Mitundu yosiyanasiyana ya insulini imakhala ndi nthawi yayitali. Kusankhidwa kwa mankhwala ofunikira kwa wodwala, dongosolo la mankhwala, pafupipafupi kugwiritsa ntchito kumachitika ndi adotolo pamaziko a kupezeka kwake kwa matenda ndi mikhalidwe ya munthu.

Gulu

Munthawi yovomerezeka, kapamba amatulutsa mayunitsi 50-100 a zochita za mahomoni, omwe malinga ndi kulemera kwa thupi ndi 0.5-1 pa kilogalamu imodzi. Chigawo chimodzi chogwira ntchito chimafanana ndi ma 34 ma kilogalamu. Pafupifupi theka la ndalamazi ndizoyambira.

Imawongolera kagayidwe kazakudya kunja kwa chakudya. Gawo lachiwirili limatchedwa chakudya, kuchuluka kwake kumadalira mafuta omwe amapezeka ndi chakudya.

Nthawi zosiyanasiyana masana, mapangidwe a insulini osiyanasiyana amapangidwa, ambiri thupi limafunikira itatha kadzutsa, ndipo osachepera onse m'mawa.

Mpaka 1983, matenda a shuga adathandizidwa ndi insulin ya nyama. Kenako mahomoni opanga anapangidwa, zomwe zinayambitsa kuletsa kugwiritsa ntchito nyama. Kupanga insulin kukonzekera kumachitika mwa kukhazikitsidwa kwa matupi athu m'magulu a mankhwala a Escherichia osakhala tizilombo, pambuyo pake iwonso ayamba kupanga mahomoni.

Mitundu yamakono ya insulini ndi momwe zimasinthira nthawi yayitali, kapangidwe ka gene, komanso mawonekedwe a amino acid. Amagawidwanso malinga ndi kuchuluka kwa kuyeretsedwa:

• zachikhalidwe
• monocomponent
• zophatikiza zambiri.

Nthawi yodziwika bwino yaphatikiza:

• kopitilira muyeso
• kakafupi (chakudya)
• sing'anga komanso nthawi yayitali (basal).

Apidra ali ndi njira yayifupi kwambiri (m'maiko ena amatchedwa Epidera), Humalog. Zochita zazifupi mu mankhwala a Actrapid, Humodar R, Farmasulin N, Insuman R.

Kuchita kwapakatikati kapena kotenga nthawi yayitali kumawonedwa m'mankhwala omwe nthawi zambiri amalembedwa molumikizana ndi insulin yochepa - Protafan, Lantus, Insuman B, Farmasulin HNP, Insuman B

Mankhwala a insulini amatha kuchitika ndi ma insulin ophatikizidwa, nthawi zambiri vuto lotere limachitika ndi mtundu wachiwiri wa matenda a insulin.

Ultrashort insulin

Insulin yochepa-yochepa idapangidwa kuti muchepetse glycemia mwachangu. Kugwiritsidwa ntchito kwake kumakhala koyenera pazinthu zowopsa, monga encephalopathy, kapena zimagwiritsidwa ntchito ngati chakudya. Iyenera kutumikiridwa musanadye. Kutalika kwa ntchito ndi maola 4-6, kuchuluka kwa zochitika kumachitika pakadutsa mphindi 60-90 pambuyo pa kutsata. Oyimira odziwika ndi awa:

Werengani komanso Stem Cell Diabetes Therapy

Pambuyo pakukonzekera, zoyipa sizimawonedwa kawirikawiri, komabe, mawonetsedwe awo amafunika kufunsidwa ndi endocrinologist kuti athane nawo bwino.

Kuchita zinthu mwachidule

Dzina lina la insulin yochepa limawonedwa ngati losavuta. Imayamba nthawi ya theka la ola pambuyo pa utsogoleri, ndipo nthawi yake imafika maola 8. Iyenera kuperekedwa kwa mphindi zochepa chakudya chisanafike kuti hypoglycemic ikugwirizane ndi kuwonjezeka kwa shuga. Mankhwala omwe ali mgululi akuphatikizapo:

Cholinga cha mankhwala enaake chimatsimikiziridwa ndi kupezeka kwa insulin yaulere kwa odwala omwe ali ndi matenda a shuga malinga ndi pulogalamu ya boma.

Mankhwala a pakatikati komanso nthawi yayitali

Madokotala nthawi zambiri amapatula mankhwala onse a sing'anga komanso othandizira pakali pano ngati insulin. Kutalika kwa zotsatira kumatenga maola 12.

Njira yodwala matenda a shuga nthawi zambiri imafunikira mankhwala osakanikirana ndi mankhwala osakhalitsa kapena apakatikati kapena nthawi yayitali, popeza okhawo omwe ndi ochepa omwe amatha kulumpha mu shuga la magazi akamadya.

Amatumizidwanso kwa odwala usiku kupewa kusinthasintha kwakukulu mu glycemia.

Oimira otchuka a gululi ndi:

Mankhwalawa sadziwika ndi zoyipa, komabe, ngati zimachitika, zimachitika chifukwa chogwiritsa ntchito mankhwalawa kwa nthawi yayitali.

Chifukwa chiyani insulin imatchedwa "genetically engineer"

Odwala ena amachita mantha ndi mawu oti "opangidwa mwabadwa," kuwakumbutsa "GMOs oyipa."

M'malo mwake, kunali kupangidwa kwa mankhwalawa komwe kunapulumutsa miyoyo ya anthu mamiliyoni ambiri odwala matenda ashuga.

Poyamba, madokotala amagwiritsa ntchito insulin yotalikirana ndi nyama (makamaka nkhumba ndi ng'ombe). Komabe, mahomoni awa sanali achilendo kwa anthu okha, komanso adalowa nthawi yomweyo m'magazi, ndikupangitsa kudumpha mu glucose ndikupangitsa zovuta zambiri.

Insuluble ya insuble idapangidwira kuganizira zosowa zonse za wodwala yemwe ali ndi matenda ashuga, ndikupangitsa mitundu yosiyanasiyana yokhudza thupi. Pambuyo poti ichitike, imagwera ma amino acid wamba ndipo imachotsedwa m'thupi.

Chachikulu mankhwala

Mafuta a insulle a insulin amatanthauza mankhwala osokoneza bongo osakhalitsa.

Pamodzi ndi cell wall receptor, mankhwalawa amapanga insulin receptor zovuta zomwe zimapangitsa njira zina:

1. Kupatula kwa michere yokwanira kukonza ndi kuyamwa kwa glucose ndi minofu,
2. Kuchuluka kwa zoyendera zapakati pazachuma ndi glucose,
3. Kuchepa kwa mapangidwe a glycogen m'chiwindi,
4. Kuthandizira kupanga mapuloteni ndi mafuta.

Ndi subcutaneous makonzedwe, mankhwalawa amayamba kugwira ntchito pambuyo pa mphindi 20-30, ndikufika pazokwanira mkati mwa maola 1-3, pafupifupi maola 5-8.

Mankhwalawa amagawidwa mosiyanasiyana m'matumbidwe: mwachitsanzo, samalowa mkati mwa chotchinga komanso samadutsa mkaka wa m'mawere. Mapeto ake atatha, insulin ya munthu imachotsedwa kudzera mu impso (pafupifupi 80%) itawonongedwa ndi insulinase.

Contraindication

Mankhwalawa nthawi zambiri amaloledwa ndi thupi, chifukwa samasiyana ndi chilengedwe pancreatic enzyme.

Contraindicated ogwiritsira ntchito insulin mu:

• Kutsitsa shuga wamagazi (hypoglycemia),
• Kuchulukitsa chidwi chathu cha thupi kwa insulin.

Insulin yaumunthu: zomwe zimapezeka kwa odwala matenda ashuga

Mulingo woyenera wa mahomoni ndiye maziko a kukula kwathunthu kwa thupi la munthu. Chimodzi mwa zinthu zofunika kwambiri m'thupi la munthu ndicho insulin. Kuperewera kwake kapena zochulukirapo kumabweretsa zotsatirapo zoyipa. Matenda a shuga ndi hypoglycemia ndi magawo awiri olimbitsa thupi omwe amakhala osasangalatsa a thupi, omwe amanyalanyaza chidziwitso cha insulin ndi kuti mulingo wake uyenera kukhala wotani.

Zotsatira zoyipa

Ngakhale idalekerera bwino, insulin ikhoza kukhala ndi zotsatirapo zoyipa ngati:

Nthawi zina kuyamba kumwa kwa mankhwalawa kumayendera limodzi ndi kusinthasintha kwa thupi m'njira ya edema kapena mawonekedwe osokoneza. Izi mawonetseredwe nthawi zambiri amatha pambuyo pa milungu ingapo yamankhwala.

Kuphatikiza ndi mankhwala ena

Mukamagwiritsa ntchito insulin yaumunthu ndi mankhwala ena, mphamvu yake ya hypoglycemic imalimbitsidwa kapena kufooka.

Kuchepetsa shuga kumatha kuwonjezeka mukamamwa insulin ndi:

Nikotini ndi mowa zimathandizira kukulitsa mphamvu za shuga zomwe zimapangitsa kuchepetsa shuga.

Kuti muchepetse kuthamanga kwa mankhwalawa, kugwiritsa ntchito kwake ndi:

Komanso, kuphatikizapo insulin, mankhwalawa amatha kutsitsa kapena kukulitsa zotsatira za hypoglycemic:

Ntchito ndi kusankha kwa mankhwalawa

Mlingo ndi njira yoyendetsera insulin yaumunthu nthawi zonse imatsimikiziridwa payekhapayekha ndi endocrinologist, poganizira zofunikira za shuga ndi mkodzo wa wodwalayo.

Mankhwalawa amaperekedwa m'magulu a shuga m'njira zingapo: subcutaneously (s / c), intramuscularly (i / m) kapena kudzera m'mitsempha (i / v). Nthawi zambiri, insulin imayendetsedwa kamodzi. Kuti muchite izi, gwiritsani ntchito:

Mankhwala nthawi zambiri kutumikiridwa m`thupi mu pachimake zinthu zotumphukira ndi shuga: ketoacidosis, matenda ashuga.

Iwo akulangizidwa kupereka insulin 15-30 mphindi musanadye, katatu patsiku. Nthawi zina 5-6 imodzi ya mankhwala amaloledwa.

Mlingo wa insulin nthawi zambiri amawerengedwa mogwirizana ndi magawo a 0,5-1 pa 1 makilogalamu. Ngati insulini imagwiritsidwa ntchito kuposa 0,6 mg wa pa kilogalamu ya thupi, ndiye kuti mankhwalawa amayenera kuperekedwa kawiri pa tsiku. Pafupifupi, tsiku lililonse mlingo pafupifupi 30-40 (mwa ana, magawo 8).

Amayi oyembekezera nthawi zambiri amapatsidwa mlingo wa 0,6 PESCES pa kg iliyonse yakulemera. Jekeseni amatulutsa nthawi 3-5 pa tsiku, malinga ndi kuchuluka kwa zakudya.

Nthawi zambiri, insulin yothamanga imaphatikizidwa ndi insulin yotalikirapo.

Malamulo a insulin

Ngakhale akatswiri odziwa bwino za matenda ashuga amalakwitsa popereka insulin.

Malamulo ofunikira kwambiri a insulin Therapy ndi awa:

1. Kuyang'ana moyo wa alumali ndi malo osungira mankhwalawa: sayenera kuwonetsedwa ndi kutentha kwambiri kapena hypothermia.
2. Refreshate insulin mbale Mbale. Ndikokwanira kusunga botolo loyambira m'malo amdima firiji.
3. Kuyanjananso kwa mankhwalawa ndi malangizo ndi upangiri wa dokotala.
4. Tulutsani mpweya ku syringe musanalowe. Sikoyenera kupukuta khungu ndi mowa. Kulimbana ndi matenda a insulin ndikosowa kwambiri, ndipo mowa umachepetsa mphamvu ya mankhwalawo.
5. Kusankha malo oyenera kukhazikitsa. Kwa insulin yochepa, uwu ndi m'mimba. Ikabayidwa m'khosi komanso pang'onopang'ono, mankhwalawa amagwira ntchito pang'onopang'ono.
6. Kupewa kwa zovuta pamalo a jekeseni momwe mungagwiritsire ntchito dera lonse lapansi. Mimba yonse imagwiritsidwa ntchito kuperekera insulin yochepa: kuchokera pamwamba pamafupipafupi mpaka mtengo womangira, ndi mbali zoyaka za thunthu. Ndikofunika kubwezeretsanso pafupifupi 2 cm kuchokera pamalo akale jekeseni, ndikuyambitsa syringe pamalo a 45-60 madigiri, kuti mankhwalawa asatayike.
7. Musanagwiritse ntchito mankhwalawa, ndikofunikira kupukuta khungu ndi chala chachikulu. Ngati ilowa m'matumbo, mankhwalawa amachepetsa ntchito yake. Mukayika singano, gwiritsani syringe kwa masekondi 5 mpaka 10.
8. M'mimba, insulin yochepa imayendetsedwa bwino mphindi 20 asanadye. M'malo ena, mankhwalawa amaperekedwa theka la ola musanadye.

Zina zamalonda zamankhwala

Insulin imapangidwa ngati njira yothetsera jakisoni ndipo imagulitsidwa ku malo ogulitsa mankhwala.

Ma insulin omwe amapangidwa ndi chibadwa cha anthu amatha kupangidwa pansi pa mayina amtunduwu:

Chifukwa cha matekinoloje amakono a genetic, insulin (recombinant) ya insulin ya anthu inapangidwa. Ndi iye omwe ali m'gulu la zomwe akukonzekera: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Mankhwalawa amasiyana ndi oyamba mu kusintha kwa ma amino acid, omwe amawonjezeranso zinthu zina zatsopano (mwachitsanzo, zotsatira zazitali za magawo awiri), zomwe ndizofunikira kwambiri kwa odwala matenda ashuga.

Bongo

Zimachitika kuti utsogoleli wa insulin nthawi zina umabweretsa hyperglycemia.

Zizindikiro zazikulu za hyperglycemia ndizowonetsera mu:

Zizindikiro zofananira zikayamba, wodwalayo ayenera kudya chakudya chamafuta ochepa (nthawi zambiri maswiti, chidutswa cha shuga kapena tiyi wokoma).

Pofuna kuwonongeka mu thanzi, wodwalayo ayenera kuyitanitsa ambulansi mwachangu. Nthawi zambiri, madokotala amapaka jakisoni kapena 40% dextrose solution (kudzera m'mitsempha). Kuzengereza pankhaniyi nkoopsa kwambiri ndipo kungayambitse kudwala kapena kufa.

Mavuto

Kuchiza kwa nthawi yayitali ndi insulin kumatha kubweretsa zovuta zingapo. Zazikulu.

Insulin ndiye mankhwala othandizira matenda a shuga a mtundu woyamba. Nthawi zina amagwiritsidwanso ntchito kukhazika mtima pansi wodwalayo ndikuwongolera moyo wake wamtundu wachiwiri wa matenda. Izi ndi chilengedwe chake ndi mahomoni omwe amatha kuthana ndi kagayidwe kazachilengedwe mu milingo yaying'ono.Nthawi zambiri, kapamba amapanga insulin yokwanira, yomwe imathandizira kukhala ndi shuga m'thupi. Koma ndi zovuta zazikulu za endocrine, mwayi wokhawo wothandiza wodwala nthawi zambiri ndi jakisoni wa insulin kwenikweni. Tsoka ilo, ndizosatheka kuzipeza pakamwa (mwanjira yamapiritsi), popeza zimawonongeka kwathunthu m'mimba ndikugaya mtengo wake wachilengedwe.

Zokonzekera zomwe zimapezeka kuchokera ku zopangira zachilengedwe

Kulandila timadzi ta nkhanu ndi ng'ombe ndi ukadaulo wakale womwe sugwiritsidwa ntchito masiku ano. Izi zimachitika chifukwa cha mankhwala ochepa omwe adalandiridwa, zomwe zimapangitsa kuti pakhale zovuta zina komanso kuyeretsa kosakwanira. Chowonadi ndi chakuti popeza mahomoni ali ndi mapuloteni, amakhala ndi ma amino acid ena.

Insulin yomwe imapangidwa mthupi la nkhumba imasiyana mu ma amino acid omwe amapangidwa ndi insulin yaumunthu 1 amino acid, ndi bovine insulin ndi 3.

