Zisonyezo za mankhwala a insulin:

Ketoacidotic chikomaso (magawo onse), kuwonongeka kwakukulu kwa mtundu uliwonse wa matenda a shuga ndi kukula kwa ketosis kapena ketoacidosis

Type 1 shuga mellitus (kuperewera kwathunthu kwa insulin)

Mimba, kubereka, kuyamwa

Zowonongeka ndi ma opaleshoni othandizira odwala omwe ali ndi matenda osokoneza bongo a mtundu uliwonse (makamaka m'mimba)

Pachimake myocardial infaration

Ngozi yamitsempha yamagazi

Matenda am'magazi (leukemia, thrombocytopenia, kuphatikizapo magazi)

Gawo la organangiopathies

Matenda Akulumala Ndi Otupa

Kuchulukitsa kwa matenda aakulu (bronchitis, cholecystitis, zilonda zam'mimba zam'mimba, ndi zina zambiri).

Matenda a kutupa kwa nthawi yayitali (chifuwa chachikulu, ndi zina)

Zodwala zam'mimba kwambiri komanso zotupa zopweteka pakhungu (zilonda zam'mimba, necrobiosis, zilonda, ma carbuncle)

Matenda a chiwindi ndi impso limodzi ndi kuphwanya kwawo ntchito

Kukana kugwiritsa ntchito mankhwala amkamwa hypoglycemic (kuperewera kwa hypoglycemic potsatira mankhwala okwanira tsiku lililonse)

Woonda kwambiri

Tikuyenera kunena kuti kusankhidwa kwa insulin kumasonyezedwa kwathunthu kwa matenda amtundu wa 1, ndikupanga mtundu wa matenda ashuga (hyperglycemic) com, ketoacidosis, panthawi yapakati, pakubadwa kwa mwana komanso kuyamwa.

Pakadali pano, odwala omwe ali ndi matenda a shuga omwe amalandira insulin mankhwala, amagwiritsidwanso ntchito ma genulin omwe amapanga insulin, ndipo amagwiritsidwa ntchito, omwe samasiyana ndi munthu mu mankhwala, koma amasiyana ndi amino acid ndi pharmacokinetics.

Zokhudza kukonzekera kwa insulin:

Mayina apadziko lonse

Dzina lazamalonda lolembetsedwa ku Russian Federation

Ultrashort zochita (anthu insulin analogues)

Pambuyo pa mphindi 5 mpaka 15

Soluble waumunthu wopanga insulin

Pambuyo 20-30 mphindi

Kutalika kwapakati

Isofan - Insulin Yaumunthu Yaumunthu

Pambuyo maola 6-10

Wochedwa (munthu wa insulin analogues)

Zosakanikirana za insulin yochepa ndi NPH-insulin

Human-genetically insulin biphasic insulin

Insuman Comb 25

Zofanana ndi za insulin yochepa ndi NPH-insulin, mu osakaniza omwe amachita mosiyana

Zosakaniza za ultrashort insulin analogs ndi ma protein a insulin

Lizpro biphasic insulin

Kusintha kwa Humalog 25

Kusintha kwa Humalog 50

Zofanana ndi zofanizira za ultrashort kanthu ndi NPH-insulin, mu osakaniza omwe amachita mosiyana

Biphasic Insulin Aspart

Pazinthu zakuthupi, munthu wathanzi amapanga ma insulin 23 mpaka 60 patsiku, omwe amachokera ku 0,6 mpaka 1.0 mayunitsi / kg pa kulemera kwa thupi. Secaltion ya basal insulin imachitika tsiku lonse ndipo ndimayunitsi awiri a insulin pa ola limodzi. Kuphatikiza apo, pachakudya chilichonse, pachimake kapena pakabowo insulin katulutsidwe kamayang'anidwanso, mpaka magawo 1,0-0-2.0 kwa chakudya chilichonse cha 10-12 g.

Ntchito ya mankhwala a insulin ndi kuyeneranso kutengera katulutsidwe ka thupi ka insulin mwa wodwala matenda a shuga. Chifukwa cha izi, mitundu yonse ya insulin yomwe ilipo imagwiritsidwa ntchito.

Pali mitundu iwiri yodziwika bwino ya insulin.

- kwambiri (zoyambira - bolus)

Pakulimbitsa insulini kwambiri, majakisoni awiri a insulin (IDI) amagwiritsidwa ntchito nthawi zambiri kuyerekezera chakudya cham'mawa musanadye chakudya chamadzulo, kapena pogona, kapena jekeseni imodzi ya insulin yotalikilapo nthawi yogona. Katulutsidwe ka chakudya ka insulin kamayesedwa ndi subcutaneous makonzedwe aifupi kapena a ultrashort insulin musanadye chakudya chachikulu (kadzutsa, nkhomaliro, chakudya chamadzulo). Malangizo a insulin amenewa amalimbikitsidwa kwa odwala omwe ali ndi matenda amtundu wa 2. Ndi kusankhidwa kwake, ndizotheka kukhalabe chindapusa chokwanira cha kagayidwe kazakudya, pokhapokha ngati wodwalayo amaphunzitsidwa komanso kudziyang'anira, njira iyi ilinso ndi zovuta, zomwe zimapangitsa kuti chiwopsezo cha matenda a hypoglycemia chiwonjezeke.

Mu mankhwala a insulin achikhalidwe, jakisoni waifupi komanso wapakati amaperekedwa pokhapokha chakudya cham'mawa komanso chakudya chamadzulo. Insulin yomwe ikugwira ntchito mwachidule (ICD) musanadye chakudya chamadzulo simumayikiridwa poyembekeza kuti insprandial hyperglycemia imatha chifukwa cha insulin yopitilira nthawi yayitali, yomwe imaperekedwa pa kadzutsa. Ndi regimen iyi ya insulini makonzedwe, nthawi zambiri sizingatheke kulipira chiphuphu chabwino cha carbohydrate metabolism. Chiwembu chotere sichimagwiritsidwa ntchito nthawi zambiri ndipo, monga lamulo, mwa odwala okalamba omwe ali ndi matenda a shuga a 2, omwe moyo wawo sakhala wapamwamba ndipo kugwiritsa ntchito kwambiri mankhwala a insulin sikuvomerezeka chifukwa choopsa cha hypoglycemia.

Mwachitsanzo, powerengera ziwonetsero zomwe zimapezeka kwambiri

Wodwala A., wazaka 20, kulemera 65 makilogalamu, kutalika - 178 masentimita, adalowetsedwa kuchipatala ndi madandaulo a ludzu, polyuria (mpaka malita 4-6 patsiku), kufooka kwathunthu, kuchepa thupi kwa makilogalamu 8 pa sabata. Zizindikirozi zimadziwika pafupifupi sabata limodzi. Kafukufuku wodziwikiratu adawonetsa kuuma kwa khungu ndi ma mucous membala. Kwa ziwalo zopanda matenda. Kuthamanga glycemia ndi 16,8 mmol / L, mkodzo acetone ndi wabwino. Kutengera ndi matenda azachipatala ndi a labotale, a mtundu woyamba wa matenda a shuga adapezeka.

1. Mlingo wa insulin pafupifupi tsiku lililonse kwa odwala omwe ali ndi matenda oopsa a shuga amatsimikizika kuchokera pakuwerengera kwa 0.3-0.5 U / kg pa kulemera kwa thupi: 650.5 = 32 U

Ndi mtundu woyamba wa matenda ashuga 1, amangokhala ndi insulin (ICD) yochepa pokhapokha yomwe imayikidwa, yomwe imayendetsedwa kangapo katatu pa tsiku, kutengera kuopsa kwa hyperglycemia komanso kupezeka kwa acetonuria ndi maola 3-4. Panthawi ya makonzedwe atatu, ICD imayikidwa musanadye chakudya chachikulu malinga ndi kuchuluka kwa chakudya (XE) - 1 XE 2.0 -1.5-1.0 IU ya insulin (motsutsana, asanadye chakudya cham'mawa, chakudya chamadzulo komanso chakudya chamadzulo) glycemia wambiri musanadye. Pa mulingo wa glucose osaposa 6.7 mol / L, insulin imayendetsedwa mu mlingo womwe umawerengeredwa pa kuchuluka kwa XE; pamitengo yapamwamba, kusintha kwa insulin kumachokera pamalingaliro akuti 1 U ya insulin imachepetsa glycemia pafupifupi 2.2 mmol / L. Panthawi yomwe acetonuria apezeka, kuchuluka kwa jakisoni wa insulin kumawonjezeka mpaka ku 4-6 chifukwa cha podkolok yowonjezera yomwe imayikidwa pakati pa jakisoni wamkulu (mlingo wa ICD wokhala ndi jakisoni wowonjezera nthawi zambiri amakhala mayunitsi 4-6).

Ochuluka a tsiku lililonse a insulin (2/3) amawonetsedwa mu theka la tsiku, ena - theka lachiwiri ndipo ngati kuli kotheka, usiku. Malinga ndi kuchuluka kwa mbiri ya glycemic yomwe imachitika tsiku lililonse pakusankhidwa kwa insulin ya tsiku ndi tsiku, mlingo wa insulin umasinthidwa. Minyewa ya m'magazi ikamapangika ndipo acetonuria amachotsedwa, wodwala yemwe ali ndi matenda a 1 amamulembera njira zowonjezera insulin, kuphatikiza jakisoni wa ICD ndi ISD. Tiyerekeze kuti mchitsanzo chathu, kuchuluka kwa insulin (32 PIECES) tsiku lililonse kunali kokwanira kulipirira zovuta zamatumbo ndipo palibe kukonza komwe kumafunikira. Kuchokera pa mankhwalawa, chiwerengero cha ICD ndi ISD chikuyenera kuwerengedwa.

2. Mlingo watsiku ndi tsiku wa insulin (ICD) yatsiku ndi tsiku ndi 2/3 pazofunikira tsiku lililonse: 322 / 3 = 21ED

3. Mlingo watsiku ndi tsiku wa anthu omwe amagwiritsa ntchito insulin (ISD) ndi 1/3 pazofunikira zonse tsiku ndi tsiku: 321 / 3 = 11 ZIWANDA

4. M'mawa wam'mawa, 2/3 ya mlingo wa tsiku ndi tsiku wa ISD umayendetsedwa: 112 / 3 = 7 PIECES. Madzulo 1/3 - 4 mayunitsi

5. Mlingo wa ICD umagawidwa motere:

nthawi yamadzulo (chakudya chamadzulo) dose tsiku lililonse la ICD: 211 / 4 = magawo asanu

pa kadzutsa ndi chakudya chamasana - 3/4 ya tsiku lililonse la ICD: 21/3/4 = 16 PESCES. Kugawa kwa jekeseni aliyense ndi 50% (mayunitsi 8) kapena kwa nkhomaliro ndi magawo 2-5 ambiri, chifukwa Nthawi zambiri chakudya chamafuta chimadyedwa nthawi ya nkhomaliro kuposa chakudya cham'mawa (6 mayunitsi ndi magawo 10)

Chifukwa chake, kuwerengera kwa insulin kuyenera kutha ndi kukonzekera kwa insulin mankhwala regimen, yomwe inalembedwa m'mbiri yamankhwala ndi mankhwala:

8.30 - 6 PIECES S.Actrapidi HM + 7 PIECES S. Protafani HM

13.30 - 10 UNITS S.Actrapidi HM

32 magawo / tsiku, sc

Kukhazikitsidwa kwa chikhalidwe cha insulin yothandizira pakadali pano kuli koyenera kwambiri kwa okalamba omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo, omwe chithandizo cha mankhwala osokoneza bongo komanso mapiritsi sothandiza kapena kumayambiriro kwa matendawa kunawulula kuphwanya chiwindi, impso, kupindika kwamankhwala pamimba. Malamulo achikhalidwe a insulin mankhwala ayenera kumvetsedwa ngati kuyambitsa kwa insulin mu "ziwiri" jakisoni: chakudya cham'mawa chisanafike, ICD kuphatikiza ndi ISD komanso musanadye chakudya chamadzulo, kuphatikiza kofananako.

