Insulin glargine

Zakudya zopatsa thanzi, masewera olimbitsa thupi ndikutsatira malangizo ena a madokotala samapereka zotsatira zoyenera. Chifukwa chake, odwala matenda ashuga nthawi zambiri amapatsidwa mankhwala othana ndi insulin. Chimodzi mwa izo ndi Insulin Glargin. Ichi ndi chidziwitso cha mahomoni achilengedwe opangidwa ndi thupi la munthu. Kodi kugwiritsa ntchito mankhwalawa ndi ziti?

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwala amapezeka mu mawonekedwe a yankho la subcutaneous (s / c) makonzedwe: madzi owoneka, opanda utoto (3 ml aliyense m'magalasi owoneka opanda galasi, 1 kapena 5 makatoni m'matumba a chithuza, paketi 1 mu chikwama cha makatoni, 10 ml pagalasi yowonekera mabotolo opanda mtundu, pa katoni 1 pa botolo ndi malangizo ogwiritsira ntchito Insulin glargin).

1 ml yankho lili:

• yogwira mankhwala: insulin glargine - 100 PIECES (gawo la zochita), lofanana ndi 3.64 mg,
• zothandiza: zinc chloride, metacresol, glycerol, sodium hydroxide, hydrochloric acid, madzi a jekeseni.

Mankhwala

Insulin glargine ndi mankhwala osokoneza bongo a hypoglycemic, analog of a insulin.

The yogwira mankhwala ndi insulin glargine, analogue ya insulin ya anthu yomwe imapangidwanso ndi DNA (deoxyribonucleic acid) tizilombo ta K12 mabakiteriya amtundu wa Escherichia coli.

Insulin glargine amadziwika ndi otsika solubility m'malo osalowerera ndale. The solubility yathunthu yogwira pophika mankhwala imatheka chifukwa cha hydrochloric acid ndi sodium hydroxide. Kuchuluka kwawo kumapereka yankho ndi acid reaction - pH (acidity) 4, yomwe, pambuyo poti mankhwala ayambitsidwa ndi mafuta osakanikira, amakhala osagwirizana. Zotsatira zake, microprecipitate imapangidwa, pomwe pamakhala kutulutsidwa kwapang'onopang'ono kwa insulin glargine, yomwe imapereka mankhwalawa nthawi yayitali komanso mawonekedwe osalala odziwika bwino a nthawi yokhazikika.

The kinetics yomanga insulin glargine ndi metabolites yake yogwira M1 ndi M2 ku insulin zolandilira zimakhala pafupi ndi insulin yamunthu, yomwe imatsimikiza kuthekera kwa insulin glargine kukhala ndi mphamvu yofanana ndi insulin.

Chochita chachikulu cha insulin glargine ndikuyang'anira kagayidwe ka shuga. Mwa kuletsa kaphatikizidwe kagayidwe kachakudya ka magazi m'chiwindi ndikuwonjezera kuyamwa kwa glucose pogwiritsa ntchito minofu ya adipose, minofu yamatumbo ndi zina zotumphukira, zimathandiza kuchepetsa kuchuluka kwa shuga m'magazi. Imaphatikizira lipolysis mu adipocytes ndikuchedwa kuchepa kwa proteinol, kwinaku ikukula mapangidwe a mapuloteni.

Kuchita kwa nthawi yayitali kwa insulin glargine kumachitika chifukwa cha kuchepa kwake. Nthawi yayitali ya insulin glargine pambuyo pa subcutaneous makonzedwe ndi maola 24, pazokwanira ndi maola 29. Zotsatira za mankhwalawa zimachitika pafupifupi ola limodzi pambuyo pa kuperekedwa. Tiyenera kukumbukira kuti nthawi ya insulin glargine odwala osiyanasiyana kapena wodwala m'modzi amatha kusiyanasiyana.

Mphamvu ya mankhwalawa kwa ana omwe ali ndi matenda a shuga 1 amseri wazaka 2 zatsimikizidwa. Mukamagwiritsa ntchito insulin glargine, pamakhala chiwopsezo chochepa kwambiri cha matenda a hypoglycemia masana ndi usiku ana mu zaka 2-6 poyerekeza ndi insulin-isofan.

Zotsatira za kafukufuku yemwe wakhalapo kwa zaka 5 zikuwonetsa kuti odwala omwe ali ndi matenda a shuga a 2, kugwiritsa ntchito insulin glargine kapena insulin-isophan kumathandizanso pakukula kwa matenda ashuga retinopathy.

Poyerekeza ndi insulin yaumunthu, kuyanjana kwa insulin glargine ya IGF-1 receptor (insulini-monga kukula kwa chinthu 1) kuli pafupifupi nthawi 5-8, ndipo metabolites yogwira M1 ndi M2 ndizochepa pang'ono.

Odwala omwe ali ndi mtundu 1 wa matenda a shuga, kuchuluka konse kwa insulin glargine ndi metabolites ake kumakhala kotsika kwambiri kuposa momwe amafunikira theka-kumangiriza kwa IGF-1 receptors, kutsatiridwa ndi kutsegulira kwa njira ya mitogenic proliferative, yomwe imayambira pa IGF-1 receptors. Mosiyana ndi kuzungulira kwa thupi kwa amkati IGF-1, njira yochizira ya insulini yothandizidwa ndi glargine insulin imakhala yotsika kwambiri poyerekeza ndi pharmacological yokhazikika yomwe ingayambitse njira ya mitogenic proliferative.

Zotsatira zakufufuza kwamankhwala zikuwonetsa kuti mukamagwiritsa ntchito insulin glargine mwa odwala omwe ali ndi chiopsezo chachikulu chotenga matenda a mtima komanso kulekerera kwa glucose, kusala bwino kwa matenda a glycemia kapena matenda oyamba a matenda a shuga 2, mwayi wokhala ndi vuto la mtima kapena kufa kwamtima ndi ofanana. ndi mankhwalawa. Palibe kusiyana komwe kunapezeka mwa kuchuluka kwa gawo lililonse lomwe limapanga mfundo zomaliza, chisonyezo chophatikizika cha zotsatira za microvascular, ndi kufa kwa zifukwa zonse.

Pharmacokinetics

Poyerekeza ndi insulin-isophan, pambuyo pokhazikika kwa insulin glargine, kuyamwa pang'onopang'ono komanso kwa nthawi yayitali kumawonedwa, ndipo palibe chiwonetsero chambiri.

Malinga ndi maziko a tsiku ndi tsiku subcutaneous makonzedwe a Insulin glargine, kuyanʻanila ndende ya yogwira mankhwala m'magazi ifika pambuyo 2-5 masiku.

Hafu ya moyo (T_1/2a) insulin glargine pambuyo pa intravenous makonzedwe akufanana ndi T_1/2 insulin yamunthu.

Pamene mankhwalawa adalowetsedwa pamimba, ntchafu, kapena phewa, palibe kusiyana kwakukulu mu serum insulin mozama komwe kunapezeka.

Insulin glargine imadziwika ndi kusinthasintha kocheperako kwa mbiri ya pharmacokinetic mwa wodwala yemweyo kapena odwala osiyanasiyana poyerekeza ndi insulin ya anthu apakati.

Pambuyo pa insulin glargine itayambitsidwa mu subcutaneous mafuta, pang'ono pang'ono a-chain (beta-chain) kuchokera ku carboxyl end (C-terminus) amapezeka ndimapangidwe a metabolites awiri: M1 (21 A -Gly-insulin) ndi M2 (21 A - Gly-des-30 B-Thr-insulin). Metabolite M1 imafalikira makamaka m'madzi am'magazi, kuwonetsa kwake kwadongosolo kumawonjezeka ndi kuchuluka kwa mankhwalawa. Kuchita kwa insulin glargine kumadziwika makamaka chifukwa cha kuwonekera kwa zokhudza metabolite M1. Mwambiri, insulin glargine ndi metabolite M2 sizingaoneke mu kayendedwe kazinthu. Mwakamodzikamodzi kupezeka kwa insulin glargine ndi M2 metabolite m'magazi, kuchuluka kwa onsewo sikudalira kuchuluka kwa mankhwalawo.

Zotsatira za m'badwo wa wodwala komanso jenda pa pharmacokinetics ya insulin glargine sizinakhazikitsidwe.

