Insulin yamunthu

Insulin yopangidwa ndi chibadwa cha anthu ndi gawo la jakisoni yothetsera matenda a shuga. Gwiritsani ntchito mankhwalawa mosamala, muyezo wokhazikitsidwa mosamala, apo ayi phwandolo limadzala ndi zovuta kapena mankhwala osokoneza bongo. Kuphatikiza apo, adokotala ali ndi udindo wopereka mankhwala ndikuwachiza, popeza pali mitundu yambiri ya insulin, iliyonse yomwe ili ndi mawonekedwe enieni a zochita.

Genulin engineering insulin - ndi chiyani?

Insulin imakhudzana ndi ma metabolic ambiri a thupi la munthu, kotero zotsatira zazikulu zimawonekera pakuchepetsa katundu - zimatsitsa kuchuluka kwa shuga m'magazi. Komabe, pazifukwa zambiri, kapamba nthawi zambiri amaletsa kupangika kwa mahomoni, kenako insulin yopangidwa mwanjira ina.

Insulin yopangidwa mwabadwa imatha kulocha insulin yaumunthu, ndipo imapezedwa ndi mankhwala mwa kuphatikiza Escherichia coli kapena m'malo mwa amino acid ya mahomoni a porcine.

M'mbuyomu, hormoneyi idapangidwa kuchokera ku nyama zapancreatic, koma posakhalitsa njirayi idasinthidwa ndi kuphatikizidwa ndi mankhwala. Mankhwala opangidwa ndi nyama adakhalabe, koma amawonedwa ngati osagwira ntchito. Pakapangira mankhwala, pakakhala pano, mtundu wa osagwirizana ndi matenda a E. coli kapena yisiti umagwiritsidwa ntchito. Chifukwa chake pangani zosiyana. Makhalidwe abwino a ndalamazi ndi awa:

• kutsatira kwa amino acid
• zochita nthawi - ultrashort, yayifupi, nthawi yayitali komanso nthawi yayitali.

Kutalika kwa zochita za mankhwala

Njira yothetsera insulin imasiyana pakadutsa kachitidwe. Kusiyana pakati pa zida zomwe zalembedwa patebulo:

Kugwiritsa ntchito insulin yaumunthu

Kukhala bwino komanso thanzi la munthu wodwala matenda ashuga kumatengera malamulo ogwiritsa ntchito mankhwalawa. Mlingo ndi chithandizo ziyenera kuyang'aniridwa mwachindunji ndi dokotala. Kugwiritsa ntchito moyenera mankhwalawa kutengera malamulo otsatirawa.

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:

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

Kutalika kwa insulin

Potengera nthawi ndi magwiridwe antchito, insulin imasiyanitsidwa:

1. ultrashort
2. mwachidule
3. nthawi yayitali
4. 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:

1. Himulin Wokhazikika,
2. Khalid
3. Monodar (K50, K30, K15),
4. Insuman Rapid,
5. 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:

1. Lantus
2. Monodar Long,
3. Monodar ultralong,
4. Ultralente
5. Ultralong,
6. Humulin L ndi ena,
7. Lantus
8. Levemir.

Zotsatira zoyipa ndi vuto la kumwa

Ndi bongo wa insulin yokonzekera mwa anthu, zotsatirazi zingaoneke:

• Zofooka
• Thukuta lakuzizira
• Pallor
• Kudzanjenjemera
• Kusweka mtima
• Mutu
• Njala
• Zingwe.

Zonsezi pamwambapa zimawonetsedwa ngati zizindikiro za hypoglycemia. Ngati mkhalidwe wayamba kumene ndipo mukuyamba kale, mutha kuchotsa zizindikirazo mwaumoyo. Pachifukwa ichi, tengani zinthu zokhala ndi shuga komanso chakudya chamafuta ambiri.

Komanso yankho la dextrose ndi glucagon limatha kuyambitsidwa m'thupi. Wodwala akayamba kuperewera, njira yosinthika ya dextrose iyenera kuperekedwa. Amagwiritsidwa ntchito mpaka mkhalidwe utasintha.

Odwala ena amatha kuyambitsidwa ndi insulin. Zina mwazizindikiro zazikulu ndi:

1. Kutha
2. Kutupa,
3. Urticaria,
4. Kutupa
5. Thupi
6. Kutsitsa magazi.

Hyperglycemia imachitika chifukwa cha mankhwala ochepa kapena chifukwa cha matenda opatsirana, komanso chifukwa chosagwirizana ndi zakudya. Nthawi zina munthu amakumana ndi lipodystrophy komwe mankhwalawa amaperekedwa.

