Kodi Rinsulin NPH ndi chiyani: mawonekedwe a mankhwalawa, mawonekedwe ake, kufunika kwa kugwiritsidwa ntchito

Kuwulula Elias Delgado adalandira ndalama kuchokera ku Novo Nordisk, Lilly, sanofi-aventis, Novartis, MSD, Bayer, GSK ndi Pfizer.

Kugwiritsidwanso ntchito kwa nkhaniyi ndi kololedwa pamalamulo omwe alembedwa pa Htzz: http :wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

Tidawerengera momwe ma glargine insulin chithandizo regimens (glargine) amathandizira odwala matenda amishuga a 2 mellitus (T2DM) ku Spain.

Izi zinali zowunikira, kafukufuku wokhazikitsidwa ndi registry ya odwala 1,482 omwe alandila ndende ya Hagedorn (NPH) omwe sanachite nawo ndale omwe amasinthiratu kukondera kapena kuthandizidwa ndi NPH mwakufuna kwa ofufuzawo. Zotsatira zazikulu zinali kusintha kwa HbA1c pa miyezi 49 yowonera komanso zochitika za hypoglycemia.

Asanayambe chithandizo, tanthauzo la ± kupatuka kwa HbA1c linali loipa kwambiri poyerekeza ndi gulu la NPH (8.3 ± 1.2% poyerekeza 7.9 ± 1.1%, p1% idakwaniritsidwa ngakhale panali kuchuluka kwambiri kwa insulin mulingo.

Makhalidwe a Rinsulin® NPH

Pali mitundu yosiyanasiyana yamankhwala a mahomoni omwe amagwiritsidwa ntchito kuti asunge kuchuluka kwa glucose m'magazi tsiku lonse mkati mwazinthu zomwe amapanga (3.9-5,5 mmol / l). Amayimiridwa ndi mankhwala omwe ali ndi zosakaniza zosiyanasiyana zogwira ntchito komanso nthawi yosiyanasiyana ya zochita zake - ultrashort, yochepa, yapakati, yayitali komanso yayitali ya insulin (werengani zambiri apa).

Kuyerekeza nthawi yayitali ya mitundu yosiyanasiyana ya insulin

Rinsulin NPH ndi mtundu wopangidwira wa insulin wa anthu, womwe umasungunuka m'madzi ndi zinthu zingapo zofunika. Chidule cha "NPH" chimayimira Hagedorn Neutral Protamine, chinthu chopangidwa ndi a Danes Hans Hagedron, omwe mawonekedwe ake ndi ofanana (isophane) omwe ali ndi ma insulin opanga ma cell a anthu komanso protamine.

Chifukwa cha izi, mu malangizo ena a mankhwala omwe ali ndi prefix NPH, chinthu chogwira ntchito chimasonyezedwa ngati insulin-isophan. Insulin Rinsulin NPH amatanthauza mahomoni okhala ndi insulin pakati.

Nazi zifukwa zake zazikulu:

• Mphamvu ya mankhwalawa imadalira mtundu womwe umagwiritsidwa ntchito, njira ndi malo oyendetsera. Chifukwa cha izi, mbiri ya nthawiyo imatha kusinthasintha, koma magwiridwe ake ali mkati mwake:
  1. kuyamba kwa achire zotsatira - pambuyo 1.5 maola,
  2. pachimake - pakati 4 mpaka 11 jakisoni,
  3. Kutalika kokwanira kwa ntchito ndi maola 18.
• Mankhwalawa sanapangidwe kuti aletse kuukira kwa hypoglycemia ndi jekeseni wamkati.
• 1 ml ya Risulin muli 100 IU yogwira ntchito. Kuti muwerenge mlingo wofunikira, kulemera kwa odwala matenda ashuga kumachulukitsidwa ndi 0.5 kapena 1 IU. Kuwongolera kumachitika motsogozedwa ndi dokotala ndipo zimatengera zomwe zikuwonetsa glucose wamagazi omwe amapezeka pogwiritsa ntchito glucometer. Amayi okalamba, oyembekezera komanso oyamwitsa amalangizidwa kuti azitsatira kwambiri shuga ndi kuchepetsa ma insulin. Kuwonjezeka kwa mlingo kumafunikira kwa matenda omwe amayenda ndi malungo.

Malo Othandizira a Rinsulin® NPH - Dera lakunja la Thigh

• Sungani makatoni kapena njira zambiri zotayira syringe mufiriji. Pamaso jakisoni, ayenera kuwotha m'manja.
• Kugwiritsa ntchito mankhwalawa sikulola kukana kutsatira zakudya zamafuta ochepa, makalasi okhazikika malinga ndi pulogalamu yapadera yochitira masewera olimbitsa thupi komanso kugwiritsa ntchito ma insulin aafupi (bolus).
• Kuwongolera kuthandizira kwa insulin mankhwala ndikudziwona nthawi yeniyeni yokhazikitsira insulini yapakati, tikulimbikitsidwa kusunga diary yapadera ndipo nthawi zambiri imayang'anira kuchuluka kwa shuga m'magazi masana.

Njira yolondola ya jakisoni wa hypodermic kwa akulu, kutengera kutalika kwa singano

Yang'anani! Popeza kukonzekera kwa insulin kumayikidwa pang'onopang'ono kokha, kuti asalowe mwangozi mumtsempha wamagazi, jakisoni amayenera kukhala molingana ndi malamulowo.

Kuphatikiza pa Rinsulin® NPH, gulu la omwe akukonzekera insulin kukonzekera (NPH) limaphatikizapo:

Ma insulins omwe ali pamwambawa ali ndi mawonekedwe ofanana: kuyambira pambuyo pa 2, nsonga pambuyo 6-10, nthawi yayitali kuyambira maola 8 mpaka 16 (18).

Yang'anani! Rinsulin R ya mankhwala si analogue kapena fanizo la Rinsulin NPH, ndipo kalata P sisonyeza mtundu wina wapadera wonyamula chinthu yogwira mu syringe. Rinsulin P ndiwofulumira (!) Kukonzekera komwe kumagwiritsidwa ntchito musanadye chakudya kuti athandizire kuyamwa kwa chakudya champhamvu kwambiri.

Zoyipa

Endocrinologists omwe amawunikira mosamala zazomwe dziko lapansi lipanga la matenda ashuga amalimbikitsa kusiya kugwiritsa ntchito insulin yapakatikati. Ngakhale insulin yayitali simunayikidwe kwaulere, gulani ndi kubayidwa.

Mtengo wokwera ndi wolungamitsidwa. Kuwerengera kwa mankhwalawa ndikosavuta, kuchuluka kwa jakisoni kumachepetsedwa nthawi zosachepera 2, kuchuluka kwa contraindication kumachepetsedwa, pamakhala zotsatira zoyipa ndi zotsatirapo zake.

Njira yothandiza kwambiri yogwiritsira ntchito shuga m'magazi a mtundu 1 wa shuga

Ichi ndichifukwa chake simuyenera kugwiritsa ntchito Rinsulin NPH:

1. Ngati jakisoni amawona mogwirizana ndi nthawi yanthawi zonse kapena kangapo pa 2,5 patsiku, pafupipafupi amalimbikitsidwa zakudya zamafuta ochepa, zikasinthidwa kwakanthawi zimayambitsa boma la jakisoni la "linang'ambika" ndikulakwitsa kosagwirizana ndi zotsatirazi zonse.
2. Protamine yomwe ili m'mankhwalawa ndi mapuloteni amanyama omwe amawonjezeredwa makamaka kuti atchulukitse zochita za insulin yokha. Ili ndi kuthekera kwambiri ndipo ndiyomwe imayambitsa mavuto.
3. Ambiri odwala matenda ashuga, posachedwa, amayenera kuchita ziwonetsero zamitsempha yama mtima, pomwe wina wosemphana ndi jekeseni akhoza kulowa m'magazi. Pali ziwonetsero zokhumudwitsa zomwe zimanena zotsatira zingapo zakupha ndi zovuta zambiri zoyipa zomwe zachitika, monga asayansi apeza, chifukwa cha kulumikizana kwa wothandizira wosiyana ndi protamine.
4. Nthawi zina, jakisoni wa sing'anga wa insulin sakukwanira usiku wonse, zomwe zimayambitsa zovuta za matenda a shuga "m'mawa kutacha", zomwe zikufooketsa.
5. Zidadziwikanso kuti mu theka la odwala "omwe amakhala" pamankhwala osokoneza bongo a insulin hypoglycemic amapezeka nthawi zonse ndipo lipid dystrophy imayamba.

Kuti mumalize nkhaniyi, onerani kanema wakufupi ndi katswiri wa matenda ashuga waku America Richard Bernstein. Kutsatira malingaliro ake, ndizothekadi kupewa kupezeka kwa hypoglycemia, ndikusunga shuga molimbika pakulamulira kwa maola 24.

Wotsutsa nkhani yasayansi yazachipatala ndi zaumoyo, wolemba buku la zasayansi - Rodionova T. N., Orlova M. M.

Cholinga: kuwunika momwe mankhwalawa amathandizira odwala omwe ali ndi matenda a shuga 2 mellitus (T2DM) omwe ali ndi glargin insulin analogi ndi Detemir insulin. Zida ndi njira. Kafukufukuyu adachitika mwa odwala 147 omwe ali ndi matenda a shuga a 2 omwe poyamba adalandira chithandizo chamankhwala othandizira pakamwa hypoglycemic ndi NPH-insulin ndipo adasamutsidwira kuchipatala cha endocrinological kapena kunja kwa chithandizo cha insulin ndi Detemir ndi Glargin. Kuunikaku kunaphatikizanso kuyesa kwa wodwalayo za momwe wodwalayo alili, kuwunika kwa labotale ndi kutsimikiza kwa kuchuluka kwa hemoglobin ya glycated pambuyo pa miyezi itatu ndi isanu ndi umodzi. ZotsatiraMalinga ndi zotsatira za kafukufukuyu, kugwiritsa ntchito insulin analogues (Detemir, Glargin) poyerekeza ndi NPH-insulin kwa miyezi 6 ndikulola kukwaniritsa mfundo za glycemia mu 70% ya odwala T2DM omwe ali ndi chiopsezo chochepa cha hypoglycemia. Pomaliza Kugwiritsa ntchito kwa zamankhwala machitidwe amakono a insulin analogues (Detemir, Glargin), omwe ali ndi mbiri yopanda kanthu, nthawi yayitali komanso njira yochepetsera mankhwala osakaniza algorithm, amalola kuyerekeza kubwezeretsa kwachilengedwe kwa ma protein ambiri mwa kuyerekeza ndi NPH- insulin

Cholinga: kuyerekezera mphamvu ya mankhwalawa a mankhwala a insulin Glargin ndi insulin Detemir odwala omwe ali ndi matenda a shuga 2. Zinthu ndi njira. Odwala a 147 omwe ali ndi matenda a shuga a 2 omwe poyambapo amalandila chithandizo chophatikizidwa ndi antihyperglycemic agent wa pakamwa ndi NPH-insulin akhala akuphunziridwa. Mlingo wa hemoglobin wa glycated wafotokozedwera m'miyezi itatu ndi isanu ndi umodzi kuti awunikidwe pafupipafupi pakuwongolera aglycemia. Zotsatira Malinga ndi kafukufuku wogwiritsa ntchito insulin analog (Detemir, Glargin) motsutsana ndi NPH insulin kwa miyezi 6 yomwe imaloledwa kufikira eni ake a glycemia 70% ya odwala omwe ali ndi matenda a shuga 2 omwe ali ndi chiopsezo chochepa cha hypoglycemia. Pomaliza Kugwiritsa ntchito kwachipatala zamankhwala amakono a insulin analog ndi algorithm yosavuta yopanga mlingo, amalola kuyerekezera momwe mungathere pachitetezo cha insulin, kuthandiza kukwaniritsa kubwezeretsa kwa kagayidwe kazachilengedwe mu kuchuluka kwakukulu kwa odwala poyerekeza ndi NPH insulin.

Zolemba pazaka yasayansi pamutu wakuti "Kuunika kwa ntchito bwino kwa mitundu ingapo ya mankhwala a insulin pochizira matenda a shuga a 2"

UDC 616.379-008.64-085.357: 557.175.722-036.8 (045) Nkhani yoyambirira

KULIMA KWA ZINSINSI ZOFUNA KUTI APHUNZITSE ZIWEREWERE ZOPANDA CHIWONSE POPANDA CHIWERUZO CHOBWINO 2

T. I. Rodionova - Saratov State Medical University yotchedwa V.I. Razumovsky ”, Unduna wa Zaumoyo wa Russia, Mutu wa Dipatimenti ya Endocrinology, Pulofesa, Dokotala wa Sayansi Yamankhwala, M. M. Orlova - Saratov State Medical University adatchedwa V.I. Razumovsky »Unduna wa Zaumoyo wa Russia, Wothandizira wa Dipatimenti ya Endocrinology, Woyankha wa Sayansi Yachipatala.

KUSINTHA KWA KUSINTHA KWA KUSINTHA KWA ZINSINSI ZOFUKA ZA INSULIN

POPHUNZITSIRA ZIWEREU 2

T. I. Rodionova - Saratov State Medical University n.a. V. I. Razumovsky, Mutu wa Dipatimenti ya Endocrinology, Pulofesa, Dokotala wa Medical Science, M. M. Orlova - Saratov State Medical University n.a. V. I. Razumovsky, dipatimenti ya Endocrinology, Pulofesa Wothandizira, Woyenerera wa Sayansi ya Zamankhwala.

Tsiku loti alandire - June 9, 2014; Tsiku lolembera atolankhani - Seputembara 10, 2014.

Rodionova T.I., Orlova M.M. Kuwunika kwa kugwiritsa ntchito mitundu yosiyanasiyana ya mankhwala a insulin pochizira matenda a shuga a 2. Saratov Journal of Medical Science Science 2014, 10 (3): 461-464.

Cholinga: kuwunika momwe mankhwalawa amathandizira odwala omwe ali ndi matenda a shuga 2 mellitus (T2DM) omwe ali ndi glargin insulin analogi ndi Detemir insulin. Zida ndi njira. Kafukufukuyu adachitika mwa odwala 147 omwe ali ndi matenda a shuga a 2 omwe poyamba adalandira chithandizo chamankhwala othandizira pakamwa hypoglycemic ndi NPH-insulin ndipo adasamutsidwira kuchipatala cha endocrinological kapena kunja kwa chithandizo cha insulin ndi Detemir ndi Glargin. Kuunikaku kunaphatikizanso kuyesa kwa wodwalayo za momwe wodwalayo alili, kuwunika kwa labotale ndi kutsimikiza kwa kuchuluka kwa hemoglobin ya glycated pambuyo pa miyezi itatu ndi isanu ndi umodzi. Zotsatira Malinga ndi zotsatira za kafukufukuyu, kugwiritsa ntchito insulin analogues (Detemir, Glargin) poyerekeza ndi NPH-insulin kwa miyezi 6 ndikulola kukwaniritsa mfundo za glycemia mu 70% ya odwala T2DM omwe ali ndi chiopsezo chochepa cha hypoglycemia. Pomaliza Kugwiritsa ntchito kwa zamankhwala machitidwe amakono a insulin analogues (Detemir, Glargin), omwe ali ndi mbiri yopanda kanthu, nthawi yayitali komanso njira yochepetsera mankhwala osakaniza algorithm, amalola kuyerekeza kubwezeretsa kwachilengedwe kwa ma protein ambiri mwa kuyerekeza ndi NPH- insulin

Mawu ofunikira: lembani matenda a shuga a 2 mellitus, glycemic control, insulin Glargin, insulin Detemir.

Rodionova TI, Orlova MM. Kuunika kwa kugwiritsa ntchito mitundu yosiyanasiyana ya insulin pochiza matenda amishu 2. Saratov Journal of Medical Science Science 2014, 10 (3): 461-464.

Cholinga: kuyerekezera mphamvu ya mankhwalawa a mankhwala a insulin Glargin ndi insulin Detemir odwala omwe ali ndi matenda a shuga 2. Zinthu ndi njira. Odwala a 147 omwe ali ndi matenda a shuga a 2 omwe poyambapo amalandila chithandizo chophatikizidwa ndi antihyperglycemic agent wa pakamwa ndi NPH-insulin akhala akuphunziridwa. Mlingo wa hemoglobin wa glycated wafotokozedwera m'miyezi itatu ndi isanu ndi umodzi kuti awunikidwe pafupipafupi pakuwongolera glycemia. Zotsatira Malinga ndi kafukufuku wogwiritsa ntchito insulin analog (Detemir, Glargin) motsutsana ndi NPH insulin kwa miyezi 6 yomwe imaloledwa kufikira eni ake a glycemia 70% ya odwala omwe ali ndi matenda a shuga 2 omwe ali ndi chiopsezo chochepa cha hypoglycemia. Pomaliza Kugwiritsa ntchito kwachipatala zamankhwala amakono a insulin analog ndi algorithm yosavuta yopanga mlingo, amalola kuyerekezera momwe mungathere pachitetezo cha insulin, kuthandiza kukwaniritsa kubwezeretsa kwa kagayidwe kazachilengedwe mu kuchuluka kwakukulu kwa odwala poyerekeza ndi NPH insulin.

Mawu ofunikira: mtundu wa shuga 2, kuwongolera glycemic, insulin Glargine, insulin Detemir.

Kuyamba Matenda a shuga mellitus (DM) ndi amodzi mwa matenda oyipa kwambiri pamagulu chifukwa cha kuchuluka kwambiri kwa matenda ashuga padziko lapansi, omwe, malinga ndi bungwe la International Diabetes Federation, lidzakwana anthu opitilira 552 miliyoni pofika 2030. Zowonjezereka zikuchitika

Wolemba maudindo - Orlova Marina Mikhailovna Tel: +79173250000 E-mail: [email protected]

makamaka chifukwa cha mtundu wachiwiri wa matenda a shuga, omwe amachititsa 85-95% ya anthu onse odwala matenda ashuga. Vuto limodzi lofunika kwambiri pa thanzi lathu la zachuma ndi kuchuluka kwa matenda ashuga. Kuti muchepetse chiopsezo chokhudzana ndi zovuta za matendawa mochedwa, kuyang'anira glycemic control kwa odwala matenda ashuga ndikofunikira kwambiri. Chofunikira chakhudza milingo ya hyperglycemia ndi glycated hemoglobin (HLA | s) ndi

Saratov Journal ya Medical Science Science. 2014. Vol. 10, Na. 3.

kusala kudya kwa plasma glucose (GPN). Monga momwe amadziwika, GPN ndiye gawo lalikulu la glycemia kwathunthu kwa odwala omwe ali ndi matenda a shuga a 2, omwe salipiridwa popereka mankhwala a hypoglycemic mankhwala (PSSP). Kuchulukitsidwa kwa basal insulin kwa PSSP kumachepetsa HbAlc, kukulitsa gawo la postprandial glycemia mosasamala za HbAlc. Kuyamba koyambirira kwa mankhwala a insulini a matenda a shuga a 2 kumapangitsa kuti matendawa akhazikike komanso amathandizira kuti ntchito ya p-cell isungidwe. Malinga ndi ma algorithms amakono, insulini ya basal ndi gawo lachiwiri la chithandizo cha T2DM, chomwe chimagwiritsidwa ntchito posagwiritsa ntchito njira yosinthira (kusintha zakudya ndi zochita zolimbitsa thupi) komanso kugwiritsa ntchito metformin 1, 5.

Malinga ndi kafukufuku ku Netherlands, kugwiritsa ntchito insulin Glargin kumathandizira kuwongolera glycemic, mkhalidwe wam'maganizo ndikuwongolera moyo wabwino wa odwala atayambitsidwa insulin. Mbiri yopanda pake ya Glargin imatsanzira kubisala kwapansi pa insulin, kuchepetsa kwambiri chiopsezo cha hypoglycemia poyerekeza ndi ma insulins a NPH.

Mosiyana ndi ma insulini ena, pamene Glargin adayikidwa, sikuti pali kuchuluka kwakukulu kwa kulemera kwa thupi, komanso kumakonda kutsika kwake. Malinga ndi mayesero azachipatala, popereka insulin Glargin, monga lamulo, kuwonjezeka kwa kulemera kwa thupi kumawonedwa, komwe kulibe kusiyana kwakukulu pakumayerekeza ndikugwiritsa ntchito insulin NPH mwa odwala omwe ali ndi matenda a shuga a 2. Chifukwa chake, m'maphunziro awiri akulu okhudzana ndi odwala oposa 10,000 omwe ali ndi mtundu wachiwiri wa shuga omwe amalandila Glargin insulin kwa masabata 24, phindu lolemera la 1-2 kg linawonedwa 8, 9. Mosiyana ndi izi, kafukufuku yemwe anachitika ku Germany. kuphatikiza odwala opitilira 12,000 omwe ali ndi T2DM omwe anali ndi glycemia wosakhutiritsa pomwe amatenga PSSP, adawonetsa kuchepa kochepa kwa index yolimbitsa thupi mwa odwala omwe amalandira insulin Glargin, poyerekeza ndi gulu lomwe kutumikizana kwa PSSP kudapitilira.

Kugwiritsa ntchito kwa insulin analogue yomwe imatenga nthawi yayitali kumalola kuwongolera mwachangu kwa glycemic poyerekeza ndi kusintha kwamachitidwe amoyo ndi insulin insulin, mankhwala ena a SSSP 4, 10. Zonsezi zomwe zili pamwambapa za insulin analogue, ngati zingatheke, zitha kugwiritsidwa ntchito poyambitsa insulin mankhwala kwa odwala omwe ali ndi matenda a shuga. yomwe imavomerezedwa ndi ma algorithms amakono a ADA (2014) ndi "Algorithms apadera othandizira odwala omwe ali ndi matenda osokoneza bongo a mellitus" (2013).

Cholinga: kuwunika momwe mankhwalawa amathandizira odwala omwe ali ndi matenda a shuga 2 mellitus (T2DM) omwe ali ndi glargin insulin analogi ndi Detemir insulin.

