Matenda a shuga a insulin

Pakutha kwa zaka za 1980s, panali anthu pafupifupi 6,600 ogwiritsa ntchito mapampu a insulini ku United States, ndipo tsopano pali anthu pafupifupi 500,000 ogwiritsa ntchito mapampu a insulin padziko lapansi, ambiri mwa iwo ku United States, pomwe munthu aliyense wachitatu yemwe ali ndi matenda a shuga a 1 amagwiritsa ntchito pampu ya insulin. M'dziko lathu, chiwerengero cha anthu omwe akugwiritsa ntchito pampu ya insulini nawonso chikukula kwambiri m'zaka zaposachedwa.

Pali mitundu yambiri yamapampu a insulin. Kodi zimasiyana bwanji ndipo ndi ziti zomwe zingakonde?

Kodi mapampu ndi ati

Mapampu amasiyanitsidwa ndi gawo la insulin management (kuchuluka kwa insulini komwe kungapangidwe ndi pampu), kukhalapo kapena kusowa kwa othandizira wa bolus, kayendetsedwe kanthawi kochepa, machitidwe owunika a glycemic (CGM) ndi zina, zosafunikira kwenikweni.

Tsopano mdziko lapansi pali anthu pafupifupi 500,000 ogwiritsa ntchito mapampu a insulin.

Gawo la insulin - Uwu ndiye muyeso wochepa kwambiri wa insulin yomwe pampu imatha kubaya. Mapampu amakono amatha kuperekera insulini muzowonjezereka mpaka 0,01 PIECES. Mlingo wocheperako wa insulin ungakhale wofunikira mwa makanda ndi ana aang'ono. Pafupifupi mapampu onse amakono amakhala ndi dzina lotchedwa bolus assist, kapena la bolus Calculator. Mfundo zoyambilira za kagwiritsidwe kake ndizofanana pamitundu yonse ya pampu, komabe, pali zosiyana zomwe zingakhudze zotsatira.

Mapampu ena ali ndi gulu lowongolera lomwe mutha kuwerengera kenako kulowa insulini kapena kusintha makina osakhudzidwa ndi ena. Izi zitha kukhala zothandiza kwambiri kwa iwo omwe amachita manyazi kubayirira insulin m'malo opezeka anthu ambiri, monga kusukulu. Kuphatikiza apo, mita ili ndi mita yopanda, ndipo simukuyenera kunyamula ina.

Mapampu okhala ndi njira yowunikira ya glycemic amalola kuwunikira kwenikweni kwa misinkhu wamagazi. Komabe, mapampu awa amafunikira zowonjezera zowonjezera, zomwe zimatchedwa sensor kuti aziwunikira, zomwe zimabweretsa ndalama zowonjezera. Kuphatikiza apo, sizingatheke kusiyiratu kuyeza kwamwazi m'magazi - sensor iyenera kuyang'aniridwa, ndiye kuti, zowerengera zake ziyenera kufananizidwa kangapo patsiku ndi glucose omwe amagwiritsa ntchito glucometer.

Palinso mapampu omwe amaikidwa mwachindunji pakhungu ndipo safuna chubu chowonjezera kuti mupeze insulin, yomwe ingakhale yabwino kwa anthu ena. Tsoka ilo, mapampu oterewa sanalembetsedwebe m'dziko lathu ndipo kupeza kwawo ndikugwirira ntchito kumayenderana ndi zovuta zina.

Chifukwa chake, kuthekera kosiyanasiyana kwa mapampu a insulini kumalola munthu aliyense yemwe ali ndi matenda ashuga kusankha zochita zomwe akufuna kuti akwaniritse kuchuluka kwa glucose m'magazi, moyo wosinthika, thanzi labwino komanso moyo wabwino. Lankhulani ndi wothandizira zaumoyo wanu kuti ndi pampu iti yabwino kwambiri.