Mukamagwiritsa ntchito mankhwalawa angathenso kwakanthawi:

Kupeza wolowa mmalo m'malo mwa insulin ya anthu ndi njira yabwino yochizira matenda ashuga. Thupi limathandizira kuchepetsa kuchuluka kwa glucose m'magazi, chifukwa chakuti glucose amatha kulowa bwino ndi maselo, momwe kayendedwe kamayendedwe ake amasinthira. Mankhwalawa amalowa m'malo mwa insulin ya anthu, koma amayenera kumwedwa pokhapokha ngati akuwongolera adokotala, chifukwa pakhoza kukhala zovuta zina.

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:

1. Ntchito zosakwanira za adrenal, chithokomiro cha England
2. 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.

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H cholembera chokhazikika (Berlinsulin H cholembera chokhazikika), Berlsulin H yokhazikika U-40 (Berlinsulin H yachibadwa U-40), Insuman mwachangu (Insuman mwachangu), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Zotsatira za pharmacological

Ndi njira ya insulin yosalowerera ndendende yofanana ndi insulin ya anthu. Zimatanthauzira ma insulin osakhalitsa. Kuchepetsa glucose wamagazi, kumathandizira kuyamwa kwake ndi ma minofu, lipogenesis, glycogenogeneis, kaphatikizidwe ka mapuloteni, kumachepetsa kuchuluka kwa shuga ndi chiwindi.

Kukhazikika kwa mankhwalawa ndi mphindi 20-30 pambuyo pa kuperekedwa. Kuchuluka kwake kumachitika pakati pa maola 1 ndi 3. Kutalika kwa kuchitapo kanthu ndi maola 6-8.

Mbiri ya insulin yosakanikirana ndi insulin yaumunthu ya munthu imadalira mlingo ndikuwonetsa kupatuka kwakapakati komanso kwakonda pakati. Mafuta ochokera kumalo opakidwa jakisoni amayenda msanga kuposa nkhumba yosakanikirana ndi nkhumba.

,: gawo la kukana kwa othandizira pakamwa.

Matenda a shuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, ndi opaleshoni yomwe ikubwera, allergies kukonzekera insulin yoyambira nyama, insulin lipoatrophy, insulini chifukwa cha kuchuluka kwa ma cell a anti-insulin, pakuthana kwa maselo apakhungu a kapamba.

Zotsatira zoyipa

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

Insulin ndiye mankhwala othandizira matenda a shuga a mtundu woyamba. Nthawi zina amagwiritsidwanso ntchito kukhazika mtima pansi wodwalayo ndikuwongolera moyo wake wamtundu wachiwiri wa matenda. Izi ndi chilengedwe chake ndi mahomoni omwe amatha kuthana ndi kagayidwe kazachilengedwe mu milingo yaying'ono. Nthawi zambiri, kapamba amapanga insulin yokwanira, yomwe imathandizira kukhala ndi shuga m'thupi. Koma ndi zovuta zazikulu za endocrine, mwayi wokhawo wothandiza wodwalayo nthawi zambiri ndi jakisoni wa insulin kwenikweni. Tsoka ilo, ndizosatheka kuzipeza pakamwa (mwanjira yamapiritsi), popeza zimawonongeka kwathunthu m'mimba ndikugaya mtengo wake wachilengedwe.

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.

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.

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.

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

1. Kuchuluka kwa kuyeretsa.
2. Zomwe zimalandila ndiku nkhumba, bovine, insulin ya anthu.
3. Zowonjezera zomwe zimaphatikizidwa ndi yankho la mankhwalawa ndizosunga, othandizira, ndi ena.
4. Kusintha
5. pH yankho.
6. 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.

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:

1. pakutsitsimuka komanso kusamalidwa kwambiri,
2. odwala matenda ashuga a ketoacidosis,
3. 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:

1. hyperosmolar chikomokere,
2. matenda ashuga ketoacidosis,
3. pambuyo opaleshoni kwa odwala matenda a shuga,
4. pomwe chithandizo cha insulin chimathandizira kuti shuga akhale mu plasma,
5. 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:

1. Kwenikweni, chizindikirochi chimasiyana kuchokera pa 0,6 mpaka 0,7 mayunitsi / kg.
2. Ndi kulemera kambiri, kufunikira kwa insulin kumawonjezeka.
3. 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.

Fomula, dzina la mankhwala: palibe deta.
Gulu lamagulu: mahomoni ndi okana / ma insulin.
Machitidwe hypoglycemic.

