Levemir Penfill

Munkhaniyi, mutha kuwerengera malangizo ogwiritsira ntchito mankhwalawa Levemir. Amapereka ndemanga kuchokera kwa alendo omwe amabwera patsamba lino - ogula mankhwalawa, komanso malingaliro a akatswiri azachipatala pakugwiritsa ntchito Levemir machitidwe awo. Chopempha chachikulu ndikuti muwonjezere ndemanga zanu za mankhwalawa: mankhwalawo adathandizira kapena sanathandizire kuchotsa matendawa, ndizovuta ziti zomwe zimawoneka ndi zotsatirapo zake, zomwe mwina sizinalengezedwe ndi wopanga. Analogs a Levemir pamaso pazochitika zopanga mawonekedwe. Gwiritsani ntchito mankhwalawa odwala matenda ashuga akuluakulu, ana, komanso pa nthawi yoyembekezera. The zikuchokera mankhwala.

Levemir - yaitali insulin, mafuta osungunuka a insulin ya anthu. Levemir Penfill ndi Levemir FlexPen amapangidwa ndi recombinant DNA biotechnology pogwiritsa ntchito mavuto a Saccharomyces cerevisiae.

Kuchita kwa nthawi yayitali kwa mankhwalawa Levemir Penfill ndi Levemir FlexPen ndi chifukwa chodziyimira pawokha cha maselo a insulir kumalo operekera jakisoni ndikumanga kwa mamolekyulu a mankhwala kupita ku albumin pogwiritsa ntchito phula lomwe limakhala ndi unyolo wamafuta acid. Poyerekeza ndi isofan-insulin, insulini ya detemir imaperekedwa kwa zotumphukira za minofu pang'onopang'ono. Njira zophatikizidwazo zomwe zimaperekedwako zimapereka mayendedwe odziwikanso komanso mawonekedwe a Levemir Penfill ndi Levemir FlexPen poyerekeza ndi isofan-insulin.

Imalumikizana ndi cholandirira chapadera pa cell ya cytoplasmic maselo ndikupanga insulini-receptor zovuta zomwe zimapangitsanso njira zina, kuphatikizapo kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase).

Kutsika kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa zotupa, kukondoweza kwa lipogenesis, glycogenogeneis, ndi kuchepa kwa kuchuluka kwa shuga ndi chiwindi.

Pambuyo subcutaneous makonzedwe, pharmacodynamic yankho limakhala lofanana ndi mlingo kutumikiridwa (pazipita mphamvu, nthawi ya zochita, ambiri zotsatira).

Mbiri yakuwongolera kwa shuga usiku ndiyosasangalatsa komanso chifukwa cha insulin, poyerekeza ndi insulin isofan, yomwe imawonetsedwa pangozi yakuchepera usiku hypoglycemia.

Kupanga

Kudziletsa insulin + akubwera.

Pharmacokinetics

Cmax mu plasma imafikiridwa pambuyo maola 6-8 mutatha kuyendetsa. Ndi kawiri tsiku lililonse la Css makonzedwe a mankhwala mu madzi am`magazi zimatheka pambuyo jekeseni 2-3.

Kusiyanitsa kwapakati pa intraind payekha ndikotsika kwa Levemir Penfill ndi Levemir FlexPen poyerekeza ndi kukonzekera kwina kwa insulin.

Panalibe kusiyana kwakanthawi pakati pa amuna ndi akazi mu pharmacokinetics ya mankhwala a Levemir Penfill / Levemir Flexpen.

Kupanga mankhwala a Levemir Penfill ndi Levemir FlexPen ndi ofanana ndi kukonzekera kwa insulin yaumunthu, ma metabolites onse omwe amapangidwa satha ntchito.

Kafukufuku womanga mapuloteni akuwonetsa kusowa kwa kuyanjana kwakukulu pakati pa kanyumba kanyumba ka insulin ndi mafuta acid kapena mankhwala ena omanga mapuloteni.

The terminal theka-moyo pambuyo subcutaneous jekeseni kutsimikiza ndi kuchuluka kwa mayamwidwe subcutaneous minofu ndi maola 5-7, kutengera mlingo.

Zizindikiro

• insellinus wodwala matenda a shuga (mtundu 1 wa matenda a shuga),
• shuga yosadalira insulin (mtundu 2 shuga mellitus).

Kutulutsa Mafomu

Yothetsera subcutaneous makonzedwe a Levemir Penfill m'magalori makatoni a mayunitsi 300 (3 ml) (jakisoni ma ampoules a jekeseni).

Yothetsera subcutaneous makonzedwe a galasi la Levemir Flexpen a 300 PIECES (3 ml) mu njira zowerengeka zotulutsira zolembera zophatikizira zingapo za 100 PIECES mu 1 ml.

Malangizo ogwiritsira ntchito, Mlingo ndi njira ya jakisoni

Lowani mosaneneka mu ntchafu, khoma lakunja lam'mimba kapena phewa. Ndikofunikira kusintha malo a jekeseni mkati mwa anatomical dera kuti muchepetse kukula kwa lipodystrophy. Insulin imachita zinthu mwachangu ngati itayambitsidwa khoma lakumbuyo lamkati.

Lowani 1 kapena 2 kawiri pa tsiku potengera zosowa za wodwala. Odwala omwe amafuna kugwiritsa ntchito mankhwalawa 2 kawiri pa tsiku kuti athe kuyamwa kwambiri amatha kulowa mgonero ngakhale nthawi yamadzulo, kapena asanagone, kapena maola 12 atatha kumwa kwa mankhwalawa.

Odwala okalamba, komanso vuto la chiwindi ndi impso, kuchuluka kwa shuga wamagazi kuyenera kuyang'aniridwa kwambiri ndikuwonetsa kuchuluka kwa insulin.

Kusintha kwa magazi kungafunikenso pakuwonjezera zolimbitsa thupi kwa wodwala, kusintha zakudya zake, kapena mukudwala.

