NovoMix 30 flexpen: malangizo ogwiritsira ntchito, contraindication, mtengo, ndemanga, kufotokoza, mavuto

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Zinthu zina zambiri zosangalatsa

Maumwini onse ndi otetezedwa.

Kugwiritsa ntchito malonda pazinthu sikuloledwa.

Chidziwitsochi cholinga chake ndi akatswiri azachipatala.

Zolemba zofananira

Zotsatira za shuga

Victoza wa mankhwala osokoneza bongo: malangizo ogwiritsira ntchito

Momwe mungachiritsire matenda a shuga ndi Tiogamm?

Mfundo za mankhwalawa Novomix

Mankhwalawa amalowa m'mashelefu am'magazi mu makatiriji kapena pensulo zapadera zamatumba. Kuchuluka kwa mitundu yonse ya Mlingo ndi 3 ml. Kuyimitsidwa kumakhala ndi magawo awiri.

Mukamwetsa, mankhwala:

1. Zimakhudza ma insulin receptor,
2. Imalepheretsa kwambiri shuga,
3. Amachepetsa shuga
4. Matenda amasinthasintha shuga, omwe amadzuka kwambiri atatha kudya.

Mankhwalawa sasokoneza kuthekera kukhala ndi ana ndipo samatsogolera pakukula kwa masinthidwe am'mimba komanso zotupa za khansa. Novomix ndi mankhwala otetezeka omwe samakhala ndi zotsatira zoyipa akamagwiritsa ntchito moyenera.

Mahomoni, omwe ndi maziko a mankhwalawo, ali ofanana ndi insulin yachilengedwe ndipo motero samawopseza thupi.

Contraindication, gwiritsani ntchito mukanyamula komanso kudyetsa mwana

Mankhwalawa amatsutsana ndi hypersensitivity kuti insulin aspart kapena mbali yothandizira. Mankhwala osavomerezeka kwa ana osakwana zaka 6. Mukakhala ndi mwana, Novomix amalembedwa pokhapokha ngati pali phindu lomwe lingakhale loopsa kwa mwana wosabadwa.

Mukamanyamula mwana, yang'anani mosamala kuchuluka kwa shuga m'magazi ndikuwunika nthawi zonse. Mu trimester yoyamba ya kubereka, kufunikira kwa insulin sikungatheke, mu 2nd ndi 3 trimester imachulukitsidwa. Pambuyo pobereka, mankhwalawa amatha kuchepetsedwa, chifukwa kufunika kwa insulin kumatsika kwambiri.

Zotsatira zoyipa zomwe zingachitike

Pogwiritsa ntchito molakwika kapena nthawi yayitali, Novomix imatha kusokoneza thupi la wodwalayo. Odwala amawonetsa mavuto:

1. Hypoglycemia. Izi ndi zofunikira kwambiri pamene kuchuluka kwa shuga m'magazi kumatsika kwambiri kuzidziwitso za pathological (osakwana 3.3 mmol pa lita imodzi). Hypoglycemia imayamba mwa odwala omwe adapatsidwa mankhwala okwanira. Zizindikiro za shuga wochepa zimachitika mwadzidzidzi. Khungu limakhala lofiirira, munthu amangokhalira thukuta, kutopa msanga komanso kudwala nkhawa. Odwala omwe amakhala ndi shuga yochepetsedwa amagwirana manja, amachepera mphamvu ndipo amasokonezeka. Maganizo a anthu amakhala ndi nkhawa, mtima wawo umathamanga komanso kugona. Nthawi zambiri, odwala omwe ali ndi hypoglycemia amakhala ndi njala yosalamulirika. Masomphenya akucheperachepera ndipo nseru ikuwonekera. Wodwalayo akayamba kudwala matenda obwera chifukwa cha hypoglycemia. Ngati thandizo siliperekedwa pa nthawi, hypoglycemia imabweretsa kudwala kwa wodwala,

Zotsatira zoyipa - mawonekedwe osokonezeka omwe amaphatikizidwa ndi kuchuluka kwa minofu turgor, matenda ashuga a retinopathy, zotumphukira za m'mitsempha, kupweteka kwa malo a jekeseni.

Novomiks: Malangizo ogwiritsira ntchito

Musanagwiritse ntchito, gwiritsani katoni kapena cholembera ndi kutulutsa. Samalani mtundu wa chidebe - mthunziwo uziyenera kukhala yunifolomu ndi yoyera. Zotupa zomatira kukhoma kwa cartridge siziyenera. Kugwiritsa ntchito singano kamodzi kokha - ngati mutanyalanyaza lamuloli, ndiye kuti mutha kutenga kachilombo.

Musanagwiritse ntchito, ndikofunikira kutsatira mfundo zoyambirira ndi kusamala:

• Osagwiritsa ntchito mankhwalawo ngati kale anali mu freezer,
• Ngati wodwala akuwona kuti shuga ndi ochepa, ndizoletsedwa kupereka mankhwalawo. Kuchulukitsa shuga, zokwanira
• Idyani zakudya zosavuta (monga maswiti)

Musaiwale za kuwunikira pafupipafupi kuchuluka kwa shuga. Tsatirani malangizo kuti muchepetse zovuta komanso kutsika kwamphamvu kwa shuga.

