Chiwopsezo cha insulini: zimachitika bwanji ndipo nchifukwa chake

Insulin ndi yofunika kwa gulu lalikulu la anthu. Popanda icho, munthu amene ali ndi matenda a shuga amatha kufa, chifukwa iyi ndi njira yokhayo yodzithandizira yomwe ilibe ma analogues pano. Komanso, mu 20% ya anthu, kugwiritsa ntchito mankhwalawa kumayambitsa zovuta zosiyanasiyana zovuta. Nthawi zambiri izi zimakhudza atsikana achichepere, nthawi zambiri - achikulire kuposa zaka 60.

Zomwe zimachitika

Kutengera kuchuluka kwa kuyeretsa ndi zosadetsa, pali zosankha zingapo za insulin - anthu, zophatikizanso, bovine ndi nkhumba. Ambiri zimachitikira mankhwala palokha, zochepa kwambiri pazinthu zomwe zimapangidwa, monga zinc, protamine.

Munthu ndiye amene samva zambiri, pomwe kuchuluka kwakuipa komwe amalembedwa pogwiritsa ntchito bovine.

M'zaka zaposachedwa, ma insulin oyeretsedwa kwambiri agwiritsidwa ntchito, momwe mawonekedwe a proinsulin saposa 10 μg / g, omwe athandizira kusintha kwa zinthu ndi insulin allergy ambiri.

Hypersensitivity imayambitsidwa ndi ma antibodies a magulu osiyanasiyana. Ma immunoglobulins E ndi omwe amachititsa kuti anaphylaxis, IgG azigwirizana, komanso nthaka yogwirizanitsa ndi ziwengo zomwe zidzafotokozeredwe pansipa.

Zomwe zimachitika mdera lanu zimathanso kukhala chifukwa chosagwiritsidwa ntchito molakwika, mwachitsanzo, kuvulala khungu ndi singano kapena malo osankhidwa bwino.

Mafuta a ziwengo

Pompopompo - amapezeka mphindi 15-30 pambuyo pa kuperekera insulin mwa kuyabwa kwambiri kapena kusintha pakhungu: dermatitis, urticaria kapena redness pamalo a jekeseni.

Kuyenda pang'ono - Zisanayambike zizindikiro, tsiku kapena zina zidzadutse.

Pali mitundu itatu yakuyenda pang'onopang'ono:

1. Pafupipafupi - ndi malo a jakisoni okha omwe amakhudzidwa.
2. Zosakhazikika - madera ena amakhudzidwa.
3. Kuphatikizidwa - kukhudzidwa monga tsamba la jekeseni ndi ziwalo zina zamthupi.

Nthawi zambiri, ziwopsezo zimawonetsedwa pakusintha pakhungu, koma zowopsa komanso zowopsa, monga kugwedezeka kwa anaphylactic, ndizotheka.

Pagulu laling'ono la anthu, kumwa mankhwala amakwiya ophatikizidwakuchitapoyodziwika ndi zizindikiro zosasangalatsa monga:

• Kuwonjezeka pang'ono kwa kutentha.
• Zofooka.
• Kutopa
• Kudzimbidwa.
• Zopweteka.
• Kuphipha kwa bronchi.
• Misewu yayikulu.

Nthawi zina, zimachitika zovuta ngati:

• Kutentha kwambiri.
• Subcutaneous minofu necrosis.
• Pulmonary edema.

Zizindikiro

Kupezeka kwa ziwengo kwa insulin kumatsimikiziridwa ndi immunologist kapena allergist potengera kusanthula kwa zizindikiro ndi mbiri. Kuti mupeze matenda olondola, mudzafunikiranso:

1. Patsani magazi (kusanthula kwakanthawi, kuchuluka kwa shuga komanso kudziwa mulingo wa ma immunoglobulins),
2. Pewani khungu ndi magazi matenda, matenda, kuyabwa khungu chifukwa chiwindi kulephera.
3. Pangani zitsanzo za mitundu yaying'ono ya mitundu yonse. Zomwe zimatsimikiza zimatha ola limodzi pambuyo pa njirayi ndi kukula kwake ndi kukula kwa papule.

Chithandizo cha ziwengo

Kuchiza kumayikidwa kokha ndi dokotala, kutengera mtundu wa ziwengo.

Zizindikiro zakuthwa kwambiri zimadutsa popanda kulowerera mkati mwa mphindi 40-60.

Ngati mawonetseredwe akukhala kwa nthawi yayitali ndikuipiraipira nthawi iliyonse, ndiye kuti ndikofunikira kuyamba kumwa ma antihistamines, monga diphenhydramine ndi suprastin.

Jekeseni imagwiritsidwa ntchito nthawi zambiri m'malo osiyanasiyana a thupi. Ngati izi sizikuthandizira, ndiye kuti inshuwaransi ya bovine kapena nkhumba imasinthidwa ndi anthu oyeretsedwa, momwe mulibe zinc.

Pankhani ya zochitika mwadongosolo, adrenaline, ma antihistamine amawongoleredwa mwachangu, komanso kuyikidwa kuchipatala, komwe kupuma ndi magazi ake zimathandizira.

Popeza ndizosatheka kusiyiratu kugwiritsa ntchito mankhwalawa kwa wodwala matenda a shuga, mlingo umachepetsedwa kwakanthawi kambiri, kenako pang'onopang'ono. Pambuyo pokhazikika, pang'onopang'ono (nthawi zambiri masiku awiri) amabwerera pazomwe zimachitika kale.

Ngati, chifukwa cha anaphylactic mantha, mankhwalawo adathetsedwa, ndiye kuti musanayambirenso chithandizo, zotsatirazi zikulimbikitsidwa:

• Yendetsani zitsanzo zamitundu yonse yamankhwala.
• Sankhani yoyenera (yambitsa zotsatira zochepa)
• Yesani kuchuluka kochepera.
• Wonjezerani mlingo pang'onopang'ono, kuwongolera mkhalidwe wa wodwalayo pogwiritsa ntchito kuyezetsa magazi.

Ngati mankhwalawa anali osathandiza, ndiye kuti insulin imaperekedwa nthawi yomweyo ndi hydrocortisone.

Kuchepetsa

Ngati ndi kotheka, sinthani mlingo, wodwalayo adayikidwa zakudya zama carb ochepamomwe chilichonse, kuphatikiza zovuta zamagulu, zimadyedwa pang'ono. Zinthu zonse zomwe zimatha kupangitsa kuti thupi lizigwedezeka kapena kusokoneza thupi siziphatikizidwa m'zakudya, monga:

• Mkaka, mazira, tchizi.
• Wokondedwa, khofi, mowa.
• Kusuta, zamzitini, zokometsera.
• Tomato, biringanya, tsabola wofiyira.
• Caviar ndi nsomba zam'madzi.

Zosankha zake zidatsalira:

• Amamwa mkaka wowawasa.
• Curd.
• Nyama yotsika.
• Kuchokera ku nsomba: nsomba ndi nsomba.
• Kuyambira masamba: kabichi, zukini, nkhaka ndi broccoli.

Zina mwazizindikirozi sizingasonyeze kuti siwofatsa, koma mankhwala osokoneza bongo.

• Chivomerezero chala.
• Kuthamanga kofulumira.
• Thukuta lausiku.
• Mutu wopweteka.
• Kukhumudwa

Mu zochitika zapadera, bongo wowonjezereka ungapangitse kuti mutulutse mkodzo wa nthawi yausiku ndikuwonjezera, kuwonjezereka kwa chidwi ndi kunenepa, komanso hyperglycemia yam'mawa

Ndikofunika kukumbukira kuti ziwengo zimatha kukhala ndi zotsatira zoyipa kwa thupi, chifukwa chake ndikofunikira kuti mupimidwe mosamala musanamwe mankhwalawo ndikusankha mtundu woyenera wa insulin.

Chiwopsezo cha insulin: kodi zingachitike ngati timadzi timene timachitika?

Popanga insulin, mapuloteni amtundu wa nyama amagwiritsidwa ntchito. Amakhala chifukwa chomwe chimayambitsa mavuto ambiri. Insulin ikhoza kupangidwa potengera:

Mitundu ya Mankhwala a Insulin

Recombinant-mtundu insulin imagwiritsidwanso ntchito paudindo. Odwala omwe amapaka insulin tsiku lililonse amakhala pachiwopsezo chotenga mankhwala. Ndi chifukwa cha kukhalapo kwa ma antibodies mthupi kupita ku mahomoni. Ndi matupi awa omwe amakhala gwero la zomwe zimachitikazo.

Chiwopsezo cha insulin chimatha kukhala mitundu iwiri:

Zizindikiro - khungu lakumaso hyperthermia

Ndi chiwonetsero cha zomwe zimachitika nthawi yomweyo, ziwengo za matupi awo zimawoneka nthawi yomweyo munthu akangovulaza insulin. Kuyambira nthawi ya makonzedwe mpaka kumayambiriro kwa zizindikiro, zosaposa theka la ola limadutsa. Munthawi imeneyi, munthu akhoza kukhala wowonetsedwa:

• Hyperemia pakhungu pakubaya,
• urticaria
• dermatitis.