Kusanthula kwa zotsatira za mayesero azachipatala ndi ma subgroups kunawonetsa kusakhalapo kwakusiyana mu chitetezo ndi kuyenera kwa insulin glargine kwa osuta poyerekeza ndi anthu ambiri.

Odwala onenepa kwambiri, chitetezo ndi kugwiritsa ntchito bwino kwa mankhwalawa sikukuvulala.

Ma pharmacokinetics a insulin glargine mwa ana a zaka 2 mpaka 6 omwe ali ndi matenda a shuga 1 ali ofanana ndi achikulire.

Ndi chiwindi chachikulu cholephera, kusintha kwa insulin kumachepera chifukwa kuchepa kwa mphamvu ya chiwindi ku gluconeogenesis.

Contraindication

• zaka mpaka 2
• Hypersensitivity pamagawo a mankhwala.

Mochenjera, insulin glargine iyenera kugwiritsidwa ntchito kwa odwala omwe ali ndi proliferative retinopathy, stenosis yayikulu yamitsempha yamagazi kapena ziwiya zam'mimba, panthawi yoyembekezera komanso yoyamwitsa.

Glulin insulin, malangizo: ntchito ndi mlingo

Insulin glargine sayenera kuthandizidwa kudzera (iv)!

Njira yothetsera vutoli imapangidwira kukonzekera kwa sc mu mafuta ochepa a pamimba, ntchafu kapena mapewa. Masamba a jakisoni ayenera kusinthidwa mkati mwa amodzi mwa malo omwe akulimbikitsidwa.

Palibe kuyambiranso kwa mankhwala musanagwiritse ntchito.

Ngati ndi kotheka, insulin glargine imatha kuchotsedwa mu katoni ndikuyika syringe yoyenera insulin ndipo mlingo womwe ungafunike ukhoza kuperekedwa.

Makatoni angagwiritsidwe ntchito ndi ma syringes amkati.

Mankhwala sayenera kuphatikizidwa ndi ma insulini ena!

Mlingo, nthawi ya makonzedwe a hypoglycemic mankhwala ndi kutsata kwake kwa kuchuluka kwa shuga m'magazi kumatsimikiziridwa ndikusinthidwa payekha ndi dokotala.

Zomwe zimachitika pakusintha kwa wodwalayo, kuphatikizapo zochitika zolimbitsa thupi, pazomwe zimayamwa, nthawi yayitali komanso nthawi yayitali ya mankhwala ziyenera kukumbukiridwa.

Insulin glargine iyenera kutumikiridwa s / c 1 nthawi patsiku nthawi imodzi, yabwino kwa wodwala.

Odwala onse omwe ali ndi matenda ashuga ayenera kuyang'anitsitsa kuchuluka kwa shuga wamagazi.

Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, insulin glargine ingagwiritsidwe ntchito ngati monotherapy komanso kuphatikiza othandizira ena a hypoglycemic.

Malangizo a insulin ayenera kuchitika mosamala komanso moyang'aniridwa ndi achipatala. Kusintha kwa mankhwalawa kungafunike ngati thupi la wodwalayo lachepetsedwa kapena kuchuluka, nthawi ya makonzedwe a mankhwalawo, momwe amakhalira komanso zochitika zina kumawonjezera kukonzekera kwa hyper- kapena hypoglycemia.

Insulin glargine si mankhwala osankhidwa a matenda ashuga ketoacidosis, chithandizo chomwe chimaphatikizapo kuyambitsa insulin yochepa.

Ngati njira yothandizira mankhwalawa imaphatikizapo jakisoni wa basal ndi prandial insulin, ndiye kuti mlingo wa insulin glargine, wokhutiritsa kufunika kwa insal insulin, uyenera kukhala mkati mwa 40-60% ya tsiku lililonse la insulin.

Odwala omwe ali ndi matenda a shuga a mtundu wa 2 omwe akuchiritsidwa ndi mitundu yamkamwa ya hypoglycemic othandizira, mankhwala ophatikizidwa amayenera kuyambitsidwa ndi mlingo wa insulin 10 IU 1 nthawi patsiku ndikuwongolera kwamunthu wina kalendala.

Ngati njira yothandizira yamankhwala yapitayi ikuphatikiza insulini yokhala pakati kapena panthawi yayitali, ndiye kuti posamutsa wodwalayo kuti agwiritse ntchito insulin glargine, pangafunikire kusintha mlingo ndi nthawi yolamulidwa ndi insulin (kapena analogue) masana kapena kusintha mlingo wa mankhwala amkamwa a hypoglycemic.

Posamutsa wodwala pakuthandizira kuchuluka kwa insulin glargine, yokhala ndi 300 IU mu 1 ml, kupereka insulin glargine, mlingo woyambirira wa mankhwalawa uyenera kukhala 80% ya mlingo wa mankhwala omwe adagwiritsidwa ntchito kale, omwe amakanika, komanso kuti azitha kutumizidwa kamodzi patsiku. Izi zimachepetsa chiopsezo cha hypoglycemia.

Mukamasintha kuchokera kukayamba kwa insulin-isophan 1 nthawi patsiku, mlingo woyambirira wa insulin glargine samasinthidwa kamodzi ndipo amaperekedwa kamodzi.

Mukasintha kuchokera ku makulidwe a insulin-isofan 2 kawiri pa tsiku ndikutulutsa insulin glargine kamodzi pogona, tikulimbikitsidwa kuti mlingo woyambira tsiku ndi tsiku wa mankhwalawo uzikhala wochepetsedwa ndi 20% kuchokera pamankhwala omwe amapezeka tsiku lililonse a insulin. Zotsatirazi zikuwonetsa kukonza kwake kutengera zomwe munthu akuchita.

Pambuyo pa mankhwala oyamba ndi insulin yaumunthu, insulin glargine iyenera kuyambitsidwa kokha moyang'aniridwa ndi achipatala, kuphatikizapo kuwunika kuchuluka kwa shuga m'magazi. Pakati pa masabata oyamba, ngati kuli kotheka, mankhwalawa amasinthidwa. Izi ndizofunikira makamaka kwa odwala omwe ali ndi antibodies kwa insulin yaumunthu omwe amafunikira kupatsidwa mlingo waukulu wa insulin yaumunthu. Kugwiritsa ntchito kwawo insulin glargine, analogue ya insulin ya anthu, kungapangitse kusintha kwakukulu poyankha insulin.

Ndi kuwonjezeka kwa minofu kudziwa insulin chifukwa kusintha kagayidwe kachakudya, kusintha kwa mankhwalawa kungatheke.

Odwala omwe ali ndi matenda osokoneza bongo okalamba, tikulimbikitsidwa kugwiritsa ntchito zolimbitsa koyambirira komanso kukonza ma insulin glargine ndikuwonjezera pang'onopang'ono. Tiyenera kukumbukira kuti muukalamba kuzindikiritsidwa kwa hypoglycemia ndikovuta.

Zizindikiro ndi mawonekedwe akumasulidwa

Chofunikira chachikulu cha mankhwalawa ndi kupanga insulin Glargin. Pezani ndikupanga DNA ya mabakiteriya Escherichia coli (unasi wa K12). Chizindikiro chogwiritsidwa ntchito ndi matenda a shuga omwe amadalira odwala a zaka zopitilira 6, achinyamata ndi akulu.

Ikagwiritsidwa ntchito moyenera, mankhwalawa amapereka:

• Matenda a kagayidwe kachakudya kagayidwe kazakudya kagayidwe kazakudya ndi kagayidwe kazakudya,
• kukondoweza kwa zolandilira za insulin zomwe zimakhala m'matumbo a minofu ndi mafuta ochulukirapo,
• kuperewera kwa shuga ndi minofu yamafupa, minofu yam'mimba ndi mafuta osunthika,
• kuyambitsa kwa mapuloteni omwe akusowa,
• kuchepa kwa kupanga shuga owonjezera m'chiwindi.

Mawonekedwe a mankhwalawa ndi yankho. Glargin imagulitsidwa m'mak cartridge 3 kapena m'mbale 10 ml.