Kumayambiriro ndi pakati pa zaka za zana la 20, pamene mankhwala ofananawo analibe, ngakhale insulin yotereyi inali yopambana pamankhwala ndikulola kutenga chithandizo cha odwala matenda ashuga kupita nawo kumalo ena atsopano. Ma Horoni omwe adapangidwa ndi njirayi amachepetsa shuga m'magazi, komabe, nthawi zambiri ankayambitsa zovuta komanso chifuwa. Kusiyana pakapangidwe ka amino acid ndi zosafunikira zakumwa zimakhudza mkhalidwe wa odwala, makamaka m'magulu omwe ali pachiwopsezo cha odwala (ana ndi okalamba). Chifukwa china chosalolera bwino insulin yotereyi ndi kupezeka kwa kuyamwa kwa mankhwala osagwiritsa ntchito (proinsulin), komwe sikunali kotheka kuti athetse kusiyanasiyana kwa mankhwalawa.

Masiku ano, pali ma insuge apamwamba apamwamba omwe alibe zoperewera. Zimapezeka kuchokera kapamba wa nkhumba, koma zitatha zimayatsidwa ndikuwonjezera kuyeretsa. Zili ndi mitundu yambiri ndipo zimakhala ndi zotuluka.

Insulin ya nkhumba yosinthidwa sikuti imasiyana ndi mahomoni amunthu, chifukwa chake imagwiritsidwabe ntchito

Mankhwalawa amaloledwa ndi odwala bwino ndipo samayambitsa mavuto, samachepetsa chitetezo cha mthupi ndipo amachepetsa shuga la magazi. Bovine insulin sikugwiritsidwa ntchito ngati mankhwala masiku ano, chifukwa chifukwa chakunja kwake kumakhudza chitetezo chathupi komanso machitidwe ena a thupi.

Katswiri wa Majini a Insulin

Insulin yaumunthu, yomwe imagwiritsidwa ntchito ngati odwala matenda ashuga, pamsika wamafuta amapezeka m'njira ziwiri:

• ntchito enzymatic mankhwala a porcine insulin,
• kugwiritsa ntchito majini osinthika amtundu wa Escherichia coli kapena yisiti.

Ndi kusintha kwa mankhwala a physico-cell, mamolekyulu a porcine insulin pansi pa michere yapadera amakhala ofanana ndi insulin yaumunthu. Kapangidwe ka amino acid kamakonzedwe kotsatira sikusiyana ndi kapangidwe kazinthu zachilengedwe zomwe zimapangidwa m'thupi la munthu. Pakupanga, mankhwalawa amatsukidwa kwambiri, chifukwa chake sizoyambitsa thupi kapena mawonekedwe ena osayenera.

Koma nthawi zambiri, insulin imapezeka pogwiritsa ntchito mitundu yosinthika (genetically modified). Pogwiritsa ntchito njira za biotechnological, mabakiteriya kapena yisiti amasinthidwa m'njira yoti iwonso atulutse insulin.

Kuphatikiza pakupanga insulin yokha, kuyeretsedwa kwake kumachita mbali yofunika. Kuti mankhwalawa asayambitse zovuta zilizonse komanso zotupa, pagawo lililonse ndikofunikira kuyang'anira kuyera kwa zovuta za michere ndi zothetsera zonse, komanso zosakaniza zomwe zimagwiritsidwa ntchito.

Pali njira ziwiri zopangira insulin. Yoyamba mwa izo idakhazikitsidwa ndikugwiritsa ntchito mitundu iwiri yosiyanasiyana.Iliyonse imapangika gawo limodzi lokha la mamolekyule a ma DNA (pali awiri okha, ndipo amapindika molunjika). Kenako maunyolo awa amalumikizidwa, ndipo mu njira yotsatila ndikothekanso kupatulira mitundu yogwira insulin kwa iwo omwe alibe phindu lililonse kwachilengedwe.

Njira yachiwiri yomwe mungalandire mankhwalawa pogwiritsa ntchito Escherichia coli kapena yisiti zimatengera kuti microbe yoyamba imapanga insulin (ndiye kuti, omwe adalowetsa kale, proinsulin). Kenako, pogwiritsa ntchito enzymatic chithandizo, fomu iyi imayatsidwa ndikugwiritsidwa ntchito ngati mankhwala.

Ogwira ntchito omwe ali ndi mwayi wopezeka m'malo ena opanga zovala ayenera kuvala suti yodzitetezera, yomwe imachotsa kulumikizana ndi mankhwalawa ndi madzi amthupi la anthu.

Njira zonsezi nthawi zambiri zimakhala zamagalimoto, mpweya ndi mawonekedwe onse polumikizana ndi ma ampoules ndi mbale sizowoneka bwino, ndipo mizere yokhala ndi zida ndiyosindikiza.

Njira za biotechnology zimathandizira asayansi kuti aganizire njira zina zothanirana ndi shuga. Mwachitsanzo, pakadali pano, maphunziro oyamba opanga ma cell a pancreatic beta akuchitika, omwe amatha kupezeka pogwiritsa ntchito njira zopangira majini. Mwina m'tsogolomu adzagwiritsidwa ntchito kukonza zomwe zimachitika m'thupi mwa wodwala.

Kupanga zamakono ndi njira yovuta yaukadaulo, yomwe imaphatikizapo magalimoto ndi kulowerera pang'ono kwa anthu

Zowonjezera zina

Kupanga kwa insulin popanda maipi mu masiku amakono kuli kosatheka kulingalira, chifukwa amatha kusintha zinthu zake zamankhwala, kuwonjezera nthawi yanthawi ndikukwaniritsa kuyera kambiri.

Mwa zomwe ali nazo, zosakaniza zina zonse zitha kugawidwa m'magulu otsatirawa:

• prolongators (zinthu zomwe zimagwiritsidwa ntchito popereka nthawi yayitali ya mankhwala),
• mankhwala ophera tizilombo toyambitsa matenda
• olimbitsa, chifukwa chomwe acidity yoyenera imasungidwa mu yankho la mankhwalawa.

Kupitiliza Zowonjezera

Pali ma insulin omwe amagwira ntchito kwa nthawi yayitali omwe zochita zake zimakhala kwa maola 8 mpaka 42 (kutengera gulu la mankhwalawo). Izi zimatheka chifukwa cha kuwonjezera pa zinthu zapadera - zotambuzira ku yankho la jakisoni. Nthawi zambiri, imodzi mwamafuta awa imagwiritsidwa ntchito pazolinga izi:

Mapuloteni omwe amalimbitsa nthawi ya mankhwalawa amayeretsedwa mwatsatanetsatane ndipo amakhala otsika pang'ono (mwachitsanzo, protamine). Mchere wamchere wa zinc sukhudzanso zochita za insulin kapena thanzi la munthu.

Madera okhathamiritsa

Tizilombo toyambitsa matenda tomwe timapangira insulini ndikofunikira kuti tizilombo tating'onoting'ono tisachulukane panthawi yosungirako ndikugwiritsa ntchito momwemo. Zinthu izi ndizosungirako komanso kuonetsetsa kuti mankhwalawo amasungidwa. Kuphatikiza apo, ngati wodwala amapereka mahandawo kuchokera kwa iye yekha, ndiye kuti mankhwalawo amatha kwa masiku angapo. Chifukwa cha ma antibacterial apamwamba kwambiri, sangakhale ndi mwayi wotaya mankhwala osagwiritsidwa ntchito chifukwa choganiza kuti zitha kubereka mwanjira yankho la ma virus.

Zinthu zotsatirazi zitha kugwiritsidwa ntchito ngati mankhwala ophera majeremusi popanga insulin:

Ngati yankho lake lili ndi ayoni a zinc, amakhalanso ngati chosungirako chifukwa cha antimicrobial

Popanga mtundu uliwonse wa insulini, zinthu zina zoyambitsa matenda zimakhala zoyenera. Kuchita kwawo ndi mahomoni kuyenera kufufuzidwa pamlingo woyeserera koyambirira, popeza osungirako sayenera kusokoneza zochita za insulin kapena kusokoneza katundu wake.

Kugwiritsira ntchito mankhwala osungirako nthawi zambiri kumapangitsa kuti timadzi timadzi timene timatulutsa pakhungu popanda kulandira mankhwala asanachitike ndi mowa kapena antiseptics (wopanga nthawi zambiri amatanthauza izi pamalangizo). Izi zimathandizira kukhazikitsa kwa mankhwalawa ndikuchepetsa kuchuluka kwa mankhwalawa pokonzekera jakisoni wokha. Koma malingaliro awa amangogwira ntchito ngati yankho limaperekedwa pogwiritsa ntchito syringe imodzi ya insulini ndi singano yopyapyala.

Olimbitsa

Olimba amafunika kuti pH yothetsera vutoli ikhalebe yokhazikika. Kusungidwa kwa mankhwalawa, ntchito zake ndi kukhazikika kwa katundu wamafuta zimadalira kuchuluka kwa acidity. Popanga mahomoni a jakisoni kwa odwala matenda ashuga, ma phosphates nthawi zambiri amagwiritsidwa ntchito pazolinga izi.

Kwa insulin yokhala ndi zinc, njira zothetsera kukhazikika sizofunikira nthawi zonse, chifukwa zitsulo zazitsulo zimathandizira kukhalabe koyenera. Ngati agwiritsidwa ntchito, ndiye kuti mitundu ina ya mankhwala imagwiritsidwa ntchito m'malo mwa phosphates, popeza kuphatikiza kwa zinthu izi kumabweretsa kupendekera ndi kusafunika kwa mankhwalawo. Chuma chofunikira chomwe chikuwonetsedwa kwa okhazikika onse ndi chitetezo ndi kulephera kulowa pazosintha zilizonse ndi insulin.

A endocrinologist wokhoza bwino ayenera kuthana ndi kusankha kwa majakisoni obwera ndi shuga kwa wodwala aliyense payekhapayekha. Ntchito ya insulin sikuti kungokhala ndi shuga wambiri m'magazi, komanso osati kuvulaza ziwalo zina ndi machitidwe ena. Mankhwalawa ayenera kukhala osalowerera m'thupi, otsika pang'ono komanso oyenera kugula. Ndiwothekanso kosavuta ngati insulin yosankhidwa ikhoza kusakanizidwa ndi mitundu yake ina kutengera nthawi yochitapo kanthu.

Insulin yaumunthu ndi chida chothandiza kupangira odwala omwe ali ndi mitundu yoyamba komanso yachiwiri ya matenda ashuga. Ndi chipangizo chamajini chomwe chimasungunuka kwambiri mu zakumwa. Kuvomerezedwa kuti mugwiritse ntchito ngakhale mukakhala ndi pakati.

Actrapid, Humulin, Insuran.

INN: Semi-yopanga insulin yaumunthu.

Kodi amapangidwa ndi chiyani?

Mutha kukhala munjira izi:

• Kugwiritsa ntchito mankhwala enaake a insulin,
• Zotsatira zake, momwe majini osinthika a yisiti kapena Escherichia coli amakhudzidwa, mabakiteriya a coli.

Insulin yotere ndi biphasic. Imayeretsedwa koyamba, kenako imapangidwa kupanga mankhwala omaliza. Kapangidwe kamankhwala awa sikosiyana kwambiri ndi insulin yoyera yopanga mankhwala. Ena okhazikika, othandizira opha zamphamvu ndi zotsekemera zomwe zimapangitsa mabakiteriya kuti awonjezeranso munthu.

Mtundu waukulu wamasulidwe ndi yankho la jakisoni. 1 ml ikhoza kukhala ndi ma insulin 40 kapena 100 a insulin.

Zotsatira za pharmacological

Mankhwalawa akukhudzana ndi ma insulin osakhalitsa. Kapangidwe kenakake ka insulin-receptor pamwamba pa michere yambiri yamaselo ambiri, omwe amawoneka atatha kulumikizana mwachindunji ndi mawonekedwe a membrane a cell. Kuphatikizika kwa cycloo oxygenase mkati mwa maselo a chiwindi ndi mawonekedwe a mafuta akuwonjezeka.

Insulin imatha kulowa mwachindunji m'maselo a minofu. Poterepa, machitidwe onse omwe amapezeka m'maselo amasinthidwa. Kuphatikizika kwa michere yofunika ya hexokinase ndi glycogen synthetase kumakulanso.

Kuchulukana kwa shuga m'magazi kumatsika chifukwa chogawa mwachangu mkati mwa maselo. Kutsimikizika kwake kwabwino ndi matupi onse amthupi kumachitika. Pali kukondoweza kwa machitidwe a glycogenogeneis ndi ma cell lipogenis. Mapangidwe a mapuloteni amapangidwa mwachangu. Mlingo wofunikira wa kupanga shuga m'magazi a chiwindi umachepetsedwa kwambiri ndikuchepetsa kuwonongeka kwa ulusi wa glycogen.

Pharmacokinetics

Kuchuluka kwa mayamwidwe a insulin nthawi zambiri kumadalira momwe zinthu zomwe zimagwirira ntchito zimathandizira. Zambiri zimachitika chifukwa cha mlingo womaliza, kuchuluka kwa insulini mu jakisoni wa jekeseni komanso pamalo omwe jakisoniyo yayamba.Timalizi zimagawidwa mosiyanasiyana. Insulin siyingalowe chotchinga cha placenta.

Itha kuwonongeka pang'ono ndi insulinase mwachindunji m'chiwindi. Imapukusidwa makamaka mwa kusefa impso. Kuthetsa theka-moyo sikudutsa mphindi 10. Kuchuluka kwa insulin koyera m'magazi kumawonedwa mkati mwa ola limodzi pambuyo pake. Zotsatira zake zimatha mpaka maola 5.

Zisonyezero zakugwiritsa ntchito insulin yaumunthu

Pali ma pathologies angapo omwe chithandizo chimasonyezedwa:

• lembani 1 ndikulemba matenda ashuga 2
• matenda ashuga acidosis,
• ketoacidotic chikomokere,
• matenda a shuga pa nthawi yomwe ali ndi pakati.

Pakakhala mkhalidwe wokondweretsa wodwala, ayenera kuchipatala. Ngati thanzi silikuyenda bwino, hemodialysis imachitidwa. Nthawi zina, pakakhala zovuta zina, chitani mankhwala mosamala. Mlingo ndi nthawi yayitali ya mankhwala amatsimikiziridwa ndi kupezeka dokotala potengera kuopsa kwa matenda a matenda.

Momwe mungatengere insulin yaumunthu

Mlingo ndi njira yotsogoza mwachindunji imatsimikiziridwa pokhapokha pa shuga ya magazi osala, kenako maola awiri mutatha kudya. Kuphatikiza apo, phwando limatengera kuuma kwa chitukuko cha glucosuria.

Nthawi zambiri, subcutaneous makonzedwe. Chitani mphindi 15 chakudya chachikulu chisanachitike. Pankhani ya matenda a shuga a ketoacidosis kapena chikomokere, insulin yomwe ingabayidwe, imabayidwa jekeseni, nthawi zonse kudzera m'mitsempha ya gluteus, opaleshoni iliyonse isanachitike.

Ndikulimbikitsidwa kupereka mankhwalawa katatu pa tsiku. Popewa kupweteka kwambiri pamlomo. Ndiye dystrophy yama subcutaneous yamafuta siziwona.

Akuluakulu tsiku lililonse mlingo 40 ndi ana, ndipo kwa ana ndi magawo 8. Nthawi zonse oyendetsera kasamalidwe kawiri pa tsiku. Ngati pali chosoweka chotere, ndiye kuti mutha kulandira insulin mpaka kasanu.

Zotsatira zoyipa za insulin yaumunthu

Mukagwiritsidwa ntchito, zotsatirazi zotsatirazi zimakonda kukhala:

• matupi awo sagwirizana: urticaria, edema ya Quincke,
• kupuma movutikira, kugwa kwamwadzidzidzi,
• hypoglycemia: kutuluka thukuta kwambiri, khungu lake, kugwedezeka kwambiri, kugona mosalekeza, kukhumudwa, kugona tulo, migraines, mkwiyo wambiri, kutopa, kusawona bwino kwa malankhulidwe ndi mawu, minyewa ya nkhope,
• hypoglycemic coma,
• hyperglycemia ndi acidosis: pakamwa mokhazikika, kukhumudwa kwambiri, khungu la nkhope,
• chikumbumtima
• kuchepa kwa masomphenya
• kuyamwa ndikutupa pamalo omwe mankhwalawo adathandizidwa.
• mawonekedwe a kutupira kwa nkhope ndi miyendo, kuphwanya Refraction.

Izi zimachitika kwakanthawi ndipo sizifunikira chithandizo chilichonse chamankhwala. Amadutsa pang'onopang'ono atachotsa ndalamazo.

Malangizo apadera

Musanakumane yankho mwachindunji kuchokera m'botolo, muyenera kulionadi kuti likuwonekera bwino. Ngati matenda atayamba, mankhwalawa sayenera kumwa.

