Insulin glargine

Insulin glargine ndi analogue ya insulin ya anthu, yomwe imapangidwanso pogwiritsa ntchito DNA ya mabakiteriya amtundu wa Escherichia coli (unasi wa K12). Insulin glargine, yolumikizana ndi ma insulin receptors enieni (omanga magawo ofanana ndi a insulin yaumunthu), imayimira pakati pokhudzana ndi insulin. Insulin glargine imayang'anira kagayidwe ka glucose. Mankhwalawa amachepetsa kuchuluka kwa shuga m'magazi ndikulimbikitsa kudya kwake ndi matupi amthupi (makamaka minyewa ya adipose ndi minofu yam'magazi) ndikuletsa gluconeogeneis (njira ya kupanga shuga m'magazi). Insulin imathandizira kaphatikizidwe kazakudya zamapuloteni, zimalepheretsa mapuloteni ndi lipolysis mu adipocytes. Mukabayidwa mu subcutaneous mafuta, njira yothetsera insulin glargine imakhala yosasinthika ndipo microprecipitates imapangidwa, kuchokera mwa iwo mumakhala kutulutsidwa kwamankhwala ochepa, izi zimatsimikizira kutalika kwakanthawi ndikuwonetseratu, kosalala kwa nthawi yokhazikika. Pafupifupi ola limodzi, machitidwewo amakula ndi subcutaneous makonzedwe a mankhwala. Nthawi yayitali yochita ndi tsiku limodzi, pazofika maola 29. Pakadutsa masiku awiri kapena anayi pambuyo pa gawo loyamba m'magazi, kuphatikiza kwakukulu kumachitika. Poyerekeza ndi insulin-isofan, insulin glargine imatha kuyamwa pang'onopang'ono komanso nthawi yayitali, ndipo insulin glargine ilibe chidwi kwambiri. Mwa munthu wopeza mafuta ochepa, insulin glargine yochokera kumapeto a bokosi lamtundu wa B imasweka pang'ono ndipo ma metabolites omwe amapanga amapangika: 21A-Gly-insulin (M1) ndi 21A-Gly-des-30B-Thr-insulin (M2). Ma insulin glargine osasinthika ndi zinthu zake zowonongeka zimapezeka mu seramu yamagazi. Mutagenicity wa insulin glargine pakuyesedwa kwa chromosome aberration (mu vivo mu Chinese hamster, cytogenetic in vitro pa maselo V79), pamayeso angapo (kuyesa ndi hypoxanthine-guanine phosphoribosyltransferase ya maselo aku mamalia, mayeso a Ames), sanapezeke. Carcinogenicity ya insulin glargine idaphunziridwa mu makoswe ndi mbewa, zomwe zimalandira 0,455 mg / kg (pafupifupi nthawi 10 ndi 5 panjira ya anthu akapatsidwa subcutaneally) kwa zaka ziwiri. Zotsatira za kafukufukuyu sizinatilole kufikitsa pamalingaliro omaliza okhudza mbewa zazimayi chifukwa cha kufa kwakukulu m'magulu onse, ngakhale atakhala ndi mlingo wotani. Histiocytomas adapezeka pamalo opangira jakisoni mu mbewa zachimuna (osati zowerengeka) m'makola amphongo (ofunikira kwambiri) komanso akamagwiritsa ntchito zosungunulira za asidi. Zotupa zoterezi sizinapezeke mu nyama zazimayi pomwe insulini imasungunuka mu zosungunulira zina kapena pamene mchere wamchere unagwiritsidwa ntchito. Kwa anthu, tanthauzo lazowonera izi sizikudziwika. Mu maphunziro a chonde, m'maphunziro a pambuyo ndi pregatal mu makoswe achimuna ndi amuna omwe ali ndi subcutaneous makonzedwe a mankhwala Mlingo womwe umakhala pafupifupi kasanu ndi kawiri nthawi yomwe amalimbikitsidwa kuyambitsa kumwa kwa subcutaneous makonzedwe a anthu, chifukwa cha matenda oopsa a amayi, kuphatikiza angapo amafa.

Matenda a shuga, omwe amafunikira mankhwala a insulin, mwa odwala omwe ali ndi zaka zopitilira 6.