Zotsatira za pharmacological

Chochita chachikulu cha Glargin insulin, monga insulin ina, ndikukhazikitsidwa kwa kagayidwe ka shuga. Mankhwala amachepetsa shuga m'magazi ndikulimbikitsa kukoka kwa glucose pogwiritsa ntchito zotumphukira (makamaka mafupa a minofu ndi minyewa ya adipose), komanso kuletsa mapangidwe a shuga m'chiwindi. Insulin Glargin linalake ndipo tikulephera adipocyte lipolysis, timalepheretsa mapuloteni komanso timalimbitsa kaphatikizidwe katemera.

Insulin Glargin imapezeka pobweretsa masinthidwe awiri a kapangidwe ka insulin yaumunthu: m'malo mwa asiparagine amino acid glycine pamalo A21 a Chingwe ndikuwonjezera ma molekyulu awiri a arginine kumapeto kwa gawo la NH2.

Insulin Glargin ndi yankho lomveka bwino pa asidi acid pH (pH 4) ndipo amakhala ndi madzi ochepa pH. Pambuyo pothandizidwa ndi subcutaneous, yankho la acidic limalowa mu mawonekedwe osagwirizana ndi mapangidwe a microprecipitate, komwe ma glargin insulin amatulutsidwa pang'onopang'ono, ndikupereka mawonekedwe osalala (osawoneka bwino) a mawonekedwe a ndende ya maola 24. Kutalika kwa nthawi yayitali kwa Glargin insulin chifukwa cha kuchepetsedwa kwa mayamwidwe ake, komwe kumalumikizidwa ndi mtengo wotsika kwambiri. Chifukwa chake, mankhwalawa amatha kukhala ndi insulin yokwanira mwa odwala omwe ali ndi matenda osokoneza bongo omwe amapezeka kamodzi patsiku. Malinga ndi kafukufuku wakunja ndi mankhwala azachipatala, insulin Glargin ndiyofanana pobereka ndi insulin ya anthu.

Malangizo ogwiritsira ntchito

Mlingo wa mankhwalawa amasankhidwa payekha kwa wodwala aliyense. Njira yothetsera vutoli imayendetsedwa kamodzi kamodzi patsiku. Ndikofunika kuchita izi nthawi imodzi. Madera a jakisoni ndi gawo lopendekera la adipose la ntchafu, pamimba kapena phewa. Pa jakisoni aliyense, tsamba la jekeseni liyenera kusinthidwa.

Mtundu 1 wa matenda ashuga, Glargin insulin imatchulidwa kuti ndiyo yayikulu. Ngati matenda amtundu 2 amagwiritsidwa ntchito ngati monotherapy kapena kuphatikiza ena othandizira ena a hypoglycemic.

Nthawi zina odwala amawonetsedwa kusintha kuchokera ku insulin yapakati kapena yayitali kupita ku Glargin. Pankhaniyi, musintha chithandizo chamankhwala osinthika kapena kusintha tsiku ndi tsiku insulin.

Mukasintha kuchokera ku Isofan insulin kukhala jakisoni imodzi ya Glargin, muyenera kuchepetsa kuchuluka kwa insulin insulin (mwa 1/3 m'milungu yoyambirira yamankhwala). Izi zimathandiza kuchepetsa chiopsezo cha nocturnal hypoglycemia. Kuchepetsa Mlingo kwakanthawi kodziwika kumathetsedwa ndi kuwonjezeka kwa insulin yochepa.

Zotsatira zoyipa

Glargin ndi mankhwala achilengedwe omwe amakhudza njira za metabolic ndi shuga wamagazi.Ndi chitetezo chofooka cha thupi, kugwiritsa ntchito molakwika komanso mawonekedwe ena a thupi, mankhwala amatha kuyambitsa mavuto osafunikira.

Lipodystrophy ndi zovuta zomwe zimatsagana ndi kuwonongeka kwa nembanemba yamafuta kumalo a jakisoni a mahomoni. Pankhaniyi, mayamwidwe ndi kuyamwa kwa mankhwalawa amasokonezeka. Popewa izi, muyenera kusinthasintha gawo la makulidwe a insulin.

Hypoglycemia ndi njira ya m'magazi momwe kuchuluka kwa shuga m'magazi kumatsika kwambiri (zosakwana 3.3 mmol / l). Amayamba ngati wodwala atapatsidwa mlingo waukulu wa insulin. Zobwerezedwa mobwerezabwereza zimakhudza dongosolo lamkati lamanjenje. Munthu amadandaula za kusefukira ndi chisokonezo, mavuto okhala ndi nkhawa. Muzochitika zovuta, kumakhala kutaya kwathunthu chikumbumtima. Ndi hypoglycemia wolimbitsa thupi, manja akunjenjemera, kumangokhalira kumva njala, kugunda kwamtima komanso kusakwiya. Odwala ena amatuluka thukuta kwambiri.

Mawonetseredwe amatsutsa. Izi makamaka zimachitika mdera: kupweteka kwa jakisoni, urticaria, redness ndi kuyabwa, zotupa zingapo. Ndi hypersensitivity kwa mahomoni, bronchospasm, mawonekedwe amakhudzanso khungu (ambiri kuphimba thupi amakhudzidwa), ochepa matenda oopsa, angioedema, ndi mantha. Kuthetsa chitetezo kumabwera nthawi yomweyo.

Zotsatira zoyipa kuchokera kumbali yamapulogalamu owoneka siziperekedwa. Ndi malamulo a shuga m'magazi, minofu imapanikizika ndikupanga nkhawa. Kukonzanso kwa mandala a diso kumasinthanso, komwe kumayambitsa kusokoneza kowoneka. Popita nthawi, amachoka popanda kusokonezedwa ndi anthu ena.

Matenda a shuga a shuga ndi kupindika kwa shuga. Kuphatikizidwa ndi kuwonongeka kwa retina. Chifukwa cha kutsika kwakuthwa kwa shuga m'magazi, matendawa amatha kukulirakulira. Pali proliferative retinopathy, yomwe imadziwika ndi vitreous hemorrhage komanso kuchulukana kwa ziwiya zatsopano zomwe zimapanga macula. Ngati sanachiritsidwe, chiopsezo chakuwonongeka kwathunthu chikuwonjezeka.

Thandizo loyamba la bongo

Dontho la shuga m'magazi limachitika pamene milingo yayikulu kwambiri ya Glargin ikuperekedwa. Kuti athandize wodwalayo, adye chakudya chomwe chimakhala ndi chakudya cham'mimba (mwachitsanzo, chogulitsa).

Ndikulimbikitsidwanso kuyambitsa glucacon intramuscularly kapena mafuta ochepetsa. Zosathandizanso kwenikweni ndi jakisoni wamadzi a dextrose solution.

Zochita zolimbitsa thupi ziyenera kuchepetsedwa. Dokotala amayenera kusintha mtundu wa mankhwala ndi zakudya.

Kuyanjana kwa mankhwala osokoneza bongo

Glargin sigwirizana ndi mayankho a mankhwala. Ndi zoletsedwa kusakaniza ndi mankhwala ena kapena kubereka.

Mankhwala ambiri amakhudza kagayidwe ka glucose. Pankhaniyi, muyenera kusintha mlingo wa basal insulin. Izi zikuphatikiza pentoxifylline, Mao inhibitors, kapangidwe ka hypoglycemic, salicylates, ACE inhibitors, fluoxetine, disopyramide, propoxyphene, fibrate, mankhwala a sulfonamide.

Njira zomwe zimachepetsa hypoglycemic zotsatira za insulin zimaphatikizapo somatotropin, diuretics, danazole, estrogens, epinephrine, isoniazid, proteinase inhibitors, glucocorticoids, olanzapine, diazoxide, mahomoni a chithokomiro, glucagon, salbutamol, clozapine, terbutagen, g.

Mchere wa Lithium, beta-blockers, mowa, clonidine ungakulitse kapena kufooketsa mphamvu ya hypoglycemic ya insulin.

Mimba komanso kuyamwa

Amayi obereka mwana amasankhidwa pokhapokha atakambilana ndi adokotala. Kugwiritsa ntchito mankhwalawa ndikofunikira ngati phindu lomwe lingakhalepo kwa mayi woyembekezera limayesa chiwopsezo kwa mwana wosabadwayo. Ngati mayi woyembekezera akuvutika ndi matenda osokoneza bongo, amafunika kuwunika pafupipafupi njira za metabolic.

