49 soluble insulin (maumboni amtundu wa anthu)

Ma Horona ndi okhathamiritsa mwachidule / osokoneza bongo.

100ME / ml-5ml D.t.d.№5 mu flac.

S:: mwanjira 30 mphindi musanadye kanayi pa tsiku

Rp. Insulini 40 ME (5 ml)

S. jekeseni wothandizirana ndi 0,5 ml katatu pa tsiku kwa mphindi 30 musanadye.

Kuyanjana ndi cholandirira kumtundu wakunja kwa maselo, ndikupanga insulini yolandirira

Mtundu woyamba, matenda a shuga 2, matenda ashuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, matenda osokoneza bongo a amayi apakati, musanayambe chithandizo ndikukonzekera insulin yayitali

Thupi lawo siligwirizana, hypoglycemia, hypoglycemic coma, kuchepa kwa mawonekedwe osakhalitsa (nthawi zambiri kumayambiriro kwa mankhwala), hyperemia, pruritus, ndi lipodystrophy (pamalo opangira jekeseni).

50 Insulin-Isophan (Umisiri wa Majini a Anthu)

Insulin Yapakatikati

S: jekesani kuyimitsidwa mosaneneka 2 pa tsiku

Rp. Insulini-isophani 40 ME (5 ml)

S. jekeseni wothandizirana ndi 0,5 ml 2 pa tsiku kwa mphindi 30 musanadye.

Imalumikizana ndi ma membrane amtundu wakunja wa cytoplasmic wa cell ndikupanga insulini-receptor zovuta zomwe zimathandizira njira zamkati

Mtundu wachiwiri wa matenda a shuga a mellitus, lembani matenda ashuga a 2 a azimayi oyembekezera.

hypoglycemic zinthu hypoglycemic chikomokere. kutupa, zolakwika zapakanthawi

51 ipratropium bromide

Rp. Sol.Atroventi 0.25% -20ml ovomereza inh.

S: 0,5 mg (40 madontho) katatu patsiku kudzera mwa nebulizer, yemwe kale anali wowonjezera mu 4 ml ya saline.

Rp: Sol. Ipratropiibromidi 0,25% - 20ml

D.S: 2 ml (madontho 40) kusungunuka mu 2 ml ya 0,9% sodium kolorayidi, kutsanulira mu nebulizer. 1 inhalation katatu patsiku.

Matenda oletsa kupuma a m'mapapo (matenda oletsa kupuma a bronchitis, pulmonary emphysema), mphumu ya bronchial (yolimbitsa komanso yofatsa).

Hypersensitivity to atropine ndi zotumphukira zake, ndi zinthu zina za mankhwalawa, mimba (I trimester), ana osaposa zaka 6

mutu, nseru, pakamwa pouma, tachycardia, palpitations, kusokonezeka kwa malo okhala, kuchepa kwa thukuta, kutayika kwa m'mimba motility, kwamikodzo posungira, matupi awo sagwirizana.

52 Itracanazole. Othandizira antifungal a gulu la triazole

Rp. Intraconazoli 0,1

S: mkati 1 kapisozi 1 nthawi patsiku.

linalake ndipo tikulephera polimbana ndi ergosterol - gawo lofunikira la nembanemba cell.

Mycoses of the khungu, mucosa mkamwa ndi maso, onychomycosis chifukwa dermatophytes, yisiti ndi nkhungu, candidiasis zowonongeka pakhungu ndi mucous nembanemba vulvovaginal candidiasis, pityriasis versicolor, systemic mycoses

dyspepsia, m'mimba kupweteka, kuchuluka kwa chiwindi transaminase ntchito, kupweteka mutu, chizungulire, zotumphukira neuropathy, kutopa, kugona.

Kodi pali kusiyana kotani pakati pa kukonzekera kwa insulin wina ndi mnzake

Kuchuluka kwa kuyeretsa.
Zomwe zimalandila ndiku nkhumba, bovine, insulin ya anthu.
Zowonjezera zomwe zimaphatikizidwa ndi yankho la mankhwalawa ndizosunga, othandizira, ndi ena.
Kusintha
pH yankho.
Kutha kusakaniza mankhwala achidule komanso osakhalitsa.

Insulin ndi mahomoni omwe amapangidwa ndi maselo apadera mu kapamba. Ndi puloteni wokhala ndi mitundu iwiri, yomwe imaphatikizapo 51 amino acid.

Pafupifupi magawo 6 biliyoni a insulini amwedwa chaka chilichonse padziko lapansi (gawo limodzi ndi ma micrograms a 42). Kupanga kwa insulini kumakhala kwaukadaulo kwambiri ndipo kumachitika kokha kudzera mwa njira za mafakitale.

Magwero a insulin

Pakadali pano, kutengera gwero la zopangidwazo, nkhumba insulin ndi kukonzekera kwa insulin ya anthu ndizayokha.

Ma insulin a nkhumba tsopano ali ndi kuyeretsa kwambiri, ali ndi vuto labwino, ndipo palibenso zotsutsana nazo.

Kukonzekera kwa insulin kwaumunthu kumagwirizana kwathunthu pakupanga kwamankhwala ndi mahomoni amunthu. Nthawi zambiri zimapangidwa ndi biosynthesis pogwiritsa ntchito ma genetic engineering technology.

Opanga akuluakulu amagwiritsa ntchito njira zopangira zotere zomwe zimatsimikizira kuti malonda awo amakwaniritsa zonse zabwino. Palibe kusiyana kwakukulu machitidwe aumunthu ndi porcine monocomponent insulin (i.e., oyeretsedwa kwambiri) adapezeka; mokhudzana ndi chitetezo cha mthupi, malinga ndi maphunziro ambiri, kusiyana kwake ndi kochepa.

Zinthu zothandiza zomwe zimagwiritsidwa ntchito popanga insulin

Mu botolo ndi mankhwalawa muli yankho lomwe silokhala ndi insulin ya mahomoni, komanso mankhwala ena. Aliyense wa iwo ali ndi gawo linalake:

kuchuluka kwa zochita za mankhwala,
njira yothetsera matenda
kukhalapo kwa buffer katundu wa yankho ndi kukhalabe wosalimba pH (acid-base balance).

