Otsatirawa akufotokozera momwe mungawerengere Mlingo wa insulin yofulumira (yochepa komanso ya ultrashort) musanadye, komanso m'malo omwe muyenera kuthana ndi shuga. Njira zowerengetsera mlingo zomwe zafotokozedwa patsamba lino zidapangidwa ndi Dr. Bernstein, yemwe wakhala ndi matenda ashuga amtundu 1 kwa zaka zopitilira 70. Njira izi ndizosavuta. Amafuna nthawi komanso khama kuchokera kwa odwala matenda ashuga. Ndikofunikira kuyeza shuga osachepera kanayi pa tsiku ndikutha kugwira ntchito ndi zomwe mwalandira. Musati musambe musanadye okhazikika, nthawi zonse mlingo womwewo wa insulin. Kugwiritsa ntchito njira zapamwamba kwambiri zopewera matenda ashuga kumakupatsani shuga 3.9-5.5 mmol / L khola maola 24 tsiku lililonse, ngakhale mutakhala ndi matenda osokoneza bongo a 1 odwala akulu ndi ana, makamaka makamaka ndi mtundu wachiwiri wa shuga. Izi zimapereka chitetezo cha 100% ku zovuta.

Musanayambe kuwerengera, werengani kanema wa Dr. Bernstein. Dziwani chifukwa chachikulu chomwe, pogwiritsa ntchito insulin, shuga amalumpha mwa akulu ndi ana omwe ali ndi matenda ashuga. Ndiosavuta kuthetsa, ndipo izi zithandiza kusintha zotsatira za mankhwalawa. Mvetsetsani momwe mungapangire menyu, sankhani moyenera mlingo wa insulin ndi nthawi ya jakisoni musanadye.

Choyamba, muyenera kusinthana ndi zakudya zamafuta ochepa. Ngati simukufuna kusintha zakudya zamagulu onse ndipo muyenera kudzisamalira nokha, mutha kugwiritsa ntchito njira zosavuta zowerengera kuchuluka kwa insulin yomwe dokotala angakuuzeni. Komabe, musadabwe kuti shuga yanu idzadumpha, simumva bwino, ndipo m'kupita kwanthawi, mavuto osaneneka amadzimverera. Miyendo, impso, kapena maso amatha kukhudzidwa. Ana odwala matenda ashuga omwe amathandizidwa molingana ndi njira zoyenera zotsalira anzawo wathanzi pakukula ndi kukula. Izi zatsimikiziridwa ndi maphunziro ambiri. Werengani nkhani ya "Matenda a shuga mu Ana" kuti mumve zambiri.

Choyamba, pezani momwe mungasankhire kuchuluka kwa insulini yowonjezera usiku ndi m'mawa. Mtundu wachiwiri wa matenda ashuga, jakisoni wa insulini yowonjezera nthawi zambiri imakhala yokwanira, ndipo mankhwala omwe amapangidwa mwachangu amatha kuthandizidwa. Ndi insulin iti yomwe mungasankhe, momwe mitundu yake yosiyanasiyana imasiyanirana - onani nkhani "Mitundu ya Insulin ndi Zotsatira Zake".

Odwala omwe ali ndi matenda amtundu wa 2 komanso mtundu woyamba wa shuga, omwe amatsata zakudya zamafuta ochepa, nthawi zambiri amafunika ma insulin 2-8 nthawi yotsika kuposa momwe madokotala amagwiritsidwira ntchito. Izi zikugwira ntchito kwa onse achikulire odwala ndi odwala matenda ashuga. Kupereka Mlingo wokhazikika womwe ungayambitse hypoglycemia (shuga m'magazi). Chifukwa chake, kuwerengetsa kwa milingo kuyenera kukhala njira imodzi.

Kuwerengeredwa kwa mankhwala a insulin musanadye: Tsatanetsatane wambiri

Pakati pa chakudya, kapamba wathanzi amatulutsa ndikusunga insulin. Imabisitsa timadzi tambiri m'magazi mosalekeza, koma gawo lalikulu limasungidwa. Ikakwana nthawi yoti amwe chakudya, kapamba amatulutsanso Mlingo waukulu wa insulin yokonzekereratu mkati mwa mphindi 2-5. Chifukwa cha izi, kuchuluka kwa glucose m'magazi kumangobwerera mwachangu. Tsoka ilo, odwala omwe ali ndi shuga yocheperako kwambiri alibe nkhokwe. Chifukwa cha izi, shuga mutatha kudya amakhalanso okwera kwa nthawi yayitali, zomwe zimayambitsa kukula kwa zovuta. Jekeseni wa mankhwala ogwiritsira ntchito mwachangu (amafupikitsidwa komanso owonjezera-mwachidule) musanadye zakudya kuti apangire vutoli. Mfundo zotsatirazi momwe mungawerengere Mlingo.

Kutulutsa mwachangu milingo yayikulu ya insulin m'magazi kumatchedwa bolus. Zimachitika chakudya ndi kukonza. Chakudya chamadyerero chimapangidwa kuti azitha kudya zakudya zomwe zadyedwa. Kuwongolera - kubwezeretsa shuga kukhala wabwinobwino ngati wokwezedwa panthawi ya jakisoni. Mlingo wa insulin yochepa musanadye chakudya ndi kuchuluka kwa zakudya komanso kukonza.

Zakudya Zabwino

Pakufunika, muyenera kudziwa zonse ziwiri. Munthawi yabwino, shuga musanadye zakudya zili pamtunda wa 4,5-5,5 mmol / l, motero, sayenera kukonzekera.Izi zimachitika kawirikawiri kwa anthu odwala matenda ashuga omwe amatsatira malangizo a Dr. Bernstein. Koma musayembekezere kuti nthawi iliyonse idzakhala yopanga popanda kuwongolera.

Dia masamu. Kuwerengedwa kwa mlingo wa kukonzekera shuga. Carbohydrate coefficients ndi insulin sensitivity factor.

Anthu ambiri odwala matenda ashuga a ADULT akudziwa angati magawo a insulini amayenera kuperekedwa kuti muchepetse shuga, koma cholakwa cha muyezo nthawi zambiri chimayambitsa hypoglycemia kapena samachepetsa shuga lokwanira.

KWA ATSOGOLO a Ana NDIMALANDIRATsitsani ndikuwerenga buku CEREFULLY http://www.test-poloska.ru/novosti/opublikovana-besplatnaya-kniga-insulinovaya-pompa/

Mtundu uliwonse wa matenda ashuga 1 ayenera kukhala ndi chiwerengero chake cha insulin, chofunikira kuti achepetse shuga. Kukonza shuga kwamwazi kumachitika nthawi zambiri chakudya chotsatira chisanachitike. Insulin yomwe timapangira chakudya imatchedwa prandial kapena bolus.

POPHUNZITSIRA KUTI AKHALE OGWIRITSA NTCHITO AKUFUNIKIRA:

​1.EGENCIA GLYCEMIA (AH) - shuga wamagazi pakadali pano.

2. TARGET GLYCEMIA (TG) - mulingo wa shuga wamwazi womwe wodwala aliyense ayenera kuyesetsa. CG iyenera kuvomerezedwa ndi dokotala, poganizira za matenda ashuga, zaka, matenda omwe ali ndi vuto, mwachitsanzo, ana ndi odwala matenda ashuga omwe ali ndi nthawi yochepa yamatenda amalimbikitsidwa 6-6 CG chifukwa cha kutengera kwawo kwa hypoglycemia, komwe ndi kowopsa kuposa shuga.

3. DZIWANI LA ​​KUDZIPEREKA KWA INSULIN (PSI) - chikuwonetsa kuchuluka kwa mmol / l kutsitsa shuga 1 magazi aifupi kapena a insulin.

Njira zowerengera PSF:

ULTRA SHORT (fanizo la insulin yaumunthu) HUMALOG, NOVORAPID, APIDRA
100: LED = X mmol / L

ZOCHULUKA ZOPANDA CHITSITSO - ACTRAPID NM, HUMULIN R, RAPID
83: LED = X mmol / L

100 ndi 83 ndizopanga zomwe zimapangidwa ndi omwe amapanga insulin potengera zaka zambiri za kafukufuku.
LED - chonse Ndiweft Doz za zonse NdipoNsulin - ndi bolus (chakudya) ndi basal. Mwachiwonekere, ndi chithandizo chosinthika cha insulin, SDI sichikhala chokhazikika. Chifukwa chake, kuwerengera kumatenga pafupifupi masamu a SDI ochepa, masiku 3-7. Mwachitsanzo, munthu amapanga magawo 10 + 8 + 6 patsiku. insulin yochepa ndi 30 mayunitsi. kukulitsidwa. Chifukwa chake tsiku lililonse insulin (SDI) ya tsiku ndi tsiku ndi 24 + 30 = 54. Koma, kangapo mlingo waufupi unali wapamwamba kapena wotsika, ndipo magawo 48-56 amatulutsidwa. patsiku. Chifukwa chake, ndizomveka kuwerengera masamu amatanthauza SDI kwa masiku 3-7.

4. KULIMA KWA COBOHYDRATE (UK) - ikuwonetsa kuchuluka kwama protein a prandial insulin omwe amayenera kuyamwa 12 g yamafuta (1 XE). Ndikukumbusani kuti timatcha prandial yochepa kapena ultrashort insulin. M'mayiko osiyanasiyana 1 XE amatenga 12,5 g wamafuta, pomwe 15 g, pomwe 10 g. Ndimayang'ana kwambiri pazotsatira zomwe zimalimbikitsidwa kusukulu yanga ya matenda ashuga - 1 XE = 12 g yama chakudya.

WONSE KWAMBIRI , timayamba kusankha ma coefficients a carbohydrate malinga ndi momwe Mlingo wa insulin yomwe muli nayo ulondola, ndipo insulin ya basal siyikutsogolera kusinthasintha kwakuthwa kwa chakudya cha glycemia OUTSIDE.

MALANGIZO A BASAL INSULIN Amasankhidwa PAKATI PA BASAL TESTES werengani zambiri mu zolemba

Kwa odwala omwe ali ndi zolembera za syringe

ndi ma pomponos http://moidiabet.ru/blog/podbor-bazalnoi-skorosti-na-pompe

Momwe MUNGATANIre KUTI MUZIKHALA NDI MOYO WABWINO KWAMBIRI

12: (500: SDI) = Dongosolo LAKUYENDA.

Ndimalongosola momwe zimachitikira

1. Opanga insulin adayika "Rule 500", malinga ndi momwe, ngati mungagawe nambala 500 ndi SDI - mlingo wa insulin (basal + prandial patsiku) tsiku lililonse, tidzapeza Nambala ya CARBOHYDRATES, yomwe imatha kuyamwa 1 unit ya prandial insulin.

ZOFUNIKIRA mumvetsetse kuti mu "ulamuliro 500" timaganizira za insulin yonse ya tsiku ndi tsiku, koma chifukwa chake timalandira kufunikira kwa 1 XE ya prandial insulin. "500" ndichokhazikika chochokera ku zaka zakafukufuku.

(500: SDI) = kuchuluka kwa magalamu amafuta am'madzi omwe gawo limodzi likufunika. insulin

2. Kenako mutha kuwerengetsa zigawo zingati. timafunikira insulin pa 1 XE.Pa 1 XE titenga chakudya chamagulu 12, titi, ngati titha kugawanitsa 12 ndi chiwerengero chomwe talandira kuchokera ku 500, tiwerenga UK yathu. Ine.e. Mutha kugwiritsa ntchito njira zotsatirazi:

12: (500: SDI) = UK wanu woyesedwa.

CHITSANZO: Munthu amapanga magawo 30 a insulin yochepa ndi 20 basal patsiku, zomwe zikutanthauza
SDI = 50, timawerengera UK = 12: (500: 50) = 12:10 = magawo 1,2 pa 1 XE

UK = 12: (500: 25) = 0,6 magawo pa 1 XE

Zofunika! Ngati mlingo wa insulin wa tsiku ndi tsiku sikhala wokhazikika, kusintha chifukwa cha insulin, ndikofunikira kutenga kachulukidwe ka SDI kwa masiku angapo kuti muwerenge CC.

Zofunika! Kuti mugwiritse ntchito bwino Code ya Criminal pochita, muyenera kudziwa kuti kufunika kwa insulin kumasiyana tsiku lonse. Kwambiri - pakudya cham'mawa, pafupifupi - pakudya nkhomaliro komanso kotsika - pa chakudya chamadzulo. Asayansi, kutengera zaka za kafukufuku, apeza kuti ambiri ATSOGOLO Anthu aku UK Criminal Code ndi pafupifupi:

Chakudya cham'mawa 2,5 - 3 mayunitsi. insulin pa 1XE

Kwa nkhomaliro 2 - 1.5 mayunitsi. pa 1XE

Chakudya chamadzulo, 1.5 - 1 mayunitsi. pa 1XE

Kutengera UK wanu, wowerengeka ndi kakhalidwe ndikuganizira kufunika kwa insulin masana, mutha kusankha chidziwitso chanu molondola. Kuti muchite izi, ndikofunikira kuyendetsa shuga m'magazi (SC) musanadye komanso maola awiri mutatha kudya. SC yoyambirira isanadye iyenera kukhala yoposa 6.5 mmol / L. Maola awiri mutatha kudya, SC iyenera kuwonjezeka ndi 2 mmol, koma osapitilira zovomerezeka za 7.8, komanso chakudya chotsatira chisanachitike choyambirira. Kusinthasintha kwakololedwa - 0,5 - 1 mmol. Ngati SC isanadye chakudya chotsatira NDI CHAKUDYA choyambirira, kapena panali hypoglycemia, ndiye kuti insulini DOSE inali yayikulu, i.e. Nambala yamilandu idatengedwa kuposa momwe ikufunikira, ndipo iyenera kuchepetsedwa. Ngati SC chakudya chotsatira chisanakhale chambiri kuposa choyambirira, ndiye kuti insulini inali yosakwanira, mwanjira iyi timachulukitsa CC.

Zofunika! Kusintha Mlingo wa insulin yochepa kumachitika chifukwa cha masiku atatu akuwongolera. Ngati vuto (hypoglycemia kapena shuga wambiri) libwerezedwa masiku atatu m'malo omwewo, sinthani mlingo. Sitimapanga zisankho pakuwonjezereka kwa episodic imodzi ya shuga.

SK musanadye nkhomaliro ndi chakudya cham'mawa 4.5-6.5, zomwe zikutanthauza kuti mlingo wa insulin pakudya cham'mawa komanso masana amasankhidwa molondola

SC isanadye nkhomaliro ndi CAKUTI kuposa chakudya cham'mawa chisanafike - onjezani kuchuluka kwa insulin yaifupi

SC musanadye chakudya chamadzulo NGAKHALE kuposa chakudya chamasana - onjezani kuchuluka kwa insulin yayifupi

SK musanagone (maola 5 mutadya chakudya chamadzulo) KWAMBIRI kuposa musanadye chakudya - onjezani kuchuluka kwa insulin yayifupi.

SK musanadye chakudya cham'mawa BELOW kuposa chakudya cham'mawa musanadye - muchepetse kuchuluka kwa insulin yochepa

SC musanadye BELOW kuposa chakudya chamasana - chepetsani kuchuluka kwa insulin yayifupi

SK musanagone (maola 5 mutatha kudya chakudya) CHABWINO kuposa musanadye - muchepetse insulin yochepa chakudya chamadzulo.

Kuthamanga shuga m'magazi kumadalira tsiku la basal insulin.

SC imachulukitsidwa musanadye kadzutsa - timayang'ana shuga usiku 1.00,3.00,6.00, ngati tili ndi hypogemic, timachepetsa mlingo wamadzulo wa insulini yowonjezera, ngati SK ndi yayikulu, timachulukitsa mlingo wamadzulo wa insulin yowonjezera. Pa lantus - sinthani mlingo wonse.

Ngati shuga m'magazi agwera pamwambapa, mutha kungogawa kuchuluka kwa insulini yochepa ndi kuchuluka kwa amadyedwa a XE, ndikupeza UK nthawi ino yamasiku. Mwachitsanzo, adapanga magawo khumi. 5 XE, SK musanadye chakudya chinali 6.2, pofika chakudya chotsatira chidakhala 6.5, zomwe zikutanthauza kuti panali insulini yokwanira, ndipo magawo awiri adapita 1 XE. insulin Potere, UK ikhale ofanana 2 (10 magawo: 5 XE)

5. YAKHALA Nambala ya XE. Kuti muwerenge molondola kuchuluka kwa XE, ndikofunikira kuyeza zinthuzo pamalingo apamagetsi, gwiritsani ntchito tebulo la XE kapena kuwerengetsa XE kuchokera pazopezeka zamafuta mu 100 g ya malonda. Anthu odziwa bwino za matenda ashuga amatha kuyerekezera XE ndi diso, komanso mu cafe, mwachitsanzo, ndizosatheka kuyesa zinthu. Chifukwa chake, zolakwika sizitha, koma muyenera kuyesetsa kuzichepetsa.

Mfundo zakuwerengera XE:

a) CHITSANZO. Ngati muli ndi chinthu chomwe chili patebulo la XE, ndiye kuti mungogawa muyeso wamafuta amtunduwu ndi kulemera kwa izi = 1 XE, zomwe zikuwonetsedwa patebulopo.Mwanjira iyi, WEIGHT ya PORTION imagawidwa ndi WEIGHT ya malonda omwe ali ndi 1 XE.

Mwachitsanzo:
kulemera apulo popanda msingi wa 150g, pagome mtengo wa apulo wolemera 120g = 1XE, zomwe zikutanthauza kuti timangogawa 150 ndi 120, 150: 120 = 1.25 XE ili mu apulo Wanu.
Kulemera mkate wakuda (kokha osati Borodinsky osati Fragrant) 50g, patebulo 1 XE = 25 g la bulauni mkate, kenako m'ndime 50: 25 = 2 XE
kulemera kaloti grated 250 g, 180 g kaloti = 1XE, ndiye m'gawo lanu 250: 180 = 1.4 XE.

Osanyalanyaza magawo ang'onoang'ono omwe alibe 1 XE, nthawi zambiri mukamawonjezera magawo awa mumalandira 1.5 kapena kuposa XE, omwe ayenera kukumbukiridwa powerengera kuchuluka kwa insulin. Nthawi zonse werengani izi XE-shki, zimawonjezera shuga!

b) POPHUNZIRA. Tsopano pazinthu zomwe siziri pagome la XE, kapena zomwe zili pagome, koma kapangidwe kake kamasiyana malinga ndi wopanga. Pankhaniyi, muyenera kuyang'ana kuchuluka kwa CARBOHYDRATES pa 100 g ya mankhwala, kuwerengetsa kuchuluka kwamafuta m'gawolo, ndikugawa ndi 12. Pankhaniyi, GAWANI NTHAWI YA A CarboHYDRATES MU PORTION pofika 12.
Mwachitsanzo, tenga Wofalitsa wathu wokonda kwambiri. Tiyerekeze kuti 100g cracker ili ndi 60g chakudya. Munalemera g 20. Tidziwa kuti 1 XE ndi 12 g yamafuta.
Timalingalira (60: 100) * 20: 12 (popeza 1 XE ili ndi 12 g yamafuta), zidapezeka kuti 20 g ya cracker iyi ili ndi 1 XE.

Mwachitsanzo, Activia curd, 100 g ili ndi 15 g yamafuta, kulemera kwa curd ndi 125 g, mu 1 XE mudakalipo 12 g yamafuta.
Timaganizira (15: 100) * 125: 12 = 1.6 XE. Poterepa, OSAKHALA mozungulira XE! muyenera kuwerengera XE yonse palimodzi, ndipo pokhapokha muwerenge kuchuluka kwa insulin yochepa kwa kuchuluka kwa XE. Pano mu chitsanzo ichi, ngati muwonjezerera zofanana ndi ma 250 g a karoti grated ku curd, ndiye kuti palimodzi ndi curd mumapeza 3 XE! Ambiri odwala matenda ashuga ozungulira XE, izi sizolakwika. Tsopano, tikadazungulira ma car Xot a 1.6 XE mpaka 2 XE ndi 1.5 XE mpaka 1.5 XE, titha kutenga 3.5 XE, kubaya jakisoni wa kuchuluka kwa mapiritsi ndikupeza hypoglycemia patatha maola awiri mutadya .