Mwachitsanzo, powerengera njira ya mankhwala a insulin:

Patient K., wazaka 72, wolemera makilogalamu 70, adavomerezedwa ku dipatimenti ya endocrinology motsogozedwa ndi endocrinologist wa chigawo chodziwitsidwa mwachindunji: mtundu 2 shuga mellitus, woyamba adapezeka. Kuthamanga kwamagazi a magazi kunali 9,1 mmol / L, mkodzo acetone anali wopanda pake. Atafunsidwa, zidapezeka kuti wodwalayo amakhudzidwa kwambiri ndi kuchepa kwa zowoneka bwino. Kufooka wamba, kutopa, pakamwa pang'ono pang'onopang'ono, ludzu linawonjezeka kwa zaka 4-5, koma osafunsa dokotala. Katswiri wa maso pa fundus adavumbulutsa kutaya kambiri m'matumbo, zombo zomwe zangopangidwa kumene, "thonje" komanso zotakasika za dera la macular, ndipo gawo la odwala matenda ashuga retinopathy adapezeka.

Chizindikiro chodziwitsa odwala omwe ali ndi insulin m'thupi ndi gawo la retinopathy.

1. Kufunika kwa insulin tsiku lililonse kwa wodwala yemwe ali ndi matenda oopsa a shuga (omwe sanalandire chithandizo cha insulin kale) ndi 0,3-0,5 U / kg thupi: 70-0.3 = 21 U. Monga momwe zinalili kale, ICD yokha ndiyomwe imayikidwa pele chakudya chachikulu. Pambuyo pake, monga mlingo womaliza tsiku ndi tsiku wa insulin amasankhidwa, mlingo wa ICD ndi ISD amawerengedwa. Tiyerekeze kuti kwa ife kufunika kwa insulin tsiku lililonse ndi magawo 28.

2. 2/3 ya mlingo wa insulin wa tsiku ndi tsiku waperekedwa m'mawa: 282 / 3 = 18ED.

3. Chiwerengero cha ICD: ISD m'mawa m'mawa chiyenera kukhala pafupifupi 1: 2, i.e. 6 magawo ndi magawo 12, motsatana.

4. 1/3 yofunikira tsiku ndi tsiku la insulin imayendetsedwa usiku 281 / 3 = 10ED.

5. Chiwerengero cha ICD: ISD nthawi yamadzulo ikhoza kukhala 1: 1 (ndiye kuti, magawo 5 ndi magawo asanu, motsatana) kapena 1: 2.

Kuwerengera kwa kuchuluka kwa insulini kuyenera kutha ndi kukonzekera kwa insulini regimen, yomwe inalembedwa m'mbiri yamankhwala ndi mankhwala:

Mankhwala a insulin

Mankhwala a insulin Ndi magawo omwe cholinga chake chikwaniritse chipukuta matenda a carbohydrate metabolism pobweretsa insulin kukonzekera m'thupi la wodwalayo. Muzochita zamankhwala, imagwiritsidwa ntchito makamaka pochiza matenda osokoneza bongo a matenda osiyanasiyana, komanso matenda amisala ndi ena.

Chithandizo cha insulini ndicholinga chokwanira kuti athe kulipira matenda osokoneza bongo, kupewa hyperglycemia komanso kupewa zovuta za matenda ashuga. Kukhazikitsa insulini ndikofunikira kwa anthu odwala matenda ashuga amtundu wa 1 ndipo angagwiritsidwe ntchito m'malo ena kwa anthu odwala matenda a shuga a 2.

Zizindikiro

Pakadali pano, pali zokonzekera zambiri za insulini zomwe zimasiyana nthawi yayitali (ultrashort, yochepa, yapakatikati, yayitali), malinga ndi kudziyeretsa (monopik, monocomponent), mitundu ya mitundu ya anthu (nkhumba, nkhumba, bovine, mainjini, ndi ena)

Ku Russia, insulin yomwe idalandidwa kuchokera ku ng'ombe idachotsedwa kuti isagwiritsidwe ntchito, izi zimachitika chifukwa cha zotsatira zoyipa zambiri zikagwiritsidwa ntchito. Nthawi zambiri, m'mawu awo oyamba, zimachitika zosiyanasiyana, milomo ya m'mimba imayamba, insulini imayamba.

Insulin ikupezeka poyerekeza 40 IE / ml ndi 100 IE / ml. Ku Russia, kuzunzidwa kwa 100 IE / ml pakadali pano ndizofala kwambiri, insulin imagawidwa m'mbale 10 ml kapena mu 3 ml syringe cartrges.

Kusintha Zizindikiro |

Mankhwala a insulin

Ntchito ya "chakudya" insulin, yomwe imapangidwa ndi zikondamoyo mwa anthu athanzi poyankha kudya, imachitidwa ndi insulin yochepa kapena ya ultrashort. Ma insulini awa amapangidwa ngati kuchitapo kanthu mofulumira kuti mupeze insulin musanadye chakudya kuti muchepetse kuchuluka kwa shuga wamagazi mukatha kudya. Chifukwa chake, ma insulin awa amawonetsedwa katatu pa tsiku - asanadye chakudya cham'mawa, asanadye chakudya chamadzulo komanso asanadye.

Pafupifupi ndi Ultrashort Insulin

Insulin yofupikitsa (insulin yosavuta, kapena insulin yofulumira) ndi madzi omveka bwino komanso opanda khungu. Imayamba mwachangu komanso nthawi yayitali.

Ngati mukugwiritsa ntchito imodzi mwazosavuta, muyenera kukumbukira izi.

• Chifukwa cha kuyamba pang'onopang'ono kwa insulin yamtunduwu, ndikofunikira kusunga mphindi 20 mpaka 40 pakati pa jakisoni ndi zakudya. Ndikofunikira kuti nsonga ya insulini igwirizane ndi kuchuluka kwa kuchuluka kwa shuga m'magazi.
• Ngati jakisoni wa insulini atapangidwa, pakatha mphindi 20 mpaka 40 ndikofunikira kudya chakudya chofotokozedwa mosamala momwe mlingo wa insulin unapangidwira. Chakudya chocheperako chimayambitsa kutsika kwa shuga (hypoglycemia), ndipo chokulirapo chidzatsogolera kukuwonjezereka (hyperglycemia).
• Pakati pa chakudya chachikulu, zokhwasula-khwasula ndizofunikira (kadzutsa 2, chakudya chamadzulo, chakudya chamadzulo chachiwiri). Izi ndichifukwa choti nthawi yovomerezeka ya insulin yosavuta ndiyotalikirapo kuposa nthawi yowonjezera shuga m'magazi mutatha kudya komanso maola awiri ndi atatu mutatha kudya kumafika nthawi pomwe pali insulin yokwanira m'magazi ndipo mulibe malo osungirako shuga. Popewa hypoglycemia panthawiyi, akamwe zoziziritsa kukhosi zofunika.

Ma Ultra -fupi-insulins inshuin (Humalog ndi Novorapid) pochita zawo amafanana ndi kuyankha kwa thupi pakuwonjezeka kwa shuga wamagazi atatha kudya, odzipereka limodzi ndi kudya.

Chifukwa chake, kugwiritsa ntchito kwawo ngati insulin ya chakudya kumakhala ndi zotsatirazi.

• Kuyamba mwachangu kumakupatsani mwayi kuti mupeze insulin musanadye, pomwe mukudziwa kale kuchuluka kwa umphawi womwe udyedwe tsopano.
• Nthawi zina, zikavuta kudziwa zakudyazi pasadakhale, kuphatikiza ana ang'onoang'ono, jakisoni ikhoza kuperekedwa pambuyo pudya, kusankha mlingo kutengera kuchuluka kwa chakudya.
• Chifukwa chakuti nthawi yayitali ya ultrashort imatulutsa pafupifupi nthawi yofanana ndi kuchuluka kwa shuga m'magazi mutatha kudya, simungathe kudya pakati pa zakudya zazikulu.

Chifukwa cha mikhalidwe iyi, Humalog ndi Novorapid ndizosavuta, makamaka paunyamata, mukafuna kukhala ndi ufulu wambiri wokumana ndi abwenzi, kuchezera ma discos ndi kusewera masewera.

Kodi ma insulini amasiyana bwanji?

Ma insul-duration insulins (Humulin N, Protafan) amapezeka mwanjira yoletsa kwamtambo (chifukwa chowonjezera zinthu ku insulin yomwe imachedwetsa kuyamwa kwake ndikuchititsa kuti ikhale yayitali).

Insulin iyi imayamba kugwira ntchito maola 1.5-2 pambuyo pa jekeseni, zotsatira zake zimakhala nthawi yayitali kuposa insulin yochepa. Insulin ya basal imayenera kukhala ndi shuga wabwinobwino pakati pa chakudya ndi usiku. Popeza ma insulini onse owonjezereka omwe amagwiritsidwa ntchito mwa ana amakhala ndi maola 14 kuti apange kuchuluka kwa insulini tsiku lonse, ayenera kuperekedwa kawiri pa tsiku - asanadye chakudya cham'mawa komanso asanadye chakudya chamadzulo. Kuonetsetsa kuti pali insulin yofananira, kuyimitsidwa kwake kuyenera kusakanikirana bwino asanadziwe jakisoni.

Ma insulin omwe amakhala nthawi yayitali (Lantus, Levemir), mosiyana ndi ma insulin apakatikati, ndi madzi owonekera bwino. Izi insulini amatchedwanso fanizo la insulin yaumunthu, chifukwa chakuti zimasiyana mumapangidwe amakanidwe amtundu wa insulin opangidwa ndi inshuwaransi yaumunthu (chifukwa chomwe nthawi yawo imakwaniritsidwa).Kutalika kwa nthawi ya Lantus ndi maola 24, kotero kuti jakisoni imodzi patsiku ndikokwanira. Chofunikira china cha insulin iyi ndi kusowa kwa zochitika zapamwamba.

Kutalika kwa nthawi ya Levemir ndi maola 17-20, kotero kuti nthawi zambiri jakisoni 2 wa insulin tsiku lililonse amafunika. Mosiyana ndi Protafan, ili ndi mitundu yambiri yochita.

Chifukwa cha izi, Levemir adapeza kugwiritsidwa ntchito kwa ana ambiri, pomwe Lantus singagwiritsidwe ntchito chifukwa cha zosowa zosiyanasiyana za insulin masana masana ndi usiku (monga lamulo, ndizochepa usiku komanso zochulukirapo masana).

Intake-Injection Interval

Tiyenera kukumbukira kuti kutalika kwa zochita za insulin zimatengera mlingo wake, i.e. Ngati insulin yayikulu ikuperekedwa, ndiye kuti imatenga nthawi yayitali kuposa mlingo wocheperako.

Kutengera mtundu wa insulin yaying'ono yomwe imagwiritsidwa ntchito (yosavuta kapena ya ultrashort) komanso kuchuluka kwa shuga m'magazi musanadye, pali kusiyana pakati pa "jakisoni - kudya zakudya" (Gome 9).