Kugwirizana kwina ndi mankhwala ena

Mukamawerengera mlingo, onani kuti mankhwalawa amatha kuthana ndi kagayidwe kazakudya. Mankhwalawa akuphatikizapo:

mankhwala omwe amachititsa kutsika kwamphamvu kwa shuga,

• Okreotide
• Mao zoletsa,
• Salicylates,
• Anabolics
• Sulfonamides,
• Zinthu zomwe zimakhala ndi mowa.

Kuphatikiza apo, gulu la mankhwala likuyimira pomwe kufunikira kwa Novomix 30 FlexPen kumawonjezeka. Gawoli limaphatikizapo: mahomoni a chithokomiro, mapiritsi oteteza kubala, danazole, thiazides, HSC.

Zokhudza mphamvu pakuyendetsa

Zotsatira zoyipa kwambiri zomwe zimawonedwa pa chithandizo chakuchuluka kwa shuga ndizovuta zowopsa. Chimodzi mwazizindikiro za hypoglycemia ndikuphwanya kwa kupsinjika, chifukwa chomwe wodwalayo sangathe kuyendetsa makina ovuta kapena kuyendetsa galimoto popanda chiwopsezo.

Pambuyo pa utsogoleri, onetsetsani kuti palibe chiopsezo chowonjezeka kwambiri mu shuga. Ngati zizindikiro za hypoglycemia sizikuwoneka, sizikulimbikitsidwa kuyendetsa galimoto, chifukwa shuga imatha kugwa nthawi iliyonse.

Mlingo ndi kusintha

Novomix amaikidwa ngati monotherapy kapena molumikizana ndi mankhwala ena. Mlingo umatengera umunthu ndi mtundu wa matenda:

• Mu matenda a shuga amtundu wachiwiri, mlingo woyambirira ndi magawo 6 musanadye chakudya choyamba ndi gawo limodzi musanadye chakudya. Ndi kuchuluka kwa insulini, mlingo umasinthidwa kukhala magawo 12,
• Ngati wodwalayo asintha mankhwalawa ndi biphasic insulin kukhala ku Novomix, mlingo woyambirira amakhalabe wofanana ndi njira yapitayi. Komanso, mlingo umasinthidwa ngati pakufunika. Posamutsa wodwala watsopano mankhwala, kuwunikira mosamalitsa kwa adokotala amafunikira,
• Ngati chithandizo chikufunika kulimbikitsidwa, wodwalayo amapatsidwa mankhwala awiri,
• Kuti musinthe mlingo, muyeze glucose wanu wothira masiku atatu apitawa. Ngati munthawi imeneyi kuchepa kwambiri kwa shuga munthawi yake, mulingo wakewo sunasinthidwe.

Mlingo umasinthidwa osapitirira kamodzi pa sabata. Mutha kudziwana ndi malingaliro pazakusintha kwa mankhwalawa m'malamulo oyendetsedwa ndi phukusi.

Momwe mungapangire insulin

Kuphatikiza kwa mankhwala osankhidwa bwino ndikulowetsa koyenera m'thupi ndi njira yayikulu yoperekera chithandizo cha matenda a shuga:

1. Musanagwiritse ntchito yankho, gwirirani kwa maola 1-2 pa kutentha kwa madigiri 15-20. Ndiye kunyamula katiriji ndikumujambulira molondola. Gwirani cartridge pakati pa manja anu, ndikusakaniza manja anu ngati kuti mukugubuduza ndodo kapena chinthu china chilichonse chofunikira kwambiri. Bwerezani mpaka ma 15.
2. Pindani katiriji mozungulira ndikuigwedeza kotero kuti mpira mkati mwa chidebe umagudubuka kuchokera mbali ina kupita mbali ina.
3. Bwerezaninso magawo 1 ndi 2 mpaka zomwe zili mumtsukozo zikhale mitambo ndikuyera.
4. Phatikizani pang'onopang'ono mafuta osaneneka. Osalowetsa mkatikati mwa katiriji m'mitsempha - izi zimapangitsa kuwonjezeka kwa shuga m'magazi.
5. Ngati mankhwala osakwana 12 PIERESESI atasiyidwa mumtsuko, gwiritsani ntchito mlingo watsopano kuphatikiza wogawana.

Sungani batani loyambira litapanikizidwa mpaka mlingo wonse wa mankhwalawo utabayidwa pakhungu. Ngati mumagwiritsa ntchito zinthu ziwiri, musasakanikize mu katoni imodzi.

Nthawi zonse tengani chida chopopera jekeseni nanu pokhapokha ngati choyambacho sichingachitike.

Thandizo loyamba la bongo

Chizindikiro chachikulu cha bongo wa Novomix ndi hypoglycemia yayikulu. Wodwala amene ali ndi vutoli amatha kuthandizidwa m'njira zingapo:

• Ndi kuchuluka pang'ono kwa shuga, perekani kwa wodwala chilichonse chomwe chili ndi mafuta osavuta. Izi zimaphatikizapo confectionery: maswiti, chokoleti, ndi zina zambiri. Zonyamula zokhala ndi shuga nthawi zonse - kufunika kowonjezera kuchuluka kwa shuga kumatha kuchitika nthawi iliyonse,
• Hypoglycemia yayikulu imathandizidwa ndi njira ya glucagon. Mankhwala ali mu kuchuluka kwa 0,5-1 mg. jekeseni wamafuta kapena mafupa a mkati,
• Njira ina yothandizira glucagon ndi yankho la dextrose. Zimayambitsidwa kwambiri, pomwe wodwalayo wadwala kale glucagon, koma samadzidwalanso kwa nthawi yopitilira mphindi 10. Dextrose amathandizira kudzera m'mitsempha. Ndiophunzitsidwa kapena dotolo wapadera yekhayo amene angachite izi.