Osasokoneza njira zowerengera.
werengani mu TABLE - DIVIDE TIWONSE mpaka KUCHITA
taganizirani MU KULUMIKIRA - DIVIDE CarBOHYDRATES mu gawo 12.

Kuti muwone msanga kuchuluka kwa magalamu azinthu zomwe zingakhale ndi mkate umodzi, muyenera 1200 yogawika ndi kuchuluka kwa chakudya mu 100 g ya malonda. Mwachitsanzo, tchipisi cha 100 g Goute chili ndi chakudya cham'magawo 64. 1200: 64 = 19 g mu 1 XE.

c) KULENGA KWA ZINSINSI ZABWINO. Mukamaphika kunyumba, muyenera kufotokozera mwachidule mafuta omwe ali ndi zosakaniza. Apa njira zonse zowerengera zimagwiritsidwa ntchito. Mwachitsanzo, pangani makeke amkaka

400 g ya kanyumba tchizi (pa 100 g ya 3 g yamakanidwe ophatikizika) = 12 g wama chakudya pakompyuta = 1 XE
Mazira 2 - osawerengera
4 tbsp. supuni ufa (60 g) = 4XE
3 tbsp. supuni ya shuga (45 g) = 3 XE
mchere kulawa

ZONSE: m'kanyumba tchizi chachikulu 8 XE
CHITSANZO: cheesecake 560 g
Wotenthedwa, kulemera ZONSE za syrniki ndikugawa 8 XE.
Zapezeka kuti 560: 8 = 70 g wa syrniki muli 1 XE, adalemera 200 g gawo lawo, zomwe zikutanthauza kuti 200: 70 = 3XE pagawo ili.

Mawu ochepa za masamba. Masamba (kupatula mbatata) ndizakudya zomwe zili ndi index yotsika ya glycemic, zimakhala ndi fiber yambiri, zimachepetsa kuyamwa kwa mafuta amthupi ndipo, chifukwa chake, amalimbikitsidwa kwa odwala matenda ashuga. Komabe, ambiri amakhulupirira kuti masamba sangatengedwe mukamawerengera XE. Izi ndizoyambitsa zomwe zimabweretsa shuga wambiri. Tiwerenge. Tinene kuti mwadya masamba ochepa a nkhomaliro:

saladi 70 g beets = 0,5 XE

ndipo ndimatafuna 90 g ya kaloti = 0,5 XE

ndipo sanawaganizire pakuwerengera kuchuluka kwa insulin. Mwachidziwikire, shuga m'magazi azikhala apamwamba kuposa momwe angafunire chakudya chamadzulo.

6. NTHAWI YOTHANDIZA KWAMBIRI (AI). Ma insulin omwe amagwira amakhala m'magazi kuchokera kuzakudya zakale. Insulin sikutha pambuyo pokhazikitsa. Pakati pa ola lililonse, ntchito ya SHORT ndi ULTRA-SHORT insulin imachepetsedwa ndi 20-25% ya mlingo woyambira. Zochita za BASAL INSULINS (Lantus, Protafan, NPH, etc.) Sizinachitike.

Mwachitsanzo nthawi ya 8 m'mawa adayambitsa magawo khumi. zamanyazi. Ntchito zake zidzachepa motere:

8,00 - magawo 10.
9,00 - magawo 8.
10,00 - 6 mayunitsi.
11.00 - 4 magawo.
12,00 - 2 mayunitsi.
13.00 - 0 mayunitsi

7. NTHAWI YOTHANDIZA KUTI MUZINTHAUZA. Ichi ndi chiyani Ino ndi nthawi yochokera pakubaya wa insulin yayifupi kuyamba chakudya. Muyenera kudziwa bwino nthawi yoyamwa komanso zochita za insulin yomwe mukugwiritsa ntchito. Malangizo ogwiritsira ntchito insulin nthawi zonse amafotokoza za pharmacokinetics yake.

The pharmacokinetics yaifupi (ma insulins a anthu) kuyamba kwa mphindi 30 ndi ola limodzi, pachimake pambuyo 2-4 maola, nthawi ya kuchitira ndi maola 6-8.

Pharmacokinetics ya ultrashort insulin: kuyambika kwa mphindi 15-30, kuchuluka kwa maola 0.5-1.5 maola (Novorapid 1-3 maola), pazofunikira kwambiri maola 3-5.

Zikuwonekeratu kuti ma insulin a ultrashort amayamwa kale komanso amachotsedwa mofulumira. Izi ziyenera kukumbukiridwa pakuwerengera nthawi yowonekera kwa jakisoni wa insulin. Muyenera kumvetsetsa kuti pofika nthawi yonyamula mafuta, insulin iyenera kuyamwa komanso kuyamba kugwira ntchito - kutsitsa shuga. Kupanda kutero, shuga okwanira maola awiri mutatha kudya sangathe. Momwe mungachite. Nthawi zonse timayang'ana shuga m'magazi tisanadye:

Shuga wamba wamagazi - nthawi yowonekera 10 min. kwa ultrashort insulin ndi 30 min kwa insulin yochepa.

Mwazi shuga - kuwonjezera nthawi yowonekera (onjezerani insulin kale)

Shuga wamagazi ndi ochepa - nthawi yowonetsera 0, yambani kudya ndi chakudya chamagulu (kudya insulin nthawi yomweyo musanadye)

Ponena za malingaliro omaliza, ndikufuna kuwonjezera kuti sindikugwirizana ndi njirayi. Zoyenera kuchita ngati shuga m'magazi adatsika pang'ono asanadye komanso kabichi yotsogola ndi chidutswa cha nkhuku chili pambale? Ine.e. palibe chakudya chamafulumira. Koma simungathe kudyetsa mwana pang'ono ngati mumupatsa chakudya chotsekemera musanadye, ndipo mwalandira kale insulini! Zikatero, ndimayimitsa hypoglycemia 2 XE (200 ml ya timadziti mumayikidwe osakanizira OK 4 a shuga) ndikungopanga insulin, kale kuchuluka kwa chakudya chomwe ndingadye. Koma awa ndi lingaliro langa chabe, aliyense wodwala matenda ashuga amatha kupeza yankho lake potengera malangizo omwe ali pamwambapa.

Kuwonjezeka kwa nthawi yowonetsera ndikothekanso pamene kudya zakudya zokhala ndi index yayikulu ya glycemic (GI). Kumbukirani kuti zopangidwa munkhanizi zimatengedwa mwachangu komanso zimawonjezera shuga m'magazi. Kugwiritsa ntchito mankhwala ngati awa sikulimbikitsidwa. Koma, ngati nthawi zina mumadula chakudyacho, muyenera kuchita izi moyenera.

Kuphatikiza apo, ndikofunikira kudziwa:

KWA GASTHROPATHY - kulowetsa chakudya pang'onopang'ono, chitani insulini mochedwa GUTHA CHAKUDYA.

POPHUNZITSIRA KUGANIZIRA chakudya kuchokera m'mimba, insulini iyenera kupangidwa mofulumira, i.e. kuwonjezera kukhudzika.

MALO OGULITSA MALO OGULITSA MALO OGULITSIRA.

(AG - CH): PSI = DC, uyu ndi muyeso wokonza shuga.

Tikutenga kusiyana pakati pa zenizeni komanso zenizeni za glycemia ndikuigawa ndi chidwi, timapeza insulini yomwe muyenera kulowa Kuchepetsa kapena kuwonjezera kuchuluka kwa shuga kuti mupeze zofunika.

Ndi shuga wamagazi ONANI TARGET, DK imakhala YABWINO nthawi zonse, zomwe zikutanthauza kuti muyenera ADD insulin kukana.

Ndi shuga wamagazi BONANI chandamale, DK nthawi zonse NDI YABWINO, zikutanthauza zomwe mukufuna Chotsani mlingo wa insulin kuwonjezera sk.

BOLUS CALCULATION ALGORITHM (DOSES OF INSULIN) ASANABWINO NGATI MABODZA amawongolera

Chifukwa chake, tikudziwa athu a PSI, CC, CH, adayang'ana shuga m'magazi asanadye (AH), adaganizira za insulin AI ya jekeseni wam'mbuyomu, tsopano mutha kuwerengera kuchuluka kwa insulini yomwe muyenera kuchita.

(UK * XE) + (AG - CH): PSI-AI = BOLUS ndiyo njira yathunthu yowerengera muyeso wa bolus

1. Tiwerengera kuchuluka kwa XE ndikuichulukitsa ndi likulu nthawi ino yamasiku. Timalandila Mlingo wa kukondoweza kuchuluka kwa chakudya chamagulu (XE)

2. Timayang'ana shuga wamagazi ndikuwerengera Mlingo wochepetsera kapena kuonjezera SC pa phindu lomwe mukufuna

3. Fotokozerani mwachidule 1 ndi 2 mfundo (UK * XE) + (AG - TG):

4. Chotsani insulin AI yogwira ntchito pazotsatira zake. Timalandira chakudya chambiri pa nthawi yake - BOLUS.

Ngati pali insulini yogwira, ndiye kuti iyenera kuchotsedwa kuchokera pazotsatira zake. Insulin yogwira imapitilirabe kugwira ntchito m'magazi, ndipo ngati simukuganizira, hypoglycemia ingachitike.

CHITSANZO: AG 14, TG 6, PSI = 2, AI 1 unit, UK 2, takonzekera kudya 4 XE. Pankhaniyi SC pamwambapozikutanthauza kuti muyenera ADD DOSE DK Kuchepetsa shuga

1. (UK x XE) = 2x4 = 8 mayunitsi. insulin pa kukopeka 4 XE.
2. (14-6): 2 = DC 4 mayunitsi. onjezeranikuchepa SC mpaka 6

3. (8 + 4) - 1 AI = 11 magawo chotsa ntchito insulin

Zokwanira: muyenera kulowa mayunitsi 11. insulin

CHITSANZO: AG 4, TG 6, PSI = 2, AI 1 unit, UK 2, takonzekera kudya 6 XE. Pankhaniyi SK pansipa chandamale tisanadye ndipo tiyenera Chotsani DC kuwonjezera shuga

1. UK x XE = 2x6 = 12 mayunitsi kuyamwa kwa insulin 6 XE

2. (4-6): 2 = DK -1 unit thana ndi kuchuluka shuga mpaka 6

3.12 + (- 1) - 1 unit AI = 10 mayunitsi

Ponseponse: muyenera kulowa mayunitsi 10. insulin

Tikadapanda kuyang'ana pa ck tisanadye, sibwenzi tikuganizira za insulin, koma titapanga mayunitsi 12 pa 6XE, tikadakhala hypoglycemia.

Chifukwa chake, timangoyang'ana pa SC tisanadye komanso timaganizira za insulin yochokera ku bolus yam'mbuyomu..

Inde, kuyambitsa ma insulin mayunitsi mpaka 1/10 (0.9, 2.2, 1.4), omwe amapezeka chifukwa cha kuwerengera kumeneku, ndizotheka pampu yokha. Sungani zolembera mu zowonjezera za mayunitsi 0,5. amakupatsani mwayi kuti mulowetse mlingo wokhala ndi mayunitsi 0,5. Mukamagwiritsa ntchito cholembera cha 1 cholembera, timakakamizidwa kuzungulira ziwerengero. Pankhaniyi, mutha kuwerengera kuchuluka kwa XE yomwe muyenera "kudya" pazogawana za "insulin" zowonjezera. Mwachitsanzo: chifukwa cha kuwerengera, nyumba za mayunitsi 2.6 zidapezeka. Titha kulowa mayunitsi 2,5, ngati magwiridwewo ndi mayunitsi 0,5, kapena atatu, ngati gawo la gawo ndi gawo limodzi. Tikuwerengera kusankha kwa magawo atatu: tikupeza mayunitsi owonjezera a 0.4. insulini, tikudziwa Code yathu Yankhondo panthawi yanthawi masana, timati magawo 1,2. pa 1 XE, ndipo pangani gawo:

0.4 * 1: 1.2 = 0.3 XE mukufunikirabe kudya.

Mwanjira ina, timagawa insulin yochulukirapo ku UK ndipo timapeza kuchuluka kwa XE kuwonjezera. Kapenanso timagawa insulini yovulazidwa pang'ono pamakhalidwe aupandu ndipo timalandira zochuluka za XE zochotsa m'gawolo.

Kuwerengedwa konse pamwambapa ndikuwonetsa, ndipo kukwanira kwa PSI yowerengedwa ndi CC kuyenera kutsimikiziridwa moona.

Kutenga mwayi uwu, ndikufuna kuthokoza aphunzitsi a International Diabetes Program, Lifestyle Training and Advisory Center, dipatimenti ya Endocrinology ndi Diabetesology ya Russian Medical Academy of Postgraduate Education Natalya Chernikova ndi Bulat Iskanderovich Valitov. Chidziwitso chomwe amapeza pamisonkhanoyi chinasintha kwambiri njira yanga yothandizira odwala matenda ashuga, kusintha moyo wanga, ndipo ndikufuna kugawana zidziwitso izi kwa onse ogwiritsa ntchito tsambali. Musakhumudwe ngati china sichikumveka, chinthu chachikulu sichikutaya zonse, koma yesani kukhala katswiri pakuthandizira matenda a shuga. "Kuyendetsa matenda a shuga kuli ngati kuyendetsa mumsewu wokhala ndi magalimoto ambiri. Aliyense angathe kutero, muyenera kudziwa malamulo oyendetsa," Michael Berger, katswiri wa matenda ashuga waku Germany.

Kodi muyenera kubayira insulin musanadye?

Pofuna kuchiza matenda a shuga, muyenera kusinthira ku chakudya chochepa cha carb, kenako pulagi ya insulin. Sikuti odwala onse omwe amaletsa chakudya chamagulu m'thupi mwawo omwe amafunika jakisoni musanadye. Musanayambe mankhwala a insulin, muyenera kuwona momwe shuga imakhalira tsiku lililonse kwa masiku angapo. Zitha kuchitika kuti pambuyo pa maola awiri ndi atatu mutatha kudya chakudya chamadzulo kapena chakudya chamadzulo shuga siziwonjezeka, amakhalabe mu mulingo wamba wa 4.0-5,5 mmol / l. Sungani ziwerengero kwa masiku 3-7, kenako pangani jakisoni musanadye. Pamene chidziwitsochi chikukonzekera, phunzirani jakisoni ndi syringe yopanda ululu. Mulimonsemo, ziyenera kuchitika panthawi ya chimfine ndi matenda ena opatsirana.

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri wofatsa komanso wolimbitsa thupi choyamba amagwiritsa ntchito zakudya zamafuta ochepa, kenako mapiritsi omwe amachepetsa shuga m'magazi ambiri. Ndipo pokhapokha ndi pomwe amawonjezera insulin mankhwala ku pulogalamu yawo yamankhwala. Chonde dziwani kuti chifukwa cha kutuluka kwa m'mawa, odwala ochepa amatha kusunga shuga wabwinobwino pambuyo pa chakudya cham'mawa popanda jakisoni. Pazifukwa zomwezo, kudya chakudya cham'mawa kumakhala kotsika kuposa chakudya chamadzulo komanso chamadzulo.

Mwachitsanzo, kuwona kuchuluka kwa shuga m'magazi kwa masiku angapo kunawonetsa kuti muyenera kubaya insulin mwachangu musanadye chakudya cham'mawa.Poterepa, kuchuluka kwa mapuloteni ndi chakudya chamafuta omwe mumakhala ndi kadzutsa kuyenera kukhala komwe tsiku lililonse.

Kupitilira apo muphunzira kuwerengera chakudya komanso kukonza. Izi zisanachitike, muyenera kuwerenga nkhani "Mitundu ya insulin ndi zomwe amachita". Mvetsetsani zomwe ndizogulitsa insulin yochepa komanso ya ultrashort yomwe ilipo, momwe amasiyana. Sankhani kuti ndi mankhwala ati omwe mungabaye nawo musanadye.

Anthu ambiri odwala matenda ashuga omwe amakakamizidwa kubaya jakisoni wothamanga sazindikira kuti sizotheka kupewa zigawo za shuga wotsika magazi. Amaganiza kuti kuukira kwa hypoglycemia ndi njira imodzi yosapeweka. M'malo mwake, imatha kusunga shuga wokhazikika ngakhale ndi matenda oopsa a autoimmune. Ndipo makamaka, ndi matenda a shuga a 2 ochepa. Palibe chifukwa chakuwonjezera kuchuluka kwa shuga m'magazi anu kuti mudzilimbitse nokha motsutsana ndi hypoglycemia yoopsa. Onerani kanema pomwe Dr. Bernstein akufotokoza nkhaniyi ndi bambo wa mwana yemwe ali ndi matenda a shuga 1. Phunzirani momwe mungasinthire zakudya zopatsa thanzi komanso mulingo wa insulin.

Kuwerengedwa mlingo wa insulin pa chakudya (chakudya

Anthu odwala matenda ashuga omwe amatsata zakudya zochepa zama carbohydrate amafunika kubaya insulin mwachangu pamapuloteni omwe amadya, osati chakudya chambiri. Chifukwa gawo la mapuloteni amadyedwa lidzasinthidwa kukhala glucose m'thupi. Ngakhale izi, mankhwalawa azikhala otsika 2-10 kuposa odwala omwe amadya malinga ndi kutsimikiziridwa ndi chithandizo chamankhwala. Kuti mupeze mlingo woyambira, mukuganiza kuti gawo limodzi la insulin yofupikira imakhudza 8 g yamafuta kapena 60 g ya mapuloteni. Ma Ultrashort analogs (Humalog, Novorapid, Apidra) ndi amphamvu kwambiri kuposa insulin yofupikitsa anthu. Dr. Bernstein alemba kuti Novorapid ndi Apidra ndi amphamvu ma 1.5 nthawi kuposa insulin yochepa, ndi Humalog - 2.5 nthawi.

Tikutsindika kuti awa sakhala achidziwitso, koma chidziwitso chochokera kwa Dr. Bernstein. Opanga mankhwala a Humalog, Novorapid ndi Apidra amati onse ali ndi mphamvu zofanana. Chiwonetserochi chikuyamba kuchita zinthu mwachangu kwambiri kuposa olimbana nawo. Makhalidwe omwe aperekedwa patebulopo amangogwiritsidwa ntchito kuwerengera mlingo woyambira. Athandizeni pambuyo pake pazotsatira za jakisoni woyamba pa matenda ashuga. Musakhale aulesi kusintha mosamala mlingo wa insulin ndi zakudya mpaka shuga atakhala wokhazikika pamtunda wa 4.0-5,5 mmol / L.

Kodi mungawerengere kuchuluka kwa insulin yochepa musanadye ndi chitsanzo chenicheni?

Nachi chitsanzo. Tiyerekeze kuti wodwala yemwe ali ndi matenda a shuga a 2, yemwe ali ndi chidwi chofuna kudya, akufuna kudya mazira 6 pakudya kwamasana, komanso 250 g ya saladi yatsopano yomwe amadyera mandala. Mafuta ophikira amawonjezeredwa ku saladi. Koma sizifunikira kuganiziridwa, monganso zakumwa zomwe mulibe shuga, uchi ndi zina zotsekemera za kalori yayikulu. Wodwalayo amavulala ndi Apidra insulin kuti adye. Ndikofunikira kuwerengera mulingo woyenera musanadye chakudya.

Pakapita kanthawi, mafani a zakudya zosiyanasiyana amafunika kukhala ndi mabuku akuluakulu okhala ndi matebulo azakudya zopangidwa ndi zakudya zosiyanasiyana zomwe zilipo. Zambiri tsopano zikupezeka mosavuta pa intaneti. Wathu wodwala matenda ashuga adazindikira mwachangu zomwe amapezeka mumapuloteni, mafuta ndi chakudya m'magawo omwe amadzadya.