Tebulo 9. The "jekeseni - kulowetsedwa" kutengera mtundu wa insulin ndi msanga wa glycemia

Glycemia asanadye, mmol / l	Mwachidule kuchita insulin	Ultra Yokhala-Mwachidule Insulin
Pansipa 5.5	Kubaya - mphindi 10-15 - chakudya	Kudya - Kulowa
5,5-10,0	Kubaya - mphindi 20-30 - kudya	Jekeseni - kudya nthawi yomweyo
Opitilira 10,0	Kubaya - 30-45 mphindi - chakudya	Kubaya - 15 min - chakudya
Zopitilira 15.0	Kubaya - 60 min - chakudya	Kubaya - 30 min - chakudya

Chonde dziwani kuti mukamagwiritsa ntchito insulin yayifupi, mosasamala kuchuluka kwa shuga m'magazi, musanadye, jakisoni wa insulini uyenera kuchitidwa PANTHA tisanadye, komanso mukamagwiritsa ntchito Humalog kapena Novorapid, zonse PAMBUYO PAMBUYO PAKATI

Chitsanzo cha kuwerengera chizindikiritso cha insulin

Wodwala A., wazaka 20, thupi 70 makilogalamu, kutalika - 176 masentimita, adalowetsedwa kuchipatala ndi madandaulo a ludzu, polyuria (mpaka malita 3-4 patsiku), kufooka kwathunthu, kuchepa thupi kwa makilogalamu atatu pa sabata. Zizindikirozi zimadziwika pafupifupi masiku 5, zimagwirizanitsa maonekedwe awo ndi ARVI yosamutsidwa.

Kuunika mozama kumavumbula zizindikiro za kuchepa madzi m'thupi m'thupi popanda matenda. Kuthamanga glycemia ndi 9,8 mmol / L, mkodzo acetone ndi wopanda pake.

1) Kufunikira kwa tsiku ndi tsiku kwa insulin mwa wodwala yemwe ali ndi matenda oopsa a shuga ndi 0.3-0.5 U / kg kulemera kwa thupi: 70x0.5 = 35 U.
2) Tsiku lililonse mwachidule akuchita insulin (ICD) amapanga 2/3 pazofunikira zonse za tsiku ndi tsiku: 35x2 / 3 = 23 magawo.
3) Tsiku lililonse Nthawi Yapakatikati Insulin (ISD) ndi 1/3 pazofunikira zonse tsiku ndi tsiku: 35x1 / 3 = 12 PIECES.
4) M'mawa m'mawa, 2/3 ya mankhwalawa tsiku lililonse a ISD imayendetsedwa: 12x2 / 3 = 8 PIECES, ndipo madzulo a 1/3 - 4 PIECES.
5) Mlingo wa jekeseni wa ICD koyambirira ndi:

• nthawi yamadzulo (chakudya chamadzulo)% ya tsiku ndi tsiku ya ICD: 23x1 / 4 = 5 PISCES,
• chakudya cham'mawa ndi nkhomaliro wathunthu - 3/4 tsiku lililonse mlingo wa ICD: 23x3 / 4 = 18 PIECES.

Kugawa kwa jakisoni aliyense ndi 50% (maunitsi 9) kapena kwa nkhomaliro, mayunitsi 2-4 kwambiri, chifukwa nthawi zambiri mafuta ochulukirapo kuposa chakudya cham'mawa (mayunitsi 8 ndi 10).

Chifukwa chake, kuwerengera kwa insulin kuyenera kutha ndi kukonzekera kwa insulin mankhwala regimen, yomwe inalembedwa m'mbiri yamankhwala ndi mankhwala:

8.30 - 8 PISCES of S. Actrapidi HM + 8 PISCES of S. Protaphani HM
13.30 - 10 PIECES S.Actrapidi HM
17.30 - 5 magawo a S. actrapidi HM + 4 magawo a S. protaphani HM
35 mayunitsi / tsiku, sc

Ndi chithandizo chenicheni cha insulin, mlingo wa ICD womwe umayendetsedwa zimatengera kuchuluka kwa chakudya chamagulu omwe amapezeka kuti adyedwe komanso kuchuluka kwa glycemia.

Chitsanzo cha kuwerengetsa chiwembu chosonyeza mankhwala a insulin

Patient K., wazaka 62, wolemera makilogalamu 70, adapita kuchipatala ndi madandaulo a kuchepa kwakukulu kwa mawonekedwe owoneka bwino, omwe adatembenukira kwa dokotala wamaso masiku angapo apitawa. Pambuyo popenda ngongole, pomwe zotupa zingapo m'matumba, zombo zatsopano zopangidwa, thonje ndi zolimba zotuluka, makamaka madera a macular, adapezeka, wodwalayo adapezeka ndi matenda a shuga a prinopathy.

Phunziro la kagayidwe kazakudya umalimbikitsidwa. Mulingo wothamanga wa glycemia anali 9,1 mmol / l, mkodzo acetone anali wopanda pake. Ndi mafunso mwatsatanetsatane, zidapezeka kuti kufooka, kutopa, pakamwa pang'ono pang'onopang'ono, ludzu lokwanira (mpaka malita a 2,5 patsiku) linasokonekera kwa zaka 4-5, ndipo silinkaonana ndi dokotala.

Chizindikiro chodziwitsa odwala omwe ali ndi insulin m'thupi ndi gawo la retinopathy.

1) Kufunika kwa insulin tsiku lililonse kwa wodwala yemwe ali ndi matenda oopsa a shuga (omwe sanalandire chithandizo cha insulin kale) ndi kulemera kwa thupi la 0.5 U / kg: 70x0.5 = 35 U
2) 2/3 pazofunikira za tsiku ndi tsiku za insulin zimaperekedwa m'mawa: 35x2 / 3 = 23 magawo.
3) Chiŵerengero cha ICD: insulini yokhala ndi nthawi yokwanira m'mawa iyenera kukhala 1: 2-1: 3, i.e. 6-8 U ICD ndi 14-16 U ISD.
4) 1/3 yofunikira tsiku ndi tsiku la insulin imayendetsedwa nthawi yamadzulo 35x1 / 3 = 12 PIECES.
5) Chiwerengero cha ISD: ICD nthawi yamadzulo iyenera kukhala 1: 1, (i.e. 6 magawo ndi magawo 6, motsatana) kapena 1: 2, (i.e. magawo 4 ndi magawo 8, motsatana).

Nthawi zina kuchipatala, kuwerengetsa kwa mlingo woyamba wa insulini womwe umayambitsidwa kumadalira deta ya glucosuria tsiku lililonse. Pakadali pano, ndikofunikira kwambiri kugwiritsa ntchito izi kuti musinthe mlingo wa insulin womwe umayendetsedwa. Izi zafotokozedwa mwatsatanetsatane mu gawo loperekedwa ku vutoli.

Kuwerengera kwa kuchuluka kwa insulini kuyenera kutha ndi kukonzekera kwa insulini regimen, yomwe inalembedwa m'mbiri yamankhwala ndi mankhwala:

8.30 - 6 mayunitsi S. Actrapidi HM + 16 magawo S. Protaphani HM
17.30 - 4 PISCES of S. Actrapidi HM + 8 PISCES of S. Protaphani HM
34 PISIKI, P / C

Kusintha kwa insulin mankhwala

Kuwongolera mlingo wa insulin kuchipatalachi kumachitika kawirikawiri (ndi mankhwala a insulin), poganizira kuchepa kwa shuga ndi mkodzo wa tsiku ndi tsiku. Pachifukwa ichi, kuchuluka kwa magalamu a glucose omwe amawerengedwa mumkodzo amawerengedwa. (Chithandizo cha insulin chachikhalidwe chimaganizira kuti wodwalayo ali pachakudya chokhazikika chokhazikitsidwa ndi zakudya zomwe zimakonzedweratu, ndipo sangathe kuwonjezera chakudya).

Mwachitsanzo, kuchuluka kwa mkodzo wothiriridwa patsiku kunali malita 4, shuga 1.5% amatsimikizika mu mkodzo, ndipo glucosuria tsiku ndi tsiku ndi 60 magalamu. Pakugwiritsa ntchito 4-5 magalamu a shuga, 1 UNIT ya insulin ndiyofunikira. Pankhaniyi, ndikofunikira kuwonjezera tsiku la insulin ndi 15 magawo.

Nthawi zambiri, ngati njira yolondola ya mankhwala a insulini ikufunika, dokotala amagwiritsa ntchito kuchuluka kwa glycemia wophunziridwa nthawi zosiyanasiyana za tsiku (mbiri ya glycemic). Malangizo a insulin omwe amaperekedwa molingana ndi mbiri ya glycemic nthawi zambiri amatha kokha kuchipatala kapena ngati wodwalayo ali ndi njira yodziletsa - magazi shuga mita.

Malangizo a insulin omwe amaperekedwa mwa odwala omwe ali ndi vuto la matenda a shuga 1 odwala omwe akukhudzidwa kwambiri ndi insulin. Izi ndichifukwa choti:

1) glucosuria amawonetsa chidziwitso chokha chakuti mu glycemia wodwalayo amapitilira gawo lathu laimpso (zimasinthasintha m'magulu osiyanasiyana a odwala: okalamba odwala 13.9 mmol / l kapena kuposa, amayi apakati 5.6-6.7 mmol / l, zokhudza thupi kuchepa, pamlingo wa 8.9-10 mmol / l),
2) sikuwonetsa kukhalapo kwa hypoglycemia,
3) makulidwe amakono kuti akwaniritse chipukuta cha chakudya cha m'magazi (pamimba yopanda kanthu 5-6 mmol / l ndi 7.5-8 mmol / l mutatha kudya kwa odwala omwe ali ndi matenda a shuga 1) ambiri mwa odwala, mwachidziwikire ochepera kuposa glycemia, zomwe zidzadutsa gawo lachiwonetsero.

Chifukwa chake, akungodalira deta ya glucosuria tsiku ndi tsiku, dokotala sangathe kusankha kuchuluka kwa insulin kuti akwaniritse chipukuta cha carbohydrate metabolism, ndiye kuti, cholinga chachikulu chothandizira wodwala matenda a shuga sichingatheke.

Pankhani ya insulin yokwanira, kukonza kumachitika pokhapokha malinga ndi glycemia, kukumbukira kudya magawo a mkate (XE), zolimbitsa thupi, nthawi ya tsiku. Chifukwa chake, mukamagwiritsa "zowonjezera" XE m'maola, ndikofunikira kuyambitsa 1,2-2.5 IU ya insulin yocheperako, nthawi ya 1 IU, madzulo 1-1.5 IU. Kuphatikiza apo, ndikofunikira kuganizira zotsatira za kudziletsa kwa glycemia, yomwe (pankhani yofutukula zakudya) imachitidwa jakisoni iliyonse isanachitike.

Kuwerengera kwa kuchuluka kwa insulini, kutengera mlingo woyambirira wa glycemia, kumatanthauza kuchepa kwa mlingo wa insulin poyerekeza ndi womwe unawerengedwa, ngati glycemia asanadye anali 3, 3 mmol / l, kuwonjezeka mpaka standardoglycemia adakwaniritsidwa 6 kapena kuposa mmol / l, kuchuluka kwa insulin magawo a mkate, ngati glycemia ndi 3,4-5.6 mmol / l.

