Insulin P: mtengo ndi wopanga, kusiyana

Masiku ano, chifukwa cha asayansi omwe ali pamakina a endocrinologists pali kukonzekera kwa insulin ndi nthawi yosiyanasiyana yochitira: yochepa kapena yayitali. Kenako aliyense wa iwo amagawidwa m'mitundu yaying'ono. Kugawidwa kwa mankhwala kotereku kumathandizira akatswiri kuyendayenda bwino popanga mankhwala, kupanga ma glycemic control regimens, kuphatikiza mitundu yambiri ya insulin.

Ultra Wotenga Nthawi Ya Insulin

Zimasiyanasiyana pakanthawi kochepa kuyambira pakubaya jakisoni mpaka pakuyamba kuchepa kwa glycemia. Kutengera mtundu wa chinthu, kutsitsa shuga kumawonekera kale pakadutsa mphindi 10-20 pambuyo pa jekeseni, zotsatira zake zapamwamba zimapangidwa pambuyo pa maola 1-3, kutalika kwa nthawi ndi maola 3-5. Ngati mukufunika kusintha glycemia mwachangu: Apidra, Humalog kapena Novorapid (Flexpen ndi Penfill).

Insulin yochepa

Mankhwala a gululi amayamba kugwira ntchito patatha mphindi 30-60 pambuyo pa jekeseni, nsonga ya chochita imawonedwa pambuyo pa maola 2-4, zotsatira zimatha pafupifupi maola 6-8. Zinthu zosungunuka zosiyanasiyana (nyama kapena munthu) zimakhala ndi zinthu izi:

Mayina a mankhwala: Actrapid MS, Actrapid NM, Biogulin R, Gensulin R, Monosuinsulin MK, Rinsulin R, Humulin Regular, Humodar R.

Wochedwa insulin

Maziko a mankhwalawa ndi kuphatikiza kwa zinthu zomwe zili ndi nthawi yayitali komanso yayitali. Adagawikana ndi sing'anga yayitali komanso yayitali. Mankhwala a mtundu woyamba amayamba kugwira ntchito patatha maola 1.5-2 pambuyo pa jakisoni, amapanga kuchuluka kwa magazi pakati pa maola 3-12 atabayidwa, ndikuwongolera zomwe zili ndi shuga kwa maola 8-12.

Mankhwala okhala ndi nthawi yayitali: Br-Insulmidi MK, Biosulin N, Gensulin N, Protafan NM, Protafan MS, Humulin NP, Insuman Bazal, Humodar B.

Insulin yowonjezera

Imakhala ndi kuchepa kwa shuga pambuyo maola 4,8 mutabadwa, jakisoni wowonjezereka amatha pambuyo pa maola 8-18 ndikuwongolera glycemia kwa maola 20-30.

Kukonzekera: Lantus, Levemir (Penfill ndi Flexpen).

Mankhwala osakaniza a insulin

Kuchuluka kwa hypoglycemic kumawonekera theka la ola pambuyo pakukonzekera pansi pa khungu, kumakulirakulira patatha maola 2-8 ndikuwongolera zomwe zili ndi glucose nthawi zambiri kuyambira maola 18 mpaka 20.

Kukonzekera: Biosulin 30/70, Gansulin 30P, Gensulin M30, Insuman Comb 15 GT, Rosinsulin M kusakaniza 30/70, NovoMix 30 (Penfill ndi FlexPen).

Mitundu ya mankhwala ambiri omwe ali ndi machitidwe osiyanasiyana

Ultrashort insulin

Kukonzekera kwa mtundu uwu ndi fanizo la zinthu zaumunthu. Kukhazikitsidwa kuti insulin yomwe imapangidwa ndi thupi m'maselo a kapamba ndi ma mamolekyulu am'magazi omwe amakhala osokoneza bongo pang'ono ndi hexamers. Pambuyo pa kayendetsedwe pansi pa khungu, amakamizidwa pang'onopang'ono, motero, ndende kwambiri, yofanana ndi yomwe imapangidwa m'thupi mutatha kudya, sizimatheka.