Kuti muchepetse shuga kuti asagwere kachiwiri, idyani zakudya zomwe zili ndi mafuta osavuta komanso ovuta. Musaiwale za kusamala - idyani m'magawo ang'onoang'ono kuti musayambitse kuwonongeka.

Mayina amalonda, mtengo wake, malo osungira

Mankhwala amapita ku mashelufu ammagazi pansi pa mayina angapo amalonda. Iliyonse yaiwo imapangidwa m'njira inayake ndikuyambitsa ntchito yogwira.

Mtengo umasiyana pang'ono:

1. Novomiks FlexPen - ma ruble 1500-1700,
2. Novomiks 30 Penfill - 1590 rubles,
3. Insulin Aspart - ma ruble 600 (a syringe).

Mankhwala tikulimbikitsidwa kuti asungidwe pamtunda osapitirira 25 digiri m'malo opanda ana.

Ngati mankhwalawo sakugwirizana ndi inu kapena sakuvomerezedwa ndi thupi chifukwa cha zida zothandizira, tikukulimbikitsani kuti muzidziwika bwino ndi mitundu yotsimikiziridwa:

• Novomix 30 Penfill. Ili ndi mankhwala awiri omwe amapangira insulin. Zimaphatikiza mahomoni omwe amakhala kwa nthawi yayitali komanso yayitali. Zimathandizira kupanga zinthu zofunika kwambiri, zimapangitsa kuyenda kwa glucose pama cellular komanso kuthekera kwake kuzingidwa ndi minofu ina. Imakhudza chiwindi, imachepetsa kupanga shuga ndipo imachepetsa kuchuluka kwake m'magazi. Mosiyana ndi classic Novomix, ndizovomerezeka kwa maola osachepera 24. Kapangidwe kazinthu zomwe zimagwira ntchito zimasinthana ndi insulin yachilengedwe, kotero chida ndichotetezeka m'thupi. Kugwiritsa ntchito moyenera, mankhwalawa sikuyambitsa mavuto. Contraindified asanafike zaka 18, ndi hypoklycemia ndi hypersensitivity,
• Novomix 30 FlexPen. Zimakhudza kupanga kwa insulini ndipo imalimbikitsa zomwe zimachitika mkati mwa maselo. Kutalika kwa nthawi kumatengera dera la jakisoni, zolimbitsa thupi, Mlingo ndi zinthu zina. Mankhwala amapatsidwa mankhwala ochizira matenda amiseche 1 ndi mtundu 2,
• Novomix 50 FlexPen. Chida ichi ndi chofanana ndendende ndi mankhwala awiri omwe tafotokozawa. Kusiyanaku kumachitika pang'onopang'ono pazogwira ntchito. Pachifukwa ichi, muyenera kufunsa dokotala musanayambe chithandizo.

Mukamasankha mankhwala oyenera, musangoganizira mtengo wake, komanso mfundo zina zofunika. Izi zimaphatikizapo mtundu wa insulin, zomwe zimachitika mthupi lanu, kulolera zinthu komanso matenda ena.

Mlingo ndi makonzedwe

Kuyimitsidwa kwa jekeseni wa subcutaneous. Contraindication ndi hypoglycemia, hypersensitivity.

Rosinsulin C imayendetsedwa mobwerezabwereza 1-2 pa tsiku, pafupifupi theka la ola musanadye. Nthawi iliyonse, tsamba la jakisoni liyenera kusinthidwa. Nthawi zina, endocrinologist angafotokozere wodwalayo mu mnofu jakisoni wa mankhwala.

Tcherani khutu! Mtsempha wa magazi insulin ya sing'anga nthawi yoletsedwa! Munthawi zonse, dokotala amasankha payekha mlingo, womwe umatengera mawonekedwe a matendawa komanso zomwe zili m'magazi ndi mkodzo.

Mlingo wamba ndi 8-16 IU, womwe umaperekedwa nthawi 1 patsiku, chifukwa mumatha kugwiritsa ntchito mankhwala a insulini ndi singano yomwe imachotsedwa. zomverera - zakula mpaka 24 IU patsiku kapena kupitirira.

Ngati mlingo wa tsiku ndi tsiku wa mankhwalowo uposa 0.6 IU / kg, umathandizidwa kawiri patsiku m'malo osiyanasiyana. Ngati mankhwalawa amaperekedwa mu 100 IU patsiku kapena kuposerapo, wodwalayo ayenera kuchipatala. Kusintha kwa insulin imodzi kupita kwina kuyenera kuchitika moyang'aniridwa ndi madokotala.

Mankhwalawa amatanthauza ma insulin apakatikati, omwe amalangizidwa:

1. Kuchepetsa magazi
2. Kuonjezera mayamwidwe a shuga ndi minofu,
3. Kupititsa patsogolo glycogenogeneis ndi lipogeneis,
4. Kuchepetsa kuchuluka kwa shuga m'magazi,
5. kaphatikizidwe kazakudya zama protein.

• angioedema,
• kupuma movutikira
• urticaria
• kutsika kwa magazi,
• malungo.

1. zolimbitsa thukuta,
2. khungu
3. njala
4. kugunda kwa mtima
5. nkhawa
6. thukuta
7. chisangalalo
8. kunjenjemera
9. paresthesia mkamwa,
10. kugona
11. kukhumudwa
12. machitidwe osazolowereka
13. kusakhazikika
14. kusatsimikizika kwa mayendedwe
15. mantha
16. malankhulidwe ndi mawonekedwe owoneka,
17. kusowa tulo
18. mutu.