Kupanga ndi mawonekedwe a kumasulidwa

m'mabotolo a 10 ml (100 IU / ml), mu paketi ya makatoni 1 botolo kapena makatoni a 3 ml, mu paketi ya matuza 5 makatoni, mumapaketi a makatoni 1 a blister pack, kapena 1 cartridge of 3 ml mu system ya OptiKlik cartridge ", Mu phukusi la makatoni 5 a katoni

Mlingo wa insulin glargine ndi mlingo

Insulin glargine imabayidwa subcutaneous m'madzi onunkhira am'mapewa, pamimba kapena ntchafu, 1 nthawi patsiku nthawi imodzi. Ndi makonzedwe atsopano aliwonse, mawebusayiti amafunika kusintha m'malo omwe analimbikitsidwa. Nthawi ya tsiku ndi mlingo wa makonzedwe amakhazikitsidwa payokha. Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, mankhwalawa angagwiritsidwe ntchito onse mu mawonekedwe a monotherapy, komanso pamodzi ndi mankhwala ena a hypoglycemic.
Mitsempha yoyeserera yokhazikika ya mlingo, womwe umapangidwira kukonzekera kwa mankhwalawa, imatha kuyambitsa kwambiri hypoglycemia. Insulin glargine sayenera kutumikiridwa kudzera mkati, popeza nthawi yochitapo imachitika chifukwa cha kuyambitsa kwake minofu yamafuta ochepa.
Mukasinthira njira ya insulin kapena yotalikira kapena yayitali, mungafunike kusintha njira yotsikira ya insalini komanso ma antidiabetic chithandizo (makonzedwe a mankhwalawa komanso Mlingo wa ogwiritsira ntchito insulin kapena milingo ya othandizira pakamwa). Posamutsa odwala kuchokera ku makonzedwe a insulin-isofan 2 kawiri pa tsiku kuti akwaniritse insulin glargine kamodzi patsiku, kuti achepetse vuto la usiku ndi m'mawa hypoglycemia, ndikofunikira kuchepetsa mlingo woyambira wa insulin ndi 20-30% m'milungu yoyamba ya mankhwala. Mlingo wa insulin yocheperako utha kuwonjezereka panthawi ya kuchepetsa, ndiye kuti muyezo wa mankhwalawo uyenera kusinthidwa payekhapayekha. Mukasinthana ndi insulin glargine komanso milungu yoyamba itatha, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi.
Ndi bwino kagayidwe kachakudya ndi kuchuluka kwa insulin chiwopsezo, kusintha kwa mankhwala kungafunikire. Kuwongolera kwa dose kungafunikenso, mwachitsanzo, pakusintha momwe wodwalayo alili, kulemera kwa thupi, nthawi ya tsiku yoperekera mankhwala, ndi zochitika zina zomwe zimawonjezera chiopsezo chokhala ndi hyper- kapena hypoglycemia.
Insulin glargine si mankhwala osankhidwa pochizira matenda ashuga ketoacidosis (mu nkhani iyi, kulowetsedwa kwa insulin yochepa ndikulimbikitsidwa).
Zomwe timagwiritsa ntchito mankhwalawa ndizochepa, motero palibe njira yowunika chitetezo chake komanso momwe amathandizira odwala omwe ali ndi vuto laimpso kapena kwa chiwindi. Odwala ndi mkhutu aimpso ntchito, kufunika kwa insulini kumachepa chifukwa chakufooka kwa njira zake zodziwirira. Kwa odwala okalamba, kuwonongeka kwa pang'onopang'ono mu ntchito ya impso kungapangitse kuchepa kosafunikira kwa insulin. Odwala omwe ali ndi vuto lalikulu la chiwindi, kufunikira kwa insulin kungachepe chifukwa kuchepa kwa kuthekera kwa biotransfform ya insulin ndi gluconeogeneis. Ngati kuchuluka kwa shuga m'magazi sikugwira ntchito, ngati pali vuto loti mukhale ndi hyper- kapena hypoglycemia, musanasinthe Mlingo wa mankhwalawa, ndikofunikira kuyang'ana njira yopangira jakisoni wothandiziratu, kulondola kwa kutsata njira yolembetsedwera ndi malo othandizira mankhwalawa, poganizira zinthu zonse zomwe zikugwirizana ndi vutoli.
Mbiri ya phukusi lomwe limayikidwa limakhudza nthawi ya hypoglycemia, kotero imatha kusintha ndikusintha kwa mankhwalawa. Chifukwa cha kuchuluka kwa nthawi yomwe imatenga kuti insulini ichite kwa nthawi yayitali mukamagwiritsa ntchito Lantus, chiopsezo chokhala ndi hypoglycemia usiku chimachepa, pomwe m'mawa chiwopsezochi chikuwonjezeka. Odwala omwe hypoglycemia imakhala yofunikira kwambiri (stenosis yamitsempha ya ubongo kapena mitsempha ya m'mimba, proliferative retinopathy) amafunika njira zapadera zotetezera, ndipo tikulimbikitsidwa kukulitsa kuchuluka kwa shuga m'magazi. Odwala ayenera kudziwa momwe zinthu zomwe zimayambira ku hypoglycemia zingathenso kuchepa, kusintha kapena kusapezeka, kuphatikiza odwala omwe apititsa patsogolo kayendedwe ka shuga, odwala okalamba, odwala omwe hypoglycemia ikukula pang'onopang'ono, odwala omwe ali ndi nthawi yayitali ya matenda a shuga neuropathy, odwala omwe ali ndi vuto lamaganizidwe, odwala omwe amalandila chithandizo chofanana ndi mankhwala ena. Izi zimatha kuyambitsa kwambiri hypoglycemia (ndikulephera kudziwa) ngakhale wodwala asanadziwe kuti akupanga hypoglycemia.
Ndikofunikira kuganizira za kuopsa kwa zochitika zina za hypoglycemia (makamaka usiku) mukazindikira kuchepa kwa hemoglobin yochepetsedwa kapena yokhazikika.
Kuthana ndi odwala zakudya, zakudya, regimen, kugwiritsa ntchito moyenera mankhwalawa, kuwongolera kwa zizindikiro za hypoglycemia kumathandizira kuchepetsa kwambiri chiopsezo cha hypoglycemia. Zinthu zomwe zimawonjezera kukonzekera kwa hypoglycemia zimafunikira kuwunikira mosamala, chifukwa zingayambitse kufunika kwa kusintha kwa mankhwala. Zinthu zotere ndi monga: kuwonjezeka kwa insulin sensitivity (pochotsa nkhawa), kusintha kwa malo a insulin, osadziwika, otenga nthawi yayitali kapena kuwonjezereka zolimbitsa thupi, kuphwanya zakudya ndi zakudya, matenda omwe amayenderana ndi matenda otsegula m'mimba, kusanza, kudya mosadukiza, endocrine zovuta (kuperewera kwa adrenal cortex kapena adenohypophysis, hypothyroidism), kumwa mowa, kugwiritsa ntchito mankhwala ena.
Kwambiri kuwongolera ndende ya magazi m'magazi amafunikira limodzi matenda. Nthawi zambiri, kuyesedwa kwamatumbo kuti mupeze matupi a ketone ndikusinthidwa pafupipafupi kwa mankhwalawa. Nthawi zambiri kumawonjezera kufunika kwa insulin. Odwala omwe ali ndi matenda amtundu woyamba a shuga ayenera kupitiliza kudya kawirikawiri mafuta pang'ono, ngakhale kuti sangadye konse kapena amatha kudya zakudya zochepa chabe (ndikusanza ndi zina zotero). Odwala oterowo sayenera kusiya kuperekera insulin.

