Ultra-yochepa-insulin Apidra

Ultrashort insulini imayamba kugwira ntchito mphindi 5-15 pambuyo pa kutsata, ndipo zotsatira zake zambiri zimachitika mu ola limodzi. Zovomerezeka pafupifupi maola anayi. Chifukwa chake, muyenera kuyikamo mphindi 15 musanadye chakudya, koma osati kale, apo ayi, kuyambitsa kwa hypoglycemia ndikotheka.

Ndikupangira kuwerenga zolemba zomwe ndidapeza pa netiweki pamutu wa ultrashort insulin Apidra.

Apidra® (Apidra®)

Zogwira ntchito: insulin glulisin

Fomu ya Mlingo: yankho la subcutaneous makonzedwe

1 ml yankho lili:

yogwira mankhwala: insulin glulisin 100 UNITS (3.49 mg), otuluka: metacresol (m-cresol) 3.15 mg, trometamol (tromethamine) 6.0 mg, sodium chloride 5.0 mg, polysorbate 20 0,01 mg , sodium hydroxide kuti pH 7.3, hydrochloric acid kuti pH 7.3, madzi a jakisoni mpaka 1.0 ml.

Kufotokozera: Chowera, chopanda utoto.

Gulu la Pharmacotherapeutic: hypoglycemic wothandizira - anthawi yochepa insulin.

ATX: A.10.A.B.06 Insulin glulisin

Mankhwala

Insulin glulisin ndi analogue yobwerezabwereza ya insulin ya anthu, yofanana ndi mphamvu kwa insulin wamba ya anthu. Pambuyo pothandizidwa ndi insulin, glulisin amayamba kuchita zinthu mwachangu ndipo amakhala ndi nthawi yofupikirako kuposa insulin yaumunthu.

Kafukufuku wodzipereka kwa odwala omwe ali ndi thanzi labwino komanso odwala omwe ali ndi matenda osokoneza bongo adawonetsa kuti ndi subulinaneous insulin, glulisin amayamba kuchita zinthu mwachangu komanso amakhala ndi nthawi yofupikirapo kuposa kusungunuka kwa insulin yamunthu. Ndi subcutaneous makonzedwe, kutsitsa kuchuluka kwa shuga m'magazi, ntchito ya insulin glulisin imayamba mu 10-20 mphindi.

Mothandizidwa ndi mtsempha wa magazi, zotsatira za kuchepa kwa magazi m'magazi a insulin glulisin ndi insulle ya insulin yamunthu ndizofanana mu mphamvu. Gawo limodzi la insulin glulisin limakhala ndi ntchito yofanana yotsitsa shuga monga gawo limodzi la insulin yaumunthu.

Mu gawo lomwe ndimaphunzirira odwala omwe ali ndi mtundu wa 1 shuga mellitus, ma glucose-kutsitsa mafayilo a insulin glulisin ndi insulle ya insulle yaumunthu amathandizidwa mosavomerezeka pamankhwala a 0,15 U / kg panthawi zosiyanasiyana pokhudzana ndi chakudya chamagulu 15.

Zotsatira za phunziroli zidawonetsa kuti insulini glulisin yoyendetsedwa mphindi 2 asanadye chakudya chimapereka chiwonetsero chofananira cha glycemic pambuyo podya monga munthu amasungunuka kwa insulin mphindi 30 asanadye. Pakaperekedwa mphindi ziwiri asanadye, insulin glulisin imapereka chiwongolero chabwinoko pakatha chakudya kuposa chakudya chosungunuka chomwe munthu amakhala nacho pakadutsa mphindi 2 asanadye.

Glulisin insulin kutumikiridwa mphindi 15 chakudya chitayamba kupereka chiwonetsero chofananira cha glycemic pambuyo chakudya monga munthu wosungunuka wa insulin, kutumikiridwa mphindi 2 chakudya chisanachitike.

Gawo loyamba lomwe ndimaphunziro a insulin glulisin, insulin lispro ndi insulin ya insulin ya anthu omwe ali m'gulu la onenepa kwambiri adawonetsa kuti mwa odwalawa, insulin glulisin imakhalabe ndi machitidwe omwe amathandizira.

Phunziroli, nthawi yoti ifike 20% ya AUC yonse inali insulin glulisin, 121 mphindi ya insulin lispro ndi 150 min yankho la insulle ya anthu, komanso AUC (0-2H), yomwe ikuwonetsanso ntchito zapansi zoyambira glucose, motero, inali 427 mg / makilogalamu a insulin glulisin, 354 mg / kg kwa insulin lispro, ndi 197 mg / kg ya insulle ya anthu sungunuka.

Maphunziro azachipatala

Mtundu woyamba wa shuga

M'masabata makumi awiri ndi awiri omwe amayesa gawo lachitatu la III, lomwe limafananizira insulini glulisin ndi insulin lispro yomwe imayendetsedwa mosakhalitsa asanadye (0-15 mphindi) kwa odwala omwe ali ndi matenda a shuga 1 omwe amagwiritsa ntchito insulin glargine monga insulin insulini, insulin glulisin inali yofanana ndi lispro insulin yoletsa glycemic, yomwe idayesedwa ndi kusintha kwa kuchuluka kwa glycosylated hemoglobin (HbA1c) panthawi yotsiriza ya kafukufuku poyerekeza ndi zotsatira zake.

Chiyeso cha milungu 12 cha gawo lachitatu chomwe chimachitika mwa odwala omwe ali ndi matenda a shuga 1 omwe adalandira insulin glargine monga chithandizo choyambira cha basal chinawonetsa kuti mphamvu ya insulin glulisin yoyang'anira mukangomaliza kudya inali yofanana ndi ya insulin glulisin musanadye chakudya (0 -15 min) kapena insulin ya anthu sungunuka (30-45 mphindi musanadye).

Mwa kuchuluka kwa odwala omwe anamaliza phunziroli, pagulu la odwala omwe adalandira insulin glulisin asanadye, panali kuchepa kwakukulu kwa HbA1C poyerekeza ndi gulu la odwala omwe adalandira insulin yaumunthu yosungunuka.

Type 2 shuga

Kuyesedwa kwamankhwala kwa gawo la 26 la milungu yachitatu yotsatiridwa ndikutsatiridwa kwa masabata a 26 mu mawonekedwe a kafukufuku wachitetezo adachitidwa kuti afanize insulin glulisin (0-15 mphindi musanadye) ndi insulin ya insulle ya anthu (30-45 mphindi asanadye), omwe adalowetsedwa m'mankhwala odwala omwe ali ndi matenda a shuga 2, kuwonjezera insulin-isophan monga basal insulin.

Phunziroli, odwala ambiri (79%) adasakaniza insulin yawo yochepa ndi isulin insulin nthawi yomweyo asanalowe. Odwala a 58 panthawi ya kuchepa kwa mankhwalawa amagwiritsa ntchito mankhwala am'mlomo a hypoglycemic ndipo adalandira malangizo kuti apitirize kumwa nawo mwanjira yomweyo.

Popitirira kulowetsedwa kwa insulini kulowetsedwa pogwiritsa ntchito chipumphu-chinthu 1 (matenda a shuga 1), mwa odwala 59 omwe amathandizidwa ndi Apidra ® kapena insulin aspart, kuchepa kwa zochitika za catheter kumawonetsedwa m'magulu onse azithandizo (0,08 ma occlusions pamwezi ndi Apidra® ndi 0,15 ma occlusions pamwezi pogwiritsa ntchito insulin aspart), komanso pafupipafupi pamafotokozedwe a malo a jakisoni (10,3% mukamagwiritsa ntchito Apidra® ndi 13.3% mukamagwiritsa ntchito insulin aspart).

Nthawi yomweyo, pakatha milungu 26 ya chithandizo, odwala omwe amalandila chithandizo cha insulini glulisin kuti akwaniritse kuwongolera kwa glycemic ofanana ndi lispro insulin amafunikira kuwonjezeka kocheperako pa tsiku lililonse la insulin insulin, kudya insulin mwachangu komanso kuchuluka kwa insulin.

Mtundu ndi jenda

M'mayeso azachipatala olamulidwa mwa akulu, panalibe kusiyana pakukhazikika komanso kufunikira kwa insulin glulisin pakuwunika kwamagulu omwe amadziwika ndi mtundu.