Mukasamutsa insulin kuchokera pakatikati ndikukhala ndi insulin yayitali, insulini ingafune mlingo komanso kusintha kwa nthawi. Kuwunikira mosamala kuchuluka kwa shuga m'magazi pomasulira komanso m'masabata oyamba a chithandizo cha insulini tikulimbikitsidwa. Malangizo a concomitant hypoglycemic mankhwala angafunike (mlingo ndi nthawi ya makonzedwe osakhalitsa a insulin kukonzekera kapena kumwa mankhwala a mkamwa hypoglycemic).

Zotsatira zoyipa

• hypoglycemia, Zizindikiro zomwe nthawi zambiri zimayamba mwadzidzidzi ndipo zimaphatikizira kuchepa kwa khungu, thukuta lakuzizira, kutopa kwambiri, manjenje, kunjenjemera, kutopa mwadzidzidzi kapena kufooka, kusokonezeka kwa chidwi, kusokonezeka kwa chidwi, kugona, kugona kwambiri, kuwonongeka kwa mutu, kupweteka kwa mutu. kupweteka, nseru, palpitations. Hypoglycemia yayikulu imatha kuwononga chikumbumtima ndi / kapena kukhumudwa, kusokonezeka kwakanthawi kapena kosasintha kwa ubongo kugwira ntchito mpaka pakufa,
• zimachitika za hypersensitivity zakwanuko (redness, kutupa ndi kuyabwa pamalowo jakisoni) nthawi zambiri zimakhala zosakhalitsa, i.e. kusowa ndi mankhwala
• lipodystrophy (chifukwa chosagwirizana ndi lamulo la kusintha malo a jakisoni m'dera lomwelo),
• urticaria
• zotupa pakhungu
• Khungu
• zolimbitsa thukuta,
• matenda am'mimba,
• angioedema,
• kuvutika kupuma
• tachycardia
• kutsika kwa magazi,
• kuphwanya Refraction (nthawi zambiri amakhala osakhalitsa ndipo amawonetsedwa koyambirira kwa mankhwala ndi insulin),
• diabetesic retinopathy (kupitiliza kwa nthawi yayitali pakulamulira kwa glycemic kumachepetsa chiopsezo cha kupitirira kwa matenda ashuga retinopathy, komabe, kulimbikitsidwa kwa insulin mankhwala ndikusintha kolimba pakuwongolera kwa metabolism ya carbohydrate kungayambitse kuwonongeka kwakanthawi mu boma la matenda ashuga retinopathy.
• zotumphukira neuropathy, zomwe nthawi zambiri zimatha kusintha,
• kutupa.

Contraindication

• kuchuluka insulin sensitivity kunyansidwa.

Mimba komanso kuyamwa

Pakadali pano, palibe zomwe zimagwiritsidwa ntchito pazachipatala za Levemir Penfill ndi Levemir FlexPen pa nthawi yoyembekezera komanso mkaka wa m`mawere.

Munthawi ya kuyambika komanso nthawi yonse yomwe muli ndi pakati, kuwunika mosamala mkhalidwe wa odwala omwe ali ndi matenda osokoneza bongo ndikuwunika kuchuluka kwa shuga m'magazi a m'magazi ndikofunikira. Kufunika kwa insulini, monga lamulo, kumachepera mu trimester yoyamba ndipo pang'onopang'ono kumawonjezeka pang'onopang'ono wachiwiri komanso wachitatu wokonzekera kutenga pakati. Pambuyo pobadwa, kufunikira kwa insulin kumabwereranso msanga momwe kunaliri asanakhale ndi pakati.

Panthawi yoyamwitsa, zingakhale zofunikira kusintha mlingo wa mankhwala ndi zakudya.

M'maphunziro oyesera a nyama, palibe kusiyana komwe kunapezeka pakati pa embryotoxic ndi teratogenic zotsatira za detemir ndi insulin ya anthu.

Gwiritsani ntchito ana

Sitikulimbikitsidwa kugwiritsa ntchito insulin Levemir Penfill ndi Levemir Flexpen mwa ana osakwana zaka 6.

Gwiritsani ntchito odwala okalamba

Kwa odwala okalamba, kuchuluka kwa shuga m'magazi kuyenera kuyang'aniridwa kwambiri ndikuwonetsetsa kuti insulin yayenera.

Malangizo apadera

Amakhulupirira kuti kusamalidwa kwambiri ndi insulin sikukulitsa thupi.

Chiwopsezo chocheperako cha nocturnal hypoglycemia poyerekeza ndi ma insulin ena amaloleza kusankha kwakukulu kwa mlingo kuti akwaniritse gawo la shuga.

Detemir insulini imapereka chiwongolero chokwanira cha glycemic (kutengera kusala kwa shuga m'magazi) poyerekeza ndi isofan insulin. Mlingo wosakwanira wa mankhwalawa kapena kusiya kulandira chithandizo, makamaka mtundu wa matenda a shuga 1, angayambitse kukula kwa hyperglycemia kapena matenda ashuga a ketoacidosis. Monga lamulo, zizindikiro zoyambirira za hyperglycemia zimawonekera pang'onopang'ono, kwa maola angapo kapena masiku. Zizindikiro zake zimaphatikizaponso ludzu, kukodza mwachangu, kusanza, kusanza, kugona komanso kuyanika pakhungu, pakamwa pouma, kusowa chilimbikitso, kununkhira kwa acetone mumlengalenga wotuluka. Mtundu woyamba wa matenda a shuga 1, popanda kugwiritsa ntchito mankhwalawa, hyperglycemia imabweretsa chitukuko cha matenda ashuga ndipo amatha kupha.

Hypoglycemia imatha kukhala ngati mlingo wa insulin ndiwokwera kwambiri poyerekeza ndi kufunika kwa insulin.

Kudumpha zakudya kapena kuchita masewera olimbitsa thupi mosakonzekera kungayambitse matenda a hypoglycemia.

Pambuyo kulipirira kagayidwe kazakudya, mwachitsanzo, ndi mankhwala olimbitsa kwambiri a insulin, odwala amatha kukumana ndi zisonyezo zam'mbuyomu za hypoglycemia, zomwe odwala ayenera kudziwitsidwa. Zizindikiro zachilendo zimatha kutha ndi matenda a shuga.

Matenda okhala ndi vuto limodzi, makamaka opatsirana komanso kutentha thupi, nthawi zambiri amalimbikitsa kufunika kwa insulin.