Mimba komanso kuyamwa

Maphunziro a Teratogenicity ndi kubereka adachitidwa mu akalulu a Himalayan ndi makoswe omwe ali ndi subcutaneous insulin (insulin yokhazikika ya anthu ndi insulin glargine). Akalulu anali kulowetsedwa ndi insulin nthawi ya cosanogenesis pa Mlingo wa 0,072 mg / kg patsiku (pafupifupi kawiri njira yoyenera yoyambira ya anthu omwe ali ndi subcutaneous makonzedwe). Makoswe achimuna adalowetsedwa ndi insulin isanayambike komanso nthawi yomwe akukula, panthawi yopakati pamankhwala mpaka 0,36 mg / kg patsiku (pafupifupi nthawi zisanu ndi ziwiri yolimbikitsidwa poyambira kwa anthu omwe ali ndi ma subcutaneous management) Mwambiri, zomwe zimachitika ndi insulin komanso insulin glargine mwa nyama izi sizinasiyane. Palibe kuwonongeka kwa kuyambitsidwa koyambirira kwa ubala komanso kubereka sikunadziwike.
Kwa odwala omwe ali ndi matenda ashuga kapena omwe kale anali ndi matenda osokoneza bongo, ndikofunikira kuyang'anira machitidwe a metabolic panthawi yoyenera. Mu trimester yoyamba ya mimba, kufunika kwa insulini kumatha kuchepa ndikuwonjezeka panthawi yachiwiri komanso yachitatu. Kufunika kwa insulin mukangobadwa kumene kumachepera msanga (chiopsezo cha hypoglycemia chimakulanso). Chifukwa chake, munthawi imeneyi ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi.
Pa nthawi yoyembekezera, ndikofunikira kugwiritsa ntchito mankhwalawa mosamala (mwa amayi apakati, maphunziro owongolera mosamalitsa sanachitidwe).
Gwiritsani ntchito mankhwalawa mosamala mukamayamwitsa (sizikudziwika ngati insulin glargine imayamwa mkaka wa amayi). Kuwongolera zakudya ndi insulin dosing regimen ingafunike mwa amayi oyamwitsa.

