Sirulini wa Insulin: Kusankha Ma insulin

Njira yolondola ya jakisoni imaphatikizapo kukhazikitsa insulini mu mafuta obisika (TFA), osatulutsa mankhwala ndi kusapeza bwino.

Kusankha singano yoyenera kutalika kwanu ndikofunikira kuti izi zitheke. Chisankhochi chimapangidwa ndi wodwala limodzi ndi adotolo, poganizira zinthu zingapo, zamankhwala komanso zamaganizidwe.

Singano zachikale (zazitali) zimawonedwa ngati zowopsa pokhudzana ndi jakisoni wamkati (≥ 8 mm kwa akulu ndi ≥ 6 mm kwa ana), popanda mapindu otsimikiziridwa pankhani ya kayendetsedwe ka glycemic. Kukhomera insulin m'misempha ndi kowopsa chifukwa cha insulin yosafunikira yomwe ingayambitse hypoglycemia (kumbukirani "Rule 15").

Majekeseni apafupi a singano amakhala otetezeka ndipo amalekeredwa bwino. Kafukufuku wachipatala adatsimikizira kufanana komanso chitetezo / kulekerera pogwiritsa ntchito singano zazifupi (5 mm ndi 6 mm) poyerekeza ndi zazitali (8 mm ndi 12.7 mm).

Bergenstal RM et al. Adawonetsa kuwongolera kofananako kwa glycemic (HbA1c) mwa odwala matenda ashuga komanso kunenepa kwambiri pogwiritsa ntchito 4 mm (32G) vs 8 mm (31 G) ndi singano za 12.7 mm (29 G) pamlingo waukulu wa insulin. Phunziroli, kugwiritsa ntchito singano zazifupi kumalumikizidwa ndi kupweteka pang'ono pazomwe zimachitika pafupipafupi milandu ya insulin ndikupanga lipohypertrophy.

Ndizachilendo kudziwa kuti makulidwe amkhungu pakhungu la jakisoni mwa anthu omwe ali ndi matenda ashuga, mosatengera zaka, jenda, kuchuluka kwa thupi kapena mtundu, amasiyana pang'ono ndipo ali pafupifupi pafupipafupi (pafupifupi 2.0 - 2,5 mm pamalo operekera jakisoni, osafikira ≥ 4 mm). Kukula kwa kapamba kumasiyanasiyana mwa akulu ndipo zimatengera jenda (azimayi ali ndi zambiri), index yamasamba amthupi ndi zina. Nthawi zina imatha kukhala yochepa thupi mosayembekezeka pamalo a jakisoni wa insulin (nthambi)!

Ana, khungu limachepera pang'ono poyerekeza ndi akulu ndipo amakula ndi zaka. Dongosolo la PUFA limakhala lofanana m'magulu onse awiri mpaka kufika paunyamata, kenako kuchuluka kumachitika mwa atsikana, pomwe anyamata, m'malo mwake, mawonekedwe a PUFA amatsika pang'ono. Chifukwa chake, pazaka izi, anyamata ali pachiwopsezo chowonjezereka cha jakisoni wamkati.

Pali lingaliro kuti anthu onenepa kwambiri ali ndi mafuta ochulukirapo, motero ayenera kugwiritsa ntchito singano zazitali kuti insulini "ifikire pomwe". Zimaganiziridwa kuti anthu onenepa kwambiri pamalo onse omwe amapezeka jakisoni anali ndi phula lokwanira kuti azigwiritsa ntchito singano yayitali, komanso, pazifukwa zosadziwika, amakhulupirira kuti insulini "imagwira bwino" pazigawo zakuya za pancreatic fluid. Chifukwa chake, ma singano okhala ndi kutalika kwa 8 mm ndi 12,7 mm nthawi zambiri amagwiritsidwa ntchito mwa anthu onenepa kuti "molondola" amalowetsa insulin mu kapamba, komabe, zotsatira za kafukufuku waposachedwa zimatsutsa chiphunzitso ichi.

REROMMENDATIONS posankha masingano (FITTER 2015)

1. singano yotetezeka kwambiri ndi singano yayitali 4 mm. Jakisoniyo ndiwowonerera - wokwanira kudutsa khungu ndipo amalowa m'matumba ndi chiopsezo chochepa cha jakisoni wa mu mnofu.

• Kuwonetsedwa kwa ana onse, achinyamata ndi akulu akulu owonda. Iyenera kugwiritsidwa ntchito mwa akulu omwe ali ndi BMI iliyonse ngati tsamba la jekeseni ndi miyendo.

• itha kugwiritsidwa ntchito bwino komanso moyenera mwa anthu omwe ali ndi kunenepa kwambiri.