Mankhwala

Insulin yaumunthu ndi insulin yomwe ikukonzekera njira yolandirira ukadaulo wa DNA. Insulin yaumunthu imayang'anira kuchuluka kwa shuga m'magazi, kuchuluka kwa kagayidwe kazakudya, mafuta, mapuloteni m'magulu a ziwongo (mafupa amkati, chiwindi, minofu ya adipose). Insulin yaumunthu imatha kupanga anabolic komanso anti-catabolic. Mu minofu ya minofu, pali kuchuluka kwa glycerol, glycogen, mafuta acids, kuchuluka kwa mapuloteni komanso kuwonjezereka kwa kumwa ma amino acid, koma kuchepa kwa gluconeogeneis, lipolysis, glycogenolysis, ketogeneis, proteinabolism ndi kumasulidwa kwa amino acid. Insulin yaumunthu imamangirira ku membrane receptor (tetramer, yomwe imakhala ndi zigawo 4, 2 zomwe (beta) zimamizidwa mu membala wamtundu wa cytoplasmic ndipo zimayendetsa ntchito ya tyrosine kinase, ndipo zina ziwiri (alpha) ndi extramembrane ndipo zimayambitsa insulin receptor complex, zomwe zimadutsa Autophosphorylation. Vutoli limapangika mu maselo olimba a phosphorylates threonine ndi malekezero a serine a protein kinases, omwe amatsogolera pakupanga kwa phosphatidylinositol glycan ndipo amayambitsa phosphorylation, yomwe imayambitsa ntchito ya enzymatic m'maselo omwe akufuna.M'misempha ndi minyewa ina (kupatula ubongo), imalimbikitsa kusuntha kwamphamvu kwa glucose ndi amino acid, imachepetsa mphamvu ya mapuloteni, ndikuwonjezera njira zopangira. Insulin yaumunthu imalimbikitsa kuchuluka kwa shuga mu chiwindi mu mawonekedwe a glycogen ndipo amalepheretsa glycogenolysis (gluconeogenesis). Kusiyana kwamwini pantchito ya insulin kumadalira mlingo, jakisoni malo, zochitika zolimbitsa thupi za wodwala, zakudya ndi zina.
The mayamwidwe a insulin ya anthu zimatengera njira ndi malo oyang'anira (ntchafu, pamimba, matako), insulin, kuchuluka kwa jakisoni. Insulin yaumunthu imagawidwa mosiyanasiyana m'thupi lathu, sililowa mkaka wa m'mawere komanso kudzera mu chotchinga chachikulu. Kuwonongeka kwa mankhwalawa kumachitika m'chiwindi pochita insulinase (glutathione-insulin transhydrogenase), yomwe hydrolyzes imasokoneza mgwirizano pakati pa unyolo A ndi B ndikuwapangitsa kuti azitha kupezeka ndi ma enzymes a proteinolytic. Insulin ya munthu imachotsedwanso ndi impso (30 - 80%).

Lembani 1 ndi mtundu 2 wa matenda a shuga omwe amafunikira mankhwala a insulin (motsutsana ndi mankhwala amkamwa a hypoglycemic kapena mankhwala ophatikizika, zinthu zomwe zimagwirizana), matenda a shuga nthawi yayitali.