Kukula kwa insulin

Kuti apange insulin yowonjezera, yomwe ndi imodzi mwa mankhwala awiri, zinc kapena protamine, imawonjezeredwa ku yankho la insulin yachilendo. Kutengera izi, ma insulini onse amatha kugawidwa m'magulu awiri:

protamine insulin - protafan, insuman basal, NPH, humulin N,
zinc-insulin - insulin-zinc-suspensions a mono-tard, tepi, humulin-zinc.

Protamine ndi mapuloteni, koma mayendedwe osokoneza monga mawonekedwe a ziwonetsero kwa iwo ndi osowa kwambiri.

Kuti apange njira yolowerera ndale, yankho la phosphate limawonjezedwanso kwa iyo. Tiyenera kukumbukira kuti insulini yokhala ndi phosphates ndiyoletsedwa kuphatikiza insulin-zinc kuyimitsidwa (ICS), popeza zinc phosphate imayambira munthaka iyi, ndipo zochita za zinc-insulin zimafupikitsidwa m'njira yosadalirika.

Zida zophera tizilombo

Zina mwazomwe zimapangidwira, malinga ndi njira zamatenda ndi tekinoloje, ziyenera kuyambitsidwa pakukonzekera, zimakhala ndi zotsatsira matenda. Izi zimaphatikizapo cresol ndi phenol (onse aiwo ali ndi fungo linalake), komanso methyl parabenzoate (methyl paraben), momwe mulibe kununkhira.

Kuyambitsidwa kwa chilichonse chosungirako ndipo kumapangitsa fungo linalake la insulin. Zosungirako zonse zomwe zimapezeka kuti zimapezeka mu insulin sizikukhudza.

Protamine ma insulins nthawi zambiri amaphatikizapo cresol kapena phenol. Phenol sangathe kuwonjezeredwa ku mayankho a ICS chifukwa amasintha mphamvu ya ma cell ma cell. Mankhwalawa akuphatikizapo methyl paraben. Komanso, ayoni a zinc amagwiritsa ntchito njira yotsatsira.

Chifukwa cha chitetezo chamtunduwu cha anti-bacterial ambiri, chitetezo chimalephereka kupanga zovuta zomwe zitha kuchitika chifukwa cha kuipitsidwa kwa bakiteriya pamene singano imayikidwa mobwerezabwereza mu vial yankho.

Chifukwa cha kukhalapo kwa njira yotchinjirizira, wodwalayo amatha kugwiritsa ntchito jakisoni yomweyo popanga jakisoni wa mankhwalawa kwa masiku 5 mpaka 7 (malinga ngati amangogwiritsa ntchito syringe). Kuphatikiza apo, mankhwala osungira amayesetsa kuti musamwe mowa pakhungu musanalowe, koma pokhapokha ngati wodwalayo adzivulaza ndi syringe ndi singano yopyapyala.

Insulin Syringe Calibration

Pokonzekera insulin yoyamba, gawo limodzi lokha la mahomoni linali mu mlomo umodzi wa yankho. Pambuyo pake, kupsinjika kunawonjezeka. Zokonzekera zambiri za insulin m'mabotolo omwe amagwiritsidwa ntchito ku Russia zimakhala ndi magawo 40 mu 1 ml ya yankho. Mbale zambiri zimayikidwa chizindikiro cha U-40 kapena 40 mayunitsi / ml.

Amapangidwira kuti azigwiritsidwa ntchito ponseponse, kungofuna insulini yotere ndikuwunika kwawo kumapangidwa molingana ndi mfundo iyi: syringe ikadzaza ndi 0,5 ml yankho, munthu amapeza magawo 20, 0,35 ml amagwirizana ndi magawo 10 ndi zina zotero.

Chizindikiro chilichonse pa syringe ndi chofanana ndi voliyumu inayake, ndipo wodwalayo amadziwa kale kuchuluka kwamagawo omwe ali mgawoli. Chifukwa chake, kuwerengera kwa ma syringes ndi calibrate mwa kuchuluka kwa mankhwalawa, kuwerengeka pakugwiritsa ntchito insulin U-40.Magawo anayi a insulin ali mu 0,1 ml, 6 ma unit - mu 0,15 ml ya mankhwalawo, ndi zina zotero mpaka 40 magawo, omwe amafanana ndi 1 ml yankho.

Ma millor ena amagwiritsa ntchito insulin, 1 ml yomwe muli mayunitsi 100 (U-100). Mankhwala oterowo, ma syringe amtundu wapadera amapangidwa, omwe ali ofanana ndi omwe takambirana pamwambapa, koma amawayika mosiyanasiyana.

Ikutengera izi ndende iyi (ndiyokwera ka2,5 kuposa muyezo). Pankhaniyi, kuchuluka kwa insulin kwa wodwalayo, kumene kumakhalabe chimodzimodzi, chifukwa kumakwaniritsa kufunikira kwa thupi kwa kuchuluka kwa insulini.

Ndiye kuti, ngati wodwalayo adagwiritsa ntchito kale mankhwala a U-40 ndikuvulaza 40 magawo a mahomoni patsiku, ndiye kuti alandiranso magawo 40 omwewo atabayidwa insulin U-100, koma jekeseni kochulukirapo 2.5. Ndiye kuti, magawo 40 omwewo azikhala mu 0,4 ml ya yankho.

Tsoka ilo, si madokotala onse komanso makamaka odwala matenda a shuga omwe amadziwa izi. Mavuto oyamba adayamba pomwe ena mwa odwala adayamba kugwiritsa ntchito majakisoni a insulini (ma syringe pens) omwe amagwiritsa ntchito ma penfill (ma cartridge apadera) okhala ndi insulin U-40.

Ngati mudzaza syringe ndi yankho lolembedwera U-100, mwachitsanzo, mpaka mpaka mayunitsi 20 (i.e. 0.5 ml), ndiye kuti bukuli lidzakhala ndi magawo 50 a mankhwalawo.