Mu nyengo yachiwiri ndi yachitatu ya kubereka, kufunikira kwa mahomoni kumawonjezeka. Pambuyo pobereka - imagwa kwambiri. Kusintha kwa Mlingo kuyenera kuchitika ndi katswiri. Panthawi yoyamwitsa, kusankha kwa mankhwalawo ndi kuwongolera kumafunikiranso.

Nthawi iliyonse yam'mimba, ndikofunikira kuganizira bwino za kuchuluka kwa shuga m'magazi.

Njira zopewera kupewa ngozi

Glargin, wokhala mankhwala osagwira ntchito kwa nthawi yayitali, sagwiritsidwa ntchito ngati matenda ashuga a ketoacidosis.

Ndi hypoglycemia, wodwalayo amakhala ndi zizindikiro zosonyeza kuchepa kwambiri kwa shuga m'magazi ngakhale izi zisanachitike. Komabe, mwa odwala ena, sangawonekere kapena sakhala osatchulidwa. Gulu lamavuto limaphatikizapo:

• anthu omwe amamwa mankhwala ena
• okalamba
• odwala ndi magazi abwinobwino
• odwala matenda ashuga a nthawi yayitali ndi neuropathy,
• anthu odwala matenda amisala,
• anthu aulesi, pang'onopang'ono chitukuko cha hypoglycemia.

Ngati zotere sizipezeka munthawi yake, zimatenga mawonekedwe olakwika. Wodwalayo amakumana ndi kusokonezeka kwa chikumbumtima, ndipo nthawi zina ngakhale amafa.

Aspart (NovoRapid Penfill). Imayendetsa mayankho a insulin pakudya. Imakhala yochepa komanso yofooka mokwanira. Izi zimapangitsa kukhala kosavuta kuwongolera shuga.

Chichewa (Lizpro). Kapangidwe ka mankhwalawa kumafotokozera insulin. Zinthu zomwe zimagwira mwachangu zimalowa mwachangu m'magazi. Ngati mukulowetsa Humalog muyezo womwewo komanso panthawi yoyikika, imakomedwa kawiri mofulumira. Pambuyo maola 2, zizindikirazo zimabwereranso mwakale. Zovomerezeka mpaka maola 12.

Glulisin (Apidra) - analogue ya insulini yokhala ndi nthawi yayifupi kwambiri. Ndi zochita za metabolic sizimasiyana ndi ntchito ya mahomoni achilengedwe, komanso ndi ma pharmacological - kuchokera ku Humalog.

Chifukwa cha kafukufuku wambiri komanso chitukuko, pali mankhwala ambiri othandizira odwala matenda ashuga. Chimodzi mwa izo ndi Insulin Glargin. Amagwiritsidwa ntchito ngati chida chodziyimira mu monotherapy. Nthawi zina chinthu chake chogwira ntchito chimaphatikizidwa ndi mankhwala ena, mwachitsanzo, Solostar kapena Lantus. Zotsirizirazi zimakhala ndi insulini pafupifupi 80%, Solostar - 70%.

Pharmacology

Amalumikizana ndi ma insulin receptors (omanga magawo omwe ali pafupi ndi a insulin yaumunthu), imayanjana ndi chilengedwe chofanana ndi insulin. Amayendetsa kagayidwe ka glucose. Insulin ndi mawonekedwe ake amachepetsa shuga m'magazi ndikulimbikitsa kukoka kwa glucose pogwiritsa ntchito zotumphukira (makamaka mafupa a minofu ndi adipose minofu), komanso kuletsa mapangidwe a shuga mu chiwindi (gluconeogenesis). Insulin imalepheretsa adipocyte lipolysis ndi proteinol, pamene ikupanga kuphatikiza mapuloteni.

Pambuyo poyambitsa mafuta ochepetsa mphamvu, acidic solution imasankhidwa ndikupanga ma microprecipitates, omwe ma insulin glargine amatulutsidwa nthawi zonse, ndikupereka chithunzi chokwanira, chosalala (chopanda nsonga) cha nthawi yokhazikika, komanso nthawi yayitali.

Pambuyo pa sc, kuyambika kwa zochitika kumachitika, pafupifupi, pambuyo pa ola 1. Nthawi yayitali yochita ndi maola 24, okwera ndi maola 29. Ndi limodzi lokhalo masana, chiwonetsero chokhazikika cha insulin glargine m'magazi chikufikiridwa masiku 2-5 itatha yoyamba mlingo.

Kafukufuku wofananira wa kutsindika kwa insulin glargine ndi insulin-isofan mumadzi a seramu mwa anthu athanzi komanso odwala omwe ali ndi matenda osokoneza bongo pambuyo pa sc pakumwa mankhwala adawonetsa kuyamwa pang'onopang'ono komanso kwa nthawi yayitali, komanso kusapezeka kwa nsonga ya kuchuluka kwa insulin glargine poyerekeza ndi insulin-isofan .

M'mafuta a anthu opindika, insulin glargine imakonzedwa pang'ono kuchokera kumapeto a carboxyl a B kuti apange metabolites yogwira: M1 (21 A -Gly-insulin) ndi M2 (21 A -Gly-des-30 B -Thr-insulin). Mu plasma, onse insulin glargine osasinthika ndi zopangidwa ndi cleavage zilipo.

Carcinogenicity, mutagenicity, zimabweretsa chonde

Kafukufuku wazaka ziwiri wa carcinogenicity wa insulin glargine adachitika mu mbewa ndi makoswe akamagwiritsidwa ntchito Mlingo mpaka 0.455 mg / kg (pafupifupi nthawi 5 ndi 10 kuposa Mlingo wa anthu omwe ali ndi s / c management). Zomwe zapezedwa sizinatiloleze kuti titchule zomaliza zokhudzana ndi mbewa zazimayi, chifukwa chaimfa yayikulu m'magulu onse, ngakhale atamwa mankhwala otani. Jekeseni hertiocytomas adapezeka m'makola amphongo (ofunika kwambiri) komanso mbewa zachimuna (zowerengeka) pogwiritsa ntchito zosungunulira za asidi. Zotupa zoterezi sizinapezeke mu nyama zazimayi zomwe zimagwiritsa ntchito mphamvu zamchere kapena kusungunulira insulini ina. Tanthauzo la kuyang'ana kumeneku mwa anthu sikudziwika.

Mutagenicity wa insulin glargine sanapezeke mwa mayeso angapo (mayeso a Ames, kuyesa ndi hypoxanthine-guanine phosphoribosyltransferase yama cell a mamalia), poyesa ma cherrosomal aberrations (cytogenetic mu vitro pama cell a V79, mu vivo ku Chinese hamster).

Pakufufuza kwachilengedwe, komanso kafukufuku wam'mbuyo komanso wamanthawi am'magazi abambo ndi aakazi pa s / c ya insulin pafupifupi kasanu ndi kawiri njira yolimbikitsira yoyambira pakati pa anthu, kuwopsa kwa amayi chifukwa cha hypoglycemia woyembekezera. milandu yakupha.

Mimba komanso kuyamwa

Zotsatira za Teratogenic. Maphunziro a kubereka komanso teratogenicity adachitidwa mu akalulu ndi Himalayan akalulu omwe amakhala ndi sculin ya insulin (insulin glargine ndi insulin yachibadwa yamunthu). Insulin idaperekedwa kwa makoswe achikazi isanakhwime, pakukhwima komanso panthawi yonse yoyembekezera pamtunda mpaka 0,36 mg / kg / tsiku (pafupifupi kokwana 7 poyerekeza ndi momwe mankhwalawa amayambira kuperekedwa kwa anthu). Mu akalulu, insulini imagwiritsidwa ntchito pa cosanogeneis pa Mlingo wa 0,072 mg / kg / tsiku (pafupifupi kawiri kuposa momwe munayambira kuyambitsa mankhwala a s / c mwa anthu). Zotsatira za insulin glargine ndi insulin yachilendo mu nyama izi sizinali zosiyana. Panalibe chonde chosabereka komanso kukula koyambirira kwa embryonic.

Kwa odwala omwe ali ndi vuto la matenda am'mbuyomu kapena gestational matenda a shuga, ndikofunikira kusamalira machitidwe a metabolic oyenera nthawi yonse yomwe ali ndi pakati. Kufunika kwa insulin kumatha kuchepa mu trimester yoyamba ya kutenga pakati ndikuwonjezeka panthawi yachiwiri komanso yachitatu. Mwana akangobadwa kumene, kufunika kwa insulini kumachepa msanga (chiopsezo cha hypoglycemia chikuwonjezeka). Pansi pa izi, kuyang'anira shuga wamagazi ndikofunikira.

Gwiritsani ntchito mosamala pakakhala pathupi (palibe zoyesedwa mosamalitsa zomwe amayi oyembekezera adachitapo).

FDA gulu la zochita za mwana wosabadwa - C.

Gwiritsani ntchito mosamala mukamayamwitsa (sizikudziwika ngati insulin glargine imachotsedwa mkaka wa amayi). Mwa kuyamwa azimayi, mlingo wa insulini komanso kusintha kwa zakudya kungafunike.

Zotsatira zoyipa za insulin glargine

Hypoglycemia - zotsatira zoyipa kwambiri za insulin mankhwala zimatha kuchitika ngati mlingo wa insulin ndiwokwera kwambiri poyerekeza ndi kufunika kwake. Kuukira kwa hypoglycemia, makamaka kubwereza, kungayambitse kuwonongeka kwa manjenje. Zolemba za hypoglycemia zomwe zimatenga nthawi yayitali komanso zimatha kuwononga miyoyo ya odwala. Zizindikiro za adrenergic counterregulation (kutsegulira kwa dongosolo lachifundo poyankha hypoglycemia) nthawi zambiri zimayambitsa matenda a neuropsychiatric chifukwa cha hypoglycemia (chikumbumtima chamadzulo kapena kutayika kwake, matenda osokoneza bongo): njala, kusokonekera, thukuta lozizira, tachycardia (kufalikira msanga kwa hypoglycemia ndipo ndizofunikira kwambiri, ndizomwe zimatanthauziridwa kwambiri ndi zizindikiro za adrenergic anti-regulation).

Zochitika zoyipa kuchokera pamaso. Kusintha kwakukuru mu kayendedwe ka glucose m'magazi kungayambitse kuwonongeka kwakanthawi chifukwa cha kusintha kwa minyewa yam'maso ndi cholozera cholocha cha mandala a maso. Kutalika kwa nthawi yayitali kwamwazi wamagazi kumachepetsa chiopsezo cha kupitirira kwa matenda ashuga retinopathy. Mankhwala a insulin, limodzi ndi kusinthasintha kwamphamvu kwa shuga m'magazi, angayambitse kukulira kwakanthawi kwa matenda a shuga a retinopathy. Odwala omwe ali ndi prineticolin ambiri, makamaka omwe samalandira chithandizo cha photocoagulation, zochitika zapakati za hypoglycemia zingayambitse kukula kwakumawona kwakanthawi.

Lipodystrophy. Monga mankhwala ena aliwonse a insulin, lipodystrophy ndi kuchedwa kwakanthawi mayamwidwe / mayamwidwe a insulin atha kupezeka pamalo a jakisoni. M'mayesero azachipatala panthawi ya mankhwala a insulin omwe amapezeka ndi insulin glargine lipodystrophy amawonetsedwa mu 1-2% ya odwala, pomwe lipoatrophy nthawi zambiri anali osavomerezeka. Kusintha kosalekeza kwa malo a jekeseni mkati mwa thupi omwe amalimbikitsidwa kuti apangidwe ndi insulin kungathandize kuchepetsa kuopsa kwa izi kapena kupewa kukula kwake.

Zomwe zimachitika mdera lakayendetsedwe ka kayendetsedwe kake ndi zovuta zake. Panthawi ya mayesero azachipatala pa nthawi ya mankhwala a insulin pogwiritsa ntchito insulin, zomwe zimachitika mu jakisoni zimawonedwa mu 3-4% ya odwala. Zithunzizi zimaphatikizaponso kufiyira, kupweteka, kuyabwa, ming'oma, kutupa, kapena kutupa. Zochita zazing'ono zochepa zomwe zimachitika pamalo operekera insulin nthawi zambiri zimathetsa kwakanthawi kuchokera masiku angapo mpaka milungu ingapo. Thupi lawo siligwirizana kwenikweni hypersensitivity kwa insulin ndizosowa. Kuchita kotereku kwa insulin (kuphatikizapo insulin glargine) kapena kufufutidwa kutha kuwoneka ngati khungu limakhudza, angioedema, bronchospasm, ochepa hypotension kapena kugwedezeka, ndipo motero kutha kukhala pachiwopsezo cha moyo wa wodwalayo.

Zina. Kugwiritsa ntchito insulin kungayambitse kupanga kwa antibodies kwa izo. Panthawi ya mayesero azachipatala m'magulu a odwala omwe amathandizidwa ndi insulin-isofan ndi insulin glargine, mapangidwe a antibodies akuwombana ndi insulin yaumunthu amawonedwa pafupipafupi. Nthawi zina, kukhalapo kwa ma antibodies oterewa ku insulin kungapangitse kusintha kwa mankhwalawa kuti athetse chizolowezi chokhala ndi hypo- kapena hyperglycemia. Nthawi zambiri, insulini imapangitsa kuti kuchepa kwa mankhwala a sodium ndi mapangidwe a edema, makamaka ngati insulini yowonjezereka imabweretsa kusintha kosasintha kwa kayendedwe ka metabolic.

Kuchita

Mankhwala osagwirizana ndi mayankho a mankhwala ena. Insulin glargine sayenera kusakanikirana ndi insulin ina kukonzekera kapena kuchepetsedwa (ikasakanizidwa kapena kuchepetsedwa, mbiri yake ya zochita ingasinthe pakapita nthawi, kuwonjezera, kusakanikirana ndi ma insulin ena kumatha kubweretsa mpweya). Mankhwala angapo amakhudza kagayidwe kakang'ono ka shuga, kamene kangafunike kusintha kwa insulin glargine. Mankhwala omwe amatha kupititsa patsogolo hypoglycemic zotsatira za insulin ndikuwonjezera kutengera kwa chitukuko cha hypoglycemia akuphatikiza othandizira a hypoglycemic, ACE inhibitors, disopyramides, fibrate, fluoxetine, MAO inhibitors, pentoxifylline, propoxyphene, ma salicylates ndi sulfonamide antimicrobials.Mankhwala omwe amatha kufooketsa mphamvu ya hypoglycemic ya insulini amaphatikizapo glucocorticoids, danazole, diazoxide, diuretics, glucagon, isoniazid, estrogens, progestogens, somatotropin, sympathomimetics monga epinephrine, salbutamol, terbutaline ndi ma chithokomasi a inhibitor, inhibitors. clozapine.

Beta-blockers, clonidine, mchere wa lithiamu, mowa - amatha kuwonjezera ndikuchepetsa mphamvu ya insulin. Pentamidine imatha kuyambitsa hypoglycemia, yomwe nthawi zina imasinthidwa ndi hyperglycemia. Mothandizidwa ndi mankhwala achifundo ngati a beta-blockers, clonidine, guanfacine ndi reserpine, zizindikiro za adrenergic zotsutsana nazo zitha kuchepetsedwa kapena kusapezeka.

Zambiri

Mankhwala ndi a gulu la insulin. Malonda ake ndi Lantus. Wothandizira amagwiritsidwa ntchito pochiza matenda amisempha otengera shuga. Imapezeka ngati jakisoni. Madziwo alibe mtundu ndipo ali pafupi kuwonekera.

Insulin Glargin ndi chithunzi cha insulin ya anthu yopangidwa ndi mankhwala. Zovuta pazantchito yayitali. Mankhwalawa amathandizira kuchepetsa kuchuluka kwa shuga m'magazi a wodwala.

Gawo lalikulu la kapangidwe kake ndi insulin Glargin.

Kuphatikiza apo, yankho limaphatikizapo:

• glycerol
• nthaka ya chloride
• metacresol
• hydrochloric acid,
• sodium hydroxide
• madzi.

Mankhwalawa amaloledwa kugwiritsidwa ntchito pokhapokha ndi chilolezo cha katswiri komanso muyezo womwe wapatsidwa ndi iye, pofuna kupewa zovuta.

Mankhwala

Zotsatira zazikulu za mankhwalawa ndi kuchepa kwa glucose. Izi zimachitika kudzera pakupanga mgwirizano pakati pake ndi insulin receptors. Njira yofananira yomweyo imadziwika ndi insulin ya anthu.

Kagayidwe ka glucose kamalimbikitsidwa ndi mphamvu ya mankhwalawa, popeza minyewa yamtunduwu imayamba kudya kwambiri.

Kuphatikiza apo, Glargin amalepheretsa kupanga shuga mu chiwindi. Mothandizidwa ndi iye, njira yopanga mapuloteni imathandizira kwambiri. Njira ya lipolysis, m'malo mwake, imachepetsa.

Pambuyo kulowetsedwa kwa mankhwala kulowa mthupi, sikumatha, microprecipitate imapangidwa. Pulogalamu yogwira imakhazikika mwa iwo, yomwe imamasulidwa pang'onopang'ono. Izi zimathandizira kutalika kwa mankhwalawa komanso kusalala kwake, popanda kusintha kwakukulu.

Zochita za Glargin zimayamba ola limodzi jekeseni. Imapitirira pafupifupi tsiku limodzi.

Zizindikiro, njira ya makonzedwe

Kwa chithandizo chokwanira, malangizo ogwiritsa ntchito mankhwalawa akuyenera kutsatiridwa. Malamulo akuvomerezedwa nthawi zambiri amafotokozedwa ndi adokotala.

Insulin Glargin imayikidwa pokhapokha ngati pali chifukwa. Kugwiritsa ntchito kwake ndikofunikira kwa mtundu wodalira inshuwaransi - izi zikutanthauza kuti matendawa ndi omwe amaikidwa.

Komabe, mankhwalawa ali osavomerezeka kwa aliyense - katswiri ayenera kupenda chithunzithunzi cha matenda nthawi zonse.

Kugwiritsa ntchito kololedwa kwa mitundu yonse yoyamba ndi yachiwiri. Mu mtundu woyamba wa matenda, mankhwalawa amagwiritsidwa ntchito ngati mankhwala akuluakulu. Kwina, Glargin akhoza kutumikiridwa onse mu mawonekedwe a monotherapy komanso kuphatikiza ndi mankhwala ena.

Mlingo nthawi zonse umawerengeredwa payekha. Izi zimakhudzidwa ndi kulemera kwa wodwalayo, zaka zake, koma chofunikira kwambiri ndi mawonekedwe a matendawa. Nthawi ya mankhwalawa, kuyezetsa magazi nthawi zina kumachitika kuti mumvetsetse momwe mankhwalawo amagwirira ntchito, ndikuchepetsa kapena kukulitsa nthawi.

Mankhwalawa amagwiritsidwa ntchito ngati ma jakisoni, omwe amayenera kuchitika mosazindikira. Pafupipafupi jakisoni kamodzi patsiku. Malinga ndi malangizo, akuyenera kuzichita nthawi yomweyo - izi zimathandiza kugwiranso ntchito komanso kusapezeka kwa zoyipa. Jakisoni amaikidwa paphewa, ntchafu kapena m'minyewa yamafuta am'mimba. Pofuna kupewa zoyipa, malo ena oyang'anira.

Maphunziro a kanema wa syringe-cholembera insulin

Zotsatira zoyipa ndi bongo

Ngakhale mutakufotokozerani mankhwala ndi dokotala, simungakhale otsimikiza kuti kugwiritsa ntchito kwake kudzachita popanda zovuta. Ngakhale kutsatira malangizo, mankhwala nthawi zina amakhala ndi vuto losayembekezereka, lomwe limalumikizidwa ndi machitidwe a thupi. Chifukwa chake, zoyipa zimachitika.

Mukamagwiritsa ntchito mankhwalawa, zovuta zimatha kukhalapo monga:

1. Hypoglycemia. Zodabwitsazi zimachitika ndi insulin yambiri mthupi. Nthawi zambiri mawonekedwe ake amaphatikizidwa ndi mlingo wosankhidwa wa mankhwalawa, koma nthawi zina zifukwa zake zimachokera mthupi. Kuphwanya malamulo otere ndi koopsa, chifukwa kumakhudza kugwira ntchito kwamanjenje. Ndi kwambiri hypoglycemia ndi kusowa kwa thandizo, wodwala amatha kufa. Kupatuka uku kumadziwika ndi zizindikiro monga kutaya chikumbumtima, mtima, kupindika, chizungulire.
2. Zowonongeka. Ndi mankhwala a insulin, kuchuluka kwina kwa glucose nthawi zina kumawonedwa, komwe kungayambitse retinopathy. Mawonedwe a wodwala atha kukhala operewera, kuphatikizapo khungu.
3. Lipodystrophy. Otchedwa kuphwanya pokonza mankhwala. Izi zitha kupewedwa mothandizidwa ndi kusintha kosalekeza kwa malo a jakisoni.
4. Ziwengo. Ngati kuyesedwa koyenera kwa chidwi ndi mankhwalawa kunachitika musanagwiritse ntchito Glargin, zotere zimachitika kawirikawiri ndipo sizimasiyana pakukwiya. Kuwonetsera kwina kwambiri pamenepa: zotupa pakhungu, redness pakhungu ndi kuyabwa pamalo a jekeseni.

Ngati mungapeze zotere, mosasamala kanthu za kulimba kwake, muyenera kufunsa dokotala. Nthawi zina, mutha kuwachotsa posintha mankhwalawa. Ndipo nthawi zina kusintha msanga kwa mankhwala kumafunika.

Kutsatira malangizo a dokotala kumaletsa mavuto omwe amabwera chifukwa cha mankhwala osokoneza bongo. Koma nthawi zina izi sizithandiza. Vuto la mankhwala osokoneza bongo, hypoglycemia nthawi zambiri limachitika. Kuchotsa kwake kumadalira kukula kwa chizindikirocho. Nthawi zina kuyimitsa kuukiridwa kumatheka pogwiritsa ntchito chakudya chamafuta. Ndi chiwopsezo chachikulu, thandizo la dokotala ndilofunikira.

Kapangidwe ndi mfundo zoyenera kuchitapo

Chofunikira chachikulu pa mankhwalawa ndi insulin Glargin. Ichi ndi chipangizo chopangidwa chokhazikitsidwa ndi njira yosinthira. Pakupanga kwake, zinthu zitatu zofunika zimasinthidwa. Amino acid Asparagine imasinthidwa ndi Glycine mu A unyolo, ndipo ma Arginine awiri amaphatikizidwa ndi B chain. Zotsatira za kuyambiridwaku ndi njira yapamwamba yothandizira jakisoni, yomwe imakhala ndi phindu kwa maola osachepera 24.

Zinthu zomwe zimagwira, zophatikizidwa ndi zida zothandizira, zimakhala ndi phindu lothandiza m'thupi la wodwalayo. Kugwiritsa ntchito bwino insulin Glargin:

• Zimakhudza ma insulin receptors omwe amapezeka mu mafuta ochepa ndi minofu yam'mimba. Chifukwa cha izi, mphamvu yofanana ndi ya insulin yachilengedwe imapangidwira.
• normalization kagayidwe kachakudya njira: chakudya kagayidwe kazakudya ndi shuga.
• Imathandizira kukoka kwa glucose ndi subcutaneous mafuta, minofu minofu ndi chigoba minofu.
• Amachepetsa kupanga shuga owonjezera m'chiwindi.
• Zimayambitsa kapangidwe kazakudya zomanga thupi.

Mankhwala amalowa m'mashelefu ammadzi mu mawonekedwe a yankho: mu 10 ml mabotolo kapena ma 3 ml cartridge. Zimayamba kugwira ola limodzi pambuyo pa makonzedwe.

Kutalika kwakukulu kwa kuchitapo kanthu ndi maola 29.