Zomwe zimachitika nthawi yomweyo zimakhudza matupi osiyanasiyana a thupi. Kutengera kutengera kwazizindikiro komanso mawonekedwe awo.

• kwanuko
• kachitidwe
• kuphatikiza pamodzi.

Ndi zowonongeka kwanuko, zizindikiro zimadziwika pokhapokha pakukhazikitsa mankhwala. Kuchita mwadongosolo kumakhudza mbali zina za thupi, kufalikira mthupi lonse. Pankhani yophatikiza, zosintha zakumaloko zimatsatiridwa ndi kuwonekera koyipa m'malo ena.

Ndi pang'onopang'ono ziwengo, chizindikiritso chowonongeka chimadziwika tsiku lotsatira makonzedwe a insulin. Amadziwika ndi kulowetsedwa kwa malo a jakisoni. Allergy amawonetsedwa onse mu mawonekedwe a khungu wamba ndipo amadziwika ndi kuwonongeka kwakukulu kwa thupi.

Ndi chidwi chochulukirapo, munthu amakula anaphylactic kapena edema ya Quincke.

Zizindikiro zakugonjetsedwa

Popeza umphumphu wa pakhungu umalephereka ngati mankhwalawa aperekedwa, chimodzi mwazizindikiro zazikulu ndizosintha pakhungu. Amatha kuwonetsedwa ngati:

• zotupa zambiri zobweretsa chisangalalo chachikulu,
• kuyabwa kwamphamvu
• urticaria
• dermatitis ya atopic.

Zizindikiro - Atopic Dermatitis

Zomwe zimachitika m'deralo zimayendera pafupifupi munthu aliyense amene amamvera insulin. Komabe, pamakhala zotupa zazikulu za thupi. Pankhaniyi, zizindikiro zimawoneka ngati kuchitapo kofotokozedwa. Nthawi zambiri munthu amamva:

• kukwera kutentha kwa thupi
• kupweteka kwa molumikizana
• kufooka kwa chamoyo chonse
• mkhalidwe wotopa
• angioedema.

Pafupipafupi, koma owononga kwambiri thupi. Chifukwa cha kayendetsedwe ka insulin, izi zitha kuchitika:

• malungo
• kutupa kwa minofu ya m'mapapo,
• kuwonongeka kwa minofu ya necrotic pansi pa khungu.

Odwala omwe ali ndi chidwi chachikulu ndikamayambitsa mankhwalawa nthawi zambiri amawonongeka kwambiri mthupi, zomwe zimakhala zowopsa kwambiri. Mu odwala matenda ashuga, angioedema ndi anaphylactic mantha amayamba.

Kuopsa kwa vutoli kuli m'lingaliro loti kusinthaku kumangoyambitsa thupi kwambiri, komanso kumatha kupha.

Ngati chiwonetsero champhamvu chikuchitika, munthu ayenera kuyimbira ambulansi.

Momwe mungatolere insulin?

Momwe thupi limasokoneza insulin sikuti kungoyesa thupi. Ngati zizindikiro zikuchitika, odwala nthawi zambiri sadziwa choti achite, popeza chithandizo cha matenda ashuga chiyenera kupitiliza. Sizoletsedwa kudzipatula pakokha ndi kupereka mankhwala atsopano okhala ndi insulin. Izi zimapangitsa kuyankha kulimbikitsidwa ngati kusankhidwa sikulakwa.

onani Zitsanzo pakhungu. Kuzindikira matupi a chifuwa kumachitika m'magulu azachipatala mwanjira yoyenera kudziwa zotsatira zake.

Zotsatira zake zikachitika, wodwalayo ayenera kufunsa dokotala nthawi yomweyo. Pankhaniyi, adotolo atha kukulemberani nkhawa. Chinsinsi cha njirayi ndikuyesa mayeso pakhungu. Ndikofunikira pakusankha koyenera kwa jakisoni.

Zotsatira za phunziroli ndiye njira yabwino kwambiri yothandizira jakisoni wa insulin. Izi ndichifukwa choti nthawi zina wodwalayo amakhala ochepa nthawi yokwanira kuti asankhe mankhwalawo.

Ngati jakisoni safunika kuchitika mwachangu, ndiye kuti kuyezetsa khungu kumachitika ndi kupatula kwa mphindi 20-30. Munthawi imeneyi, adokotala amawunika momwe thupi limayankhira.

Mwa insulini yodekha kwambiri yogwira thupi la anthu achidwi, mankhwala omwe amapangidwa potsatira mapuloteni amtundu wa munthu amapatulidwa. Poterepa, mayendedwe ake a hydrogen satenga nawo mbali. Amagwiritsidwa ntchito pakagwiritsidwa ntchito ndi insulin yokhala ndi mapuloteni a ng'ombe.

Momwe mungasankhire mankhwala?

Wodwala akayamba kukonzekera ndi insulin yokonzekera mapuloteni a ng'ombe, amamuika wothandizidwa ndi mapuloteni amtundu wa anthu.

Kuchepa kwa mahomoni a insulin kumakhudza kwambiri mkhalidwe wa wodwalayo ndipo amafunika njira yothetsera vutoli, chifukwa chithandizo cha matenda ashuga chiyenera kupitilizidwa.

Kubwezerani pakokha mankhwala ena ndi amodzi ndikoletsedwa, chifukwa ngati chisankho cholakwika chikapangidwa, zotsatira zoyipa za thupi zimakulirakulira. Ngati zizindikiro za ziwopsezo zimachitika, muyenera kufunsa dokotala.

Dokotalayo adzachita desensitization - njira yothandizira khungu la insulin, yomwe imawululira momwe thupi limvera ndi mankhwala ena ake.

Kusankhidwa kwa insulin kumatenga nthawi yambiri. Jekeseni iliyonse imachitika ndi kupatula kwa mphindi 20-30. Desensitization ndi njira yovuta, chifukwa nthawi zambiri wodwalayo samakhala ndi nthawi yama sampuli zingapo. Chifukwa chosankhidwa, wodwalayo amapatsidwa mankhwala omwe sanakumane ndi zovuta zina. Ndizosatheka kusankha nokha kukonzekera insulin, muyenera kufunsa dokotala.

Chiwopsezo cha insulini: zimachitika bwanji ndipo nchifukwa chake

Zomwe zimachitika ndi insulin.

Odwala omwe ali ndi matenda ashuga ayenera kuyang'anira shuga wamagazi awo tsiku lililonse. Ndi kuchuluka kwake, jakisoni wa insulin amafunikira kukhazikika bwino.

Pambuyo pakukonzekera kwa mahomoni, vutoli liyenera kukhazikika, koma zimachitika kuti pambuyo pa jakisoni wodwalayo amakhala ndi vuto la insulin. Tiyenera kudziwa kuti izi zimachitika kawirikawiri - pafupifupi 20-25% ya odwala amakumana nayo.

Mawu ake ndi chifukwa chakuti insulini ili ndi mapuloteni omwe amapanga zinthu zachilendo kwa thupi.

Mawonekedwe akuwonetseraku

Zomwe zimatha kupangitsa kuti ziwonetseke.

Pambuyo kumayambiriro kwa mankhwalawa, mawonetseredwe amtundu wa kawirikawiri komanso wachilengedwe amatha.

Zotsatira zotsatirazi zimatha kuyambitsa mawonekedwe a ziwengo:

• zolimbitsa,
• zoteteza
• olimbitsa
• insulin

Yang'anani! Allergies amatha kuchitika pambuyo pa jakisoni woyamba, komabe, izi sizimachitika. Monga lamulo, ziwengo zimapezeka pambuyo pa milungu 4 yogwiritsidwa ntchito.

Tiyenera kudziwa kuti zomwe zimachitikazo zitha kukhala ndizosiyanasiyana. Ndizotheka kukulitsa edema ya Quincke.

Mawonekedwe akuwonetseraku.

Zomwe zimagawidwa zitha kugawidwa ndi zomwe zimachitika:

1. Mtundu waposachedwa - ukuwonekera pakatha mphindi 15-30 pambuyo pa jakisoni, kudziwoneka mwa njira yochitira pamalo opaka jakisoni mwanjira yotupa.
2. Mtundu Wofatsa. Imadziwoneka yokha mwa mapangidwe a subcutaneous kulowetsedwa, imadziwonekera yokha patatha maola 20-35 pambuyo pa kuperekedwa kwa insulin.

Kuphwanya malamulo opereka jakisoni ndi komwe kumayambitsa mavutowo.

Ndikofunikira kudziwa kuti mtundu wamtundu wamderalo ungachitike chifukwa chosagwirizana ndi chipangizocho.