Mlingo wa insulin umasinthidwa motere:

• matenda opatsirana
• Kulakwitsa chithokomiro
• Matenda a Addison
• hypopituitarism,
• matenda ashuga okalamba.

Nthawi zambiri, kuwonetsedwa kwa hypoglycemia yamphamvu imayamba. Zonsezi zimayamba chifukwa cha mankhwala osokoneza bongo, kukhazikika kwa insulin komwe kumachokera munthu, kufa ndi njala, kutsegula m'mimba, kusanza komanso zizindikiro zina za kuledzera. Hypoflycemia yofatsa imatha kuyimitsidwa pomwa shuga.

Ngati zizindikiro zazing'ono za hypoglycemia zikuwoneka, muyenera kulankhulana ndi katswiri nthawi yomweyo. Wofatsa, kusintha kwa mankhwalawa kungathandize. M'mavuto akuchulukirapo, mankhwala ogwiritsira ntchito doporization ayenera kugwiritsidwa ntchito. Nthawi zambiri, kuchotsa kwathunthu kwa mankhwala kapena kulandira chithandizo kumafunikira.

Kumbukirani kuti m'dera la kayendetsedwe ka chiwongola dzanja, mitundu ina ya mafuta m'mimba imatha kuwonekera. Koma izi zitha kupewedwa ndikusintha malo a jakisoni.

Zolemba za insulin

Matenda a shuga omwe amadalira a insulin amafunikira chithandizo cha moyo wonse. Moyo wa munthu umadalira kupezeka kwa insulin. Matendawa amadziwika kuti ndi mliri wosagonjetseka ndipo ndiwo wachitatu pofalikira padziko lapansi.

Kwa nthawi yoyamba, insulin idapangidwa kuchokera ku zikondamoyo za galu. Patatha chaka chimodzi, mankhwalawo adayamba kugwiritsidwa ntchito. Pambuyo pa zaka 40, adatha kupanga mahomoni munthawi ya mankhwala.

Pambuyo kanthawi, mitundu ya insulin yokhala ndi kuyeretsa kwambiri idapangidwa. Ntchito ikuchitikanso kuti mupange insulin yaumunthu. Kuyambira 1983, mahomoni awa adayamba kumasulidwa pamsika wamafuta.

M'mbuyomu, anthu odwala matenda ashuga ankalandira mankhwala opangidwa ndi nyama. Tsopano mankhwalawa ndi oletsedwa. M'mafakitala, mutha kungogula ma genetic engineering, kupanga mankhwalawa kumangotengera kusintha kwa chinthu cha gene mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya a E. coli umagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kutulutsa timadzi tambiri timadzi tambiri.

Insulin yamakono yamankhwala ndi yosiyana:

• nthawi yowonetsera, pali yochepa, ultrashort komanso insulin yotalikilapo,
• kutsatira kwa amino acid.

Palinso mankhwala osakanikirana omwe amatchedwa osakaniza. Mu kapangidwe ka ndalama zotere mumakhala insulin yokhala ndi nthawi yayitali komanso yochepa.

Kupeza insulini kungathenso kuwonetsedwa mu matenda monga:

1. Lactic acid, matenda ashuga ndi hypersmolar,
2. Mtundu 1 wa matenda a shuga a insulin
3. Ndi matenda, chithandizo cha opaleshoni, kuchulukitsa kwa matenda osachiritsika,
4. Matenda a shuga ndi / kapena kuwonongeka kwa chiwindi, pakati komanso pobereka.
5. Type 2 osagwirizana ndi insulin omwe amadalira matenda a shuga
6. Zotupa za khungu la Dystrophic,
7. Kulimbitsa kwambiri munjira zosiyanasiyana,
8. Njira yayitali yopatsirana.

Kutalika kwa insulin

Potengera nthawi ndi magwiridwe antchito, insulin imasiyanitsidwa:

1. kopitilira muyeso
2. mwachidule
3. nthawi yayitali
4. kuchitapo kanthu kwanthawi yayitali.

Ultrashort amalowetsa zinthu pambuyo jakisoni. Kuchuluka kwake kumatheka pambuyo pa ola limodzi ndi theka.

Kutalika kwa zochita kumafika maola 4. Insulin yamtunduwu imatha kutumikiridwa musanadye kapena musanadye. Kupeza insulini sikutanthauza kupuma pakati pa jakisoni ndi chakudya.

Ultrashort insulin sikufuna zakudya zowonjezera pamtunda wa kuchitapo, komwe kuli kosavuta kuposa mitundu ina. Insulin yotere imaphatikizapo:

Ma insulin afupia amayamba kuchita pambuyo pa theka la ola. Chiwongola dzanja chikuyambira patatha maola atatu. Zochitazo zimatha pafupifupi maola 5. Insulin yamtunduwu imaperekedwa musanadye, muyenera kukhalabe ndi pakati pa jakisoni ndi chakudya. Kudya kumaloledwa pambuyo pa mphindi 15.

Kugwiritsa ntchito insulin yocheperako, muyenera kukhala ndi mankhwalawa patatha maola ochepa jakisoni. Nthawi ya chakudya iyenera kuyenderana ndi nthawi yapamwamba ya mahomoni. Ma insulin afupia:

1. Himulin Wokhazikika,
2. Khalid
3. Monodar (K50, K30, K15),
4. Insuman Rapid,
5. Humodar ndi ena.

Ma insulini apakatikati ndi mankhwala osokoneza bongo omwe nthawi yayitali ya maola 12-16. Mtundu woyamba wa shuga, insulin yamunthu imagwiritsidwa ntchito ngati maziko kapena basal. Nthawi zina muyenera kupanga jakisoni 2 kapena katatu patsiku m'mawa ndi madzulo ndi gawo la maola 12.

Insulin yotere imayamba kugwira ntchito pambuyo pa maola 1-3, ikufika pachimake patatha maola 4-8. Kutalika ndi maola 12-16. Mankhwala apakatikati akuphatikizapo:

• Humodar br
• Protafan
• Humulin NPH,
• Novomiks.
• Insuman Bazal.

Ma insulin omwe amakhala nthawi yayitali amakhala a insulin kapena oyambira insal. Munthu angafunike jakisoni imodzi kapena iwiri patsiku. Amagwiritsidwa ntchito pochiza matenda a shuga a 2.

Mankhwala amakhala ndi cumulative effect. Mphamvu ya Mlingo imawonekera kwambiri pambuyo masiku atatu. Wothandizirana kwa nthawi yayitali amagwira ntchito patatha maola 4-6 jakisoni. Zochita zawo zapamwamba zimachitika m'maola 11 mpaka 14, izi zomwe zimachitika pafupifupi tsiku limodzi.

Mwa zina mwa mankhwalawa, pali ma insulin omwe alibe phindu. Ndalama zotere zimachitika modekha ndipo nthawi zambiri zimatsata momwe masoka achilengedwe amakhala mwa munthu wathanzi.

Izi insulini ndi monga:

1. Lantus
2. Monodar Long,
3. Monodar ultralong,
4. Ultralente
5. Ultralong,
6. Humulin L ndi ena,
7. Lantus
8. Levemir.

Zotsatira zoyipa ndi vuto la kumwa

Ndi bongo wa insulin yokonzekera mwa anthu, zotsatirazi zingaoneke:

• Zofooka
• Thukuta lozizira
• Pallor
• Kudzanjenjemera
• Kusweka mtima
• Mutu
• Njala
• Zingwe.

Zonsezi pamwambapa zimawonetsedwa ngati zizindikiro za hypoglycemia. Ngati mkhalidwe wayamba kumene ndipo mukuyamba kale, mutha kuchotsa zizindikirazo mwaumoyo. Pachifukwa ichi, tengani zinthu zokhala ndi shuga komanso chakudya chamafuta ambiri.

Komanso yankho la dextrose ndi glucagon limatha kuyambitsidwa m'thupi. Wodwala akayamba kuperewera, njira yosinthika ya dextrose iyenera kuperekedwa. Amagwiritsidwa ntchito mpaka mkhalidwe utasintha.

Odwala ena amatha kuyambitsidwa ndi insulin. Zina mwazizindikiro zazikulu ndi:

1. Kutha
2. Kutupa,
3. Urticaria,
4. Kutupa
5. Thupi
6. Kutsitsa magazi.

Hyperglycemia imachitika chifukwa cha mankhwala ochepa kapena chifukwa cha matenda opatsirana, komanso chifukwa chosagwirizana ndi zakudya. Nthawi zina munthu amakumana ndi lipodystrophy komwe mankhwalawa amaperekedwa.

Mukamagwiritsa ntchito mankhwalawa angathenso kuchitika kwakanthawi:

Kupeza wolowa mmalo m'malo mwa insulin ya anthu ndi njira yabwino yochizira matenda ashuga. Thupi limathandizira kuchepetsa kuchuluka kwa glucose m'magazi, chifukwa chakuti glucose amatha kulowa bwino ndi maselo, momwe kayendedwe kayendedwe kake kamasinthira. Mankhwalawa amalowa m'malo mwa insulin ya anthu, koma amayenera kumwedwa pokhapokha ngati akuwongolera adokotala, chifukwa pakhoza kukhala zovuta zina.

Malangizo ofunikira pakugwiritsira ntchito

Amayi omwe ali ndi matenda ashuga ayenera kudziwitsa oyang'anira azaumoyo za zakutsogolo kapenanso kukhala ndi pakati. Gulu ili la azimayi nthawi zambiri okhala ndi mkaka wa m'mawere limasowa kusintha kwamankhwala, komanso zakudya.

Pophunzira za kuwopsa kwa kukonzekera kwa insulin, asayansi sanapeze zotsatira za mutagenic.

Ndikofunika kudziwa kuti kufunika kwa mahomoni kumatha kuchepa ngati munthu ali ndi vuto la impso. Munthu amatha kusamutsidwira ku mtundu wina wa insulin kapena mankhwala omwe ali ndi dzina lina loyang'aniridwa pokhapokha atayang'aniridwa ndi achipatala.

Mlingo uyenera kusinthidwa ngati zochitika za insulin, zamtundu kapena mitundu, zasinthidwa. Kufunika kwa insulin kungachepetse ndi matenda otsatirawa:

1. Ntchito zosakwanira za adrenal, chithokomiro cha England
2. Hepatic ndi aimpso kulephera.

Ndi kupsinjika kwa m'maganizo kapena matenda ena, kufunika kwa insulin kumawonjezeka. Kusintha kwa mankhwalawa kumafunikanso ndi kulimbitsa thupi.

Zizindikiro za hypoglycemia, ngati insulin ya anthu imagwiridwa, ikhoza kutchulidwa kochepa kapena zosiyana ndi zomwe zinali ndi kuyambitsa kwa insulin yoyambira nyama.

Ndi makulidwe a shuga m'magazi, mwachitsanzo, chifukwa cha chithandizo champhamvu ndi insulin, zonse kapena mawonekedwe ena a hypoglycemia amatha, zomwe anthu ayenera kudziwa.

Zoyambirira za hypoglycemia zimatha kusintha kapena kukhala zofatsa pochiza matenda ashuga kapena kugwiritsa ntchito beta-blockers.

Zotsatira zoyipa zam'deralo zimatha kuyambika pazifukwa zosakhudzana ndi mphamvu ya mankhwalawa, mwachitsanzo, kuyambitsa khungu pakhungu ndi mankhwala kapena jakisoni wosayenera.

Nthawi zina, mapangidwe a zonse sayanjana, chithandizo chofunikira ndikofunikira. Desensitization kapena kusintha kwa insulini kungafunenso.

Ndi hypoglycemia mwa anthu, chidwi ndi kuthamanga kwa zomwe psychomotor zimatha kuchepa. Izi zitha kukhala zowopsa nthawi zomwe ntchitozi ndizofunikira. Mwachitsanzo, kuyendetsa galimoto kapena njira zosiyanasiyana.

Izi ndizofunikira kwambiri kwa anthu omwe ali ndi vuto losazindikira, lomwe ndi harbinger la hypoglycemia. Muzochitika izi, adotolo omwe amafunikira ayenera kuwunikira kufunika koyendetsa galimoto modekha. Kanemayo munkhaniyi ayankhula za mitundu ya insulin.

Semi-yopanga sungunuka wa munthu insulin

Model Clinical-Pharmacological Article 1

Zochita pafamu. Kukonzekera kwa insulin kochepa. Kuyanjana ndi cholandirira kumtundu wakunja kwa maselo, ndikupanga insulini yolandirira. Mwa kukulitsa kaphatikizidwe ka cAMP (m'maselo amafuta ndi maselo a chiwindi) kapena kulowa mwachindunji mu cell (minofu), insulini yolandirira insulin imapangitsa njira zina, kuphatikizira kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase, etc.). Kutsika kwa glucose m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa zotupa, kukondoweza kwa lipoenaisis, glycogenogeneis, kaphatikizidwe ka protein, kuchepa kwa kuchuluka kwa kupanga kwa shuga ndi chiwindi (kuchepa kwa kuphulika kwa glycogen), ndi zina. mphindi, imafika pazofunikira pambuyo pa maola 1-3 ndipo imatha, kutengera mlingo, maola 5-8. Kutalika kwa mankhwalawa kumatengera mlingo, njira, malo oyendetsera ndipo ali ndi machitidwe apadera a munthu.

Pharmacokinetics Kukwana kwa mayamwidwe zimatengera njira yoyendetsera (s / c, i / m), malo oyang'anira (pamimba, ntchafu, matako), mlingo, insulin ndende ya mankhwala, etc. Amagawidwa mosiyanasiyana mu minofu. Simadutsana chotchinga ndi mkaka wa m'mawere. Imawonongeka ndi insulinase, makamaka m'chiwindi ndi impso. T 1/2 - kuchokera kwa ochepa mpaka mphindi 10. Amachotsa impso (30-80%).

Zizindikiro. Type 1 shuga mellitus, mtundu 2 shuga mellitus: gawo la kukana mankhwalawa a hypoglycemic, kuperewera pakamwa zamankhwala hypoglycemic (kuphatikiza mankhwala), matenda ashuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, matenda osokoneza bongo omwe adachitika panthawi yoyembekezera (ngati sichothandiza pakudya) ntchito pafupipafupi kwa odwala omwe ali ndi matenda a shuga ku matenda opatsirana ndimatenda akulu, ndi maopareshoni omwe akubwera, kuvulala, kubala mwana, ndi kuphwanya lamulo Ene zinthu akuyendera mankhwala yaitali kukonzekera insulin.

Contraindication Hypersensitivity, hypoglycemia.

Mlingo Mlingo ndi njira yoyendetsera mankhwalawa imatsimikiziridwa payekhapayekha pazotsatira zilizonse za glucose m'magazi musanadye ndi maola 1-2 mutatha kudya, komanso malinga ndi kuchuluka kwa glucosuria ndi machitidwe a matendawa.

Mankhwala amatumizidwa s / c, mu / m, mu / mkati, mphindi 15-30 musanadye. Njira yodziwika kwambiri yoyendetsera ntchito ndi sc. Ndi matenda ashuga a ketoacidosis, chikomokere cha matenda a shuga, pakachitika opaleshoni - mu / mu ndi / m.

Ndi monotherapy, pafupipafupi makonzedwe nthawi zambiri amakhala 3 katatu patsiku (ngati kuli kotheka, mpaka nthawi 5-6 patsiku), tsamba la jakisoni limasinthidwa nthawi iliyonse kupewa chitukuko cha lipodystrophy (atrophy kapena hypertrophy ya subcutaneous mafuta).

Pafupifupi tsiku lililonse 30-30 IU ana - 8 IU, ndiye muyezo tsiku lililonse - 0,5-1 IU / kg kapena 30-40 IU 1-3 pa tsiku, ngati n`koyenera - 5-6 pa tsiku . Pa mlingo wa tsiku ndi tsiku wopitilira 0,6 U / kg, insulin iyenera kuperekedwa ngati ma jakisoni a 2 kapena kuposa m'malo osiyanasiyana a thupi.

Ndikotheka kuphatikiza ndi ma insulin omwe amakhala nthawi yayitali.

Njira yothetsera insulini imatengedwa kuchokera ku vial ndi kuboola ndi singano yosalala ya singano yoyimitsira ndi waya yopukutira mutachotsa kapu ya aluminium ndi ethanol.