Insulin yoyamba yayifupi, yomwe imamwa katatu katatu kuposa munthu, ndi lyspro. Izi ndi zotengera za chinthu cha amkati, chomwe chimapezeka pambuyo poti ma amino acid awiri adasinthidwa m'malo mwake. Thupi lomwe lili ndi chida chatsopano lilinso ndi mitundu yosiyanasiyana: limalepheretsa mapangidwe a hexamers ndipo motero limapereka kuchuluka kwambiri kwa mankhwalawo m'magazi ndikupanga mfundo zapamwamba kwambiri.

Mndandanda wachiwiri wa mahomoni aumunthu ndi insulin. Inapezekanso pambuyo pokhazikitsa zina mwa zigawo, koma panthawiyi, asidi wodziwika bwino omwe adapangidwa molakwika adayambitsidwa ndi insulin yosavuta m'malo mwa proline. Aspart, monga Lyspro, amachitanso zinthu mwachangu ndikusweka kwambiri.

Insulin glulisin idapezekanso pambuyo poti aspargin (amino acid) idasinthidwa ndi lysine m'thupi la munthu, ndipo lysine wina pamalo a B29 adasinthidwa kukhala glutamic acid. Chifukwa cha izi, chinthu cholowera mwachangu kwambiri chinapezedwa.

Kukonzekera kwa insulini komwe kumapangidwa pazinthu izi kumayamba kugwira ntchito nthawi yomweyo. Amaloledwa kulowa pang'ono asanadye kapena atangomaliza kudya.

Mwachidule kuchita insulin

Kukonzekera kwa gululi nthawi zambiri kumatchedwa kusungunuka, chifukwa ndi njira zothetsera mavuto omwe alibe. Amapangidwa kuti azilowetsa pansi pa khungu, koma ngati ndi kotheka, amadzibayira mkatikatikati, ndipo muzovuta kwambiri, kuyambitsa mu mtsempha ndikuloledwa.

Amadziwika ndi kuyamba kwachangu (pafupifupi pambuyo pa mphindi 15-25) komanso nthawi yayitali kwambiri yosungitsa zotsatira za hypoglycemic (pafupifupi maola 6). Nthawi zambiri, insulin yogwira ntchito mwachangu imagwiritsidwa ntchito m'madipatimenti othandiza kudziwa mtundu wa mankhwala kwa wodwala. Koma imagwiritsidwanso ntchito ngati munthu ali ndi vuto lalikulu la wodwalayo, ngati kuli kofunikira kukhazikika kwa odwala matenda ashuga ngati ali ndi chikomokere kapena kholo. Ndi pa / momwe zimatheka pambuyo pa mphindi 5, motero, mankhwalawa amaperekedwa kuti akachepetse kuopsa kosintha kwa glycemia msanga. Kuphatikiza apo, insulin yochepa imagwiritsidwanso ntchito ngati anabolic, kenako imayikidwa muyezo waukulu.

Insulin Yapakatikati

Mankhwala a gululi amagwira ntchito modekha: amasungunuka kwambiri, amatengeka pang'onopang'ono kuchokera kumalo opangira jakisoni, kotero zotsatira za hypoglycemic zimatha nthawi yayitali. Limagwirira ntchito zimatheka pobweretsa zinthu zapadera ndi luso lolepheretsa zomwe zimapangitsa insulin. Nthawi zambiri, protamine kapena zinc zimagwiritsidwa ntchito pamenepa.

Kuchita insulin nthawi yayitali

Mankhwala a gululi amachokera ku glargine - chinthu chofanana ndi cha munthu, chomwe chimapezeka kudzera pakupanga ma genetic engineering. Ndiwopanga yoyamba yomwe ilibe mtengo wofunikira kuchitapo kanthu. Glargine imapezeka ndi njira yokonzanso zinthu m'matcheni a DNA: kusintha aspargin kuti glycine, kenako mbali zina za arginine zimawonjezedwanso.

Insulin yochokera ku Glargine imapezeka ngati yankho lomveka bwino ndi pH ya 4. Acid yake yachilengedwe imakhazikika ndi insulin hexamers, imathandizira kuti pakhale nthawi yayitali komanso pang'onopang'ono magazi amadzimadzi am'magazi. Chifukwa cha izi, imatha kudulwidwa nthawi zambiri, chifukwa insulin yayitali imayang'anira msana wa glycemia tsiku lonse.

Mosiyana ndi mankhwalawa, omwe amapezeka m'magazi mosiyanasiyana, amapangira mfundo zapamwamba (motero, amalumpha mu glycemia), insulin yotalikilapo sikhala yotchulidwa kwambiri, chifukwa imalowa munjira yoyendera magazi.