Ngati mukusowa jakisoni, mlingo wochepera, motsutsana ndi matenda kapena kutentha thupi, ndipo ngati simutsatira zakudya, mutha kudwala matenda ashuga a shuga ndi a hyperglycemia:

• kuchepa kwamtima
• ludzu
• kugona
• kukopa kwa nkhope,
• kuda nkhawa mpaka kugona.
• kuchepa kwakanthawi kowoneka koyambirira kwamankhwala.

Musanatolere vutoli kuchokera ku vial, onetsetsani kuti yankho likuwonekera. Ngati matope kapena vuto lazindikirika pakukonzekera, ndiye kuti singathe kugwiritsidwa ntchito.

Kutentha kwa yankho la makonzedwe kuyenera kufanana ndi kutentha kwa chipinda.

Chofunikira! Ngati wodwala ali ndi matenda opatsirana, matenda a chithokomiro, hypopituitarism, matenda a Addison, kulephera kwaimpso, komanso kwa anthu azaka zopitilira 65, kusintha kwa insulin ndikofunikira.

Zomwe zimayambitsa hypoglycemia zitha kukhala:

1. M'malo mankhwalawa.
2. Bongo.
3. Kudumpha chakudya.
4. Matenda omwe amachepetsa kufunika kwa mankhwalawa.
5. Vomiting, kutsegula m'mimba.
6. Hypofunction wa adrenal kotekisi.
7. Kupsinjika kwakuthupi.
8. Sinthani dera la jakisoni.
9. Kuchita ndi mankhwala ena.

Posamutsa wodwala kuchokera ku insulin ya nyama kupita ku insulin yaumunthu, kuchepa kwa ndende yamagazi ndikotheka.

Kufotokozera za ntchito ya mankhwala a Rosinsulin P

Rosinsulin P amatanthauza mankhwala omwe ali ndi chifupifupi hypoglycemic. Kuphatikiza ndi cholandirira cha membrane wakunja, yankho limapanga insulini yolandirira. Izi:

• kumawonjezera kapangidwe ka cyclic adenosine monophosphate mu chiwindi ndi maselo amafuta,
• imapangitsa njira zamkati mwazochitika (pyruvate kinases, hexokinases, glycogen synthases ndi ena).

Kuchepa kwa ndende ya magazi kumachitika chifukwa cha:

1. onjezera zoyendera zapamtunda,
2. kukondoweza kwa glycogenogeneis, lipogeneis,
3. mapuloteni kaphatikizidwe
4. kukonza mayamwidwe mankhwala ndi minofu,
5. kuchepa kwa kuwonongeka kwa glycogen (chifukwa cha kuchepa kwa kupanga kwa chiwindi ndi chiwindi).

Pambuyo subcutaneous makonzedwe, mphamvu ya mankhwalawa amapezeka 20-30 mphindi.The kuchuluka ndende mu magazi zimatheka pambuyo maola 1-3, ndi kupitiriza kwa zochita zimadalira malo ndi njira kasamalidwe, mlingo ndi munthu payekha wodwala.

Zizindikiro zogwiritsidwa ntchito

Rosinsulin P imagwiritsidwa ntchito motere:

1. Matenda a shuga a 1 ndi 2.
2. Kukana pang'ono kwa mankhwala amkamwa a hypoglycemic.
3. Kuphatikiza mankhwala
4. Ketoacidotic ndi hyperosmolar chikomokere.
5. Matenda a shuga ketoacidosis.
6. Matenda a shuga amapezeka nthawi yoyembekezera.

Gwiritsani ntchito zina:

• pakubala, kuvulala, maopareshoni omwe akubwera,
• musanayambe jakisoni wokonzekera insulin yayitali,
• ndimatenda a metabolic,
• ndi matenda omwe amatsatiridwa ndi kutentha thupi kwambiri.

Contraindication ndi mlingo

Contraindication ndi hypoglycemia, hypersensitivity.

Njira yoyendetsera mankhwala ndi mlingo muzochitika zonse zimatsimikiziridwa payekhapayekha. Chomwe chimapangitsa kudziwa kuchuluka kwa shuga ndi zomwe zimapezeka m'magazi musanadye komanso pambuyo pake, nthawi ya matendawa ndi kuchuluka kwa glucosuria.

Rosinsulin P idapangidwa kuti ikhale ya subcutaneous, intravenous and intramuscular management. Jakisoni amachita pambuyo mphindi 15-30 asanadye. Nthawi zambiri, yankho limaperekedwa mwachangu.

mu opareshoni, matenda a shuga a ketoacidosis ndi chikomokere, rosinsulin P imayendetsedwa ndi intramuscularly, chifukwa chake ndikofunikira kudziwa momwe mungabayire insulin molondola komanso molondola.

Ndi monotherapy, kuchuluka kwa jakisoni patsiku ndi katatu. Ngati ndi kotheka, akhoza kuchuluka mpaka nthawi 5-6. Kuti mupewe kukula kwa lipodystrophy, mafuta a minofu hypertrophy, atrophy, ndikofunikira kusintha tsamba la jakisoni nthawi iliyonse.

• angioedema,
• kupuma movutikira
• kutsika kwa magazi,
• urticaria
• malungo.