Kusamutsa wodwala kupita ku mtundu wina kapena kukonzekera kwa insulin kwa wopanga wina kuyenera kuchitika moyang'aniridwa ndi achipatala. Mukasintha ndende, wopanga, mtundu, mitundu (nyama, munthu, fanizo la insulin ya anthu) ndi / kapena njira yopangira (genetically engineered or insulin of organis) Chinyama chitha kusintha.

Dululir ya Detemir sayenera kutumikiridwa kudzera m'mitsempha, chifukwa izi zimatha kuyambitsa hypoglycemia.

Kuphatikiza Levemir Penfill ndi Levemir FlexPen insulini wofulumira wokhala ndi insulin analogue, monga insulin aspart, imabweretsa chithunzithunzi chokhala ndi kuchepetsedwa komanso kuchepetsedwa kwakukulu poyerekeza ndi kayendetsedwe kake kosiyana.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Kuthekera kwa odwala kulolera komanso kuchuluka kwa momwe angachitire amatha kusokonezeka panthawi ya hypoglycemia ndi hyperglycemia, zomwe zimakhala zowopsa nthawi zomwe maluso amenewa amafunikira makamaka (mwachitsanzo, poyendetsa galimoto kapena kugwira ntchito ndi makina ndi makina). Odwala ayenera kulangizidwa kuti achitepo kanthu popewa kukulitsa kwa hypoglycemia ndi hyperglycemia poyendetsa galimoto ndikugwiritsa ntchito njira. Izi ndizofunikira kwambiri kwa odwala omwe alibe kapena kuchepa kwa zizindikiro zakutsogolo kwa hypoglycemia kapena akuvutika ndi zochitika zapafupipafupi za hypoglycemia. Muzochitika izi, kuthekera kwa ntchito yotereyi kuyenera kuganiziridwa.

Kuyanjana kwa mankhwala osokoneza bongo

Hypoglycemic zotsatira za insulin patsogolo mankhwala m'kamwa hypoglycemic, Mao zoletsa, zoletsa Ace, carbonic zoletsa anhydrase, kusankha beta-blockers, bromocriptine, sulfonamides, anabolic mankhwala, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lifiyamu, mankhwala, yokhala ndi Mowa. Njira zakulera za pakamwa, GCS, mahomoni a chithokomiro, thiazide diuretics, heparin, tridclic antidepressants, sympathomimetics, danazole, Clonidine, pang'onopang'ono calcium njira blockers, diazoxide, morphine, phenytoin, nikotini kufooketsa mphamvu ya hypoglycemic.

Mothandizidwa ndi reserpine ndi salicylates, onse ofooketsa ndikuwonjezera zochita za insulin.

Octreotide / lanreotide imatha kuwonjezeka ndikuchepetsa kufunikira kwa insulin.

Beta-blockers amatha kuphimba zizindikiro za hypoglycemia ndikuchedwa kuchira pambuyo pa hypoglycemia.

Ethanol (mowa) amatha kukulitsa ndi kukulitsa mphamvu ya insulin.

Mankhwala ena, monga ali ndi thiol kapena sulfite, pamene kuwonda kumawonjezeredwa ndi insulin, kungayambitse kuwonongeka kwa insulin.

Analogs a mankhwala Levemir

Zofanana muzochitika zamagulu:

• Insulin
• Levemir Penfill,
• Levemir FlexPen.

Analogs mu pharmacological group (ma insulin):

• Khalid
• Apidra
• Apidra SoloStar,
• Berlinsulin,
• Berlinsulin N Basal,
• Berlinsulin N Mwachizolowezi,
• Biosulin
• Brinsulmidi
• Brinsulrapi
• Tidzalamulira 30/70,
• Gensulin
• Depot insulin C,
• Isofan Insulin World Cup,
• Iletin 2,
• Insulin aspart,
• Insulin glargine,
• Insulin glulisin,
• Insulin
• Insulin Isofanicum,
• Tepi ya insulin,
• Lyspro insulin
• Insulin maxirapid,
• Insulin sungunuka
• Insulin s
• Mafuta a nkhumba oyeretsedwa kwambiri a MK
• Insulinnt
• Insulin Ultralente,
• Insulin yamunthu
• Insulin ya chibadwa cha anthu,
• Insulin yopanga anthu insulin
• Insulin yobwerezabwereza ya anthu
• Insulin Long QMS,
• Insulin Ultralong SMK,
• Insulong SPP,
• Insulrap SPP,
• Insuman Bazal,
• Insuman Comb,
• Insuman Rapid,
• Insuran
• Pakati
• Combinsulin C
• Lantus
• Lantus SoloStar,
• Levemir Penfill,
• Levemir Phukira,
• Mikstard
• Monoinsulin
• Monotard
• NovoMiks,
• NovoRapid,
• Pensulin,
• Protamine insulin
• Protafan
• Rysodeg Penfill,
• Rysodeg FlexTouch,
• Kubwezeretsanso insulin yaumunthu,
• Rinsulin
• Rosinsulin,
• Sultofay,
• Tresiba,
• Tujeo SoloStar,
• Ultratard NM,
• Nyumba 40,
• Kandachime 40,
• Humalog,
• Kusakaniza kwa Humalog,
• Humodar
• Humulin
• Humulin Wokhazikika.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

S / c pa ntchafu, khomo lakunja lam'mimba kapena phewa. Tsamba la jakisoni liyenera kusinthidwa pafupipafupi. Mlingo ndi pafupipafupi oyendetsera (1-2 kawiri pa tsiku) amatsimikiziridwa payekhapayekha.

Pakaperekedwa kawiri pakulondola kwa glucose, mankhwalawa amatha kuperekedwa nthawi ya chakudya, pogona, kapena maola 12 atatha kumwa kwa m'mawa.

Mukamachotsa ma insulin apakatikati komanso ma insulin a nthawi yayitali kuti muchepetse insulin, muyezo ndi kusintha kwa nthawi kungafunike (kuwunikira mosamala kuchuluka kwa shuga wamagazi pakasamutsidwa komanso mu sabata zoyambirira zamankhwala ndikulimbikitsidwa).