Kusiyana kwa mapampu a insulin:

• Mlingo wochepa wa insulin (sitepe)
• Wothandizira Bolus
• Gulu lowongolera
• Miyeso yopitilira shuga
• Hypoglycemia Insulin Discontinuation
• Kukhazikitsa kwathunthu thupi (palibe njira yolowetsera chubu)

Chithunzi 1. Chipangizo cha pampu cha insulin: 1 - pampu yokhala ndi chosungira, 2 - kulowetsedwa, 3 - cannula / catheter

Pampu ya insulin - Ichi ndi chipangizo chovuta kwambiri kufanizira chomwe chingafanane ndi syringe yamagetsi. Mkati pampu pali zamagetsi zofunika kwambiri zomwe zimayendetsa ntchito pampu, ndi mota yomwe imayendetsa pisitoni. Kenako, pisitoniyo, akuyamba kugwira ntchito yosungiramo madzi ndi insulin, amachepetsa. Kupitilira apo, insulin imadutsa mu chubu, chotchedwa infusion system, kudzera mu singano, yomwe imatchedwa cannula, pansi pa khungu.

Cannulas amabwera mulitali osiyanasiyana ndipo amapangidwa kuchokera kuzinthu zosiyanasiyana. Ngati muli ndi pampu wokhoza kuyang'anira glucose mosalekeza, ndiye kuti mugwiritse ntchito ntchito imeneyi, muyenera kugwiritsa ntchito sensor yapadera, yomwe, ngati cannula, imayikidwa pansi pa khungu, ndipo kulumikizana ndi pampu kumachitika kudzera pa wayilesi yolankhulira opanda waya.

Zogwiritsa ntchito ma insulini

Mukalowetsa insulin ndi cholembera kapena syringe mumiyeso yambiri, mumagwiritsa ntchito mitundu iwiri ya insulin: insulin yayitali (Lantus, Levemir, NPH) ndi insulin yochepa (Actrapid, Humulin R, NovoRapid, Apidra, Humalog). Mumamwa insulin nthawi yayitali kamodzi kapena kawiri patsiku kuti muchepetse shuga wamagulu musanadye. Mumabayidwa ndi insulin yayifupi pachakudya chilichonse kapena ngati pali magazi akulu.

Pampu ya insulin imagwiritsa ntchito mtundu umodzi wokha wa insulin - waifupi.

Timagwiritsa ntchito zomwe zimatchedwa zachidule za insulin anthu pampu: NovoRapid, Apidra, Humalog. Ma insuliniwa ali ndi kusintha kosintha pang'ono kwa molekyulu ya insulin. Chifukwa cha kusintha kwazinthu izi, ma insulin analogue amachita zinthu mwachangu kuposa insulin yochepa ya anthu. Mofulumira ndi zomwe zimachitika, mwachangu chimakhala chofunikira (pazambiri) kuchitapo kanthu ndipo mwachangu ndi kuchitapo kanthu. Chifukwa chiyani izi ndizofunikira? Mwa munthu wopanda matenda a shuga, kapamba amatulutsa insulin nthawi yomweyo m'magazi, kuchitapo kanthu kumachitika nthawi yomweyo ndikuyamba kuima. Pogwiritsa ntchito insulin analogue, timayesetsa kuyandikira ntchito ya kapamba wabwino.

Maphunzirowa sanawonetse kusiyana pakati pamafanizo osiyanasiyana a insulin yochepa pakugwiritsidwa ntchito pamapampu, onse malinga ndi momwe zimakhudzira shuga wa magazi ndi mulingo wa HbA1c. Panalibe kusiyana pamafupipafupi a episode a hypoglycemia ndi catheter occlusion (insulin yolakwika).

Insulin yocheperako yaumunthu sichigwiritsidwa ntchito ngati mapampu a insulin, makamaka ngati pali tsankho.

Chithunzi 2. Bolus ndi jekeseni wa insulin

Chithunzi 3. Insulin ya basal ndi magulu angapo ang'onoang'ono.

