengedwa bwino amawerengedwa. Chifukwa chake, pa kilogalamu yakulemera kwa thupi idzakhala ma calorie 25 kwa odwala amuna okalamba ndi 20 kwa akazi. Mwachitsanzo, ngati mayi ali wolemera makilogalamu 70, ndiye kuti muyezo wa kalori umatsimikiziridwa kwa iye - 1400 (tsiku ndi tsiku).

Ngati munthu wapezeka ndi matenda a shuga, ayenera kutsatira zakudya mosalekeza. Chifukwa chake, polemba, muyenera kuyesa kuti zakudyazo zizikhala zopatsa mphamvu, mbale ziyenera kukhala zokoma. Poterepa, muyenera kuyesa kuchepetsa kugwiritsa ntchito zakudya zopezeka ndi zopatsa mphamvu zambiri, zomwe zimapangitsa kuti kuchuluka kwa shuga m'magazi kukwere.

Kodi chakudya nambala 9 ndi chiyani?

Kwa odwala matenda ashuga, pali mitundu yosiyanasiyana yazakudya. Izi ndi zakudya za ku France za matenda ashuga, ndi dongosolo lotchuka lotchedwa "tebulo nambala 9", lomwe ladzitsimikizira lokha. Zakudya izi zimapangidwa kuti azikhala ndi shuga wambiri. Ndi matenda a shuga a mtundu wachiwiri, zakudya No. 9 zitha kugwiritsidwa ntchito pachakudya tsiku lililonse komanso chokwanira.

Gawo No. 9 ndi chakudya cha odwala omwe ali ndi matenda a shuga, omwe ali ndi mphamvu yochepa. Ndikulimbikitsidwa kudya mapuloteni munthawi yocheperako, kuchepetsa mafuta ndikuchepetsa kwambiri kudya kwa mafuta m'thupi. Cholesterol, shuga, mchere uyenera kusiyidwa kwathunthu ndi zakudya.

Zakudya Zamasamba

Odwala amaloledwa kuphatikiza zotsatirazi muzakudya:

Pochizira mafupa, owerenga athu adagwiritsa ntchito DiabeNot bwino. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

buledi wa tirigu, rye, wokhala ndi chinangwa,
sopo (kuchokera masamba, bowa), okroshka, msuzi wa beetroot, broths ochokera ku nsomba zamitundu yochepa,
tomato ndi nkhaka, dzungu, zukini, biringanya, yophika kapena yophika kabichi, komanso tchizi,
nyama ya nkhuku, kalulu, ng'ombe yopanda mafuta, nyama yamwana wamphongo,
osaposa mazira awiri m'masiku 7 (mapuloteni okha),
nsomba - mitundu yokhala ndi mafuta ochepa m'mitundu yophika kapena yophika, imatha kukhala yokazinga (koma osati mumafuta),
skim mkaka, tchizi, mkaka,
chimanga (mapira, barele, barele, barele wa pearl, oat),
Zipatso ndi zipatso zopanda zipatso,
zopangidwa mwapadera pa sorbitol kapena saccharin,
mbatata zomwe zimakwanira pakudya tsiku ndi tsiku la chakudya,
tiyi, masamba, zipatso.

Zomwe sizingadye ndi shuga?

Ndi matenda, zotsatirazi ndizoletsedwa:

msuzi wa nyama, chifukwa ali ndi mafuta ambiri,
nyama yamafuta (mwanawankhosa, nkhumba, tsekwe, abakha), soseji ndi nyama zosuta,
makeke ochokera ku batala ndi mafuta ophikira
nsomba yamafuta, caviar, yokazinga m'mafuta,
tchizi zamchere, tchizi chanyumba, zonona, batala,
pasitala, mpunga woyera, semolina,
masamba ndi mchere
masiku, nkhuyu, nthochi, mphesa, sitiroberi,
zakumwa zoziziritsa kukhosi zomwe zimaphika shuga.

Ndi zinthu ziti zomwe zimaloledwa ndikuletsa? Ichi ndi chimodzi mwazinthu zofunika kwambiri kwa anthu odwala matenda ashuga. Mndandanda wazinthu zomwe zalembedwa pano monga zololedwa kapena zoletsedwa ndizoyang'anira mwachilengedwe. Mndandanda wathunthu wazogulitsa ndi katswiri wazakudya zofunikira pakupanga dongosolo la munthu wazakudya.

Kusiyana pakati pa mitundu ya mankhwala a insulin

Kusankha kwa insulin mankhwala a matenda amtundu wa 1 amachitika ndi endocrinologist malinga ndi mawonekedwe a thupi la wodwalayo.

