Detemir: malangizo, ndemanga, kugwiritsa ntchito insulin

Pakadali pano, kuchuluka kwa mankhwala kumathandizira ngakhale pakakhala zovuta zazikulu zaumoyo kuti mukhalebe ndi moyo wabwino. Mankhwala amakono amabwera kudzakuthandizani. Matenda a shuga ophatikizika tsopano ndi matenda omwe amapezeka pafupipafupi, koma ndi matenda ashuga mutha kukhala moyo ndikugwira ntchito moyenera. Anthu omwe akudwala matenda amtundu 1 ndi mtundu wachiwiri sangathe popanda analogi ya insulin. Ngati zolimbitsa thupi ndi kudya moyenera sizilola matenda a shuga, ndiye kuti Detemir insulin amawathandiza. Koma musanagwiritse ntchito mankhwalawa, wodwala matenda ashuga ayenera kumvetsetsa mafunso ofunikira: momwe angagwiritsire ntchito bwino mahomoni pomwe ndizosatheka kuzigwiritsa ntchito komanso zomwe zingawonetse bwanji?

Insulin "Detemir": malongosoledwe a mankhwala

Mankhwalawa amapezeka mu mawonekedwe a mtundu wopanda mawonekedwe. Mu 1 ml yake mumakhala chinthu chachikulu - insulin detemir 100 PESCES. Kuphatikiza apo, pali zina zowonjezera: glycerol, phenol, metacresol, zinc acetate, sodium hydrogen phosphate dihydrate, sodium chloride, hydrochloric acid q.s. kapena sodium hydroxide q.s., madzi a jakisoni mpaka 1 ml.

Mankhwalawa amapezeka mu cholembera, momwe muli 3 ml yankho, kufanana kwa 300 PIECES. 1 unit ya insulin imakhala ndi 0,142 mg ya insulin determir yopanda mchere.

Kodi Detemir amagwira ntchito bwanji?

Detemir insulin (dzina lamalonda ndi Levemir) limapangidwa pogwiritsa ntchito biombodic deoxyribonucleic acid (DNA) ya recombinant deicogionicic (DNA) pogwiritsa ntchito mtundu wina wotchedwa Saccharomyces cerevisiae. Insulin ndiye gawo lalikulu la Levemir flekspen ndipo ndi chithunzi cha mahomoni aumunthu omwe amamangilira zotumphukira maselo a cell ndikupanga njira zonse zachilengedwe. Zili ndi zovuta zingapo mthupi:

• imalimbikitsa kugwiritsa ntchito shuga ndi zotumphukira zimakhala ndi ma cell,
• amalamulira kagayidwe kazakudya,
• timaletsa gluconeogenesis,
• kumawonjezera kapangidwe kazakudya zomanga thupi,
• imalepheretsa lipolysis ndi proteinolysis m'maselo a mafuta.

Ndili othokoza chifukwa chowongolera machitidwe onsewa omwe magazi a magazi amachepa. Pambuyo pakukhazikitsa mankhwala, zotsatira zake zazikulu zimayamba pambuyo pa maola 6-8.

Ngati mumalowetsa kawiri patsiku, ndiye kuti kuchuluka kwa shuga kokwanira kumatha kupezeka pambuyo pakubayidwa kawiri mpaka katatu. Mankhwalawa ali ndi zotsatira zofananira kwa amayi ndi abambo. Voliyumu yake yogawa pakati ili mkati mwa 0,1 l / kg.

Hafu ya moyo wa insulin, yomwe idalowetsedwa pansi pa khungu, imatengera mlingo komanso pafupifupi maola 5-7.

Zomwe zikuchitika za mankhwala "Detemir"

Detemir insulin (Levemir) imakhala yothandiza kwambiri kuposa zinthu za insulin monga Glargin ndi Isofan. Kukula kwake kwakutali kwa thupi kumachitika chifukwa cha mayanjano odziwika bwino opanga ma cell maselo akafika ndi mbali yamafuta amafuta am'magazi a ma albumin a albumin. Poyerekeza ndi ma insulini ena, amamwazika pang'onopang'ono mthupi lonse, koma chifukwa cha izi, mayamwidwe ake amalimbikitsidwa kwambiri. Komanso, poyerekeza ndi ma analogi ena, Detemir insulin ndiwodziwikiratu, chifukwa chake ndizosavuta kuyang'anira momwe zimakhalira. Ndipo izi ndichifukwa zingapo:

• chinthucho chimakhalabe chamadzi kuyambira pomwe chimakhala chokhala ngati cholembera mpaka kufikira thupi.
• tinthu tating'onoting'ono timalumikizana ndi ma cellcule a albumin mu seramu yamagazi ndi njira yotsatsira.

Mankhwalawa amakhudza kukula kwa maselo ocheperako, zomwe sizinganenedwe za insulini zina. Zilibe ma genotoxic komanso poizoni m'thupi.

Momwe mungagwiritsire "Detemir"?

Mlingo wa mankhwalawa amasankhidwa payekhapayekha kwa wodwala aliyense yemwe ali ndi matenda ashuga. Mutha kulowa kamodzi kapena kawiri pa tsiku, izi zikuwonetsedwa ndi malangizowo. Umboni wogwiritsika ntchito kwa Detemir insulin ntchito umati kuti ukwaniritse kuongolera kwa glycemia, jakisoni amayenera kuperekedwa kawiri pa tsiku: m'mawa ndi madzulo, osachepera maola 12 ayenera kutha pakadutsa.

Kwa okalamba omwe ali ndi matenda a shuga komanso omwe akuvutika ndi vuto la chiwindi ndi impso, mankhwalawa amasankhidwa mosamala kwambiri.

Insulin imalowetsedwa pang'onopang'ono m'khosi, ntchafu ndi dera lanu. Kukula kwa zochita zimatengera komwe mankhwalawo amaperekedwa. Ngati jakisoni wapangidwa m'dera limodzi, ndiye kuti malo opumira amatha kusinthidwa, mwachitsanzo, ngati insulin ingalowetsedwa pakhungu la pamimba, ndiye kuti izi ziyenera kuchitidwa 5 cm kuchokera ku navel komanso mozungulira.

Ndikofunikira kupeza jakisoni moyenera. Kuti muchite izi, muyenera kutenga cholembera ndi kutentha kwa chipinda, antiseptic ndi ubweya wa thonje.