Mtengo wa zopatsa thanzi

Tiyerekeze kuti dzira lililonse limalemera 60 g. Mukatero, mazira 6 amalemera 360 gmaladi atsopano a gramu 250 g ali ndi katsabola ndi parsley 125 g.Mazipangizo zamasamba, muyenera kuthana ndi fiber (yazakudya chamafuta) pazakudya zonse za chakudya. Zinthu za shuga sizifunikira kuthana nazo.

Kuti mupeze kuchuluka kwazomwe mukugulitsa, muyenera kuchulukitsa zomwe zili m'mapuloteni ndi ma carbohydrate mwakulemera ndikugawa ndi 100 g.

Kudziwitsa mapuloteni ndi chakudya cha mawerengeredwe a insulin musanadye

Kumbukirani kuti odwala matenda ashuga achikulire omwe amayenera kupaka jakisoni wokwanira chakudya, Dr. Bernstein akuwonetsa kuti azikhala ndi chakudya chamafuta - osaposa 6 g pa chakudya cham'mawa, mpaka 12 g pa chakudya cham'mawa komanso chakudya chamadzulo. Kuchuluka kwa chakudya chamagulu ochulukirapo patsiku sikuposa 30. Kwa ana, ayenera kukhala otsika molingana ndi kulemera kwawo. Zakudya zomanga thupi zonse zimayenera kubwera kuchokera ku zakudya zovomerezeka. Zakudya zoletsedwa sizingadye gramu imodzi.

Wodwala matenda a shuga a 2, omwe adapereka chidziwitso, sanakumane ndi chakudya pang'ono pakukonzekera chakudya chamadzulo, koma izi ndizovomerezeka. Komabe, sizingatheke kuwonjezera kuchuluka kwa mazira ndi amadyera, komanso tchizi. Ngati chakudya chomwe chikuperekedwa sichikwanira odwala matenda ashuga, mutha kuwonjezera nyama, nsomba kapena nkhuku, zomwe zimapangidwira zophika zomwe ndi zero, kupatula chiwindi.

Kuti mupeze mlingo woyambira, inu, mukutsatira Dr. Bernstein, mumaganiza kuti 1 unit ya Apidra kapena Novorapid imakhudza 90 g mapuloteni kapena 12 g ya chakudya chamagulu.

1. Kuyamba kwa Apidra mapuloteni: 53,5 g / 90 g ≈ 0,6 PESCES.
2. Mlingo pa chakudya: 13.5 g / 12 g ≈ 1.125 maunits.
3. Mlingo wonse: 0.6 PIECES + 1.125 PIECES = 1.725 PIECES.

M'pofunikanso kuwerengera bolus yokonza (onani pansipa), yonjezerani ku bolus ya chakudya ndikazungulira kuchuluka kwake kukhala ± 0.5 PIECES. Ndipo sinthani mtundu wa insulin yoyambira musanadye masiku otsatirawo malinga ndi zotsatira za jakisoni wam'mbuyomu.

Mlingo wa insulin yochepa yaumunthu, komanso analogue ya ultrashort action Humalog imatha kuwerengeka ndi njira yomweyo ya Novorapid ndi Apidra. Mankhwala osiyanasiyana, kuchuluka kwa chakudya komanso mapuloteni amasiyana, omwe amafunika gawo limodzi. Zofunikira zonse zimaperekedwa patebulo pamwambapa. Mwangophunzira momwe mungawerengere kuchuluka kwa insulin yomwe ingafunike kuphimba chakudya chomwe mumadya. Komabe, musanadye chakudya, musanadye chakudya chokha, komanso chokonza.

KULIMA KWA DZIKO LA INSULIN

Insulin yomwe imagwiritsidwa ntchito ngati njira yothaniranirana ndi chipulumutso kwa anthu mamiliyoni ambiri, koma ndi gawo lofunikira. Ngakhale sizipangidwe mwakapangidwe, kukonzekera kwa insulini kumakhala kosiyana ndi zachilengedwe, ndipo ngati sichoncho, kuonjezera kukhudzanso kwa chitetezo chathupi pakukweza mayankho a autoimmune a thupi kwachilendo, kukonzekera kwa insulin. Madokotala osoweka amalankhula zowona pamfundo imeneyi, komanso kuti nthawi zambiri simuyenera kusankha kwenikweni mankhwala a insulini kwa wodwala wina, koma mwakulitsa kuchuluka kwa mankhwala omwe aperekedwa ndikuwadyetsa "kuwonjezera" kwa XE wodwalayo kuti mupewe mkhalidwe wa hypoglycemia.

Dreval Alexander Vasilievich, endocrinologist, dokotala wa sayansi ya zamankhwala, pulofesa, wamkulu endocrinologist wa dera la Moscow, mutu wa dipatimenti ya achire endocrinology ya MONIKI, mutu. Dipatimenti ya Endocrinology FUV MONIKI.

Chenjezo: chonde osachichotsa pamutu, zinali zongokhudza kuti mankhwalawo siwopanda, izi ndizofunikira, popanda zomwe odwala angamwalira.

Kuwerengera kwa tsiku ndi tsiku mlingo wa insulin mwa odwala omwe ali ndi matenda a shuga 1 kumachitika pogwiritsa ntchito ma coefficients: pafupifupi kuchuluka kwa insulini m'thupi kumawerengedwa pa kilogalamu imodzi ya kulemera kwenikweni kwa thupi, ngati pali kuchuluka kwa thupi - kuchuluka kwake kumachepa ndi 0,1:

• 0,4-0.5 U / kg thupi kwa odwala omwe ali ndi matenda a shuga 1,
• Kuwala kwa 0.6 U / kg kwa odwala omwe ali ndi matenda a shuga 1 amtundu wopitilira chaka chimodzi pakubwezera zabwino,
• 0,7 IU / kg thupi kwa odwala omwe ali ndi matenda ashuga amtundu 1 wopitilira chaka chimodzi chindapusa chosakhazikika
• Kulemera kwa 0,8 U / kg kwa odwala omwe ali ndi matenda ashuga 1 omwe ali ovuta,
• 0,9 IU / kg thupi kwa odwala omwe ali ndi matenda a shuga 1 amtundu wa ketoacidosis,
• Kulemera kwa thupi la 1,0 / kg kwa odwala omwe ali ndi matenda amtundu wa 1 kutha msinkhu kapena III trimester ya mimba.

Monga ulamuliro, tsiku lililonse mlingo wa insulin woposa 1 U / kg patsiku umawonetsa bongo wa insulin.Ndi mtundu woyamba wa matenda ashuga 1, kufunika kwa tsiku ndi tsiku insulin ndi magawo 0,5 pa kilogalamu ya thupi. M'chaka choyamba atatha kudwala matenda ashuga, pamatha kuchepa kwakanthawi kokwanira ka insulin - iyi ndiye yotchedwa "honeymoon" ya matenda ashuga. M'tsogolomu, zimawonjezeka pang'ono, zowongolera 0,6. Mu kuwonongeka, makamaka pamaso pa ketoacidosis, mlingo wa insulini chifukwa cha kukana kwa insulin (glucose kawopsedwe) umachuluka ndipo nthawi zambiri umakhala wa 0,7-0.8 PIECES wa insulin pa kilogalamu ya thupi.

Kukhazikitsidwa kwa insulin yochulukirapo kuyenera kutsata njira wamba yolembera insulin mwa munthu wathanzi. Amaperekedwa kawiri pa tsiku (asanadye chakudya cham'mawa, asanadye chakudya chamadzulo kapena usiku) pamlingo wosaposa 50% ya kuchuluka kwa insulin tsiku lililonse. Kukhazikitsidwa kwa insulin yochepa kapena ultrashort kanthu musanadye zakudya zazikulu (kadzutsa, nkhomaliro, chakudya chamadzulo) zimachitika mu Mlingo wowerengeredwa ndi XE.

Kufunika kwa tsiku ndi tsiku kwamankhwala am'madzi kumatsimikiziridwa ndi kuchuluka kwa zopatsa mphamvu zomwe zimafunikira wodwala wina, ndipo zitha kukhala 70 mpaka 300 g zamankhwala, zomwe zimachokera ku 7 mpaka 30 XE: pa chakudya cham'mawa - 4-8 XE, chakudya chamadzulo - 2-4 XE, pa chakudya chamadzulo - 3-4 He, 3-4 HE ayenera kufotokozedwa mwachidule m'mawa lachiwiri, chakudya chamadzulo masana komanso chakudya chamadzulo.

Insulin panthawi yazakudya zowonjezera, monga lamulo, siziperekedwa. Pankhaniyi, kufunikira kwa insulini kwakanthawi kochepa kapena ka ultrashort kayenera kukhala kosiyanasiyana kuyambira magawo 14 mpaka 28. Mlingo wa insulin waifupi kapena wa ultrashort akhoza kukhala ndipo ayenera kumasiyanasiyana malinga ndi momwe zinthu ziliri komanso mogwirizana ndi zomwe zimapangitsa shuga. Izi zikuyenera kutsimikiziridwa ndi zotsatira za kudziletsa. Tisaiwale kuti pokonza glycemia, ndikofunikira kulingalira mlingo wa insulin yocheperako kuti muchepetse zizindikiro zokwanira, motengera zotsatirazi:
• 1 unit ya insulin yochepa kapena ultrashort action imachepetsa glycemia ndi 2.2 mmol / l,
• 1 XE (South Carbohydrate) imachulukitsa kuchuluka kwa glycemia kuchokera ku 1.7 mpaka 2.7 mmol / L, kutengera mndandanda wamatumbo a glycemic.

UMBONI WABWINO KWAMBIRI NDIPONSE ZA BOLUS
M'mabuku akale, chiwerengerochi chikuwonetsedwa ngati: 50/50. Koma anthu onse ndi osiyana. Nayi kuwongolera kwachitsanzo:

30% basulin insulin:
- chakudya chochuluka mu chakudya (zoposa magalamu 200 patsiku),
- zolimbitsa thupi,
- Kusintha kwa 9 kapena kuposa shuga patsiku,
- kuyambitsa ma microbolus pafupipafupi, ngati mungagwiritse ntchito pampu,
- Zosintha pafupipafupi malinga ndi momwe tsiku limayendera.

50% ya insulin yoyambira:
- 120-200 g wa chakudya chambiri patsiku,
- 3 mpaka 6 pa tsiku,
-kugwiritsa ntchito malamulowa 350 (kwa chakudya cholimbitsa) / 120 (kwa mphamvu yakumvera) - kuwerengera bolus.

Kuwongolera Bolus

Monga momwe mukudziwira kale, odwala matenda ashuga amathetsa shuga wamagazi kwambiri ndi jakisoni wa insulin. Kuti muchite izi, muyenera kugwiritsa ntchito mankhwala osakhalitsa kapena a ultrashort. Simuyenera kuyesa kuzimitsa kuchuluka kwa glucose mothandizidwa ndi insulin yayitali - kukonzekera Lantus, Levemir, Tresiba kapena protafan. Odwala okhulupilira omwe ali ndi shuga yayikulu amayeza shuga asanadye chilichonse. Ngati yatukuka, muyenera kubaya jekeseni wowongolera, osangokhala mlingo wa insulin kuti mumwe chakudya. Otsatirawa akufotokozera momwe mungawerengere mlingo woyenera wa shuga.

Choyamba, muyenera kudziwa momwe 1 unit imatsitsira magazi anu. Izi zimatchedwa insulin sensitivity factor (PSI). Muwerenge kusiyana kwa shuga ndi zomwe muli nazo. Kenako gawani izi ndi PSI kuti mupeze mankhwala okhala ndi insulin yokwanira.

Mutha kugwiritsa ntchito zambiri za Dr. Bernstein kuti mupeze poyambira kukonzanso. Alemba kuti 1 U ya insulini yocheperako imachepetsa shuga ndi pafupifupi 2.2 mmol / L munthu wamkulu wolemera makilogalamu 63.Analogs a ultrashort zochita za Apidra ndi Novorapid ndi pafupifupi 1.5 nthawi mphamvu kuposa yochepa insulin. Humalog - 2,5 mwamphamvu. Kuti zitheke, timawonetsera izi ngati mawonekedwe a tebulo.

Kugwiritsa ntchito chidziwitso choyambira, muyenera kusintha malinga ndi kulemera kwa thupi la wodwalayo.

Kuwerengera kwa zomwe zimapangitsa chidwi cha insulin (PSI)

Mtengo wama glucose amomwe umakhala ndi 4,5-5,5 mmol / L. Kuti mupeze momwe shuga yanu imasiyanirana ndi chizolowezi, gwiritsani ntchito malire ochepa a 5.0 mmol / L.

Kuwongolera Chiwonetsero cha Bolus

Tipitiliza kupenda zinthu ndi mtundu wachiwiri wa matenda ashuga kuchokera ku zitsanzo zam'mbuyomu. Kumbukirani kuti asanadye, amapweteka jakisoni waifupi wa insulin Apidra. Kulemera kwake kwam'mimba ndi makilogalamu 96. Shuga asanadye, anali 6.8 mmol / L.

1. Kusiyana kwake ndi chizolowezi: 6.8 mmol / L - 5.0 mmol / L = 1.8 mmol / L.
2. Kulingalira kwamphamvu chifukwa cha kulemera kwa thupi: 63 kg / 96 kg * 3.3 mmol / L = 2.17 mmol / L - munthu wodwala matenda ashuga akamacheperachepera, mankhwalawo amachepetsa mphamvu ya mankhwalawo.
3. Malo owongolera: 1.8 mmol / L / 2.17 mmol / L = 0.83 ED

Kumbukirani kuti kuchuluka kwathunthu kwa insulin musanadye chakudya ndi kuchuluka kwa chakudya komanso kukonza. Chakudya chawerengeredwa kale kwambiri, chinali magawo 1.725. Mulingo wokwanira: 1.725 PIECES + 0.83 PIECES = 2.555 PIECES - mozungulira mozungulira 2 PIECES. Mlingo uyenera kukhala wambiri wa 0 PIECES kuti utha kubayidwa ndi syringe kapena cholembera.

Anthu omwe amadwala matenda ashuga, asanasinthe zakudya zamafuta ochepa, kutsatira zakudya “zopatsa thanzi,” amatsimikizira kuti iyi ndi mtundu wochepa wa insulin yochepa kapena yochepa kwambiri pakudya. Madokotala am'nyumba sazigwiritsidwa ntchito mwanjira imeneyi. Musachulukitse mulingo, ngakhale adokotala akuumiriza. Komanso, kupewa hypoglycemia (shuga wotsika magazi), kwa nthawi yoyamba ndikulimbikitsidwa kubayidwa theka la mlingo wowerengeka . Mwa ana ochepera zaka 9 mpaka 10, kusowa kwa insulin kumakhala kwakukulu kwambiri. Kwa ana omwe ali ndi matenda amtundu woyamba, mulingo woyambira, womwe umawerengeredwa ndi njira yotsimikizidwira, uyenera kuchepetsedwa ndi 8 zina. Jekeseni moyenera mlingo wocheperako ndizotheka pokhapokha pogwiritsa ntchito njira yothetsera insulin. Onse ana ndi akulu ayenera kuyamba ndi Mlingo wotsika kwambiri kuti achepetse chiopsezo cha hypoglycemia.

Kuwerengera muyeso wa insulin musanadye ndi chiyambi chabe. Chifukwa m'masiku ochepa otsatira muyenera kusintha.

Kusintha koyambira kwa insulin musanadye masiku otsatirawa?

Kuti musankhe bwino mankhwalawa musanadye, ndikofunikira kudya zakudya zomwezo tsiku lililonse. Chifukwa ngati musintha kapangidwe kazakudya, muyenera kuyambiranso kumwa. Ndipo iyi ndi pang'onopang'ono komanso njira yovuta. Mwachidziwikire, zogulitsa ziyenera kukhala zosavuta kuti pasakhale zovuta pazomwe zimapezeka. Mu malingaliro, mutha kugwiritsa ntchito zinthu zosiyanasiyana, ngati kulemera kwamapuloteni ndi chakudya sikosintha. Koma pochita, njira izi sizikuyenda bwino. Bola kuvomereza zoperewera zakudya kuti mudziteteze ku zovuta za matenda ashuga.

Popeza mutabaya insulin mwachangu musanadye, muyenera kuyeza shuga maola atatu mutatha kudya kuti muone zotsatira zake. Chifukwa chakuti pambuyo pa mphindi 30-120, zakudya zomwe zidadyedwazo zilibe nthawi yoti zikhudze kuchuluka kwa shuga m'magazi, ndipo insulin siyingamalize kuchita. Zakudya zama carb zochepa ndizochepa, ndipo motero ndizoyenera kudya.

Kodi mipata ya shuga ya magazi anu ndi iti pakusintha kwa insulin?

Ndikofunikira kusintha mlingo wa insulin musanadye kuti shuga asatulutse kuposa 0,6 mmol / l maola atatu mutatha kudya. Ndikofunikira kuphatikiza jakisoni wa timadzi timene timachepetsa shuga ndi zakudya kuti mulingo wa glucose m'magazi ukhale wokhazikika pamlingo wa 4.0-5,5 mmol / l.Ichi ndi cholinga chovuta koma chotheka ngakhale kwa odwala omwe ali ndi matenda amtundu woyamba 1, makamaka kwa odwala omwe ali ndi vuto la shuga.

Kusintha kuchuluka kwa insulin yochepa kapena ya ultrashort musanadye, muyenera kudziwa momwe 1 unit imachepetsa shuga la magazi anu. Mwanjira ina, kuti mudziwe chomwe chimapangitsa kuti insulini (PSI) idziwe. Mutha kudziwa zenizeni ndi nthawi, pamene ziwerengero za zovuta za jakisoni wa insulin zosiyanasiyana Mlingo wa munthu wodwala matenda ashuga. Makhalidwe ena opatsa chidwi amafunikira kuti ayambe mankhwala a insulin. Kuti mupeze, Dr. Bernstein amapereka njira zosiyanasiyana kwa odwala omwe ali ndi matenda amtundu wa 2 ndi matenda a shuga 1.

Choyamba, ndikofunikira kusankha Mlingo wa insulin yayitali ya jakisoni wamadzulo ndi m'mawa. Ngati mwachita kale izi, mutha kugwiritsa ntchito tebulo pansipa.

Mutha kutenga chidziwitso mwachindunji pagome. Ngati mulibe mtengo wofanana ndi womwe mukufuna, onjezani ndikugawa pakati pa manambala oyandikana, imodzi ndi yayikulu ndipo inayo imakhala yocheperako poyerekeza ndi insulin. Kapena werengani avareji yolemetsa ngati mukudziwa momwe mungachitire. Makhalidwe omwe aperekedwa akuwonekera. Wodwala aliyense amafunikira kuti adzifotokozere yekha kudzera muyeso ndi cholakwika. Komabe, zitha kugwiritsidwa ntchito kuwerengera koyambirira.

Njira nambala 2. Mutha kuwerengera zomwe zimapangitsa chidwi cha insulini pafupifupi momwe mumaganizira mukamapereka mulingo woyambira. Koma mosamala kwambiri. Yerekezerani kuti munthu wamkulu wolemera makilogalamu 63, 1 U ya insulin yochepa amachepetsa shuga ndi 5.0 mmol / L. Mafanizo ofanana kwambiri ndi apidra ndi Novorapid ndi 1.5 nthawi yolimba kuposa insulin yochepa, ndipo Humalog ndi yamphamvu kwambiri ma 2,5. Gwiritsani ntchito mitundu ili m'munsiyi, m'malo mwa kulemera kwa thupi lanu.

Insulin Sensitivity Factor (PSI) ya Odwala Matenda A shuga Awiri

Muyenera kuyeza shuga maola atatu mutatha kudya ndikuwerengera kusiyana ndi shuga wamagazi musanadye. Kusiyana kumeneku kumapangitsa kuti muphonye ndalama zochuluka motani pa insulin ndi njira yanji. Ngati mulingo wa glucose m'magazi mutatha kudya umakwera osapitirira 0,6 mmol / l - mlingo umasankhidwa molondola, ndiye kuti suyenera kusinthidwa mopitilira apo. M'masiku otsatirawa, wodwala matenda ashuga ayenera kudya zakudya zomwezo mulingo womwewo, yesetsani kubaya jekeseni wa kusintha kwake ndikuwunika zotsatira zake.