Pampu ya insal - Ichi ndi pafupipafupi makonzedwe ang'onoang'ono a mabulusi. Chifukwa cha izi, ndizotheka kukwaniritsa yunifolomu yambiri ya insulin m'magazi.

Pampu ya insulin

Chifukwa chake, pampu imagwiritsa ntchito insulini imodzi - yochepa, yomwe imaperekedwa m'njira ziwiri. Njira yoyamba yoyambirira ndi kuperekera kwa insulin yaying'ono yayikulu kuti magazi azikhala ndi shuga. Njira yachiwiri yachiwiri ndi kutsitsa insulini pakudya kapena shuga m'magazi.

Bolus insulin imayendetsedwa pamanja, othandizira a bolus angagwiritsidwe ntchito kuwerengetsa mlingo - pulogalamu yomwe idapangidwa pampope yomwe imalimbikitsa kuchuluka kwa shuga m'magazi komanso kuchuluka kwa shuga m'magazi ndi kuchuluka kwa chakudya chamagulu omwe amadyedwa (m'mitundu ina ya pampu, zochitika zolimbitsa thupi, kupsinjika ndi zinthu zina zitha kuganiziridwanso )

Insulin ya basal imabayidwa pokhapokha malinga ndi mawonekedwe anu pampu. Kuphatikiza apo, nthawi zosiyanasiyana masana, kuchuluka kwa insulin kungasinthe malinga ndi zosowa za wodwala. Mlingo wa basal insulin womwe umayendetsedwa ungasinthe pakatha mphindi 30-60 zilizonse.

Mulingo wosiyanasiyana wa makonzedwe a basal tsiku lililonse amatchedwa basal mbiri. Pachimake, insulin ya basal imakhala pafupipafupi komanso yaying'ono.

Chithunzi 4. Chithunzi cha munthu aliyense payekhapayekha atengera zamagulu ake

Zabwino kapamba

Momwemo, titha kunena kuti kapamba wabwino amagwira ntchito m'njira ziwiri. Pancreas wathanzi imagwira ntchito kosalekeza, kubisa insulini pang'ono.

Chithunzi 5. Kapangidwe kathanzi

Pancreas wathanzi pafupifupi nthawi zambiri amatulutsa insulin yaying'ono m'magazi kuti athe kuwongolera kupanga shuga yayikulu kwambiri - gluconeogenesis ndi glycolysis, ichi ndiye chotchedwa basal secretion.

Pankhani ya chakudya, zikondwererozi zimatulutsa insulin yambiri nthawi yomweyo kuti mafuta amene amapezeka ndi chakudya azilandira. Kuphatikiza apo, ngati chakudyacho ndichitali, kapamba amatulutsa insulin pang'onopang'ono pomwe chakudya chimalowa m'magazi kuchokera m'matumbo am'mimba.

Pankhani ya kuchepa kwa shuga m'magazi, mwachitsanzo pakulimbitsa thupi kapena pakusala kudya, kapamba amatulutsa insulini kwambiri kotero kuti palibe kutsika kwamphamvu kwa glucose m'magazi - hypoglycemia.

Ichi ndi chiyani

Nanga pampu ya matenda ashuga ndi chiani? Pampu ya insulin ndi chipangizo cha digito chomwe chimalowetsa insulin m'matumbo a adipose mosalekeza. Chipangizocho ndichabwino kuposa kuyendetsa maholowo pawokha, chifukwa chimatsata kapamba. Mitundu yamakono yamapampu imatha kuwunika kuchuluka kwa glucose munthawi yeniyeni (kuwonetsa zomwe zili pazenera) ndikuwerengera pawokha kuchuluka kwa jakisoni wa insulin kuti thupi likhalebe labwinobwino.

