Matenda a shuga a insulini

Chithandizo cha matenda amashuga amakono chikuchitika bwino. Zambiri zimatengera wodwala amayesetsa kuti akhale wathanzi komanso thanzi lake. Wodwala ayenera kuyang'anira menyu ake, kupatula zomwe zaletsedwa kugwiritsidwa ntchito ndi endocrinologist.

Wodwala ayenera kuchita maphunziro olimbitsa thupi mochulukitsa ndi katswiri. Pomaliza, muyenera kudziwa momwe mungadziyimirire pawokha mlingo wa insulini pakumwa kamodzi.

Pali mitundu ingapo yama mankhwala othandizira. Njira yowonjezerayi imaphatikizapo kubaya insulin mutagona musanayambe kudya kwa tsiku. Insulin yochepa imatengedwa musanadye chilichonse. Nthawi zina njira ziwiri izi zimaphatikizidwa. Thupi limaperekedwa kwa odwala onse a T1DM ndi T2DM. Palinso inshuwaransi ya ultrashort. Amagwiritsidwa ntchito pothamanga mwadzidzidzi mu shuga. Kuchuluka kwa insulini yochepa komanso njira ya ultrashort yoyambira kumayamba chifukwa cha kuchuluka kwa timadzi tambiri tomwe timapanga.

Kudziwitsa za kuchuluka kwa mahomoni

Momwe mungawerengere kuchuluka kwa insulin? Lingaliro lalikulu la malamulo oyendetsera insulin yayitali ndikuti mankhwalawa sayenera kukhudza glucose wamagazi, koma sayenera kuloleza kupitirira. Izi zikutanthauza kuti ngati munthu sanadye kenakake masana komanso osapaka insulin yochepa, ndiye kuti shugayo, atatha kubayidwa nthawi yayitali, akhalebe chimodzimodzi kwa maola 24.

Kumayambiriro kwa chithandizo cha matenda ashuga, wodwalayo sangathe kuwerengera mlingo wake molondola. Koma kusinthasintha pa gawo limodzi sikofunikira kwambiri. Pang'onopang'ono, munthu amaphunzira ndikuyamba kuzindikira molondola kuchuluka kwa mankhwala omwe amafunikira.

Kuwerengera mlingo wa insulin kumachitika pogwiritsa ntchito miyezo ya shuga mosalekeza:

• Patsiku loyamba, wodwalayo ayenera kukana chakudya cham'mawa, ndipo kuchokera nthawi yomwe amadzuka ku tulo, yeretsani kuchuluka kwa glucose ola lililonse mpaka masana.
• Kenako, tsiku lotsatira muyenera kudya chakudya cham'mawa, koma kadumpheni nkhomaliro. Pangani shuga m'magazi mukangodya chakudya cham'mawa ndipo pitilizani kuyeza ola lililonse mpaka chakudya chamadzulo.
• Patsiku la 3 muyenera kukhala ndi chakudya cham'mawa komanso nkhomaliro, koma osakana chakudya chamadzulo. Kuyeza kuyenera kuyambitsidwa pambuyo pa nkhomaliro ndikupitilira mpaka kugona mphindi 60 zilizonse.

Mlingo wa insulini amawerengedwa molingana ndi magawo otsatirawa - ngati patsiku la 1 kuchuluka kwa glucose kumakhalabe kosatha panthawi ya miyeso ndipo ndi 5 mmol / l, patsiku la 2 simapitilira 8 mmol / l, pa 3 limafikira 12 mmol / l , izi ndizizindikiro zabwino kwa wodwala yemwe ali ndi matenda ashuga. Amatanthawuza kuti kuchuluka kwa insulin yayitali kusankhidwa bwino.

Ngati mayeso a glucose amadzulo apereka chithunzi chocheperapo m'mawa pofika 2 - 3 mmol / L, muyenera kuchepetsa mlingo wa insulin ndi 1 unit kapena 2 (mwachitsanzo, m'mawa wodwala amafuna 8 mmol, ndipo madzulo - 5). Ngati ayi, mankhwalawa amatha kupitirira masiku onse, ndiye kuti ndi kofunikira kuti muwonjezere insulin yayitali mu syringe ndi gawo limodzi kapena awiri.