Zida ndi njira. Kufufuza kozungulira kwa cohort kotseguka kwamiyezi isanu ndi umodzi kunaphatikizapo odwala 147 omwe ali ndi mtundu wovuta wa 2 wodwala mellitus yemwe poyamba adalandira chithandizo chochepetsa shuga ndi PSSP ndi NPH-insulin. Panthawi yophatikizidwa phunziroli, kuchuluka kwa HbA | c m'magulu onse kumadutsa zomwe munthu amazipangira.

Kafukufukuyu adachitika pamaziko a dipatimenti yachipatala ya endocrinology komanso malo othandizira a Hospital Clinical Hospital "Clinical Hospital № 9" ku Saratov. Odwala onse adasaina chilolezo chodziwira nawo nawo phunziroli.

Njira zophatikizira mu phunziroli zinali za kulipidwa T2DM, wazaka zopitilira 18, kugwiritsa ntchito zida zowunikira zowunika za glycemia komanso chidwi chokwaniritsa chipukuta matenda.

Monga gawo la mankhwala ophatikiza, odwala onse adalandira kukonzekera kwa sulfonylurea, mlingo womwe sunasinthidwe nthawi yonseyi. Odwala omwe adalandira NPH-insulin 1 nthawi patsiku amasamutsidwa kupita ku Glargin insulin muyezo womwewo. Kwa odwala omwe adalandira jakisoni woposa limodzi wa NPH-insulin patsiku, akusintha kupita ku Glargin insulin, mlingo wa tsiku ndi tsiku unachepetsedwa ndi 20-30%.Mlingo uliwonse unkaperekedwa kwa masiku atatu aliwonse molingana ndi ma algorithm omwe amaganizira za kuchuluka kwa zamasewera omwe amadziwunikira pawokha. Pamaulendo mwezi uliwonse, malingaliro adaperekedwa pamankhwala azakudya, zolimbitsa thupi, kukonza mankhwala ngati kuli kofunikira. Miyezo ya HbA1c idatsimikizika pambuyo pa miyezi itatu ndi isanu ndi umodzi kuti pakhale kuwunika kwathunthu pakulamulira kwa glycemic. Pambuyo pa miyezi 6, kafukufukuyu adamaliza odwala 132 (92,5%) ndi zotsatira zonse za HbAlc, glycemia yofulumira komanso Mlingo wa Detemir ndi Glargin koyambirira komanso kumapeto kwa kafukufuku.

Kusanthula kwa zotsatira za zotsatira kunachitika phukusi la Statistica 7.0 (StatSoft Inc., 2004). Kwa onse omwe awerengedwa, mtundu wa magawidwewo unayesedwa, magawo omwe amaphunziridwawo anali ndi magawidwe ofanana a kuchuluka kwake kogwirizana ndi momwe amagawidwira ena onse. Ziwerengero zofotokozera zamitengo ya HbA | c ndi GPN zimawonetsedwa mwanjira ya mikhalidwe: mfundo yamtengo wambiri, kupatuka kwofananira. Poyerekeza magulu awiri odziyimira pawokha pogwiritsa ntchito njira zochulukitsira, tidagwiritsa ntchito njira zodziyimira poyerekeza zowerengera (Kafukufuku wa T-mayeso) ndi kusanthula kwa ANOVA kuti tifanizire zitsanzo zitatu zoyesedwa motsatiridwa poyerekeza awiri (kuchuluka kwa GPN, kuchuluka kwa HbAlc, mlingo wa insulini pamaulendo osiyanasiyana). Mlingo wofunikira pakuyesa ma hypotheses owerengeka adatengedwa wofanana ndi 0.05.

Zotsatira Kuti muwone momwe mankhwalawo amathandizira, odwala onse omwe ali ndi matenda a shuga 2 a mellitus (n = 147) omwe anali pa PSSP ndi NPH-insulin adagawidwa m'magulu awiri: oyamba adaphatikizapo 78 omwe adasamutsidwa kuchokera ku NPH-insulin kupita ku Detemir insulin, chachiwiri - odwala 69 omwe adasamutsidwa kuchokera ku NPH-insulin kupita ku insulin Glargin. Panthawi yophatikizidwa mu phunziroli, kusiyana kwakukulu pazaka, nthawi yayitali ya matenda, kulemera kwa thupi, HbA | c level, mulingo wa GPN, kukhalapo kwa zovuta za matenda a shuga, ndi concomitant pathology pakati pamagulu sanazindikiridwe (tebulo).

Kuwunika kwa chithandizo cha odwala omwe ali ndi mtundu wa matenda a shuga 2 kunachitika kawiri: patatha miyezi itatu ndi isanu ndi umodzi. Kutsika kwakukulu kwa HbA | c kunadziwika m'magulu onse a odwala omwe ali ndi matenda amtundu wa 2 poyerekeza ndi maziko azomwe akuwonekera pambuyo pa miyezi itatu ndi isanu ndi umodzi (p sindikutha kupeza zomwe mukufuna? Yesani ntchito yosankha mabuku.

Mtengo womwe umalunjika wa HbAlc mulingo woyenerera udakwaniritsidwa mu 68% ya odwala omwe ali ndi matenda a shuga 2 (n = 147), kuchuluka kwa odwala omwe ali ndi HbAlc kuchuluka kwa 7.0-8.0% kutsika kuchokera 13 mpaka 6%, ndipo kuchuluka kwa odwala omwe ali ndi HbAlc level> 8 , 0% yatsika kuchoka pa 87 mpaka 8%. Pakufufuza

Makhalidwe amagulu a odwala omwe ali ndi T2DM kumayambiriro kwa phunziroli

Parameter chithandizo cha insulini Detemir Insulin chithandizo Glargin P

Chiwerengero cha odwala, n 78 69

Zaka, zaka 59.7 ± 8.6 60 ± 7.3 0.28

Kutalika kwa mtundu 2 shuga, zaka 8 ± 5.6 8 ± 5.3 0.67

Kulemera kwa thupi, makilogalamu 83 ± 12.3 90 ± 15.8 0.24

ID,% 9.8 ± 1.6 9,7 ± 1.8 0.5

Kuthamanga glycemia, mmol / L 11.7 ± 4.2 11.4 ± 4.7 0.34

Kodi insulin imalembedwa liti?

Kupezeka kwa insulin mu 1921 ndikugwiritsanso ntchito kwawoko kunali kusintha kwa mankhwalawa matenda a shuga. Anthu anasiya kufa ndi matenda ashuga. Chifukwa chosowa mankhwala ena panthawiyi, odwala matenda amtundu wa 2 amathandizidwanso ndi insulin, ndizothandiza kwambiri. Koma ngakhale pakadali pano, mankhwala angapo ochepetsa shuga m'mapiritsi atapangidwa ndikugwiritsidwa ntchito, kugwiritsa ntchito insulin ndikofunikira m'gulu lalikulu la odwala matenda ashuga a 2.

Nthawi zambiri, izi zimachitika osati chifukwa chathanzi, koma kuti mupeze magazi ambiri, ngati cholinga chotere sichinakwaniritsidwe ndi njira zonsezi (zakudya, masewera olimbitsa thupi komanso mapiritsi ochepetsa shuga).

Tiyenera kumvetsetsa kuti palibe chomwe chingavulaze thupi kuchokera ku chithandizo cha insulin (mwachitsanzo, odwala omwe ali ndi matenda amtundu wa 1 omwe amaba jakisoni kwa zaka makumi angapo chiyambireni matendawa).

Kodi ndende ya insulin ndi chiyani?

Pancreas wathanzi imagwira ntchito mosavomerezeka ndipo imatha kupanga insulin yokwanira. Komabe, pakapita nthawi, zimakhala zochepa kwambiri. Pali zifukwa zingapo izi:

• Shuga wambiri. Apa tikulankhula zakukwera kwakukulu kwa mamilimita 9,
• zolakwa zamankhwala, izi zitha kukhala mitundu yayikulu
• Mankhwala ambiri omwe amamwa.

Kuchulukana kwa glucose m'magazi kumakakamizidwa kufunsa funso kuti ngati ali ndi matenda ashuga, amapaka jakisoni, matenda ena amafunika jakisoni. Mwachilengedwe, ichi ndi insulin, yomwe ikusowa mu mawonekedwe a kapamba omwe amapangidwa, komabe, mlingo wa mankhwalawa komanso pafupipafupi pakukhazikitsa amatsimikiza ndi dokotala.

Insulin imayikidwa popanda kulipira shuga. Ndiye kuti, ngati sizingatheke kukwaniritsa masheya amwazi pogwiritsa ntchito mapiritsi, zakudya zoyenera komanso kusintha kwa moyo.

Nthawi zambiri, kuikidwa kwa insulin sikumangobwera ndi kuphwanya kwamalangizo a madotolo, komanso kutsika kwa kapamba. Zonse ndizokhudza nkhokwe zake. Kodi izi zikutanthauza chiyani?

Mu kapamba pali maselo a beta omwe amapanga insulin.

Mothandizidwa ndi zinthu zosiyanasiyana, kuchuluka kwa maselo amenewa kumachepera chaka chilichonse - kapamba wamankhwala amatha. Pafupifupi, kufooka kwa pancreatic kumachitika pambuyo pa zaka 8 kuchokera pa kuzindikira kwa matenda a shuga 2.

Kukonzekera kwa insulin

Kukonzekera koyambirira kwa insulin kunachokera kwa nyama. Zinapezeka kuchokera kapamba wa nkhumba ndi ng'ombe. M'zaka zaposachedwa, kukonzekera kwa insulin ya anthu kwakhala kukugwiritsidwa ntchito. Zotsirizira izi zimapezedwa ndi ma genetic engineering, kukakamiza mabakiteriya kuti apange insulin yofanana ndi mankhwala omwe amapangidwira insulin yaumunthu (i.e. sichinthu chachilendo kwa thupi). Tsopano ma genetic opanga ma insulin a mankhwalawa ndi mankhwala osankha mankhwalawa odwala onse omwe ali ndi matenda osokoneza bongo, kuphatikizapo mtundu 2.

Malinga ndi nthawi yochitapo kanthu, zosungira zazifupi komanso zazitali (zazitali) zimasiyanitsidwa.

Chithunzi 7. Chithunzi chochepa cha insulin

Kukonzekera kwa insulin pang'ono (komwe kumatchedwanso insulin) kumakhala kowonekera nthawi zonse. Mbiri yakukonzekera kwakanthaŵi ka insulin kukonzekera ndi motere: kuyamba pambuyo pa mphindi 15-30, kuchuluka kwa maola 2-4, kumatha pambuyo pa maola 6, ngakhale m'njira zambiri magawo anthawi akakhazikika amadalira mlingo: yaying'ono mlingo, yofupikitsidwayo. 7). Podziwa magawo awa, titha kunena kuti insulin yochepa iyenera kuperekedwa pakadutsa mphindi 30. musanadye, kuti mphamvu zake zigwirizane ndi kukwera kwa shuga.

Posachedwa, kukonzekera kwa ultrashort kwawonekeranso, zomwe zimatchedwa insulin analogs, mwachitsanzo Humalog kapena Novorapid. Mbiri yawo ya zochita ndi yosiyana pang'ono ndi insulin yochepa. Amayamba kuchita zinthu ngati atangoyendetsa (mphindi 5 mpaka 15), zomwe zimathandiza wodwala kuti asamayang'ane nthawi yayitali pakati pa jakisoni ndi zakudya, koma aziwupereka nthawi yomweyo asanadye (onani mkuyu. 8). Kuchuluka kwa zochitika kumachitika pambuyo pa maola 1-2, ndipo kuchuluka kwa insulin pakadali pano kumakhala kwakukulu poyerekeza ndi insulin yachilendo.

Chithunzi 8. Mbiri yochepa ya insulin

Izi zimawonjezera mwayi wokhala ndi shuga wokwanira magazi mutatha kudya. Pomaliza, mphamvu yake imatha mkati mwa maola 4-5, omwe amakupatsani mwayi kuti musakane zakudya zapakatikati ngati mukufuna, osakhala pachiwopsezo cha hypoglycemia. Chifukwa chake, zochitika za tsiku ndi tsiku za munthu zimasinthasintha.

Chithunzi 9. Mbiri ya Insulin Yapakatikati

Kukonzekera kwa insulin kwa nthawi yayitali (kwa nthawi yayitali) kumapezeka ndi kuwonjezera zinthu zina za insulini zomwe zimachepetsa kuyamwa kwa insulin pansi pa khungu. Kuchokera pagululi pano amagwiritsa ntchito mankhwala a nthawi yayitali. Mbiri yamachitidwe awo ndi motere: kuyambira - pambuyo pa maola 2, pachimake - pambuyo maola 6-10, kutha - pambuyo maola 12-16 kutengera mlingo (onani mkuyu 9).

Anulin a insulini okhalitsa amapezeka mwa kusintha kapangidwe ka insulin. Amawonekera, motero, safuna kusakanizika musanalowe.Mwa iwo, fanizo la nthawi yayitali yochitapo kanthu limasiyanitsidwa, mawonekedwe amomwe akufanana ndi mbiri ya NPH-insulin. Izi zikuphatikiza Levemir, yemwe ali ndi kudziwiratu kopambana.

Chithunzi 10. Mbiri ya insulin yosakanikirana yomwe imakhala ndi 30% yochepa yochita insulin

Lantus ndi analogue yomwe imagwira ntchito kwa nthawi yayitali, yomwe imagwira ntchito kwa maola 24, motero imatha kutumizidwa kamodzi patsiku monga insal insulin. Mulibe chiwopsezo chochita, chifukwa chake, kugona kwa hypoglycemia usiku komanso pakati pa chakudya kumachepetsedwa.

Pomaliza, pali zosakanikirana (zosakanikirana) zomwe nthawi imodzimodzi zimakhala ndi insulin yaifupi kapena ya ultrashort zochita komanso nthawi yayitali yochitapo kanthu. Kuphatikiza apo, ma insulini amenewo amapangidwa ndi zigawo zingapo "zazifupi" ndi "lalitali": kuyambira 10/90% mpaka 50/50%.

Chithunzi 11. Chitetezo cha insulin wamba

Chifukwa chake, mbiri ya insulin imeneyi imakhala ndi mbiri yolingana ya ma insulin omwe amapanga mawonekedwe awo, komanso kuopsa kwa zotsatirazi kumatengera kuchuluka kwake (onani mkuyu. 10).

Kupanga ndi mawonekedwe a kumasulidwa

Mankhwala ali mu mawonekedwe a kuyimitsidwa kwa subcutaneous makonzedwe. Muli insulin yaumunthu pa mlingo wa 100 IU / ml. Zina mwazomwe zimapangidwira ndi:

• metacresol
• glycerin
• protamine sulfate,
• phenol
• zinc oxide
• sodium hydrogen phosphate,
• madzi oyeretsedwa a jakisoni
• yankho la 10% hydrochloric acid,
• 10% sodium hydroxide.

Mankhwala ndi kuyimitsidwa kwa tint yoyera. Njira yothetsera vutoli imatha kupangitsa khungu kukhala loyera. Ndi kugwedeza kwamphamvu, nyanjayo imasungunuka mosavuta.

Mankhwalawa amapezeka m'makalata ndi ma syringe pensulo. Mankhwala omwe amapezeka m'matakatoni ndi kuyimitsidwa kwapadera, komwe kumagwiritsidwa ntchito poyang'anira pamagetsi. Amapezeka mu Mlingo wa 100 IU / ml mu makilogalamu atatu a 3 ml. Mankhwalawa amamuika m'matumba olembetsera a ma cartridge asanu. Mu phukusi la makatoni pamakhala chithuza chimodzi ndi malangizo ogwiritsira ntchito.

Mankhwalawa amasungidwa kutentha kwa 2 ° C mpaka 8 ° C, m'malo otetezedwa ndi dzuwa ndi kutentha. Sizoletsedwa kuti zizimitsidwa. Bokosi lotseguka limasungidwa kutentha 15 mpaka C 25 mpaka C, koma osati masiku 28.

Mankhwalawa amapangidwa m'matumba a syringe. Cholembera cha Humulin chili ndi kuyimitsidwa kwa 100 IU / ml mu voliyumu ya 3 ml. Amapangidwira kuperekera mankhwala pansi pa khungu. Mankhwalawa amapakidwa m'miyala isanu ya syringe mu pulasitiki. Atayikidwa mu kabokosi katoni pamodzi ndi malangizo ogwiritsa ntchito. Chipangizochi chimasungidwa pa kutentha kwa 2 mpaka 8 ° C. Mankhwalawa amatetezedwa kuti asatenthedwe ndi kutentha ndi dzuwa. Osamawuma. Sungani pamalo otseguka firiji, koma osapitirira masiku 28.

Pali mtundu wa kutulutsidwa kwa mankhwalawa m'mabotolo agalasi 10 ml, omwe amadzaza mu bokosi la makatoni pamodzi ndi malangizo ogwiritsira ntchito. Malamulo osungira amtunduwu wamankhwala ndi ofanana ndi am'mbuyomu.

Mankhwala "Humulin M3" ndi osakaniza a insulin, amaphatikiza "Humulin NPH" ndi "Humulin Regular." Mankhwala ndi osavuta chifukwa safunika kukonzekera okha. "Humulin M3" amapukutidwa mosamala maulendo khumi m'manja musanagwiritse ntchito. Zungulitsani madigiri a 180 kangapo. Izi zimathandizira kuyimitsidwa kuti apeze chuma chochuluka. Ngati matumba oyera akuwoneka m'botolo, ndiye kuti insulin singagwiritsidwe ntchito, yaipa.

Zomwe zimathandizira kuchepa kwapancreatic:

• Shuga wamkulu wamagazi (oposa 9 mmoll),
• Mlingo waukulu wa sulfonylureas,
• Mitundu yosagwirizana ndi shuga.

Matenda a shuga ndi nthawi yomwe kapamba sangathe kuphatikiza insulin yokwanira kuti ikuthandizeni kukhala ndi shuga wamagazi (kapena shuga) yamagazi, yomwe imatengedwa kupita mbali zosiyanasiyana za thupi lathu, ndikupereka mphamvu.

Zomwe zimapangitsa kuperewera kwa insulin ndizosiyana, koma mtundu wachiwiri wa matenda a shuga ndiwofala kwambiri. Zowopsa zomwe zimayambitsa nkhaniyi ndi mbiri ya banja yodwala, kulemera ndi ukalamba.

M'malo mwake, anthu ambiri onenepa kwambiri kapena onenepa kwambiri kumayiko a azungu sayenera kuchita mantha ndi matenda ashuga. Ngakhale kulemera ndikofunika kwambiri, sikuti ndiye chiopsezo chachikulu pakukula kwake. Zakudya zomwe mumadya nthawi zambiri zimakhala zofunika kwambiri kuposa kulemera kwakemwini. Mwachitsanzo, muyenera kuchepetsa kuchuluka kwa zakumwa za shuga, kuphatikiza madzi a shuga, kaboni ya zipatso, kapenanso tiyi wokoma.

Njira zakuchitikira ndi zotsatira za insulin

Mankhwala a insulin amachitika kuti athetse vuto la glucose ndikusintha ntchito yopanga maselo a beta okhala ndi hyperglycemia wapakati. Poyamba, kukomoka kwa maselo a beta omwe amapezeka m'matumbo ndikupanga insulin kumatha kusintha. Kupanga kwamkati kwa insulin kumabwezeretsedwa ndi kuchepa kwa shuga m'miyezo yabwinobwino.

Kukhazikitsidwa koyambirira kwa insulini kuyesa odwala matenda ashuga a 2 ndi njira imodzi yothandizira odwala kuperewera pakudya ndi masewera olimbitsa thupi, podutsa gawo lokonzekera piritsi.

Njirayi ndiyabwino kwa odwala matenda ashuga omwe amakonda insulin, mmalo mwakugwiritsa ntchito mankhwala ochepetsa shuga. Komanso mwa odwala omwe amachepetsa thupi komanso omwe akuwonetsetsa kuti ali ndi matenda a autoimmune a shuga akulu.

Kuchepetsa bwino kwa shuga mu chiwindi mu mtundu 2 wa shuga kumafuna kuponderezedwa kwa njira ziwiri: glycogenolysis ndi gluconeogeneis. Kukhazikitsa insulin kumachepetsa hepatic glycogenolysis ndi gluconeogeneis, komanso kuonjezera mphamvu ya zotumphukira zimakhala kuti insulin. Zotsatira zake, zimakwaniritsidwa "kukonza" zida zonse za matenda a shuga a mtundu 2.

Zotsatira zabwino za insulin mankhwala a shuga

Pali mbali zabwino za kumwa insulin, monga:

• kusala ndi pambuyo chakudya
• kuchuluka kwa mapangidwe a insulin chifukwa cha kukhudzidwa kwa shuga kapena kudya,
• shuga wocheperako,
• kupanga shuga wa chiwindi
• kuyimitsidwa kwa secretion wa glucagon mutatha kudya,
• kusintha kwa mbiri ya lipoproteins ndi lipids,
• kukakamiza kwa lipolysis mutatha kudya,
• kusintha kwa anaerobic ndi aerobic glycolysis,
• kuchepa kwa glycation wa lipoproteins ndi mapuloteni.

Chithandizo cha anthu odwala matenda ashuga chimakhala cholinga chokwaniritsa hemoglobin ya glycosylated, kusala shuga m'magazi ndikatha kudya. Zotsatira za izi ndizochepetsera kuthekera kwa kakulidwe ndi kupitilira kwa zovuta.

Kukhazikitsidwa kwa insulini kuchokera kunja kumakhala ndi phindu pa chakudya, mapuloteni ndi metabolism yamafuta. Hormone iyi imayambitsa kutsimikizika ndikuletsa kupasuka kwa shuga, mafuta ndi amino acid. Imachepetsa kuchuluka kwa shuga mwakuwonjezera mayendedwe ake kupita pakati pa cell kudzera pa khoma la cell la adipocytes ndi myocyte, komanso kuletsa kwa kupanga chiwindi cha glucose (glycogenolysis ndi gluconeogenesis).