Nthawi iliyonse, ndikudzaza ma insulin a U-100 ndi ma syringe wamba komanso kuyang'ana pa ma cutoff, munthu adzalandira mlingo wa 2,5 kuposa womwe wawonetsedwa pamlingo wa chizindikiro ichi. Ngati dokotala kapena wodwala sazindikira vuto ili, ndiye kuti mwayi wokhala ndi vuto lalikulu la hypoglycemia ndiwokwera chifukwa cha mankhwala osokoneza bongo omwe nthawi zambiri amachitika.

Kumbali ina, nthawi zina pamakhala ma insulin omwe amawongolera makamaka mankhwala a U-100. Ngati syringe yotere imadzazidwa molakwika ndi njira yokhazikika ya U-40, ndiye kuti mlingo wa insulini mu syringe udzakhala wocheperapo ndi theka kuposa womwe walembedwa pafupi ndi chizindikiro chofananira pa syringe.

Zotsatira zake, kuwonjezereka kwamphamvu kwa glucose kumatha kuchitika koyamba. M'malo mwake, zonse, ndizomveka - pachidutswa chilichonse cha mankhwalawa ndikofunikira kugwiritsa ntchito syringe yoyenera.

M'mayiko ena, mwachitsanzo, Switzerland, malingaliro adaganiziridwa mosamalitsa, malinga ndi momwe kusintha kosinthika kunapangidwira kuti kukonzekera kwa insulin kulembedwe kuti U-100. Koma izi zimafunikira kuyanjana kwambiri ndi onse omwe ali ndi chidwi: madokotala a akatswiri ambiri, odwala, anamwino ochokera m'madipatimenti aliwonse, akatswiri a zamankhwala, opanga, olamulira.

M'dziko lathu, ndizovuta kwambiri kusamutsa odwala onse kuti agwiritse ntchito insulin U-100 kokha, chifukwa, mwakuthekera, izi zidzatsogolera kuchuluka kwa zolakwika posankha mtundu.

Kuphatikiza kwafupikitsika ndi insulin yayitali

Mankhwala amakono, chithandizo cha matenda ashuga, makamaka mtundu woyamba, nthawi zambiri chimachitika pogwiritsa ntchito mitundu iwiri ya insulin - yochepa komanso yayitali.

Zingakhale zosavuta kwa odwala ngati mankhwala omwe ali ndi mphamvu zosiyanasiyana atha kuphatikizidwa mu syringe imodzi ndikuperekedwa nthawi yomweyo kuti musavulaze khungu kawiri.

Madokotala ambiri sakudziwa chomwe chimapangitsa kuti athe kusakaniza ma insulin osiyanasiyana. Maziko ake ndi mankhwala ndi galenic (yotsimikizika ndi kapangidwe kake) yoyanjanitsidwa kwaatalikirana ndi yayifupi.

Ndikofunika kwambiri kuti posakaniza mitundu iwiri ya mankhwala, kuyambitsa mwachangu insulin sikufupika kapena kutha.

Zatsimikiziridwa kuti mankhwala omwe amagwira ntchito mwachidule amatha kuphatikizidwa jekeseni m'modzi ndi protamine-insulin, pomwe kuyamba kwa insulin yochepa sikuchedwa, chifukwa kusungunuka kwa insulin sikumangiriza kwa protamine.

Poterepa, wopanga mankhwalawa alibe ntchito.Mwachitsanzo, amatha kuphatikizidwa ndi humulin H kapena protafan. Kuphatikiza apo, zosakaniza izi zimatha kusungidwa.

Ponena za kukonzekera kwa zinc-insulin, kwakhala kuti kwayamba kalekale kuti insulini-zinc-suspension (crystalline) singaphatikizidwe ndi insulin yochepa, chifukwa imamangilira ma zinc ion kwambiri ndikusintha kukhala insulin yotalikilapo, nthawi zina pang'ono.

Odwala ena amapereka mankhwala ochepetsa, ndiye, osachotsa singano pansi pakhungu, amasintha pang'ono pang'ono, ndipo zinc-insulin imabayidwa.

Malinga ndi kayendetsedwe ka kayendetsedwe kameneka, kafukufuku wina wasayansi wambiri wachitika, chifukwa chake sitinganene kuti pazochitika zina ndi jakisoni mankhwalawa amaphatikizika ndi insulin ndipo mankhwala omwe amangogwiritsa ntchito pakanthawi kochepa amatha kupanga pansi pa khungu, omwe amachititsa kuti matendawo asamayende bwino.

Chifukwa chake, ndikwabwino kupaka insulin yayifupi mosiyana ndi zinc-insulin, pangani jekeseni awiri osiyana m'malo a khungu omwe ali osachepera 1 cm kupatula wina ndi mnzake.

Wophatikiza insulin

Tsopano makampani opanga mankhwala amapanga kukonzekera komwe kumakhala ndi insulin yocheperako limodzi ndi protamine-insulin mwachiwonetsero chokwanira. Mankhwalawa akuphatikizapo:

Zophatikiza zomwe ndizothandiza kwambiri ndizomwe kuchuluka kwa insulin kwa nthawi yayitali kuli 30:70 kapena 25:75. Kuwerengera kumeneku kumasonyezedwa nthawi zonse mu malangizo ogwiritsira ntchito mtundu uliwonse wa mankhwala.

Mankhwala oterewa ndi oyenera kwambiri kwa anthu omwe amatsatira kudya kosalekeza, olimbitsa thupi nthawi zonse. Mwachitsanzo, nthawi zambiri amagwiritsidwa ntchito ndi odwala okalamba omwe ali ndi matenda amtundu wa 2.

Ma insulin osakanikirana sakhala oyenera kukhazikitsidwa kwa mankhwala omwe amadziwika kuti "osinthika" a insulin, pakakhala koyenera kuti asinthe mlingo wa insulin yochepa.

Mwachitsanzo, izi zikuyenera kuchitika pakusintha kuchuluka kwa chakudya chamagulu m'zakudya, kuchepetsa kapena kukulitsa zochitika zolimbitsa thupi, ndi zina zambiri. Pankhaniyi, mlingo wa basal insulin (womwe umakhala nthawi yayitali) sungasinthe.