Ngati wodwala alibe vuto la kunenepa kwambiri, ndipo alibe nkhawa kwambiri m'moyo, ndiye kuti insulini imalembedwa kuchuluka kwa mayunitsi mpaka 0.5-1 kamodzi patsiku malinga ndi kilogalamu imodzi ya kulemera kwa thupi la wodwalayo.

Mpaka pano, endocrinologists apanga mitundu yotsatirayi ya mankhwala a insulin:

kukulitsa
zachikhalidwe
zochita pampu
maziko a botus.

Zolemba pa ntchito zolimbitsa insulin

Therapy yolimbitsa insulin imatha kutchedwa maziko a inshuwaransi ya insulin, malinga ndi zina mwa kugwiritsa ntchito njirayi.

Chizindikiro cha insulin yowonjezereka ndikuti chimagwira ngati chida chobisika cha insulin m'thupi la wodwalayo.

Njirayi imagwiritsidwa ntchito pakafunika insulin mankhwala a mtundu 1 wa shuga. Ndi mankhwalawa matenda amtunduwu omwe chithandizo chotere chimapereka mayendedwe abwino kwambiri azachipatala, ndipo izi zimatsimikiziridwa.

Kuti mukwaniritse ntchito imeneyi, mndandanda wina wa mikhalidwe umafunika. Izi ndi izi:

Insulin iyenera kulowetsedwa m'thupi la wodwalayo m'njira zokwanira kugwiritsira ntchito shuga.
Ma insulini omwe amalowetsedwa m'thupi ayenera kukhala ofanana kwathunthu ndi ma insulin omwe amapangidwa ndi kapamba wa wodwala yemwe ali ndi matenda osokoneza bongo.

Zomwe zidafotokozedwazi zimayambitsa zovuta za insulin mankhwala zomwe zimagawanitsa mankhwala omwe amagwiritsidwa ntchito posachedwa ndi insulin.

Ma insulin omwe amakhala nthawi yayitali amagwiritsidwa ntchito kuperekera insulin m'mawa ndi madzulo. Mankhwala amtunduwu amalinganiza kwathunthu zinthu zomwe zimapangidwa ndi maholide.

Kugwiritsa ntchito ma insulin okhala ndi kanthawi kochepa kumakhala koyenera pambuyo poti mudya chakudya chamafuta ambiri. Mlingo womwe umagwiritsidwa ntchito kuti ubweretsere mankhwalawa m'thupi umatengera kuchuluka kwa mkate womwe umapezeka mu chakudya ndipo umatsimikiziridwa mosamalitsa payekhapayekha kwa wodwala aliyense.

Kugwiritsa ntchito mankhwala a insulin olimbitsa a 1 mtundu wa shuga kumafananizira kuchuluka kwa glycemia musanadye.

Zomwe zimagwiritsidwa ntchito pa mankhwala a insulin

Chithandizo cha insulin chachikhalidwe ndi njira yophatikizira yomwe imaphatikizapo kuphatikiza insulin yochepa komanso yayitali.

Ubwino waukulu wogwiritsa ntchito mankhwalawa ndikuchepetsa kuchuluka kwa jakisoni pang'ono. Nthawi zambiri, kuchuluka kwa jakisoni panthawi ya mankhwalawa malinga ndi njirayi imachokera pa 1 mpaka 3 patsiku.

Choipa chogwiritsa ntchito njirayi ndikulephera kwofanizira zochitika za kapamba. Izi zimabweretsa chifukwa chakuti pogwiritsa ntchito njirayi ndizosatheka kulipira kwathunthu kuphwanya kwa kagayidwe kazakudya kamunthu.

Mukugwiritsa ntchito njira iyi, wodwalayo amalandira jakisoni 1-2 patsiku. Ma insulin afupiafupi ndi aatali amatumizidwa nthawi yomweyo kulowa m'thupi. Ma insulini okhala ndi nthawi yayitali yokwanira kukonzekera amapanga pafupifupi 2/3 ya kuchuluka kwa mankhwalawa, gawo limodzi mwa magawo atatu a mankhwalawa amakhala osapumira.

Chithandizo cha matenda a shuga 1 amtundu wachiberekero wamtundu wa mankhwala a insulin sikufuna kuti azichita glycemia musanadye.

Zomwe zimagwiritsidwa ntchito popopa insulin

Pampu ya insulin ndi chipangizo chamagetsi chomwe chimapangidwa kuti chithandizire kukonzekera kwa insulin kwakanthawi kochepa kapena kopitilira muyeso.