Zotsatira za pharmacological

Mndandanda wosungunuka wa insulin yaumunthu ya nthawi yayitali (chifukwa cha kudziyimira pawokha kwa maselo ophatikizira insulini pamalo operekera jakisoni ndikumanga kwa mamolekyulu a mankhwala kuti akhale ndi albumin pogwiritsa ntchito pawiri ndi mbali yamafuta amafuta acid) yokhala ndi mawonekedwe a phokoso (mosiyana kwambiri ndi insulin-isophan ndi insulin glargine).

Poyerekeza ndi insulin-isophan, imafalikira pang'onopang'ono mu ziwopsezo zopangika, zomwe zimapereka chidziwitso chodziwikiratu ndi mawonekedwe a mankhwala.

Imalumikizana ndi cholandirira chapadera pa cell ya cytoplasmic maselo ndikupanga insulini-receptor zovuta zomwe zimapangitsanso njira zina, kuphatikizapo kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase).

Kuchepa kwa kuchuluka kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa mayendedwe ake, kuchuluka kwa zotupa, kukondoweza kwa lipogenesis, glycogenogeneis, ndi kuchepa kwa kuchuluka kwa shuga m'magazi.

Pambuyo pa kukhazikitsidwa kwa 0,2-0.4 U / kg 50%, mphamvu yochulukirapo imapezeka pamtunda kuchokera maola 3-4 mpaka maola 14, nthawi yochita mpaka maola 24.

Zotsatira zoyipa

Pafupipafupi (nthawi zambiri 1/100, koma kangapo kawirikawiri 1/10): hypoglycemia (, kufooka kwa khungu, kutopa kwambiri, mantha, kunjenjemera, nkhawa, kutopa kapena zachilendo, kusokonezeka, kuchepa kwa ndende, kugona, kugona kwambiri, kuwonongeka kwa mawonekedwe) , kupweteka mutu, nseru, kulumala, muzochitika zazikulu - kusokonezeka kwa chikumbumtima ndi / kapena kukokana, kusokonezeka kwakanthawi kapena kosatha kwa ubongo kugwira ntchito mpaka pakufa), mayendedwe am'deralo (hyperemia, kutupa ndi kuyabwa pamalo opaka jekeseni) nthawi zambiri amakhala osakhalitsa ndi kutha mankhwala anapitiriza.

Osoweka (nthawi zambiri 1/1000, koma kawirikawiri 1/100): lipodystrophy pamalo opangira jakisoni (chifukwa chosagwirizana ndi lamulo losintha jekeseni mkati mwa malo omwewo), kutupa pakumayambiriro kwa mankhwala a insulin (nthawi zambiri amakhala osakhalitsa), zotupa, kuyabwa kwa khungu, thukuta, kusokonezeka kwamatumbo, angioedema, kupuma movutikira, kuchepa kwa magazi), zolakwika zoyambitsanso koyambirira kwa insulin mankhwala (nthawi zambiri kwakanthawi kochepa), matenda ashuga retinopathy (kusintha kwa nthawi yayitali pakusintha kwa glycemia zhaet chiopsezo Kukula kwa ashuga retinopathy Komabe, intensification wa insulin mankhwala ndi kusintha mwadzidzidzi mu ulamuliro wa zimam'patsa kagayidwe kungayambitse zosakhalitsa akuchuluka wa ashuga boma retinopathy).

Zosowa kwambiri (nthawi zambiri 1/10000, koma kawirikawiri 1/1000): zotumphukira za neuropathy (kusintha msanga pakayang'anidwe ka glycemic kumatha kubweretsa ululu wammbuyo wammbuyo, womwe nthawi zambiri umasintha.

Malangizo apadera

Osaba kubaya iv (chiwopsezo cha hypoglycemia)!

Kulimbitsa thupi kwambiri ndi mankhwalawa sikuti kumawonjezera kuchuluka kwa thupi.

Chiwopsezo chocheperako cha nocturnal hypoglycemia poyerekeza ndi ma insulin ena amaloleza kusankha kwa kuchuluka kwa mankhwala kuti akwaniritse kuchuluka kwa shuga m'magazi.

Mlingo wosakwanira wa mankhwalawa kapena kusiya kulandira chithandizo, makamaka mtundu wa matenda a shuga 1, angayambitse kukula kwa hyperglycemia kapena matenda ashuga a ketoacidosis. Zizindikiro zoyambirira za hyperglycemia, monga lamulo, zimawonekera pang'onopang'ono kwa maola angapo kapena masiku: ludzu, kukodza mwachangu, nseru, kusanza, kugona, Hyperemia ndi khungu louma, pakamwa pouma, kusowa chilimbikitso, kununkhira kwa acetone mu mpweya wotuluka.

Kudumpha zakudya kapena kuchita masewera olimbitsa thupi mosakonzekera kungayambitse matenda a hypoglycemia.

Atalipira chakudya cha metabolism (mwachitsanzo, ndi insulin Therapy), odwala amatha kukumana ndi zisonyezo zam'mbuyomu za hypoglycemia, zomwe odwala ayenera kudziwitsidwa. Zizindikiro zachilendo zimatha kutha ndi matenda a shuga.

Matenda olimbana ndi matenda (opatsirana, kuphatikiza omwe amathandizidwa ndi malungo) nthawi zambiri amalimbikitsa kufunika kwa insulin.

Kusamutsa wodwala kupita ku mtundu wina kapena kukonzekera kwa insulin kwa wopanga wina kuyenera kuchitika moyang'aniridwa ndi achipatala. Mukasintha ndende, wopanga, mtundu, mitundu (nyama, munthu, fanizo la insulin ya anthu) ndi / kapena njira yopangira (genetically engineered or insulin of organis) Chinyama chitha kusintha.

Odwala omwe amasintha kuti awoneke chithandizo cha insulin angafunike kusintha mlingo poyerekeza ndi Mlingo wa insulin yomwe kale anali kukonzekera. Kufunika kosinthira kwa mlingo kumatha kuchitika mutakhazikitsa mlingo woyamba kapena mkati mwa milungu ingapo kapena miyezi ingapo.