Mayamwidwe ndi Bioavailability

Pharmacokinetic concentration time-curves in odzipereka athanzi komanso odwala omwe ali ndi mtundu wa 2 ndi mtundu wa 2 matenda osokoneza bongo adawonetsa kuti kuyamwa kwa insulini glulisin poyerekeza ndi insulin ya insulin yaumunthu kunali pafupifupi kawiri nthawi yayikulu ndipo kuchuluka kwakukulu kwa plasma (Cmax) kunali pafupifupi 2 nthawi zina.

Mu kafukufuku wochitidwa mwa odwala omwe ali ndi matenda a shuga 1, atatha kulowetsedwa kwa insulin glulisin pa mlingo wa 0,15 IU / kg, Tmax (nthawi yoyambira ndende ya plasma) anali mphindi 55, ndipo Cmax anali 82 ± 1.3 μU / ml poyerekeza ndi Tmax yamphindi 82 ndi Cmax wa 46 ± 1.3 μU / ml ya insulin yaumunthu. Nthawi yomwe amakhala munthawi yogwiritsira ntchito insulin glulisin inali yocheperako (mphindi 98) kusiyana ndi insulle ya munthu (161 mphindi).

Pakufufuza kwa odwala omwe ali ndi mtundu wa 2 matenda a shuga pambuyo poyambira kutsata insulini glulisin pamlingo wa 0.2 U / kg, Cmax anali 91 mkU / ml wokhala ndi masentimita 78 mpaka 104 mkU / ml.

Ndi subcutaneous makonzedwe a insulin glulisin m'chigawo cha anterior m'mimba khoma, ntchafu, kapena phewa (m'chigawo cha minyewa ya deltoid), mayamwidwe anali mwachangu pamene adalowetsedwa m'chigawo cha khomo lakunja kwam'mimba poyerekeza ndi kuyamwa kwa mankhwalawa. Kuchuluka kwa mayamwidwe kudera lotetemera kunali kwapakatikati.

Mtheradi bioavailability wa insulin glulisin pambuyo subcutaneous makonzedwe anali pafupifupi 70% (73% kuchokera khoma lamkati lakumbuyo, 71 kuchokera ku minofu ya deltoid ndi 68% kuchokera kudera lachikazi) ndipo anali ndi kusiyana kochepa kwa odwala osiyanasiyana.

Kugawa ndi Kuchotsa

Kugawika ndi kutulutsa kwa insulin glulisin ndi madzi osungunuka pakhungu pambuyo pamitsempha yama cell ndi ofanana, ndikugawa mavitamini 13 malita ndi malita 21 ndi theka la moyo wamphindi 13 ndi 17, motsatana.

Pakufufuza kwapadera kwamaphunziro a insulin glulisin mwa onse athanzi komanso omwe ali ndi matenda amtundu wa 1 komanso mtundu wa 2, theka la moyo limachokera pamphindi 37 mpaka 75.

Magulu Opatsa Odwala

Odwala omwe ali ndi vuto la impso

Mu kafukufuku wazachipatala omwe amapangidwa mwa anthu opanda matenda a shuga omwe ali ndi magwiridwe antchito osiyanasiyana a impso (creatinine clearance (CC)> 80 ml / min, 30-50 ml / min, Zizindikiro

Matenda a shuga omwe amafunikira chithandizo cha insulin mwa akulu, achinyamata ndi ana opitilira zaka 6.

Contraindication

Hypersensitivity kuti insulin glulisin kapena chilichonse cha mankhwala. Hypoglycemia. Chenjezo: Pa nthawi yoyembekezera. Mimba ndi Kuyambukira: Mimba

Palibe maphunziro azachipatala omwe amawongolera pakugwiritsa ntchito Apidra® mwa amayi apakati. Zambiri zomwe zimapezeka pakugwiritsa ntchito insulin glulisin mwa amayi apakati (zosakwana zotsatira za 300 zapakati) sizikuwonetsa zovuta zake pakubala, kukula kwa intrauterine kwa mwana wosabadwayo kapena wakhanda wakhanda.

Kugwiritsa ntchito Apidra® SoloStar® mwa amayi oyembekezera kuyenera kuchitika mosamala. Kusamala mosamala za kuchuluka kwa shuga m'magazi ndikusungabe glycemic control ndikofunikira.

Odwala omwe ali ndi pakati asanabadwe kapena matenda ashuga ayenera kusamalitsa pakulimbana kwawo konse. Munthawi yoyamba kubereka, kufunika kwa insulini kumatha kuchepa, ndipo panthawi yachiwiri komanso yachitatu, imatha kuchuluka. Pambuyo pobadwa, insulini imafuna kuchepa mwachangu.

Mlingo ndi makonzedwe

Apidra® iyenera kutumikiridwa posachedwa (mphindi 0-15) isanachitike kapena itangotha kumene chakudya.

Apidra® iyenera kugwiritsidwa ntchito pamankhwala azachipatala omwe amaphatikizapo insulini kapena sing'anga wa insulin wa nthawi yayitali kapena wothandizira wa insulin. Kuphatikiza apo, Apidra® ikhoza kugwiritsidwa ntchito limodzi ndi mankhwala amkamwa a hypoglycemic. Mlingo wa mankhwalawa Apidra® amasankhidwa payekha.

Kupereka mankhwala

Apidra® idapangidwa kuti ichepetsedwe kosakanizira kapena kulowetsedwa kosalekeza kwa insulini pogwiritsa ntchito zida zokupaka yoyenera kuperekera insulin.

Kuchuluka kwa mayamwidwe, motero, kuyambira ndi kutalika kwa zochita zingakhudzidwe ndi: malo oyang'anira, zochitika zolimbitsa thupi ndi zina zosintha. Kuwongolera koyenda kudera lakhoma lamkati kwam'mimba kumayamwa mofulumira kuposa kuyendetsa mbali zina za thupi zomwe zafotokozedwa pamwambapa (onani gawo la Pharmacokinetics).

Chenjezo liyenera kuonedwa kuti mankhwalawo asalowe mwachindunji m'mitsempha ya magazi. Pambuyo pa kukonzekera mankhwalawa, ndizosatheka kutikita minyewa yoyang'anira. Odwala ayenera kuphunzitsidwa njira yolondola ya jakisoni.

Hypodermic insulin kusakaniza

Apidra® ikhoza kusakanikirana ndi insulin-isophan yaumunthu. Mukasakaniza Apidra® ndi insulin-isophan yaumunthu, Apidra® iyenera kukokedwa mu syringe yoyamba. Jekeseni wa subcutaneous uyenera kuchitika mukangosakaniza. Ophatikizira ma insulin omwe ali pamwambapa sangathe kutumikiridwa.

Kugwiritsa ntchito Apidra ® ndi chipangizo chochitira pampu popitiliza kulowetsedwa kosalekeza

Apidra® itha kuperekedwanso ntchito pogwiritsa ntchito chipompo chopitilira kulowetsedwa kwa insulin. Nthawi yomweyo, kulowetsedwa ndi chosungira chogwiritsidwa ntchito ndi Apidra ® ziyenera kusinthidwa ndi malamulo aseptic pafupifupi maola 48 aliwonse.

Malangizowa atha kusiyanasiyana ndi malangizo omwe amapezeka m'mabuku. Ndikofunika kuti odwala azitsatira malangizo apadera omwe ali pamwambawa kuti agwiritse ntchito Apidra®. Kulephera kutsatira malangizo apaderawa ogwiritsidwa ntchito ndi Apidra® kungapangitse kuti pakhale zochitika zovuta kwambiri.

Mukamagwiritsa ntchito Apidra® ndi chipangizo chothandizira kupompheletsa kulowetsedwa mosalekeza. Apidra® sayenera kusakanikirana ndi ma insulin ena kapena sol sol.

Odwala omwe amaperekedwa ndi Apidra® ndi kulowetsedwa mosalekeza ayenera kukhala ndi njira zina zowongolera insulin ndipo ayenera kuphunzitsidwa kuperekera insulin mwa kubaya jakisoni wa subcutaneous.

Mukamagwiritsa ntchito Apidra® ndi zida zama pampu zopitilira kulowetsedwa kwa insulin, kusokonezeka kwa chipangizo, kusachita bwino kwa kulowetsedwa kapena zolakwika pakuzisamalira zingayambitse kukulitsa kwa hyperglycemia, ketosis ndi matenda ashuga a ketoacidosis. Pankhani ya chitukuko cha hyperglycemia kapena ketosis kapena matenda ashuga ketoacidosis, kuzindikiritsa mwachangu ndi kuchotsera zomwe zimayambitsa chitukuko.