Ndipo tsatirani njirayi motere:

• gwiritsani ntchito malo opumira pogwiritsa ntchito mankhwala osokoneza bongo ndipo lolani kuti khungu liume,
• Khungu limagwidwa ndimisempha,
• singano iyenera kuyikidwira pakona, kenako mbayo ikakoka pang'ono, ngati magazi abwera, chotengera chiwonongeka, malo a jekeseni ayenera kusinthidwa,
• mankhwalawa ayenera kuthandizidwa pang'onopang'ono komanso moyenera, pomwe piston imayenda movutikira, ndipo pamalo opumira khungu limatupa, singano iyenera kuyikiridwa kwambiri,
• pambuyo mankhwala kukonzekera, ndikofunikira kukhala kwa masekondi ena 5, kenako syringe imachotsedwa ndikuyenda kokhazikika, ndipo tsamba la jakisoni limachiritsidwa ndi antiseptic.

Kuti jakisoni asapweteke, singano iyenera kukhala yochepa thupi momwe mungathere, khungu siliyenera kufinyidwa mwamphamvu, ndipo jekeseni iyenera kuchitidwa ndi dzanja lolimba popanda mantha ndi kukayikira.

Ngati wodwala wavulala mitundu ingapo ya insulini, ndiye kuti yoyamba imayimiriridwa mwachidule, kenako.

Kodi muyenera kuyang'ana musanalowe mu Detemir?

Musanapange jakisoni, muyenera:

• onaninso mtundu wa ndalama
• disinction wa nembanemba ndi antiseptic,
• yang'anirani bwino kukhulupirika kwa katoni, ngati mwadzidzidzi wawonongeka kapena kukayikira kukonzekera kwake, ndiye kuti simukufunika kuti mugwiritse ntchito, muyenera kuubwezera ku pharmacy.

Ndikofunika kukumbukira kuti ndizoletsedwa kugwiritsa ntchito Detemir insulin kapena imodzi yomwe idasungidwa molakwika. M'mapampu a insulin, mankhwalawa sagwiritsidwa ntchito, poyambitsa ndikofunikira kusunga malamulo angapo:

• kutumikiridwa kokha pakhungu,
• singano isintha pambuyo jekeseni aliyense,
• katoni sikukhutira.

Kuchita ndi njira zina

Kulimbikitsa zochita za hypoglycemic kumathandizira:

• Mankhwala okhala ndi ethanol,
• mankhwala a hypoglycemic (pamlomo),
• Li +,
• Mao zoletsa
• fenfluramine,
• ACE zoletsa
• cyclophosphamide,
• kaboni anhydrase zoletsa,
• theofylline
• osasankha beta-blockers,
• pyridoxine
• bromocriptine
• mebendazole,
• sulfonamides,
• ketonazole
• Ma anabolic
• onjezerani
• manzeru.

Mankhwala ochepetsa Hypoglycemic

Nicotine, kulera (pamlomo), corticosteroids, phenytoin, mahomoni a chithokomiro, morphine, thiazide diuretics, diazoxide, heparin, calcium njira blockers (wosakwiya), anticepressants triceclic, clonidine, danazole ndi sympathomimets amachepetsa mphamvu ya hypoglycemic.

Ma salicylates ndi reserpine amatha kuwonjezera kapena kuchepetsa mphamvu zomwe zimapangitsa kuti insulini ikhale ndi insulin. Lanreotide ndi octreotide zimachulukitsa kapena kuchepa kwa insulini.

Tcherani khutu! Beta-blockers, chifukwa cha mawonekedwe ake apadera, nthawi zambiri amabisa zizindikiro za hypoglycemia ndikuchepetsa njira yobwezeretsanso kuchuluka kwa shuga.

Mankhwala okhala ndi Ethanol amalimbikitsa ndikuwonjezera mphamvu ya hypoglycemic ya insulin. Mankhwalawa sagwirizana ndi mankhwala ozikidwa pa sulfite kapena thiol (insulin detemir awonongedwa). Komanso, malonda sangaphatikizidwe ndi mayankho a kulowetsedwa.

Malangizo apadera

Simungathe kulowa Detemir kudzera m'mitsempha, chifukwa hypoglycemia imayamba. Kuchiza kwambiri ndi mankhwalawa sikuthandizira pakuphatikiza mapaundi owonjezera.

Poyerekeza ndi ma insulin ena, insulin detemir imachepetsa chiwopsezo cha hypoglycemia usiku ndipo imathandizira kusankha kwakukulu kwa mlingo womwe umakwaniritsidwa kuti pakhale kuchuluka kwa shuga m'magazi.

Zofunika! Kuyimitsa mankhwala kapena mlingo wolakwika wa mankhwalawo, makamaka mtundu wa matenda a shuga I, amathandizira kuwoneka kwa hyperglycemia kapena ketoacidosis.

Zizindikiro zazikulu za hyperglycemia, zimapezeka kwambiri m'magawo. Amawoneka m'maola ochepa kapena masiku. Zizindikiro za hyperglycemia ndi monga:

• kununkhira kwa acetone atatuluka mpweya,
• ludzu
• kusowa kwa chakudya
• polyuria
• kamwa yowuma
• nseru
• khungu lowuma
• akukumbutsa
• Hyperemia,
• kugona kosalekeza.

Kuchita masewera olimbitsa thupi mwadzidzidzi komanso mwamphamvu, komanso kudya mosazolowereka kumathandizanso kuti hypoglycemia ikhale yabwino.

Komabe, atayambiranso kagayidwe kazakudya, mawonekedwe a chizindikiro cha hypoglycemia angasinthe, kotero wodwalayo ayenera kudziwitsidwa ndi adokotala. Zizindikiro zake zimatha kudzaza ngati matenda ashuga atatenga nthawi yayitali. Matenda opatsirana omwe amaphatikizana amathandizanso kufunikira kwa insulin.

Kusamutsa wodwala kupita ku mtundu wina kapena insulin, yopangidwa ndi wopanga wina, nthawi zonse imachitika moyang'aniridwa ndi achipatala. Pakusintha kwa wopanga, mlingo, mtundu, mtundu kapena njira yopangira insulin, kusintha kwa mlingo nthawi zambiri kumafunika.

Odwala omwe amapitidwira ku chithandizo chomwe insulir insulin imagwiritsidwa ntchito nthawi zambiri amafunika kusintha kwa mlingo poyerekeza ndi kuchuluka kwa insulin yomwe idaperekedwa kale. Kufunika kusintha kwa mankhwalawa kumawonekera pambuyo pa jekeseni woyamba kapena mkati mwa sabata kapena mwezi. Njira mayamwidwe mankhwala ngati mu mnofu makonzedwe imathamanga poyerekeza ndi sc makonzedwe.