Mlingo ndi makonzedwe a insulin ya anthu

Njira makonzedwe a mankhwala zimatengera mtundu wa insulin. Dokotala amakhazikitsa mlingo payekhapayekha, kutengera mlingo wa glycemia.
Jekeseni wotsekemera amachitika m'chigawo cha mpanda wam'mimba, ntchafu, phewa, matako. Masamba a jakisoni ayenera kusinthidwa kuti malo omwewo sawagwiritsidwanso ntchito kangapo kamodzi pamwezi. Ndi subulinaneous ya insulin, chisamaliro chimayenera kumwedwa kuti musalowe m'mitsempha yamagazi pakubaya. Odwala ayenera kuphunzitsidwa bwino kugwiritsa ntchito insulin yobereka. Musati mutisefa jekeseni tsamba pambuyo jakisoni. Kutentha kwa mankhwala omwe amaperekedwa kuyenera kukhala kutentha kwambiri.
Kuchepetsa kuchuluka kwa jakisoni watsiku ndi tsiku kumatheka ndikuphatikiza insulin ya nthawi zosiyanasiyana zoyenera kuchitapo.
Ndi chitukuko cha thupi lawo siligwirizana, hospitalization wa wodwalayo, kuzindikira kwa mankhwala omwe anali allergen, poika mankhwala okwanira ndi m'malo insulin ndikofunikira.
Kuchedwa kwa mankhwala kapena kugwiritsa ntchito mankhwala osakwanira a insulin, makamaka kwa odwala omwe ali ndi vuto la matenda a shuga 1, kungayambitse matenda a hyperglycemia ndi matenda ashuga a ketoacidosis (mikhalidwe yomwe ikhoza kuyika pangozi moyo wa wodwalayo).
Kukula kwa hypoglycemia pogwiritsa ntchito mankhwalawa kumapangitsa kuti pakhale kuchuluka kwa zinthu zolimbitsa thupi, zolimbitsa thupi, kuphwanya zakudya, kuwonongeka kwa impso, chiwindi chamafuta.
Mlingo wa insulin uyenera kusinthidwa ngati magwiridwe antchito a tchire, gland ya adrenal, chithokomiro cha chithokomiro, impso ndi / kapena chiwindi chalephera, matenda a Addison, hypopituitarism, ndi matenda osokoneza bongo a shuga opitilira zaka 65. Komanso, kusintha kwa mlingo wa insulin kungafunike ndi kuwonjezeka kwa mphamvu zolimbitsa thupi kapena kusintha kwa zakudya zomwe mumakonda. Kudya kwa Ethanol (kuphatikizapo zakumwa zoledzeretsa) kumatha kuyambitsa hypoglycemia. Osamamwa ethanol pamimba yopanda kanthu. Ndi matenda ena ophatikizika (makamaka opatsirana), mikhalidwe yomwe imayendetsedwa ndi malungo, kupsinjika kwamalingaliro, kufunikira kwa insulin kungakulitse.
Zizindikiro zakutsogolo kwa hypoglycemia pogwiritsa ntchito insulin ya munthu mwa odwala ena sizitha kutchulidwa kapena kusiyana ndi zomwe zimawonedwa ndi insulin yoyambira nyama. Ndi matenda a shuga m'magazi, mwachitsanzo, ndi mankhwala a insulin, zonse kapena zizindikiro zina zakutsogolo za hypoglycemia zitha kuzimiririka, zomwe odwala ayenera kudziwitsidwa.Zizindikiro zakutsogolo kwa hypoglycemia zimatha kuchepera kapena kusintha ndi njira yayitali ya matenda a shuga, matenda a shuga, komanso kugwiritsa ntchito ma beta-blockers.
Kwa odwala ena, kusintha kwa mlingo kumakhala kofunikira pakusintha kuchokera ku insulin yochokera ku nyama kupita ku insulin ya anthu. Izi zitha kuchitika kale poyambilira kukonzekera kwa insulin ya anthu kapena pang'onopang'ono pakangotha ​​milungu ingapo kapena miyezi ingapo atasamutsidwa.
Kusintha kuchokera ku mtundu wina wa insulin kupita ku wina kuyenera kuchitika moyang'aniridwa ndi achipatala ndikuwongolera shuga. Kusintha kwa zochitika, mtundu (wopanga), mtundu, mitundu (waumunthu, chinyama, ma insulin analogs) ndi / kapena njira yopanga (DNA recombinant insulin kapena insulini yachikhalidwe) zitha kuchititsa kusintha kwa mlingo.
Mukamagwiritsa ntchito insulin pokonzekera nthawi yomweyo ndi mankhwala a gulu la thiazolidinedione, chiopsezo chotenga matenda a edema ndi matenda osakhazikika pamtima amachulukirachulukira, makamaka kwa odwala omwe ali ndi matenda am'magazi komanso kupezeka kwa zinthu zomwe zingayambitse matenda osalephera a mtima.
Ndi hypoglycemia wodwala, kuthamanga kwa zochitika zama psychomotor ndikuyang'anitsitsa kungachepe. Izi zitha kukhala zowopsa ngati maluso awa ali ofunikira makamaka (mwachitsanzo, kuwongolera makina, kuyendetsa magalimoto ndi ena). Odwala ayenera kulangizidwa kuti azisamala kuti ateteze kukula kwa hypoglycemia mukamachita zinthu zowopsa zomwe zimafuna kuti anthu azichita mwachangu ndi zomwe zimachitika mwachangu (kuphatikiza magalimoto oyendetsa, magwiridwe antchito). Izi ndizofunikira kwambiri kwa odwala omwe kulibe kapena owonetsa zizindikiro za hypoglycemia, komanso kukula pafupipafupi kwa hypoglycemia. Zikatero, adotolo amayenera kuwunika momwe wodwalayo angachitire izi.