Insulin yayitali imapezeka m'mitundu yambiri yamitundu yambiri. Pafupifupi, mankhwalawa amathandizira glucose m'magazi kwa maola 10-36. Kuchitapo kanthu motalika chotere, komanso ndi njira yothandizira, kumakhala kosavuta chifukwa kumapulumutsa odwala ku jekeseni pafupipafupi. Mankhwalawa amapezeka mu mawonekedwe a kuyimitsidwa, omwe amapangidwira kuti azigwiritsa ntchito pakhungu kapena intramuscularly.

Insulin yokhala nthawi yayitali silingagwiritsidwe ntchito pazovuta za shuga - chikomokere, precom.

Kuphatikiza insulin

Kukonzekera kutengera mitundu ingapo ya insulini yokhala ndi mikhalidwe yosiyanasiyana imapezeka mwa kuyimitsidwa. Kuphatikizika komwe kumachitika chifukwa cha kufupika kwa insulin ndi isophane - chinthu cha nthawi yayitali. Kuphatikizika kwa zinthu komwe kuli ndi mayamwidwe osiyanasiyana kumalola kuyambika kwa glycemic mwachangu komanso nthawi yayitali.

Kusiyanitsa koyambira

Mitundu ya insulin imagawidwa osati ndi liwiro la kuchitapo kanthu, nthawi yayitali ya kayendedwe ka glucose, komanso ndiyosiyana. Kwakanthawi, mankhwala osokoneza nyama adagwiritsidwa ntchito, ndiye, ndikupanga sayansi, anthu, omwe amapanga okha.

Pakupanga insulini yoyambira nyama, zinthu zomwe zimachokera ku kapamba ka nkhumba ndi ziweto zimagwiritsidwa ntchito. Pali mitundu ingapo ya iwo, ndipo pofunsa kuti yabwino kwambiri ndiyotani, imayang'ana pa kapangidwe kazinthu ndi kapangidwe kazinthu. Amakhulupilira kuti othandiza kwambiri ndi omwe ali ndi kusiyana pang'ono koyerekeza ndi zinthu za anthu.

Kukonzekera kwa insulin komwe kumapangidwa ndi anthu kumakonzedwa ndikusintha kwazinthu. Mankhwalawa ali pafupi kwambiri ndi mankhwala amkati, koma chifukwa chololedwa mu DNA, ali ndi mawonekedwe osiyanasiyana. Chifukwa chake, masiku ano madokotala amakonda insulin yamtunduwu.

Zomwe insulini ilibwino - palibenso yankho lotsimikizika pafunso ili, pomwe asayansi akupitilizabe kugwiritsira ntchito mankhwala atsopano, kupanga zochulukirapo komanso zotetezeka. Ndipo ngakhale shuga asanagonjetsedwe, kuthandiza odwala tsopano ndikosavuta. Masiku ano, pali mitundu ingapo ya mankhwala omwe angagwiritsidwe ntchito monocourse ndikupanga njira zingapo zoyang'anira pogwiritsa ntchito insulin. Mothandizidwa ndi mitundu yosiyanasiyana, odwala ambiri amatha kukhutitsidwa ndi kufunika kwazinthu.

Rinsulin P: mawonekedwe a kumasulidwa ndi mawonekedwe a pharmacological

Mankhwalawa ndi insulin yothamanga yaumunthu yomwe imapezeka kudzera mu tekinoloje ya DNA. Chidacho chimamangiriza ku zolandilira za membrane wakunja kwa cell, ndikupanga insulini-receptor zovuta zomwe zimayambitsa zomwe zimachitika mkati mwa maselo, kuphatikizapo kupanga ma enzyme otsogolera.

Kutsika kwa shuga m'magazi kumatheka chifukwa chakukula kwa glucose pakati pa maselo, kuyamwa kwambiri komanso kulowetsedwa ndi matupi. Kukondoweza kwa glycogenogeneis, lipogenesis kumachitika komanso kuchuluka kwa shuga kumachitika ndi chiwindi kumachepa.