Zitsanzo za kukonza kwa insulin tsiku lililonse ndi mbiri ya glycemic nthawi zambiri

Wodwala A., wazaka 22, (kutalika 165 cm, thupi 70 kg) amavutika lembani matenda ashuga 1SD-1) kwa zaka 15, amalandira insulin mankhwala malinga ndi chiwembu:

8.30 - 6 PISCES of S. Actrapidi HM + 14 PISCES of S. Protaphani HM
13.30 - 8 mayunitsi S. Actrapidi HM
17.30 - 8 PISCES of S. Actrapidi HM + 8 PISCES of S. Protaphani HM
54 PIECES / TSIKU.

Pakufufuza mbiri ya glycemic, zizindikiro zotsatirazi za glycemic zidapezeka (popanda kusokoneza kadyedwe):

6.00 - 6.5 mmol / l,
13.00 - 14, 3 mmol / l,
17.00 - 8.0 mmol / l,
22.0 - 7.5 mmol / L.

Kuti mukwaniritse standardoglycemia maola 13, ndizotheka kuwonjezera kuchuluka kwa insulin yomwe imayendetsedwa m'mawa ndi 4-5 magawo ndi / kapena asanadye chakudya chamasana kuti muwonjezere mlingo wa insulin yochepa ndi magawo 2-5.

Patient K., wazaka 36, ​​yemwe ali ndi DM-1, amalandira chithandizo cha insulini malinga ndi chiwembu cha masabata atatu omaliza:

8.30 - 10 PISCES of S. Insumani Rapidi + 14 PISCES of S. Insumani Basali
13.30 - mayunitsi 8 S. Insumani Rapidi
17.30 - 6 PISCES of S. Insumani Rapidi + 18 PISCES of S. Insumani Basali
54 PIECES / TSIKU.

Pakufufuza mbiri ya glycemic, zizindikiro zotsatirazi za glycemic zidapezeka (popanda kusokoneza kadyedwe):

6.00 - 18.1 mmol / l,
13.00 - 6.1 mmol / l,
17.00 - 6.7 mmol / l,
22.00 - 7.3 mmol / l.

Kuwongolera mlingo wa insulin mankhwala mu wodwala kumakhudzanso kupatula kwa chodabwitsa cha "m'mawa kutacha" ndi chodabwitsa cha Somoji.

Chochitika cha Somoji - Ichi ndi posthypoglycemic hyperglycemia. Amayamba chifukwa cha kuchuluka kwa insulin, imayambitsa hypoglycemia, chifukwa cha glucagon (wa β-cell a kapamba) komanso mahomoni ena otsutsana ndi mahomoni (glucocorticoids, adrenaline, mahomatotropic mahomoni, adrenocorticotropic timadzi) timatulutsa timene timayambitsa kusintha kwa minofu mu shuga.

Njira zopezera shuga homeostasis zimagwira ntchito nthawi zonse, kupitirira kuchuluka kwa shuga komwe kumafunikira, potero kumayambitsa posthypoglycemic hyperglycemia. Ngati mkhalidwe wa hypoglycemic utakula m'maloto (modandaula pakadandaula madandaulo owopsa), ndiye kuti mfundo zolimbikitsa kudya glycemia zidzakhala zapamwamba kwambiri.

Poterepa, ndikofunikira kuyang'ana kuchuluka kwa shuga usiku, nthawi ya 2 koloko m'mawa. Ngati shuga ndi wocheperapo, ndiye kuti hyperglycemia yam'mawa ndizotsatira za vuto la Somogy. Mlingo wa nthawi yayitali wa insulin womwe umayendetsedwa usiku ayenera kuchepetsedwa.

Zikakhala kuti zizindikiro za usiku wa glycemia ndizokwera, chodabwitsa cha Somoji sichimachotsedwa. Muyenera kuganizira zodabwitsa za "mbandakucha." Zodabwitsa za "m'bandakucha" zimachitika chifukwa cha zochitika zapamwamba zambiri za mahomoni am'mawa. Kuwongolera kwa mlingo wa insulin yomwe imayendetsedwa pamwambapa imaphatikizapo koyamba kulekanitsa nthawi ya insulin yochepa komanso yotalika nthawi yamadzulo, ndiye kuti humulin R imaperekedwera theka la ola asanadye, humulin NPH mochedwa kwambiri asanagone, maola 21 mpaka 22. Ngati glycemia yachangu idakalipo, mlingo wa humulin NPH umakulitsidwa pang'onopang'ono mpaka zizindikirazo zikwaniritse njira yolipirira.

Patient K., wazaka 36 (kutalika 168 masentimita, kulemera kwa thupi 85 kg), yemwe ali ndi vuto la SD-1, amalandila mankhwala a insulin malinga ndi chiwembu chomwe adachita m'miyezi isanu ndi umodzi yapitayo:

8.30 - 14 PIECES S. Humulin R + 24 PIECES S. Humulin NPH
13.30 - 14 PIECES S. Humulin R
17.30 - 8 PIECES S. Humulin R + 14 PIECES S. Humulin NPH
76 PIECES / TSIKU.

Mikhalidwe ya Hypoglycemic imadziwika nthawi ndi nthawi usiku, kwa theka la chaka kuwonjezeka kwa thupi kunali 9 kg.

Pakufufuza mbiri ya glycemic, zizindikiro zotsatirazi za glycemic zidapezeka (popanda kusokoneza kadyedwe):

6.00 - 16.5 mmol / l,
13.00 - 4.1 mmol / l,
17.00 - 4.5 mmol / l,
22.00 - 3.9 mmol / l,
2.00 - 2.9 mmol / L.

Zomwe zimayambitsa kuwonongeka kwa kagayidwe kazakudya mu wodwalayu anali mankhwala osokoneza bongo ambiri, omwe amayambitsa kuchuluka kwambiri kwa thupi, komanso zochitika pafupipafupi za hypoglycemic, kuphatikiza usiku, komanso kusala posthypoglycemic hyperglycemia.

Pankhaniyi, kukonza insulin mankhwala (komwe kumachitika kuchipatala kokha) kumatanthauza kuchepa kwa mlingo wa tsiku ndi tsiku osachepera 1/3 ndikuwerengedwa kwa dongosolo la makonzedwe kutengera malamulo apamwambawa. Kuwongolera kowonjezereka kudzachitika poganizira zotsatira za mbiri ya glycemic yomwe idafufuzidwa pambuyo pokhazikitsa dongosolo latsopano la insulin.

Kupanga mankhwala ndi insulin yochepa pokhapokha

Kukhazikitsidwa kwa chithandizo chokhacho chokhala ndi insulin yochepa ndikofunikira komanso m'njira zina zotsatirazi:

• kukula kwa kuwonongeka kwa kagayidwe kachakudya njira ya ketosis (yamtundu uliwonse wa matenda ashuga),
• kukulitsa kwakukulu kwa kuwonongeka kwa kagayidwe kachakudya ndi ketoacidosis (ndi mtundu uliwonse wa matenda a shuga),
• kwambiri kuwonongeka kwa kagayidwe kachakudya njira kukula kwa mitundu iliyonse ya hyperglycemic chikomokere (ndi mtundu uliwonse wa shuga mellitus),
• Kukula kwa matupi awo sagwirizana ndi insulin kumafuna kupatsidwa insulin yochepa yongochita anthu,
• mwadzidzidzi ndikukonzekera kuchitapo kanthu opaleshoni, kuvulala,
• kutumiza.

Pankhaniyi, kuyambitsa insulin yocheperako idzapangidwa mu jakisoni 6-10, mwapang'onopang'ono, mu Mlingo wochepa (wokhala ndi chikomokere - ola limodzi).

Ngati glycemia ndi yotsika, ndiye kuti kuyambitsidwa kwa insulin kuyenera kuphatikizidwa ndikukhazikitsa njira zothetsera shuga.

Mavuto a Insulin Therapy

Pakadali pano, mankhwala a insulin amaphatikizidwa ndi zovuta zochepa. Chifukwa chake, anthu ambiri akamagwiritsira ntchito majini okhala ndi majini okhala oyera, mitundu yambiri ya lipodystrophy yatsala pang'ono kutha.

Zina mwazovuta zambiri, malo otsogolera, achikhalidwe cha hypoglycemic comas. Hypoglycemic comas ndizovuta zowopsa kwambiri.

Zovuta monga kugwirizira kwa thupi, zomwe zimatha kukhala zonse kwanuko komanso ndizothandiza, ndizofunikanso. Zotsatira zoyipa zam'deralo zimawonekera bwino pamalo opangira jakisoni ndipo zimatha kuwonetsedwa ndi kuyabwa, hyperemia, ndi kuphatikizika. Momwe thupi limagwirira pamodzi limapezeka mu mawonekedwe a Quincke's edema, urticaria, anaphylactic mantha (ndizosowa kwambiri).

Pankhani ya ziwengo, mitundu ya insulin yomwe kale idagwiritsidwa ntchito iyenera kulowetsedwa ndi insulin yocheperako (kuwonjezera kuchuluka kwa tsiku ndi tsiku), humulin idzakhala mankhwala osankha. Mitundu ikuluikulu ya ziwengo imafunikira kulumikizana kwapadera (nthawi zina kuyambitsa kupuma) ndi kukhazikitsidwa kwa glucocorticosteroids, antihistamines. Chithandizo chikuyenera kuchitika kuchipatala chapadera.

Kuchepa kochepa kwa ma inshuin amakono, kusapezeka kwa ma antibodies apamwamba kwambiri kwa iwo, kwalola asayansi angapo aku America kuti alankhule motsimikiza kusakhalapo kwa nthawi yomwe imagwiritsidwa ntchito kale ngati insulin kukana (immunological).

Kufunika kwatsiku ndi tsiku kwa insulin pakadali pano kumachitika kwambiri chifukwa cha kukana kwa insulini kwakanthawi kochepa komwe kumayenderana ndi wodwala wokhala ndi mahomoni ambiri okhudzana ndi mahomoni omwe ali ndi vuto lofanana ndi purulent-yotupa komanso matenda opatsirana, ntchito yayikulu ya patsekeke, hyperlipoproteinemia, kuchepa thupi, kunenepa kwambiri, ndi zina zambiri. .

Kodi chithandizo chachikulu cha mankhwala a bolus insulin ndi chiyani?

Matenda a shuga a insulin amatha kukhala akale kapena oyambira (olimbikitsidwa). Tiyeni tiwone kuti ndi chiyani komanso ndi zosiyana.Muyenera kuwerenga kuti, "Momwe insulini imayang'anira shuga wa magazi mwa anthu athanzi komanso zomwe zimasintha ndi matenda ashuga." Mukamvetsetsa bwino nkhaniyi, mukamachita bwino pochiza matenda ashuga.

Mwa munthu wathanzi yemwe alibe shuga, kachidutswa kakang'ono kwambiri ka insulin nthawi zonse kamazungulira m'magazi othamanga. Izi zimatchedwa basal kapena basal insulin concentration. Zimalepheretsa gluconeogenesis, i.e., kusintha kwa malo ogulitsa mapuloteni kukhala glucose. Ngati panalibe plasma insulin concentration, ndiye kuti munthuyu "amasungunuka kukhala shuga ndi madzi," monga momwe madokotala akale amafotokozera amfawo chifukwa cha matenda a shuga a mtundu woyamba.

M'mimba yopanda kanthu (panthawi yogona komanso pakati pa chakudya), kapamba wathanzi amatulutsa insulini. Gawo lake limagwiritsidwa ntchito kuti likhale ndi khola la insulin m'magazi, ndipo gawo lalikulu limasungidwa. Izi zimatchedwa bolus chakudya. Zofunika ngati munthu ayamba kudya kuti azitha kudya zakudya zomwe zadyedwa ndipo nthawi yomweyo aletse kulumpha mu shuga.