Detemir isintha mawonekedwe ake ochita ngati aphatikizidwa ndi mitundu ina ya insulin. Kuphatikiza kwake ndi insulin aspart kumabweretsa chidziwitso chakuchita ndi otsika, kuyimitsidwa pazoyenera kwambiri poyerekeza ndi kutsata kwina. Dermul wa Detemir suyenera kugwiritsidwa ntchito pamapampu a insulin.

Mpaka pano, palibe chidziwitso pakugwiritsa ntchito mankhwalawa panthawi ya pakati, kuyamwa ndi ana ochepera zaka zisanu ndi chimodzi.

Wodwalayo ayenera kuchenjeza za mwayi wa hyperglycemia ndi hypoglycemia poyendetsa galimoto ndikuwongolera njira. Makamaka, ndikofunikira kwa anthu omwe ali ndi zofowoka kapena zosakhalapo zomwe zimayambitsa hypoglycemia.

Zisonyezero zogwiritsira ntchito ndi Mlingo

Matenda a shuga ndi matenda akuluakulu omwe mankhwalawo akuwonetsedwa.

Ku kulowereraku kumachitika paphewa, pamimba pamimba kapena ntchafu. Malo omwe insulir ya insulin imalowetsedwa ayenera kusinthidwa nthawi zonse. Mlingo ndi pafupipafupi jakisoni zimakhazikitsidwa payekhapayekha.

Mukabayidwa kawiri kuti muwonjezere kuyamwa kwa shuga, ndikofunikira kuperekera mlingo wachiwiri pambuyo pa maola 12 itatha yoyamba, pa chakudya chamadzulo kapena musanagone.

Kusintha kwa Mlingo ndi nthawi yoyenera kutsata kungafunike ngati wodwalayo wasamutsidwa kuchokera kwa insulin yayitali komanso mankhwala osokoneza bongo mpaka kuyamba kunyansidwa ndi insulin.

Zotsatira zoyipa

Zotsatira zoyipa (1 mwa 100, nthawi zina 1 mwa 10) zimaphatikizapo hypoglycemia ndi zonse zomwe zikupezeka: mseru, khungu, khungu, kuchuluka kwa chakudya, kusokonezeka, zovuta zam'mimba, komanso matenda amisala omwe amabweretsa imfa. Zomwe zimachitika mderalo (kuyabwa, kutupa, malo a jekeseni) ndizothekanso, koma ndizosakhalitsa ndipo zimatha panthawi yamankhwala.

Zotsatira zoyipa (1/1000, nthawi zina 1/100) zimaphatikizapo:

• jakisoni lipodystrophy,
• kutupa kwakanthawi komwe kumachitika koyambirira kwa mankhwala a insulin,
• matupi awo saonekera (kuchepa kwa kuthamanga kwa magazi, urticaria, palpitations ndi kupuma movutikira, kuyabwa, kuperewera kwa chakudya cham'mimba, hyperhidrosis, etc.),
• kumayambiriro kwa mankhwala a insulin, kuphwanya kwina kwakanthawi kumachitika,
• matenda ashuga retinopathy.

Ponena za retinopathy, kuwongolera kwa glycemic kwa nthawi yayitali kumachepetsa mwayi wopezeka ndimatenda, koma insulini yolimbitsa thupi ndi kuwonjezeka kwadzidzidzi kwa kagayidwe kazakudya kamene kamayambitsa matenda angayambitse kudwala kwakanthawi.

Zowopsa kwambiri (1/10000, nthawi zina 1/1000) zovuta zimaphatikizapo zotumphukira neuropathy kapena ululu wammbuyo wamphongo, womwe nthawi zambiri umasinthidwa.

Bongo

Chizindikiro chachikulu cha mankhwala osokoneza bongo ndi hypoglycemia. Wodwala amatha kuchotsa mtundu wa hypoglycemia pawokha mwa kudya shuga kapena chakudya chamagulu.

Olw'okulwanyisa obukyayi s / c, i / m yaweebwa 0.5-1 mg wa glucagon oba eddirisa ya dextrose mu / mu. Ngati pambuyo pa mphindi 15 mutatha kudya glucagon wodwalayo sanayambenso kuzindikira, ndiye kuti yankho la dextrose liyenera kuperekedwa. Munthu akayambanso kuzindikira pofuna kupewa, ayenera kudya zakudya zokhala ndi chakudya.

Kodi mankhwalawa amasemphana ndi milandu iti?

Musanagwiritse ntchito Detemir, ndikofunikira kudziwa ngati chatsimikizika mosamala:

• ngati wodwala akumva chidwi ndi zigawo zina za mankhwalawo, amatha kuyambitsidwa, zotsatira zina zimatha kupha.
• Kwa ana ochepera zaka 6, mankhwalawa samalimbikitsidwa, sizotheka kuyang'ana momwe zimawakhudzira ana, chifukwa chake ndizosatheka kuneneratu momwe zidzawakhudzire.

Kuphatikiza apo, pali magulu amtundu wotere wa odwala omwe amaloledwa kugwiritsa ntchito mankhwalawa pochiza, koma ndi chisamaliro chapadera komanso kuyang'aniridwa mosalekeza. Izi zikuwonetsedwa ndi malangizo ogwiritsira ntchito. Insulin "Detemir» mwa odwala omwe ali ndi ma pathologies, kusintha kwa mankhwalawa kumafunikira:

• Kuphwanya chiwindi. Ngati awa afotokozedwa m'mbiri ya wodwalayo, ndiye kuti zomwe wachita zikuluzikulu zingasokonekera, ndiye kuti mankhwalawo ayenera kusintha.
• Kulephera mu impso. Ndi ma pathologies oterowo, mfundo za momwe mankhwalawo amatha kusinthidwira, koma vutoli litha kuthetsedwera ngati mumayang'anira wodwalayo pafupipafupi.
• Anthu okalamba. Pambuyo pazaka 65, kusintha zambiri kumachitika mthupi, zomwe zimakhala zovuta kwambiri kuzitsatira. Pakukalamba, ziwalo sizigwira ntchito mwachangu ngati achinyamata, chifukwa chake, ndikofunikira kuti asankhe mlingo woyenera kuti uthandizenso kuchuluka kwa shuga, osavulaza.

Ngati mungaganizire malingaliro onsewa, ndiye kuti chiwopsezo cha zotsatira zoyipa chitha kuchepetsedwa.