Magulu apadera a odwala

Ntchito yovuta yaimpso: Kufunika kwa insulini pakukanika kwa impso kumatha kuchepa.

Kuwonongeka kwa chiwindi: Odwala omwe ali ndi vuto la chiwindi, vuto la insulin lingathe kuchepa chifukwa cha kuchepetsedwa kwa gluconeogeneis komanso kuchepa kwa insulin metabolism.

Odwala okalamba: Zambiri zomwe zimapezeka mu pharmacokinetic mwa odwala okalamba omwe ali ndi matenda osokoneza bongo ndi osakwanira. Kugwedezeka kwa impso muukalamba kungachititse kuchepa kwa insulin.

Ana ndi achinyamata: Apidra® ikhoza kugwiritsidwa ntchito mwa ana opitilira zaka 6 ndi achinyamata. Zambiri zamankhwala pazokhudza kugwiritsa ntchito mankhwalawa kwa ana osakwana zaka 6 ndizochepa.

Tsatirani malangizo oyenera kugwiritsa ntchito zolembera zodzaza usanazidwe (onani gawo "Malangizo ogwiritsira ntchito ndi kusamalira").

Zotsatira zoyipa

Zotsatira zoyipa zomwe adaziwona ndizomwe zimachitika mu gulu la zamankhwala awa, motero, zimafanana ndi insulin iliyonse. Zovuta za metabolism ndi zakudya Hypoglycemia, zotheka kwambiri chifukwa cha insulin, zitha kuchitika ngati mulingo wambiri wa insulin utagwiritsidwa ntchito mopitilira kufunika kwake.

Zizindikiro za hypoglycemia nthawi zambiri zimachitika mwadzidzidzi.Komabe, nthawi zambiri vuto la neuropsychiatric chifukwa cha neuroglycopenia (kumva kuti watopa, kutopa kwachilendo kapena kufooka, kuchepa kwa chidwi, kugona, kusawona bwino, kupweteka mutu, nseru, kusokonezeka kapena kutayika kwa chikumbumtima, matenda opatsirana) zimayang'aniridwa ndi zizindikiro za adrenergic anti-regulation (kutsegula kwachisoni. Dongosolo la adrenal poyankha hypoglycemia): njala, kusakwiya, kusangalala kapena kugwedezeka, nkhawa, kufooka kwa khungu, thukuta "lozizira", tach icardia, palpitations kwambiri (hypoglycemia imayamba kukhazikika ndipo zikakhala zovuta, ndizomwe zimatchulidwa ndizizindikiro za kutsutsa kwa adrenergic).

Kusokonezeka Kwa Magazi

Hypersensitivity zochitika zimatha kuchitika (hyperemia, kutupa ndi kuyabwa pamalo a jakisoni wa insulin). Izi zimachitika kawirikawiri patatha masiku angapo kapena milungu ingapo ndikugwiritsa ntchito mankhwalawa. Nthawi zina, izi sizingakhale zokhudzana ndi insulin, koma zimayambitsidwa ndi kupsinjika kwakhungu komwe kumayamba chifukwa cha mankhwala a antiseptic musanalowetse jakisoni kapena jakisoni wosalakwitsa (ngati njira yolondola ya jakisoni wofundira satsatiridwa).

Systemic Hypersensitivity Reaction ku Insulin

Kusintha koteroko kwa insulin (kuphatikizapo insulin glulisin), mwachitsanzo, kumayendetsedwa ndi zotupa mthupi lonse (kuphatikizapo kuyabwa), chifuwa, kufinya, kuchepa kwa magazi, kuthamanga kwa mtima, kapena thukuta kwambiri. Milandu yambiri ya chifuwa chachikulu, kuphatikizapo mawonekedwe a anaphylactic, ikhoza kuyika moyo wa wodwala pangozi.

Kusokonezeka kwa khungu ndi minofu yolowerera

Lipodystrophy. Monga insulin ina iliyonse, lipodystrophy imatha kupezeka pamalo a jakisoni, omwe angachedwetse kuyamwa kwa insulin. Kukula kwa lipodystrophy kungayambitse kuphwanya kosinthana kwa malo a insulin, chifukwa kukhazikitsa mankhwala omwewo kumalo omwewo kungathandizire kukulitsidwa kwa lipodystrophy.

Kusinthana kosalekeza kwa malo a jekeseni mkati mwa imodzi mwa malo a jekeseni (ntchafu, phewa, kunja kwa khoma lam'mimba) kungathandize kuchepetsa ndikuletsa kukula kwa izi zosasangalatsa.

Zina

Kukhazikitsidwa mwangozi kwa ma insulin ena kwanenedwa molakwika, makamaka ochita insulin, m'malo mwa insulin glulisin.

Bongo

Ndi kuchuluka kwa insulin molingana ndi kufunikira kwake, komwe kumatsimikiziridwa ndi kudya ndi mphamvu zamagetsi, hypoglycemia imatha kupanga.

Palibe zambiri zachidziwikire zokhudzana ndi kuchuluka kwa insulin glulisin. Komabe, ndi bongo wambiri, hypoglycemia ikhoza kuyamba. Magawo a hypoglycemia wofatsa amatha kuyimitsidwa pakumwa shuga kapena zakudya zomwe zili ndi shuga. Chifukwa chake, tikulimbikitsidwa kuti odwala matenda ashuga nthawi zonse azikhala ndi shuga, maswiti, makeke kapena mandimu okoma zipatso.

Pambuyo pozindikira, tikulimbikitsidwa kupatsa wodwala zamkati mkati kuti tipewe kubwerezanso kwa hypoglycemia, zomwe zimatheka pambuyo pakuwoneka bwino kwachipatala. Pambuyo pa kukhazikitsidwa kwa glucagon, kukhazikitsa chomwe chimayambitsa vuto lalikulu la hypoglycemia ndikupewa kukula kwa zochitika zina zofanana, wodwala amayenera kuwonedwa kuchipatala.

Kuchita

Palibe kafukufuku pa zochitika zamachiritso a pharmacokinetic omwe adachitika. Kutengera kuzidziwitsidwa komwe kumanenedwa ndimankhwala ena ofanana, kuwoneka kwokhudzana kwambiri ndi ma pharmacokinetic mogwirizana. Mankhwala ena angakhudze kagayidwe ka glucose, kamene kangafunikire kusintha kwa insulin glulisin makamaka kuwunika mosamala chithandizo.

Zinthu zomwe zingachepetse zotsatira za hypoglycemic za insulin zimaphatikizapo: glucocorticosteroids, danazole, diazoxide, diuretics, glucagon, isoniazid, phenothiazine zotumphukira, somatropin, sympathomimetics (mwachitsanzo epinephrine adrenaline, salbutamol, mahomoni a chithokomiro. mu kulera kwa mahomoni), protease inhibitors ndi antiypychotic atypical (mwachitsanzo olanzapine ndi clozapine).

Beta-blockers, clonidine, mchere wa lithiamu kapena ethanol amatha kukhala wowonjezera kapena kufooketsa mphamvu ya hypoglycemic ya insulin. Pentamidine imatha kuyambitsa hypoglycemia kenako hyperglycemia. Kuphatikiza apo, mothandizidwa ndi mankhwalawa omwe ali ndi ntchito ya chisoni, monga beta-blockers, clonidine, guanethidine ndi reserpine, zizindikiro za adrenergic activation poyankha hypoglycemia sizitha kutchulidwa kapena kusapezeka.

Maupangiri Ogwirizana

Chifukwa cha kuchepa kwa maphunziro, insulin glulisin sayenera kusakanikirana ndi mankhwala ena onse, kupatulapo anthu isulin insulin. Ikaperekedwa pogwiritsa ntchito chopopera pampu yolumikizira, Apidra® sayenera kusakanikirana ndi sol sol kapena kukonzekera kwina kwa insulin.

Malangizo apadera

Chifukwa cha kufupika kwakanthawi kokhudzana ndi mankhwalawa Apidra®, odwala matenda a shuga amafunikanso kukhazikitsa ma insulin apakati kapena kulowetsedwa kwa insulini pogwiritsa ntchito insulin pampu kuti ikhalebe yolimba glycemic.