Mukamagwiritsa ntchito mtundu uwu wa mankhwalawa, mankhwalawa amaperekedwa mu Mlingo wa mini.

Njira yamagetsi ya insulin yamagetsi imatha kuchitika m'njira zosiyanasiyana. Njira zazikulu zogwiritsira ntchito pampu ndi izi:

Kupitiliza kuperekera mankhwala mthupi mwa ma microdoses okhala ndi oyambira.
Kukhazikitsidwa kwa mankhwalawa m'thupi mothandizidwa ndi kubayidwa pafupipafupi kwa jakisoni wa mankhwala.

Pankhani ya njira yoyambirira yoyendetsera insulin, kuyeserera kwathunthu kwa chinsinsi cha mahomoni mu kapamba kumachitika. Njira zoterezi zimapangitsa kuti mankhwalawa asagwiritsidwe ntchito kwa nthawi yayitali.

Kugwiritsa ntchito njira yachiwiri yobweretsera insulini m'thupi kumakhala koyenera musanadye kapena nthawi zina pakakhala kuchuluka kwa index ya glycemic.

Chiwembu chogwiritsira ntchito insulin pogwiritsa ntchito pampu imalola kuphatikiza kwa liwiro kuti azitsatira momwe insulin imabisalira m'thupi la munthu, yomwe imakhala ndi kapamba wabwino. Mukamagwiritsa ntchito pampu, catheter iyenera kusinthidwa masiku atatu aliwonse.

Kugwiritsa ntchito pampu yamagetsi kumakupatsani mwayi wothana ndi mavuto poyesa njira yobisika yolembera insulin mthupi la munthu.

Kuchita insulin mankhwala muubwana

Mankhwala a insulin mu ana amafunika kuchita payekha ndipo amafunikira zinthu zambiri ndi zochitika za thupi la mwanayo posankha njira.

Mukamasankha mtundu wa insulin yothandizira mtundu wa 1 matenda ashuga mwa ana, makonda amaperekedwa kwa 2- ndi 3-fold ya mankhwala okhala ndi insulin mthupi la mwana.

Chowonjezera cha mankhwala a insulin mwa ana ndi kuphatikiza kwa insulin ndi nthawi ina yochita kuti muchepetse kuchuluka kwa jakisoni patsiku.

Kwa ana omwe ali ndi zaka zopitilira 12, tikulimbikitsidwa kugwiritsa ntchito njira yolimbikitsira yochizira.

Mbali ya thupi la mwana imamvetseka kwambiri ndi insulin poyerekeza ndi thupi la munthu wamkulu. Izi zimafunikira endocrinologist kusintha pang'onopang'ono mlingo wa insulin yomwe mwana akutenga. Ngati mwana wapezeka ndi mtundu woyamba wa matenda a shuga, ndiye kuti kusinthaku kuyenera kugundika pakati pamagawo awiri ndi jakisoni imodzi, ndipo malire okwanira ovomerezeka osasintha nthawi imodzi sayenera kupitirira magawo anayi.

Kuti muwone bwino kusinthaku, ndikofunikira kuyang'anira kusintha kwa thupi kwa masiku angapo.

Popanga kusintha, ma endocrinologists samalimbikitsa nthawi yomweyo kusintha kwamankhwala omwe amachitika ndi m'mawa ndi madzulo makonzedwe a insulin mthupi la ana.

Chithandizo cha insulin ndi zotsatira za chithandizo chotere

Mukapita ku dokotala-endocrinologist, odwala ambiri amakhala ndi nkhawa za momwe mankhwalawo amathandizira ndi insulin komanso zomwe zingachitike chifukwa chogwiritsira ntchito mankhwala omwe ali ndi insulin.

Mulingo uliwonse, njira yeniyeni yovomerezeka imapangidwa ndi endocrinologist. Pakadali pano, amapangira cholembera chapadera kuti odwala azithandizira. Potsirizira izi, mutha kugwiritsa ntchito ma insulin omwe ali ndi singano yochepa kwambiri ya insulin.

Kuchiza wodwala yemwe ali ndi matenda a shuga insulin kumachitika molingana ndi chiwembu chotsatira:

Musanayambe kuchita insulin, kulowetsa insulin mthupi, kugwiritsa ntchito jakisoniyo.
Kudya sikuyenera kuchitika pasanathe mphindi 30 kuchokera pakumwa mankhwala.
Mlingo woyenera kwambiri wa kasodzi m'modzi sayenera kupitirira 30 magawo.