Zinthu ngati izi zimayambitsa thupi:

• Makulidwe ofunika a singano
• intradermal jakisoni,
• kuwonongeka pakhungu,
• jakisoni amakhala gawo limodzi la thupi,
• makonzedwe ozizira kukonzekera.

N`zotheka kuchepetsa chiopsezo cha sayanjana chifukwa ntchito recombinant insulin. Zotsatira zamderalo sizowopsa ndipo, monga lamulo, zimadutsa popanda kuchitapo kanthu kuchipatala.

Pamalonda a jakisoni wa insulin, chisindikizo china chitha kupangika, chomwe chimadzuka pamwamba penipeni pa khungu. Papule amalimbikira kwa masiku 14.

Yang'anani! Vuto lowopsa ndi chiphunzitso cha Artyus-Sakharov. Monga lamulo, papule imapangidwa ngati wodwala wavulala insulin nthawi zonse pamalo omwewo.

Kusindikiza kumapangidwa pambuyo pa sabata limodzi la kugwiritsa ntchito, limodzi ndi kuwawa ndi kuwawa. Ngati jakisoni walowanso papule, mapangidwe amkati amachitika, kuchuluka kwake kumakulirakulira.

Fistula wopopera ndi puroma amapangika, kuwonjezereka kwa kutentha kwa thupi la wodwala sikumachotsedwa.

Mitundu yayikulu ya zochita.

Mankhwala amakono, mitundu ingapo ya insulini imagwiritsidwa ntchito: kupanga ndi kudzipatula ku zikondamoyo za nyama, nthawi zambiri nkhumba ndi bovine. Mtundu uliwonse wamtunduwu womwe ungatchulidwe umatha kuyambitsa ziwengo, chifukwa thunthu ndi mapuloteni.

Zofunika! Momwemonso thupi limakumana ndi azimayi achinyamata ndi okalamba odwala.

Kodi pali zotheka kuti insulini? Zachidziwikire, ndizosatheka kupatula kuthekera kwazomwe zikuchitika. Kodi ndikofunikira kumvetsetsa momwe zimadziwonekera komanso zoyenera kuchita kwa wodwala yemwe akudwala matenda a shuga omwe amadalira insulin?

Nkhaniyi iyambitsa owerenga mawonekedwe azomwe zimawonetsera ziwengo.

Zizindikiro zazikulu

Mawonekedwe akuwonetseraku.

Zizindikiro zazing'ono zomwe zimachitika m'deralo zimawonekera mwa odwala ambiri.

Pankhaniyi, wodwala angatengeredwe:

• zotupa m'mbali zina za thupi, limodzi ndi kuyabwa.
• urticaria
• dermatitis ya atopic.

Njira yodziwikiratu imawonekera pang'onopang'ono, imadziwika ndi zizindikiro zotsatirazi:

• kuchuluka kwakukulu kwa kutentha kwa thupi,
• chiwonetsero cha kupweteka
• kufooka wamba
• kutopa,
• zotupa zamitsempha
• matenda ammimba
• bronchospasm,
• Edema ya Quincke (chithunzi).

Edema ya Quincke ndi ziwengo.

Zowonetsedwa kwambiri:

• minofu necrosis
• pulmonary edema,
• anaphylactic shock,
• malungo.

Izi zimadzetsa chiwopsezo pamoyo wa munthu ndipo zimafunikira kuchipatala.

Yang'anani! Kuopsa kwa vutoli kukufotokozedwa chifukwa chakuti wodwalayo amakakamizidwa kugwiritsa ntchito insulin nthawi zonse. Pankhaniyi, njira yoyenera kwambiri yamankhwala imasankhidwa - kuyambitsa kwa insulin ya anthu. Mankhwala ali ndi pH yosatenga mbali.

Matendawa ndi oopsa kwambiri kwa odwala matenda ashuga, simungathe kunyalanyaza ngakhale zizindikiro zazing'ono zomwe sizinachitike. Mtengo wa kunyalanyaza zizindikiro zowopsa ndi moyo wa munthu.

Kwa wodwala yemwe ali ndi vuto lotengera matupi ake chifukwa cha zovuta zina, dokotalayo angalimbikitse kuyesedwa kwa allergen asanayambe chithandizo. Kuzindikira kumathandiza kupewa zoyambira zisanachitike.

Kuthekera kwa kulowetsa mankhwalawa kuyenera kukambidwa ndi katswiri.

Ndikofunika kulabadira kuti odwala omwe amagwiritsa ntchito insulin ayenera kukhala ndi antihistamine nthawi zonse - izi ndizofunikira kuti anthu asamagwidwe. Fotokozerani kuthekera kwa kugwiritsa ntchito kwa mankhwalawa kuyenera kukhala ndi dokotala munthawi iliyonse.

Malangizo ogwiritsira ntchito mankhwalawa ali ocheperako ndipo nthawi zonse samayang'anira dongosolo loyenera la munthu wodwala matenda ashuga.

Momwe mungadziwire ziwengo?

Zambiri za mayeso a labotale.

Kuti mudziwe zowona zamatsenga ayenera kufunsa katswiri. Kuzindikira kumachitika chifukwa chazizindikiro ndi kukhazikitsa mbiri ya wodwala.

Kuti mupeze matenda olondola, muyenera:

• kuyezetsa magazi kudziwa kuchuluka kwa ma immunoglobulins,
• kuyezetsa magazi konse
• kuyezetsa magazi kwa shuga,
• kuchita mayeso ndi kuyambitsa mitundu yonse ya insulini yaying'ono.

Ndikofunika kudziwa kuti posankha matenda, ndikofunikira kupatula zomwe zingayambitse kuyabwa, kuphatikiza matenda, magazi kapena khungu.

Zofunika! Kuyabwa nthawi zambiri kumakhala chifukwa cha kulephera kwa chiwindi.

Njira zochizira

Njira yamankhwala imatsimikiziridwa ndi dokotala kutengera mtundu wa ziwengo ndi njira ya matenda ena a shuga wodwala wina. Zizindikiro za thupi lawo siligwirizana, zomwe zimawonetsedwa pang'ono, zimatha kudzimiririka lokha ola limodzi, izi sizikufunika kulowererapo.

Kuwonetsedwa kwa mankhwala kumafunika ngati zizindikiro za ziwengo zilipo kwa nthawi yayitali, ndipo mkhalidwe wa wodwalayo ukuipiraipira mwachangu. Zikatero, pakufunika kugwiritsa ntchito antihistamines monga diphenhydramine ndi suprastin.

Malangizo ambiri amatsata malamulo awa:

1. Mlingo wa insulin umachepetsedwa pang'ono, jakisoni amapangidwa nthawi zambiri.
2. Muyenera kusinthasintha malo a jakisoni wa insulin.
3. Bovine kapena nkhumba insulin imalowedwa m'malo ndi kuyeretsedwa, munthu.
4. Ngati mankhwalawa satha, wodwalayo amapaka jakisoni ndi insulin limodzi ndi hydrocortisone.

Ndi zochitika mwadongosolo, kuchitapo kanthu kwachipatala mwadzidzidzi kumafunika. Ma antihistamines, epinephrine, amaperekedwa kwa wodwala. Anayikidwa kuchipatala kupuma komanso magazi.

Mafunso kwa katswiri

Tatyana, wa zaka 32, Bryansk

Masana abwino Ndinapezeka ndi matenda a shuga zaka 4 zapitazo. Chilichonse chinkayenda bwino, kupatula kutsekeka kwanga chifukwa choti ndimadwala. Tsopano ndikumenya Levemir, posachedwa ndimakumana ndi ziwopsezo. Chotupa chake chimapezeka pamalo a jakisoni, chimayamwa kwambiri. M'mbuyomu, insulin iyi sigwiritsidwa ntchito. Ndichite chiyani?

Masana abwino, Tatyana. Muyenera kulumikizana ndi dokotala kuti mudziwe chomwe chimayambitsa matendawo. Levemir adatumizidwa kuti? Zomwe zidagwiritsidwa ntchito isanachitike ndipo ndi kusintha kotani komwe kunawonetsedwa?

Osadandaula, makamaka izi sizomwe zingachitike. Choyamba, werengani zakudyazo, kumbukirani zomwe adayamba kugwiritsa ntchito kuchokera ku mankhwala apakhomo.

Maria Nikolaevna, wazaka 54, Perm

Masana abwino Ndimagwiritsa ntchito Pensulin kwa sabata limodzi. Ndinayamba kuwona kuwonekera kwa kuyabwa, koma osati pamalo opaka jekeseni, koma thupi lonse. Kodi ndizosagwirizana? Ndipo momwe mungakhalire popanda matenda a shuga a insulin?

Moni, Maria Nikolaevna. Osadandaula. Mulimonsemo, muyenera kuwona dokotala ndikusankha mwayi wowonetsa kuphwanya kwa ziwalo zamkati. Zomwe zimayambitsa kuyabwa mthupi lonse sizingokhala insulini zokha.