Kusintha kulikonse kwa mankhwala a insulin kuyenera kuchitika mosamala komanso pokhapokha kuyang'aniridwa ndi dokotala. Kusintha kwa insulin, wopanga insulin, mtundu wa insulin (soluble human insulin, insulin-isophan, insulin analogs), mitundu ya insulin (nyama insulin, insulin ya anthu kapena njira ya insulini). angafunike kusintha kwa insulin. Zingafunikenso kusintha kusintha kwa nthawi yomweyo.

Kufunika kwa insulini kungasinthe pa nthawi yomwe akudwala, chifukwa chakuchulukitsa kwazinthu kapena kupsinjika. Kugwiritsa ntchito Mlingo wa insulin wokwanira kapena kuletsa kumwa, makamaka kwa odwala matenda amishuga 1, kungayambitse matenda a hyperglycemia ndi matenda ashuga a ketoacidosis, mikhalidwe yomwe ingakhale pangozi.

Hypoglycemia

Nthawi yomwe hypoglycemia imayamba imadalira mphamvu ya magwiritsidwe a insulin, motero, amasintha m'mene mankhwalawo amasintha.

Zomwe zimatha kusintha kapena kupanga zochepa zomwe zimatulutsidwa kwa hypoglycemia zimaphatikizapo: kukulitsa kwa insulin mankhwala ndi kusintha kwakukulu pa kayendetsedwe ka glycemic, kukula kwapang'onopang'ono kwa hypoglycemia, wodwala wokalamba, kupezeka kwa neuropathy kwa dongosolo la neuronomic, kupezeka kwa nthawi yayitali kwa matenda a shuga komanso kugwiritsa ntchito mankhwala ena (onani. gawo "Kuyanjana ndi mankhwala ena").

Malangizo a insulin Mlingo ungafunikire ngati odwala achulukitsa zolimbitsa thupi kapena asintha nthawi yawo yanji. Kuchita masewera olimbitsa thupi mutangotha kudya kungakulitse chiopsezo cha hypoglycemia. Poyerekeza ndi insulin ya anthu osungunuka, hypoglycemia imatha kumayambika jekeseni wa insulin analogues asanachitike.

Kuchuluka kwa hypoglycemic kapena hyperglycemic komwe sikunachitike kungakuchititseni kuti musakhale ndi chikumbumtima, chikomokere, kapena kufa.

Kulephera kwina

Kufunika kwa Apidra ®, monga ndi ma insulin ena onse, kumatha kuchepa ngati kulephera kwa impso kumapitilira.

Kulephera kwa chiwindi

Odwala omwe ali ndi vuto la kuchepa kwa hepatic, kufunika kwa insulini kumachepetsedwa chifukwa cha kuchepa kwa mphamvu ya gluconeogeneis m'chiwindi komanso kuchepa kwa insulin metabolism.

Odwala okalamba

Kugwedezeka kwa impso muukalamba kungachititse kuchepa kwa insulin. Odwala okalamba amatha kuvutika kuzindikira zizindikiritso za hypoglycemia.

Ana ndi achinyamata

Apidra® ikhoza kugwiritsidwa ntchito mwa ana azaka zopitilira 6 ndi achinyamata. Zambiri zamankhwala pazokhudza kugwiritsa ntchito mankhwalawa kwa ana osakwana zaka 6 ndizochepa.

Mankhwala a pharmacokinetic ndi pharmacodynamic a insulin glulisin amaphunziridwa mwa ana (azaka 7-11) ndi achinyamata (azaka 12-16) okhala ndi matenda amtundu wa 1. M'magulu onse awiriwa, insulin glulisin idatengedwa mwachangu, ndipo kuchuluka kwake kwa mayamwidwe sikunasiyanane ndi zomwe zimachitika mwa akulu (odzipereka athanzi labwino komanso odwala omwe ali ndi matenda a shuga 1).

Mukayamba kugwiritsa ntchito, gwiritsani ntchito miphika yosungirako, zolembera zakale za OptiSet ®, ma cartridge kapena ma OptiKlik® cartridge pamtunda wolephera kupitirira +25 ° C pamalo otetezedwa ku kuwala komanso komwe ana sangathe. Osazizira (kuperekera insulin yovuta kwambiri). Kuti muteteze kuwunika, muyenera kusunga botolo, cholembera cha OptiSet ® chomwe chadzazidwa kale, makatoni a OptiClick ® kapena makatoni ama cartridge awo.

Moyo wa alumali wa mankhwalawa mu botolo, cartridge, dongosolo la cartridge ya OptiKlik ® kapena cholembera cha OptiSet ® mutagwiritsidwa ntchito koyamba ndi milungu 4. Ndikulimbikitsidwa kuti tsiku loyambirira la mankhwalawa lizindikiridwa palemba.

Malangizo ogwiritsira ntchito ndi kuwongolera

Popeza Apidra® ndi yankho, kupumulanso musanagwiritse ntchito sikufunika.

Mbale

Mbale za Apidra® zakonzedwa kuti zigwiritsidwe ntchito ndi ma insulin omwe ali ndi muyeso woyenera wa unit ndikugwiritsira ntchito pulogalamu ya insulin pump. Yenderani botolo musanagwiritse ntchito. Iyenera kugwiritsidwa ntchito pokhapokha yankho likakhala lomveka, lopanda utoto ndipo lilibe zinthu zophatikizika.

Zomwe zimayikidwa ndikusungiramo zosungirako ziyenera kusinthidwa maola 48 aliwonse motsatira malamulo a aseptic. Odwala omwe amalandila Apidra® kudzera mu NPII ayenera kukhala ndi insulin m'malo mwake ngati vuto la pampu likulephera.

OptiSet ® Pre-Anazazitsa Syringe Pens

Musanagwiritse ntchito, yang'anani cartridge mkati mwa cholembera. Iyenera kugwiritsidwa ntchito pokhapokha yankho likakhala lowonekera, lopanda utoto, lilibe tinthu tolimba tomwe timayimira, ndikufanana, madzi.

Ma syringe a OptiSet Emp OptySet ® sayenera kugwiritsidwanso ntchito ndipo ayenera kutayidwa. Popewa matenda, cholembera chodzaza chisanachitike chizingogwiritsidwa ntchito ndi wodwala m'modzi ndipo sayenera kusamutsidwira wina.

Musanagwiritse ntchito cholembera cha sytiit ya OptiSet ®, werengani mosamala zidziwitso zogwiritsira ntchito.

Chidziwitso chofunikira pakugwiritsa ntchito OptiSet® Syringe pen

Nthawi zonse gwiritsani ntchito singano yatsopano pakugwiritsa ntchito ina iliyonse. Gwiritsani masingano okha oyenera cholembera cha OptiSet®. Pamaso jekeseni aliyense, muziyesa nthawi zonse kuti muwone ngati cholembera chilili kuti chigwiritsike ntchito (onani pansipa). Ngati cholembera chatsopano cha OptiSet ® chikugwiritsidwa ntchito, kukonzekera kuyesa kugwiritsa ntchito kuyenera kuchitika pogwiritsa ntchito zigawo 8 zomwe zimayikidwa kale ndi wopanga. Wosankha mlingo akhoza kuzunguliridwa mbali imodzi. Osatembenuza wokonza mlingo (kusintha kwa mlingo) mutakanikiza batani loyambira jakisoni. Chingwe cha insulini ichi ndi chongogwiritsa ntchito odwala okha. Simungathe kudzipereka kwa munthu wina. Ngati jakisoni wapangidwa ndi munthu wina, chisamaliro chapadera chimayenera kutengedwa kuti tipewe kuvulala mwangozi ndi matenda opatsirana. Musagwiritse ntchito cholembera cha sytige ya OptiSet ® yowonongeka, komanso ngati simukutsimikiza kuti ikugwira ntchito bwanji. Nthawi zonse khalani ndi cholembera cha sytiitet ya OptiSet ® ngati cholembera cha OptiSet ® chawonongeka kapena chatayika.

Kuyesa kwa insulin

Pambuyo pochotsa chipewa mu cholembera, zilembo zomwe zili pachosungira insulini ziyenera kufufuzidwa kuti zitsimikizire kuti ili ndi insulin yoyenera. Maonekedwe a insulini ayeneranso kufufuzidwa: yankho la insulini liyenera kukhala lowonekera, lopanda utoto, lopanda zinthu zolimba zowoneka komanso lokhazikika monga madzi. Osagwiritsa ntchito cholembera cha sytige ya OptiSet ® ngati njira ya insulin ndi yopanda mitambo, ili ndi utoto kapena tinthu tating'onoting'ono.