Kugwiritsa ntchito zolembera za syringe kumakondedwa komanso ndikutetezeka. Kugwiritsa ntchito zolembera panthawi yamankhwala kumawerengedwa bwino kwambiri pazifukwa izi:

Kupezeka kwa singano ndi kupindika kwapadera mu cholembera kumachepetsa ululu panthawi ya jekeseni.
Kupanga kosavuta kwa cholembera kumakupatsani mwayi wogwiritsa ntchito chipangacho nthawi iliyonse komanso kulikonse, ngati kuli kotheka, kubaya insulini.
Mitundu ina yamapensulo amakono omwe ali ndi ma insulin. Izi zimapangitsa kuphatikiza kwa mankhwalawa komanso kugwiritsa ntchito mitundu yambiri ya zochizira pamankhwala othandizira.

Malangizo a matenda a shuga omwe ali ndi jakisoni wa insulin akuphatikiza zotsatirazi:

Asanadye chakudya cham'mawa, wodwala matenda ashuga amayenera kupereka insulin yochepa kapena yayitali.
Kukhazikitsidwa kwa insulin musanadye chakudya chamadzulo kuyenera kuphatikizapo mlingo wokhala ndi kukonzekera kwakanthawi.
Jekeseni asanadye chakudya chamadzulo, ayenera kukhala ndi insulin.
Mlingo wa mankhwala omwe kutumikiridwa musanakagone uyenera kuphatikiza mankhwala osatulutsa.

Zilonda m'thupi zitha kuchitika m'malo angapo a thupi. Kuchuluka kwa mayeso m'dera lililonse.

Kuthiridwa mwachangu kwambiri kumachitika pamene mankhwalawa amatumizidwa pansi pakhungu pamimba.

Mavuto a insulin

Kugwiritsa ntchito mankhwala othandizira, monga chithandizo china chilichonse, sikungokhala ndi zotsutsana zokha, komanso zovuta. Chimodzi mwazomwe zikuwonetsa zovuta pamavuto a insulin ndimomwe thupi limagwirira ntchito.

Kupezeka kofala kwambiri kwa chifuwa kumagwirizanitsidwa ndiukadaulo wa jakisoni mukamagwiritsa ntchito mankhwala okhala ndi insulin. Zomwe zimayambitsa matenda osokoneza bongo zitha kukhala kugwiritsidwa ntchito kwa singano yovutirapo kapena yolimba mukabailidwa, osapangidwira makonzedwe a insulini, kuwonjezera, chifukwa cha ziwengo zitha kukhala malo olakwika a jakisoni ndi zina.

Vuto linanso la mankhwala a insulin ndi kuchepa kwa shuga m'magazi a wodwala ndi kukula kwa hypoglycemia m'thupi. Mkhalidwe wa hypoglycemia ndi wopatsa thupi.

Kupezeka kwa hypoglycemia kumatha chifukwa cha kuphwanya kusankha kwa mankhwala a insulin kapena kusala kudya kwanthawi yayitali. Nthawi zambiri glycemia imachitika munthu akamakhala ndi nkhawa yambiri.

Vuto linanso lomwe limapangitsa kuti mankhwala a insulin apangidwe ndi lipodystrophy, chizindikiro chachikulu chomwe ndi kutha kwa mafuta osafunikira m'jekeseni. Popewa kutukuka kwa vutoli, dera la jakisoni liyenera kusinthidwa.

Mu kanema munkhaniyi, njira yothandizira insulin pogwiritsa ntchito cholembera imawonetsedwa bwino.

Insulin yogwiritsidwa ntchito machitidwe a ana

Kukonzekera kwamasiku a insulin, kutengera komwe adachokera, amagawika m'magulu awiri - nyama ndi anthu (osakanikirana ndi ma insulin a biosynthetic). Kwa zaka 80, ma insulin a nkhumba ndi nkhumba akhala akugwiritsidwa ntchito pochiza matenda ashuga, omwe amasiyana ndi anthu atatu ndi amino acid, motsatana. Komanso, immunogenicity imawonetsedwa kwambiri mu insulin ya ng'ombe, yaying'ono, mwachilengedwe, mwa anthu. Ma insulin aanthu agwiritsidwa ntchito kwazaka makumi awiri zapitazi ndipo adasinthiratu chithandizo cha odwala matenda a shuga.