Zotsatira zoyipa za insulin glargine

Hypoglycemia ndizovuta kwambiri chifukwa chomwa mankhwala a insulin, amatha kuchitika pogwiritsa ntchito mlingo waukulu wa insulin poyerekeza ndi kufunika kwake. Hypoglycemia yayikulu (makamaka kubwereza) imatha kuwononga dongosolo lamanjenje. Hypoglycemia yomwe imakhalapo kwa nthawi yayitali ingawononge moyo wa odwala. Zizindikiro za adrenergic anti-regulation (poyankha hypoglycemia, kutsegula kwa dongosolo la sympathoadrenal) nthawi zambiri zimawonekera pamaso pamavuto amanjenje ndi psyche panthawi ya hypoglycemia (matenda opatsirana, kutaya chikumbumtima kapena kugona kwa tulo): kukwiya, tachycardia, thukuta lozizira (amatanthauzika kwambiri ndi hypoglycemia yofunika kwambiri komanso yopanga mofulumira).
Monga momwe zilili ndi kukonzekera kwa insulini, kuchepa kwa insulin kufinya ndi lipodystrophy kumatha kuchitika pamalo operekera jakisoni. Panthawi ya mayesero azachipatala pogwiritsa ntchito insulin glargine mu 1 - 2% ya odwala, lipodystrophy yapezeka, ndipo lipoatrophy sanadziwike konsekonse. Kusintha kosalekeza kwa jekeseni mkati mwa thupi komwe kumalimbikitsidwa pakumwa mankhwala kungachepetse kuopsa kwa mbali iyi kapena kupewa.
Kusintha kwa kaphatikizidwe ka glucose m'magazi kungayambitse kuwonongeka kwakanthawi chifukwa cha kusintha kwa mndandanda wa mandala amaso ndi minyewa ya m'maso. Yaitali matenda a shuga ndende amachepetsa chiopsezo cha matenda ashuga retinopathy. Kugwiritsira ntchito insulin, komwe kumayendetsedwa ndi kusinthasintha kwakuthwa m'magazi a shuga, kumatha kubweretsa kuchepa kwakanthawi mthupi la matenda ashuga retinopathy. Odwala omwe amatha kupatsirana retinopathy, makamaka omwe salandira chithandizo cha photocoagulation, kwambiri hypoglycemia imatha kuyambitsa masomphenya.
Pa mayesero azachipatala ndikugwiritsa ntchito insulin glargine 3 mpaka 4% ya odwala, zimachitika zimawonedwa pamalowo jekeseni (redness, kuyabwa, kupweteka, urticaria, kutupa, edema). Zochita zambiri zazing'ono zimathetsedwa m'masiku ochepa - masabata angapo. Nthawi zambiri, insulini (kuphatikizapo insulin glargine) kapena operekera msanga amakhala ndi vuto loti siligwirizana (kuphatikiza khungu, bronchospasm, angioedema, ochepa hypotension kapena mantha), zomwe zimawopseza moyo wa wodwalayo.
Kugwiritsa ntchito insulin kungayambitse kupanga kwa antibodies kwa izo. Pa maphunziro azachipatala m'magulu a odwala omwe adalandira insulin glargine ndi insulin-isophan mankhwala, mapangidwe a antibodies omwe amayambitsidwa ndi insulin ya anthu amawonedwa pafupipafupi. Nthawi zina, pamaso pa antibodies ku insulin, kusintha kwa mankhwalawa ndikofunikira kuti muchepetse chizolowezi chopanga hyper- kapena hypoglycemia. Nthawi zina, insulini ingayambitse kuchepa kwa zotupa za sodium ndi zotupa, makamaka ngati kumwa insulini kumapangitsa kuti kagayidwe kake kazikhala bwino, komwe kale kanali kosakwanira.