• Iyenera kuyikidwa pakona ya 90 °.

3. Ana ochepera zaka zisanu ndi chimodzi ndi akulu akulu kwambiri (BMI Matera
zothandiza? 24

Mulingo wamitundu ndi zolakwitsa

Ili pa sitepe, imatchedwa mtengo, kugawa kwa gawo la insulin kudzadalira kwathunthu kuthekera kwa kutulutsa bwino insulin, chifukwa cholakwika chilichonse pakayambitsa chinthucho chitha kubweretsa mavuto azaumoyo. Mlingo wa insulin wocheperako kapena wowonjezera, umadumpha mu shuga momwe wodwalayo akuwonekera, zomwe zimayambitsa zovuta za matendawa.

Ndikofunikira kuzindikira padera kuti cholakwika chofala kwambiri ndikukhazikitsa theka la mtengo wogawika pamlingo. Zikatero, zimapezeka kuti mtengo wogawika wa mayunitsi 2, gawo limodzi lokha (UNIT) limakhala theka.

Munthu wakhungu wokhala ndi matenda a shuga 1 amachepetsa shuga ya magazi ake ndi 8.3 mmol / L. Ngati timalankhula za ana, amayankha insulin kuyambira kawiri mpaka kawiri mwamphamvu. Mulimonsemo, zizindikiro zoyambirira za matenda ashuga mwa atsikana kapena abambo, mwa ana, zidzatsogolera pakufunika kokaphunzira ntchitoyi ndi syringe ya insulin.

Chifukwa chake, cholakwika cha kuchuluka kwa 0,25 kuchokera ku 100 chidzatengera kusiyana kosavuta pakati pa misempha yabwinobwino ndi hypoglycemia. Chifukwa chake, ndikofunikira kwambiri kwa aliyense yemwe ali ndi matenda a shuga amitundu yosiyanasiyana kuti aphunzire jekeseni wokwanira ngakhale waukulu Mlingo wa insulin, omwe 100% amavomerezedwa ndi adotolo.

Izi zitha kutchedwa imodzi mwazofunikira kwambiri kuti thupi lanu likhalebe labwinobwino, ngati simukuganizira kusunga kovomerezeka kwa chakudya.

Kodi mungakwaniritse bwanji?

Pali njira ziwiri zophunzirira momwe mungawerengere kuchuluka kwa insulini yofunika jakisoni:

• gwiritsani ntchito ma syringe omwe ali ndi gawo laling'ono, zomwe zingapangitse kuti mankhwalawo azigwiritsa ntchito moyenera,
• kuchepetsa insulin.

Kugwiritsa ntchito mapampu apadera a insulin sikulimbikitsidwa kwa ana ndi iwo omwe ali ndi matenda a shuga a mtundu woyamba.

Mitundu yosiyanasiyana ya matenda a shuga a insulin

Kwa odwala ambiri omwe ali ndi matenda ashuga, ndizovuta kudziwa nthawi yomweyo momwe syringe yolondola iyenera kukhalira zonse. Choyambirira, sichiyenera kukhala ndi magawo opitilira 10, ndipo pamlingo wake uli ndi mayeso ofunikira kwambiri pafupifupi 0,25 PISCES. Kuphatikiza apo, ziyenera kugwiritsidwa ntchito mwanjira yoti popanda zovuta zapadera ndizotheka kupatulira mlingo mu 1/8 UNITS ya chinthu. Kuti muchite izi, ndikofunikira kusankha mitundu yayitali komanso yopanda insulin.

Komabe, kupeza izi ndikovuta kwambiri, chifukwa ngakhale kumayiko ena zosankha za syringe ndizosowa. Chifukwa chake, odwala akudwala syringes yomwe mumawadziwa bwino, mtengo wogawika ndi magawo awiri.

Ma syringe omwe ali ndi gawo logawa gawo lawo kukhala 1 unit mumakementi am'mapiritsi ndi zovuta komanso zovuta kupeza. Ndi za Becton Dickinson Micro-Fine Plus Demi. Amakhala ndi mulingo wofotokozedwa momveka bwino ndi gawo lililonse logawikana ndi 0.25 PIECES. Kukula kwa chipangizochi ndi ma PIERES 30 pazomwe zili ndi insulin U-100.

Kodi masingano a insulin ndi ati?

Choyamba muyenera kufotokozera kuti singano zonse, zomwe zimayimiriridwa kupulogalamu yamapiritsi, ndizowala zokwanira. Ngakhale kuti opanga amapereka mitundu ingapo ya singano zama insulin, amatha kusiyanasiyana, ndipo ali ndi mitengo yosiyanasiyana.