Atalandira insulin ya anthu kudzera mwa semisynthetic njira, alanine amino acid m'malo 30 a porcine insulin B-unyolo amaloledwa ndi threonine, yomwe ili m'malo mwa insulin yaumunthu. Semi-syntulin insulin imakhala ndi zosafunikira zochepa za somatostatin, glucagon, pancreatic polypeptides omwe amapezeka mu porcine insulin, yomwe ndi gawo laling'ono lopanga insulin yamtunduwu. Insulin ya biosynthetic ilibe zinthu zoyipa ndipo ilinso ndi chitetezo chochepa m'thupi. Ikapangidwa kukhala cell, yisiti yophika kapena E.coli DNA yobwerezabwereza yomwe imakhala ndi majini amtundu wa insulin imayambitsidwa ndi mainjinijeni. Zotsatira zake, yisiti kapena mabakiteriya amayamba kupanga insulin ya anthu. Ma genetic opanga ma genetic a anthu ndi njira yopitilira patsogolo ndipo ayenera kuwonedwa ngati mankhwala oyambira posankha njira yothandizira. Ku Russia, m'zaka zaposachedwa, ma insulin omwe amapangidwa ndi chibadwidwe cha anthu okha ndi omwe amalimbikitsidwa kuti agwiritsidwe ntchito mwa ana ndi achinyamata.

Ma insulin amakono omwe amapangidwa ndi majini amasintha nthawi yayitali:

ma insulin apamwamba kwambiri,
ma insulin achidule ("aafupi" insulini),
ma insulin apakatikati ("anawonjezera" insulini),
ma insulini osakanikirana.

Makhalidwe awo a pharmacokinetic amaperekedwa tebulo 1.

Zaka khumi zapitazi zatsegula nthawi yatsopano mu insulin mankhwala: tikulankhula za kupeza ma fanizo a insulin aanthu omwe ali ndi katundu watsopano wa pharmacokinetic. Izi zikuphatikiza ma insulin apamwamba kwambiri (Humalog and NovoRapid) ndi zithunzi zopanda pake za insulin (Detemir ndi Lantus).

Malo apadera pochiza matenda ashuga kuubwana ndi unyamata amatenga ma insulin omwe amapitilira pang'ono - Humalog and NovoRapid. Ma enulin opanda insulin amalandilidwa ndikusintha ma amino acid omwe amachititsa kuti maselo azikhala ndi insulin, zomwe zimapangitsa kuti mayamwidwe awo achulukane ku deputer. Chifukwa chake, humalogue idapezedwa mwa kusintha mawonekedwe a amino acid proline ndi lysine pamalo a 28 ndi 29th mu B unyolo, novopapid - posintha amino acid proline yemweyo pamalo a 28 ndi katsitsumzukwa. Izi sizinasinthe zochita za insulin, koma zinapangitsa kuti zinthu zisinthe. Ndi subcutaneous makonzedwe, Humalog ndi NovoRapid ali ndi poyambira komanso mwachangu kwambiri, ofanana ndi gawo la zakudya pambuyo pa zakudya, komanso nthawi yofupikitsa, yomwe imapangitsa kupereka mankhwalawa mwachangu musanadye, kupewa (ngati mukufuna) pafupipafupi. Pogwiritsa ntchito fanizo la insulin laumunthu, mwayi wolipirira kuchuluka kwa chakudya cha carbohydrate, womwe umawonetsedwa ndi kuchepa kwa hemoglobin ya glycated, komanso kuchuluka kwa hypoglycemia kumachepa.

Kupeza kwaposachedwa kwambiri pantchito ya mankhwala a insulin kunali kuyambitsa machitidwe azachipatala a insulin lantus, yomwe ndi mndandanda woyambirira wopanda kanthu wa insulin ya maola 24 a munthu. Kupezeka m'malo mwa amino acid katsitsumzukwa ndi glycine pa 21 malo A ndi unyolo ndikuwonjezera ma amino acid awiri a arginine ku termin amino acid mu B unyolo. Zotsatira zake zinali kusintha kwa pH yankho la insulin pambuyo poyambitsidwa mu mafuta osunthika kuchokera ku 4.0 mpaka 7.4, omwe amachititsa kuti mapangidwe a microprecipitate, omwe amachepetsa kuyamwa kwa insulini ndikuwonetsetsa kuti magazi ake ali osasunthika komanso osasunthika kwa maola 24.

Lantus imatha kuperekedwa nthawi iliyonse masana, mwa achinyamata ndi bwino madzulo. Mlingo wake woyamba ndi 80% ya okwanira tsiku lililonse a insulin. Kuphatikiza kwa kuchuluka kwa mankhwalawa kumachitika malinga ndi kusala kudya kwa magazi ndi usiku. Mlingo wa glycemia pambuyo pa chakudya cham'mawa, masana ndi nthawi yamadzulo, umayendetsedwa ndi insulin yaifupi kapena ultrashort action. Kukhazikitsidwa kwa Lantus kumapewera majakisoni owonjezera a insulin m'mawa kwambiri mwa achinyamata ambiri omwe ali ndi vuto la "m'mawa", kumapangitsa kuchepa kwa glycemia yam'mawa, komanso kumachepetsa kulimbitsa thupi kwa odwala ambiri.