Ntchito Pensulin poyambirira? Ichi ndi insulin ya nkhumba, yomwe imatha kukhala allergen. Insulin yaumunthu ndiyomwe ilinso yovuta kwambiri. Pakapangidwe kake, kuyeretsa kokwanira kumachitika, ndipo kulibe mlendo wa protein, ndiye kuti pali njira zina zomwe mungapangire, onetsetsani kuti mwakumana ndi dokotala.

Pochiza matenda a shuga mellitus, mitundu yambiri ya insulin yokonza (bovine, nkhumba, munthu) imagwiritsidwa ntchito, mosiyanasiyana muyezo wa kuyeretsa komanso zomwe zimakhala ndi mapuloteni kapena zosafunikira zama protein. Kwenikweni, thupi lawo limakumana ndi insulini palokha, nthawi zambiri limatulutsa protini, zinki ndi zinthu zina zomwe zimagwiritsa ntchito mankhwalawa.

Chiwerengero chochepa kwambiri cha zoyipa zonse zimawonedwa mukamagwiritsa ntchito mitundu yambiri ya insulin yaumunthu, yayikulu kwambiri - ndikuyambitsa insulin ya nyama.

Chosavomerezeka kwambiri ndi insulini ya bovine, kusiyana pakati pa anthu kumadziwika kwambiri (zotsalira zina za amino acid za A unyolo ndi amodzi mwa unyolo wa B). Insulin ya nkhumba imakhala yochepa kwambiri (zotsalira za amino acid zokha za B unyolo ndizosiyana).

Chiwerengero cha milandu ya insulin allergy yachepa kwambiri pambuyo pokhazikitsa insulin yotsukidwa kwambiri muzochita zamankhwala (zomwe zimapezeka mu proinsulin ndizochepera 10 μg / g).

Kukhazikika kwokhudzana ndi zochitika zakumaloko kumatha kuphatikizidwa ndi kuperewera kwamankhwala osayenera (intradermally, ndi singano yayikulu ndikulimbana kwambiri ndi khungu, zosankha zoyenera za jakisoni, kukonzekera kwambiri, etc.).

Hypersensitivity jekeseni wa mankhwala amapangidwa ndi kutenga ma antibodies osiyanasiyana m'makalasi osiyanasiyana. Zoyipa zoyambirira zam'deralo ndi anaphylaxis nthawi zambiri zimayamba chifukwa cha ma immunoglobulins E.

Kupezeka kwa zimachitika 5-8 patatha maola kukhazikitsa insulin kukonzekera ndi chitukuko cha insulin kukhudzana amagwirizana ndi IgG.

Thupi lomwe limayambitsa insulin yomwe imayamba patatha maola 12-24 pambuyo pa kuperekera mankhwalawa nthawi zambiri imawonetsa kuchepa kwakanthawi kochepa komwe kumayambitsa matenda a insulin kapena mankhwala a zinc omwe amapezeka m'mankhwala.

Zizindikiro za Insulin Allergy

Kuchepetsa kwa insulin nthawi zambiri kumawonetsedwa ndi kupezeka kwa mawonekedwe amtundu wa hypersensitivity, omwe amatha kuchitika pambuyo pa maola a 0.5-1 pambuyo pa mankhwala ndikuwonekeratu mwachangu (poyambirira), kapena maola 4-8 (nthawi zina mawola 12-24) atabayidwa - kuchedwa, kugwiritsidwa ntchito mochedwa, mawonetseredwe azachipatala omwe amatha masiku ambiri.

Zizindikiro zikuluzikulu zakomwe zimayambitsa matendawa ndi kufupika, kutupa komanso kuyabwa pamalowo.

Kuyabwa kumatha kukhala kwanuko, pang'ono, nthawi zina kumakhala kosapirira ndipo kumatha kufalikira kumadera oyandikana ndi khungu. Nthawi zina, khungu limakhudza khungu.

Nthawi zina pamalo a jakisoni wa insulin, chisindikizo chitha kuwoneka chomwe chimakwera pamwamba pa khungu (papule) ndikuchuluka kwa masiku atatu.

Nthawi zina, kuyika insulin nthawi yayitali m'malo omwewo kungapangitse kuti pakhale zovuta zam'deralo, monga chodabwitsa cha Arthus.

Pankhaniyi, kuyabwa, kupweteka kwapweteka pamalo a jakisoni kumatha kuwonekera patatha masiku 3-5 mpaka atayamba kuperekera insulin.

Ngati jakisoni akupitilizidwa kudera lomwelo, kulowetsedwa kumapangika, komwe kumawonjezereka, kumakhala kowawa kwambiri ndipo kumatha kupangika ndikupanga fistulas ya abscess ndi purulent, kuwonjezeka kwa kutentha kwa thupi komanso kuphwanya chikhalidwe chazonse cha wodwalayo.

Mavuto

Allergy insulin ndi chitukuko cha zonse, ambiri zimachitikira amapezeka 0,2% odwala matenda a shuga, nthawi zambiri kuposa, zizindikiro zamankhwala amachepetsa maonekedwe a urticaria (hyperemia, matuza a kuyiwalika pamalo a jekeseni), komanso kawirikawiri kufikira chitukuko cha angioedema Quincke edema kapena anaphylactic. Zochitika zamachitidwe zimagwirizana ndi kuyambiranso kwa insulin mankhwala patatha nthawi yayitali.

Zotsogola ndi kupewa

Mukamakonza insulin ndikukhala yotsukidwa pang'ono, zizindikiro za ziwengo zimatha. Nthawi zina, zovuta zonse zokhudza thupi zimachitika.

Kupewa kumakhala ndi kusankhidwa koyenera kwa insulin kukonzekera ndi kusinthitsa kwakanthaŵi kwake ngati thupi lanu siligwirizana.

Kuti tichite izi, odwala ayenera kudziwa momwe ziwonetsero zimayambira ku insulin komanso momwe angaimire zotsatira zosafunikira.

Thupi lawo siligwirizana ndi insulin

Malinga ndi ziwerengero, ziwonetsero kwa insulin zimachitika mu 5-30% ya milandu. Choyambitsa chachikulu cha matenda ndi kupezeka kwa mapuloteni m'makonzedwe a insulin, omwe amadziwika ndi thupi ngati ma antigen. Kugwiritsa ntchito mankhwala aliwonse a insulin kungayambitse chifuwa.

Izi zitha kupewedwa pogwiritsa ntchito zinthu zamakono zotsukidwa kwambiri. Kapangidwe ka ma antibodies poyankha insulin yolandiridwa kuchokera kunja kumatsimikiziridwa ndi kutengera kwa chibadwa cha wodwalayo. Anthu osiyanasiyana amatha kusintha mosiyanasiyana mankhwala omwewo.

Zimayambitsa ziwengo kuti insulin kukonzekera

Mukamaphunzira kapangidwe ka insulin ya nyama ndi ya anthu, zidapezeka kuti zamitundu yonse, insulin ya nkhumba ndiyomwe ndiyandikana kwambiri ndi anthu, zimasiyana mu amino acid imodzi. Chifukwa chake, kuyambitsa insulin ya nyama kwa nthawi yayitali ndiye njira yokhayo yothandizira.

Choyipa chachikulu chinali kupangika kwa thupi lawo siligwiritsa ntchito mphamvu komanso nthawi yayitali. Kuphatikiza apo, kukonzekera kwa insulin kumakhala ndi mitundu ya proinsulin, pancreatic polypeptide ndi mapuloteni ena. Pafupifupi odwala onse, atayambitsa insulin miyezi itatu pambuyo pake, ma antibodies ake amapezeka m'magazi.

Kwenikweni, chifuwa chimayamba chifukwa cha insulin yomwe, nthawi zambiri imakhala ndi mapuloteni kapena mapuloteni ena osakhala ndi mapuloteni. Milandu yaying'ono kwambiri yazakumwa idanenedwa ndikuyambitsa kwa insulin yaumunthu yomwe imapezeka ndi ma genetic engineering. Zomwe zimayamwa kwambiri ndi bovine insulin.

Kapangidwe kakumvekera kumawonekera m'njira zotsatirazi:

1. Kuchita kwamtundu wamtunduwu komwe kumalumikizidwa ndi kutulutsidwa kwa immunoglobulin E. Amayamba pambuyo pa maola 5-8. Zikuwoneka ndi zochita zakomweko kapena anaphylaxis.
2. Zomwe amachita zikuchedwa. Kuwonetsera kwadongosolo komwe kumachitika pambuyo pa maola 12-24. Imachitika mu mawonekedwe a urticaria, edema kapena anaphylactic reaction.

Kuwonetsedwa kwanuko kungachitike chifukwa chosagwiritsa ntchito mankhwalawa - singano yolimba, imalowetsedwa mkati, khungu limavulala pakukhazikitsidwa, malo olakwika amasankhidwa, insulin yozizira kwambiri imayambitsidwa.