Zotsatira zoyipa. Thupi lawo siligwirizana (urticaria, angioedema - malungo, kufupika, kuchepa kwa magazi),

hypoglycemia (pallor of the khungu, thukuta kwambiri, thukuta, pakamwa, kunjenjemera, njala, kusokonezeka, nkhawa, paresthesias mkamwa, kupweteka mutu, kugona, kugona, mantha, kupsinjika, kusakwiya, chikhalidwe chosazolowereka, kusowa kwa kayendedwe, vuto lakulankhula ndi kuyankhula komanso masomphenya), hypoglycemic coma,

hyperglycemia ndi matenda ashuga acidosis (pa Mlingo wochepera, kulumpha jakisoni, kusadya bwino, motsutsana ndi maziko akumatenda ndi matenda): kugona, ludzu, kusowa kudya, kutulutsa nkhope),

kuda nkhawa (mpaka kukula kwa precomatose ndi chikomokere),

kuchepa kwakanthawi kowoneka (nthawi zambiri kumayambiriro kwa zamankhwala),

immunological cross-reaction ndi insulin ya anthu, kuwonjezeka kwa gawo la anti-insulin antibodies, kenako kuwonjezeka kwa glycemia,

Hyperemia, kuyabwa ndi lipodystrophy (atrophy kapena hypertrophy of subcutaneous fat) pamalo a jekeseni.

Kumayambiriro kwa mankhwalawa - edema komanso mkhutu kukonzanso (ndi kwakanthawi ndipo kumazimiririka ndi chithandizo chopitilira).

Bongo. Zizindikiro: hypoglycemia (kufooka, “thukuta” “thukuta”

Chithandizo: wodwalayo atha kuyerekezera yekha pakubweretsa shuga kapena zakudya zopatsa mphamvu zophatikizika m'thupi.

Subcutaneous, i / m kapena iv yolowetsa glucagon kapena iv hypertonic dextrose solution. Ndi chitupa cha hypoglycemic coma, 20-40 ml (mpaka 100 ml) wa 40% dextrose solution amawayamwa kudzera mu mtsempha kulowa kufikira wodwalayo atatuluka.

Kuchita. Mankhwala osagwirizana ndi mayankho a mankhwala ena.

Mphamvu ya hypoglycemic imapangidwira ndi sulfonamides (kuphatikizapo mankhwala a hypoglycemic, sulfonamides), ma inhibitors a MAO (kuphatikizapo furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (kuphatikizapo salicylates), anabolic (kuphatikiza stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, phenfluramine, Li + kukonzekera, pyridoxine, quinidine, quinine, etloroquin, etloro.

Zotsatira Hypoglycemic wa kulemala glucagon, kukula timadzi, corticosteroids m'kamwa kulera, estrogens, thiazide ndi kuzungulira okodzetsa, mahomoni BCCI, chithokomiro, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclics, clonidine, calcium muzikangana, diazoxide, morphine, chamba, fodya, phenytoin, epinephrine, blockers a H 1 histamine receptors.

Beta-blockers, reserpine, octreotide, pentamidine imatha kuwongolera ndi kufooketsa mphamvu ya hypoglycemic ya insulin.

Malangizo apadera. Musanatenge insulini kuchokera ku vial, muyenera kuwunika mawonekedwe a yankho. Matupi achilendo akaonekera, kusefukira kapena kutentha kwa zinthu pagalasi la vial, mankhwalawa sangathe kugwiritsidwa ntchito.

Kutentha kwa insulin yoyenera kuyenera kukhala kutentha kwambiri. Mlingo wa insulin uyenera kusinthidwa matenda opatsirana, matenda a chithokomiro, matenda a Addison, hypopituitarism, kulephera kwaimpso ndi matenda ashuga okonda anthu opitirira zaka 65.

Zomwe zimayambitsa hypoglycemia zimatha kukhala: insulin, mankhwala osokoneza bongo, kudumpha chakudya, kusanza, kutsegula m'mimba, kupsinjika kwa thupi, matenda omwe amachepetsa kufunika kwa insulin (matenda apamwamba a impso ndi chiwindi, komanso hypofunction ya adrenal cortex, pituitary kapena chithokomiro gland), kusintha kwa malo jakisoni (mwachitsanzo, khungu pamimba, phewa, ntchafu), komanso mogwirizana ndi mankhwala ena. Ndikotheka kuchepetsa kuchuluka kwa shuga m'magazi posamutsa wodwala kuchokera ku insulin ya nyama kupita ku insulin ya anthu.

Kusamutsa wodwala kupita ku insulin yaumunthu kuyenera kukhala koyenera nthawi zonse kumayang'aniridwa ndi adokotala. Chizolowezi chokhala ndi hypoglycemia chitha kupangitsa kuti odwala azichita nawo mwachangu magalimoto, komanso kukonza makina ndi zida zina.

Odwala omwe ali ndi matenda ashuga amatha kuyimitsa pang'ono hypoglycemia mwa iwo kudzera pakudya shuga kapena zakudya zopatsa mphamvu zamafuta (tikulimbikitsidwa kuti nthawi zonse muzikhala ndi shuga osachepera 20 g). About hypoglycemia yosamutsidwa, ndikofunikira kudziwitsa dokotala kuti athetse vuto la kufunika kwa chithandizo chamankhwala.

Mankhwalawa a insulin yocheperako pokhapokha, kuchepa kapena kuwonjezeka kwa kuchuluka kwa adipose minofu (lipodystrophy) m'dera la jakisoni ndikotheka. Izi zimapewedwa makamaka ndikusintha malo a jekeseni. Pa nthawi yoyembekezera, ndikofunikira kuganizira kuchepa (I trimester) kapena kuwonjezeka (II-III trimesters) pazofunikira za insulin. Nthawi yobadwa pambuyo pokhapokha ndipo mwayamba kubadwa, zofunika za insulin zimatha kugwa kwambiri. Pa mkaka wa m`mawere, kuwunikira tsiku ndi tsiku kumafunikira kwa miyezi ingapo (mpaka kufunika kwa insulin kukhazikika).

Insulin yaumunthu imanena za mahomoni omwe amapanga kapamba. Amagwiritsidwa ntchito pochiza matenda ashuga. Kuti muthane ndi chizolowezi cha kapamba, wodwalayo amapaka jakisoni:

• zotsatira zazifupi
• zopitilira
• nthawi yayitali yochita.

Mtundu wa mankhwalawa umatsimikizika potengera thanzi la wodwala komanso mtundu wa matenda.

Mwachidule kuchita insulin

Ma insulin omwe amagwira ntchito mwachidule, nthawi zina a ultrashort, ndi mayankho a crystalline zinc-insulin ovuta ndi mtundu wa pH wosaloledwa. Ndalamazi zimagwira mwachangu, komabe, zotsatira zake za mankhwalawa ndizosakhalitsa.

Monga lamulo, mankhwalawa amaperekedwa kwa mphindi 30-55 musanadye. Mankhwala ofanana amatha kuthandizidwa kudzera mu mnofu komanso m'mitsempha, komanso insulin.

Wothandizila wa ultrashort akamalowa m'mitsempha, shuga ya plasma imatsika kwambiri, zotsatira zake zimatha kuchitika pambuyo pa mphindi 20-30.

Posachedwa, magazi amatha kuyerekezera ndi mankhwalawo, ndipo mahomoni monga catecholamines, glucagon ndi STH adzakulitsa kuchuluka kwa glucose kukhala gawo loyambirira.

Ndi kuphwanya kwa kupanga mahomoni olimbana ndi mahomoni, mulingo wamagazi sawonjezeka kwa maola angapo pambuyo pa jakisoni wa mankhwala, chifukwa umakhudza thupi komanso mutachotsa magazi.

Mahomoni ochita kupanga mwachidule ayenera kubayidwa m'mitsempha:

1. pakutsitsimuka komanso kusamalidwa kwambiri,
2. odwala matenda ashuga a ketoacidosis,
3. ngati thupi lisintha mwachangu kufunika kwa insulini.

Odwala omwe ali ndi njira yokhazikika ya matenda a shuga, mankhwalawa nthawi zambiri amatengedwa limodzi ndi zotsatira zazitali komanso nthawi yayitali.

Ultrashort insulin ndi mankhwala apadera omwe wodwala amatha kukhala nawo mu chipangizo chapadera cha metering.

Kulipiritsa chotulutsira, zinthu zothandiziridwa zimagwiritsidwa ntchito. Izi sizimalola kuti insulini ikhale pansi pa khungu pakhungu pang'onopang'ono.

Masiku ano, timadzi tating'onoting'ono timayendetsedwa mu mawonekedwe a hexamers.Mamolekyu a chinthuchi ndi ma polima. Hexamers amatengeka pang'onopang'ono, zomwe sizimalola kufikira kuchuluka kwa insulin ndende ya plasma ya munthu wathanzi atatha kudya.

Izi zinali chiyambi cha kupanga zopangira zapakati zomwe zimayimira:

Mayesero ambiri azachipatala adachitidwa, chifukwa chake, zida zothandiza kwambiri, mayina a otchuka kwambiri

Mitundu ya insulin iyi imatengedwa kuchokera pansi pakhungu katatu katatu poyerekeza ndi insulin ya anthu. Izi zimabweretsa kuti gawo lalikulu kwambiri la insulin m'magazi limafikiridwa mwachangu, ndipo njira yochepetsera glucose imathamanga.

Ndi kuyambitsa kuphika kwa mphindi 15 musanadye, zotsatira zake zidzakhala zofanana ndi jakisoni wa insulin kwa munthu mphindi 30 asanadye.

Ma mahomoni amphamvu yothamanga kwambiri amaphatikiza lyspro-insulin. Ndi zotumphukira za insulin ya anthu yomwe imapezeka ndikusinthana kwa proline ndi lysine m'matcheni a 28 ndi 29 B.

Monga insulin yaumunthu, m'makonzedwe opangidwa, lyspro-insulin ilipo mu mawonekedwe a hexamers, komabe, wothandizirayo akadzalowa m'thupi la munthu, amasintha kukhala ma monomers.

Pazifukwa izi, lipro-insulin imakhala ndi zotsatira zake, koma zotsatira zake zimakhala kwakanthawi. Lipro-insulin iwina poyerekeza ndi mankhwala ena amtunduwu pazinthu zotsatirazi:

• imapangitsa kuchepetsa kuopseza kwa hypoglycemia ndi 20-30%,
• Kuchepetsa kuchuluka kwa A1c glycosylated hemoglobin, komwe kumawonetsa chithandizo chokwanira cha matenda ashuga.

Popanga insulin, gawo lofunikira limaperekedwa m'malo mwa proartic acid m'malo mwa Pro28 mu B. Monga lyspro-insulin, mankhwalawa, omwe amalowa m'thupi la munthu, posakhalitsa amagawanika kukhala opanga monoma.

Pharmacokinetic katundu wa insulin

Mu shuga mellitus, mankhwala a insulin amatha kukhala osiyana. Nthawi yapamwamba kwambiri ya kuchuluka kwa plasma insulin komanso zotsatira zazikulu zochepetsera shuga zimatha kusiyana ndi 50%. Kukula kwinanso kwa kusinthika koteroko kumadalira kuchuluka kosiyanasiyana kwa mankhwala kuchokera kuzinthu zowoneka bwino. Komabe, nthawi ya insulin yayitali komanso yochepa ndiyosiyana.

Zotsatira zamphamvu kwambiri ndi mahomoni a nthawi yayitali komanso nthawi yayitali. Koma posachedwa, akatswiri apeza kuti mankhwala ochepetsa mphamvu ali ndi zinthu zofananira.

Kutengera ndi insulin, ndikofunikira kubaya mahomoni nthawi zonse m'matumbo a subcutaneous. Izi zikugwiranso ntchito kwa odwala omwe sangathe kuchepetsa kuchuluka kwa shuga m'magazi chifukwa cha zakudya komanso mankhwala omwe amachepetsa shuga, komanso azimayi omwe ali ndi matenda osokoneza bongo panthawi yomwe ali ndi pakati, odwala omwe ali ndi matenda omwe amapangidwa chifukwa cha pacreatectomy. Apa titha kunena kuti nthawi zonse samapereka zomwe zikuyembekezeka.

Chithandizo cha insulin ndi chofunikira pa matenda monga:

1. hyperosmolar chikomokere,
2. matenda ashuga ketoacidosis,
3. pambuyo opaleshoni kwa odwala matenda a shuga,
4. pomwe chithandizo cha insulin chimathandizira kuti shuga akhale mu plasma,
5. Kuchotsa kwina kwa metabolic metabolologies.

Zotsatira zabwino zimatheka pogwiritsa ntchito njira zovuta zochizira:

Kufunika kwa insulin tsiku ndi tsiku

Munthu wokhala ndi thanzi labwino komanso wathanzi labwino amapanga magawo 18-40 patsiku, kapena mayunitsi 0,2-0,5 / kg wa insulin yayitali. Pafupifupi theka la bukuli ndi chimbudzi cha m'mimba, chotsalacho chimapukutidwa mutatha kudya.

Hormayo imapangidwa mawunitsi a 0.5-1 pa ola limodzi. Shuga atalowa m'magazi, kuchuluka kwa katulutsidwe ka timadzi timeneti kumakwera mpaka ku magawo 6 pa ola limodzi.

Anthu onenepa kwambiri komanso omwe ali ndi insulin kukana omwe amadwala matenda ashuga amatha kupanga ma insulini mwachangu kangapo podya.Pali kulumikizana kwa mahomoni omwe amapangidwa ndi portal system ya chiwindi, komwe gawo limodzi limawonongeka ndipo silimafikira magazi.

Odwala amtundu wa matenda a shuga 1, kusowa kwa mahomoni tsiku ndi tsiku ndi kosiyana:

1. Kwenikweni, chizindikirochi chimasiyana kuchokera pa 0,6 mpaka 0,7 mayunitsi / kg.
2. Ndi kulemera kambiri, kufunikira kwa insulin kumawonjezeka.
3. Munthu akamafuna mayunitsi 0,5 okha patsiku, amakhala ndi maholide okwanira kapena thupi labwino.

Kufunika kwa insulin ya mahomoni ndi amitundu iwiri:

Pafupifupi theka la zosowa za tsiku ndi tsiku ndi za basal fomu. Hormone iyi imathandizira kupewa kufalikira kwa shuga mu chiwindi.

Mu mawonekedwe a posachedwa, zofunika tsiku lililonse zimaperekedwa ndi jakisoni musanadye. Timadzi timadzi timatenda timadzi timene timayamwa.

Kamodzi patsiku, wodwalayo amapatsidwa jakisoni wa insulin ndi nthawi yayitali, kapena wothandizira kuphatikiza amaperekedwa kuti aphatikize insulini yokhala nthawi yayitali komanso timadzi tambiri tambiri. Kusungitsa glycemia pamlingo wabwinobwino, izi sizingakhale zokwanira.

Kenako njira yothandizira mankhwalawo imagwiritsidwa ntchito kukhala yovuta kwambiri, pomwe insulini yokhala ndi nthawi yayitali kapena insulini yocheperako kapena yogwiritsira ntchito mwachangu insulin imagwiritsidwa ntchito limodzi.

Nthawi zambiri wodwala amathandizidwa molingana ndi mtundu wosakanikirana wa mankhwala, akaperekera jakisoni imodzi pakudya kadzutsa, ndi wina nthawi ya chakudya. Hormone mu nkhani iyi imakhala ndi insulin ya nthawi yayifupi komanso nthawi yayitali.

Mukalandira mlingo wamadzulo wa mahomoni NPH kapena insulin, tepiyo silipereka glycemia usiku, ndiye kuti jakisoni imagawidwa m'magawo awiri: asanadye chakudya chamadzulo, wodwalayo amapaka jekeseni wa insulin, ndipo asanagone amayikidwa ndi insulin NPH kapena tepi ya insulin.