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

Mankhwala

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

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

Mlingo ndi makonzedwe a insulin ya anthu

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

Mimba komanso kuyamwa

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

Chifukwa chiyani insulin imatchedwa "genetically engineer"

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

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

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

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

Chachikulu mankhwala

Mafuta a insulle a insulin amatanthauza mankhwala osokoneza bongo osakhalitsa.

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

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

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

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

Zizindikiro zogwiritsidwa ntchito

Nthawi zambiri, madokotala amatipatsa insulin yosungunuka milandu:

Zodzithandiza nokha kapena kuphatikiza mankhwala a shuga a mtundu 1 ndi 2,
Kukana kwathunthu kapena pang'ono (thupi) kwa mankhwala amkamwa (otengedwa pakamwa) mankhwala antidiabetesic,
Matenda a shuga panthawi yokhala ndi pakati (ngati zakudya sizikuyenda bwino)
Mavuto a shuga mellitus (ketoacidosis, hypersmolar kapena ketoacidotic chikomokere),
Njira ya matenda ashuga pozungulira matenda angapo,
Zowopsa m'malo mwa anthu odwala matenda ashuga omwe ali pakamwa pakumwa mankhwala ochepetsa shuga (nthawi yothandizila, matenda akulu, kuvulala kapena ma frostbites, asanabadwe, etc.),
Matenda ashuga nephropathy kapena chiwindi.
Zotupa za khungu la Dystrophic (furunculosis, carbuncle, zilonda zam'mimba),
Kusintha kwa insulin yokhala ndi nthawi yayitali.

Zotsatira zoyipa

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

Kukula kwa hypoglycemia chifukwa chokana mankhwala ndi thupi kapena kutulutsa zochita ndi insulin yake.
Thupi lawo siligwirizana (urticaria, pruritus, kapena kwambiri Quincke edema kwambiri kutupa kwa nkhope ndi mucous nembanemba, pallor ndi kupuma movutikira),
Hypoglycemic chikomokere,
Kukhala ndi vuto la kusokonezeka (nthawi zina mpaka kumangomangika),
Hyperglycemia kapena diabetesic acidosis (motsutsana ndi maziko akumatenda kapena matenda, zakudya zoperewera, atabaya jakisoni kapena mlingo wolakwika),
Kuzindikira kwamtundu wamunthu mu mawonekedwe amdzu, kugona, kuchepa kwa chakudya, redness nkhope,
Zomwe zimachitika mderalo poyambira limodzi (kuwotcha, kuyabwa, redness, kuchuluka kapena kuwonetsa kwa minofu ya adipose).

Kuphatikiza ndi mankhwala ena

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

Kuchepetsa shuga kumatha kuwonjezeka mukamamwa insulin ndi:

Sulfonamides (sulfonamide kapena othandizira a hypoglycemic),
Mao zoletsa (furazolidone, etc.),
ACE zoletsa (Captopril, enalapril, etc.),
NSAIDs (aspirin, diclofenac, etc.),
Androgens ndi anabolic steroids (Anavar, Androxon, etc.),
Mankhwala a Antimalarial (quinoline, quinidine, etc.),
Tetracyclines (tetracycline, doxycycline),
Mankhwala ena (theophylline, pyridoxine, morphine, ndi ena otero)

Kuti muchepetse kuthamanga kwa mankhwalawa, kugwiritsa ntchito kwake ndi:

Glucocorticoids
Amphetamines
Estrogens (kuphatikizapo monga njira zakulera pakamwa),
Zodzikongoletsera
Sympathomimetics
Mahomoni a chithokomiro
Mankhwala olekanitsidwa (triamterone, phenytoin, glucagon).

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

Beta blockers,
Reserpine
Morphine
Octreotide: Gwiritsani ntchito kusankha ndi kusankha

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

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

Belly
Mapewa
Khungu limakulunga kumtunda.

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

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

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

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

Nthawi zambiri, insulin yothamanga imaphatikizidwa ndi insulin yotalikirapo.

Malamulo a insulin

Ngakhale akatswiri odziwa bwino za matenda ashuga amalakwitsa popereka insulin.

Malamulo ofunikira kwambiri a insulin Therapy ndi awa:

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

Zina zamalonda zamankhwala

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

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

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

Bongo

Zimachitika kuti utsogoleli wa insulin nthawi zina umabweretsa hyperglycemia.

Zizindikiro zazikulu za hyperglycemia ndizowonetsera mu:

Zofooka
Pallor
Thukuta lakuzizira
Zokhudza mtima
Mutu
Kudzimva kwanjala
Amatentha thupi
Kuchuluka kwa lilime, milomo, miyendo.

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

Mavuto

Kuchiza kwa nthawi yayitali ndi insulin kumatha kubweretsa zovuta zingapo. Mitu ikuluikulu ndi:

Kupezeka kwa hypoglycemia. Mavuto azakudya, mankhwala osokoneza bongo, zochita zolimbitsa thupi, matenda a impso ndi chiwindi zimatha kuyambitsa izi.
Postinjection lipodystrophy. Kupewa kwa matenda ndikusintha malo a jakisoni, kuwonjezera njira ya novocaine (0.5-1,5 ml) ku insulini, ndikupereka syringe ku Ѕ yamatenda a adipose.
Kukana kwa mankhwala. Mankhwala ena (omwe nthawi zambiri amaphatikizidwa) omwe amachepetsa shuga amasankhidwa.
Thupi lawo siligwirizana.Kugwiritsa ntchito mankhwala othandizira (antihistamines, glucocorticoids) ndi kusintha kwina kwa mankhwalawa.

Insulin yamtundu wa anthu ndiyo imapulumutsa kwa odwala ambiri omwe ali ndi matenda ashuga. Komabe, ndikofunikira kugwiritsa ntchito mankhwalawa mwanzeru, poganizira malamulo onse a kayendetsedwe kake. Ndikofunikira kuti dokotala akuwongolereni mankhwalawa, kuwerengetsa mlingo wake ndikuwunika momwe wodwalayo alili panthawi yonse ya chithandizo.