Kuphatikiza apo, insulin imayambitsa lipogenesis ndipo imalepheretsa kugwiritsa ntchito mafuta aulere acids mu metabolism ya mphamvu. Imalepheretsa minofu ya proteinol komanso imathandizira kupanga mapuloteni.

Zifukwa zochizira jakisoni wa mahomoni

- cholowa, - msinkhu (munthu wamkuluyo, ndiodwalanso), - kunenepa kwambiri, - kupsinjika, - matenda omwe amawononga ma cell a beta omwe amapanga insulin: khansa ya kapamba, kapamba, etc., - matenda opatsirana: , nthomba, rubella, chimfine, ndi zina zambiri.

Ngati mumaganizira za izi, poyamba sizikudziwika chifukwa chake kubaya jakisoni wa mahomoni m'thupi la odwala matenda ashuga. Kuchuluka kwa mahomoni otere m'thupi la munthu wodwala kumakhala koyenera, ndipo nthawi zambiri kumapitilira.

Koma nkhaniyi ndi yovuta kwambiri - munthu akakhala ndi matenda "okoma", chitetezo cha mthupi chimakhudza maselo a beta mthupi la munthu, kapamba, yemwe amachititsa insulin. Mavuto oterewa samachitika mwa odwala matenda ashuga amtundu wachiwiri, komanso oyamba.

Zotsatira zake, kuchuluka kwa ma cell a beta kumwalira, zomwe zimafooketsa thupi.

Ngati tizingolankhula zazomwe zimayambitsa matenda, kuti nthawi zambiri izi zimachitika chifukwa cha kunenepa kwambiri, munthu akapanda kudya moyenera, sasunthira pang'ono ndipo moyo wake sungamachedwe wathanzi. Amadziwika kuti anthu ambiri okalamba komanso azaka zapakati amadwala kwambiri, koma si onse omwe amakhudzidwa ndi matenda "okoma".

Nanga bwanji munthu nthawi zina amakhudzidwa ndi matenda, ndipo nthawi zina satero? Izi zimachitika makamaka chifukwa cha kudziwikiratu kwamtundu wamtundu, kuukira kwa autoimmune kumatha kukhala kokulirapo kotero kuti jakisoni wa insulin yekha ndi amene angathandize.

Mitundu ya insulin

Pakadali pano, ma insulini amasiyanitsidwa ndi nthawi yowonekera kwawo. Izi zikutanthauza kuti mankhwalawa amatha kutsika magazi. Musanalembe mankhwala, munthu akasankhidwa kuti atenge mlingo wa mankhwalawo.

Chifukwa chakuti matenda ashuga ali ndi mitundu yambiri, zizindikiro, zovuta, komanso, mtundu wa chithandizo, akatswiri adapanga njira yabwino yopangira matendawa. Ganizirani mitundu, mitundu ndi digiri ya matenda ashuga.

I. Mtundu woyamba wa matenda ashuga a shuga (a shuga omwe amadalira insulin, matenda ashuga).

Nthawi zambiri, mtundu uwu wa shuga umawonedwa mwa achinyamata, nthawi zambiri wowonda. Ndi zovuta.

Chomwe chagona mu ma antibodies opangidwa ndi thupi lokha, lomwe limatchinga ma cell a β-cell omwe amapanga insulin mu kapamba. Kuchiza kumakhazikika pakugwiritsanso ntchito insulin, mothandizidwa ndi jakisoni, komanso kutsatira kwambiri zakudya.

Kuchokera pamenyu ndikofunikira kupatula kwathunthu kugwiritsa ntchito chakudya chamafuta (shuga, zakumwa zokhala ndi shuga, maswiti, zipatso zamadzimadzi).

Kuchuluka kwa shuga m'magazi a munthu wathanzi sikukuchepera 3.6 ndipo osapitirira 6.1 mmol pa lita imodzi pogona ndi njala (pamimba yopanda kanthu), komanso osapitirira 7.0 mmol pa lita imodzi mukatha kudya. Mwa amayi apakati, kuchuluka kwambiri kumatha kuwonjezeka ndi 50-100% - izi zimatchedwa matenda apakati a shuga. Pambuyo pa kubadwa, kuchuluka kwa glucose nthawi zambiri kumadzikhudza kwawokha.

Odwala omwe ali ndi mtundu wofatsa wamatenda, kuchuluka kwa glucose panthawi yogona ndi njala nthawi zambiri kumakhala kokwanira kuposa 10 wathanzi kuposa anthu athanzi. Mukatha kudya, chiwerengerochi chimatha kupitilira 20% 50%.

Mtundu wofatsa wa matenda a shuga omwe amadalira insulin sufuna kuti wodwala azilowetsa insulin tsiku lililonse. Ndikokwanira kutsatira chakudya chokhala ndi zopatsa mphamvu zochepa za thupi, kuchita masewera olimbitsa thupi komanso kumwa mapiritsi omwe amalimbikitsa mphamvu yopanga mahomoni ndi maselo a kapamba.

Mu anthu omwe ali ndi matenda a shuga okwanira, kuchuluka kwa shuga m'magazi komanso kugona ndi 30-50% kuposa zomwe zimachitika, ndipo amatha kuwonjezeka ndi 50-100% mukatha kudya. Ndi matenda ashuga oterowo, ndikofunikira kuchita insulin tsiku lililonse ndi ma insulin apafupi komanso apakati.

Odwala omwe ali ndi matenda oopsa, kapena matenda a shuga 1, kuchuluka kwa shuga usiku komanso nthawi ya njala kumatha kuwonjezeka ndi 50-100%, ndipo mukatha kudya - kangapo. Odwala otere amafunika kubaya insulin musanadye chilichonse, komanso asanagone komanso masana.

Kukonzekera kwa mankhwala a insulin kumasiyana mosiyanasiyana komanso nthawi yayitali.

Insulin imagawidwa m'mitundu inayi:

1. Bulgaria.
2. Nkhumba.
3. Nkhumba yosinthidwa ("munthu").
4. Wamunthu, wopangidwa ndi genetic engineering.

Woyambayo, m'zaka za 20 za zana lomaliza, adagulidwa timadzi totsitsa ta shuga kuchokera kuzimbudzi za ng'ombe. Hormone ya Bovine imasiyana ndi mahomoni amunthu mu ma amino acid atatu, chifukwa chake, ikagwiritsidwa ntchito, nthawi zambiri imayambitsa zovuta zosiyanasiyana. Pakadali pano, zaletsedwa m'maiko ambiri padziko lapansi.

Mkati mwa zaka zapitazi, timadzi totulutsa shuga tinatulutsidwa mkati mwa nkhumba.Mahoroni a Porcine anali osiyana ndi munthu m'modzi amino acid, chifukwa chake sichinali kuyambitsa ziwopsezo, koma ndikugwiritsa ntchito nthawi yayitali, zimakulitsa chitetezo cha insulin.

Mu 80s ya zaka za zana la 20, asayansi adaphunzira momwe angasinthire mtundu wina wa amino acid mu hormone ya nkhumba ndi amino acid wofanana wopezeka mu mahomoni amunthu. Chifukwa chake mankhwalawa a insulin "yaumunthu" adabadwa.

Sizomwe zimayambitsa zotsatira zosafunikira ndipo ndizochulukirapo.

Ndi kupanga mainjiniya, mahomoni ochepetsa mphamvu ya anthu aphunzitsidwa kukula mkati mwa mabakiteriya osinthika ma genetic. Hormone iyi imakhala ndi mphamvu kwambiri ndipo ilibe zotsatira zoyipa.

Malinga ndi nthawi ya kuchitapo kanthu, ma insulins amagawidwa m'mitundu inayi:

1. Mwachidule.
2. Ultrashort.
3. Yapakatikati.
4. Kuchita kwanthawi yayitali.

Mankhwala ochita kupanga mwachidule amakhala ndi mphamvu yochepetsa shuga kwa maola 6-9. Kutalika kwa nthawi ya ultrashort insulin ndi 2 nthawi zochepa. Mitundu yonse iwiri ya mankhwalawa imagwiritsidwa ntchito kutsitsa shuga wamagazi mukatha kudya. Nthawi yomweyo, muyenera kubaya mankhwala achidule theka la ola musanadye, komanso ultrashort - mu mphindi 10.

Mankhwala a pafupifupi nthawi ya kuchitira kukhalabe achire zotsatira 11-16 maola. Ayenera kuperekedwa kwa maola 8-12 aliwonse, pafupifupi ola limodzi asanadye.

Mankhwala okhala ndi nthawi yayitali amatha kuchepetsa shuga pasanathe maola 12-24. Amapangidwa kuti azilamulira msana wa usiku ndi m'mawa shuga.

M'zaka zaposachedwa, lingaliro la matenda ashuga ndi matenda amodzi payekha, momwe njira zochiritsira komanso zolipirira ziyenera kuganizira zaka za wodwalayo, chakudya chake ndi ntchito, matenda okhudzana, ndi zina zambiri. Ndipo popeza kulibe anthu ofanana, sipangakhale malingaliro ofananiratu othandizira odwala matenda ashuga.

Wofunsidwa wa Sayansi Yamankhwala

endocrinologist wapamwamba kwambiri

Anthu omwe ali ndi matenda amtunduwu ali ndi chidwi chofuna kudziwa kuchuluka kwa insulini ya magazi.

Monga lamulo, pankhaniyi, ndikofunikira kuti pakhale mphamvu ya kapamba kuti apange insulin yaumunthu. Ngati wodwala salandira chithandizo choyenera, ndiye kuti akhoza kungofa.

Matenda a shuga a mtundu wodziwika bwino ndiwovuta kwambiri kuposa matenda amtundu wachiwiri. Ngati lipezeka, kuchuluka kwa insulini yomwe imapangidwa sikungathandize kapena kulibe.

Ndiye chifukwa chake thupi la wodwala silitha kuthana ndi kuchuluka kwa shuga palokha. Ngozi yofananira imayimiriridwa ndi gawo lotsika la chinthu - izi zimatha kubweretsa kukomoka mosayembekezereka ngakhale kufa.

Ndikofunikira kwambiri kutsatira malingaliro a akatswiri ndikuwongolera chithandizo pogwiritsa ntchito insulin.

Musaiwale za kuwunikira pafupipafupi za shuga komanso kupima mayeso.

Popeza munthu yemwe ali ndi mtundu woyamba wa matendawa sangakhale ndi moyo popanda kukhala ndi insulin, ndikofunikira kuti atenge vutoli mozama.

Ngati wodwala alibe zovuta za kunenepa kwambiri ndipo samakhala ndi nkhawa kwambiri, insulin imayikidwa mu ½ - 1 unit 1 nthawi patsiku malinga ndi 1 kg ya thupi. Nthawi yomweyo, insulin yokwanira imakhala ngati chida chobisika cha mahomoni.

Malamulo a insulin chithandizo amafunika kukwaniritsidwa kwa zinthu izi:

• mankhwalawa amayenera kulowa m'thupi la wodwalayo wokwanira kugwiritsa ntchito shuga,
• ma insulin omwe amalumikizidwa kunja ayenera kukhala kutsanzira kwathunthu kwa secretion, ndiye kuti, zomwe zikondazo zimatulutsa (kuphatikiza malo omwe atulutsira chakudya kwambiri).

Zofunikira zomwe zatchulidwa pamwambapa zimafotokozera mtundu wa insulin mankhwala, momwe mulingo wa tsiku ndi tsiku umagawikidwira nthawi yayitali kapena yopanga ma insulin.

Ma insulin aatali nthawi zambiri amathandizidwa m'mawa ndi madzulo ndipo amayeserera mwamphamvu zochita zogwiritsira ntchito kapamba.

Kumwa insulini yochepa ndikofunikira mukatha kudya zakudya zopatsa mphamvu. Mlingo wa insulin yamtunduwu umatsimikiziridwa payekhapayekha ndipo umatsimikiziridwa ndi kuchuluka kwa ma XE (magawo a mkate) pachakudya chopatsidwa.

Pofika nthawi ya zochita, ma insulini onse amatha kugawidwa m'magulu otsatirawa:

• kopitilira muyeso kochepa
• zochita zazifupi
• zochita zapakati
• kuchitapo kanthu kwanthawi yayitali.

Ultrashort insulin imayamba kuchita mphindi 10-15 pambuyo pa kubayidwa. Zotsatira zake m'thupi zimatha kwa maola 4-5.

Mankhwala ochita kupanga mwachidule amayamba kuchita pafupifupi theka la ola pambuyo pobayira. Kutalika kwa kukopa kwawo ndi maola 5-6. Ultrashort insulin imatha kutumikiridwa nthawi isanayambe kapena itangotha ​​chakudya. Insulin yochepa imalimbikitsidwa kuti iperekedwe pokhapokha chakudya, chifukwa samayamba kuchita mwachangu kwambiri.

Insulin yochita pakati, pakudya, imayamba kuchepetsa shuga pokhapokha maola awiri, ndipo nthawi yodziwika bwino imafika maola 16.

Mankhwala osakhalitsa (owonjezeredwa) amayamba kukhudza kagayidwe kazakudya pambuyo pa maola 10-12 ndipo samachotsedwa m'thupi kwa maola 24 kapena kupitilira.

Mankhwala onsewa ali ndi ntchito zosiyanasiyana. Ena mwa iwo amaperekedwa nthawi yomweyo musanadye chakudya kuti muchepetse postprandial hyperglycemia (kuchuluka kwa shuga mutatha kudya).

Insulin zapakatikati ndi zazitali zimaperekedwa kuti zitha kukhalabe ndi shuga masana mosalekeza tsiku lonse. Mlingo ndi makonzedwe amasankhidwa payekhapayekha kwa munthu aliyense wodwala matenda ashuga, kutengera zaka zake, kulemera kwake, machitidwe a matenda ashuga komanso kupezeka kwa matenda amodzimodzi.

Pali pulogalamu ya boma yotumiza insulin kwa odwala omwe ali ndi matenda ashuga, omwe amapereka kwaulere mankhwalawa kwa onse omwe akufunika.

Pali mitundu yambiri ndi mayina a insulin a shuga mumsika wazamankhwala masiku ano, ndipo pakapita nthawi padzakhala zochulukirapo. Insulin imagawidwa malinga ndi njira yayikulu - imakhala yochepa motani pakatha shuga pambuyo magazi Mitundu ya insulin iyi ilipo:

• ultrashort - amachita zinthu mwachangu kwambiri,
• zazifupi ndizochepa komanso zofewa kuposa zazifupi,
• nthawi yayitali yochitira ("sing'anga"),
• kuleza mtima (kutalikitsa).

Mu 1978, asayansi anali oyamba kugwiritsa ntchito njira zopangira majini kuti “akakamize” Escherichia coli Escherichia coli kupanga insulin ya munthu. Mu 1982, kampani yaku America ya Genentech idayamba kugulitsa zinthu zambiri.

Izi zisanachitike, inshuwaransi ya bovine ndi nkhumba imagwiritsidwa ntchito. Amasiyana ndi anthu, chifukwa chake nthawi zambiri amayambitsa zotsutsana.

Mpaka pano, insulin ya nyama sigwiritsidwanso ntchito. Matenda a shuga amathandizidwa kwambiri ndi jakisoni wa insulin yaumunthu.

Chizindikiro cha kukonzekera kwa insulin

Kuyambira 2000s, mitundu yatsopano yowonjezera ya insulin (Lantus ndi Glargin) idayamba kusanduliza nthawi yayitali NPH-insulin (protafan). Mitundu yatsopano yowonjezera ya insulini sikuti imangokhala insulin ya anthu, koma mawonekedwe awo, omwe amasinthidwa, amawongolera, poyerekeza ndi insulin yeniyeni ya anthu. Lantus ndi Glargin amakhala nthawi yayitali komanso bwino, ndipo sakonda kuyambitsa chifuwa.

Zotheka kuti kusintha NPH-insulin ndi Lantus kapena Levemir monga insulini yanu yowonjezera (basal) kudzakuthandizani pazotsatira zanu zamatenda a shuga. Kambiranani izi ndi dokotala. Werengani zambiri mu nkhani ya "Insulin Lantus ndi Glargin yowonjezera. Medi-NPH-Insulin Protafan. "

Chakumapeto kwa ma 1990, ma ultrashort analogi a insulin Humalog, NovoRapid ndi Apidra adawonekera. Anapikisana ndi insulin yaifupi yaumunthu.

Ultra-yochepa-insulin analogue amayamba kutsika magazi mkati mwa mphindi 5 atabayidwa. Amachita zinthu mwamphamvu, koma osakhalitsa, osaposa maola atatu.

Tiyeni tiyerekeze zolemba za analogue yaifupi-yochepa-yochepa ndi insulin yofupika ya anthu pachithunzichi.

Werengani nkhani iyi "Ultrashort insulin Humalog, NovoRapid ndi Apidra. Insulin yochepa yaumunthu. "

Yang'anani! Ngati muli ndi chakudya chochepa kwambiri cha matenda a shuga a mtundu woyamba kapena a 2, ndiye kuti insulini yocheperako yamunthu ndiyabwino kuposa ma insulin anthawi yochepa.

Zomwe zimachitika komanso chifukwa cha matenda ashuga

Choyamba, muyenera kulabadira shuga yamagazi yambiri. Kale chizindikiritso choposa 6 mmol / l m'magazi chikusonyeza kuti ndikofunikira kusintha zakudya.

Mofananamo, ngati chizindikirocho chikufika ndi zisanu ndi zinayi, ndikofunikira kuyang'anira kuwonongeka. Mlingo wofanana ndi shuga umatsala pang'ono kupha maselo a pancreatic beta a mtundu 2 shuga.

Mkhalidwe uwu wa thupi umakhalanso ndi mawu akuti shuga. Ndikofunikira kudziwa kuti ichi sichiri chizindikirocho pakuwongolera mwachangu kwa insulin, nthawi zambiri, madokotala amayesera njira zingapo zoyesera.

Nthawi zambiri, zakudya komanso mankhwala amakono ambiri zimathandiza kuthana ndi vutoli. Kutalika kwa insulini kumachedwa zimadalira pokhapokha pakutsatira malamulowo ndi wodwalayo komanso nzeru za dokotala aliyense.

Nthawi zina ndikofunikira kuti mupereke mankhwala kwakanthawi kuti mubwezeretse kupanga kwa insulini, nthawi zina ndizofunikira moyo.

Zolemba za insulin yothandizira ana ndi amayi apakati

Amayi oyembekezera, amayi oyamwitsa, ndi ana osakwana zaka 12 omwe amapezeka ndi mtundu wachiwiri wa matenda osokoneza bongo amawapeza ndi mankhwalawa chifukwa amalephera.

Ana ali ndi jekeseni wa insulin, poganizira izi:

• kuchepetsa kuchuluka kwa jakisoni tsiku ndi tsiku, kuphatikiza jekeseni, komwe kuchuluka kwa mankhwalawa kwa nthawi yayitali komanso yapakati kumasankhidwa payekha,
• Mankhwala othandizira amalimbikitsidwa kuti atchulidwa atakwanitsa zaka khumi ndi ziwiri,
• Pakusintha kwachilengedwe mosiyanasiyana, anaphunzitsa kusintha kosiyanasiyana pakati pa jakisoni wam'mbuyo ndi wotsatira kuti agone mu 1.0 ... 2.0 IU.

Pochita maphunziro a insulin azimayi apakati, ndikofunikira kutsatira malamulo awa:

• jakisoni wa mankhwala m'mawa, m'mawa musanadye chakudya cham'magazi, shuga ayenera kukhala m'mitundu 3.3-5.6 mmol / lita,
• mutatha kudya, kuphatikizika kwa glucose m'magazi kuyenera kukhala kosiyanasiyana mamilimita 5.6-7.2 mamililita / lita,
• kupewa matenda am'mawa ndi masana hyperglycemia mu mtundu woyamba wa I ndi mtundu wa II, pamafunika jekeseni awiri,
• musanadye chakudya choyambirira komanso chotsiriza, jakisoni amachitidwa pogwiritsa ntchito ma insulin achidule komanso apakati,
• kupatula usiku ndi "kudziwiratu" hyperglycemia, imalola jakisoni wa mankhwala a hypoglycemic musanadye chakudya, jekeseni musanalowe.

Zizindikiro Za Matenda A shuga

Musanadziwe kuti insulini ikufunika bwanji kwa mtundu wachiwiri, tidzapeza zomwe zimawonetsa kukula kwa matenda "okoma". Kutengera mitundu yamatenda ndi mawonekedwe a wodwalayo, mawonetseredwe azachipatala amasiyanitsidwa pang'ono.

Muzochita zachipatala, Zizindikiro zimagawika m'mizere yayikulu, komanso zachiwiri. Ngati wodwala ali ndi matenda ashuga, Zizindikiro zake ndi polyuria, polydipsia, ndi polygraphy. Izi ndi zinthu zitatu zazikuluzikulu.

Kukula kwa chithunzi cha chipatala kumadalira momwe thupi limvera kuti chiwonjezere shuga, komanso pamlingo wake. Amadziwika kuti nthawi yomweyo, odwala amawona zizindikiro zosiyanasiyana.

Onani zambiri mwatsatanetsatane:

1. Polyuria imadziwika ndi kukodza pafupipafupi komanso kopanda mphamvu, kuwonjezeka kwamphamvu kwamkodzo patsiku. Mwachizolowezi, sipayenera kukhala shuga mu mkodzo, komabe, ndi T2DM, glucose amadziwika chifukwa cha mayeso a labotale. Anthu odwala matenda ashuga nthawi zambiri amagwiritsa ntchito chimbudzi usiku, pamene shuga wambiri amachoka m'thupi kudzera mkodzo, zomwe zimapangitsa kuti madzi atheretu.
2. Chizindikiro choyamba chikugwirizana kwambiri ndi chachiwiri - polydipsia, chomwe chimadziwika ndi chikhumbo chofuna kumwa nthawi zonse. Kuthetsa ludzu lanu ndizovuta mokwanira, mutha kunena zambiri, mwina zosatheka.
3. Kusindikizanso ndi "ludzu", koma osati zakumwa, koma chakudya - wodwalayo amadya kwambiri, ndipo nthawi yomweyo sangathetse njala yake.