Monga lamulo, kutalika kwa mphamvu ya kukonzekera kwa insulin kumatsimikiziridwa ndi kuchuluka kwa mayamwidwe, zomwe zimatengera zinthu zingapo (dera ndi njira yoyendetsera, mlingo). Chifukwa chake, mawonekedwe azinthu amatha kusiyanasiyana wodwala aliyense. Koma makamaka pambuyo pa kayendetsedwe ka subcutaneous, Rinsulin P imachitika pambuyo pa theka la ola, ndipo mphamvu yakeyo imatheka pambuyo pa maola 1-3 ndipo imatha mpaka maola 8.

GEROFARM-BIO OJSC wopanga insulin R amapanga mankhwalawa m'mitundu itatu:

1. Solution (10 IU / ml) wa jakisoni wa 3 ml ya mankhwalawa m'magalofu am'magolo okhala ndi zokutira ndi mphira.
2. Ma cartridge 5 mu chithuza chamtundu wa foil ndi PVC.
3. Katoni yophatikizidwa ndi cholembera ya syringe yosiyanasiyana yopangidwa ndi pulasitiki, yoyikidwa mu katoni.

Kukwana kwa mayamwidwe ndi isanayambike kuchitapo kanthu kwakanthawi insulin amatsimikiza ndi dera, malo, kayendetsedwe ka ndende ndi kugwirako ntchito kwa chinthu chogwira ntchito. Mankhwalawa sagawidwa mothandizidwa ndi minyewa yonse, samalowa mkaka wa m'mawere ndi chotchinga chachikulu.

Amawonongedwa ndi insulinase makamaka impso ndi chiwindi. Mankhwala amuchotseredwa mu 30-80% ya impso. T1 / 2 ndi mphindi 2-3.

Malangizo ogwiritsira ntchito mankhwalawa

Mankhwalawa akuwonetsedwa mtundu uliwonse wa matenda a shuga, makamaka pakakana kwathunthu kapena pang'ono mapiritsi ochepetsa shuga. Amagwiritsidwanso ntchito pamavuto azikhalidwe za anthu odwala matenda ashuga motsutsana ndi kuwonongeka kwa kagayidwe kazinthu kagayidwe kachakudya ndi matenda omwe amayanjana. Komabe, mankhwalawa saikidwa pa hypoglycemia komanso tsankho la munthu pazigawo zake.

Mankhwalawa amapangidwira utsogoleri wa iv, v / m, s / c. Njira yoyendetsera ndi mlingo wake ndi mankhwala a endocrinologist kutengera mtundu wa wodwalayo. Pakatikati mwa mankhwalawa ndi 0,5-1 IU / kg pa kulemera kwake.

Mankhwala a insulin omwe amangokhala mwachangu amaperekedwa m'mphindi 30. musanayambe kudya chakudya chamafuta. Koma, choyamba, muyenera kudikirira mpaka kutentha kwa kuyimitsidwa kukhale mpaka madigiri 15.

Pankhani ya monotherapy, insulin imayendetsedwa katatu mpaka katatu patsiku. Ngati mlingo wa tsiku ndi tsiku umaposa 0,6 IU / kg, ndiye kuti muyenera kulowetsa jakisoni awiri kapena angapo m'malo osiyanasiyana.

Monga lamulo, wothandizirayo amapaka jekeseni m'mimba khoma. Koma jakisoni amathanso kupanga m'mapewa, matako ndi ntchafu.

Nthawi ndi nthawi, malo a jakisoni amayenera kusinthidwa, zomwe zingateteze kuoneka ngati lipodystrophy. Pankhani ya kayendedwe ka subcutaneous of the hormone, muyenera kusamala kuti muwonetsetse kuti madziwo salowa mumtsempha wamagazi. Komanso, jakisoni atatha, jakisoni sangasambe.

Kukonzekera kwa / mu ndi / m kumatheka pokhapokha kuyang'aniridwa ndi achipatala. Makatoni amagwiritsidwa ntchito pokhapokha ngati mawonekedwe amadzimadzi ali ndi mawonekedwe osayera, chifukwa chake, pakuwonekera kwina, yankho sayenera kugwiritsidwa ntchito.

Ndikofunika kukumbukira kuti ma cartridge ali ndi chida chodziwika chomwe sichimalola kusakanikirana ndi zomwe zili ndi mitundu ina ya insulin. Koma ndikadzaza zolondola za cholembera, amatha kugwiritsidwanso ntchito.