Pambuyo pa jakisoni wa insulin yofulumira, kuchuluka kwa glucose sikunachepe, koma m'malo mwake kunakula. Chifukwa chiyani?

Ngati mulingo wambiri, shuga atha kukweza pang'onopang'ono, m'malo mongoleka. Thupi lotchedwa glycogen limasungidwa m'chiwindi. Ngati ndi kotheka, thupi limatha kusintha magaziwo kukhala magazi ndikuwamasula. Izi zimakuthandizani kuti mulipire kuchuluka kwa glucose wotsika, mwachitsanzo, ndi insulin yambiri.

Pakanakhala kuti palibenso njira yopangira chipukuta misozi, anthu atha kuzindikira nthawi yomweyo chifukwa chosowa glucose wogwira ntchito bwino bongo. Tsoka ilo, nthawi zina kulipira kumagwira mopitirira muyeso, ndichifukwa chake shuga yamagazi imakwera. Yembekezani maola osachepera 4 musanalowe jekeseni yotsatira ya insulin.

Zotsatirazi zikufotokozera momwe mungadziwire kuchuluka kwa zakudya ndi mapuloteni ambiri omwe amaphatikizidwa ndi gawo limodzi la insulin, komanso kuchuluka kwake komwe kumatsitsa shuga m'magazi. Mukalandira chidziwitsochi, mutha kuwerengera mulingo woyenerera momwe mungathere.

Kodi mungadziwe bwanji kuchuluka kwa chakudya ndi mapuloteni 1 a insulin?

Choyamba, muyenera kuyesa kwa masiku angapo ndi zinthu zomwe zimakhala ndi mapuloteni okha, zokhala ndi michere ya zero. Ichi ndi nyama (kupatula chiwindi), nsomba kapena nkhuku. Mazira kapena zinthu zina za mkaka sizoyenera. Anthu odwala matenda ashuga akukonzekera kudya, mwachitsanzo, 300 g ya nyama komanso china chilichonse chamasana kapena chakudya chamadzulo. Muyenera kudziwa pasadakhale kuchokera pagome lathanzi kuti ndi protein yani yomwe ili m'zinthu izi. Amadya tsiku ndi tsiku zakudya zina.

Cholinga cha kuyesaku ndikusankha kuchuluka kwa insulin, mothandizidwa ndi yomwe shuga ya magazi itatha chakudya chokhala ndi puloteni yomwe imakwera mosaposa 0.6 mmol / l.

1. Pimani shuga ndi glucometer
2. Lowetsani yochepa kapena insulort insulin
3. Yembekezerani kuti izi zichitike.
4. Idyani
5. Ikani shuga kachiwiri patatha maola atatu mutatha kudya

Ngati kusiyanasiyana ndi kalozera musanadye kulibe kupitirira 0.6 mmol / l - zabwino kwambiri. Ngati ndiwokwera - tsiku lotsatira idyani zomwezo ndikuwonjezera mlingo. Ngati shuga pambuyo chakudya idatsika kuposa kale, tsiku lotsatira muyenera kuchepetsa mlingo.

Tiyerekeze kuti 300 g ya nyama ili ndi 60 g (20%) ya mapuloteni abwino. Kusankha mlingo woyenera, mupeza kuchuluka kwa insulini yofunika kuti mumwenso 1 g ya mapuloteni. Kenako, kuyesanso komweku kumachitika ndi chinthu chomwe chimakhala ndi mapuloteni komanso zakudya zina. Mwachitsanzo, tchizi cholimba. Sankhani mlingo woyenera wa chakudya chopangidwa ndi izi. Pogwiritsa ntchito zoyeserera zakale, chotsani kuchuluka kwa insulin yomwe imagwiritsidwa ntchito kuyamwa mapuloteni. Amakumbukirabe mahomoni omwe adapita kukathandizira mafuta. Tsopano ndikosavuta kuwerengetsa kuchuluka kwa insulini yomwe ingafunikire kuphimba 1 g yama chakudya.

Zomwe Zimakhudza Insulin Sensitivity

Gawo lomaliza lofunikira. Ndikofunikira kudziwa kuwongolera kwa% kwa zovuta zam'mawa. Mwa anthu ambiri odwala matenda ashuga, insulin imatha kuchepa kuyambira 4 koloko mpaka 9 a.m. Kuti mumwenso kuchuluka kwa mapuloteni komanso zakudya zamagulu musanadye chakudya cham'mawa, mungafunikire insulini yambiri kuposa chakudya chamadzulo chisanafike. Kuyerekeza kusintha kwa chakudya cham'mawa - kuwonjezeka kwa 20%. Yang'anani kuchuluka kwa izi zomwe zili zoyenera kwa inu. Kuti alipire ndalama zodzuka m'mawa, Dr. Bernstein adalangiza kuti asamadyenso magawo 6 a chakudya m'mawa. Pazakudya zamadzulo komanso chakudya chamadzulo, mutha kuwonjezera magawo awo mpaka magawo 12. Zakudya zonse za chakudya zimayenera kubwera kuchokera ku zakudya zovomerezeka.

Komanso werengani apa mwatsatanetsatane za zinthu zomwe zimakhudza insulin sensitivity. Chofunika kwambiri mwa iwo ndi shuga wambiri wamwazi, maphunziro akuthupi, komanso matenda opatsirana. Pangani ndipo pang'onopang'ono mudzaze tebulo molingana ndi mtundu womwe waperekedwa pamwambapa.

Kodi kudziwa bwino kuchuluka kwa shuga kumachepetsa 1 unit ya insulin? Kodi ndi mlingo uti womwe umafunikira kuti muchepetse shuga wa magazi ndi 1 mmol / l?

Kuti mudziwe kuchuluka kwa shuga komwe kumachepetsa 1 unit ya insulin, muyenera kufa ndi njala pang'ono. Ganizirani kuchuluka kwa shuga. Ngati yatukulidwa, jekeseni mlingo wa insulin yofulumira, yomwe imayenera kubwezeretsanso mwakale. Lembani mlingo ndikuyembekezera maola 5. Osamadya chilichonse panthawiyi. Ingosungani mapiritsi a glucose kuti mupeze jakisoni kwambiri ndipo hypoglycemia imachitika (shuga wotsika wamagazi). Mutha kumwa madzi, tiyi wamafuta. Pambuyo maola 5, onaninso shuga. Munazindikira kuchuluka kwa kuchuluka kwa momwe timadzi timene timalandira. Pambuyo pake, ndikosavuta kuwerengetsa kuchuluka kwa shuga omwe amachepetsa 1 unit ya insulin, komanso kuchuluka kwa mankhwala omwe amafunikira kuti muchepetse shuga ndi 1 mmol / l.

Mitundu yosiyanasiyana ya insulin yochepa komanso ya ultrashort, zotsatira zake zimakhala zosiyanasiyana. Musakhulupirire kuti Humalog, Apidra ndi NovoRapid ali ndi mphamvu yomweyo. Mutha kudzionera nokha kuti amachita mosiyanasiyana. Humalog ndi pafupi 1.66 nthawi kuposa Apidra ndi NovoRapid. Ndikofunikanso kudziwa kuti insulin sensitivity imachepetsedwa kwambiri ngati shuga wamwazi apamwamba kuposa 11-13 mmol / L. Mwachitsanzo, wodwala yemwe ali ndi matenda ashuga anapeza kuti 1 unit imachepetsa shuga yake kuyambira 8 mpaka 5 mmol / L. Komabe, angafunike mlingo wa 25-50% yambiri kuti achepetse shuga kuyambira 13 mpaka 10 mmol / L. Ngati ndi kotheka, onetsetsani kuti mwayeserera, khazikitsani kusintha kwapakati pa%.

Kodi ndi mitundu yanji ya ultrashort ya insulin Humalog, Apidra ndi NovoRapid?

Chonde dziwani kuti mawonekedwe ofanana kwambiri a Apidra ndi NovoRapid, makamaka Humalog, ndi amphamvu kwambiri. Afunika kuchepetsedwa kwa ana onse odwala matenda ashuga a 1, komanso odwala matenda ashuga ambiri. Chifukwa anthu omwe amatsata zakudya zama carb ochepa amafunika Mlingo wambiri wa insulin musanadye.Popanda kuchepetsedwa, Mlingo wotsika chotere suyenera kubayidwa molondola. Dr. Bernstein salimbikitsa kugwiritsa ntchito Humalog ngati insulin yayikulu asanadye. Chifukwa mankhwalawa nthawi zambiri amayambitsa kuphuka kwa shuga m'magazi. Iye mwini amagwiritsa ntchito mitundu itatu ya insulini: yowonjezera, yochepa musanadye, ndi Humalog pamilandu mukafunikira kuti muchepetse shuga yayikulu. Komabe, simukufuna kuchita izi. Mwinanso kusankha kwa Apidra kapena NovoRapid ndikofunikira kwambiri.

Mukawerengera insulin musanadye koyamba, muwona kuti iyi ndi njira yayitali komanso yovuta. Kuti ikhale yosavuta, zimakhala zomveka kudya zakudya zomwezo momwe zingathere, tsiku ndi tsiku, pogwiritsa ntchito mitundu yoyenera yomwe idasankhidwa kale. Lemberani tsiku ndi tsiku. Sonkhanani zambiri zamitundu mitundu ya chakudya ndi insulin. Phunzirani zinthu zofunika zomwe zimakhudza chidwi cha mahomoni awa ndikuphunzira momwe mungasinthire. Ngati mungayesere, mutha kukhalabe ndi shuga wabwinobwino, monga momwe mumakhalira anthu athanzi - 4.0-5,5 mmol / l maola 24 patsiku.

Kuwerengera mlingo wa insulin (imodzi ndi tsiku)

Theoretical algorithm yowerengera tsiku ndi tsiku insulin odwala omwe ali ndi matenda a shuga (DM) mtundu 1 amachitika pogwiritsa ntchito ma coefficients osiyanasiyana: pafupifupi kuchuluka kwa insulini m'thupi kumawerengedwa pa kilogalamu ya kulemera kwenikweni kwa thupi, ngati pali kuchuluka kwa thupi - kuchuluka kwake kumachepa ndi 0,1, ndikuchepa kwake kumawonjezera pofika 0.1:

Kulemera kwa 0,4-0,5 U / kg kwa odwala omwe ali ndi matenda a shuga 1, 0,6 U / kg thupi kwa odwala omwe ali ndi matenda amtundu wa 1 omwe amapitilira chaka chimodzi pakulipira kwabwino, thupi la 0.7 U / kg kwa odwala omwe ali ndi matenda a shuga 1 amtundu wopitilira chaka chimodzi ndi chindapusa chokhazikika, 0,8 IU / kg yolemetsa kwa odwala omwe ali ndi matenda amtundu wa 1 omwe ali ndi vuto lalikulu, 0,9 IU / kg ya kulemera kwa thupi kwa odwala omwe ali ndi matenda a shuga 1 amtundu wa ketoacidosis, 1, 0 / U kulemera kwa thupi kwa odwala omwe ali ndi matenda a shuga 1 amsinkhu wobereka kapena III trimester ya mimba.

Monga ulamuliro, tsiku lililonse mlingo wa insulin woposa 1 U / kg patsiku umawonetsa bongo wa insulin. Ndi mtundu woyamba wa matenda ashuga 1, kufunika kwa tsiku ndi tsiku insulin ndi magawo 0,5 pa kilogalamu ya thupi.

Kukhazikitsidwa kwa insulin yochulukirapo kuyenera kutsata njira wamba yolembera insulin mwa munthu wathanzi. Amaperekedwa kawiri pa tsiku (asanadye chakudya cham'mawa, asanadye chakudya chamadzulo kapena usiku) pamlingo wosaposa 50% ya kuchuluka kwa insulin tsiku lililonse. Kukhazikitsidwa kwa insulin yochepa kapena ultrashort kanthu musanadye zakudya zazikulu (kadzutsa, nkhomaliro, chakudya chamadzulo) zimachitika mu Mlingo wowerengeredwa ndi XE.

Kufunika kwa tsiku ndi tsiku kwamankhwala am'madzi kumatsimikiziridwa ndi kuchuluka kwa zopatsa mphamvu zomwe zimafunikira wodwala wina, ndipo zitha kukhala 70 mpaka 300 g zamankhwala, zomwe zimachokera ku 7 mpaka 30 XE: pa chakudya cham'mawa - 4-8 XE, chakudya chamadzulo - 2-4 XE, pa chakudya chamadzulo - 3-4 He, 3-4 HE ayenera kufotokozedwa mwachidule m'mawa lachiwiri, chakudya chamadzulo masana komanso chakudya chamadzulo.

Insulin panthawi yazakudya zowonjezera, monga lamulo, siziperekedwa.

Pankhaniyi, kufunikira kwa insulini kwakanthawi kochepa kapena ka ultrashort kayenera kukhala kosiyanasiyana kuyambira magawo 14 mpaka 28. Mlingo wa insulin waifupi kapena wa ultrashort akhoza kukhala ndipo ayenera kumasiyanasiyana malinga ndi momwe zinthu ziliri komanso mogwirizana ndi zomwe zimapangitsa shuga. Izi zikuyenera kutsimikiziridwa ndi zotsatira za kudziletsa.

Chitsanzo cha kuwerengera mlingo wa insulin 1

Wodwala matenda ashuga amtundu 1, wodwala wazaka 5, chipukuta misozi. Kulemera makilogalamu 70, kutalika kwa masentimita 168. Kuwerengedwa kwa kuchuluka kwa insulini: Kufunikira kwa tsiku lililonse kwa 0,6 PESCES x 70 kg = 42 PESCES of insulin. IPD 50% kuchokera ku 42 PIERES = 21 (yozungulira mpaka 20 PIECES): asanadye kadzutsa - 12 PISCES, usiku 8 PIECES. ICD 42- 20 = ZITHUNZI 22: Asanadye chakudya cham'mawa, PIECES 8-10, asanadye chakudya cham'mawa, 6-8 PISCES, asanadye chakudya, 6-8 PISCES.

Kusintha kwina kwa IPD - molingana ndi mseru wa glycemia, ICD - malinga ndi glycemia ndi kumwa kwa XE. Kuwerengera uku ndikuwonetsa ndipo kumafunikira kukonzedwa, komwe kumachitika motsogozedwa ndi kuchuluka kwa glycemia komanso kumwa kwa mafuta mu XE.

Tisaiwale kuti pokonza glycemia, ndikofunikira kulingalira mlingo wa insulin yocheperako kuti muchepetse zizindikiro zokwanira, motengera zotsatirazi:

1 unit ya insulin yaifupi kapena ya ultrashort action imachepetsa glycemia ndi 2.2 mmol / l, 1 XE (10 g yamafuta) imachulukitsa kuchuluka kwa glycemia kuchokera 1.7 mpaka 2.7 mmol / l, kutengera index ya glycemic.

Chitsanzo cha kuwerengetsa mlingo wa insulin 2

Wodwala matenda a shuga 1, odwala zaka 5, zolipirira. Kulemera makilogalamu 70, kutalika kwa masentimita 168. Kuwerengedwa kwa kuchuluka kwa insulini: Kufunikira kwa tsiku lililonse kwa 0,6 PESCES x 70 kg = 42 PESCES of insulin. IPD 50% kuchokera ku 42 PIECES = 21 (yozungulira mpaka 20 PIECES): asanadye kadzutsa -12 PISCES, usiku 8 PIECES. ICD 42 -20 = 22 IU: musanadye chakudya cham'mawa 8-10 IU, musanadye chakudya cham'mawa 6-8 IU, musanadye chakudya cham'mawa 6-8 IU.

Kusintha kwina kwa IPD - molingana ndi mseru wa glycemia, ICD - malinga ndi glycemia ndi kumwa kwa XE. Morly glycemia ya 10,6 mmol / l, imaganiziridwa kuti imagwiritsidwa ntchito ndi 4 XE. Mlingo wa ICD uyenera kukhala PIERESI 8 pa 4 XE ndi 2 PIECES kuti "achepetse" (10.6 - 6 = 4.6 mmol / L: 2.2 = 2 PIECES of insulin). Ndiye kuti, m'mawa mu ICD muyenera kukhala magawo 10.

Itha kuganiziridwa kuti kugwiritsa ntchito moyenera malangizo omwe aperekedwa pochizira komanso kutsatira kwambiri kuchuluka kwa glucose othandizira kungathandize odwala kukhala ndi moyo wautali komanso wabwino. Komabe, ayenera kutsimikizira kufunika kogula ma glucometer awo ndikuwunikira pafupipafupi glycemia komanso kuchuluka kwa hemoglobin ya glycated.

Momwe mungawerengere kuchuluka kwa insulin mu mtundu I wa shuga

Momwe mungawerengere tsiku ndi tsiku insulin ya mwana yemwe ali ndi matenda a shuga a mtundu woyamba? Funso limakhala pa makolo, ndipo simumalandira yankho kuchokera kwa madokotala. Osati chifukwa madokotala sakudziwa, koma chifukwa, mwina, sakhulupirira makolo osakhazikika.

Kudziyang'anira pawokha kumatenda tsiku ndi tsiku komanso ola limodzi. Ndipo pafupipafupi, makolo a ana odwala matenda ashuga amapanga zisankho zazikulu, zenizeni, zathanzi ndi moyo wa ana awo. Chifukwa chake, funso "zomwe muyenera kudziwa ndi zomwe simuyenera kudziwa" sizoyenera konse. Zachidziwikire - chilichonse kuti mudziwe, kumvetsetsa ndikutha kutero.

Ndidatenga monga American waku America ngati maziko a kumvetsetsa kwanga kwa insulin. Choyamba, chifukwa anthu aku America samafotokozera bwino, ndipo chachiwiri, chifukwa dongosolo la America limachita ndi Israeli, ndipo ichi ndi chinthu choyamba chomwe tidakumana nacho atatha kuwonetsa matenda athu a shuga.

Chifukwa chake, tiyenera kudziwa chiyani za kuchuluka kwa insulin tsiku lililonse?

Chofunikira tsiku lililonse cha insulini chimawerengeredwa pa kilogalamu imodzi ya thupi labwino kwambiri. Ndiye kuti, chimodzi chomwe chimapangidwa ndi asayansi kwa mwana wamba. Ndipo ana oterowo, monga mukudziwa, mulibe chilengedwe. Koma kuti tisawope “mankhwala osokoneza bongo” tsopano, tikudziwa kuti muyezo wa insulin ya jekeseni muyenera kusintha magawo 0,3-0.8 / kg patsiku.

Izi ndizomwe zikuyimira. Tsopano tiyeni tiwone ngati mlingo wa insulin wa tsiku lililonse wa mwana wathu amawerengeredwa molondola. Pali njira yofunikira, yomwe madokotala amapangira insulin. Zikuwoneka ngati:

X = 0,55 x kulemera / kg (Mankhwala okwanira tsiku ndi tsiku a insulin (basal + bolus) = 0,55 x pa munthu aliyense wolemera kilogalamu.

X = kulemera / lb: 4 (Izi ndi ngati mumayeza kulemera mapaundi, koma sitiganizira zafanizoli, ndizofanana ndi kakhazikidwe kamakilogamu, ndipo sikofunikira kwambiri kwa ife).

Ngati thupi likulimbana ndi insulin kwambiri, mufunika mankhwala ambiri. Ngati thupi limakhudzidwa kwambiri ndi insulin, ndiye kuti insulini yotsika ingafunike.

Tinene kuti mwana akulemera makilogalamu 30. Kuchulukitsa kulemera kwake ndi 0.55. Timalandira 16.5. Chifukwa chake, mwana uyu ayenera kulandira magawo a 165 a insulin tsiku lililonse. Mwa zomwe, mwachitsanzo, magawo 8 amawonjezera insulin ndipo 8.5 ndi insulin yochepa musanadye (kadzutsa 3 + nkhomaliro ya 2,5 + chakudya chamadzulo 3). Kapena magawo 7 ndi basal insulin ndipo 9,5 ndi bolus.

Koma tikudziwa motsimikiza: kulibe matenda a shuga! Timangoyesa kutsatira tanthauzo la golide, koma ngati sizikukwanira ... Chabwino, tikusuntha pakatikati komwe tikufuna.