Mawonekedwe a ziwonetsero kwa insulin

Ziwengo kwa insulin anati 20% ya odwala. Pogwiritsa ntchito insulin yothandizanso, mafupidwe amomwe amachititsa sayanjana amachepetsa. Ndi mawonekedwe amderalo, mawonetseredwe nthawi zambiri amawonekera ola pambuyo jekeseni, amakhala osakhalitsa ndipo amatha mofulumira popanda chithandizo chapadera.

Pambuyo pake kapena kuchedwa kuchitikira kwanuko kumatha kupanga maola 4 mpaka 24 pambuyo pa jekeseni ndikutha maola 24. Nthawi zambiri, zizindikiro za matenda ammundu zimachitika mu hypersensitivity kuti insulin imawoneka ngati redness la khungu, kutupa ndi kuyabwa pamalowo jekeseni. Khungu loyenda limatha kufalikira mpaka pafupi ndi zimakhala.

Nthawi zina chimakhala chidindo chochepa pamalo a jakisoni, omwe amakwera pamwamba pa khungu. Tsamba ili limatenga pafupifupi masiku awiri. Vuto losowa kwambiri ndi chiphunzitso cha Artyus-Sakharov. Kuchita kotereku kumachitika ngati insulin imagwiritsidwa ntchito malo amodzi.

Kupanga pankhaniyi kumawonekera pakatha pafupifupi sabata, limodzi ndi kuwawa ndi kuwawa, ngati jakisoni atagundika papulo yotere, ndiye kuti kulowetsedwa kumapangika. Pang'onopang'ono zimachulukira, zimapweteka kwambiri, ndipo matenda akaphatikizika, amawonjezera. Fomu ya fisula ndi purulent, kutentha kumakwera.

Zowonekera kwazomwe zimayenderana ndi insulin ndizosowa, zimawonetsedwa ndi zotere:

• Kuchepa kwa khungu.
• Urticaria, matuza oyenda.
• Edema wa Quincke.
• Kugwedezeka kwa anaphylactic.
• Kuphipha kwa bronchi.
• Polyarthritis kapena polyarthralgia.
• Kudzimbidwa.
• Misewu yayikulu.

Kuchita kwadongosolo pokonzekera insulin kumawonetsedwa ngati mankhwala a insulin adasokonezedwa kwa nthawi yayitali, kenako ndikuyambiranso.

Thupi lawo ndi insulin

Etiology. Chiwopsezo cha insulin ndi insulin kukana chifukwa cha mphamvu ya chitetezo cha mthupi chimasungidwa ndi ma antibodies. Allergen sangakhale insulini, koma mapuloteni (mwachitsanzo protamine) ndi zosafunikira (mwachitsanzo zinc) zomwe zimapanga mankhwalawa. Komabe, nthawi zambiri, ziwengo zimayambitsidwa ndi insulin yokha kapena ma polima ake, monga zikuwonetsedwa ndi zochitika zakomweko zomwe zimachitika chifukwa cha insulin ya anthu komanso kayendetsedwe ka zinthu ku insulin yoyesedwa kwambiri.

Bovine, nkhumba, ndi ma insulin a anthu amagwiritsidwa ntchito pochiza matenda ashuga. Insulin yaumunthu imachepa kwambiri kuposa ma insulin a nyama, ndipo insulin ya porcine imakhala yochepa kwambiri kuposa bovine. Bovine insulin imasiyana ndi insulin yaumunthu m'magulu awiri a amino acid a A chain ndi amino acid omwe amatsalira a B unyolo, ndi insulin ya amino acid yotsalira ya B.

Maunyolo amtundu wa insulin ya anthu ndi porcine ndi ofanana. Ngakhale insulin yamunthu ndiyosavomerezeka kwambiri kuposa nkhumba, kuyanjana kwa insulin yaumunthu kumatheka. Mlingo wa kuyeretsa kwa insulini umatsimikizidwa ndi zomwe proinsulin imayipitsa. M'mbuyomu, insulin yomwe ili ndi 10-25 μg / g ya proinsulin idagwiritsidwa ntchito; tsopano insulin yotsukidwa kwambiri yomwe imagwiritsa ntchito zosakwana 10 μg / g ya proinsulin imagwiritsidwa ntchito.

Kuchepa kwakanthawi koyamba komwe thupi lanu siligwirizana, komanso kukana insulini pambuyo pofunitsitsa kukhala ndi insulin, zitha kukhala chifukwa chakuletsa IgG. Zotsatira zoyipa zam'deralo zomwe zimachitika patatha maola 8-24 pambuyo pa jekeseni wa insulin zimatha kukhala chifukwa cha kuchepetsedwa kwa mtundu womwe sagwirizana ndi insulin kapena zinc.

Kukana kwa insulini kumatha kukhala chifukwa cha machitidwe onse a chitetezo cha m'thupi komanso osagwiritsa ntchito chitetezo. Njira zopanda chitetezo mthupi zimaphatikizira kunenepa kwambiri, ketoacidosis, vuto la endocrine, matenda.

Nthawi zambiri zimachitika mchaka choyamba cha mankhwala okhala ndi insulin, amakula patatha milungu ingapo ndipo amatenga masiku angapo mpaka miyezi ingapo. Nthawi zina kukana insulini kumachitika pa nthawi yofunitsitsa insulini.

Chithunzi cha chipatala.

Chiwopsezo cha insulin chitha kuchitika mderalo komanso mwatsatanetsatane. Amawonedwa mu 5-10% ya odwala. Nthawi zambiri pamachitika zochitika zofatsa. Pazaka zingapo zapitazi, kufalikira kwa thupi lawo chifukwa cha insulin kwatsika kwambiri.

Zotsatira zoyipa zam'deralo (edema, kuyabwa, kupweteka) zimatha kuyamba ndikuchedwa. Zoyambirira zimawonekera ndikusowa mkati mwa ola 1 jakisoni, omaliza atatha maola ochepa (mpaka maola 24). Nthawi zina, zimachitika kawiri konse: mawonetseredwe ake oyambilira amakhala osapitilira ola limodzi, ndiye pambuyo pa maola 4-6 pambuyo pake, mawonekedwe owonjezereka amapezeka.

Nthawi zina papule yopweteka imawoneka pamalo opangira insulin, omwe amakhala masiku angapo. Mapapu nthawi zambiri amapezeka sabata ziwiri zoyambirira za mankhwala a insulin ndipo amatha milungu ingapo. Mikwingwirima yayikulu yakomweko, makamaka ikukhudzana ndi insulin iliyonse, nthawi zambiri imayambira kuchitapo kanthu.

Zotsatira zoyipa za insulin zimachitika kawirikawiri. Nthawi zambiri amawonetsedwa ndi urticaria. Zotsatira zoyipa zonse zimachitika ndi kuyambanso kwa insulin mankhwala patapita nthawi yayitali.

Zotsatira zoyipa zam'deralo nthawi zambiri zimakhala zofatsa, chokani msanga osafunikira chithandizo. Kuti muchite izi mwamphamvu komanso molimbika, zotsatirazi zikulimbikitsidwa:

H1-blockers, mwachitsanzo, hydroxyzine, akulu - 25-50 mg pakamwa katatu pa tsiku, kwa ana - 2 mg / kg / tsiku pakamwa mu magawo 4 agawidwe. Malingana ngati zochita zakomweko zikupitirirabe, gawo lililonse la insulin limagawika ndikugawidwa m'malo osiyanasiyana. Zopangira nkhumba kapena insulin yaumunthu yomwe ilibe zinc imagwiritsidwa ntchito.

Kusamalidwa makamaka kuyenera kuthandizidwa pakukweza matupi awo chifukwa nthawi zambiri izi zimayambira kusanachitike kwa anaphylactic. Kulowerera kwa insulin mankhwala ngati insulin yodalira shuga ikulimbikitsidwa osavomerezeka pamenepa, chifukwa izi zimatha kukulitsa vutoli ndikukulitsa vuto la anaphylactic atayambiranso chithandizo ndi insulin.

Anaphylactic zochita:

Anaphylactic zochita insulin amafuna yemweyo mankhwala anaphylactic zimachitika chifukwa allergen ena. Ndi kukula kwa anaphylactic, kufunika kwa insulin chithandizo kumayesedwa. Komabe, nthawi zambiri, ndizosatheka kusintha insulin ndi mankhwala ena. Ngati mawonetseredwe a anaphylactic reaction apitilira kwa maola 24-48, ndipo chithandizo chokhala ndi insulin chimasokonezedwa, zotsatirazi zikulimbikitsidwa: choyamba, wodwalayo amagonekedwa kuchipatala, ndipo mlingo wa insulin umachepetsedwa katatu, ndipo chachiwiri, mlingo wa insulin ukuwonjezekanso pakatha masiku angapo kwa achire. Ngati chithandizo cha insulin chasokonekera kwa maola opitilira 48, insulin sensitivity imayesedwa pogwiritsa ntchito kuyesa kwa khungu ndikutsimikiza kumachitidwa.