1. zolimbitsa thukuta,
2. tachycardia
3. chisangalalo
4. kugona
5. khungu
6. njala
7. kumverera kwa nkhawa
8. thukuta
9. kunjenjemera
10. paresthesia mkamwa,
11. malankhulidwe ndi mawonekedwe owoneka,
12. kusatsimikizika kwa mayendedwe
13. kukhumudwa
14. machitidwe achilendo
15. kusakhazikika
16. mphwayi
17. kusowa tulo
18. mutu.

Poyerekeza ndi matenda kapena kutentha thupi, jakisoni wosaiwalika, mlingo wochepa, ndipo ngati zakudya sizitsatiridwa, wodwalayo atha kudwala matenda ashuga ndi hyperglycemia:

• kusowa kwa chakudya
• ludzu
• kugona
• kutupa kwa nkhope
• kuda nkhawa mpaka kugona.
• kuchepa kwakanthawi kowoneka koyambirira kwamankhwala.

Musanatole rosinsulin C kuchokera pambale, muyenera kuwonetsetsa kuti yankho likuwonekera. Ngati phokoso kapena phokoso lazindikirika ndi insulin, silingagwiritsidwe ntchito. Kutentha kwa jekeseni kuyenera kukhala kutentha.

Tcherani khutu! Ngati wodwala ali ndi matenda opatsirana, kusokonezeka kwa chithokomiro cha chithokomiro, hypopituitarism, matenda a Addison, kulephera kwaimpso, komanso kwa anthu azaka zopitilira 65, kuyenera kwa insulin kuyenera.

Zotsatira za hypoglycemia zitha kukhala:

1. Kusintha kwa mankhwala.
2. Mlingo wowonjezera.
3. Kudumpha chakudya.
4. Matenda omwe amachepetsa kufunika kwa mankhwalawa.
5. Kholingo, m'mimba.
6. Ntchito yosakwanira ya adrenal cortex.
7. Zochita zolimbitsa thupi.
8. Kusintha kwa dera la jakisoni.
9. Kuchita ndi mankhwala ena.

Mukasamutsa wodwala kuchokera ku insulin ya nyama kupita ku insulin yaumunthu, kuchepa kwa shuga m'magazi ndikotheka.

Ma Analogs a NovoMix

Palibenso mankhwala ena omwe ali ndi mtundu wofanana ndi NovoMix 30 (aspart + aspart protamine), ndiye kuti, analogue yathunthu. Ma insulin ena a biphasic, analog ndi anthu, akhoza kulowezani m'malo mwake:

Kusintha kwa Humalog 25

Kusintha kwa Humalog 50

Kumbukirani kuti kusankha mankhwala ndi mlingo wake ndibwino ndi katswiri.

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yothanirana ndi shuga? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kugwiritsa ntchito ... werengani zambiri >>

Zizindikiro ndi contraindication

Biphasic insulin Aspart (analog ya Flexpen) imagwiritsidwa ntchito pochiza mtundu wa 1 ndi mtundu 2 wa shuga ngati wadutsa gawo logalira insulin.

Mankhwalawa sagwiritsidwa ntchito ndi tsankho la munthu payekhapayekha komanso chifukwa chowonjezera chidwi chawo. Kugwiritsa ntchito mwa ana ochepera zaka zisanu ndi chimodzi sikunafufuzidwe, chifukwa chake sikulimbikitsidwa kugwiritsa ntchito oimira aliwonse pazaka izi.

Kugwiritsira ntchito amayi oyembekezera kumakhalanso kochepa. Maphunziro azachipatala athunthu sanachitike. Zomwezo zimagwiranso ntchito ku FlexPen ndi Novorapid Penfill. Koma m'maphunziro awiri a mankhwala a Novorapid Penfill pa amayi apakati, palibe zomwe zimapezeka pazotsatira zoyipa za chinthucho pokhudzana ndi pakati komanso momwe mwana aliri.

Amayi oyamwitsa amatha kugwiritsa ntchito insulin pazofunikira, sizikhudza mwana. Pangakhale kofunikira kusintha mlingo wa mayiyo.

Zotsatira zoyipa zimawoneka ngati gawo lalikulu la timadzi. Mkhalidwe wa hypoglycemia mukamagwiritsa ntchito mankhwala a biphasic amakula pafupipafupi kuposa momwe amapangira mlingo waukulu.

Zotsatira zotsatirazi nthawi zina zimawonekera:

• Urticaria, zotupa pakhungu, kawirikawiri - anaphylactic zimachitika.
• Peripheral neuropathy.
• Refractory matenda (kawirikawiri kumayambiriro kwa mankhwala), retinopathy.
• Lipodystrophy pamalo opangira jekeseni.
• Zomwe zimachitika mdera lanu pamabungwe oyang'anira.

Kumwa mankhwala ena limodzi ndi kuwonjezereka kwa zotsatira za Aspart ndi kuthekera kwa hypoglycemia:

• Kulera kwamlomo.
• Zoletsa za MAO, ACE.
• Ma antidepressants.
• Thiazide okodzetsa.
• Heparin.

Mowa ungapangitse komanso kufooketsa mphamvu ya chithandizo cha mahomoni.

Gulu la insulin

Bovine, nkhumba, ndi insulin yaumwini imabisidwa, kutengera magawo awo. Mitundu iwiri yoyambirira sigwiritsidwa ntchito masiku ano. Chachitatu, makamaka chopezeka pogwiritsa ntchito matekinoloje obadwa nawo, ndicho chisankho choyamba cha mankhwala a insulin.