Kuyambira pomwe chakudya chimayamba komanso kwa maola pafupifupi 5, thupi limalandira insulin. Uku ndikutulutsa kofinya ndi kapamba wa insulin, yomwe idakonzedwa pasadakhale. Zimachitika mpaka glucose onse wazakudya atengeke ndi minyewa yochokera m'magazi. Nthawi yomweyo, mahomoni otsutsana amachitanso kanthu kuti shuga m'magazi asatsike kwambiri komanso hypoglycemia isachitike.

Basis-bolus insulin mankhwala - amatanthauza kuti "baseline" (basal) ndende ya insulini m'magazi imapangidwa ndi jakisoni wa sing'anga kapena wa nthawi yayitali usiku ndi / kapena m'mawa. Komanso, phulusa la insulin (paphiri) la insulin mukatha kudya limapangidwa ndi jakisoni wowonjezera wa insulin yaifupi kapena ya ultrashort musanadye nawo. Izi zimapangitsa, ngakhale pang'ono, kutsanzira kugwira ntchito kwa kapamba wabwino.

Chithandizo cha insulin chachikhalidwe chimaphatikizanso kuyambitsa insulini tsiku lililonse, yoikika munthawi yake ndi mlingo. Poterepa, wodwala matenda a shuga sakonda kuyeza kuchuluka kwa shuga m'magazi ake ndi glucometer. Odwala amalangizidwa kuti azidya zakudya zomwezo tsiku lililonse. Vuto lalikulu ndi izi ndikuti palibe kusinthasintha kosinthasintha kwa mlingo wa insulini kukhala shuga. Ndipo odwala matenda ashuga amakhala "omangika" kuzakudya ndi dongosolo la jakisoni wa insulin. Mu chikhalidwe cha insulin mankhwala, jakisoni awiri a insulin nthawi zambiri amapatsidwa kawiri patsiku: yochepa komanso yapakati nthawi yochitapo kanthu. Kapena kusakaniza kwa mitundu yosiyanasiyana ya insulin kumabayira m'mawa ndi madzulo ndi jakisoni imodzi.

Mwachiwonekere, chithandizo cha matenda ashuga a shuga chimakhala chosavuta kuposa maziko. Koma, mwatsoka, nthawi zonse zimabweretsa zotsatira zosakhutiritsa. Ndikosatheka kupeza chipukutiro chabwino cha matenda a shuga, ndiko kuti, kubweretsa kuchuluka kwa shuga m'magazi pafupi ndi zikhalidwe zabwinobwino ndi mankhwala a insulin. Izi zikutanthauza kuti zovuta za matenda ashuga, zomwe zimayambitsa kulumala kapena kufa msanga, zikukula mwachangu.

Chithandizo cha insulin chachikhalidwe chimagwiritsidwa ntchito pokhapokha ngati ndizosatheka kapena zosatheka kupatsa insulini molingana ndi chiwembu chokhazikika. Izi zimachitika pomwe:

• okalamba odwala matenda ashuga, ali ndi moyo wotsika,
• wodwala ali ndi matenda amisala
• wodwala matenda ashuga sangathe kuwongolera shuga m'magazi ake,
• wodwala amafunikira chisamaliro chakunja, koma ndizosatheka kupereka mtundu.

Kuti muthane ndi matenda a shuga ndi insulin pogwiritsa ntchito njira yofunikira ya mankhwala oyambira a bolus, muyenera kuyeza shuga ndi glucometer kangapo masana. Komanso, wodwalayo azitha kuwerengera kuchuluka kwa insulin yayitali komanso yofulumira kuti asinthe mlingo wa insulin pakali pano shuga.

Momwe mungasinthire mankhwala a insulin a matenda a shuga 1 kapena 2

Amaganiziridwa kuti muli kale ndi zotsatira za kudziletsa kwathunthu kwa shuga m'magazi odwala matenda a shuga masiku 7 otsatizana. Malangizo athu ndi a odwala matenda ashuga omwe amatsata zakudya zamafuta ochepa ndikugwiritsa ntchito njira yopepuka. Ngati mutsatira zakudya “zopatsa thanzi”, zodzaza ndi mafuta, ndiye kuti mutha kudziwa kuchuluka kwa insulini m'njira zosavuta kuposa zomwe zafotokozedwa mu nkhani zathu. Chifukwa ngati zakudya za anthu odwala matenda ashuga zili ndi chakudya chamagetsi, ndiye kuti simungapewe magazi.

Momwe mungapangire regimen ya insulin - njira iliyonse:

1. Sankhani ngati mukufuna jakisoni wa insulin yochulukirapo usiku.
2. Ngati mukufuna jakisoni wa insulin yowonjezera usiku, ndiye kuwerengera poyambira, ndikusintha patsiku lotsatira.
3. Sankhani ngati mukufuna jakisoni wa insulin yowonjezera m'mawa. Izi ndizovuta kwambiri, chifukwa poyesera muyenera kudumpha chakudya cham'mawa komanso nkhomaliro.
4. Ngati mukufuna jakisoni wa insulin yowonjezereka m'mawa, ndiye muwerengereni mlingo woyambira wa insulin, ndikusintha kwa masabata angapo.
5. Sankhani ngati mukufuna jakisoni wa insulin yachangu musanadye chakudya cham'mawa, chakudya chamasana komanso chakudya chamadzulo, ndipo ngati ndi choncho, chakudya chofunikira chisanachitike, ndipo isanachitike - ayi.
6. Muyenera kuwerengera poyambira mwachidule kapena insulin ya insulin musanadye.
7. Sinthani Mlingo wamtundu waifupi kapena wa ultrashort musanadye, malinga ndi masiku apitawa.
8. Chitani kafukufuku kuti mudziwe kuti ndi mphindi zingati musanadye jakisoni.
9. Phunzirani momwe mungawerengere kuchuluka kwa insulini yochepa kapena ya ultrashort pamilandu mukafuna kusintha matenda a shuga.

Momwe mungakwaniritsire mfundo 1-4 - werengani mu nkhani ya "Lantus and Levemir - insulin. Asinthe shuga m'mimba yopanda kanthu m'mawa. " Momwe mungakwaniritsire mfundo 5-9 - werengani muzolemba "Ultrashort insulin Humalog, NovoRapid ndi Apidra. Human Short Insulin ”komanso“ jakisoni wa Insulin musanadye. Momwe mungachepetse shuga kuti akhale wabwinobwino ngati ukukwera. " M'mbuyomu, muyenera kuphunziranso nkhani ya "Kuchiza matenda a shuga ndi insulin. Mitundu ya insulin ndi iti. Kusunga Malamulo a Insulin. ” Apanso, tikukumbukira kuti zosankha zakufunika kwa jakisoni wa insulin yowonjezera komanso yachangu zimapangidwa popanda china. Mmodzi wodwala matenda ashuga amangofunika insulini yowonjezera usiku ndi / kapena m'mawa. Ena amangowonetsa jakisoni wa insulin yachangu musanadye kotero kuti shuga akhalebe wabwinobwino atatha kudya. Chachitatu, insulin yayitali komanso yachangu imafunikira nthawi yomweyo. Izi zimatsimikiziridwa ndi zotsatira za kudziletsa kwathunthu kwa shuga m'magazi 7 otsatizana.

Tidayesera kufotokoza m'njira yofikirika komanso yomveka ya momwe angapangire bwino dongosolo la insulin yodwala matenda amtundu 1 komanso matenda a shuga. Kuti mudziwe insulin yomwe mungabayire, munthawi iti komanso munthawi iti, mumayenera kuwerenga zolemba zazitali, koma zidalembedwa mchilankhulo chomveka bwino. Ngati muli ndi mafunso, afunseni mu ndemanga, ndipo tidzayankha mwachangu.

Chithandizo cha matenda a shuga amtundu 1 omwe ali ndi jakisoni wa insulin

Odwala onse omwe ali ndi matenda amtundu wa 1, kupatula okhawo omwe ali ofatsa kwambiri, ayenera kulandira jakisoni wa insulin musanadye. Nthawi yomweyo, amafunika jakisoni wa insulin yowonjezera usiku ndi m'mawa kuti akhalebe shuga wamba. Ngati muphatikiza insulin yokwanira m'mawa komanso madzulo ndi jakisoni wa insulin yachangu musanadye, izi zimakupatsani mwayi wowerengeka kapenanso wa munthu wathanzi.

Werengani zida zonse zomwe zili mgululi "Insulin pochiza matenda amtundu 1 komanso matenda a shuga a 2." Yang'anirani mwapadera zolembedwa "Zowonjezera insulin Lantus ndi Glargin. Kati NPH-Insulin Protafan ”ndi“ jekeseni wa insulin mwachangu musanadye. Momwe mungachepetse shuga kuti akhale wabwinobwino ngati wadumpha. ” Muyenera kumvetsetsa bwino chifukwa chake insulin yayitali imagwiritsidwa ntchito komanso yomwe imathamanga. Dziwani njira yochepetsera nkhawa yokhazikika yokhala ndi shuga wabwinobwino pomwe nthawi yomweyo mumalipira insulin.

Ngati muli ndi kunenepa kwambiri pamaso pa matenda a shuga 1, ndiye kuti mapiritsi a Siofor kapena Glucofage atha kukhala othandiza kuchepetsa milingo ya insulin ndikupangitsa kuti muchepe mosavuta. Chonde imwani mapiritsi awa ndi dokotala, osadzipatsa nokha.

Mtundu wachiwiri wa insulin ndi mapiritsi

Monga mukudziwa, chomwe chimayambitsa matenda a shuga a 2 ndikuchepa kwa chidwi cha maselo kuchitira insulin (insulin kukana). Odwala ambiri omwe ali ndi vutoli, kapamba amapitiliza kupanga insulini yake, nthawi zina imapitilira kuposa anthu athanzi. Ngati shuga lanu la m'magazi lalumpha mutatha kudya, koma osachulukitsa, ndiye kuti mutha kuyesa kuloweza jakisoni wa insulin yofulumira musanadye ndi mapiritsi a Metformin.

Metformin ndi chinthu chomwe chimakulitsa chidwi cha maselo kuti apange insulin. Ili ndi mapiritsi Siofor (kuchitapo kanthu mwachangu) ndi Glucophage (kumasulidwa kosasunthika). Izi ndizotheka kwambiri kwa odwala omwe ali ndi matenda a shuga a 2, chifukwa amatha kumwa mapiritsi ambiri kuposa jakisoni wa insulin, ngakhale atatha kudziwa jakisoni wopanda vuto. Musanadye, m'malo mwa insulin, mutha kuyesa kumwa mapiritsi a Siofor othamanga, ndikuwonjezera pang'onopang'ono.

Mutha kuyamba kudya osapitirira mphindi 60 mutatha kumwa mapiritsi. Nthawi zina zimakhala zosavuta kubayitsa jakisoni waifupi kapena wa ultrashort musanadye kuti mutha kudya pambuyo pa mphindi 20-45. Ngati, ngakhale mutamwa mlingo waukulu wa Siofor, shuga amadzuka chakudya, ndiye kuti jakisoni wa insulin amafunikira. Kupanda kutero, zovuta za matenda ashuga zimayamba. Kupatula apo, muli kale ndi zovuta zoposa zaumoyo. Sikunali kokwanira kuwonjezera kudula mwendo, khungu kapena kulephera kwa impso kwa iwo. Ngati pali umboni, ndiye kuti muthandizire matenda anu a shuga ndi insulin, musakhale opusa.