Mimba komanso kuyamwa

Pakati pa nthawi yayitali, ndikofunikira kuti pakhale chitetezo chokwanira cha azimayi omwe amalandiridwa ndi insulin. Pa nthawi yoyembekezera komanso mkaka wa m`mawere, ndikofunikira kusintha mlingo wa insulin kuti ulipire shuga. Kufunika kwa insulin nthawi zambiri kumachepera mu trimester yoyamba ya kutenga pakati ndikuwonjezeka kwachiwiri ndi kachitatu trimester ya mimba. Kufunika kwa insulini kumatha kuchepa kwambiri pakubadwa kwa mwana komanso pambuyo pake. Amayi omwe ali ndi matenda ashuga amafunika kudziwitsa dokotala za mimba kapena kukonzekera kwake. Mwa azimayi omwe ali ndi matenda a shuga, kusintha kwa mankhwala a insulin ndi / kapena zakudya kungafunike pakamwa. Insulin yaumunthu sinali mutagenic mu in vitro komanso mndandanda wa vivo m'maphunziro a kawopsedwe amtundu.

Zotsatira zoyipa za insulin yaumunthu

Hypoglycemia (kufooka kwa khungu, kuchuluka thukuta, kunjenjemera, kunjenjemera, kutuluka thukuta, kusanza, tachycardia, palpitations, njala, kukwiya, nkhawa, kupweteka pakamwa, kupweteka mutu, kugona, kugona, mantha, kusowetsa mtendere , chizolowezi chosazolowereka, kusatsimikizika kayendedwe, chisokonezo, kukhumudwa ndi masomphenya, kulephera kudziwa, chikomokere, imfa), posthypoglycemic hyperglycemia (chochitika cha Somogy), insulini kukaniza (chofunikira cha tsiku ndi tsiku chimaposa 20) Mayunitsi 0, edema, kuwonongeka kwa maonekedwe, kuyimitsidwa ndi khungu (kuyabwa, zotupa pakhungu, kuyabwa kambiri, kufupika, kufupika, kukomoka, kusefukira kwambiri, kugunda kwa mtima, kuthamanga, kuwonda, kufooka, kufupika, post-jekeseni lipodystrophy, yomwe imayendetsedwa ndi kulowetsedwa kwa insulin, kukulira kwa ululu pamene kupsinjika kwa mumlengalenga kumasintha).

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:

1. Zimalepheretsa ma amino acid kuti asagonjetsedwe kukhala shuga wophweka.
2. Zimasintha kaphatikizidwe ka mapuloteni - maziko a moyo.
3. Simalola mapuloteni m'misempha kuti asokonezeke, amalepheretsa minyewa ya atrophy - anabolic.
4. Amachepetsa kudzikundikira kwa matupi a ketone, ochulukirapo omwe amapha anthu.
5. 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:

1. Nkhumba kapena bovine - zochokera nyama. Zopangira zikondamoyo zogwiritsidwa ntchito. Kukonzekera kwa zopangira nkhumba kumakhala ndi ma proinsulin, omwe sangathe kulekanitsidwa, amakhala magwero azosokoneza.
2. 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.
3. 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:

1. 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.
2. 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.

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.

Fomula, dzina la mankhwala: palibe deta.
Gulu lamagulu: mahomoni ndi okana / ma insulin.
Machitidwe hypoglycemic.