Malinga ndi kutalika kwa kuchitapo, pali:

• IUD - owonjezera omwe amagwira ntchito mwachidule,
• ICD - ma insulin osakhalitsa,
• ISD - mankhwala a nthawi yayitali pochita,
• IDD - kuchitapo kanthu
• ma insulin ophatikizika (amakhala ndi insulini yamaudindo osiyanasiyana).

Mfundo zoyenera kuchita ndi insulin ndi zotsatira zake

Insulin ndi mahomoni a polypeptide. Nthawi zambiri, mu β-maselo a kapamba amene amayambira amapangika - ma proinsulin, omwe C-peptide imayikidwa ndikupanga insulin. Ndi kuwonjezeka kwa glucose wamagazi, kukwiya kwa mitsempha ya vagus, komanso mothandizidwa ndi zinthu zina zingapo, njira zomwe zimatulutsira insulini zimayambitsidwa.

Mwa kumangiriza ku cholandirira pa membrane wa selo lomwe likuyang'aniridwa, timadzi timene timayamba kugwira ntchito, ndikuwonetsa mphamvu zake:

• kutsika kwa shuga m'magazi (kumapangitsa kuti mayamwidwe azikhala ndi minofu, kumalepheretsa mapangidwe ake mkati mwa thupi kuzinthu zina),
• amachititsa kaphatikizidwe ka glycogen,
• amalepheretsa mapangidwe a matupi a ketone,
• amaletsa mapangidwe a glucose kuchokera ku mankhwala osagwiritsa ntchito chakudya,
• imayambitsa mapangidwe a lipoprotein ochepa kwambiri ndi triglycerides,
• imayambitsa kapangidwe ka mapuloteni osiyanasiyana,
• imathandizira kupanga glycogen, yomwe imagwiritsa ntchito mphamvu zamphamvu zathupi,
• amalepheretsa kuwonongeka kwa mafuta, imayambitsa kupanga kwa mafuta acids kuchokera ku chakudya.

Momwe insulin yakunja imachitikira mthupi

Njira yayikulu yoyendetsera insulin ndi yodutsa, koma pangozi zadzidzidzi, kuti mupeze zotsatira zabwino, mankhwalawa amatha kulowa mu minofu kapena mtsempha.

Kuchuluka kwa mayamwidwe m'thupi la malo ophatikizira subcutaneous kumadalira malo a jakisoni, mtundu ndi mlingo wa mankhwalawo, kuchuluka kwa kayendedwe ka magazi ndi ntchito ya minofu m'dera la jakisoni, komanso potsatira njira ya jakisoni.

• Ma insulin okhala ndi yocheperako pang'ono amakhala otengedwa mwachangu kwambiri ndipo ali mkati mwa mphindi 10-20 pambuyo pa kubayidwa kwa jakisoni. Amagwira kwambiri pambuyo pa mphindi 30-180 (kutengera mankhwala). Zovomerezeka kwa maola 3-5.
• Zotsatira za insulin zazifupi zimachitika mphindi 30-45 pambuyo poyang'anira. Kuchuluka kwa zochitika ndikuchokera ku 1 mpaka maola 4, kutalika kwake ndi maola 5-8.
• Kutalika kwa insulin kumatenga pang'onopang'ono kuchokera m'malo a jakisoni ndikuthandizira kuchepa kwa shuga m'magawo awiri pambuyo poti jekeseni wa subcutaneous. Kuchuluka kwa zomwe zalembedwa mkati mwa maola 4-12, kuchuluka kwa mankhwalawa ndi masiku 0.5-1.
• Insulin yokhala ndi nthawi yayitali imayamba kugwira ntchito pambuyo pa maola a 1-6 pambuyo pothandizidwa ndi subcutaneous, imachepetsa shuga chimodzimodzi - kuchuluka kwa mankhwalawa ambiri sikufotokozeredwa, kumatenga maola 24, zomwe zimapangitsa kuti pakhale jekeseni wa mankhwala kamodzi kokha patsiku.

"Khalidwe" la insulin m'thupi pambuyo makonzedwe limakhudzidwanso ndi:

• Mlingo wa mankhwalawa (ndikachulukirapo, mankhwalawa amayamba kucheperachepera nthawi yayitali)
• gawo la thupi lomwe jekeseni adapangira (m'mimba, mayamwidwe ndiwambiri, m'mapewa pang'ono, m'matumbo a ntchafu ngakhale pang'ono),
• Njira yoyendetsera (mwa jakisoni wotsekemera, mankhwalawa amamwetsedwera pang'onopang'ono kuposa momwe amapaka jekeseni minofu, koma amakhala motalikirapo),
• kutentha kwa minofu m'dera loyang'anira (ngati liwonjezereka, kuchuluka kwa mayamwidwe kumawonjezeka),
• lipomas kapena lipodystrophy ya zimakhala (pazomwe zili, werengani pansipa),
• ntchito ya kutikita minofu kapena minofu (njira zoyamwa zimathandizira).

M'mayiko ena, akatswiri amafufuza za insulin pokonzekera njira zomwe wodwala angagwiritse ntchito mosavuta. Chifukwa chake, ku US mumakhala insulini yothandizira pakhungu. Imayamba kuchita pambuyo pa mphindi 30 (zomwe zikufanana ndi IUD), nsonga ya zochitika imadziwika pambuyo pafupifupi maola awiri, nthawi yake imakhala mpaka maola 8 (omwe ali ofanana ndi ICD).