Madzi ndi makina a i / m amathamanga mwachangu komanso kwakukulu poyerekeza ndi kasamalidwe ka s / c.

Akasakanizidwa ndi kukonzekera kwina kwa insulin, mawonekedwe amachitidwe amodzi kapena zonse ziwiri zimasintha. Kuphatikiza mankhwalawo ndi analogue yofulumira (insulin aspart) kumabweretsa chithunzithunzi chochepetsedwa komanso kuchepetsedwa kwakukulu poyerekeza ndi kayendetsedwe kake kosiyana.

Sicholinga chogwiritsa ntchito mapampu a insulin.

Palibe deta pakadwala yomwe imagwiritsidwa ntchito pakuwunika kwa insulin panthawi yomwe ali ndi pakati komanso mkaka wa m`mawere, komanso mwa ana osaposa zaka 6.

Odwala ayenera kulangizidwa kuti achitepo kanthu kuti ateteze kukula kwa hypoglycemia ndi hyperglycemia poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafuna kuti anthu azikhala ndi chidwi komanso azithamanga. Izi ndizofunikira kwambiri kwa odwala omwe alibe kapena kuchepa kwa zizindikiro zakutsogolo kwa hypoglycemia kapena magawo a hypoglycemia.

Kuchita

mankhwala Oral hypoglycemic, Mao zoletsa, zoletsa Ace, carbonic anhydrase zoletsa, si kusankha beta-blockers, bromocriptine, sulphonamides, anabolic mankhwala, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, mankhwala Li +, etanolsoderzhaschie mankhwala kuwonjezera zotsatira hypoglycemic.

Kulera kwapakhomo, corticosteroids, mahomoni a chithokomiro, thiazide diuretics, heparin, tridclic antidepressants, sympathomimetics, danazole, clonidine, calcium njira blockers, diazoxide, morphine, phenytoin, nikotini amachepetsa hypoglycemic effect.

Reserpine ndi salicylates amachepetsa kapena kuwonjezera mphamvu ya mankhwalawa.

Octreotide ndi lanreotide zimachulukitsa kapena zimachepetsa kufunika kwa insulin.

Beta-blockers amatha kuphimba zizindikiro za hypoglycemia ndikuchedwa kuchira pambuyo pa hypoglycemia.

Ethanol imatha kukulitsa ndi kukulitsa mphamvu ya insulin.

Mankhwala osagwirizana ndi mankhwala omwe ali ndi thiol kapena sulfite (chiwonongeko cha insulin

Mankhwala sayenera kuwonjezeka kulowetsedwa njira.

Mafunso, mayankho, ndemanga pa mankhwala Levemir Penfill

Zomwe zimaperekedwa zimakonzekera akatswiri azamankhwala komanso zamankhwala. Chidziwitso chokwanira chokhudza mankhwalawa chili m'malangizo omwe amaphatikizidwa ndi zomwe amapanga ndi wopanga. Palibe chidziwitso chomwe chatumizidwa patsamba lino kapena tsamba lililonse la tsamba lathu chomwe chingagwire ntchito ngati cholowa m'malo mwapadera kwa katswiri.

Akuluakulu ndi othandiza ogwira ntchito

Levemir Penfill ndi mankhwala omwe amabwera mumtundu wa yankho la jakisoni, wobayidwa pansi pa khungu. Gawo lalikulu lothandizirana ndi madzi a jekeseni ndi insulin. Mankhwala ndi omwe amafananizidwa ndi insulin yomwe imapangidwa ndi thupi la munthu ndipo amadziwika ndi zochita zazitali.

Kuti muwone kugwiritsira ntchito bwino kwa mankhwalawo ndikuwatsimikizira kuti ali otetezeka, zinthu zotsatirazi zimaphatikizidwa ndi yankho:

• phenol
• glycerol
• sodium hydroxide
• metacresol
• sodium kolorayidi
• zinc acetate
• sodium hydrogen phosphate,
• madzi okonzedwa mwapadera.

Madziwo amawonekera poyera, osakhala ndi mtundu uliwonse komanso wokhala ndi fungo labwino.

Zoyembekezeredwa

Levemir Penfill insulin ndi mankhwala osungira moyo, motero ndikofunikira kuti odwala adziwe zotsatira zomwe angagwiritse ntchito. Kuti mumvetsetse za mankhwala omwe amapezeka pamankhwala, muyenera kuphunzira malangizo, omwe amati kuti zomwe zimapangidwazo zimapangidwa ndi njira yopangira pogwiritsa ntchito ukadaulo wa DNA. Zotsatira zake, mphamvu ya insulin pamthupi imadziwika ndi kuchepa kwapang'onopang'ono komanso nthawi yayitali pochitapo kanthu poyerekeza ndi kutenga mahomoni apakati komanso apafupi.

Kamodzi m'magazi, zigawo zikuluzikulu zopanga insulin zimagwira pa membrane cell receptors. Zotsatira zake, maubwenzi amapangidwa omwe amalimbikitsa njira zamkati mwachangu ndikuwonjezera kuchuluka kwa kupanga enzyme.

Maonekedwe a kutsokomola

Levemir Penfill ndiyodziwika chifukwa cha kuthamanga kwathamanga, koma chizindikirocho chimatengera kwathunthu:

• masamba a jekeseni
• Mlingo wogwiritsidwa ntchito
• zaka odwala
• thanzi lanu.

Pambuyo pa maola 6-8 atatha kubayidwa, Levemir Penfill insulin amawonetsa ntchito yayitali. Chigawochi chimagwira mwachangu m'magazi ndi ziwiya zake m'magawo akuluakulu a 0,5 l / kg.

Zizindikiro zakuchipatala

Mankhwala aliwonse ayenera kugwiritsidwa ntchito mosamala kutsatira malangizo kapena kutsatira malangizo onse omwe dokotala akuthandizani. Katswiri wokhawo amene amatha kusanthula bwino chithunzichi ndi matendawa, amaganizira za kusanthula kwachipatala ndipo, malinga ndi mbiri yakale yomwe yasungidwa, apatseni mankhwala.