Detemir insulin ndi analogue yopanda pachimake ya nthawi yayitali, mphamvu yolimbikira yomwe idakwaniritsidwa ndikuphatikiza unyolo wa zotsalira 14 zamafuta acid mpaka malo a 29 a B-chain. Detemir imayendetsedwa kawiri pa tsiku.

Kapangidwe ka ma insulin osakanikirana kumaphatikizapo insulini ya nthawi yayitali komanso zochitika zazifupi m'njira zosiyanasiyana - kuchokera pa 90 mpaka 10 mpaka 50 mpaka 50. Ma insulin osakanikirana ndiwosavuta chifukwa kugwiritsidwa ntchito kwawo kungachepetse kuchuluka kwa jakisoni omwe amagwiritsidwa ntchito pogwiritsa ntchito zolembera. Komabe, machitidwe a ana, sanapeze ntchito yambiri pokhudzana ndi kufunika kwa odwala ambiri kuti asinthe mlingo wa insulin yayifupi nthawi zambiri, kutengera glycemic indices. Komabe, ndi njira yokhazikika ya matenda a shuga (makamaka zaka zoyambirira za matendawa) mothandizidwa ndi insulin yosakanikirana, kubwezeredwa kwabwino kumatheka.

Mankhwala a insulin

Malangizo omwe adalipo pa regimen ya mankhwala a insulin ndi njira yokhayo yokhazikitsira mtundu wa regimen, womwe uyenera kuganizira zosowa zakuthupi ndi moyo wopezeka wa mwana aliyense.

Chomwe chimagwiritsidwa ntchito kwambiri ndi regimen yolimbikitsidwa (kapena baseline-bolus), yomwe imayang'anira insulini yochepa musanadye chakudya chachikulu chilichonse ndikulimbitsa insulin kuyambira kamodzi mpaka katatu patsiku (onani Chithunzi 2). Nthawi zambiri, insulin yayitali imathandizidwa kawiri - madzulo ndi m'mawa. Nthawi yomweyo, kuyesayesa kumapangidwa kuti mutsanzire basal secretion mothandizidwa ndi insulin yayitali, komanso kupuma kwaposachedwa mothandizidwa ndi insulin yochepa.

Chithunzi 2: Zithunzi zopangidwira pamaziko a insulin.

Kukhazikitsidwa kwa jakisoni wachitatu wa insulin yotalikilapo kumatchedwa kukhathamiritsa kwa basal insulin. Funso la kufunikira ndi nthawi ya jakisoni wachitatu limasankhidwa pamaziko a mbiri ya glycemic. Ngati glycemia imadzuka chakudya chisanachitike pa maola 1.5-2 pambuyo pa nkhomaliro, jakisoni wowonjezera wa insulin asanaperekedwe chakudya (onani Chithunzi 3, 4). Monga lamulo, izi zimachitika pakudya chamadzulo (nthawi ya 19.00-20.00) chakudya chamadzulo. Ndi chakudya cham'mawa choyambirira (nthawi ya 18.00) ndikuyambitsa jekeseni wachiwiri wa insulin yayitali musanagone, hyperglycemia nthawi zambiri imawonedwa pa 23.00. Panthawi imeneyi, zotsatira zabwino zimaperekedwa ndikukhazikitsidwa kwa jakisoni wowonjezera wa insulin musanadye.

Chithunzi 3. Chakulitsa cha insulin.

Njira imeneyi imalola kufikira kufikira njira yakuthupi ya insulin mwa anthu athanzi. Kuphatikiza apo, zimapangitsa kukulitsa mtundu wa moyo ndi zakudya za odwala omwe ali ndi matenda ashuga. Zowonongeka zake zamaganizidwe ndizakufunika kwa jakisoni pafupipafupi komanso kuwongolera pafupipafupi kwa glycemic, komabe, izi zikuwongoleredwa pakalipano chifukwa cha kupita patsogolo kwamakono (zopangira syringe yabwino ndi singano za atraumatic ndi glucometer yokhala ndi zida zodziwikiratu zodzikongoletsera zala zopweteka). Kuwonjezeka kwa zochitika za hypoglycemic, komwe nthawi zina kumanenedwa chifukwa cholimbitsa insulin, sikuti izi zimachitika chifukwa cha madokotala omwe amafunitsitsa kukwaniritsa Normoglycemia. Mukamathetsa nkhaniyi, muyenera kufunafuna chololera, kuyesetsa kukhalabe ndi glycemia yomwe siyimapangitsa pafupipafupi. Mlingo wa glycemia uliwonse wa mwana ndiwofanana payekha.