Kuchita kwa insulin glargine ndi zinthu zina

Insulin glargine ndiyosagwirizana ndi mankhwala ena. Insulin glargine sayenera kusakanikirana ndi ma insulin ena kapena kuchepetsedwa (kuchepetsedwa kapena kusakaniza kungasinthe mbiri ya insulin glargine pakapita nthawi, komanso kusakanikirana ndi ma insulin ena kungayambitse mpweya).Mankhwala ena amagwiritsa ntchito kagayidwe kakang'ono ka shuga; izi zingafune kusintha kwa insulin glargine. Kukonzekera komwe kumapangitsa hypoglycemic zotsatira za insulin ndikuwonjezera kudziwikiratu kwa chitukuko cha hypoglycemia kumaphatikizapo angiotensin kutembenuza ma enzyme inhibitors, pakamwa hypoglycemic othandizira, fibrate, disopyramide, fluoxetine, pentoxifylline, monoamine oxidase inhibitors, propoxyphene, sulfanilamides. Zomwe zimafooketsa mphamvu ya hypoglycemic ya insulin imaphatikizapo danazol, glucocorticoids, diazoxide, glucagon, diuretics, isoniazid, gestagens, estrogens, somatotropin, mahomoni a chithokomiro, sympathomimetics (salbutamol, epinephrine, terbutaline inhibolaseasein, phenolutinasease. Clonidine, beta-blockers, mowa, mchere wa lithiamu ungathe kufooketsa ndikuwonjezera mphamvu ya hypoglycemic ya insulin. Pentamidine imatha kuyambitsa hypoglycemia, ndipo nthawi zina imatsatiridwa ndi hyperglycemia. Mothandizidwa ndi mankhwala okhala ndi mtima wachifundo (clonidine, beta-blockers, reserpine, guanfacine), zizindikiro za kutsutsana ndi adrenergic zitha kukhala kuti kulibe kapena kuchepetsedwa.

Bongo

Ndi mankhwala osokoneza bongo ambiri a insulin, glargine imayamba kukhala wamphamvu kwambiri komanso nthawi yayitali, yomwe imawopseza moyo wa wodwalayo. Chithandizo: Hypoglycemia wolimbitsa mtima nthawi zambiri amathandizira kugaya chakudya m'magazi, zimatha kusintha kusintha kwamankhwala, ntchito zolimbitsa thupi, kudya, hypoglycemia, yomwe imayendetsedwa ndi chikomokere, minyewa yamitsempha, kukomoka, kumafuna kulowetsedwa kapena kukhazikika kwa makonzedwe a glucagon. kudya kwa nthawi yayitali chakudya chamagulu ndi kuyang'aniridwa kuchipatala kungafunike, popeza pambuyo pachipatala chowoneka kuyambiranso kwa hypoglycemia ndikotheka.

Kugwiritsa ntchito mankhwala a insulin glargine

Mlingo umayikidwa payekha. Amatumizidwa s / c kamodzi patsiku, nthawi zonse nthawi imodzi. Insulin glargine iyenera kuphatikizidwa ndi mafuta ochulukitsa a m'mimba, phewa kapena ntchafu. Maselo a jakisoni amayenera kusinthana ndi mtundu uliwonse wa mankhwala. At shuga yodalira matenda a shuga mankhwalawa amagwiritsidwa ntchito ngati insulin yayikulu. At shuga yosadalira insulin (mtundu II) mankhwalawa angagwiritsidwe ntchito ngati monotherapy, komanso kuphatikiza mankhwala ena a hypoglycemic. Posamutsa wodwala kuchokera ku insulin yokhala ndi nthawi yayitali kapena yapakati pa insulin glargine, pangafunikire kusintha tsiku ndi tsiku insulin kapena kusintha lingaliro la antidiabetic mankhwala (Mlingo ndi mawonekedwe a makonzedwe achidule a insulin kapena mayendedwe awo, komanso Mlingo wa mankhwala osokoneza bongo). Makamaka insulin-isofan ngati jekeseni imodzi ya insulin glargine iyenera kuchepetsa tsiku ndi tsiku la insulin ndi 20-30% milungu yoyamba kumwa madzi kuti muchepetse chiopsezo cha hypoglycemia usiku ndi m'mawa kwambiri. Munthawi imeneyi, kuchepa kwa insulin glargine kuyenera kulipiriridwa ndi kuwonjezeka kwa Mlingo waifupi wa insulin.