Fomula ya Forsham imadziwikanso kwa odwala, omwe ndi osavuta kuwerengera komanso osiyanasiyana mosiyanasiyana kutengera shuga. Pamaso pa glucose mu kuchuluka kuchokera pa 150 mg /% mpaka 216, zikuwoneka motere: (x - 150) / 5. Ine.e. ndi shuga 180 mg /% - (180-150) / 5 = 6 magawo a insulin.

Ngati shuga ndi oposa 216 mg /%, ndiye kuti njirayo imasinthidwa motere: (x - 200) / 10. Mwachitsanzo, ndi glucose mu 240 mg /%, mlingo wa insulin ndi (240-200) / 10 = 4 magawo. Kusankha mlingo wogwiritsa ntchito fomuloli ndikosavuta.

Kuwerengeredwa kwa nthawi ndi kuchuluka kwa makulidwe a insulin yayifupi

Musanawerengere kuchuluka kwake, ndikofunikira kudziwa ngati insulin yayifupi ndiyofunika. Izi zikuyenera kuchitika ndi sing'anga wopezekapo. Ngati atapereka insulin yayitali kwakanthawi, kuchuluka kwa shuga mkati mwa maola 24 kumakhalabe kosakwanira komanso kumangowonjezera chakudya chamadzulo, dokotala angakulangizeni jakisoni wofulumira, wokhazikika mwachangu nthawi 1 - mphindi 45 asanadye. Ngati mudalumpha mwadzidzidzi masana, muyenera kupereka insulin mwachangu musanadye.

Kuwerengera kwa insulin ndi njira yochepa yoyendetsera ikuwonetsa kuti muyezo wa jekeseni wa jekeseni 3 kwa ola limodzi asanadye. Ndipo yeretsani shuga m'magazi asanu aliwonse. Pokhapokha glucose akatsika kuposa momwe mumayambira koyamba ndi 0,3 mmol / L muyenera kuyamba kudya. Simungathenso kudikirira, apo ayi shuga atha kwambiri.

Kuyeza kwa shuga m'thupi kumapitirirabe masiku otsatirawa, mpaka mlingo wosankhidwa wa insulin yothamanga umachepetsedwa ndi theka. Amaba jakisoni wochepa pokhapokha kuchuluka kwa glucose m'thupi ndichoposa 7.6 mmol / L. Momwe mungawerengere moyenera kuchuluka kwa mankhwala oyenera, adokotala adzakulangizani.

Kudziwitsa za kuchuluka kwa mahomoni a ultrashort

Monga tanena, kukhazikitsa insulini yocheperako pang'ono kumachitika ndikumadumphira kwa glucose mthupi, ngakhale jakisoni wa mtundu wautali wa mahomoni ndi insulin yochepa. Asanaikidwe ngati dokotala, pali zina zomwe zingakhale ndi chidwi:

• Wodwala amadya nthawi yanji
• Kodi amadya zakudya ziti komanso zomwe amadya,
• Kodi mwatsatira malingaliro a kuchuluka kwa chakudya pachakudya chilichonse,
• Wodwala ndi wodwala bwanji pankhani yochita zolimbitsa thupi,
• Kodi adayikidwa mankhwala ena amtundu wina wa matenda ena,
• Kaya wodwala matenda ashuga adakumana ndi zovuta kapena zovuta zina za comorbidities.

Kuchuluka kwa zakudya zomwe zimadyedwa kumaganiziridwa m'magawo a mkate. 10 g yazakudya zopatsa mphamvu ndi 1 XE. 1 XE imatha kuwonjezera shuga ndi 1.6 - 2.2 mmol / L.

Momwe mungasankhire mtundu wa insulin yotsalira-yochepa? Hormashort ya Ultrashort imalowetsedwa m'masekondi 300 - mphindi 15 musanadye. Pali mankhwala osiyanasiyana a ultrashort insulin. Muyenera kuwerenga malangizo mosamala. Chowonadi ndi chakuti ma analogi a ultrashort amachepetsa kuchuluka kwa shuga kuposa amfupi. Ena mwa iwo amachepetsa ndi nthawi 2.5, ena ndi 25%. Ndiye kuti, mankhwala amtunduwu ayenera kugwiritsidwa ntchito muyezo wotsikitsitsa, womwe umawerengeredwa ndi katswiri.