Pambuyo poikapo, singano iyenera kutulutsidwa ndi kapu yake yakunja kenako ndikuitaya. Chifukwa chake, kupewetsa kumatha kupewedwa, kusokonekera kungatheke, ndipo mpweya sungalowe ndi singano ndikutseka.

Mukamagwiritsa ntchito zolembera zama syringe zochuluka, tengani cholembera mu firiji musanagwiritse ntchito kaye ndikudikirira kuti mufikire kutentha kwa firiji. Komabe, ngati madziwo afundira kapena kwatentha, ndiye kuti sangathe kugwiritsidwa ntchito.

Malamulo ena amafunikirabe kusungidwa:

• singano singagwiritsenso ntchito,
• Pulogalamu ya insulin yomwe cholembera imadzazidwa imangogwiritsidwa ntchito payekha, pomwe cholembera cha syringe sichitha kudzazidwa,
• cholembera chogwiritsidwa ntchito sichisungidwa mufiriji,
• kuteteza cholembera ku chitsulo, chophimba chophimba nthawi zonse.

Mankhwala omwe agwiritsidwa kale ntchito ayenera kusungidwa kutentha kwa madigiri 15 mpaka 25 osaposa masiku 28. Komanso, musalole kuti chipangizochi chizitenthe kapena kuyatsidwa ndi dzuwa.

Mlandu wa bongo m'magazi, kuchuluka kwa shuga kumatha kuchepa kwambiri. Kuchiza kwa hypoglycemia kumatenga zakudya zokhala ndi chakudya chamagulu kapena zakumwa zotsekemera. Chifukwa chake, odwala matenda ashuga ayenera kukhala ndi maswiti kapena juwisi nawo nthawi zonse.

Ndi hypoglycemia yayikulu, pamene wodwalayo sakudziwa, amapaka jekeseni wa shuga (40%) kapena glucagon.

Munthu akazindikira, ayenera kudyetsedwa chakudya chamagulu, zomwe zimalepheretsa kuukira kwachiwiri.

Zochita Zosiyanasiyana ndi Kuyanjana Ndi Mankhwala

Zotsatira zoyipa ndizolephera mu chakudya cha carbohydrate. Chifukwa chake, kuwunika kwa madotolo ndi odwala kumatsikira kuti pambuyo pa kuperekedwa kwa Rinsulin P, hypoglycemia ikhoza kuyamba. Izi zikuwonetsedwa ndi khungu, kupweteka pakhungu, kupweteka kwa mutu, kugona, kunjenjemera, kusowa kwa magazi, chizungulire, chizungulire, ndipo mu milandu ikuluikulu, matenda a hypoglycemic.

Zotsatira zoyipa, monga edema ya Quincke, zotupa pakhungu, ndizothekanso. Kugwedezeka kwa anaphylactic, komwe kumatha kubweretsa imfa, nthawi zina kumayamba.

Kuchokera kuzomwe zimachitika mdera lanu, kuyabwa, kutupa ndi vuto la jekeseni nthawi zambiri kumachitika. Ndipo pankhani ya insulin yokhala ndi nthawi yayitali, lipodystrophy imapezeka pamalo a jakisoni.

Zina zomwe zimakumana ndi zovuta zimaphatikizira kutupa ndi kuwonongeka kwa mawonekedwe. Koma nthawi zambiri zizindikirozi zimachoka pachithandizo chamankhwala.

Pali mankhwala angapo omwe amakhudza zofunikira za insulin. Chifukwa chake, ndemanga zamankhwala zimanena kuti kuchepa kwa shuga kwa insulin kumakhala kolimba ngati kugwiritsidwa ntchito kuphatikizidwa ndi njira zotsatirazi:

1. mapiritsi a hypoglycemic,
2. Mowa
3. ACE / MAO / carbonic anhydrase inhibitors,
4. Kukonzekera kwa lifiyamu
5. osasankha β-blockers,
6. Fenfluramine,
7. Bromocriptine
8. Cyclophosphamide,
9. salicylates,
10. Mebendazole ndi zina.

Nicotine, glucagon, phenytoin, somatropin, morphine, estrogens, kulera pakamwa, diazoxide ndi corticosteroids amachepetsa mphamvu ya hypoglycemic. Mahomoni a chithokomiro omwe amakhala ndi ayodini, CCB, diazture ya thiazide, Epinephrine, Clonidine, Heparin, Danazole, antidepressants and trathcimantics amachepetsa mphamvu yotsitsa shuga.

Kugwiritsa ntchito ma B-blockers kungatsekeke zizindikiro za hypoglycemia. Lanreotide kapena Octreotide ndi mowa zimatha kuwonjezera kapena kuchepa kwa insulini.

Ndizosagwirizana kwambiri kuphatikiza insulin yaumunthu ndi mankhwala ofanana ndi nyama.

Malangizo apadera

Poyerekeza ndi maziko a mankhwala a insulin, ndikofunikira kuyang'anira mawonetsedwe a glycemia nthawi zonse. Zowonjezera, kuwonjezera pa bongo, matenda ena, kugwiritsa ntchito mankhwala osokoneza bongo, kuwonjezera masewera olimbitsa thupi, kutsegula m'mimba, kusintha kwa jakisoni komanso ngakhale chakudya chosagwirizana kungapangitse kuchepetsa shuga.

Kuphatikiza apo, kusokonezeka pakukhazikitsidwa kwa insulin ndi Mlingo wolakwika kungayambitse matenda a hyperglycemia mwa odwala matenda a shuga 1. Popanda chithandizo, ketoacidosis yoopsa ikhoza kukhala.

Ngati pali kuphwanya magwiridwe antchito a impso, chiwindi, chithokomiro, hypopituitarism, matenda a Addison komanso ukalamba, ndikofunikira kusintha mlingo wa insulin. Kuphatikiza apo, kusintha kwa muyezo kungakhale kofunikira pakusintha zakudya ndikuwonjezera zolimbitsa thupi.

Kufunika kwa insulini kumachulukira pamaso pa matenda othandizira, makamaka omwe amatsatiridwa ndi kutentha thupi. Ndizofunikira kudziwa kuti mukamasintha kuchoka ku mtundu wina wa insulin kupita ku wina, muyenera kuyang'anitsitsa shuga wa magazi.

Mtengo wa Rinsulin P umachokera ku 448 mpaka 1124 rubles.

Kuphatikiza pa Insulin P, pali mankhwala Rinsulin NPH. Koma ndalama izi zingasiyane bwanji?

Rinsulin NPH

Mankhwala nawonso insulin yaumunthu yomwe imapezeka kudzera mu tekinoloje ya DNA. Komabe, poyerekeza ndi Insulin P, ilibe yochepa, koma mphamvu yapakati. Mankhwalawa onse akhoza kuphatikizidwa.

Monga lamulo, pambuyo pa kukonzekera kwa sc, zochita za insulin zimayamba pambuyo pa maola 1.5. Zotsatira zazikulu zimatheka pambuyo maola 4-12 ndipo zimatha tsiku limodzi.

Kuyimitsidwa kumakhala ndi mtundu woyera, ndipo poyimirira kumapeto kwa botolo, mafomu okhazikika, omwe, akagwedezeka, amasinthidwanso. Chithandizo chogwira mankhwalawa ndi insulin-isophan.

Monga momwe othandizira amagwiritsidwa ntchito:

• madzi osungunuka
• Promina Sulfate
• sodium hydrogen phosphate dihydrate,
• glycerol
• metacresol
• kristalo phenol.

Kuyimikako kumapezeka m'magalatalo atatu a galasi 3 ml iliyonse, yoyikidwa mu katoni katoni. Komanso, chogulikachi chitha kugulidwa m'magalofu am'magalasi omwe amaikamo ma syringe ambiri a Rinastra.

Ma pharmacokinetics ndi zofunikira zogwiritsira ntchito mankhwalawa ndizofanana ndi zomwe zimagwiritsidwa ntchito Rinsulin R. Mlingo wa mankhwalawa umatsimikiziridwa ndi adokotala payekhapayekha.

Mlingo wamba wa mankhwalawa ndi 0,5-1 IU / kg pa kulemera kwa thupi. Koma kulowetsedwa kwa mtsempha kumatsutsana.

Malangizo ogwiritsira ntchito Rinsulin NPH pazotsatira zoyipa, mawonekedwe osokoneza bongo a mawonekedwe ndi njira zogwiritsira ntchito sizinasiyane ndi zokhumudwitsa za insulin ya anthu osakhalitsa.

Mtengo wa kuyimitsidwa uku ndikuchokera ku ruble 417 mpaka 477. Kanemayo munkhaniyi akuthandizani kudziwa momwe mungapangire insulin.