Kuyesa kwa khungu ndi insulin kumatha kudziwa mankhwalawa omwe amayambitsa zovuta zoyipa pang'ono kapena zosagwirizana. Zitsanzo zimayikidwa ndi ma piritsi angapo a insulin 10, obayira intradermally.
Desensitization imayamba ndi mlingo womwe umakhala wofupikirapo kakhumi poyerekeza ndi zomwe zimayambitsa zotsatira zabwino pakhungu. Mankhwalawa amachitika kokha kuchipatala. Choyamba, kukonzekera kwa insulin kochepa kumagwiritsidwa ntchito, pambuyo pake amawonjezeredwa mankhwala okhala ndi nthawi yayitali.

Ngati mankhwalawa amayamba chifukwa cha insulini pakukhala wofunitsitsa, mlingo wa mankhwalawa suwonjezereka mpaka zotsatira zake zitapitirira. Ndi chitukuko cha anaphylactic, mlingo umatheka, pambuyo pake umachulukana bwino. Nthawi zina, munthawi ya anaphylactic, njira ya desensitization imasinthidwa, kuchepetsa nthawi pakati jakisoni wa insulin.

Kukana kwa insulin chifukwa cha ma immune immune system:

Ndi kufunikira kwakakulirakulira kwa insulini, kuthandizira kuchipatala ndi kuyezetsa ndikofunikira kuti athetse zifukwa zomwe siziri chitetezo cha mthupi chifukwa cha insulin. Mankhwala othana ndi insulin, nthawi zina zimakhala zokwanira kusinthira nkhumba yoyesedwa kapena insulin yaumunthu, ndipo nthawi zina kumatha mayankho a insulini wambiri (500 mg / tsiku) kapena protamine-zinc-insulin. Ngati kusokonezeka kwakukulu kwa metabolic kumawonedwa ndikufunika kwa insulini kumawonjezeka kwambiri, prednisone imayikidwa, 60 mg / tsiku ndi pakamwa (kwa ana --1-2 mg / kg / tsiku ndi pakamwa). Pa chithandizo cha corticosteroid, kuchuluka kwa shuga m'magazi kumayang'aniridwa nthawi zonse, chifukwa hypoglycemia imatha kupanga ndikuchepa kwambiri kwa zofuna za insulin. Pambuyo pakuchepetsa ndikukhazikitsa kufunika kwa insulin, prednisone imakhazikitsidwa tsiku lililonse. Kenako mlingo wake umachepetsedwa, kenako mankhwala amatha.

Zotsatira zoyipa za insulin zokonzekera zomwe sizimakhudzana ndi kwachilengedwe

Pakadali pano, zokonzekera zonse za insulin zimayeretsedwa kwambiri, i.e. sikuti mulibe mapuloteni osayera, chifukwa chake machitidwe a chitetezo cha mthupi omwe amayamba chifukwa cha thupi (ziwopsezo, kukana insulini, lipoatrophy pamalo a jekeseni) ndizosowa kwenikweni.

Ngakhale kupezeka kwa pafupipafupi kwa mankhwala osokoneza bongo a insulin omwe amapezeka ku matenda a shuga 1, kuchuluka kwa zovuta za insulin zamankhwala 1 ndi mtundu 2 za shuga ndizofanana. Ngati mumangokhala ndi chizolowezi chowerengera tsiku ndi tsiku komanso momwe mungagwiritsire ntchito jakisoni wamakono a insulin, ndiye kuti mu milungu iwiri yoyambirira ya chithandizo akhoza kuganiziridwa mu milandu ya 1-2%, yomwe mu miyezi yotsatira ya 1-2 imangosowa mu 90% ya odwala, ndi ena onse 5% ya odwala - pakatha miyezi 6-12.

Mitundu itatu ya momwe thupi lawo siligwirizana ndi zomwe zimachitika mwakukonzekera kwa insulin zimasiyanitsidwa, ndipo zomwe zimayambitsa matendawa pokonzekera insulin yatsopano zimakhalabe chimodzimodzi monga kale kwa nyama:

zotupa zapaderapo zokhala ndi zotupa: mkati mwa mphindi 30 pambuyo pa jekeseni, zotupa zimawonekera pamalo a jekeseni, omwe amatha kutsatiridwa ndi ululu, kuyabwa ndi matuza ndikusowa mkati mwa ola limodzi. Izi zitha kuphatikizidwa ndi kukonzanso pamalo a jekeseni wa zotupa zopweteka (kupweteka, erythema) ndi kuchuluka pambuyo pa maola 12 - 24 (biphasic reaction), zomwe zimachitika mu Arthus (kuchuluka kwa antigen-antibody complexes pamalo opangira jakisoni) insulin pambuyo maola 4-6 ndi peak pambuyo maola 12 ndipo amadziwika ndi zotupa zakwanuko zazing'onozing'ono ndi neutrophilic kulowetsedwa. Kawirikawiri siziwoneka bwino, komwe kuchepa kwakanthawi kovutikira (mtundu wa tuberculin): kamakhala patatha maola 8 mpaka 12 pambuyo pa kukhazikitsidwa ndi chiwerengero pambuyo pa maola 24. Pa jakisoni wothandizira, kutupa kumachitika ndi malire omveka bwino ndipo nthawi zambiri kumakhudza mafuta osaneneka, opweteka ndipo nthawi zambiri amayenda ndi kuyabwa ndi kupweteka. Mbiri yakale imavumbula kuphatikizika kwa mononucleocytes, mwatsatanetsatane: m'mphindi zochepa zotsatira za insulin, urticaria, angioedema, anaphylaxis ndi zina mwatsatanetsatane zomwe zimachitika, zomwe nthawi zambiri zimayendera limodzi ndi zochitika zakomweko.

Nthawi yomweyo, overdiagnosis ya insulin ziwopsezo, makamaka zamtundu wa kuchipatala, zimawonekera - pafupifupi wodwala m'modzi mwa theka la chaka amavomerezedwa kuchipatala chathu ndi matenda a insulin, omwe adakhala chifukwa chokana insulin.

Ngakhale kusiyanitsa kusiyanasiyana kwa ziwonetsero mpaka kukonzekera kwa insulini kuchokera ku ziwonetsero zosiyanasiyana sikuli kovuta, chifukwa kumakhala ndi mawonekedwe ofotokozera (Zizindikiro zapadera). Kafukufuku wokhudzana ndimomwe thupi limagwirira kukonzekera kwa insulin zaka zoposa 50 za mankhwala a insulini kunawonetsa kuti palibe zatsankho zomwe zimayambitsa matenda a insulin (monga urticaria, etc.) popanda chifuwa pamalo opaka jekeseni etc.).

Koma ngati mukukayikirabe za kupezeka kwa ziwopsezo, ndiye kuti mukuyenera kuyesa mayeso enaake mwazomwe mukukonzekera insulin, yomwe imawerengedwa kuti ndi yolanditsa wodwalayo, ndipo chifukwa cha izi simukufunika kuti mupeze insulin, chifukwa palibe machitidwe anaphylactic ngakhale pamavuto okayikira. Panthawi yomweyo mtundu wa ziwopsezo insulin, kuyabwa, redness, matuza, nthawi zina ndi pseudopodi, etc. kuwonekera m'malo intradermal makonzedwe a insulin pambuyo mphindi 20.

Chiyeso chamtundu woyambirira chimayesedwa ngati chotupa chimapezeka pamalo a jekeseni wa intradermal wokulirapo kuposa 5 mm, ndipo zimayang'aniridwa zimatchulidwa pamene chithupsya chili chachikulu kuposa masentimita 1. Kupatula mitundu yonse ya zosagwirizana ndi malo omwe mukutsatira, tsamba la intradermal insulin management liyenera kuwonedwa kwa mphindi 20 pambuyo pa kubayidwa pambuyo 6 maola komanso 24 maola.

Ngati ziwonetserozo zatsimikiziridwa, ndiye kuti kuyezetsa ndi insulin ina ndikukonzekera zomwe zingachitike kuti wodwalayo apitirize chithandizo. Ngati mulibe insulin yotere ndipo zomwe zakhudzidwazo zikufotokozedwa, ndiye kuti muchepetse muyeso wa insulin yomwe imayikidwa pamalo amodzi: gawani mlingo wofunikira mu malo angapo jakisoni kapena perekani chithandizo ndi insulin dispenser.

Ndi malingaliro amderalo a mtundu waposachedwa, hyperensitization intradermal imathandizanso. Mankhwalawa nthawi zambiri amakhala osakhalitsa, chifukwa m'miyezi ikubwera ziwonetserozo za insulin zimatha pakati pa chithandizo cha insulin.