Kukonzekera kwa Ultrashort kumagwiritsidwa ntchito ngati spikes mu shuga la magazi pazifukwa zosiyanasiyana. Chomwe chikugwiritsidwira ntchito ndikuti chimayamba kugwira ntchito mpaka nthawi yomwe thupi limasinthira zakudya zomwe zimapezeka mukamadya kukhala glucose.

Mfundo zazikuluzikulu zowerengera

Tiyenera kukumbukira kuti hypoglycemia (yotsika shuga) imapereka zovuta komanso hyperglycemia (mkulu). Chifukwa chake, pali malire a kuchuluka kwa mahomoni omwe amaperekedwa, omwe amayenera kuwerengedwa ndipo osavomerezeka kuti adutsidwe.

Mukamasankha mtundu wa insulin kwa wodwala wina, dokotala amaganizira kuchuluka kwa matenda ake a shuga. Izi zikutanthauza - kuchuluka kwa kagayidwe kamene kamapatuka kwazaka zonse, kuchuluka kwa moyo kwakhala kukuipiraipira. Mu shuga yomwe imalipidwa, ziwerengero za metabolic ndizabwinobwino. Ndi shuga wowola, kagayidwe kake kamachepa kwambiri ndipo moyo wa wodwalayo umakhudzidwa kwambiri. Ziwerengero zamtundu wa insulin zomwe zimayendetsedwa:

• Pankhani ya matenda a shuga 1 kumayambiriro koyambirira, mankhwalawa saposa magawo 0,5 a insulin pa 1 kg ya kulemera,
• Ngati matenda a shuga a mtundu woyamba akhazikitsidwa kale, koma amalipiridwa, adotolo amakupatsani mlingo wofikira ku magawo 0,6 pa kilogalamu imodzi yakulemera,
• Ngati T1DM siinalipiridwe, imatsika ndikupereka zovuta, ndiye kuti kuchuluka kwa mahomoni owerengedwa kumatha kukhala mpaka magawo 0,7 pa kilogalamu imodzi,
• Wodwala kwambiri wophatikizidwa ndi ketoacidosis (kuphwanya kwa kagayidwe kazakudya kamene kamakhala ndi mpweya wambiri m'thupi komanso ma ketone m'magazi), mlingowo umatha kuwonjezeka mpaka magawo 0,9 pa kilogalamu imodzi,
• M'miyezi itatu yapitayi yodwala mwa wodwala yemwe ali ndi matenda ashuga, dokotala amatha kuwonjezera kuchuluka kwa magawo 1.0 pa 1 makilogalamu.

Kuti mupeze kutsimikiza kwamtundu wa insulin mu shuga, muyenera kufunsa dokotala.

Malamulo owerengera

Lamulo lofunikira mu algorithm yowerengetsera kuchuluka kwa insulini ndikofunikira kwa wodwalayo kuposa gawo limodzi la 1 la mahoni pa kilogalamu imodzi ya kulemera. Mukanyalanyaza lamuloli, kudzakhala ndi insulin yambiri, yomwe ingayambitse vuto lalikulu - kukomoka kwa hypoglycemic. Koma posankha ndendende mlingo wa insulin, ndikofunikira kuganizira kuchuluka kwa kubwezeretsedwa kwa matendawa:

• Mu magawo oyamba a matenda amtundu 1, muyezo wa insulin mumasankhidwa malingana ndi 0,5 ya mahomoni pa kilogalamu yolemera.
• Ngati mtundu 1 wa shuga umakhala wolipiridwa bwino pachaka, ndiye kuti inshuwaransi yokwanira imakhala magawo 0,6 a timadzi ta kilogalamu imodzi ya kulemera kwa thupi.
• Mu mtundu woyamba wa shuga 1 komanso kusinthasintha kosalekeza m'magazi am'magazi, mpaka magawo 0,7 a mahomoni pa kilogalamu imodzi ya kulemera amafunikira.
• Pankhani ya shuga wowola, muyezo wa insulin udzakhala magawo 0.8 / kg,
• Ndi gestational shuga mellitus - 1.0 PIECES / kg.

Chifukwa chake, kuwerengetsa kwa kuchuluka kwa insulin kumachitika molingana ndi algorithm: Mlingo wa insulin wa tsiku ndi tsiku (U) * Chiwerengero chonse cha thupi / 2.

Mwachitsanzo: Ngati mlingo wa insulin wa tsiku ndi tsiku ndi magawo 0,5, ndiye kuti uyenera kuchulukitsidwa ndi kulemera kwa thupi, mwachitsanzo 70 kg. 0.5 * 70 = 35. Chiwerengero chotsatirachi 35 chikuyenera kugawidwa ndi 2. Zotsatira zake ndi nambala 17.5, yomwe iyenera kuzunguliridwa, ndiye kuti, peze 17. Ndipo likukonzekera kuti m'mawa mankhwala a insulin akhale magawo 10, ndipo madzulo - 7.

Mlingo wa insulin umafunika pa 1 mkate uti

Gulu la mkate ndi lingaliro lomwe lakhazikitsidwa kuti lipange zosavuta kuwerengera mlingo wa insulin musanadye chakudya. Pano, powerengera magawo a mkate, sizinthu zonse zomwe zimakhala ndi chakudya zomwe zimatengedwa, koma "zowerengedwa" zokha:

• mbatata, beets, kaloti,
• mankhwala a chimanga
• zipatso zokoma
• maswiti.

Ku Russia, mkate umodzi umafanana ndi magalamu 10 a chakudya. Gulu limodzi la mkate limafanana ndi kagawo ka mkate woyera, apulo wina wamkulu, masipuni awiri a shuga. Ngati gawo limodzi la mkate likalowa m'thupi lomwe silitha kudzipangira payokha, ndiye kuti glycemia imakulirakulira kuchokera 1.6 mpaka 2.2 mmol / l. Ndiye kuti, izi ndizomwe zisonyezero zomwe glycemia imatsika ngati gawo limodzi la insulin lipangidwe.

Izi zikutanthauza kuti pachakudya chilichonse chokhala ndi mkate, chimayenera kukhazikitsa gawo limodzi la insulin. Chifukwa chake, ndikulimbikitsidwa kuti onse odwala matenda ashuga azitha kupeza patebulo la chakudya kuti awerenge molondola kwambiri. Kuphatikiza apo, jekeseni iliyonse isanachitike, ndikofunikira kuwongolera glycemia, ndiye kuti, pezani kuchuluka kwa shuga m'magazi ndi glucometer.

Ngati wodwalayo ali ndi hyperglycemia, ndiye kuti, shuga wambiri, muyenera kuwonjezera kuchuluka koyenera kwamagulu a mahomoni ku chiwerengero choyenera cha magawo a mkate. Ndi hypoglycemia, mlingo wa mahomoni umacheperachepera.

Mwachitsanzo: Ngati wodwalayo ali ndi shuga pafupifupi 7 mmol / l theka la ola musanadye ndipo akufuna kudya 5 XE, ayenera kuyang'anira gawo limodzi la insulin yochepa. Kenako shuga woyamba wamagazi amachepa kuchoka pa 7 mmol / L mpaka 5 mmol / L. Komabe, kuti mumalize mkate wa magawo asanu, muyenera kulowa magawo asanu a mahomoni, mlingo wonse wa insulin ndi magawo 6.

Momwe mungasankhire mlingo wa insulin mu syringe?

Kuti mudzaze syringe yokhazikika ndi voliyumu ya 1.0-2.0 ml ndi kuchuluka kwa mankhwalawa, muyenera kuwerengera mtengo wogawa wa syringe. Kuti muchite izi, sankhani kuchuluka kwa magawo 1 ml a chida. Hormone yomwe imapangidwa mkati imagulitsidwa mumbale za 5.0 ml. 1 ml ndi 40 magawo a mahomoni. Magawo 40 a mahomoni amayenera kugawidwa ndi nambala yomwe idzapezeke powerengera magawo 1 ml a chipangizocho.

Mwachitsanzo: Mu 1 ml ya syringe magawo 10. 40:10 = 4 mayunitsi. Ndiye kuti, mgawo limodzi la syringe, zigawo 4 za insulin zimayikidwa. Mlingo wa insulin womwe muyenera kulowamo uyenera kugawidwa ndi mtengo wogawika, kotero mumalandira kuchuluka kwa magawo omwe ayenera kudzazidwa ndi insulin.

Palinso ma syringe omwe amakhala ndi chubu yapadera yodzaza ndi mahomoni. Pakukanikiza kapena kutembenuza batani la syringe, insulin imabayidwa pang'onopang'ono. Mpaka nthawi ya jakisoni mu syringes, muyeso wofunikira uyenera kukhazikitsidwa, womwe udzalowe m'thupi la wodwalayo.

Momwe mungayendetsere insulin: malamulo apadera

Makulidwe a insulini amapezeka molingana ndi algorithm wotsatira (pamene kuchuluka kwa mankhwala kwawerengedwa kale):

1. Manja azikhala ndi tizilombo toyambitsa matenda, valani magolovesi azachipatala.
2. Pukutirani botolo la mankhwalawo m'manja mwanu kuti lisakanikidwe, gwiritsani ntchito kapu ndi nkhumba.
3. Mu syringe, jambulani mpweya mu kuchuluka kwa momwe ma hormone adzagwiritsidwire ntchito.
4. Ikani vial ndi mankhwalawo molunjika patebulo, chotsani kapu pachifuwa ndikuchiyika mu vial kudzera pa cork.
5. Kanikizirani syringe kuti mpweya kuchokera mkati mwake ulowe.
6. Sinthani botolo moyang'anitsitsa ndikuyika syringe 2-4 zambiri kuposa zomwe ziyenera kuperekedwa kwa thupi.
7. Chotsani singano mu vial, imasulani mpweya ku syringe, ndikusintha mlingo kuti ukhale wofunikira.
8. Malo omwe jakisoni idzachitikire amayesedwa kawiri ndi chidutswa cha ubweya wa thonje ndi antiseptic.
9. Yambitsani insulin mosakakamiza (ndi kuchuluka kwa mahomoni, jakisoni umachitika intramuscularly).
10. Chiritsani tsamba la jakisoni ndi zida zogwiritsidwa ntchito.

Kuti munthu atengedwe mofulumira ndi mahomoni (ngati jakisoni ndiwofatsa), jakisoni wam'mimba imalimbikitsa. Ngati jakisoni wapangidwa ntchafu, ndiye kuti kuyamwa kumakhala pang'onopang'ono komanso kosakwanira. Jekeseni m'matako, phewa limakhala ndi kuchuluka kwa mayamwa.

Ndikulimbikitsidwa kusintha malo a jekeseni molingana ndi algorithm: m'mawa - m'mimba, masana - m'mapewa, madzulo - m'chafu.

Insulin yowonjezera ndi mlingo wake (kanema)

Insulin yotalikilapo imaperekedwa kwa odwala kuti akhale ndi shuga othamanga wamagazi, kotero kuti chiwindi chikhale ndi mphamvu yopanga glucose mosalekeza (ndipo izi ndizofunikira kuti ubongo uzigwira ntchito), chifukwa mu shuga mellitus thupi silingachite izi zokha.

Insulin yayitali imayendetsedwa kamodzi pa maola 12 kapena 24 kutengera mtundu wa insulin (masiku ano mitundu iwiri yogwira insulin imagwiritsidwa ntchito - Levemir ndi Lantus). Momwe mungawerengere molondola kuchuluka kwa insulin yayitali, akutero katswiri wodziletsa matenda ashuga mu kanema:

Kutha kuwerengera moyenera mlingo wa insulin ndi luso lomwe munthu aliyense wodwala matenda a shuga ayenera kudziwa. Mukasankha mtundu wa insulin yolakwika, ndiye kuti bongo umatha kugwiritsidwa ntchito mopitirira muyeso, womwe ungathandizike ngati munthu atathandizidwadi. Mlingo woyenera wa insulin ndi chinsinsi cha kukhala ndi matenda ashuga.