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

Mankhwala

Insulin yaumunthu ndi insulin yomwe ikukonzekera njira yolandirira ukadaulo wa DNA. Insulin yaumunthu imayang'anira kuchuluka kwa shuga m'magazi, kuchuluka kwa kagayidwe kazakudya, mafuta, mapuloteni m'magulu a ziwongo (mafupa amkati, chiwindi, minofu ya adipose). Insulin yamunthu imatha kukhala ndi anabolic komanso anti-catabolic athari. Mu minofu ya minofu, pali kuchuluka kwa glycerol, glycogen, mafuta acids, kuchuluka kwa mapuloteni komanso kuwonjezereka kwa kumwa ma amino acid, koma kuchepa kwa gluconeogeneis, lipolysis, glycogenolysis, ketogeneis, proteinabolism ndi kumasulidwa kwa amino acid. Insulin yaumunthu imamangirira ku membrane receptor (tetramer, yomwe imakhala ndi zigawo 4, 2 zomwe (beta) zimamizidwa mu membala wamtundu wa cytoplasmic ndipo zimayendetsa ntchito ya tyrosine kinase, ndipo zina ziwiri (alpha) ndi extramembrane ndipo zimayambitsa insulin receptor complex, zomwe zimadutsa Autophosphorylation. Vutoli limapangika mu maselo olimba a phosphorylates threonine ndi malekezero a serine a protein kinases, omwe amatsogolera pakupanga kwa phosphatidylinositol glycan ndipo amayambitsa phosphorylation, yomwe imayambitsa ntchito ya enzymatic m'maselo omwe akufuna. M'misempha ndi minyewa ina (kupatula ubongo), imalimbikitsa kusuntha kwamphamvu kwa glucose ndi amino acid, imachepetsa mphamvu ya mapuloteni, ndikuwonjezera njira zopangira. Insulin yaumunthu imalimbikitsa kuchuluka kwa shuga mu chiwindi mu mawonekedwe a glycogen ndipo amalepheretsa glycogenolysis (gluconeogenesis). Kusiyana kwamwini pantchito ya insulin kumadalira mlingo, jakisoni malo, zochitika zolimbitsa thupi za wodwala, zakudya ndi zina.
The mayamwidwe a insulin ya anthu zimatengera njira ndi malo oyang'anira (ntchafu, pamimba, matako), insulin, kuchuluka kwa jakisoni. Insulin yaumunthu imagawidwa mosiyanasiyana m'thupi lathu, sililowa mkaka wa m'mawere komanso kudzera mu chotchinga chachikulu. Kuwonongeka kwa mankhwalawa kumachitika m'chiwindi pochita insulinase (glutathione-insulin transhydrogenase), yomwe hydrolyzes imasokoneza mgwirizano pakati pa unyolo A ndi B ndikuwapangitsa kuti azitha kupezeka ndi ma enzymes a proteinolytic. Insulin ya munthu imachotsedwanso ndi impso (30 - 80%).

Lembani 1 ndi mtundu 2 wa matenda a shuga omwe amafunikira mankhwala a insulin (motsutsana ndi mankhwala amkamwa a hypoglycemic kapena mankhwala ophatikizika, zinthu zomwe zimagwirizana), matenda a shuga nthawi yayitali.

Mlingo ndi makonzedwe a insulin ya anthu

Njira makonzedwe a mankhwala zimatengera mtundu wa insulin. Dokotala amakhazikitsa mlingo payekhapayekha, kutengera mlingo wa glycemia.
Jekeseni wotsekemera amachitika m'chigawo cha mpanda wam'mimba, ntchafu, phewa, matako. Masamba a jakisoni ayenera kusinthidwa kuti malo omwewo sawagwiritsidwanso ntchito kangapo kamodzi pamwezi. Ndi subulinaneous ya insulin, chisamaliro chimayenera kumwedwa kuti musalowe m'mitsempha yamagazi pakubaya. Odwala ayenera kuphunzitsidwa bwino kugwiritsa ntchito insulin yobereka. Musati mutisefa jekeseni tsamba pambuyo jakisoni. Kutentha kwa mankhwala omwe amaperekedwa kuyenera kukhala kutentha kwambiri.
Kuchepetsa kuchuluka kwa jakisoni watsiku ndi tsiku kumatheka ndikuphatikiza insulin ya nthawi zosiyanasiyana zoyenera kuchitapo.
Ndi chitukuko cha thupi lawo siligwirizana, hospitalization wa wodwalayo, kuzindikira kwa mankhwala omwe anali allergen, poika mankhwala okwanira ndi m'malo insulin ndikofunikira.
Kuchedwa kwa mankhwala kapena kugwiritsa ntchito mankhwala osakwanira a insulin, makamaka kwa odwala omwe ali ndi vuto la matenda a shuga 1, kungayambitse matenda a hyperglycemia ndi matenda ashuga a ketoacidosis (mikhalidwe yomwe ikhoza kuyika pangozi moyo wa wodwalayo).
Kukula kwa hypoglycemia mukamagwiritsa ntchito mankhwalawa kumathandizira kuti pakhale mankhwala ochulukirapo, zolimbitsa thupi, kuphwanya zakudya, kuwonongeka kwa impso, chiwindi chamafuta.
Mlingo wa insulin uyenera kusinthidwa ngati magwiridwe antchito a tchire, gland ya adrenal, chithokomiro cha chithokomiro, impso ndi / kapena chiwindi chalephera, matenda a Addison, hypopituitarism, ndi matenda osokoneza bongo a shuga opitilira zaka 65. Komanso, kusintha kwa mlingo wa insulin kungafunike ndi kuwonjezeka kwa mphamvu zolimbitsa thupi kapena kusintha kwa zakudya zomwe mumakonda. Kudya kwa Ethanol (kuphatikizapo zakumwa zoledzeretsa) kumatha kuyambitsa hypoglycemia. Osamamwa ethanol pamimba yopanda kanthu. Ndi matenda ena ophatikizika (makamaka opatsirana), mikhalidwe yomwe imayendetsedwa ndi malungo, kupsinjika kwamalingaliro, kufunikira kwa insulin kungakulitse.
Zizindikiro zakutsogolo kwa hypoglycemia pogwiritsa ntchito insulin ya munthu mwa odwala ena sizitha kutchulidwa kapena kusiyana ndi zomwe zimawonedwa ndi insulin yoyambira nyama. Ndi matenda a shuga m'magazi, mwachitsanzo, ndi mankhwala a insulin, zonse kapena zizindikiro zina zakutsogolo za hypoglycemia zitha kuzimiririka, zomwe odwala ayenera kudziwitsidwa. Zizindikiro zakutsogolo kwa hypoglycemia zimatha kuchepera kapena kusintha ndi njira yayitali ya matenda a shuga, matenda a shuga, komanso kugwiritsa ntchito ma beta-blockers.
Kwa odwala ena, kusintha kwa mlingo kumakhala kofunikira pakusintha kuchokera ku insulin yochokera ku nyama kupita ku insulin ya anthu. Izi zitha kuchitika kale poyambilira kukonzekera kwa insulin ya anthu kapena pang'onopang'ono pakangotha ​​milungu ingapo kapena miyezi ingapo atasamutsidwa.
Kusintha kuchokera ku mtundu wina wa insulin kupita ku wina kuyenera kuchitika moyang'aniridwa ndi achipatala ndikuwongolera shuga. Kusintha kwa zochitika, mtundu (wopanga), mtundu, mitundu (waumunthu, chinyama, ma insulin analogs) ndi / kapena njira yopanga (DNA recombinant insulin kapena insulini yachikhalidwe) zitha kuchititsa kusintha kwa mlingo.
Mukamagwiritsa ntchito insulin pokonzekera nthawi yomweyo ndi mankhwala a gulu la thiazolidinedione, chiopsezo chotenga matenda a edema ndi matenda osakhazikika pamtima amachulukirachulukira, makamaka kwa odwala omwe ali ndi matenda am'magazi komanso kupezeka kwa zinthu zomwe zingayambitse matenda osalephera a mtima.
Ndi hypoglycemia wodwala, kuthamanga kwa zochitika zama psychomotor ndikuyang'anitsitsa kungachepe. Izi zitha kukhala zowopsa ngati maluso awa ali ofunikira makamaka (mwachitsanzo, kuwongolera makina, kuyendetsa magalimoto ndi ena). Odwala ayenera kulangizidwa kuti azisamala kuti ateteze kukula kwa hypoglycemia pochita zinthu zoopsa zomwe zimafuna kuti anthu aziganiza mwachangu ndi chidwi chachikulu (kuphatikizapo kuyendetsa magalimoto, kugwira ntchito ndi machitidwe). Izi ndizofunikira kwambiri kwa odwala omwe kulibe kapena owonetsa zizindikiro za hypoglycemia, komanso kukula pafupipafupi kwa hypoglycemia. Zikatero, adotolo amayenera kuwunika momwe wodwalayo angachitire izi.

Mimba komanso kuyamwa

Pakati pa nthawi yayitali, ndikofunikira kuti pakhale chitetezo chokwanira cha azimayi omwe amalandiridwa ndi insulin. Pa nthawi yoyembekezera komanso mkaka wa m`mawere, ndikofunikira kusintha mlingo wa insulin kuti ulipire shuga. Kufunika kwa insulin nthawi zambiri kumachepera mu trimester yoyamba ya kutenga pakati ndikuwonjezeka kwachiwiri ndi kachitatu trimester ya mimba. Kufunika kwa insulini kumatha kuchepa kwambiri pakubadwa kwa mwana komanso pambuyo pake. Amayi omwe ali ndi matenda ashuga amafunika kudziwitsa dokotala za mimba kapena kukonzekera kwake. Mwa azimayi omwe ali ndi matenda a shuga, kusintha kwa mankhwala a insulin ndi / kapena zakudya kungafunike pakamwa. Insulin yaumunthu sinali mutagenic mu in vitro komanso mndandanda wa vivo m'maphunziro a kawopsedwe amtundu.

Kuchita kwa insulin yaumunthu ndi zinthu zina

Zotsatira za hypoglycemic za insulin ya anthu zimachepetsedwa ndi glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisone ndi ena), amphetamines, adrenocorticotropic timadzi, flucrocortisone, calcium blockers, estrogens, baclofen, heparin, levrateroxine sodium, leparogrogen sodium. diuretics (hydrochlorothiazide, indapamide ndi ena), amprenavir, danazol, isoniazid, diazoxide, lithiamu carbonate, chlorprotixen, sympathomimetics, nicotinic acid, beta-adrenergic agonists (mwachitsanzo, ritodrin, salbutamol, terbutaline ndi ena), ma tridclic antidepressants, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, zotumphukira za phenothiazine. Kungakhale kofunikira kuwonjezera kuchuluka kwa insulin ya biphasic yaumunthu mukamagwiritsidwa ntchito molumikizana ndi mankhwalawa.
Zotsatira hypoglycemic wa insulin anthu azimveka metformin, sulfonamides, repaglinide, androgens m'kamwa hypoglycemic wothandizira, testosterone, anabolic mankhwala, bromocriptine, disopyramide, guanethidine, monoamine oxidase zoletsa, angiotensin II cholandilira muzikangana, carbonic zoletsa anhydrase, fluoxetine, carvedilol, fenfluramine, angiotensin akatembenuka enzyme zoletsa (captopril , enalapril ndi ena), tetracyclines, octreotide, mebendazole, ketoconazole, clofibrate, theophylline, quinidine, chloroquine, non-steroid mankhwala odana ndi kutupa, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol ndi ena) (chigoba cha hypoglycemia, kuphatikizapo tachycardia, kuthamanga kwa magazi), ethanol ndi ethanol.Pangakhale kofunikira kuti muchepetse mlingo wa inshuwaransi ya anthu yopanga magawo awiri mukagwiritsidwa ntchito molumikizana ndi mankhwalawa.
Beta-blockers, clonidine, reserpine amatha kubisa mawonetsedwe a zizindikiro za hypoglycemia.
Poyerekeza ndi maziko a atenolol (mosiyana ndi osagwiritsa ntchito beta-blockers), zotsatira zake sizikukwera kwambiri, ndikofunikira kuchenjeza wodwala kuti ndi chitukuko cha hypoglycemia, tachycardia ndi kugwedeza kungakhale kulibe, koma kusakwiyitsa, njala, nseru kuyenera kupitilira, ndipo thukuta limangokulitsa.
Kuchuluka kwa insulin ya anthu m'magazi kumakulitsidwa (chifukwa cha kuthamanga kwa mayamwidwe) mankhwala osokoneza bongo a chikonga komanso kusuta.
Poyerekeza ndi maziko a octreotide, reserpine, kusintha kwa hypoglycemic kungatheke (onse kuphatikiza ndi kufooka), kumafuna kusintha kwa insulin.
Poyerekeza ndi maziko a clarithromycin, kuchuluka kwa chiwonongeko kumachepetsa ndipo, nthawi zina, zotsatira za insulin zimatha kuchuluka.
Poyerekeza ndi maziko a diclofenac, momwe mankhwala amasinthira, akagwiritsidwa ntchito palimodzi, ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi.
Poyerekeza ndi metoclopramide, yomwe imathandizira kutsanulira kwam'mimba, kusintha kwa mlingo kapena machitidwe a insulin makonzedwe angafunike.
Insulin yamunthu imagwirizana mosiyanasiyana ndi mayankho a mankhwala ena.
Ngati pakufunika kugwiritsa ntchito mankhwala ena, kuphatikiza insulin ya anthu, ndikofunikira kukaonana ndi dokotala.

Hormone insulin

Ulemu wopanga ntchito zoyambirira zomwe zidapanga njira yodziwitsira matendawa ndi wa wasayansi waku Russia Leonid Sobolev, yemwe mu 1900 adaganiza zogwiritsa ntchito kapamba kuti apeze mankhwala opatsirana ndipo adapereka lingaliro la insulin. Zoposa zaka 20 zidagwiritsidwa ntchito pakufufuza kwina, ndipo pambuyo pa 1923 kupanga insulini ya mafakitale kudayamba. Masiku ano, maholide amaphunziridwa bwino ndi sayansi. Amatenga nawo gawo la kuwonongeka kwa ma carbohydrate, omwe amayambitsa matenda a metabolism komanso mafuta.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Kuwongolera kuchuluka kwa shuga mthupi la mayi wapakati ndikofunikira. Mu trimester yoyamba, kufunika kwa insulin yoyera kumachepera pang'ono, ndipo kumapeto kwa nthawi kumawonjezeka.

Pa yoyamwitsa, mayi angafunike kusintha kwa insulin ndi zakudya zapadera.

MP ilibe mutagenic komanso ma genetically poizoni.

Ndi chiwalo chiti chomwe chimatulutsa insulini

Zikondamoyo, komwe ma bunge a B-cell amapezeka, amadziwika ndi sayansi ngati zilumba za Lawrence's kapena chilumba cha pancreatic, amagwira ntchito monga insulin yopanga insulin. Mphamvu yokhudza maselo ndiyochepa ndipo imangokhala 3% yokha ya kuchuluka kwa kapamba. Kupanga kwa insulini kudzera m'maselo a beta kumachitika, gawo laling'ono la proinsulin limasungidwa ndi timadzi.

Kodi subtype ya insulin siyikudziwika mokwanira. Hormayo imodzimodzi, isanatenge mawonekedwe omaliza, imalowa mu chipinda cha cell cha Golgi, pomwe chimatsirizidwa kukhala boma la mahomoni athunthu. Mchitidwewo umatha pomwe mahomoni amayikidwa m'miyala yapadera ya kapamba, komwe amasungidwa kufikira munthu atadya. Mphamvu za B-cell ndizochepa ndipo zimatha msanga munthu akamagwiritsa ntchito zakudya zosavuta za carbohydrate, zomwe zimayambitsa matenda ashuga.

Kodi insulin ya hormone ndi iti - iyi ndiye yofunika kwambiri kuyang'anira metabolic. Popanda izi, shuga wolowa m'thupi kudzera mu chakudya sangalowe mu khungu. Hormayo imachulukitsa kuchuluka kwa ma membrane a maselo, chifukwa chake glucose amalowetsedwa m'thupi la selo. Nthawi yomweyo, timadzi timene timalimbikitsa kusintha kwa glucose kukhala glycogen, polysaccharide yomwe ili ndi malo osungirako mphamvu, omwe imagwiritsidwa ntchito ndi thupi laumunthu ndikofunikira.

Ntchito za insulin ndizosiyanasiyana. Amapereka minofu yamasamba ntchito, kukhudza njira za mapuloteni ndi mafuta kagayidwe.Ma hormone amatenga gawo lazidziwitso za ubongo, zomwe malinga ndi zolandilira zimazindikira kufunikira kwa chakudya chamafuta othamanga: ngati pali zambiri zake, ubongo umazindikira kuti maselo amafa ndi njala ndipo ndikofunikira kupanga zosungira. Zotsatira za insulin thupi:

1. Zimalepheretsa ma amino acid kuti asagonjetsedwe kukhala shuga wophweka.
2. Amasintha kaphatikizidwe wa mapuloteni - maziko a moyo.
3. Simalola mapuloteni m'misempha kuti asokonezeke, amalepheretsa minyewa ya atrophy - anabolic.
4. Amachepetsa kudzikundikira kwa matupi a ketone, ochulukirapo omwe amapha anthu.
5. Imalimbikitsa kuyendetsa kwa potaziyamu ndi ion ya magnesium.

Udindo wa insulin mthupi la munthu

Kusowa kwa mahomoni kumalumikizidwa ndi matenda omwe amatchedwa shuga. Omwe akudwala matendawa amakakamizika kupaka jekeseni wowonjezera m'magazi. Choyipa china ndi kuchuluka kwa mahomoni, hypoglycemia. Matendawa amapangitsa kuti magazi azithanso kuchepa komanso kuchepa kwa mtima. Kuchulukitsa kuwonjezeka kwa insulin katulutsidwe ndi glucagon ya mahomoni opangidwa ndi ma alpha maselo a pancreatic a Langerhans.