Carcinogenicity komanso zimapangitsa kuti mwana akhale ndi pakati

Asanagulitsidwe, mankhwalawa adayesedwa a carcinogenicity - kuthekera kwa zinthu zina kukulitsa mwayi wa zotupa zoyipa ndi kusinthika kwina. Mlingo wowonjezera wa insulin unaperekedwa kwa mbewa ndi makoswe. Izi zidabweretsa:

• Imfa zambiri pagulu lililonse la nyama zoyesedwa,
• Zotupa zoyipa mu akazi (m'munda wa jakisoni),
• Kusakhalapo kwa zotupa mukasungunuka mu zosungunulira zopanda-acidic.

Mayesowo adawonetsa kawopsedwe kakakulu chifukwa chodalira insulin.

Kutha kubereka ndi kubereka mwana wathanzi kumadwaladwala.

Bongo

Zizindikiro kwambiri komanso nthawi yayitali hypoglycemia, kuwopseza moyo wa wodwalayo.

Chithandizo: magawo a hypoglycemia wolimbitsa thupi nthawi zambiri amayimitsidwa ndi kumeza chakudya cham'mimba chambiri. Pangakhale kofunikira kusintha mtundu wa mankhwala, zakudya kapena zolimbitsa thupi. Ndime za hypoglycemia yoopsa, yophatikizika ndi chikomokere, kukomoka kapena matenda amitsempha, amafunika kulowetsedwa kwamkati mwa minyewa, komanso kutsekeka kwa mayankho a dextrose. Zakudya zamafuta nthawi yayitali komanso kuyang'aniridwa kwa akatswiri kungafunike, popeza hypoglycemia imatha kubwereranso pambuyo pakuwoneka kachipangidwe kazachipatala.

Mlingo ndi makonzedwe

Mankhwala Glargin ali ndi insulin glargin - analogue yomwe imagwira munthu nthawi yayitali. Mankhwala amayenera kuperekedwa nthawi imodzi patsiku nthawi imodzi.

Mlingo wa Glargin ndi nthawi ya tsiku lothandizira ake amasankhidwa payekha. Odwala omwe ali ndi matenda a shuga a mtundu wa 2, Glargin angagwiritsidwe ntchito ngati mankhwala a monotherapy komanso kuphatikiza othandizira ena a hypoglycemic. Zochita za mankhwalawa zimafotokozedwa m'magawo (UNITS). Magawo awa amangogwira ntchito ku Glargin: izi sizofanana ndi ziwalo zomwe zimagwiritsidwa ntchito kufotokoza zochita za ma insulin ena.

Okalamba okalamba (woposa zaka 65)

Odwala okalamba, kuwonongeka kwa impso kungapangitse kuchepa kwapang'onopang'ono kwa zofunika za insulin.

Odwala ndi mkhutu aimpso ntchito

Odwala omwe ali ndi vuto la impso, kufunika kwa insulin kumatha kuchepetsedwa chifukwa cha kuchepa kwa insulin metabolism.

Glargin iyenera kuperekedwa nthawi zonse nthawi imodzi 1 patsiku. Kutentha kwa insulin yovundikira kuyenerana ndi kutentha kwa chipinda.

Palibe kusiyana kwazamankhwala mu seramu insulin ndi glucose pambuyo pa Glargine mu mafuta opaka pamimba, phewa, kapena ntchafu. Mu gawo lomwelo la kayendetsedwe ka mankhwala, ndikofunikira kusintha malo a jekeseni nthawi iliyonse.

Mukamayambitsa, tsatirani malangizo:

1. Glargin insulin solution iyenera kukhala yowoneka bwino komanso yopanda utoto. Osagwiritsa ntchito yankho ngati likuwoneka lamitambo, lakuda, lopaka pang'ono kapena lokhala ndi tinthu totsalira tambiri.

2. Mukamagwiritsa ntchito katemera wa insulin, tsatirani malangizo ogwiritsidwa ntchito ndi Beijing Gangan Technology. Co LTD., China.

3. Musanayambe kupanikizika, gwiritsani ntchito jakisoni ndi antiseptic. Mankhwalawa amaperekedwa nthawi zambiri m'mimba, phewa kapena ntchafu. Ndi jakisoni aliyense, ndikofunikira kusintha tsamba la jakisoni.

4. Pangani khungu lanu ndi zala zanu, ikani singano mu malo opukusira jakisoni ndikudziwitsa zala zanu. Pang'onopang'ono pitani pa piston ya syringe cholembera panthawi yonse ya mankhwala. Masekondi angapo atatha kuperekera insulin, chotsani singano ndikudinikiza tsamba la jakisoni ndi swab masekondi angapo. Osapaka jakisoni pamalo kuti musawonongeke ndi mafuta onunkhira kapena kutayikira kwa mankhwalawa.

Kusintha kuchokera ku chithandizo ndi mankhwala ena a hypoglycemic kupita ku Glargin

Mukasinthira regimens ya mankhwala ndi ma insulin ena ndi regimen ya mankhwala a Glargin insulin, zingakhale zofunikira kusintha muyezo wa tsiku ndi tsiku wa Glargin, ndipo zingakhale zofunikira kusintha madontho a concomitant antidiabetic mankhwala (okhazikika a insulin, osakhalitsa a insulin analogue, mankhwala opatsirana pakamwa.

Posamutsa odwala kuchokera mumayendedwe a mankhwalawa a insulin ya anthu nthawi yayitali kawiri patsiku kumayambiriro kwa mankhwala sabata yoyamba, insulin Glargin iyenera kuchepetsedwa ndi 20-30% poyerekeza ndi kuchuluka kwa insulin ya anthu a nthawi yayitali. Pankhani yoyendetsa bwino magazi a m'magazi, mankhwalawa amayenera kusinthidwa malinga ndi zomwe adotolo akuuza.

Odwala omwe amalandira mlingo waukulu wa insulin yayitali, chifukwa cha kukhalapo kwa ma antibodies a insulin ya anthu akapita ku Glargin, kusintha poyankha kumatha.

Pakusintha komanso m'milungu ingapo yoyambirira, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi ndikuwongolera mosamala mankhwalawa.

Pankhani ya kusintha kwa kagayidwe kake ndi kuwonjezereka kwa chidwi cha insulin, kuwongolera kwina kwa mankhwalawo kungakhale kofunikira. Kusintha kwa magazi kungafunikenso, mwachitsanzo, pakusintha kulemera kwa thupi la wodwala, moyo, nthawi ya tsiku yoperekera mankhwala osokoneza bongo, kapena zochitika zina zomwe zimathandizira kukulitsa kukonzekera kwa hypo- kapena hyperglycemia.

Zotsatira zoyipa

Hypoglycemia: Hypoglycemia imatha kuchitika chifukwa chakuyambitsa mtundu wa insulin yolakwika, kuchuluka kwambiri kwa insulin komanso / kapena zakudya zosavomerezeka limodzi ndi masewera olimbitsa thupi.

Lipodystrophy: Ngati simusintha dera la insulin, angayambitse mafuta ochepa kapena lipid hyperplasia.

Thupi lawo siligwirizana: Ndi mankhwala a insulin, thupi lanu siligwirizana, limatha kupezeka m'malo a jakisoni, monga redness, ululu, kuyabwa, ming'oma, kutupa ndi kutupa. Izi zimachitika nthawi zonse ndizosafunikira ndipo nthawi zambiri zimazimiririka ndikapitiliza mankhwala. Zochitika zoyipa zonse sizigwirizana. Ndi kukula kwawo, chiwopsezo cha moyo wa wodwalayo chitha kuchitika.

Zochitika zosiyana ndi ziwalo zamasomphenya: Kusintha kwakukulu pakuphatikizidwa kwa shuga m'magazi kungayambitse kuwonongeka kwakanthawi.

Kupititsa patsogolo kayendedwe ka glucose ndikuwonjezera mankhwala a insulini kungayambitse kuchepa kwakanthawi machitidwe a matenda ashuga retinopathy. Ndi chitukuko cha hypoglycemia, kutha kwakanthawi kwakanthawi kungachitike kwa odwala omwe ali ndi proliferative retinopathy (makamaka odwala omwe salandila laser coagulation chithandizo). Kukhalitsa kwa nthawi yayitali kwamagazi a shuga kumachepetsa chiopsezo chokhala ndi matenda a shuga.