"Levemir Penfill" amapeza ntchito pochiza matenda ashuga. Mankhwalawa atha kutumikiridwa ngati mankhwala akuluakulu, ogwiritsira ntchito nthawi zina, kapena musankhe chithandizo chovuta pozindikira ndikuphatikiza insulin ndi mankhwala ena.

Akatswiri amati chida ichi chitha kugwiritsidwa ntchito pochiza odwala pafupifupi onse, kuphatikiza ana omwe afika zaka zisanu ndi chimodzi.

Contraindication

Ngakhale chitetezo chokwanira komanso kuthekera kogwiritsa ntchito ana, mankhwalawo ali ndi zovuta zake. Malangizo opita ku Levemir Penfill alembe zotsatirazi zomwe zimapangitsa kuti mankhwalawo akhale osatheka. Izi zikuphatikiza:

• ukalamba wa wodwala
• matenda a impso kapena chiwindi
• Hypersensitivity payekha.

"Levemir Penfill" ndi "Levemir Flexspen" ali ndi mawonekedwe ofanana, kotero, zotsutsana zonse zomwe zalembedwa zimagwiritsa ntchito mitundu yonse iwiri yamankhwala. Pankhaniyi, zoletsa ndizokhwima, koma tsankho la munthu limatha kuwongoleredwa nthawi zina. Munthawi zina, kugwiritsa ntchito mankhwalawa kumaloledwa, koma katswiri amayenera kuwunika wodwalayo mosamala, ngati pakufunika, asinthe mankhwalawo kapena asinthe njira zamankhwala pakuchoka kwina kulikonse.

Kufunika kwa chithandizo choyenera

Levemir Penfill, mawonekedwe ake omwe amaphatikiza madzi okha a jekeseni, ndikofunikira kukonzekera kwa odwala matenda a shuga. Nthawi zambiri, popanda wodwala kuti amupatse, wodwala amatha kufa. Komabe, kuvulaza kwakukulu ku thanzi kumatha kuchitika ngati simutsatira malamulo a mankhwalawo ndipo simutsatira malangizo onse a dokotala.

Mankhwalawa ayenera kugwiritsidwa ntchito malinga ndi zomwe zaphatikizidwa, ndipo simungasinthe kalikonse popanda kudziwa katswiri. Zikakhala zoterezi, kudzilimbitsa nokha kumatha kukhala matenda oyipa kwa wodwala.

Momwe mungagwiritsire ntchito mankhwalawa

Levemir Penfill amapezeka ngati jekeseni wofikira. Kufotokozera kwa mankhwalawa ndi motere:

• Phukusi lili ndi ma cartridge magalasi,
• 3 ml yankho lokonzekera jakisoni limakwanira katiriji iliyonse.

Ngati jakisoni, syringe yapadera ya insulin ndiyofunikira. Njira yothetsera vutoli imangoperekedwa pokhapokha, vuto lina siligwiritsidwa ntchito. Jekeseni amayenera kuperekedwa kokha m'malo ena a thupi. Izi ndichifukwa choti m'malo ena zofunikira zimamwa mwachangu, zomwe zimatsimikizira kutha kwa mankhwalawa.

Malo abwino oti jakisoni ndi:

Pofuna kupewa kukula kwa zizindikiro zosasangalatsa komanso zoyipa, ndikofunikira kusinthana ndi malo omwe amaba jakisoni nthawi ndi nthawi, koma mwa magawo omwe akulimbikitsidwa. Kupanda kutero, insulin yopanga imasiya kulowa mwachangu kulowa m'magazi ndikuphatikizidwa moyenera, zomwe zingakhudze chithandizo komanso kupambana kwa chithandizo.

Timaphunzira malangizo ogwiritsa ntchito

Levemir Penfill ili ndi malangizo ogwiritsira ntchito phukusi lililonse. Iyenera kuphunziridwa mosamala. Komabe, katswiriyo nthawi zonse amapereka mankhwala a insulin yekha payekhapayekha. Kuchuluka kwa mankhwala omwe amathandizidwa kumayendetsedwa ndi zinthu zambiri:

• kukhalapo kwa matenda owonjezera,
• zaka odwala
• mawonekedwe a shuga.

Komanso, adotolo amatha kusintha nthawi zonse mulingo wocheperako kapena waukulu, kutengera mphamvu yomwe akuyembekezera. Koma nthawi yomweyo, amawongolera njira yochiritsirayo, amasanthula mphamvu ndipo, mogwirizana ndi izi, amasintha dongosolo la ma jakisoni.

Ndikofunikira kugwiritsa ntchito mankhwala "Levemir Penfill" kamodzi kapena kawiri pa tsiku. Malangizowo amanenanso kuti jakisoni amayenera kuyikidwa nthawi yomweyo.

Chenjezo kwa Gulu Lodwala Lapadera

Levemir Penfill ayenera kuyikidwa kokha ndi dokotala yemwe amatha kuganizira zina mwazinthu zokhudzana ndi gulu lapadera la odwala. Nthawi zina, kusamala kwambiri ndikofunikira, chifukwa thupi la okalamba kapena ana amatha kuyankha poyambitsa mankhwala opangira osati malinga ndi zomwe anakonza.

Okalamba insulin mankhwala

Zosintha zilizonse zokhudzana ndi zaka zimawonekera mumkhalidwe waumoyo. Nthawi yomweyo, amatha kuchitapo kanthu chifukwa cha kuyamwa kwa mahomoni opanga, chifukwa chomwe wodwalayo amakhala ndi zovuta nthawi zambiri. Chifukwa chake, musanagwiritse ntchito mankhwalawa, kuyezetsa magazi kwa okalamba kuyenera kuchitika kuti kukhazikike kwa matenda okhudzana ndi matenda a shuga.

Chisamaliro chachikulu chimaperekedwa pa ntchito ya chiwindi ndi impso, komabe, sitinganene kuti wodwalayo wokalakwayo akuphwanya lamulo la mtundu wa insulin. Madokotala amagwiritsa ntchito mankhwalawa mankhwalawa odwala, koma amayang'anitsitsa thanzi lawo ndipo ngati kuli kotheka, muchepetseni.

Mbali zakuchiritsa ana

"Levemir Penfill" akhoza kutumizidwa kukonza ma insulin m'thupi la ana opitilira zaka 6. Komabe, wachichepere ndi kuphwanya malamulo mosamalitsa popereka mankhwalawa.