Model Clinical-Pharmacological Article 1

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

Pharmacokinetics Kukwana kwa mayamwidwe zimatengera njira yoyendetsera (s / c, i / m), malo oyang'anira (pamimba, ntchafu, matako), mlingo, insulin ndende ya mankhwala, etc. Amagawidwa mosiyanasiyana mu minofu. Simadutsana chotchinga ndi mkaka wa m'mawere. Imawonongeka ndi insulinase, makamaka m'chiwindi ndi impso. T_1/2 - kuchokera ochepa mpaka mphindi 10 Imafufutidwa ndi impso (30-80%).

Zizindikiro. Type 1 shuga mellitus, mtundu 2 shuga mellitus: gawo la kukana mankhwalawa a hypoglycemic, kuperewera pakamwa zamankhwala hypoglycemic (kuphatikiza mankhwala), matenda ashuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, matenda osokoneza bongo omwe adachitika panthawi yoyembekezera (ngati sichothandiza pakudya) ntchito pafupipafupi kwa odwala omwe ali ndi matenda osokoneza bongo othana ndi matenda oyambitsidwa ndi kutentha thupi, kugwiritsa ntchito maopaleshoni, kuvulala, kubala mwana, ndi kuphwanya malamulo pazokhudza Kusinthana kwa zinthu musanafike kuchipatala ndi kukonzekera kwa insulin yayitali.

Contraindication Hypersensitivity, hypoglycemia.

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

Mankhwala amatumizidwa s / c, mu / m, mu / mkati, mphindi 15-30 musanadye chakudya. Njira yodziwika bwino yoyendetsera ndi sc. Ndi matenda ashuga ketoacidosis, chikomokere matenda a shuga, pa nthawi ya opaleshoni - mu / mu ndi / m.

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

Akuluakulu tsiku lililonse 30-30 PIERES, ana - 8 PISCES, ndiye kuti muyezo - tsiku lililonse 0,5-1 PIECES / kg kapena 30-40 PIECES katatu pa tsiku, ngati pangafunike - 5-6 pa tsiku . Pa mlingo wa tsiku ndi tsiku wopitilira 0,6 U / kg, insulini iyenera kutumikiridwa ngati ma jakisoni a 2 kapena kuposa m'malo osiyanasiyana a thupi. Ndikotheka kuphatikiza ndi ma insulin omwe amakhala nthawi yayitali.

Njira yothetsera insulini imatengedwa kuchokera ku vial ndi kuboola ndi singano yosalala ya singano yoyimitsira ndi mphira kuti ipukutule pambuyo pochotsa kapu ya aluminium ndi ethanol.

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

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

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

kuda nkhawa (mpaka kukula kwa precomatose ndi chikomokere),

kuchepa kwakanthawi kowoneka (nthawi zambiri kumayambiriro kwa zamankhwala),

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

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

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

Bongo. Zizindikiro: hypoglycemia (kufooka, thukuta lozizira, khungu la pakhungu, palpitations, kunjenjemera, mantha, njala, paresthesia m'manja, miyendo, milomo, lilime, mutu), hypoglycemic coma, kupweteka.

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

Subcutaneous, i / m kapena iv yolowetsa glucagon kapena iv hypertonic dextrose solution. Ndi kukula kwa vuto la hypoglycemic coma, 2040 ml (mpaka 100 ml) wa 40% dextrose solution amawayikira kudzera mu mtsempha kulowa kufikira wodwalayo atatuluka.

Kuchita. Mankhwala osagwirizana ndi mayankho a mankhwala ena.

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

Glucagon, somatropin, corticosteroids, kulera kwamkamwa, estrogens, thiazide ndi loop diuretics, BMKK, mahomoni a chithokomiro, heparin, sulfinpyrazone, sympathomimetics, danazole, tricyclic antidepressants, colonidin, inthocin, inthani. epinephrine blockers H₁histamine zolandila.

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

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

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

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

Kusamutsa wodwala kupita ku insulin yaumunthu kuyenera kukhala koyenera nthawi zonse kumayang'aniridwa ndi adokotala.Chizolowezi chokhala ndi hypoglycemia chimatha kuvulaza kuthekera kwa odwala kutenga nawo mbali mokwanira mumsewu, komanso kukonza makina ndi zida zamagetsi.

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

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

Odwala omwe amalandira insulin yoposa 100 ya insulin patsiku, amasintha mankhwalawa, amafunikira kuchipatala.

Kulembetsa boma boma. Kusindikiza kovomerezeka: mu ma 2 ma. M: Medical Council, 2009. - Vol 2, gawo 1 - 568 s., Gawo 2 - 560 s.

Zokonzekera zomwe zimapezeka kuchokera ku zopangira zachilengedwe

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

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

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

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

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

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

Katswiri wa Majini a Insulin

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

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

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

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

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

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

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

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

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

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

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

Zowonjezera zina

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

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

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

Kupitiliza Zowonjezera

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

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

Madera okhathamiritsa

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

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

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

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

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

Olimbitsa

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

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

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

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H cholembera chokhazikika (Berlinsulin H cholembera chokhazikika), Berlsulin H yokhazikika U-40 (Berlinsulin H yachibadwa U-40), Insuman mwachangu (Insuman mwachangu), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Zotsatira za pharmacological

Ndi njira ya insulin yosalowerera ndendende yofanana ndi insulin ya anthu. Amatanthauzanso ma insulin osakhalitsa. Kuchepetsa glucose wamagazi, kumathandizira kuyamwa kwake ndi minofu, lipogenesis, glycogenogeneis, kaphatikizidwe ka mapuloteni, kumachepetsa kuchuluka kwa shuga ndi chiwindi.

Kukhazikika kwa mankhwalawa ndi mphindi 20-30 pambuyo pa kuperekedwa. Kuchuluka kwake kumachitika pakati pa maola 1 ndi 3. Kutalika kwa kuchitapo kanthu ndi maola 6-8.

Mbiri ya insulin yosakanikirana ndi insulin yaumunthu ya munthu imadalira mlingo ndikuwonetsa kupatuka kwakapakati komanso kwakonda pakati. Mafuta ochokera kumalo opakidwa jakisoni amayenda msanga kuposa nkhumba zosakanizira zosungunulira.