Chithunzi 4. Kukhathamiritsa kwa insulin yolimbitsa.

Mwa ana a zaka zoyambira ziwiri za moyo, zolimbazo sizimagwiritsidwa ntchito pafupipafupi.

Njira yodziwira mankhwala a insulin imayambira pakukhazikitsa insulin yochepa komanso yayitali tsiku limodzi - musanadye chakudya cham'mawa komanso chakudya chamadzulo. Kugwiritsa ntchito kwake kumatheka mwa ana ambiri azaka ziwiri zoyambirira za matendawa, osakhala ndi nthawi yayitali ya matenda a shuga (onani Chithunzi 5).

Chithunzi 5. Malangizo a insulin.

Ngati mlingo wochepa wa insulin yochepa umayendetsedwa musanadye nkhomaliro, chiwembu choterechi chitha kupitilizidwa kwakanthawi kwa kuwonjezera kuchuluka kwa insulin musanadye chakudya cham'mawa komanso kugawa chakudya chochepa (kusintha gawo limodzi la mkate kapena chakudya chamasana).

Chithunzi 6. Malamulo a insulin achire.

Kuphatikiza apo pali njira zingapo zosawonongera (onani Chithunzi 6):

okhazikika insulin m'mawa ndi madzulo,
insulin yayitali yokhayo m'mawa,
insulin yayitali komanso yochepa m'mawa komanso insulin yochepa chabe m'mawa,
insulin yochepa chabe musanadye kadzutsa, nkhomaliro ndi chakudya chamadzulo, ndi zina zambiri.

Njira izi nthawi zina zimagwiritsidwa ntchito mwa odwala omwe ali ndi kanthawi kochepa ka matenda a shuga komanso kusungidwa pang'ono kwa ntchito ya β-cell.

Mulimonse momwe zingakhalire, kusankha kwa mankhwala a insulini kumatsimikiziridwa osati kwambiri ndi kufunsa kwa dotolo kapena banja la wodwalayo malinga ndi mbiri yoyenera ya kayendetsedwe ka insulin, yomwe imapereka chindapusa cha kagayidwe kazakudya.

Mlingo wa insulin

Muubwana, kufunikira kwa insulini, kuwerengera pa kilogalamu imodzi yakulemera, nthawi zambiri kumakhala kwakukulu kuposa achikulire, zomwe zimachitika chifukwa cha kuthamanga kwambiri kwa kayendedwe ka autoimmune, komanso kukula kwamphamvu kwa mwana komanso kuchuluka kwakukulu kwa mahomoni a contra-mahormone pakutha msinkhu.Mlingo wa insulin umasiyana malinga ndi zaka komanso nthawi yayitali ya matendawa.

M'chaka chimodzi chimodzi kapena ziwiri kuyambira kumayambiriro kwa matendawa, kufunika kwa insulin kumawonjezera 0.5-0.6 U / kg kulemera kwa thupi. 40-50% m'miyezi yoyambirira pali kuchotsedwa kwina kwamatenda, mukakwanitsa kulipiritsa chakudya cha metabolism, kufunika kwa insulin kumachepera mpaka 0,1-0.2 U / kg, ndipo mwa ana ena ngakhale kuthetsedwa kwa insulini pomwe mukudya chakudya kusamalira kukhalabe Normoglycemia. (Kukhazikika kwachidziwitso ndikuthekera kwakukulu komwe kungayambitse matenda a shuga ndikukhazikitsa chithandizo cha insulin, ndikulimbikitsa kwambiri insulin komanso kubwezeredwa kwabwino kwa kagayidwe kazakudya).

Zaka zisanu pambuyo pa mphindi ya shuga, odwala ambiri in-maselo amasiya kugwira ntchito. Pankhaniyi, kufunika kwa insulin nthawi zambiri kumakwera mpaka 1 U / kg ya kulemera. Pa kutha msambo, imakula kwambiri, kufikira achinyamata ambiri 1.5, nthawi zina mayunitsi 2 / kg. Pambuyo pake, mlingo wa insulin umatsitsidwa ndikuyenda pafupifupi 1 U / kg. Pambuyo pakuwola kwa nthawi yayitali matenda a shuga, kufunika kwa insulin kumatha kufika 2-2,5, nthawi zina 3 IU / kg, ndikutsatira kuchepetsedwa kwa mankhwala, nthawi zina mpaka koyambirira.