Kutengera ndi zomwe ndakumana nazo, nditha kunena kuti m'chigawo chathu 13, malamulo onse a shuga omwe timawadziwa adayamba kuvina. Ndipo amavinabe, kusuntha kuchokera ku gaak kupita kuvina kwa St. Witt. Ndili ndi "kupuma" kale sikokwanira kukwera nawo kumapazi.

Mwana amakula ndi masentimita 14 mchaka, koma pafupifupi chaka sichinkalemera! Posachedwa pomwe wayamba kuti akhale bwino. Ndipo apa si insulin, koma majini. Chifukwa chake aliyense anakulira m'mabanja athu. Koma ubongo wa kholo sugona: mwana amadya pang'ono! Koma kudya zochulukirapo - prick kwambiri, ndikuwerengera njira sikumalolezedwanso.

Koma formula imakhazikitsidwa "kulemera" kwabwino! Ndipo ungazipeze bwanji mu kutha? Timasowabe 8-10 makilogalamu ku zabwino! Ndiye pamaziko a zomwe mungawerengere tsiku ndi tsiku insulin: kutengera kulemera kwenikweni kapena koyenera? Ngati titengera izi, ndiye kuti tili ndi insulini. Ndi "abwino" - ochulukirapo. Tinakhazikika pa "golide" wathu.

Ndikuganiza kuti izi ndizowona osati kutha msinkhu kwa achinyamata, ana akhama komanso mosagwirizana amakula pazaka 5, komanso pazaka 7-8, ndi khumi.

Komabe, tikufuna njira zowerengera. Monga nsanamira za malire ku Europe. Palibe chifukwa chogwiritsa ntchito kasamalidwe ka miyambo, koma ndichabwino kudziwa kuti simulinso ku Czech Republic, koma ku Germany kapena ku Poland. Pokhapokha chifukwa pamalo opangira mafuta gasi lina likugwiritsidwa kale ntchito, ndipo yanu singatengedwe. Mukudziwa zambiri - mukupumira. Chifukwa chake, timatenga chilinganizo, ndikukhulupirira, kudziyesa tokha ndikukhalabe ndi moyo.

Momwe mungawerengere kuchuluka kwa insulin mwanzeru?

Insulin ndi timadzi tomwe ma kapamba amayang'anira. Odwala omwe ali ndi matenda ashuga, kufunika kwa insulini kumakweza pang'ono poyerekeza ndi anthu athanzi, motero nthawi zambiri matendawa amaperekedwa jekeseni wowonjezera wa mankhwala.

Kodi muyenera kuchita chiyani mutapezeka kuti muli ndi matenda ashuga?

Kumbukirani kuti panthawi yomwe mwapezeka ndi matenda ashuga, chinthu choyamba chomwe muyenera kuda nkhawa ndi cholembera momwe muyenera kuyika zambiri pazomwe zikuwonetsa shuga.

Gawo lotsatira, lofunika kwambiri komanso lofunikira, liyenera kukhala kugula kwa glucometer, komwe mumatha kuyeza kuchuluka kwa shuga m'magazi kwakanthawi kulikonse. Akatswiri amalimbikitsa kuyeza kuchuluka kwa shuga musanadye, komanso maola awiri mutatha.

Makhalidwe abwinobwino ndi 5-6 mmol pa lita imodzi musanadye, ndipo zoposa zisanu ndi zitatu mutatha maola awiri mutatha. Koma ndikofunikira kudziwa kuti pa vuto lililonse lomwe chizindikiro ichi chimasiyanasiyana, ndichifukwa chake kuti muwerenge kuchuluka kwa insulini muyenera kulumikizana ndi dokotala yemwe angadziwe pokhapokha mutayezera kuchuluka kwa shuga panthawi 6 mpaka 7.

Kuphatikiza apo, ndikofunikira kudziwa kuti nthawi yayitali yomwe munthu amamwa insulin kudzera mu jakisoni, thupi limachepetsa. Ngati matendawa atenga nthawi yayitali kwambiri, kapamba amapitiliza kupanga insulin, yofunikira kwambiri mthupi. Nthawi yomweyo, mlingo wa insulin uyenera kuchuluka pang'onopang'ono kuti usavulaze thanzi.

Ndi dotolo wa endocrinologist, atasanthula mozama machitidwe onse a thupi lanu, omwe angapereke malingaliro pakuwonjezera kuchuluka kwa insulin, komanso kupaka utoto wokwanira. Kuphatikiza apo, odwala matenda ashuga amayenera kuwunikira miyezi isanu ndi umodzi kuchipatala, kapena kunja, kuti madokotala azitha kuyang'ana kusintha konse mthupi.

Kuti mupeze molondola kuchuluka kwa insulini, muyenera kukhala ndi chidziwitso chapadera, komanso kukhala ndi chidziwitso chomwe chingapezeke pogwiritsa ntchito zida zamakono zamankhwala apamwamba kwambiri. Chifukwa chake, kuti mukhale ndi moyo wautali komanso wachimwemwe, odwala matenda ashuga ayenera kutsatira mosasamala zofunikira zonse za madotolo.

Kuwerengera kwachitsanzo kuchokera pabwaloli

Tiyeni tiyese kuwerengera za mlingo wa insulin.Chifukwa chake, mankhwala a insulin ali ndi zigawo ziwiri (bolus - yochepa komanso ya ultrashort insulin ndi basal - insulin yayitali).

1. Kwa anthu omwe ali ndi chinsalu chotsalira cha insulin (mfundo iyi iyenera kuyang'aniridwa ndi endocrinologist), mlingo woyambira wa tsiku ndi tsiku ndi 0.3-0.5 U / kg wa PERFECT BODY WEIGHT (womwe umawerengeredwa pogwiritsa ntchito njira ya kukula-100) Pali njira zambiri zolondola, koma kwambiri komanso osazindikira. Popeza kuti tikuopa kupitiliza, timaganiza kuti mwasungabe zinsinsi zanu.

Zili choncho 0,5ED * 50kg = 25ED (timatenga 24, chifukwa mu syringes yogawa pa 2 PIECES)

2. Mlingo wa tsiku ndi tsiku umagawidwa pakati pa basal ndi bolus 50/50. Ine.e. Magawo 12 ndi 12.

Basal, mwachitsanzo, LEVIMER - PIERESI 12 patsiku (ngati gawo limodzi la insulin limatenga nthawi yayitali kuposa mayunitsi 12, ndiye kuti timagawa ndi 2, mwachitsanzo 14 - zikutanthauza 8 m'mawa komanso 6 tisanadye chakudya) M'mikhalidwe yathu, sizofunikira.
Bolusnaya -. NOVORAPID - magawo anayi musanadye kadzutsa, nkhomaliro ndi chakudya chamadzulo.

3. Pambuyo pa izi, timatsatira kufa kosasintha (werengani za zakudya pamwambapa)

4. Pambuyo pa tsiku, timatenga mbiri ya glycemic.

Mwachitsanzo, zidzakhala motere:

musanadye chakudya cham'mawa 7.8 maola awiri 2 mukatha kudya kadzutsa - 8.1 musanadye nkhomaliro maola 4,6 patsiku maola awiri mutatha kudya chakudya chamadzulo. 8.1

Kutanthauzira kwa zotsatira:

Mlingo wa bolus musanadye chakudya cham'mawa chokwanira, chifukwa glycemia atatha kadzutsa oposa 7.8 ==> onjezani magawo awiri a Novorapid - zimapezeka kuti asanadye kadzutsa ndikofunikira kuti musayike 4, koma magawo 6. Asanadye nkhomaliro - momwemonso Koma musanadye chakudya - zonse zili bwino - siyani magawo anayi

Tsopano tiyeni tisunthire ku basal insulin. Muyenera kuyang'ana ziwerengero za glycemic musanadye kadzutsa (shuga yofulumira) ndi 23:00 ayenera kukhala mu 3.3-5.3. Likukhalira kuti m'mawa shuga amawonjezeka - mutha kugawanitsanso mlingo mu magawo awiri. (m'mawa ndizambiri - 8, ndipo nthawi yamadzulo - 4) ngati ziwerengerozo zimapezeka nthawi yomweyo - ndiye kuti timawonjezera 2 ED pamankhwala olimbitsa a insulin. (kuyambira m'mawa ndikwezeka).

Pambuyo pa masiku awiri, kubwerezanso mbiri ya glycemic ndikubwereza zonse zomwe zanenedwa pamwambapa, ziwerengero ziyenera kukhazikika.

p / w milungu iwiri ya 2 fructosamine p / w glycated hemoglobin (ngati imakwezedwa (monga momwe mumafunira), ndiye kuti shuga siyalipidwa)

Pokhapokha NDIDZATSITSITSA ZAUTHENGA uwu USIYENSE KUGWIRITSITSITSITSITSITSONKA DZIKO LAPANSI. Sindikumveranso UTHENGA WABWINO WONSE.

Buku lamalangizo

Mukangozindikira kuti muli ndi matenda a shuga, yambani kuyimba buku lomwe mumalemba za shuga ndi kuchuluka kwa chakudya chomwe mumadya nthawi ya nkhomaliro, nkhomaliro komanso chakudya chamadzulo.

Mukamayendera, onetsetsani kuti mwalingalira nthawi ya tsiku lomwe muyeso umapangidwira, kuchuluka kwa chakudya chamafuta, komanso kuchuluka kwa magalimoto. Musaiwale za zina zowonjezera zomwe zimakhudza shuga m'magazi: kulemera kwa thupi ndi kutalika, kupezeka kwa matenda ena osachiritsika, dongosolo lolembetsedwa ndi akatswiri ena. Ndizofunikira kwambiri pakuwerengedwa kwa insulin yomwe imakhalapo kwa nthawi yayitali.

Tcherani khutu: "chidziwitso" chambiri cha matenda ashuga, chimachepetsa "inshuwarani" wekha, yomwe kwakanthawi imapitiliza kupangidwa ndi kapamba. Komabe, simuyenera kuwonjezera kwambiri kumwa kwake musanapemphedwe ndi endocrinologist ndikuwunikiratu ngati mwapezeka kuchipatala. Odwala omwe ali ndi matenda ashuga amayenera kuwunika osachepera 1 pachaka.

Wobayira jakisoni wa insulin nthawi zambiri amaperekedwa kuti achepetse kuchuluka kwa shuga m'magazi. Mlingo wake umatengera:

kuchuluka kwa XE komwe mumakonzekera kudya pakudya (osaposa 6), kusala kudya kwa magazi, komanso kuchita masewera olimbitsa thupi mutatha kudya. 1 XU nthawi zambiri imafuna kukhazikitsidwa kwa magawo awiri a insulin yochepa. Ngati pakufunika kuti muchepetse kwambiri shuga m'magazi, ndiye kuti pa "kowonjezera" 2 mmol / L, 1 unit ya ICD imayendetsedwa.

Kusankhidwa kwa mlingo wa insulin wakhalapo kwa nthawi yayitali kumayamba ndi jakisoni wambiri.Chifukwa chake, ngati mumalowa magawo 10 musanagone, m'mawa mfundo zamagazi sayenera kupitirira 6 mmol / l ndi mlingo wokwanira. Ngati mwapereka mankhwala oterewa, thukuta lanu lakulirakulira ndipo chikhumbo chanu chikukulirakulira, muchepetse ndi ziwalo ziwiri. Chiwerengero pakati pausiku ndi tsiku mlingo uyenera kukhala 2: 1.

Zotsatira zake pakuwerengera mlingo wa insulin. Kuwerengera bwanji?

Tawona kale mu zolemba zam'mbuyomu kuti mtengo (mtengo) wa gawo la insulini umasintha tsiku lonse. Zimasintha mogwirizana ndi zigawo za mkate (XE) komanso mogwirizana ndi shuga. Chifukwa chake, munthu aliyense yemwe akudwala matenda ashuga ayenera kudziwa momwe angapangire mlingo wa insulin, mukusintha masana. Nthawi zambiri, anthu ambiri omwe ali ndi matenda ashuga amakhala ndi zotere tsiku lonse:

M'mawa, insulini ndi "yotsika mtengo" - ndiye kuti, kuchuluka kwa insulini kumafunikira kuti pakhale chakudya chamagulu omwe amadya ndi chakudya komanso kuchepetsa shuga. Masana, insulini "imakwera pamtengo" - mlingo wa insulin womwe umafunika kuchepetsa shuga m'magazi ndikulipira chakudya chochepa kwambiri. Nthawi zambiri ndimatenga mtengo wamasiku onse a insulin ngati 1: 1 mpaka magawo a mkate ndipo, kuyambira pamenepo, ndimawerengera zomwe zimachitika m'mawa ndi madzulo. Madzulo, insulini ndi "yotsika mtengo" - insulin yotsika imagwiritsidwa ntchito pakupanga mikate ya mkate kapena kutsika shuga m'magazi kuposa m'mawa ndi masana.

Momwe mungadziwire zowongolera za mtengo wa insulin, ndi momwe mungazigwiritsire ntchito, ndiye kuti, kuwerengera mlingo wa insulin?

Tiyeni tione chitsanzo.

Pa 1: 1 mlingo wa inshuwaransi ya botus, timamwa mlingo wa masana - timakhala ndi nthawi kuyambira maola 10 mpaka 14 (koma dziwani kuti zonse ndizofunikira pakokha - mutha kukhala ndi gawo lina - kudziwa chilichonse pokhapokha ngati muli ndi nthawi komanso chidziwitso). Pakadali pano, mwana wanga wamwamuna wazaka zisanu ndi zitatu amakhala ndi chakudya chambiri ndi chakudya chamasana (ngati tili kunyumba kumapeto kwa sabata kapena tchuthi), kapena nkhomaliro chabe (pambuyo pa sukulu).

Chakudya chotsatira, timaganizira chakudya chamadzulo. Timalingalira za XE mndandanda wazakudya zathu ndipo timatsimikiza kuti tidzadya chakudya chamoto ku 2.8 XE. Mlingo wa insulini pa "mtengo" watsiku ndi tsiku uzikhala 2.8 * 0.9 = 2.5 magawo. Kutengera chidziwitso cha anthu ena odwala matenda ashuga, sitingayike pachiwopsezo cha hypoglycemia - ndipo patsogolo tidzachepetsa insulin ndi 20%:

Mayunitsi 2,5 - (2,5 * 20/100) = mayunitsi 2.0 a insulin.

Timayeza shuga m'magazi tisanadye - 7.4 mmol / L. Timaika "deuce", timadya chakudya chamadzulo. Timayeza kuchuluka kwa glycemia pambuyo maola 2 (popeza tili ndi Humalog, ndipo imakhala pafupifupi maola awiri). Timakhala ndi shuga m'magazi - 5.7 mmol / L. Mwazi wa magazi unachepa, ndiye kuti mlingo wa mankhwala a bolus omwe timabayikira chakudya tisanadye chakudya chonse komanso kutsitsa glycemia ndi:

7.4 mmol / L - 5.7 mmol / L = 1.7 mmol / L.

Tikuwona kuchuluka kwa mlingo wa bolus womwe umatsitsa shuga:

1 unit ya insulin - imachepetsa shuga m'magazi ndi ma insulin a 4.2 mmol / L X - amachepetsa shuga la magazi ndi 1,7 mmol / L

X = 1 * 1.7 / 4.2

X = 0,4 - zambiri za insulini zochokera ku mayunitsi a 2,5 omwe tinalowa tisanadye chakudya tidapita m'magazi a shuga, zomwe zikutanthauza kuti magawo 2.1 otsalawo adagwiritsidwa ntchito pakugwira zigawo za 2.8 zama mkate. Chifukwa chake, chakudya chamadzulo chamadzulo chimakhala chofanana ndi:

2.8 / 2.1 = 1.3 - ndiye kuti, gawo limodzi la insulini limaperekera chakudya kwa 1.5 XE.

Mwa mfundo zomwezi, timachita kuwerengera komanso kuwerengera chakudya cham'mawa, kokha sitimatsitsa mlingo wa bolus isanachitike, koma kuonjezera, kapena, ngati pali mantha a hypoglycemia, achisiye chimodzimodzi masana.

Mwachitsanzo, konzekerani chakudya cham'mawa chomwe chili ndi chakudya ku 3 XE. Timawerengera bolus pamtengo wa tsiku ndi tsiku wa insulin: 3.0 * 0.9 = 2.7 magawo a insulin. Poganizira za m'mbuyomu za anthu odwala matenda ashuga, pomwe, monga lamulo, insulin imakhala "yotsika mtengo" m'mawa, tidzayambitsa magulu atatu.

Timayeza shuga m'mawa tisanadye kadzutsa - 5.4 mmol / L. Timayika mayunitsi a 3.0 a bolus insulin (tili ndi humalogue) ndipo timadya chakudya cham'mawa ku 3 XE. Pambuyo pa maola awiri (nthawi yayitali), timayezera kuchuluka kwa shuga - 9.3 mmol / L.Chifukwa chake kuchuluka kwathu kwa botus sikokwanira kulipirira magawo atatu a buledi ndipo ena mwa iwo amapita kukawonjezera glycemia. Timawerenga gawo ili:

9.3-5.4 = 3.9 mmol / L - mulingo wamafuta wamwazi wakwera pamtengo uwu.

Podziwa mtengo wa chakudya chamagulu a shuga a shuga kuchokera palemba lolingana (3.4 mmol / L), titha kuwerengetsa kuchuluka kwa mafuta omwe amapezeka kuti achulukitse kuchuluka kwa shuga m'magazi:

1 XE - imawonjezera shuga m'magazi ndi 3.4 mmol / L X XE - imakulitsa shuga wamagazi ndi 3.9 mmol / L

X = 1 * 3.9 / 3.4

X = 1.1 mayunitsi a mkate anapita kukawonjezera shuga. Kapena, mwachidule, mlingo wa insulin wa bolus sunali wokwanira 1.1 XE. Timapeza magawo ena onse a buledi omwe anali okwanira insulin (gawo lochapidwa):

3.0XE - 1.1XE = 1.9XE

Chifukwa chake, tinayambitsa magawo atatu a insulin musanadye chakudya cham'mawa, adatilola kuti titenge michere yokha pa 1.9XE, 1.1XE yotsalira idapita kukakulitsa glycemia. Momwemo, m'mawa kukonza mgwirizano wa insulin pakudya kadzakhala kofanana ndi:

3,0/1,9=1,58 - ndiye kuti, pokonzekera thupi la 1 mkate pakudya cham'mawa, mudzafunika kuyambitsa mayunitsi 1.6.

Pomaliza, ndikufuna kukumbutsani kuti mulingo wambiri, kukonza zina, mtengo wama insulin ndi mikate ya mkate ndi munthu payekha ndipo amawerengedwa padera pa aliyense wodwala matenda a shuga. Mfundo zomwe zaperekedwa munkhaniyi ndizofunikira ndipo zimangoperekedwa pongofotokozera mfundo za kuwerengera. Kugwiritsa ntchito ngati malangizo okonzedwa sikuletsedwa.

Mlingo wa tsiku ndi tsiku wa insulin, kuwerengera

Kuchepetsa shuga kwa odwala matenda a shuga ndi kugwiritsa ntchito insulin, mapiritsi, mankhwala ochepetsa shuga ndi mankhwala azitsamba. Zisonyezero zoika insulin:

mtundu I shuga mellitus, mtundu II matenda ashuga mellitus pa vuto la mankhwala osakwanira othandizira kudya ndi pakamwaacogosis, precomatous zinthu, kuchepa thupi, kutenga pakati, kuyamwa, polyneuropathy, angiopathy ndi kukula kwa zilonda zam'mimba. matenda, chithandizo cha opaleshoni, kuwonongeka kwa chiwindi ndi impso.

Njira ya insulin mankhwala

kwambiri chisamaliro - - subcutaneous angapo jakisoni wakufotokozera yemwe akuchita posachedwapa matenda a shuga, panthawi yomwe ali ndi pakati, ndi ketoacidosis, mtsempha wozungulira makonzedwe osakhalitsa a insulin mu chikomokere, njira yoyambira ya insulin.