,: gawo la kukana kwa othandizira pakamwa.

Matenda a shuga a ketoacidosis, ketoacidotic ndi hyperosmolar coma, ndi opaleshoni yomwe ikubwera, allergies kukonzekera insulin yoyambira nyama, insulin lipoatrophy, insulini chifukwa cha kuchuluka kwa ma cell a anti-insulin, pakuthana kwa maselo apakhungu a kapamba.

Zotsatira zoyipa

Hypoglycemia (nthawi zambiri kuposa momwe mumagwiritsira ntchito insulin pokonzekera nyama), AR - nthawi zambiri. Zolakwika zakanthawi kochepa - nthawi zambiri kumayambiriro kwa insulin.

Mulingo woyenera wa mahomoni ndiye maziko a kukula kwathunthu kwa thupi la munthu. Chimodzi mwamahomoni ofunika kwambiri m'thupi la munthu ndi insulin. Kuperewera kwake kapena zochuluka kumabweretsa zotsatirapo zoyipa. Matenda a shuga ndi hypoglycemia ndi magawo awiri olimbitsa thupi omwe amakhala osasangalatsa a thupi, omwe amanyalanyaza zambiri za insulin ndi momwe mulingo wake uyenera kukhalira.

Hormone insulin

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

Ndi chiwalo chiti chomwe chimatulutsa insulini

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

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

Kodi insulin ya hormone ndi iti - iyi ndiye yofunika kwambiri kuyang'anira metabolic. Popanda izi, shuga wolowa m'thupi kudzera mu chakudya sangalowe mu khungu. Hormayo imachulukitsa kuchuluka kwa ma membrane a maselo, chifukwa chake glucose amalowetsedwa m'thupi la selo. Nthawi yomweyo, timadzi timapangitsa kuti shuga asandulike kukhala glycogen, polysaccharide yomwe imakhala ndi mphamvu zomwe thupi la munthu limagwiritsa ntchito ngati zikufunika.

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

Zimalepheretsa ma amino acid kuti asagonjetsedwe kukhala shuga wophweka.
Zimasintha kaphatikizidwe ka mapuloteni - maziko a moyo.
Simalola mapuloteni m'misempha kuti asokonezeke, amalepheretsa minyewa atrophy - zotsatira za anabolic.
Amachepetsa kudzikundikira kwa matupi a ketone, ochulukirapo omwe amapha anthu.
Imalimbikitsa kuyendetsa kwa potaziyamu ndi ion ya magnesium.

Ntchito ya insulin m'thupi la munthu

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

Minofu yodalira insulin

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

Zotsatira zoyipa za insulin yaumunthu

Hypoglycemia (kufooka kwa khungu, kuchuluka thukuta, kunjenjemera, kunjenjemera, kutuluka thukuta, kusanza, tachycardia, palpitations, njala, kukwiya, nkhawa, kupweteka pakamwa, kupweteka mutu, kugona, kugona, mantha, kusowetsa mtendere , chizolowezi chosazolowereka, kusatsimikizika kayendedwe, chisokonezo, kukhumudwa ndi masomphenya, kulephera kudziwa, chikomokere, imfa), posthypoglycemic hyperglycemia (chochitika cha Somogy), insulini kukaniza (chofunikira cha tsiku ndi tsiku chimaposa 20) Mayunitsi 0, edema, kuwonongeka kwa maonekedwe, kuyabwa, khungu post-jekeseni lipodystrophy, yomwe imayendetsedwa ndi kulowetsedwa kwa insulin, kukulira kwa ululu pamene mawonekedwe amlengalenga amasintha).

Madzi a insulin

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

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

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

Wokwera

Kuchulukitsa kwanthaŵi yayitali kwamankhwala osokoneza bongo kumawopseza kusintha kwosasintha kwa matenda. Vutoli limachitika chifukwa cha kutsika kwa shuga. Mutha kumvetsetsa kuchuluka kwa insulin ndende ndi zizindikiro: kunjenjemera, thukuta, palpitations, kugwidwa mwadzidzidzi ndi njala, nseru, kukomoka. Zizindikiro zotsatirazi zimakhudza kuchuluka kwa mahomoni:

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

Kutsitsidwa

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

Zomwe insulin imapangira odwala matenda ashuga

Nkhani ya zida zopangira mahomoni ndi yofunika kwa odwala ambiri. Insulin yomwe ili m'thupi la munthu imapangidwa ndi kapamba, ndipo mitundu yotsatirayi imapezekanso:

Nkhumba kapena bovine - zochokera nyama. Zopangira zikondamoyo zogwiritsidwa ntchito.Kukonzekera kwa zopangira nkhumba kumakhala ndi ma proinsulin, omwe sangathe kulekanitsidwa, amakhala magwero azinthu zoyipa.
Biosynthetic kapena nkhumba yosinthidwa - kukonzekera kwapawiri kumapangidwa ndikusintha ma amino acid. Zina mwazabwino ndi kuphatikiza thupi la munthu komanso kusowa kwa ziwengo. Zowonongeka - kuperewera kwa zopangira, zovuta za ntchito, mtengo wokwera.
Genetic engineering recombinant - imatchedwa "insulin yaumunthu" mwanjira ina, chifukwa imafanana kwathunthu ndi mahomoni achilengedwe. Thupi limapangidwa ndi ma enzyme a yisiti tizilombo toyambitsa ndi kusinthidwa kwamtundu wa E. coli.

Malangizo ogwiritsira ntchito insulin

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

Zizindikiro zogwiritsidwa ntchito

Malinga ndi malangizo omwe aphatikizidwa phukusi lililonse la kukonzekera kwa insulin, zomwe zikuwonetsa kugwiritsidwa ntchito ndi mtundu wa 1 shuga mellitus (wotchedwanso insulin) ndipo, mwanjira zina, lembani matenda ashuga a 2 a mellitus (osadalira insulini). Zinthu zotere zimaphatikizira kusalolera kwa othandizira a hypoglycemic, kukula kwa ketosis.