Minofu yodalira insulin

Insulin imathandizira kupanga mapuloteni m'misempha, popanda minofu minofu sangathe kupanga. Kupanga kwa minofu ya adipose, yomwe nthawi zambiri imagwira ntchito zofunika kwambiri, ndizosatheka popanda mahomoni. Odwala omwe amayamba matenda a shuga amakumana ndi ketoacidosis, mtundu wa vuto la metabolic lomwe limapangitsa kuti njala yayambike.

Madzi a insulin

Ntchito za insulin zimaphatikizapo kuthandizira kuchuluka kwa glucose m'magazi, kuyang'anira kagayidwe ka mafuta ndi mapuloteni, kusintha michere minofu. Nthawi zonse pamakhala zotsatirazi.

• kapangidwe kazakudya zomanga thupi,
• mulingo wa kagayidwe ndi katemera amasungidwa,
• imapangitsa kaphatikizidwe ka glycogen, kamene kamakulitsa kupirira ndikusintha kwamisempha minofu,
• ma amino acid, shuga, potaziyamu amalowa m'maselo.

Mafuta a insulin amayeza mu µU / ml (0,04082 mg wa mankhwala a kristalo amatengedwa ngati gawo limodzi). Anthu athanzi amakhala ndi chizindikiro chofanana ndi 3-25 pamaudindo otere. Kwa ana, kuchepa mpaka 3-20 μU / ml ndikuloledwa. Mwa amayi apakati, chizolowezi chimakhala chosiyana - 6-27 mkU / ml, mwa anthu achikulire opitilira 60 chizindikiro ichi ndi 6-35. Kusintha kwazomwe zikuchitika kukuwonetsa kukhalapo kwa matenda oopsa.

Kuchita ndi mankhwala ena

Njira yothetsera insulin yopanga ndi yoletsedwa kuphatikiza ndi njira zina za jakisoni. Zotsatira zazikulu za hypoglycemic zimangowonjezereka ngati zimagwiritsidwa ntchito limodzi ndi sulfonamides, Mao inhibitors, ndi anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine ndi ena a beta-blockers amathandizanso pakugwiritsa ntchito mankhwalawa.

Mphamvu ya hypoglycemic imafooka mukatengedwa ndi mahomoni akuluakulu a chithokomiro, njira za kulera, glucagon, estrogens, heparin, sympathomimetics ambiri, antidepressants, antagonists a calcium, morphine ndi nikotini.

Modziletsa amakhudza insulin pakamwa shuga a beta-blocker, reserpine ndi pentamidine.

Kuyenderana ndi mowa

Kumwa insulin sikugwirizana ndi kumwa mowa. Zizindikiro za kuledzera zikuchulukirachulukira, ndipo zotsatira za mankhwalawo zimachepetsedwa kwambiri.

Pali mitundu ingapo yofunika:

• Berlinsulin N Mwachizolowezi,
• Diarapid CR,
• Wotsimikiza
• Insulin Actrapid,
• Insuman Rapid,

Wokwera

Kuchulukitsa kwotalikirapo kwamapulogalamu amtundu wa insulin kumawopseza kusintha kwosasintha kwa matenda. Vutoli limachitika chifukwa cha kutsika kwa shuga. Mutha kumvetsetsa kuchuluka kwa insulin ndende ndi zizindikiro: kunjenjemera, thukuta, palpitations, kugwidwa mwadzidzidzi ndi njala, nseru, kukomoka, chikomokere. Zizindikiro zotsatirazi zimakhudza kuchuluka kwa mahomoni:

• zolimbitsa thupi,
• kupsinjika kwakanthawi
• Matenda a chiwindi ndi kapamba,
• kunenepa
• kuphwanya kukana kwa maselo ku chakudya,
• ovary polycystic,
• Kulephera kwa ntchito yamatumbo
• khansa ndi chotupa chinyezi cha adrenal gland.

Kutsitsidwa

Kuchepa kwa ndende ya insulin kumachitika chifukwa cha kupsinjika, kulimbitsa thupi kwambiri, kutopa kwambiri, tsiku lililonse kumwa mafuta ambiri oyeretsedwa. Kuperewera kwa insulin kumalepheretsa kuchuluka kwa shuga, ndikuchulukitsa kuchuluka kwake. Zotsatira zake, pamakhala ludzu lamphamvu, nkhawa, kugwidwa mwadzidzidzi ndi njala, kusakwiya, komanso kuyamwa pafupipafupi. Chifukwa cha zofanana ndi insulin yotsika komanso yayikulu, kuzindikira kwake kumachitika ndi maphunziro apadera.

Malangizo ogwiritsira ntchito insulin

Ntchito za insulin ndizofunikira kwambiri kwa thupi la munthu. Ngati muli ndi matenda ashuga, mumalandira chithandizo kuchokera kwa dokotala komanso mankhwala malinga ndi momwe mankhwalawo amaperekedwa kwaulere m'mafakitala kapena zipatala. Pakufunika kwachangu zitha kugulidwa popanda mankhwala, koma muyeso uyenera kuonedwa. Popewa bongo wambiri, werengani malangizo ogwiritsira ntchito insulin.

Makulidwe a insulin

Dokotalayo amakupatsirani mankhwalawa pambuyo popezeka ndi kuyezetsa magazi. Zochizira matenda a shuga gwiritsani ntchito mankhwala osiyanasiyana malinga ndi nthawi yochepa: yayifupi komanso yayitali. Chisankho chimatengera kuopsa kwa matendawa, momwe wodwalayo alili, kuthamanga kwa kuyambika kwa mankhwala:

1. Kukonzekera kwakanthawi kochepa kumapangidwira kwa subcutaneous, intravenous kapena intramuscular management. Imakhala yofulumira, yochepa, yochepetsa shuga, imaperekedwa kwa mphindi 15-20 musanadye kangapo / tsiku. Zotsatira zimachitika mu theka la ola, pazofunikira - mu maola awiri, maola pafupifupi asanu ndi limodzi okha.
2. Kuchita nthawi yayitali kapena kupitilira apo - kumakhudza maola 10-36, kungachepetse jakisoni tsiku lililonse. Zoyimitsidwa zimaperekedwa kudzera mwa intramuscularly kapena subcutaneally, koma osati kudzera m'mitsempha.

Ma syringe amagwiritsidwa ntchito kuwongolera kulowetsedwa ndi kutsata mlingo. Gawo limodzi limafanana ndi ziwerengero zingapo. Malangizo a insulin

• sungani zokonzekera mufiriji, ndipo zomwe zimayambira firiji, konzekerani mankhwala musanalowe, chifukwa ozizira ndi ofooka.
• ndibwino kubaya mahomoni osakhalitsa pakhungu la m'mimba - jekeseni mu ntchafu kapena pamwamba pa matako mumagwira pang'onopang'ono, moyipa kwambiri phewa.
• mankhwala ogwira ntchito yayitali adalowetsedwa kudzanja lamanzere kapena lamanja,
• jekeseni aliyense m'malo osiyanasiyana,
• jekeseni wa insulin, gwira gawo lonse lathupi lathunthu - kuti mupewe kuwawa ndi zisindikizo.
• kutali ndi jakisoni womaliza osachepera 2 cm,
• musagwire khungu ndi mowa, mumawononga insulin,
• ngati madziwo akutuluka, singano idayikidwa molakwika - muyenera kuigwira pakhale madigiri 45-60.

Mtengo wa insulin

Mtengo wa insulin umatengera mtundu wa wopanga, mtundu wa mankhwalawa (nthawi yayitali / yayitali, chochita chodyetsa) komanso kuchuluka kwa ma CD. Mtengo wa 50 ml ya insulinum ya mankhwala pafupifupi ma ruble 150 ku Moscow ndi St. Insuman yokhala ndi cholembera - 1200, Protafan yoimitsidwa ili ndi mtengo pafupifupi ruble 930. Mlingo wa mankhwala amakhudzanso kuchuluka kwa insulin.

Insulin yaumunthu ndi chida chothandiza kupangira odwala omwe ali ndi mitundu yoyamba komanso yachiwiri ya matenda ashuga. Ndi chipangizo chamajini chomwe chimasungunuka kwambiri mu zakumwa. Kuvomerezedwa kuti mugwiritse ntchito ngakhale mukakhala ndi pakati.

Actrapid, Humulin, Insuran.

INN: Semi-yopanga insulin yaumunthu.

Gulu lina

Akatswiri ena amati kukonzekera insulin kukonzekera mwanjira ina, kutengera komwe idachokera. Mwachitsanzo, mankhwala onse amatha kugawidwa m'mafanizo aumunthu, genetic engineering, omwe amapezeka ndikuchotsa nkhumba ndi ng'ombe ku kapamba.

Chowoneka mosiyana ndi izi ndi zomwe zimachitika pafupipafupi, zomwe sizimawoneka poyambitsa ma analog a munthu. Oimira otchuka a gululi - Insulrap, Ultratent.

Porcine insulin ikhoza kukhala ndi nthawi yayitali. Sizosiyana kwambiri ndi anthu, kusiyana kumangokhala mu gulu limodzi la ma amino acid. Koma izi zitha kuchititsanso kuti pakhale zovuta zoyipa.

Mankhwala opangidwa ndi chibadwa cha mankhwala amapezeka mwa kubweretsa ma amino acid mu DNA ya Escherichia, atayamba kupanga mahomoni. Ndizosatheka kudziwa kuti ndi insulin iti yomwe imafikira wodwala wina poyesa koyamba, chifukwa sizikudziwika momwe thupi lake lidzachitikire polowa mapuloteni akunja kuchokera kunja.

Werengani komanso Matenda a shuga

Mankhwala ofanana ndi omwe amapezeka m'matumba a anthu amapereka monga:

Gululi limaphatikizapo zigawo ziwiri nthawi imodzi - kusinthidwa kwa chibadwa komanso anthu. Madotolo amawona kuti ndioyenera kwambiri kwa odwala matenda ashuga, popeza kuopsa kwa zovuta kapena zotsatira zoyipa sizotsika kwambiri kuposa zomwe akupikisana nawo. Izi ndichifukwa chosapezeka puloteni wakunja.

Malangizo

Ndikofunikira kupatsa chidwi ndi mankhwalawa omwe sangayambitse njira za autoimmune, zomwe zimaphatikizapo ziwengo. Izi ndichifukwa choti shuga mellitus wamtundu woyamba, choyambirira, amatanthauza iwo.

Kugwiritsira ntchito insulin ya nyama kumaphatikizira kulowa kwa mapuloteni achilendo mthupi la munthu. Palibe amene anganeneretu zotulukapo za izi. Odwala ena amawalekerera bwino, ena molakwika. Nthano pa kuyikika kwa mankhwalawa imawonetsa koyambira kwa insulin yamtunduwu: NM - analogue of human, MS - a high degree of a oyera.

Komanso, poyang'ana phukusi, mutha kupeza chidziwitso cha yankho. Mmililita imodzi ya mankhwalawa imatha kukhala ndi magawo 40-300 ochita. Monga lero, ma insulin amagwiritsidwa ntchito pafupipafupi kuposa ena omwe ali ndi mayunitsi 100 pa millilita imodzi pakulowetsa ndi syringe kapena inshuwaransi 300 pakugwiritsa ntchito cholembera.

Mitundu yomwe imatchedwa "magpies", yomwe odwala okalamba adazolowera, siimamasulidwa kwazaka pafupifupi 10, komabe, anthu ambiri zimawavuta kuti asiyire insulin "zana limodzi".

Kusunga kwa mankhwala kumachitika mufiriji, kutentha mpaka madigiri 8 Celsius. Ndikofunikira kudziwa kuti ndizoletsedwa mwamphamvu kuti isamasuke, pambuyo pake itayika katundu wake, kuti musalowe.

Ngati insulin yosavuta ikakhala ndi mitambo, imakhala ndi mpweya, mapokoso kapena zodetsa zina, ndiye kuti mankhwalawa amawonedwanso kuti ndi osayenera kugwiritsidwa ntchito.

Mankhwala okhazikika omwe ali ndi iwowo ali ndi mitambo, koma wogawana, osatopa.

M'mayiko a CIS, odwala onse omwe ali ndi matenda ashuga omwe amafunikira chithandizo cha insulin amalembetsedwa ndi endocrinologists. Ali ndi ufulu wogawa mankhwalawo kwaulere chifukwa cha mtengo wake wokwera.

Kuwerengera kwa insulin mlingo wa mtundu 1 ndi mtundu wa 2 shuga: chidziwitso chofunikira

Kuti mupeze inshuwaransi yokwanira ya matenda amtundu 1 komanso matenda amtundu 2, ndikofunikira kusankha kuchuluka kwa insulini yoyendetsedwa molumikizana. Nkhaniyi imafotokoza mwatsatanetsatane zomwe zimawerengera za insulin yayifupi, ultrashort komanso kuchitapo kanthu kwa nthawi yayitali. Mitundu yoyenera yokhala ndi zitsanzo zotsimikiza imaperekedwa kutengera mtundu ndi kuchuluka kwa chakudya chomwe mumadya.

Mtundu woyamba 1 ndi mtundu 2 wodwala matenda ashuga, ngati mliri, ukufalikira kwa odwala ochulukirachulukira, akumayambitsa kusokonezeka kwa metabolic komanso zovuta zina ngakhale mwa ana. Ngati m'mbuyomu kudali kovuta kuchitira zotupa ndi matenda a shuga a 2, ndipo ndi matenda amtundu 1 sikunali kokwanira, popeza insulin, maziko a chithandizo cha pathogenetic, sizinapezeke, koma tsopano malangizo akupangika.

Ma gengu opangidwa ndi chibadwa cha majini apezeka.Njira za pathogenetic za matendawa zidaphunzira, zomwe zidapangitsa kufotokoza tanthauzo la insulin yotalikilapo komanso yochepa mu insulin.

Zimangoyankha mafunso molondola: momwe mungawerengere kuchuluka kwamahomoni omwe amaperekedwa komanso momwe mungadziwire kuchuluka kwa manambala omwe angakwere, komanso kuchuluka kwake.

Chifukwa chiyani ndikofunikira kuwerengera molondola mlingo wa insulin?

Mankhwala aliwonse omwe amwedwa pamlomo kapena wololedwa kuyamwa amayenera kumwedwa muyezo wokwanira ndikuvomerezedwa ndi madokotala. Izi zimachitika makamaka pamankhwala a mahomoni.

Chifukwa chake, kuchuluka kwa insulin, makamaka kwa ana, kumafunikira kuwongolera ndi kusankha, chifukwa ngati mulingo wa insulin uchulukira kwambiri, ndiye kuti shuga ya m'magazi imatsitsidwa pang'onopang'ono.

Ngati ndi hyperglycemia pali choopseza cha hyperosmolar ndi ketoacidotic coma, ndiye kuti mikhalidwe ya hypoglycemic ndiowopsa kwambiri. Izi ziyenera kupewedwa makamaka mosamala, chifukwa ndizovuta kwambiri kuchotsa thupi kuchokera ku chikomokereni ngati shuga ya magazi yafupika.

Izi zimafunikira njira zopulumutsira komanso momwe dipatimenti yapadera idzakhalire. Ngakhale ndi izi, sizotheka nthawi zonse kuchiritsa ndikuyika pamiyendo ya wodwala yemwe ali ndi vuto la hypoglycemic.

Nthawi yomweyo, kusankha mtundu wa insulini ndikofunikira kuti glycemia ikhale yoyenera. Cholinga cha matenda a shuga 1, komanso matenda a shuga a mtundu wachiwiri, ndi glycosylated hemoglobin.

Zimawonetsa digiri ya glycemia kwa miyezi itatu ndipo ndi yodalirika, yowonetsa kubwezeretsedwa kwa matendawa ndi kukwana kwa mlingo womwe wapatsidwa wa insulin ndi analogue yayifupi. Ichi ndichifukwa chake funso la momwe mungawerengere kuchuluka kwa mankhwalawa likuyenera kwa odwala omwe ali ndi endocrinopathy.

Muzochitika zomwe mawerengedwa sanawonetse, ndipo kuchuluka kwa mahomoni sikokwanira, kuchuluka kwa glucose kumakwera. Ndi hyperglycemia, makamaka yayitali, chiopsezo cha ngozi zam'mimba ndi zovuta zina zimawonjezeka.

Ichi ndichifukwa chake kusankha koyenera kwa mankhwala a insulin mu mtundu 2 wa shuga ndikofunikira pankhani ya kudwala kwa matenda ndi kukula kwa zinthu zosafunikira komanso zowopsa.