Mukapezeka kuti mwazindikira koyamba, mlingo wa insulin tsiku lililonse umatsimikizika potengera kuchuluka kwa magawo 0,5 pa kilogalamu imodzi yakulemera. Mlingo wa tsiku ndi tsiku umasankhidwa mu regimen yolimbitsa thupi (5-6 jakisoni wa insulin yochepa).

Munthawi yonse ya mankhwala a basal-bolus regimen, muyezo wa basal insulin ndi insulini yowonjezera jakisoni asanadye amagawidwa motere:

Chitsanzo. Wodwalayo adalimbikitsa kuchuluka kwa insulin 42 magawo patsiku. Gawo limodzi mwa magawo khumi ndi atatu (14) lidzakhala insulin yokhala nthawi yayitali. Mlingo wotsalira - 28 PIERES amagawidwa motere: 10 PISCES asanadye kadzutsa, 10-12 PESCES musanadye nkhomaliro ndi 67 PISCES asanadye.

Kuchita insulin kwa nthawi yayitali kuyenera kuperekedwa nthawi yamadzulo nthawi yomweyo monga jakisoni wa insulin yocheperako (mankhwala a nthawi yayitali) kapena m'mawa.

Chifukwa chake, popereka mankhwala a insulin, ndikofunikira kuti muthe kuyang'ana pa mankhwalawa monga pazokwanira nthawi yoyambayo. Kuwongolera kowonjezereka kumachitika molingana ndi mbiri ya glycemic ndi glucosuric.

Mankhwala a insulin

Mu matenda a shuga mellitus, kuwonjezera pa zakudya komanso kumwa pakamwa za hypoglycemic, njira yothandizira monga insulin mankhwala imakhala yofala kwambiri.

Amakhala ndi wokhazikika wothandizidwa ndi insulin mthupi la wodwalayo ndipo amasonyezedwa kuti:

• Mtundu woyamba wa shuga
• zovuta za matenda ashuga - ketoacidosis, chikomokere (hyperosmolar, matenda ashuga, matenda oopsa),
• Mimba ndi kubereka ana odwala shuga kapena odwala matenda osokoneza bongo
• kuwonongeka kwakukulu kapena kusowa kwa mphamvu kuchokera ku mtundu wanomwe wa matenda a shuga a 2,
• chitukuko cha matenda ashuga nephropathy.

Regimen yothandizira insulin imasankhidwa kwa wodwala aliyense payekhapayekha.

Pankhaniyi, dokotala amakumbukira:

• kusinthasintha kwa magazi odwala
• chikhalidwe cha zakudya
• nthawi yakudya
• mulingo wakuchita zolimbitsa thupi
• kukhalapo kwa matenda oyanjana.

Mapangidwe achikhalidwe

Chithandizo cha insulin chachikhalidwe chimaphatikizapo kukhazikitsa nthawi yokhazikika ndi jakisoni. Nthawi zambiri, jakisoni awiri (mahomoni ofupika ndi okhalitsa) amapatsidwa 2 r / tsiku.

Ngakhale kuti madongosolo oterewa ndi osavuta komanso omveka kwa wodwalayo, ali ndi zovuta zambiri. Choyamba, uku ndikusowa kwa kusintha kosinthasintha kwa mlingo wa mahomoni kupita ku glycemia wapano.

M'malo mwake, wodwala matenda ashuga amasintha kukhala ndi zakudya zabwino komanso jakisoni. Kupatuka kwina kulikonse kochokera pamoyo wamasiku onse kumatha kudzetsa kulumikizidwa kwakukuru kwa glucose ndikuwonongeka mu thanzi.

Kusakwanira kwa shuga ndi njira yodziwika yoperekera mankhwala

Mpaka pano, akatswiri a ma endocrinologists asiya njira yochizira.

Amayikidwa pokhapokha ngati sizingatheke kupereka insulin malinga ndi kubisala kwachilengedwe:

• odwala okalamba omwe ali ndi moyo wotsika.
• Odwala omwe ali ndi vuto la matenda amisala,
• mwa anthu omwe sangathe kuyang'anira pawokha glycemia,
• mu odwala matenda ashuga omwe amafunikira chisamaliro chakunja (ngati ndizosatheka kuzipereka zapamwamba).

Chiwembu choyambira

Kumbukirani zofunikira za physiology: kapamba wathanzi amatulutsa insulini nthawi zonse. Zina mwa izo zimatchedwa kuzungulira kwa mahomoni m'magazi, pomwe enawo amasungidwa mu kapamba.

Munthu adzafunikira nthawi ya chakudya: kuyambira pomwe chakudyacho chikuyamba ndi kwa maola 4-5 atatha, insulin imadzidzimutsidwa, imaperekedwa m'magazi kuti ipeze mofulumira zakudya komanso kupewa glycemia.

Kubisirana kwa mahomoni ndizabwinobwino

A basal bolus regimen amatanthauza kuti jakisoni wa insulini amapanga kutsanzira kutulutsa kwazinthu za mahomoni. Yake yoyambira imasungika chifukwa cha kuphatikiza kwa 1-2 kwa mankhwala omwe akhala akuchita kwa nthawi yayitali. Ndipo kuwonjezereka kwa nsonga (kuchuluka) kwa kuchuluka kwa mahomoni m'magazi kumapangidwa ndi "zidule" za insulin yochepa musanadye.

Zofunika! Mukamasankha mtundu waukulu wa insulin, muyenera kuyang'anira shuga nthawi zonse. Ndikofunikira kuti wodwalayo aphunzire kuwerengera kuchuluka kwa mankhwalawa kuti asinthane ndi kuchuluka kwa shuga.

Kuwerengera Basal Dose

Tazindikira kale kuti insulin ya basal ndiyofunikira kuti ikhalebe yofulumira kudya glycemia. Ngati pakufunika chithandizo cha insulin, majekeseni ake amalembedwa kwa odwala omwe ali ndi matenda a shuga a mtundu wa 1. Ndipo mankhwala omwe ali odziwika masiku ano ndi Levemir, Lantus, Protafan, Tujeo, Tresiba.

Zofunika! Kuchita bwino kwa mankhwalawa kumadalira momwe mawerengeredwe a kuchuluka kwa insulin amapangidwira.

Pali njira zingapo zosankhira insulin yomwe ikupita patsogolo (IPD). Ndikosavuta kugwiritsa ntchito njira yoyeserera.

Malinga ndi iye, kuchuluka kwa insulin (SSDS) ya tsiku ndi tsiku iyenera kukhala (UNITS / kg):

• 0.4-0.5 - ndi matenda oyamba ndi shuga,
• 0.6 - kwa odwala matenda ashuga (anazindikira chaka kapena kupitirira) mu chiphuphu chokwanira,
• 0,7 - ndi chiphuphu chosasunthika cha shuga,
• 0,8 - ndi kuwonongeka kwa matendawa,
• 0,9 kwa odwala ketoacidosis,
• 1.0 - kwa odwala nthawi yakutha kapena kubereka.

Mwa awa, ochepera 50% (ndipo nthawi zambiri 30-40%) ndi mankhwala omwe amapezeka nthawi yayitali, ogawidwa jakisoni awiri. Koma awa ndi malingaliro apakati. Pakusankhidwa kwa Mlingo woyenera, wodwalayo ayenera kudziwa kuchuluka kwa shuga ndikuyikamo.

Gawo lodziyang'anira lokha la odwala matenda ashuga:

M'ndime Zofunika kuzisonyeza:

• zakudya zopatsa thanzi (zakudya ziti, zidadyedwa motani, ndi zina zambiri),
• mulingo wakuchita zolimbitsa thupi
• kumwa mankhwala
• jakisoni wa insulini (dzina la mankhwala, mlingo),
• zinthu zachilendo, zovuta,
• mowa, khofi, etc.
• kusintha kwa nyengo
• kukhala bwino.

Nthawi zambiri, tsiku lililonse IPD imagawidwa pawiri: m'mawa ndi madzulo. Nthawi zambiri sizotheka kusankha nthawi yomweyo kuchuluka kwa mahomoni ofunika kwa wodwala nthawi yogona. Izi zimatha kubweretsa zigawo za onse a hypo- ndi hyperglycemia m'mawa wotsatira.

Kuti mupewe izi, madokotala amalimbikitsa kuti wodwalayo adye mwachangu (maola 5 asanagone). Komanso, pendani kuchuluka kwa shuga m'mawa komanso m'mawa kwambiri. Amakhala otani?

Glucometer - chipangizo chosavuta chodziyang'anira pawokha

Kuti muwerenge kuchuluka kwa mankhwalawa kuyambira kwa insulin yayitali, muyenera kudziwa kuchuluka kwa mankhwala a mmol / l 1 amachepetsa shuga la magazi. Dongosolo ili limatchedwa Insulin Sensitivity Coefftire (CFI). Amawerengeredwa ndi njira:

CFI (yowonjezera ins.) = 63 kg / diabetes kulemera, kg × 4,4 mmol / l

Izi ndizosangalatsa. Kuchuluka kwa thupi kwamunthu, kumachepa mphamvu ndi insulin.

Kuti mupeze mlingo woyenera wa mankhwala omwe mungabaye usiku, gwiritsani ntchito mawonekedwe awa:

SD (usiku) = Kusiyanitsa pang'ono pakati pa msinkhu wa shuga musanagone komanso m'mawa (kwa masiku 3-5 omaliza) / CFI (kwa ins.)

Gubitsani mtengo wotsatira kwa magawo 0,5 ndikugwiritsa ntchito. Komabe, musaiwale kuti pakapita nthawi, ngati glycemia m'mawa yopanda kanthu ikukwera kapena kutsika kuposa masiku onse, mlingo wa mankhwalawa ukhoza kusintha ndipo uyenera kusintha.

Tcherani khutu! Kupatula pang'ono pokhapokha (kutenga pakati, kutha msala, matenda owopsa), ma endocrinologists samalimbikitsa kugwiritsa ntchito mankhwalawa usiku pamwamba pa magawo 8. Ngati mahomoni ochulukirapo amafunikira powerengera, ndiye kuti china chake sichili bwino ndi zakudya.

Kuwerengeredwa kwa mlingo wa Bolus

Koma mafunso ambiri mwa odwala amagwirizana ndi momwe angawerengere molondola mlingo wa insulin (ICD) yochepa. Kukhazikitsidwa kwa ICD kumachitika muyezo wowerengeredwa pamaziko a mkate (XE).

Ma insulin achidule amaperekedwa kwa odwala omwe ali ndi vuto lalikulu la matenda ashuga - ketoacidosis ndi chikomokere

Mankhwala osankhidwa ndi Rinsulin, Humulin, Actrapid, Biogulin. Insulin ya insulle yaumunthu sikugwiritsidwa ntchito pakadali pano: idasinthidwa kwathunthu ndi ma enalog opanga ofanana kwambiri (werengani zambiri apa).

Zambiri. Chigoba cha mkate ndi chizindikiritso chomwe chimagwiritsidwa ntchito poyerekeza chakudya chamagulu omwe apatsidwa. 1 XE ndi wofanana 20 g wa mkate ndipo, motero, 10 g yamafuta.

Pazonse, zofunika tsiku ndi tsiku zamafuta zimasiyana kwa wodwala wina kuchokera 70 mpaka 300 g patsiku.

Mtengo uwu ukhoza kugawidwa motere:

• kadzutsa - 4-8 XE,
• nkhomaliro - 2-4 XE,
• chakudya chamadzulo - 2-4 XE,
• Zakudya zazing'ono (chakudya chamasana, chakudya chamadzulo) - 3-4 XE.

Nthawi zambiri, jakisoni wa ICD amapangidwa katatu patsiku - chakudya chachikulu chisanachitike.

Potere, mlingo wa mankhwalawa ungasinthe ndipo uyenera kusintha malinga ndi momwe wodwalayo amadya komanso ma shuga a magazi, chifukwa:

• 1 XE imakulitsa shuga wamagazi ndi 1.7-2.7 mmol / l,
• kukhazikitsidwa kwa 1 U ICD kumachepetsa glycemia ndi avareji a 2.2 mmol / L.

Tiyeni tiwone chitsanzo:

• Wodwala wodwala matenda ashuga amtundu 1 akudwala kwa zaka 4, kubwezeredwa kumakhala kokwanira. Kulemera - 60 kg.
• Timawerengera SDDS: 0.6 × 60 kg = 36 PIECES.
• 50% ya SDDS ndi IPD = 18 magawo, omwe magawo 12 asanadye chakudya cham'mawa komanso magawo 6 usiku.
• 50% ya SDDS ndi ICD = 18 magawo, omwe asanadye kadzutsa - mayunitsi 6-8, nkhomaliro - mayunitsi 4-6, chakudya chamadzulo - mayunitsi 4-6.

Popeza matenda ashuga ndi matenda osachiritsika omwe amakhala ndi njira yayitali, chidwi chachikulu chimayenera kulipira maphunziro a odwala. Ntchito ya dotolo sikuti kungopereka mankhwalawo komanso kufotokozera momwe limapangidwira thupi, komanso kunena momwe angasinthire mlingo wa insulin kuchokera pa mulingo wa glycemia.

Mawu okhudzana ndi mankhwala a insulin ndi matanthauzidwe awo

Fotokozani mawu omwe tikufuna kufotokozera mankhwalawa a matenda a shuga ndi insulin.

Maziko - insulin yowonjezera, yomwe imatenga nthawi yayitali mutatha jakisoni (maola 8-24). Uyu ndi Lantus, Levemir kapena Protafan. Amapanga maziko a insulin m'magazi. Jakisoni oyambilira amapangidwira kuti shuga asakhale bwino pamimba yopanda kanthu. Osayenera kuzimitsa shuga wapamwamba kapena kugaya chakudya.

Chimbudzi ndi jakisoni wa insulini yofulumira (yaifupi kapena ya ultrashort) musanadye chakudya kuti mupeze chakudya chomwe chakudya ndikuletsa kuti shuga asatuluke mukatha kudya. Komanso, bolus ndi jakisoni wa insulin yofulumira panthawi yomwe shuga yachuluka ndipo ikufunika kuti ibwezeretsedwe.

Chakudya chogwiritsa ntchito ndi mtundu wa insulin yofulumira yomwe imafunika kuyamwa chakudya. Sizitengera momwe zinthu ziliri pamene wodwala wa shuga adakweza kale shuga asanadye.

Corusction bolus - mlingo wa insulin yofulumira, yomwe imafunikira kuti muchepetse shuga wokwanira kukhala yokhazikika.

Mlingo wa insulin yochepa kapena ya ultrashort musanadye ndiye kuchuluka kwa chakudya ndi kukonza mabulusuli. Ngati shuga musanadye zabwinobwino, ndiye kuti cholowacho ndi zero. Ngati shuga adalumphira mwadzidzidzi, ndiye kuti muyenera kupaka jekeseni wowonjezera, osadikirira chakudya chotsatira. Mutha kubayanso jekeseni kakang'ono ka insulin prophylactically, mwachitsanzo, musanalankhule pagulu lopanikizika, lomwe lidzakweza shuga.

Insulin yofulumira imatha kukhala yaifupi ya anthu (Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R ndi ena), komanso ma analogues apamwamba aposachedwa kwambiri (Humalog, Apidra, NovoRapid). Kodi ndi chiyani ndipo akusiyana bwanji, werengani apa. Ngati mutsatira zakudya zamafuta ochepa musanadye, ndibwino kupaka insulin yochepa ya anthu. Mitundu ya insulashash ya insulin ndiyabwino kugwiritsa ntchito mukamafuna kuti shuga ibweretsedwe mwachangu.

Basis-bolus insulin mankhwala - mankhwala a shuga ndi jakisoni wa insulin yowonjezera usiku ndi m'mawa, komanso jekeseni wa insulin yofulumira musanadye. Iyi ndiye njira yovuta kwambiri, koma imapereka chiwongolero cha shuga komanso kupewa zinthu zovuta za shuga. Basis-bolus insulin therapy imaphatikizapo jekeseni 5-6 patsiku. Ndikofunikira kwa odwala onse omwe ali ndi matenda amtundu woyamba 1 shuga. Komabe, ngati wodwala ali ndi matenda a shuga a 2 kapena mtundu 1 wa shuga wofatsa (LADA, MODI), ndiye kuti mwina atha kupangira jakisoni ochepa a insulin.

Insulin sensitivity factor - kuchuluka kwa 1 UNIT ya insulini kumatsitsa shuga.

Chakudya chopatsa thanzi - magalamu angati a chakudya omwe amapezeka amakwirira gawo limodzi la insulin. Ngati mutsatira zakudya zamafuta ochepa kuti muchepetse matenda a shuga, "kuchuluka kwa mapuloteni" ndikofunikira kwa inu, ngakhale lingaliro ili siligwiritsidwa ntchito mwalamulo.

Zokhudza insulin sensitivity factor ndi carbohydrate chiopsezo ndizopadera mwa aliyense wodwala matenda a shuga. Makhalidwe omwe amapezeka muzowongolera sagwirizana ndi enieni. Amapangidwa kuti awerenge kuchuluka kwa insulin, mwachidziwikire sicholondola.Zokhudza insulin sensitivity factor ndi chakudya chopatsa mphamvu zimakhazikitsidwa poyesa zakudya zopatsa thanzi komanso zama insulin. Amasiyana mitundu yambiri ya insulini komanso nthawi zosiyanasiyana masana.

Kodi mumafunikira jakisoni wa insulin musanadye

Momwe mungadziwire ngati mukufuna jakisoni wa insulin yachangu musanadye? Izi zitha kukhazikitsidwa pokhapokha podziyang'anitsitsa shuga wa magazi osachepera masiku atatu. Ndikwabwino kusawononga masiku atatu, koma sabata yonse kuti muwone ndikukonzekera. Ngati muli ndi matenda ashuga akulu amtundu woyamba, ndiye kuti muyenera jakisoni wa insulin yowonjezera usiku ndi m'mawa, komanso ma bolashi musanadye nawo. Koma ngati wodwala ali ndi matenda a shuga a 2 kapena mtundu 1 wa shuga wofatsa (LADA, MODI), ndiye kuti mwina jakisoni wocheperako amafunikira.

Mwachitsanzo, malinga ndi zotsatira za kuwona, zitha kutheka kuti mumakhala ndi shuga nthawi zonse masana, kupatula nthawi yakudya. Chifukwa chake, mumafunika jakisoni wa insulin yochepa musanadye chakudya chamadzulo. M'malo mwa chakudya cham'mawa, chakudya cham'mawa kapena chamasana chitha kukhala chakudya chovuta. Wodwala aliyense yemwe ali ndi matenda ashuga ali ndi vuto lakelo. Chifukwa chake, kupereka mitundu yonse ya mankhwala a insulin kwa aliyense ndi udindo wa dokotala mosasamala. Koma ngati wodwalayo ndi waulesi kwambiri kuti athe kuyendetsa shuga ndikulemba zotsatira zake, ndiye kuti palibe chomwe chimatsala.

Inde, sizokayikitsa kuti chiyembekezo chodzabayira insulin nthawi zambiri masana chimakupatsani chisangalalo chachikulu. Koma ngati mutsatira zakudya zamafuta ochepa, zitha kuzindikira kuti mumafunikira jakisoni wa insulin musanadye ena, koma osati pamaso pa ena. Mwachitsanzo, mwa odwala ena omwe ali ndi matenda a shuga a 2, ndizotheka kuti azikhala ndi shuga wabwinobwino mwa kubaya insulin yochepa musanadye chakudya cham'mawa komanso chakudya chamadzulo, komanso asanadye chakudya chamadzulo amangofunika kumwa mapiritsi a Siofor.

Momwe mungawerengere Mlingo wa insulin musanadye

Ngakhale adokotala kapena odwala matenda ashuga sangathe kudziwa kuchuluka kwa insulin musanadye chakudya kuyambira pachiyambire. Kuti muchepetse chiopsezo cha hypoglycemia, timaganizira pang'onopang'ono matendawo poyamba, kenako ndikuwonjezera pang'onopang'ono. Poterepa, nthawi zambiri timayezera shuga wamagazi ndi glucometer. M'masiku ochepa mutha kudziwa mlingo woyenera wa mankhwala. Cholinga ndikupanga shuga kukhala abwinobwino, monga mwa anthu athanzi. Ndi 4.6 ± 0,6 mmol / L musanadye komanso mutatha kudya. Komanso, nthawi iliyonse, iyenera kukhala osachepera 3.5-3.8 mmol / L.