Ngati zokhudza zonse ziwopsezo insulin kutsimikizika pa intradermal kuyeza, intradermal hyposensitization ndi insulin ikuchitika, zomwe zimatha kuchokera masiku angapo mpaka miyezi, ngati palibe chifukwa chofunikira chothandizira kuperekera mlingo wonse wa insulin (matenda a shuga kapena kupindika kwambiri kwa matenda ashuga).

Njira zambiri zafunsidwa kuti intradermal hyposensitization ndi insulin (makamaka insulin Katemera), yomwe imasiyana kwambiri pamlingo wokuwonjezeka kwa intulin ya insulin. Kuchuluka kwa hyposensitization pankhani ya thupi lawo siligwirizana nthawi yomweyo zimatsimikiziridwa ndi kuyankha kwa thupi pakuwonjezeka kwa insulin.

Nthawi zina amauzidwa kuti ayambe ndi okwera kwambiri, pafupifupi homeopathic, ma dilutions (1: 100,000, mwachitsanzo). Njira za hyposensitization zomwe zimagwiritsidwa ntchito masiku ano pochiza ziwengo pakukonzekera kwa insulin yaumunthu komanso kufananiza kwa insulin kwafotokozedwa kwa nthawi yayitali, kuphatikiza pakulemba kwanga kwa udokotala, komwe kumapereka zotsatira za chithandizo changa pafupifupi milandu makumi asanu yatsoka yomwe imakhudzana ndi mtundu wapafupi kwa onse omwe adapanga kukonzekera kwa insulin.

Mankhwalawa amalemedwa kwambiri kwa wodwala komanso kwa dotolo, ndipo nthawi zina amakokoloka kwa miyezi ingapo. Koma pamapeto pake, zinali zotheka kuti achotse zodetsa nkhawa zonse za insulin kwa odwala onse omwe apempha thandizo.

Ndipo pamapeto pake, momwe mungachitire ndi ziwopsezo za insulin, ngati zikuwonekera pazokonzekera zonse za insulin, ndipo wodwala amafunikira insulini mwachangu pazifukwa zaumoyo? Ngati wodwala akudwala matenda a shuga kapena precom, ndiye kuti insulin imayikidwa mu mankhwala ofunika kuchotsera mkaka, ngakhale kudzera m'mitsempha, popanda njira yoyambirira ya hyposensitization kapena makonzedwe a antihistamines kapena glucocorticoids.

Mdziko lonse lapansi limachita insulini, milandu inayi imafotokozedwa, ndipo ziwiri za insulini zimachitika ngakhale kuti panali ziwengo, ndipo odwala adatha kuchotsedwa pamankhwala osokoneza bongo, ndipo sanayambepo anaphylactic reaction, ngakhale anali ndi insulin. Nthawi zina ziwiri, madokotala atasiya kuperekera insulin, odwala amwalira ndi matenda ashuga.

Kukayikiridwa kwa ziwopsezo pakukonzekera insulin yaumunthu kapena analogue ya insulin yaumunthu mwa odwala omwe adavomerezedwa ku chipatala chathu sichinatsimikizidwe mulimonsemo (kuphatikizapo kuyesedwa kwa intradermal), komanso kukonzekera kwa insulin kunayikidwa kwa odwala, popanda zovuta zilizonse .

Kukana kwa insulini pakukonzekera kwamakono kwa insulin, komwe kumayambitsa ma IgM ndi ma IgG ma insulin, ndikosowa kwambiri, chifukwa chake, kutsutsana ndi insulin kuyenera kuyambitsidwa koyamba. Odwala osanenepa kwambiri, chizindikiritso cha insulin chomwe chikufunika ndi kufunika kwa insulin ya mayunitsi 1-2 / kg yolemetsa, komanso yayikulu - zopitilira 2 kg / kg. Ngati insulin yolembedwera wodwalayo ilibe chiyembekezo cha hypoglycemic, ndiye kuti muyenera kufufuza:

thanzi la cholembera cha insulin, kukwana kwa chizindikiritso cha insulini ya insulin ndende, kuchuluka kwa cholembera, cholembera, ndi tsiku lotha, ndikulowetsa cartridge (vial) ndi yatsopano, yang'anani momwe njira zoperekera ziwonjezere odwala. kufunika kwa insulin, makamaka yotupa ndi oncological (lymphoma),

Ngati zifukwa zonse zomwe zili pamwambazi sizikupezeka palimodzi, ndiye kuti mukulangizani mlongo yekhayo woyang'anira kuti apereke insulini. Ngati njira zonsezi sizikukwaniritsa zotsatira za chithandizo, titha kuganiza kuti wodwalayo ali ndi chitetezo chokwanira cha insulin. Nthawi zambiri, pakatha chaka chimodzi, kawirikawiri zaka 5, zimatha popanda chithandizo chilichonse.

Kuzindikira kwa kukana chitetezo cha insulin ndikofunikira kutsimikizira kuphunzira kwa ma antibodies a insulin, omwe, mwatsoka, sikuchitika. Kuchiza kumayambira ndikusintha kwa mtundu wa insulin - kuchokera kwa munthu kupita ku mankhwala a insulin yaumunthu kapena mosinthanitsa, kutengera momwe wodwala amakhalira.

Ngati chitetezo cha insulin chitha kukhala chosowa, ndiye kuti ndi T2DM, kuchepa kwa chidwi cha zochita za insulin ("kwachile" kukana insulin) ndi gawo lake lofunikira.

Komabe, zimakhala zovuta kutsimikizira izi insulin yotsutsana ndi odwala omwe ali ndi matenda a shuga 2 mwanjira zovomerezeka. Monga tafotokozera pamwambapa, kukana insulini kumayesedwa lero ndi kufunika kwake pa kilogalamu imodzi yakulemera kwa thupi.

Popeza kuchuluka kwa odwala omwe ali ndi matenda amtundu wa 2 achepa, kuwerengetsa kwa insulin pa 1 makilogalamu owonjezera thupi lawo kumakhala mu insulin. Ngati kuli kofunikira kuwunika momwe insulini ikuyendera pokhudzana ndi kulemera koyenera kwa thupi mwa odwala onenepa kumakhala chete. Mwambiri mwina sichoncho, popeza minofu ya adipose imadalira insulini ndipo imafunikira kachidutswa kakang'ono ka insulin kuti isagwire ntchito.

Kuchokera pamalingaliro achire, kufunsa kwa njira yodziwira kukana kwa insulin kwa odwala omwe ali ndi matenda amtundu wa 2 sikofunikira mpaka atayikiridwa kuti akhoza kukana insulini pakukonzekera insulin.

Tiyenera kudziwa kuti chitsimikizo cha kukana insulin kwa mayunitsi 200 / tsiku chinayambitsidwa chifukwa chamalingaliro olakwika. Kafukufuku woyeserera koyambirira pa agalu, zidapezeka kuti inshuwaransi yawo ya tsiku ndi tsiku yotulutsa insulini sinapitirire mayunitsi 60.

Kuwerengera kufunika kwa insulin mu galu pa kilogalamu imodzi yakulemera kwa thupi, ofufuzawo, poyerekeza ndi kulemera kwapakati kwa thupi la munthu, adazindikira kuti nthawi zambiri magawo 200 amabisidwa mwa munthu. insulin patsiku. Pambuyo pake zidapezeka kuti mwa anthu tsiku lililonse insulin katulutsidwe sikhala mayunitsi 60, koma achipatala sanadzakhale gawo lomwe limapangitsa kuti insulini ikhale ndi 200 / tsiku.

Kukula kwa lipoatrophy (kutha kwa mafuta osakanikirana) kumalo opangira jakisoni kumalumikizidwanso ndi ma antibodies kupita ku insulin, omwe amakhudzana makamaka ndi IgG ndi IgM, ndikuletsa zotsatira za insulin.

Ma antibodies awa, omwe amadzaza pamalo opangira jakisoni pokonzekera ma insulini kwambiri (chifukwa cha kuchuluka kwa insulin antigen pamalo a jekeseni), amayamba kupikisana ndi insulin receptors pa adipocytes.

Kutengera ndi zomwe tafotokozazi, luso la mankhwalawa lipoatrophy pakusintha mtundu wa insulin kuchokera ku porcine insulin kupita kukonzekera kwa insulin ya anthu ndizodziwikiratu: ma antibodies omwe amapangidwa pa porcine insulin sanagwirizane ndi insulin yaumunthu ndipo insulin yawo yoletsa adipocytes idachotsedwa.

Pakadali pano, lipoatrophy pamalo omwe jakisoni wa insulin sawonekera, koma ngati zidachitika, ndikhulupirira, zingakhale bwino kusintha ma insulin a anthu ndi ma insulin ansi, kutengera komwe insulin lipoatrophy idayambika.