Mankhwala

Kulumikizana ndi insulin receptors: magawo omangirizira enieni a insulin glargine ndi ma insulin receptor a anthu ali pafupi kwambiri, ndipo amatha kuyanjana ndi kwachilengedwenso zotsatira zofanana ndi insulin.

Chochita chofunikira kwambiri cha insulini, motero insulin glargine, ndikuyang'anira kagayidwe ka shuga. Insulin ndi mawonekedwe ake amachepetsa shuga m'magazi ndikulimbikitsa kukoka kwa glucose pogwiritsa ntchito zotumphukira (makamaka mafupa a minofu ndi adipose minofu), komanso kuletsa mapangidwe a shuga mu chiwindi (gluconeogenesis). Insulin imalepheretsa adipocyte lipolysis ndi proteinol, pamene ikupanga kuphatikiza mapuloteni.

Kutalika kwa nthawi ya kuchitira insulin glargine kumakhudzana makamaka ndi kuchepetsedwa kwa mayamwidwe ake, omwe amalola kuti mankhwalawa azigwiritsidwa ntchito kamodzi patsiku. Pambuyo pa utsogoleri wa sc, kuyamba kwa zochita kumachitika, pafupifupi, pambuyo pa ola 1. Nthawi yayitali yochita ndi maola 24, okwera ndi maola 29.

Pharmacokinetics

Kafukufuku wofananira wa kutsindika kwa insulin glargine ndi insulin-isofan mumadzi a seramu mwa anthu athanzi komanso odwala omwe ali ndi matenda osokoneza bongo pambuyo pa sc pakumwa mankhwala adawonetsa kuyamwa pang'onopang'ono komanso kwa nthawi yayitali, komanso kusapezeka kwa nsonga ya kuchuluka kwa insulin glargine poyerekeza ndi insulin-isofan .

Ndi kamodzi kwa kayendetsedwe ka Lantus kamodzi patsiku, khola la insulin glargine m'magazi limafikiridwa patatha masiku 2 - 2 pambuyo pa kumwa koyamba.

Ndi makina a iv, theka la moyo wa insulin glargine ndi insulin ya anthu anali wofanana.

Mwa munthu wopeza mafuta ochepa, insulin glargine imachotsedwa pang'ono kuchokera kumapeto kwa carboxyl (C-terminus) ya B chain (Beta unyolo) kupanga 21 A -Gly-insulin ndi 21 A -Gly-des-30 B -Thr-insulin. Mu plasma, onse insulin glargine osasinthika ndi zopangidwa ndi cleavage zilipo.

Mlingo ndi makonzedwe

S / c mu mafuta opindika a pamimba, phewa kapena ntchafu, nthawi zonse nthawi imodzi 1 patsiku. Masamba a jakisoni amayenera kusinthana ndi jakisoni aliyense watsopano m'malo omwe akutsimikizidwira mankhwala a sc.

Mu / pakubweretsa njira yanthawi zonse, yolimbikitsidwa ndi sc, kungayambitse kukula kwa hypoglycemia.

Mlingo wa Lantus ndi nthawi yakatsiku lakukhazikitsidwa kwake amasankhidwa payekha. Odwala omwe ali ndi matenda a shuga a 2 mtundu, Lantus angagwiritsidwe ntchito ngati monotherapy komanso kuphatikiza mankhwala ena a hypoglycemic.

Kusintha kuchokera ku chithandizo ndi mankhwala ena a hypoglycemic kupita ku Lantus. Mukalowetsa pakati kapena pakakhala nthawi yayitali mankhwala a insulin, mungafunike kusintha tsiku ndi tsiku insulin, komanso mungafunike kusintha njira yothandizirana ndi antidiabetesic mankhwala (ma doses ndi makonzedwe a makina ogwiritsira ntchito mankhwala osokoneza bongo osakanikirana kapena kufananiza kwa mankhwala osokoneza bongo. ) Posamutsa odwala kuti ayambe kutumiza insulin-isophan kawiri masana kupita kuntchito imodzi ya Lantus kuti muchepetse chiopsezo cha hypoglycemia usiku ndi m'mawa kwambiri, mlingo woyambira wa insulin uyenera kuchepetsedwa ndi 20-30% m'milungu yoyamba yamankhwala. Munthawi yochepetsera mlingo, mutha kuwonjezera kuchuluka kwa insulin yochepa, kenako, mankhwalawa ayenera kusintha mosiyanasiyana.

Lantus sayenera kusakanikirana ndi insulin ina yokonzekera kapena kuchepetsedwa. Mukasakanikirana kapena kuchepetsedwa, mawonekedwe amachitidwe ake amatha kusintha pakapita nthawi, kuphatikiza, kusakanikirana ndi ma insulin ena kungayambitse mpweya.

Monga ma fanizo ena a insulin yaumunthu, odwala omwe amalandira Mlingo wambiri wa mankhwala chifukwa cha kupezeka kwa antibodies kwa insulin ya anthu amatha kupeza kusintha poyankha insulin pamene akusintha kupita ku Lantus.

Mukasinthira ku Lantus komanso milungu yoyamba itatha, kuyang'anira shuga wamagazi ndikofunikira.

Pofuna kusintha kwa kagayidwe kazinthu komanso kuwonjezereka kwa chidwi cha insulin, kuwongolera kwina kwa mankhwalawa kungakhale kofunikira. Kusintha kwa magazi kungafunikenso, mwachitsanzo, pakusintha kulemera kwamthupi la wodwala, moyo, nthawi ya tsiku yoperekera mankhwala, kapena pachitika zina zomwe zimawonjezera kukonzekera kwa hypo- kapena hyperglycemia.

Mankhwala sayenera kuperekedwa kwa iv. Kutalika kwa zochita za Lantus ndi chifukwa cha kukhazikitsidwa kwa minofu yaying'ono ya adipose.

Malangizo apadera

Lantus si mankhwala osankhidwa pochiza matenda ashuga a ketoacidosis. Zikatero, iv ikulimbikitsidwa kuti ikhale ndi insulin yochepa. Chifukwa chazocheperako ndi Lantus, sizinali zotheka kuwunika kuti magwiridwe ake ndi otetezeka pochiza odwala omwe ali ndi vuto la chiwindi kapena odwala omwe ali ndi vuto lochepa kwambiri kapena laimpso. Odwala omwe ali ndi vuto laimpso, kufunika kwa insulini kumatha kuchepa chifukwa chakufooka kwa njira zake zowonongera. Mwa odwala okalamba, kuwonongeka kwa pang'onopang'ono mu ntchito ya impso kungayambitse kuchepa kwamphamvu kwa zofunikira za insulin. Odwala omwe ali ndi vuto lalikulu la kuchepa kwa hepatic, kufunika kwa insulin kumatha kuchepetsedwa chifukwa cha kuchepa kwa mphamvu ya gluconeogeneis ndi biotransfform ya insulin. Pankhani yoyendetsa bwino magazi pamagazi, komanso ngati pali chizolowezi chomanga matenda a hypo- kapena hyperglycemia, musanapitirize kukonza mankhwala, ndikofunikira kuwunika kulondola kwa kutsata njira, njira zoyendetsera mankhwalawa ndi njira ya jekeseni yothandiza, poganizira zinthu zonse zomwe zikugwirizana ndi vutoli.

Hypoglycemia. Nthawi ya kukonzekera kwa hypoglycemia zimatengera mawonekedwe a omwe amagwiritsidwa ntchito chifukwa cha insulin, motero, angasinthe ndikusintha kwa regimen yothandizira. Chifukwa cha kuchuluka kwa nthawi yomwe zimatenga nthawi kuti munthu akhale ndi insulin yayitali kulowa mthupi pogwiritsa ntchito Lantus, mwayi wokhala ndi nocturnal hypoglycemia umachepa, pomwe m'mawa izi zitha kuchuluka. Odwala omwe ma episode a hypoglycemia amatha kukhala ndi vuto la matenda, monga odwala omwe ali ndi vuto lalikulu la mitsempha ya m'mimba kapena mitsempha ya m'magazi (chiopsezo cha matenda a mtima ndi matenda a hypoglycemia), komanso odwala omwe akukhala ndi prinifosic prinogathy. kuchepa kwamono kwakanthawi chifukwa cha hypoglycemia), kusamalitsa kwapadera kuyenera kuonedwa, komanso kumalimbikitsidwanso kukulitsa kuwunika kwa magazi. Odwala ayenera kudziwa momwe zinthu zomwe zimasinthira hypoglycemia zimasinthira, kukhala osatchulika kapenanso kusapezeka m'magulu ena omwe ali pachiwopsezo. Maguluwa akuphatikizapo:

- odwala omwe asintha kwambiri magazi a shuga,

- odwala omwe hypoglycemia imayamba pang'onopang'ono,

- odwala okalamba,

- odwala neuropathy,

- odwala omwe ali ndi shuga yayitali,

- odwala omwe ali ndi mavuto amisala,

- odwala omwe amalandila chithandizo chamankhwala ena ndi ena (onani "Kuyanjana").