Mlingo wa insulin yachangu musanadye zimatengera chakudya chomwe mumadya komanso kuchuluka. Lembani kuchuluka kwa zakudya komanso zomwe mumadya, ku gramu yapafupi. Izi zimathandiza mamba khitchini. Ngati mutsatira zakudya zamafuta ochepa kuti muchepetse matenda a shuga, ndikofunika kugwiritsa ntchito insulin yayifupi ya anthu musanadye. Awa ndi Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R ndi ena. Ndikulangizidwanso kukhala ndi Humalog ndikumudula mukafunikira kuthamangitsa shuga. Apidra ndi NovoRapid ndi osachedwa kuposa Humalog. Komabe, insulin yochepa kwambiri siikhala yothandiza kwambiri kuti pakhale zakudya zamafuta ochepa, chifukwa amachitika mofulumira kwambiri.

Kumbukirani kuti kuchuluka kwa insulin musanadye chakudya ndi kuchuluka kwa chakudya komanso malo okuwongolera. Chakudya Chakudya - kuchuluka kwa insulin yomwe ingafunike kuphimba chakudya chomwe mukufuna kudya. Ngati munthu wodwala matenda ashuga atadya zakudya zoyenera, ndiye kuti mafuta ochepa okha ndiwo amawaganizira. Ngati mumadya zakudya zamafuta ochepa, ndiye kuti zopatsa mphamvu, komanso mapuloteni, zimawerengedwa. Chowongolera ndi kuchuluka kwa insulini yomwe imafunikira kuti muchepetse shuga la wodwala kukhala yokhazikika ngati itakwezedwa panthawi ya jakisoni.

Momwe mungasankhire mulingo woyenera wa jakisoni wa insulin musanadye:

1. Kuchokera pazomwe mungatchulidwe (onani pansipa), werengani mlingo woyambira wa insulin mwachangu musanadye.
2. Lowetsani insulin, ndiye kudikirani mphindi 20-45, kuyeza shuga musanadye, idyani.
3. Mukatha kudya, pimani shuga ndi glucometer pambuyo 2, 3, 4, ndi 5 maola.
4. Ngati shuga agwera pansi pa 3.5-3.8 mmol / L, idyani mapiritsi ochepa a shuga kuti muchepetse hypoglycemia.
5. Pamasiku otsatira, onjezani kuchuluka kwa insulin musanadye (pang'onopang'ono! Mosamala!) Kapena kutsikira. Zimatengera kuchuluka kwa shuga nditatha kudya.
6. Mpaka shuga atakhala okhazikika, bwerezani zomwe zikuchitika kuyambira pa mfundo yachiwiri. Nthawi yomweyo, musanengeni jakisoni wa "insulin", koma osinthidwa molingana ndi shuga dzulo zitatha kudya. Chifukwa chake, pang'onopang'ono muzindikire mlingo woyenera.

Cholinga ndikupanga shuga isanayambe komanso itadya 4.6 ± 0,6 mmol / L khola. Izi ndi zenizeni ngakhale ndi matenda oopsa a 1 shuga, ngati mumatsatira zakudya zamafuta ochepa ndikujambulira zochepa, muyezo wa insulin. Kuphatikiza apo, izi ndizosavuta kukwaniritsa ndi matenda a shuga a 2 kapena mtundu wofatsa 1 shuga.

Kwa matenda amtundu wa 1 komanso wa 2, njira zosiyanasiyana zimagwiritsidwa ntchito kuwerengera muyeso wamankhwala insulin musanadye. Njirazi zikufotokozedwa mwatsatanetsatane pansipa. Kusintha kwa Mlingo wa insulin kumachitika palokha kwa wodwala aliyense. Sungani mapiritsi a shuga pokhapokha ngati mukufuna kusiya hypoglycemia. Phunzirani kuchepetsa insulin pasadakhale. Muyenera kuchita izi.

Kodi malire a insulin yofulumira musanadye?

1. Muyenera kudya katatu katatu patsiku - kadzutsa, chakudya chamadzulo ndi chakudya chamadzulo, komanso nthawi yotalikirana ndi maola 4-5, osatinso. Ngati mukufuna, mutha kulumpha zakudya masiku ena. Nthawi yomweyo, mumasowa kuwombera kwa chakudya.
2. Simungathe kuseka! Chithandizo cha boma chimati ndizotheka, ndipo Dr. Bernstein - ndizosatheka. Mamita anu adzatsimikizira kuti akunena zoona.
3. Yesani kudya kuchuluka kwamapuloteni ndi chakudya chamagulu tsiku lililonse chakudya cham'mawa, nkhomaliro komanso chakudya chamadzulo. Zakudya ndi mbale zimasiyana, koma phindu lawo lazakudya liyenera kukhala lomwelo. Izi ndizofunikira kwambiri m'masiku oyambirirawo, pomwe simun "adalowe mu regimen", koma sankhani mitundu yanu.

Zotsatira zam'mawa zam'mawa zimasokoneza kuwerengera mankhwala a insulin musanadye. Chifukwa cha momwe amachitira, jakisoni wa insulin musanadye chakudya cham'mawa chimakhala chochepa kwambiri kuposa jakisoni wofanana wa insulin musanadye chakudya chamadzulo kapena chamadzulo. Kupatuka kwenikweni kwa wodwala aliyense wa shuga kuyenera kutsimikiziridwa payekhapayekha poyesa, kenako mlingo uyenera kuwonjezeka moyenerera musanadye chakudya cham'mawa. Werengani zambiri za zodabwitsa zam'mawa zam'mawa komanso momwe mungazilamulire.

Tsopano tiyeni tiwone zitsanzo za momwe Mlingo wa mankhwala ochepetsa insulin amawerengedwa musanadye. Kuphatikiza apo mu zitsanzo zonse, zimaganiziridwa kuti wodwala matenda ashuga amadzidula, m'malo mwa ultrashort, insulin asanadye. Mitundu ya insulashash ya insulin ndiyamphamvu kwambiri kuposa insulin yochepa ya munthu. Mlingo wa Humalog uyenera kukhala wofanana ndi pafupifupi 0,4 Mlingo wa insulin yochepa, ndipo mlingo wa NovoRapid kapena Actrapid uyenera kukhala pafupifupi ⅔ (0.66) Mlingo wa insulin yochepa. Ma coefficients 0,4 ndi 0,66 amafunika kutchulidwa payekhapayekha.

Mtundu 1 wa matenda ashuga kapena matenda apamwamba a 2 shuga

Mtundu woyamba wa matenda ashuga 1, muyenera kubayira insulin mwachangu musanadye chakudya chilichonse, komanso insulin yokwanira usiku ndi m'mawa. Amakhala jekeseni 5-6 patsiku, nthawi zina ochulukirapo. Ndi matenda apamwamba a shuga a 2, chinthu chomwecho. Chifukwa kwenikweni imalowa mu matenda a shuga a 1 omwe amadalira insulin. Musanawerenge kuchuluka kwa insulin yofulumira musanadye, muyenera kukonza chithandizo ndi insulin yayitali. Phunzirani momwe mungabayire molondola Lantus, Levemir kapena Protafan usiku ndi m'mawa.

Tiyeni tikambirane za mtundu wa shuga wachiwiri womwe umamasulira mtundu wa shuga wovuta kwambiri chifukwa chamankhwala osayenera. Odwala ambiri omwe ali ndi matenda amtundu wa 2 amalandiranso zowawa zambiri kuposa zabwino zomwe amathandizidwa nazo. Chakudya chamafuta ochepa sichikhala chithandizo chachikulu cha matenda ashuga a mtundu 2, chifukwa ogwira ntchito kuchipatala akukana kusintha. Mu 1970s, adakananso kukhazikitsidwa kwa ma glucometer ... Pakapita nthawi, malingaliro wamba adzakhalapo, koma masiku ano zinthu zomwe zili ndi matenda amtundu wa 2 ndizachisoni.

Odwala amadya chakudya chopatsa thanzi. Amatenganso mapiritsi owopsa omwe amamwa kapamba wawo.Zotsatira zake, maselo a pancreatic beta amafa. Chifukwa chake, thupi limasiya kutulutsa yake insulin. Matenda a shuga a Mtundu Wachiwiri amamasulira mtundu woyamba wa matenda ashuga. Izi zimawonedwa pambuyo poti matendawa atenga zaka 10-15, ndipo nthawi yonseyi akuchiritsidwa molakwika. Chizindikiro chachikulu ndikuti wodwalayo mwachangu komanso mosadalirika amachepetsa thupi. Mapiritsi nthawi zambiri amachepetsa shuga. Njira yowerengera kuchuluka kwa ma insulin omwe afotokozedwa apa ndi oyenera milandu ngati imeneyi.

Chifukwa chake, wodwala wodwala matenda ashuga a mtundu woyamba kapena mtundu wachiwiri wa 2 adasankha kuti asinthane ndi njira yatsopano yodalirika. Amayamba kudya chakudya chamafuta ochepa. Komabe, ali ndi vuto lolimba. Chakudya chopanda jakisoni wa insulin, ngakhale chimachepetsa shuga, sikokwanira. Ndikofunikira kubaya insulini kuti zovuta za matenda ashuga zisamachitike. Phatikizani jakisoni wa insulin yowonjezera usiku ndi m'mawa ndi jakisoni wa insulin yofulumira musanadye.

Mwinanso, mukudziyambitsa nokha mlingo wa insulin, womwe udanenedwa kuchipatala. Muyenera kusinthira ku kuwerengera kosinthika kwa mankhwalawa malinga ndi momwe mumadyera komanso zizindikiro za shuga. Mfundo zotsatirazi momwe mungachitire izi. Onetsetsani kuti ndizosavuta kuposa momwe zimamvekera. Kuwerengera kwamasamu kuli pasukulu yoyamba. Kusuntha kuchokera ku chakudya chopatsa thanzi ndikuyenera kukhala ndi zakudya zochepa zamankhwala ochepa, muyenera nthawi yomweyo kuchepetsa kuchuluka kwa insulin ndi nthawi 2-7, apo ayi padzakhala hypoglycemia. Odwala omwe ali ndi mtundu wocheperako wa shuga amakhala ndi mwayi "wolumpha" kuchokera pama jakisoni kwathunthu. Koma odwala omwe ali ndi matenda ashuga akulu amtundu wa 1 kapena matenda apamwamba a 2 sayenera kudalira izi.

Zomwe muyenera kuchita:

1. Sankhani mlingo woyenera wa insulin usiku ndi m'mawa. Werengani nkhani yokhudza Lantus, Levemir ndi Protafan mwatsatanetsatane. Pali njira yowerengera.
2. Dziwani kuchuluka kwa magalamu a chakudya komanso mapuloteni omwe amaphatikizidwa ndi 1 UNIT ya insulin yomwe mumabaya musanadye. Timawerengera poyambira malingana ndi kuchuluka kwa manambala (onani pansipa), kenako timalongosola "zoona" mpaka shuga atakhala wokhazikika komanso wabwinobwino.
3. Dziwani kuti shuga yanu ndimachepera motani 1 UNIT ya insulin yothamanga yomwe mumabaya. Izi zimachitika pochita zoyeserazi, zomwe zikufotokozedwa pansipa.
4. Dziwani kuti ndi mphindi zingati musanadye zakudya zomwe mwayilowetsa mwachangu ndi insulin. Standard: insulin yochepa mumphindi 45, Apidra ndi NovoRapid mu mphindi 25, Humalog m'mphindi 15. Koma ndikwabwino kudziwa payekhapayekha, kudzera poyeserera kopepuka, komwe kumafotokozedwanso pansipa.

Chovuta ndikuti muyenera kusankha nthawi imodzi kuchuluka kwa insulin yayitali komanso yachangu. Mavuto akabwera ndi shuga wamagazi, nkovuta kudziwa chomwe chinayambitsa. Mlingo wolakwika wa insulin yowonjezera? Muli ndi vuto lolakwika la insulin musanadye? Kapena kodi Mlingo woyenera wa insulin, koma amadya kwambiri / zochepa poyerekeza?

Zinthu zazikulu zomwe zimakhudza shuga:

• Chakudya chopatsa thanzi
• Mlingo Wowonjezera wa Insulin
• Sungani jakisoni wa insulin musanadye

Tiyerekeze kuti lero muli ndi shuga wambiri kapena kulumpha. Pankhaniyi, mawa mukusintha chimodzi mwazinthu zazikulu zomwe zatchulidwa pamwambapa. Nthawi yomweyo, sungani zinthu ziwiri zomwezo monga dzulo. Onani momwe shuga yasinthira ndikufotokozera. Mutha kukhazikitsa boma lokhazikika pochita zoyeserera zambiri za mankhwala a insulin komanso zakudya. Izi nthawi zambiri zimatenga masiku 3-14. Pambuyo pa izi, muyenera kuthana ndi zinthu zachiwiri - zolimbitsa thupi, matenda, nkhawa, kusintha kwa nyengo, etc. Werengani zambiri mwatsatanetsatane "Zomwe zimakhudza shuga wamagazi: zinthu zachiwiri".

Moyenerera, mumagwiritsa ntchito insulin yochepa musanadye komanso ngakhale owonjezera ultrashort mukafunikira kuthimitsa shuga yayikulu. Ngati ndi choncho, ndiye kuti mtundu uliwonse wa insulin, muyenera kudziwa payokha momwe 1 unit imatsitsira shuga. Zowonadi, ochepa odwala matenda ashuga adzafuna "kusewera" ndi mitundu itatu ya insulin - imodzi yowonjezera ndi iwiri mwachangu. Ngati mukuwonetsetsa kuti Humalog, Apidra kapena NovoRapid sagwira ntchito bwino musanadye, chifukwa chodumpha mu shuga, kenako sinthani insulin ya anthu.

Zambiri zokhudzana ndi kuchuluka kwa mankhwalawa (manambala sakulondola!):

• Insulin yochepa - Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R ndi ena.
• Mitundu yonse ya insulin yayifupi ndiyofanana mphamvu ndipo imayamba kuchita zinthu mwachangu.
• Ultrashort insulin - Humalog, NovoRapid, Apidra.
• NovoRapid ndi Apidra ndi amphamvu kwambiri nthawi 1.5 kuposa insulin iliyonse. Mlingo wa NovoRapid ndi Apidra uyenera kukhala ⅔ (0.66) wa mlingo wofanana wa insulin yochepa.
• Humalog ndi yamphamvu kwambiri ma 2,5 kuposa insulin iliyonse yayifupi. Mlingo wa Humalog uyenera kukhala 0,4 Mlingo wofanana wa insulin yochepa.

Odwala omwe ali ndi matenda oopsa a shuga, omwe kapamba wawo samatulutsa insulini, 1 gramu yamatumbo imawonjezera shuga wa magazi ndi pafupifupi 0.28 mmol / l wokhala ndi kulemera kwa kilogalamu 63,5.

Wodwala wodwala matenda ashuga wolemera makilogalamu 63,5:

• 1 unit ya insulin yochepa imachepetsa shuga la magazi ndi pafupifupi 2.2 mmol / L.
• 1 unit ya insulin Apidra kapena NovoRapid idzachepetsa magazi ndi pafupifupi 3.3 mmol / L.
• 1 unit ya insulin Humalog imachepetsa shuga la magazi ndi pafupifupi 5.5 mmol / L.

Momwe mungadziwire momwe 1 U ya insulin yochepa imachepetsera shuga mwa munthu yemwe ali ndi kulemera kwina kwa thupi? Ndikofunikira kupanga gawo ndikuwerengera.

Mwachitsanzo, kwa wodwala yemwe ali ndi shuga yayikulu wokhala ndi thupi lolemera 70 makilogalamu, 2.01 mmol / L adzapezedwa. Kwa wachinyamata wolemera makilogalamu 48, zotulukapo zake zimakhala 2.2 mmol / L * 64 kg / 48 kg = 2.93 mmol / L. Munthu akamalemera kwambiri, mphamvu ya insulin imachepa. Yang'anani! Izi si ziwerengero zenizeni, koma zikuwonetsa, pokhapokha pakuwerengera Mlingo wa insulin. Dziyeretseni nokha mwa kuyesa. Amasiyana ngakhale pa nthawi zosiyanasiyana za tsiku. Asanadye chakudya cham'mawa, insulin ndi yofooka kwambiri, motero mlingo wake umayenera kuchuluka.

Tikudziwanso pafupifupi:

• 1 unit yaifupi insulin imakhudza pafupifupi 8 magalamu a chakudya.
• 1 unit ya insulin Apidra ndi NovoRapid imakhudza pafupifupi 12 magalamu a chakudya.
• 1 UNIT ya insulin Humalog imakwirira 20 magalamu a chakudya.
• 1 unit ya insulin yochepa imakhala pafupifupi magalamu 57 a mapuloteni amadyedwa kapena pafupifupi 260 magalamu a nyama, nsomba, nkhuku, tchizi, mazira.
• 1 UNIT ya insulin Apidra ndi NovoRapid imakhudza pafupifupi 87 magalamu a mapuloteni amadyedwa kapena pafupifupi 390 magalamu a nyama, nsomba, nkhuku, tchizi, mazira.
• 1 UNIT ya insulin Humalog imakwirira pafupifupi 143 magalamu a mapuloteni amadyedwa kapena pafupifupi magalamu 640 a nyama, nsomba, nkhuku, tchizi, mazira.

Zidziwitso zonse pamwambapa ndizodziwonetsa. Amangopangidwira kuwerengera poyambira, mwachidziwikire sicholondola. Fotokozerani chithunzi chilichonse mwa kuyeserera. Ziwerengero zenizeni za wodwala aliyense wa shuga ndi zosiyana. Sinthani mlingo wa insulin payokha, kuyesa ndi cholakwika.

Makhalidwe omwe tawonetsedwa pamwambapa amatanthauza odwala omwe ali ndi matenda amtundu woyamba 1 omwe kapamba samatulutsa insulin konse komanso omwe alibe vuto la insulin. Ngati ndinu wonenepa kwambiri, ndinu wachinyamata mu nthawi ya kukula msanga kapena mayi woyembekezera, ndiye kuti kufunika kwa insulini kumakulirakulira. Komabe, ngati maselo a beta a kapamba anu amapangitsanso insulini, ndiye kuti mulingo woyenera wa insulini mu jakisoni ungakhale wotsika kwambiri.

Kuwerengeredwa kwa insulin Mlingo wa matenda a shuga 1: mwachitsanzo

Tiona mwachidule nkhani yakukonzekera menyu komanso kuwerengera kuchuluka kwa insulini. Tiyerekeze kuti wodwala yemwe ali ndi matenda ashuga oopsa amalemera 64 kg musanadye Actrapid NM - insulin yochepa yaumunthu. Wodwalayo azidya zakudya zotsatsa komanso zomanga thupi tsiku lililonse:

• Chakudya cham'mawa - 6 magalamu a chakudya ndi magalamu 86 a protein,
• Chakudya chamasana - magalamu 12 a chakudya ndi magalamu a 128 a protein,
• Chakudya chamadzulo - 12 magalamu a chakudya ndi 171 magalamu a mapuloteni.

Sitimaganizira zamafuta akudya, chifukwa sizimakhudza shuga. Idyani mafuta omwe amapezeka muzakudya zamapuloteni modekha. Kumbukirani kuti nyama, nsomba, nkhuku, mazira ndi tchizi zolimba zimakhala ndi 20-25% ya mapuloteni oyera. Kuti mupeze kulemera kwa zinthu zamapuloteni zomwe ngwazi yathu imadya, muyenera kuchulukitsa kuchuluka kwa mapuloteni ndi 4 kapena 5, avareji ya 4.5.Muyenera kuti mukhale ndi njala pazakudya zochepa zamagalimoto :).