Ndi mtundu woyamba wa matenda osokoneza bongo a shuga motsutsana ndi kuwonjezeka kwa kudya, kuchepa kwambiri kwa thupi kumawonedwa. Ngati nthawi singayang'ane izi, chithunzicho chimatsogolera kumadzi.

Zizindikiro zochepa za endocrine pathology:

• Kusenda kwa pakhungu, mucous nembanemba.
• Kufooka kwa minofu, kutopa kwambiri, kuchita zolimbitsa thupi pang'ono kumayambitsa kutopa kwambiri.
• Kumauma pakamwa komwe madzi amadzimadzi sangathe.
• Pafupipafupi migraine.
• Mavuto ndi khungu, omwe ndiovuta kuthana ndi mankhwala.
• Kuchuluka kwa manja ndi miyendo, kusawona bwino kwamaso, kuzizira pafupipafupi ndi matenda opumira, matenda oyamba ndi fungus.

Pamodzi ndi zazikulu komanso zachiwiri zizindikiro, matendawa amadziwika ndi enieni - kuchepa kwa chitetezo cha m'thupi, kuchepa kwa malo owawa, mavuto omwe ali ndi kuthekera kwa erectile mwa amuna.

Matenda a shuga a mtundu wanga akayamba kumene kukula mu thupi la mwana kapena mwana, ndi zovuta kudziwa nthawi yomweyo.

Matenda a shuga amapezeka pang'onopang'ono, ndipo sizikupangitsa kuti matendawa azikula msanga, komanso kuwonjezeka kwa glucose mpaka malo ovuta kwambiri ndi matenda osiyanasiyana a matenda ashuga.

Zizindikiro zoyambirira za shuga

- kumva kumatha ludzu, - mkamwa wowuma mosalekeza, - kutulutsa mkodzo (kuchuluka diuresis), - kuchuluka kuwuma ndi kuyabwa kwambiri pakhungu, - - kudziwikiratu kwa matenda apakhungu, mafinya, - kuchiritsa kwa nthawi yayitali, - - thukuta kwambiri, kufooka kwa minofu.

Zizindikiro za matenda ashuga

- kupweteka kwapafupipafupi, kukomoka, kusazindikira, - kupweteka m'maso, - kupsinjika kwa miyendo, kupweteka m'miyendo, - kuchepa kumverera kwa khungu, makamaka pamapazi, - kutupa kwa nkhope ndi miyendo, - chiwindi chokwanira, - , - kuthamanga kwa magazi, - wodwalayo amayamba kutulutsa fungo la acetone.

Palibe jakisoni chithandizo

Anthu ambiri odwala matenda ashuga satembenuka jakisoni chifukwa ndiye kuti simungathe kuwachotsa.Koma chithandizo chotere sichothandiza nthawi zonse ndipo chimayambitsa zovuta zazikulu.

Zilonda zimakupatsani mwayi wokwanira wa mahomoni pamene mapiritsi sangathenso kupirira. Ndi matenda a shuga a 2, pali kuthekera kwakuti kusinthira mapiritsi ndikotheka.

Izi zimachitika ngati ma jakisoni amaperekedwa kwa nthawi yochepa, mwachitsanzo, pokonzekera opareshoni, mukamanyamula mwana kapena mkaka wa m'mawere.

Jakisoni wa mahomoni amatha kuchotsa katundu kuchokera kwa iwo ndipo ma cell ali ndi mwayi wopuma. Nthawi yomweyo, kudya komanso kukhala ndi moyo wathanzi kumangoyambitsa izi. Kuwayikira kwa njirayi kumakhalapo pokhapokha ngati mukutsatira kwathunthu zakudya zomwe dokotala akutsimikiza. Zambiri zimatengera mawonekedwe a thupi.

Mfundo zachithandizo cha insulin ndizosavuta. Munthu wathanzi akamatha kudya, kapamba wake amatulutsa muyezo woyenera wa insulin m'magazi, glucose amalowetsedwa ndi maselo, ndipo mulingo wake umachepa.

Mwa anthu omwe ali ndi mtundu woyamba wa 2 ndi mtundu wa matenda a shuga, pazifukwa zosiyanasiyana, njirayi imalephera, motero iyenera kutsanziridwa pamanja. Kuti muwerengere moyenera kuchuluka kwa insulini, muyenera kudziwa kuchuluka ndi zinthu zomwe thupi limalandira zimagwirira ntchito komanso kuchuluka kwa insulini pakufunika kwawo.

Kuchuluka kwa chakudya m'thupi sizimakhudzanso zopatsa mphamvu, chifukwa chake zimakhala zomveka kuwerengera zopatsa mphamvu ngati mtundu wa I ndi mtundu wa matenda a shuga II umayendera limodzi ndi kunenepa kwambiri.

Ndi mtundu I shuga mellitus, chakudya sichofunikira nthawi zonse, chomwe sichinganene za mtundu wachiwiri wa matenda a shuga. Ichi ndichifukwa chake wodwala aliyense wamatenda a shuga amayenera kudziwa shuga wawo wamagazi molondola komanso amawerengera moyenera ma insulin.

Musanayambe chithandizo, ndikofunikira kufufuza bwino za thupi, chifukwa chiyembekezo chabwino cha kuchira chimatengera izi.

- kutsitsa shuga wamagazi, - kusintha kagayidwe, - kuletsa kukula kwa zovuta za matenda ashuga.

Kupitilira apo, chithandizo chimasiyana malinga ndi mtundu wa matenda ashuga. Tiyeni tizilingalire mosiyana.

Chithandizo cha matenda a shuga 1

Monga tanena kale pakati pa nkhaniyi, mu gawo "Kugawidwa kwa matenda osokoneza bongo", odwala matenda a shuga 1 amafunikanso jakisoni wa insulin, popeza thupi silingathe kupanga mahomoni ambiri mokwanira. Njira zina zoperekera insulin ku thupi, kupatula jakisoni, pakadali pano palibe. Mapiritsi a insulin okhala ndi matenda a shuga 1 sangathandize.

- Zakudya, - kukhazikitsa zochotsa munthu kuchita zolimbitsa thupi (DIF).

Kudziyang'anira nokha kwa chithandizo cha insulin

Ngati muli ndi matenda ashuga osafunikira kotero kuti muyenera kupanga jakisoni wa insulin musanadye, ndikofunika kuti mupitilize kudzipenda nokha magazi. Ngati mukufuna jakisoni wa insulin yotalikilapo usiku ndi / kapena m'mawa, osaba jekeseni mwachangu musanadye, kuti mupeze chipukuta cha matenda a shuga, ndiye kuti muyenera kuyeza shuga m'mawa pamimba yopanda kanthu komanso madzulo musanagone.

Komabe, gwiritsani ntchito magazi tsiku lonse 1 pa sabata, makamaka masiku awiri sabata iliyonse. Ngati zikuwoneka kuti shuga yanu imakhala osachepera 0,6 mmol / L pamwambapa kapena pansi pazomwe mukufuna, ndiye muyenera kufunsa dokotala ndikusintha china chake.

Nkhaniyi imapereka chidziwitso chofunikira chomwe odwala onse omwe ali ndi matenda amtundu wa 1 kapena mtundu wa 2 omwe amalandira jakisoni wa insulin ayenera kudziwa. Chachikulu ndikuti mwaphunzira mitundu ya insulini yomwe ilipo, zomwe ali nazo, komanso malamulo osungira insulin kuti isawonongeke.

Ndikulimbikitsani kuti muwerenge mosamala zolemba zonse za "Insulin pochiza matenda amtundu wa 2 komanso mtundu wa 2 matenda ashuga 'ngati mukufuna kubwezera bwino matenda anu a shuga. Ndipo, inde, tsatirani mosamala zakudya zamafuta ochepa.

Dziwani tanthauzo la njira yowonjezera kuwala.Gwiritsani ntchito mankhwalawa kuti musungitse shuga yokhazikika yokhazikika komanso kuti mukhale ndi insulin yaying'ono.

Pharmacology ya mankhwala

Humulin insulin ndi wothandizira wa hypoglycemic. Zimatanthauzanso ndi insulin. "Humulin NPH" ndimunthu mapuloteni amtundu wa pancreatic wa mtundu wa DNA recombinant. Cholinga chake chachikulu ndi kuteteza kagayidwe kachakudya ka glucose. Insulin ilinso ndi anti-catabolic ndi anabolic zotsatira, zimakhudza minofu yosiyanasiyana ya thupi. Nthawi yomweyo, kuchuluka kwa glycogen, glycerin ndi mafuta achilengedwe m'misempha kumawonjezeka. Pali kuwonjezeka kwa kudya kwa amino acid. Ketogenesis, glycogenolysis, lipolysis, mapuloteni catabolism, gluconeogeneis amachepetsedwa. Amino acid amamasulidwa.

Humulin NPH ndi mankhwala osokoneza bongo. Imayamba kugwira ntchito ola limodzi pambuyo pokhazikitsa. Kuchuluka kwake kumachitika m'chigawo cha 2-8 mawola ake atalowa. Kutalika kwa mankhwalawa ndi maola 18-20. Zotsatira za insulin zimayendetsedwa ndi mlingo, jakisoni malo, zochitika zolimbitsa thupi za wodwalayo.

Mankhwalawa sagawidwe pogawana minyewa yonse ya ziwalo. Sichidutsa chotchinga ndipo sichidutsa mkaka wa m'mawere. Imagwa mchikakamizo cha insulinase. Amapangidwira impso ndi chiwindi. Amachotseredwa ndi impso.

Zizindikiro zogwiritsidwa ntchito

Chizindikiro choikidwa "Humulin" ndi matenda ashuga komanso mkhalidwe wa thupi, momwe mumakhala mukusowa insulin yopangidwa ndi anthu. Pankhaniyi, chithandizo cha insulin ndi chofunikira. Mankhwala enanso omwe amagwiritsidwa ntchito ngati ali ndi pakati mwa amayi omwe ali ndi matenda a shuga.

Contraindication

Insulin "Humulin" sangathe kulembedwa ngati pali Hypersensitivity pazomwe zimapanga mankhwala. Mankhwalawa amatsutsana mu hypoglycemia.

Ngati Humulin imagwiritsidwa ntchito panthawi yapakati, ndiye kuti odwala otere ayenera kuyang'aniridwa mosamala. Kufunika kwa insulin kumachepa mu trimester yoyamba ndikuwonjezeka kwa II ndi III. Pakupereka komanso pambuyo pobadwa kwa ana, kudalira insulin kumachepetsa kwambiri. Amayi omwe akudwala matenda ashuga ayenera kudziwitsa adotolo za kuyambika kapena kwamtsogolo mtsogolo. Pa yoyamwitsa, kukonza insulin kungafunike.

"Humulin NPH": malangizo ogwiritsira ntchito

Mlingo wa mankhwalawa umakhazikitsidwa ndi adokotala kwa wodwala aliyense payekhapayekha. Zimatengera mulingo wa glycemic. Mankhwala a shuga amaperekedwa pang'onopang'ono. Kubaya kwa mnofu kumaloledwa. Mothandizidwa movomerezeka ndi "Humulin NPH" ndiwotsutsana kwambiri.

Mankhwala omwe atumizidwa ayenera kukhala ndi kutentha kwa chipinda. Jakisoni pansi pa khungu amalowetsedwa m'dera la phewa, pamimba, matako ndi ntchafu. Masamba obayira sangasinthe. Ndi subcutaneous makonzedwe, chisamaliro chikuyenera kuthandizidwa ndikuwonetsetsa kuti jakisoni sanapangidwe mumtsempha wamagazi. Pambuyo pokonzekera insulin, tsamba la jakisoni siliyenera kutenthedwa.

Odwala onse ayenera kuphunzitsidwa bwino kugwiritsa ntchito chipangizocho popereka mankhwala a insulin. Malamulo othandizira mankhwalawa aliyense amasankha yekha.

Ngati mankhwalawa amagwiritsidwa ntchito ngati ma cartridge, ndiye kuti musanagwiritse ntchito, ma cartridge a Humulin amafunika kuti azikulungika pang'ono pakati pa manja, pafupifupi khumi. Zomwezo zimayenera kusinthidwa ndi 180 ° mpaka mpweya utakhala utasungunuka kwathunthu ku insulin. Pambuyo pamanyengowa, yankho limayenera kukhala ndi yunifolomu ya turbid.

Katiriji sikufunika kugwedezeka kwambiri, izi zimapangitsa kuti zikhale zowawa, zomwe zingasokoneze mlingo woyenera wokhazikitsidwa.

Mkati mwa cartridge muli mpira wamgalasi yaying'ono. Zimathandizira kusakanikirana kwabwino kwa insulin. Osagwiritsa ntchito insulin ngati mapokoso akuwonekera chifukwa chosakaniza yankho.

Makatoni amapangidwa mwanjira yoti sangathe kusakaniza mitundu ingapo ya insulini.Sangapangidwe kuti akhale osinthika kapena kudzazidwa.

Momwe mungagwiritsire ntchito mankhwalawa kuchokera ku 10 ml vial, osatsekedwa makatiriji ndi ma syringe pensulo? Ndi mtundu wa insulin, zomwe zimapangidwira pamimba zimasonkhanitsidwa mu syringe ya insulin. Mlingowo umaperekedwa ndi dokotala aliyense payekha. Mukangogwiritsa ntchito syringe, singano imawonongeka.

Singano imachotsedwa atangolowa jakisoni, zimatsimikizira kusabereka ndikulepheretsa kutayikira kwa mankhwalawa, kumalepheretsa mpweya kuti usalowe ndipo singano idatsekeka. Singano sagwiridwanso ntchito ndi anthu ena. Mbale zimagwiritsidwa ntchito mpaka zopanda kanthu. Kwa makonzedwe, cholembera cha insulin chitha kugwiritsidwanso ntchito.

"Humulin NPH" imatha kuperekedwa limodzi ndi "Humulin Regular". Kuti apange jakisoni, insulin yofupikitsa ("Humulin Regular") imayamba kukokedwa mu syringe, kenako ndikupanga mankhwala osokoneza bongo. Izi zosakanikirana zimakonzedwa nthawi yomweyo isanachitike. Ngati insulin yolondola ya gulu lililonse ikufunika, ndiye kuti syringe yosankhidwa imasankhidwa kwa Humulin NPH ndi Humulin Regular.

Zotsatira zoyipa

Mukamagwiritsa ntchito "Himulin" (cholembera chimathandizira kuperekera mankhwalawo ndipo ndioyenera kwa iwo omwe amawopa singano), zotsatira zoyipa zimatha kuchitika. Makamaka, odwala amakhala ndi nkhawa za hypoglycemia. Zitha kuthandizira osati thanzi labwino, komanso kutha kwa kuzindikira ngakhale kufa.

Mukamagwiritsa ntchito mankhwalawa, zotsatira zoyipa za m'deralo zimatha kuonedwa. Amapezeka mu khungu, khungu limatupa komanso kuyabwa. Zotsatira zoyipa zimadutsa patangopita masiku ochepa. Kusintha kwa thupi koteroko sikugwirizana konse ndi kuyambitsa insulin. Izi zitha kukhala zotsatira za jakisoni wolakwika.

Mawonekedwe a thupi lawo siligwirizana ndimayendedwe a insulin. Iwo, mosiyana ndi zomwe zimachitika mdera lanu, ndizovuta kwambiri. Kuchekacheka uku, kupuma movutikira, kugunda kwa mtima, kuvuta kupumira, thukuta kwambiri. Kuchita kwa thupi koteroko kukuopseza moyo ndipo kumafunikira chithandizo chamanthawi.

Pogwiritsa ntchito insulin nthawi yayitali, lipodystrophy imatha kupezeka pamalo a jekeseni.

Bongo

Mankhwala osokoneza bongo a insulin Human amatha kuyambitsa hypoglycemia, yomwe imayendera limodzi ndi zizindikiro monga ulesi, tachycardia, thukuta, mutu, kusanza Reflex. Ndi insulin yochulukirapo, kunjenjemera kumachitika mthupi, khungu limasunthika komanso kusokonezeka kwa malingaliro.

Ndi chithandizo cha nthawi yayitali ndi insulin yaumunthu, zizindikiro za hypoglycemia zimatha kusintha.

Hypoglycemia yofatsa imayimitsidwa pakumeza shuga pang'ono kapena shuga. Nthawi zina, kukonza insulin mlingo, zolimbitsa thupi ndi zakudya zofunika. Kugwiritsa ntchito jakisoni wa subcutaneous komanso mu mnofu wa glucagon, kusintha kwa mankhwalawa kumachitika kwa magawo olimbitsa komanso oopsa a hypoglycemia, kenaka kudya nyama.

Ndi kuchuluka kwa hypoglycemia, chikomokere chimachitika, kukokana kwa malekezero, matenda amitsempha. Mwanjira imeneyi, shuga amagwiritsidwa ntchito kapena njira ya glucose imathandizira kudzera m'mitsempha. Wodwala akangodwalanso, amafunika kudya chakudya chamagulu ambiri. Izi zikuthandizani kupewa vuto lobwerezabwereza la hypoglycemic.

Zochita Zamankhwala

Mlingo wa insulin ukhoza kuchulukitsidwa mukamapereka mankhwala omwe angakulitse kuchuluka kwa shuga m'magazi. Choyamba, ndi:

• njira zakulera zothandizira pakamwa,
• glucocorticosteroids,
• beta-adrenergic agonists, omwe terbutaline, ritodrine ndi salbutamol ndiwodziwika kwambiri,
• danazol
• thiazide okodzeya,
• mahomoni a chithokomiro,
• diazoxide
• chlorprotixen,
• lithiamu carbonate
• diazoxide
• nicotinic acid
• isoniazid
• zotumphukira za phenothiazine.

Kuchepetsa mlingo wa kukonzekera kwa insulini kungafunike mukamagwiritsa ntchito mankhwala omwe amachepetsa shuga.Mankhwalawa akuphatikizapo:

• beta blockers,
• mankhwala okhala ndi ethanol,
• anabolic steroids
• manzeru
• fenfluramine,
• ganethidine,
• hypoglycemic mankhwala akumwa pakamwa,
• salicylates, awa akuphatikiza acetylsalicylic acid,
• mankhwala a sulfonamide,
• ma antidepressants omwe ndi monoamine oxidase inhibitors,
• ACE zoletsa monga Captopril ndi enalapril,
• octreotide
• angiotensin II receptor antagonists.

Zizindikiro za hypoglycemia zitha kutsekedwa ndi clonidine, beta-blockers ndi reserpine.

Insulin ya nyama sayenera kusakanikirana ndi insulin yaumunthu, chifukwa mphamvu ya chisakanizo chotere sichinaphunziridwe. Zomwe sizinaphunzire momwe zimakhudzira thupi la osakaniza amtundu wa anthu opanga osiyanasiyana.

Malangizo apadera

Kuchotsa wodwala kuchokera kukonzekera kwa insulini kupita kwina kuyenera kuchitidwa moyang'aniridwa ndi achipatala. Zotheka kuti odwala afunika kusintha kwa mlingo. Kufunika kwa kusintha kwa mankhwalawa kumatha kuchitika pambuyo poyambanso kukonzekera kwa insulin yatsopano, ndipo mutatha kugwiritsa ntchito milungu ingapo.

Zizindikiro za hypoglycemia ndikuyambitsa insulin yaumunthu zimasiyana ndi zomwe zimapezeka mukagwiritsira ntchito insulin yoyambira nyama.

Magazi akayamba kulimba, magazi kapena zizindikiro zilizonse za hypoglycemia zimatha. Odwala ayenera kuchenjezedwa za izi pasadakhale.

Zizindikiro za hypoglycemia pakusintha kwa wodwala nthawi ndi nthawi, zimatha kukhala zochepa ngati wodwalayo wakhala akudwala matenda a shuga kwa nthawi yayitali, akudwala matenda a shuga a neuropathy ndipo akuchitiridwa beta-blocker.

Musaiwale kuti kugwiritsa ntchito Mlingo wopitilira omwe amalimbikitsidwa ndi adokotala komanso kukana chithandizo ndi insulin kungayambitse matenda a hyperglycemia ndi matenda ashuga a ketoacidosis.

Kudalira kwa insulini kumachepa ndikusokoneza chithokomiro cha chithokomiro komanso gren adrenal gland. Zomwe zimawonedwa ndi kuperewera kwaimpso ndi chiwindi. Kufunika kwa insulini kumawonjezeka ndikusintha kwa matenda ena, komanso kupsinjika kwamanjenje, ndikulimbitsa thupi kowonjezereka komanso ndikusintha kwazakudya. Zonsezi pamwambapa zimafunikira kusintha kwa insulin.

Hypoglycemia ikachitika, osati kuchuluka kwa chidwi kumachepa, komanso kuthamanga kwa zochitika zama psychomotor. Chifukwa cha izi, sikofunikira kuyendetsa galimoto mdziko lino ndikugwira ntchito ndi njira zovuta zomwe zimafunikira chidwi chachikulu.

Mtengo wa mankhwala

Matenda a shuga ndi mankhwala ofunika kwambiri. Itha kugulidwa ku pharmacy, koma pokhapokha ngati mwalandira mankhwala. Mtengo wa kuyimitsidwa kwa Humulin insulin ya 100 IU / ml mu 10 ml vial umasiyana kuzungulira ma ruble 600, mtengo wa Humulin 100 IU / ml wa 3 ml wokhala ndi ma cartridge 5 umasinthasintha kuzungulira ma ruble 1,000. Mtengo wa Humulin Regular 100 IU / ml wokhala ndi voliyumu ya 3 ml yokhala ndi ma cartridge 5 ndi ma ruble 1150. Humulin M3 ingagulidwe kwa ma ruble 490. Phukusili limakhala ndi zolembera zisanu.