Palibe maphunziro omwe adachitika pazotsatira za insulin m'matupi a ana ang'ono ngati awa. Chifukwa chake, palibe katswiri yemwe angayambike kuyika patsogolo thanzi la wodwala wake ndikupereka mankhwala osiyanasiyana omwe alimbikitsidwe pagululi.

Umboni wonena za levemir flekspen

Mimba yonse yakhala matenda ashuga. Anadziletsa, sanadye shuga, makeke, kupanikizana, ndi zina zambiri, adatsata zakudya zowerengera zowerengera za mkate ndikusunga diary ya chakudya. Koma, mwatsoka, zonsezi sizinandithandize. Panali shuga wambiri, nthawi zina mpaka magawo 13 omwe amafikira chakudya (ndipo chizolowezi ndi 7). Endocrinologist zotchulidwa insulin, monga mapiritsi ali contraindicated kwa amayi apakati. Ndidakwiya kwambiri, ndimaganiza kuti ndiziimbira jakisoni nthawi zonse, koma adandifotokozera kuti ndimachitira mwana zonsezi. Chogoba "Novo-haraka" m'magawo a mkate katatu pakadutsa mphindi 5 musanadye, komanso "Levemir" magawo awiri usiku. Ndidaphunzira kugwiritsa ntchito zolembera zotsimikizira, ndizothandiza. Ndikofunikira kuti tidziwitse kuchuluka kwa magawo, kupaka jekeseni. Zilibe zowawa, yankho lake silinachepe, koma nthawi zina ndinali ndi mikwingwirima, mwina sindimafikako. Ma singano a zolembera zotsalira siotsika mtengo, koma sindinasinthe nditangogwiritsa ntchito, popeza iyi ndi insulin yanga. Shuga nthawi yomweyo amabwereranso. Pambuyo pa masabata 35, kapamba wa mwana adayamba kugwira ntchito ndipo adayamba kuthandiza ndi shuga, ndipo Levemir adathetsedwa usiku wonse.Ndinabereka mwana wamkazi wathanzi, koma chifukwa chakubadwa kwanthawi yayitali komanso matenda anga a shuga, mwana anali ndi shuga wochepa pobadwa.

Kufotokozera kwapfupi

Levemir Flexpen ndi insulin yokhala nthawi yayitali. Kuti mupeze mankhwalawa, njira yogwiritsa ntchito njira yogwiritsira ntchito biotechnological imagwiritsidwa ntchito, yomwe ikukhudzana ndi kuyambitsa kwamoyo ndi njira zachilengedwe popanga mankhwala. Pankhaniyi, yisiti yophika buledi imagwiritsidwa ntchito - mtundu wa bowa wopangidwa ndi microscopic yochokera ku gulu la saccharomycetes. Kuchita kwanthawi yayitali kumalumikizidwa ndi mawonekedwe a mamolekyulu a mankhwala, kuphatikiza kuthekera kwawo poyanjana komanso kulumikizana ndi serum albin. Mankhwala amadziwika ndi kuchedwa kugawa mu zotumphukira, zomwe zimapangitsa kuti mayamwidwe ndi mbiri ya mankhwala azitha. Kutsika kwa shuga m'magazi a m'magazi kumalumikizidwa ndi mayendedwe owonjezereka mkati mwa maselo, kugwiritsa ntchito kwambiri minofu, kusinthika kwa kutembenuka kwa acetyl-CoA kukhala mafuta acids, kaphatikizidwe ka glycogen kuchokera ku glucose, ndi kuchepa kwapang'onopang'ono pakupanga shuga m'magazi. Kutalika kwa Hypoglycemic zotsatira za mankhwala ndi mankhwala omwe angagwiritsidwe ntchito ndipo amatha kukhala mpaka maola 24. Mankhwalawa amasiyanitsidwa ndi, popanda lakuthwa nsonga za usiku, ndipo mwanjira yake, kuchepa kwa hypoglycemia usiku. Hafu ya moyo wa mankhwala pambuyo subcutaneous makonzedwe amasiyanasiyana kwa 5 mpaka 7 maola. Kukhazikikako kumatha kupangidwa m'magawo osiyanasiyana a thupi (mbali ya mwendo kuyambira m'chiuno mpaka kuwerama bondo, mkono wam'mwamba mpaka cholowelera cham'manja, khoma lamkati lakumbuyo). Ndikofunika kuti musinthe malowa kuti muchepetse mafuta am'deralo. Mukapanga jekeseni khoma lamkati lamkati, mphamvu ya hypoglycemic imakula msanga. Pafupipafupi makonzedwe a mankhwala zimatsimikiziridwa ndi kufunika kwa wodwala ndipo ndi 1-2 pa tsiku. Ngati mukufuna kuphatikiza mankhwalawa kawiri, muyeso wachiwiri umaperekedwa musanadye chakudya chamadzulo, kapena musanagone. Nthawi yayitali pakati pa m'mawa ndi madzulo Mlingo wake ndi maola 12. Kwa anthu okalamba, komanso odwala omwe ali ndi vuto la impso komanso kwa chiwindi, owunika kwambiri azachipatala ayenera kuwongolera kusintha kwa mankhwalawa panthawi yake ngati kuli kotheka.