"Detemir" pa nthawi yoyembekezera komanso poyamwitsa

Chifukwa cha maphunziro a kugwiritsa ntchito insulin "Detemira» mayi woyembekezera komanso mwana wake wosabadwa, zinatsimikiziridwa kuti chida sichikhudzidwa ndikukula kwa khanda. Koma kunena kuti ndizotetezeka kwathunthu, sizingatheke, chifukwa panthawi yomwe kusintha kwa mahomoni kumachitika mthupi la mzimayi, komanso momwe mankhwalawo angachitire mosiyanasiyana sizingatheke. Ichi ndichifukwa chake madokotala, asanapange mankhwala panthawi yoyembekezera, onetsetsani kuopsa kwake.

Pa chithandizo, muyenera kuyang'anira kuchuluka kwa shuga. Zizindikiro zimatha kusintha kwambiri, kotero kuwunikira kwakanthawi ndi kusintha kwa mankhwalawa ndikofunikira.

Ndizosatheka kunena ndendende ngati mankhwalawa alowa mkaka wa m'mawere, koma ngakhale atapezeka, akukhulupirira kuti sizingavulaze.

Kuchita ndi mankhwala ena

Zotsatira za "Detemir" zitha kupotozedwa chifukwa chogawana ndi mankhwala ena. Nthawi zambiri, madokotala amayesa kupewa kuphatikiza mankhwalawa, koma nthawi zina sangathe kutero, pomwe wodwala ali ndi matenda ena othandizira. Zikatero, chiwopsezo chitha kuchepetsedwa ndikusintha Mlingo. M'pofunika kuwonjezera mlingo ngati mankhwalawa akaperekedwa kwa odwala matenda ashuga:

Amachepetsa mphamvu ya insulin.

Koma ndikofunikira kuchepetsa mlingo, ngati mankhwalawa amalimbikitsidwa:

Ngati mlingo sunasinthidwe, ndiye kuti kumwa mankhwalawa kumayambitsa hypoglycemia.

Mitu ya mankhwalawa

Odwala ena amayenera kuyang'ana mayendedwe a Detemir a insulin omwe amapangidwa ndi zinthu zina. Mwachitsanzo, odwala matenda ashuga omwe ali ndi chidwi chokhudzana ndi zigawo za mankhwalawa. Pali zithunzi zambiri za Detemir, kuphatikizapo Insuran, Rinsulin, Protafan ndi ena.

Koma ndikofunikira kukumbukira kuti analogue yokha ndi mlingo wake uyenera kusankhidwa ndi dokotala aliyense payekha. Izi zikugwirira ntchito ku mankhwala aliwonse, makamaka okhala ndi matendawa.

Mtengo wa mankhwala

Mtengo wa insulin Detemir Danish kupanga umachokera ku 1300-3000 rubles. Koma ndikofunikira kukumbukira kuti mutha kuzipeza zaulere, koma pankhaniyi, muyenera kukhala ndi chilangizo cha Chilatini cholembedwa ndi endocrinologist. Detemir insulin ndi mankhwala othandiza kuchiza matenda a shuga 1 ndi mtundu 2, chinthu chachikulu ndikutsatira malingaliro onse, ndipo zimangopindulitsa odwala matenda ashuga.

Ndemanga za Insulin

Anthu odwala matenda ashuga komanso madotolo amayankha bwino Detemir. Zimathandizira kuchepetsa shuga yamwazi, imakhala ndi zotsutsana pang'ono komanso mawonekedwe osafunikira. Chokhacho choyenera kuganizira ndikulondola kwa kayendetsedwe kake ndikutsatira malingaliro onse ngati, kupatula insulin, mankhwala ena amalimbikitsidwa kwa wodwala.

Matenda a shuga masiku ano si chiganizo, ngakhale kuti matendawa amayesedwa ngati amwalira mpaka atapangidwa insulin. Kutsatira malingaliro a dokotala ndikuwonetsetsa kuchuluka kwa shuga m'magazi, mutha kukhalabe ndi moyo wabwino.

Pharmacological zimatha mankhwala a insulin

Tekinoloje zamakono zomwe zimapangidwanso mu DNA zakonzanso mbiri ya zochita za insulin yosavuta (yanthawi zonse). Detemir insulin imapangidwa ndi recombinant DNA biotechnology pogwiritsa ntchito kupopera Saccharomyces cerevisiae, ndi chosungunuka basalle analog ya insulin ya anthu yotenga nthawi yayitali yokhala ndi mbiri yopanda kanthu yochitapo kanthu. Mbiri yakuchitikaku ndiyosasiyana kwenikweni poyerekeza ndi isofan-insulin ndi insulin glargine. Kuchitikira kwanthawi yayitali kumachitika chifukwa chodziyimira pawokha wa mamolekyu a insulir pamalo omwe amapangira jekeseni komanso kumanga mamolekyu kupita ku albumin pogwiritsa ntchito phula lomwe limakhala ndi unyolo wamafuta acid. Poyerekeza ndi isofan-insulin, insulir ya detemir imagawiridwa pang'onopang'ono mu zotumphukira za chandamale. Njira zophatikizidwazo zomwe zimathandizira kuti muchepetse magazi zimathandizanso kuti khungu lizitha kubereka komanso lizikhala ndi insulini. Dermul ya Detemir imadziwika ndi kudziwikiratu kwakanthawi kokwanira kwa odwala poyerekeza ndi insulin NPH kapena insulin glargine. Kukuwonetseredwa kwa kuchitapo kanthu kumachitika chifukwa cha zinthu ziwiri izi: cholowa cha insulini chimakhalabe chosungunuka pamagawo onse kuchokera pamtundu wa mlingo mpaka kumangiriza ku insulin receptor komanso kugwedezeka kwa chomangika ndi serum albumin.