Kuchita kwa insulin yaumunthu ndi zinthu zina

Zotsatira za hypoglycemic za insulin ya anthu zimachepetsedwa ndi glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisone ndi ena), amphetamines, adrenocorticotropic timadzi, flucrocortisone, calcium blockers, estrogens, baclofen, heparin, levrateroxine s, leparogrogen sodium diuretics (hydrochlorothiazide, indapamide ndi ena), amprenavir, danazol, isoniazid, diazoxide, lithiamu carbonate, chlorprotixen, sympathomimetics, nicotinic acid, beta-adrenergic agonists (mwachitsanzo, ritodrin, salbutamol, terbutaline ndi ena), ma tridclic antidepressants, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, zotumphukira za phenothiazine. Pangakhale kofunikira kuwonjezera kuchuluka kwa inshuwaransi ya chibadwa cha anthu magawo awiri mukamagwiritsidwa ntchito molumikizana ndi mankhwalawa.
Zotsatira hypoglycemic wa insulin anthu azimveka metformin, sulfonamides, repaglinide, androgens m'kamwa hypoglycemic wothandizira, testosterone, anabolic mankhwala, bromocriptine, disopyramide, guanethidine, monoamine oxidase zoletsa, angiotensin II cholandilira muzikangana, carbonic zoletsa anhydrase, fluoxetine, carvedilol, fenfluramine, angiotensin akatembenuka enzyme zoletsa (captopril , enalapril ndi ena), tetracyclines, octreotide, mebendazole, ketoconazole, clofibrate, theophylline, quinidine, chloroquine, non-steroid mankhwala odana ndi kutupa, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol ndi ena) (chigoba cha hypoglycemia, kuphatikizapo tachycardia, kuthamanga kwa magazi), ethanol ndi ethanol. Pangakhale kofunikira kuti muchepetse mlingo wa inshuwaransi ya anthu yopanga magawo awiri mukagwiritsidwa ntchito molumikizana ndi mankhwalawa.
Beta-blockers, clonidine, reserpine amatha kubisa mawonetsedwe a zizindikiro za hypoglycemia.
Poyerekeza ndi maziko a atenolol (mosiyana ndi omwe samasankha-beta-blockers), zotsatira zake sizikukwera kwambiri, ndikofunikira kuchenjeza wodwala kuti ndi chitukuko cha hypoglycemia, tachycardia ndi kugwedeza kungakhale kulibe, koma kusakwiyitsa, njala, nseru kuyenera kupitilira, ndipo thukuta limakulitsa.
Kuchuluka kwa insulin ya anthu m'magazi kumakulitsidwa (chifukwa cha kuthamanga kwa mayamwidwe) mankhwala osokoneza bongo a chikonga komanso kusuta.
Poyerekeza ndi maziko a octreotide, reserpine, kusintha kwa hypoglycemic kungatheke (onse kuphatikiza ndi kufooka), kumafuna kusintha kwa insulin.
Poyerekeza ndi maziko a clarithromycin, kuchuluka kwa chiwonongeko kumachepetsa ndipo, nthawi zina, zotsatira za insulin zimatha kuchuluka.
Poyerekeza ndi maziko a diclofenac, momwe mankhwala amasinthira, akagwiritsidwa ntchito palimodzi, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi.
Poyerekeza ndi metoclopramide, yomwe imathandizira kutsanulira kwam'mimba, kusintha kwa mlingo kapena machitidwe a insulin makonzedwe angafunike.
Insulin yamunthu imagwirizana mosiyanasiyana ndi mayankho a mankhwala ena.
Ngati pakufunika kugwiritsa ntchito mankhwala ena, kuphatikiza insulin ya anthu, ndikofunikira kukaonana ndi dokotala.

Bongo

Pankhani ya insulin ya anthu osokoneza bongo, hypoglycemia imayamba (kupha mphamvu, kuchuluka kwa thukuta, khungu, tachycardia, njala, kunjenjemera, thukuta, nseru, kusanza, kupweteka pakamwa, kugona, mutu, nkhawa, kukwiya, nkhawa, kusayenda bwino, . Nthawi zina, mwachitsanzo, pakhale nthawi yayitali kapena kuwunika kwambiri matenda ashuga, Zizindikiro zakutsogolo za hypoglycemia zimatha kusintha.
Chithandizo: Hypoglycemia yoletsa kuchepera shuga, shuga, zinthu zomwe zili ndi mafuta ambiri, zitha kusintha kusintha kwa insulini, kuchita zolimbitsa thupi kapena kudya, ndi hypoglycemia, intramuscular kapena subcutaneous makonzedwe a glucagon, ndikulowerera kwambiri kwa chakudya chamagulu, okhala ndi vuto lalikulu la hypoglycemia matenda a mitsempha, kukomoka, chikomokere, kutsekeka kapena kutsekeka kwa glucagon kapena / intravenous makonzedwe ozama a 40% yofunikira ndikofunikira ndipo dextrose (shuga), pambuyo ayambe chikumbu mtima ayenera kupatsidwa chakudya wolemera mu chakudya, kuteteza zisadzachitikenso wa hypoglycemia. Kuphatikiza chakudya chamagulu ochulukirapo komanso kuwunika wodwala kungafunike, popeza kuyambiranso kwa hypoglycemia ndikotheka.

Udindo wa insulini m'thupi ndi osatheka kuzikulitsa. Mulingo uliwonse wa kusowa kwa insulini umakhala wambiri ndi matenda oopsa a endocrine - matenda ashuga. Zaka 40 zapitazo, odwala matenda ashuga sanakhalepo zaka zopitilira 10-15.

Mankhwala amakono amagwiritsa ntchito insulin yofunikira kwambiri yaumunthu yopanga ma genulin kuti isinthe magazi. Chifukwa cha mankhwalawa, matenda ashuga asiya kukhala chiganizo, kupatsa mwayi odwala kwa moyo wonse komanso wautali.