Kusankhidwa kwa kuchuluka kwa insulin yochepa

Kufotokozera momwe mungawerengere kuchuluka kwa insulin, muyenera kupereka malingaliro ofunikira. Pofuna kuti wodwala asavutike ndi kuwerengetsa kuchuluka kwa chakudya komanso kuchuluka kwa zinthu zomwe zawonongeka, magawo a mkate amapangidwa.

Kugwiritsa ntchito kwawo kumathandizira mosavuta komanso kumathandizira kutsimikiza kwa insulin. 1 unit imawerengedwa ngati 10 g ya chakudya chamafuta. Wina akhoza kugwiritsa ntchito 12 g.

Komabe, ziyenera kukumbukiridwa kuti powerengera kuchuluka kwa insulin ya matenda a shuga a 2 kapena kuwonongeka kwa insulini 1, phindu lomwelo limagwiritsidwa ntchito nthawi zonse.

Kuti "muthetse" mkate 1 umafunikira manambala angapo a magawo a mankhwala a mahomoni. Zimatengera nthawi yamasana, chifukwa kuchuluka kwa ntchito zolimbitsa thupi ndi kukula kwa kapamba omwe amasungidwa ndi zida zapachilumba kumatha kusintha kwa circadian. M'mawa, pa 1 XE, 2 PIECES ya insulin ndi yofunika, pa nkhomaliro - 1 PIECES, ndipo madzulo 1.5 PIECES.

Kuti musankhe kuchuluka kwa insulin yayifupi, mufotokozere momveka bwino zoyenera kuchita. Choyamba, kumbukirani mfundo zochepa, zolemba.

• Kudya kalori tsiku ndi tsiku ndi chinthu choyamba kuganizira. Kutanthauzira kwake kumatengera mtundu wa zomwe zikuchitika, mulingo wakuchita zolimbitsa thupi. Chizindikiro chapakati cha wodwala wolemera makilogalamu 60, omwe zolimbitsa thupi zake zili pafupi ndi pafupifupi, ndi 1800 kcal.
• Gawo la chakudya chamafuta omwe amadya masana ndi 60%. Pafupifupi - 1080 kcal.
• Mukamadya 1 g yamafuta, 4 kcal yamphamvu imamasulidwa.
• Ndi chizolowezi kudziwa mtundu wa insulini mu matenda ashuga, kukumbukira kulemera kwa thupi. Pansipa pali tebulo lomwe likuwonetsa momwe zingwe zamahomoni zimayenera kuperekedwera kulemera kwa thupi. Kuchulukitsa chizindikiro ichi ndi kulemera, timalandira insulin tsiku lililonse.
• Choyamba, kuti ikhale yosavuta, insulin yochepa imasankhidwa, kenako - yayitali,
• Zakudya zomanga thupi kapena zamafuta sizimaganizira posankha mtundu.

Tipenda mtundu wina wamankhwala. Wodwala wolemera makilogalamu 60, akudwala matenda a shuga kwa zaka 4. Mlingo wakuchita zolimbitsa thupi ndi wapakati (kuti apangitse kuwerengera kwa insulini kukhala kosavuta kwambiri). Monga momwe zatsimikizidwira kale, 1080 kcal ndiye kuchuluka kwa tsiku ndi tsiku kwa odwala ndi magawo omwe akonzedweratu.

Poganizira kuti 1 g yamafuta pakachulukidwe amapanga 4 kcal ya mphamvu, 270 g ya chakudya chamagulu adzafunikira kuphimba 1080 kcal.

Kutengera kuti 1 mkate mkate ndi wofanana ndi mafuta 12, timawerengetsa kuti kuchuluka kwa zigawo za mkate zomwe zingapereke mphamvu zoyenera zidzasinthidwe kukhala 22 (270/12 = 22,5, kuzunguliridwa - 22).

Kuchokera munthawi ya zakudya zimadziwika kuti 30% yogwiritsa ntchito mphamvu iyenera kuphimbidwa m'mawa, pakudya nkhomaliro - 40%, komanso chakudya chamadzulo 30%. Ndikosavuta kudziwa kuti pankhaniyi muyenera kugwiritsa ntchito 7 XE m'mawa (1 XE sakusankha magawo awiri a insulin, zomwe zikutanthauza kuti: 7 XE x 2 unit insulin = 14 unit) ndi jekeseni 14 ya insulin yifupi.

Panthawi ya nkhomaliro, 40% imafanana pafupifupi 8 XE (8 XE x 1 IU ya insulin = 8 IU) komanso kuchuluka komweko kwa mahomoni.

Madzulo, kuchuluka kwa chakudya chamagulu ochulukitsa mwa wodwala kumeneku kudzakhala 7 PIERES, ndikuganizira zofunikira za insulin 1.5, kuti mugwiritse ntchito kuchuluka kwa chakudya, muyenera kuyambitsa mwadzidzidzi ma PISCES 10 a mankhwalawa.

Umu ndi momwe mungawerengere kuchuluka kwa insulin yayifupi. Pakupita kwa nthawi, munthu ayenera kuzindikira zomwe thupi limachita pakakhala chithandizo chomwe chasankhidwa.

Kwa mwezi umodzi muyenera kukayezetsa magazi pafupi ndi katatu ndikuwunika kuchuluka kwa hemoglobin pambuyo pa miyezi itatu kuti mumvetsetse ngati chithandizo cha insulin chiri chokwanira pazomwe zimasintha kagayidwe kazakudya.

Zosungidwa zamankhwala

Amasungidwa pa kutentha osaposa + 25 ° C pamalo otetezedwa kwambiri kuchokera kwa ana aang'ono. Ndikofunika kupewa dzuwa lowongolera mwachindunji.

Ndikofunikira kuonetsetsa kuti yankho silitaya kuonekera kwake, ndipo palibe mawonekedwe pansi. Izi zitachitika, ndiye kuti mankhwalawo sangathe kugwiritsidwa ntchito.

Wopanga

Pali mabungwe angapo omwe amapanga insulin yaumunthu:

• Sanofi (France),
• NovoNordisk (Denmark),
• EliLilly (USA),
• Pharmstandard OJSC (Russia),
• National Biotechnology OJSC (Russia).

Insulin yaumunthu imanena za mahomoni omwe amapanga kapamba. Amagwiritsidwa ntchito pochiza matenda ashuga. Kuti muthane ndi chizolowezi cha kapamba, wodwalayo amapaka jakisoni:

• zotsatira zazifupi
• zopitilira
• nthawi yayitali yochita.

Mtundu wa mankhwalawa umatsimikizika potengera thanzi la wodwala komanso mtundu wa matenda.

Kutalika kwa zochita za mankhwala

Njira yothetsera insulin imasiyana pakadutsa kachitidwe. Kusiyana pakati pa zida zomwe zalembedwa patebulo:

Kusankha kwa insulin yayitali

Ndi tanthauzo lamaunifolomu a analogue ya timadzi tochepa tomwe timapanga, tapeza. Zimatsalira kuti mudziwe momwe mungawerengere komanso malamulo ati posankha mankhwala omwe amagwira ntchito kwanthawi yayitali komanso owonjezera. Kumbukirani kuti kuchuluka kwake kumayendetsedwa kamodzi, ngati mankhwalawa ndi othandizira kwa maola 24, ndipo agawidwa pawiri, jakisoni ndi maola 12.

Momwe mungasankhire mlingo wa insulin yayitali

• Dziwani kuchuluka kwa mahomoni tsiku lililonse, mosasamala nthawi yanthawi yake (kuchuluka kuchuluka kwa thupi ndi cholembera kuchokera pagome, m'malo athu 60x0.8 = 48 magawo),
• kuchuluka kwakanthawi kochepa kwa mankhwalawa kumachotsedwa kuchokera ku kuchuluka kwa mayunitsi a hormone ndipo mtengo wotsimikizika umapezeka (48-14 (m'mawa) - 8 (nkhomaliro) - 10 (nthawi yamadzulo) = 16 PIECES.

Kuwerengera kwa insulini kunawonetsa kuti mankhwala omwe atenga nthawi yayitali ayenera kupatsidwa mankhwala ochulukirapo a 16 PIECES, ndi mahomoni osakhalitsa - 32 PIECES, ogawidwa pazigawo zitatu.

Momwe mungachitire ndi shuga wamagazi ambiri?

Izi (hyperglycemia) zimakukakamizani kuti musinthe chithandizo chomwe mwasankha kale. Kupatula njira yolakwika yoperekera mankhwala, ayenera kukumbukiridwa.

1. Mankhwala okhathamira omwe amakhala kwakanthawi kwamankhwala amathandizidwa ndi minofu ya phewa kapena ntchafu.
2. Pamafunika kugwiritsa ntchito insulini yochepa, pamimba pamakhala bwino monga malo a jakisoni, popeza kuti kuyamwa kwa mankhwalawa kumatenga nthawi yayitali.
3. Mankhwala osankha pang'ono amagwiritsidwa ntchito mphindi 15-20 chakudya chisanafike. Ngati mankhwalawa akukwaniritsa mphamvu ya ultrafast (ultrashort analogues), ndiye kuti iyenera kuyikidwa kaye asanadye.
4. Mankhwala opangidwa ndi chibadwa, omwe amagwira ntchito kwa maola 12, amalamulidwa kawiri (ziyenera kudziwitsidwa kuti kuchuluka kwa mahomoni owerengedwa amagawika pawiri).
5. Ma analogu a Ultra aatali amaperekedwa kamodzi.
6. Jakisoni imachitika mwachangu, koma mankhwalawa amaperekedwa pang'onopang'ono (kuwerengetsa pang'onopang'ono mpaka 10), pokhapokha singano itachotsedwa.

Ngati mfundo zonse zakwaniritsidwa, kuwerengera kunali kolondola, ndipo hyperglycemia imapezekabe pakupenda kwa mbiri ya glycemic, kuphatikiza kwa mahomoni ofunikira ndikofunikira, komwe kuli koyenera kukambirana ndi dokotala.

Kuphatikiza apo, zochitika zolimbitsa thupi za mtundu woyamba wa shuga ziyenera kuganiziridwanso. Musanachitike chochitika, chomwe chimatsatana ndi kugwiritsa ntchito mphamvu, muyenera kugwiritsa ntchito magawo awiri a mkate (24 g) wamafuta. Zomwezi zimafunikanso kuchita pambuyo pochita masewera olimbitsa thupi.

Mtundu wachiwiri wa matenda ashuga, kuwerengera zolimbitsa thupi sikofunikira. Komanso kuyang'ana kuchuluka kwa mikate yomwe amadya panthawi yolowera jakisoni wothirira pogwiritsa ntchito zosakaniza zopangidwa kale. Koma poyambitsa basal-bolus, ndikofunikira kuyang'anira zomwe zidyedwa.

Insulin pochiza matenda a shuga

Chithandizo chapadziko lonse lapansi cha matenda onse a carbohydrate metabolism ndi insulin. Mankhwala a mahomoni awa amagwiritsidwa ntchito pochiza matenda ashuga:

• Mtundu 1
• Mitundu iwiri
• machitidwe
• kapamba
• mitundu ina.

Pazochitika zonse, mankhwala a insulin amapereka chokhazikika. Ndi matenda a pancreatogenic ndi mtundu wa 1, yankho lake ndiye njira yokhayo yothandizira. Nthawi zina, insulin imagwiritsidwa ntchito molingana ndi mawonekedwe, yokha kapena yophatikiza ndi njira zina.

• regimen yonse (mitundu iwiri ya insulin),
• regimen imodzi ya insulin (nthawi zambiri imakhala ya insulin, yomwe imakhala yofanana kwambiri ndi insulin ya postprandial)
• kuphatikiza mapiritsi ndi insulin (basal insulin ndi mapiritsi omwe amakulitsa chinsinsi cha maselo a beta).

Ndi matenda a mtundu 2, insulin imayenda bwino ndi metformin.Mapiritsi amawerengedwa kwa odwala otero ngakhale ndi chiwembu chonse (ngati palibe contraindication).

Ndondomeko ndi Mlingo wake amasankhidwa ndi adokotala kuchipatala. Wodwalayo amaphunzitsidwa m'makalasi apadera ku School of Diabetes. Wodwala ayenera kudziwa njira ya jakisoni ndi mfundo za kusintha kwa mlingo.

Mbiri yakale

Kuchiyambiyambi kwa zaka za m'ma 1900, mtundu 1 wa matenda ashuga anali matenda oopsa. Madokotala sakanatha kupereka chithandizocho. Chifukwa chake, kuyambira mphindi zowerengeka za nthendayi kufikira imfa ya wodwala, miyezi yochepa idadutsa.

Zaka 20 zapitazi, madokotala aku Canada adachitapo kanthu posintha matenda ashuga. Amasiyanitsa chinthu chomwe chitha kutsitsa magazi.

Madokotala adalandira yankho kuchokera kuzinthu zanyama (pancreas ya ng'ombe). Kutengera zomwe zili poyera, mankhwala oyamba ochizira matenda a shuga adapangidwa pambuyo pake.

Kuyambira pamenepo, madotolo adapatsidwa mwayi wopereka chithandizo chamankhwala cha mahomoni kwa odwala omwe ali ndi matendawa.

Kwa nthawi yayitali, kukonzekera konse kwa insulini kunapezeka kuchokera ku zikondamoyo za nyama. Ngakhale zaka 10-15 zapitazo, odwala ambiri amagwiritsa ntchito mankhwala a nkhumba ndi mahomoni a bovine. Zachidziwikire, njira izi sizinali zothandiza kwambiri komanso sizinali zotetezeka nthawi zonse.

• khalani ndi mbiri yosayikira,
• tsitsani Hypo- ndi hyperglycemic zinthu,
• chifukwa kukana insulini,
• thandizirani kukulitsa zovuta zakumudzi (lipohypertrophy),
• Nthawi zambiri zimayambitsa matupi awo sagwirizana.

Mu makumi asanu azaka za zana la 20, makampani ogulitsa mankhwala adayamba kupanga kukonzekera kwatsopano kwa ma pancreatic hormone. Njira zoterezi zidapezeka ndi mainjiniya. Ma insulini oterewa amapangidwa ndi magulu osakanikirana a mabakiteriya kapena bowa.

Ma microorganic ali m'malo abwino ndipo amatulutsa timadzi tambiri tambiri. Kenako yankho lake limatsukidwa, kusungidwa ndi kulongedza. Ngati ndi kotheka, mapuloteni kapena zinc zimawonjezeredwa pokonzekera.

Mankhwala awa amasintha mawonekedwe a mankhwalawo.

Mbadwo waposachedwa kwambiri wa kukonzekera kwa mahomoni umatchedwa analogues of insulin ya anthu. Amapangidwa kuchokera ku genetic engineering. Kusintha magwiridwe antchito a mamolekyulu, asayansi amasintha kufanana kwa amino acid. Zotsatira zake, insulin imapeza chuma chatsopano komanso imakhala yabwino kwa wodwalayo.

Pakadali pano, m'maiko ambiri a padziko lapansi, kukonzekera kwa nyama kwa maholide a chamba sikugwiritsidwa ntchito. Ma insulin opangira ma genet ndiwotchuka kwambiri. Ndipo fanizo la mahomoni amunthu limagwiritsidwa ntchito pang'ono (chifukwa cha mtengo wokwera).

Zotsatira za Insulin

Insulin imodzi yokha imagwira ntchito m'thupi la munthu. Amapangidwa ndi maselo a pancreatic beta. Gawo la insulin limalowa nthawi yomweyo m'magazi, lina - limadziunjikira ndipo limasungidwa pambuyo pake. Maselo a Beta amatha kuzindikira kuchuluka kwa shuga m'magazi. Amayankhanso pazinthu zina.

M'malo opanda phokoso, munthu akapumula, zikondamoyo zimayenda kapena kugona, zimatulutsa insulin yaying'ono m'magazi. Kubisa kwamtunduwu kumatchedwa basal. Pafupifupi, ndizofanana ndi magawo a 0.5-1,5 pa ola limodzi mwa munthu wamkulu.

Munthu akadya, maselo a beta amatulutsa masitolo a insulin. Madzi ochuluka kwambiri nthawi yomweyo amalowa m'magazi. Kubisa kwamtunduwu kumatchedwa posachedwa (atatha kudya).

Kuchuluka kwa mahomoni kumadalira kapangidwe kazakudya, kuchuluka kwake komanso kumva kwake kwa minofu. Insulin yambiri imatulutsidwa poyankha chakudya (makamaka digestible).

Kupezeka kwa mahomoni ambiri kumawonedwa mwa anthu omwe ali ndi matenda a metabolic komanso magawo oyamba a matenda a shuga a 2.

Mkuyu. 1 - Kutulutsa kwachilengedwe kwa insulin katulutsidwe.