Singano ubwenzi

Mukachotsa kapu, samalirani mosamala ndikulowetsa singano ndi cholembera. Kuyang'ana kukonzeka kwa cholembera kuti mugwiritse ntchito. Pamaso pa jekeseni iliyonse, ndikofunikira kuyang'ana kukonzekera kwa cholembera kuti mugwiritse ntchito. Kwa cholembera chatsopano chatsopano komanso chosagwiritsidwa ntchito, chizindikiro cha mankhwalawa chiyenera kukhala nambala 8, monga momwe zimapangidwira kale ndi wopanga.

Ngati cholembera chikagwiritsidwa ntchito, wopereka amayenera kuzunguliridwa mpaka chizindikiritso cha mankhwalawo chikuima nambala 2. Wowunikirawo azizungulira mbali imodzi yokha. Kokani batani loyambira kwathunthu kuti mupeze mlingo. Osazungulira wosankha wa mankhwalawo mutatha batani loyambira litulutsidwe.

Zovala za singano zakunja ndi zamkati ziyenera kuchotsedwa. Sungani kapu yakunja kuti mupeze singano yogwiritsidwa ntchito. Mukugwira cholembera ndi singano yoloza m'mwamba, ikani pang'onopang'ono zitsulo za insulini ndi chala chanu kuti thovu lakumwamba lithe kulunjika ku singano. Pambuyo pake, ndikanikizani kwathunthu batani loyambira. Ngati dontho la insulin litulutsidwa kuchokera kunsonga ya singano, cholembera cha singano ndi singano chimagwira ntchito molondola. Ngati dontho la insulin silikupezeka kumapeto kwa singano, muyenera kubwereza kuyeserera kwa cholembera kuti mugwiritse ntchito mpaka insulin itadzafika kumapeto kwa singano.

Kusankha insulin

Mlingo wa mayunitsi 2 mpaka 40 ungayikidwe mu zowonjezera za 2 mayunitsi. Ngati mlingo wopitilira mayunitsi 40 ukufunika, uyenera kutumikiridwa pobayira ziwiri kapena zingapo. Onetsetsani kuti muli ndi insulin yokwanira muyezo wanu.

Mlingo wotsalira wa insulin pachidebe chowonekera cha insulin umawonetsa kuchuluka kwa insulini yomwe imatsala mu cholembera cha sytiitet ya OptiSet ®. Mlingowu sungagwiritsidwe ntchito kumwa mankhwala a insulin. Ngati piston wakuda ali kumayambiriro kwa mzere wachikuda, ndiye kuti pali magawo 40 a insulin. Ngati pisitoni yakuda ili kumapeto kwa mzere wachikuda, ndiye kuti pali magawo 20 a insulin. Wosankha mlingo uyenera kutembenuzidwa mpaka muvi womwenso uwonetsa mlingo womwe ungafune.

Kumwa kwa insulin

Batani loyambira jekeseni liyenera kukokedwa mpaka kumalizira kuti mudzaze cholembera. Chongani ngati mulingo wofunikira uli ndi zonse. Dziwani kuti batani loyambira limasuntha molingana ndi kuchuluka kwa insulin yomwe yasiyidwa mu thanki ya insulin. Dinani batani limakupatsani mwayi wofufuza kuti ndi mtundu uti womwe ukuimbidwa. Mukamayesedwa, batani loyambira liyenera kupitilizidwa mphamvu. Mzere womaliza wowoneka bwino pabatani wayambira kuchuluka kwa insulin yomwe yatengedwa. Pomwe batani loyambira likhala, pamwamba pamtambo wonsewo ndiwowoneka.

Makulidwe a insulin

Ophunzitsidwa mwapadera ayenera kufotokozera wodwalayo njirayo.

Singano ikuyenera kulowetsedwa mosazindikira. Batani loyambira jekeseni liyenera kukanikizidwa mpaka pakufika. Kungodinanso kukusiyani pomwe batani la jekeseni litakankhidwa njira yonse. Kenako, batani loyambira jakisoni liyenera kusindikizidwa kwa masekondi 10 musanachotsere singano pakhungu. Izi zitsimikiza kukhazikitsidwa kwa mlingo wonse wa insulin.

Kuchotsa singano

Pakapita jakisoni aliyense, singano imayenera kuchotsedwa mu cholembera ndikuchotsa.Izi zimathandiza kupewa matenda, komanso kutayika kwa insulini, kudya kwa mpweya komanso kuthekera kwa singano. Singano sayenera kugwiritsidwanso ntchito. Pambuyo pake, bwezerani chipewa pa cholembera.

Makatoni

Makatoni amayenera kugwiritsidwa ntchito ndi cholembera cha insulin, monga OptiPen® Pro1 kapena ClickSTAR ®, komanso malinga ndi malingaliro omwe ali muzidziwitso zoperekedwa ndi wopanga chipangizocho. Sichiyenera kugwiritsidwa ntchito ndi zolembera zina zanenjelo zomwe zingapangidwenso, popeza kulondola kwa dosing kumangokhazikitsidwa ndi zolembera za OptiPen® Pro1 ndi ClickSTAR® syringe.

Malangizo a wopanga ogwiritsira ntchito cholembera cha OptiPen ® Pro1 kapena chimbale cha ClickSTAR® chokhudza kulongedza katiriji, kupaka singano, ndi jakisoni wa insulini ziyenera kutsatiridwa chimodzimodzi. Yenderani cartridge musanagwiritse ntchito. Iyenera kugwiritsidwa ntchito pokhapokha yankho likakhala lomveka bwino, lopanda utoto, lopanda zinthu zolimba zowoneka.

Tisanayike katiriji mu cholembera chosakanizira, katirijiyu ayenera kukhala otentha kwa maola awiri. Pamaso pa jekeseni, thovu ndi mpweya ziyenera kuchotsedwa mu katoni (onani malangizo ogwiritsira ntchito cholembera). Malangizo ogwiritsira ntchito cholembera uyenera kutsatiridwa mosamalitsa. Makatoni opanda kanthu sangakwaniritsidwe. Ngati cholembera cha sytiit ya OptiPen® Pro1 kapena ClickSTAR® chawonongeka, sichitha kugwiritsidwa ntchito.

Ngati cholembera sichigwira ntchito moyenera, yankho lake limatha kutengedwa kuchokera ku cartridge kupita ku syringe ya pulasitiki yoyenera kwa insulin pazomwe 100 PIECES / ml ndikupatsidwa kwa wodwala. Popewa kutenga kachilomboka, cholembera chindapusa chomwe chikugwiritsidwa ntchito chiyenera kugwiritsidwa ntchito mwa wodwala yemweyo.

Makina a cartridge a Opticlick®

Pulogalamu yama cartridge ya OptiClick ® ndi galasi la cartridge lokhala ndi 3 ml ya glulisin insulin solution, yomwe imayikidwa mu chidebe chowonekera cha pulasitiki yokhala ndi zida za piston.

Ngati cholembera cha sytige cha OptiClick ® chawonongeka kapena chasokonekera chifukwa cha kusowa kwamakina, ziyenera m'malo mwake china chatsopano.

Asanakhazikitse dongosolo lama cartridge mu cholembera cha sytiit ya OptiClick®, liyenera kukhala pakumtentha kwa maola awiri. Yang'anani dongosolo lama cartridge musanayikidwe. Iyenera kugwiritsidwa ntchito pokhapokha yankho likakhala lomveka bwino, lopanda utoto, lopanda zinthu zolimba zowoneka.

Musanagwiritse ntchito jakisoni, ma thovu a mpweya amayenera kuchotsedwa mu dongosolo lama cartridge (onani malangizo ogwiritsira ntchito cholembera). Makatoni opanda kanthu sangakwaniritsidwe. Ngati cholembera sichigwira ntchito moyenera, yankho limatha kutengedwa kuchokera ku dongosolo lama cartridge kupita ku syringe ya pulasitiki yoyenera ya insulini pakukumana kwa 100 PIECES / ml ndikulowetsa wodwala.

Popewa kutenga kachilomboka, cholembera chindapusa chomwe chitha kugwiritsidwanso ntchito ngati wodwala m'modzi.