Chifukwa chiyani insulin imatchedwa "genetically engineer"

Odwala ena amachita mantha ndi mawu oti "opangidwa mwabadwa," kuwakumbutsa "GMOs oyipa."

M'malo mwake, kunali kupangidwa kwa mankhwalawa komwe kunapulumutsa miyoyo ya anthu mamiliyoni ambiri odwala matenda ashuga.

Poyamba, madokotala amagwiritsa ntchito insulin yotalikirana ndi nyama (makamaka nkhumba ndi ng'ombe). Komabe, mahomoni awa sanali achilendo kwa anthu, komanso adangolowa m'magazi, ndikupangitsa kudumpha mu glucose ndikupangitsa zovuta zambiri.

Insuluble ya inshuwaransi idapangidwa poganizira zosowa zonse za wodwala yemwe ali ndi matenda ashuga, ndikupangitsa mitundu yosiyanasiyana yokhudza thupi. Pambuyo pakutha kwake, imang'ambika kukhala ma amino acid wamba ndipo imachotsedwa m'thupi.

Chachikulu mankhwala

Mafuta a insulle a insulin amatanthauza mankhwala osokoneza bongo osakhalitsa.

Pamodzi ndi cell wall receptor, mankhwalawa amapanga insulin receptor zovuta zomwe zimapangitsa njira zina:

1. Kupatula kwa michere yokwanira kukonza ndi kuyamwa kwa glucose ndi minofu,
2. Kuchuluka kwa zoyendera zapakati pazachuma ndi glucose,
3. Kuchepa kwa mapangidwe a glycogen m'chiwindi,
4. Kuthandizira kupanga mapuloteni ndi mafuta.

Ndi subcutaneous makonzedwe, mankhwalawa amayamba kugwira ntchito pambuyo pa mphindi 20-30, ndikufika pazokwanira mkati mwa maola 1-3, pafupifupi maola 5-8.

Mankhwalawa amagawidwa mosiyanasiyana m'matumbidwe: mwachitsanzo, samalowa mkati mwa chotchinga komanso samadutsa mkaka wa m'mawere. Mapeto ake atatha, insulin ya munthu imachotsedwa kudzera mu impso (pafupifupi 80%) itawonongedwa ndi insulinase.

Contraindication

Mankhwalawa nthawi zambiri amaloledwa ndi thupi, chifukwa samasiyana ndi chilengedwe pancreatic enzyme.

Contraindicated ogwiritsira ntchito insulin mu:

• Kutsitsa shuga wamagazi (hypoglycemia),
• Kuchulukitsa chidwi chathu cha thupi kwa insulin.

Zotsatira zoyipa

Ngakhale idalekerera bwino, insulin ikhoza kukhala ndi zotsatirapo zoyipa ngati:

Nthawi zina kuyamba kumwa kwa mankhwalawa kumayendera limodzi ndi kusinthasintha kwa thupi m'njira ya edema kapena mawonekedwe osokoneza. Izi mawonetseredwe nthawi zambiri amatha pambuyo pa milungu ingapo yamankhwala.

Kuphatikiza ndi mankhwala ena

Mukamagwiritsa ntchito insulin yaumunthu ndi mankhwala ena, mphamvu yake ya hypoglycemic imalimbitsidwa kapena kufooka.

Kuchepetsa shuga kumatha kuwonjezeka mukamamwa insulin ndi:

Nikotini ndi mowa zimathandizira kukulitsa mphamvu za shuga zomwe zimapangitsa kuchepetsa shuga.

Kuti muchepetse kuthamanga kwa mankhwalawa, kugwiritsa ntchito kwake ndi:

Komanso, kuphatikizapo insulin, mankhwalawa amatha kutsitsa kapena kukulitsa zotsatira za hypoglycemic:

Ntchito ndi kusankha kwa mankhwalawa

Mlingo ndi njira yoyendetsera insulin yaumunthu nthawi zonse imatsimikiziridwa payekhapayekha ndi endocrinologist, poganizira zofunikira za shuga ndi mkodzo wa wodwalayo.

Mankhwalawa amaperekedwa m'magulu a shuga m'njira zingapo: subcutaneously (s / c), intramuscularly (i / m) kapena kudzera m'mitsempha (i / v). Nthawi zambiri, insulin imayendetsedwa kamodzi. Kuti muchite izi, gwiritsani ntchito:

Mankhwala nthawi zambiri kutumikiridwa m`thupi mu pachimake zinthu zotumphukira ndi shuga: ketoacidosis, matenda ashuga.

Iwo akulangizidwa kupereka insulin 15-30 mphindi musanadye, katatu patsiku. Nthawi zina 5-6 imodzi ya mankhwalawa amaloledwa.