Cholinga cha mankhwala obwezeretsa insulin ndikutsata mitundu yonse ya zobisika. Izi zimatheka moyenera mothandizidwa ndi mankhwala omwe ali ndi mitundu yosiyanasiyana yochita.

Pali mitundu inayi ya mankhwala:

• mwachidule (zosavuta) insulini,
• insulin yochita pakati
• insulin
• insulin yayitali.

Kuphatikiza apo, makampani opanga mankhwala amapanga kukonzekera kosakanikirana (amakhala ndi insulin nthawi yomweyo m'mitundu iwiri).

Gome 1 - Kutalika kwa zochita za insulin yomwe anthu amagwiritsa ntchito (malingaliro osavuta).

Insulin yocheperako komanso yapakati imapangidwa mwabadwa. Ultrashort komanso nthawi yayitali ndi fanizo zamakono za mahomoni amunthu.

Kupanga secretion ya basal, omwe akuchita zinthu pakatikati ndikuzindikira insulin amagwiritsidwa ntchito.

• imagwira maola 8-14,
• ili ndi chochitika chapamwamba (pambuyo pa maola 3-5).

Insulin yotereyi mu regimen yonse imayendetsedwa 2 kawiri pa tsiku. Kubwezeretsa kwake kwakukulu ndikutheka kwa hypoglycemia maola angapo jekeseni atatha. Vutoli limakhala loopsa kwambiri usiku, pomwe wodwala wagona.

• chokwanira kwa maola 18-26,
• ilibe chiyambi kutchulidwa.

Insulin yotere imagwira ntchito mwachilengedwe. Imatsutsana ndi kubisalira kwa thupi kwa mahomoni, sikumabweza lakuthwa magazi. Mankhwala osakhalitsa amaperekedwa 1 kamodzi patsiku.

Pofuna kutsata katulutsidwe ka postprandial, ma insulin amafupifupi ndi a ultrashort amagwiritsidwa ntchito.

Mahomoni osavuta aumunthu:

• Iyamba kuchita ukatha mphindi 30,
• nsapato zake zidalembedwa patatha maola 2-4,
• Kutalika kokwanira kwa maola mpaka maola 5-6.

Insulin yotere iyenera kuperekedwa musanadye. Komanso, kuyambira jakisoni mpaka kumayambiriro kwa chakudyacho muyenera kudutsa osachepera mphindi 15-20. Insulin yochepa imagwira ntchito pang'onopang'ono. Sangapondereze kulumpha mu glucose wamagazi atatenga maswiti.

Chifukwa chake, insulin yotere iyenera kuphatikizidwa ndi zakudya zoyenera mosamalitsa. Mankhwalawa ndi mahomoni osavuta aumunthu kwa nthawi yayitali. Maola 3-4 atatha kudya, chakudya chonse chimatha kale, ndipo insulin ikupitilizabe kugwira ntchito.

Katunduyu wa mankhwalawa amagwirizanitsidwa ndi chiopsezo cha hypoglycemia maola 4-6 mutatha kadzutsa, nkhomaliro kapena chakudya chamadzulo. Kuti achepetse kuchepa kwa glycemia, odwala amalangizidwa kuti azitha kudya zazing'ono (katatu pa tsiku kwa 1-2 XE).

Zotsatira zake, kuwonjezera pa zazikulu 3, zakudya zitatu zowonjezera zimapezeka muzakudya za wodwalayo. Inde, kudya kwamtunduwu kumathandiza kwambiri, koma sikuti nthawi zonse kumakhala kothandiza.

• Iyamba kuchita mphindi 5 mpaka 15,
• ili ndi nsonga yotchulidwa pambuyo maola 1-2,
• Kutalika konse kwa ntchito yake mpaka maola 4-5.

Ma insulini awa ndi osavuta kwambiri ndipo amawatsanzira mosabisa kutulutsa kwachilengedwe kwa mahomoni. Amatha kuperekedwa nthawi yomweyo asanadye, pomwe kapangidwe kake ndi kuchuluka kwa chakudya kumadziwika kale. Chifukwa cha izi, ndikosavuta kuwerengera mankhwalawo. Komanso, insulin zotere sizifunikira zokhwasula-khwasula.

Chifukwa chake, ndizosavuta kugwiritsa ntchito kwa anthu ogwira ntchito, ophunzira ndi ana asukulu. Kuphatikiza apo, ma analogi a ultrashort amatha kuthana ndi kukwera kwakuthwa kwa shuga m'magazi. Ndi njira yoyenera, izi zimapangitsa kuti nthawi zina titha kuphwanya zakudya popanda kuvulaza thanzi.

Kukonzekera kosakanikirana kumatha kukhala ndi insulin:

• wapakati komanso wamfupi
• lalifupi komanso lalifupi kwambiri,
• nthawi yayitali komanso ultrashort.

Mayankho osiyanasiyana amapezeka, mosiyana pa chiŵerengero cha zigawo zosiyanasiyana. Childs, kuchuluka kwa basal insulin predominates.

Ku Russia, zosakaniza zimayikidwa ndi chiŵerengero:

Zosakaniza za insulin zimagwira pokhapokha ndi mtundu wa 2 shuga. Malo awo amaphatikizidwa ndi mbiri ya zochita za zigawozo. Zosakaniza zimayikidwa katatu pa tsiku. Nthawi zambiri, jakisoni amafunikira chakudya cham'mawa komanso chakudya chamadzulo. Ngati zikuyambira ndi analogue ya ultrashort, ndiye kuti jakisoni amaperekedwa nthawi yomweyo asanadye. Kusakaniza komwe kumakhala ndi insulin yosavuta kuyenera kuperekedwa kwa mphindi 15-30 asanadye.

Zosakanikirana ndi magawo 25/75 ndi 30/70 ndizoyenera kwambiri kwa okalamba omwe ali ndi chidwi chachikulu. Kusakaniza komwe kumakhala magawo ofanana a basal ndi postprandial insulin (50/50) nthawi zambiri amalembera anthu azaka zapakati omwe ali ndi moyo wokangalika ndi zolakwika zadyera.

Zipangizo za Inulin

Kukonzekera kwa insulin ndi mayankho a subcutaneous and intravenous management.

Msempha, mankhwalawa amaperekedwa pokhapokha kuwonongeka kwa matenda, mwachitsanzo, ketoacidosis, lactic acidosis kapena hyperosmolar coma. Panthawi ya zinthu zotere, ziwiya zamafuta am'mimba zimayamba, ndipo kukoka kwa michere kumachepetsa. Mukamachita insulin mosasamala, mankhwalawa sagwira ntchito.

Insulin imalowetsedwa m'mitsempha kudzera pa kachipangizo kapadera ka mafuta onunkhira. Kulowetsedwa mwachizolowezi ndi glucose kapena sodium chloride njira zimatha kuchitikanso. Koma ma dontho wamba sawathandiza kwenikweni, chifukwa insulin imangokhala pang'ono pamakoma a dongosolo.

M'moyo wamba (pakulipiritsa kapena matenda a shuga), odwala amachita okha chifukwa cha insulin. Amabayira yankho pang'onopang'ono.

Ntchito jakisoni:

• insulin ma insulin
• syringe zolembera
• mapampu a insulini.

Syringes yankho - zotheka. Kuchuluka kwawo ndi 0.5-1 ml. Mulingo umakhala chizindikiro pa syringe thupi. 1 ml yankho lili ndi magawo 100 a insulin. Chifukwa chake, nambala yomaliza pamlingo ndi 100. Ku Russia, syringes yotsalira ndi muyeso wa insulin wokhala ndi magawo 40 mu 1 ml amagulitsidwa. Jakisoni wotere sayenera kugwiritsidwa ntchito.

Ma syringe pensi a insulin momwe mungathere. Amatha kusinthika komanso kupatsirana. Zotulutsira zoterezi zimakupatsani mwayi wopereka insulini molondola. Munthu amene ali ndi vuto losawona bwino amatha kupanga jakisoni. Katakitala wa insulin amayikidwa mu cholembera. Singano yolumikizidwa ndi chotungira. Mlingo amasankhidwa pogwiritsa ntchito mawonekedwe.

Pampu za insulin ndizida zamtengo wapatali zopangidwira kupangiziratu insulin. Makatoni okhala ndi ultrashort kapena kukonzekera kwakanthawi amalipiritsa mu zida zamtunduwu. Pampu imalowetsa yankho pang'onopang'ono kudzera mu singano. Chipangizocho chidakonzedwa ndi adokotala komanso wodwala iye mwini. Insulin imabayidwa pakapita mphindi zochepa zilizonse. Izi zimatsanziratu kapangidwe ka kapamba.

Mapampu ena a insulin ali ndi zowonjezera. Amathandizira kuwerengetsa kuchuluka kwa mankhwalawa pachakudya, amasunga deta pazowonjezera shuga m'magazi ndi kufunika kwa mahomoni. Nthawi zina zida zimakhala ndi masensa kuti azitha kuyendetsa glycemia. Mapampu oterowo amatha kupereka machenjezo otsochera ndi shuga m'magazi kapena ndi hyperglycemia yayikulu.

Pampu sichilowa m'malo mwa kapamba, ngakhale imatha kutsanzira ntchito yake. Lingaliro lalikulu lolakwika la odwala ambiri omwe amalota chida chamakono ichi ndi chiyembekezo cha kuphweka kwa chithandizo.

M'malo mwake, kutumiza insulin ndi pampu ndizovuta kwambiri. Pamafunika kudziyang'anira mobwerezabwereza, kusanthula pafupipafupi kwa glycemia.

Wodwala ayenera kukhala ndi zoyambira zogwira ntchito ndi pampu, athe kusintha pawokha mozungulira ma cartridge ndi machitidwe omwe ali ndi singano, ndikuyambitsa pulogalamu yotumiza insulin.

Momwe mungayendetsere insulin?

Ndikofunikira kwambiri kuti wodwalayo apange jakisoni wodziimira pakhungu la m'mimba ndi matako. Madera ena a thupi amathanso kugwiritsidwa ntchito. Madotolo ndi othandizira (achibale) amatha kupanga jakisoni m'matako, m'mapewa, ng'ombe zamphongo za odwala, etc.

Insulin yochepa imayendetsedwa bwino pansi pa khungu la khoma lakunja kwam'mimba. Hormoni imatengedwa mwachangu kuchokera kudera lino. Izi zikutanthauza kuti kuchepa kokwanira kwa postprandial glycemia kumaperekedwa.

Kutalika kwa insulin komwe kumakomera ntchafu. Kuchokera apa, mahomoni amatenga pang'onopang'ono. Chifukwa chake, mankhwalawa amagwira ntchito mosakhazikika komanso kwa nthawi yayitali, pokwaniritsa kufunika kwa insulin.

Pofuna kupewa zovuta zamankhwala zam'deralo, malo omwe jakisoni akusinthidwa nthawi zonse (m'gawo lomwelo). Mwachitsanzo, pamimba imagawidwa m'maganizo m'magulu anayi (kumanja kumanzere ndi kumanzere pamwamba pa navel ndi kumunsi kumanzere).Mu sabata yoyamba ya mwezi, jakisoni onse amachitika kokha m'mwambamwamba kumanja.

Kenako pitani kumalo ena (kumtunda kumanzere). Masiku 7 otsatirawa ali ndi jekeseni pamimba iyi. Kenako, ndikusuntha koloko, pitani kumunsi kumanzere. Apa jakisoni amachitidwa sabata lachitatu la mwezi uliwonse. Kenako pitani ku sikolo yachinayi.

Ndi chiyambi cha mwezi wotsatira, majekeseni amachitidwanso mkati mwamimba.

Kukonzekera syringe ya jakisoni:

• insulin yochita kupanga pakati yasakanikirana (pendani pang'onopang'ono botolo pakati pa manja),
• gwiritsani ntchito kapu ya vial ndi antiseptic,
• Amakoka mpweya mu syringe (muyezo wa insulin)
• Kubaya kapu yamabotolo ndi singano,
• alowetsani mpweya m'botolo
• amatenga insulin kuchokera m'botolo (muyezo woyenera kuphatikiza ndi magawo 1-4),
• chotsani singano pachotengera,
• wogwirizira sindiko mogwirizana, chotsani mpweya wonse womwe wagwera mkati,
• onani kuyika kwa singano (kumasulidwa mayunitsi awiri a insulin).

Kukonzekera kwa jakisoni ndi cholembera:

• Sakanizani insulin ya nthawi yayitali (chogwiriracho chimasunthidwa ndikutsika mu arc),
• ikani singano pa cholembera
• onani kuyika kwa singano (kumasulidwa mayunitsi awiri a insulin).

Momwe jakisoni amachitikira:

• Khungu limasanthulidwa koyamba (kukhalapo kwa kutupa, kuipitsidwa, lipohypertrophy kumayesedwa),
• ndiye kuti khola la khungu litero
• ndiye kuti singano kapena cholembera imalowetsedwa m'munsi mwa khola
• ndiye kuti mlingo wonse wa insulin umalowetsedwa pang'onopang'ono,
• kenako wodwalayo amawerengera 10-20,
• singano itachotsedwa ndipo pakhungu pakumasulidwa.

Palibe chifukwa chotsuka khungu ndi antiseptic nthawi iliyonse musanalowe. Izi nthawi zambiri zimakhala zosafunikira. Wothandizira antiseptic amapaka khungu ndikuchepetsa chitetezo chake.

Pambuyo pa jekeseni, khungu pakhungu la jakisoni silingatenthe kapena kusenda kapena kusenda. Izi zimatha kusokoneza mankhwalawa.

Momwe mungasungire insulin?

Mankhwala a mahomoni ali pamndandanda wazofunikira. Amaperekedwa kwaulere pansi pa kukakamizidwa inshuwaransi ya zamankhwala kwa odwala onse omwe ali ndi matenda ashuga.

Insulin italandiridwa kuzipatala, iyenera kusungidwa bwino.

• imitsani yankho
• tenthetsani mabotolo
• Sungani zonyamula dzuwa.

Maselo a insulin ayenera kugona mufiriji pamtunda wa madigiri 2-11. Botolo kapena cartridge lomwe limagwiritsidwa ntchito pakadali pano limasungidwa kutentha kwawindo m'malo amdima (kabati, pagome).

Osagwiritsa ntchito mankhwalawa tsiku likatha (lomwe lasonyezedwa pa phukusi). Komanso, insulini imaganiziridwa kuti itha ntchito ngati masabata opitilira 6 atadutsa pambuyo pa kugwiritsa ntchito (kutsegulira botolo).

Ngati mukuyenda, tengani mankhwala okwanira, ma syringe ndi ma CD operekera. Nthawi zina mankhwalawa amabweretsa mafunso kwa oyang'anira msonkho. Chifukwa chake, ngati mukuyenera kudutsa malire, tengani satifiketi ya chithandizo cha chipatala.

M'mayiko otentha, yang'anirani mwachidwi kutengera ndi kusungira kwa insulin. Pamaulendo ndi maulendo, gwiritsani ntchito zotengera zamafuta (zimasunga kutentha kwa tsiku lopitilira). M'mahotelo, sungani insulin mufiriji.

Endocrinologist I. Tsvetkova

Chalangizidwa kuti muwone:

Ndemanga 4 pa "Mbiri Yopanga Insulin"

Meyi 31, 2010 pa 00:33

➡ Akatswiri a insulin okondedwa. Funso: Mukuwona bwanji tsogolo lakapangidwe ka insulini, kapangidwe ka nyama, pamayendedwe, kosungunuka kwanthawi yayitali ngati pakufunikira, kumatha kudya mpaka kawiri pa sabata?

Meyi 31, 2010 pa 19: 23

Insulin ndiokwera mtengo. Ndikosavuta kuletsa kubereka, chifukwa chake shuga amatengera.

Novembala 1, 2011 pa 12:18

Moni Kodi panali kafukufuku wina wokhudzana ndi psychoneuropathologists pofotokoza kuti podzilimbitsa nokha kuti mutha kutsitsa shuga mu thupi lanu, dzilimbikireni nokha ndikukwaniritsa bwino mbali iyi? Mwachitsanzo, ndidaphunzira kudzilimbikitsira ndikuchepetsa shuga yanga kukhala yabwinobwino! Mwamuna amatha kudzipulumutsa ndikudzipha ndi kusazindikira kwake, akungodalira adokotala.

Novembala 1, 2011 pa 20:06

Sindikudziwa maphunziro asayansi okhazikika awa. Komabe, adawerenga mwachitsanzo, m'buku la M. Norbekov, "The Experience of Fool, or the Key to Insight," momwe ana achichepere amachotsera shuga m'kati mwa bafa ndikudziyerekeza kuti ali shuga.