Mukamawerengera kuchuluka kwa insulini yofulumira musanadye, tikufuna kuteteza odwala matenda ashuga ku hypoglycemia. Chifukwa chake, tsopano tikunyalanyaza zovuta zam'mawa, komanso kukana kwa insulini (kuchepa kwamphamvu kwa maselo kupita ku insulin), zomwe zingatheke ngati wodwala watupa kwambiri. Izi ndi zinthu ziwiri zomwe zingatipangitse kuti tiwonjezere Mlingo wa insulin musanadye. Koma poyambilira sitimawaganizira.

Kuti mupeze poyambira chakudya, timagwiritsa ntchito zomwe zalembedwa pamwambapa. 1 unit ya insulin yochepa pafupifupi yokwanira magalamu 8 a chakudya. Komanso, gawo limodzi la insulin yochepa limakhala pafupifupi magalamu 57 a mapuloteni azakudya.

Chakudya Chakudya Cham'mawa:

• 6 magalamu a chakudya / 8 magalamu a chakudya = ¾ UNITS ya insulin,
• 86 magalamu a mapuloteni / magalamu 57 a mapuloteni = 1.5 ZINSINSI za insulin.

TOTAL ¾ PIECES + 1.5 PIECES = 2.25 PIECES of insulin.

Chakudya chamasana:

• 12 magalamu a chakudya / 8 magalamu a chakudya = 1.5 ZINSINSI za insulin,
• 128 magalamu a protein / 57 magalamu a protein = 2.25 magawo a insulin.

ZONSE ZONSE 1.5 PIECES + 2.25 PIECES = 3.75 PIECES of insulin.

Chakudya chakudya chamadzulo:

• 12 magalamu a chakudya / 8 magalamu a chakudya = 1.5 ZINSINSI za insulin,
• 171 magalamu a protein / 57 magalamu a mapuloteni = 3 magawo a insulin.

ZONSE ZONSE 1.5 ZIWANDA + 3 ZOCHITIKA = 4.5 ZINSINSI za insulin.

Ngati kapamba wanu akupitiliza kupanga insulin yake, ndiye kuti milingo yoperekedwa pamwambapa ifunika kutsitsidwa. Ma cell a beta a pancreatic apulumuka, amatha kutsimikiza pogwiritsa ntchito kuyezetsa magazi kwa C-peptide.

Zoyenera kuchita ngati wodwalayo ati adzapange jekeseni posachedwa, koma insulin yochepa-yayifupi, NovoRapid kapena Humalog asanadye? Tikukumbukira kuti kuchuluka kwa Apidra ndi NovoRapida ndiye gawo la insulin yayifupi, yomwe tidawerengera. Humalog ndiye wamphamvu kwambiri. Mlingo wake uyenera kukhala Mlingo wochepa wa insulin.

Ngati ndi kotheka, sinthani poyambira chakudya kuchokera pa insulin yayifupi kupita kwa yochepa kwambiri:

Chonde dziwani: wodwala ali ndi chidwi champhamvu (munthu wathu! :)). Chakudya chamasana, amadya mapuloteni a 128 - pafupifupi magalamu 550 a mapuloteni. Monga lamulo, odwala matenda ashuga amtundu woyamba amadya zochepa. Tinene kuti chakudya chamasana mukukonzekera kudya magalamu 200 a mapuloteni omwe ali ndi magalamu 45 a mapuloteni abwino. Komanso saladi wa masamba obiriwira, momwe 12 g mafuta. Pankhaniyi, muyenera kupaka jakisoni wa 2.25 IU wa insulin yifupi, 1.5 IU ya Apidra kapena NovoRapida kapena 1 IU ya Humalog musanadye. Chakudya cham'mawa komanso chamadzulo, Mlingo umakhala wotsika kwambiri. Kutsiliza: Onetsetsani kuti mwaphunzira momwe mungapangire insulin.

Zowonadi zowonjezera za insulin pazakudya zina zimakhala zochepa kwambiri, ndipo zina - zokulirapo. Kuti mudziwe momwe insulini imagwirira ntchito, muyenera kuyeza shuga wa magazi 4 ndi maola 5 mutatha kudya. Ngati mungayezedwe kale, zotsatira zake sizikhala zolondola, chifukwa insulin ikupitirirabe, ndipo chakudyacho chikugayidwabe.

Tidapanda dala poyambira kudya mabelo a insulin. Chifukwa chake, ndizokayikitsa kuti shuga yanu mukatha kudya ingagwere pamlingo wa hypoglycemia. Komabe, izi siziphatikizidwa. Makamaka ngati mwayamba kudwala matenda a diabetesic gastroparesis, i.e., kuchepetsedwa kwa m'mimba mutatha kudya chifukwa cha neuropathy. Kumbali inayo, ngati mukunenepa kwambiri komanso chifukwa cha kukana kwa insulini, ndiye kuti Mlingo wa insulin yofulumira musanadye chakudya amafunika kwambiri.

Chifukwa chake, tsiku loyamba la jakisoni waifupi kapena wa insulin, timayesa shuga tisanadye, kenanso pambuyo pa chakudya cha 2, 3, 4, ndi 5 titatha kudya. Tili ndi chidwi ndi kuchuluka kwa shuga yomwe idakula mutatha kudya. Kuchulukaku kungakhale kwabwino kapena kosalimbikitsa. Ngati zili ndi vuto, ndiye kuti nthawi ina mukamadzachepetsa mulingo wa insulin musanadye.

Ngati shuga ndi maola 2-3 mutatha kudya pokhapokha musanadye, musasinthe mlingo wa insulin. Chifukwa munthawi imeneyi, thupi silinakwanitse kugaya komanso kuyamwa zakudya zamafuta ochepa. Zotsatira zomaliza ndi maola 4-5 mutatha kudya.Fotokozani. Chepetsani mankhwalawa pokhapokha, mutatha kudya pambuyo pa maola atatu ndi atatu, shuga "amawuma" pansi pa 3.5-3.8 mmol / L

Tiyerekeze kuti wodwala wathu ali ndi zotsatirazi:

• Maola 4-5 mutadya kadzutsa - shuga adakula ndi 3.9 mmol / l,
• Maola 4-5 pambuyo pa nkhomaliro - idatsika ndi 1.1 mmol / l,
• Maola 4-5 mutatha kudya - kuchuluka ndi 1.4 mmol / L.

Mlingo wa insulin musanadye chakudya, amamuona kuti ndi wolondola, pambuyo pa maola 5 chakudya chatha, shuga atapatuka pazakudya asanadutse 0,6 mmol / l mbali iliyonse. Zachidziwikire, tinaphonya mitundu yoyambira, koma izi zinali zoyembekezeredwa. Zotsatira zam'mawa zam'mawa, zomwe zimachepetsa mphamvu ya jakisoni wofulumira wa insulin musanadye chakudya cham'mawa, zimawonetsedwa bwino poyerekeza ndi jakisoni musanadye chakudya chamadzulo.

Kodi muyenera kusintha zochuluka motani pa insulin? Kuti tidziwe, tiyeni tiwerenge ma bolawo okonza. Wodwala yemwe ali ndi matenda oopsa a shuga, omwe kapamba wake samatulutsa insulin konse, gawo limodzi la insulin yochepa limatsitsa shuga ndi pafupifupi 2.2 mmol / l, ngati munthu akulemera 64 kg.

Kuti mupeze phindu la kulemera kwanu, muyenera kupanga gawo. Mwachitsanzo, kwa munthu wolemera makilogalamu 80, mumapeza 2.2 mmol / L * 64 kg / 80 kg = 1.76 mmol / L. Kwa mwana wolemera 32 kg, 2.2 mmol / L * 64 kg / 32 kg = 4.4 mmol / L amapezeka.

Wodwala matenda ashuga kwambiri omwe amatchulidwa mu nkhani iyi amakhala ndi 64 kg. Poyambira, timaganiza kuti 1 unit ya insulin yochepa imachepetsa shuga ya magazi ake ndi pafupifupi 2.2 mmol / L. Monga tikudziwa, mutadya nkhomaliro komanso chakudya chamadzulo, shuga ake adalumphira, ndipo pambuyo pa chakudya chamadzulo chinatsika. Chifukwa chake, muyenera kuwonjezera kuchuluka kwa insulin musanadye chakudya cham'mawa komanso chakudya chamadzulo, komanso kutsikira pang'ono musanadye chakudya chamadzulo. Kuti tichite izi, timagawa kusintha kwa shuga ndi 2.2 mmol / L ndikuzungulira zotsatira zake kukhala 0,25 IU ya insulin mmwamba kapena pansi

Tsopano tikusintha mtundu wa insulin yochepa musanadye chakudya potengera zotsatira za tsiku loyamba la zoyesazo. Nthawi yomweyo, timayesetsa kusunga kuchuluka kwa mapuloteni ndi zakudya zamafuta omwe amadya chakudya cham'mawa, nkhomaliro komanso chakudya chamadzulo chimodzimodzi.

Tsiku lotsatira, bwerezani zomwezo, kenako ina, monga pakufunika. Tsiku lililonse, kupatuka m'magazi a anthu mukatha kudya kumakhala kocheperako. Mapeto ake, mupeza mlingo woyenera wa insulin yochepa musanadye.

Monga mukuwonera, kuwerengera sikovuta. Mothandizidwa ndi chowerengera, munthu aliyense wamkulu amatha kuzisamalira. Chovuta ndichakuti kuchuluka kwa zakudya zopezeka m'mawa, chakudya chamadzulo ndi chakudya chamadzulo kumayenera kukhala chimodzimodzi tsiku lililonse. Zakudya ndi mbale zimatha kusinthidwa, koma kuchuluka kwa chakudya komanso mapuloteni ayenera kukhala chimodzimodzi tsiku lililonse. Milozo ya kukhitchini imathandizira kutsatira lamuloli.

Ngati mutatha kudya nthawi zonse mumangokhala kuti simunakhuta, mutha kuwonjezera kuchuluka kwa mapuloteni. Mapuloteni ena omwewo akuyenera kudyedwa m'masiku otsatirawa. Poterepa, simungathe kuwonjezera kuchuluka kwa chakudya chambiri! Musadye zopitilira 6 za chakudya cham'mawa, magalamu 12 a nkhomaliro komanso chakudya chofanana. Mutha kudya zakudya zamafuta ochepa, bola ngati mungadye zochulukirapo. Pambuyo pakusintha kuchuluka kwa mapuloteni munthawi yachakudya china, muyenera kuyang'ana momwe shuga amasinthira mukatha kudya ndikusankhanso insulin yabwino kwambiri.

Chitsanzo china cha moyo

Wodwala matenda a shuga 1, zaka 26, kutalika 168 cm, kulemera kwa 64 kg. Amawona zakudya zamafuta ochepa, amavulaza Biosulin R. asanadye.
Nthawi ya 7 a.m. shuga yotsika inali 11.0 mmol / L. Chakudya cham'mawa: nyemba zobiriwira 112 magalamu, dzira 1 pc. Zakudya zomanga thupi ndi magalamu 4.9 okha. Asanadye chakudya cham'mawa, adalowetsa insulin Biosulin R pa mlingo wa 6.Pambuyo pake, pa maola 9 mphindi 35 shuga anali 5.6 mmol / L, ndipo pofika maola 12 adakwera 10,5 mmol / L. Ndinafunika kubayitsa mayunitsi ena 5 a insulin yomweyo. Funso - mudalakwitsa chiyani?

Biosulin P ndi insulin yochepa ya anthu. Ngati mutsatira zakudya zamafuta ochepa pobayira jakisoni musanadye, ndibwino kuposa mitundu yayifupi ya insulin.

Wodwala amakhala ndi shuga ya 11.0. Akukonzekera kuluma nyemba 112 za nyemba ndi 1 pc ya mazira akudya cham'mawa. Tikuwona magome a zakudya zopatsa thanzi. 100 magalamu a nyemba zobiriwira zimakhala ndi magalamu 2.0 a protein ndi 3.6 magalamu a chakudya. M'magalamu a 112, izi zimapereka magawo a 2.24 a mapuloteni ndi 4 magalamu a chakudya. Dzira la nkhuku limakhala ndi pafupifupi magalamu 12,7 a mapuloteni ndi magalamu 0,7 a chakudya. Pamodzi, chakudya chathu cham'mawa chimakhala ndi mapuloteni 2.24 + 12.7 = 15 magalamu ndi chakudya 4 + 0.7 = 5 magalamu.

Podziwa phindu la chakudya cham'mawa, timawerengera poyambira kuchuluka kwa insulini yochepa musanadye. Uwu ndi chiwerengero: kukonza mabasi + chakudya. Timalingalira kuti ndi thupi lolemera makilogalamu 64, 1 U ya insulin yochepa imachepetsa shuga la magazi ndi pafupifupi 2.2 mmol / L. Shuga wamba ndi 5.2 mmol / L. Corusction bolus imapezeka (11.0 - 5.2) / 2.2 = 2.6 mayunitsi. Gawo lotsatira ndikulingalira chakudya. Kuchokera pagululi timaphunzira kuti gawo limodzi la insulin yochepa limakhudza pafupifupi 8 magalamu a chakudya kapena pafupifupi magalamu 57 a mapuloteni azakudya. Puloteni, timafunikira (15 g / 57 g) = 0,26 PIECES. Kwa chakudya chamafuta, mumafunikira (5 g / 8 g) = 0,625 PIECES.

Mlingo wa insulin wokwanira: 2.6 IU yokonza bolus + 0,26 IU pa mapuloteni + 0,625 IU wa chakudya chamafuta = 3,5 IU.

Ndipo wodwalayo adabayira ziwalo 6 tsiku lomwelo. Chifukwa chiyani shuga adakwera ngakhale insulin yambiri idalowetsedwa kuposa momwe ikufunikira? Chifukwa wodwala ndi mwana. Mlingo wowonjezera wa insulin unamupangitsa kuti amasulidwe kwambiri mahomoni opsinjika, makamaka, adrenaline. Zotsatira zake, shuga amalumpha. Ndikukonzekera kuti ngati mutabaya insulini yocheperako, ndiye kuti shugayo sawonjezereka, koma m'malo mwake amachepetsa. Umu ndi momwe amadabwitsa.

Mulingo wochepa kapena wosalondola wa insulin yofotokozedwa pamwambapa ndi ziwalo za 3.5. Tingoyerekeza kuti mutha kubayitsa mayunitsi atatu kapena anayi, kusiyana kwake sikudzakhala kwakukulu kwambiri. Koma tikufuna kuthetsa shuga. Ngati mungathe kuchita izi, ndiye kuti simusowa kuti mugwire pakubwezeretsa kwakukulu. Ndipo chakudya chonse ndi pafupifupi 1 UNIT ± 0,25 UNITS.

Tinene kuti padzakhala kukonza kwa 1 PIECE ± 0,25 PIECES ndi chakudya cha yemweyo 1 PIECES ± 0.25 PIECES. Magawo awiri a 2 units 0,5. Pakati Mlingo wa insulin 3 ndi 4, kusiyana sikokulira. Koma pakati pa Mlingo wa 1.5 PIERES ndi 2 PIERES, kusiyana kwa msambo wa chikopa cha magazi kumakhala kofunika. Kutsiliza: muyenera kuphunzira kuchepetsa insulin. Palibe njira popanda icho.

Mwachidule. Mu mtundu woyamba wa matenda ashuga 1 ndi matenda apamwamba a 2, taphunzira momwe tingawerengere chakudya komanso kukonza pobayira jakisoni wa insulin musanadye. Mwaphunzira kuti choyamba muyenera kuwerengera muyeso wa insulini malinga ndi ma coefficients, kenako ndikusintha malinga ndi zomwe zikuwonetsa shuga mutatha kudya. Ngati shuga, pambuyo pa maola 4-5 atatha kudya, wakula kuposa 0,6 mmol / L, mlingo wa insulin musanadye umafunika kuchuluka. Ngati itachepa mwadzidzidzi - Mlingo wa insulin umafunikiranso kutsitsidwa. Mchere ukakhala wabwinobwino, umasinthanso osapitirira ± 0,6 mmol / l asanadye komanso chakudya - Mlingo wa insulin unasankhidwa molondola.

Type 2 shuga kapena mtundu wofatsa 1 shuga LADA

Tiyerekeze kuti muli ndi matenda amtundu wa 2, osati vuto lotsogola kwambiri. Mumatsata zakudya zama carbohydrate otsika, mumamwa mapiritsi a Siofor kapena Glucofage Long, ndikujanso jakisoni wa insulin usiku ndi m'mawa. Mlingo wa insulin Lantus, Levemir kapena Protafan amasankhidwa kale molondola. Chifukwa cha izi, shuga m'magazi anu amakhalanso abwinobwino ngati mutadumphira chakudya. Koma mukatha kudya, amadumpha, ngakhale mutamwa mapiritsi ambiri ovomerezeka. Izi zikutanthauza kuti jakisoni waifupi wa insulin amafunikira chakudya musanadye. Ngati ndinu aulesi kwambiri kuzichita, ndiye kuti zovuta za matenda ashuga zimayamba.

Kwa matenda a shuga a 2 kapena mtundu wofatsa 1 shuga, LADA, muyenera choyamba kubayitsa Lantus kapena Levemir usiku ndi m'mawa. Werengani zambiri apa. Mwina jakisoni wautali wa insulin ungakhale wokwanira kukhala ndi shuga. Ndipo pokhapokha shuga atatha kudya, onjezerani insulin mwachangu musanadye.

Pancreas ikupitiliza kupanga insulini ina, ndipo izi ndi zomwe mkhalidwe wanu umasiyana ndi odwala omwe ali ndi matenda amtundu woyamba 1 shuga. Sitikudziwa kuti muli ndi insulini ingati kuti muchepetse shuga yayikulu mutatha kudya, koma muyenera kuwonjezera zochuluka motani ndi jakisoni. Komanso, sitikudziwa bwino momwe insulin imasamalirira maselo (kukana insulini) chifukwa cha kunenepa kwambiri kumakulitsa kufunikira kwa insulin. Zikakhala zotere, sizophweka kungoganiza ndi kumwa kwa insulin yochepa musanadye. Momwe mungawerengere molondola kuti pasapezeke hypoglycemia? Lotsatirali ndi yankho lafunso ili.

Musanalowe jakisoni, muyenera kubayira insulin kokha kwa odwala omwe ali ndi matenda amtundu wa 2 omwe ali aulesi kuchita masewera olimbitsa thupi

Zimamveka kuti mukutsatira zakudya zamagulu ochepa. Muyeneranso kudya zakudya zofanana zamankhwala ndi mapuloteni tsiku lililonse chakudya cham'mawa, chakudya chamadzulo komanso chamadzulo. Muzisunga shuga musanadye komanso pambuyo masiku atatu, kenako werengani kuti mupeze Mlingo wa insulin musanadye.

Sonkhanani zambiri za kuchuluka kwa shuga m'magazi mukatha kudya kadzutsa, nkhomaliro, ndi chakudya chamadzulo, ngati simupaka insulin musanadye, koma ingomwa mapiritsi anu a shuga.

Ndikofunikira kuyeza shuga musanadye, kenako pambuyo pa chakudya 2, 3, 4 ndi 5 mukatha kudya. Chitani izi kwa masiku 3-7 motsatana. Lembani zomwe mwapeza, sungani zolemba. Masiku ano muyenera kudya katatu patsiku, osadya. Zakudya zamafuta ochepa zimakhala ndi maola 4-5. Mudzakhala odzaza nthawi zonse osaneneka.

Nthawi yowonera ikukonzekera ndi masiku 3-7. Tsiku lililonse mumakhala ndi chidwi ndi kuchuluka kwakukulu kwa shuga mutatha kadzutsa, nkhomaliro komanso chakudya chamadzulo. Mwambiri, zidzakhala maola atatu mutatha kudya. Koma wodwala aliyense yemwe ali ndi matenda ashuga ndi osiyana. Izi zitha pambuyo maola 2, komanso maola 4 kapena 5. Muyenera kuyeza shuga ndikuwona momwe amakhalira.

Tsiku lililonse, lembani kuchuluka kwa shuga ochulukirapo mutatha kadzutsa, nkhomaliro, ndi chakudya chamadzulo. Mwachitsanzo, Lachitatu asanadye, shuga anali 6.2 mmol / L. Atatha kudya, adakhala: