Malangizo ogwiritsira ntchito mankhwala osokoneza bongo, analogi, ndemanga

Mankhwalawa amapangidwa ndi recombinant DNA biotechnology pogwiritsa ntchito mtundu wa Saccharomyces cerevisiae. Mankhwala, omwe amalumikizana ndi ma membrane ena a kunja kwa cell ya cell, amapanga insulin receptor zovuta zomwe zimapangitsa kuti ma cell azikhala mkati mwa cell, kuphatikiza kupanga ma enzyme ena ofunikira (pyruvate kinase, hexokinase, glycogen synthetase ndi ena). Kuchepa kwa kuchuluka kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa mayendedwe ake mkati mwa maselo, kuchulukitsa ndikumwedwa ndi minyewa, komanso kuchepa kwa mapangidwe a shuga m'magazi. Mankhwala amathandizira glycogenogeneis, lipogenesis, kaphatikizidwe kazinthu kena.
Kutalika kwa chochita cha mankhwalawa makamaka chifukwa cha kuperewera kwake, kutengera mtundu wake, malo ake ndi njira yake yothandizira ndi zina, chifukwa chake, mawonekedwe amomwe mankhwalawa amatha kusiyanasiyana osati mwa odwala osiyanasiyana, komanso mwa munthu yemweyo. Pafupifupi, ndi subcutaneous makonzedwe a mankhwalawa, kuyamba kwa chochitika kumachitika pambuyo pa maola 1.5, mphamvu kwambiri imatheka pambuyo pa maola 4 mpaka 12, nthawi yochitapo mpaka tsiku. Kukhazikika kwa vutoli komanso kukwaniritsidwa kwa mankhwala kumadalira mlingo (kuchuluka kwa mankhwala omwe amaperekedwa), tsamba la jekeseni (ntchafu, m'mimba, matako), kuchuluka kwa insulin pamankhwala ndi zina. Kuchuluka kwa insulini m'madzi a m'magazi kumafikiridwa patatha maola 2 mpaka 18 pambuyo pochita zinthu zina. Palibe zomangamanga zomanga mapuloteni a plasma zimadziwika, kupatula kuzungulira kwa ma antibodies kupita ku insulin (ngati alipo). Mankhwalawa amagawidwa mosiyanasiyana mu minyewa yonse, samalowa mkaka wa m'mawere kudzera mu chotchinga chachikulu. Kwambiri mu impso ndi chiwindi, mankhwalawa amawonongedwa ndi insulinase, komanso, mwina, mapuloteni disulfide isomerase. Ma insulin metabolites sagwira ntchito. Hafu ya moyo wa insulini kuchokera m'magazi ndi mphindi zochepa chabe. Kuchotsa hafu ya moyo kuchokera ku chamoyo kumapangitsa pafupifupi maola 5 - 10. Amachotsa impso (30 - 80%).
Palibe chiopsezo cha mankhwalawa kwa anthu chomwe chidawululidwa panthawi yophunzira zamakedzana, zomwe zimaphatikizapo maphunziro a kawopsedwe omwe ali ndi Mlingo wobwereza, maphunziro a chitetezo pamatenda, maphunziro a carcinogenic omwe angapangidwe, genotoxicity, ndi zotsatira zoyipa pakubala.

Type 1 shuga mellitus, mtundu 2 shuga mellitus: kukana pang'ono kwa mankhwala a hypoglycemic (munthawi yophatikiza chithandizo), gawo la kukana kwa mankhwala amkamwa a hypoglycemic, matenda amiseche, mtundu wa 2 wodwala matenda a shuga.

Njira yogwiritsira ntchito zinthu za insulin-isophan genetic engineering ndi waukulu

Mankhwalawa amaperekedwa pokhapokha. Mlingo uliwonse umadziwika ndi dokotala payekha potengera kuchuluka kwa shuga m'magazi, nthawi zambiri mlingo wa mankhwalawa umachokera ku 0,5 mpaka 1 IU / kg (kutengera kuchuluka kwa glucose wamagazi ndi mawonekedwe a wodwalayo). Nthawi zambiri, mankhwalawa amaperekedwa mwachangu mu ntchafu. Komanso, mankhwalawa amatha kutumikiridwa mosazungulira mu khosi, kunja kwam'mimba khoma, komanso dera la minofu ya m'mapazi. Kutentha kwa mankhwala omwe amaperekedwa kuyenera kukhala kutentha kwambiri.
Osamayendetsa mitsempha.
Kufunika kwa insulin tsiku lililonse kumatha kukhala kotsika kwa odwala omwe ali ndi zotsalira za insulin komanso kupanga odwala kwambiri omwe ali ndi vuto la insulin.
Popewa kukula kwa lipodystrophy, ndikofunikira kusintha malo a jakisoni mkati mwa anatomical dera.
Mukamagwiritsa ntchito insulin, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi. Kuphatikiza pa kuchuluka kwa mankhwalawa, zomwe zimayambitsa hypoglycemia zimatha kukhala: kulumpha zakudya, kusintha mankhwala, kutsegula m'mimba, kusanza, kuwonjezera masewera olimbitsa thupi, kusintha malo a jekeseni, matenda omwe amachepetsa kufunika kwa insulin (kuvulala kwa impso ndi / kapena ntchito ya chiwindi, pituitary pituitary, adrenal cortex, chithokomiro England, kuyanjana ndi mankhwala ena.
Kuphwanya mankhwala a insulin kapena dosing yosayenera, makamaka kwa odwala omwe ali ndi matenda amtundu wa 1, kungayambitse matenda a hyperglycemia. Monga lamulo, zizindikiro zoyambirira za hyperglycemia zimayamba pang'onopang'ono, kwa maola angapo kapena masiku. Amaphatikizaponso kukodza kambiri, ludzu, nseru, chizungulire, kusanza, kuyanika ndi khungu, kusowa chilimbikitso, pakamwa kowuma, kununkhira kwa acetone mu mpweya wotuluka. Popanda chithandizo chapadera, hyperglycemia imatha kuyambitsa matenda a diabetesic ketoacidosis, omwe ali pachiwopsezo cha moyo.
Mlingo wa insulin uyenera kusinthidwa kuti ukhale ndi matenda a Addison, matenda a chithokomiro osokoneza bongo, matenda aimpso komanso / kapena chiwindi, hypopituitarism, matenda ndi zina zomwe zimayendera ndi kutentha, wazaka zopitilira 65. Komanso, kusintha kwa muyezo wa mankhwalawo kungafunike ngati wodwala wasintha zakudya zomwe amakonda kapena akuwonjezera mphamvu zolimbitsa thupi.
Mankhwala amachepetsa kulolera kwa mowa.
Ulendowu usanachitike, womwe umalumikizidwa ndi kusintha kwa malo, wodwalayo amafunika kufunsa adokotala, chifukwa posintha nyengo kumatanthauza kuti wodwalayo azabaya insulin ndikudya chakudya nthawi ina.
Ndikofunikira kuchita kusintha kwa mtundu wina wa insulini kupita kwina ndikuyang'aniridwa ndi kuchuluka kwa shuga m'magazi.
Pogwiritsa ntchito mankhwalawa (makamaka pachifuniro choyambirira, kusintha mtundu wina wa insulini kupita ku wina, kupsinjika kwamphamvu m'maganizo kapena kuchita masewera olimbitsa thupi), kutha kuyendetsa zinthu zosiyanasiyana, kuyendetsa galimoto ndi kuchita zinthu zina zoopsa zomwe zimafuna kuthamanga kwa mota ndi malingaliro komanso chidwi chachikulu.

Mimba komanso kuyamwa

Palibe choletsa kugwiritsa ntchito insulin panthawi yapakati komanso panthawi yoyamwitsa, popeza insulin simalowa m'matumbo komanso kulowa mkaka wa m'mawere. Hypoglycemia ndi hyperglycemia, yomwe imatha kukhala ndi chithandizo chosankhidwa bwino, imakulitsa chiopsezo cha kufa kwa fetal komanso maonekedwe a fetal. Amayi oyembekezera omwe ali ndi matenda ashuga amayenera kuyang'aniridwa ndi madokotala panthawi yonse yomwe ali ndi pakati, ayenera kuyang'anitsitsa kuchuluka kwa shuga wamagazi, ndipo malingaliro omwewo amagwiranso ntchito kwa amayi omwe akukonzekera kutenga pakati. Mu trimester yoyamba ya mimba, insulin amafuna nthawi zambiri imachepa ndipo pang'onopang'ono imachulukirachulukira kwachiwiri komanso kwachitatu. Pambuyo pa kubala, kufunikira kwa insulin nthawi zambiri kumabweza msanga pamlingo womwe umawonedwa asanakhale ndi pakati. Nthawi yoyamwitsa, amayi omwe ali ndi matenda osokoneza bongo angafunike kusintha zakudya zawo komanso / kapena mtundu.

Zotsatira zoyipa za insulin-isophan umisiri wamtundu wa anthu

Chifukwa cha kuchuluka kwa kagayidwe kazakudya: Hypoglycemic zinthu (kuchuluka thukuta, thukuta, kutopa, khungu lotupa, kusokonezeka m'maso, kunenepa, mantha, mutu, nkhawa, kukwiya, kupweteka pakamwa, kuchepa ndende chisamaliro, kusokonezeka, kugona, kusazindikira, kukokana, kusokonezeka kwakanthawi kapena ubongo, ntchito), kuphatikizapo hypoglycemic coma.
Zotsatira zoyipa: zotupa pakhungu, uritisaria, edema ya Quincke, kugunda kwa anaphylactic, kuphatikiza zotupa pakhungu, kuchuluka thukuta, kuchepa magazi, kuyabwa, kupweteka m'mimba, angioedema, kupuma movutikira, kugunda kwamtima, kukomoka / kukomoka.
Zina: zolakwika zoyenda pang'onopang'ono (nthawi zambiri kumayambiriro kwa chithandizo), kupweteka kwam'mimba neuropathy (zotumphukira neuropathy), matenda ashuga retinopathy, edema.
Zomwe zimachitika: kutupa, kutupa, kutupa, hyperemia, kupweteka, kuyabwa, hematoma, lipodystrophy pamalo opangira jekeseni.

Kugwirizana kwa chinthu insulin-isophan chibadwa chaumunthu chazinthu zina

: glucocorticoids, kulera kwapakamwa, mahomoni a chithokomiro, heparin, thiazide okodzetsa, mankhwala opha ziwopsezo, danazole, clonidine, sympathomimetics, calcium blockers, phenytoin, morphine, diazoxide, nikotini.
: Monoamine oxidase zoletsa m'kamwa hypoglycemic mankhwala, angiotensin akatembenuka zoletsa enzyme, kusankha beta-blockers, carbonic anhydrase zoletsa, octreotide, bromocriptine, sulfonamides, tetracyclines, anabolic mankhwala, clofibrate, mebendazole, ketoconazole, pyridoxine, cyclophosphamide, theophylline, mankhwala lifiyamu fenfluramine.
Mothandizidwa ndi salicylates, reserpine, kukonzekera komwe kumakhala ndi ethanol, kufooketsa komanso kuwonjezera zochita za insulin ndizotheka.
Octreotide, lanreotide imatha kuwonjezera kapena kuchepetsa kufunika kwa insulin.
Beta-blockers amatha kuphimba zizindikiro za hypoglycemia ndikuchira pang'onopang'ono pambuyo pa hypoglycemia.
Ndi kuphatikiza kwa mankhwala a insulin ndi thiazolidinedione, ndizotheka kukulitsa kulephera kwa mtima, makamaka kwa odwala omwe ali ndi chiopsezo cha chitukuko chake. Mankhwalawa akaphatikizidwa, amafunika kuwunika odwala kuti azindikire kulephera kwa mtima, kupezeka kwa edema, ndi kunenepa kwambiri. Ngati zizindikiro za kulephera kwa mtima zikuchulukirachulukira kwa odwala, chithandizo cha thiazolidinedione ziyenera kusiyidwa.

Bongo

Ndi mankhwala osokoneza bongo ambiri, hypoglycemia imayamba.
Chithandizo: wodwalayo amatha kuchotsa hypoglycemia yekha, chifukwa chake ndikofunikira kudya zakudya zopatsa thanzi kapena shuga mkati, chifukwa chake amalimbikitsidwa kwa odwala omwe ali ndi matenda osokoneza bongo kuti azinyamula shuga, makeke, maswiti, ndi zipatso zotsekemera. Mu kwambiri hypoglycemia (kuphatikizapo kutayika kwa chikumbumtima), 40% dextrose yothetsera imayendetsedwa kudzera m'mitsempha, intramuscularly, subcutaneally kapena kudzera m'mitsempha - glucagon. Pambuyo pozindikira, wodwalayo ayenera kudya zakudya zamafuta ambiri kuti aletse kukonzanso kwa hypoglycemia.

Pharmacology

Imakhudzana ndi ma membrane ena am'mimba a cytoplasmic cell ndipo amapanga insulini-receptor zovuta zomwe zimapangitsanso zochitika zina, kuphatikizapo kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase, etc.). Kutsika kwa glucose m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa mayamwidwe ndi mayamwidwe ndi minofu, komanso kuchepa kwa kuchuluka kwa shuga m'magazi. Zimayambitsa lipogenesis, glycogenogeneis, kaphatikizidwe kazinthu kena.

Kutalika kwa nthawi ya kukonzekera kwa insulin kumatsimikiziridwa makamaka ndi kuchuluka kwa mayamwidwe, zomwe zimatengera zinthu zingapo (kuphatikizapo mlingo, njira ndi malo oyang'anira), chifukwa chake zochitika za insulin zimasinthasintha kwambiri mwa anthu osiyanasiyana, komanso m'modzi munthu yemweyo. Pafupifupi, pambuyo pa utsogoleri wa sc, kumayambira kumachitika pambuyo pa maola 1.5, mphamvu yayikulu imakhala pakati pa maola 4 ndi 12, nthawi yayitali mpaka maola 24.

Kukwanira kwathunthu ndi kuyambika kwa mphamvu ya insulin kumadalira malo a jakisoni (m'mimba, ntchafu, matako), mlingo (kuchuluka kwa insulin), kuchuluka kwa insulin, mankhwalawa. Amawonongedwa ndi insulinase makamaka m'chiwindi ndi impso. Imafufutidwa ndi impso (30-80%).

Zotsatira zoyipa za insulin-isophan umisiri wa chibadwa cha anthu

Chifukwa cha kuchuluka kwa kagayidwe kazakudya: hypoglycemic zinthu (pallor of the khungu, thukuta kwambiri, palpitations, kugwedeza, njala, kukwiya, paresthesia mkamwa, mutu). Matenda oopsa a hypoglycemia angayambitse kukula kwa chikomokere kwa hypoglycemic.

Zotsatira zoyipa: kawirikawiri - zotupa pakhungu, edema ya Quincke, yosowa kwambiri - kuwopsa kwa anaphylactic.

Zina: kutupa, zolakwika zosakhalitsa (nthawi zambiri kumayambiriro kwa mankhwala).

Zomwe zimachitika: Hyperemia, kutupa ndi kuyabwa pamalowo jekeseni, ndikugwiritsa ntchito nthawi yayitali - lipodystrophy pamalo opangira jekeseni.

Chenjezo kwa insulin-isophan umisiri wa chibadwa cha anthu

Ndikofunikira kusintha malo a jekeseni mkati mwa anatomical dera kuti muchepetse kukula kwa lipodystrophy.

Poyerekeza ndi maziko a mankhwala a insulin, kuyang'anira kuchuluka kwa shuga m'magazi ndikofunikira. Zomwe zimayambitsa hypoglycemia, kuwonjezera pa insulin yochulukirapo, imatha kukhala: kusintha kwa mankhwala, kudumpha chakudya, kusanza, kutsegula m'mimba, kuchuluka kwa zochitika zolimbitsa thupi, matenda omwe amachepetsa kufunikira kwa insulin (chiwindi ndi matenda a impso, hypofunction ya adrenal cortex, pituitary kapena chithokomiro cha chithokomiro), kusintha kwa malo jakisoni, komanso kucheza ndi mankhwala ena.

Kulephera kapena kusokoneza kwa insulin makonzedwe, makamaka kwa odwala omwe ali ndi matenda amtundu wa 1, angayambitse matenda a hyperglycemia. Nthawi zambiri, zizindikiro zoyambirira za hyperglycemia zimayamba pang'onopang'ono kwa maola angapo kapena masiku. Izi zikuphatikiza ludzu, kukodza kwambiri, nseru, kusanza, chizungulire, khungu ndi kuwuma pakhungu, pakamwa pouma, kusowa chilimbikitso, kununkhira kwa acetone mu mpweya wotuluka. Ngati sanalandire, hyperglycemia mu mtundu 1 wa shuga angayambitse kukula kwa matenda ashuga a ketoacidosis.

Mlingo wa insulin uyenera kusinthidwa ngati vuto la chithokomiro likulephera, matenda a Addison, hypopituitarism, chiwindi ndi matenda a impso komanso matenda osokoneza bongo omwe ali ndi zaka zopitilira 65. Kusintha muyezo wa insulini kungafunikenso ngati wodwala akuwonjezera kuchuluka kwa zochita zolimbitsa thupi kapena asintha zakudya zomwe amakonda.

Matenda onga, makamaka matenda ndi machitidwe omwe amatsatana ndi malungo, amalimbikitsa kufunika kwa insulini.

Kusintha kuchokera ku mtundu wina wa insulin kupita ku wina kuyenera kuchitika mothandizidwa ndi misempha yamagazi.

Mankhwala amachepetsa kulolera kwa mowa.

Pokhudzana ndi cholinga choyambirira cha insulini, kusintha kwa mtundu wake kapena kukhalapo kwa kupanikizika kwakukulu kwakuthupi kapena kwamalingaliro, ndizotheka kuchepetsa kuyendetsa galimoto kapena kuwongolera njira zosiyanasiyana, komanso kuchita zochitika zina zowopsa zomwe zimafuna chidwi chochulukirapo komanso kuthamanga kwa malingaliro ndi magalimoto.

Zomwe zimachitika ndi insulin-isophan umangidwe wa chibadwa cha anthu

Insulin yochita pakati. Insulin yaumunthu yomwe idagwiritsidwa ntchito pogwiritsa ntchito ukadaulo wa DNA.

Imakhudzana ndi ma membrane ena am'mimba a cytoplasmic cell ndipo amapanga insulini-receptor zovuta zomwe zimapangitsanso zochitika zina, kuphatikizapo kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase, etc.).Kutsika kwa glucose m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa mayamwidwe ndi mayamwidwe ndi minofu, komanso kuchepa kwa kuchuluka kwa shuga m'magazi. Zimayambitsa lipogenesis, glycogenogeneis, kaphatikizidwe kazinthu kena.

Kanema (dinani kusewera).

Kufotokozera za ntchito yogwira Insulin-isophan genetic engineering / Insulinum isophanum humanum biosynthetum.

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

Isofan insulin: malangizo ogwiritsira ntchito komanso mtengo wa mankhwalawa

Chithandizo cha insulin chimakhala ndi mawonekedwe ena, chifukwa ntchito yayikulu yothandizira pakubwezerera kwa malfunctions mu carbohydrate metabolism pakubweretsa mankhwala apadera pansi pa khungu. Mankhwala oterowo amakhudza thupi komanso insulini yachilengedwe yopangidwa ndi kapamba. Pankhaniyi, mankhwalawa amakhala athunthu kapena osapatula.

Mwa mankhwala omwe amagwiritsidwa ntchito popanga matenda ashuga, imodzi mwabwino ndi insulin Isofan. Mankhwala ali ndi chibadwa chomanga insulin ya nthawi yayitali.

Chidachi chimapezeka m'njira zosiyanasiyana. Amayendetsedwa m'njira zitatu - subcutanely, intramuscularly komanso kudzera m'mitsempha. Izi zimathandiza wodwala kusankha njira yabwino kwambiri yolamulirira glycemia.

Zizindikiro zogwiritsidwa ntchito ndi mayina ogulitsa a mankhwalawa

Kugwiritsa ntchito mankhwalawo kumasonyezedwa ngati mtundu wa shuga womwe umadalira insulin. Komanso, chithandizo chamankhwala chiyenera kukhala moyo wonse.

Insulin monga Isofan ndi mankhwala opangidwa ndi chibadwa cha anthu omwe amalembedwa mu milandu yotere:

mtundu 2 shuga (wodalira insulin),
opaleshoni njira
kukana hypoglycemic wothandizila kumwa pakamwa monga mbali ya zovuta mankhwala,
matenda a shuga (osagwiritsa ntchito mankhwalawa),
pafupipafupi matenda.

Makampani opanga mankhwala amapanga insulin yaumunthu yopangidwa ndi mayina osiyanasiyana. Odziwika kwambiri ndi Vozulim-N, Biosulin-N, Protafan-NM, Insuran-NPH, Gensulin-N.

Mitundu ina ya isofan insulin imagwiritsidwanso ntchito ndi awa:

Wopanda pake
Humulin (NPH),
Pensulin,
Isofan insulin NM (Protafan),
Actrafan
Insulidd N,
Biogulin N,
Chitetezo cha Protafan-NM.

Ndikofunikira kudziwa kuti kugwiritsa ntchito tanthauzo lililonse la Insulin Isofan kuyenera kuvomerezana ndi adokotala.

Insulin yamunthu imakhala ndi vuto la hypoglycemic. Mankhwala amalumikizana ndi ma membrane a cell a cytoplasmic, ndikupanga insulini-receptor. Imayendetsa njira zomwe zimapezeka mkati mwa maselo ndikupanga ma enzymes akuluakulu (glycogen synthetase, pyruvate kinase, hexokinase, etc.).

Kuchepetsa kuchuluka kwa shuga kumachitika ndikuwonjezera kayendedwe kake kakang'ono kwambiri, kutsitsa kuchuluka kwa shuga m'magazi, ndikulimbikitsa mayamwidwe ndikuwonjezera kuyamwa kwa glucose ndi minofu. Komanso, insulin yaumunthu imayendetsa kaphatikizidwe wa mapuloteni, glycogenogeneis, lipogeneis.

Kutalika kwa mankhwala kumadalira kuthamanga kwa mayamwidwe, ndipo chifukwa cha zinthu zosiyanasiyana (dera la kayendetsedwe, njira ndi mlingo). Chifukwa chake, mphamvu ya Isofan insulin ikhoza kusefukira mwa odwala komanso odwala matenda ashuga.

Nthawi zambiri pambuyo pa jekeseni, mphamvu ya mankhwalawa imadziwika pambuyo pa maola 1.5. Chiwonetsero chachikulu kwambiri pakugwira bwino ntchito kumachitika maola 4-12 pambuyo pa makonzedwe. Kutalika kwa chochitika - tsiku limodzi.

Chifukwa chake, kuperekera kwathunthu ndi kuyambika kwa ntchito kwa wothandizirazi zimatengera zinthu monga:

dera la jakisoni (matako, ntchafu, pamimba),
yogwira mankhwala ndende
Mlingo.

Kukonzekera kwa insulin kwa anthu kumagawidwa mosiyanasiyana mu minofu. Samalowa m'matumbo ndipo samayamwa mkaka wa m'mawere.

Amawonongedwa ndi insulinase makamaka mu impso ndi chiwindi, omwe amawonjezera kuchuluka kwa 30-80% ndi impso.

Malangizo ogwiritsira ntchito insulin Isofan akunena kuti nthawi zambiri amathandizidwa mosavomerezeka mpaka 2 pa tsiku musanadye kadzutsa. Pankhaniyi, muyenera kusintha jakisoni tsiku lililonse ndikusunga syringe yomwe imagwiritsidwa ntchito kutentha kwa chipinda, ndi yatsopano mufiriji.

Nthawi zina mankhwala kutumikiridwa intramuscularly. Ndipo njira yolowerera yogwiritsira ntchito insulin yomwe imagwiritsa ntchito siigwiritsidwa ntchito.

Mlingo amawerengedwa payekhapayekha kwa wodwala aliyense, potengera kuchuluka kwa kuchuluka kwa shuga m'magazi achilengedwe komanso kutsimikizika kwa matendawa. Monga lamulo, avareji ya tsiku ndi tsiku imachokera ku 8-24 IU.

Ngati odwala ali ndi insulin, ndiye kuti tsiku lililonse mankhwalawo ndi 8 IU. Ndi chiwopsezo chovuta cha mahomoni, mlingo umawonjezeka - kuyambira 24 IU patsiku.

Ngati kuchuluka kwa tsiku ndi tsiku kwamankhwala kumaposa 0,6 IU pa 1 makilogalamu, ndiye kuti jakisoni awiri amapangidwa mbali zosiyanasiyana za thupi. Odwala omwe ali ndi tsiku lililonse la 100 IU kapena kuposerapo ayenera kugonekedwa m'chipatala ngati insulin italowedwa m'malo.

Komanso, posamutsa kuchokera ku mtundu wina wamtundu kupita ku wina, ndikofunikira kuwunika zomwe zili ndi shuga.

Kugwiritsa ntchito insulin yaumunthu kumatha kuyambitsa matupi awo. Nthawi zambiri, ndi angioedema (hypotension, kupuma movutikira, malungo) ndi urticaria.

Komanso, kupitilira muyeso kungayambitse hypoglycemia, yowonetsedwa ndi zizindikiro zotsatirazi:

kusowa tulo
chikopa,
kukhumudwa
hyperhidrosis
mantha
dziko lokondwa
kugunda kwa mtima
mutu
chisokonezo,
Vuto lama vestibular
njala
kugwedezeka ndi zinthu.

Zotsatira zoyipa zimaphatikizira diabetesic acidosis ndi hyperglycemia, zomwe zimawonetsedwa ndi kutulutsa nkhope, kugona, kusowa kudya komanso ludzu. Nthawi zambiri, mikhalidwe yotere imachitika motsutsana ndi maziko a matenda opatsirana komanso kutentha thupi, jekeseni ikaphonya, mulingo wake sukulondola, ndipo ngati zakudya sizitsatiridwa.

Nthawi zina kuphwanya kwa chikumbumtima kumachitika. Pamavuto, pamakhala mkhalidwe wovuta komanso wamakhalidwe.

Kumayambiriro kwa mankhwalawa, kusokonezeka kwa nthawi yochepa kumatha kuchitika. Kuwonjezeka kwa gawo la anti-insulin matupi kumadziwikanso ndi kupita patsogolo kwa glycemia komanso zochita zamagetsi zamtundu wa mtanda ndi insulin ya anthu.

Nthawi zambiri tsamba la jakisoni limatupa ndikuluma. Poterepa, mafuta onunkhira a minyewa kapena ma atrophies. Ndipo pa gawo loyambirira la zamankhwala, zolakwika zosakhalitsa ndi edema zimatha.

Ngati mankhwala osokoneza bongo ochulukirapo, shuga m'magazi amatsika kwambiri. Izi zimayambitsa hypoglycemia, ndipo nthawi zina wodwala amagwa.

Ngati mulingo wachepera, muyenera kumwa zakudya zamatumbo ambiri (chokoleti, mikate yoyera, mpukutu, maswiti) kapena kumwa chakumwa chokoma kwambiri. Pakukhumudwa, yankho la dextrose (40%) kapena glucagon (s / c, v / m) limaperekedwa kwa wodwala mu / mu.

Wodwala akayambanso kudziwa bwino, ndikofunikira kumudyetsa chakudya chamafuta ambiri.

Izi zimapangitsa kuti matenda obwera chifukwa cha hypoglycemic ayambirenso kuchepa.

Kuyimitsidwa kwa oyang'anira sc sikugwiritsidwa ntchito ndi njira zina zamankhwala ena. A Co-makonzedwe ndi sulfonamides, Ace / Mao / carbonic anhydrase, NSAIDs, Mowa zoletsa, anabolic mankhwala, ndi chloroquine, androgens, kwinini, bromocriptine, pirodoksin, tetracyclines, kukonzekera lifiyamu, clofibrate, fenfluramine, Ketonozolom, Tsiklofosvamidom, theophylline, mebendazole Angathe hypoglycemic kwenikweni.

Kufooka kwa hypoglycemic zochita kumathandizira:

H1 histamine receptor blockers,
Glucagon
Somatropin
Epinephrine
GKS,
Phenytoin
kulera kwamlomo
Epinephrine
Ma estrogens
odana ndi calcium.

Kuphatikiza apo, kuchepa kwa shuga kumayambitsa kugwiritsidwa ntchito kophatikizana kwa Isofan insulin yokhala ndi loopide ndi thiazide diuretics, Klondin, BMKK, Diazoxide, Danazol, mahomoni a chithokomiro, ma tridclic antidepressants, sympathomimetics, Heparin ndi sulfinpyrazone. Nikotini, chamba ndi morphine zimakulitsanso hypoglycemia.

Pentamidine, beta-blockers, Octreotide ndi Reserpine angalimbikitse kapena kufooketsa glycemia.

Njira zopewera kugwiritsa ntchito mankhwala a Isofan insulin ndikuti munthu wodwala matenda ashuga asinthidwe malo omwe jakisoni wa insulin adzaperekedwa. Kupatula apo, njira yokhayo yolepheretsa kuwoneka kwa lipodystrophy.

Poyerekeza ndi maziko a mankhwala a insulin, muyenera kuyang'anira kuchuluka kwa shuga. Kuphatikiza pa kugwirira ntchito limodzi ndi mankhwala ena, zinthu zina zimayambitsa hypoglycemia:

matenda ashuga komanso kusanza,
m'malo mankhwala
kuchuluka zolimbitsa thupi
matenda omwe amachepetsa kufunika kwa mahomoni (aimpso ndi chiwindi kulephera, kuchepa kwa chithokomiro, chithokomiro cha pituitary, etc.),
Zakudya zosadziwika,
kusintha kwa jakisoni malo.

Mlingo wosalondola kapena kupumira kwakatikati pakati pa jakisoni wa insulin kungathandize kukulitsa hyperglycemia, makamaka ndi matenda a shuga 1. Ngati chithandizo sichinasinthidwe mu nthawi, ndiye kuti wodwala nthawi zina amakhala ndi vuto la ketoacidotic.

Kuphatikiza apo, kusintha kwa mlingo kumafunika ngati wodwalayo akuposa zaka 65, ndiye kuti wasokonekera kugwira ntchito kwa chithokomiro, impso kapena chiwindi. Ndikofunikira pa hypopituitarism ndi matenda a Addison.

Kuphatikiza apo, odwala ayenera kudziwa kuti kukonzekera kwa insulin ya anthu kumachepetsa kulolera. M'migawo yoyambirira yamankhwala, pakakhala njira yothetsera vutoli, kupanikizika, kulimbitsa thupi mwamphamvu, sikofunikira kuyendetsa galimoto komanso njira zina zovuta kapena kuchita nawo zinthu zoopsa zomwe zimafuna kuwonjezeredwa chidwi komanso kuthamanga.

Odwala omwe ali ndi pakati ayenera kuganizira kuti m'nthawi yoyambirira kufunikira kwa insulin kumachepa, ndipo mu 2 ndi 3 kumawonjezeka. Komanso, mahomoni ochepa kwambiri angafunike pogwira ntchito.

Mankhwala a Isofan afotokozeredwa mu kanema munkhaniyi.

Matenda a shuga - M: Mankhwala, 1964. - 603 p.
Matenda a Rudnitsky L.V. Chithandizo ndi kupewa, Peter - M., 2012. - 128 c.
Kennedy Lee, Basu Ansu Diagnosis ndi chithandizo cha endocrinology. Njira yovuta, GEOTAR-Media - M., 2015. - 304 p.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Malangizo ogwiritsira ntchito

Malangizo ogwiritsira ntchito amawunikira mtundu waukulu wamatenda omwe ma insulin omwe amapangidwira matendawa amagwiritsidwa ntchito - insulin yodalira matenda a shuga. Chithandizo mu izi zimachitika mu moyo wonse. Pankhaniyi, ndikofunikira kutsatira jakisoni. Kuphatikiza apo, Isofan imagwiritsidwa ntchito pa mtundu 1 ndi matenda ashuga 2.

Dokotala atha kukulemberani mankhwala ngati pali vuto kuchokera ku mankhwala omwe amachepetsa shuga. Kenako insulin imayikidwa ngati mankhwala osakaniza.

Kuwonjezeka kwa shuga m'magazi kungakhale chifukwa chazovuta, mwachitsanzo, pambuyo pakuchita opaleshoni. Pankhaniyi, insulin ikhoza kutumikiranso ngati chithandizo chovuta. Amalandira amayi apakati omwe ali ndi matenda ashuga.

Isofan imagwiritsidwa ntchito kokha pa mtundu 1 ndi matenda ashuga 2!

Mankhwalawa amadziwikiridwa kwa odwala omwe amatha kuyanjana ndi hypoglycemia.

Kutengera mphamvu

Zotsatira zoyipa za kutenga Isofan ndi:

Zotsatira zoyipa za kagayidwe kazakudya. Izi zikuwonetsedwa ngati mawonekedwe amkhungu pakhungu, thukuta kwambiri, kuthamanga mtima, mawonekedwe a kunjenjemera, munthu amafunafuna kudya, amakhala ndi chisangalalo, amamva mutu pafupipafupi.
Chiwonetsero chofotokozedwa ndi zotupa pakhungu, edema ya Quincke. Nthawi zina, mankhwalawa amayambitsa anaphylactic.
Kutupa kumatha kuwoneka.
Pambuyo jakisoni, kuyabwa kapena kutupa, kupweteka kumatha kuchitika. Ngati chithandizo cha mankhwala chimatenga nthawi yayitali, lipodystrophy imapangidwa.

Pankhani imeneyi, kumayambiriro kwa chithandizo, chithandizo cha insulin chitha kuchitika pokhapokha poikidwa ndi dokotala komanso moyang'aniridwa.

Mlingo wowonjezera

Pankhani ya kuyambitsa kuchuluka kwa mankhwala, wodwalayo amatha kuwona zizindikiro za hypoglycemia. Poterepa, muyenera kudya chidutswa cha shuga kapena zakudya zopatsa mphamvu yamafuta ambiri. Itha kukhala ma cookie, madzi a zipatso, maswiti.

Kuyambitsa Isofan kwambiri kungachititse kuti musamale kwambiri. Ndikulimbikitsidwa kuti mupeze jakisoni wambiri wa 40% dextrose solution. Glucagon imatha kutumikiridwa intramuscularly, kudzera m'mitsempha kapena mozungulira.

Kuchita zamtanda

Malangizo ogwiritsira ntchito mankhwalawa amafotokozera mwatsatanetsatane mawonekedwe a mankhwalawo komanso mawonekedwe ake ogwiritsira ntchito.

Kapangidwe kamtundu wamtundu wa Isofan ndikogwira ntchito ngati mankhwala otsatirawa atengedwa nthawi yomweyo:

Hypoglycemic pamlomo wothandizira.
Mao ndi ACE zoletsa, carbonic anhydrase.
Sulfonamides.
Anabolikov.
Tetracyclines.
Mankhwala okhala ndi ethanol.

Kuchita kwa Isofan kumachepa mukamagwiritsa ntchito: Kulera kwapakamwa, mankhwala a glucocorticoid, mahomoni a chithokomiro, antidepressants, morphine. Ngati sizotheka kusiya mankhwala omwe amakhudza insulin, ndikofunikira kuchenjeza adokotala omwe akupezekapo.

Mankhwala ofanana

Odwala a shuga ali ndi chidwi chofunsa funso lomwe limatanthawuza insulin. Ndikulimbikitsidwa kugwiritsa ntchito fanizo lotsatira la Isofan pochiza: Humulin (NPH), Protafan-NM, Protafan-NM Penfill, Insumal, Actrafan.

Musanasinthe Isofan kukhala analog, ndikofunikira kufunsa dokotala. Mankhwala a insulin ndi chithandizo chachikulu. Zimafunikira kulangidwa ndi wodwalayo komanso zomwe dokotala akuwona.