Chiwerengero cha insulin yayitali komanso yochepa: kuyambira kuchuluka kwa insulin yayitali mwa ana a zaka zoyambirira za moyo mpaka kuchuluka kwa insulin yayifupi achinyamata. tebulo 2).

Monga akuluakulu, ana amafunikira gawo limodzi la insulin m'mawa kuposa chakudya chamadzulo ndi chakudya chamadzulo.

Tikuyenera kunena kuti awa ndi mawonekedwe wamba, mwana aliyense amafunikira insulini komanso kuchuluka kwa ma insulin a nthawi zina amakhala ndi machitidwe awo.

Mavuto a Insulin Therapy

Hypoglycemia ndi vuto lomwe limayamba chifukwa cha magazi ochepa. Zomwe zimayambitsa matenda kwambiri a hypoglycemic: kuchuluka kwa insulin, kuchita masewera olimbitsa thupi mopambanitsa, kudumphadumpha kapena kusakwanira kudya, kumwa mowa. Mukamasankha mtundu wa insulin, kuyenera kuyesedwa pakati pa chidwi chofuna kukwaniritsa kagayidwe kabwino pafupi ndi Normoglycemia ndi chiopsezo cha hypoglycemic.
Matenda osokoneza bongo a insulin (Somogy syndrome). Kuchuluka kwa insulin ndi hypoglycemia kumapangitsa kuti thupi lizisokoneza, zomwe zimayambitsa matenda a posthypoglycemic hyperglycemia. Omaliza amakhala ndi hyperglycemia yayikulu (nthawi zambiri imakhala pamwamba pa 16 mmol / l) komanso kukana kwa insulin kwakanthawi, kuyambira maola angapo mpaka masiku awiri.
Zotsatira za insulin. Kusiyanitsa pakati pa matupi awo sagwirizana ndi insulin (kutupa kwa khungu, kuchepa thupi, kuwonda, kuyabwa, nthawi zina kupweteka jakisoni) komanso chifuwa; M'zaka zaposachedwa, chifukwa cha insulin yabwino, mitundu yonse ya mankhwalawa ndi yovuta kwambiri.
Lipodystrophy amatchedwa kusintha kwamafuta obisika a insulin pamalo a jakisoni wa mawonekedwe a atrophy (atrophic form) kapena hypertrophy (mawonekedwe a hypertrophic). Ndi kukhazikitsidwa kwa insulin yaumunthu m'machitidwe azachipatala, kuchuluka kwa lipodystrophy kwachepa kwambiri.

Zikuyembekeza kukonza insulin mankhwala ku Russia

Kukhazikitsa kwa analogues a insulin ya anthu kumakulitsa mwayi wopeza chipukuta misozi, kukonza njira ya matendawa kwa ana ndi achinyamata omwe ali ndi matenda ashuga.

Pampu za insulin, zogwiritsidwa ntchito zaka zingapo zakunja, zawonekera pamsika wapakhomo lero, koma kugwiritsa ntchito kwawo ndizochepa chifukwa cha mtengo wawo wokwera.

Pakadali pano, maphunziro akuchitika kunja kuti adziwtse bwino komanso chitetezo cha kugwiritsa ntchito mitundu ya insulin, yomwe imalumikizidwa ndi chiyembekezo chokana kukana jakisoni wa insulin yochepa musanadye.

Funso la kagwiritsidwe ntchito ka kuchipatala pakugulitsa maselo likhalabe lotseguka kufikira njira yoteteza maselo omwe adasinthidwa ku njira yomweyo ya autoimmune yomwe ikukhudza ma β-cell awo amapezeka. Pakadali pano, kupatsirana kwa β-cell kunja kumachitika kokha mwa odwala omwe ali ndi vuto lalikulu laimpso, munthawi yomweyo ndi kupatsirana kwa impso komanso kuikidwa kwa immunosuppressants. Ntchito zina zonse zosinthira ndi zofufuza ndipo zimachitika kwa odzipereka. Komabe, ofufuza aku Canada adakwanitsa kupeza zotsatira zolimbikitsa zoyambirira.

V. A. Peterkova, Doctor of Medical Science, Pulofesa
T. L. Kuraeva, MD
E.V. Titovich, woyimira masayansi azachipatala
Institute of Pediatric Endocrinology GU ENTs RAMS, Moscow