Mwa kulumikizana ndi cholandilira chapadera pa cytoplasmic membrane yamaselo, imapanga insulin-receptor zovuta zomwe zimapangitsa njira zamkati, kuphatikiza kapangidwe kazinthu zingapo za enzymes (hexokinase, pyruvate kinase, glycogen synthetase, ndi zina). Kutsika kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe kabisikulidwe, kuchuluka kwa minofu, kukondoweza kwa lipogenesis, glycogenogeneis, kutsika kwa kuchuluka kwa shuga ndi chiwindi, etc. Pazinthu za 0,0-0.4 U / kg pa 50%, kuchuluka kwakukulu kumachitika pamtunda kuchokera pa 3-- Maola 4 mpaka maola 14 mutakhazikitsa. Pambuyo subcutaneous makonzedwe, pharmacodynamic mayankho anali olingana ndi mlingo kutumikiridwa (pazipita mphamvu, nthawi ya zochita, ambiri zotsatira). Pambuyo pa jekeseni wa SC, detemir imamangiriza ku albin kudzera mu unyolo wamafuta ake. Chifukwa chake, mumkhalidwe wokhazikika, kuchuluka kwa insulin yopanda malire kumachepetsedwa kwambiri, komwe kumapangitsa kuti glycemia ikhale yokhazikika. Kutalika kwa nthawi ya detemir pa mlingo wa 0,4 IU / kg ndi pafupifupi maola 20, motero mankhwalawa amayikidwa kawiri patsiku kwa odwala ambiri. M'maphunziro a nthawi yayitali (miyezi isanu ndi umodzi), shuga wa plasma wothamanga mwa odwala omwe ali ndi mtundu wa shuga I anali bwino poyerekeza ndi isofan-insulin, yodziwika mu maziko / mankhwala a bolus. Glycemic control (glycosylated hemoglobin - HbA1c) pa mankhwalawa ndi insulin detemir anali ofanana ndi omwe amathandizidwa ndi isofan-insulin, omwe ali ndi chiopsezo chocheperako cha kuchepa kwa thupi usiku chifukwa chogwiritsidwa ntchito. Mbiri yakuwongolera shuga usiku ndi yosalala komanso yowonjezera insulin poyerekeza ndi isofan insulin, yomwe imawonetsedwa pangozi yochepera usiku ya hypoglycemia.

Pazipita kuchuluka kwa insulir insulin mu magazi seramu amafikiridwa maola 6-8 pambuyo makonzedwe. Ndi regimen yowonjezera ya tsiku ndi tsiku, kukhazikika kwa mankhwala mu seramu ya magazi kumatheka pambuyo pobayira katatu.

Kuchulukitsa ndizofanana ndi kukonzekera kwa insulin yaumunthu, ma metabolites onse omwe amapangidwa satha ntchito. Maphunziro Omanga Mapuloteni mu vitro ndi mu vivo awonetsere kusowa kwa kulumikizana kwakukulu pakati pa chiphuphu cha insulin ndi mafuta acids kapena mankhwala ena omwe amamangilira mapuloteni amwazi.

Hafu ya moyo pambuyo pa jekeseni wa sc imatsimikiziridwa ndi kuchuluka kwa kuyamwa kwa minofu yaying'ono ndipo ndi maola 5-7, kutengera mlingo.

Pamene s / kumayambiriro kwa ndende mu magazi seramu anali olingana ndi mlingo kutumikiridwa (pazipita ndende, kuchuluka kwa mayamwidwe).

Malo a Pharmacokinetic amaphunzitsidwa mwa ana (a zaka 6 mpaka 12) ndi achinyamata (wazaka 13 mpaka 17) ndikuyerekeza ndi akulu omwe ali ndi mtundu wa matenda a shuga a shuga. Panalibe kusiyana kulikonse pamakampani a pharmacokinetic. Panalibe kusiyana kwakukulu pama pharmacokinetics a detemir insulin pakati pa odwala okalamba ndi achinyamata, kapena pakati pa odwala omwe ali ndi vuto laimpso ndi kwa chiwindi ndi odwala athanzi.

Kugwiritsa ntchito mankhwala a insulin

Kapangidwe ka subcutaneous management. Mlingo umatsimikiziridwa payekhapayekha pazinthu zonse. Dermul ya Detemir iyenera kutumikiridwa 1 kapena 2 pa tsiku malinga ndi zosowa za wodwala. Odwala omwe ayenera kugwiritsa ntchito kawiri pa tsiku kuti azitha kuyendetsa magazi glucose amatha kulowa mgonero ngakhale nthawi yamadzulo, kapena asanagone, kapena maola 12 atatha kumwa kwa m'mawa. Dermul insulin imalowetsedwa mu ntchafu, khoma lakunja kwam'mimba kapena phewa. Masamba obaya ayenera kusinthidwa ngakhale atabayidwa m'dera lomwelo. Monga ndi ma insulin ena, mwa odwala okalamba komanso odwala omwe ali ndi vuto la impso kapena hepatic, kuchuluka kwa shuga wamagazi kuyenera kuyang'aniridwa mosamala kwambiri komanso njira ya kununkhira payokha ikusinthidwa. Kusintha kwa magazi kungakhale kofunikira pakulimbitsa thupi la wodwalayo, kusintha zakudya zake wamba, kapena matenda ena.

Zochita ndi mankhwala a insulin

Pali mankhwala angapo omwe amakhudza kufunika kwa insulin.

Hypoglycemic zotsatira za insulin zimatheka ndi: hypoglycemic mankhwala m'kamwa, Mao zoletsa, zoletsa Ace, carbonic anhydrase zoletsa, si kusankha β-blockers, bromocriptine, sulfonamides, anabolic mankhwala, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lifiyamu, mankhwala okhala ndi Mowa.

Hypoglycemic momwe insulin imafooketsa: njira zakulera za pakamwa, corticosteroids, mahomoni a chithokomiro, thiazide okodzetsa, heparin, ma tridclic antidepressants, sympathomimetics, danazole, clonidine, pang'onopang'ono calcium njira blockers, diazoxide, morphine, phenytoin, nikotini. Mothandizidwa ndi reserpine ndi salicylates, ndizotheka kufooketsa kapena kuwonjezera zochita za mankhwala Octreotide / lanreotide, yomwe imatha kuwonjezeka ndikuchepetsa kufunikira kwa insulin. Ma blockers a Β-adrenergic amatha kubweza zizindikiro za hypoglycemia ndikuchedwa kuchira pambuyo pa hypoglycemia. Mowa umatha kukulitsa mphamvu ya hypoglycemic ya insulin.

Mankhwala ena, mwachitsanzo, okhala ndi thiol kapena sulfite, pamene kuwonda kumawonjezeredwa ndi yankho la insulin, amatha kuwononga. Chifukwa chake, musamawonjezere insulin chifukwa cha kulowetsedwa.

Pharmacological zochita za chinthu

Detemir insulin imapangidwa pogwiritsa ntchito michere ya michere yotchedwa recombinant deoxyribonucleic acid (DNA) pogwiritsa ntchito mtundu wina wotchedwa Saccharomyces cerevisiae.

Insulin ndiye chinthu chachikulu cha mankhwala a Levemir flekspen, omwe amatulutsidwa monga njira yankho mu zolembera 3 za syringe (300 PIECES).

Ma analogue amtundu wa anthu amamangiriridwa ndi zotumphukira zomwe zimagwira mu cell ndipo zimayambitsa zochitika zachilengedwe.