Komabe, vuto la mayankho amderalo pokonzekera insulin silinathe.Amadziwika kuti lipohypertrophy amawonedwabe ndipo samalumikizidwa ndi adipocyte hypertrophy, monga momwe dzinalo lingawonekere, koma ndi chitukuko cha zotupa pamalowo a jekeseni wa subcutaneous, ndi kusinthika kofewa komwe kumatsutsana ndi subcutaneous adipose minofu hypertrophy.

Zomwe zimachitika mwatsatanetsataneyu sizikudziwika, monga momwe zilili ndi mtundu uliwonse wa keloid, koma limagwirira mwina ndiwowopsa, chifukwa malowa amapezeka makamaka mwa anthu omwe samasintha kawirikawiri malo a insulin management ndi singano ya jekeseni (iyenera kutayidwa pambuyo pobayira chilichonse!).

Chifukwa chake, malangizowo akuwonekeratu - kupewa kuyambitsa insulini m'dera la lipohypertrophic, makamaka popeza kuyamwa kwa insulini kuchokera pamenepo kwachepetsedwa komanso kosatsimikizika. Ndikofunikira kusintha tsamba la jakisoni ndi singano yoyendetsera insulin nthawi iliyonse, yomwe odwala ayenera kupatsidwa kuchuluka kokwanira.

Ndipo pamapeto pake, ndizovuta kwambiri kusiyanitsa zotupa m'malo a jakisoni wa insulin, omwe nthawi zambiri amawonetsedwa ndi zisindikizo zamafuta am'mimba, amapezeka tsiku mutayamba jakisoni ndikupasuka pang'onopang'ono pakupita kwa masiku kapena masabata. M'mbuyomu, onsewa nthawi zambiri amakhala a machitidwe osachedwa kuyamwa, koma atayeretsedwa kwambiri ndi kukonzekera kwa insulin, sawaganiziranso motero.

Amatha kudziwika ndi mawu osamveka bwino ngati "kukwiya", kapena akatswiri - "kutupa" - pamalo operekera insulin. Mwinanso zifukwa ziwiri zomwe zimapangitsa kuti izi zisachitike. Choyambirira, uku ndikoyambitsidwa kwa kukonzekera kwa insulini yozizira yochotsedwa mufiriji nthawi yomweyo musanalowe.

Tizindikire kuti Mbale (insulin cholembera ndi cartridge) zomwe zimagwiritsidwa ntchito pochizira insulin ziyenera kusungidwa kutentha. Ubwino wa kukonzekera kwa insulini sikungakhudzidwe, makamaka ngati mumatsatira lamulo loti vial (cartridge) imagwiritsidwa ntchito osaposa mwezi umodzi ndikuchotsedwa pambuyo pake, ngakhale insulini ikadaliramo.

Chemists adayesetsa kuyesetsa kukonzekera "non-acidic", yotchedwa "yandale", kukonzekera insulini komwe idasungunuka kwathunthu. Ndipo pafupifupi (!) Kukonzekera konse kwamakono a insulin sikutenga mbali, kupatula Lantus, komwe kutalika kumatsimikiziridwa ndi crystallization ya insulin. Chifukwa cha izi, zotupa zakumaloko zimakonda kukhazikika kuposa mankhwala ena pakukonzekera kwake.

Njira yakuchiritsira ndikuti mupeze insulin m'matumbo a mafuta amkati kuti kutupa kusawonekeke pakhungu, komwe kumadetsa nkhawa kwambiri. Izi sizimakhudza chithandizo, ndipo machitidwe anga sanakhale chifukwa chosinthira mankhwalawa, i.e. zochita zimakhala zokwanira.

Tinapanga kafukufuku wapadera wofuna kudziwa vuto la kusintha kwa singano mosalekeza pambuyo pa jakisoni aliyense wa insulin, ndipo tinapeza kuti kusapeza nthawi komanso malo operekera insulin kumachitika kawirikawiri kochepa momwe singano ya jakisoni imasinthidwira.

Zomwe sizomwe zimachitika mwadzidzidzi, chifukwa chikhalidwe chakusintha kwa singano chikugwiritsidwanso ntchito. Tiyenera kudziwa kuti wopanga amapanga ukadaulo wapadera wopangira singano za atraumatic insulin. Komabe, jakisoni woyamba, singano itayika, ndikugwiritsa ntchito pafupipafupi imakhala yosakwanira .. Matenda a singano amapezeka pafupipafupi, nthawi zambiri samasinthidwa. Koma mwa odwala ena, singano idadwala pambuyo pa jakisoni woyamba.

Matenda a singano amapezeka pafupipafupi pomwe samasinthidwa (Gome 4). Koma mwa odwala ena, singano idadwala pambuyo pa jakisoni woyamba.

Insulinophobia yayikulu, kuopa kuchiritsidwa ndi kukonzekera kwina kwa insulin, komwe kumakhala kofala pakati pa anthu ambiri, kwakhala zotsatira zatsopano za insulin zomwe sizinakumanizidwepo kale, zomwe zinayambitsa matekinoloje atsopano pakupanga insulin.

Chitsanzo ndi kukana chithandizo ndi nkhumba insulin pazifukwa zachipembedzo. Nthawi ina, makamaka ku United States, anthu adakhazikitsa kampeni yotsutsana ndi ma insulin omwe adapangidwa kuti asinthane ndi majini.

Komanso, akaperekedwa, mtundu wa insulin womwe umagwiritsidwanso ntchito umagwiritsidwa ntchito.

Odwala omwe amapaka jakisoni tsiku ndi tsiku, chiopsezo chotengera mankhwalawa chimawonjezeka. Ndi chifukwa cha kukhalapo kwa ma antibodies mthupi kupita ku mahomoni. Ndi matupi awa omwe amakhala gwero la zomwe zimachitikazo.

Chiwopsezo cha insulin chimatha kukhala mitundu iwiri:

mwachangu, wodekha pang'onopang'ono.

Ndi chiwonetsero cha zomwe zimachitika nthawi yomweyo, ziwengo za matupi awo zimawoneka nthawi yomweyo munthu akangovulaza insulin. Kuyambira nthawi ya makonzedwe mpaka kumayambiriro kwa zizindikiro, zosaposa theka la ola limadutsa. Munthawi imeneyi, munthu akhoza kukhala wowonetsedwa:

kutupa kwa khungu pamalo a jekeseni, urticaria, dermatitis.

Zomwe zimachitika nthawi yomweyo zimakhudza matupi osiyanasiyana a thupi. Kutengera kutengera kwazizindikiro komanso mawonekedwe awo.

kwanthawi, kachitidwe, zophatikizika.

Ndi zowonongeka kwanuko, zizindikiro zimadziwika pokhapokha pakukhazikitsa mankhwala. Kuchita mwadongosolo kumakhudza mbali zina za thupi, kufalikira mthupi lonse. Pankhani yophatikiza, zosintha zakumaloko zimatsatiridwa ndi kuwonekera koyipa m'malo ena.

Ndi pang'onopang'ono ziwengo, chizindikiritso chowonongeka chimadziwika tsiku lotsatira makonzedwe a insulin. Amadziwika ndi kulowetsedwa kwa malo a jakisoni. Allergy amawonetsedwa onse mu mawonekedwe a khungu wamba ndipo amadziwika ndi kuwonongeka kwakukulu kwa thupi. Ndi chidwi chochulukirapo, munthu amakula anaphylactic kapena edema ya Quincke.

Wodwala wazaka zisanu ndi ziwiri yemwe ali ndi vuto la insulin

Ali ndi zaka ziwiri, Mngelezi Taylor Banks adapezeka ndi matenda a shuga 1. Izi sizosadabwitsa ngati mnyamatayo sanasonyezenso insulin, jakisoni womwe amafunikira chithandizo. Madokotala akuyesabe kupeza njira yothandiza pochiritsira mwana, chifukwa jakisoni wa timadzi timeneti timayambitsa mikwingwirima yambiri komanso ngakhale kugwa kwamisempha.

Kwa nthawi yayitali, madotolo amayesera kupatsa Taylor insulin kulowetsedwa kudzera mwa dontho, koma izi zinayambitsanso ziwengo. Tsopano makolo ake, Jema Westwall ndi Scott Banks, abweretsa mwana ku chipatala chodziwika bwino cha Great Ormond Street ku London, madotolo omwe ali ndi chiyembekezo chotsiriza.

Komabe, mwa ana iyi ndi mtundu wofala kwambiri wamatenda obadwa nawo amtundu wa chibadwa. Matenda a 2 a mtundu wa shuga nthawi zambiri amakhala ndi moyo wopanda thanzi komanso kunenepa kwambiri, ndipo pankhaniyi, jakisoni wa insulin sikufunika nthawi zonse.

Mankhwala osokoneza bongo a insulin ndi chinthu chosowa kwambiri chomwe chimapangitsa kuti odwala otere akhale ovuta. Madokotala aku London tsopano afunika kudziwa momwe Taylor angatulutsire mahomoni omwe amafunikira popanda kuvutitsidwa ndi ziwengo