Ngati tikulankhula za singano zabwino kuti mupeze insulin kunyumba, ndiye kuti iyenera kukhala yomwe imakulolani kuti mulowe mu mafuta osaneneka. Njira iyi imapangitsa kuti apange jakisoni wabwino.

Jakisoni wozama kwambiri sayenera kuloledwa, chifukwa pamenepa jakisoni wa intramuscular amapezeka, yemwe 100% imapangitsa ululu. Kuphatikiza apo, zidzakhala zolakwika kupanga chodzikongoletsera pamakona oyenera, zomwe zingalole insulin kulowa mwachindunji. Izi zimayambitsa kusinthasintha kosadziwika bwino m'magazi a munthu wodwala ndipo kumakulitsa matenda.

Kuti atsimikizire kuyika bwino kwa chinthucho, opanga amapanga singano zapadera zomwe zimakhala ndi kutalika kwake komanso makulidwe. Izi zimapangitsa kuti musakhale ndi vuto lolowera zolakwika zamilandu zambiri, kuphatikiza mtengo ndizotheka.

Njira zoterezi ndizofunikira kwambiri, chifukwa akuluakulu omwe ali ndi matenda ashuga komanso osakhala ndi mapaundi owonjezera, amakhala ndi minofu yowonda kwambiri kuposa kutalika kwa singano yokhazikika ya insulin. Kuphatikiza apo, singano ya 12-13 mm siyabwino kwathunthu kwa ana.

Masingano amakono apamwamba kwambiri a syringe ya insulin amadziwika ndi kutalika kwa 4 mpaka 8 mm. Ubwino wawo wapamwamba pazingano zovomerezeka ndikuti nawonso ndiwocheperako m'mimba mwake motero amakhala omasuka, ndipo mtengo wake ndi wokwanira.

Ngati titha kuyankhula manambala, ndiye kuti singano yapamwamba ya insulini, kutalika kwa 0,4, 0,36, komanso 0.33 mm ndiyachilengedwe, ndiye kuti yofupikirako ndi kale mamilimita 0,3, 0,25 kapena 0,23. Singano yotereyi siyingatulutse zomverera zowawa, chifukwa zimapangitsa kupindika kukhala kovuta.

Kodi mungasankhe bwanji singano yabwino?

Malangizo amakono posankha kutalika kwa singano amati siopitilira 6 mm. 4, 5 kapena 6 mm singano amatha kukhala oyenera pafupifupi magulu onse odwala, ngakhale iwo onenepa kwambiri.

Pogwiritsa ntchito singano zotere, palibe chifukwa chokhazikitsira khola. Ngati tikulankhula za achikulire omwe ali ndi matenda ashuga, ndiye kuti singano za kutalika kumeneku zimapereka mwayi woyambitsa mankhwala pamakona pafupifupi 90 kuchokera kwa wachibale mpaka khungu. Pali malamulo angapo:

• Iwo omwe amakakamizidwa kuti adziwitsire mwendo, m'mimba moyandikira kapena mkono ayenera kupanga khola la khungu, ndipo mudzafunikanso kupanga punction pakona madigiri 45. Izi ndichifukwa choti zili m'zigawo izi za thupi zomwe minofu yaying'ono imakhala yocheperako komanso yocheperako.
• Wodwala matenda ashuga safunika kugula syringes ndi singano yoposa 8 mm, makamaka makamaka ikafika koyambirira kwamankhwala.
• Kwa ana aang'ono ndi achinyamata, ndibwino kusankha singano 4 kapena 5 mm. Pofuna kuti insulini isalowe m'matumbo, gulu ili la odwala liyenera kupanga khola la pakhungu lisanalowe, makamaka pogwiritsira ntchito singano yoposa 5 mm. Ngati ndi 6 mm, ndiye muzochitika zotere, jakisoni amayenera kupangidwira pakona 45 madigiri, osapanga crease.
• Tisaiwale kuti kuwawa kwa zomverera pakuwongolera kumadalira pakulimba ndi kukula kwa singano. Komabe, nkwanzeru kuganiza kuti singano yopyapyala yopanga singaberekenso chinthu chokhacho, chifukwa singano yotere imaphulika pakabayidwa.

Kupanga jakisoni popanda ululu ndizotheka. Kuti muchite izi, muyenera kusankha singano zoonda komanso zapamwamba kwambiri ndikugwiritsa ntchito njira yapadera pakukhazikitsa insulini mwachangu, monga chithunzichi.

Kodi singano yoperekera insulin ingatenge nthawi yayitali bwanji?