Momwe mungachepetse Mlingo wa insulin ndi matenda a shuga a 2

Kwa matenda a shuga a 2, muyenera kugwiritsa ntchito mapiritsi omwe ali ndi insulin ngati munenepa kwambiri ndipo mlingo wa insulin yowonjezera usiku ndi magawo 8-10 kapena kuposerapo. Pankhaniyi, mapiritsi a shuga oyenera amathandizira kukana insulin ndikuthandizira kuchepetsa insulin. Zingawonekere, ndi mwayi wanji? Kupatula apo, mukufunikabe kupanga jakisoni, mosasamala kanthu kuti muyezo wa insulin muli syringe. Chowonadi ndi chakuti insulini ndiye mahomoni akuluakulu omwe amachititsa kuti mafuta azikhala pansi. Mlingo waukulu wa insulin umapangitsa kuchuluka kwa thupi, kuletsa kuchepa kwa thupi ndikuwonjezera mphamvu ya insulin. Chifukwa chake, thanzi lanu lidzakhala lopindulitsa kwambiri ngati mungachepetse kuchuluka kwa insulin, koma osati pamtengo wowonjezera shuga.

Kodi mapiritsi ogwiritsira ntchito piritsi omwe ali ndi insulin ya matenda 2 a shuga ndi ati? Choyamba, wodwalayo amayamba kumwa mapiritsi a Glucofage usiku, limodzi ndi jakisoni wa insulin yowonjezera. Mlingo wa Glucofage umakulitsidwa pang'onopang'ono, ndipo amayesa kutsitsa insulin yayitali pakanthawi kochepa ngati miyeso ya shuga m'mimba yopanda kanthu ikusonyeza kuti izi zitha kuchitika. Usiku, zimalimbikitsidwa kutenga Glucophage, osati Siofor, chifukwa imatenga nthawi yayitali ndipo imakhala usiku wonse. Glucophage imakhalanso yocheperako kuposa Siofor kuyambitsa kukhumudwa. Pambuyo pakukula kwa Glucofage pang'onopang'ono mpaka kuchuluka, pioglitazone ikhoza kuwonjezeredwa kwa iyo. Mwina izi zithandizanso kuchepetsa kuchuluka kwa insulin.

Amaganiza kuti kutenga pioglitazone motsutsana ndi jakisoni wa insulin pang'ono kumakulitsa chiopsezo cha mtima wosweka. Koma Dr. Bernstein amakhulupirira kuti phindu lomwe lingakhalepo limaposa chiwopsezocho. Mulimonsemo, ngati mungazindikire kuti miyendo yanu ikutupa pang'ono, musiyeni kumwa pioglitazone. Glucophage ndiyokayikitsa yomwe ingayambitse zovuta zina kusiyanitsa kugaya zakudya, kenako osatero. Ngati, chifukwa cha kutenga pioglitazone, sikutheka kuchepetsa kuchuluka kwa insulin, ndiye kuti ndiye kuti kuthetsedwa. Ngati, ngakhale mutatenga mlingo waukulu wa Glucofage usiku, sizinali zotheka kuti muchepetse kuchuluka kwa insulin yayitali, ndiye kuti mapiritsi awa nawonso adathetsedwa.

Ndizoyenera kukumbukira apa kuti maphunziro akuthupi amalimbikitsa kukhudzidwa kwa maselo kuti apatsenso insulin nthawi zambiri zamphamvu kuposa mapiritsi a shuga. Phunzirani momwe mungapangire masewera olimbitsa thupi mosangalala ndi matenda a shuga 2, ndikuyamba kusuntha. Maphunziro akuthupi ndi mankhwala ochizira matenda amitundu iwiri, omwe amakhala m'malo achiwiri akatha kudya zakudya zamagulu ochepa. Kukana jakisoni wa insulini kumapezeka mu 90% ya odwala omwe ali ndi matenda a shuga 2, ngati mutsatira zakudya zamagulu ochepa ndipo nthawi yomweyo mumachita maphunziro olimbitsa thupi.

Pambuyo powerenga nkhaniyi, muphunzira momwe mungapangire mtundu wa insulin yodwala matenda a shuga, ndiko kuti, kupanga zisankho zokhudzana ndi insulin, munthawi yanji komanso muyezo uti. Talongosola za kusiyanasiyana kwa mankhwala a insulin a matenda a shuga 1 komanso mtundu 2 wa matenda ashuga. Ngati mukufuna kupeza chindapusa chabwino cha matenda ashuga, ndiko kuti, kuti mubweretse shuga m'magazi anu monga momwe kungathekere, muyenera kumvetsetsa mosamala momwe mungagwiritsire ntchito insulin pazomwezi. Muyenera kuwerenga nkhani zazitali mu insulin yotchedwa "Insulin pochiza matenda amtundu 2 komanso matenda a shuga." Masamba awa onse adalembedwa momveka bwino momwe zingathere komanso kupezeka kwa anthu opanda maphunziro a udokotala. Ngati muli ndi mafunso, ndiye mutha kuwafunsa mu ndemanga - ndipo tidzayankha nthawi yomweyo.

Moni Mayi anga ali ndi matenda ashuga a 2. Ali ndi zaka 58, masentimita 170, 78 kg. Mavuto - matenda ashuga retinopathy. Monga adanenera dokotala, adamwa Glibomet kawiri pa tsiku kwa mphindi 15 asanadye. Zaka 3 zapitazo, adokotala adayambitsa insulin protafan m'mawa ndi madzulo a magawo 14-12. Mafuta othamanga kwambiri anali 9-12 mmol / L, ndipo pofika madzulo amatha kufika 14-20 mmol / L. Ndidazindikira kuti atasankhidwa kukhala protafan, retinopathy idayamba kupita patsogolo, izi zisanachitike ndi vuto lina - phazi la matenda ashuga. Tsopano miyendo yake sikuwavutitsa, koma ali pafupi saona. Ndili ndi maphunziro a udokotala ndipo ndimamugwirira ntchito yonse. Ndidaphatikiziranso tini yochepetsera shuga komanso zopatsa mphamvu zamagulu m'zakudya zake. Miyezi ya shuga idayamba kutsikira mpaka 6-8 mmol / L m'mawa ndi 10-14 madzulo. Kenako ndidaganiza zochepetsa mapiritsi ake a insulin ndikuwona momwe kuchuluka kwa shuga m'magazi kumasinthira. Ndinayamba kuchepetsa mlingo wa insulin ndi 1 unit sabata limodzi, ndikuwonjezera kuchuluka kwa Glibomet kukhala mapiritsi atatu patsiku. Ndipo lero ndikumusisita m'magawo atatu m'mawa ndi madzulo. Koma chosangalatsa ndichakuti mulingo wambiri wa glucose ndi womwewo - 6-8 mmol / L m'mawa, 12-14 mmol / L madzulo! Kodi zinafika poti tsiku lililonse la Protafan lingasinthidwe ndi ma bioadditives? Mkulu wa glucose akakhala wamkulu kuposa 13-14, ndimabayitsa AKTRAPID 5-7 IU ndipo mulingo wotseka shuga umabweranso wamba. Chonde ndiuzeni ngati zinali zoyenera kuti amupatse mankhwala a insulin konse. Komanso, ndidazindikira kuti mankhwalawa amamuthandiza kwambiri. Ndikufuna kudziwa zambiri za mankhwala othandiza kwambiri pochiza matenda a shuga a 2 komanso retinopathy. Zikomo!

> Monga adokotala adalembera, adatenga Glibomet

Glibomet imaphatikizapo glibenclamide. Amanena za mapiritsi owononga a shuga, omwe timalimbikitsa kusiya. Sinthani ku metformin yoyera, i.e. Siofor kapena Glucofage.

> zinali zoyenera konse
> kuperekera mankhwala a insulin?

Tikukulimbikitsani kuti muyambe kulandira mankhwala a insulini mwachangu ngati shuga itatha chakudya kudumphira pamwamba pa 9.0 mmol / L osachepera kamodzi ndipo pamwamba pa 7.5 mmol / L pachakudya chochepa chamafuta.

> phunzirani zambiri zamankhwala othandiza kwambiri

Nayi nkhani "Kuchiritsa kwa Matenda A shuga", mupeza zonse pamenepo. Ponena za retinopathy, njira yabwino ndikukhwimitsa shuga m'magazi potsatira pulogalamu yathu yachiwiri ya matenda ashuga. Mapiritsi ndipo ngati kuli kotheka, laser coagulation yamitsempha yamagazi - yoyikidwa ndi ophthalmologist.

Moni Mwana wanga wamkazi ali ndi matenda ashuga 1. Ali ndi zaka 4, kutalika kwa 100 cm, kulemera kwa 16 kg. Pa insulin mankhwala kwa zaka 2.5. Jekeseni - magawo anayi a Lantus 4 m'mawa komanso chizungulire cha chakudya chamitundu iwiri. Shuga m'mawa 10-14, m'mawa shuga 14-20. Ngati, asanagone, 0,5 ml imodzi ya humalogue idasokonekera, ndiye kuti m'mawa shuga amawuka kwambiri. Tinayesetsa kuyang'aniridwa ndi madokotala kuti tiwonjezere muyeso wa mayunitsi a lantus 4 ndi humalogue ndi mayunitsi a 2,5.Kenako mawa ndi chakudya chamadzulo mulingo wambiri wa insulin, madzulowo tinali ndi acetone mkodzo wathu. Tidasinthira kumayendedwe a lantus 5 ndi gawo la 2 mayunitsi, koma shuga amakhalabe okwera. Nthawi zonse amatilembera ku chipatala tili ndi shuga tili ndi zaka 20. Kunyumba, timayambanso kusintha. Mtsikanayo amagwira ntchito, shuga atayamba kulimbitsa thupi amayamba kukula. Tikutenga zakudya zamagetsi kuti muchepetse shuga. Ndiuzeni momwe ndingakwaniritsire shuga abwinobwino? Mwinanso insulini yokhala nthawi yayitali siyabwino kwa iye? M'mbuyomu, poyamba anali pa protofan - kuchokera kwa iye mwana anali ndi ma cramp. Zotsatira zake, ziwengo. Kenako anasamukira ku levemir - maphikidwewo anali okhazikika, zinafika poti amangoyika levemir okha usiku. Ndipo adasinthidwa bwanji ku lantus - shuga amakhala wokwera nthawi zonse.

> Ndiwuzeni momwe ndingakwaniritsire shuga wabwinobwino?

Choyamba, sinthani ku chakudya chochepa chamafuta ndikuchepetsa mulingo wanu wa insulin malinga ndi shuga. Pangani shuga ndi glucometer osachepera 8 pa tsiku. Phunzirani mosamala zolemba zathu zonse pansi pamutu wa insulin.

Pambuyo pake, ngati muli ndi mafunso, afunseni.

Ngakhale mwana yemwe ali ndi matenda amtundu woyamba amadya "monga wina aliyense," kukambirana zina ndi zopanda pake.

Zinkawoneka kuti mukudziwa zambiri zazokhudza matenda a shuga monga LADA. Chifukwa chiyani izi kapena ndikuyang'ana kwina kolakwika?

> kapena kodi ndikuyang'ana kwina kolakwika?