Mlingo wa insulin nthawi zambiri amawerengedwa mogwirizana ndi magawo a 0,5-1 pa 1 makilogalamu. Ngati insulin imaperekedwa zoposa 0,6 mg wa pa kilogalamu ya thupi, ndiye kuti mankhwalawa amayenera kuperekedwa kawiri pa tsiku. Pafupifupi, tsiku lililonse mlingo pafupifupi 30-40 (mwa ana, magawo 8).

Amayi oyembekezera nthawi zambiri amapatsidwa mlingo wa 0,6 PESCES pa kg iliyonse yakulemera. Jekeseni amatulutsa nthawi 3-5 pa tsiku, malinga ndi kuchuluka kwa zakudya.

Nthawi zambiri, insulin yothamanga imaphatikizidwa ndi insulin yotalikirapo.

Malamulo a insulin

Ngakhale akatswiri odziwa bwino za matenda ashuga amalakwitsa popereka insulin.

Malamulo ofunikira kwambiri a insulin Therapy ndi awa:

1. Kuyang'ana moyo wa alumali ndi malo osungira mankhwalawa: sayenera kuwonetsedwa ndi kutenthedwa kapena hypothermia.
2. Refreshate insulin mbale Mbale. Ndikokwanira kusunga botolo loyambira m'malo amdima firiji.
3. Kuyanjananso kwa mankhwalawa ndi malangizo ndi upangiri wa dokotala.
4. Tulutsani mpweya ku syringe musanalowe. Sikoyenera kupukuta khungu ndi mowa. Kulimbana ndi matenda a insulin ndikosowa kwambiri, ndipo mowa umachepetsa mphamvu ya mankhwalawo.
5. Kusankha malo oyenera kukhazikitsa. Kwa insulin yochepa, uwu ndi m'mimba. Ikabayidwa m'khosi komanso pang'onopang'ono, mankhwalawa amagwira ntchito pang'onopang'ono.
6. Kupewa kwa zovuta pamalo a jekeseni momwe mungagwiritsire ntchito dera lonse lapansi. Mimba yonse imagwiritsidwa ntchito kuperekera insulin yofupikitsa: kuchokera kumtunda wamtengo wokwera mtengo kupita ku inguinal khola, yokhala ndi mbali ina ya thunthu. Ndikofunika kubwezeretsanso pafupifupi 2 cm kuchokera pamalo akale jekeseni, ndikuyambitsa syringe pamalo a 45-60 madigiri, kuti mankhwalawa asatayike.
7. Musanagwiritse ntchito mankhwalawa, ndikofunikira kupukuta khungu ndi chala chachikulu. Ngati ilowa m'matumbo, mankhwalawa amachepetsa ntchito yake. Mukayika singano, gwiritsani syringe kwa masekondi 5 mpaka 10.
8. M'mimba, insulin yochepa imayendetsedwa bwino mphindi 20 asanadye. M'malo ena, mankhwalawa amaperekedwa theka la ola musanadye.

Zina zamalonda zamankhwala

Insulin imapangidwa ngati njira yothetsera jakisoni ndipo imagulitsidwa ku malo ogulitsa mankhwala.

Ma insulin omwe amapangidwa ndi chibadwa cha anthu amatha kupangidwa pansi pa mayina amtunduwu:

Chifukwa cha matekinoloje amakono a genetic, insulin (recombinant) ya insulin ya anthu inapangidwa. Ndi iye omwe ali m'gulu la zomwe akukonzekera: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Mankhwalawa amasiyana ndi oyamba mu kusintha kwa ma amino acid, omwe amawonjezeranso zinthu zina zatsopano (mwachitsanzo, zotsatira zazitali za magawo awiri), zomwe ndizofunikira kwambiri kwa odwala matenda ashuga.

Mavuto

Kuchiza kwa nthawi yayitali ndi insulin kumatha kubweretsa zovuta zingapo. Zazikulu.

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.

Model Clinical-Pharmacological Article 1

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.

MlingoMlingo 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).

Insulin yopangidwa ndi chibadwa cha anthu ndi gawo la jakisoni yothetsera matenda a shuga. Gwiritsani ntchito mankhwalawa mosamala, muyezo wokhazikitsidwa mosamala, apo ayi phwandolo limadzala ndi zovuta kapena mankhwala osokoneza bongo. Kuphatikiza apo, adokotala ali ndi udindo wopereka mankhwala ndikuwachiza, popeza pali mitundu yambiri ya insulin, iliyonse yomwe ili ndi mawonekedwe enieni a zochita.