Makulidwe a insulin

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

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

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

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

Mtengo wa insulin

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

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

Actrapid, Humulin, Insuran.

INN: Semi-yopanga insulin yaumunthu.

Pharmacokinetics

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

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

Momwe mungatengere insulin yaumunthu

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

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

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

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

Malangizo apadera

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

Mlingo wa insulin umasinthidwa motere:

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

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

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

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

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

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

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

MP ilibe mutagenic komanso ma genetically poizoni.

Kuchita ndi mankhwala ena

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

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

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

Mitundu ya insulin

Insulin idapangidwa koyamba kuchokera ku zikondamoyo za agalu. Patatha chaka chimodzi, mahomoniwa adagwiritsidwa ntchito kale. Zaka zina 40 zidapita, ndipo zidatheka kupanga insulin mosiyanasiyana.

Pambuyo kanthawi, zinthu zofunikira kwambiri zodziyeretsa zinapangidwa. Pambuyo pazaka zowerengeka, akatswiri adayamba kupanga kapangidwe ka insulin ya anthu. Kuyambira 1983, insulini idayamba kupangidwa pamakampani ambiri.

Zaka 15 zapitazo, matenda ashuga ankawagwiritsa ntchito zopangidwa ndi nyama. Masiku ano, ndi oletsedwa. M'mafakitala, mutha kupeza zokonzekera zaumisiri, kupanga ndalama izi kutengera kutengera kwa chinthu cha gene mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya osagwiritsa ntchito mankhwala a Escherichia coli amagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kupanga insulin kwa anthu.

Kusiyana pakati pa zida zonse zamankhwala zomwe zilipo lero ndi:

munthawi yowonekera, osachita kanthu kwakanthawi kochepa, ma insulin osakhalitsa pang'ono komanso insulin yochepa.
mogwirizana ndi amino acid.

Palinso mankhwala ena omwe amaphatikizidwa kuti "zosakaniza", amakhala ndi insulin yokhala ndi nthawi yayitali komanso yochepa. Mitundu yonse 5 ya insulin imagwiritsidwa ntchito pazolinga zawo.

Mwachidule kuchita insulin

Ma insulin omwe amagwira ntchito mwachidule, nthawi zina a ultrashort, ndi mayankho a crystalline zinc-insulin ovuta ndi mtundu wa pH wosaloledwa. Ndalama izi zimagwira mwachangu, komabe, mphamvu ya mankhwalawa ndiyosakhalitsa.

Monga lamulo, mankhwalawa amaperekedwa kwa mphindi 30-45 musanadye. Mankhwala ofanana amatha kuthandizidwa kudzera mu mnofu komanso m'mitsempha, komanso insulin.

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

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

Ndi kuphwanya kwa kupanga ma hormonal a contra-mahormone, kuchuluka kwa shuga kwa magazi sikokwanira kwa maola angapo pambuyo pobayira jakisoni wa mankhwala, chifukwa kumakhudza thupi komanso pambuyo pochotsa magazi.

Mahomoni ochita kupanga mwachidule ayenera kubayidwa m'mitsempha:

Pa nthawi ya chisamaliro chambiri,
odwala matenda ashuga a ketoacidosis,
ngati thupi lisintha mwachangu kufunika kwa insulini.

Odwala omwe ali ndi khola la matenda a shuga, mankhwalawa nthawi zambiri amatengedwa limodzi ndi zotsatira zazitali komanso nthawi yayitali.

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

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

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

Izi zinali chiyambi cha kupanga zopangira zapakati zomwe zimayimira:

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

Mitundu ya insulin iyi imatengedwa kuchokera pansi pakhungu katatu katatu poyerekeza ndi insulin ya anthu. Izi zimabweretsa kuti gawo lalikulu kwambiri la insulin m'magazi limafikiridwa mwachangu, ndipo njira yothetsera shuga yatsala pang'ono.

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

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

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

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

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

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

Pharmacokinetic katundu wa insulin

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

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

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

Chithandizo cha insulin ndi chofunikira pa matenda monga:

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

Zotsatira zabwino zimatheka pogwiritsa ntchito njira zovuta zochizira:

Kufunika kwa insulin tsiku ndi tsiku

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

Hormayo imapangidwa kukhala magawo a 0,5-1 pa ola limodzi. Shuga atalowa m'magazi, kuchuluka kwa katulutsidwe ka timadzi timeneti kumakwera mpaka ku magawo 6 pa ola limodzi.

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

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

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

Kufunika kwa insulin ya mahomoni ndi amitundu iwiri:

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

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

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

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

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

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

Kuchita kwa insulin yaumunthu ndi zinthu zina

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

Kuyenderana ndi mowa

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

Pali mitundu ingapo yofunika:

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

Zosungidwa zamankhwala

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

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

Wopanga

Pali mabungwe angapo omwe amapanga insulin yaumunthu:

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

Udindo wa insulini m'thupi ndi osatheka kuzikulitsa. Mulingo uliwonse wa kusowa kwa insulini uli ndi matenda akulu a endocrine - matenda ashuga. Zaka 40 zapitazo, odwala matenda ashuga sanakhalepo zaka zopitilira 10-15.

Mankhwala amakono amagwiritsa ntchito insulin yofunikira kwambiri yaumunthu yopanga ma genulin kuti isinthe magazi. Chifukwa cha mankhwalawa, matenda ashuga asiya kukhala chiganizo, kupatsa mwayi odwala kwa moyo wonse komanso wautali.

Contraindication

achina,
kusalolera kapena hypersensitivity magawo a mankhwala.

Izi zotsutsana ziyenera kuganiziridwapo musanayambe chithandizo.

Momwe mungatengere insulin yaumunthu

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

Zotsatira zoyipa za insulin yaumunthu

Mukagwiritsidwa ntchito, zotsatirazi zotsatirazi zimakonda kukhala:

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

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

Zokhudza mphamvu pakuwongolera njira

Ndi mankhwala a insulin, kuphwanya pang'ono mbali zina zama psychomotor zimachitika ndikusokonezeka kotheka ndikotheka. Chifukwa chake, ndikwabwino kupewetsa galimoto yoyendetsa yokha ndi makina olemera.