Mndandanda wa insulin wa anthu umalimbikitsa kutsegulira kwa zotsatirazi mthupi:

• kukondoweza kwa glucose komwe kumachitika ndi zotumphukira maselo ndi minofu,
• shuga kagayidwe kachakudya,
• kuletsa kwa gluconeogenesis,
• kuchuluka kwa mapuloteni,
• kupewa lipolysis ndi proteinolysis mu mafuta maselo.

Chifukwa cha njirazi zonse, pali kuchepa kwa ndende yamagazi. Pambuyo pa jakisoni wa insulin, Detemir amayamba kuchita bwino kwambiri atatha maola 6-8.

Ngati mumalowetsa yankho kawiri patsiku, ndiye kuti insulini yofanana ndi insulin imatheka pambuyo pobayidwa kawiri kapena atatu. Kusintha kwamkati kwamkati mwa Detemir insulin kumakhala kotsika kwambiri poyerekeza ndi mankhwala ena a basal insulin.

Hormone iyi imakhudzanso zomwe zimagonana ndi amuna ndi akazi. Voliyumu yake yogawa pafupifupi ndi 0,1 l / kg.

Kutalika kwa theka la moyo wa insulin yovomerezeka pakhungu limatengera mlingo wa mankhwalawa ndipo pafupifupi maola 5-7.

Malangizo ogwiritsira ntchito mankhwalawa

Dokotala amawerengera kuchuluka kwa mankhwalawa, poganizira kuchuluka kwa shuga kwa odwala matenda ashuga.

Mlingo uyenera kusinthidwa ngati kuphwanya zakudya za wodwala, kuwonjezera zolimbitsa thupi kapena kuwoneka kwa ma pathologies ena. Insulin Detemir ikhoza kugwiritsidwa ntchito ngati mankhwala akuluakulu, kuphatikiza ndi insulin kapena mankhwala ochepetsa shuga.

Jakisoni amatha kuchitika mkati mwa maola 24 nthawi iliyonse, chinthu chachikulu ndikuwonetsetsa nthawi yomweyo tsiku lililonse. Malamulo oyambira kuperekera mahomoni:

1. Jakisoni amapangidwa pansi pa khungu kulowa m'mimba, mapewa, matako kapena ntchafu.
2. Kuti muchepetse kuthekera kwa lipodystrophy (matenda am'mafuta am'mimba), gawo la jakisoni liyenera kusinthidwa pafupipafupi.
3. Anthu opitilira zaka zopitilira 60 ndipo odwala omwe ali ndi vuto la impso kapena chiwindi amafunika kuyang'anitsitsa shuga ndi kusintha kwamankhwala osokoneza bongo.
4. Mukasamutsidwa kuchokera ku mankhwala ena kapena koyambirira kwa mankhwalawa, ndikofunikira kuyang'anitsitsa kuchuluka kwa glycemia.

Tiyenera kudziwa kuti mankhwalawa a insulini Detemir samatengera kuwonjezeka kwa wodwala. Asanapite maulendo ataliatali, wodwalayo ayenera kufunsa katswiri wothandizirana ndi mankhwalawa chifukwa chogwiritsa ntchito mankhwalawa.

Kuchepetsa kwakanema kwa zamankhwala kumatha kubweretsa mkhalidwe wa hyperglycemia - kuchuluka kwambiri kwa shuga, kapena ngakhale matenda ashuga a ketoacidosis - kuphwanya kwa kagayidwe kazakudya chifukwa chosowa insulin. Ngati dokotala sakulumikizidwa mwachangu, zotsatira zake zingachitike.

Hypoglycemia imapangidwa pamene thupi limatha kapena silikhuta mokwanira ndi chakudya, ndipo mlingo wa insulin, nawonso umakhala wokwera kwambiri. Kuti muwonjezere kuchuluka kwa shuga m'magazi, muyenera kudya chidutswa cha shuga, kapu ya chokoleti, china chokoma.

kutentha thupi kapena matenda osiyanasiyana nthawi zambiri kumakulitsa kufunikira kwa mahomoni. Kusintha kwa mlingo wa yankho kungakhale kofunikira pakukula kwa matenda a impso, chiwindi, chithokomiro, tiziwalo tamatumbo ndi ma thumbu a adrenal.

Mukaphatikiza insulin ndi thiazolidinediones, ndikofunikira kuganizira kuti akhoza kuthandiza kukulitsa matenda a mtima ndi kulephera kosalekeza.

Mukamagwiritsa ntchito mankhwalawa, kusintha kwa ndende ndi psychomotor kumatha.

Contraindication ndi zotheka kuvulaza

Mwakutero, palibe zotsutsana pakugwiritsa ntchito insulin Detemir. Zolepheretsa zimangokhudzana ndi kukhudzidwa kwapazinthu zina ndi zaka ziwiri zokha chifukwa choti kafukufuku wazokhudza ana a insulin sanachitepo kanthu.

Panthawi yobala mwana, mankhwalawa amatha kugwiritsidwa ntchito, koma moyang'aniridwa ndi dokotala.

Kafukufuku wambiri sanawone zotsatira zoyipa mwa mayi ndi mwana wake wakhanda pomayambitsa jakisoni wa insulin panthawi yomwe anali ndi bere.

Amakhulupirira kuti mankhwalawa amatha kugwiritsidwa ntchito poyamwitsa, koma palibe maphunziro omwe adachitika. Chifukwa chake, kwa amayi omwe ali ndi pakati komanso kuyamwitsa, adokotala amasintha muyeso wa insulin, kulemera pamaso pake phindu la mayi ndi chiwopsezo cha mwana wawo.

Zokhudza momwe thupi limakhudzira, malangizo omwe angagwiritsidwe ntchito ali ndi mndandanda woyenera:

1. Mkhalidwe wa hypoglycemia wodziwika ndi zizindikiro monga kugona, kukwiya, kutsekeka kwa khungu, kunjenjemera, kupweteka mutu, chisokonezo, kukhumudwa, kukomoka, tachycardia. Vutoli limatchulidwanso kuti insulin.
2. Hypersensitivity yapafupi - kutupa ndi kufupika kwa jekeseni, kuyabwa, komanso mawonekedwe a lipid dystrophy.
3. Thupi lawo siligwirizana, angioedema, urticaria, zotupa pakhungu ndi thukuta kwambiri.
4. Kuphwanya kwam'mimba thirakiti - nseru, kusanza, kupweteka m'mimba, kutsegula m'mimba.
5. Kufupika, kunachepetsa kuthamanga kwa magazi.
6. Zowonongeka - kusintha kwa kukonzanso komwe kumatsogolera ku retinopathy (kutupa kwa retina).
7. Kukula kwa zotumphukira neuropathy.