Aliyense wopanga ma syringe ndi singano za anthu odwala matenda ashuga amayesetsa kuti njira ya jakisoni ikhale yosavuta momwe angathere. Pazomwezi, malangizo a singano amawongola mwanjira yapadera mothandizidwa ndiukadaulo wamakono komanso wopitilira patsogolo, kuwonjezera apo, amagwiritsa ntchito mafuta apadera.

Ngakhale njira yovuta kwambiri yamalonda, kugwiritsa ntchito singano mobwerezabwereza kumapangitsa kuti ziwoneke bwino komanso kuzimitsa kwake kwa mafuta ophimba, chimodzimodzi, sizigwira ntchito nthawi zana. Poona izi, jakisoni aliyense wotsatira wa mankhwala omwe amakhala pansi pakhungu amakhala wowonjezereka komanso wowawa komanso wamavuto. Nthawi iliyonse wodwala matenda ashuga ayenera kuwonjezera mphamvu kuti singano ilowe pansi pakhungu, zomwe zimawonjezera mwayi woperewera kwa singano komanso kuwonongeka kwake.

Palibe chovutanso kwambiri chomwe chingakhale kuvulaza kwakhungu pakhungu pogwiritsa ntchito masingano akhungu. Zilonda zoterezi sizingaoneke popanda kukulitsa kuwala. Kuphatikiza apo, mutagwiritsa ntchito singano yotsatira, nsonga yake imagwada kwambiri ndikuchita ngati mbedza, yomwe imang'amba minofu ndikuvulaza. Izi zimakakamiza nthawi iliyonse pambuyo pa jekeseni kuti abweretse singano pamalo ake oyambira.

Chifukwa chogwiritsa ntchito singano imodzi pakulowetsa insulin, mavuto pakhungu ndi minofu yolowerera amawonedwa, mwachitsanzo, izi zitha kukhala mapangidwe azisindikizo, zovuta zomwe zimabweretsa zimadziwika ndi aliyense wodwala matenda ashuga.

Kuti muwazindikire, ndikokwanira kufufuza mosamala ndikusanthula khungu, fufuzani ndi chithunzi. Nthawi zina, kuwonongeka kowoneka sikumawoneka, ndipo kupezeka kwawo kumatha kuchitika ndikumverera, pomwe palibe chitsimikizo cha 100%.

Zisindikizo pansi pa khungu zimatchedwa lipodystrophic. Amangokhala vuto la zodzikongoletsera, komanso chovuta kwambiri kuchipatala. Zimakhala zovuta kuperekera insulin m'malo otere, omwe amachititsa kuti zinthu zisamayende bwino komanso kuti zisamayende mosiyanasiyana, komanso kulumpha ndi kusinthasintha kwa magazi m'thupi la wodwalayo.

M'malangizo aliwonse komanso pachithunzi cha syringe pensulo ya anthu odwala matenda ashuga kumawonetsedwa kuti singano imayenera kuchotsedwa nthawi iliyonse mukatha kugwiritsa ntchito chipangizocho, ambiri mwa odwala amangonyalanyaza lamuloli. Potere, njira pakati pa cartridge yokha ndi sing'anga imatseguka, zomwe zimapangitsa kuti mpweya ukhale wotayika komanso kutayika kwa insulini chifukwa chothira kwambiri pafupifupi 100%.

Kuphatikiza apo, njirayi imayambitsa kuchepa kwa kulondola kwa insulin dosing ndikuchulukitsa matenda. Ngati pali mpweya wambiri m'makatoni, ndiye kuti nthawi zina munthu amene ali ndi matenda ashuga salandila kupitilira 70 peresenti ya 100 ya mankhwalawo. Pofuna kupewa zoterezi, ndikofunikira kuchotsa singano masekondi 10 mutabayidwa insulin, monga chithunzichi.

Popewa mavuto azaumoyo ndi kudumphadumpha omwe ali ndi shuga odwala matenda a shuga, ndibwino kuti musalumphe ndi kugwiritsa ntchito singano yatsopano. Izi zitha kupewa kutsekeka kwa njira yokhala ndi makhosi a insulin, omwe sangalole kuti pakhale zotchinga zina kuti mulowe yankho.

Ndikulimbikitsidwa kuti ogwira ntchito zachipatala azisanthula nthawi ndi nthawi kwa wodwala wawo njira iliyonse yobweretsera insulin pansi pa khungu, komanso momwe malo omwe majekesowo adapangidwira. Ichi ndiye njira ina yopewera kuwonjezerera zizindikiro za matenda ashuga komanso kuvulala pakhungu la wodwalayo.