Nkhani yatsatanetsatane yokhudza mtundu wa shuga wa LADA 1 mu mawonekedwe ofatsa apa. Ili ndi chidziwitso chapadera kwa odwala omwe ali ndi matenda amtunduwu. Ku Russia, palibe kwina kulikonse.

Moni
Ndili ndi matenda ashuga a 2. Ndinasinthira kudya zakudya zamagulu ochepa zam'thupi 3 masabata apitawa. Ndimatenganso m'mawa ndi madzulo Gliformin piritsi limodzi la 1000 mg. Shuga m'mawa pamimba yopanda kanthu, musanadye chakudya komanso musanadye chakudya nthawi yofananira - kuyambira 5.4 mpaka 6, koma kulemera kwake sikuchepa.
Kodi ndifunika kusinthitsa insulini m'malo mwanga? Ngati ndi choncho, mu Mlingo uti?
Zikomo!

> kulemera sikuchepetsedwa

msiyeni iye yekha

> Kodi ndikufunika panjira yanga?
> kusinthana ndi insulin?

Moni Ndili ndi zaka 28, kutalika 180 masentimita, kulemera kwa makilogalamu 72. Ndadwala matenda ashuga amtundu woyamba kuyambira 2002. Insulin - Humulin P (36 mayunitsi) ndi Humulin P (28 mayunitsi). Ndinaganiza zoyeserera - kuti ndiwone momwe matenda anga a shuga az amakhalira. M'mawa, osadya chilichonse, adayeza shuga - 14.7 mmol / l. Anabaya insulin R (mayunitsi atatu) ndikupitilizanso kusala, ndikumwa madzi okha. Pofika madzulo (18:00) anayeza shuga - 6.1 mmol / l. Sanabaye insulin. Ndinapitilizabe kumwa madzi okha. Ku 22,00 shuga wanga anali kale 13 mmol / L. Kuyesaku kudatenga masiku 7. Kwa nthawi yonse yosala kudya, amamwa madzi amodzi. Kwa masiku asanu ndi awiri m'mawa, shuga anali pafupifupi 14 mmol / L. Pofika 6:00 p.m. adamenya insulin Humulin R yachibadwa, koma pofika 10 p.m. shuga adakwera 13 mmol / l. Pa nthawi yonse yosala kudya, sipanakhalepo ndi hypoglycemia. Ndikufuna ndidziwe kuchokera kwa inu chifukwa chamakhalidwe anga omwe amavuta, chifukwa sindinadye chilichonse? Zikomo

Ndikufuna ndidziwe kuchokera kwa inu chifukwa chamakhalidwe anga omwe ali ndi shuga

Matenda a kupsinjika omwe amatulutsidwa ndi tiziwalo timene timatulutsa timayambitsa timagazi ta shuga tambiri ngakhale mu kusala. Chifukwa cha matenda amtundu 1, mulibe insulin yokwanira kulumpha.

Muyenera kusinthira ku chakudya chamafuta ochepa, ndipo koposa zonse, kuti muphunzire ndikugwiritsa ntchito njira zowerengera molondola mankhwala a insulin. Kupanda kutero, nyama yankhosa imangoyang'ana pakona.

Chowonadi ndi chakuti poyamba, ndikadwala, shuga anali osadukiza, akumadula insulin yokwanira. Pakapita kanthawi, "dokotala m'modzi wanzeru" adalangiza njira yosala kudya, yomwe amati ndiyanjala imatha kuchiritsidwa matenda ashuga. Nthawi yoyamba yomwe ndimakhala ndi njala masiku 10, yachiwiri inali kale 20. Shuga anali ndi njala pafupifupi 4.0 mmol / L, sizinakwere pamwamba, sindinabayire insulin konse. Sindinachiritse matenda ashuga, koma mlingo wa insulin unachepetsedwa kukhala magawo 8 patsiku. Nthawi yomweyo, thanzi lathunthu linasintha. Pakupita nthawe, iye adagumanambo njala. Ndisanayambe, ndinamwa madzi ambiri a apulosi. Popanda jakisoni wa insulin, adakhala ndi njala masiku 8. Panalibe mwayi woyeza shuga nthawi imeneyo. Zotsatira zake, ndidagonekedwa m'chipatala ndi acetone mu mkodzo +++, ndi shuga 13.9 mmol / L. Zitachitika izi, sindingachite popanda insulini konse, kaya ndidadya kapena ayi. Ndikofunikira kumayamwa mulimonse. Ndiuzeni chonde, chachitika ndi chiyani mthupi langa? Mwinanso chifukwa chenicheni si nkhawa yamafuta? Zikomo

zomwe zidachitika mthupi langa?

Simunamwe madzi osakwanira mukusala, zomwe zidapangitsa kuti mkhalidwewo ukhale woipa kwambiri kotero kuti kuchipatala kunali kofunikira

Masana abwino Ndikufuna upangiri wanu. Amayi akhala akuvutika ndi matenda a shuga a 2 kwazaka pafupifupi 15. Tsopano ali ndi zaka 76, kutalika 157 cm, kulemera 85 kg. Miyezi isanu ndi umodzi yapitayo, mapiritsiwa anasiya kukhala ndi shuga. Adatenga maninil ndi metformin. Kumayambiriro kwa mwezi wa June, glycated hemoglobin anali 8.3%, tsopano mu Seputembara 7.5%. Mukamayeza ndi glucometer, shuga nthawi zonse amakhala 11-15. Nthawi zina anali wopanda m'mimba 9. Magazi a biochemistry - Zizindikiro ndizabwinobwino, kupatula cholesterol ndi TSH yowonjezereka pang'ono. Endocrinologist anasamutsa mayi kupita ku insulin Biosulin N kawiri pa tsiku, m'ma 12 mayunitsi, madzulo magawo 10, komanso mapiritsi a mannil mamawa ndi madzulo asanadye. Timabaya insulini kwa sabata limodzi, pomwe "mavinidwe" a shuga. Zimachitika 6-15. Kwenikweni, zizindikiro 8-10. Kupanikizika nthawi ndi nthawi kumakwera mpaka 180 - amachita ndi Noliprel forte. Miyendo imasunthidwa pafupipafupi chifukwa cha ming'alu ndi zilonda - pomwe zonse zili bwino. Koma miyendo yanga imandipweteka kwambiri.
Mafunso: Kodi ndizotheka kuti pa msinkhu wake azitsatira zakudya zamagulu ochepa? Chifukwa chiyani shuga “amalumpha”? Njira yolakwika yolowera, singano, mlingo? Kapena kodi ingoyenera kukhala nthawi yoti musinthe? Insulin yolakwika? Ndikuyembekezeradi yankho lanu, zikomo.

kodi ndizotheka kuti pa msinkhu wake azitsatira zakudya zamagulu ochepa?

Zimatengera momwe impso zake zilili. Kuti mumve zambiri, onani nkhani yakuti “Zakudya za impso ndi matenda a shuga.” Mulimonsemo, musinthane ndi zakudya izi ngati simukufuna kuyenda pa amayi anu.

Chifukwa sikuti mukuchita zonse bwino.

Timatsatira malangizo onse a endocrinologist - zikukwaniritsidwa, adokotala amalemba njira zolakwika?

Kodi mungachite bwanji? Kupatula maninil, kuwonjezera insulini?

Kodi dokotala amakulemberani chithandizo cholakwika?

Pali tsamba lathunthu lokhudza madotolo am'nyumba omwe amachiza matenda molakwika 🙂

Choyamba, fufuzani impso. Zowonjezera, onani nkhani yokhudza chithandizo cha matenda a shuga 2 + a jakisoni a insulin ndi ofunikira, chifukwa milanduyi siyinayanjidwe.

Sankhani mtundu woyenera wa insulin monga momwe zalembedwera patsamba lanu. Ndikofunika kuti muzigwiritsa ntchito mitundu ya insulin yokhazikika komanso yofulumira, osati zomwe mudalamulidwa.

Zikomo Tiphunzira.

Moni, kodi ndimabayirira insulin molondola m'mawa makumi atatu ndi atatu a protafan komanso madzulo komanso ndimatha kudya chakudya chamagulu 30, ndinadumphadumpha shuga ndipo sindimadya chakudya, koma ndimamwa nthawi yomweyo, ndinapumira 1 ndikuwonjezera shuga m'mawa ndi m'mawa.

Moni. Mwamuna wanga ali ndi matenda ashuga a 2 kuyambira 2003. Mwamuna wazaka 60 amakhala pamapiritsi a mankhwala osiyanasiyana omwe amalimbikitsa madokotala (siofor, glucophage, pioglar, onglise,) Chaka chilichonse amathandizidwa kuchipatala, koma shuga anali kukulira. Kwa zaka 4 zapitazi, shuga anali oposa 15 ndipo adafika pa 21. Chifukwa cha insulin iwo sanasamutsire ake, zinali 59. Kwa zaka 1.5 zapitazi, ndinataya makilogalamu 30 nditatenga Victoza (ndikubaya jekeseni kwa zaka 2) monga momwe dokotala wanenera. Ndipo ndinatenga onglise ndi glycophage 2500. Shuga sanagwere pansi 15. Pa chithandizo chotsatira mu Novembala, insulin ya AKTAPID inalembedwa pa 8 mayunitsi katatu patsiku ndipo usiku LEVOMIR 18ED. Ku chipatala, acetone +++ adapezeka atazindikira momwe mankhwalawo amathandizira, adazengereza, mayunitsi 15 adalembedwa zotsatana ndi acetone ndi shuga. Acetone amasunga nthawi zonse mkati mwa 2-3 (++) Amamwa madzi 1.5-2 malita tsiku lililonse. Sabata yapitayi, adatembenukiranso kuchipatala, m'malo mwa Actrapid, NOVO RAPID adalembedwa ndipo mankhwalawo amayenera kutengedwa okha, ndipo adotolo wa acetone sayenera kulabadira acetone. Mwamuna wanga sakumva bwino. Kumapeto kwa sabata tikufuna kusinthira ku NOVO RAPID. Kodi mungandiuze pa mlingo uti? Ndingakhale wothokoza kwambiri. Mwamuna alibe zizolowezi zoyipa.

Kodi tanthauzo la chakudya chochepa chamagulu owonjezera? Zachinyengo zamtundu wanji? Ndine mtundu wa 1 wodwala matenda ashuga wazaka 20. Ndimalola kudya chilichonse! Nditha kudya keke yapancake. Ndimangopanga insulin yambiri. Ndipo shuga ndi wabwinobwino. Knead ine chakudya chochepa chama carb, chonde?

Masana abwino
Ndili ndi zaka 50. Zaka 4 mtundu 2 shuga. Adagonekedwa kuchipatala ndi shuga 25 mmol. Kusankhidwa: magawo 18 a lantus usiku + metformin 0,5 mg ndi mapiritsi 3-4 pa tsiku ndi chakudya. Mutatha kudya chakudya chamafuta (zipatso, mwachitsanzo), kumakhala kumang'ambika kuderalo mwendo wapansi ndipo sindimakonda. Koma ndimaganiza kuti popanda ma carbohydrate ndizosatheka kwathunthu, makamaka popanda zipatso, pali mavitamini. Shuga m'mawa osapitilira 5 (5 ndi osowa kwambiri, m'malo mwa 4), nthawi zambiri amakhala pansi pa 3.6-3.9. mutatha kudya (pambuyo maola 2) mpaka 6-7. Nditaphwanya zakudya zinali mpaka 8-9 kangapo.
Ndiuzeni, ndingamvetsetse bwanji kuti ndisunthire bwanji, ngati ndisiyiratu mankhwala - ndimachepetsa mapiritsi kapena insulin? komanso momwe ndingachitire bwino m'malo anga? Madokotala safuna kwenikweni kuchita chilichonse. Zikomo patsogolo.