Malangizo a insulin

Ndizodziwika bwino kuti mwa anthu athanzi, kupanga insulin masana nthawi zambiri kumakhala kochepa - izi zimatchedwa basal, kapena maziko, secretion ya insulin (onani mkuyu. 11).

Chithunzi 12. Kubweretsa insulin molingana ndi chiwembu: jakisoni awiri a insulin yayitali

Poyankha kuwonjezeka kwa shuga m'magazi (ndikusintha kwakukulu kwa shuga) kumachitika pakumeza chakudya chama chakudya), kutulutsidwa kwa insulin m'magazi kumachulukitsa kangapo - izi zimatchedwa secretion wa chakudya cha insulin.

Ngati matenda ashuga amathandizidwa ndi insulin, kumbali imodzi, ndikufuna kuyandikira zomwe zimachitika mwa munthu wathanzi. Komabe, zingakhale zofunika kuperekera insulin pafupipafupi. Chifukwa chake, mitundu ingapo yamankhwala othandizira insulin imagwiritsidwa ntchito pano.Makamaka, zotsatira zabwino zitha kupezeka ndikamayambitsa insulin yowonjezera kamodzi kapena kawiri pa tsiku (onani mkuyu. 12). Nthawi zambiri, zosankha izi zimagwiritsidwa ntchito pakumwa mapiritsi ochepetsa shuga. Zikuwonekeratu kuti pamenepa, kuwonjezeka kwa shuga m'masana ndikuwonjezeka kwambiri kwa insulini sikumakhala koyenera panthawi yotsika komanso kutha kwa zotsatira zake.

Nthawi zambiri, mankhwalawa amapha mankhwalawa mtundu 2 wa shuga. Amatchedwa setso insulin mankhwala.

Pokhudzana ndi magawo omwe ali pamwambawa pazochitika zakukonzekera kwa insulin, regimen iyi imafunikira kuti wodwalayo azikhala ndi zakudya zitatu komanso zitatu zapakatikati, ndipo ndikofunikira kuti kuchuluka kwa chakudya m'zakudya izi ndizofanana tsiku lililonse. Mtundu wosavuta wa regimen iyi ndi kukhazikitsa insulin yosakanikirana kawiri pa tsiku.

Nthawi zina, mungafunike dongosolo lotsogolera insulin, lomwe limafanana kwambiri ndi kupanga kwa insulin ndi kapamba wabwino. Amatchedwa kuti insulin yolimbitsa thupi kapena machitidwe angapo a jakisoni angapo.

Ntchito ya basal secretion ya insulin pamenepa imasewera ndi insulin kukonzekera kwa nthawi yayitali. Ndipo m'malo mwa chakudya chobisira insulini, kukonzekera kwanthaŵi yochepa ka insulin kumagwiritsidwa ntchito, komwe kumapangitsa kuti shuga iwonjezeke.

Njira yodziwika bwino kwambiri yamalamulo iyi ndi iyi:

1. M'mawa (musanadye chakudya cham'mawa) - kukhazikitsidwa kwa insulin yayifupi komanso yayitali.
2. Masana (asanadye chakudya chamadzulo) - insulin yochepa.
3. Madzulo (tisanadye chakudya chamadzulo) - insulin yochepa.
4. Usiku - kukhazikitsidwa kwa insulin yayitali.

Ndikotheka kugwiritsa ntchito jakisoni imodzi ya Lantus-insulin analogue m'malo mwa jakisoni wa insulin yayitali. Ngakhale kuchuluka kwa jakisoni, regimen yolimbitsa inshuwaransi imalola kuti wodwalayo azisinthasintha kwambiri pakudya kwake, ponse pa nthawi ya chakudya komanso kuchuluka kwa chakudya.

Mafuta mankhwalawa insulin

Tsoka ilo, insulini yovulazirayo "sadziwa" kuti mumadya ndi kuchuluka motani. Chifukwa chake, inunso muyenera kuonetsetsa kuti zochita za insulin zikugwirizana ndi zakudya. Chifukwa chake, muyenera kudziwa chakudya chomwe chimadzutsa shuga m'magazi.

Monga mukudziwa kale, zopangidwa muzakudya zimakhala ndi zinthu zitatu: mapuloteni, mafuta ndi chakudya. Onsewa ndi okwanira mafuta opatsa mphamvu, koma si onse omwe amawonjezera shuga m'magazi. Mafuta ndi mapuloteni alibe mphamvu yowonjezera shuga, kotero kuyambira pakuwoneka kwa kayendetsedwe ka insulin, safunikira kukumbukiridwa. Zakudya zomanga thupi zokha ndizomwe zimapatsa mphamvu shuga zowonjezera shuga, motero, ziyenera kukumbukiridwa kuti zizindikiritsa mlingo woyenera wa insulin.

Ndi zakudya ziti zomwe zimakhala ndi chakudya chamagulu? Izi ndizosavuta kukumbukira: zakudya zambiri zam'mera, komanso kuchokera ku nyama - zinthu zamkaka zokha zamkaka (mkaka, kefir, yogati, ndi zina).

Zinthu zomwe zimawonjezera shuga m'magazi ndipo zimafunika kuwerengera zitha kugawidwa m'magulu asanu:

1. Maphala (chimanga) - buledi ndi zinthu zophikira, pasitala, mbewu monga chimanga.
2. Zipatso.
3. Mbatata.
4. Mkaka ndi mkaka zamadzi.
5. Zinthu zokhala ndi shuga osachedwa, zomwe zimatchedwa kuti mosavuta kugaya chakudya.

Kuti mudye mitundu yosiyanasiyana, muyenera kuphunzira momwe mungasinthire zakudya zina zomanga thupi ndi ena, koma kuti magazi a magazi asasinthe kwambiri. M'malo mwake ndikosavuta kuchita ndi dongosololi. magawo a mkate (XE). XE imodzi ndi yofanana ndi kuchuluka kwa chinthu chomwe chimakhala ndi magalamu 10-12 a chakudya, mwachitsanzo, chidutswa chimodzi cha mkate wolemera 20-25 g Ngakhale gawo ili limatchedwa "mkate", mutha kufotokozera mwa iwo osati kuchuluka kwa mkate, komanso zinthu zina zilizonse zamagulu omwera.

Mwachitsanzo, 1 XE ili ndi lalanje lalitali kwambiri, kapena kapu imodzi ya mkaka, kapena supuni ziwiri zokhala ndi phala.Kusavuta kwadongosolo la chakudya chamtunduwu ndikuti wodwala safunika kuyesa zinthuzo pamakala, koma m'malo mwake kuti muwone kuchuluka motere - pogwiritsa ntchito mavidiyo omwe ali oyenera kuzindikira (chidutswa, galasi, chidutswa, supuni, ndi zina).

Monga tafotokozera pamwambapa, mankhwala a insulin achikhalidwe (jakisoni awiri a insulin patsiku) adzafunika tsiku lomwelo la chakudya. Mukamagwiritsa ntchito mankhwala othandizira / a insulin, mutha kudya momasuka, kusintha nthawi yodyera komanso kuchuluka kwa mikate.

Malangizo posintha insulin

Ndikofunika kuti wodwala pa insulin aphunzire momwe angasinthire mosinthika mlingo wa insulin momwe angafunikire. Koma izi zitha kuchitika pokhapokha mukamadziyang'anira nokha shuga. Njira yokhayo yolondola Mlingo wa insulini ndizizindikiro za shuga zamwazi, zoyesedwa masana ndi wodwalayo! Chifukwa chake, chizindikiritso cha mlingo woyenera wa insulin nthawi yayitali madzulo chizikhala chizolowezi chothamanga magazi komanso kusowa kwa hypoglycemia usiku. Pankhaniyi, kukhalapo kwa shuga wabwinobwino nthawi yogona, i.e. Momwe zimakhalira ndi insulin yayitali, imawerengera mpaka m'mawa.

Kuti muwone kuchuluka kwa insulin yochepa yomwe idaperekedwa musanadye, ndikofunikira kuyeza shuga m'magazi 1.5-2 mutatha kudya (pa "nsonga" yowonjezera ya shuga), kapena, m'malo ovuta kwambiri, chakudya chisanafike (pambuyo pa maola 5-6).

Kuyeza kwa shuga musanadye chakudya chamadzulo kumathandizira kuwunika kuchuluka kwa insulin yochepa musanadye chakudya chamadzulo ndi chakudya cham'mawa chambiri. Shuga wamagazi nthawi yogona ayenera kuwonetsa kuchuluka kwa insulin yochepa musanadye.

Malangizo a kuchepetsa mlingo wa insulin

Cholinga chochepetsera kuchuluka kwa insulin ndi zomwe zimachitika mu hypoglycemia ngati izi hypoglycemia sizinaphatikizidwe ndi cholakwika cha wodwalayo (kudya kosaduka kapena kudya magawo ochepa a mkate, kupanga cholakwika ndi insulin, kuchita masewera olimbitsa thupi kwambiri, kapena kumwa mowa).

Zochita za wodwalayo ziyenera kukhala motere:

1. Tengani zakudya zotsekemera kuti muchepetse hypoglycemia.
2. Dziwani shuga m'magazi musanabaye. Ngati sichikhalanso bwino, chitani zomwe mukuyenera kuchita.
3. Ganizirani zomwe zimayambitsa hypoglycemia. Ngati chimodzi mwazifukwa zikuluzikulu zinayi chikupezeka (insulin yambiri, XE pang'ono, zolimbitsa thupi, mowa), konzekerani cholakwacho tsiku lotsatira ndipo musasinthe mlingo wa insulin. Ngati simunapeze chifukwa, ndiye kuti mlingo wa insulin tsiku lotsatira sunasinthebe, chifukwa izi hypoglycemia zitha kukhala mwangozi.

4. Onani ngati hypoglycemia ichira nthawi yomweyo tsiku lotsatira. Ngati chibwereza, ndiye kuti ndikofunikira kusankha insulin yomwe ingayimbe nayo chifukwa. Pazinthu izi tikufunika kudziwa nthawi yanthawi ya insulin.
5. Pa tsiku lachitatu, chepetsani kuchuluka kwa insulini yolingana ndi 10%, ndikumaliza manambala onse (monga lamulo, awa azikhala magawo 1-2). Ngati hypoglycemia ibwereranso nthawi yomweyo, tsiku lotsatira limachepetsa mlingo wa insulin.

Izi ndi zitsanzo za zomwe wodwalayo achita kuti achepetse kuchuluka kwa insulin panthawi ya hypoglycemia masana ndi mitundu yosiyanasiyana ya mankhwala omwe amathandizira ndi insulin:

1) Asanadye chakudya cham'mawa komanso asanadye - insulin yochepa komanso yapakati nthawi yochitapo kanthu.

Wodwala 2.10 pa 16 h pali hypoglycemia. Palibe chifukwa chomveka cha hypoglycemia chomwe chinapezeka. Wodwala sasintha mlingo wa insulin 3.10. Hypoglycemia imabwerezedwanso m'maola a 15.10.10 wodwalayo amachepetsa mlingo wa insulin yomwe idayambitsa hypoglycemia - - insulin - yomwe ikukula - asanafike chakudya cham'mawa - 10% (kuchokera ku mayunitsi 22 adzakhala magawo 2), i.e. amapanga 20 mayunitsi.

2) Asanadye chakudya cham'mawa komanso asanadye - - insulin yosakanikirana.

Wodwala 2.10 pa 16 h pali hypoglycemia. Palibe chifukwa chomveka cha hypoglycemia chomwe chinapezeka. Wodwala sasintha mlingo wa insulin 3.10.Hypoglycemia imabwerezedwanso maola 15. 4.10 wodwalayo amachepetsa mlingo wa insulin yomwe idayambitsa hypoglycemia - insulin yosakanikirana isanayambike chakudya cham'mawa - mwa 10% (kuchokera magawo 34 adzakhala magawo atatu), i.e. amapanga mayunitsi 31

3) Asanadye chakudya cham'mawa - insulin yochepa komanso yapakatikati, musanadye chakudya chamadzulo - musanadye chakudya chamadzulo, musanadye - asanagone insulin, asanagone - insulin.

Wodwala 2.10 pa 16 h pali hypoglycemia. Palibe chifukwa chomveka cha hypoglycemia chomwe chinapezeka. Wodwala sasintha mlingo wa insulin 3.10. Hypoglycemia imabwerezedwanso m'maola a 15.10.10 wodwalayo amachepetsa mlingo wa insulin yomwe idayambitsa hypoglycemia - - insulin yocheperako musanadye chakudya - ndi 10% (kuchokera magawo 10 adzakhala 1 unit), i.e. amapanga mayunitsi 9

Malangizo akuwonjezera mlingo wa insulin

Cholinga chowonjezera insulin yolinganizika ndikuwonekera kwa shuga wambiri, yemwe samagwirizanitsidwa ndi zolakwika zina zilizonse zotsatirazi:

1) insulini yaying'ono (cholakwika chaukadaulo chokhala ndi mlingo wokhazikika, kulowererapo m'thupi, jakisoni m'dera lina la thupi lomwe insulin imalowerera kwambiri),
2) chakudya chochuluka kwambiri (cholakwika pakuwerengera),
3) zolimbitsa thupi pang'ono kuposa zabwinobwino
4) matenda onga.

Zochita za wodwalayo ziyenera kukhala motere:

1. Onjezani mlingo wa insulin yochepa kapena wosakanikirana ndi insulin panthawiyo.
2. Dziwani shuga m'magazi musanabaye. Ngati sichikhalanso bwino, chitani zomwe mukuyenera kuchita.
3. Ganizirani zomwe zimayambitsa shuga wambiri. Ngati chimodzi mwa zifukwa zikuluzikulu zinayi chikupezeka, ndiye tsiku lotsatira, konzani cholakwacho ndipo musasinthe mlingo wa insulin. Ngati simunapeze chifukwa, ndiye kuti mlingo wa insulin tsiku lotsatira sunasinthe, chifukwa shuga wambiriyu akhoza kukhala wopanda pake.
4. Onani ngati shuga wambiri wabwerezedwa nthawi yomweyo tsiku lotsatira. Ngati chibwerezedwa, ndikofunikira kudziwa kuti ndi insulin iti yomwe ingathe "kuimba mlandu" pazomwezi, kudziwa nthawi yomwe insulin ingapangidwire.
5. Pa tsiku lachitatu, onjezani kuchuluka kwa insulini yofananira ndi 10%, ndikusankha manambala onse (monga lamulo, awa azikhala magawo 1-2). Ngati shuga wambiri abwerezedwa nthawi yomweyo, tsiku lotsatira, muwonjezere mlingo wa insulin.

Izi ndi zitsanzo za zomwe wodwalayo achita kuti awonjezere mlingo wa insulin ndi shuga wambiri musanadye chakudya chamitundu yambiri pogwiritsa ntchito insulin:

1) Asanadye chakudya cham'mawa komanso asanadye - insulin yochepa komanso yapakati nthawi yochitapo kanthu.

Wodwala 7.09 amakhala ndi shuga wamagazi ambiri asanadye. Palibe chifukwa chodziwika bwino cha hyperglycemia chomwe chinapezeka. Kuchepetsa msanga wamagazi, wodwalayo amawonjezera mlingo wa insulin yochepa asanadye chakudya cham'gulu la 8 mpaka 10. M'mawa wa Seputembara 8, wodwalayo sasintha mlingo wa insulin. Mwazi wamagazi ambiri umabwerezedwa musanadye. Wodwalayo amapangiranso asanadye chakudya 10 magawo a insulin yochepa. Pa Seputembara 9, wodwalayo amawonjezera mlingo wa insulin yomwe imayambitsa hyperglycemia - woonjezera-insulin asanadye chakudya cham'mawa - ndi 10% (kuchokera ku mayunitsi 22 adzakhala magawo 2), i.e. amapanga mayunitsi 24. Asanadye chakudya chamawa patsikuli, wodwalayo amapanga mlingo wapitalo wa insulin - magawo 8.

2) Asanadye chakudya cham'mawa komanso asanadye - - insulin yosakanikirana.

Wodwala 7.09 amakhala ndi shuga wamagazi ambiri asanadye. Palibe chifukwa chodziwika bwino cha hyperglycemia chomwe chinapezeka. Kuchepetsa msanga wamagazi awa, wodwalayo amawonjezera mlingo wa insulin yosakanikirana musanadye chakudya chamtundu wa 22 mpaka 24. M'mawa wa Seputembara 8, wodwalayo sasintha mlingo wa insulin. Mwazi wamagazi ambiri umabwerezedwa musanadye. Wodwalayo amapanganso asanadye chakudya chamtundu 24 wa insulin yosakanikirana. 9.09 wodwalayo amawonjezera mlingo wa insulin yomwe imayambitsa hyperglycemia - insulin yosakanikirana isanayambike chakudya cham'mawa - ndi 10% (kuchokera magawo 34 adzakhala magawo atatu), i.e. amapanga mayunitsi 37 Asanadye chakudya chamawa patsikuli, wodwalayo amapanga mlingo wapitalo wa insulin yosakanikirana - magawo 22.

3) Asanadye chakudya cham'mawa - insulin yochepa komanso yapakatikati, musanadye chakudya chamadzulo - musanayambe kudya, musanadye - insulin, yochepa, musanagone - insulin.

Wodwala 7.09 amakhala ndi shuga wamagazi kwambiri asanadye. Palibe chifukwa chodziwika bwino cha hyperglycemia chomwe chinapezeka. Kuchepetsa msanga wamagazi, wodwalayo amawonjezera mlingo wa insulin yochepa asanadye chakudya cham'gulu la 8 mpaka 10.Wodwalayo sasintha mlingo wa insulin m'mawa komanso asanadye chakudya pa Seputembara 8. Mwazi wamagazi ambiri umabwerezedwa musanadye. Wodwalayo amapangiranso asanadye chakudya 10 magawo a insulin yochepa. Seputembara 9, wodwalayo amawonjezera mlingo wa insulin yomwe idayambitsa hyperglycemia - - insulin yocheperako musanadye chakudya - ndi 10% (kuchokera magawo 10 adzakhala 1 unit), i.e. amapanga mayunitsi 11 Asanadye chakudya chamawa patsikuli, wodwalayo amapanga mlingo wapitalo wa insulin - magawo 8.

Muyenera kudziwa kuti matenda aliwonse (makamaka a kutupa) angafunike kwa wodwala kuti awonjezere insulin. Pafupifupi nthawi zonse, pamenepa, zidzakhala zofunikira kupanga insulin yochepa pakulipira jakisoni angapo.

Kusungidwa kwa insulin

Monga mankhwala aliwonse, nthawi yosungirako insulini ndiyochepa. Pa botolo lirilonse, nthawi zonse pamakhala chithunzi cha alumali.

Mafuta a insulin amayenera kusungidwa mufiriji pa kutentha kwa madigiri 2-8 Celsius (osavomerezeka ayi). Mbale za insulin kapena zolembera, zomwe zimagwiritsidwa ntchito jekeseni tsiku ndi tsiku, zimatha kusungidwa kutentha kwa chipinda kwa mwezi umodzi. Komanso, musalole kuti insulini ikule kwambiri (musamusiye padzuwa kapena nthawi yachilimwe m'galimoto yotseka).

Onetsetsani kuti mukuchotsa insulini mu thumba la pepala mutatha jekeseni, chifukwa insulin imawonongeka ndi kuwala. Ngati mutenga insulini (tchuthi, ulendo wamabizinesi, ndi zina zambiri), simungathe kutenga katundu wanu (ikhoza kutayika, kuthyoka, ndi kuwuma pa ndege).

Ndende ya insulin

Pakadali pano, magawo awiri a insulin amagwiritsidwa ntchito ku Russia: 40 magawo 1 ml ya mankhwalawa (U-40) ndi magawo zana mu 1 ml ya mankhwalawa (U-100). Kulimbirana kumasonyezedwa pachotengera chilichonse cha insulin. Momwemonso, ma syringe amapezeka pazinthu zosiyanasiyana za insulin, amalembedwa moyenera. Chifukwa chake, nthawi zonse mukalandira gulu la insulin kapena syringe yatsopano, zomwe zimachitika mu insulin ndizoyang'anira mbale ndi syringe ziyenera kufufuzidwa.

Ngati pali vuto linalake, vuto lalikulu la kuchuluka kwake lingachitike, mwachitsanzo: 1) insulini imatengedwa kuchokera ku vial ndi syringe yopangidwira insulin ya 40 U / ml, komwe ndende ndi 100 U / ml - nthawi yochulukirapo ya insulini idzasonkhanitsidwa, 2) ndi syringe yopangidwira insulin ya 100 Units / ml, amatenga insulini kuchokera m'botolo, pomwe ndende ndi 40 Units / ml - pomwe insulin imacheperachepera 2,5.

Syringe Insulin Yokhala

Mndandanda wa zochita mukatola insulini pogwiritsa ntchito syringe ndi motere:

1. Konzani vial ya insulin ndi syringe.
2. Ngati mukufuna kulowetsa insulin yayitali, isakanizani bwino (yokulungira botolo pakati pa manja mpaka njira itakhala yamtambo).
3. Sungani mpweya wambiri mu syringe momwe zigawo za insulin zidzafunikira kusungidwa pambuyo pake.
4. Lowetsani mpweya mu botolo.
5. Choyamba, jambulani insulin yochulukirapo mu syringe kuposa momwe mungafunire. Izi zimachitika kuti ndikosavuta kuchotsa thovu lakuzunguliridwa mu syringe. Kuti muchite izi, pirani pang'onopang'ono thupi la syringe ndikumachotsera insulini yambiri komanso mpweya kubwerera m'mbale.

Kodi ndizotheka kusakaniza insulin mu syringe imodzi? Zimatengera mtundu wa insulin wautali. Ma insulini omwe amagwiritsa ntchito mapuloteni (NPH-insulins) amatha kusakanikirana. Kufunika kophatikizira insulin ndikuchepetsa kuchuluka kwa jakisoni.

Kutsata kwa zochita mukamalemba mu syringe imodzi ya insulin ziwiri ndi motere:

1. Lowetsani mpweya mu phula la insulin yotalikilapo.
2. Lowetsani mpweya mu insulin vial.
3. Choyamba, sonkhanitsani insulini yochepa (bwino), monga tafotokozera pamwambapa.
4. Kenako lembani insulin (yamitambo) yayitali. Izi zikuyenera kuchitika mosamala kuti gawo limodzi la insulin yomwe yatola kale isalowe m'mbale yowonjezera.

Popeza pakhoza kukhalabe zolakwika ndi kudzisakaniza, kusakanikirana kwa insulin komwe kumapangidwa kumapangidwa - ma insulin omwe amaphatikizidwa omwe adanenedwa kale. Musanayambe kutenga insulin yotere, iyenera kusakanizika chimodzimodzi monga insulin yowonjezera.

Njira ya Inulinion ya Insulin

Kuchulukana kwa insulin kumatengera ndi gawo liti la singano lomwe limalowa. Jakisoni wa insulin amayenera kuperekedwa nthawi zonse mu mafuta amkati, koma osatinso mwachidwi osati intramuscularly (onani mkuyu. 16). Pofuna kuchepetsa mwayi wolowa mu minofu, odwala omwe ali ndi kulemera kwabwinobwino, tikulimbikitsidwa kugwiritsa ntchito ma syringe ndi ma syringe ndi singano zazifupi - 8 mm kutalika (singano yachikhalidwe imakhala kutalika pafupifupi 12-13 mm). Kuphatikiza apo, singano izi ndizowonda pang'ono, zomwe zimachepetsa ululu panthawi ya jakisoni.

Chithunzi 16. Kukonzekera kwa insulini ndi singano zamautali osiyanasiyana (singano: 8-10 mm ndi 12-13 mm)

Chithunzi 17. Molondola komanso molakwika khungu

Kuti mupange jakisoni wa insulin, muyenera:

1. Amasuleni malo pakhungu lomwe insulin ingalowe. Pukutani ndi mowa malo a jakisoni sofunikira.
2. Gwiritsani ntchito chala chachikulu ndi chofiyira kuti khungu lisunthe (onani mkuyu. 17). Izi zimachitidwanso kuti muchepetse mwayi wolowa mu minofu.
3. Ikani singano pamunsi pa khungu pang'onopang'ono mpaka pakhungu kapena madigiri 45.
4. Popanda kumasula khola, sinikizani syringe plunger njira yonse.
5. Yembekezani masekondi angapo mutayambitsa insulin, kenako ndikuchotsa singano.

Ma cholembera

Momwe zimathandizira jakisoni wa insulini pogwiritsa ntchito zolembera zomwe zimatchedwa syringe. Amalola wodwala kuti akwaniritse njira ina yabwino m'moyo, chifukwa palibe chifukwa chonyamula vial ndi insulin ndikuyitenga ndi syringe. Botolo la insulin, penfill, limalowetsedwa kale mu cholembera.

Pofuna kusakaniza insulin yayitali musanabaye, muyenera kusintha kutembenuka kwa cholembera 180 ° (ndiye kuti mpira womwe umapangidwa umasakaniza insulin). Choyimbirachi chimayika mlingo wofunikira pazenera la nyumbayo. Poika singano pansi pa khungu monga tafotokozera pamwambapa, muyenera kukanikiza batani mpaka kumapeto. Pambuyo masekondi 7-10, chotsani singano.

Masamba obayira a insulin

Magawo angapo a thupi amagwiritsidwa ntchito jakisoni wa insulin: kutsogolo pamimba, kutsogolo kwa chakunja cha ntchafu, kunja kwa mapewa, matako (onani mkuyu. 18). Sitikulimbikitsidwa kudzijambulitsa nokha phewa, chifukwa ndizosatheka kusonkhanitsa khola, zomwe zikutanthauza kuti chiopsezo cha kukhudzana ndi intramuscular chikuwonjezeka.

Muyenera kudziwa kuti insulini yochokera m'malo osiyanasiyana a thupi imakhudzidwa ndi kuthamanga kosiyanasiyana: makamaka, mwachangu kuchokera pamimba. Chifukwa chake, musanadye, ndikulimbikitsidwa kupatsa insulin yochepa m'derali. Zingwe za kukonzekera kwa insulin kwa nthawi yayitali zitha kuchitika matako kapena matako. Kusintha malo a jakisoni ayenera kukhala ofanana tsiku lililonse, apo ayi zitha kubweretsa kusinthasintha kwamisempha ya magazi.

Chithunzi 18. Masamba obayira a insulin

Tiyeneranso kusamalidwa kuti tiwonetsetse kuti zisindikizo sizimapezeka m'malo omwe amapangira jakisoni. Kuti muchite izi, ndikofunikira kusinthana ndi malo omwe jakisoniyo anali, ndikuchokanso pamalo pomwe jakisoni wapitalo ndi masentimita pafupifupi 2.

I.I. Dedov, E.V. Surkova, A.Yu. Zazikulu

Malangizo

Mothandizidwa ndi mtundu uwu wa mankhwalawa, zimamveka kuti mitundu yonse ya mankhwala imawerengeredwa kale, kuchuluka kwa zakudya patsiku kumakhala kosasinthika, ngakhale mndandanda wazakudya ndi kukula kwake zimayikidwa ndi wazakudya. Imeneyi ndi njira yokhwima kwambiri ndipo imagawidwa kwa anthu omwe, pazifukwa zina, sangathe kuwongolera shuga wawo wamagazi kapena kuwerengera kuchuluka kwa insulin potengera kuchuluka kwa chakudya mu chakudya chawo.

Choipa cha njirayi ndikuti sizitengera mawonekedwe a thupi la wodwalayo, kupanikizika kothekera, kuphwanya zakudya, kuwonjezera zolimbitsa thupi. Nthawi zambiri, amalamula odwala okalamba. Mutha kuwerenga zambiri za iye m'nkhaniyi.

Kwambiri insulin mankhwala

Njirayi imakhala yachilengedwe, imaganizira za thanzi ndi katundu wa munthu aliyense, koma ndikofunikira kuti wodwalayo azigwiritsa ntchito moyenera maudindo ake mosamala. Thanzi lake komanso thanzi lake zimadalira izi. Chithandizo chachikulu cha insulin chitha kuphunziridwa mwatsatanetsatane ku ulalo womwe unaperekedwa kale.

Zizindikiro zazikulu za kuperekera mankhwalawa ndikuphwanya magwiridwe antchito a kapamba. Popeza chiwalo chamkati chimagwira mbali zonse za kagayidwe kachakudya mthupi, ndipo kusokonezeka kwa ntchito yake kumayambitsa zovuta mu ziwalo zina zamkati ndi ziwalo.

Maselo a Beta ali ndi udindo wopanga zinthu zachilengedwe zokwanira. Komabe, ndikusintha komwe kumayenderana ndi m'badwo mthupi pakakhala mavuto ndi kapamba, kuchuluka kwa maselo yogwira kumachepa, zomwe zimapangitsa kuti pakhale insulin.

Ziwerengero zamankhwala zikuwonetsa kuti "zomwe akumana nazo" za endocrine pathology wazaka 7-8, pazithunzi zambiri zachipatala, amafunikira mankhwala.

Kodi mankhwalawo amaperekedwa kwa ndani ndipo ndi liti? Ganizirani zifukwa zomwe mwaperekera matenda amtunduwu:

• Dera la hyperglycemic, makamaka, mtengo wa shuga ndiwopamwamba kuposa magawo 9.0. Ndiye kuti, kuwonongeka kwa nthawi yayitali kwa matenda.
• Kumwa mankhwala kutengera sulfonylureas.
• Kutopa kwamatenda.
• Kuchulukitsa kwa concomitant aakulu pathologies.
• Kuchokera pa matenda a shuga, mitundu ya Lada, zikhalidwe zopweteka (matenda opatsirana, kuvulala kwambiri).
• Nthawi yokhala ndi mwana.

Odwala ambiri amayesetsa m'njira iliyonse kuti achedwetse tsiku loti apangire jakisoni. M'malo mwake, palibe chomwe mungadandaule, m'malo mwake, pali njira yoperekedwa yomwe imathandiza anthu omwe akudwala matenda osachiritsika kuti akhale ndi moyo wokwanira.

Zochita zimawonetsa kuti posachedwa, insulini imalembedwa mtundu wachiwiri wa matenda ashuga. Lingaliro lachipangizoli limangoleketsa kupewetsa mavuto ake, komanso limalepheretsa kupitilira kwa matendawa, limakankhira kumbuyo zotsatira zoyipa zomwe zingakhalepo.

Cholinga cha pulani yotereyi iyenera kutsimikiziridwa, apo ayi izikhala ndi gawo loyipa.

Kufunika kwa insulin pochiza matenda a shuga sikukayikira. Kuchita zamankhwala kwa nthawi yayitali kwatsimikizira kuti kumathandizira kutalikitsa moyo wa wodwalayo, pomwe nthawi yomweyo akuchedwetsa zotsatirapo zoipa kwa nthawi yayitali.

Chifukwa chiyani ndikufunika kubayitsa mahomoni? Ichi chimakwaniritsa cholinga chimodzi - kukwaniritsa ndi kutsata hemoglobin wa glycated, glucose pamimba yopanda kanthu ndikatha kudya.

Ngati mwazonse, insulin ya odwala matenda ashuga ndi njira yokuthandizirani kumva bwino, ndikuchepetsa kupitilira kwa zomwe zimayambitsa matenda, komanso kupewa zovuta zovuta.

Kugwiritsa ntchito insulin kumapereka zotsatirazi zochizira:

1. Kukhazikitsidwa kwa mankhwalawa komwe kumanenedwa kumatha kuchepetsa glycemia, pamimba yopanda kanthu ndikatha kudya.
2. Kuchulukitsa kamapangidwe am'madzi a pancreatic poyankha kukondoweza ndi shuga kapena zakudya.
3. Kutsika kwa gluconeogenesis ndi njira ya metabolic yomwe imatsogolera pakupanga shuga kuchokera kumagulu osagwiritsa ntchito chakudya.
4. Kukula kwa shuga kwa chiwindi.
5. Lipolysis yafupika mukatha kudya.
6. Kutsitsa pang'onopang'ono kwa mapuloteni m'thupi.

Mankhwala a insulin othandizira odwala matenda amtundu wa 2 amakhala ndi phindu pa kagayidwe kazakudya zam'mimba, lipids ndi mapuloteni m'thupi la munthu.Zimathandizira kuyambitsa mawonekedwe ndi kuponderezana kwa kuwonongeka kwa shuga, lipids ndi amino acid.

Kuphatikiza apo, imasinthasintha kuchuluka kwa zizindikiritso chifukwa kuwonjezeka kwa kayendedwe ka glucose kupita ku ma cellular, komanso chifukwa cha kuletsa kwake kupanga kudzera pachiwindi.

Horm imalimbikitsa lipoogiis yogwira, imalepheretsa kugwiritsidwa ntchito kwamafuta acids mu metabolism yamphamvu, imathandizira kupanga mapuloteni, ndikuletsa minofu proteinolysis.

Njira zamakono zamankhwala othandizira insulin zimatsata zachilengedwe, zokhudzana ndi chitetezo cha thupi pancreas ya mahomoni - insulin. Amasankhidwa ngati wodwala salemera mopitirira muyeso komanso ngati palibe mwayi wokhala ndi nkhawa yayikulu m'maganizo, kuyambira kuwerengera tsiku ndi tsiku - 0.5-1.0 IU (mayunitsi apadziko lonse lapansi) la hormone pa kilogalamu imodzi yakulemera kwa thupi.

Zofunikira zotsatirazi ziyenera kukwaniritsidwa:

• Mankhwala ayenera kubayidwa mu Mlingo wokwanira kupangitsa kuti pakhale magazi ambiri,
• insulin yovulaza kunja kwa shuga iyenera kutsata kwathunthu momwe maselo obisalira omwe amapezeka ndi zisumbu za Langerhans, zomwe ndizofunikira kwambiri mutatha kudya.

Njira yowonjezereka ikuchokera mu mfundo izi, pomwe tsiku ndi tsiku, pofunikira polojekiti yofunikira imagawidwa pang'onopang'ono, jekeseni wosiyanitsa ndi mphamvu yake yakanthawi - yochepa kapena yotalikilapo.

Mtundu wotsiriza wa insulin uyenera kubayidwa usiku ndi m'mawa, mutangodzuka kumene, womwe umatsata molondola komanso mokwanira kayendedwe ka kapamba.

Wobwera mwachangu insulin jekeseni amatchulidwa pambuyo chakudya, ndi kuchuluka kwa chakudya. Monga lamulo, jakisoni imodzi imawerengeredwa payekhapokha malinga ndi kuchuluka kwa mkate wachilendo, womwe ndi wofanana ndi chakudya.

Chithandizo cha setso (chazikulu) cha insulin ndi njira yochizira odwala matenda ashuga, pomwe ochita kupanga kwakanthaŵi komanso osakhalitsa amakhala osakanikirana ndi jakisoni imodzi. Ubwino wa njirayi ya kaperekedwe ka mankhwala ndikuchepetsa kuchuluka kwa jakisoni - nthawi zambiri amafunika kubaya insulin katatu patsiku.

Choyipa chachikulu chamtunduwu wa mankhwalawa ndikusoweka kutsata kwathunthu kwazomwe zimachitika pakhungu pancreas, zomwe zimapangitsa kuti sizingatheke kulipira kwathunthu zolakwika pazakudya zam'mimba.

Njira yokhayo yogwiritsira ntchito mankhwala amtundu wa insulin ikhoza kuyimiridwa motere:

1. Chofunikira tsiku ndi tsiku la insulin imaperekedwa kwa wodwala mu mawonekedwe a jakisoni 1-3 patsiku:
2. Jakisoni m'modzi amakhala ndi ma insulins apakatikati ndi osakhalitsa: kuchuluka kwa insulin kwakanthawi ndi 1/3 ya kuchuluka kwa mankhwalawo.

insulin yotalika pakati imakhala ndi 2/3 ya voliyumu yonse.

Chithandizo cha insulin ndi njira yobweretsera mankhwalawo mthupi pamene syringe yachikhalidwe silifunika, ndipo jakisoni wotsekemera umachitika ndi zida zapadera zamagetsi - pampu ya insulin, yomwe imatha kubayitsa insulin yochepa komanso yochepa posankha ma insulin mu mawonekedwe a microdoses.

Pampu ya insulin imatsata molondola kuchuluka kwa chilengedwe cha mahomoni m'thupi, momwe imayendetsera m'njira ziwiri.

• Malangizo a basal makonzedwe, pamene ma microdoses a insulin amalowa mthupi mosalekeza ngati ma microdoses,
• Malangizo a bolus momwe pafupipafupi komanso Mlingo wa mankhwala amaperekedwera odwala.

Njira yoyamba imakupatsani mwayi wokhala ndi mahomoni a insulini omwe ali pafupi kwambiri ndi zachilengedwe zomwe zimabisidwa ndi ma pancreas, zomwe zimapangitsa kuti pasakhale jekeseni wa insulin yemwe amakhala nthawi yayitali.

Njira yachiwiri nthawi zambiri imagwiritsidwa ntchito musanadye, zomwe zimapangitsa:

• chepetsani mwayi wowonjezera mndandanda wa glycemic kukhala wovuta,
• limakupatsani mwayi wosiya kugwiritsa ntchito mankhwala osokoneza bongo ndi nthawi yayitali kwambiri.

Mukaphatikiza mitundu yonse iwiriyi, kutulutsa kwachilengedwe kwa insulin mthupi la munthu kumatsanziridwa molondola monga momwe kungathekere. Mukamagwiritsa ntchito pampu ya insulin, wodwalayo ayenera kudziwa malamulo oyambira kugwiritsa ntchito chipangizachi, chifukwa chake muyenera kufunsa dokotala.

Kuphatikiza apo, ayenera kukumbukira pakakhala koyenera kusintha catheter kudzera momwe jekeseni wa insulin amachokera.

Odwala omwe amadalira insulin (mtundu I shuga mellitus) amadziwika kuti athetse insulin. Chofala kwambiri ndi njira yotsatira ya jakisoni mukabayidwa:

• insulin ya basal (yapakatikati komanso yayitali) - kamodzi kapena kawiri pa tsiku,
• bolus (kanthawi kochepa) - basi chakudya chisanachitike.

Ma insalins:

• nthawi yayitali yovomerezeka, Lantus (Lantus - Germany), Levemir FlexPen (Denmark) ndi Ultratard XM (Ultratard HM - Denmark),
• nthawi yayitali ya Humulin NPH (Humulin NPH - Switzerland), Insuman Basal GT (Insuman Basal GT - Germany) ndi Protafane HM (Protaphane HM - Denmark).

Kukonzekera kwa Bolus:

• osankha mwachidule amaika "Actrapid HM Penfill" ("Actrapid HM Penfill" - Denmark),
• kuvomerezedwa kwakanthawi kwa NovoRapid (NovoRapid - Denmark), Humalog (Humalog - France), Apidra (Apidra - France).

Kuphatikiza kwa ma bolus ndi basal jekiseni regimens amatchedwa regimen yambiri ndipo ndi imodzi mwazinthu zochepa zamankhwala olimbikitsidwa. Mlingo wa jakisoni iliyonse umatsimikiziridwa ndi madokotala potengera mayeso omwe amachitika komanso momwe zilili ndi momwe wodwalayo alili.

Kuphatikizidwa bwino ndi insulin ya munthu payekha kumapangitsa kuti thupi la munthu lisavutike kwambiri ndi mtundu wa chakudya. Nthawi zambiri, kuchuluka kwa omwe amakhala ndi ma insulin nthawi yayitali komanso sing'anga ndi 30.0% -50.0% ya mlingo wonse wa mankhwala omwe amaperekedwa.

Bolus inulin imafuna kusankha kwa wodwala aliyense payekha.

Mwachizolowezi, mankhwala a insulin a mtundu II wa shuga amayamba ndi kuphatikiza pang'onopang'ono kwa mankhwala omwe amachepetsa magazi m'misempha yachilendo monga mankhwala operekedwa kwa odwala.

Mankhwala, mankhwala ndi mankhwala, zomwe ndi insulin glargine ("Lantus" kapena "Levemir"). Pankhaniyi, ndikofunikira kupangira jekeseni yankho nthawi yomweyo.

Mlingo wambiri watsiku ndi tsiku, kutengera mtundu wa maphunzirowo ndi kuchuluka kwa kunyalanyaza matendawa, kukhoza kufika 10,0 IU.

Ngati palibe kusintha kwa wodwalayo ndipo matenda a shuga akupita patsogolo, ndipo chithandizo cha mankhwala malinga ndi chiwembu "jekeseni yotsitsa shuga mkamwa" sichikupereka zotsatira zomwe zimafunikira, amasintha kupita ku chithandizo chamankhwala, chomwe chimachokera pakumwa mankhwala omwe amapezeka ndi insulin.

Masiku ano, mankhwala othandizira kwambiri, omwe mankhwalawa amayenera kubayidwa katatu patsiku. Kwa omwe ali omasuka kwambiri, odwala amakonda kuchepetsa kuchuluka kwa jakisoni.

Kuchokera pakuwona momwe achire amathandizira, kuphweka kwa mankhwalawa kuyenera kuonetsetsa kuti mankhwalawa amachepetsa kwambiri shuga. Kuwunika bwino kumachitika pambuyo pakubayidwa kwa masiku angapo.

Pankhaniyi, kuphatikiza kwa m'mawa komanso kumwa mankhwalawa ndikosayenera.

Ndi chitetezo chokwanira komanso kulekerera kwabwino kwa odwala a insulin omwe amapezeka ndi njira zopangira ma genetic, zovuta zina ndizotheka, zazikulu zomwe ndi:

• kuwoneka kwa matupi awo sagwirizana pamalowo jakisoni, wokhudzana ndi kupweteka koyambitsa kapena kuperekera mankhwala ozizira kwambiri,
• kuchepa kwa mafuta osunthika omwe amapezeka m'malo a jakisoni,
• kukulitsa kwa hypoglycemia, komwe kumapangitsa kukulitsa thukuta, kumangokhala ndi njala, komanso kuchuluka kwa mtima.

Malinga ndi akatswiri a matenda ashuga ku Europe, mankhwala a insulin sayenera kuyamba molawirira kwambiri komanso osachedwa. Osati chilonda, chifukwa kusakwanira kwachinsinsi kungakhale kwachiwiri kwa insulinitensity, komanso chifukwa cha chiopsezo cha hypoglycemia. Sanachedwe, chifukwa ndikofunikira kukwaniritsa kuyenera koyenera ka glycemic.

Amaganiziridwa kuti muli kale ndi zotsatira za kudziletsa kwathunthu kwa shuga m'magazi odwala matenda a shuga masiku 7 otsatizana. Malangizo athu ndi a odwala matenda ashuga omwe amatsata zakudya zamafuta ochepa ndikugwiritsa ntchito njira yopepuka.

Ngati mutsatira zakudya “zopatsa thanzi”, zodzaza ndi mafuta, ndiye kuti mutha kudziwa kuchuluka kwa insulini m'njira zosavuta kuposa zomwe zafotokozedwa mu nkhani zathu. Chifukwa ngati zakudya za anthu odwala matenda ashuga zili ndi chakudya chamagetsi, ndiye kuti simungapewe magazi.