Zochitika zoterezi zimatha kuyambitsa kukula kwa hypoglycemia (kutayika kwa chikumbumtima) wodwalayo asanadziwe kuti akupanga hypoglycemia.

Ngati kuchuluka kwa kuchepa kwa khungu kapena kuchepa kwa khungu kwa khungu kwa glycosylated hemoglobin kumadziwika, ndikofunikira kulingalira za mwayi wokhala ndi zigawo za hypoglycemia zomwe zimachitika mobwerezabwereza (makamaka usiku).

Kutsatira kwa odwala ndi dongosolo la dosing, zakudya ndi zakudya, kugwiritsa ntchito bwino insulini komanso kuwongolera kuyambika kwa zizindikiro za hypoglycemia kumathandizira kuchepetsa kwambiri chiopsezo cha hypoglycemia. Zinthu zomwe zimawonjezera kukonzekera kwa hypoglycemia zimafunikira kuwunikira mosamala, monga angafunikire kusintha kwa insulin. Izi ndi monga:

- kusintha kwa oyang'anira a insulin,

- kuchuluka kwa chidwi ndi insulin (mwachitsanzo, mukamachotsa kupsinjika),

- zachilendo, kuchuluka kapena zolimbitsa thupi nthawi yayitali,

- Matenda oyenda limodzi ndi kusanza, kutsekula m'mimba,

- kuphwanya zakudya ndi zakudya,

- kudumphika chakudya

- mavuto ena a endocrine osawerengeka (mwachitsanzo, hypothyroidism, kusakwanira kwa adenohypophysis kapena adrenal cortex),

- chithandizo chofanana ndi mankhwala ena.

Matenda apakati. Pa matenda oyanjana, kuwunika kwambiri shuga pamafunika. Mwambiri, kusanthula kumachitika kuti pakhale matupi a ketone mumkodzo, ndipo insulin dosing imafunikira nthawi zambiri. Kufunika kwa insulin nthawi zambiri kumachuluka. Odwala omwe ali ndi matenda amtundu woyamba a shuga ayenera kupitiliza kudya zakudya zochepa, ngakhale atha kudya pang'ono kapena sangathe kudya, ngati akusanza, ndi zina zambiri. Odwala awa sayenera kusiya kuperekera insulin.

Zotsatira zoyipa za mankhwala a insulin glargine

Zokhudzana ndi zotsatira zama metabolism a carbohydrate: machitidwe a hypoglycemic (tachycardia, kutuluka thukuta, pallor, njala, kusakwiya, kusakhazikika kwa matenda, kusokonezeka kapena kusokonezeka kwa chikumbumtima). Zomwe zimachitika: lipodystrophy (1-2%), kutupa kwa khungu, kuyabwa, kutupa m'malo a jekeseni. Zotsatira zoyipa: urticaria, edema ya Quincke, bronchospasm, ochepa hypotension, mantha. Zina: zolakwika zoyenda pang'onopang'ono, kupitirira kwa matenda ashuga (kusintha kwa shuga m'magazi), edema. Zochita zazing'ono zomwe zimapezeka malo a jakisoni zimathekedwa pakatha masiku angapo (masabata angapo) kuyambira pakuyamba chithandizo.

Zochita ndi mankhwala a insulin glargine

Mphamvu ya hypoglycemic ya insulin imapangidwira ndi ma inhibitors a MAO, mankhwala osokoneza bongo a hypoglycemic, ACE inhibitors, fibrate, disopyramides, fluoxetine, pentoxifylline, propoxyphene, salicylates ndi sulufanilamides. , somatotropin, sympathomimetics ndi mahomoni a chithokomiro. Clonidine, β-adrenergic blockers, saltamu ndi ethanol zimatha kutsitsa ndikuchepetsa mphamvu ya hypoglycemic.Pentamidine imatha kuyambitsa hypoglycemia, yomwe nthawi zina imabweretsa hyperglycemia. adrenergic kutsutsana mwina kuchepetsedwa kapena kulibe.