Kukopa pa kuthekera kuyendetsa ma transp. Wed Ndi ubweya.

Kuthekera kwodwala chidwi komanso kuthamanga kwa zochitika zama psychomotor zitha kufooketsedwa ndi hypoglycemia kapena hyperglycemia, komanso kusokonezeka kwa maonekedwe. Izi zitha kukhala pachiwopsezo pamavuto omwe luso limakhala lofunikira, mwachitsanzo, poyendetsa galimoto kapena m'njira zina.

Kutulutsa fomu / Mlingo

Njira yothetsera makina osunthira, 100 PESCES / ml.

10 ml ya mankhwalawa mu botolo la galasi loyera, lopanda utoto (mtundu I). Botolo limapangidwa m'maso, limafinya ndi chipewa cha aluminium ndikutchinga ndi kapu yoteteza. Botolo 1 limodzi ndi malangizo ogwiritsira ntchito pabokosi lamakatoni.
3 ml ya mankhwalawa kapu yamagalasi oyera, opanda khungu (mtundu I). Katirijiyo amakhazikika mbali imodzi ndi khwangwala ndipo amamezedwa ndi chipewa cha aluminiyamu, mbali inayo - ndi phula.

Makatoni asanu pazinthu zilizonse za filimu ya PVC ndi zojambulazo. Mzere umodzi wa blister pamodzi ndi malangizo ogwiritsira ntchito pabokosi la makatoni. Katiriji imayikidwa mu cholembera cha sytige OptiSet®. Syringe iliyonse ya 5 OptiSet ® pamodzi ndi malangizo ogwiritsira ntchito pabokosi lamakatoni okhala ndi chikhadabo. Cartridge imayikidwa mu OptiClick® cartridge system. Pa makatoni 5 ogwiritsira ntchito OptiKlik ® pamodzi ndi malangizo ogwiritsira ntchito pakembedwe kamakatoni okhala ndi makatoni.

Insulin "Apidra" - kwa ana omwe ali ndi matenda ashuga

Unduna wa Zaumoyo ku Israeli wavomereza kugwiritsa ntchito insulin Apidra (insulin Glulisin), analogue ya insulin yothamanga kuti igwiritsidwe ntchito ndi ana azaka 6 zakubadwa.

Posachedwa, Apidra insulin adalembetsedwera ku USA ndipo amaloledwa kwa ana azaka 4, m'maiko a EU - kwa ana ndi achinyamata kuyambira zaka 6.

Apidra insulin, yopangidwa ndi kampani yapadziko lonse yamankhwala Sanofi Aventis, ndi analog ya insulin yomwe imagwira mwachangu, yomwe imayamba mwachangu komanso nthawi yayifupi. Amawonetsedwa kwa odwala omwe ali ndi matenda amtundu wa 1 ndi mtundu wa 2, kuyambira ali ndi zaka 6. Mankhwalawa amapezeka mu mawonekedwe a cholembera kapena inhaler.

Apidra imapatsa odwala kusinthasintha kwakukulu pokhudzana ndi jakisoni ndi nthawi ya chakudya. Ngati ndi kotheka, insulin Apidra ikhoza kugwiritsidwa ntchito ndi insulin yayitali monga Lantus.

Za matenda ashuga

Matenda a shuga ndi matenda osachiritsika, ofala chifukwa cha kuchepa kwa chinsinsi cha insulini ya mahomoni kapena ntchito yake yochepa. Insulin ndi mahomoni ofunikira kuti asinthe shuga (shuga) kukhala mphamvu.

Popeza kapamba pafupifupi kapenanso satulutsa insulin, odwala matendawa amakhala ndi jakisoni wa insulin tsiku lililonse moyo wawo wonse. Mtundu wachiwiri wa matenda ashuga, kapamba amapitiliza kupanga insulini, koma thupi limagonjera molakwika chifukwa cha mphamvu ya timadzi timene timayambitsa matenda a insulin.

Malinga ndi ziwerengero, ana 35,000 omwe ali ndi matenda ashuga amakhala ku Israel. International Diabetes Federation (IDF) ikuyerekeza kuti pali ana 440,000 osakwana zaka 14 omwe ali ndi matenda ashuga amtundu 1 padziko lonse lapansi omwe amapezeka ndi matenda atsopano 70,000 pachaka.

Kuchita zinthu mwachangu (mwachangu)

Kuchita mwachangu insulin (ultrashort) kumaphatikizapo lero mitundu itatu yamankhwala atsopano:

lispro (Humalog), aspart (NovoRapid), glulisin (Apidra).

Chofunikira kwambiri pa insulin yomwe imagwira mwachangu ndichomwe chimayambira komanso kutha mwachangu poyerekeza ndi ma insulini "osavuta". Kuchulukitsa kwa glucose pankhaniyi kumachitika mofulumira, zomwe zimachitika chifukwa cha kuthamanga kwa insulini kuchokera pamafuta a subcutaneous.

Kugwiritsa ntchito insulin yogwira ntchito mwachanguyi kungachepetse nthawi yayitali pakati pakubayidwa komanso kudya mwachindunji. Chifukwa cha izi, kuchuluka kwa glycemia mukatha kudya kumachepetsedwa ndipo zochitika za hypoglycemia zimachepetsedwa.

Kukhazikika kwa insulin yofulumira kumachitika pakapita mphindi 5 mpaka 15 pambuyo pa kutsata, ndi kuchuluka kwake kwa zochita, ndiko kuti, mphamvu zake zambiri zimatheka pambuyo pa mphindi 60. Kutalika kokwanira kwa insulin yamtunduwu ndi maola 3-5. Insulin yogwira ntchito mofulumira iyenera kuperekedwa kwa mphindi 5 mpaka 15 musanadye chakudya kapena chakudya chisanafike. Kuphatikiza apo, kuyendetsa insulin mwachangu mukatha kudya kumathandizanso kuti pakhale chiwongolero chabwino cha glycemic.

Tiyenera kukumbukira kuti kuyambitsidwa kwa insulin yachangu kale kuposa mphindi 20 mpaka 30 chakudya chisanafike kumayambitsa hypoglycemia.

Mukamasintha kuyambitsa mitundu iyi ya insulin, ndikofunikira kuti mulamulire kuchuluka kwa glycemia pafupipafupi kuti mudziwe momwe mungagwiritsire ntchito bwino kuchuluka kwa insulini yoyendetsedwa komanso kuchuluka kwa chakudya chambiri. Mlingo wa mankhwalawa munjira iliyonse umakhazikitsidwa payekhapayekha.

Mlingo umodzi wa insulin yomwe ikugwira mwachangu sayenera kupitirira 40 mayunitsi. Zambiri momwe mungawerengere kuchuluka kwa insulin.

Insulin imatha kupangidwa m'mbale ndi ma cartridge. Ngati mumagwiritsa ntchito insulin mu mbale, ndiye kuti mutha kusakaniza insulin yofulumira komanso kukonzekera kwa insulin kwa nthawi yayitali mu syringe imodzi. Pankhaniyi, insulin yothamanga imayamba kukokedwa mu syringe. Ma cartridge insulin sanapangidwe kuti azikonzekera zosakanikirana ndi mitundu ina ya insulin.

Ndikofunika kulabadira makamaka chifukwa chakuti insulin yolimbikira ntchito iyenera kugwiritsidwa ntchito pokhapokha pokhudzana ndi kudya.

Epidera. Apidra Insulin glulisin. Insulinum glulisinum. Muli ndi insulin glulisin (INN - Insulinum glulisinum), yopangidwa pogwiritsa ntchito ukadaulo wa DNA wogwiritsa ntchito E. coli.

Njira yotulutsira mankhwala. Kubayikira jakisoni 100 IU / ml katiriji 3 ml, jakisoni wa 100 IU / ml botolo, jakisoni wa 100 IU / ml syringe cholembera OptiSet 3 ml.

Kugwiritsa ntchito komanso kumwa mankhwala. Epidera amatumikiridwa nthawi yomweyo asanakwane (0-15 mphindi) kapena atangodya. Epidera ayenera kugwiritsidwa ntchito polembetsanso mankhwala a insulin, omwe amaphatikizapo insulin kapena yanthawi yayitali kapena analogue ya basal insulin, ndipo angagwiritsidwe ntchito munthawi yomweyo ndi othandizira pakamwa a hypoglycemic.