Momwe mungapangire regimen ya insulin - njira iliyonse:

1. Sankhani ngati mukufuna jakisoni wa insulin yochulukirapo usiku.
2. Ngati mukufuna jakisoni wa insulin yowonjezera usiku, ndiye kuwerengera poyambira, ndikusintha patsiku lotsatira.
3. Sankhani ngati mukufuna jakisoni wa insulin yowonjezera m'mawa. Izi ndizovuta kwambiri, chifukwa poyesera muyenera kudumpha chakudya cham'mawa komanso nkhomaliro.
4. Ngati mukufuna jakisoni wa insulin yowonjezereka m'mawa, ndiye muwerengereni mlingo woyambira wa insulin, ndikusintha kwa masabata angapo.
5. Sankhani ngati mukufuna jakisoni wa insulin yachangu musanadye chakudya cham'mawa, chakudya chamadzulo ndi chakudya chamadzulo, ndipo ngati ndi choncho, chakudya chofunikira chisanachitike, komanso chisanafike - sichoncho.
6. Muyenera kuwerengera poyambira mwachidule kapena insulin ya insulin musanadye.
7. Sinthani Mlingo wamtundu waifupi kapena wa ultrashort musanadye, malinga ndi masiku apitawa.
8. Chitani kafukufuku kuti mudziwe kuti ndi mphindi zingati musanadye jakisoni.
9. Phunzirani momwe mungawerengere kuchuluka kwa insulini yochepa kapena ya ultrashort pamilandu mukafuna kusintha matenda a shuga.

Momwe mungakwaniritsire mfundo 1-4 - werengani mu nkhani ya "Lantus and Levemir - insulin. Asinthe shuga m'mimba yopanda kanthu m'mawa. "

Momwe mungakwaniritsire mfundo 5-9 - werengani muzolemba "Ultrashort insulin Humalog, NovoRapid ndi Apidra. Human Short Insulin ”komanso“ jakisoni wa Insulin musanadye.

Momwe mungachepetse shuga kuti akhale wabwinobwino ngati ukukwera. " M'mbuyomu, muyenera kuphunziranso nkhani ya "Kuchiza matenda a shuga ndi insulin.

Mitundu ya insulin ndi iti. Kusunga Malamulo a Insulin. ”

Apanso, tikukumbukira kuti zosankha zakufunika kwa jakisoni wa insulin yowonjezera komanso yachangu zimapangidwa popanda china. Mmodzi wodwala matenda ashuga amangofunika insulini yowonjezera usiku ndi / kapena m'mawa.

Ena amangowonetsa jakisoni wa insulin yachangu musanadye kotero kuti shuga akhalebe wabwinobwino atatha kudya. Chachitatu, insulin yayitali komanso yachangu imafunikira nthawi yomweyo.

Izi zimatsimikiziridwa ndi zotsatira za kudziletsa kwathunthu kwa shuga m'magazi 7 otsatizana.

Tidayesera kufotokoza m'njira yofikirika komanso yomveka ya momwe angapangire bwino dongosolo la insulin yodwala matenda amtundu 1 komanso matenda a shuga. Kuti mudziwe insulin yomwe mungabayire, munthawi iti komanso munthawi iti, mumayenera kuwerenga zolemba zazitali, koma zidalembedwa mchilankhulo chomveka bwino. Ngati muli ndi mafunso, afunseni mu ndemanga, ndipo tidzayankha mwachangu.

Ndi kuchepa kwamphamvu kwa kubisala kwa cell ya beta komanso kusagwira bwino ntchito kwa mankhwala ochepetsa shuga, insulin imalimbikitsidwa m'njira zophatikiza kapena kuphatikiza mankhwala ochepetsa shuga.

Zizindikiro zokwanira zama insulin

• Zizindikiro zakuchepera kwa insulini (mwachitsanzo, kuchepa thupi, zizindikiro za kuwonongeka kwa matenda amtundu wa 2),
• kukhalapo kwa ketoacidosis ndi (kapena) ketosis,
• zovuta zilizonse za matenda a shuga a 2,
• kuchuluka kwa matenda osachiritsika, matenda opatsirana opweteka kwambiri (stroko, gangrene, vuto la mtima), kufunikira kwa maopareshoni, matenda oopsa,
• omwe adapezeka kumene amtundu wachiwiri wa shuga, womwe umayendetsedwa ndi shuga wambiri masana komanso pamimba yopanda kanthu, osaganizira kulemera kwa thupi, zaka, kuchuluka kwa matendawa,
• omwe adapezeka kumene amtundu wachiwiri wa matenda ashuga pamaso pa ziwengo ndi zina zotsutsana ndi kugwiritsa ntchito mankhwala a shuga m'mapiritsi. Matenda a hemorrhagic, matenda a impso ndi chiwindi.
• mimba ndi mkaka wa m`mawere
• kuwonongeka kwambiri kwa impso ndi chiwindi.
• Kuperewera koyenera kwa shuga mu mankhwalawa ndi muyezo waukulu wa mapiritsi ochepa a shuga omwe amachepetsa m'malo osakanikirana komanso Mlingo wokwanira.
• precoma, chikomokere.

Mankhwala a insulin amadziwika kuti ali ndi odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi magawo a labotale otsatirawa:

• kusala shuga m'magazi pamwamba pa 15 mmol / l mwa odwala omwe akukayikira,
• kuchuluka kwa plasma ya C-peptide pansipa 0,2 nmol / l pambuyo poyesedwa mwamphamvu ndi 1.0 mg ya glucagon,
• ngakhale mutagwiritsa ntchito mankhwala osachepera tsiku lililonse okonzekera shuga, kuthamanga kwa shuga m'magazi kumakhala kwakukulu kuposa 8.0 mmol / l, mutatha kudya kwambiri kuposa 10.0 mmol / l,
• mulingo wa glycosylated hemoglobin nthawi zonse umapitirira 7%.

Ubwino wambiri wa insulin pochiza matenda a shuga a mtundu wachiwiri ndi momwe zimachitikira mbali zonse za matenda amtunduwu. Choyamba, zimathandizira kulipirira kusowa kwa mphamvu ya kupanga insulin, yomwe imawonedwa ndi kuchepa kwapang'onopang'ono pakugwira ntchito kwa maselo a beta.

Chithandizo cha insulin chakanthawi kochepa chimaperekedwa kwa odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi vuto lalikulu la concomitant (kwambiri chibayo, kulowetsedwa kwa myocardial, ndi zina zambiri), mukamayang'anitsitsa shuga wa magazi pamafunika kuchira msanga.

Kapena muzochitika zomwe wodwalayo sangathe kumwa mapiritsi (matenda amkatikati mwa m'mimba, kumapeto kwa operekera opaleshoni, makamaka thirakiti la m'mimba, ndi zina zambiri).

Matenda akulu amawonjezera kufunika kwa insulin m'thupi la munthu aliyense. Mwina munamvapo za hyperglycemia wopanikizika pamene magazi a magazi amatuluka mwa munthu wopanda matenda a shuga panthawi ya chimfine kapena matenda ena omwe amapezeka ndimatenda akulu komanso / kapena kuledzera.

Madokotala amalankhula za nkhawa ya hyperglycemia yokhala ndi kuchuluka kwa shuga m'magazi okwanira 7.8 mmol / L mwa odwala omwe ali kuchipatala chifukwa cha matenda osiyanasiyana. Malinga ndi kafukufuku, 31% ya odwala omwe ali m'mawodi othandizira komanso kuchokera 44 mpaka 80% ya odwala omwe ali m'mawodi a postoperative ndi malo othandizira odwala kwambiri adakweza kuchuluka kwa glucose, ndipo 80% ya iwo m'mbuyomu analibe matenda a shuga.

Odwala oterowo amatha kuyamba kupatsa insulini kudzera m'mitsempha kapena pang'onopang'ono mpaka mawonekedwe atalipidwa. Nthawi yomweyo, madokotala samazindikira msanga matenda a shuga, koma amayang'anira wodwalayo.

Ngati ali ndi hemoglobin yapamwamba kwambiri (HbA1c pamwambapa 6.5%), yomwe imawonetsa kuchuluka kwa glucose m'miyezi itatu yapitayi, ndipo glucose wamagazi samatulutsa nthawi yomweyo akamachira, ndiye kuti akupezeka ndi matenda a shuga komanso amamuthandizira mankhwala ena.

Pankhaniyi, ngati ali ndi matenda a shuga a 2, mapiritsi ochepetsa shuga atha kutumizidwa kapena insulin ikhoza kupitilizidwa - zonse zimatengera matenda omwe amakhalanso okhudzana. Koma izi sizitanthauza kuti opareshoni kapena machitidwe a madotolo adayambitsa matenda ashuga, monga momwe odwala athu amawanenera nthawi zambiri ("adawonjezera shuga ...", ndi zina zambiri.

d.). Zimangowonetsa komwe kukonzekera kuli.

Koma tidzakambirana za izi pambuyo pake.

Chifukwa chake, ngati munthu yemwe ali ndi matenda a shuga a 2 atenga matenda oopsa, malo ake osungirako insulin sangakhale okwanira kuti akwaniritse kufunika kotsutsana ndi kupsinjika, ndipo asamutsira insulin mankhwala, ngakhale atakhala kuti sanafunenso insulin kale.

Nthawi zambiri, akachira, wodwalayo amayambanso kumwa mapiritsi.Mwachitsanzo, ngati atamuchita opareshoni pamimba, ndiye kuti amalangizidwa kuti apitilize kupaka insulini, ngakhale ngati chinsinsi chake cha insulin chitasungidwa.

Mlingo wa mankhwalawa udzakhala wocheperako.

Kumbukirani kuti mtundu wa 2 shuga ndi matenda opita patsogolo, pomwe mphamvu ya ma cell a pancreatic beta imayamba kuchepa. Chifukwa chake, mlingo wa mankhwalawa umasinthasintha, nthawi zambiri umapitilira, mpaka pang'onopang'ono umafikira pazomwe zimalekerera pomwe zotsatira zoyipa zamapiritsi zimayamba kupambana pazotsatira zawo zabwino (shuga-kutsitsa).

Kenako ndikofunikira kusinthira ku chithandizo cha insulin, ndipo chidzakhala chokhazikika, mlingo ndi mawonekedwe a insulini okha ndi omwe angasinthe. Inde, pali odwala otere omwe kwa nthawi yayitali, kwa zaka, amatha kukhala pachakudya kapena chochepa cha mankhwala ndikulipirira.

Izi zitha kuchitika, ngati matenda a shuga a mtundu 2 adapezeka koyambirira ndipo ntchito ya beta-cell idasungika bwino, ngati wodwalayo atha kuchepetsa thupi, amawunika zakudya zake ndikumayenda kwambiri, zomwe zimathandiza kukonza kapamba - mwa kuyankhula kwina, ngati insulin yanu sinawonongeke ndiyosiyana zakudya zovulaza.

Kapena mwina wodwalayo analibe matenda ashuga, koma panali prediabetes kapena hyperglycemia (onani pamwambapa) ndipo madotolo adafulumira kuti adziwe matenda a shuga 2.

Ndipo popeza matenda ashuga enieni sawachiritsa, nkovuta kuchotsa kuzindikira komwe kale kudali kale. Mwa munthu wotere, shuga wa magazi amatha kutuluka kangapo pachaka motsutsana ndi kupsinjika kapena matenda, ndipo nthawi zina shuga amakhala wabwinobwino.

Komanso, mankhwalawa amachepetsa shuga kwa odwala okalamba omwe amayamba kudya pang'ono, amachepetsa thupi, monga ena amanenera, "kuwuma", kufunikira kwawo kwa insulin kumachepa ndipo ngakhale chithandizo cha matenda ashuga sichitha.

Koma pazambiri zambiri, mlingo wa mankhwalawa nthawi zambiri umakulira.

Poyamba, ziyenera kudziwitsidwa kuti katswiri wa endocrinologist ayenera kuthana ndi kusankha kwa mankhwalawa komanso mtundu wa mankhwalawa malinga ndi mayeso osiyanasiyana.

Mphamvu ndi kutalika kwa insulin mwachindunji zimadalira mkhalidwe wa metabolism m'thupi la wodwalayo.

Mankhwala osokoneza bongo amatha kutsitsa shuga m'magazi pansi pa 3.3 mmol pa lita, chifukwa chomwe wodwalayo amatha kugwa. Chifukwa chake, ngati palibe odziwa endocrinologist mu mzinda wanu kapena dera lanu, majekeseni ayenera kuyamba ndi mitundu yotsika kwambiri.

Kuphatikiza apo, ziyenera kukumbukiridwa kuti 1 ml ya mankhwalawa imatha kukhala ndi 40 kapena 100 mayiko a insulin (IU). Pamaso jakisoni, m`pofunika kuganizira za kuchuluka kwa yogwira mankhwala.

Zochizira odwala omwe ali ndi mtundu wambiri wa matenda ashuga, mitundu iwiri ya mankhwala imagwiritsidwa ntchito:

Ndi chithandizo chokwanira, wodwalayo amaphatikizidwa ndi mankhwala osakhalitsa kapena nthawi yayitali yochita kawiri pa tsiku - pa maola 7 ndi 19. Potere, wodwalayo ayenera kutsatira zakudya zamafuta ochepa, kudya chakudya cham'mawa nthawi ya 7:30 m'mawa, kudya nkhomaliro maola 13 (zosavuta kwambiri), kudya chakudya chamadzulo ndi maola 19 ndikupita kukagona pakati pausiku.

Pa chithandizo champhamvu, wodwalayo amapaka jekeseni wa mankhwala opatsirana pogwiritsa ntchito mankhwala a ultrashort kapena osakhalitsa katatu patsiku - pa maola 7, 13 ndi 19. Kwa anthu omwe ali ndi matenda ashuga osawerengeka, kuti achepetse shuga m'mawa ndi m'mawa, kuphatikiza pa jakisoni watatuyu, mankhwalawa amapatsidwanso mankhwala.

Ayenera kukwapulidwa maola 7, 14 ndi 22. Jekeseni wa mankhwala a nthawi yayitali (Glargin, Detemir) amathanso kutumikiridwa mpaka kawiri pa tsiku (pogona komanso pambuyo maola 12).

Kuti mupeze molondola kuchuluka kwa insulini yomwe imaperekedwa musanadye, muyenera kudziwa kuti 1-1.5 IU ya mahomoni imatha kupatulira chakudya chimodzi (XE) cha chakudya m'thupi la munthu cholemera makilogalamu 64.

Ndi kulemera kochulukirapo kapena kocheperako, kuchuluka kwa ME komwe kumafunikira kuti kusokoneze 1 XE kumawonjezeka kapena kutsika moyenerera. Chifukwa chake, munthu wolemera makilogalamu 128, muyenera kulowa mu II ya 2 IU ya mahomoni kuti athetse 1 XE.

Tiyenera kukumbukira kuti insulin yotsalira-yayifupi imakhala yogwira nthawi 1.5-2.5 nthawi zambiri kuposa mitundu ina, motero, imafunika zochepa. Standard XE imakhala ndi magalamu a 10-12 a chakudya.

Pochiza matenda a shuga a mtundu wachiwiri, ma insulin omwewo amagwiritsidwa ntchito pochiza matenda a shuga 1 a mellitus. Nthawi zambiri amalimbikitsa kufupika komanso kwa ultrashort (lispro, aspart) kwa jabs chakudya, owonjezera, lantus ndi detemir amakondedwa, chifukwa amakulolani kuti muchepetse kagayidwe kazachilengedwe ndipo ndi ofatsa.

Pakadali pano, njira zingapo zakhala zikugwiritsa ntchito bwino kupatsira analogue yakunja ya pancreatic hormone yeniyeni mwa odwala matenda a shuga.

• Kusintha kwathunthu ku mankhwala obwezeretsera a insulin, pamene zakudya, mapiritsi ochepetsa shuga, ndi njira zina zochizira matenda osokoneza bongo zinakhala zopanda ntchito. Chiwembuchi chimatha kusiyanasiyana kamodzi pa jakisoni 1 nthawi patsiku mpaka kulowa m'magazi monga mtundu 1 wa shuga.

• Njira zophatikizika: jakisoni ndi mankhwala a hypoglycemic amagwiritsidwa ntchito nthawi imodzi. Zosakanikirana zosakanikirana pano ndizangodzipatula, osankhidwa pamodzi ndi adokotala.

Njira iyi imawonedwa ngati yabwino kwambiri. Nthawi zambiri, insulin yowonjezera (nthawi 1-2 patsiku) komanso kumwa tsiku lililonse mankhwala amkamwa kuti muchepetse shuga la magazi kumaphatikizidwa.

Nthawi zina asanadye chakudya cham'mawa, kukhazikitsidwa kwa insulin yosakanikirana kumasankhidwa, popeza kufunika kwam'mawa sikulepheretsedwanso ndi mapiritsi.

• Kusintha kwakanthawi kwa jakisoni. Monga taonera kale, makamaka njira imeneyi ndi yoyenera kuchita maopaleshoni akuluakulu, kuvulala kwambiri, kuthina, kuvulala, kutenga pakati, kuchepa kwamphamvu kwa insulin, komanso kuchuluka kwambiri kwa hemoglobin.

Popeza zotsatira zabwino zakulipira matenda a shuga a mtundu wachiwiri pa insulin amakakamiza madokotala kuti alimbikitse momwe angachiritsire matendawa, odwala ambiri, komanso madokotala, amapezeka ali pamavuto: "nthawi yakupereka insulin ndi iti?".

Kumbali ina, kuopa kumvetsetsa kwathunthu kwa wodwalayo kumapangitsa madokotala kuchedwetsa nthawi yomweyo, mavuto azachipatala omwe amapita patsogolo salola kuti insulini ichitike kwakanthawi. Munthawi zonsezi, chisankho chimapangidwa payekhapayekha.

Kumbukirani, njira zilizonse zochizira matenda a endocrine pathologies zitha kugwiritsidwa ntchito mutakambirana ndi adokotala! Kudzipatsa nokha mankhwala kukhala koopsa.

Type 1 matenda a shuga a insulin

• Chithandizo cholimba kapena chofunikira

Insulin (IPD) yochitika kwa nthawi yayitali imathandizidwa kawiri pa tsiku (m'mawa ndi usiku) Insulin yofulumira (ICD) imayendetsedwa kawiri pa tsiku (asanadye chakudya cham'mawa komanso asanadye chakudya chamadzulo) kapena isanachitike chakudya chachikulu, koma mlingo wake ndi kuchuluka kwa XE ndizokhazikika ( wodwalayo sasintha kuchuluka kwa insulin ndi kuchuluka kwa XE) - palibe chifukwa choyezera glycemia musanadye chilichonse

Kuwerengetsa kwa insulin

Mlingo wonse wa insulin (SSDS) wa tsiku ndi tsiku = = kulemera kwa 0,5 U / kg *

- 0,3 mayunitsi / kg kwa odwala omwe ali ndi matenda a shuga 1 omwe atulutsidwa kumene "

- 0,5 U / kg kwa odwala omwe ali ndi matenda nthawi yayitali

- 0.7-0.9 mayunitsi / kg kwa odwala omwe akudziwa matendawa kwa nthawi yayitali

Mwachitsanzo, kulemera kwa wodwala ndi 60 kg, wodwalayo wadwala zaka 10, ndiye SDDS ndi 60 kg x 0.8 U / kg = 48 U

Mlingo wa IPD ndi 1/3 ya SDDS, ndiye kuti mlingo wa IPD umagawika m'magawo awiri - 2/3 imayendetsedwa m'mawa musanadye chakudya cham'mawa ndipo 1/3 imayendetsedwa usiku madzulo asanagone (nthawi zambiri mlingo wa IPD umagawidwa m'magawo awiri pakati)

Ngati SDDS ili magawo 48, ndiye kuti muyezo wa SDI ndi magawo 16, magawo 10 omwe amaperekedwa asanadye chakudya cham'mawa komanso magawo 6 asanagone.

Mlingo wa ICD ndi 2/3 ya SDDS.

Komabe, ndimakulitsa othandizira mankhwala a insulini, kuchuluka kwa ICD musanadye chilichonse kumatsimikiziridwa ndi kuchuluka kwa magawo a mkate (XE) omwe amapangidwira chakudya, kuchuluka kwa glycemia musanadye, kufunikira kwa insulin pa I XE panthawi yopatsa tsiku (m'mawa, tsiku, madzulo)

Kufunika kwa ICD kadzutsa ndi 1.5-2.5 U / 1 XE. kwa nkhomaliro - 0.5-1.5 U / 1 XE, kwa chakudya chamadzulo 1-2 U / 1 XE.

Ndi Normoglycemia, ICD imangoperekedwa ngati chakudya, ndi hyperglycemia, insulin yowonjezera imayambitsidwa kuti ikonzedwe.

Mwachitsanzo, m'mawa wodwala amakhala ndi shuga wa 5.3 mmol / L, akukonzekera kudya 4 XE, zomwe amafunikira insulin asanadye kadzutsa ndi 2 U / XE.Wodwala amayenera kupereka zigawo 8 za insulin.

Pachithandizo cha insulin chachikhalidwe, mlingo wa ICD umagawika m'magawo awiri - 2/3 imayendetsedwa musanadye chakudya cham'mawa ndipo 1/3 imayendetsedwa musanadye chakudya chamadzulo (ngati SDDS ili magawo 48, ndiye kuti ICD ndi magawo 32, ndipo asanadye chakudya cham'mawa, mayunitsi 22 amaperekedwa, komanso pamaso paineine magawo 10) , kapena mlingo wa ICD umagawika pafupifupi magawo atatu omwe amaperekedwa asanadye kwambiri. Kuchuluka kwa XE pachakudya chilichonse kumakhala kokhazikika.

Kuwerengeredwa kwa kuchuluka kwa XE

Zakudya zamtundu woyamba wa shuga ndi zaumoyo isocaloric, cholinga chake ndikuwonetsetsa kukula komanso kukhazikika kwa mathupi onse.

Zakudya za tsiku ndi tsiku zopatsa mphamvu - kulemera koyenera kwa thupi X X

X - kuchuluka kwa mphamvu / makilogalamu kutengera mphamvu ya wodwala

32 kcal / kg - zolimbitsa thupi zolimbitsa

40 kcal / kg - pafupifupi zolimbitsa thupi

48 kcal / kg - zolimbitsa thupi

Kulemera kwa thupi (M) = kutalika (masentimita) - 100

Kulemera kwa thupi (W) = kutalika (masentimita) - 100 - 10%

Mwachitsanzo, wodwala amagwira ntchito yosungirako ndalama kubanki yosungirako ndalama. Kutalika kwa wodwala ndi masentimita 167. Kenako thupi lake labwino ndi 167-100-6.7, i.e. pafupifupi 60 makilogalamu, poganizira zolimbitsa thupi zochitika zina, zopatsa mphamvu za tsiku ndi tsiku za chakudya chake ndi 60 x 32 = 1900 kcal.