Mankhwala osokoneza bongo amachititsa kuti shuga ayambe kugwa mofulumira. Ndi hypoglycemia wofatsa, munthu ayenera kudya mankhwala omwe amakhala ndi chakudya chamagulu ambiri.

Wodwalayo akavulala kwambiri, makamaka ngati sakudziwa, kufunikira kuchipatala mwachangu ndikofunikira. Dokotala amapaka jakisoni wa shuga kapena glucagon pansi pa khungu kapena pansi pa minofu.

Wodwalayo akachira, amapatsidwa shuga kapena chokoleti kuti asafooketse shuga kangapo.

Mtengo, ndemanga, njira zofananira

Mankhwala a Levemir flekspen, omwe amagwira ntchito omwe ndi insulin Detemir, amagulitsidwa m'malo ogulitsa mankhwala osokoneza bongo ndi malo ogulitsa pa intaneti.

Mutha kugula mankhwalawa pokhapokha ngati mukupatsidwa mankhwala ndi dokotala.

Mankhwalawa ndiokwera mtengo kwambiri, mtengo wake umasiyana kuchokera ku 2560 mpaka 2900 rubles aku Russia. Pankhaniyi, si wodwala aliyense amene angakwanitse.

Komabe, ndemanga za Detemir insulin ndizabwino. Anthu ambiri odwala matenda ashuga omwe adalumikizidwa ndi mahomoni ofanana ndi anthu adazindikira izi:

• kutsika kwapang'onopang'ono kwa shuga m'magazi,
• kukhalabe ndi mankhwalawa kwa pafupifupi tsiku limodzi,
• kugwiritsa ntchito zolembera,
• kawirikawiri zimachitika zoyipa,
• kukhalabe kulemera kwa odwala matenda ashuga chimodzimodzi.

Kuti mukwaniritse shuga wabwinobwino mungathe kutsatira malamulo onse a matenda a shuga. Uku sikuti ndi jakisoni wa insulin kokha, komanso masewera olimbitsa thupi, zovuta zina zokhudzana ndi zakudya komanso kudziletsa pakukhazikika kwa ndende yamagazi. Kuthana ndi ma dosages olondola ndikofunikira kwambiri, popeza kuyambika kwa hypoglycemia, komanso zotsatirapo zake zazikulu, siziyikidwa pambali.

Ngati mankhwalawa pazifukwa zina sizigwirizana ndi wodwalayo, adokotala amatha kukupatsirani mankhwala ena. Mwachitsanzo, insulin Isofan, yomwe ndi analogue ya mahomoni amunthu, omwe amapangidwa ndi mainjiniine. Isofan imagwiritsidwa ntchito osati mu shuga mellitus woyamba komanso wachiwiri, komanso mawonekedwe ake (mwa amayi apakati), pathways, komanso othandizira opaleshoni.

Kutalika kwa nthawi yake kumakhala kocheperako kuposa Detemir insulin, komabe, Isofan ilinso ndi hypoglycemic kwambiri. Ili ndi zovuta ngati zomwezi, mankhwala ena angakhudze kugwira ntchito kwake. Gawo la Isofan limapezeka m'mankhwala ambiri, mwachitsanzo, Humulin, Rinsulin, Pensulin, Gansulin N, Biosulin N, Insuran, Protafan ndi ena.

Kugwiritsa ntchito moyenera insulin ya Detemir, mutha kuchotsa zizindikilo za matenda ashuga. Zofananira zake, kukonzekera komwe kumakhala ndi insulin Isofan, kudzakuthandizani pamene kugwiritsa ntchito mankhwalawo ndikoletsedwa. Momwe imagwirira ntchito komanso chifukwa chomwe mukufunira insulini - mu kanema munkhaniyi.

Kutulutsa mafomu ndi kapangidwe kake

Mankhwalawa amapezeka mu mawonekedwe a jekeseni wofunidwa kuti ayang'anire pakhungu. Mitundu ina ya mulingo, kuphatikizapo mapiritsi, siipangidwa. Izi ndichifukwa choti mumgawo wama cell insulin umagawika ma amino acid ndipo sungathe kukwaniritsa ntchito zake.

Insulin Detemir ndi wofanana ndi insulin ya anthu.

Gawo lolimbikira limayimiriridwa ndi insulin. Zomwe zili mu 1 ml ya yankho ndi 14.2 mg, kapena 100 mayunitsi. Zowonjezera zina zikuphatikiza:

• sodium kolorayidi
• glycerin
• hydroxybenzene
• metacresol
• sodium hydrogen phosphate dihydrate,
• zinc acetate
• kuchepetsa hydrochloric acid / sodium hydroxide,
• madzi a jakisoni.

Chimawoneka ngati yankho lomveka bwino, losasankhidwa, lokhala ndi mayankho. Imagawidwa m'makola atatu a 3 ml (penfill) kapena cholembera (Flexspen). Katakitala wakunja. Malangizowo akuphatikizidwa.

Pharmacokinetics

Kuti mupeze kuchuluka kwakukulu kwa plasma, maola 6-8 ayenera kutha kuchokera panthawiyi. Bioavailability pafupifupi 60%. Kuphatikizika kwa kufanana ndikuwongolera kwa nthawi ziwiri kumatsimikiziridwa pambuyo pa jekeseni wa 2-3. Voliyumu yogawa pafupifupi 0,1 kg / kg. Kuchuluka kwa insulini yovulazidwa kumazungulira ndi mtsempha wamagazi. Mankhwalawa sagwirana ndi mafuta acids komanso ma pharmacological omwe amamangilira mapuloteni.

Kupanga masanjidwewo sikusiyana ndi kukonza kwa insulin yachilengedwe. Kutha kwa theka-moyo kumapangika kuyambira maola asanu mpaka asanu ndi awiri (malinga ndi mlingo womwe umagwiritsidwa ntchito). Pharmacokinetics sizimadalira jenda komanso zaka za wodwalayo. Mkhalidwe wa impso ndi chiwindi sichikhudzanso izi.

Momwe mungatengere Insulin Detemir

Njira yothetsera vutoli imagwiritsidwa ntchito subcutaneous makonzedwe, kulowetsedwa mwa mtsempha kungayambitse kwambiri hypoglycemia. Sijowina intramuscularly ndipo sagwiritsidwa ntchito pamapampu a insulin. Zingwe zitha kuperekedwa m'dera la:

• phewa (minofu yotentha),
• m'chiuno
• khoma lakutsogolo kwa peritoneum,
• matako.