Mlingo wa Epidera amasankhidwa ndikuwongolera payekhapayekha.

Kuchuluka kwa mayamwidwe ndipo, mwina, kuyambika ndi kutalika kwa zochita zimatengera tsamba la jakisoni, kukhazikitsa kwake ndi zizindikiro zina. Kubayidwa kwapakati pa khoma lam'mimba kumayamwa mofulumira kuposa malo ena obayira.

Zowonongeka zamitsempha yamagazi ziyenera kupewedwa. Pambuyo pa jekeseni, musakonzetse jakisoni wa jekeseni. Odwala ayenera kuphunzitsidwa njira yolondola ya jakisoni. Mankhwala a epidera a pharmacokinetic nthawi zambiri amasungidwa mu odwala omwe ali ndi vuto laimpso. Komabe, ngati vuto laimpso silikuyenda bwino, kufunika kwa insulin kumatha kuchepa.

Mankhwala a epidera a pharmacokinetic odwala omwe ali ndi kuchepa kwa chiwindi sanaphunzire. Kwa odwala omwe ali ndi vuto la chiwindi, kusowa kwa insulin kungakhale kocheperako chifukwa cha kuchepa kwa gluconeogeneis komanso kuthekera kwa insulini.

Kuwonongeka kwa chiwindi kungayambitse kuchepa kwa insulin. Palibe chidziwitso chokwanira chachipatala chokhudza kugwiritsa ntchito Epidera mwa ana ndi achinyamata.

Zochita zamankhwala. Insulin glulisin ndi analogue yobwerezabwereza ya insulin ya anthu, yofanana ndi potency. Insulin glulisin imagwira ntchito mwachangu komanso kwa nthawi yochepa kuposa insulin yaumunthu. Chochita chachikulu cha insulin ndi analogues, kuphatikizapo insulin glulisin, cholinga chake ndikukhazikitsa kagayidwe ka glucose.

Insulin imachepetsa kuchuluka kwa shuga m'magazi polimbikitsa kupezeka kwa glucose, makamaka minofu yamatumbo ndi minofu ya adipose, komanso kuletsa kaphatikizidwe ka shuga. Insulin imalepheretsa lipolysis mu adipocytes, proteinol komanso imathandizira kaphatikizidwe ka mapuloteni.

Ndi subcutaneous makonzedwe a insulini glulisin komanso wabwinobwino wa insulin ya anthu 0,15 U / kg panthawi yosiyanasiyana ndi mphindi 15 zaphikidwe, kunapezeka kuti post-prandial glycemic yofanana ndi nthawi zonse insulin ya munthu ntchito mphindi 30 asanadye.

Poyerekeza insulin glulisin ndi insulin yachibadwa ya munthu mphindi 2 asanadye, insulini glulisin imapereka chitetezo choyenera pambuyo pa insulin. Kugwiritsira ntchito insulin glulisin pakatha mphindi 15 chakudya chikapatsa glycemic control, zofanana ndi zomwe zimachitika kawirikawiri insulin ya anthu, yoyendetsedwa kwa mphindi ziwiri asanadye.

Insulin glulisin imasunga koyamba kwa odwala omwe ali ndi kunenepa kwambiri. Zisonyezero za nthawi kuti zitheke 20% yazinthu zonse za AUC ndi AUC0-2 h, zomwe ndizomwe zimawonetsa mphamvu ya insogin yoyambirira, inali 114 min ndi 427 mg / kg motsatana chifukwa cha insulini glulisin ndi 121 min ndi 354 mg / kg kwa insulin lispro, 150 min ndi 197 mg / kg kwa insulin yochepa yamunthu.

M'mayeso azachipatala olamulidwa mwa akulu, insulini glulisin sinawonetse kusiyana pakutetezeka komanso kuchita bwino pamagulu omwe anali osiyana ndi mtundu komanso jenda. Kulowetsedwa mwachangu kwa insulin glulisin kumaperekedwa m'malo mwa amino acid asparagine pamalo a B3 a insulin yaumunthu ndi lysine ndi lysine pamalo B29 ndi glutamic acid.

Mapulogalamu a Pharmacokinetic mu odzipereka athanzi labwino komanso odwala omwe ali ndi mtundu woyamba wa 2 kapena matenda osokoneza bongo adawonetsa kuti mayamwidwe a insulini glulisin anali maulendo 2 mwachangu kwambiri komanso nthawi yayitali ya kuchuluka kwa insulin yaanthu.

Pambuyo pokonzekera insulin, glulisin imachotsedwa mofulumira kuposa insulin yaumunthu, ndipo theka la moyo wa mphindi makumi anayi ndi theka la insulin glulisin ndi mphindi 86 za insulin wamba. Mwa anthu athanzi kapena odwala omwe ali ndi matenda amtundu wa I kapena mtundu wa 2, pafupifupi theka la moyo anali kuchokera pa mphindi 37 mpaka 75.

Pankhani ya kuwonongeka kwa impso, kusowa kwa insulin kumatha kuchepa, komabe, kuthekera kwa insulin glulisin kukhala ndi mphamvu yotsalira kumakhalabe. Mankhwala a insulin glulisin mwa odwala omwe ali ndi vuto la chiwindi sanawerenge. Zambiri pa pharmacokinetics zamankhwala odwala okalamba omwe ali ndi matenda ashuga ndizochepa.

Kugwiritsa ntchito mankhwala a insulin glulisin musanadye ana ndi achinyamata kumawathandiza kuti azitha kuyamwa poyerekeza ndi insulin ya anthu wamba, monga momwe zimakhalira ndi odwala akuluakulu. Kusintha kwamphamvu m'magulu a shuga (AUC) ndi 641 mg / h / dl kwa insulin glulisin ndi 801 mg / h / dl kwa insulin wamba ya anthu.

Zizindikiro zogwiritsidwa ntchito. Matenda a shuga.

Zotsatira zoyipa zomwe zingachitike. Zotsatira zoyipa kwambiri za insulin mankhwala ndi hypoglycemia, zomwe zimachitika chifukwa cha kuchuluka kwa insulin.

Contraindication. Hypersensitivity insulin glulisin kapena zigawo zina za mankhwala, hypoglycemia.

Insulin Apidra (Epidera, Glulisin) - ndemanga

Ndikufuna kunena mawu ochepa, kotero kuti ndiyankhule pakutsatira kothintha, pakusintha kuchoka ku humalogue kupita ku apidra. Ndikutembenukira lero lero. Ndakhala pa Humalog + Humulin NPH kwa zaka zoposa 10. Ndinaphunzira zabwino ndi zovuta zonse pazomangamanga, zomwe zilipo zambiri. Zaka zingapo zapitazo ndidasinthidwa kupita ku apidra kwa miyezi iwiri ndi iwiri, chifukwa panali zosokoneza mu chipatalachi.

Momwe ndimamvetsetsa, sindinali ndekha. Ndipo mukudziwa, mavuto ambiri omwe ndimayanjanitsidwa nawo kale anazimiririka. Vuto lalikulu ndi kutuluka kwa m'mawa. Shuga pamimba yopanda kanthu pa apidra mwadzidzidzi adakhazikika. Ndi macheza, komabe, palibe zoyesera zamtundu wa humalogue ndi NPH, kapena kuyesa kwa shuga usiku wonse, sizinaphule kanthu.

Mwachidule, ndidadutsa mayeso, ndidadwala ambiri, ndipo endocrinologist wathu adandilembera apidra m'malo mwa humalogue. Lero ndi tsiku loyamba lomwe ndinapita kukagwira naye ntchito. Zotsatira zake zimakhala zoipa kwambiri. Anachita chilichonse lero mwamtheradi ngati kuti adalowetsa humalogue, ndipo mwina amathira shuga wina m'matumba ake. Asanadye chakudya cham'mawa, nthawi ya 8:00 a.m. panali 6,0, zomwe ndikuganiza kuti ndizabwinobwino.

Ndidagwidwa ndi apidra, ndimadya chakudya cham'mawa, zonse zili monga mwa masiku monga XE, ndimafika kuntchito nthawi ya 10:00. Shuga 18,9! Sambani iyi ndi mbiri yanga yonse! Zikuwoneka kuti sindinangobaya. Ngakhale insulin yofupikitsa imatha kupereka zotsatira zabwino. Zachidziwikire, nthawi yomweyo ndidapanga mayunitsi ena 10, chifukwa ndimaona kuti ndizosamveka kupita ndi zoterezi. Pofika masana, nthawi ya 13:30, sk anali kale 11.1. Lero ndimayang'ana shuga ola lililonse ndi theka.