Kudya kalori tsiku ndi tsiku ndi 55 - 60% ya chakudya

Pomwepo, gawo la chakudya chamoto ndi 1900 x 0,55 = 1045 kcal, ndiye 261 g yama chakudya. IXE = 12 g wama chakudya, i.e. wodwala amatha kudya 261 tsiku lililonse. 12 = 21 XE.

Ine.e. pa chakudya cham'mawa komanso chakudya chamadzulo, wodwala wathu amatha kudya 4-5 XE, chakudya chamasana 6-7 XE, zokhwasula-khwasula 1-2 XE (makamaka osapitirira 1.5 XE). Komabe, ndi regimen yowonjezera ya insulin, kugawa kovuta kwa zakudya sikofunikira.

Njira yophatikiza ya mankhwala a insulin imaphatikizira kuyanjana kwa insulin yonse mu jakisoni imodzi ndipo imatchedwa setso insulin. Ubwino waukulu wa njirayi ndikuchepetsa kuchuluka kwa jakisoni pang'ono (1-3 patsiku).

Choipa cha mankhwala a insulini yachikhalidwe ndikuchepa kwa kuthekera kwa kutsanzira kwathunthu kwachilengedwe cha kapamba. Zolakwika izi sizimalola kuperekera kwathunthu chakudya cha odwala omwe ali ndi matenda a shuga 1, chithandizo cha insulin pamenepa sichithandiza.

Njira yophatikizira mankhwala a insulin pankhaniyi imawoneka ngati iyi: wodwalayo amalandira jakisoni 1-2 patsiku, nthawi yomweyo amadzibaya ndi kukonzekera kwa insulini (izi zimaphatikizapo ma insulin apafupi komanso osakhalitsa).

Kutalika kwapakatikati kumapangitsa inshuwaransi pafupifupi 2/3 ya kuchuluka kwa mankhwalawa, 1/3 ya insulin yayifupi.

Ndikofunikira kunena za pampu ya insulin. Pampu ya insulin ndi mtundu wa chinthu chamagetsi chomwe chimapereka ma insulin mozungulira nthawi yayitali komanso nthawi yayifupi.

Njira imeneyi imatchedwa pump insulin therapy. Pampu ya insulin imagwira ntchito m'njira zosiyanasiyana zoperekera mankhwala.

1. Kupitiliza kosalekeza kwa mahomoni a pancreatic omwe ali ndi microdoses yoyendetsa kuthamanga kwa thupi.
2. Kuthamanga kwa Bolus - wodwalayo amatha kukonza kuchuluka ndi kuchuluka kwa mankhwala a insulini ndi manja ake.

Akalembetsedwa koyamba akagwiritsidwa ntchito, kumbuyo kwa insulin katulutsidwe kamapangidwa, zomwe zimapangitsa kuti m'malo mwake pakhale kugwiritsa ntchito mankhwala omwe amapezeka nthawi yayitali. Kugwiritsidwa ntchito kwa regimen yachiwiri ndikofunikira pakudya musanadye kapena panthawi yomwe index ya glycemic ikwera.

Momwe mawonekedwe a bolus amayatsidwa, chithandizo chogwiritsira ntchito insulin chimapereka mwayi wosintha insulin yamitundu yosiyanasiyana.

Zofunika! Ndi kuphatikiza kwa mitundu yomwe ili pamwambapa, kuyerekeza kwakukulu kwazomwe zimachitika pachitetezo cha insulin ndi kapamba wamoyo ndizotheka. Woperekera catheter asinthe osachepera kamodzi mu tsiku la 3.

Malangizo a odwala omwe ali ndi matenda amtundu wa 1 amathandiza kuti pakhale mankhwala oyambira 1-2 pa tsiku, ndipo asanadye - chakudya. Mtundu woyamba wa shuga, mankhwala a insulini amayenera kusintha kwathunthu kupangika kwa mahomoni omwe amapanga kapamba wa munthu wathanzi.

Kuphatikiza kwa mitundu yonseyi kumatchedwa "basic-bolus therapy", kapena regimen yokhala ndi jakisoni angapo. Imodzi mwa mitundu ya mankhwalawa ndi othandiza kwambiri ku insulin.

Chiwembu ndi Mlingo, poganizira umunthu wake ndi zovuta zake, wodwala ayenera kusankha dokotala. Mankhwala oyambira nthawi zambiri amatenga 30-50% ya okwanira tsiku lililonse. Kuwerengera kwa inshuwaransi yoyenera kuchuluka kwa insulin kumawonekera payekha.

Chithandizo cha insulin, monga china chilichonse, chimatha kukhala ndi zotsutsana komanso zovuta. Maonekedwe a thupi lawo siligwirizana pamalo a jakisoni ndi zitsanzo zowoneka bwino za zovuta za insulin.

Insulin yokhala ndi matenda a shuga a 2 sagwiritsidwa ntchito kawirikawiri, chifukwa matendawa amakhudzana kwambiri ndi zovuta za metabolic m'malo ocheperako poyerekeza ndi insulin. Nthawi zambiri, timadzi timeneti timapangidwa ndi ma cell a pancreatic beta.

Ndipo, monga ulamuliro, wokhala ndi matenda amtundu wa 2, amagwira ntchito pafupipafupi. Mwazi wamagazi ukuwonjezeka chifukwa cha kukana insulini, ndiko kuti, kuchepa kwa chidwi cha minofu kufikira insulin.

Zotsatira zake, shuga sangalowe m'magazi am'magazi, mmalo mwake, amadziunjikira m'magazi.

Mtundu wachiwiri wa matenda ashuga komanso kusintha pafupipafupi m'magazi a shuga, maselo amenewa amatha kufa kapena kufooketsa zomwe amagwira. Pankhaniyi, kuti athetse vuto, wodwalayo amayenera kupweteka kwakanthawi kapena kubwereza insulin.

Komanso, jakisoni wa mahomoni angafunike kuti thupi likhalebe lolimba panthawi yofalitsa matenda opatsirana, omwe ndi mayeso enieni a chitetezo cha matenda ashuga. Kapamba pakadali pano atha kutulutsa insulin yokwanira, popeza imathanso chifukwa chakumwa thupi.

Ndikofunikira kumvetsetsa kuti nthawi zambiri, jakisoni wa mahomoni omwe ali ndi shuga osadalira insulin amakhala osakhalitsa. Ndipo ngati adotolo akuvomereza mtundu uwu wa zamankhwala, simungayesere kusintha ndi china chake.

Mu mtundu wofatsa wa matenda a shuga a 2, odwala nthawi zambiri samatha mapiritsi ochepetsa shuga. Amayendetsa matendawa pokhapokha mothandizidwa ndi zakudya zapadera komanso kuchita masewera olimbitsa thupi mopepuka, osayiwala mayeso omwe adokotala amakhala nawo komanso kuyezetsa magazi.

Koma munthawi imeneyi pomwe insulin imalembedwa kuti ichotse khungu kwakanthawi, ndibwino kutsatira malangizowo kuti akhalebe osunga matendawa mtsogolo.

Zambiri

Kukonzekera koyambirira kwa insulin kunachokera kwa nyama. Zinapezeka kuchokera kapamba wa nkhumba ndi ng'ombe.

M'zaka zaposachedwa, kukonzekera kwa insulin ya anthu kwakhala kukugwiritsidwa ntchito. Zotsirizira izi zimapezedwa ndi ma genetic engineering, kukakamiza mabakiteriya kuti apange insulin yofanana ndi mankhwala omwe amapangidwira insulin yaumunthu (i.e. sichinthu chachilendo kwa thupi).

Tsopano ma genetic opanga ma insulin a mankhwalawa ndi mankhwala osankha mankhwalawa odwala onse omwe ali ndi matenda osokoneza bongo, kuphatikizapo mtundu 2.

Malinga ndi nthawi yochitapo kanthu, zosungira zazifupi komanso zazitali (zazitali) zimasiyanitsidwa.

Chithunzi 7. Chithunzi chochepa cha insulin

Kukonzekera kwa insulin pang'ono (komwe kumatchedwanso insulin) kumakhala kowonekera nthawi zonse. Mbiri ya kukonzekera kwakanthaŵi kwa insulin ndi motere: kuyamba mu mphindi 15-30.

, pachimake patatha maola 2-4, kutha pambuyo pa maola 6, ngakhale m'njira zambiri zofunikira za machitidwe zimadalira mlingo: wocheperako mlingo, wafupikitsa kuchitako (onani mkuyu.

7). Podziwa magawo awa, titha kunena kuti insulin yochepa iyenera kuperekedwa pakadutsa mphindi 30.

musanadye, kuti mphamvu zake zigwirizane ndi kukwera kwa shuga.

Posachedwa, kukonzekera kwa ultrashort kwawonekeranso, zomwe zimatchedwa insulin analogs, mwachitsanzo Humalog kapena Novorapid. Mbiri yawo ya zochita ndi yosiyana pang'ono ndi insulin yochepa.

Amayamba kuchitapo kanthu pafupipafupi pambuyo pa kupangika (mphindi 5 mpaka 15), zomwe zimapatsa wodwala mwayi woti asayang'anitse nthawi yayitali pakati pa jakisoni ndi zakudya, koma kumuperekera nthawi yomweyo musanadye (onani

mkuyu. 8).

Kuchuluka kwa zochitika kumachitika pambuyo pa maola 1-2, ndipo kuchuluka kwa insulin pakadali pano kumakhala kwakukulu poyerekeza ndi insulin yachilendo.

Chithunzi 8. Mbiri yochepa ya insulin

Izi zimawonjezera mwayi wokhala ndi shuga wokwanira magazi mutatha kudya. Pomaliza, mphamvu yake imatha mkati mwa maola 4-5, omwe amakupatsani mwayi kuti musakane zakudya zapakatikati ngati mukufuna, osakhala pachiwopsezo cha hypoglycemia. Chifukwa chake, zochitika za tsiku ndi tsiku za munthu zimasinthasintha.

Chithunzi 9. Mbiri ya Insulin Yapakatikati

Kukonzekera kwa insulin kwa nthawi yayitali (kwa nthawi yayitali) kumapezeka ndi kuwonjezera zinthu zina za insulini zomwe zimachepetsa kuyamwa kwa insulin pansi pa khungu. Kuchokera pagululi pano amagwiritsa ntchito mankhwala a nthawi yayitali. Mbiri yamachitidwe awo ndi motere: kuyambira - pambuyo pa maola 2, pachimake - pambuyo maola 6-10, kutha - pambuyo maola 12-16 kutengera mlingo (onani mkuyu 9).

Anulin a insulini okhalitsa amapezeka mwa kusintha kapangidwe ka insulin. Amawonekera, motero, safuna kusakanizika musanalowe. Mwa iwo, fanizo la nthawi yayitali yochitapo kanthu limasiyanitsidwa, mawonekedwe amomwe akufanana ndi mbiri ya NPH-insulin. Izi zikuphatikiza Levemir, yemwe ali ndi kudziwiratu kopambana.

Chithunzi 10. Mbiri ya insulin yosakanikirana yomwe imakhala ndi 30% yochepa yochita insulin

Lantus ndi analogue yomwe imagwira ntchito kwa nthawi yayitali, yomwe imagwira ntchito kwa maola 24, motero imatha kutumizidwa kamodzi patsiku monga insal insulin. Mulibe chiwopsezo chochita, chifukwa chake, kugona kwa hypoglycemia usiku komanso pakati pa chakudya kumachepetsedwa.

Pomaliza, pali zosakanikirana (zosakanikirana) zomwe nthawi imodzimodzi zimakhala ndi insulin yaifupi kapena ya ultrashort zochita komanso nthawi yayitali yochitapo kanthu. Kuphatikiza apo, ma insulini amenewo amapangidwa ndi zigawo zingapo "zazifupi" ndi "lalitali": kuyambira 10/90% mpaka 50/50%.

Chithunzi 11. Chitetezo cha insulin wamba

Chifukwa chake, mbiri ya insulin imeneyi imakhala ndi mbiri yolingana ya ma insulin omwe amapanga mawonekedwe awo, komanso kuopsa kwa zotsatirazi kumatengera kuchuluka kwake (onani mkuyu. 10).

Kuchulukana kwa insulin kumatengera ndi gawo liti la singano lomwe limalowa. Jakisoni wa insulin amayenera kuperekedwa nthawi zonse mu mafuta amkati, koma osatinso mwachidwi osati kudzera mu intramuscularly (onani.

mkuyu 16). Pofuna kuchepetsa mwayi wolowa m'matumbo, odwala omwe ali ndi kulemera kwabwinobwino, tikulimbikitsidwa kugwiritsa ntchito ma syringe ndi ma syringe ndi singano zazifupi - 8 mm kutalika (singano yachikhalidwe imakhala kutalika pafupifupi 12-13 mm).

Kuphatikiza apo, singano izi ndizowonda pang'ono, zomwe zimachepetsa ululu panthawi ya jakisoni.

Chithunzi 16. Kukonzekera kwa insulini ndi singano zamautali osiyanasiyana (singano: 8-10 mm ndi 12-13 mm)

Chithunzi 17. Molondola komanso molakwika khungu

1. Amasuleni malo pakhungu lomwe insulin ingalowe.

Pukutani ndi mowa malo a jakisoni sofunikira. 2

Ndi chala chachikulu ndi chofiyira, tengani khungu ndikutulutsa (onani. Mkuyu.)

17). Izi zimachitidwanso kuti muchepetse mwayi wolowa mu minofu.

3. Ikani singano pamunsi pa khungu pang'onopang'ono mpaka pakhungu kapena madigiri 45.

4. Popanda kumasula khola, sinikizani syringe plunger njira yonse.

5.Yembekezani masekondi angapo pambuyo poti insulini yabayidwa, ndiye kuti muchotsere singano.

Mavuto a Insulin Therapy

Pali zikhulupiriro zambiri zabodza kuzungulira insulin. Ambiri a iwo ndi mabodza komanso kukokomeza. Inde, jakisoni watsiku ndi tsiku amabweretsa mantha, ndipo maso ake ndi akulu. Komabe, pali choona chimodzi choona. Kwenikweni ndikuti insulin imatsogolera ku chidzalo. Zowonadi, mapuloteni awa okhala ndi moyo wongokhala amatsogolera ku kuwonjezeka, koma amatha motero.

Onetsetsani kuti muli ndi matenda otere. Pankhaniyi, kusunthaku ndi njira yabwino yopeweretsera kukwanira, komanso kuthandizanso kudzutsanso chikondi cha moyo ndikusokoneza zovuta zokhudzana ndi kuzindikira kwanu.

Ndikofunikanso kukumbukira kuti insulin siyimasungidwa chakudyacho. Ngakhale shuga atakhala wabwinobwino, nthawi zonse muyenera kukumbukira kuti mumakonda matendawa ndipo simungathe kumasuka ndikulola china chilichonse kuwonjezedwa pachakudya.

Insulin ndi othandizira kukula kwa minofu, kuchititsa kuti magawo a cell agulitsidwe. Ndi kuchepa kwamphamvu kwa insulin, chiopsezo cha zotupa zam'mawere zimawonjezeka, pomwe chimodzi mwazinthu zowopsa ndizovuta zamtundu wamtundu wa matenda ashuga a 2 ndi mafuta a m'magazi ambiri, ndipo monga mukudziwa, kunenepa kwambiri komanso matenda a shuga nthawi zonse zimayendera limodzi.

Kuphatikiza apo, insulin ndiyo imayang'anira kusungidwa kwa magnesium mkati mwa maselo. Magnesium ali ndi katundu wopumula khoma lamitsempha. Poyang'aniridwa ndi chidwi ndi insulin, magnesium imayamba kuchotsedwa m'thupi, ndipo sodium, m'malo mwake, imachedwa, zomwe zimayambitsa kuchepa kwa ziwiya.

Udindo wa insulini pakukula kwa matenda angapo umatsimikiziridwa, pomwe, posakhala chifukwa chawo, umapanga nyengo zoyenera:

1. Matenda oopsa.
2. Matenda a oncological.
3. Njira zotupa zosafunikira.
4. Matenda a Alzheimer's.
5. Myopia.
6. Matenda oopsa a ubongo amayamba chifukwa cha insulin pa impso ndi mantha. Nthawi zambiri, pansi pa insulin, vasodilation imachitika, koma zikhalidwe la kutaya chidwi, dipatimenti yachifundo yokhudzana ndi machitidwe amanjenje imagwira ntchito komanso ziwiya zopapatiza, zomwe zimabweretsa kuthamanga kwa magazi.
7. Insulin imathandizira kupanga zotupa - ma enzymes omwe amathandizira njira yotupa ndipo amalepheretsa kaphatikizidwe ka adiponectin ya mahomoni, omwe ali ndi anti-yotupa.
8. Pali maphunziro omwe akuwonetsa gawo la insulin pakukula kwa matenda a Alzheimer's. Malinga ndi lingaliro lina, puloteni wapadera amapangidwa m'thupi lomwe limateteza maselo muubongo kuti atulutsidwe ndi minyewa ya amyloid. Ndizinthu izi - amyloid, zomwe zimapangitsa kuti ma cell a ubongo atha kugwira ntchito yawo.

Mapuloteni omwewo amateteza kuchuluka kwa insulin m'magazi. Chifukwa chake, pakuwonjezeka kwa insulin, mphamvu zonse zimagwiritsidwa ntchito pakuchepa kwake ndipo ubongo umakhalabe wopanda chitetezo.

Kuyang'ana kwambiri kwa insulin m'magazi kumapangitsa kuti pakhale vuto la m'maso, zomwe zimachepetsa kuthekera kwazowoneka bwino.

Kuphatikiza apo, pakhala kupitapo pafupipafupi kwa myopia mu mtundu 2 wa matenda a shuga komanso kunenepa kwambiri.

Wodwala matenda ashuga yemwe amadziwa zomwe zili ndi matenda osokoneza bongo ayenera kuchita chilichonse kuti apewe zovuta. Mu shuga, mitundu itatu yamavuto amadziwika:

• Limbi pafupi.
• Wodwala / Womwalira Fr.
• Wolemetsa / Womaliza Fr.

Zowonjezera: Zakudya Zopatsa Thupi ndi Zosewera

Mudazindikira kuti amapangira jakisoni, momwe mungasankhire mankhwala, ndipo mukafunikira kuchita izi, lingalirani mfundo zazikulu pakuchiritsa matenda. Tsoka ilo, ndizosatheka kuthetsa matenda ashuga kwamuyaya. Chifukwa chake, njira yokhayo yowonjezera chiyembekezo cha moyo komanso kuchepetsa zovuta za jakisoni.

Kodi insulin ingavulaze bwanji? Pali vuto linalake pakuthandizira kwa mtundu wachiwiri wa matenda osokoneza bongo kudzera m'mahomoni.Chowonadi ndi chakuti mukapaka jakisoni, zimayambitsa mapaundi owonjezera.

Matenda a shuga a Type 2 pa insulin ndi chiopsezo cha kunenepa kwambiri, motero ndikulimbikitsidwa kuti wodwalayo azichita nawo zamasewera kuti awonjezere chidwi cha minofu yofewa. Kuti ntchito ya mankhwalawa ikhale yothandiza, chisamaliro chapadera chimaperekedwa ku zakudya.

Ngati mukunenepa kwambiri, ndikofunikira kutsatira zakudya zamafuta ochepa, kuchepetsa kuchuluka kwamafuta ndi chakudya pamenyu. Mankhwalawa amayenera kuikidwa poyang'anira zakudya zanu, shuga amayenera kuwerengedwa kangapo patsiku.

Chithandizo cha matenda a shuga a mtundu wachiwiri ndi njira yovuta kwambiri, yomwe zakudya ndi masewera, ngakhale ndi kukhazikika kwa glycemia wofunikira.

Zambiri za matenda a shuga a Type 2 amaperekedwa mu kanema munkhaniyi.

Ndi matenda a shuga amtundu uliwonse, kupatula mankhwala a insulin, ndikofunikira kuti wodwala azitsatira zakudya. Mfundo zachikhalidwe zochizira odwala ndizofanana kwa odwala omwe ali ndi mitundu yosiyanasiyana ya matendawa, komabe pali zovuta zina. Odwala omwe ali ndi matenda a shuga omwe amadalira insulin, zakudya zake zingakhale zochulukirapo, popeza amalandila timadzi timeneti kuchokera kunja.

Ndi chithandizo chosankhidwa bwino komanso matenda opatsirana bwino a shuga, munthu amatha kudya pafupifupi chilichonse. Zachidziwikire, timangolankhula zokhazokha komanso zopangidwa mwachilengedwe, popeza zakudya zosavuta ndi zakudya zopanda pake siziperekedwa kwa odwala onse. Nthawi yomweyo, ndikofunikira kuperekera insulin kwa odwala matenda ashuga ndikutha kuwerengera moyenera kuchuluka kwa mankhwalawa, kutengera kuchuluka kwa chakudya.

Maziko a odwala omwe amapezeka ndi matenda a metabolic ayenera kukhala:

• Masamba atsopano ndi zipatso zokhala ndi chisonyezo chotsika kapena chapakati cha glycemic,
• mafuta ochepa mkaka,
• chimanga chokhala ndi chakudya pang'onopang'ono pakupanga,
• kudya nyama ndi nsomba.

Anthu odwala matenda ashuga omwe amathandizidwa ndi insulin nthawi zina amatha kugula buledi ndi maswiti achilengedwe (ngati alibe matendawa). Odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga ayenera kutsatira zakudya zowonjezera, chifukwa momwemo ndi zakudya zomwe ndizo maziko a chithandizo.