Tsamba la jakisoni liyenera kusinthidwa pafupipafupi kuti muchepetse kuwoneka kwa lipodystrophy.

Mlingo woyeserera amasankhidwa mosiyanasiyana. Mlingo umadalira glucose yachangu. Kusintha kwa mankhwalawa kungakhale kofunikira pakuchita zolimbitsa thupi, kusintha kwa zakudya, matenda ofanana.

Mankhwalawa amaperekedwa m'malo osiyanasiyana, kuphatikiza khoma lakunja kwa peritoneum.

Kugwiritsa ntchito mankhwalawa kumaloledwa:

• ndekha
• molumikizana ndi jakisoni wa insulin,
• kuphatikiza liraglutid,
• ndi antidiabetic oyamwa.

Ndi zovuta zovuta za hypoglycemic, tikulimbikitsidwa kupereka mankhwalawa nthawi 1 patsiku. Muyenera kusankha nthawi iliyonse yabwino ndikumamatira mukamapanga jakisoni tsiku ndi tsiku. Ngati pakufunika kugwiritsa ntchito yankho kawiri pa tsiku, muyezo woyamba umaperekedwa m'mawa, ndipo wachiwiri ndi nthawi ya maola 12, chakudya chamadzulo kapena musanagone.

Pambuyo popukusira pang'onopang'ono jakisoni, ndende ya cholembera imagwiridwa pansi, ndipo singano imasiyidwa pakhungu kwa mphindi zosachepera 6.

Mukamasintha insulin ina kukonzekera Detemir-insulin m'masabata oyamba, kuyang'anira mosamalitsa kwa glycemic index ndikofunikira. Pangakhale kofunikira kuti musinthe mankhwalawa, mankhwalawa komanso nthawi yomwe mumamwa mankhwala othandizira odwala matenda ashuga, kuphatikiza amkamwa.

Ndikofunika kuyang'anitsitsa kuchuluka kwa shuga ndikusintha panthawi yake muyezo wa okalamba.

Ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga ndikusintha panthawi yake mu okalamba ndi odwala omwe ali ndi impso-hepatic pathologies.

Pakati mantha dongosolo

Nthawi zina zotumphukira neuropathy amakula. Nthawi zambiri, zimasinthidwanso. Nthawi zambiri, zizindikiro zake zimawonekera ndi kukhazikika kwa mtundu wa glycemic index.

Kuchokera kumbali ya kagayidwe

Nthawi zambiri pamakhala kuchuluka kwa shuga m'magazi. Hypoglycemia yayikulu imayamba mwa 6% yokha mwa odwala. Zitha kupangitsa mawonetseredwe okhudzika, kukomoka, kusokonekera kwa ubongo ntchito, kufa.

Nthawi zina zimachitika kupezeka jakisoni. Pankhaniyi, kuyabwa, khungu rede, zotupa, matupa angaoneke. Kusintha tsamba la jakisoni wa insulin kungachepetse kapena kuthetsa izi; kukana kwa mankhwalawo kumafunikira kawirikawiri. Kugwirizana kwakuthekera ndikotheka (matumbo kukhumudwa, kupuma movutikira, kusintha kwa matenda, kuchepa kwa mawonekedwe, kutuluka tachycardia, anaphylaxis).

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Mukamachititsa maphunziro, zotsatira zoyipa kwa ana omwe amayi awo amagwiritsa ntchito mankhwalawa panthawi yoyembekezera sizinazindikiridwe. Komabe, gwiritsani ntchito pakunyamula mwana ayenera kugwiritsidwa ntchito mosamala. Munthawi yoyambirira ya kubereka, mkazi amafunikira insulini amachepetsa pang'ono, ndipo pambuyo pake amawonjezeka.

Palibe umboni wotsimikiza kuti insulin ikadutsa mkaka wa m'mawere. Kudya kwake pakamwa mwa khanda sikuyenera kuwonetseredwa moipa, chifukwa m'mimba mwake, mankhwalawo amatuluka msanga ndipo umatengedwa ndi thupi ngati ma amino acid. Mayi woyamwitsa angafunikire kusintha kwa mlingo komanso kusintha kadyedwe.

Kuchita ndi mankhwala ena

Kuphatikizikako sikungasakanizidwe ndimadzi osiyanasiyana azakumwa ndi mayankho amakanidwe. Ziwawa ndi ma sulfite zimayambitsa kuwonongeka kwa kapangidwe ka wothandizirayo.

Mphamvu ya mankhwalawa imachulukanso ndikugwiritsanso ntchito:

• Clofibrate
• Fenfluramine,
• Pyridoxine
• Bromocriptine
• Cyclophosphamide,
• Mebendazole
• Ketoconazole
• Theofylline
• mankhwala antidiabetesic pamlomo
• ACE zoletsa
• antidepepressants a gulu la IMAO,
• osasankha beta-blockers,
• zoletsa za kaboni wa anhydrase ntchito,
• Kukonzekera kwa lifiyamu
• sulfonamides,
• zotumphukira za salicylic acid,
• machez
• anabolics.

Kuphatikiza ndi Heparin, Somatotropin, Danazole, Phenytoin, Clonidine, Morphine, corticosteroids, mahomoni a chithokomiro, sympathomimetics, calcium antagonists, thiazide diuretics, TCAs, kulera kwapakamwa, nikotini, kugwira insulin kumachepa.

Ndikulimbikitsidwa kuti musamwe mowa.

Mothandizidwa ndi Lanreotide ndi Octreotide, mphamvu ya mankhwalawa imatha kuchepa ndikukula. Kugwiritsa ntchito kwa beta-blockers kumabweretsa kuwongolera kwa kuwonetsa kwa hypoglycemia ndikuletsa kubwezeretsanso kuchuluka kwa shuga.

Kuyenderana ndi mowa

Ndikulimbikitsidwa kuti musamwe mowa. Kuchita kwa mowa wa ethyl ndikosavuta kudziwonetsa, chifukwa imatha kuwonjezera ndikulimbikitsa mphamvu ya Hypoglycemic.

Zofananira zonse za Detemir-insulin ndi Levemir FlexPen ndi Penfill. Pambuyo pokambirana ndi dokotala, ma insulin ena (glargine, Insulin-isophan, ndi ena otero) angagwiritsidwe ntchito ngati cholowa m'malo mwa mankhwalawo.