Chipangidwe NovoMix 30 FlexPen

Kuyimitsidwa kwa s / c kukongoletsa kwamtundu yoyera, kopanda pake (popanda zipu, mapale amatha kuwoneka), ataimirira, kununkhira, kupanga mbewa yoyera komanso yopanda utoto kapena yopanda utoto, kuyimitsidwa koyenera kuyenera kupanga mosangalatsa.

Omwe amathandizira: glycerol, phenol, metacresol, zinc chloride, sodium chloride, sodium hydrogen phosphate dihydrate, protamine sulfate, sodium hydroxide, hydrochloric acid, madzi d / ndi.

* 1 unit imafanana ndi 35 mcg wa mankhwala osokoneza bongo a insulin.

3 ml - makatoni am'magalasi (1) - ma syringe ambiri omwe amatulutsa jakisoni wa jakisoni wobwereza (5) - mapaketi a makatoni.

Kutalika kwapakati pa insulin analogue ndi kuyambiranso kuchitapo kanthu

Analogue ya insulin ya anthu a nthawi yayitali ndikuyamba mwachangu zochita.

NovoMix ® 30 FlexPen ® ndi kuyimitsidwa kwamitundu iwiri komwe kumapanga insulin anartuble (30% yochepa-insulin analog) ndi makhiristo a aspart protamine insulin (70% yapakati-insulin analog).

Insulin aspart yomwe imapangidwanso ndi biotechnology ya DNA yogwiritsidwanso ntchito pogwiritsa ntchito Saccharomyces cerevisiae.

Imalumikizana ndi cholandirira chapadera pa cell ya cytoplasmic maselo ndikupanga insulini-receptor zovuta zomwe zimapangitsanso njira zina, kuphatikizapo kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase). Mphamvu ya hypoglycemic imalumikizidwa ndi kuchuluka kwa kayendedwe kazinthu zamagetsi ndikuwonjezera kuyamwa kwa glucose ndi minofu, kukondoweza kwa lipogenesis, glycogenogeneis, ndi kuchepa kwa kuchuluka kwa kupanga kwa chiwindi ndi chiwindi.

Poyerekeza ndikusungunuka kwa insulin yaumunthu, insulin aspart (yolimbitsa thupi insulin ya anthu) imayamba kuchita zinthu mwachangu, motero imatha kutumikiridwa musanadye chakudya (kuyambira 0 mpaka 10 mphindi musanadye). Gawo lachigiriki (70%) limakhala ndi insulini ya puloteni (analogue ya insulin ya anthu a nthawi yayitali), momwe imafanana ndi zochita za isophane insulin.

Pambuyo pa s / c ya mankhwala a NovoMix ® 30 FlexPen ®, zotsatira zimayamba pambuyo pa mphindi 10-20. Kuchuluka kwake kumawonedwa patatha maola 1-4 mutabayidwa. Kutalika kwa mankhwalawa kumafika maola 24.

Ikagwiritsidwa ntchito kwa odwala omwe ali ndi mtundu woyamba wa 2 ndi mtundu wa 2 shuga, NovoMix ® 30 FlexPen ® ilinso ndi zotsatira zofanana pamlingo wa glycated hemoglobin monga biphasic insulin yamunthu 30. Insulin aspart ndi insulin yaumunthu imakhala ndi zochitika zofananira molar ofanana.

Kafukufuku wazachipatala wa miyezi itatu wokhudzana ndi odwala omwe ali ndi vuto la mtundu woyamba wa 2 ndi mtundu wa 2 adawonetsa kuti NovoMix ® 30 FlexPen ® ilinso ndi zotsatira zofanana pa glycated hemoglobin monga biphasic insulin yamunthu. Insulin aspart imachitanso zofanana ndi insulin yaumunthu mu molar ofanana.

Pakafukufuku wazachipatala wokhudzana ndi odwala omwe ali ndi mtundu wa matenda a shuga 2 mellitus (n = 341), odwala adasinthidwa mwachisawawa pamagulu othandizira okha ndi NovoMix ® 30 FlexPen ®, NovoMix ® 30 FlexPen ® kuphatikiza ndi metformin ndi metformin yophatikizidwa ndi sulfonylurea. Kuthandiza koyambirira kwa HbA 1c pambuyo pa milungu 16 ya chithandizo sikunakhale kosiyana kwa odwala omwe amalandila NovoMix ® 30 FlexPen ® osakanikirana ndi metformin komanso odwala omwe amalandila metformin limodzi ndi zotumphukira za sulfonylurea. Phunziroli, 57% ya odwala anali ndi basal HbA 1c apamwamba kuposa 9%; mwa odwalawa, NovoMix ® 30 FlexPen ® pophatikizana ndi metformin adapangitsa kutsika kwakukulu kwa HbA 1c kuposa kwa odwala omwe amathandizidwa ndi metformin osakanikirana ndi zotumphukira za sulfonylurea.

Pakafukufuku wina, odwala omwe ali ndi matenda a shuga 2 omwe samatha kulamulidwa bwino ndikumamwa mankhwala a hypoglycemic adasankhidwa m'magulu otsatirawa: NovoMix ® 30 FlexPen ® 2 nthawi / tsiku (odwala 117) ndi insulin glargine 1 nthawi / tsiku (116 wodwala). Pambuyo pa masabata 28 operekera mankhwala, kutsika kwapakati pa HbA 1c pagulu la NovoMix ® 30 FlexPen ® kunali 2.8% (kutanthauza koyamba kunali 9.7%). 66% ndi 42% ya odwala omwe amagwiritsa ntchito NovoMix ® 30 FlexPen ®, kumapeto kwa kafukufukuyu, anali ndi mfundo za HbA 1c pansi pa 7% ndi 6.5%, motsatana. Kutanthauza kuti kusala kwam'magazi glucose kutsika ndi pafupifupi 7 mmol / L (kuyambira 14 mmol / L koyambirira kwa phunzirolo mpaka 7.1 mmol / L).