Ndili ndi matenda a T2DM kwa zaka 30, ndimaba jekeseni Levemir m'magawo 18 m'mawa ndipo madzulo ndimamwa metformin + glimepiride 4 m'mawa + Galvus 50 mg 2 nthawi, komanso shuga m'mawa 9-10 masana 10-15. Kodi pali regimens ina ndi mapiritsi ochepa? Dokotala masana insulin salimbikitsa glycated hemoglobin 10

Moni Ndili ndi matenda ashuga a 2. Ndili ndi zaka 42 ndipo ndimalemera makilogalamu 120. kutalika 170. Dokotala adandiwuza kuti ndithandizire insulin musanadye mayunitsi 12 a Novorapid komanso usiku 40 mayunitsi Tujeo. Shuga masana osakwana 12 sizichitika. M'mawa m'ma 15-17. Kodi ndili ndi chithandizo choyenera komanso mungalangize chiyani?

Masana abwino Ngati mungadziwe ngati ndidapatsidwa chithandizo choyenera malinga ndi kusanthula kwa C-peptide, zotsatira za 1.09, insulin 4.61 μmE / ml, TSH 1.443 μmE / ml, Glycohemoglobin 6.4% Glucose 7.9 mmol / L, ALT 18.9 U / L Cholesterol 5.41 mmol / L, Urea 5.7 mmol / L pakadali pano pali 8-15 shuga 5.0 ngati sindidya chilichonse kwa theka la tsiku. Msinkhu 1.72 wolemera 65kg unakhala, anali 80kg. zikomo

Malonda a insulin

Mwa mitundu yomwe ilipo ya mankhwala a insulin, mitundu 5 yayikulu ndi iyi:

1. Jekeseni imodzi yokha ya insulin yochita kwa nthawi yayitali kapena yapakatikati,
2. Kubayira kawiri insulin yapakatikati,
3. Kubayidwa kawiri pakati komanso kosakhalitsa kwa insulin,
4. Katatu katemera wa nthawi yayitali komanso yayitali,
5. Maziko ndi njira ya bolus.

Njira yachilengedwe yopanga insulin tsiku ndi tsiku imatha kuyimiridwa ngati mzere wokhala ndi ma vertices panthawi ya insulin yomwe imachitika ola limodzi mutatha kudya (Chithunzi 1). Mwachitsanzo, ngati munthu atenga chakudya nthawi ya 7 koloko, masiku 12, 18 ndi 22 pm, ndiye kuti insulin ikakhala nthawi ya 8 am, masiku 13, 19 ndi 23 pm.

Pokhotakhota pobisalira mwachilengedwe pamakhala magawo olunjika, kulumikiza komwe timapeza maziko - mzere. Zigawo zachindunji zikugwirizana ndi nthawi zomwe munthu yemwe alibe matenda ashuga samadya ndipo insulin imachotsedwapo pang'ono. Panthawi ya kutulutsidwa kwa insulin mutatha kudya, mzere wachindunji wazobisika zachilengedwe umagawidwa ndi nsonga za mapiri ndi kukwera kowopsa komanso kutsika pang'ono.

Chingwe chachinayi ndi njira "yabwino", yofanana ndi kutulutsidwa kwa insulin ndi zakudya 4 patsiku panthawi yodziwika bwino. M'malo mwake, munthu wathanzi amatha kusuntha nthawi yakudya, kulumphira nkhomaliro kapena chakudya chamadzulo, kuphatikiza nkhomaliro ndi nkhomaliro kapena kudya pang'ono, nsonga zowonjezera zazing'ono za insulin zimawonekera pamapindikira.

Bweretsani ku nkhani

Jekeseni imodzi ya insulin yayitali kapena yapakatikati

Jakisoni imodzi imatheka chifukwa cha kuyamwa kwa insulin tsiku lililonse m'mawa musanadye chakudya cham'mawa.

Zochita za chiwembuchi ndizopondera zomwe zimayambira nthawi ya makonzedwe a mankhwalawa, kufikira pofika nthawi ya nkhomaliro ndikutsika chakudya chamadzulo (graph 2)

Chiwembuchi ndi chimodzi chophweka, chili ndi zovuta zambiri:

• Mphepete yowombera kamodzi sangafanane ndi mawonekedwe achilengedwe otetezedwa ndi insulin.
• Kugwiritsa ntchito njirayi kumaphatikizapo kudya kangapo patsiku - chakudya cham'mawa chopepuka chimasinthidwa ndi chakudya chambiri, chakudya chambiri komanso chakudya chochepa.
• Kuchuluka kwake ndi kapangidwe kake ka chakudya kuyenera kugwirizanitsidwa ndi mphamvu ya zochita za insulin pakadali pano komanso kuchuluka kwa zinthu zolimbitsa thupi.

Zoyipa zamakimuyi zimaphatikizapo chiopsezo chachikulu cha hypoglycemia, usana ndi usiku. Kupezeka kwa nocturnal hypoglycemia, limodzi ndi kuchuluka kwa insulin yam'mawa, kumawonjezera chiopsezo cha hypoglycemia pa nthawi yofunikira kwambiri ya mankhwalawa

Kukhazikitsidwa kwa mlingo waukulu wa insulini kumasokoneza kagayidwe ka mafuta m'thupi, komwe kungayambitse matenda ophatikizika.

Izi sizikulimbikitsidwa kwa anthu odwala matenda ashuga amtundu 1, mitundu iwiri ya anthu odwala matenda ashuga, mankhwalawa amagwiritsidwa ntchito molumikizana ndi mankhwala ochepetsa shuga omwe amaperekedwa pakudya kwamadzulo.

Bweretsani ku nkhani

Kubayidwa kawiri kwa insulin yapakatikati

Chithandizo cha insulin ichi chimachitika chifukwa chobweretsa mankhwala m'mawa m'mawa musanadye chakudya chamadzulo komanso madzulo musanadye chakudya chamadzulo. Mlingo wa tsiku ndi tsiku wa insulin umagawidwa m'mawa ndi madzulo pazotsatira za 2: 1, motero (graph 3).

• Ubwino wa pulogalamuyi ndikuti chiopsezo cha hypoglycemia chichepe, ndikulekanitsidwa kwa insulini mumadontho awiri kumapangitsa kuti mlingo wocheperako uzungulira thupi la munthu.
• Zovuta zomwe zimakhudza chiwembucho zimaphatikizira kulumikizidwa kwambiri ku regimen ndi zakudya - wodwala matenda ashuga ayenera kudya zosakwana 6 pa tsiku. Kuphatikizanso, kupindika kwa insulini, monga momwe zimakhalira pachiwonetsero choyamba, sikutalikirana kwambiri ndi kutengera kwa insulin katulutsidwe.

Kodi matenda a fungal ndiofala bwanji pakati pa odwala matenda ashuga? Mungathane nawo bwanji?

Chithandizo cha matenda a shuga a 2 - mankhwalawa ndi mankhwala a hypoglycemic. Werengani zambiri mu nkhaniyi.

Ma almond a shuga - mapindu ndi zovulaza

Bweretsani ku nkhani

Kubayiranso kawiri kwa kwapakatikati ndikuyambitsa insulin pang'ono

Imodzi mwalamulo zoyenera amaonedwa kuti ndi jakisoni wapawiri wa insulin komanso wapakati.Izi zimadziwika ndi kuyambitsa kwa mankhwala m'mawa ndi madzulo, koma mosiyana ndi zomwe zidapangidwa kale, zimatha kusintha mtundu wa insulin tsiku lililonse malinga ndi masewera olimbitsa thupi omwe akubwera kapena kudya.

Mwa odwala matenda ashuga, chifukwa cha kusintha kwa kuchuluka kwa insulin, zimatha kusiyanitsa zosankha za anthu odwala matenda ashuga pogwiritsa ntchito mankhwala omwe ali ndi shuga wambiri kapena kuwonjezera chakudya chomwe chimatengedwa (tchati 4).

• Ngati masana mukukonzekera masewera olimbitsa thupi (kuyenda, kuyeretsa, kukonza), m'mawa muyeso wa insulin yochepa ukuwonjezeka ndi magawo awiri, ndipo mlingo wapakatikati umachepa ndi magawo anayi mpaka asanu ndi limodzi, chifukwa zolimbitsa thupi zimathandizira kuchepetsa shuga,
• Ngati chochitika chovomerezeka ndi chakudya chamadzulo chikonzekera madzulo, mlingo wa insulin yochepa uyenera kuwonjezeka ndi magawo anayi, ndipo mlingo wapakatikati uyenera kusiyidwa chimodzimodzi.

Chifukwa cha magawano a tsiku ndi tsiku a mankhwalawa, kupindika pawiri jakisoni wapakati komanso wosakhalitsa kwa insulin kumayandikira kwambiri kupendekera kwachilengedwe, zomwe zimapangitsa kukhala koyenera kwambiri komanso koyenera pochizira matenda a shuga. Kuchuluka kwa insulini wovulala kumazungulira ndendende m'magazi, komwe kumachepetsa chiopsezo cha hypoglycemia.

Ngakhale zabwino, chiwembu sichikhala ndi zovuta, zomwe zimagwirizanitsidwa ndi kudya zolimba. Ngati chithandizo cha insulin chowirikiza chimakulolani kuti musiyanitse chakudya chomwe chimatengedwa, ndiye kuti kupatuka pa dongosolo la zakudya ndizoletsedwa. Kupatuka pa dongosolo la theka la ola kumawopseza kupezeka kwa hypoglycemia.

Zakudya za tsiku ndi tsiku za mavitamini. Zinthu za matenda ashuga

Ndi mayeso ati omwe amayambira kupeza matenda ashuga?

Zizindikiro za shuga mwa amuna. Werengani zambiri mu nkhaniyi.

Bweretsani ku nkhani

Katatu wobayira wa nthawi yayitali komanso wa insulin

Kubayira katatu kwa insulin m'mawa ndi masana kumagwirizana ndi njira yoyamba yothandizira anthu awiri, koma imasinthasintha madzulo, zomwe zimapangitsa kukhala koyenera.Chiwembuchi chimaphatikizanso kuyambitsa kuphatikiza kwa insulin yochepa komanso ya nthawi yayitali m'mawa musanadye chakudya cham'mawa, Mlingo wa insulin yochepa musanadye nkhomaliro komanso kuchuluka kwa insulin yayitali musanadye chakudya (Chithunzi 5) .Dongosolo limasinthasintha, chifukwa chimalola kusintha kwa nthawi yamadzulo ndi kuchepa kwa insulin yayitali. Kupindika kwapakati patatu kumayandikira kwambiri kumapindikira kwachilengedwe katemera wa insulin madzulo.

Bweretsani ku nkhani

Maziko - Bolus Scheme

Maziko - njira yotsimikizika ya insulin kapena yolimbikitsa kwambiri, popeza ndiyomwe imayandikira kwambiri kupindika kwa insulin secretion.

Ndi malamulo oyambira a insulin, hafu ya mlingo wonse umagwera insulin, ndipo theka la "lalifupi". Gawo limodzi mwa magawo atatu a insulin yayitali imayendetsedwa m'mawa ndi masana, kupumula nthawi yamadzulo. Mlingo wa insulin "yochepa" zimatengera kuchuluka ndi chakudya chomwe watengedwa.