Mitundu ya insulin yochepa kwambiri - imachita zinthu mwachangu kuposa aliyense

Mitundu ya insulashort ya insulin ndi Humalog (Lizpro), NovoRapid (Aspart) ndi Apidra (Glulizin). Amapangidwa ndi makampani atatu osiyanasiyana azachipatala omwe amapikisana nawo.

Insulin yochepa yachizolowezi ndi yaumunthu, ndipo ultrashort ndi fanizo, i.e. chosinthika, kusinthidwa, poyerekeza ndi insulin yeniyeni ya anthu. Kusintha kuli potengera kuti amayamba kutsitsa shuga wamagazi ngakhale othamanga kuposa amfupi - mphindi 5 mpaka jakisoni.

Apidra ya amayi apakati

Kukhazikitsidwa kwa mankhwalawa kwa amayi apakati kuyenera kuchitika mosamala kwambiri. Kuphatikiza apo, mkati mwa chithandizo chotere, kuyang'anira kuchuluka kwa shuga wamagazi kuyenera kuchitika pafupipafupi. Ndikulimbikitsidwa kuti:

odwala omwe adapezeka kuti ali ndi matenda a shuga nthawi yomweyo asanabadwe kapena omwe adapanga matenda omwe amadziwika kuti ndi azimayi oyembekezera, ndikulimbikitsidwa nthawi yonseyo kuti azitha kuyang'anira mayendedwe a glycemic,
munthawi yoyamba kubereka, kufunikira kwa oyimira akazi kugwiritsa ntchito insulin kumatha kuchepa msanga,
monga chilamulo, chachiwiri ndi chachitatu, chidzachuluka,
pambuyo pakupereka, kufunika kogwiritsa ntchito gawo la mahomoni, kuphatikiza Apidra, kudzacheperanso.

Tiyeneranso kukumbukira kuti azimayi omwe akukonzekera kukhala ndi pakati amakakamizidwa kudziwitsa dokotala wawo za izi.

Ndikofunikanso kukumbukira kuti sizikudziwika kwathunthu ngati insulin-glulisin imatha kudutsa mwachindunji mkaka wa m'mawere.

Kuthilira uku kwa insulin yaumunthu kungatengedwe panthawi yapakati, koma chitani zinthu mosamala, kuwunika kuchuluka kwa shuga ndipo, kutengera ndi iwo, sinthani mlingo wa mahomoni. Monga lamulo, munthawi yoyamba kubereka, mlingo wa mankhwalawa umachepa, ndipo wachiwiri ndi wachitatu, umayamba kuwonjezeka.

Pambuyo pobala, kufunika kwa mlingo waukulu wa Apidra kutha, ndiye kuti mankhwalawa amayambiranso.

Palibe maphunziro azachipatala pakugwiritsa ntchito Apidra pa nthawi yapakati. Zambiri zomwe zimagwiritsidwa ntchito pakugwiritsa ntchito insulayi ndi amayi apakati sizikusonyeza kuyipa kwake pakubadwa kwa mwana wosabadwa, njira yoyembekezera, kapena mwana wakhanda.

Kuyesedwa kwa kubereka nyama sikunawonetse kusiyana kulikonse pakati pa insulin ya munthu ndi insulin glulisin pokhudzana ndi kakulidwe ka embryonic / fetal, pakati, ntchito ndi kubereka.

Amayi oyembekezera akuyenera kupatsidwa Apidra mosamala ndi kuyang'anira kuwunika kwa plasma glucose komanso kayendedwe ka glycemic.

Amayi oyembekezera omwe ali ndi vuto la matenda ashuga amayenera kudziwa kuchepetsedwa kwa kufunikira kwa insulin panthawi yoyamba ya kubereka, kuwonjezeka kwa trimester yachiwiri ndi yachitatu, ndi kuchepa msanga pambuyo pobala.

Panthawi yonse yoyembekezera, ndikofunikira kukhalabe mkhalidwe wa metabolic ofanana kwa odwala omwe ali ndi matenda a preexisting kapena gestational matenda a shuga. Kufunika kwa insulin mu trimester yoyamba yam'mimba kumatha kuchepa, nthawi zambiri kumachulukirachulukanso komanso chachitatu. Pambuyo pobadwa, insulini imafuna kuchepa mwachangu.

Zambiri pazakugwiritsira ntchito insulin-glulisin ndi amayi apakati sizipezeka. Kuyesa kwachilengedwe kwa zinyama sikunawonetse kusiyana kulikonse pakati pa insulle ya insulle ya munthu ndi insulin-glulisin pokhudzana ndi pakati, kukula kwa fetal, kubereka mwana ndi chitukuko cha pambuyo pake.

Komabe, amayi apakati amayenera kupereka mankhwalawa mosamala kwambiri. Munthawi ya chithandizo, kuwunika shuga kumayang'aniridwa pafupipafupi.

Odwala omwe anali ndi matenda ashuga asanabadwe kapena omwe adayambitsa matenda a shuga kwa amayi apakati ayenera kukhalabe ndi vuto la glycemic nthawi yonseyi.

Munthawi yoyamba kubereka, kufunikira kwa wodwala ka insulin kumatha kuchepa. Koma, monga lamulo, mu trimesters wotsatira, zimawonjezeka.

Pambuyo pobereka, kufunikira kwa insulin kumacheperanso. Amayi omwe akukonzekera kutenga pakati ayenera kudziwitsa woyang'anira wawo zaumoyo za izi.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwala ayenera kuperekedwa ndi subcutaneous jakisoni, komanso kulowetsedwa mosalekeza. Ndikulimbikitsidwa kuti muchite izi mwapadera minofu yamafuta ochepa komanso mafuta pogwiritsa ntchito pulogalamu yapadera yopopera.

Jakisoni wotsekemera uyenera kuchitika mu:

Kubweretsa Apidra insulin pogwiritsa ntchito kulowetsedwa kosalekeza kapena minofu yamafuta kuyenera kuchitika m'mimba. Madera omwe samaba jakisoni wokha, komanso ma infusions omwe adapangidwa kale, akatswiri amalimbikitsa kusinthana wina ndi mnzake pakukhazikitsa kwatsopano kwa chinthucho.

Zinthu monga dera lodzala, zochitika zolimbitsa thupi, ndi zina “zoyandama” zimatha kukhala ndi chiyambukiro pakukula kwa mayamwidwe ndipo, monga chotulukapo chake, pakubweretsa komanso kuchuluka kwake.

Kukhomeredwa pansi kwa khoma lam'mimba kumakhala chotsimikizika cha mayamwidwe ambiri kuposa kumizidwa m'malo ena a thupi. Onetsetsani kuti mwatsata malamulo osamala kuti musatenge mankhwala oikidwa m'mitsempha yamagazi.

Palibe kafukufuku wamakina omwe adachitika. Kutengera zomwe takumana nazo ndi mankhwala enanso, kuphatikizana kwa zamankhwala zamatenda ofunikira ndizokayikitsa.

Dziwitsani dokotala wanu za mankhwala onse omwe mumamwa, ngakhale atachitika mwanjira imodzi!

Zinthu zina zimakhudza kagayidwe ka glucose, kotero kusintha kwa insulin glulisin makamaka kuwunika mosamala kungafunike.

Zinthu zomwe zimathandizira kutsika kwa shuga m'magazi ndikuwonjezera chizolowezi cha hypoglycemia zimaphatikizira mankhwala a hypoglycemic apakhungu, angiotensin-kutembenuza enzyme zoletsa, disopyramides, fibrate, fluoxetine, MAO zoletsa, pentoxifylline, propoxyphene, salicylates ndi sulfibamide.

Beta-blockers, clonidine, mchere wa lithiamu ndi mowa zimatha kutsitsa ndikuchepetsa mphamvu ya shuga ya magazi. Pentamidine imatha kuyambitsa hypoglycemia, yomwe nthawi zina imalowa mu hyperglycemia.

Kuphatikiza apo, mothandizidwa ndi mankhwala achifundo ngati ß-blockers, clonidine, guanethidine ndi reserpine, zizindikiro za adrenergic antiregulation zitha kukhala zofatsa kapena zosakhalapo.

Maupangiri Ogwirizana