Kafukufuku wazachipatala wa masabata 16 adachitidwa mwa ana ndi achinyamata omwe amayerekezera shuga wamagazi atatha kudya ndi NovoMix ® 30 FlexPen ® (asanadye), insulin / biphasic human insulin 30 (asanadye) ndi insulin-isophan ( kutumikiridwa asanagone). Phunziroli linakhudza odwala 167 azaka zapakati pa 10 mpaka 18. Mitengo ya HbA 1c m'magulu onse awiriwa idakhala pafupi ndi zoyambirira zakafukufuku wonse. Komanso, mukamagwiritsa ntchito NovoMix ® 30 FlexPen ® kapena biphasic insulin 30 ya anthu, panalibe kusiyana pakachitika hypoglycemia. Kafukufuku wokhudzana ndi khungu wamaso awiri adachitidwanso mwa odwala omwe ali ndi zaka 6 mpaka 12 (odwala okwana 54, masabata 12 pamtundu uliwonse wamankhwala).Zomwe zimachitika mu hypoglycemia komanso kuchuluka kwa glucose atatha kudya m'gululi pogwiritsa ntchito NovoMix ® 30 FlexPen ® anali otsika poyerekeza ndi zomwe zimagwiritsidwa ntchito pagululi pogwiritsa ntchito biphasic human insulin 30. Malangizo a HbA 1c kumapeto kwa kafukufuku pagululi amagwiritsa ntchito biphasic insulin 30 ya anthu anali otsika kwambiri kuposa pagululi lomwe linagwiritsa ntchito NovoMix ® 30 FlexPen ®.

Mu insulin aspart, m'malo mwa proline amino acid pamalo a B28 a aspartic acid amachepetsa chizolowezi chopanga ma molekyulu kupanga hexamers mumagawo a solvole NovoMix ® 30 FlexPen ®, omwe amawoneka osungunuka a insulin. Pankhaniyi, insulin aspart (30%) imayamwa kuchokera ku mafuta a subcutaneous mwachangu kuposa insulle insulin yomwe ili mu biphasic insulin yamunthu. Insulin aspart protamine (70%), monga insulin isofan yamunthu, imakamwa nthawi yayitali.

Mukamagwiritsa ntchito NovoMix ® 30 FlexPen ® C max insulin mu seramu imakhala yokwera 50% kuposa momwe mumagwiritsira ntchito insulin 30 ya anthu, pomwe nthawi yakufika ku C imakhala pafupifupi 2 nthawi yotsika. Mankhwalawa akaperekedwa kwa odzipereka athanzi pamlingo wa thupi la 0.2 U / kg, pafupifupi max C anali 140 ± 32 pmol / L ndipo adafika pambuyo pa mphindi 60.

Odwala omwe ali ndi matenda a shuga a 2 mtundu, C max amafikiridwa pambuyo pa mphindi 95 ndipo amasungidwa kwambiri kuposa 0 kwa maola 14 pambuyo pa utsogoleri.

The serum insulin ndende imabweranso pamlingo woyambirira pambuyo pa maola 15-18 pambuyo pobayira.

Pafupipafupi T 1/2, yowonetsa kuchuluka kwa mayamwidwe a kachigawo koyendetsedwa ndi protamine, ndi maola 8-9

Pharmacokinetics mu milandu yapadera yamankhwala

Makhalidwe a pharmacokinetic a NovoMix ® 30 FlexPen ® mwa ana ndi achinyamata sanaphunzire. Komabe, mankhwala a pharmacokinetic ndi pharmacodynamic a soluble insulin aspart adawerengera ana (azaka 6 mpaka 12) komanso achinyamata (azaka 13 mpaka 17) omwe ali ndi matenda ashuga amtundu 1. Kwa odwala azaka zonse ziwiri, insulin aspart imadziwika ndi kuyamwa mwachangu ndi ma T max ofanana ndi achikulire. Komabe, mfundo za max za C m'magulu awiriwo zinali zosiyana, zomwe zikuwonetsa kufunikira kwa kusankha kwa mankhwala a insulin.

Kwa odwala okalamba, komanso odwala omwe ali ndi vuto la chiwindi kapena matenda a impso, pharmacokinetics ya NovoMix ® 30 FlexPen ® siinaphunzire.

Deta Yotetezera

Mu mayeso a in vitro, omwe anaphatikiza kumangiriza insulin ndi ma IGF-1 zolandila ndi zotsatira zake pakukula kwa maselo, zidawonetsedwa kuti zofunikira za aspart insulin ndizofanana ndi insulin yaumunthu. Kuphatikiza apo, zidapezeka kuti insulin aspart imamangiriza ma insulin receptors mwanjira yofanana ndi insulin yaumunthu. Pophunzira za pachimake (mwezi umodzi) komanso matenda oopsa (miyezi 12), deta sizinapezeke chifukwa cha kupezeka kwa mankhwala oopsa omwe amapezeka mu spart insulin.