Mwanjira ina, munthu wodwala matenda ashuga safunikiranso kuyeza shuga komanso ngati kuli koyenera, aperekeni jakisoni wa mahoni, chida ichi chimangochita zokha, ngati pampu. Kukula kwa pampu ya insulin sikupitilira foni yam'manja. Pampu ya insulin, insulin yolimbikira kwambiri imagwiritsidwa ntchito. Ngati ndi kotheka, mutha kuyimitsa kuchuluka kwa mahomoni, komwe sikungachitike mutayamwa insulin nokha. Mutuwu umathandizira kwambiri moyo wa odwala matenda a shuga omwe amadalira insulin, koma, mwatsoka, kukonza kumasiyana kuyambira ma ruble 5 mpaka 15,000 pamwezi, ndipo si aliyense amene angakwanitse.

Contraindication

• Matenda a diabetic retinopathy (odwala matenda ashuga omwe ali ndi vuto lotsika sangawone zolemba pa chipangizocho komanso asatenge nthawi yoyenera).
• Kuthetsa kukhudzidwa kwa magazi a shuga ndende (shuga wamagazi amayenera kuyezedwa osachepera kanayi pa tsiku).
• Kusafuna kuyang'anira kugwiritsa ntchito XE (mkate magawo).
• Mawonekedwe a ziwengo pakhungu la pamimba.
• Zovuta zam'mutu (zimatha kubweretsa jakisoni wosalamulira wa mahomoni, omwe amangovulaza wodwala).

Mfundo zoyendetsera chipangizocho

Valavu imayikidwa pampu ya insulin yomwe imakanikiza pansi pa thankiyo (kudzaza ndi insulin) pa liwiro lomwe sing'anga idakonza. Chubu loonda komanso losasunthika (catheter) limatuluka mu chosungira ndi singano ya pulasitiki kumapeto, yomwe imayikidwa mu subcutaneous adipose minofu pogwiritsa ntchito chipangizo chapadera.

Kukhazikitsa kwa insulin kumagawidwa m'mitundu iwiri:

Vidiyo imaperekedwa papampu ya insulin, yomwe imatha kuphatikizika mosavuta ndi lamba kapena lamba. M'mashopu apadera, ndizosintha osiyanasiyana pazovala zapompo (zokutira, matumba, ndi zina).

Njira yoyambira

M'malamulo oyambira, insulini ya mahomoni imayendetsedwa mosalekeza pamiyeso yaying'ono, yomwe imatsata njira yobisa insulin ndi kapamba wa munthu wathanzi (kupatula zakudya). Masana, pulogalamuyi imatha kuphatikizidwa ndi mitundu 48 ya maimelo yotumiza mahoni kwa theka lililonse la ola, ngakhale kuli kofunikira kuganizira zaomwe munthu amakhala nawo mthupi ndi kuchuluka kwa zolimbitsa thupi (tsiku, usiku, masewera olimbitsa thupi). Mulingo woyambira weniweni umatsimikiziridwa ndi dokotala wodziwa bwino, yemwe amadziwa mbiri ya matendawa ndi zovuta zake. Mlingo wa kubereka kwa insulini umatha kusinthidwa masana malinga ndi dongosolo lake (yobereka imatha kuyimitsidwa, kutsitsidwa kapena kuwonjezeredwa). Kusiyanaku kumawerengedwa kuti ndikofunika kwambiri, chifukwa ndi insulin yotalikilapo sichimapezeka.

Makonda a Bolus

Malangizo a insulin amathandizira kuperekera insulin amagwiritsidwa ntchito pakudya kapena, ngati kuli kotheka, kusintha kuchuluka kwa shuga m'magazi. Pampu iliyonse ya insulin, kupatula, imakhala ndi othandizira. Ichi ndi chowerengera chapadera chomwe chimathandiza wodwala matenda ashuga kudziwa kuchuluka kwa jakisoni molingana ndi makonda ake.

Mitundu yosiyanasiyana ya insulin pump

Pali mibadwo itatu ya mapampu a insulini.

Mapampu a insulin a m'badwo woyamba ali ndi ntchito imodzi yokha - kupatsa insulini mu kuchuluka kosakonzedwa.

Mapampu a insulini am'badwo wachiwiri, kuphatikiza popereka mankhwala a insulin, amathandizira odwala matenda ashuga kudziwa kuchuluka kwa mlingo.

Mibadwo ya 3 ya insulin mapampu amaika insulini, kudziwa mlingo, komanso kuwonetsa kuchuluka kwa shuga m'magazi mu nthawi yeniyeni, kupewa kutulutsa kwa hyperglycemia kapena hypoglycemia.

Ubwino wazida

Phindu lalikulu la pampu ya insulin:

• Kuyang'anira zenizeni zenizeni zama glucose (mutha kudziwa nthawi yomweyo zakudya zomwe muyenera kukana kapena kudziletsa pakumwa kwawo).
• Kuchepetsa kwambiri milandu ya hypoglycemia.
• Makina owerengera a Bolus.
• Short kapena ultrashort insulin.
• Kuwerengera kosavuta kwa Mlingo wa insulin kutengera gawo la ntchito.
• Kusungirako ndi insulin kumatenga masiku 3-4.
• Chizindikiro chowopsa (prerequisites for hyperglycemia or hypoglycemia, insulin).
• Kulumikizana ndi kompyuta yanu kapena zida zamagetsi (mitundu yamakono).
• Nthawi yambiri yaulere.

Kupitiliza kosalekeza kwa insulin kumapangitsa kuti shuga azikhala ndi shuga m'magazi a shuga, motero amapereka ufulu komanso kulimbikitsa odwala matenda ashuga. Mothandizidwa ndi mapulogalamu ochita ntchito zosiyanasiyana, pampu ya insulini imatha kusintha gawo lililonse la ntchito yonyamula. Mwachitsanzo, ngati wodwala yemwe ali ndi matenda osokoneza bongo aganiza zopita kokachita masewera olimbitsa thupi, amakakamizidwa kumwa tambala totsegulira theka lililonse la ola, chifukwa insulini imapezeka m'magazi, ndipo zochitika zolimbitsa thupi zimathandizira zotsatira zake komanso kutsekemera kwa glucose kumachepa. Ndi pampu ya insulin, ma nuances oterewa satuluka, chifukwa adzasunga mahomoni pamlingo wokhazikika.

Pampu ya insulin ya ana

Matenda a shuga amakhalanso ndi ana, chifukwa mwana amafunitsitsa kukhala pachibwenzi ndi anzawo, ndipo matendawa ndi osavomerezeka. Ndipo muyenera kutsatiranso zakudya, kuwunika shuga wamagazi mosalekeza - ndipo popanda thandizo la munthu wamkulu, izi sizigwira ntchito nthawi zonse. Pampu ya insulin ndi yoyenera kwa ana asukulu pazifukwa zingapo:

• Ntchito za kuperekera kwa insulin kudzakuthandizani kuwerengera mulingo woyenera, poganizira zomwe zimachitika mthupi ndi kuchuluka kwa zochitika zolimbitsa thupi.
• Ndiosavuta kwa mwana kuphunzira kudzidalira pakuyendetsa matenda a shuga.
• Kuyang'anira zenizeni zenizeni za glucose kumathandizira kupewa hyperglycemia kapena hypoglycemia.
• Palibe chifukwa chotsatira kwambiri zochita za tsiku ndi tsiku, zomwe zimapulumutsa mwana kuchokera ku "moyo womwe wakonzedwa".
• Ndondomeko ya bolus ya mahomoni a insulin ingathandize thupi kuthana ndi chakudya “cholemera”.

Matenda a shuga sayenera kuletsa mwana kuchita masewera. Pampu ya insulini ndi yabwino pamenepa, chifukwa ndizosavuta kusankha kuchuluka kwa insulin yobereka. Poyamba, dokotala yemwe akupezekapo angakuthandizeni kukhazikitsa chipangizocho, zina zimatengera umunthu wa chovalacho, mwachitsanzo, pangafunike kusintha. Chipangacho pachokha chimakhala chosazungulira osati chotseka. Mwana akayamba kusambira, ndiye kuti mpopewo uyenera kuchotsedwa kutalitali kwa phunzirolo, ndipo pulagi iyenera kuyikidwa pa catheter. Pambuyo pa phunziroli, pulagiyo imachotsedwa, ndipo chipangizocho chikualumikizanso, komabe, ngati phunziroli lidatenga nthawi yoposa 1 ola, ndikofunikira kusintha mlingo wa mahomoni a insulin.

Mwanjira ina, pampu ya insulini pochiza matenda ashuga mwa ana ndiwothandiza kwambiri, chifukwaNdikofunika kuti ana asamasiyana ndi anzawo komanso kuti adziyese wofanana nawo.

Mwachidule. Pampu ya insulin imapangitsa moyo kukhala wosavuta kwa odwala matenda ashuga omwe amadalira insulin. Chipangizochi chimatha kuwonetsa kuchuluka kwa glucose mu nthawi yeniyeni, kuwerengera kuchuluka kwa kuchuluka kwa ma cell a insulin ndikulowamo mosasamala tsiku lonse, potero kumasula mwiniwake ku zovuta ndi zovuta zosafunikira. Chida ichi ndi chofunikira makamaka kwa ana odwala matenda ashuga, chifukwa chitha kumuthandiza mwana kuti asadzipetse kuchita masewera olimbitsa thupi komanso asachite manyazi akamailowetsa insulin kudzera mu cholembera. Ndemanga za anthu odwala matenda ashuga omwe ali ndi chipangizochi ali ndi zabwino kwambiri, koma mtengo wa kukonza si wa aliyense.

Angapo ma insulin angapo (syringes / syringe pensulo)

Pamene madokotala amalimbikitsa kubayira insulini ndi zolembera za syringe, ndiko kuti, jakisoni imodzi kapena iwiri ya insulin yowonjezera ndi majekeseni angapo a insulin yochepa pakudya komanso ndi kuchuluka kwa glucose wamagazi, timayesetsa kupanga ntchito ya kapamba wabwino. Insulin yomwe imatenga nthawi yayitali imaberekanso kupindika kwa kapamba, ndiko kuti, imasunga kuchuluka kwa shuga m'magazi, kutsekeka kapena kuchepetsa kuchepa kwa chiwindi. Insulin yochepa imaperekedwa kuti ipeze chakudya kapena kuchuluka kwa shuga m'magazi kuti achepetse kuchuluka kwake.

Chithunzi 6. Sola

Tsoka ilo, ndi njira iyi yoyendetsera, sititha kubereka kapamba molondola, popeza kuchuluka kwa insulini kumakhala kofanana nthawi yayitali. Nthawi yomweyo, mawonekedwe a inshuwaransi masana sadzagwiritsidwe ntchito. Mwachitsanzo, achinyamata nthawi zambiri amakhala ndi vuto la "m'mawa kutacha" ndikufunika kwambiri kwa insulin m'mawa kwambiri, zomwe zimapangitsa kuti magazi azikhala ndi magazi pakadali pano.

Ngati tikufuna kuwonjezera kuchuluka kwa insulin yayitali usiku, izi zimatha kuyambitsa hypoglycemia usiku, kutsatiridwa ndi hyperglycemia, yomwe imangokulitsa vutoli. Pankhani ya chakudya chotalikilapo, mwachitsanzo pa tchuthi, palibe njira yochepetsera zochitika zazifupi za insulin, zomwe zingayambitse hypoglycemia kwakanthawi pambuyo pa kubayidwa.