Malangizo apadera

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

Mlingo wa insulin umasinthidwa motere:

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

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

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

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

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

MP ilibe mutagenic komanso ma genetically poizoni.

The ntchito aimpso kuwonongeka

Ngati wodwala ali ndi vuto lililonse la impso, kungakhale kofunikira kusintha mlingo wa insulin.

Kugwiritsa ntchito kwa vuto la chiwindi

Mosamala, anthu omwe ali ndi matenda a chiwindi ayenera kumwa mankhwalawa. Pakusintha pang'ono kwa zitsanzo za chiwindi, tikulimbikitsidwa kusintha mlingo.

Bongo

Zizindikiro zosokoneza bongo zimatha kuchitika pafupipafupi:

hypoglycemia - kufooka, thukuta kwambiri, khungu la pakamwa, kunjenjemera kwa malekezero, lilime lonjenjemera, njala,
hypoglycemic chikomokere ndi chindoko.

Chithandizo chake chimakhala chodziwikiratu. Hypoglycemia yofatsa imatha kudutsa shuga kapena zakudya zamafuta ambiri.

Glucagon woyela amapaka jekeseni kuti aletse zizindikiro za kuchuluka kwa mankhwala osokoneza bongo. Ngati mwayamba kukomoka mwadzidzidzi, mpaka 100 ml ya njira yothetsera ya dextrose imayendetsedwa mpaka wodwalayo atachoka.

Kuchita ndi mankhwala ena

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

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

Kuyenderana ndi mowa

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

Pali mitundu ingapo yofunika:

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

Migwirizano ya Holiday ya Mankhwala

Insulin yaumunthu ingagulidwe kokha pamasitolo apadera.

Kodi ndingagule popanda kulandira mankhwala?

Wogulitsa ndi Chinsinsi chapadera.

Mtengo wake umatengera malire a mankhwala ndi kuchuluka kwa mabotolo omwe ali phukusi. Mtengo wapakati umachokera ku 500 mpaka 1700 rubles.

Zosungidwa zamankhwala

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

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

Tsiku lotha ntchito

Khalani otseguka botolo likuvomerezeka masiku 30 okha. Pambuyo pa nthawi imeneyi, mankhwalawo amatayidwa.

Wopanga

Pali mabungwe angapo omwe amapanga insulin yaumunthu:

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

Chifukwa chiyani insulin imatchedwa "genetically engineer"

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

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

Chachikulu mankhwala

Mafuta a insulle a insulin amatanthauza mankhwala osokoneza bongo osakhalitsa.

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

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

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

Zizindikiro zogwiritsidwa ntchito

Nthawi zambiri, madokotala amatipatsa insulin yosungunuka milandu:

Contraindication

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

Contraindicated ogwiritsira ntchito insulin mu:

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

Ntchito ndi kusankha kwa mankhwalawa

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

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

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

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

Nthawi zambiri, insulin yothamanga imaphatikizidwa ndi insulin yotalikirapo.

Soluble waumunthu wopanga insulin ndi zonse za izo

50 Insulin-Isophan (Umisiri wa Majini a Anthu)

51 ipratropium bromide

Kodi pali kusiyana kotani pakati pa kukonzekera kwa insulin wina ndi mnzake

Magwero a insulin

Kukula kwa insulin

Zida zophera tizilombo

Insulin Syringe Calibration

Kuphatikiza kwafupikitsika ndi insulin yayitali

Wophatikiza insulin

Mankhwala

Mlingo ndi makonzedwe a insulin ya anthu

Mimba komanso kuyamwa

Chifukwa chiyani insulin imatchedwa "genetically engineer"

Chachikulu mankhwala

Zizindikiro zogwiritsidwa ntchito

Zotsatira zoyipa

Kuphatikiza ndi mankhwala ena

Malamulo a insulin

Zina zamalonda zamankhwala

Bongo

Mavuto

Model Clinical-Pharmacological Article 1

Zokonzekera zomwe zimapezeka kuchokera ku zopangira zachilengedwe

Katswiri wa Majini a Insulin

Zowonjezera zina

Kupitiliza Zowonjezera

Madera okhathamiritsa

Olimbitsa

Zotsatira za pharmacological

Zotsatira zoyipa

Hormone insulin

Ndi chiwalo chiti chomwe chimatulutsa insulini

Ntchito ya insulin m'thupi la munthu

Minofu yodalira insulin

Zotsatira zoyipa za insulin yaumunthu

Madzi a insulin

Wokwera

Kutsitsidwa

Zomwe insulin imapangira odwala matenda ashuga

Malangizo ogwiritsira ntchito insulin

Zizindikiro zogwiritsidwa ntchito

Makulidwe a insulin

Mtengo wa insulin

Pharmacokinetics

Momwe mungatengere insulin yaumunthu

Malangizo apadera

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Kuchita ndi mankhwala ena

Mitundu ya insulin

Mwachidule kuchita insulin

Pharmacokinetic katundu wa insulin

Kufunika kwa insulin tsiku ndi tsiku

Kuchita kwa insulin yaumunthu ndi zinthu zina

Kuyenderana ndi mowa

Zosungidwa zamankhwala

Wopanga

Contraindication

Momwe mungatengere insulin yaumunthu

Zotsatira zoyipa za insulin yaumunthu

Zokhudza mphamvu pakuwongolera njira

Malangizo apadera

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

The ntchito aimpso kuwonongeka

Kugwiritsa ntchito kwa vuto la chiwindi

Bongo

Kuchita ndi mankhwala ena

Kuyenderana ndi mowa

Migwirizano ya Holiday ya Mankhwala

Kodi ndingagule popanda kulandira mankhwala?

Zosungidwa zamankhwala

Tsiku lotha ntchito

Wopanga

Chifukwa chiyani insulin imatchedwa "genetically engineer"

Chachikulu mankhwala

Zizindikiro zogwiritsidwa ntchito

Contraindication

Ntchito ndi kusankha kwa mankhwalawa

Kusiya Ndemanga Yanu

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