Zotsatira zina: Pogwiritsa ntchito insulin, mapangidwe a antibodies kwa iwo amatha kuonedwa. Mankhwalawa apakati-insulini ndi insulin Glargin, mapangidwe a antibodies omwe amalumikizana ndi insulin ya anthu ndi insulin Glargin amawonedwa pafupipafupi. Nthawi zina, kuoneka kwa ma antibodies ku insulin kungapangitse kusintha kwa insulin kuti mulingo wambiri ukhale m'magazi.

Nthawi zina, insulin, makamaka chifukwa cha kuchuluka kwa insulin, imatha kuyambitsa kusungunuka kwa sodium ndikupanga edema.

Zolemba ntchito

Gwiritsani ntchito ana

Chitetezo ndikuyenda bwino kwa inshuwaransi ya Glargin mwa ana omwe ali ndi matenda ashuga kuyenera kuwunikidwa potengera ndi momwe amagwiritsidwira ntchito.

Gwiritsani ntchito mwa okalamba

Kufunika kwa insulin kwa odwala okalamba omwe ali ndi matenda osokoneza bongo amatha kuchepetsedwa pamaso pa kulephera kwa impso.

Kulandila pa mimba ndi mkaka wa m`mawere

Amayi obereka mwana, mankhwala amaperekedwa pokhapokha atakambilana. Mankhwalawa amawonetsedwa pokhapokha ngati phindu lomwe lingachitike kwa mayi ndilokwera kuposa chiwopsezo kwa mwana wosabadwayo. Ngati mayi woyembekezera ali ndi matenda osokoneza bongo, ndikulimbikitsidwa kuwunika momwe metabolic amapangira.

Mu nyengo ya 2 ndi 3 ya kubereka, kufunika kwa insulin kumawonjezeka. Pambuyo pobereka, kufunika kwa mankhwalawa kumatsika kwambiri.

Mwezi uliwonse wam'mimba, muyenera kusamala ndi shuga zamagazi ndikuwonetsetsa nthawi zonse.

Zina zomwe zimagwirizana ndi mankhwala

Mankhwala angapo amawononga kagayidwe kazakudya. Muzochitika izi, mlingo wa insulin umayenera kusinthidwa. Mankhwala omwe amachepetsa kwambiri shuga akuphatikizapo:

• ACE ndi Mao zoletsa,
• Ma Disopyramides,
• Ma salicylates ndi othandizira a sulufide motsutsana ndi ma virus
• Fluoxetine,
• Maulalo osiyanasiyana.

Mankhwala ena amatha kuchepetsa kuthamanga kwa mahomoni: glucocorticosteroids, diuretics, danazol, glucagon, isoniazid, diazoxide, estrogens, gestagen, ndi zina.

Hypoglycemia

Ichi ndi mkhalidwe wa m'magazi momwe mulingo wamagazi amachepetsedwa kwambiri (osakwana 3.3 mmol / l). Zimachitika ngati wodwala amapatsidwa mlingo waukulu wa insulin kwambiri, woposa zosowa zake. Ngati hypoglycemia imakhala yayikulu ndipo imachitika pakapita nthawi, imawopseza moyo wa munthu. Zobwerezedwa mobwerezabwereza zimakhudza dongosolo lamanjenje. Kudziwa kwa munthu kumayamba kusokonezeka ndikusokonezeka;

Pazinthu zapamwamba, munthu amataya khungu kwathunthu. Ndi hypoglycemia yolimbitsa thupi, manja a munthu amanjenjemera, amafunitsitsa kudya, amakwiya mosavuta ndipo amakhala ndi vuto la mtima wothamanga. Odwala ena awonjezera thukuta.

Thupi lawo siligwirizana

Izi makamaka zimachitika mderalo: urticaria, zotupa zosiyanasiyana, redness ndi kuyabwa, kupweteka kwa malo a jekeseni. Hypersensitivity insulin ikukula: mawonekedwe a khungu (pafupifupi khungu lonse limakhudzidwa), bronchospasm, angioedema, manjenje, kapena ochepa matenda oopsa. Izi zimachitika nthawi yomweyo ndipo zimawopseza wodwala.

Nthawi zina, kuyambitsidwa kwa timadzi timatulutsa kumapangitsa kuti zina zisinthe - kusintha kwa sodium, kupanga mapangidwe a edema ndi mapangidwe a chitetezo cha chitetezo ku insulin. Muzochitika izi, mlingo wa mankhwalawa umayenera kusinthidwa.

Momwe zimapangitsa mwayi wa hypoglycemia ukuwonjezeka

Mukamatsatira njira yoikidwiratu, kuyang'anira misempha ya magazi ndikudya moyenera, mwayi wa hypoglycemia umachepetsedwa. Ngati pali zina zowonjezera, sinthani mlingo.

Zomwe zimayambitsa kutsika kwa glucose ndizophatikiza:

• Hypersensitivity to insulin,
• Kusintha kwa dera komwe mankhwalawo amayamba.
• Matenda omwe amaphatikizidwa ndi chopondapo chopindika (kutsegula m'mimba) ndi kusanza, kupangitsa matenda a shuga,
• Zochita zolimbitsa thupi zachilendo kwa wodwala,
• Mowa
• Kuphwanya zakudya ndi kugwiritsa ntchito zakudya zoletsedwa,
• Chithokomiro
• Kuphatikiza pamodzi ndi mankhwala osagwirizana.

Ndi matenda obwera ndi matenda, kayendedwe ka glucose wamagazi kakuyenera kukhala kokwanira kwambiri.

Patsani magazi ndi mkodzo pafupipafupi kuti mudziwe mayeso ambiri. Ngati ndi kotheka, sinthani mlingo wa insulin (makamaka mtundu 1 wa shuga).

Insulin Glargin: malangizo ogwiritsira ntchito

Chochita chimalowetsedwa bwino m'thupi m'mimba, ntchafu ndi mapewa. Mgwirizano wa mahomoni umagwiritsidwa ntchito 1 nthawi patsiku panthawi inayake. Masamba enanso obayira kuti musatsekele zisindikizo ndi zotsatirapo zina zosasangalatsa. Sizoletsedwa kubayira mankhwala mu mtsempha.

Dzina lamalonda, mtengo wake, malo osungira

Mankhwalawa akupezeka pansi pa mayina otsatirawa:

• Lantus - 3700 ma ruble,
• Lantus SoloStar - ma ruble 3500,
• Insulin Glargin - ma 35 rubles.

Sungani mufiriji kutentha kwa madigiri 2 mpaka 8. Mukatsegulira, sungani pamalo amdima ndipo ana sangathe kuwapeza, kutentha mpaka madigiri 25 (osati mufiriji).

Insulin Glargin: analogues

Ngati mtengo wa mankhwala a Insulin glargine sugwirizana ndi inu kapena ngati zotsatira zoyipa zambiri zimachitika chifukwa cha kukhazikitsidwa kwake, bweretsani mankhwalawo ndi imodzi mwanjira zofananira:

• Humalog (Lizpro) ndi mankhwala omwe amawapanga ngati insulin. Humalog imatengedwa mwachangu kulowa m'magazi. Ngati mumagwiritsa ntchito mankhwalawa pokhapokha pa tsiku lokhazikika komanso muyezo womwewo, Humalog imakhala yolumikizidwa nthawi ziwiri mwachangu ndipo imafika pamlingo wofunikira mu 2 hours. Chipangizocho chikugwira ntchito mpaka maola 12. Mtengo wa Humalog umachokera ku ma ruble 1600.
• Aspart (Novorapid Penfill) ndi mankhwala omwe amatsutsa kuyankha kwa insulin pakudya. Imakhala yofooka komanso yochepa, zomwe zimapangitsa kuti magazi azikhala ochepa. Mtengo wa malonda umachokera ku ruble 1800.
• Glulisin (Apidra) ndiye mndandanda waufupi kwambiri wa insulin. Mwa mankhwala a pharmacological sizimasiyana ndi Humalog, komanso mwa zochita za metabolic - kuchokera ku insulin yachilengedwe yopangidwa ndi thupi la munthu. Mtengo - 1908 ma ruble.

Mukamasankha mankhwalawa, lingalirani za mtundu wa matenda ashuga, matenda opatsirana komanso machitidwe a thupi.