Kufunika kwa kusintha kwa mankhwalawa kwa mankhwalawo kumatha kuchitika komanso kuwonjezereka kwa kuchuluka kwa zochitika zolimbitsa thupi, kusintha kwazomwe mumadya, komanso kupezeka kwa matenda ophatikizika. Choyipa chachikulu chosavomerezeka chomwe chingachitike mukamagwiritsa ntchito mankhwala ndi hypoglycemia. Zizindikiro zake ndi: kuphimba pakhungu, kuwonekera thukuta, kutopa kwambiri, kuchuluka kwamanjenje, kunjenjemera kwa zala, kusokoneza, kusokoneza thupi, kuchuluka kwakukhalitsa kwa chidwi, kusokonezeka kowoneka, kuperewera kwamtima, chidwi chakusanza. Ndi hypoglycemia yayikulu, kutha kwa chikumbumtima ndikotheka. Glycemia wambiri amatha kupha. Ndikotheka kukulitsa zomwe zimachitika mdera la jakisoni: hyperemia, kutupa, kumverera kwa kupweteka koyipa kwa khungu, kuchititsa kufunafuna malo osakwiya. Zomwe zimachitika mderalo nthawi zambiri zimakhala zachilengedwe mwadzidzidzi ndipo zimazimiririka zokha popanda kuchitapo kanthu. Milandu yokhudzana ndi thupi lawo siligwirizana: urticaria, zotupa za pakhungu. Muzochita za ana, ndimagwiritsa ntchito mankhwalawa odwala omwe afika zaka 6. Mankhwala amphamvu ndi Levemir samakhudza kwambiri thupi la wodwalayo. Kuchepetsa kwa pharmacotherapy kapena osakwanira mlingo kungayambitse hyperglycemia. Zizindikiro zake: Kulimbikitsidwa kumwa, kusokonekera pafupipafupi, kulimbikitsa kusanza (kuphatikiza ogwira ntchito), kugona, kufooka kwa khungu, Hyposalivation, kusowa kwa chakudya, kununkhira kwa acetone mkamwa. Ndi mlingo wokwanira, hypoglycemia imayamba. Kukula kwake ndikothekanso ndi kusakhalapo kwakutali kwa chakudya m'thupi, kuchita masewera olimbitsa thupi mopitirira muyeso. Kupezeka kwa ma concomitant pathologies (makamaka matenda omwe amapezeka ndi kuwonjezeka kwakukulu kwa kutentha kwa thupi) kungafunike kuwonjezeka kwa mlingo wa mankhwalawo.

Pharmacology

Yopangidwa ndi recompinant DNA biotechnology pogwiritsa ntchito Saccharomyces cerevisiae. Ndi tsamba losungunuka la insulin ya anthu omwe akhala akuchita zinthu zazitali mwachinsinsi.

Mbiri yamachitidwe a mankhwala Levemir ® FlexPen ® ndiosiyana kwambiri ndi isofan-insulin ndi insulin glargine.

Kuchitika kwakanthawi kwa mankhwalawa Levemir ® FlexPen ® ndi chifukwa chodziyimira payekha wa mamolekyu a insulir pamalo opangira jakisoni komanso kumanga kwa mamolekyulu a mankhwalawa kuti albumin pogwiritsa ntchito phula lomwe limakhala ndi mbali yamafuta acid. Poyerekeza ndi isofan-insulin, insulini ya detemir imaperekedwa kwa zotumphukira za minofu pang'onopang'ono. Njira zophatikizidwazo zomwe zimaperekedwako zimapereka mayendedwe obwereza komanso mawonekedwe a Levemir ® FlexPen ® poyerekeza ndi isofan-insulin.

Mlingo wa 0.2-0.4 U / kg 50%, kuchuluka kwake kwa mankhwalawa kumachitika mosiyanasiyana kuyambira maola 3-4 mpaka maola 14 atatha kutsata. Kutalika kwa nthawi mpaka maola 24, kutengera mlingo, zomwe zimapangitsa kupereka nthawi 1 / tsiku kapena 2 nthawi / tsiku. Ndi kaimidwe kawiri tsiku lililonse kwamakonzedwe a C_ss akwaniritse makonzedwe a 2-3 Mlingo wa mankhwala.

Pambuyo sc makonzedwe, pharmacodynamic poyankha anali wofanana mlingo kutumikiridwa (pazipita, nthawi ya zochita, ambiri zotsatira).

Kafukufuku wautali wawonetsa kusinthasintha kwakachepa kwa tsiku ndi tsiku.
kusala kudya kwa plasma glucose pochiza odwala omwe ali ndi Levemir ® FlexPen ® mosiyana ndi isofan-insulin.

M'maphunziro a nthawi yayitali omwe ali ndi odwala omwe ali ndi mtundu wachiwiri wa shuga omwe adalandira insal insulin mankhwala osakanikirana ndi mankhwala a hypoglycemic, adawonetsedwa kuti amawongolera glycemic (malinga ndi glycosylated hemoglobin -_1s) kumbuyo kwa mankhwala a Levemir ® FlexPen ®, inali yofanana ndi yomwe pochiza isofan-insulin ndi insulin glargine wokhala ndi phindu lolemera.

Gome 1. Kusintha kwa thupi pa insulin

Mu maphunziro, kugwiritsa ntchito mankhwala osakanikirana ndi mankhwala a Levemir ® FlexPen ® ndi mankhwala a hypoglycemic amachepetsa chiopsezo chokhala ndi hypoglycemia usiku pang'ono ndi 61-65%, mosiyana ndi isofan-insulin.

Chiyeso chotseguka, chosasankhidwa cha odwala adachitidwa ndi odwala omwe ali ndi matenda amtundu wa 2 omwe sanakwaniritse zomwe akufuna.

Phunziroli linayamba ndi nyengo ya kukonzekera kwa masabata 12, pomwe odwala adalandira chithandizo chamankhwala a liraglutide osakanikirana ndi metformin, ndipo omwe 85% odwala adakwaniritsa HbA_1s ® FlexPen ® mu kumwa kamodzi tsiku lililonse, wodwala winayo anapitilizabe kulandira liraglutide kuphatikiza ndi metformin kwa milungu 52 yotsatira. Munthawi imeneyi, gulu la achire, lomwe linalandira, kuphatikiza liraglutide ndi metformin, jekeseni imodzi ya Levemir ® FlexPen ®, idawonetsa kuchepa kwa index ya HbA_1s kuyambira koyamba 7.6% mpaka pa 7.1% kumapeto kwa masabata 52, pakalibe zigawo za hypoglycemia yayikulu. Powonjezera muyezo wa Levemir ® FlexPen ® ku liraglutide therapy, omalizawo adasunganso mwayi wokhudzana ndi kuchepa kwakukulu kwa kulemera kwamthupi mwa odwala (onani Gome 2).

Gome 2. Zoyeserera zamankhwala - zothandizira Levemir ®, zotchulidwa kuwonjezera pa mankhwala ophatikizidwa ndi liraglutide ndi metformin